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NBDE 2 > PHARM > Flashcards

PHARM Flashcards

1
Q

Amantidine

A

Anti-viral

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2
Q

Methamoglobinemia can be cause /exacerbated in which LA

A

Prilocaine (Citanest)

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3
Q

LA metabolized both liver and blood

A

Articane / Septo

  • ok for liver *

Both amide and ester

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4
Q

Which antihistamine is least likely to cause drowsiness?

A

Loradadine

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5
Q

Med given to Parkinsons pt? How does it work?

A

Carbidopa-levidopa ; increase Dopamine

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6
Q

A1- receptors do ?

A

vasocontriction

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7
Q

Benzo antidote

A

Flumazanil [Romazicon]

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8
Q

APAP antidote

A

N-acetylcistine

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9
Q

Epinephrine reversal agent

A

Phenoxybensamine

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10
Q

Allergic to ASA, give them?

A

Plavix, APAP

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11
Q

Cidal

A 
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

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12
Q

Static

A

Tetracyclines
Macrolides
Sulfonamides
Linkostomides

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13
Q

Used for bradycardia and side effect is xerostomia

A

Atropine

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14
Q

T/F. Aspirin can be give to asthmatics.

A

FALSE. DONT give Asthmatics (Sev /Reactive asthma/Nasal polyps) ASA, NSAIDs

D/t inhibition of COX pathways activating Lipooxygenase pathways , increasing Leukotrienes, causing BRONCHOSPASM

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15
Q

T/F. BENZOs can be given to preggers

A

FALSE

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16
Q

Meds given to recovering opiod addicts

A

Methadone

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17
Q

Mechanism of action of Benzodiazepines

A

Facilitates GABA receptor binding by inc frequency of fl channel opening

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18
Q

8-hr NSAID

A

Naproxen

give if pt allergic to codine

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19
Q

Max epi given in cardiac pts ?

A

0.04mg

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20
Q

Epi + propanolol what is the effect?

A

Hypertensive crisis - HR dec BP inc

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21
Q

Length of time NSIADs will suppresses platelets

A

5-7 days

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22
Q

Med given for Statis epilepticus sz

A

Diazepam or valium

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23
Q

Med given for grand mal sz

A

pheytoin/dilation

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24
Q

Med given for petit mal sz

A

ethosuccyimide

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25
Q

Erytrho (mycin?) side effect is

A

stomach upset ???

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26
Q

MoA of LA

A

vasocontriction

block Na channels intracellularly

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27
Q

Azithromycin
Clarithromycin
Erythromycin
Lincomycin

A

attack the 50S ribosomal subunit

-

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28
Q

______: effect of a drug as a function of level of binding to its receptor

A

Efficacy

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29
Q

______ : maximal effect of a drug, greatest response

A

Intrinsic

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30
Q

_________, prevents NAG-NAM cross-linkages in cell walls.

A

Amoxicillin, like penicillin

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31
Q

Minocycline prevents the function of

A

30S ribosomal subunit.

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32
Q

Pregnant, what’s CI for pain killer?

A
  • 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
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33
Q

Side effects of narcotic overdose other than respiratory depression:

A

coma, pin-point pupil (Mosby p. 291)

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34
Q

Systemic antifungal?

A

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

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35
Q

Methotrexate (anti-neoplastic) contraindications:

A
  • 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
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36
Q

_______: response to a drug over range of concentration

A

Potency

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37
Q

Pain killer in Lactating woman, CI is?

A
  • 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]

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38
Q

Drugs generally considered incompatible/CI with breastfeeding

A
  1. Anti-neoplastics
  2. Anti-convulsants: Phenobarbital (long-acting barbiturate ex CNS stim), ethosuximide (tx of absence seizure), primidone (parent form of phenobarbital)
  3. Drugs of abuse: amphetamine, cocaine, heroin
  4. Cyclosporine
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39
Q

TI =

A

LD50/ED50

Theraputic index

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40
Q

Pt on warfarin: What blood test do you look at before extractions?

A

INR

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41
Q

pt has Aspirin allergy, pain killer option?

A
  • APAP

- avoid nsaids

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42
Q

Cross-allergy is most likely to happen with the anesthetic agents

A

lidocaine and mepivacaine.

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43
Q

Ester-type local anesthetics include (6):

A 
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

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44
Q

Amide-type anesthetics include (6):

A 
articaine, 
bupivacaine, 
lidocaine , 
mepivacaine, 
prilocaine, 
ropivacaine.
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45
Q

mechanism of action of acetylsalicylic acid (aspirin)?

A

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.

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46
Q

target of H2 histamine receptor blockers

A

Parietal cells

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47
Q

Neuromuscular blockade of the phrenic nerve can be caused by extremely high doses of

A

streptomycin

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48
Q

Nalidixic acid is considered __________ in low concentrations and _______ in higher concentrations.

A

bacteriostatic ; bacteriocidal

ANTISEPTIC [quinolone] IN UTIs (gram neg) -not used anymore too many se

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49
Q

Alcohol has a synergist efffect with ?

A

bzdp, barbiuates

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50
Q

Augmentin:

A

amoxicillin and clavulanate potassium…know that it is a MRSA drug (Methicillin Resistant Staphylococcus Aureus)

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51
Q

What’s most likely to cause seizures?

A

hyponatremia

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52
Q

What does alpha 1 receptor do:

A

vasoconstrict

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53
Q

propanolol

A

Non-selective Beta blocker

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54
Q

albuterol

A

B2 agonist

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55
Q

Narrow angle glaucoma, what drug contraindicated?

A

anticholinergic

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56
Q

Amyl nitrate IS A

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.

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57
Q

Which of the following antibiotics acts upon the 50S ribosomal subunit?

A

Azithromycin
Clarithromycin
Erythromycin
Lincomycin

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58
Q

___________and _________ inhibit the transpeptidase enzyme.

A

Penicillins and cephalosporins

β-lactamase is an enzyme responsible for cleaving penicillins, making them ineffective against the bacteria.

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59
Q

Heparin functions by preventing the conversion of

A

prothrombin to thrombin.

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60
Q

Pen G is excreted in the _____

A

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)

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61
Q

A 1.8 mL carpule with 1:100,000 epinephrine yields ______ mg of epinephrine

A

0.018 mg

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62
Q

MAx epi in Caridac pts

A

two carpules may be given safely, because 0.036 mg is lower than the 0.04 mg limit.

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63
Q

_____________ is a penicillinase-resistant β-lactam similar to methicillin and is used to treat multi-drug-resistant S. aureus (MRSA) infections.

A

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
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64
Q

How does LA block pain?

A

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.

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65
Q

loratidine ; Azelastine ; Ranitidine = ?

A

Second gen anti-histamines (cimetidine, Famotidine)
SE: HA, Fatigue ( NO sedation- no BBB crx)
MOA: H2 recept

1st gen = muscarinic / anticholinergic se

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66
Q

Histamine is produced by _____?

A

decarboylation of histidine

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67
Q

Histamine is secreted by ______?

A

Enterochromafin - like endocrine cells in the glands of the stomach

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68
Q

Histamine release is stimulated from ____?

A

mast cells via C5a and C3a

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69
Q

Histamine receptor stimulation from ___1___ causes ____2___ activation of adenolyate cyclase and cyclic adenosine monophospate

A
  1. parietal cells

2. G-protein

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70
Q

__1_ and __2__ LA are the least myotoxic and _3__ is the most myotoxic LA.

A
  1. Tetracaine
  2. Procaine
  3. Bupivicaine

Myotox = dose-dependent ; reversible&raquo_space;myonecrosis ; dysregulates intracell Ca2+.

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71
Q

_______ is not inhibited by warfarin.

A

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.

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72
Q

ABx se = harily black tongue

A

Eyrthomycin

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73
Q

Opioids act by initiating a ______ cascade of pain inhibition and also binding to opioid receptors in the ____ and _____

A

descending

CNS and PNS.

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74
Q

Short duration local anaesthetics include:

A

Mepivacaine

Prilocaie

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75
Q

pseudomonas aeruginosa is not resistant to which penicillins?

A

Pseudomonas aeruginosa is inherently resistant to all penicillins xcept:
c a t m (i) p
carbenicillin, azlocillin, ticarcillin, mezlocillin, piperacillin.

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76
Q

Tx for ghonnneria ?

A

Ceftriaxone (Rocephin)

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77
Q

Tx for Clamydia?

A

Azithromycin

Chenelle got it and her dentist put her on a zpack

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78
Q

How shld get abx prophylaxis ?

A 
Cardiac [3]
- Hx of IE
- Hx of  CYANOTIC congenital defects - untxd (VSD =/=)
- prosthetic valves
Immunity
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79
Q

Ibuprofen shld be avoided in:

A
  • PRegger
  • WArfin
  • pre-exsiting ulcers
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80
Q

NSAID to give if ALL to APAP?

A

Ibuprofen

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81
Q

endogenous opioid peptides found in the body:

A
  1. endomorphins,
  2. endorphins
  3. enkephalins
  4. dynorphins
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82
Q

Precursor to APAP?

A

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.

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83
Q

Herbal preparations that interfere with blood clotting include:

A 
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.

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84
Q

Astralagus is an

A

immunostimulant that may decrease the effectiveness of immunosuppressants.

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85
Q

_____ is an herbal anxiolytic and sedative-hypnotic. It may cause temporary mouth numbness upon the administration of a local anesthetic.

A

Kava-kava

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86
Q

Some of the adverse effects of taking loop diuretics include:

A

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

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87
Q

Acetazolamide is a ____1____. This drug is usually used for patients who experience mountain sickness and it is also used to treat ____2____.

A
  1. carbonic anhydrase inhibitor

2. glaucoma

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88
Q

Abx with etoh has disulfriam-like rxn

A

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

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89
Q

_________ 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 ____.

A
  1. St. John’s Wort (CYP3A inducer)
  2. tetracyclines
  3. digoxin
  4. warfarin

High doses may cause ataxia, drowsiness, and inebriation.

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90
Q

Some of the adverse effects of taking loop diuretics include:

A

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

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91
Q

Furosemide
HCTZ
Spirinolactone

A

Loop diruretic
Thiazide
Potassium sparing

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92
Q

Used to treat mountain sickness

A

Acetazolamide = carbonic anhydrase inhibitor.

Also tx for glaucoma.
Mountain sickness = above 10,000 feet&raquo_space; acetazolamide to prevent dizziness and nausea,

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93
Q

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___.

A
  1. CYP2C9 and CYP 3A4
  2. Coumadin[ warfarin]
  3. lithium

Metronidazole = abx for anaerobic bact = flagyl

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94
Q

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__.

A
  1. acute narrow-angle glaucoma
  2. intraocular pressure
  3. flumazenil [Romazicon]
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95
Q

Metronidazole is contraindicated in pregnancy, along with ____1_____, the ___2____, and the ___3_____.

A
  1. chloramphenicol (broad, static/50S,
  2. aminoglycosides (broad, cidal/30S, -mycins)
  3. tetracyclines ( Broad, Static/30S , -cyclines)
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96
Q

T/F. Levofloxacin is OKAY to give pregnant.

A

FALSE.

Levofloxacin has not been proven to be safe for use in pregnant patients. = Quinolone/

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97
Q

Abx ok to give preggers?

A

PEN (cidal)

if allergic = AZITHROMYCIN (Macrolide/static)

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98
Q

Inhibition of mycolic acid synthesis is the mechanism of action of _______.

A

isoniazid

TB med

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99
Q

Bacterial cell wall synthesis inhibition is the mechanism of action of beta-lactam drugs, such as _____.

A

penicillin

low toxicity , cheap

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100
Q

NSAIDs inhibit the COX-2 enzyme that is responsible for prostaglandin synthesis from _________ .

A

arachidonic acid

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101
Q

DNA-dependent RNA polymerase inhibition is the mechanism of action of _____________.

A

Rifampin

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102
Q

_______is an excitatory neurotransmitter in the category of neuropeptide. It plays a major role in pain perception

A

Substance P

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103
Q

____1____ are derived from the metabolism of arachidonic acid, but are produced by the _____2___ enzyme pathway. NSAIDs do not work on this pathway.

A
  1. Leukotrienes

2. lipo-oxygenase

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104
Q

Nme a few CONTRAINDICATIONS for the use of ibuprofen?

A
  1. Warfarin - ibuprofen = NSAID and effects platelet fxn
  2. 1st trimester of pregnancy ( defect, HTN, Miscarraige)
  3. Stomach ulcer ( irritates gastric ining)
105
Q

properties of amide local anesthetics (LAs):

A
  • LIVER metabolism
  • WAter soluble
  • affected by acidity of local tissue
  • affect somenerve fibers more than others
  • contain preservatives to inc shlef life
106
Q

________ is another neuropeptide that has potent vasodilator effects. It is created by proteolytic enzymes in response to pain and works locally to dilate arterioles.

A

Bradykinin

107
Q

The antituberculosis drugs combination therapy is :

A

Isoniazid, Rifampin, Rifampin, Pyrazinamide, and Rifabutin

108
Q

The t 1/2 for penicillin G and V is about _____ because of rapid excretion by the kidney.

A

0.5 hours

109
Q

________ are broad-spectrum drugs and have about 10% cross-allergenicity with penicillins.

A

Cephalosporins

110
Q

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

A
  1. endothelial

but it is not impacted directly by NSAIDs

111
Q

The elimination half-life of __1____ is short because of rapid excretion by the kidney, 90% of which is by tubular secretion.

A
  1. penicillins

Very little of penicillins get metabolized.

112
Q

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?

A

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.

113
Q

Metronidazole is limited to __1___ and is ____2____. It is contraindicated in ___3____ and __4__.

A
  1. anaerobes
  2. antiparasitic
  3. pregnancy
  4. alcohol
114
Q

___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.

A
  1. Ciprofloxacin
115
Q

Cidal or Static? Ionizing Radition

A

CIDAL

Ionizing radiation kills bacterial cells by disrupting their DNA and is a bacteriocidal method.

116
Q

Cidal or Static? Dessication

A

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.

117
Q

Ester are metabolized by ______ in the ______.

A

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

118
Q

Safest LA to use in children

A

Lido ( amiides)
Bupivicaine ( marcaine) IS NOT SAFE in kids
pka= 8.1

119
Q

LA that cause the least amt of vasodilation?

A

Mepivacaine (carbocaine,polocaine)

120
Q

LA that is a vasoconstrictor

A

cocaine

121
Q

Shortest duration LA

A

Septocaine

122
Q

LA m.o.a

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)

123
Q

Longest duration LA

A

Bupivacaine ( Marcaine)

124
Q

ADV of Midazolam (Versed) to Diazepam (Valium)

A
  • Less incident of thrombophelbits
    -SHorter elimination t1/2 life
    NO significant active metabs
125
Q

The clinical activity of a singel IV dose of Valium ( 10mg) is most dependent on?

A

Hepatic biotransformation

126
Q

alpha 1 receptors cause what reaction

A

Vasoconstriction

INC HR and BP

CI in cardiac dz and hyperthyroid

a1 agonist = hemostatic agents ( retraction cords)

127
Q

methylphenidate aka

A

Ritalin
ADHA durg ( adhd boy>girls)
blocks reuptake of NE and Dopamine

128
Q

Amphetmine

A

Aderrall -indirect sympathomemetic (causing release of dopamine and NE may blk uptake)

can induce anx ; insomnia; inc HR excitabily

129
Q

parzosin lowers bp by

A

smooth muslce relaxation of vasculature

130
Q

Epi + propranolol results in

A 
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

131
Q

Beta blocker med ok to use wiht epi?

A

Metoprolol - ( selective b1 blckr)

132
Q

The drug classes to tx angina

A

propranolol; ca chanel blk ; Nitro

133
Q

Does propanolol alter ionic movement?

A

No

134
Q

Role of epi ( vasoconstrictor) in LA

A
  1. Prolong numbness
  2. REduce tox
  3. PRomote hemostasis
  • counteracts vasodil of LA)
135
Q

Max epi for ASA1

A

0.2mg

136
Q

Mepivicaine Pka

A

7.6

lower = faster onset ( faster to non-ionized form = faster to crx membrane= onset)

137
Q

AMx epi for cardiac

A

0.04mg/kg

138
Q

Max lido w/o epi

A

4.4mg/kg

139
Q

Max lido w/epi

A

7mg/kg

140
Q

Adverse effects of metronidazole include a __1__ taste and ____2____.

A
  1. metallic

2. oral candidiasis

141
Q

Adverse effects of tetracyclines include

A

tooth staining, liver toxicity during pregnancy, and photosensitivity.

142
Q

Bone turnover is INCREASED by the ____ activity, which increases osteoclast action.

A

RANKL

143
Q

The body’s inflammatory response due to tissue injury is mediated by

A

Histamine, prostaglandins and leukotrienes

144
Q

______ 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.

A

Tramadol
Tramadol
5HT and norepinephrine

145
Q

Diltiazem [cardezim] is a _____inhibitor, and would result in decreased metabolism of hepatically-modified opioids.

A

CYP3A

anti-hypertensive & CCB
It can treat high blood pressure and chest pain (angina).

146
Q

Tx for petit mal sz

A

Ethosuximide

147
Q

Lido pka

A

7.8

also prilocaine and speto = 7.8

148
Q

Diazepam CI

A

Preggers ; Myesthenia GRavis, Acute narrow anlge glaucoma, ASTHMA

149
Q

Tx for staticus epilepticus sz

A

Diazepam ( valium)

if given IV least likely to cause resp depress

150
Q

Tx for grand mal sz

A

Dilantin

151
Q

Erythromycin may interact with many medications, including

A

theophylline, carbamazepine, cyclosporin, tacrolimus, warfarin, digoxin, terfenadine, astemizole, cisapride, lovastatin, triazolam, and disopyramide

152
Q

Metronidazole (Flagyl) interacts with

A

Antabuse, anticoagulants, Dilantin, Hismanal, Lithobid, Phenobarbital, Tagamet, and vitamins.

153
Q

what can induce sz?

A

Hyponatrimia

154
Q

MEthyldopa, clonidine, NE, phenylepherine Epinepherine are all

A

indirect sympathomemetics

155
Q

T/F. AntiHistamines can be used for motion sickness

A

TRUE

156
Q

Epinepherine reversal agent?

A

Alpha adrenoceptor blockers, like phenoxybenzamine inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP

157
Q

Salivary secretion increases with use of :

A

Pilocarpine,

Neostigmine (cholinergic agonists)

158
Q

Ephedrine, guanethidine, cocaine, amphetamine are all

A

indirect sympaths

159
Q

Tx of coise for adrenergically induced arrythmya is

A

propanolol

160
Q

Salivary secretion DECREASES with use of:

A

atropine and

scopolamine (anti-cholinergics)

161
Q

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.

A

parasympathetic nervous system

CHOLINERGICS = REST & DIGEST
slow heart, constrict pupils, stimulate GI smooth musc, stim sweat, saliva,

162
Q

List of cholingerics

A

Acetylcholine
Neostigmine
Pilocarpine

163
Q

___________: Acetylcholinesterase inhibitor, doesn’t penetrate BBB, tx of M. gravis

A

Neostigmine

164
Q

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.

A

physostigmine

165
Q

______________: used for atropine, scopolamine overdose, tx of glaucoma, acetylcholinesterase

A

Physostigmine

166
Q

T/F. Atropine is a Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides

A

TRUE

167
Q

Atropine poisoning tx:

A

physostigmine

168
Q

what meds to decrease saliva?

A

atropine, scopolamine, Pilocarpine, neostigmine

169
Q

For a Xerostomic pt, give

A

pilocarpine or Cevimeline

170
Q

If patient has xerostomia what wont you give?

A

Atropine - anticholinergic

171
Q

What drug does not cause miosis [pupil constriction] of the eyes?

A

atropine anticholinergic ( opposite of rest & digest = pupil dilation ( fight or flight)]

172
Q

nontoxic side effects of pilocarpine are:

A

excess sweating and salivation, bronchospasm

IN TOXIC DOSE =

173
Q

________: Muscarinic agonist, tx for glaucoma and xerostomia

A

Pilocarpine

174
Q

Belladonna is a

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.

175
Q

___________ is used to treat glaucoma by lowering pressure inside the eye.

A

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.

176
Q

_______ is a Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides

A

Atropine

177
Q

_____ injection is used to treat a muscle disease called myasthenia gravis.

A

Neostigmine

178
Q

Glycopyrrolate effect?

A

reduce salivary secretion, as well as the acidity of gastric secretion.

(is a muscarinic anticholinergic),

179
Q

What is the antidote for pilocarpine?

A

Atropine

180
Q

Which of the following groups of drugs is contraindicated for patients who have glaucoma?

A

Anticholinergic

increases intraocular pressure

181
Q

Cholinergics : Rest and digest as

___________ : Fight or Flight

A

Catecholamines = made by adrenal glands,

Fight or flight = Dopamine, E/NE aka adrenaline

182
Q

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

A

Propantheline bromide (pro-Banthine)

183
Q

A patient has a deficiency in acetyhcholinesterase. After giving her this drug, action is prolonged.

A

d-tubocurarine (inhibits acetylcholine receptor = weakness of skeletal

184
Q

Administration of succinylcholine to patient deficient in serum cholinesterase would casue?

A

c. prolonged apnea

185
Q

Only LA that is a vasoconstrictor?

A

Cocaine

186
Q

Pt taking narcotic for long term what causes:

A

headache due to increase intracranial pressure

187
Q

_______ competively inhibits DOPA decarboxylase (which causes a decrease in dopamine and NE/EPI). Its an anti-hypertensive, acts on A2 adrenergic as well.

A

Methyldopa

188
Q

Theraputic Index LD/ED is a measure of :

A

safety of drug

189
Q

_____ response to a drug over a given range of concentrations

A

potency

Potent = depend on dose of drug-less mg for same efficacy has more potency

190
Q

How is bioavailability measured?

A

How much drug is absorbed in the circulation 
Blood to urine ratio 


191
Q

what determines the frequency of dosing

A

Elimination rate of a drug =HALF LIFE

192
Q

Most important determinant of drug dose is

A

POTENCY of drug.

193
Q

“intrinsic” and “receptors” refer to

A

efficacy

EFFICACY = NUMBER OF RECEPTORS that must be ACTIVATED to yield maximal response. Higher efficacy = activates less receptors to produce this response.

194
Q

____1____ effect of a drug -efficacy is the max effect of the drug. Max effect is also called ___2___

A
  1. efficacy

2. intrinsic activity. (antagonists are not efficient/no intrinsic activity)

195
Q

**in the Tufts packet—“Drug A had greater efficacy than drug B, so Drug A” is …

A

is capable of producing a greater maximum effect than drug B.

196
Q

The maximal or “ceiling” effect of a drug is also correctly referred to as the drug’s

A

efficacy

197
Q

T/F. Valium causes orofacial clefting

A

FALSE. 
 DOES NOT!

198
Q

Which of the benzodiazepine you don’t give to seniors?

A

Long acting one (like diazepam)

Short to intermediate-acting benzodiazepines are preferred in the elderly such as oxazepam and midazolam (versed).

199
Q

Diazepam action =

A

work by increasing the effect of a brain chemical called GABA (gamma amino butyric acid)

= antianxiety and anticonvulsant ( can be hypnotic)

200
Q

Benzos are great for dentistry due to an action of-

A

amnesia and little memory of the event.

201
Q

Drug used to tx OCD is

A

Xanax-Alprazolam but does not include depression— OCD, anx, panic disorder

202
Q

Best benzo for iv sedation =

A

MIDAZOLAM (versed)

203
Q

What does IV Midazolam do?

A

Amnesia

204
Q

Benzodiazepines: ones not metabolized by the liver (safe to use in liver failure)

A

Lorazepam ( ativan)
Oxazepam
Temazepam

205
Q

Which drug best reverses the effect of benzodiazepines?

A

Flumazenil (Romazicon): Benzodiazepine antagonist ; competive GABA receptor.

Helped Benzo Flu away

206
Q

contraindication of lorazepam:

A

preggers

207
Q

Which barbiturates MOST readily penetrates the blood-brain barrier?

A

Thiopental

rapid-onset short ultra acting barbiturate(IV) for general anesthesia - for desenation

208
Q

______ is a non-benzodiazpine hypnotic, used for insomnia

A

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

209
Q

A patient’s early recovery from an ultrashort-acting barbiturate is related primarily to

A

redistribution

210
Q

Chief mechanism by which the body metabolizes short-acting barbiturates is?

A

hydroxylation and oxidation.

211
Q

Which Tryciclic drug used for iv sedation is ok for preggers/breast feeders?

A

Promethazine

212
Q

________ = Psychotropic w. anxiolytic; low CNS depression, low psychomotor skill impairment

A

Buspirone

*Buspar—different from benzodiazepines because it does NOT cause, CNS depression, muscle relaxant, or anti-convulsant!!!!! UNIQUE!!! Anxiolytic and antidepressant

213
Q

TCA mechanism of action:

A

inhibit reuptake of NE and 5-HT (serotonin)

214
Q

do not give which medication to lactating female?

A

Codiene and tetracycline

215
Q

Know drugs used for conscious sedation?

A

SSRIs/BDZ

{ Diazepam and Prozac(fluoexitine) }

216
Q

Most common psychological problem in elderly?

A

Depression

217
Q

Prozac - acts on

A

serotonin ( SSRI)

218
Q

Smoking cessation drug in pt with hx of depression?

A

Zyban Bupropion/Wellbutrin

Wellbutrin can treat depression and help people quit smoking. It can also prevent depression caused by seasonal affective disorder (SAD).

219
Q

What catecholamine do tricyclic antidepressants affect?

A

serotonin

220
Q

____________= most common tricyclic antidepressant, inhibits reuptake of NE and Serotonin

A

Amitrriptyline

221
Q

St. John’s Wart is a hebral used to treat

A

Depression

can also reduce the effectiveness of Drugs that suppress the immune system ( txp drugs - Humira,Prograf ect)

222
Q

How do Phenothiazines work?

A
  1. Block DA receptors
  2. Act on the extrapyramidal pathway
    se: Tardive dyskinesia
223
Q

lithium is used for?

A

Manic phase of bipolar disorder

224
Q

Strongest synthetic longacting corticosteroid =

A

dexamethasone

225
Q

Onset of action of antipsychotic is:

A

5-6 days

226
Q

GI concern with corticosteroids:

A

Ulcers.

Long term effect = osteoporosis/hyperglycemia/immunosupp

227
Q

Contraindation use of corticosteroids:

A

diabetes
(also: HIV, TB, CADIDIASIS | Aspirin)
corticosteroids cause peptic ulcers and aspirin worsens it by increasing the risk of bleeding

228
Q

What catecholamine does Phenothiazine (antipsychotic) affect?

A

Dopamine

229
Q

Critical dose of steroids for adrenal insufficiency

A
  • 20 mg of cortisone or its equivalent

20 mg x 2 wks in the last 2 years

230
Q

which antibiotic is antimicrobial and anticollagenlyctic:

A

doxycycline

once per day dosing ( + minocycline)

231
Q

mechanism of action of pen is closely related to ?

A

keflex ( cephalaxin )

232
Q

Abx tx for Cysts-why doesn’t penicillin work well?

A

b/c can’t penetrate cyst barrier

233
Q

ABx rx if pen allergy

A

clarithromycin 500mg

234
Q

AMOX/PEN AND METHOTREXANE: DON’T MIX!!

A

AMOX AND METHOTREXANE: DON’T MIX!!
amox/pen dec elim -> inc risk of tox —> sz
reversal = leukovorin ( folinic acid)

235
Q

tetracycline mechanism of action :

A

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

236
Q

antibiotic used in perio :

A

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

237
Q

1 side-effect of erythromycin is?

A

stomach upset.

238
Q

aminoglycosides ae:

A

oto toxicity and nepho toxicity

239
Q

Tx of MRSA

A

vancomycin

240
Q

***OD Methotrexate—give

A

LEUCOVORIN

241
Q

Alkalizing anti-cancer drug called procarbazine causes

A

HEPATOXITY

242
Q 
QUESTION: 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

243
Q

Premedicate these conditions:

A

artificial heart valve,
previous IE,
congenital heart (valvular/cyanotic) defect,
( HEART + Immunity)

244
Q

For pts with heart disease or multiple sclerosis what LA to give?

A

mepivicaine without epiniphrine

Epi CI in these pts

245
Q

Pt taking MAO inhibitors what you CAN NOT give him:

A

epinephrine

246
Q

Local anesthetics containing EPI are contraindicated in patients taking

A

MAO inhibitors.

247
Q

best LA to use w/o vasoconstrictor

A

mepivicane (carbo)

248
Q

Levonordefrin is added to certain cartridges containing mepivacaine. The desired effect of levonordefrin is due to what pharmacologic effect?

A

VASOCONSTRICTION

Stimulation of α-adrenergic receptors

249
Q

s/s of *Cocaine OD—

A

mydriasis

250
Q

s/s of *Opiate OD—

A

pinpoint pupil miosis

251
Q

What do you give IV for ventricular arrhythmia?

A

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.

252
Q

Which pair of anesthetics is most likely to cause cross allergy?

A
  1. Lidocaine and mepivocaine
253
Q

How much epi for a cardio pt?

A

0.04mg

254
Q

MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI for adult and child?

A 
7mg/kg = adult’s 
4.4mg/Kg = kids
255
Q

IAN given to kid - what teeth are affected?

A

All mandibular teeth are numb ( numb for 3hrs)

256
Q

Excretion of an acidic drug will be enhanced if the patient is given_______?

A

Sodium bicarbonate

257
Q

What is the mechanism of local anesthetics? intracellularly

A

Blocks Na channels

258
Q

For a patient with myasthenia gravis, which of the following medications is acceptable?

A- Erythromycin

B- Clarithromycin

C- Imipenem

D- Penicillin

A

D Penicllin is okay to give.

Macrolides (Azithro/Erythro) are known to exacerbate MG symptoms

NBDE 2 (13 decks)

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