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NBDE Pt 2 Flash Cards > Pharmacoloy 2 > Flashcards

Pharmacoloy 2 Flashcards

1
Q

Amide anesthetics are metabolized in the ___

Ester anesthetics are metabolized by ___ in the ____

A

Liver

Pseudocholinesterase

Plasma

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2
Q

Lidocaine, bupivicaine, mepivicaine, articaine, and prilocaine are all ___ anesthetics

A

Amide

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3
Q

Procaine, cocaine, tetracaine, benzocaine are all ___ anesthetics

A

Ester

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4
Q

List 5 amide anesthetics

A

Lidocaine

Bupivicaine

Mepivicaine

Articaine

Prilocaine

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5
Q

Why are ester anesthetics less commonly used than amide anesthetics?

A

More toxic and more allergic due to methylparaben

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6
Q

Which is the safest anesthetic to use in children?

A

Lidocaine

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7
Q

What is the brand name of bupivicaine?

A

Marcaine

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8
Q

Which anesthetic is the least safe in children?

A

Bupivicaine (marcaine)

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9
Q

What is the brand name of mepivicaine?

A

Carbocaine

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10
Q

Which anesthetic causes the least vasodilation?

A

Carbocaine (mepivicaine)

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11
Q

True or false… anesthetics by themselves are vasodilators

A

True. Which is one reason why epinephrine is often used with them

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12
Q

Which amide anesthetic has on ester chain? Thus metabolized both in the liver and the blood plasama

A

Articaine

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13
Q

Which amide anesthetic is linked to methemglobinemia? (A blood disorder in which an abnormal amount of methemoglobin is produced which leads to too little oxygen delivered to the tissues)

A

Prilocaine

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14
Q

Which anesthetic has the longest duration?

A

Bupivicaine (marcaine)

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15
Q

Which anesthetic has the shortest duration?

A

Articaine

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16
Q

Lidocaine is packaged in ___%.

Bupivicaine is packaged in ___%

A

2%

0.5%

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17
Q

Mepivicaine (carbocaine) can be packaged in ___% or ___%. It is also often packaged without ___

A

2% or 3%

Epinephrine

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18
Q

Articaine is packaged in ___%

A

4%

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19
Q

Which anesthetic is the only one that is a vasoconstrictor?

A

Cocaine

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20
Q

Local anesthetics are ____ blockers

A

Sodium channel

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21
Q

Only the ___ form of local anesthetics can penetrate the neuron membrane

A

Non-ionized (free base)

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22
Q

Successful anesthetic is achieved when __ consecutive nodes of ranvier are blocked

A

3 (this is called the critical length)

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23
Q

Would a lipid soluble or water soluble local anesthetic be more potent?

A

A lipid soluble anesthetic is more potent and has a longer duration of action

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24
Q

[increased/decreased] protein binding leads to longer duration of action because…

A

Increased

Because the drug has a greater attraction to the receptor sites

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25
Q

The [lower/higher] the pKa the stronger the acid is thus the faster the onset of action

A

Lower

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26
Q

What are the pKas of mepivicaine, lidocaine/prilocaine/articaine, and bupivicaine?

A

Mepivicaine = 7.6

Lidocaine/prilocaine/articaine = 7.8

Bupivicaine = 8.1

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27
Q

How many mg of lidocaine are in a 1% carpule? 2%? 4%?

A

18mg

36mg

72mg

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28
Q

Name three properties of vasoconstrictor added to local anesthetics

A

Prolongs numbness

Reduces toxicity

Promotes hemostasis

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29
Q

What is the maximum epinephrine dose for an ASA 1 patient?

A

0.2mg

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30
Q

What is the maximum epinephrine for a cardiac patient?

A

0.04mg

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31
Q

What is the max lidocaine without vasoconstrictor?

A

4.4mg/kg

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32
Q

What is the max lidocaine with vasoconstrictor?

A

7mg/kg

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33
Q

How fast should local anesthetic be injected?

A

1 carpule per minute

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34
Q

How long is the short needle? How long is the long needle?

A

Short = 20mm

Long = 32mm

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35
Q

What is the diameter of a 30 gauge needle? 27 gauge? 25 gauge?

A

30 gauge = 0.3mm

27 gauge = 0.4mm

25 gauge = 0.5mm

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36
Q

What are the three advantages to a lower gauge needle? (Higher diameter)

A

Do not deflect as much

Do not break as often

Have better aspiration

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37
Q

About how much lidocaine is administered for an IA block?

A

3/4. Carpule

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38
Q

Which block has the highest failure rate?

A

IA block

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39
Q

What is the difference between teh mental block and the incisive nerve block?

A

The incisive nerve block is the same as the mental nerve block except you hold pressure over the mental formats for 2 minutes after injection to force anesthetic into the mental foramen

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40
Q

In the PSA block, you enter the long needle ___mm (which is __ the length of the long needle)

A

16mm

Half

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41
Q

Which nerve block has the highest hematoma risk?

A

PSA

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42
Q

The PSA block affects the maxillary molars and the buccal tissue around it, but it doesn’t anesthetize the __ cusp of the ___

A

MB

First molar

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43
Q

The ___ blocks the maxillary anteriors AND premolars

A

Infraorbital block

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44
Q

Sulfonamides are [bacteriostatic/bacteriocidal]. They compete with ___ and inhibit ___ synthesis. Name two sulfonamides

A

Bacteriostatic

PABA

Folate synthesis (thus affecting the DNA)

Sulfadiazine, sulfamethoxazole

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45
Q

Fluoroquinolones are [bacteriocidal/bacteriostatic]. They inhibit ___ synthesis. Name two fluoroquinolones.

A

Bacteriocidal

DNA

Ciprofloxacin, levofloxacin

(FLOX)

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46
Q

Penicillins are [bacteriocidal/bacteriostatic]. They inhibit ___ synthesis. They are called ____ antibiotics, which are a class of broad spectrum antibiotics, because they contain a __ ring.

A

Bacteriocidal

Cell wall

B-lactam

B-lactam

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47
Q

Penicillins are cross-allergenic with ___ because they are chemically related.

A

Cephalosporins

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48
Q

Which type of penicillin must be administered IV and is more sensitive to acid degradation?

A

Penicillin G

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49
Q

Which penicillin is less sensitive to acid degradation and thus can be taken orally?

A

Penicillin V

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50
Q

Amoxicillin is commonly prescribed and it is [broad/narrow] spectrum penicillin

51
Q

What is augmentin? What is significant about this?

A

Amoxicillin + clavulanic acid

B-lactamase-resistant

52
Q

True or false… methicillin is a penicillin that is B-lactamase resistant

53
Q

True or false… dicloxacillin is a penicillin that is B-lactamase resistant

54
Q

What is the best/broadest gram negative spectrum penicillin antibiotic?

A

Ampicillin

55
Q

Which penicillin is used specifically against pseudomonas species?

A

Carbenicillin

56
Q

Cephalosporins are [bactericidal/bacteriostatic]. They have a ___ ring and inhibit ___ synthesis.

A

Bactericidal

B-lactam

Cell wall

57
Q

Which type of B-lactam antibiotic has 5 different generations?

A

Cephalosporins

58
Q

Monobactams are [bactericidal/bacteriostatic]. They inhibit __ synthesis and have a ___ ring. Name one important monobactam.

A

Bactericidal

Cell wall

B-lactam

Aztreonam (AM)

59
Q

Carbapenems are [bactericidal/bacteriostatic]. They inhibit ___ synthesis and have a ___ ring. Name one important carbapenem

A

Bactericidal

Cell wall

B-lactam

ImipeNEM (nem)

60
Q

Name 4 types of B-lactam antibiotics

A

Penicillins

Cephalosporins

Monobactams

Carbapenems

61
Q

Tetracyclines are [bactericidal/bacteriostatic]. They inhibit ____. Name three important examples.

A

Bacteriostatic

Protein synthesis (30s ribosomal subunit)

Tetracycline, doxycycline, minocycline

62
Q

What is the broadest antimicrobial spectrum antibiotic?

A

Tetracyclines

63
Q

Macrolides are [bactericidal/bacteriostatic] they inhibit ___ synthesis. Name three important macrolides

A

Bacteriostatic

Protein (50S ribosomal subunit)

Erythromycin

Clarithromycin

Azithromycin (THROMYCIN)

64
Q

What is the mnemonic for macrolides?

A

Mac likes to throw mice

Macrolides = -thromycin

65
Q

Lincosamides are [bactericidal/bacteriostatic]. They inhibit ___. Name two important lincosamides

A

Bacteriostatic

Protein synthesis (50S ribosomal subunit)

Clindamycin

Lincomycin

(MYCIN)

66
Q

What is the mnemonic for lincosamides?

A

Link also hides mice

Lincosamides = -mycin

67
Q

When is antibiotic prophylaxis required?

A

Certain cardiovascular conditions

Compromised immunity

68
Q

Name 4 cardiovascular conditions that require antibiotic prophylaxis

A

Prosthetic heart valves

History of endocarditis

Heart transplant with valvulopathy/valve dysfunction

Congenital heart problems

69
Q

Name 3 cases where a pt with compromised immunity needs antibiotic prophylaxis?

A

Organ transplant

Neutropenia

Cancer therapy

70
Q

What is the antibiotic of choice for prosthetic joint prophylaxis?

A

Keflex 2g 1 hr prior to treatment

71
Q

True or false… antibiotic prophylaxis is NOT recommended in cases with a cardiac pacemaker. Rheumatic fever without valvular dysfunction. Mitral valve prolapse without valvular regurgitation

72
Q

Name three cardiovascular conditions that do NOT need antibiotic prophylaxis

A

Cardiac pacemaker

Rheumatic fever with valvular dysfunction

Mitral valve prolapse without valvular regurgitation

73
Q

What antibiotic causes GI upset and pseudomembranous colitis?

A

Clindamycin

74
Q

___ spectrum antibiotics are most likely to cause super infections

75
Q

What antibiotic is assocaited with aplastic anemia?

A

Chloramphenicol

76
Q

What antibiotic is assocaited with liver damage?

A

Tetracycline

77
Q

What antibiotic is associated with allergic cholestatic hepatitis?

A

Erythromycin estolate

78
Q

True or false… bactericidal and bacteriostatic drugs cancel each other out

79
Q

Penicillins and ___ often interact. How?

A

Probenecid (which is uric acid reducer or gouty arthritis)

Probenecid alters the renal clearance of penicillin

80
Q

Tetracycline and ___ interact with each other. Why?

A

Antacids and dairy products

Because tetracycline is a chelating agent which binds calcium and other ions. Thus limiting its absorption and its affective ness

81
Q

Broad spectrum antibiotics and ___ drugs interact. Why?

A

Anticoagulants

Because they reduce the vitamin K sources

82
Q

Antibiotics may interact with ____. Why

A

Oral contraceptives

Alters gut flora which affects the oral contraceptive absorption

83
Q

Macrolides may interact with what drug?

A

Seldane/digoxin

84
Q

Clindamycin tends to concentrate well in ___

85
Q

Tetracycline tends to concentrate well in ___

A

Gingival crevicular fluid

86
Q

Name two drugs used to treat herpes infections

A

Acyclovir

Valcyclovir

87
Q

Name two drugs used to treat candidiasis. Which is often in the troche form?

A

Fluconazole

Ketoconazole

(Clotrimazole (Mycelex)

88
Q

Aspirin is a [irreversible/reversible] blocker of _____. It can cause ___ issues.

A

Irreversible

Cox 1 and Cox 2

GI

89
Q

Ibuprofen is a [reversible/irreversible] blocker of ____ and affects the ____.

A

Reversible

Cox 1 and cox 2

Kidney

90
Q

What is ketorolac?

A

NSAID that reversibly binds to Cox 1 and cox 2

It can be administered IV, IM or orally

91
Q

Indomethacin is an NSAID that binds reversibly to COX 1 and COX 2. It is linked to ____

A

Blood dyscracias

92
Q

Celecoxib (Celebrex) binds to ___

A

COX 2 selectively

Less bleeding problems

93
Q

____ is an NSAID that binds to COX 2 selectively and is used for arthritis

94
Q

Name two NSAIDs that are COX 2 selective

A

Celecoxib (Celebrex)

Meloxicam

95
Q

Where does acetaminophen inhibit pain?

A

In the CNS

96
Q

Acetaminophen can negatively impact which organ?

97
Q

True or false.. acetaminophen is a potent NSAID

A

False. It is not an NSAID

98
Q

What is the drug of choice to treat a child with a fever?

A

Acetaminophen

99
Q

____ is contraindicated in children because it can cause Reye’s syndrome

100
Q

Aspirin is an analgesic And anti-inflammatory drug that inhibits ____ thus affecting ___ synthesis.

A

COX 1 and 2

Prostaglandin (come from phospholipids which go to arachdonic acid to prostaglandins)

101
Q

True or false… aspirin is antipyretic (used to treat fevers)

A

True (by inhibiting PG synthesis in temperature regulation center of hypothalamus)

102
Q

Explain the antipyretic mechanism of aspirin.

A

It inhibits PG synthesis in the temperature regulation center of the hypothalamus

103
Q

How is bleeding time affected by aspirin?

A

Inhibits TXA2 synthesis thereby inhibiting platelet aggregation

104
Q

Name 7 toxic effects of aspirin

A

Occult bleeding from GI tract

Tinnitus

Nausea and vomiting

Metabolic acidosis

Decreased tubular resorption of uric acid

Salicyclism

Delirium

Hyperventilation

105
Q

Name 4 important corticosteroids

A

Prednisone

Hydrocortisone

Triamcinolone

Dexamethasone

106
Q

Steroids inhibit the enzyme ___ which in turn inhibits ___ synthesis

A

phospholipase A2

Arachadonic acid

107
Q

Name six side effects of steroids.

A

Gastric ulcers

Immunosuppression

Acute adrenal insufficiency***

Osteoporosis

Hyperglycemia

Redistribution of body fat

108
Q

What is the rule of 2’s?

A

Adrenal suppression can occur if a pt is taking 20mg of cortisone daily for 2 weeks within 2 years of dental treatment

109
Q

What is the difference between oxycodone and OxyContin?

A

OxyContin has a CONtrolled release mechanism

110
Q

Codeine suppresses the ___ reflex

111
Q

Which opioid is most similar to codeine?

A

Tramadol (ultram)

112
Q

Which opioid is lethal if combined with an MAOI?

A

Meperidine (Demerol)

113
Q

Vicodin is a combo of ___ and ____

A

Hydrocodone and acetaminophen

114
Q

Percocet is a combo of ___ and ___

A

Oxycodone and acetomenophin

115
Q

What is the dosage of Tylenol 1-4?

A

Tylenol 1 - 300mg APAP + 8mg codeine

Tylenol 2 - 300mg APAP + 15mg codeine

Tylenol 3 - 300mg APAP + 30mg codeine

Tylenol 4 - 300mg APAP + 60mg codeine

116
Q

What are the therapeutic and side effects of morphine? (Mnemonic)

A 
Miosis (pupil constriction)
Out of it
Respiratory depression
Pneumonia (aspiration pneumonia)
Hypotension
Infrequency (urinary retention/constimpaton)
Nausea and vomiting
Euphoria & dysphoria
117
Q

What is naloxone?

A

Inverse agonist of opioids, used in emergencies

118
Q

___ and ___ are used to treat opioid addiction

A

Naltrexone

Methadone

119
Q

Name three opioids that have mixed agonist-antagonist actions

A

Pentazocine

Nalbuphine

Buprenorphine

120
Q

What is the most common side effect of NO2?

121
Q

What is a common affect of long term exposure to nitrous oxide?

A

Peripheral neuropathy

122
Q

What is the sensation experienced during the onset of nitrous oxide?

123
Q

What is MAC?

A

Minimum alveolar concentration - it is the concentration of the gas in the alveoli required to render 50% of patients immobile (general anesthesia)

124
Q

What is the MAC of nitrous oxide? What is significant about this?

A

105%

It is nowhere near as potent as other agents. It is IMPOSSIBLE to immobilize 50% of patients with NO2

NBDE Pt 2 Flash Cards (23 decks)

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