1. consider the characteristics of drug effects, how does one differentiate between therapeutic effects and adverse effects?
    • Therapeutic effects are desired effects
    • Adverse effects are undesired effects
  2. Identify an example in which a side effect is used for a therapeutic effect
    antihistamine used for insomnia
  3. Identify an example of an off-label use
    antihypertensive drug propranolol to prevent or treat migraines
  4. List 4 characteristics to consider before selecting a drug for a therapeutic effect
    • diagnosis
    • physiologic status
    • variations in disease
    • pharmacodynamic and pharmacokinetic variables
  5. Define tachyphylaxis
    an uncommon condition where tolerance to a drug develops rapidly
  6. list factors that can alter drug effects and explain the cause for the alteration.
    • pt non-compliance
    • psychologic factors - placebo
    • tolerance to the medication - when a drug is taken for a long period of time, and greater doses are necessary for the same effect
    • time of administration - agents likely to disturb taste need to be taken after meals
    • sex of client - women may be more sensitive to men
    • age and weight - children or geriatric pts require lower doses
  7. What 2 groups age groups are more likely to experience ADE's?
    • pediatric
    • geriatric
  8. Give 2 examples of how the registered dental hygienist can monitor for ADE's and how the dental hygiene treatment plan can be affected.
    • follow-up questioning - may nee to monitor for potential side effects
    • oral examination for ADEs - for example xerostomia leading to recommendation of home fluoride
  9. Explain the mechanisms involved in each component of Type A and Type B ADE's. Make a list of each inorder to organized the information and avoid confusion. What is the most common type?
    • Type A: cytotoxic and toxic reactions from overdose, drug-drug interactions, drug-food interactions, drug-disease interactions
    • Type B: hypersensitivity related reactions, allergy-related reactions, idiosyncratic reactions, age-related variables
    • Type A are most common
  10. Which ADEs are related to a genetic determination?
    Type - B idiosyncratic
  11. Which type of ADEs are usually more serious?
    type B
  12. Which type of ADEs are predictable?
    Type A
  13. Which type of ADE usually manifests after long periods of drug ingestion?
    type B
  14. List examples of cytotoxic reations and describe associated etiologic factors for each.
    • overdose of barbiturates - results in oversuppression of respiration leading to death
    • oxidative pathway - produce compounds that vind covalently with cellular macromolecules
    • reductive pathway - gives rise to the formation of free radicals
  15. List examples of drug-drug reactions and describe associated etiologic factors for each.
    • Pharmacologic interaction - drugs compete for same receptor site
    • physiologic - drugs interact with different receptor sites and enhance or oppose
    • chemical - drug a competes with drug b interacting with its receptor
    • receptor alterations - drgs increase or decrease the number of its own receptors
    • absorption -
    • distribution
    • metabolism
    • renal excretion
    • biliary excretion
  16. list examples of drug-food reactions and describe etiologic factors
    • tetracycline vs. mile - avoid milk
    • absorption - meals with high fatty acid component will increase absorption of liquid drugs
    • metabolism - grapefruit inhibits enzyme in liver
    • excretion - vitamin C lowers pH in kidney delaying excretion
  17. list examples of drug-disease interactions and describe etiologic factors
    • propranolol vs. asthma - blocks receptors that aid in bronchodilation
    • beta 1-adrenergic antagonists vs. diabetes - adversely affects glycogen metabolism
    • aspirin vs. peptic ulcers - cause GI bleeding
    • APAP and amoxilcillin vs. renal dysfunction - renal toxicity
    • opioids vs. hyperthyroidism - hypertension cardiac arrhythmias
  18. What patient instructions regarding diet should be given when tetracycline is prescribed?
    to avoid milk and dairy products
  19. Why are some drugs to be taken on an empty stomach?
    because certain nutrients can act as a mechanical barrier that prevents drug access to mucosal surfaces, reducing or slowing the absorption of some drugs
  20. give an example of a chelating drug-food interaction.
    tetracylcine with calcium in milk and other dairy products
  21. Which liver enzymes are responsible for drug-grapefruit interactions?
    CYP450 3A4 isoenzyme
  22. How would an acidic agent affect excretion of other acidic drugs used simultaneously?
    It could prolong the duration of drug action by inhibiting renal tubular excretion of the drug
  23. differentiate between hyporeactive and hyperreactive reactions.
    • hyporeactive - high dose creates response
    • hypperreactive - low dose creates response
  24. Which groups are most likely to have idiosyncratic reactions?
    those on the extreme of the age spectrum (children and elderly)
  25. Outline the process of the allergic drug reaction from sensitization to production of hives. What is the role of an antigen, a hapten, and plasma cell?
    • antigen - drug enters the body and is recognized as 'foreign' to antibodies
    • hapten - a substance (drug) that is lower weight than an antigen; such as penicillin, it attaches to another molucule (protein)
    • plasma cell - plasma cells recognize penicillin attached to albumin as an antigen and create antibodies to destroy it
  26. What age groups and sexes are more likely to develop drug allergies?
    • younger or older populations
    • women
  27. which type of hypersensitivity reaction is immediate?
    type I
  28. Which type of hypersensitivity reaction is delayed?
    Type IV
  29. Anaphylaxis is an example of what type of hypersensitivity reaction?
    type I
  30. Which immunoglobins are associated with each type of hypersensitivity reaction?
    • type I - IgE
    • type II and III - IgG
  31. Which hypersensitivity reaction involves T-cell activation?
    type IV
  32. which hypersensitivity reaction is most dangerous?
    type IV
  33. Which type of hypersensitivity reaction results fom the TB skin test?
    type IV
  34. differentiate between hypersensitive and pseudoallergic reactions.
    pseudoallergic reactions cannot be explained on an immunologic basis like hypersensitivity reactions
  35. What is a teratogenic reaction?
    a reaction that causes physical or functional disorders in the fetus in the absence of toxic effects on the mother
  36. Differentiate between a primary oncogenic effect and a secondary oncogenic effect.
    • primary - are produced by procarcinogenic drugs; covalent binding oxidized metabolites to DNA leads to carcinogenic effects
    • secondary - associated with therapeutic immunosuppression; drug induced immunosuppression to prevent rejection of an organ; leads to reactivation of latent infection with oncogenic viruses
  37. List and describe the various clinical manifestations of type A ADEs.
    • cytotoxic effects - liver injury; mucositis
    • GI disturbances
    • urinary incontinence
    • mood alterations
    • cardiovascular dysfunction
    • equilibrium problems
    • xerostomia
    • bleeding diatheses
    • bacterial infections
    • fungal infections
    • viral infections
    • gingival hyperplasia
    • neurologic complications
    • inadequate nutrition
  38. List signs of hepatotoxicity
    • nausea
    • vomitting
    • anorexia
    • abdominal pain
    • jaundice a few days later
  39. What is a possible ADE associated with benzocaine and prilocaine that can affect blood components?
    • interferes with hemoglobin oxygen carrying capacity
    • cyanosis
    • nausea
    • sedation
    • seizures
    • coma
  40. What is mucositis, and how can it lead to systemic infection?
    • ulceration of oral mucous membranes occurs during cancer chemotherapy
    • it provides an entry mechanism leading to systemic infection by the wide variety of oral microorganisms
  41. What area of the brain induces vomiting?
    chemoreceptor trigger zine found in the medullary area of brain
  42. describe the effects of chronic xerostomia and the dental hygiene implications
    • reduced lubrication, reduced antibacterial, antiviral, antifungal activity; loss of mucosal integrity; loss of buffering capacity; reduced lavage and cleansing of oral tissues, interference with normal remineralization of teeth, and altered digestion, taste, and speech
    • place pt on maintenance schedule of 3-4 months
  43. anticoagulant drugs increase the risk for what ADE?
    increase bleeding time and increase intraoperative bleeding
  44. Describe the mechanisms by which an infection occurs as a result of an ADE
    Therapeutic immunosuppression can exacerbate latent viral activity
  45. What is dysgeusia?
    taste disurbance
  46. List the clinical manifestations of type-B ADEs
    • idiosyncratic reactions
    • allergic/immunologic reactions:
    • Type I, II, III, and IV hypersensitivity
    • pseudoallergic reactions
    • lichenoid stomatitis
    • erythema multiforme and steven-johnson syndrome
    • teratogenic effects
    • oncogenic effects
  47. describe the various clinical appearances of hypersensitivity reactions.
    • allergic - erythematous, cramping, vomiting, diarrhea, hives and rash, itching, vasodilation, bronchoconstriction, jaundice, redness, edema, fever, malaise
    • pseudoallergic - asthma, hives
    • lichenoid stomatits - reticular, erythematous, or atrophic around buccal mucosa, gingivae, and lateral borders of tongue
    • erythema multiforme and stevens-johnson syndrome - crusting of lips, painful lesions, ulcerations and erosions on oral mucosa
    • teratogenic - altered growth, retardation, developmental impairments
    • oncogenic - lip cancer, oropharyngeal kaposi sarcoma
  48. Describe clinical signs associated with the four types of hypersensitivity reactions.
    • Type I - anaphylaxis
    • Type II - fever, urticaria, swelling of face and feet, lymphadenopathy, and arthralgia, sometimes jaundice
    • Type III - redness, edema, hemorrhage, ischemic necrosis of tissue
    • Type IV - inflammatory response, erythema, tiny vesicular lesions, and edema in target tissues
  49. Which hypersensitivity reaction leads to shock?
    Type I
  50. Which hypersensitivity reaction includes high fever?
    Type II
  51. Which type of hypersensitivity reaction includes diarrhea and vomiting?
    Type I
  52. Which type of ADE includes lichenoid stomatits?
  53. Differentiate between the pathology of erythema multiforme and the ADEs that are similar.
    • EM major and minor are related to an infectious agent (HSV)
    • SJS is related to pharmacologic agents (sulfonamides, anticonvulsive drugs, and COX-1 inhibitors)
    • similar ADEs, they both affect eyes/iris
  54. Describe pathognominic signs associated with EM ans SJS. What is the management for photophobia
    • hemorrhagic crusting of lips
    • management of photophobia is to direct overhead dental light away from the pts eyes
Card Set
week five