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Friday, May 28

  1. page home edited Welcome Welcome to DEH-28 ... Applied Pharmacology Fall 2009 This site was developed s…

    Welcome

    Welcome
    to DEH-28
    ...
    Applied Pharmacology Fall 2009
    This site was developed so the members of the Class of 2010 could build knowledge of basic pharmacology. I hope you enjoy your time here and your experience building this wiki. This is your site where you can add and link all that is needed to the assigned topics. Please take a minute to join this site so I can see who is making contributions to our site. This is a public space but only the Class of 2010 can edit it.
    Not sure how to add your comments and thoughts? Watch this simple video on how to utilize a wiki.
    (view changes)
    10:56 pm

Friday, January 1

  1. 10:52 pm

Tuesday, June 9

  1. page Drug action and Adverse Reactions edited ... Development Page {53074-004-9F65D813.jpg} The membrane barriers play a major role dur…

    ...
    Development Page
    {53074-004-9F65D813.jpg}
    The membrane barriers play a major role during any drug action or adverse reacton. Membrane barriers can either consist of a layer of closely packed cells or a cell membrane also known as the plasma membrane.The cell membrane is what surrounds and protects the living cells of our body. It must regulate what can enter from the extrinsic environment into the intrinsic envionment of the cell to cause an action or adverse reaction. It is important to understand what the cell membrane consist of since this is the membrane of choice used to explain drug interactions. It is made up of a lipid bilayer made up of phospholipids, cholesterol and proteins which expand from the outside to the inside of the cell allowing a gateway to the intracellular environment.
    ...
    Because the cell membrane is lipoid, lipid-soluble drugs diffuse most rapidly. Small molecules tend to penetrate membranes more rapidly than larger one.
    **http://www.youtube.com/watch?v=s0p1ztrbXPY**
    specializedSpecialized transported processes.
    Carrier mediated transport:
    I.The passage of lipid insoluble substances through the cell membrane is mediated by carrier proteins in the cell membrane.
    ...
    *
    1. Sodium is more concentrated on the outside of the cell, whereas potassium is more concentrated on the inside of the cell.
    ...
    the cell.
    {Image129.gif}
    http://www.youtube.com/watch?v=_bmp2_T0c7k
    ...
    Most complex method
    Endocytosis= series of events in which substance is engulfed and internalized by the cell .
    ...
    cell membrane.
    **http://www.youtube.com/watch?v=4gLtk8Yc1Zc**
    Here is a video that incorporates 4 different methods of diffusion all into one.
    ...
    Low cost
    painless
    ...
    small intestines
    Drawbacks:
    Patient Compliance is required.
    Delayed absorption
    Metabolic inactivation may occur before the drug reaches the blood
    ...
    the other.
    What can affect absorption?
    The duration of exposure, concentration of the drug, and surface availability can affect absorption.
    ...
    Intestinal contents
    Formation of insoluble salts
    ...
    in liver
    2- INHALATION
    alveolar membrane = highly permeable to agents in gaseous state, fine powder, and droplets.
    ...
    4- embolism
    5- infection
    ...
    hematoma formation
    intramuscular route
    given in cases where patient is not cooperative , can't give drug orally, or high percent of drug inactivation is required.
    ...
    skin, mucous membrane, Iontophoresis
    drugs applied to epithelial surfaces for loc al effects
    ...
    of kertanization
    1. Describe the characteristics of a drug including the log dose-effect curve, potency, efficacy and chemical signaling between cells.
    A) Log dose effect curve
    ...
    D) Chemical signaling between cells
    i) At a chemical synapse a narrow gap or synaptic cleft, separates the presynaptic cell from the postsynaptic cell. Due to the cleft the cells are not electrically coupled and an action potential occurring in the presynaptic cell cannot be transmitted directly to the membrane at the postsynaptic cell. Instead, a series of events converts the electric signal arriving at the synaptic terminal in to a chemical signal that travels across the synaptic cleft where it is converted back into an electrical signal in the postsynaptic cell. This is done by neurons sacs called synaptic vesicles that exist in the cytoplasm at the tip of the presynaptic axon. The vesicles contain neurotransmitters, the substance is released as an intercellular messenger into the synaptic cleft to the post synaptic membrane where synaptic receptors will uptake it.
    ...
    Drug Effects:
    There are differences between people that affect the variation of individual response to a drug from person to person. Even with a standardized dose, pharmacodynamic differeences, are evident within a test group. Along with those differences, Pharmacokinetic differences, differences in standardized dose, can play a major factor in drug responsiveness. A third component of this variance is the failure of patients to take their medication correctly, as prescribed by their physician.
    Patient Factors:
    ...
    Patient Body Weight:
    A patient's body weight can vary exponentially from person to person , creating a challenge for a physician to achieve the correct so called, "standard dose." Body composition or "Mass" is an extremely important fluctuating factor in the successful therapeutic use of a drug. Two different factors can be seen within person of the same weight that produce completely different outcomes. Firstly, a person of high adipose, or excessive body fat, may not be as responsive to a drug that a person of highly muscularized body tissue may be. Because of this biological make-up, an expansive knowledge of lipophillic and hydrophillic drugs is critical.
    ...
    of reactions
    Allergic- Administration of the drug causes an undesirableimmunologic response, i.e., rash, anaphylaxis, which is often unpredictable.Side effect- Undesirable effect occurs which is expected orpredictable at therapeutic doses, i.e., nausea, dry mouth.Side effects are the most common adverse effects.Drug toxicity- Occurring most commonly in children and frail elders,this is when a physiologic system is damaged fromdoses over therapeutic levels, i.e., nephrotoxicity fromover ingestion of NSAIDs. Toxicity is usually predictable. Drug-drug interaction- The absorption, distribution, metabolism, and/or excretion of one drug is altered by the administration of another drug, i.e., erythromycin taken with digoxin increases the digoxin level or NSAIDs and methotrexate interactions are usually predictable.Drug–physiology interaction- The presence of a drug at therapeutic levels adversely alters a physiologic system – can overlap with a side effect, i.e., administration of Clindamycin can result incolitis and diarrhea. Such interactions are usually predictable.Drug-laboratory test interaction -There is no effect on the physiologic system being tested, but a false positive or false negative test result,i.e., amoxicillin can cause a false-positive urine glucose test. Such interactions are usually predictable.Idiosyncratic- By definition these are unpredicted physiologic, or, psychological responses occurring at therapeutic doses.These are unique to an individual.
    Describe and compare the pharmacologic effects, adverse reactions and uses of cholinergic and anticholinergic agents.
    ...
    Drugs Distributed?
    Distribution refers to the movement of drugs throughout the body. The first layer to be crossed is the capillary membrane tissue. Once the drug enters the systemic circulation it is then diluted by the plasma volume. Depending on the molecular weight of the drug, this will affect its passing across the capillary membrane. Such as lipophilic drugs, they cross the membrane quickly. Another factor that influences passage across the cell membrane is their pH. Intracellular pH is 7.0 and extracellular pH is 7.4. Acidic drugs maintain outside the cell whereas the acidic drugs remain within.
    ...
    endothelial cells.
    Drugs can enter the oral cavity through passive diffusion across the alveolar and ductal cells of the salivary glands, passive diffusion across the oral epithelium, or through the gingival crevice.
    Distribution of drugs isn’t equal throughout the body. The volume of distribution can be used to figure out drugs are distributed among the different parts of the body. The quantity of the drug given is divided by the plasma concentration of the drug at equilibrium. This then gives you the volume of distribution. This is the amount of water by which a particular dose would have to be diluted to produce a given plasma concentration assuming no drug has been lost through incomplete absorption, metabolism or excretion.
    BackgroudBackgroud: Adrenergic vasoconstrictors
    ...
    harmful topatients.
    Methods.

    Methods:
    The faculty
    ...
    rating of
    alleged
    alleged adverse drug
    ...
    to dentistry,
    based
    based on the
    ...
    focused on
    the
    the adrenergic vasoconstrictors epinephrine and
    levonordefrin.
    Results.
    levonordefrin.
    Results:
    Vasoconstrictor drug interactions involving
    tricyclic
    tricyclic antidepressants, nonselective β-
    adrenergic
    β-adrenergic blocking drugs,
    ...
    general anesthetics
    and
    and cocaine are
    ...
    both humans
    and
    and animals as
    ...
    causing serious
    morbidity
    morbidity or death.
    ...
    adverse interactions
    involving
    involving adrenergic neuronal blocking drugs,
    drugs
    drugs with α-adrenergic
    ...
    less compelling,
    suggesting
    suggesting for the
    ...
    that clinically
    significant
    significant reactions may
    ...
    used in
    excessive
    excessive doses. In
    ...
    oxidase inhibitors,
    there
    there is no
    ...
    a significant
    interaction
    interaction with epinephrine or levonordefrin.
    Conclusions.

    Conclusions:
    Potentially serious adverse
    drug
    drug interactions involving adrenergic vasoconstrictors
    can
    can occur in
    ...
    most circumstances,
    careful
    careful administration of
    ...
    of vasoconstrictors
    and
    and avoidance of
    ...
    retraction cord
    containing
    containing epinephrine, coupled
    ...
    monitoring of
    vital
    vital signs, will
    ...
    with no
    risk
    risk or only
    ...
    in the
    case
    case of cocaine
    ...
    adrenergic vasoconstrictors
    be
    be avoided completely.
    ...
    optimal patient
    safety,
    safety, dentists must
    ...
    potential drug
    interactions
    interactions involving adrenergic
    ...
    DENTISTRY: VASOCONSTRICTORS
    POSSIBLE DRUG INTERACTION
    Vasoconstrictor with tricyclic antidepressant
    ...
    hyperthyroidism are present.
    No substantial evidence of an
    interaction
    (view changes)
    8:29 pm

Sunday, June 7

  1. page Prescription Writing edited ... 3. Surface area- patient's height and weight = adult dose average adult surface area {9-PR…
    ...
    3. Surface area- patient's height and weight = adult dose
    average adult surface area
    {9-PRESCRIPTION-PADS_03.jpg}
    {PrescriptionPad.jpg}

    Categories of Prescriptions & Examples
    SCHEDULE
    ...
    |||||||||| PRIMARY CARE ASSOCIATES ||
    |||||||||| 1234 Wellness Road · Resume Speed, Kansas · (913) 999-1212 ||
    |||||||||| ||||
    || |||| Name ||
    ...
    ||
    || |||| Address ||
    ...
    ||
    |||||||||| ||||
    |||||||||| ||||
    RX
    Doxycycline 100 mg
    Disp #14
    Sig: Take 1 capsule bid x 7 days
    ||^ || ||^ |||| ||^ ||
    ||^ || ||^ |||| ||^ ||
    ||^ || ||^ |||| ||^ ||
    || || || |||| || ||
    The heading
    ...
    the patient
    Body -Rx, The name of the drug, amount to be dispensed, patient directions
    Closing - Prescribers signature, DEA number, Refill instructions, If generic substitution permitted
    (view changes)
    10:45 am
  2. 10:42 am
  3. page Drug action and Adverse Reactions edited ... A patient's body weight can vary exponentially from person to person , creating a challenge fo…
    ...
    A patient's body weight can vary exponentially from person to person , creating a challenge for a physician to achieve the correct so called, "standard dose." Body composition or "Mass" is an extremely important fluctuating factor in the successful therapeutic use of a drug. Two different factors can be seen within person of the same weight that produce completely different outcomes. Firstly, a person of high adipose, or excessive body fat, may not be as responsive to a drug that a person of highly muscularized body tissue may be. Because of this biological make-up, an expansive knowledge of lipophillic and hydrophillic drugs is critical.
    Types of reactions
    ...
    anaphylaxis, which isoftenis often unpredictable.Side effect-
    ...
    Toxicity is usuallypredictable.Drug-drugusually predictable. Drug-drug interaction- The
    ...
    distribution, metabolism, and/orexcretionand/or excretion of one
    ...
    the administration ofanotherof another drug, i.e.,
    ...
    taken with digoxinincreasesdigoxin increases the digoxin
    ...
    NSAIDs and methotrexateinteractionsmethotrexate interactions are usually
    ...
    therapeutic levels adverselyaltersadversely alters a physiologic
    ...
    with a sideeffect,side effect, i.e., administration
    ...
    interactions are usuallypredictable.Drug-laboratoryusually predictable.Drug-laboratory test interaction
    ...
    physiologic system beingtested,being tested, but a
    ...
    false-positive urine glucosetest.glucose test. Such interactions
    ...
    are unpredicted physiologic orpsychologicalphysiologic, or, psychological responses occurring
    Describe and compare the pharmacologic effects, adverse reactions and uses of cholinergic and anticholinergic agents.
    How Are Drugs Distributed?
    ...
    Drugs can enter the oral cavity through passive diffusion across the alveolar and ductal cells of the salivary glands, passive diffusion across the oral epithelium, or through the gingival crevice.
    Distribution of drugs isn’t equal throughout the body. The volume of distribution can be used to figure out drugs are distributed among the different parts of the body. The quantity of the drug given is divided by the plasma concentration of the drug at equilibrium. This then gives you the volume of distribution. This is the amount of water by which a particular dose would have to be diluted to produce a given plasma concentration assuming no drug has been lost through incomplete absorption, metabolism or excretion.
    BackgroudAdrenergic vasoconstrictorsareBackgroud Adrenergic vasoconstrictors are commonly used
    ...
    enhance the painrelievingactionpain relieving action of local
    ...
    and to controllocalcontrol local bleeding. Although
    Methods. The faculty of a March 1998 symposiumentitled “Adverse Drug Interactions inDentistry: Separating the Myths From the Facts” extensivelyreviewed the literature on drug interactions.
    They then established a significance rating of
    (view changes)
    10:19 am

Monday, June 1

  1. page Cardiovascular Drugs edited ... 2- Class II agents = ant sympathetic Nervous system , beta blocker 3- Class II = affect K+ ef…
    ...
    2- Class II agents = ant sympathetic Nervous system , beta blocker
    3- Class II = affect K+ efflux
    ...
    AV node
    Class I in subdivided according to the agent’s effect on the depolarization
    Na+ channels exist in three stages: open, inactivated, closed
    ...
    Weakness
    Persistent peripheral edema.
    Heart Failure in heart failure
    First Agents Used:
    ACE inhibitors
    Diuretics
    Cardiac Glycosides
    Beta-blockers (mild-to-moderate disease
    LIPID-

    LIPID-
    LOWERING DRUGS
    There are different types of lipoproteins based on density of their complex. Lower density = higher lipid content
    VLDL- very low density lipoprotein
    ...
    Hyperlipidemia may originate from genetics or dietary factors, or disease states such as diabetes mellitus, hypothyroidism, uremia. Atherosclerosis is caused by the accumulation of fatty streaks and plaques in arteries. Relationship between lipoproteins and atherosclerosis is that patients with hyperlipidemia can see a reduction in cholesterol with regression of plaque formation and less of a chance to attain atherosclerosis.
    Therapeutic measures include starting with altering the patients diet if further help is needed then adminstration of drugs shoud be given based on patients age, gender, ischemic vascular disease. Lipid lowering drugs are commonly used in patitents with ischemic heart disease to prevent MI. Drugs that lower plasma cholesterol are used to delay or reverse progression of atherosclerosis.
    ...
    lowering drugs:
    Lipoprotein
    Concentrations
    ...
    b. contraction is greater due to increased filling volumes - Starling’s Law
    c. ejection fraction is improved
    ...
    ejection velocity
    Adverse Side Effects Of The Glycosides :
    {10940W.jpg}
    (view changes)
    5:58 pm
  2. page Cardiovascular Drugs edited ... - The Vaughan William classifications o Based on the primary mechanism of action o Has …
    ...
    - The Vaughan William classifications
    o Based on the primary mechanism of action
    o HasHas limitation since
    o There are five main classes in the Vaughan Williams classification of antiarrhythmic agents:
    1- Class I agents that interfere with Na+ channels
    2- Class II agents = ant sympathetic Nervous system , beta blocker
    3- Class II = affect K+ efflux
    ...
    AV node
    Class I in subdivided according to the agent’s effect on the depolarization
    Na+ channels exist in three stages: open, inactivated, closed
    ...
    Quinidine may interact with the followings”
    - Hepatic enzyme inducers = decrease plasma quinidine concentration ex: rifampin
    ...
    drug concentration
    Implication in dentistry:
    There is Potential for an increase incidence of orthostatic hypotension and hypertensive syncope
    ...
    hypertensive reaction.
    Antianginal Drugs
    Angina occurs when there is a greater demand for oxygen than can be met by diseased coronary arteries. It is treated with:
    ...
    Nitrates: are drugs of choice for relieving acute angina.
    Pharmacokinetics:
    ...
    into circulation.
    Pharmacodynamics:
    Nitrates cause smooth muscle of veins and to a lesser extent, the arteries to relax and dilate. Nitrates work in following way:
    ...
    Reduces amount of blood in ventricles at end of diastole, when ventricles are full.
    By reducing preload, nitrates reduce ventricular size and ventricular wall tension. This, in turn, reduces oxygen requirements of heart.
    ...
    for oxygen.
    Pharmacutherapeutics:
    ...
    adverse reaction.
    Drug interactions:
    Severe hypotension can result when nitrates ineract with alcohol
    ...
    Metoprolol and propranolol are absorbed almost entirely from GI tract whereas less than half the dose of atenolol or nadolol is absorbed. These beta adrenergic blockers are distributed widely. Propranolog is highly protein bound; the other beta adrenergic blockers are poorly protein bound. Propranolol and metoprolol are metabolized in liver and their metabolites are excreted in urine. Carvedilol is metabolized in liver and excreted in bile and feces. Atenolol and nadolol aren’t metabolized and are excreted unchanged in escretions.
    Pharmacodynamics:
    ...
    for oxygen.
    Pharmacotherapeutics:
    Beta adrenergic blockers are indicated for long-term prevention of angina. Metoprolol may be give IV in acute coronary syndrome, followed by an oral dose. Carvedilol and metoprolol are indicated for heart failure. Beta adrenergic blockers are also first-line therapy for treating hypertension.
    ...
    Sudden stopping beta adrenergic blocker may trigger angina, hypertension, arrhythmias and acute MI
    Calcium channel blockers
    ...
    of hypertension.
    Pharmacokinetics:
    Administered orally, and are absorbed quickly and almost completely. Because of the first-pass effect, the bioavailability of these drugs is much lower. Calcium Channel blockers are highly bound to plasma proteins. They are metabolized rapidly and almost completely in the liver.
    Pharmacodynamics:
    Prevent passage of calcium ions across myocardial cell membrane and vascular smooth muschle cells. This causes dilation of coronary and peripheral arteries which decreases force of heart’s constractions and reduces workload on heart.
    ...
    additional oxygen.
    Pharmacotherapeutics:
    Used only for long-term prevention of angina, not for short term relief of chest pain. Calcuim channel blockers are particularly effective for preventing prinzmetal’s angina.
    ...
    Weakness
    Persistent peripheral edema.
    LIPID-Heart Failure in heart failure
    First Agents Used:
    ACE inhibitors
    Diuretics
    Cardiac Glycosides
    Beta-blockers (mild-to-moderate disease
    LIPID-
    LOWERING DRUGS
    There are different types of lipoproteins based on density of their complex. Lower density = higher lipid content
    VLDL- very low density lipoprotein
    ...
    Hyperlipidemia may originate from genetics or dietary factors, or disease states such as diabetes mellitus, hypothyroidism, uremia. Atherosclerosis is caused by the accumulation of fatty streaks and plaques in arteries. Relationship between lipoproteins and atherosclerosis is that patients with hyperlipidemia can see a reduction in cholesterol with regression of plaque formation and less of a chance to attain atherosclerosis.
    Therapeutic measures include starting with altering the patients diet if further help is needed then adminstration of drugs shoud be given based on patients age, gender, ischemic vascular disease. Lipid lowering drugs are commonly used in patitents with ischemic heart disease to prevent MI. Drugs that lower plasma cholesterol are used to delay or reverse progression of atherosclerosis.
    ...
    lowering drugs:
    Lipoprotein
    Concentrations
    ...
    b. contraction is greater due to increased filling volumes - Starling’s Law
    c. ejection fraction is improved
    ...
    ejection velocity
    Indication for use:
    treatment of congestive heart failure and managment of atrial flutter and fibrilation.

    Adverse Side Effects Of The Glycosides :
    Hypertension (High Blood pressure) can cause stroke, coronary artery disease, stroke, renal failure and more.
    Assential hypertention means that the cause is unknown and represents most of the hypertension cases.
    Secondary hypertension is caused from a known disorder.
    The two factors affecting blood pressure are CO, which is the venous return, inotropic and the chronotropic state of the myocardium and TPR which is the diametor and stiffness of the arterioles. To figure out the mean arterial blood pressure try this formula:
    CO x TPR= MAP.
    Momentr to moment control of blood pressure depends on the bororeceptors. Regulation of BP depens on the short term help from the sympathetic nervous system and the long term by the renal system. Diretics, drugs affecting angiotension, CA++ channel blochers, drugs affecting sympathetic function, direct acting vasodilators and mics. drugs are the ways that antihypertensives are separated.

    {10940W.jpg}
    Check list of common cardiac drugs
    (view changes)
    5:57 pm

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