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Flashcards by ACAPUN INSTITUTE, updated more than 1 year ago
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Created by ACAPUN INSTITUTE
almost 3 years ago
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| Question | Answer |
| tachycardia in a patient administered with atropine or scopolamine results from a. release of adrenal catecholamines b. blockade of vagus nerve activity c. blockade of the nicotinic cholinergic receptor d. stimulation of the alpha adrenergic receptor e. stimulation of the beta adrenergic receptor | b. block of vagus nerve activity |
| cholinergenic stimulation effects? SLUD | salivation lacrimation defecation urination heart rate decreased (bradycardia) miosis (pinpoit pupils) ***all PNS stuff |
| a paralyzing dose of succinylcholine initially elicits a. CNS stimulation b. CNS depression c. decreased salivation d. muscle fasiculation e. extrapyramidal reactions | d. muscle fasiculation ***agonist at nicotinic receptors |
| symptoms of atropine poisoning | burning dry mouth and hyperthermia **atropine is cholinergenic antagonist so sweating and saliva are reduced |
| atropine overdose? | CNS excitation and tachycardia |
| confusion and hallucinations result from oversdose of scopolamine are most efficaciously treated by adminstering? | physostigmine ***scopolamine is ANTIcholinergenic |
| Symptoms of cholinergic crisis --SLUD! | bradycardia lacrimation salivation weakness muscles **NOT Vasoconstriction |
| succinycholine is subject to inactivation via ... | plasma esterases |
| Reserpine | depletes NE by inhibiting reuptake |
| alpha 1 receptor stimulation effects = | vasoconstriction, urinary retention, mydriasis |
| beta receptor stimulation: | increased heart rate (B1) bronchodilation (B2) vasodilation (B2) |
| alpha 1 = | vasoconstriction ***alpha 1 blockers =vasodilation |
| beta blockers = | decrease heart rate (b1) bronchoconstriction (b2) |
| Levodopa used for = | parkinsons ***dopamine deficiency in brain ***does not cross BBB but is precursor to DA |
| alpha or beta adrenergic blocking drugs are = | competitive inhibitors |
| mechanism of action for guanethidine = | uncoupling of action potential from the NE release mechanism ***antiadrenergic |
| Amides vs. ester metabolism | Amides - in LIVER Esters - by pseudocholinesterase in blood plasma |
| Benzocaine and cocaine are (amides/esters). | esters |
| Why are ester LAs more toxic and more allergic? | Methylparaben |
| Safest to use in children? | Lidocaine |
| Must unsafe for children? | Bupivicaine (Marcaine) |
| Causes least vasdilation? | Mepivicaine (Carbocaine) |
| Ester/amide hybrid? | Articaine (Septo) |
| Longest duration of action? | Bupivicaine (Marcaine) |
| Longest duration of action? | Bupivicaine (Marcaine) |
| Shortest duration of action? | Articaine (Septo) |
| Methemoglobinemia risk? | Prilocaine (Citanest) |
| Percentages of each LA? | 2% Lido 0.5% Bupivicaine (Marcaine) 2% or 3% Mepivicaine (Carbo) 4% Articaine (Septo) |
| T/F: LA by themselves are vasodilators. | True for the most part Hence the need for epi. Although Mepivicaine (Carbo) is the least vasodilating, so does not have epi. Cocaine is the only vasoconstricting LA. |
| T/F: Cocaine is the only LA that is vasoconstricting on its own. | True |
| LA are ________ channel blockers. | sodium |
| Only the (ionized/non-ionized) form of LA can penetrate the neuron membrane. | non-ionized |
| Why does infection make LA less effective? | the inflamed tissue has lower pH, so the excess H+ ions keep the LA in its ionized form, preventing it from penetrating the neuron membrane. |
| Minimum # of nodes that must be blocked to achieve anesthesia | 3 nodes of Ranvier |
| How does increased lipid solubility/hydrophobicity affect LA pharmacokinetics? | more potent longer duration of action |
| How does increased lipid binding affect LA pharmacokinetics? | longer duration of action |
| Lower pKa means.... | faster onset of action Mepivicaine (Carbo) < Lido, Prilo, Septo < Bupivicaine (Marcaine) |
| Calculating LA | 1mL ~ 1g So 1 carpule is 1.8mL ~ 1.8g = 1800mg So for 1% LA --> 18mg So for 2% Lido --> 36mg per carpule 4% Septo --> 72mg Septo For 1 carpule of with 1:100,000 epi --> 0.018mg of epi |
| 3 purposes of vasoconstrictor? | 1. prolong numbness 2. reduce toxicity 3. promote hemostasis |
| Max epi to give to ASA I patient | 0.2mg (~11 carpules) |
| Max epi to give to cardiac pt | 0.04mg (~2 carpules) |
| Max lido w/ and w/o epi | With epi: 4.4mg/kg W/o epi: 7mg/kg |
| Short vs. long needle length | Short - 20mm Long - 32mm |
| Injection w/ highest failure rate? | IAN block |
| IAN block techniques | Halstead = classic Gow-Gates = open mouth Akinosi = closed mouth |
| The triangle you aim for when doing a classic IAN block? | Coronoid notch, pterygomandibular raphe, max teeth 1.5mm above occlusal plane |
| Why avoid inserting needle to the hub? | risk for needle breaking |
| Extent of IAN block anesthesia? | all right side, except for buccal molars |
| Mental nerve block | 1. Locate rubbery bundle with finger. Around apices of mand PMs 2. Insert needle anterior to the foramen Will only numb the facial tissue of the anterior teeth, not the teeth itself |
| If only want to numb the anterior teeth? | Give an incisive nerve block. Same as mental nerve block except hold pressure for 2 minutes after injection to force anesthetic into mental foramen |
| How to administer PSA block | 1. Palpate the zygomatic arch (cheek bone) 2. Inject just posterior to that. 16mm depth (half of long needle length) at a 45 degree angle to the mucosal plane, and then redirect posteriorly. |
| T/F: PSA block has a high hematoma risk. | True |
| Will PSA block numb all 3 molars completely? | Only 25% chance 75% the MB root of the 1st molar is not innervated by PSA |
| To numb the max anteriors + PMs + MB root of 1st molar, what could you give? | Infraorbital block |
| Landmark for Greater Palatine Nerve block? | on the hard palate, between the 2nd molar and midline Tip: Push down with a cotton tip applicator for a minute, so patient can get used to the pressure feeling. |
| Sulfonamides (i.e. Bactrim, SULFAdiazine, SULFAmethoxazole) | Bacteriostatic Folate synthesis inhibitor (competes w/ PABA) "Sulfa drugs" |
| Fluoroquinolones (CiproFLOXACIN, LevoFLOXACIN) | Bactericidal DNA synthesis inhibitor |
| Penicillins | Bactericidal Cell wall synthesis inhibitor, beta-lactam broad-spectrum cross allergy with cephalosporins |
| Penicillin G vs. Pencillin V | Penicillin G - for IV, more sensitive to acid degradation Penicillin V - for oral |
| Augmentin | amoxicillin + clavulanate (beta-lactamase-resistant) |
| Penicillin w/ best and broadest Gram(-) spectrum? | Ampicillin |
| Penicillin used specifically against Pseudomonas? | Carbenicillin |
| Cephalosporins, Monobactams, Carbapenems | bactericidal cell wall synthesis inhibitor, beta-lactam |
| Tetracyclines | bacteriostatic protein synthesis inhibitor (30S ribosomal subunit) |
| Antibiotic with the Broadest antimicrobial spectrum? | Tetracyclines |
| Macrolides + Lincosamides (-mycin) | bacteriostatic protein synthesis inhibitor (50S ribosomal subunit) |
| When is premed required? | Cardio conditions + compromised immunity - prosthetic heart valve - Hx of endocarditis - Heart transplant w/ valvulopathy/valve dysfunction - congenital heart problems - organ transplant - neutropenia - cancer therapy |
| First choice premed Rx for IE? | First choice premed Rx for IE? |
| First choice premed Rx for IE? | Adult: 600mg Clinda 1hr before Tx Child: 20mg/kg Clinda 1 hr before Tx |
| Adult: 600mg Clinda 1hr before Tx Child: 20mg/kg Clinda 1 hr before Tx | Adult: 2g Ampicillin 30min before Tx Child: 50mg/kg Ampicillin 30min before Tx same dosages as Amox! |
| 1st choice premed for prosthetic joint prophylaxis? | 2g Keflex 1 hr before Tx |
| When is premed not recommended for cardio cases? | -cardiac pacemaker -Rheumatic fever w/o valvular dysfunction -Mitral valve prolapse without valvular regurgitation |
| Antibiotic side effect of GI upset and P. colitis? | Clindamycin |
| Most likely to cause superinfection? | Broad spectrum antibiotics |
| Antibiotic associated w/ aplastic anemia? | Chloramphenicol |
| Antibiotic associated w/ liver damage? | Antibiotic associated w/ liver damage? |
| Antibiotic associated w/ allergic cholestatic hepatitis? | Erythromycin estolate |
| _______ shouldn't be taken with antacids or milk. | Tetracycline |
| Clindamycin concentrates in _____. | bone |
| Tetracycline concentrates well in __________. | gingival crevicular fluid |
| Best Rx for herpes infection? | Acyclovir or Valcyclovir |
| Best Rx for Candidiasis? | Best Rx for Candidiasis? |
| Best Rx for Candidiasis? | Fluconazole, Ketoconazole |
| Clotrimazole (Mycelex) comes in what form? | troche form |
| Aspirin(ASA) is a (reversible/irreversible) COX 1 and 2 blocker. | irreversible |
| NSAIDs are ____________ blockers, which inhibits prostaglandin synthesis. | COX 1 and COX 2 Celebrex and Meloxicam are only COX 2 blockers though. |
| Ibuprofen is not good for which organ? | kidney |
| MOA of acetaminophen? | Inhibits prostaglandin synthesis in CNS |
| Aspirin is tough on what bodily system? | GI |
| Drug of choice in feverish child? | acetaminophen |
| Why shouldn't give aspirin to children? | Risk for Reye's Syndrome |
| Max dose for ibuprofen and acetaminophen in a day? | ibuprofen 3.2g/day acetaminophen 4g/day |
| Therapeutic effects of aspirin? | COX1&2 blocker --> analgesic + anti-inflammatory Inhibits PG synthesis in hypothalamus --> antipyretic Inhibits TXA2 synthesis --> inhibits platelet aggregation --> increases bleeding time |
| Toxic effects of aspirin? | -GI bleeding!! -tinnitus -nausea, vomiting -metabolic acidosis -decreased tubular resorption of uric acid -salicylism -delirium -hyperventilation |
| Corticosteroids (-one) MOA | Inhibits phospholipase A2 --> inhibits arachidonic acid synthesis --> analgesic + anti-inflammatory |
| SE of steroids | -gastric ulcers -immunosuppression!! -acute adrenal insufficiency!! -osteoporosis -hyperglycemia -redistribution of body fat |
| Rule of 2s | Acute adrenal insufficiency if patient has had 20mg of corticosteroids for 2 weeks within 2 years of Tx |
| Narcotics/opioids MOA | Mu-opioid receptor agonists in CNS |
| OxyCONtin | CONtrolled release form of oxycodone |
| Which narcotic/opioid suppresses cough reflex? | Codeine |
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