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NBDE II Board Busters > Pharmacology > Flashcards

Flashcards in Pharmacology Deck (159):
1

catecholamines pass the blood brain barrier well? poorly?

very poorly

2

acetylcholine affects what 2 receptors

nicotinic
muscarinic

secreted by cholinergic fibers

after a threshold stimulus, liberation of Ach alters the cell membrane's permeability

3

epinephrine is a direct acting catecholamine and adrenergic agonist or antagonist?

AGONIST

4

norepinephrine is a direct acting catecholamine that works through which receptors in the CNS?

a1, a2, b-adrenergics

5

dopamine (intropin) is an immediate precursor to?

acts through which 2 subtype receptors?

NE

D1 - activates adenylyl cyclase
D2 - inhibits adenylyl cyclase

6

serotonin (5-hydroxytryptamine) works through at least 14 subreceptors __ type neurons

tryptominergic

7

the major inhibitory neurotransmitter in the CNS is

GABA

8

opioid peptides include (3)

beta-endorphin
enkephalines
dynorphin

9

these 2 nts have EXCITATORY effects on neurons everywhere in the CNS

glutamate
aspartate

10

catecholamines are a group of

sympathomimetic compounds

11

these 2 catecholamines stimulate the myocardium

epi
NE

12

clinically, epi is for

anaphylaxis, glaucoma, asthma, vasoconstriction to prolong anesthesia

13

clinically, norepi causes

vasoconstriction in hypotension

14

CNS stimulants include

1. analeptics
2. xanthines
3. sympathomimetic amines

1. analeptics - can overcome drug-induced RESPIRATORY DEPRESSION and hypnosis [metrazol, coramine, dopram, picrotoxin, strychnine]

2. xanthines - improve mental ALERTNESS, reduce urge to sleep, elevate MOOD [caffeine, theophylline, theobromine]

3. sympathomimetic amines - to treat NARCOLEPSY, OBESITY, ADHD [amphetamines, methylphenidate, phenmetrazine]

15

__ is the only xanthine important in asthma tx, by stimulating medulla respiratory centers to cause bronchial dilation

theophylline

16

caffeinism occurs if you intake > __ mg caffeine per day

600-750 (10 cups)

> 1000 mg is TOXIC

17

caffeine stimulates the CNS unequally, with the __ being the most excited, and __ least excited

CORTEX most,
spinal cord least

18

the Autonomic Nervous System (ANS) is an efferent motor system that fxns independent of consciousness and controls __

automatic VISCERAL fxns required for life

19

drugs block or mimic ANS transmitters to clinically modify what functions?

autonomic fxns like: cardiac and smooth muscle, vascular endothelium, exocrine glands, presynaptic nerve terminals)

20

ANS consists of 2 parts

sympathetic nervous system - response to STRESS, fight or flight

parasympathetic - at REST, rest and digest

21

SYMPATHETIC NERVOUS SYSTEM FUNCTION

-epi released from adrenal medulla
-HR incr (tachycardia)
-CO, Bp, blood flows from skin and internal organs into SKELETAL MUSCLE
-energy stores are mobilized
-pupils dilate (MYDRIASIS
-bronchioles dilate
-FEAR activates ANS sympathetics -> HYPERTENSION (a1 adrenergic receptors cause arteriolar vasoconstriction)
-DECR. salivation

22

PARASYMPATHETIC NERVOUS SYSTEM FUNCTION

-effectors are activated as needed, does not discharge as a complete system
-Cranial nerves with PS activity = 3, 7, 9, 10
-MIOSIS (pupils constrict)
-bradycardia
-incr. salivation

23

4 types of drug-receptor binding

1. ionic - from electrostatic attraction btw ions of opp. charge
2. H bonds - btw polar (water) molecules
3. Van der Waals - weak interactions when atoms close
4. Hydrophobic - btw drug, receptor and aqueous environment

24

covalent bonds

sharing e- by pair of atoms, for structural integrity of molecules, NOT involved in drug-receptor rxns

25

4 families of physiologic receptors

1. receptors as enzymes (cell surface protein kinases) - kinases work by phosphorylating proteins

2. ion channels - drugs bind channels to cause opening or closing -> alters cell membrane potential

3. G-protein coupled receptors - second messengers like cyclic AMP are produced to cause an effect in the cell

4. Receptors in the cell nucleus - receptors for steroid hormones are soluble DNA-transcription factors in nucleus

26

alpha (a) receptors are primarily excitatory or inhibitory?

located where?

EXCITATORY

vascular smooth muscle, pre-synaptic nerve terminals, blood platelets, fat cells, CNS neurons

*exception, some a-receptors relax GI smooth muscle

27

2 types of alpha receptors

1. post junctional a1 adrenergic (MORE COMMON)
-radial smooth muscle in iris, arteries/arterioles/veins, GI tract
-causes CONTRACTION and VASOCONSTRICTION
-in arterioles of skin, mucosa, viscera, kidney

2. pre-junctional a2 adrenergic
-INHIBITS release of NE
-on presynaptic nerve endings to stop NE release
-on post-synaptic endings in CNS to DECR. sympathetic tone

28

what nts combine with both types of alpha receptors

epi and norepi

29

beta receptors are mainly responsible for excitatory or inhibitory effects?

INHIBITORY, like vasodilation and relaxation of respiratory smooth muscle

*exception: some mediate excitatory increases in heart's force and rate of contraction

30

2 types of beta receptors

1. post-junctional b1 adrenergic
-in HEART myocardium cell, intestine smooth muscle, adipose tissue
-NE and epi both bind to INCR. HR, CO, BP, force of contraction

2. post-junctional b2 adrenergic (MOST COMMON)
-in BRONCHIOLAR and VASCULAR smooth muscle
-cause VASODILATION in bronchial and uterine muscle to cause relaxation
-incr. blood glucose
-ONLY EPI (NE combines weakly or not at all to these)

31

epi combines with __ receptors to vasodilate bronchioles and tx asthma?

b-2 adrenergic receptors

32

pharmacologic agonist

binds to physiologic receptors to cause specific cellular effects, a full response

33

pharmacologic antagonist

binds receptor, does not trigger effect
-agonist can't reach receptor site

34

competitive antagonism is when?

non-competitive antagonism is when?

-response CAN be achieved by increasing agonist dose

-NO response with increasing agonist

35

sympathomimetic agents (adrenergic AGONISTS) do what?

mimic effects of STIMULATION of organs/structures of the SYMPATHETIC nervous system

36

uses for adrenergic agonist therapy includes

1. control hemorrhage - a1 vasoconstriction
2. allergic shock (anaphylaxis) - a1 vasoconstriction, b2 airway dilation, b1 incr. cardiac output
3. nasal decongestant - a1 vasoconstriction
4. bronchial relxation/airway - b2 agonist
5. cardiac stimulation - b1 agonist

37

__ is the prototypical adrenergic agonist

epi

38

in anaphylaxis, epi works on what receptors, doing what?

a1 - vasoconstriction to incr. BP
b1 - incr. cardiac output
b2 - dilates bronchial tubes

39

bronchodilators (b2 agonists) to tx acute asthma include

epi
albuterol
salmeterol
metaproterenol

40

amionphylline is a theophylline compound used for

bronchodilation for asthma or COPD, RELAX bronchial smooth muscle, a CNS stimulant that tx asthma

41

epi, penylephrine, albuterol, and isoproternol are all __ agonists

adrenergic; bind to adrenergic receptors

42

Direct acting Sympathomimetic agents - interact with a or b receptors, can be receptor selective or non-selective

Include ->

phenylephrine - a1 selective agonist, nasal decongestant, mydriatic, tx chronic orthostatic hypotension, 100x less potent than epi

clonidine - a2 selective agonist, anti-hypertensive

dobutamine - b1 selective agonist

terbutaline - b2 selective agonist, tx COPD, bronchopasm

albuterol - b2 selective agonist, long term tx obstructive airway diseases, ER tx bronchospasm, delay premature delivery

43

epinephrine (adrenaline) is a vasoconstrictor and stimulates what receptors

a1,2
b1,2

direct acting agonist

actions: vasoconstriction, incr BP, bronchodilation (b2), decr. blood volume in nasal tissue, OPPOSITE effects of histamine

44

epi is contraindicated in pts with

common epi side effects

ANGINA, cause of cardistimulatory effects

headaches, agitation (anxiety), tachycardia

45

norepinephrine is a __ agonist

a1, 2
b1

46

isoproterenol is a __ agonist

b1,2

MOST POTENT BRONCHODILATOR

47

Indirect acting Sympathomimetic agents - cause release of stored NE at post-ganglionic nerve endings, similar to STIMULATING the SYMPATHETIC nervous system

includes these drugs:

tyramine
amphetamine
methamphetamine
hydroxyamphetamine
methoxamine
ephadrine

48

DA, EPI, NE< isoproterenol and phenylephrine are used as pressor agents to?

maintain BP in vascular shock; bronchodilators for asthma attacks and anaphylactick shock

49

amphetamines

stimulate CNS and PND
increase systolic and diastolic bp
weak bronchodilator and respiratory stimulant

pass readily in CNS and cause rapid release of NE in brain

50

ADHD drugs

methylphenidate (ritalin) - mild CNS stimulant
focalin - new form of above
concerta - long acting ritalin
Adderal (mixed amphetamine salts)
strattera (atemoxetine) - non-stimulant
metadate CR - controlled delivery
dextroamphetamine (dexedrine)

51

dextroamphetamine (dexedrine) is used to treat

narcolepsy

52

4 types of Sympatholytic agents (anti-adrenergic) that act in a way OPPOSITE to the sympathetic nervous system. 4 types that all treat hypertension are

1. beta-adrenergic receptor blockers (b blockers)

2. alpha-adrenergic receptor blockers (a blockers)

3. centrally-acting anti-hypertensive agents (a 2 selective agonists)

4. neuronal depleting agents

53

beta blockers treat?

side effects?

hypertension, angina, cardiac arrhythmias, MI, glaucoma, prophylaxis of migraine

weakness, drowsiness

54

propranolol, timolol, nadolol

block b1 and b2, so they are NON-selective beta blockers

propranolol is the drug of choice for adrenergically induced arrythmias

55

non-selective b blockers are contraindicated in pts with

asthma or other chronic obstructive airway disease -> cause fatal bronchospasm

56

acebutolol (sectral) is a

b1 selective antagonist, tx HTN and arrhythmias

57

metoprolol is a

competitive b1 cardioselective antagonist

tx HTN, acute angina pectoris, good after heart attack

58

atenolol (tenormin) is a

competitive b1 cardioselective antagonist

tx HTN, chronic angina pectoris, after MI, LONG PLASMA 1/2 life

excreted by kidneyes

59

___ and __ are longer acting and more predictable than propranolol, b1 selective so SAFER to use in pts with asthma or bronchitis

metoprolol
atenolol

60

a blockers can cause

tachycardia, lower BP, vasodilation, orthostatic hypotension

any alpha antagonist can cause EPI reversal

main effects - reduce BP, reflex tachycardia

61

a blockers act by?

major adverse effect is?

competitively inhibiting catecholamines at the a receptor site -> blood vessels DILATE

hypotension

62

after vasovagal syncope, __ is the 2nd most likely cause of transient unconsciousness in the dental office

orthostatic hypotension

63

factors that can cause orthostatic hypotension include

drugs, bad postural reflex, pregnancy, Addison's, CHRONIC ORTHOSTATIC HYPOTENSION (Shy-Drager Syndrome)

increases with age

also an adverse effect of NSAIDs

64

drugs that can cause orthostatic hypotension (5)

1. antihypertensives
2. phenothiazines
3. tricyclic antidepressants
4. narcotics
5. antiparkinson drugs

65

2 types of alpha blockers (selective and non-selective)

a1 to treat?

non-selectives do not treat what conditions?

1. Selective a1 blockers - tx cardiac conditions (HTN, benign prostatic hyperplasia (BPH))

2. Non-Selective block a1 and a2, NOT for cardiac conditions cause it can cause tachycardia. Used for pre-surgery mgmt of PHEOCHROMOCYTOMA and RAYNAUD'S PHENOMENON

66

selective a1 blockers include (3)

1. Doxazosin (cardura) - tx HTN, long duration of action
2. Prazosin (minipress) - not used much
3. Terazosin (Hytrin) - mild to mod HTN, and BPH

67

non-selective a1 and a2 blockers include (2)

1. Tolazine (Priscoline) - direct peripheral vasodilation, treats persistent pulmonary HTN of newborn
2. PHentolamine HCl (Regiitine) and PHenoxybenzamine HCl (Dibenzylene) - manage pheochromocytoma (adrenal medulla tumor)

68

pheochromocytoma is a tumor of the?

adrenal medulla
releases excess EPI and NE -> causes HTN, tachycardia, arrhythmias

69

epi reversal is a predictable result of using epi with a pt who received what kind of drug?

alpha blocker

without blockers, epi and NE will cause BP to increase
after a blocker, the pressor effect of NE is reduced and EPi causes a fall in BP (because NE only stimulates a receptors and has no b2 effects)

after blocking a receptors, only b can be stimulated

70

pressor response produces

increase in BP and is mediated by a receptors
-depressor response produces decr. bp, mediated by b2 receptors

71

centrally acting anti-HTN agents are a2 selective agonists that

include (3)

reduce BP by reducing cardiac output, vascular resistance

1. Clonidine - a2 selective, in combo with thiazide and hydralazine, relaxes blood vessels
2. Guanfacine and Guanabenz - stimulate a2 to inhibit sympathetic outflow, reduce peripheral resistance
3. Methyldopa - combine with diuretic to produce FALSE transmitter tat replaces NE, good to tx HTN in pts with RENAL DAMAGE

72

adverse effects of methyldopa

orthostatic hypotension, bradycardia, sedation and fevere, GI colitis, hepatitis, cirrhosis

73

neuronal depleting agents deplete

includes (2)

catecholamine (NE, EPI, serotonin)

1. Reserpine blocks uptake of NE, EPI, serotonin
2. Guanethidin - blocks release of NE

74

a and b adrenergic blockers act by

competitive inhibition of postjunctional adrenergic receptors

75

autonomic nervous system has __ fibers that secrete __, and __ fibers that secrete norepi, epi, or dopamine.

cholinergic fibers secrete acetylcholine

adrenergic fibers secrete norepi, epi, dopamine (catecholamines)

76

cholinergic fibers (neurons) release/secrete __

2 kinds

ACh
-primary nt

1. Preganglionic sympathetic & parasympathetic

2. Postganglionic parasympathetic - a MUSCARINIC response

77

postganglionic SYMPathetic fibers are what kind?

adrenergic!! not cholinergic

78

postganglionic sympathetic fibers that innervate sweat glands secrete

acetylcholine

79

acetylcholine receptors are divided into 2 groups

1. Muscarinic
-autonomic effector cells in CNS (heart, vascular endotheliu, smooth muscle, prseynaptic nerve terminals, exocrine glands)
-respond to MUSCARINE and ACh

2. Nicotinic
-in ganglia, skeletal muscle end plates, CNS
-respond to NICOTINE and ACh
-acts at neuromuscular jxn of skeletal muscle

80

2 major nicotinic receptors

1. at neuromuscular jxns at somatic nervous systems - where neuromuscular blockers work here

2. at autonomic ganglia in both sympathetic and parasympathetic systems - ganglionic blockers work here

81

ACh is the chemical mediator at:

all autonomic ganglia, parasympathetic postganglionic synapses, transmitter at neuromuscular junction in skeletal muscle and sweat glands

82

ACh causes alteration in cell membrane permeability to produce these actions:

cholinergic drug actions - slow hear, miosis, simtulate bronchi, GI tract, gallbladder, bile duct, bladder, ureters, stimulate sweat + salivary + tear + bronchial glands

83

cholinesterase inhibitors increase/decrease salivation?

increases cause it reduces acetylcholine metabolism

84

overdose of cholinergic drugs cause

sweating, urination, bradycardia, copieous saliva

but NOT mydriasis (dilation)

85

all __ receptors are CHOLINERGIC

M receptors

bind acetylcholine and are antagonized by ATROPINE

86

3 classes of cholinergic agonists

choline esters

cholinergic alkaloids

cholinesterase inhibitors

-stimulate muscarinic sites by mimicking ACh, BUT if these are given before ACh, then the action of ACh is enhanced and prolonged

87

indirect acting cholinergic agonists (cholinesterase inhibitors) act by

cause a __ effect

inhibit at what sites?

increase the effects of ACh in the autonomic nervous system and at neuromuscular junctions

cause a CHOLINERGIC EFFECT -> eventually causes muscle paralysis

they inhibit acetylcholinesterase at BOTH muscarinic and nicotinic sites

88

indirect acting cholinergic agonists (cholinesterase inhibitors) include (4)

1. edrophonium - good to dx myasthenia gravis
2. neostigmine and pyridostigmine - tx myasthenia gravis, can reverse blockade
3. malathion and parathion - insecticides
4. physostigmine

89

pralidoxime (protopam) is a cholinesterase reactivator used as an antidoe to reverse?

muscle paralysis due to organophosphate anticholinesterase pesticide poisoning

90

symptoms of organophosphate poisoning

excess salivation, bronchoconstriciton, diarrhea, skeletal muscle fasciculations (twitching)

91

organophosphates inhibit cholinesterase. 5 of them are

1. isoflurophate and echothiophate - tx glaucoma
2. malathion - insecticide
3. parathion - insecticide
4. tabun
5. metrifonate - anthelmintic

92

direct acting cholinergics are in 2 gruops

1. choline ESTERS - decrease BP due to general vasodilation, flushing of skin, slow HR [carbachol to produce miosis, bethanecol for post-op ab distension and urinary retention]

2. cholinergic ALKALOIDS
-pilocarpine used as a MIOTIC and to tx open-angle glaucoma and xerostomia

93

xerostima is caused by

meds, cancer therapy, Sjogren's syndrome, head and neck trauma, bone marrow transplants, endocrine disorders, etc.

94

cholinergics tx dry mouth by inducing salivation. cholinergics used are (2)

1. pilocarpine (salagen) - cholinergic agonist and alkaloid, tx xerostomia caused by salivary gland hypofunction

2. cevimeline (evoxac) tx xerostomia in pts with Sjogren's

95

cholinergic crisis symptoms

bradycardia, lacrimation, extreme salivation, vasodilation, muscle weakness

96

typical cholinergic effects caused by stimulation of ACh (cholinergic) receptors are

salivation, miosis, excess sweating, flushing, incr. GI motility and bradycardia

97

mecamylamine (inversine) is a __ blocking drug

nicotinic ganglion

98

anti-cholinergic (anti-muscarinic) drugs produce opposite effects of cholinergics like

xerostomia (block postganglionic cholinergic fibers), mydriasis (dilation), anti-spasmodic, decr. GI motility, less gastric and salivary secretions, tachyardia

99

anti-cholinergics are contraindicated in __ patients

GLAUCOMA, cardio probs, GI obstruction, asthma

100

anticholinergics work by

therapy for:

preventing ACh from occupying the same receptor

Parkinson's, motion sickness, bladder syndrome, traveler's diarrhea

101

anticholinergic/antimuscarinic drugs include

glycopyrrolate - diarrhea, bladder
propantheline bromide - diarrhea
benzotropine - Parkinson's
trihexyphenidyl HCl - Parkinson's
atropine sulfate - causes mydriases, cycloplegia
scopolamine - reduces motion sickness
belladonna derivatives

102

nicotinic receptor antagonists (nicotinic blockers) divided into

1. Ganglionic blockers

2. Neuromuscular blockers

1. Ganglionic - not used cause of parasympathetic blockade that causes xerostomia, constipation, blurred vision, postuarl hypotension [mecamylamine, trimethaphan for HTN in emergency, cause fall in BP]

2. Neuromuscular - complete skeletal muscle relaxation and helps in endotracheal intubation, interact with nicotinic receptors, danger is it can lead to paralysis

103

2 classes of neuromuscular blockers include

1. non-depolarizing (competitive) - cause paralysis [Tubocurare (curare] is the prototype]
*Neostigmine/Pyridostigmine used to REVERSE paralysis

2. depolarizing (non-competitive) - [Succinylcholine prototype], used in caution with pts with low pseudocholinesterase (can cause respiratory failure)

104

Skeletal muscle spasmolytics (relaxants) are used for some CNS diseases like?

include (5)

multiple sclerosis, cerebral palsy, CVAs

1. baclofen - derivative of GABA
2. carisoprodol
3. cyclobenzaprine
4. methocarbamol
5. quinine - nocturnal leg cramps

105

bioavailability measures

rate and amount of therapeutically active drug that reaches systemic circulation

amt of drug absorbed/amt of drug administered

IV provides 100% bioavailability

106

drug's onset of action is primarily determined by rate of?

absorption

major effect of a drug is determined by how much is FREE IN PLASMA

107

oral route of administration

safest and easiest

hepatic FIRST PASS metabolism, not for emergencies

drugs are absorbed best from the DUODENUM

108

intramuscular injection

-5 min rapid onset
-good for solutions too irritating to be subcutaneous
-aqueous soln absorbs fast, and oily ones are slow
-anterior thigh for kids
-1 inch deep for adults, 1/4 inch for kids

109

subcutaneous injection

intra-arterial injection concern

-15 min onset, less rapid

-can burn

110

intravenous injection

-most RAPID onset
-100% bioavailability, allows TITRATION

111

inhalation

-5 min
-most frequent in pediatric pts

112

patch delivery

-in blood over 12-24 hrs
-SYSTEMIC effect

113

distribution of a drug into tissue mainly depends on _

rate of blood flow to the tissue

-also gastric emptying time and degree of plasma protein binding (albumin) matters but not as much

114

most drugs travel through blood by binding to __

albumin

115

physiochemical properties of drugs that influence their passage across membranes are

lipid solubility, degree of ionization, molecular size, molecular shape

116

most drugs are absorbed by what kind of transport

facilitated diffusion

driving force is concentration difference

117

biotransformation of drugs in the liver in 2 phases

Phase I - P450 system
Phase II - conjugation

118

DEA Schedule I drugs

not for medical use, can't be prescribed

119

DEA Schedule II drugs

strong potential for ABUSE or ADDICTION, but have legitimate medical use

amphetamines, morphine, cocaine, pentoarbital, oxycodone, methadone, codein

need rx, can be prescribed but not refilled, can't be called in

120

DEA Schedule III

written rx signed, can call in, can have refills

analgesic combos

121

DEA Schedule IV

diazepam (valium), lorazepam, triazolam, xanax

122

who determines which drugs can be sold by rx?

FDA

123

allergic rxns to anesthetics is more common with what kind?

__ is the component of local anesthetics that causes allergy

esters (not amides)

bisulfites

124

mechanism of local anesthetics

decrease Na+ uptake through sodium channels, decreases nerve's excitability and impulses fail to propagate

NO effect on K+

125

when tissues are normal (pH = 7.4), what % of the local anesthetic is in free base form? (non-ionized)

10-20%

enough to penetrate nerve to cause anesthesia

126

the lower the drug's pKa, and higher the pH of the solution or injected tissue, the MORE or LESS free base avail?

MORE

127

potential action of locals depends on the ability of

the SALT to liberate the FREE BASE (active form)

128

esters are metabolized in the __
amides in the __

plasma
liver

129

esters mainly avail as

topicals

PROCAINE (novocaine) one of the originals

130

the only local anesthetic that increases the pressor activity of EPI and NE is

cocaine
-ester
-causes definite vasoconstriction

131

amides

used with caution or not at all in pts with compromised liver
-metabolized by P450 enzymes

132

the only amid local anesthetic metabolized int he bloodstream is

articaine (septocaine)

contraindicated in pts sensitive to amides or sodium bisulfite

max dose 7 mg/ kg

133

prilocaine (citanest)

-causes less vasodilation than lido
-less potent than lido

not for pts with liver disease, hypoxic conditions

metabolized into orthotoluidine -> can produce methemoglobinemia

134

bupivacaine (marcaine)

longest duration of action of any local anesthetic

135

lidocaine (xylocaine)

anti-arrhythmic agent in the ventricle
-decreases cardiac excitability

lido + mepi most likely to show cross-allergy

136

mepivacaine (carbocaine)

equal to lido in efficacy and used without EPI

TOXIC to neonates

short lasting

137

max. lido dose in kids

max. in adults

in kids, by weight, 4.4 mg/kg

in adults, 300 mg

138

chloral hydrate

only non-barbiturate sedative-hypnotic indicated in dentistry
-used orally for anxious kids
-kids will get excited and irritable before sedation
-DOES NOT RELIEVE PAIN

139

nitrous oxide must be coupled with __ % oxygen

20

140

nitrous is contraindicated for

upper respiratory infxns, emphysema, bronchitis, 1st trimester of pregnancy, autistic pts (communication difficult), NEVER on pts with contagious disease

141

drug of choice against syncope is

inhaled ammonia
-irritates trigem nerve sensory endings

142

inhalation agents

1. isoflurane - for old ppl, safe for heart disease
2. halothane, enflurance - decreases cardiac output, halothane sensitizes heart to catecholamines (risk of ventricular arrhytmia); enflurane is CNS irritant so avoid in pts with seizures

lipophilic moleculres

143

IV agents, classes

1. Barbiturates
2. Benzodiazepines
3. Neuroleptanalgesics
4. Others

144

Barbitruates (2)

1. thiopental (pentothal) - MOST COMMON, ultrashort acting
2. methohexital (brevital) - outpatient, rapid recovery, short acting

145

Benzodiazepines do not provide anesthesia, provide anterograde amnesia, and include

1. midazolam (versed) - pt groggy, preferred to diazpema because more water soluble

2. diazepam (valium) and lorazepam (ativan) - ANTI ANXIETY, contraindicated in pts with narrow angle glaucoma. diazepam for cerebral palsy and status epilepticus

3. flumazenil -benzodiazepine antagonist for recovery

4. alprazolam (xanax) - anxioloytic effects in pts with agoraphobia

146

__ and __ are benzodiazepines that provide preop sedation but are more irritating

lorazepam (ativan) and diazepam (valim)

147

__ are the most effective oral sedative drugs in dentistry

benzodiazepines
-used for anxiety and sleep disorders
-dont' use during pregnancy

148

Neuroleptanalgesics are neruoleptic-opiod combos that combine __ and __

Fentanyl and Droperidol

Fentanyl - opioid used as premed or adjunct to inhalation agents, used with droperidal and NO.

149

opioid adverse effects are reversed and recovery hastened by admin of

Naloxone (Narcan)
-opioid antagonist

150

Propofol (Diprivan)

IV anesthetic, metabolized in liver
-respiratory depressant
-doesn't increase intracranial pressure
-safer for pregnant women, less likely to cause bronchospasms
-contraindicated in kids, caution if pt has hypotension

151

etimodate (amidate) andvantage is

minimal respiratory and cardiovascular depressant effects
-no alnalgesic effects
-no hypotension or significant HR effects

152

ketamine

for DISSOCIATIVE ANESTHESIA
-cause catatonia, amnesia, analgesia without loss of consciousness
-antagonist at NMDA receptor to block excitatory effects
-not good for adults, better in kids

153

only anesthetic that acts as a cardiovascular stimulant is

KETAMINE

154

benzodiazepines, barbiturates and narcotic analgesics all produces

SEDATION and can cause physiologic dependence

-FLUMAZENIL is a benzodiazepine antagonist used to REVERSE benzo overdose

155

tranquilizer is a drug that promotes tranquility by

calming, soothing, quieting, or pacifying WITHOUT sedation or depressant effects

major ones = anti-psychotics
minor ones = anti-anxiety (benzos)

156

Benzodiazepines (minor tranquilizers)

how does it work? what nt?

bad effects are?

anti-anxiety, induce sleep (sedative-hypnotic), anti-convulsant, skeletal muscle relaxant

work by DEPRESSING LIMBIC SYSTEM and RETICULAR FORMATION through potentiation of GABA

adverse effects - CNS depression, GI disturbances, hypotension, ataxia, muscle relaxation, NEVER take with alcohol

157

benzodiazepines taken orally are

chlordiaepoxide (librium)
lorazepam (ativan)
alprazolam (xanax)
diazepam (valium)

158

benzodiazepines rx as HYPNOTICS for insomnia include

1. Flurazepam (Dalmane)
2. Temazepam
3. Triazolam (Halcion) - metab by liver by P450 isoform CYP 3A4 (avoid in pts taking inhibitors for that); antifungals can also elevate triazolam levels

159

Midazolam (versed)

a benzodiazepine in liquid form for pre-op sedation of kids, and injectable for IV.