Pharmacology Flashcards
(207 cards)
1
Q
the _______ of the drug is plotted where the dose is increasing sharply
A
therapeutic range
2
Q
the ________ of a drug may exhibit is plotted where the curve plateaus
A
maximum response
3
Q
a function of the amount of a drug to produce an effect
A
potency
4
Q
the potency is _____ when the dose is smaller
A
greater
5
Q
maximum intensity of effect or response that can be produced by the drug regardless of dose
A
efficacy
6
Q
what happens when you administer more of a drug? - more or less chance of adverse effects? more or less efficacy?
A
same efficacy, more chance of adverse effects
7
Q
half life is related to what?
A
duration of effect
8
Q
the length of drugs effect
A
duration
9
Q
the time it takes for the drug to have an effect
A
onset
10
Q
placed directly into the GI tract by oral or rectal administration
A
enteral
11
Q
drug bypasses GI tract, includes injection, inhalation, and topical
A
parenteral
12
Q
considered safest, least expensive, and most convenient drug administration
A
oral route
13
Q
largest area of absorption
A
small intestine
14
Q
drugs with high first pass effect needs smaller or larger dose
A
larger
15
Q
drug blood levels are less predictable for which drug administration
A
oral
16
Q
are drugs absorbed well or poorly rectally?
A
poorly and irregularly
17
Q
produces most rapid drug response, absorption phase is bypassed, more predictable response, drug irretrievability, allergy, local irritation
A
IV route
18
Q
absorption occurs due to high blood flow in skeletal mm, useful for sustained effect, massage increases absorption
A
IM route
19
Q
places for IM injections
A
deltoid or gluteal
20
Q
route used to administer protein products, may produce sterile abscess or hematoma, ex: insulin and LA
A
Subcutaneous route
21
Q
provides rapid delivery of drug across large surface area or respiratory mucosa
A
inhalation route
22
Q
drug application to body surface, most effective in keratinized tissue, used when local effect is desired, may have systemic uptake
A
topical
23
Q
injected into dermis, ex: TB skin test
A
intradermal route
24
Q
topical contraindicated when
A
ulcerated, burned, abraded skin
25
study of how drug is absorbed, distributed, metabolized, and excreted by the body
pharmacokinetics
26
readily move across most biological membranes by diffusion (only drugs to pass blood brain barrier)
lipid soluble drugs
27
transfer of drugs from site of administration to blood stream
absorption
28
absorption depends on what factors
drug solubility, circulation at deposition site, surface area, drug pH, temp at site, mechanical factors (massaging injection site)
29
process b which a drug reversibly leaves the blood stream and enters system
distribution
30
after being absorbed, drugs go where?
organ with highest blood flow,
oral- liver
sublingual- heart
31
distribution dependent on what?
blood flow, capillary permeability (blood brain barrier), binding drugs to protein
32
an abundant plasma protein that binds to a remarkably wide range of drugs
plasma albumin
33
major site for drug metabolism
liver
34
does elimination terminate drugs effect?
yes
35
drugs are most often eliminated by biotransformation or excretion to where
urine or bile
36
what excretion is most important?
renal
37
routes of excretion
renal, liver, lungs, bile, GI, sweat, milk, exhalation, saliva, ging crevicular fluid
38
drugs may be excreted or unchanged as
metabolites
39
major route of Fl elimination
excretion in urine
40
factors that alter drug effects
pt compliance, physiological factors, tolerance, pathologic state, time of administration, route of administration, sex, genetic variation, drug interactions, environment, age/weight
41
amount of desired effect is excessive, dose relation
toxic reaction
42
dose related reaction that is not part of the desired therapeutic outcome, non therapeutic action of drug such as the drowsiness that occurs with antihistamine use
side effect
43
abnormal drug response that is usually genetically related
idiosyncratic reaction
44
hypersensitivy response to a drug to which the pt has been previously exposed, not dose related!
drug allergy
45
casual relationship between maternal drug use and congenital abnormalities
ex: thalidomide induction fo phocomelia (shortened limbs)
teratogenic effects
46
local tissue irritation, ex: necrosis at site of injection
local effect
47
effect of one drug is altered by another
drug interactions
48
immune hypersensitivity reaction, mild or life threatening
allergic reactions
49
tx of mild allergic reactions
antihistamine with to w/ out steroids
50
tx of anaphylactic reaction
epi SQ w/ or w/ out steroids
51
meds for ging enlargement
phenytoin, cyclosporine, CCBs (nifedipine, verapamil, amlodipine)
52
ging overgrowth associated with phenytoin generally occurs where
ant facial region
53
do digoxin, beta blockers, and tegretol cause ging overgrowth?
no
54
ANS system controls what?
automatic, involuntary responses
55
ANS responsible for
BP, HR, GI motility, salivation, bronchial/smooth mm tone
56
two divisions of ANS
parasympathetic and sympathetic
57
NTM for rest and digest system
ACH
58
used to mimic the effects of the PNS, also known as cholinergic agents or muscarinic drugs
parasympathomimetics
59
parasympathomimetics used to tx what?
xerostomia, urinary retention, glaucoma
60
cholinergic agents derived from plant alkaloids
pilocarpine- stimulates saliva
| nicotine
61
contraindications for parasympathomimetics
asthma, peptic ulcer, cardiac disease, GI/urinary obstruction
62
inhibits ACH effects by blocking ACH receptors
anticholinergic agents
63
examples of anticholinergics
atropine, immodium, scopolamine
64
prototype of anticholinergic, use pre-op to decrease salivary flow in dental setting
atropine
65
used for motion sickness, anticholinergic
scopolamine
66
SNS NTM
NE
67
sympathomimetics, or adrenergic agents, mimic effects of SNS
epi, albuterol, ritalin, adderal, dopamine, clonidine (opiate and benzo withdrawal)
68
adverse effects of adrenergic agents
CNS disturbances (anxiety, fear, tension, headache, tremor), cardiac arrhythmias, cerebral hemorrhage, pulmonary edema
69
contraindications for sympathomimetics
angina, uncontrolled hypertension/hyperthyroidism
70
beta receptor located mainly in heart
beta 1
71
beta receptor located all over body, but mainly in lungs
beta 2
72
action of beta 1 receptors
increase heart rate/bp, heart needs more O2
73
prototype of nonselective b-adrenergic blockers, lowers BP by lowering CO, adverse reactions- bronchoconstriction, arrhythmias
propranolol
74
reduces aqueous humor in the eye, used topically in the tx of glaucoma
timolol (timoptol, timoptic)
75
cardioselective b-blocker, eliminates bronchoconstrictor effect, used in tx of hypertensive asthmatic pts
atenolol
76
cardioselective beta blocker, used for hypertension, prevention of MI and angina
metroprolol (lopressor)
77
limit epi containing LA to ___ carpules in pts taking non selective beta blockers due to potential increase in BP
2
78
prototype of non-narcotic analgesias, considered a NSAID, analgesia, antipyretic, anti-inflammator, inhibits PG synthesis, fever reduced through action on hypothalamus
aspirin
79
side effects of aspirin
interferes with clotting, GI irritation, hypersensitivity, Reye's syndrome, toxicity (salicylism)
80
symptoms of aspirin toxicity
GI upset, vomiting, dim vision, tinnitus, coma, respiratory and metabolic acidosis, death from respiratory failure
81
Considered a NSAID, inhibits PG synthesis, analgesic, antipyretic, anti-inflammatory, side effects- interferes with clothing, GI irritation
Ibuprofen (advil, motrin, nuprin)
82
can you take ibuprofen with aspirin?
no
83
considered NSAID, reversible inhibits COX 1 and @ enzymes, analgesic, antipyretic, anti-inflammatory, prolongs bleeding time, increased risk for CV thrombotic events
Naproxen (aleve)
84
taking an NSAID and phenytoin can do what
increase phenytoin levels
85
analgesic, antipyretic, prototype- Tylenol, side effects and interactions are rare, drug of choice for pts on anticoagulants or with PUD
Acetaminophen
86
drug of choice following SRP
acetaminophen
87
acetaminophen overdose can result in
hepatotoxicity, liver necrosis, death
88
used for pain when non opioids fail, block pain receptors in the brain without loss of consciousness
narcotic/opioid analgesics
89
narcotic/opioid prototype
morphine
90
most commonly used opioid in dentistry
codeine
91
sign of overdose/addiction of opioid is ___ pupils
pinpoint
92
overdose of narcotics
respiratory depression and death
93
emesis is a ___ of codeine
side effect
94
does codeine cause constipation
yes it can
95
opioid antagonist, used to tx opioid overdose
narcan
96
tx of narcotic withdrawal and dependance, taken orally for once a day, heroin, morphine, other opioids,
methadone
97
things to note for heroin users
pinpoint pupils, discolored tongue, use NSAIDs for pain relief
98
the ability to kill bacteria, irreversible action
bactericidal
99
the ability to inhibit or slow the multiplication or growth of bacteria
bacteriostatic
100
lowest concentration needed to inhibit visible growth of an organism
minimun inhibitory concentration (MIC)
101
natural or acquired ability of an organism to be immune or to resist the effects of an anti-infective agent
resistance
102
range of activity of a drug
spectrum
103
occurs when the combo of 2 antibiotics produce more effects that if their individual effects were added
synergism
104
occurs when a combo of 2 agents produce less effect than either agent alone
antagonism
105
most commonly prescribed antibacterial in the dental profession
penicillin VK
106
penicillin inactivated by gastric acids
penicillin G
107
work by destroying bacterial cell wall integrity which leads to lysis, most effective against rapidly goring organism (logarithmic phase)
penicillin
108
antibiotic most likely to produce anaphylactic reaction
penicillin, usually rash
109
______ in combo with amoxicillin (known as augmentin) prevents penicillinase from breaking amoxicillin down
clavulanic acid
110
may be used systemically to tx NUG/NUP, mixing this with other antibiotics usually results in antagonism, bacteriostatic, work by inhibiting protein synthesis
tetrecycline
111
inhibit collagenase production- may be used in chronic perio
tetracyclines
112
effective against obligate anaerobes only, has anabuse like reaction- alcohol should be avoided (even mouth rinse)
nitromidazoles (metronidazole)
113
antiTB drugs
rifampin, isoniazid, pyrazinamide, ethambutol (all 4 drugs need to be taken at same time to tx active TB)
114
TB, red urine, tears, saliva
rifampin
115
TB, may lead to hepatotoxicity
Isoniazid, Pyrazinamide
116
TB, decreased red/green color discrimination, decreased visual acuity
ethambutol
117
if taking only isoniazid and rifampin only, what does this mean?
preventative
118
___ consecutive neg sputum tests needed to determine someone with TB is no longer contagious
3
119
antigen used to aid in the diagnosis of TB, known as mantoux skin test
purified protein derivative
120
topical, most frequently used anti fungal in dentistry
nystatin
121
diflucan, systemic med used in tx of oral candidiasis
fluconazole, anti fungal
122
clotrimazole
mycelex, anti fungal
123
ketoconazole
Nizoral, anti fungal
124
cardiac conditions you need premeditated for to precent IE
artificial heart valves, history of IE, congenital heart defects
125
cardiac conditions that no longer need premedicated for IE
mitral valve prolapse
126
what to administer for pre med if not allergic to penicillin
amoxicillin 2000 mg 30 min to 1 hr before
127
what to use for premed if allergic to penicillin
Cephalexin 2000 mg 1 hr before, clindamycin, azithromycin, clarithromycin, cephradine 2000mg 1 hr before for joint replacement
128
non cardiac conditions for pre med
renal dialysis shunt, ventroculoatrial hydrocephalic shunt, NOT STENTS
129
preservative/antioxidant for vc in LA
sodium metabisulfite or sodium bisulfate
130
how does LA work?
inhibit the influx of sodium ions
131
metabolized in blood, greater potential for allergic reactions, not available in carts
esters
132
examples of esters
procaine, benzocaine, tetracaine, proproxycaine
133
metabolized in liver, allergic reactions uncommon
amides
134
LA, most commonly used anesthetic solution in dental offices, profound anesthesia, medium duration, MRD 300mg, safe for lactation, can also have topical, comes in 1:100,000
Lidocaine (Xylocaine)
135
LA, not effective topically, can have with Lev, shorter duration than Lido, max dose 300 mg
Mepivacaine (Carbocaine)
136
LA, longer duration, 1:200,000, don't use in pts with O2 problems, can cause methomoglobinemia
Prilocaine (citanest, citanest forte)
137
LA, longest duration, max dose 90 mg
Bupivacaine (Marcaine)
138
new LA, 4% 1:100,000, increase potency, max dose 500 mg
Articaine (Septocaine)
139
LAs you can get w/ out vc
lido, mepivacaine, citanest
140
LA that always have vc
articaine, bupivacaine
141
maximum quantity of a drug that can be safely administered during an appt
MRD-max recommended dose
142
to determine MRD do what?
MRD x pt weight
143
an LA is a base or acid?
weak base
144
2 major classes of anti anxiety agents
barbiturates and benzodiazepines
145
principle effect: CNS depression, no analgesic effect, anti anxiety, phenobarbital is a long acting drug of this type used in tx of epilepsy
barbiturates
146
useful in short term tx of anxiety, insomnia, and alcohol withdrawal, have sedative properties, no antipsychotic or analgesic activity, smoking reduces effectiveness, can be used for apprehensive dental pts, mm relaxer, used for TMJ problems, reverses status epileptics and LA overdose
Benzodiazepines
147
what type of drugs are these? diazepam (valium), lorazepam (ativan), xanax (alprazolam), tranxene
benzos
148
potent CNS depressant, produce reversible loss of consciousness and insensitivity to painful stimuli
general anesthetics
149
stage of anesthesia, reduced pain sensation (development of anesthesia), pt remains conscious, end of this stage is marked by loss of consciousness
stage 1- analgesia
150
stage of anesthesia, begins with unconsciousness and is associated with involuntary movement and excitement
stage 2- delirium or excitement
151
stage of anesthesia, most major surgery performed in this
stage 3-surgical anesthesia
152
stage of anesthesia, complete cessation of all respiration, if this stage is not immediately reversed, pt will die
stage 4- respiratory or medullary paralysis
153
what is normally used for IV anesthetic?
short acting barbiturates or IV benzos
154
most commonly used inhaled anesthetic, rapid onset/recovery, raises pain threshold, exhaustion is the route of excretion, no biotransformation
Nitrous oxide
155
contraindications for N2O
COPD, upper respiratory infection -including stuffy nose, emotional instability, pregnancy, cystic fibrosis, language barrier
156
N2O abuse symptoms
vitamin B12 deficiency, dementia and parkinson symptoms
157
CV contraindications for dental tx
acute MI, unstable angina, uncontrolled CHF, uncontrolled arrhythmias, significant uncontrolled hypertension
158
most common drug used in tx of CHF (increases contractile strength), Digoxin (lanoxin) most common, increases gag reflex and salivation
Digitalis Glycosides
159
problems with digitalis glycosides
in combo with sympathomimetics, digoxin can lead to cardiac arrhythmias, use caution in in LA with vc, tetracycline and erythromycin increase digoxin blood levels
160
drug of choice for acute angina, vasodilator, smooth mm relaxant
nitroglycerin
161
most often pts are asymptomatic, but can experience what symptoms
headache, visual changes, dizziness
162
considered 1st line therapy for hypertension, promotes excretion of sodium and water, decreases blood volume and pressure
diuretics
163
hypertension med, hydrochlorothiazide is most common, frequently associated with xerostomia, must avoid orthostatic hypotension
thiazide diuretics
164
used in management of hypertensive pts with CHF, Furosemide (Lasix) most common
Loop diuretics
165
lowers BP by decreasing cardiac output, considered 2nd line therapy, ex: propranolol (inderol- non selective) and metoprolol (lopressor-selective)
b-adrenergic blocking agent
166
work by producing systemic vasodilation by blocking vasoconstriction in smooth mm of bcd, not reduced by NSAIDs, can cause xerostomia and ging enlargement
CCBs
167
what type of drugs are these?
| Cardizem (dilitiazem), norvase (amlodipine), verapamil (isoptin, calan), nifedipine (procardia, adalat)
CCBS- know these!
168
BP lowered by blocking the conversion of angiotensin I to angiotensin II (causes vasodilation), adverse reactions- hypotension, allergic reactions, dry cough
Angiotensin Converting Enzyme (ACE) Inhibitors
169
what type of drugs are these?
Lisinopril (prinivil, zestril), Catopril (capoten), Analapril (vasotec)
*** end in -pril
ACE inhibitors
170
NSAIDs decrease effectiveness of what?
ACE inhibitors
171
one of most commonly employed anticoagulant agent used in hospitals, injection only
heparin
172
often used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or bvs, into coagulant
plavix (clopidogrel)
173
most serious drug reaction of warfarin
aspirin- increase bleeding tendencies, antibiotics also effect them
174
anticonvulsant, ging enlargement occurs, often used with phenobarbital
Phenytoin (dilantin)
175
most common barbiturate used in tx if epilepsy, most common side effect- sedation
phenobarbital
176
used for partial seizures, tx trigeminal neuralgia, anticonvulsant
carbamazepine (tegretol)
177
benedryl most common, mild allergic reactions, cause xerostomia and sedation, block antihistamine receptors (involved in respiratory function- vasodilation and bronchospasm)
antihistamine
178
common examples of oral hypoglycemics
metformin (glucophage) and glyburide (diabeta, micronase)
179
diseases tx with drugs include?
asthma, COPD, upper respiratory tract infections
180
midl asthma, use what?
inhaled b agonist- usually albuterol
181
rapidly alleviates an acute attack of asthma when taken by inflation but is rarely used as a bronchodilator
isoproterenol
182
produces dilation of the bronchioles and improves airway function, useful as bronchodilator in the tx of asthma and for reversal of bronchospasm
metaproterenol (alupent)
183
type of asthma inhaler, provide immediate relief, albuterol (proventil, ventolin) and pirbuterol (maxair)
short acting bronchodilators
184
used in long term to prevent asthma attacks
corticosteroids
185
oral medication used to tx chronic asthma and the bronchospasm associated with emphysema and chronic bronchitis
theophylline
186
what asthma drug can cause insomnia
albuterol
187
what should you avoid in asthmatics?
aspirin
188
1st line tx for COPD
anticholinergics
189
drug of choice for long term management of COPD
ipratropium (atrovent)
190
b-adrenergic agonists that act to constrict the BVs of the nose, font use for more then 3-5 days
nasal decongestants
191
drugs that promote removal of exudate or mucus from respiratory passages
expectorants
192
may contain opioids or related agents used for the symptomatic relief of a nonproductive cough
antitussives
193
partially neutralize hydrochloric acid in the stomach, can inhibit absorption of tetracyclines, digitalis, iron, GI drug
antacids
194
most prevalent GI disease in US
GERD
195
2 ways GERD is tx-
histamine blocking agents (don't use with antacids), and PPIs (potent inhibitor of gastric acid secretion)
196
name PPIs
omeprazole (prilosec)
197
name histamine blocking agents
cimetidine (tagametHB), famotidine (pepcid AC)
198
if taking tagamet, what does that mean?
usually being tx for ulcers
199
what type of drugs are these?
| lipitor (atorvastatin), mevacor (lovastatin)
statin drugs used to lower cholesterol
200
what are these used for?
| Zidovudine (AZT), Didanosine (ddl), Zalcitabine (ddC), Stavudine (d4T), Laninvudine (3TC)
HIV protease inhibitors
201
what is levothyroxine?
synthroid, thyroid hormone replacement
202
if sythroid use is too low, pt might be
cold intolerant, if taken off too soon can cause myxedema coma
203
may cause ging enlargement, steroid hormone, nausea, vomiting, can promote endometrial carcinoma, lowers LDL, increase HDL
estradiol
204
exogenous thyroid hormone used in tx of hypothyroidism, give once daily because of long half life, toxicity- nervousness, heart palpitations, tachycardia, intolerance to heat
synthroid
205
antihyperlipidemic agent which limits cholesterol synthesis and increases catabolism of LDL, decrease triglyceride levels, GI upset common, don't take with Warfarin
Lipitor (atorvastatin)
206
another antihyperlipidemic drug increases catabolism of LDL, inhibits HMG Co-A
Mevacor (lovastatin)
207
intermediate acting glucocorticoid, reduces inflammatory response, suppresses immunity, can exacerbate hypertension, osteoporosis with long use
Prednisone
