[Music] so now let's look at um drugs you can use when you can take or your clients can take when in pain so there are drugs that there's two categories there's the nsaids drug and there's the opioid strike the nsaid strengths are known as non-steroidal anti-inflammatory drugs they're basically drugs that you cannot get addicted to hopefully and they're also drugs that you can just take over the counter they're not prescription whereas opioids like these are with prescription you need a prescription to get access to these drugs but nsaids um are the ones that you can find over the counter so let's look at some of the drugs that you can get over the country well the first one we're going to look at is aspirin and this is the also known as silicillic acid and what's interesting about aspirin is that it's a blood thinner it's an anti-platelet um asian which means that it does not crop blood um it is a blood thinner so you don't want to take aspirin if you're taking warfarin because imagine warfarin which is a blood thinner and you combine that with aspen which is another blood thinner you might bleed out right it's not it's not fun so don't take aspirin with the warfarin it is a blood thinner it's also anti-paretic which means it reduces fever it's also analgesic analgesic means it reduces pain relieves pain and it's also anti-inflammatory which means that it reduces inflammation okay so if you have inflammation if you have fever if you have pain this isn't not a bad medication to take now we always think that this is only used for pain aspirin is only used for pain but it could also be used for arthritis it could be also used for cardiovascular disease so heart conditions if your blood if you have heart issues and your blood is not pumping properly you probably would need like a blood thinner to help the um blood pump properly in the heart so aspen sometimes they give you a low dose aspirin to um allow the blood to circulate properly in the heart another drug you can take is ibuprofen and ibuprofen um if you look at the trade names or the brand names it's advil or it's motrin so um this is an antipyretic which means fever reducing reduces fever it's an analgesic which means it reduces pain and it's also anti-inflammatory inflammatory um it reduces inflammation same thing with a naproxen or a leaf same function but here's something interesting acetaminophen acetaminophen which is also known as tylenol has the word no in it you see that it has the word no in it why am i highlighting this because it is not anti-inflammatory so if you go to the dentist with inflammatory pain let's say you have swelling in your gums for example and you're in pain the dentist is not going to recommend tylenol for you instead the dentist will recommend apple apples usually the number one choice for ibuprofen because that is anti-inflammatory whereas tylenol is not anti-inflammatory so if you get like swelling or something it's not gonna help if you take time alone but it will help for fever it's antipyretic it will help for pain because it's analgesic but not for inflammation so think of no as it is not helpful for inflammation it's also not affecting coagulation which means it's also not a blood thinner if you look at opioids which are prescription drugs there are these three ones are the ones you should know codeine this is the one that's commonly prescribed in dentistries like tylenol three strong medication morphine is also very strong and oxycodone is also strong these drugs are needed prescription is needed and the way these drugs work is that they actually bind to three receptors so remember how we were talking about neurotransmitters and how they come when they bind to the brain or they've signed the bacterial receptor the names of the receptors are immune catholic or delta if you buy into any of those what will happen is you will stop feeling pain and also opioids what they're really good at doing is they they just slow down the brain they just slow down the central nervous system they slow down everything in your body so they make you feel tired they make you um they could make you feel drowsy they um make you feel just very relaxed and happy but it's so easy to get addicted to and it's really honestly really bad for you that you need to be mindful so opioids they help with pain they're like a strong strong pain medication but they also depress just the brain and they slow the whole body down [Music] so when you look at what's actually happening when you take a non-opioid drug so when you take like these drugs let's say aspen what's happening is let's say you get cut when you get cut and now there's bacteria entering into your body because you know they'll cut the injured bacteria entered into a body but what happens and i co-operate in a lot more detail in one of my other videos but what actually happens is that we have enzymes called cox enzymes and coccines are when they realize that we're hurt they release prostaglandins which are these yellow dots and when prostaglandins are released what happens is prostate glanding opens up or dilates the blood vessels so it opens up the blood vessel and it allows you can see how the blood vessel is a bit bigger now but it has opened up it has dilated it's expanded here it's a little bit more narrow when that happens all the white blood cells can actually squeeze out so it squeezes out and it eats up the bad bacteria but as the white blood cells are squeezing out look at the the arm that i got sloshed into it expanded it's this swelling there's more breathing there's a lot of pain and when you have swelling there's a lot of pain look at the redness here not much red but here's a significant amount of redness there's a lot of pain so what happens is when you take aspirin for example it blocks the cock's enzyme and when it blocks this the clocks enzyme there's no prostaglandins being released when there's no prostaglandins being released there's no redness no swelling that we won't feel that pain that pain that we feel will not feel that the inflammation will be gone so that's how it works it inhibits prostaglandin synthesis it stops inhibits the yellow dots from being produced so it's uh and when that happens you don't feel the inflammation you don't get the inflammation you don't feel the pain either this is a table that just describes or explains all of it so see how it summarizes everything so one thing to note over here is that they all help with reducing fever they're all antipyretic but are they all anti-inflammatory no right because acetaminophen is not or does not help with reducing inflammation okay um let's do a question which s describes the mechanism of action for solicits what do you think somewhat selects me from the word salicylic acid which is aspirin so which of these best fall or are the best mechanism of options for aspirin [Music] you said b you are correct it is a pain reliever it is fever reducing it helps with inflammation and it's also anti-platelet which means it's like a blood thinner and in case you're interested this means stop digesting and timing stop this means you feel tired aspirin does not make you feel tired and this one is a cough suppression aspirin does not help with cough okay so this is your best answer what about this question what is the drug of choice for inflammatory dental hate is it aspirin is it ibuprofen is it acetaminophen or is it codeine [Music] the answer is ibuprofen or advil studies have shown that advil because it is an anti-inflammatory it does help reducing pain acetaminophen is not anti-inflammatory so it does not help with inflammatory dental pain aspirin it is anti-inflammatory but um it's also a blood thinner and it's just it's just better ibuprofen has shown to have better results and codeine codeine is an opioid drug right which we're gonna reduce until you absolutely need it which medication is crunch contraindicated with aspirin you cannot take with aspirin and yeah it is warfarin that's right because warfarin is a blood thinner remember the word war i think of people bleeding out in a war so warfarin is a blood thinner just like aspen and you don't want to comply combine those two digoxin we talked about it in the previous video and it's um used for heart it's used to dig deeper contractions for the heart your feather pain is a um watching what do you think mythology is this is one that takes remember it ends in pine so it's probably calcium channel blocker yeah so kind of thing that ends in pine is a calcium channel blocker remember california and pine trees remember that and if you know anything about calcium channel blocker um remember the trick here you switch this and it becomes an o so it causes gingival overgrowth right gingival overgrowth or another word for saying gingival overgrowth is gingival hyperplasia and remember when you think of the word hyper hyper means more of so more gums right hyperplasia means more gingival more more gums more gingiva and nitroglycerin this is the one that um we put sub-gingivally and not subjectively sublingually sorry and sublingually and not what that does it helps with chest pain so if you have angina chest pain is nitroglycerin so aspirin and warfarin are contraindicated and when we're looking at opioids one of the worst thing that can happen when someone gets high on opiate is their heart could stop breathing they can stop breathing and that's called respiratory depression so they stop breathing their lungs you know give out and that's the cause of death with overdose that's typically what happens when people go deep respiratory depression now let's say someone is you know having is is really high right now on opioids what can they do what can be done well what can be done is they can give them naltrexone so you can call 911 the medics will come and they'll inject naltrexone and now terexon is an opioid antagonist remember antagonist does the opposite like it doesn't work it just tries to reverse the opioid blocks actually it blocks the effects of opioids rather so hopefully naltrexone will help them with their recovery when you look at the different opioids we look at kodi which is like tidal title number three we have oxycodone which is even more stronger and we have morphine which is even more stronger so these are the drugs and i just highlighted the ones that i think you should know and when you look at these you can see more things really strong compared to coding [Applause] so all our pharmacological actions of opioids except which one [Music] you said excitation you would be correct remember opioids what do they do they just slow everything down in the body right they slow everything down so is it an anal music does it you know help with analgesia yeah pain relieving right it helps with pain it helps slow down it helps with cough so if you don't cough as much and it sedates you puts you tired and it gives you that feeling of happiness intense happiness so it slows your brain down so you're relaxed and feeling good and your pain is um you know gone and your cough is gone and you're sedated you're tired and yet you're so happy and content but it would not excite you because excitation is the opposite right excitation does not go with all the rest so by using process of elimination you can figure out that excitation is not something that opioids will do you will not get excited and energetic when you take opioids [Applause] naloxone or narcan is an example of an it's an example of an opioid antagonist where it blocks the opioids um from working antagonist means it blocks it blocks it it's not a perfect fit when we were looking at the lock and key it didn't go in properly and it just blocks or it doesn't work at all just blocks the opioid effect what happens when we have an infection so when we have an infection typically we take antibiotics and when we take antibiotics sometimes we can get like super infection so super infection is another infection on top of another on top of your initial infection so supra infection is super infection infection occurring after or on top of an earlier infection so let's say i take antibiotics and then after antibiotic i notice i had blush like a white patch all over my mouth that's the second infection that's known as a super infection so when we look at antibiotics or anti-infective agents an antibiotic or anti-infective you think there are bactericidal drugs and bacteriostatic antibiotics cyto comes from the word suicidal so it means to kill so these bacteria sorry these antibiotics kill the bacteria literally kills them where and then we have bacteriostatic where we have these bacteria sorry these antibiotics that slow down the growth of bacteria they're not killing it but they're slowing down the growth of bacteria so the ones that i think are important are this one this one and this one so cephalosporins metro basil and penicillin and the way to remember this is if you think of this is really inappropriate so i do apologize but think of c me p if i if you're seeing me p you can think of c for c m for mean and p for p and that's how you remember the c plus the phallic squares these are bacteriacidal these are the um antibiotics or anti-infective drugs that kill bacteria and e for measuring bedazzle and pe for penicillin okay and then all the other ones like clindamycin and tetracycline those are bacteriostatic they just slow down the growth of bacteria what is interesting to note here is that penicillin is what is prescribed if someone needs pre-med they will be prescribed penicillin but if someone is allergic to penicillin then they could be prescribed clindamycin we will also look at tetracycline which is an important one in dentistry because if someone takes tetracycline what can happen is they can get tetracycline stainings so when you look at this um who can get tetracycline stainless those people that have um that are pregnant and children who are younger than nine years of age because then they can get permanent staining and be stating you know it's permanent you can't really do anything about it unless you get cosmetic work done [Music] okay let's see what's next [Music] so who do we give pre-med to who needs pre-meds well anyone that has a prosthetic cardiac valve so when i think of the word prosthetic i think of something uh made outside man-made something fake so prosthetic is something that was a man-made and inputted into the heart like a vowel that person would need a pre-med in someone who had previous infective endocarditis so they had itis means inflammation they had inflammation in the lining of the heart card carditis carditas come from um heart and endos like a lining around the heart so if they had an infection before on the lining of the heart they would need pre-med and people who were born congenital means they were born with a heart condition and if you look at canadian dental association it actually tells you what type of congenital conditions are included for pre-med and what you do not need pre-med for so if you look at it over here if they had any shunts placed in if they had surgery done during the first six months um and where the prosthetic materials may be man-made right shunts their prosthetic was input into their heart um that can like a prosthetic patch that can allow that can require pre-med or antibiotic prophylaxis and what is the antibiotic that's given well two grams of amoxicillin okay about this one comes from the family of penicillin one hour before um the appointment but if they're allergic to amoxicillin because a lot of people are allergic to penicillin i am um i get hives then they can take clindamycin okay so clendon myosin or azithromycin reproduction is all from the family and again it has to be one hour before your appointment [Music] okay what if you have a viral infection so what if you have like [Music] hsb1 which stands for herpes simplex virus one this is the one that happens a viral infection in your mouth herpes simplex virus2 this is in the general area that's transmitted sexually so if you have lesions and when i say lesions this is like cold sores if you have like lots and lots of cold sores on your lips around the inside you can even get like sores on the inside of your vesicles on the inside of your mouth it could be hsb1 type of viral infection so it you would take an antiviral drug or agent like acid acid clover um there's also uh docosano which is like a breville showing a picture of that but notice how all of them and or most of them end in b-i-r-b-i-r for viral or virus infection okay so anything that ends in b-i-r you can know that that's for a viral infection like herpes simplex one where you get like cold sores and if you've ever had cold sores and you have to use a breatha which is um the costumer paradox the personal probably the better way of saying it the personal or briefer um that is for quote service and this one you can get without prescription all the other ones that end in vir that one you're doing a prescription for let's say you have thrush in your mouth so you have a candy diocese so candy diocese is like thrush in your mouth um it's like a white past that you have and um the treatment for that is nice starting so my styling is a great way to get rid of the candidiasis of the flush and it can become in the form of the losses or the candy or um actually this is that's the one that it shows over here and it has a high sugar content but basically you just like it's like a candy so you just swirl it around your mouth and let's hope to reduce the blush besides nice styling which is good for fungal infection you can have you can use amidazoles and in the dazzles they end in of that there's quattro naswell there's ketoconazole and there's pre-columns all and um they end in azole and how can you remember this what what do you think of when you think of israel think about like um [Applause] a memory trick that could help you so um this is really inappropriate but when i think of aso if i think of it like that i think uh like i think of some like uh forgive me for saying this but and then think of someone who has been you know an a-hole for you uh two words you and they got karma you know bad karma came to them and they got their whole mouth full of crush if you think of it like that um of someone who has thrush in their mouth because they were this to you then maybe you can remember that anything that ends in aso or azo um is for thrush now i want you to keep this in mind because there's another medication that ends in um this as well and i'm going to talk about that so keep that in mind okay because there's another medication that ends in this as well that is not used for thrust and i will show you that when we get to that slide good let's talk about gastrointestinal diseases so let's say i mean how many of us have had heartburn or reflux when we get acid you know shot back into our mouth what do you think would happen if you have heartburn and if you have acid reflux let's say if you have acid reflux and the uh contents get into your your mouth what could happen to your teeth erosion is correct so what can happen is because the content that got back up is very acidic it can erode your teeth not something to be mindful of okay so if someone has gerd which is a gastrointestinal esophageal reflux disease where you know things are coming out this way um there are drugs that they can take that can help so there is something called a histamine two blocking agents and you can see when they end they end in dying okay you see that they end in the word dying and [Music] the way actually the way you actually say this medication is cymeridine so cyanidine doesn't you know but just think of it as dying okay and think about what happens when you're dying when you eat when you eat you could possibly get like an acid reflux so this medication histamine two blocking agents they are there to help you with um reducing or blocking that the acid from coming back up [Music] and then there are something called so that's one medication they can take and sometimes you're gonna you the doctor might prescribe multiple medications to take at once so another medication that could be prescribed is called a proton pump inhibitor and what they do again inhibitor means they block the pump so that acids uh don't um can't come in it reduces the acid because that's what we want you just don't want any acid inside the stomach because when you get acid inside the stomach it can go up so when you look at the ending of the proton pump inhibitors do you see how i was talking about the fungal infection that they end in azole well if it has a p right before it so if it has a pr or p right before it before the remember that that would be a protein pump inhibitor so protein pump inhibitor p for protein pumpkin the puzzle and this is for acid reflux this is for gerd this is for gastroesophageal um reflux disease okay so puzzle and anything that ends in dye they are for um and also antacids so um like tops tums is also another one that you can take when you have an acid reflux so histamine two may end in dying proton pump inhibitors they end in p so parasol like these examples here [Music] and they can also take uh antacids um so like tops anti-emetics when you think of anti-genetics this is for throwing up so to put on timing stopping the vomiting and there are medications that help stop medicate and stop vomiting laxatives are also important um they also fall under the category for the gastro um intestinal tracts [Music] okay let's look at what can happen or what drugs someone can take and where gonna look at brain disorders okay actually let me just check something um i don't have a question before i move on so here's a question which of the following is the best non-narcotics and non-um prescription um or over-the-counter analgesic pain reliever for the management of a dental patient with peptic ulcer disease or gastroesophageal reflux disease or bird which of the following is the best one to take [Music] tricky one the answer is actually a tylenol because tylenol does not aggravate the stomach aspirin and nsaids basically do aggravate the stomach they can you know these medications can cause and can worsen the ulcer that you have and further aggravate the gerd by time the tylenol um itself is the best choice it will not upset the stomach um this one right here channel three this is codeine and coding is an opioid and it's not asking for opioids asking for non-narcotic right so these are all the examples of non-narcotic but nsaids can abstract the stomach so acetomenopain is the one that doesn't upset the stomach so this is your best option okay so let's look at brain disorder so if you have um if you are if you are having hallucinations or if you know of someone that's having hallucinations or disordered thoughts or paranoia or you know if someone is sick with a scissor fannia um these are the type of medications they could be taking now this first generation medication and these are the ones that have lots and lots of side effects second generation medications are the better one they don't have a lot of side effects and notice that they end in a pine not sorry not pine i don't even think of pine because we know that pine is for calcium channel blockers which is for the heart this is a pine and i have an a right before it so apine is the an anti-psychotic agent it helps with hallucinations it helps with people who are schizophrenic it helps with paranoia and so how can you remember this well think of a pine magazine you have one prime magazine a pine magazine and that pine magazine is really good for people who are under uh you know who are hallucinating who are schizophrenic um and that when they look at that just imagine them just relaxing um when they see that they're smoothing pine images through the inclined trees so anything that ends in a pine is for antipsychotic reasons and the drug is for antipsychotic or the drug falls under the antipsychotic category [Music] now when we look at the antipsychotic drugs the way it actually works is let me show you another picture actually but before i show you the other pictures there's if you are depressed okay so if you we're looking at all different brain disorders so if you are not feeling well and you're depressed there are drugs that you can take like ssri selective serotonin reuptake inhibitor smri serotonin norepinephrine reuptake inhibitor and tricyclic antidepressant i'm gonna circle the word serotonin i'm also gonna start um highlight the word norepinephrine okay these make us feel good if we have serotonin in our body we feel good if we have no epinephrine in our body we feel good what happens is when you have when you take this drug which is known as the selective serotonin reuptake inhibitor what it does is when you do serotonin this is all serotonin when they come out of the neuron and they're in the synapse here which is the middle part um it has to bind to a receptor once advanced to a receptor um it will do its job [Music] what happens with this medication is it shuts off it blocks so you can see this these are blockers it blocks the serotonin from going back up because we want the serotonin to stay in this area because when it stays in the synapse when it stays in here we feel so much better we're not depressed so we want serotonin to stay in this area we don't want it to go back up because if it goes back up we're going to feel we're going to have less serotonin and when we have less serotonin we're not going to feel good so for depression what we want is we want serotonin to stay in this area we also like it with norepinephrine um so norepinephrine is also another one that makes us feel good so serotonin and norepinephrine we want it to stay in this area we don't want it to go back up um and you know go away from our from us we wanted to stay in our in our body and nice enough so that we can feel better so these are great drugs for antidepressants and the prozac is a good example of a serotonin of an ssri serotonin or selective serotonin reuptake inhibitor so you need so excellent another antidepressant is bupropion and bupropion is a strong medication also known as well veteran but the only thing is that um it is to dopamine related so it impacts the people dopamine in you and dopamine makes you feel good but it has seizures so people who take this could also get seizures so that's why the side effect is pretty bad with this medication so here's a question for you guys the selective serotonin reuptake inhibitors are used to treat which condition depression major depression migraine headaches seizures or schizophrenia yeah it is for depression that's why if you chose depression if you chose a you are correct because remember serotonin makes you feel good and because it makes you feel good it will get rid of the depression anti-anxiety so what if you're really anxious you're anxious then you can take a drug that's known as a benzodiazepine and benzodiazepine there are like many different drugs that you can take and notice that they either end in z e diazepam so they end in z-e-p-a-n the riser pan so they again end in z-e-p-a-m or alkaline which ends in z-o-l-a-l so zepan or zola which is like xanax this is that how can you remember this boy imagine let's think about this z-e for zebra imagine a uh zebra named pam and this zebra who was named pam is very very calm okay so imagine a calm zebra named pam and so then you can remember anything that ends in zepam diazepam is makes you very calm zolam may you think uh what starts with zero i don't know a zombie a zombie named lamb maybe so a zombie whose name is lam and he was very very calm right so anything that keeps you really calm reduces the anxiety um ends in zapan and zolam horizon okay anti-convulsant so what if you're seizing like crazy and you need a drug the drug that you might be prescribed is benatori and phenotone is um a great drug because it helps stop seizures but it also causes gingival enlargement so we looked at um there are three drugs actually that cause gingival enlargement there is we looked at patheticine and is memory ends in pine so this is a calcium channel blocker so calcium channel blocker which is for the heart it helps with the heart then we have a nepeta pin we also have another one which i'll talk about later on is called cyclosporine and cyclosporine is another drug that causes gingival enlargement remember to see and see you can combine that to make a gingival enlargement more the trick is if you think of the word cycle think of like a bicycle i cannot draw but think of a bicycle and when you think of a bicycle like that when you think of this you can think of that but it causes gingival enlargement the other drug that actually by the way cycles for and this is a drug for when you have a transplant so if you get like a kidney transplant or a lung transplant or whatever transplant cyclosporine is given to you to allow you to accept that transplant and then benator is another drug this is an anti-convulsant this is facetious and the way to remember phenotoid that causes gingival enlargement again this is from student rdh all of these tricks are from student rdh is when you think of ben you might want to think of like you know one of those um i can't even draw but one of those fans that you might have in your room when it's really hot and um you know it spins and when you think of that band so it might sound like fan so when you think of fan you can imagine this right happening and so when you think of that it might automatically make you think oh this is also one of the drugs that cause gingival enlargement so phenotoid nicotine and cyclosporine they cause gingival enlargement and so because we're on the topic of seizures and people who have seizures what do you do when people have seizures well if you can move the plant to the floor um if you can tilt the client's head to one side the reason why it says tilt the patient's head to one side is to prevent any aspiration so like you don't want them to swallow any food or liquid or something that could enter their airway or lungs so and you don't want to cause pneumonia too so um that's why they're saying tilt the patient's head to one side and then anything sharp that's around them just remove them all because you don't want it to get injured you don't want them to get injured all right let's look at asthma and copd so asthma is considered a reversible airway obstruction so when you can't breathe but because um [Music] the reason why there's how to here you have lots of increase in secretions in the lungs and the swelling and the bronchioles [Music] and the reason why someone could get asthma is because well maybe they're allergic maybe they were exercising maybe they're under a lot of stress maybe this pollution and that can also cause asthma so when you have clients with asthma just minimize their stress so that they don't get asthma and remember that they should always bring their proper in with them for the appointment and so signs of asthma is like they could be like you know shortened having shortness of breath and they could be wheezing like crazy so it is reversible it's reversible because the bronchioles are still healthy because if you look at copd which is not reversible it's irreversible they're already damaged right that they have been destroyed the bronchioles have been destroyed but in asthma they're still healthy so that's why it's reversible in asthma because it's still healthy it's irreversible here with copd which is chronic obstructive pulmonary pulmonary disease because that's to look at the bronchioles it's already damaged now for to treat them you could use an mdi which is a metered dose inhaler so you can use an inhaler and um you always want them to bring that with them in the uh dental when you have them with you for an appointment now there are two drugs that we're going to focus on so someone has asthma there's short acting beta 2 agonists and there is long acting data to the agonist so let's look at this first beta 2 beta 2 we use there's beta 1 and there's beta 2. beta 1 is for the heart and the way to remember this there's one part so the one stands for it's um with the heart it's a beta blocker for the heart beta two when you see the number two is referring to the lungs and the lungs you can remember this the two because we have two lungs we have one heart beta one heart two lungs so beta two or the lungs now we have albuterol and albuterol is a medication for asthma and copd and it is short acting what does short acting mean short acting means if you take albuterol you will be you will get over the asthma in a short period of time you'll feel better in a short period of time so our beautiful and short afternoons are provental or ventilated um are ones and again from student rdh what they said was think of vent because it has a little vent in there think of bent from the starbucks venti and you're chugging it down really really fast and you feel so much better as soon as you chuck it down really really fast so in a short period of time you feel so much better because you chugged it down really fast um when you think of pro vent student rdh was saying you know you're you're venting really really um you're pro adventuring you're you're venting really really fast so that you feel better right away so it's short acting is fast active it you feel better it's almost you feel so much better right away so albuterol you take this drug if you take this inhaler if you take this puffer you will feel a lot better right away it's actually the um the first line of treatment for someone who has these um the asthma attack long acting is um salmeterol or servant and sauna again from student rdh think of some salmon diet so people who are on the salmon mediterranean diet they live for a long period of time so that's how you can remember it long acting because salmon diet means you live for a very long period of time um and so when you think of long acting what does that mean well that means that it takes a long time for [Music] it to start working [Applause] the reason for that is because it gets absorbed very slowly once you administer it and also another thing to note that is the the good thing about this long-acting beta-2 agonist is that um they stay in your they stay in your body for a long period of time and they release really slowly as when they're inside your body so it's long-acting because it's takes a long time for it to kick in because it's slowly absorbed but once it's in you get like it releases its effects slowly over time so the active ingredients are released slowly [Music] you can also take corticosteroids for asthma so from people who have asthma they may be also represcribed on corticosteroids for a long period of time and cortisol stairs don't necessarily help with the um if you have an asthma attack it doesn't help with the attack the asthma attack but it helps you recover so it's good for recovery and it decreases the chance of you dying okay so it's like um it's used in conjunction with the long-acting beta-2 agony so they take this and corticosteroids if they you know have asthma [Music] and it's for people who have mild moderate or even severe as well now when you take this puffer with corticosteroids like um these corticosteroids that are lifted here which are chosen um you can get thrush so a good way to get rid of that is encourage them as soon as they take this thread make sure they rinse with water to avoid the candy diocese to avoid the thrush what is the first line of defense for an intermittent as much as someone has an asthma attack and they want to recover right away what is the best thing you can give them what's the first line of defense what's the first thing you give them short acting it's d short acting because you want them to recover right away you want something that was quickly um work and so short after means in a short period of time they will recover they will get better [Music] oral adverse effects of chronic use of inhaled corticosteroids include [Music] [Applause] it includes candidiasis okay so this can happen so as we talked about when someone is um using corticosteroids a lot they can get thrush they can get candidiasis and so it's really important that they rinse with water every time they inhale corticosteroids every time they take that puffer because it can prevent them from getting flushed after stomatitis this is like pankosaurus for pedic lesions these are like cold sores and xerostomia means drying out okay local anesthesia so when you're looking at local anesthesia these these are drugs that help you numb your mouth and numb your teeth and it does and so there are two types there's esters and amines and the biggest difference between the two is that esters have actually if you look at all of them they all end in cane right you see that they all end in cane but when you look at amides mite has an i in there in there in that word right amon has an eye and so do all the um amy's listed below they all have an eye before the king light okay has an eye right the pivot cane has an eye all of them have an eye before the cane but when you look at esters i don't see any eyes before the cane right benzo no eye cocaine no i prokane no i tetracaine no eyes so esters are you know have no eye and they're actually broken down in the blood whereas amy's they have an eye and they're broken down or metabolized in the liver [Music] let's look at this question all of these low prosthetic asians are amongst except for which one [Music] cocaine procaine is an ester because there is no eye before the came this one is um the prophet cain is an amide because we see the eye before the cane and the perfect king is an ink amide because we see an eye before the king lidocaine is an amy because we see an eye before the cane and fly looking is an amar because we see the eye before the king but procaine doesn't have an eye hence it's an ester if you look here an ester procaine so things to keep in mind is when we're looking at cardiac patients or people with heart issues when we're giving them epinephrine so sometimes with local anesthetic we add epinephrine like a look of lidocaine with epinephrine and i'll tell you why in a bit but if you have a cardiac patient you do not want to give too much epinephrine just 0.04 as your as your maximum okay no more than 0.04 because for a healthy patient we can give up to 0.2 people who don't have um heart issues so cardiac patients therapies therefore other things to consider epinephrine we don't give to people who have uncontrolled diabetes they're not managing their diabetes or if someone is on to a cyclic anti-depressant but the key thing to remember here is cardiac patients 0.04 milligram is your max dose of epinephrine so these are many different types of local anesthetic light we're going to talk about the three main ones that i want you guys to know lidocaine is the one that is the safest safe to use in pregnancy and if most of the time when we give lidocaine we might give them with epinephrine epinephrine is a basal constrictor so if you look at this next slide when you give a local anesthetic with epinephrine what it does is it constricts your blood vessels so the blood vessel gets smaller right from big it gets small and when that happens that's good because epinephrine allows his basal constriction so that the local anesthetic won't get easily flushed up like we see here when we have epinephrine when it gets vasoconstricted the local anesthetic will stay in that area for a longer period of time so you'll stay numb for a longer period of time it will get flushed out that fast so when you have epinephrine when you add epinephrine you stay numb for longer if you don't add epinephrine into the lidocaine then we say it's nitrogen plain lidocaine plain means no epinephrine was added no vasoconstriction is added mcpivocaine can have a vasoconstrictor but it's not epinephrine as you see [Music] it has level norediferin and that's a that's used from a perfect cane um if it doesn't have the vasoconstriction then the same republican plane and it's used for short dental procedures so it's not you won't stay home for a long period of time for pippa cane however it takes a long time for it to kick in so it's a slow onset but it can be used for long dental procedures in fact you can keep your numb for seven hours if you needed to do a very long dental procedure the flip okay would be your local anesthetic of choice because it can keep you numb for seven hours ideally though most people like to use lidocaine [Applause] all right let's look at nitrous oxide so nitrous oxide is also known as laughing gas um i know my kids get nitrous oxide when they have their dental weapon but just keep in mind that people who cannot get nitrous oxide or breathing that laughing yet are people who have respiratory issues so people who have copd people who have stuffed nose people who are pregnant especially within the first trimester of pregnancy and even people with bowel obstructions um interesting to note is that if you're a dental professional who are working around nitrous oxide there have been studies that show that you could even have miscarriages or get abortion um have spontaneous abortions or miscarriages and you could your child could even have genetic effects so there's a way to monitor how much nitrous oxide you're around nitrous oxide is a strong anaesthetic agent true or false [Music] the answer is false it's not strong it's weak um if it was strong it would put you to sleep nitrous oxide does not put you to sleep nitrous oxide just calms you down it does not put you to sleep in fact um the next question actually tells you what nitrous oxide does so all of the following are characteristics of nitrous oxide except [Music] except this one it does not slow down your heart and you don't like not monitoring your heartbeat when we're doing nitrous oxide but it is a weak and aesthetic because it doesn't put you to sleep it is a strong analgesic it's a good pain um management it's a good you know joy for pain management it has strong amnesia you actually do forget there is a little loss of memory so when kids take it you know a procedure could be half an hour long but they might think it was just only two minutes long so they you know the loss of memory part is there with nitrous oxide but it does not slow down your heart rate okay so this is an exception okay we're almost done three more slides and then we're done with pharmacology so we were looking at the cyclosporine before and we said the cyclosporine causes gingival enlargement and think of this as cyclo cycle for if you think of a bicycle the cycle we might we might be thinking of an o and then we think of an o think of gingival enlargement the reason why someone would take this drug is because if they get a transplant if they get a transplant um they would need this drug to trick their body to accept that transplant otherwise without this drug the body will reject the transplant so you need this type of drug an immunosuppressant drug so that you do not reject that organ that you just got transplanted in you biphosphonate drugs so um there are cancer patients who um may be in pain and they may be taking a biophosphate drug and this drug is this actually let's retract a little bit this is a drug that is used um to prevent the bone from getting weak so it's used for osteoporosis and any other similar diseases also people with cancer can also take destructivity soon to slow down the tumor development the only downside is sometimes you can get osteonecrosis of your jaw so sometimes um after like you do a dental procedure you might see that the jawbone is starting to you know deteriorate starting to die and that is a downside with biophosphate drugs so it does impact the bone lastly we're going to look at diabetes so we have two types of diabetes type 1 are people who cannot make any insulin and insulin is really important because it insulin is a hormone that regulates blood sugar it basically is keeps blood sugar levels within the desired range and if you don't have insulin if you can't make your butters and make insulin then you're going to have to inject insulin so that you can control the sugar level in your body so that's type 1 diabetes where you have to inject the insulin type 2 diabetes it means that you have insulin but the insulin um is not working properly or your body cannot make enough insulin so you need a little bit more insulin so that you might need medication so metformin or fortinet is a great one for diabetes the common one commonly uh used drug for diabetes and if you look at metformin and fordhammer they have the same letters kind of within each term so that's not within each word that's how you can remember they kind of go hand in hand for them that is the trade name metformin because this lowercase is the generic name so here's a question which of the following diagnostic tests measure glycemic control over time so measure glycemic is like when i think of glycemic think of glucose [Music] it's the hb a1c so hba1c is a test that individuals with diabetes go for every two to six months they have to go for blood work and they measure they measure the hba1c level and if it is seven percent or lower we um that's good okay that means it's good we're happy but if it's higher than seven percent then that is not stable it is not good so anytime you're doing debridement with someone who has diabetes ask them for the hba1c level because if it is less than seven percent that's good but if it is higher than seven percent um then we may not want to see them because they are it's uncontrolled and we only want to see um individuals that are controlled so they don't have a medical emergency what they do over here with the hba1c test is they come up with an average number of what the blood glucose um allows you to test measures the percentage of hemoglobin in the red blood cell that is stuck onto glucose and it kind of it's to make put it very simply what it does it measures your recent average blood sugar or glucose level and because it's an average measurement you don't really need to fast on that day so if you're diabetic you don't really fast when you go for that blood work and it just kind of measures the average um glucose or hba1c level so seven percent or lower is great all right that's all um again i have many many videos on pharmacology found in my playlist so if you find that there are some sections here that didn't stick feel free to refer to my other videos thank you guys