PRINCIPLES OF PHARMACOLOGY - DPHR 501

Claire L. Gill, Pharm.D., D.D.S.

Office Rm 4276 & patient admitting clinic room 127
Phone 09862, 08751
Email clairegi@hsc.usc.edu
Website http://www.usc.edu/hsc/pharmacy/pd_labs/dent/
Goals
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For the dental student to gain a thorough understanding of the basic principles of pharmacology
For the dental student to obtain a solid understanding of the pharmacology of the medications
that are used extensively in the practice of dentistry, particularly local anesthetics,
vasoconstrictors, analgesics, antibiotics, antianxiety agents
For the dental student to identify the need for treatment modifications that result from
medications that a patient is taking (or the medical conditions that necessitate the drug therapy).
To be able to anticipate problems (emergencies, drug interactions, oral changes) that a patient
who is taking medications might experience.
Identify medications that a patient is taking as to the pharmacological class the drug belongs to,
and possible significant side effects and/or contraindications.
Develop the skills needed to utilize an appropriate drug reference text and locate the information
needed to treat a patient.
To develop the knowledge to select the most appropriate local anesthetic and vasoconstrictor for
any given patient and situation.

Required text Pharmacology and Therapeutics for Dentistry by Yagiela, John A, Neidle, Enid A. , Dowd,
Frank J.. 1998, fourth edition
Texts - Available in the library - either on RESERVE or in the reference section*
Pharmacology and Dental Therapeutics by Seymour, R.A. (QV 50 W239t 1999)
Pharmacology and Therapeutics for Dentistry by Yagiela, John A et al (QV 50 N397p 1998)
Basic and Clinical Pharmacology by Katzung, Bertram (QV 4 B3102 1998)
Basic Pharmacology and Clinical Drug Use in Dentistry by Cawson, R.A., (QV C383c 1989)
Lexicomp - Drug Information Handbook for Dentistry (QV 50 D794)*
Mosbys Dental Drug Reference (QV 39 M8935)*
Attendance will be taken with pop quizzes, and practice prescription writing exercises
Grading - 30% participation as an expert /pop quizzes
30% mid-term examination
40% final examination
(Experts Four students will serve as experts to address specific topics or the questions for each hour
session, assignments for the experts are listed with the schedule. The experts are to be completely
prepared to explain, discuss and present the pharmacology for that session. On Mondays there will be two
sessions, so there will be four experts for the 1pm session and four experts for the 1:50 pm session. The
experts should discuss the uses/indications for the drugs, the mechanism of action, common adverse
effects, oral changes if any, treatment modifications for dental therapy, and drug interactions with drugs
in dentistry.)
Examinations will be short answer, essay and multiple choice.

Pharmacology DPHR 501 - Schedule of topics and reading assignments and expert assignments
Jan. 7

Introduction - Principles of pharmacology

Pages 696-706 Prescription writing and drug regulation

Jan. 11 JAMA/JADA articles

On website
Jan. 14 pages 1-68

Jan. 18 - pages 71-83

a.

Prophylactic antibiotics
Experts 4 volunteers

1. Pharmacodynamics mechanisms of drug action, pharmacotherapeutics

2. Pharmacokinetics drug interactions
Experts 1. 4219, 4222, 4269,4274
2. 4229,4232, 4234, 4238
Introduction to the autonomic nervous system
Adrenergic drugs
Experts 1. 4205, 4209, 4212, 4215

Jan. 21 Holiday no class

Jan. 25 pages 100-125 Adrenergic blocking drugs and cholinergic drugs
Experts 4255, 4258, 4263, 4266
Jan. 28 pages 133144 1.Drugs affecting nicotinic receptors
2.Dental drugs that work via the SNS/PNS
Experts 1. 4281, 4285, 4288
2. 4242, 4245,4248
Feb. 1 pages 145-167 Drugs affecting the central nervous system, antipsychotics and antidepressants
Experts 4314,4306,4303,4292
Feb. 4 pages 168-184
pages 185-196

1. Antianxiety drugs, cental acting muscle relaxants

2. sedative-hypnotics and central nervous system stimulants
Experts 1. 4306, 4310, 4201, 4207
2. 4294, 4297, 4300, 4306

Feb. 8 pages 197-207

Anticonvulsants
Experts 4224, 4236, 4251, 4271

Feb. 11 pages 208-216 1. Antiparkinsonian agents

Pages 217-234 2. Local anesthetics
Experts 1. 4202, 4206, 4211, 4214
2. 4220, 4230, 4240, 4250
Feb. 15 pages 235-265 Principles of general anesthesia, agents used in general anesthesia, deep
sedation, conscious sedation
Experts 4226, 4246, 4256, 4276
Feb. 18 holiday no class
Feb. 22- pages 266-280

Opiod analgesics and antagonists

Experts 4253, 4273, 4283, 4293

Feb. 25 - pages 281-296 1. Peripherally acting analgesics and antipyretics

Pages 297-319 2. Antiinflammatory drugs
Experts 1. 4204, 4218, 4228, 4268
2. 4260, 4265, 4295, 4308
Mar. 1 pages 320-332

Histamine and histamine antagonists

Experts 4279, 4299, 4239, 4249

Mar. 4 pages 333-348 1.Introduction to cardiovascular pharmacology antiarrythmic agents
Pages 349-361 2. Cardiac glycosides and other drugs used to treat heart failure
Experts 1. 4203, 4208, 4213, 4217
2. 4254, 4261, 4270, 4275
Mar. 8 - pages 362-69
pages 393-402

Antianginal agents
Experts 4262, 4278, 4280, 4302
Lipid lowering drugs
Experts 4264, 4313, 4298, 4282

Mar. 11 pages 370-377 Diuretic agents

Pages 378-392 Antihypertensive agents
Experts 1. 4296, 4304, 4312, 4210
2. 4216, 4221, 4227, 4259
Mar. 15 Midterm examination
Mar. 18 pages 420-439 1. Hemostatic, anticoagulant and thrombolytic drugs
Pages 440-448 2. Drugs acting on the respiratory system
Experts 1. 4284, 4290,4301,43072.
2. 4233, 4244, 4257, 4277
Mar. 22 pages 449-458 1. Drugs acting on the GI tract
Pages 459-471 2. Hormones of homeostasis
Experts 1. 4311, 4223, 4231, 4247
2. 3407, 3419, 3423, 3424
Mar. 25 pages 482-495 Principles and mechanisms of antibiotic therapy
pages 496-533 1. Antibacterial antibiotics
Experts 1. 3401,3406, 3410, 3417
2. 3402, 3408, 3413, 3426
Mar. 29 Pages 534-546 1. Antifungal and
2. antiviral agents
Experts 1. 3432, 3429, 3425, 3418
2. 3428, 3430, 3431, 3422
April 1- pages 547 566 Immunotherapy
Experts 3403, 3409, 3412, 3420
Pages 582-607 Aliphatic alcohols and anticaries agents
Experts 4267, 4272, 4286, 4241
April 5 pages 617-622 1. Analgesic use for effective pain control
Pages 634-43
2. Antimicrobial agents in the prevention and treatment of infection
Experts 1. 4287, 4235,
2. 4237, 4243
April 8 pages 644-655 1.Oral complications of cancer therapy
Pages 656-670 2. Drugs of abuse
Experts 1. 4225, 4252, 3404 ,3427
2. 3405, 3411, 3415, 3421
April 12 last day of class REVIEW
Final exam date to be announced
Feb. 25
Mr. J. B. comes for routine prophylaxis - takes coumadin and requests a pain medication after the
treatment. Mr. J.B.s M.D. responds to your consultation request, stating that Mr. J.B.s INR = 2.3 and

that his prosthetic valve is functioning very well and that he will need the standard AHA prophylactic
antibiotic regimen.
March 4
Mr. J.B. comes to the office and he appears to be very short of breath. His physician has just started him
on hydrochlorothiazide, and digoxin.
Several months later Mr. J.B.informs your staff that he has received a heart transplant. He is taking
prednisone and cyclosporin in addition to his other medications.
Mar. 22
Mr. J.B. has referred his wife to you. She has asthma and Type II diabetes. She takes beclomethasone
and albuterol by inhalation and glyburide, metformin and rosiglitazone for her diabetes. Mrs. J.B. has just
been diagnosed with hypertension and dyslipidemia. She is taking nifedipine and lovastatin.
Mrs. J.B.s physician has started her on insulin. She reports that she has been having difficulty sleeping
because she does not like to have to give herself injections. Her physician has started her on Restoril for
sleep and doxepin for depression. She needs to go to the oral surgeon to have an impacted third molar
removed. Is Restoril a controlled substance? If it is - why? The oral surgeon prescribes Vicodin for post
operative discomfort - is there a possibility of a drug interactions?
April 1
Mr. J.B. has started himself on antacids because he thinks that he has an ulcer, he wonders if he should
be taking fluoride tablets to make his teeth stronger.
Jan. 11
Mr. J.Bs physician prescribes the four antibiotic regimen for the treatment of his ulcers. How does this
effect the dental prophylactic antibiotic regimen?
Mar. 8
Mrs. J.B. reports that she is now being treated for angina pectoris. She takes Isordil, Persantine and has
nitroglycerin as well. Her physician told her that she couldnt take a beta blocker because of her asthma.
Can she put the nitroglycerin in the bottle with her other tablets?
Mar. 11
Mr. G.S. is a new patient he reports that he had a minor stroke 3 months ago and his physician
instructed him to get a dental check up. His BP is 160/94 x 3. He is taking hydrochlorothiazide,
Tenormin, Warfarin, Catapres and hydralazine

April 5
Ms. B.J. Smith comes for routine prophylaxis, she has rheumatoid arthritis and takes indomethacin,
hydroxychloroquine, prednisone, methotrexate and has take gold injections in the past. She wants to
know how much acetaminophen is too much?
Feb. 4
Ms. B.J. Smith just had her hip replaced with a prosthetic hip, what considerations are in order for
prophylactic antibiotics? How long are the prophylactic antibiotics generally prescribed? She is nervous
the night before dental treatment, what sedative would be best for her - she has no one to drive her at this
time.
Mar. 29
Ms. P. Jama presents for routine prophylaxis, on E and I you note that her thyroid is enlarged. Her BP is
200/100 and pulse 110. She appears to have a thick white coating on her tongue. Are there any over the
counter medicines that she could use?
Ms. P. Jama reports that her physician has prescribed propranolol and propylthiouracil. Her BP is
137/82 and pulse is 75. What drug interaction can occur with lidocaine?

Feb. 11
Mrs. Zloft reports having bipolar disorder for 35 years, she takes lithium and Prozac. She states that she
is prone to anaphylactic reactions with local anesthetics - if this happened, how would you treat it?
Mar. 25
Ms. J.Cluney is allergic to sulfites, which of the local anesthetics would be acceptable drugs to administer.
She also reports mitral valve prolapse with regurgitation, she is allergic to penicillin (anaphylaxis),
clindamycin and erythromycin. Which antibiotic should she receive? She thinks that she might be
pregnant - are there any contraindications to the antibiotics?
Ms. Cluney thinks that she is allergic to ester anesthetics, which local anesthetic should she receive?
Feb. 8
Mr. P. Knutesen reports that he takes, phenytoin,, and valproate, he needs a routine prophylaxis.
Feb. 1
Mr. Knutesens son has a developmental disability, he takes receives fluphenazine injections every two
weeks, he also takes felbamate and carbamazepine
Feb. 11
Ms. Q. Ti has Parkinsons disease. She takes levodopa and carbidopa, selegiline and amantadine.
April 8
Mr. Dean reports that he has recurrent apthous ulcers, which have been more of a problem since he
started chemotherapy for melanoma about 1 year ago. The doctor thinks he needs prophylactic antibiotic
prior to dental therapy.

Questions for Mr. J.B. who is taking Coumadin, needs a prophy and requests a pain medication after
treatment.
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What is Coumadin?
How does Coumadin work?
What are the indications for Coumadin?
How is Coumadin therapy monitored?
What adverse effects can occur with Coumadin?
Mr. J. B. just started Coumadin yesterday, when will it begin to work?
Mr. J.B.s doctor decided to discontinue the Coumadin, when will Coumadins effects be terminated?
Your instructor requests that you write a MD consultation for Mr. J.B., what information will you
request?
Do any drug interactions occur with Coumadin?
What risks are associated with giving block anesthesia to a patient on Coumadin?
How is heparin different than Coumadin?
Name three different over the counter analgesic medications that Mr. J.B. could take.
Describe how each of these pain medications work.
List several adverse effects associated with these pain medications.
What occurs when an overdose of these medications is given.
Which analgesic would be preferred for Mr. J.B.?
Which anesthetic and vasoconstrictor would you recommend for Mr. J.B.

Questions - Mr. J.B.s MD responds to your consultation letter

1. Why do you think that Mr. J.B. has a prosthetic heart valve?
2. What is a heart murmur?
3. Which heart murmurs are considered to be high risk for endocarditis?
4. What is the rationale for prophylactic antibiotics prior to invasive dental procedures?
5. Which dental procedures are considered to be invasive? (list 10)
6. Which dental procedures are NOT considered to be invasive?
7. Which heart valve abnormalities are considered to be high risk?
8. How does amoxicillin work?
9. How is penicillin different from amoxicillin?
10. What adverse effects are seen with penicillin and amoxicillin?
11. If the patient is allergic to penicillin what antibiotics are contraindicated?
12. How do clarithromyin and azithromycin work?
13. Mr. J.B. says that he is allergic to amoxicillin, clarithromycin, cephalexin and azithromycin, which
antibiotic should he receive?
14. How does clindamycin work?
15. What adverse effects are associated with clindamycin.
16. If Mr. J.B. forgot to take his antibiotic prior to his dental appointment, could you administer it to him
just prior to the procedure?
17. Mr. J.B. wants 5 appointments per week because he is going to Africa for a year. How would you give
the prophylactic antibiotics for his deep scaling and root planing.
18. What patient education is important for Mr. J.B.?
19. Is a chlorhexidine rinse pre-operatively indicated? If chlorhexidine was not available, what
medication could you use (per /AHA)?

Questions Mr. J.B. arrives quite short of breath. His physician has prescribed hydrochlorothiazide and
digoxin for him.
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What is the most likely reason that Mr. J.B. is short of breath.
What other physical sign would you ask Mr. J.B. about?
What kind of a drug is hydrochlorothiazide?
How does it work?
What side effects are associated with this group of medications?
Are there any oral adverse effects unique to these medications?
What other conditions can diuretics be prescribed for?
What is the mechanism of digoxin?
What adverse effects are associated with digoxin?
Does digoxin have a narrow margin of safety?
What are the signs and symptoms of digoxin toxicity?
Patients with hypokalemia are more susceptible to digoxin toxicity, how can this be avoided?
What other conditions is digoxin indicated for?
Mr J.B.s doctor decides to prescribe enalapril. What group of drugs does this drug belong to?
What is the mechanism of action of enalapril?
What adverse effects are associated with enalapril?
What other conditions could enalapril be prescribed for?
What are angiotensin receptor inhibitors? How do they differ from angiotensin converting enzyme
inhibitors?
19. What local anesthetic and vasoconstrictor would you select for Mr. J.B.?

Questions for Mr. J.B. has received a heart transplant and is now taking cyclosporin and prednisone in
addition to his other medications.
1. How does cyclosporin work?
2. What side effects are associated with cyclosporin?
3. Name two other drugs that cause gingival hyperplasia. Is there a difference between the three
hyperplasias? How can the hyperplasia best be treated and prevented.
4. What other conditions is cyclosporin indicated for?
5. What kind of a drug is prednisone?
6. How does prednisone work?
7. What side effects are associated with prednisone? What physical appearance changes are seen in
patients taking prednisone?
8. What other conditions could prednisone be prescribed for?
9. What is adrenal suppression?
10. What are Cushings and Addisons disease?
11. How is an acute adrenal crisis prevented and treated if it should occur?
12. What is the rule of 2s?
13. What prophylactic antibiotic regimen would be indicated for this patieint prior to dental therapy?
14. Is Mr. J.B. more susceptible to infection? Why?
15. How soon after the heart transplant can Mr. J.B. receive scaling and root planing?
Questions for Mrs. J.B. who is taking beclomethasone, and albuterol via inhalation and glucophage,
metformin and rosiglitazone.
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How could you evaluate the likelihood of Mrs. J.B. to have an asthma attack while in the dental
chair?
How could you evaluate the likelihood of Mrs. J.B. to have a hypoglycemic reaction while in the
dental chair?
What role would fear, pain and or anxiety have in the development of such emergencies?

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How does inhaled beclomethasone work?

What group of drugs does albuterol belong to? How do they act?
What adverse effects are associated with beclomethasone and albuterol?
How does Mrs. J.B. monitor her diabetic condition?
Her MD sends you Mrs. J.B.s most recent lab work her HbA1c is >8%, her FPG is greater that
150mg/dl. Is her diabetic condition well controlled?
How does glucophage work? What adverse effects are associated with this group of drugs?
How does metformin work/ What adverse effects are associated with this drug?
How does rosiglitazone work? What adverse effects are associated with this drug?
Mrs. J.B.s physician is considering starting Mrs. J.B. on insulin. What are the different kinds of
insulin that are available?
Is a patient with diabetes more likely to have periodontal disease?
Which local anesthetic and vasoconstrictor would you select for Mrs. J.B.

Mrs. J.B. has just been diagnosed with hypertension and dyslipidemia. She is taking nifedipine and
lovastatin.
1. What is nifedipine? Name two other drugs that belong to this group of drugs but have different
indications
2. What is the mechanism of action of this class of drug?
3. What are the indications for these drugs?
4. What adverse effects occur with these drugs?
5. What are the highest systolic/diastolic blood pressure that you would treat this patient with?
6. Are there any treatment modifications that are indicated because of this patients conditions?
7. What is a dyslipidemia
8. Why are dyslipidemias treated?
9. What is the mechanism of action of the hypolipidemic drugs?
10. What are the indications for the hypolipidemic drugs?
11. What adverse effects are associated with the hypolipidemic drugs?
12. What drug interactions are associated with the hypolipidemic drugs?
Mrs. JB reports that she has been having difficulty sleeping because she does not like to give herself
injections. Her physician has started her on Restoril for sleep and doxepin for depression. She needs to
go to the oral surgeon to have an impacted third molar removed.
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Is Restoril a controlled substance? If it is - why? How many refills can she have? Can she obtain
these refills after 6 months?
The oral surgeon prescribes Vicodin for post operative discomfort- is there a possibility of a drug
interaction?
What group of drug does Restoril belong to?
What is the mechanism of action of these drugs?
What specific advantage do these drugs have over the older drugs?
What adverse effects are associated with these drugs?
What is the duration of action of these drugs?
What group of drugs does doxepin belong to?
What is the mechanism of action of this grup of drugs?
When do these drugs begin to exert their pharmacological effects?
What adverse effects are associated with these drugs?
What specific oral complications are associated with these drugs?
What drug interactions are associated with these drugs?
What are tardive dyskinesias? How might they effect dental therapy?
What is orthostatic hypotension? How is this significant for the dental environment?
What is in Vicodin?
What is the mechanism of action of these drugs? Why are they given together?
Will Mrs. JB be excessively sedated after she takes the Vicodin?

Mr. J.B. has started himself on antacids because he thinks that he has an ulcer, he wonders if he should be
taking fluoride tablets to make his teeth stronger?
1. What are antacids composed of? Name some examples.
2. How do antacids work?
3. What effect will the administration of antacids have on the other drugs that Mr. J>B> is taking?
4. If Mr. J.B>does begin to take sodium fluoride orally, will the antacid effect the absorption of the
fluoride?
5. Give two examples of drugs that bind to antacids.
6. Do antacids tend to cause diarrhea or constipation?
7. Mr. J.B. calls you stating that he thinks that he accidentally took 10 fluoride tablets. What symptoms
would he be experiencing? What could he take to stop the fluoride from being absorbed?
8. What other drugs might be prescribed for the treatment of ulcers?
9. What drug interactions can occur with the H2 antagoinists like cimetidine?

Mr. J.B.s physician prescribes the four antibiotic regimen for the treatment of his ulcers. How does this
effect the dental prophylactic antibiotic regimen?
1. What organism is this antibiotic regimen directed at?
2. How often will this antibiotic regimen be effective?
3. How would we know if the micro-organisms became resistant to these antibiotics?
4. How do aerobic and anaerobic bacteria differ? Which antibiotics are particularly effective against
anaerobic bacteria?
5. Are there other treatment modalities besides the four antibiotic regimen for his ulcers>
6. How will Mr. J.B. know if he is cured?
Mrs. J. B. reports that she is now being treated for angina pectoris. She takes Isordil, Persantine and has
nitroglycerin as well. Her physician told her that she couldnt take a beta blocker because of her asthma.
She wants to know if she can put the nitroglycerin tablets into a bottle with her other tablets?
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Why are beta blockers contraindicated in patients with asthma? Would a pure (100%) beta 1 blocker
be contraindicated as well?
What is the cause of angina pectoris? What are the symptoms of angina pectoris?, What activities or
situations would precipitate an attack of angina pectoris? What is unstable angina?
How do the drugs that treat angina pectoris work? What is the difference between a drug that is taken
for prophylaxis and one that is taken for an acute attack of angina pectoris?
How would you differentiate between an attack of angina pectoris and a myocardial infarction?
What medical/surgical treatments might be performed for a patient with severe angina pectoris?

Mr. G.S. is a new patient, he reports that he had a minor stroke 3 months ago and his physician instructed
him to get a dental check up because he noted halitosis. His BP is 160/94 x 3 He is taking
hydrochlorothiazide, Tenormin, Warfarin, Catapres and Hydralazine.
1. What types of dental services would you be able to provide this patient in the USCSD?
2. What category are each of the drugs listed and what is their mechanism of action?
3. When would you be able to treat him and what would his BP have to be?
4. What types of adverse effects are associated with his medications that would impact on your delivery
of care?
5. What information would you want from his physician? What treatment modifications are indicated?
6. If. Mr. G.S. has great anxiety about dental care - how would you manage this and why?
7. What is the maximum amount of epinephrine that his patient should receive?

Ms. B.J. Smith comes in for routine prophylaxis, she has rheumatoid arthritis and takes indomethacin,
hydroxychloroquin, prednisone and methotrexate. She has received gold injections in the past. She wants
to know how much acetaminophen is too much for her to take.
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How do the drugs that she is taking act? What adverse effects are associated with these drugs?
Does she need prophylactic antibiotics?
What drug interactions are associated with these drugs?
What difference would it make I she had osteoarthritis vs rheumatoid arthritis?
Is there a maximum amount of acetaminophen that she should take?
What would happen to her if she exceeded this amount?
If she was not taking prednisone now but had taken 20mg per day for 3 months last year, would this
be important to know?
What other conditions is methotrexate prescribed for?

Ms. B.J. Smith has just had hip replacement. What considerations are in order for propylactic antibiotics?
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How long are prophylactic antibiotics generally prescribed prior to dental procedures when the patient
has a prosthetic hip?
Is a consultation with her orthopedist indicated?
What micro-organism is most commonly associated with infected prosthetic joints?
What dental procedures do not require prophylactic antibiotics?
Is the antibiotic therapy for hip replacement different than that for prosthetic heart valves?
If Ms. Smith forgets to take the prophylactic antibiotics, how long would you have to wait after
administering the antibiotics chairside?

Mrs. P. Jama presents for routine dental prophylaxis. Upon routine E and I you note that her thyroid
gland is enlarged. Her BP is 200/100 and her pulse is 110. She appears to have a thick white coating on
her tongue. Are there any over the counter medications that she could use?
1. What ocular changes often accompany hyperthyroidism? Are these reversible?
2. Ms. P. Jamas physician prescribes propranolol and propylthiouracil?
3. How do these drugs work in the treatment of hyperthyroidism?
4. Are there any drug interactions of significance for dentistry with these drugs? (e.g. lidocaine)
5. Ms. P. Jama says that her physician has started her on verapamil because she was developing an
arrhythmia. What group of drugs does verapamil belong to?
6. Several months later Ms. P. Jama returns and states that now her thyroid gland has been removed.
What medication would you expect her to be taking now?
7. Could Mrs. P. Jama possibly still become hyperthyroid again?
8. How is a goiter differentiated from hyperthyroidism?
9. Why is iodine given? Could iodine stain teeth?
Mrs. Zloft reports having bipolar disorder for 35 years, she takes lithium and Prozac. She states that she
is prone to experience anaphylactic reactions with local anesthetics - if this happened how would you treat
it?
1. How do lithium and Prozac work?
2. Is lithium effective to treat depression?
3. What adverse effects are associated with these medications.
4. Are there any dental side effects associated with these medications?
5. What symptoms would a patient having an anaphylactic reaction demonstrate?
6. What drugs are most likely to cause anaphylactic reactions?
7. If Mrs. Zlofts allergist provides a letter stating that she is indeed allergic to all local anesthetics what
could you use as an injectable local anesthetic?
8. What is the most likley cause of an adverse event after local anesthetic administration?
9. Mrs. Zloft begins to hyperventilate after you administer the local anesthetic injections. How would
you treat this? Ms. Zloft is complaining that her limbs feel numb and she thinks that she is having
another anaphylactic reaction.

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10. What treatment is contraindicated when a patient hyperventilates?

Ms. J. Cluney is allergic to sulfites. She also reports that she has mitral valve prolapse with regurgitation
and is allergic to penicillin (anaphylaxis), clindamycin, and erythromycin. Suddenly Ms. J. Cluney states
that she thinks that she might be pregnant and she is concerned about the effects of the antibiotic on the
baby.
1. What are the usual signs and symptoms of allergy to sulfites?
2. What is the difference between sulfa drugs and sulfites?
3. Where might a patient be exposed to sulfites?
4. Which of the local anesthetics would be acceptable drugs to administer?
5. What is the drug of choice for prophylactic antibiotics?
6. She thinks that is also allergic to anesthetics like Novocaine - which anesthetics are similar?
Mr. Fortknox takes phenytoin, and valproate. He says his gums bleed profusely when he brushes.
1. What conditions would these drugs be prescribed for?
2. How do these drugs work?
3. What adverse effects are associated with these drugs?
4. What other drugs cause gingival hyperplasia? Is this dose related?
5. Mr. Fortknox states that he has had a seizure in the morning, is this a contra-indication for
treatment?, what kinds of things might predispose Mr. Fortknox to have a seizure.
6. What is an aura? Give some examples.
7. After a patient has had a grand mal seizure, what should you monitor the patient for?
8. After the patient has experienced a grand mal seizure, should you call the paramedics and have the
patient taken to the emergency room?

Mr. Cluneys son has a developmental disability. He receives fluphenazine injections every 2 weeks, he
also take felbamate and carbamazepine.
1. What drug category does fluphenazine belong to?
2. How does it exert its pharmacological effect?
3. What adverse effects are associated with this group of drugs?
4. Is this patient at increased risk for periodontal disease or caries?
5. What are felbamate and carbamazepine indicated for?
6. What is their mechanism of action?
7. what adverse effects are associated with these medications?
8. write a prescription for Jr. Cluney for fluoride.
9. Jr. Cluney says his gums are always very sore after cleanings. He asks you to have the doctor write
him a prescription for Percodan? What schedule is this drug? Why? What would you recommend for
Jr. Cluney?
Ms. Q. Ti has Parkinsons disease. She takes levodopa, carbidopa, selegiline and amantadine.
1.
2.
3.
4.
5.
6.
7.
8.

What area of the brain is affected in parkinsons disease? What are extrapyramidal symptoms?
How do levodopa and carbidopa work? Why are they given together?
What adverse effects are associated with these drugs?
What kind of drug is selegiline? What adverse effects are associated with selegiline?
What kinds of foods and drugs are contraindicated if the patient is taking segeline?
What kind of a drug is Amantadine? What is its proposed mechanism of action?
What side effects are associated with amantadine?
What special considerations for maintenance of oral hygiene would apply to this patient?

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Mr. Dean has recurrent apthous ulcers. He is currently receiving chemotherapy for melanoma.
1. What is the etiology of apthous ulcers? How would you differentiate between apthous ulcer and
herpes?
2. If Mr. Dean had herpes, how could this be treated?
3. Because Mr. Dean is receiving chemotherapy as an outpatient is an MD consult needed prior to dental
hygiene services?
4. Is Mr. Dean at risk for excessive bleeding? Why?
5. Why would Mr. Deans physician suggest prophylactic antibiotic prior to dental procedures?
6. Would the AHA guidelines for proplylactic antibiotic be appropriate for Mr. Dean? Would a static or
cidal drug be preferred?
7. Can Mr. Dean brush and floss as usual?

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