Pharm Test 1 Flashcards
(199 cards)
1
Q
What % of the top 200 drugs are in CVD group
A
25%
2
Q
CVD absolute contraindications to dental treatment [4]
A
Unstable or recent onset of angina pectoris
uncontrolled congestive heart failure (CHF)
uncontrolled arrhythmias
Significant, uncontrolled hypertension
3
Q
What is the cardiac dose of epinephrine
A
0.04mg
(2x 1:100,000)
4
Q
Cardiac pacemaker is an electrical device implanted in a pts chest to?
A
regulate the heart rhythm
5
Q
If the cardiac pacemaker is not appropriately shielded what used in dentistry may interfere with the pacemakers activity?
A
Some electrical devices used in dentistry EXAMPLE cavitron
6
Q
Do pts with pacemakers normally require an antibiotic prophylaxis
A
No
7
Q
Studies show that presence of periodontal disease predicts an increase in what 2 things resulting from CVD
A
Morbidity and mortality
8
Q
Persons with untreated CVD are at increased risk for ?
A
severe perio disease
insulin dependant diabetes
atherosclerosis
emboli production
9
Q
Right side heart failure causes systemic congestion leading to
A
peripheral edema with fluid accumulation
10
Q
In right side heart failure, the right ventricle is unable to ?
A
remove all blood from the right side of the heart
11
Q
If the left side of the heart fails, the blood backs up into the ___ leading to?
A
pulmonary circulation (lungs)
leading to pulmonary edema, producing dyspnea and orthopnea
12
Q
Which side of the heart usually fails first?
A
Left side
13
Q
Dental patients with left side heart failure may need to be positioned in the dental chair in what position
A
semi reclined position
14
Q
What is the most common type of drug used in the trx of heart failure? what is used as the prototype
A
digitalis glycosides; digoxin (Lanoxin)
15
Q
Digitalis Glycosides (digoxin, Lanoxin, Digitek) can reduce? increase? What is the therapeutic index?
A
can reduce pulmonary edema
increase contractility of the heart
have a narrow therapeutic index
16
Q
Digitalis glycosides like digoxin (Lanoxin), is used to treat arrhythmias but its toxicity can do what?
A
Cause arrhythmias
17
Q
What dental manifestation is associated with digoxin toxicity ?
A
Increased salivation
18
Q
What two antibiotic agents can increase the toxicity of digoxin in some pts
A
erythromycin and tetracycline
19
Q
Diuretics often used in trx of heart failure (HF) can produce?
A
Hypokalemia
*this can predispose a pt to serious arrhythmias
20
Q
Cells of the cardiac muscles have an intrinsic rhythm called?
A
automaticity
21
Q
The ___ node in the ___ atrium has the fastest rate of depolarization and directs other cells of the heart
A
sinoatrial (SA) node in the right atrium
22
Q
SA node sends a message (action potential) to atrioventricular (AV) node via?
A
atrial muscle
23
Q
AV node sends message via the bundle of His to the?
A
Purkinje fibers
24
Q
From the Purkinje fibers a message is sent to the cardiac muscle cells wherein the message direct the cells to do what?
A
direct the cells to all contract
25
I a normally functioning heart the bundle of His receives its electrical input from what node?
AV node
26
Antiarrhythmic agents work by
depressing parts of the heart that are beating abnormally
27
What is angina?
insufficient oxygen for body demand
28
Angina pectoris is characterized by pain or discomfort in the chest radiating to the
left arm and shoulder
29
When/why does angina pectoris occur
occurs when coronary arteries do not supply enough oxygen to the myocardium
30
Anginal pain can be precipitated by
stress, physical exercise or emotional (anxiety)
31
What 3 compounds/agents are antianginal drugs
Nitroglycerin-like compounds
B-adrenergic blocking agents
calcium channel blocking agents (CCB)
32
What nitrate is most used for acute anginal episodes?
Nitroglycerin (NTG)
33
NTG is a vasodilator or vasoconstrictor?
Vasodilator (lowers the oxygen demand- reduced workload of the heart)
34
Short acting nitrates includes?
sublingual (SL) NTG
35
NTG should be made available to the dental team for trx of an
acute anginal attack
36
Administration of what drugs with doses of any nitrate is contraindicated
Phosphodiesterase 5 (PDE5) inhibitors: sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis)
37
The combination of phosphodiesterase 5 inhibitors with any dose of nitrates can cause dangerously
low blood pressure
38
NTG storage: it is degraded by?
Degraded by heat and moisture (but not by light)
39
Storage of NTG?
DO NOT STORE IN PLASTIC, DO NOT REFRIGERATE (should be stored in its original glass container and tightly closed)
40
In the case of an attack BTG should be administered how many times within how many minutes?
only 3x, 5 mins apart within 15 minutes
41
Prophylactic nitrates should be given what hour "vacation" every day to avoid tolerance development
8-12 hour vacation
42
Prevent an attack of angina pectoris by administering
nitrous oxide
43
Calcium channel blocking agents may be used in the trx of? (3)
angina
cardiac arrhythmias
hypertension
44
Adverse effects of CCB agents include
dizziness, weakness, constipation and hypotension
45
CCB agent Nifedipine is associated with
gingival enlargement and dysgeusia
46
Before administering NTG the dental team should make sure the patient has not used PDE5 inhibitor within the past
24 hours
47
An anginal attack not relieved by 3 doses of SL NTG may be experiencing an?
Myocardial infarction
48
What is the most common cardiovascular disease
hypertension (34%)
49
Normal BP is
less than 120/80
50
Elevated BP is
120-129/less than 80
51
stage 1 hypertension reading
130/80 to 139/89
52
stage 2 hypertension reading
greater than/equal to 140/ greater than/equal to 90
53
Hypertension etiology usually is unknown, and can occur without regard to stress or "tension"; no common symptoms and is known as the
silent killer
54
The big 4 antihypertensive groups?
*diuretics
*angiotensin-converting enzyme inhibitors (ACEIs)
* angiotensin receptor blockers (ARBs)
*calcium channel blocking agents (CCBs)
55
3 major types of diuretics
thiazides (-like) diuretics
loop diuretics
potassium (K)- sparing diuretics
56
Thiazide diuretics are considered the first line of therapy for hypertension. Works by promoting?
excretion of sodium and water which in turn lowers blood volume and pressure
57
hydrochlorothiazide (HCTZ, Esidrix) is the most commonly used
Thiazide diuretic
58
Common adverse reactions of Thiazide diuretics include
hypokalemia and hyperuricemia
59
Eating what when taking thiazide diuretics will replenish potassium
bananas
60
Epinephrine should be limited to __ for pt taking thiazide diuretics
cardiac dose
61
The most important dental drug interaction with the thiazides is interaction with
NSAIDs
* can reduce the antihypertensive effect of the thiazide diuretics
62
most commonly used loop diuretic and can be used when rapid diuresis is required
furosemide (Lasix)
63
Thiazide diuretics are more effective in pts with normal kidney function, ___ diretics are more effective in pts with impaired kidney function
loop diuretics
64
Loop diuretics are primarily used in medicine to treat ___ and __ often due to congestive heart failure (CHF) or renal insufficiency
hypertension and edema
65
Angiotensin- converting enzyme inhibitors (ACEIs) suffix of drugs
-pril
66
ACEIs are a class of agents that are of special benefit to diabetics. ACEIs retard the progression of
diabetic nephropathy whether hypertension is present or not
67
ACEIs should not be given to women who could be or become
pregnant
68
Teratogenicity of ACEIs could cause
fetal and neonatal morbidity and mortality
69
What dental drug can antagonize the effects of ACEIs
NSAIDs
70
Angiotensin receptor blockers (ARBs) suffix of drugs
- artan
71
ARBs adverse rxns: teratogenicity can occur if ___ is administered to pregnant women
losartan
*Cozaar is prototype of losartan
72
NSAIDS may antagonize the antihypertensive effect of
losartan
73
Calcium channel blocking agents suffix of drugs
-dipine
74
Calcium channel blocking agents (CCBs) are used to treat?
hypertension
arrhythmias
angina pectoris
75
Examples of CCB agents
nifedipine (Procardia, Adalat)
verapamil (Isoptin, Calan)
diltiazem (Cardizem)
76
CCBs work by producing systemic vasodilation by
blocking vasoconstriction in smooth muscles of blood vessels
77
Oral manifestations of CCBs
xerostomia and dysgeusia
*gingival enlargement mostly with nifedipine
78
CCb agent effects are NOT reduced by
NSAIDs
79
What are considered 2nd line of therapy, frequently used to treat hypertension and act by inhibiting the actions of the fight-or-flight stress hormones epinephrine and noradrenaline
B- adrenergic blocking agents
80
B-adrenergic blocking agents suffix of drugs
-olol
81
B-adrenergic blockers lower blood pressure primarily by
decreasing cardiac output
82
B1 receptors, stimulation is associated with
increased heart rate, cardiac contractility, and atrioventricular conduction
83
B2 receptor stimulation causes vasodilation of
skeletal muscle and bronchodilation in pulmonary tissues
84
propranolol blocks both B1 and B2 receptors and can worsen what?
Asthma
85
Amount of epinephrine given to pts taking nonspecific b-blockers should be limited to
the cardiac dose
*neither gingival retraction cord containing epi or 1:50,000 epi should be used
86
a1-adrenergic blocking agents suffix
-zosin
87
a1-adrenergic blockers are more effective when combined with
diuretics or b-blockers
88
___, especially indomethacin, can reduce antihypertensive effect of the a-blockers
NSAIDs
89
Precautions the dental professional should exercise with a pt taking an a-adrenergic receptor blocker (3)
raise and lower dental chair slowly
use LA with no or low-dose epi
use caution and local measures for excessive bleeding tendency
90
The incidence of xerostomia is highest with what central a-adrenergic agonist
Clonidine
91
The drug of choice for trx of a pregnant hypertensive women is
hydralazine: Apresoline
(central a-adrenergic agonist: direct vasodilators)
92
what serious toxic reaction is associated with hydralazine
serious lupus erythematosus like toxic reaction
93
What will help prevent orthostatic hypotension in pts taking antihypertensive agents who have been supine for some time
should be slowly raised from that position
dangle their legs over the side of the chair and wiggle them before standing
94
LDL (low density lipoproteins) is ___ cholesterol
bad cholesterol
95
HDL (high density lipoproteins) is ___ cholesterol
good cholesterol
96
elevations of plasma lipid concentrations above accepted normal values resulting in elevations in cholesterol and or triglycerides
hyperlipidemia and hyperlipoproteinemia
97
3-Hydroxy-3-Methylglutaryl coenzyme A Reductase Inhibitors lower cholesterol levels by inhibiting
HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis
Example: lovastatin (Mevacor), atorvastatin (Lipitor), fluvastatin (Lescol)
98
Suffix of anti-hyperlipidemic agents suffix
-statins
99
Niacin aka nicotinic acid (a B vitamin) works by inhibiting the secretion of
Very low density lipoproteins (VLDLs) without accumulation of triglycerides in the liver
*(lower cholesterol levels)
100
In large doses of Niacin reaches therapeutic effect and lowers
Cholesterol levels
(Causes flushing in the face and neck region)
101
Dental implications of Niacin include
Hypotension
Hyperuricemia, allergic reactions, cholestasis and hepatotoxicity
102
Anticoagulants are drugs that lower / decrease
Blood clotting
103
Indications for anticoagulants
Myocardial infarction (MI) or thrombophlebitis
104
What is the most important anticoagulant and used almost exclusively
warfarin (Coumadin)
105
Many factors required in the clotting process are synthesized in the
Liver
***(Prothrombin (II) and factors VII, IX, and X require vitamin K for synthesis)
106
Warfarin antagonizes what vitamin
Vitamin K
(And interferes with the synthesis of four clotting factors to produce an anticoagulant effect)
107
Anticoagulant therapy attempts to reduce intravascular clotting. If the dose is too large what may occur? If the dose is too small what danger remains?
If the dose is too large hemorrhage may occur
If the dose is too small the danger of embolism remains
108
The effect of warfarin is monitored using the
International normalized ratio (INR)
-time it takes in seconds for blood to clot
109
The therapeutic target INR for most indications such as thrombophlebitis is between
2 and 3
110
For patients with a prosthetic heart valve the target INR is between
2.5 and 3.5
111
The presence of petechial hemorrhages in the oral cavity can be a sign of an advance effect associated with the
Oral anticoagulants
(Look for it on hard palate)
112
What drug has the most serious interaction with warfarin
Aspirin
113
A statistically significant association was found between acetaminophen use and?
Abnormal elevation of the INR
114
Describe the antibiotic interaction with Warfarin
Antibiotics can potentiate the effect of warfarin
-bc warfarin also inhibits vitamin k dependant factors and added anticoagulant effect occurs
-this interaction does not have a chance to develop when antibiotics are used before a dental procedure
115
Which antibiotics have the greatest effect on altering warfarins anticoagulant action
Erythromycin and metronidazole
-Clindamycin has no effect
-doxycycline, tetracycline and amoxicillin have small effect
116
Phenobarbital induces the liver microsomal enzymes that
Reduce warfarins effect
117
Dental patients taking warfarin require special attention. What should we as the clinician do?
Always assess for any signs of bleeding
Consider dose reduction ONLY under advice of treating physicians
Allow several days for a change in effect of dose of warfarin is changed due to latent onset time
118
In most dental procedures is there a required change in the dose of warfarin?
NO
119
Seizure disorders are estimated to affect approximately what % of the population
1%
120
Two major groups of seizures
Partial: simple and complex attacks
Generalized: tonic-clonic (grand mal) and absence (petit mal)
121
Describe difference between petit mal and grand mal
Absence (petit mal): little movement
Tonic-clonic (grand mal): major movement of large muscle groups
**** consciousness lost in both types
122
Brief loss of consciousness with little movement
Absence seizures (petit mal)
123
Drug of choice for absence seizures (petit mal)
Ethosuximide
124
Longer periods of loss of consciousness and major activity of the large muscles of the body
Tonic-clonic seizure (grand mal)
125
Drugs of choice for tonic clonic seizures (Grand Mal)
Valproate, lamotrigine, levetiracetam
126
Continuous tonic clonic seizures that last longer than 5mins or recur before the end of the postictal period of the previous seizure is considered an emergency
Status epilepticus
127
Drug of choice/drug therapy for status epilepticus
Parenteral benzodiazepines
E.g. diazepam (Valium)
128
Partial (focal) seizures involve activation of only
Part of the brain
129
Elementary (simple) partial attack is aka?
Is consciousness impaired?
Jacksonian seizures
Not impaired
130
Complex partial attack is aka
Is consciousness impaired ?
Psychomotor or temporal lobe
Yes impaired and slow to return (lasts several minutes)
131
With complex partial attacks some pts may experience?
An aura
*consciousness is slow to return
132
Drugs of choice for partial seizures
Lamotrigine, carbamazepine, leveticeram, oxacarbazepine
133
The goal of anticonvulsant drug therapy is
To reduce the frequency of seizures and reduce the potential adverse reactions
134
General adverse reactions of antiepileptic agents includes
CNS depression
GI distress
135
General adverse reactions of antiepileptic agents: CNS depression is additive with other CNS depressants such as ?
How should the dose be adjusted?
Opioids
Dose should be reduced
136
The most important drug interaction of anticonvulsant drugs is stimulation of
Hepatic microsomal enzymes
*metabolism of the anticonvulsants can saturate liver microsomal enzymes
137
Is anticonvulsants therapeutic index narrow or large
Narrow
138
Valproates are used to treat pts with myoclonic and atonic seizures. It is often the first agent used to treat patients with
Generalized tonic-clonic seizures
139
Other uses of valproate: FDA approved for
Migraine prophylaxis and bipolar disorder
140
Valproate adverse reactions
GI
CNS: sedation, drowsiness
Hepatoxicity: liver function tests should be performed
Bleeding: bleeding time may be prolonged
Teratogenicity
141
Carbamazepine (Tegretol) is used to treat seizures. In dentistry used in the treatment of
Trigeminal neuralgia
142
Adverse reactions of carbamazepine (Tegretol)
CNS: dizziness vertigo drowsiness
GI: nausea, vomiting, gastric distress
Hematologic: can cause blood dyscrasias (clotting disturbances? And compromise immune function *WBC count should be monitored
Oral: dry mouth, glossitits, stomatitis, petechia
143
Drug management of pt taking carbamazepine (Tegretol)
Check mouth for oral side effects
Look for symptoms of blood dyscrasias
Monitor wbc
Consider drug interactions (doxycycline and erythromycin)
Emphasize oral hygiene
Child taking chewable exposed to sugar for extended period of time (63% sugar in child chewable tablet)
144
Phenytoin (Dilantin) mid used to treat
Generalized tonic-clonic and partial seizures
145
Phenytoin (Dilantin) has teratogenicity effects which include
Fetal hydantoin syndrome
- congenital abnormality (craniofacial anomalies, microcephaly, nails or digit hypoplasia, limb defects, growth deficient and mental development delay
146
Gingival enlargement while taking phenytoin (Dilantin) occurs in approximately what % of all chronic users
50%
147
Hyperplasia in relation to phenytoin use is more commonly located
In the anterior rather than the posterior surfaces and the buccal rather than the lingual
148
Gingival enlargement management in relation to phenytoin use
Choose another antiepileptic drug
Discontinue phenytoin
Improve oral hygiene
Consider gingivectomy
Consideration of other drugs
149
Gingival enlargement management: surgical intervention to reduce phenytoin-induced gingival enlargement should wait until at least how many months after cessation of therapy
18months
Bc some pts experience additional reduction in the enlargement after the 1 year period
150
Phenytoin can produce osteomalacia as a result from interference with
Vitamin D metabolism
(Phenytoin can cause vitamin d deficiency)
151
What is the most common barbiturate used in Trx of epilepsy
Phenobarbital (Luminal)
152
The most common side effect of phenobarbital (Luminal) is
Sedation
153
What benzodiazepine is used as an adjunct to treat ethosuximide resistant absence seizures
Clonazepam
154
Drug of choice for absence seizures
Ethosuximide (Zarontin)
155
Nonseizure uses of antiepileptics
Used to manage chronic pain syndromes (neurological pain)
-carbamazepine: trigeminal neuralgia and atypical facial pain
-phenytoin: neurologic pain
-valproic acid: migraine prophylaxis
-gabapentin: neuropathic pain
-pregabalin: neuropathic pain and fibromyalgia
156
New anticonvulsant agent: Gabapentin. It is not metabolized so therefore there is less chances of
Drug interactions
157
The most common type of psychosis is schizophrenia. What is it?
Loss of the perception of reality: delusions, paranoia
**NOT multiple personalities
158
Psychiatric drugs are classified by their therapeutic use and include
Antipsychotic
Antidepressant
Drugs for bipolar depression
159
Antipsychotic agents are divided into what groups
First generation and second generation groups
160
Antipsychotic agents are divided into what groups
First generation and second generation groups
161
First generation antipsychotic drugs are active against
The positive effects of psychosis but have little effect on the negative effects
162
Mechanism of action for second generation antipsychotic agents
Action at more than one receptor (e.g dopamine, serotonin and NE receptors) improving their efficacy
-less side effects than first gen
-effective against positive and negative effects
163
Psychiatric effective disorders include
-Endogenous: unrelated to external events; directly related to chemical imbalances
-exogenous unipolar depression; directly related to a specific or traumatic event
Bipolar depression (mania): with or without depression; alternating periods of depression and excitation. also known as manic depressive disorder
164
What are positive symptoms that antipsychotics treat
Agitation, hallucination, auditory delusions, delusions, unwanted thoughts, distorted speech
165
What are the negative symptoms that antipsychotics address/treat
Apathy, social withdrawal, blunted effect (flat), thought and speech impaired, lack of pleasure
166
First generation antipsychotics are also used to treat
Hiccups
Example prochlorperazine (Compazine)
167
First generation antipsychotics differ in the degree of sedation and drowsiness they produce. the degree of sedation is one factor that determines
Which antipsychotic agent is prescribed
(Tolerance develops to sedative effect but not antipsychotic effect)
168
In general lower potency antipsychotic agents such as chlorpromazine in relation to sedation, have what 3 characteristics
More sedation
More peripheral side effects
More autonomic effects
169
Higher potency first gen antipsychotics in relation to sedation such as haloperidol have what characteristics (2)
More extrapyramidal effects
Less sedation
170
Extrapyramidal effects or movement disorders can occur with all first gen antipsychotics. These effects include
Acute dystonia
Parkinsonism
Akathisia
Tardive dyskinesia
171
What is tardive dyskinesia
Involuntary, repetitive body movements involving the tongue, lips, face and jaw
-movements coordinated and rhythmic
-typically in women older than 40 that have been taking large doses on phenothiazine (first gen agent) for a minimum of of 6months to 2 years or as long as 20 years
-gradual onset
-symptoms are exacerbated on drug withdrawal
172
Extrapyramidal side effects of the first gen antipsychotics agents can also cause severe intermittent pain in what region
TMJ
-counteract effects like this by giving Anticholinergics like benztropine (Cogentin)
173
Patients on first gen antipsychotics CANNOT take what kind of meds
Smoking cessation meds like bupropion (Zyban)
- it could produce seizures
174
First gen antipsychotics can produce a what anticholinergic effects? (Hint opposite of SLUD)
How to counteract the anticholinergic effect?
Blurred vision
Xerostomia
Constipation
-to counteract anticholinergic effect use of sugarless products and artificial saliva to be encouraged
175
Electroconvulsive therapy (ECT) is what? Is it still used today?
Shock therapy
Still used today in Trx of depression that cannot be managed with drugs (memory loss can occur)
176
Neuroses is related to anxiety. What disorders are associated?
Anxiety panic disorders, phobias, OCD
177
Treatment for anxiety related disorders
Benzodiazepines (Clonazepam)
178
Agranulocytosis means a failure of the bone marrow to make enough
White blood cells (neutrophils)
179
2nd gen antipsychotics: Clozapine cause’s agranulocytosis in about what % of patients taking it
1%
-bc it produces potentially life threading agranulocytosis clozapine should only be used after trying other agents
180
Clients taking clozapine which causes agranulocytosis, require weekly
Blood cell count monitoring
181
First gen antipsychotics interact in an additive or potentiating fashion with all CNS depressants. What can occur?
Sedation and respiratory depression
182
What should not be used to treat vasomotor collapse (acute drop in BP) in pts taking first gen antipsychotics
Epinephrine
-could cause fainting and a further drop in BP
183
Drug of choice for schizophrenia
Antipsychotics
184
2 antipsychotic agents available as a long acting injectable for schizophrenic pts who fail to take their oral meds
Fluphenazine and haloperidol
185
Antidepressant agents are used not only to manage depression but also
Chronic pain and migraine headache
186
What are sometimes known as the first gen antidepressants
Tricyclic antidepressants
187
Tricyclic antidepressants are no longer first line therapy and are reserved for what pts
Moderate to severe treatment resistant depression
-examples: imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor)
188
First generation antipsychotics are usually combined with anticholinergic agents such as anti Parkinson’s meds to decrease
Extrapyramidal effects
189
In the cases of suicidal thoughts what works faster and is much safer nowadays than any antidepressant
ECT electroconvulsive therapy
190
What anticholinergic effects may be associated with tricyclic antidepressants (TCAs)
Xerostomia
Blurred vision
Urinary retention
Constipation
SO decrease in SLUD
191
The most serious peripheral side effect associated with TCAs is
Cardiac toxicity
(MI or CHF)
192
Vasoconstriction drugs in LA must be limited to what dose with tricyclic antidepressants
Cardiac dose
193
Other antidepressants: bupropion (Wellbutrin, Zyban) is reserved for pts who are not responsive to other agents because of a potential for
Seizures
194
bupropion is an on and off and on again market drug. It is released as Zyban which is a smoking cessation drug. So it’s taking what CANNOT TAKE bupropion since it may produce seizures
First gen antipsychotics
195
Other antidepressants: nefazodone (Serzone) carries a black box warning regarding its potential to cause
Life threatening liver failure (hepatic failure)
196
Lithium can be used to treat
Bipolar (manic) depression
197
It’s undergoing lithium therapy should be observed for the following signs of overdose toxicity
CNS: muscle rigidity, hyperactive deep reflexes, excessive tremor
198
The manic phase has been treated with
Carbamazepine, valproate, and gabapentin
199
What is used more often than lithium for the treatment of bipolar depression because of its more tolerable side effects
Valproate
