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NDBI Review Pharm Ppt Slides

NDBI Review Pharm Ppt Slides

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1
NBDE II Review
The Exam: Test logistics
\u2022 2 days
\u2013Day 1: 400 Multiple Choice Questions
(200 a.m. + 200 p.m.)
\u2022 General dental and specialty topics admixed
\u2022 Diagnosis, treatment planning and management
emphasis
\u2022 Image booklet to supplement some of the questions
The Exam: Test logistics
\u2013Day 2: 200 multiple choice questions a.m.
\u2022 10-13 cases with 9-14 multiple choice questions each
\u2013Scores are shown as low, average, or high for each
section\u00e0 but only one overall percentile is given at the
end
\u2013Study with the dental decks, supplemental review

material, and old exams\u2026but learn theconcepts behind the questions! Questions change, but the concepts they test are similar over the years. The more you look over the material, the more comfortable you will be.

Pharmacology I
Whyor Whendo we use drugs (clinically)?
\u2022 To control, cure, or prevent disease
Who can prescribe drugs, and Where?
\u2022 Licensed doctors, requires DEA registration and
is state specific
\u2022 DEA regulates drug laws (legal Rx and illegal) in
this country
What can you Rx?
\u2022 Drugs within the scope of your practice
\u2022 Must be cognizant of Controlled Substances Act
\u2013 Drug Schedules I-V
DEA Schedules
\u2022 Schedule I
[Use illegal/restricted to research; high abuse potential; no accepted
medicinal use in US]
Examples: hallucinogens, heroin, marijuana
Schedule II
[Requires prescription; high abuse potential; no refills or verbal orders
allowed; some states require triplicate Rx]
Examples: amphetamines, barbiturates, opiates (single entity, some combos)
Schedule III
[Requires prescription; moderate abuse potential; max 5 refills/6mo;
verbal orders allowed]
Examples: anabolic steroids, dronabinol, ketamine, opiates (some combos)
Schedule IV
[Requires prescription; low/moderate abuse potential; max 5
refills/6mo; verbal orders allowed]
Examples: appetite suppressants, benzodiazepines, sedative/hypnotics
Schedule V
[Requires prescription or may be OTC with restrictions in some states;
limited abuse potential; max 5 refills/6mo; verbal orders allowe d]
Examples: opiate or opiate-derivative antidiarrheals and antitussives
2
How do we use drugs?
\u2022Enteral \u2013 GI tract route of administration
\u00bbOral\u00e0 stomach\u00e0 intestines\u00e0 liver
(portal circulation)\u00e0 heart\u00e0 general
circulation\u00e0 target tissues
\u00bbSublingual orRectal\u00e0 straight into general
circulation and bypasses first-pass liver
metabolism
\u2022Parenteral \u2013 Non-GI route of administration
\u00bbIntravascular, intramuscular, subcutaneous
\u00e0straight into general circulation and
bypasses first-pass liver metabolism
How else do we use drugs?
\u2022Other \u2013
Inhalation
i.e. anesthetics, sterols for asthma
Intra-nasal
i.e. calcitonin for osteoporosis, cocaine
Intra-thecal
i.e. analgesics, anti-neoplastics
Topical
i.e. anesthetics, antibiotics, antifungals
Key Concepts of Drug Activity
\u2022 Pharmacokinetics
\u2013 The body\u2019s effect on a drug
\u2022 Pharmacodynamics
\u2013 The drug\u2019s effect on the body
Pharmacokinetics
Dose and Route of Administration (Input)
Circulatory System / Plasma
1. Absorption
Target Tissues
Excretion in urine, feces, bile (Output)
2. Distribution
3. Metabolism
4. Elimination
- The body\u2019s effect on a drug
1. Absorption
\u2022 The onset of action of a drug isprimarily
determined by the rate ofabsorption
\u20224 factors that affect theabsorption of drugs into
the bloodstream:
1. Bioavailability
\u2022 The amount (quantity or %) that reaches the blood
or plasma. Usually, a drug\u2019s major effect is
produced by the amount of drug that isfree in
plasma.
2. Stability
\u2022 Insulin is unstable in the GI tract, hence the
injections for Diabetics to bypass the enteral route
3. Permeability
\u2022 pH (acid-base interactions, protonation, pKa, Hendersson-
Hasselbach)
\u2013 Coated tabs (buffered)
\u2022 Gastric Emptying
\u2013 Parasympathetic vs. Sympathetic

\u2013 Food in the stomach delays gastric emptying and increases acid production to allow for proper digestion; drugs destroyed by acid should be taken without food when possible

\u2022 Lipid solubility (hydrophobic, non-ionized, i.e. sterols)
\u2022 Water solubility (hydrophilic, ionized or charged)
\u2022 Transport mechanisms (passive, active, or facilitated)

\u2022 Contact time, surface area, blood supply
1. Absorption
3
4. First-pass hepatic metabolism
\u2022 For enteral drugs, some are inactivated by the liver
before reaching systemic circulation, thus
decreasing bioavailability; others drugs are
activated by the liver, increasing bioavailability
\u2022 IV (intravenous) route of administration bypasses
first-pass liver metabolism, also increasing
bioavailability
1. Absorption
Can stress effect drug absorption
from an enteral route?
Would you tell your patients to take
Penicillin on an empty or full
stomach?
Hint: Penicillin is inactivated by stomach acid. What if patient
has nausea when taking it on an empty stomach?
Pharmacokinetics
Dose and Route of Administration (Input)
Circulatory System / Plasma
1. Absorption
Target Tissues
Excretion in urine, feces, bile (Output)
2. Distribution
3. Metabolism
4. Elimination
- The body\u2019s effect on a drug
2. Distribution
\u2022 In circulation, drugs bind to plasma proteins
(mainlya l b u m i n) relatively non-specifically
\u2022 Competition for plasma protein binding sites
(affinity) explains some drug-drug interactions

\u2013 i.e. sulfonamide antibiotics and warfarin anti-
coagulants are highly bound to plasma proteins, so if
you give a sulfonamide to a patient on chronic

warfarin therapy, the sulfonamide can displace
warfarin and cause dangerously high free warfarin
concentrations in the blood
A patient is treated with drug A, which has a high affinity for
albumin and is administered in amounts that do not

exceed the binding capacity of albumin. A second
drug, drug B, is added to the treatment regimen. Drug
B also has a high affinity for albumin and is
administered in amounts that are 100 times the binding
capacity of albumin. Which of the following might

occur after administration of drug B?

A. An decrease in tissue concentration of drug A B. An increase in tissue concentration of drug A C. A decrease in the half -life of drug A

D. A decrease in the volume of distribution (Vd) of Drug A
Test Question?
2. Distribution
\u2022 Other factors affecting drug distribution:
\u2013 Blood flow
\u2013 Capillary permeability
\u2013 Drug structure
\u2013 Affinity
\u2013 Half -life of drug (t1/2)
\u2013 Drug volume of distribution (Vd)
\u2013 Hydrophobic or Hydrophilic nature of drug\u2026

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