NEW YORK CITY COLLEGE OF TECHNOLOGY City University of New York Dental Hygiene Professor, Marilyn Cortell, RDH, MS, FAADH

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1 NEW YORK CITY COLLEGE OF TECHNOLOGY City University of New York Dental Hygiene Professor, Marilyn Cortell, RDH, MS, FAADH Office Hours Pharmacology DEN 2315 Credits 2 TBA, I am available outside of office hours, Feel free to contact me. Prerequisites BIO 2312/BY 301.2, BIO 3302/BY 302 Corequisites DEN 2300/DH 300, DEN 2311/DH311 Required Text Drug Information Handbook for Dentistry, 18th edition, Wynn et al Weekly Learning Objectives and modules downloaded from Blackboard Oral Pharmacology for the Dental Hygienist, Mea Weinberg, Library Reserve COURSE GOALS: DEN 315 will introduce the dental hygiene student to the principles and fundamentals of pharmacology as they apply to dentistry. COURSE DESCRIPTION: DEN 315 is a lecture course designed to provide the dental hygiene student with a clear, and concise introduction to pharmacology. Course content is organized in a modular format by body systems and pharmacologic/therapeutic categories. The clear focus is on the pharmacodynamics and therapy s including drug properties, indications for use, mechanism of action, adverse effects interactions and contraindications. Emphasis is placed on the pharmacological principles of drugs most familiar to the dental environment. This course is continuously being updated based on current, relevant and evidence based subject material. Specific Course Learning Objectives and Outcomes for most modules are found on the front page of your module. Should the presentation be a powerpoint the specific module will be listed in BB under Course Documents and entitled: Course Learning Objectives and Outcomes ACADEMIC INTEGRITY: Students and all others whose work utilize information, ideas, texts, images, and other intellectual property owe both their audience and sources accuracy and honesty in using, crediting, and citing. As a community of intellectual and professional workers, the College recognizes its responsibility for providing instruction in information literacy and academic integrity offering models of good practice while responding vigilantly and appropriately to infractions of academic integrity. Accordingly, academic dishonesty is prohibited in The City University of New York and at New York City College of Technology and is punishable by penalties, including failing grades, suspension, and expulsion. I will issue a zero upon suspecting or identifying cheating or plagiarism and reserve the right to fail a student for the course or reduce their final grade by up to 10 points. As college students you are well aware of behaviors that will result in disciplinary action. Refrain from even thinking about jeopardizing your own integrity. 1

2 ATTENDANCE: To prove attendance, all students are: RESPONSIBLE FOR SIGNING THE DAILY ATTENDANCE SHEET Should it be noted that a student has signed for another student not attending class both students will drop a letter grade during the final grade calculations. LATE ARRIVALS and ABSENCES The college has a specific late arrival and attendance policy in that you are allowed 3 late arrivals and 3 absences per semester in a class that meets one time per week. When you are not in class and have not notified the instructor it is considered an unexcused absence. See penalty below: Timely Arrival Points off Final Grade 3 late arrivals 1/3 off the final grade B+ to B Attendance Points off Final Grade 3 absences 1/3 off the final grade B+ to B Beyond the 4 th absence or when a student s unexcused class absences exceed the limit established by the college and discussions have taken place with me, the college policy of Withdrawal Unofficially may be assigned. Should you withdrawal officially from the course, he/she will be assigned a grade in accordance with the existing withdrawal policy of the College. Between Late arrival to class and/or absences your grade has the potential to drop 2/3 of a grade from B+ - B- READING ASSIGNMENTS: A reading assignment for each class has been established and is found in the Course Schedule available on-line. Reading assignments and answering Course Objectives and Learning Outcomes in the form of Study Guide Questions prior to class is IMPERATIVE. Should a topic or segment be unclear when you arrive home and begin studying please see or me. Although independent, each module builds on the other and a lack of understanding in one will be detrimental in applying information to many others. Also, this lack of understanding will make it difficult for you to transfer lecture knowledge to clinical patient application. EXAMINATIONS: Four exams (note dates in Course Schedule) will be given during the semester within the first hour of class time. A final exam will be conducted during final exam week and may be replaced by oral presentations or case study project at the discretion of the professor GRADING POLICY Exam # 1 20% Exam # 2 20% Exam # 3 20% Exam # 4 20% Written Assignment Oral Case Presentation 20% MAKE UP POLICY: 2

3 You will not be able to make up any missed exam. Should you have an acceptable excuse the remaining exams will be weighed accordingly. Missing a final exam will be handled according to NYCCT policy. Student Learning Objectives: The competent dental hygienist will: 1. Understand, assimilate and communicate basic pharmacological principles of drugs including their actions, interactions and affect on body systems. Discipline Knowledge, Discipline Skill Gen Ed: Learning Goal A1, Possess knowledge of drug groups most commonly found in dentistry along with conditions, diseases and drugs affecting dental treatment. The student will apply didactic knowledge in a clinical setting. Discipline Knowledge, Discipline Skill Gen Ed: Learning Goal A1, # 1, 4 3. Utilize critical thinking and problem solving skills when evaluating individual patient drug therapy in order to provide appropriate treatment to a diverse patient population. Discipline Integration, Values Ethics and Relationships Gen Ed: Learning Goal III, # 3 Introductory level 4. Obtain information and demonstrate resourcefulness relative to current pharmacotherapeutics from a variety of available sources utilizing and recognizing all information as evidence based. Discipline Knowledge, Discipline Skill Gen Ed: Learning Goal III, # 5, Intermediate level 5. Perform a complete medical assessment to develop strategies for improving patients total quality of life with regard to drug dosage, interaction and utilization of local anesthesia. Discipline Knowledge, Discipline Skills, Discipline Integration Gen Ed: Learning Goal A2, # 1 6. Develop an group oral presentation and written one to two page document that focuses on the pharmacodynamics and pharmacotherapeutics of drugs. The presentation will include, although not limited to, individual patient case studies, specific oral, systemic diseases and conditions the practicing dental hygienist may encounter. Discipline Knowledge, Discipline Skills, Discipline Integration Gen Ed: Learning Goal A1 # 2, 4 7. Understand that skills taught in pharmacology are foundational and emphasis is placed on Life Long Learning as drugs and their applications continually change. Discipline Knowledge, Discipline Skills, Discipline Integration Gen Ed: Learning Goal A1 # 2, 4 3

4 At the completion of each module you will be able to: Module One Course Objectives and Learning Outcomes, Introduction, Science and Study of Drugs 1. Define the terms Drug and Pharmacology 2. State the importance of the RDH in understanding the basics of pharmacology 3. Evaluate and assess specific components of the medical history 4. State the branches of pharmacology and their specific function 5. Know what sources drugs are derived from 6. Discuss topics found in a drug monograph 7. Explain the names provided to drugs during the development and marketing process 8. Explain the reason for recent exceptions to the 17 yr. Federal Patent Law 9. What is meant by TALL-MAN Letters 10. Explain the Phases that constitute the Drug Approval Process 11. Discuss criteria for drug substitution with a generic drug 12. Understand substances that may be therapeutic but not regulated or approved by any gov. agency 13. Discuss the Schedules of Controlled Substance Act of 1970 and distinguish one from the other Module Two Drug Actions and Interactions 1. Define drug potency, efficacy, interaction, agonist, antagonist, prototype drug, & MED 2. Explain what is meant by Mechanism of Action 3. Mathematically determine drug ½ life. Ex. A patient is taking a drug that has a half-life of 6 hours. In how many days will this drug be approximately 97% eliminated from the body? What is the trace percentage amount remaining? 4. Explain cellular changes that occur when a drug attaches/binds to a receptor site. 5. Explain the Lock and Key mechanism of drug binding 6. List routes of drug administration that are likely to be used in dentistry 7. Breakdown the Pharmacokinetic steps a drug passes through after entrance into the body 8. Describe the methods of transport that drugs use to elicit a pharmacologic effect. 9. Explain, in detail, the plasma distribution of a drug as it relates to bound vs. unbound drug. In which state is the drug therapeutically active & in which state is the drug likely to produce an adverse effect 10. State primary route of drug metabolism and excretion 11. Discuss drug dosage as it relates to impaired body function 12. Explain what happens when a drug interaction takes place? 13. Discuss the Blood Brain Barrier? Module Three Adverse Reactions 1. Define adverse drug reactions 2. Differentiate between therapeutic and adverse effects and allergic responses to a drug 3. Describe in simple terms what is meant by a drug interaction 4. Identify categories required by the FDA in drug monograph listing adverse drug effects 5. Define a teratogenic effect 6. Briefly describe the differences between pregnancy categories ABCD & X 7. Know which drug reaction is NOT dose related 4

5 Module Four Prescription Writing 1. List the information required in a prescription 2. Know the equivalency s such as One gram = how many milligrams? 3. Know when a child weights 60 pounds how many kilograms does the child weigh 4. Identify abbreviations commonly used in prescription writing 5. Write a prescription for premedication using the anti-infective drug amoxicillin Module Five Autonomic Nervous System 1. Discuss the Autonomic Nervous System 2. State should the dental hygienist be familiar with ANS drugs? 3. List the effects of drugs that stimulate the sympathetic division on the following. Heart rate, blood vessels, bronchioles, GI tract, pupil of the eye, saliva 4. List the effects of drugs that block the sympathetic division on the following. Heart rate, blood vessels, bronchioles, GI tract, pupil of the eye, saliva 5. List the effects of drugs that stimulate the parasympathetic division on the following. Heart rate, blood vessels, bronchioles, GI tract, pupil of the eye, saliva 6. List the effects of drugs that block the parasympathetic division on the following. Heart rate, blood vessels, bronchioles, GI tract, pupil of the eye, saliva 7. Compare the similarities between the Sympathetic Nervous System with those of drugs that block (antagonists) the parasympathetic nervous system 8. List the chemical transmitters of the two divisions. 9. Name the enzyme that terminates the action of the neurotransmitters, Acetylcholine, norepinephrine and epinephrine. 10. State what physiological responses will be present when Acetylcholine is terminated 11. Understand a Nerve Action Potential 12. Identify the location of the nicotinic, muscarinic, alpha and beta receptors. 13. Identify a cholinergic drug occasionally used in dentistry stating reason for use. 14. Identify occasions when Anticholinergic drugs are used in dentistry and medicine. 15. List the two pharmacological effects of epinephrine 16. Discuss the MOA of a beta adrenergic blocking agent as it relates to heart disease and name two drugs Module Six Non Narcotic/NonOpiod Analgesic: 1. Contrast the 2 classification of Oral Pain providing examples 2. For what type of dental pain would a nonnarcotic analgesics be used 3. Name two groups that subdivide the analgesics and discuss site of action. 4. Explain the mechanism of action (MOA) of aspirin 5. Name the four Pharmacologic Effects of Aspirin 6. Define the effects of aspirin on GI tract 8. List drugs that may have an interaction with aspirin 9. Identify systemic conditions in which aspirin is contraindicated 10. Know the accepted stroke prevention dosage of aspirin for prevention of the above condition 11. Compare & contrast aspirin and acetaminophen 12. Overdose of acetaminophen can result in damage to what organ 13. State the drug used for an overdose of acetaminophen 14. Name and explain the syndrome associated with aspirin and flu symptoms and chicken pox 15. Know the analgesic drug of choice for children 16. Understand what is meant by Codeine # 2, 3, and Discuss three distinct pharmacological effects of NSAIDs 18. Explain the MOA of NSAID s 19. Know the dental use of ibuprofen is for the management of 5

6 20. Dose of ibuprofen to treat mild dental pain include max dose/day 21. List three adverse effects of ibuprofen 22. State 4 drug interactions with use of ibuprofen 23. Explain what is meant by Cox I and COX II inhibitors 24. Prototype NSAID is Module Seven Narcotic/Opiod Analgesics 1. State 3 conditions that may contraindicate prescribing a narcotic for post dental treatment 2. Explain when a DEA number is necessary 3. State the classification of narcotic drugs 4. Describe adverse reactions to narcotics 5. Know what gastrointestinal adverse effect is experienced by more than 10% of patients 6. State the prototype narcotic drug 7. Discuss the pharmacokinetics of opiods 8. Name opiod receptors stating where they are found. 9. Know what narcotic is commonly used in dentistry for mild pain 10. Explain what is meant by Tylenol #, 2, 3, 4 relative to their ingredients 11. Name two popular brand name drugs used for moderate to severe pain 12. Determine adult dose of hydrocodone w acetaminophen for dental pain using evidence based resource 13. Name narcotic antagonists and explain their mechanism of action 14. Name two brand names for oxycodone/oxycontin with acetaminophen 15. List drugs and supplements that may interact with narcotic analgesics 16. State four (4) Pharmacologic Effects of Narcotics 17. What is the most common symptom of a narcotic overdose 18. List both illegal and legal drugs known to be addictive 19. Know what clinical findings the dental hygienist may observe to implicate addiction Module 8 Antiinfective Agents & TB 1. Define the following terms: bactericidal, bacteriostatic, superinfection, drug resistance 2. Discuss the concern for prescribing antibiotics unnecessarily 3. Discuss the pharmacologic categories of antibiotics and list examples under each 4. List and know bactericidal and bacteriostatic antiinfective drugs 5. Distinguish between narrow spectrum and broad-spectrum antibiotics 6. Name the drug of choice for treating oral infections 7. Identify adverse reactions associated with many antiinfectives 8. Recognize oral manifestations that may be present when a patient is taking an antibiotic 9. List common drug interactions with antibiotics; explain why 10. Describe penicillin induced allergic reactions and name the most dangerous 11. State the dental procedures possessing the highest risk for acquiring Bacterial Endocarditis 12. State medical conditions with the highest risk for Joint Infection 13. State the routine prophylactic regimens for administering antibiotic prophylaxis 14. Identify alternative drugs used when a patients is allergic to penicillin 15. Understand what distinguishes tetracycline from other antibiotics 16. Describe three possible adverse effects with the use of tetracyclines 17. Name 2 substances that interact with tetracycline 18. Name a topical antibiotic, state the condition for which it is used 19. Name 3 agents commonly used to treat TB 6

7 20. State the TB protocol for patients with positive skin test, negative chest X-ray, no clinical symptoms 21. State a potentially serious adverse effect with the use of Clindamycin 22. Know the antibiotic most often used to treat sinus infections Module 9 A Antiviral Drugs 1. What distinguishes the cell wall of a virus from cell wall of a bacteria? 2. Recognize what oral areas most viral infections are noted 3. State the Mechanism of Action (MOA) of antiviral drugs 4. State the most common oral infections and what is the likely cause 5. List 2 antiviral Rx drugs and 2 OTC drugs in treatment of oral viral conditions 6. State the drug most commonly prescribed for herpes labialis 7. Describe the similarity of chicken pox and herpes simplex infections 8. Identify what non-viral oral lesion is commonly mistaken for a viral lesion 9. State the agents used for treating non viral oral lesions Module 9 B Anti-Fungal Drugs 1. Explain a fungus and list the 3 groups of mycosis indicating the most relevant in dentistry 2. List conditions that contribute to the emergence of oral fungal infections 3. Explain the MOA of antifungal drugs 4. List the most common fungal infection observed in a dental setting 5. Conditions commonly associated with fungal infections 6. List 4 antifungal agents used in dentistry to treat oral candidiasis 7. Discuss the drug used in the Swish and Swallow protocol and what condition it is associated with 8. Troches are dissolvable lozengers of what drug 9. Discuss why a yeast infection can develop after the use of an antibiotic? Module 10 Antipsychotic Agents 1. Describe the etiology of schizophrenia 2. Identify the protype phenothiazine drug used to treat psychoses 3. List three new atypical antipsychotics 4. State the common oral side effect of antipsychotic drugs 5. State significant drug interactions with the antipsychotic family of drugs 6. Identify the prototype atypical antipsychotic agent and discuss the MOA 7. Compare extrapyramidal symptoms with tardive dyskinesia. Module 11 Antidepressant Drugs 1. Explain in detail the 3 types of depression including clinical symptoms 2. State the pathophysiology for the development of depression 3. List 5 major classifications of antidepressants and state the MOA of each 4. List 5 drugs under each pharmacologic category 5. List number one drug interactions for each of the categories 6. Compare Prozac with Elavil. Use both the generic and brand name in your comparison 7. Name the Pharmacologic Category and state adverse effects greater than 10%: of the following significant drugs: Effexor, Elavil, Prozac, Paxil, Zoloft 7

8 8. Explain the MOA of neurotransmitters relating to SSRIs & Monoamineoxydase inhibitors 9. State the recent boxed warning with the use of SSRI s 10. Name 2 food sources connected to interference with the metabolism of SSR s & MAOI s 11. Explain the smoking cessation protocol for ZYBAN 12. Define what is meant by the Gold Standard for treatment of Bipolar Disorder 13. Discuss the MOA of this drug 14. Elaborate on drugs often used in combination with Lithium 15. State category of drugs known to interact with Lithium Module 12 Anti-anxiety Drugs 1. Discuss four types of anxiety 2. Recognize the class of drugs used both as an antianxiety and a sedative 3. Name the four classes of drugs used to treat anxiety 4. Contrast a sedative and hypnotic 5. Name the prototype Benzodiazepine and the dental application of this drug 6. Explain the dental use of an anti-anxiety medication 7. Describe the MOA of the benzodiazepines 8. Discuss adverse effects of the benzodiazepine family of drugs 9. Explains the potentially dangerous drug interaction in the Benzodiazepine family 10. Describe the interaction between valproic acid and diazepam 11. List 5 CNS effects caused by alprazolam with an incidence > List two cardiovascular effects with an incidence >10% 13. Discuss dental use of muscle relaxant drugs and a common adverse effect 14. Be familiar with Local Anesthetic agents used during various dental procedures. 15. Name two local anesthetic drugs and indicate how they are administered Module 13 Anti-Epileptic Drugs 1. Define epilepsy and the deficient neurotransmitter 2. List the two broad groups of epilepsies 3. Compare and contrast the different seizure types within each group 4. Describe use of carbamazepine (Tegretol) and phenytoin (Dilantin) 5. Name the drug likely to induce gingival hyperplasia and what might the dental hygienist do to enhance oral health for the patient on anticonvulsant drug therapy 6. List benzodiazepines used for the treatment of epilepsy 7. List non seizure use of anticonvulsants Module 14 Central Nervous System Stimulants (Amphetamines) 1. State the therapeutic category of Ritalin 2. Identify and discuss conditions a Central Nervous Stimulant (CNS) can be used 3. Explain the phenomenon making CNS stimulants effective in the treatment of ADHD & ADD 4. State adverse dental effects CNS stimulant drugs 5. Understand Oppositional Defiance Disorder and drugs used in treatment Modules 15 Local and Nitrous Oxide Anesthesia 1. Differentiate between local and general anesthetics 2. Discuss the relevance of ph and pk A as it applies to the chemistry of a local anesthetic 3. List the two major chemical groups that classify local anesthetics 4. List the composition of a LA and what role each ingredient plays 8

9 5. Discuss the mechanism by which local anesthetic blocks pain 6. Explain why local anesthetics loose effectiveness in inflamed tissue 7. Distinguish between esters and amides as they are metabolized 8. List toxic affects of local anesthetics on the CNS and CVS 9. Compare & contrast Lidocaine, Mepivicaine, Bupivicaine 10. Name and compare two vasoconstrictors used in dentistry 11. State the current use of esters and list two 12. Discuss the Maximum Safe Dose for both healthy and cardiac patients 13. Name the antagonist drug used to accelerate the return of intraoral & perioral anesthesia 14. Discuss 2 dental injection techniques & include the nerve division & area in the oral cavity they anesthetizes Module 16 Nitrous Oxide Sedation 1. Discuss Nitrous Oxide and its application in dentistry 2. Define a scavenger system stating why it is used 3. Explain the cause of diffusion hypoxia and how to prevent it 4. Discuss contraindications to the use of nitrous oxide 5. Describe signs & symptoms of over sedation with N 2 O 2 Module 17 Cardio-Vascular Disease 1. List 5 situations in which the patient s medical doctor should be contacted 2. Distinguish between the various types of Angina 3. Identify the symptoms of Angina Pectoris 4. Name four agents used to treat Angina Pectoris 5. Explain the MOA for the nitrates class of drugs 6. State the categories of Anticoagulation Therapy 7. Discuss the MOA of each anticoagulant category and state one drug in each 8. State the MOA of Calcium Channel Blockers 9. Discuss the therapeutic drug categories that can elicit gingival hyperplasia 10. List 4 drugs under the CCB category 11. List drugs categories included in the Big 5 Drug Categories 12. State the mechanism of action and name the prototype drug under each 13. Discuss briefly the type of hypertension we will most likely see in a dental setting 14. Define the Mechanism of Action of ACE inhibitors 15. Name 4 drugs under this category 16. Identify the number one adverse effect of ACE inhibitors 17. State the mechanism of action of the alpha and beta blockers 18. Identify drug interactions with beta blockers 19. State the signs and symptoms of Digitalis toxicity 20. Discuss Raynaud s Phenomenon and what drug is it associated with 21. Discuss Hypercholesterolemia 22. State what drug category is used to treat arrhythmias and name 2 drugs Module 18 Diabetes/Endocrine/Thyroid 1. Contrast Type I Diabetes with Type II 2. State the number 1 adverse effect of insulin 3. Distinguish biguanides from sulfonylureas 4. Name the prototype first generation Sulfonylurea 5. Name two drugs in the biguanide family 6. Explain insulin resistance 9

10 7. Recognize dental considerations for clients with diabetes 8. Name the popular drug used to treat hypothyroidism 9. List any drug interactions and adverse effects with this drug 10. Discuss hyperthyroidism 11. Describe dental considerations for patients with thyroid disease 12. Distinguish between Goiter and Cushing s Disease Module 19 Drugs Used to Treat Osteoporosis, Bisphosphonates 1. Define what is meant by the terms Osteoporosis and Osteopenia 2. Identify the drug category predominantly used to treat Osteoporosis 3. State the adverse effects of Bispohoshonates 4. Explain the process of Bisphosphonate Induced Osteonecrosis of the Jaw (BION) 5. Discuss the role of the dental hygienist is treating a patient with (BION) Module 20 Rheumatoid Arthritis TBA Module 21 Emergency Drugs 1. List and explain the drugs normally found in a facilities emergency kit 2. Know under what circumstances these drugs may be used. 3. Describe potential emergency situations seen in a dental setting Module 22 Antihistamines 1. Explain what function histamines have in our body 2. Discuss under what circumstances would an anti-histamine be prescribed Module 23 Gastrointestinal Tract Drugs 1. Explain the term Proton Pump 2. Discuss what drugs are used to decrease acid secretions 3. Describe the Mechanism of Action of the Proton Pump Inhibitor Drugs 4. Discuss what is meant by H2 histamine receptors 5. Name 4 Over the Counter Drugs that act as Antacids 6. Discuss use of Amoxicillin, Clarithromycin, Metronidazole & Tetracycline in treatment of peptic ulcer 7. Research the role of histamines in production of gastric ulcers 8. Describe role of histamine 2 blockers Module 24 Respiratory Tract Drugs 1. Name the primary drug used as an expectorant and three combinations available 2. Name three Anti-tussive agents and give brand name examples 3. Name two narcotic agents used in combination as anti-tussives 4. What is the MOA of nasal spray vasoconstriction 5. Name 4 alpha-adrenergic drugs used in the treatment of nasal congestion rev. 8/10/12, mcortell 10