Student RDH Pharmacology 2024

Brand name vs. Generic name

Brand Name: Manufacturers name, capitalized. ie. Tylenol

Generic Name: chemical name for drug, lowercase, Ie, acetaminophen

pc/ac means

pc- after meals

ac- before meals

hs means

at bedtime

Safest route of drug administration is

GI tract- SAFEST

slowest, most variable route.

If taken orally, may cause GI upset.

What is enteral absorption of drugs associated with?

First pass effect

What is the first pass effect?

When the GI or liver metabolizes the drug BEFORE it reaches systemic circulation

Parenteral drug administration is often used in

emergency situations

IV (directly enters blood stream)

Drugs BYPASS the GI tract

Best option to CONTROL level of drugs

Topical and transdermal drugs are

absorbed slowly by capillaries and effects last a long time.

For this reason, toxicity should be monitored.

Potency of drug

the amount needed to achieve desired effect.

A lower amount needed to reach desired effect is more potent.

efficacy of a drug

degree to which a drug produces its desired response in a patient. Increasing the dose does not improve the effect.

there is no relationship between potency and efficacy.

potency vs efficacy

potency: amount of drug necessary to produce desired effect

efficacy: ability of drug to achieve desired effect

Adverse reactions to drugs

All adverse reactions are undesirable.

Side effects are predictable, and dose related.

toxic reactions (toxic effects on organs for example) is dose related.

Allergic effects: NOT dose related, and unpredictable.

Type I and Type IV reactions:

Type I- immediate reaction (anaphylactic shock)

Type IV- delayed response (contact dermatitis)

Absorption refers to

entry of drug into the bloodstream.

The rate of absorption depends on:

-route of administration (IV? Oral?)

-pKa of the drug

-drug solubility

-and pH of the media

Distribution refers to

Distribution of drug to other parts of the body, once it reaches the blood stream (after it is absorbed)

Metabolism refers to

How the body breaks down and converts the drug into other substances.

primary site for metabolism is the liver.

Excretion refers to

Drug and metabolites then exit the body.

happen in the kidney- drugs and their metabolites are flushed out through the urine.

Each kidney contains one million nephrons (microscopic filtering units that filter the blood and result is excreted as urine).

Each nephron has a glomerulus (network of capillaries that performs the initial step in filtering. Each glomerulus is surrounded by a thin-walled Bowmans Capsule).

Nephrons and glomerulus of the kidney

Other ways drugs can be excreted (other than urine)

saliva, GCF, sweat, breast milk, lungs

Antihypertensive medications

-Beta-blockers: (non selective or selective) reduce cardiac output

- Calcium channel blockers relax blood vessels

-Diuretics remove water and reduce blood volume

- ACE inhibitors reduce constriction of blood vessels.

What is a common side effect of antihypertension medication

orthostatic hypotension.

to prevent this, bring the chair up slowly to allow the patient to adjust.

Diuretics MOA

*First-line agents for mild-mod HTN*

They work by blocking sodium re-uptake in the nephrons (loop of Henle) in the kidneys.

As a result, more water is released from the body, decreasing blood volume and therefore decreasing peripheral resistance.

Examples:

Hydrochlorothiazide

furosemide

Beta Blockers MOA

Block Beta 1, Beta 2 or both receptors.

Beta 1--> causes vasconstriction

Beta 2--> causes bronchiodilation

Examples of non-selective beta blockers

propanolol (Inderal)

timolol (Timoptol)

What beta blockers are CONTRAINDICATED for asthma patients?

non-selective

propranolol

timolol

(Props to Tim!)

Examples of selective beta blockers

atenolol (Tenormin)

metoprolol (Lopressor)

What is the MRD for epinephrine for patients taking non-selective beta blockers?

0.04 mg

What other uses for beta blockers?

angina

antiarrhythmic

anxiety

MI

Calcium Channel Blockers MOA

Stop calcium from entering cells of the heart/blood vessel walls

therefore stopping vasoconstriction

Can cause gingival hyperplasia.

-PINE:

Ex: Procardia (nifedipine), Diltaliziem, amliodipine, vermapil

ACE inhibitors

Stop the enzyme that produces angiotension II in the RAAS system (this substance causes vasoconstriction)

Calcium channel blockers cause

gingival hyperplasia

-dipine

ACE inhibitors can cause

dry cough

-pril

Anti-anginal agent

Nitroglycerin

Vasodilates, taken sublingually to avoid GI tract, quicker onset

Angiotension II Receptor Blockers

ARB's: "Sartan" and "Vasartan: suffixes

-prevent the release of aldosterone (sodium retaining hormone)

-block angiotensin II from the angiotension I receptors found in many tissues

*cause vasodilation and decrease peripheral resistance

*Best for women who are newly diagnosed

-do NOT take during pregnancy

ARBs vs ACE inhibitors

-ARBS don't cause cough, ARBS can't be taken in pregnancy

-Equally effective for treating HTN

-Both are well tolerated

ACE inhibitors block an enzyme that converts angiotensin I from becoming angiotensin II, which prevents the release of aldosterone (which then stops sodium retention, leading to vasodilation.

ARBS blocks the receptor site at angiotensin II.

CHF Drugs

ABCDDD

- ACEs & ARBS

- Beta Blockers

- Calcium CB

- Digoxin

- Dilators

- Diuretics (lowers BP)

CHF drugs

Digoxin--> increases force of contraction of the heart

Side effects gag/salivation

Caution with epi, can cause dysrhythmia

Spiralactone--> treats CHF, excessive aldosterone excretion

Potassium sparing diuretics

What is CHF

is a dysfunction of the of the heart as a pump of blood. This results in insufficient oxygen delivery to tissues accompanied by the accumulation of fluid in the lungs.

Side effect of CHF Drug, digoxin

gag reflex/salivation.

Caution with epi (can cause dysrhythmia)

Side effect of CHF drug, (potassium sparing diuretic) Spirolactone

Spironolactone (Aldactone) causes hyperkalemia, and water retention

Antiarhythmic drugs treat

irregular heart rhythms

atrial fibrillation

atrial fibrillation

rapid, random, ineffective contractions of the atrium

Structure of the heart

has four chambers (right and left atriums, right and left ventricles)

SA node triggers electrical impulse to cause atria (upper chambers) to contract. The signal then goes to the AV node which then goes to the purkinjke fibers that cause the ventricles to contract.

IE: SA--->AV--->PF

Classes of antiarrhythmics and MOA

Class I: Sodium Channel blockers (slow electrical impulse conduction in the heart muscle itself.)

Examples of Na Channel Blockers:

-Rhythmodan, Teva-Mixelitine

Class II: Beta-blockers-> slow electrical impulse at SA and AV nodes.

Class III: Potassium channel blockers: blocks repolarization --->slow down impulse in all heart cells. EX: Multaq (

Class IV: Calcium channels---> (-Pine) slow down heart rate at SA and AV nodes.

Examples of CCBs

vermapil, ditalizem, nifedipine

Lidocaine can be used as a

antiarrhythmic drug

Anticoagulation drugs

heparin, warfarin (coumadin), Plavix

reduce the ability of blood to clot after MI or strokes

INR values

2-3

3 means it clots FAST

2-fast, 3-too slow (3 and under is good for dental procedures)

Ideal INR is

3 or BELOW (1 is ideal)

If someone is taking warfarin or coumadin, they should use WHAT for pain?

NOT aspirin or NSAID, use TYLENOL.

Aspirin use as a blood thinner....

often used daily (baby aspirin, 81 mg dose) to prevent MI, is an antiplatlet but does NOT cause excessive bleeding.

If a patient is on a blood thinner (other then aspirin, obviously) they should use what for pain?

Tylenol

Aspirin (by itself) does not cause

NOT cause excessive bleeding

NSAIDs are....

antipyretic

analgesic

anti-inflammatory

NSAIDs MOA

Reversibly inhibit COX-1 & COX-2

Block prostaglandin synthesis (PGEs cause the experience of pain)

COX-1 enzyme

protects stomach lining, decreases fever, promotes platelet aggregation

blocking COX-1 can results in gastric ulceration and renal toxicity

Too much use of NSAIDs can result in

-gastric ulcers (blocks COX-1 which is helpful for protective gastric secretions)

- renal toxicity (blocks COX-1 and can damage kidney)

Blocking of WHAT enzyme is responsible for the NSAID's antipyretic, analgesic and anti-inflammatory effects?

COX-2 inhibition

How do NSAIDs effect temperature?

Affects the hypothalamus (which controls body temperature)

NSAIDs are commonly used for?

Arthritis

NSAIDs (including Aspirin) adverse effects

-GI ulcers/GI irritation (ESPECIALLY ASPIRIN)

-renal toxicity

-CANNOT be taken with blood thinners (will interfere with bloods ability to clot)

- Excessive use can also cause neuropathy

Name the NSAIDs

Aspirin, ibuprofens (advil, motrin), naproxen (aleve)

Aspirin is also a

antiplatlet agent (but won't cause excessive bleeding like blood thinners would)

Acetaminophen (Tylenol) is NOT

NOT anti-inflammatory, NO effect on clotting

(only fever reducer and pain reliever)

ie analgesic and antripyretic

AcetamiNOphen

NO USE for inflammation

I Nap and I feel Alive (NSAIDs)

Aleve, naproxen, advil, aspirin

Tylenol is perfect for

-children

-patients on blood thinners

-patients with kidney disorders

Opiods

Naloxone, naltrexone

Opiods cause...?

respiratory depression and constipation

SLOw + OPIoid=?

SLOPPY

Opioids makes you SLOW.

(slow bowel, breathing, thinking, miosis)

causes constipation

Opiod receptors

mu, kappa, delta

Most pure opioids block

all receptors (mu, kappa, delta) but mostly mu receptors

EX: morphine, hydromorphone, fentanyl, methadone

Pure opioid antagonist (say, for fentanyl) is

Naloxone (Narcan)

What is the most common OPIOID used in dentistry?

Codeine

(Tylenol + codeine= Tylenol #3)

Natural Opioid (opiate)

morphine

semi-synthetic opioids

oxycodone and hydrocodone

Oxycodone combinations

PercoCET= Oxy + aCETaminophen

Percodan= Oxy + aspirin

Nitrous Oxide

Used for patient anxiety OR muscle relaxation (ex, for patient with cerebral palsy)

-Provides STAGE 1 anesthesia

cerebral palsy

paralysis caused by damage to the area of the brain responsible for movement

Nitrous Oxide contradictions

Res[iratory issues (COPD, airway congestion)

Pregnancy

Cystic fibrosis (too much mucous) ,Infections

Emotional illness (manic, depression)

History of substance abuse

Antibacterial agents

Can be: Bacteriocidal or bacteriostatic

Superinfection

overgrowth of normal microbiota that is resistant to antibiotics

Penicillin

DRUG of choice

BACTERIOCIDAL

(amoxicillin, penicillin V, penicillin G, etc)

Clindamycin Side effects

bacteriostatic agent

Side effects: GI cramps and nausea are common

CAN CAUSE C. DIFF INFECTION. This is why it is no longer in pre-med guidelines M

Penicllin = penCIL= ?

BacterioCIdaL

-Linda has Static Hair

Clindamycin is bacteriostatic.

Macrolides

-Zithro's (azithromycin, clarithromycin)

Bacteriostatic agents

Same side effects as clindamycin- GI cramps/nausea

Tetracycline is

bacteriostatic

Atridox: Doxy hyclate gel

Arestin: minocycline microspheres

periostat: Doxycilycine capsules

CAN CAUSE DISCOLORATION of unerupted teeth, CI for children under 9 or pregnant/nursing mothers

Tetracycline (and it's derivatives) can be blocked from absorbing by

milk/antacids.

Periochip

Subgingival sustained release delivery system, containing Chlorhexidine

Periostat

systemic delivery of 20 mg capsule of doxycycline hyclate (oral administration)

WORKS AGAINST AA!

Arestin

minocycline microspheres

Atridox

doxycycline gel

Name 3 bacteriocidal agents (Pe Me Ce!)

Penicillin

Metronidazole

Cephlasporin

Metronidazole is used to treat? (and side effects?)

PDZ

MORE commonly then tetracycline!!

side effects: Black hairy tongue and metallic taste

Antiviral Agents

agent that combats specific viral diseases

A virus needs a host

Common Antivirals and what they treat

Acyclovir---> Herpes simplex 1, Mono, shingles

Docosanol (Abreva) ---> treats oral herpes labialis

Retrovir ---> treats HIV

Anti-TB agents

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

antidepressant drugs

SSRIs--> Newest generation Ex: Celexa, Prozac, Zoloft

TCAs--> Older generation, Amitriptyline (NO EPI!!! )

MAOs --> Nardil

NDRIs --> Bupropion (also used for smoking cessation)

Anti-psychotic medication

Chlorpromazine, clozapine (-Zine, Apine)

Side effects: xerostomia