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NBDE II > pharm 2 > Flashcards

pharm 2 Flashcards

1
Q

Oral drugs – undergo

A

1st pass metabolism in liver.

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2
Q

What is used to determine whether a drug will cross glomerulus: attached to a protein or not;
acid or base; positive or negatively charged

A

attached to a protein or not

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3
Q

Which drug absorbs better in stomach acid?

A

Weak acid

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4
Q 
In order for a drug to do its effect in what state should it be?
Weak acid,
Weak base
Liposoluble
Hydrophobic
Hydrophilic
A

Liposoluble

  • NON ionized drugs are soluble in lipid.
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5
Q

When a drug does not exert its maximum effect is because it’s bound to?

A

Albumin

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6
Q 
Which of the following best explains why drugs that are highly ionized tend to be more rapidly excreted than those that are less
ionized? The highly ionized are
A. less lipid soluble.
B. less water soluble.
C. more rapidly metabolized.
D. more extensively bound to tissue.
A

A. less lipid soluble.

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7
Q

Therapeutic Index LD/ED is a measure of:

A

safety of drug

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8
Q

QUESTION: LD50 means at this dose,

A

50% of the test animals died

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9
Q

QUESTION: What is bioavailability of a drug?

A

amount of drug that is available in blood

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10
Q

What does bioavailability measured?
How much drug is absorbed in the circulation
Blood to urine ratio

A

How much drug is absorbed in the circulation

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11
Q

What pharmacokinetic factor influences the need for multiple doses in a day (dose rate)? half-life; bioavailability, or
clearance

A

half-life

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12
Q

Two different drugs with same dosages, bind to the same receptor, and cause same intrinsic affect. However, they have different
affinities for the receptor. In which aspect these 2 drugs are similar?
a. ED50
b. LD50
c. Potency
d. Efficacy

A
  • Efficacy bc they can both produce the same maximal response if enough is given
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13
Q

Fixed dose drug A w/ low dose of Drug B increase drug B effect when same dose of drug a is give w/ increased does of drug B:
competitive antagonist, synergism, partial agonist

A
  • partial agonists bind & activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist.
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14
Q

Three carpules (2 ml carpules, 40 mg/ml) of local anesthetic X are required to obtain adequate local anesthesia. To obtain the same
degree of anesthesia with local anesthetic Y, five carpules (2 ml carpules, 40 mg/ml) are required. If no other information about the two drugs is
available, then it is accurate to say that drug X:
is less potent than drug Y.
is more efficacious than Y.
is less efficacious than drug Y.
X&Y are = in potency & efficacy.

A

X is more potent
no info on efficacy really

if ceiling effect was the same but with different doses,
efficacy would be the same

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15
Q 
The maximal or "ceiling" effect of a drug is also correctly referred to as the drug's
A. agonism.
B. potency.
C. efficacy.
D. specificity.
A

efficacy

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16
Q

vagal reflex

A

reflex to suddenly increased BP –> slows down HR

can give atropine to block

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17
Q

Epinephrine reversal –

A

when also taking α blocker (ex. prazosin, chlorpromazine) cause decrease in BP b/c β-mediated vasodilation
predominates

o Beta2 trumps A1 so vasodilation happens & BP decreases

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18
Q

Alpha-1 agonist:

A

increase smooth muscle tone, vasoconstrictor –> ↑ BP

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19
Q

Alpha-2 agonist:

A

given orally b/c they cause hypotension by reducing sympathetic CNS outflow

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20
Q

What does Alpha-1 do?

A

Vasoconstriction of peripheral vessels (smooth muscle)

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21
Q

When you stimulate alpha 1 receptors what happens?

a. Vasoconstriction
b. Hypertension

A

Vasoconstriction

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22
Q

What does alpha-1 receptors do to the heart?

A

Vasoconstriction, increase blood pressure, increase peripheral resistance, mydriasis
(pupil dilution) and urinary retention

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23
Q

Adrenalin – stimulates which receptors

A

alpha 1, 2 and beta 1, 2 receptors

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24
Q

Heart has which receptors.

A

beta-1

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25
Q

Slow infusion of epinephrine will cause which of the following and know which receptor is responsible -

A 
Alpha 1 (Vasoconstriction
during anaphylaxis), Beta 1 (Increases cardiac output), Beta 2 (bronchodilation)
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26
Q

Patients BP spike after EPI, what receptor?

A

B1

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27
Q 
Hemostatic agents in retraction cord target what receptor?
• a1 
• b1
• b2
• gaba
• muscarinic receptor
A

a1 (vasoconstriction)

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28
Q

Retraction cord with epinephrine can cause:

A

increase HR, BP

- do not use in hyperthyroid or cardiac disease.

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29
Q

After using a gingival retraction cord, tissue reacts by recession. Where do you see this the most? Lingual, buccal, interproximal.

A

buccal

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30
Q

Smooth muscle relaxation is caused by which of the following drugs?

a. prazosin
b. atropine
c. theophylline
d. amphetamine

A

a. prazosin (alpha 1 blocker…blocks vascular smooth muscle constriction)
b. atropine (anticholinergic)
c. theophylline (treat asthma, COPD…it relaxes bronchial smooth muscle…so I guess it does do smooth muscle…)
d. amphetamine (psychostimulant…increase wakefulness)
- answer should be an alpha-1 antagonist/blocker

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31
Q 
Which of the following combinations of agents would be necessary to block the cardiovascular effects produced by the injection of
a sympathomimetic drug?
Atropine and prazosin
Atropine and propranolol
Prazosin and propranolol
Phenoxybenzamine and curare
Amphetamine and propranolol
A

Prazosin and propranolol

  • sympathomimetic drug injection (ex. NE) stimulates α/β receptors so α-blocker prazosin + β blocker propranolol is needed.
  • Atropine is an muscarinic/cholinergic receptor blocker that would stimulate heart (opposite effect)
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32
Q 
Each of the following drugs produces vasoconstriction of vessels if injected into the gingiva EXCEPT one. Which one is this
EXCEPTION?
Epinephrine (EpiPen®)
Terazosin (Hytrin®)
Levonordefrin (Neo-Nedfrin®)
Phenylephrine (Neo-Synephrine®)
Norepinephrine (Levophed®)
A
  • Terazosin, selective alpha-1 antagonist, is used to tx HTN & enlarged prostate (BPH)
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33
Q

Epinephrine + propanolol:

A

increases BP, decreases HR

Propranolol is a nonselective beta blocker so epi only acts at only alpha receptors, which in the periphery are mainly alpha-1 receptors
- This causes vasoconstriction &Increased ⬆ BP –> increased firing, which triggers aortic and carotid sinuses –> increased vagal activity
on the heart –> decreased
⬇ HR.

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34
Q

If using with epi, Change propranolol for?

A

Metoprolol … little change on HR, but no marked increase in BP.
- METOPROLOL = selective B blocker (proprano is nonselective) and is ok to use with EPI!

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35
Q

Propranolol + epinephrine = bad reaction due to: drug interaction, anxiety, allergy

A

drug interaction,

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36
Q

Patient taking propranolol with epinephrine. What receptor caused hypertensive crisis?

  • alpha 1
  • alpha 2
  • beta 1
  • beta 2
A

alpha-1

  • If a patient on a nonselective beta-blocker receives a systemic dose of epinephrine, however, the beta-blocker prevents the
    vasodilation, leaving unopposed alpha vasoconstriction. (alpha-1)
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37
Q

What is the effect seen when propranolol and epinephrine are injected simultaneously -

A

in cases of mild reactions it causes

hypotension; in severe reaction it is malignant hypertension

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38
Q

All these drugs alter ionic movement except - Propranolol, CCB, HCTZ, and Digoxin

A

Propranolol

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39
Q 
QUESTION: A patient receiving propranolol has an acute asthmatic attack while undergoing dental treatment. The most useful agent for
management to the condition is?
a. Morphine
b. Epinephrine
c. Phentolamine
d. Aminophylline
e. Norepinephrine
A
  • Aminophylline: Bronchodilator, class theophylline
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40
Q 
The drug-of-choice for the treatment of adrenergically-induced arrhythmias is:
quinidine.
lidocaine.
phenytoin.
propranolol
A

propranolol

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41
Q

Direct alpha sympathomimetic: clonidine, guanethidine , methyldopa

A

clonidine

guanethidine is indirect - acts on neurons to inhibit NE release
methldopa is fake neurotransmitter

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42
Q

Epinephrine Reversal with?

A

Alpha adrenoceptor blockers (ex. phenoxybenzamine)

- inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP instead of high BP

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43
Q

Epinephrine reversal: after giving a patient epinephrine, following hypertension, which of these drugs would cause a drop in BP?

A

Phenoxybenzamine

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44
Q

What receptor or signaling pathway is linked most directly to α2-adrenoceptor stimulation? I

A

nhibition of adenylyl cyclase through

GI, resulting from stimulation of α2-adrenergic receptor, leads to intracellular ⬇ cAMP

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45
Q

amphetamines MOA

A

indirect-acting sympathomimetics

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46
Q

ADHD meds

A

Methylphenidate = Ritalin

o Methylphenidate: blocks dopamine uptake in central adrenergic neurons by blocking dopamine transport or carrier proteins.

  • Amphetamine = Adderall
    o Amphetamines & cocaine: increase catecholamine NE SERETONIN DOPAMINE release as a primary mechanism.
    § Amphetamines stimulate CNS alpha receptors
    o Adderall: psychostimulant medication composed of amphetamine and dextroamphetamine, which increases the amount of
    dopamine and norepinephrine in the brain
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47
Q

ADHD with gender

A

M>F

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48
Q

Amphetamines MOA –

A

lead to NE release in brain

- stimulate the release of norepinephrine from central adrenergic receptors & at higher dosage, release of dopamine

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49
Q

Methylphenidate brand name, Amphetamine brand name

A

Methylphenidate = Ritalin, Amphetamine = Adderall.

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50
Q

Kid is taking Adderall (amphetamine) & is very anxious what do you do?

A

Tell him to stop taking amphetamine on the day
appointment
- Amphetamine can induce anxiety, and are contraindicated for patients that are very nervous

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51
Q

Side effect of Amphetamines

A

– Insomnia (difficulty of falling asleep)

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52
Q

Amphetamines, what are symptoms?

A

Increased heart rate & excitability

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53
Q

Cholinergic crisis:

A

bradycardia, lacrimation, salivation, voluntary muscle weakness, diarrhea, bronchoconstriction – tx w/ atropine

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54
Q

cholinergic agonists: examples and effect on slivation

A

increased salivation

pilocarpine (direct), neostigmine

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55
Q

anticholinergic agents

A

atropine/scopolamine

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56
Q

antticholinergic overdose

A

confusion, hallucinations, burning mouth, hyperthermia – tx w/ physostigmine

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57
Q

direct cholinergic agonist

A

pilocarpine, methacholine (xerostomia)

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58
Q

indirect acting cholinergic agonists MOA

A

prevent enzyme breakdown

reversible anti-cholinesterase: physostigmine (CNS and PNS) and neostigmine (PNS only)

irreversible = insecticides and organophosphates
tx overdose with pralidoxime

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59
Q

Competitive muscarinic receptor blockers =

A

Atropine, scopolamine, propantheline

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60
Q

What is used for motion sickness?

A

scopolamine

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61
Q

Neostigmine and pilocarpine increase?

A

Salivation
- Pilocarpine (muscarinic agonist) & neostigmine are parasympathomimetic that acts as a reversible acetylcholinesterase inhibitor. They
increase salivation, urination, bronchoconstriction, bradycardia, miosis (pupil constrict), vasodilation

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62
Q

Glycopyrrolate effect?

A

reduce salivary (muscarinic anticholinergic)

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63
Q

Atropine: _____ salivation

A

decrease

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64
Q

What meds decrease saliva?

A

atropine, scopolamine

- Pilocarpine, methacholine, neostigmine, etc. cause salivation.

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65
Q

QUESTION: If patient has xerostomia, what medication won’t you give?

A

Atropine - anticholinergic

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66
Q

What drug does not cause miosis of the eyes?

A

Atropine

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67
Q

Pt have bradycardia, what should we give him?

A

Atropine b/c atropine will increase heartrate causing tachycardia.

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68
Q

Drug to decrease saliva because you want to take an impression- Atropine, Pilocarpine, Neostigmine

A

ATROPINE

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69
Q

Atropine poisoning tx:

A

physostigmine

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70
Q

Patient salivates a lot, what is tx before surgery?

A

Atropine **antimuscarinic

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71
Q

Xerostomic pt, give

A

pilocarpaine or cevimeline.

- Cimeviline just like pilocarpine to increase salivation in xerostomia

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72
Q

What drug do you give to a pt with xerostomia?

A

Pilocarpine

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73
Q

Pilocarpine used for?

A

parasympathomimetic alkaloid, for tx of glaucoma and xerostomia.

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74
Q

What is the side effect of pilocarpine (Tx of dry mouth) in toxic dose?
Bradycardia and hypotension
Apnea
Cardiac shock

A

Bradycardia and hypotension

  • nontoxic side effects»> excess sweating and salivation, bronchospasm
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75
Q

Propantheline bromide (pro-Banthine):

A

anti-cholinergic (anti-muscarinic), relieve cramps or spasms of the stomach, intestines, and
bladder.

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76
Q

Which of the following groups of drugs is contraindicated for patients who have glaucoma? Adrenergic, Cholinergic, Anticholinergic
Adrenergic blocking

A

Anticholinergic

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77
Q 
Which of the following drug groups increases intraocular pressure and is, therefore, contraindicated in patients with glaucoma?
A. Catecholamines
B. Belladonna alkaloids 
C. Anticholinesterases
D. Organophosphates
A

B. Belladonna alkaloids – anti-cholinergic

organophosphates are irreversible cholinesterase inhibitors; indirect agonists

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78
Q

tubocurarine

A

inhibits ACH receptor –> weakness of skeletal muscles

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79
Q

Decrease of pseudocholinesterase would lead to increase in? Succinylcholine or tubocurare

A

Succinylcholine

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80
Q

Administration of succinylcholine to patient deficient in serum cholinesterase would cause…

a. convulsions
b. Hypertension
c. prolonged apnea
d. Acute asthma attack

A

c. prolonged apnea

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81
Q

miosis can be caused by which drigs

A

opioids and cholinergics

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82
Q

mydriasis can be caused by which drugs

A

anticholinergics and increased serotonin

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83
Q

A patient who has Parkinson’s disease is being treated with levodopa. Which of the following characterizes this drug’s central
mechanism of action?
a. it replenishes a deficiency of dopamine
b. it increases concentrations of norepinephrine
c. it stimulates specific L-dopa receptors
d. it acts through a direct serotonergic action

A

a. it replenishes a deficiency of dopamine

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84
Q

Cause of Parkinson?

A

Dopamine deficiency, give them methyldopa (levodopa) to increase dopamine in the CNS

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85
Q

Why do you need to take carbidopa with levodopa:

A

prevents breakdown of levodopa before it crosses the blood brain barrier

Carbidopa addition prevents levodopa from being converted into
dopamine in the bloodstream, peripheral enzymatic degradation so more reaches the brain.

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86
Q

How does carbidopa tx Parkinson’s disease?

A

potentiates effects of dopamine

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87
Q

anti-psychotics effect

A

sedate, blunt emotional expression, attenuate aggressive & impulsive behavior.

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88
Q

anti-psychotics adverse effects

A

Produce anticholinergic adverse effects,

dystonias and extrapyramidal symptoms. Tardive dyskinesia most common after several years.

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89
Q

tardive dyskinesia whose side effect

A

anti-psychotics

phenothiazine

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90
Q

Phenothiazines (PTZ) MOA :

A

Block DA receptors, act on the extrapyramidal pathway

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91
Q

Where in the brain does anti-psychotics works?

A

blocking the absorption of dopamine

extrapyramidal pathways

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92
Q

What catecholamine does Phenothiazine (anti-psychotic) affect? Dopamine, serotonin, acetylcholine

A

Dopamine

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93
Q

Phenothiazine side effect:

A

Tardive Dyskinesia

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94
Q

proverbial anti-psychotic

A

phenothiazine

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95
Q

What acts on extrapyramidal?

A

Phenothiazines (chlorpromazine)

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96
Q

Onset of action of antipsychotic is:

A

5-6 days

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97
Q

Lithium is used for treatment of?

A

Manic phase of bipolar disorder

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98
Q

Patient is in her 70’s, she lives alone, what could she be suffering from?

A

Depression

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99
Q

Most common psychological problem in elderly?

A

Depression

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100
Q

Old people have dementia as the most prominent psychiatric issue:

A

depression

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101
Q

What is associated with depression? Age, economic status, professional status, etc

A

Age

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102
Q

Most common mental illness among elderly?

A

Depression

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103
Q 
Main sign of dementia:
a. confusion
b. short term memory loss
c. long term memory loss
-
A

b. short term memory loss

short term memory loss = first main sign. Long term loss occurs later.

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104
Q

Where in the brain does anti-depressants works?

A

decrease amine-mediated neurotransmission in the brain

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105
Q

Tricyclic anti-depressant (TCA) mechanism of action:

A

inhibit reuptake of NE and 5-HT (serotonin)

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106
Q

TCA 2nd generation-

A

-triptylines and -pramines

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107
Q

How do tricyclics work?- by

A

not allowing reuptake of neurotransmitter (NE, 5-HT, serotonin)

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108
Q

What catecholamine do tricyclic antidepressants affect? Dopamine, serotonin, acetylcholine

A

serotonin

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109
Q

Patient is taking TCA anti-depressants what do you take into consideration? Limit duration of procedures, keep in mind the
epinephrine limit

A

keep in mind the

epinephrine limit

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110
Q

Side effect of having TCA and epi: HTN, hypotension, hyperglycemia, hypoglycemia

A

HTN

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111
Q

Most common antidepressant does what?

A
  • Inhibits reuptake of NE, 5-HT, & DA (TCA)
  • Inhibit reuptake of 5-HT (SSRI)
  • Inhibit reuptake of N & 5-HT (SNRI)
  • Inhibit MAO; prevent breakdown of NE & 5-HT (MAOI)
  • Block D2 receptor (phenothiazine)
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112
Q

If someone has a history of depression & wants to quit smoking, what do you give?

A

Zyban (Bupropion), it’s an anti-depressant &
smoking cessation aid
- not Chantix (smoke cessation only)

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113
Q

Amitriptyline –

A

most common tricyclic antidepressant, inhibits reuptake of NE and serotonin

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114
Q

Zoloft works on what receptor?

A

Presynaptic monoamine transporters (inhibit reuptake of 5-ht)
- Sertraline hydrochloride (Zoloft) = selective serotonin reuptake inhibitor (SSRI)

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115
Q

Prozac (fluoxetine) -

A

acts on serotonin (SSRI)

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116
Q

What do you use St. John’s Wart?

A

Depression

- St. John’s Wart = noncompetitive reuptake inhibitor of serotonin yeah because is for depression

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117
Q

What does St. John’s Wart do (side effect)?

A

Decrease the body immunity

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118
Q

St johns wart- used for?

A

Depression, don’t use with benz and HIV medication

- In HIV pt, it interacts w/ anti-HIV drugs & reduces their function so the immunity decreases

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119
Q

Know drugs used for conscious sedation à

A

SSRIs/BDZ Diazepam and Prozac (fluoexitine)

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120
Q

Buspirone -

A

psychotropic w. anxiolytic; low CNS depression, low psychomotor skill impairment
- Buspar—different from benzodiazepines because it does NOT cause CNS depression, muscle relaxant, or anti-convulsant!!!!!** UNIQUE!!!
Anxiolytic and antidepressant

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121
Q

side effect of corticosteroids

A

gastric ulcers, immunosuppression, acute adrenal insufficiency, osteoporosis, hyperglycemia, redistribution of body fat.

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122
Q

Strongest glucocorticoid/long-acting Corticosteroid?

A

Dexamethasone

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123
Q

Negative effect of chronic use glucocorticoids? In

A

fection, reduce inflammation, hyperglycemia.

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124
Q

GI effects with corticosteroids: .

A

Ulcers

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125
Q

Long term side effect of corticosteroids-

A

osteoporosis and hyperglycemia

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126
Q

What is the side effect of prolonged corticosteroid therapy?

A

Osteoporosis

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127
Q

Too much cortisone causes what to bone?
Osteoporosis
Osteopetrosis
Osteosclerosis

A

Osteoporosis

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128
Q

Where do you see moon faces?

A

steroid treatment

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129
Q

Containdation for corticosteroid use:

A

diabetes (also: HIV, TUBERCULOSIS, CADIDIASIS, PEPTIC ULCER)

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130
Q

Aspirin contraindicated with:

A

corticosteroid use

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131
Q

Critical dose of steroids for adrenal insufficiencies -

A

20 mg of cortisone or its equivalent daily, for 2 weeks within 2 years of dental
treatment

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132
Q

QUESTION: Least amount of cortisone to affect the adrenergic system?

A

2 mg for 2 weeks for 2 years

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133
Q

Pt taking corticosteroid with rheumatoid arthritis, pt needs TE, why would you consult with physician?

A

full blood panel, assess for
adrenal insufficiency
- want to make sure pt can produce enough corticosteroid with addition to what they are taking so you won’t have over inflammatory
response from TE

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134
Q

Pt on 3 months tx of steroids, what is your tx?

A

no tx and consult GP for dose

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135
Q

If a pt. has been using 10 mg of corticosteroid for 10 years, what would you do for pt. before any tx?

A

Have pt continue and increase

the dose

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136
Q

Cortisone exerts its action by binding to intracellular receptor, receptors on membrane, proteins in plasma

A

intracellular receptor

  • Enter cell and bind to cytosolic receptor migrate to nucleus gene expression or with plasma membrane on target cells
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137
Q

QUESTION: If pt doesn’t get steroid tx in time for their temporal vasculitis, what will have happened?
• hearing loss
• vision loss
• retro-ocular headache

A

• vision loss

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138
Q

Asthma – long-term asthma give corticosteroid to

A

decrease inflammation

- Inhaled corticosteroids are the most effective medications to reduce airway inflammation and mucus production.

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139
Q

absolute contraindication for nitrous oxide

A

severe respiratory compromised, COPD, respiratory infection, pneumothorax/collapsed lung

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140
Q

relative contraindications for nitrous

A

cardiovascular conditions, pregnancy (teratogenic effect), nasal congestion, children with high anxiety,

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141
Q

Nitrous oxide is in which container

A

blue cylinder (oxygen in green)

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142
Q

Nitrous oxide MOA

A

oxidizes the cobalt in vitamin B12, resulting in the inhibition of methionine synthase. Nitrous oxide has greater

analgesic potency than other inhaled anesthetics

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143
Q

Dreaming while on nitrous is what? Overdose or normal

A

normal

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144
Q

How do you check to see if the oxygen (reserve) bag is okay?

A

It shouldn’t be that full or that collapsed

145
Q

Device used in evaluation of N20?

A

Pulse oximeter (measure amount of O2 in blood)

146
Q

The correct total liter flow of nitrous oxide-oxygen is determined by

A

the amount necessary to keep the reservoir bag 1/3 to 2/3 full.

147
Q

Nitrous oxide: Total flow rate

A

4-6 L per min

148
Q

Max amount of Nitrous Oxide for a kid

a. 40 %
b. 50%
c. 70%

A

50%

70 for adult

149
Q

Nitrous for pedo pt is at 50%, what we do?

A

We stop giving it.

150
Q

Nitrous safety switch happens at what percent?

A

70%

151
Q

Abuse of nitrous oxide it results in

A

peripheral neuropathy.

152
Q

Why is nitrous oxide used on children?

A

Alleviate anxiety

153
Q

Child with fear is best treated with:

A

nitrous oxide

154
Q

What is an adverse effect of nitrous?

A

Nausea

155
Q

Most common side effect of nitrous oxide?

A

Nausea

156
Q

If patient does not have 100% oxygen after nitrous oxide?

A

Diffusion hypoxia

157
Q

QUESTION: Nitrous should not be given in ____ trimester of pregnancy

A

1st

158
Q

What trimester is nitrous use contraindicated in?

A

first

159
Q

When is nitrous contraindicated for a child?

A

upper respiratory tract infection

160
Q

When is nitrous contraindicated? Asthma or COPD

A

COPD

161
Q

local anesthetic chemical structure

A
  • Lipophilic group (ex. aromatic ring) = facilitates penetration into nerve sheath
  • Intermediate chain (ester or amide link) = ester is more prone to hydrolysis so shorter action duration
  • Hydrophilic 20 or 30 amino terminus = weak base that is either charge or uncharged
162
Q

mnemonic to identify ester vs amide anesthetics

A

esters: no “i” before “caine”
like procaine, benzocaine etc

amides: yes “i” before “caine”

like lidocaine, mepivacaine etc

163
Q

what do onset and duration depend on

A

dose and lipid solubility (potency)

increased potency with increased lipid solubility because rapid penetration and duration

164
Q

pKa related to onset

A

lower pKa faster onset

165
Q

which nerver fibers blocked first

A

A-δ & C fibers (conduct pain sensation) are blocked w/ lower [LA] than Aα motor fibers.

166
Q

what does duration of action of local anesthtic depend on

A
  • diffusion away from site of action – MAJOR FACTOR, depends on vascularity of tissue surrounding the nerve.
  • protein binding: high protein bound –> prolong duration (ex. bupivacaine, etidocaine, tetracaine)
167
Q

max dose of 2% lido with 1:100,000 epi

A

7mg/kg for adult | 4.4mg/kg for pediatrics

168
Q

Max dose of epi for cardio pt:

A

0.04mg (2 carps of 1:100k epi, 1 carp of 1:50k epi , or 4 carp of 1:200k epi max = 4 carps)

169
Q

Max dose of epi for healthy person:

A

0.2 mg (8 carp of 1:100k epi)

170
Q

Know where L.A. metabolized?

A

Amides made in P450 enzyme of liver. Esters in pseudocholinesterase of plasma.

171
Q

Mode of action of Lidocaine:

A

Block sodium channels

172
Q

What is the mechanism of local anesthetics?

A

Blocks Na channels intracellularly

173
Q

QUESTION: Mech of action of local anes on nerve axon –

A

decreases sodium uptake through Na+ axon channels

174
Q

QUESTION: What is the primary reason for putting epi in LA?

A

to slow its removal from the site. PROLONG DURATION OF ACTION

175
Q

Adding a vasoconstrictor to local anesthesia does all the following EXCEPT:

a. Decreases rate of absorption
b. Increases duration of action
c. Minimizes toxicity and helps homeostasis
d. all of above

A

d. all of above

176
Q

Local anesthetics broken down by what:

A

biotransformation

177
Q

QUESTION: Patient got LA injection & started breathing fast, hands and finger are moving, heart rate is up -

A

You injected into a blood vessel

178
Q

Patient get LA injection, he started to breathe a lot, HR goes up, due to what?

A

cardiovascular response to vasoconstrictor

179
Q

HTN pt. you just gave 4 carpules of 2% xylocaine with 1:100k epi. BP went up to 200/100. what’s possible mechanism/cause?

A

Due

to vasoconstrictor injected into venous system.

180
Q

You gave local anesthetic, BP went down to 100/50 and HR went down too, what could it be due to?

A

Syncope

181
Q

QUESTION: Infection around a tooth & can’t numb patient, why?

A

Infection reduces the free base amount of anesthetic (lowers pH)

182
Q

Why doesn’t anesthesia work when you have an infection?

A 
Decreased pH (acidic environment) leads to more ionized form (less
nonionized)
183
Q

Abscess, give LA, decreased in effect, why?

A

LA is unstable in low pH or LA is in ionized form, needs to be in free base form or
unionized form to cross membranes

184
Q

Where do you inject if infiltration in the area will not be able to avoid the infection?

A

Block

185
Q

As LA becomes more ionized, it becomes more

A

water soluble.

186
Q

If you have pain, what would be the hardest to anesthetize?

a. Irreversible pulpitis and maxillary
b. Irreversible pulpitis and mandibular
c. Necrotic pulp and maxillary
d. Necrotic pulp and mandibular

A

b. Irreversible pulpitis and mandibular

  • When irreversible pulpitis, the teeth that are hard to anesthetize are the mandibular molars > mandibular premolars > maxillary
    molars & premolars > mandibular anterior teeth.
  • fewest problems w/ the maxillary anterior teeth
187
Q

The pKA of an anesthetic will affect what. Metabolism, potency, peak effect, onset

A

onset

188
Q

When do you know that is it a non-odontogenic pain?

A

When pain is not relieved with LA

189
Q

How do you treat lidocaine overdose?

A

Diazepam

190
Q

What slows the metabolism of lidocaine?

A

Propranolol
- stays in system longer because propranolol slows down heart –> slower blood delivery to liver –> metabolism of lidocaine is slower –>
stays in system longer)

191
Q

How much epi for a cardio pt?

A
  1. 04mg
192
Q

Lidocaine is not metabolized

A

in plasma (but in liver)

193
Q

QUESTION: Which of the following anesthetic can be used as topical? butamben, dibucaine, lidocaine, oxybuprocaine, pramoxine,
proparacaine, proxymetacaine, and tetracaine

A

lidocaine

194
Q

What anesthesia do you give IV for ventricular arrhythmia?

a. Quinidine
b. Lidocaine

A

Lidocaine

195
Q

Cocaine overdose symptoms? pinpoint pupils or mydriasis

A

mydriasis

196
Q

Which LA causes vasoconstriction?

A

Cocaine

- Cocaine has intrinsic vasoconstrictive activity

197
Q

Pt is in rehab for cocaine, what you prescribe for pain?

A

ADVIL

198
Q

Prilocaine causes

A

methemoglobinemia (when given over 500mg)
- Symptoms of methemoglobinemia: cyanosis, headache, confusion, weakness, chest pain

because toluidine

199
Q

Administer 600 mg of prilocaine. What possible result?

A

Methemoglobinemia above 500mg

- can be treated with methylene blue

200
Q

Levonordefrin is added to certain cartridges containing mepivacaine to: increase .

A

vasoconstriction

201
Q

QUESTION: best LA to use w/o vasoconstrictor:

a. pro
b. benzo
c. lido
d. articaine
e. mepivicane

A

mepivicane (carbo)

202
Q

Articaine(septocaine): metabolized in

A

blood first.

- unique bc it is an Amide, but has an ester group that is metabolized in the bloodstream

203
Q

Articaine - conjugated at

A

blood Stream by esterase (unlike other amides, it metabolized in blood stream).

bc has an ester group in addition to amide!

204
Q

Anesthesia of facial nerve will cause all except:
• instant muscular dysfunction in half the face
• excessive salivation
• inability to smile
• inability to close eye
• corner of mouth will droop

A

• excessive salivation

205
Q

Which drug is LEAST likely to result in an allergy reaction?

a. epinephrine
b. procaine
c. bisulfite
d. lidocaine

A

a. epinephrine

206
Q 
What is the best predictor for pulpal anesthesia?
Concentration of anesthetic
Volume of anesthetic
Back pressure
Type of anesthetic
A

Back pressure

  • back pressure anesthesia stops hemorrhage, anesthesia after 30 sec, patient doesn’t feel it
207
Q

which roots of M1 does PSA block

A

not MB

208
Q

QUESTION: Which order will sensation disappear?

A
  1. pain, 2. temp, 3. touch, 4. pressure
209
Q

PSA numbs palatal tissue

A

false

210
Q

The dentist is performing a block of the maxillary division of the trigeminal nerve into which anatomical area must the local
anesthetic solution be deposited or diffused?
a. pterygomandibular space
b. pterygopalatine space
c. retropharyngeal space
d. retrobulbar space
e. canine space

A

b. pterygopalatine space

211
Q

For a patient with multiple sclerosis
A. epinephrine is contraindicated in local anesthetic.
B. the amount of anesthetic needed for a given procedure is less than for a normal patient.

C. the amount of anesthetic needed for a given procedure is more than for a normal patient.
D. a single cartridge of anesthetic will most likely not last as long as it would for a normal patient.

A

A. epinephrine is contraindicated in local anesthetic.

use mepivacaine (levonoderfin)

212
Q

Lidocaine calculation: a cartridge that contains 1.8 ml of solution at a 2% (20mg/ml) lidocaine concentration, how much drug?

A

36

mg/ml of drug (20 mg/ml X 1.8 ml/cart. = 36 mg/ml)

213
Q

Lidocaine calculation: 2% lidocaine or 1:100,000. how much anesthetic is in a cartridge?

A

36mg

214
Q

Max dosage of 2% lidocaine for a kid in mg/kg:

A
  1. 4 mg/kg

- MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI - 7mg/kg for adult’s 4.4mg/Kg for Pedo

215
Q

Numb the kid, how many hours is the soft tissue numb?

A

3 hrs.

216
Q

Kids have

A

higher pulse, basal metabolic activity & higher respiratory rate but lower BP

217
Q

Typical pulse for a 4-year-old is

A

110 (12 yr. old is 75, adult is 70)

218
Q

20 kg child how many mgs of lidocaine can you give:

A

88mg

- Max lidocaine w/ epi for kids = 4.4 mg/kg X 20 kg = 88 mg

219
Q

Kid is 16kg, How many mg max amount of lidocaine?

A

70mg

220
Q

88 lbs. (40kg) child patient is given 2 cartridges 1.8 ml each of 2% lidocaine with 1: 100,000 epinephrine. Approximate what % of
maximum dosage allowed for this patient was administered?
a. 10%
b. 20%
c. 40%
d. 60%

A
  • 88lbs2.2 kg/lb. = 40 kg. 40kg4.4mg/kg (max dose for lido) = 176mg = max dose for this patient; 36 mg x 2 cartridges = 72 mg injected
  • -> 72mg injected/176mg = 40%
221
Q

50 lb. patient given 5 carps of 2% lido with 1:100k epi. During procedure 20 min later, he started twitching his arms and legs & went
unconscious (convulses), why? Overdose of lidocaine, overdose of the epi, allergy

A

Overdose of lidocaine

overdose of epi would give HTN

222
Q

Maximum recommended dosage of lidocaine HCl injected subcutaneously (not IV) when combined with 1:1,00,000 epinephrine is?

a. 100 mg
b. 300 mg
c. 500 mg
d. 1 gram

A

c. 500 mg

223
Q
  1. 6ml of 4% prilocaine contain how much anesthesia?
    a. 72 mg
    b. 80 mg
    c. 144 mg
    d. 360 mg
A

c. 144 mg

- 4% prilocaine = 40 mg/mL; 3.6 mL x 40 mg/mL = 144 mg

224
Q

How many carps of 4% [X] anesthetic should be given if maximum amount that you want to give is 600mg of drug?

A 
- approximately
8 carps (go over calculation)
- 4% = 40 mg/mL = 600/40 = 15 mL/1.8ml (in 1 carp) = 8 carps
225
Q 
The maximum allowable adult dose of mepivacaine is 300 mg. How many milliliters of 2% mepivacaine should be injected to attain
the maximal dosage in an adult patient?
a. 5
b. 10
c. 15
d. 20
e. 25
A

c. 15

- 2% mepivicaine = 20mg/ml; 300mg/20 = 15 mL

226
Q

Maximum dose of mepivicaine?

A

400mg

- Maximum dosage: prilocaine (600 mg) > articaine + lidocaine (500 mg) > Bupivacaine (90 mg)

227
Q

A recently-introduced local anesthetic agent is claimed by the manufacturer to be several times as potent as procaine. The product
is available in 0.05% buffered aqueous solution in 1.8 ml. cartridge. The maximum amount recommended for dental anesthesia over a 4-hour
period is 30 mg. This amount is contained in approximately how many cartridges?
a. 1-9
b. 10-18
c. 19-27
d. 28-36
e. Greater than 36

A
  • 0.05% = 0.5 mg/mL = 30m mg/ (0.5 mg/mL) = 60 mL/ (1.8 mL/carp) = 33.3 carp
228
Q

What determines max. dose for anesthetic for a child?

A

Weight

229
Q

A 26-month old child w/ 12 carious teeth. How to treat?

a. General Anesthesia
b. Oral sedation
c. Nitrous oxide
d. local anesthesia

A

a. General Anesthesia

230
Q

QUESTION: Kid under general anesthesia:

A

give chloral hydrate and midazolam

231
Q

QUESTION: Pt is under oral sedation. You should monitor everything except?

  • Respiration
  • Oxygen saturation level
  • Electo cardiogram
  • Skin and oral mucosa color
A

• Electo cardiogram

232
Q

1 cause for problems during IV sedation?

A

Hypoxia

233
Q

A 77 years old female 110 lbs. weight requires removal of mandibular teeth under local anesthesia. She is apprehensive. The
appropriate dose of IV diazepam to sedate her?
a. 5 mg
b. 10 mg
c. 15 mg
d. 20 mg

A

b. 10 mg

- 2mg for midazolam IV, 10 mg diazepam IV

234
Q

Pt goes home from elective orthognathic sx and in 24hrs, without sign of inflam or edema, but a fever of 102 F-

A

Atelectasia (or pneumotosis – depending on answers)

- Atelectasia and pneumotosis = most common cause of fever within 24 hour of GA

235
Q

Pre-med with odontogenic infection:

A
  • Amox for SBE prophylaxis
  • Penicillin for odontogenic infections
  • Tetracycline for periodontal infections (better penetration, stays in bone tissue longer)
236
Q

Which procedure least likely to produce bacteremia? extraction, non-surgical endo, oral prophylaxis

A

oral prophylaxis

237
Q

Condition that DOES NOT require antibiotic prophylaxis

o Prosthetic heart valve
o Rheumatic heart valve
o Congenital heart formations
o Cardiac pacemaker

A

o Cardiac pacemaker

238
Q

Indication for antibiotic prophylaxis:

A

artificial heart valve, previous IE, congenital heart (valvular) defect, total joint replacement w/ co-morbidity

239
Q

Prophylactic treatment for prosthetic heart valves –

A

premedication required

240
Q

Prophylactic treatment for Pacemaker –

A

No premedication required

- Just stay away from ultrasonic and electric testing/ electrocautery

241
Q

What is the pre-medication dosage for child 44 lbs.?

A

1-gram amoxicillin 1 hour prior Tx.

- 44 lbs. = 20Kg X 50mg/Kg = 1000mg = 1g Amoxicillin

242
Q

Pt w/ mitral valve prolapse w/ regurgitation –

A

don’t premedicate

243
Q

(Patient’s medical tab say he is allergic to Amoxicillin), He needs to be premediated, what do you prescribe?

A

Clindamycin, 600mg

1hr before the dude shows up for the appointment.

244
Q

Man has accident and pin placed in arm. What antibiotic prophylaxis does he need?

A

None

245
Q

QUESTION: Pt w/ total knee replacement but was taking Amoxicillin for a while; how do you premedicate?

A

NO (or MED CONSULT)

246
Q

Pt had hip replacement 10 years ago, what do you use to premedicate?

A

No premedication needed

247
Q

Pt needs antibiotic prophylaxis. He is taking penicillin already, what do you give him?

A

Clindamycin

248
Q

Regular premedication case:

A

Give amoxicillin 2g 1hr b4

249
Q

What is recommended prophylaxis for pt that can’t take penicillin?

A

Clindamycin

250
Q

why premedicate?

A

benefits of premedication outweigh potential harm associated with penicillin

251
Q

Endocarditis definition:

A

inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or
prosthetic valves)

252
Q

QUESTION: Infectious Endocarditis pre-medications definition?

A

For patients who has cardiovascular problems and are at risk of infection over
their lifetime.

253
Q

When is it appropriate to prescribe antibiotic prophylaxis in patient with previous infective endocarditis?

A

if consequence of

potential infection is detrimental to life

254
Q 
Which of these procedures pose a risk for Infective Endocarditis?
• Primary teeth shedding
• RCT
• Some sort of surgery
• IA injection
A

• Some sort of surgery

255
Q

Guideline of antibiotic prophylaxis, especially for kids -

A

for kids, Amox is 50mg/kg and Clinda is 20 mg/kg

256
Q

QUESTION: Know the doses for someone that is allergic to penicillin, what you can give them?

A

Clarithromycin 500mg

257
Q

If a patient is allergic to Ampicillin, what else can you premedicate with?

A

Clindamycin 600mg 1, Cephalexin 2g, Azithromycin 500

mg, or Clarithromycin 500 mg all 1-hr before.

258
Q

Most bacteriostatic meds works by:

A

Inhibiting protein synthesis

259
Q

Broad spectrum antibiotics like tetracycline:

A

increase superinfection and resistance.

260
Q

broad spectrum antibiotics –>

A

increase superinfection (infxn by candidiasis) and resistance.

261
Q

Why don’t we use broad spectrum antibiotics?

A

Produce resistant bacteria

262
Q

If you increase spectrum of bacteria, it leads to

A

more infections

263
Q

QUESTION: Antibiotics are least useful for tx of this periodontal conditions: LAP, NUG, chronic periodontitis

A

chronic periodontitis

264
Q

Antibiotic metabolism is affected by chronic tx with what drugs? Benzos, barbs, SSRI, TCA

A

Benzos

265
Q

Pt is taking an antibiotic, which is metabolized in the liver. Metabolism of this antibiotic is decreased by which drug?

a. TCA
b. SSRI
c. phenothiazine
d. diazepam

A

diazepam

266
Q

You give antibiotics through IV, patient experience sudden allergic reaction, what’s the FIRST thing you do?

A

remove the IV line.

267
Q

Penicillin, why is this so good to give as an antibiotic?

A

Low toxicity, cheap

268
Q

Keflex (cephalexin) mechanism is closely related to what

A

penicillin

269
Q

What is the effect of Penicillin and Cephalosporin’s

A

(cell wall synthesis) via beta lactam ring

270
Q

Transpeptidase enzyme is inhibited by

A

penicillin

- Transpeptidase, a bacterial enzyme that cross-links the peptidoglycan chains to form rigid cell walls

271
Q 
Which of the following penicillin would be used to treat a Pseudomonas infection?
Nafcillin (Unipen)
Amoxicillin (Amoxil)
Benzedrine penicillin (Bicillin)
Phenoxymethyl penicillin (Pen-Vee K)
Ticarcillin (Thar)
A
  • Ticarcillin is a carboxypenicillin. Its main use is for the treatment of Gram-negative bacteria, particularly Pseudomonas aeruginosa.
272
Q

Why do penicillins have decreased effectiveness in abscess?

A

hyaluronidase, pen unable to reach organism

273
Q

With cyst, why doesn’t penicillin work well?

A

b/c can’t penetrate cyst barrier

274
Q

1 dental antibiotic for an infection within 24hrs is

A

Pen VK 1gm booster and 500mg q6h

Penicillin V potassium is a slow-onset antibiotic, bacteriocidal against gram (+) cocci & major pathogen of mixed anaerobic infections. In
the absence of an allergic reaction, penicillin VK is the drug of choice in treating dental infections.

if early (first 3 days of infection): penicillin VK, amoxicillin, clindamycin, cephalexin

275
Q

For an infection:

A

give PenVK 500mg à give 1g at once and then 500 mg every 6 hours (7 days)

276
Q

What antibiotic used for endo, pulpal involvement?

A

PEN VK (yes it actually says VK together)

277
Q

cephalosporin spectrum vs penicillin spectrum

A

cephalosporin is narrower

cephalosporin is a beta lactam antibiotic, bactericidal, 1st generation, more concentrated on gram (+), more resistant to penicillinase

278
Q

broadest abx effect

A

chlortetracycline

279
Q

Tetracycline mechanism of action:

A

protein synthesis inhibitor (30s), bacteriostatic

280
Q

How does tetracycline work?

A

Block activity of collagenase, bind to 30S (block AA linked tRNA)
- Tetracycline is usually not used because they cause yeast infections, as well opportunistic infect.

281
Q

Doxycycline

A
  • Doxycycline reversibly binds to the 30 S ribosomal subunits and possibly the 50S ribosomal subunit(s), blocking the binding of aminoacyl
    tRNA to the mRNA and inhibiting bacterial protein synthesis.
  • It’s a tetracycline, treats malaria
282
Q

20 mg of doxycycline action in periodontal dressing

A

20 mg = no anti-bacterial effect but it inhibits collagenase

283
Q

QUESTION: Which antibiotic is anti-microbial and anti-collagenlyctic? clindamycin, doxycycline, metronidazole, amoxicillin

A

doxycycline

284
Q 
Tetracycline does not do one of the following:
reduce host response
reduce bacterial infection
reduce host collagenase
decrease gingival crevicular fluid flow
A

decrease gingival crevicular fluid flow

285
Q

Minocycline & Doxycycline:

A

Both increase GCF secretion, both released in GCF (Gingival crevicular fluid)
- tetracycline is more concentrated in GCF more than in blood

286
Q

Mechanism of action of Minocycline in the Arestin:

A

decrease collagenases activity

- Minocycline, another tetracycline antibiotic, has also been shown to inhibit MMP activity.

287
Q

What drug has the highest concentration in crevicular fluid?

A

Tetracycline

288
Q

Which one of the following drug is chelated with Ca++?

A

Tetracycline

289
Q

what reduces absorption of tetracycline

A

milk and antacids
Don’t take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline.

290
Q

What is most affected by tetracycline? Enamel or Dentin

A

Dentin, causes intrinsic stain

291
Q

What age are you most likely get infection that resulted in enamel hypoplasia or tetracycline staining?

A

before 4 months in utero for

primary; birth for permanent

292
Q

What medication do you not give to lactating female?

A

Codeine and tetracycline

293
Q

Child comes in with an oral infection and is NOT allergic to Pen. What do you prescribe?

a. Penicillin
b. Amoxicillin
c. Tetracycline

A

Amoxicillin

294
Q

What happens when you have penicillin and decide to prescribe tetracycline with it?

A

Tetracycline will decrease the efficacy of
Penicillin.
- Don’t do it. Tetracline is bacteriostatic whereas penicillin is bacteriocidal. The two mechanisms of action (CIDAL+STATIC) cancel each other
out because when you need bacterial growth to actually use penicillin, but you don’t have that growth when you prescribe Tetracycline.

295
Q

QUESTION: Penicillin and erythromycin taken together cause:
•summation
•potentiation
•antagonists

A

antagonists

296
Q

1 side-effect of erythromycin is?

A

Stomach upset.

297
Q

In lethal doses of erythromycin, what do you see? Hepatocellular, GI damage

A

GI damage

298
Q

Myasthenia gravis patient, what can’t you give them? Erythromycin, clarithromycin, penicillin or Impemene

A

Erythromycin

299
Q

If you have maxillary sinusitis, what antibiotic would you give?

A

Amoxicillin with clavulanic Acid (Augmentin)
- Clavulanic acid increases spectrum of action & restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.

300
Q

What the clavulanic acid do when is mixed with amoxicillin (Augmentin)?

A

decrease sensitivity from b-lactamase

301
Q

clavulanic acid in amoxicillin -

A

prevents beta lactam degradation by beta lactamase producing bacteria

302
Q

Augmentin:

A

blocks the action of penicillinase, penicillinase resistant

303
Q

Metronidazole -

A

prescribed in necrotizing ulcerative gingivitis (NUG) or aggressive periodontitis

  • metronidazole is contraindicated in patients on alcohol causing disulfiram type of reaction
  • has red urine
304
Q

Antibiotic against only anaerobes parasites (protozoa)?

A

Metronidazole

305
Q

Clostridium difficile (colon inflammation) is treated with

A

metronidazole. Unless pt is pregnant or breastfeeding, then use
vancomycin.

306
Q

QUESTION: Best treatment of localized aggressive periodontitis:

A

tetracycline, Doxycycline

307
Q

Which antibiotic is NOT inhibit cell wall synthesis?

  • amoxicillin
  • vancomycin
  • azithromycin
A

azithromycin (this inhibits protein synthesis)

308
Q

QUESTION: Gentamycin (aminoglycosides) - May cause

A

auditory nerve deafness

309
Q

aminoglycosides: toxicity

A

ototoxicity and nephro

310
Q

Pseudomonas colitis:

A

c. difficile and clindamycin

311
Q

Which of the following describes clindamycin?

a. inhibits cell wall synthesis
b. does not penetrate well into bony tissue
c. it usually given in combination with erythromycin
d. is effective against gram-negative bacteria only
e. is effective against most anaerobes

A

e. is effective against most anaerobes

312
Q

Which of the following describes ciprofloxacin (Cipro®)?
Inhibits cell wall synthesis.
Effective against Pseudomonas aeruginosa.
Effective only against anaerobic bacteria.
An antibiotic-of-choice for treating otitis media in young children.
Effective against oral anaerobes.

A

Effective against Pseudomonas aeruginosa.

313
Q

QUESTION: Chloramphenicol (antibiotic) adverse effect

A

aplastic anemia

314
Q

Anti-cancer drugs are least likely to cause what? Ulcers, thromboembolism

A

thromboembolism

315
Q

What’s an adverse effect of a drug that you can’t mix with antibiotics?

A

Methotrexate because it won’t clear out of the system,
specifically with amoxicillin.
- Penicillin can decrease elimination of methotrexate (cancer drug), increasing risk of methotrexate toxicity, which can cause seizures.

316
Q

Methotrexate (MTX) is an:

A

antimetabolite and antifolate drug. Used for tx of cancer, autoimmune diseases, ectopic
pregnancy, and for the induction of abortions. It inhibits folic acid metabolism.

317
Q

QUESTION: Which drug will be used to treat an overdose of methotrexate?

A

Leucovorin

- Methotrexate toxicity effects can be reversed by folic acid (leukovorin)

318
Q

Which medication for anticancer works on folate synthesis/ prevents folic acids synthesis/prevents folic acid production:

A

methotrexate

319
Q

Methotrexate is an anti-cancer drug that inhibits

A

folate reductase

320
Q

Drug agonist of folic acid?

A

Sulfa, Trimethoprim, Methotrexate

321
Q

Anti-cancer drug (Mechlorethamine), that was an alkylating agent, what was it effect?

A

Neurotoxic

322
Q

Alkalizing anti-cancer drug called procarbazine causes:

A

Hepatotoxicity
- Inhibits CYP450, increased effect of barbiturates, phenothiazenes, and narcotics. Has monoamine oxidase inhibition properties (MAOI),
and should not be taken with most antidepressants and certain migraine medications.

323
Q

Non-alkylating anti-cancer side effect?

A

myelosuppression (BONE MARROW SUPPRESSION)

324
Q

amantadiene is for what

A

influenza A

325
Q

tamiflu, oseltamivirm zanamivir is tx for what

A

influenza A and B

326
Q

acyclovir

A

herpes 1, 2, VZV, EBV

327
Q

gancyclovir

A

CMV

328
Q

ribavirin

A

Hep C and RSV

329
Q

CMV tx

A

gancyclovir

330
Q

Hep C tx

A

ribavirin

331
Q

Picture of lesion at corner of mouth, patient says it
comes and goes now and then, what type of infection would you
suspect?

A

Viral

332
Q

Amantadine is an anti-viral and anti-parkinsonian or

anti-TB and its anti-viral.

A

anti-viral and anti-parkinsonian

333
Q

What anti-viral is used to for all the these: HSV, VZV, CMV?

A

Valacyclovir

and acyclovir

334
Q

What virus causes postherpetic neuralgia?

A

VZV

335
Q

Acyclovir has selective toxicity mechanism of action b/c:
inhibits viral mRNA
inhibits cellular mRNA in infected cells
only phosphorylated and activated in infected cells

A

only phosphorylated and activated in infected cells

- Inhibits mRNA, doesn’t work on DNA

336
Q

HIV patient with sinusitis due to what?

A

Mucormycosis

337
Q

Most reliable measure of HIV progression? CD4 count, viral load

A

CD4 count

338
Q

CD4 count and T-cell count for HIV symptoms: pt had HIV

A

CD4 less than 200

339
Q

Pt has viral load of 100,000:

A

pt has high virus load and prone to infection

340
Q

Pt’s viral load was 100,000, and T cell count was 50. What is the right statement?

A

Pt’s T cell count is too low

- Healthy T-cell count: 500-1500 units/ml

341
Q

Which of the following is not a risk of oral cancer

a. Tobacco
b. Alcohol
c. HPV
d. HIV

A

HIV

342
Q

Which of the following agents is used for HIV infection?

a. amantadine
b. acyclovir
c. zidovudine
d. ribavirin
e. isoniazid

A

c. zidovudine (also called AZT)

a. amantadine (Parkinson’s and influenza A)
b. acyclovir (Herpes)
c. zidovudine (also called AZT)
d. ribavirin (Hep C; also RSV)
e. isoniazid (TB; also streptomycin)

343
Q

What oral manifestation is seen in children with HIV?

A

Candidiasis

344
Q

Fungal agent for HIV:

A

Fluconazole or ketoconazole

345
Q

Candidiasis & HIV, what do you give systemic or topical anti-fungal?

A

Nystatin

346
Q

Azoles:

A

anti-fungal, inhibit lanosterol conversion to ergosterol

347
Q

Polyenes

A

anti-fungal, bind to ergosterol on cell membrane and create a pore/transmembrane channel

o Includes Amphotericin B

348
Q

Topical anti-fungal:

A

Mycelex (clotrimazole), Nystatin, Ketoconazole

349
Q

Systemic anti-fungal:

A

Fluconazole (Diflucan), Amphotericin B, Ketoconazole

- Know “FAK”

350
Q

Nystatin how to :

A

“swish & swallow”

351
Q

antifungal troches

A

clotrimazole, 5/day x 14; DO NOT CHEW

352
Q

systemic antifungals use

A

fluco - 100mg.day

353
Q

Medication for angular chelitis:

A

nystatin

354
Q

Oral anti-fungal infection:

A

Nystatin

- Clotrimazole(Mycelex) and Nystatin are oral anti-fungals

355
Q

Griseofulvin:

A

used for athlete’s foot.

- treat fungal infections such as ringworm, “jock itch,” and athlete’s foot.

356
Q

Clotrimazole mechanism of action:

A

Alter the enzyme for synthesis of ergosterol, which alters cell membrane permeability

357
Q

Mechanism of miconazole (antifungal):

A

inhibits the synthesis of ergosterol a critical component of the cell membrane

358
Q

Best topical antifungal?

A

Mycelex

NBDE II (12 decks)

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