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
Identify an example in which a side effect is used for a therapeutic effect
antihistamine used for insomnia
Identify an example of an off-label use
antihypertensive drug propranolol to prevent or treat migraines
List 4 characteristics to consider before selecting a drug for a therapeutic effect
variations in disease
pharmacodynamic and pharmacokinetic variables
an uncommon condition where tolerance to a drug develops rapidly
list factors that can alter drug effects and explain the cause for the alteration.
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
What 2 groups age groups are more likely to experience ADE's?
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
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
Which ADEs are related to a genetic determination?
Type - B idiosyncratic
Which type of ADEs are usually more serious?
Which type of ADEs are predictable?
Which type of ADE usually manifests after long periods of drug ingestion?
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
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
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
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
What patient instructions regarding diet should be given when tetracycline is prescribed?
to avoid milk and dairy products
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
give an example of a chelating drug-food interaction.
tetracylcine with calcium in milk and other dairy products
Which liver enzymes are responsible for drug-grapefruit interactions?
CYP450 3A4 isoenzyme
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
differentiate between hyporeactive and hyperreactive reactions.
hyporeactive - high dose creates response
hypperreactive - low dose creates response
Which groups are most likely to have idiosyncratic reactions?
those on the extreme of the age spectrum (children and elderly)
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
What age groups and sexes are more likely to develop drug allergies?
younger or older populations
which type of hypersensitivity reaction is immediate?
Which type of hypersensitivity reaction is delayed?
Anaphylaxis is an example of what type of hypersensitivity reaction?
Which immunoglobins are associated with each type of hypersensitivity reaction?
type I - IgE
type II and III - IgG
Which hypersensitivity reaction involves T-cell activation?
which hypersensitivity reaction is most dangerous?
Which type of hypersensitivity reaction results fom the TB skin test?
differentiate between hypersensitive and pseudoallergic reactions.
pseudoallergic reactions cannot be explained on an immunologic basis like hypersensitivity reactions
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
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
List and describe the various clinical manifestations of type A ADEs.
cytotoxic effects - liver injury; mucositis
List signs of hepatotoxicity
jaundice a few days later
What is a possible ADE associated with benzocaine and prilocaine that can affect blood components?
interferes with hemoglobin oxygen carrying capacity
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
What area of the brain induces vomiting?
chemoreceptor trigger zine found in the medullary area of brain
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
anticoagulant drugs increase the risk for what ADE?
increase bleeding time and increase intraoperative bleeding
Describe the mechanisms by which an infection occurs as a result of an ADE
Therapeutic immunosuppression can exacerbate latent viral activity
What is dysgeusia?
List the clinical manifestations of type-B ADEs
Type I, II, III, and IV hypersensitivity
erythema multiforme and steven-johnson syndrome
describe the various clinical appearances of hypersensitivity reactions.