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155 Cards in this Set
- Front
- Back
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cidal or static preferred
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cidal
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administer vancomycin for pseudomembranous colitis
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FALSE this is no longer standard of care
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penicillin mode of action
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prevents cell wall synthesis in bacteria
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probenicid
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penicillin secreted in distal tubule
500 mg probenicid + 500 mg penicillin |
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DOC for most odontogenic infections
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penicillin
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uses for amoxicillin
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otitis media, uti, sbe prophylaxis
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why do we use amoxicillin for prophylaxis
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better absorbtion, half life, and plasma concentration
NOT because of wider spectrum |
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name the beta lactamase inhibitors
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clavulonic acid, sulbactam, tazobactam
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when to use augmentin
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bite wounds, otitis media, uti, non odontogenic sinusitis
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cephlosporin
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cidal, broader than penicillin
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keflex, duracef
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oral cephlasporins
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what do you use for a mild penicillin allergy, patient with an odontogenic infection
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cephlosporin
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differece between keflex and duracef
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keflex is q6h
duracef is bid - better complience both 500 mg |
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2nd generation cephlosporin indications
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otitis media, non odentigenic sinusitis
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clarithromycin
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bid, 250 mg
mild to moderate infection with PCN allergy sinus infection |
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which antibiotic gets some bone penetration
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clindomycin
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which antibiotic has the disulfarum effect
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metronidizole
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What acts as the "velcro" on platelts?
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GP IIb/IIIa
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fishnet of clotting
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fibrin
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recruits more platelets
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thromboxane A2
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where does thromboxane A2 come from
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arachadonic acid via COX 1
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difference between thrombosis and embolus
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mobility
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arterial thrombosis
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platelet rich
treat with anti platelt drugs |
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venous thrombosis
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fibrin rich - treat with anticoagulants
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cause of arterial thrombosis
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atherosclerosis
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cause of venous thrombosis
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slow blood movement
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precursor of thromboxane A2
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arachadonic acid --> prostaglandin H2 --> thromboxane A2
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What acts as the "velcro" on platelts?
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GP IIb/IIIa
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fishnet of clotting
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fibrin
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recruits more platelets
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thromboxane A2
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where does thromboxane A2 come from
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arachadonic acid via COX 1
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difference between thrombosis and embolus
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mobility
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arterial thrombosis
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platelet rich
treat with anti platelt drugs |
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venous thrombosis
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fibrin rich - treat with anticoagulants
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cause of arterial thrombosis
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atherosclerosis
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cause of venous thrombosis
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slow blood movement
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precursor of thromboxane A2
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arachadonic acid --> prostaglandin H2 --> thromboxane A2
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Irriversibly blocks COX1
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Aspririn
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life of a platelet
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10 days
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combine ASA and NSAIDs
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NO, but you can use aspirin with COX2 blockers
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binds to ADP receptor
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clopidogrel
ADP interface then inhibits GP IIb/IIIa platelets can't bind to each other |
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what 2 are irreversible
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ASA and clopidogrel
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which pts are especially important to maintain clopidogrel use
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STENTS.... but probably other pts too
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evaluated by aPTT
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intrinsic system
XII |
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evaluated by PT = INR
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extrinsic system
VII |
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limits the espansion of thrombus by preventing fibrin formation
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heparin and lmwh
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when to use heparin or LMWH
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for venous thrombosis
(remember these are the fibrin based) |
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allows anti Thrombin II to inhibit factor Xa and Thrombin
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heparin
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how do you measure heaparin use
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aPTT
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reverses heparin action
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protamine sulfate
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why use LMWH
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more predictable than heparin
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coumadin mechanism of action
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inhibits vit K epoxide reductase
vit K is not regenerated vit K dependant factors are retarded |
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reversed by vit K
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warfarin
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drugs afecting coumadin
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ASA, NSAIDS, propoxyphene
fluconazole |
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what to use for pain when on coumadin
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acetaminophen.... vicadin
NO aspirin or NSAIDS |
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what type of pain is a cavity prep
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somatic nociceptive
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nociceptive pain
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known inciting incident
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pain from the pulp
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visceral nociceptive
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difference between chronic and acute pain
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acute has a known cause and sympathetic effects
chronic has no sympathetic effects and no realy known cause |
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sharp pain from
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A delta
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dull pain from
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C fibers
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1st order neuron
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source --> periphery of CNS
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2nd order neuron
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dorsal horn --> thalamus
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3rd order neuron
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thalamus ---> cerebral cortex and limbic system
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chemical mediators that cause pain
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histamine, bradykinin, substance P
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activate receptors
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opiods
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block prostaglandin synthesis
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non opiods
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difference between COX 1 and COX2
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cox 1 - homeostasis
cox 2 - injury induced |
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SE's of NSAIDS
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GI, Antiplatelet, Decreased renal blood flow
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4 absolute condraindications for aspirin
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aspirin induced nasal polyps
salicylate hypersensitiity ruticaria pregnancy |
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COX 2 disadvantages
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poor 3rd molar efficacy
EMBOLIC phenomena sulfa allergy contradindications |
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acetaminophen limits
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4 g healthy
2 g for liver questionable health |
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max does ibuprofen
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3200mg
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max dose naproxen sodium
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1375 mg
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max does acetaminophen
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4000 mg
2000 mg compromised liver |
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thoght to be the the principle mediator of analgesia
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Mu opiate receptor
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meperidine
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synthetic kappa agonist
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codeine, hydrocodone, oxycodone
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semisynthetic opiate receptor agonists
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what converts synthetic opiods to active metabolites
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CYT P450 CYP2D6
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Pentazocine
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agonist at kappa
antagonist at mu |
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monoamine theory of depression
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depression onset by lack of serotonin and/or norepinephrine
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common tricyclic SE's
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anti cholinergic, anti adrenergic (blocks alpha 1), anti histaminergic( sedation, weight gain, drowsiness)
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tca dental interations
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decreased metabolism due to inihibitors of CYP 3A4 and 2D6
azoles, macrolides, doxycycline *possible epi interatiion |
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SSRI
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block reuptake of serotonin ONLY
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SSRI interations
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MANY CYP 450
CYP 2D6 Inhibitor - blocks codeine --> morphine and reduces efficacy of hydrocodone and oxycodone |
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SNRI
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serotonin and norepinphrine reuptake inhibitors
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SNRI dental interacionts
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check azoles and macrolides
caution for epi |
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MAO
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food interactions
meperadine contraindicated |
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buprroprion
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blocks dopamine reuptake
cigarette stop advers overstimulation, seizures, xerostomia |
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EPI interations
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TCA, SNRI, ADHD drugs, Cocaine
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parkinsons affects what part of brain
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substantia nigra and corpus striatum
(loss of dopaminergic neurons) |
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used with L DOPA
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sinamet (carbidopa)
dopamine does not cross BBB |
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Sinamet SE's
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random movements (mouthing)
careful with epi off/on phenomea orthostatic hypertension |
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Bros Rope Prami
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dopamine receptor agonists
used because they don't have to be converted.... last longer |
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selegiline
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selective MAO-B inhibitor
doubles time before L DOPA needed NO epi Interaction |
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Indications for Amoxicillin
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SBE prophylaxis
otitis media |
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Not indicated for any head and neck infection
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Extended spectrum penicillins
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name the beta lactamase inhibitors
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clavulonic acid
sulbactam tazobactam |
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indications for augmentin
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ear infection
bite wound non odontogenic sinusitus |
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treat significant anaerobic infection
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may need beta lactamase inhibitors, metronidizole, or different antibiotic altogether
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treat odontogenic infection with mild penicillin allergy
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keflex - cephlexin
Keflex 500 mg q6h or Duracef 500 mg q 12 hrs |
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why use cephadroxil (duracef)
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better compliance
keflex is every 6 hrs duracef is every 12 hrs |
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when to use erythromycin
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severe allergy - mild infection
rarely use |
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mild to moderate infection with PCN allergy (true allergy)
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clarithromycin
cephlosporin for mild allergy clindamycin for severe allergy |
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common macrolide adverse affects
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GI complications
Coumadin interaction erythromycin is worse |
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clindamycin indications
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osteo myelitis
prophylaxis in PCN allergy SEVERE PCN allergy |
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odontogenic infection in immunocompromised pt with severe PCN allergy
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clindamycin
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metronidizole indications
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chronic anaerobic infection
bone penetrations use in combo w/ PCN or Ceph for severe infection 500 mg p o q 8 hrs |
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Tetracycline indication
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peri implantitis
dry socket prevention |
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trimethoprim indications
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non odontogenic sinusitis
uti uri travelers diarrhea |
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candidiasis topical
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nystatin or clotrimazole
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fluconazole
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systemic
ONLY for esophageal candidiasis |
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what do you give AIDS pt with candidiasis
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ketoconazole
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chronic osteomyletis
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clindamycin
300-900 mg q hrs |
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bite wounds
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augmentin
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non odontegenic sinusitis
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augmentin
clarithromycin trimethoprim;sulfmthoxizol cefaclor |
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odontogenic sinusitus
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pen vk
500 mg po q 6 hrs |
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prevent or treat herpes labialis
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acyclovir
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mild PCN allergy
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cephlexin
cephadroxil |
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actinomycosis
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pen vk w/ probenicid up to 3 months
clindamycin if pcn allergy |
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odontogenic infection
severe PCN allergy |
clindamycin
clarithromycin |
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interaction that is related to action of drug
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pharmacodynamic
ex effect of adding a antagonist to an agonist |
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interaction that is related to processed in the body
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pharmacokinetic
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interation from drug mixture
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pharmaceutical
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pharmacokinetic interactions
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ADME
absorbtion, distribution, metabolism, excretion |
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medical maximum
lidocaine, articaine with epi |
7 mg/kg
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which LA's have special consideration
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bupivicaine - cardiotoxicity>CNS toxicity
prilocaine - methemoglobinemia |
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alpha 1
beta 1 beta 2 |
vasoconstrict
increase heartrate vasodalate |
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labetalol, carvedilol
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alpha and beta blocker
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non selective beta blockers interation with epi
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they block b1 and b2, so alpha 1 is left open for affect
Hypertension and Bradycardia |
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alpha blockers with epi
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alpha blockers usually taken for BPH
epi will affect the B1 and B2 receptors termed "alpha blockade" - Tachycardia and HYPOtension "epinephrine reversal" MORE PRONOUNCED W/ levonorderfin |
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which antidepressants can show exaggerated epi responses
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SNRI and Tricyclics
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maximum dental epinephrine for healthy patient
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.2 mg = 10 carps
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COMT inhibitors
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"capones"
when given with epinephrine there can be a SERIOUS exaggerated response makes sense - nothing to metabolize epi - can lead to a LOT in the system |
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1/100,000 epi
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=.01 mg/ml we use 1.8 mL carps .... so each carp has roughly .02 mg epi
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traditional NSAID adverse affects
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bleeding, renal, GI, asthma
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why does NSAIDs have asthma like effects
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they block COX which shifts to leukotriene side ... and they cause bronchoconstriction
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nsaids with warfarin
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DONT DO IT
can severely increase bleeding |
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nsaids with sulfonylurea hypoglycemics
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risk of hypoglycemia
not metformin |
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NSAIDS reduce renal blood flow - this is important because it doesnt allow normal excretion of which drugs
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Digoxin
Lithium |
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cyclosporine and tacrolimus
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anti rejection agents that can lead to sever renal toxicity when combined with NSAIDS
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BP drugs with NSAIDS
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Diuretics - reduced effects
ACE inhibitors, beta blockers, angitensin receptor blockers can be renal toxic |
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what metabolizes opiods
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cyp 2d6
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which drugs can make opiods less effective and why
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they inhibit cyp 2d6
SSRIs Buproprion Celecoxib Diltiazem |
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stronger opiods if normal dont work
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hydromorphone
morphine |
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which antibiotic can block oral contraceptives
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rifampin .... possibly others
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Coumadin with antibiotics?
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Penicillins and metronidizole can INCREASE ANTICOAGULATION
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erythromycin and clarythromycin
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can lead to increased blood level of a lot of drugs
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what drug increase lithium levels
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tetracycline
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metronidizole with ethanol
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induces vomiting
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GABAa agonist
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benzodiazapines
used as a sedatives |
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tardive dyskinesia
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random movements seen with antipsychotics ..... often leads to TMJ problems and makes dental treatment difficult
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hypersalivation
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clozapine (an atypical antipsychotic)
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phenytoin, carbamzapine
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Na channel blockers for epilepsy
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gingival pain
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primidone
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