Pharmacology Mental Dental| 204 QUESTION| WITH COMPLETE SOLUTIONS

Amides are metabolized by Correct Answer: Liver Correct Answer: Esters are metabolized by: Correct Answer: Pseudocholinesterase in Plasma What are the esters: aine Correct Answer: Procaine Cocaine Tetracaine Benzocaine What amide is safest in children? Correct Answer: Lidocaine (Xylocaine) What amide is NOT safe in children and has longest duration of action? Correct Answer: Bupivicaine (Marcaine)- longest duration What amide causes the lease amount of vasodilation? Correct Answer: Mepivicaine (Carbocaine, Polocaine) What amide can cause methemoglobinemia? Correct Answer: Prilocaine (Citanest) Which anesthetic is metabolized in both the liver and the plasma and has the shortest duration of action? Correct Answer: articaine LA's are vasodilators in general. Which LA is a vasodilator ? Correct Answer: ester: cocaine is only vasoconstrictor LA's are ___ channel blockers Correct Answer: soidum channel blocker s What form of LA can penetrate neuron membrane? Correct Answer: Non-ionized (free base) from How does a drugs lipid solubility/hydrophobicity effect a drugs potency? Correct Answer: Increases potency Increased protein bindings leads to longer/shorter duration of action? Correct Answer: Longer Pharmacokinetics 1. Increased blood flow to the site of injection wlll have a ___ duration of action of the LA 2. Increased lipid solubility will have a more ____ drug and ___ duration of action (more drug diffuses to hydrophobic layer of membrane if more lipid soluble. 3. A lower pka, higher pH means a __ onset of aciton Correct Answer: 1. shorter duration 2. potent , longer duration of actoin 3. lower pka, faster onset of action pka: lowrer the pka, stronger the acid, gives up proton faster, so in non ionized form mepivicaine: lidocaine,prilocaine, articaine, bupivicaine Correct Answer: 7.6 7.8 8.1 How do vasoconstrictors affect LA? Correct Answer: Prolong Numbness Reduce Toxicity Promote hemostasis Remember that epi(vasoconstrictors) are going to counter act the vasodilating properties of local anesthetics Correct Answer: Max Epi for ASA I patient? Correct Answer: 0.2 mg Max Epi for cardiac patient? Correct Answer: 0.04mg Max lidocaine without vasoconstrictor? Correct Answer: 4.4mg/kg Max lidocaine with vasoconstrictor? Correct Answer: 7mg/kg rate to inject LA? Correct Answer: 1 carpule per minute Needle Diameters 30-Gauge ------- 27-Guage------ 25-Guage------ Correct Answer: 0.3 mm 0.4 mm 0.5 mm Injection with highest failure rate? Correct Answer: IA nerve block With IAN give 3/4 carpule Depth of PSA injection is _____mm Correct Answer: 16 mm Incisive nerve block is same as the ___ nerve except hold pressure for 2 minutes after injection to fore aneesthetic into mental formation Which numbs the actual teeth? Correct Answer: mental foramen incisive Block that numbs maxillary anterior and premolars. Also called a true asa block? Correct Answer: infraorbital ____: blocks soft tissue facial to PM and anterior teeth Correct Answer: mental PSA has high risk for:_____ in the pterygoid space Correct Answer: Hematoma is pterygoid space MOA of sulfonamides Correct Answer: anti-folate drugs: PABA analog that blocks Dihydropteroate synthase (bacteriostatic) Examples of Sulfonamides Correct Answer: sulfanilamide, sulfamethoxazole, sulfisoxazole MOA of Fluoroquinolones Correct Answer: Bactericidal DNA Synthesis Inhibitor Examples of Fluoroquinolones Correct Answer: Ciprofloxacin Levofloxacin Moxifloxacin MOA of penicillins Correct Answer: inhibit peptidoglycan cross-linking (Cell wall inhibitor) Penicillins are cross-allergic with what type of drug? Correct Answer: Cephalosporins Penicillin V is given ___ Correct Answer: orally Penicillin G is given Correct Answer: IV, more sensitive to acid degradation ______is the best broadest gram negative spectrum ab Correct Answer: ampicillin : Best/Broadest gram-negative spectrum type of penicillin used specifically against pseudomonas bacteria Correct Answer: Carbenicillin MOA of Cephalosporins Correct Answer: cell wall synthesis inhbitiors same as Penicillin (beta-lactam antibiotics) Bactericidal 1st Generation Cephalosporin Correct Answer: cephalexin (Keflex) 3rd generation cephalosporins Correct Answer: ceftriaxone Monobactam MOA? Example of Monobactam Spectrum of activity? ROA? Correct Answer: cell wall synthesis inhibitor, beta lactam Aztreonam (Azactam) Resistant to Gram (-) beta-lactamases (similar to the 3rd and 4th gen cephal.) ROA- Parenteral MOA of Carbapenems Correct Answer: Imipenem Bactericidal Cell wall synthesis inhibitor, b-lactam Class of antibiotic with broadest antimicrobial spectrum ? MOA? Correct Answer: Tetracyclines , docycycline, minocycline Protein Synthesis Inhibitor (30s ribosomal subunit) Bacteriostatic Macroslides MOA Mac likes to throw myce Correct Answer: bacteriorstatic and attack protein synthesis inhbitor (50s ribosomal subunits) Erythromycin Clarithromycin Azithromycin MOA of Erythromycin (macrolide) Correct Answer: Protein Synthesis Inhibitor (50s) Lincosamides Link also hides myce Correct Answer: Bacteriostatic Protein Synthesis Inhibitor (50s) Clindamycin Lincomycin What cardiovascular conditions require Prophylaxis? 1. Prosthetic heart ___ 2. history of______ 3. heart ___ with ______ dysfunction 4. _____ heart problems Correct Answer: Prosthetic Heart Valve Histroy of Endocarditis Heart Transplant with valvulopathy/valve dysfunction Congenital Heart Problems Compromised immunity requiring prophylaxis? (3) Correct Answer: Organ Transplant Neutropenia Cancer Therapy Rx for prosthetic joint prophylaxis. What is drug of choice, dosage, time Correct Answer: Keflex (cepholosporin) 2g, 1 hour before treatment Rx for infective endocarditis 1. Adult: drug, dosage, time 2. Children, drug, dosage, time Correct Answer: adult: amoxicillin, 2g), 1 hrs before tx