OSD3 final drugs

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  1. raltegravir (Isentress):
    • Class: Antiretroviral Agent, Integrase Inhibitor
    • Mechanism of Action: Incorporation of viral DNA into the host cell’s genome is required to produce a self-replicating provirus and propagation of infectious virion particles. The viral cDNA strand produced by reverse transcriptase is subsequently processed and inserted into the human genome by the enzyme HIV-1 integrase (encoded by the pol gene of HIV). Raltegravir inhibits the catalytic activity of integrase, thus preventing integration of the proviral gene into human DNA.
  2. abacavir (Ziagen)
    • Class: Antiretroviral Agent, Reverse Transcriptase Inhibitor (Nucleoside)
    • Mechanism of Action: Nucleoside reverse transcriptase inhibitor. Abacavir is a guanosine analogue which is phosphorylated to carbovir triphosphate which interferes with HIV viral RNA-dependent DNA polymerase resulting in inhibition of viral replication.
  3. lamivudine (Epivir)
    • Class: Antiretroviral Agent, Reverse Transcriptase Inhibitor (Nucleoside)
    • Mechanism of Action: Lamivudine is a cytosine analog. After lamivudine is triphosphorylated, the principle mode of action is inhibition of HIV reverse transcription via viral DNA chain termination; inhibits RNA- and DNA-dependent DNA polymerase activities of reverse transcriptase. The monophosphate form of lamivudine is incorporated into the viral DNA by hepatitis B virus polymerase, resulting in DNA chain termination.
  4. acyclovir (Zovirax):
    • Antiviral Agent
    • Mechanism of Action Acyclovir is converted to acyclovir monophosphate by virus-specific thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes. Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA.
    • Dental Use Treatment of initial and prophylaxis of recurrent mucosal and cutaneous herpes simplex (HSV-1 and HSV-2) infections in immunocompromised patients
  5. terazosin (Hytrin):
    • Alpha 1 Blocker
    • Mechanism of Action Alpha1-specific blocking agent with minimal alpha2 effects; this allows peripheral postsynaptic blockade, with the resultant decrease in arterial tone, while preserving the negative feedback loop which is mediated by the peripheral presynaptic alpha2-receptors; terazosin relaxes the smooth muscle of the bladder neck, thus reducing bladder outlet obstruction
    • Effects on Dental Treatment Xerostomia (normal salivary flow resumes upon discontinuation) and orthostatic hypotension.
  6. omeprazole (Prilosec):
    • Proton Pump Inhibitor; Substituted Benzimidazole
    • Mechanism of Action Proton pump inhibitor; suppresses gastric basal and stimulated acid secretion by inhibiting the parietal cell H+/K+ ATP pump
    • Effects on Dental Treatment Taste perversion, dry mouth, esophageal candidiasis, and mucosal atrophy (tongue).
  7. labetalol (Trandate)
    • Beta-Blocker With Alpha-Blocking Activity
    • Mechanism of Action Blocks alpha-, beta1-, and beta2-adrenergic receptor sites; elevated renins are reduced. The ratios of alpha- to beta-blockade differ depending on the route of administration: 1:3 (oral) and 1:7 (I.V.).
    • Local Anesthetic/Vasoconstrictor Precautions
    • Use with caution; epinephrine has interacted with nonselective beta-blockers to result in initial hypertensive episode followed by bradycardia
    • Effects on Dental Treatment Taste disorder.
    • Many nonsteroidal anti-inflammatory drugs, such as ibuprofen and indomethacin, can reduce the hypotensive effect of beta-blockers after 3 or more weeks of therapy with the NSAID. Short-term NSAID use (ie, 3 days) requires no special precautions in patients taking beta-blockers.
  8. sevelamer (Renvela):
    • Phosphate Binder
    • Mechanism of Action Sevelamer (a polymeric compound) binds phosphate within the intestinal lumen, limiting absorption and decreasing serum phosphate concentrations without altering calcium, aluminum, or bicarbonate concentrations.
  9. diltiazem (Tiazac)
    • Antianginal Agent; Antiarrhythmic Agent, Class IV; Calcium Channel Blocker; Calcium Channel Blocker, Nondihydropyridine
    • Mechanism of Action Nondihydropyridine calcium channel blocker which inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina
    • Effects on Dental Treatment Diltiazem has been reported to cause >10% incidence of gingival hyperplasia; usually disappears with discontinuation (consultation with physician is suggested).
  10. Epogen with dialysis:
    • Colony Stimulating Factor; Erythropoiesis-Stimulating Agent (ESA); Growth Factor; Recombinant Human Erythropoietin
    • Mechanism of Action Induces erythropoiesis by stimulating the division and differentiation of committed erythroid progenitor cells; induces the release of reticulocytes from the bone marrow into the bloodstream, where they mature to erythrocytes. There is a dose response relationship with this effect. This results in an increase in reticulocyte counts followed by a rise in hematocrit and hemoglobin levels.
    • Effects on Bleeding Although ESAs have been associated with thromboembolic events, there is no information available to require special precautions for dental procedures.
  11. pseudoephedrine (Sudafed)
    • Class: Alpha-/Beta- Agonist; Decongestant
    • Mechanism of Action Directly stimulates alpha-adrenergic receptors of respiratory mucosa causing vasoconstriction; directly stimulates beta-adrenergic receptors causing bronchial relaxation, increased heart rate and contractility
    • Dental Use: Temporary symptomatic relief of nasal congestion due to common cold, upper respiratory allergies, and sinusitis; also promotes nasal or sinus drainage
    • Local Anesthetic/Vasoconstrictor Precautions
    • Use with caution since pseudoephedrine is a sympathomimetic amine which could interact with epinephrine to cause a pressor response
    • Effects on Dental Treatment Xerostomia (normal salivary flow resumes upon discontinuation)
  12. Emtricitabine-tenofovir (Truvada)
    • a.     NRTI: ARV
    • b.     Tx of HIV infection in combination with other ARV
    • c.      No LA precautions
    • d.     No EODT
    • e.     No EOB
    • f.      No adverse reactions except dosage adjustment in renal impaired patients
    • g.     MOA: Inhibits viral replication
  13. Darunavir (Prezista):
    • a.     PI: ARV
    • b.     Tx of HIV in combo with other ARV
    • c.      No LA  precautions
    • d.     No EODT
    • e.     Increased bleeding in Hemophilia A or B patients
    • f.      Potentially cause dysplipidemia (elevated cholesterol and triglycerides and redistribution to cause abdominal girth, buffalo hump, facial atrophy, and breast enlargement) and hyperglycemia. Vomiting and diarrhea more common in children
    • g.     MOA: Inhibits protease resulting in immature, non-infectious viral particles
  14. Ritonavir (Norvir)
    • a.     PI: ARV
    • b.     Tx HIV infection in combination; PI booster
    • c.      No LA Precautions
    • d.     EODT: xerostomia and taste perversion
    • e.     EOB: Increased bleeding in Hemophilia A and B patients
    • f.      Adverse effects: Hypercholesterolemia, increased triglycerides, nausea, vomiting, taste perversion, elevated GGT in liver (can be seen in disease of liver, biliary tract, and pancreas)
    • g.     MOA:Inhibits HIV-1 protease activity resulting in immature, noninfectious viral particles
  15. Losartan Potassium (Cozaar):
    • a.     Antiotensin II receptor blocker
    • b.     Tx of HTN, diabetic neuropathy in pts with Type II DM, and stroke reduction in those with HTN and left ventricular hypertrophy
    • c.      No LA Precautions
    • d.     No EODT
    • e.     No EOB
    • f.      Adverse effects: Chest pain, fatigue, hypoglycemia, diarrhea, UTIs, anemia, weakness
    • g.     MOA: blocks the vasoconstrictor and aldosterone secreting effects of Angiotensin II
  16. Glimepride (Amaryl):
    • a.     Anti-diabetic agent, sulfonylurea
    • b.     Tx of Type II DM (may be used in conjunction with insulin or metformin)
    • c.      No LA precautions
    • d.     EODT: Morning dental appointments to minimize chance of stress induced hypoglycemia
    • e.     No EOB
    • f.      Adverse effects: Dizziness, headache, hypoglycemia
    • g.     MOA: Stimulates insulin release from pancreatic Beta cells, reduces glucose output from liver, and increases peripheral insulin sensitivity
  17. Atorvastatin (Lipitor):
    • a.     Anti-lipemic agent, HMG-CoA reductase inhibitor
    • b.     Tx of dysplipidemias or primary prevention of CV disease (atherosclerotic). Reduces risk of MI or stroke
    • c.      No LA Precautions
    • d.     No EODT
    • e.     No EOB
    • f.      Adverse effects: Diarrhea, arthralgia, and nasopharyngitis
    • g.     MOA: Inhibits HMG-CoA  reductase (rate limiting enzyme in cholesterol synthesis
  18. Gabapentin (Neurontin):
    • a.     Anticonvulsant; GABA analog
    • b.     Tx of neuropathic pain, partial seizures, and management of postherpetic neuralgia
    • c.      No LA precautions
    • d.     EODT: xerostomia, dry throat, and dental abnormalities
    • e.     NO EOB
    • f.      Adverse effects: Dizziness, somnolence/ drowsiness, ataxia, and fatigue
    • g.     MOA: Structurally related to GABA but doesn’t bind to GABA-A or GABA-B receptors
  19. Zolpidem (Ambien):
    • a.     Hypnotic; nonbenzodiazepine
    • b.     Tx of insomnia
    • c.      No LA precautions
    • d.     EODT: xerostomia
    • e.     No EOB
    • f.      Adverse effects: Headache, somnolence, and dizziness
  20. Ipratropium albuterol (Combivent):
    • a.     Anti-cholinergic and Beta 2-Adrenergic agonist
    • b.     Tx of COPD in patients on a bronchodilator who continue to have bronchospasms
    • c.      No LA precautions
    • d.     EODT: Xerostomia, dry mucous membrane, and unusual taste
    • e.     No EOB
    • f.      Adverse effects: Bronchitis, URI
    • g.     MOA: Ipratrobium blocks Ach at parasympathetic sites causing bronchodilation. Albuterol       relaxes bronchial smooth muscle by action on Beta 2 receptors with little effect on HR
  21. Aspirin (Ecotrin) low strength 81mg:
    • a.     Anti-platelet; salicylate
    • b.     Tx post-op pain; Prevention of MI, TIA, and acute ischemic stroke; Management of rheumatoid arthritis
    • c.      No LA precautions
    • d.     EODT: Increased Bleeding and hemorrhage possible
    • e.     EOB: Prolonged bleeding. No evidence to discontinue in dental surgery
    • f.      Adverse effects: rare with low dose aspirin
    • g.     MOA: Irreversibly inhibits COX1 and COX2 enzymes via acetylation which results in decreased formation of prostaglandin precursors; irreversibly inhibits formation of prostaglandin derivative (thromboxane A2) via acetylation of cyclooxygenase, thus inhibiting platelet aggregation. Has antipyretic, analgesic, and anti-inflammatory properties
  22. Clopidogrel bisulfate (Plavix)
    • a.     Anti-platelet agent
    • b.     Reduces rate of atherothrombotic events (MI, stroke, etc) in patients with recent stroke, MI, or PAD. Reduces atheromboltic events in patients with unstable angina
    • c.      No LA precautions
    • d.     EODT: Premature discontinuation of this and aspirin increases risk of a catastrophic event of stent thrombosis leading to MI or death. Elective surgery should be postponed for a year after stent placement
    • e.     EOB: Irreversibly inhibits platelet aggregation fro 7-10 days (life of platelets) and should NOT be discontinued in patients with cardiac stents. If normal platelet function is desired, discontinue for 5 days
    • f.      Adverse effects: Bleeding and hemorrhage may occur
    • g.     MOA: Irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface and reduces platelet aggregation for the lifespan of the platelet (7-10 days).
  23. Loratadine (Claratin):
    • a.     Histamine H1 Antagonist; 2nd generation; piperidine derivative
    • b.     Relieves nasal and non-nasal symptoms of allergic rhinitis and tx of chronic idiopathic urticarial
    • c.      No LA precautions
    • d.     EODT: Xerostomia and stomatitis in children
    • e.     NO EOB
    • f.      Adverse effects: Headaches and somnolence
    • g.     MOA: long acting tricylic antihistamine with selective peripheral histamine H1-receptor antagonist properties.
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OSD3 final drugs
2013-06-13 06:29:01
OSD3 final drugs

OSD3 final drugs from case
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