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Flashcards in Pharmacology Deck (213):
1

Function of the AMOUNT of a drug to produce an effect. Greater when dose is Smaller.

Potency

2

Maximum intensity that can be produced by drug Regardless of Dose. Only can increase side effects

Efficacy

3

Placed directly into GI tract by oral or rectal.

Enteral

4

Bypasses GI tract including injection, inhalation, and topical

Parenteral

5

Orally delivered drugs must FIRST pass through HEPATIC PORTAL CIRCULATION possibly inactivating some drugs

First-Pass Effect

6

Phase 1 reactions carried out by ___ (aka mixed functions oxidases) in the LIVER.
(Oral Route)

Cytochrome P-450 enzymes

7

Route: Safest, least expensive, convenient. Mostly absorbed in small intestine. Drug blood levels less predictable.

Oral

8

Route: Used if patient is vomiting or unconscious. Poorly absorbed.

Rectal

9

Route: Produces MOST RAPID drug response. Absorption phase bypassed. EMERGENCY situations

Intravascular

10

Route: Sustained effect. Massage increases absorption.

Intramuscular
(deltoid or gluteal most common site)

11

Route: Administering protein products. Insulin and LAs. Sterile abscess.

Subcutaneous

12

Route: Injected into epidermis. TB

Intradermal

13

Route: Rapid delivery across large surface area.

Inhalation
(inhalers & nitrous)

14

Route: Increased concentration of active ingredient. Local effect. May have systemic uptake.

Topical
(contraindicated if surface is ulcerated, burned, or abraded)

15

ADME

Absorption, Distribution, Metabolism, Excretion

16

Study of how a drug is absorbed, distributed, metabolized, and excreted by the body

Pharmacokinetics

17

Transfer of drug from site to blood. Active or Passive. Occurs at MANY sites. Dependent on several factors.

Absorption of drugs

18

Readily move across MOST biological membranes by diffusion. ONLY drugs to pass BBB

Lipid Soluble Drugs

19

Factors dependent on drug absorption (6)

1) Drug solubility 2) Circulation at site 3) Surface area 4) Drug pH 5) Temperature at site 6) Mechanical factors

20

Transfer of drug from blood to system with Highest Blood Flow. (oral-liver, sublingual-heart) Dependent on few factors.

Distribution of drugs

21

Factors dependent on drug distribution (3)

1) Blood flow 2) Capillary permeability (BBB) 3) Binding of drug to proteins (plasma albumin)

22

Major site of drug metabolism. (disease may impair metabolism)

Liver

23

Termination of drug effects

Elimination

24

Elimination is by ___ and/or ___ into urine or bile

Biotransformation ; Excretion

25

Routes of elimination (10)

1)RENAL (kidney) 2)Gingival Crevicular Fluid 3)Saliva 4)Liver 5)Bile 6)Lungs 7)Exhalation 8)GI 9)Sweat 10)Milk

26

Fluoride eliminated by ___

Excretion in the Urine

27

Drug altering effects (12)

1)Pt compliance 2)Psychologic factors 3)Tolerance 4)Pathologic state 5)Time 6)Route 7)Gender 8)Genes 9)Drug interactions 10)Age 11)WEIGHT 12)Environment

28

Child dosing determined by ___
Cowling and Young Rules

Age

29

Surface Area Rule determined by ___

Weight in kg

30

Reaction - Abnormal drug response that is usually genetically related

Idiosyncratic

31

Adverse Drug Reactions (7)

1) Toxic 2) Side effects 3) Idiosyncratic 4) Teratogenic 5) Local 6) Drug interactions 7) Allergic Reactions

32

Reaction - amount of desired effect is excessive; dose related

Toxic

33

Reaction - dose-related, not part of the therapeutic outcome; e.g. drowsiness with benadryl

Side effect

34

Reaction - hypersensitivity response to a drug that pt has been previously exposed; NOT dose related; mild to life-threatening

Allergic

35

Reaction - maternal drug use causing congenital abnormalities

Teratogenic

36

Reaction - local tissue irritation

Local

37

Reaction - one drug altered by another; can result in toxicity or lack of efficacy

Drug interaction

38

Treatment of allergic reactions: mild , anaphylactic

mild - antihistamine with or without steroids
anaphylactic - epinephrine subcutaneously with or without steroids

39

What can generate gingival overgrowth (5)

1) mouth breathing 2) Phenytoin 3) Genes 4) Cyclosporin 5) Calcium Channel Blockers

40

Med - an organ rejection preventative medication

Cyclosporine

41

Med - calcium channel blockers (2)

nifedipine (procardia)
dilatiazem (cardizem)

42

Med - drugs that do NOT cause gingival overgrowth (2)

Digoxin, Beta blockers

43

ANS regulates (5)

1) BP 2) Heart rate 3) GI motility 4) Salivation 5) Bronchial/smooth muscle tone

44

Rest and Digest

Parasympathetic

45

Drugs that mimic PANS (3)

Parasympathomimetics, cholinergic agents, muscarinic drugs

46

Drugs that mimic PANS are used for (3)

xerostomia, urinary retention, glaucoma

47

Cholinergic agents from plant alkaloids (2)

Pilocarpine (stimulates saliva)
Nicotine (tobacco cessation)

48

Contraindications to drugs that mimic PANS (4)

Asthma(bronchoconstriction) Peptic ulcer(increases GI secretions) Cardiac disease(heart rate decrease) GI/Urinary obstruction(GI motility increase)

49

Agent - blocks ach receptors by inhibiting ach effects

Anticholinergic

50

Effects of Anticholinergic agents (4)

ABCD - Anticholinergic agents, Blurred vision & Bladder retention, Constipation, Dry mouth

51

Examples of Anticholinergic agents (3)

Immodium(diarrhea)
Atropine(decrease salivary flow)
Scopolamine(motion sickness)

52

PANS neurotransmitter

Acetylcholine

53

SANS neurotransmitter

Norepinephrine
(ach in PRE-ganglionic synapse)

54

Fight or Flight

Sympathetic

55

Examples of drugs that mimic SANS (5)

Epinephrine
Pseudoephedrine
Albuterol
Ritalin
Adderall

56

Drugs that mimic SANS (2)

Sympathomimetics, adrenergic agents

57

Drugs that mimic SANS are used for (8)

Colds(decongestants), asthma(bronchodialators), anaphylactic shock, glaucoma, vasoconstrictors, cardiac arrest, CNS stimulation, ADD

58

Functions of SANS (4)

Vasoconstricts, dilates bronchioles, increases heart rate, dilates pupils

59

Functions of PANS (4)

Stimulates salivary gland secretion, dilates blood vessels, accelerates peristalsis, absorption of nutrients

60

Contraindications to drugs that mimic SANS (4)

Angina
Uncontrolled hypertension
Uncontrolled hyperthyroidism
Cocaine & Amphetamine Abuse

61

___ is contraindicated for Cocaine & Amphetamine abuser if used within ___

Epinephrine & 24 hours

62

Adverse reactions of adrenergic agents (4)

CNS disturbances (anxiety, fear, tension, headache, tremor)
Cardiac arrythmias
Cerebral hemorrhage
Pulmonary edema

63

Oral signs - rampant caries & burned mucosal surfaces

Meth abuse

64

How to treat meth abusers

no medications available, cognitive behavioral interventions

65

Adrenergic drugs to know (3)

Albuterol
Dopamine
Clonidine

66

Med - minimizes symptoms that accompany withdrawal from opiates and benzodiazepines

Clonidine

67

Med - drug of choice for shock; continuous infusion

Dopamine

68

Med - bronchodilator, acute asthma, few cv effects

Albuterol

69

Beta blockers (type/location)

Beta 1 : heart
Beta 2: lungs, muscles, arterioles

70

increases heart rate, BP, and oxygen needed for blood

Beta 1 receptor

71

Beta 1 blocker drug action

decreases heart rate, BP, and useful when heart is deprived of oxygen

72

Often Rx after heart attack

Beta 1 blocker

73

Hormone produced in kidney that constricts blood vessels; beta blockers prevent release of

Renin

74

Relaxing effect, Rx for anxiety, migraine, and alcohol withdrawal

Beta 2 blocker

75

Should not be used in pt with asthma or any reactive airway disease

Non-selective beta blockers

76

Beta blockers are used for (6)

Cardiac arrhythmias, angina pectoris, hyperthyroidism, M.I., glaucoma, migraine prevention

77

Beta adrenergic drugs to know (4)

Propranolol
Timolol
Atenolol
Metoprolol

78

Med - lowers BP by lowering cardiac output; adverse reaction bronchoconstriction & arrhythmias

Propranolol
(Inderol)

79

Med - reduces aqueous humor in the eye, tx of glaucoma

Timolol
Timoptol, Timoptic

80

Med - eliminates bronchoconstrictor effect, tx of hypersensitive asthmatic pts; cardioselective

Atenolol

81

Med - tx of hypertension, prevention of M.I. and angina

Metoprolol
Lopressor

82

Nonopioid Analgesics (3)

Aspirin, NSAIDs, Acetaminophen

83

Med - used for Analgesia, Antipyretic, Anti-inflammatory; inhibition of prostaglandin synthesis

Aspirin & NSAIDs

84

Med - used for Analgesia & Antipyretic

Acetaminophen

85

Med - fever reduced through hypothalamus

Aspirin

86

Contraindications for Aspirin & NSAIDs (2)

Coumadin (warfarin) - blood clotting effect
Peptic ulcer

87

Med - children with hx of chicken pox or influenza should NOT use ___ due to what metabolic disorder

Aspirin; Reye's Syndrome

88

Term - overdose of Aspirin

salicylism

89

Define - ringing of the ears

Tinnitus

90

Ibuprofen can decrease effects of drugs including (7)

ACE inhibitors, Aspirin, Beta blockers, Corticosteroids, Cyclosporine, Lithium, Loop diuretics

91

Acetaminophen overdose (3)

Hepatotoxicity
Liver necrosis
Death

92

Med - for post-operative pain, drug of choice after root planning

Acetaminophen

93

Narcotic / Opioid Analgesics (4)

Morphine, Codeine, Demerol, Dilaudid

94

MOA of narcotics and opioids

Blocks pain receptors in brain w/o loss of consciousness

95

Most commonly used opioid in Dentistry

Codeine in conjunction with Acetaminophen (schedule 3 narcotic)

96

Sign of OD or addiction to ANY opioid

Pinpoint pupils (<2.9mm)

97

Med - antitussive; may cause constipation, emesis (vomiting); OD leads to respiratory depression & death

Codeine

98

Med - opioid antagonist, used for tx of opioid OD; should be in Dental Emergency Kit

Narcan

99

Med - tx of narcotic withdrawal/dependence; 1x day, works for 24-36 hrs, only effective for opioid addictions

Methadone

100

Pain meds for heroine addicts

NSAIDs

101

Type of drug abuser needs pre-med with antibiotics

IV

102

Define - substance acts against/destroys infections

Anti-infective/antibiotic

103

Define - substance that destroys/suppresses growth of bacteria

Antibacterial

104

Define - Kills bacteria; irreversible

Bactericidal

105

Define - Inhibits bacterial growth

Bacteriostatic

106

Lowest concentration needed to inhibit visible growth of an organism

MIC - minimum inhibitory concentration

107

Range of activity to drug

Spectrum

108

drug combo for better effect

Synergism

109

drug combo lessens effect

Antagonism

110

Antibiotic types (3)

Penicillins, Tetracyclines, Nitromidazoles

111

Penicillin derivatives (3)

Amoxicillin, Augmentin, Ampicillin

112

Most common Rx in dentistry; effective in 90% of bacteria in dental infections

Pen VK

113

MOA of penicillin

destroys bacterial cell wall integrity; lysis

114

Med - Not effective against penicillinase (beta lactamase)

Amoxicillin

115

Med - Clavulanic acid combined with Amoxicillin; prevents penicillinase from breaking down Amox.

Augmentin

116

Med - avoid use in early pregnancy and childhood; tooth discoloration

Tetracycline

117

Do Not take tetracycline with ___ (3)

dairy, antacids, iron tablets

118

Med - topically used for aggressive perio; systemically for NUG/NUP

Tetracycline

119

Med - NO Alcohol Mouth Rinse! Effective against obligate anaerobes only; alcohol should be avoided.

Nitromidazoles
(Metronidazole)

120

Antibacterial side effects (3)

GI upset, secondary fungal infections(candidiasis/yeast infection), Allergies

121

Antituberculosis Agents (4); must be on all if active

RIPE - Rifampin, Isoniazid, Pyrazinamide, Ethambutol

122

Med - red urine, tears, and saliva

Rifampin (TB)

123

Med - affects vision; decreases acuity and red/green differentiation

Ethambutol (TB)
(Myambutol)

124

Med - preventative against developing TB

Isoniazid

125

TB - no longer contagious if...

3 consecutive negative sputum smears

126

Antigen used to diagnose TB, known as Mantoux skin test

PPD - purified protein derivative

127

Fungal infections common... (3)

after antibiotics, steroids, or immunocompromised

128

Most common Antifungals (4)

Nystatin, Fluconazole, Mycelex(clotrimazole), Nizoral(ketoconazole)

129

Med - most common antifungal used in dentistry, tx of candidiasis, topical

Nystatin

130

Med - systemic tx of candidiasis

Fluconazole
(Diflucan)

131

Abbreviation - ac

before meals (ahead of consumption)

132

Abbreviation - bid

twice a day (bi daily)

133

Abbreviation - gt

drop

134

Abbreviation - hs

before bedtime (heavy sleeping)

135

Abbreviation - po

by mouth (per oral)

136

Abbreviation - pc

after meals (post consumption)

137

Abbreviation - prn

as needed (per Rx need)

138

Abbreviation - q3h

every 3 hours

139

Abbreviation - qd

per day

140

Abbreviation - qid

4x a day (quad daily)

141

Abbreviation - tid

3x a day (tri daily)

142

Abbreviation - sig

label; instructions (see instruction guide)

143

Abbreviation - stat

immediately

144

Abbreviation - tab

tablet

145

Abbreviation - ud

use as directed

146

Schedule 1 (abuse potential/handling)

highest - no accepted medical use (cocaine)

147

Schedule 2 (abuse potential/handling)

high - Rx only, NO REFILLS, most abused (codeine)

148

Schedule 3 (abuse potential/handling)

moderate - Rx, phone in, no more than 5 refills within 6 months (tylenol with codeine)

149

Schedule 4 (abuse potential/handling)

less - Rx, phone in, no more than 5 refills within 6 months (alprazolam/Xanex)

150

Schedule 5 (abuse potential/handling)

least - OTC (ibuprofen)

151

Requirement for any Rx controlled substance

DEA number

152

Requirement for Schedule 2 drugs

written in pen or typed; some states require triplicate pads

153

Antianxiety agents (2)

Barbiturates & Benzodiazepines

154

Med - no analgesic effect, CNS depression

Barbiturates

155

Med - long acting; used in tx of epilepsy

Phenobarbital

156

Med - short acting, tx of anxiety, insomnia, and alcohol withdrawal, does not affect ANS, can be given prior to sedation

Benzodiazepines

157

Benzodiazepines (4)

Diazepam(Valium), Lorazepam(Ativan), Xanax(Alprazolam), Tranxene

158

Anesthesia Stage 1

Analgesia - remains conscious, breathes regularly, Nitrous maintains

159

Anesthesia Stage 2

Delirium or excitement - unconscious, involuntary movement

160

Anesthesia Stage 3

Surgical anesthesia - major surgery

161

Anesthesia Stage 4

Respiratory or medullary paralysis - stops breathing, if not reversed death will occur

162

Med - most common used for CHF (increases contractile strength); also increases gag reflex and salivation

Digitalis Glycosides
Digoxin (Lanoxin)

163

Med - increases Digoxin levels in ~10% of pts (2)

Tetracycline & erythromycin

164

Med - tx of angina, vasodilator, smooth muscle relaxant, sublingual, emergency kit!

Nitroglycerine

165

Hypertension symptoms (3)

Usually asymptomatic; occ. headache, vision changes, and dizziness

166

First line therapy for hypertension - why

Diuretics - excretes sodium & water/decreases blood volume & pressure

167

Med - Diuretics (2)

Thiazide - xerostomia, orthostatic hypotension
Loop - CHF

168

ACE Inhibitor drugs (3)

Lisinopril (prinivil, zestril)
Captopril (capoten)
Enalapril (vasotec)

169

Most common ACE inhibitor used with CHF

Enalapril

170

ACE inhibitors adverse reactions (3)

avoid postural hypotension, allergic reactions, dry cough; also associated with dysgeusia(taste)

171

Second line therapy for hypertension - why

Beta blockers - decreases cardiac output

172

Anticoagulants (2)

Coumarins & Heparin

173

Coumarin prevents inactive to active conversion of ___

Vitamin K

174

Med - anticoagulant for hospitalized pts, by injection only

Heparin

175

Consideration of Warfarin pts

Dose reduction under advising physician several days before tx

176

Anticonvulsants (3)

Phenytoin (dilantin)
Phenobarbital
Carbamazepine (tegretol)

177

Antihistamines block __ receptors

H1 (bronchospasm and vasodilation)

178

Most common side effect with insulin is __ ;
shortness of breath is not a sign of this

hypoglycemia

179

Insulin dependent

Type 1 - juvenile-onset

180

Non insulin dependent

Type 2 - adult-onset

181

Diabetes Mellitus Drugs (2)

Metformin (glucophage), Glyburide (diabeta, micronase)

182

Med - bronchodilator tx of asthma; reverses bronchospasm

Metaproterenol

183

Types of Asthma inhalers (4)

short acting, corticosteroids, corticosteroid plus long acting, long acting

184

inhaler type - immediate relief; albuterol and pirbuterol

short acting

185

inhaler type - long term to prevent asthma attack; QVAR, Flovent

corticosteroid

186

inhaler type - for asthma, combo; Advair

corticosteroid plus long acting

187

inhaler type - relieves asthma for longer time; Salmeterol (serevent)

long acting

188

Med - treats chronic asthma; erythromycin can cause toxicity

Theophylline

189

Med - can cause insomnia

Albuterol

190

Med - should be avoided in asthmatics (4-19% have hypersensitivity)

Aspirin

191

Med - tx of COPD

Atrovent (Ipratropium); anticholinergics

192

Med - rebound swelling can occur, do not use for more than few days

nasal decongestants

193

Med - removes exudate and mucus

expectorant

194

Med - for non productive dry cough

antitussive

195

Med - a systemic antacid contraindicated in cv pts due to high sodium load

Sodium bicarbonate

196

Antacids can inhibit absorption of (3)

Tetracyclines, Digitalis, Iron

197

Most prevalant GI disease in US

GERD - gastroesophageal reflux disease

198

GERD is treated by 1 of 2 meds

Histamine 2 blocking agent, PPI - protein pump inhibitor

199

Med - should not be used with antacids (disrupts absorption); ex. TagametHB (cimetidine), Pepcid AC (famotidine)

Histamine 2 blocking agents

200

Med - potent inhibitor of gastric acid secretion; ex. Prilosec (omeprazole)

PPI - protein pump inhibitors

201

Med - used for tx of gastric ulcers
*gastric ulcers do not cause gingival bleeding

TagametHB (cimetidine)

202

Med - commonly used for HIV protease inhibitor

AZT (zidovudine)

203

Med - alcohol in combo with ___ will result in dangerously low BP

nitroglycerin

204

Med - acceptable drugs to use during pregnancy (7)

LAs, acetaminophen, PenV, Amoxicillin, Cephalosporins, Clindamycin, Nystatin

205

Med - decreases effectiveness of muscle relaxants

NSAIDs

206

Med - SSRIs (selective serotonin reuptake inhibitors) FDA approved (2)

Prozac (fluoxetine)
Zoloft (sertraline)
Paxil (paroxetine)

207

Med - can promote endometrial carcinoma and breast cancer in post menopausal women, can cause gingival enlargement

estrogen steroid hormone

208

Med - can increase anticoagulant effect of Warfarin; HMG Co-A inhibitor

Lipitor (Atorvastatin)

209

Med - glucocorticoid; risk of infection & delays healing; increase hypertension; adrenal crisis possible; osteoporosis

Prednisone

210

Prednisone side effects (8)

edema, buffalo hump, moon face, peptic ulcer, mental disturbances, increase body hair growth, acne, insomnia

211

Prednisone used for (4)

autoimmune disorders, Addisons disease, inflammatory symptoms, allergies

212

Med - hypothyroidism; long half-life

Synthroid (levothyroxine)

213

Synthroid (levothyroxine) side effects (3)

nervousness, tachycardia, intolerance to heat