Concepts 2

Front 1

Within the Physician's Desk Reference the white section represents _________.

Back 1

product information

Front 2

Within the Physician's Desk Reference the blue section represents _________.

Back 2

product category index

Front 3

Within the Physician's Desk Reference the pink section represents _________.

Back 3

Brand and Generic Name index

Front 4

Sweet, fruity, acetone breath indicate _________.

Back 4

diabetes/diabetic coma

Front 5

Ammonia breath/body odor indicate ________.

Back 5

renal failure

Front 6

Putrefaction/rotting breath/body odor indicate ________.

Back 6

pulmonary infection

Front 7

White nails = ________
Yellowing nails = ________
splinter hemorrhages = ________
clubbing nails = __________

Back 7

cirrhosis (scarred tissue)/liver disease
malignancy
bacterial endocarditis
cardiopulmonary insufficiency, cystic fibrosis

Front 8

lid retraction = __________
xanthomas = ___________
sclera yellowing = ________
redden conjuctiva = ______

Back 8

hyperthyroidism
hypercholesterolemia
hepatitis
allergy

Front 9

Amoxicillin
Disp: 4 x 500mg tablets
Sig: Take 4 tablets 30-60 mins prior to dental procedure

Back 9

Prophylactic antibiotic

Front 10

If patient is allergic to amoxicillin then _______ should be prescribed.

Back 10

clindamycin

Front 11

The best coverage time of antibiotics is _______.

Back 11

1-2 hours

Front 12

If the patient forgot to take their prophylactic antibiotic, the dose can safely be taken ________ after procedure.

Back 12

2 hours

Front 13

If a patient is currently taking antibiotics then select an antibiotic from a DIFFERENT class and have them wait ____ days in order to complete the antibiotic therapy of dental/hygiene treatment and then start usual regimen.

Back 13

10

Front 14

Restorative dentistry with or without cord
Local anesthetic
Radiographs
Placement of ortho appliances
Impressions
Placement of rubber dam
These procedure do or do not require antibiotic prophylaxis

Back 14

do not

Front 15

Reevaluation appointments should be scheduled for ALL patients receiving initial periodontal therapy. Record all pockets 4mm or above, review OHI, and schedule future appointments for any necessary retreatment.

Back 15

reeval appt

Front 16

What stage of treatment is the patient's current status compared with the baseline data gathered and the time to change or modify care should be re-treated, referred, or place on supportive therapy?

Back 16

evaluation

Front 17

_______ are sounds of turbulent blood flow passing through the chambers of the heart.

Back 17

Heart murmur

Front 18

A heart murmur as a result of pregnancy or early childhood that reflects normal changes in growth and DOES NOT require premedication is ________.

Back 18

Innocent Heart Murmurs (IF)

Front 19

A heart murmur that is caused by disease such as rheumatic heart disease is __________.

Back 19

Pathological/ORGANIC heart murmur (PO)

Front 20

Use gingival packing with epinephrine to reduce bleeding in a hypertensive patient. T/F

Back 20

false

Front 21

The cardiac dose of anesthesia is _____ for patients with low to intermediate risk.

Back 21

.036 mg of epi= 2 carps 1:100,000 epi

Front 22

Prosthetic valve endocarditis (PVE) can be caused by bacteria of oral origin either _______ or _______.

Back 22

stretococci
staphylococci

Front 23

Mechanical Valve lasts LONGER than tissue valves, THROMBOEMBOLISM is a danger but is treated with ANTICOAGULANTS. DOES NEED PREMEDICATION.

Back 23

STUDY

Front 24

Tissue valve DOES NOT LAST AS LONG AS MECHANICAL VALVE. Free of thromboemboisms so NO NEED FOR ANTICOAGULANTS. DOES NOT NEED PREMEDICATION.

Back 24

STUDY

Front 25

The specialized electrical system that results in vasodialation of blood vessels in the heart and decrease of HR is _________ and mimics cardio drug medications.

Back 25

parasympathetic

Front 26

The specialized electrical that results in vasoconstriction of blood vessels in the heart and increase HR is ______ and mimics epi.

Back 26

sympathetic

Front 27

vasodialtion = decreased HR
vasocontriction = increased HR

Back 27

study

Front 28

Endogenous Epinephrine (adrenaline) affects patient in which 2 ways.

Back 28

increases heart rate
alters blood pressure

Front 29

A patient with 130/90 is in what stage of hypertension? What would be a treatment recommendation for this stage?

Back 29

Prehypertension=diastolic pressure less than 90mm/Hg

Step I : Life style changes
weight reduction
stress reduction
no smoking
increase aerobic exercise
salt restriction

Front 30

Name the BIG 5 hypertensive group.
AAceBCD

Back 30

Diuretics
Beta-adrenergic agents
Alpha one blockers
Angiotensin Converting Enzyme inhibitors
Calcium channel blockers

Front 31

Step II - Pharmacological Therapy
STEP III: Augmentation of Doses
STEP IV - Drug Combinations

Back 31

study

Front 32

What are the 2 MECHANISIMs OF ACTION OF ANTIHYPERTENSIVE DRUGS

Back 32

Decreases cardiac output= work load is less on the heart
Lower total peripheral resistance= blood flows easier

Front 33

Three major types of DIURETIC AGENTS

Back 33

Thiazides
Thiazides like loop diuretics
Potassium-sparing diuretics

Front 34

Most common first line of drugs for hypertension is ____________ a THIAZIDE DIURETIC.

Back 34

hydrochlorothiazide (Esidrex®)

Front 35

hypokalmia= arrhythmias & muscle weakness may occur

Back 35

study

Front 36

Action: Diuresis (excretion of urine)
Thiazides inhibit reabsorption of ________ at the distal convoluted tubule of the kidney

Back 36

(Na+) sodium

Front 37

_________-strong cousin of thiazide and most powerful of diuretics. Action:
inhibition of sodium and potassium reabsorption at the level of proximal and distal tubule

Back 37

Thiazide LOOP DIURETICS

Front 38

furosemide (Lasix®)
bumetanide (Bumex®)
torsemide (Demadex®)
-nide, -mide = ___________

Back 38

Thiazide LOOP DIURETICS

Front 39

____________________ =
“Puny” diuretics-weak diuretic action.Action: antagonist of aldosterone receptor
aldosterone acts on the distal tubule to reabsorb sodium
aldosterone action does not interfere with potassium absorption
*Used in combination with thiazide or loop diuretics to help retain Ka+ and prevent hypokalmia****

Back 39

POTASSIUM-SPARING DIURETICS

Front 40

Spironolactone/Aldactone®/Aldactazide®= _____________

Back 40

POTASSIUM-SPARING DIURETICS

Front 41

____________= manages the loss of Ka+ by diuretics
K-Dur, K-Tab, K-Lot

Back 41

POTASSIUM SALT

Front 42

Adverse effects of Potassium salt are 2 things (think stomach)

Back 42

nausea •abdominal pain

Front 43

What are oral side effects of diuretics? (think dry) (2)

Back 43

Xerostomia
Oral lichenoid eruptions
looks like lichen planus

Front 44

diuretics, ACE inhibitors,
A and ß-blockers,
+ non-steroidal anti inflammatory agents (NSAIAS = ______

Back 44

might inhibit the action of the anti-hypertensive agent

Front 45

Hypokalemia (Abnormally low level of Ka+)
*Dehydration and electrolyte imbalance
*Electrolyte abnormalities may lead to arrhythmia
*Hypotension-when in combination with other agents***** are ADVERSE EFFECTS of ________

Back 45

DIURETIC AGENTS

Front 46

_____receptors are located in the heart which cause vasoconstriction
and block the receptors causing vasodilatation or relaxation of smooth muscles

Back 46

ß 1

Front 47

Action: Lower BP by primarily decreasing cardiac output and decrease in sympathetic outflow and reduces peripheral resistance
is of which drug __________

Back 47

ßETA-ADRENERGIC BLOCKING AGENTS

Front 48

Lungs have beta __ receptors
results in smooth muscle relaxation of the bronchioles

Back 48

2

Front 49

atenolol, metoprolol=
propranolol, nadolol =
ßETA-ADRENERGIC BLOCKING AGENTS

Back 49

selective
non selective

Front 50

SELECTIVE
Are advantages to use in patients with asthma- don’t interfere with bronchodialation
Less likely to produce an effect with epinephrine
Non-Selective
Can have interaction with epinephrine
Can cause a 2-4 times in vasopressor response (blood pressure elevates)
Increase BP triggers the vagus nerve causing reflex bradycardia***
****Limit epinephrine to cardiac dose and not retraction cord*****

Back 50

study

Front 51

Indication: angina pectoris, hypertension, post MI, atrial fibrillation, tachycardia
Action: blocks the B1 and B2 receptors
*****slows down heart rate
***reduces myocardial oxygen demand
****Used prophylactically to reduce frequency of attacks
describes ______

Back 51

NON-SELECTIVE B-ADRENERGIC ßLOCKERS/ Hypertension

Front 52

acebutolol
metoprolol
atenolol
bisoprolol
what classification drugs?

Back 52

Selective ß1 Blockers/ Hypertension
aabm

Front 53

propranolol/Inderol®
nadolol /Corgard®
timolol
pindolol
what classification drugs?

Back 53

NON-SELECTIVE B-ADRENERGIC ßLOCKERS/ Hypertension
pptn

Front 54

ßeta-blockers
exacerbation of asthma(bronchoconstrictor- B2 mediated)
bradycardia
may produce CNS depression
fatigue
lethargy
depression

Back 54

study

Front 55

Alpha-blockers
dizziness
headache
nausea
dry mouth-10% patients
orthostatic hypotension (position)
fluid retention
side effects

Back 55

study

Front 56

Action:
Block the conversion of angiotensin I to angiotensin II
Angiotensin II is a potent vasoconstrictor
No angiotensin II, means **** increased vasodilation and reduced blood pressure ****
Cardiac rate is relatively unaffected

Back 56

Angiotensin-Converting Enzyme (ACE) Inhibitors

Front 57

captopril /Capoten®
enalapril /Vasotec®
lisinopril /Prinivil®,
Zestril®
benazepril / Lotensin®
-il =___________

Back 57

(ACE) Inhibitors

Front 58

Hypotension****
Dizziness, fainting, tachycardia****
Dry hacking cough*****
Oral- dysgeusia (altered taste) ****is a fairly common side effect of captopril. Is reversible after first few months of taking this drug.
Non allergic angioedema (swelling lips)******
Burning mouth syndrome****

Back 58

(ACE) Inhibitors Side effects

Front 59

Action:
Inhibits the movement of extracellular calcium (Ca+) ions into cells
Leads vasodilatation
Reduce cardiac after load

Back 59

Calcium Channel Blockers

Front 60

verapamil / Isoptin®,
Adalat®
diltiazem / Cardizem®****

nifedilpine/ Procardia ®

nicardipine /Cardene®
-pine or il

Back 60

Calcium Channel Blockers

Front 61

Excessive hypotension
Flushing (not allergic reaction)
Shortness of breath****
Nasal congestion=may interfere with the use of N20 ****
Headache in about 20% of patients

Back 61

Calcium Channel Blockers (CCB): Side Effects

Front 62

Xerostomia
Dysgeusia
Gingival hyperplasia
begins within 1 to several months after start of therapy
Most common with nifedipine*****

Back 62

Calcium Channel Blockers (CCB): Oral Manifestations
nifedipine
diltiazem
verapamil

Front 63

How to cure ccb induced hyperplasia?

Back 63

Resolution:
Weeks to months, upon discontinuation of the therapy

If patient continues with the drug, a gingivectomy may be required

Front 64

atorvastatin /Lipitor®
lovastatin /Mevacor®
aimvastatin /Zocor ®
suffix: statins

Back 64

Antihyperlipidemics

Front 65

Action:
Lowers cholesterol by inhibiting HMG-Co-A=the rate limiting enzyme in cholesterol synthesis
****Contraindicated in pregnant or nursing women****

Back 65

Antihyperlipidemics

Front 66

________=
B vitamin
Inhibits secretion of VLDL=very low density lipoproteins
_________=
Inhibits intestinal absorption of cholesterol

Back 66

niacin
ezetimibe / Zetia

Front 67

Gastrointestinal complaints/ stomach aches
Agents promote gallstone formation
Can increase anticoagulant effect of warfarin
Liver enzymes elevation- drug induced hepatitis
side effects of __________

Back 67

Antihyperlipidemics

Front 68

flushing of skin (pre-treat with aspirin)
dry skin
hypotension
side effects of ________

Back 68

Niacin

Front 69

Patients taking hyperlipidermics are at increased risk for cardiovascular emergencies
Always check and record
Blood pressure
pulse rates

Back 69

study

Front 70

Drugs commonly used for heart valve replacement, myocardial infarction, arrhythmias
therapeutic window is very narrow

Back 70

ANTICOAGULANTS

Front 71

Indicated for patients who have had recent MI or stroke
***NSAIDs should be avoided because of the risk of GI bleeding
which medication?

Back 71

clopidogrel/ Plavix®

Front 72

Latent (delayed) period of effect and latent period of discontinuation
Sometimes discontinued before dental procedures
Adverse effect: Hemorrhage

Back 72

warfarin -Coumadin®

Front 73

Warfarin +_______ = could be fatal hemorrhage
Warfarin +_______ = potentiate the effect of warfarin. _______ is the preferred antibiotic when patient is on Coumadin®.

Back 73

aspirin
antibiotic
Clindamycin

Front 74

Contraindications for use of Aspirin (tylenol); alcohol

Ibuprofen (Motrin®) or naproxen (Aleve®) can be used

Back 74

warfarin

Front 75

Petechial hemorrhages on the hard palate
Ecchymoses
oral manifestations for ________

Back 75

warfarin

Front 76

Abnormal pacemaker rhythms
Ectopic pacemaker (electrical
activation of the heart outside the
SA node)
Altered impulse-conducting system
Occurs at the SA and AV node
all caused by ________

Back 76

arrhythmia

Front 77

types of arrhythmias
ventricular = _______
arterial = _______

Back 77

bradycardia vb
tachycardia at

Front 78

Anti-arrhythmic drugs interfere with
_________

Back 78

depolarization

Front 79

Severe chest pain related to a failure of the coronary arteries to supply a sufficient amount of oxygen to the myocardium on demand
due to obstruction of the coronary vessels by atherosclerotic plaques
Pain can be precipitated by stress by physical of emotional exertion, anxiety and apprehension such as generated by a dental appointment

Back 79

angina

Front 80

1. Nitrates
2. Calcium Channel blockers
3. B-adrenergic blocking agents
reduce the work load of the heart
lower oxygen requirements to myocardium=therefore reduces pain

Back 80

MAJOR ANTIANGINAL DRUGS

Front 81

Action: vascular smooth muscle relaxation throughout the body: venous dilators
Results indirectly to the heart:
reduced the resistance against which the heart pumps
reduced workload on the heart
decreased oxygen demand
decreased pain

Back 81

NITRATES/Angina

Front 82

________rapid onset of action, lasts 30 min.
preferred to treat acute angina attacks
Tablet
Nitrolingual
Spray
Nitroglycerine _______- used in inches every 6-8 hours
very messy
Nitroglycerine ________-provide steady constant release of drug over 24 hours (not for acute attacks)

Back 82

Nitroglycerine (Nitrostat®)
Topical Ointment
Transdermal Patches

Front 83

Oral forms
stomach acid reduces the nitrates activity
Topical/sublingual use
May produce sublingual burning or tingling

Back 83

adverse effects of nitro

Front 84

Hypotension
Fainting
Severe headaches
Orthostatic hypotension
Adverse Reactions from _______

Back 84

Nitroglycerin

Front 85

Prevention Strategies for angina
Sedation
Benzodiazepine, an anti-anxiety agent, may prevent an acute angina attack in the anxious patient
Nitroglycerin-may be administered before any anxiety provoking procedure
Patient should have his/her own medication supply during dental procedures
A patient with acute chest pain may either be experiencing an anginal attack or myocardial infarct
The patient should be taken to an emergency room ASAP for diagnostic evaluation if pain persists after nitroglycerin administered

Back 85

study

Front 86

verapamil (Calan®)
diltiazem (Cardizem®)
nifedipine (Procardia®, Adalat®)
Action:
inhibition of calcium efflux
slows down depolarization
increased vasodilatation
decreases myocardial work

Back 86

Calcium Channel Blockers/Angina

Front 87

dizziness
weakness
constipation
hypotension
nifedipine, diltiazem, verapamil are associated with:
gingival hyperplasia
Dysgeusia (altered taste)
Adverse Effects of ________

Back 87

Calcium Channel Blockers

Front 88

Pathogenesis
Increased heart rate
decreased cardiac output
increased sympathetic action (vasoconstriction)
Increased pumping
Ineffective distribution of oxygenated blood
weak cardiac contraction
“Back-up” of blood into failing ventricles

Back 88

chf

Front 89

Cardiac ________= not always considered first line of defense
e.g. digoxin (Lanoxin®, Digitoxin®)
_______ = does prevent progression of CHF in reducing morbidity and hospitalization

_______= for patients with mild to moderate CHF
_______= relieves many symptoms of CH

Back 89

glycosides
ACE-Inhibitors
B-Blockers
Diuretics

Front 90

adverse reactions
1. Gastrointestinal
anorexia
nausea
vomiting
***copious salivation and increase in gag reflex
2. Cardiac arrhythmia
ventricular fibrillation
diuretic use increases risk
(due to hypokalemia

Back 90

digoxin

Front 91

Erythromycin and ______ can
increase the toxicity of digoxin in some
patients

Back 91

tetracycline

Front 92

Digitalis + diuretic = Arrhythmia
2. Sympatomimetic agents (vasoconstrictors) + digitalis = Arrhythmia

Back 92

drug reactions digoxin

Front 93

Quinidine
Procainamide
Mexiletine
Tocaine
Phenytoin
Lidocaine
propanolol
acebutonol
Bretylium
Amiodarone
Calcium Channel Blockers

Back 93

Arrhythmia medications