Pharmacology IV Flashcards Preview

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Flashcards in Pharmacology IV Deck (239):
1

T/F
The anticipation of pain will cause a greater perception of pain.

NSAID

True

Non-Steroidal Anti Inflammatory Drug

2

An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Pain

3

Absence of pain in response to a stimulus that is normally painful

Analgesia

4

Absence of all sensory modalities

Anesthesia

5

What are endogenous morphines called?

Endorphins

*CNS - analgesia, euphoria

6

What was the first endorphin to be purified and acts as a delta receptor?

Enkephalins

"in the head" - greek

7

What endorphin has a high affinity for kappa-opioid receptor?

Dynorphins

8

Describe the 2 types of pain and what drugs alleviate these.

Dull, aching, inflammatory - NSAIDS

Sharp, piercing, lancinations - Narcotics

9

T/F
Narcotics are anti-inflammatory

False

NOT anti-inflammatory

10

What 2 types of drugs are best for Mild to Moderate pain?

Severe?

Salicylates, NSAIDS

Opiates

11

What type of analgesics act primarily at peripheral nerve endings, have antipyretic effects (mediated centrally) and inhibit prostaglandin synthesis?

Non-opioid Analgesics

12

What type of analgesic act primarily within the CNS and have depressive effects that reduce the response to pain?

Opioid Analgesics

13

T/F
Analgesia and anti-inflammatory effects in the periphery are obtained using Salicylates and NSAIDS.

True

14

CNS analgesia, anti-inflammtory effects, and antipyretic effect can be achieved using what 3 drugs?

NSAIDS

Acetaminophen (Tylenol)

Opiates (have more side effects)


***not Salicylates

15

______ are True Analgesics, while ______ only acts as analgesics.

NSAIDS

Opiates

16

______ inhibit prostaglandin synthesis by inhibiting COX.

NSAIDS

17

What 2 types of Prostaglandins do NSAIDS inhibit?

Cytoprotective

Inflammatory

18

______ is a "miscellaneous" analgesic and NOT an NSAID and works on COX 3 in the CNS

*it is not anti-inflammatory

Acetaminophen (Tylenol)

19

By what pathway do COX affecting drugs inhibit prostaglandins?

Cyclooxygenase > Endoperoxides > Prostaglandins (protective/inflammatory)

20

COX 1 controls what?

COX 2 controls what?

Cytoprotective/homeostatic Prostaglandins

Inflammatory Prostaglandins

21

Name 3 classes of Cytoprotective prostaglandins controlled by COX1.

Prostacyclin - stomach, endothelium

Prostaglandin E2 - kidneys

Thromboxane A2 - platelets

22

What type of Cyclooxegenase controls/maintains Renal blood flow, Body temp, BP, Heart rate, stomach acid, and Reproduction?

COX1

23

What explains ulceration/bleeding in GI tract due to taking NSAIDS?

COX1 inhibited

*protective mucous lining decreased

24

What drug blocks COX2 only?

Celebrex

25

What drug blocks COX 3?

Acetaminophen

*CNS suppression of prostaglandin synth
*NON anti-inflammatory

26

Non-selective NSAIDS block _______.

Selective NSAIDS block ______.

______ blocks COX 3 and is not categorized as an NSAID.

COX 1 and COX 2

COX 2 only (Celebrex - celecoxib)

Tylenol

27

T/F
Acetylsalicylic Acid reduces pain by inhibiting prostaglandin synth and works on COX 1 and 2.

True

28

Aspirin produces a peak effect on an empty stomach in _______.

30 minutes

29

Aspirin is widely distributed and ____ to plasma proteins

Poorly bound

30

Aspirin displays ______ kinetics, so its half-life is dose-dependent.

Zero-order kinetics

*constant amount, rather than constant %, is eliminated

31

Aspirin is a ____ and a ______ and a ______.

Analgesic

Antipyretic

Anti-inflammatory

32

What is the anti-inflammatory dose of Aspirin?

What will this dose do if chronically taken?

3500 mg/day

GI ulceration/bleeding

33

A dose of aspirin greater than _____/day is considered _______.

What was this dose once used to treat?

What is used to treat gout now?

3 g Uricosuric (excrete uric acid)

Gout


Probenecid (Benemid)

34

Low doses of aspirin can have the opposite effect of high doses in what way?

Hx of what makes aspirin no longer a choice?

Uric acid retention


Gout

35

How long does the anti-platelet effect of Aspirin last?

7-10 days

*Irreversible effect (lasts for life of platelet)

36

Aside from Aspirin's anti-platelet effect, what is another way it reduces blood clots?

COX inhibitor shuts down Thromboxane A2

*Thromboxane A2 causes vasoconstriction and platelet aggregation

37

What is the low dose of Aspirin used to prevent stroke/heart attack?

81 mg

38

GI pain through direct irritation, inhibition of protective prostaglandins, and the exacerbation of pre-existing ulcers, gastritis, hiatal hernia, or reflux disease is caused by what drug?

*also bleeding due to irreversible effects on platelets

Aspirin

39

What is contraindicated in children with viral infections?

What is this called?

How does it manifest?

Aspirin

Reye's Syndrome

Diarrhea/vomiting concentrated aspirin in blood.
Hepatotoxicity.
Fluid on brain (encephalitis)

40

At high doses, aspirin can cause tinnitus, confusion, dizziness, etc, along with Acidosis. This leads to ______.


_______ ensues.

Hyperventilation

Respiratory/Metabolic Acidosis

*death from OD on aspirin usually acidosis/electrolyte imbalance from 6-10 grams

41

T/F
Aspirin allergy is less than 1%, but many report allergy (usually stomach problems).

True

42

If allergic to Aspirin, what is a cross-sensitivity?

other NSAIDS

*avoid aspirin, all NSAIDS

43

What is the Aspirin hypersensitivity triad?

Aspirin hypersensitivity

Asthma

Nasal polyps

44

Describe the mechanism of the Aspirin allergy:

COX cascade inhibits PGE2 (bronchodilator)

Forms leukotrienes (bronchoconstrictors)

*looks like asthma attack

45

Due to the mechanism of Aspirin allergy, what is contraindicated for use?

Asthma

46

What are the 5 Contraindications for Aspirin?

Allergy

Chronic gastritis

Gout

Anticoagulants (warfarin/coumadin)

3rd Trimester (bleeding, decreases prostaglandins responsible for uterine contraction)

***low-dose aspirin in pregnancy has many benefits and is not teratogenic

47

Full strength dose aspirin:

prevention dose aspirin:

325 mg

81 mg

48

How can a person taking Aspirin (damaged platelets) still clot?

Fibrin

Thromboxane A2 still made by endothelial cells

49

What compound does COX mediate that affects formation of prostaglandin precursors and thromboxanes?

Arachidonic Acid

50

How are NSAIDS and Aspirins effects different on platelets?

NSAIDS reversible on blood platelets

51

Ibuprofen has a half life of _____

Naproxen has a half life of _____

1 day

4 days

*this might be 4-5 half lives - time to be off drug before procedure

52

What prophylactic can ibuprofen interfere with?

Low dose aspirin - 81 mg

*interferes with anti-platelet effect

53

In order to not interfere with Aspirin's effects, ibuprofen should be given _____ after aspirin is ingested or _______ before aspirin ingestion.

40 minutes after

8 hrs before

54

What are 5 adverse side effects of NSAIDS?

Cardiovascular - MI, stroke, hypertension

Renal - function, nephrotoxicity

GI - bleeding in elderly, more than 3 drinks/day

CNS - dizziness, tinnitus, sedation

Skin rxns

55

______ is worse for kidneys and ____ is worse for liver, however both with damage both.

Ibuprofen

Tylenol

56

What syndrome sloughs skin from palms/feet and is associated with hypersensitivity to NSAIDS?

Steven-Johnson syndrome

57

How do NSAIDS damage the kidney (lead to necrosis in some cases)?

Prostaglandin inhibition shuts down renal blood flow

*5 days high dose dangerous for kidney

58

ibuprofen OTC dose

Rx dose:

onset:

duration:

1/2 life:

200 mg

400-800 mg

30-60 min

4-6 hrs

2-4 hrs

59

ibuprofen Dental dosing children:

adults:

max adult daily dose:

4-10 mg/kg (every 6-8 hrs)

200-400 mg (every 4-6 hrs)

1200 mg

60

ibuprofen 400-600 mg every ___ hrs for 24 hrs before dental procedure decreases post-op _____ and hastens healing time

6

edema

61

What is the "ceiling" for dental pain in an ibuprofen dose?

400 mg

*chronic inflammatory pain pts take more - but days/weeks to reach effects

**beyond 400 little analgesic effect gained

62

3 names for naproxen:

Aleve

Anaprox

Naprosyn

63

Naproxen analgesic onset:

half life:

duration:

dental dose:

max/day:

1 hr

12-17 hrs

analgesic less than 7 hrs, anti-inflammatory less than 12 hrs

500 mg initial, 250 every 6-8 hrs

1250 mg/day

64

Name 4 important NSAIDS used in dentistry (in other category):

piroxicam (Feldene) - longest lasting nsaid (45-50 hr 1/2 life)

flurbiprofen (ANSAID)

ketorolac (Toradol) - injection, opioid level relief

diflunisal (Dolobid)

65

T/F
Prescription drugs, expensive drugs, colored pills all give more pain relief (placebo effect)

True

66

T/F
Celebrex (celecoxib) is the only COX 2 selective inhibitor and was originally approved for arthritis pain.

COX 2 isn't expressed in GI, platelets, or kidneys

True

True

67

What drug reduces risk for adenocarcinoma of the colon, improves lung cancer, and delays onset/degree of Alzheimer's?

Celebrex (celecoxib)

68

T/F
Celebrex (celecoxib) is contraindicated with low-dose Aspirin use.

False

*perfectly ok to use with

69

T/F
Celebrex (celecoxib) is contraindicated with Aspirin/NSAID allergy?

True

70

What is the main side effect of Celebrex (celecoxib)?

What atom does Celebrex (celecoxib) contain that may cause allergy?

Unanticipated bleeding

Sulfa

71

T/F
Celebrex (celecoxib) in contraindicated with Hx of gastritis/gastric ulcer/GI bleeding AND pregnancy

True

*unanticipated bleeding side effect

72

What drug, used for autoimmune diseases and cancer, does ibuprofen interfere with?

How does ibuprofen interfere?

Methotrexate

Metabolic breakdown - causes toxicity

73

What 2 drugs interfere with Methotrexate?

How?

Ibuprofen - metabolic breakdown (toxicity)

Aspirin - displaces and interferes with clearance (toxicity)

74

Lithium excretion is blocked by what?

NSAIDS

75

How can Aspirin and NSAIDS be taken together?

Separate dosing intervals

76

Taking several NSAIDS together can have an additive toxic effect.

Alcohol increases GI bleeding associated with NSAIDS

True

True

77

_______ and ________ can decrease the effectiveness of many common antihypertensive medications.

(diuretics, beta blockers, ACE inhibitors)

Aspirin

NSAIDS

78

7 contraindications/cautions with NSAIDS

Asthma

CV

Renal

Coagulopathies

Ulcers (stomach, colitis)

Allergy to Aspirin/other NSAIDS

Geriatrics

79

Acetaminophen acts on COX 3 in CNS (more than peripheral) and doesn't do what 3 things?

Inhibit platelet aggregation

Irritate GI tract

Cause bronchoconstriction

80

Acetaminophen is hepatotoxic and excreted by what?

Kidneys

81

Why shouldn't you take Tylenol for arthritis?

NOT anti-inflammatory

82

Tylenol is equally potent to ______

No ____ irritation

Aspirin

Gastric

83

What is the max dose acetaminophen/day?

4000 mg (4 grams)

*although Tylenol brand now limits to 3 grams/day

84

Acetaminophen and Aspirin are equally _____ and equally ______, but ______ is less useful clinically.

Efficacious

Potent

Acetaminophen (b/c NOT anti-inflammatory)

85

Three characteristics absent Acetaminophen:

2 characteristics it has:

No anti-inflammatory effect, no effect on uric acid, no anti-coagulant effects

Analgesic and Antipyretic

86

Acetaminophen dental dosing Children:

Adults:

Max adults:

Max in pts regularly consume alcohol:

10-15 mg/kg (every 4-6 hrs)

325-650 mg (every 4-6 hrs)

4 grams/day

2 grams/day

87

2 situations to avoid using Acetaminophen:

Liver disease

Alcoholism

*more than 3 drinks/day increases risk liver damage
**alcohol stimulates (enzymes that lead to) acetaminophens toxic metabolite

88

Acetaminophen combined with _______ leads to an increased bleeding risk.

Warfarin (coumadin)

*enhanced anticoagulation
***increases 10-fold according to one study

89

T/F
Aspirin is more effective if given prior to initiation of pain

True

90

T/F
Aspirin and NSAIDS are Analgesics, Antipyretics, and Anti-inflammatory

Tylenol is an Analgesic and Antipyretic

True

91

Describe the GI side effects of Aspirin:

Dyspepsia, nausea, vomiting, gastric bleeding

*direct irritation/inhibition cytoprotective prostaglandins
*stimulated trigger zone in CNS for nausea/vomiting
*exacerbates ulcers, etc (acid)

92

NSAID analgesia occurs at what dose?

NSAID anti-inflammatory effects occur at what dose?

up to 400

over 400 (400-800 4x/day)

93

Prescription for ibuprofen for Dental Pain:
Rx:

Disp:

take:

Do not exceed:

Rx: ibuprofen 400 mg tablets

Disp: 16 tablets

Take 1-2 tablets by mouth 3-4 timer per day as needed for pain. Do not exceed 8 tablets within 24 hours.

94

What is the longest lasting NSAID?

dose?

half life?

piroxicam (Feldene)

10 mg 2x/day

45-50 hrs

95

flurbiprofen (ANSAID) dose:

onset:

1/2 life:

100 mg every 12 hrs

1-2 hrs

5.7 hrs

96

ketorolac (Torodol) use up to ___ days.

Primarily given by _____.

Causes _____ damage.

5

injection

Renal

97

diflunisal (Dolobid), aka?

onset:

duration:

1/2 life:

Super Aspirin (but just like aspirin)

1 hr

8-12 hrs

8-12 hrs

98

Presciption for diflunisal (Dolobid) Rx:

Disp:

Sig:

Rx: Dolobid 500 mg tablets

Disp: 16 tablets

Sig: Take 2 tablets initially, then 1 tablet every 8-12 hours as needed for pain

99

T/F
Cox 2 inhibitors are contraindicated with pregnancy

True

*no ibuprofen if prego

100

For high risk surgeries, Aspirin use must be discontinued _______ prior to surgery.

1-2 weeks

*platelets must regenerate
**don't take off if known risk factors for Heart Disease

101

NSAIDS should be discontinued by counting 4-5 half lives prior to surgery to prevent what?

Bleeding

*platelet effects reversible

102

What increases the Excretion of Aspirin?

Alkalinization by sodium bicarb (aspirin more ionized and excreted more)

103

T/F
Aspirin inhibits prostaglandin synth in the hypothalamus

(which prevents the induction of peripheral vasodilation/sweating)

True

104

High dose aspirin, above ____ mg, is used for arthritis management.

True

*chronic use leads to GI probs

105

T/F
Opiates are indicated to manage Moderate to Severe dental pain if the patient either cannot take NSAIDS or have some Contraindication for NSAIDS

True

106

Narcotics = Opiates = Opioids

What is found in Opium?

Opioids latest/correct term

Alkaloids found in Opium

107

T/F
Opioid receptors are the site of opioid action

True

*mediate specific pharmacologic effects

108

Where is the Analgesic Effect of Opiates produced in the brain?

Midbrain pain-modulating circuit

medulla/spinal cord/dorsal horn

109

Where are high concentrations of Endogenous Opioid peptides found?

Where does Systemic Administration of Opiods produce its analgesic effect?

Descending Pain Modulating Circuit

CNS - widely distributed in spinal cord and brain

110

The Pain Suppressor System (descending) involves ________ and _______ neurotransmitters.

Serotonin

Enkephalin-mediated (endogenous)

111

What are the 3 major components that mediate the Descending Analgesia System?

*opioids put directly into these 3 areas will have profound effects

Periaquaductal Grey Matter (midbrain)

Nucleus Raphe Magnus (medulla)

Inhibitory Neurons (dorsal horns)

112

Projections from the Periaqueductal Gray Matter (midbrain) are _____ and highly sensitive to morphine.

Projections from the dorsolateral pons are ______.

Serotonergic

Noradrenergic

113

T/F
Endogenous Opioids act as neurotransmitters, and are implicated in the mechanisms for the Placebo effect.

True

*brain actually releases endogenous opioids.

114

Name 3 groups of Endogenous Opioids.

Endorphins

Enkephalins

Dynorphins

115

Endogenous Opioids (endorphins, enkephalins, dynorphins) act through what 3 different G protein coupled receptors?

mu

delta

kappa

116

T/F
Endorphin can refer to all endogenous opioid peptides or a single specific opioid called Beta-endorphin.

True

117

What 2 sites produce Endogenous Opioids?

Pituitary Gland

Hypothalamus

118

Beta-Endorphin acts via _____ and influences ______ and ______.

Enkephalin is widely distributed and acts via ____ and _____.

Dynorphin is found in the spinal cord, brain, hypothalamus and acts via _____.

mu, appetite, sex

mu, delta

kappa

119

What endogenous endorphin acts via mu?

via mu and delta?

via kappa?

Beta-endorphin

Enkephalin

Dynorphin

120

Endorphins are comprised of ____ families of enkephalin-sequenced peptides.

3

*Proenkephalin A and B, and Pro-opiomelanocortin are the precursor molecules

121

Name 4 places Endorphins are found:

Pancreatic Islet Cells

Sympathetic Nervous System

Adrenal Medullary Chromaffin Cells

CNS

122

B-endorphin is distributed all over the brain, is involved in BP, temperature, food intake, and acts via ____ receptor.

Mu

123

Why do opioids cause constipation?

Mu receptors in GI tract

124

What class of endogenous opioids act as weak analgesics that mimic opiate activity?

What class are responsible for producing analgesia in placebo responders in acupuncture?

Enkephalins

Enkephalins

125

What accounts for the side effects (resp. depression, pupil constriction, decrease in body temp, and decrease in gut motility) of opioids?

Opiate receptors found in tissues NOT involved in Analgesia.

126

T/F
The recognition site (receptor site) is highly specific for Opioids

True

127

Name 5 Opioid receptor subtypes:

*which has best analgesic effect and is most addictive?

Mu (best analgesic/most addictive)

Delta

Kappa

Epsilon

Sigma (no longer opioid receptor)

128

What are the 2 subclassifications of Mu and what are their effects (3/1)?

Mu1 - Supraspinal analgesia, euphoria, physical dependence

Mu2 - Respiratory Depression

*Mu1 causes addiction

129

A drug must bind to ____ to be physically addicting

Mu

130

Drugs that bind to Mu have the best _____.

____ is the downside.

Analgesic properties

Addiction

131

What opioid receptor causes Spinal analgesia, miosis (pinpoint pupils), and sedation?

Kappa

132

What opioid receptor causes Analgesia, Emotion, and Seizures?

Delta

*rec use effect

133

What opioid receptor causes Analgesia (only listed effect)?

Epsilon

134

What opioid receptor causes Autonomic stimulation, Dysphoria, Hallucinations, nightmares, respiratory stimulation, tachycardia, and anxiety?

Sigma

135

What is determined by the strength of attachment of an opioid to its binding site?

Potency

136

Opioids cause _______ of nerve cells, ______ of nerve firing and _______ of transmitter release.

Hyperpolarization (potassium efflux)

Inhibition

Presynaptic inhibition


*the hyperpolarization makes less likely to respond to pain stimuli (inhibits Ca++ influx also) - this all decreases neurotransmitter release.

137

The hyperpolarization makes less likely to respond to pain stimuli (inhibits Ca++ influx also) - this all decreases neurotransmitter release.

True

138

Name 2 Opium Alkaloids

Morphine

Codeine

139

Name 4 Semi-synthetic opioids

Heroin

Oxycodone

Hydrocodone

Hydromorphone

140

Meperidine, methadone, fentanyl, pentazocine, buprenophine, tramadol, etc are all _______.

Fully synthetic opioids

141

Agonists elicit a ______, and Antagonists block agonists by ______.

Receptor response

Binding receptor

142

Morphine is a ______ Agonist

It has _____ Analgesia

It is ____ and ____ activated

Pure

Unlimited

Mu, Kappa

143

T/F
Tolerance happens with all opioids and Cross-tolerance also occurs

True

144

What drug acts as a Mu and Kappa Antagonist and is given for any OD.

*no analgesia
**will reverse respiratory depression (all opioid depression)

naloxone (Narcan)

145

Opioid Distribution:

Metabolism:

Duration of Action:

Excretion:

1st pass, goes to fetus

Glucuronic acid conjugation in Liver

4-6 hrs orally

Metabolites exit in urine

146

4 Clinical uses of Opioid Drugs:

Analgesia

Sedation/euphoria

Cough suppression

GI (diarrhea)

147

Physical addiction, Respiratory depression, Constipation, Emesis (nausea), Miosis, Urinary retention, CNS stimulation, CV, Biliary tract constriction, Histamine release are all adverse effects of Opioids

True

148

What would indicate an allergy to an Opioid?

GI cramping and diarrhea

149

Most hypersensitivity rxns to Opioids are _____

Dermatologic

150

In dentistry, what are the 2 clinical indications for Opioid use?

(there are more in medicine)

Analgesia

Sedation

151

Opium is the dried juice obtained from the unripe seed capsules of the poppy plant _______.

Paparer somniferum

*25% dried juice alkaloids (morphine, codeine, etc)

**when smoke opium, mostly morphine and codeine

152

Name six Pure Agonists opioids like morphine:

(heroin is also a pure agonist)

oxycodone (Percodan, Percocet)

hydrocodone (Vicodin, Lorcet)

codeine

dihydrocodeine (Synalgos D-C)

meperidine (Demerol)

fentanyl

153

What mixed agonist/antagonist is equally potent as morphine and has superior oral efficacy?

What is it used for (2 things)?

Methadone (C-II)

Detox, chronic pain therapy

154

What antidote for an Opioid OD is given orally or IM?

What antidote is given IV to reverse OD of fentanyl and meperidine?

naltrexone (Depade, ReVia, Vivitrol)

naloxone (Narcan)

155

What "new" antagonist acts as a partial agonist (partial Mu agonist/weak Kappa antagonist)?

buprenorphine and naloxone (Bunavail)

*naloxone is the pure antagonist

156

Morphine is the Prototype Pure Agonist that acts like internal _____/______.

Enkephalins/Endorphins

157

How is morphine generally administered?

IM

*oral poorly absorbed
**not used in dentistry

158

What is the most widely abused drug by hospital personnel (b/c no miosis)?

meperidine (Demerol)

159

What are the primary side effects to the synthetic drug meperidine (Demerol)?

*not as much sedation and euphoria as morphine/heroin

Nausea

Respiratory Depression (risk of death in addicts)

160

How is meperidine (Demerol) used in dentistry?

What are the advantages to using this instead of fentanyl?

(remember, this is the most abused drug by hospital personnel)

IV sedation (conscious)

Respiratory depression risk lower - wider margin of safety

161

What opioid, with many GI side effects, is one of the most frequently prescribed in dentistry?

Why is it given instead of morphine?

codeine *Tylenol III

can give orally

162

What is the optimum dose of codeine?

What is the potency compared to morphine?

60 mg

1/6 (10 mg morphine = 60 mg codeine)

163

What is the drug of choice for cough suppression?

codeine

164

codeine is indicated for moderate to moderately severe pain - what should you prescribe for severe pain?

oxycodone

165

Name 5 adverse rxns to codeine:

Nausea

Dizziness

Excitability

Constipation

Allergy - skin or asthma-like

166

What is the proper codeine dosing?

What system reflects mg concentration of codeine?

15-60 mg every 4-6 hrs

1 = 8 mg; 2 = 15 mg; 3 = 30 mg; 4 = 60 mg

167

Tylenol #3 has 300 mg acetminophen and ____mg codeine.

30

*Tylenol 1 (8 mg) sold OTC in Canada

168

Fiorinal with codeine (1,2,3) is a combo of _____, aspirin, and ______.

Barbituate

caffeine

169

hydrocodone (Vicodin) has acetaminophen that works ________ (as a pain reliever - fever lowering property works centrally) and opioid that works _______.

peripherally

centrally

170

hydrocodone (_______) is ____ times more potent than ____.

Vicodin

3

codeine

171

Name 2 hydrocodone/acetaminophen drugs that have 300 mg acetaminophen:

1 with 325 acetaminophen:

Vicodin, Xodol

Norco

172

hydrocodone also comes with ibuprofen (200 mg, low dose) and has 4 brand names:

Ibudone

Reprexain

Vicoprofen

Xylon

173

What drug with the same efficacy and potency of codeine, is no more effective than Tylenol III?

dihydrocodeine (Syngalos DC)

174

What Schedule II drug is highly addictive, as potent as morphine, and is used in dentistry in combo products for severe pain?

oxycodone

175

Name 4 examples of Oxycodone drugs:

Percocet

Percodan

Roxicet (doesn't separate drug - drug seekers know)

Combunox

176

What drug, 100x more potent that morphine, is used in dentistry?

What is it used for?

3 ways administered?

fentanyl

conscious sedation only

IV, transdermal, lollipop

177

Active-Tramadol, EnovaRX-Tramadol, Ultram, Ultram ER, and 3 others (____,_____,____) are the tramadols

ConZip

Synapryn

FusePaq

178

What duration should tramadol be used for dental pain?

less than or equal to 5 days

179

What drug binds to Mu and inhibits the reuptake of norepinephrine and serotonin?

tramadol

180

Tramadol is associated with ______, and has a rare complication of anaphylaxis.

Seizures

181

Acetaminophen and tramadol is known as ______.

Ultracet

182

What NSAID provides analgesia at the Opioid level and in indicated for moderate to severe dental pain?

How long should this drug be used?

ketorolac (Toradol)

5 days

183

Because ketorolac (Toradol) is an NSAID, what complications must we watch for?

Bleeding/GI

184

Ketorolac (Toradol) dental dosing for Adults IM:

IV:

Oral:

60 mg single dose; 30 mg every 6 hrs; max 120mg/day

30 mg single dose; 30 mg every 6 hrs; max 120mg/day

20 mg single dose; 10 mg every 4-6 hrs; max 40 mg/day

185

T/F
Most pts are better managed with NSAIDS

True

186

If a patient demands more drugs, what should you do?

Refer to pain clinic

187

What is the most widely used opiate agent used for the management of dental pain?

What is the most widely used codeine preparation?

hydrocodone (Vicodin or Lorcet)

Tylenol III

188

What drug is prescribed if the pt has a history of codeine allergy?

meperidine (Demerol)

189

T/F
morphine and hydromorphone (Dilaudid) are used in Dentistry to manage severe pain

False

*these are NEVER used in dentistry

190

Caution/side effects for Elderly Patients, NSAIDS might ______

Aspirin

Opiates

GI bleeding

hemorrhage

constipation

191

From highest to lowest, rank Opiates by Potency:

fentanyl

morphine = oxycodone

meperidine

hydrocodone (3x codeine)

codeine (1/6 morphine) = dihydrocodeine

192

Opioid medications should only be used for...

The number of dispensed should be no more than...

treatment of acute pain

number doses needed

193

T/F
Sharing meds with others is illegal and driving should be avoided

True

194

T/F
Dentists use only short-acting opioids, and Long-acting opioids shouldn't be used for treatment of acute pain

True

195

T/F
If pain persists beyond the anticipated treatment duration, the patient should be carefully reevaluated

True

196

What database must be checked before prescribing opioids (and periodically when renewing)?

Arizona Controlled Substances Prescription Drug Monitoring Program

197

What is one or more prolonged episodes of depression measured in weeks called?

Unipolar depression

198

What are 2 subtypes of Unipolar Depression?

Primary (endogenous - "chemical imbalance")

Secondary (exogenous)

*secondary often develops with preexisting nonaffective disorder (trauma, chronic pain, etc)

199

Bipolar (manic depressive) is usually treated with what?

Lithium

200

T/F
Depression is the 3rd leading cause of death among 10-24 year olds, depression manifests in high risk behaviors, and introverts tend to seek stimulants.

True

201

T/F
Women are 2x as likely to experience depression as men

True

202

What is the comorbidity between Depression and Anxiety disorders?

50%

203

Primary (endogenous) Unipolar Depression is a chemical imbalance of what neurotransmitter in particular?

Serotonin

204

What are 3 functions of Serotonin

Mood elevator

Sleep

Satiety

205

Affective disorders are associated with what 2 neurotransmitter types in the brain?

noradrenergic

serotonergic

*circuitry between the 2 is closely linked

206

Decreased levels of Norepinepherine and/or Serotonin leads to...

Increased levels of these lead to...

Depression

Mania

*receptors equally important

207

What are the 2 proposed mechanisms for Antidepressants?

Increase extracellular levels of neurotransmitter

Improve Receptor Function

*therapeutic effects are only seen after several weeks of taking drugs

208

Why do women have greater incidence of depression?

Estrogen linked to serotonin levels

209

What 2 ways do Antidepressant Drugs increase neurotransmitter in synaptic cleft?

Inhibit reuptake

Degrade enzymes (that degrade neurotransmitter)

210

What Antidepressant increases synaptic serotonin and norepinephrine?

Increases synaptic norepinephrine?

Blocks the degradation of norepinephrine, dopamine, and serotonin?

Increases synaptic serotonin?

Tricyclics

Tetracyclics

MAO'Is

SSRI's

211

What drug acts as a dopamine/norepinephrine/serotonin Reuptake Inhibitor, has Increased Risk for Seizures, and risk for emergent hypertension with concurrent nicotine patch use?

bupropion (Wellbutrin, Zyban)

*b/c of hypertension risk, take BP on pts using this drug

212

MAO is an enzyme responsible for the degradation of what?

MAOI, think ______, _______

norepinephrine, serotonin, and dopamine

Old drug, Old people

213

With MAOI's, take ___ prior to administering local anesthesia, and use caution with ______.

BP

Epinephrine

214

4 MAOI's

isocarboxazid (Marplan)

phenelzine (Nardil)

selegiline (Atapryl, Eldepryl, Selpak)

tranylcypromine (Parnate)

215

How do MAOI's lead to a hyperadrenergic crisis?

what is released in the bloodstream?

What foods to avoid?

shuts off enzyme degradation in intestine/liver and vasoactive amines aren't catabolized -

releases endogenous catecholamines

tyramine (hard cheese, red wine)

216

Name 3 popular SSRI's

*which is only approved drug for children with OCD?

fluoxetine (Prozac, Sarafem)

paroxetine (Paxil)

*sertraline (Zoloft)

217

T/F
Antidepressants increase the risk of suicidal thinking with Major Depressive Disorder

True

218

Excitalopram (antidepressant) is not approved for use in ________.

children

219

What are the side effects of SSRI's?

Agitation, anxiety, aggression, suicidal ideation (within 6 weeks)

220

T/F
Serotonin syndrome includes tremor, increased bowel sounds, tachycardia, agitation, autonomic instability

True

221

Name 4 Serotonin/Norepinephrine reuptake inhibitors
(these are different from Tricyclics - are "selective")

*which treats fibromyalgia?

desvenlafaxine (Pristiq)

duloxetine (Cymbalta)

*milnacipran (Savella) - fibromyalgia

venlafaxine (Effexor XR)

222

Selective serotonin/norepinephrine reuptake inhibitors - should be used cautiously with what?

epinephrine

*could lead to too much

223

Effexor XR, generic name:

Therapeutic category:

Oral complications:

venlafaxine

selective serotonin/norepinephrine reuptake inhibitor (NOT Tricyclic)

xerostomia, stomatitis, taste, tongue discoloration

224

Name 1 Tetracyclic:

Mechanism?

treats?

maprotiline (Ludiomil)

norepinephrine reuptake inhibitor

anxiety with depression

225

Tricyclics block reuptake of _____ and ______ , and have an additional use because it exhibits _______ properties

norepinephrine

serotonin

analgesic

226

With Tricyclics, take ____ before local anesthesia, caution with ______

BP

epinephrine

227

Tricyclics have ______ effects causing blurred vision and xerostomia, ______ effects causing dizziness and reflex tachicardia, and __________, causing sedation.

Anticholinergic

Sympatholytic

Histamine antagonism

228

2 Tricyclics that block norepinephrine and serotonin?

2 Tricyclics that are selective norepinephrine reuptake blockers?

amitryptyline (Elavil) *granddaddy

imipramine (Tofranil)

desipramine (Norpramin)

nortripyline (Pamelor)

229

The weed, ______ has many DDI's and what 4 antidepressive constituents?

St. John's Wort

hyperforin

hypericin

flavonoids

tannins

230

T/F
St. John's Wort is more efficacious than placebo for the treatment of mild to moderately severe depressive disorders

*Chochrane review concluded similarly effective to standard antidepressants

True

231

Hypericin in St. John's Wort does what 2 things?

cyto P450 inducer in liver

reduced anticoagulant effect of warfarin (increases clotting)

232

Because St. John's Wort is fairly powerful and has many DDI's, (including rendering contraceptives ineffective in some users), the recommendation is to discontinue all herbs ____ days before surgery

14

233

T/F
The potency and efficacy of all antidepressants are similar

max blood conc 2-4 hrs, one dose/day

True

234

Antidepressants can have a side effect of orthostatic hypotension, so watch for ____ in older adults

Falling

235

Lithium, used for bipolar disorder, has what 2 brand names?

Eskalith

Lithobid

236

T/F
Lithium prevents the release of neurotransmitters and decreases the rate of serotonin synth

True

237

Lithium takes how long before improvements are seen?

Also, Lithium has a _____ therapeutic window

weeks

very low

238

T/F
Side effects of Lithium include nausea, vomiting, diarrhea, weakness, tremors, renal damage, hypothyroidism, thinning hair, sexual dysfunction

True

239

Diuretics, Anticonvulsants, Antihypertensives, and what other class of drug increase lithium levels in the blood and thus its toxicity?

NSAIDS

*contraindicated - use acetaminophen instead

Decks in Tim's Cards Class (140):