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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
Carbapenems
Cell Wall Synthesis Inhibitors, B-lactam suffix: -nem
26
Tetracyclines
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
27
Macrolides
Protein synthesis inhibitors (50s ribosomal subunit) DDI: * Seldane/Digoxin-->inhibit metabolism of seldane/digoxiin Mac Likes to Throw Mice * Suffix: -thromycin
28
Lincosamides
Protein Synthesis inhibitors (50s ribosomal subunit) Link likes to hide mice Suffix: -mycin
29
Clindamycin: Side effect
GI Upset PSeudomonas Colitis
30
Side effect of Broad Spectrum Antibiotics
Superinfection (Ex: tetracycline)
31
Chloramphenicol: Side effect
Aplastic anemia
32
Tetracycline: Side effect
Liver Damage
33
Erythromycin: Side effect
Allergic Cholestatic Hepatitis
34
Penicillin: DDI
Penicillin + Probenecid (Gout Drug): Decreased renal clearance of penicillin
35
Tetracycline: DDI
Tetracycline + Antacids/Dairy: Tetracycline chelates Ca+ and decreases absorption
36
Broad spectrum antibiotics: DDI
Broad Spectrum + Anticoagulants: decrease Vit K producing bacteria= Increased anticoagulants action
37
Antibiotics + Oral Contraceptives: DDI
Decrease normal GI Flora & recycling steroid hormones
38
What drug has the highest concentration in Bone?
Clindamycin
39
What drug has the highest concentration in GCF?
Tetracycline
40
Antibiotic Prophylaxis Recommendation
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
Recommended antibiotics for Prophylaxis: Infective Endocarditis
42
Antifungals
Suffix: -azole Clotrimazole= **Troche form**
43
NSAIDS: List Drugs, MOA, Impacts
**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
Therapeutic Effects of Aspirin
**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
Acetaminophen
**NOT an NSAID** 1st choice for child fever: * **Aspirin causes Reye's Syndrome** **Hard on the liver** MOA: Unknown (inhibits pain in CNS)
46
Max Doses for: Ibuprofen Acetaminophen Aspirin
Ibuprofen: 3200mg/day Acetaminophen: 4000mg/day Aspirin: 4000mg/day
47
Corticosteroids: * prefix/suffix * Therapeutic Effects * Side Efffects
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
Narcotics/Opiods: Drug Names
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
Vicodine
Hydrocodone + Acetaminophen
50
Percocet
Oxycodone + Acetaminophen
51
Percodan
Oxycodone + Aspirin
52
Tylenol 1 vs 2 vs 3 vs 4
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
Opioids: * MOA
MOA: mu-opioid receptor agonists
54
Opioids: * Therapeutic effects * Side Effects
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
Naloxone
Naloxone: *Inverse Agonist (Antagonist) * emergency Tx of OD
56
Naltrexone
Naltrexone: * Antagonist * Addiction Tx
57
Methadone
Methadone: * Addiction Tx * Detox morphine addicts
58
Mixed Agonist-antagonist (MAA) Drugs
Pentazocine Nalbuphine Buprenorphine
59
Morphine Overdose causes:
Coma Miosis Respiratory depression
60
What is the mechanism of respiratory depression?
Loss of sensitivity of medullary respiratory center to carbon dioxide
61
Nitrous Oxide
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
Pathognomonic symptoms of narcotic overdose
Coma Miosis Respiratory depression
63
What is the mechanism behind respiratory depression?
Loss of sensitivity of medullary respiratory center to carbon dioxide
64
What is the cause of death in opiod-intoxifiction?
Respiratory depression
65
Codeine
suppress cough reflex

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