,

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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.

~if~ ~_~?e~ :'_1~:~~.~.~~!9~~-

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,

trY

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.

m.

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_

i.

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

G:\Ooards2005.doc

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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d'.

e..

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
(0:

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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thIf..Hf!,el~Q_o"~[TIo~l!.do,cf!'n.e can bec.~educed, ' r-: : VI .r:

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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-

C9

(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!
~

\3

the epinephrine in the local anesthetic? rave's disease Diabetes c. HIV d. Alcoholism e. Schizophrenia
G.

(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

3

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

(!)

U

(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
Y
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

*
~

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

"-l.

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.

1-9 10-18 19-27

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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.

11

(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.

G: \[3 card s2005 .doc

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f_ '~~~~~. take I capsule every 8 hrs until gone (7 days) Kids: 8. # of pills. allergenicity. e ryth romyci n isn't d.:f1Fii:iSTS usually injected rather than taken orally (Certainly no one in dentistry uses Pen G".dis Pe:rl sed depends on # of appointments ChildTen~:."Y1.__ ------+---:-----:--:--. although use Ihelatest guidelines that you have heard about)) (here's a big change obviously. 112 hr before (Kids: 50 mglkg) Clindarnycin (for PCN-allergic) 600 mg IV 1/2 hr prior..I.II._dindamycin. ~~. dispense. stomatitis.I. drug of choice against certain conditions. dispense 21.y. Bacteriostatic agents such as tetracydine limi! population growth. _ /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._.. Ar1_t!!.9--b_!. side effects or toxicities of etc: Cardiac pacemakers a. 2 g.O mgfkg I hr prior For PCN a lIergk: Clindamycin: 600 mg (4 X 150 mg) PO 1 hr before treatment. and neither are doses given before and after treatment .nicillin has the best gram·negative I T. so dispense 2S.'-_ .:._ 1---------. thus resulting in folic acid -.m. bronchoconstncuon and carolovascular collapse 6 . Many Questions are asked regarding -penicillios..l dOTI't (AHA 1997 Guidelijles) Prop hylaxis Required Prosthetic valves Prnphylaxls Not Rcqu ired c.gainsl certain bugs. For example: .___~d_rB-aGte:riosta~c agents such as Ihe §...am.::~~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:". ...ilnij. take 2 tablets at once".somi-tli:i._jelr. take I capsule every 8 Amoxlcltlln I" choice: Arnoxicillin: 2 s (4 X 500 mg)._" '~~. 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 .ln fungal celt walls to weaken Ihe wall . What are symptoms seen during allergic reactions to penicillins: dermatitis.. '.: __. Bactericidal .::.-.. since combinations are no longer used.' ..w/lich is just below the 0. PO I hr before treatment.12 mglkg tid or qid 500 mg..~fQ. f-. pem'ciHin G: Ihe latter is more sensitive 10 acid degradatiorrarr. but do not kill bugs by interfering with protein synth€sfs (in bacterlal nboscrnes .-•. p._ _ -------c. etc.agents such as penicillin kill rapidity growing cells by inhibiting cell wall synthesis b.§_iT!giQillll}__andgenlamycin (1988according to latest recommendation of AHA and ADA.ll_~ such as nystatin bind to!ergosterol.id_§_ compete with . PO I hr before treatment _ 1/ of pills to be dispensed depends on II of appointments Examples ofpittienf cardio_~e<iiaJcoJj'4ib.review your latest prophylaxis guidelines) I q blv 2S0-500mg.~c. 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.. (4 X SOOmg)..~."'tl_rfS.a. 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.. kids (20 mglkg) a.-----1 Periodontal Surgery lrrrplants Taking Of Impressions e.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.• Keflex.t~_~ a. PABA~ folic acid synthesis. so I would think they would not use too many of the~ ques lions) b.• Required Extractions Not Required Restorative Procedures Intracanal endodontic treatment L am. dispense 30. spectrurii' r(~+J->. 2 I . -deficiency 3..y_diMs. that requlre propli:"Ib:li. then 1 tab every 6 hrs IIn ti I gon e (7 days) *some sources do not indicate loading dose.J.o. The 2nd largest category expects action of the various antibiotics: you to know the mechanism at Ampicillin rv!lM 2 g. Penicillin V vs.

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

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

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

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

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

4) Centrally acting adrenergic drugs such as methyldopa or clonidine . ~p~roxysmal tachycardia. ~rurosemide. The second major category of questions mechanism of action of the various agenls: Antiarrhythmics: irregularity a. '. S. Digitalis therapy reduces the compensatory changes that are associated with congestive heart failure such as Increased heart size.1) Lldocain!?jventricular arrhythmias).j1..~ 5) Neuronal blockers such as guanethidine (reserved for severe h ypertension J' 6) Angiotensin converting enzyme inhibitors such as Captopril.---c. sometimes blockers' such as'verapamil propranolol. ~~--.~ril_ -angina: Nilroglycerin.~ vessels resulting in vasodila-tion-··_ . 2) Beta-blockers such as propranolol or the cardioselective beta blocker metoprololor aler'iCi1Of 3) Alpha-t blockers'such'as-pr:aZoSln. Cardiac glycosides such as digitaliS or digitoxin are effective because they have a positive inotropic effect. atrial fibrillation).. Congestive hear failure (e) same question 8S above. It also has an antimuscarinic action preventing the bradycardia that follows vagal stimulation.l II fi\ I ' p( ! a..--'..I~~.:teri es b._ __ -- - ..11f)ir:. /'Supraventricular tachyarrhythmias .. Quinidine is classed as an antiarrthymic dn. -.. '. c.g (Type I-blOCKSsodium cbsnnets). H-: d. most drugs have the ultimate effect of reducing peripheral resistance via vasodilation ACE inhibitors: Captopril blocks the enzyme which (d) by elimination. •. "3( Quinidine (supraventricular tachyarrhythmias. emotions and exercise..d. calcium channel .{_.?: cts by increasing a the refractory period of cardiac muscle Type 1B agents such as. paroxysmal tachycardia) 6) _F'~p!~~olo. propranolol: nonselective tleta block:. Prazosln: selective aipa·1 blocker.(ll!!.lldocalne decrease cardiac excitability -. arrhythmias: ~.i. oxygen to meet - Nitroglycerin increases oxygen supply to the heart by a alrect vas6OilatoQ'_action on the smooth muscle in coronarya. II reduces alllomaticity and responsiveness and increases refractoriness. increasing the force of contraction of the myocardium.iso have weak dilatory actJon.b 4) Veraparnil (supraventricular tachyarrhythmias. 11 u! 1-81 .. r~_~~t~g.' b. edema.hus t resulting in fluid loss and a reduction in blood This decreases the work the heart has toi:iunip~ )'. Ant:2ngjrt3 dn.. Type lA agents such as qujnLd_lo. Angina pectoris ._ .. The lattsr is a potent vasoconstrictor (administration of angiotensin will result in an elevation of blood pressure). 2.. f\.- converts angiotensin) to angiotensin II. Quinidine is principally used to treat a.!_(paroxysmal tachycardia) a.. rate. ' Diuretics: ~se the renal absorpJj9.Cardiovascular Drugs This category covers a lot of drugs and a lot of Questions. while digoxin (digHnlit... in t1ie CNS to reduce sympathetic outflow to peripheral b¥) ~l.I]l.... Angina is primarily trealed with nitroglycerin.. This is achieved by an inhibiUon of Na+. Congestfve H~~~-=-~~~i~_g_:Jr . Calcium channel 5lOckers decrease oxygen demand by .--.Q[Q!g_I: selectj~eta::-l bloCker. Remember problem is that the heart beats '------'_ 'Orug-condition questions c. Wl1e'n'"digitalis is used for atrial fibrillation it acts by decreasing the rate of A·V ccnduction ..acting: furosemide ) Potassium sparinp: spironolactone heart tenure drugs. Adrenergic Agents: trl(f1Cl" ")"\::C('f}i-y7 f~i"". _I~.. reducing afterload by reducing peripheral resistance via vasodilation Antihypertensives: Remember.r' <. etc.ta!ls~digOxin.09P.) is the drug of r:. .Qml: ads cenLrally as a'fiilse'ii-e-urorraFismitler stimulating <wh'i:!'re-ceptors to reduce sympathetic outnow ~.. concerns a.!gs: problem is insufficient demands of myocardium a._ Congestive hear failure C d... Phenytoin (to reverse digitalis induced arrhythmias).rj: ../. atrial • fibrillation).\'Y"':(. K+ ATPASE leading to increased calcium influx..l... Quinidine is used to treat a. 1) Oluretics such as the high ceiling or loop-acting diuretic. Thiazides: chlorothiazlde b. They can be categorized as: 1.. Propranolol reduces oxygen demand by preventing . Digitalis (atrial fibrillation. Inhibit!! binding of nerve induced release of NE resultingm-va~ b. - 2. Questions asking about which drug from a lisl might be used to treat a certain condition: hypertension...!.r).l!) ~?_§9~~lation. Hypertension b. .j reduces cardiac j t{ .' 1\. 1.. r ~ Congestive heart failure: Glycosides ACE inhibitors such as captopril such a&~I.~ for congestive heart failure.D_QL~Q. Clonldrne: selective agonist stimulates alpha-Zraosptors ~A.iaj.i7..chronotropic responses to endogenouiepTnephnne.£~i" 'J.f"i)J output and inhibits renin se~ e. Hypertension Angina pectoris Atrial fibrillation Ventricular fibrillation e.lo. ...')JJ . reduces cardiac output '. HypertenSion ((a)) is trealed primarily with beta blockers such as propranolol.u!J1. _Mi1. i 2). just gave you 8 differenllype of 12 . ~.. Types of diuretics which may be mentioned include: voiUnle.

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

Exacerbate existing diabetes e. When digi lalls is used in atrial fibrillation. which would rela(e to option (d). so ipso fa c/o.ulale. (b) Gap/opril is an angio/ension-converting enzyme inhibitor ttie: blocks the activation ofangio/ension I to angiotension II. 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. 21. AbOlish cardiac decompensation b. just revereea. Ihusslowing the heart down. Lidocaine. 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. Decreasing the heart rate reflexly b. Thus (d) is wrong. Procainamide (b) same question as above. ~ ~ e. vasoconstrictor. Has a direct action on vascular smooth muscle b. bradykinin metabolites do not accum. because angiolension /I is a po/ent Cardiac Glycosides 25. The: mas! useful diureUc drugs act by ~ Increasing fhe g10merular filtration rate ~ Decreasing the rena! reabsorption of sodium c. Cause hypoglycemia (I) first off. since high sodium levels cause fluid retention whiCh can increase BP. Digoxin exerts its positive inotropic effect by 14 . Blocks autoregulatory mechanisms in the heart c. Administration of angiotensin results in a. Increase renal excretion of sodium and chloride b. Which of the following drugs act by inhibiting renal.. Decre. 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. r~b·· Angiotensin I ~ Angiotensin III c. Increasing the secretion of antidiuretic hormone (b) people with high BP am always lold to reduce set! intake. Antihlstarnlnic effects ~~3~~ o ~~~~:~~:~ i:l~ssure e.asing the renal excretion of chloride d. answer (b). Drugs such as lidocaine are used /0 nannalizs these rhythms. and hypokalemia can potentiate digitalis induced arrythmias optionee) Theyy apparentlyean also cause hyperglycemia.and 16. - 20_ The primary antihypertensive to accumulation of Serotonin a. 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. All of the a/her alternatives given would exacerbate the arrflylhmia. Cause hypokalemia f. Increase renal excretion of potassium c. A sedative effect b. Nitroglycerin dilates the coronary arteries in angina pectoris by a. depresses cgrdiac excitability.2)Direct action on smooth muscle in the vessel walls Q Increasing the etfective refractory period in the alrium e. Increase the toxicity of digitalis d. A sedative effect (c) effect of cap/april (Capoten) is due 24. (b) is why they can cause hypokalemia.(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. a local enestnetic. digitalis glyOJsides e. reabsorption ot sodium? Urea Chlorothiazide Theophylline d. the therapeutic objective is to a. reducing renal reabsorption of sodium makes BP go down 19. Inhibit va'gai impulses 10 the heart fC:)Decrease the rate of AN conducnon ~ Increase the rate of carciac repolarization e. how can you have an option (f)?! (a) is how diuretics lower BP. Blocking beta-adrerrerqic receptors (c) 1 S_ Propranolol is of value in treating angina pectoris because it a. Thus (c) Is wrong. Bradykinin metabolites d. Which of the following is NOT characteristic of the thiazide diuretics? 8. which is conveniently option (e). Increasing the metabolic work of the myocardium . Increasing Ihe renal reabsorption of potassium e. Administration of angiotensin results in a. Antl-inflammatory effects b. How the heck are you supposed 10 remember all of/his? Antiangina 17.

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

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

. Mechanism of action questions effects on bleeding: Analgesic etiects: prostaglandins NSAIDS: regarding analgesic. Dept.remember afllipyresis means antifever. salicylism. \VI" " f_1.pirin lnhibits s Synthesis of thrombox. 2) aspirin and other antiinflarnmatories like prednlsone. . (-11'/1 U' f . hydrocortisone.< . acetaminophen and ibuprofen 1) I· 1!LWL.and 3) between aspirin and ibuprofen. They hope (0 confuse you by using prOS/Beylin.. antipyretic effects. c. the right word is pros/aglandin.. while (e) is how coumarin workS.. and does not cause GI upset 2) Anti-inflammatories like prednisone. you could get the answer by elimination.. The locus ?I actiO. etc..r ih ': i.. b. Umblc system e.7. 'f' u. 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. interfere with by Acllvating antithrombin Preventing vasoconstriction G:\8oards2005. Nowadays. 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. Ace taminophen causes liver toxicity.?phen tacks _ a\o activity. i) Q.doc 17 . regul'ation center Bleeding time: inhibit synthesis platelet synthesis of lhromboxane A2 preventing (5 lts from Inhibition Of.this limits your choices /0 (a) and (b). A third type 01 question focuses on the dlfferenoe between 1) aspirin and acetaminophen.glandin synthe~is in the eNS affecting r hypothalarnic temperature regulation b. Inhibition of bradykinin in the periphery leading to sweating c... D. 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.triarncinolone etc. Uncouple oxidative phosphorylation 9.epatotoxlC. Tufts Denial School Analgesics1.J ~I"'.·n. . osla. d.(:D 7.pr~. and aspirin blocks this action.'. tinnitus.).J.L... even if you didn'l remember that Ihromboxane A2 induces plalelel aggregation. (Which of the following is a COX·2 inhibitor?) 5.'" .1. because of the many side effects o( aspirin that turn up in these kinds of questions.rl· !. e ceteminoph en and ibuprofen are used much more commonly than aspirin. acid-base disturbance Of metabolic acidosis.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. agents.9 beca. So since aspirin is the comparator prototype drug.:. of aspirin's central antipyretic effect is the n a. reviewing these questions are stitt useful -.. These old questions focus a 10/ on aspirin.':1" t. c. Acetamin ophen is the drug of cbotce for the feverish chi/d{they usually ask the reverse. Temperature regulation cenler is in tne hypothalamus.increased risk of Reye's syndrome) 8.0 5.us ~ Basal gangl18 d. Suppression of chOlinergic mediators in the hypothalamus e. but of course you know that this is wrong immediately. as in (c). Cerebrat cortex -"·l~ (b) memorizaUon question. The mechanism of the antipyretic action of sallcylates probably -:-. nausea and vomiting. Thus. (d) is how heparin works. 4. Acelamin. is n. of General Dentistry. antipyretic and c. are steroids and do not act primarily by PG inhibition 3) "ib. b. delirium.y-yutaneous vasodilation leading to increased heat loss "'--d./1 I 'Jf'\". Anti-lnflarnmatory hemostasis a. antirheumatic and antiinflammatory effects.. SUmulation of norepinephrine in the hypothalamus (a) 2.:-Depression 01 oxidative processes leading to decreased heal production ~ (c) 3. decreased tubular reabsorption of uric acid.. Brain stem Hypothatam. hyperventilation.!.use a.-causes much tess Gt irritation 4) Difiunisaf (Dolobid) has a longer half-Ilfe than aspirin. 4.D. 1) But expect newer questions asking you to know: a. Thompson. • ". such as aspirin. Newer versions of the boards have questions sbout COX-2 inhibitors like vioxx. . b. Ph. e.. Depression of oxidative enzymes leading to decreased heat production d. but you have already eliminated /hal choice because i/ aoestit mention prevention oiptetetet aggregation. The therapeutic effect of the salicylates is explained on the basis of the ability of the drug 10 a. n v. r. 1. A patient who has been taking targe quantities of aspirin might ncreased postoperative bleedin. d.~. Therapeutic effects of aspirin include pain relief. 6.Prepared by M. Activate autonomic reflexes b.. The anupyretic action of salicytates Is explained in part by a. Analgesia leading to sedation Increased blood flow through the hypothalamus f. Adverse or toxic effects include all of the foltowing: occult bleeding from the GI tract. which is which drug should be aVoided in the feverish child (aspirin. Frequently asked questions on NSAIDS AtfirV . especially when combined with eleoho! or taken in excess of 4 grJday.

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

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

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

Dept.t are given in the question that distinguish it trom the other drugs of Ihe class Ihal are listed as ettemetives. Asedalive d. Faels 1. but 3 are agonisls ((a). 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. Levallorphan e. Meperidine (b) shortened version of the above question 17. Nalorphine c. Pentazocine d. it can elicit withdrawal symptoms d. btlt acts just like morphine to oroooce lolerance and physical dependence. Methadone is used in detoxification 15_ A heroin-dependent patient should NOT be given nalbuphine (Nubain ) for pain because a. 2.. I . 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.. Nalorphine c. ·11may produce respiratory depression c. Codeine ' "- u. Methadone c. It is equlanalqeslc with codeine b. and is the one drug left by the process of elimination. Which of lhe fol. Pentazocine e. they are stabiliZing on Ihe heart and some are actually used in open-heart surgery ((b)). Propoxyphsne of opioid overdosage is 14 Which of the following antagonistic activities? a. Antagoniz. Which of Ihe following analgesics should be avoided in this patient? a. in ttns case Ihe fact is (d). and they do not cause Circulatory co/lapse ((d)). Tufts Denial School breiostem 10 the carbon dioxide lension of the blood. Naloxone b.fI is a full agonist with analgesic tmxsenies. Ph. Precipitates withdrawal reactions b. You are asked to not only identify a drug from the list as being from this class. and 3 would be met by an an/agonist such as naloxone. II is effective only on parenteral administration (e) lot of memortzstion required here for a drug that isn't used that much. propoxyphene d. or perhaps even a mixed agonist-antagonist such as pentazocine. ((a)). leval/orphan is an propoxyphene. but it soon became apparent that (d) was also true 18_ The antagonist 01 choice in the treatment a. (b). they can be convulsive. 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. A long-acting local anesthetic e.. Meperidine e.Prepared by M_L Thompson. When taken orally it is not euphon'c in addicls. Aspirin b. Which of the fenowing is a complete antagonist of the opioid receptor and the agent of choice in the treatment of narcotic overdose? a.I!~'_l-. It may induce dysphoria and mental aberrations e. Alphaprodine d. D_. An antipsychotle (b) G: IB oards2005 . Penlazcine c. optot« agonist. but no/lerminally so ((e)).anlagonist c. of General Dentistry. It has no anatgesic properties b. Naloxone b. Its abuse potential is less than thai of heroin d. II is a partial opioid . but additionally thai it has Ihe properties tha.. Withdrawal ts less severe Ihan with morphine because methadone has a much longer half life. Indomethacin e. _ . just like morphine.of action. _ [Vlt:<U'""UUIIC: c.es the depressant actions of morphine c. I guess it was big news when these questions were wrItten many years ago and they seemed tiopetut. Penlazocine is an opioid thai has both agonistic and (a) nalorphine and pentazocine are mixed agonistantagonists. 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. therapeutically an advantage.. Cyclazocine d. as Is 19. Acetaminophen t. 20. Melhadone you will remember is not an antagonist like neloxone. Naloxone d. An opioid analgesic c. end also depresses pontine and medullary centers regulating respiratory frequency Opioids do not cause oxygen apnea.king drugs has a history (6 months ago) of narcotic dependency.doc 21 . 1 is an antagonist only ((c))_ (e) pentazocine is the only drug which has both types . Levallorphan e. All are drugs which acl via opiate receptors. Asa mixed agonist-antagonist. (d)). 16_ A patient while no! currenlly ta. In this example.lowing statements does NOT characterize pentazocine? a. there is only one drug which meets this criterion. Will not in itself produce physical dependence d. Codeine b.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

F--. and reproductive funclion even/dally-retums upon cessation of therapy.. Cardiac amhymias are the main bad side effect of epinephrine as a vesoconsutctor. 4 and 5.5 grils. 37.s. ~~ ~ t! I~ ~'.actQrsc:ommon to all forms of drug abuse include ~.~i: -.blocking agent. and is thus a drug of choice for acute asthmatic attacks.hypoglycemia . Cocaine doesn 1 cause this kind of effractlor exompi«. is usually thoughl to be tru« only for morphine..0 e.~:. but has not been clearly demonstrated for all abused drogs. -..__..".inephrine for local hemostasis result in • 01. They cause insulin release by (c). '-_.:.QL~_b_Q. physical dependence d.ardiac arrthyrnia ---·-·---C. • #9. increased activity of the cerebral areas c.--an acute asthma attack d. and perhaps cocaine. 1/2 of 3 is gone..' e~". r --U-:""- -r.) 'Q. 43. ~celal. you inject 2 more for a total 0'3_5 immediately after the third dose. caffeine. (c). any of the above The snsweris (d).Dicoumarol is an oral anticoagulant. At the third dose. ~. (- d.'}"~ ~~5 d. Whicl1 of the /ollowing combinations o. permanent sterility c.r. Camamazepine..~. cholinergic stimulation C:::S:irect stimulation of pancreatic bela cells The answer is (b).... Tufts Dental School 24.----._/. transmitter in the eNS..0 . and (c). . clolllng time b.<... _ ~~. Beta receptors are found in Ihe heart and stimulation of beta receptors increases heart tete.olami[je d._g. leaving the choice between been pos/ulaled /0 inhibit GABA effects. ""'!.:::r.L.~ . (a) can't be /lle answer.-. 42.. ..alpha agonists decreese insulin release. clonazeparn _. .-a~tagOni. adrenergic simulation b. bleeding time c.. etcotx».. Amen.. -=::::::::::..a dacrease in blood pressure would not result from adrenergic stimulation. ' /. barbiturates and sedatives. . and are the. Epi stimulales both alpha and beta receptors.-/' Answer is (c)."..:. Thus the risk in an extraction is (hpt the palient. Dept. (d) is obviously wrong. bul this is not the mechanism of su/fony/ureas.Uf~.st pairs in antidotal therapy? acceptable dloournarol-protamlne J\Bo:lTds2005_doc 39 .•. Thompson.' _._ ..5 . succinylcholine Answer is (b). . tolerance. Ph D. of General Dentistry. at 4 hrs 112 from first injection is' _ gone. Clonazepam is a benzodiezeoin«.--. Sulfonyl ureas cause insulin secretion by a. increased activity of Ihe cerebellum b. epi elevates blood glucose. Research has failed 10 prove the link between estrogen and breast cancer. rnorphlne-naloxone ~ represents nist.- !':. is common to many drugs such as opiates. 27_ Alcoholic euphoria resnus from a. or thai a serious interaction with a drug that you might require in your management of the patient. such as barbiturates or setlcvtete« may occur.. are the main drugs used to treat trigeminal neuralgia.. (b).B~arbamazepine ·. succinykholine is a depolarizing neuromuscular ..This is a memorization question.-. Which of the following drugs is often used 10 treat trigeminal neuralgia? a. cancer of the breast . increased blood pressure is the rule..Alcohol inhibilS the eNS.ur. (e) Is the only appropriate test. force of contraction. (a) is wrong. leaving 1 gm in the body and you inject 2 mora for a lota. thus eUm/nating (a). miOSIS ··~b-. cardiac output and oxygen vlifizalion. The use 01 ep. The answer according to Ihe gods of the testing board is' (a).2. ~.Ihromboembolic disorders is The two major side effects are suspected carcinogenicity and the tendency 10 produce It:r2mboembofisms..Prepared by M. physical dependence. while acetazo/amine is an' anliconvulsanllike csroemezepine.-f6Ierance c. Thus (e) is 1. 6. .".1. Alcoho/has the maior inhibitory cortex. (D). -k'l:. Since dicoumaro/ prevents blOOd clolting by prevenUng the conversion of Vitamin K to prothrombin. (c) is wrong· beta stimulation in smooth muscle and bronchi causes bro ncho dilation . A dnl9 has a hJIJ1-.Liver funclion can be allered but this is reversible. increased activity of the spinal synapses ~creased activity of the medullary centers Omoval of inhibitory activity of the cortex Answer is (e)."". Ihe laboratory lest most valuable surgical risk is a. Answer is (e). Miosis ((a)) is a cholinergic effect typically observed with opiates. hepatic necrosis b. psychological dependence e.b)· muscarinic agonists increase insulin release..• . as wefl as phenytoin. (. leaving 1. Answer is (c).0 a.2 gm at 0 hr. beta agonists increase it Thus beceuse both of these are adrenergic stimulation. ~ /0'.4./ after the second injection of 3.~.metnortunion. gms are given every 4 hrs If 2 what will be the amount in gms in the body immediately after the third dose? ") 7.. If a patient requiring an extraction reports that he is on dicoumarol therapy. complete blood cell count Gplasma prothrombin time in evaluating the 4_ The highesl risk associated with use of oral contraceptlves a. sedimentation rate d._e-. any of Ihe above duMng' surgery migh t 28.~ . a drastic drop in blood pressure e. cancer of the uterus . ' "'-. <I. especially in the the answer.may bleed excessively. You may need to adjust the anticoagulant activity to within a safe range for surgical procedures.primary oral antidiabetic agents used therapeutically.

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

usually occurring after prolonged treatment with large doses.' f. ~ .. Ph.it is also a poient inhibitor of the mixed function oxidase drug me/abolizing enzyme system in the liver." {'J I ' __ ". 78. if you look the others up.":::-1. Just for your future edification. elopedhyporeacllvltv tolerance antagonism c. and hallucinations resulting from an overdose of scopolamine are mas} efficaciously treated by . Answer is (b). and d .. Remember. tinnitus.I I. desensitization to a drug Is . thyrotropin is there 10 contuse you with parathyroid hormone.. Which of Jhs following hormones acts to elevate blood concentrafion of ionic catcium? __:a glucagon '~"')parathyrojd '-. which acts as an antimetabolite. nausea -b. ' Answer is (d) . Which of the following are important criteria for the adequate clinical evaluation of a new drug? a. Thyrocalcitonin is another name for ealcitonln. thyrocalcltonin . hypoglycemia. Glucagon is a pancreatic hormone that stimutates glucose production."':'"'-a \.t'rei ri. aldosterone d. and d 5. thyrotropin e. Methotrexate is an example of a cell cycle specific antimetabolite that inhibits DNA synthesis during the S phase. 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. b. excretion etc. W... " .~. tinnitus . aI/owing endogenously released ACh to accumulate to overcome the acliot1 of scopolamine. L Thompson. 55. Thus the Gods of the Board questions have decreed thai the answer shall be (a)_ _77. Tocountersci a competitive muscarinic receptor block. a. confusion. vomiling and GI _bleeding are all symptofrJS:O_( . lomustlne c.. is the main function of parathyroid horrnone. The 'Ia/ter refers to some alteration of receptors Ihal leads to diminished response to the drug. gastrointestinal bleeding 1. detoxification d. (e) is an alkaloid derived from plants. b. Ant. a and cOI1!y 4.Prepared by M.·. b.~. except that calcium concentrations regulate the synthesis and release of calcitonin.doc 41 . "c" would also result in reduced blood flow so slower absorption would also be a problem."Salicyfism" is a mild toxic reecuon to aspirin (acety/sa/icyJic acid). band d 5..E. !-" ~\' \. b only 3.-.. a.. comparison with a placebo b.. absorption from the GI tract. Vincristine acts during the mitotic phase Answer is (a)· your choices are between tolerance and desensilizaUon.. The answer is to give a drug which knocks outlhe acelylcholinesterase. and since 1/1is wasn1 covered in class you might be one to guess it also.. vomiting d.) rr= _.. Levodopa has nothing /0 do with this question.jy".j .". clsptaun b.'-' ~" Il. because it is broken down almos! instantaneously by acetylcholinesterase. you need to increase the revels of egonist. 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. (d) is a folate antagonist. Wow. excerclse b. The dNg Which will do this is physostigmine.. evaluatlon of side effects G: \8 oards2005 . The other alternativGs are /0 confuse you because you probablyai least remember thai it is an antihistamine. a and b 2.1"1\ . Nausea. c. but you don~ know tile difference beMeen H1 and H2 antihistamines. Which of the following antimetabolite'? anticancer drugs can be classlfied as an a. D. vasoconstriction ~he presence of congestive heart faiture '----t( administering the drug as an insoluble complex 1. You might see il in a questian regarding drug metabofism. Salicylism includes which of the following? -. most cancer chemotherapy drugs cause cell death by affecting the ability of cells tadivide. The answer must thus be te)_ 66. (a) & (b) are alkytatJng agents.". (a) and (d). c.. and c 2.. This is its only clinical use. (""':~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).. i /.fU> Answer is (d). you can't give ACh 82. " A: " .. all of the above Answer is (e). . atropine admini~. c. is contraindicated in children suffering from influenza or chicken pox: aspirin has been implicated in the development of Renee's syndrome_ 67 _ Disorientation. a. b. "d" is often used for prolonged and steady drug reteese so it also is true..<J]iCYlism.. aspirin. tering p'rvVP~)h ~_. '11" is obviously right for the same reason.h <:' . thus (a) is wrong.-". Tufts Dental School secretion ((c)) In cases of peptic ulcer. in this case acetylcholine.."' ' ~.I would guess (d) because its the only one I've ever heard of. and is really a mechanism whereby tolerance may occur. vincristine P~d methotrexate . Absorption 01 a drug from the intramuscular site 01 administration may be slowed by a. They hope \0 confuse you because there is a correlation between calcitonin and calcium.maintaining the concentration of Ca+r in extracellular fiuid by regulating the deposition and mobilization of calcium from bone.scopolamine is a muscarinic receptor blocker similar /0 etroolne. b. of General Dentistry... Dept. fever.imetabolites may act in 2 ways (1) . However. levodopa ~acetylcholine :(Lphysosligmine . we got it n'ght! Actual/y. and atdosterone regulates Na+ levels not Ca+«.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.3. and d 4. .

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

lbriurn) 'Cb': 58.000 (opUon (a)) is the same as 2 cc of 1:100. Each of the following drugs has a significant anti-inflammatory property except one ..Teducing Cournadin to one half the usual dose for two days d.000 is twice as concentrated as 1:100. The maximum safe dose 01 epinephrine that can be administered this patient is: a. Option (e) would take longer to reduce (PT) then jusl slopping Ihe Coumadin. a potent vasodilator . ravte lislf'ld thaI goes direcrly 93. since they would be safe bul not maximal.the sstest bet is to consult physician .ino.--'-a. so 1. intramuscular (a) enteral means via Gllmel-only into GI tract is (a) oral. Which of the following drugs is often administered t. His protrhombin time (PT) is prolonged. heparin is nota Coumadin antagonist...000 equals . aspirin corn s 01 '" c.. (a) memorize. carbamazepine (Tegretol) e. In angina. Guidelines into wnst adjustments to make in Coumadin tnerepypricr to dental treatment have changed since this type of question was written .Withdrawing Cournadln for two days '--c_. is an anticonvulsant. adminislering a platelet transfusion 10 enhance coagulability (b) the issue is obviously thaI the patient may bleed excessiveiy. Since 1:50. which is obviously important in an emergency.000 epi .. 1:100. A patient has a hisl. nol an anticonvU/sanU1S. since it can·t get enough (a) and {bJ are usefUl actions in angina. memorize. chlorpromazine (Thorazine) d.:.enyloifl.hreatening arrhythmias? a. but an anticoagulant in its own right. Most are anliconvulsants. ce. FinaJly. a situsiion that would ceuse problems during dental surgical procedures.your usual choice as a loca! anesthetic. Which of !he following is an example 01 an enteral route of q ·6\-a1 iniSlraliOn? submucosal c. '-b) (b) venlricular arrythmias are tne life threatening ones.this is an action thai is needed in heart failure patients. but diazepam is drug of choice. adminislering vitamin K (Aqua Mephyton) . 1: 50. administering a Cournadin anlagonist. ~troplne "-lU1>pinephrin e c. 1: 100. Which of the lollowing methods is preferred for reducing the PT to an acceptable level? .000 (b) Ihe rule is _. it could be that no adjustment should be made at all. (c) geez. quinidine lidocaine <« verapamil d.phen ~ ~profen e.and lidocaine is particularly effective for this k. inhalation d . increasing cardiac contractility d-..2 carpules of xy/ocaine with 1:100. ~oma2J'ne is an antipsychotic. 1: 50. A male patient who is receiving Coumadin therapy presents for an elective extraction. . such as heparin e. 1 ce. D_. Which 01 the following is the current drug of choice for status"f'~p!icus? \. Options (a) and (e) might be appropriate in an emergency situation.indomethacin . mostly used for supraventricular /achyarrythmias 75. Two carpules is 3.rtainfy not for minor surgery anyways.. GC. 1 cc of 1 :50. Propranolol (Inderal) exerts its major antlanginal effect by a.6 cc Tilis eliminates options (c) and (d). so (b) has 10 be the righl answer. the goal is to reduce the oxygen demands of the heart. they keep repealing this question year etter year after year" if you don llmmediate/y know that the answer is acetaminophen. Dentisl should consut.02 mg per ce. Whicll one is the exception? a. G :\Boards2005_doc 43 ..000 1: 100.. so (b) would equal/he max of.:50.depending on palfenfs status.=d by M _L. with the patient's physician about stopping the Cnumadin for a few deys.. 1 CC. but that is not what we are dealing wlth here. dilating coronary arteries b. Ph. I will call Mr. Of course. you could have just remembered. dilating systemic blood vessels c.000 so sUfi nol close 10 max. propranolol to treat life- b. 2 CC. DEpt of Genera! DEntistry. Thompson. 04 mg. 2 c. a diuretic d.ory at significant cardiovascular impairment. which acts to decrease cardiac output ana contractilily (so (c) is obviously wrong.04 mg of epi max in CV patients. 83.000.000 99_ Bradycardia is MOSTcomrnonly treated with which of the follOwing ~~? \ to a.. Fleming and change your grade in Pharmacology to an OF"! 72.E eta m. ~diazepam (Valium) phenytoin (Oilantin) c. not propranolol.subcutaneous e. bvt are Ihe way thai nitroglycerin and calcium channel blockers work. nol angina) 62. The easiest way to figure this one out is to remember you shouldn't give more than 2. Tufts Dental School Board Exam Review Addendum More board questions that were released after I prepared the original review: 52. chlordiazepoxide (l.-_J2:.sumula.~repar. you shouldn 1 be laking this test.ting vagal slowing of the heart (::jloCking beta-adrenergic receptors altha heart (e) my god.000 equals _01 mg per cc.ind of arrhylhmia when given parenterally in an emergency situation_ 1/ has a very rapid onset of action when given IV. . 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. if you donY remember propranolol as the prototype nonspecific beta adrenergic receptor blocker. : b--::". The others all also have antianylhmic action.000 d.

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

168.since it ooesn'.this is decreased by cirrhosisthe result is deficiencies in prothrombin dependent coagulation factors '. A <I yr old child is shy. biotransformation (b) obviously . since the purpose of drug melabolism is to change Ihe drug into an excretable form.__ee u in plasma b.doc 45 . -n. oot onset.L Thompson. WhiCh of the following drugs causes the LEAST eNS depression and impairment of psychomotor skills? a. !"?\ltJuspirone ""e"'.8bsorplion "'-c-~ distribution d. prazosln and propranolol G: '-Bo" rds200 5.: 176. ~ this is the exception. Onset is very /asl. nol gradual. (b). Meperidine (Demerol). lJ:. chronic bronchitis r-b. timid. (a) applies only to pentobarbital. Nafoxone is a drug used to reverse the ettects of too mucn morphine.8 Ip ra zola m d.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. 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 . have /0 be absorbed. excretion . but can cause impairment of psychomotor skills). and fearful.. '. Which of the following . the rate may differ significantly in various animal species b. atropine and prazosin . Which of the IQltowing combinations of agents would be necessary to block the cardiovascular effects produced by the injection 01 a sympathomimetic drug? a.__c.. ffi)innammation reduces the availability of the free base '--c~ drug will be absorbed more rapidly because of the the increased blood supply d. Tufts Dental School (c:sedation and ability to produce dependence amnesia and skeletal muscle relaxation a (e) the only definition which covers alll. detoxified in the liver d. which results in reduced availability of the free base form needed 10 cross /he neural membrane. Injection of a local anesthetic into an inflamed area usually has a less than optimal result. a_ Naloxone for the restorative appointments for this (c) vitamin K is stored in the liver.drrhosi s -o. <Jnd (e) are sedative regimens Ihat would probably induce deeper sedation than nnroue. non ionized form d.. (c). ionized. 42. or (e)! Nervous patients. excreted by the kidney c. it generally involves alterations of Ihe chemical structure of the drug ". blocking Ihe cholinergic nerve endings b.it is not a benzodiazepine like diazepam and a/prazo/am (BOZs may not be that sedating.. Buspirone is used to relieve anxie/y . and not a strong sedative lik.! I I be MOST appropriate child? . Nitrous oxide/oxygen ~. 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. 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. it aln~ going 10 get to irs active site to have an effect Same if II is bound to plasma proteins . which is weier soluble. 177. and (d) applies only 10 diazepam. A primary advantage lollowing? of intravenous sedation is which of the 49.-- --0 __- ~ ~ Prepared by M. bound 10 plasma protein (a) if its excreted or detoxified.hree drugs. Hydroxyzine hydrodlloride [atarax) or hydroxyzine parncate (Vislarit) in divided doses a. Ph. it primarily occurs in the liver microsomal enzyme system c.I asked Ihis on the exam! Titratability is the primary advantage or iv drug administration. 179. Making i1lipid soluble and nonion/zed would make it stay longer in the body. The other slalements are true. . diazepam -. "'" "'" 191. (d). atropine and propranolol c.----. Each of the following is true regarding drug btotransformatlon EXCEPT one.drug has to be abSOrbed before any of the olher actions can lake place. VIi..3 the prostaglandins stabilize the nerve membrane '. chloral hydrate (b) memorize. do salivale more. a. The others would determine duration of action. 154 The onset of action of a drug is primarily determined of by the rate a. it usually converts a drug to its lipid soluble. Dept of General Dentistry. Which of the following best explains why? . Local anesthetics aid in reducing the now of sativa during operative procedures by a.IPromethazine d. The major effect of a drug is produced by the amount of the drug . D_. memorize. however. Which one is the EXCEPTION? a. (b) applies only to meperidine. ilnd lIlal mlJch sedation doesn1 seem to be called for flere. angina diabetes \. th~lJs '. b. 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). 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.--theumatic fever e.--. so (d) is oul (a) and (b) are not possible.e chloral hydrate 17_4.

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

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

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

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

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