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APM > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Define clinical pharmacology

A

the application of pharmacological principles and methods in the medical clinic or towards patient care

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2
Q

Define toxicology

A

The study of adverse affects, molecular targets, and characterisation of drugs or any chemical substance in excess (the dose makes the poison)

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3
Q

Define Agonistic drugs

A

a drug that binds to and activates a receptor to cause a response

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4
Q

Define antagonistic drugs

A

a drug that blocks or dampens a biological response by binding to a blocking a receptor

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5
Q

Define pharmacokinetics

A

[what the body does to the drug] how the drug is absorbed, distributed, moved around, metabolised and excreted

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6
Q

Define pharmacodynamics

A

[what the drug does to the body] — How well the targets (e.g. receptors, ion channels, enzymes, and immune system components) respond to the drug

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7
Q

Name the axis on a dose-response graph

A

increasing dosage across the X axis and increasing response across the Y axis

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8
Q

What gradient depicts a margin of safety on a dose response graph?

A

The higher the gradient, the less the margin of safety as changing the dose a little can have a large response change

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9
Q

What is the ED50

A

a value showing the dose required to produce 50% of the maximum response

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10
Q

Define Potency

A

the amount of drug necessary to produce a certain effect (often used in comparing ED50 values)

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11
Q

Define Efficacy

A

the maximum response that a given drug will produce, irrespective of dose (Emax)

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12
Q

What are the 4 main types of targets for drug action?

A

Receptors, Enzymes, Transporters and Ion Channels

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13
Q

What is a prodrug?

A

Prodrugs are inactive precursors that are metabolised to active metabolites (e.g. L-dopa is converted to dopamine)

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14
Q

Explain the mechanism of ligand gated channels

A

it permits the movement of positively charged ions into the synaptic cleft of the cytoplasm in response to the binding of a chemical messenger ligand

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15
Q

What are the 4 stages of drug disposition (ADME)

A

Absorption: the passage of a drug from its site of administration into the plasma
Distribution through the blood plasma and different body tissues
Metabolism: the chemical changes of the substance in the body
Excretion or elimination of the substance or the products of its metabolism

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16
Q

What is an analgesic?

A

A drug used to relieve pain

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17
Q

True or false: analgesics remove sensation

A

False, they just remove pain not full sensation

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18
Q

During pain perception, what is released into the blood plasma and what does it trigger?

A

Bradykinin is released, which causes the release of prostagladins and substance P which stimulates the nervous system

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19
Q

What are the most common types of analgesics given for toothache or post dental surgery

A

Non-opoid analgesics

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20
Q

True or false: ibuprofen causes xerostomia

A

True

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21
Q

Name three examples of Corticosteroids and what they do

A

Orabase-HCA, Oracort, Oralone, they are all anti-inflammatory

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22
Q

Explain pharmacogenetics

A

the identification of genetic variants that affect the responses to medications in patients

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23
Q

What is the term for when patients do not respond to a drug because of their particular genetic makeup?

A

Refractory

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24
Q

what tpyes of drugs are particularly affected by polymorphism?

A

Drugs involved in the liver, with proteins and enzymes

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25
Q

What is codiene?

A

opiate used to treat mild to moderate degrees of pain

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26
Q

What is the name of the catalyst involved in codiene and what does it do?

A

CYP2D6, as codiene is a prodrug this catalyses its breakdown into morphine in the liver

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27
Q

Give an example for the most common intravenous sedation drugs

A

Midazolam, which is in the branch of benzodiazepines, which works as a general CNS (HR included) depressant

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28
Q

What does midazolam bind to to work?

A

the GABAa receptor on the GABA neurotransmitter, which opens a chloride ion channel to increase -ve charge and depress the nervous system AP

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29
Q

what are the phases of midazolam recovery?

A
  1. recovery from sedation, 2. recovery from psycho-motor impairment. so cant drive or operate machinery directly after even if you can get up and walk e.t.c
30
Q

What is the most popular antibiotic prescribed by dentists?

A

amoxicillin, which is a type of penicillin

31
Q

What antibiotic is particularly used for anaerobic bacteria and protozoa?

A

Metronidazole, a nitroimidazole antibiotic medication

32
Q

What happens if one takes alcohol on metronidazole?

A

a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath

33
Q

Antidepressants can cause ____

A

Xerostomia by blocking acetylcholine action which blocks saliva/mucous production

34
Q

Nitroglycerin is a ______ used to treat _____ that can also cause _____

A

Nitrates, Agina, headaches that can be referred to as toothache (it is a vasodilator, causes blood vessel swelling)

35
Q

What is the primary oral effect of heorin?

A

Dental decay

36
Q

What are people who are type 1 diabetic more at risk of?

A

Dry mouth, Gum inflammation, Poor healing of oral tissues, Thrush (yeast thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes), getting hypoglycemia

37
Q

What are examples of complications from use of steroids?

A

Oral yeast infections, blood blisters, adrenal supression

38
Q

What happens when L.A is given when the patient is on beta blockers?

A

B inhibit hepatic enzymes, resulting in the reduced metabolism of lidocaine (local anaesthetic), could lead to increased serum levels and, possibly, toxicity of lidocaine.
With non-selective blockers, acute hypertensive episodes if they receive vasopressors contained in local anaesthetics, e.g. epinephrine

39
Q

What are examples of complications from use of bisphosphonates?

A

they are used to prevent bone resorption so after extraction can lead to exposure of dead bone (osteonecrosis) which causes pain and an attachment surface

40
Q

What is Steven-John’s syndrome and what are it’s symptons?

A

hypersensitivity complex causes by a severe allergic reaction to medication. It causes massive ulcers and lesions on the lips and mucous membranes, making it hard to eat/drink/speak

41
Q

What is the difference between anaesthesia and analgesia?

A

Analgesia is the removal of pain, anaesthetics is the removal of all sensation

42
Q

Give some ‘unconventional’ examples of local anaesthesia

A

Pressure, hypoxia, extreme cooling

43
Q

Give 5 examples of methods of administering anaesthetics

A

Nerve block, subcutaneous injection (e.g. infiltration), topical, epidural, Intrathecal (injection into spinal canal)

44
Q

Give examples of properties of ideal anaesthesia

A

stable in solution, (requires no additive), non-irritating to tissues, no permanent damage to nerves, no systemic toxicity, no allergic response, potent
effective topically and by infiltration, rapid onset of action, predictable duration

45
Q

What are the names for the two general types of local anaesthetics?

A

Lignocaine and Procaine. Lignocaines use an amide as the intermediate chain and Procaines use an ester linkage

46
Q

What are the two terminal groups in a local anaesthetic?

A

Lipophilic aromatic terminal and a hydrophilic amino terminal

47
Q

What is the purpose of the aromatic terminal and what property allows this?

A

To be lipophilic to penetrate fatty tissue such as the lipid nerve sheath to gain access to the nerve cell membrane to reach its site of action - unpolarised

48
Q

What is the purpose of the amino terminal and what property allows this?

A

amino group allows charge for solubility in water so it can be dissolved in a solvent to inject it and to move through the interstitial fluid after injection

49
Q

Give 4 examples of ester linked agents

A

Benzocaine, Procaine, Chloroprocaine and Tetracaine

50
Q

Give 4 examples of amide linked agents

A

Lidocaine, Mepivocaine, Ropivaciaine, Bupivacaine, articaine

51
Q

Describe the mechanism of action

A

The receptor for the voltage-gated Na+ channel isn’t accessible from the outside of the cell so the non-polar molecule diffuses through, then ionises and binds

52
Q

Local anaesthetics bind most readily when the Na+ channel is in what state?

A

Inactivated

53
Q

Which subunit of a Na+ channel does a L.A bind to?

A

IV

54
Q

What is the order of sensitivity to L.A?

A

autonomic > warm > pain > pressure

55
Q

True or False: rapidly firing axons will cause a lower amount of anaesthetic binding at a given concentration

A

False, it will be higher as the more firing means more opening which leads to more inactivated states which allows for more binding

56
Q

What is the affect of acidosis on L.A

A

[When arterial pH is <7.35] Reduces the action as it will cause more ionisation of molecule meaning it cannot diffuse through nerve membrane

57
Q

What is a tonic v.s phasic blockade

A

Tonic- with pig gaps between impulses, it returns to equilibrium after each impulse so no stacking of blockages
Phasic - short gaps between impulses causes ‘stacking’ of bound channels

58
Q

What 2 main types of topical anaesthesia used?

A

Benzocaine (bubblegum, good with kids) and Xylanor gel

59
Q

What do you need to always check on a local anaesthetic cartridge before use?

A

Name, concentration, expiry date, serial number, solution

60
Q

What local anaesthetic has both an amide and ester link?

A

Articaine

61
Q

What anaesthetic is more effective when used plain as opposed to lidocaine?

A

Priolcaine 4% (also called citanest)

62
Q

What local anaesthetic has a slow onset but long duration?

A

Bupivacaine

63
Q

True or false: you can rely on the patient to describe how much they drink.

A

True, but actually never trust what they say

64
Q

Which anaesthetic should be avoided for pregnant women and why?

A

Anything with Felypressin, as it is similar in structure to oxytocin and so is theoretically possible to kick start labour

65
Q

Describe the possible effects of a needlestick on the patient.

A

Soft tissue trauma, nerve trauma, intravascular injection that can lead to cardiac arrest and attack on the liver

66
Q

List the reasons for a failure of a L.A

A

Insufficient solution injected, inaccurate placement, someone’s anatomical differences, some teeth are harder than other, outdated L.A, infection/inflammation, pH in the mouth, intravascular injection

67
Q

In the event of a latex allergy, which anaesthetics have a rubber-free bung and so can be used?

A

Citanest (prilocaine) with octapressin

68
Q

What is one thing you can do to avoid psychogenic reactions?

A

Don’t wave the needle around, prepare and move it below the patient or out of sight

69
Q

What to do during a vasovagul attack? (faint)

A

Lie the patient flat down, loosen tight clothing, call for help, check airway, 02 if needed, assume more complicated if they are not recovered in 2-3 minutes

70
Q

What can you give to someone with heart complications?

A

Felypressin as opposed to adrenaline as it puts less stress on the heart

71
Q

What can happen if you inject the muscles of mastication?/

A

Trismus (lockjaw)

72
Q

What instruction should be given to patient at the injection?

A

DONT SAY SHARP SCRATCH

focus them on breathing, ‘dont think about your right thumb’, explain using very neutral phasing

APM (4 decks)

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