Pharmacology Flashcards
(41 cards)
Odontogenic Infection
PEN VK –> Clindamycin (anaerobic effective)
Patient on prednisone with erythema multiform and needs an EXT. What do you do?
- AKA steven johnson syndrome
- The disease is an immune complex (IgM) deposition on superficial microvasculature on the skin and in the oral mucosa –> hypersensitivity syndrome
- Treated with steroids.
- All steroids (at 15 mg/day or 5 mg/day for a month) suppress the adrenal cortex. Thus, if undergoing an EXT an additional “stress dose” steroid should be added.
- Individuals on suppressive doses of steroids take up to 1 year to regain full adrenal cortex function and may show hyper pigmentation (due to high ACTH –> melanocytes)
- Test for adrenal insufficiency = ACTH levels
- 20 mg of cortisol released daily, with 200 mg in times of stress
Anterior pituitary –> ACTH –> adrenal cortex –> glucocorticoids. Thus, if steroids are taken, no ACTH will be produced and long term, the adrenal cortex may atrophy.
Cushing syndrome
- high cortisol (glucocorticoid) –> Fluid retention (BP) + poor wound healing (high glucose levels, low CHO metabolism)
- moon face, tranquil obesity, hair loss
- Caused by Pituitary tumor
Leukemia
Leukemia = Cancer → High WBC that do not properly function (Low RBC and platelets) = Results in gingivitis, perio problems, bruising and hemorrhaging (ecchymosis)
- ALL = childhood = normal lymphocytes become cancerous in the BM = lymphocytes are neither B or T cells and are called null cells = 80% cure rate = Dx: pallor, fatigue, infection = Most responsive to Tx (untreated, death is in 6 months due to hemorrhage or infection)
- AML = most malignant = Auer rods
- CLL = least malignant
- CML = fatal = Philadelphia chromosome 9 and 22 = spongy, bleeding gums
Enlarged lymph nodes, spleen and liver is seen in acute vs chronic leukemias
1:1 Acute: Chronic leukemias
AML, CML line (myelogenous) = higher oral manifestations
Aleukemic leukemia = Leukemia in bone marrow, but no increase in WBC
Subleukemic leukemia = Leukemia cells in the blood, but no increase in WBC
Stem Cell leukemia = too immature to classify = leukemia that are poorly differentiated precursors to lymphoblasts, monoblatsts
Erythroblastosis fetalis
Rh incompatibility → Rh (+) fetus in a Rh (-) mother → anemia form = also from blood type ABO incompatibility = Fetal teeth appear blue, brown or green due to blood pigment deposits on enamel and dentin. Enamel hypoplasia may occur.
Pernicious anemia
megaloblastic = Glossitis is common = low intrinsic factor = low B12 which is needed for RBC formation = shilling 24 hour urine test to determine Vit B12 absorption
Other low B12 = Thalessemia = hemolytic anemias = flaring of max anteriors
Agranulocystosis
low granulocytes (PMN) = caused by anti-thyroid drugs (methimazole) = causes rapid perio disease, oral ulcers, gingival bleeding, jaundice, fever, infected oral cavity = rapid onset = No inflammatory cell infiltration around the lesions!
Cyclic neutropenia is a type of agranulocytosis, with severe gingivitis
Petechiae vs purpura vs ecchymosis
Petechiae
Sickle Cell Anemia
Glutamic acid → valine = X-rays show normal lamina dura and teeth, but the marrow spaces are enlarged due to loss of trabeculae (osteosclerotic areas are seen in large radiolucenct marrow spaces)
RBC life span = 120 days (with Sickle Cell, its now 20 days)
Platelet life span = 7-10 days
Plummer Vinson Syndrome
Fe deficiency anemia association, but idiopathic
Spoon shaped fingernails
RISK: SCC of the tongue
What is the most serious and life threatening blood dycrasias associated with drug toxicity?
Aplastic anemia
Xerostomia causing medication
- Anti-psychotics (anti-depressants)
- Anti-HTN
- Anti-histamines
- Bronchodilators
- Anti-chlinergics
- Sedatives
Its not a disease, its a symptom
LA use in operative restorations decrease salivation by reducing anxiety and sensitivity
Cord packing in a person with heart conditions (including hyperthyroidism) require use of:
Alum (aluminum potassium sulfate)
- Never use ZnCl (causes necrosis, delays wound healing)
ADHD
idiopathic cause, most don’t require Rx.
ADHD Tx (called stimulants)
- Ritalin (methylphenidate)
- Concerta (methylphenidate extended release)
- Adderral (amphetamine + dextroamphetamine)
Rx for trigeminal neuralgia
Carbamazepine (Tegretol)
Drugs metabolized via kidney
NSAIDS morphine ASA ACE meperidine
Possible steroid use!
LA needles
positive aspiration is directly correlated to needle gauge
25 gauge = largest = most accurate due to least likely to bend and not break = used when high aspiration risk.
NO
- CNS (limbic and reticular activator systems)
- Limit: 60:40 N: O2
- No degradation, thus excretion via lungs is 100%
- Correct flow rate: reservoir bag should be 1/3 to 2/3 full
- Patient must have 21% O2, which is what is in normal air
Flight or flight response
syncope
increase in catecholamines –> sweat, palpations, tacky, decrease in peripheral resistance leading to blood pooling in peripheral = vasovagal bradycardia
Ammonium irritates the trigeminal sensory nerves to wake people up
O2 is not used int he hyperventilation syndrome type of syncope.
No NO or 100% O2 for COPD
Patients on tricyclic antidepressants or non-selective beta blockers should avoid
epi
Triazolam is what?
pre-sedative drug
- Cant be taken with anti-fungals (-conazole) since they inhibit CYP 3A4, which is an enzyme that degrades triazolam. Its inhibition will increase concentration, thus toxicity.
Rx abbreviations
h. s. = at bedtime
a. c. = before meals
p. c. = after meals
p. o. = by mouth
sig. = label
Heart burn meds
proton pump inhibitors = prazole
H2 receptor blockers = inhibit histamine in stomach = tidine
antacids = neutralize acid in stomach
EtOH affects the brain centers as follows:
- cerebral cortex
- limbic system
- cerebellum
- hypothalamus and pituitary gland
- medulla (brain stem)
