24. Pharmacology: Part II (Narcotics-Non narcotics) Flashcards Preview

.DENTAL BOARD EXAM REVIEWER > 24. Pharmacology: Part II (Narcotics-Non narcotics) > Flashcards

Flashcards in 24. Pharmacology: Part II (Narcotics-Non narcotics) Deck (120):
1

Gold standard of narcotics

Morphine

2

Narcotics are derived from what type of plant?

Poppy plant : Papaver somniferum

3

Narcotics are also known as (3Os)

Opioids
Opiates
Opium

4

3 receptors of narcotics

Mu
Kappa
Delta

5

Drugs with morphine-like properties that acts in CNS

Morphine

6

Opioid receptors (mu kappa delta) nakikita sa: Limbic system (emotion center)

* Narcotics = controls pain and reaction to pain
: (because inaalter ung limbic system)

Limbic system:
🔺Hippocampus - memory center
🔺Amygdala - resp for fear,anger, arousal; (almond shape)
🔺substantia nigra - dopamine production
🔺basal ganglia - voluntary motor movts

7

Most common side effect of narcotics

Nausea
- (Area Postrema)

8

Part of nervous system that controls
✅cough reflex
✅gastric motility
📌 action of narcotics???

Solitary nuclei - gag,cough reflex..

📌 Narcotics suppresses cough reflex

9

Narcotics that suppresses Cough reflex

"anti tussive" (Dextromethorphan)

10

Drug taken to inhibit gastric motility

Loperamide (Diatabs)

11

BQ: "gate" in gate control theory

Substantia gelatinosa of Rolando

12

Most accepted theory for pain;
- painful stimulus: gate opens
- non painful: gates closes

Gate control theory

13

BQ: What are the endogenous opioids produced by our body?

Enkephalins
Endorphins

14

BQ: Narcotic agents blocks pain in the "peripheral" nervous system. True/False?

False - blocks pain in CNS!

15

BQ: What is the combination of Diphenoxylate and Atropine

Lomotil

16

Induces gastric motility

Laxatives (Bisacodyl)

17

Therapeutic effects of Narcotics:

Analgesia
Euphoria
Sedation
Eliminates cough

18

BQ: what kind of drug is Guaifenesin?

Expectorant

19

Most common side effect of narcotics

Nausea

20

BQ: drug that puts patient in "trans like state"

Ketamine

21

Adverse effect of narcotics which is opposite of euphoria

Dysphoria

22

Most serious side effect of narcotics

Respiratory depression

23

BQ: Morphine Triad (due to overdose)

Miosis (pupillary constriction:pinpoint)
Respiratory depression
Coma

24

BQ: What are the components of Neuroleptic analgesia? (Anesthetic technique that puts px in stage 1 anesthesia)

1. neuroleptic agents/antipsychotics
- Butyrophenones : (induces hallucinations)
2. Narcotics
3. Nitrous oxide (optional)

25

BQ: What is the drug that causes "dissociative" anesthesia? / "trans like state"

Ketamine
- conscious mind separated from body
- "trans like state"

26

BQ: What type of drugs are contraindicated to glaucoma

Diazepam
Anticholinergic drugs

27

Ano nakikita ng patient na may glaucoma?

"Tunnel vision"

28

BQ: type of NARCOTIC drug contraindicated to glaucoma?

Meperidine (may slight anticholinergic effect)

29

BQ: Drug contraindicated to glaucoma
choices: one of "DiTriBeAM" bec it has slight anticholinergic

Is Diphenhydramine contraindicated to glaucoma? Yes. (All DiTriBeAM sa boards)

30

Drug used for severe orofacial pain

Codeine
- "prodrug" : converted to morphine
- orally
- common na ginagamit sa dental: bec low drug dependence

31

Acetaminophen is similar with what drug in ph

Acetaminophen : Paracetamol
Tylenol ~~~~~~~ Biogesic

32

Other term for acetaminophen

"APAP"
(N-acetyl paraminophenol)

33

Oxycodone + Acetaminophen = what brand name?

"Tylox"

34

"Percocet"

Oxycodone

35

"Molly"

Ecstasy

36

What is the route of administration of morphine and meperidine

Parenteral (IV)

37

More potent than morphine

Fentanyl

38

BQ: "Diacetylmorphine"

Heroin

39

BQ: strip name of drugs
- "Horse"
- "Big H"
- "Brown sugar"

Heroin

40

Strip name of cocaine

Coke
Candy

41

"Poor man's cocaine"
(Shabu/meth/crystals)

Methamphetamine HCl

42

Dental disease assoc with Methamphetamine HCl

"Meth mouth"
- Meth = enhances sympathetic nervous system
- Saliva during symp = ⬇️ = Xerostomia ➡️ Caries and Perio dse = METH MOUTH!!!

43

Strip name of "MJ" / "Weed" / "Blunt"

Marijuana (Cannabis sativa)

44

BQ: Drug that shouldnt be combined with MAO-Inhibitors

Meperidine

45

BQ: Narcotic antagonists

Naloxone
("naltrexone" : pag wala sa choices ung naloxone)

46

BQ: Give 4 drugs that are associated with respiratory depression and dependence

"SNAB"
Sedative hypnotics
Narcotics
Alcohol
Benzodiazepines

47

BQ: "non schedules narcotic" (no prescription needed)

Tramadol

48

BQ: Drugs with different classification
(Opioid/Non opioid)

Tramadol
Propoxyphene (Darvon)
Pentazocine (Talwin)

49

BQ: Some narcotics(depressant) that are metabolized to a CNS stimulant by the LIVER

Meperidine (Demerol) ➡️ "nor"meperidine
Propoxyphene (Darvon) ➡️ "nor"propoxyphene

50

BQ: Study SCHEDULE II drugs : HIGH potential for abuse or dependence

1. Hydromorphone (Dilaudid)
2. methadone (Dolophine)
3. Meperidine (Demerol)
4. Oxycodone (percocet)
5. fentanyl (sublimaze, duragesic)
6. Morphine
7. Opium
8. Codeine

51

BQ: Impaired control over taking the drug
(Pag nasa isip mo ung drug)

Psychic dependence

52

Continued administration of the drug is required to prevent unpleasant "withdrawal syndromes" ✅ (Ex. Alcoholic, smokers)
- "hinahanap ng body mo yung drug"

Physical dependence

53

BQ: Increasingly large dose of narcotics are required to produce the same degree of analgesia (Ex. Caffeine)

Tolerance

54

BQ: Opioid withdrawal: Life threatening or not?

Not life threatening

55

Most common drug assoc with withdrawal symptoms

Alcohol (life threatening)

56

4 na kailangan para makapag induce ng General anesthesia = which results to COMA

Sedation
Amnesia
Muscle paralysis
Analgesia

57

Stage na delikado or critical sa patient

Stage 2
- dapat maging stage 3 na agad
- uses FAST ACTING / Ultrashort

58

End of stage 1 and start of stage 2

Unconsciousness

59

Desirable stage during GA

Stage 3

60

Guerin's stages of General Anesthesia

Stage 1 - Amnesia and analgesia
Stage 2 - Excitement and Delirium
Stage 3 - Surgical anesthesia
Stage 4 - Medullary Paralysis

61

Inhalational drugs used in GA

Halothane
Desflurane

62

Short acting hypnotic agent

Propofol

63

Used for dissociative anesthesia

Ketamine (trans like state)

64

Blocks pain mainly in the PERIPHERAL NERVOUS SYSTEM
- Doesn't have CNS depression effects
- Doesn't act in Opioid receptors

Non narcotic analgesics

65

Non narcotic analgesics

Acetaminophen
Aspirin
NSAIDS

66

General pharmacological effects of Non narcotics

Mild to mod pain
Controls fever / antipyretic
Anti inflammatory

67

Non narcotic analgesics block what enzyme resulting to decrease prostaglandin production

Cyclooxygenase

68

BQ: Prostaglandins produced in CNS causes:

Fever and pain

69

BQ: Prostaglandins produced in PNS causes:

Pain
Inflammation (vasodilation)
Gastric protection

70

Enzyme that breaksdown PHOSPHOLIPID BILAYER during tissue damage

Phospholipase A2

71

Breakdown of Phospholipid bilayer by Phospholipase A2 results to production of what chemical?

Arachidonic acid

72

Once arachidonic acid goes to the RESPIRATORY SYSTEM, It will bind to what enzyme?

Lipooxygenase

73

Arachidonic acid + Lipooxygenase =

Production of LEUKOTRIENES

74

Binding site of Leukotrienes

Leukotriene-Receptor sa Lungs

75

Binding of Leukotrienes to Leukotriene-receptor sa lungs = it will result to?

Bronchoconstriction
- main reason kaya nagkaka-ASTHMA

76

Drug that inhibits "lipooxygenase pathway"
✅ It creates a barrier = so that Leukotrienes can't bind to the receptors.
✅ prevents Bronchoconstriction

Leukotriene receptor blocker

77

BQ: Example of a "Leukotriene receptor blocker" that prevents ASTHMA

Montelukast

78

If yung Arachidonic acid nakarating sa CNS - it will meet what enzyme?

COX2

79

COX2 in CNS converts AA into:

Prostaglandins: (pain and fever)

80

COX1 in PNS converts AA into:

Thromboxane A2 (platelets: blot clotting)
Prostaglandins
- protects stomach
- Inc renal blood flow

81

Prostaglandin that protects stomach and increases renal blood flow is derived from?

AA + "COX1" in PNS

82

COX2 in PNS converts AA into:

Prostaglandins
- pain
- inflammation (vasodilation=inc blood flow)

Prostacyclins
- inflammation/swelling

83

Enzyme responsible pag nagkakaroon ng WOUND

COX2 of PNS
(Converts AA into Prostaglandins and Prostacyclins = pain and inflammation)

84

Produced mainly by platelets: Helps in blood clotting

Thromboxane A2

85

BQ: What are the 3 end products of cyclooxygenase pathway?

Thromboxane A2
Prostaglandins
Prostacyclins

86

BQ: An Exception: CENTRALLY ACTING Non-narcotic analgesic

(*non narcotic=PNS acting*)

Acetaminophen

87

Acetaminophen inhibits what enzyme?

Cyclooxygenase (COX2 in CNS)
-inhibits pain and fever

88

Is acetaminophen/paracetamol an NSAID?

No. Not an NSAID!
- bec it doesnt have an anti inflammatory effect/ doesnt control swelling

89

Centrally acting analgesics

Narcotic analgesics

90

Peripherally acting analgesics

Non-narcotic analgesics
{*except: ACETAMINOPHEN}

91

NSAIDS acts on CNS/PNS???

Nsaids - PNS

92

NSAIDS inhibits what enzymes?

Cox1 and Cox2 in PNS

93

Toxic effects of NSAIDS

- "reduces formation of blood clot" (TXA2)

- "gastric irritation/ulcers" (removes prostaglandins that protects stomach)

- "kidney damage" (removes prostaglandins na nagiincrease ng renal blood flow)

94

Therapeutic effects of NSAIDS

Anti-inflammatory
Analgesic
(-inhibits prostaglandins and prostacyclins)

95

Aspirin is an active or inactive drug?

Inactive / "prodrug"
- converted to SALICYLATES

96

Aspirin: CNS/PNS?

Peripherally acting drug

97

BQ: Side effect of aspirin pag binigay sa child with viral infection

Reye's syndrome

(Viral inf presents "fever": Aspirin has mild effects on CNS kaya mej anti pyretic dati!now anticoagulant na!)

98

Is Aspirin sometimes classified as "NSAID"?

Yes: Aspirin = NSAID ✅
(Has mild anti inflammatory effect)

99

BQ: MOA of aspirin? Why is ASPIRIN used as a "blood thinner" or "anticoagulant"?

Aspirin "IRREVERSIBLY blocks COX1"

(*Platelets uses COX1 to produce TXA2*)
ASPIRIN kahit wala na sa body: causes platelets to be permanently damaged or non functional=hindi na makakaproduce ng TxA2 which is resp for blot clotting = Kaya ginagamit sya as anticoagulant but lasts only until 10 days (lifespan ng platelets)

* Unlike sa NSAIDS: Once na nawala NSAID sa body (after 4hrs): platelets will restore cox1 = can produce TXA2 again

100

BQ: How many days prior to surgery must the patient stop taking Aspirin?

7 days (stop!)

101

NSAIDS that selectively blocks COX 2

COX 2-inhibitors

*Cox2 lang iniinhibit therefore:
Cox1❌: No adverse effects: gastric irritation, renal damage, inc bleeding tendency

102

Drug examples of Cox2-inhibitors

Celecoxib
Etoricoxib (Arcoxia)
Valdecoxib

103

BQ: which of the ffg drugs na wag ibibigay sa patient prior to surgery?

NSAID (ung nasa choices)

*specifically: Aspirin dapat: but aspirin is considered a NSAID*

(Nsaids like mefenamic acid ok lang ibigay before surgery)

104

Only non narcotic analgesic WITHOUT anti inflammatory effects

Acetaminophen
- no anti inflammatory effect bec: Centrally acting
- anti pyretic and analgesic only

105

3 drugs that are HEPATOTOXIC ("Hart")

Hepatotoxic:
- Acetaminophen
- Rifampicin
- Tetracyclines

106

"Overdose of aspirin"

Salicylism

107

Toxic effects of ASPIRIN:

✅gastric irritation: ❌cox1:prostaglandins
✅renal damage: ❌cox1:prostaglandins
✅salicylism: overdose
✅prevents clotting: ❌cox1:txa2
✅Reye's syndrome - if aspirin is given to a child with viral infection

108

Aspirin and other NSAIDS can enhance the effects of

Warfarin(Coumadin) and Coumarin

*wag icocombine: anticoagulant + anticoagulant = BLEEDING!!!!!

109

BQ: Drug used to treat Salicylism?

Sodium bicarbonate

110

BQ: What is the parent drug that is converted to acetaminophen?

Phenacetin

111

BQ: Excessive doses of these 2 drugs can lead to "Narcotic-like" adverse effects

Pentazocine
Propoxyphene

112

BQ: Drug interaction of PNS acting and CNS acting Non-narcotic analgesics

Pns + Cns non-narcotic analgesic are SYNERGISTIC!!! (1+1=>2)

Example: Ibuprofen(nsaid:pns) + Paracetamol(cns) = Alaxan

113

Non scheduled drug: dont need prescription

Tramadol

114

NSAID + another NSAID cannot be combined ❌

⬆️⬆️ Toxic effects!!!!
✅ Nsaid + Paracetamol = Synergistic

115

Brand name of Ibuprofen

Alaxan, medicol, midol

116

Generic name of flanax

Naproxen

117

Examples of NSAIDS:

Ibuprofen
Naproxen
Diclofenac
Mefenamic acid
Sulindac
Piroxicam
Oxaprozin
Indomethacin
Nabumetone

118

Toxic effects of COX2-inhibitors

Can lead to heart attack or stroke or any cardiac disease

{explanation:}
Wall of bv is made up of Prostacyclin and TxA2
Cox2-inhibitors inhibits Prostacyclins; Magdodominate TxA2⬆️=constricted BV dahil lumalapot yung blood: ⬆️obstruction

119

Ideally: Cox2-inhibitors are taken maximum of how many days

Maximum of 7 days

120

NSAIDS that reduces pain, fever(minor), and inflammation WITHOUT having GI problems

Cox2-inhibitors