medications from all lectures Flashcards
(100 cards)
1
Q
cortisone and prednisone are examples of _____.
Why are they important.
A
Steroids
Important because they can result in adrenal insufficiency and the pt is unable to mount a normal response to the stress of an infection or invasive dental procedure.
2
Q
what drugs should be avoided for pts that use cocaine and methamphetamine
A
- vasoconstrictors
(these agents may precipitate arrhythmias, sever hypertension, MI, and stroke)
3
Q
you should be cautious to rx what type of meds for pts with substance use, misuse and abuse
A
narcotic and sedative meds use with great caution or not at all because want to prevent a relapse
4
Q
what signs and symptoms should you watch out for in family hx
A
- HTN
- Diabetes
- Auto imm disorders
- Cancer
- Other hereditary ds and syndromes
5
Q
when getting medical hx, for medications what do pts tend to leave behind
A
- OTC drugs or herbal medicine
6
Q
what is this
A
clubbing of fingers
not age dependent.
7
Q
what is this
A
- xanthomas
due to high cholesterol and get these deposits in the skin.
8
Q
if pt is on coumadin what is their INR
A
INR: 2-3
9
Q
HTN: what category of drugs are used:
A
- Angiotensin converting enzyme inhibitors (ACE inhibi)
- Calcium-channel blockers
- Diuretics
- Alpha adrenergic blockers
- Beta adrenergic blockers
10
Q
lisinopril
category, used for what, dental implications
A
- common ACE inhibitor for HTN
- Dental implication: angioedema, neutropenia/agranulocytosis, taste disturbances
11
Q
captopril
drug category, used for, dental implications
A
- common ACE inhibitor for HTN
- Dental implication: angioedema, neutropenia/agranulocytosis, taste disturbances
12
Q
losartan
drug category and used for
A
Angiotensin II receptor blocker, used for HTN
13
Q
Sodium channel blockers for HTN dental implication
A
dry mouth, gingival overgrowth, hypersentivity reaction syndrome
14
Q
Nifedipine
drug category, what is it used for, dental implications
A
ca+ channel blockers
dental implication: gingival overgrowth, dry mouth, and taste disturbances.
15
Q
hydrochlorothiazide
drug category, what is it used for, dental implications
A
- diuretic for HTN
- Dental implication: dry mouth
16
Q
spironolactone
drug category, what is it used for, dental implications
A
diuretic for HTN
Dental implication: dry mouth
17
Q
hydrochlorothiazide
drug category, what is it used for, dental implications
A
diuretic for HTN
Dental implication: dry mouth
18
Q
methyldopa
drug category, what is it used for, dental implications
A
alpha adrenergic blocker for HTN
dental implication is dry mouth
19
Q
atenolol
drug category, what is it used for, dental implications
A
beta adrenergic blockers
dental implication: dry mouth, angioedema
20
Q
propranolol
drug category, what is it used for, dental implications
A
beta adrenergic blockers
dental implication: dry mouth, angioedema
* also used sublingually
21
Q
post-operative meds to avoid for HTN pt
A
- avoid long-term use of NSAIDs (2 weeks or more)
- avoid microlide ab with ca2+ channel blocker (incr. CCB levels)
22
Q
if a pt is on selective beta-blockers we should limit epi how
A
limit epi to 2 carpules.
23
Q
medical management for hypertension
A
beta blockers
calcium channel blockers
24
Q
medical managment for angina
A
nitrates (nitroglycerine) for stable angina
25
medical managment for stroke
antiplatelet agents like aspirin, clopidogrell (plavix) for stroke prevention
26
medical managment for revascularization
- coronary artery bypass grafting (CABG)
- PCI stent
27
medical managment for hyperlipidemia
* HMG-CoA reductase inhibitor (statins)
* Cholesterol absorption inhibitor (ezetimibe)
* Fibrates
* Bile acid sequestrants
* Niacin
* Omega-3 fatty acids
28
HMG-CoA reductase inhibitor statins used for IHD
* atorvastatin (lipitor)
* pravastatin (pravachol)
* rosuvastatin (crestor, ezallor)
* simvastatin (zocor)
29
what statins to avoid if have IHD
statins- avoid CYP inhibitors such as flucanazole and clarithromycin
CYP enzymes are a protein superfam invovled in the synthesis and metabolism of drugs, toxins and normal cellular components
30
clopidogrel (plavix)
inhibits platelet agglutination, but the platelet count is not affected
arrhythmia pharmacotherapy, oral anticoagulants
31
ASA (aspiring 81mg - low dose)
inhibits platelet agglutination, but the platelet count is not affected
arrhythmia pharmacotherapy, oral anticoagulants
32
warfarin (coumadin)
arrhythmia pharmacotherapy, oral anticoagulants
vitamin k antagonist
inr monitoring
highly variable
33
direct oral anticoagulants (DOACs) for arrhythmias are
- direct thrombin inhibitor
- direct factor Xa inhibitors
34
ace inhibitors and beta blocker are used for which stages:
stage b
stage c
stage A is ONLY ace inhibitor
35
if a pt is tkaing digitalis glycoside (digoxin)- positive inotrope- what should we avoid giving them
epinephrine should be avoided if possible
the combination causes an increase risk of arrhythmia.
36
if a pt has a mechanical implant what do they require
long term anticoagulants
37
if a pt has bioprosthetic implant what do they require
short term anticoagulation and long term antiplatelet therapy
38
antibiotic prophylaxis is recommended for only which group of infective endocarditis
high risk pateints.
39
different antibiotics for prophylaxis
oral- **amoxicillin**
if unable to take oral meds- **ampicillin** or cefazolin
if allergic to penicillin or ampicillin, oral- clindamycin or clarithromycin
if allergic to penicillin or amipicilllin and unable to do oral- clindamycin or cefazolin
40
if a pt is already taking a beta-lactam (penicillin, amoxicillin) for an active infection and urgent dental tx is _necessary_ rx:
azithromycin ro clarithromycin
41
if a pt is already taking a beta-lactam (penicillin, amoxicillin) for an active infection and urgent dental tx is elective:
wait 10 days after completion of the ab for their active infectin and then rx: amoxicillin according to AHA guidlines
42
should you give ab prophylalxis if pt has a heart murmur?
typically no, not required HOWEVER if any murmur is due to endocarditis, prosthetic heart valve, complex congenitary cyanotic heart ds, AHA continues to recommend ab prophylacis for most dental procedures.
43
when measuring BP:
if the cuff is too small-
if the cuff is too large-
arm too high-
arm too low-
small - false elevated values
large- false low value
high- arm is above heart level - it under-estimates systolic and diastolic pressures
low- below the heart level- over estimates systolic and diastolic pressures reading
44
white coat HTN values:
it will ELEVATE BP by 30 mmHg
45
Pregnant pt BP
if a pregnant pt has equal to or more than 10 mmHg increase in systolic BP from baseline
we are at risk of eclampsia --\> immediate referral
46
what is korotkoff sounds
the first audible 'beating sound''
the systolic pressure
47
how can we tell diastolic
once the sound completely dissapears
48
normal bp
\<120/80 mmHg
49
elevated bp
120-129/ \<80 mmHg
50
stage I
130-139/or 80-89 mmHg
51
stage II
\> or equal to 140/or 90 mmhg
52
hypertensive crisis
greater than or equal to 180 and/or \>120
urgent referral --\> see dr ASAP
if pt is symptomatic --\> ER
53
rapid weight loss may be a sign of:
malignancy, diabetes, tuberculosis, neoplasm or other wasting ds
54
rapid weight gain can be a sign of
heart failure, edema, hypothyroidism or neoplasm
55
what is cyanosis
a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
it can indicate cardiac or pulmonary insufficiency
56
pigmentation on skin and nails can be use to
hormonal abnormalities
57
alterations in fingernails usually seen in chronic disorder: clubbing
cardiopulmonary insufficiency
58
alterations in fingernails usually seen in chronic disorder: white discoloration
cirrhosis
59
alterations in fingernails usually seen in chronic disorder: yellowing
malignancy
60
alterations in fingernails usually seen in chronic disorder: splinter hemorrhages
infective endocarditis
61
where are common areas for actinic keratosis and basal cell carcinomas
the dorsal hand surface
62
a raised, darkly pigmented lesion with irregular borders could be a
melanoma
63
what can you do to inspect for the eyes and nose
a cranial nerve exam
64
eyes and nose indicators of systemic ds: lid retraction
hyperthyroidism
65
eyes and nose indicators of systemic ds: xanthomas of the eyelids
## Footnote
*they look like yellowish*
hypercholesterolemia
66
eyes and nose indicators of systemic ds: yellowin gof the sclera
liver ds
hepatitis, alcoholics
67
eyes and nose indicators of systemic ds: conjuctive reddening
allergy or sicca syndrome
68
what pre-dental tx sedation can you give an anxious and stressed pt
benzodiazepines (triazolam .25mg) 1 hour before
69
mavyret
epclusa
harvoni
are used for what
mavyret (glecaprevir/pibrentasvir)
epclusa (sofosbuvir/velpatasvir)
harvoni (ledipasvir/sofosbuvir)
for hep C protease inhibitor therapy
70
for post op tx what do we NOT give pts with liver ds
NSAIDS
can give up to 2mg per day of acetominophen for pain managment
71
LA to avoid for liver ds pts bc metabolized by the liver
lidocaine
mepivacaine
prilocaine
bupivacaine
72
analgesics to avoid for liver ds pts bc metabolized by the liver
aspirin
acetaminophen (tylenol, datril)
codeine
meperidiene
ibuprofen (motrin)
73
sedatives to avoid for liver ds pts bc metabolized by the liver
diazepam
barbiturates
74
antibiotics to avoid for liver ds pts bc metabolized by the liver
ampicillin
tetracycline
metronidazole
vancomycin
75
if opiods are necessary for dental tx on a liver ds pt what should you use
hydromorphone is the preferred choice
avoid hydrocodone, oxycodone.
76
if need a sedative for a liver ds pt what would you use
lorazepam - because it has a short, like about half of the half time of the others. so its less risk of it having an affect on the body because there for a shorter period of time.
77
methylprendisolone is used for what
this is an intermediate-acting glucocortisoid used in a topical form to decrease post op inflammation
78
dexamethasone is used for what
it is a long-acting glucocorticoids that is used for oral ulcerations
79
prednisolone
triamcinolone
methylprednisolone are what type of drugs
intermediate acting glucocorticoids
used topciallly (methyprednisolone)
80
bexamethasone
betamethason are what type of drugs
long-acting glucocoritcoids
used for oral ulcerations ( dexamethesome)
81
what drugs to avoid for pts with hyperadrenalism
* avoid NSAIDs and aspiring --\> can result in peptic ulcers and GI bleed
* If pt also has osteoporosis and osteopenia
* may have history of bisphosphate use.
82
if a pt is having a thyrotoxic crisis/storm for hyperthyroidism what should you administer
1. cpr and vital signs
2. ice or wet packs
3. **administer hydrocortisone 100 to 300 mg**
4. IV glucose
5. **Administer propylthiouracil**
6. send to ED
83
if a pt is having a myxedema coma for hypothyroidism what should you administer?
1. CPR and vital signs
2. conserve body heat - blanket
3. administer hydrocortisone 100 to 300 mg
4. IV saline and glucose
5. Administer thyroxine
6. Send to ED
## Footnote
*myXedema with thyroXine and... hydrocortisone(the same for hyperthry)*
84
drug interactions/side effects seen in hyperthyroidism
- caution w aspirin, NSAIDS (can incr. T4)
- contraindicated to use ciprofloxacin because it decreases the absorption of thyroid hormone
- avoid LA with epi and gingival retraction cord w epi
85
drug inteactions/side effects in hypothyroidism
- avoid CNS depressants (narcotics, babituates, sedatives)
- Cytochrome p450 inducers (phenytoin, carbamazepine, and rifampin) should be avoided bc it increases metabolism of levothyroxine.
86
**biguanide - metformin**
**insulin**
**decrease in gluconeogenesis**
main one for type 1: insulin
main one for type 2: biguanide-metformin
87
sulfonylureas
glucagon-like peptide 1 receptor agonsit
in DM
increase in insulin secretion
to help the insulin pathway
88
thiazolidinediones
in DM
sensitzation to insulin
to help the insulin pathway
89
DPP4
GLP1 receptor agonist
in DM
decrease in glucagon secretion
to help the insulin pathway
90
sodium-glucose cotransporter -2 inhibitors
alpha-glucosidease in DM
use it for intestinal and renal absorption of glucose.
to help the insulin pathway
91
DM avoid:
* tetracyclines (doxycycline too) with insulin
* fluroquinoles **cirpofloxacin** (Cipro), **levofloxacin (levaquin)** with insulin
* aspirin with sulfonylureas
* all of these can cause hypoglycemia
92
analgesic of choice for pregnant pts
acetaminophen
93
Which two antibiotics are contraindicated in preg pts
tetracycline and doxycycline CONTRINDICATED
teratogenic
94
which sedation should be used on a preg pts
- no pharmacologic sedation is preferred
if ABSOLUTLEY necessary then nitrous oxide for less than 30 mins and with at least 50% oxygen.
95
if pt has sickle cell anemia what should you avoid
- avoid prilocaine
- consider giving LA without epi.
- epi given can be 1:100,000 no stronger []
96
anesthesia for thrombocytopenia, von willebrand ds, hemophilia,
avoid block injections and implement local hemostatic measures for dental tx.
97
how do you treat von willebrand ds
desmopressin DDAVP
98
how do you tx hemophilia
desmopressin DDAVP for Hemophilia A
99
medical related bleeding disorders:
1. Plavix (clopidogrel)
2. Coumadin (warfarin)
3. Direct Oral Anticoagulants (DOAC) and direct thrombin inhibitors
100
coumadin (warfarin)
vit k antagonist
side effect is bruising
usef for a lot of pts with hear probs.
monitor INR to keep around 2-3
INR for pts with prosthetic heart vales is (3-3.5)
Antidote is vit k
