drugs and therapeutics

Question 1

what are the amide LAs

Answer 1

mepivacaine, articaine, etidocaine, prilocaine, bupivacaine, lignocaine

Question 2

what are the ester LAs

Answer 2

procaine, chloroprocaine, cocaine, tetracaine, benzocaine

Question 3

where are ester and amide LAs metabolised

Answer 3

esters are metabolised in the plasma by butyrylcholinesterases

amides are metabolised in the liver

Question 4

what is the mechanism of local anaesthesia

Answer 4

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

Question 5

what are the more common adverse reactions with local anaesthesia

Answer 5

syncope

psychogenic reaction

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

CNS depression – unconsciousness, resp depression

cardiac depression

neurotoxicity

Question 6

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

Answer 6

with

Question 7

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

Answer 7

3% mepivacaine

Question 8

what are the types of analgesics

Answer 8

paracetamol
simple
combination 
opioid 
LA
TCA
anti convulsants

Question 9

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

Answer 9

weak analgesic
weak anti inflammatory
strong anti pyretic

Question 10

what are the risks of paracetamol

Answer 10

hepatotoxicity

Question 11

what is the dosage for paracetamol

Answer 11

1g QDS PRN max 4g a day

Question 12

NSAIDs should be used in caution in

Answer 12

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

Question 13

dosage for ibuprofen

Answer 13

400mg tds

Question 14

how is the analgesic property of ibuprofen

Answer 14

mild

Question 15

what is the dosage for naproxen

Answer 15

275-550mg BD

Question 16

use of arcoxia should be avoided in those with what allergy

Answer 16

sulfonamide

Question 17

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

Answer 17

acetaminophen (paracetamol)

Question 18

when to prescribe gastric cytoprotection with NSAIDs

Answer 18

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

Question 19

what can be given for gastric protection when prescribing nsaids

Answer 19

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

Question 20

possible effect of NSAID interaction with alcohol and corticosteroids

Answer 20

increased GI bleed, PUD

Question 21

possible effect of NSAID interaction with anti hypertensives

Answer 21

decrease anti hypertensive response

Question 22

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

Answer 22

potentiate drug, increase bleeding

interfere with anti thrombotic activity of aspirin

Question 23

possible effect of NSAID interaction with oral hypoglycemics

Answer 23

increased hypoglycemic effect

Question 24

aspirin should be avoided in children under the age of

Answer 24

16

Question 25

side effects of tramadol

Answer 25

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

Question 26

what should you do for effective pain relief

Answer 26

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

Question 27

what drugs can be used for chronic pain management

Answer 27

opioids anti neuralgics anti depressants benzodiazepines

Question 28

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

Answer 28

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

Question 29

amoxicillin coverage

Answer 29

broad spectrum covers gram positive and negative aerobes limited activity against anaerobes

Question 30

side effect of amoxicillin

Answer 30

diarrhea

Question 31

coverage for erythromycin

Answer 31

gram positive aerobes and anaerobes no gram neg activity beta lactamase producing bacteria

Question 32

what are some important drug interactions with macrolides

Answer 32

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

Question 33

what is the coverage of metronidazole

Answer 33

obligate anaerobes esp gram negative anaerobes

Question 34

side effects of metronidazole

Answer 34

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

Question 35

drug interactions with metronidazole

Answer 35

phenytoin: increased risk of drowsiness, ataxia lithium; lithium toxicity alcohol warfarin: increased bleeding statins: increased risk of myopathy, rhabdomyolysis

Question 36

what drugs are frequently associated with c diff diarrhea and colitis

Answer 36

fluoroquinolones cephalosporins clindamycin penicillin

Question 37

drug interactions with azoles

Answer 37

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

Question 38

side effects of systemic corticosteroids

Answer 38

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

Question 39

what drugs should be avoided in patients with liver disease

Answer 39

``` aspirin nsaids cox 2 inhibitors paracetamol narcotic analgesics benzodiazepines azoles clindamycin ```

Question 40

what drugs should be avoided in patients with renal disease

Answer 40

``` aspirin nsaids cox 2 inhibitors tetracyclnes aminoglycosides sulphonamides ciprofloxacin ``` caution use of penicillin and cephalosporins

Question 41

prescription for laop

Answer 41

amoxicillin 500mg tds/clindamycin 300mg bds if antibiotic cover is necessary chx 10ml tds ponstan (mefenamic acid) 500mg tds famotidine 20mg bd

Question 42

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

Answer 42

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

Question 43

medication for traumatic ulcer

Answer 43

triamcinolone acetonamide 0.1%

Question 44

medication for neurogenic pain

Answer 44

gabapentin 100-300mg tds, must titrate. start with 100mg bd then monitor others: pregabalin, carbamazepine

Question 45

medication for oral lichen planus

Answer 45

dexamethasone | nyastatin mouthwash 5ml qds

Question 46

medication for tmj pain

Answer 46

anarex (paracetamol + orphenadrine [muscle relaxant]) 2 tabs tds or ? ibuprofen 400mg tds

Question 47

medication for candidiasis

Answer 47

nyastatin 5ml qds for 14 days

Question 48

gastric irritation prescription

Answer 48

famotidine 20mg bd | omeprazole 40mg om