Mixed Narcotic Agonists/Antagonists

These drugs all produce analgesia, but have a lower potential for abuse and do not produce as much respiratory depression.

A. Pentazocine

• Has a combination of opiate analgesic and antagonist activity.
• Orally, it has about the same analgesic potency as codeine.
• In contrast to morphine, cardiac workload tends to increase due to an increase in pulmonary arterial and cerebrovascular pressure. Blood pressure and heart rate both also tend to increase.
• Adverse reactions to Pentazocine

• Nausea, vomiting, dizziness.

• Psychotomimetic effects, such as dysphoria, nightmares and visual hallucinations.

• Constipation is less marked than with morphine.

B. Nalbuphine

• Has both analgesic and antagonist properties.
• Resembles pentazocine pharmacologically.
• Analgesic potency approximately the same as morphine.
• Appears to be less hypotensive than morphine.
• Respiratory depression similar to morphine, but appears to peak-out at higher doses and to reach a ceiling.
• Like morphine, nalbuphine reduces myocardial oxygen demand. May be of value following acute myocardial infarction due to both its analgesic properties and reduced myocardial oxygen demand.
• Most frequent side effect is sedation.

C. Butorphanol

• Has both opiate agonist and antagonist properties.Resembles pentazocine , pharmacologically., 3.5 to 7 times more potent than morphine., Produces respiratory depression, but this effect peaks out with higher doses. The respiratory depression that does occur lasts longer than that seen following morphine administration.
• Butorphanol, like pentazocine, increases pulmonary arterial pressure and possibly the workload on the heart.
• Adverse reactions include sedation, nausea and sweating.

D. Buprenorphine

• A derivative of eto`rphine. Has both agonist and antagonist activity. 20 to 30 times more potent than morphine.Duration of action only slightly longer than morphine, but respiratory depression and miosis persist well after analgesia has disappeared.
• Respiratory depression reaches a ceiling at relatively low doses.
• Approximately 96% of the circulating drug is bound to plasma proteins.
• Side effects are similar to other opiates:
  • sedation, nausea, vomiting,
  • dizziness, sweating and headache.

Patient positioning

The most common medical emergency encountered in the dental office setting is syncope. So patients in the supine or semi-supine position to improve venous return and cerebral blood flow provided that the position is tolerated by the patient and is appropriate for their medical condition.

Nimesulide

analgesic and  antipyretic properties

Nimesulide is a relatively COX-2 selective, non-steroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic properties. Its approved indications are the treatment of acute pain, the symptomatic treatment of osteoarthritis and primary dysmenorrhoea in adolescents and adults above 12 years old.

Banned - not used

Pharmacology is the study of drugs and the way they interact with living systems.  Clinical pharmacology is the study of drugs in humans.

A drug is any chemical that can effect living processes.

Therapeutics: the medical use of drugs.

An ideal drug has several important properties.  Three of these properties are of utmost importance: effectiveness, safety and selectivity. 

Effectiveness: This is the most important quality that a drug can have.  Effectiveness refers to the drug's ability to do what it is supposed to do.

Safety:  Although no drug can be totally safe, proper usage can lessen the risks of adverse effects.

Selectivity:  A truly selective drug would have no side effects, and would effect only the body process' for which it is designed and given.  Therefore, there is no such thing as a selective drug.

Pharmacokinetics: The way the body deals with a drug.  Pharmacokinetics is concerned with the processes of absorption, distribution, metabolism and excretion.

Pharmacodynamics:  What a drug does to the body.

Pharmacokinetics and pharmacodynamics are two of the processes that determine how a person will respond to a drug.  Other factors include how a drug is administered (dose, route, and timing of administration), interactions with other drugs, and individual physiological variables (weight, age, function of body systems).

Drugs Used in Diabetes

Goals of diabetes treatment

lower serum glucose to physiologic range
keep insulin levels in physiologic range
eliminate insulin resistance

best initial step in management: weight loss, contractile-based exercise weight loss is more important for insulin sensitivity than is a low-carb diet

Modalities of diabetes treatment

Type I DM

insulin
low-sugar diet

Type II DM
exercise
diet
insulin

6 classes of drugs 

Insulin
Sulfonylureas -    Glyburide
Meglitinides  - Nateglinide
Biguanides    Metformin    
Glitazones (thiazolidinediones)    Pioglitazone
α-glucosidase inhibitors    Acarbose
GLP-1 mimetics (incretin mimetics)    Exenatide
Amylin analog    Pramlintide

Ampicillin offered a broader spectrum of activity than either of the original penicillins and allowed doctors to treat a broader range of both Gram-positive and Gram-negative infections. Ampicillin is often used in molecular biology as a test for the uptake of genes (e.g., by plasmids) by bacteria (e.g., E. coli)