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DENT 319 - Pharmacology > Pharmacology of the Medically Compromised Patient > Flashcards

Pharmacology of the Medically Compromised Patient Flashcards

1
Q

Function of digoxin

A
  • Inhibits Na-K ATPase pump
  • Strengthens myocardial tone (increased myocardial contractility)
  • Enhances vagal tone, slows conduction through SA & AV nodes
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2
Q

3 indications for digoxin

A
  • Chronic atrial fibrillation
  • Certain other arrhythmias
  • Heart failure
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3
Q

3 drugs for which interactions with digoxin must be considered

A
  • Sympathomimetic amines
  • Itraconazole
  • Some antibiotics (macrolides and tetracycline in particular)
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4
Q

Interaction of digoxin with sympathomimetic amines

A

Increased risk of arrhythmias (additive)

NOTE: Use vasoconstrictor with caution –> may lead to cardiac excitation

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5
Q

Interaction of digoxin with itraconazole

A

Digitalis toxicity –> decreased clearance of digoxin

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6
Q

Interaction with digoxin with antibiotics (esp. macrolides and tetracycline)

A

Increased risk of digitalis toxicity –> altered intestinal flora (increases drug absorption in pts who inactivate digoxin by bacterial metabolism in lower intestine)

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7
Q

Dental consideration regarding increased vagal tone by digoxin

A

Exaggerated gag reflex

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8
Q

3 common calcium-channel blockers

A
  • Amlodipine besylate (Norvasc)
  • Diltiazem hydrochloride (Apo-diltiazem, Tiazec, Cardizem)
  • Nifedipine (Adalat XL)
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9
Q

Function of calcium-channel blockers

A
  • Inhibit calcium ion influx across cardiac and smooth muscle cells –> decreased myocardial contractility & O2 demand
  • Dilates coronary arteries and arterioles (relaxes vascular smooth muscle)
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10
Q

4 indications for calcium channel blockers

A
  • Exertional angina
  • Unstable angina
  • Coronary spasm
  • Hypertension
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11
Q

4 dental considerations for pts taking calcium-channel blockers

A
  • May cause gingival hyperplasia and dry mouth
  • May experience probs with postural hypotension
  • Use with azole antifungals or macrolide antibiotics may augment pharmacodynamic effects of Ca channel blockers due to inhibition of cytochrome P450 system –> increased plasma levels
  • Diltiazem = inhibits metabolism of benzodiazepines –> increased sedation
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12
Q

Function of Nitroglycerin

A
  • Reduces cardiac O2 demand by decreasing left ventricular end-diastolic pressure and systemic vascular resistance
  • Increases blood flow through collateral coronary vessels
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13
Q

2 indications for nitroglycerine

A
  • Prophylaxis against chronic anginal attacks
  • Treatment of acute anginal attacks
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14
Q

2 dental considerations regarding nitroglycerine

A
  • Patients may experience orthostatic hypotension (change positions slowly!)
  • Patients may complain of burning mouth with the use of sublingual tabs or spray
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15
Q

3 common selective Beta1-Adrenergic antagonists

A
  • Atenolol (Tenomin, Apo-Tenolol)
  • Metoprolol (Lopressor)
  • Bisoprolol (Apo-bisprolol)
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16
Q

Function of selective beta1-adrenergic antagonists

A
  • Decrease cardiac output, peripheral resistance & cardiac oxygen consumption
  • Depresses renin secretion
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17
Q

4 indications for selective beta1-adrenergic antagonist

A
  • Hypertension
  • Angina
  • Reduce mortality in patients with MI (metoprolol)
  • Some cardiac arrhythmias
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18
Q

4 dental considerations for selective beta1-adrenergic antagonists

A
  • Use with NSAID’s (generally if mroe than 5 days) decreases the anti-hypertensive effect of the drug
  • Orthostatic hypotension
  • Patients may complain of dry mouth and alterations in taste
  • Possible lichenois stomatitis
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19
Q

4 common ACE inhibitors

A
  • Ramipril (Altace)
  • Enalapril maleate (Vasotec)
  • Perindopril (Coversyl)
  • Lisinopril (Zestril, Apo-lisinopril)
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20
Q

Function of ACE inhibitor

A
  • Prevents conversion of angiotensin I to angiotensin II reducing peripheral arterial resistance
  • Inhibits degradation of bradykinins –> increased vasodilation
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21
Q

4 indications for ACE inhibitors

A
  • Hypertension
  • Sometimes used in the management of essential hypertension (alone or in combo with thiazide diuretic)
  • Treatment of symptomatic CHF
  • Diabetic nephropathy
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22
Q

Interaction of ACE inhibitors with concurrent NSAID and/or sympathomimetic use

A

Possible reduction of antihypertensive effect of the drug (i.e. reduced bioavailability)

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23
Q

6 possible symptoms/conditions to consider with ACE inhibitor use

A
  • Dry mouth
  • Loss of taste
  • Dry, persistent, tickling, non-productive cough
  • Possible oral angioedema (lips, tongue, mucous membrane)
  • Bone marrow depression may result in:
    • Neutropenia
    • Agranulocytosis
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24
Q

4 Angiotensin II-Receptor antagonists

A
  • Irbesartan (Avapro)
  • Telmisartan (Micardis)
  • Losartan (Cozaar)
  • Valsartan (Diovan)
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25
Q

3 indications for angiotensin II-receptor antagonists

A
  • Hypertension (alone or in combination)
  • CHF
  • Diabetic nephropathy
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26
Q

4 dental considerations for angiotensin II-receptor antagonists

A
  • Concurrent use with NSAIDs (>5 days) may diminish anti-hypertensive effects
  • Hypotension can occur in pts who may be volume depleted (i.e. very long dental surgical procedures)
  • Orthostatic hypotension
  • Dry mouth
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27
Q

4 statins

A
  • Atorvastatin (Lipitor)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)
  • Pravastatin (Pravachol)
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28
Q

Function of statins

A

Inhibit HMG-Co reductase enzyme, and early step in cholesterol biosynthesis

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29
Q

2 indications for statins

A
  • An adjunct to diet, in order to decrease LDL, total cholesterol and triglycerides
  • Adjunct to diet to increase HDL in pts with 1o hypercholesterolemia
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30
Q

2 dental considerations for pts taking statins

A
  • With macrolides (esp erythromycin) or azole antifungals –> increase statin serum levels with increase risk of myopathy

OR

  • Rhabdomyolysis (inhibition of CYP450-3A4 enzyme system)
  • NOTE: Mild myopathy common
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31
Q

Function of ezetimibe (Apo-ezetemibe)

A

Cholesterol Absorption Inhibitor –> selectively inhibits the intestinal absorption of cholesterol

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32
Q

2 indictions for ezetimibe use

A
  • Used alone or in combo with a statin as an adjunct to diet in order to decrease LDL, total cholesterol and triglycerides
  • Adjunct to diet to increase HDL in pts with primary hypercholesterolemia
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33
Q

Dental considerations for ezetimibe

A

Myalgia and back pain

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34
Q

Function of furosemide (Lasix, Apo-Furosemide)

A

Loop diuretic –> inhibits sodium & chloride resorption at the proximal and distal tubules & ascending loop of Henle

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35
Q

3 indications for furosemide

A
  • Acute pulmonary edema
  • Peripheral edema in heart failure
  • Hypertension
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36
Q

6 dental considerations for pts taking furosemide

A
  • Use of NSAIDs inibits diuretic response
  • Use with aminoglycosides may potentate the risk of ototoxicity
  • W/ corticosteroids may increase risk of hypokalemia
  • Orthostatic hypotension
  • dry mouth
  • Oral lichenoid reaction
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37
Q

Function of hydrochorothiazide (Apo-Hydro, Novo-Hydrazide)

A

Thiazide diuretic –> increases Na and water excretion by inhibiting Na & Cl resorption in distal segment of nephron

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38
Q

2 indications for hydrochorothiazide

A
  • Edema (CHF, renal failure)
  • Hypertension
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39
Q

4 dental considerations for pts taking hydrochorothiazide

A
  • Use w/ NSAIDs may increase risk of renal failure (use w/ caution)
  • Use of corticosteroids may increase risk of hypokalemia
  • Orthostatic hypotension possible
  • Possible dry mouth
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40
Q

Function of warfarin

A

Anticoagulant; interferes with the synthesis of kitamni K-dependent clotting factors

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41
Q

2 indications for warfarin

A
  • Prophylaxis and treatment of DVT & pulmonary embolism
  • Prevention & treatment of systemic embolism re: MI, atrial fib. prosthetic heart valve
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42
Q

Management of pts taking warfarin

A

Determine prothrombin time prior to invasive dental procedures (INR 2-3 safe)

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43
Q

Interaction of warfarin with acetaminophen

A

Increased anticoagulant effect (unknown mechanism) –> use w/ caution & monitor status

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44
Q

Interaction of warfarin with azole antifungals, macrolides and metronidazole

A

Increased anticoagulant effect –> avoid concurrent use

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45
Q

Interaction of warfarin with NSAIDs

A

Increased risk of gastric erosion and ulceration of gastric mucosa –> avoid concurrent use

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46
Q

Function of clopidogrel (Plavix)

A

Anticoagulant –> platelet aggregation inhibitor

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47
Q

3 indications for clopidogrel

A
  • Secondary prevention of thromboembolic events in pts with recent MI, stroke, or peripheral vascular disease
  • Acute coronary syndrome
  • Prevention of stent thrombosis (with ASA)
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48
Q

Interaction of clopidogrel with azole antifungals

A

Inhibit conversion of the pro-drug to the active form of clopidogrel (CYP2C enzyme) –> avoid concurrent use

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49
Q

Interaction of clopidogrel with NSAIDs

A

Potential risk of increased GI bleed –> use with caution

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50
Q

Function of dabigatran (Pradaxa)

A

Anticoagulant –> direct thrombin inhibitor

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51
Q

4 indications for dabigatran

A
  • Decreased risk of stroke & systemic embolism in nonvalvular atrial fib
  • Treatment of DVT & pulmonary embolism, following parenteral anticoagulant therapy
  • Decreased risk of recurrence of DVT and PE
  • Prophylaxis of DVT & PE following hip replacement
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52
Q

Interaction of dabigatran with NSAIDs

A

Risk of bleeding may increase –> avoid concurrent use if possible, otherwise use lower dose and monitor therapy

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53
Q

Interactino of dabigatran with azole antifungals

A

May increase serum concentration of dabigatran –> avoid concurrent use

54
Q

Interaction of dabigatran with clarithromycin

A

May increase serum concentration of dabigatran, use lower dose and monitor or avoid concurrent use if possible

55
Q

Function of levothyroxine sodium (Synthroid)

A
  • Thyroid hormone replacement
  • Stimulates metabolism of all body tissues by accelerating rate of cellular oxidation
56
Q

Interaction of synthroid with sympathomimetics (i.e. epinephrine)

A

May lead to increased risk of coronary insufficiency (use with caution)

57
Q

Danger of employing narcotic analgesics and sedatives to hypothyroid patient

A

Possible excessive respiratory depression

58
Q

Function of metformin (Glucophage, Apo-metformin)

A

Biguanide derivative –> decreases hepatic glucose production and intestinal absorption of glucose & improves insulin sensitivity by increased peripheral glucose uptake and utilization

59
Q

Indication of metformin

A

Adjunct to diet to lower blood glucose level in patients with Type II non-insulin dependent diabetes

60
Q

2 dental considerations for metformin users

A
  • May produce unpleasant metallic taste
  • Certain drugs eliminated by renal tubular system (i.e. vancomycin) may compete with metformin –> increased hypoglycemia
61
Q

Function of glyburide (Diabeta, Euglucon)

A

Sulfonylurea –> prob stimulates insulin release from pancreatic beta cells & reduces glucose output by the liver –> increases peripheral sensitivity to insulin and causes mild diuretic effect

62
Q

Indication for glyburide

A

Adjunct to diet to lower blood sugar in patients with Type II non-insulin diabetes

63
Q

Drug interactions with glyburide

A

Hypoglycemia may be potentiated when given with fluconazole or NSAIDs

64
Q

Function of repaglinide

A

Meglitinide –> stimulates pancreas to excrete more insulin

NOTE: similar to sulfonylurea, but faster acting and shorter duration

65
Q

Indication for repaglinide

A

Adjunct to diet to lower blood sugar in patients with Type II non-insulin diabetes

66
Q

Interaction of repaglinide with azole antifungals & clarithromycin

A

Increased risk of hypoglycemia –> avoid concurrent use

67
Q

Interaction of repaglinide with sympathomimetics (i.e. epinephrine)

A

May reduce hypoglycemic effect and lead to hyperglycemia –> use with caution

68
Q

Function of sitagliptin (Januvia)

A

Increases insulin synthesis and release

69
Q

Indication for sitagliptin

A

Type II diabetes as an adjunct to diet and exercise

70
Q

Drug often prescribed in combination with sitagliptin

A

Metformin

71
Q

Dental considerations for sitagliptin users

A

Some reports of angioedema of face, lips, tongue, but no drug interactions of importance

72
Q

Indication for saxaglyptin (Onglyza)

A

Type II diabetes as an adjunct to diet and exercise to improve glycemic control

73
Q

Drug prescribed in conjuction with saxaglyptin

A

Metformin

74
Q

4 side effects of saxaglyptin

A
  • Hypoglycemia
  • Nausea & dyspepsia
  • Myalgia
  • Back pain
75
Q

2 types of drugs to avoid use with saxaglyptin use

A

Metabolized by CYP3A4, so

  • Azole antifungals (esp. ketoconazole & itraconazole) –> caution
  • Macrolide AB’s
76
Q

5 common antiulcer drugs

A
  • Omeprazole (Losec)
  • Pantoprazole (Pantoloc)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Rabeprazole (Pariet)
77
Q

4 indications for PPIs

A
  • Symptomatic GERD
  • Erosive esophagitis
  • Short term treatment of duodenal ulcers & benign gastric ulcers
  • H. pylori infection (with clarithromycin)
78
Q

Interaction of PPIs with NSAIDs

A

Use with caution – may exacerbate GERD or PUD

79
Q

Interaction of PPIs with ketoconazole and itraconazole

A

Decreased bioavailability of ketoconazole and itraconazole due to need for low gastric pH for optimal absorption (avoid concurrent use)

80
Q

Function of salbutamol sulfate (Ventolin)

A

Relaxes bronchial smooth muscle by stimulating Beta 2 receptors

81
Q

2 indications for salbutamol sulfate

A
  • Prevention and treatment of bronchospasm (reversible obstructive airway disease)
  • Prevention of exercise-induced bronchospasm
82
Q

3 oral side effects of salbutamol sulfate

A
  • Dry, irritated throat
  • Hoarse voice
  • May cause bad taste
83
Q

2 indications for fluticasone propionate (Flonase, Flovent Diskus)

A
  • Maintenance treatment of asthma (prophylactic)
  • Management of nasal symptoms of seasonal allergies in adults
84
Q

3 oral side effects of fluticasone propionate

A
  • Pharyngitis
  • Throat irritation
  • Oral candidiasis
85
Q

Interaction of fluticasone propionate with azole antifungals

A

CYP3A4 inhibitors –> increase plasma levels of fluticasone (caution)

86
Q

Function of montelukast (Singulair)

A

Leukotriene receptor antagonist

87
Q

2 indications for montelukast

A
  • Maintenance treatment of asthma (prophylactic)
  • Management of nasal symptoms of seasonal allergies in adults
88
Q

3 adverse effects of montelukast

A
  • Headache
  • Dry throat
  • Dental pain
89
Q

Interaction of montelukast with azole antifungals

A

CYP3A4 inhibitors –> increase plasma levels of fluticasone (caution)

90
Q

Function of alendronate sodium (Fosamax) and risedronate sodium (Actonel)

A
  • Bisphosphanates –> specific inhibitors of osteoclast-mediated bone resorption
  • Increases bone density (alendronate)
91
Q

3 indications for Fosamax and Actonel

A

Treatment/prevention of:

  • Post-menopausal osteoporosis in women
  • Osteoporosis in men to prevent incidence of fractures
  • Paget’s disease of the bone in men and women
92
Q

3 adverse effects of fosamax and actonel

A
  • Perverse alteration of taste (for some)
  • Very irritating to GIT (caution with NSAIDs)
  • Risk of osteonecrosis of the jaw reported
93
Q

Function of tamsulosin (Flomax)

A

Peripherally acting anti-adrenergic, causing relaxation of prostate smooth muscle –> increased urinary flow rate and a reduction of symptoms of BPH

94
Q

Indication for tamsulosin

A

Treatment of signs and symptoms of benign prostatic hyperplasia

95
Q

3 dental considerations for tamsulosin

A
  • Possible cough or sinusitis
  • Headache and dizziness relatively common
  • Possible back pain –> alterating dental chair position

NOTE: no known drug-drug interactions

96
Q

Function of amitriptyline hydrochloride (Elavil)

A

Tricyclic antidepressant; non-selective monoamine reuptake inhibitor

97
Q

3 indications for Elavil

A
  • Management of depression
  • Depressive state of bipolar disorder
  • Management of chronic, non-malignant pain
98
Q

5 dental considerations for Elavil

A
  • Significant sedative properties (additive CNS depression w/ other CNS depressants)
  • May potentiate cardiovascular effects of sympathomimetics –> possible cardiac arrhythmias
  • Orthostatic hypotension
  • Xerostomia
  • Rarely: black tongue, bitter taste, sublingual adenitis, stomatitis
99
Q

Function of MAOI’s (monoamine oxidase inhibitors)

A

Promotion of accumulation of neurotransmitters through inhibition of MAO enzyme system

100
Q

Indication for MAOI’s

A

Severe depressions with close follow-up

101
Q

2 important drug interactions of MAOI’s

A
  • Potentiation of sympathomimetics –> hypertensive crisis (avoid)
  • Opioids = increased CNS depression –> possible coma & convulsions
102
Q

2 side effects of MAOI’s

A
  • Orthostatic hypotension
  • Xerostomia
103
Q

4 SSRI’s

A
  • Fluoxetine HCl (Prozac)
  • Paroxetine HCl (Paxil)
  • Sertraline (Zoloft)
  • Citalopram HCl (Celexa)/escitalopram
104
Q

4 indications for Prozac

A
  • Various forms of depression
  • OCD
  • Bulemia & anorexia
  • Occasionally panic disorders
105
Q

Important drug interactions with Prozac

A

Additive CNS depression w/ concurrent use of opioids and sedative-hypnotics

106
Q

2 side effects of Prozac

A
  • Abnormal taste
  • Xerostomia
107
Q

3 indications for Paxil

A
  • Various forms of depression
  • Panic disorders
  • Social anxiety
108
Q

3 side effects of Paxil

A
  • Aphthous stomatitis
  • Glossitis
  • Orthostatic hypotension
109
Q

2 indications for Zoloft

A
  • Various forms of depression
  • OCD
110
Q

Interaction of Zoloft with NSAID’s

A

Increased risk of abnormal platelet aggregation (caution)

111
Q

Interaction of Zoloft with Tramadol

A

Possible increased risk of serotonergic syndrome (avoid)

112
Q

Interaction of Zoloft with opioids, macrolides and azole antifungals

A

May increase risk of QTc prolongation and torsade de points

113
Q

3 side effects of Zoloft

A
  • Xerostomia
  • Taste perversions
  • Myalgia
114
Q

2 indications for celexa

A
  • Depression occurring post-CVA
  • Alleviation of disturbances in elderly with dementia disorders
115
Q

Interaction of Celex with azole antifungals or erythromycin

A

May increase blood levels of citaprolam

116
Q

3 SSNRIs

A
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Bupripion HCl (Wellbutrin)
117
Q

3 indications for Effexor

A
  • Major depressive illness
  • Refractory depression
  • Generalized anxiety disorder
118
Q

Interaction of Effexor with other CNS depressants

A

Increased sedation (not recommended)

119
Q

3 possible side effects of Effexor

A
  • Taste disturbances
  • Stomatitis
  • Candidiasis
120
Q

4 indications for Cymbalta

A
  • Major depression
  • GAD
  • Diabetic peripheral neuropathic pain
  • Fibromyalgia
121
Q

2 adverse effects of Cymbalta

A
  • Xerostomia
  • Nausea
  • NOTE: No important drug-drug interactions of interest to dentistry
122
Q

Function of bupropion HCl (Wellbutrin) and decreases neuronal uptake of serotonin and norepinephrine

A

Dopamine reuptake blocking compound

123
Q

3 indications for Wellbutrin

A
  • SAD
  • ADHD
  • Aid to smoking cessation (Zyban)
124
Q

3 dental considerations for Wellbutrin

A
  • Xerostomia
  • Taste disturbances
  • Withdrawal of benzodiazepines may increase risk of seizures (caution)
125
Q

3 antipsychotics

A
  • Quetiapine fumarate (Seroquel)
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
126
Q

Side effect of olanzapine

A

Xerostomia

127
Q

Drug interactions with lithium carbonate (Carbolith)

A
  • NSAID’s = Increased plasma lithium –> possible toxicity (avoid)
  • Erythromycin and metronidazole = risk lithium toxicity
128
Q

2 side effects of lithium carbonate

A
  • Taste disturbances
  • Lichenoid eruptions orally
129
Q

FUnction of pregabalin (Lyrica)

A

Antiepileptic

130
Q

4 indications for pregabalin

A

Management of:

  • Neuropathic pain
  • Postherpetic neuralgia
  • Fibromyalgia
  • Partial onset seizures
131
Q

3 adverse effects of lyrica

A
  • Dizziness
  • Somnolence
  • Dry mouth
132
Q

2 drug interactions with Lyrica

A

Additive effects with oxycodone, lorazepam

DENT 319 - Pharmacology (7 decks)

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