Pharmacology Test 2

Front 1

___ are substances produced by microorganisms that suppress, destroy or alter the action of organisms

Back 1

Antibiotics
- substances produced by microorganisms that suppress, destroy or alter the action of organisms

Front 2

___ substances that only retard the growth of bacteria (reversible). This only prevents bacteria from reproducing and requires a rapidly producing microorganism

Back 2

Bacteriostatics
- substance that retard the growth of bacteria

Front 3

___ is the growth of a group of microorganisms different from the original infective agents. Ex: when a pt gets put on amoxicillin and gets a yeast infection

Back 3

Superinfection
- growth of group of microorganisms different from the original infective agents

Front 4

___ is the ability of 2 or more antiinfectives to increase efficacy of eithe one or both (opposite of antagonism)

Back 4

Synergism
- ability of 2 or more antiinfectives to increase efficacy of 1 or both

Front 5

What is the most likely type of organism cause the infection in an..
early infection= ____
later infection= _____
Late stages = _____

Back 5

Early infection gram +
later infection = gram + & -
Late stages = mostly gram (-) with pus exudate

Front 6

__ is a bactericidal agent that disrupts or retards synthesis of bacterial cell wall proteins

Back 6

Penicillins

Front 7

Penicillin resistance is usually due to ___ producing organisms.

Back 7

Penicillinase producing organisms
= any enzyme used to destroy penicillin - the cause of resistance to penicillin

Front 8

What are some adverse reactions to the antiinfectives Macrolides (erythromycin/Z-pak)?

Back 8

Adverse reactions to Macrolides (erythromycin)...
- GI = Abdominal Cramps, diarrhea (resulting in pt noncompliance)

Front 9

___ is a type of antiinfective that is concentrated in the crevicular fluid and used frequently by periodontist

Back 9

Tetracyclines

Front 10

___ is more likely than any other drug to cause pseudomembranous colitis. It is useful for PREMED (if pt has penicillin allergy and used for oral anaerobic infections esp. perio

Back 10

Clindamycin
- most likely to produce an adverse reaction of pseudomembranous coilitis.
- used for premed if pt has penicillin allergy

Front 11

Flagyl is the trade name for what antiinfective agent?

Back 11

Metronidazole - Flagyl

Front 12

What are some adverse reactions to Metronidazole (Flagyl)? This drug reacts with alcohol causing cramps and nausea

Back 12

adverse reaction to Metronidazole (flagyl) = xerostomia, metallic taste, CNS, renal toxicity

Front 13

What are some adverse effects of Cephalosporins (keflex)?

Back 13

Adverse effects of Cephalosporins
= GI superinfection, CROSS HYPERSENSITIVITY with penicillins, renal toxicity

Front 14

What heart condition does a patient not have to take an antibiotic premedication?

Back 14

Pt does not premed for a heart murmur unless the murmor is due to rheumatic fever. If pt has both of these then pt has rheumatic heart disease which requires premed

Front 15

___ is an antifungal agent that alters the cell wall permeabillity. Used for pt with superinfection or denture sore mouth

Back 15

Nystatin

Front 16

_ is an antifungal agent that is available in creams or lozenges. Contraindicated during pregnancy causing child to have multiple digit

Back 16

Ketoconazol

Front 17

Zovirax is the trade name for what antiviral agent? this drug inhibits DNA/ RNA synthesis

Back 17

Acyclovir (ZOvirax)
= inhibits DNA/ RNA synthesis

Front 18

___ , ___, ___ are antiviral agent used for treatment of HIV.

Back 18

HIV Agents:
1. Nucleoside (AZT, Retrovoir) reverse transcriptase inhibitors
2. Nonnucleoside reverse transcriptase inhibitors (Viramune)
3. Protease inhibitors (Saquinavir)

Front 19

___ was the first local anesthetic but had potential for abuse.

Back 19

Cocaine

Front 20

Local anesthetics act by interference with the depolarization of the nerve membrane. The drugs affect myelinated nerves at the ___

Back 20

local anesthetics affect myelinated nerves at the Nodes of Ranvier

Front 21

___ is an adverse reaction to local anesthetics. It is a genetic reaction (auto. dom) leading to increased serum calcium levels resulting in muscular rigidity, acidosis and elevated body temps.

Back 21

Malignant hyperthermia
- adverse reactions to local anesthetics
- results in muscular rigity, acidosis, and elevated body temp - genetic reaction

Front 22

Composition of Local Anesthetic Carpules:
__ adjust pH of a solution
__ makes solution isoton
___ acts as preservation in multidose bottole not in single dose dental carpules

Back 22

SODIUM HYDROXIDE- adjust the pH of solution
SODIUM CHLORIDE makes solution isotonic
Methylparaben or propylparaben - acts as preservation in multidose bottle not in single dose

Front 23

Lidocaine is a form of ___ that is frequently used to control cardiac arrythmias, rapid onset, 1 to 1/2 hrs with casoconstrictor

Back 23

AMIDES

Front 24

___ is used as topicals.
Procaine is the safest type of these, frequently used as a n antiarrythmic agent.

Back 24

Esters
- benadryl also can be used

Front 25

During what stage of the depth of aneshesia is the ideal stage for surgery? Old way of classifying the surgical anesthesia

Back 25

Stage 3

Front 26

What are some adverse reactions of general anesthetics?

Back 26

adverse reactions of general anesthetics....
= Cardiovascular: hyper & Hypotension, ventricular arrhythmias, cardiovascular collapse, cardiac arrest
Hepatic- can lead to liver damage

Front 27

What are some advantages of Nitrous Oxide?

Back 27

(+) of nitrous oxide
- rapid onset, easy administration, close control, rapid recovery, pedo application, less tense dental treatment team
- CNS sedation resulting in mild analgesia & results in peripheral vasodilation

Front 28

What are some adverse effects of Nitrous Oxide?

Back 28

Adverse effects Nitrous Oxide
= Contraindicated in cases of respiratory obstruction & cases of COPD (asthma, emphysema) & emotionally unstable pt or a pt on psychotherapeutic meds

Front 29

___ is any substance that either natural or chemically created that suppresses or destroys the infective organisms

Back 29

Antiinfective agents

Front 30

___ occurs when one antiinfective agent's effect is diminished by the addition of another chemical (opposite of synergism)

Back 30

Antagonism

Front 31

___ are substances that actually destroy bacteria (irreversible), requires a rapidly growing bacterial population.

Back 31

Bactericidals

Front 32

___ is bactericidal agent that disrupts or retards synthesis of bacterial cell wall proteins. has narrow spectrum antiinfective (some gram (+) and some gram (-) cocci some spirochetes and anaerobes

Back 32

Penicillins

Front 33

Penicillin is distributed to most body tissues including saliva, breast milk and transplacental. What are 2 places it is not distributed too?
Half life= 30 min
Penicillin metabolized in the __ & excreted in the kidneys

Back 33

Penicillin distributed to most body including saliva,breast milk, transplacental (exceptions are CSF & bone)
- Metabolized in Liver & excreted in the kidneys

Front 34

__ are broad spectrum antibiotics consisting of erthromcin (zpak). Spectrum of activity similar to penicillins but ineffective against the usual dental anaerobes. Used with pt w/ hypersensitivity to penicillins
- Bacteriostatic

Back 34

MACROLIDES
-bacteriostatic by interference w/ protein synthesis(just prevents from reproducing)
-used in pt with hypersensitivity to penicillin
-Half life 2 hours

Front 35

__ is broad spectrum bacteriostatic antiinfectives by interfering w/ bacterial protein synthesis (doxycycline)
-usually administered orally may be chelated by calcium containing products
-Concentrated by liver
-superinfection w/ monillasis & pseudomembranous colitis

Back 35

Tetracyclines
- concentrated by liver
- administered orally may be chelated by calcium containing products
-concentrated in crevicular fluid
- superinfection w/ monilliasis & pseudomembranous colitis

Front 36

___ is concentrated in developing teeth & bones resulting in intrinsic staining (contraindicated in 2nd half od pregnancy through age 8)
- liver damage may result from IV use, kidney samage from outdated drugs, anemia,photosensitivity & vertigo

Back 36

Tetracyclines
- Not indicated for prohylactic use against Bacterial endocarditis unless infective agent is Aa

Front 37

__is bacteriostatic antibiotic against gram (+) some gram (-) & anaerobic bacteroides
- interfers w/ protein synthesis
- crosses the placental barrier

Back 37

CLINDAMYCIN (cleosin)

Front 38

___is synthetic antiinfective, active against trichomonas amebicidal,& bactericidal against obligate anaerobes
-Destroys ring structure of DNA
- has a 1/2 life of 8 hours

Back 38

Metronidazole (flagyl)
- useful to treat periodontal anaerobes except Aa
- reacts w/ alcohol
- synthetic antiinfective
-destroys ring structure of DNA
-has anti-inflammator effect

Front 39

___ (keflex)
- bactericidal antibiotic w/actions similar to penicillins inhibits cell wall synthesis
- wide spectrum against organism involved w/ oral infections esp. anerobes

Back 39

CEPHALOSPORINS
Keflex

Front 40

Cephalosporins have a half life of what?
Where does it metabolized and excreted? Adverse effect include what (4)?

Back 40

Cephalosporins
half-life: 1 hour to 6 hour
Metabolized in the liver and excreted in the urine
Adverse effect: GI, superinfection, cross hypersensitivity with penicillin

Front 41

Antibiotic Premedication requirements for use (5)

Back 41

Antibiotic Premedication requirements for use:
-used for prevention of bacterial endocarditis
-used when possibility of introducing significant bacteremias
-based upon AHA recommendations
-also used in prosthetic joint replacement
-primary and specialty physicians should be consulted

Front 42

(4) Types of Antituberculosis agents

Back 42

(4) Types of Antituberculosis agents
-Isoniazid
-Rifampin
-Pyrazinamide
-Ethambutol

Front 43

This is a type of Antituberculosis agents:
-bactericidal only against actively proliferating organism, disrupts cell wall
-taken for 9-12 months
-used alone as prophylactic agent to those recently exposed to Tb or seroconverts

Back 43

This is a type of Antituberculosis agents: ISONIAZID
-bactericidal only against actively proliferating organism, disrupts cell wall
-taken for 9-12 months
-used alone as prophylactic agent to those recently exposed to Tb or seroconverts

Front 44

This is a type of Antituberculosis agents:
-Bactericiostatic antibiotic that inhibits DNA and RNA enzymes
-taken for 9-12 months

Back 44

This is a type of Antituberculosis agents:RIFAMPIN
-Bactericiostatic antibiotic that inhibits DNA and RNA enzymes
-taken for 9-12 months

Front 45

This is a type of Antituberculosis agents:
-bactericidal
-usually used only for the first 2 months or until negative sputum samples

Back 45

This is a type of Antituberculosis agents:PYRAZINAMIDE
-bactericidal
-usually used only for the first 2 months or until negative sputum samples

Front 46

This is a type of Antituberculosis agents:
-bacteriostatic agent
-used if all other antituberculosis can't be used

Back 46

This is a type of Antituberculosis agents:ETHAMBUTOL
-bacteriostatic agent
-used if all other antituberculosis can't be used

Front 47

Type of antifungal agent:
-fungicidal and fungistatic antibiotic by altering cell wall permeability
-poorly absorbed through mucosa, skin, or GI
-primarily tropical treatment for 10-14 days
-few adverse effect

Back 47

Type of antifungal agent:NYSTATIN
-fungicidal and fungistatic antibiotic by altering cell wall permeability
-poorly absorbed through mucosa, skin, or GI
-primarily tropical treatment for 10-14 days
-few adverse effect

Front 48

Type of antifungal agent:
-synthetic antifungual agent, available in creams, ointments, lozenges
-alter cell wall permeability
-adverse reaction most GI
-Ketoconaxzol contraindicated during pregnancy cause less or more fingers

Back 48

Type of antifungal agent:IMIDAZOLES
-synthetic antifungual agent, available in creams, ointments, lozenges
-alter cell wall permeability
-adverse reaction most GI
-Ketoconaxzol contraindicated during pregnancy cause less or more fingers

Front 49

Type of antiviral agent:
-inhibits DNA/RNA synthesis
-applied topically or systemically
-distributed well in all tissues
-selectively toxic to infected host cells
-adverse effects:headache, burning, itching, GI

Back 49

Type of antiviral agent:ACYCLOVIR (Zovirax, Denivir, Famvir)
-inhibits DNA/RNA synthesis
-applied topically or systemically
-distributed well in all tissues
-selectively toxic to infected host cells
-adverse effects:headache, burning, itching, GI

Front 50

Type of Antiviral agent:
-HIV type include what? what is the function of this type?
-all have variable side effects
-frequently used in combination
-many GI, CNS and bone marrow suppression adverse effect

Back 50

Type of Antiviral agent:
-Nucleoside reverse transcriptase inhibitors (AZT, Retrovir)
-all have variable side effects
-frequently used in combination
-many GI, CNS and bone marrow suppression adverse effect

Front 51

LOCAL ANESTHETICS
-__ frequently used compound in dental office for obvious reasons
-because used routinely, __ __ can have systemic effect
-___placental and blood-brain barrier
-___ first local anesthetic but potential for abuse

Back 51

LOCAL ANESTHETICS
-MOST frequently used compound in dental office for obvious reasons
-because used routinely,CAN FORGET can have systemic effect
-CROSS placental and blood-brain barrier
-COCAINE first local anesthetic but potential for abuse

Front 52

LOCAL ANESTHETICS
-How does it acts?
-what does it affect?
-has myocardia effect, used to treat ___

Back 52

LOCAL ANESTHETICS
-Acts by interference with the depolarization of the nerve membrane
-affects smaller nonmyelinated nerves first then larger or myelinated nerves last
-affect myelinated nerves of nodes of ranvier
-has myocoardial effect, used to treat arrhythmias

Front 53

Properties of an Ideal Local Anesthetic
(9)

Back 53

Properties of an Ideal Local Anesthetic
-potent anesthetic
-reversible
-absence of toxicity, local reactions, systemic adverse effects
-rapid onset
-adequate durations
-long shelf life
-low cost
-non-toxic metabolites
-ease of excretion

Front 54

ADME
Adsorption depends on (5)

Back 54

ADME Adsorption depends on (5)
-route of administration
-vascularity in area of injection
-degree of inflammation present
-presence of heat, massage
-potency and dose of any vasoconstrictor

Front 55

ADME
Distribution?

Back 55

ADME Distribution
-distributed throughout body tissue
-more concentrated in more vascular organs
transplacental and also blood brain barrier

Front 56

TOxicity to local anesthics affects 2 systems what are they? what happens to these systems when given too much of the anesthetic

Back 56

toxicity to local anesthetics affect CNS & Cardiovascular (C-V)
CNS: initial stimulation as restlessness, tremors &convulsions, depression leading to coma& death
C-V: myocardial depression, possible fatal arrhythmia (irregular heartbeat)

Front 57

ADME Metabolize how and excreted where?

Back 57

ADME
-Metabolize: amides by the liver and esters in the blood
-Excretion: amides and esters excreted by the kidneys

Front 58

Adverse reactions to local anesthetics
___ ___: genetic reaction (auto dom), leading to increase serum calcium levels resulting in muscular rigidity, acidosis and elevated body temps. 50% mortality if not treated immediately

Back 58

Adverse reactions to local anesthetics
Malignant hyperthermia: genetic reaction (auto dom), leading to increase serum calcium levels resulting in muscular rigidity, acidosis and elevated body temps. 50% mortality if not treated immediately

Front 59

Adverse reactions to local anesthetics
___ ___: rare to amides, more common with esters ranges from rash to anaphylactic shock

Back 59

Adverse reactions to local anesthetics
Allergic reactions: rare to amides, more common with esters ranges from rash to anaphylactic shock

Front 60

PREGNANCY CATEGORIES AND DRUG SAFETY TO DEVELOPING FETUS
____ ____: no risk to developing fetus in the first trimester and no evidence of risk in later trimesters

Back 60

DRUG SAFETY TO DEVELOPING FETUS
Category A: no risk to developing fetus in the first trimester and no evidence of risk in later trimesters

Front 61

DRUG SAFETY TO DEVELOPING FETUS
____ ____: controlled studies failed to demonstrate risk to the fetus

Back 61

DRUG SAFETY TO DEVELOPING FETUS
Category B: controlled studies failed to demonstrate risk to the fetus

Front 62

DRUG SAFETY TO DEVELOPING FETUS
____ ___: Controlled studies show adverse effect in animal studies but no adequate studies in humans. Potential benefits of administration may warrant its use

Back 62

DRUG SAFETY TO DEVELOPING FETUS
Category C: Controlled studies show adverse effect in animal studies but no adequate studies in humans. Potential benefits of administration may warrant its use

Front 63

___ is a compound that produces a reversible loss of consciousness and insensibility to painful stimuli by depression of the CNS

Back 63

GENERAL ANESTHETICS
-compounds that produce a reversible loss of consciousness & insensibility to painful stimuli by depression of CNS

Front 64

___ usually incorporated a combo of drugs, requires constant monitoring, also requires respiratoy support due to concomitant respiratory depression

Back 64

GENERAL ANESTHETICS
- incorporates combo of drugs

Front 65

depth of anesthesia classfication: Old way
Stage __: delirium or excitement, involuntary movement, respiration irregular, tachycardia, unconsciousness, controlled by drug combination

Back 65

STAGE 2
-delirium/ excitement, involuntary movement, respiration irregular, tachycardia, unconsciousness, controlled by drug combo

Front 66

depth of anesthesia classfication: Old way
Stage __: patient is conscious & can respond to commands - used for pain relief

Back 66

STAGE 1 - pt is conscious and responds to commands it is used for pain relief

Front 67

depth of anesthesia classfication: Old way
Stage __: Surgical anesthesia, divided into 4 planes differentiated by eye movements, depth of respiration, muscle relaxation, dilated pupils through severe respiratory depression & muscle paralysis

Back 67

STAGE 3- surgical anesthesia

Front 68

depth of anesthesia classfication: Old way
Stage __: Cessation of all respiration, maximum pupil dilation, circulatory failure & death if not immediately reversed

Back 68

STAGE 4 - cessation of all respiration, circulatory failure and death if not immediately reversed, maximal pupil dilation

Front 69

Anesthesia divided into 3 categories: (new way)
___ is depth of anesthesia sufficient for surgery
___ is termination of surgery and continues until pt is fully responsive
___ includes preop meds and administration of anesthetics

Back 69

General anesthesia 3 categories:
MAINTENANCE - sufficient for surgery
RECOVERY- termination of surgery & continues until pt is fully responsive
INDUCTION- preop medication & administration of anesthetics

Front 70

What are some of the cardiovascular and respiratory adverse reactions to general anesthetics??

Back 70

Adverse reactions to general anesthetics...
~ Cardiovascular: hyper- and hypotension, ventricular arrhythmias,cardiovascular collapse, cardiac arrest
~Respiratory: depressed respiration to respiratory arrest

Front 71

What are some of the Hepatic & Teratogenic & Misc. adverse reactions to general anesthetics?

Back 71

Adverse reactions to general anesthetics..
~Hepatic: Chronic exposure of hospital personnel leads to liver damage
~Teratogenic: to O-R personnel with chronic exposure (male & female)
~ Misc: headache, fatigue, addiction

Front 72

What are the route of administration for these general anesthetics?
___- gases of halothane, enflurane ande isoflurane, desflurane & sevoflurane
___- ultrashort acting barbiturates, propofol, ketamine, opioids & benzodiazepines

Back 72

INHALATION- gases of halothane, enflurane ande isoflurane, desflurane & sevoflurane
INTRAVENOUS (IV)- ultrashort acting barbiturates, propofol, ketamine, opioids & benzodiazepines

Front 73

INJECTABLE LOCAL ANESTHETICS
AMIDES
-____ Frequently used by MDs to control cardiac arrythmias, rapid onset, 1-1.5 hr with vasoconstrictor
-____ similar to lidocaine, usual vasoconstrictor is levonordefrin

Back 73

INJECTABLE LOCAL ANESTHETICS
AMIDES
-Lidocaine (xylocaine)Frequently used by MDs to control cardiac arrythmias, rapid onset, 1-1.5 hr with vasoconstrictor
-mepivacaine similar to lidocaine, usual vasoconstrictor is levonordefrin

Front 74

INJECTABLE LOCAL ANESTHETICS
AMIDES
-____ less potent, less toxic than lidocaine with slightly longer duration
-____ less toxic, more potent than lidocaine with much longer duration of action. Good for long procedures or post-op surgery

Back 74

INJECTABLE LOCAL ANESTHETICS
AMIDES
-Prilocaine less potent, less toxic than lidocaine with slightly longer duration
-bupiacaine (marcaine) less toxic, more potent than lidocaine with much longer duration of action. Good for long procedures or post-op surgery

Front 75

INJECTABLE LOCAL ANESTHETICS
____-no longer available as single dose dental carpules, usually used as topical
-____- safest, frequently used as an antiarrythmic agent
-example:___
-___: more potent, more toxic than procaine, slow onset long duration

Back 75

INJECTABLE LOCAL ANESTHETICS
ESTERS-no longer available as single dose dental carpules, usually used as topical
-PROCAINE safest, frequently used as an antiarrythmic agent
-example:PROPOXYCAINE-
-TETRACAINE: more potent, more toxic than procaine, slow onset long duration

Front 76

___ is a poor anesthetic agent, used in combo w/ rapidly acting IV agent, administered in combo w/ another inhalation , anesthetic to produced balanced state of unconsciousness, used in dental office to reduce anxiety, reduces concentration of mild analgesia& amnesia

Back 76

NITROUS OXIDE
-reduces concentration of mild analgesia& amnesia,a poor anesthetic agent, used in combo w/ rapidly acting IV agent, used for dental anxiety

Front 77

What are some of the advantages of using Nitrous Oxide?

Back 77

Advantage of Nitrous Oxide...
- rapid onset, easy administration, close control, rapid recovery, pedo application, less tense dental treatment team, CNS sedation resulting in mild analgesia & amnesia, results in peripheral vasodilation

Front 78

WHat are some of the adverse effect of using Nitrous Oxide?

Back 78

Adverse effect of Nitrous Oxide
- contraindicated in cases of respiratory obstruction (congestion, disease)
- contraindicated in cases of COPD (asthma, emphysema)
-contraindicated in emotionally unstable pt or pt on psychotherapeutic meds

Front 79

Adverse effects of Nitrous Oxide..
- requires presence of female staff member when practioner is male
- chronic expose to staff manifest higher incidence in spontaneous ___& ___
- abused by medical personel often

Back 79

Nitrous oxide manifest a higher incidence of spontaneous abortions and miscarriags

Front 80

Most common % of solutions
0.5% = __ mg
2.0% = __ mg
3.0%= __mg
4.0%= __ mg
5.0%= __mg

Back 80

0.5%= 9mg
2.0% = 36 mg
3.0% = 54 mg
4.0% = 72 mg
5.0% = 90 mg