pharm 2 Flashcards
(358 cards)
1
Q
Oral drugs – undergo
A
1st pass metabolism in liver.
2
Q
What is used to determine whether a drug will cross glomerulus: attached to a protein or not;
acid or base; positive or negatively charged
A
attached to a protein or not
3
Q
Which drug absorbs better in stomach acid?
A
Weak acid
4
Q
In order for a drug to do its effect in what state should it be? Weak acid, Weak base Liposoluble Hydrophobic Hydrophilic
A
Liposoluble
- NON ionized drugs are soluble in lipid.
5
Q
When a drug does not exert its maximum effect is because it’s bound to?
A
Albumin
6
Q
Which of the following best explains why drugs that are highly ionized tend to be more rapidly excreted than those that are less ionized? The highly ionized are A. less lipid soluble. B. less water soluble. C. more rapidly metabolized. D. more extensively bound to tissue.
A
A. less lipid soluble.
7
Q
Therapeutic Index LD/ED is a measure of:
A
safety of drug
8
Q
QUESTION: LD50 means at this dose,
A
50% of the test animals died
9
Q
QUESTION: What is bioavailability of a drug?
A
amount of drug that is available in blood
10
Q
What does bioavailability measured?
How much drug is absorbed in the circulation
Blood to urine ratio
A
How much drug is absorbed in the circulation
11
Q
What pharmacokinetic factor influences the need for multiple doses in a day (dose rate)? half-life; bioavailability, or
clearance
A
half-life
12
Q
Two different drugs with same dosages, bind to the same receptor, and cause same intrinsic affect. However, they have different
affinities for the receptor. In which aspect these 2 drugs are similar?
a. ED50
b. LD50
c. Potency
d. Efficacy
A
- Efficacy bc they can both produce the same maximal response if enough is given
13
Q
Fixed dose drug A w/ low dose of Drug B increase drug B effect when same dose of drug a is give w/ increased does of drug B:
competitive antagonist, synergism, partial agonist
A
- partial agonists bind & activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist.
14
Q
Three carpules (2 ml carpules, 40 mg/ml) of local anesthetic X are required to obtain adequate local anesthesia. To obtain the same
degree of anesthesia with local anesthetic Y, five carpules (2 ml carpules, 40 mg/ml) are required. If no other information about the two drugs is
available, then it is accurate to say that drug X:
is less potent than drug Y.
is more efficacious than Y.
is less efficacious than drug Y.
X&Y are = in potency & efficacy.
A
X is more potent
no info on efficacy really
if ceiling effect was the same but with different doses,
efficacy would be the same
15
Q
The maximal or "ceiling" effect of a drug is also correctly referred to as the drug's A. agonism. B. potency. C. efficacy. D. specificity.
A
efficacy
16
Q
vagal reflex
A
reflex to suddenly increased BP –> slows down HR
can give atropine to block
17
Q
Epinephrine reversal –
A
when also taking α blocker (ex. prazosin, chlorpromazine) cause decrease in BP b/c β-mediated vasodilation
predominates
o Beta2 trumps A1 so vasodilation happens & BP decreases
18
Q
Alpha-1 agonist:
A
increase smooth muscle tone, vasoconstrictor –> ↑ BP
19
Q
Alpha-2 agonist:
A
given orally b/c they cause hypotension by reducing sympathetic CNS outflow
20
Q
What does Alpha-1 do?
A
Vasoconstriction of peripheral vessels (smooth muscle)
21
Q
When you stimulate alpha 1 receptors what happens?
a. Vasoconstriction
b. Hypertension
A
Vasoconstriction
22
Q
What does alpha-1 receptors do to the heart?
A
Vasoconstriction, increase blood pressure, increase peripheral resistance, mydriasis
(pupil dilution) and urinary retention
23
Q
Adrenalin – stimulates which receptors
A
alpha 1, 2 and beta 1, 2 receptors
24
Q
Heart has which receptors.
A
beta-1
25
Slow infusion of epinephrine will cause which of the following and know which receptor is responsible -
```
Alpha 1 (Vasoconstriction
during anaphylaxis), Beta 1 (Increases cardiac output), Beta 2 (bronchodilation)
```
26
Patients BP spike after EPI, what receptor?
B1
27
```
Hemostatic agents in retraction cord target what receptor?
• a1
• b1
• b2
• gaba
• muscarinic receptor
```
a1 (vasoconstriction)
28
Retraction cord with epinephrine can cause:
increase HR, BP
| - do not use in hyperthyroid or cardiac disease.
29
After using a gingival retraction cord, tissue reacts by recession. Where do you see this the most? Lingual, buccal, interproximal.
buccal
30
Smooth muscle relaxation is caused by which of the following drugs?
a. prazosin
b. atropine
c. theophylline
d. amphetamine
a. prazosin (alpha 1 blocker...blocks vascular smooth muscle constriction)
b. atropine (anticholinergic)
c. theophylline (treat asthma, COPD...it relaxes bronchial smooth muscle...so I guess it does do smooth muscle...)
d. amphetamine (psychostimulant...increase wakefulness)
- answer should be an alpha-1 antagonist/blocker
31
```
Which of the following combinations of agents would be necessary to block the cardiovascular effects produced by the injection of
a sympathomimetic drug?
Atropine and prazosin
Atropine and propranolol
Prazosin and propranolol
Phenoxybenzamine and curare
Amphetamine and propranolol
```
Prazosin and propranolol
- sympathomimetic drug injection (ex. NE) stimulates α/β receptors so α-blocker prazosin + β blocker propranolol is needed.
- Atropine is an muscarinic/cholinergic receptor blocker that would stimulate heart (opposite effect)
32
```
Each of the following drugs produces vasoconstriction of vessels if injected into the gingiva EXCEPT one. Which one is this
EXCEPTION?
Epinephrine (EpiPen®)
Terazosin (Hytrin®)
Levonordefrin (Neo-Nedfrin®)
Phenylephrine (Neo-Synephrine®)
Norepinephrine (Levophed®)
```
- Terazosin, selective alpha-1 antagonist, is used to tx HTN & enlarged prostate (BPH)
33
Epinephrine + propanolol:
increases BP, decreases HR
Propranolol is a nonselective beta blocker so epi only acts at only alpha receptors, which in the periphery are mainly alpha-1 receptors
- This causes vasoconstriction &Increased ⬆ BP --> increased firing, which triggers aortic and carotid sinuses --> increased vagal activity
on the heart --> decreased
⬇ HR.
34
If using with epi, Change propranolol for?
Metoprolol ... little change on HR, but no marked increase in BP.
- METOPROLOL = selective B blocker (proprano is nonselective) and is ok to use with EPI!
35
Propranolol + epinephrine = bad reaction due to: drug interaction, anxiety, allergy
drug interaction,
36
Patient taking propranolol with epinephrine. What receptor caused hypertensive crisis?
- alpha 1
- alpha 2
- beta 1
- beta 2
alpha-1
- If a patient on a nonselective beta-blocker receives a systemic dose of epinephrine, however, the beta-blocker prevents the
vasodilation, leaving unopposed alpha vasoconstriction. (alpha-1)
37
What is the effect seen when propranolol and epinephrine are injected simultaneously -
in cases of mild reactions it causes
| hypotension; in severe reaction it is malignant hypertension
38
All these drugs alter ionic movement except - Propranolol, CCB, HCTZ, and Digoxin
Propranolol
39
```
QUESTION: A patient receiving propranolol has an acute asthmatic attack while undergoing dental treatment. The most useful agent for
management to the condition is?
a. Morphine
b. Epinephrine
c. Phentolamine
d. Aminophylline
e. Norepinephrine
```
- Aminophylline: Bronchodilator, class theophylline
40
```
The drug-of-choice for the treatment of adrenergically-induced arrhythmias is:
quinidine.
lidocaine.
phenytoin.
propranolol
```
propranolol
41
Direct alpha sympathomimetic: clonidine, guanethidine , methyldopa
clonidine
guanethidine is indirect - acts on neurons to inhibit NE release
methldopa is fake neurotransmitter
42
Epinephrine Reversal with?
Alpha adrenoceptor blockers (ex. phenoxybenzamine)
| - inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP instead of high BP
43
Epinephrine reversal: after giving a patient epinephrine, following hypertension, which of these drugs would cause a drop in BP?
Phenoxybenzamine
44
What receptor or signaling pathway is linked most directly to α2-adrenoceptor stimulation? I
nhibition of adenylyl cyclase through
| GI, resulting from stimulation of α2-adrenergic receptor, leads to intracellular ⬇ cAMP
45
amphetamines MOA
indirect-acting sympathomimetics
46
ADHD meds
Methylphenidate = Ritalin
o Methylphenidate: blocks dopamine uptake in central adrenergic neurons by blocking dopamine transport or carrier proteins.
- Amphetamine = Adderall
o Amphetamines & cocaine: increase catecholamine NE SERETONIN DOPAMINE release as a primary mechanism.
§ Amphetamines stimulate CNS alpha receptors
o Adderall: psychostimulant medication composed of amphetamine and dextroamphetamine, which increases the amount of
dopamine and norepinephrine in the brain
47
ADHD with gender
M>F
48
Amphetamines MOA –
lead to NE release in brain
| - stimulate the release of norepinephrine from central adrenergic receptors & at higher dosage, release of dopamine
49
Methylphenidate brand name, Amphetamine brand name
Methylphenidate = Ritalin, Amphetamine = Adderall.
50
Kid is taking Adderall (amphetamine) & is very anxious what do you do?
Tell him to stop taking amphetamine on the day
appointment
- Amphetamine can induce anxiety, and are contraindicated for patients that are very nervous
51
Side effect of Amphetamines
– Insomnia (difficulty of falling asleep)
52
Amphetamines, what are symptoms?
Increased heart rate & excitability
53
Cholinergic crisis:
bradycardia, lacrimation, salivation, voluntary muscle weakness, diarrhea, bronchoconstriction – tx w/ atropine
54
cholinergic agonists: examples and effect on slivation
increased salivation
| pilocarpine (direct), neostigmine
55
anticholinergic agents
atropine/scopolamine
56
antticholinergic overdose
confusion, hallucinations, burning mouth, hyperthermia – tx w/ physostigmine
57
direct cholinergic agonist
pilocarpine, methacholine (xerostomia)
58
indirect acting cholinergic agonists MOA
prevent enzyme breakdown
reversible anti-cholinesterase: physostigmine (CNS and PNS) and neostigmine (PNS only)
irreversible = insecticides and organophosphates
tx overdose with pralidoxime
59
Competitive muscarinic receptor blockers =
Atropine, scopolamine, propantheline
60
What is used for motion sickness?
scopolamine
61
Neostigmine and pilocarpine increase?
Salivation
- Pilocarpine (muscarinic agonist) & neostigmine are parasympathomimetic that acts as a reversible acetylcholinesterase inhibitor. They
increase salivation, urination, bronchoconstriction, bradycardia, miosis (pupil constrict), vasodilation
62
Glycopyrrolate effect?
reduce salivary (muscarinic anticholinergic)
63
Atropine: _____ salivation
decrease
64
What meds decrease saliva?
atropine, scopolamine
| - Pilocarpine, methacholine, neostigmine, etc. cause salivation.
65
QUESTION: If patient has xerostomia, what medication won’t you give?
Atropine - anticholinergic
66
What drug does not cause miosis of the eyes?
Atropine
67
Pt have bradycardia, what should we give him?
Atropine b/c atropine will increase heartrate causing tachycardia.
68
Drug to decrease saliva because you want to take an impression- Atropine, Pilocarpine, Neostigmine
ATROPINE
69
Atropine poisoning tx:
physostigmine
70
Patient salivates a lot, what is tx before surgery?
Atropine **antimuscarinic
71
Xerostomic pt, give
pilocarpaine or cevimeline.
| - Cimeviline just like pilocarpine to increase salivation in xerostomia
72
What drug do you give to a pt with xerostomia?
Pilocarpine
73
Pilocarpine used for?
parasympathomimetic alkaloid, for tx of glaucoma and xerostomia.
74
What is the side effect of pilocarpine (Tx of dry mouth) in toxic dose?
Bradycardia and hypotension
Apnea
Cardiac shock
Bradycardia and hypotension
- nontoxic side effects>>> excess sweating and salivation, bronchospasm
75
Propantheline bromide (pro-Banthine):
anti-cholinergic (anti-muscarinic), relieve cramps or spasms of the stomach, intestines, and
bladder.
76
Which of the following groups of drugs is contraindicated for patients who have glaucoma? Adrenergic, Cholinergic, Anticholinergic
Adrenergic blocking
Anticholinergic
77
```
Which of the following drug groups increases intraocular pressure and is, therefore, contraindicated in patients with glaucoma?
A. Catecholamines
B. Belladonna alkaloids
C. Anticholinesterases
D. Organophosphates
```
B. Belladonna alkaloids -- anti-cholinergic
organophosphates are irreversible cholinesterase inhibitors; indirect agonists
78
tubocurarine
inhibits ACH receptor --> weakness of skeletal muscles
79
Decrease of pseudocholinesterase would lead to increase in? Succinylcholine or tubocurare
Succinylcholine
80
Administration of succinylcholine to patient deficient in serum cholinesterase would cause...
a. convulsions
b. Hypertension
c. prolonged apnea
d. Acute asthma attack
c. prolonged apnea
81
miosis can be caused by which drigs
opioids and cholinergics
82
mydriasis can be caused by which drugs
anticholinergics and increased serotonin
83
A patient who has Parkinson’s disease is being treated with levodopa. Which of the following characterizes this drug’s central
mechanism of action?
a. it replenishes a deficiency of dopamine
b. it increases concentrations of norepinephrine
c. it stimulates specific L-dopa receptors
d. it acts through a direct serotonergic action
a. it replenishes a deficiency of dopamine
84
Cause of Parkinson?
Dopamine deficiency, give them methyldopa (levodopa) to increase dopamine in the CNS
85
Why do you need to take carbidopa with levodopa:
prevents breakdown of levodopa before it crosses the blood brain barrier
Carbidopa addition prevents levodopa from being converted into
dopamine in the bloodstream, peripheral enzymatic degradation so more reaches the brain.
86
How does carbidopa tx Parkinson’s disease?
potentiates effects of dopamine
87
anti-psychotics effect
sedate, blunt emotional expression, attenuate aggressive & impulsive behavior.
88
anti-psychotics adverse effects
Produce anticholinergic adverse effects,
| dystonias and extrapyramidal symptoms. Tardive dyskinesia most common after several years.
89
tardive dyskinesia whose side effect
anti-psychotics
phenothiazine
90
Phenothiazines (PTZ) MOA :
Block DA receptors, act on the extrapyramidal pathway
91
Where in the brain does anti-psychotics works?
blocking the absorption of dopamine
extrapyramidal pathways
92
What catecholamine does Phenothiazine (anti-psychotic) affect? Dopamine, serotonin, acetylcholine
Dopamine
93
Phenothiazine side effect:
Tardive Dyskinesia
94
proverbial anti-psychotic
phenothiazine
95
What acts on extrapyramidal?
Phenothiazines (chlorpromazine)
96
Onset of action of antipsychotic is:
5-6 days
97
Lithium is used for treatment of?
Manic phase of bipolar disorder
98
Patient is in her 70’s, she lives alone, what could she be suffering from?
Depression
99
Most common psychological problem in elderly?
Depression
100
Old people have dementia as the most prominent psychiatric issue:
depression
101
What is associated with depression? Age, economic status, professional status, etc
Age
102
Most common mental illness among elderly?
Depression
103
```
Main sign of dementia:
a. confusion
b. short term memory loss
c. long term memory loss
-
```
b. short term memory loss
short term memory loss = first main sign. Long term loss occurs later.
104
Where in the brain does anti-depressants works?
decrease amine-mediated neurotransmission in the brain
105
Tricyclic anti-depressant (TCA) mechanism of action:
inhibit reuptake of NE and 5-HT (serotonin)
106
TCA 2nd generation-
-triptylines and -pramines
107
How do tricyclics work?- by
not allowing reuptake of neurotransmitter (NE, 5-HT, serotonin)
108
What catecholamine do tricyclic antidepressants affect? Dopamine, serotonin, acetylcholine
serotonin
109
Patient is taking TCA anti-depressants what do you take into consideration? Limit duration of procedures, keep in mind the
epinephrine limit
keep in mind the
| epinephrine limit
110
Side effect of having TCA and epi: HTN, hypotension, hyperglycemia, hypoglycemia
HTN
111
Most common antidepressant does what?
* Inhibits reuptake of NE, 5-HT, & DA (TCA)
* Inhibit reuptake of 5-HT (SSRI)
* Inhibit reuptake of N & 5-HT (SNRI)
* Inhibit MAO; prevent breakdown of NE & 5-HT (MAOI)
* Block D2 receptor (phenothiazine)
112
If someone has a history of depression & wants to quit smoking, what do you give?
Zyban (Bupropion), it’s an anti-depressant &
smoking cessation aid
- not Chantix (smoke cessation only)
113
Amitriptyline –
most common tricyclic antidepressant, inhibits reuptake of NE and serotonin
114
Zoloft works on what receptor?
Presynaptic monoamine transporters (inhibit reuptake of 5-ht)
- Sertraline hydrochloride (Zoloft) = selective serotonin reuptake inhibitor (SSRI)
115
Prozac (fluoxetine) -
acts on serotonin (SSRI)
116
What do you use St. John’s Wart?
Depression
| - St. John’s Wart = noncompetitive reuptake inhibitor of serotonin yeah because is for depression
117
What does St. John's Wart do (side effect)?
Decrease the body immunity
118
St johns wart- used for?
Depression, don’t use with benz and HIV medication
| - In HIV pt, it interacts w/ anti-HIV drugs & reduces their function so the immunity decreases
119
Know drugs used for conscious sedation à
SSRIs/BDZ Diazepam and Prozac (fluoexitine)
120
Buspirone -
psychotropic w. anxiolytic; low CNS depression, low psychomotor skill impairment
- Buspar—different from benzodiazepines because it does NOT cause CNS depression, muscle relaxant, or anti-convulsant!!!!!** UNIQUE!!!
Anxiolytic and antidepressant
121
side effect of corticosteroids
gastric ulcers, immunosuppression, acute adrenal insufficiency, osteoporosis, hyperglycemia, redistribution of body fat.
122
Strongest glucocorticoid/long-acting Corticosteroid?
Dexamethasone
123
Negative effect of chronic use glucocorticoids? In
fection, reduce inflammation, hyperglycemia.
124
GI effects with corticosteroids: .
Ulcers
125
Long term side effect of corticosteroids-
osteoporosis and hyperglycemia
126
What is the side effect of prolonged corticosteroid therapy?
Osteoporosis
127
Too much cortisone causes what to bone?
Osteoporosis
Osteopetrosis
Osteosclerosis
Osteoporosis
128
Where do you see moon faces?
steroid treatment
129
Containdation for corticosteroid use:
diabetes (also: HIV, TUBERCULOSIS, CADIDIASIS, PEPTIC ULCER)
130
Aspirin contraindicated with:
corticosteroid use
131
Critical dose of steroids for adrenal insufficiencies -
20 mg of cortisone or its equivalent daily, for 2 weeks within 2 years of dental
treatment
132
QUESTION: Least amount of cortisone to affect the adrenergic system?
2 mg for 2 weeks for 2 years
133
Pt taking corticosteroid with rheumatoid arthritis, pt needs TE, why would you consult with physician?
full blood panel, assess for
adrenal insufficiency
- want to make sure pt can produce enough corticosteroid with addition to what they are taking so you won’t have over inflammatory
response from TE
134
Pt on 3 months tx of steroids, what is your tx?
no tx and consult GP for dose
135
If a pt. has been using 10 mg of corticosteroid for 10 years, what would you do for pt. before any tx?
Have pt continue and increase
| the dose
136
Cortisone exerts its action by binding to intracellular receptor, receptors on membrane, proteins in plasma
intracellular receptor
- Enter cell and bind to cytosolic receptor migrate to nucleus gene expression or with plasma membrane on target cells
137
QUESTION: If pt doesn’t get steroid tx in time for their temporal vasculitis, what will have happened?
• hearing loss
• vision loss
• retro-ocular headache
• vision loss
138
Asthma – long-term asthma give corticosteroid to
decrease inflammation
| - Inhaled corticosteroids are the most effective medications to reduce airway inflammation and mucus production.
139
absolute contraindication for nitrous oxide
severe respiratory compromised, COPD, respiratory infection, pneumothorax/collapsed lung
140
relative contraindications for nitrous
cardiovascular conditions, pregnancy (teratogenic effect), nasal congestion, children with high anxiety,
141
Nitrous oxide is in which container
blue cylinder (oxygen in green)
142
Nitrous oxide MOA
oxidizes the cobalt in vitamin B12, resulting in the inhibition of methionine synthase. Nitrous oxide has greater
analgesic potency than other inhaled anesthetics
143
Dreaming while on nitrous is what? Overdose or normal
normal
144
How do you check to see if the oxygen (reserve) bag is okay?
It shouldn't be that full or that collapsed
145
Device used in evaluation of N20?
Pulse oximeter (measure amount of O2 in blood)
146
The correct total liter flow of nitrous oxide-oxygen is determined by
the amount necessary to keep the reservoir bag 1/3 to 2/3 full.
147
Nitrous oxide: Total flow rate
4-6 L per min
148
Max amount of Nitrous Oxide for a kid
a. 40 %
b. 50%
c. 70%
50%
70 for adult
149
Nitrous for pedo pt is at 50%, what we do?
We stop giving it.
150
Nitrous safety switch happens at what percent?
70%
151
Abuse of nitrous oxide it results in
peripheral neuropathy.
152
Why is nitrous oxide used on children?
Alleviate anxiety
153
Child with fear is best treated with:
nitrous oxide
154
What is an adverse effect of nitrous?
Nausea
155
Most common side effect of nitrous oxide?
Nausea
156
If patient does not have 100% oxygen after nitrous oxide?
Diffusion hypoxia
157
QUESTION: Nitrous should not be given in ____ trimester of pregnancy
1st
158
What trimester is nitrous use contraindicated in?
first
159
When is nitrous contraindicated for a child?
upper respiratory tract infection
160
When is nitrous contraindicated? Asthma or COPD
COPD
161
local anesthetic chemical structure
- Lipophilic group (ex. aromatic ring) = facilitates penetration into nerve sheath
- Intermediate chain (ester or amide link) = ester is more prone to hydrolysis so shorter action duration
- Hydrophilic 20 or 30 amino terminus = weak base that is either charge or uncharged
162
mnemonic to identify ester vs amide anesthetics
esters: no "i" before "caine"
like procaine, benzocaine etc
amides: yes "i" before "caine"
like lidocaine, mepivacaine etc
163
what do onset and duration depend on
dose and lipid solubility (potency)
increased potency with increased lipid solubility because rapid penetration and duration
164
pKa related to onset
lower pKa faster onset
165
which nerver fibers blocked first
A-δ & C fibers (conduct pain sensation) are blocked w/ lower [LA] than Aα motor fibers.
166
what does duration of action of local anesthtic depend on
- diffusion away from site of action – MAJOR FACTOR, depends on vascularity of tissue surrounding the nerve.
- protein binding: high protein bound --> prolong duration (ex. bupivacaine, etidocaine, tetracaine)
167
max dose of 2% lido with 1:100,000 epi
7mg/kg for adult | 4.4mg/kg for pediatrics
168
Max dose of epi for cardio pt:
0.04mg (2 carps of 1:100k epi, 1 carp of 1:50k epi , or 4 carp of 1:200k epi max = 4 carps)
169
Max dose of epi for healthy person:
0.2 mg (8 carp of 1:100k epi)
170
Know where L.A. metabolized?
Amides made in P450 enzyme of liver. Esters in pseudocholinesterase of plasma.
171
Mode of action of Lidocaine:
Block sodium channels
172
What is the mechanism of local anesthetics?
Blocks Na channels intracellularly
173
QUESTION: Mech of action of local anes on nerve axon –
decreases sodium uptake through Na+ axon channels
174
QUESTION: What is the primary reason for putting epi in LA?
to slow its removal from the site. PROLONG DURATION OF ACTION
175
Adding a vasoconstrictor to local anesthesia does all the following EXCEPT:
a. Decreases rate of absorption
b. Increases duration of action
c. Minimizes toxicity and helps homeostasis
d. all of above
d. all of above
176
Local anesthetics broken down by what:
biotransformation
177
QUESTION: Patient got LA injection & started breathing fast, hands and finger are moving, heart rate is up -
You injected into a blood vessel
178
Patient get LA injection, he started to breathe a lot, HR goes up, due to what?
cardiovascular response to vasoconstrictor
179
HTN pt. you just gave 4 carpules of 2% xylocaine with 1:100k epi. BP went up to 200/100. what’s possible mechanism/cause?
Due
| to vasoconstrictor injected into venous system.
180
You gave local anesthetic, BP went down to 100/50 and HR went down too, what could it be due to?
Syncope
181
QUESTION: Infection around a tooth & can't numb patient, why?
Infection reduces the free base amount of anesthetic (lowers pH)
182
Why doesn’t anesthesia work when you have an infection?
```
Decreased pH (acidic environment) leads to more ionized form (less
nonionized)
```
183
Abscess, give LA, decreased in effect, why?
LA is unstable in low pH or LA is in ionized form, needs to be in free base form or
unionized form to cross membranes
184
Where do you inject if infiltration in the area will not be able to avoid the infection?
Block
185
As LA becomes more ionized, it becomes more
water soluble.
186
If you have pain, what would be the hardest to anesthetize?
a. Irreversible pulpitis and maxillary
b. Irreversible pulpitis and mandibular
c. Necrotic pulp and maxillary
d. Necrotic pulp and mandibular
b. Irreversible pulpitis and mandibular
- When irreversible pulpitis, the teeth that are hard to anesthetize are the mandibular molars > mandibular premolars > maxillary
molars & premolars > mandibular anterior teeth.
- fewest problems w/ the maxillary anterior teeth
187
The pKA of an anesthetic will affect what. Metabolism, potency, peak effect, onset
onset
188
When do you know that is it a non-odontogenic pain?
When pain is not relieved with LA
189
How do you treat lidocaine overdose?
Diazepam
190
What slows the metabolism of lidocaine?
Propranolol
- stays in system longer because propranolol slows down heart --> slower blood delivery to liver --> metabolism of lidocaine is slower -->
stays in system longer)
191
How much epi for a cardio pt?
0. 04mg
192
Lidocaine is not metabolized
in plasma (but in liver)
193
QUESTION: Which of the following anesthetic can be used as topical? butamben, dibucaine, lidocaine, oxybuprocaine, pramoxine,
proparacaine, proxymetacaine, and tetracaine
lidocaine
194
What anesthesia do you give IV for ventricular arrhythmia?
a. Quinidine
b. Lidocaine
Lidocaine
195
Cocaine overdose symptoms? pinpoint pupils or mydriasis
mydriasis
196
Which LA causes vasoconstriction?
Cocaine
| - Cocaine has intrinsic vasoconstrictive activity
197
Pt is in rehab for cocaine, what you prescribe for pain?
ADVIL
198
Prilocaine causes
methemoglobinemia (when given over 500mg)
- Symptoms of methemoglobinemia: cyanosis, headache, confusion, weakness, chest pain
because toluidine
199
Administer 600 mg of prilocaine. What possible result?
Methemoglobinemia above 500mg
| - can be treated with methylene blue
200
Levonordefrin is added to certain cartridges containing mepivacaine to: increase .
vasoconstriction
201
QUESTION: best LA to use w/o vasoconstrictor:
a. pro
b. benzo
c. lido
d. articaine
e. mepivicane
mepivicane (carbo)
202
Articaine(septocaine): metabolized in
blood first.
| - unique bc it is an Amide, but has an ester group that is metabolized in the bloodstream
203
Articaine - conjugated at
blood Stream by esterase (unlike other amides, it metabolized in blood stream).
bc has an ester group in addition to amide!
204
Anesthesia of facial nerve will cause all except:
• instant muscular dysfunction in half the face
• excessive salivation
• inability to smile
• inability to close eye
• corner of mouth will droop
• excessive salivation
205
Which drug is LEAST likely to result in an allergy reaction?
a. epinephrine
b. procaine
c. bisulfite
d. lidocaine
a. epinephrine
206
```
What is the best predictor for pulpal anesthesia?
Concentration of anesthetic
Volume of anesthetic
Back pressure
Type of anesthetic
```
Back pressure
- back pressure anesthesia stops hemorrhage, anesthesia after 30 sec, patient doesn’t feel it
207
which roots of M1 does PSA block
not MB
208
QUESTION: Which order will sensation disappear?
1. pain, 2. temp, 3. touch, 4. pressure
209
PSA numbs palatal tissue
false
210
The dentist is performing a block of the maxillary division of the trigeminal nerve into which anatomical area must the local
anesthetic solution be deposited or diffused?
a. pterygomandibular space
b. pterygopalatine space
c. retropharyngeal space
d. retrobulbar space
e. canine space
b. pterygopalatine space
211
For a patient with multiple sclerosis
A. epinephrine is contraindicated in local anesthetic.
B. the amount of anesthetic needed for a given procedure is less than for a normal patient.
C. the amount of anesthetic needed for a given procedure is more than for a normal patient.
D. a single cartridge of anesthetic will most likely not last as long as it would for a normal patient.
A. epinephrine is contraindicated in local anesthetic.
use mepivacaine (levonoderfin)
212
Lidocaine calculation: a cartridge that contains 1.8 ml of solution at a 2% (20mg/ml) lidocaine concentration, how much drug?
36
| mg/ml of drug (20 mg/ml X 1.8 ml/cart. = 36 mg/ml)
213
Lidocaine calculation: 2% lidocaine or 1:100,000. how much anesthetic is in a cartridge?
36mg
214
Max dosage of 2% lidocaine for a kid in mg/kg:
4. 4 mg/kg
| - MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI - 7mg/kg for adult’s 4.4mg/Kg for Pedo
215
Numb the kid, how many hours is the soft tissue numb?
3 hrs.
216
Kids have
higher pulse, basal metabolic activity & higher respiratory rate but lower BP
217
Typical pulse for a 4-year-old is
110 (12 yr. old is 75, adult is 70)
218
20 kg child how many mgs of lidocaine can you give:
88mg
| - Max lidocaine w/ epi for kids = 4.4 mg/kg X 20 kg = 88 mg
219
Kid is 16kg, How many mg max amount of lidocaine?
70mg
220
88 lbs. (40kg) child patient is given 2 cartridges 1.8 ml each of 2% lidocaine with 1: 100,000 epinephrine. Approximate what % of
maximum dosage allowed for this patient was administered?
a. 10%
b. 20%
c. 40%
d. 60%
- 88lbs*2.2 kg/lb. = 40 kg. 40kg*4.4mg/kg (max dose for lido) = 176mg = max dose for this patient; 36 mg x 2 cartridges = 72 mg injected
- -> 72mg injected/176mg = 40%
221
50 lb. patient given 5 carps of 2% lido with 1:100k epi. During procedure 20 min later, he started twitching his arms and legs & went
unconscious (convulses), why? Overdose of lidocaine, overdose of the epi, allergy
Overdose of lidocaine
overdose of epi would give HTN
222
Maximum recommended dosage of lidocaine HCl injected subcutaneously (not IV) when combined with 1:1,00,000 epinephrine is?
a. 100 mg
b. 300 mg
c. 500 mg
d. 1 gram
c. 500 mg
223
3. 6ml of 4% prilocaine contain how much anesthesia?
a. 72 mg
b. 80 mg
c. 144 mg
d. 360 mg
c. 144 mg
| - 4% prilocaine = 40 mg/mL; 3.6 mL x 40 mg/mL = 144 mg
224
How many carps of 4% [X] anesthetic should be given if maximum amount that you want to give is 600mg of drug?
```
- approximately
8 carps (go over calculation)
- 4% = 40 mg/mL = 600/40 = 15 mL/1.8ml (in 1 carp) = 8 carps
```
225
```
The maximum allowable adult dose of mepivacaine is 300 mg. How many milliliters of 2% mepivacaine should be injected to attain
the maximal dosage in an adult patient?
a. 5
b. 10
c. 15
d. 20
e. 25
```
c. 15
| - 2% mepivicaine = 20mg/ml; 300mg/20 = 15 mL
226
Maximum dose of mepivicaine?
400mg
| - Maximum dosage: prilocaine (600 mg) > articaine + lidocaine (500 mg) > Bupivacaine (90 mg)
227
A recently-introduced local anesthetic agent is claimed by the manufacturer to be several times as potent as procaine. The product
is available in 0.05% buffered aqueous solution in 1.8 ml. cartridge. The maximum amount recommended for dental anesthesia over a 4-hour
period is 30 mg. This amount is contained in approximately how many cartridges?
a. 1-9
b. 10-18
c. 19-27
d. 28-36
e. Greater than 36
- 0.05% = 0.5 mg/mL = 30m mg/ (0.5 mg/mL) = 60 mL/ (1.8 mL/carp) = 33.3 carp
228
What determines max. dose for anesthetic for a child?
Weight
229
A 26-month old child w/ 12 carious teeth. How to treat?
a. General Anesthesia
b. Oral sedation
c. Nitrous oxide
d. local anesthesia
a. General Anesthesia
230
QUESTION: Kid under general anesthesia:
give chloral hydrate and midazolam
231
QUESTION: Pt is under oral sedation. You should monitor everything except?
* Respiration
* Oxygen saturation level
* Electo cardiogram
* Skin and oral mucosa color
• Electo cardiogram
232
#1 cause for problems during IV sedation?
Hypoxia
233
A 77 years old female 110 lbs. weight requires removal of mandibular teeth under local anesthesia. She is apprehensive. The
appropriate dose of IV diazepam to sedate her?
a. 5 mg
b. 10 mg
c. 15 mg
d. 20 mg
b. 10 mg
| - 2mg for midazolam IV, 10 mg diazepam IV
234
Pt goes home from elective orthognathic sx and in 24hrs, without sign of inflam or edema, but a fever of 102 F-
Atelectasia (or pneumotosis – depending on answers)
| - Atelectasia and pneumotosis = most common cause of fever within 24 hour of GA
235
Pre-med with odontogenic infection:
* Amox for SBE prophylaxis
* Penicillin for odontogenic infections
* Tetracycline for periodontal infections (better penetration, stays in bone tissue longer)
236
Which procedure least likely to produce bacteremia? extraction, non-surgical endo, oral prophylaxis
oral prophylaxis
237
Condition that DOES NOT require antibiotic prophylaxis
o Prosthetic heart valve
o Rheumatic heart valve
o Congenital heart formations
o Cardiac pacemaker
o Cardiac pacemaker
238
Indication for antibiotic prophylaxis:
artificial heart valve, previous IE, congenital heart (valvular) defect, total joint replacement w/ co-morbidity
239
Prophylactic treatment for prosthetic heart valves –
premedication required
240
Prophylactic treatment for Pacemaker –
No premedication required
| - Just stay away from ultrasonic and electric testing/ electrocautery
241
What is the pre-medication dosage for child 44 lbs.?
1-gram amoxicillin 1 hour prior Tx.
| - 44 lbs. = 20Kg X 50mg/Kg = 1000mg = 1g Amoxicillin
242
Pt w/ mitral valve prolapse w/ regurgitation –
don’t premedicate
243
(Patient’s medical tab say he is allergic to Amoxicillin), He needs to be premediated, what do you prescribe?
Clindamycin, 600mg
| 1hr before the dude shows up for the appointment.
244
Man has accident and pin placed in arm. What antibiotic prophylaxis does he need?
None
245
QUESTION: Pt w/ total knee replacement but was taking Amoxicillin for a while; how do you premedicate?
NO (or MED CONSULT)
246
Pt had hip replacement 10 years ago, what do you use to premedicate?
No premedication needed
247
Pt needs antibiotic prophylaxis. He is taking penicillin already, what do you give him?
Clindamycin
248
Regular premedication case:
Give amoxicillin 2g 1hr b4
249
What is recommended prophylaxis for pt that can’t take penicillin?
Clindamycin
250
why premedicate?
benefits of premedication outweigh potential harm associated with penicillin
251
Endocarditis definition:
inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or
prosthetic valves)
252
QUESTION: Infectious Endocarditis pre-medications definition?
For patients who has cardiovascular problems and are at risk of infection over
their lifetime.
253
When is it appropriate to prescribe antibiotic prophylaxis in patient with previous infective endocarditis?
if consequence of
| potential infection is detrimental to life
254
```
Which of these procedures pose a risk for Infective Endocarditis?
• Primary teeth shedding
• RCT
• Some sort of surgery
• IA injection
```
• Some sort of surgery
255
Guideline of antibiotic prophylaxis, especially for kids -
for kids, Amox is 50mg/kg and Clinda is 20 mg/kg
256
QUESTION: Know the doses for someone that is allergic to penicillin, what you can give them?
Clarithromycin 500mg
257
If a patient is allergic to Ampicillin, what else can you premedicate with?
Clindamycin 600mg 1, Cephalexin 2g, Azithromycin 500
| mg, or Clarithromycin 500 mg all 1-hr before.
258
Most bacteriostatic meds works by:
Inhibiting protein synthesis
259
Broad spectrum antibiotics like tetracycline:
increase superinfection and resistance.
260
broad spectrum antibiotics -->
increase superinfection (infxn by candidiasis) and resistance.
261
Why don’t we use broad spectrum antibiotics?
Produce resistant bacteria
262
If you increase spectrum of bacteria, it leads to
more infections
263
QUESTION: Antibiotics are least useful for tx of this periodontal conditions: LAP, NUG, chronic periodontitis
chronic periodontitis
264
Antibiotic metabolism is affected by chronic tx with what drugs? Benzos, barbs, SSRI, TCA
Benzos
265
Pt is taking an antibiotic, which is metabolized in the liver. Metabolism of this antibiotic is decreased by which drug?
a. TCA
b. SSRI
c. phenothiazine
d. diazepam
diazepam
266
You give antibiotics through IV, patient experience sudden allergic reaction, what’s the FIRST thing you do?
remove the IV line.
267
Penicillin, why is this so good to give as an antibiotic?
Low toxicity, cheap
268
Keflex (cephalexin) mechanism is closely related to what
penicillin
269
What is the effect of Penicillin and Cephalosporin’s
(cell wall synthesis) via beta lactam ring
270
Transpeptidase enzyme is inhibited by
penicillin
| - Transpeptidase, a bacterial enzyme that cross-links the peptidoglycan chains to form rigid cell walls
271
```
Which of the following penicillin would be used to treat a Pseudomonas infection?
Nafcillin (Unipen)
Amoxicillin (Amoxil)
Benzedrine penicillin (Bicillin)
Phenoxymethyl penicillin (Pen-Vee K)
Ticarcillin (Thar)
```
- Ticarcillin is a carboxypenicillin. Its main use is for the treatment of Gram-negative bacteria, particularly Pseudomonas aeruginosa.
272
Why do penicillins have decreased effectiveness in abscess?
hyaluronidase, pen unable to reach organism
273
With cyst, why doesn’t penicillin work well?
b/c can’t penetrate cyst barrier
274
#1 dental antibiotic for an infection within 24hrs is
Pen VK 1gm booster and 500mg q6h
Penicillin V potassium is a slow-onset antibiotic, bacteriocidal against gram (+) cocci & major pathogen of mixed anaerobic infections. In
the absence of an allergic reaction, penicillin VK is the drug of choice in treating dental infections.
if early (first 3 days of infection): penicillin VK, amoxicillin, clindamycin, cephalexin
275
For an infection:
give PenVK 500mg à give 1g at once and then 500 mg every 6 hours (7 days)
276
What antibiotic used for endo, pulpal involvement?
PEN VK (yes it actually says VK together)
277
cephalosporin spectrum vs penicillin spectrum
cephalosporin is narrower
cephalosporin is a beta lactam antibiotic, bactericidal, 1st generation, more concentrated on gram (+), more resistant to penicillinase
278
broadest abx effect
chlortetracycline
279
Tetracycline mechanism of action:
protein synthesis inhibitor (30s), bacteriostatic
280
How does tetracycline work?
Block activity of collagenase, bind to 30S (block AA linked tRNA)
- Tetracycline is usually not used because they cause yeast infections, as well opportunistic infect.
281
Doxycycline
- Doxycycline reversibly binds to the 30 S ribosomal subunits and possibly the 50S ribosomal subunit(s), blocking the binding of aminoacyl
tRNA to the mRNA and inhibiting bacterial protein synthesis.
- It’s a tetracycline, treats malaria
282
20 mg of doxycycline action in periodontal dressing
20 mg = no anti-bacterial effect but it inhibits collagenase
283
QUESTION: Which antibiotic is anti-microbial and anti-collagenlyctic? clindamycin, doxycycline, metronidazole, amoxicillin
doxycycline
284
```
Tetracycline does not do one of the following:
reduce host response
reduce bacterial infection
reduce host collagenase
decrease gingival crevicular fluid flow
```
decrease gingival crevicular fluid flow
285
Minocycline & Doxycycline:
Both increase GCF secretion, both released in GCF (Gingival crevicular fluid)
- tetracycline is more concentrated in GCF more than in blood
286
Mechanism of action of Minocycline in the Arestin:
decrease collagenases activity
| - Minocycline, another tetracycline antibiotic, has also been shown to inhibit MMP activity.
287
What drug has the highest concentration in crevicular fluid?
Tetracycline
288
Which one of the following drug is chelated with Ca++?
Tetracycline
289
what reduces absorption of tetracycline
milk and antacids
Don’t take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline.
290
What is most affected by tetracycline? Enamel or Dentin
Dentin, causes intrinsic stain
291
What age are you most likely get infection that resulted in enamel hypoplasia or tetracycline staining?
before 4 months in utero for
| primary; birth for permanent
292
What medication do you not give to lactating female?
Codeine and tetracycline
293
Child comes in with an oral infection and is NOT allergic to Pen. What do you prescribe?
a. Penicillin
b. Amoxicillin
c. Tetracycline
Amoxicillin
294
What happens when you have penicillin and decide to prescribe tetracycline with it?
Tetracycline will decrease the efficacy of
Penicillin.
- Don’t do it. Tetracline is bacteriostatic whereas penicillin is bacteriocidal. The two mechanisms of action (CIDAL+STATIC) cancel each other
out because when you need bacterial growth to actually use penicillin, but you don’t have that growth when you prescribe Tetracycline.
295
QUESTION: Penicillin and erythromycin taken together cause:
•summation
•potentiation
•antagonists
antagonists
296
#1 side-effect of erythromycin is?
Stomach upset.
297
In lethal doses of erythromycin, what do you see? Hepatocellular, GI damage
GI damage
298
Myasthenia gravis patient, what can’t you give them? Erythromycin, clarithromycin, penicillin or Impemene
Erythromycin
299
If you have maxillary sinusitis, what antibiotic would you give?
Amoxicillin with clavulanic Acid (Augmentin)
- Clavulanic acid increases spectrum of action & restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.
300
What the clavulanic acid do when is mixed with amoxicillin (Augmentin)?
decrease sensitivity from b-lactamase
301
clavulanic acid in amoxicillin -
prevents beta lactam degradation by beta lactamase producing bacteria
302
Augmentin:
blocks the action of penicillinase, penicillinase resistant
303
Metronidazole -
prescribed in necrotizing ulcerative gingivitis (NUG) or aggressive periodontitis
- metronidazole is contraindicated in patients on alcohol causing disulfiram type of reaction
- has red urine
304
Antibiotic against only anaerobes parasites (protozoa)?
Metronidazole
305
Clostridium difficile (colon inflammation) is treated with
metronidazole. Unless pt is pregnant or breastfeeding, then use
vancomycin.
306
QUESTION: Best treatment of localized aggressive periodontitis:
tetracycline, Doxycycline
307
Which antibiotic is NOT inhibit cell wall synthesis?
* amoxicillin
* vancomycin
* azithromycin
azithromycin (this inhibits protein synthesis)
308
QUESTION: Gentamycin (aminoglycosides) - May cause
auditory nerve deafness
309
aminoglycosides: toxicity
ototoxicity and nephro
310
Pseudomonas colitis:
c. difficile and clindamycin
311
Which of the following describes clindamycin?
a. inhibits cell wall synthesis
b. does not penetrate well into bony tissue
c. it usually given in combination with erythromycin
d. is effective against gram-negative bacteria only
e. is effective against most anaerobes
e. is effective against most anaerobes
312
Which of the following describes ciprofloxacin (Cipro®)?
Inhibits cell wall synthesis.
Effective against Pseudomonas aeruginosa.
Effective only against anaerobic bacteria.
An antibiotic-of-choice for treating otitis media in young children.
Effective against oral anaerobes.
Effective against Pseudomonas aeruginosa.
313
QUESTION: Chloramphenicol (antibiotic) adverse effect
aplastic anemia
314
Anti-cancer drugs are least likely to cause what? Ulcers, thromboembolism
thromboembolism
315
What’s an adverse effect of a drug that you can’t mix with antibiotics?
Methotrexate because it won’t clear out of the system,
specifically with amoxicillin.
- Penicillin can decrease elimination of methotrexate (cancer drug), increasing risk of methotrexate toxicity, which can cause seizures.
316
Methotrexate (MTX) is an:
antimetabolite and antifolate drug. Used for tx of cancer, autoimmune diseases, ectopic
pregnancy, and for the induction of abortions. It inhibits folic acid metabolism.
317
QUESTION: Which drug will be used to treat an overdose of methotrexate?
Leucovorin
| - Methotrexate toxicity effects can be reversed by folic acid (leukovorin)
318
Which medication for anticancer works on folate synthesis/ prevents folic acids synthesis/prevents folic acid production:
methotrexate
319
Methotrexate is an anti-cancer drug that inhibits
folate reductase
320
Drug agonist of folic acid?
Sulfa, Trimethoprim, Methotrexate
321
Anti-cancer drug (Mechlorethamine), that was an alkylating agent, what was it effect?
Neurotoxic
322
Alkalizing anti-cancer drug called procarbazine causes:
Hepatotoxicity
- Inhibits CYP450, increased effect of barbiturates, phenothiazenes, and narcotics. Has monoamine oxidase inhibition properties (MAOI),
and should not be taken with most antidepressants and certain migraine medications.
323
Non-alkylating anti-cancer side effect?
myelosuppression (BONE MARROW SUPPRESSION)
324
amantadiene is for what
influenza A
325
tamiflu, oseltamivirm zanamivir is tx for what
influenza A and B
326
acyclovir
herpes 1, 2, VZV, EBV
327
gancyclovir
CMV
328
ribavirin
Hep C and RSV
329
CMV tx
gancyclovir
330
Hep C tx
ribavirin
331
Picture of lesion at corner of mouth, patient says it
comes and goes now and then, what type of infection would you
suspect?
Viral
332
Amantadine is an anti-viral and anti-parkinsonian or
| anti-TB and its anti-viral.
anti-viral and anti-parkinsonian
333
What anti-viral is used to for all the these: HSV, VZV, CMV?
Valacyclovir
| and acyclovir
334
What virus causes postherpetic neuralgia?
VZV
335
Acyclovir has selective toxicity mechanism of action b/c:
inhibits viral mRNA
inhibits cellular mRNA in infected cells
only phosphorylated and activated in infected cells
only phosphorylated and activated in infected cells
| - Inhibits mRNA, doesn’t work on DNA
336
HIV patient with sinusitis due to what?
Mucormycosis
337
Most reliable measure of HIV progression? CD4 count, viral load
CD4 count
338
CD4 count and T-cell count for HIV symptoms: pt had HIV
CD4 less than 200
339
Pt has viral load of 100,000:
pt has high virus load and prone to infection
340
Pt’s viral load was 100,000, and T cell count was 50. What is the right statement?
Pt’s T cell count is too low
| - Healthy T-cell count: 500-1500 units/ml
341
Which of the following is not a risk of oral cancer
a. Tobacco
b. Alcohol
c. HPV
d. HIV
HIV
342
Which of the following agents is used for HIV infection?
a. amantadine
b. acyclovir
c. zidovudine
d. ribavirin
e. isoniazid
c. zidovudine (also called AZT)
a. amantadine (Parkinson’s and influenza A)
b. acyclovir (Herpes)
c. zidovudine (also called AZT)
d. ribavirin (Hep C; also RSV)
e. isoniazid (TB; also streptomycin)
343
What oral manifestation is seen in children with HIV?
Candidiasis
344
Fungal agent for HIV:
Fluconazole or ketoconazole
345
Candidiasis & HIV, what do you give systemic or topical anti-fungal?
Nystatin
346
Azoles:
anti-fungal, inhibit lanosterol conversion to ergosterol
347
Polyenes
anti-fungal, bind to ergosterol on cell membrane and create a pore/transmembrane channel
o Includes Amphotericin B
348
Topical anti-fungal:
Mycelex (clotrimazole), Nystatin, Ketoconazole
349
Systemic anti-fungal:
Fluconazole (Diflucan), Amphotericin B, Ketoconazole
| - Know “FAK”
350
Nystatin how to :
“swish & swallow”
351
antifungal troches
clotrimazole, 5/day x 14; DO NOT CHEW
352
systemic antifungals use
fluco - 100mg.day
353
Medication for angular chelitis:
nystatin
354
Oral anti-fungal infection:
Nystatin
| - Clotrimazole(Mycelex) and Nystatin are oral anti-fungals
355
Griseofulvin:
used for athlete’s foot.
| - treat fungal infections such as ringworm, "jock itch," and athlete's foot.
356
Clotrimazole mechanism of action:
Alter the enzyme for synthesis of ergosterol, which alters cell membrane permeability
357
Mechanism of miconazole (antifungal):
inhibits the synthesis of ergosterol a critical component of the cell membrane
358
Best topical antifungal?
Mycelex
