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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
- physiologic status
- 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.
- 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
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
- absorption -
- renal excretion
- biliary excretion
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
- GI disturbances
- urinary incontinence
- mood alterations
- cardiovascular dysfunction
- equilibrium problems
- bleeding diatheses
- bacterial infections
- fungal infections
- viral infections
- gingival hyperplasia
- neurologic complications
- inadequate nutrition
List signs of hepatotoxicity
- abdominal pain
- 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
- 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
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
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
Which hypersensitivity reaction leads to shock?
Which hypersensitivity reaction includes high fever?
Which type of hypersensitivity reaction includes diarrhea and vomiting?
Which type of ADE includes lichenoid stomatits?
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
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