Pharmacology Chapters 6-11

Front 1

In 1997 the New England Journal of Medicine linked 2 diet drugs with valvular heart disease: ______ & ______

Back 1

Redux: (dexfenfluramine hydrochloride)
Pondimin: (fenfluramine hydrochloride)

Front 2

Meridia (________)

Back 2

Sibutramine

Front 3

Adverse effects of Meridia:
In some people, sibutramine raises _______ _______ , pulse, and irregular heart beats

Back 3

blood pressure

Front 4

_______ reduced appetite by interacting with serotonin the brain.

Back 4

Sibutramine

Front 5

Sibutramine is not associated with _____ _____ _____

Back 5

Valvular heart disease

Front 6

Concerns about fen/phen
American Heart Association recommendation:
*Prior reports have linked high blood pressure in lungs, called ______ ______, to treatment with fenfluramine or phentermine alone.

Back 6

Pulmonary hypertension

Front 7

Concerns about fen/phen
American Heart Association recommendation:
*Dexfenfluamine also increases the risk of pulmonary hypertension, especially when patients receive high doses for ___ months or more

Back 7

3

Front 8

Concerns about fen/phen
American Heart Association recommendation:
*____ ____ ____ occurs when the heart valve is damaged and either can't open properly or doesn't close all the way and lets blood leak backward

Back 8

Valvular heart disease

Front 9

Concerns about fen/phen
American Heart Association recommendation:
*Primary pulmonary hypertension is an often-_____ disorder affecting the blood vessels in the ____

Back 9

fatal; lungs

Front 10

Concerns about fen/phen
American Heart Association recommendation:
*Pulmonary hypertension results in death within four years in __ percent of its victims

Back 10

45

Front 11

All persons who have taken fenfluramine or dexfenfluramine for any period of time should have a thorough _____ _____ and _____ _____ _____

Back 11

Medical history & cardiovascular physical examination

Front 12

Guideline concerns for fen/phen:
*The ______ should administer antibiotic prophylaxis before dental procedures known to create a risk for ________

Back 12

practitioner; endocarditis

Front 13

Guideline concerns for fen/phen:
*If there are signs of a new murmur or symptoms such as shortness of breath, a ________ ________ should be ordered.

Back 13

echocardiographic evaluation

Front 14

Guideline concerns for fen/phen:
*For a emergency procedure in a patient who hasn't been evaluated for _______, antibiotic prophylaxis should be administered.

Back 14

Valvulopathy

Front 15

Guideline concerns for fen/phen:
*Very mild,clinically insignificant valvular regurgitation-backward leakage of blood through out the valvue-- is present in many health adults. Person should only be classified as having ______ if they have clinically significant leakage.

Back 15

Valvulopathy

Front 16

Nonopioids:
*Work At The ____ ____ ____
*Inhibit _____

Back 16

* Peripheral Nerve Ending
* Prostaglandins

Front 17

Opioids:
*Work Within The _____
*Work by Depressing The ____

Back 17

*CNS
*CNS

Front 18

Nonopioids:
_______= Increase Mucus, Decrease Stomach Acid
_______= Decrease Mucus, Increase Stomach Acid

Back 18

Prostaglandins ; Salicylates

Front 19

Salicylates:
-When aspirin becomes old, it breaks down to acids, you can smell it.
-They can also cause more stomach irritation due to ____ ____.

Back 19

Acid Breakdown

Front 20

Salicylates ( _____ )
Inhibit ______ ______

Back 20

Aspirin; Prostaglandin Synthesis

Front 21

Nonopioids:
Cell = _____ ______

Back 21

Uric Acid

Front 22

*GOUT*
-An inherited disease
-Occurs primarily in ______
-Occurs in the_____ _____ or _____
_____ _____are found in the joint
-The excess uric acid is due to lack of secretion or excessive production of Uric Acid

Back 22

Men ; Big Toe or Knee; Urate Crystals

Front 23

Drug interactions with Salicylates Warfarin

* _____ + _____= Bleeding

Back 23

Warfarin + Aspirin

Front 24

Treatment of Aspirin Poisoning
*For Acidosis - Drink _____ _____
= The urine is alkalinized & causes more urine secretion

Back 24

Sodium Bicarbonate

Front 25

Hypersensitivity (Allergy) to Salicylates:

A true aspirin sensitivity occurs in ____ % of population

* There is a cross sensitivity with Nonsteroidal Antiinflammatories (NASAIDS)

*True Allergic Reactions: _____, _____ & _____ _____ _____

Back 25

1%; Rash, Wheezing, Uric Acid Retention

Front 26

Adverse effect of Salicylates (Bleeding):

*Aspirin _____ binds to platelets reducing aggregation (clotting)
*Bleeding time is prolonged until all new platelets form (normal clotting can resume in ____-____ days)
*When____% of the platelets have been replaced
*____ days later, normal clotting should begin

Back 26

Irreversibly; 4-7 days; 20%; 1 1/2 days

Front 27

Acetaminophen
*_______
*Metabolized in the ______
Not for Alcoholism

Back 27

Tylenol ; liver

Front 28

Drug Interactions W/ Acetaminophen

Back 28

None

Front 29

Bone marrow suppression- _________

Back 29

Methotrexate

Front 30

A lethal Dose of Aspirin
Child= _____gm
Adult=____-____gm

Back 30

4 Gm ; 10-30 gm

Front 31

Prostaglandins
______ Uterine Contraction

Back 31

Increase

Front 32

Acetaminophen ( _______ )

Back 32

Tylenol

Front 33

Nonsteroidal Antiinflammatories
( _______, _______ )

Motrin, Antiinflammatory, non-steroidal

Back 33

Ibuprofen; Naproxen

Front 34

Nonopioids are divided into:
1. _______
2. _______
3. _______

Back 34

1. Salicylates (Aspirin)
2. Nonsteroidal Antiinflammatories (Ibuprofen, Naproxen)
3. Acetaminophen (Tylenol)

Front 35

Prostaglandins produce ______ _____

Back 35

Uterine Contractions

Front 36

Zero-Order Kinetics of Salicylates:
-With a small dose, the 1/2 life is ____-_____ hrs.

-With a large dose, the 1/2 life can be _____-_____ hrs.

-only a certain amount of aspirin metabolized at a time.

Back 36

2-3 Hours ; 15-30 Hours

Front 37

Salicylates (Aspirin)

ASA----->______+______

Back 37

HA + SA
Aspirin ----> Acetic Acid + Salicylic Acid

Front 38

Prostaglandins vasodilate ______ , causing ______ & ______

Back 38

Capillaries; Erythmea & Swelling

Front 39

Uses of Acetaminophen
*Patients allergic to _______
*Patients w/ ______ ______
*Children

Acetaminophen should not be administered to children less than _____ of age or for more than 10 days.

Back 39

-Salicylates (Aspirin)
-Gastric Irritation
-3

Front 40

Adverse effects of (NASAIDS) Nonsteroidal Antiinflammatories:
Blood Clotting---
They are bound ______
The effect lasts only as long as the NASAID is in the system.

1 Day for _______
4 Days for _______

Back 40

Reversibly;
1 day- Ibuprofen
4 days- Naproxen

Front 41

Drugs used to treat Gout
______-Inhibits the synthesis of uric acid.
It is also used in patients having chemotherapy treatment or radiation for malignancies- kill CA cells
(Destruction of cells causes a release of ______ ______ ______ )

Back 41

Allopurinal ; Uric acid precursors

Front 42

______ is used to treat cancers & arthritis (autoimmune disease)

Back 42

Methotrexate

Front 43

Drug interactions with Salicylates: Warfarin

The aspirin displaces the Warfarin at the binding site= more Warfarin in the _____ _____= More anticoagulant= more _______

Back 43

Blood stream; Bleeding

Front 44

Drug interactions with Salicylates:

______ is bound to plasma binding sites

Back 44

Warfarin

Front 45

Contraindications & Cautions for taking NASAIDS
1.
2.
3.
4.
5.
6.
7.

Back 45

1. Asthma
2. Cardiovascular disease
3. Renal disease
4. Peptic ulcer
5. Ulcerative Colitis
6. Geriatric Patients
7. Hypersensitivity reactions to Aspirin

Front 46

Uses of Salicylates (Aspirin)
* Provide _____ for mild to moderate pain.
* Controls fever (antipyretic) _____ _____ ______

Back 46

Analgesia ; Avoid in children

Front 47

Drug interactions with NASAIDS
1.
2.
3.

Back 47

1. Lithium
2. Digoxin
3. Methotrexate

Front 48

______ are more likely to have a hypersensitivity reaction

Hypersensitivity Triad:
1.
2.
3.
-If have one symptom will probably have the other.

Back 48

Asthmatics;
1.Aspirin hypersensitivity
2.Asthma
3.Nasal Polyps

Front 49

2 Nonsteroidal Antiinflammatory Drugs (NASAIDS)
-Ibuprofen-______
-________

*NASAIDS inhibit Prostaglandin synthesis

Back 49

Motrin ; Naproxen

Front 50

Hypersensitivity Reactions to NASAIDS:
1.
2.
3.
4.
5.
6.
7.

Back 50

1. Hives
2. Itching
3. Chills
4. Fever
5. Steven's-Johnson Syndrome
6. Exfoliative Dermatitis
7. Anaphylaxis

Front 51

Patient Instructions for use of Nonsteroidal Antiinflammatory Drugs:

*Take With Food
*Use with caution when driving due to possible ________
*Do not use aspirin concurrently
*Do not take ____ analgesics w/ prescription NASAIDS
*Take w/ full glass of water

Back 51

Drowsiness ; OTC

Front 52

Salicylates-their properties:

Back 52

*Analgesic
*Antipyretic
*Antiinflammatory
*Anti-platelet
*Urrcosic

Front 53

Pharmacokinetics of Salicylates:
*Rapidly & completely absorbed in _____ & _____ _____
*Peak effect is produced in ____ Minutes
*Buffered Aspirin dissolves more quickly & reaches peak effect in ____ min.
*It is disturbed to body tissue & fluids

Back 53

Stomach & Small Intestine; 30 Minutes; 20 Minutes

Front 54

Salicylates (Aspirin) :
Decreases _____ & _____
Causes stomach irritation; decreases uterine contractions and increases stomach acid

Back 54

Erythema & Swelling

Front 55

Adverse Effects of NASAIDS:
*_____-Irritation, pain, bleeding
*_____-Sedation, dizziness, confusion, mental depression, headache, vertigo
*_____
*_____-Ulcerative stomatitis, gingival ulcerations, dry mouth

Back 55

Gastrointestinal; CNS; Convulsions; Oral

Front 56

Advantages of Acetaminophen:
*Does not cause ____ ____ ____ & ____ ____
*Does not affect platelet______
good for ppl w/ gout, blood thinner, ulcer

Back 56

Uric Acid Retention & gastric irritation; Platelet coagulation

Front 57

Types of Salicylates (Aspirin):
Enteric-Coated
ADV.-Reduced _____ _____
DIS.-Erratic absorption & Unreliable _____ _____

Back 57

Stomach Irritation; Blood levels

Front 58

Types of Salicylates (Aspirin):
*______
*______ dissolves in the intestine instead of the stomach
*______ Buffered, w/ Caffeine

Back 58

*Regular
*Enteric-coated
*Combinations

Front 59

Toxicity to Salicylates (Aspirin): "Saliylism":
*Tinnitus, headache, nausea, vomiting, dizziness, ringing in ears
*hyperthermia & Electrolyte imbalance

Hyperventilation
=________
=________ loss of bicarbonate, sodium & potassium
=________

Back 59

Alkalosis; Renal; ACIDOSIS

Front 60

Treatment of Aspirin Poisoning:
-Induce vomiting
-Administer _____ _____ to absorb the aspirin

Back 60

Activated Charcoal

Front 61

Uses of Salicylates (Aspirin):
-Reduces inflammation (antiinflammatory) used for ______
-Prevents clotting ( _____ _____ )

Back 61

Arthritis; myocardial infarction

Front 62

Drug interactions w/ Salicylates:
*Aspirin may cause Gout by counteracting Probenecid's uricosuric effect-prevent secretion (by inhibiting the excretion of _____ _____

Back 62

Uric Acid

Front 63

Drugs used to treat Gout:
* _______
* _______- used in treatment of acute Gout

Back 63

NASAIDS; Cholchicine

Front 64

Pharmacological effects of (NASAIDS):
1.
2.
3.

Back 64

1. Analgesic
2. Antipyretic
3. Anti-inflammatory

Front 65

NASAIDS increase the effect of _____ & _____

______- NASAIDS increase the toxicity of this

Back 65

Lithium & Digoxin; Methotrexate

Front 66

Adverse Reactions of Salicylates:
*Gastrointestinal- _____, _____, _____
*Reyes syndrome- No Salicylates to children
*Pregnancy-
Decreased ________
Found in ______ ______

Back 66

Nausea, vomiting, bleeding; contractions; breast milk

Front 67

Zero-order kinetics of Salicylates:
*The 1/2 life of Salicylates is ______ ______.
* A _____ _____ of Salicylates is excreted (Not a % of the amount)

Back 67

*dose dependent
*Constant amount

Front 68

Pharmacological Effects of Acetaminophen:
*
*
Does not possess ________

Back 68

*Analgesic
*Antipyretic

*Anti-inflammatory

Front 69

Drug interactions w/ Salicylates:
*Aspirin displaces Methotrexate from the _____ _____
=more Methotrexate in the blood
=toxicity
=______ _____ _____

Back 69

Binding site; Bone Marrow Suppression

Front 70

Salicylates (Aspirin)
*Reduce fever, but has no effect on normal _____ _____
*In toxic doses, Aspirin produces _______

Back 70

Body Temperature; hyperthermia

Front 71

Drugs used to treat Gout:
_____- increases the excretion of uric acid by administering a uriocosuric agent.
-Headaches & sore gums have been noticed as side effects
-This drug increases the level of NASAIDS & ______

Back 71

Probenecid; Penicillin

Front 72

Drug interactions w/ Salicylates:
* Probenecid has an uricosuric effect (uric acid is excreted)-helps secrete _____ ( _____ )

Back 72

Urine (gout)

Front 73

Prostaglandins:
(Remember: _____ inhibits prostaglandins)
-Increased levels of prostaglandins produces an increased _______ ______

Back 73

Aspirin; Body Temp.

Front 74

Adverse Effects of Acetaminophen:
Hepatic Necrosis:
*________
*________- Alcohol stimulates the enzyme that metabolizes Acetaminophen to its toxic metabolite.

Can take ____ gm, if patient drinks less than ____ alcoholic beverages daily. If the patient drinks more, then no Acetaminophen should be given.

Back 74

Hepatitis; Alcoholics
2 gm, 3 alcoholic beverages

Front 75

Inflammation infection----> Leukocytes Increase----> _________ to secrete prostaglandins

Back 75

hypothalamus

Front 76

Opioids Bind to Receptors in the _____ & the _____ _____.

Back 76

CNS & Spinal Cord

Front 77

3 Opioid Receptor Sites (stimulated by Opioids)
1.
2.
3.

Back 77

1. Mu-sedation/anglesia
2. Kappa-sedation/anglesia-dysphoria
3. Delta-Pain

Front 78

Mu & Kappa are involved in producing analgesia
______-produce sedation

Back 78

Kappa

Front 79

Endogenous substances with opioid-like action

Back 79

Endorphins

Front 80

Endorphins:
They are probably ________
They possess analgesic action

Back 80

Neurotransmitters

Front 81

Opioids: Pharmacological Effects:

Analgesia:
______ raises the pain threshold & affects the cerebral cortex to depress the reaction of pain.

*Mu & Kappa Antagonists are _______

Back 81

Codeine; Stimulated

Front 82

Opioids: Pharmacological Effects:
Kappa receptors produce ______
With larger doses-_______ results

Depress the cough center in the _____ _____

Back 82

Sedation; Euphoria; adrenal medulla (requires low dose)

Front 83

Opioids: Pharmacological Effects:
1.
2.
3.
4.

Back 83

1. Analgesia
2. Sedation & Euphoria
3. Cough Suppression
4. Gastrointestinal

Front 84

Pharmacokinetics: Opioids:
Absorption:
*oral, lungs, nasal & oral mucosa, mucous membrane and skin
*Undergo ____ ____ metabolism (which reduces bio-availability)
*Distributed to the fetus (can cause respiratory depression)
*Onset in ___ ___
*Dosing every ___-___ hours

Back 84

*1st pass; 1 hour; 4-6 hours

Front 85

Opioids: Pharmacological Effects:
Gastrointestinal-Constipation:
_____ smooth muscle tone of the intestines
_________ propulsive contraction and motility

Used for_______

Back 85

Increase; Decrease; Diarrhea

Front 86

Opioids: Adverse Reactions
The adverse effects are proportional to their strength.

Respiratory Depression
-Depression is related to the dose of opioid
-Respiratory depression is usually the cause of death in ______.-brain stem desensitized, vessel in brain _____

Back 86

overdose; dilate

Front 87

Respiratory Depression in an overdose:
_____ depress the respiratory center in the brain (in a dose related manner)
The brain stem has a decreased sensitivity to _____ _____
Rate and depth of breathing are _____
Reduced ventilation produces vasodilation of vessels in the brain.
Vasodilation produces increased intracranial pressure.

Back 87

Opioids; Carbon dioxide; reduced

Front 88

Do not use Opioids in patients with _____ _____

Back 88

head injuries

Front 89

Patients with hyperthyroidism are more tolerant to the _____.

Back 89

Depression

Front 90

Opioids: Contraindications/Cautions:
*_____/ ____& _____ _____-addiction potential
*_____ ____-can increase intracranial pressure.
*_____ ____-respiratory depression can occur
*_____-respiratory depression of near-term fetus
*______-exacerbates or produces
*

Back 90

Alcoholics/Addicts & Chronic pain; Head injury; Respiratory disease; Pregnancy; Constipation

Front 91

Opioids:Contraindications/Cautions
1.
2.
3.
4.
5.
6.

Back 91

1. Alcoholic/addicts
2. Head injury
3. Chronic pain
4. Respiratory disease
5. Pregnancy
6. Constipation

Front 92

Opioids: Adverse Reactions:
Nausea & Vomiting :
-Opioids directly stimulate ____ ____ zone located in the medulla.

Back 92

CTZ trigger

Front 93

Opioids: Adverse Reactions:
Constipation:
_____ does not develop with use-always remain the same

Back 93

Tolerance

Front 94

Opioids: Adverse Reactions:
Myosis-Pinpoint Pupils:
_____ does not develop with use

Back 94

Tolerance

Front 95

Opioids: Adverse Reactions:
Urinary Retention:
Opioids _____ smooth muscle tone in the urinary tract

Back 95

increase

Front 96

Opioids: Adverse Reactions:
CNS:
Occasionally Opioids produce _____ stimulation

Back 96

CNS

Front 97

Opioids: Adverse Reactions:
Cardiovascular:
Opioids may stimulate ______ _____, ______ & ______

Back 97

postural hypotension, bradycardia & syncope

Front 98

Opioids: Adverse Reactions:
Histamine Release:
Opioids can stimulate the release of histamines causing ______

Back 98

Itching

Front 99

Opioids: Adverse Reactions:
Pregnancy:
May _____ labor
____ fetal respiration

*also in breast milk

Back 99

prolong; depress

Front 100

Opioids: Adverse Reactions:
1.
2.
3.
4.
5.
6.
7.
8.

Back 100

1. Nausea & Vomiting
2. Constipation
3. Myosis-Pinpoint Pupils
4. Urinary Retention
5. CNS
6. Cardiovascular
7. Histamine Release
8. Pregnancy

Front 101

Opioids Addiction:
-The degree of addiction is proportional to the strength of the Opioid.
-An addict will develop tolerance to the effects of Opioids except for ______ & ______

Back 101

Myosis (pinpoint pupils) & Constipation

Front 102

Opioids Addiction:
-The major symptom of overdose is ______ ______.
-Opioid overdose is treated with antagonist- ________

Back 102

Respiratory Depression; Naloxone

Front 103

Opioid Addiction Withdrawal symptoms:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Back 103

1. yawning
2. itching
3. perspiration
4. Gooseflesh (cold turkey)
5. nausea
6. vomiting
7. tachycardia
8. tremors
9. chills

Front 104

Excuses of the Addict: Opioids:
*Claims many ____ & states many pain meds to not work.
*Cancels dental appointments
*Experiences pain for days after _____ & _____ _____
*Moves from dental office to dental office
*Claims a low ______
*Needs Refills

Back 104

allergies; scaling and root planning; threshold

Front 105

Treatment of the Addict: Opioids:
*Substituting oral ______ for the injectable heroin and then slowly withdrawing
* "Cold Turkey"
* Maintain the patient on high levels of Methadone
*Administer oral ______ (a long-acting antagonist)-off heroin for 1 week

Back 105

Methadone; Naltrexone

Front 106

Drug Interactions with the Opioids:
Alcohol or sedative-hypnotic drugs can potentate the opioid respiratory depressant effect.
*reduces the opioid with _______

Back 106

Antihistamines

Front 107

Opioid Agonists:
1.
2.
3.
4.
5.
6.
7.

Back 107

1. Morphine
2. Oxycodone
3. Hydrocodone
4. Codeine
5. Propoxphene
6. Meperidine
7. Methadone

Front 108

Opioid Agonists:
*Used parenterally after surgery
* Use orally to treat pain in the terminally ill

Back 108

Morphine

Front 109

Opioid Agonists:
Morphine:
Tab-____ reaches blood stream

Back 109

1/4

Front 110

Opioid Agonists:
Oxycodone:
Oxycodone + Aspirin=_______
Oxycodone + Acetaminophen= _____
*Oxycontin-CA
Terminally ill

Back 110

Percodan; Percocet

Front 111

Opioid Agonists:
Hydrocodone:
Hydrocodone + Acetaminophen= _____, _____, _____
Hydrocodone + Aspirin= _____

Back 111

Vicodin, Lortab, Lorcet; Percodan

Front 112

Opioid Agonists:
Codeine:
-oral ____ reaches blood stream
Codeine + Aspirin or Acetaminophen
#2=___mg
#3=___mg
#4=___mg
*Affect Kappy/Mu opioid receptors

Back 112

2/3rds;15 mg; 30 mg; 60 mg

Front 113

Opioid Agonists:
Abused by medical personnel
Very large 1st pass
Same as dermerol (inject)

Back 113

Meperidine

Front 114

Opioid Agonists:
Primarily used for Opioid addicts

Back 114

Methadone

Front 115

Opioid Agonists:
Darvocette N-100
Synthetic Opioid
High addiction possibilities
(Darvon)

Back 115

Propoxphene

Front 116

Mixed Opioids:
-Surgery after already knocked out

Back 116

Pentazocine- (Talwin)

Front 117

Mixed Opioids:
Pentazocine-(Talwin):
*Agonist-Antagonist
*Increases both the ____ ____ & ____ ____

Back 117

blood pressure & heart rate

Front 118

Mixed Opioids:
Treat Pentazocine overdoses with _____ .
Triggers K receptor site dysphoria

Back 118

Naloxone

Front 119

Opioid Antagonists:
It is an antagonist at all 3 receptor sites

Back 119

Naloxone

Front 120

Opioid Antagonists:
-in emergency kit
-It will reverse Opioid induced respiratory depression
-Administered Parenterally

Back 120

Naloxone

Front 121

Opioid Antagonists:
Should be administered IV or intramuscularly

Back 121

Alcoholism

Front 122

Opioid Antagonists:
Alcoholism:
__mg dose repeated every ___-___ minutes up to ____mg
If no response occurs after ___mg, reevaluate

Back 122

2mg, 2-3minutes, 10mg, 10mg

Front 123

Opioid Antagonist:
Used to maintain a opioid-free state

Back 123

Naltrexone

Front 124

Opioid Antagonist:
Naltrexone:
It should not be administered until the patient has remained opioid free for at least _____ week(s)
Also used for _____

Back 124

1; alcoholics

Front 125

Bacterial Endocarditis:
Bacteremias commonly occur during activities of daily living such as routine _____ _____ or _____.

Back 125

Tooth brushing or chewing

Front 126

Bacterial Endocarditis:
In general, prophylaxis is recommended for procedures associated with significant bleeding from hard or soft tissues, _____ _____, _____ & ______ _____ _____

Back 126

Periodontal surgery, scaling & professional teeth cleaning

Front 127

Bacterial Endocarditis:
If unanticipated bleeding occurs antibiotic prophylaxis administered within ___ hours following the procedure will provide effective prophylaxis.

Back 127

2

Front 128

Endocarditis Prophylaxis not recommended:
*Coronary Artery Bypass
*Mitral Valve Proplapse without Valvar Regurgitation
*Innocent _____ _____
*Previous Rheumatic Fever without Valvar Dysfunction
*_____ _____

Back 128

Heart Murmur; Cardiac pacemakers

Front 129

Cardiac Conditions Associated with Endocarditis:
*Prosthetic Cardiac Valves
*Previous Bacterial Endocarditis
*______ _____ _____

Back 129

Congenital heart disease

Front 130

Cardiac Conditions Associated with Endocarditis:
Congenital heart disease:
Unrepaired cyanotic congenital heart disease(pallatative shunts & conduits)
*Completely repaired congenital heart disease with prosthetic materical or device during the 1st _____ months after procedure

Back 130

6

Front 131

Cardiac Conditions Associated with Endocarditis:
*Repaired congenital heart disease with residual defects
*Cardiac Transplant
____ _____ _____

Back 131

High Risk Patients

Front 132

Bacterial Endocarditis:
Antibiotics administered more than ____ hours following the procedure will have no effect

Back 132

4 hours

Front 133

Bacterial Endocarditis:
Edentulous patients may develop bacteremia from ulcers by ____ _____ _____

Back 133

ill-fitting dentures

Front 134

Bacterial Endocarditis:
If a series of dental procedures is required, it may be wise to observe an interval of time between procedures to reduce the potential for the emergence of resistant organisms and allow ______ of the mouth with antibiotic _____ _____

Back 134

repopulation; susceptible flora

Front 135

Standard Prophylactic Regimens:
Standard: ______
Allergic to Penicillin: _______

Back 135

Amoxicillin; Clindamycin

Front 136

Standard Prophylactic Regimens:
Amoxicillin: _____ mg tabs
Clindamycin: ______mg tabs

Back 136

500 mg; 300 mg

Front 137

Standard Prophylactic Regimens:
Instructions 30-60 minutes before appointment
Amoxicillin-500 mg tabs, ___g taken before appt. ____tabs

Back 137

2; 4 tabs

Front 138

Standard Prophylactic Regimens:
Instructions 30-60 minutes before appointment
Clindamycin-300 mg tabs, ___mg taken before appt._____tabs

Back 138

600; 2 tabs

Front 139

Endocarditis Prophylaxis Recommended:
*Dental Extractions
*Periodontal Procedures: Scaling, root planing, probing, recall appointments
*Dental implant ______
*Endodontic
*_____ placement of antibiotic fibers

Back 139

placement; Subgingival

Front 140

Endocarditis Prophylaxis Recommended:
*Initial placement of orthodontic bands
*Intraligamentary local anesthetic injections
*Prophylactic cleaning of teeth or implants where ______ is anticipated

Back 140

bleeding

Front 141

Endocarditis prophylaxis not recommended:
*restorative dentistry
*LA Injections
*Placement of _____ _____
*Postoperative suture removal
*Placement of removable prosthodontic or orthodontic applicances
*_______
* _______ treatment
*Orthodontic appliance adjustment
*Shedding of primary teeth
*X-rays

Back 141

rubber dams; impressions; flouride

Front 142

General Anesthetic:
The patient must be constantly monitored because they lack _____ ____.

Back 142

Protective Reflexes

Front 143

Stages & Planes of General Anesthetic:
Stage 1:_____
*Reduced sensation to pain
*The patient is ______
*______ are present
*Respiration remains regular

______ ______ maintains the patient in stage 1

Back 143

Analgesia; Conscious; Reflexes; Nitrous Oxide

Front 144

Stages & Planes of General Anesthetic:
Stage II: ______ or _____
*Begins with _______
*Involuntary movement and excitement
*Respiration becomes _____
*Muscle tone_____
*Uncomfortable for the patient due to incontinence
*Ultra short acting barbiturates take them rapidly into the next stage

Back 144

Delirium or Excitation; Unconsciousness; Irregular; increases

Front 145

Stages & Planes of General Anesthetic:
Stage III: _____ _____
Stage IV: _____ or _____ _____
*complete cessation of respiration
*pinpoint pupils are maximally dilated
*_____ _____ falls

Back 145

Surgical Anesthesia; Respiratory or Medullary Paralysis; blood pressure

Front 146

Classification of General Anesthetics:
*Inhalation ( _____ & _____ ____ )

Back 146

Gases & Volatile Liquids

Front 147

Classification of General Anesthetics:
*The less soluble the anesthetic is in the body, the ______ the onset and recovery.
*N2O-_____ solubility
*______ high solubility and long recovery

Back 147

faster; low; Halothane

Front 148

General Anesthetic:
MAC: ______ ______ ______

Back 148

Minimum Alveolar Concentration

Front 149

General Anesthetic: MAC:
Used to compare the _____ of general anesthetics

Back 149

Potency

Front 150

General Anesthetic: MAC:
Low MACs= _____ potency
N2O-MAC greater than _____
Halothane-MAC _____

Back 150

Increased; 100; 0.75

Front 151

General Anesthetic: Nitrous Oxide-NO2

*Little odor
*Colorless
*_____ soluble of all inhalation anesthetics
*The patient remains _____ with protective reflexes

Back 151

Least; Conscious

Front 152

General Anesthetic: Administration of N20:
*Start with 100% ____ for 2-3 minutes
*Gradually add ____ until the patient response indicates the desired level of sedation

Back 152

O2; N2

Front 153

General Anesthetic: Administration of N2O:
*Best indicator of sedation is to ask the patient simple questions ( ____ responses)
*At termination, 100% O2 for ____ minutes

Back 153

Slow; 5 minutes

Front 154

General Anesthetic: Diffusion Hypoxia:
When the mask is removed without placing the patient on 100% O2, the patient reports ______.

Back 154

headache

Front 155

General Anesthetic: Pharmacological Effects:
CNS- Auditory perception is not affected
-We want a tranquil, _____ _____
*Time frame is ______

Back 155

Quiet environment; decreased

Front 156

General Anesthetic: Adverse Reactions:
1.
2.
3.

Back 156

1. Nausea
2. Vomiting
3. Death

Front 157

General Anesthetic: Safety:
O2: _____
N2: _____
*if O2 runs out, system stops "____ ___"
Pins will not allow switching of tanks

Back 157

O2-Green
N2-Blue
"Fail Safe"

Front 158

General Anesthetic: Contraindications:
*Chronic Obstructive Pulmonary Disease
*Emotional Instability
*_____, _____, _____ ______
*______-miscarriage among staff

Back 158

Lithium, Phenothiazines, Tricyclic Antidepressants; Pregnancy

Front 159

Abuse of N2O-General Anesthetic:
*_______
*Numbness & paresthesia of hands and legs

Back 159

Neuropathy

Front 160

Classification of General Anesthetics:
Intravenous Anesthetics:
*_____
*Ultra short acting _______
*Benzodiazepines

Back 160

Opioids; Barbiturates

Front 161

General Anesthetics: Opioids:
*______
Disadvantage:
*Prolonged respiratory depression
*Requires careful _______

*Reversed by _______ (opioid antagonist)

Back 161

Morphine; Monitoring; Naloxone

Front 162

General Anesthetics: Ultra short acting Barbiturates:

* ____ ____ (Pentothal)
*___Onset
*It accumulates in body tissues, resulting in prolonged recovery.

Back 162

Thiopental Sodium; Rapid

Front 163

General Anesthetic:
Benzodiazepines:
*_______ (Valium)

Back 163

Diazepam

Front 164

Local Anesthetic: Nerve Impulses:
*A resting nerve fiber has
___ ions on the outside &
___ anions on the inside

The action potential travels down the nerve and the sodium channels open, resulting in a ____ _____

Back 164

+,- ; + potential

Front 165

Local Anesthetic: Mechanism of Action of Anesthetic:
*Local Anesthetic attaches to a receptor on the _____ _____.
*The local anesthetic blocks the conduction of nerve impulses by decreasing the permeability of the nerve _____ _____.
*The threshold of excitability is increased= _______ _______

Back 165

-Nerve Membrane; Cell Membrane; We don't feel the pain

Front 166

Local Anesthetic:
The main clinical effect of the local anesthetic is _______ ______ of _____ _____ _____

Back 166

Reversible blockage; peripheral nerve conduction

Front 167

Local Anesthetic:
The losses of Nerve function are in the following order:
1.
2.
3.
4.
5.

Back 167

1. Cold
2. Warmth
3. Pain
4. Touch
5. Pressure

Front 168

Local Anesthetic: Pharmacokinetics of Anesthetic Absorption:
When injected, absorption depends upon:
1.
2.
3.

Back 168

1. Vascularity
2. Inflammation
3. Vasodilating properties of the anesthetic

Front 169

Local Anesthetic: Pharmacokinetics - Distribution:
Highly vascular organs have higher concentrations on anesthetic

* Local anesthetic crosses:
-the ______
-the ____-_____ _____

Back 169

The placenta, the blood-brain barrier

Front 170

Local Anesthetic:
Esters- Metabolized in the _____
Amides- Metabolized in the _____

Back 170

plasma, liver

Front 171

Local Anesthetic:
Alcoholics or patients with severe liver disease may have an accumulation of _____=produces toxicity.

Back 171

amides

Front 172

Local Anesthetic: Pharmacokinetics - Metabolism:
_____ & _____

Back 172

Esters & Amides

Front 173

Local Anesthetic: Absorption- Topical:

*_____ ______
*_____ ______

Can have absorption equal to an intravenous injection

Back 173

Mucous Membranes, Denuded Surfaces

Front 174

Local Anesthetic:
Mucous membranes- if scrape- topical can = _______

Back 174

injection

Front 175

Local Anesthetic: Absorption - Systemic toxicity:
We want to reduce the systemic absorption of the anesthetic

* _________: (Epinephrine)
-Reduce blood supply to the area
-Limit systemic absorption
-Reduce systemic toxicity

Back 175

Vasoconstrictors

Front 176

Local Anesthetic:
_____,_____,_____- Absorb faster

Back 176

infection, swelling, heat

Front 177

Local Anesthetic: Vasoconstrictors:
*____ the duration of action
*____ the depth of anesthesia
*____ systemic absorption
*Reduce the _____ ____.
*Reduce bleeding in the area of _____.
Constricts vessel tissues, keeps anesthetic in area.

Back 177

Prolong, Increase, Delay, Toxic Effect, Injection

Front 178

Local Anesthetic: Vasoconstrictors: Sympathetic Adrenergic Agonists:
______ keep anesthetic in the area injected .

If a anesthetic does not contain a ________ the anesthetic is quickly absorbed from the injection site and distributed into the systemic circulation.

Back 178

Vasoconstrictors; Vasoconstrictors

Front 179

Local Anesthetic: Allergy
____: taken off the market due to allergic reactions
____: No Allergy

Always write down the name of anesthetic given

Back 179

Esters; Amides

Front 180

Local Anesthetic: Pregnancy:
Must have approval of _____- document this in the chart, obtain a fax.

_____ in the smallest effective dose should be used

Back 180

OBGYN; Lidocaine

Front 181

Lidocaine-Pregnancy Category ____

Back 181

B

Front 182

Local Anesthetic: Adverse Reactions:
1.
2.
3.
4.
5.
6.

Back 182

1. Concentration
2. Route of administration
3. Rate of injection
4. Vascularity
5. Patients weight
6. Rate of metabolism and excretion

Front 183

Local Anesthetic: Adverse Reactions:
______: the higher the concentration, the more anesthetic enters the systemic system

Back 183

Concentration

Front 184

Local Anesthetic: Adverse Reactions:
______: Intravenous injections can produce high blood levels

Back 184

Route of Administration

Front 185

Local Anesthetic: Adverse Reactions:
Rate of Injection: ______

Back 185

Hematoma

Front 186

Local Anesthetic: Adverse Reactions:
Inflammation, infection or vasodilation will increase _____ and the systemic toxicity.

Back 186

Vasularity

Front 187

Local Anesthetic: Adverse Reaction: Toxicity:
CNS Stimulation ( ____, ____, ____ )
May occur before CNS depression
CNS depression results in cardiovascular and _______ depression

Coma

Back 187

Restlessness, tremors, convulsions; Respiratory

Front 188

Local Anesthetic: Adverse Effect:
It is okay to administer Amide Local Anesthetic to patients with _____ _____.

okay to use Lidocaine 2%

Back 188

Malignant Hyperthermia;

Front 189

Build up of Calcium, hereditary

Back 189

Malignant Hyperthermia

Front 190

Malignant Hyperthermia
Symptoms:
-Rise In _____
-_____ _____
- Extremely high _____
-Acidosis

Back 190

Calcium, Muscular rigidity , fever

Front 191

They thought Amide Local Anesthetic precipitated ______ ______.

Back 191

Malignant Hyperthermia

Front 192

Local Anesthetic: Esters:

Non in use in _____ _____
_____ _____ is commonly used

Back 192

Dental Cartridges, Benzocaine Topical

Front 193

Local Anesthetic: Amides:
-Most commonly used
-No cross sensitivity

Back 193

Lidocaine 2%

Front 194

Local Anesthetic: Amides:
Lidocaine 2%-
Adverse Reaction- _____, ____, _____

Back 194

Hypotension, shivering, headache

Front 195

Local Anesthetic: Amides:
Lidocaine 2% w/ Vasoconstrictor
1:100,000 w. epi
1:50,000 - ______ ______

Back 195

Oral Surgery

Front 196

Local Anesthetic: Composition of Local Anesthetic:
-_____ _____: Adjusts the pH between 6 & 7

Back 196

Sodium Hydroxide

Front 197

Local Anesthetic: Composition of Local Anesthetic:
-_____ _____-Makes the injection isotonic

Back 197

Sodium Chloride

Front 198

Local Anesthetic: Composition of Local Anesthetic:
Preservative found in multiple-dose vitals to prevent bacterial growth

Back 198

Methylparaben

Front 199

Local Anesthetic: Composition of Local Anesthetic:
Methylparaben:
Dental Cartridges are ______-use containers

Back 199

single

Front 200

Local Anesthetic: Composition of Local Anesthetic:
*Sulfites retard oxidation
*Trigger asthmatic attack

Back 200

Antioxidant

Front 201

Local Anesthetic: Composition of Local Anesthetic:

Slow absorption
Reduce systemic toxicity

Back 201

Vasoconstrictor

Front 202

Local Anesthetic: Composition of Local Anesthetic:

Vasoconstrictors:
_____ duration
_____ bleeding
_____ absorption

Back 202

prolong, decreases, delays

Front 203

Local Anesthetic: Composition of Local Anesthetic:

Adrenergic Sympathetic
Constricting Blood Vessels

Back 203

Vasoconstrictors

Front 204

Local Anesthetic: Allergy

_____- a preservative no longer found in anesthetic carpules

_____- may be used to treat a patient with allergy to local anesthetic

Back 204

Methylparaben ; Benadryl

Front 205

Local Anesthetic: Sulfites: (Andicodant): A patient who reports allergy to Sulfa does not exhibit cross sensitivity to _____.

Sulfites are present as an antioxidant in _____ _____.

Asthmatics may be triggered into attack.

Back 205

Sulfites, local anesthetic,

Front 206

_____ used in foods to prevent browning.

Back 206

Sulfites

Front 207

Local Anesthetic: Amides:
Mepivicaine (Carbocaine):
2% w/ 1:20,000 Neo-Cabefrin vasoconstrictor
3% _____ a vasoconstrictor

Back 207

without

Front 208

Local Anesthetic: Amides:
Prilocaine (Citanest) 1: 200,000 w/ epi
*____ potent and less toxic than Lidocaine

Back 208

less

Front 209

Local Anesthetic: Amides:
Prilocaine (Citanest):

- ______-Anesthetic locks onto the blood cell and won't let O2 on
-Symptoms: ____ _____
-Contraindicated in patients with oxygenated problems (Sickle Cell)

Back 209

Methemoglobinemia, Blue Lips,

Front 210

Local Anesthetic: Amides:
*Bupivacaine (Marcaine):
(oral surgeon uses a lot)
-Used to _____ anesthesia
-Where there will be post-operative pain

Back 210

prolonged

Front 211

Local Anesthesia: Cardiovascular Disease:
Concern that the ____ would elevate the blood pressure.

We now recognize that a patient can produce endogenous epinephrine if there is inadequate anesthesia

It is better to use ____ amounts of epinephrine

Back 211

Epinephrine, Small

Front 212

Local Anesthetic: Treat With Caution/Patient Selectivity:

* Uncontrolled _____ _____ ____
* Hyperthyroidism
* _____ _____
* Cardiac Arrhythmias

Back 212

High Blood Pressure, Angina Pectoris

Front 213

Local Anesthesia: No Anesthesia for 6 Months:

1. _______ _______
2. _______ _______

Back 213

Myocardial Infarct, Cerebrovascular Accident

Front 214

Local Anesthesia: Drug Interactions:

_____ ______

_____ ______ _____ ______

Amitriptyline (Elavil)

_______

Back 214

Tricyclic Antidepressants

Non-Selective Beta Blockers- "olol"

Antidiobatic

Front 215

Local Anesthesia: Factors that influence toxicity:

1.
2.
3.
4.
5.
6.
7.

Back 215

1. Large person-Child less
2. Amount of drug
3. Concentration of LA
4. Route of Administration, aspirate? (Vein/Artery)
5. Rate-Not too fast
6. Vascular-inflammatory swelling, vessels dilated
7. Rate of metabolism- liver damage-Excretion-Kidney

Front 216

Most patients without immune function deficiencies, in whom drainage can be obtained, need no antibiotics to manage their _____ _____

Back 216

dental infections

Front 217

Anti-infective Drugs: Dental Infections:
____-Streptococcus mutans
____ ____-Actinobacillus

Back 217

Caries, Periodontal Disease

Front 218

Anti-infective Drugs: Dental Infections:
Evolution of Dental Infections:
1. ______- aerobic organisms (Streptococci viridans)
2. _____ & _____-Anaerobes "mixed" (Bacteroides)
3. ______ _____-No aerobic organisms
form an abcess
Clindamycin & Metronidazole & Drain

Back 218

Gram +, Gram + & Gram -, Anaerobic Organisms

Front 219

Anti-infective Drugs: Which antibiotic to choose?

If the infection is just forming (Gram +)
_____ _____

Back 219

Pen VK

Front 220

Anti-infective Drugs: Which antibiotic to choose?
If the infection is just forming (Gram +), Choose Pen VK, if allergic then _______ or ________

Back 220

Erythromycin or Clindamycin

Front 221

Anti-infective Drugs: Which antibiotic to choose?
Mixed Stage:
Metronidazole ( ______ )
Clindamycin ( _____, _____, ______)

Back 221

Flagyl; Gram +, Gram -, Gram Anaerobes

Front 222

Anti-infective Drugs: Bacteriostatic Drugs (inhibit the growth of bacteria):

1.
2.
3.
4.

Back 222

1. Clindamycin
2. Macrolides-Erythromycin
3. Sulfonamides
4. Tetracyclines

Front 223

Anti-infective Drugs: Bacteriostatic Drugs:

Macrolides- _______

Back 223

Erythromycin

Front 224

Anti-infective Drugs: Bactericidal Drugs (Kill Bacteria):

1.
2.
3.
4.
5.
6.
7.

Back 224

1. Aminoglycosides
2. Metronidazole
3. Cephalsporins
4. Penicillins
5. Quinolones
6. Rifampin
7. Vancomycin

Front 225

Bactericidal Drugs (Kill bacteria)

Aminoglycosides- _______
Metronidazole- _______
Cephalosporins- _____, _____, _____
Penicillins- _______, ______
Quinolones- _______, ______

Back 225

Neomycin; Flagyl; Keflex, Duricef, Ceclor; Pen V, Amoxicillin; Cipro, Floxin

Front 226

Anti-infective Drugs: Diseases that decrease resistance to infection:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Back 226

1. AIDS
2. HIV
3. Alcoholism
4. Cancer
5. Cirrhosis of the liver
6. Diabetes Mellitus
7. Downs Syndrome
8. Leukemia
9. Malnutrition

Front 227

Anti-infective Drugs: Drugs that decrease resistance to infection:
1.
2.
3.

Back 227

1. Methotrexate
2. Adrenocorticosteriods
3. AZT

Front 228

Indications for Antimicrobial drugs:
The patient- do they lack ______?
The Infection- is it acute, rapidly spreading - or is it mild, localized with drainage?
Prophylactic Coverage- ____ ____, ____ ____, ____ or _____ _____

Back 228

defenses; Heart Murmur, Health Valve, Hip or knee replacement

Front 229

Antifungals/Antivirals:
______ are more likely to occur in immunocompromised patients

Back 229

Antifungals

Front 230

Antifungals/Antivirals:
Fungal infections are divided into:
1A:
1B:
2:

Back 230

1A: Mucocutaneous
1B: Tinea
2: Systemic

Front 231

Antifungals/Antivirals:
______-C. Albican
Treated with:
Nystatin
Clotimazole
Ketoconazole
Fluconazole

Back 231

Mucocutaneous

Front 232

Antifungals/Antivirals:
_____: (Affect skin & produce athlete's foot, jock itch & ring worm)

Treated with:
OTC and prescription medicines

Back 232

Tinea

Front 233

Antifungals/Antivirals:
______: Blastomycosis, Coccidioiomycosis, Histoplasmosis

Treated With:
Amphotericin B
Miconazole

Back 233

Systemic

Front 234

Antifungals/Antivirals:
Nystatin-Macrolide Antibiotic:

Used to treat mucocutaneous infections.
It is not absorbed from the _____ ____ or _____ _____

If taken orally, it is poorly absorbed from the _______ _______

Back 234

mucous membranes, intact skin, gastrointestinal tract

Front 235

Antifungals/Antivirals:
Forms of Nystatin-Macrolide Antibiotic:
1.
2.
3.

Back 235

1. Aqueous
2. Pastilles
3. Vaginal Tablets

Front 236

Antifungals/Antivirals:
Nystatin-Aqueous

Aqueous Suspension-50% sucrose
Swish, swirl, and spit 5ml (1 tsp) QID
It should remain in the mouth for ___ minutes.
Infants & small children- 1/2 a dropper full ( ____ml) placed each side of the mouth and rubbed around

Back 236

2, 2.5

Front 237

Antifungals/Antivirals:
Nystatin-Pastilles:

____-Flavored, rubbery
contain sucrose
____ minutes to dissolve in the mouth
It is in contact with the infected mouth longer
Take 1 tablet QID for 10-14 days or ___ hours after the infection subsides

Back 237

Licorice, 15, 48

Front 238

Antifungals/Antivirals:
Nystatin- Vaginal Tablets:

Take 1 tablet QID
It does not contain _____
No taste
Stays in the infected mouth longer
Use 10-14 days or 48 hours after infection subsides

Back 238

Sugar

Front 239

Antifungals/Antivirals:
Imidazole:

1.
2.

Back 239

1. Clotrimazole
2. Ketoconazole

Front 240

Antifungals/Antivirals:

Imidazoles - Clotrimazole: Pregnancy Category ____.

Synthetic Antifungal
Available as:
A sugar free ____
A _____ cream

Back 240

C, lozenge, OTC

Front 241

Antifungals/Antivirals:

Imidazoles - Clotrimazole:

Lozenges dissolves in ____-____ min.
Spectrum against candida
Adverse RXN:
______ _____, ______, _______

Back 241

15-30 minutes; Abdominal pain, diarrhea, nausea

Front 242

Antifungals/Antivirals:

Imidazoles - Clotrimazole:

Used to treat oropharyngeal candidiasis

Instruct patient to dissolve lozenge in the mouth slowly

1 tab (10 mg) __ times/day for 10-14 days or for 48 hours after the symptoms have cleared

Back 242

5

Front 243

Antifungals/Antivirals:

Imidazoles - Ketoconazole

Must have an _____ environment to absorb

Used for dental treatment of: mucocutaneous & oropharyngeal candidiasis

Spectrum:
Candidiasis, Coccidioidomycosis, Blastomycosis, Histoplasmosis

Back 243

acidic,

Front 244

Antifungals/Antivirals:

Imidazoles - Ketoconazole:

Adverse RXN: ________
Pregnancy Category: _____
Excreted in breast milk

Back 244

Hepatotoxicity, C

Front 245

Antiviral Drugs:

Difficult to treat viruses because they are ______ organisms.

To kill the virus, the host cell must also be attacked

Back 245

obligate

Front 246

Antiviral Drugs:

Acyclovir-Topical

It is _______ against herpes labialis in dentistry.

Back 246

Ineffective

Front 247

Antiviral Drugs-Acyclovir:

When taken orally, the peak concentration occurs within ___ hours.

Food does not affect _____.

Spectrum Includes:
Herpes Simplex I & II
Varicella-Zoster
Epstein-Barr
Cytomegalovirus

Back 247

2, absorption

Front 248

Antiviral Drugs-Acyclovir -Topical:

Forms:
Topical: used to treat initial herpes genitalis.
used to treat initial and recurrent mucocutaneous herpes simplex I & II in immunocompromised patients

It has not been effective in treatment of _____ herpes genitals or herpes labialis infections

Back 248

recurrent

Front 249

Antiviral Drugs:

Acyclovir has not been shown to effectively treat herpes labialis in _____, _____ or ______ form

Back 249

Topical, tablet, capsule

Front 250

Acyclovir-Oral

Is used in the treatment of ____ herpes genitalis.

Management of _____ herpes genitalis infections in immunocompromised & noncompromised patients.

Back 250

initial, recurrent

Front 251

Antiviral Drugs:
Penciclovir-Denavir:

Available _______.

Reduces _____ & _____ of lesions on the lips and face associated with primary and recurrent herpes simplex

Back 251

Topically; Duration & Pain

Front 252

Acquired Immunodeficiency Syndrome:

AIDS is the disease produced by infection with the retrovirus _____.

The antiviral drugs are used in combination " ______"

Opportunistic infections often occur in these patients as well.

Back 252

HIV, cocktails

Front 253

Inhibits HIV synthesis

Back 253

AZT

Front 254

AZT:

Reduces ______ & ______ from AIDS and AIDS related complex

Back 254

Morbidity & Mortality

Front 255

AZT:

Opportunistic infections are ______.
Toxicity is related to _____ ______ ______.

Back 255

Reduced, Bone Marrow Suppression

Front 256

_____ & ______ can inhibit AZT

It is okay to administer nonsterioidal antiinflammatory drugs

Back 256

Acetaminophen & Aspirin

Front 257

Opportunistic Infections of HIV Patients:

Cryptococcus neoformans-_______-Amphoteicin B

Back 257

Meningitis

Front 258

Opportunistic Infections of HIV Patients:

Candida-______-Clotrimazole, Ketoconazole

Back 258

Esophagitis

Front 259

Opportunistic Infections of HIV Patients:

Pneumocystis Carinii-_____- Trimethoprim-sulfamethoxazole

Back 259

Pneumonitis

Front 260

Opportunistic Infections of HIV Patients:

_______-Lungs, Pneumonitis-Gancyclovir

Back 260

Cytomegalovirus

Front 261

Opportunistic Infections of HIV Patients:

Mycobacterium- _______-INH + Rufanoub + Pyrazinamide

Back 261

Lungs

Front 262

Opportunistic Infections of HIV Patients:

Toxoplasma gondii-______-Pyrimethamine-sulfadiazine

Back 262

Encephalitis

Front 263

Antibiotics:
Reduced absorption when calcium or other Cation +2 minerals or food products are consumed.

Back 263

Tetracyclines

Front 264

Antibiotics:
Patient must be warned that it can cause pseudo membranous colitis

Back 264

Clindamycin

Front 265

Antibiotics:
Causes most gastrointestinal problems

Back 265

Erythromycin

Front 266

Antibiotics:
It is "cidal" and destroys the cell wall integrity

Back 266

Penicillin

Front 267

Antibiotics:
Will cause nausea, abdominal cramps and vomiting in alcoholics

Back 267

Metronidazole

Front 268

Antibiotics:
Can cause photosensitivity

Back 268

Tetracycline & Cipro

Front 269

Antibiotics:
Doxycyline is in what class of antibiotic

Back 269

Tetracycline

Front 270

Antibiotics:
Erythromycin is in what class of antibiotic

Back 270

Macrolides

Front 271

Antibiotics:
If your patient states they are allergic to penicillin, what antibiotic could have a cross sensitivity reaction?

Back 271

Keflex

Front 272

Anti-infective drugs: Adverse reactions to Antibiotics:

1.
2.
3.
4.
5.

Back 272

1. Superinfections
2. Allergic RXN
3. Drug Interactions
4. Gastrointestinal
5. Pregnancy

Front 273

Anti-Infective Drugs: Adverse Reactions:

The wider the spectrum & the longer the use the more production of different organisms

Back 273

Superinfections

Front 274

Anti-Infective Drugs: Adverse Reactions:

Allergic RXN: _____ & ______ = high incidence of allergy

Back 274

Pens (Most RXN) & Cephlasporins

Front 275

Anti-Infective Drugs: Adverse Reactions:

Pregnancy:
Not Used _____ & _____

Okay- Penicillin
- Clindamycin
- Erythromycin

Back 275

Tetracycline, Metronidazole

Front 276

Anti-Infective Drugs: Adverse Reactions:

Gastrointestinal:

Stomach pain, increased motility & diarrhea

_______= highest incidence
_______= pseudo membranous colitis

Back 276

Erythromycin; Clindamycin

Front 277

Anti-Infective Drugs: Adverse Reactions:

Drug interactions:

Oral Contraceptives:
______ & ______ most likely to interfere.

Back 277

Penicillin & Tetracyclines

Front 278

Anti-Infective Drugs: Adverse Reactions:

Drug interactions:

Oral Anticoagulants: _____ _____

____ is produced by bacteria in the intestine, the antibiotic kills these bacteria.
_____ inhibits the enzyme that metabolizes Warfarin

Back 278

Blood Thinners, Vit K, Erythromycin

Front 279

Anti-Infective Drugs: Penicillin is distributed to:

1.
2.
3.
4.
5.

Back 279

1. Tissue
2. Saliva
3. Kidneys
4. Placenta
5. Breast Milk

Front 280

Anti-Infective Drugs: Penicillin:

The highest blood levels are reached if the Penicillin is taken ___ hour before or ____ hours after eating.

Back 280

1, 2

Front 281

Anti-Infective Drugs: Adverse Reactions: Allergy & Hypersensitivity:

Rash:
___-___% of the reactions are rashes

Anaphylaxis:
Occurs within minutes
Epinephrine injection must be administered

Back 281

80-90%

Front 282

Anti-Infective Drugs: Adverse Reactions: Allergy & Hypersensitivity:

Oral Lesions:
1.
2.
3.
4.

Back 282

1. Stomatitis
2. Furred or black tongue
3. Acute Glossitis
4. Cheilosiss

Front 283

Anti-Infective Drugs: Types of Penicillins:
____- used for most dental infections

Penicillinase-resistant Pens-
______ & ______
Produce side effects such as gastrointestinal discomfort, bone marrow depression, renal and hepatic malfunction.

Back 283

Pen V; Cloxacillin & Dicloxacillin

Front 284

Anti-Infective Drugs: Allergic RXN to Penicillins:

___%-___% of patients will have a reaction.

Oral reactions are less common than parenteral reactions.

Back 284

5-10

Front 285

Anti-Infective Drugs: Allergic RXN to Penicillins:

Anaphylaxis is more frequent in patients pretreated with Beta Blockers ("___").

Allergic RXNs to Penicillin may be followed by more serious reactions.

A negative history does not guarantee that an allergic reaction will no happen in the future.

Back 285

"olol"

Front 286

Anti-Infective Drugs: Penicillin

Mechanism of action:

Destroys the ____ ____

Most effective against ____ growing organisms

Back 286

cell wall, rapidly

Front 287

Anti-Infective Drugs: Penicillin:

_____ : Producing staphylococci are resistant because their enzymes destroy some penicillin by cleaving the B-lactam ring

Back 287

Penicillinase

Front 288

Anti-Infective Drugs: Penicillins: Pharmacokinetics:

Administered orally or parenterally: should not be administered _______ as it will enhance its allergenicity.

Back 288

Topically

Front 289

Anti-Infective Drugs: Penicillins: Pharmacokinetics:

Orally:
Safer, the blood level rises slowly.
___ predictable levels due to differences in absorption, some degraded by gastric acid or patient compliance.

Back 289

Less

Front 290

Anti-Infective Drugs: Types of Penicillins:

_______ & ________
Penicillinase-susceptible

Back 290

Ampicillin & Amoxicillin

Front 291

Anti-Infective Drugs: Types of Penicillins:

______
produces higher blood levels
used to treat respiratory infection, urinary tract infection and meningitis.

Back 291

Amoxicillin

Front 292

Anti-Infective Drugs:
Tetracyclines:

Spectrum : ______
interfere with the synthesis at the 30 S subunit

Effective against:
____ & _____ aerobes and anaerobes.

Back 292

Bacteriostatic; Gram + & Gram -

Front 293

Anti-Infective Drugs:
Tetracyclines:

Use:
______ ______

Back 293

Periodontal Infection

Front 294

Anti-Infective Drugs:
Tetracyclines:

Pharmacokinetics:

Secreted in ____ & ____
*Stored in dentine and enamel of unerrupted teeth.
*Concentrated in the gingival cervical fluid
*Cross placenta into _____

Back 294

Milk (breast milk) & Saliva, fetus

Front 295

Anti-Infective Drugs: Macrolides/Erythromycin:

Spectrum: ______, Gram +, Gram - aerobes, Gram - anaerobes

Ineffective against typical dental anaerobes

Back 295

Bacteriostatic

Front 296

Anti-Infective Drugs: Macrolides/Erythromycin:

Pharmacokinetics: Broken down in gastric fluid.
Administered ____ hours before or ____ hours after a meal.

Back 296

2, 2

Front 297

Anti-Infective Drugs: Macrolides/Erythromycin: Mechanism of Action: Inhibits the enzyme at the ____ Ribosome.

Not effect against many anaerobes involved in dental infections

Adverse RXN:
*_________ - Cramps, Nausea, Vomitting
*Jaundice

Back 297

505, Gastrointestinal

Front 298

Anti-Infective Drugs: Macrolides/Erythromycin:

Drug Interactions:
Increases serum, concentrations of Digoxin, Warfarin, Cyclosporin by inhibiting ______ ______.

Uses:
In patients allergic to ______
It is not effective against bacteroides

Back 298

Hepatic Metabolism, Penicillin

Front 299

Anti-Infective Drugs: Clindamycin:

Spectrum: _______
Gram +, Gram - Anaerobes (Bacteroides)

Back 299

Bacteriostatic

Front 300

Anti-Infective Drugs: Clindamycin:
Adverse RXN:

_______ _______
Diarrhea, nausea, vomiting, dehydration

Back 300

Pseudo membranous Colitis

Front 301

Anti-Infective Drugs: Tetracycline: Adverse Effects:

Superinfection:
Oral or vaginal candidiasis can result

Photosensitivity: When exposed to sunlight, can have an exaggerated sun burn (sun block)
________

*gastrointestinal
*nephrotoxicity (kidneys)-throw away

Back 301

Bleaching

Front 302

Anti-Infective Drugs: Tetracyclines: Adverse Effects:

Teeth & Bone

Do not use during the last ____ of pregnancy or in children less than __ years old.

Tetracycline will affect the primary teeth if given to the mother during the last half of pregnancy or to the infant the 1st 4-6months of life.

If administered between 2months and 7-8 years old of age, the permanent teeth will be affected.

Back 302

1/2, 9

Front 303

Anti-Infective Drugs: Tetracycline: Drug Interactions:

Cautions: Do not take within 2 hours
form nonabsorbably chelates

Dairy products (Ca+, Mg++, Al+++)

Mineral supplements ( ____ , ____ )
Combine with Cations

Oral contraceptives
*________

Back 303

(Iron Fe +2, Zinc Mg +2), Anticoagulants

Front 304

Anti-Infective Drugs: Metronidazole/Flagyl:

Spectrum: _____
Penetrates the cell wall

Adverse RXN:
*Gastrointestinal
*Oral-dry mouth, metallic taste, black furred tongue

Back 304

Bactericidal

Front 305

Anti-Infective Drugs: Metronidazole/Flagyl:

Drug Interactions:
_______-nausea, abdominal cramps
watch mouthwash with ______.
*Warfarin

Back 305

Alcohol, Alcohol

Front 306

Anti-Infective Drugs: Metronidazole/Flagyl:

Drug Interactions:
Uses:
Periodontal infections
Combined _____+ _____ instead of the expensive Augmentin

Back 306

Flagyl + Amoxicillin

Front 307

Anti-Infective Drugs: Cephalosporins:

Structurally related to ________.
Spectrum: _____
Inhibition of cell wall synthesis

Back 307

Penicillins, Bactericidal

Front 308

Anti-Infective Drugs: Cephalosporins:

Allergy:
Cross sensitivity with Penicillins in ___% of the population.

Mechanism of Action:
Lysis cell bacteria wall

Back 308

10

Front 309

Anti-Infective Drugs: Antibiotics used for nondental infections

______-Cipro
Spectrum: ______
Drink lots of H2O

Back 309

Quinolones, Bacteriocidal

Front 310

Anti-Infective Drugs: Antibiotics used for nondental infections:

_______

Bactericidal
Administered Parenterally
They are toxic to the 8th cranial N=auditory problems or vertigo (balance)

Causes toxicity (hearing loss)

Back 310

Aminoglycosides

Front 311

Anti-Infective Drugs: Antibiotics used for nondental infections:

______

Antimicrobial's
Produced by living organisms
Bacteriostatic

Back 311

Sulfonamides

Front 312

Anti-Infective Drugs: Anti tuberculosis Drugs:

3 Drugs are administered concurrently in active cases
1.
2.
3.

if these medicines are taken compliantly, the patient will become non infective in 2-3 weeks.

Back 312

1. Isoniazid
2. Rifampin
3. Pyrazinamide

Front 313

Anti-Infective Drugs: Anti tuberculosis Drugs:

______ & ______
continued every day for 9-12 months

Back 313

Isoniazid, Rifampin

Front 314

Anti-Infective Drugs: Anti tuberculosis Drugs:

_______ - Continued every day for 2 Months

Back 314

Pyrazinamide