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Oms > drugs and therapeutics > Flashcards

drugs and therapeutics Flashcards

1
Q

what are the amide LAs

A

mepivacaine, articaine, etidocaine, prilocaine, bupivacaine, lignocaine

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2
Q

what are the ester LAs

A

procaine, chloroprocaine, cocaine, tetracaine, benzocaine

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3
Q

where are ester and amide LAs metabolised

A

esters are metabolised in the plasma by butyrylcholinesterases

amides are metabolised in the liver

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4
Q

what is the mechanism of local anaesthesia

A

reversible blockage of propagation of peripheral nerve impulses by binding Na channels

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5
Q

what are the more common adverse reactions with local anaesthesia

A

syncope

psychogenic reaction

CNS excitation – tremors, convulsions, dizziness, lightheadedness, localised involuntary muscle activity

CNS depression – unconsciousness, resp depression

cardiac depression

neurotoxicity

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6
Q

in children, you should use LA with or without adrenaline?

A

with

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7
Q

what la should you avoid in children due to high risk of overdose

A

3% mepivacaine

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8
Q

what are the types of analgesics

A 
paracetamol
simple
combination 
opioid 
LA
TCA
anti convulsants
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9
Q

how are the analgesic, anti inflammatory, anti pyretic properties of paracetamol

A

weak analgesic
weak anti inflammatory
strong anti pyretic

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10
Q

what are the risks of paracetamol

A

hepatotoxicity

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11
Q

what is the dosage for paracetamol

A

1g QDS PRN max 4g a day

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12
Q

NSAIDs should be used in caution in

A 
asthmatics
elderly
peptic ulcer disease
bleeding 
liver
renal 
heart failure 
takin gprednisolone
taking ace inhibitor 
taking aspirin 
peripheral edema, ascities
at risk of vascular events
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13
Q

dosage for ibuprofen

A

400mg tds

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14
Q

how is the analgesic property of ibuprofen

A

mild

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15
Q

what is the dosage for naproxen

A

275-550mg BD

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16
Q

use of arcoxia should be avoided in those with what allergy

A

sulfonamide

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17
Q

NSAID can be used in combination with what for effective acute pain relief

A

acetaminophen (paracetamol)

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18
Q

when to prescribe gastric cytoprotection with NSAIDs

A

patients with known risk eg reflux, history of gastritis, PUD

patients with potential risk of GI bleed eg SSRI, corticosteroids

elderly over 60 years old

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19
Q

what can be given for gastric protection when prescribing nsaids

A

antacids eg mmt
h2 antagonist eg famotidine
proton pump inhibitor eg omeprazole

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20
Q

possible effect of NSAID interaction with alcohol and corticosteroids

A

increased GI bleed, PUD

21
Q

possible effect of NSAID interaction with anti hypertensives

A

decrease anti hypertensive response

22
Q

possible effect of NSAID interaction with anti coag, anti platelets, ssri

A

potentiate drug, increase bleeding

interfere with anti thrombotic activity of aspirin

23
Q

possible effect of NSAID interaction with oral hypoglycemics

A

increased hypoglycemic effect

24
Q

aspirin should be avoided in children under the age of

A

16

25
Q

side effects of tramadol

A 
headache
nausea
sweating
drowsiness
risk of suicide
respiratory depression 
decreased seizure threshold, hence avoid in epileptics, those on ssri, tca
26
Q

what should you do for effective pain relief

A 
profound local anaesthesia
pre op anaesthesia
good surgical technique
strict asepsis
regular post op analgesia
long acting la on discharge
combination NSAID/paracetamol
27
Q

what drugs can be used for chronic pain management

A

opioids
anti neuralgics
anti depressants
benzodiazepines

28
Q

in the case of dentoalveolar infections, antibiotics are only required in

A

cases of spreading infection eg cellulitis, lymph node involvement, swelling, systemic signs and symptoms eg fever

cases of severe infection eg trismus, extra oral swelling

immunocompromised

29
Q

amoxicillin coverage

A

broad spectrum covers gram positive and negative aerobes

limited activity against anaerobes

30
Q

side effect of amoxicillin

A

diarrhea

31
Q

coverage for erythromycin

A

gram positive aerobes and anaerobes

no gram neg activity

beta lactamase producing bacteria

32
Q

what are some important drug interactions with macrolides

A

atorvastatin: diffuse myalgia, rhabdomyolysis
carbamazepine: increased risk of ataxia, vertigo, drowsiness, confusion

cyclosporin, tacrolimus: overt immunosuppression, nephrotoxicity

diazepam, midazolam: excess prolonged sedation, increased risk of airway obstruction in pediatric dental patients

felopidine, CCB: excessive anti hypertensive effect, resulting in hypotension and oedema

warfarin: increased INR, increased bleeding

33
Q

what is the coverage of metronidazole

A

obligate anaerobes esp gram negative anaerobes

34
Q

side effects of metronidazole

A

metallic taste, furred tongue, gi upset, headache, peripheral neuropathy, weakness

35
Q

drug interactions with metronidazole

A

phenytoin: increased risk of drowsiness, ataxia

lithium; lithium toxicity

alcohol

warfarin: increased bleeding
statins: increased risk of myopathy, rhabdomyolysis

36
Q

what drugs are frequently associated with c diff diarrhea and colitis

A

fluoroquinolones
cephalosporins
clindamycin
penicillin

37
Q

drug interactions with azoles

A

fluconazole interacts with warfarin and statins, can cause heart palpitations in susceptible patients

warfarin - increase pt
statin - rhabdo
tacro, cyclo - increase immunosuppression
clopidogrel - decrease anti platelet effect
theophylline - arrhythmia
midazolam - increase sedation

38
Q

side effects of systemic corticosteroids

A 
short course:
mood change
fluid retention 
gi upset 
insomnia
hyperglycemia
long course:
easy bruisability
moon face
buffalo hump 
weight gain
39
Q

what drugs should be avoided in patients with liver disease

A 
aspirin 
nsaids
cox 2 inhibitors
paracetamol
narcotic analgesics
benzodiazepines
azoles
clindamycin
40
Q

what drugs should be avoided in patients with renal disease

A 
aspirin 
nsaids
cox 2 inhibitors
tetracyclnes
aminoglycosides
sulphonamides
ciprofloxacin

caution use of penicillin and cephalosporins

41
Q

prescription for laop

A

amoxicillin 500mg tds/clindamycin 300mg bds if antibiotic cover is necessary

chx 10ml tds

ponstan (mefenamic acid) 500mg tds
famotidine 20mg bd

42
Q

prescription for a patient with uncontrolled diabetes taking warfarin who just underwent dental extractions

A

tranexamic acid 10ml tds for 2 days
amoxicillin 500mg tds
panadiene 2 tabs tds
chx 10ml tds

43
Q

medication for traumatic ulcer

A

triamcinolone acetonamide 0.1%

44
Q

medication for neurogenic pain

A

gabapentin 100-300mg tds, must titrate. start with 100mg bd then monitor

others: pregabalin, carbamazepine

45
Q

medication for oral lichen planus

A

dexamethasone

nyastatin mouthwash 5ml qds

46
Q

medication for tmj pain

A

anarex (paracetamol + orphenadrine [muscle relaxant]) 2 tabs tds

or ?

ibuprofen 400mg tds

47
Q

medication for candidiasis

A

nyastatin 5ml qds for 14 days

48
Q

gastric irritation prescription

A

famotidine 20mg bd

omeprazole 40mg om

Oms (24 decks)

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