Pharm Final Study Guide

• Ratio of the median lethal dose to the median effect dose
• The greater the therapeutic index the safer it is
• TI of at least 10 is considered safe

Dose of a drug required to produce the desired clinical effect

Dose causes death

• No legal medicinal use in the US
• Used for research purposes
• High abuse 
• Hallucinogens, LSD, marijuana, selective opiates

• Have high abuse potential
• Legal medicinal uses
• Written prescription order required, no refills
• Amphetamines, selected opiates, some barbiturates

• Moderate dependence
• Prescription verbal/written
• 5 refills within 6 months
• Anabolic steroids, Vicodin, acetaminophen with codeine, select opiate combos

• Low abuse potential
• Prescription verbal or written
• 5 refills within 6 months
• Benzos, barbiturates, select opiates

• Low abuse
• Verbal/written prescription
• Some states allow OTC if pharmacist dispensed and over 18
• Cough/diarrhea preparations

• What the body does to the drug
• - absorption
• - distribution
• -metabolism
• - excretion

• Enteral (in the GI tract) - oral, rectal
• Parenteral (bypasses GI tract) - IV, IM, Subq, Inhalation, Intradermal, Topical

• Safest
• Slow absorption
• Patient compliance
• Cheap

• No GI Upset
• Can be given to unconscious patients
• Irregular absorption

• Rapid and uniform absorption
• Painful

• Short onset of action
• Immediate effect
• Best emergency route
• Most dangerous, injection site reaction

• Local anesthetic
• Uniform but slow absorption

• Rapid onset
• Difficult dosage monitoring
• Can be respiratory irritant (not nitrous)

Only penetrates top skin layers (TB test)

• Skin, oral mucosa, eyes
• patches, topicals, nitroglycerine

• Molecule size
• Compliance
• Age
• Gender, Genetics, Diseases
• Interactions with food/drugs
• -

• Transport to the site of action
• Protein binding
• Receptor availability
• Blood levels

• Determines absorption
• More ionized, less absorbed

More soluble, more absorbed

• Passes through liver first
• Effects bioavailability (GI)

Direct receptor effect

Interferes with action of agonist

• Presynaptic chemical released that excites or inhibits
• -Acetylcholine
• Norepinephrine
• Dopamine
• Serotonin
• Epinephrine
• GABA

Protein on cell surface for molecular binding

• Time it takes for half the drug to be metabolized
• Lidocaine is 1.5-2 hours

Rapid drug tolerance

Undesired or unintended response

Hypersensitivity

Drug produces unusual side effects that cannot be predicted

Fetal damage during development

• Fight or Flight
• Adrenergic  receptors

• Rest and digest
• Cholinergic receptors

• Adrenergic
• Pupil dilation
• Vessel constriction
• Inhibit salivary glands

• Adrenergic
• Increase heart rate
• Increase heart contractility
• Increase BP

• Adrenergic
• Dilate blood vessels
• Dilate bronchial smooth muscle
• Glycogen 
• Liver releases glucose

• Direct acting -Stimulate ACh release (pilocarpine/Salagen)
• Indirect acting - inhibit ACh reuptake?? (Aricept)

• Atropine (sal-tropine) - dries secretions
• Atropine (Atripison) - suppress salivation, bronchial secretions, treat GI disorders
• Military carries atropine for antidote
• Scopolamine - motion sickness
• Atrovent - treats COPD

• Xerostomia
• Urine retention
• Constipation
• Tachycardia
• Blurred vision

Mimics sympathetic effects

• Epineprhine - better for patients with high BP (alpha and non-selective beta)
• - Alpha causes vaso constriction
• - Beta-1 causes cardiac stimulation
• - Beta-2 causes bronchodilation
• Levonordefrin - better for cardiac patients (little effect on heart rate or contractility)

• Alpha - blocks vasoconstriction, decreases BP by decreasing peripheral resistance, increases urine flow
• Beta - selective (atenolol, metoprolol) or nonselective (propranolol)

• Sal-tropine
• Dries secretions

• Beta-2 agonist
• Xerostomia

• Alpha blocker
• BPH treatment
• Orthostatic hypotension

• Salagen
• Cholinergic agonist
• Treats xerostomia

• Local anesthetic
• Need to wait 24 hours before using vasoconstrictors

• Selective Beta-1 blocker
• Treats hypertension

• Alpha blocker
• Antihypertensive

• Nonselective Beta blocker
• Treatment of hypertension and migraines

• Better for patients with high BP
• Alpha: vasoconstriction
• Beta-1: cardiac stimulation
• Beta-2: bronchodilation
• Uses: anaphylaxis, acute asthma, cardiac arrest, nasal congestion, glaucoma, vasoconstrictor

• Better for cardiac patients
• Vasoconstriction with little effect on heart rate and contractility
• ABSOLUTE CONTRAINDICATION WITH TRYCYCLIC ANTIDEPRESSANTS
• Used with mepivacaine (Carbocaine)??

natural receptors block pain

Inhibit prostaglandin synthesis

• Analgesics/narcotics
• No fever reduction
• Acts on the CNS

• GI constipation
• Respiratory depression
• Nausea
• Vomiting
• Miosis (pupil constriction)
• Urinary retention
• Dysphoria
• Drowsiness
• Euphoria
• Hypotension/bradycardia/syncope in high doses
• histamine release leading to vasodilation

• protective
• always available

• produced during inflammation
• Celebrex is selective inhibitor

• aspirin
• acetaminophen
• ibuprofen
• naproxen sodium

OTC aspirin, acetaminophen,  ibuprofen, naproxen sodium

Prescription ibuprofen or naproxen sodium

• Oral morphine
• methadone, hydromorphone
• levorphenol
• oxycodone

• Combination opioid
• oxycodone with APAP for acute pain (mod/severe)
• Blocks pain perception in cerebral cortex in opioid receptors and prostaglandin synthesis in CNS
• Considerations include nausea, constipation and xerostomia

• Non-opioid analgesic
• mild pain relief
• anti-inflammatory
• adult fever reduction
• anti-platelet preventing stroke/heart attack
• irreversible COX inhibitor
• increased bleeding

• Anti-inflammatory
• treatment for oral lesions, asthma
• avoid concurrent use with NSAIDS
• mask infections such as candidiasis or hyperglycemia
• most common is prednisone

• Hydrocodone with APAP
• Blocks pain perception in cerebral cortex in opioid receptors and prostaglandin synthesis in CNS

• NSAID
• Non-opiod analgesic
• Treats inflammation
• Interferes with anti-platelets
• Diminishes aspirin effectiveness
• Reversibly inhibits COX

• Non-opiod analgesic for mild/moderate pain
• migraine prevention
• increased bleeding

• APAP
• No anti-inflammatory
• Child fever reduction
• Long term pain relief for osteoarthritis
• LEADING CAUSE OF ACUTE LIVER FAILURE
• Inhibits prostaglandin

• Roxanol SR
• Opiod analgesic
• moderate/severe acute or chronic pain
• xerostomia
• orthostatic hypotension
• syncope
• constipation

• Opiod analgesic
• Binds to opiod receptors in CNS
• Post op pain
• risk of abuse
• xerostomia

• Narcan
• Opiod antagonist
• Antidote for opiod overdose
• Sympathetic excess

• increased bleeding potential,
• increased risk of allergic reactions and infections such as candidiasis,
• many drug interactions,
• GI distress and oral mucosal irritation

• Primary dental care
• OTC COX inhibitors such as Tylenol, aspirin, ibuprofen

• Primary dental care
• Oxycodone with a COX-inhibitor

• used for hypoxia, loss of consciousness
• helpful in any emergency situation except hyperventilation

anaphylactic shock

Angina pectoris attack

hypoglycemia

• asthma attack
• bronchospasm

suspected MI or angina nonresponsive to nitroglycerine

Syncope

• Angifungal agent
• Used for treatment of candidiasis
• Binds to sterols in fungal cell membrane allowing leakage of cellular contents

• Respiratory stimulant
• Used for syncope

• Corticosteroid, long acting with minimal sodium-retaining potential
• Anti-inflammatory, antiemetic
• Used for aphthous stomatitis, lichen planus and other oral vesiculoerosive diseases
• Decreased production of inflammatory mediators
• Reversal of increased capillary permeability

• Alpha/Beta agonist
• Used for anaphylactic shock and as vasoconstrictor
• Causes xerostomia
• Stimulates alpha, Beta-1 and Beta-2 adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation, and dilation of skeletal muscle vasculature

• Zovirax
• Antiviral agent
• Treatment of recurrent mucosal and cutaneous HSV, shingles, chickenpox
• Inhibits DNA synthesis and viral replication

• Dental gas
• Treats hypoxia and dental emergencies
• Do not use with hyperventilation or COPD

• Topical local anesthetic, antihemorrhoidal
• Don't use if allergies to ester-amids
• Blocks initiation and conduction of nerve impulses by decreasing neuronal membrane permeability to sodium ions

• Antiarrhythmic
• Local anesthetic
• With epi, is LA of choice for pregnant patients
• Metallic taste

• Previous infective endocarditis
• Prosthetic cardiac valves
• Certain congenital heart disease/malformations
• AV shunt (hydrocephalus)
• Indwelling catheter
• Surgically constructed pulmonary shunts/conduits
• Total joint replacement
• Diabetics - uncontrolled or frequently infections or poor healing

• Extractions
• Periodontal procedures
• Dental implants
• Reimplantation of avulsed teeth
• Endodontic or surgery beyond the apex
• Subgingival antibiotic fibers/strips
• Initial placement of orthodontic bands
• Intraligamentary local anesthetic injections
• Prophylactic cleaning of teeth/implants where bleeding is anticipated
• NOT NEEDED FOR X-RAYS

• Amoxicillin
• Adults: 2 gm
• Children: 50 mg/kg
• 30-60 minutes prior to procedure

• Clyndamycin
• Adults: 600 mg
• Children: 20 mg/kg
• or
• Cephalexi/cefadroxil
• Adults: 2 gm
• Children: 50 mg/kg
• or
• Azithromycin/clarithromycin
• Adults: 500 mg
• Children 50 mg/kg
• All 30-60 minutes prior to procedure

• Interrupt/inhibit bacterial cell wall synthesis
• Bacteriocidal
• 10% of people allergic
• Another 10% get rashes

• cephalexin/Keflex
• cefadroxil/Duricef
• Interrupt/inhibit bacterial cell wall synthesis
• Bacteriocidal

• ciprofloxacin/Cipro
• levofloxacin/Levaquin
• moxifloxacin/Avelox
• Interrupt/inhibit bacterial DNA replication or repair
• Bacteriocidal

• Flagyl
• Interrupt/inhibit bacterial DNA replication or repair
• Bactericidal 
• Side effects include nausea, vomiting, metallic taste, xerostomia, disulfiram (antabuse)-like reaction

• interrupt/inhibit protein synthesis
• bacteriostatic
• lots of drug interactions

• doxycycvline/Atridox
• minocycline/Arestin
• interrupt/inhibit protein synthesis
• bacteriostatic
• pregnancy category D
• GI upset
• hypoplasia/discoloration during development
• superinfection common
• photosensitivity

• interrupt/inhibit protein synthesis
• bacteriostatic
• psuedomembranous colitis associated with use

• antimicrobial resistance
• superinfection
• GI complaints
• candida albicans
• drug interactions (Coumadin, oral contraceptives)

• WBC needs to be at least 0.5
• Anything below 0.5 requires premed prior to invasive dental procedures
• Viral load (VL) and CD4 numbers do not affect treatment
• CD4 200 or less likely to present with oral pathology

• antibiotic
• Used for treatment of periodontitis, as adjunctive therapy in recurrent aphthous ulcers, infections, acne
• Esophagitis, superinfections, and candidal superinfection are side effects
• Not recommended during pregnancy or children under 8
• Inhibits bacterial protein synthesis on 50S ribosomes

• Macrolide antibiotic
• Used as alternate oral antibiotic for prevention of infective endocarditis in penicillin allergic patients, when amoxicillin can't be used
• Causes abnormal taste
• QT interval patients use vasoconstrictors with caution and consult physician before using
• Inhibition of protein synthesis

• minocycline
• tetracycline antibiotic
• Adjunct to scaling and root planing procedures in adult periodontitis
• Patients should avoid eatingn hard/crunchy/sticky foods for 1 week, brushing for 12 hours, using IP clwaing devices for 10 days
• Inhibits protein synthesis

• Lincosamide antibiotic
• Penicillin alternative
• Used for periodontitis, infections
• Inhibits protein synthesis

• Penicillin antibiotic
• Standard premed regimen
• Used for orofacial infections
• Prolonged use can cause oral candidiasis
• Inhibits bacterial cell wall synthesis

• doxycycline
• tetracycline antibiotic
• used for chronic adult periodontitis
• avoid brushing/flossing treated area for 7 days
• discoloration of teeth (children), gum discomfort, toothache, periodontal abscess, tooth sensitivity, mobility, jaw pain
• Inhibits protein synthesis

• Amoxicillin/Clavulanate combo
• Penicillin antibiotic
• Treatment of orofacial infections, pneumonia, otitis media, infections
• Oral candidiasis with prolonged use
• Amoxicillin inhibits bacterial cell wall synthesis with clavulanate enhancing that action

• Flagyl
• Amebicide, antibiotic, antiprotozoal, nitroimidazole
• For treatment of oral soft tissue infections due to anaerobic bacteria, amebiasis, trichamoniasis, bacterial vaginosis
• Unusual/metallic taste, glossitis, stomatitis, xerostomia, furry tongue
• inhibition of protein synthesis and cell death

• doxycycline
• tetracycline antibiotic
• used for periodontitis
• hemolytic anemia, thrombocytopenia, glossitis, tooth discoloration, candida albicans, opportunistic infections
• not for pregnancy or children under 8
• inhibits protein synthesis
• noted to reduce elevateed collagenase activity in gingival crevicular fluid of patients with periodontal disease

• Keflex
• cephalosporin antibiotic (1st generation)
• Used for infections and antibiotic premed
• inhibits bacterial cell wall synthesis

• antifungal
• treatment of susceptible cutaneous, mucocutaneous, and oral cavity fungal infections normally caused by the Candida species
• Binds to sterols in fungal cell membrane allowing for leakage of cellular contents

sustained elevation in arterial pressure due to the amount of blood in the vessel being greater than the space available

• diuretics
• beta-blockers
• ACE inhibitors
• calcium channel blockers
• angiotensin-receptor blockers
• alpha blockers

• stable angina occurs when the chest pain is intermittent on exertion but relieved by rest
• unstable angina occurs when oxygen demand exceeds oxygen supply at rest and the frequency/severity of attcks increase

• vasodilator (nitroglycerin/Nitrostat)
• calcium channel blockers
• beta blockers
• antiplatelet drugs
• anticoagulants

• Signs and symptoms of left ventricular heart failure (CHF) include cough, pulmonary edema, dyspnea during exertion or when lying flat. The patient may be unable to tolerate the supine position, orthopnea (can only breathe upright)
• usually treated with a combination of drugs

• diuretics
• ACE inhibitors
• calcium channel blockers
• beta blockers
• cardiac glycoside - digoxin (Lanoxin)
• nonselective beta blocker - carvedilol (Coreg)

• dysrrhythmia
• occurs when there is abnormal electrical activity in the heart - impulse does not start in SA node or rate of beats is abnormal
• bradycardia or tachycardia may occur

• class I: sodium channel blockers, lidocaine
• class II: beta blockers (propranolol, nonselective)
• class III: potassium channel blockers (amiodarone/Cordarone)
• class IV: calcium channel blockers (verapamil/Calan)

• angina: temporary ischemia, chest pain
• MI: ischemia and resulting deficiency of oxygen to the myocardium is permanent

• Mechanism of action: decrease the heart rate and output of blood from the heart by blocking beta-sympathetic stijulation in the heart
• Adverse reactions: increased risk of hypotension with nonselective beta blockers with LA/vasoconstrictor, bradycardia, dizziness, fatigue, nausea, xerostomia

• Mechanism of action: dilate coronary arteries
• Adverse reactions: severe headache, hypotension

• the "pines"
• Mechanism of action: interrupt movement of calcium into the heart cells and blood vessels to produce vasodilation
• Adverse reactions: gingival hyperplasia, xerostomia, dysgeusia (taste disturbance)

• Mechanism of action: cause body to eliminate excess fluids and sodium through urination
• Adverse reactions: hypokalemia or hyperkalemia

• "prils"
• Mechanism of action: vasodilation and decrease resistance to blood flow
• Adverse reactions: dry/hacking, nonproductive, persistent cough that worsens in the supine position

• "statins"
• Mechanism of action: interfere with cholesterol synthesis in the liver
• anti-cholesterol drug

• Mechanism of action: inhibit faxtor X_a and thrombin activity so that fibrinogen can't be converted into fibrin, stops blood from clotting
• Adverse reaction: excessive bleeding

• Mechanism of action: prevent platelet aggregation
• Adverse reaction: increased bleeding time

• INR 3.0 or less within the last month no need for medical consult as long as patient knows daily regimen and dosage
• INR greater than 3.0 require medical consult prior to treatment

• 120-139/80-89 - inform client and recheck in 6 months
• 140-159 and/or 90-94 - advise behavior changes, check at each appointment (ASA II)
• 160-179 and/or 95-104 - recheck in 5 minutes, recommend medical consult, routine therapy using stress control protocols, check each appointment (ASA IIIa)
• 180-199 and/or 105-114 - recheck in 5 minutes, required medical consult, check each appointment (ASA IIIb)
• 200+ and/or 115+, recheck in 5 minutes, immediate medical consult, no treatment until corrected, check at each appointment (ASA IV)

• Inderal
• Nonselective beta blocker
• Treatment of hypertension
• Decrease heart rate and output of blood by blocking beta stimulation in the heart

• Lanoxin
• Cardiac glycoside 
• Used for CHF
• Very narrow therapeutic index
• Can cause fatal side effects like tachycardia, arrhythmias, hypokalemia
• Increases influx of calcium increasing contractiosn byt slowing heart rate

• Lopressor
• Selective B1 blocker
• Reduces BP by slowng heart rate thus decreasing cardiac output
• Used for hypertension

• HCTZ
• Thiazide diuretic
• Combined with NSAIDS reduces antihypertensive effect which may result in elevated BP
• Interferes with sodium reabsorption in distal tubule of kidney, promotes diuresis reducing plasma and extracellular fluid volume reducing peripheral resistance

• Cardura
• antihypertensive
• most often used to treat BPH

• Procardia
• calcium channel blocker

• used for angina pectoris, sublingual, 0.4 mg pills/spray
• has strong vasodilation effects

• Xylocaine
• class I antiarrhythmic drug

• Pravachol
• HMG CoA inhibitor
• anticholesterol

• Coumadin
• interferes with synthesis of vitamin-K dependent clotting factors in the liver
• prevents clot formation
• Most common adverse effect is bleeding

• Altace
• ACE inhibitor
• causes vasodilation
• dry, hacking cough

• Zetia
• reduces blood cholesterol by inhibiting absorption of cholesterol from the small intestine

• Mechanism of action: CNS depression, exact mechanism unknown
• Adverse effects: nausea, vomiting, delirium, headache, drug interactions (CNS depressants - illegal to combine for hygienists)
• Contraindications: COPD, pregnancy during 1st trimester, med consult in 2nd and 3rd, emotional instability, mental illness, communication barriers, recovering addict, bowel obstruction, inner ear infection, certain eye surgeries, respiratory obstruction

Minimally depressed level of consciousness produced solely by inhalation of combo nitrous/oxygen when the patient retains the ability to independently/continuously maintain an airway and respond purposefully to physical stimulation and verbal commants

• lidocaine (Xylocaine)
• pregnancy category B
• hydrochloride salt so sodium channel blocker used for arresting ventricular arrhythmias in emergencies

Stimulates alpha, beta 1 and beta 2 adrenergic receptors resulting in relaxation of smooth muscle of bronchial tree, cardiac stiulation and dilation of skeletal muscle vasculature

• Stimulates alpha receptors
• CONTRAINDICATED IN PATIENT TAKING TRYCYCLIC ANTIDEPRESSANTS

Blocks initiation and conduction of nerve impulses by decreasing neuronal membrane permeability to sodium ions

• Binds selectively to intracellular surface of sodium channels to block influx of sodium into the axon
• Citanest
• amide
• added to Oraqix

• amide local anesthetic
• binds selectively to intracellular surface of sodium channels blocking influx of sodium into the axon
• vasoconstrictor is levonordefrin
• anesthetic of choice without levo when vasoconstrictor is contraindicated
• Carbocaine

blocks generation and conduction of nerve impulses possibly by increasing threshold, slowing propagation and reducing rate of action potential

blocks the generation and conduction of nerve impulses possibly by increasing threshold, slowing propagation and reducing rate of action potential

• agents become ineffective once they reach the bloodstream
• lipid-soluble free base needed to penetrate nerve membrane
• water-soluble cationic form needed to bind to specific receptor sites within the nerve membrane to block action potential
• vascularity of injection site
• degree of inflammation present
• ability of LA to bind to protein
• presence/absence of vasoconstricting agent
• technique used

• hydrolyzed in the plasma by enzyme pseudocholinesterase
• procaine, propoxycaine, tetracaine, benzocaine

• in liver by CYP450 enzymes
• lidocaine, mepivacaine, prilocaine, bupvacaine

• amide and ester
• metabolism occurs in both plasma and liver
• do not administer for inferior alveolar nerve block - increased incidence of paresthesias

• epinephrine: 0.2 mg
• levonordefrin: 1 mg

• epinephrine: 0.04 mg
• levonordefrin: .02 mg

lidocaine

Marcaine (bupivicaine)

• Topex
• Hurricane
• ester
• water insoluble
• safest topical

• A condition in which more than 1% of the hemoglobin in blood has been oxidized to ferric form which is incapable of transporting oxygen
• associated with some amides - benzocaine, prilocaine, articaine
• cyanosis is symptom
• treatment with complete transfusion of blood hemoglobin

• All category C except
• lidocaine and prilocaine are category B
• prilocaine twice as concentrated
• only lidocaine used in pregnancy

• Contraindicated if cocaine used within the last 24 hours
• Contraindicated in patients with BP 180/110, unstable angina and other heart conditions and uncontrolled hyperthyroidism

Chronic illness caused by increased responsiveness of the airways to various stimuli, which results in edema, inflammation, bronchoconstriction, and reversible airway obstruction

• lack of patient compliance with drug regimen
• lack of response to drug regimen due to acid reflux, sinus infection, cigarette smoke, allergies, genetic abnormalities

• Inhaled corticosteroids - drug of choice for persistent asthma
• fluticasone (Flovent
• Systemic corticosteroids - drug of choice for acute asthma attacks and when asthma cannot be controlled by bronchodilators alone
• prednisone
• mast cell stabilizers
• cromyolyn sodium (Intal, Nasalcrom)
• Short acting beta 2 agonist
• albuterol (Ventolin, Proventil, Proair)
• leukotriene receptor antragonist
• montelukast (Singulair)
• Combination inhaled corticosteroid and long-acting beta 2 agonist
• Advair Diskus (fluticasone and salmeterol)

• Inflammation of the mucous membrane lining the bronchi
• Acute or chronic
• Chronic bronchitis has increased secretion of the alveolar epithelium
• Blue bloaters

• Antibiotics
• bronchodilators

• Irreversible obstructive disease of the lungs with dilation and destruction of the walls of the terminal bronchioles without fibrosis
• Leads to irregular enlargement of respiratory spaces
• Pink puffers

• anticholinergic bronchodilators
• Atrovent
• Spiriva

• Patients have gradually lost the impetus to breathe due to increased CO2
• Characterized by dyspnea, sputum production and coughing
• Use oxygen cautiously when administering nitrous oxide

• anticholinergic bronchodilators
• Atrovent
• Spiriva

• Decreased thyroid hormone synthesis
• Cretinism in children

• mental/physical retardation
• delayed tooth eruption
• malocclusion
• increased risk for periodontal disease
• poorly-shaped teeth
• caries
• inflamed/pale/enlarge gingiva

levothyroxine (Synthroid/Levoxyl/Levothroid)

• Excess production of thyroid hormones
• Graves disease
• Plummers disease
• Hashimoto's disease
• EPINEPHRINE IS CONTRAINDICATED IN UNCONTROLLED CASES - CAN TRIGGER "THYROID STORM"

• tachycardia
• hypertension
• exophthalamus
• nervousness
• weight loss
• moist skin
• fatigue

Antithyroid drugs

characterized by a back flow of stomach contents into the esophagus resulting in burning pain radiating up to the neck

• tooth erosion
• mucosal ulders
• dysguesia
• burning tongue

• H2 receptor blockers
• proton pump inhibitors
• antacids
• cimetidine (Tagamet): anti-histamine H2 receptor antagonist, blocks the release of gastric acid

• Used to treat osteoporosis
• Not metabolized or excreted - extremely long half life
• OSTEONECROSIS OF THE JAW
• Treated with alendronate (Fosamax)

• promote the release of exudate or mucous from the respiratory passages and decrease viscosity of these substances
• guaifenesin

• diphenhydramine (Benadryl): 1st generation, sedation, xerostomia, GI upset
• loratadine (Claritin): 2nd generation, no sedation effects

• Depress the cough center located in the medulla
• codeine - gold standard
• dextromethorphan - highly abused nonopioid

• H1: reduce/eliminate effects mediated by histamine, used to treat allergies and for sedation
• H2: block the action of histamine on parietal cells in the stomach, used to treat dyspepsia, PUD, GERD

Inhibit airway inflammation at all levels of the respiratory passage and increase the number and responsiveness of B2 receptors; anti-inflammatory effects due to suppression of T-lymphocyte activation and inhibition of mast cells and eosinophils from releasing chemical mediators of inflammation

• oral candidiasis
• dysphoria (unease)
• cough
• xerostomia

• glucose intolerance (hyperglycemia)
• weight gain
• hypertension'
• bone demineralization/osteoporosis
• vision disturbances/cataracts
• immunosuppression
• gastric irritation (peptic ulcers)
• hypokalemia
• acne
• behavioral changes
• retarded growth in children
• nervousness
• Cushing syndrome (redistribution of body fat)

• symptoms of infection may be masked
• candidiasis
• systemic and drug interactions: avoid macrolides, metronidazole, increased risk of peptic ulcers with COX-1 inhibitors

• Claritin
• antihistamine
• 2nd generation H1 receptor antagonist
• competitively blocks effects of histamine at peripheral H1 receptors sites
• Does not cross blood-brain barrier
• Xerostomia

• Flovent, Flonase
• Nasal corticosteroid
• Used for rhinitis
• Prevents inflammation by controlling rate of protein synthesis, depressiong migration of PMN, reversing capillary permiability, and stabilizes liposomal membrane

• Singulair
• leukotriene-receptor antagonist
• blocks the effects of the release of leukotrienes
• Used to manage asthma not controlled by B2 agnosit or corticosteroids
• Dental pain, increased bleeding, throbocytopenia

• Tagamet
• Histamine H2 antagonist
• Used to treat GERD
• blocks the release of gastric acid

• systemic corticosteroid
• COPD
• Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability

• Fosamax
• bisphosphonate
• Used to treat osteoporosis
• Inhibits osteoclast cells by binding to the bone, causing death of the osteoclast
• Osteonecrosis of the jaw

• antitussive - opioid
• gold standard
• depresses the cough center located in the medulla

• Benadryl
• 1st generation H1 receptor antagonist
• competitively blocks the effects of histamine at peripheral H1 receptor sites
• Xerostomia

• phenytoin (Dilantin)
• phenobarbital (Luminal
• ethosuximide (Zarontin)

• Dilantin
• Anti-convulsant
• shortens action potential in the heart, suppresses, ventricular activity, stabilizes sodium ions crossing cell membranes in motor cortex
• ADE: cardiovascular and CNS, gingival hyperplasia

• Ativan
• anti-anxiety
• benzodiazepine
• Binds to GABA within the CNS inhibiting excitability
• Xerostomia

• anti-maniac agent
• bipolar/depression
• influences reuptake of serotonin/norepinephrine
• ADE: cardiovascular/CNS
• xerostomia

• Elavil
• tricyclic antidepressant
• increases serotonin/norepinephrine by inhibitionn of reuptake
• LEVONORDEFRIN ABSOLUTE CONTRAINDICATION

• Valium
• anti-anxiety
• benzodiazepine
• binds to GABA within the CNS inhibiting excitability
• xerostomia

• Luminal
• anti-convulsant (barbiturate), sedative hypnotic
• depresses sensory cortex, decreases motor activity
• drowsiness, bradycardia, hypotension, syncope

• Zarontin
• anti-convulsant
• depresses nerve transmission in motor cortex, increasing seizure threshold
• CNS effects

• Prozac
• anti-depressant
• selective serotonin reuptake inhibitor
• xerostomia

• Noctec
• hypnotic
• CNS depressant due to active metabolite trichloroenthanol
• ADE: cardiovascular and CNS

• Zyban
• anti-depressant
• dopamine/norepinephrine reuptake inhibitor
• tachycardia, caution with local anesthetic, monitor vitals, abnormal taste, xerostomia
• used for smoking cessation

• Neurontin
• anti-convulsant
• GABA analog
• drowsiness, dizzy, xerostomia

• thorazine - 1st generation anti-psychotic
• anti-emetics
• block dopamine receptors
• use local anesthetic with caution, xerostomia, hypotension

• thiazide diuretic - HCTZ
• loop diuretic - furosemide (Lasix)
• potassium-sparing diuretic - spironolactone (aldactone)
• combination diuretic - dyazide (triamterene/HCTZ)
• B-receptor blockers - selective (atenolol/tenormin, metoprolol/Lopressor); nonselective (propranolol (Inderal)
• Central A2 agonist - clonidine (Catapres)
• Calcium channel blockers - nifedipine (Procardia), amlodipine (Norvasc)
• ACE inhibitors - ramipril (Altace)
• Angiotensin II receptor blockers - losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan)