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ABGD study > Pharm > Flashcards

Pharm Flashcards

1
Q

Sensation Sequence

A

Pain–>Cold–>Warmth

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2
Q

Resting potential of a nerve

A

-70mV due to Na/K pump moving 2K ions in and 3Na out (negative potential)

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3
Q

If a stimulus changes to -55mV then…

A

Na gates open. Na rushes in which DEPOLARIZES to +30mV (firing)

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4
Q

Repolarization to Hyperpolarization (describe what happens)

A

Na gates close, and K gates open. K rushes Out (repolar) to -90mV (hyperpolarization)

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5
Q

What channel does anesthetic work against?

A

Goes INTO nerve cell and blocks Na Channels. nerve doesnt respond

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6
Q

pH >7: what happens to LAH+?

A

LAH+–> LA+H+ (drug can move through lipid bilayer and bid to the NA channel)

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7
Q

pH <7: what happens to LAH+?

A

LA+H+–> LAH+ (much less of the anesthetic can bind to a Na Channel due to being unable to get through lipid layer)

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8
Q

Are local anesthetics basic or acidic?

A

basic

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9
Q

If an anesthetic is in an acidic environment the drug is…

A

ionized

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10
Q

Which LA are amides?

A

lido, mepivicaine, prilo, bupiv, ropiv, articiaine (thiophene ring instead of benzene)

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11
Q

where are amides metabolized

A

liver

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12
Q

What LA are esthers?

A

procaine, tetracaine

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13
Q

Where are esthers metabolized?

A

plasma

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14
Q

Benzodiazepines are most commonly used as…

A

anxiolysis, sedation, anxiety, anticonvulsant, muscle relaxors

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15
Q

Side effects of Benzos

A

decrease BP, HR, Respiration is normal, may increase confusion

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16
Q

Mechanism of benzos

A

Enhances GABA effect on GABAa receptors on chloride channels

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17
Q

What is the chemistry of LAs?

A

Aromatic Nucleus, Amide of ester link, and amino group

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18
Q

Ingredients in LA?

A

vasoconstrictors, antioxidant, sodium hydroxide (adjusts pH), sodium chloride (isotonic), methylparaben, sodium metabisulphite(vasoconstrictor preservative)

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19
Q

What might you be allergic to if allergic to LA?

A

esters because of the p-aminobenzoic acid (PABA)
methylparaben- maybe

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20
Q

Prilocaine metabolism

A

primary transformation in the liver and secondary in the lungs

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21
Q

Systemic toxicity signs of LA

A

circumoral numbness
tongue paresthesia
dizziness
tinnitus
blurred vision
restlessness
agitation
nervousness
paranoia
slurred speech
drowsiness
unconsciousness

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22
Q

Minimal to moderate toxicity signs

A

Euphoria
increase in BP
loss of consciousness

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23
Q

Severe toxicity signs

A

muscle twitch–> tonic clonic—>Respiratory Arrest

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24
Q

Seizure management? What drug to give?

A

Thiopental 1-2mg/kg to abruptly terminate the seizure.

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25
Q

What drugs or conditions can increase the threshold for LA induced seizures

A

Benzos and
hyperventilation

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26
Q

pH of a cell is usually what pH?

A

7.4

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27
Q

Will a LA with a low or high pKA be more available for cell absorption?

A

low (more absorption, faster onset)

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28
Q

What symptoms follow a seizure due to LA overdose?

A

Decrease of BP, HR, RR, and CNS depression

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29
Q

Lidocaine pKa?

A

7.8

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30
Q

Bupivicaine pKa?

A

8.1

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31
Q

Mepivacaine pKa?

A

7.7

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32
Q

Rank the LA in order of lipid solubility: Carbo, lido, marcaine

A

carbo, lido, marcaine

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33
Q

Septo: mg/lb, MRD

A

3.2mg/lb, 500mg

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34
Q

Marcaine: mg/lb, MRD

A

0.6 mg/lb, 90mg

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35
Q

Lido w/o vaso: mg/lb, MRD

A

2.0mg/lb, 300mg

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36
Q

lido w/ vaso: mg/lb, MRD

A

3.0mg/lb, 500mg

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37
Q

Carbo: mg/lb, MRD

A

3.0mg/lb, 400mg- natural vasoconstrictor mechanism

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38
Q

LA considerations: if a patient has a bisulfite allergy?

A

avoid vasoconstrictor

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39
Q

LA considerations: if a patient has a atypical plasma cholinesterase?

A

avoid esters

40
Q

LA considerations: Methemoglobinemia?

A

Prilocaine

41
Q

LA considerations: Liver Dysfunctions

A

avoid or be considerate of Amides

42
Q

LA considerations: Renal dysfunction

A

avoid or be considerate with both Amides and Esthers

43
Q

LA considerations: cardiovascular disease

A

avoid >0.2mg epi.

44
Q

LA considerations: hyperthyroidism

A

avoid vasoconstrictor

45
Q

Arachidonic Acid Cascade next?

A

Cox1, Cox2

46
Q

Cox 1 acts on…?

A

Prostaglandins–> GI protection
Thromboxins–> platelet aggregation

47
Q

Cox 2 acts on…?

A

Prostaglandins–> inflammation, pain, fever
PGI2–> cardiovascular protection

48
Q

Regular and Max Dose of ASA?

A

5mg/lb,
60-80mg/kg/24 hrs.
MAX 6gm/24hr

49
Q

Mechanism of Action of ASA?

A

inhibits prostaglandins, synthesis by inhibiting Cyclooxygenase.
Reduces fever by causing vasodilation
Irreversible binds to platelets

50
Q

Half life of ASA?

A

low dose: 2-3 hrs
High dose: 15-30 hours

51
Q

NSAIDS Mech of Action

A

inhibits prostaglandins, synthesis by inhibiting Cyclooxygenase.
REVERSIBLE binds to Platelets

52
Q

Peak and Half Life of NSAIDs

A

Peak: 1-2 hrs
Half Life: 2-4 hours

53
Q

APAP max dose

A

4g/24 hrs (3g on bottle to minimize OD)

54
Q

APAP: peak and half life?

A

Peak: 1-3 hours
Half Life: 1-4 hours.

55
Q

Steroids Mechanism of action

A

Inhibits PLA’s synthesis which is a precursor for pain

56
Q

Which LAs are pregnancy Category C?

A

Articaine, mepivacaine and bupivacaine

57
Q

Nystatin

A

CLASS :Polyene
MECHANISM: Alters fungal
cell wall permeability
INDICATIONS: localized infections
INTERACTIONS: none
SIDE EFFECTS: Minimal: contact dermatitis, hypersensitivity and Stevens-Johnson Rxn

58
Q

Clotrimazole

A

CLASS: Imidazole
MECH: alters fungal wall permeability
INDICATIONS: local infections >3
ADMIN: Troche
INTERACTION: careful with liver disease

59
Q

Ketoconazole and Fluconazole

A

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.

60
Q

Itraconazole

A

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.

61
Q

Classes of Antihypertensive drugs

A

ACE-inhibitor
Angiotensin II Receptor Blocker
Beta Blocker
Calcium Channel Blocker
Diuretic
Loop Diuretic
Alpha-2 Agonist
Vasodilators

62
Q

Name 3 ACE-inhibitors and what it does

A

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”

63
Q

Name 3 Angiotensin II Receptor Blocker (ARB) and its mechanism of action.

A

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”

64
Q

Name 3 beta blockers and mechanism of action. (for HTN)

A

MEDS: Metoprolol (selective B1)
Atenolol (selective B1
Carvedilol (non-selective, A1 block)
“-lol”
MoA: Block epi and NE.

65
Q

Name 2 Calcium Channel Blockers and Mech of Action.( for HTN)

A

Amlodipine Besylate(Norvasc)
Nifedipine “-dipine”

MoA: blocks Ca which allows constriction

gingival growth

66
Q

Name 3 Diuretics used to tx HTN and mech of action.

A

MEDS: Hydrochlorothiazide
Spironolactone
Chlorthalidone

inhibits sodium chloride transport in the distal convoluted tubule. More sodium is then excreted in the kidney with accompanying fluid

67
Q

Name a loop diuretic and its Mech of Action

A

furosemide*, bumetanide, and torsemide

Mech of Action: inhibiting the apical sodium/potassium/chloride transporter in the thick ascending limb of the loop of Henle.

68
Q

What medications are commonly taken with HCTZ

A

**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

68
Q

Name an Alpha-2 agonist and it’s mechanism of action

A

Clonidine
stimulating the pre-synaptic alpha 2 adrenoceptors, thereby decreasing noradrenaline(constrictor) release from both central and peripheral sympathetic nerve terminals. decreases HR

68
Q

Name a Vasodilator and its mech of action.

A

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

68
Q

Name two classes of antiarrythmic drugs and examples of each.

A

Cardiac Glycosides- Digoxin
Local Anesthetic -Lidocaine

69
Q

Name 3 classes of Anti-anginal drugs and an example of each.

A

Beta Blocker- Propranolol
CCB- Diltiazem, Verapamil Hydrochloride
Vasodilator- Isosorbide Mononitrate
Nitroglycerin

69
Q

Name 2 antiplatelet drugs.

A

Salicylate (Aspirin)
Clopidogrel

69
Q

Name 4 anticoagulant drug classes and an example.

A

Wafarin (Coumadin)
-Factor Xa Inhibitor: Apixaban, adn Rivaroxaban (Xarelto)
-Low molecular weight heparin: Enoxaparin (Lovenox)
Thrombin Inhibitor: Dabigatran (Pradaxa)

70
Q

What drugs help with urinary retention and what are their classes?

A

Alpha-1-Antagonist: Tamsulosin
5 Alpha-Reductase Inhibitor: Finasteride

71
Q

Anti- Hyperlipidemia drugs

A

HMG-CoA Reductase Inhibitors:
-Atorvastatin
-Simvastatin
-Pravastatin
-Rosuvastatin
-Lovastatin

Fenofibrate (activates peroxisome proliferator activated receptor alpha)

72
Q

Name 7 Anti-diabetic drug classes

A

-Biguanide
-Insulin
-Sulfonylurea
-Dipeptidyl peptidase-4 inhibitor
-Thiazolidinediones
-Sodium-glucose co-transporter 2 (SGLT2) Inhibitor
-Glucagon-like Peptide 1 Receptor Agonist

73
Q

What medication is a biguanide

A

Glucophage (metformin)-
alteration of the energy metabolism of the cell… by inhibiting hepatic gluconeogenesis and opposing the action of glucagon

74
Q

Name insulin versions.

A

Glargine (lantus, qwuikpen)- long acting

Insulin Human- “normal” acting

Insulin Aspart- Rapid Acting
Insulin Lispro- Rapid Acting

75
Q

Dipeptidyl peptidase-4 inhibitor example (diabetes)

A

Sitagliptin phosphate
Metformin Hydrochloride/Sitagliptin Phosphate
Thiazolidinediones
Pioglitazone Hydrochloride
Sodium-glucose co-transporter 2 (SGLT2) Inhibitor
Canagliflozin
Glucagon-like Peptide 1 Receptor Agonist
Liraglutide

76
Q

Thiazolidinediones example (DM)

A

Pioglitazone Hydrochloride

77
Q

Sodium-glucose co-transporter 2 (SGLT2) Inhibitor name one. (DM)

A

Canagliflozin

78
Q

name a Glucagon-like Peptide 1 Receptor Agonist
(DM)

A

Liraglutide

79
Q

APAP max dose and dosing

A

4000mg/day

325mg · 2 pills every 4 to 6 hours
500 mg · 2 pills every 6 hours
**650 mg · 2 pills every 8 hour

80
Q

Pain medication (NSAIDs) and dosing

A

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

81
Q

What does albuterol do?

A

bronchodilator
Beta-2 agonist

82
Q

What does montelukast do? Class? AKA?

A

inhibit bronchoconstriction.
Leukotriene Receptor Antagonist
(singular)

83
Q

Anticholinergic meds?

A

Toptropium- bronchodialtor, for COPD
Ipatropium Bromide (often used with albuterol)
Solifenacin Succinate- (oftne used for bladder control)
Dicycylomine Hydrochloride (for IBS)

84
Q

Name Anticonvulsant drugs

A

Gabapentin
Clonazepam
Benzodiazepine Lorazepam (Ativan) Diazepam
Lamotrigine
Topiramate
Pregabalin
Phenytoin

85
Q

Antidepressant classification of drugs

A

-Selective Serotonin Reuptake Inhibitor (SSRI)
Serotonin -Norepinephrine Reuptake Inhibitor (SNRI)
-Dopamine/ Norepinephrine Reuptake Inhibitor
-Tricyclic Antidepressants
-Monoamine Oxidase Inhibitors (MAOIs)

86
Q

Name SSRIs and relevance to dental.

A

Sertraline
Fluoxetine
Citalopram
Trazodone
Escitalopram

Xerostomia, dry throat and lips, oral soreness or burning, dysgeusia (altered taste), halitosis, and bruxism.

87
Q

Name SNRIs and relevance to dental.

A

Duloxetine
Venlafaxine
Paroxetine

Xerostomia, drooling, postural hypotension (dizziness when standing after lying or sitting), and bruxism.

88
Q

What is an example of a Dopamine/Norepinephrine Reuptake Inhibitor

A

Bupropion (wellbutrin)

89
Q

Name an example of a TCA

A

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

90
Q
A

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