NEW Pharmacology Exam 2: Dental Drug Classes, Emergencies & Clinical Considerations

What is the safest FDA pregnancy category?

Category A

What pregnancy category is lidocaine classified under?

Category B

What is the risk associated with epinephrine in pregnancy?

Large doses may cause vasoconstriction, decreasing placental blood flow and potentially causing fetal anoxia.

Which analgesic is considered safe during pregnancy?

Acetaminophen (Tylenol)

What are the risks of using aspirin during pregnancy?

Prolongs gestation, complicates delivery, decreases placental function, increases hemorrhage, and increases fetal stillbirths and deaths.

What is a significant concern with codeine use during pregnancy?

Associated with hernias, cleft lip and palate, respiratory depression, and withdrawal symptoms in the baby.

Which antibiotics are considered safe during pregnancy?

Amoxicillin and Erythromycin

What is the pregnancy category of tetracyclines?

Contraindicated; can cause permanent tooth discoloration and affect developing bones.

What should be done with breast milk during metronidazole treatment?

Breast milk should be expressed and discarded during treatment and for 48 hours after the last dose.

What are the physical manifestations of Fetal Alcohol Syndrome?

Stunted growth, CNS problems, facial dysmorphology, tremors, and abnormal reflexes.

What are the three categories of medical emergencies?

1. Lost or altered consciousness 2. Respiratory 3. Cardiovascular

What medication is used for anaphylaxis?

Epinephrine

What is the brand name for diphenhydramine?

Benadryl

What condition does albuterol treat?

Asthma and respiratory distress

What is the primary use of nitroglycerin?

Chest pain, angina, and myocardial infarction; it acts as a vasodilator.

What does the Minimum Inhibitory Concentration (MIC) refer to?

The lowest concentration of an antibiotic needed to inhibit visible growth of an organism.

What is the difference between bactericidal and bacteriostatic antibiotics?

Bactericidal kills bacteria, while bacteriostatic stops bacteria from multiplying.

What is 'synergism' in the context of antibiotics?

When two antibiotics combined produce a greater effect.

What can cause antibiotic resistance?

Not enough antibiotic administered or the duration of therapy being too short.

What is a common adverse effect of broad-spectrum antibiotics?

Superinfections due to the destruction of normal microorganisms.

What probiotic is recommended to avoid GI upset during antibiotic treatment?

Lactobacillus acidophilus gel caps.

Which antibiotics are associated with photosensitivity?

Ciprofloxacin (Cipro) and Doxycycline.

What are the classes of bactericidal antibiotics?

1. Penicillins 2. Cephalosporins 3. Nitroimidazoles 4. Quinolones (fluoroquinolones)

What is the most commonly prescribed antibiotic in dentistry?

Penicillin VK

What is Augmentin composed of?

Amoxicillin plus clavulanic acid.

What is penicillinase?

An enzyme that breaks down penicillin.

What is a common allergic reaction to penicillins?

Anaphylactic reaction or rash.

What are tetracyclines classified as?

Bacteriostatic antibiotics.

What effect do tetracyclines have on penicillin?

They can decrease the effectiveness of penicillin.

What is probenecid used for?

To treat gout and decrease renal elimination of penicillins, increasing blood levels.

What is Cephalexin (Keflex) used for?

A first-choice bactericidal antibiotic for prophylaxis in patients allergic to penicillin.

What is Metronidazole (Flagyl) primarily used for?

Anaerobic bacteria, periodontal infections, and necrotizing ulcerative gingivitis (NUG).

What are common side effects of Metronidazole?

GI upset/nausea, metallic taste, dry mouth, dark urine, and Antabuse-like reaction with alcohol.

What is the primary use of Ciprofloxacin (Cipro)?

It is a fluoroquinolone antibiotic.

What are the side effects of Ciprofloxacin?

Photosensitivity/phototoxicity and joint/cartilage damage.

What are the three bacteriostatic antibiotic classes?

Macrolides, Lincomycins, and Tetracyclines.

What is Clindamycin (Cleocin) used for?

An antibiotic for patients with penicillin allergies.

What major risk is associated with Clindamycin?

C. diff infection leading to pseudomembranous colitis.

What is the anti-collagenase effect of tetracyclines?

They prevent the destruction of collagen in the periodontium.

What should tetracyclines not be given with?

Antacids, as they bind to minerals.

What are systemic antibiotics recommended for?

Aggressive periodontitis.

What are the systemic signs of infection?

Fever, lymphadenopathy, and cellulitis.

What is infective endocarditis?

An infection of the valves of the heart.

Which heart valves are most often affected by infective endocarditis?

Mitral/bicuspid valve.

What conditions require antibiotic prophylaxis?

Prosthetic cardiac valve, previous infective endocarditis, cardiac transplant with valve issues, and certain congenital heart diseases.

What is the antibiotic prophylaxis protocol for dental procedures?

2 g amoxicillin one hour before treatment.

What are non-invasive procedures that do NOT require prophylaxis?

Local anesthetic injections, X-rays, and orthodontic appliances/brackets.

What is the organism responsible for tuberculosis?

Mycobacterium tuberculosis.

How is tuberculosis spread?

Through inhalation of aerosols from coughing and sneezing.

What are early symptoms of tuberculosis?

Fever, chills, GI upset, and night sweats.

What conditions can activate latent tuberculosis?

Malnutrition, diabetes, HIV, corticosteroid use, and alcoholism.

What are later symptoms of active tuberculosis?

Weight loss/anorexia, nausea, and vomiting.

What are some later symptoms of active TB?

Weight loss, nausea, vomiting, night headaches, palpitations, productive cough with green/yellow sputum, coughing up blood.

What is the gold-standard test for TB?

PPD Mantoux skin test.

What does a positive PPD test look like?

Induration: localized raised swelling.

What is a disadvantage of the PPD test?

It does not differentiate between TB exposure and actual disease.

How is the PPD test administered?

As an intradermal injection.

What is the treatment for latent TB?

Treated with a single drug: Isoniazid (INH) or rifampin.

What is the treatment duration for active TB?

Approximately 6-9 months.

What does RIPE stand for in TB treatment?

Rifampin, Isoniazid, Pyrazinamide, Ethambutol.

What is a major side effect of Rifampin?

Red/orange urine, tears, and saliva.

What is a major side effect of Isoniazid?

Hepatotoxicity/liver problems.

What is a major side effect of Pyrazinamide?

Hepatotoxicity/liver problems.

What is a major side effect of Ethambutol?

Decreased visual acuity and red/green color vision problems.

What are the two types of seizures?

Partial (focal) seizures and generalized seizures.

What is the most common seizure type?

Tonic-clonic seizure (formerly called grand mal).

What characterizes the tonic phase of a seizure?

Intense muscle contractions.

What characterizes the clonic phase of a seizure?

Alternating contraction and relaxation of muscles.

What is status epilepticus?

A medical emergency where seizures are repeated continuously or occur without adequate recovery.

What is the mechanism of action of tricyclic antidepressants (TCAs)?

Increase the concentration of norepinephrine (NE) and/or serotonin.

What is the gold-standard medication for bipolar disorder?

Lithium (Lithobid).

What neurotransmitter is in excess in schizophrenia?

Dopamine.

What are common anticholinergic side effects?

Xerostomia (dry mouth), root caries, oral candidiasis.

What is the primary neurotransmitter affected in Alzheimer's disease?

Acetylcholine (ACh).

What medication is used to treat Alzheimer's symptoms?

Donepezil (Aricept).

What nerve is stimulated in migraines?

Trigeminal nerve (fifth cranial nerve, CN V).

What are primary headaches?

Headaches with no identifiable or treatable cause, such as migraines and tension-type headaches.

What are secondary headaches?

Headaches with an identifiable cause, such as head trauma or brain tumors.

What are the first-generation antiepileptic drugs?

Phenytoin, Phenobarbital, Carbamazepine, Valproic acid, Ethosuximide, Lorazepam, Diazepam.

What is a major side effect of Phenobarbital?

Respiratory depression.

What is the mechanism of action of benzodiazepines?

They bind to receptors on GABA.

What are antineoplastic drugs?

Medications used to treat various cancers/neoplasms and abnormal cell growth.

How do chemotherapeutic drugs work?

They attack faster-growing cells, affecting bone marrow, GI tract, and skin.

What is the method of cancer treatment with antineoplastic drugs?

"Hit hard and fast" to prevent resistant cancer cells from developing.

What characterizes benign tumors?

Cells do not invade surrounding tissues.

What characterizes malignant tumors?

Cells invade and spread/metastasize to other areas of the body.

What is bone marrow suppression?

A toxic effect of antineoplastic drugs leading to leukopenia and thrombocytopenia.

What is leukopenia?

A decrease in white blood cells that predisposes the patient to serious infections.

What is neutropenia?

A decrease in neutrophils.

What is thrombocytopenia?

A decrease in platelets that can cause serious bleeding problems.

What is anemia?

A decrease in red blood cells.

What is the purpose of Cetuximab (Erbitux)?

Used with radiation for unresectable squamous cell cancer of the head and neck.

What is the function of Filgrastim (Neupogen)?

Increases neutrophil production and decreases infection risk.

What is the purpose of Epoetin alfa (Epogen)?

Stimulates red blood cell production, used for chemotherapy-induced anemia.

What are common gastrointestinal disturbances caused by antineoplastic drugs?

Nausea and vomiting.

What are dermatologic disturbances associated with antineoplastic drugs?

Alopecia (hair loss), dry skin, and blisters.

What are oral complications of cancer treatment?

Xerostomia, oral mucositis, esophagitis, candidiasis, and taste alterations.

What is oral mucositis?

Inflammation, ulcerations, and sores in the mouth.

What are common locations for oral mucositis?

Buccal mucosa, labial mucosa, soft palate, ventral surface of the tongue, and floor of the mouth.

What is the prototype medication for bisphosphonates?

Alendronate (Fosamax), used for osteoporosis.