Pharm Flashcards
Sensation Sequence
Pain–>Cold–>Warmth
Resting potential of a nerve
-70mV due to Na/K pump moving 2K ions in and 3Na out (negative potential)
If a stimulus changes to -55mV then…
Na gates open. Na rushes in which DEPOLARIZES to +30mV (firing)
Repolarization to Hyperpolarization (describe what happens)
Na gates close, and K gates open. K rushes Out (repolar) to -90mV (hyperpolarization)
What channel does anesthetic work against?
Goes INTO nerve cell and blocks Na Channels. nerve doesnt respond
pH >7: what happens to LAH+?
LAH+–> LA+H+ (drug can move through lipid bilayer and bid to the NA channel)
pH <7: what happens to LAH+?
LA+H+–> LAH+ (much less of the anesthetic can bind to a Na Channel due to being unable to get through lipid layer)
Are local anesthetics basic or acidic?
basic
If an anesthetic is in an acidic environment the drug is…
ionized
Which LA are amides?
lido, mepivicaine, prilo, bupiv, ropiv, articiaine (thiophene ring instead of benzene)
where are amides metabolized
liver
What LA are esthers?
procaine, tetracaine
Where are esthers metabolized?
plasma
Benzodiazepines are most commonly used as…
anxiolysis, sedation, anxiety, anticonvulsant, muscle relaxors
Side effects of Benzos
decrease BP, HR, Respiration is normal, may increase confusion
Mechanism of benzos
Enhances GABA effect on GABAa receptors on chloride channels
What is the chemistry of LAs?
Aromatic Nucleus, Amide of ester link, and amino group
Ingredients in LA?
vasoconstrictors, antioxidant, sodium hydroxide (adjusts pH), sodium chloride (isotonic), methylparaben, sodium metabisulphite(vasoconstrictor preservative)
What might you be allergic to if allergic to LA?
esters because of the p-aminobenzoic acid (PABA)
methylparaben- maybe
Prilocaine metabolism
primary transformation in the liver and secondary in the lungs
Systemic toxicity signs of LA
circumoral numbness
tongue paresthesia
dizziness
tinnitus
blurred vision
restlessness
agitation
nervousness
paranoia
slurred speech
drowsiness
unconsciousness
Minimal to moderate toxicity signs
Euphoria
increase in BP
loss of consciousness
Severe toxicity signs
muscle twitch–> tonic clonic—>Respiratory Arrest
Seizure management? What drug to give?
Thiopental 1-2mg/kg to abruptly terminate the seizure.
What drugs or conditions can increase the threshold for LA induced seizures
Benzos and
hyperventilation
pH of a cell is usually what pH?
7.4
Will a LA with a low or high pKA be more available for cell absorption?
low (more absorption, faster onset)
What symptoms follow a seizure due to LA overdose?
Decrease of BP, HR, RR, and CNS depression
Lidocaine pKa?
7.8
Bupivicaine pKa?
8.1
Mepivacaine pKa?
7.7
Rank the LA in order of lipid solubility: Carbo, lido, marcaine
carbo, lido, marcaine
Septo: mg/lb, MRD
3.2mg/lb, 500mg
Marcaine: mg/lb, MRD
0.6 mg/lb, 90mg
Lido w/o vaso: mg/lb, MRD
2.0mg/lb, 300mg
lido w/ vaso: mg/lb, MRD
3.0mg/lb, 500mg
Carbo: mg/lb, MRD
3.0mg/lb, 400mg- natural vasoconstrictor mechanism
LA considerations: if a patient has a bisulfite allergy?
avoid vasoconstrictor
LA considerations: if a patient has a atypical plasma cholinesterase?
avoid esters
LA considerations: Methemoglobinemia?
Prilocaine
LA considerations: Liver Dysfunctions
avoid or be considerate of Amides
LA considerations: Renal dysfunction
avoid or be considerate with both Amides and Esthers
LA considerations: cardiovascular disease
avoid >0.2mg epi.
LA considerations: hyperthyroidism
avoid vasoconstrictor
Arachidonic Acid Cascade next?
Cox1, Cox2
Cox 1 acts on…?
Prostaglandins–> GI protection
Thromboxins–> platelet aggregation
Cox 2 acts on…?
Prostaglandins–> inflammation, pain, fever
PGI2–> cardiovascular protection
Regular and Max Dose of ASA?
5mg/lb,
60-80mg/kg/24 hrs.
MAX 6gm/24hr
Mechanism of Action of ASA?
inhibits prostaglandins, synthesis by inhibiting Cyclooxygenase.
Reduces fever by causing vasodilation
Irreversible binds to platelets
Half life of ASA?
low dose: 2-3 hrs
High dose: 15-30 hours
NSAIDS Mech of Action
inhibits prostaglandins, synthesis by inhibiting Cyclooxygenase.
REVERSIBLE binds to Platelets
Peak and Half Life of NSAIDs
Peak: 1-2 hrs
Half Life: 2-4 hours
APAP max dose
4g/24 hrs (3g on bottle to minimize OD)
APAP: peak and half life?
Peak: 1-3 hours
Half Life: 1-4 hours.
Steroids Mechanism of action
Inhibits PLA’s synthesis which is a precursor for pain
Which LAs are pregnancy Category C?
Articaine, mepivacaine and bupivacaine
Nystatin
CLASS :Polyene
MECHANISM: Alters fungal
cell wall permeability
INDICATIONS: localized infections
INTERACTIONS: none
SIDE EFFECTS: Minimal: contact dermatitis, hypersensitivity and Stevens-Johnson Rxn
Clotrimazole
CLASS: Imidazole
MECH: alters fungal wall permeability
INDICATIONS: local infections >3
ADMIN: Troche
INTERACTION: careful with liver disease
Ketoconazole and Fluconazole
CLASS: Imidazole
MECH: increases fungal wall permeability
INDICATIONS: systemic or local
ADMIN: tablet- no gastric acidity needed
INTERACTION: Tefernadine, cisapride
Sulfonylureas: ↑ hypoglycemia
Coumadin: monitor PT/INR
SE: nausea, vomiting, hepatoxicity, stevens johnson syndrome, avoid in breast feeding.
Itraconazole
CLASS: Triazole
MECH: Blocks the synthesis of ergosterol
INDIC: chronic oral candidiasis
ADMIN: tablet
INTERACT: Terfenadine, cisapride, astemizole
H2Blockers,omeprazole, lansoprazole
Coumadin: monitor PT/INR
SE: nausea, vomiting, hepatoxicity, stevens johnson syndrome, avoid in breast feeding.
Classes of Antihypertensive drugs
ACE-inhibitor
Angiotensin II Receptor Blocker
Beta Blocker
Calcium Channel Blocker
Diuretic
Loop Diuretic
Alpha-2 Agonist
Vasodilators
Name 3 ACE-inhibitors and what it does
Inhibit angiotensin-converting enzyme to decrease angiotensin II, a vasoconstrictor, and increase the level of bradykinin, a peptide vasodilator.
B produces prostaglandin which can cause SE: angioedema and cough.
MEDS: Lisinopril, Enalapril. “-pril”
Name 3 Angiotensin II Receptor Blocker (ARB) and its mechanism of action.
inhibit the angiotensin II receptor type 1 and thereby block the arteriolar contraction and sodium retention effects of renin–angiotensin system.
Used for: HTN, Diabetic kidney disease, CHF
MEDS: Losartan (Cozaar)
Valsartan
Irbesartan “-sartan”
Name 3 beta blockers and mechanism of action. (for HTN)
MEDS: Metoprolol (selective B1)
Atenolol (selective B1
Carvedilol (non-selective, A1 block)
“-lol”
MoA: Block epi and NE.
Name 2 Calcium Channel Blockers and Mech of Action.( for HTN)
Amlodipine Besylate(Norvasc)
Nifedipine “-dipine”
MoA: blocks Ca which allows constriction
gingival growth
Name 3 Diuretics used to tx HTN and mech of action.
MEDS: Hydrochlorothiazide
Spironolactone
Chlorthalidone
inhibits sodium chloride transport in the distal convoluted tubule. More sodium is then excreted in the kidney with accompanying fluid
Name a loop diuretic and its Mech of Action
furosemide*, bumetanide, and torsemide
Mech of Action: inhibiting the apical sodium/potassium/chloride transporter in the thick ascending limb of the loop of Henle.
What medications are commonly taken with HCTZ
**Lisinopril (Diuretic/ACEi)
Taken together to reduce BP
Side Effects: reduced heart rate, dizziness, fainting, headaches
**Losartan K (Diuretic/ARB)
**Triamterene (Diuretic/Thiazide)
used for patients who develop low blood potassium when on Hydrochlorothiazide alone
Name an Alpha-2 agonist and it’s mechanism of action
Clonidine
stimulating the pre-synaptic alpha 2 adrenoceptors, thereby decreasing noradrenaline(constrictor) release from both central and peripheral sympathetic nerve terminals. decreases HR
Name a Vasodilator and its mech of action.
Hydrazaline Hydrochloride
Hydralazine is a direct-acting smooth muscle relaxant and acts as a vasodilator primarily in resistance arterioles,
inhibition of inositol trisphosphate-induced Ca2+ release
Name two classes of antiarrythmic drugs and examples of each.
Cardiac Glycosides- Digoxin
Local Anesthetic -Lidocaine
Name 3 classes of Anti-anginal drugs and an example of each.
Beta Blocker- Propranolol
CCB- Diltiazem, Verapamil Hydrochloride
Vasodilator- Isosorbide Mononitrate
Nitroglycerin
Name 2 antiplatelet drugs.
Salicylate (Aspirin)
Clopidogrel
Name 4 anticoagulant drug classes and an example.
Wafarin (Coumadin)
-Factor Xa Inhibitor: Apixaban, adn Rivaroxaban (Xarelto)
-Low molecular weight heparin: Enoxaparin (Lovenox)
Thrombin Inhibitor: Dabigatran (Pradaxa)
What drugs help with urinary retention and what are their classes?
Alpha-1-Antagonist: Tamsulosin
5 Alpha-Reductase Inhibitor: Finasteride
Anti- Hyperlipidemia drugs
HMG-CoA Reductase Inhibitors:
-Atorvastatin
-Simvastatin
-Pravastatin
-Rosuvastatin
-Lovastatin
Fenofibrate (activates peroxisome proliferator activated receptor alpha)
Name 7 Anti-diabetic drug classes
-Biguanide
-Insulin
-Sulfonylurea
-Dipeptidyl peptidase-4 inhibitor
-Thiazolidinediones
-Sodium-glucose co-transporter 2 (SGLT2) Inhibitor
-Glucagon-like Peptide 1 Receptor Agonist
What medication is a biguanide
Glucophage (metformin)-
alteration of the energy metabolism of the cell… by inhibiting hepatic gluconeogenesis and opposing the action of glucagon
Name insulin versions.
Glargine (lantus, qwuikpen)- long acting
Insulin Human- “normal” acting
Insulin Aspart- Rapid Acting
Insulin Lispro- Rapid Acting
Dipeptidyl peptidase-4 inhibitor example (diabetes)
Sitagliptin phosphate
Metformin Hydrochloride/Sitagliptin Phosphate
Thiazolidinediones
Pioglitazone Hydrochloride
Sodium-glucose co-transporter 2 (SGLT2) Inhibitor
Canagliflozin
Glucagon-like Peptide 1 Receptor Agonist
Liraglutide
Thiazolidinediones example (DM)
Pioglitazone Hydrochloride
Sodium-glucose co-transporter 2 (SGLT2) Inhibitor name one. (DM)
Canagliflozin
name a Glucagon-like Peptide 1 Receptor Agonist
(DM)
Liraglutide
APAP max dose and dosing
4000mg/day
325mg · 2 pills every 4 to 6 hours
500 mg · 2 pills every 6 hours
**650 mg · 2 pills every 8 hour
Pain medication (NSAIDs) and dosing
Ibuprofen- MAX DAILY DOSE: 3,200mg
Meloxicam (Mobic)- 7.5-15mg per day
Naproxen-MAX DAILY DOSE: 1,250mg (1000 after 1st day)
1000 milligrams (mg) (taken as two 500 mg tablets) once a day. Short term ER: 1500 mg
500 mg PO initially, then 250 mg PO q6-8hr or 500 mg PO q12hr PRN;
Dislofenac- (also OTC gel 1%)
Diclofenac potassium liquid capsules: 25 mg QID
Diclofenac free acid capsules: 18 mg or 35 mg TID
Diclofenac potassium immediate-release tablets: 50 mg TID with; an initial dose of 100 mg
Celecoxib- Adults—400mg, then 200 mg per day
What does albuterol do?
bronchodilator
Beta-2 agonist
What does montelukast do? Class? AKA?
inhibit bronchoconstriction.
Leukotriene Receptor Antagonist
(singular)
Anticholinergic meds?
Toptropium- bronchodialtor, for COPD
Ipatropium Bromide (often used with albuterol)
Solifenacin Succinate- (oftne used for bladder control)
Dicycylomine Hydrochloride (for IBS)
Name Anticonvulsant drugs
Gabapentin
Clonazepam
Benzodiazepine Lorazepam (Ativan) Diazepam
Lamotrigine
Topiramate
Pregabalin
Phenytoin
Antidepressant classification of drugs
-Selective Serotonin Reuptake Inhibitor (SSRI)
Serotonin -Norepinephrine Reuptake Inhibitor (SNRI)
-Dopamine/ Norepinephrine Reuptake Inhibitor
-Tricyclic Antidepressants
-Monoamine Oxidase Inhibitors (MAOIs)
Name SSRIs and relevance to dental.
Sertraline
Fluoxetine
Citalopram
Trazodone
Escitalopram
Xerostomia, dry throat and lips, oral soreness or burning, dysgeusia (altered taste), halitosis, and bruxism.
Name SNRIs and relevance to dental.
Duloxetine
Venlafaxine
Paroxetine
Xerostomia, drooling, postural hypotension (dizziness when standing after lying or sitting), and bruxism.
What is an example of a Dopamine/Norepinephrine Reuptake Inhibitor
Bupropion (wellbutrin)
Name an example of a TCA
Amitriptyline
can be used for post op pain with implants or facial pain. 10 mg/day; this was increased to 60 mg/day after 40 days
