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NBDE Part II > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Odontogenic Infection

A

PEN VK –> Clindamycin (anaerobic effective)

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2
Q

Patient on prednisone with erythema multiform and needs an EXT. What do you do?

A
  • AKA steven johnson syndrome
  • The disease is an immune complex (IgM) deposition on superficial microvasculature on the skin and in the oral mucosa –> hypersensitivity syndrome
  • Treated with steroids.
  • All steroids (at 15 mg/day or 5 mg/day for a month) suppress the adrenal cortex. Thus, if undergoing an EXT an additional “stress dose” steroid should be added.
  • Individuals on suppressive doses of steroids take up to 1 year to regain full adrenal cortex function and may show hyper pigmentation (due to high ACTH –> melanocytes)
  • Test for adrenal insufficiency = ACTH levels
  • 20 mg of cortisol released daily, with 200 mg in times of stress

Anterior pituitary –> ACTH –> adrenal cortex –> glucocorticoids. Thus, if steroids are taken, no ACTH will be produced and long term, the adrenal cortex may atrophy.

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3
Q

Cushing syndrome

A
  • high cortisol (glucocorticoid) –> Fluid retention (BP) + poor wound healing (high glucose levels, low CHO metabolism)
  • moon face, tranquil obesity, hair loss
  • Caused by Pituitary tumor
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4
Q

Leukemia

A

Leukemia = Cancer → High WBC that do not properly function (Low RBC and platelets) = Results in gingivitis, perio problems, bruising and hemorrhaging (ecchymosis)

  1. ALL = childhood = normal lymphocytes become cancerous in the BM = lymphocytes are neither B or T cells and are called null cells = 80% cure rate = Dx: pallor, fatigue, infection = Most responsive to Tx (untreated, death is in 6 months due to hemorrhage or infection)
  2. AML = most malignant = Auer rods
  3. CLL = least malignant
  4. CML = fatal = Philadelphia chromosome 9 and 22 = spongy, bleeding gums

Enlarged lymph nodes, spleen and liver is seen in acute vs chronic leukemias

1:1 Acute: Chronic leukemias
AML, CML line (myelogenous) = higher oral manifestations

Aleukemic leukemia = Leukemia in bone marrow, but no increase in WBC
Subleukemic leukemia = Leukemia cells in the blood, but no increase in WBC
Stem Cell leukemia = too immature to classify = leukemia that are poorly differentiated precursors to lymphoblasts, monoblatsts

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5
Q

Erythroblastosis fetalis

A

Rh incompatibility → Rh (+) fetus in a Rh (-) mother → anemia form = also from blood type ABO incompatibility = Fetal teeth appear blue, brown or green due to blood pigment deposits on enamel and dentin. Enamel hypoplasia may occur.

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6
Q

Pernicious anemia

A

megaloblastic = Glossitis is common = low intrinsic factor = low B12 which is needed for RBC formation = shilling 24 hour urine test to determine Vit B12 absorption

Other low B12 = Thalessemia = hemolytic anemias = flaring of max anteriors

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7
Q

Agranulocystosis

A

low granulocytes (PMN) = caused by anti-thyroid drugs (methimazole) = causes rapid perio disease, oral ulcers, gingival bleeding, jaundice, fever, infected oral cavity = rapid onset = No inflammatory cell infiltration around the lesions!

Cyclic neutropenia is a type of agranulocytosis, with severe gingivitis

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8
Q

Petechiae vs purpura vs ecchymosis

A

Petechiae

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9
Q

Sickle Cell Anemia

A

Glutamic acid → valine = X-rays show normal lamina dura and teeth, but the marrow spaces are enlarged due to loss of trabeculae (osteosclerotic areas are seen in large radiolucenct marrow spaces)

RBC life span = 120 days (with Sickle Cell, its now 20 days)
Platelet life span = 7-10 days

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10
Q

Plummer Vinson Syndrome

A

Fe deficiency anemia association, but idiopathic
Spoon shaped fingernails
RISK: SCC of the tongue

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11
Q

What is the most serious and life threatening blood dycrasias associated with drug toxicity?

A

Aplastic anemia

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12
Q

Xerostomia causing medication

A
  1. Anti-psychotics (anti-depressants)
  2. Anti-HTN
  3. Anti-histamines
  4. Bronchodilators
  5. Anti-chlinergics
  6. Sedatives

Its not a disease, its a symptom

LA use in operative restorations decrease salivation by reducing anxiety and sensitivity

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13
Q

Cord packing in a person with heart conditions (including hyperthyroidism) require use of:

A

Alum (aluminum potassium sulfate)

- Never use ZnCl (causes necrosis, delays wound healing)

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14
Q

ADHD

A

idiopathic cause, most don’t require Rx.

ADHD Tx (called stimulants)

  • Ritalin (methylphenidate)
  • Concerta (methylphenidate extended release)
  • Adderral (amphetamine + dextroamphetamine)
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15
Q

Rx for trigeminal neuralgia

A

Carbamazepine (Tegretol)

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16
Q

Drugs metabolized via kidney

A 
NSAIDS
morphine
ASA
ACE
meperidine

Possible steroid use!

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17
Q

LA needles

A

positive aspiration is directly correlated to needle gauge

25 gauge = largest = most accurate due to least likely to bend and not break = used when high aspiration risk.

18
Q

NO

A
  • CNS (limbic and reticular activator systems)
  • Limit: 60:40 N: O2
  • No degradation, thus excretion via lungs is 100%
  • Correct flow rate: reservoir bag should be 1/3 to 2/3 full
  • Patient must have 21% O2, which is what is in normal air
19
Q

Flight or flight response

A

syncope
increase in catecholamines –> sweat, palpations, tacky, decrease in peripheral resistance leading to blood pooling in peripheral = vasovagal bradycardia

Ammonium irritates the trigeminal sensory nerves to wake people up

O2 is not used int he hyperventilation syndrome type of syncope.

No NO or 100% O2 for COPD

20
Q

Patients on tricyclic antidepressants or non-selective beta blockers should avoid

A

epi

21
Q

Triazolam is what?

A

pre-sedative drug
- Cant be taken with anti-fungals (-conazole) since they inhibit CYP 3A4, which is an enzyme that degrades triazolam. Its inhibition will increase concentration, thus toxicity.

22
Q

Rx abbreviations

A

h. s. = at bedtime
a. c. = before meals
p. c. = after meals
p. o. = by mouth
sig. = label

23
Q

Heart burn meds

A

proton pump inhibitors = prazole
H2 receptor blockers = inhibit histamine in stomach = tidine
antacids = neutralize acid in stomach

24
Q

EtOH affects the brain centers as follows:

A
  1. cerebral cortex
  2. limbic system
  3. cerebellum
  4. hypothalamus and pituitary gland
  5. medulla (brain stem)
25
Q

drugs travel through the body via

A

albumin plasma

26
Q

immunosuppressant drug acronym

A

-rolimus (tacrolimus)

27
Q

PEDO sedation

A

Chloral hydrate = most common = sedative hypnotic
Barbituate = sedative hypnotic
Pentobarbital = sedative, but non-algesic

28
Q

Benzodiazepine

A
  • most effective oral sedatives in dentistry (anti-seizure, anti-anxiety)
  • potentiates GABA = increased neural inhibition and CNS depression via post-synaptic CNS nerve endings
    Diazepams (valium, versed, ativan)
29
Q

Drugs that prolong QT interval = torsade de pointes = arrythmia

A

Erythromycin
Clarithromycin
(NOT Azithromycin)

30
Q

Angina Prevention

A

chest pain from artery occlusion

  1. Nitroglycerin = coronary a. (and vein) vasodilator. RISK: orthostatic hypotension, H/A
  2. Ca Channel blockers = dilate coronary BV to increase BF to heart
  3. Beta blockers = decrease work load of heart, thus less O2 is required
  4. Amyl nitrite
31
Q

TX cyanide poisoning

A

Amyl nitrite

  • Oxidizes hemoglobin to methemoglobin which binds to cyanide
  • vasodilator
  • Inhalation only
  • Also tx angina
  • Can be addicting due to sex and euphoria
32
Q

PT test

A

plasma deficicnecy in clotting factors 5,7,10

33
Q

Tx of C. diff

A

vancomycin

  • used for severe staph and strep cases
  • RISK: red man syndrome
34
Q

Which antibiotic causes issues with bone marrow?

A

Chloramphenicol

- Will lead to aplastic anemia, however it is not a contraindication

35
Q

Tx herpes labialis

A

Penciclovir (Denavir)

- DNA synthesis inhibitor of HSV-1

36
Q

Drug suffixes:

    • coxib
  2. -dipine
  3. -olol
  4. -ilol / - alol
  5. -onium / -urium
  6. -osin
  7. -pril
  8. -sartan
A
  1. COX-2
  2. Ca channel
  3. beta blocker
  4. alpha and beta blockers
  5. quarternary ammonium compounds for skeletal muscle relaxants
  6. Alpha 1 blocker
  7. ACE
  8. Angiotensin II
37
Q

What increases PCN blood levels?

A

Probenecid (Gout Tx)

  • inhibits renal tubule secretion
  • can be given concurrently for this effect
38
Q

Prophylxais main choice

A

Amoxicillin

39
Q

Which antibiotic cause opportunistic infections easily?

A

Tetracycline

- Although they are used for ANUG when PCN can’t be used

40
Q

Why shouldn’t tetracyclines be given with milk, antacids, or iron supplements?

A

chelation products (Ca, Mg, Fe, Al) prevent absorption of tetracycline in the GI

41
Q

Atropine

A

Anti-cholinesterase

  • Causes SA node increase (A fib)
  • Prevents Acetylcholine on muscarinic receptors
  • pulpil dilation by paralysis of the ciliary muscle, preventing lens accommodation
  • CONTRAINIDECATED in glaucoma (along with any anti-cholinesterase drug and valium)

NBDE Part II (13 decks)

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