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148 Cards in this Set
- Front
- Back
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What drug is used for total joint replacement prophylactic therapy in patients who are allergic to penicillin or ampicillin?
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clindamycin
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What type of bacteria is clindamycin used to combat?
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gram positive cocci and anaerobes
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What type of drug is bath salts?
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mephedrone
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What are some of the clinical symptoms of mephedrone?
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Tachycardia, hypertension, vasoconstriction, insomnia, nausea, Bruxism, tinnitus, pupil dilation, headache, Breathing difficulty, Increased body temperature, chills, sweating, rhabdomyolysis, renal failure, seizures, high anion gap metabolic acidosis, respiratory failure, liver failure.
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How do you manage a patient that presents after having taken mephedrone?
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supportive care and benzodiazepines for agitation/psychosis
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Can you screen bath salts the same way as other drugs of abuse (DOA)?
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no, will not appear on standard immunoassays
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What is MDPV?
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Methylenedioxypyrovalerone (MDPV) is a norepinephrine-dopamine reuptake inhibitor (NDRI).
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If your patient took MDPV before his appointment, how long will the psychological effect last?
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3 to 4 hours
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If your patient took MDPV before his appointment, what are the physical side effects?
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tachycardia and hypertension, lasting 6 to 8 hours
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If a patient has taken MDPV over a long period of time, what will the physical symptoms lead to?
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spectacular and unmanageable side effects
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How do you treat a MDPV overdose?
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benzodiazepines, general anesthesia used when sedatives ineffective. (treat in ER for severe hypertensive issues)
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What is the antihelminth drug you can find in a pet store that has stimulant properties?
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Piperazine Derivative
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Can you detect Piperazine Derivative in typical immunoassay testing?
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no
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What is piperazine derivative known as?
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party pill, legal ecstasy, can be used to avoid withdrawl symptoms from amphetamines
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How do you manage a patient that presents on piperazine derivative drugs?
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Benzodiazepines for agitation and IV fluid resuscitation
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What are some examples of “synthetic Cannabinoids” and “herbal marijuana alternatives”?
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doctored incense, Spice, K2, Chill Zone, Sensation, Chaos, Aztec Thunder, Red Merkury, and Zen. Also known as baybean, beach bean, blue lotus, lion's ear/tail, wild dagga, Indian warrior, and dwarf skullcap are examples of the herbal ingredients.
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What are standard cannabis drug immunoassays directed at?
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THC
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Can you find synthetic cannabinoids through standard drug testing?
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no
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What is the clinical presentation of a patient that presents under the influence of synthetic marijuana?
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hypertension, tachycardia, nausea, vomiting, agitation, anxiety, paranoia, seizures, and suicidal ideation.
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How do you manage patients that are high on synthetic cannabinoids?
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supportive care. Symptoms usually resolve in less than 24 hours
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What are the local anesthetic amides?
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lidocaine, mepivicaine, prilocaine, bupivacaine, and etidocaine. (let my people bring eggs)
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Where are amide anesthetics metabolized?
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in the liver (into inactive metabolites)
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What type of local anesthetic is articaine?
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atypical amide local (contains an amide group & an ester group)
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Where is articaine metabolized?
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in blood plasma and in the liver by plasma carboxylase
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What are the ester local anesthetics?
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cocaine, procaine, tetracaine, and chloroprocaine.
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Where are ester type local anesthetics metabolized?
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in plasma by pseudo-cholinesterase
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What is the major metabolite by-product of ester anesthetics that results in allergic reactions?
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PABA (paraminobenzoic acid)
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What is another name for Articaine?
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Septocaine
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What is another name for Bupivicaine ?
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Sensorcaine, Marcaine,
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What is another name for Chloroprocaine ?
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Nesacaine
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What is another name for Etidocaine ?
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Duranest, Duranest MPF
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What is another name for Levobupivacaine ?
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Chirocaine
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What is another name for Lidocaine ?
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Dilocaine, Xylocaine
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What is another name for Mepivacaine ?
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Carbocaine, Carbocaine with neo-cobefrin, Carbocaine with levonordefine, Isocaine, Polocaine, Polocaine MPF, Scandonest
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What is another name for Prilocaine ?
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Citanest plain, Citanest Forte
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What is another name for Procaine ?
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Novocaine
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What is another name for Tetracaine ?
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Pontocaine
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What is the Maximum Recommended dose per appointment of Articaine?
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3.2 mg/per lb or 500 g max.
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What is the Maximum Recommended dose per appointment of Bupivacaine?
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0.6 mg/per lb or 90 g max
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What is the Maximum Recommended dose per appointment of Licocaine?
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2.0 mg/per lb or 300 g max
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What is the Maximum Recommended dose per appointment of Mepivacaine?
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2.0 mg/per lb or 300 g max
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What is the Maximum Recommended dose per appointment of Prilocaine?
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2.7 mg/per lb or 400 g max
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If a 100% solution, by definition contains 1 gram or 1000 mg of drug per milliliter of solution (1000 mg/ml), how much would 10% solution contain?
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100 mg/ml
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Drug concentration is expressed as?
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a percentage
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Drug Percentage is measured in?
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grams per 100 mL
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1% is ____ mg/mL?
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1 g/100 mL = 1000 mg/100 mL = 10 mg/mL
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Bupivacaine 0.25% = ________mg/mL?
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2.5 mg/mL
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Tetracaine 0.5% = ________mg/mL?
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5 mg/mL
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Lidocaine 1% = ________mg/mL?
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10 mg/mL
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Viscous lidocaine 2% = ________mg/mL?
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20 mg/mL
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Benzocaine 20% = ________mg/mL?
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200 mg/mL
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When epinephrine is combined in an anesthetic solution, the result is expressed as?
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a dilution
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1:1,000 dilution means _______mg/mL?
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1 mg per 1 mL (ie, 0.1% )
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1:10,000 means _______mg/mL?
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1 mg per 10 mL (ie, 0.01%)
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1:2,000 means _______mg/mL?
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1 mg per 2 mL (ie, 0.05%)
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1:20,000 means _______mg/mL?
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1 mg per 20 mL (ie, 0.005%)
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1:100,000 means _______mg/mL?
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1 mg/100 mL (i.e, 0.001%)
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0.1 mL of 1:1000 epinephrine added to 10 mL of anesthetic solution _______mg/mL?
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1:100,000 dilution, or 0.01 mg/mL
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1 cartridge (1.7ml) 2% Lidocaine provides_____mg lidocaine and _______mg epi?
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34 mg lidocaine (2%) and 0.017 mg epinephrine (1:100,000)
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1 cartridge (1.8ml) 3% Carbocaine provides_____mg carbocaine?
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54 mg carbocaine
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1 cartridge (1.7ml) 4% Septocaine provides _____mg septocaine and _______mg epi?
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68 mg articaine HCl (4%) and 0.017 mg epinephrine (1:100,000)
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What are the only two vasoconstrictors used in local anesthetic solutions in the United States?
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Epinephrine and levonordefrin
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What are the 3 epi concentrations available?
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1:50,000, 1:100,000, and 1:200,000
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What is the only LA that containes 1:50,000 conc of epi?why such a high conc?
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lidocaine, to achieve hemostasis of hemorrhage
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Where can you find epi 1:1000,000 concentrations?
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lido 2% & articaine 4%
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Where can you find epi 1:200,000 concentrations?
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articaine 4%, prilocaine 4%, bupivacaine 0.5%
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What is the max recommended dose of epi in a single appointment?
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0.2mg (healthy pt) or 0.4mg (medically compromised)
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What is added to LA solutions to increase shelf life?
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sodium bisulfite (if pt has sulfite (not sulfa) allergy = no anesthetic with vasoconstrictor)
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When considering anesthetic with epi, which of the following goes up after using drug with epi (heart rate, stroke volume, cardiac output, peripheral resistance, mean arterial pressure)?
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Heart rate, stroke volume, cardiac output
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When considering anesthetic with epi, which of the following goes down after using drug with epi (heart rate, stroke volume, cardiac output, peripheral resistance, mean arterial pressure)?
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peripheral resistance
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When considering anesthetic with epi, which of the following stays the same after using drug with epi (heart rate, stroke volume, cardiac output, peripheral resistance, mean arterial pressure)?
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mean arterial pressure
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If using a vasoconstrictor, by what percent is the following increased (heart rate, stroke volume, cardiac output, MAP, blood glucose)?
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Heart rate ↑ 20%, Stroke volume ↑ 20%, Cardiac output ↑ 35%, MAP stays about the same, but there is a redistribution of the cardiac output to muscular and hepatic circulations, Blood glucose ↑ 20%
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It is a bad idea to mix _______ _________ _____-blockers with epinephrine?
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non-selective beta-blocker (exaggerates response
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What are the contraindications for using vasoconstrictors?
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recent MI, high risk arrhythmia, unstable angina, taking digitoxin, diabetes, uncontrolled hyperthyroidism, severe asthma, allergy, pheochromocytoma **, drug abuse, stroke history, MAOI’s, sulfite sensitivity
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If pt arrives taking beta blockers for post traumatic stress, how many carps of anesthesia with vasoconstrictor can be given?
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1 carp
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Shortest acting of all local anesthetics because it has greater vasodilating properties?
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lidocaine
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In plain form, mepivacaine's duration is only ______minutes for pulpal anesthesia and about _____hours for soft tissue anesthesia. With the addition of epinephrine, its duration significantly increases to about _____minutes for pulpal tissue and about _____hours for soft tissue?
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5-10, 1-2
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Citanest Plain is with/without vasoconstrictor and Citanest Forte is with/ without vasoconstrictor?
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without, with
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Prilocaine with epinephrine (Citanest Forte) is a good choice for patients exhibiting cardiovascular disease or hyperthyroidism….. Why?
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Because epinephrine is 1:200,000,
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Benefits of using articaine?
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low risk of toxicity, only available with vasoconstrictor
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What does high lipid content of tissue result in, when injecting Articaine (Septocaine)?
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high lipid = increased diffusion
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Articaine is labeled as a ____mL solution?
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1.7
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What are the only anesthetics available in only 1:200,000 epi solutions?
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prilocaine & bupivacaine
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What local anesthetic has 4 times the potency of other anesthetics?
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bupivacaine (1.5 to 5 hours pulpal, 4 to 9 hours soft tissue)
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Lidocaine cartridge size?
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1.7mL
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Carbocaine cartridge size?
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1.8mL
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Septocaine cartridge size?
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1.7mL
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What hypertension cardiovascular disease drug do you avoid vasoconstrictors?
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Nonselective Beta blockers (propranolol)
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If patient is using digitalis and you want to use vasoconstrictors what do you have to do?
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monitor for arrhythmias
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For strokes do you have to make any special acceptions when dealing with vasoconstrictors?
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no
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For hepatic and renal disease, do you have to make any special acceptions when dealing with vasoconstrictors?
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reduce dosage
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With heart issues, do you have to make any special acceptions when dealing with vasoconstrictors?
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minimize use
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What are the 7 steps in rational prescribing?
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1. Dx 2. PPI (pathophysiologic implication) of dx 3. TO (therapeutic objective) 4. DOC (drug of choice) 5. Dosing Regimen 6. Plan to monitor, end point of therapy 7. Pt education
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Elements of RX?
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1. Pt info, date 2. Drug info (name, strength, quantity) 3. Directions 4. Printed name and signature 5. DEA number 6. Additional notes 7. Refill amount 8. Indications for use
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Should the instruction “take as directed” be used when writing a script?
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no
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Can “PRN” be used as a refill designation?
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no
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What are the age limits that you must dose by weight?
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12 and under
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What are some of the effects herbs can have on drugs prescribed?
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Alter protein binding, Counteract therapeutic effects, Mask important symptoms, Can produce toxicity
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What are the best drugs to use when dealing with neuropathic pain?
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anti-convulsants and tricyclic anti-depressants
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What are the 5 drugs used to treat neuropathic pain?
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antidepressive: Gabapentin (Neurontin), Duloxetine (Cymbalta), Pregabalin (Lyrica)
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How does the neuropathic medication Gabapentin control pain?
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only controls the way pain is perceived, it does not address the underlying problem
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What is the dosage of the neuropathic medication Gabapentin?
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300-1800mg given in 3 doses
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What is the clinical concerns of the neuropathic medication Gabapentin?
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arrhythmias, coagulation, hemorrhage, hepatitis, liver function tests (INR) increased, infection (5%), thrombocytopenia
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Hypnotic and sedative drugs are selective/non-selective…. and work as general depressants of the CNS?
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non-selective
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If sedative dose is low, a sedative action results in?
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a reduction in restlessness and emotional tension.
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If sedative dose is higher, the same drug produces?
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a hypnotic sleep inducing effect.
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If sedative dose is too high, the result is?
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anesthesia or death.
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Which are safer Barbiturates or Benzodiazepines?
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Benzodiazepines ( have been largely replaced because much safer )
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Barbiturates are CNS depressants and have similar effects as?
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alcohol (suicide drug via respiratory depression).
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How do benzodiazepams work?
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as sedative hypnotic drugs that hyperpolarize membranes in CNS by binding GABA receptors , shifting chloride permeability (less excitable)
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If you give too much local anesthetic and a seizure results, what would you give to help patient?
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Benzodiazepam drug
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What effect to benzodiazepams have on respiration?
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depresses respiration
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What drug is administerd to antagonize the effects of benzodiazepams?
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flumazenil (half life is 30 minutes)
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What is the biggest risk concern of opiod analgesics?
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long half-life results in risk of toxicity as plasma levels rise
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Would you use short or long acting agonist drugs in acute pain?
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short acting agonist
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What are the main types of receptors responsible for physiologic dependence, respiratory depression and euphoria (opioid analgesics)?
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mu receptors
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If you get a spinal injection what receptors are involved?
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delta & kappa
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Analgesics function by binding to receptors located where?
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spinal cord & brain
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What diseases states should be advised to avaoid opioids?
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hepatic, COPD, Dementia, renal insufficiency
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What drug is more active than morphine that has a narrow therapeutic window?
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methadone
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Where is methadone metabolized? Where is it stored?
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liver
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What is a dental complication seen in patients that abuse methadone drugs?
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xerostomia
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What are the narcotic antagonists?
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nalorpine, naloxone, naltrexone
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What are narcotic antagonists used for?
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abolish respiratory depression caused by morphine and other related compounds
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Which narcotic antagonist is longest lasting and well absorbed into body?
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naltrexone (50 to 100mg)
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How must naloxone (narcan) be given to treat opioid respiratory depression?
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multiple doses since half-life is shorter than duration of agonist drug
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What drug is used to treat alcoholics?
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naltrexone (revia)
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What is recommended is NSAID’s cant be used because of allergy?
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acetaminophen
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When should NSAID’s be avoided?
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alcohol use, warfarin use
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What is the pain/ anti-inflammartory dose for acetaminophen?
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650-1000mg every 4 hours (max 4 mg/day)
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What is the pain/ anti-inflammartory dose for aspirin?
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325-650mg every 4 hours (max 4 mg/day)
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What are the 2 non-typical NSAIDS?
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acetaminophen & aspirin
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If a patient has been taking NSAID’s for a long time and continues having same pain symptoms, what needs to be done?
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discontinue use (rebound headache)
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What are the short acting (less than 6 hours) NSAIDS?
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Diclofenac (Cataflam), Flurbiprofen (Ansaid), Ibuprofen (Motrin), Tolmetin( Tolectin)
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Ibuprofen dosing?
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The maximum OTC adult analgesic dose is 1800mg/day, but the anti-inflammatory dose is 2400mg/day. A regimen for treating orofacial pain is 2400mg/day: 800mg tid for 3 weeks.
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Naproxen dosing?
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adult regimen is 1000 mg/day: 500mg bid for 3 weeks (this is the maximum dose)
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Tolmetin dosing?
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adult regimen is 600 mg – 1.8 g/day: 400 mg 3 times/day (this is the maximum dose)
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Flurbiprofen dosing?
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100 mg every 12 hours (maximum dose is 300 mg/day)
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Patients on long-term NSAID therapy should be monitored for?
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GI complications, Anemia (CBC), Hepatic toxicity (liver enzymes), Renal toxicity, Hyperkalemia (K+), Changes in vision
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What is the synthetic glucocorticoid sold in the USA and Canada under the brand names Medrol and Solu-Medrol?
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Methylprednisolone
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It is typically used for its anti-inflammatory effects, but has a wide range of effects. ?
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Methylprednisolone
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Methylprednisolone has serious side effects if taken long-term, including?
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Weight gain, Glaucoma, Oosteoporosis and Psychosis and depression, Low potassium, seizures, Swelling, Hypertension and shortness of breath, Adrenal gland suppression of cortisone production ( Addisonian crisis).
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What is the main concern for patient taking methylprednisolone?
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interacting with patient that has osteoporosis
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Effective at relieving muscle pain and spasm and are also anxiolytics
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indicated for muscle relaxation and sleep?
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What are the 2 most common benzodiazepines for orofacial pain patients?
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diazepam (Valium) and clonazepam (Klonopin).
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Diazepam dosing?
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5-10mg at bed, disp 30, no refills.
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Clonazepam dosing?
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0.5-1mg at bed, disp 30, no refills.
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What is the main drug used in dentistry for muscle relaxation and pain?
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cyclobenzaprine in 10 mg tablets
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