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Chapter 30 Principles of Pharmacology Pharmacology • The science or branch of medicine that conducts research and development in the use and effects of drugs Drug • A substance used in the prevention, diagnosis, or treatment of a disease. • All drugs must be recognized and defined by the US Food, Drug and Cosmetic Act before they can be marketed to the public in the US A drug is identified by three names • Chemical name: which is the chemical formula of a drug • Generic name: which may be used by any company; acetaminophen is an example of a generic name • Brand name, or trade name: which is controlled by business firm as a registered trademark; such as Tylenol is brand name for acetaminophen Dispensing • Patent medicines: drugs that can be obtained without a prescription; also known as over-the-counter drugs • Ethical drugs: Prescription drugs (from a physician or dentist), supplied to patients only by a pharmacist. Prescriptions • A written order by a physician or dentist for preparation and administration of a medicine • Persons legally authorized to prescribe medications are issued a Federal Drug Enforcement Agency (DEA) identification number. • Dental assistants cannot prescribe medications Terminology of Prescriptions • Superscription: patient name, address, the date and symbol Rx • Inscription: name and quantity of the drug • Subscription: directions for mixing the medication • Signature: instructions for the patient on how to take the medication, when and how much Telephone Guidelines • Narcotics cannot be ordered without a written prescription • It is illegal for a Dental assistant to “call in” a prescription • Notify the dentist if the Pharmacist calls the office • Never attempt to evaluate a patient’s reaction to a drug. Mosby’s Drug Consult • Annual source of information supplied by drug companies • It is a bound text, as well as a electronic source Drugs • Local-acting drug – Affects only the specific area of the body to which it is applied, such as a topical ointment • Systemic drug – Taken internally – Can affect the whole body by way of circulatory system Administration • Four stages – Absorption • Absorbed from site of entry—speed varies, slowest is orally – Distribution • Enters bloodstream, attaches to proteins within blood, and circulates throughout the body – Metabolism • Compound is released, and drug becomes metabolized and is then excreted through liver or kidneys – Excretion • Drug leaves the body by way of kidneys, liver, breast milk or sweat Routes • Oral—tablets, liquid • Topical—apply on surface of mucosa • Transdermal –patch that continuously releases medication • Inhalation—breathing in substance • Sublingual—medication placed under the tongue Controlled Substances Act • Drugs that are covered under the Federal Comprehensive Drug Abuse Prevention and Control Act are divided into five schedules Schedules • Schedule I – No current accepted medical use/high potential for abuse • Schedule II – High potential for abuse, some medical usefulness • Schedule III – Less abuse potential than Schedule I and II, and has accepted medical usefulnes • Schedule IV – Low abuse potential and have accepted medical usefulness • Schedule V – Lowest abuse potential and accepted medical usefulness/no prescription needed Chapter 37 • Anesthesia and Pain Control Topical Anesthesia • Provides numbing effect in an area where in injection is to take place – Ointments, liquids, sprays or patches Local Anesthesia • Most frequently used form of pain control in dentistry • Obtained by injecting an anesthetic solution near a nerve where treatment is to take place • Each local anesthetic cartridge contains – Local anesthetic drug – Sodium choloride – Distilled water Uses of Vasoconstrictors • Slows down the intake of an anesthetic agent and increases the duration of action • Prolongs the effect of the anesthetic agent by decreasing the blood flow in immediate area of the injection • Decreases bleeding in the injected area Contraindications to Vasoconstrictors • May cause strain on the heart • Not recommended for patients with a history of: – Angina – Chest pain (heart related) – Recent myocardial infarction – Coronary artery bypass surgery – Untreated or severe hypertension – Congestive heart failure Duration of Anesthetics • Know the duration (in minutes) of each of the following – Short-acting local anesthetic – Intermediate-acting local anesthetic – Long-acting local anesthetic Injection Techniques • Infiltration Anesthesia – Usually used for Maxillary arch – Also used for secondary injection to block gingival tissues surrounding mandibular teeth • Block Anesthesia – Usually used for mandibular arch – Block nerves for the quadrant Syringe • Know the parts of the syringe and their functions Cartridges/Disposable Needle • • • • • Know the color-coding system Know the parts of the cartridge Know the parts of the needle Know the size of the needle for dentistry Lumen—the hollow center of the needle-how the anesthetic flows through needle – The larger the gauge number—thinner the needle – The smaller the gauge number—thicker the needle Complications and Precautions • Know in detail – Injection into a blood vessel – Infected areas – Toxic reactions – Systemic reactions – Temporary numbness – paresthesia Inhalation sedation • • • • Know the chemical make-up Advantages of Nitrous Oxide Use Contraindications of Nitrous Oxide Use Equipment • Intravenous sedation – Understand the uses of IV sedation • General Anesthesia – Know definition – Know in detail the four stages of anesthesia • Happy Testing