PHARM Flashcards
Amantidine
Anti-viral
Methamoglobinemia can be cause /exacerbated in which LA
Prilocaine (Citanest)
LA metabolized both liver and blood
Articane / Septo
- ok for liver *
Both amide and ester
Which antihistamine is least likely to cause drowsiness?
Loradadine
Med given to Parkinsons pt? How does it work?
Carbidopa-levidopa ; increase Dopamine
A1- receptors do ?
vasocontriction
Benzo antidote
Flumazanil [Romazicon]
APAP antidote
N-acetylcistine
Epinephrine reversal agent
Phenoxybensamine
Allergic to ASA, give them?
Plavix, APAP
Cidal
Penicillin Cephlasporins Monobactams Carbapenins Flouroquinolones
Penny is Suicidal - shoot in the Head (Ceph) or stab in the neck with a pen and be lyin on the FLour by your mono ( self) on the carpet
Static
Tetracyclines
Macrolides
Sulfonamides
Linkostomides
Used for bradycardia and side effect is xerostomia
Atropine
T/F. Aspirin can be give to asthmatics.
FALSE. DONT give Asthmatics (Sev /Reactive asthma/Nasal polyps) ASA, NSAIDs
D/t inhibition of COX pathways activating Lipooxygenase pathways , increasing Leukotrienes, causing BRONCHOSPASM
T/F. BENZOs can be given to preggers
FALSE
Meds given to recovering opiod addicts
Methadone
Mechanism of action of Benzodiazepines
Facilitates GABA receptor binding by inc frequency of fl channel opening
8-hr NSAID
Naproxen
give if pt allergic to codine
Max epi given in cardiac pts ?
0.04mg
Epi + propanolol what is the effect?
Hypertensive crisis - HR dec BP inc
Length of time NSIADs will suppresses platelets
5-7 days
Med given for Statis epilepticus sz
Diazepam or valium
Med given for grand mal sz
pheytoin/dilation
Med given for petit mal sz
ethosuccyimide
Erytrho (mycin?) side effect is
stomach upset ???
MoA of LA
vasocontriction
block Na channels intracellularly
Azithromycin
Clarithromycin
Erythromycin
Lincomycin
attack the 50S ribosomal subunit
-
______: effect of a drug as a function of level of binding to its receptor
Efficacy
______ : maximal effect of a drug, greatest response
Intrinsic
_________, prevents NAG-NAM cross-linkages in cell walls.
Amoxicillin, like penicillin
Minocycline prevents the function of
30S ribosomal subunit.
Pregnant, what’s CI for pain killer?
- Opioids (no known safe level of narcotic use during pregnancy), NSAIDs, naproxen, aspirin should not be taken (increased chance of miscarriage and birth defects)
- APAP considered safe during pregnancy
Side effects of narcotic overdose other than respiratory depression:
coma, pin-point pupil (Mosby p. 291)
Systemic antifungal?
Ketoconazole, fluconazole, and clotrimazole
best absorbed from the stomach when the pH is most acidic, so antacids, H2-blockers (cimetidine, ranitidine) can inhibit their absorption
Methotrexate (anti-neoplastic) contraindications:
- anti-metabolite, used for tx of RA, psoriasis, life-threatening neoplastic diseases
- pregnant women → causes fetal death or teratogenic effects
- chronic liver disease, alcoholic liver disease (prolonged use may cause liver toxicity, cirrhosis)
- preexisting blood dyscrasias, such as bone marrow hypoplasia, leucopenia, anemi
_______: response to a drug over range of concentration
Potency
Pain killer in Lactating woman, CI is?
- codeine
- aspirin should be avoided since it can cause rashes or bleeding abnormalities in infants
[ APAP, ibuprofen, and naproxen considered safe for both mother and the baby]
Drugs generally considered incompatible/CI with breastfeeding
- Anti-neoplastics
- Anti-convulsants: Phenobarbital (long-acting barbiturate ex CNS stim), ethosuximide (tx of absence seizure), primidone (parent form of phenobarbital)
- Drugs of abuse: amphetamine, cocaine, heroin
- Cyclosporine
TI =
LD50/ED50
Theraputic index
Pt on warfarin: What blood test do you look at before extractions?
INR
pt has Aspirin allergy, pain killer option?
- APAP
- avoid nsaids
Cross-allergy is most likely to happen with the anesthetic agents
lidocaine and mepivacaine.
Ester-type local anesthetics include (6):
benzocaine, chloroprocaine, cocaine, piperocaine, procaine tetracaine.
Ester drive a benz, messes it up wiht coco but keeps it white w/ clorox; its a four seater and has a fancy exhaust pipe
Amide-type anesthetics include (6):
articaine, bupivacaine, lidocaine , mepivacaine, prilocaine, ropivacaine.
mechanism of action of acetylsalicylic acid (aspirin)?
Aspirin inhibits COX-1 and COX-2.
Cyclooxygenase (COX) is an enzyme involved in the synthesis of prostaglandins ( PGE2, PGF2α )
PGE2 and PGF2α mediate pain within the body.
target of H2 histamine receptor blockers
Parietal cells
Neuromuscular blockade of the phrenic nerve can be caused by extremely high doses of
streptomycin
Nalidixic acid is considered __________ in low concentrations and _______ in higher concentrations.
bacteriostatic ; bacteriocidal
ANTISEPTIC [quinolone] IN UTIs (gram neg) -not used anymore too many se
Alcohol has a synergist efffect with ?
bzdp, barbiuates
Augmentin:
amoxicillin and clavulanate potassium…know that it is a MRSA drug (Methicillin Resistant Staphylococcus Aureus)
What’s most likely to cause seizures?
hyponatremia
What does alpha 1 receptor do:
vasoconstrict
propanolol
Non-selective Beta blocker
albuterol
B2 agonist
Narrow angle glaucoma, what drug contraindicated?
anticholinergic
Amyl nitrate IS A
short-acting vasodilator
- for a prolonged period of time may result in methemoglobinemia
Causes of methemoglobinemia include exposure to environmental factors such as benzocaine, benzene, and nitrites.
Amyl nitrite can be used to treat angina pectoris and cyanide poisoning. Physiologic effects include dizziness, headache, decrease in blood pressure, increased heart rate, and relaxation of involuntary muscles. Overdose leads to headache, emesis, nausea, dyspnea, syncope, and hypotension.
Which of the following antibiotics acts upon the 50S ribosomal subunit?
Azithromycin
Clarithromycin
Erythromycin
Lincomycin
___________and _________ inhibit the transpeptidase enzyme.
Penicillins and cephalosporins
β-lactamase is an enzyme responsible for cleaving penicillins, making them ineffective against the bacteria.
Heparin functions by preventing the conversion of
prothrombin to thrombin.
Pen G is excreted in the _____
removed from the body primarily via secretion from the renal tubules
The half-life of pen G prior to elimination is said to be about 30 minutes.
PEN G less stable in acidic conditions ( vs PEN V)
A 1.8 mL carpule with 1:100,000 epinephrine yields ______ mg of epinephrine
0.018 mg
MAx epi in Caridac pts
two carpules may be given safely, because 0.036 mg is lower than the 0.04 mg limit.
_____________ is a penicillinase-resistant β-lactam similar to methicillin and is used to treat multi-drug-resistant S. aureus (MRSA) infections.
Oxacillin
Oxacillin has replaced methicillin in clinical use because of the adverse effects of methacillin.
Antibiotic-resistant strains called oxacillin-resistant Staphylococcus aureus (MRSA/ORSA) have become increasingly prevalent worldwide.
Penicillinase-resistant antibiotics include the following:
Oxacillin
Cloxacillin
Dicloxacillin
Nafcillin
Methicillin
How does LA block pain?
Blocking Na+ ions form entering neural axon.
this blocks the signal transduction mechanism and the brain doesnt receive the pain input. The primary ions involved in nerve transduction Na, Cl, K+. LA dnt absorb Ca or release Mag at the synapse.
loratidine ; Azelastine ; Ranitidine = ?
Second gen anti-histamines (cimetidine, Famotidine)
SE: HA, Fatigue ( NO sedation- no BBB crx)
MOA: H2 recept
1st gen = muscarinic / anticholinergic se
Histamine is produced by _____?
decarboylation of histidine
Histamine is secreted by ______?
Enterochromafin - like endocrine cells in the glands of the stomach
Histamine release is stimulated from ____?
mast cells via C5a and C3a
Histamine receptor stimulation from ___1___ causes ____2___ activation of adenolyate cyclase and cyclic adenosine monophospate
- parietal cells
2. G-protein
__1_ and __2__ LA are the least myotoxic and _3__ is the most myotoxic LA.
- Tetracaine
- Procaine
- Bupivicaine
Myotox = dose-dependent ; reversible»_space;myonecrosis ; dysregulates intracell Ca2+.
_______ is not inhibited by warfarin.
Factor VIII
Warfarin, an oral anticoagulant, inhibits the vitamin K-dependent synthesis of factors II (prothrombin), VII (proconvertin), IX (Christmas factor) and X (Stuart-Prower)- takes several days to take affect. Factor 8 is not inhibietd by coumadin.
ABx se = harily black tongue
Eyrthomycin
Opioids act by initiating a ______ cascade of pain inhibition and also binding to opioid receptors in the ____ and _____
descending
CNS and PNS.
Short duration local anaesthetics include:
Mepivacaine
Prilocaie
pseudomonas aeruginosa is not resistant to which penicillins?
Pseudomonas aeruginosa is inherently resistant to all penicillins xcept:
c a t m (i) p
carbenicillin, azlocillin, ticarcillin, mezlocillin, piperacillin.
Tx for ghonnneria ?
Ceftriaxone (Rocephin)
Tx for Clamydia?
Azithromycin
Chenelle got it and her dentist put her on a zpack
How shld get abx prophylaxis ?
Cardiac [3] - Hx of IE - Hx of CYANOTIC congenital defects - untxd (VSD =/=) - prosthetic valves Immunity
Ibuprofen shld be avoided in:
- PRegger
- WArfin
- pre-exsiting ulcers
NSAID to give if ALL to APAP?
Ibuprofen
endogenous opioid peptides found in the body:
- endomorphins,
- endorphins
- enkephalins
- dynorphins
Precursor to APAP?
Both acetanilide and phenacetin are metabolized into acetaminophen.
Once this occurs, acetaminophen may be further metabolized by the liver into the conjugated metabolites glucuronide (A) or sulfate (B).
If high amounts of acetaminophen are ingested, then a large amount of N-Acetyl-benzoquinoneimine is formed (C). This is the toxic pathway because this compound forms a conjugate with glutathione that depletes the body’s stores of glutathione. Glutathione is integral for the normal functioning of the liver and the nitric oxide cycle. It is a vital antioxidant as well.
Herbal preparations that interfere with blood clotting include:
chamomile garlic ginger ginkgo echinacea.
Patients should stop taking the herbals 7 days prior to surgery.
Garlic may increase bleeding due to inhibition of platelet aggregation.
Astralagus is an
immunostimulant that may decrease the effectiveness of immunosuppressants.
_____ is an herbal anxiolytic and sedative-hypnotic. It may cause temporary mouth numbness upon the administration of a local anesthetic.
Kava-kava
Some of the adverse effects of taking loop diuretics include:
hearing problems, increased uric acid (which can cause gout attacks), potassium and magnesium depletion, and a rapid reduction in blood volume.
Loop diuretic ex: Furosemide
Acetazolamide is a ____1____. This drug is usually used for patients who experience mountain sickness and it is also used to treat ____2____.
- carbonic anhydrase inhibitor
2. glaucoma
Abx with etoh has disulfriam-like rxn
Metronidazole ( flagyl)
A disulfiram-like drug is a drug that causes an adverse reaction to alcohol leading to nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort, and general hangover-like symptoms among others
_________ is an herb that treats mild to moderate depression.
It has been known to have multiple interactions with medication like ______, sulfonamides, benzodiazepines, opioids, and more. It also decreases the plasma concentration of ___3__ and ____.
- St. John’s Wort (CYP3A inducer)
- tetracyclines
- digoxin
- warfarin
High doses may cause ataxia, drowsiness, and inebriation.
Some of the adverse effects of taking loop diuretics include:
hearing problems,
increased uric acid (which can cause gout attacks), potassium and magnesium depletion
rapid reduction in blood volume.
furosemide/lasix
HCTZ ( thiazide diuretic- s.e = sensitv to light, inc uric acid)
Amiloride = K+ sparing
Furosemide
HCTZ
Spirinolactone
Loop diruretic
Thiazide
Potassium sparing
Used to treat mountain sickness
Acetazolamide = carbonic anhydrase inhibitor.
Also tx for glaucoma.
Mountain sickness = above 10,000 feet»_space; acetazolamide to prevent dizziness and nausea,
Metronidazole is also an inhibitor of enzymes of _____and_____, therefore, it will increase the toxicity of other drugs such as ___2____, cholesterol-lowering medications, and __3___.
- CYP2C9 and CYP 3A4
- Coumadin[ warfarin]
- lithium
Metronidazole = abx for anaerobic bact = flagyl
Benzodiazepines, such as Diazepam [valium] and Midazolam [versed], should not be used with individuals with _____1____ because it can increase the ___2____ and may cause blindness. An overdose of midazolam can be reversed with ____3__.
- acute narrow-angle glaucoma
- intraocular pressure
- flumazenil [Romazicon]
Metronidazole is contraindicated in pregnancy, along with ____1_____, the ___2____, and the ___3_____.
- chloramphenicol (broad, static/50S,
- aminoglycosides (broad, cidal/30S, -mycins)
- tetracyclines ( Broad, Static/30S , -cyclines)
T/F. Levofloxacin is OKAY to give pregnant.
FALSE.
Levofloxacin has not been proven to be safe for use in pregnant patients. = Quinolone/
Abx ok to give preggers?
PEN (cidal)
if allergic = AZITHROMYCIN (Macrolide/static)
Inhibition of mycolic acid synthesis is the mechanism of action of _______.
isoniazid
TB med
Bacterial cell wall synthesis inhibition is the mechanism of action of beta-lactam drugs, such as _____.
penicillin
low toxicity , cheap
NSAIDs inhibit the COX-2 enzyme that is responsible for prostaglandin synthesis from _________ .
arachidonic acid
DNA-dependent RNA polymerase inhibition is the mechanism of action of _____________.
Rifampin
_______is an excitatory neurotransmitter in the category of neuropeptide. It plays a major role in pain perception
Substance P
____1____ are derived from the metabolism of arachidonic acid, but are produced by the _____2___ enzyme pathway. NSAIDs do not work on this pathway.
- Leukotrienes
2. lipo-oxygenase
Nme a few CONTRAINDICATIONS for the use of ibuprofen?
- Warfarin - ibuprofen = NSAID and effects platelet fxn
- 1st trimester of pregnancy ( defect, HTN, Miscarraige)
- Stomach ulcer ( irritates gastric ining)
properties of amide local anesthetics (LAs):
- LIVER metabolism
- WAter soluble
- affected by acidity of local tissue
- affect somenerve fibers more than others
- contain preservatives to inc shlef life
________ is another neuropeptide that has potent vasodilator effects. It is created by proteolytic enzymes in response to pain and works locally to dilate arterioles.
Bradykinin
The antituberculosis drugs combination therapy is :
Isoniazid, Rifampin, Rifampin, Pyrazinamide, and Rifabutin
The t 1/2 for penicillin G and V is about _____ because of rapid excretion by the kidney.
0.5 hours
________ are broad-spectrum drugs and have about 10% cross-allergenicity with penicillins.
Cephalosporins
Nitric oxide is a transmitter that is released by ___1____ cells and has many diverse functions in the body. One of them is to act as an inflammatory mediator
- endothelial
but it is not impacted directly by NSAIDs
The elimination half-life of __1____ is short because of rapid excretion by the kidney, 90% of which is by tubular secretion.
- penicillins
Very little of penicillins get metabolized.
What is the maximum number of 1.8 mL carpules of 2% Lidocaine HCl + Epinephrine 1:100,000 that can be administered for a healthy 18-year-old 50 kg male?
9.7 carpules
REcc dose is 7mg/kg
2% concentration = 20 mg/mL
20 mg/mL * 1.8 mL/carpule = 36 mg/carpule
There are 36 mg of lidocaine per carpule.
7 mg/kg * 50 kg = 350 mg
The maximum recommended dosage of licaine for a healthy 50 kg patient is 350 mg.
350 mg * (1 carpule/36 mg) = 350/36 = 9.7 carpules
9.7 is the maximum recommended number of carpules this patient should receive.
Metronidazole is limited to __1___ and is ____2____. It is contraindicated in ___3____ and __4__.
- anaerobes
- antiparasitic
- pregnancy
- alcohol
___1_____ is an example of a fluoroquinolone and is used for some sensitive organisms such as E. coli, Neisseria gonorrhoeae, Mycoplasma pneumoniae, and Haemophilus influenzae.
- Ciprofloxacin
Cidal or Static? Ionizing Radition
CIDAL
Ionizing radiation kills bacterial cells by disrupting their DNA and is a bacteriocidal method.
Cidal or Static? Dessication
Static
Desiccation involves extreme drying or dehydration and is a bacteriostatic method. Certain bacterial species with capsules may take a longer amount of time to be affected, while viruses and endospores may be unaffected by this technique.
Ester are metabolized by ______ in the ______.
pseudocholinesterase ; plasma
Ester drives a white BENZ a, messes it up with COco but keeps it white w/ clorox; its a TETRA seater and has a fancy exhaust PIPE
amiides
Safest LA to use in children
Lido ( amiides)
Bupivicaine ( marcaine) IS NOT SAFE in kids
pka= 8.1
LA that cause the least amt of vasodilation?
Mepivacaine (carbocaine,polocaine)
LA that is a vasoconstrictor
cocaine
Shortest duration LA
Septocaine
LA m.o.a
sodum channel blocker of neuron - sucess if 3 consective nodes of ranvier are blocked
only non-ionized form can diffuse thru hydrophobic membrane
Less effective in acdic (ie inflammed infxn tissue)
Longest duration LA
Bupivacaine ( Marcaine)
ADV of Midazolam (Versed) to Diazepam (Valium)
- Less incident of thrombophelbits
-SHorter elimination t1/2 life
NO significant active metabs
The clinical activity of a singel IV dose of Valium ( 10mg) is most dependent on?
Hepatic biotransformation
alpha 1 receptors cause what reaction
Vasoconstriction
INC HR and BP
CI in cardiac dz and hyperthyroid
a1 agonist = hemostatic agents ( retraction cords)
methylphenidate aka
Ritalin
ADHA durg ( adhd boy>girls)
blocks reuptake of NE and Dopamine
Amphetmine
Aderrall -indirect sympathomemetic (causing release of dopamine and NE may blk uptake)
can induce anx ; insomnia; inc HR excitabily
parzosin lowers bp by
smooth muslce relaxation of vasculature
Epi + propranolol results in
INC BP + DEC HR = DDI alpha 1 ( vasoconsriction inc BP-> relfex brady)
propranolol is a nonselective BB ( blocks b1 and b2 –> leavinf unopposed a1
Mild case -HPN ; Sev case = maligant HTN
Beta blocker med ok to use wiht epi?
Metoprolol - ( selective b1 blckr)
The drug classes to tx angina
propranolol; ca chanel blk ; Nitro
Does propanolol alter ionic movement?
No
Role of epi ( vasoconstrictor) in LA
- Prolong numbness
- REduce tox
- PRomote hemostasis
- counteracts vasodil of LA)
Max epi for ASA1
0.2mg
Mepivicaine Pka
7.6
lower = faster onset ( faster to non-ionized form = faster to crx membrane= onset)
AMx epi for cardiac
0.04mg/kg
Max lido w/o epi
4.4mg/kg
Max lido w/epi
7mg/kg
Adverse effects of metronidazole include a __1__ taste and ____2____.
- metallic
2. oral candidiasis
Adverse effects of tetracyclines include
tooth staining, liver toxicity during pregnancy, and photosensitivity.
Bone turnover is INCREASED by the ____ activity, which increases osteoclast action.
RANKL
The body’s inflammatory response due to tissue injury is mediated by
Histamine, prostaglandins and leukotrienes
______ does have opioidergic and monoaminergic activity but no known NMDA-receptor activity. ______ is considered a weak opioid. It is unique in its properties for causing reuptake inhibition of both _______ and ______, leading to their accumulation, in dorsal horn spinal synapses.
Tramadol
Tramadol
5HT and norepinephrine
Diltiazem [cardezim] is a _____inhibitor, and would result in decreased metabolism of hepatically-modified opioids.
CYP3A
anti-hypertensive & CCB
It can treat high blood pressure and chest pain (angina).
Tx for petit mal sz
Ethosuximide
Lido pka
7.8
also prilocaine and speto = 7.8
Diazepam CI
Preggers ; Myesthenia GRavis, Acute narrow anlge glaucoma, ASTHMA
Tx for staticus epilepticus sz
Diazepam ( valium)
if given IV least likely to cause resp depress
Tx for grand mal sz
Dilantin
Erythromycin may interact with many medications, including
theophylline, carbamazepine, cyclosporin, tacrolimus, warfarin, digoxin, terfenadine, astemizole, cisapride, lovastatin, triazolam, and disopyramide
Metronidazole (Flagyl) interacts with
Antabuse, anticoagulants, Dilantin, Hismanal, Lithobid, Phenobarbital, Tagamet, and vitamins.
what can induce sz?
Hyponatrimia
MEthyldopa, clonidine, NE, phenylepherine Epinepherine are all
indirect sympathomemetics
T/F. AntiHistamines can be used for motion sickness
TRUE
Epinepherine reversal agent?
Alpha adrenoceptor blockers, like phenoxybenzamine inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP
Salivary secretion increases with use of :
Pilocarpine,
Neostigmine (cholinergic agonists)
Ephedrine, guanethidine, cocaine, amphetamine are all
indirect sympaths
Tx of coise for adrenergically induced arrythmya is
propanolol
Salivary secretion DECREASES with use of:
atropine and
scopolamine (anti-cholinergics)
Acetylcholine is the chief neurotransmitter of the _____________, the part of the autonomic nervous system (a branch of the peripheral nervous system) that contracts smooth muscles, dilates blood vessels, increases bodily secretions, and slows heart rate.
parasympathetic nervous system
CHOLINERGICS = REST & DIGEST
slow heart, constrict pupils, stimulate GI smooth musc, stim sweat, saliva,
List of cholingerics
Acetylcholine
Neostigmine
Pilocarpine
___________: Acetylcholinesterase inhibitor, doesn’t penetrate BBB, tx of M. gravis
Neostigmine
Because it enhances the transmission of acetylcholine signals in the brain and can cross the blood–brain barrier, _______________ salicylate is used to treat anticholinergic poisoning caused by overdoses of atropine, scopolamine and other anticholinergic drugs. It is also used to reverse neuromuscular blocking drugs.
physostigmine
______________: used for atropine, scopolamine overdose, tx of glaucoma, acetylcholinesterase
Physostigmine
T/F. Atropine is a Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides
TRUE
Atropine poisoning tx:
physostigmine
what meds to decrease saliva?
atropine, scopolamine, Pilocarpine, neostigmine
For a Xerostomic pt, give
pilocarpine or Cevimeline
If patient has xerostomia what wont you give?
Atropine - anticholinergic
What drug does not cause miosis [pupil constriction] of the eyes?
atropine anticholinergic ( opposite of rest & digest = pupil dilation ( fight or flight)]
nontoxic side effects of pilocarpine are:
excess sweating and salivation, bronchospasm
IN TOXIC DOSE =
________: Muscarinic agonist, tx for glaucoma and xerostomia
Pilocarpine
Belladonna is a
anti-cholinergic
Belladonna is a plant. The leaf and root are used to make medicine. The name “belladonna” means “beautiful lady,” and was chosen because of a risky practice in Italy. The belladonna berry juice was used historically in Italy to enlarge the pupils of women, giving them a striking appearance.
___________ is used to treat glaucoma by lowering pressure inside the eye.
Physostigmine
ophthalmic reduces pressure in the eye by increasing the amount of fluid that drains from the eye. Physostigmine ophthalmic also causes the pupil to become smaller and reduces its response to light or dark conditions.
_______ is a Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides
Atropine
_____ injection is used to treat a muscle disease called myasthenia gravis.
Neostigmine
Glycopyrrolate effect?
reduce salivary secretion, as well as the acidity of gastric secretion.
(is a muscarinic anticholinergic),
What is the antidote for pilocarpine?
Atropine
Which of the following groups of drugs is contraindicated for patients who have glaucoma?
Anticholinergic
increases intraocular pressure
Cholinergics : Rest and digest as
___________ : Fight or Flight
Catecholamines = made by adrenal glands,
Fight or flight = Dopamine, E/NE aka adrenaline
____________ is anti-cholinergic (anti-muscarinic), relieve cramps or spasms of the stomach, intestines, and bladder.
Propantheline bromide (pro-Banthine)
A patient has a deficiency in acetyhcholinesterase. After giving her this drug, action is prolonged.
d-tubocurarine (inhibits acetylcholine receptor = weakness of skeletal
Administration of succinylcholine to patient deficient in serum cholinesterase would casue?
c. prolonged apnea
Only LA that is a vasoconstrictor?
Cocaine
Pt taking narcotic for long term what causes:
headache due to increase intracranial pressure
_______ competively inhibits DOPA decarboxylase (which causes a decrease in dopamine and NE/EPI). Its an anti-hypertensive, acts on A2 adrenergic as well.
Methyldopa
Theraputic Index LD/ED is a measure of :
safety of drug
_____ response to a drug over a given range of concentrations
potency
Potent = depend on dose of drug-less mg for same efficacy has more potency
How is bioavailability measured?
How much drug is absorbed in the circulation Blood to urine ratio
what determines the frequency of dosing
Elimination rate of a drug =HALF LIFE
Most important determinant of drug dose is
POTENCY of drug.
“intrinsic” and “receptors” refer to
efficacy
EFFICACY = NUMBER OF RECEPTORS that must be ACTIVATED to yield maximal response. Higher efficacy = activates less receptors to produce this response.
____1____ effect of a drug -efficacy is the max effect of the drug. Max effect is also called ___2___
- efficacy
2. intrinsic activity. (antagonists are not efficient/no intrinsic activity)
**in the Tufts packet—“Drug A had greater efficacy than drug B, so Drug A” is …
is capable of producing a greater maximum effect than drug B.
The maximal or “ceiling” effect of a drug is also correctly referred to as the drug’s
efficacy
T/F. Valium causes orofacial clefting
FALSE. DOES NOT!
Which of the benzodiazepine you don’t give to seniors?
Long acting one (like diazepam)
Short to intermediate-acting benzodiazepines are preferred in the elderly such as oxazepam and midazolam (versed).
Diazepam action =
work by increasing the effect of a brain chemical called GABA (gamma amino butyric acid)
= antianxiety and anticonvulsant ( can be hypnotic)
Benzos are great for dentistry due to an action of-
amnesia and little memory of the event.
Drug used to tx OCD is
Xanax-Alprazolam but does not include depression— OCD, anx, panic disorder
Best benzo for iv sedation =
MIDAZOLAM (versed)
What does IV Midazolam do?
Amnesia
Benzodiazepines: ones not metabolized by the liver (safe to use in liver failure)
Lorazepam ( ativan)
Oxazepam
Temazepam
Which drug best reverses the effect of benzodiazepines?
Flumazenil (Romazicon): Benzodiazepine antagonist ; competive GABA receptor.
Helped Benzo Flu away
contraindication of lorazepam:
preggers
Which barbiturates MOST readily penetrates the blood-brain barrier?
Thiopental
rapid-onset short ultra acting barbiturate(IV) for general anesthesia - for desenation
______ is a non-benzodiazpine hypnotic, used for insomnia
Ambien ( Zolpidem)
Not benzo but anticonvulsant and muscle relaxant also reversed by Flumazenil [Romazicon] just like Benzos…potentiates GABA receptors…short half life…negative se: hallucinations and amnesia
A patient’s early recovery from an ultrashort-acting barbiturate is related primarily to
redistribution
Chief mechanism by which the body metabolizes short-acting barbiturates is?
hydroxylation and oxidation.
Which Tryciclic drug used for iv sedation is ok for preggers/breast feeders?
Promethazine
________ = Psychotropic w. anxiolytic; low CNS depression, low psychomotor skill impairment
Buspirone
*Buspar—different from benzodiazepines because it does NOT cause, CNS depression, muscle relaxant, or anti-convulsant!!!!! UNIQUE!!! Anxiolytic and antidepressant
TCA mechanism of action:
inhibit reuptake of NE and 5-HT (serotonin)
do not give which medication to lactating female?
Codiene and tetracycline
Know drugs used for conscious sedation?
SSRIs/BDZ
{ Diazepam and Prozac(fluoexitine) }
Most common psychological problem in elderly?
Depression
Prozac - acts on
serotonin ( SSRI)
Smoking cessation drug in pt with hx of depression?
Zyban Bupropion/Wellbutrin
Wellbutrin can treat depression and help people quit smoking. It can also prevent depression caused by seasonal affective disorder (SAD).
What catecholamine do tricyclic antidepressants affect?
serotonin
____________= most common tricyclic antidepressant, inhibits reuptake of NE and Serotonin
Amitrriptyline
St. John’s Wart is a hebral used to treat
Depression
can also reduce the effectiveness of Drugs that suppress the immune system ( txp drugs - Humira,Prograf ect)
How do Phenothiazines work?
- Block DA receptors
- Act on the extrapyramidal pathway
se: Tardive dyskinesia
lithium is used for?
Manic phase of bipolar disorder
Strongest synthetic longacting corticosteroid =
dexamethasone
Onset of action of antipsychotic is:
5-6 days
GI concern with corticosteroids:
Ulcers.
Long term effect = osteoporosis/hyperglycemia/immunosupp
Contraindation use of corticosteroids:
diabetes
(also: HIV, TB, CADIDIASIS | Aspirin)
corticosteroids cause peptic ulcers and aspirin worsens it by increasing the risk of bleeding
What catecholamine does Phenothiazine (antipsychotic) affect?
Dopamine
Critical dose of steroids for adrenal insufficiency
- 20 mg of cortisone or its equivalent
20 mg x 2 wks in the last 2 years
which antibiotic is antimicrobial and anticollagenlyctic:
doxycycline
once per day dosing ( + minocycline)
mechanism of action of pen is closely related to ?
keflex ( cephalaxin )
Abx tx for Cysts-why doesn’t penicillin work well?
b/c can’t penetrate cyst barrier
ABx rx if pen allergy
clarithromycin 500mg
AMOX/PEN AND METHOTREXANE: DON’T MIX!!
AMOX AND METHOTREXANE: DON’T MIX!!
amox/pen dec elim -> inc risk of tox —> sz
reversal = leukovorin ( folinic acid)
tetracycline mechanism of action :
protein synthesis inhibitor (30s) = static
Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline. Antacids and milk reduce theabsorption of tetracyclines
antibiotic used in perio :
Metronidazole
(moa= fungal protozoa disrupt)
Metronidazole is commonly prescribed in NUG; metronidazole is CI in pts on alcohol –> disulfiram type of rxn and has red urine
1 side-effect of erythromycin is?
stomach upset.
aminoglycosides ae:
oto toxicity and nepho toxicity
Tx of MRSA
vancomycin
***OD Methotrexate—give
LEUCOVORIN
Alkalizing anti-cancer drug called procarbazine causes
HEPATOXITY
QUESTION: Condition that DOES NOT require antibiotic prophylaxis: o Prosthetic heart valve o Rheumatic heart valve o Congenital heart formations o Cardiac pacemaker
o Cardiac pacemaker
Premedicate these conditions:
artificial heart valve,
previous IE,
congenital heart (valvular/cyanotic) defect,
( HEART + Immunity)
For pts with heart disease or multiple sclerosis what LA to give?
mepivicaine without epiniphrine
Epi CI in these pts
Pt taking MAO inhibitors what you CAN NOT give him:
epinephrine
Local anesthetics containing EPI are contraindicated in patients taking
MAO inhibitors.
best LA to use w/o vasoconstrictor
mepivicane (carbo)
Levonordefrin is added to certain cartridges containing mepivacaine. The desired effect of levonordefrin is due to what pharmacologic effect?
VASOCONSTRICTION
Stimulation of α-adrenergic receptors
s/s of *Cocaine OD—
mydriasis
s/s of *Opiate OD—
pinpoint pupil miosis
What do you give IV for ventricular arrhythmia?
Lidocaine
Lidocaine administered intravenously has been highly effective in terminating ventricular premature beats and ventricular tachycardia occurring during general surgery, during and after cardiac surgery, following acute myocardial infarction, and in the course of digitalis intoxication.
Which pair of anesthetics is most likely to cause cross allergy?
- Lidocaine and mepivocaine
How much epi for a cardio pt?
0.04mg
MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI for adult and child?
7mg/kg = adult’s 4.4mg/Kg = kids
IAN given to kid - what teeth are affected?
All mandibular teeth are numb ( numb for 3hrs)
Excretion of an acidic drug will be enhanced if the patient is given_______?
Sodium bicarbonate
What is the mechanism of local anesthetics? intracellularly
Blocks Na channels
For a patient with myasthenia gravis, which of the following medications is acceptable?
A- Erythromycin
B- Clarithromycin
C- Imipenem
D- Penicillin
D Penicllin is okay to give.
Macrolides (Azithro/Erythro) are known to exacerbate MG symptoms
