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NBDE Pt 2 Flash Cards > Pharmacology 3 > Flashcards

Pharmacology 3 Flashcards

1
Q

What are some toxic reactions to local anesthetics due to high systemic levels?

A

Cardiovascular collapse due to myocardial depression, hypotensive shock)

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2
Q

Prilocaine may cause ___ as an adverse effect.

A

Methemoglobinemia

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3
Q

Local anesthetics act by interfering with the ___ in the neuron.

A

Sodium transport

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4
Q

In regards to local anesthetics, only the ___ form can penetrate tissue membranes. Inflamed tissue has a lower than normal pH, which decreases the amount of non-ionized form available to penetrate

A

Non-ionized (or free base form)

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5
Q

True or false… the duration of procaine is longer than that of an equal dose of lidocaine

A

True

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6
Q

Procaine hydrochloride is metabolized into __ and ___

A

Diethylaminoethanol

Benzoic acid

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7
Q

Name one short acting anesthetic

A

Procaine (ester type)

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8
Q

Name three moderate lasting anesthetics

A

Prilocaine

Mepivicaine (carbocaine)

Lidocaine

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9
Q

Name three long acting local anesthetics

A

Bupivicaine (marcaine)

Tetracaine

Etidocaine

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10
Q

The duration of action of lidocaine could be increased with the presence of what medication? Why?

A

Propranolol

Propranolol slows down the heart via beta receptor blockade, thus blood deliver (and lidocaine) to the liver is reduced.
Propranolol and lidocaine also compete for the same enzyme in the liver thus metabolism of lidocaine can be reduced

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11
Q

Methemoglobinemia may result from a toluidine metabolite of the local anesthetic ___, called ___.

A

Prilocaine

Orthotoluidine

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12
Q

True or false… high plasma levels of local anesthetics may cause depression of inhibitory neurons in the CNS which could result in respiratory depression and death

A

True

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13
Q

If you inject lidocaine intraoral-arterially, what would likely be the first sign of lidocaine toxicity?

A

CNS excitation

Initially LAs inhibit central inhibitory neurons, which results in CNS stimulation, which can proceed to convulsions. At higher doses, they inhibit both inhibitory and excitatory neurons, leading to a generalized state of CNS depression which can result in respiratory depression and death

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14
Q

How is a patient with Grave’s disease more sensitive to epinephrine in local anesthetic?

A

Grave’s disease is an autoimmune disease that causes hyperthyroidism - the resulting high levels of circulating thyroid hormone result in hypermetabolic state with heightened sympathetic activity, which combined with injected epinephrine could result in a hypertensive crisis.

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15
Q

Cardiovascular collapse elicited by a high circulating dose of a local anesthetic may be caused by ____

A

Myocardial depression

LA’s in toxic doses depress membrane excitability and conduction velocity

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16
Q

What is the most serious consequence of local anesthetic toxicity?

A

Postconvulsive CNS depression

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17
Q

Local anesthetics block nerve conduction by…

A

Preventing an increase in membrane permeability to Na+

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18
Q

Only the __ form of LAs can pass through the membrane. Once inside the membrane only the ___ is effective in affecting the __ channel.

A

Nonionized (free base)

Ionized

Sodium

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19
Q

Most local anesthetics are weak [acids/bases] with a pKa ranging from __-__.

A

Bases

7.5 - 9.5

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20
Q

True or false… the greater the drug concentration, the faster the onset and the greater the degree of effect

A

True

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21
Q

True or false… local anesthetics block only myelinated nerve fibers at the nodes of ranvier

A

True

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22
Q

True or false… the larger the diameter of the nerve fiber, the faster the onset of effect

A

False… the smaller the diameter the faster the onset

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23
Q

True or false… the faster the penetrance of the drug the faster the onset of effect.

A

True

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24
Q

1:100,000 epinephrine = ___mg/ml

A

0.01 mg/ml

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25
Q

What is the maximum amount of epinephrine that can be given to a patient with cardiovascular disease? What about a normal, healthy patient?

A
  1. 04mg

0. 2mg

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26
Q

1:200,000 = ___mg/ml

A

0.005 mg/ml

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27
Q

Which is more sensitive to acid degradation, penicillin V or penicillin G?

A

Penicillin G - thus it should be injected instead of taken orally

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28
Q

Which penicillin has the best gram-negative spectrum?

A

Ampicillin

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29
Q

Which two drugs are common to have cross-allergenicity with penicillin?

A

Cephalosporins and ampicillin

Note that erythromycin isn’t

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30
Q

Which penicillin is useful against penicilliniase-producing bugs such as staphylococcus?

A

Dicloxacillin (Also nafcillin and methicillin)

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31
Q

What penicillin is specifically used for pseudomonas infections?

A

An extended spectrum such as carbenicillin

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32
Q

What is to be used for prophylaxis for the patient with a prosthetic joint?

A

Keflex, 2g PO 1 hr before treatment

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33
Q

Name 3 cardiovascular conditions that require antibiotic prophylaxis

A

Prosthetic valves

Previous endocarditis

Pulmonary shunts

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34
Q

Name 3 cardiovascular conditions that do not need antibiotic prophylaxis

A

Pacemaker

Rheumatic fever without valvular dysfunction

Mitral valve prolapse without valvular regurgitation

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35
Q

Antifungals such as nystatin bone to ___ in fungal cell walls to weaken the wall

A

Ergosterol

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36
Q

What are some symptoms seen during allergic reactions to penicillins?

A

Dermatitis

Stomatitis

Bronchoconstriction

Cardiovascular collapse

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37
Q

What agent produces GI sunset and pseudomonas colitis?

A

Clindamycin

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38
Q

Aplastic anemia is associated with with antibiotic?

A

Chloramphenicol

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39
Q

Liver damage or hepatotoxcitity is associated with which antibiotic?

A

Tetracycline

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40
Q

Erythromycin estolate is assocaited wit allergic ___

A

Cholestatic hepatitis

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41
Q

True or false… tetracycline and penicillin (cidal-static interaction) cancel each other out due to opposing mechanisms of action

A

True

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42
Q

___ alters the rate of renal clearance of penicillin

A

Probenecid

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43
Q

Effectiveness of tetracyclines is reduced by concurrent ingestion of __ or ___

A

Antacids

Dairy products

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44
Q

Broad spectrum antibiotics enhance the action of coumarin anticoagulants because of the reduction of ___ sources

A

Vitamin K

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45
Q

Antibiotics such as __ decrease the effectiveness of oral contraceptives due to suppression of normal GI flora involved in the recycling of active steroids from bile conjugates, leading to more rapid excretion of __ from the body

A

Ampicillin

Steroids

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46
Q

Macrolides such as erythromycin inhibit the metabolism of drugs such as ___ and ___

A

Seldane

Digoxin

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47
Q

___ or ___ are systemic-acting antifungals useful for treating candidiasis

A

Fluconazole

Ketoconazole

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48
Q

Are anaphylactic reactions to penicillin more likely to occur when the drug is administered orally or parenterally?

A

Parenterally

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49
Q

What form of penicillin has the broadest gram-negative spectrum?

A

Ampicillin

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50
Q

What bactericidal antibiotic is used specifically in the treatment of infections caused by pseudomonas species and indole-positive proteus species?

A

Carbenicillin

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51
Q

Which antibiotic is able to achieve a higher concentration in bone than in serum, making it useful in treating bone infections such as osteomyelitis?

A

Clindamycin

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52
Q

Which antibiotic is able to achieve a higher concentration in gingival crevicular fluid than in serum?

A

Tetracycline

53
Q

How does tetracycline reduce the effectiveness of concomitantly administered penicillin?

A

Tetracycline is bacteriostatic and would slow the rapid growth of the microbial population that a bactericidal drug such as penicillin needs to be effective. Since only when rapidly dividing are the cells making cell walls

54
Q

Name four side effects of prolonged tetracycline hydrochloride therapy.

A

Suprainfection

Photosensitivity

Discoloration of newly forming teeth

GI symptoms (when administed orally)

55
Q

1st generation cephalosporins are effective against ___ organisms, the 3rd generation are effective against…

A

Both gram-positive and gram negative

Increased activity against gram-negative but greatly decreased activity against gram-positive microorganisms

56
Q

Sulfonamides and trimethoprim are synergistic bacteriostatic agents because in bacteria they…

A

Interfere sequentially with folinic acid production

57
Q

Tetracycline chelates with ___

A

Calcium

58
Q

The concurrent administration of penicillin G and probenecid results in…

A

Decreased renal excretion of penicillin G

59
Q

When broad-spectrum antibiotics are administered with coumarin anticoagulants, the anticoagulant action may be [increased/decreased] because of…

A

Increased

Reduction of vitamin K sources

60
Q

Erythromycin should be avoided in the patient taking ___ because…

A

Seldane or digoxin

Erythromycin-seldane potentially lethal interaction whereby erythromycin blocks the metabolism of seldane into its antihistamine metabolite - it stays unmetabolized and causes CARIDAC ARRHYTHMIAS.

61
Q

What type of drug is furosemide?

A

Diuretic that is a loop-acting diuretic (high ceiling) used to treat hypertension.

62
Q

Prazosin is a ___ blocker

A

Alpha-1

63
Q

Name two centrally acting adrenergic drugs

A

Methyldopa

Clonidine

64
Q

Name one neuronal blocker reserved for severe hypertension

A

Guanethidine

65
Q

Name two angiotensin converting enzyme inhibitors used to treat hypertension

A

Lisinopril

Captopril

66
Q

Lidocaine can be used to treat ___ arrhythmias

A

Ventricular

67
Q

__ is used to reverse digitalis-induced arrhythmias

A

Phenytoin

68
Q

___ is used to treat supraventricular tachyarrhthmias and atrial fibrillation

A

Quinidine

And

Verapamil

69
Q

__ is used to treat atrial fibrillation and paroxysmal tachycardia and also increases contractility

A

Digitalis

70
Q

___ is a beta blocker used to treat paroxysmal tachycardia

A

Propranolol

71
Q

Name two glycosides and one ACE inhibitor that is used to treat congestive heart failure

A

Digitalis

Digoxin

Captopril

72
Q

Type 1A antiarrhythmics such as ___ act by…

A

Quinidine

Increasing the refractory period of cardiac muscle

73
Q

Type 1B antiarrhythmics such as ___ decrease ____

A

Lidocaine

Cardiac excitability

74
Q

When digitalis is used for atrial fibrillation it acts by decreasing the rate of ___

A

AV conduction

75
Q

Antiangina drugs work by…

A

Providing increased oxygen supply to the myocardium

76
Q

How does nitroglycerin treat angina?

A

Increases oxygen supply to the heart by a direct vasodilators action on the smooth muscle in coronary arteries

77
Q

How does propranolol treat angina?

A

Reduces oxygen demand by preventing chronotropic responses to endogenous epinephrine, emotions, and exercise

78
Q

How do calcium channel blockers treat angina?

A

Decrease oxygen demand by reducing afterload by reducing peripheral resistance via vasodilation

79
Q

Captopril is a ___ inhibitor that…

A

ACE

Inhibits the conversion of angiotensin 1 to angiotensin 2. The latter is a potent vasoconstrictor (administration of angiotensin will result in an elevation of blood pressure)

80
Q

Prazosin is a selective __ blocker. It inhibits__ resulting in ___

A

Alpha 1

Binding of nerve induced release of NE resulting in vasodilation

81
Q

Methyldopa acts centrally as a false neurotransmitter stimulating __ receptors to reduce sympathetic outflow resulting in ___

A

Alpha

Vasodilation

82
Q

Clonidine is a selective agonist that stimulates ___ receptors in the CNS to reduce sympathetic outflow to peripheral vessels resulting in vasodilation

A

Alpha 2

83
Q

Propranolol is a nonselective ___ blocker that reduces cardiac output and inhibits __ secretion

A

Beta

Renin

84
Q

Metoprolol is a [nonselective/selective] beta-1 blocker that reduces cardiac output

A

Selective

85
Q

What is the function of diuretics?

A

Decrease the renal absorption of sodium, thus resulting in fluid loss and a reduction in blood volume. This decreases the work the heart has to pump. Also have a weak dilatory action. Types of diuretics which may be mentioned include…

Thiazides
High-ceiling or loop acting
Potassium sparing

86
Q

___ such as __ or __ are effective for treating congestive heart failure because they have a positive inotropic effect, increasing the force of contraction of the myocardium. This is achieved by an inhibition of NaKATPase leading to increased calcium influx.

A

Cardiac glycosides

Digitalis

Digitoxin

87
Q

Verapamil is most efficacious in the treatment of ___

A

Atrial fibrillation

88
Q

What is the drug of choice for the initial therapy of mild hypertension?

A

Chlorothiazide

89
Q

True or false.. guanethidine and ganglionic blocking agents are usually reserved for the treatment of severe hypertension

A

True

90
Q

Most drugs useful in the treatment of cardiac arrhythmias act primarily by…

A

Increasing the refractory period of cardiac muscle

91
Q

Define arrhythmias.

How do they result?

A

Arrhythmias are defined as any abnormality of the normal sinus rhythm of the heart due to disease or injury induced damage to the impulse conducting systems. They also result form the development of ectopic pacemakers or abnormal pacemaker rhythms.

92
Q

Propranolol is of value in treating angina pectoris because it…

A

Prevents chronotropic responses to endogenous epinephrine emotions and exercise

93
Q

Administration of angiotensin results in [increased/decreased] blood pressure

A

Increased

94
Q

The primary antihypertensive effect of captopril is due to accumulation of ___

A

Angiotensin 1 (because it is not converted to angiotensin 2.

Captopril also maintains lowered BP by elevating bradykinin (which has potent vasodilatory action) in the blood by blocking its metabolism.

95
Q

The most useful diuretic drugs act by [increasing/decreasing] the renal reabsorption of sodium

A

Decreasing

96
Q

___ is a class of antihypertensive drugs that act by inhibiting renal reabsorption of sodium.

A

Chlorothiazide

97
Q

How does digoxin exert its positive inotropic effect?

A

Inhibition of Na+K+ATPase, leading to increased calcium influx

Cardiac glycosides such as digoxin are thought to act by altering calcium ion movement, with a desired effect of increasing the force of contraction of the myocardium (inotropic effect).

98
Q

Digitoxin is effective in the treatment of cardiac failure because it…

A

Has a positive cardiac inotropic action

99
Q

The primary action of therapeutic doses of digitalis on cardiac muscle is an increase in…

A

Force of contraction

100
Q

In the treatment of congestive heart failure, digitalis glycosides generally decrease what 4 things?

A

Edema

Heart size

Heart rate

Residual diastolic volume

101
Q

The mechanism of action of prazosin, an antihypertensive agent is to…

A

Inhibit the postsynaptic action of NE on vascular smooth muscle

102
Q

Selective beta-1 adrenergic agonists will produce [increased/decreased] cardiac output

A

Increased

103
Q

Administration of ___ increases the likelihood of a toxic response to digitalis. It is a diuretic which causes potassium loss or hypokalemia. This results in greater penetration of digitalis into the myocardium, and thus potential toxicity

A

Chlorothiazide

Chlorothiazide is contraindicated with digitalis

104
Q

The highest risk associated with use of oral contraceptives is…

A

Thromboembolic disorders

105
Q

How doe sulfonyl ureas cause insulin secretion?

A

Direct stimulation of pancreatic beta cells

106
Q

If a patient requiring an extraction reports that he is on dicoumarol therapy, the laboratory test most valuable in evaluating the surgical risk is ___

A

Plasma prothrombin time

107
Q

The various insulin preparations useful in the treatment of diabetes myelitis differ primarily in ___

A

Onset and duration of action

1) fast-acting (insulin suspension)
2) intermediate acting (isophane insulin suspension)
3) long acting: protamine zinc insulin suspension

108
Q

Which anticancer drug can be classified as an antimetabolite?

A

Methotrexate - example of a cell cycle specific antimetabolite that inhibits DNA synthesis during the S phase.

Most cancer chemotherapy drugs cause cell death by affecting the ability of cells to divide.

109
Q

Which hormone acts to elevate blood concentration of ionic calcium?

A

Parathyroid

110
Q

Why shouldn’t a heroin dependent patient be given nalbuphine?

A

The mixed agonist-antagonists were designed to combine analgesia with enough antagonistic properties to prevent their abuse. It can elicit withdrawal symptoms in a herosin dependent patient.

111
Q

___ can be used to treat life-threatening ventricular arrhythmias

A

Lidocaine

112
Q

A patient on coumadin therapy presents for an extraction yet has a prolonged PT time. What is the correct course of action?

A

Withdrawing coumadin for 2 days after consulting with physician

113
Q

What is the drug of choice for status epilepticus?

A

Diazepam

114
Q

Bradycardia is most commonly treated with what drug?

A

Atropine

Bradycardia a reflexive slowed heart rate, controlled by vagal input to the heart, and is cholinergically mediated, which means you need a cholinergic receptor blocker to reduce the vagal effect.

115
Q

What group of drugs is contraindicated for patients who have glaucoma?

A

Anticholinergics

Anticholinergics will increase intraocular pressure, which is already the problem with glaucoma patients

116
Q

Low dose aspirin therapy prevents the formation of thromboembolism by what mechanism?

A

Inhibiting thromboxane synthetase in the platelets

117
Q

Succinylcholine blocks neuromuscular transmission by…

A

Depolarizing the motor endplate of skeletal muscle to overstimulate the receptor, thereby causing its subsequent depolarization of the neuron and a block of muscle activity

118
Q

How does curare block neuromuscular transmission?

A

Nicotinic receptor blocker

119
Q

What is buspirone used for?

A

To relieve anxiety. It is not a benzodiazepine and does not have as much CNS depression

120
Q

A patient with which of the following conditions is most likely to have postoperative bleeding after multiple extractions? Why?

Angina
Diabetes
Cirrhosis
Rheumatic fever
Chronic bronchitis
A

Cirrhosis

vitamin K is stored in the liver - this is decreased by cirrhosis - the result is deficiencies in prothrombin dependent coagulation factors

121
Q

Local anesthetics aid in reducing the flow of saliva during operative procedures by…

A

Reducing sensitivity and anxiety during tooth preparation

122
Q

Which is more potent, oxycodone or codeine?

A

Oxycodone

123
Q

Auditory nerve deafness is associated with the use of what antibiotic?

A

Gentamicin

124
Q

What is the main adverse side effect of the following antibiotics?

Polymixin

Chloramphenicol

Amphotericin B

Gentamycin

A

Polymixin - renal necrosis

Chloramphenicol - bone marrow depression

Amphotericin B - nephrotoxicity

Gentamycin - auditory nerve deafness

125
Q

Allergic reactions to local anesthetics are caused by ___

A

An antigen-antibody reaction

126
Q

What drug class is amantadine?

A

Antiviral

127
Q

What drug class are ephedrine, tyramine, and amphetamine classified under?

A

Indirect-acting sympathomimetics

128
Q

Thrombophlebitis, which occurs after IV administration of diazepam is usually attributed to which substance of the mixture?

A

Propylene glycol

129
Q

Name 3 signs that a patient is being administered too much nitrous oxide.

A

Nausea

Euphoria

Giddiness

(Tingling of the hands is usually the first symptom that is perceived by patients)

NBDE Pt 2 Flash Cards (23 decks)

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