Pharmacology

2M- Erythromycin Macrolides interfere with metabolism of other drugs such as seldan
and digoxin, by interfering with cytochrome P-450
283L- Erythromycin interfere with metabolism of drugs such as seldan and digoxin
which leads to increase in their concentration in blood and so CVS collapse and death
occurs.
171M- Enteric coated (stomach resistant) long acting Erythromycin is called E.R.Y.C

10M- signs of CNS oxygen deprivation

Dilated pupils
Absence of reflexes especially light reflex
Urination / spermation / defecation
Bluish color
Acidosis (increased co2 in blood and so carbonic acid) leads to
destruction of respiratory and circulation centres
12M- *Belladonna Alkaloids ( Atropine and scopolamine and hyoscyamine) are
contraindicated with glaucoma because they raise the intraocular pressure
*Belladonna alkaloids are used with Phenobarbital to treat irritable bowel syndrome and
ulcers in the intestines.
245L- Homatropine causes paralysis of ciliary muscles of eye (cycloplegia)
247L- atropine is more potent than Quaternary ammonium derivative (methylatropine)
after oral administration.
287L- Atropine increases Heart rate in moderate to high doses (not related to ptosis in
myasthenia gravis)
12M- Phenytoin taken orally effects include
Gingival hyperplasia
Corrects certain cardiac dysrhythmia ( digoxin induced ones)
Used as an anti-seizure but without causing CNS depression
L.N hypertrophy
Toxic to cerebral and vestibular systems
Cognitive defects and fetal abnormalities
Coarsening of facial features and hirsutism
294L- Grand mal seizure is best treated by phenytoin.
279L- Diazepam is used to Treat lidocaine induced seizures ( type of grand mal seizure)
80M- Phenytoin is better in treatment of epilepsy than phenobarbital because phenytoin
exerts less sedation for a given degree of motor cortex depression.
Valproic Acid (Anticonvulsant) withdrawal from a pediatric patient spontaneously causes
gingival bleeding and acute stomatitis
Phenobarbital withdrawal from a dependant patient can cause convulsions

28M- Impending insulin shock signs

Weakness
Mental confusion
Cold perspiration (sweating)
(but not convulsions that happens after the insulin shock occurs)
35M- *Fexofenadine ( allegra) Tx of hay fever, is a 2nd generation antihistaminic that
can be taken with cimetidine (OTC for heartburn)
*Drugs contraindicated to take with cimetidine
Astemizole is 2nd generation antihistaminic (Interaction causes fatal
Arrhythmia)
Diphenhydramine ( 1st generation antihistaminic used in Tx of
Parkinsonism)
Hydroxyzine (1st generation antihistaminic used as Anxiolytic)
Terfenadine (seldane) (Interaction causes fatal Arrhythmia)
N.B seldane is contraindicated with
Cotidiane
Erythromycin
H1 receptors are located on
smooth muscles
Vascular endothelial cells
Heart
brain
H2 receptors are located in
Stomach ( that's why cimetidine is used for heartburn)
Heart
169M- Hydroxyzine can be used as a sedative, and it causes xerostomia
(anticholinergic effect)
46kc- Inhalation sedation used for a child can be supplemented by
Hydroxyzine (antihistaminic decrease salivation and cns depressant)
(Not diazepam, meperidine or ketamine)

37M- Amide LAs bond is longer than Ester LAs so

Amides are more potent i.e they are more effective in lower doses

43M- constitutional symptoms are symptoms that can affect different systems of the
body such as fever or chills.
52M- Disadvantages of oral sedation
Administrator has little control over drug actions
Significant difference between bioavailability of different drugs
Most drugs have a slow onset of action and long durations
168M- Oral route is the slowest rate of absorption. (hence the slow onset of action)
154k2- onset of action is dependant upon absorption (not distribution of the drug)
68M- Adrenal insufficiency causes CVs collapse in stressful situations
Adrenal insufficiency Other side effects: (Addisons)
Hypoglycemia
Weight loss
Muscle weakness
Hypotension
Intraoral melanosis (ACTH cross reacts with melanin receptors).
Cortisone uses:
Fight or flight hormone with epi
Increase B.P
Anti-inflammatory
Immunosuppressant
Cortisone Side effects: (cushings)
Hyperglycemia
Insulin resistance
Diabetes mellitus
Osteoporosis
Anxiety
Depression
glaucoma
69M- Using IV barbiturates as a general anesthetic results in the patient moving fast
through stage 2 (Delirium and Excitement)

71M- Digoxin most serious intoxication effect is ventricular fibrillation

92M- Isoniazid is the most potent anti-tubercular drug

96M- Anti-Diabetic agents mode of action

Block glucagon release
Bloch catecholamines release
Stimulate insulin release from B-cells
Increase glucose metabolization in liver
93M- isopropyl alcohol main Metabolite is Acetone.
101M- Alcohol euphoria is due to removal of inhibitory effect on cortex.
137M- 0.5% alcohol in blood is lethal to 50% of the population
152M- Ethanol effects:
Cutaneous V.D
Diuresis
Cns depression
Enzyme induction in liver(reacts with acetaminophen causing liver
damage)
Increase gastric acid secretion
34M- Ethyl Alcohol is used as Antidote for methanol poisoning because
Inhibits methanol metabolism by
Competes successfully with methanol for alcohol dehydrogenase so it
Prevents formation of formaldehyde as a result
So it prevents damage to optic nerve and the resultant blindness.
98M- Ethyl Alcohol is partially absorbed by stomach
170M- Mixing Alcohol with Phenobarbital can increase CNS depression because they
potentiate each other.

122M- O.D on TCA ( high sympathetic activity)---Treat with Anticholinesterase

(Physostigmine) to increase parasympathetic activity.
N.B physostigmine is used to treat
xerostomia
anticholinergic drugs O.D
 TCA O.D

277L- Tx of Xerostomia
Pilocarpine
Physostigmine
neostigmine
N.B Malathion is an Antiparasite.

128M- Concentration of sodium ions determine the affinity for binding agonists or
antagonists to the opioid receptor. (increasing intracellular sodium reduces Agonist
Affinity)

131M- Amyl Nitrite Inhalation (V.D used with Angina)

Tachycardia
Coronary dilatation
Peripheral arterial dilatation
Decreasing arterial B.P
138M- Amyl nitrite prolonged use causes methemoglobinemia (abnormal
methemoglobin that cannot carry oxygen) (also Acetaminophen and prilocaine)
132M-
Clarks rule for pedo dose------ Weight of child in LBs/150 lb x adult
dose
Blood surface area can also be used to calculate pedo dose
mg/kg can be used to calculate pedo dose
(can not use vital signs to calculate child dose)

140M- Organo Phosphate can be absorbed through the skin (irreversible

anticholinesterase)
158M- O.D on irreversible anticholinesterases causes death by excessive muscle
cholinergic stimulation leading to paralysis of intercostal muscles and diaphragm
(respiratory failure).
240L- OrganoPhosphates Or DFP (diisopropylfluorophosphate) are non-competitive
inhibitors of Acetyl-choline. It cause:
 Diarhea
Increased salivation and lacrimation and sweating
Skeletal muscle fasciculations

143M- Depressive Psycho-neurotic disease (ocd) is treated by TCA

145M- Digitalis is given in case of atrial fibrillation instead of quinidine to avoid

ventricular Tachycardia.
N.B quinidine has the same action as procainamide (decreasing sodium influx and so
increasing the refractory period)
150M- L-dopa becomes ineffective with age in the treatment of parkinsonism because
parkinsonism is a progressive disease with progressive neuronal cell loss in substantia
nigra.
153M- Digitalis mechanism of action
It inhibits Na/K pump while Na concentration is high intracellularly
This reverses action of Na/Ca pump and instead of exporting calcium out
of the cell
It imports Calcium in the cell and pumps sodium out.
Increasing Ca concentration intracellularly forces K out across the cell
membrane down the electrical gradient so K concentration decreases
intracellularly ( as it is the only ion that can move freely across the membrane)
155M- Neuroleptic analgesia is the combination of schedule 3 narcotic with
antipsychotic.

163M- Alpha adrenergic blockage is the reason why antipsychotics cause postural
hypotension. ( Alpha 1 cannot be stimulated so V.D occurs)
275L- postural hypotension is caused by antihypertensive medication because many of
those interfere with sympathetic control of vascular reflexes.
164M- Ritalin (Methylphenidate--amphetamine like) is used in Tx of hyperkinetic
children (ADHD)
165M- Drug Metabolism results in:
More water soluble drug
Inactive drug
More active drug (diazepam)
 Less active drug (not less ionized drug)
166M-Disk sensitivity test to ABx is done to determine microorganisms sensitivity to a
range of ABx
167M- Procaine is the least effective topical anaesthetic
Lidocaine is the most effective.
172M- Tramadol (ultram) is a centrally acting analgesic opiod on mu receptor
It is biotransformed to more active metabolites
It works by inhibiting reuptake of Epi and norepi ( increasing epi and
Norepi in brain)
174M- Ketorolac (Nsaid analgesic) and diclofenac (voltaren) (Nsaid analgesic) can be
given IM or Oral.
(aspirin, acetaminophen, ibuprofen and naproxen can be given orally only)
57K2- Aspirin is contra indicated with coumarin ( they potentiate each other)

187M-
Diabetic Pt. to have LAs without sedation should eat normally and take
normal insulin dose
Diabetic Pt. to have LAs with sedation should not eat and lower the Insulin
dose.
132kc- Aspirin is not recommended for diabetics
8L- Epi in LAs is contraindicated for Pt with multiple sclerosis ( they have high
circulating epi)
Epi is contraindicated for parkinsons patient taking levodopa because it sensitizes the
heart receptors.
95L- duration of action of diazepam depends on rate of elimination of active
metabolites.

136M- Muscle relaxant effects of Diazepam and Lorazepam is similar to Meprobamate.

(anxiolytic)
N.B the body can develop tolerance to the diazepam muscle relaxation effect.
128L- Lorazepam is not used for conscious sedation in dentistry because of its long
duration of action.
279L- Diazepam is used to Treat lidocaine induced seizures
75k2- diazepam is used to treat status epilepticus (successive epileptic seizures without
recovery)
130-Verrill's sign (ptosis) is the indication of diazepam sedation endpoint.
129L-Midazolam is better than diazepam in
Lower incidence of thrombophlebitis (no solvent as it is water soluble)
Shorter half life
No active metabolites
More rapid onset if given IM
(not less potential for respiratory depression)
132L- if Midazolam is injected intra arterially it rather than IV it will cause severe pain in
extremities.
122L- Actinomycosis Israelii causes actinomycosis of jaw and it's treated by, 10^6 units
of penicillin IV per day followed by long term intraoral medication.
123kc- before starting NO/O2 analyze vital signs
125L- a reservoir bag is used with no/o2 sedation to regulate the difference between the
constant gas flow from the machine and the pts. Cyclic breathing.
126L- NO is used to regulate the Pts. threshold to pain and not his reaction to it.
124M- toxic component of Nitrous oxide gas is Nitric oxide.
132k2- nitrous oxide is contraindicated for psychotic patient.
127L- with NO sudden irrational numbing is the sign of Pt. entering stage II of
Anaesthesia
160K- start of nitrous oxide sedation is signed by tingling of hands ( not euphoria)
43k3- most common side effect of Nitrous oxide is nausea (not hallucinations)
46kc- Inhalation sedation used for a child can be supplemented by
Hydroxyzine (antihistaminic decrease salivation and cns depressant)
(Not diazepam, meperidine or ketamine)
N.B ACE inhibitors used for tx of hypertension and CHF (Captopril and lisinopril) cause
Angioedema and are teratogenic.

274L- angioneurotic edema exhibits periorbital and lip skin swollen

N.B penicillin anaphylactic reaction are immediate and not 15 mins later.
284L- hypersensitivity reaction to penicillin is type I and II and II and IV

227L- LD50/ED50 is used to measure therapeutic index ( safety of drug)

228L- Recovery from ultra short acting Barbiturates is due to redistribution by blood (not
break down in liver)
230L- Fluconazole is given orally to treat vaginal candidiasis.
239L- Epi., levonordefrin and phenylephrine cause gingival V.C
248L- quaternary ammonium group found in structure of cholinergic agents is important
for direct nicotinic stimulation.
249L- Reduction of rest membrane potential at postsynaptic membrane is done via ACh

251L- cholinomimetics (pilocarpine, methacholine, carbachol and bethanechol)

Methacholine has stronger CVS action than carbachol.
Carbachol and bethanechol are almost completely resistant to
acetylcholinesterase
Bethanechol is selective to GIT and urinary bladder smooth muscles
(salivary stimulator and urine production)
Carbachol is used in Tx of Glaucoma and to close the pupil.
253L- Acetylcholine is a congener ( same group) as Methacholine.
254L- Morphine is more potent than codeine
124k3- oxycodone has higher risk of dependence than codeine
255L- Subgingival placement of local ABx requires ABX systemic coverage for qualified
individuals to prevent bacterial endocarditis.
135k3- auditory nerve deafness can be caused by streptomycin and gentamycin ABx.
231L- Streptomycin side effects
Competitive inhibition for ACH receptors
Reduce Ach release
Causing block of neuromuscular junction, resulting in respiratory difficulty.
25M- Penicillin V and Benzyl penicillin are secreted mostly unmetabolized in urine
258L- benzyl penicillin is excreted mainly by renal tubular secretion
236L- Methicillin is a narrow spectrum Beta lactam ABx that is not absorbed orally.
N.B Penicillin G is weaker when absorbed orally.
226L- Carbenicillin and ticarcillin is used for Tx of pseudomonas aeruginosa and
proteus infection.
237L- Ciprofloxacin is effective cephalosporin against pseudomonas aeruginosa and
proteus infection.
265L- Moxalactam is a third generation cephalosporin.
43K- cephalosporins are absolutely contraindicated with Pts. exhibiting immediate
reaction to penicillin (not any reaction to penicillin)
238L- Clindamycin effective against most anaerobes.

257L- Abx can be obtained for bacteria or fungi (but not viruses)
259L- Nalidixic Acid ( urinary tract antiseptic) is a quinolone synthetic ABx
260L- Ethambutol and isoniazid are anti T.B Abx
263L- T.B Tx is isoniazid and rifampin (because they have different modes of action)
70M- Rifampin and ampicillin ( to a lesser effect) is the most reported ABx to interfere
with oral contraceptives. (more than tetracycline or penicillin)
262L- sulfamethoxazole (Bactrim constituent ABx) has limited solubility in water so it
can cause renal lithiasis (kidney stones)
159M- A mixture of sulfonamides is used instead of just one to avoid crystalluria.
264L- Oxacillin and dicloxacillin are used to treat staphylococcus infections because
they are penicillinase resistant ABx
45J- Tetracycline is a chelating agent (can form several bonds with metal ion) i.e
interfere with action of collagenase (good in periodontitis)

134kc- Tetracycline will interfere with action of collagenase (produced by bacteria).

89k3- prolonged use of tetracycline causes
Discoloration of teeth
Superinfections
Photosensitivity (sun allergy)
Diarhea
(not visual disturbances)
267L- Demeclocycline is associated with sensitivity of skin to the sun rays
268L- doxycycline most slowly excreted tetracycline ( it has a long half life so it can be
given as a single dose per day)
299L- Novobiocin is Abx
Amantadine is antiviral agent
256L- Methylparaben (preservative) is cross allergic with para aminobenzoic acid found
in ester LAs

285L- zidovudine (retrovir) AZT is used to treat HIV infections.

286L- Aminopterin is the first drug to show dramatic remission in acute leukemia
children
278L- Pharmacokinetics and Pharmacodynamics of aging Pt.
Decrease renal excretion of drugs
Increase half life of drugs
Decrease rate of biotransformation of drugs
Alter volume of sequestration and distribution of drugs in body fat
(not increased plasma protein binding of drugs).
184k3- opioids are least likely to cause xerostomia out of
Antidepressants
Benzodiazepines
antihistamines
269L- Endogenous opioid peptides are
Endorphins
Dynorphins
Enkephalins
133M- opioid overdose is characterized by pinpoint pupils
128k- opiates are contra indicated for Pt. with head injury ( raise CSF pressure)
289L- Meperidine and other opioids are contraindicated with MAO inhibitors because
they cause life threatening condition.
57kc- ELavil (Amitriptyline) is a MAO inhibitor used as an antidepressant and has
anticholinergic effects (xerostomia)
290L-Ephedra (ephedrine) is an anti congestant banned for use in sports and commonly
misused for weight loss.
295L- Phenothiazines are antipsychotics ( cause tardive dyskinesia)
Sedatives
 Antiemetics ( due to anticholinergic action)
Block dopaminergic receptors
Alpha adrenergic blocker
Potentiate action of narcotics/opioids
(But not an anticonvulsant)
296L- Extrapyramidal syndrome (tardive dyskinesia) side effect to antipsychotics is due
to effect on basal ganglia (not brainstem)
10K- prostaglandins are derived from unsaturated fatty acids in cell membrane, NSAIDs
act by decreasing their production along with thromboxane A2
125k2- thromboxane synthetase is preferentially inhibited by aspirin and so prevents
formation of thromboemboli
N.B
prostacyclin inhibits platelet activation
Thromboxane induced platelet aggregation and arterial constriction
57K- When using Thiazide diuretics Administer K because it cause hypokalemia
36K2- Systemic absorption of lidocaine causes
Tonic clonic convulsions ( grand mal seizure)( treated with diazepam)
Decreased COP
Respiratory depression
(Not increased gastric motility)
44k2- indomethacin is an NSAID that causes blood dyscrasias ( F.B reaction in blood)
45j- Life threatening arrhythmia is treated by lidocaine
45J- Adrenergically produced arrhythmia is treated by propranolol.
93k2- Propranolol is used to treat Arrhythmias because it block B2 receptors slowing
down the heart
103k2- highly ionized drugs are excreted faster because they are less lipid soluble
229L- Excretion of Acidic drugs is enhanced by giving Pt. sodium bicarbonate because
alkalinization of urine causes
Increase of reabsorption of weak bases
decrease reabsorption of weak acids.
1J- Henderson-hasselbalch equation states that weak acids become more ionized in
alkaline Ph.leading to their decreased absorption by proximal tubules.
119k2- a tablespoon has 15 ml of liquid substance
168k2- LAs given in inflamed tissue is less effective because inflammation reduces
availability of free (non-charged) base ( which is responsible for crossing the cell
membrane)
97k3- if pt. Is allergic to amide and ester LAs use diphenhydramine.
179k2- drug biotransformation includes
Converting drug to ionized form/ water soluble form
Rate differs in different species
Occurs in microsomal enzymes in liver
191k2- Buspirone (serotonin partial agonist) is the anxiolytic that causes least CNS
depression and impairment of psychomotor skills with low risk of dependence.
(Better than benzodiazepine, barbiturates and chloral hydrate)
106k3- a hypnotic causes more cns depression than an anesthetic, to produce a state
of sleep from which one must be aroused (coma)
22k3-
If Pt. is on Dicumoral therapy, you need prothrombin time (measure of
extrinsic pathway) test before surgery.
Dicumoral and warfarin deplete Vit. K ( so no prothrombin is made)
Treatment for dicumoral toxicity is Vit K admnstration.
N.B
bleeding time assess platelet functions
Partial thromboplastin time (intrinsic pathway) used if pt is on heparin.
113M- Heparin prevents conversion of Fibrinogen to fibrin (test with PTT)
74K3- AHA recommends Prophylaxis ABx for 20kg child---1gm Amoxicillin one hour
before tx and 500 mg orally 6 hrs after tx (not penicillin v)
117k3- inhalation of 100% oxygen is contraindicated for pt. With chronic obstructive
pulmonary disease.
200k3- a covalent bond between a drug and a receptor is the least likely bond to occur.
69kc- Cyclosporin ( immunosuppressant) causes swollen gums (does not cause
melanosis)
N.B
review ADA recent guidelines for prophylactic ABx uses.
Acetaminophen + oxycodone (tylox)
Aspirin + codeine (empirin 3)
106kc- Metoprolol (B2 agonist) is a bronchodilator
7J- a healthy Pt. that experiences convulsions with LAs shot..has syncope and anxiety
(not caused by epi or injecting Las in vien...it takes more than one carpule to do that)
18J- recommended dose for children
3mg/kd of 2% lidocaine
3.2 mg/kg of 2% lidocaine with epi
37J- Diabetic Pt. act normal at first then sweat, tremors.are hypoglycemic.
79J- if pt has angina it is important to reduce stress level in appointment to avoid an
attack
89J- Meperidine (demerol) can be used as an analgesic for pt with several extractions
and gastric ulcer...as it has no effect on gastric ulcers ( acetaminophen is insufficient)