exam 1 review

What does ADME stand for?

Absorption

Distribution

Metabolism

Excretion

Identify 1 sialogogue (generic and brand name)

Pilocarpine (salagen)

identify 1 antisialogogue (generic and brand name)

Atropine (Atropen)

Protracted use of sulfa drugs may produce symptoms of vitamin K deficiency because sulfa drugs:

Disrupt the guts normal flora, leading to decreased synthesis and absorption of the vitamin

Equation for the therapeutic index

LD 50/ ED 50

Why is epinephrine is used to treat anaphylactic reactions

Vasoconstrictor, relaxes tight airway muscle and constricts blood vessels

Which class of autonomic drug is not used to treat glaucoma?

Anticholinergic drugs

What does “cardioselective” mean with regard to local anesthesia?

Dictated how safety

Identify 2 cardioselective agents (generic and brand names)

metoprolol (Toprol)

atenolol (Tenormin)

3 contraindications to nitrous oxide-oxygen analgesia

Respiratory problems

Pregnancy

Lack of communication

With regard to nitrous oxide-oxygen analgesia, explain what diffusion hypoxia is and how to prevent it

a drop in blood oxygen levels

Give 100% oxygen at the end of treatment for 3-5 min

Misconceptions about nitrous oxide-oxygen analgesia

Completely unconscious

Complete pain control

Reason why local anesthetic may not work if a tooth is infected

Acidity (lower ph-lower onset)

Adema (dilute LA)

Reasons why a vasoconstrictor may be added to a local anesthetic

To keep localize

Duration

Decreases blood level and bleeding

Diffusion

identify one way loca anesthetics work (mechanism of action)

Decreases sodium (depolarizes conduction)

Why should alcohol be avoided if one is taking a central nervous system depressant?

Alcohol is a depressant

Will cause synergistic effect → 1 + 1 =2

What is the difference between bacteriostatic and Bacteriocidal?

Bacteriocidal → inhibits cells wall synthesis, kills cells

Bacteriostatic → inhibits protein synthesis so micros cannot growth and multiply

What is Chlorhexidine’s mechanism of action?

Bacteriocidal

What clinical oral effects may happen of a patient is taking a broad spectrum antibiotic for a few months?

Superinfection

General adverse reactions or concerns regarding antibiotic use:

GI

Allergic

Disrupt natural gut flora

Which antibiotic is particularly noteworthy of an interaction with systemic contraceptives

rifampicin (Rifampin)

Your patient says that she takes 8-10 antacid tablets a day because the tetracycline she is taking is upsetting her stomach. How would you respond?

Wait 2 hr, tetracycline bind to metals (they cancel each other)

Why is amoxicillin the drug of choice for antibiotic prophylaxis for infective endocarditis? 

Gets in the blood faster

the premedication regimen for amoxicillin. 

2 g

If someone has an allergy to penicillin and can take oral meds, what would be given if the patient needs antibiotic prophylaxis?

Cephalexin - 2g

Azithromycin - 500mg

Doxycycline- 100 mg

Name at least 2 medications commonly used in the treatment of tuberculosis

Isoniazid (INH)

rifampin

List at least 3 antifungal medications (generic and brand names)

fluconazole (Diflucan)

ketoconazole (Nizoral)

nystatin (Mycostatin)

What instructions should be given to a patient who is prescribed an antifungal agent that is in a suspension? 

Shake it

5 major conditions that require antibiotic prophylaxis.  

• Prosthetic heart valve

• Previous infective endocarditis

• Heart transplant that develops cardiac valvulopathy

• Prosthetic joint with Hx of infection

• Certain specific, serious congenital heart conditions

What other conditions may require antibiotic prophylaxis? 

IV drug abuse

HIV with other immunocompromised conditions

Which antibiotic might be prescribed for someone with MRSA? 

Vancomycin

Nitrous oxide -oxygen

Increases pain threshold without loss of consciousness; analgesic, amnesic, anxiolytic

Nitrous Oxide-Oxygen Analgesia advantages

a. rapid onset and recovery

b. least toxic, safe when used appropriately

c. may be used in children

a. nonflammable

e. nonirritating to the G.l tract

f. Good analgesia, anxiolytic (antianxiety) effect

Nitrous Oxide - Oxygen Analgesia disadvantage

-Abuse potential

-reduction in fertility

-improper use

-nausea

-diffusion hypoxia*

What causes infective endocarditis?

Viridans Group Streptococci

(VGS)

Premed for IE:

2 g amoxicillin, 30-60 min before

Antifungal agents

• nystatin (Mycostatin® Nilstat®)

• clortrimazole (Mycelex®)

• ketoconazole (Nizoral®)

• fluconazole (Diflucan®)

• Griseofulvin (GRIS-PEG)

• amphotericin B (Fungizone®)

ketoconazole + antacids=

decr. absorption

ketoconazole + alcohol =

disulfiram-type rxn

concomitant use of fluconazole (Diflucan®) with warfarin _________

increases bleeding.

Antiviral Agents

• acyclovir (Zovirax®)

• penciclovir (Denavir®)

• docosanol (Abreva®)

• Lysine

• Valtrex®

Anti-tuberculosis Agents

1. isoniazid (INH®)

2. rifampin (Rifadin®)

3. pyrazinamide

4. streptomycin

5. ethambutol

PRISE

amoxicillin

2 g or. 2000 mg

Cephalexin

2 g

Azithromycin

500 mg

Doxycycline

100 mg

Side effect

occurs when a drug acts on non-target organs to produce "undesirable" effects

EXAMPLES:

Nausea with: codeine, antibiotics, ibuprofen

Sedation with: antihistamines

Toxic reaction

predictable, dose related rn that acts on target organs

•More common than allergic rxns

•Excessive levels of drug

• Damage to tissues/organs can be reversible or irreversible

  
  

Ex: tinnitus with aspirin

Idiosyncratic reaction

Genetically-related abnormal response to a drug

• A drug having an opposite reaction than the therapeutic rn

Ex: sedatives causing hyperactivity

Allergic reaction (hypersensitivity reaction)

• Non-predictable, immunologic response of the body toward the drug

• Signs/symptoms:

Rash

swelling

itching (hives or urticaria)

wheezing

coughing

difficulty breathing

angioedema

anaphylaxis

Teratogenic effect

• Drugs affect the fetus

• FDA pregnancy categories:

A,B,C, D and X

(least to most risky to fetus)

Other names for adrenergic drugs

Sympathomimetics

Adrenergic Agonists

Other names for Adrenergic Blockers

Sympatholytic

Beta-adrenergic blockers

Beta blockers

Other names for Cholinergic drugs

Parasympathomimetic

Other names for Cholinergic Blockers

Parasympatholytic

anticholinergic

Side effects of ADRENERGIC DRUGS

1. Cardiac- arrhythmias, tachycardia, incr. in B.P.

2. CNS- excitation, anxiety, tremors, insomnia

EXAMPLES OF ADRENERGIC DRUGS

• Epinephrine- tx. of anaphylaxis, asthma, added to L.A.; tx. of hypotension, incr. cardiac output and heart rate

  
  

• levonordefrin (Neo-Cobefrin®) vasoconstrictor with less effect than epinephrine

  
  

• phenylephrine (Neo-Synephrine®) Nasal decongestant: pseudoephedrine (Sudafed®)

  
  

• Ritalin®, Concerta®, Adderall® ADHD,ADD tx.

• Beta2Agonists- albuterol (Proventil®, Ventolin®) Tx. of asthma

adverse rxn of adrenergic blockers

hypotension

bradycardia

fatigue

depression

hypoglycemia

impotence

ADRENERGIC BLOCKERS Examples

1. propranolol (Inderal®) Tx. of migraine, CHF, hypertension

2. metoprolol (Toprol®, Toprol XL®, Lopressor®) Tx. of CHF, hypertension; "cardioselective beta blocker"

3. atenolol (Tenormin®) Tx. of CHF, hypertension; "cardioselective beta blocker'

lol ending

CHOLINERGIC DRUGS Adverse effects

SLUD (incr. in Salivation, Lacrimation, Urination, Defecation) and sweating, bradycardia, decr. in respiration

CHOLINERGIC Drugs

I. pilocarpine (Salagen®) for xerostomia (sialogogue), glaucoma (eye drops)

2. neostigmine (Prostigmine®)

3. pyridostigmine (Mestinon®)

4. physostigmine (Eserine®)

5. bethanechol (Urecholine®) used to treat urinary retention following general anesthesia

ine

ANTICHOLINERGIC DRUGS Adverse rxn

Anti-SLUD + blurred vision, confusion, tachycardia

"3-D" effects: drying (xerostomia)

decreased motility (GI &GU)

dilated pupils

Meds that cause xerostomia

ANTICHOLINERGIC DRUGS

specifically, atropine (AtroPen®)

Meds to treat xerostomia

Cholinergic drugs

Specifically, pilocarpine (Salagen®)

ANTICHOLINERGIC Drugs

**I. atropine (AtroPen®)- preanesth. agent to decr. salivary (antisialogogue) & resp. secretions

2. scopolamine (Transderm Scop®)- anti-motion sickness agent

3. methantheline (Banthine®)- antisialogogue- (peptic ulcer disease) (irritable bowel syndrome)

Uses of metrodinazole (Flagyl)

• STIs (Sexually Transmitted Infections)

• Perio infection

• NUG.

• Treatment of periodontal infections, EXCEPT against A. actinomycetemcomitans

Metrodinazole with warfarin =

Increase bleeding

Meds to treat MRSA

VANCOMYCIN

What is MRSA?

(methicillin-resistant Staphylococcus aureus) is a type of staph bacteria that cannot be killed by many common antibiotics