Pharm

Question 1

A patient is taking a beta bronchodilator (Proventil). What drug should you never give to this patient?

Answer 1

NSAIDs because it will cause bronchospasm

Question 2

What are the five classes of anti-hypertensives?

Answer 2

a) Thiazide diuretics = help the kidneys eliminate excess salt and water from the body’s tissues → not as good as ACE inhib or ARBs, they can cause new-onset diabetes
b) ACE inhibitors = inhibit angiotensin-converting enzyme (ACE a potent vasoconstrictor)
c) Calcium channel blockers = block the entry of calcium into muscle cells in artery walls
d) Beta blockers = not used as much because risk of stroke – not first line defence
e) Angiotensin II receptor antagonists (ARBs) = used when they can’t tolerate ACE inhibitor – can’t use in conjunction with ACE inhib.

Question 3

What five drug classes cause gingival hyperplasia?

Answer 3

Gingival hyperplasia from:

a) Anticonvulsant – Phenytoin
b) Calcium channel blockers – Nifedipine
c) Cyclosporins
d) immunosuppressants

Question 4

Describe the stages of hypertension and the ranges of systolic and diastolic pressures associated with each one.

Answer 4

Normal = 90-119/60-79. 
Prehypertension = 120-139/80-90. 
Stage 1 = 140-159/90-99. 
Stage 2 = >160/>100. 
Isolated systolic hypertension >140/<90.

Question 5

Describe the action of bisphosphonates.

Answer 5

Bisphosphonates → suppresses action of osteoclasts.

Question 6

Describe the action of Coumadin (Warfarin).

Answer 6

Coumadin (Warfarin) = vitamin K antagonist → takes 48 to 76 hours to work

Question 7

How does Vitamin K affect Warfarin?

Answer 7

Liver makes vitamin K (as the body’s natural clotting enzyme) → Since Warfarin is a vitamin K antagonist → Less vitamin K = more bleeding! → More vitamin K = more clotting.

Question 8

What can reverse the effects of Warfarin?

Answer 8

Vitamin K and prothrombin complex concentrate

Question 9

Would you ever consider taking a patient off clopidogrel (Plavix?)

Answer 9

No, never.

Question 10

What herbal supplements are associated with bleeding risk?

Answer 10

Chamomile, dong quai, feverfew, fish oil, garlic, ginger, gingko, ginseng, st john’s wort, vitamin E

Question 11

What are four principles that go along with giving prophylactic antibiotics?

Answer 11

a) Pick the right antibiotic for the job
b) should have enough in the tissue at time of surgery
c) procedure should have significant risk for infection
d) use the shortest effective antibiotic

Question 12

Which antibiotic has no activity against aerobic bacteria and should not be given with alcohol and Warfarin?

Answer 12

Metronidazole

Question 13

Describe the pathway of inflammation. What enzymes are released?

Answer 13

Tissue damage → arachidonic acid release → cyclooxygenase produces prostaglandins → edema

Question 14

What are the contraindications to the use of corticosteroids?

Answer 14

Active infection, tuberculosis, ocular herpes simplex, primary glaucoma, acute psychosis and diabetes mellitus.

Question 15

How does NASAIDs work?

Answer 15

Inhibit synthesis of prostaglandins from arachidonic acid.

Question 16

Most local anesethics with the exception of Articane are classified as ______ and are metabolized by the liver.

Answer 16

Amide

Question 17

The maximum safe does of epinephrine in local anesthetic for healthy vs cardiac patient are ____ and ____ mg.

Answer 17

Healthy = 0.2 mg → Cardiac = 0.04 mg

Question 18

What is the maximum dose in mg/kg using 2% lidocaine 1:100 k epi? Carps per 160 lb adult?

Answer 18

Lido 2% 1:100 k max = 7 mg/kg or 13 carps

Question 19

What is the maximum dose in mg/kg using 4% articane 1:100 k epi? Carps per 160 lb adult?

Answer 19

Articane 4% 1:200 k max = 7 mg/kg or 7 carps

Question 20

Why is Augmentin (amox-clav) good for maxillary sinus infections?

Answer 20

Because it is good vs. beta-lactamase producing bacteria.

Question 21

Why is Tylenol 3 a preferred analgesic for post-sinus augmentation pain?

Answer 21

After grafting, Tylenol 3 has codeine → good antitussive and prevents coughing.