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!"rcpa,ed by M_L Thompson, Ph. D., Dept, of General Dentistry, Tufts Dental School

Pharmacology Board Review

depression, .p.DIQc.ajn~,

2005
This listor questions and topics is the result of gOing through about 10 years worth of old Board Exams in Pharmacology, cutting outau the Questions, categorizing Ihem into topic areas (e .. . g antlbiotics. local anesthelIcs, etc.), and then further grouping them into the type of information about a category of drugs thai was being asked for. When you do this, you see thai many exams repeal questions (sometimes they reword them a little bit 10 make Ihem look different!), but in actuality it is possible to get a leel for the various facts that you are expected to know, and that there aren't that many of them. As you go through this handout. you will see Ihat I point out to you the major facts that tend to get asked over and over again for the various major drug categories, and t also give you actual examples of questions (and the reworded versions), as well as the correct answer. In many cases, 1 have wrll!en out a delailed explanation of the answer, jus! to enlighten you further. So good luck and enjoy .. The downside is that these questions are from old Board exams. Some of the material is obviously dated, as drugs fall 00.1 of fashion, newer drugs get used instead of older drugs, etc, At the beginning of each section! will to indica,te some things that have changed and thus you may" want to place less emphasis on some of the questions here.

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hypotensive

shock) or 10 a specific agent such as

III. A 3rd class of Questions are aimed at your knowledge 01 the mechanism of action allocal anesthetics: Itley prevent the generation of nerve impulses by interfering with sodium transport inlo the neuron. . .. IV. The last most frequent type of Question regarding local anesthetics has to do wilh issues regarding absorption of local aneslhetics. , Remember, .QfI_IY th§ non-ioniz_~q_(o_!_[reebase form) form can penetrate tissue membranes. Inflamed iTssue"fi"as-a-lowerthan _!l_9.mlal.pH, which-dec[.eas.es.the .. mount.of l1.oIH9nized form .., a availa~le to p'i::n§!.!r~te. ' ... -

V. Usually at leasl one question cemes up asking you to calculate
how many mg of local anesthetic a patient has received, e.q. how many mg of lidocaine' in 1 .8 ml of a 2% lidocaine solution? 2% lidocaine is 20 gm/100 ml or 20 mg/1 ml, so 36 in 1.8 rnl,

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1. Which of the following is a local anesthetic subject to inactivation by plasma esterases? a. Procaine ·~lidocajhe c. Prilocaine d. Mepivacaine e. Bupivacaine

On a positive note, there used 10 be a separate pharmacology section of 100 questions. Nowadays, you might see 25,30 in some versions, other versions Jess. Unforiunately, they still can draw from the realm of pharmacology so you gol(3 review it all. However, the good thing is that since they ask fewer questions, and since they are trying to ask more clinically relevant stuff, if you really focus your efforts on analgesics, antibiotics, and anesthetics, you should be covered for the majority of questions. There are that well. they always going to be some random, unpredit:table questions means you have to review more if you want to do really Maybe you will luck 00.1, and these will be the questions are lesting and they don't count

(a) Proccaine is the only ester Iisfed - all/he rest are amide5
2.

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ine dlffers from lidocaine in that a. rocaine is a p--aminobenzoic acid ester and lidocaine is not .. Lidocaine is a meta-aminobenzoic acid ester and 'procaine is not c. The duration of action of procaine is longer than that of an equal total dose of lidocaine d, Procaine hydrochloride metabolized into diethylaminoell1anol and benzoic acid.

is

(a) this is basically a tiue-tetse type question statement that is true

(a) is the only

Local Anesthetics I. The largest category of LA questions focuses on your ability to distinguish amide LAs from esters: (This I hope is deemphasized, since amide local anesthetics are used almost exdusively now) esters= procaine, tetracaine, cocaine. All the rest are amides: lidocaine, mepivacaine, buplvacame, prtlocaine, dibucaine. also require you 10 know that qmides aremetaboli~~lil:.lil(.er,

3. Which of the following local anesthetics would be expected to produce a sensitization reaction in a patient allergic 10 lidocaine? ~. Mepivacaine ..lK Tetracaine ~ Procaine ......___,d. rilocaine P ~'e. Oibucaine

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They

(a), (b) and (c) (a), (d) and (e) Iii, .Jbja(ldJl;j only iv. (b), (c) and (d) v. (b), (d) and (e) (ii) enotber ester vs. amide type Iden/ification qaestion.lidoccaine is an amide, thus other amides will be cross-allergenic - mepivaca/ne, pri/ocaine and dibucaine are the other smktes listed. Procaine and tetracaine are esters and will not-be cross·allergenic_

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esters mainly by e. et~~~~~.E§_~m. a. ~n infre~uen.t Ques~: ~ . ks which class of drugs "fias the most consistency In structur . LAs are the drug group most consistent in drug structure, because s are either amides or esters, differing only in their structure in the intermediate chain (its either an amide or an ester) that connects theO)romatic group to the secondary or tertiary amino terminus. II. The next category of questions. has to do with toxic reactions to local a nesthatics, either due to h 19h systemic levels of local anesthetics in general (cardiovascular coflapse due 10 myocardial

9. The hydrolysis of procaine occurs mainly in the

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a.
b. c. d.

Liver Lungs Plasma
tviuSClllS

this list the only ester listed Is tetreceine.

e. Kidneys
(c) procaine is an ester:eslE/rs are metabolized predominately by pseudocholinesterases in I,he plasma,

14, Bupivacaine (Marcaine ) has all of the following properties relative to lidocaine (Xylocaine ) EXCEPT bupivacaine a. Is more toxic b. Is an ester-type local aneslhetic c, Has a slower onset of action ---=JL_ Has a longer duration of action

10, Which

of the following is local anesthetic subject to inactivation plasma esterases? a, Lidocaine e. Prilocaine c. Tetracaine d. Mepivacaine e, Bupivacaine (c) esters are metabolized by plasma esterases - letracaine IS the only ester listed, all the rast are amides

by

(d) According /0 textbooks, local anesthetics fall into the fol/owing classes in tenTIs of duralion 01 action: short procaine; moderale: prilocaine, mepivacaine, lidocaine; !0:5i, bupivacaine, tetracaine, etkioceln«. Slatements (a), 3, and 4 would be true if the queslion was comparing mepivacaine /0 bupivacaine, which are structurally similar; but the comparison is to lidocaine. The only difference thaI applies is duralion of action ((d)), bupivacaine Is longer,.. (b) is wrong, both ara amides.

11. The activity of procaine a. Elimination by the b. Storage in adipose c. Metabolism in the d. Metabotis in the plasma

is terminated by kidney tissue liver only liver and by pseudocholinesterase

in the

15. .A.mide-type local anesthetics a. Serum (5:)Uver 'c! Spleen d. Kidney e. Axop'asrn

are metabolized

in the

(b) don't forget: esters in plasma; amides in liver 1i5. The duration of action ot lidocaine would be increased in the presence of, which ot the following rneclcafions? i,; a. (""S) d. e.

(d) reme ber #9 above? see the word "mainly'? same question, ,ul worded a little differently /0 throw you off. Again, procaine i an ester; eslers are metabolized predominately by oseuaoct: lines/erases in the plasma. but also to some extent by estersr the liver.

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Praz.osm Propranolol Hydrochlorothiazide Lisinopri! . Digoxin

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12. All of the folio ing factors are significant determinants of the durafron of conpuction block with amide-type local anesthetics

EXCEPT th~ [" . .. . ",-I a. pH ol tissues In ',he 8:ea of injection
b
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Blood

nO'1 ,I,hfOU,9h,.I,h.e,area of condUC~lon. block . Concentr lion ot the Injected anesthefic solution

. Degree ori V<lSOdlla.tatlon caused by the local anesthetic Blood pla~ma chohnesterase levels . . .. ,

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(b) Ihis is an interacUon I t,es/ed you on severa/limes

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(c) the w rd "EXCEPT' should alen you thallhls IS basicafly a twe, -~,al~e, YPe, GU"estion with 4 twe slale. meats and 1 false. t sietemet: ; you just have /0 figure oul which one! In this case,

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r /.r: :".'.,' "___." n.!}\\ po/en.tia".Y accum,ulB,/e t,OIOX. leve. tc [n') r(r\.l 'i Iidoc?J!l,e_als~ compete the same
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know w~y! Propranolol inte~cts with lidocaine in two ways, Syslowmg down the heart Via beta receptor blockade, blood deliv~ry (tmd lidocain~l~./he li~er is reduced, thus lidocaine ~JIl.~!!!.S:,I'!J.~f!_sr.I:!~~_'!!!.C:_ ~/!~I.!!~t!q.n}on9.er, a~d can
IS., Propranolol and

enzyme in, the liver,

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16. Seve, re,'li~efJchseafe'TeaH'~ffec~
the following? ~ Lidocaine ~' Procaine c. Pri!oca!ne d. Mepivacaine

'the biofr~~fo;';naiion

01 which 01

you just hve 10 remember thai plasma cholinesterase levels are only important for Ihe duration of action of ester-type LAs, no! amid~s. which are metabolize in the liver. All tne other slalamen!s' are variables which affect duralion of the block, but apply~o both esters and amides

a

J 13, Which of the (allowing ls can traindicaled, for a patient Who had an allergic reactioh 10 procaine six months ago? a, Nerve bldck with lidocaine b. Topical arplicatlon of lidocaine ..........L Topical application of tetracaine d. Infiltration with an antihistamine (c) eqein, jusl another question that requires you lobe able to pick au! an ester or an amide from a lisl. Since ptoceine is ~n ester, only another ester LA would be cross-allergenic. In

(b) Answer is (b)- You should be able to recognize that all of these drugs are local anesthetics, Local anesthetics are of one of two types, either esters or emiaes. Ester types are subject to hydrolysis in the plasma and thus have short half lives. Amides are metabolized primarily in the liver and have ~/rmg~ives, Thus the blolransformaUon (e,g" melabofism; again, the rats are using a differenl word to confuse you, even though they are aSKing the same basic question) of an amide type local anesthetic would be the most alterod in the presence of sever filler disease. The key word here is "least". Of the drugs listed. only procaine is an ester. The rest are emkies.

2

Prepared

by

M.L. Thompson,

Ph. D., Dept. of General Dentistry, Tufts Dental School

Questions

regarding

toxicity:

17 A patient has been given a large volume of a certain local anesthetic solution and subsequently develops cyanosis with methemoglobinemia. Which of the following drugs most likely was
administered? fl. Procaine (.:.E]Jf;Jrilocaine c. Dibucaine d. Lidocaine e. Mepivacaine (b) s!rictly memorization

(c) same question as i;ioove just worded differently The inlraarterial injection would result in Ihe high plasma levels men/joned in the previous question. 20. The first sign that your patient may be experiencing toxicity from too muctl epinephrtne would be a. Cardiovascular collapse b. Convulsions Elevated pulse rate d. Slurred speecn-

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(c) it is a sympathomimetic after all. All the other reactions are retated to elevated .lidocaine levels

20. Which disease condition would make the patient mcst sensitive to 18. Use of prilocaine carries the risk of which of the following adverse
eHects? 3. Porphyria b. Renal toxicity (or;., Gastric bleeding Methemoglobinemia

"---b!
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the epinephrine in the local anesthetic? rave's disease Diabetes c. HIV d. Alcoholism e. Schizophrenia
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(d) same as above but asked backwards. Methemoglobinemia may result from a loluidine metabolite of priiocaine, ottbo tofuidine.

(a) Grave·s disease is an aufoimmune disease that causes hyperthyroidi§!!] - Ihe resulting high levels of circulating Ihyroid hormone result in a hypermelalJolic slate with heightened sympathetic activity, which combimid with injected epinephrine could resull in a hypertensive crisis.

21. Cardiovascular
19. The most probable cause for a serious toxic reaction to anesthetic is a, Psychogenic b. Deterioration of the anesthetic agent c. Hypersensitivity to the vasoconstrictor d. Hypersensitivity to the locat anesthetic ~ Excessive blood level of the local anesthetic

a toea I

collapse elicited by local anesthetic may be caused by 3. Syncope b. Vagal. stimulation c. Histamine release d. MYocardial depression e. - Medliilary· siiri1Ui'ation

a

high circulating dose 01 a

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(e) Most toxic reactions of a serious nature are related 10 excessive blood levels arising from inadvertent intravascular injection. Hypersensitivity tesctions (ootkme b & c) are rare. but excessive blood levels will induce toxic reactions like CNS stimulation in most everyone. This is a 'case where option (e) is the "best" answer, because it is more likely than the other alternatives, which might be true, but are not as likely (e.g, "most probable·) (0 happen.

(d) Cardiovascular collapse is due 10 a direct action of the local anesthetic on the heett muscle ilself (LA·s in toxic doses dep.reM membrane~ excila_t?J!!iY_~.lJdQ[1_(i.ucJ.iQ.,!j@!.9.0!r). c ttius (d) is the conect answer. All of the o(lJer alternatives ere; indirect ways 10 affectlhe heart. -

22. The most serious consequence

20. High plasma levels of local anesthetics may cause a. Inhibition of peristalsis b. stimulation 01 barorecep!ors resulting in severe hypotension ~c. Inhibition of the vagus nerve to the heart (=::!) Depression of inhibitory neurons in the CNS (d) initially LAs inhibil central inhiMory neurons, which results in Cf'!J.S_$mulation, which can proceed to convulsions. AI higher doses, Ihey inhibit bolh (1)ft!l?lto"(_and ex~t.ato!y neurons,·/eading 10 a generalized state oleNS depression whle!) can result in respiratory depression snd"deatii. 20a. Unfortunately. you injected your lidocaine intra-arterially. The first sign 01 lidocaine toxicity that might be seen in the patient would be a. Elevated pulse fate b. Sweating c. eNS excitation d. Cardiovascular collapse 8. eNS depression

of systemic local anesthetic loxlclty is B. Vertigo b. Hypertension c. Hyperventilation d. Post depressive central nervous system convulsions 8postconvuISive central nervous system depression (e) Of the options listed, this is the one that will kill/he patienl. which I guess makes it the most serious.

23. Hypotensive

shock may resutt from excessive of the follOwing local anesthetics EXCEPT a. Cocaine b. Procaine c. Lidocaine d. Tetracaine e. Mepivacaine

blood levels of each

(a) AJI the listed local anesthetics except cocaine are vasodilators, especiaffy esier-ctype drugs such as prcccsine and the amide lidocaine. Cocaine is Ihe only local anesthetic that predictably produces vasoconstriction. Cocaine is also

G:IBoards2005,doc

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Ihe only local anesthetic to block tbe reuptake
released from nerve endings

of NE info

e. Magnesium (a) see how many different ways Ihey can ask the same Question?

adrenergic neurons, and thus potentiate the NE that has been

24. Which of the following aneslhailc dlugs produces powerful stimulaucn of the cerebral cortex?

+=a.
b.

Cocaine

Question s rEgardfng

pH effects

on eb sorption

of local anesthetic s

Procaine Udoc;aine d. Tetracaine e. Mepiv3Giline

c.

30_ If \J1epH 01 an area is lower than normal body pH, the membrane
theory of localanesfhetic action predicts Ihallhs local anesthe lic activity would be a. Greater. owing to an increase in the free-base form of the drug b. Greater, owing to an increase in the cationic form of the drug .rk-, Less, ow!ng to an increase,in the free-base form .of the drug It91 less, oWing to a, decrease In the free-base form of the drug e, None of the above (d) the next three or four questions are ai/ versions 01 the same thing - see the explanation below

(a) see explanation

above

Questions

regarding

mechanism

of action:

25. Local anesthetics block nerve conduction by a.: Depolarizing the nerve membrane to neutrality b. Increasing membrane permeability to K+ c.lncreasing membrane permeabIlity to Na+ d. Preventing an increase in membrane permeability to K+ f'ffi Preventing an increase in membrane permeability to Na+

31. A local anesthetic injected into an inflamed area will NOT give

(!)

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(e) didn11'make you memorize Ihis? Yo~ s00uld al ke,:sl remember Na+ ions are involved, which Ilmiis your cnoices /0 (c) and (e). (e) would increase or facililale nervous impulse conduction, which is the opposite of what you want the local anesthetic 10 do, so pick (e).

maximum effects because The pH of inflamed tissue inhibits the release of the free base b. The drug will not be absorbed as rapidly because of the decreased blood supply c. The chemical mediators of inflammation will present a chemical antagonism to the anesthetic d. Prostaglandins stabilize the nerve membrane and diminish the effectiveness of the local anesthetic (a) while some of the other ettemetives sound plausible., tllink the factoids you were taught aboullocal anesfheflcs and variables that affect their action, An important one was the role of pH and ionization factors" Remember. the free base or nonionized form is the form that passes through membranes, yet once inside the neuron only the ionized for'!l isettective. Inflarnmed tissue has a lower pH than normal tissue and will shift the equilibrium Of the LA soMion such that most of it remains ionized and thus unavailable 10 penetrate

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26. Which of the following is true regarding the mechanism of action of local anesthetics? a. Usually maintain the nerve membrane in a slate 01 (">: hyperpotarization .. !~ Prevent the generation of a nerve action potential. • c. Maintain the nerve membrane in a state of depolanzat\on d. Prevent increased permeability of the nerve membrane to potassium ions e_ Interfere with intracellular nerve metabolism (b) Ihis should be really obvious!

~about

'b~'\v-:

32_ The penetration of a local anesthetic into nervous tissue is a
functlon of the a, Lengll"1 of the central alkyl chain b. Lipid solubility of the ionized form ('1;:) lipid solubility of the unionized form "'(J:' Ester linkage between the aromatic nucleus and the alkyl chain e. Amide linkage between the aromatic nucleus and the alkyl chain (e) only options (b) and (c) are relevan! here - the others have nothing to do with LA penetration into membranes. Membrane permeabifity is affected by whether or not the molecule is "charged" or ionized ornot (e.g" unionized). Only the ta/ter form passes readily through membranes. See. they're asking the same thing they asked .in the previous question. just coming at it from another angle. Remember the facl and you can cover Ihe enqles.

27. local anesthetic agents prevent the generation of nerve impulses

by

3. Decreasing

threshold for stimulation inward movement of sodium ion inward movement of potassium ion

r'C:1 Decreasing

b. Decreasing resting membrane potential

'0:"' Increasing

(c) Answer is (c)- straight memorizalfon.- nerve impul~es .are generated by the influx of sodium resulting In depotertzetior: repolarizallon and inactivity occurs when polassi~m moves out (sodium-potassium pump). LAs act by blocking Ne+ movemenl.

28. locat anesthetics interfere with the transport of which of the

m Sodium
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c. d.

following ions during drug-receptor Calcium Chloride Potassium

Interaction 35. At a pH of 7.8, lidocaine (pKa '" 7_8) will exist in 'a. the ionized form b. the nonlonlzed form c, an equal mixture of ionized and nonionized forms

4

Prepared

by

M.L.

Thompson,

Ph. D., Dept. of General Dentistry,

Tufts Dental School

d. a mixture 10 times more ionized than non ionized forms
(c) the ratio of ionized 10 unionIzed forms is given by the formula log AlAH'" pH·pKs. In this instance the difference between pH and pKa is 0, Thus lidocaine will exist as an equal mixture ( so (c)..i~ Mostloea/anesthetics are weak bases with pKa ranging from 7.5 to 9.5. LA '$ intended for injection are usually prepared in salt form by addition of Hel. They penetrate 8S the unionized form into the neuron where they reequi/ibra/e to both charged and uncharged forms inside the neuron -/he positively charged ion blocks nerve conduction.

(d) 2% solution := 20 mglml X 1.8 ml = 36 mg /idoccaine. you thought you would never have to do this stuff again!

And

33. The more rapid onset of action of local anesthetics in small nerves is due to a. The stightly lower pH of small nerves (1):'; The greater surface-volume ratio of small nerves The increased rate of penetration resulting from depolarization d. Smaller nerves usually having a higher threshold

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36. Three ml of a local anesthetic solution consisting of 2% lidocaine with 1:100,000 epinephrine contains how many milligrams of each? a. 6 mg. lidocaine, 0_3 mg_ epinephrine b. 6 mg. lidocaine, 0.03 mg. epinephrine c. 60 mg. lidocaine 0.3 mg. epinephrine o, 60 mg. lidocaine 0.03 mg epinephrine e. 600 mg lidocaine, 0.3 mg. epinephrine f. 600 mg. lidocaine. 0,03 mg. epinephrine
(d) 2% lidocaine = 20 mg/mt x 3 := 60 mg lidocaine 1 :100,000 epi " 0.01 mg/ml x 3 := 0.03 mg epi

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37. The maximum allowable adutt dose of mepivacaine is 300 mg.
How many milliliters of 2% mepivacaine should be injected to attain the maximal dosage in an adult patient?

a. 5

WhO knows? Who cares? probably the answer Is (b) - the theory goes thai there is a size dependent criUcallength of aneslhtetic exposure necessary 10 block a given nerve. Small fibers will be blocked first because the anesthetic concentration to h critical length in a small fiber will be reached faster than the eritica/length in a larger fiber. You have /0 block three nodes of tsnvler, and they are farther apart in larger fibers than they are in small diameter fibers. Make sense?

b. 10

c. 15
d. 20

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34, Which of the following statements are true regarding onset, degree and duration 0/ action olloeal anesthetics? "-! a.' The greater the drug concentration. the fasler tile onset and the greater the degree of effect b. Local anesthetics block only myelinated nerve fibers a1 the nodes of Ranvier c. The larger the diameter of the nerve fiber, the faster the onset 01 effect '-J d. The faster the penetrance of the drug. the faster the onset of effect

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38. A recently introduoed local anesthetic agent Is claimed by the manufacturer to be several times as potent as procaine. The product is available in 0.05% buffered aqueous solution in 1.8 rnl. cartridge. The maximum amount recommended for dental anesthesia over a 4·hour period is 30 mg. The amount is contained in approximately how many cartridges?

---a:--.28=36-- ..

a. b. c.

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iii. iv.

(a). (b), and (c) (a), (b) and (d) (a) and (c) only (b), (c) and (d)

(ii) if you knew the tee: above about small nerves, then this question basically becomes a true false type thing, and (c) is the false statement. (a) and (d) make logical sense so you are stuck picking between (b) and (c). You have your pick of memorizing the small nerve thing or the myelinated nerve nodes of ran vier thing, And now, lor those of you that complained have to know this stuff?" in class "do we really

(d) 0.05% = 0.5 mg/ml. To give 30 mg, you have to give 30mglO.5 mg/ml or 60 mI. 1 cartridge'" 1.8 ml, thus SOmi /{8ml = 33.3 cartridges. - first express the percenlage of solution as a fraction of 100, then Sdd the units gm/ml. 0.05% equals 0.5 or 112 gms per 100 mi. The cartridge is 1.8 ml which you can round off to almost 2 mls total. In this 2 ml you would have 1 gm of the local anesthetic. You need to give 30 gms, which would require 30 cartridges. The altemative that meets this answer is (d). Don't gel tricked by the placement of the decimal point-many people read the 0.05% as being the same as 5 gms rather than 0.5 gms.

39. According to AHA guidelines, the maximum # of carpulss of local anesthetic containing 1:200,000 epinephrine that can be used in the patient with cardiovascular disease is

a.

1

.

35. A dentist administers 1.8 ml of a 2% solution of lidocaine. many mg of lidocaine did the patient receive? a. 3.6 b. 9 c. 18 d. 36 e. 180

How

b. 2

c. 3 d. 4

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e.

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(d) the AHA limit i.s.JJM.!JJg, compared to 0.2 mg in the healthy patient. 1:200,000 equals 0.005 mg/ml or 0.009 per 1.B ml carpule. 4 carpules would thus contain 0.036 mg.

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__ ------+---:-----:--:--.::.12 mglkg tid or qid 500 mg. 2 I ."Y1. that requlre propli:"Ib:li. and neither are doses given before and after treatment . bronchoconstncuon and carolovascular collapse 6 .somi-tli:i.' . but do not kill bugs by interfering with protein synth€sfs (in bacterlal nboscrnes .. allergenicity.ilnij.gainsl certain bugs. although use Ihelatest guidelines that you have heard about)) (here's a big change obviously. dispense. pem'ciHin G: Ihe latter is more sensitive 10 acid degradatiorrarr.._" '~~..y.O mgfkg I hr prior For PCN a lIergk: Clindamycin: 600 mg (4 X 150 mg) PO 1 hr before treatment.J.a.t~_~ a.review your latest prophylaxis guidelines) I q blv 2S0-500mg..• Keflex. PO I hr before treatment _ 1/ of pills to be dispensed depends on II of appointments Examples ofpittienf cardio_~e<iiaJcoJj'4ib._. . Penicillin V vs. dispense 30.~. Bacteriostatic agents such as tetracydine limi! population growth..II. side effects or toxicities of etc: Cardiac pacemakers a. Many Questions are asked regarding -penicillios._jelr..nicillin has the best gram·negative I T.~c. 2 g. PO I hr before treatment. drug of choice against certain conditions."'tl_rfS. Ar1_t!!.:. -deficiency 3.ln fungal celt walls to weaken Ihe wall . stomatitis.dis Pe:rl sed depends on # of appointments ChildTen~:.. then 1 tab every 6 hrs IIn ti I gon e (7 days) *some sources do not indicate loading dose._ _ -------c.-•. thus resulting in folic acid -. take I capsule every 8 Amoxlcltlln I" choice: Arnoxicillin: 2 s (4 X 500 mg). take I capsule every 8 hrs until gone (7 days) Kids: 8. For example: .y_diMs..~fQ. e ryth romyci n isn't d.id_§_ compete with . so I would think they would not use too many of the~ ques lions) b.::~~1W~~~i~1~~£~~!1'~i'ifi~~~~b1~r~ctilJn Penicillin YK : Which combination of agents should be used prophylaclically for patient with heart valve to prevent bacterial endocardilis:". take 2 tablets at once". 112 hr before (Kids: 50 mglkg) Clindarnycin (for PCN-allergic) 600 mg IV 1/2 hr prior.-----1 Periodontal Surgery lrrrplants Taking Of Impressions e. since combinations are no longer used. p. take 1 q 6h until gone Kids (less than 12 yrs): 20-50 rng/kg qid q&1v Cli I\d a my cl n 150-JOO rng.m. etc. dispense 21.agents such as penicillin kill rapidity growing cells by inhibiting cell wall synthesis b.ll_~ such as nystatin bind to!ergosterol.I. Which penicillin is useful against penicillinase-producing bugs such as staphylococcus: diclo~~911In Which is specific for Pseudomonas spectrum such as carbenicillin infections: an extended . '.04 mg limit Previous endocarditis Pulmonary shunts Rheumatic fever without valvular dysfunction Mitral valve prolapse without valvular regurgitauon Antibiotics The most frequently asked type 01 question requires you to be able to compare various penicillin antibiotics in terms of potency a.l dOTI't (AHA 1997 Guidelijles) Prop hylaxis Required Prosthetic valves Prnphylaxls Not Rcqu ired c. ~~.I. Bactericidal .w/lich is just below the 0. What are symptoms seen during allergic reactions to penicillins: dermatitis...am. spectrurii' r(~+J->. kids (20 mglkg) a._ 1---------. Which drugs from a Jist are or are not cross-allergenic-with penicillin: most usually asked about ones are: _'?€ Jl ~ a~o~p~riDs and 3_r:'pi ci IIi n~re. # of pills. f_ '~~~~~. f-.'-_ .9--b_!.:f1Fii:iSTS usually injected rather than taken orally (Certainly no one in dentistry uses Pen G".___~d_rB-aGte:riosta~c agents such as Ihe §..: __.. _ /I of pills to be dispensed depends on tI of appointments non-or-al: hrs until gone (7 _days) Kids (under 20 kg): 20-40 mgfkg tid 2. so dispense 2S. PABA~ folic acid synthesis. (4 X SOOmg)._dindamycin...-.§_iT!giQillll}__andgenlamycin (1988according to latest recommendation of AHA and ADA.• Required Extractions Not Required Restorative Procedures Intracanal endodontic treatment L am..o. The 2nd largest category expects action of the various antibiotics: you to know the mechanism at Ampicillin rv!lM 2 g.

AJI of the above may be cross-ejlerqenlc Wi lh (0 (b) This Is a memorization question. Erythromycin c. penicillin V is preferred to penicillin G because penlclllin V 8.)J'. antifungals asked or ketoconazols: systemic-acting t. as erythrornyctn inhil the metabolism of drugs such a. lincomycin e.. d.s i§.pJ. Aplastic 8.J /'. Thompson. Erythrornycln e.. r: :: -.. Has a longer duration of action e.. Which of the following antiblotlcs shows an incidence of approximately 8% cross-allerqenlclty with penicillins? a.. i/ cannot be given IV or subcutaneously.J . with (b) the correct answer. so review a. More and more questions these d. associated with allergio. letracydine .s. (a) ampicillin sort of sounds like penicillin so i/ must be the answer an antiviral used for various forms ~ b.. of General Dentistry. Diffusioninlo the cerebrospinal fluid (c) agairl. Fluconazole . Telracydine is cross-allergenic with penicillin 10 Ihe pentclllin-sensltlve patient? 5. involving interactions between antibiotics and other 8 TetracycJine and penicillin (cldat-stattc lnteractlonjcancel each other out due to opposing mechanisms of action Probenecid alters Ihe rate of renal clearance of peniciltin b. J. Clindamycin d.. leading to more rapid excretion of )tJro. Is less allergenic ('"0":\ Is less sensitive to acid degradation Y Has a greater gram-negative spectrum d. but with some different alternatives thrown in.. b.\Boards2G05... procaine and benzathine salts of penicillin G is their a. J \ Which of the following anunlotcs and should NOT be administered rOll Ampicillin 'if. just asking you to know sometl1ing aboullhe various forms of penicillin. c."£~ndamyc~ WhiCh agents are most likely or least likely 10 cause superinfection: most: broad spectrum agents such as letracyclinesj. -.-..-~-.. For trealirlg most oral infections. "'~..wlIh letracycJine f.. . Dicioxaclilin G --anemia is associated with chloramphenlccl is associated d.his form. b o... (b) and (d) are all used orally. advantage of penldllln V over penicillin G is Grealer reslstance 10 peniclllinase Broader antibacterial spectrum r" ~ MOle reliable oral absorption '--c( Slower renal excretion e. i on antibiotics: Frequenfly questions 5. Clindarnycln d. b.resulling in variable and irregular absorption Penicillin V is acid slable and available for oral use. neomycin ("t. digoxin.etc. ~ha\ ag~nt produces GI upset and pseudomonas colitis: 3. Since in mosl cases you are going to use Pen VK orally.} cephalexln bacitracin d .... _. The sole therapeutic a.. Ampicillirl . The principal diHerence among potassium.__.t. vancomycin e.Pre)):lH"-d by M.tmte. ·e. 'fj.__ Acyclovir: -. None of the above (c) reworded version of the above is administered ONLY by deep 13. DEPt. Potency b.".) . Liver damage or hepatotoxicity Erylhro~¥.. ...least: narrow spectrum aqents such as penicillin Y sodium ~Penidllirl G procaine Perliclilin V potassium (c) Answer is (c). Obviously..j ._.s selcane. Questions drugs: 8.c: 7. Which of the following anfibiotlcs penlclllin? a... Penicillin G is destroyed by acid in the slomach .. In I. this question is an old one showing its age and probably not likely /0 appear anymore on board excams Effectiveness of tetracyclines is reduced by concurrent irlgestion of anlacids or dairy products Broad spectrum antibiotics enhance the action at coumarin antlcoaqulants because of the reduction of Yil'lmin K J!gurc~~ Antibiotics such as ampicillin decrease the effsctlveness of oral contraceptives (iue fo suppression of normal GI flora involved in Ihe recycling of active steroids from bile conjugates.L. You have to remember lhal the oephalosporins (like cephalexin) are chemically related /0 the penicillins. Tufts Dental School b. Ph D.Ys are being asked about antivirals and antlfunqals .~. Penicillin G procaine is typically given intramuscularly in repository form.i9".L-1. then you can handle any rewording of this question. Neomycin Cephalexin c. c":)'_'c_' /. whereas penicillin Gis not (b) memartzetion: basically the only difference 12. -.doc 7 .s~ 4.. yielding a tissue depot [rom which Ille dllJg is .(a).. c. Toxicity (C'1 Duration of action \o..isef~ffor_treatjng ca:f1d.. if you can recognize whther or not a drug is a penicillin or a cephalosporin. .. Which of the fotlowirlg penicillins mtrarrwscoter injection? (b) jus! slightly reworded version of the above question. . 11 f.'f"r·. 1(.':.'_' ~~0~. Is bact€ricidal.~!eroids from the body Macrolides such. The others are not chemically relaled and· thus cross·al/ergerlici/y is unlikely 6...! Anlibacterial spectrum e.absorbed over hours.~n hepatitis estolate "------..-"JJ'.\. and you remember thai these are Ihe classes that show cressallergenicity. G..

d. but it doesn't work against staph for other reasons. Once sensitized.. Cyclosermes 17. Remember. Tetracycline d. Methicillin carbenicillin (e) Wow. Injecting a small amount of penicillin intravenously (b) all of the other methods involve unacceptable risk._~. Penicillin V e._ Dicloxaci~ c.. For the dentist. Ampicillin is ineffective. (al. it is not a dose-related response that wonY be problematic if you only inject a little bit. Ampicillin is an extended spectrum penicillin. Clindamycin e. Taking a thorough medical history ''--c":'' Placing a drop 01 penicillin on the eye d Having lne patient inhale a penicillin aerosol e. Chloramphenicol patient? 19. Penicillin V c. if you haven '/ heard this a zillion limes by now . Erythromycin (a) same question asked backassward i. Injecting penicillin intradermally ( b. Which of the fottowing penicittins has a broader gram-negative spectrum than penicillin G? a.e. but the reason (b) is the right answer is thai/he spectrum of activity of erlhromycin is vety similar to penicillin. An extended spec/rum agent is required. clindamyc_in.. Only (a) or (c) above that produce penicillinase (e) thai's really the only use for dic/oxacillin (b) boy. Which of the following is a bactericidal antiblofic used specifically in the treatment of infections caused by Pseudomonas species and indole-positive Proteus species? a. Most anaphylactic reactions to penicillin occur a. TIle others offer a much broader spectrum of coverage than we usually require. erythromycin. When the drug is administered orally --. (c)."Peniciliin V (_~ 14. I bet you didn': think they would ask something like this!.c... Which of the following antibiotics is the substitute of choice for penicillin in the penicillin-sensitive a. Which of the followlng antibiotics should be consids red the drug 01 choice in the treatment of infection caused by a peni cillin aseproducing staphylococcus? a. Standards have now changed such that clindamycin is the drug of choice in this situation. . b.. since it tsnt a penicli/in. Penicillin V 14. Ampicillin . while Pen-v is too narrow in spectrum. even a small amount can cause an allergic response.. Neomycin b.~:Erythromycin ~~ . (d) IV. (c) . In patients with a negative skin test 10 penicillin allergy ~. Bacitracin . None of the alternatives lisled would be a problem in terms of crossallergenicity. Any of Ihe above e. When the drug is administered parenterally --. Phenethicillin (b) didnY they just ask the same Ihing in the question above? 13.b..__Iookfo!. a/ways use the drug with the narrowest spectrum possible that includes the microbe in question. and is not penicillinase resistant.. Erythromycin snouton: be affected by penieillinases._.. Oral infections caused by organisms should be trealed with ~mpiciU i. (b) and v. Which 01 the following antibiotics is LEAST effective against p . 8 . Polymyxins (b) ihet's why il is considered an "exienaed-spectrom: penicillin form of (C) Cephalosporins a.~ d.:J 16. .. In patients who have already experienced an allergic reaction to tM drug c._Jb). Which 01 the following penicillins has the best gram-nega !ive spectrum? ~Nafciltln ~picillin c. the most reliable method of detecting a patient's allergy to penicillin is by a. Nafcillin ~mpicillin ~Cephalexin d.-- 15. Within minutes after drug administration 20. But if they don't include (b) of those listed only (b) is penicillinase resislant. Tetracycline -: . b·.e. Ampicillln c.'. F"rythromYCIn d.~b). "'--. 18 . (d) (iii) memorize (~e' Dicloxacillin \...IL. Chloramphenicols (c) see above b.__ :. Methicillin d. (b) and (d) and (d) and (e) (e) only and (e) 21. Methicillin d. Which of the following groups of anlibiotics is related both structurally and by mode of action to the penicillins? a. illmase-producino microorganisms? mpicillin Cephalexin c. Tetracydine (' ::.

Polymyxin B e. but is not associated with liver damage. Sulfonamide Iit. of General Dentistry.L. arnoxicillin in bone 30. 24 The probable mechanism of the bacteriostatic action of sutto-iamides involves a. cephalosporins are chemically related to the penicillins and share their relatively nontoxic nature. . G IBoards2005.2:\ V.c. Which of the follOwing antibiotics superinfection? a. 25. Nuclear acid synthesis . Clindamycin d.J Erythrornycln esto!ate d. Coagulation ot intrace!lular proteins c. Inhibiting the formation of the cytoplasmic bacterial membrane . Penicitlm's effectiveness against rapidly grovving cells is primarily due to rts eHect on ~3. Tetracyclines have been shown 10 be hepatotoxic fo. is an antifungal agent thai produces such adverse Side effects as nephroloxicity and hypokalemia. Erythromycin colitis has been (e) tetracycline is becieriosietic and would slow Ihe rapid growth of the microbial population lhal a bactericidal drug such as penicillin needs to be effective. Streptomycin b. Erythromycin succinate (c)just because associated with an allergic 26. Penicillifl G Tetracycline Cephalosporlns e. Tetra. Reducing absorption of penicillin b. Amphotericin B antibiotics is most likely 10 cause liver <.Prepared by M. memorize rapidly dividing are the cells making cell walls 37. (d) the . Gastrointestinal upset and pseudomembranous prominenUy associated with a.cyctine ("G.. Tetracycline reduces the effectiveness of concomitanlly administered penicillin by 8. Increasing binding of penicillin to serum proteins \(J)None of the above 31. Thus (c) is Ihe correct answer. penicillin b. (e) amphotericin B. Dept. Nystatin b. Erythromycin base A Erythromycin stearate \_£. Inhibilion of metabolism by binding acetyl groups ··-e-:' Competition with para-aminobenzoic acid in folic acid '~~ synthesis (e) memorize (c) (a) streptomycin can damage the eighth nerve. Inducing a deficiency of folic acid by competition with paraaminobenzoic acid (d) same as above wordeddifferent/y 29. Tufts Dental School 22. The action of which of the following drugs will most likely be impaired by concurrent administration of tetracycline? 8. Of those listed. Cephalexin c. D. Suppressing bacterial protein synthesis b. C""" Protein synthesis on bacterial but not mammalian ribosomes ·~cr""Protein synthesis on mammalian but not bacterial rjbosomes (c) that's why it is selectively toxtc.doc 9 .. Thompson.llowing high doses in pregnant patients with a history of renal disease. The qUestion might beve substilu/ed gingival fluid for bone . Gentamicin b. sine only when (c) The only 2 possibilities [hal produce GI upset are (c) and (e). Clarilhromydn b. The sultonarnldes act by a. Which antibiotic is able to achieve a higher concentration than in serum? a. Erythromycin c. Which of the following damage? 8.that would make Ihe enswer tetracycline (c) superinfections are (/su8l1y seen following the use of broad spectrum agents.. Cell wall synthesis b. erythromycin (~indamycin ~etronidazole e.. Chelation of melal ions e. Protein synthesis ( ~eH wall synthesis 'eo---~ucleic acid synthesis d.l Penicillin \J Lincomycin (d) the classic cidal.''""d. (b) and (c) are associated with this adverse side effecl. Which of the following erythromycins cholastatlc hepatitis? a. since this is jusf a reworded version of tne same tea 23. Inducing ·the formation of "letha\" bacterial proteins .)Penlcillin G '-e: Streptomycin e. with no effecl on the liver. Ph. Disruption of the cell membrane b. affec(ing both balance and hearing. Increasing renal excretion of penicillin d. As for producing colitis. (c) is the only drug which does both. (b) other than allergic reections.. Wouldn1 you like it if your doctor prescribed a drug for you Ihat did (d)? 28. Reduction in oxygen utilization by the ce!ls d.but not liver toxicily.sialic inleradion! See above. CeH membrane permeability (b) memorize. all are wide spec/rum except Pen·G 27. Chlortetracycline acts by interfering with a. Chloramphenicol is LEAST likely to cause (c) that's why it is very useful for Ireating bone infections such as osteomyelitis. Increasing metabolism of penicillin c. penicillins are extremely safe.

Both inhibit folic acid synthesis ~Interfere sequen!iallywlth folinic acid production c. Lack of signi.. tetracyclines are broad spectrum antibiotics effective against both gram-negative and gram-positive cocci and bacilli. Crystalluria. Cephalexin might be a choice. Are both inhibitors of dihydrofotic acid reductase e.. nausea. dizziness and acute anemia b. vomiting and anaphylactic shock c. but the third generation ones have increased activity against gram-negative but greatly decreased aclivily against gram-posiUve microorganisms. 1Q per cent aluminum (a) sulfate chloride solution 38_ Acyclovir is useful for trealing a. Vancomycin (Vancocin ) b. bronchoconstrictlon and cardiovascular collapse ~Dermatitis. Ampiciilin (b) clindamycin is the current recommendation. Staph aureus c.. (a) memorize An tibiotics. Mis cellane0l!s Sulfonamides and trimelhoprim are synergistic bacteriostatic agents because in bacteria they a. Tetracyclines certainly have more side effects than penicillin. Clindamycin has a' spectrum of activity similar to erthyromycin and vancomyCin.. Cephalexin Clindamydn C. c/indamycin as an answer. and it must certainly be avoided in the ensptiytectk: patient. Erythromycin (Erythrocin ) (~hlortetraCYCline (Aureomycin) 'e. and are cerlainly one of the antibiotics to avoid dvring pregnancy_ 33. dificile u. Colitis thai results following clindarnycln overgrowth of (£_. No effects on drug metabolism 10 . Clindamycin (Cleocin ) c.IU c.. Erylhromycin d.therefore ii's the right answer.. Each of the follOwing is a side effect ot prolonged tetracycline hydrochloride therapy EXCEPT. is the most effeclive agent . VI lUo::"y't<'!I'" ". mainly affecting gram· positive microorganisms_ 1st generation cepha/osporins are effective against both gram-negative and gram·posilive organisms. <:> (e) memorize 34. Aplastic anemia is a serious toxic effect that occurs particularly after a course of treatment with which of the following antibiotics? a.. Are both anlimetabolites of para-aminobenzoic d.fections of the mucous membrane? ( a'. Rapid absorption b. Symptoms that may be characterized as allergic manifestations during penicillin therapy are a.ficanl binding to plasma proteins e. .._. L. so if you get a question that doesn't include .. Do not cause superinfectlons ". Amoxicillin e. a. bur there is the issue of c sallergencicity. Lincomycin c. litll_e aJlergeniclty Pc\ Ability to achieve and maintain adequate concentrations at V 'the site of infection d. Have no side effects b.~0Inst fungus In. hromycin. HIV CY 42. Whicll of the following substances . Candida albleans therapy is caused by an \ in the penicillin 40. Oliguria. Candidiasis b. Nystatin ointment "t:r. Deafness.. Are both transformed in vivo into a single active compound (b) 37 _ Wh ich antibiotic is appropriate for premedication ® allergic palient? a. Suprainfection b.remember. Saturated magnesium e.1 __ ~. Gastrointestinal symptoms (when administered (c) memorize orally) 36. stomatitis.. hematuria. Amoxicillin and ampicillin are penicillins! 41.~re safer to use during pregnancy ~ave a wl~er range of antibacterial activity e. Erythromycin used /0 be. ANUG (c) always think used for herpes as the first answer 32. .1 . which is less than that of tne ielrecylines... narrow spectrum.---A Ihird generation cephalosporin (d) Answerls (d). I 1. Colitis Herpes simplex d.P9... Streptomycin (0hlorampheniCOI 3·9_ Which of the following has the broadest antimicrobial spectrum? a.. Produce higher blood levels faster after oral administration (d) broad spectrum vs. look for e. Polymyxin ointment d. The mas! desirable property of an antibiotic when used to treat an odontogenic infection is a. Photosensitivily ~Vestibular disturbances d. Discoloration of newly forming teeth e.! C.... e. Penicillin b. Pseudomonas d. Tetracydine d.. bronchoconstriction and cardiovascular ~ollapse (d) 38. A distinct advantage that tetracyclines have over penicillins is thaI tetracyclines a.

Cephalexin Erythromycin Tetracycline Sulfisoxazole e.. .. thus (b) is Ihe most obvious 1st choice. \f\I1len the two type re gl loge/her.:' 46.ions ~)lq.. They are effective substitutes for penicillin prophylaxis against infective endocarditis Answer is (e)· Again.s. I asked you this on tne exam' 47.L.fUeratIon in the acid-basebalance (~jlteralion in the rate of renal clearance Answer is (d)· penicillin is metabolized in the liver.!_':::/: . the important phrase in the question is_ not (Hey.lnteracHon between penicillin and probenicid is best described by which of the following mechanisms? a. Chtoramphenicol (c) a. not an antifungal 71. The therapeutic effectiveness of which of the following drugs witl be most affected by concomitant ingestion of antacids? . Erythromycin ® c.c. and is an annoying side eHed in adults resulting from al/eration of the oral. e .. • .. a.d 14...-::" ... Thus it is most ettective against bacteria that are multiplying. ~ .. Which of the following is NOT characleristic 01 tetracycline antibiotics? a... Drug Interact. Which of the following drugs chelates with calcium? Erythromycin Potymyxin 8 (FE") Tetracycline '"""d~ Penicillin G e.it stays unmetabolized and causes cen. The causalive bacterium is not susceptible to penicillin or erythromycin. whereby e. gas/ric and intestinal flora. Dept. . (d) & (e) require en antibiotic..... />' ..l 11 .. such ~» Antibiotics. Thus patients with renal disease will Show high-blood levels 01 penlcillin.: I G: IBoards2005 .. eO. since erylhromyctn decreaSes lhe metabolism of so many other useful drugs. the anticoagulant action may be a. The concurrent results in a. .""'. renal excretion of probenecid renal excretion of penicillin G bactericidal effect of penicillin G excretion of probenecid in the feoes (c) (b) Nystatin is the prototypic antifungal agent. 45. The real answer is (e). Thompson.." T~L. Remember that these druqs ate antagonistic 10 each other and tnus cent be used concurrently.. They form a stable complex with the developtng tooth matrix d.i-o<~rr " ~~'~ --::' . 15-20% of group A streptococci are resistant 10 tetrscycllnes._U~-. 43.rythromycin blocks the metabo.. of General Dentistry. This is due to streptococcal infection. Similarly. Obviously the feet that you will remember about letrecy/ines is Iflat they can discolor ieett: in the fe/us when taken by the mother during pregnancy. D. And you wondered why we had. 44.. probenicid.it can ~ do this iI isn t going /0 be very effective. penicillin resistant treating lntecuons gram poshive infections (p metabolism of penicillin G. cell membrane or both. They have a low tendency for sensitization. '". d./ismof setoene to its antihistamine metabolite . but none are resistant to penicillin or erythromycin. Penicillin is a baclericidal drug which kJlls or destroys microorganisms by interfering with Ihe synlhesis or func/ionof the cell wall. therapeutic index .. Tetracycline is a bacteriostatic antibiotic that y inhibi!ing the growth and multiplication of organisms y innib ing protein synthesis by binding reversibly to e 30 S bunit of the bacterial ribosome. Absorption is impaired when taken with antacids b.... '. competition at the receptor site b. It may be nscsssery 10 treat predisposed patients wilh tetracycline for a few weeks.. should be avoided in the patient taking Aspirin Seldane Benadryl Ibuprofen Propranolol (b) remember Ihe famous erythromycin -Setosne po/entially Ie/hal interaction..L ~. Increased Increased Decreased Decreased e. RedUCed because of enhanced hepatic drug metabolism Reduced because of increased proteln-blndlng Increased because of reduction of vilamin K sources tncreased because of decreased renal excretion 01 the anticoagulant Vir.. L ~ .. reduces the renal clearance of penicillins. Increased administration of penicillin G and probeneci. and eliminates (a). a uricosuric agent (a drug which tends to enhance the excretion of uric acid by reducing renal tubular transport mechanisms). Tufts Dental School (c) if .J:. When broad-spectrum antibiotics are administered with coumarin anticoagulants.Prepared by M. Penicillin V (c) hey. :y.. 90% is excreted by lubular secreticn.doc ·o. just Wayne and Garth). e. But don't circle that answer because (a) is also cnerecteristic of tetracyclines (they are the most likeiy of all the antibiotics to cause superinfection). . especially in juvenile periodontitis patients. acceleration of drug biotransformation . Recently a nonstreptococcal induced subacute bacterial endocarditis has been identified. those lectures On pharmacokinetics! 42. (c) -I ./... Nystatin is of greatest clinical uselulnessin ""--2 a viral infections ( 'Ojfungal infections spirochetal infections d.. and then folJow this with a course of penicillin or erythromycin. a. Ph. . Tetracyclines are not the drug of choice for prophylaxis against infective endocardifls. Baoterroldss e. their effeci'fveness is negaled or redu ed.K . but a high " . Of course tbis question could have many olher opl/ons listed..bul it rapidly disappears from the blood due to rapid clearance by the kidneys. b.. They predispose to monilial superinfection c.fiac autbvmias.

reduces cardiac output '. 1) Oluretics such as the high ceiling or loop-acting diuretic.iso have weak dilatory actJon.. ' Diuretics: ~se the renal absorpJj9.r' <.Q[Q!g_I: selectj~eta::-l bloCker.I]l. Hypertension Angina pectoris Atrial fibrillation Ventricular fibrillation e. 1. -.acting: furosemide ) Potassium sparinp: spironolactone heart tenure drugs.I~~. reducing afterload by reducing peripheral resistance via vasodilation Antihypertensives: Remember.' 1\. 2.09P.u!J1.11f)ir:. Clonldrne: selective agonist stimulates alpha-Zraosptors ~A. Hypertension b.) is the drug of r:..chronotropic responses to endogenouiepTnephnne.D_QL~Q. ~~--. This is achieved by an inhibiUon of Na+.--'. increasing the force of contraction of the myocardium.!_(paroxysmal tachycardia) a. Angina pectoris . ~.Qml: ads cenLrally as a'fiilse'ii-e-urorraFismitler stimulating <wh'i:!'re-ceptors to reduce sympathetic outnow ~.(ll!!. Digitalis (atrial fibrillation.. arrhythmias: ~. Quinidine is classed as an antiarrthymic dn.b 4) Veraparnil (supraventricular tachyarrhythmias.~ 5) Neuronal blockers such as guanethidine (reserved for severe h ypertension J' 6) Angiotensin converting enzyme inhibitors such as Captopril.j1.... r ~ Congestive heart failure: Glycosides ACE inhibitors such as captopril such a&~I.._ .d.. Prazosln: selective aipa·1 blocker. 2) Beta-blockers such as propranolol or the cardioselective beta blocker metoprololor aler'iCi1Of 3) Alpha-t blockers'such'as-pr:aZoSln. Thiazides: chlorothiazlde b.--. calcium channel ..Cardiovascular Drugs This category covers a lot of drugs and a lot of Questions.. r~_~~t~g. "3( Quinidine (supraventricular tachyarrhythmias. Inhibit!! binding of nerve induced release of NE resultingm-va~ b.- converts angiotensin) to angiotensin II.. Digitalis therapy reduces the compensatory changes that are associated with congestive heart failure such as Increased heart size. i 2). H-: d. Propranolol reduces oxygen demand by preventing .. - 2.. _Mi1. atrial • fibrillation)... Angina is primarily trealed with nitroglycerin. oxygen to meet - Nitroglycerin increases oxygen supply to the heart by a alrect vas6OilatoQ'_action on the smooth muscle in coronarya.. _I~. paroxysmal tachycardia) 6) _F'~p!~~olo. '.. while digoxin (digHnlit. They can be categorized as: 1. 11 u! 1-81 . Type lA agents such as qujnLd_lo. It also has an antimuscarinic action preventing the bradycardia that follows vagal stimulation.l II fi\ I ' p( ! a. in t1ie CNS to reduce sympathetic outflow to peripheral b¥) ~l._ __ -- - . K+ ATPASE leading to increased calcium influx. just gave you 8 differenllype of 12 .?: cts by increasing a the refractory period of cardiac muscle Type 1B agents such as. •.{_. atrial fibrillation). Types of diuretics which may be mentioned include: voiUnle.i7. The lattsr is a potent vasoconstrictor (administration of angiotensin will result in an elevation of blood pressure).:teri es b. emotions and exercise.lo.\'Y"':(.lldocalne decrease cardiac excitability -. Quinidine is principally used to treat a. Phenytoin (to reverse digitalis induced arrhythmias). II reduces alllomaticity and responsiveness and increases refractoriness. S. Remember problem is that the heart beats '------'_ 'Orug-condition questions c... c.ta!ls~digOxin.l!) ~?_§9~~lation..~ril_ -angina: Nilroglycerin..£~i" 'J. Congestive hear failure (e) same question 8S above.. .. '... Adrenergic Agents: trl(f1Cl" ")"\::C('f}i-y7 f~i"". Wl1e'n'"digitalis is used for atrial fibrillation it acts by decreasing the rate of A·V ccnduction . 4) Centrally acting adrenergic drugs such as methyldopa or clonidine . propranolol: nonselective tleta block:.' b. most drugs have the ultimate effect of reducing peripheral resistance via vasodilation ACE inhibitors: Captopril blocks the enzyme which (d) by elimination. Quinidine is used to treat a.r)./..j reduces cardiac j t{ . etc..iaj. sometimes blockers' such as'verapamil propranolol..hus t resulting in fluid loss and a reduction in blood This decreases the work the heart has toi:iunip~ )'..---c.rj: . f\.. Cardiac glycosides such as digitaliS or digitoxin are effective because they have a positive inotropic effect. Ant:2ngjrt3 dn.1) Lldocain!?jventricular arrhythmias)._ Congestive hear failure C d. ~p~roxysmal tachycardia. edema.~ for congestive heart failure.. Congestfve H~~~-=-~~~i~_g_:Jr . . Questions asking about which drug from a lisl might be used to treat a certain condition: hypertension...i.~ vessels resulting in vasodila-tion-··_ .. HypertenSion ((a)) is trealed primarily with beta blockers such as propranolol. The second major category of questions mechanism of action of the various agenls: Antiarrhythmics: irregularity a. . Calcium channel 5lOckers decrease oxygen demand by .!. ~rurosemide.g (Type I-blOCKSsodium cbsnnets)..!gs: problem is insufficient demands of myocardium a. concerns a. /'Supraventricular tachyarrhythmias . rate..')JJ .l.f"i)J output and inhibits renin se~ e.

0 .. . f • \. ~apamil is most efficacious Atrial fibrilla lion Atrial tachycardia c. Suppressing SA node impulse formation d. Digitalis b. Congestive heart failure ~ Paroxysmal atrial tachycardia l~AII of the above (d) . Sedatives and reserpine Thiazide diuretics and reserpine Sedatives and thiazide diuretics Guanethidine and ganglionic blocking agents (d) 4 /"f. . ~ :f ~ J. Propranolol c. .L.. such as quinidine.. Nadolol Timolol Mstoprolot Propranolol (c) receptor blocking agents 5.."'e:') Aminophylline " 14. Pentaerythritol tetranitrate (a) and Mechanism of Action Questions Antiarrhythmics 12. . Digitalis is useful in the treatment of which of the following conditions? a. Increasing spontaneous pacemaker activity 9. I' (\t)).. Antiarrhythmic drugs. Most drugs useful in the treatment of cardiac arrhythmias act primarily by a. b. ~j. The a.-~. '. Calecholamine-induced . g.. i r ~~"l' .." --.' ._. D. '#. c..J (\p :7i .>'... 8.. Stimulation of the beta-adrenergic receptor Increased refractory period of cardiac muscle G . Ih-j . Pentobarbital (e) 11.. All of the following drugs are useful in the treatment of cardiac arrhythmias EXCEPT a. • :. r:: I . Thiazide diuretics (a) 0 o 61 Jr t/ '-</7. Ephedrine ---0--. Thompson. drug of cholce for initial therapy for mild hypertenslon Reserpine Guanethidine Phenobarbital is V...(e) I VI . suppress certain cardiac arrhythmias by a. Stimulation at cardiac ATP-ase activity c. Blockade of Ihe vagus nerve b.. Which of the following antihypertensives treatment of severe hypertension? are usually reserved lor (a) memorize A ~ drugs is most useful in treating or preventing a. doc 13 ...Prepared by M../ (:7:/ . Alpha-methyldopa in the treatment of 3.-'iJ~ Procainamide e.:.'.. Procainamide ..Lr . Which of the following beta-adrenergic . Dept. Quinidine Propranolol . a> ' 15: arrhyihrnias 10. of Gene fa I Dentistry. Blockade of the Beta-adrenergic receptor d. Causing a positive inotropic effect ncreasing the refractory period of cardiac muscle ~c:_.} .': •• e t: - ~j . Nitroglycerin d..::L q/'/ '---I""' 13. .. Lidocaine c.~..~ !. Chlorothiazide e. Phenytoin >1.l I I ' '. Blocking the alpha-adrenergic receptor c..\ Which of the following angina pectoris? a. Methyldopa d. b.. is thought to be cardioseleclive? a. • i . ThJinosl Important phkmacologiC acti~~ of drugs that suppress cardiac arrhythmias is a. 7. All of the following drugs are useful in the treatment of hypertension ~EPT ~ a:-<.\0 card 52005. .Reserpine c.. Blocking Purklnle fibers b.. Lidocaine prcduces its antiarrhythmic effects by a. j '\ I .. ''-1 J . V¥1 I! 7 I B· l "J].~!~ ._.~ ~Y. Ph. Atrial fibrillation b. Tufts Dental School arrythmia d. ... Suppressing cardiac ATP-ase activity ~ Increasing ectopic pacemaker activity \_J Increasing the refractory period of cardiac muscle (d) 6. <""\. Ventricular tachycardia U. (e) (e) 1 S. Isosorbide dinitrate e. G . Each of the following drugs can be used in the prevention treatment of angina pectoris EXCEPT \_~ DigitaliS b...! _. ! f. Digitalis b. Stimulating the beta-adrenergic receptor b.. Increasing AV conduction (i)\) Decreasing cardiac excitability Increasing cardiac conduction velocity d.

depresses cgrdiac excitability. How the heck are you supposed 10 remember all of/his? Antiangina 17. The: mas! useful diureUc drugs act by ~ Increasing fhe g10merular filtration rate ~ Decreasing the rena! reabsorption of sodium c. Bradykinin metabolites d. vasoconstrictor. Ihusslowing the heart down. so ipso fa c/o. - 20_ The primary antihypertensive to accumulation of Serotonin a. Blocking beta-adrerrerqic receptors (c) 1 S_ Propranolol is of value in treating angina pectoris because it a. accumulation of angiotension J is the usual effect Cap/opril also maintains lowered BP by elevating bradykinin (which has poten: vasodilatory aclion) in the blood by blocking its me/abo/ism. The refractory period of cardiac muscle is Increased. A sedative effect b. how can you have an option (f)?! (a) is how diuretics lower BP.2)Direct action on smooth muscle in the vessel walls Q Increasing the etfective refractory period in the alrium e. Exacerbate existing diabetes e. the therapeutic objective is to a. r~b·· Angiotensin I ~ Angiotensin III c.(b) arrhythmias are defined as any abnonnality of the normal sinus rhyihm of the heart due to disease or injury induced damage 10 Ihe impulse conducting systems_ They also result from the development ofec/opic pacemakers or abnormal pacemaker mytbms. digitalis glyOJsides e. a local enestnetic. Administration of angiotensin results in a. Thus (c) Is wrong. (b) Gap/opril is an angio/ension-converting enzyme inhibitor ttie: blocks the activation ofangio/ension I to angiotension II. Digoxin exerts its positive inotropic effect by 14 . reabsorption ot sodium? Urea Chlorothiazide Theophylline d. Nitroglycerin dilates the coronary arteries in angina pectoris by a. Increasing the secretion of antidiuretic hormone (b) people with high BP am always lold to reduce set! intake. answer (b). When digi lalls is used in atrial fibrillation. since high sodium levels cause fluid retention whiCh can increase BP. ~ ~ e. Produce a decrease in the rate of atrial contraction (c) Mechanism of Action tuuretk:« Drugs 22. The decreased blood concentration of angio/ension If reduces blood pressure.. Inhibits oxygen metabolism in cardiac cells Provides relief within seconds of an acute anginal attack Prev~nts chronolro~ic responses to endogenous epinephrine ~ emotions and exercise L rT~ (e) ACE Inhibitors 23. because angiolension /I is a po/ent Cardiac Glycosides 25. Increase renal excretion of potassium c.asing the renal excretion of chloride d. Has a direct action on vascular smooth muscle b. Administration of angiotensin results in a. Decre. which would rela(e to option (d). 21. Drugs such as lidocaine are used /0 nannalizs these rhythms.and 16. reducing renal reabsorption of sodium makes BP go down 19. bradykinin metabolites do not accum. which is conveniently option (e). Increased heart rate Increased blood pressure Antihlstaminic effects Antl·inflammatory effects (c) I guess because more angiotensin that is a potent vasoconstrictor II would be tormec. Decreasing the heart rate reflexly b. Cause hypoglycemia (I) first off. Blocks autoregulatory mechanisms in the heart c. Increase the toxicity of digitalis d. Which of the following drugs act by inhibiting renal. Procainamide (b) same question as above. Increase renal excretion of sodium and chloride b. Lidocaine. All of the a/her alternatives given would exacerbate the arrflylhmia. Thus (d) is wrong. (b) is why they can cause hypokalemia. Inhibit va'gai impulses 10 the heart fC:)Decrease the rate of AN conducnon ~ Increase the rate of carciac repolarization e. A sedative effect (c) effect of cap/april (Capoten) is due 24. and hypokalemia can potentiate digitalis induced arrythmias optionee) Theyy apparentlyean also cause hyperglycemia. Increasing Ihe renal reabsorption of potassium e. Antl-inflammatory effects b. Antihlstarnlnic effects ~~3~~ o ~~~~:~~:~ i:l~ssure e. Increasing the metabolic work of the myocardium . Cause hypokalemia f. AbOlish cardiac decompensation b. just revereea. Which of the following is NOT characteristic of the thiazide diuretics? 8.ulale.

Block beta-adrenergic receptors b.rnescle is an increase in '<. but acl by different mechanisms. which is the failure of tile heart to rune/ion adequately as a pump and thus maintain an adequate circulation. is the drug with central action.-. Guanethidine (a) All of these drugs are used to treat hypertension. Inhibit formation of angiotensin II c. (a) is tn« way epinephrine works. (b) and (e) (a) and (e) only (e) and (d) (e) only All of the above \~~/) 29. Calcium d. (d) propranolol blocks bela receptors in the heart. v. Refractory period of the atrial muscle d. (b) metroook» is a selectively blocks be/a-1 receptors in the heart /0 reduce cardiac output. \Board s2 005.L Thompson. Potassium of which 34. The cardiac glycosides will increase the concentration ion in an active hear! muscle? a. Which of the following owes a significant amount of its rhypertensive effect to a central action? Melhyldopa Metoprolol c.~ (a). u iii. (a). . doc 15 . Inhibition 01 pnosprornesterase _. d:\1 nhibilion '-----------in IIu x of Na +. A decrease in rate 01 the hear where tachycardia exists i. while (e) guanethidine prevents t~ase and causesdep/eljon of catediOiamines . Which of the following ions augments the inotropic effect of digitalis? a. with a desired effect of increasing Ihe force of contraction of Ihe myocardium (e.silii'Gf. Ph. C:. Activation of adenylcyclase b. The mechanism of action 01 prazosin. Hydralazine d. A decrease in end-diastolic pressure c. Which 01 the following drugs is Ihought to reduce arterial blood pressure by activating alpha receptors in the vasomotor center 01 the medulla? r1\ Prszosin \_) Clonidine G. D.Has a positive cardiac inotropic action Adrenergic Agents '. Force of contraction ~en(riCular eXCitability c. Inhibit nerve-induced release of norepinephrine StimUIate central inhibitory alpha-adrenerplc receptors Inhibit the postsynaptic action of norepinephrine on vascular smooth muscle (e) 33. Refractory period of the varurlcular muscle E'.c_ An agonist effect of bela-receptors '. c. Tufts Dental School 8. an antihypertensive (e) 27. e. Is primarily a diuretic b. A decrease in central venous pressure 8. g. Edema .Remember. Chloride e. Oecreases abnormal cardiac rhythms d. While several of Ihe eltemetives involve calcium. cardiac g/ycosides such as digoxin are used in the treatment of congestive heart failure. the way digoxin does it is via (d). Heart size ~'d. Rate of conduction of impulse to the muscle (a) 0 agent is to a. Reduces the ventricular rate c.---> 32.e. Calcium Chloride Magnesium (c) 31.-Heart ra te ". inhibilion of Ne+. methyldopa.~.[s:·re/eased like a false transmitter: 1/ 90@~J).1ijk~n up inlo. Digitoxin is effective in lhe treatment of cardiac failure because it 8.it alters eNS control of blood pressure by acting on cardioregulalory and vasomotor systems of the brain by stimulating alpha2 receptors in the brain stem. (b:"'Vrine flow .sTt1e.. K + ATPAS E leading 10 increased calcium 3~. iv. Decreasing tile amount of calcium available for excitaUoncontraction coupling Answer is (d). Produces peripheral vascconstrlcilon l~c'e:--'. Dept of General Dentistry. K+ ATPase. and a sobsequent enhancement of the contractile mechanism. file inotropic effect). 28. A decrease in end-diastolic volume b.91 cross the blood-brain barrier. Sodium b.Prepared by M. Residual diastolic volume (b) 26..a. (ewlling in an increase of calcium ion influx into the cardiac cells. Sodium Lithium e.stor. digitalis glycosides generally decrease all of Ihe following EXCEPT a. Cardiac glycosides are thougfl/ to acl by altering cekium ion movement. In the treatment of congestive heart failure. Bromide c. The beneficial effects of digitalis in congestive heart failure result in pan from the fact that digitalis causes a. An increase in stroke volume and cardiac output d.. Propranolol e. (c) hydralazine bes a direct action on vascular smooth muscle 10 reduce hypertension via vasodilalion.. The prima')! action of therapeutic doses of digitalis on cardiac . Clonidine is the usual drug that is Involved in [his particular question.age ~v-.

thus any answer with eltemetive a (i and ii) is wrong. Similarly. Relaxation of bronchial smooth muscle . receptor blocker. Thiazide c_ Mercurial d. Lidocaine Spironolactone h lorothiazide cetylsallcyllc acid (d) Chfot1hiazide is a diuretic which causes potassium loss or hypokalemia. How the hell are you supposed to remember all of 16 . Thus ii. (d) answer is (d). \ The release of renin from juxtaglomerular cells 'tI:--The release of norepinephrine from nerve terminals /'e. ~::~. f':'\~~\!j_::)JJ '-. Decreased P-R interval (e) ~o. acts via this mechanism by stimulating alpha-..straight memorization. Diazepam b. Symptoms of digitalis toxicity indude all 01 the following EXCEPT a. I 1- 36_ One of the proposed mechanisms of the antihypertensive bela-adrenergic receptor blocking apents is a. This resuns in greater penetration of digitalis into the myoceraium. Guanethidine e. This leaves (v) as the only possible right answer. . Extrasystoles b.c. Nausea and vomiting c. (v) Answer is (v). An increase in cardiac output (e) effect of (2 37. ill. High-ceiJing ~~O_OJJ'J~-C.it has no effect on NE reteese.lnereased cardiac output "-r::_/ Decreased diastolic pressure d.see above explanation this stuff??? 35_ Propranolol (Inderal) can be useful in the treatment of hypertension because it blocks a.deafness is typical!y associated with use of ethacrynic acid. 41. d is wrong as well-propranolol is a competitive beta. iii. a loop or high-ceiling diuretic. Decreased peripheral resistance e. iv. Propranolol d.You should immedi8/ely recognize Ih8/ proptenoto! is the pretotypic bela-adrenergic receptor blocker. v.2 euioreceptors. Another drug used for hyperlension. Chlorothiazide (b). The reflex tachycardia seen with the use of other ' -' antihypertensives i_ ii. (d) and (e) (c) and (e) only 39.L. Sodium reabsorption in the kidney (C.L (b) Miscellaneous Side Effect Questions in 38. (a) and (b) (a) and (d) (b). (e) and (d) (c). Yellow-green vision d. aside from blocking bete-t receptors. Indeed.. Sedation b. blocking of renin ra/ease is thought to be the other mechanism whereby be/a-blockers alief nypertenston. Selective beta-l adrenergic agonis!s will orocuce which of the following effects? Glycogenolysis : b'. Clonidine. Administration of which of the follOwing drugs increases the likelihood of a toxic response to digitalis? 2. A diuretic effecl ~IAn anlirenin effect YA vagal blocking eltecl e. Alpha-1 adrenergic receptors b. and tv are wrong. A-V conduction block e. and thus po/ential toxicity. Osmotic b. Ototoxicity with deafness may encountered occasionally patlents laking which of the following diuretic agenls? a.

.and 3) between aspirin and ibuprofen. as in (c). 6. Umblc system e. Depression of oxidative enzymes leading to decreased heat production d. Anti-lnflarnmatory hemostasis a. such as aspirin. Adverse or toxic effects include all of the foltowing: occult bleeding from the GI tract. Analgesia leading to sedation Increased blood flow through the hypothalamus f. b.:.-causes much tess Gt irritation 4) Difiunisaf (Dolobid) has a longer half-Ilfe than aspirin.'. Frequently asked questions on NSAIDS AtfirV .r ih ': i.increased risk of Reye's syndrome) 8. osla. Inhibition of bradykinin in the periphery leading to sweating c. \VI" " f_1. 2) aspirin and other antiinflarnmatories like prednlsone.... reviewing these questions are stitt useful -. 1. b... Inhibit the synthesis of prostaglandins Competitively antagonize prostaglandins at the receptor sita aspirin inhibits the synthesis of AntipvretlC effects: aspirin lnhlbils PG synthesis in the hypothalamic temperature. delirium. because of the many side effects o( aspirin that turn up in these kinds of questions. Tufts Denial School Analgesics1. Mechanism of action questions effects on bleeding: Analgesic etiects: prostaglandins NSAIDS: regarding analgesic. Therapeutic effects of aspirin include pain relief. and does not cause GI upset 2) Anti-inflammatories like prednisone.':1" t.glandin synthe~is in the eNS affecting r hypothalarnic temperature regulation b. . of General Dentistry. Thompson.·n. (Which of the following is a COX·2 inhibitor?) 5.. etc. Uncouple oxidative phosphorylation 9. 4.. Newer versions of the boards have questions sbout COX-2 inhibitors like vioxx. Thus. So since aspirin is the comparator prototype drug.Prepared by M.. d.doc 17 . ./1 I 'Jf'\". but you have already eliminated /hal choice because i/ aoestit mention prevention oiptetetet aggregation. the right word is pros/aglandin. . while (e) is how coumarin workS.:-Depression 01 oxidative processes leading to decreased heal production ~ (c) 3.~. Brain stem Hypothatam.0 5. antipyretic and c. (d) is how heparin works. salicylism. even if you didn'l remember that Ihromboxane A2 induces plalelel aggregation. especially when combined with eleoho! or taken in excess of 4 grJday. antirheumatic and antiinflammatory effects. acetaminophen and ibuprofen 1) I· 1!LWL. They hope (0 confuse you by using prOS/Beylin. decreased tubular reabsorption of uric acid. Acetamin ophen is the drug of cbotce for the feverish chi/d{they usually ask the reverse. of aspirin's central antipyretic effect is the n a.this limits your choices /0 (a) and (b). • ". and aspirin blocks this action.use a. Ace taminophen causes liver toxicity. The anupyretic action of salicytates Is explained in part by a. tinnitus.'" . These old questions focus a 10/ on aspirin. d.us ~ Basal gangl18 d. is n. which is which drug should be aVoided in the feverish child (aspirin. you could get the answer by elimination. The locus ?I actiO. Temperature regulation cenler is in tne hypothalamus. Suppression of chOlinergic mediators in the hypothalamus e. Acelamin. regul'ation center Bleeding time: inhibit synthesis platelet synthesis of lhromboxane A2 preventing (5 lts from Inhibition Of.epatotoxlC. Dept. A patient who has been taking targe quantities of aspirin might ncreased postoperative bleedin.(:D 7. A third type 01 question focuses on the dlfferenoe between 1) aspirin and acetaminophen. but of course you know that this is wrong immediately. hyperventilation. c. SUmulation of norepinephrine in the hypothalamus (a) 2.?phen tacks _ a\o activity. 'f' u.pr~. i) Q.pirin lnhibits s Synthesis of thrombox..triarncinolone etc..9 beca... r.L. 4. absorption of vitamin Kand prevents synthesis of blood ciotti n 9 fa ctor s (a) Tne first fact you must remember is that aspirin pre venls platelet aggregation.1. hydrocortisone. Activate autonomic reflexes b. c. (-11'/1 U' f . D.7. n v. The therapeutic effect of the salicylates is explained on the basis of the ability of the drug 10 a.< . agents. antipyretic effects. nausea and vomiting.). A 2nd type of Question has to do with pharmacclopical or toxic effects of aspirin: you get to pick which of the list is or is not associated with aspirin. Nowadays...J ~I"'.J. b. acid-base disturbance Of metabolic acidosis. interfere with by Acllvating antithrombin Preventing vasoconstriction G:\8oards2005.ane A2 and prevents platelet aggregation Synthesis of prostacyclin and prevents platelet aggregation Synthesis of prostaglandin and prevents production of bloon platelets Thrombin and prevents formation of the fibrin network G.rl· !. The mechanism of the antipyretic action of sallcylates probably -:-. e.. 1) But expect newer questions asking you to know: a.remember afllipyresis means antifever.y-yutaneous vasodilation leading to increased heat loss "'--d. Cerebrat cortex -"·l~ (b) memorizaUon question. e ceteminoph en and ibuprofen are used much more commonly than aspirin.D.!. Ph. are steroids and do not act primarily by PG inhibition 3) "ib.

---(e) X . Answers 2-5 are all non-st·eroidaf an/iinnamma/ory drugs which cause gastric imtstio» and bleeding due to their effects on prostaglandin synthesis in the mucosal wall of the gut.buprofen ~robenecid c. ~.. Diflunisal b.§ question on boards is the production of a . Delirium b. nole the difference in Ihis question and #11 ami 12. Jr. so much that use is limiled in humans. Oinunisal is a salicylate analgesic. The answer is ibuprofen Tricky . .with gastric 17. henytoi~ a. 10. -. (b).~ Inhibibng thrombin genera~on Inhibiling platelet aggregation Inhibiting polymerization of fibrin (d) Well. because it doesn 1 cause Gf upset.. you should really know Ihal acetaminophen is uwally Ihe enswer to these types of analgesics Questions. Reduction of fever \ b.J e..) ("11 f1 Ibuprofen . but high doses can cause ailihe olher effects listed.. pettieps you may know Ihat alcohol also causes GI imtation. iii. Prolonged use of which of the following drugs does NOT cause a predisposition 10 gastric irritation and bleeding? a" effects of aspirin include Analgesia Tranquilizailon Pyretic acton Anti-inflammatory action Antirheumatic action (b) (e) (d) (e) (c) (d) (e) (d) (e) b. Analgesia c..acs. " (a) This is a straight drug identification question. '... bul if you didn I know thai. acetaminophen.. Metabolic acidosis (c) il only lowers your temperature if you have a fever" laking aspirin does not have any effect on body temperature in the non-feverish patient. so it is out.J. Each of ine fOllowing agents has been associated irritation EXCEPT a.. Aspirin b. What about alocohol vs. (a). (a).'J. Tinnitus b. L... phenytoin. Which of the following is NOT produced by excessive doses 01 acetylsalicylic acid? a.. Ibuprofen was previously the answer 10 "shows reduced GI irritation".. Pentazocine d. Corticosteroids inhibir phospholipase A2.~ (iii) . but it does cause some.. b.-_""". Q) and and and and v. the enzymatic step that precedes prostaglandin synthetase.-.~/Q_".-of/en_ i)pp. At! of the following are pharmacologic and toxicologic properties of aspirin EXCEPT a..ti [~/ f'r.-... Phenylbutazone (a) you might be tempted /0 answer acetaminophen.3.. like espuin. So aspirin and ibuprofen are out. c.you had 10 sort through two distinguishing characteristics.J.-'. . but remember it is also notenninflammatory. Phenylbutazone '-_' . Indomethacin Acetaminophen . Salicylism ~n!ipyresls ~ Suppression of the immune response r~ (e) 16. Indomethacin is a vel}' strong NSAID Ihat causes lots of GI im'talion.. so it is out.. inhibition of prostaglandin synlhesis (d) -.<J.-J"".' '-e>. Acetylsalicylic acid Y 14. is an anti---convulsanl~i/s major side ettec: that . (d) and l.G. Analgesia ~ Antipyresis ~Melhemaglobinemia e. Suppression of inflammatory response d. (a). e. Tinnitus b. Which of the following antl-lnflarnrnatory agents does NOT act primarily by inhibiting activity of prostaglandin synthetase? a.. (c) triamcinolone is a corticosteroid. which you have /0 remember to answer #12 and this quesiion. anti-inflammatory agenl that appears to produce fewer gastrointestinal disturbances than high does of aspirin is .'7:~). Acetaminophen e. ~ ~ 12. Ibuprofen d. All of the following are pharmacologic or toxicologic properties of acetylsalicylic acid EXCEPT a. Shortening of bleeding time c. Indomethacin f\\\-(\-tl.. #.~". Tinnitus /£\ Hypothermia Y Hyperventilation e.w--~v ). Bleeding from Ihe gaslronintestinal tract Ulncrease in the renal excretion of uric acid at high doses (e) 19..(d---:-i.'-~gingival hyperplasia.e. 11 A nonsteroidal. Of the following. Alcohol c.. I: (b).. Good Question! 15. Ibuprofen ~_ Triamcinolone Oxyphenbutazone e. c. d. 18. \: Acetylsalicylic acid p. Therapeutic ~. aspirin does NOT cause 18 . All of the fonawing are possible effects of aspirin EXCEPT a.

The popularity ot acetaminophen as an aspirin ettemstive is because the incident of such effects with this drug is very low. and respiratory _d.--.s. analqesia. It may induce methemoglobinemia It can be combined with codeine It has anti-inflammatory properties It is not cross-allergenic with aspirin acetaminophen? iZ). (d) Answer is (d).. of General Dentistry. The last most frequently asked type of question regarding opiates concerns overdose of toxicity. c. 24. and one reason for the popularity of aspin'n eitemetives such as acetaminophen and ibuprofen.to. (d) reworded version of Ihe preceding question.(a) & (b) are the major side effects of aspirin (restAting from Ihe inhibnion of prostaglandin synthesis) for the majority of people. . a. Corticosteroids are potent nonspecific inhibitors of the inflammatory process. Aspirin Ibuprofen Acetaminophen Salicylate Difiunisal (b) because Irue (c) acetaminophen is tne best choice. ometimes S they asT\l'i'e mechanism of respiratory depression: lOSS of sensitivilyof the_mg. The ot. and c~ao. I' Analgesics· Morphine One of the most frequently asked questions concerns mixedagonisl-anatagonists (MAP. ~:. Prednisone d. d. Which of the fOIiOWi. anli-inllarnrnatory ng agents does NOT act primarily by inhibiting the activity of cyctooxyqenase? Frequently asked questions on morphine: )l.n!P~_ The···· sUDstuullon they often rnakels diarrhea lor constipation. 3.. Nausea and vomiting c. It r~'. Ibuprofen b.J1I bleeding b. a.flP(e. Some questions give you a lis! of pharmacological effects and ask you to identify which is not an effect of morphine.hers would be inappropriate as well.loxone is an antagonist used to treat overdose. which produce these effects /0 a lesser extent. 23.D~P.~nter. 5 are side effects of aspirin-type drugs. Which of the following is the most appropriate lever In a child under 12? a. hepatic and renal necrosis he ve been reported. the otl1ers ttvee-tou: times a day is required. 25. euphoria.Prepared by M. but sometimes nalbuRl1[!l~ Since these drugs neve proved io be not very poputar with patients.--..durinazy ret!.L Thompson. Aspirin is contraindicated due to the po/enUal for causing Reye:S syndrome. or perhaps diuresis for urinal)' retention. 2.ugh reflex e.di~~ide. Although Ihey do reduce prostaglandin production as well. as betow.. of the following is NOT true about acetaminophen? Is a non-prescription drug Is cross-atlerqsnlc with aspilill Possesses both analgesic and antipyretic effects May induce methemogtobinemia at high doses May be the pharmacologically active form of acetophenetidin (phenacetin) it ainY a salicylate. so I would imagine that they don't ask somany questions on these drugs anymore. s~tion.. acting at a variety of point throughout the inflammatory process.. Alternatives 1. because acetaminophen can undergo biotranslormation to a toxic intermediate. but is s major therapeutic use of narcotic opiates such as codeine. The one they usually expect you to know {s_P'§. especially when combined with alcohol consumption. Acid-base disturbance d. e. hepatic necrosis is the mosl prominent. Suppression of the co. It has antipyretic properties b. 4.•. Phenylbutazone Answer is (e). Indomethacin e.(a).QJ. Decreased tubular reabsorption of uric acid a. Diflunisal c. and that melfia~one is used in detoxification of morphine addicts. . Nowadays.nisal (Do!obid) Ibuprofen (c) Oiflunisal can be taken twice a day. Y Acetaminophen Aspirin Diflu. and 5 are NSAtDS Ihal reduce inflammation by reducing proslaglandin synthesis by blocking the activity of cyclooxygenase. Which analgesic from the following list has the longesl halr-lile? 21.) . In overdose morphine causes co~miosis. I think th ey wo uld also put something abo UI ttver damage in the question.!l.l.siQn.:Jry respi~a!ory . Which of the following is NOT true regarding a. Tufts Dental School Occl. e.'. (d) is not seen with aspirin.. since tne alcohol induces Ihe liver enzymes which maxe the hepatotoxic melabolites of acetaminophen (c) Remember. (c). bul usually not the #1 choice. acetaminophen (/yleno/) is an espirin ettemeiive.. 20. d. # 3 & 5 maya/so be seen following larger doses of aspirin. dysphoria.~ 1.. Additional drug identifications they always ask involve knowing that na. probably by inhibiUng the release of the fatty acid substrate for prostaglandin synthesis. Morphine produces respjratory depression. However. b.they ask you !oidentify which drugs out of a list of 5 is an MM. Which " . especially after vel}' high doses.l]I. Ibuprofen is approved. they have fallen out of use. Prednisone is a corticosteroid. Dept. just asking what you know eboul acetaminophen. a. I guess they are hoping that you will gel/he eitects of codeine and aspirin mixed up.. carbo~. 4.jp. 4. since the two are often compared and eonlrasted as moderate pain relievers. . they do this by a mechanism olher then blocking cyc/ooxygenase. Ph D.:::]) c.doc 19 . but the other statements are drug to use to lower b. :\c G:\Boards2005.

Mydriasis. convulsions and depressed respiration e. _10. (d) (b) and and and only (d) (e) (e) intramuscularly may some of the related opioids depends chiefly upon a. By By By By binding to specific receptors in the CNS decreasing the influx of sodium decreasing the synthesis of prostaglandins decreasing nerve activalin al the site of injury 13. If you can ~ breathe loa well. All of the otner answers are side effects of opiate adminislration. Stirnulafion of the nodose ganglion of tile vagus nerve c. Loss of sensitivity of the medullary respiratory center to carbon dioxide (e) memorization. Direct. (c). B. Peripheral blockade of chemoreceptor impulses c. Codeine c. Oxygen apnea b. Vomiling I~ Diarrhea Urinary retention Q. Terminal convulsions d. A direct irritant action on the gastric mucosa b. (a).. nterln the brain stem less ~ensilive to changes in C02 e.these drugs are sedating. Inhibiting the Herine-Sueuer reflex c. Respiratory depression is (a) They might reword the question in a way tne! asks you 10 remember that the specific receptors are Ihe mu receptors. Opiales set on receptors in Ihe gullo produce constipation Thus (b) is obviously wrong. meperidine and 6_ Therapeutic doses of morphine administered produce a_ Constipation b. coma and depressed respiration> b. Y.all these years I thought Ihey just made this up. (a). A parasympalhominetic action b. a. so the only dis/raclor is coma or coovutsions. A specific effect at myoneural junctions 01 phrenic and intercostal nerves (ef) I told you this in my fecture on morphine-if you miss this you'll hurl my feelings_ question as above" just reworded 7. So if seems they want you 10 think thaI the emelic response /0 morphine is locally ectivsted. What happens is thai opiokis decrease the response of respiratory centers in the 20 . Acetaminophen €. Phenyibu!azone drugs acts to suppress Ihe cough reflex? 12_ Which of the following are pathognomon ic symptoms of narcotic overdose? .I activity b. The decrease in ventilation caused by morphine. b. Mydriasis. c. Constipation e.whale funny name . Of the two. a memorization Queslion.5. (a). Dysphoria i. codeine is much better st this than meperidine. Euphoria c. d. (d) iv. (e) . Meperidine d.again. stimulation of the gastrointestinal musculature (c) is Ihere such a thing as the nodose ganglion? my god. I jus/ googled it and there really such a thing . Occurrence of which of the following is LEAST chsracterlstc narcotic ingestion? a. convulsions ano depre~~ad respiration (a) pinpoint pupils (miosis) and respiratory depression are hallmark opioid overdose effects. but actually it is an effect produced by morphine acling on the CTZ in ttie medulla. Dysphoria d. (a). in tne term of paregoric (tincture of opium). (c). The cause of death with opioid intoxication 8. Bronchiolar constriction e. 'I'" All of the above (v) memorize 8. (d) and (e) v . Blockade of afferent autonomic impulses from the lungs e. the key word is leas/. on (b) Again. Cardiac arrest c. Dspresston of corti ca.c effects of morphine? a. Which of the following are phanmacologi. (b) and (c) ii. An increase in carbon dioxide concentration in the blood d. end Lomolil (Ioperamide) are over ttie counter oral preparations for the trea/menl of dia rm ea.. (a) and ii. All of the above (v) same 11. coma and smooth muscle spasms c. Don'l be fooled by (a). Igue~s you mighl go into a comet (b) the only drugs that do this are opioids. M'ydriasrs. Netcotics.ndering the res. Rendering the aortic chemoreceptor system lnsensuive to 02 ~e. Mental cioudiog e. (b) and (dJ iii_ (a) and (e) [v. Decreased response 10 pain i. Stimulation of the medullary chemoreceptor trigger zone d. Miosis. ooma and depressed respiration d. Circulatory collapse e. but this has nothing to do with the decrease in respiratory rete. Morphine causes vomiting by 8. Small doses of barbiturates and rnorph ine depress respiraucn primarily by a. Respiratory depression b Euphoria c. Sedation d. Increase in intracranial pressure of 9. and codeine and merperidine are the two opioids on the list. (b) iii.plratorv C€. Morphine binds to which site to produce analgesia? a. Which of the following 8_ ASA b. Miosis.

Naloxone d. Naloxone b.fI is a full agonist with analgesic tmxsenies. _ . and they do not cause Circulatory co/lapse ((d)). but it soon became apparent that (d) was also true 18_ The antagonist 01 choice in the treatment a. Naloxone b. All are drugs which acl via opiate receptors. Propoxyphsne of opioid overdosage is 14 Which of the following antagonistic activities? a. You are asked to not only identify a drug from the list as being from this class. 2. Tufts Denial School breiostem 10 the carbon dioxide lension of the blood. Levallorphan e. Meperidine e. but 3 are agonisls ((a). 1 is an antagonist only ((c))_ (e) pentazocine is the only drug which has both types . Methadone is used in detoxification 15_ A heroin-dependent patient should NOT be given nalbuphine (Nubain ) for pain because a. II is a partial opioid . and 3 would be met by an an/agonist such as naloxone. Melhadone you will remember is not an antagonist like neloxone. An antipsychotle (b) G: IB oards2005 . just like morphine.I!~'_l-. but no/lerminally so ((e)). A long-acting local anesthetic e. Asa mixed agonist-antagonist. None of the above (a) reworded version of Ihe preceding question (e) This is an example of the type of question where the drug class is given.. Aspirin b. Pentazocine e.es the depressant actions of morphine c. Codeine ' "- u. Alphaprodine d. Indomethacin e. D_. Penlazcine c. Precipitates withdrawal reactions b. Cyclazocine d. Nalorphine c. Nalorphine c. but additionally thai it has Ihe properties tha.t are given in the question that distinguish it trom the other drugs of Ihe class Ihal are listed as ettemetives. Codeine b. In this example. it can elicit withdrawal symptoms d. It is equlanalqeslc with codeine b. of General Dentistry. Pentazocine d. Its abuse potential is less than thai of heroin d. Antagoniz. they are stabiliZing on Ihe heart and some are actually used in open-heart surgery ((b)). I guess it was big news when these questions were wrItten many years ago and they seemed tiopetut. propoxyphene d.doc 21 . Withdrawal reactions are less intense and stressful man those 01 morphine (d) This is an example of the kind of Question thai requires tnet you have memorized a fact about a parlicular drug. It may induce dysphoria and mental aberrations e. Penlazocine is an opioid thai has both agonistic and (a) nalorphine and pentazocine are mixed agonistantagonists. II is effective only on parenteral administration (e) lot of memortzstion required here for a drug that isn't used that much. 20. Withdrawal ts less severe Ihan with morphine because methadone has a much longer half life. as Is 19... Faels 1. Will not in itself produce physical dependence d. Asedalive d. and is the one drug left by the process of elimination.. Which of the fenowing is a complete antagonist of the opioid receptor and the agent of choice in the treatment of narcotic overdose? a. An opioid analgesic c. It has no anatgesic properties b.lowing statements does NOT characterize pentazocine? a.king drugs has a history (6 months ago) of narcotic dependency. Levallorphan e. ((a)).. they can be convulsive. _ [Vlt:<U'""UUIIC: c. Dept. Meperidine (b) shortened version of the above question 17. The high abuse potential of nalbuphine may add to the patient's problems (e) see above (drug withdrawal) of patients physically dependent on morphine because rnathadona a. in ttns case Ihe fact is (d). Which of Ihe following analgesics should be avoided in this patient? a.anlagonist c. therapeutically an advantage. ·11may produce respiratory depression c. or perhaps even a mixed agonist-antagonist such as pentazocine. end also depresses pontine and medullary centers regulating respiratory frequency Opioids do not cause oxygen apnea. btlt acts just like morphine to oroooce lolerance and physical dependence. 16_ A patient while no! currenlly ta. since statemenl(c) was true and was 22_ Meperidine (Demercl) is B_ An antidepressant b. None at the above (b) see above 21_ Which of the following drugs is currently widely used in trea ling opioid-dependent individuals? a. I . leval/orphan is an propoxyphene. (d)). Acetaminophen t. optot« agonist.Prepared by M_L Thompson. Ph. Methadone c. Which of lhe fol. (b). there is only one drug which meets this criterion. When taken orally it is not euphon'c in addicls.of action.

etc. phenobarbital (c) see above -this question must dfrle back 10 world war 1/1 What you need in this siluation is a chemical that will help is 22 . (a). succmylchollne is a depolarizing neuromuscular junction blocker. Methacholine and pilocarpine are direci·acting cholinergic agonisls. blockade. but neostigmine also has some direct ACh like activity at the neuromuscular junction. c. 2. in addition to prolonging the activity of endogenous ACh. propantheline e. resulting in tachycardia. and (eJ (d) and (e) - 2.Iaryngospasm g. burning dry mouth. acting like acetylcholine at ganglionic sites e. voluntary muscle weakness. methacholine. hyperthermia: treat with physostigmine c. a. Scopolamine is a muscarinic entagonist/ike atropine. they just prevent ACh effects by blocking receptors: atropine and propantheline are postgangli'onic muscarinic receptor blockers-thus Ihe answer is (d). The 2nd type of question has to do with phySiological effects of chotinergic stimulation. b. They sometimes see use in treating xerostomia.Autonomies: Cholinergics any aclions of their own. (e) wrong-these drogs don 1 have d. or overdose toxicity situations (and what drug you would give to reverse the toxicity).) methacholine (bJ scopolamine (c) pralldoxlme \d) neostigmine Ie) pilocarpine 1. (c) is wrong. preventing synthesis of acetylcholine c. Organophosphate CJD insecticides and nerve gases inhibit the action 01 which of the following enzymes? a. alropine. whereas neostigmine acts indirec/ly. and (d) (d) and (e) (d).botulinum toxin does this. (3:)8). hallucinations. subject to rapid inactivation by plasma pseudocholinesterase: it is used 10 prevent . carbonic anhydrase (d) memory . monoamine oxidase c. preventing release of acetylcholine b. (b). Which ® of the following drugs is best to administer after poisoning by an organophosphate cholinesterase inhibitor? aatroplno @ pralidoxlme b. so it iss/most impossible 10 enhance its destructtan.(a) is wrong. organophosphates and insecticides irreversibly inhibit cholinesterase €. phenytoin (d) . '4:\ Frequentfy Identification asked questions and mechanism about Cholinergics: of action questions: 1. 5. ACh is broken down almost instantaneously. b). scopolamine. depressing acetylcholinesterase release inhibiting acetylcholineslerase activity c. You need to know the following types of facts: a. salivation. acting on the cholinergic receptor. pilocarpine. An additional fact that often gets asked about atropine has to do with the fact that it blocks vagal reflexive control 01 heart rate. propantheline are compelWve muscarinic receptor blockers which sometimes are used to control salivary secretions. or by indirectly increasing the duralion of action Ach by preventing its enzymatic degradation. phosphodiesterase acetylcholinesterase e.you and Ihebugs stimulation die from 100 much cholinergic 4_ Drugs which are additive with or potentiate the effects of acetylcholine include (a. Atropine and propanthelin e exert their efleclson peripheral s lructures by a. neostigmine only peripherally.cting cholinergic agonists.neostigmine is a cbotmesterese inhibitor Ilke physostigmine. physostigmine and neostigmine are reversible anticholinesterases that differ in thai physostigmine acts both centrally and peripherally. confusion. enhancing destruction of acetylcholine competeing with acetylcholine for receptor sites e. resulting in tachycardia. d. (b) is wronghemicholinium works this way. (c). mecamylamine and hexamethonium are ganglionic blockers that produce orthostatic hypotension c::E) Neostigmine produces its effect by a. J. pralldoxme is an enzyme regenerator used in organophosphate toxicity r. increasing the amount of acetyl. An additional fact lhat often gets asked about atropine has to do with the faelthat it blocks vagal reflexive control of heart rate.choline released from nerve terminals (b) . and will reduce orbioc« cholinergic eciion via direct receptor antagonism. (a). producing physiologic effects opposite to those of acetylcholine (3) drugs which potentiate cholinergic stimulation can do so by being either direct acting cholinergic agonis/s. Pralldoxime is a chemical antidote used /0 regenerate AchE after nerve gas or insec/icide exposure 5. May be used for xerostomia. and (c) (c). increasing the rate of acetylcholine synthesis d. d-tubocurarine is a non-depolarizing neuromuscular junction blocker h. Ihe laUer are irreversible. are direct a. lacrimation. These differ from the insecticides and nerve gases listed below in that they are reversible and can be used clinically. bronchoconslriction -treat by giving atropine b. cholinergic crisis symptoms: bradycardia. scopolamine overdose: disorientation. adenylate cyclase b. diarrhea. 2_ 1_ Drug idenlification type queslions thai involve mechanism of action.

since it is an indirect acting cholinergic agonist. mecamylamine which of the following might be prescribed? 7.it knocks the insecticide off Ihe enzyme. ti pilocarpine e. Thompson. but if you must know . mecamylamina. atropine and scopolamine are not in this lisl.. Xerostomia is too little saliva and thus one could use a cholinergic agonist to sUmulate more saliva secretion (a:ssuming there is functional salivary gland tissue.holinerglc neuron /0 release Ach which would then stimulate the NMJ cant happen. atropine b. In treating xerostomia. The usual suspects. and (d) Is an anllcholinesterase. Pralidoxime does just that . less intense and of shorter duration d. nicotinic receptors direclly then you can see enetiec: on the muscle" Neostigmine is one of those anticholinesterases that can ac/like Ach at nicolinic receptors.iving neura/lnput. diazepam b. Of (a) (b) is a 11. (c) this has got to be a real/yold question . ooesn. Remember. you want to give a drug thaI has an anticholinergic action.anglionic bloclter.. allowing lt /0 again be able 10 break down Ach As for the oiller eltemetives: atropine is a competilive muscettnic cholinergic receptor blocker. and Phenob~rbHa' is a barbiturate anticonvulsant. if you wish to reduce salivation.Prepared by ML. so it's nol so easy. succinylcholine compounds is a ganglionic blocking agent? 10. and while i! will reduce your patient's anxiety. Ph. C) d. Dept. d!isopropylfluorophosphale capable of acting directly on tile end-plate (9)8 strange and amazjng truth! Denereveteo means Ihe skelettJl muscle is not rece. epinephrine diazepam (Valium) neostigmine (Prostigminej succinylcholine (Anectine) (e) lNhal is needed is a sAeletal muscle retexen: This requires a drug that eels at Ihe neuromuscular junction. a. and while in this stale it cannot be stimulated by Ihe Ach and thus paralysis results.. like curare. while the other class.he others. so I wouldnllhink thiW would ~lill a~k you abDul/hem. curarine .. promethazine A physostigmine (j)propantheline e. neostigmine . those listed. Of t. and a blocker at Ihall) Ephedrine is a mixed acting adrenergic agonist. in addition to prolonging Ihe action of Ach itself by blocking Ihe acelylcholinesterase that is Irying to break Ihe Ach down. being so unspecific in Iheir action (they would have both anticholinergic and antiadrenergic action) arenl used clinically anymore.~kblocked (J:}enhanced and prolonged c.. e. propan/heline isPro8anthine. When neosUgmine is administered of acetylcholine will be before acetylcholine. it? Diazepam is valium. and thus stimulating a r. succinylcholine is a depolarizing neuromuscular junction blocker used for shot: term paralysis. too non-epecitk. an synthetic atropine like drug used 10 dry salivalion and as an antispasmodic agent. it doesn't do much to make them stop salivating . etc.. ephedrine (2') neostigmine Cr" scopolamine e.. has no effect on acetylcholinestarasa more potent t~an. are called depolarizing blockers . atropine is a cholinergic (Muscarinic) recomo« blocker. acetylcholine (c) this is the reverse of question 2 in tne preceding column (c) salivation is Iypically considered to be a cholinergic response. mecamylamine is a gangiionic blocker (nol the action we desire. epinephrine is an adrenergic agonist. gallamine is another long acting neuromuscular junctjon blocker for paralysis.mighl even 9.doc 23 .some.-. end are ..g. is a competitive blocking agent skeletal muscle because it G :\8 oards2005 . edrophonium is an anticholinesterase used to treat myasthenia gravis. like succinylcholine. The acuon of acetylcholine by neostigmine is not affected 12. Which of lhe following a. but stimulate the recplor so much that it depolarizes. Ihal depends thai you know what some of Ihe olher drugs are. Maybe Iheylis/ed the Ihe anliconvulsants to Ihrow you off since you think that some one might experience organophosphate exposure convulsions after ~!s . which m". D. Which of lhe following acts by antagonizing dlolinesterase? a.:. Which of the following is used to prevent laryngospasm? a~ atroplne b. Curarine is a nicolinic receptor blocker that causes muscular paralysis. 8. atropine and scopolamine are cholinergic antagonists.actually used to reduce salivation.. hexamethonium. So what can you remove by eliminalion? Well. of General Dentistry. Which of the following drugs is most likely to dry secretions in lhe oral cavity? a. But if you inject a drug which can stimulate the. atropine ~ mus~rin. only succinylcholine (e) is in this category. Neostigmine can stimulate denervated a.y no! be the case in patients that have been subject 10 radiation therapy!) From the tist. are competitive receptor blockers. ara ganglionic blockers.b edrophonium <~) mecamylamine d.e ( c. these paralysis prodUCing drugs al/ set via nicotinic receptor at the neuromuscular junction . none of the above. gallamine triethodide c. and (e) diazepam benzodiazepine. Tufts Dental School reqenerete AchE that has been bound irreversibly by the organophosphate insecticide or nerve gas. Ihey think (b) the aclion will be prolonged because neostjgmine prevenls its breakdown by AchE! Its action would be blocked by atropine or scopolamine Ihis kind of question Should be on every test! Again. only neostigmine would produce a cholinergic effecl. 6._:_.p c.. phenytoin is an antic-<Jnvulsanf. diphenhydramine (d) I guess since Dentists deal with so much spit. is a congener 01 acetylcholine b.they don'//hemselves block the nicotinic receptor from being stimulated by curare. the action .

. adrenergic blocking e.-----0. blockade of vagus nerve activity c. Physostigmine is an anlicholine sterss . blockade or the nicotinic cholinergic receptor d. miosis regarding physiological actions uf cholinergic effects: drugs· an . (b).imagine! But it doesn 1seem to ha ve anticholinergic activity Ihal is significant enough to cause significant reduction of saliva. Methantheline.only muscarinic such as atropIne headache. since it does not include atropine. 5. hyperthermia) muscle: no effect:>. Option (d). The most useful drug to induce saliva tion is one which has properties that are ~ adrenergic ~cholinergic c. What I don't like about this question is thai the antihistamines are also anticholinergic and will have a drying action. or for that matter. and expect you /0 know which one is in the mix to conlrol salivalion. (a) and 2: (a). the remaining answer. b. ganglionic blocking d. of ganglionic blocking agents will result in miosis b. decreased bronchodilation decreased lacrimation. atropine and methantheline ere the dl1.. GI tract: increased acid secretion Urinary tract. discussed propen/heline as Pro-Ban/bine.) urination intraocular CV: increased tachycardia) decreased salivat/on and GI tract: decreased acrd secretion Urinary tract: Respiratory: activity. •• r~ " __ - 0•• _ . and delirium Quaternary amines like methantheline actions and propantheline only have peripheral (3) you are probably thinking. $0 see. O\{b) and 4:'(b). 15.has no neural input) activity. 13. Meprobamate happens 10 be an antianxiety. being the protolype anticholinergic drug has 10 be one of Ihe answers.. dry skin. But of course you should figure out that atropine (b). chlorpromazine! Well. enhanced activity of the parasympathetic nervous system (d) a ganglionic blocker. a drug like propantheline is better.why. get into the brain and excitement. in cooirest. so is more selective for just drying up excessive salivation . decreased sweating (overdose. hallucinations receptors. Skeletal hot. arising from decreases in sympathetic tone to the vasculature 16. (d) and (b) only and (e) (e) only and (d) (el used in the control of excessive Glandular. diarrhea .) meprobamate ~(b) atropine '"(c) methantheline (d) codeine (e) chlorpromazine 1. smooth (but . 2. these are drugs that may have been useful in tbe olden days.only from injected receptors Ihe muscarinic spasmodic (overaose: urinal/on sweating . who the hell ever heard of meprobamate and methantheline. I guess the distinction from propantheline is thai it doesn1 cause sedation. eNS: tertiary amfnes cause restlessness. release or adrenal calecholamines b. or 3. this is just the opposite way of asking What was asked in tne other questions given here! If anticholinergic agents are useful 10 reduce salivation.so Ihls would work 10 dry up Ihe oral cavity. a synthetic version of atropine! So option 3. Now only the most corrupt aentis! would prescribe codeine 10 reduce salivation. stimulation of the beta adrenergic receptor 24 . is Ban/hine.copious salivation (_gJorthostatic hypotension e. only an idiot couldn·t figure out thai a cholinergic agent would be useful to induce sal/va lion I muscle: tremor cramps Anticholinergic above: Eye: mydriasis and fasciculatl'ons) (antfm uscarinicl actions arelhe reverse amJ increase of Ihe of and loss of eccomoaetton pressure heart rate (overdose. Increased vomiting. and e are symptoms of cholinergic stimulation. Looks 10 me so far Ihal Ihey have thrown in a lot of drugs used in a sedation context. cholinergic blocking (b) well.. stimulation of the alpha adrenergic receptor e. agents. c. Tachycardia in a patient administered with atropine or scopolamine results from a.---- make il worse like the barbiturate sedatives do! Promethazine is an an/ihist8mine used for 1M sedation.-C-. since they don't act on nicotinic . spasmodic (overdose. So what is meprobamate . In a previous auestion. you didn ~ even have to recognize thai chlorpromazine is an antipsychotic drug. ----- -. skele/al muscle re. nausea. but would be probably replace in this type of questions by more modem equivalents. here's Eye.a/so has use for external sphincter spasticity . a synthetic atropine type drug .1gsfor this purpose. so #4 should also be incorreclthat leaves 1. Respiratory: Glandular: Skeletal increased bronchoconstriction lacrimation. Oprions a.outline ofcholinerqic and reduction vasodilation since muscle sfimulation of intraocular pressure choJj~ergic on the v sscuetr salivation diarrhea) and CV: bradycardia.so if you want only that effecl and not Ihe sedative action as well. since ilacls by prevenUng cACh from stimulating nicotinic receptors atlhe ganglia level will have both anticholinergic and antiadrenergic effects. is an antiadrenerglc effect. a very sedating antihistamine Ihat is used as a sedalion agent .. 14 Drugs that are commonly salivation include (a. and thus can ~ be right. and ataxia (overdose: muscle weakness. Administration B. Questions OK.laxanl drug sometimes used by denlfsts to treat muscle spasms associated with TMO . (c).if we can eliminate thai one then we are down to only option 3 as a possible answer.•• ~ " .is thai in this list? Diphenhydramine Is Benadryl. So option 5 has to bee incorrect.

Thompson.effects opposite to those observed from cholinergic stimulation. So if you can~ salivate or sweat." teversibta anticholinesterase. since the /isl corresponds roughly to the list in this question. (a).igna/ to the vagus nerve to stimulate the heart to slow it back down. (b) and (e) only 5. which isjusl two molecules of acetylcholine fused together-the ot.her information has no relevance unless you're just stuck thinking "gee.Prepared by M. G\8oards20D5. since none of rhe responses involve SLUD type reactions.arding toxicity of cholinergic drugs: insecticide 17. and (e) (d) and (e) All of the above (2) glandular secretions are generally under cholinergic control. the following are possible etlects of cholinomimetic drugs mydriasis bradycardia increased peristalsis stimulation of sweat glands increased secretion by bronchial glands 20. Questions reg. Dept. 5. and thus will have effects like atropine . 4.Ihal neostigmine is an indirect acting cholinergic drug and then know what the symptoms of cholinergic stimlJlalion are. (b). I know that SUX has something to do with autonomies but not sure exacl1y what!" 19. (d). eNS depression . decreased salivation d. thaI leaves (a) as the only possibility. b. Symptoms of atropine poisoning in man include (a) decreased intraocular pressure (b) burning dry mouth (e) nausea.L. c. excessive salivation c. here. This reflex is ctJolinergically media/ed. rate is decreased (bradycardia)thus since tbe question asks for an effect which does '101 occur wilh cholinergic stimulation.doc 25 . not mydriasis. 21. extrapyramidal reactions initially elicits (d) because succinylcholine (SUX) is an agonist at nicotinic receptors. Miosis. eNS stimulation b. Ph. (b) and (d) (b). diarrhea (a) .Atropine and scopolamine are muscarinic cholinergic receplor blockers. or increased salivation. lacrimation. and amnesia prior to surgery (c. {d} and (e) 2 . D. and (e) only 3. Based on its known mechanism and sites of action. muscle faslculation e. (b). All of the above (5) scopolamine is an an!icholinergic drug. of General Dentistry. skeletal muscle paralysis are assocla led with neosligmine 18. 3. so Ihe initial response is muscle stimulation. leaving the sympathetic system in charge with a resulting tachycardia. bonchlolar constriction e. Tufts Dental School (b) . (a) and (c) 2. and will be blocked by cholinergic blockers such as atropine. A paralyzing dose of succinylcholine a. you very possible will show what kind of symptoms? How about a burning dry mouth and hypeHhemia? Nausea and vomiting are cholinergic overdose. atropine will block {he normal cholinergic control over the tieer. Even when given in the absence of /1igher than normal heart ret». anlicholinergic type reaction and thus doesn1 fit the pattern of responses given.Ihe non-depolarizing neuromuscular junction blockers (you did remember this right?) 22.The first thing you have 10 know is /hal a cholinomimetic drug is one thai mimics the action of acetylcholine. convulsions d. diarrhea b.. Symptoms of poisoning by an organophosphate include all of the following except: a. But even if you didn'l know those facts you might be able to get if you remember that neostigmine is a drug thai is used to reverse the skeletal muscle paralysis produced by drugs of the clJrare class . (a). Remembering SLUD ooesnt work (e) basically ItIS same question as the preceding qlJeslion. scopolamine should theoretically be useful in (a) trealment of peptic ulcer (b) providing euphoria. All of the following symptoms poisoning except a. oeteceuo«. though. Option (a) Is from nicotinic receptor stimulation. But (he NMJ rapidly depoladzes due 10 the inabi/iry of the plasma cholinesterase 10 break down the SUX. The difference is Ihal neostigmine is. skeletal muscle fasiculation b.and (cl 4. Damn! So how do you fihutre this on8 oul? You can memorize the lis/ of thorapeutic uses of ani/cholinergic drugs /I)a/I gave you in your syllabus (easiesl way. vomiting and diarrhea ftl) hvnertherrrtla orthostatic hypotension iei 1. whereas insecticides are irreversible. Option (d) is an atropine. and urination. the endogenous neurotransmitter in the parasympathetic or cholinergic nervous system. so sweating and salivation are greatly reduced by the anticholinergic drug atropine. hot. as is orthostatic hypotension. bronchoconstriction d. €I.. the question just basically wants you to recognize two things . salivation c. All of except a. d. Just knowing thai eliminates all the ettetnetives except (b). so therefore you should be preapared for any other type of question like this. c. (b) and (c) and (e) are also cholinergic stimulation. Bul again. (a)..) relieving bronchoconstrictlon (d) relieving some of the symptoms of Parkinson disease (e) visualization or the retina 1 . The acronym for remembering the effects of cholinergic stimulation is SL UD. Ihey just changed organophosphate insecticides 10 neostigmine. But you should also remember that heart rete is kepi under tight reflexive control: any sudden increase in HR usually stimulates beroreceptors 10 send a f. (d) organophospllates kill yOIJ from too mUel! cholinergic stimulation (SLUO). occurs with cholinergic stimuletion. The heart is the exception in thai activity or beer. dry skin e.

Receptor blockers: alpha or beta adrenergic drugs such as prazosln or propranolol act by competitive inhibition of posthmcuonal adrenergIc receptors b. Alpha methyldopa: acts centrally as a false neurotransmitter which gets taken up into storage vesicles and released with NE. don Y miss that word! $0 looking at the list. and the reason that scopolamine is used for sedation. ptyalism and increased sweating e. in addition to the prototypes atropine and scopolamine. Atropine-like drugs are classed a. drugs: amphetamine. and thus is useless 10 inject. (c) is histamine produced. vasoconstriction is the exception we are looking for. which results from the stimulation of nicotinic receptors at the neuromuscular junction resulting in paralysis of skeletal muscles. convulsion c. (aJ or bradycardia. Reserpine: depletes inhibits NE by inhibiting reuptake the release of catecholamines 25. so that can't be it. to reverse the bradycardia that sometimes arises. either direct or indirect to overcome its effects. while I haven 1 gala clue what ''ptyalism" is . c. H1 antihistamines. of the following is a symptom of cholinergic bradycardia lacrimation vasoconstriction extreme salivation weakness of voluntary muscles crisis except b. iii. Acetylcholine won'/ work because it gels broken down way 10 rapidly by acetylcholinesterase. il undergoes rapid inactivation in the GI tract (e) that's why it is long-acting this enzyme 28. while atropine isn1 (b) and (e) are cholinergic stimulalion t think. thus decreasing sympathetic activity iv. it rapidly redistributes away from the NMJ c. constriction of the pupils and blurring of vision (a) jusl when YOlllhought you could gel by with/he anti-SLUD slrategy. they then expect you to remember that atropine overdose causes CNS excitation and tachycardia? Actually. and (e) as possibles. All of these might tum up in the kind of question Which of the following causes xerostomia?" Adrenergits: 1. skin rash and cutaneous itching d. so ya need a cholinergic agonist. TCAs. and ephedrine act by stimulating the release of stored NE TeAs and cocaine block reuptake destruction MAOls block enzymatic (c) this is an e xcepf question. tyramine. because they cause xerostomia. Drug identification type questions thai involve mechanism of action. acetylcholine d. it is subject to inactivation by plasma esterasss d. intestlnal cramps and diarrhea c. Physiological action questions: Many of these questions involve actions of epinephrine in the presence of either an alpha or beta blocker. opioid analgesics are all drugs that have potent anticholinergic activity. can occur from too much cholinergic stimulation of the he (that's why atropine is useful in surgery.do you? Bui I do know that if atropine causes dry hot skin because it prevents sweating Ulen (d) can't be right! 24. e. eNS excitation and tachycardia b. So.don~ you wish you had goHen comfortable with this Iype of terminology during the course? Imagine how many different drugs they might put into this kind of question! Anticholinergics. sympatholytic d. Indirect acting sympathomimetic a. The options in the list are c and (d). (e) results from cholinergic stimulation of the NMJ. c. b. cholinomimetic c. You need to know the following types of facts: a. sympathomimetic in patient's that have a deficiency in as bIevodopa c. by default. The most likely signs or symptoms of overdosage wilt! atropine are a. It is short-acting because a. c. so we are left with (a). Drugs that inhibit the action of adrenergic nerves: i. that is one of the interesting diffs between atropine and scopolamine. The immediate cause of death from irreversible inhibitors is a. "Epinephrine reversal": in the presence of an alpha blocker (usually they give prazosin. the immediate cause of death is due to (d). anti-cholinergic e. physostigmine (d) so ya goUa know scopolamine is anticholinergic. Disorientation. atropine and hallucinations resulting from an are most efficaciuosly treated by 27. respiratory paralysis e.while some of these are indeed associated with organoptlosphate toxicity. Clonidine: stimulates alphaZ receplors in CNS with a resulting decrease in sympathetic outflow c. dehydration from vomiting and diarrhea cholinesterase ii. 2. Physostigmine will work since it is an indirect acely/cholinesterase. it Is subject to rapid metabolism in the liver b. bul drug such as chlorpromazine may also be given) epi causes decrease in blood pressure rather than increase because beta mediated vasodilation predominates b. cardiac arrhythmia d. such as: a.23. (d) again . Succinylcholine is a short-actlnp neuromuscular junction blocking agent useful for providing a brief paralysis 10 aid in intubating patients. 26.' vagal reflex: injection of a pressor dose of NE may result in decreased heart rate due 10 activation of baroreceplors which an 26 . d. are obviously imporlant to know for dentistry. shock b. anti-adrenergic b. confusion overdose of scopolamine administering a. we got the S (option d) and the L (option b) from SLUD. Each a. Guanethidine: (d) .

. The most important ones to remember are: 6. Increasing the metabolism 01 norepinephrine c. 5. then everybody could get it right! But then._ . Inhibit catechol-O·melhyllransferase c. Incre<lsed rate of metabolism of norepinephrine c. Combining with a receptor substance 011 the effector cell e.. Vagal reftex is atropine (e) again. _----- . Option (d) they just made up to tootyoo.. nausea and vomiting. Which of the following statements most accurately describes (he effecliveness of action of methyldopa? a. A mechanism for the antiadrenergic actlon of guanethidine is a.doc 27 ..-_. nol norepinephrine. They usually throw in a question regarding the use of levodopa in the treatment of Parkinson's: remember. Block the passage of the nerve action potential in the postganglionic nerve frber·s d. But you still have to know. Adrenergics· Mechanism of Action 4_ Alpha or beta-adrenerpic blocking drugs act by a. --. b. .leling norepinephrine from adrenergic nerve terminals (c) dortt you just lovelhe way they obfuscate? Why can Y they just say the block the receplors. Injected DA doesn't cross BBB.ine and subsequent actton as a false transmitter e_ Uncoupling 01 the action potential from the norepinephrine release mechanism g_ Which of the follo\'. It causes formation 01a false transmitter that is released at vascular smooth muscle e.1ng characterizes (he mechanism of action on levodopa? a. and will produce sympathetic stimulation in the periphery. ---_ . 1\ causes rapid depletion of norepinephrine from adrenergic nerve terminals d. Inhibiting synthesis of norepinephrine. TCA antidepressant. wf1ich in the absence of carbidopa. c. - 'cpared by ML. B. epneatine. see 'false" transmitter. of General Dentistry. It stimulates specific l-dopa receptors in basal ganglia c. mydriasis vasoconstriction. so you might be tempted 10 jump at this answer. blocking means a neurotransmitter has actually been released. Thompson. although they would reduce sympathetic activity. Since levodopa has dopa in its name. reducing sympathetic outflow via alpha-1 agonist aclion. Parkinson's is a result of DA deficiency in brain. making reserpine an example of an Indirecl·actlng sympatholytic. Ph. Inhibit monoamine oxidase b. It increases concentranons of norepinephrine in the brain to counterbalance an otherwise overactive cholinergic system (c) this you just got/a memorize. why can't they just say guanethidine olherdrugs thai could be substituted reduces NE release! You mighl see Ihese same options listed for several hus you must be familiar with Ihe effects of alpha or beta receptor stimulation or block. vasodilalion (82) Alpha·' block: vasodilation heart rate (81). Tufts Dental School stimulate blocked by vagal reflex to reduce heart rate. and jump at option (d).. since you guys work with local anesthetics. b. since they think you will speed reading the options. Promoting storage of the mediator b. didn~ Ijust tell yo. and menta! disturbances are all associated withlevodopa therapy. cardiac arrthymias. A toea! anesthetic effect on the adrenergic nerve terminal e. Amphetamine acts by a. but (d) is the answer.blocks ils activity Taken this way. Causing a slow depletion of the mediator d. bronchoconstriction beta block: decreased (82) 3._. . MAOls: block NT degradation. but levodopa..ceuses release but also acts at receptor itself.. afthough it all depends on your interpretation of what "blocking" means.. Causing a rapid release of the mediator· c. It produces a false transmitter. Development of abnormal facial movement. Option (b) again is a sympatholytic action. D" Dept.- --~.. Remedy is to increase DAin brain. J don Y even teet the: any of the other alternatives should even tempt you... Interfering with the response of Ihe receptor to the mediator (b) amphetamine is one of the (Tlany indirecl-acting sympa/homimetics. converts the levodopa to DA In the periphery. options (a) and( e) wouldn~ work. Stabilize the axon terminal membrane thus preventing release of norepinephrine (d) I would be majorly surprised if they slitl ask questions about this drug since it hasn~ been used clinically in the les! 30 yrs. since. Inhibition of dopa decarboxylase b. Competitive inhibition of postjunctionaJ adrenergic receptors d.U in the previous question Iha/lhf!Y CQuidjust change the drug and use some of (lie same definitions? But they are tricky.. and now you want a drug that somehow .. . Option (d) is troe except for Ihe teci that the imbalance is be/ween dopamine and too much cholinergic activity. but l don1 really think there any clinically relevant drugs thaI work this way. or have a "sympatholytic' aclion.' cocaine: reuplake inhibiUon and release. It acts by causing Ihe release of neurotransmitler. 7_ The mechanism of action 01 reserpine is to a. It acts through a direct anticholinergic action b. bronchoditation (92). you CQuidjust natTOw the question down 10 options (b) and (c). a. and no! read further 10 see Ihat option (e) is Ihe correct answer. Carbidopa is given with levodopa to block dopa decarboxylase advity in periphery. a precursor to DA does cross BBB. Depletion of norepinephrine from the nerve terrnlnals d. urinary bela receptor stimulation: increased heart rate (81). . Substitution for norepinephr. In my mind. the effecl of which is primarily at central nuclei (e) see. It causes marked cardiac slowing b. they don~ actually block a oeurotrensmnie«. It direcUy relaxes vascular smooth muscle c. You also need to remember that levodcpa is sympathomimetic. G :\8 oard s200 5 . reup/ake inhibiUon. Drugs like methy/dope and clonidine are Ihe only centrally acting antihypertensives.Just as a review. d Alpha-1 receptor stanulatlon: retention. It replenishes tne otherwise deficient dopamine in patients with parkinsonism d. ---- -. decreasing Ihe amounl ollevodopa that ends up In the brain. Dep.

a. Norepinephrine (a) reserpine causes depletion of N£ from storage sites. the only sttemeiive thai fists both an a/ph a (prazosin) and bela (propranolol) blocker is (c). Mydriasis or papilfary dilation is also a be/a receptor response. increased systolic and diestotic pressure and reflex tachycardia. increased contractility Vascular smooth muscle: vasoconstriction Skeletal muscle vessels: relaxation or dilation Bronchiolar smooth muscle: relaxationfbron ch cdi latlon Sweat gtands: sweating 14. Dila~on of skeletal muscle vascular beds e./0-1). So the treatment is 10 restore OA teveu: Okay. Propranolol.Physiological Effe·cts 28 . with the effects listed in option (il): relaxation of bronchiolar smooth muscle (8e. Since !his 1/'. a drug that acts like NE) stimulates both alpha and beie-recepiors. is the only bela-blocker lisled. Hexamethonium (c) picky memorization! They are all receptor blockers. none ofthe options including (b) work. Which of the rottowing changes produced by intravenous administration of epinephrine result from stimulation of betaadrenergic receptors? 8. and positiver chronotropic and inotropic action on the heM (b) 12. thus the epinephrine Will stimulate beta receptors primarily. After pretreatment 11. iii. Atropine and prazosin b. Amphetamine c. Ii. Alphareceptor stimulation produces vasoconstriction.Parkinson's is due /0 a de. intravenous administration of epinephrine should result in a. Posldve chronotropic and inotropic effects c. dand e c and d only c. Atropine is a muscetinic (cholinergic) receptor blocker that would accelerate the heart.goolsts.bandc a. wHh phentolamine. d and e e and e only it li. naloxone is opioid receptor blocker. Adrenergics . iii. so vasoconstriction leading to increased blood pressure A1pha-2 agonists.ficiency in dopamine. Splanchnic vasoconstriction d. I would be vel)' surprised if they asked such a question' Wait. iv. Cardiac acceleration c. Dilation of the pupil d. the opposite effect that you want. Phentolamine e. Isoproterenol d.used clinically. producing a decrease in diastolic BP. Epinephrine c. so c is a/so right. Afpha and beie-recepior blockers can block tbese effects.dande tv v. Atropine and propranolol c. Respiratory inhibition b. .The injection of a sympathomimetic (e.:g is no longe. v. While you might be tempted by ''cardiac acceleration". Increased systolic pressure e. Each 01 the lollowing drugs catecholamine EXCEPT B. thus (a) and 2 are wrong. Naloxone c. a. Atropine b. band d a. thus (e) is wrong. Which of the following combinations of agents would be necessary 10 block the cardiovascular effects produced by the injection of a sympathomimetic drug? a. Alpha-1 a.. skeletal muscle vessel dilation (beI8-2). Amphetamine and propranolol (c) . b andd band e c. Which of the following drugs competttlvely blocks the action of norepinephrine at bela-adrenergic receplors? a. increased smooth muscle lone. thus positive inotropic and chronotropic actions Beta-Z agonists: dilation of skeletal muscle blood vessels and bronchi or relaxation of bronchiolar smooth muscle Or to organize it another way: Eye: mydriasis or relaxatl on of diary muscle Heart: acceleration. As for # 5. Phenoxybenzamine and curare e. which will increase systolic bP. Amphetamine b. Phenylephrine d. Secretion of a mucoid viscous saliva i. amphetamine is an indirect acting sympathomimetic. and bela·2 stimulation which wi/I dilate vessels going 10 the lIVer and skeJetal muscle. Decreased diastolic pressure i. Phenoxybenzamine is an alpha-blocker.g. Propranolol d. phentolamine is a non-speciticetobeblocker. thus cannot be released by amphetamine. 13. not a blocker. here's a quick stim ulatlon: review of the effects of adrenergic 10. given orally they cause hypotension by reducing sympathetic outflow from the CNS Beta·1 stimulation: increased cardiac rate and force of contraction. and b only a. and hexamethonium is a ganglionic blocker. All of the others listed ael postsynaplicafly. Isoproterenol d.gents? a. Norepinephrine (b) is considered to be a direct-acting see question #8 (iv}wel/. I think I said that a few questions ago! 15.be/a receptor stimulation means stimulation of beta-1 receptors in the cardiac muscle. (ii~ p~entolamine is an alpha blocker. Pretreatment with reserpine prevents a response to which of the lollowing a. (Jot bela receptor-thus (d) is wrong. bul curare is a nicotinic receptor blocker. Prazosin and propranolol d. Epinephrine b.. Relaxation 01 bronchial smooth muscle b. atropine is muscarinic receptor blocker.

The only alphablocker listed is prazosin. This decrease in blood pressure is cafled "eptneptvine reverse!". d. (b)all of the above are ections of epinephrine excep.alternatives 2-4 all increase heart rste. ii. Increases liver glycogenolysis b. D. Produces a rise in blood pressure d. c. Injection of epi usually causes a rise in blood pressure due to 1) myocardial stimulation that increases ventricular contraction. Produces restlessness and anxiety when b. Propranolol d.Prepared by ML. tsqproterenot (a) epinephrine is a potenl stimulator of both alpha and beta receptors. Phenytephrine d. Propranolot c. Levonord efri n b. Each block a. (a).h as epinephrine produce vesoconsuiction. ThiS is accomplished with beta2 receptor stimulation. (0) and (c) (b). Direct stimulation of alpha receptors c. Administration of which of the following drugs would produce vasoconstriction of the gingival vessels? a. Metho. Amphetamine d. Phentolamine c. (c) and (d) (b). Chlorpromazine €. e.h would scoompttsh both "b" and "en. blood flow /0 skeletal muscles is increased due 10 powerful be/a-2 receptor vasodilator action that is only partially counterbalanced by a vasoconstrictor action on the alpha receptors thaI are also present in Ihe vascular bed. of the following is a predlctable adverse effect of druqs that the sympathetic nervous system EXCEPT Gastrointestinal disturbance Postural hypotension Nasal congestion Urinary retention Miosis (d) What is needed for bronchodilalion is relaxation of bronchial smooth muscles. (b) NE stimulates alpha and beta1 receptors more lIIan beta2. Norepinephrine c. (d) and (e) (c). Thompson. e. Amphetamine b. Epinephrine d. Activation of baroreceptor reflexes b. Which of the following is NOT an acton of epinephrine administered intravenously in a high dose? a. "a" and "c" are false. v. while (e) methoxamine is a vasoconstrictor that stimulates alpha receptors preferentially. Injection of a pressor dose of norepinephrine may result in a decreased heart rale because of 8. AdminislraUon 01 an otherwi se effective pressor dose of epinephrine could cause an "epinephrine reversal" in a patient taking Which of the fottowing drugs? 8. 21. Phenylephrine l. Atropine is a cholinerpic muscarinic receptor blocker.re pronounced. tne total peripheral resistance is decreased and the mean blood pressure fal/s. # 3 is the only alternative /hal includes bolh band e thus you don't have to know anything else. propranolol is a beta-blocker. v. Reduce vascular absorption of the local anesthetic Increase Ihe rate 01 liver metabolism of the local anesthetic Increase Ihe concentration of the locai anesthetic at its receptor site Antagonize the vasodilalinq effects ollhelocal anesthellc i. Tufts Dental School 16. 17 "Epinephrine reversal' 01 blood pressure can best be demonstrated by injecting epinephrine intravenously after pretreatment with a.Alpha-adrenergic aganisls suc. ~ c. iv. Alpha-adrenergic agonists are used in combination anesthetics to a. Reserpine b. Atropine c.doc 29 . So option (b) has 10 be the exception. d. Neostigmine e. Direct stlrnutason of beta-zreceptors e.nd (e) and (e) (d) only is a result of stimulation of the smooth (iii) vasoconstriction G: \8 card 52005 . III.:<amine agents. because it is just obviously wrongJ iii. (c) (b). and isoproterenol is a predominaleiy beta receptor agonist. 20. neostigmine is a cholinesterase inhibitor. When given in the presence of an alpha blocker. which are :specific for cholinergic dr"gs. (d) (0) and (b) (c) only a. 2) an increase in neeat rale.. and most important. (iii) Answer is (c). (c) phenylephn·ne is an alpha receptor agonist. tsoorotereno! is the only drug listed with potent bela2 action. Direct stimulation of beta-t receptors d. lsoproterenot e. beta-receptor mediated vasodilation is mo. 01 the following sympathomimetic bronchodllator is a. Ph. whic. However. Stimulate myocardial contraction lllilhiocal (a] and (a) and (a).. Direct stimulation of muscarinic receptors (a). lithium carbonate (d) CPZ is a potent alpha blocker like pretoslo. 3) vasoconstriction due to alpha receptor stimulation. answer (a). 19. (a) stimulates alpha receptors in the CNS. b. Iv. bronchiolar consiticuor: Epinephrine would cause bronchodi/aUon . Propranolol €. Evokes extrasystoles in tile heart e. Prazosln b. while NE has no effect at muscarinic receptors (e). (d) and (e) (d) and (e) only ii. of General Dentistry. Causes bronchiolar constriction c. (2) reduce the toxic effect of the drug by delaying its absotption into the general Circulation and (3) 10 render the area of injeclion less hemorrhagic. Dept. 23. Vasoconstrictors are include in local anesthetic preparations to (1) prolong and increase the deplh of anesthesia by retaining the anesthetic in the area injected.thai is why il is used to treat acute brocbospesm. 22. the most potent 18.

Amantadine c. Levodopa alone e. 24. Phentoalmine Is a nonselective alpha blocker and thus would cause vasodilation Propranolol is a non·specific be/a-blocker. since the problem with Parkinson's is not enough OA. Nausea and vomiting are seen during Ihe lirst phese of therapy tnn toiersnce develops to these effects. especially in the face b. as always! 1. apparently. one of Ihe firsl things you should know about levodopa therapy is Ihsl some people think Ihat levodopa can sensit. depression and anxiety. 25. Inhibits the peripheral stimulatory fibers from the central nervous system e. specific receptor and produces a response '. (c) and (e) are alpha-1 eqonists. the levodopa gels rapidly degraded by enzymes unless you block the enzyymatic degradation by giving carbidopa along with the levopdopa. is often used in the treatment of parkinsonism because it 8.. Decreases the peripheral metabolism of levodopa d. (b).. involuntary movements. 1/ also can stimulate the emetic center. Carbidopa. (c) and (d) (b). pseudoephedrine might have aislracled you. Possesses the property of affinity but not of intrinsic activitv d. 26. (a).muscle of the peripheral vescutetire. How you are supposed to remember all this stuff about levodopa is way beyond me.S. Prazosin e. c. Albuterol c. Elicits a pharmacologic response wJthout binding 10 a receptor c. or tne options. For this ection. Uwodopa also sensitizes the neen to epinephrine induced arrhythmias.. Phenylephrine b.' Genera! Principles of Drug Action Remember this section of the course? This is where we defined a bunch of terms that described how drugs interact with receptors to produce their effects. which results from abnonnally low tevets of dopamine in the brain. Potentiates the central adion of dopamine b. iiT. dyskineSia (OptiOii (tI)j. So option (e) is all Ihal is left 10 be the exception.hal has bronchodilatory effects. for most patients suffering from parkinsonism involves oral administraHan 01 a. Psychotic disturbances 2. Abnormal involunlary movements (AIMS) are the most prevalent and troublesome "extrapyramidal" side effects. Exa'cerbation of an acute psychosis d. 01 lhe following. Well. Your apologies are graciously accepted. Development 01 abnormal. Dopamine b. Of the list albulerol 'S tile only beta-2 agonistlisled. but that is beside Ihe point You should think levodopa here. producing Ihe eitects given in (d) . (a). but good luck. Increased incidence of arrhythmias is also a problem. (b) and (d) (a). All of Ihe effects are established side effects of L· DOPA therapy. mood changes. The problem with giving levosopa by itself is thai il is rapidly metabolized in tne periphery before il Is sbte 10 cross Ihe BBB. When comparing drugs with respect to intensity of response.C!)armaCOlogiC agonist is a chemical substance that a. Adverse effects of levodopa indude: 8. d. Binds to a. (v) Answer is (e).L-DOPA does and is converted to DOPA in the brain) is used to increase dopamine in the brain. typically involving Ihe orofacjal musculature. thus Ihe answer is (e). you need a drug /11011 is a beta-2agonisl (remember those charts?). prazosin and propranolol are antihypertensives. or L·DOPA is the direct precursor of dopamine (which can Y be used because il doesn't cross Ihe blood brain beater. Arrhythmias b.Levodopa is the primary drug used to treat parkinson's disease. Potentiates the central action of norepinephrine c. Benztropine d. 28. Exhibits no activity except to oppose the effect of an . so you can improve the disease by giving /evodopa /0 increese OA levels in the brain. receptors in the heert and this is a contraindicatjon to using a local enestbeiic containing epinephrine. Pseudoephedrine d . Lavodopa therapy for Parkinson disease may result In each of the following effects EXCEPT: a. Most of you yawned and thought "What the hell do we need to know Ihis sluff for . Increases the permeability of the blood-brain barrier 10 levodopa (c) because thaI is jusl what it does! v. Extreme sedation (e) tevodooe apparently oversiimuletes OA receptors in the basal ganglia and can cause visual and auditory hal/ucinalions (optior: c). one of the most effective treatments currently available in the U. iv.. and (c) (a]. However. since it is a decongestant. antagonist (a) 27. Levodopa plus carhidopa (e) I guess this was true many years ago when this quesJion was written. The psychotic effects are much less prevalent seen in only a small percentage of patients. Extreme sensitivity to sympathomimetic drugs c. but I don 'I know if this would s!!11be considered 10 be one of the most effective treatments . That leaves you wilh a choice be/ween (b) and (e). Nausea and vomiting e. a dopa-decarboxylase inhibitor. Propranolol (b) an asthmatic palienl typically takes a drug t. Phenylephn'ne is an alpha·1 agonist used for sluffy noses. Nausea and vomiting Abnormal involuntary i.. the drug that produces the greatest maximum effect is the one with lhe 30 . which is an elpha~ 1 stimulatory action.just tell us about antibiotics!" Well the Great Soard Gods vlan! YOu to know some of ihis stuff -that's why I put it in the course. (c) and (d) All of the above movements ii.ize the beie-. Which of the following drugs would be most likely taken by an asthmatic patlent? a. Levodopa.

If it did. very dangerous is.ter efficacy than drug 8.rated to the dose of the drog and beceus« the majority of the population do not possess an atypical genetic basis for the response to the drog. The ratio of the median lethal dose (LOSO) to the median effective dose (EDSO) is the a.... They are Ihe most unpredictable in occummce because the genetically-based difference responsible for such a reaction to a drog may not become evident until the drug is taken for the first time by the paOent... therefore. Interaction between nitroglycerin and epinephrine is what type 01 3. '.a.. Allosteric (~Physiologic Biochemical d. relatively safe is.b.. Potentiation b. Thus the drugs would have opposing actions. Tufts Dental School highest a. . (c) epinephrine acts asa physiologic antagonist It nonsp.._ r1v I . Side-effecls ! ~ r. relevant.~ High High Low Low therapeutic therapeutic therapeutic therapeutic index index index index and and and and is. . and thus show a prolonged drug action and increased sensitivity to the drug... therefore. ".. II drug has a grea. Thompson.. whereas nitroglycerin relaxes vascular smooth muscle. Has a greater margin 01 safely than drug B . A drug with a high LOSO and a low ED50 -'~--b_ '. C. Tachyphylaxis V '\ r~ -r--.~ -. . • t d· C. has a A ---c. However. therefore. very dangerous is. D. vasoconstriction.' e. while the nonnal dose may result in a toxic reaction.'. this is Induction Synergism Idiosyncrasy d.. Hypersensitivity e. such thai a therapeutic effect is oresen! at doses much lower than nonna/ly used. 1/ does nol prevent the 13. ls more toxic than drug B b. Has a grea ter affinity for the receptor than drug B ? c.. ._-'_. The maximum tolerated dose to the minimum effective dose :'d~ The lethal dose for 50% of animals to the effective dose for ~50% of animals (d) reworded version of above - •.. bronchodifation.. Species ~Genetic factors ~e or the patient d.-... nitroglycerin does not ect al alpha receptors as does epinephrine. d. _r. Ihe effect is one of abnormal sensitivity to a drug. (c) obvious 9. Half the toxic dose to half the effective dose c.. as do antihistamines. In Ihis case Ihe interacllon is via competing physiological effects.L. // does not reverse the effect of histamine by blocking at a specific receptor ((d)).--. Idiosyncrasies to drugs are related to a. Ph..by Answer (b) is not of action for cromo/yn.)I.doc 31 . .'-"'-.7 V. Which of the following responses is least predictable in occurrence? a.lOsyncrasr--". Cumulative action (b) supposedly why Tylenol #3 was made 5. When the combined action of two drugs is greater than Ihe sum of their individual actions. relatively sale (b) epinephrine would stimulale alpha adrenergic receotors 10 produce vasoconstriction.• '=~ . .. therefore.. Epinephrine antagonizes the effects of histamine by s_ Preventing the release of histamine -: .i'i-epared by M. Potency ?~ Efficacy Therapeutic "'0-:-' releaSe of his/amine as does a drug preventing masl cell degranulation). two: (b) TI= LD501ED50. Competilive antagonism :=.'. Morbidity index Mortality index Anesthetic ratio Therapeutic index (d) as I said above 6_ The therapeutic index 01 a drug is the ratio 01 a. then drug A <J.ecifically enieqonire» histamine by exerting its own distinct effects.. b.-"--'\__. An example is tne response to succinylcholine in patients with atypical plasma cholinesterase.. Affinity b.. the effecls are predictable given the dose and knowledge of what the drug does.~_ Is capable of producing a greater maximum effect than drug "~_"""'8 (d) obvious antagonism? . Physiologic antagonism '-e-/ Noncompetitive antagonism (d) and you wondered why I made you leam /llisl 8. 7' 7 _ The phenomenon in which two dl1Jgs produce opposite effects on a physiologic system but do not act at the same receptor site is a.. while (a) is the mechanism which inhibits mast cell degranulation index such as cromolyn ((a)./" /". d. The other alternatives are typically re. (r /""'0 -.! ::. it. Chemical Antagonism c. the interaction woutd be competitive. Toxicity b. the aciions are proouceo by the drugs acting on different mechanisms. 12.. for example. :. .p.. Dept.~ ~iC. Typically. Therapeutic effects I »-/!::)/'/. The effective dose to the toxic dose b..r: '--'-Y-'. Acting on the central nervous system (~ Producing physiologic actions opposite 10 that 01 histamine Competitively blocking histamine at the ca1!ular receptor site ~---a-j (e) Idiosyncratic reactions are genetically delennined abnonnaJ responses to a drug.. Competitive e_ Pharmacologic ~J 4... and decreased GI motility..t:» /'/:<. never forget 10. of General Dentistry. . These patients don't metabolize succinylcholine at the same rate.. Alt of the above G: 18 oards2005 .

An antagonist has affinity for the receptor but not intrtnstc activity d...ffinity of a drug is depe_.~er>!e~~i_on -. iv. 2.Produces no secatlon (I Has less addiction pot... GABA Advantages vs. Drug A is more efficacious Drug A is 100 times as potent d. chlordiazepoxide. (0) question wants you to remember that barbs are not analgesic . -. Drug A in a dose of 5 mg.--!l. Is substantially less expensive e...d antagonists. (e) and (b) and (e) (c).l!)~~a bal~1>._. Mechanism of action: modulate the activity of the inhibitory neurotransmitter.A) many BDZs form active metabolites.espiratory . vlty o u ~~-the maximum effect of a drug occurs when all receptors are occupied . 3.the effect could effects and toxlciries.mechanism of action. thiopental's action is ~d by redistribution of the drug au! of the brain-it enters the brain rapidly and exits rapidly.'dissociates determines drug efficacy _ _. All of the following statements are true regarding the..ential Is a very short-acting drug d. Ncreplnephrlne (a) effects by modul'ating Sedatives This category consists benzodiazaplnes of mostly questions regarding 3.c actions and adverse side (d) I guess itiet's why they are idiosyncratic be caused by anything. 1\ follows the law of mass action (a) 2._ndent n Its intrinstc ac.. ~nt1NapeutiBndex.Q__ ' U (d) 1.. r. produces the same magnitude of response as drug B in a dose of 500 mg_ Which of the following statements is correct? a.i_U~ Q2P. etc. _ . The degree of drug action is dependent on the law of mass action L ~.r. (c) . Low intrinsic activity and low affinity c. iii. (c) and (bj. h of the following neurohumors? GABA .. (d) and (c) (e) (d) (e) Sedatives 1. Barbiturate depressien overdose kills you because of..this is us ually in !he form of a list of actions and they want you to indicate which is not true. The magnitude of the effect of a drug is proportional to the number of receptors occupied e. (a).. High intrinsic activity and high affinity b. Benzodiazepinesexert a. .. . B) IV injection of diazepam can cause irJitation suches thrombophlebitis due to the solvent 'l'he BOZ is dissolve-din. 3_ Questions about toxicity a.te the disease a patient with iQ_!§Lr:n. --~~. Benzodiazepines (ii) produce their antianxiety . 16.. Neuromuscular their main effect on [oncncns and barblturales. High intrinsic activity and low affinity No intrinsic activity and high affinity .~_ A partial agonist has intrinsic activity but no affinity for the receptor site .---" •. (a) question in occurrence about barbs is always regarding lhiopenlaland redlstrlbutlon. Other points to remember: .~ ii. . '. Glycine c. therapeuti.less profound eNS depression. Acetylcholine e. _. _ . Dopamine d. Diazepam is preferred to a barbiturate as an antianxiety agent because diazepam «h. Drug A is less toxic _. c.. e.-. barbs: less addiction P9tential.occupation theory of drug-receptor interaction EXCEP~.--.. v.. an effective antagonist should exhibit a. less r~_~~_i_r_~~<?_ry." Drug A has a shorter duration of act jon e. (b) and (a). C~.--.T The a.. Drug A is a batter drug to use when a max. Does not potentiate the action of eNS depressants b-\ "Y (b) 2. . c.._ 17 _ The occupational theory of drug-receptor interaction states that 03_ The magnitude of the drug response is proportional to the number of receptors occupied . and requires you to know the dil1erences between the two types of drugs in terms of 32 . occupy the same receptor sile. in Barbs are contraindicated wiII. According 10 the theory thaI agonists an... enhance porphyrin synthesis and thus - ""''-.....p~ '\6--.. An antagonist drug has affinity but no intrinsic activity d! The rate at which the drug·receplor complex associates and ·". Remember._ 2'1 4. Here's a capsule review: i 4 _ Two drugs. . _ Barbiturates: ':t.- 15...imal response is desired 1. Examples: diazepam.aggrava. A and B... b. have the same mechanism of action. thus quick onset and short curallon of aclll:lfl.

~ Which 01 the following factors conLributes to the short duration of action of a single dose of thiopental? a. -----iii.._ "0" is true.. ----. nol cardiovascular depression.:).Lr. barbiturates are always classified according to duration of aclion (Jbio. . (b) and (c) (a) and (b). Dept of General Dentistry. and 5 because barbiturates cause death by respiratory depression. ·c· is also true.)._ high lipid solubility of the undissoclatad form d. )n:p~red by M.__ . Depress all levels of the eNS e.urales are not analgesics. (e) (b) and (c).r .?-.. Barbiturates are contralndicated <.. Of course. Plasma protein binding e. you should have been able to rapidly elimlnale answers (c). Maintaining an open airway '-. d. This elimina/es # 3 so the answer must be (b).. Which of the following are true regarding barbilurales? a.~ [a) and (b) only 5.. Speed of recovery from short-acting anesthesia with thiopental depends chiefly on the rapidity 01 a. (b).l ability to enter and leave tile brain tissue rapidly is the classic example a/ways given of a drug whose duration of action is de/ermined by redistribution away from its site of action in Ihe brain to less well pel1used tissues. Are metabolized by the liver .. Importanl steps in the treatment of barbiturate poisoning include: ~a. The action of the ultrashort-acting primarily by the process of a.J2. thus any answer with "a" such as (a) can be eliminated. raj. (e) and (e) . Renal failure c. e. iii. (d) only (ii) .. The cause of death from acute barbiturate a..~c. (d) 9.N\t o >ti~".. Significantly elevates pain thresholds -=::::: b. Convulsions b.. Administering a central neTVOUSsystem stimulant l____lY (a).long-acfing. Ph. rapid accumulation in body fa! ----§. Emphysema b. Predisposition to laryngospasm (b) Barbitura/es are problema/ic as anesthetics because they often induce excessive setiveuo» and bronchial secretion... 4. Thus (b) has 10 be the false statement.. liver damage Renal failure espiratory failure ardiovascular depression pOisoning is 4_ All of the following pertain to general anesthesia induced by thiopental EXCEPT: .. Renal tubular secretion b. thus the answer must contain "b" as one of the etternetives.L Thompson.. Which of the following adverse effects is most commonly assoclated with administration 01 an intravenous barbiturate? 3... rapid biotransformation b. Increasing the input of afferent stimuli -. Hypotension b. usually requiring the use of an anfich.. Fast induction __b_. Oxidation ~edislributjon ~enal excretion d. 7. Possess anticonvulsant properties .o/ineryic drug to be administered to reduce these secretions.a. 'd.--.Barbft. Hepatic degradation of Ihe thiopental group (~edistributiOn from the brain to skeletal muscle '-~'Reverse diffusion across the..b.'/.r. J'. Nausea and vomiting ~ResPiratOry depression (e) 31 ..c neurons Central adrenergic nerve endings (e) Answer is (c)~ memorizationGABA receptor.___ Are classified according to duration of action c. They leave ou: the word redistribution from the answer to confuse you -Ihey know this is the way you learned it: ttiiopentet (d) is correct- 10. Cause death byca~ulardepr:~. d. Administering a narcotic antagonisl ~ e.. Tufts Dental School e b._.~ Possess signijjcan! analgesic properties --.Bo~rds2005 . (a) and (c) only lv.1 6..C~ c. H. in a dental patient with: G :'..':':~-_':. (b) and (e) only v. low therapeutic index d._) Decreased secretions \J(\ (r-.sion 1. D.. Short duration of anesthesia e.. Hepatic necrosis d.. Maintaining respiration c... BDZ·s bind to sites on the (b) 6. Possess serious drug dependence potential d. Vary in degree of lipid solubility and hypnotic potency 12.l'·L.. --~ -_. thus (d) and (e) are eliminated . ultra-short acling.. Peripheral reflex synapses Central GABAergic neurons Central serotcnerp... Hypertension ... elc. v.neo§'. iv. Undiagnosed severe pain c. (d) (d) and (dl (e) and (e) f\J~. Conjugation with sulfate (b) barbiturates is terminated (iii) Answer is (c). plJenobarbilal. blood-brain barrier e_ None of the above (c) 11.doc 33 . Which 01 the following is NOT characteristic of barbitura tes? a.

.~~r~0_i. . They block the dopamine receptor "b.. If diazepam (Valium) is to be given intravenously. Side effect: anticholinergic or atropine side effects 3. "dO is the absolute contraindication for barbiturate use. (b) and (e) lv. a specific 02 receptor blocker. r would imagine that st they ask more questions about those than they do about 1 generation drugs. drugs e. r• \I ~:~. . bul remember thai MAO inhibitors such as tranylcypromine or .l!!i~~!. -e. i f ~. If you also can dredge up from the recesses of your memory ban/{s thai antipsychotics are also effective anUemel. (a). iii. a... Release of serotonin in the brain b."f~ . (2 generation antidepressants (SSRls) like f1uoxetine (Prozac) are much more commonly used than TeAs or MAOls. again a drug 10 asks that you remember that lithium is the drug of choice for the manic phase of manic depre~rofj:----'-- \\)JT~ -\V-i. iv. (b) only (IJ Answer is (a). phenylene are also used.. Release of serotonin in the brain Release of norepinephrIne In the brain locka de of dopaminergic sites in lhe brain n increase in the dopamine contenl of the cerebral cortex e. -. c. (e) and (d) i) ii. Which of the following are pharmacotogic properties of antipsychotic drugs? <.. Alkalinize the urine b.~ti_o_n_!:_s.<. (b) and (c) (b). When pain is present. "c· would seem to be a pretty strong contraindication. None of Ihe other allematives apply.. 2nd generaUon drugs are fiuoxellne nd and trazodone. And realty. 1. it is recommended that a large vein be used in order to a. so focus on those questions} They ask for: a. resulting in arousal. Block dopamine (S·HD recept~s Treat negative o.. Prevention of the release of norepinephrine from brain neuron terminals (c) 34 . Thus the answer must contain "d". None of the above The last type of question. as well as positive side effects Fewer extrapyramidal dyskinesia The antipsychotic effects of phenothiazines result from a. Since both (a) and (b) differ only by etiemsiive c. .~9A t§rgi'{§_gyski~_~la like clo. and (b) only (a).which of the following is used 10 treat depreSsion? . They are synergistic with LSD e. TeAs are the most commonly used antidepressant medication. c. Mechanism of antipsychotic dopaminergic sites in the brain b. c__S) The antipsychotic effects of the phenolhiazines are probably the result of 8. . since these drugs stimulate the synthesis of enzymes involved in the synthesis of porphyrins and thus will aggravate this disease.. making (a) the right answer. 13. r Antipsychoties Mechanism of Action . Aspirate stomach contents ~ Administer a eNS stimulant '<.. rage and perhaps (lelirium in the patient. (Since we are now well into the era of 2nd generation anti psychotics. that is the second fact you must know. they may even make the pain worse... b.. They cause emesis d. and are often used clinically for this purpose. - Acute intermittent porphyria 2. ' '.m_ul. Mechanism of action: blockade of a!))ine reuptake or alterations of receptor number (SSRls bloc~ rliiiplakElselec1ivefy) . so figure more questions regarding these) The drug ID the questions may ask for: a. the only 1't generation drug still used to any extent is haloperidol [Haldol].xl~aR¥~~. action: blockade of effects.ics._.__ . Release of norepinephrine in the brain Blockade of dopaminergic sites in the brain r Prevention Of tne release of norepinephrine from brain neuron terminals e_ Increase in the dopamine content of the cerebral cortex (c) updated version of this question instead of phenothiazines might use haloperidol Major side eHects: i) anticholinergic 2nd generation a. 1 ~.. Antidepressant questlcns are usually about tricyclic antidepressants such as imipramine or amitriptvli0Etusually of the type ... d.. They affect the hypothalamic temperature regulation system c. r ~~ } ._~~Ii. ~~. thus limiting your answer to t. v.. Barbiturates are not analgeSics. ii) 2. Hasten the onset of action f'b:\ Decrease lhe risk of thrombophlebitis Offset lhe vasoconstrictor qualities of diazepam d. -. c.__ ~ Assure adequate respiration Administer osmotic diuretics 1. but sedatives. eliminating (c) and (d).ardive 3. They cause hypertension CUCa) ii. ~-.lLvr. (a) and (d) only iii. ( ". (c] and (d) (c). The most important therapeutic measure to be taken in a case of barbiturate poisoning is to a. thus i 0(· ii has to be right..zapine: receptors but also serotonin symptoms like t.~~... Y (b) (b) is correct This is one of the adverse side effects of IV diazepam. Annpsychotics questions are usually about phenothiazines and usually about chlorpromazine.J. then you realize Ihal (e) is wrong.. Thus. (d) and (e) (d) and (e) only (d) Psychopharrnacclcqy: Antidepressants and Antlpsychotlcs (i) You should immediately know that (a) has 10 be included as part of the answer.

. an antipsychotic drug used in the treatment of schizophrenia. Which of the following drugs is most effective antidepressant? a. smi-.key word bere is irreversible G _ Tardive dyskinesia ~ !~~~~lrnee~.. Chlorpromazine is an antipsychotic used 10 treat scbizopnient«. Symptoms do NOT produce of action d Postural hypotension of parkinsonism 12. Stimulation of reuptake of norepinephrine from the synaptic cleft G :\8 o<lrds2005 . The drug most commonly used to treat severe mental depression is a. Sodium ..JJ5. The phenothiazine enunsycnotlc« are the only drugs listed whiCh act via dopamine.. Phenothiazine derivatives are antipsychotic drugs such as haloperidol (Halcyon) or chlopromazine used in the treatment of disorders such as schizophrenia.. (b) Ihis quesuo» is obviously from the earty 80'S.ra:--f'henOlhiazines '---e. Alcohols b. Tranylcypromine is the only otner antidepressani listed bul is an MAO inhibitor. The others. !./ ... Dept. Which of the following is most likely 10 be the major mechanism of action of the tricyclic antidepressants? a.. .(c) should sland out immediately because Ihis is almoslalways mentioned as a side etfecWLdi/antin.. so review your syllabus on entidepressents. ." c.'JC~bJ{l· r-Cl·/. Muscarinic r: c.Prepared by M_L Thompson.abnormal rapid alternating movements of tongue an. ~ Parkinsonism ~ Tardive dyskinesia Vf'. You should remember that the most troubling side effect of these drugs is the production of tardive dyskinesia and Ihe parkinsonian-like extrapyramidal disorders. such as tricyclics and MAO inhibitors affect aqrenergic transmission. you would see a different lisl of drugs today.d perioral areas.. Side Effects 5. ------. i 7. These are 2nd choice drugs due to side effects..Chlorpromazine is the prototypic phenothiazine.i~V:~~~ts e_ Anliadrenergic effects (c) Antidepressants 10. J~:. Inhibition of neuronal synthesis of norepinephrine c. Dextroamphetamine is a neurological following classes of drugs? a.-Benzodiazepines (d) ._~-~-b. drug list as an Mechanism 8_ PhenothiazIne derivatives <l. Tranylcypromine d . Today you would probably s'ee something like Prozec. of General Dentistry. both vasomotor centers and the autonomic nervous system) as possible answers.ics ~~Monoamine oxidase inhibitors side-effect of which of the (d) Tardive dyskinesia is an irreversible eonCiilion that consists of involuntary movement of skeletal muscles.. a condition which may be seen following prolonged use of drugs_ This is typically a dopaminergie mediated effect.al/ are seen . Salicylales c.. Diazepam b.-'. Reserpine G ACQ]!D~ d.. Xerostomia c.p/. Barbiturates . ere. Phenothiazines are the only antipsychotic drugs lis/ed.. >_-~_ .Extrapyramidal side effects are the major side effects of anlipsychotic medicalion and include Parkinson-like effects as well as tardive dyskinesia (from development of supersensitivity resulting from chronic blockade of dopamine receptors in basal ganglia). Which of Ihe following drugs are most likely 10 cause extrapyramidal stirn ulation? 3. but an anti-convulsant..doc 35 . As a rule these drugs have anticholinergic and anti-alpha-adrenergic side effects.pos1urai hypotension (due 10 an an Ii-adrenergic depressant effect.. Infertility ! . . which would eliminate xerostomia. Potentiation of serotonin synthesis in nervous tissue d. which Is not a phenothiazine. Xerostomia (}")Gingival hyperplasia e.:. Cbtorpromazine and relaled drugs are thought at act by blocking which of the following receptors? a. Enhanced release of acetylcholine b. facial grimacing. and etten results from an allergic reaction to these drugs. Other antipsychotic drugs used for this purpose are haloperidol and Ihioridazjne_ These drugs acl via dopaminergic receptors. -'-~'<. Chlorpromazi~e ~tl\.'-::r. Antibiotics b. Jaundice is a less frequent side effect than the extrapyramidal symptoms. Chlorpromazine e.:. Which of the following is an irreversible side-effect long-term administration of phenothiazines? a_ Sedation b. Jaundice Photosensitivity ~ (e) .. -Vopaminergic 'tt· Central serotonin (c) Answer is (c).. D.. Tufts Dental School 4. Jaundice b.. Thus # 5 is elimina/ed.. barbiturates ecl via GABA as does etcono: .. Hydroxyzine (c) drug list. Imipramine C\" . Adrenergic b.._. Thus the answer is (cJ- g_ All of Ihe following actions are associated with the use of A chlorpromazine EXCEPT: a... 11. Tricyclic antidepressants c_ Barbiturate anUepileplics (----Cf"'Y>henolhiazine antipsychot.. e.jr resulting from (c) Answer is (c). Ph.~ .

_.lbipofar dfsofder?r In general . c. Preventlhe union of antigen with antibody c. (e) is the only answer Ihal meets allihese req (lirem en/s.. ----. of the manic phase of i'. 36 . 15. eliminating (a).. Side Effects '\c~_. Parkinsonism b. Hypertension e. Acute anxiety ~anic'depressive _. (c) and (d) only v.. Chlorpromazine (a) (a).. The current drug of choice for treatment.:: Atropine ''Y.1y.. ~"'''=-~.you need to remember that 1.~~-.. Schizophrenia A. Imipramine d.. Methacholine (b) TeAs are strong anticho. However.J is particularly effective in treating psychosis (e) 1"6. who already has a compromised immune system. and perforation and hemorrhage may result. 01 the manic phase of depressive psychosis? Reserpine 1. redistribution ~- Frequenlfy asked q(Jestions on anti'inflammatory druqs.~sion. Peptic ulcers C~a. $0 "b" has /0 be in lhe answer. Are therapeutically beneficial when administered orally.!. Suppress theinflammalory response 10 celt injury r-··t.... Thus »: has to be in the answer. (c) and (d) lv.:J ~ Myocardial atrophy 8. Antimanics 14..I~n9~!lP£r~. 1.j_f'P" (\fJf. Tricyclic anllcepressants nearly resembles have a prominent side effect thai most the usual pharmacological action of a..hibit the release of serotonin from vascular storage sites (a) three versions of a question asking the same Ieciola-« whflt if th~y eeid f..linergics.. acute . Reserpine d...o ~ Blockade of the reuptaks of amine neurotransmillers into the synaptic cleft (e) a long winded way of saying re(Jp/ake blockers released adr~.)Lithium D. ~. Redistribution of body fat (d) Anti. Because Illeyere immunosuppressive.. Inhibit the production of antibodies b.. i~~I. Glucocorticosteroids are useful as secondary treatment of anaphylaxis because they a. (b) and (d) iiI. Gastric ulcer b. (a). Which 01 the following conditions contraindicate use of corticosteroids in a dental patient? a.. Lithium carbonate a.. 2.~~... Osteoporosis (?-c. worse. Amphetamine e. These are corticosteroids or glucocorticolds and thaI they the immune syetern in addrtlon to tnelr antiinfiamma\ory activity. hey /lave been T known 10 csuse peptic (Jlcers:-as-we!i as mask the symptoms of an ulcer. All of the above (v) Answer is (e). Decrease activity in lymphoid tissue Heighten the immune response to antigens d. they would obvious make an AIDS patient. orally and fJarenlemlly.Lithium ~"-~jC8ffeine c. Ihey suppress Ihe:JmQ1J)Q€Lsystgrn of the boJ.y QJNt.{c1j ~:Answer is (d). Which of the following drugs has its primary use in the treatment 2. Similarly. AIDS b. such as hydrocortisone are inhibiting every step of tile -~~. (b) and (c) ii.. Which of the following does NOT result from prolonged treatment with steroids? a. ./G\L. Propranolol e. Prevent the release of histamine from sensitized celts d. ~-~ .' Ephedrine d. Tuberculosis d. Cause retention of sodium and fluid b. Thus laten! infections such as -~ 'tob"ercumSis-rnay-gtf'S)'sTemic or opportunistic infections such as Candidiasis may become more of a problem suppress ' . Candidiasis c.r~ manic-depressive . hypeLglyoe~_ia. Amphetamine psychosis is 3.1 mipramine e. Use of corticosteroids in inhalers for asthma. of body fat osteoporosis. teien: t(Jberc(Jlosis could also be reactivaled~ Thus # 3 and (d) can be eliminated.. (b). while advantageous in reducing the side effects resulting from systemic administration. Which 01 the following statemen Is is NOT true regarding the adrenal corticosteroids? 13... Can produce a diabetes-like syndrome with hIgh blood levels e.Glucocorticoids Classed as anfiinflammatories. Codeine ri'b. Side effect profile: gastric ulcers. and atropine is the only anticholinergic drug listed c. .'..inflammatory Drugs: 4. has led 10 an increase in problems with Candidiasis.Corticosteroids are antiinflammatory drugs used topically. Hypergfycemi. parenterally or topically &.

~ /1~--'" 6._. Decreaseexdtability of the motor cortex l (b) maybe cuz it's the base of fhe brain? They will even/ually depress inedullary centers (Slage IV). ~. In general anesthesia.. h- Ph. Spinal cord ~ Medulla oblongata c. the more must be given to reach critical tension in the brain.L 01. ~. a. Dept. Tufts Denial School inflammatory process. . Answer is (c). Peripheral neurilis d. J Stimulate medullary centers .:'. ~ ~ -/. Gastric ulcers ~. Adrenal steroids are used successfully conditions EXCEPT (.y) .. . Molecular weight b. High tissue-blood partition coefficient (b) 2.'<"' J". Signs and stages of anesthesia are most likely to be seen with a general anesthetic that has a <I. doc 37 . - Thompson... The behavior of patients under general anesthesia suggesls that the most resistant part of the central nervous system is the .%q. 4. Severe hypertension (a) jus! because General 1.~ })\~s. -"=" Some questions are based on the progressive depression of eNS function leading to anesthesia thaI characterized older anesthetic agents. (I v f • i c.. That's why nitrous oxide. (a) is stage II of anesthesia Freouently asked questions.\.that would be a neuromuscular G:\Bonrds2005.· w--. patient will slop breathing and die. and (e) are desirable ectoos. Cerebellum e. Anesthetics. A second set of questions has 10 do with adverse side effects of various general anesthetics. General anesthesia with halothane is commonly preceded by administration of atropine to a. all of Ihe above. thai are handled by other drugs Ihal are more selective than glucocorticoids.ocking cholinergic receptors educe salivation and bronchial secretions caused by alothane d. All 01 the following influence tile rate of induction during anesthesia EXCEPT: a. The more soluble the agent is .hetic in the inspired mixture e. Produce delirium b. '. 3. Which of the following forms of drug toxicity is associated with the ~Iogena!ed hydrocarbon general anesthetics? ~Liver damage h. Low potency (0'. Solubility of the anesthetic in blood (blood-gas partition coefficient._.~/ein blood works so {asland ieeves tne body so quickly oncey(iiTs~lop administration. Myocardial atrophy c.eneral Dentistry. 7.~u.\1JJJ.agent is primarily related to its a. Spinal cord (a) that's Slags IV. '. (a) adrenal steroids. Atropine does not induce muscular relaxation. ihe more insoluble the agenl is. Pulmonary ventilation b.ium Ill: surgical anesthesia IV: medullary paralysis 2.\y c. inhibit vagal overactivlty commonly caused by halothane nduce muscular relaxation by bl. General' anestheucs can do all of Ihe following EXCEPT: . maybe cuz it's the base of the brain? 1._: Hemoglobin content of the blood d.l 5. Degree of blood solubiti. ~. -N. ~6 'f ~' " S\.. the tast part of the eNS 10 be depressed is ~~dUlla ~rebnJm c. 5. Remember the 4 stages of anesthesia: Stage Stage Stage Siage I: analgesia ll: delir. or::: Produce a state of unconsciousness d. lnteractlon with preoperative drugs .) Slow rate of induction ~ Low Ostwald coefficient d. '1. Remember that onset of anesthesia is inversely proportional to solubility of the anesthetic in the blood. e. c= .~ ~: d. Midbrain d.L. I. \ fJj.. \"US_·J.~ . r0 • . (c) 49. The rapidity of onset 01 anesthesia with an inhatatlon anesthetic . Cerebral cortex (motor area) d. High oil-water solubility coefficient e. Blood supply to the lungs c. Cerebral cortex (sensor area) (b) Ouestlons a. Ostwald coafficlent). 3.r. Halothane is associated with hepatotoxicity.. "jj!. a.. which is very ins9..-r. The other allematives are single steps along the pathway. thus (d) is the correct answer.this is Ihe classic clinical use of atropine and one you should have committed to memory.lways come up regarding factors that influence the rate of induction.__ fi\ ' Prepared by M.. ~~~~sso~~~:~~osus Rheumatoid arthritis Aphthous stomaUtis to treat all of the following r-. (d). i'". actually cause gastric ulcers!"AII the rest are therapeutic uses.''''. the tester the onset and offset of effect. olherwise known as corticosteroids. D.. Reduce perception of painful stimuli e. I '\ _.J' (b) the rule is.. C.in blood. Concentration of the anest. Temperature in the gas phrase d. (c).

-----_ . Diphenhydramine does not stimulate dopaminergic nerves in the basal ganglia. Cy diz ine c. Drug-mediated in treating a. in Ihal cholinergic and dopaminergic tracts mla. Dilate smooth muscles of'the bronchioles (c) (a) Remember that Parkinsonism is a due to a deficiency of DA in the brain. T rea ling derm atologic manifestations (ex. \_ ~C:-:Oecrease gastric acid secretJon ~ Hasten excretion of barbiturates e. thus (b) and (d) are wrong. the others for al/ergies used d'S H 1 antih istamines are useful for: 1. Which of the following drugs is useful in treating dermatologic manifestalions of an allergic response? a. but is wrong. Preoperative medicalion for sedation. junclion blocker such as curare. and thus reducing cholinergic activity vi" antlc~olmerglc drugs improves or enhances dopaminergic fun~tlon: sugqesti~g... Serotonin antagonists ~ d. Alropine is used to ovetnde vagal activity. Diazepam b. noncompeUtive antagonism e. asked quite as frequently as the ones above: 38 . competitive his/amine receptor blockers. and is currenOy Ireated with levodopa and csrbiaooe. Dimenhydrinate e. - b. Now available 1. inhibition of release of bound histamine is receptor antagonists (b) Answer is (b) . 2.diphe. H1 and H2. Drugs wilh an/I~~olme~lc activity are often stilf the first drug tried. IS based upon which of the following effects? Anticholinergic Local anesthetic c. The implied drug class is antihistamines. 4. Anaphylaxis Contact dennatitis a SID c h ypera ddi ty -: ocallzed allergic reactions (d) same question repeated three different ways Anti hi staml nes: Questions regarding antihistamines generally want you to know what H 1 and H2<mlihislamines are used for: 5.antiemetic anticholinergic effects. histamine receptor antagonist. CNS depressant on the midbrain e. 3. Cimelidine IS used therapeutically to a. Stimulate respiration ~. Stimulant to dopaminergic nerves in the basal ganglia H2 antihistamines secretion such as cimelidine are used 10 reduce gastric acid OTe for heartburn (ex. Thus the answer is (a).mct tf1~ brain. 2.memorization . Asthma inhibition of Hz-histamine receptors is most useful Miscellaneous questions from a variety of categories that are not . but this is the mechanism of action of cramo/yn.1 3. An/lhls/amme drugs such as diphenhydramine often have strong anticholinergic activity. Protect against. which accounts for their effectiveness in drying nasal secretions associated with a cold. properties.epinephrine is lhe physiological an/agonist of histamine. Of the drugs given only 2. (c) a/so draws some answers. Adrenergic-blocking d. bUI diphenhydramine has 110 adrenergic bloc~ing acllvlty. prior to these. :. but thai is not the reason it is given before halothane.. chlorpheniramine) of an allergi c response. are usad to treat ulcers not skin conditions.. but don~ be. There are two desses' of antihistamines. 'antichollnergic drugs were the first drugs found 10 be somewhat effective for treatment of this dise'!se. but these are not responsible forils efficacy in Perkinson's .s · GH2-histamine (e) 41 .- . (ex.-_. H1 antihistamines are used to treat alfergic teectiotis.0 Promethazine d. and (e) are antihistamines. ---. Atropine 0' Hexylresorcinol '--~ Chlorpheniramine e. Dlphenhydramme does have the actions given in (b) and (d). (ex.nhy~ramine (Benadryl ) in controlling the symptoms 01 rklnsonlsm. Anticholinergic drugs c. represented by cimetidine. (c). Chlorpheniramine (c) meC/izine is used for vertigo. #! might confuse you. Many students answer (e).H1 antihistamines are .ana~hylaxis . promethazine) For controlling the symptoms diphenhydramine) 01 parkinsonism 6.. cimetidine). and eh/orphaniramine is an H1 drug. Which of tile following annhlstarntnes is most commonly preoperative medicalion? 8. Adrenergic blockers ((c)) do see some use in the treatment of Pa~ki~son:s. H 1. the answer is (8).ysioiogic antaqonlsrn d. The mechanism of action of H 1 antihistamines MAO enzyme inhibition mpetitive antagonism • >-" . Phenoxybenzamine (d) Answer is (eY. Meclizine __Q. Therefore_. However. H2. Gastric acid secretion has been shown to be most effectively reduced with Ihe use of a Adrenal steroids b. Use of . one is inMbitory 10 the other. (e) is Ihere 10 confuse you.

' _.5 .alpha agonists decreese insulin release..Uf~. leaving 1 gm in the body and you inject 2 mora for a lota. cardiac output and oxygen vlifizalion.a dacrease in blood pressure would not result from adrenergic stimulation.ur. increased activity of the spinal synapses ~creased activity of the medullary centers Omoval of inhibitory activity of the cortex Answer is (e). ~. bul this is not the mechanism of su/fony/ureas. increased activity of the cerebral areas c.actQrsc:ommon to all forms of drug abuse include ~./ after the second injection of 3.:::r. psychological dependence e.Alcohol inhibilS the eNS.. and reproductive funclion even/dally-retums upon cessation of therapy.. 6._g. Dept. hepatic necrosis b.This is a memorization question.L.ardiac arrthyrnia ---·-·---C. miOSIS ··~b-.. ' /.----. (a) is wrong.".1.". Alcoho/has the maior inhibitory cortex. .- !':. . 43._e-. clonazeparn _. a drastic drop in blood pressure e.". <I. Tufts Dental School 24. sedimentation rate d.olami[je d. you inject 2 more for a total 0'3_5 immediately after the third dose. epi elevates blood glucose. cancer of the breast .2..__. permanent sterility c. any of Ihe above duMng' surgery migh t 28.. ""'!.) 'Q. ' "'-.~ . If a patient requiring an extraction reports that he is on dicoumarol therapy. and are the. or thai a serious interaction with a drug that you might require in your management of the patient.:..-...~i: -. Ph D.primary oral antidiabetic agents used therapeutically. gms are given every 4 hrs If 2 what will be the amount in gms in the body immediately after the third dose? ") 7. A dnl9 has a hJIJ1-. Cardiac amhymias are the main bad side effect of epinephrine as a vesoconsutctor. (D).--.Ihromboembolic disorders is The two major side effects are suspected carcinogenicity and the tendency 10 produce It:r2mboembofisms. beta agonists increase it Thus beceuse both of these are adrenergic stimulation. F--. -. The answer according to Ihe gods of the testing board is' (a). as wefl as phenytoin. Beta receptors are found in Ihe heart and stimulation of beta receptors increases heart tete. -k'l:. (c). clolllng time b... any of the above The snsweris (d). 4 and 5. 37. physical dependence d.blocking agent. barbiturates and sedatives. You may need to adjust the anticoagulant activity to within a safe range for surgical procedures. . 27_ Alcoholic euphoria resnus from a. especially in the the answer. transmitter in the eNS.-/' Answer is (c).. (a) can't be /lle answer.may bleed excessively. ~celal. . are the main drugs used to treat trigeminal neuralgia. At the third dose.0 a. r --U-:""- -r.. • #9._ . and (c).B~arbamazepine ·. etcotx». caffeine. ~~ ~ t! I~ ~'. Sulfonyl ureas cause insulin secretion by a. increased activity of Ihe cerebellum b.0 . is common to many drugs such as opiates.. succinykholine is a depolarizing neuromuscular . succinylcholine Answer is (b).. Ihe laboratory lest most valuable surgical risk is a. Answer is (c).• .~. 1/2 of 3 is gone. Miosis ((a)) is a cholinergic effect typically observed with opiates. Answer is (e). at 4 hrs 112 from first injection is' _ gone.:.. (c) is wrong· beta stimulation in smooth muscle and bronchi causes bro ncho dilation . (e) Is the only appropriate test.inephrine for local hemostasis result in • 01. is usually thoughl to be tru« only for morphine. Whicl1 of the /ollowing combinations o.~:. and is thus a drug of choice for acute asthmatic attacks.hypoglycemia .0 e. of General Dentistry. They cause insulin release by (c).. (. leaving 1.. but has not been clearly demonstrated for all abused drogs."".. such as barbiturates or setlcvtete« may occur.4.•. increased blood pressure is the rule.-.' e~"..~. ~ /0'. thus eUm/nating (a). cholinergic stimulation C:::S:irect stimulation of pancreatic bela cells The answer is (b).'}"~ ~~5 d. (b). Epi stimulales both alpha and beta receptors. The use 01 ep.2 gm at 0 hr. complete blood cell count Gplasma prothrombin time in evaluating the 4_ The highesl risk associated with use of oral contraceptlves a.. Amen.st pairs in antidotal therapy? acceptable dloournarol-protamlne J\Bo:lTds2005_doc 39 . Camamazepine.~ .-a~tagOni.Prepared by M. and perhaps cocaine..QL~_b_Q. physical dependence. Thus the risk in an extraction is (hpt the palient. '-_. Cocaine doesn 1 cause this kind of effractlor exompi«.Dicoumarol is an oral anticoagulant. Which of the following drugs is often used 10 treat trigeminal neuralgia? a..s. force of contraction. leaving the choice between been pos/ulaled /0 inhibit GABA effects.Liver funclion can be allered but this is reversible.. . _ ~~. Clonazepam is a benzodiezeoin«. .metnortunion.r.b)· muscarinic agonists increase insulin release.<. Thus (e) is 1. cancer of the uterus . adrenergic simulation b.. while acetazo/amine is an' anliconvulsanllike csroemezepine. 42. -=::::::::::. tolerance.--an acute asthma attack d. (d) is obviously wrong.-f6Ierance c.5 grils. Research has failed 10 prove the link between estrogen and breast cancer.. Thompson. Since dicoumaro/ prevents blOOd clolting by prevenUng the conversion of Vitamin K to prothrombin.. bleeding time c. ~. (- d. rnorphlne-naloxone ~ represents nist._/.

59.. Protein binding sites are just uptake sites that lake up a drug and keep it from getting to its real receptor sile of action.€Qph_ar]e insulin SUSPfi!!sion. 5 mg. In most cases this inactivates the drug. none of the above useful in the treatment of diabetes U hsmisuccinate Answer is (d). warfarin-phenylbulawne d.mosl people answer 3. LaCK of aldosterone results in electrolyte imbalances. c mode of transtormatlon . a 64.hem/succinate.the curve would be similar in shape except shifted 10 the right.5 ml norepinephrine . 1:1000 epinephrine ml (100 mg) hydrocortisone resulti. 2. drug effect observed b. :3 indicates if can't be an antagonist. for example coumarin is 97% protein bound and only 3% is len fa reach effective sites. patients can't respond to stressful situations (such as denial procedures) adequately.. donY you? Answer is (e}« drug A depicts a dose response curve for a full agonlst. The answer is thus (e). while triamcinolone lacks any effecis-OOsodium retention NE and Epi would nol be used in this situation-Ihey might be used in a case of adrenal medulla insufficiency. IImust either be en antagonist or neither an agonist or antagonist in this system.~I!!in injrgclion. with the major . drug B is neither an agonisl or an antagonist (5) sorry ceot reproduce the figure. (d): hyperbaric oxygen would be a usetul treetmen: for carbon monoxide poisoning. 2) intermediate acting: 1. look this up in your course syllabus.. drug A is a partial agonist. In Fig.90 mr. Based upon the responses seen. Of the other corticosteroids given. three doses of drug B are tested for actlvtty in the same lest system. Drug B thus can'l be a panial agonist. he dose given for prednisolone ((b)) is too low. but there are some exceptions which involve the . aid In sleeplnp b. don llhey? If not. Cimelidine is administered to 8. 1% lrtarndnolone acelonide ~0. Similar symptoms may also be seen when a parient is withdrawn from chronic adrenal staroid therapy.. Aldos/erone is a mineralocorticoid Ihat controls sodium retention and potassium excretion. mechanism of action ~. drug Ais an agonist. dose required for a given effect d. All of the other alternatives diverge widely in Iheir structures. prednisolone acetate c. which means (d) is wrong.es the 10xiCitY of warfarin by displacing it from plasma protein binding sites. drug A is an dnt~Qonfst dr. and 3) long acting: prot<!'!line zinc insulin suspension - 48.formation of metabolites with activity (diazepam) or When an inactive prodrug is given (Ievodopa) which becomes active after Ihe first step in the biotransformation pathway (DOPA) somelimes are aSked in questions of this fonn. and an adrenal crisis may occur. 0. carbon monoxlde-carbon dioxide Fig.. In which of the following groups of drugs is there the most consistency ln chemical structure? a.usually biotransformation resull s in a more waler soluble. (b) is wroRg-Pro_!gmine is an antagonist of hepatiQ. diabefes med/calions can be organized into 3 groups based on their onset and duration of action: 1)f.c.. drug A is a agonist..:g B lS 2 partj81 agonist c.-~onsel and guration of action e. Displacement of a drug from prolein binding sites is expected to increase the 8. In Fi. Administration with another drug that is also extensively plasma protein bound will displace the drug that is already on these sites via compeation.Addison's disease results from failure of Ihe adrenal cortices to produce adrenocortical hormones such as aldosterone. The various insulin preparations mellitus differ primarily in a. The duration of action of drug B in the presence of drug A will usually be hortened rolonged nchanged Answer is (b). The dose response curve for drug B is net-no response at all. But / think they give you copy of this exam. drug B is an antagonist e.g. diuretics . immediately with 8. You still have your course syllabus.igmoida/ aos» response curve going from 0-100% response.Remember that local anesthetics are either esters or amides. 1. The recommended treatment is (e). nonbarblturate sedatives Answer is (e).. thus (b) is eliminated from tutthet consideration. in..Remember.' phenylbutazone enhanr. In Fig . 3....'he typical :.remember. and thus effectively increase Ihe level of drug Ihal can now gel 10 an active receptor site. three different doses of drug A are tested lor activity. The fact fhat it doesn't seem 10 stter the dose response curve for Drug A in 61. do not pass go.dosleronism) from a minor denial procedure.£ anliepileptics ( ~ocal anesthetics '-d:-'ge ne ra I an ss the tics e. Some drugs are extensively protein bound. (c). drug A is an agonist. none of the above answer is (a).!1ol dicoumaro/. drug B is an antaponlst d. In an addison ian crisis (hypoal. more readily excreted form of the parent drug.ng from stress the patient should be treated 46. 52.as~in9. nol C02 56. relieve astnma ~ inhibit gastric secretion ~ relieve cold and nu symptoms Answeris (c). which of the following statements best describe drugs A and 81 a.b. la) Should be immediately obvious.!. do nOI collect $200.. duration of drug effect c.go no furlher. three doses of drug A are tested in the presence of the high dose of drug B.. problem being hyponatremia (sodium loss). Drug A inhibits the biotransformation of Drug B. confusing protein binding sites from active receplor sites where drugs exert their effects. locus of action b.. cimetidine or "Tagame/"IS an H2 antihistamine are used therapeutically to inhibit gas/ric 40 . Due to depressed adrenal function.5 ml. Answer is (e).YDI!:'2!9P_orjl~~me . drug B an partial agonist e.

of General Dentistry. "d" is often used for prolonged and steady drug reteese so it also is true.. levodopa ~acetylcholine :(Lphysosligmine . absorption from the GI tract. Dept. aspirin. Tocountersci a competitive muscarinic receptor block.I would guess (d) because its the only one I've ever heard of. but you don~ know tile difference beMeen H1 and H2 antihistamines. c. The drugs thus inhibit one or more phases of the cell cycle or prevent a cell in Go (Ihe nondividing phase) from entering in/a the cycle of cell division. The 'Ia/ter refers to some alteration of receptors Ihal leads to diminished response to the drug.jy".. . tinnitus. is contraindicated in children suffering from influenza or chicken pox: aspirin has been implicated in the development of Renee's syndrome_ 67 _ Disorientation. vincristine P~d methotrexate . vomiling and GI _bleeding are all symptofrJS:O_( . which acts as an antimetabolite. Thus the Gods of the Board questions have decreed thai the answer shall be (a)_ _77. This is its only clinical use. '11" is obviously right for the same reason. if you look the others up. Absorption 01 a drug from the intramuscular site 01 administration may be slowed by a. all of the above Answer is (e). Ph.. (""':~I~... b.E..~. and d 4. b only 3.) rr= _. all of the above Answer is (c)· "a" can't be righlbecause exercise increases blood flow through muscles and thus improves absorption Thus # 1 is wrong. (a) and (d).t'rei ri.by incorporation into a metabolic pathway and formation of a false metabolite which is nonfunctional or (2) by inhibition of the catalytic function of an enzyme or enzyme system.. The dNg Which will do this is physostigmine. vasoconstriction ~he presence of congestive heart faiture '----t( administering the drug as an insoluble complex 1. The answer is to give a drug which knocks outlhe acelylcholinesterase.. you can't give ACh 82. a and cOI1!y 4.1"1\ . vomiting d. a and b 2. L Thompson. clsptaun b... (d) is a folate antagonist. b.maintaining the concentration of Ca+r in extracellular fiuid by regulating the deposition and mobilization of calcium from bone.<J]iCYlism. . desensitization to a drug Is . a.. " .doc 41 ." {'J I ' __ ". b. band d 5.~. They hope \0 confuse you because there is a correlation between calcitonin and calcium.scopolamine is a muscarinic receptor blocker similar /0 etroolne.". Remember.Prepared by M. aldosterone d.it is also a poient inhibitor of the mixed function oxidase drug me/abolizing enzyme system in the liver.. a. Which of Jhs following hormones acts to elevate blood concentrafion of ionic catcium? __:a glucagon '~"')parathyrojd '-. gastrointestinal bleeding 1.-. usually occurring after prolonged treatment with large doses..imetabolites may act in 2 ways (1) . thyrotropin is there 10 contuse you with parathyroid hormone. b. hypoglycemia. tinnitus ."Salicyfism" is a mild toxic reecuon to aspirin (acety/sa/icyJic acid). The other alternativGs are /0 confuse you because you probablyai least remember thai it is an antihistamine. Wow. elopedhyporeacllvltv tolerance antagonism c. Which of the following antimetabolite'? anticancer drugs can be classlfied as an a. and c 2. Ant... you need to increase the revels of egonist.h <:' . D. W. evaluatlon of side effects G: \8 oards2005 .j . Tufts Dental School secretion ((c)) In cases of peptic ulcer. Vincristine acts during the mitotic phase Answer is (a)· your choices are between tolerance and desensilizaUon. aI/owing endogenously released ACh to accumulate to overcome the acliot1 of scopolamine. (e) is an alkaloid derived from plants.":::-1. You might see il in a questian regarding drug metabofism.-".. thyrotropin e."' ' ~. and hallucinations resulting from an overdose of scopolamine are mas} efficaciously treated by . and atdosterone regulates Na+ levels not Ca+«. Methotrexate is an example of a cell cycle specific antimetabolite that inhibits DNA synthesis during the S phase.·. fever.. c. excretion etc.fU> Answer is (d). However. is the main function of parathyroid horrnone. thus (a) is wrong. atropine admini~. and d 5. confusion. we got it n'ght! Actual/y. thyrocalcltonin . ~ .. i /. nausea -b. (a) & (b) are alkytatJng agents.'-' ~" Il.' f. and is really a mechanism whereby tolerance may occur. ' Answer is (d) . "c" would also result in reduced blood flow so slower absorption would also be a problem.3. comparison with a placebo b. Which of the following are important criteria for the adequate clinical evaluation of a new drug? a. excerclse b. !-" ~\' \. Thyrocalcitonin is another name for ealcitonln.I I.. s 07h~r no/able side effects of Iispirih"Wmch result from ingestion of a single large dose are disturbances of 8cia-bsse imbalance (acidosis or alkalosis).. The answer must thus be te)_ 66. 55.. tering p'rvVP~)h ~_."':'"'-a \. and since 1/1is wasn1 covered in class you might be one to guess it also. Levodopa has nothing /0 do with this question. " A: " . a. most cancer chemotherapy drugs cause cell death by affecting the ability of cells tadivide. Just for your future edification. except that calcium concentrations regulate the synthesis and release of calcitonin. Answer is (b).. 78. Salicylism includes which of the following? -. Glucagon is a pancreatic hormone that stimutates glucose production. detoxification d. in this case acetylcholine. lomustlne c. because it is broken down almos! instantaneously by acetylcholinesterase. b. and d . Nausea..". c.

chlordiazepoxide o Answer is (b). they represent Ihe first stage of biotransformation.c. b. b. and e 5. pentobarbital d. A toxic effect can be broadly defined as any undesired effect of the drug.Jloxicity is both time and dose dependent '-. chlorpromazine methylphenidate -'.This is a pure memorizetlon question. b. which typically have a long duration of aclion because they are converted to pharmacologically active metabolites with long half-Jives. even a minimal concentration can be harmful Answer is (a). you should instanlly be able to identify (a) as the correct answer. d. Al!emative (a) is tricky.ot synergistic of Ihe following? a. and e sympathomimetic."1\1-1 which "e~ Answer is (e). There Is no reaction called N-a/ky/ation. pentobarbital is a barbiturate. Synthetic (phase /I) reections consist of Ihe conjugation of drugs or their metabolites with functional groups. it has no analgesic properties . n. these drugs can mimic the effect of morphine In a drug free patient. Thus. d and e only 6.andd 2. A heroin dependent patient should not be given nalbuphine (Nubain) for pain because d. 8. 99. 86.Nalbuphine is a mixed agonist-antagonist thai is analgesically equipotent with morphine (Ihus # 1 is ruled out). sulfate conjugation d . for some drugs. diazepam b. _ b. 80lh are sedating. 97. thus # 4 can~ be the exception To rule out # 5. c. The central actions of ethyl alcohol are flo:. Of the alternatives. drugs exert a single action most ~t. utilization of control groups d.) c. The constant quest ofpharmacolqgy as a science is to design or identify drugs that have as naiTow or specifiC range of action as possibfe. thus precipitating withdrawal. all of the above Answer is #6" A gimme-this is just common sense.:. meperidine c. Oxazepam. a. It has pronounced antagonistic effects at the mu receptor. and iorezepem are exceptions that are not converted to active melabolites. C. Ea ch of the following agents has a long duration of action due to the presence 01 liver generated active metabolites EXCEPT a. but not 10 many single action drugs have been identified. Thus (b). and thus are wrong because tlley are synthetic reactions. N-alkylaHon O-dealkylation c. # 2 is ruled out # 4 is not likely.b. L050IE050).. it may produce respiratory depression as a mixed gonis/-antagonist. analgesia is produced by its agonistic effects at kappa oplold receptors. The mixed agonisl-enlagonisls were designed fo combine analgesia wl!h enough antagonistic properties to proventtheir abuse. bu/orphanol is the exception.Nonsynthelic reactions (phase I reactions) include the various transformations of molecular structure: oxidation. which is a nonsynthelic or phase 1 oxidative reaction.elicit withdrawal ymploms the high abuse potential 01 nalbuphine may add to the atienl's problems . 84. it ca. midazolam. AI. an oxidative phase . All of these drugs are benzodiazepines. symptoms of toxicity can be anything ranging from nausea 10 death ~ e. a. and can be used clinically to reverse respiratory depression (by blocking mu receptors) without a loss of analgesic effects (by stimulating kappa receptors). Answer is (d). double blind experimental. design 1. Both of/hese classes of drugs are also typically sedating. Each of the following statements relates to the general aspects of toxicology EXCEPT \3' .1 reaclion is left as the right answer 92. Of Ihis class of drugs.. diazepam oxazepam c.The central actions of alcohol are depressant Thus the choice of correct answer cornes down 10 knowing which of the drugs listed is not 8 eNS dBprestJant. and e 3.. The answer is thus (b). reduction.If you learned anything from pharmacology. Alternatives (c) and (b) should remind you of phrases such as dose-response CUives and tnereoeuuc index (the retio of a toxic or lelhal dose to a therapeutic dose. However. 4. Thus. Meperidine is an opiate.i/ will not precipitate withdrawal because it is only a weak mu anlagonist. (c) and (d) are conjugation reactions.! of the following methods of drug biotransformation classified as synthetic excell!: ("~. comparison with a standard drug e. The correct answer is (e). Diazepam is a benzodiazepine. methylphenidate (Ritalin).c.a. toxicity can be due to overdosage of a drug ----. It is made to sound /ike N-defilkylation. while chlorpromazine is a phenothiazine antipsychotic. Typical/y. but antagonize opiate eclion in a dependent paVent. tturazepem d. d. d. glucuronide conjugaHon are IJ Answer is (b). think of nerve gas. # 3 is the right answer. Ritalin is an indirect acting 42 . and hydrolysis. and sets simitar to amphetamine in the crss-u is a stimulant.

04 mg of epi max in CV patients. ce.=d by M _L.depending on palfenfs status. . nol an anticonvU/sanU1S. ravte lislf'ld thaI goes direcrly 93.your usual choice as a loca! anesthetic. 1:100. which acts to decrease cardiac output ana contractilily (so (c) is obviously wrong. Guidelines into wnst adjustments to make in Coumadin tnerepypricr to dental treatment have changed since this type of question was written . The others all also have antianylhmic action. A male patient who is receiving Coumadin therapy presents for an elective extraction. aspirin corn s 01 '" c. Each of the following drugs has a significant anti-inflammatory property except one . it could be that no adjustment should be made at all. if you donY remember propranolol as the prototype nonspecific beta adrenergic receptor blocker. the goal is to reduce the oxygen demands of the heart. ~troplne "-lU1>pinephrin e c. The easiest way to figure this one out is to remember you shouldn't give more than 2. increasing cardiac contractility d-. Which of the following drugs is often administered t.. 1 cc of 1 :50..the sstest bet is to consult physician . heparin is nota Coumadin antagonist.Teducing Cournadin to one half the usual dose for two days d. administering a Cournadin anlagonist. (a) memorize. Since 1:50.. so 1. so (b) has 10 be the righl answer. Tufts Dental School Board Exam Review Addendum More board questions that were released after I prepared the original review: 52. a diuretic d.2 carpules of xy/ocaine with 1:100. mostly used for supraventricular /achyarrythmias 75. Option (e) would take longer to reduce (PT) then jusl slopping Ihe Coumadin.ory at significant cardiovascular impairment. Of course. Most are anliconvulsants. The maximum safe dose 01 epinephrine that can be administered this patient is: a. you could have just remembered.--'-a.02 mg per ce. Which of the lollowing methods is preferred for reducing the PT to an acceptable level? .000 (opUon (a)) is the same as 2 cc of 1:100. nol angina) 62. D_.:. Two carpules is 3. 1 ce. you shouldn 1 be laking this test.enyloifl.000 (b) Ihe rule is _.:50. 1: 100. chlorpromazine (Thorazine) d. 1 CC. carbamazepine (Tegretol) e. 2 CC. is an anticonvulsant. dilating systemic blood vessels c.000 d. Fleming and change your grade in Pharmacology to an OF"! 72.000 equals _01 mg per cc.000 epi . propranolol to treat life- b.. Ph. A patient has a hisl.. so (b) would equal/he max of. not propranolol. bvt are Ihe way thai nitroglycerin and calcium channel blockers work. 04 mg.. such as heparin e. In angina. 2 c. a potent vasodilator . ~diazepam (Valium) phenytoin (Oilantin) c.000 1: 100. which is obviously important in an emergency.and lidocaine is particularly effective for this k. DEpt of Genera! DEntistry. GC. since they would be safe bul not maximal. a situsiion that would ceuse problems during dental surgical procedures. '-b) (b) venlricular arrythmias are tne life threatening ones.ind of arrhylhmia when given parenterally in an emergency situation_ 1/ has a very rapid onset of action when given IV. inhalation d .. dilating coronary arteries b.indomethacin . memorize. Thompson. since it can·t get enough (a) and {bJ are usefUl actions in angina. quinidine lidocaine <« verapamil d.~repar.lbriurn) 'Cb': 58.hreatening arrhythmias? a.ting vagal slowing of the heart (::jloCking beta-adrenergic receptors altha heart (e) my god. (c) geez.phen ~ ~profen e. I will call Mr.000 is twice as concentrated as 1:100.subcutaneous e. Whicll one is the exception? a.rtainfy not for minor surgery anyways. with the patient's physician about stopping the Cnumadin for a few deys. Which 01 the following is the current drug of choice for status"f'~p!icus? \. chlordiazepoxide (l.Withdrawing Cournadln for two days '--c_. His protrhombin time (PT) is prolonged.6 cc Tilis eliminates options (c) and (d). Dentisl should consut.000 99_ Bradycardia is MOSTcomrnonly treated with which of the follOwing ~~? \ to a. adminislering a platelet transfusion 10 enhance coagulability (b) the issue is obviously thaI the patient may bleed excessiveiy. but diazepam is drug of choice. but an anticoagulant in its own right..ino.E eta m..this is an action thai is needed in heart failure patients. 83. Propranolol (Inderal) exerts its major antlanginal effect by a. adminislering vitamin K (Aqua Mephyton) . G :\Boards2005_doc 43 . 1: 50. Options (a) and (e) might be appropriate in an emergency situation.000 so sUfi nol close 10 max.-_J2:. intramuscular (a) enteral means via Gllmel-only into GI tract is (a) oral. Which of !he following is an example 01 an enteral route of q ·6\-a1 iniSlraliOn? submucosal c. they keep repealing this question year etter year after year" if you don llmmediate/y know that the answer is acetaminophen. 1: 50. FinaJly. : b--::". but that is not what we are dealing wlth here. and is one of the answers tothe-qUJ"-s1iQn "which of Ihe following causes gingival hyperpiesia?" Don't forgel diazepam is also given (or antianxiety and sedation. ~oma2J'ne is an antipsychotic..000.sumula.000 equals . ..

The correct total liter flow 01 nitrous oxide. 128.Aressure.-. Which of the following effects are common diazepam.of the drugs listed (d) is Ihe best.you knew those d.-Jg lis.. Low dose aspirin blocks Ihe latter. anticonvulsant. controlled by vagal input 10 the neon. Cursre is a nfcoHnic receptor blocker. is a reflexive slowed hearl rate. The dentist should 8. (a) would enhance neuromuscular action. A dentist is considering the use of nitrous-oxide conscious sedation lor a patient.bul youve galla block the vagal input.limination (b) has to be the riqtiienswer since (a) and (c) are indications for Ihe use of nitrous 103. Thus highly ionized drugs. cholinergic --. A/ropine is the only drug lisled which is a cholinergic agent. The two drugs used clinically to do this are 94_rare and succinylcholine. the largest volume lha! the patient can exchange within ons minunte idnl know this-' hope you did! I hope someone leaches Ihis ~~eWhere in the curriculum! f~. which is already the problem with glaucoma patients. 137. because if you knew bradycardia was cardiac slowing... you might be tempted to think epi. and thromooxene. Succinylcholine a. (e) is how spider venoms and snake toxins work. norepinephrine c. (a) wouldn ~ help either. wllich is less potent at beta receptors than isoproterenol. prostacyclin. the amount necessary to keep the reservoir bag 1/3 to 213 full d. (d) isn't possible_ (b) memorize adequately 153. more rapidly metabolized d. analgesia and relief of anxiety to pentobarbital. which usually speeds up the heart. so (c) is right. thereby causing its subsequent depolarization of the neIJron and a block of nuscle activity. the prototype anticholinergic drug was don1 use it with glaucoma patients. (a) is the mechanism of action of corlicosterofd d. amphetamine is an indirect acting o"igonisl that causes the release of norepinephrine. isoproterenol ~ methoxamine agents is the most 0: (c) one of the things you had 10 memorize about atropine. inhibiting ~epoldrizing . phenylephrine {6. inhibiting b. amphetamine b. (d) for bronchodilation you want a potent beta-2 adrenergic receptor agonist.1less lipid soluble ~ess water soluble c. immediately has upper sider. A patient who is receiving an IV diazepam sedation eye-lid ptosis (Verill's sign). Which of the following best explains why drugs that are highly ionized tend to be more rapidly excreted than those that are less ~ed? The highly ionized are ( ra\. 148. which are less lipid soluble don t get stored in fatty tissueend am subject to more rapid excretion. should the patient have a history of which of the following? D_ dental anxiety ~~yehoUc care ~ntrolled hypertension (b) even if you didn 1know that nitrous can ailer the patienl's sense of reality (that's why you don Y give it alone in your office. not succinylcholine. assist respiration. which decreases it. (ef) is Ihe mechanism of action of anticoagulant drugs like coumadin. which means you need a cholinergic receptor blocker 10 reduce the 132. would be Ihe right answer.oxygen is determined by a a standard 6 liter per minute flow b. administer one more increment of diazepam and proceed with the treatment ~ this is the sign you look for fo tell the patient is sedated_ (c) See. and meperidine? 8./. Isoproterenol is a non-specific beta agonist Me/hoxamine and pheny/ephn'ne are alpha-1 eqonists.slJcclnylcholine acls 10 overstimatste the receptor. Drugs in categories (b) end (d) are actually used to tmat glaucoma.a!-energiC6lOCking 139. However. this type of sedation wit! be CONTRAINDICATED. antichotinergic r a. they might fantasize thai you had your way with them when you didnl!) by e. and lend (0 get stored in iettissue from where they are only slowly released. 125. b.(a) bradycardia vagal effect.. prostacyclin synthetase in the blood vessel walls ~romboxane synthetase in the platelels ~ilamin K in the liver (c) pla/e/et aggregaUon is controlled by two factors. and hypnotic b. as il will increase it:ltrao_cnlat.e paUent to be adequately sedated ace the patient in the Trendelenberg position d. epi won 1 work.-!-~ c. adrenergic ..c( inducing e_·blOcking blocks neuromuscular transmission by chotinesterase the central nervous system the motor endplale of skeletal muscle the formation of cholinesterase at tns endplate release of acetylcholine at the endplate C~. Low dose aspirin therapy prevents the formation of Ihromboemboti by preferentially inhibiting Which of the following? a_ phospholipase A2 in the blood vessel walls b. Which of the following sympathomimetic potent bronch. more extensively bound to tissue (a) nonionized forms of drugs cross membranes more readily and are highly lipid soluble. 44 . definitions / made you memorize would come in useful. and is cholinsrgically media/ed.' Neuromuscular transmission requires the action of acetylcholine at tile nicotinic receptors on the neuromuscular junction endplate.odilator? a. and is actually made use of cfinically with myasthenia gravis patients. They threw in epinephrine as a lease. so they ere obviously not contraindicated_ Obviously. . th. which enhances it.~Jgs. the patient's metabolic oxygen requirements c. 110_ Which of the following groups of drugs is CONTRAINDICATED lor patients who have glaucoma? a.

it has 10 be free to get distributed 10 active site 16_ A patient who has which of the following concltlons is most likely 10 have postoperative bleeding after multiple extractions? a. ffi)innammation reduces the availability of the free base '--c~ drug will be absorbed more rapidly because of the the increased blood supply d. A primary advantage lollowing? of intravenous sedation is which of the 49. atropine and propranolol c.drug has to be abSOrbed before any of the olher actions can lake place. (d). have /0 be absorbed.drrhosi s -o. angina diabetes \. and (d) applies only 10 diazepam. chloral hydrate (b) memorize. Meperidine (Demerol). Local anesthetics aid in reducing the now of sativa during operative procedures by a..--theumatic fever e. Which of the following . 168. and fearful. promethazine (Phenergan) and chlorpromazine (Thorazlne) combined (b) most likely because i/ is lilretable and thus can be used to provide just enough of an effect 10 calm the anxious child. WhiCh of the following drugs causes the LEAST eNS depression and impairment of psychomotor skills? a. (c). blocking innervation to major salivary gtands ~ blocking efferent parasympathetic nerve pathways reducing sensitivity and anxiety during looth preparation C5 (d) locets dont have actions (a). which results in reduced availability of the free base form needed 10 cross /he neural membrane.3 the prostaglandins stabilize the nerve membrane '. D_. prazosln and propranolol G: '-Bo" rds200 5. fewer side effects from Ihe sedation slower biotransformation lor prolonged action '------5 the ability to ntrateinoivldualized dosage d_ a smooth and more gradual onset of sedation ~ (c) hey . Ph.this is decreased by cirrhosisthe result is deficiencies in prothrombin dependent coagulation factors '. so I would suggest you look at the many different wordings of this question and know thai/My are just testing the factoid thaI inflamed tissue has a lower pH. The others would determine duration of action. Dept of General Dentistry. detoxified in the liver d. Nafoxone is a drug used to reverse the ettects of too mucn morphine. Each of the following is true regarding drug btotransformatlon EXCEPT one. "'" "'" 191. Which of the following best explains why? . . atropine and prazosin . th~lJs '.IPromethazine d. chronic bronchitis r-b. oot onset. The major effect of a drug is produced by the amount of the drug . Hydroxyzine hydrodlloride [atarax) or hydroxyzine parncate (Vislarit) in divided doses a. Making i1lipid soluble and nonion/zed would make it stay longer in the body.e chloral hydrate 17_4.I asked Ihis on the exam! Titratability is the primary advantage or iv drug administration. Tufts Dental School (c:sedation and ability to produce dependence amnesia and skeletal muscle relaxation a (e) the only definition which covers alll. memorize. -n. nol gradual. bound 10 plasma protein (a) if its excreted or detoxified. blocking Ihe cholinergic nerve endings b.__c.hree drugs. but can cause impairment of psychomotor skills). 179.8 Ip ra zola m d. which is weier soluble.L Thompson. 154 The onset of action of a drug is primarily determined of by the rate a. excreted by the kidney c. Ihe Chemical mediators of inflammation will present a chemical antagonism to the anesthetic (b) they ask a varianl of this qVfJs/ion every single year. diazepam -.. it aln~ going 10 get to irs active site to have an effect Same if II is bound to plasma proteins . '. The other slalements are true. Which of the IQltowing combinations of agents would be necessary to block the cardiovascular effects produced by the injection 01 a sympathomimetic drug? a. excretion . (b) applies only to meperidine. (b).__ee u in plasma b. A <I yr old child is shy. a_ Naloxone for the restorative appointments for this (c) vitamin K is stored in the liver. however.--. !"?\ltJuspirone ""e"'. it primarily occurs in the liver microsomal enzyme system c. a. VIi. Which one is the EXCEPTION? a.: 176.doc 45 . <Jnd (e) are sedative regimens Ihat would probably induce deeper sedation than nnroue. Buspirone is used to relieve anxie/y . 42. the rate may differ significantly in various animal species b..it is not a benzodiazepine like diazepam and a/prazo/am (BOZs may not be that sedating. since the purpose of drug melabolism is to change Ihe drug into an excretable form. it generally involves alterations of Ihe chemical structure of the drug ". Nitrous oxide/oxygen ~. (a) applies only to pentobarbital. non ionized form d. ilnd lIlal mlJch sedation doesn1 seem to be called for flere. do salivale more.-- --0 __- ~ ~ Prepared by M.. b.----. timid. ionized. biotransformation (b) obviously . it usually converts a drug to its lipid soluble. or (e)! Nervous patients. and not a strong sedative lik. so (d) is oul (a) and (b) are not possible.8bsorplion "'-c-~ distribution d. Onset is very /asl.! I I be MOST appropriate child? . Injection of a local anesthetic into an inflamed area usually has a less than optimal result.since it ooesn'. 177. ~ this is the exception.. lJ:.

usy absorption when taken orally.t.l!. xylocaine d.. since hardly anyone outside periodontists hardly uses tetmcyctines anymore in denUslry that they would not ask you a lot of questions about tetracyclines. \' b..P~onstrictive actions? \.?.neSi'j. phenoxybenzamine and curare e. or papillary dilation effect of 136. but curare is a neuromuscular junclion blocker. procaine c. asscciateo with the use of a.?pidn~ f make you memorize potency vs. chloramphenicolbone marrow depression.. is usually injected..:. capable ofj)foducJng. amphoteriCin B ~nephro!oxicjty 151. so I would expect these kinds of questions 10 disappear. te/racycline is apparenlly the one . Atropine is a muscarinic blocker (anticholinergic). thet's wily most require the addition of epinephrine. gen t arnyon. and propranolol. When compared therapeutically 10 penidllin slower renal excretion .1 . So once aga. due to lo.. the patient might experience which of the following side effects? a. As a result of this medication. :.~. penicillin V has a . superinfection c..'. herpangina b./-' ' "'-/ r . diarrhea b. you're ready. blurred vision '-. -.. The maximal or ceiling. efficacy? Potericy~s how much drug does i/ take to produce anef[. it's an excel/enl/ocal anesthetic/'j. ': _ b.icholinergic mydriasis. whicl1 of the following is considered to have the highest dependence liability? a. 46 .. 124. Which one is the EXCEPTION? a. oj. doesn1-!."l(' ! 'j. potency \. "more reliable oral absorption ~hro<lder a.. amphotericin B 0::.{•. d. metronidazole d.:::.___ r ••• - ---~~----~ ~--~- d.n all locals except for cocaine are vesodiletorv./. chloramphenicol 06. so that leaves (d) gingivitis 110.I think they like /0 justify keeping some cocaine in their office (~But -'-~. '--t"efficacy 112. recurrent apthous stomatitis (~necrolizing ulcerative gingivitis (d) by process of elimination: herpangl'na is a viral condilion.·Y. diarrhea ~ bradycardia .~.. phenoxybenzamine is an alpha-blocker.r:' discoloration of newly forming teeth (d) since you use tetracycline everyday. '. but if they do.._.d/and f!fficacy is now much of an effect i!Ji 2rjryJfJ.' specificity (c) efficacy sounds like it might have something 10 do WI~h effect.is. Which of the following antibiotics is found at much higher concentrations in crevicular fluid than in serum? a. d . angina pectoris is heart pain caused by lack of oxygen..' Ihe effects ere polymixin· renal necrosis. oxycodone (in Percodan) c.since periodontists use tetracyclines a /0(. sedation b. Pen G is hardly used in dentistry anymore. Amphetamine is a sympathomimeUc dIVQ. effect of a drug is also correctly referred' 10 as the drug's a. photosensitivity visual disturbance "'--. greater resistance to penicillinase e.. a non-specitk: beta-blocker. Of the following local anesthetics. which has intrinsic ~§.r'J.':/.~C<line b. which pn'marily affecls absorption from Gllraci.".: '·'i.J r:ve . When administered (b) same drugs just different salts. (dJ what the heck is 'crevicular fluid" and where . :.. de~f.___/ need to gel some antibiotic in there.:~ "\.-~a. To reduce a patient's salivary now. codeine b. Auditory n~.-. c\indamycin b. bupivacalne (a) ah. so you would need a pairing of drugs which blocks those receptors. epthous stoma/itus is canker sores . Officer./1" f.{y_ r . 118. a dentist has prescribed atropine. ro~ Each of the following is a common side effect of prolonged tetracycline therapy EXCEPT one. not a blocker or sympatholytic drug. Antibiotics are usetul in the treatment of which of the following? a. you have committed all this stuff to memory. as oral centrally acting analgesics. Pen G.. the classic coceine is a local anes/heUc ques!ion! I told you they asked this question all the lime ... Prezosin.' (d) each one of these drugs has a side effect/hat Ihey may use in the slem of this question. propoxyphene (Oarvon) taZOcine (Talwin) emoriza that list of opioid analgesic potencies ropoxyphene<codeine<penfazocine<oxycodone /I would go -.)~. 89.. right? 135..~tomach cramping (d) because it will also cause the anl. angina oectorts /-. right? I would hope.. are the only pair that block both types sympathetic/adrenergic receptors. polyrnlxin B fJLf''. amphetamine and propranolol (c) a sympathomimetic dIVg is going to potentially activate both alpha and bela receptors.must be something 10 do with gums.' c.these are notlile result of a bacterial infection.J~i·"'. an a/pha-1 btocker."." Ji /. lower potential for allergic reaclion r~ G.. and give you the same list of dWgs.s it? If you . penicillin c.ntilfacterial spectrum d. agonism r=> b. tetracycline (~ 75.

that is a non-mversible situation that can't be overcome . antihistamines d. novobiocin c. van der Waal's forces (a) why would you care which one is Ihe least likely? Actually.~h of the f~lIowing compounds . After a threshold stimulus.. The liberation of which of Ihe following smitter substances causes this alteration? acetylcholine b. in addition to tbetraesirea mechanism of action.. as anlifunga!s. If it did it would be an agonist. have no idea what hydroxycholine is scores. but has no intJinSlc activity. the BEST oral sedative drugs for dentistry fall into the class of a. which is an immediate type reaction 200. (a) miconazole and amphotericin B you should recognize. which il actually is. tar b. You donl have to have any idea what/he question is about (I don U) as long as you recognize that there is only one transmitter listed .. acetylsalicylic acid (a) easy . cholinesterase c. How dumb do they think you guys are? hydrogen bonding c. 11.. antidepressants c.you get a long-lasting drug effect that can only be overcome by making new receptors. anticholinergics (a) xerostomia is an anticholinergic effect. nicotine \ d.P repared by M. high high low high high none none low (c) naloxone is the example I made you leam of a "pure" competitive receptor antagonist .amantadine (Symmetrel) . I hope. phenothiazines . dipole-dipole bonding d. Some antagonists work this way.'lCillich drug group is the LEAST likely to cause xerostomia? \3!opioids b. covalent bonding . the cell membrane becomes 172. Allergic reactions to local anesthetics a. Tufts Dental School 168. any type of reaction to the penicillins O for penicillin- (a) see the words "definitely· and CONTRAINDICA TED . rniconazole (monistat) d.''''''a~enzodiazepines -. sweating urination mydriasis bradycardia e. narcotics b. Carbon monoxide (c) if you are addicted to formaldehyde.L Thompson. acetylsalicylic acid is aspirin.. Ph. which is a hal/mark effect of anticholinergic drugs. 184 . Which of the following agents found in tobacco products cause addiction? a. d. Which one is the EXCEPTION? a. Phenolhiazines have more side effects. so your choice is between (a) and (b). barbiturates c.doc 47 . hydroxycholine d. b.. D. fonnaldehyde . 23. .__" . because if it binds cova/enl/y. and why they are used in eye exams (d) BOZs are better than narcotics or barbiturates because they don~ cause anywhere near the problem with respiratory depression that those two do .P(. Which of the following is a beta-adrenerqlc receptor blocking agent used for the treatment of hypertension? G. lntrinslc Activity c. Which of the following best describes the drug-receptor activity of naloxone? Affinity a. 42.why do you think they worded it thaI way? This means worst case scenario. which would be someone who has hii'd li'n anaphylactic reaction to penicillin. . you are dead! Same with the others. amphotertcln B is used as an antiviral agent? 187. They could also have reworded this question by substituting competitive antagonist for naloxone. of General Dentistry. slow detoxification ":-c~an antigen-antibody reaction '----c( improper administration technique (c) another duh! They must throw these in there to inflate your are caused by rmanently allered.the only "transmitter" tisted is acetylcholine. benzodiazepines e. 189. Currently. one wQuld expect to see each of the follOwing signs EXCEPT one. All the drugs listed except opioids are unfortunately strongly anticholinergic.such a drug binds to a receptor with high affinity. b.. Cephalosporins are definitely CONTRAINDICATED giepatients who exhibit immediate-type reactions nausea and vomiting with erythromycin c._J 46. so guess (a) 36. Novobiocin sounds like an antibiotic. Dept. rapid absorption b. copious serous saliva (c) mydriasis is papillary dilation. Which ot the following types of chemical bonding is the least Ifk~Y to be involved in a drug-receptor interaction? fa.\Boards2005.the others kinda sound the same cholinesterase is the enzyme that breaks acetylcholine down. With an overdose of a cholinergic drug. electrostatic bonding e.

direct-acting parasympatnornlrnetlcs A. mu at the supraspinal/evel and kappa at the spinal level (the receptor that pentazocine (Ta/win). d._s} atenolol (Tenormin) a. stroke. Which of the following adverse reactions of ora! contraceptives the most common and the most serious? 8. alpha-adrenergic effect d. preventing antagonizes the effects of histamine by the release of histamine on the central nervous system oducing physiologic actions opposite to thai of histamine ompetitively blocking histamine at the cellular receptor site 80. unlike esters are nol by rule cross-allergenic (c) Ihis is one of those questions where they give you five drugs as possible answers. sigma e..ester pairing. Which one is the EXCEPTION? a... Epinephrine ~ QiCling 8. decreased resistance to infection (d) they all sound pretty serious.~olaSSjUm administration of may 110. and amphetamine classified? a.t. and (e) is a type I calcium channel blocker 107. which are used in the treatment of hypertension. is usually attributed to which of the following substances in the mixture? a.r. e.A. Only (e) meeis crilerion. while chlor/Jexidine is a antimicrobial mouthwash tne: 85.AJ. and d are all clinically useful actions of the phenothiazines. this is Ihe question everybody mis:. sodium b. I r C •. delta d. often in combinetion with Demerol because it reduces Ihe nausea associated with the use of the opioid and also potentiates its analgesic effect. The supraspinal primarily analgesiC activity of morphine is mediated through its influence upon which opioid receptor (~pe? \. ~Qu VthiS prilocaine-tetracaine procaine-rnaplvacaine procaine-lidocaine lidocaine-benzocaine are looking for an ester . (c) exaclly why I kepi asking you on every exam to give me an example of physiological antagonism as a drug-drug interaction question. procaine.. benzoic acid elhYI alcohol propylene glycol sodium metabisulfite 50. don 1they. Which of the following represents the drug-ot-choice treatment of candidiasis ~acyclovir ~ystatin for an HIV-infected patient? in the (a) these are al/ opioid receptors . epsilon a:ynu 121. Thrombophlebitis. '--. chloride rC' calcium •. potentiation of the action of narcotics e.Promethazine (Phenergan) is used in dentistry as 8 sedative. which occurs after intravenous administration of diazepam.AZr d. an anticonvulsant (e) see. lidocaine-mepivacaine 48 . . an antiemetic effect c..+. v 1--' . (d) is a direct acting vasodilator. allowing lower dose 10 be used.would you take one if you were gonna get all of Ihose bad things? is 119. lidocaine. liver damage.P-. which you might remember were ciscussea under the category of antipsychotic drugs. So (a) is an alpha-1 blocker.t.. or by (d) which is how antihistamines work.t{. I mean hypotensive shock. hydralazine (Aprezoline) e.. (c) memorize this picky little fact please! (c) hey. 1/ does not act via (a). and can creale 5 different questions jusl by changing the question regarding mechanism of action. anticholinesterases alpha-adrenergic blocking agents ~ndirect-acling sympathornlrnetlcs -o.p'. uterine neoplasia ~hromboembolic disorder e. which is how cromolyn (Intal) works. hepatotoxicity c. (d) so they don't gel hypokCl/emia . Thiazides.)/ ~.'k appa c. c.foTtunately only (d) is a real tis« with oral contraceptive therapy . In which of the following categories are ephedrine.duh! 76.(C' \.J.a. Amides. c. Which pair of anesthetics is most likely to show crossallergenicity? a. prazostn (Minipress) clonidine (Catapress) \. tyramine.ed on the exam! Don 'I you wish you had learned it then? 57. Actions a. Fr. immunosuppression . (b) alpha-2 agonist that decreases sympathetic outfloe from eNS. prilocaine and mepivacaine are amides. cancer. But wait. sedation b. Alpha adrenergic ettecis are an adverse side effect.only mu and kappa are involved In analgesia. hypotension b. the m_fxedacting agonist/antagonist acts on c.!:v. benzocaine and letracaine are esters. thus again reducing the potential for adverse side effects. (a) and (c) are antiviral drugs used to treat HIV. ' . Each of the following is a pharmacologic effect of phenothiazines EXCEPT one. require supplemental a. b. chlorhexidine (b) candidiasis is a fungal infection needs to be treated with an antifungal agent like nystatin. they do ask you questions about drugs thai you don'l normally use every day. verapamil (Calan) ". Q ..

[heir other c[inically useful actions. .. is a good reason for using sedat. mepivacaine that increases and norepinephrine is the pressor activity of (b) only benzodiazepines are actually cJassifieda-s-ant~eIY drugs. 160_ Vifh icll. remember. anxiety or fear {/£'1.ion_ Which one is this EXCEPTION? . The other drugs listed are just local anesthetics that don 'I have this action .' methohex.alcoholism <geptic ulcer e_ rheumatic heart disease for a patient (d) patients using corticosteroids for arthritis often develop ulcers because these drug block prostaglandin action in tne stomach.. dibucaine d.----9.'cocaine ~b-:-'procaine c.to allay apprehension. Ph. such as opioids have antianxiety actions in addillon [0 . He has a temperature of 38_5 degrees C (101 degrees F). EXCEPT one. with the exception of nitrous oxide. the patient will still feel pain. pentazocine an coiota.always ask some dumb question like this about cocaine-like you guys use it eve!}' day in your office (you better nou'). al!hough other drugs.these are classified as sealives. (r:-. to aneviate stress in a severely medically compromised patient d. Methohexital is a berbhurete. acting by causing the release of adrenergic neurotransmitters as well as blocking their reootsk»..ital lorazepam haloperldoi pentazocine phenylpropanolamine 46_ The only local anesthetic r~ epinephrine _. why do they .spared by M. and phenylpropanolamine is a decongestant used in cold medications. A patient presents for ireatment of a large flucluant mass ir) the subrnandibular space as a result of extension of odontogenic infection. cocaine is an indirect acling adrenergic agonist. alternate application of heal and cold to the area to improve . of Gene ral Dentistry."__ circulation • 'C"ihcision and drainage and a culture for antibiotic sensitivity --ct'""anlibiotic therapy to reduce the swelling and infection (e) anlibiotic therapy won~ be very effective if you don~ incise and drain first. barbilurate sedatives may make the patient more sensitive to pain.0 decrease the amount of local anesthesia thai is required '------1or a given procedure c. thereby prolonging their activity. doc 49 .. thereby increasing acid secretion while decreasing the protective mucosal barrier of the stomach. Any way.r- 176. e. giddiness . Haloperidol is an antipsychotic.L Thompson. Sedatives.Iingling of lhe hands '-. euphoria c. to accomplish certain procedures that a practitioner would not normally be able to do on an anxious patient G:\ Bonrds2005. the dentist should treat this patient with which of the following? a. Tufts Dental School 2. anemia b. ~. 155_ Corticosterold therapy for arthritis is oontraindicated who also has which of the follOwlng conditions? a. lidocaine e. nephritis rS. 179_ Which of the following is ctassified as an antianxiety drug? S d. Dept. D. have no analgesic effect . (b) iorazepam is the only BDZ listed. (a) hey. of lhe following is the firs! symptom that is usually perceived by the patient being administered nitrous oxide? a_ nausea b. (a) and (b) are pallialive actions the patient can take at home" not actions for the dentist (b) sedation does not decrease the local anes/helic requirement.they just block sodium influx inlo the neuron.___/ (d) the first three are all signs that the patient is gelling too much nitrous. Initially. salicylate therapy 10 reduce the temperature b. 8. Each of the following.

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