Flashcards in II Pharm IV Deck (266):
What are the most abused drugs in all age groups?
Alcohol and tobacco
4 Factors that increase potential for abuse:
Easy to obtain/distribute
What are "potential" pts?
call office seeking pain meds w/o being seen
In order to give a script:
pt of record
Why is a drug "scheduled"
Potential for abuse
Drugs that are used in a manner/amount inconsistent w/ med or social pattern of culture
When a drug necessitates continued administration to prevent withdrawal:
Physical dependence is addiction
*chronically dependent opiates for pain = physical dependence but not an addict
You can be physically dependent on a drug and not be addicted to the drug:
*but addicts are usually physically dependent
Perceived need or craving for a drug:
What is the primary reason for relapse:
3 signs of addiction:
Compulsive drug-seeking behavior
Continued use despite serious consequences
ALWAYS psychological dependence (so relapse common)
Physiologic tolerance or psychological dependence short of addiction:
4 behaviors associated w/ addiction:
Habituation will ALWAYS lead to addiction or dependency
With repeated dosing, drug must be increased to produce same effect:
What kind of tolerance to Psychoactive drugs produce?
*definite decrease in the response of brain tissue to constantly increasing amounts of drug
Is tolerance the same as Metabolic Tolerance?
*it is central tolerance - would need accelerated metabolic rate - not really a factor w/ most psychoactives
Behavior of others associated with user that results in continued drug abuse:
The state of being free of drugs:
Using opiates for sleeping aid would be considered what?
Nicotine/EtOH are considered "gateway" drugs
If pt has Hx of drug abuse, what must you watch out for?
3 things can't use w/ these pts:
opiates, benzodiazepines, nitrous oxides
*ANY substance that can promote relapse
A primary, chronic, progressive, relapsing disease process with genetic, psychosocial, and environmental factors influencing its development and manifestations:
When comparing drugs in the same group, the time required to produce physical dependence is shortest with a rapidly metabolized drug.
The time course of withdrawal rxns is related to the half-life of the drug
How do we Tx abuse:
*but person must WANT help
The leading cause of ER visits and accidental overdose among kids (esp in AZ)
Access to stored meds
3 considerations for Drugs and Children:
Increased mem. permeability
Dosing based on weight
Half adult dose
Poison Prevention Act 1970:`
prescriptions must have Child-resistant containers
2 psychological trends in children seeking drugs:
If anxiety - seek downers
Low self esteem - uppers
Kids are abusing prescription drugs more than cocaine, heroin, hallucinogens, and Ecstasy combined
*prescription drugs more popular than recreational drugs
What causes more overdoses in adolescents than cocaine and heroin combined?
Opiates (hydrocodone w/ acetaminophen especially)
2 reasons inhalants are abused:
Huffing/Sniffing very easy
Accessible (markers, glue, white out)
What is difluoroethane?
Why important for Dentistry?
Can lead to what?
Inhalant - halogenated hydrocarbons
Increase heart muscle sensitivity to Epinephrine
Inhalants known as poppers, snappers?
Kids abuse prescription drugs more than street drugs and this is known as "pharming"
5 signs of inhalants
*produce similar effects as anesthetics
Inability to coordinate movements
What is the most abused drug among children?
5 causes of death due to inhalants:
Sudden sniffing death
Cardiac death (difluoroethane)
What is in Robitussin
What does Dextromethorphan do at low dose?
What drug is it similar to and where does it act?
Robotripping involves drinking ____oz's of DXM (Robitussin) until nausea causes you to ____ and ______
A lot of cold meds are _______ and considered ________
This means they can't be used in people that have ______
What cold med doesn't have Acetominophen but still contains DXM (dextromethorphan)?
What is Coricidin's street name?
Alcohol use is on the rise, including binge drinking
*continues to decline
Alcohol use is decreasing except for what demographic?
College age girls
Why are women more susceptible to alcohol poisoning?
Don't make as much Alcohol Dehydrogenase as men
As of _____, cigarette use reached an all-time low due to peer disapproval
More popular among teens: cigarettes or e-cigs?
The FDA regulates e-cigs
but, legislation just passed
In 1998 ____% students had tried tobacco
In 2014 ___%
The greatest decline of illicig drug use has been with what drug?
Most students recognize synthetic marijuana as a dangerous class of drug:
Amphetamine-like stimulant found naturally in the Khat plant:
(less than 1% student use)
The use of exctasy, salvia, and shrooms have declined
10 illicit drugs that have remained unchanged in use:
What receptor does ecstasy bind to in the brain?
Most teens get their drugs from a friend/relative
3,4 methylenedioxypyrovalerone (MDPV):
aka, drone, meph, meow meow, methylone
Substance abuse disorders are expected to double by 2020 and the Tx admission for substance abuse has doubled since 1992
1/3 Baby Boomers use Rec. drugs
Elderly adults w/ substance abuse put themselves at risk for what 3 things?
Newest demographic for HIV
Women over 65
Adults over 65, increasing use of what?
5 diseases Elderly Smokers will die from:
Most commonly used recreational drug?
The proportion of older adults seeking Tx for substance abuse is increasing compared to younger adults
Alcohol/Rec. drug dependency often come about by what 3 things?
Chronic pain use - initial
Psychological probs - sleeping, anxiety, depression
4 Recreational and OTC meds abused by older adults:
4 substances abused by older adults:
Rx and OTC meds
Cocaine/Heroine (diminished after 60)
Most commonly abused CNS depressants?
2 other classes used fairly commonly:
What are the 2 most commonly abused CNS stimulants?
5 Examples of depressants:
The most frequently abused drug:
Alcohol is oxidized to what in the liver?
Acetaldehyde is metabolized to what?
CO2 and water
6 cancers linked to Acetaldehyde:
Alcohol is eliminated from the body via _____ kinetics
What is the rate?
4 signs alcohol intoxication?
Nystagmus (involuntary eye movement)
3 severe, centrally mediated signs of intoxication:
4 physiologic considerations of Alcohol Use in older adults:
Decreased body water/body mass (higher conc. alcohol)
4 reasons the Elderly are more sensitive to Alcohol:
*this is why older people develop problems with alcohol even if drinking habits have not changed
Metabolize more slowly
Stays in body longer
Decrease body water
Lower body's tolerance
Alcohol induced changes in the Elderly Brain that is often misdiagnosed as dimentia:
Biological Brain Disorder
Biological Brian Disorder: withdrawal, Seizures, Organic hallucinations, Psychosis, Dementia, and _______
Delirium tremens (DT's)
4 consequences of Chronic Alcoholism in the Elderly:
Existing conditions worsen (HTN, diabetes, etc)
Psychological (isolation, depression, anxiety, suicide)
Mixing alcohol with what can cause GI bleeding?
Alcohol plus what can cause liver damage?
Cold/allergy meds + antihistamines + alcohol = 4 things
CNS drugs + alcohol = 5 things
Alcohol withdrawal occurs in stages and includes what 4 things?
Grand mal seizures
DT's (delirium tremens), shaky tremor movements
Chronic signs of alcoholism, watch what 4 things:
Mothers that drink:
Fetal Alcohol Syndrome
2 features of Fetal Alcohol Syndrome:
What drug inhibits the metabolism of Aldehyde Dehydrogenase, increasing serum levels of Acetaldehyde?
disulfiram (Antabuse )
disulfiram is used for what?
If you drink while taking disulfiram you will _____
Other than alcohol, what is a contraindication when taking disulfiram (Antabuse)
Alcohol containing mouth rinses
For an Alcoholic, 5 Dental Tx Considerations:
Bilateral Parotid gland enlargement
Liver failure (bleeding)
Difficulty metabolizing drugs
7 oral complications of Alcoholism
No Tongue Papillae
Oral cancer (squamous cell)
leukoplakia, ulceration of lateral borders of tongue
If you're Tx an alcoholic, examine the tongue carefully for what?
4 abused opioids:
*oxycontin widely abused by dentists
Why are opioids typically abused?
Produce complete satiation for all drives of body
*only in absence of pain
What drug is widely abused by dentists?
*brand that is oxycodone only
Physical dependency increases motivation to obtain the drug and fear of withdrawal overrides motivation to stop using
*addicts often resort to criminal activity to obtain drug
Oxycodone, when asked by name, should be a Red Flag?
*most concentrated part of oxy in middle of tablet
Oxycodone can be smoked,
What pain meds are included in REMS program?
Risk Eval and Mitigation Strategy (FDA)
Extended-release, oral-dosage forms of opioids
*potential for abuse very high
Number of women dying from opioid painkiller overdose increased how much between 1999 and 2010?
*deaths up ____%
*deaths up 400%
In 2007 it was the first tome in 100 yrs that drug induced death exceeded death from motor vehicles
3 reasons women have more opioid overdoses?
More likely to get a prescription
Engage in doctor shopping
Abuse of prescription (Rx) painkillers by pregnant women can affect the infant how?
This increased by ____% between 2000 and 2009
Neonatal abstinence syndrome
CDC Opoid recommendations for Rx's
follow responsible guidelines
Use states' Rx drug monitoring programs
Discuss pain Tx options
Avoid prescribing combos of Rx painkillers and benzodiazepines
2 Things clinicians must avoid when prescribing pain meds (and other controlled substances)
Big quantities (always limit quantity)
Why injecting heroin is a problem:
Heart valve damage
If a pt has heart valve damage secondary to heroin use, what would they need prior to dental Tx?
The heroin death rate has increased by how much across 28 states?
7 signs of Acute Opioid Overdose
What is the drug to use if you overdose on an opioid?
*used for acute narcotic overdose
What is used to treat opioid withdrawal?
2 reasons Methadone is used to Tx opioid withdrawal:
Physiologically equivalent to heroin
Replace heroin and gradually withdrawn
Dental implication to Opioid-tolerant pts?
Require more pain meds
*asking for more pain meds may be sign of addiction
diazepam (Valim), lorazepam (Ativan), alprozolam (Xanax) are what class of drugs?
Unavailability of BDZ (unavailability due to hospitalization/other med problem):
*go through withdrawal
3 indications for BDZ's
*significant physical dependence/addiction
BDZ's have significant ______ effect with other sedatives.
Never combine BDZ's with what?
BDZ's have a prolonged ______, which predisposes to easy intoxication
BDZ withdrawal is similar to what kind of withdrawal?
Dangerous DDI with BDZ's
When giving a BDZ Rx teach pts to do what?
Consequence of long half life of BDZ's:
Linger days after - alcohol can still be dangerous
What is the Antidote to BDZ overdose?
Flumazenil used for BDZ overdose WON'T block _____ effects from alcohol, barbiturates, general anesthetics, or opiates (won't block other depressants)
may not reverse what?
may cause what?
3 uses for BDZ's in dentistry:
What are 2 the most commonly abused Legal stimulants?
Most potent vasoconstrictor in all of medicine?
Only reason cocaine is used medically?
Profound sense of euphoria, produces intense psychological dependency but no tolerance or withdrawal
If over-use cocaine, euphoria stays but what increases?
4 signs of Cocaine use:
Localized gingival recession/bleeding and alveolar bone necrosis in maxillary premolar area
What should a dentist never do within 24 hrs of cocaine use?
What is the most commonly abused form of amphetamines?
Methamphetamine (crystal meth)
What produces LONGER effects, cocaine or meth?
Amphetamines are considered what?
dextroamphetamine (Dexadrine) is used for what?
What does it inhibit?
A selective norepinephrine reuptake inhibitor used for ADHD?
Is this an amphetamine?
Main drug for ADHD
Stimulant psychedelic, first used as an appetite suppressant?
Ecstasy side effects include: Anorexia, nausea, muscle stiffness, ataxia, sweating, tachycardia, hypertension _______ and ______
6 side effects of Ecstasy:
Long term psychiatric
Meth is a stimulant where?
What form of meth is used for ADHD, narcolepsy, and obesity?
*know both names
Meth is dangerous b/c it uses multiple pathways in the brain and downregulates ______
*brain structure/function become altered with chronic use
1st time on meth:
surge of dopamine
(and norepinephrine and serotonin)
Sensation of insects crawling beneath the skin, seen in meth use (crank bugs)
Meth is especially neurotoxic to what?
Degradation of dopamine produces what?
*secondary to Meth use
ROS - reactive oxygen species
*likely what kills neurons after meth use
What are 4 manifestations of Amphetamine Psychosis?
Parents often miss meth withdrawal signs, b/c they include prolonged sleep moodiness, and depression
Depression with Meth is often longer/deeper than with Cocaine, which is why _____ is common
What is the antidote to meth?
*nothing comparable to heroin addicts
2 most common routes of taking meth?
Who uses meth?
increasing in college and young professionals
Meth OD is heart failure, and long term physical damage to kidneys, liver, and lungs
*know these 7 signs!!
Like cocaine, there is no tolerance effect to prolonged use of Meth
Erosion, poor OH, caries, perio infection, bruxism, tissue damage, oral ulcerations/infections, oral burns:
Signs of Acute OD of CNS stimulants
*know these 8
Withdrawal rxns to CNS stimulants in a Modest Abuser:
fatigue, prolonged sleep
Prolonged sleep, depression, suicidal tendency
Consequences of smoking: lung cancer, oral cancer, lowered ______, heart disease, periodontal disease
Nicotine turns on what cytokine?
turns on osteoclasts - leads to osteoporosis/rapid bone loss in perio disease
When burned, how many chemicals are in cigarette smoke?
2 reasons nicotine is especially detrimental to women?
Estrogen gone as protective barrier - increase in IL-6 (normally suppressed by estrogen)
IL-6 increases osteoclastic activity
Orally, in smokers, where will you most often see narrow, deep, perio defects with fibrotic tissue.
What is a secondary reason meth users will have bad teeth?
Meth users crave sugar
Irritability, HTN, increased pulse, nausea/vomiting, dizzy, coronary artery disease, lung and oral cancer:
8 notable chemicals in cigarettes:
hydrogen cyanide-genocidal agent WWII
Erosion, poor OH, Caries, perio infection, bruxism, tissue damage, oral ulcerations, oral burns:
Anxiety, irritability, difficulty concentrating, headaches, drowsiness, increased apetite, sleep disturbances, and craving
Nicotine (tobacco) withdrawal
Cigars are safer than cigarettes
*and more nicotine
Major cause of esophageal cancer:
3 ways smoking contributes to cancer:
(3 types of cancer)
Oral cavity/pharynx cancer
Girls smoke more than boys
*boys do it to look cool, girls establish at younger age
What are "light" cigarettes?
Are they less dangerous?
E-cig nicotine can help people to quit long term
What is the only cancer that hasn't had any statistical changes for a 5 year prognosis?
Why are women more likely to be successful when attempting to stop smoking?
more likely to use support group
Ask, Advise, Refer:
Program to assist dental professionals with helping pts to quit smoking
Why must pts completely stop smoking before initiating smoking cessation therapy?
Nicotine is a vasoconstrictor
*raises CV risk - can't smoke and take nic patches at same time
The safety and efficacy of nicotine therapy are not established in children
People require how many attempts on average to stop smoking?
7-12 weeks (3 months) less dosage than through smoking, designed to decrease nicotine craving:
3 risks to bupropion (Zyban) for smoking cessation:
Dopamine reuptake inhibitor used as an antidepressant and for smoking cessation:
***wellbutrin if antidepressant
smoking cessation drug that is a partial neuronal alpha4 B2 nicotinic receptor agonist (occupies nicotine receptor sites in brain)
varenicline (Chantix) mechanism:
stimulates dopamine activity
*but less than nicotine - decreases craving/withdrawal symptoms
Some people have a higher chance of relapse at certain times of day
What drug used for smoking cessation has the highest success rate?
2 contraindications to nicotine replacements:
Hallucinogens (psychodelics) foster _____ dependence
_____ develops quickly
3 consequences of long-term use of hallucinogens:
Hallucinogens are powerful _______ and ______
2 major psychoactive chemicals in marijuana:
What marijuana chemical is an appetite stimulant?
Which is neuroprotective?
What does long-term chronic use of marijuana cause?
Teens with genetic predisposition for depression, schizophrenia, and psychotic disorders are at increased risk for these if they use marijuana
4 oral complications to marijuana use:
What herbal mixture produces the same effect as marijuana and acts on same receptors as THC?
K2/spice has what type of effects?
What is the synthetic version of marijuana?
Schedule ____ drug
Approved for what 2 things?
nausea, appetite stimulation
4 predatory drugs:
Another name for Rohypnol:
it is a _______
What euphoric sedative (anabolic) drug is associated with sexual assualt cases?
analogue found in industrial solvents:
GHB - gamma hydroxy-butyrate
sodium oxybate (Xyrem)
A sedative hyptnotic drug, analgesic and hallucinogenic
(also used as general anesthetic in vetrinary medicine)
adverse cardiac events
The high of marijuana:
What molecule is implicated in a lot of psychiatric disorders such as anxiety, depression, OCD, and schizophrenia?
Headaches and migraines involve a disregulation of what?
What receptors are important for pain modulation in descending pathways, especially chronic pain?
Serotonin (5-HT) - stimulation produced analgesia
Data supports that migraines are caused by what?
Chronic 5-HT dysregulation
What family of drugs is a vasoconstrictor that inhibits depolarization of Dural blood vessel-associated nociceptors and possibly blocks neurogenic inflammation?
2 examples of Ergot derivatives used to "abort" a migraine?
ergotamine + caffeine
Timing is an important factor for migraine drugs, and taking them at the beginning of the episode will be more effective
What ergot derivative is used for chronic, protracted migraine in a hospital setting?
3 families of drugs that can be used to treat migraines:
What anti-emetic is used for migraines?
Family of drugs that cause vasoconstriction and reduce neurogenic inflammation and provide relief from nausea (antiemetic)?
First drug in the class of Triptans?
(vasoconstrictor, reduces neurogenic inflammation)
2 examples of Triptans?
Acetaminophen + sedative that helps migraines and tension headaches?
2 components of isometheptene and what they do:
acetaminophen - analgesic
dichrolalphenazone - tranquilizing
Why are anti-emetics used to treat migraines?
Control nausea/gastric irritation
Because antiemetics are also antipsychotics, they cause _______ effects in the brain and result in ______
8 classes of drugs that can be used for migraine prophylaxis:
Selective 5-HT and NE reuptake inhibitor
Ca ++ channel blockers
NSAID used for migraine prophylaxis:
Intractable migraine, only drug to use after hasn't responded to other interventions?
4 corticosteroid mechanisms:
GABA receptor modulators
Suppress neurogenic inflammaiton
Block neurogenic extravasation
Block high-voltage activated Ca++ currents by blocking Ca++ channels
A form of arthritis caused by accumulation of uric acid crystals in joints:
Overload of uric acid in Gout leads to what?
Formation of tiny crystals of urate
Gout is considered a chronic and progressive disease
Gout affects joints, but does not affect organs
*decreases kidney function
Gout can be inherited
Gout, uric acid is a breakdown product of ______, resulting in overload of uric acid in the body that produces painful ______ attacks and deposits of lumps of crystals in body tissue
Where is gout usually found?
Extremities, esp big toe
Elevated levels of Uric Acid w/o symptoms:
2 types of Gout:
Excessive production of uric acid
Reduced excretion of uric acid
With gout, what foods should you avoid?
5 things that predispose to Gout:
Injury to joint
5 foods that are protective against Gout:
Dark pure chocolate
Pts with longstanding hyperuricemia can have uric acid crystal deposits called what?
*this is in other tissue
4 distinct stages of Gout:
Drug used to treat Acute attack of Gout (only use for drug)
*inhibits neutrophil migration/phagocytic activity of inflamed joints
Original drug on the market for gout?
4 side effects for colchicine (for gout)
bone marrow depression
Drug of choice for pts that make too much uric acid
*works by inhibitying synth of uric acid
Drug used for management of Chronic Gout
*also used during chemo and radiation
4 side effects of allopurinol:
What drug for Gout works by increasing the excretion of uric acid?
probenecid (Bememid) is indicated for what?
Acute gout w/ increased severity/frequency
What drug interferes with the Uricosuric action of probenecid?
*only at LOW DOSE
probenecid can be combined with what antibiotic to delay the excretion of the antibiotic?
*allows you to keep penicillin in body for longer