Test 2- Pharmacology

Question 1

What is sympathomimetic

Answer 1

vasoconstrictors resemble the response of adrenergic nerves to stimulation (classified as adrenergic or sympathomimetic)

Question 2

what are the functions of vasoconstrictors

Answer 2

• decrease absorption reducing toxicity and increasing duration
• smaller volumes of anesth
• increase efficency
• reduce bleeign

Question 3

what are direct acting sympathomimetic amines*

Answer 3

exert action directly on adrenergic receptors (EPI)

Question 4

• what are alpha receptors

Answer 4

smooth muscle in blood vessels.. constricts lumen

Question 5

what are beta receptors*

Answer 5

smooth muscle relaxation (vasodilation and bronchodilation)

Question 6

What is the most common vasoconstrictor

Answer 6

epi

Question 7

what other vasoconstrictor is available in the US

Answer 7

levonorefrin in mepivicaine 1:20,000

Question 8

• 1:100,000 has how much epi
  1: 200,000
  1: 50,000

Answer 8

.01 mg/ml
.005 mg/ml
.02 mg/ml

Question 9

concentration of epi always refers to

Answer 9

1 mL

Question 10

*how much epi is in one CARTRIDGE @ 1:100,000

3 CARTRIDGES?

Answer 10

.018

.054

Question 11

what is the concentration of the vasoconstrictor in a 1:100,000 solution of lidocaine

Answer 11

.01 mg/ml

Question 12

If 2 carps of 2% lido with 1:100,000 Epi are administered what is the quantitiy of epi

Answer 12

.036 mg

Question 13

if 4 cartridges of .5% bupivicaine with 1:200,000 epi are administred what quantity of epi was given

Answer 13

.036 mg

Question 14

What is the other name for epi

Answer 14

adrenalin

Question 15

what is the important ingredient in the chemical structure of epe

Answer 15

sodium bisulfite

Question 16

what does sodium bisulfite do

Answer 16

delays deterioration

Question 17

what is the mode of action of epi

Answer 17

alpha and beta receptors

Question 18

what happens in the myocardium with the use of eip

Answer 18

cardiac output and heart rate are increased

Question 19

what happens to the coronary arteries with epi

Answer 19

produces dilation of the coronary artery

Question 20

what happens to blood pressure with epi

Answer 20

systolic is increased and diastolic is decreased

Question 21

there is a decrease in cardiac ________ with epi

Answer 21

efficency

Question 22

What are the side effects of epi

Answer 22

CNS Stimulation, anxiety, fear, tension, restlessnes, throbing

Question 23

What is the other name for Levonordefrin

Answer 23

neo-cobefrin

Question 24

what is the mode of action for levonordefrin

Answer 24

alpha receptors, some beta

Question 25

what factors should be considered when selecting a vasoconstrictor

Answer 25

- length of procedure - need for hemostasis - medical status of pt

Question 26

how long does 2% lido without epi provide pulpal anesthesia for? with epi

Answer 26

10 min | 60 min

Question 27

what 4 conditions must be weighed for the use of a vasoconstrictor

Answer 27

- high blood pressure - cardiovascular disease - hyperthyroidism - tx with MAOI and tricyclic antidepressants

Question 28

what are absolute contraindications with tricyclics

Answer 28

levonordefrin and norepinephrine

Question 29

What can 4 carps of LA with 1:100,000 epi stimulate

Answer 29

beta action stimulates glycogenisis

Question 30

what is the rebound effect

Answer 30

bleeding postoperatively

Question 31

a 2% lido with ph of 6.8 is changed to _____ with the addition of epi

Answer 31

4.2

Question 32

What are the 2 effects of LA on blood vessels

Answer 32

Vasodilation (prilocaine) | vasoconstriction (cocaine)

Question 33

what is the effect of vasodilation of LA

Answer 33

increase absorbtion, decrease duration and quality, increases potential for toxicity

Question 34

what are the forms of LA

Answer 34

oral, topical, injection

Question 35

what LA is the only on that works

Answer 35

cocaine

Question 36

where are topical LA absorbed

Answer 36

in mucous membranes, not effective on intact skin

Question 37

after injection of LA the rate of uptake is good but is related to

Answer 37

the vascularity of the inj site and vaso activity of drug

Question 38

what organs have higher blood levels

Answer 38

highly perfuse | brain, liver, kidney, lungs, spleen

Question 39

what contains the highest percentage of LA because of its mass

Answer 39

skeletal muscles

Question 40

where does all anesthetic eventually go

Answer 40

the liver

Question 41

what does the liver do to anesthetic

Answer 41

hydrolyses it

Question 42

what has a significant bearing on the potential toxicity of a drug

Answer 42

the plasma concentration of LA

Question 43

What are blood levels influenced by

Answer 43

- rate of adsorption in cardiovascular system - rate of distribution - elimination of drug

Question 44

what is elimination half life

Answer 44

the time needed for 50% reduction in blood levels | 75% for 2 half lives

Question 45

ALL LA can cross what

Answer 45

blood brain and placental barrier

Question 46

What are people usually allergic to with esthers?*

Answer 46

PABA

Question 47

what is PABA?

Answer 47

what procaine/novacaine is hydrolyized to before excretion

Question 48

Where are esthers used

Answer 48

outside of US, mexico, Japan

Question 49

What is an example of an esther

Answer 49

procaine/novacaine

Question 50

What are esthers hydrolyzed by in the plasma

Answer 50

pseudocholinesterase

Question 51

What are all injectable dental anesthetics

Answer 51

amides

Question 52

where are amides hydrolyzed

Answer 52

in the liver

Question 53

when does pesudocholinesterase break down

Answer 53

as soon as it gets into the bloodstream which means its ability to work is bad

Question 54

What is an absolute contraindicaiton

Answer 54

documented, repeatable allergy

Question 55

what is a relative contraindication

Answer 55

SIGNIFICANT liver dysfunction, heart failure, renal disease, hypotension, CHF -watch how much you give

Question 56

What is the primary means of excretion of LA

Answer 56

kidneys

Question 57

*LA are chemicals that:

Answer 57

reversibly block action potientials in all excitable membranes

Question 58

how does LA act in the CNS | CVS

Answer 58

as a depressant | circumoral and lingual numbness

Question 59

*what is the direct action of LA on the cardiovascular system

Answer 59

-direct action on myocardium is depression in general but more resistant than CNS

Question 60

What is the primary effect of LA on bloodpressure

Answer 60

Hypotension

Question 61

What is the effect of LA on the respiratory system at non overdose levels? overdose levels?

Answer 61

relaxant action | repiratory arrest

Question 62

Is malignant hyperthermia a concern with LA*

Answer 62

NO

Question 63

What LA has the greatest degree of protein binding

Answer 63

ones that have a longer duration of clinical activity

Question 64

how is toxicity of LA manifested

Answer 64

gen. tonic clonic convulsion