Pharmacology

ACE-inhibitors

: (they end in "pril") recommended for people with chronic stable angina who also have hypertension, diabetes, and LVEF less than 40%, chronic kidney disease, or other vascular diseases. They lower angiotensin II and raise bradykinin levels, leading to reductions in LV and vascular hypertrophy, atherosclerotic progression, plaque rupture, and thrombosis. These changes result in improved myocardial oxygen supply/demand balance.

Clindamycin

: A bacteriostatic antibiotic against primarily gram-positive organisms and anaerobic species.

Define teratogenicity and describe why identifying drugs that produce it is so difficult.

: A teratogen is an agent that can disturb the development of the embryo or fetus. Teratogens halt the pregnancy or produce a congenital malformation (a birth defect). Classes of teratogens include radiation, maternal infections, chemicals, and drugs. The incidence of congenital anomalies is generally low, animal tests may not be applicable to human, prolonged drug exposure may be required, teratogenic effects may be delayed, behavioral effects are difficult to document, controlled experiments can't be done in humans.

olols

: B-blockers

adverse rxn for tetracycline

: GI distress, incorporation into developing teeth and bones causing hypoplasia, hepatotoxicity, nephrotoxicity, hematologic effects, superinfection (multiplying of resistant organisms, overgrowth of candida albicans is common), photosensitivity, and allergy. Should not be taken with dairy products, mineral supplements, or fortified foods.

Dentally Useful Antifungal Agents

: Nystatin, Clotrimazole, Ketoconazole, Fluconazole.

Penicillin

A B-lactam antibiotic, can be divided into four groups, one = penicillin G and V, and two = penicillinase resistant penicillins, three = amoxicillin, four = extended-release penicillins. They work by attaching to proteins in the microbe cell wall, inhibiting cross-linkages in the cell wall.

Physical dependence

A condition in which a person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses.

Compare and contrast the parasympathetic and sympathetic nervous systems. Include neruostransmitters, receptor sites, and effects on innervated organs.

PANS and SANS often produce opposite effects. PANS handles conservation of the body processes rest & digest. SANS is designed to cope w/sudden emergencies such as the fight or flight situation both can stimulate muscles. PANS: the neurotransmitter released from the postganglionic nerve is Ach. B/c the postsynaptic tissue responds to muscarine, the cholinergic synapses are distinguished from one another (pre-ganglionic nerves release Ach to nicotinic receptors. SANS: NE is the transmitter substances released by the postganglionic nerves & is designed as adrenergic. Skeletal muscles contain Ach receptors called cholinergic somatic.

The dentist recommends a short course of over-the-counter ibuprofen. What should patients be told about this drug?

Patients should be told the name of the drug, the dose, and how to take it. They should also be told to be very careful about bruising or cutting themselves. They should call their doctor if they notice any bruises or cut themselves, because of the potential for increased bleeding.

SLUD:

Salivation, Lacrimation, Urination, and Defecation.

side effect reaction

a dose related reaction that is not part of the desired therapeutic outcome, a drug acts on non-target organs to produce undesirable effect, side effect and adverse reaction are often used interchangeably.

agonist

a drug that has affinity for a receptor, combines w the receptor & produces an effect. Naturally occurring neurotransmitters are agonists

competitive agonist

a drug that has affinity for a receptor, combines w the receptor & produces no effect its presence causes a shift to the right in the dose response curve

Pilocarpine (Salagen)

a cholinergic agent

trade name

a commercial, legal name. Pharmaceutical company discovering the drug gives the trade name. Capitalized ex: Motrin

what are different ways which drugs can be metabolized

-Active to inactive: an inactive compound may be formed from an active parent drug -Inactive to Active: an inactive parent drug may be transformed into active compound. Active to Active: an active parent drug may be converted to a second active compound which is then converted to an inactive problem

What are some red flags associated with opioid addiction?

1) patient claims allergies to NSAIDs or lower-potency opioid analgesics; 2) calls with a request for an opioid analgesic just as the office is closing or after hours; 3) cancels dental appointment but still requests the opioid analgesic even though patient will be out of town "on business;" and 4) often changes dental provider because no one understands his or her "low pain threshold."

Explain the three trimesters and the special risks for each one.

1st trimester, the organs in the fetus are forming. This is considered the most critical time for teratogenicity. Often, the woman is unaware that she is pregnant for the first half of this trimester. Dental prophylaxis and examination without x-rays should be performed at this time. Alterations to care if patient is experiencing nausea.

prils

ACE inhibitors

List the adverse reactions associated with the anticholinergic agents.

Adverse reactions are extensions of their therapeutic effects; xerostomia, photophobia, tachycardia, fever, urinary and gastrointestinal stasis.

adverse rxn for metronidazole

Adverse effects include GI distress (12% of people taking metronidazole), CNS effects (headache, dizziness, vertigo, ataxia), renal toxicity, XEROSTOMIA, glossitis, stomatitis, black-furred tongue. NOT TO BE TAKEN WITH ALCOHOL, a metabolite of metronidazole is anabuse. Oral effects might be due to monilial overgrowth

sartans

ARBs (angiotensin receptor blockers)

Under what conditions is antibiotic prophylaxis necessary?

According to AHA guidelines, antibiotic prophylaxis is only recommended for those persons who are at high risk for developing adverse outcomes from infective endocarditis. The following factors should be considered when determining whether to use prophylaxis: the specific dental procedure, the cardiac and medical condition of the patient, and the drug and dose needed.

What are the adverse reactions to acetaminophen?

Acetaminophen has been associated with both nephrotoxicity and hepatotoxicity.

Compare and contrast acetaminophen with aspirin in terms of pharmacologic and therapeutic effects.

Acetaminophen is used to treat pain and fever and only possesses antipyretic and analgesic effects. Aspirin, however, has antipyretic, analgesic, and anti-inflammatory effects. Aspirin can be used to treat pain, fever, and inflammation.

Dentally Useful Antiviral Agents

Acyclovir, Famciclovir, Valacyclovir, Penciclovir, Docosanol

distribution

All drugs occur in 2 forms in the blood: bound to plasma proteins & free drug. For a drug to exert its activity it must be made available at its site of action in the body. The passage of drugs into various body fluids compartments such as plasma, interstitial fluids & intracellular fluids

What antibiotic dose and dosing regimen should be used?

Amoxicillin is the drug of choice as long as a patient is not allergic to it. The dose is 2 g one hour before the procedure. If a patient were penicillin allergic, then these other antibiotics could be used as follows: Clindamycin - 600 mg 1 hour before the procedure. Azithromycin or clarithromycin - 500 mg 1 hour before the procedure. Cephalexin or cefadroxil - 2 g 1 hour before the procedure (only if the penicillin allergy is distant and minor).

toxic reaction

An extension of the pharmacologic effect, results from a drugs effect on target organs, the amount of the desired effect is excessive.

atropine

Anticholinergic

Can aspirin be used in children less than age 18? Why or why not?

Aspirin is contraindicated in children under the age of 18 because of the risk for developing Reye's syndrome. The use of aspirin in children or adolescents with either the chicken pox or the flu has been epidemiologically associated with Reye's Syndrome

Name the pharmacologic class to which atenolol (Tenormin) belongs. Describe the effects that make B-blockers useful in the treatment of arrhythmias, angina, and hypertension

Atenolol (Tenormin) is a B-blocker it's a selective B1-blocker). Beta-blockers are drugs that bind to beta-adrenoceptors and thereby block the binding of norepinephrine and epinephrine to these receptors. This inhibits normal sympathetic effects that act through these receptors. Beta-blockers are sympatholytic drugs. Some beta-blockers partially activate the receptor while preventing norepinephrine from binding to the receptor. These are called partial agonists and they provide

Metronidazole

Bactericidal and amoebicidal action, also has anti-inflammatory effects

Tetracycline:

Broad spectrum antibiotic affecting a wide range of microorganisms. Contraindicated during last half of pregnancy and first nine years of childhood due to its effects on developing teeth.

idipines

Calcium Channel blockers

Discuss the use of clotrimazole and ketoconazole in the treatment of oral candidiasis. State one problem with each agent. Explain when administration of each is appropriate.

Clotrimazole is a synthetic antifungal agent available in the form of a slowly dissolving, sugar-containing lozenge for oral use that dissolves in approximately 15 minutes. Patients with xerostomia may have difficulty dissolving this product. Salivary drug concentrations are maintained for approximately three hours. The drug is bound to the oral mucosa, from which it is slowly released. Some absorption occurs. The most common adverse reactions involve GI distress. It has also been reported to produce elevated liver enzymes in 15% of patients. It is not recommended for use in pregnant women or in children younger than three years old. Ketoconazole alters cellular membranes and interferes with intracellular enzymes. It is indicated in the treatment and management of mucocutaneous and oropharyngeal candidiasis (oral thrush).It can be used prophylactically.The most frequent adverse reactions associated with ketoconazole are nausea and vomiting, these can be minimized by taking with food

What are the physiologic effects of alcohol?

Direct contact in mouth, esophagus, stomach, and intestine, influence on almost every organ system in the body after entering the bloodstream. Low to moderate doses: disinhibition, social setting and mental state may determine individual response, euphoric, friendly, and talkative or aggressive and hostile, interfere with motor activity, reflexes, and coordination. Moderate doses: slightly increase heart rate, slightly dilates blood vessels in arms, legs, and skin, moderately lowers blood pressure, stimulates appetite, increases production of gastric secretions, increases urine output. High doses: social setting has little influence on effects, difficulty in walking, talking, and thinking, induces drowsiness and causes sleep, induces a hangover when drinking stops.

Effective Dose (ED)

Dose required to produce desired clinical effects in 50% of test animals

Tolerance

Drug tolerance is a pharmacological concept describing subjects' reduced reaction to a drug following its repeated use. Increasing its dosage may re-amplify the drug's effects; however, this may accelerate tolerance, further reducing the drug's effects

Should a patient taking high blood pressure medication take a drug like ibuprofen? Why or why not?

Drugs such as ibuprofen should be avoided in patients taking antihypertensives because they can increase the risk for serious cardiovascular and thrombotic events.

Describe the pharmacologic effects of the anticholinergic agents on the exocrine glands, smooth muscle, and eye.

Exocrine glands: reduce the flow of volume of exocrine secretions. (therapeutic in dentistry to create a dry field) Smooth muscle: relaxation (ex. Ipratropium inhaler to treat asthma) Eye: Mydriasis (dilation of the pupil) and Cycloplegia (ex. used in eye exams to dilate eyes).

State the pharmacological effect of the adrenergic agents on the eye, bronchioles, and salivary glands.

Eye: Decrease in intraocular pressure (for glaucoma treatment) and Mydriasis. Bronchioles: relaxation of smooth muscle (for asthma and anaphylaxis) Salivary glands: flow of saliva is reduced, resulting in xerostomia

Statins

First choice of therapy for most patients with atherosclerotic heart disease and elevated cholesterol values and are further categorized as being of high or moderate intensity. Can be combined with other drugs to increase HDLs while they decrease LDLs

adverse rxn for macrolides (erythromycin)

GI effects, cholestatic jaundice, and drug interactions with theophylline, digoxin, triazolam, warfarin, carbamazepine, and cyclosporine. May produce toxicity depending on the dosage of each drug.

adverse rxn for cephalosporins

GI effects, nephrotoxicity, superinfection (resistant gram-negative organisms overproduce), local reaction (irritating to local tissues where administered), and allergy.

adverse rxn for clindamycin

GI effects, superinfection (Candida albicans), neutropenia, and allergy.

Describe the pharmacologic effects of the cholinergic agents on the heart, gastrointestinal tract and eye:

Heart: cholinergic agents have a direct effect on the heart, produce a negative chronotropic & negative inotropic action. A decrease in cardiac output bradycardia & blood pressure is associated w/these agents. GI: cholinergic agents excite the smooth muscle producing an increase in activity, motility & secretion. Eye: cholinergic agents produce mitosis & causes cycloplegia- a paralysis of the ciliary muscle of the eye that results in the loss of visual accommodation. Intraocular pressure is also decreased, these agents are useful in the TX of glaucoma.

Are there any drug interactions with hydrocodone?

Hydrocodone may interact with cough and cold medications and allergy products that are sedating. The combination may cause increased sedation, dry mouth, constipation, and urinary retention. Patients should use caution with driving, operating heavy machinery or equipment, or anything that requires thought or concentration.

Explain the FDA pregnancy categories and state their significance.

In 2015 the US Food and Drug Administration (FDA) eliminated the pregnancy categories A, B, C, D, and X for drugs with new information that is more meaningful to both the practitioner and patient. Under the previous classification system, categories A & B are considered safe for use during pregnancy, category C in animal reproduction show adverse effect on fetus; no tests on humans, category D show positive evidence of human fetal risk based on adverse reaction in data, category X studies in animals or human have demonstrated fetal abnormalities and/or positive evidence of risk or adverse reaction; WEIGH RISK vs. BENEFIT.

Macrolides (erythromycin):

Inhibit organism protein synthesis, activity closely resembles penicillin against gram-positive bacteria

The anti-tuberculosis agents are

Isoniazid, Rifampin, Pyrazinamide, and Ethambutol.

For the commonly used dental drugs, such as local anesthetics, antibiotics, and analgesics, state the agents in each group that are the least safe.

Local anesthetics; Bupivacaine. Antibiotics; Tetracyclines. Analgesics; Aspirin and NSAIDs.

Phase 3

MORE CLINICAL EVALUATION TAKES PLACE INVOLVING A LARGE NUMBER OF PATIENTS WHO HAVE THE CONDITION FOR WHICH THE DRUG IS INDICATED BOTH SAFETY AND EFFICACY MUST BE DEMONSTRATED DOSAGE IS DETERMINED

What is "meth mouth", and how can it be treated?

Meth-mouth is severe tooth decay and loss, tooth fractures, and enamel erosion due to xerostomia and bruxism combined with poor nutrition, increased sugar consumption, and poor oral hygiene. Treatment can be dangerous because local anesthetics are often necessary. Cardiac effects associated with local anesthetics and vasoconstrictors can intensify the cardiac effects of meth. To treat patients, the oral health team should prescribe fluoride to fight tooth decay and prevent caries and drugs to treat xerostomia. Patients should be counseled on proper nutrition and good oral-hygiene techniques

What is the role of metronidazole in dentistry and what are its adverse effects and any drug-food interactions?

Metronidazole is used for the treatment of infections caused by susceptible organisms in both medical and dental conditions. It has special usefulness because of its anaerobic spectrum. It can be used if the suspected organism is susceptible to metronidazole. Adverse effects include nausea, headache, glossitis, stomatitis, and a black, furred tongue. Metronidazole can interact with alcohol and cause a disulfiram-like reaction. Symptoms include nausea, abdominal cramps, flushing, vomiting, or headache. Alcohol should be avoided during metronidazole administration and for 1 day after therapy has ceased. Products such as mouthwashes or elixirs that contain alcohol should not be used during this period.

Contraindications to dental treatment in patients with cardiovascular disease

NI should wait six months before receiving any type of oral health care to give the heart a chance to heal. Absolute contraindications to dental treatment exist for; unstable or recent onset angina pectoris, uncontrolled heart failure, uncontrolled arrhythmias, and significant uncontrolled hypertension. Consult with the patient's provider to determine what treatment alterations might be warranted.

Schedule I drugs

NO accepted medical use. Experimental use only in research. AP: HIGHEST (marijuana, LSD, hallucinogens)

Ibuprofen

NSAID ex: Advil & Motrin. undergoes hepatic metabolism & is excreted by the kidney

Are there interactions between NSAIDs and antihypertensive drugs?

NSAIDs can also reduce the antihypertensive effects of diuretics, angiotensin-converting enzyme (ACE) inhibitors, and beta- blockers, similar to aspirin.

What is the rationale for using acetaminophen in a patient with an ulcer?

NSAIDs or aspirin would aggravate an ulcer. Acetaminophen is not irritating to the stomach and is better suited for patients with ulcers.

Describe the long-term problems associated with cigarette smoking. Mention several organs that are affected.

Nicotine produces an increase in blood pressure and pulse rate and induces nausea, vomiting, and dizziness although smokers are often tolerant to these effects. Chronic use is related to oral and lung cancers and coronary artery disease.

What is the mechanism of action of nitroglycerine in treating angina and what are its adverse reactions?

Nitroglycerin is a vasodilator, a medicine that opens blood vessels to improve blood flow. It is used to treat angina symptoms, such as chest pain or pressure, that happens when there is not enough blood flowing to the heart. Nitroglycerin works by relaxing the smooth muscle of blood vessel walls and dilating coronary arteries, which increases blood flow and oxygen supply to the heart. Adverse reactions include; headache (can be severe), orthostatic hypotension, and reflex tachycardia.

Aspirin and NSAIDS inhibit prostaglandin synthesis (COX I and II) and can cause premature closure of the ductus arteriosus.

Persons with asthma are more likely to have a hypersensitivity reaction to aspirin. Aspirin irreversibly binds platelets, NSAIDS reversibly bind platelets. Acetaminophen does not have anti-inflammatory action or affect platelets and is the drug of choice for pregnant patients. Considerations for the duration of anti-platelet effects. Black Box warnings for non-opioids.

Phases of clinical studies (Phase 1)

Phase 1: small & then increasing doses are administered to limited # of healthy volunteers to determine safety. Biological effects, metabolism, safe dose range in humans & toxic effects of drugs

Describe a unique dental use for pilocarpine

Pilocarpine is a naturally occurring cholinergic agent and can be used to treat xerostomia.

State the pharmacologic effects of the adrenergic agents, especially in dentistry.

Plays an important part in treatment of anaphylaxis and asthma and, added to local anesthetic solutions (vasoconstriction) to prolong their action

excretion

Process by which metabolic wastes are eliminated from the body. Renal (kidneys) most important; lungs, bile, GI, sweat, saliva & breast milk

Cephalosporins

Structurally related to the penicillins, active against a wide variety of gram-positive and gram-negative organisms.

epinephrine & amphetamine

Sympathomimetic agent

What is the role of tetracycline antibiotics in the treatment of periodontitis?

Tetracycline is used as second-line therapy for the treatment of periodontitis. It used in people who are allergic to or cannot tolerate penicillin.

Antibiotic resistance:

The ability of bacteria and other microorganisms to resist the effects of an antibiotic to which they were once sensitive. Antibiotic resistance is a major concern of overuse of antibiotics. Also known as drug resistance.

What are the adverse reactions associated with hydrocodone (and other opioids)?

The adverse reactions associated with hydrocodone include sedation, dysphoria, constipation, urinary retention, pupil constriction, and respiratory and cardiovascular depression in high enough doses.

Hydrochlorothiazide

The most commonly used thiazide diuretic. Thiazides initially inhibit the reabsorption of sodium from the kidney. Water and chloride ions passively accompany the sodium producing diuresis.

Should antibiotic prophylaxis be given to a patient with a prosthetic joint before dental procedures? Describe the factors, if any, that would influence the decision.

The newest recommendations do not encourage routine prophylaxis following joint replacement. Any factors that would influence the decision include the existence of any serious medical condition that could immunocompromise the patient and whether the joint is at risk for infection. The dental hygienist and dentist should speak with the patient's physician and then determine if prophylaxis is necessary.

3rd trimester

The woman is beginning to feel uncomfortable and it is difficult for her to lie prone for any length of time. IF dental treatment is needed, she may feel more comfortable sitting or with the right hip elevated. In addition, this is the time when premature labor is most likely to begin. Drugs that may affect the newborn child should not be given during this trimester

What are the adverse reactions associated with tetracycline and what should a patient be told about them?

There are many different adverse reactions associated with tetracycline. The most common adverse reaction associated with tetracycline antibiotics is GI upset. GI adverse reactions include nausea, vomiting, diarrhea, gastroenteritis, glossitis, stomatitis, xerostomia, and superinfection due to candida. Unfortunately, tetracycline needs to be taken on an empty stomach. Dairy products, vitamins, or antacids can inhibit the absorption of tetracycline.

Acetaminophen

Tylenol. Produce analgesia by elevating the pain threshold. Analgesic & antipyretic

Explain the four mechanisms by which an allergic reaction can occur.

Type I - Mediated by IgE antibodies, can in anaphylaxis or urticaria (hives, rash). Type II - Complement dependent reactions involving either IgG or IgM antibodies, cytotoxic (hemolytic) response, can result in anemia. Type III - Mediated by IgG antibodies, immune-complex disease, can cause serum-sickness, urticaria, arthralgia, arthritis, lymphadenopathy, and fever. Type IV - Delayed-hypersensitivity reactions mediated by sensitized T-lymphocytes and macrophages.

Nitroglycerin

Used for the management of acute angina. It is a vasodilator that produces relaxation of vascular smooth muscle.

Digoxin

Used to treat some arrhythmias. It shortens the refractory period of atrial and ventricular tissues. Toxic doses can result in ventricular arrhythmias.

Describe the reason for the difficulty associated with the treatment of herpes simplex labialis with antiviral agents. Describe any useful clinically proven effect of either topical or systemic agents in dentistry.

Viruses are difficult to treat because they cooperate with the host's cells. Acyclovir applied topically has been shown to shorten duration of lesions by a few hours. Docosanol (Abreva) has been shown to shorten duration of lesions by a half of a day. Penciclovir, available topically, has been shown to reduce both the duration of the lesion and the pain of the lesions on the lips and face. The advantages of penciclovir over acyclovir are that it can achieve a higher concentration within the cell and the drug remains in the cell longer. Adverse reactions with antivirals include; local burning sensation, nausea, CNS effects, erythema at the site of application, rash, and pruritus.

Scheduled II drugs

Written Rx with provider's signature only. No refils. AP: HIGH (oxycodone, morphine, amphetamine)

Addiction

a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences.

therapeutic index (TI)

a quantitative measurement of the relative safety of a drug. Compares the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes toxicity. TI is small (narrow TI) then toxicity is more likely. TI large (wide TI) then the drug will be safer.

Psychological dependence:

a state that involves emotional-motivational withdrawal symptoms, e.g. anxiety and inability to feel pleasure, upon cessation of drug use or certain behaviors

aspirin

acetylsalicylic acid (ASA) analgesic, antipyretic , anti-inflammatory & antiplatelet effects is related to its ability to inhibit prostaglandin.

Black box warnings

an FDA designation that the drug manufacture promptly displays in a box in the PI. To draw attention to specific warnings. May have serious side effects, fatal, life threatening or health risks

What is angina and what are some of its causes?

an ischemic heart disease, is characterized by severe squeezing or pressure-like thoracic pain brought on by exertion or stress.

azoles

antifungals (miconazole)

topical

application to body surfaces. SKin, oral mucosa & sublingually

generic name

before any drug is marketed it is given a generic name that becomes "official" name of the drug. Not capitalized ex ibuprofen

olams

benzodiazepines

Discuss the use of the antifungal agent nystatin in the treatment of oral candidiasis. State three dose forms useful in dentistry and describe their pros and cons.

binding to sterols in the fungal cell membrane causing increased membrane permeability. Potassium and other cellular constituents leak out. Nystatin is not absorbed from the mucous membranes or through intact skin, it is poorly absorbed from the GI tract. In usual therapeutic doses, blood levels are not detectable. It is not absorbed but is excreted unchanged. Nystatin is available in the form of an aqueous suspension which should be used as a rinse and expectorated, or frozen into a popsicle. Diabetic patients must take the sugar content of Nystatin into account. Nystatin is also available in pastilles, licorice flavored, rubbery lozenges that also contain sugar. The pastilles dissolve in the mouth, bathing lesions for a longer period than with aqueous suspension. Nystatin can also be applied in the form of a cream to treat denture stomatitis, by applying a thin layer of nystatin cream to the tissue side of a denture. Patients should be instructed to use nystatin for 10-14 days, or for 48 hours after the signs and symptoms of the infection have been eradicated.

Scheduled V drugs

can be bought OTC in some states. AP: LEAST (codeine containing cough syrups)

Interference with natural defense mechanisms

certain drugs (such as corticosteroids) reduce the body's ability to fight infections. These drugs cause the patient to get infections more easily and to have more difficulty fighting infections.

what are scheduled drugs?

controlled substance divided into 5 schedules according to their abuse potential.

What are the long-term effects of chronic alcohol consumption?

deficiency of proteins, minerals, and water-soluble vitamins. Impotence, gastritis, esophageal varices, arrhythmias, and hypertension have also been reported.

chemical name

describes the chemical composition and molecular structure of a drug. Code name

Withdrawal syndrome

drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of meditational or recreational drugs.

inhalation

gaseous, microcrystalline, liquid or powder form of drugs. Local or system usage

What are the adverse reactions associated with penicillin? What should a patient be told about them?

gastrointestinal and include GI upset, nausea, vomiting, and diarrhea. There is also the possibility of allergic reaction. A patient should be told to try to take the penicillin on an empty stomach, or take it with food or milk if it causes GI upset. The dental practitioner should also tell a patient what to do in case of symptoms of an allergic reaction.

Idiosyncratic reaction

genetically related abnormal drug response. certain populations are more susceptible to certain adverse reactions to specific drugs.

physiological agonist

has affinity for a different receptor site than the agonist. Its presence decreases the max. response of the agonist by producing an opposite effect via different receptors

what is HF?

heart cannot pump efficiently, the heart is unable to keep up with the body's needs. This occurs because the heart muscle has suffered an injury and cannot keep up its work. Left side heart failure results in pulmonary edema. Right side heart failure results in peripheral edema. Heart failure usually begins on the left side, and progresses to include the right side

adverse rxn for penicillin

include toxic reactions and allergic or hypersensitivity reactions. The penicillins are the most common cause of drug allergies.

ARBs: (they end with "sartan")

indicated for those patients with chronic stable angina who also have hypertension, diabetes mellitus, an LVEF less than 40%, or chronic kidney disease and who cannot tolerate ACEIs, these work much like ACEIs.

how can metabolism be altered by an effect on liver microsomal enzymes?

induction drug is metabolized causing an increase of enzymes which causes a decrease effect of the drug. Inhibition drug is metabolized causing a decrease of enzymes which causes an increases effect of the drug.

Superinfection

infection occurring after or on top of an earlier infection, especially following treatment with broad-spectrum antibiotics. All anti-infective agents can produce an overgrowth of an organism that is different from the original infecting organism and resistant to the agent being used

Phase 4

involves post marketing surveillance. Toxicity of the drug occurs in pt.'s taking the drug after it is released is recorded. Drugs have been removed from market only after phase 4 has shown serious toxicity.

INR is the international normalized ratio

is a laboratory measurement of how long it takes blood to form a clot. It is used to determine the effects of oral anticoagulants on the clotting system.

2nd trimester

is an excellent time for the patient to receive oral care and another prophylaxis if needed. The patient's periodontal status should be carefully evaluated. The patient is most comfortable during this trimester.

Coumadin (warfarin)

is an oral anticoagulant. It stops the synthesis of clotting factors VII, IX, and X.

major route of drug excretion

kidney

Phase 2

larger groups of humans are given the drug and any adverse reactions are reported to the FDA/ primarily to test effectiveness

efficacy

maximum effect of a drug regardless of dose

oral route

most common & popular route of administrating. An advantage is the large absorbing area present in the small intestine.

What groups of patients should not receive tetracycline therapy? Why is it contraindicated in these patients?

most noted for its effects on teeth and bones. It can cause a permanent discoloration of teeth and enamel hypoplasia if given during the time of enamel calcification. It should not be used during pregnancy or the first 8 or 9 years of life. Nursing mothers should not take tetracycline as well. If tetracycline is given, it can cause a permanent staining that begins as a yellow fluorescence and progresses with time to a brown color. Large doses of tetracyclines have also decreased the growth rate of bones in the fetus and infant.

intravenous

most rapid drug response, immediate onset of action. Injection is directly into the blood the absorption phase is bypassed. Has a quick predictable response

drug allergy

non predictable, not dose related, immunologic response resulting in a reaction such as a rash or anaphylaxis.

potency

of a drug is a function of the amount of drug required to produce an effect.

what are the antibiotics used in dentistry?

penicillin, cephalosporins, macrolide (erythromycin), clindamycin, tetracyclines & metronidazole

What are the dental concerns associated with hydrocodone?

perform a detailed medication/health history to determine whether or not a patient is allergic to opioid analgesics or may require a dosage reduction. Elderly patients, those with prostatic hypertrophy, and those with liver and kidney disease should have their dosages reduced. This will help to minimize or avoid adverse reactions. Other dental concerns include increased risk for sedation and dry mouth.

Scheduled IV drugs

prescription may be telephoned no more than 5 Rx's in 6 months. AP: LESS (diazepam, tramadol)

Scheduled III drugs

prescription may be telephoned no more than 5 Rx's in 6 months. AP: MODERATE (codeine mixtures)

Absorption

process by which drug molecules are transferred from the site of administration to the circulating blood. Drug is required to pass thru biologic membranes

Metabolism (biotransformation)

produces compounds that are more polar (ionized) ,changing of drugs more easily excreted by the kidneys

morphine is a

prototype opioid

Statins

reduce cholesterol

naloxone & naltrexone are what type of agents?

reversal agents

what is the importance of conducting health/med histories?

safely treating pt. medications may interact w meds used in oral health care

what are important features of a good reference book?

specific for disease states, geriatrics orpeds, drug interactions, Rx's drugs or nonprescription drugs. lists names of both RX's & OTC drugs. a standard pharm. book.

Pharmacology

study of drugs and their interactions with living cells & systems.

Lethal Dose (LD)

the dose that causes death in 50% of test animals

Abstinence

the fact or practice of restraining oneself from indulging in something, typically alcohol.

Abuse

the habitual taking of addictive or illegal drugs

brand name

the name of the company marketing the product, often used interchangeably w the trade name.

Pharmacokinetics

the study of how a drug enters the body, circulates within the body, is changed by the body & leaves the body. Absorption, distribution, metabolism & excretion

T 1/2 (half life)

the time required for the serum drug level to decrease by 50%

why should a dental practice keep more than 1 type of reference book?

to have a quick refrence guide look up info regarding medication therapy, herbal supp. etc

why should the oral health care provider have knowledge of pharmacology?

to provide optimal oral healthcare