Pharmacology Flashcards
what metabolizes esters
esterases in the blood
what is the mechanism of action of local anesthetics
prevent generation of nerve impulses by preventing sodium transport into the neuron
what form of LA is absorbed into the neuron
non-ionized form (free base form)
how does inflammed tissue affect LA absorption
is decreases the pH of the tissue which decreases the amount of non-iodized form of the LA meaning less gets into the nerve
Effect of beta blockers on LA concentrations
taking beta blockers slows down heart conduction and blood flow and thus causes LA to be in circulation longer
What is the initial effect of LA in toxic concentration, then second effect at higher levels
first they inhibit inhibitory neurons = convulsions
higher doses inhibit inhibitory and excitatory = CNS depression, coma, death
What does epinephrine initially cause
elevated pulse rate
Graves disease
hyperthyroidism = high metabolic state
Which is the only LA that causes vasocontriction
Cocaine
also causes stimulation of the cerebral cortex
what happens to the ratio of ionized and free base form of a LA if the pH and pKa are the same
there will be 50/50 ionized and free base form
penicillin V vs. G
G is more sensitive to acid degredation and thus usually injected
which penicillin has the best gram negative spectrum
ampicillin
which antibiotics are cross-allergenic with penicillin
cephalosporin
not erythromycin
dicloxacillin
penicillinase resisitant
what antibiotic for pseudomonas infection
extended spectrum carbenicillin
Bacterial types Healthy gongiva Chronic perio Aggressive perio ANUG
Actinomyces Viscosis Porphyromonas gingivalis Bacterioides forsythus AA Treponema denticola
Macrolides
Bind 50s subunit of ribosomes, inhibit translation
protein synthesis inhibitor
bacteriostatic
Azithromycin, erythromycin, clarithromycin
Use: patients with penicillin allergies
SE: GI upset, inhibition of drug metabolism, QT prolongation
Nystatin
Antifungal
topically administered
used for oral candidosis
Beta lactams
Bacteriocidal
penicillins
carbapenems
monobactams
cephalosporins
Penicillin G
narrow spectrum
Penicillin V
narrow spectrum
Penicillins
beta lactams (cell wall inhibitors)
bacteriocidal
effective against gram negative cocci
Naficillin
administration: IV
used to treat methicillin sensitive staph aureus
Penicillinase resistant
Oxacillin
administration: IV
used to treat methicillin sensitive staph aureus
Penicillinase resistant
Clavulanic Acid
Sulbactam
Tazobactam
beta lactamase inhibitors
Carbenicillin
pseudomonas aeruginosa infections
“Antipseudomonal penicillin”
administration: enteral or parenteral
used with aminoglycoside to prevent resistance formation
Sulfonamides
folic acid sytnthesis inhibitor
Bacteriostatic
Use: UTI, RA, Ulcerative colitis, ance, conjuctivitis
used less frequently due to increasing bacterial resistance
SE: Crystalluria, Rashes, Psychosis
Piperacillin
antipseudomonal
Trimethoprim
Folate inhibitor
Used to treat UTI
Trimethoprim
Folate inhibitor
Use: UTI
SE: Rash, Megaloblastic anemia, Leukopenia
used with sulfamethoxazole
Amphenicols
protein synthesis inhibitor (bacteriostatic)
used for serious, resistant infections
SE = severe bone marrow depression (gray baby syndrome)
Tetracycline
protein synthesis inhibitor
Bacteriostatic
Broad Spectrum
use: for periodontitis, severe acne, chlamydia
EX: tetracycline, doxycycline, minocycline
Aminoglycosides
protein synthesis inhibitor
EX: gentamycin, amikacin, Neomycin, Streptomycin
SE: Ototoxicity, Nephrotoxicity
Clindamycin
narrow spectrum
50 S subunit inhibitor
Use: Oral infections, prophylaxis
BT: S. Pneumonia, S. Pyogenes, S. Aureus, Viridans, Bacteroids
Streptomycin
Used for Tuberculosis
Penicillin G
administration = IV or IM (unstable in gastric acid)
Penicillin V
administration = Enteral
Floroquinolones
Levofloxacin, Ciprofloxacin, Moxifloxacin, norfloxacin, sparfoloxacin
Most common antibiotics for oral infections
penicillin
Amphotercin B
SE: Lipophilic can lead to toxicity
Acyclovir
Prodrug
Amantadine
Use: influenza (resistance is common)
Rimantadine
Use: influenza (resistance is common)
patients who need prophylaxis
- Heart Valve surgery
- Endocarditis
- Heart transplant with abnormal valve function
- uncured cyanogenic congenital heart disease
- congenital heart defects repaired in last 6 months
- residual heart defects
What to use as prophilactic with penicillin allergy
clindamycin
clarithromycin
azithromycin
What to use as prophilactic, no allergy, no oral medication
ampicillin
cefazolin
Ceftriaxone
What to use as prophilactic, allergy, no oral medication
Clindamycin
Cefazolin
Ceftriaxone
Inipenem
atypical beta lactam
Use: P. Aeruginosa, Gram - rods, Streptococci
Vancomycin
last resort antibiotic
Use: MRSA, C dificile
administration: IV
Aminopenicillins
Amoxicillin, Ampicillin, Bacampicillin
Amoxicillin
SE: Rash in people with mono or taking allopurinol
Ampicillin
Administration: Parenteral
Use: intraabdominal infections, severe UTI
taken with sulbactam
Ticarcillin
antipseudomonal
taken with clavulanic acid
Penicillinase resistant penicillins
methicillin oxacillin dicloxacillin cloxacillin nafcillin
Cloxacillin
penicillinase resistant
Metronidazole
narrow spectrum
use: parasitic infection
Oseltamivir (tamiflu)
neuraminidase blocker (required for viral budding)
What occurs when diazepam or triazolam is taken with the following drugs:
itraconazole
clarithromycin
cytochrome P-450 inhibitors
increased sedation
What occurs when tetracyclines are taken with the oral antacids
reduced absorption of tetracylines
What occurs when aspirin is taken with anticoagulants
increased bleeding tendancy
what occurs when aspirin is taken with probenicid
decreased effect of prebenicid
what occurs when aspirin is taken with methotrexate
increased methotrexate toxicity
what occurs when acetominophen is taken with alcohol
increased risk of liver toxicity
what occurs when local anesthetics are given with cholinesterase inhibitors
reduced effect of the cholinesterase inhibitors
What drugs are contraindicated in a patient with methaglobin reductase deficiency
benzocaine, prilocaine
causes methemogloinemia
What drugs are contraindicated in a patient with Glucose -6-phosphate dehydrogenase deficiency
aspirin, primaquine, sulfonamides
hemolytic anemia
What drugs are contraindicated in a patient with abnormal heme synthesis
barbiturates, sulfonamides
porphyria
What drugs are contraindicated in a patient with Low plasma cholinesterase activity
procaine and other ester anesthetics
Local anesthetic toxicity
