Page 1Page 2Page 3Page 4Page 5Page 6Page 71REVIEW DOCUMENT FOR DENTAL PHARMACOLOGYGeneral Anesthetics! Definitions: partial pressure, MAC, blood/gas partition coefficient, oil/gas partition coefficient! What determines anesthetic potency?! What are the 4 potential targets for the action of general anesthetics?! How do blood/gas solubility, ventilation rate and cardiac output affect equilibration ofanesthetics (rate of induction of anesthesia)?! What is the mechanism of the “concentration effect” and the related “second gas effect”?! What factors determine the rate of anesthetic equilibration into different tissues?! What is the route of elimination of general anesthetics and how is recovery from anesthesiaaffected by the blood/gas partition coefficient, ventilation rate and cardiac output?! What are the common pharmacological effects of inhalational anesthetics?! Know the major differences between the inhalational anesthetics (e.g., which is most/leastpotent, induction/recovery rate, etc.- see table p. 14 of handout; don't need to memorizenumbers).! What are the major uses of the various intravenous anesthetic agents discussed and their majoradvantages and disadvantages?Antiseizure Drugs! Know what a seizure is, its potential causes and how it relates to epilepsy.! Know the mechanisms by which neurons become hyperexcitable! Know how seizures are classified (i.e., simple partial vs. complex partial vs. tonic-clonic, etc. -see table in handout)! Know the general principles of antiseizure drug therapy ! Know the identified mechanisms by which antiseizure drugs work.! Know the drugs of choice for the various types of seizures, their mechanism of action and2major side effects.! What are the 4 major types of drug interactions seen with antiseizure drugs?Opioid Analgesic Drugs1.Know about mechanism of nociception (physiology)Dorsal corn of the spinal cord – gate control mechanism2. Know about classification of opioid analgesic drugsStrong agonists – morphine, meperidine, methadone, heroin, fentanylModerate agonists – propoxyphene, codeineMixed agonists-antagonists – pentazocine, nalbuphine, buprenorphineAntagonist – naloxone, naltrexone3. Know about endogenous opioid peptidesEnkepalins, endorphins, dynorphins, endomorphins4. Know about opioid receptors and the mechanism of actionMu (m), Kappa (k), Delta (d). All G-protein coupled receptors. Increase K+ efflux(hyperpolarization) and reduce voltage-gated Ca2+ entry.5. Know about the sites of opioid receptor expressionm - periaqueductal gray, spinal trigeminal nucleus, cuneate and gracile nuclei, thalamus,nucleus of solitract, nucleus ambiguus, parabrachial nucleus, neurons of the postremak - hyphothalamic regiond - dorsal horn of the spinal cord6. Know about the pharmacological actions of opioidsCNS - analgesia, sedation, euphoria, mental clouding, respiratory depression, nausea and vomiting, cough reflex, pupillary constriction (miosis)GI – constipation, biliary tract spasm7. Know about the contraindications of opioidsDecreased respiratory reserve (emphysema, severe obesity, asthma), biliary colic,head injury, reduced blood volume, hepatic insufficiency, convulsant states8. Know about tolerance and physical dependenceTolerance develops to – analgesia, euphoria, sedation, lethal dose, nauseaTolerance does not develop to - miosis, constipation, respiratory depression (partial)Physical dependence – treat with methadone (long acting opioid)9. Know about antitussive and anesthetic usage of opioids3Antitussive – codeine, dextromethorphanAnesthetic – fentanyl, sufentanil10. Know about antagonistsNaloxone – readily reverses the coma and respiratory depression of opioid overdoseNaltrexone – longer duration of action (up to 48 hrs) PsychopharmacotherapyKnow mechanism of action for first generation (“traditional”) and second generation (“atypical”)antipsychotics, and the major classes of antidepressants and anxiolytics. Know how first generation (“traditional”) and second generation (“atypical”) antipsychotics differ. Understand what types of side effects are associated with blockade of alpha1-adrenergic, muscarinic, andhistamine receptors. Understand the principles of drug interactions such as CYP inhibitors and inducers, protein binding andprotein saturation. Antidepressants and mood stabilizers1. Discuss key difference(s) between unipolar and bipolar mood disorders.2. Identify various antidepressants classified by mechanism of action(s) (e.g., multiple receptor actions,SSRIs, MAO-Is).3. Discuss the impact of agonism or antagonism at pre-synaptic autoreceptors (i.e., short-loop negativefeedback system.4. Recognize possible mechanisms by which mood stabilizers such as lithium may work (e.g., NE-AcHbalance hypothesis; thyroid-catecholamine hypothesis).5. Discuss possible drug interactions with antidepressants and mood stabilizers mediated by the P450microenzyme system (e.g., inhibition may increase concentration of substrate agent and lead to toxicity).Anxiolytic and sedative-hypnotic drugs1 Identify anxiolytic agents based on purported mechanism(s) of action (e.g., BZDs, azapirones, SSRIs).2 Know the inter-relationship of the GABA receptor, the chloride ion channel and the BZD receptor.3 Know the different types of ligands at the BZD receptor (e.g., full agonist, antagonist, full inverse4agonist).4 Know the impact of the pharmacokinetics of various anxiolytic-sedative hypnotics on their clinical effect(e.g., onset of action, duration of action, metabolism).5 Know the most common adverse effects associated with the BZDs.(Pharmacology of sleep)1. Know the sleep stages 2. Know the effects of acute and chronic alcohol use on sleep.3. Know the role of GABA A receptor complex in the hypnotic action of barbiturates, benzodiazepines andnon-benzodiazepines.4. Know the effects on sleep of benzodiazepines, imidazopyridines, and cyclopyrrolones. Heavy Metal Toxicity 1. Know specific chelating agents for each metal, and route of administration.Lead: Calcium disodium EDTA (IV)2, 3-dimercaptosuccinic acid (Succimer) (Oral)2, 3-dimercaptoproponol (BAL, Dimercaprol) (IM)Penicillamine (Oral)Cadmium: Calcium disodium EDTA (IV)Mercury: 2, 3-dimercaptosuccinic acid (Succimer) (Oral)2, 3-dimercaptoproponol (BAL, Dimercaprol) (IM)Penicillamine (Oral)N-acetyl-penicillamine (Oral)Arsenic: N-acetyl-penicillamine (Oral)Penicillamine (Oral)Arsine gas (AsH3) (hemolytic agent): transfusionIron: