Prépa.ed by M.L. Thompson, Ph.D, Dept of General Deatisty, Tufts Dental School Pharmacology Board Review 2005 This la of questions and topics isthe result of going threugh about 10 ‘years worth of old Board Exams in Pharmacclogy, cutting out at the questions, eategorzing hem into topic areas (e.g _nibiotics, local anesthetics, ec), aed ten further grouping ‘hem into the type ofinlormation about a category of drugs that vas being asked for. When you do Wis, you see that may exams repeat questions (sometimes they reward them a ite bit to make thom look diferent), butin actually itis possible to get 2 foal for the various facts Pat you are expected to know, and that tere arent that many of them. As you go through this. handout you wil see that | point out to you the major fats that {ond to got asked over and over again forthe various major drug Calegories, and also give you acual examples of questions (and te revorded versions), as well s te comect answer In many cases, Ihave wien out 2 dotaled explanation ofthe ‘answer, just To enlighten you further. So goodluck and enjoy. ‘The downside is that these questions ore from old Board exams. ‘Some of the materials obvcusl dated, as drugs fallout of faehon, newer duge get used instead of oer drugs, etc. At the beginning of each section wil ty to indicate seme things that hhave changed and thus you may want o place less emphasis on some ofthe questions here (On a postive note, there used tobe 2 separale pharmacology section 11 100 questions. Nowadays, you might see 25-20 In 6ome ‘ersions, other versions less. Unfortunately, they stil ean craw from the realm of pharmacology so you gotta review tal However, he good thing isha since they ask fewer questions, ‘and since they ae trying to ask more cinicallyrolevat stuf, Yyou really foots your flor on analgesics, anbictics, and [Bnosthellcs, you should be covered forthe majorly of questions. “There are slways going to he some random, unpredictable questions ‘thal means you have fo review more i you want to 60 really well Maybe you wil luck out and these willbe the questions thay are testing and they don't count. Local Anesthetics |. To fargost category of LA questions focuses on your ability to distinguish amide LAs om esters: (This I hope is eemphasized, since amide ocal anesthetles are used almost ‘exclusively now) esters procaine, teiacaine, cocalne. All the rest are amides: lidocaine, mepivacaine, bupwvacaine, plccaine, dibucaine. They ‘iso require you lo know that amides are metabolizes inthe Byer, stars mainly by esterases i plasma. An fifequent ques hich class of drugs fs the most consistency in struc ate the drug group most consistent n drug stucture, becal 2a either amides or esters, fering only in their structure inthe intermediate chain (Is efter en amide oF an ester) that connects the aromatic group fo the seconclaty or terry ame terminus. 1, The next category of questions nes todo with toxic reactions to local anesthetics, ether due thigh systemic levels of loea! anesthetics in goneral (cardiovascular colapee dus to myocardial ‘6 sBoards2005.d0e depression, hypotensive shock) or toa specie agent such 35 procaine, which causes methemoglobinemia Ii 8.3 cass of questions are smed at your krowedge of he ‘mechanism of uci a local anesbretics: hay prevent the ‘eneration of nerve impulses by interfering wth Sodium Wansrt Into the neuron 1, The las mos frequent type of question regarding local anesthetics has fo do with issbes regarcing absorption oneal anesthetics Feemember, only the nonvionzed (cr ree taco form) form ean peneirateGssue membranes. named seus has alaver than _ommalgH, which decceases te aaount of ren-onzed orm ‘avaiable lo penetrate, Usually at east one question comes up asking you to caleulale how many mg of local anesthetic a patent hes reeaved, e.g. how ‘many mg of idocsine in 1.8 ml ofa 2% kocane soluee? 2a lidocaine fs 20 v0 ct 20 mg/t ml, £0 39 9 1.8m 1. Which ef te folowing is local anestnotic sutoe to nactvation by plasma esterases? "a. Procaine ‘Dosa © Pillecsine . Mepivacaine ©. Bupivacaine (a) Proceaine fs the only eter feted ~ a the ret are amices 2 fers from ldocaine in hat rocane i 3 p-amincbenzoic acid ester and idsaine is nat Lidocaine is a meta-aminobenzoi acid eslr and procaine = rot 1. The duration of action af prosine is longer than thal of an qual teal dese of idoeaine 4. Procalne hydrochloride ls metabolized into ‘ettyfaminootnand! and benzo acid (6) his is basicaly a tue-lalze lype question. (ais te only ‘Statement tats tue 3. Which ofthe folowing local anesthetics would be exnected to ‘produce @ sensization reaction ina patent serge to Koocaine? “a: Mepivacaine “be Teracaine Procane <8 Paiceaine Se. Dibucaine L. (a. eyandioy ELI) (a), (6) and fe) Te fo)ang ony iv. (b), (c) and (d) ¥ OLiGhand fe) (i) enether ester vs. amide type ideniication ‘question idoccaine is an amie, thus other amides wil be ‘ross.alergenic - mepivacaine, priecaine and dbucaino are {he ethor amides tated. Procae and etcaine se estore ‘and wil no be cress-alergeni. 2. The hydrolysis of procaine occurs mainly intheLver Lungs Plasma useies Kidneys (6) procaing isan esto, estrs are metabolized predominately by peeudocholhesterases inthe plasma, 10. Which ofthe fcwin i oa anesthetic subject inaction by forma eserases? 3 Lidocaine & Procone © Tetacaine 4. Mepivacine © Buphacsre (c) estors are metabolized by plasms esterases etracsine fs the only ester fisted, athe rest ar amides 11. The actly of procaine is terminated by ‘2. Elimination by the Kidney ®. Storage in acipose issue {Metabolism in te ver only . Melabotsm in ne liver and by pseudochotnesteraso in the plasma (c) 1emember #9 above? se the word ‘mainly"? some ‘Question, bul worded a ile diferent fo throw you of. Again, broceine fa ester, estors are metabolized predomintely by /psoudochounestoreses in ihe plasm, but seo to some extent by esters hte ver 12. Allof the flowing factors are significant determinants ofthe ‘duration of contuction Block with amie-type local anestntics EXCEPT the 2. pl of tiasyes in tho area o injection Bod plasma cholinesterase levels Blood flow Urough th area of conduction block pane’ (6) the word “EXCEPT” should alert you tha thief basically Sitve tale type question with ¢ tr statements and 1 felse Sfalament: you just have fo gure out which one! In this caso, ‘youjust have fo remember tht plasm cholinesterase lavels are only important forthe duration of action of estr-type LAS, ‘ol amides, which are metebalized nthe liver. th other slatomonis ae variables which affect duration o ho block, but apply to both esters andamices. 12, Which ofthe folowing Ie contsincicates for a patent who hed an alles reaction to procaine six months ago? ‘a. Nerve block with idocaine| 1: Topical application of icocsine Topical application of tetracaine I~ Infation with an antistamine (e) again, jus anothor queen tat requles you tobe able to lok out an ester or an amige tram a et. Since procaine is ‘an oster, ony another estar Lt would be erose-alengenia, In Degree of vasodiataton caused bythe local anesthote fe 0 pee » Goncentrgion ofthe injacied anesthetic solution {ai this fs the ony ostor iste fs tetraccine 14, Bupivacaine (Marcaine ) has all ofthe flowing propertivs relate to ldnesine (ylocaine ) EXCEPT bupivacaine ‘2. Is more lorke b, Is an ester-typa local anesthetic € Hasa slower onset of action 4g. Hava longer duration of action (8) According to textbooks, local anesthetics fa into the Tollewing lasses in tems of duration of action: shod procaine: moderate: prlecsine, mepivecein, idaczine; Ina upivecsine, etracaine, etdacaine. Stsleménts (a), 3, ana 4 ‘would be true if the question was comparing mepivacaine lo bupiacsine, which ere structural sme; but the ‘comparison is fo docaine. The only difrence tht apis is ‘duraton of acon (q), bupivacaine is lnger. (2) is wroM, both are amides. 15, Amide-ype local anesthetics are metabolized in the 2. Senm Oe Spleen 6. Kido fe Axapiasm (©) dont forget: esters in plasma: amigos infor 415. The duration of acon of idcsine would be nxeased tho presence of wich ofthe following medications? DF ae ON oad Ee ony @.Uirepr AOC! © Dgoxn TA Le ict this is an interaction I tested you on several times ~ now you a a {Of ow whyt Proprancil tracts win kccin in wo ways By slowing down the haat via bata receptor blockade, blood delivery (and lidocaing) fo he liver i reduced thus idccoine is Inthe systemic creulation Tanger ara can foc levels. Propranolol and Iidgeaine also compete for te samo enzyme ithe Iver, fe emiton tec a int LU tal irbicraion ctv Oe okes the folowing? ‘Usoeaine Procaine ‘e Prlocsine 6. Mepivacaine (2) Answeris(0)- You shouldbe able lo recognize that al ol these drugs ee local anesthetics. Local anesinetes are of ‘070 of two types, either esters or amides. Estr types ore ‘Subject o hyorolsis nthe plasma and tus have short hat! ‘ves. Amides are metabeltzed primanlyi the iver end have ives. Thus the biolrancformaton (°@. ‘metebolism; again, te rats aro using a diferent wor to Conti you, even though they are asking the same basic ‘question ofan emide type local anesthe would be the most ‘attered the presence of sever liver disease. The key word hhereis “east” Of the crugs listed, only procaine isan ester Tho ros are amides. x bY7- boy - FHFQuestions regarding toxicity: 17. A pnienthas been given a are volume of cern local anesthetic solon an subsequently Javelops cyano wth metnemoalobremia. Which of te fllonng craps mas ely was Bominstoud? 2. Procaine CQ Ipriceaine © busine &. Usoeaine © Mepiacaine () strictly memarzation 18. Use of pilacaine caries the ck of which ofthe flowing adverse fects? ‘3. Porphyria 1. Renal toxicity Gastric Bleeding Cd) Methemegibinemia (4) same as above but asked backwards. Methemoatobinemis may reso trom @ foluine metabolite of priveaine, onhototuiine 19. The most probable cause for saris lene reaction to local snosthotete Peyerogenic 2 Detrortion of the anesthetic agent €. Hyporsensitily tothe vasocarstctor 4. Hipersensitivy '6 te loeal anesthetic Excessive blood level of he loal anesthetic © () Most toxic reactions ofa serous neture are elated to excessive blood levels ering rom inadvertent travascular Injection. Hypersensiviy reactions (options b & c) are rere, but excessive blood revels wil nduce foie reactions Ika CNS Stimulation in most everyone. This sa case where option) Igthe “best” answer, because fis more Ikely than the othor allematives, which might be ive, bu re nol 2s ely (6, “nos! probable’) 10 happen 20. High plasma levels of focal anesthetics may cause 3. Inhitilion of peristalsis > stimulation of beroreceptore resulting in severe hypotension Inebiton ofthe vagus nerve fo the hea CB) Depression a inistery noons inthe CNS (2) iniay LAs innit conta inhibitory neurons, which results in CHS simulation, which can proceed 1 convulsions. ‘At higher doses, they inhib both Mhitory and exeatory ‘neurons, Teadig to 2 goneralzed state of CNS depression ‘stich ean resul ia respiratory depression and deat. 209. Unfortunately, you injected your Kdocaine intra-arterial, The fist sign of lidocaine toxicity that might be seen in the pation would Elevated pulse rate ‘Sweating CNS exatation Cardiova5eaEr collepse ENS depression pareeg (G\Boards2005.doe ued by M.L. Thompson, Ph D,, Dept of General Dentistry, Tue Dental Schoo) (6) same question as above just worded dierent. The ins ‘rel njocton would resin tho high plasma levels ‘mentioned in he previous question 20. The frst sign that your paiont may he expetencing today tom ea much epinephrine would be 18. Cardovascular collapse . Convustons Eievated pulse rote “Stared speech (c)itis sympathomimetic afer ell Allie other reactions ave ‘elated fo elovated kdocaine levels 20. Which disease condition would make the patent most sensitive to the epinepine in the local anesthetic? Graves disease Diabetes © HIV 4. Aicoholsm ©. Schizophrenia (a Graves esac een cuctmmune csese tat causes ‘parryi rsuing igh rl facing fat hetma resut no typernotbele sate wit hetnened syrpomati ctv, unich cored wh Igected epinephrine oud rat no fperensve esis 21. Cardiovascular cllapee aited by a high crulang doce of 2 local anesthetic may be caused by ‘3. Syncope 1. Vagal simutation ©, Histamine elesee ._ Myocardial depression 2. Medullary stimulation (0) Carfovascuiarcolpse s due (oo dec action ofthe Iocal anesineve onthe heart muscle sel (A infarc ses cena membrane extant ancora ets (Gis he conect ariswer AY ofthe ole ater Inet ways fo affect the hear. 22, The most serious consequence of systemic local anesthetic tony is 2. Vertigo 5. Hypertension ©. Hypenentiaon Pestana ental nervous saan consort #6 roearlsivecetra ero sytem depresson " (@) OF the options listed, this the one that wi ki the pene ‘thick !quees makes # iho mast serious. 23. Hypotensive shock may result from excossive blood levels of each of ie flowing local anesthetics EXCEPT ‘Cocaine roca Udbeaine Tetacaine ‘Mepivacaine (2) Al tho listed tocol anesthetics except cocaine are vasoditors, especially esterclype drugs such as proceaine ‘and the amie Idocaine. Cocaine isthe ony local anesthetic that preieteby produces vasoconstriction, Cocaine isso‘he ony local anesthetic to block the reuptake of ME into adrenergic neurons, and thus potenite the NE that has been released from norve endings 24, Whieh of me folowing ancathotic Juss produoes power elimglation ofthe cerebral cotex? a. Cosine , Proeaine © Loosing 4. Tewrecaino Mepivacaine () see explanation above ‘Questions regarding mechanism of action: 25, Local anesthetics block nerve conduction by 2, Depoatizing the nerve membrane fo neutrality 5 Increasing membrane permeablly to K* Increasing membrane permeabiy to Na+ {. Preventing an Increase in membrane permeability 10 K+ (Pst nie ere presto Noe (e) iam make you memorize this? You should at keast remember Na* fons are involved, which ims your eholces to (c) and (e).(e} would ncrease or faciato nervous impusse Conduction, whieh is th opeasto of what you want the foc ‘anesthetic 0.40, £0 pick). Magnesium (2) see how many diferent ways they can ask the same ‘weston? Questions regarding pH effects on absorption of local anesthetics 30. Ifthe pH ofan area is lower than normal bedy pH, tre membrane ‘meory of local anesthetic acon predicts tat te lec arestnebe actly would be ‘3, Groale,oving fo an increase i the free-bese fxm of he ug », Greater, owing to an increase in the cation for of he dug Less, oung ta 2a inrease inthe foosbace for ofthe snug ‘Less, owing lo a decrease in the free-base form ofthe dug @. None of the above {c) the next tree or four questions areal versions ofthe ‘Same thing ~s6@ the exclanation below 234. Alecal anesthetc injected into an infared area will NOT ove ‘maximum effects because “The pH of flamed tissue inhibits the release ofthe tee base ‘The drug il not be absocbed as rapidly because ol he decreased blood supply The enemial mediator of ntammation wil presenta ‘chemical antagonism tothe anesthetic 64. Prostaglancins stablize the nerve membrane and éminish the effectiveness ofthe local anesthetic Phree Lae « whic sre otc atomatins sound pas, th 26, Which of the owing iste regarding the mechanism of action pry, cotiocal anesthetics? ‘2, Usually manta the nerve membrane ina state of typerplarzation CB) Plevent te genccation fa nerve acon potent © Maintain Ue nerve membrane ina site of epctarzation . Prevent incensed permesbiy ef he nerve memrane 0 assiom ions «vor wth inracelar nore metabelsm (0) this shouldbe realy obvious! 27. Local anesthetic agents prevent the generation of nerve impulses by >. Decreasing treshold for stimulation 2b. Decreasing reeting membrane potent! Decreasing inward movement of sedi fon Increasing inward movement ef potassium ion {@) Answeris (o- straight memorization: nerve impulses are (enerated by the influx of soclum resutng in depoterzaion. Tepolanzation and inecvly occurs when polassium moves ‘ut (sodlumpotacsium purmp). LAs ac by blocking Na+ movement 28. Local anesthetic interfere with the transport of whic ofthe folowing ons during drug-tezeptor Interaction ‘Soolum Calc © Chore 6. Potassium ‘bout the fecolds you were taught about eal anesthetes {End vanabies that stfecttnir action. An imparts one was {ho role of pH and lonization factors. Remember, he oe FETE paso or noricnized form's the form that passes through ‘membranes, el once inside the neuron oni ths ianize fr [Seffectve, Iniarmmed fseue has ower pH than porns! issue afd wil shit the equiforium of fe LA scfuion such {at most oft remeins ionized and thus unavalble fo ‘ponowate ‘32. The penetration of 2 local anesthetic nto nervous Ussve Is 3 funeon of te 3. Length of the ceil styl chain . LBlasolubitty of te ionized form LUpid solubity ofthe unionize form Ester inkage between the aromatic nucleus and the ay pain «. Amie linkage between the aromatic nufeus athe aly chain (ony options (o) and () are olevant hore - the others have nothing to do with LA ponetration info membranes. Membrane permeatity is fected by whether er not tne motecue i= "charged" oF lized or not e.g, unionized) Only the fater {erm passes roel through membranes. Seo, theyre ching lhe some thing they asked inthe previus question just ‘coming at trom another angle. Remember the faci snd you an cover the angles. 535, Ata pH of 7.8, lidocaine pKa = 7.8) wil exist in 2, Bo lonized form be nonienized form 6. an equal mire of ionized and nooienaed formsPrepared by M.L. Thompson, Ph D., Dept. of General Deatisny, Tufts Dental Schoo! 1 minture 10 times more ienized than nonlonized forms (c) the ratio of ionized lo unionized frm is given by the ormuta fog AH php. In thls Instone ihe aforoaca ‘benwoon pH and pKa Fs 0. Thus docs wil exis as ar ‘equal mixture (50 (chis.corect). Mos local anesthetics are ‘weak bases with pKa ranging fom 7.5 (0 9.5 LA's intended Tarinection are usualy prepared in gal form by adlion of HCL They penetete 6s the unionized form inf tha neuron tener they reequilrate fe bath charged and uncharged {arms inside the neuron = fe positively charged in Blocks rere conducton. 2 The more rapid onset of action of aca! anesthetics in smal nerves 34 wh dogtee and duration of action ellecal anesthetics? NG eve to ‘The sight lower pH of small nerves ) The greater surface-velume rato of small nerves The increased rate of penetration resulting from sepolarzation 6, Smaller nerves usually having a higher teshols se Wino knows? Who cares? probably the answers (2) the theory ‘9008 that there is@size dependent ciica length of ‘nesinietic exposure necessary to block a given nerve. Sina bers wll ba biochod fret because te anectheue ‘concentaton to erica! fngth in smal fier wi be reached fastr than he eeal angi ina targe er, You have fo Block tree nodes of river, and they ae arthor part n SRG TECTe an Tey aT ni smal lemeter rs Moke sense? ich of he flowing statements are tue regarding onset, “The greater the crug concentration, the fasier the onset and the greater the degree of eect ~.b. Local anesinetic Block only myelinated nerve fibers at the nodes of Ranvier The larger the diameter ef he nerve fiber, the faster the onset ofetiect, 14 The taster the penetrance of the drug the faster the onset of fect dha (2). and (e) (2). () and @) i (@)and (c) only Ww () (@)anaie) (i) you know in fect above shout smal nerves, tn this ‘question basically Becomes a tue flee type ting, and (c) is the fase statement. (2) are (¢) make logical senso so you are stuck picking between (o) snd (e). You have your pick of ‘nomorzing the sma nee thing othe myelinated nerve des of ranver ting. ‘And now, for these of you that complained in class "do we really, hhave te know this tut?” 35. A donist administers 1.8m of 22% soluton of Idocaine. How ‘many mg o!lidoeaine oi the patent racive? 2 38 De. 6 8 6 36 160 GBoarde2005.doe () 2% solution = 20 mg/ml X 1.8 ml = 36mg laoccaine. Aad {you thought you would never have fo do this stu aga! 36, Thee mot 2 losal aneetnete solution consisting o! 28 Hea ‘wth 100,000 epinephrine contains now many migra of each? ‘2 Omg. idocaine, 0.3 ma. epinephrine 1, Ging. idacaine, 0.03 mg. epinephrine © 80rng. idgcaine 0.3 mg. epinephrine 4. 60mg, idocsie 0.03 mg epinephrine 2. 600 mig idocaine, 0.3 mg. epineptine 1 G00 mo, tdossing, 0.03 ma. epephiine 437 The maximum aonable acu dose of mepivacsine is 300 mg. ‘How many mies of 2% mepivacaine should be injected to alain he maximal dosage in an adult patient? 28 i cos py © 48 Nears @ ? 2 (6) 2% mophacoine = 20 mg/m, s0 200 mg 20 moh a In Oy 304 = 2% Ven x ee a By = rege Fal | Sih 238, A recent iniroduced local anesthetic agent i aimed ty the ‘manulactuer fo be several mes as poten as procaine. ‘The products available 0.05% buffered aqueous sain in 1.8 mi taridge, The maamum amount recommenced fr data fnesthesis over a ¢-hour parca is 30 mg. The amount is Conlained i approximately how many carbidges? 2 18 5. 1048 0.5 mg, r 1927 x OTe va BS ip : 4 <2. Greatorthan 36 ia (2) 005% = 0 mg/ml. To give 30 mg, you nave fo give S0mp0.5 mgini or 60 mi. 1 cartnoge = 1.8 thus Ami Tbmi= 33.3 cartes. - frst express the percentage of ‘allan as @ action of f00, then aad the urs gm. 0.05% ‘equals 0.5 or 172 gms per T00 ml. The carte is 1.8 mh teh you ean round ef (0 almost 2 rls ta. In this 2m you Would have 1 gm of te local anesthetic. You need o give 20 ‘ome, which would require 30 canndges. The afemative int Ineets this answer 1s (9) on ge foked bythe placement of te decimal portsmany people read the 0.03% e8 being the same as 5 gms rather than 05 ams. 138, Acoarding to AHA guidelines, tne maximum # of exmpules ot local anesthatie containing 1:200,000 ephnepvine thai can be ‘sein patient wi crdovascur dees le 2 oo 3 4 " parey (a) the AHA lint 0,04 ma, compared fo 02 mg inthe eet patent. 1:200,000 equals 0.009 mgt cr 0.008 per 118 mi carpule 4 carpules would thus contain 0026 ng,whic i just botow the 0.04 mg lt Aniibiotics ‘The most feaquently asked type of question requis you to be able ‘0 compare vatious paniin anbbiotes in eins of potency against cerlain bugs, alleen, 49 of choice agains! certain conaitone, cle. For ey Srieiiineed teaten meena td questions) an iC etcencin tas Se bel pasha acrid cape (&.Which drags from alist are o* are not croes-allergenc with penicilin: most usualy asked about ones are: ephaloeporins and ampciin are, erythromycin Isnt 4. Wihien penieitin is useful against penictinase-producing bugs such as staphylococcus: ddoractin Which is speci for Pseudomonas infections: an extended spectrum such 2s carbeniiin. Which combination of agents should be used prophylactically for patient with heat valve to prevent bacterta endocarcte: ampicilin and gentamyen (1968- ocording to latest recommendation ot eA and ADA sihough use the lalest guidelines tat you have heard ‘boul (here's @blg change obviously, since Eombinations are no longer used, and nelther are ‘doses given bofore and aller treatment ~review your Iatest prophylaxis guidelines) ‘ropiylaais Regimens For SBE (AHA 1097 Gandainasy TF choice: Armen B(@ X00 ma) POT before treatment # of pil be digemed dopends on (of sppoiniments Cider 30 eI prior | For FEN allergic Cindampein 00 mg @X 150 me) —] PO Ihr before aeatment..#of pills tobe dispensed depends on# of apptnimene “Ampiciln VM 2g, 12 before (Kids: 50 mek) (Cindamyein fr PON alergie) 600 mg 1V 12 tr prior, kids (20 meg) piso be dispensed depends on # of ppomerents ‘Bramptes of pale’ cardiovascular conan ‘that require prophylaxis and some tht ‘don't (AHA 1997 Guideline) Prophiylaris Net Required Fraihaie wales | Cavdiae perme Rhewrate fer whut Frevout ecarttit ‘vate étuntion Falmonary | — Mal valve rots witout” ‘shunts ‘valvular reputation ‘Bvanpiew OeDeml Procedures That Require Fropiglans | "Nat Sane TH Don (eesti XTL4 1997 Guldelines Coveat: our clinic ule, std they der from these, are aso ‘angered correct ansvers) Required Not Required ‘Earactone Restorative Proceores Tnacanal edocs Fatt Srey Trp "Ting OF ipso 250-s00me, dispense 30, ke Fables a nce hen 1 tab every 6 hr unl gone (days) ome sores do ot indeate ing dose, s dispense 24, ke | oh nul gone ids (ess than 12 yr) 20-50 mpg eid Gngamycin | T5O30O me, Hapense Di ake Temple ey | an hs oi gone (7 day) Kids: 8:12 mg/kg td or gid “Kwsricilin | $00 mg, dpense, i, take Vapale way rs unl gone (7 days) qte Kids (under 20k 20-40 mere 2. The 2nd lnrgest category expects you to know the mechanism of ‘acton ofthe various anthiotis: 2, Bactericidal agents such as pericilin kt rpity gring cai by inhibiting col wall synthesis, , Bactriostate agenis auch as tetracycine mit population towth, but do not kil bugs by interfering wih protein ‘Syihests on becieral becomes & Anlungats suc as nystan bn teresting cot als 10 weaken the Wall estat gens such asthe sulbpamites compat wit PABA fe a0 aye, ts eet cae seney ‘3. Many questions are asked regarcing side efecto toxicities of pening, fekacycines, cindamycn, ele: 4. What ae symptoms soen during alec reactions to Penictins: dermatts,stomats, ronchcanstcion and ‘ardiovescutarcolepsePrepared by M.L. Thompson, Ph, D., Dept of General Dentistry, Tufts Dental School ©. wagon produces GI uel and pseudomenas col 2 Ample Sincanyen 2. Delain sos . Which agents are most tkaly oleast key to cause peels auies Superafeeten: most braadepeckvm agents Sven 63 istajetnes ast nao specm apes sch pelo PE ee S Sis cesayed y ald th stra vesting conse 41 Aplastic anemia is at teite win enoramphenica ‘nd iegur absorton.Penei Vs tet ste ond Semen ‘tail for or ute. Poin G procane's pea) aven ©. Liver damage or hepatotovicity is associated will. tetracycine ‘intramuseuisrty in repository form, yielding @ tissue depot from 1. Enytheomycin estolate associated with argc chest which the drug is absorbed over hours. nti Jom, i eannct epatts be given IV or subcutaneously. {8 The principal inerance among potassium, procaine and 4, Questions involving interactions between antbiotics and other erase ner rence rae tugs: ‘Potency ‘2. Tetracyctine and peniitn (ida static nteracton}cancel Toney leach other out due lo opposing mechanisms of acon Duration of action \G) antibacterial spectrum Probenecid alors the rate of renal clearance of peniciin °. Diflusion into the cerebrospinal uid Efectiveness of tetracycines is reduced by concurrent ingestion of antacid or eaty products (6) again Just ashing you fo know somethin abou the various forme of ponialin Since in most cases you a0 going fo use Pen 4d. Brood spectrum antbiotiss enhance the action cf coumarin i erty, this question fs an old one sowing is age and ‘aniiceagulans because ofthe reduction ofMiiamia probably net lkaly to eppear anymore on bos exeams €. Anibiotics such a¢ aman octease the effeciveness of ‘oral contraceptives due b suppression of normal Gi fora Ineo eG oeeTe ee 11. Which ofthe folowing antibiotics is coss-alergenic with pniciia Involved Inthe cycling of active steroids fom Ble ae oe ae ee on ee ‘and should NOT be adminisored to tho peniiin-sontive pation” jugates, leading to more rapid excretion ofthe pa oe from the boa Enytnomycin 1. Macrcides such as entromycin tte metals of . Gincamyen tops such as Seldon, dpoan, ee & Ccomen . Tetegsine Crultrenuini, ¢radun bd prt cH 5. ore and nore questions these days ae being sched about (0) anpicin sro sounds ie prc mua be te ‘nivale nd antitingaa, soreview Shower 8. _Acyclovir: an antiviral used for various forms b. Fluconazole or keloconsze 12, Which ofthe felling anttioscs may be eoee-allgen with systemic-actng Sea ig a a SER Frequent aed questions on eno: © Ginanyeh 5 Epmch 5 tain ne lint pane pte ¢ Sam. rennet (Te aman sin nth srt BESET sco curcan ot et D ie stag occa Piatt ene epi e 4 nes ige aie Eseries 2 SESE SE cto wos (mena yy ree tn vg nia so neo 6: eso nape tbl ein Vom gn eet ea ee b) cephalexin 2, Grete resistance to penlinate seca ®. Broder antbacatat spect 6 wancemgin CB More reliable ot abecipton f lebaeyae “ Siwer ena excreton ©. Nove of he stove (2) a sgt rmeded var tb abo qv, ‘See cern atomatves town in Obvcus you con (6) owordodvarton of the stove ‘ecopne wither or ota dg traps as cphaspora 7. Winch ofthe folowing pence ie aaministeed ONLY by deep ‘tegency, honour can Pade any revert te gestion intramuscular injection? G.\Boards2005 doe14, Which ol the folowing groups of antibiotics is retated both structurally and by mode of acton tothe peniclins? 2. Polymyains a. Cydloserines ) Cephalosporins CCloramphenico's (6) see above 13, For the const tne most reliable method of detecting a patent's silegy to penilin is by ‘2, Injecting penicitn inradermaty 6 PS Taking @ thorough meciea history Se" placing 2 dtp of peniciti onthe eye {2 Having the patient inhale a peneitin aerosol 2. Injecting 9 small amount of penielinintavencusty (0) all of ne ether methods involve unscceptable isk: Once Sensilzed, even a small amount can cause an alergic response. Remember, Its ot dose rele response that wont be problematic yeu only injec lite Bit 14, Which of the following antibiotics i the substitute of choice for penialin i tho peralin-senstve patent? ‘a. Bacivacin BS Erythromycin © Telracycine . Chocamoheric! {) boy, if you havent heard tis @zilion limes by now.. None of the atermatves listed would be 8 problem i terme of cross. ‘allergen, bu the reason 2) the right answers thatthe Specitum of acthity of erthromycin is very salar fo periciin, ‘The ciners ofer a much broader spectrum of covarage then we usualy requie,alvays use the drug wilh the rarowest “spectrum possible Wat inetvdes the microbe in question, ‘Standards have now changed such that clindamycin isthe ‘drug of ehoice in this stration. But they don't Include Slindamyein, look for entromyein. aw 16, Moet anaphylactic reactions to penelin occur 23. When the drug is administered orally —b! Inpatients wha have sleody experienced an allergic reaction to be drug ‘Inpatients wih a negative skin test to ponictnaferay ~d. When the drug is admnistered parenterally fe, Witin minutes afer rug edministaion |G). @)and@ (©). (6) ana) 6) and (e) (6) and (6) enty ¥ (@.(andie) (i) memorize 416, Which of he folowing penitins nas a broader gram-negative pact than penellin G? 3. Natatin Boyes lain ©. Perici V (0) that's why itis considered an “extendoa spectrum form of penieln 17. Which ofthe folowing pencline has the best gramwegative spectrum? Nein impli © Mebiciin @. Periiin'v ©. Phenethictin (©) dn they ust ask the same thing in the question above? 18, Which ofthe folowing antbictcs shouldbe considered the crus of choice in tho treatmant of infection caused by @penctinase- roducng staphylococeus? 2. Neomycin| b. Ampeitia ©. Tetacycine jde-Peniitin v Dicoracil (o) that’s reat the only uso for éctoxsein 18, Oral infections caused by rganisms thal predues penciinace should be teated vit ‘3—Ampial Dielowaciin > & 9, Any the above © Only (a) or(@) above (0) of ose listed only () is peniilinase resistant. Anica i {an extended spocizum peniclr, and isnot penelinase ‘sist Erytromycin shouldnt be affected by penclinases, Since tisnt a peniiin, uti doosnt work again! staph fr ther reasons. 20. Which ofthe following anbotes i LEAST efectve against tase proticng mcsercanins? ‘Cephalexin ‘= Metallin, @. Ciingamyein fe. Enjhromycin () same question asked tackessward 21,_Whish ofthe folowing isa bactercicalantiiote used special in the treatment of infections caused by Pseudomonas species and Indole postive Proteus species? ‘a. Arpiclin Penciin V Tetrscycine 8 Dicoxscltin 8) Cabeniciin (6) Wow, I bet you dt think they woul ask something ike Ist An extended spectrum agent is routed. Ampicilin is Ineffective, wile Pen-Vis loa narrow in spectromPrepared by M.L, Thompson, Pb. D, Dept of General Dentistry, Tufts Dental School 22. Peici's eflectvenessapsitapity ring cas may ductot eet on 2 Protein synthesis (CES Cotwat synthesis Se flocne ci ayethosis 4. Chelation of etl one © Celimembrone pemeatity (t) memorize, memorize 23, Chionetracyeine acts by ntererng with 3. Call wall synthesis by. Nuclear aed synthesis Protein synthesis on Dacteral but not mammalian ribosomes ~ a Proten synthesis on mammalian but net bacterial bosoms (c) that's why tis solectvely tose. Woulan? you tke iif your \octor prescribed o drug for you thet cid ()? 24 The probable mechanism of te bacierostatic action of sulfonamides invelves '2. Disruption ofthe cel membrane . Coagulation of intraceluiar proteins Reduction in oxygen utlzaton by the cals 5, Inhibition of metabolism by binding ace! groups ‘© Competition with para-amincbenzoie acd in fle cid synthesis, () memorize 25, The sulfonamides act by 2. Suppressing bacterial proten synthesis © Intwbitng the formation at be extopismic bactensl membrone .e. ncueing the formation of “tha bacterial proteins . inducing a deficiency of fofe acid by competition with parse ‘minebenzoie 208, (a) same as above worded aiferenty 26, Which antibiotic fe able to achieve a higher concentration bone thon ie serum? 3 penciia 2 eryinromyein {egindamyein “a hetonidarole f amoxeiin {c) that’s why itis vary usell for treating bone infections ‘such as osteamyeltis. The question might have substtutod ‘gingival Mid for bone ~ tht would make the answer fetrecyetine 27, Tetracydine reducos the effectiveness of concomi ‘ministered periciin by '3. Reducing absorption of prin . Increasing metabotsm of pencil. €. Increasing renal excretion ef penicitin &. Increasing binding of penich o serum proteins None ofthe above ty (6) ‘ovacyetine is bactorctatle snd would slow th rapid growth ofthe microbial popation that a bactericidal drag Such as penicilin needs foe effective, sine only when 6 WBoards2008 doc ‘epidly diving are the cells making cel als 237. The action of which ofthe folowing drugs will most key be impaired by concurrent administration of evacyaine? 3. Cenitrernyein >. Enythvomyen ¢. Sufonamise Peniciin LUncomycin (2) the classic cide static interaction! See above, since tis |s ust areworded version ofthe same foc! 28, Which ofthe folowing antibities te most kel te causeIner damage? ‘3 Steplomycin Punesin & Qelegene Cephatopons © Anphotston 8 (2) (2) stroptomycin can damage the eighth nen, tfecting both bsiance and hearing, but is nct associated wih iver damage. (0) ether than alergic reactions, pencils ae fexromely safe, with no effect on the Hive: () te ‘cephalosporins are cherncaly related othe percitins and Share their relatively nontoxic nature. (e) amphotericin is {an antifungal agent tat produces such adverse side eects {5 nephrolexicly and hypokalemia, but na ver towcy Thus {e) i the comact answer. Tetracyeinos have been shown 10 ‘be hepatotoric following high doses in pregnant paints with a history of renal cfsease. 20. Which ofthe following enythromycins associated wih an alleric cholestatic hepatitis? 2. Enyvomyein base Enthvomyein stearate Erythromycin eslotste ‘6 Erythromycin succinate (c)just because 30, Which ofthe following antibiotics is LEAST hel to cause sunernfecton? ‘8. Gentarecin b_ Tetreyeine eens ‘suepiomycin ‘. Chlorarphenicot {o) superintections aro usually sen feloairg the use of broad spectrum agents. Of those listed. ll are wie spectum except Pen-G 31, Castolnestinal upset and peeudemembrancus cats hae been rominenty associated wath 2. Nystatin . Gephalenin © Clindamycin 4. Polympain B ©. Eytvomyain (e}, Te onty 2 possiomties ns produce GI upset se (e) ond (6). &s fo producing colts, (b) and (c) are assoceld with this adverse sido fect. (c) 1s the only drug which does both,therefore i's the ight answer 22. Symptoms that may be characterized as allergic maifestaions ‘uring penicin therapy are 8. Deatness, dizziness and acute anemia '. Crystaliria, nausea, voniing and anaphylactic shock ©. Oliguria, Rematura, brenchocenstiction and cardiovascular collapse Ces ‘stomatitis, bronchoconstriction and cardiovascular lapse ° 238, Aplasle anemia is a serious love effet hat occurs parculay tira corse of eaten wh which ofthe folowing snobs? * Pevitin 8. Uncomjen © Towacyesne &._Seplomyen (2 pnoramohenicat (eo) memorito £24. Each ofthe following is a ste ofect of prolonged tet acytine hhydrechlorge therapy EXCEPT: *3 Suprainfecion _B. Photosonsitty E> Vestibuorcisturbances . Discoloration of ney forming teeth fe. Gastrointestinal symptoms (when acministered orally) (o) memorize 236. Colts hat resus folowing cndamycn therapy is caused by an overgiouth of NC oitete Staph aureus & Pseudomonas 4. Candia abicans (6) memorize Antibiotics, Miscellaneous 37. Which aniibiati is appropiate for premesisation inthe penciin allergic patient? a. Cephalexin BD Cindamyen & Erythronycin 6. Ammoxlta fe Ampieiin (e)ctndemyein Is th curent recommendation. Enthromyein used fo be, 50 you get a question that doesnt include Cingamyen at an nse ok fr nae Cephalexin ‘might be a choice, bu theres tha issue of ess- ‘tlergenciety, and & mus ertainly be avoided inthe Sraptyloct patient Ameatelin and ampeltin are ponies! 38, Acycioviris usetl for Weating 3 Candidiasis, Colts Horpes simplex a IV ANUS {) always think used for hemos ae the fit snsmer ‘98. A distinct advantage that tetracyclines have over penicilins is that tetracycines ‘2. Have no side effects bb. Donot cause supernfections Are safer to use during pregnancy lave 8 wider range of antbacteral actly Produce higher blood levels faster afer ral administration (0) breed spectaum vs. namow spectrum. Tetracystines cerainly have more side effects than pric, and are ‘certainly one ofthe anbotics to avait dung pregnancy. 39. Which ofthe folowing has the broadest antimicrobial spectuan? ‘a, Vancomycin Vancocin | 2. Glndamycia (Cleocin) c-&_Enythromyein Enytvocin ) Ca" aioretracyeine (Aureornycin ) ‘hité generstion cephslosparin (8) Answor is ()-rememter,tetracyclnes ae broad Spectrum antbiotes effective against bah gramsaegative and ‘gram-positive coce! end bach Cindanycin has @ spectrum ‘factitysimtar fo erthyremycin and vereamyetn which less than that ofthe letracylines, mainly affecting gram ive microorganisms ist generation cophalosporns are ‘fective against both gran negative and gram-positive ‘organisms, but ie tid generation ones have increased activity agains gram-negative but oealy decreased acon ‘against grarepostive microorganisms 40, Suifonamides and trimethoprim are synerisic bacteriostatic agents because mn bactora they ‘th ib foe aed synthesis a inerere sequeniay we flnic acs rodcton ‘Are oth antimetsbotes of pare-aminaberzoie &. Are bth inter of ityciatle ack wise {fre bath Wansformod i wo ino a engl ative compound Co) 441. Which ofthe folowing substances is te moa effective agent “saginst fungus infections of tre mucous mombrane? CS!) Nystatin ointment +b Undecyienic acid © Palymyain intent {. Saturated magnesium sultate 2. 10 percent aluminum chide solution f@ 42. The mest desirable property of an antibiotic when uses to teat an Ddontogenic infection is a. Rapid absorption é Ute alergenciy Abily to achieve and maintain adequate concentrations a Lack o significant binding to plasma proteins “ie ste of infection ©. Noetfects on drug metabolismPrepared by M.L. Thompsoa, Ph. D, Dept. of General Dentistry, Tufts Dental Schoo! (6)itit cant do this it isnt going tobe very efective. 14. Nystatin is of greatest cnical usefulness in Weating 3. viral infections (7b fungal infections ~vsprochtal infections 4. Bacloroides infections © peniilin resistant gram postive nfecons () Nystatin isthe prototype antfungal agent, thus () is the ‘mast obvious 1st choice, an eliminates (a). (0) & (e) eque ‘an aniibiotic, not an antifungal 42, Which of the folloning drugs chelates with calcium’? rythromyein Poymyain B CE) Teracycine se Penelin & CChioramphenico! © 43. Wich of the folowing is NOT characteristic of tetrscycine nbiot? ®. 4 ‘Absorpiion is impaired when taken wih antacids ‘They predispose fo mona superinfection ‘They form 2 sable complex with te developing tooth mauix They have a fv tendency for sensitization, but a high therapeutic index “They ate otfloctve substiuics for ponicilin prophylans against Infectve endocardis| ‘Answer is (e)- Again, the Inportant pase in the questions. ‘nat (Hey, just Weyne and Garth. Obviously the fact that you ‘wil remember about tetracyinesis that they can discolor {eotn in te fetus when faken by the mother during prognency. ut dont circle nat answor because () I also charactonstc oftetracyelins (thoy ara the most bkely ofa the antibiotics lo cauee superinfection), and is an annoying zie offoc in ‘dus resulng rom ateraton ofthe eal, gastic and Intestinal fra. The eal answer I (e). Teracylines are not the drug of choice for proplyiaxis agains! infecive cencocartis. This is due fo streptococcal infection. 15-20% of rou A streplocace! are resistant fo ttracyctines, but none ‘are resistant fo peniciin or erythromycin. Recently anon Stteptococcal inauced subscute bacterial endocarditis has ‘been ideniied, especialy n juvenile peedontts patients. The causative bactervnfs ot suseepeo to pentiin or cenjahromycin. it may be necessary fo teal predisposes pationts with tetracyeine fr afew weeks, and then follow this wih @ course of penciin er enthrarycn. Remember that these drugs are antagoniste to each ciher and thus cant be used concurrenly. Peoelinis a bacterial drug which Ks ‘or destroys miecorganisms by interfering wit the synthesis brfuncton ofthe col wal cell merrbrane or both. Thus tis ‘most effective against bacteria that are multiplying. Tetracycline is a bacteroslatc antiotic that pote the growth and multe sto of organisms oe pratain synthesis by binaing rversibly of the bacterial ibosome. When the two type (ogether, their effectiveness is regaled or Antibioties, Drug Interactions G\Boarde2005 doe 444. The concurtent aoministraon of penicilin G and probenecid results in 3. Increased metabctsm of peiciin 6 Increased renal excretion of probenectd [Decreased renal excretion of penciin G Docraased bacteiisa effect of penicilin G Ineseased excretion of probenecid inthe fees @ 7. nteracon between cenelin and probenicid Is best dastives by ‘which ofthe flowing mechanisms? ‘2 competion athe receptor ste acceleration of cru bitransformation ‘glertion in the acé-base balance eration in the rate of renal clearance ‘Answer is (2) penciin fs metabolized inthe War, but ‘rapidly dissppears from the blood duo to rsp clearance by the kidneys. 90% is excreted by tubular secretion. Thus patients with renal disease wil show high Hood eves of ‘enkiin. Sinfey,probenkid, a uricosure agent dey Iwhich tende fo enhance the exeration of ure acid by reducing renal tubular transport mechanisms), reduces the renal. clearance of peniclins. And you wondered wny we nad nose lectures on pharmacokinetics! 45, when broad-spectum antibiotics ate administered wih coumarin atts the asp oct ay bn 1 Reduced becase cand apa masts Fetus becnse ol Reesaes parang iced Sie cto var ces Ireaed becuse of urea onl rcuon ane oacorgaant © WEE wnetee Ob tn a re 45. The therapeutic efectiveness of which of he flowing drugs il ‘be mast affected by concomitant ingestion of antachle? ‘2 Cephalexin Enthromycin| €) Tetracydine Sulfsoxazote ©. Penietin v| (6) ey, | askod you ths onthe exam! 47. Enytivomycin shouldbe avoided inthe patent aking a. Aspirin B) Seidane Benadrt 4. Ibuprofen &Propranalat (0) remember te famous enthromycin- Scare potenti lethal interaction, whereby erythromycin Becks the ‘metabolism of Sekdano to ls antihistamine metabaite- i ‘slays unmetabolzed and causes cantic scthymias. OF Course this question could have mary other cptons iste, shes entiromycin decreases the metsbolsm of 0 many other useful cris, such as-aGoxin A MMWR Fo Qa, of :Cardiovascular Druge This category covers a ot of drugs and ait of questins. They can be calegonzed as: 4+. Questions asking about which drug liom alist night be used hypertension: N 1) Diuretics such a the high ceing of oop-acting drei, turosemise; 2) Bela-blockers such as proprenoil othe cardoselective beta blocker meteprelerserobt 3) Alphs- blockers Suh 38 razon 4) Cenvaly acing atrenerie ergs Such 2s methy/dopa or tonite 5} Neuronal blockers such as guanethidine reserved for severe hypertension} 6) Angiotensin convering enzyme iors such as Captor Hingpal angina: Ntuog}yoerin, sometimes propranolol, calcium channel Dockers such a8 verapamit arrhythmias: 7) Lidocaine (venticul arthytmias), (2), Phonytoin (0 reverse digas Induéod axhytrriae), 3)" Quinine (sunmaventroulr tachyarrhthies, ail oe __ felton, WED 9_ Vereen (eupravenicaaeachyary ti paroxysmal tachycardia. alta ibrilaion), Digitalis (aa frllaton, paroxysmal tachycardha) _Propranoll (paroxysmal tachyearia) a8 Congestive hear failure: Gycosides such asia digorn, ACE inhibitors such as captopril 2. The second major category ef questions conesine ‘mechsniem of acton of he various agents Antlarhythmics: Remember problem i tha the heart beats iragulenty =< 3. Type 1A agents euch as quinidine: acts by Ineeasing te reractor perlod of eardiae muscle ‘Type 18 agents such asdocaipe decease cariee exciabiiy rien cigtais is used for atl fbration it acts by decreasing the rale of AV conduction ‘Aetiongins druge: problem ei ‘demands of myccaréium 2. Nitoglycerin increases onygen supply tothe heat by & ‘rect vassliatory acon onthe smooth muscle in coronary ateres , Propranolol reduces oxygen demand by preventing ‘hvonotpic responses to endogenous epinpiv motors an exercise. &. Calcium channel Blockers decrease oxygen demand by reducing afferloas by reducing peripheral resistance Vi ‘vaccdaion ‘Antihypertensives: Remember, most drugs have he ultimate ‘etfect of reducing penipheral resistance va vasodlation ‘ACE inhibitors: Caplop blocks the enayme wich fi fe é ea converts angiotensin Ito angiotensin The later is 3 potent vasoconstrictor (admiistraton of anglers wit ‘esol nan elevation of blood pressure) Adroncrgle Agents: = Prazosin: selective ais blocker. nh binding of ‘atv induced release of NE resuting ir vaacaratoT _tethyidope: sets eenbaly as a fake neurcansmite: CEPIF? —~ stimulating alpha receptors to reduce sympathetic otic oH resuling In vasa ton FLL Ls 6. Clonidine: selective agonist stimtstes alpha. 2receptors inthe CNS fo reduce sympathetic outew to pesihesa ~ vessels resulting in vasodiation—~— ‘6. Bigprancll: nonselective Wata block? reduces carsiac ‘uiput and ints seni secret . Mer seect SBA SE caves criac output Diuretics: 2 the renal absorption of sodum, hus, ‘esuling in ud lose anda reductcn in Bood volume. Ths decreases the work the heart haste pump. Also have weak dlatoy acion. Types of dures wich may be ‘mentioned include: 8, Thlexdes: ce Potassium sparing: sptenolactone Congestive hesrt failure drugs: 2, Cardiac glycosides cuen ae cigs digtoxin are loctve because they have a pesive inakopic eect, Increasing the force of contacton of he mccain, This is achieved by an inhititon of Nav, K+ ATPASE leading Io Increased calcium inux. Digitalis berepyrecuoes te compensatory changes thal are assocsied with congestive hoot laure such 2s Inoteased hear size, rate, edema, ele Drug-conetfon questions 1. Quinidine Is principally used to eat 3. Hypertension b.Angina pectoris Congestive hear faire | 6 Supraveniicuartachyarmybsmios () by elivaion. Hypertension (3) i treat pemmany with ete rockers such as propranotalArgine Is primaniy tested Wah ntrogveern, white eonxin (gins i the crag cf once forcongesive heat falur Quinine classed es on ‘etanthymie rug (Type Focks sodium charts). It ‘reduces automaticity and responsiveness andinceases ‘etractoriness. I also has an atinuscarine acon preventing the bredycardi that fotows vege! stimsation, 2, Quinine i used to teat 2 Hypertension| Angina pecors Ail Talsbon ‘Venticulefbeation ©. Congestive hea favre (6) same question as atove, ust gave youPrepared by M.L. Thompson, Ph. D., Dept. of Gencral Dentisty, Tufs Dental Schoo! arr Verapamil is most efficacious in the teatment of Alta! filaion Sy Alta tachycarate ©, Ventrcula tachycardia 4, Caledrolaming-induced antytimias (a) memorize 4, Which of the following drugs is mos! useful in tealing or preventing ‘engine pectoris? 2 Digitalis 3. Quiniene / Propranctot “G Procainamide ‘9, Pentobareitat Each ol the following drugs can be used inthe prevention and lweatment of angina pectoris EXCEPT Digitalis Proptanota Iutropiyeorin leosorbide dinitrate Pentaerytnitel tetranirate o 6 Allo he following crugs are usefuin te veatment of hypertension (CEPT “BS ephedine Reserpine ©. Methyldopa 1, Thiazidedoetics eo () AN o the following diugs are use in the teatment of cardiac ‘arrhyttmias EXCEPT ‘2. Digital 8. Udoeaine ©. Phenytoin i, Procainamide ))aminophyline fe) 8. The drug of choice for inal therapy for mild hypertension is 3 Revecpin b. Guanetaine €. Phenobarbilat GBoards2005 doc 4. Chloothiaide @. Alphe-methyidopa 1 Yet ng nannies tyne ea errand ran at o 11, Which of the folowing beta-adrenergic receptor blocking agents is thought to be cavdloselactive? ‘a Nadolt Timo Oils Propranalel © Mechanism of Action Questions Antiarrhythmics eamaemnastan Soe ee TS cma o 15, Most rugs usefulin the treatment of cardioe achytherias ot semacy by ‘2 Blocking Purkire bers B. Blocking the alpha-adrenerac receptor ‘Suppressing SA node impulse formation Causing 2 postive inotropic eller reasing te eractery period of carciae musee O rae ; er period of Caach pads 14. Theol mporan pbc con ods a wes cate anyhrios ‘2. Blockade ofthe vagus nerve ', Stimulation of cardiac ATP-ase actty ©. Bigckade of ta Beta-acrenergereceplor 1, Stimulation of he bata-acreneigc receptor GB) neteaed retain pores of crsae muse @ 18, Usocaine reduces is anny ffect by incrseing AV conauston (B eretsin caida ean Increasing cardiac conduction vl Inereasing spotaneaus pacemaker atiy(b) antythmias ae defined as any abnomaity ofthe normal Sinus rhythm ofthe heart due lo disease or iriury induced ‘damage tothe impulse conducting systems. They also result ‘rom the development of ectopic pacemakers or abnormal pacemaker myths. Dugs such as lidocaine aro used fo normalize these sythms. Lidocaine, a focal anesthetic. Geprosses cerdize exchabiny, answor (b). The refractory porad of carciac muscle 8 mieeased, thus swing the heart Gown. aloft other alematives given would excerbato the anythin, 16, When digitale used in aa vilalen, the therapeutic objective isto ‘2 Abolch catiac decompensation by Inhibit vagal impulses tothe heart Decrease the rate of AY conduction Increase the rate of cavlac repolarization ‘2 Produce a decrease in he rate of ata contraction o 17. Nizegleetin tates the coronary arteries in angina pectoris by 1 Decreasing the heat rate ee 2 cresting the motabote werk of he myocarsium Ce Direc action en emeoth muscle inthe vessel wats CP increesing the ellecive retracor period nthe atu 2. Blaching beta Sdrenerseeeoplors © 18. Propranoll sof value in treating angina pectoris because it 2. Has a direct action on vaseulor smocth muscle ©. Blocks avtoregulatory mechanisms fn tne ear © Inhibits oxygen metabolism in carclac cals Provides rel! within secends ofan acute anginal attack ') Prevents chronotiopic responses lo endogenous epinephrine fomotons and exercise co) ACE Inhibitors 19, Administration of angiotnsin results in ‘2. Antenflammatory effects ‘nthistamiic eects Increased blood pressure Ipereased heart rato ©. Asedatve effect @ 20, The primary anthypertensive elect of captopril (Capoten) is due to accumnaaton of ‘Serotonin, B) Angiotensin! Angiotensin it 3. Bradskinin metabottes (©) Copfopi is an angictesion-converting enzyme inhibitor that locks the activation of angotension Io angiotensin The decreased blood concentration of angiotension I reducos blood pressure, because angotonsion Ils a potent vasoconstrictor. Thus (¢)s wrong, accumulation of “angotension 1s the usual effect. Capon alco maintsins lowered BP by elevating bradykinin (nich has potent vasodilatory action) inthe blood by Blocking ts motaboken. Thus (is wrong, bradykinin meiabotes Go net accurute 21. Adminstration of angotensi reuite in ‘a. Asedalve efiect Increased heart rate Incteased blood pressure nthietominie effects ©. Ant-inlammatory effects (6) Lguess because more angiotensin ii would be formes, 2 that is a potent vasoconstnctor Mechanism of Action Diuretics 22, Which ofthe flowing is NOT characterise of he tezige ures? Increase renal excretion of sodium and ehlerde 1. Increase real excretion of potassiom Increase te tox of aga 6 Exacernate exstng ciabetes f (Cause hypokalemia Cause hypoglycemia (frst of, ow can you nave an option (7! (a) is now ‘ureies lower BP, (b) i why they can cause hypoksiemia, which i eanvenienty option (e), and typokatenra can Potente digitalis indveed arrythmaias option). They ‘pperenty can also cause hyperglycemia, which would rote {o.option (a). How the heck are you supposed fe rememter al orth? 23. The most useful rei rugs at by Ineeasing the glomorr fio ae CED Decreasing the rena resbeorton ot soium Decreasing the renal exreton of chloe Increasing be renal reabsorpion of polasiom ©. Inreasing te serena anlureic Hormone (0) people with high BP are abways fold to recuce soft inte, ‘sine high sodium levels cause Mud rterion which can Increase BP, 20 ipso facto, reducing rena reabsorpion of ‘soalum makes BP eo down 24. Whi the fofoving rue acy inhi eal eabsrpen Urea Chicrothiszide ‘Theophyfine 4. dgitats glycosides ©. Procsinamide () some question 28 above, just reverted, Cardiae Giyeosides 25. Digoxin exes its positive intopic effect byPrepared by ML. Thompson, Ph. D., Dept. of General Dentistry, Tufts Dental School 2, Activation of adenyloyclase i. Inhiition of phosphodiesierase —c, An agonist effect of beta eceplors SNinhiston of Nae, Ke ATPASE leading to increased calcium Sine 26, 2 22. 2 6 @. Decreasing te amaunt of calcium available for excitation. Contraction coupling ‘Answers (6)- Remember, cadac ayeosides such a digoxin 219 used in he treatment of cangestve heat failure, which is the feitre ofthe heat to function adequately as «pump end thus maintain an adequete cicutaton. Caralac oveosices are thought to at by altenng calcium fon movement, with a desired effect of increasing te free of eantractien of te iiyocardium (e.g. the inotropic effect). While severe ofthe fllematives involve calcium, the way digoxin does Is va (2), Innibiton ef Nev, Ke ATPase, resuling In an incroaso of Calelumion influx ints the cardiac cols, and a subsequent ‘enhancement oft contract mechanism. (2) fs tho way ‘pinopivine works Digoxin is efectve in he trestment of cardiac folure because it 2. Isprimarly a diuretic . Reduces the ventoula rate 6 Decreases abnormal carcac thythms 4. Produces peripheral vasaconsiicton (C@\Hias 8 positve earaiac notrepe: action © ‘The primary action of therapeutic doses of dials on cardiac mesde i an neease in aL Fores of contraction Ventricular exctabity © Refractory period of the alr muscle 4, Relactory pet ofthe veriioular muscle ©. Rate of conduction of impulse te the muscie 9) ‘The beneficial effects of digtalisin congestive hear falure result in part rom the fat that digas caveee 32 A decrease in end-dastolic volume . A decrease in end-iastolc pressure ©. Aninereece inetone volume and cardiac output 4 ‘idocreace in canal vancus pressure ‘Acecrease in rate ofthe Neat where lachycarcla exists 1 @).tband) 1 G@).and () only ii. (e)and(@) ie. (only ¥. Allef the above “The cardiac lycosdes wil Increase the concentration of which ioninan active heart muscle? ‘3. Sodium ©. Bromige ©. Calcium & Chirie Potassium < 7, \Boa1ds2005.doe 20. Which of he fotoning ions augments the inotropic effect of Solas? ‘2. Sod Lithium Galeirm Chioids fe. Magnesium @ 31, Inthe treatment of congestive heart ature, digits elyeneides generally decease al of te telowing EXCEPT a Edema 2 Utne tow Rear eos Su Head f. Resid dastalc volume » Adrenergle Agents {82 The mechanism of action of prazosin, an antihypertensive agents, to "2. lock beta-adrenergic receptors 1. innit formation of angiotensin I ©, Innit narve-indced roieace of norepinepnine (Simi Cental inbiteryalphaacrenergc receptor: Ini the postsynaptic ction of norepinephrine en vascular smoot muscle © 38, Which of he following owes a significant amount ots carpeted oncmedct TP elope! © taaane 4. Propranoiot &. Guanethicine (6) Alto these drugs eve used to ret hypertension, but act by dmeront mechanams, (9), metry, sto dag with conta ation f afer ONS canto of boo pressure by tctng on cercoreuiatary and vasomotrsystens of he lyin by smut sipha2 receptors nthe brain scm. CGlenicine isthe usual org that fs nvelved inthis patter ueston. (2) metropott isa selectively teks be ‘ceptors in the heart a reaice cardiac ope. () hydralazine has a dct action on vascular smooth muscle 0 ‘eae hypertension va vasodlotion.()poprano Boeke teta receptors nthe heer, while (e)cuanelinepreven's ‘the smleage and causes doptetion of catecataies taken up lnfa-storage vesces adie released tke a ase Vans oes rot ers the hood bran bar. 34. Which ofthe following drugs is thought to reduce arterial blood prossure by activating alpha receptors inthe vasomotor center of the medulla? Prazosin clonicine© Propranolt 6 Guanetndine © Chlorothiazide (0)- see above explanation 35. Propranota Inderal) can be useful inthe ueatment of hypertension because it oeks "> Aipha-t adrenergic receptors B. Sodium reabsorption in the kidney he release of renin from juxtaglomervar cals ne release of norepinephrine from nerve terminals (The telex tachycardia seen with he use of other ‘anthypertensves & (ayand@) i (a)and (0) {b), (c) and a) iv. fe. (6) and (e) ¥ (ean (e) only (0) Answers ()- You shouts immediately recognize that ‘broprandblis the protolypc beta-adrenoraicrecoptr blocker, {us any answer wih atemative 8 (end i) s wrong. ‘Simian, dis wrong as welkpropranoiol is a compeiitve beta- ‘acoplor blacker Khas no efoct on NE release. Ancthor dry sed for hypertension, Cloning, acis va this mecharism by ‘Stimulating afpta-2 autoraceptors. Thus fl, and Wv are tnvong. This leaves (x) ae tha ony possible right answer. Indeed, aside trom blocking beta-1 receptors, blocking of ‘renin release fs thought be the other mechanism whereby beta-blockers ater hypertension. 38. One of te proposed mechanisms ofthe anthyparionsive effect of beta-adrenergic receptor blocking agents is = Secation A ciara effect ‘An antrnin effet “aA vagal blocking effect, An increase in cardiac cutput © [37 Selective tet acreneric aris il produce which of he ‘Song eee i Gcopera A Dieter taco “sc Decreased diastolic pressure 4 Oecrensee perpher resistance Relation of tron sooth muscle co) Miscellaneous Side Effect Questions 38. Ototeaety vith destness may encountered oceasionally in patent taking when ofthe following lure agents? ‘Osmotic ‘Thiazige Mores etn CHa une: (4) answer's ()- straight mamorization- deafness is typicaly associated with use of ethacrynic sci, a oop or high-ceing Ciuretic. How the hel are you supposed to remember el of, this stwr77? 38, Symptoms of digitalis toxicity nude al ofthe flowing EXCEPT 2. Extrasysioles Nausea and veriing © Yellow-green vision 6. A.V exrducton block (& Decteated P-R interval @ 4, Alpen col eo dos noess he set nn aes Pees 2 eee See cogeeiets ee oa (9 Cada ewes psn so Ss a Miemeaen anor 4Prepared by ML. Thompson, Ph, D., Dept of General Dentistry, Tufts Dental Sehool Analgesics: NSAIDS: 1. Mechanism of action questions regaiding analgest, antpyreic and ‘elfects on Bleeding ‘Analgesic effects: aspirin inibisthe synthesis of prostaglandins Antipyreic effects: aspirin inhibis PG synthesis in he hhypothelsmic temperature reguation center ‘Bleeding time: inhibit synthesis of tomboxane A? preventing Dlatelet synihesis CSET Ey a a 2. And type of question has to do wih pharmacclogical or toxic ‘etfecs of asp: you gett pick which ofthe Istis ois not ‘associated wih aspirin, Therapeutic effects of aspthn include pan rel, antipyretic ettects, atheumatc and et Inflammatory effects. Adverse or lone effects include all ofthe following: ccoult bleeding from to Gl tract, tinnitus, nausea and Vomiting. aclé-base disturbance or metabolic acdock, decreased tubular reabsorption of uric acid, salicyism, debrium, hhyperventiaon, et 3. A third type of question focuses on the diference botween 1) ‘2pirin and acetaminophen, 2) sspirin ang other ant inlarmetres te predisone,and 3) betwee) asin and apron Ceptet hrrrunsphn lau. 1) _nedtbnophen acy. is —Tpatatote, snd does nolcauee Gl upset 2) _nitiotertnatres he pedisone, tyerocortsone, ‘ramonolne stare stooge and don! Bt pay by PGinhiaion 2) Ieaprofn eouses much es Gt naton 42) Ditunisat (Dolce) has atenger hae than api, seramnapnen ard bupton 4. Newer versions of the Boards have questions about COX-2 ‘Inhibitors lke vioxx. (Which ofthe following is a COX-2 innibiter?) 5. These old questions focus 2 lot on aspirin. Nowadays, ‘acetaminophen and ibuproten are used much more Commonly than aspicin, beeause of the many side effects of aspirin that turn up in these kinds of questions. So sinco aspirin is the comparstor prototype drug, reviewing these questions are sil useful 4) But expect newer questions asking you to know: ‘2. Acetaminophen causes liver toxiely, especially when combined with alcoho! or taken in excess of 4 gritay. b. Acetaminophen isthe drug of choice forthe overish child they usvaly ask the reverse, which Is which drug should be avoided inthe Teverish child (asprin. Increased rick of Reye's syndrome) Frequently asked questions on NSAIDS NU. 4. The therapeutc effect ofthe salcyates Is explsned on the basis of the aptly of he aru to 2. Aativate autonomic retexes .Uncoupte oxidative phosphorylation G:\B00"4s2005 doc Inhibit the eynhosis of postagtandine 6. _Campeiively antagonize prostaglandins athe receplr sie 5. The mectariom ofthe antoyeti acton of says pebbiy is for Inhibion of prostaglandin synthesis inthe CNS afecting hypoinslamic temperature regulation Inhibition of bradykinin in the periphery leading to sweating Depression of enidative enzymes leading io decreased heat reduction 1d. Suppression of chotinergic mediators in he hypothalamus ‘@ Simulation of norepinephvine nthe hypothalamus @ 6. The antipyretic action of salicylates is explained in part by ‘2 Analgesia leading to sedation Increased blood fow through ine nypotratamus ulaneous vasodlaion leading fo inereased heal oss pression of oxidative processes leading to decreased heat production Co of, Tat ato tener stoic oath oe Bron stem Hypathaiareas Basal ganglia 3. Lmeicsyetem © Corebal cortex (@) memonzation question- remember anipyresis means ‘ntiever. Termperature reputation contris ihe bypethatomus: 8, Apatent who has bon taking large quantities of sein might increased postoperative bleeding because aspire inhibits Synthesis of thromboxane A2 and preven tel aggregation Synthesis of prestacycin and prevents platelet aaoregaton ‘Synness of prestalandin and prevents production a ised platelets 6. Thrombin and prevents formation ofthe fxn nwo ©. Gl absorption of wiamin K and prevents synthesis of bleod clotng factors (6) The fst ft you must remember is that aspirin prevents ltelet aggregation. this lnits your chaes to a) and ‘They hope to confuse you by using prosiayln, but ofcourse you know that ths is wrong immediately. the righ word ‘postepianan, asin (2), But you have aracy efminated that ‘Choice because doesn’ mention prevention ef platlet ‘2zoregstion. Thus, van Iryou aiont remember that Utrembexane A? induces platelet aggregation, and espioe blocks this action, you cou get the ansmor ty etnation. (di now neparin works, while) fs how coumern works ‘8, Anthintammatory agents, such as aspin, interfere wih hemostasis by ‘2 Acivatng antithrombin Preventing vascoanstiction‘nhibting thrombin generation Inning platelet agregation Inhibiting polymerization of fxin @ 10. Which ofthe folowing antvintammatery agents does NOT act frimay by inning aetity of prostaglandin synthetase? 2 Dilunisal Ibuprofen é Trismcinclone xyphenbutzzone © Acetysalcyicacis ( wlameinctone isa coricosteod. Comlcasterids inhtit ‘phospholipase A2 the enzymatic slep thal procedes (srosiagiande syahotace, Ditunial ie a eakcyiate enelgesic, like aspinn, 11. Anonstercial, antinlemmatory agent that appears to produce fener gastoitestnal tutbances than high dove of asprin © “a purrofen robenecls & Pontazosine 4. Acetaminophen . Phenylbulazone (a) you might be tempted fo answer acetaminophen, because H doesn’ cause Gl upset, Du rememter Its also not ant inflammatory. The answer's ibuprofen. Ticky — you hed to 01 rough two ostinguishing characteristics. Good ‘uestion! 12, Prolonged use of which ofthe flowing drugs doos NOT cause a redispesiton o castration and beedng? \ Well you shoutd realy know that acetaminophen is usvety the answer to these types of analgesics questions, but @ you ‘ido ko that, permaps you may know that sec! causes Glietation, soit iz ut. 14, Which ofthe folowing is NOT procuced by excessive doses ot acetylsalicylic acid? ‘2. Dalitum Tinnitus © too + Hyperventiation Metabolic aldosis (6) onl lowers your temperature if you have 0 fever. taking ‘spin dos not have any effect on body temperature in ihe Non-feversh patient, but high doses can cause athe other (fects Ite. 15, Alof the fling ae pharmacologic and oniolp poperies ot ‘aspirin EXCEPT Ten Ths 5 Analgesia €. Saleytem CAE Potiyresis Ca stone te nmune espoee ) 16. Therapeutic efects of aepirin include ‘oie SE Trongtaton © Pyreteacton ‘Anivintarnmatory action ‘Anleumate sean = 3 Pent AN Aer nf, Yess. _& @htranse Saipan > Mago can, Yew og Beeler c. Indomethacin WA OS Ji (2), (8) and (e) ¢, Phenylbutazone me x {), (c) and (2) 1 ee vee ini Shen ete ements 98 a pester ee steeping Se ee eee es Se etiincascelead wpe iia tan arsenate ete scene ael eer et enero ore b Satna “ ingival hyperpasi. 13, Each ofthe touowing agents has been associated with gastric initaton EXCEPT 3 Aspiin .aleahot & Ibuprofen 6 indomethecin '@°\ Acetaminophen (e) note the aference in ths question and #11 and 12. Ibuprofen was prevcusly the answer fo "shows reduced Gt ination”, but does cause same, which you have fo ‘remember fo answer 812 and tis question. So asptn and ‘uproien are ou. Inomethacin is 8 very strong NSAID that causes los of Gl irtatin, so much tht use is ited in Antec RN rion & peslglandinsynheie @ 18. Allof the folowing are possible effects of aspkin EXCEPT Ay 2. Reduction affever {_B. Shoriening of bleeding time Suppression of inflammatory response 1. Bleeding from the gastrointestinal act (Erte therena excretion fw set ati nes ol 18. Of the folowing, asprin does NOT causePrepared by MLL. Thompson, Ph. D. Dept. of General Dentistry, Tufts Dental School 2. Occutt bleeding 2. Ibuprofen ©. Nausea and vomiting . Ditunisal © Acla-tace disturbance © Prednisone . Suppression of he cough reer 4. Indemsthacin © Decreased tubular reabeorpion af rc acd ©. Phenybutazone (a) Answer i (}- (@) & (b) sre the major side effects of ‘spinin(resulng from the inhbiion of prostaglandin {yi sis) forthe mejonty of pople, ond one reascn fr the popularity of aspirin allematives such as acetaminephen and Ibuprofen, which produce these effects fo lesser extent. #3 4 5 may also be Seen folowing larger doses of espn. (és ‘not seen wi aspinn, but Isa major therapeutic use of ‘narcotic opiates such as codeine. I quess they are hoping that {you wil go the effects of codene and sepirn mixes Up, sco Ihe two are offen compared and contrasted as moderate pain ‘Answers (6) (a). 2. 4, and § are NSAIDS that reduce lntemmaton by reducing prostaglandin syethass by Booking the actvity of cyclocxygensse. Prednisone isa corticostrot Corticosteroids sre potent nonspecific inhibi o the infammatary process, acting at a variety of pint throughout the intammatory pracess. AMhough they do reduce prostaplandin production as wel, they do this ty 2 mechanism other then blocking éyclooxygenase, probably by inhibin tho release ofthe fatty acid substrate or rostaplanin synthocis. 24, Which of the folowing i the mast eppropriatecug 6 use to ower fever in a chid under 12? 3. Aspirin 20. Which ofthe following is NOT tue about acetaminophen? 5. tbuproten '2. 182 nonpreserption dug © Acetaminophen < Myeriacis, coma and emeatn muscle spasms Myesiasis, come and depressed respiration Mosis, convulsions and cepressed respaton yetiale, connisons and depressed resprotion casey (2) pinpoint pup (moss) and respiralry depression are hallmark epiois overdose effects, so the only actors ‘coms or convulsions If you ean’ Broth co wel, | uses yeu might go no 2 comal 413, Tho cause of desth with opioid intoxication is ‘Oxygen apnea Garcia arost Terminal convulsions eulstory calapse Respiratory depression (c) - again, a memorization question. Whet happens stat opioids decrease the response of respiratory centers in thebrainstem tothe certan dose tension ofthe Bcd, and also depresses pontine and medulary centers reguisting ‘respiratory frequency. Opioids do not cause oxygen apnea, (ia). they can be convulewve, But not terminal #0 (2), they 1270 stabilzing on the hear and some are actualy used'in ‘open-heart surgery (()),andthey do not eause circulatory collapse (a) 14. Which of he following isan opioid that has both agonistic and antagonistic activities? ’@ Codeine Methadone © Naloxone 6. Meperidine ‘e. Pentazocne (0) This is an example of he type of question where the drug ‘lass is given. You are asked to na ony dentty a arug from the Ist as being from this cass, but eddtionlly that it has the ‘proporise that are quan in the question that einguish # from the other drugs of the class that ae listed as stematves. In tis example, thor is only one drug whic ‘meets this crferon. All are rugs which act via onate ‘recepiors, but 3 are agonists (e) (0). (). 118 an antagonist ‘nly (fe) pentazocine isthe only ug which has both Iypes of action, ands the one drug ion by te process of elimination, 15. Aneroin-depenaent patent shou NOT be glven natbuphine (bain tor pain becouse ‘a Ithas no anaigeste properties may produce respiratory depression & Asambxod aponistantagonst, it can elit wincrawal symotoms 4. Thehigh abuse potential ef nalbuphine may add to the patients problems () see sbove 16. A patient while not curently taking drugs has 2 history (6 months. {290} of nacole dependency. Which o the folowing analgesics ‘should bo aveided in this patent? 2. Aspirin b. Pentazcine ©. propoxyphene 4. Indomethacin . Acetaminophen 1 None ofthe above (0) see above 17. Which ofthe following statements does NOT characterize pentazocine? 2. Ills equanelgesic with codeine B ttis a partial opioid antagonist. is abuse potentials less tan thet of heroin 3. Itmay induce dysphoria and mental aberrations ©. ILis effective only on parenteral administration {6) fet of memorization required here for a drug that Isn't lized that much. | guess Hwas big news when these questions were written many years ago and they seemed ‘hopeful, since statement (¢) was tue and was GBoards2005 doe 18, ‘The antagonist of choice Inthe treatment cl ep overdoaag, 22, Mepesdine (Demerat Prepared by ML. Thompson, Ph. D., Dept. of General Dentistry, Tufls Dental School therapeutically an advantage, but it soon became ‘apparent that (2) was also true 2. Noloxone . Nalorphine ©. Pentazocine <. Levallosphan . Proporyphene (6) nalophine and pentazocino ae mixed agonist Antagonists, levalorphan is an opie aponst, 35 is propoxyphene 19, Which of te folowing is 2 complete antagonist of he opicg ‘ecepior and the agent of choice n the treatment of narcotic ‘overdose? 2. Naleoone 1. Nalorrine © Cydazocine 4. Lovatorphan fe. None the above (a) reworded version ofthe preceding question 20. Meinadoneis used in detoxification (drug witcrawal) of patents ‘physicaly dependent on morphine because metiadone 2. Predhaates withdrawal reactions 1. Aniagonizes the depressant actions of mopine . Wil rot intel produce physical dependonce 4. Windrawel reactions are less intense and sbesstu than thee of moephine () Tis i an example ofthe kindof queston that requires that you have memorized a fact about a patil dug, tis azo he facts (d. Methadone you wil remember is net an ‘antagonist fhe naloxore- tis afl agonist with anelgesie ropertes, ust the morphine. Wen taken orally isnot feuphori in adits, but acts ust the morphine to produce tolerance and physical dependence. Withéowa! less ‘severe than with morphbe because methadone has 2 much longer haf te. Facts 1,2, and 3 would bo met by 2 ‘antagonist such as nalewone, or perhaps even a mixed ‘genstanlagonist such as pentazocne Which of ie following devs is curently widely used in treating ‘pici-depenentincvevais? 3. Codene (0) shortened version ef the above question ‘An anliepressant ‘an opie analgesic sedative ‘long-acting local anesthetic ‘Anantpsyenotc » peoge‘Autonomics Chotinergies 1 Drug ienticaion type questions that valve mechanism of action "You need to kno the following types of facts 2. alpine, scopolamine, propanthelne are compelitve muscarinic receptor blockers which sometimes are used Contrl salivary seereions. An adationl fae thal olen gels Asked about atropine hes to do with the fact that It blocks ‘toga eflesive control of heart rate, resulting in tachyearia, physostigmine and neostigmine ae reversible ‘sriicholnastorases Inet difer intel prysostgmine acts both ‘centrally and peripherally, neostigmine only peripherally. but ‘eostigmine alse has some drect ACH ike actiy atthe "euremuscuar junction, in addon to prolonging the activity Sf endogencus ACh, They someimes see use in Weating erostomia pilocarpine, methacholine, et. are drect acing chalinerpic ‘agonists, May be used fer xerostomia, 4, organaphosphates ard insecticides rreversibly inhibit chalinesterase ‘2. praidonime isan enzyme regeneretor used in ‘organophosphate toxicty 1, succinychatine is 2 depolerzing neuromuscular junction ‘blacker, subject fo rapid inacivaon by plasma ppseudocholinesterase: it's used o prevent laryngospasm 9. Getubocurarne isa non-depotarzing neuromuscular function ‘locker hh mecamylamine and hexemethoniam are gengionc blockers That pracuce erhostaic hypotension 2. The 2nd type of question has todo with physiological effects of chatinergle simulation, blockade, or overdose toxicity situations (and what drug you would give to roverse the toxic). 9. cholnergic ensis symptoms: bradjcarda, lactation, ‘Salvation, voluntary muscle weakness, iantiea, bronehocansticton Weal by giving av opine ». scopolamine overdose: dsarentaton, confusion, hallucinations. burning dy mouth hyperthermia: teat with Physostigmine An additional fact that offen gots asked about atropine has to ‘do‘with the fact that blocks vagal reflexive conto of beat fale, resuling in tachycarcia, Frequently asked questions about Chotnergies: Identiieation and mechanism of 2 jon questions: 1. Atropine and propantheine exert tei eects on peripheral stuctures by 2 preventing elease af acebichane 3b. reventng eynnecis of acetyichoine enhancing destucton of acetyicotne @) competcina wit acetylene for recepor sites producing sysicloic elects eppcite to those of Seelychotine (4) = (a) is wrong- botulinum toxin does this. () fs wrong Ihemichotnium works this way. (c)s wrong- ACh is broken ) 18, Which ofthe folowing changes produced by intravenous ‘administration of epinepivine result rom stimaation of bela- adteneral receptors? ‘2. Respiratory inition 2. Carciae acceleration © Dilton of the pus Increased systolic pressure © Decreased dastoe preseure L abande i abandd i bande W. edande w Candle only (Gujwo, beta receptor stimulation means stimulation of bele-1 receptors in the cardiac muscle,which wil increase systole ‘bP and bote-2 stimulation which wil ate vessels going the iver and skeletal muscle, producing 2 cecrease in dfastole BP. Mydresis or pepiary dilations also a bots ‘receptor response, so cis also right While you might be {tempted by “cardiac acceleration’, nane ofthe options Incluing (b) workPrepared by M.L. Thompson, Ph, D., Dep. of General Dentistry, Tufts Dental School 16, Which ofthe fellowing is NOT an acfon of epinephrine when administered intravenously in a high dose? '2 Increases liver glycogenotyis ©, Causes bronchiolar eonetiion Produces a ise in blood pressure Evokes extrasystoles in thehesrt © Produces restlessness and arsity (bjal of the above are actions af epinephrine except bronchiolar constriction. Epinepivine would cause. bronchodation — thal is why itis used to treat acute brechospasm. So option (b) has fo bo the exception, becouse isjust obviously wrong! 17. “Spinephvine reversal” of blood pressure can best be demonstrated by injecting epinephrine invavencusly afer pretreatment with 4 Prazosin Atropine Proprandlot Neostigmine Isoprotereno! (2) epinephrine is a potent stiufolor ofboth alpha and beta ‘receptors. injection of op usual causes @ rise In Blood pressure due fo 1) myocardial stimutetion that increases Ventricular contraction, 2} an ncrease ih heart rate, and most Jimporent, 3) vasocanstnction cue f0 apa recepter ‘mulation. However, blood Now fo skeletal muscles i Ineroasod duo fo powerful beta-2 receptor vasodilator action {at is only partialy counterbalanced by a vasoconstrictor ‘action on the alpha receptors tha are also present inthe Vaseular beat When given Inthe presence of en alpha biocker, beta receptor mediated vasodilation is more prencunced, the lta peripheral resistance ls decreased ond fhe moan tioog pressure fas. This Secresse in boos pressure is called "epinephrine reversar. The ony alpha blocker listed is prazosin, answer (2). Atropine i a cholinergic ‘muscarinic receptor blocker, propranolol isa beta-blocker, ‘eestiomine is 8 cholinestereee iibor, and isoproterenol is 8 predominetely beta receptor agonist. 18. Each of he following # predictable adverse elect of dugs that biock the sympathetic nervous system EXCEPT. 8 “3 Gastroineetineleitirbance Postural hypotension Nasal congestion Urinary retention Miosss 18, Injection of a pressor dose of norepinephrine may resin a (eereased hear rate because of 8 a ‘Astvaion of barorecepts oflexes Direct stimulation of ape receptors Direct stimulation of beta? receptors Direct stimulation of bots 2eceptore Direct stimulation of musearne receptors (2)- atematves 2-4 al increase heart rato, while NE has no feffect at muscarinic receptors (e, which are specie for cholinergic drugs. 20. Alpha-adrenergic agonists are used In combination win local anesthatics 0 ‘Simulate myocardial exntrsction GABoards2005 doe a Reduce vascular absorption of the lcel anesthetic ©. Inerease the rae of ver metabolim ofthe local anesthetic 4. Increase the concentration ofthe local anesthetic als, recoptor sito ‘&Antagonize the vasodiating effects ofthe local anesthetic LG. @yand (a (by, (c) are (a) Wb). (6) and (e) Wy. (o),(@) and (e) (and (e) only (i) Answer ts (e-Alphe-adreneraie agonists such a= fphnephrine produce vasoconstriction, which would ‘accomplish beth °D" and "e". #318 the ony allemave that Includes both band e thus you don have fo krew anything ‘else. "a and "c*are false. Vasoconstrctors are include n local anesthe preparstions to (1) prolong andincrease the depth of anesthesia ty retaining the anesthetcin Ye area Infect, (2) reduce the toxic effec of the cus ty oeaying ts ‘absorption Ito ihe general erulation and (3) 16 renser the ‘108 of infection lass hemorrhagic. 21, Administration of an oherwise effective pressor dose of ‘epinephrine could cause an “epinephrine ravorea” ina pation {aking which a the following drugs? Reserpine Proprancat “Amphetamine CChixpremarine [team carbonate parse (€)CP2's a potent aa blocker ke prazosin. 22, Othe following sympathomimetic agents, the mos potent bronchodlatos ‘Amphetamine Norepinephrine Phenylephrine Isoproterench Metroramine pases (8) What ie nooded for bronehodilation is relaxation ef bronchial smeath muscles, This is accomplished wih beta? receptor simulation. Isoproterenclis the oni ug fisted vith ‘potent beta action. () stimulates apa recepiors inthe ENS, (6) NE stimulates alpha ond beta! recepters mare than betad,() phenylephrine i an alpha receptreporist, write (@) methoxamine Is a vasoconstrictor Ut siastes alpha receptors preferentoly 23. Administration of which ofthe following drugs wous produce vvasoconetrcion of the gingival assole? ‘3 Levonordetrin 5) Phentotamine © Epinephrine @. Proprancot & Phenylephrine 1 @yana@) T. @)and (o)onty ML f@),@)and(e) ©), @)and () ¥. @)and() only (i vasoconstieton is rosut of stimulaton of be sathmuscle ofthe peripheral vasculatie, wich isan alpha-t Sinuratery action. Of te options, a). () and (e) ae aiha-t ‘gonists Phentoalmine is a nonselective alphe blocker snd lus would cause vasodilation. Prpranotl is a non-specic bete-tecker 24, Carbidopa, a dopa-decarboxylase init, is oten used inthe treatment of parkingonism because it Potenfiates the centel action of dopamine Ptenistes the cental action of norepinephrine Decreases the perpheral metabolism of levodopa Innit the peripheral shmulstory fibers fom the central nervous system Increases the petmeablty ofthe blood-brain barir to vevodopa (6) because that is just what it does! 25. Of the flowing, one ofthe most effective tteatments curently valabe in the U.S. for most pants suffering tor parkinsonism inves oral administration of 26. Levodopa therapy for Parkincon disease may rel 3. Dopamine b. Amantadine © Benztopine 4 Lavedopa stone © Levodopa plus caridopa (e quess thi was true many years ago whon this question tras writen, but! don know this would sil be considered lo be one of the most effective treatments, but thats beside the pant. You shoutd think levodopa here, since the probiom ttn Parkinson's i 20 enough DA, so you can improve the tdseace by giving fovodopa fo hnrease DA levels in the bain. The problem wih vg lovosopa by isos that is rapialy ‘metabofzedin the penhory Before is able to cross the 1356, However, the levodopa gels rapa degraded by fentymes unless you book the enzyymatc cogradation by ‘giving caridopa along with the levopdopa neach of ne ‘cloning effects EXCEPT: ve” ‘Development of normal, voluntary movements especialy in the face Enreme sensitviy to sympathomimete drugs Exacerbation of an acute psychosis Nougea ane verting Extreme sedation (c) ovodops apparently overstimuates DA receptors inthe basal ganpis and can cause visual end auaton” helucinatons fopton ), dyskinesia (option (o)), mood Changes, depression ana anvity. also can stimulate the ‘eric conte, producing the effects given in (a). Tat loaves {you wit 2 choice Between (b) and fe). Well apparent, one ‘ofthe first tings you should know about levodopa therapy Is. {at some people think tha levosopa can sensitize the belo-1 eceptor in the heart end this fe 2 conteindleain to using 3 local anesthete contening epinephrine. So option (o) sal! that is of tobe the exception. How you are supposed fo remember el his stuff about lovodopa is way beyond me, but good ck! 27. Adverse ees of lvodopa include: 6 frmytnmies Peychotc disturbances 30 Nausea and vomting Abnormal invaluntary movernanis {6}, >. ond (c) HG), wand (a) (a). (eband a) x.) (e)and @) v. Allofine above (Answers (¢)-Lovodopa i te primary drug used to teat ‘arkinson's dsease, which resus fom abeormaly on lets ‘of dopamine inthe brain. Levedopa, or -DOPA isthe direct precursor of dopamine which can be used because! Seesn't ross te Blood brain baer L-DOPA does andi ‘converted fo DOPA inthe brain) is used fo increase dopamine Inthe brain Ai of te ellocts are eslblished ee ects o! ‘DOPA therapy, thus the answer sf). Abnorm! invatuntary ‘movements (AIMS) ae the mast prevalent and tovblesame "extrapyromide! sige effects ypealy involving the orieca) ‘musculature. Nausea and voting are seen curing he fst phase of therapy but folerance develops (0 these eects. The ‘psychotic effects are much fess prvatort, seen in ony 6 ‘small porcentage of patents. Increased incidence of ‘Snbylhmis is also problem. Lavodopa aso sonsties tne hhesrtto epinephrine induced arya. 28. Which ofthe following drugs would be mast Ike taken by ‘an asthmatic patient? ‘2. Phenylephrine B Abbuterot & Pseudoephedrine 3. Prazosin, ‘8. Propranclo (0) en asthmatic patient typical takes acug that has bronchodilator eects. For this action, you need #crug thats 2 bota-2 agonist (remember those charts). Ofte ist, bcos the only bota-2 agonist listed Phenylphna is an alg! agonist used for stuf'y noses, pseudoephedrine might nave Asiracted you, since itis @ decongestant, prazosin and propranolel are aninypertensives. General Principles of Drug Action Romomber this section of the course? This is where we defines a bunch of terme tha described how drugs erect ih eceptors to produce thelr effects. Mosl of you yarmed and ‘aught “What the hell do we need fo know this stuf for jst ‘Us about antbitesl Wel the Great Board Gods wan! you i nowt some ofthis stl - thats why I putt the course. Your ‘apologies are graciously accepted, a alvaye! rmacologic agonists a chemical substance that Binds fo a specie receptor and produces 2 response Fails a pharmacologic esponse wihout binding Io 3 receptor Possesses the property of afnty but ot of ininsic acy Exhibits no activity except to oppose the effect ofan antagonist @ 2. When comparing drugs with respect to intensity of response, the ‘rug tha produces the greatest maximum effec the one wih herepored by M.L. Thompson, Ph. D., Dept. of General Dentistry, Tufts Dental School Pighest 3 Atty b_ Potency eo) Efficacy Si Therepeutieindex (ch obvious 3. drug has a gruateretfeacy than dg B, ten crag A 3. Is more toxc than drug 5 1. Has greater aint forthe receptor than drug 8 ‘¢__ Has a greater margin of salty than drug 8 “.~ ts capable of producing 2 grester maximum effect than drug cose (obvious 4. A dug wit 3 high LOso and alow EDsq has & Ay, Hoh herpetic index and, theretre, very dengereus “DD High werapeute index and is, therefore, relatively safe —e" Low tnerapeutic index ends, therefore, very dangerous ‘. Low therapeutic index and is, therefore, eativly sate (0) Tre LDSOEDS0, never forget 5. The ratio ofthe mesian lethal dose (LDsg) tothe median effctve {dose (EDso) is the 2 Metbily index Moray index nf nesthetie ratio. Therapeutic index (4) 98 said above 6, The therapeutc index ofa crug is ne rato of The effective dose tothe toe dose b Hallthe tox dose to half the elective dose The maximum tolerated doco tothe minimum effective dose 4 The lethal cose for 50% of imate to the efsctve cose for Sorc oranimats (6) reworced version of above 7. The phenemanon in which two cus produce opposite elfects on a phySlologic system ul do nol acta te same receptor sile fs 3. Potentiation 8 Chemical Anagontn Competitive antagoniem “G, Phyloegsanlagoriem 2" Noncompelive antagonism (4) and you wandered why made you loam tis! 8. Epinephrine antagonizes the effects of histamine by '3. Preventing the release of histamine Acting on the central nervous system Te) Producing physiologic actons cpposie to tha of histamine “Tir” Competively Blocking histamine at me cefutar receptor ito (6) epinegtnine acs as a physiologic entegonist. ‘renspeeifaly antagonizes histamine by exerting ts own sinc! effects for example, vasoconstriction, bronchodtiaton, and decressed GI motty. I does not reverse the effect of histamine by blocking eta specific receptor (()), 28 do antiistamines. I! doos not provent the GABoards2005 doc releese ofhistaine 2s does a drug such as cromolyn (). by preventing mast cell degranulation). Answor () i not ‘elevart, while (isthe mechanism of action fr comely, hich inhibits mast ell degranulation. 9, Interaction between nitroglycerin and epinephrine i what type of ‘antagonism? 3. Allosteric Physiologie Biochemical & Competitive Pharmacologic (©) epinoptrine would stimulate alpha adrenergic recoptrs lo produce vasoconsirton, whereas nireoiycermn relaxes Vascular smooth muscle. Thus the two rugs would Nave ‘opposing actions. However, the actions are produced by the ‘Grogs acting on aferent mechenlsms;nitroeerin does net ‘ect al alpha recaplore as dovs epinepane If the Inieraction would be compete. In his case the Interaction is ia competing physiological erect 10, When the combined acton of two drugs is areater han the sum of hele indice! actions, iiss wrdvten CB) Sein idosyrensy Hypersoncitvty ©. Cumulative ection (©) supposed why Tylenol #3 was made 12, Which of the faonng responses ast rete In encurence? “Fosety Suet Besmees—> dene f Tacypryiais Therapeuticettects §— LA, COATT « eaeee (6) Kiosyreatc reactions are geneticaly determined ‘bnormel responses fo 8 dug. They are the most Unpredictable mh cocumence beceute th gonetcaly-beced Aitfrence respensible for sucha reection toa drug may no! bbocome evicent unt te dg i taken forthe fst tine by no ppatiant. Typical, the etfoct sone of sbrral sonst 0.2 ‘rug, such tata therapeutic effect is presenta doses rmuch Tower than normaly used, while the normal dose may rest a 2 onc reaction. n example i the response fo ‘succiyichoine n patients wth atypical olesma ‘holnesteeze. These patents dont motabolze ‘succiyichoine a te same rate, and thus show a prfonges ‘ug action and increased sonstvity tothe dug. The other ‘atlemalives are typicaly related to the dose ef the drug and because the majonty ofthe population do not possess an atypical gonetc bass fo the response fo the cru the effects ‘78 predictable given the dose and knowiedge of what the chug does, 18, Idosyncrasies fo drugs are related fo ‘8. Species rete factors 2 ofthe patient Allo the above(0) | guess that’s why they are iiosynerate~ the ettoct could be caused by anything +4. Two drag, A ane B, have the same mechanism of action. Drug & ina does of 5 mg, produces the same magnitude of response as ‘hug B ina dace of 500 mg. Which of the fllowing statements is correct? ‘rug A ts ess tox Drug Ais more effescious Drug As 100 tmes as potent Drug & has a shore duration of acon Drug A is a batter drug to use when a maximal response is desires he 15, According tothe theory tat agonists and antageists occupy the Some receptor site, an eflecve antagonist chould exhibit 3 High intrinsic actviy and high afety Lominiinsic actly and tow afiity ©. Highinrnsie activity and ow afinity (Ca Neti tty anc ig atty @ 16. Allo ne atoning statements ae te ogre 2onpaon shay of gran nsacion EXCEPT afi iia dant in sy aT antom ees of try ooo when espn re ccawied Satopia sn for te reoeper bt not nine mn 4. The mogtute of he elt of 2d is proportional fo the sumoer of reeptors xrptes Motows te wef ase acon (a) 47. The oeavpationa thor of vg receptor interaction states that AC 12 The magatude of the crag responce is proportional tothe umber of receptors occupied ty, A poral agonist as ininsie activity but no affinity forthe ‘recepler site ce Amantagonist drug hs affinity but ne intinsic acy The rate at which the drug receptor complex associates and "\ gisaciaies determines drug affcacy 0. The degree of drug actions dependent onthe law of mass action LG) toyand(e) ii, (0) (o)and ce) i. ©), (eband (@) iv. B)and ) ¥" te) @)and co) @ Sedatives “This cotogary conelats of mosty questions regarding benzodiazepines and barbiturates, and requis you to know the diferences between the two types of drugs In trmes of 2 mechanism of acto, therapeutic actions and adverse side flocs ond toveitss. Here's 9 capsule review BenzodiazepinesS> i). Z 1. Examples: diazepam, chioazeposide, ele 2, Mochanism of acon: matte the actly ofthe inhibitory neuretransmitter, GABA 3 Advantages vs. arts: les adcon potent. xs profound CNS depression, tagererapeITEInce, fess resi depression : 4. Other points to omember: A} many 802s form ave meabeltes 8) 1V inicio of darerem can cause Winton sca rantings ee aes _—__rhelSBa ie sessteaT earsurses: Hae ounti 4. (@) question in cecurence about barbs always regarding Uiopentl and redistibuton. Remember, iopental's acon ted by recstibuton ofthe drug oi ofthe brit enters the bain rapidly and ents api. tus guck onset ard shot orator orscion— 2. (b) question wants you to remember tht barbs are ot ‘analgesic ths le usualy nthe form ofa sof actions and hey ‘rant you fo indicate wich is not fe 2. estons aout ony - a. Barbirate verdooe his you bec etespzalony _soanosion ©. Barbs ae conkinscoled in patent wthntemiten_ ya. tr enene porn sens sr gavate te disease Sedatives 1. Dezaponi plas brat tn ney ott Eero ects atten CO foe en nt teers un ibrar essere ©. Gor notptotat act CNS cross o 2. Benzodiazepines produce leis antianxiety fects by modulating ofthe flewing neurohumers? '2.) GABA Gycine © Dopamine Acetylcholine Norepinephrine 2. Benzodiazepines exer their main effect on ‘Neuromuscular junctons>separed by ML. Thompson, Ph. D., Dept of General Denisry, Tufts Dental School Peripheral reflex synapses Central GABAergic neurons. ental serotonergic neurons Cental adrenergic nerve endings cage () Answers (c)- momorizaton- BDZ’ tind to sos on the GABA recopter, 4 Ale floving pertain to genera anesthe naced by ‘pnt EXCEPT a astinaucion : # ) peceased sections UNinercen Qs nel 'c_Low therapeutic index oe 4. Shot duraion ot anestosia 2. Predeposton flayagospesm (0) Berbiturotes are problematic 6s onesthalice because they ‘often induce excessive saivaton and bronctialsecreton, Usually requng the use ofan anticholinergic aug fo be ‘Sdminisered fo reauce these secretions. Thus (9) hes fo be the ltse statement ‘31, Which o he following factors contibutes tothe short duration of acton ofa single dose of thiopental? ‘3. rapid bietranefoemation . rapid accumulation in body fat LAS, ih pid solbity ofthe unissocialed form {ably to enter ang leave the brain tissue raplly (4) is comect- thiopental isthe classic example always given ofa drug whose duration of action Is determined by _iodistebtion away tom i se of action i the brain floss “Wel peruted tissues. They leave oul he word redistribution from the ancwor fa confuse you thoy now this ste way youleared i 5. Speed of recovery form shortacing anesthesia with thiopental ‘depends chiefly on the rapt of 3. Renal tubular secraton _-B._Hepalle degradation of the thopontal group Redistribution trom the Brin to ckeetal muscle Reverse difusion across he bload-rain bare ©. None ofthe above © 6. The action of the ulrashort-actng bartituraes is terminated ‘bemariy by the process of '2 Oxdation Betton 4d. Prasma protein binding © Conjugation with saat e 7. Which ofthe following is NOT characteristic of berbituales? 12 Possess anticonvulsant properties, LB Possess significant analgeste propertes ©. Possess serious drug dependence potential &. Vary in degree of lipid solbity anéhypnatle potency (G°Bosrds2005 doe 3 o 8, The cause of death rom acute bariturale poisoing is Convulsions . ver damage Ronalfalure spar faltre ovascular depression @ 8. Which ofthe folowing adverse etfecs is most commenty associated with administration ofan intravenous batituraie? ‘2. Hypotension. ©. Renal fature © Hepatic necrosis 1 Nausea and vemiing Eyer sennin @ 10, Important stops inthe treatment of barbiturate poisaning inches: 2. Maintaining an open airway Sb. Increasing the input of afferent stimu S\E Maintaining respration “d. Aaministring a narcate antagonist “Sse! Administering a central nervous system stint (opera yon CDA Cardo & i ony © (ang eon © ony « 11. Which ofthe falonng ar tue rearing barinetes? 2. Slricanty olvats pain breselse SV Arometabotze by te Wer NE Are classitied according to duration of acon Depress alievels fhe CNS Cabos oe iar depression Rusu by car 1. (a), (and (e) TL (a) ana () il.) (6) and (8) iv. (b) ans (e) v. (@). (6). and (e) (i) Answoris()- Barbturates are not analgesics, thus any ‘answer with ‘s" such as (a) canbe eliinatod. b's tue, thus the answer must contains" as one ofthe atematives, thus (2) and fe) are eliminated." s also tue, barbiturates 1at8 afirays classified according to duration cf action ulta-short acting: phenobarblaliong ating, ofc) ‘This efiafatos # 3 so the answer must bo (). Ofcourse, you should have Bean able to rapiciy eliminate ansvers() 4, and 5 because bariturates cause desih by reepaton” ‘depression, net cardiovascular depression, 12, Barbitrates are contraindicated in a dental patent wit ‘Na. Emphysema ®. Hypertonsion Xe Unciagnosed severe pain~ 7 4. Aeate intermittent porphytia 1) (ayte) and ca) iC (a) and @) only i, ()and fe) Iv. (enly (0) Ansmeris (a)-“0"is the absolute contraindication for Dorturate use, since these drugs stimulate tho synthosis of ‘enzymes involved n he syrnesis of porptyins and thus wil ‘apgravate this disease. Thus the answer must contin “2 ‘eliminating (c) and (2). Sinée both (a) and 2) fer only by ‘iterative chat the second fact you must know. Barbturates ore not snalgesics, but sedatves. When pain is present, they may even make the pain worse, resulting I ‘Srousal 1290 and porhaps delirium in the patient Thus, °c” ‘would seem to be a prety strong contrsincetion, making (2) the right answer 12. tf diazepam (Valium ) i to be given inavencusy, is ‘recommended theta Iarge vein be used in order to 2, Haste the onset of action Decrease te risk of thrombophlebitis (Offset he vasoconstrictor qualities of diazepam 1. None af he above (0) (0)18 comect. This is one of the advarso side effects of V Clazepam. Nono of to oer altematives apply. 14, The mest important therspeatie moasure tobe token ina caso of 1 barbiturate coining is to ‘3 kalnie the une . Asprate stomach contents Agministera CNS stimulant Assure adequate respiration ‘Aaminister osmotic duretes @ Peychopharmacology: Antidepressants and Antipsychotics Antipsychotics questions are usualy about phenotazines and Usually about chlorpromazine. (Since we are now well into the ‘era of 2 generation antipsychotics, ! would imagine thet ‘they ask more questions abeut those than they do about 1™ ‘donoration drugs. And really, the only 1" generation drug Sill used to any extent is haloperidol (Haldo!), a specific D2 receptor blocker, so focus on those questions} They #3k or ‘3, Mechanism of antipsychotic action: blockade of opaminergic ses in He brain b.__ Major side effects: anticholinergic effec, 1) extrapyramidal stimulation resuling in tardive dyskinesia & 2 generation drugs ike elazapine: ‘8. Block dopamine receptors but also serotonin (HT) receptors _. Treat negative as well as postive symptoms ©. Fowor extrapyramidal side effects Ike tardive ‘dyskinesia M Antipsychotics is ‘Mechanism of Action A Z 2. The antipsychotic effects of he phenothiazines are prabably 2. _Aaldepressantquestons are usualy about weyelic Bmidepessais such 3 imipramine sty thetype hich fe lowing is ees eat Geprescan ToAS ere re most commen sed anidenessanneten Bolremember tat HAO iniiorssoch ae anyon Ahenyene aro ssaused. 2nd generator dru 7 Rooretne Se tezotane. @™ goneraton antdepeasants (964) he fluoxetine (Prozac) are much more commonly vse tan Tohs of NADI, 50 figure more qvestons regarding tec ‘The gr Othe goeatons may s3 or 2. _Machanism of action: blockade of amine reupiake ot alterations of recepter number (SSRIs block serotor ‘uptake eeleetvely) b. Side effect: anichotinergc o abopine sida effects 3. Thelasttype of question, again a drug asks that you remember tat lthium the drug of chic forthe manic phase fof menie depression ~~ Nuun 73 Ta, 4. Which ofthe folowing ate pharmacologic properties of antipsychotic drugs? ‘They block the dopamine receptor ‘They affect the hypottalamic temperature regulation system They cave emesie They are synergistic with LSO They cause hypertension Deana ony yang (e) i @).fedane ts) We fel hance) Gana veyonty (You should immediately tnow that (a) has tobe included 25 pa of the answer, thus [orl hes tobe righ. yu also (an credge up from the recesses of your memary Banks tat antipsychotics are eso efecve antiemetics, and are otn Used elnicaly for this purpose, then youreaze that) f= vwrong, ths liniting your answer to recuilof '2. Release of serotonin inthe bean bb. Release ofnarepinephrine in te bran ‘G>) Biockade of dopaminergic sites inthe brain Prevention ofthe release of norepinephrine from brain ewron terminals Incease inthe dopamine content ofthe cerebral cortex (6) updsted version of tis question might use haloperidst Instead of phenothiazines 3. The antipsychotic effects of phenothiazines reel fom 2. Release of serotonin nthe brain = 5 Release of ntepinepne inthe bala lockade of dopaminergic sits in the brah increase inthe dopamine content of he ceretral cortex «2. Prevertion ofthe release af norepineptvine fom braln neuron terminals oPrepared by ML. Thompson, Ph. D., Dept of General Dentistry, Tufts Dental School 4. Chlorpromazine and celled drugs are thought at act by blocking which ofthe folowing receptors? 2 Acrenergic b Muscarinic ‘Dopaminergic “a> Central serotonin (e) Answers ()- Chlorpromazine is the prototypic ‘Bheneshiazine, an antipsychotic drug used the treatment of schizophrenia. Other snpsyehatc rugs used for this purpose ar9 haloperidol and thioridazine, These drugs act via ‘tepaminerie receptors Side Etfects 5. Which of he folowing i an ineversbe side-efect resuting fom Tons ter simmaraton et prenotaznes? 2 Soeaton & Xerostomia Imray 4. Painsbnism 4 BH Westen OWA TOC COUEE 4 (ele or seen hey wordereisiovertle er seCh 6. Tardive dyskinesia is 2 neurological side-etect of which ofthe following classes of rugs? a. Alcohols , Tricyclic antidepressants . Barpiursteantiepleptics Ce Rheratanne atiaycots ‘2 Monagmine oxage inhibitors (2) Tarcive dyskinesia is an irevorsibie condition that Consists of invaluntary movement of skeletal muscles, 2 Condition which may be seen following prolonged use of f hugs. This is typicaly @ dopaminergic medieted effec. The ‘phenothiazine entioychaties are the only drugs listed which ‘2c va dopamine. The cher, such as eyeles and MAO Intubitors affect adrenergic tansmission,baritratas ac via GABA, as does alcoho! 7. Which ofthe folowing drugs are moet likely to cause extrapyramidal simuisten? 2 Antics B. Salieyiates & Bariurates (Bsprenothiozines ) Stimulate modula centers Se Produce a stale of unconselousness &. Reduce percepton of painful stimuli ©. Decrease exctabay of te motor cortex (t) maybe cuss the base of the brain? They wif eventvaly depress medullary centers (Stoge IV), patient wil Sop ‘breathing and co (c). (4). and () are cesrelesctios,() i ‘stage Ilofenesinesi 7. In general anesthesia, te last part of the CNS tote deressedis ©. Midbrain 4. Cerebetum (8 Spinal cord (e) that's Stage IV. maybe cuz t's the base of he train? 49, General enesthesie with halothane is commonly preceded by ‘administration of atropine (2 ‘3. Inhibit vagal overactivity commonly caused by halothane Induce muscular relaxation by blocking choline rcoptors \ducesalvafon and bronctisl secretions caused by. jalothane da of te above, ‘Answers (his isthe classe clinical use of atropine and fone you shoul! have coramited fo memery.Aopine does not Indice muscuiar relaxation: thet wouid be» neuromuscularjuretion blocker such as curar, thus (b) and (a) are wrong. #! ‘might confuse you. Atropine Is used fo ovarde vagal activity, but that i not ho reason tis given before halothane. Antihistamines: (Qvestions regarding anthistsminas generaty want yeu to know what Hy and Hp anihistamines are used for Hy anthistamines are useful for: Preoperative medicatc antichetnerge effects (ex. promethazine) ‘Treating dermatologic manifestalons ofan allergic response, (ex chleepheniamine) for sedation, antiemetic properties, For centoting the symptoms of parkinsonism (ex. ‘nennyseamine) Hp antihistamines such as cimetisine aro used fo reduce gastric acid secretion (ex. cimetidine). Now available OTC for heartburn 1. Which ofthe folowing drugs is useful in eating dermatologic ‘manifestations of sn alse response? 2. Diazepam B. Atropine Hexyresoreinol JChierprentarine © Phenoxybenzamine (a) Answers ()- The imgied drug class is enthistamines. Of the drugs given only 2 (cand () are anthistamines. ‘Thera are we classes of andhistamiines, Ht and H2. H2, toprosented by cimetidine, re usod 0 treat vicars not skin Concstions #1 antihistamines are used fo trea allergic reactions, and ehlorsrenirarane is an Ht drug. Thus the answers (2 2. Cimetidine is used therapeutcaly to 12 Stimulate respiration Protect against anaptiyanis (Fe pecrease gastie eid secretion ‘Hasten excretion of barbiturates ‘© Diale smoatn muscles of he bronchioles @ 23, Gastric acid secretion has been shown to be most effectively ‘reduced wih the use of 2 Adal steroids 1. Antchotnercc drugs ©, Serotonin antagonists © )Hzhistamine receptor antagonists aed S ” 4, Drug-mediates inion of H-Nistamine receplos is most useful in eating 8. Asma Fy b. Anaphylaxis ‘Contact dermatiis astic hyperaciy ocalized aloe reactions (4) same quostion repeated tes aifrent ways 5, Which ofthe following anthistamines is most commonly used a6 preoperative mecleaton? 2 Medline Cyctzine Promethazine & Dimenhydrinate ‘8. Chlopheniramine {e) mecizine is used for verge, the others for allergies 6. Use of sishenhyamine (Bensdryt in convling the sympians of rkinsoniem ie baced upon which ofthe fllowing elects? fantenotnerge ‘Local anesthetic ©. Adrenergie-locking {. CNS depressant onthe midorain «2. Stimulant io doperrinergic nerves inthe basal ganglia (a) Remember that Parkinsonism is a due fo @ deficiency of [DA inthe brain, ands curently trestod with levodopa arc carbidops, However, porto these, anenelinersic digs wore the fst drugs found 1 be somentatofectve for restmert ef {tis cisease, in that cholinergic and dopaminergic tracts Interact inthe bain, and thus reducing chofnerge sti vis anticheinargie drugs improves or enhances coparinoric function, suggesting ono is inhibitory tothe other. Drugs with antihlinrgie actly are often sii th rst drug ied ‘Antnistamine crugs such as dptentycamine ofen ave ‘Strong anticholinergic activ, which accounts fr ther ‘offectvenessin drying nasal sccrotions associated with @ Cold. Therefore, the answers (o), (ei there fo confuse you ‘but dont be. ihontycramrine does nt stinuiate ‘dopaminane nerees nthe baea! gong. Aareneroic ‘Blockers (()) do see some use nthe eaiment of Parkinson's, but ephenhycamine bas ro adrenergic Hocking ‘acinty. Diphenhyeramine ooes have the actions given ino) ‘and (0), but these are not responsible foritseffcacy in Portinson’s. 41, The mechanism of action of Ht anthistamins is Gea ‘3. nancampotive antagonism Inhibition of release of bound histamine (0) Answers ()-memeriation - 14 anthistemines are ‘competve histamine receptor blockers. Many studonts ‘answer (e), bul this Is the mechanism ef ection of eroroty. (6) also draws somo answers, bul is wrorg-epineptvine is ne _physiclogical antagonist of histamine. Miscellaneous questions from a vatlety of eategories that are not asked quite as frequently as the ores above:Prepared by M.L. Thompson 24, Which ofthe following drugs is often used to eat trigeminal ‘nvutalgla? a:clonazepam (PWreatbemazeping se-acelazovamine 1, suecinytetotne Answor is ()- This is a memesizaon question. Carbamazepine, as well as phenytoin, are the main drsgs used to treat trigeminal neuralgia. Clonazopam is a benzodiazepine, succinylcholine is a depelariira ‘neuromuseurar blocking agent, while acatazolamine is an ‘anticonvulsant ike carbamazepine, 1. The use of epinephrine for local hemostasis during surgery might vest in 2. hypoglycemia Bscatdac arrnyia ~e Gn acute asthma attack {a crastc drop in blood pressure any ofthe above The answor is (t), Cardiac arthymias are th main bad side fect of epinephrine as a vasoconstcior. Ep stimutaes bath ‘alpne and beta receptors. Beta receptors are foundin tho head and stimulation of beta receptors increases heart rae, Ierce of contraction, carci output snd oxygen uiizaton, (2) Js wrong, epi elevates blood glucose. c)s wrong-bota ‘slimilation in smooth muscle and bronchi causes bronchodllation, and is thus a dg of choles for acute ‘asthmatic attacks. (dis obviously wrong-a decrease in blood pressure would nt result rom adrenergic stimution, Imereacod blood proseure is ine rue. 4. The highest isk associated with use of oral convaceptves is "2 hepatic necrosis ©. permanent sterity canoer of the breast ance of the ulers ‘ bwomboembclc dieorders The two mejor side effects ae suspected carcinogenicity and the tendency to proauce tremboemtolisns. Liver function ‘an be aifered bu nis Is reversbi. Ressarch has fled fo prove te fink between estrogen end breest cancer, nd repreductve function eventually rtums upon cessation of therapy. The answer according tothe gods ofthe testing board se). Amen. 9, Facies common to al forms of drug abuse include “bstclerence: € physical dependence & psyenolgien! dependence any ofthe above Tne answer is (2). Misis (0) is cholinergic eet typicaly observed wih opiates. Cocaine doosnt cause iis kind of ‘ec for example. (0), oterance, fs common to many ups Such 28 opiates, brbirafes and sedatives, But has nol Been leary demonstrated forall abused ups. physical Gependence, s usualy thought tobe ue ony for morphine, total, cateine, and perhaps cocaine. 3 8Boards2005.doe 39 Ph, D, Dept. of General Dentistry, Tufts Dental Schoo! 27, Aleoholieexphorlaresuts rom 2 Increased activiy ofthe cerebelm >. increased activity of he cerebral areas increased activty ofthe ssinal synapses ecreased actly of tie medullary centers neva of init acl ofthe cvtex ‘Answers (6) Alcohol inhibits the CNS, ths elminsting o), (0), and (c), leaving the choice between 4 end 5. Alcohot has ‘oan postulated fo inhibit GABA effect, the mejor inititoy transmiterin the CNS, espocialy inthe cotex. Thus (eis ‘he answer. 28, Suifonylureas cause insulin secretion by a. adrenergic smulaton by chotnergie stimulation eect stimulation of pancreatic beta cells “Answers (c}- memorization alpha agonists decrease insuin release, bola agonists increase #. Thus bocause bath of ‘hese are acronerge stimulation, (2) cant be the answer. (0) Imusesrnieegorisis increase insulin release, bul hs i not, the mechanism ofsufonytureas. They cause insuin oleae ‘by (0, and ae th primary oral antifabetc agerts used therapeutical. 37. a pation equiing an extraction reports that he i¢ en sicoumsret therapy, the aboretory test most valuable in evaluating the surgical risks 3. Coting time b: beeing tne ©. sedimentation rate Complete blood cel count Ce Answers (}- Dicoumarolis an oral anticogut, Thus the tisk in an extraction Is hat the patient may bleed excessively, for that a serious interaction with a drug tha! you might rue In your management ofthe pavent such 9s berstustes of ‘alylates may occur You may need toads! he ‘aniicoegulant activity to wihin 2 safe range for surgical procedures. Since clecumarol prevents blood cting by bbroventing te conversion of Vitamin Ko protic) the only appropriate test 42, Adiug has 2 nallife of 4 hour. 12 gms are given every 4 hs ‘what willbe te amgunt in gms in the body immedtely after the geet gs See nite ys Be fis ( i 88 AS. ‘Answers (¢)- 2 gm at Oh, at 4 rs 12 trom fst injection i (gone, leaving 1 gm inthe body and you init 2 more fr 8 {otal after the second injection of 3. At the third dose, 1/2 of 3 is gone, leaving 1.5 gr, you inject 2 more for ates of 39, Immeciatoly aftr the bird oe, 43, Which ofthe folowing combinations represents accestsble istantagonist pais in antgotl rerepy? Tioriie ‘aloxone leoumarot- protamine© warfain:phenyibuiazone 4 carton mononide-carbon dione (@) shouldbe immeciately abvious- go no tutor, do not pass go, do not collect $200. (2) 5 wrong.2extamina isan antagenis! of ___leparin, et afcounaro.( phenylbuterone enhances te acy of wart by displacing i ram plasma protein binding siles.(d): Ryperbane oxygen would be @ use tretment for ‘carbon monoxide polzoning, rot CO2 46, The various insulin preparations useUin the testment of diabetes ‘mets dfer primarily In 2Tocus af aeven i, mechanism of action NE nese of tanstemation “Syoneet and duration of action none of te above Answer is (2) remember, diabetes medications can be ‘organized into 3 groups based on Ihc onset and duration of ‘ction: #lastacilng neue injector, 2) intermediate acting Tsophane insutn suspension, and 3) eng acting: protamine Jin insu suspension 48, Displacoment of a drug from protein binding silos is expected to ‘moreaee the 2. ug effect observed duration of crag eect ©, dose requled fr a gven effect ‘rene ofthe above ‘answer i ()- most pecple answer 3, confusing protein binding sites ftom active racopir sites where drugs exert ther effects Protein binding sos are just uptake stos that {ako up a drug and keop i om geting toils real receptor site faction. Some drugs are extensively protehn bound, for ‘example coumarin is 97% protein bound and only 2s left to reach effective sites. Administration with another deg that fs also extensively plasma proten Bound wil spice the crug that is alteady on these sles via competion, 27d thus offectiely neato the lovel of dg tha can now get fo an Active receptor sta. 62.n Fig. 1. thres diferent doeee of drug A are teste for activity. In Fig 2, hres doves of drug 8 a letes for actin he samme test system. In Fg. 3, tree dosee of drug A are tested inthe presence o! the igh dose of crus B. Based upon tho responses Seen. which ofthe following statements Best describe drugs A ond 8? 2. drug Asa partial agonist; dug Bis an antagonist 6 orug Ais at antagonist: drug 8 fs 2 paral agonist ‘¢ crug Ais an agonist, crup B i an aniagonist, 4.orug Aisa agonist drug 8 en partial agonist ©. Grug Ais an agonist: drug 8 fs neiher an agonist or an aniagorist, (5) sony cant reproduce the fgure. But! think they give you 12 copy ofthis exam, dont they? If ot, Jook thie up in your couree syllabus. You sil have your course syllabus, dent you? Answers (e- orug A cepts a dose response curv for ‘full agonist the typcalslomaidal dove response curve {ong fom 0.100% response, ths () i eiminated from Turthar consideration. The dose response curve fe dug 8 is fa-no response at al. Drug 8 thus cant be a part! agonist, ‘bien moans (2) [8 wrong. Imus elthor be an antagonist or roither an agonist er antagonist inthis system. The fact thet it doosait seem (0 allo the dose response curv for Dag Ain 40 Fig. 3indestes ca be an antagonist. the curve woul bo sinarin shape except shied fo the aght Tho answer is tue (0) 56. Inan addlsonion crisis hypoaldaseroniam) testing fom stess rom a minor dental procedure, the patient snoulsbe vealed immediately wits 2.0.8 mi norepinephrine . 5 mg. preshisolone acetate ©. 1% triamcinolone acetoride 0.5 mi, 11000 epinephrine ra (100 mg) hydrocorisone hemisuecnale ‘Answer o- Adhon's dase ress a ice he ‘strana cafes to prods aranacoealormongs seh 2s ‘Soxorore. Acloroe 9 mmaraneota tht cons Soclum mtn and potasm excel Leck of. “tosoone resus cyto mesancts, wn te mao problem tang hyponaronia dum la) uni symone ‘tay seo be eo athen» pelo widen io Crone ‘cena sora thorapy. bo fo dapested acrna! uncon Pas eat rapond fo hese tute (uch o drt Preeti ati, dan aalctelryotr. Te ‘ecammanded vestments), 100 mo. haocaisone hermetic celcolasoe en fo oere ive fe precisoloe (sto lon, whe roone feck efecto Soom etntan ME and pt woud mt be used is stun hey mig bese ina case of ‘anal medley 59, Drug A inhibits the biotraneformation of Drug B, The duration of action of drug Bin the presence of drug A wil usualy be ‘shortened longed rchanged Answers ()- usually bcransfomatonresuts in a more ‘wator solute, mare readly excreted fom ofthe parent avo In most cases this inactivates the dr, bul thro ao some ‘oxcoptone which invlve the formation of metabeltes with ‘city (hazenam) or when an inactive prodrug = given (Jevodons) which Becomes active afr Io frst stop the bietronstormation pathway (DOPA) semotimes are asked n (quastons ef tis form. Et. In which of the following groups of drugs is there the most consistency in chemical suctre? a.ciuetes ntielleptics| ‘cocal anesthetics ‘general anesthetics '.nonberbitrate sedatives Answers (o) Remember thet ea! aresthlice are ether ‘esters or amigos. Al ofthe thor atmatves eiverpe wisely in their structures. 664, Cimetisine fs administered to 2 aidin sleeping relieve asta Jnnibit gestric secretion relieve cold end fu symploms Answeris(o}- Remomber,cimoticine or “Tagamet” is an H2 ‘nttstemin are used therapeuticaly to ini gastric‘secretlon (c) In e98es of pope weer. This ist ony einical use. You might see fina quoston regarding drug ‘metabotsm itis alo a polontiybir ofthe xed function ‘udase drig metabolizing enzyme system i he fver. The ‘ther atematives ar fo contuse you bocause yu probably at feast remember thal is an anthstamine, but you dont RoW the dmerenco Dotween #11 and H2 ardhistamines. 65. Which ofthe folowing anticancer rugs can be classed as an ‘anfimetabelite? ‘cisplatin .tomustine 6 vinerstne “d methovexale Answers (f)-I would guess (2) because its the ony one "ve lever heard of, and since this wasn% covered in class you ‘night be one fo quess also. Wow, we god right Actua, i "yOu look the others up, (2) & (0) ae allyiting agents, (0) 16 {alkaloid darived trom plons. i a flo antagonist which acts as an antimetebotte. Just for your fture tediication, most cancer chemotherapy drugs cause cell death by afecting the abity of eels o dvge. The drs thus inhibit ‘one or more phases of the celeyele or prevent cll In Gp (the noneividing phase) trom entering into the cycle of cel ‘vison. Antimeteboties may actin 2 ways (1) by incorpraton into a metabolic pathway and formation of 2 {alse metabolte which Is nonfanctona o (2) by Iain of {he cataytetunction of an enzyme or enzyme systom. Methotrerste isan example ofa cell cycle specie antimetobotie that inhibits GNA synthesis during the phase. Vincnstine acts during the mictc phase 656, Which of he following hormones act fo elevate blood concentration of ionie eam? _xgucagon Barats ridosterone| 3: tyrobepn © myrocaletonn ‘Answer i (b} maintaining the concentration of Ca++ in ‘exraoaular fui by reguatng the depostion and mobitzation ‘of calcum from bone, absorption from the GI vee, excretion 2:6 is the main function of parathyroid hormone, ‘Thyrocalctonin Is anther name for calctonin. They hope 10 confuse you because theres 2 coreltion between calcitonin [Bnd calcum, except that calcium concentrations regula the Syihesis and release of eaetonin. Glucagon lea pancreale ormone that stimulates glucose production. thyrotropin is there to confuse you with paathyrod hormone, ard slocelorone regulates Ne+ lovele not Ca {67 Disorientation, confusion, and hallucinations resuling rom an ‘verdase of scopolamine are most effcaciously Weated bY ‘ministering 3. atepine levodopa 3 acetyiealine a physostigmine “Answers (d}- scopolamine is © muscarnl recepor blocker ‘Sinlarto atropine, thus (28 wrong, Levadopa has nothing 0 ‘dowith his question. To counteract a competive muscarinic receptor block, you raed fo incroase the levels of agonist, 2 this case acetyicnoting, However, you cant give ACh GBoards2005 doc 4 Prepared by ML. Thompson, Ph. D., Dept of General Dentistry, Tufts Dental School because itis broken down sims insiantanaousy by acetylcolinesterase. The answer Isto give @ arg which noch ou he seeivlchoinasterese,alewing endogencisly ‘loasad ACH 10 accumulate to overcome the acon of ‘scopolamine. The drug which wil do this is hysnstigmine. essa nyporeactity to drug ic ‘antagonism ©. detosication 4 desensitization “Answeris (- your choices are between tolerance and desensitization, (2) and (2). Te lator refers fo some atteration of receptors ta! leads to dminished response o the drug. and s realy a ‘mechanism whereby tolerance may occur. Thus the Gods ofthe ‘Board questions have decreed that the answer shale (2) 77. Absorption of a drug fem the intramuscular site of administration may be slowed by arexcerdce ‘vasoconsticton he presence of congestive heat (aivre ‘zeministerng the org a an Insclsbe compiex faandd 2 bony 3.p,canda Payer) 5.allot te above “Answers (e- "0" cant be right because exereise increases blood flow ‘rough muscles and thus improves absorption. Thus #1 1s ‘wrong. ‘ls obviously right for ine same reason "e” would aso ‘resul in reduced blood Tow so slower absorpion would a be ‘2 protiom. "sls oon used for prolonged and etoady dug release 80 i als i ve. The answer must tas bee). 78, Salioyism incudes when of te flowing? Gans vomiting 4. gastrointestinal bleoding onde dose are disturbances of aclo-base imbalance fecidosis oF ‘akkalosis), fever, Iypoglycemia. Remember, aspirin, is ‘ontrsincicetein chen sufening frm ifuenza or chicken pox aspirin nas been impficated inthe development of Ronoo's syndrome. £82. Which ofthe folowing ar important ciara forthe adequate clinical evaluation of @ new drop? ‘2 comparison wih placebo ©. evalation of sido etoctstization of canto groupe ‘Comparison witha standard drug ‘double blind experimental design ,b,¢, anda 2,6.0, ande aledande bic ande b. dande only alll the above Ansari #6-A gimme thsi just common sense, 24, Each ofthe follow agen has 2 long duration of action due to the presence of ner oneratedaclve metabotles EXCEPT diazepam oxazepam furazepam © chlorcinzeponide Ansiner I (b) This is @ pure merization question. Al of inese crugs ae benzodiazepines, which fypicaly have along ‘duration a action because they are converted {0 phaimacologicaly sctive metabottes with fang halves. xazepem, miazctam, and lorazepam are exceptions that fare not converted to active metabaltes. Tho answer is tus @, 86, Each ofthe fllowing statements relates lo the general aspects of toccology EXCEPT py most druge exert a single action SS fonety f bot te and dase dependent ° tonlety ean be due to overdosage ofa ctug <4. symptoms of toxicity can be enjhing ranging from nausea te oes 5. ©. for some ces, even a minimal concentration canbe harmful Answer is (af you leamed anything from pharmacology, {you should instently be able fo cent (o) asthe corect Snswer The constant quest of pharmacology as a science is io design or enti cruge that have as narrow oF specie range of action es possible, But nt fo many single action rugs have been identified. Aitemaives(c) and (2) should temind you of prases such ae dose-osponce curves and therapeutic Index (te ratio ofa toxe or lethal dose fo a theraneute dose, LOS0/ED50). A foe effoct can be brosaly Gotined as any undesired effect ofthe drup, thus # 4 cant be {he exception To rfe out # 8, tink of nerve gas. £2. The conta actions of ethyl aleaho! are nat synergistic with which ol he folowing? 8 6 ‘azepam ‘moperidine pentobartits ‘chlorpromazine ‘metnypnenigato ‘Answer it (o) The central actions of aleohot are depressant Thus the choica of corect answer comes down to owing which ofthe drugs listed Is not a CNS dopreasant. Diazoparn {s.a benzoatazepie, pontobarbial is a tarbturate. Boh are ‘sedeting, Mepoidine isan opiate, whe chorpromazin fs 2 pphenothizine antpeychotie. Bath ef hase clsesos of drugs fre also ypcely sedating. The corect answers (), ‘methyeniéole Ftan). tan ie aninreet acing 2 sympathomimetic, and ots similar amphetamine in the ENS-is a stimuart 7. Atperoin dependent patient should net be given nalbuphine (Nubein) for pain because 42. ithas no analgesic provers Bit may produce respraory depression €. 88 a mined agonist-antagonst, ican elt withéreval (\symotoms \ihe high abuse potential of nalbuphine may add tothe atent'sprobiems “Answer is (4) Natbuphine is @ mixed agorst-antagonst that ‘is analgesiealy equipotent wiih morphine (hus # 118 vied ‘out. However, snafgesia Is produced by ts agonistic effects {t kappa opioid receptors. thas pronounced antagonistic effects tthe mu recepir, and can be used cinicay fo rovorse resaratory depression (by Blocking mu receptors) without a loss of analgesic effects (by stimulating koppe ‘racoptors). Thus, #216 red out. #4 nt ikay. The mixes ‘agonist-entagonists were designed to combine anelgesia wih {enough antagonistic proportes fo preven tol abuse. Thus 4 31s the right answer. Typical, these crs can mimic the effet of morphine in @ dug free patient, but antagonize plate acton in a dependent patie, tus precptatng ‘tharewal Of his class of drugs, butorphanol is the ‘exception. wil not prociptate withdrawal bocause is cniy@ ‘wosk mu ontegonist 99, Allof the folowing methods of drug bictransformation ate Classifed as synthetic excep ceiamcen O-dealryaton \ Ste notion 4. glucuronide conjugation Answer I (t)- Nonsynthetic reactions (ahese I reactions) Include the various transformations of motocuar structure: ‘oxidation, reduction, and hycrotsts; they represent the fest Slage of bitransformation. Syniheti (hase I) reactions Consist ofthe confunation of nas or ther lables wit) functions! groups. Ofte altematives, (and () are Conjugation reactions, and thus are wrong because they are synthetic reactions. Alteratve (a) te tieky ts made fo. sound ike Ndeakyiation, whieh is a nonsyntheic or phase ‘oeidative reaction. There is no reaction cand N-ikyation ‘Thus (0), an oxidative phase I reaction Isla as the nanPhepared by ML. Thompson, Ph, D., Dept of General Dentistry, Tufts Dental School Board Exam Review Addendum More board questions that were released after | prepared the original review: 152, Which of the following rugs is often administered to vest fe- threatening armythmias? (3, guniine Bylidocaine ~d verapamil ©. propranolol (0) ventricular arythmias are the Ste threatening ones, and Tidocaine is particulary effective for this kind of anythmia linen given parenteraly in an emergency eiuatien hes 2 Very rapid onset of eeton when given IV, which i obviously Important in an emergency. The others af aso have artiamythmic action, mostly used for supraventricular lachyamhmias ‘58. Amale patient who is eeiving Coumadin therapy presents for an lective extraction. His protmombin tme (PT) s prolonged. Which Of the following methods is prefered fer reducing the PT 10 an acceptable evel? ‘2. administering vitamin K (Aqua Mephyten) ‘BN Withdrawing Coumacin fortwo days, 2 reducing Coumadin fo one half the usual dose fortwo Gays ©. ominsteing 9 Coumadin antagonist. such as heparin © aminstering a platelet ransfusion to enhance Coagulabitiy (t) the issue is obviously thatthe patient may bleed excesively, 2 ‘stuation that would cause problems during dental surgical procedures. Denis! shoud consult withthe patent’ physician ‘boul stopping the Coumadin fora few days. Optens () and (e) ‘might be appropriate in an emergency sian, but that isnot ‘what we are dealing with here. Option (c) would take longer to reduce (PT) then just stopping the Coumadin. Finally. heparin hot » Coumadin antagonat, bu an anticoagulant ins ox ih Guiaetines Into what adjustments to make In Coumadin. therapy prior to dental treatment have changed since this type of question was written ~ the safest bets fo consult -enysicfan — depending on patient's status, It eould be that no ‘2gjustment should Be made at al, certalaly net for minor ‘Surgery anyways. 652, Each of he folowing drugs has a significant antnfamematony ‘propery except one, Which ones the exception? ‘2 asp --b.cortsal Ce tepiamnornen profen indomethacin () gees, they keep ropestng this question year ale year afer "year if you don} iminedately keow Wat the answor ‘eceleminophien, Iwi cll Mr Fleming and change your orade In Pharmeclogy to 29 71 172. A patient has ahistory of sgiiicent cardiovascular impairment. ‘The maximum safe dose of epinephvine that can be administered to this patients: ‘a. 1¢6, 1: £0,000, G-\Boards2005.doe 4 b.2 co, 150,000 ¢. 46%, 100,000 4.2.6, + 100,000 (o) the rue is. 04 mg of epi max in CV patients. The casiost way "to figuo this ene out is o remember you shouldnt ave more than 2.2 carpules of xyfecaine with (100,00 ep your usvat choice as a local anesthe, Two corpus is 26¢¢ This ‘eliminates options (c) an (), since thay wouid be safe Cut act, ‘maximal. Since 1:50,000 is twice as concentrated as 4:100,000, 1 ce of 1:50,000 (option (a) sth some ae 2ce of 100,000 se sti not close fo max, £0 2) has tobe the nght ‘answer, Of eourse, you could have just remembored, 1:100,000 equals 01 mg perce, £0 1:50,000 equals 02 mg per cc, 50(b) would equa the max of.04 mg 78, Whien ofthe following ie he caren! arug of eroie fe status. ptcus? (Eslciazepam (valium) ‘ licoesine-mepivacaine » priocaineevaccine ©: procalnewnepivaccine 6. procaine toecaine fidocaine-benzocsine (et yu ore lcoking for an ester - esterpsiving. Only () mecis his criterion. procaine, benzocaine and tetacaine ae feelers, idocain,prilcaine end mepivacaine ae ences, ‘Amides, uni esters ao not by rue cross-atergenc 107. Thrombophledis, which occurs after intayenous administzton ‘ofiazepam, is usually atovied to which f the falling subetances inthe mice? ‘3 benzoic acs j Gere Pree ‘sodium metabisulfite ¥ He Af (c) momorize thie ploy ie fact ploaset 110, Each of he following Is a pharmacologe eect of rencmiaznes EXCEPT one, Whieh one fs fre EXCEPTION? ‘sedation an anfemetic effort alphaeacrenarcic elect 6 potentiation ofthe action of marcotes fan anticonvulsant (ol see, they do ask you questions abou drugs that you dent ‘normally use every day. Actions 3, cand d are a irically useflectons ofthe phencthiazines, wich you ‘night ramembor ware discussed undor the category oF ‘ntpsyehote drugs. But wai Promethazine (Phenersa0) Is used in denis as 8 sedoive, often in combinoen ‘nn Demerot because reduces te nausea associated With the use of he onoid and also potentiates ts ‘analgesic effect, lowing lower dose fo be used. hus ‘gain redvoing ine potential for savorse side effects ‘Alpha adrenergic effects are an adverse side affect 110 Eepene aegonan a fect fi oy aac incte sree ect in ee ee (6) exacty why | kept asking you on every exam to give me an ‘sxemple of physalogical entagarism as a drug Interaction question 1 does rot act via), WMG 8 Mo cromotyn (nto) works, or by) wich s how “inthistomines work 4124. Which ofthe fllowing represents the drogoichoice ithe treatment of condidasl for an HIV-infected patient? seysow Spee ner 4 conestine (0) cantatas 2 tngatinecton tat rest ees ih am atfangl agente stot a) er “ntvral crags used fo reat HIV, while chtornedaine 6 3 ‘entinierbia! meuihuash 82pared by M.L. Thompson, Ph, D. Dept of General Dentistry, Tufts Dental School 2. A patient presents for reaiment ofa large fctuant mass In the submandibular space as a resul of exension of edentogenic infection. He has a lemperature of 38.5 dogroes © (101 degrees F). nay, tue dentst should treat this patent with which ofthe falowing? 2. salicylate merapy to reduce tho temperature b. alternate application of heal and cold to the area to improve cop, Siulation ‘TSincsion and drainage and a culture for antbio senstity A anibiotic therapy ta reduce the sweling and infecion (6) antibiotic theropy wont be very effective if you dont incizo ‘2nd crn fst. (a) and (b) are paltve actions the patent Can take at home, net actions forthe dentist. 46, The only local anesthetic that increases the pressor act of “belo spinephing and noresineptring is “SErprocaine € atucaine .tkocaine & mepivacaine (2) ney, hy do they aivays ask come dumb question tke tis ‘about cocaine-iho you guys use H every day in your oice (you better neti). Any way, remember, cocaine fs an Inelrec! seting adrenergic sgoric. ating by causing tho ‘release of acrenergic neuratransmifers 0s well a blocking thei reuptake, thereby profonging tht sett. ‘The other drupe iste are ust oval anesthotcs that don have iis action - they just block sodium fx into the 188 Corcostraid ata or ari fs contaatd for a pale tho ico s whch he ttowng Sonn? 2 repr stonetsm Ciente acer meumaticheat disease (2) patents using contcosterlds for ants often deveon ulcers because these drug lock prstagiandin ection i Ihe stomach, thereby inewasing acd secretion while ecreasing ine protective mucosel barier ofthe stomach “160, Which ofthe folowing isthe fist symptom that f usualy perceived by the patent boing adminciered rious oxo? euphoria € aicainess ‘yingkng ofthe hands Yd) the frst tree area signs tha the palientis geting too ‘much nitrous. 176. Each of he folowing, EXCEPT one, is a good reason for using ‘sedation. Which one is this EXCEPTION? Au tay sprain, amity fet Dp decrease the amount of local anesthesia tha is required tora given procedure to aleviale stress in 2 severely medicaly compromised patient 4. fo accomplish certain procedures tata practioner woul not normally Be able 10 de on an ansious patient GrBoards2005 doc 9 (©) sedation ces not decrease the local anesthetic require, the petlent wi sleet pain. Sedative, win the exception of nirous oxide, have no analgesic effec! barbiturate sedatives may mako tne pier mare sensitive fo pan. 179, Which of the folowing s assiied as an anlanxiety drug? 3. metiohextal lecazepam haloperidol 6. pentazocine e._phonyipropanotamine (b) only benzodiazepines are actualy classified ax aatianiety ‘drugs, athough etter drugs, uch as opioids have ~~ ‘aniansely actions in addon to thir ether cincaly Useful ctons. (2) lorazepam isthe only BDZ Weted Methoherial sa barbiturte- these are classed as ‘seatves. Haloperdal san anipsyehote, pentazocie an ‘iota, and phenyipropenolemne s 9 decongestant used incold medteatons.