Pharmacoloy 2 Flashcards
(124 cards)
1
Q
Amide anesthetics are metabolized in the ___
Ester anesthetics are metabolized by ___ in the ____
A
Liver
Pseudocholinesterase
Plasma
2
Q
Lidocaine, bupivicaine, mepivicaine, articaine, and prilocaine are all ___ anesthetics
A
Amide
3
Q
Procaine, cocaine, tetracaine, benzocaine are all ___ anesthetics
A
Ester
4
Q
List 5 amide anesthetics
A
Lidocaine
Bupivicaine
Mepivicaine
Articaine
Prilocaine
5
Q
Why are ester anesthetics less commonly used than amide anesthetics?
A
More toxic and more allergic due to methylparaben
6
Q
Which is the safest anesthetic to use in children?
A
Lidocaine
7
Q
What is the brand name of bupivicaine?
A
Marcaine
8
Q
Which anesthetic is the least safe in children?
A
Bupivicaine (marcaine)
9
Q
What is the brand name of mepivicaine?
A
Carbocaine
10
Q
Which anesthetic causes the least vasodilation?
A
Carbocaine (mepivicaine)
11
Q
True or false… anesthetics by themselves are vasodilators
A
True. Which is one reason why epinephrine is often used with them
12
Q
Which amide anesthetic has on ester chain? Thus metabolized both in the liver and the blood plasama
A
Articaine
13
Q
Which amide anesthetic is linked to methemglobinemia? (A blood disorder in which an abnormal amount of methemoglobin is produced which leads to too little oxygen delivered to the tissues)
A
Prilocaine
14
Q
Which anesthetic has the longest duration?
A
Bupivicaine (marcaine)
15
Q
Which anesthetic has the shortest duration?
A
Articaine
16
Q
Lidocaine is packaged in ___%.
Bupivicaine is packaged in ___%
A
2%
0.5%
17
Q
Mepivicaine (carbocaine) can be packaged in ___% or ___%. It is also often packaged without ___
A
2% or 3%
Epinephrine
18
Q
Articaine is packaged in ___%
A
4%
19
Q
Which anesthetic is the only one that is a vasoconstrictor?
A
Cocaine
20
Q
Local anesthetics are ____ blockers
A
Sodium channel
21
Q
Only the ___ form of local anesthetics can penetrate the neuron membrane
A
Non-ionized (free base)
22
Q
Successful anesthetic is achieved when __ consecutive nodes of ranvier are blocked
A
3 (this is called the critical length)
23
Q
Would a lipid soluble or water soluble local anesthetic be more potent?
A
A lipid soluble anesthetic is more potent and has a longer duration of action
24
Q
[increased/decreased] protein binding leads to longer duration of action because…
A
Increased
Because the drug has a greater attraction to the receptor sites
25
The [lower/higher] the pKa the stronger the acid is thus the faster the onset of action
Lower
26
What are the pKas of mepivicaine, lidocaine/prilocaine/articaine, and bupivicaine?
Mepivicaine = 7.6
Lidocaine/prilocaine/articaine = 7.8
Bupivicaine = 8.1
27
How many mg of lidocaine are in a 1% carpule? 2%? 4%?
18mg
36mg
72mg
28
Name three properties of vasoconstrictor added to local anesthetics
Prolongs numbness
Reduces toxicity
Promotes hemostasis
29
What is the maximum epinephrine dose for an ASA 1 patient?
0.2mg
30
What is the maximum epinephrine for a cardiac patient?
0.04mg
31
What is the max lidocaine without vasoconstrictor?
4.4mg/kg
32
What is the max lidocaine with vasoconstrictor?
7mg/kg
33
How fast should local anesthetic be injected?
1 carpule per minute
34
How long is the short needle? How long is the long needle?
Short = 20mm
Long = 32mm
35
What is the diameter of a 30 gauge needle? 27 gauge? 25 gauge?
30 gauge = 0.3mm
27 gauge = 0.4mm
25 gauge = 0.5mm
36
What are the three advantages to a lower gauge needle? (Higher diameter)
Do not deflect as much
Do not break as often
Have better aspiration
37
About how much lidocaine is administered for an IA block?
3/4. Carpule
38
Which block has the highest failure rate?
IA block
39
What is the difference between teh mental block and the incisive nerve block?
The incisive nerve block is the same as the mental nerve block except you hold pressure over the mental formats for 2 minutes after injection to force anesthetic into the mental foramen
40
In the PSA block, you enter the long needle ___mm (which is __ the length of the long needle)
16mm
Half
41
Which nerve block has the highest hematoma risk?
PSA
42
The PSA block affects the maxillary molars and the buccal tissue around it, but it doesn’t anesthetize the __ cusp of the ___
MB
First molar
43
The ___ blocks the maxillary anteriors AND premolars
Infraorbital block
44
Sulfonamides are [bacteriostatic/bacteriocidal]. They compete with ___ and inhibit ___ synthesis. Name two sulfonamides
Bacteriostatic
PABA
Folate synthesis (thus affecting the DNA)
Sulfadiazine, sulfamethoxazole
45
Fluoroquinolones are [bacteriocidal/bacteriostatic]. They inhibit ___ synthesis. Name two fluoroquinolones.
Bacteriocidal
DNA
Ciprofloxacin, levofloxacin
(FLOX)
46
Penicillins are [bacteriocidal/bacteriostatic]. They inhibit ___ synthesis. They are called ____ antibiotics, which are a class of broad spectrum antibiotics, because they contain a __ ring.
Bacteriocidal
Cell wall
B-lactam
B-lactam
47
Penicillins are cross-allergenic with ___ because they are chemically related.
Cephalosporins
48
Which type of penicillin must be administered IV and is more sensitive to acid degradation?
Penicillin G
49
Which penicillin is less sensitive to acid degradation and thus can be taken orally?
Penicillin V
50
Amoxicillin is commonly prescribed and it is [broad/narrow] spectrum penicillin
Broad
51
What is augmentin? What is significant about this?
Amoxicillin + clavulanic acid
B-lactamase-resistant
52
True or false... methicillin is a penicillin that is B-lactamase resistant
True
53
True or false... dicloxacillin is a penicillin that is B-lactamase resistant
True
54
What is the best/broadest gram negative spectrum penicillin antibiotic?
Ampicillin
55
Which penicillin is used specifically against pseudomonas species?
Carbenicillin
56
Cephalosporins are [bactericidal/bacteriostatic]. They have a ___ ring and inhibit ___ synthesis.
Bactericidal
B-lactam
Cell wall
57
Which type of B-lactam antibiotic has 5 different generations?
Cephalosporins
58
Monobactams are [bactericidal/bacteriostatic]. They inhibit __ synthesis and have a ___ ring. Name one important monobactam.
Bactericidal
Cell wall
B-lactam
Aztreonam (AM)
59
Carbapenems are [bactericidal/bacteriostatic]. They inhibit ___ synthesis and have a ___ ring. Name one important carbapenem
Bactericidal
Cell wall
B-lactam
ImipeNEM (nem)
60
Name 4 types of B-lactam antibiotics
Penicillins
Cephalosporins
Monobactams
Carbapenems
61
Tetracyclines are [bactericidal/bacteriostatic]. They inhibit ____. Name three important examples.
Bacteriostatic
Protein synthesis (30s ribosomal subunit)
Tetracycline, doxycycline, minocycline
62
What is the broadest antimicrobial spectrum antibiotic?
Tetracyclines
63
Macrolides are [bactericidal/bacteriostatic] they inhibit ___ synthesis. Name three important macrolides
Bacteriostatic
Protein (50S ribosomal subunit)
Erythromycin
Clarithromycin
Azithromycin (THROMYCIN)
64
What is the mnemonic for macrolides?
Mac likes to throw mice
Macrolides = -thromycin
65
Lincosamides are [bactericidal/bacteriostatic]. They inhibit ___. Name two important lincosamides
Bacteriostatic
Protein synthesis (50S ribosomal subunit)
Clindamycin
Lincomycin
(MYCIN)
66
What is the mnemonic for lincosamides?
Link also hides mice
Lincosamides = -mycin
67
When is antibiotic prophylaxis required?
Certain cardiovascular conditions
Compromised immunity
68
Name 4 cardiovascular conditions that require antibiotic prophylaxis
Prosthetic heart valves
History of endocarditis
Heart transplant with valvulopathy/valve dysfunction
Congenital heart problems
69
Name 3 cases where a pt with compromised immunity needs antibiotic prophylaxis?
Organ transplant
Neutropenia
Cancer therapy
70
What is the antibiotic of choice for prosthetic joint prophylaxis?
Keflex 2g 1 hr prior to treatment
71
True or false... antibiotic prophylaxis is NOT recommended in cases with a cardiac pacemaker. Rheumatic fever without valvular dysfunction. Mitral valve prolapse without valvular regurgitation
True
72
Name three cardiovascular conditions that do NOT need antibiotic prophylaxis
Cardiac pacemaker
Rheumatic fever with valvular dysfunction
Mitral valve prolapse without valvular regurgitation
73
What antibiotic causes GI upset and pseudomembranous colitis?
Clindamycin
74
___ spectrum antibiotics are most likely to cause super infections
Broad
75
What antibiotic is assocaited with aplastic anemia?
Chloramphenicol
76
What antibiotic is assocaited with liver damage?
Tetracycline
77
What antibiotic is associated with allergic cholestatic hepatitis?
Erythromycin estolate
78
True or false... bactericidal and bacteriostatic drugs cancel each other out
True
79
Penicillins and ___ often interact. How?
Probenecid (which is uric acid reducer or gouty arthritis)
Probenecid alters the renal clearance of penicillin
80
Tetracycline and ___ interact with each other. Why?
Antacids and dairy products
Because tetracycline is a chelating agent which binds calcium and other ions. Thus limiting its absorption and its affective ness
81
Broad spectrum antibiotics and ___ drugs interact. Why?
Anticoagulants
Because they reduce the vitamin K sources
82
Antibiotics may interact with ____. Why
Oral contraceptives
Alters gut flora which affects the oral contraceptive absorption
83
Macrolides may interact with what drug?
Seldane/digoxin
84
Clindamycin tends to concentrate well in ___
Bone
85
Tetracycline tends to concentrate well in ___
Gingival crevicular fluid
86
Name two drugs used to treat herpes infections
Acyclovir
Valcyclovir
87
Name two drugs used to treat candidiasis. Which is often in the troche form?
Fluconazole
Ketoconazole
(Clotrimazole (Mycelex)
88
Aspirin is a [irreversible/reversible] blocker of _____. It can cause ___ issues.
Irreversible
Cox 1 and Cox 2
GI
89
Ibuprofen is a [reversible/irreversible] blocker of ____ and affects the ____.
Reversible
Cox 1 and cox 2
Kidney
90
What is ketorolac?
NSAID that reversibly binds to Cox 1 and cox 2
It can be administered IV, IM or orally
91
Indomethacin is an NSAID that binds reversibly to COX 1 and COX 2. It is linked to ____
Blood dyscracias
92
Celecoxib (Celebrex) binds to ___
COX 2 selectively
| Less bleeding problems
93
____ is an NSAID that binds to COX 2 selectively and is used for arthritis
Meloxicam
94
Name two NSAIDs that are COX 2 selective
Celecoxib (Celebrex)
Meloxicam
95
Where does acetaminophen inhibit pain?
In the CNS
96
Acetaminophen can negatively impact which organ?
Liver
97
True or false.. acetaminophen is a potent NSAID
False. It is not an NSAID
98
What is the drug of choice to treat a child with a fever?
Acetaminophen
99
____ is contraindicated in children because it can cause Reye’s syndrome
Aspirin
100
Aspirin is an analgesic And anti-inflammatory drug that inhibits ____ thus affecting ___ synthesis.
COX 1 and 2
Prostaglandin (come from phospholipids which go to arachdonic acid to prostaglandins)
101
True or false... aspirin is antipyretic (used to treat fevers)
True (by inhibiting PG synthesis in temperature regulation center of hypothalamus)
102
Explain the antipyretic mechanism of aspirin.
It inhibits PG synthesis in the temperature regulation center of the hypothalamus
103
How is bleeding time affected by aspirin?
Inhibits TXA2 synthesis thereby inhibiting platelet aggregation
104
Name 7 toxic effects of aspirin
Occult bleeding from GI tract
Tinnitus
Nausea and vomiting
Metabolic acidosis
Decreased tubular resorption of uric acid
Salicyclism
Delirium
Hyperventilation
105
Name 4 important corticosteroids
Prednisone
Hydrocortisone
Triamcinolone
Dexamethasone
106
Steroids inhibit the enzyme ___ which in turn inhibits ___ synthesis
phospholipase A2
Arachadonic acid
107
Name six side effects of steroids.
Gastric ulcers
Immunosuppression
Acute adrenal insufficiency***
Osteoporosis
Hyperglycemia
Redistribution of body fat
108
What is the rule of 2’s?
Adrenal suppression can occur if a pt is taking 20mg of cortisone daily for 2 weeks within 2 years of dental treatment
109
What is the difference between oxycodone and OxyContin?
OxyContin has a CONtrolled release mechanism
110
Codeine suppresses the ___ reflex
Cough
111
Which opioid is most similar to codeine?
Tramadol (ultram)
112
Which opioid is lethal if combined with an MAOI?
Meperidine (Demerol)
113
Vicodin is a combo of ___ and ____
Hydrocodone and acetaminophen
114
Percocet is a combo of ___ and ___
Oxycodone and acetomenophin
115
What is the dosage of Tylenol 1-4?
Tylenol 1 - 300mg APAP + 8mg codeine
Tylenol 2 - 300mg APAP + 15mg codeine
Tylenol 3 - 300mg APAP + 30mg codeine
Tylenol 4 - 300mg APAP + 60mg codeine
116
What are the therapeutic and side effects of morphine? (Mnemonic)
```
Miosis (pupil constriction)
Out of it
Respiratory depression
Pneumonia (aspiration pneumonia)
Hypotension
Infrequency (urinary retention/constimpaton)
Nausea and vomiting
Euphoria & dysphoria
```
117
What is naloxone?
Inverse agonist of opioids, used in emergencies
118
___ and ___ are used to treat opioid addiction
Naltrexone
Methadone
119
Name three opioids that have mixed agonist-antagonist actions
Pentazocine
Nalbuphine
Buprenorphine
120
What is the most common side effect of NO2?
Nausea
121
What is a common affect of long term exposure to nitrous oxide?
Peripheral neuropathy
122
What is the sensation experienced during the onset of nitrous oxide?
Tingling
123
What is MAC?
Minimum alveolar concentration - it is the concentration of the gas in the alveoli required to render 50% of patients immobile (general anesthesia)
124
What is the MAC of nitrous oxide? What is significant about this?
105%
It is nowhere near as potent as other agents. It is IMPOSSIBLE to immobilize 50% of patients with NO2
