Special Considerations

Question 1

Benzocaine

Answer 1

cause convulsions-treat with diazepam

Question 2

Procaine (Novocaine)

Answer 2

cause convulsions-treat with diazepam

Question 3

Cocaine

Answer 3

Drug abuse liability

Treat convulsions
with diazepam

Question 4

Lidocaine

Answer 4

Treat convulsions with diazepam

Combine with epinephrine to vasoconstrict and prevent systemic absorprion

also a class 1B anti-arrhythmic due to capacity to inhibit cardiac Na+ channels

Question 5

Ropivacaine

Answer 5

S-isomer of ropivacaine has reduced affinity for cardiac VGSCs, and hence appears to be associated with less cardiotoxicity compared to other local anesthetics

Treat convulsions with diazepam

Combine with epinephrine to vasoconstrict and prevent systemic absorprion

Question 6

epinephrine

Answer 6

Adjunct: many LA formations will contain Epi

Epi increases LA action by 50%

Question 7

Clonidine

Answer 7

Adjunct in LA formulations

Morphine activates presynaptic mu opioid receptors on C-fibers (less so on Adelta fibers) to elicit similar analgesic effect as clonidine

Question 8

Diazepam (Valium®)

Answer 8

Taper dose of diazepam over several weeks

Question 9

Disulfiram

Answer 9

Closely monitor patient

Typically inpatient therapy

Failure with non-compliance

Question 10

Naltrexone

Answer 10

Combo of naltrexone plus disulfiram does not offer substantial advantage over either drug alone

If abusing opioids will precipitate withdrawal in opioid-dependent indiv.

Question 11

Naloxone

Answer 11

Naloxone is short acting mu opioid receptor antagonist; duration/severity of withdrawal symptoms is less severe (profuse sweating, N/V/D, tachycardia)

Question 12

Acamprosate, Topiramate

Answer 12

Combo of acamprosate + disulfiram more effective than either drug alone as anti-craving med

Not used to treat alcohol withdrawal syndrome (i.e. seizures; treat seizures with diazepam)

Question 13

N- acetylcysteine (NAC)

Answer 13

Chronic alcoholics up- regulate CYP2E1, CYP1A2 and CYP3A4

Question 14

H2 Receptor Antagonists

Answer 14

Available otc

Can use pphx

Question 15

Proton Pump Inhibitors (PPI)

Answer 15

Much better during the day

OTC

Poor choice for occasional heartburn

Question 16

Antacids

Answer 16

Combine 2 diff antacids to get best bal- Mg(OH)2 which causes diarrhes and Al(OH)3 which causes constipation

Question 17

Bismuth Subsalicylate

Answer 17

Active ingredient in Pepto-Bismol

Question 18

Ondansetron

Answer 18

↑ effectiveness by adding dexamethasone (a corticosteroid) or aprepitant (Neurokinin 1 receptor antagonist) by

Question 19

Azathioprine

Answer 19

Clinical response can take weeks-months

Question 20

Prednisone

Answer 20

NOT useful for LT therapy

Question 21

Alosetron

Answer 21

Use if standard therapy fails for women only

Need special prescribing program

Question 22

Loperamide

Answer 22

Low abuse potential because poorly absorbed from GI

Question 23

Mg(OH)2

Answer 23

Cathartic dose leads to complete evacuation in less than 3 hours (colonscopy prep)