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Tufts Pharmacology
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Which of the following is a procaine - only ester listed, rest are amides
local anesthetic subject to
inactivation by plasma
esterases?

a) procaine

b) lidocaine

c) prilocaine

d) mepivacaine

e) bupivacaine

Procaine differs from lidocaine a

in that

a) prcaine is a p-aminobenzoic
acid ester and lidocaine isn't

b) lidocaine is meta-
aminobenzoic acid ester and
procaine isn't

c) the duration of action of

procaine is longer than that of
an equal dose of lidocaine

d) procaine hydrochloride is
metabolized into
diethylaminoethanol and
benzoic acid

Tufts Pharmacology
which of the following local
anesthetics would be expected
to produce a sensitization
reaction in a patient allergic to
lidocaine
ii - lidocaine is an amide, thus other amides will be
cross-allergenic - mepiv, prilocaine, and dibucaine
are the other amides. procaine and tetracaine are
esters

a. mepivacaine

b. tetracaine

c. procaine

d. prilocaine

e. dibucaine

i. a, b, and c

ii. a, d, and e

iii. b and c only

iv. b, c, and d

v. b, d, and e

the hydrolysis of procaine c - procaine is an ester, esters are metabolized by

occurs mainly in the
pseudocholinesterase which is in the plasma

a. liver

b. lungs

c. plasma

d. muscles

e. kidney

Tufts Pharmacology
which of the following is a local c - only ester listed
anesthetic subject to
inactivation by plasma
esterase's

a. lidocaine

b. prilocaine

c. tetracaine

d. mepivacaine

e. bupivacaine

the activity of procaine is d - also metabolized by some extent by esters in

terminated by
the liver

a. elimination by the kidney

b. storage in adipose tissue

c. metabolism in the liver only

d. metabolism in the liver and

by pseudocholinesterase in the
plasma

Tufts Pharmacology
all of the following factors are c - amides are metabolized in the liver, not by
significant determinants of the cholinesterases
duration of conduction block
with amid-type local
anesthetics EXCEPT the

a. pH of tissues in the area of

injection

b. degree of vasodilatoin
caused by the local anesthetic

c. blood plasma cholinesterase

levels

d. blood flow through the area

of conduction block

e. concentration of the injected

anesthetic solution

which of the following is c

contraindicated in a patient
who had an allergic reaction to
procaine six months ago?

a. nerve block with lidocaine

b. topical application of
lidocaine

c. topical application of
tetracaine

d. infiltration with an
antihistamine

Tufts Pharmacology
bupivacaine has all of the d-

following properties relative to in terms of duration of action...

lidocaine EXCEPT bupivacaine

short: procaine

moderate: prilocaine, mepivacaine, lidocaine

a. is more toxic
long: bupivacaine, tetracaine, etidocaine
b. is an ester-type local
anesthetic

c. has a slower onset of action

d. has a longer duration of

action

amide-type local anesthetics b

are metabolized in the

a. serum

b. liver

c. spleen

d. kidney

e. axoplasm

the duration of action of b - interacts with lidocaine in two ways...slows down

lidocaine wouldd be increased the heart via beta receptor blockade, blood
in the presence of which of the delivery to the liver is reduced thus lidocaine
following medications?
remains in systemic circulation longer and can
potentially accumulate to toxic levels. they compete
a. prazosin
for the same enzyme in the liver thus metabolism of
b. propranolol
lidocaine can be reduced.
c. hydrochlorothiazide

d. lisinopril

e. digoxin

Tufts Pharmacology
severe liver disease least b
affects the biotransformation
of which of the following?

a. lidocaine

b. procaine

c. prilocaine

d. mepivacaine

a patient has been given a b

large volume of a certain local
anesthetic solution and
subsequently develops
cyanosis with
methemoglobinemia. which of
the following was likely
administered?

a. procaine

b. prilocaine

c. dibucaine

d. lidocaine

e. mepivacaine

use of prilocaine caries the risk d

of which of the following
adverse effects?

a. porphyria

b. renal toxicity

c. gastric bleeding

d. methemoglobinemia

Tufts Pharmacology
the most probable cause for a e - arising from inadvertent intravascular injection.
serious toxic reaction to a local the other are possible but less likely so e is the best
anesthetic is
option

a. psychogenic

b. deterioration of the
anesthetic agent

c. hypersensitivity to the
vasoconstrictor

d. hypersensitivity to the local

anesthetic

e. excessive blood level of the

local anesthetic

high plasma levels of local d - initially, LAs inhibit central inhibitory neurons,
anesthetics may cause
which rsults in CNS stimulation which can proceed
to convulsions. at higher doses, they inhibit the
a. inhibition of peristalsis
inhibitory and excitatory neurons leading to a
b. stimulation of baroreceptors generalized state of CNS depression which can
resulting in severe hypotension
result in respiratory depression and death
c. inhibition of the vagus nerve
to the heart
d. depression of inhibitory
neurons in the CNS

Tufts Pharmacology
unfortunately, you have c
injected your lido intra-
arterially. The first sign of
lidocaine toxicity that might be
seen in the patient would be

a. elevated pulse rate

b. sweating

c. CNS excitation

d. cardiovascular collapse

e. CNS depression

The first sign that your patient c - epi is sympathomimetic. all other reactions are
may be experiencing toxicity related to elevated lido [cardiovascular collapse,
from too much eli would be
convulsions, slurred speech]

a. cardiovascular collapse

b. convulsions

c. elevated pulse rate

d. slurred speech

which disease condition would a - autoimmune disease that causes

make the patient most sensitive hyperthyroidism, so high levels of TSH =
to the epi in the LA?
hypermetabolic state with heightened sympathetic
activity, combined with epi could result in
a. Grave's disease
hypertensive crisis
b. Diabetes

c. HIV

d. Alcholism

e. Schizophrenia

Tufts Pharmacology
cardiovascular collapse d. cardiovascular collapse is due to a direct action
elicited by high circulating of the local anesthetic on the heart muscle itself- LA
dose of local anesthetic may in toxic doses depresses membrane excitability and
be caused by
conduction velocity, all other ways are indirect
effects
a. syncope

b. vagal stimulation

c. histamine release

d. myocardial depression

e. medullary stimulatoin

the most serious consequence e

of systemic local anesthetic
toxicity is

a. vertigo

b. hypertension

c. hyperventilation

d. post depressive CNS

convulsions

e. postconvulsive CNS
depression

hypotensive shock may result
form excessive blood levels of
each of the following local
anesthetics EXCEPT
a. cocaine
a - all of the listed local anesthetics are vasodilators
except for cocaine. produces vasoconstriction. also
blocks the reuptic of NE into adrenergic neurons,
and thus potentiate the NE that has been released
from nerve endings

b. procaine

c. lidocaine

d. tetracaine

e. mepivacaine

Tufts Pharmacology
which of the following a
anesthetic drugs produces
powerful stimulation of the
cerebral cortex?

a. cocaine

b. procaine

c. lidocaine

d. tetracaine

e. mepivacaine

local anesthetics block nerve e

conduction by

a. depolarizing the nerve

membrane to neutrality

b. increasing membrane
permeability to K+

c. increasing membrane
permeability to Na+

d. preventing an increase in
membrane permeability to K+

e. preventing an increase in
membrane permeability to Na+

Tufts Pharmacology
if the pH of an area is lower d - the free base form, or nonionized form is the
than normal body pH, the form that passes through the membrane, yet once
membrane theory of local inside the neuron only the ionized form is effective.
anesthetic action predicts that inflamed tissue has a lower pH than normal tissue
the local anesthetic activity and will shift the equilibrium of the LA solution such
would be
that most of it remains ionized and unable to
penetrate
a. greater, owing to an increase
in the free-base form of the
drug

b. greater, owing to a decrease

in the free-base form of the
drug

c. less, owing to an increase in

the free base form of the drug

d. less, owing to a decrease in

the free base form of the drug

Tufts Pharmacology
a local anesthetic injected into a
an inflamed area will NOT give
max effects b/c

a. the pH of inflamed tissue

inhibits the release of the free
base

b. the drug will not be

absorbed as rapidly b/c of the
decreased blood supply

c. the chemical mediators of

inflammation will present a
chemical antagonism to the
anesthetic

d. prostaglandins stabilize the

nerve membrane and diminish
the effectiveness of local
anesthetic

at a ph of 7.8, lidocaine (pka = c

7.8) will exist in

a. the ionized form

b. the unionized form

c. equal mixture

Tufts Pharmacology
the more rapid onset of local b - small fibers will be blocked first b/c the
anesthetics into small nerves is anesthetic concentration to critical length in smaller
due to
fiber will be reached faster than in a larger fiber. you
have to block 3 nodes of rangier and they are
a. slightly lower pH of small farther apart in larger fibers than in smaller diameter
nerves
fibers
b. the greater surface-volume
ratio of small nerves

c. the increased rate of

penetration resulting form
depolarization

d. smaller nerves usually have a

higher threshold

a dentist administers 1.8mL of d

2% lidocaine. How many mg of

lidocaine did the pt receive?

2% solution = 20mg/mL x 1.8mL = 36mg lid

a. 3.6

b. 9

c. 18

d. 36

e. 180

3mL of LA consisting of 2% d-

lidocaine w/1:100K epi contains

how many mg of each?

2% lido = 20mg/mL x 3mL = 60mg lidocaine

1:100K epi = .01mg/mL x 3 = .03mg epi

a. 6mg lido, .3mg epi

b. 6mg lido, .03mg epi

c. 60mg lido, .3mg epi

d. 60mg lido, .03mg epi

e. 600mg lido, .3mg epi

Tufts Pharmacology
The max allowable adult dose c

of mepivacaine is 300mg. how

many mL of 2% mepivacaine is 2% = 20mg/mL -- 300/20 = 15mL

to be injected to attain the max
dosage in an adult patient?

a. 5

b. 10

c. 15

d. 20

e. 25

A recently introduced local d.

anesthetic agent is claimed by .05% = .5mg/mL

the manufacturer to be several

times as potent as procaine. 30mg/.05 = 60mL

The product is available in .05%

buffered aqueous solution in 60mL/1.8mL = 33.3 cartridges

1.8mL cartridge. The max amt
recommend over a 4hr period
is 30mg. The amount is
contained in about how many
cartridges?

a. 1-9

b. 10-18

c. 19-27

d. 28-36

e. 36+

Tufts Pharmacology
According to AHA guidelines, d -

the max number of carps of AHA limit is .04mg compared to .2mg in the healthy
local containing 1:200K epi that patient.

can be used in a patient with

cardiovascular disease is
1:200K = .005mg/mL or .009 per 1.8mL carp

a. 1
4 car pules would thus contain .036mg which is just
b. 2
below the .04 mg limit
c. 3

d. 4

e. 11

For treating oral infections, b

penicillin V is preferred to
penicillin G because it is

a. less allergenic

b. less sensitive to acid

degradation

c. has a greater gram-negative

spectrum

d. has a longer duration of

action

e. is bactericidal, whereas
penicillin G isnt

Tufts Pharmacology
the sole therapeutic advantage c
of pencillin V over pencillin G is

a. greater resistance to
penicillinase

b. broader antibacterial
spectrum

c. more reliable oral

absorption

d. slower renal excretion

e. none of the above

which of the following c - destroyed by stomach acid resulting in variable

penicillins is administered and irregular absorption. penicillin v is very acid
ONLY by deep intramuscular stable and available for oral use. penicillin G is
injection?
typically given IM in repository form, yielding a
tissue deposit form which the drug is absorbed over
a. ampicilin
hours.
b. dicloxacillin sodium

c. penicillin G procaine

d. pencillin V potassium

the principal difference among c - likely not to appear on new exams

potassium, procaine, and
benzanthine salts of penicillin
G is their

a. potency

b. toxicity

c. duration of action

d. antibacterial spectrum

e. diffusion into CSF

Tufts Pharmacology
which of the following a
antibiotics is cross-allergenic
with pencillin and should NOT
be administered to the
penicllin-sensitive patient

a. ampicillin

b. erythromycin

c. clindamycin

d. lincomycin

e. tetracyline

which of the following b - cephalosporins are chemically related to the

antibiotics may be cross- penicillins
allergenic with penicillin?

a. neomycin

b cephalexin

c. clindamycin

d. erythromycin

e. all of the avobe

which of the following b - spectrum activity of erythromycin is very similar

antibiotics is the substitute of to penicillin. the others are not cross allergenic but
choice for penicillin in the offer a much broader spectrum of coverage than
penicillin-sensitive patient?
we usually require. the drug with the narrowest
spectrum possible should be used. now
a. bacitracin CLINDAMYCIN is the drug of choice
b. erythromycin

c. tetracycline

d. chloramphenicol

Tufts Pharmacology
most anaphylactic reactions to iii
penicillin occur

a. when the drug is

administered orally

b. in patients who have already

experienced an allergic
reaction to the drug

c. in patients with a negative

skin test to penicillin allergy

d. when the drug is

administered parenterally

e. within minutes after drug

administration

i. a, b, and d

ii. b, c, and d

iii. b, d, and e

iv. b and e

v. c, d, and e

which of the following b - considered an "Extended-spectrum" form of

penicillins has a broader gram- penicillin
negative spectrum than
penicillin G?

a. nafcillin

b. ampicillin

c. cephalexin

d. methicillin

e. penicillin V

Tufts Pharmacology
which of the following e - really it's only use
antibiotics should be
considered the drug of choice
for treatment of infection
caused by a penicillinase-
producing staphylococcus

a. neomycin

b. ampicillin

c. tetracycline

d. penicillin V

e. diclolaxacillin

which of the following a - ampicillin is a extended spectrum penicilin and is

antibiotics is LEAST effective not pellicinase resistant. erythromycin shouldn't be
against penicillinase-producing affected by penicillinase since it isn't a penicillin
microorganisms?

a. ampicillin

b. cephalexin

c. methicillin

d. clindamycin

e. erythromycin

Tufts Pharmacology
which of the following e
bactericidal antibiotic used
specifically in the treatment of
infections caused by
pseudomonas species and
indole-positive Proteus
species?

a. ampicillin

b. penicillin V

c. tetracycline

d. diclolaxacillin

e. carbenicillin

penicillin's effectiveness b
against rapidly growing cells is
primarily due to it's effect on

a. protein synthesis
b. cell wall synthesis

c. nucleic acid synthesis

d. chelation of metal ions

e. cell membrane permeability

chlortetracycline acts by c - that's why it's selectively toxic

interfering with

a. cell wall synthesis

b. nuclear acid synthesis

c. protein synthesis on
bacterial but not mammalian
ribosomes

d. protein synthesis on
mammalian but not bacterial
ribosomes
Tufts Pharmacology
the probable mechanism of e
action of the bacteriostatic
action of sulfonamides involves

a. disruption of the cell

membrane

b. coagulation of intracellular
proteins

c. reduction in oxygen
utilization by the cells

d. inhibition of the metabolism

by binding acetyl groups

e. competition with para-

aminobenzoic acid in folic acid
syntehsis

the sulfonamides act by

d

a. supressing bacterial protein

synthesis

b. inhibiting the formation of

the cytoplasmic bacterial
membrane

c. induing the formation of

'lethal' bacterial proteins

d. inducing a deficiency of folic

acid by competition with PABA

Tufts Pharmacology
which antibiotic is able to c - that's why it's very useful in treating bone
achieve a higher concentration infections such as osteomyelitis. this question may
in bone?
have substituted gingival fluid for bone...in that case
the answer is tetracylcine
a. penicillin

b. erythromycin

c. clindamycin

d. metrondiazole

e. amoxicillin

tetracycline reduces the e - tetracycline is bacteriostatic and would slow the

effectiveness of concomitantly rapid growth of the microbial population that a
administered penicillin by
bactericidal drug such as penicillin needs to be
effective, since only works when cells are rapidly
a. reducing the absorption of dividing and making cell walls
penicillin

b. increasing metabolism of
penicillin

c. increasing renal excretion of

penicillin

d. increasing binding of
penicillin to serum proteins

e. none of the abov3

Tufts Pharmacology
 c-

streptomycin can damage the 8th nerve, affecting

both balance and hearing but isn't associated with
liver damage

which of the following penicillins are extremely safe except for allergic
antibiotics is most likely to reactions...they do not damage the liver

cause liver damage?

the cepahalosporins are chemically related to the

a. streptomycin penicillins and thus share their nontoxic nature

b. penicillin G

c. tetracyline
amphotericin B is an anti fungal agent that produces
d. cephalosporins
such adverse effects as nephrotoxicity and
e. ampotericin B hypokalemia but not liver toxicity

tetracyclines have been shown to be hepatotoxic

following high doses in pregnant patients with a
history of renal disease

which f the following c

erythromycin associated with
an allergic cholestatic
hepatitis?

a. erythromycin base

b. erythromycin stearate

c. erythromycin estolate

d. erythromycin succinate

Tufts Pharmacology
which f the following c - super infections usually seen after use of broad
antibiotics is LEAST likely to spectrum agents
cause superinfection?

a. gentamicin

b. tetracycline

c. penicillin G

d. streptomycin

d. chloramphenicol

GI upset and c - only two possibilities that could provide GI upset

pseudomembranous colitis has are c and e ...as for colitis both b and c can do that
been prominently associated
with

a. nystatin

b. cephalexin

c. clindamycin

d. polymyxin B

e. erythromycin

Tufts Pharmacology
symptoms that may be d
characterized as allergic
manifestations of penicillin are

a. deafness, dizziness, and

acute anemia

b. crystalluria, nauseau,
vomitting, and anaphylactic
shock

c. oliguria, hematuria,
bronchoconstriction, and
cardiovascular collapse

d. dermatittis, stomatitis,
bronchoconstriction and
cardiovascular collapse

aplastic anemia is a serious e

toxic effect that occurs
particularly after a course of
treatment with which of the
following antibiotics?

a. penicillin

b. lincomycin

c. tetracycline

d. streptomycin

e. chloramphenicol

Tufts Pharmacology
each of the following is a side c
effect of prolonged
tetracycline hydrochloride
therapy EXCEPT

a. suprainfection

b. photosensitivity

c. vestibular disturbances

d. discoloration of newly
forming teeth

e. GI symptoms

colitis that results following a

clindamycin therapy is caused
by an overgrowth of

a. C. difficile

b. staph aureus

c. pseudomonas

d. candida albicans

which antibiotic is appropriate b

for premedication in the
penicillin allergic patient?

a. cephalexin

b. clindamycin

c. erythromycin

d. amoxicillin

e. ampicillin

Tufts Pharmacology
 acyclovir is used to treat
c

a. candidiasis

b. colitis

c. herpes

d. HIV

e. ANUG

a distinct advantage that d - broad vs. narrow

tetracylines have over tetracyclines certainly have more side effects than
penicilins that that tetracylines
penicillin, and are certainly one of the antibiotics to
avoid during pregnancy
a. have no side effects

b. do not cause super

infections

c. are safer to use during

pregnancy

d. have a wider range of

antibacterial activity

e. produce high blood levels

faster after oral admin

which of the following has the d. tetracyclines are broad spectrum antibiotics
broadest antimicrobial effective against both gram positive and gram
spectrum?
negative cocci and bacilli.

cindamycin has a spectrum of activity similar to

a. vancomycin
erythromycin and vancomycin which is less than that
b. clindamycin
of the tetracyclines mainly affecting gram positive
c. erythromycin
organisms but the third generation ones have
d. chlortetracycline
increased activity against gram negative but greatly
e. third generation decreased activity against gram positive
cephalosporin

Tufts Pharmacology
sulfonamides and trimethoprim b
are synergistic bacteriostatic
agents because in bacteria
they

a. both inhibit folic acid

synthesis

b. interfere sequentially with

folinic acid production

c. are both antimetabolites of

PABA

d. are both inhibitors of

dihydrofolic acid reductase

e. are both transformed in vivo

into a single active compound

which of the following a

substances is the most
effective agent against fungus
infections of the mucous
membrane?

a. nystatin

b. undecylenic acid

c. polymyxin ointment

d. saturated magnesium sulfate

e. 10% aluminum chlroide

solution

Tufts Pharmacology
the most desirable property of c
an antibiotic when used to
treat an odontogenic infection
is

a. rapid absorption

b. little allergenicity

c. abiity to achieve and

maintain adequate
concentrations at the site of
infection

d. lack of significant binding to

plasma proteins

e. no effects on drug
metabolism

which of the following drugs c

chelates with calcium?

a. erythromycin

b. polymyxin B

c. tetracycline

d. penicillin G
e. chloramphenicol

Tufts Pharmacology
which of the following is NOT e - tetracyclines are the most likely of all antibiotics
characteristic of tetracycline to cause superinfection.

antibiotics?

they are NOT the drug of choice for prophylaxis.

a. absorption is impaired when this is due to streptococcal infection because 15-
taken with antacids
20% of streptococci are resistant to tetracycline
b. they predispose to monilial
superinfection

c. they form a stable complex

with the developing tooth
matrix

d. they have a low tendency for

sensitization, but a high
therapeutic index

e. they are effective substitutes

for penicillin prophylaxis
against infective endocarditis

the concurrent administration c

of penicillin G and probenecid
results in

a. increased metabolism of
penicillin G

b. increased renal excretion of

probenecid

c. decreased renal excretion of

penicillin G

d. decreased bactericidal
effect of penicillin G

e. increased excretion of
probenecid in the feces

Tufts Pharmacology
interaction between penicillin d - penicillin is metabolized in the liver but it rapidly
and probenicid is best disappears from the blood due to the rapid
described by which of the clearance by the indeys. 90% is excreted by tubular
following mechanisms?
secretion. thus patients with renal disease will show
high blood levels of penicillin. similarly, probenicid,
a. competition at the receptor a uricosuric agent [drug which tends to enhance the
site
excretion of uric acid by reducing renal tubular
b. acceleration of drug bio- transport mechanisms], reduces the renal clearance
transformation
of penicillins. a
c. alteration in the acid-base
balance
d. alteration in the rate of renal
clearance

when broad-spectrum c
antibiotics are administered
with coumarin anticoagulants,
the anticoagulant action may
be

a. reduced b/c of the

enhanced hepatic drug
metabolism

b. reduced b/c of increased

protein binding

c. increased b/c of reduction of

vitamin k sources

d. increased b/c of decreased

renal excretion of the
anticoagulant

Tufts Pharmacology
the therapeutic effectiveness c
of which of the following drugs
will be most affected by the
concomitant ingestion of
antacids?

a. cephalexin

b. erythromycin

c. tetracycline

d. sulfisoxazole

erythromycin should be b - POTENTIALLY LETHAL INTERACTION

avoided in the patient taking

a. aspirin

b. seldane

c. benadryl

d. ibuprofen

e. propranolol

Quinidine is principally used to

treat

HTN tx by beta blockers such as propranolol.

angina treated by nitroglycerin, while digoxin is the
a. hypertension

drug of choice for CHF. quinine is an anti arrhythmic

b. angina pectoris

drug that reduces automaticity and responsiveness

c. CHF

and increases refractoriness. it also has an

d. supraventricular
antimuscarinic action preventing the bradycardia
tachyarrhythmias
that follows vagal stimulation.

Tufts Pharmacology
 quinidine is ued to treat
c

a. htn

b. angina pectoris

c. atrial fibrillation

d. ventricular fibrillation

e. CHF

verapamil is most efficacious in a

the treatment of?

a. atrial fibrillation

b. atrial tachycardia

c. ventricular tachycardia

d. cathecholamine-indcued
arrhythmias

which of the following drugs is c

most useful in treating or
preventing angina pectoris?

a. digitalis

b. quinidine

c. propranolol

d. procainamide

e. pentoarbital

Tufts Pharmacology
each of the following drugs an a
be used in the prevention and
treatment of angina pectoris
except

a. digitalis

b. propranolol

c. nitroglycerine

d. isosorbide dinitrate

e. pentaeryhtritol tetranitrate

all of the following drugs are a

useful in the treatment of HTN
except

a. ephedrine

b. resperine

c. methyldopa

d. thiazide diuretics

digitalis is useful in the d

treatment of which of the
following conditions?

a. atrial fibrillation

b. CHF

c. paroxysmal atrial tachycardia

d. all of the above

Tufts Pharmacology
all of the following drugs are e
useful in the treatment of
cardiac arrythmias EXCEPT

a. digitalis

b. lidocaine

c. phenytoin

d. procainamide

e. aminophylline

the drug of choice for initial d

therapy for mild HTN is

a. reserpine

b. guanethidine

c. phenoarbital

d. chlorothiazide

e. alpha-methyldopa

which of the following d

antihypertensives are usually
reserved for treatment of
severe HTN

a. sedatives and reserpine

b. thiazide diuretics and

reserpine

c. sedatives and thaiazide

diuretics

d. guanethidine and ganglionic

blocking agents

Tufts Pharmacology
which of the following beta- c
adrenergic receptor blocking
agents is thought to be
cardioselective?

a. nadolol

b. timolol

c. metroprolol

d. propranolol

anti arrhythmic drugs, such as d

quinine, suppress certain
cardiac arrhythmias by

a. stimulating beta-adrenergic
receptor

b. suppressing cardiac ATP-ase

activity

c. increasing ectopic
pacemaker activity

d. increasing the refractory

period of cardiac muscle

Tufts Pharmacology
most drugs useful in the e
treatment of cardiac arrythmias
act primarily by

a. blocking purkinje fibers

b. blocking the alpha-

adrenergic receptors

c. suppressing SA node
impulse formation

d. causing positive ionotropic

effect

e. increasing the refractory

period of cardiac muscles

lidocaine produces its b

antiarrythmic effects by

a. increasing AV conduction

b. decreasing cardiac
excitability

c. increasing cardiac
conduction velocity

d increasing spontaneous
pacemaker activity

Tufts Pharmacology
when digitalis is used in atrial c
fibrillation, the therapeutic
objective is to

a. abolish cardiac
decompensation

b. inhibit bagal impulses to the

heart

c. decrease the rate of A-V

conduction

d. increase the rate of cardiac

repolariazaton

e. produce a decrease in the

rate of atrial contraction

nitroglycerin dilates the c

coronary arteries in angina
pectoris by

a. decreasing the heart rate

reflexly

b. increasing the metabolic

work of the myocardium
c. direct action on smooth
muscles in the vessel walls

d. increasing the effective

refractory period in the atrium

e. blocking beta-adrenergic
receptors

Tufts Pharmacology
propranolol is of value in e
treating angina pectoris
because it

a. has a direct action on

vascular smooth muscle

b. blocks autoregulatory
mechanisms in the heart

c. inhibits oxygen metabolsim

in cardiac cells

d. provides relief within

seconds of acute anginal
attack

e. prevents chronotrophic
responses to endogenous epi
emotions and exercise

administration of angiotensin c
results in

a. anti-inflammatory effects

b. antihistaminic effects

c. increased blood pressure

d. increased heart rate

e. a sedative effect

the primary antihypertensive b - ACE inhibitor. decreases the conversion of

effect of catpropril is due to angiotensin 1 --> angiotensin 2. decreased blood
accumulation of
concentration of angiotensin 2 reduces BP b/c
angiotensin 2 is a potent vasoconstrictor. captropril
a. serotonin
blocks metabolism of bradykinin
b. angiotensin I

c. angiotensin II

d. bradykinin metabolites

Tufts Pharmacology
administration of angiotensin c - more angiotensin 2 would be formed, potent
results in
vasoconstrictor

a. sedative effect

b. increased heart rate

c. increased blood pressure

d. antihistaminic effects

e. anti-inflammatory effects

which of the following is not f-

characteristic of the thiazide

diuretics
answer a is how diuretics lower BP which is why they
cause hypokalemia..hypokalemia can potentiate
a. increase renal excretion of digitalis induced arrythmias
sodium and chloride

b. increased renal exception of

potassium

c. increased toxicity of digitalis

d. exacerbate existing diabetes

e. cause hypokalemia

f. cause hypoglycemia

the oat useful diuretic drugs b

act by

people w/high BP are told to reduce salt intake

a. increasing glomerular since high sodium levels cause fluid retention which
filtration rate
can increase BP
b. decreasing renal
reabsorption of sodium

c. decreasing renal excretion

of chloride

d. increasing real an
reabsorption of potassium

e. increasing the secretion of

Tufts
ADH Pharmacology
digoxin exerts its positive d

inotropic effect by

cardiac glycosides such as digoxin are used in the

a. activation of adenylcyclase
treatment of CHF, which is the failure of the heart to
b. inhibition of function adequately as a pump and thus maintain an
phosphodiesterase
adequate circulation. cardiac glycosides are
c. an agonist effect of beta- thought to act by altering calcium ion movement
receptors
with a desired effect of increasing the force of
d. inhibition of Na, K ATPase contraction of the myocardium. while several of the
leading to increased calcium alternatives involve calcium, the way digoxin does it
influx
is the pump which enhances the contractile
e. decreasing the amount of mechanism

calcium made available for

excitation-contraction coupling activation of adenylcyclase is how epi works

digitoxin is effective in the e

treatment of cardiac failure
because it

a. is primarily a diuretic

b. reduces ventricular rate

c. decreases abnormal cardiac

rhythms

d. produces peripheral
vasocontriction

e. has a positive cardiac

inotropic action

Tufts Pharmacology
the beneficial effects of v
digitalis in CHF result in part
from the fact that digitalis
causes

a. a decrease in end-diastolic
volume

b. a decrease in end-diastolic
pressure

c. an increase in stroke volume

and cardiac output

d. a decrease in central venous

pressure

e. a decrease in the rate of

heart where tachycardia exists

i. a, b, and c

ii. a and c

iii. c and d

iv. e only

v. all of the above

the primary action of a

therapeutic doses of digitalis
on cardiac muscles is an
increase in

a. force of contraction

b. ventricular excitability

c. refractory period of atrial

muscle

d. refractory period of
ventricular muscle

e. rate of conduction of
Tufts
impulsePharmacology
to muscle
the cardiac glycosides will c
increase the concentration of
which ion in an active heart
muscle?

a. sodium

b. bromide

c. calcium

d. chlroide

e. potassium

in treatment of CHF, digitalis b

glycosides generally decrease
all of the following EXCEPT

a. edema

b. urine flow

c. heart size

d. heart rate

e. residual diastolic volume

Tufts Pharmacology
the mechanism of action of e
prazosin, an antihypertensive
agent is to

a. block the beta-adrenergic

receptors

b. inhibit formation of
angiotensin II

c. inhibit nerve-induced release

of norepinephrine

d. stimulate central inhibitory

alpha-adrenergic receptors

e. inhibit the post synaptic

action of norepinpherine on
vascular smooth muscle

Tufts Pharmacology
 a-

all of these drugs treat HTN but act by different

mechanism

methyldopa- alters CNS control of BP by acting on

cardioregulatory and vasomotor systems of the
which of the following owes a brain by stimulating alpha 2 receptors in the brain
significant amount of its stem.

antihypertensive effect to a clonidine is the usual drug involved in this particular

central action
question

a. methyldopa
metroprolol is a selective beta 1 receptor blocker in
b. metroprolol
the heart - reduces cardiac output

c. hydralazine

d. propranolol
hydralazine has a direct action on vascular smooth
e. guanethidine muscle to reduce HTN via vasodilation

d. propranolol blocks beta receptors in the heart

e. guanethidine prevents the release and causes

depletion of catecholamines taken up into storage
vesicles and is released like a false transmitter. it
does not cross the blood-brain barrier

Tufts Pharmacology
which of the following drugs is b
thought to reduce arterial
blood pressure by activating
alpha receptors in the
vasomotor center of the
medulla?

a. prazosin

b. clonidine

c. propranolol

d. guanethidine

e. chlorothiazide

propranolol can be useful in v

the treatment of HTN b/c it propranolol is a beta blocker. has no effect on alpha
blocks
receptors or NE release.

a. alpha 1 adrenergic receptors

b. sodium reabsorption in the

kidney

c. the release of renin from

juxtaglomerular cells

d. release of NE from nerve

terminals

e. reflex tachycardia seen with

the use of other anti-
hypertensives

i. a and b

ii. a and d

iii. b, c, and d

iv. c, d, and e

v. c and e only

Tufts Pharmacology
one of the proposed c
mechanisms of the
antihypertensive effect of
beta-adrenergic receptor
blocking agents is

a. sedation

b. a diuretic effect

c. antirenin effect

d. vagal blocking effect

e. increase in cardiac output

selective beta 1 adrenergic b

agonist will produce which of
the following effects?

a. glycogenolysis

b. increased cardiac output

c. decreased diastolic pressure

d. decreased peripheral
resistance

e. relaxation of bronchial
smooth muscle

ototoxicity with deafness may d

be encountered occasionally
in patients taking which of the
following diuretic agents?

a. osmotic

b. thiazide

c. mercurial

d. high-cieling

Tufts Pharmacology
symptoms of digitalis toxicity e
include all of the following
EXCEPT

a. extrasystoles

b. nausea and vomiting

c. yellow-green vision

d. A-V conduction block

e. decreased P-R interval

administration of which of the d - chlorothiazide causes potassium loss which

following drugs increases results in greater penetration of digitalis into the
likelihood of toxic response to myocardium....thus potential toxicity
digitalis?

a. diazepam

b. lidocaine

c. spironolactone

d. chlorothiazide

e. acetylsalicylic acid

the therapeutic effect of c

salicylates is explained on the
basis of the ability of the drug
to

a. activate autonomic reflexes

b. uncouple oxidative
phosphorylation

c. inhibit the synthesis of

prostaglandins

d. competitively antagonize
prostaglandins at the receptor
site
Tufts Pharmacology
the mechanism of antipyretic a
action of salicylates probably
results from

a. inhibition of prostaglandin
synthesis in the CNS affecting
hypothalamic temperature
regulation

b. inhibition of bradykinin in the

periphery leading to swearing

c. depression of the oxidative

enzymes leading to decreased
heat production

d. suppression of cholinergic
mediators in the hypothalamus

e. stimulation of
norepinephrine in the
hypothalamus

the antipyretic action of c

sallicylates is explained in part
by

a. analgesia leading to
sedation

b. increased blood flow

through the hypothalamus

c. cutaneous vasodilation
leading to heat loss

d. depression of oxidative
processes leading to
decreased heat production

Tufts Pharmacology
the locus of action of aspirin's b - antipyresis means anti fever. temperature
central antipyretic effect is the
regulation occurs in the hypothalamus

a. brain stem

b. hypothalamus

c. basal ganglia

d. limbic system

e. cerebram cortex

a patient who has been taking a - aspirin PREVENTS platelet aggregation..

large quantities of aspirin might

show increased postoperative d - how heparin works

bleeding because aspirin e - how coumarin works

inhibits

a. synthesis of thromboxane A2
and prevents platelet
aggregation

b. synthesis of prostcyclin and

prevents platelet aggregation

c. synthesis of prostaglandin
and prevents production of
blood platelets

d. thrombin and prevents

formation of fibrin network

e. GI absorption of vitamin K
and prevents synthesis of
blood clotting factors

Tufts Pharmacology
anti-inflammatory agents, such d
as aspirin, interfere with
hemostasis by

a. activating antithrombin

b. preventing vasoconstriction

c. inhibiting thrombin
generation

d. inhibiting platelet
aggregation

e. inhibiting polymerization of
fibrin

which of the following anti- c - triamcinolone is a corticosteriod. corticosteriods

inflammatory agents does not inhibit phosphlipase A2, the enzymatic step that
act primarily by inhibiting precedes prostaglandin synthethase. diffusional is a
activity of prostaglandin salicylate analgesic, like aspirin
synthetase?

a. diflusinal

b. ibuprofen

c. triamcinolone

d. oxyphenbutazone

e. acetylsalicylic acid

Tufts Pharmacology
a nonsteroidal, anti- a - you might be tempted to answer
inflammatory agent that acetaminophen, but this is not an anti-inflammatory.
appears to produce fewer GI
disturbances than high doses
of aspirin is

a. ibuprofen

b. probenecid

c. pentazocine

d. acetaminophen

e. phenylbutazone

prolonged use of which of the a-

following drugs does NOT

cause a predisposition to b-e are all NSAIDS which cause gastric irritation
gastric irritation and bleeding?
and bleeding due to their effects on PG synthesis in
the mucosal wall of the gut.

a. phenytoin

b. ibuprofen
phenytoin is an anti-convulsant ...its major side
c. idomethacin
effect is gingival hyperplasia
d. phenylbutazone

e. acetylsalicylic acid

each of the following agents e -

has been associated with

gastric irritation except

indomethacin is a strong NSAID that is known to
cause LOTS of GI irritation, so much so that it's use is
a. aspirin
limited in humans
b. alcohol

c. ibuprofen

d. indomethacin

e. acetaminophen

Tufts Pharmacology
which of the following is NOT c - it only lowers your temperature if you have a
produced by excessive doses fever - taking aspirin doesn't have any affect on
of acetylsalicylic acid?
body temp in the non-feverish patient but high
doses can cause all other effects
a. delirium

b. tinnitus

c. hypothermia

d. hyperventilation

e. metabolic acidosis

all of the following are e

pharmacological and
toxicologic properties of
aspirin EXCEPT

a. tinnitus

b. analgesia

c. salicylism

d. antipyresis

e. suppression of immune
response

Tufts Pharmacology
therapeutic effects of aspirin iii
include

a. analgesia

b. tranquilization

c. pyretic action

d. anti-inflammatory action

e. antirheumatic action

i. a, b, and c

ii. a, c, and d

iii. a, d, and e

iv. b, c, and d

v. b, d, and e

all of the following are d

pharmacological or
toxicologic properties of
acetylsalicylic acid EXCEPT

a. tinnitus

b. analgesia

c. antipyresis

d. methemoglobinemia

e. inhibition of PG syntehsis

Tufts Pharmacology
all of the following are possible e
effects of aspirin EXCEPt

a. reduction of fever

b. shortening of bleeding time

c. suppression of inflammatory
response

d. bleeding from GI

e. increase renal excretion of

uric acid at high doses

of the following, aspirin does d

NOT cause

side effect of narcotic opiates like codeine

a. occult bleeding

b. nausea and vomitting

c. acid-base disturbance

d. suppression of cough reflex

e. decreased tubular
reabsorption of uric acid

which of the following is NOT b - because it isn't a salicylate

true abut acetaminophen?

a. is a non-prescription drug

b. is cross-allergenic with
aspirin

c. possesses both analgesic

and antipyretic effects

d. may induce
methemoglobinemia at high
doses

e. may be the
pharmacologically active form
of acetophenetidin
Tufts Pharmacology
which of the following is not d
true regarding
acetaminophen?

a. it has antipyretic properties

b. it may induce
methemoglobinemia

c. it can be combined with

codeine

d. it has anti-inflammatory
properties

e. it is not cross-allergenic with

aspirin

c - acetaminophen is an aspirin alterntive. 1, 4, and 5

are associated with aspirin type drugs. The
the most prominent acute toxic
popularity of acetaminophen as an aspirin
effect associated with
alternative is b/c the incident of such effects w/this
acetaminophen use is

drug is very low. however, b/c acetaminophen can

undergo biotransfomration to a toxic
a. hemorrhage

intermediate....hepatic and renal necrosis have been

b. renal necrosis

reported especially after very high doses. Hepatic

c. hepatic necrosis

necrosis is the most prominent, esp when combined

d. gastric ulceration

with alcohol consumption since alcohol induces the

e. respiratory alkalosis
liver enzymes which make the hapatotoxic
metabolites of acetaminophen

Tufts Pharmacology
 c - prednisone is a corticosteroid

which of the following anti- diflunisal, indomethacin, and phenylbutazone are

inflammatory agents does NOT NSAIDS that reduce inflmattion by reducing
act primarily by inhibiting the prostaglandin synthesis by blocking
activity of cyclooxygenase?
cyclooxygenase

a. ibuprofen
corticosteroids are potent nonspecific inhibitors of
b. diflunisal
the inflammatory process, acting at a variety of
c. prednisone
point throught the inflammatory process. although
d. indomethacin
they do reduce PG production as well, they do this
e. phenylbeutazone by a mechanism other than blocking COX, probably
by inhibiting the release of the fatty acid substrate
for PG synthesis

which of the following is the c

most appropriate drug to use

to lower fever in a child under aspirin is contraindicated b/c of potential for

12?
causing Reye's syndrome

a. aspirin
ibuprofen is approved but not the #1 choice
b. ibuprofen

c. acetaminophen

d salicylate

e. diflunisal

which analgesic tom the c - diflunisal can be taken 2 times a day while the
following list has the longest other require 3-4x/day
half life?

a. acetaminophen

b. aspirin

c. diflunisal

d. ibuprofen

Tufts Pharmacology
occurrence of which of the b - narcotics in the form of paregoric [tincture of
following is LEAST opium] and lomotil are over the counter oral
characteristic of narcotic preparations for the treatment of diarrhea. opiates
ingestion?
act on receptors in the gut to produce constipation

a. vomiting

b. diarrhea

c. urinary retention

d. bronchial constriction

e. increase in intracranial
pressure

therapeutic doses of morphine v

administered IM may produce

a. constipation

b. euphoria

c. dyspohoria

d. mental clouding

e. decreased response to pain

i. a and b only

ii. a, b, and d

iii. a, d, and e

iv. c, d, and e

v. all of the above

Tufts Pharmacology
which of the following are vv
pharmacological effects of
morphine?

a. respiratory depression

b. euphoria

c. sedation

d. constipation

e. dysphoria

i. a, b, and c

ii. a, b, and d

iii. a and e

iv. c, d, and e

v. all of the above

which of the following drugs b - opiods are the only drugs that do this, and
acts to suppress the cough codeine and meperidine are the only opiates on the
reflex?
list. codeine is much better at this than meperidine

a. ASA

b. codeine

c. meperidine

d. acetaminophen

e. phenylbutazone

Tufts Pharmacology
morphine binds to which site to a - the specific receptors are the mu receptors
produce analgesia?

a. by binding to specific
receptors in the CNS

b. by decreasing the influx of

sodium

c. by decreasing the synthesis

of PG

d. by decreasing nerve
activation at the site of injury

morphine causes vomitting by

c

a. a direct irritant on the gastric

mucosa

b. stimulation of the nodose

ganglion of the vagus nerve

c. stimulation of the medullary

chemoreceptor trigger zone

d. direct stimulation of the GI

musculature

Tufts Pharmacology
the decrease in ventilation e
caused by morphine,
meperidine and some of the
related opiods depends chiefly
upon

a. depression of cortical
activity

b. peripheral locked of
chemoreceptor impulses

c. an increase in carbon
dioxide concentration in blood

d. loss of sensitivity of the

medullary respiratory center to
carbon dioxide

small doses of barbiturates and d

morphine depress respiration
primarily by

a. parasympathetic action

b. inhibiting the herine-bueuer

reflex

c. rendering the aortic

chemorceptor system
insensitive to O2

d. rendering the respiratory

center in the brain stem less
sensitive to changes in CO2

e. a specific effect at
myoneural junctions of phrenic
and intercostal nerves

Tufts Pharmacology
which of the following drugs is b. ventricular arrythmias are the life threating ones,
often administered to treat life- and lidocaine is particularly effetive for this kind of
threatening arrhythmia's?
arrythmia when given parenterally in an emergency
situation. It has a very rapid onset of action when
a. quinidine
given IV, which is obviously important in an
b. lidocaine
emergency. The others all also have antiarrythmic
c. verapamil
action, mostly used for supraventricular
d. propanolol tachyarrythmias

A male patient who is receiving b. the issue is obviously that the patient may bleed
Coumadin therapy presetn for excessively, a situation that would cause problems
an elective extraction. His during dental surgical procedures. Dentist should
prothrombin time (PT) is consult with the patient's physician about stopping
prolonged. Which of the the Coumadin for a few days. Options (a) and (c)
following methods is preffered might be appropriate in an emergency situation, but
for reductin ghte PT to an that is not what we are dealing with her. Option (c)
acceptable level?
would take longer to reduce (PT) than just stopping
a. administering vitamin K (aqua the Coumadin. Finally, heparin is not a coumadin
mephyton)
antagonist, but an anticoagulant in its own right.
b. Withdrawing Coumadin for Guidelines into what adjustments to make in
two days
coumadin therapy prior to dental treatment have
c. reducing coumadin to one changed since this type of question was written -the
half the usual dose for two safest bet is to consult physician -depending on
days
patient's status, it could be that no adjustment
d. administering a Coumadin should be made at all, certainly not for minor
antagonist, such as heparin
surgery anyways.
e. administering a platelet
transfusion to enhance
coagulability

Tufts Pharmacology
the antagonist of choice in the a
treatment of opioid OD is

a. naloxone

b. nalorphine

c. pentazocine

d. levalloprhan

e. propoxyphene

methadone is used in d - methadone is not an antagonist like naloxone --

detoxification of patients it is a full agonist w/analgesic properties just like
physically dependent on morphine. when taken orally, it is not euphoric in
morphine because methadone
addicts, but acts just like morphine to produce
tolerance and physical dependence. withdrawal is
a. precipitates withdrawal less severe than with morphine because methadone
reactions
has a mch longer half life.

b. antagonizes the depressant

actions of morphine
facts 1,2, and 3 would be met by an antagonist such
c. will not in itself produce as naloxone or perhaps even a mixed agonist-
physical dependence
antagonist like pentazocine
d. withdrawal reactions are less
inense and stressful than those
of morphine

Tufts Pharmacology
which of the following drugs is b
currently widely used in
treating opioid dependent
individuals?

a. codeine

b. methadone

c. alphaprodine

d. pentazocine

e. meperidien

meperedine [demerol] is
b

a. an antidepressant

b. an opioid analgesic

c. a sedative

d. a long-acting local
anesthetic

e. an antipsychotic

atropine and propantheline d - they are postganglionic muscarinic receptor

exert their effects on blockers

peripheral structure by

botulinum toxin prevents release of ash

a. preventing release of ach

b. preventing synthesis of ach

hemicholinium prevents synthesis of ash

c. enhancing destruction of

ach
ach is broken down almost instantly so c isn't even
d. competing with ach for possible
receptor sites

e. producing physiological
effects opposite to those of
ach

Tufts Pharmacology
neostigmine produces its b - cholinesterase inhibitor just like physostigmine.
effect by
these differ from the insecticides and nerve gases
listed below in that they are reversible
a. deprssing ash release

b. inhibiting ach-esterase
activity

c. increasing the rate of ach

synthesis

d. acting like ach at ganglionic

sites

e- increasing amount of ach

released from nerve terminals

organophosphate insecticides d-
and nerveg ases inhibit the
action of which of the
following enzymes??

a. adenylate cyclase

b. monoamine oxidase
c. phosphodiesterase

d. acetylcholinesterase

e. carbonic anhydrase

Tufts Pharmacology
drugs which are additive with iii.
or potentiate the effects of
acetycholine include

a. methacoline

b. scopolamine

c. pralidoxime

d. neostigmine

e. pilocarpine

i. a, b, and c

ii. a, c, and d

iii. a, d, and e

iv. b, d, and e

v. c, d, and e