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Pharm II > (04-12-17) Drug Interactions > Flashcards

(04-12-17) Drug Interactions Flashcards

1
Q

pharmacodynamic

A

related to the ACTION of a drug

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2
Q

pharmacokinetic

A

related to processes by which a drug is absorbed, distributed, metabolized, and eliminated by the body

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3
Q

pharmaceutical

A

related to mixture of two drugs

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4
Q

what type of LA is good for CV diseased ppl?

A

Mepivicaine 3%

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5
Q

how do AMIDE LAs work?

A
  • block nerve impulses by inhibiting voltage-sensitive Na+ channels
  • prevents noxious stimuli from reaching the brain
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6
Q

where are AMIDE LAs metabolized?

A

liver*****

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7
Q

what are the pharmacodynamics of AMIDE LAs affected by?

A
  • pH of solution and surrounding tissue
  • lipid solubility
  • addition of a vasoconstictor
  • pKa
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8
Q

what is the absolute medical maximum dose for lido 2% with and without epi?

A
  • with epi : 7mg/kg

- without epi : 5 mg/kg

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9
Q

what is the absolute medical maximum dose for articaine 4% with and without epi?

A
  • with epi : 7mg/kg

- without epi : 5 mg/kg

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10
Q

what is the absolute medical maximum dose for mepivicaine 3% with and without epi?

A
  • with epi : 6.6 mg/kg

- without epi : 5.5 mg/kg

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11
Q

what is the absolute medical maximum dose for bupivacaine 0.5% with and without epi?

A
  • with epi : 3 mg/kg

- without epi : 3 mg/kg

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12
Q

what is the absolute medical maximum dose for prilocaine 4% with and without epi?

A

with epi : 8 mg/kg

without epi : 8mg/kg

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13
Q

if an LA has 2% concentration, what is the mg/carp?

A

34 mg/carp

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14
Q

what is clark’s rule?

A
  • it is in reference to CHILDREN
  • based on weight in pounds
  • max dose = (weight of child in lbs/150)x(max adult dose in mg)
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15
Q

what is the safest LA for children?

A

2% lido with 1:100k epi

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16
Q

what are the early signs of an LA overdose?

A
  • tachycardia & htn
  • seizures
  • loss of consciousness
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17
Q

what are the late signs of LA overdose

A
  • bradycardia & HYPOtension
  • dec CO
  • ventricular arrhymias and death
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18
Q

what is the treatment for mild symptoms of LA overdose?

A
  • temp discontinue procedure and reassure pt

- monitor vitals

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19
Q

what is the treatment for moderate symptoms of LA overdose?

A
  • temp discontinue procedure and reassure pt
  • monitor vitals
  • supplement O2
  • admin valium (IV) for seizure
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20
Q

what is the treatment for severe symptoms of LA overdose?

A
  • temp discontinue procedure and reassure pt
  • monitor vitals
  • supplemetnal O2
  • admin valium
  • CPR (call 911)
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21
Q

receptors that cause vasoconstriciton, inc in peripheral resistance, and inc in arterial BP?

A

alpha 1 receptors

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22
Q

what are the two most commonly used vasoconstrictors and what do they primarily effect?

A
  • epinephrine : A1, B1, B2 effects (is most potent)

- levonordefrin : A1 effects

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23
Q

receptors which, when activated, inhibit the release of norepi

A

A2 receptors

*agonist = clonidine

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24
Q

receptors which, when activated, inc contraciton and heart rate

A

B1 receptor

25
Q

receptors which, when activated, cause vascular muscular relaxation

A

B2 receptor

26
Q

what are the benefits of epinephrine?

A
  • vasoconstriction - reduce blood loss
  • prolongs actions of LA - limits diffusion
  • limits systemic absorption of LA
27
Q

vasoconstrictors are metabolized and inactivated by what 2 enzymes?

A
  • catechol-O-methyltransferase (COMT)

- monoamine oxidase (MAO)

28
Q

what are the potential systemic side effects of vasoconstrictos?

A
  • inadvertent intra-arterial injections

- drug-drug interactions

29
Q

what are the possible issues with combining vasoconstrictors and amphetamines?

A
  • could potentiate clincal effects of epi
  • promotes the release of norepi and can block the reuptake of NE

*ex adderall, ritalin, cocaine

30
Q

what do non-selective beta blockers lead to?

A
  • HTN

- reflex bradycardia

31
Q

what are the vasoconstrictor interactions between antidepressants and epi regarding tricyclics?

A

-prevent neural uptake of catecholamine at the adrenergic nerve terminals

  • create an exaggerated response to epi at synaptic cleft
  • *leads to inc BP and HR

***but most exogenously administered epi is metabolized by COMT

32
Q

what are the vasoconstrictor interactions regarding an alpha blockade?

A
  • leads to HYPOtension and tachycardia
  • more pronounced with levonordefrin than epi at low doses
  • “epinephrine reversal”
33
Q

what do COMT inihibitors do?

A
  • used for parkinson’s disease for pts taking Sinemet
  • dec I-dopa metabolism

*EXAGGERATED RESPONSE TO EPI

34
Q

what are the two market drugs that are COMT inhibitors?

A
  • tolcapone (Tasmar)

- entacapone (Comtan)

35
Q

the amount of administered epi that reaches the general circulation after LA for dentistry has been hypothesized to be less than what?

A

the amount of epi releasd in response to the pain and stress of inadequate anesthesia

36
Q

what is the mg maximum epi dosage for a healthy pt?

A

0.2mg = 11 cartriges

37
Q

what are the issues with vasoconstrictors and pts with CVD?

A
  • take vitals prior to injection and 5 minutes post injection
  • administer more if vital signs allow
  • do not administer more than 0.04mg epi at one time
38
Q

what is the max epi dosage for a CVD pt?

A

0.04mg = 2.2 cartriges

39
Q

what do NSAIDS combine?

A
  • analgsic
  • anti-pyretic (fever)
  • anti-inflammatory
40
Q

what 3 things do COX-1 prostaglandins promote?

A
  • gastric protection
  • platelet aggregation
  • renal blood flow
41
Q

what does COX -2 prostaglandins promote?

A

renal blood flow

42
Q

what are the adverse effects of NSAIDS?

A
  • GI bleeding
  • platelet dysfunciton
  • renal dysfunction
  • CNS issues
  • exacerbation of asthma (due to shift to leukotriene pathway)
43
Q

what is the most common COX-2 selective NSAIDS?

A

celecoxib (celebrex)

  • good anti-inflammation
  • concern for embolitic phenomena
  • expensive
  • not good for 3rds molar pain
44
Q

what are the possible CV effects with NSAIDS?

A
  • peripheral edema

- dec effect of antihypertensives and diuretics

45
Q

what put patients at risk for hypoglycemia when they are on NSAIDS?

A

competition for plasma protein binding sites

bleeding

46
Q

what is the only NSAID that does NOT put pts at risk for hypoglycemia?

A

*METFORMIN **

SHE SAID THIS WOULD BE ON TEST FOR SURE

47
Q

when you combine opioids with ____ you receive excessive sedation?

A 
CNS depressants (xanax)
antihistamines (allegra)
48
Q

when you combine opioids with ____ you receive constipation?

A

anticholinergic (spiriva)

antidiarrheal (imodium)

49
Q

when you combine opioids with ____ you receive hypotension?

A

antihypertensives (hypotension)

50
Q

what enzyme is need for the conversion of most opioids?

A

CYP 2D6

*hydrocodone will provide some analgesia w/o the conversion so it is the best to use if pt is deficient

51
Q

what % of whites, AAs, and asian americans have a deficiency in the CYP 2D6 gene?

A
  • whites : 10%
  • AAs : 3%
  • Asians : 1%

***hydrocodone will provide some analgesia w/o the conversion so it is the best to use if pt is deficient

52
Q

what opioid does not need the CYP 2D6 enzyme for conversion of the drug to be metabolized?

A

hydrocodone

53
Q

what should be the PRIMARY ANALGESIC USED FOR ALL PTS?

A

NSAIDS (unless contraindicated)

  • ibuprofen 600mg
  • tylenol 500-1000mg
54
Q

why should you as a dentist not have to worry about dependence to opioids?

A

-tolerance and dependence require at least 2 weeks regular administration and you should only give enough for 3-5 with acute pain

55
Q

which antibiotics, when used with coumadin, enhance anticoagulation ?

A
  • penicillin (dec vit-K synthesis in gut)

- metronidazole (inhibits metabolism of coumadin)

56
Q

do antibiotics have an inhibition on oral contraceptives?

A

yes, tell women to use other BC

57
Q

tetracyclines inc what _____ levels in the body

A

lithium

58
Q

metronidazole mixed with _____ causes severe nausea and vomitting?

A

ethanol

Pharm II (16 decks)

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