Pharmacology Midterm
methantherine
(Banthine)
benztropine
(Cogentin)
propranolol
(Inderal)
atropine
(Sal-Tropine)
scopolamine
(Scopace)
atenolol
(Tenormin)
labetalol
(Trandate)
Drugs active at both alpha & beta sites has an ending _
-alol
Drugs that are beta blockers end in the suffix _
-olol
How many cigarettes does 1mg of Nicotine Replacement Therapies (NRT) equal?
1 cigarette
What are 8 qualities of an ideal anit infective?
1. Is elective in its activity for microbial populations thus not affecting the host's tissues. 2. Destroys any size of microbial population in any stage of its development (bactericidal). 3. Reaches pathogens located in any anatomical location. 4. Reaches consistent therapeutic levels rapidly regardless of the route of administration and has a long duration of action. 5. Easy to administer, is stable during storage and is reasonable at cost. 6. Compatible with other drugs given concurrently. 7. Does not interfere with host's defense mechanisms (i.e. immunological and phagocytic activity) 8. Does not predispose the host to superinfections or allergies
A therapeutic index larger than __ is a safe drug
10 mg
What percent of the population is allergic to penicillin?
10%
How long does a meth high last?
16-24 hours
q.i.d
4 times a day
How many harmful chemicals are Nicotine Replacement Therapies (NRT) free of?
4000+
How many medications does the average elderly pt take?
6-8
What are most anti infective drug dosage regimens from?
7-10 days
How much more potent is fentanyl than morphine?
80-100 times
Discuss the most important features of a good reference book
A good reference book will have both the generic and trade name of the drug. It will contain the necessary information regarding drug doses, adverse effects, drug interactions, contraindications, mechanism of action, and information regarding patient teaching.
What are some reasons that a patient might be noncompliant with medication?
A patient could be noncompliant with medication because of the adverse reactions, he/she did not understand the directions, or he/she does not believe that the medication is necessary.
What should a patient be told about the medication that the dentist has chosen?
A patient should be told the name and dose of the medication and how he should take it. He should be counseled about the additive CNS depressant effects with alcohol, opioid analgesics, and other CNS depressant medications. He should also be counseled about the sedating and amnestic properties of benzodiazepines.
What should a patient be told about an antibiotic?
A patient should be told the name of the antibiotic, the strength of the antibiotic, and how to take it. The dental practitioner should also review potential adverse reactions or symptoms of allergic reactions with a patient and what to do should they occur.
When would a prescription NSAID be appropriate?
A prescription for an NSAID would be appropriate if a patient had inflammation that was not treated by acetaminophen. Extreme caution should be used if one is prescribed
What does ADME stand for in pharmacokinetics?
A-absorption D-distribution M-metabolism E-excretion
Which nonopioids exact mechanism of action is unknown and is a weak inhibitor of prostaglandin synthesis in CNS?
APAP
What is the term for the state of being free of drugs which is the goal of any treatment program?
Abstinence Syndrome
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 of acetaminophen?
Acetaminophen has been associated with both nephrotoxicity and hepatotoxicity.
Compare and contrast acetaminophen to 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.
What are the pharmacologic effects of acetaminophen?
Acetaminophen possesses analgesic and antipyretic effects comparable to aspirin with no clinically significant anti-inflammatory effects.
What are the different ways that drugs can be metabolized?
Active to inactive - Inactive compound may be formed from an active parent drug. Inactive to active - An active parent drug may be transformed into an active compound. Active to active - An active parent drug may be converted to a second active compound, which is then converted to an inactive product.
Which drug group acts by blocking alpha and beta receptors or both? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group acts decreaseing sympathetic tone in blood vessels resulting in vasodilation which results in a reduction in blood pressure? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group adverse reactions includebronchoconstriction, bradycardia, hypoglycemia? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group are the following drugs in propranolol (Inderal), labetalol (Trandate), atenolol (Tenormin)? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group blocks SANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group is sympatholytic and blocks SANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group is sympatholytic? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group is used to treat peripheral vascular disease (i.e., Raynauds syndrome), severe migraine headaches, hyperthyroidism, angina pectoris, cardiac arrhythmia and hypertension? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Blocking Drugs
Which drug group adverse reactions include: Anxiety, Tremors, Palpitations, increase blood pressure, Arrhythmias? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group are the following drugs: epinephrine, NE, levonordefrin, ephedrine or, pseudoephedrine, albuterol - ashtma, amphetamine - ADHD, phenylephrin, (Neo-Synephrine)? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group contraindications include: Uncontrolled CVD (arrhythmias, angina), Hypertension, Hyperthyroidism? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group effects the CNS by producing CNS excitation or alertness and higher doses produce anxiety, apprehension, restlessness, and tremors? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group effects the cardiovascular system by increasing force & rate of contraction of the heart (increase Bp), the total peripheral resistance (TPR) is increased and the vessels are vasoconstriction (alpha)? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group effects the eye by lowering intraocular pressure and can cause mydriasis? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group effects the respiratory system by dilating/relaxing the bronchiole smooth muscles? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group effects the respiratory system/lungs by causing vasodilation? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group effects the salivary gland by decreasing salivary flow which results in xerostomia as well as viscous effects? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group has metabolic effects like increasing glycogenolysis stimulation causes hyperglycemia? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is classified as having direct action, indirect action, or mixed action? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is sympathomimetic and mimics SANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is sympathomimetic? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is used for bronchodilation to treat asthma, emphysema, and allergic reaction? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is used for nasal decongestion? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is used for the CNS for treatment of attention deficit hyperactivity disorder, narcolepsy, and as diet aids? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is used for vasoconstriction in dentistry because of their vasoconstrictive actions on blood vessels (epi)? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group is used to raise blood pressure and treat cardiac arrest? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which drug group mimics SANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Adrenergic Drugs
Which factor that alters drug effects is: determines how much or how little of a drug you need children less elderly more. Smaller less. Larger more
Age and weight
Opioid drugs are used for which of the following? Analgesics Antitussives (cough-codeine) Antidiarrheals Pre-anesthetic medication All of the above
All of the above
Which of the most current guidelines need to be checked regarding antibiotic prophylaxis/premedication?
American Heart Association and the American Dental Association
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).
What are some of the nonpharmacologic methods of helping a patient deal with her anxiety?
An anxious patient could be scheduled for a morning appointment, one could talk with her and calmly reassure her, or the dental practitioner could provide the patient with a set of headphones during the procedure. The patient could listen to relaxation CDs or the music of her choice to occupy herself during the procedure.
Which anti anxiety combo is prescribed if anxiety is an important consideration to decrease pain threshold?
Analgesic-Sedative Combos
What is the term for any agent to counter or stop an infection (antiviral, antifungal, antibiotic)
Anti infective agen
Which drug group adverse reactions include Xerostomia (secretion stoppage) No sweating Sedation Blurred vision (due to cylcoplegia) Photophobia (fear of light) Tachycardia (high doses) Urinary and GI stasis Hyperpyrexia - high fever High doses to the CNS Hallucinations Seizures restlessness? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group blocks PANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group causes stimulation in high doses or cause sedation in low doses on the CNS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group do the following medications belong in: atropine (Sal-Tropine) methantherine (Banthine) scopolamine (Scopace) Propantheline Bromide benztropine (Cogentin)? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group effects smooth muscle by delaying gastric emptying and decrease esophageal and gastric emptying and causing bronchial dilation? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group effects the cardiovascular system by causing Tachycardia with large doses and bradycardia with low doses? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group effects the endocrine glands decrease flow and volume of secretions in respiratory, gastrointestinal, and genitourinary tracts? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group effects the eye by causing mydriasis and cycloplegia? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is contraindicated for patients with Glaucoma, Prostatic hypertrophy, Intestinal or urinary obstruction or retention, Cardiovascular disease? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is contraindicated with drug interactions Additive anticholinergic effect phenothiazines, antihistamines, tricyclic antidepressants? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is parasympatholytic and blocks PANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is parasympatholytic? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is used as preoperative medication in dentistry and pre-anesthetic drug for surgery to inhibit salivary and bronchial secretions. It is used to create a dry, oral field? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is used for gastrointestinal disorders to decrease gastrointestinal motility and is used to treat ulcers, diarrhea, and hypermotility? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is used for ophthalmologic examinations as topical use can cause mydriasis which causes a full visualization of the retina and cycloplegia relaxes the lens so that proper prescriptions for glasses can be determined? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group is used for treatment of motion sickness, and Parkinson Disease? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug groups counteract/blocks acetylcholine, blocking muscarinic receptor at post ganglion and preventing the action of Ach? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic Drugs
Which drug group causes decreased bronchial secretions? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Anticholinergic DrugsAnticholinergic Drugs
Missed appointments and failure to pay for services Behavior management problems Medical complications - delay treatment to complete medical consultation ***Pain tolerance may be decreased Typically, only uses emergency dental care Always check for oral lesions Remember many drug abusers have poor oral hygiene.
Appointment and Management Considerations of Drug Abusers
Can aspirin be used in children under the age of 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
Describe the mechanism of the most important drug interaction of barbiturates.
Barbiturates are potent stimulators of liver microsomal enzyme production. An increase in enzyme production can lead to an increase in the rate of drug destruction because microsomal enzymes are responsible for drug metabolism.
Between Benzodiazepines and Barbiturates, which is life threatening?
Batboturates
Joe T. is a 50 yr old, 320 pound white male who has been coming to your practice for 2 yrs and he undergoes kidney dialysis. His teeth are in fairly good condition with the exception of one tooth. The tooth is almost dead, it requires a crown, and Joe will need a root canal. He is in pain just thinking about having the root canal. His main concern is adequate pain control after the procedure. Joe considers himself to be rather astute and notices that the dose of the OTC ibuprofen is 200 mg while that of OTC ketoprofen is 12.5 mg. Why is the dose of ibuprofen larger than ketoprofen?
Bc ketoprofen is more potent, ibuprofen is less potent
What type of drugs are Valium, Xanax; date rape drug - i.e. flunitrazepam?
Benzodiazepines
Is memory loss a problem with benzodiazepines? What should a patient be told?
Benzodiazepines are associated with anterograde amnesia. The memory loss is limited to events occurring after drug administration and most likely results from impaired consolidation processes that store information. A patient should be counseled about the amnestic qualities of benzodiazepines. She should be instructed not to operate heavy machinery or equipment and to avoid any activity that requires thought or concentration. Lastly, she should have someone drive her to and from her appointment.
The dentist decides to prescribe diazepam which is to be taken the night before her appointment and approximately one hour before her appointment. What is the rationale for using benzodiazepines to treat anxiety?
Benzodiazepines are used to treat anxiety because they have relatively fast onset of action and their duration of action is short, intermediate, or long. These drugs are safe and effective in the treatment of anxiety.
Name the pharmacologic class to which atenolol (Tenormin) belongs. Describe the effects that make beta-blockers useful in the treatment of arrhythmias, angina, and hypertension.
Beta-adrenergic blocker - Selective for beta 1 receptors. They are used to treat arrhythmias, angina, and hypertension because they decrease cardiac output, cardiac work, and heart rate.
What is the term for amount of drug in the blood measured as a concentration, usually micrograms/ml?
Blood serum level
Drug misuse is the self-administration of a drug in increasing quantities, resulting in dependence, functional impairment, and deviation from approved social norms. Drug abuse is the indiscriminate or inappropriate use of drugs. The first statement is true. The second statement is false. The first statement is false. The second statement is true. Both statements are true Both statement are false
Both statement are false - the terms are switched
Drug abuse is the self-administration of a drug in increasing quantities, resulting in dependence, functional impairment, and deviation from approved social norms. Drug misuse is the indiscriminate or inappropriate use of drugs. The first statement is true. The second statement is false. The first statement is false. The second statement is true. Both statements are true Both statement are false
Both statements are true
Which FDA approved tobacco cessation product is by prescription only, up to 30% of smokers succeeded in quitting when combined with psychological support, treatment should begin 1-2 weeks before the quit date Initial: 150 mg daily for 3 days Then: 150 mg twice daily at least 8hr apart 8 up to 52 weeks (dose tapering not necessary, side effects are insomnia and dry mouth and precautions/contraindications include history of seizure disorder, history of eating disorder, currently taking Wellbutrin or MAO inhibitors and severe liver disease?
Bupropion SR (Zyban SR)
Which FDA approved tobacco cessation product is when pt may experience nausea if they smoke when using and the exact mechanism is not known?
Bupropion SR (Zyban SR)
Which tobacco cessation pharmacotherapies are approved by the FDA and considered the first line?
Bupropion SR (Zyban SR) Varenicline (Chantix) FDA approved 5/06 Nicotine Replacement Therapies (NRT)
What is the principle effect of hypnotics/barbituates?
CNS depressant, much more than benzos
Name two major pharmacologic effects of barbiturates.
CNS depression, analgesia.
Describe the major adverse reactions of barbiturates.
CNS depression, lethal in high doses.
State the pharmacologic effects of the general anesthetics.
CNS depression, sedation, analgesia.
Which anti anxiety mediation group produces skeletal muscle relaxation, is used in treating back and muscle pain and in pts with muscle spasms, can be used for treatment of TMJ, with common side effects include GI upset, sedation and dizziness?
Centrally Acting Muscle Relaxants
Which anti anxiety medication group does diazepam (Valuim) fall into?
Centrally Acting Muscle Relaxants
__ should not be used in an individual with a history of prophylaxis, angioedema or urticaria with penicillin or amoxicillin
Cephalosporins
Explain how metabolism can be altered by an effect on liver microsomal enzymes.
Certain drugs can affect liver microsomal enzymes, which can then speed up or slow down metabolism. This can lead to toxicity or decreased drug effects.
Which anti infective usually contains sugar as a sweetener and is used for children?
Chewable and Liquid Dose
Which drug acts indirectly by either causing the release of the neurotransmitter (ACH) which then goes to the receptor site OR inhibiting the enzyme cholinesterase? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drug group acts directly on the parasympathetic receptors (Nicotinic, Muscarinic)? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drug group includes irreverisble drugs - poisons (insecticides, chemical warfare agents) malathion, sarin? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drug group is classified as s either direct or indirect acting agents? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drug group is parasympathomimetic and mimics PANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drug group is parasympathomimetic? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drug group mimics PANS? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs excites the smooth muscle of GI tract causing an increase in activity, motility, and secretion of digestive enzymes? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs group causes bronchospasm, bronchial secretions and increased salivary flow? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs group causes miosis (excessive constriction of the pupil of the eye), a decrease in intraocular pressure and increases fluid in the eyes? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs group is associated with the adverse reactions SLUD-P? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs groups contraindications are bronchial asthma, hyperthyroidism, gastrointestinal or urinary tract obstruction, peptic ulcer disease, severe cardiac disease include? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs groups includes Pilocarpine and is used for direct treatment of xerostomia (may cause side effects of sweating, nausea, rhinitis, flushing) and Glaucoma as topical doses in the eye? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs groups is used for post operative urinary retention? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which drugs provides a negative chronotropic (rate) action, negative inotropic (force and strength) action: slowing down the heart causing bradycardia and relaxing the smooth muscles (vasodilation)? Cholinergic Drugs Anticholinergic Drugs Adrenergic Drugs Adrenergic Blocking Drugs
Cholinergic Drugs
Which tobacco cessation product not approved by the fda precautions include rebound, hypertension and side effects include dry mouth, drowsiness, dizziness, and sedation?
Clonidine
Which tobacco cessation products have not been approved by the FDA and are considered the second line?
Clonidine and Nortriptyline
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 - It is available as an oral lozenge for the local treatment of oropharyngeal candidiasis. Patients are instructed to suck on the lozenge, which dissolves in about 15 to 30 minutes, as if they were sucking on a cough drop. The most common adverse reactions include abdominal pain, diarrhea, and nausea. This may be difficult for a young child to use because the patient must suck on the lozenge for 15 to 30 minutes Ketoconazole - Ketoconazole absorption is decreased in the presence of food and can cause liver damage. It is used for the treatment and management of mucocutaneous and oropharyngeal candidiasis.
What 4 CNS stimulants are commonly abused?
Cocaine Caffeine Tobacco Amphetamines
What are the four commonly abused Central Nervous System Stimulants (Sympathomimetic Stimulants)?
Cocaine, Caffeine, Tobacco, Amphetamines
List the contraindications to the use of nitrous oxide.
Contraindications to nitrous oxide therapy include nasal congestion, emotionally unstable patients, uncontrollable children or adults, chronic obstructive pulmonary disease, and pregnancy.
Which regulation act divides controlled substances into five schedules according to their abuse potentials?
Controlled Substance Act
Which drug regulation act of 1970 regulates the manufacture and distribution substances that have "potential for abuse" ex: narcotics)?
Controlled Substances Act
What 6 methods can you employ to reduce patient anxiety without drugs?
Create a calm serene office space Play music that will calm and not provoke a mood Office staff presents an air of concern and compassion for the patient. The staff does not respond negatively to the patient's negative vocalizations or behaviors that are due to fear Inform the patient of actions of the day so there will be no mystery or uncertainty
State the therapeutic uses of the adrenergic agents, especially the uses these agents have in dentistry.
Dentistry - Create a dry field, localize the anesthetic, hemostasis, decreased systemic absorption of the local anesthetic, vasoconstriction. General medicine - Decongestion, asthma/allergic reactions, hemostasis, treatment of shock, treatment of cardiac arrest.
What factors should be considered before antibiotic prophylaxis?
Depends on the specific dental procedure being performed, the cardiac and medical condition of the patient, risk for bad outcomes from infective endocarditis and the drug and dose necessary
Explain the difference in mechanism of action between the direct-acting and indirect-acting cholinergic agents.
Direct action - Cholinergic drugs resemble acetylcholine and act directly on the receptor. Indirect action - These agents, such as amphetamine, release endogenous norepinephrine, which then produces a response. Depletion of the endogenous norepinephrine with reserpine diminishes the response to these agents. Indirect-acting parasympathomimetics or cholinesterase inhibitors inactivate the enzyme acetylcholinesterase.
What is a good question to ask to find out how addicted pt is?
Do you smoke within 30 mins of waking up?
If drug A will cause a greater effect than drug B, what does this mean?
Drug A has a greater efficacy than drug B
Regulates the manufacturing and distribution of substances that have a potential for abuse, including opioids, stimulants, and sedatives
Drug Enforcement Administration
Which factor that alters drug effects is: can occur when the effect of one drug is effected by another
Drug interactions:
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.
List the adverse reactions associated with the anticholinergic agents..
Dry mouth, blurred vision, constipation, urinary retention
__ is the dose of a drug that produces an effect/response in 50% of the population (people or animals)
ED50
Which factor that alters drug effects is: Where you are (smoking) pts may need a higher dose of drug, pesticides can alter drugs
Environment
Explain the limits to the accepted medical uses of the amphetamine-like agents. Explain why ephedrine tablets are bought by the case by some individuals.
Ephedrine and drugs such as pseudoephedrine have been used by those individuals to make methamphetamine, an illegal drug. Amphetamine-like agents are only used to treat obesity, attention deficit disorder, and narcolepsy
What 5 CNS depressants are commonly abused?
Ethyl Alcohol Inhalants Nitrous Oxide Opioids Sedative/Hypnotics - Benzodiazepines and Barbiturates
Describe the pharmacologic effects of the anticholinergic agents on the exocrine glands, smooth muscle, and eye.
Exocrine glands - Reduce the flow and volume of exocrine gland excretions. Smooth muscles - Relax the smooth muscles in the respiratory and GI tracts. Eye - Increased intraocular pressure, mydriasis.
State the pharmacologic effect of the adrenergic agents on the eye, bronchioles, and salivary glands.
Eye - Decrease in intraocular pressure. Bronchioles - Smooth muscle relaxation. Salivary glands - Stimulate the salivary glands.
Grants approval so that drugs can be marketed in the United States
FDA
What is the name of the six question test determines that level of nicotine dependence?
Fagerstrom Test for Nicotine Dependence (FTND)
T or F The greater the potency the larger the dose
False
State the potential hazards associated with the general anesthetic agents.
Faulty equipment can blow up. There is also a risk for abuse with nitrous oxide and a risk of miscarriage.
Regulates the trade practices of drug companies and prohibits the false advertising of foods, nonprescription drugs, and cosmetics
Federal Trade Commission
What are the 6 reasons it is necessary for a hygienist to possess some knowledge of pharmacology?
For when obtaining med history, appointment scheduling, medication administration in the dental office, knowledge and recommending prescriptions, info sharing among health care professionals and handling medical emergencies
Which factor that alters drug effects is: some demographic are more/less sensitive than others. Eskimos have a higher tolerance to drugs and need more of the drug to get an effective/therapeutic dose
Genetic variation
State the contraindications and cautions to the use of anticholinergic agents and explain their relationship to the pharmacologic effects of these agents.
Glaucoma - Increase intraocular pressure and can exacerbate glaucoma. Prostatic hypertrophy - Anticholinergic drugs can exacerbate urinary retention in older men with BPH who already have difficulty urinating. Intestinal or urinary obstruction or retention - Can precipitate or exacerbate urinary retention or constipation in patients with chronic disorders. Cardiovascular disease - Can block the vagus nerve and cause tachycardia. This can be a problem in patients with hypertension or angina
Define the t 1/2 , or half-life, of a drug and state its significance.
Half-life - The amount of time that passes for the concentration of a drug to fall to one half of its blood level at any time. Drugs with shorter half-lives have a short duration of action, and drugs with long half-lives have a long duration of action.
Which drug regulation act of 1914 provided federal control over narcotics and required the registration of all practitioners prescribing narcotics?
Harrison Narcotic Act
Describe the pharmacologic effects of the cholinergic agents on the heart, GI tract, and eye.
Heart - Decreased cardiac output, decrease in total peripheral resistance. Indirect effect on the heart - Increased cardiac output and blood pressure. GI tract - Increases in GI activity, motility, and secretion. Eye - Miosis, decreased intraocular pressure.
Compare and contrast hydrocodone with ibuprofen.
Hydrocodone is an opioid analgesic that binds to κ, μ, and σ receptors located along the pain-analgesic pathways in the CNS (spinal, midbrain, thalamic, and cortical sites of action) and produces altered perceptions and response to pain. Ibuprofen is an NSAID and works by blocking prostaglandin synthesis. The main adverse reactions of NSAIDs are GI, whereas the most common adverse reactions of hydrocodone are CNS related. Hydrocodone has abuse potential, whereas ibuprofen does not. Ibuprofen is ideal for the treatment of mild to moderate pain, and hydrocodone is used to treat moderate to severe pain.
What is hydrocodone and how effective is it in treating or managing dental pain?
Hydrocodone is an opioid analgesic that produces fewer adverse reactions and has less potential for abuse than morphine. However, the risk for abuse with hydrocodone has risen dramatically. It is now a Schedule II controlled substance drug. It is used for the relief of mild to moderate pain in patients who cannot tolerate NSAIDs or in whom NSAIDs are ineffective. It is effective in treating and/or managing dental pain.
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.
Compare and contrast the OTC NSAIDs.
Ibuprofen is the oldest and the most commonly used OTC and prescription NSAID. It is rapidly absorbed orally, and food delays its rate but not its extent of absorption. It undergoes hepatic metabolism and is excreted in the kidneys. Ibuprofen has been proven to be effective in the management of dental pain and is usually the drug of choice. Ibuprofen is dosed every 4 to 6 hours. Adverse reactions include GI upset and some confusion. It is also available in a pediatric dose form in both prescription and OTC strength. Trade names include Motrin IB, Advil, Nuprin, Children's Motrin, and others. Naproxen (Aleve) is similar to ibuprofen but differs in its duration of action and is dosed every 6 to 8 hours for the prescription product and every 12 hours for the OTC product.
Should a patient be concerned about becoming addicted to benzodiazepines? Why or why not?
If this is a limited, one-time prescription for a benzodiazepine, a patient should not be overly concerned about becoming addicted to benzodiazepines. Physiologic addiction usually occurs after an extended period of large doses of benzodiazepines.
What are the four contraindications for Nicotine Replacement Therapies (NRT)?
Immediate myocardial infarction (< 2 weeks) Accelerated Hypertension Serious Arrhythmia Serious or worsening angina pectoris
Which drugs are included in "potential for abuse"?
Includes opioids (narcotics), stimulants, and sedatives. For example: oxycodone, cocaine, heroin, morphine, codeine, Ritalin, Valium
Which commonly abused CNS depressant with high-dose exposure causes intoxication, with effects similar to CNS depressant, products that can be abused by include gasoline, glue, paint, lighter fluid, spray cans, nail polish, correction fluid?
Inhalants
Name the one absolute contraindication to the use of barbiturates.
Intermittent porphyria or a positive family history of porphyria.
Drug B is safer
Is drug A or B safer?
Explain two precautions that should be taken in the dental office to discourage drug abusers
Keep prescription pads under lock and key. Write prescriptions in ink so that they cannot be changed.
Which of the following organs responsible for excretion of the majority of drugs out of the body? a. GI tract b. Salivary glands c. Lungs d. Kidneys e. Sweat glands
Kidneys
What four drug do RDHs deliver?
LA, N2O, topical, fluoride
What is the term for the amount of a drug taken that will cause 50% of a normal population to die?
LD 50
To determine how much of a drug will cause a person to die, the concept __ was developed
Lethal dose 50
State the major route of drug excretion.
Major route of drug excretion: Renal route, which includes glomerular filtration, active tubular secretion, and passive tubular diffusion.
Which commonly abused CNS depressant Psychedelics (Hallucinogens) is an antiemetic (anti nausea), heavy abuse can lead to oral changes xerostomia, gingivitis, leukoplakias and causes euphoria, enhanced sensory perception?
Marijuana
What are the following?: Nausea - from chemotherapy Smoked better than Marinol pills (contains THC) AIDS Wasting Syndrome - deadly loss of appetite and extreme weight loss and nausea effects of anti-AIDS drugs Spasticity - spinal cord injuries and MS Controversy as to helping with glaucoma
Marijuana as Medicine
Discuss the use of midazolam as conscious sedation in a patient with dental anxiety. Council the patient regarding midazolam.
Midazolam is used to help relax the anxious patient during the dental procedure. The patient is relaxed and somewhat sedated during the procedure. The patient should have someone drive him home. He should be counseled about the sedation and the amnestic effects of midazolam. The patient should also be counseled about additive CNS depressant effects with alcohol, opioid analgesics, and other CNS depressant medications.
Jane Smith is a 42 year old female patient who is new to your practice. You note that she appears to be somewhat anxious about being in your office. She is breathing rather quickly, is flushed, and is complaining about heart palpitations. You take her pulse and note that it is high. A detailed medication/health history reveals an otherwise, normal healthy individual. Ms. Smith takes an occasional ibuprofen or acetaminophen for pain. Ms. Smith does tell you that doctor's and dentist's offices make her rather nervous and this is not the first time that she has had these symptoms in a health professional's office. You are concerned because Ms. Smith must return next week for a filling. What are the adverse reactions associated with benzodiazepines?
Mild CNS depression, fatigue, drowsiness, muscle weakness, short term memory loss
Which nonopiods mechanism of action is very close to aspirin and inhibits prostaglandin synthesis?
NSAIDs
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.
What is the term for a type of microorganism that is not and never has been in the spectrum of activity of an antimicrobial drug.
Natural resistance
Is nausea due to an allergic reaction or is it a side effect of the penicillin?
Nausea is a side effect of penicillin.
Which Nicotine Replacement Therapies (NRT) is OTC, comes in different flavors, is sugar free, is used every hour for the first few weeks, duration is 12 weeks, there is no eating or drinking 15 minutes before and during use (can interfere with the absorption), may delay weight gain, side effects include mouth soreness and gastrointestinal side effects (hiccups, heartburn, nausea) and precautions are that the pt should not used nicotine while using this product and should not used if they have TMJ disorder?
Nicotine Gum (OTC)
What are the five Nicotine Replacement Therapies (NRT)?
Nicotine Gum (OTC) Nicotine Patch (OTC) Nicotine Lozenge (OTC) Nicotine Nasal Spray Nicotine Inhaler
Which Nicotine Replacement Therapies (NRT) is by prescription, with 6-16 cartridges being used per day, is absorbed by the buccal mucosa, is used for 3 minimum-6 maximum weeks, is recommended with gradual tapering off, side effects include local irritation of the mouth and throat and precautions are acute cardiovascular disease and do not breath into lungs?
Nicotine Inhaler
Which Nicotine Replacement Therapies (NRT) is OTC and dosing depends on if the pt smokes within 30 mins of waking up, is used for up to 12 weeks, side effects include mouth soreness, indigestion, cough, heartburn, insomnia and precautions are do not use more than one at a time, do not chew or swallow whole and do not eat or drink 15 minutes before using?
Nicotine Lozenge (OTC)
Which Nicotine Replacement Therapies (NRT) is by prescription, the nicotine is rapidly absorbed through the nasal mucosa, is used for 3-6 months, side effects include nasal irritation and precautions are acute cardiovascular disease and may be abused?
Nicotine Nasal Spray
Which Nicotine Replacement Therapies (NRT) is OTC, location should be clean, dry and hairless, should be left on for no more than 16 hours (Nicotrol) or 24 hours (Nicoderm), is used for up to 8 weeks, side effects includel local skin reaction, insomnia and precautions are acute cardiovascular disease?
Nicotine Patch (OTC
Which FDA approved tobacco cessation product provides patients with a low dose of nicotine while they are adapting to a life without the rituals and social aspects associated with tobacco use?
Nicotine Replacement Therapies (NRT)
Which FDA approved tobacco cessation product reduces physical withdrawal symptoms, diffuses slowly and is not like inhaled nicotine, provides nicotine at lower dose than when self administered, provides a steady dose of nicotine with the patch, or as needed with gum, inhaler, lozenge and/or nasal spray, is used for a limited time and should be used as directed / should not be used while using tobacco?
Nicotine Replacement Therapies (NRT)
Which commonly abused CNS depressant is associated with hallucinations, headache, dizziness, hypoxia and is available in tanks and propellant in whipping cream?
Nitrous Oxide
Jane Smith is a 42 year old female patient who is new to your practice. You note that she appears to be somewhat anxious about being in your office. She is breathing rather quickly, is flushed, and is complaining about heart palpitations. You take her pulse and note that it is high. A detailed medication/health history reveals an otherwise, normal healthy individual. Ms. Smith takes an occasional ibuprofen or acetaminophen for pain. Ms. Smith does tell you that doctor's and dentist's offices make her rather nervous and this is not the first time that she has had these symptoms in a health professional's office. You are concerned because Ms. Smith must return next week for a filling. What should you tell Ms. Smith about the medication that the dentist has chosen?
No driving, don't drink or any other drugs like alcohol
Which anti anxiety medication group are the folloing examples of?: chloral Hydrate - Noctec, Somnos meprobamate - Equiril, Miltown buspirone - Buspar
Nonbenzodiazepine - Nonbarbiturate Sedative-Hypnotics
Which anti anxiety medication group includes the drug Choral Hydrate and has a rapid onset and fairly short duration of action?
Nonbenzodiazepine - Nonbarbiturate Sedative-Hypnotics
Which anti anxiety medication group is associated withh gastric irritation, vomiting (watch out for aspiration), can come in a liquid form with a bad odor/taste, and can lead to dependence with long term use?
Nonbenzodiazepine - Nonbarbiturate Sedative-Hypnotics
Which anti anxiety medication is the latest group of drugs used to treat insomnia, vinds to benzodiazepine receptors and decreases sleep latency, has the potential to cause physical and psychological dependence and the ability to cause daytime sedation and impair driving in the morning after night administration?
Nonbenzodiazepine -Benzodiazepine Receptor Agonists
Which tobacco cessation product not approved by the fda precautions include risk of arrythmias, and side effects include sedation and dry mouth?
Nortriptyline
Discuss the use of the antifungal agent nystatin in the treatment of oral candidiasis. State three dosage forms useful in dentistry and describe their pros and cons.
Nystatin - Nystatin is available as a liquid suspension, pastilles, and vaginal tablets; all dose forms can be used to treat oral infections. The suspension contains sugar, and the pastilles are licorice-flavored and also contain sugar. The vaginal tablets do not contain sugar and, when taken by mouth, stay in the mouth longer than pastilles or the suspension. However, they do not taste good and most patients would be better off with the suspension. A patient's likelihood to adhere with a swish and swallow is probably higher than sucking on a pastille or vaginal tablet.
Are there any dental concerns associated with one baby aspirin each day?
One baby aspirin each day can cause increased bleeding in patients. This may mean increased bleeding and a longer time for blood to clot during scaling and planing
Dentistry and sedatives
Onset is usually rapid with duration measured in hours DO NOT drive Do not mix with other CNS depressants especially alcohol. Absolutely contraindicated for pregnant women There is no pain relief at normal sedative doses Analgesics necessary - Nonopioids preferred
Is there a need for concern with opioid addiction for patients taking these drugs to treat or manage dental pain? Why or why not?
Opioid addiction should not be a concern for patients (non-substance abusers) who may require an opioid analgesic to treat moderate to severe dental pain. The duration of opioid analgesic use is limited and not a long-term process. The concern arises for people with a history of substance abuse problems
__ are vitamin K inhibitors
Oral anticoagulant
State the dosage forms most frequently used in dentistry.
Oral tablets and capsules.
Which component of the ANS has nicotonic and muscarinic receptors?
PANS
Which component of the ANS has preganglionic fibers that are long, post ganglionic fibers that are short and the ganglia is close to the effector organ?
PANS
Which component of the ANS originates in two general areas: cranial nerves and sacral segments
PANS
Which component of the autonomic nervous system performs the maintenance role of the body and conservation of body processes?
Parasympathetic Autonomic Nervous System (PANS)
What are the two components of the autonomic nervous system?
Parasympathetic Autonomic Nervous System (PANS) and Sympathetic Autonomic Nervous System (SANS)
Which factor that alters drug effects is: People with different illnesses can effect how drugs are metabolized/absorbed/distributed
Pathologic state
Which factor that alters drug effects is: Lack of understanding, lack of motivation, not clear communication- pt can take medication wrong. Important the pt takes as prescribed
Patient compliance
Which factor that alters drug effects is: meditation- if you believe in it the outcome can be more positive "The secret"
Patient's opinion
Explain why a list of the most current drugs should be available in every dental office
Patients are usually familiar with the most common drugs. Having this list available allows the dental health care practitioner to have a readily available reference to help determine drug names
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.
What is the Greek meaning for drug or medicine?
Pharmaco
Define the term pharmacokinetics. Name the four categories involved.
Pharmacokinetics - Simply speaking, what the body does to the drug. It is the study of how a drug enters the body, circulates within the body, is changed by the body, and leaves the body. The four categories involved are absorption, distribution, metabolism, and excretion.
What is the term for a state of mind in which the drug is necessary for continued functioning of certain bodily processes?
Physical/Physiologic dependence
What are 5 reasons antibiotics fail?
Poor patient compliance Prescription not filled Starts medication, feels better in couple days - they stop taking it, it can come back worse Inconsistent in taking meds, they don't get the blood serum level constant Susceptible bacteria are removed leaving behind resistant strai
What is a DH concern with Adrenergic Blocking Drugs?
Postural hypotension
Define and differentiate between the potency and efficacy of a drug.
Potency - Function of the amount of drug required to produce an effect. Efficacy - Maximum intensity of effect or response that can be produced by a drug.
State the potential advantages of the nonbenzodiazepine-benzodiazepine receptor agonists.
Potentials include lower risk for abuse and dependence and a lower incidence of daytime sedation.
State the major therapeutic uses of the anticholinergic agents.
Preoperative medication, treatment of GI disorders, ophthalmologic examination, Parkinson's disease or drug-induced Parkinson's disease, motion sickness, dentistry - produce a dry field.
Which of the following anticholinergics helps GI motility and peptic ulcers? atropine (Sal-Tropine) methantherine (Banthine) scopolamine (Scopace) Propantheline Bromide benztropine (Cogentin)
Propantheline Bromide
Which commonly abused CNS depressant Psychedelics/Hallucinogens - LSD, PCP and marijuana?
Psychedelics (Hallucinogens)
Which commonly abused CNS depressant Psychedelics (Hallucinogens) induces states of altered perception?
Psychedelics/Hallucinogens - LSD, PCP
What two Psychedelics (Hallucinogens) are commonly abused?
Psychedelics/Hallucinogens - LSD, PCP Marijuana
What is the term for a state of mind in which a person believes that he or she is unable to function without a specific drug and drug seeking behavior and craving is present?
Psychological dependence - (behavioral dependence)
Which factor that alters drug effects is: Dr can give pt placebo so the pt thinks its working, but really it is a sugar pill. If Dr has a positive attitude pt is more likely to think positive about the medication. Want to get the pt perception of drugs ( some pts don't believe in drugs, some believe in some drugs and not others, some are all natural)
Psychological factors
__ is a sign of cocaine abuse
Pupil dilation
What are some red flags associated with opioid addiction?
Red flags associated with opioid addiction include: 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."
All of the following are important components of general anesthesia except one. Which one is the exception? Loss of consciousness Respiratory paralysis Skeletal muscle relaxation Loss of pain sensation Good patient control
Respiratory paralysis
What would increase the risk of developing nephrotoxicity with acetaminophen?
Risk of developing these conditions would be further increased if a patient were taking aspirin or an NSAID in conjunction with the acetaminophen
Which component of ANS has norepinephrine recptors?
SANS
Which component of the ANS has preganglionic fiberst that are short and post ganglionic fibers that are long?
SANS
Which component of the ANS originates in the spinal column starting at T1 and going down to L2?
SANS
What does SLUD-P stand for?
Salivation Lacrimation Urination Diarrhea Paralysis
Which schedule are these drugs? Heroin, LSD, hallucinogens - LSD
Schedule I
Which drug schedule has high abuse potential and can be given with a written prescription and signature, but no refills?
Schedule II
Which schedule are these drugs? Oxycodone, morphine, amphetamine, secobarbital, Fentanyl, hydrocodone mixtures
Schedule II
What is the biggest difference between schedule II and schedule III?
Schedule II is no refills, schedule III can be refilled
Which drug schedule has moderate abuse potential with prescriptions being telephoned in and is allowed no more than 5 refills in 6 months?
Schedule III
Which schedule are these drugs? Codeine mixtures (Tylenol #3), Ketamine, Steroids, Testosterone
Schedule III
Which drug schedule has less abuse potential and prescriptions may be telephoned in, but no more than five prescriptions in 6 months?
Schedule IV
Which schedule are these drugs? Diazepam (Valium), dextropropoxyphene forms (Darvon, Darvocet), Tramadol, Xanax, Ambien
Schedule IV
Which drug schedule has the least abuse potential and can be bought OTC in some states?
Schedule V
Which schedule are these drugs? Codeine-containing cough syrups. Robitussin AC
Schedule V
Which commonly abused CNS depressant are Benzodiazepines and Barbiturates?
Sedative/Hypnotics
Which classification of antianxiety medication is a mild CNS depressant? Sedatives Hypnotics/Barbiturates Nonbenzodiazepine - Benzodiazepine Receptor Agonists Nonbenzodiazepine -Nonbarbiturate Sedative
Sedatives
Differentiate between "selective" and "nonselective" beta-blockers.
Selective beta-blockers - Have a higher affinity for beta 1 receptors, which have more activity on the heart and blood vessels. Nonselective beta-blockers - Affect all beta 1 receptors to include those in the lungs.
Explain the rationale for the use of several agents during general anesthesia.
Several agents are used during general anesthesia to provide the patient with balanced anesthesia. This provides the patient with good patient control, adequate muscle relaxation, and pain relief.
Administration of nitroglycerin to an alcoholic patient will cause what reaction? Tolerance to the drug Depress the cns Severe hypotension Slow respiration and pulse
Severe hypotension
If suspected abuser - What should a dental health care worker do to prevent any liabilities?
Signed statement indicated drugs not used within last 24 hours
Which type of smoker smokes on weekends and at parites?
Social Smoker / 'Chipper'
Heart rate is sped up with __ and slowed down with __
Sped with SANS Slowed with PANS
Name and describe the four stages of anesthesia.
Stage 1 - Analgesia; Stage II - delirium and excitement; Stage III - surgical anesthesia; Stage IV - Respiratory and medullary paralysis.
What are the four stages of general anesthesia?
Stage 1 > analgesia Stage II > delirium or excitement Stage III > surgical anesthesia Stage IV > respiratory or medulla paralysis
Which component of the autonomic nervous system involves Stress, "fight or flight" response and prepares body to act immediately and in dramatic ways to protect itself or remove itself from danger?
Sympathetic Autonomic Nervous System (SANS)
The receptors know as alpha receptors and beta receptors are located in which portion of the autonomic nervous system? Sympathetic portion Parasympathetic portion
Sympathetic portion
What are the different dose forms of tetracycline available and how do they differ from one another?
Tetracycline is available as topical solution, capsules, liquid, and gels. The liquid and capsules are swallowed and absorbed into the systemic circulation. Topical solutions act locally and are usually used to treat acne.
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.
Is any one opioid more addicting than the other? If so, what is this based upon?
The addictive potential for opioid analgesics and other drugs is based on the schedules of the Controlled Substance Act of 1970. Drugs such as heroin and morphine have a higher potential for abuse than cough syrups that contain codeine.
What are the adverse reactions associated with hydrocodone?
The adverse reactions associated with hydrocodone include sedation, dysphoria, constipation, urinary retention, pupil constriction, and respiratory and cardiovascular depression in high enough doses.
What are the adverse reactions associated with nitrous oxide?
The adverse reactions most commonly occurring with nitrous oxide have been the result of misuse or faulty installation of equipment. Other adverse reactions include nausea, vomiting, and headache.
Why is it especially important to us the correct dose form of acetaminophen in children?
The correct dose form of acetaminophen is necessary because of the risk for overdose in young children.
What are the dental concerns associated with tuberculosis and when is it okay to treat a person with tuberculosis?
The dental concerns associated with tuberculosis are that the patient may have active disease. TB is communicable, so a person with active disease can infect those in the dental office. If a person with active TB seeks oral health care, contact that person's physician and delay health care until the disease is no longer in an active state.
What are the dental concerns associated with hydrocodone?
The dental hygienist should 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.
Is nephrotoxicity and hepatotoxicity only associated with toxic doses of acetaminophen?
The doses required for these adverse reactions are constant and are usually taken over a long period of time. Long-term, chronic dosing could cause these adverse reactions. Those doses and duration used in dentistry are usual doses, yet short in duration, and should not present a significant problem in dentistry.
Compare and contrast the parasympathetic and sympathetic nervous systems. Include neurotransmitters, receptor sites, and effects on innervated organs.
The main neurotransmitter of the parasympathetic nervous system is acetylcholine and its receptor is nicotine. Stimulation of this receptor site affects the smooth muscle, exocrine glands, and cardiac muscles and include a decrease in heart rate, miosis of the eye, bronchial smooth muscle contraction, and skeletal muscle dilation. The major neurotransmitters of the sympathetic nervous system are epinephrine and norepinephrine. The receptors are α, β 1 ,and β 2 . Stimulation of these receptors can stimulate the heart, raise blood pressure, and cause constriction of the blood vessels, bronchial smooth muscle relaxation, and relaxation of the GI tract.
What is the importance of the medication/health history?
The medication/health history is necessary in order to safely treat the patient. It allows the dental hygienist to provide the best possible care to the patient.
BJoe T. is a 50 yr old, 320 pound white male who has been coming to your practice for 2 yrs and he undergoes kidney dialysis. His teeth are in fairly good condition with the exception of one tooth. The tooth is almost dead, it requires a crown, and Joe will need a root canal. He is in pain just thinking about having the root canal. His main concern is adequate pain control after the procedure. Joe considers himself to be rather astute and notices that the dose of the OTC ibuprofen is 200 mg while that of OTC ketoprofen is 12.5 mg. What should you tell Joe about drug potency?
The more potent a drug is the less of the dose you take to have the same effect. Do not alter the dose
What are the adverse reactions associated with penicillin? What should a patient be told about them?
The most common adverse reactions associated with amoxicillin are 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 amoxicillin 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.
What are the adverse reactions associates with benzodiazepines?
The most common adverse reactions associated with benzodiazepines are drowsiness, sedation, blurred vision, ataxia, and psychomotor impairment. Disorientation, confusion, aggressive behavior, and excitement can occur, especially in the elderly. There have been reports of benzodiazepines producing xerostomia, swollen tongue, increased salivation, and a metallic or bitter taste. Other adverse reactions include diplopia, nystagmus, and they can affect the gastrointestinal (GI) and genitourinary (GU) tracts.
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.
Explain the influence of pH on the dissociation characteristics of weak acids and weak bases.
The pH of the tissues at the site of administration and the dissociation characteristics (pKa) of the drug will determine the amount of drug present in the ionized and non-ionized state. The proportion in each state will determine the ease with which the drug will penetrate the tissues.
A patient has called and complained of nausea, itching, and a rash after taking a prescription for penicillin. What is happening to this patient?
The patient is having an allergic reaction to penicillin
Though an elderly patient appears healthy and weighs 110 pounds, what are your concerns regarding drug distribution?
The patient's percentage of body fat to muscle mass has changed over time, so she has more fat than muscle because of her age. She also has lower protein stores in her body, again because of her age. Both could lead to an increased incidence of adverse and toxic reactions.
Describe the dose-response curve using the terms ED 50 (effective dose) and LD 50 (lethal dose).
The potency of a drug can be expressed in terms of the median effective dose (ED 50 ). The ED 50 is the dose of a drug required to produce a specific effect in 50% of the subjects or the dose that produces half of the maximum effect. The median lethal dose (LD 50 ) is the dose when one half of the subjects die.
Does acetaminophen have any potential drug interactions? If so, what are they and how can they be avoided?
The risk for developing hepatotoxicity is further increased when combined with alcohol consumption. This could be avoided by not drinking alcoholic beverages while taking acetaminophen.
Jane Smith is a 42 year old female patient who is new to your practice. You note that she appears to be somewhat anxious about being in your office. She is breathing rather quickly, is flushed, and is complaining about heart palpitations. You take her pulse and note that it is high. A detailed medication/health history reveals an otherwise, normal healthy individual. Ms. Smith takes an occasional ibuprofen or acetaminophen for pain. Ms. Smith does tell you that doctor's and dentist's offices make her rather nervous and this is not the first time that she has had these symptoms in a health professional's office. You are concerned because Ms. Smith must return next week for a filling. The dentist decides to prescribe diazepam (Valium) which is to be taken the night before her appointment and approximately one hour before her appointment. What is the rationale for using benzodiazepines to treat anxiety?
They are short acting, they are safer, they are fast in and fast out so that is better for the pt
Can a patient allergic to penicillin receive other types of penicillin antibiotics?
This is really dependent on the treating physician or dentist. The patient could probably receive a cephalosporin antibiotic, which is related to penicillin. He should use caution and report any unusual symptoms to his dentist or physician at once.
Which factor that alters drug effects is: Certain drugs need to be taken on a full stomach, some need to be before bed. Time of day can alter how the drug effects the body. Route deals with the onset of action. If someone is having a severe allergic reaction, you want a rapid onset so you wouldn't give something orally, youd want something into the vein
Time and route of administration
In dentistry, a cholinergic drug is used to: Produce a dry field for taking impressions Calm an anxious patient Treat dry mouth by inducing salivation Reduce the chance of infection
Treat dry mouth by inducing salivation
State two major uses of the cholinergic agents.
Treatment of glaucoma and treatment of myasthenia gravis.
Describe a unique dental use for pilocarpine.
Treatment of xerostomia.
T or F The greater the potency the smaller the dose
True
What are the following?: effect on an organ system, pain management, neurological (altering mood/behavior), regulate systems, diagnosis, prevention (bc) and cure diseases
Use of drugs
Which FDA approved tobacco cessation product should be taken after eating & with a full glass of water, pts should be treated for 12 weeks, possible side effect include suicidal thoughts (screen for history of depression) nausea, sleep disturbance, constipation, vomiting, precautions/contraindications are history of depression or suicidal thoughts, impaired renal function (use reduced dose), use w/NRTs may increase side-effects and has not been tested on patients under the age of 18yr?
Varenicline (Chantix)
Which FDA approved tobacco cessation product stimulates dopamine release as well as blocks the nicotinic receptor thus relieving withdrawal symptoms?
Varenicline (Chantix)
How do antiinfectives interact with oral anticoagulants?
Vitamin K is the bodies natural clotting factor. When antibiotics are used they can cause a decrease of Vitamin K in the gut and increases blood. Oral anticoagulants are Vitamin K inhibitors
Drug A
Which drug is more potent?
Yes, bc they have the same efficacy
Will both drugs provide the same effect?
Why is medication used for tobacco cessation?
Withdrawal symptoms can be relieved by use of specific FDA approved drugs When medications are properly used & combined with counseling, from 30-50% of tobacco users will succeed in their quit attempt
Jane Smith is a 42 year old female patient who is new to your practice. You note that she appears to be somewhat anxious about being in your office. She is breathing rather quickly, is flushed, and is complaining about heart palpitations. You take her pulse and note that it is high. A detailed medication/health history reveals an otherwise, normal healthy individual. Ms. Smith takes an occasional ibuprofen or acetaminophen for pain. Ms. Smith does tell you that doctor's and dentist's offices make her rather nervous and this is not the first time that she has had these symptoms in a health professional's office. You are concerned because Ms. Smith must return next week for a filling. Should Ms. Smith be concerned about becoming addicted to benzodiazepines? Why or why not?
Yes, give just enough for the apt
What do ALL prescriptions for a controlled substance require?
a Drug Enforcement Agency number (DEA)
What is half life based on?
a normal dose
What is written in an order for a specific medication for a specific patient at a particular time with appropriate instructions for how the patient is to use the prescribed medication?
a prescription
Which agents do not have anti-inflammatory properties? codeine APAP - tylenol hydrocodone ibuprofen a,b a,b,c
a,b,c
Define the following terms: a. Agonist b. Competitive antagonist c. Physiologic antagonis
a. Agonist - A drug that has affinity for a receptor, combines with that receptor, and produces an effect. b. Competitive antagonist - A drug that has affinity for a receptor, combines with that receptor, and produces no effect. c. Physiologic antagonist - Has affinity for a different receptor site than the agonist.
Explain each of the steps involved in oral absorption, including the following: a. Disruption b. Disintegration c. Dispersion d. Dissolution
a. Disruption - The initial disruption of a tablet coating or capsule shell. b. Disintegration - The tablet or capsule contents disintegrate or break apart. c. Dispersion - The concentrated drug particles must be dispersed (spread) throughout the stomach or intestines. d. Dissolution - The drug must be dissolved (in solution) in the GI fluid.
Define the major routes of drug administration, including the following: .a. Oral b. Intravenous c. Inhalation d. Topical
a. Oral - Drugs given by mouth. Examples: tablets, capsules, liquids. b. Intravenous - Any drug administered via injection directly into the blood. c. Inhalation - The administration of the gaseous, microcrystalline, liquid, or powdered form of drugs. d. Topical - Application of a drug to body surfaces
Which part of pharmacokinetics involves transporting drug molecules from site of administration to the circulating blood stream?
absoption
Which part of pharmacokinetics requires drug molecules to pass through or across biological membranes?
absorption
What is the preganglionic neurotransmitter of both PANS and SANS?
acetylcholine
What is the term for a pattern of abuse that includes compulsive use despite complications (medical and social) and frequent relapses?
addiction
The higher the dose of a drug, what is their increased risk of?
adverse effects
With a larger dose there is greater chance of __
adverse reactions
__ are extensions of the drugs pharmacological effects, this can be something that we do or don't want
adverse reactions
'p
after
p.c.
after meals
Do agonists or antagonists fit well in the receptor cite and enhance cellular activity?
agonists
Drugs that enhance/stimulate cell function are called:
agonists
What are the 4 adverse reactions of anti infectives?
allergy, superinfecion, GI complaints and pregnancy
Do alpha or beta receptors cause vasoconstriction of blood vessels when activated?
alpha
Do alpha or beta receptors constrict causing a increase in BP?
alpha
Do alpha or beta receptors promotes contraction of smooth muscle in skin & skeletal muscle?
alpha
Which benzodiazepines/sedative is used for anxiety, but is highly addictive and also called xanax? chlordiazepoxide diazepam lorazepam alprazolam midazolane triazolam
alprazolam
All of following are therapeutic effects of barbiturates except one: anxiolysis sedation sleep induction analgesia anesthesia
analgesia
Do agonists or antagonists not fit well in receptor sites and block cellular activity?
antagonists
Drugs that inhibit/block cell function are called:
antagonists
What is the term for substances that destroy and suppress growth or multiplication of bacteria?
antibacterial
What is the term for agents made by microbes that are utilized to stop other microbial life forms?
antibiotic agent
What is the term for an agent that stops fungus -most common fungus in the mouth is Candidiasis?
antifunfual agent
What is the term for substances that destroy or suppress the growth or multiplication of microorganisms?
antimicrobial agent
What is the term for any agent that stops virus?
antiviral agent
What is the term for an unpleasant emotional state characterized by apprehension and nervousness that is a natural human experience?
anxiety
Jane Smith is a 42 year old female patient who is new to your practice. You note that she appears to be somewhat anxious about being in your office. She is breathing rather quickly, is flushed, and is complaining about heart palpitations. You take her pulse and note that it is high. A detailed medication/health history reveals an otherwise, normal healthy individual. Ms. Smith takes an occasional ibuprofen or acetaminophen for pain. Ms. Smith does tell you that doctor's and dentist's offices make her rather nervous and this is not the first time that she has had these symptoms in a health professional's office. You are concerned because Ms. Smith must return next week for a filling. What is happening to Ms. Smith?
anxiety attack, situational anxiety
What are the two major groups of SANS?
aplha and beta(1) beta (2)
What would be a localized anti invective to treat periodontal disease?
arestin
p.r.n
as needed
Which nonopioid inhibits or suppresses production of prostaglandins and is used as a blood thinner?
aspirin
h.s.
at bedtime
Which of the following anticholinergics dries saliva? atropine (Sal-Tropine) methantherine (Banthine) scopolamine (Scopace) Propantheline Bromide benztropine (Cogentin)
atropine (Sal-Tropine)
What is the term for kills bacteria, goal is to destroy the cell wall?
bacterialcidal
What is the term for halts the growth of the bacteria?
bacterostatic
Which intravenous general anesthesia are the following examples of?: Brevital and Pentothal
barbituates
a or a'
before
a.c.
before meals
When is medication administration in the dental office important to having some knowledge of pharmacology?
being aware of drug to drug interactions
Which intravenous general anesthesia are the following examples of?: valium and versed
benzodiazepines
Which intravenous general anesthesia are used as integral part of conscious sedation, is used mainly for sedation purposes and has a short duration of action?
benzodiazepines
Which ant anxiety are the following drug interaction associated with?: Decrease metabolism of benzos with cimetidine, isoniazid (TB medication), omeprazole Decrease effect of levodopa (used for parkinson's) Increase effects of digoxin, and phenytoin valporic Acid (bipolar medication) increases sedative effects SSRI's- Selective Serotonin Reuptake Inhibitors increases diazepam levels Additive effects - other CNS depressants can increase effects of drugs
benzodiazepines/sedatives
Which anti anxiety is used to treat short term treatment of anxiety (can get addicting), panic attacks, insomnia, alcohol withdrawal and usually used in combinations with another drug for seizures, can be used for conscious sedation (amnesia effect) and pre op sedation?
benzodiazepines/sedatives
Which anti anxiety medication are the following adverse reactions with?: Central Nervous System Fatigue, drowsiness, muscle weakness, ataxia. Anterograde Amnesia This effect when drug is taken and can last up to several hours after. Respiratory Effects Can produce respiratory depression Visual Effects Can produce diplopia, nystagmus (looking at the eye), blurred vision Dental Effects Xerostomia, increased salivation, swollen tongue, bitter or metallic taste
benzodiazepines/sedatives
Which anti anxiety medication are the following effects associated with? Behavioral Effects Reduce anxiety and panic. Cause sedation Anticonvulsant Effects Prevent the spread of seizures Muscle Relaxation Skeletal muscle relaxation
benzodiazepines/sedatives
Which anti anxiety medication are well absorbed after oral administration, can be given IV (but most commonly orally), has a rapid onset of action, easily crosses the blood brain barrier, is metabolized in the liver and excreted in the kidneys?
benzodiazepines/sedatives
Which anti anxiety medication is a mild CNS depressant that relaxes or decreases anxiety, makes you sleepy, causes ataxia (loss of full control of body movements) and has a wide margin of safety?
benzodiazepines/sedatives
Which anti anxiety medications mechanism of action enhances or facilitates GABA and acts as an agonist at the benzo receptor rice reducing the symptoms of anxiety?
benzodiazepines/sedatives
Which type of medications are the following anti anxiety medications?: chlordiazepoxide diazepam lorazepam alprazolam midazolane triazolam
benzodiazepines/sedatives
Which of the following anticholinergics is used for Parkinsons disease? atropine (Sal-Tropine) methantherine (Banthine) scopolamine (Scopace) Propantheline Bromide benztropine (Cogentin)
benztropine (Cogentin)
Are beta 1 or beta 2 receptors found in the heart?
beta 1
Which beta receptor increases the chronotropic and inotropic activity?
beta 1
too much of __(which beta) can cause excess stimulation and can lead to arrhythmias
beta 1
What is a good way to remember beta 1 vs beta 2?
beta 1 - one heart beta 2 - two lungs
Are beta 1 or beta 2 receptors found in the lungs?
beta 2
Which beta receptor causes bronchial dilation (by relaxing airway smooth muscle) in the lungs?
beta 2
Which beta receptor causes vasodilation in blood vessels of skeletal muscle the principal effect of activation of these receptors is relaxation?
beta 2
Which beta receptor causes vasodilation lowering BP?
beta 2
Which beta receptor has to do with skeletal muscle and smooth muscle relaxation?
beta 2
What is the term for similar blood concentrations after a predetermined period of time that generic drugs must have?
biological equivalence
What is another word for metabolism?
biotransformation
Which barrier in the body may a drug have to pass through during ditribution?
blood brain barrier
Which part of a prescription includes The Rx symbol, name and dosage size or concentration of the drug, amount to be dispensed, directions to the patient?
body
Used interchangeably with the trade name. The brand name is technically the name of the company marketing the product. Example: Motrin
brand name
Which Nonbenzodiazepine - Nonbarbiturate Sedative-Hypnotics is used for the relief of anxiety with an unknown mechanism of action, but as no sedation or additive effect with alcohol and takes 1-2 weeks to be effective? chloral Hydrate - Noctec, Somnos meprobamate - Equiril, Miltown buspirone - Buspar
buspirone - Buspar
p.o.
by mouth
Is the first letter of a trade name capitalized or lower case?
capitalized
caps.
capsules
Which type of dental in infection are produced by Streptococcus mutans, antibiotivs/antibiotics are not used to treat or prevent?
caries
What are the four types of dental infections?
caries, periodontal disease, localized dental infection and systemic infection
What is the term for a predetermined chemical and physical standard that generic drugs must have?
chemical equivalence
Usually determined by the chemical structure of the drug and is used when the drug is being investigated. Example: (RS)-2-(4-(2-methylpropyl)phenyl)propanoic acid
chemical name
Which drug name is the chemical structure? Ex: 2-(4-isobutylphenyl)-propionic acid
chemical name
What are the three equivalences that generic drugs must have?
chemical, biological and therapeutic
Which benzodiazepines/sedative is first generation Librium? chlordiazepoxide diazepam lorazepam alprazolam midazolane triazolam
chlordiazepoxide
Which part of a prescription includes Prescriber's signature, DEA number, refill instructions?
closing
Which commonly abused CNS stimulant causes psychological dependence and there is no tolerance or withdrawal, there should be caution with epi if a pt is using this drug,t their pupils will be dilated?
cocaine
__ is a sign of heroin use
constricted pupils
Which Centrally Acting Muscle Relaxants is the strongest, common and works the best?
cyclobenzaprine (Flexeril)
d
day
How do antiinfectives interact with oral contraceptives?
decreases the effect of bc, need additional methods
Which factor of rate of absorption has to do with the more ionized a drug is the slower the absorption and the less ionized a drug is the faster it is absorbed?
degree of ionization
What is the new term for addiction?
dependence
The most serious side effect of narcotic analgesics is their ability to: a. produce nausea b. depress appetite c. increase blood pressure d. depress respiratory function
depress respiratory function
What is the mechanism of action of general anesthetics?
depresses the CNS -should be monitored carefully
Which benzodiazepines/sedative is one of the top 200 prescribed drugs and is also called Valium? chlordiazepoxide diazepam lorazepam alprazolam midazolane triazolam
diazepam
Sig.
directions
disp.
dispense
Which part of pharmacokinetics has to do with target organs, nontarget organs, plasma, interstitial fluids, brain, placenta?
distribution
What is the the drug used to treat chronic alcoholism?
disulfiram - (Antabuse)
In SANS, preganglionic fibers are short. What type or reaction does this result in?
diverse
What demonstrates what happens when more and more of a drug is added?
dose response curve
What determines how much of a drug causes a particular effect or side effect in the body?
dose response curve
What term is from an old French term that means a chemical material that has a biological effect?
drug
What term is defined as the use of drugs for nonmedical purposes, usually with the intent of altering consciousness?
drug abuse
Which factor of rate of absorption has to do soluble drugs absorbing faster and insoluble drugs absorbing slower?
drugs solubility
What is the term for how long the drug will function?
duration
Does water solubility make it harder or easier for the body to eliminate?
easier
What is the term for the dose of a drug where 50% of the population got the designed therapeutic effect?
effective dose 50 (ED50)
__ metabolize drugs a lot slower. If a drug is hanging around in the body they can have toxic effects
elderly
Which route of administration is when the drugs are placed directly into the gastrointestinal tract by oral or rectal administration?
enteral
Which of the following is a sympathomimetic drug that can increase blood pressure? a. atropine b. epinephrine c. scopolamine d. phenylephrine
epinephrine
Which commonly abused CNS depressant is rapidly absorption, is associated with deficiency of proteins, vitamins and minerals, liver damage Oral effects - glossitis, candidiasis, slow healing, angular chelitis, increase bleeding (alcohol thins blood, decreased platelets and prevents them from sticking, lack of vitamin K)?
ethyl alcohol
Which intravenous general anesthesia is conscious sedation and has a safe cardiovascular profile?
etimidate
q
every
q. 3h.
every 3 hours
q. 4h,
every 4 hours
100 mg - 4hrs -50mg-4 hrs-25mg
example of half life
How are alcohol and general anesthetic drugs excreted?
exhaled from air in the lungs
T or F The nicotine patch is effected by water
false
Are females or males more sensitive to drugs?
females and children
When is appointment scheduling important to having some knowledge of pharmacology?
for a pt with diabetes
What is the term for reversible loss of consciousness and Insensibility to painful stimuli. You want loss of sensation, loss of reflexes. You need to use a combo of drugs?
general anesthesia
What are the following adverse reactions associated with?Many and primarily affect the heart and the lungs Cardiovascular collapse and arrest, hyper or hypotension, respiratory depression or arrest, and laryngospasm. Hepatotoxicity can occur with repeated exposure, especially in operating room personnel. Other adverse reaction include headache, fatigue, irritability, and the risk of addiction.
general anesthetics
"Official" name of the drug. Example: ibuprofen
generic name
Is ibuprofen a trade name or generic name?
generic name
Which drug name is the official name of the drug, with the first letter always lower case?
generic name
What are the three goals of surgical anesthesia?
good pt control, adequate muscle relaxation and pain relief
What is correlated to the time the drug leaves a body?
half life
What is the term for the metabolic limit of mg of drugs to be removed per hour?
half life
What is the term for the time it takes for half of the drug to leave the blood?
half life
Which part of a prescription includes Name, address, and telephone number of the prescriber, name, address, age, and telephone number of the patient, date of prescription?
heading
What are the three basic sections of a prescription?
heading, body and closing
What does the term inotropic refer to?
heart force and strength
What does the term chronotropic refer to?
heart rate
Which type of smoke smokes 2 packs a day?
heavy smoker
h
hour
Which ant anxiety medication groups pharmacokinetics are well absorbed both orally and rectally, is metabolized in the liver and excreted by the kidneys (similar to benzo)?
hypnotics/barbituates
Which anti anxiety medication group decreases drug effects of Beta-blockers, oral contraceptives, APAP (tylenol), phenytoin, doxyclycline (antibiotic), steroids, warfarin, tricyclic antidepressants?
hypnotics/barbituates
Which anti anxiety medication group has interactions with many CNS depressants like alcohol, Monoamine Oxidase Inhibitors (MAOI's)- antidepressant ans has interactions with food and opioids
hypnotics/barbituates
Which anti anxiety medication groups adverse reactions include CNS depressant- relaxation, drowsiness and respiratory depression?
hypnotics/barbituates
Which anti anxiety medication groups mechanism of action is producing their pharmacologic effect by enhancing GABA receptor binding, is less specific than benzo and thereby caused pronounced generalized CNS depressant effects?
hypnotics/barbituates
Which anti anxiety medication groups pharmacological effects include central nervous system depression and anticonvulsants effects?
hypnotics/barbituates
Which anti anxiety medication is contraindicated in pts with porphyria (genetic metabolic disease) and pts with severe liver or respiratory disease bc the drug is metabolized in the liver and depresses the resp system?
hypnotics/barbituates
Which anti anxiety medication is used to treat anxiety, seizure disorders and to induce general anesthesia, ultra short acting (general anesthesia), short acting and intermediate acting anxiety and insomnia and long acting seizures/epilepsy?
hypnotics/barbituates
Which antianxiety medication group is a very great CNS depressant, induces and maintains sleep, a very narrow therapeutic index, causes complete resp and cardio depression?
hypnotics/barbituates
stat
immediately
Which level of Flagg's Level of Anesthesia takes place prior to surgery, administration of preoperative medications and anesthetics required for surgery?
induction
What are the three Flagg's Level of Anesthesia?
induction, maintenance and recovery
What is the term for a pathological state caused by microbial organisms of sufficient number to promote an inflammatory response?
infection
What is an antibiotic prophylaxis used to prevent?
infective endocarditis
Which type of anesthesia are the following examples of? halothane - fruity odor, nonflammable and safe for asthmatics but can cause hypotension and arrhythmias enflurane - halogenated ether, depresses heart, reduces blood pressure isoflurane - pungent smell, can provoke coughing desflurane and sevoflurane - newest halogenated hydrocarbons
inhalation
Which type of anesthesia is halogenated hydrocarbons and volatile general anesthetics that are liquids that evaporate easily at room temperature because of their low boiling points? Inhalation, is a potent CNS depressant, has several adverse effects and are all metabolized in the liver to a varying extent. Inhalation Intravenous
inhalation
Which tobacco cessation products need a prescription?*
inhaler spray chantix wellban
Which type of anesthesia are the following examples of?: Ultrashort-acting barbiturates Benzodiazepines Opioids
intravenous
What are the following advantages associated with? produces more rapid drug response, can produce an almost immediate onset of action, bypasses absorption phase of the pharmacokinetic process, produces a more predictable drug response
intravenous routes of administration
What are the following disadvantages associated with? phlebitis, local irritability, drug irretrievably in the face of an allergic reaction
intravenous routes of administration
When needing a rapid response to an allergic reaction, which route of administration would be best?
intravenous routes of administration
What is the importance of reviewing health history in regards to pharmacology?
its important to be aware of illnesses and medications and to rule out possible medication complications, contraindications and drug interactions
Which intravenous general anesthesia are chemically related to PCP hallucinogens, produces dissociated anesthesia and is primarily used by oral surgeons?
ketamine
If you have __ problems, be careful taking ibprofen
kidney
The __ the therapeutic index number the wider the margin of safety of the drug
larger
The _______ the therapeutic index, the safer the drug
larger
What is the generic name of Xylocaine and Octocaine?
lidocaine
Which type of smoker smokes less than one pack a day?
light smoker
Jane Smith is a 42 year old female patient who is new to your practice. You note that she appears to be somewhat anxious about being in your office. She is breathing rather quickly, is flushed, and is complaining about heart palpitations. You take her pulse and note that it is high. A detailed medication/health history reveals an otherwise, normal healthy individual. Ms. Smith takes an occasional ibuprofen or acetaminophen for pain. Ms. Smith does tell you that doctor's and dentist's offices make her rather nervous and this is not the first time that she has had these symptoms in a health professional's office. You are concerned because Ms. Smith must return next week for a filling. What are some of the nonpharmacologic methods of helping Ms. Smith deal with her anxiety?
listening to music, being calm and compassionate, being empathetic, schedule pt in the morning
What is known as the first pass effect?
liver
What is the primary site of drug metabolism?
liver
Which form of excretion is less common than the kidneys, but is excreted in feces via bile?
liver
In PANS, the preganglionic fibers are long, what type of reaction does this result in?
localized
Which type of dental infection is usually an extension of pulpal (periapical abscesses) or periodontal infections (lateral periodontal abscesses), drainage is the normal course of therapy, antibiotics depend on the infecting organism, antibiotics/ anti infectives are used especially if the pt is immunocompromised?
localized dental infections
What are the risk associated with Marijuana as medicine?
long term use - lung damage, cognitive and motor impairments, short term memory
What are the following?: Depletion of neurotransmitters Tachycardia, arrhythmia and hypertension heart attack, stroke and even death Insomnia, anxiety, paranoia, hallucinations, and aggression Extreme rise in body temperature, which can cause brain damage Sensation of bugs crawling on skin - sores on skin nutritional deficiency- they crave sweets Libido is increased - risky sexual behavior Meth Mouth
long term use of meth
Which benzodiazepines/sedative is used for anxiety, sleep, but can cause short term memory loss and is also called ativan? chlordiazepoxide diazepam lorazepam alprazolam midazolane triazolam
lorazepam
Is the first letter of a generic name capitalized or lower case?
lower case
What does LSD stand for?
lysergic acid diethylamide
Which level of Flagg's Level of Anesthesia is when the patient has reached depth of anesthesia sufficient to allow the surgery to begin and ends upon the completion of the surgical procedure?
maintenance
In which stage of pharmacokinetics are durgs altered, inactivated, changed or prepared for elimination?
metabolism
In which stage of pharmacokinetics can age, gender and type of drug effect by increasing or decreasing?
metabolism
Which commonly abused CNS stimulant is a highly addictive amphetamine that releases a surge of dopamine, causing an intense rush of pleasure or prolonged sense of euphoria?
meth
Which of the following anticholinergics dries the oral cavity? atropine (Sal-Tropine) methantherine (Banthine) scopolamine (Scopace) Propantheline Bromide benztropine (Cogentin)
methantherine (Banthine)
Case study example - crack cocaine abuser with active decay throughout the mouth; the pattern of decay was indicative of what? method of drug administration can cause bruxism
method of drug administration, can cause bruxism
Which benzodiazepines/sedative is used for preop and pedo pts and is also called versed? chlordiazepoxide diazepam lorazepam alprazolam midazolane triazolam
midazolane
Which classification of pain is associated with dental pain and common analgesic are used, APAP, aspirin and NSAID?
mild
Which classification of pain is simple extraction, minor surgery and common analgesics are used NASAIDS, Tylenol with codeine?
moderate
Which type of smoker smokes one pack a day?
moderate smoker
What is another name for narcan?
naloxone
What drug is an "opioid antagonist" used to counter the effects of opioid overdose, for example morphine and heroin overdose and blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness?
narcan
Which drug is used for myasthenia Gravis - autoimmune disorder that causes muscle weakness and what type of drug is it?
neostigmine and it is a cholinergic drug
Alcohol in combo with __ result in dangerously low BP
nitroglycerin
Which mechanism of action is the following for with analgesic drugs: peripherally acting at the site of injury, block/inhibit the formation of prostaglandin?
nonopiods
Which analgesic drug classification is salicylates (aspirin-like), acetaminophen, nonsteroidal inflammatory drugs (NSAIDs)
nonopioids
What is the primary neurotransmitter for SANS?
norepinephirine
How do antiinfectives interact with other anti infectives?
not ideal to give multiple antibiotics
n.p.o
nothing by mouth
When are opioids used?
only when a pt can't tolerate NSAIDs
What is the term for the time it takes for a drug to act?
onset
Which analgesic drug classification is morphine and codeine derivatives, methadone and fetanyl?
opiods
Which analgesic drug classifications mechanism of action effects the response to pain by depressing the CNS, binding to receptors to produce an altered perception to pain, reducing intensity of pain signals reaching the brain, effecting those brain areas controlling emotion, which diminishes the effects of a painful stimulus?
opiods
Which intravenous general anesthesia are given during the induction phase and during surgery, provides pain relief during and after surgery and can cause prolonged respiratory depression?
opioid analgesics
Which intravenous general anesthesia are the following?: morphine, fentanyl
opioid analgesics
Which commonly abused CNS depressant develops tolerance to analgesic effects, if you have pain the drug will help you with pain. If you do not have pain you will get a high and become addicted?
opioids
Which commonly abused CNS depressant includes heroin, morphine, methadone, OxyContin, Fentanyl?
opioids
The PANS and SANS have __ effects on the effector organ
opposite
What are the following?: Black to brown areas of extensive decay along cervical third of teeth (may involve entire labial surface) Rapid decay - caused by frequent use of drug, chronic xerostomia, frequent ingestion of carbonated, sugary drinks Bruxing during euphoric state may lead to TMJ dysfunction, and incisal attrition Fractured teeth with retained roots Periodontal disease significant
oral effects of meth
What are the following advantages associated with? Convenient, easy to use, safest, small intestine provides a large area for drug absorption, most widely used, cost effective
oral routes of administration
What are the following disadvantages associated with? slower onset of action, GI adverse effects, blood levels are less predictable
oral routes of administration
What is the term for an unpleasant sensory or emotional experience arising from actual or potential tissue damage?
pain
Which route of administration is when drugs bypass the gastrointestinal tract and includes various injections, inhalations and topical preparations?
parenteral
Which anti infectives can be used during pregnancy?
penicillin, erythromycin, clindamycin
Which component of pain is the physical component that involves the message of pain carried thru peripheral nerve endings?
perception
Which type of dental infection has many different bacteria involved and can be treated with use of local or systemic antibiotic/anti infectives?
periodontal disease
What is the term for the study of the movement of the drugs within the body?
pharmacokinetics
What is the term for the study of drugs that have an effect on a biological system?
pharmacology
Which phase of the various stages of testing that a drug must go pass before it is marketed to the public is: Dosing and safety trials in healthy volunteers?
phase I
Which phase of the various stages of testing that a drug must go pass before it is marketed to the public is: Clinical efficacy and adverse effects of the drug in humans?
phase II
Which phase of the various stages of testing that a drug must go pass before it is marketed to the public is: Large-scale clinical trials that evaluate the safety and efficacy of the drug in those people that have the condition for which the drug is indicated?
phase III
Which phase of the various stages of testing that a drug must go pass before it is marketed to the public is: Post-marketing surveillance, looking for adverse reactions once the drug is marketed to the general population?
phase IV
With benzodiazepines/sedative what are three factors about abuse, tolerance and overdose?
physical and psychological dependence with long term use, tolerance develops and overdose can occur with when mixed with other CNS depressants
Which drug treats toxic doses of anticholinergic drugs and what type of drug is it?
physostigmine and it is a cholinergic drug
__ is related to the dosage given?
potency
Which intravenous general anesthesia are unrelated to any other general anesthetic, used for induction and maintenance of balanced anesthesia, is popular for outpatient surgery, can cause cardio and respiratory depression and is how michael jackson died?
propofol
When is obtaining med history important to having some knowledge of pharmacology?
pts may present with various medical problems requiring many medications
Which component of pain is the physiological component that involves the emotional response which varies with patients state at the time of the painful event?
reaction
Which level of Flagg's Level of Anesthesia begins when surgical procedure is completed and continues thru post-op/recovery period?
recovery
If there is less prostaglandin the rate of fire is decreased. What does this do?
reduces pain
How should a RDH managae a pt who is inebriated?
reschedule
Which schedule has the highest abuse potential and is not currently accepted for medical use in the USA and used only experimentally and in research?
schedule I
Which of the following anticholinergics helps with motion sickness? atropine (Sal-Tropine) methantherine (Banthine) scopolamine (Scopace) Propantheline Bromide benztropine (Cogentin)
scopolamine (Scopace)
What is the term for generally refers to microorganism sensitivity?
sensitivity
__ means susceptibility to a specific antimicrobial
sensitivity
What is the important first step of a pt quitting smoking?
setting a quit date
Which pain classification is major surgery common analgesics are used, morphine also fentanyl?
severe
Which factor that alters drug effects is: women are more sensitive than men to drugs bc they are smaller and hormones, pregnancy can alter the effects certain drugs
sex
Which factor of rate of absorption has to do with the route administered?
site of placement
What three factors is absorption modified by?
site of placement. drugs solubility and degree of ionization
What five factors determine distribution?
size of tissues involved, blood flow to tissues, solubility, plasma protein binding capacity and need to pass physical barriers
The __ the therapeutic index, the narrower the margin of safety of the drug
smaller
The greater the potency of a drug the __ the dose
smaller
What are three reasons why we study anti infectives?
some are used to treat oral lesions/dental infections Recognize premedication needs in order to provide safe DH care Review and evaluate the medical history especially for allergies
Which stage of general anesthesia is analgesia?
stage I
Which stage of general anesthesia is characterized by development of analgesia or reduced sensation to pain. Pt remains conscious. Nitrous Oxide maintains the patient in this stage?
stage I
Which stage of general anesthesia begins with loss of consciousness and is associated with involuntary movement and excitement?
stage II
Which stage of general anesthesia is delirium or excitement?
stage II
Which stage of general anesthesia is the stage where major general surgery is performed and is divided into 4 planes that are based upon eye movement, depth of respiration, and muscle relaxation?
stage III
Which stage of general anesthesia is the surgical stage?
stage III
Which stage of general anesthesia is characterized by respiratory or medullary paralysis, complete cessation of all respiration and not immediately reversed, the patient will die?
stage IV
Which stage of general anesthesia is respiratory or medulla paralysis and a stage that you definitely don't want to get to?
stage IV
What does a drug do to organ systems, tissues and cells? (3 things)
start doing something stop doing something modify cells normal function
As a general adverse reaction to ant infectives the broader the spectrum the more chance for __, more narrow less chance
superinfection
What is the term for caused by an overgrowth of microorganisms different from the causative infection?
superinfection
What are the three minor routes of excretion?
sweat, saliva and breast milk
Which type of dental infection produce symptoms such as fever, malaise and tachycardia, and needs to be treated with anti infectives?
systemic infections
What is the equation for half life?
t1/2
tabs.
tablets
Which antimicrobial drug group would require that the client be warned to avoid dairy products? penicillin tetracycline macrolides sulfonamides
tetracycline
Which organ may be effected by distribution more bc it is so vascular?
the heart
What is the most common place for removal of drugs?
the kidney via the urine
The shorter the half life __
the shorter the effectiveness
Define the term Pharmacology
the study of drugs and their action on living organisms
What are the important differences between nonopioids and opioids?>
their site of action and their mechanism of action
If the biological equivalence is equal then the __ will also be equal
therapeutic equivalence
What is the term for functioning the same way (although can be altered for vegan/herbal) that drugs must have?
therapeutic equivalence
What describes the relationship between dosages that cause a lethal effect with a the therapeutic effect?
therapeutic index
With hypnotics/barbituates, what are two factors that have to do with tolerance and overdose?
there is a high rate of abuse and complete respiratory and cardiovascular depression, tolerance develops and larger doses can lead to a lethal dose
What does the FDA regulate for drugs?
they approve the drug and determine if the drug is safe and effective, prescription or OTC, meets quality control standards and regulates advertising and labeling of the drug
What is the mechanism of action of anti infectives?
they are bacterostatic and bacterialcidal
t.i.d
three times a day
Why is the maximum intensity or response of a drug used?
to compare different drugs
What is the term for the need for an increased dose of drug to achieve the desired effect or if the same dose produces a diminished effect?
tolerance
Which factor that alters drug effects is: Larger dose needed to have an effect. Repeating taking drugs builds tolerance so pt will need a larger dose to get effect or a new drug
tolerance
The official name of the drug when it is commercially marketed. It is registered as a trademark and is protected by federal patent laws for 20 years. Example: Motrin
trade name
What are these examples of? Advil, Aches-N-Pain, Brufen, Midol 200, Motrin, Nuprin
trade name
Which name of a drug is given by the company a twenty year patent and after that can have more than one name?
trade name
Which benzodiazepines/sedative is used for sleep and conscious sedation and is also called halcion?chlordiazepoxide diazepam lorazepam alprazolam midazolane triazolam
triazolam
T or F Alpha receptors cause constriction
true
T or F An alcohol abuser has increased risk for oral cancer, monitor oral self-care, and bleeding problems
true
T or F Any drugs that are addictive should be okay in low doses for a short time
true
T or F Drugs can change schedules over time
true
T or F Drugs have to pass through biological membranes in order to have an effect
true
T or F In both cases opioids and nonopoids attempt to halt signal from the site of injury to conscious mind
true
T or F SANS fibers extend to all same organ systems of the PANS
true
T or F With Nicotine Replacement Therapies (NRT) there is no indication of increased cardiovascular risk except with acute disease
true
T or F beta receptors cause dilation
true
T or F giving epi to a cocaine user can cause heart attack
true
T or F nicotine vapor from the inhaler is absorbed through the buccal mucosa - the vapor is NOT inhaled.
true
T or F Nitroglycerin is a vasodilator, means it will lower BP. alcoholic pt will have a severe drop
true
T or F Nonbenzodiazepine - Nonbarbiturate Sedative-Hypnotics are more safe because they don't cause CNS depression
true
T or F Pupil dilation is a sign of cocaine abuse
true
T or F When looking at hypnotics/barbituates, most everything is the same as benzos, but exaggerated
true
T or F constricted pupils is a sign of heroin use
true
b.i.d.
twice a day
Which intravenous general anesthetic has a rapid onset of action when intravenously (30-40 seconds), do not provide the pt with analgesia, has serious adverse effects including bronchospasm, laryngospasm, cardio and respiratory effects?
ultrashort acting barbiturates
s'
without
c'
woth
Which anti anxiety medication are the following examples of?: zolpidem - Ambien ( can cause short term memory loss) zaleplon - Sonata (used for insomnia) eszopclone - Lunesta (used for insomnia)
zolpidem - Ambien ( can cause short term memory loss) zaleplon - Sonata (used for insomnia) eszopclone - Lunesta (used for insomnia)