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Flashcards in dent pharm Deck (18):
1

1-illinois dental practice act

2-prescription must contain

3-IDPA

4-never do...

1-prescribe meds for therapeutic reasons
-need documented dx that necessitates a prescription
-if you have Illinois Controlled Substance license you can prescribe controlled substance
-prescribing medications= predicted on a valid diagnosis of problem

2-name of pt
date
name and strength of drug
quantity
direction for use
prescribers name, address, & signature      
DEA number for controlled substances

3-licensed dentists write prescription w/ DENTAL RELATED AILMENTS…to write it for anything non-dental= violation of Illinois dental practice act

4-Never write a prescription for someone you haven’t seen---no clinician-patient relationship can be established if you don’t see the patient

            -little legal protection if something goes wrong

2

1-medical history

2-initial assessment

3-getting medical history

4-good drugs

5-no good drugs

1-thorough, analyze, listen, consultations
-oral/legal implications
-update it
-record BP each time & test BG
-ommissions on med history form
-pt perception
-past medical history
-current medications

2-history, clinical exam, radiology, assessment/dx, tx plan, tx or referral, prescription

3-more info & pt rapport from interview
---pt that writes has been seen to give more errors

4-pain suppressants & antibiotics

5-oral contraceptives, antidepressants, continuous refills, habitual prescribing, large quantities, non therapeutic prescriptions

3

1-antibiotic

2-antibacterial agents

3-bactericidal

4-bacteriostatic

5-resistance

1-compound produced by a microorganism that inhibits another microorganism

2-substances that destroy/suppress growth of multiplying bacteria

3-ability to kill bacteria irreversibly

4-ability to inhibit or retard multiplication or growth of bacteria---work w/ immune system to get rid of organism

5-natural or acquired ability of an organism to be immune to or resist the effects of an anti-infective agent

4

Dental antibiotics

1-curative tx

2-prophylatic tx

3-not routinely

----

4-empiric therapy

5-targeted therapy

6-prophylactic therapy

1-infections that cant be treated via surgery, supplement to surgery in regard to pt general condition, spread of osteomyelitis

2-before tx---absolute indications= prosthetic, joint replacement, heart valves, previous bacterial endocarditis, congenital heart problems, certain times w/ heart transplants   

3-tooth extraction, perio surgery, root resection, removal of 3 molars, endo therapy

4-antibiotics admin that have activity against the predicted or most likely pathogens---causing the pts infection based on signs and symptoms of infection

5-antibiotics used to treat established infections where site of infection, causative pathogens & antibiotic susceptibilities are known

6-antibiotics given to prevent development of infection during a procedure or immunocompromised state where there is a risk of infection

5

1-dental infections 

2-when to use antibiotics

3-prevention of infective endocarditis 

4-newish guidelines w/ endocarditis 

5-dont need prophylaxis

1-via intro of extra oral pathogens 
-through a change in balance of indigenous flora
-entry of bacteria into sterile vital pulp of tooth
-from caries that will then destroy enamel (dec w/ fluoride in h2o)

2-use when cant treat effectively
-compromised health
-prophylactically for certain conditions---prosthetic heart valves & joints

3----prophylaxis recommended
prosthetic cardiac valve
previous infective endocarditis
congenital heart disease (CHD)
-during first 6 mo after procedure
cardiac transplant 

anything else--prophylaxis isnt recommend

its recommended here bc endothelialization w/in 6 mo after procedure

4-all dental procedures w/ manipulation of gingiva or PA region of teeth or perforation of oral mucosa

5-anesthetic injections through non infected tissue, radiographs, placing RPD, ortho things, shedding of deciduous, & bleeding from trauma

6

1-pt premed 

2-conditions not requiring premed

1-if has valvular heart disease or congenital cardiac defect
---standard= amoxicillin---adults= 2 g 30-60 min b4
kids= 50 mg 30-60 min b4
if allergic= clindamycin adults= 600 mg 30-60 b4
kids= 20 mg 30-60 min b4

2-coronary bypass surgery
MVP
physio heart murmur= turbulence of BF
rheumatic fever 
pacemakers & implanted defib
stents
poorly controlled diabetes
pins, plates, screws
total joint replacement after 2 years 

7

1-amoxicillin

2-amoxicillin prophylaxis

3-augmentin

4-penicillin

5-keflex

6-clindamycin

7-clindamycin prophylaxis

8-periostat-doxycycline

1-250/500/875 
 &&& suspension 
1 capsule every 8 hours until finished

2- 500 mg 30-60 min prior

3-amoxicillin w/ clavulanate K
250/125, 500/125, 1000, 62.5 & suspensions
1 tab every 12 hours until done

4-250-500 
1 tab every 6 hours until gone

5-250-500
1 capsule every 6 hours until gone

6-150, 300
1 capsule every 6 hrs until gone

7-4 capsules 30-60 min before tx

8- 20 mg---inhibits collagenase activity 
-suppresses collagenase & modulates host response to inflammation as an adjunct for perio tx
-1 tablet twice daily

8

1-dosing

2-tx of minors

3-preggo precautions

1-watch the dose, weight is most imp

2-minor= 18 and younger---cant get tx w/o parent or guardian
exceptions= minor who is preggo, married, or has court ordered emancipation, telephone permission from guardian, or minor in dire need of tx 

3-emergency dental tx can be performed at any time throughout preggo, getting whatever xrays are needed to diagnose problem
-optional dental work= postponed until after preg
-if work needs to be done= 2nd & 3rd trimester are safest but 1st trimester should be avoided 
-dont use meds not safe for fetus---tetracyclines, barbiturates & benzodiazepines
-LA, acetaminophen, penicillin, erythromycin, clindamycin, cephalosporins= okay but no ibuprofen in 3rd trimester
 

9

1-prescribing antibiotics

2-antibiotics

3-dental considerations

4-antibiotic side effects

1-stick to order of antibiotic use 
-know what your second choices are 
-known what to use for resistant bugs that dont improve w/ antibiotic use 
-know prophylactics regimens
-and new antibiotics

2-type of infection---viral or bacterial
-side effects of antibiotics
-24 to 48 hrs to begin
-prescribing habits take years to develop
-10 day course of tx w/ oral/systemic effects
-body weight matters

3-monitor for effect & change antibiotic or review dosage 
-start w/ simple antibiotics
-consider other diseases when prescribing & tolerability

4-GI upset
fungal overgrowth
photosensitivity
allergies
glossitis & stomatitis
hairy tongue & dry mouth 
---to be effect antibiotics must get to site of infection
 

10

1-amoxicillin

2-cephalosporins

3-clindamycin

1-used against most oral infections
-1st choice for prophy antibiotic tx in non-penicillin allergic pt
-500 mg every 8 hrs 
-use w/ clavulinic acid 
-1st choice for prophy premed

2-keflec
-expensive
-500 mg every 6 hrs ---alternative prophy premed 
-use in penicillin allergic pts

3-effect against most oral 
1st choice in pencillin allergic pts
150 mg every 8 hrs
-2nd choice for prophy premed 

11

1-tetracycline & doxycycline

2-doxycycline

3-metronidazole

4-quinolones

5-order for prescribing

6-order if allergic to penicillin

1-broad spec
-in saliva
-used in regractory perio infections
-in penicillin allergies
-discolors developing teeth
-photosensitivity
-dont take w/ dairy

2-submicrobial dose= 20mg---suppressed collagenase & modulates inflam 
-100 mg (twice)= antibiotic dose when allergic to penicillin

3-reserved for tx of serious infections
-adjunct w/ other antibiotics (amoxicillin) in tx of perio disease

4-cpiro/levofloxacin
-1-2 times dosing a daily
-not common

5-amoxicillin & other penicillins
cephalexin
clindamycin
azithromycin
tetracycline & doxycycline

5-clindamycin, azithromycin, tetracycline/doxycycline

12

1-acetaminophen

2-NSAIDS

3-nsaids disadv

4-salient points

 

1-acts centrally---use when peripheral acting NSAIDs arent working
-little blood thinning so use if pt uses blood thinners
-relief for mild dental pain
-less irritation to stomach= pt has GERD or other GI so use then
-no physical dependence

2-acts peripherally (at site of pain)
-anti-inflam= several doses
-effective
-no psychological or physical dependence 
-good for endo, perio, post op pain & dental pains

3-not sufficient for extreme pain
-tinnitus at high doses
-stomach irritation
-watch other meds---cant take w/ blood thinners 
-not good during preggo--esp 3rd trimester, affects BV formation & can lead to premature delivery
-careful w/ asthma & diabetic pts
-inc BP

4-most NSAIDs work in similar fashion---some may be more effective on individual basis 
-ceiling effect for analgesis that is lower than anti-inflam effect (ibuprofen 400 mg vs 600-800 qid)
-anti-inflam effects make take longer to be realized
-acetamino (650 mg), ibuprofen (200 mg) & naproxen (220 mg) all OTC 
-ibuprofen in 400, 600, 800= rx
-naproxen in 375, 500, 750 = rx

13

1-salient NSAIDS

2-common doses

3-opiods

4-opiates

1-acts peripherally (narcotics & acetamin dont)
-anti inflam effects
-inc GI acid production
-not used in preg
-blood thinning effect not to be used when pts on blood thinners
-effective for dental pain 

2-acetamin= 650 mg 1 tab every 4-6 hrs 
ibuprofen= 400 mg #12 1 tab every 4 hrs
naproxen= 500 mg 1 tab every 12 hours 

3-include all opiates but also include chemicals that have been synthesized in same way---resemble opiates in structure

4-derived directly from opium poppy by separating and purifying the various chemicals in the poppy

14

1-narcotics adv

2-narcotics disadv

1-effective
no blood thinning (unless in combo w/ blood thinner (like ibuprofen))
-no stomach irritation
-central effect

2-psychological depend
-physical depend
-tolerance quickly developed
-avoid during preggo but can be used 
---short term= T3 & vicodin---category C not for nursin
---drowsiness= caution about driving vehicles

15

1-narcotic compounds

2-acetaminophen

3-ibuprofen

4-naproxen
 

1-hydrocodone & acetaminophen----5/300
hydrocodone & ibuprofen---7.5/200
codeine & acetaminophen---#3  30/300, #4 60/300

2-OTC---325 mg, 500 mg, 650 mg
650 mg 1 tab every 6 hrs 

3-200 mg OTC---NSAID
rx---400 600 800 -----max= 2600 mg a day
400 mg, 1 tab every 4 hours

4-220 mg OTC
rx---250, 375 500 
naproxen 500 #12 1 tab every 12 hrs

16

1-vicodin

2-acetaminophen w/ codeine

3-aspirin

 

1-hydrocodone/acetamin
5/500, 10/500, 7.5/500 
#12
1 tab every 6 hrs

2-tylenol #3
-#12---1 tab every 4 hours 

3-dont prescribe aspirin for dental pain
refrain from advising pt to pick up aspirin
-dont recomment
-bc there are many side effects & drug interactions
-let the MDs use for anti platelet effect

17

1-synthetics narcotics (ultram)

2-ultram

3-NSAIDS 

4-amoxicillin

1-manufactures
-fewer addicting side affects
-can still be abused
-not quite as effective as narcotics

2-tramadol---50mg 
1 tab every 6 hours 
(max = 8 tabs daily)

3-usually first choice & work from there depending on pt conditions

4-1st choice for antibiotic & work from there

18

1-role of opioids when treating dental pain 

1-mild to moderate pain= acetamin or nsaids
mod to severe pain= nsaids or opioids
severe to unrelenting= re-assess