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xD3 Med Mgmt Ex2 > Drug Interactions (Desai) > Flashcards

Drug Interactions (Desai) Flashcards

1
Q

What are 4 types of adverse drug reactions?

A
  1. Idiosyncratic
  2. Toxic (overdose)
  3. Allergic
  4. Incompatible/Interaction/Side effect
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2
Q

What is a reaction to a drug that is opposite its effect, (e.g. patient is agitated after getting a sedative)?

A

Idiosyncratic reaction

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3
Q

What is the term for too much of a drug, too soon that will manifest in CNS, kidneys, liver, cardiovascular, or respiratory?

A

Drug overdose (toxicity)

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4
Q

What are 4 factors that can lead to patient overdose on drug?

A
  1. Age
  2. Body weight
  3. Debilitating systemic disease
  4. Genetic predisposition
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5
Q

When dealing with adverse drug reactions, which of the following factors is most important: age, body weight, debilitating systemic disease, or genetic predisposition?

A

Body weight

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6
Q

What are 3 causes of drug overdose in a dental practice?

A
  1. Total dose administered is excessive
  2. Intravascular injection
  3. Abnormal rapid absorption
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7
Q

What systemic problem can lead to drug overdose?

A

Slow renal drug elimination

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8
Q

What is the maximum dose of Lidocaine in a healthy patient?

A

3.2mg/lb, maximum 500mg

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9
Q

What is max number of 2% Lido carpules you can give to not exceed the 500 mg maximum?

A

500mg x (1carpule / 36mg) = 13 carpules

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10
Q

What is lidocaine’s effect on the heart?

A

Decreases automaticity. It slows it (lido is an ER drug used to control atrial fibrillation)

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11
Q

What are 2 causes of a patient getting an overdose even though correct dose was administered?

A
  1. intravascular injection

2. Rapid uptake and distribution

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12
Q

What is the standard of care to avoid intravascular injection of local anesthetic?

A

Aspirate before injection, in 2 different planes

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13
Q

What are signs of local anesthetic overdose?

A
  1. Confusion
  2. Talkative
  3. Tremor
  4. Nystagmus
  5. Elevated vital signs
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14
Q

In a local anesthetic overdose there will be stimulation followed by depression resulting in what type of seizure?

A

Tonic-clonic seizure resulting in loss of respiration

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15
Q

What is emergency drug for seizures?

A

10mg of Valium IV

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16
Q

What is the maximum dose of Epinephrine in a healthy patient?

A

.2mg

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17
Q

What is the amount of epi in 1:100,00 solution?

A

.01mg/mL = .018 mg / carpule

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18
Q

What is the maximum number of carpules of 1:100,00 epi to get to the maximum epi dose of .2mg?

A

11 carpules 1:100,000 epinephrine

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19
Q

What is the maximum dose of epi for patients with cardiovascular disease?

A

.04mg

20
Q

What is the maximum dose of Levonordephrine?

A

1.00 mg in health

.2 mg for cardiac disease patient

21
Q

Levonordephrine comes in what concentration?

A

1:20,000 = 0.5mg/mL = 0.9 mg/1 carpule

22
Q

What is the maximum number of carpules to get to max amount 1:20,000 Levonordephrine?

A

11

23
Q

What is the proper management of an epinephrine overdose?

A
  1. Reassure pt
  2. Oxygen
  3. Vitals
  4. Inform it should stop in 1-3 mins
24
Q

A type I allergic reaction has what character and what mediates it?

A

Immediate

IgE mediates causing histamine release from Mast Cells

25
Q

A type 2 allergic reaction has what character and what mediates it?

A

Cytotoxic response due to Antigen-Antibody complex activating cytotoxic cells. IgM/IgG-Ab complex mediated.

26
Q

Anaphlaxis and urticaria are what type of allergic reactions?

A

Type I, IgE mediated

27
Q

Transfusion reactions and Goodpasture’s syndrome are what type of allergic reactions?

A

Cytotoxic with IgM/IgG-Ab activating cytotoxic cells

28
Q

Goodpasture’s syndrome is an autoimmune problem where IgG/IgM-Ab complexes activatie cytotoxic cells in Type II response, but antibodies attack what?

A

Lung and Kidneys

29
Q

What must occur before a type I allergic reaction?

A

Must be sensitized by allergen binding IgE causing Il-4 to make B-cells produce IgE antibodies for that antigen

30
Q

What are 5 things mast cells / basophils release when antigen binds the IgE attached to the cell surface?

A
  1. Histamine
  2. Cytokines
  3. Interleukins
  4. Leukotrienes
  5. Prostaglandins
31
Q

Vasodilation in a Type I IgE mediated hypersensitivity reaction results in what?

A

Anaphylaxis, rash

32
Q

Edema in a Type I IgE mediated hypersensitivity reaction results in what?

A

Urticaria (hives), angioedema, laryngeal edema

33
Q

Mucous secretions in a Type I IgE mediated hypersensitivity reaction results in what?

A

Rhinorrhea

34
Q

Nerve stimulation in a Type I IgE mediated hypersensitivity reaction results in what?

A

Itching

35
Q

An immediate allergic reaction usually occurs within what time period?

A

Within 60 min of exposure to antigen

36
Q

What is the first thing to do when not allergic reaction? (Not sure what this question means)

A

Call 9-1-1

37
Q

What are 3 things done to manage allergic reaction while 911 is called?

A
  1. Administer oxygen, take vitals, give 1:100 Epi 0.3 mg IM or Subcutaneous
  2. O2, vitals, 50mg Benedryl IM
  3. O2, vitals, 100mg Solucortef IM (corticosteroid)
38
Q

What is the timeframe for a delayed allergic reaction?

A

More than 60 minutes

39
Q

What is an oral antihistamine for management of delayed allergic reaction?

A

Diphenhydramine (Benedryl), 50 mg, qid, for 24 to 48 hrs. If symptoms worsen get to ER.

40
Q

What is the term for an overdose of a drug that injures a physiologic system?

A

Toxicity

41
Q

What is the term for an expected or predictable undesirable effect of a drug that occurs at therapeutic doses?

A

Side effect

42
Q

What is the term for the presence of one drug effects the pharmacodynamics (absorption, distribution, metabolism, excretion) of another drug?

A

Drug-drug interaction

43
Q

What is the term for when the presence of a drug alters the body’s physiology, leading to a harmful condition (may overlap with the concept of side effect)

A

Drug-physiology interaction

44
Q

What is the term for when a drug will alter laboratory test results without impacting the physiologic system being measured - essentially a false-positive or a false-negative laboratory test result?

A

Drug-laboratory test interaction

45
Q

What is the term for when a drug triggers an immunologic response?

A

Allergic reaction

46
Q

What is the term for when a drug creates a physiologic or psychological response that is unpredictable and is unique to the individual?

A

Idiosyncratic reaction

xD3 Med Mgmt Ex2 (6 decks)

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