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Pharmacology > exam 3 lecture 1 > Flashcards

exam 3 lecture 1 Flashcards

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1
Q

when was mepivicaine (carbocaine) released?

A

1960

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2
Q

all muscle relaxants are indicated as an adjunct to rest and PT. for relief of muscle spasm associated with acute painful musuloskeletal conditions

A

methocarbamol (Robaxin)

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3
Q

this is used for the management of non productive cough (antitussive properties)

A

benzonatate (Tessalon Perles)

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4
Q

what is mepivicaine used for?

A

not good topically.. used for infiltration, block, spinal, epidural, and caudal anesthesia

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5
Q

these are only used parenterally

A

amides

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6
Q

what is the maximum safe dose of epi for a healthy pt?

A

0.2 mg which is 11 cartridges

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7
Q

this is commonly used in dentistry and dental hygiene as a 3% solution without vasoconstrictor for short procedures

A

mepivicaine (Carbocaine)

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8
Q

what else is absorption determined by?

A

the proportion of the agent present in the free base form (non-ionized)

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9
Q

what pregnancy category is lidocine and prilocaine?

A

B

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10
Q

what are the two main regions affected by local anesthetic toxicity?

A

CNS and cardiovascular system

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11
Q

what happens after absorption of anesthetics?

A

they are distributed throughout the whole body

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12
Q

what year was cocaine claimed to be placed in the eye which produced complete anesthesia?

A

1884

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13
Q

what factors influence toxicity?

A 
drug
concentration
route of admin.
rate of inject.
vascularity
pt. weight
rate of metabolism and excretion
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14
Q

this is autosomal dominant trait with symptoms that include an acute rise calcium which produces muscular rigidity, metabolic acidosis and extremely high fever.. the mortality rate is 50%.. amide local anesthetic are no longer suspected as agents that can precipitate an attack.. treat with dantrolene

A

malignant hyperthermia

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15
Q

what is the dental dose of epinephrine?

A

.018 mg/ cartridge (1.8 ml) of 1:100,000

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16
Q

what are some adverse effects of benzodiapines?

A 
cns depression
amnesia (forget about procedure)
respiratory (none)
cardiovascular (decrease BP)
visual (angle closure or eye twitching called nystagmus)
dental-xerostomia
phlebitis-
pregnancy and lactation- increase in malformities aka cleft lip, avoid if pregnant
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17
Q

what is the major advantage of bupivacaine (Marcaine)

A

prolonged duration of action

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18
Q

what are some adverse reactions to the CNS system with anesthetics?

A

restlessness, tremors, convulsions and may be seen in CNS stimulations.. CNS depression , respiratory and cardiovascular depression and coma may follow

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19
Q

this is a mild CNS depression (reduction of activity and simple anxiety)

A

sedation

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20
Q

local anesthetics provide a reversible blockage of peripheral nerve conduction.. these agents:

A

inhibit the movement of the nerve impulses along the fibers, at sensory endings, at myoneural junctions, and at synapses

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21
Q

how does prilocaine come supplied?

A

dental cartridges as a 4% solution with and without 1:200,000 epinephrine

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22
Q

these have higher concentrations of anesthetics

A

highly vascular organ

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23
Q

what is lidocaine used dentally with?

A

2% lidocaine with 1:50,000 to 1:100,000 epinephrine

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24
Q

what is the category of drugs termed that are classified as minor tranquilizers?

A

benzodiapaines

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25
if dental anesthesia is needed during pregnancy, what may be administered?
lidocaine and mepivicaine
26
what is another reason anesthetics are weak bases?
dilution by fluid, inflammation and vasodilation in the area
27
what is prilocaine used for?
infiltration, block, epidural and caudal anesthesia may or may not be used with epinephrine
28
the inherent toxicity and the amount of vasodilation it produces
drug
29
how are anesthetics excreted?
both amides and esters and their metabolites are by the kidneys and urine
30
this is for antipshycotic activity..it treats psychoses and commonly produces xerostomia
major tranquilizer
31
this is a newer drug used to treat migraines..
Imetrex
32
what happens with anesthetics after they combine with the receptor?
they block the conduction of nerve impulses by decreasing the permeability of the nerve cell membrane to sodium ions
33
what are some advantages of using a vasoconstrictor?
control bleeding decrease systemic toxicity keep numb longer
34
losses of nerve function occur in what order?
``` autonomic cold warmth pain touch pressure vibration proprioception motor ```
35
what are the two major categories anesthetics are divided into and what are the differences?
amides- metabolized in the liver and there is an I somewhere in the generic name before -caine esters are metabolized in the plasma
36
what is recommended for patients who are truly allergic to all local anesthetics?
diphenhydramine (benadryk) in a concentration of 1% plus 1:100,000 epinephrine
37
what are vasoconstrictors used to?
prolonged duration of action increase depth of anesthesia delay systemic absorption reduce toxic effect in systemic circulation reduces bleeding in area
38
these are the original sedative hypnotic agents and were replaced by benzodiazepines
barbituates
39
this was introduced in 1960, it's rate of onset, duration, potency and toxicity are similar to lidocaine
mepivicaine (Carbocaine)
40
what is bupivacaine used for?
infiltration, block, anesthesia
41
this is a non-barbiturate sedative hypnotic.. inexpensive, orally effective with rapid onset (20-30 minutes), lasts about 4 hours, pre op sedative for children and 50 mg-1gm
chloral hydrate
42
both can accumulate with renal disease
rate of metabolism and excretion
43
what is the composition of a local?
vasoconstrictor, antioxidant (prolong shelf life), sodium hydroxide (adjusts pH), sodim chloride, methylparaben and propylparaben (preservatives to prvent bacterial growth)
44
how long does lidocaine last?
rapid onset 2-3 minutes.. provides 1-1/2 hours of pulpal anesthesia and 3-4 hours of soft tissue anesthesia
45
what can carisoprodol (SOMA) do to urine?
change the color to purple red
46
what is used to treat trigeminal neuralgia (also use tegretol)
baclofen (Lioresal)
47
what are the adverse reactions of the barbituates?
sedative or hypnotic doses- can cause fetal harm if given to pregnant woman.. can be exaggerated in elderly or debilitated pt.. anesthetic doses- high concentrations used for intubation acute poisoning- overdose causes death due to resp. failure chronic long term use- leads to phys. and psyiological dependence
48
what is the max. safe dose of epi for a cardiac pt?
0.04 mg which is 2 cartridges
49
what is an example of the lipid solubility affecting the potency?
bupivacaine used as a 0.5% solution is about 10 times more lipid soluble than lidocaine, used as a 2% solution
50
how does the metabolism work of anesthetics?
amides-liver esters-plasma in severe liver disease or alcoholism, amides can accumulate and produce systemic toxicity
51
when is bupivacaine indicated?
when pulpal anesthesia is greater than 1 1/2 hours is required or when postop pain is expected (endo, perio, or oral surgery)
52
what are some centrally acting muscle relaxants?
cyclobenzaprine(Flexeril) carisoporodol (SOMA) methocarbamol (Robaxin) chlorzoxazone (Parafon forte)
53
who are more susceptible to adverse reactions of local anesthetics?
children, elderly, debilitated persons
54
what pregnancy category is mepivicaine/bupivacaine?
C
55
what are members of ANS drugs called?
adrenergic agonists or sympathomimetics
56
what does the rate of absorption depend upon with anesthetics?
the vascularity of the tissues
57
what type of adverse effects can anesthetics cause to the cardiovascular system?
few deaths have been reported of dental anesthesia however, may have effect upon conduction and produce fatal arrthymias
58
what drugs are included in the benzodiapaine category?
``` diazepam (valium) midazolam (Versed) triazolam (Halcion) lorazepam (Ativian) alprazolam(Xanax) chlordiazepoxide (Librium) ``` all pregnancy catergories D and X
59
the higher this is, the more drug that enters the systemic circulation
concentration
60
what are the pharmacologic effects of barbitutes?
CNS depression- principle effect.. addative effect with alcohol and opiods Analgesia- no significant analgesic effects Anticonvulsant- phenobarbital used to treat epilepsy
61
what is a positive effect of chlorozoxane (Parafon forte)
doesn't cause much drowsiness
62
these are applied to denuded surfaces that may approximate the absorption that occurs with IV injections
topical anesthetics
63
why is anesthesia difficult when infection is present?
because they are weak bases
64
what are the medical uses of benzodiapines?
anxiety control- panic attacks insomnia management- produces sleep treat epilepsy- drug of choice for status (Diazepam) treat alcoholism- used for withdrawls control muscle spasms- cerebal palsy and MS
65
what is used a lot for migraines and is a sedative and analgesic combo?
butabital/APAP (Fioricet)
66
what affects the potency of the agent?
the lipid solubility of an agent
67
which is more allergenic, esters or amides?
esters
68
when was the amide lidocaine (xylocaine) released?
1952
69
what are the properites of an ideal anesthetic?
``` potent local anesthetic reversible local anesthetic absence of systemic reactions rapid onset satisfactory duration low cost long shelf life ease of metabolidm and excretion ```
70
what is the smallest dose possible of pregnancy category?
lidocaine
71
what do local anesthetics affect first?
small, unmyleinated fibers first and the large, heavily myelinated fibers last
72
why are benzodiazapines used in dentistry?
premed before general anesthesia produces retrograde amnesia post op instructions should be given in writing requires continuous monitoring of resp/cardio functioning
73
presence of inflammation, infection, or vasodilation increases the vascularity and therefore systemic toxicity
vascularity
74
how much are solutions of bupivacaine?
0.5% with 1:200,000 epinephrine
75
what are the dosage calcuations for local anesthetic and vasoconstrictor?
amount in 1 cartridge of 2% lido with epi 1:100,000 is: local- 36 mg/cartridge epi- .018 mg/ cartridge 2 cartridges would be 72 mg lido with .036 mg epi 3 cart. would be 108 mg lido with .054 mg epi 2% lido with epi 1:100,000 (5)
76
This produces less CNS effects, doesn't effect driving, or appear to be addictive..use for anxiety?
buspirone (BuSpar)
77
what are the pharmacological effects of benzodiapines?
behavorial- animal studies (repeated doses reduce REM) Anticonvulsant- increase seizure threshold and helps prevent seizures muscle relaxation- produce relaxation of skeletal muscles effective for muscle spasticity secondary to pathologic states: cerebal plasy or paraplegia
78
this was introduced in 1948 and it is the anesthetic to which others are compared?
lidocaine (Xylocaine, Octocaine)
79
this is utilized slightly longer duration of action is required or when the lowest concentration of epinephrine is desired
prilocaine
80
this includes sleep and has a greater CNS depression
hypnosis
81
these are commonly used topically, no more used in dental cartridge, otc for teething, sunburn or insect bites
esters
82
what are some adverse reactions benzodiazpeines cause to the CNS?
depression... | ("roofies" or rohypnol date rape drug).. causes fatigue, drowsiness, muscle weakness and ataxia
83
what is lidocaine used for?
topical, infiltration, block, spinal, epidural, and caudal anesthesia..also used intravenously to treat cardiac arrhythmias during surgery
84
this appears to be less potent and less toxic than lidocaine and has a slightly longer duration of action
prilocaine (Citanest, Citanest Forte)
85
what may be added to a local anesthetic to reduce systemic absorption?
vasoconstrictor.. it reduces blood flow to the area, limits systemic absorption and reduces systemic toxicity.
86
the faster this is, the lower chance that the local area can accept the volume injected
rate of injection
87
what is the strongest muscle relaxant, most sedating and what dpes it produce?
cyclobenzaprine (Flexeril) produces xerostomia in 30% of use
88
small vs. large
pt. weight
89
inadvertent intravenous injections--high blood levels
route of administration
90
what are the most commonly employed drug in the dental office?
local anesthetics
91
why would you use a barbitaute?
therapeautic uses are determined by their duration of action
92
what do anesthetics do to local effects?
local irritation and hematoma
93
the action of this is like that of the sedative hypnotics... this treats anxiety, and potentional for addiction
minor tranquilizer

Pharmacology (12 decks)

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