Pharmacology

Question 1

Scopolamine

Answer 1

An anticholinergic. Works best if initiated prior to symptoms. Transdermal scop path used for 72 hours placed behind the ear. Transdermal is most effective method for motion sickness.

Question 2

Meclizine

Answer 2

A first generation antihistamine ( an H1 receptor antagonist with anticholinergic properties)

Question 3

Botox

Answer 3

Neuromodulator taken up by presynaptic neuron which acts as a protease and degrading SNARE protein required for vesicle fusion resulting in vesicles with acetylcholine which cannot bind to postsynaptic neurons and be released.

Question 4

Local anesthetic

Answer 4

Binds to voltage gated sodium channels. Different anesthetics have different affinities for binding.

Sequence of blockage occurs with sympathetic fibers progressing to pain and temperature then touch and then motor function.

All local anesthetics (except benzocaine) have pkas above physiologic pH, therefore an anesthetic with a lower pKa there is more drug available to cross the lipophilic cellular membrane.

Esters have one “i” and amides have two “i”s in their spelling

Amides are metabolized by the liver. Esters are metabolized by pseudocholinesterase. Esters are associated with more allergic reactions

Question 5

Propranolol

Answer 5

A non selective beta adrenergic antagonist. Side effects include hypoglycemia, GERD, psoriatic like rash, somnolence, bronchospasm

Question 6

Aspirin

Answer 6

• Cyclooxeginase inhibitor
• Decreases prostoglandins and thrombaxane
• Increases leukotriene levels (because arachadonic acid pathway is shifted from cyclooxygenase to lipoxygenase)

Question 7

Monteleukast

Answer 7

A leukotriene receptor antagonist. Trade name Singulair. Used in asthma and seasonal allergies.

Question 8

Celecoxib

Answer 8

A selective Cox-2 inhibitor that has been shown to be well tolerated in patients with AERD

Question 9

Cocaine

Answer 9

A unique local anesthetic. It is a vasoconstrictor (other LAs are vasodilators). It is an amino ester and metabolized by plasma cholinesterases. Prevents the reuptake of serotonin, norepinephrine and dopamine in the brain (what makes it a stimulant and appetite suppressant). Topical concentration is typically 4%

Question 10

Gardasil and Cervarix

Answer 10

HPV vaccines which are equally effective. Gardasil is approved for both men and women, cervarix only women. Gardasail protects against 9 strains and cervarix only HPV 16&18

Question 11

LAST

Answer 11

Lidocaine anesthetic system toxicity. Initially manifests with excitatory effects on the central nervous system. Patients complain of dizziness/lightheadedness, tinnitus, perioral paresthesias and agitation then tonic clonic seizures. Toxicity is worsened by hypoventilation

Cardiovascular toxicity occurs at higher doses than CNS toxicity.

Question 12

Lugol’s solution

Answer 12

Potassium iodide and elemental iodine in water. Can be used as a source of iodine in deficient patients or as a water disinfectant. Some give to patients prior to thyroidectomy to decrease thyroid vascularity.

Question 13

Atrovent nasal spray

Answer 13

Generic- ipratropium bromide

An anticholinergic nasal spray used for vasomotor rhinitis.

Question 14

Jessner’s solution

Answer 14

14 g resorcinol, 14 g salicylic acid, 14mL lactic acid mixed in 100mL ethanol

Used for superficial depth chemical peel. Can be mixed with 35%TCA for a medium depth chemical peel.

Question 15

Unique side effect of prilocaine and benzocaine?

Answer 15

Methemoglobinemia

Can occur if prilocaine or benzocaine given in large quantities. Treat with slow infusion of 1% methylene blue 1-2 mg/kg