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BOARDs > Pharm > Flashcards

Pharm Flashcards

1
Q

Amides vs Esters Local Anesthetics: General

A

Amides:
* Metabolism: Liver
* ** 2 i’s**

Esters:
* Metabolism: Plasma
* 1 i
* More Toxic, More allergic–>Bc Methylparabeen (Food preservative) interacts w/esters

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2
Q

List the names, %, and facts for Amide Local Anesthetics

A

2% Lidocaine
* Safest for children

0.5% Bupivicaine
* Most dangerous for children
* Longest lasting

2/3% Mepivicaine
* Least vasodilation

4% Articaine
* 1 ester chain
* metabolized in both liver and plasm
* Shortest acting

4% Prilocaine
* cause Methemoglobinemia (hepatic disease contraindication)

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3
Q

List the names and facts for Ester Local Anesthetics

A

Procaine

Cocaine:
* vasoconstricts (All other are dilators)

Tetracaine

Benzocaine:
* common topical anesthetic

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4
Q

A vasoconstrictor is added to LA to:

A
  1. Prolong Numbness
  2. Decrease Toxicity
  3. Promote Hemostasis
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5
Q

What is the max epinephrine for ASA 1 patient?

A

0.2 mg

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6
Q

What is the max epinephrine for cardiac patient (MI or Arrythmia)?

A

0.04 mg

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7
Q

What is the max lidocaine w/vasoconstrictor vs w/o vasoconstrictor?

A

w/o vasoconstrictor: 4.4mg/kg, not to exceed 500 mg

w/vasoconstrictor: 7mg/kg

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8
Q

LA: MOA

A

Na+ Channel Blocker
* Prevent the generation of nerve action potentials by decreasing the inward movement of sodium ion
* Prevent increased membrane permeability to Na+

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9
Q

Absorption issues of LA

A

Only non-ionized (Free-base form) form can penetrate neuronal mmembrane

Inflammed tissue=acidic (Decreased pH): Decreases the non-ionized form available–> Decreased effectiveness of LA in infected/inflamed tissue

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10
Q

Amide LA: pKa’s

A

Mepivacaine: 7.6
* Closer to pH of inflammed tissue= Increased effectiveness vs others in acidic tissues

Lidocaine/Prilocaine/Articaine: 7.8

Bupivacaine: 8.1

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11
Q

List all Bacteriostatic Antiobiotics

A

ECSTATiC

Erythromycin
Clindamycin
Sulfonamides
Tetracylcines
Azithromycin
Trimethoprim
Chloramphenicol

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12
Q

List all Bacteriocidal Antiobitics

A

Molecules For Virtually Annihilating Prokaryotic Cells

Metronidazole
Fluorquinolones
Vancomycin
Aminoglycosides
Penicillins
Cephalosporins

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13
Q

Sulfonamides

A

Folate Synthesis Inhibitor
* compete w/PABA
* result in folic acid deficiency

prefix: sulfa-

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14
Q

Fluoroquinolones

A

DNA Synthesis Inhibitors

suffix: -floxacin

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15
Q

Penicillins

A

Cell wall synthesis inhibitor, B lactam ring

  • cross-allergenic w/cephalosporins bc Chemically related

DDI:
* Probenicide (GOUT)= Decreased renal clearance of penicillin

Suffix: -cillin (Except Augmentin)

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16
Q

Penicillin G

A

IV
* more sensitive to acid degradation

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17
Q

Penicillin V

A

Oral
* more reliable oral absorption

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18
Q

Amoxicillin

A

Broad Spectrum

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19
Q

Augmentin

A

Amoxicillin + Clavulanic Acid–> B-lactamase resistant

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20
Q

Methicillin

A

B lactamase resistant

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21
Q

Dicloxacillin

A

B-lactamase resistant

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22
Q

Ampicillin

A

Best/Broadest spectrum Gram -

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23
Q

Cephalosporins

A

Cell wall synthesis inhibitors, B-lactam

Prefex: -Ceph/Cef

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24
Q

Monobactams

A

Cell Wall Synthesis Inhibitors, B-lactam

Suffix: -am

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25
Q

Carbapenems

A

Cell Wall Synthesis Inhibitors, B-lactam

suffix: -nem

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26
Q

Tetracyclines

A

Protein Synthesis inhibitor (30s ribosomal subunit)
*broadest antimicrobial spectrum of all antibiotics

Side Effect:
* Liver damage
* Super infection (Broad AB)

DDI:
* Antiacids/Diary=Chelate Ca2+ & Decreased absorption

Highest conc in GCF

Suffix: -cycline

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27
Q

Macrolides

A

Protein synthesis inhibitors (50s ribosomal subunit)

DDI:
* Seldane/Digoxin–>inhibit metabolism of seldane/digoxiin

Mac Likes to Throw Mice
* Suffix: -thromycin

28
Q

Lincosamides

A

Protein Synthesis inhibitors (50s ribosomal subunit)

Link likes to hide mice

Suffix: -mycin

29
Q

Clindamycin: Side effect

A

GI Upset
PSeudomonas Colitis

30
Q

Side effect of Broad Spectrum Antibiotics

A

Superinfection (Ex: tetracycline)

31
Q

Chloramphenicol: Side effect

A

Aplastic anemia

32
Q

Tetracycline: Side effect

A

Liver Damage

33
Q

Erythromycin: Side effect

A

Allergic Cholestatic Hepatitis

34
Q

Penicillin: DDI

A

Penicillin + Probenecid (Gout Drug):

Decreased renal clearance of penicillin

35
Q

Tetracycline: DDI

A

Tetracycline + Antacids/Dairy:

Tetracycline chelates Ca+ and decreases absorption

36
Q

Broad spectrum antibiotics: DDI

A

Broad Spectrum + Anticoagulants:

decrease Vit K producing bacteria= Increased anticoagulants action

37
Q

Antibiotics + Oral Contraceptives: DDI

A

Decrease normal GI Flora & recycling steroid hormones

38
Q

What drug has the highest concentration in Bone?

A

Clindamycin

39
Q

What drug has the highest concentration in GCF?

A

Tetracycline

40
Q

Antibiotic Prophylaxis Recommendation

A
  1. Previous Hx of Infective Endocarditis
  2. Prosthetic Heart Valves or heart valve repair w/prosthetic material
  3. Heart transplant w/valve regurgitation
  4. Repaired congenital heart defect w/residual shunts or valve regurgitation
  5. Unrepaired Cyanotic Heart disease (5 T’s)
41
Q

Recommended antibiotics for Prophylaxis: Infective Endocarditis

42
Q

Antifungals

A

Suffix: -azole

Clotrimazole= Troche form

43
Q

NSAIDS: List Drugs, MOA, Impacts

A

IRREVERSIBLE COX 1 & 2 Blocker
Aspirin (ASA): GI (upset stomach)

Reversible COX 1 & 2 Blocker
Ibuprofen: Hard on kidney
Naproxen
Ketorolac: IV, IM, Oral
Indomethacin
Difunisal: Longer half life

COX 2 Selective Blocker
Celecoxib
Meloxicam

44
Q

Therapeutic Effects of Aspirin

A

Analgesic:
* Inhibits COX 1 & 2–> Decrease PG synthesis

Anti-inflammatory:
* Same as above

Antipyretic:
* Inhibits PG synthesis in Hypothalamus

Bleeding Time:
* Decrease TXA2 synthesis=inhibits platelet aggregation

45
Q

Acetaminophen

A

NOT an NSAID

1st choice for child fever:
* Aspirin causes Reye’s Syndrome

Hard on the liver

MOA: Unknown (inhibits pain in CNS)

46
Q

Max Doses for:
Ibuprofen
Acetaminophen
Aspirin

A

Ibuprofen: 3200mg/day

Acetaminophen: 4000mg/day

Aspirin: 4000mg/day

47
Q

Corticosteroids:
* prefix/suffix
* Therapeutic Effects
* Side Efffects

A

Suffix: -one

Therapeutic Effects:
Analgesic:
* Inhibit Phospholipase A2 (Arachidonic acid sytnehsis)-upstream of NSAIDs
Antiinflammatory: Same

Immunosuppresion:
* latent infections (Tuberculosis) go systemic
* Opportunistic infections (Candidiasis) become a problem

Side Effect:
* Gastric ulcers
* immunosuppresion
* Osteoporosis
* Hyperglycemia
* Redistribution of body fat
ACUTE ADRENAL INSUFFICIENCY: Rule of 2: Adrenal suppresion risk if pt takes:
* 20 mg Cortisone
* for 2 weeks
* within 2 years of dental Tx

48
Q

Narcotics/Opiods: Drug Names

A

Morphine
Hydrocodone
Oxycodone
Oxycontin: Controlled release
Codeine: suppresses cough reflex, cough syrup
Tramadol: similar to codeine

Heroin
Fentanyl
Meperidine (Demerol): Lethal if combined w/MAOI

49
Q

Vicodine

A

Hydrocodone + Acetaminophen

50
Q

Percocet

A

Oxycodone + Acetaminophen

51
Q

Percodan

A

Oxycodone + Aspirin

52
Q

Tylenol 1 vs 2 vs 3 vs 4

A

Hint: Start w/ttylenol 3

Tylenol 1: 300mg Acetaminophen + 8 mg Codeine

Tylenol 2: 300mg Acetaminophen + 15 mg Codeine

Tylenol 3: 300 mg Acetaminophen + 30 Mg codeine

Tylelnol 4: 300 mg Acetaminophen + 60 mg codeine

53
Q

Opioids:
* MOA

A

MOA: mu-opioid receptor agonists

54
Q

Opioids:
* Therapeutic effects
* Side Effects

A

Therapeutic/Side Effects: (MORPHINE)
Miosis (pupil dilation)
Out of it (sedation)
Respiratory Depression
Pneumonia (aspiration pneumonia)
Hypotension
Infrequency (urinary retention & constipation)
Nausea & Vomiting
Euphoria & dysphoria

55
Q

Naloxone

A

Naloxone:
*Inverse Agonist (Antagonist)
* emergency Tx of OD

56
Q

Naltrexone

A

Naltrexone:
* Antagonist
* Addiction Tx

57
Q

Methadone

A

Methadone:
* Addiction Tx
* Detox morphine addicts

58
Q

Mixed Agonist-antagonist (MAA) Drugs

A

Pentazocine
Nalbuphine
Buprenorphine

59
Q

Morphine Overdose causes:

A

Coma
Miosis
Respiratory depression

60
Q

What is the mechanism of respiratory depression?

A

Loss of sensitivity of medullary respiratory center to carbon dioxide

61
Q

Nitrous Oxide

A

MAC: 105%
* To avoid Diffusion Hypoxia–> 100% O2 for 5 mins after NO2

Sensation before onset: Tingling

Side Effects: Nausea

Long Term Exposure: Peripheral Neuropathy

62
Q

Pathognomonic symptoms of narcotic overdose

A

Coma
Miosis
Respiratory depression

63
Q

What is the mechanism behind respiratory depression?

A

Loss of sensitivity of medullary respiratory center to carbon dioxide

64
Q

What is the cause of death in opiod-intoxifiction?

A

Respiratory depression

65
Q

Codeine

A

suppress cough reflex

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