You are on page 1of 46

, ;. M.L. Thompson, Ph. D.,Dspt. Of Pharmacology.

Tufts Medical School


Trepar~~d

Pharmacology Board v ~ ~ ~ a i l y a t l e a ~ t ~ n e q ~ e ~ t i ~ n ~ ~ m e ~ ~ a
calculate how many mg of local anestRetic a atient has
Review 1997 received,
lidocainee.g.
solution? 2% lidocaine
how many
mg/l ml, so 36 in 1.8 ml.
is a r r nin/ 1i.tPml
mg of lidocaine
--V '
-
a 2%
0 0 mlofor 20

This list of questions and topics is the result of going through 1. Which of the following is a local anesthetic subject to
about 10 years worth of old Board Exams in inactivation by plasma esterases?
Pharmacology, cutting out all the questions, cate orizing a. Procaine
them into topic areas (e.g. antibiotics, local anesketics. b. Lidocaine
etc.), and then further grouping them into the r p of c. Prilocaine
information about a cat ory of drugs that was being d. Mepivacaine
asked for. When you d o x s , you see that many exams e. Bupivacaine
repeat questions (sometimes they reword them a little bit to
make them look different!), but in actuality it is possible to (n) ~ r o c c i i ~ is
r e tlre ollly ester listed -- nll the rest nre
e t a feel for the various facts that you are expected to nntides
&now,and that there arent that man of them. As you go
through this handout, you will see t L t I point out to you
the major facts that tend to get asked aver and over again 2. Procaine differs from lidocaine in that
for the various ma' r drug categories, and I also give you
P
actual examples o questions (and the reworded versions),
as well as the correct answer. In some cases, I have
a. Procaine is a p-aminobenzoic acid ester and lidocaine
is not
b. Lidocaine is a meta-aminobenzoic acid ester and
written out a detailed explanation of the answer, just to rocaine is not
enlighten you further. So good luck and enjoy. c. r h e duration of action of procaine is longer than that of
an equal total dose of lidocaine
The 2nd part of this handout rovides some clinical scenarios d. Procaine hydrochloride is metabolized into
that may help you regarling Part B. diethylaminoethanol and benzoic acid.

(n) this is bnsicnlly n true-filse type qlrestio~r.(n) is tile


oltly stnten~atttlmt is true

3. Which of the following local anesthetics would be expected


Local Anesthetics to produce a sensitization reaction in a patient allergic to
lidocaine?
I. The largest category of LA questions focuses on your ability a. Mepivacaine
to distinguish amide LAs from esters: b. Tetracaine
c. Procaine
d. Prilocaine
esters = procaine, tetracaine, cocaine. All the rest are amides: e. Dibucaine
lidocaine, mepivacaine, bupivacaine, prilocaine, dibucainc.
They also require you to know that amides are metabolized i. (a), (b) and (c)
in the liver, esters mainly b esterases in plasma. An ii. (a), (d) and (e)
infrequent question asks iviich class of drugs has the most iii. (b) and (c) only
consistency in structure. LAs are the drug group most iv. (b), (c) and (dl
consistent in drug structure, because LAs are either amides v. (b), (dl and (el
or esters, differing only in their structure in the intermediate
chain (its either an amide or an ester) that connects the
(ii) nllotiler ester us. antde t pe ide~tfificatiott
aromatic group to the secondary or tertiary amino terminus.
q~testio)t.lidoccni~te X
is nn nnti e, thtrs other nmdes will be
cross-allergetric - mepivnmirre, prilocnine atrd diblrcailte
11. The next cate ory of uestions has to do with toxic reactions nre the other anrides listed. Procnitre a d tetracaine are
to local anestietics, e k e r due to high systemic levels of esters and will trot be cross-allergenic.
local anesthetics in general (cardiovascular collapse due to
myocardial depression, h tensive shock) or to a specific
agent such as prilocaine, w%h causes methemoglobinemia.
9. The h drolysis of procaine occurs mainly in the
III. A 3rd class of questions are aimed at your knowledge of the a. liver
mechanism of action of local anesthehc,:: they revent the b. Lungs
generation of nerve impulses by interfering wit! sodium c. Plasma
transport into the neuron. d. Muscles
e. Kidneys
IV.The last most frequent ty of question regarding local
anesthetics has to d o witKssues re arding absor tion of rocaine is nlr ester; esters nre nzetabolized
R
local anesthetics. Remember, only t e non-ionizei'(or free
base form) form can penetrate tissue membranes. Inflamed
F d n l i n n i c l t j by pscudoodtolirtesleraser in the plnsma.
tissue has a lower than normal pH, which decreases the
amount of non-ionized form available to penetrate.
10. Which of the following is local anesthetic subject to
inactivation by plasma esterases?
a. Lidocaine
b. Prilocaine
c. Tetracaine
d. Mepivacaine
e. Bupivacaine

plnsnln esternses - tet rncniiie


(c) esters nre nretnbolized
"r
is tlle ollly ester listed, nli t re rest nre nnrides

13. Amide-type local anesthetics are metabolized


11. The activity of procaine is terminated by a. Serum
a. ELimination by the kidney b. Liver
b. Stora e in adipose tissue
c. ~ e t a % o l i s m
in the liver on1
d. Metabolism in the liver a n g b y pseudocholinesterase in e. Axoplasm
the plasma
( b ) do1l.t forget: esters ill plnsnrn; nnrides in liver
(dl renlenrber #9 nbove? see tlle zc~ord "nrnhrly"? snnle
qltestio~r,brrt worded n little differently to tlrroru yorr off.
Agni~r,procabre is n11 ester; esters nre nletnbolized 16. Severe liver disease least affects the biotransformation of
redonlirtntely by psercdoclrolirresternses in the ylnsnrn, which of the following?
&ct nlso to sonw exte~rtby esters br tlre liver. a. Lidocaine
b. Procaine
c. Prilocaine
2. All of the follo\\.in factors are significant determinants of d. Mepivacaine
the duration of coniuction block with amide-type local
anesthetics EXCEPT the (b) Alrswer is (b)- Yorc slrorcM be nble to recog~ii:e tlmt nll
a. H of tissues in the area of injection of tllese drrcgs nre local nnesthetics. Local nnesthetics nre
b. begree of vasodilatation caused by the local anesthetic of olre of two t pes, eitller esters or nnrides. Ester types
c. Blood lasma cholinesterase levels nre sub~ectto ~ydrolysisirr tlle pbsnln n ~ l dthus llnw
d. Blood i o w through the area of conduction block
e. Concentration of the injected anesthetic solution d
short llnl liz~es.Anrrdes nre nretnbolized prinlnrily in tlre
liver nn llnve loll er llnlf liz~es.Tlrrcs t l ~
biotm~~sfornrntio~~ feg., ndnbolisnt; ngnin, t l rats
~ are
( c ) tlre word "EXCEPT" slrortld nlert voll tllnt this is ltsilrg n difiere~rtword to corrfrcse oil, even thouglt t l q
bnsicall n trice-fnlse ty\~e qrrestiorr with 4 true stntenle~rts ore asking the snnle basic questiorlr o an n n d e type local
arm I glse sfnten~e,rt; yorr rcrt llrlz~eto fi lire orlt tohicli nlrcstlletrc would be tlle most nltera/in tlre presetrce of
one! 111 tlris cnse, yorl pot bnzle to renrenrfer tllnt lnsnrn sezper liver disease. Tlle key word here is "least ". O f tlre
R
clroli~lesternseIez~elsnre ollly inrportnlrt for the itrntiorr
of nctio~rof ester-ty e LAs, rot anrides, wllicll nre
drrcgs listed, oirly procni~leis a11 ester. Tlle rest are
n nr rdes.
nretabolized br tlre i z r r . All tlie otlrr stntmte,rts ore
z~nrinbfestohiclr nffect drirntioll of the block, blct apply to
botlr esters nrrd nnrides.
Questions regardi~zgtoxicity:

13. Which of the following is contraindicated for a patient who 17. A patient has been given a large volume of a certain local
had an allcr ic reaction to procaine six months ago? anesthetic solution and subsequently develops cyanosis
a. Nerve Aock with lidocaine with methemoglobinemia. Which of the following drugs most
b. Topical application of lidocaine like1 was administered?
c. To ical application of tetracaine a. Locaine
d. 1ntf;tration with an antihistamine b. Prilocaine
c. Dibucaine
(c) agnitl, just anotller qriestiot~tllnt requires yo14 to be d. Lidocaine
nble to pick out an ester or all nnride from n list. Si~rce e. Mepivacaine
procairre is all ester, oirly nnotller ester L A worrM be
cross-nllerge~ric.111 tlris list tlre o ~ l l yestcr listed is (b) strictly rnemorizat ion
tet racaine.

18. Use of prilocaine carries the risk of which of the following


14. Bupivacaine (Marcaine 1 has all of the following properties adverse effects?
relative to lidocaine (Xylocaine 1 EXCEPT bupivacaine a. Porphyria
a. Is more toxic b. Renal toxicity
b. Is an ester-type local anesthetic c. Gastric bleeding
c. Has a slower onset of action d. Methemoglobinernia
d. Has a longer duration of action
( d ) snnre as above but a s k d backwards.
(d) Accordi~rgto textbooks, local n~restlleticsfall ill to tlle Metllenloglobi~lenrianlny resrilt from a tolliiditte
1-reparedL?.M.L. Thompson, Ph. D.,Dept. Of Pharmacology, Tufts Medical School

nretnbolite oj prilocnittc, ortlrotolrt idine. c. Lidocaine


d. Tetracaine
e. Mepivacaine
19. The most robable cause for a serious toxic reaction to a
local anestEetic is (n) A~rsweris (0)- A11 tlre listed locnl ntrestl~eticse x q t
a. Psychogenic cocaitte are z~nsodilntors,especinlly ester-dy e drrtgs
b. Deterioration of the anesthetic agent suclt as proccnbte ntrd tlre nnride lidoca6te. &caitte is the
c. Hypersensitivity to the vasoconstrictor only local anestlretic tlrat predictably prodlrces
d. Hypersensitivity to the local anesthetic vasocorrstridiott . Cocnitte I S nlso tlle o1tly Jocnl nrtestlletic
e. Excessive blood level of the local anesthetic to block tlle rertptnke o NE i ~ t t ondrelrer 'c trertro~ts,n~rd
thus potetrtinte f l u NE! tlrat lras bee11 r e g d fronl rterve
endirrgs
(e) Most toxic renctio~tso j n seriorrs tmtrrre nre rehted to
excessive blood levels arising fronr ittndvertnrtt
i~rtravascrtlnr inject io11. Hypersertsitiz)ity react iotts
(options b b c ) are rare, brtt excessiz~eblood Zez~elswill 24. Which of the followin anesthetic d m g s produces powerful
induce toxic renctions like C N S stintrtlntio~tin ntost stimulation of the ceretral cortex?
eveyotte. This is n cnse wllere optiort (e) is the a. Cocaine
"best "n~tszuer,becnrtse it is nrore likely tlmtr tlle other b. Procaine
altotrntiz)es, which ntight be true, but are ttot as likely c. Lidocaine
(e.g, "nrost probnble") to lmppmt. d. Tetracaine
e. Mepivacaine

20. High lasma levels of local anesthetics may cause ( n ) see explntrntiotr nborle
a. 1nRibition of eristalsis
b. stimulation oPbaroeceptors resulting in severe
hv~otension
c. 16fiibition of the vagus nenle to the heart Questions regarditig mechanisnz of actiotz:
d. Depression of inhibitory neurons in the CNS

(dl itr itinlly LAs irrlribit cetrtrnl itrlribitory rtertrotrs, 25. Local anesthetics block nerve conduction by
wlriclt resrtlts in C N S stinrrtlntioir, wlliclr cntt :,roceed to a. Depolarizing the nerve membrane to neutrality
corrr~rrlsio~rs.At lriglter doses, t l q itrlribit bar!; i~rlribitory b. Increasing membrane permeability to K+
nitd excitntoy ~rertrotrs,lendirrg to n geirernlized stnte of c. Increasing membrane permeability to Na+
C N S depressiott zulriclr cn~rres~tIt itt respirnto y d. Preventing an increase in membrane permeability to K+
depresstort ntrd denth. e. Preventing an increase in membrane permeability to Na+

(c-! didtt't 1 nuke yorc ntenrorize this?You should at kenst


21. Cardiovascular collapse elicited by a high circulating dose rcntenrber Na+ iorts are i~tz)olz)ed, whiclt Jintits your
of a local anesthetic may be caused by clroices to ( c ) a ~ t d(e). (c) wottld irrcrease or jacrlitnte
a. S ncope rrervous intprt lse cotrdrtctiorr, zolriclt is the opposite oj
b. &gal stimulation wlrnt yorc want tlle locnl nttestlletic to do, so pick (e).
c. Histamine release
d. Myocardial depression
e. Medullary stimulation 26. Which of the following is true regarding the mechanism of
action of local anesthetics?
( d ) Cnrdior)nsncrthr colhpse is drre to n direct nctio~roj a. Usually maintain the nerve membrane in a state of
tlre locnl ntrestlretic otr tlte lrenrf ntrtscle itself (LA'S itr hyperpolarization
toxic doses dcpress nrentbm~reercitnbility n ) d cotrdrtctio~t b. Prevent the generation of a nerve action potential
zrlocity), tlrrrs ( d ) is tlle correct nirszoer. All oj tlre otlrer c. Maintain the nerve membrane in a state of
nlter~tativesnre i~rdirectwnys to nfiect tlre lzeart. depolarization
d. Prevent increased permeability of the nerve membrane to
tassium ions
e. Kerfere with intracellular nerve metabolism
22. The most serious consequence of systemic local anesthetic
toxicity is (b) this should be really obz)ious!
a. Vertigo
b. Hypertension
c. Hyperventilation
d. Post depressive central nervous system convulsions 27. Local anesthetic agents prevent the generation of nerve
e. Postconvulsive central nervous system depression impulses by
a. Decreasing threshold for stimulation
b. Decreasing restin membrane potential
(e) Of the aptior~slisted, tlris is tlle one t h t will kill the
patient, whrclr I guess m k e s it tlle most serious.
c.
d.
%
Decreasing inwar movement of sodium ion
Increasing inward movement of potassium ion

(c) Answer is (c)- strni ht memorizntiotr- nerve impulses


23. Hypotensive shock may result from excessive blood levels are gerrerated b y the infBux oj sodiunr resulting in
of each of the following local anesthetics EXCEPT depolarization. repolarrzatio~rnttd itractivity occurs wlletr
a. Cocaine otassirrm moves out. (sodiunr-potassittnt pltmp). LAs act
b. Procaine Ey b l o c ~ n gNO+ nrovenrettt.
Menibrnire pernrenbility is nffected by zulretlter or i1ot tlte
nlolecrrle is "clrarged" or ioiritd or irot (e. ., ~ilrioirizcd).
Oiily tlre latter jornr pnsses rendily tlrrorcgTr nrenrbmiies.
28. Local anesthetics interfere with the transport of which of See, tlrey're nskrrrg the snnze tlriirg tlrey nsked iti tlle
the following ions during drug-receptor interaction prezjiorrs qlrestioir, just conriirg nt it front airother nirgk.
a. Sodium Renrenrber tlre fact nrrd yorr cnir correr tlle niigles.
b. Calcium
c. Chloride
d. Potassium
e. Magnesium 35. At a pH of 7.8, lidocaine (pKa = 7.8) will exist in
a. the ionized form
b. the nonionized form
(n) see lrow nmtry differeirt wnys tlrcy cnir nsk tlrr snnie c. an equal mixture of ionized and nonionized forms
qrtestioir? d. a mixture 10 times more ionized than nonionized forms
(c) the ratio ofioirizeri to uirionized forms is giveif by tlle
Questions regarding pH effects on absorytiorr formula lo A I M = H-pKa. In this instniice tlre
diJfereirce %etwrcn pfl aiid pKa is 0.Thrrs lidocnhre will
of local anestlzetics exist as air eqrral mixtrrre ( so (c) is correct). Most lourl
nnestlletics nre wenk bnses with pKn rniigiiig from 7.5 to
9.5. LA'S i~iteirdedfor iirjectioii are rrstrally prepared iii
30. If the pH of an area is lower than normal body H, the
J
membrane theory of local anesthetic action pr icts that the
snlt fornr additioii of HCI. Tlrey peiretrnte as tlre
rririotrizec.i%rnr iirto tlre ireuroir ~ulreret l q reeqrrilibrnte
local anesthetic activity would be
a. Greater, owing to an increase in the free-base form of
the drug
f ,!
to botli clmr ed nird rrirclrnr ed ornrs iirside tlle ireuroir -
tlre positive& clinrged ioir loc s irerzr coirdrrction.
b. Greater, owing to an increase in the cationic form of the
drug 33. The more rapid onset of action of local anesthetics in small
c. Less, owing to an increase in the free-base form of the
nenres is due to
d% a. The slightly lower pH of small nerves
d. Less, owing to a decrease in the free-base form of the
b. The jyeater surface-volume ratio of small nerves
d% c. The increased rate of penetration resulting from
e. None of the above
depolariza tion
d. Smaller nerves usually having a higher threshold

Wlro kirorus? Who cores? probnbly tlle nirswer is (b) - tlle


31. A local anesthetic injected into an inflamed area \\*illNOT tlreo goes tlrnt tllere is n srre depeildeirt criticnl
give maximum effects bccausc leirg;): of ai~estlrteticexposure irecessary to block a
a. The pH of inflamed tissue inhibits the release of the free
base
b. The drug will not be absorbed as rapidly because of the
1
give11 trerve. Snmll fibers zuill be blocked irst becnrise
tlre nirestlrefic cor~ceiitratiotrto It criticnl engtlr iii n
snlnll fiber ulill be renclred fnster tllnir tlre criticnl
decreased blood supply leirgtlr iii n Inr er fiber. Yorr lmve to block tlrrec irodcs of
c. The chemical mediators of inflammation will present a rniir~ier,aird t l e y nre fnrtller npnrt br lnrger fibers tlmir
chemical antagonism to the anesthetic they nre iir snrnll dinnreter fibers. Mnke s n r d
d. Prostaglandins stabilize the nente membrane and
diminish the effectiveness of the local anesthetic

(n) zulrile sonre o tlle otlrer n1terirntiz)es solrild plnrrsible, 34. Which of the followin statements are true regarding onset,
tlibik nborrt tlre /Rctoids you were tnlrglrt "bout lourl degree and duration ok action of local anesthetics?
a. The reater the dru concentration, the faster the onset
1
niiestlletics nild twrinbles thnt n cct tlreir nctioir. Air
inrportniit oire runs tlle role of p nird ioirizntioir fnctors.
Remeniber, tlle free bnse or rrotrioirized fornr is the fornr
and k e greater the %e of effect
b. Local anesthetics b l o c ! n l y myelinated nerve fibers at
tlrnt passes throiiglr nrenibmircs, yet oirce iiiside tlle the nodes of Ranvier
c. The lar er the diameter of the nerve fiber, the faster the
"f
neuron oirly tlte roirized form is e ective. lnflnnrnred
tissue Ims a lower pH tlrnil irornrn tissrre niid will slrift
the equilibriunr of the L A solirtion srrclr t h t niost of it
onset of effect
d. The faster the penetrance of the drug, the faster the onset
remains i o n i d and thus rlirnz~nilnbleto perretrnte of effect
i. (a), (b), and (c)
ii. (a), @) and (dl
32. The penetration of a local anesthetic into nervous tissue is iii. (a) and (c) only
a function of the iv. @I, (c) and (d)
a. Length of the central alkyl chain
b. Lipid solubility of the ionized form
c. Lipid solubility of the unioniztd form
d. Ester linkage between the aromatic nucleus and the
alkyi chain
I
(ii) if you knew the act above about small nerves, then
this uestion basica ly becomes a true false t pe thin ,
nild rc) is thefalse statement. (a) and ( d ) m a h lo .caf
e. Amide linkage between the aromatic nucleus and the sense so you are stuck picking between fb) and (cf You
alkyl chain h u e your ick of ntemorizirrg tlre smnll irerve thing or tlre
myelrirata!nerue nodes of rairoier thiiig.
(c) oirly optioirs (b) nird (c) nre relez~nirtlrere - the otlrers
lmzv ilotlriirg to do ruitlr L A peiretrntioir iirto nrenrbrni~es.
prepared b}' M.L.Thompson, Ph. D., Dept. Of Pharnlacology, Tufts Medical School
A >I" b .f
35. A dentist administers 1.8 ml of a 2% solution of lidocaine.
HOW* many mg of lidocaine did the patient receive?
a. 3.6
b. 9
c. 1 8
d. 36
e. 180 Antibiotics
1. The most frequently asked type of question rquires you to be
able to compare various penicillin antibiotics m terms of
potency against certain bugs, allergenicity, drug of choice
against certain conditions, etc. For example:
36. Three ml of a local anesthetic solution consisting of 2%
lidocaine with 1:100,000 epinephrine contains how many a. Penicillin V vs. enicillin G: the latter is more
milli ams of each? sensitive to acicfdegradation and thus is usually
a. Fmg. lidmine, 0.3 mg. epinephrine injected rather than taken orally
b. 6 mg. lidocaine, 0.03 mg. epinephrine
c. 60 mg. lidocaine 0.3 mg. epinephrine b. Which nicillin has the best gram-negative spectrum:
d. 60 mg. lidocaine 0.03 mg epinephrine ampiciKn
e. 600 mg lidocaine, 0.3 mg. epinephrine c. Which dru s from a list are or are not cross-allergenic
f. 600 mg. lidocaine, 0.03 mg. epinephrine with penic!hin: most usually asked about ones are:
cephalosporins and ampicillin are, erythromycin isn't
( d ) 2% lidocniltc = 20 nrglnrl x 3 = 60 nrg lidocni~le d. Which penicillin is useful against penicillinase-
1:100,000 epi = 0.01 nrg/n~lx 3 = 0.03 nrg cpi producing bugs such as staphylococcus: dicloxacillin
e. Which is specific for Pseudomonas infections: an
extended spectrum such as carbenicillin
37. The maximum allo~\.ableadult dose of mepivacainc is 300
mg. How many milliliters of 2% mepivacaine should be f. Which combination of agents should be used
injected to atta~nthe maximal dosage in an adult patient? prophylactically for atient with heart valve to
a. 5 prevent bacterial enxmarditis: ampicillin and
b. 10 gentamycin (1988- according to latest recommendation
c. 15 of AHA and ADA, although use the latest guidelines
d. 20 that you have heard about))
e. 25

2. The 2nd lar est category expects you to know the mechanism
of action o h h e various antibiotics:
a. Bactericidal a ents such as penicillin kill rapidity
growing cells%y inhibiting cell wall synthesis
38. A recently introduced local anesthetic agent is claimed by
the manufacturer to be several times as potent as procaine. b. Bacteriostatic agents such as tetracycline limit
The roduct is available in 0.05% buffered aqueous solution population growth, but do not kill bu s by interfering
in I.&. cartridge. The madmum amount recommended for %
with protein synthesis on bacterial ri osomes
dental anesthesia over a Chour period is 30 mg. The amount c. Antifungals such as nystatin bind to ergosterol in
is contained in approximately how many cartridges? fungal cell walls to weaken the wall
a. 1-9
b. 10-18 d. Bacteriostatic a ents such as the sulfonamides compete
C. 19-27 with PABA in klic acid synthesis, thus resulting in
d. 28-36 folic acid deficiency
e. Greater than 36

( d ) 0.05% = 0.5 niglnrl . To gizle 30 nrg, yorc irate to give


30nrg/0.5 nrg/ml or 6 0 nrl. 1 cnrtridge = 1.8 ml, thus 60nrl 3. Many uestions are asked regarding drug interactions or
/1.8ml = 33.3 cnrtridges. - irst express the percentnge of side ezects or toxicities of penicillins, tetracyclines,
solutiorr as a fraction o 1O d the11 add tiw units gm/ml. clindamycin, etc:
0.05% unls 0.5 or 1 h gms per 100 nrl. The cnrtrd e is a. What are symptoms seen during allergic reactions to
1.8 rnl %ich you can routtd off to almost 2 mls total. fn penicillins: dermatitis, stomatitis, bronchoconstriction
firis 2 nrl you wouM ltazpe 1 gnr of the local altestlzetic. You and cardiovascular collapse
need to p v e 30 I S , wlticir would reqiiire 3 0 cartridges.
The alternative %1 meets tlris answer is ( d ) . Dotr't get b. What agent produces GI upset and pseudomonas colitis:
tricked by tlre plncentetrt of tlze decinlnl poitrt-many peo le clindamycin
remi tlw 0.05% ns bebtg tlte sunw ns 5 gnrs rntlwr tlul1l gS c. Which agents are most likely or least likely to cause
gnrs. superinfection: most-broad spectrum agents such as
tetracyclines; least-narrow spectrum agents such as
penicillin G
d. Aplastic anemia is associated with chloramphenicol
8 The principal difference a m o n g ~ t a r s i u mprocaine
, and
e. Liver damage or hepatotoxicity is associated with benzathine salts of penicillin is their
tetracycline a. Potency
f. Erythromycin estola te associated rvi th allergic b. Toxicity
cholestatic hepatitis c. Duration of action
d. Antibacterial spectrum
e. Diffusion into the cerebrospinal fluid
4. Questions involving interactions between antibiotics and (c) agairr, just nskirtg yori to hiow sonrething about tlte
other drugs: zlnriorrs fornrs of poricilliir. Since irr niost cnses yori nre
a. Tetracycline and penicillin cancel each other out due to goirrg to use Perf V K ornlly, this qriestiorr is nrr old orre
opposing mechanisms of action slrowirrg i f s age and probably not likely to a p p r atrynrore
orr bonrd excams
b. Probenecid alters the rate of renal clearance of
penicillin
c. Effectiveness of tetracyclines is reduced by concurrent '10. All of the following antibiotics are considered to have a
ingestion of antacids or dairy products high rate of allergenicity EXCEPT
a. Penicillins
d. Broad spectrum antibiotics enhance the action of b. Erythromycin
coumann anticoagulants because of the reduction of c. Sulfonamides
Vitamin K sources d. Amphotericin B
e. Antibiotics such as am icillin decrease the effectiveness
of oral contraceptives Bue to suppression of normal GI
flora involved in the recycling of active steroids from
bile conjugates, leading to more rapid excretion of the 11. Which of the followin antibiotics is cross-allergenic with
steroids from the body penicillin and should $0~he administered to the penicillin-
sensitive patient?
a. Am icillin
b. ~r-yt\rom~cin
Frequelztly asked questio~lson n~itibiotics: c. Cllndamycin
d. Lincomycin
e. Tetracycline
5. For treatin most oral infections, enicillin V is preferred to
penicillin because penicillin sort of sortrlds like perricillirr so it mrtst be
(n) an~picillii~
a. Is less allergenic fhe nrrswer
b. Is less sensitive to acid degradation
i. E: eater am-negative spectrum
X n 6 e r %ration of action
e. Is bactericidal, whereas penicillin G is not
12. Which of the following antibiotics may be cross-allergenic
with enicillin?
a. 8mmycin
(b) nrenrorizntiorr: bnsicnlly !\re oilly diffcrerlce b. Cephalexin
c. Clindamycin
6 . The sole therapeutic advantage of penicillin V over d. E thromycin
e. ~ y o the
f above
penicillin G is
(b) ntis is n nrenroriznfiorr rlestiorr, witlr (b) tlle correct
a. Greater resistance to penicillinase n~rsruer.Yorr h u e to rentenier tlmt the ceplulosporira
b. Broader antibacterial spectrum (like cephalexitr) are clunricnlly relnted to tlle penicillitrs.
c. More reliable oral absorption Tlle otl~ersnre not clrenlicnlly relnteci nrrd thrrs cross-
d. Slower renal excretion nllergeiricity is urllikely
e. None of the above
(c) reworded zlersiorl of tlle abozle
13. Which of the following antibiotics shows an incidence of
7. Which o f the following penicillins is administered ONLY by approximately 8% cross-allergenicity with penicillins?
deep intramuscular injection? a. neomycin
a. Am itillin b. cephalekn
b. ~ i c ~ x a c i l l sodium
in c. bacitracin
c. Penicillin G procaine d. vancom cin
d. Penicillin V potassium e. tetracycLne

(c) Answer is (c)- (a), (b)ntrd ( d ) are all used orally.


(b) 'ust slight1 reworded version of the above questiorr, brrt
Penicillirr G is destroyed b ncid itr tlte stonrnclt resultittg with some drf&ent alternatives throwrr in. Obviously, ij
in rwriablc arrd irregular n!sorptiorr. Perricillin V is acid yort a n recognrze w h t k r or not a drug is a penicillin or a
stable and ar~ailnblefor oral use. Petricillirr G procaine is ceplralospori~t,and you remember that these are the classes
typically g'vetr iir tmnrrrscrtlnrl in repository form, t h t show cross-allergetricity, therr you cart handle any
yieldins n tiss~iei f ot hont ioficb the drlt b nbsorbd rezoordirrg of this question.
over horrrs. In this T r m , if cnrtrrot be girrrl fV or
srtbcrttnrreoalsly.
14. Which of the following groups of antibiotics is related both
structurally and by mode of action to the penicillins?
a. Polymyxins
Prepared by M.L. Thompson, Ph. D., Dqt.Of Pharnlacolog-, Tufts Medical School

b. Cycloserines c. Methicillin
c. C e halosporins d. Penicillin V
d. ~ h r o r a m ~ h e n i c o l s e. Phenethicillin

(c) see nboae (bj

13. For the dentist, the most reliable method of detecting a 18. Which of the following antibiotics should b e considered the
FP
patient's allergy to nicillin is by
a. Injecting penic~lin intradermally
b. Taking a thorou h medical history
drug of choice in the treatment of infection caused by a
penicillinase-producing staphylococcus?
a. Neomycin
c. Placing a drop of penicillin on the e e b. Ampicillin
d. Having the patient inhale a penicilin aerosol c. Tetrac cline
e. Injecting a small amount of penicillin intravenously d. ~ e n i c i i i nV
e. Dicloxacillin
(b) all of the other metlrods itrz~olr)etrrtncceptnbk risk.
Orlce setrsitized, evert a snrnll anrotort cnrr cnrtse arr
nllergic resporlse. Renrenrber, it is riot n dose-relnted
respotrse t h t worl't be problenrntic if yorr only irlject ti
little bit. 19. Oral infections caused by organisms that produce
penicillinase should be treated with
a. Am icillin
14. Which of the following antibiotics is the substitute of b. ~ i c K x a c i l l i n
choice for penicillin in the penicillin-sensitive patient? c. Erythromycin
a. Bacitracin d . Any of theabove
b. Erythromycin e. Only (a) o r (c) above
c. Tetracycline
d. Chloramphenicol ( b ) of those listed orrly ( b ) is yetricillitrnse resistnrlt.
Anrprcillirr is nri extertded spectrtrnr poricilliil, nrrd is trot
pet~icillirlnse resistntrt .

20. Which of the following antibiotics is LEAST effectikle


against penicillinase-producing microorganisms?
a. Am icillin
b. cepRalexin
c. Methicillin
d. Clindamycin
e. Erythromycin
15. Most anaphylactic reactions to penicillin occur
a. When the drug is administered orally (n) snnle qrrestiotr nsktd bncknsswnrd
b. In patients who have already exper~encedan allergic
reaction to the d r u g
c. In atients with a negative skin test to penicillin allergy 21. Which of the following is a bactericidal antibiotic used
d. ~ R e the
n drug is administered parenterally ifically in the treatment of infections caused by
e. Within minutes after drug administration SEdonrorras species and indole-positive Proteus species?
a. Ampicillin
b. Penicillin V
i. (a), (b) and (d) c. Tetracycline
ii. (b), (c) and (d) d. Dicloxacillin
iii. (b), (d) and (e) e. Carbenicillin
iv. (b) and (e) only
v. (c), (dl and (el (el Wow, I bet you didrr't thirrk t l q woitld ask sonlrtllittg
like this!. An extended spectrunt agetrt is required.
Anrpicillin is ineffectizw, while Peii-V is too narrow irl
spectrum.
Which of the following penicillins has a broader gram-
trum than penicillin G? 22. Penicillin's effectiveness against rapidly growing cells is
n?a%,'iK
b. Am icillin
primarily d u e to its effect o n
a . Protein s nthesis
c. cepRalexin b. Cell wal&nthesis
d. Methicillin c. Nucleic acld synthesis
e. Penicillin V d. Chelation of metal ions
e. CeU membrane permeability

17. Which of the following penicillins has the best gram-


negative sst;ectrum? 23. Chlortetra cline acts b y interfering with
a. Nafci lin
b. Ampicillin
?'
a. Cell wa 1 synthesis
b. Nuclear a a d synthesis
c. Protein synthesis on bacterial but not mammalian suclt ndz)erse side effects ns rleplrrotoxicity nnd
ribosomes lrypoknlentia, btrt lizler toxicity.'Tlttts (c) ts tlte correct
d. Protein synthesis on mammalian but not bacterial nrrswer. Tetrncyclirres llnzre beer1 sltozutt to be llepntotoxic
ribosomes follozoitrg high doses irt pregrrnttt pntiettts luitlt n lristoy
of rertnl disense.

29. Which of the following erythromycins associated with an


24. The probable mechanism of the bacteriostatic action of aller ic cholestatic hepatitis?
sulfonamides involves a. Erythromycin base
a. Disruption of the cell membrane b. Erythromycin stearate
b. Coagulation of intracellular proteins c. Erythromycin estola te
c. Reduction in oxy en utilization by the cells d. Erythromycin succinate
d. Inhibition of met&olism by binding acetyl grou s
e. Competition with para-aminobenzoic acid in foyic acid
synthesis
30. Which of the following antibiotics is LEAST likely to cause
superinfection?
a. Gentarnicin
23. The sulfonamides act by b. Tetrac cline
a. Sup ressin bacterial protein synthesis c. ~ e n i c i i i nG
b. lnhi[iting tge formation of the cytoplasmic bacterial d. Streptomycin
membrane e. Chloramphenicol
c. Inducing the formation of "lethal" bacterial proteins
d. Inducing a deficiency of folic acid by competition \\*ith ( c ) srrperiufectio,~nre rrsrtnlly s e w follozuilrg the trse of
para-aminobenzoic acid brood spectrrrnt ngertts. Of tlrose l i s t d , nll nre wide
spectrrrnr except Pen-G

31. Gastrointestinal upset and seudomembranous colitis has


26. Which of the follot\*ingstatements is true regarding been rominently a s s o c i a t e k t h
streptom cin? a. 8ystatin
a, It is gactericidal b. Cephalexin
b. It has a gram-positive spectrum c. Clindamycin
c. It is usual1 administered orally d. Polymyxin B
d. It disruptsiacterial cell membranes e. Erythromycin
e. It is associated a low incidence of bacterial
resistance
(n) c is ,tot trrtc: streytonrycitr is ndntirristerd o t ~ l yz~in
itljectiotr; (e ) is fnlse: resistnrrce dez)elops rnpidly

27. Tetracycline reduces the effectiveness of cencemitantly 32. Sym toms that may be characterized as allergic
administered penicillin by manirestations during penicillin therapy are
a. Reducingabso tionof a. Deafness, dizziness and acute anemia
b. Increasing meta'golism openicillin
penicillin b. Crystalluria, nausea, vomiting and anaphylactic shock
c. Increasing renal excretion of penicillin c. 0 1 1 uria, hematuria, bronchoconstriction and
d. Increasin binding of penicillin to serum proteins carsiovascular collapse
e. Nenc ef t f e s k v e d. Dermatitis, stomatitis, bronchoconstriction and
cardiovascular collapse
(e) tetrn clirre is bnderiostntic ntlii would slow tlre rpiii
owth o F h r nlicrobinl populntiott tlmt n bnctericidal
%trg rtrclr ns petticillitt t t d s to be effectirr

33. Aplastic anemia is a serious toxic effect that occurs


28. Which of the following antibiotics is most likely to cause articularIy after a course of treatment with which of the
liver damage? Pollowing antibiotics?
a. Streptomycin a. Penicillin
b. Penicillin G b. Lincomycin
c. Tetrac cline c. Tetracycline
d. ~ e ~ h a r o s p o r i n s d. Streptomycin
e. Amphotericin 0 e. Chloram phenicol
(c) Answer is (c)- (n), streptonrycitr cntr dnmnge the
eigltth nerve, affectitrg botlt bnlntlce nrtii lmri~tg,,brrt is
trot associatd witlt ltver daninge. (b): otlrer tjmn nllergic
I
renctiotrs, erricillills are extremely snfe, with rio efect ort
the liver. &), tlte ceplmlosporite nre clrenricnlly re n t d to
tlre petricillitts nrtd slmre tlteir relntively rto~rtoxictrntrire.
34. Each of the followin is a side effect of rolonged
tetracycline hydrochforide therapy EXE
a. Suprainfection
!(W
(e), nnrpltotericitt B, is nrt ntitifiotgnl ngetzt tlmt prodrices b. Photosensitivity
Prepared by M.L. Thompson, Ph. D..Dept. Of Phannacolop, Tufts Medical School

c. Vestibular disturbances administration


d. Discoloration of newly formin teeth
e. Gastrointestinal symptoms ( d e n administered orally) (A)

39. Which of the following has the broadest antimicrobial


spectrum?
35, Gastrointestinal upset and seudomembranous colitis have a. Vancomycin (Vancocin )
been prominently asvxiatefwith use of which of the b. Clindarnycin (Cleocin )
follow$ng anti-infective agents? c. Erythromycin (Erythrocin )
a. Nystatin (M costatin ) d. Chlortetracycline (Aureomycin )
b. Cephalexin keflex ) e. A third generation cephalosporin
c. Clindamycin (Cleocin )
d. Polymyxin B (Aeros (if) Arrswer is (d)- renrenrber, tetracyclirtes are brond
K"""
e. Erythromycin (Eryt r o a n ) spectrrt nr antibiotics ellfectir~eagninst both gram-negntizv
nr~dgram-positiz)e cocci nnd bacilli. Clirianrycirr has a
spectrrtm of actiz)ity similnr to erthyrom cin arid
zvnconrycin, wlriclr is less tlvtrr tlurt of t h tetrncyl6res,
nrnirrly aflect irrg r r n - p o s i t ive nricroorgarrisnrs. 1st
generatiori cephn osporrris are eflective agninst both
Antibiotics, Miscellaneous gmnt-negative arrd gram-positit~eor airisnrs, bilt the
third gerrerntion orres imoe irrcreasei nctizlity ngnirrst
gmnr-rregntive brlt grently decrensed nctivity ngniirst
36. In accordance with the latest recommendations of the grnnr-positive nricroorgnrr isnrs.
American Heart Association and the American Dental
Association, a dental patient tvith a prosthetic heart valve
with no drug allergik should receid prophylactically 40. Sulfonamides and trimethoprim are synergistic
which of the follo!zring antibiotic com inations? bacteriostatic agents because in bacteria they
a. Ampicillin and cephalexin a. Both inhib~tfolic acid synthesis
b. Ampicillin and entamicin b. Interfere sequentially with folinic acid production
c. Gentamicin anterythromycin c. Are both antimetabolites of para-aminobenzoic
d. Erythromycin and tetracycline d. Are both inhibitors of dihydrofolic acid reductase
e. Penicillin G potassium and vancomycin e. Are both transformed iir ziw into a single active
compound
( b ) - Pntieirts toitlr prostlretic llenrt z~alz~es
nre nt risk for
bncterinl eirdocnrcfitis, aird t h i s req~!irenrnxinrrlnr
prop11 lnxis n nirrst possible iirfectiotr fronr deirtnl
procdures. T f i s reqiqlles n conrbhmtiotr of arrtibiotics
ojferirrg rotectioir ngaiirst both gmnr rtegntitre nitd
E:'
positizr Rncterin. ( b ) is the conrbrrrntiort yorr sltorrM
nrenrorized. It is tlre orrly derttnl use of the nnrirroglycoside
41. Which of the followin substances is the most effective
agent against fungus ~~$ections
of the mucous membrane?
a. Nystatin ointment
gerttnnrycirt. T l ~ econrbinntiort of ,~nnrprcillir~
nrtd b. Undecylenic acid
I
ge~rtnnryciit/ u s n syrrergrstic efect n nirrst streptococci
f
arrd atterococcnl tmrrsiarts irr 1 re orn cnvity tlwt nlny be
relntively iilseirsititpe to eiricilliir nlo~re.Anrpicillitr nrrd
c. Polyrnyxin ointment
d. Saturated magnesium sulfate
e. 10 per cent aluminum chloride solution
gerrtnnryciir conrhirre botRbnctericidnl aid imcteriostntk
nctioir. Mniiy strlderrts nirstoer (e), becnrlse vnrrconrycirr
cnrr nlw be tised iir this sittlntioir, brtt oirl ns arr
nltcrrrntizr to perricilliir iir peiricilliir nllrgic pntieirts.
nrrls the conrbiirntiorr of z~nirconryciirnrrd perricillirr nukes 14. Nystatin is of greatest clinical usefulness in treating
110 ser15e. a. viral infections
b. fungal infections
c. s irochetal infections
d. {acterroides infections
37. The action of which of the following drugs will most likely e. penicillin resistant gram positive infections
be im aired by concurrent administration of tetracycline?
a. &loramphenicol
b. E hromycin
'I;
c. Su onamide
d. Penicillin
f"
(b) Nystatin is the prototypic n n t ~ rignl agetit, tl~lls(b) is
the nrost obvious 1st choice, nrrd e min nates (0). ( d ) 0 5
require an antibiotic, not an antifitngal
e. Lincomycin

42. Which of the following drugs chelates with calcium?

38. A distinct advantage that tetracyclines have over b.


a. ET
PO ymyxin B
hromycin
c. Tetrac cline
penicillins is that tetracyclines d. Penici&n G
a. Have no side effects e. Chlorarnphenicol
b. Do not cause superinfections
c. Are safer to use during prepancy
d. Have a wider range of antibacterial activity
e. Produce higher blood levels faster after oral
43. Which of the following is NOT characteristic of Thris pntieltts zoitlr reirnl disense tr?ill slroul ltiglr blood
tetracycline antibiotics? levels of peiricillirt. Sinrilnrlv, probeiricid, n riricos~iric
a. Absorption is impaired when taken with antacids ngeirt (n drug wlriclr teirds ti, eitlrnirce tlte excretiotr of uric
b. They redispose to monilial su erinfection ncid by rdlrcirrg rerrnl tltbtrlnr trnrts or1 ntednnisnts),
c. They Lrrn a stable complex wit! the developing tooth reduces the reml clenrnitcr o/ peitici6iirs. A t d yo11
matrix zuorrdered why we Imd tlrose lectrires oil
d. They have a low tendency for sensititation, but a high pi~nrnlncokinetics!
therapeutic index
e. They are effective substitutes for penicillin prophylaxis
agalnst infective endocarditis 45. When broad-spectrum antibiotics are administered with
coumarin anticoagulants, the anticoagulant action may be
Answer is (el- A aiir, tile inrportntlt hrnse 61 tlre a. Reduced because of enhanced hepatic drug metabolism
question isrtot(heyI just Wayrre ntlR~nrt11).Obz~ioasly b. Reduced because of increased protein-binding
the fnct tllnt you will renrenrber nborrt tetmcylittes is t h t c. Increased because of reduction of vitamin K sources
they cair discolor teeth itr tlte fetris ruherr tnketr by tite d. Increased because of decreased renal excretion of the
mother duritrg preprnncy. But doir 't circle tllnt ntrszr7er an ticoagulant
because (a) is also characteristic \o tetmcyclitres (tliey are
tite nrost likely of nll the airtibiotics to uttse
superitrfectioir), ntrd is nit nnnoybrg side effect iir ndriits
resultiir fronr nlterntioir of tite ornl, gnstrrc ntrd itrtestiiml
f7ora. 7% renl nitswer is (e). Tetmcycliires nre trot the 46. The thera utic effectiveness of which of the followin
drug of clroice or pro hvhxis ngnrirst iirfectirle drugs w i l l g most affected by concomitant ingestion o k
etrdocndit is. T l i s rs A h to st reptococcnl iirfectioir. 15- antacids?
20% of rotcp A str~ptococciare resistntrt to a. Cephalexin
tetrncyciires, but rtorre nre resistnrrt to petricilliir or b. Erythromycin
e ytlrronrycirr. Recerr tl n noir-streptococcnl itrdrrced c. Tetracycline
slrkcrr f e bnctrrinl etrdcnrditis lvrs beerr idetrtr ied, d. Sulfisoxazole
especinlly iir jtizrrrile periodorrtitis ytients. &e e. Penicillin V
cnrisntizje bncteririnr is rrof srlsceptible to peiricillitl or
erythronlycirl. It nlny be ltecessny to trcnt predisposed
patieirts with tetrncyclitre for n fcz~fweeks, n~rdthen
follow this zoitir n corrrse of pcrricillirr or eytlrronlvcilt.
Renrenrber t1mt these drrlgs nre nrrtngorristic to enclr otllcr
ntrd tlrrls cnrr't be rrsed co~rcr~rreirtly. Perricillitl is n
bnctericidnl drrtg zuilicir kills or destroys nlicroorgnrrisnts
f
by itrter erirrg roith the sytrtlresis or frrrrctiorr o tlrc cell
zunll, ce 1 nrenrbrnrre or both. Tlrrls it is n~oste ~ c t i z r
ngnirrst bncterin timt nre nrriltiplyiirg. Tetrncyclitre is n
bncteriostntic nrrtibiotic tllnt ncts by itl/ribitirr~the grozuth
nrrd nrltlti licntiorr of orgntrisnrs by irtlribitirrg proteir~
sytrtltesis [V birtdb~ relrrsibly to the 30 5 srrb~itritof t h
bncterinl rihosonre. brerr iite two types nre ghrrr
togetlrer, tlreir effcctiz~etrcssis ~lesntcdor rdliced.

Antibiotics, Drug Interactions

44. The concurrent administration of penicillin G and


probenecid results in
a. Increased metabolism of penicillin G.
b. Increased renal excretion of robenecid
c. Decreased renal excretion ofpenicillin G
d. Decreased bactericidal effect of penicillin G
e. Increased excretion of probenead in the feces

'1. Interaction between penicillin and probenicid is best


described by which of the following mechanisms?
ition at the receptor site
a.mmp't
b. acce eration of drug biotransformation
c. alteration in the acid-base balance
d. alteration in the rate of renal clearance
Alrswer is (dl- perricilliir is nletnbolized iir the liver, but it
by the ~ t r y s 90 6
rapidly disnppears onr tlte blood drie to rnpid chrntrce
. o is excreted by trtbrthr secretior~.
Prepared by M.L. Thompson, Ph. D., Dept. Of Pharmacology, Tufts Medical School

ACE inhibitors: Captopril blocks the enz me which


Cardiovascular Drugs converts angiotensin I to an iotensin 11. &e latter is
a potent vasoconstrictor (alministration of
This cate ory covers a lot of drugs and a lot of questions. angiotensin will result in an elevation of blood
pressure).
They can%e categorized as:
Adrenergic Agents:
1. Questions asking about which drug from a list might be
used to treat a certain condition: a. Prazosin: selective alpa-1 blocker, inhibits binding
hypertension: of nerve induced release of NE resulting in
vasodilation
I ) Diuretics such as the high ceilin diuretic, furosemide; b. Methyldopa: acts centrally as a false
2) Beta-blockers such as propran801 or the neurotransmitter stimulating alpha receptors to
cardioselective beta blocker metoprolol; reduce sympathetic outflow resulting in
3) Alpha-1 blockers such as prazosin, vasodilation
4) Centrally acting adrenergic drugs such as methyldopa c. Clonidine: selective a onist stimulates alpha-
or clonid ine 2receptors in the C N ~ reduce
~ O sympathetic outflow
5) Neuronal blockers such as guanethidine (reserved for to peripheral vessels resulting in vasodilation
severe hypertension) d. Pro ranolol: nonselective beta blocker reduces
6) Angiotensin converting enzyme inhibitors such as c a r i a c output and inhibits renin secretion
Captopril e. Metoprolol: selective beta-1 blocker, reduces
cardiac output
angina: Nitro lycerin, sometimes propranolol, calcium
channel bkockers such as verapamil Diuretics: decrease the renal abso tion of sodium, thus
resulting in fluid loss and a rxuction in blood
arrhvthmias: volume. This decreases the work the heart has to
3) Lidocaine (ventricular arrhythmias), pump. Also have weak dilatory action. Types of
diuretics which may be mentioned include:
2) Phenytoin (to reverse digitalis
arrhythm-ias),
- induced
3) Quinidine (supraventricular tachyarrhythmias, a. Thiazides: chlorothiazide
a trial fibrillation), b. Highceiling or loop acting: furosemide
m e r a p a m i l (sEprye;tritu~; tachyarrhythmias,
-
~aroxvsmaltachvcar la atria brilla at ion),
5 ) ~ i g i t a l i s(at ;ial fibrillation, paroxysmal
c. Potassium sparing: spironolactone
tach cardia) Corrgestive henrt failure drugs:
6) $ropranolol (paroxysmal tachycardia)
a. Cardiac lycosides such as digitalis or digitoxin
Congestive heart failure: Glycosides such as digitalis, are effective fecause they have a positive inotropic
digoxin, ACE inhibitors such as captopril effect, increasin the force of contraction of the
myocardium. &is is achieved by an inhibition of
Na+, K+ ATPASE leading to increased calcium influx.
2. The second major category of questions concerns Digitalis therapy reduces the compensate changes
mechanism of action of the various agents: that are associated with congestive heart x i l u r e such
as increased heart size, rate, edema, etc.
Antiahythmics: Remember problem is that the heart
beats irregularity
a. Type 1A agents such as quinidine: acts by increasing Drug-co~rditionquestions
the refractory period of cardiac muscle
b. Type 1B agents such as lidocaine decrease cardiac
excitability 1. Quinidine is principally used to treat
c. When digitalis is used for atrial fibrillation it acts a. Hypertension
by decreasing the rate of A-V conduction b. Angina pectoris
c. Congestive hear failure
Antian ina drugs: problem is insufficient oxygen to meet d. Supraventricular tachyarrhythmias
demanck of myocardium
( d ) try elimination. H ertension ((a)) is treated
a. Nitro lycerin increases oxygen supply to the heart priniarily with betn b g k e r s such as propranolol. Angina
by a %Iredvasodilatory action on the smooth muscle is primarily treated with rritroglycerirt, while digoxirt
in coronary arteries (dr 'tnlis) is the drug of choice for congestive heart
b. Propranolol reduces oxygen demand by preventing
chronotropic responses to endogenous epinephrine, f ai f'ure.1-blocks
(Ty Quinidine is classed as an arrtrarrthymic drug
sodium clmnnels). It reduces autonraticity
emotions and exemse. an responsiveness and incruses refractoriness. It also
c. Calcium channel blockers decrease oxygen demand has an antimitscnrinic action preventing the bradycardin
by reducing afterload by reducing peripheral tlrnl follows vagnl slimulntiori.
resistance via vasodilation
Antihypertensives: Remember, most drugs have the
ultimate effect of reducing peripheral resistance via 2. Quinidine is used to treat
vasodilation a. Hypertension
b. An6ina pectoris a. Reserpine
c. Atrial fibrillation b. Guanethidine
d. Ventricular fibrillation c. Phenobarbital
e. Congestive hear failure d. Chlorothiazide
e. Alpha-methyldopa

3. Verapamil is most efficacious in the treatment of


a. Atrial fibrillation 10. Which of the following antihypertensives are usually
b. Atrial tachycardia reserved for treatment of severe hypertension?
c. Ventricular tachycardia a. Sedatives and reserpine
d. Catecholamine-induced arrhythmias b. Thiazide diuretics and reserpine
c. Sedatives and thiazide diuretics
d. Guanethidine and ganglionic blocking agents

4. Which of the follot\ing d m s is most useful in treating or


preventing angina pectoris. 9
a. Digitalis 11. Which of the following beta-adrener ic receptor blocking
b. Quinidine 5
agents is thought to be cardioselective.
c. Propranolol a. Nadolol
d. Procainamide b. Timolol
e. Pentobarbital c. Metoprolol
d. Propranolol

5 . Each of the follo~\*ing drugs can be used in the prevention


and treatment of angina pectoris EXCEPT
a. Digitalis Meclrarr ism of Actio~rQuestions
b. Propranolol
c. Nitro lycerin
d. ~ s o s o i i d edinitrate At1 tiarrlr y tlrmics
e. Pentaerythritol tetranitrate
12. Antiarrhythmic dru s, such as quinidine, suppress certain
cardiac arrhythmias%y
a. Stimulating the beta-adrenergic receptor
All of the followin drugs are useful in the treatment of b. Suppressing cardiac ATP-ase activity
hypertension E X ~ E I T c. Increasing ectopic pacemaker activity
a. Ephedrine d. Increasing the refractory period of cardiac muscle
b. Reserpine
c. Methyldo a
d. Thiazide cfiuretics
13. Most d m s s useful in the treatment of cardiac arrhythmias
act primarily b
a. Blocking A r k i n ' fibers
7. Digitals is useful in the treatment of which of the following b. Blocking the alpffa-adrenergic receptor
conditions? c. Suppressing SA nude impulse formation
a. Atrial fibrillation d. Causing a positive inotropic effect
b. Congestive heart failure e. Increasing the refractory period of cardiac muscle
c. Paroxysmal atrial tachycardia
d. All of the above

8. All of the following dru s are useful in the treatment of


r
14. The most im rtant harmacologic action of drugs that
i!
suppress car iac a n ythmias is
a. Blockade of the va s nerve
cardiac arrhythmias E ~ C E M !?=
b. Stimulation of car iac ATP-ase activity
a. Di italis c. Blockade o f t he Beta-adrenergic receptor
b. ~ijocaine d. Stimulation of the beta-adrenergic receptor
c. Phenytoin e. Increased refractory period of cardiac muscle
d. Procainamide
e. Aminophylline
(el
15. Lidocaine produces its antiarrhythmic effects by
a. Increasing AV conduction
9. The drug of choice for initial therapy for mild hypertension b. Decreasing cardiac excitability
is c. Increasing cardiac conduction velocity
Prepared by M.L. Thompson, Ph. D., Dept. Of Pharnlacology, Tufts Medical School

d. Increasing spontaneous pacemaker activity


( d ) Cnpto ril is ntr arrgiotetrsiotr-cotrz~ertirrgeirzynre
It?) nrrliythnrins nre defiled ns nrry nbtrornmlity of t l u itrhiFitor ! L t blocks t l u actiz~atiotro atrgiotetrsiqtr I to
trornrnl sittris rhytlrnr of tlw lwnrt dtre to disense or itr 'linl nngrotensrotr 11. Tfre decrensed hroo~cotrcenrrnrrotrof
itrdlicul dnnlnge to t l u inlpube cotdsctitrg systenrs. !%$ ntrgiotetrsiotr 11 recirices blood pressrire, becnrise
nlso restilt from tlre dez)elopnutrt oj ectopic pncenrnkers or nngiotarsiotr 11 is n potetlt z~nsocottstrictor.Wrlis (c) is
nbtrornrnl pncenrnker rltytlrnrs. Dnigs srrclr ns lidocnitre rurotrg, nccunrulntiotr of atrgiotetrsiotr I is tlte lisrinl tffect.
nre used to ~rornrnlizethese rlrytlrnrs. Liiocnitre, n locnl Cnpto ril also nrniritarns lowered B P b y elevntitrg
nrlestlretic, depresses cardinc excitnbility, ntlswer (b). Tlle braykininb in the blood by blockitrg its nlctnbolisnr. W ~ I ~ S
refrnctory period of cnrdinc nrriscle is itrcrensed, tllris ( d ) is wrotr , brndykitrirr nlctnbolites do not accrrnrlilnte.
slowing tlre henrl dowtr. All of the otller nltertrntizpes However, t f u key says this is t l u ri Rt atrsmer. Most
givetr wolild exncerbnte tlre nrrlrytllnrin. eople pick (b), wlriclt I tbitlk is pro%nbly t h closest to
Keitrg correct, utlless t l q didtrpt nlean to lit nlctnbolites
after bradykitritr. Atrgiotetrsion I accurnukes, blit it ims
16. When di6italis is used in atrial fibrillation, the therapeutic tro effect otr blood pressure.
objective is to
a. Abolish cardiac decompensation
b. Inhibit va a1 impulses to the heart
c. Decrease fhe rate of A-V conduction 21. Administration of angiotensin results in
d. Increase the rate of cardiac repolarization a. A sedative effect
e. Produce a decrease in the rate of atrial contraction b. Increased heart rate
c. Increased blood ressure
d. Antihistaminic eRects
e. Anti-inflammatory effects

Arttiartgirla Drugs
17. Nitroblycerin dilates the coronary arteries in angina Mecltanisnr of Actiort
pectoris by
a. Decreasing the heart rate reflexly
b. Increasins the metabolic work of the myocardium Diuretics
c. Direct action on smooth muscle in the vessel walls
d. Increasin the effective refractory period in the atrium
e. lock in^ fet a-adrenergic
receptors 22. Which of the following is NOT characteristic of the
thiazide diuretics?
a. Increase renal excretion of sodium and chloride
b. Increase renal excretion of potassium
c. Increase the toxicity of digitalis
18. Propranolol is of value in treating angina pectoris because d. Exacerbate existing diabetes
it e. Cause hypoMemia
a. Has a direct action on vascular smooth muscle f. Cause hypoglycemia
b. Blocks autoregulatory mechanisms in the heart
c. Inhibits oxygen metabolism in cardiac cells
d. Provides relief within seconds of an acute anginal
attack
e. Prevents chronotropic re nses to endogenous 23. The most useful diuretic drugs act by
epinephrine emotions an exercise a. Increasing the glomerular filtration rate
b. Decreasing the renal reabsorption of sodium
c. Decreasing the renal excretion of chloride
d. Increasing the renal reabsorption of potassium
e. Increasing the secretion of antidiuretic hormone
ACE Inhibitors
19. Administration of angiotensin results in
a. Anti-inflammato effects 24. Which of the following drugs act by inhibiting renal
b. Antihistaminic ezects reabsorption of scdium?
c. Increased blood pressure a. Urea
d. Increased heart rate b. Chlorothiazide
e. A sedative effect c. Theophylline
d. digitalis glycosides
e. Procainamide

20. The primary antihypertensive effect of captopril (Capoten )


is due to accumulation of
a. Serotonin
b. Angiotensin I Cardiac Glycosides
c. Angiotensin Ifl
d. Bradykinin metabolites
Digoxin exerts its positive inotropic effect by
a. Activation of adenylcyclase
b. Inhibition of hosphodiesterase 30. Which of the following ions augments the inotropic effect of
c. An agonist effect of - m e tors digitalis?
d. lnhib~tionof Na+, K+ A ~ A s Eleading to increased < Mium
b. Lithium
calcium influx
e. Decreasing the amount of calcium available for c. Calcium
excitationtontraction coupling d. Chloride
e. Magnesium
(dl Answer is (d)- Renlentber, cnrdinc glycosides strclr ns
digoxirr nre used irr tlle trenfntertt of cortgestive hurt
fatlure, tohiclt is tlle fnilitre of tlle llenrt to fiirtctiott
adequately as n pitntp nnd tliiis ntnilttnitt n1t adeqiinte
circulatiorr. Cnrdinc glycosides nre tltougltt to act by 31. In the treatment of congestive heart failure, digitalis
d
alterirrg calciunt ion mozjenrent, toitlt n desired eject of
iitcreasiirg the force of coritrnctiort of tlre nryocnr ttinr (e.8.
tlle iitotropic effect). Wltile sezrernl of tlre alteritntives
glycosides generally decrease all of the followng EXCEPT
a. Edema
b. Urine flow
iirzrolz~ecnlcittnt, tlte wny digoxirt does it is vin (dl, c. Heart size
inltibitiolt of Nn+, K+ ATPnsc, restrltittg i l l ntt irtcrense of d. Heart rate
cnlciltnr iolt iltfllix irtto tlle cnrdinc ulls, nlid n srrbseqirerrt e. Residual diastolic volume
errlrnitcenreltt of the colttrnctile nteclutrtisnt. (n) is the Tony
epirrepltrilte works. (El

26. Digitoxin is effectivein the treatment of cardiac failure


because it
a. 1s primarily a diuretic
b. Reduces the ventricular rate
c. Decreases abnormal cardiac rhythms
d. Produces peripheral vasoconstriction
e. Has a positive cardiac inotropic action 32. The mechanism of action of prazosin, an antihypertensive
agent is to
a. Block beta-adrener ic receptors
b. Inhibit formation ofangiotensin I1
c. Inhibit nerve-induced release of nore inephrine
27. The primary action of therapeutic doses of digitalis on d. Stimulate central inhibitory alpha-a8energic receptors
cardiac muscle is an increase in e. Inhibit the postsynaptic action of norepinephrine on
a. Force of contraction vascular smooth muscle
b. Ventricular excitability
c. Refractory period of the atrial muscle (el
d. Refractory riod of the ventricular muscle
e. ate of con$ktion of impulse to the muscle
33. Which of the following owes a significant amount of its
antihy ertensive effect to a central action?
a. d t h y l d o p a
b. Metoprolol
28. The beneficial effects of di italis in congestive heart failure c. Hydralazine
result in part from the fact &at di italis causes d. Propranolol
a. A decrease in end-diastolic v i u m e e. Guanethidine
b. A decrease in enddiastolic pressure
c. An increase in stroke volume and cardiac output (a) All o these dru s are used to trent h pertensiott, but
d. A decrease in central venous pressure J
nct by dierent nrecfaiiisnts. (n), nletltyl opa. is t l drug
~
e. A decrease in rate of the hear where tachycardia exists

i. (a), (b) and (c)


d
witlr central actiolr- it alters CNS cotttrol o blood
pressure b acting on cardioregulnto an vasomotor
s stems o/!'lu brain b stinrulatittg &ha2 receptors bl
ii. (a)and (c)only t L brain stem. ~ l o n i z n eis the usual drug t h t is
iii. (c) and (d) ittvolved in this particular question. (b) metropolol is a
iv. (el only selectively blocks beta-2 receptors in the heart to reduce
v. All of the above cardiac output. (c) hydralazine has a direct action on
vasculnr smooth muscle to reduce h ertension via
vasodilntion. ( d ) propranolol blocks g a receptors i f 1 tltr
heart, while (e) guanethidine prevents the release and

29. The cardiac glycosides will reduce the concentration o f


which ion in an active heart muscle?
!
causes depletion o catecholamines taken u p into storage
vesicles and is re eased like a false transmitter. It does trot
cross the blood-brain barrier.
a. Sodium
b. Bromide
c. Calcium
d. Chloride 34. Which of the following drugs is thought to reduce arterial
e. Potassium blood pressure b y activatin alpha receptors in the
vasomotor center of the mefulla?
a. Prazosin
Prepared by M.L. Thompson, Ph. D., Dqt. Of Pharmacology, Tufts Medical School

b. Clonidine Iiiglt-ceililtg dirrretic. How the llell nre yo11 srrpposed to


c. Propranolol renrenrber all of this stuff???
d. Guanethidine
e. Chlorothiazide
39. S m toms of digitalis toxicity include all of the following
E&&
a. Extrasystoles
35. Propranolol (Inderal ) can be useful in the treatment of b. Nausea and vomiting
hypertension because it blocks c. Yellow-green vision
a. Alpha-1 adrenergic rece tors d. A-V conduction block
b. Sodium reabsorption in &e kidney e. Decreased P-R interval
c. The release of renin from juxta lomerular cells
d. The release of norepinephrine l? om nerve terminals
e. The reflex tachycardia seen with the use of other
antihypertensives
40. Administration of which of the following drugs increases
i. (a)and(b) the likelihood of a toxic response to digitalis?
ii. (a) and (d) a. Diazepam
iii. (b), (c) and (d) b. Lidocaine
iv. (c), (d) and (e) c. S ironolactone
v. (c) and (el only d. &lorothiazide
e. Acetylsalicylic acid
( v ) Aiiszc~eris (el- Yori sltorrld intnredintely rccogitize tlmt
proprnirolol is the prototypic beta-ndreirergic receptor (dl Clriort!rinzide is n dirtretic rolriclr crrnses potnssirrnl
blocker, tlrrts nity nirszoer zoitlr nlter~rntirjen ((n) nird 2 ) is loss or irypohlenrin. This resrtlts irr p t e r perretrntioir of
rc1roitg. Sinrilnrfty, d is wroitg ns well-propmitolo1 is n digitnlis iirto the nryocnrdirtnl, nird t rrrs potelttinl toxicity.
conrpetitir~ebetn- receptor blocker- it lrns iro efect oil NE
relense. Airother d r l q used for hyperteitsion, Cloitidiite,
acts z~inthis nrecltnirtsnr by stinrlrlntiirg nlplm-2 41. Which of the following cardiac depressants is
nlrtoreceptors. Tllrrs (b), 3, nird 4 nre zoroirg. This lenrjes contraindicated in a patient with cardiac arrhythmia?
( e ) ns tlle o ~ i possible
y right nirsrcyer.lirdeed, nside front a . Lidocaine
blockiitg betn-l receptors, blockiirg of reiriir relense is b. Quinidine
tltorrght to be the other nrecltnlrisnr rolwreby betn-blockers c. Phenytoin
nlter hyperteirsioir. d . Propranolol
e. Procainamide
36. One of the proposed mechanisms of the antihypertensive
effect of beta-adrenergic receptor blocking agents is
a. Sedation
f
(d) All o t h e nre used to trent nr thnrins, bltt
proprn~tool is probnbly tlle nrrswer %urtse it cnrr
sonretinles resrtlt iit colrgetioe Irenrt failrtre.
b. A diuretic effect
c. An antirenin effect
d. A vagal blocking effect
e. An increase in cardiac output

Selective beta-1 adrenergic agonists 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

Miscellaneous Side Effect Questions


38. Ototoxicit with deafness may encountered occasionally in
patients ta&ng which of the following diuretic agents?
a. Osmotic
b. Thiazide
c. Mercurial
d. Highceiling
( d ) ntrstoer is (d)- strni ht ntentorizntiolt- denpress is
typicnlly nssocinted zuitf rrse of etlrncryrtic n c d , n loop or
Analgesics- NSAIDS: 6 . The antipyretic action of salicylates is explained in part by
a. Analgesia leadin to sedation
1. Mechanism of action questions rebarding analgesic, b. Increased blood l o w through the hypothalamus
antipyretic and effects on bleeding: c. Cutaneous vasodilation leading to increased heat loss
d. Depression of oxidative processes leading to decreased
Anal esic effects: aspirin inhibits the synthesis of heat production
-+gaK
Antipyretic effects: aspirin inhibits PG synthesis in the
hypothalamic temperature regulation center 7. The locus of action of aspirin's central antipyretic effect is
the
Bleeding time: inhibit synthesis of thromboxane A2 a. Brain stem
preventing platelet synthesis b. Hypothalamus
c. Basal ganglia
d. Limbic system
2. A 2nd type of question has to d o with pharmacological or e. Cerebral cortex
toxic effects of aspirin: ou get to ick which of the list is
or is not associated wit{ aspirin. Phera utic effects of ( b ) Answer is (b)- ntentorizatiort questioit- renlentber
aspirin include pain relief, antipyretic eRLts, nttt ipyresis ntealts ntrtifever. Tentpernfltrc regtrlotiort
antirheumatic and anti-inflammatory effects. Adverse or certter is irt the llypotllnlnntus.
toxic effects include all of the following: occult bleeding
from the GI tract, tinnitus, nausea and vomiting, acid-base
disturbance o r metabolic acidosis, decreased tubular
reabsorption of uric acid, salicylism, delirium, 8. A patient who has been taking large uantities of aspirin
hypcnrentilation, etc. might show increased postoperatiirebqeeding because
aspirin inhibits
a. Synthesis of thromboxane A2 and prevents platelet
3. A third type of question focuses on the difference between 1) aggregation
as irin and acetaminophen, 2) aspirin and other anti- b. Synthesis of prostacyclin and prevents platelet
iniammatories like prednisone, and 3) between aspirin aggregation
and ibuprofen: c. S thesis of prostaglandin and prevents production of
b G d latelets
1) Acetaminophen lacks anti-inflammatory activity, is d. Thromiin and prevents formation of the fibrin network
hepatotoxic, and does not cause GI upset e. G.I. absorption of vitamin K and prevents synthesis of
2) Anti-inflammatories like prednisone, hydrocortisone, blood clotting factors
triamcinolone etc. are steroids and d o not act
rimarily by PC inhibition
3) rbuprofen causes much less GI irritation P
(a) Attszuer is (0)- T1t.e rst fnct yorr nrust renrenlber is
tlln f nspiritt prezjettts atelet ng regntiort- this lintits
your c i o i u s to (n) ntt Rib). TI^ Rope to coti/u= air ty
usirtg prostac~litr,but of cottrse yott krtozu t wt t rrs ts
Freque~ttlyasked questions on NSAIDS t
wrort inrnzedintely, the ri ht tuord is prosta larrdirt, ns
irt ( c f but yotr ltazw alren y elinrinatd tlwt cfoice bemuse
b
if doent't metrtiott rezpentiort o plntelet aggregntion.
Tltlrs, azen if ou l d i r ' t rentent er tlmt throntboxnrte A2
induces pbte$t aggre ation, and nspirirr blocks lltis
4. The thera eutic effect of the salicylates is explained on the nctioit, you colrld et t%e answer b y elintinnt ioit. ( d ) is how
basis of tRe ability of the drug to heparitr works, w h e (e) is how co~rnwriwworks.
a. Activate autonomic reflexes
b. Uncouple oxidative phosphorylation
c. Inhibit the synthesis of prostaglandins 9. Anti-inflammatory agents, such a s aspirin, interfere with
d. Competitively antagonize prostaglandins at the receptor hemostasis by
site a. Activating antithrombin
b. Preventing vasoconstriction
c. Inhibiting thrombin generation
d. Inhibiting platelet aggregation
e. Inhibiting polymerization of fibrin
5. The mechanism of the antipyretic action of salicylates
probably results from
a. Inhibition of prostaglandin synthesis in the CNS
affecting h thalamic temperature regulation
b. inhibition %radykinin in the periphery leading to 10. Which of the followin6 anti-inflammatory agents does NOT
sweatin5 act primarily by inhibiting activity of prostaglandin
c. Depression of oxidative enzymes leading to decreased synthetase?
heat production a. Diflunisal
d . Suppression of cholinergic mediators in the b. Ibuprofen
hypothalamus c. Triamcinolone
e. Stimulation of norepinephrine in the hypothalamus d . Oxyphenbu tazone
e. Acetylsalicylic acid
Prepared by M.L. Thompson, Ph. D., Dept. Of Pharmacology, Tufts Medical School

d. Anti-inflammatory action
e. Antirheumatic action
11. A nonsteroidal, anti-inflammatory a ent that appears to
produce fewer gastrointestinal disturtances than high does i. (a), (b) and (c)
of as irin is ii. (a), (c) and (d)
a. Ku rofen iii.(a), (d) and (e)
b. ~ r o k n e c i d iv. (b), (c) and (d)
c. Pentazocine v. (b), (d) and (e)
d. Acetaminophen
e. Phenylbutazone
(n) yoti mi 111 be tenrpterl to nttszoer ncetnnri~roplrerr,
berxrrse it &estrlt cntrse GI rrpset, k i t renrenrher it is nlso 17. All of the followin are pharmacoIo ic or toxicoIogic
not artti-inflnntnrntoy. Tlle alrszoer is ibriprofeit. properties of acetykalicylic acid
a. Tinnitus
EXEEPT
b. Analgesia
12. Prolonged use of which of the followin6 drugs does NOT c. Antipyresis
cause a predisposition to gastric irritation and bIeeding? d. Methemoglobinemia
a. Phenytoin e. Inhibition of prostaglandin synthesis
b. Ibuprofen
c. Indomethacin
d. Phenylbutazone
e. Acetylsalicylic acid
18. All of the following are possible effects of aspirin EXCEPT
(n) Arrszoer is (a)- n t i s is n strniglrt dr~r iderttyicntion a. Reduction of fever
qrrestiolt. Artsz~~ers 2-5 nre nll ~~orr-steroi&l b. Shortening of bleeding time
f
nrttiirt nntntntory drtr s zolliclt cnrrse gnstric irritntiotr
I
nltd h redilrg due to tfeir el ects or1 prostnglnrtdirr
sytthcsis ill tlte nrricosnl zon 101tlre gtrt. # 3 is nrr nltti-
c. Suppression of inflammatory response
d. Bleeding from the gastronintestinal tract
e. Increase in the renal excretion of uric acid at high doses
cotr z~ulsnltt-its ntnjor side ellect t llnt oflerr n p e n r s ns n
riestiolr olr bonrds is tlw prodlrctior~ ojgiirgtz~nl
Ilyperplns in.
19. Of the followin aspirin does NOT cause
a. Occult blf&ng
13. Each of the followin a ents has been associated with b. Nausea and vomiting
gastric irritation E X ~ E ~ T c. Acid-base disturbance
a. Aspirin d. Suppression of the cou h reflex
b. Alcohol e. Decreased tubular realsorption of uric acid
c. Ibuprofen
d. Indomethacin ( d ) Atrswer is (d)- (n) & (b) are tlre nznjor side effects oj
e. Acetaminophen aspirilr (restrltiltg Jrom tlre irthibitiott oj prostngln~rdirt
syrrtltesis) lor the nrajority 01people, and orte rensort lor
the poptrlnrity 01nspirilr nlterrrntives suclr ns
ncetnntillopltert nrld ibtrprolert, wlriclt produm tllese
elects to n lesser extertt. # 3 & 5 nt nlso be seen
Lllowilr lnrger doses 01nspirin. ( Z i s not see11 with
of acetyIsalicylic acid. Y
14. Which of the followin is NOT produccd by excessive doses
nspirin.$ut rs n nmjor tlrernpelitic use o/ narcotic opiates
a. Delirium slrclr as codeirte. I guess t l q nre hopin tlmt you will get
b. Tinnitus tlre elects 01codeitre nlrd nspirilr nlixeif u ,srrrce the t w
c. Hypothermia are ole11 compnred and coetrastd ns nrograte pnirt
d. H perventilation re1iezpers.
e. d t a b o l i c acidosis

20. Which of the following is NOT true about acetaminophen?


a. Is a non-prescription drug
15. All of the following areeharmacologic and toxicologic b. Is cross-aller enic with aspirin
properties of aspinn EX E M
a. Tinnitus
b. Analgesia
c. Possesses bok analgesic and antip
r
ic effects
d. May induce methemo lobinemia at 'gh doses
e. May be the pharmaAogically active form of
c. Salicylism acetophenetidin (phenacetin)
d. Antipyresis
e. Suppression of the immune response

21. Which of the following is NOT true regarding


acetaminophen?
16. Therapeutic effects of aspirin include a. It has antipyretic properties
a. Analgesia
b. Tranquiliza tion
c. Pyret~caction
R'
b. It may induce methemo obinemia
c. It can be combined wit codeine
d. It has anti-inflammatory properties
e. It is not cross-allergenic with aspirin depression: loss of sensitivity of the medullary respiratory
center to carbon dioxide.

22. The most prominent acute toxic effect associated with Frequently asked questiorzs on morphine:
acetaminophen use is
a. Hemorrhage
b. Renal necrosis
c. Hepatic necrosis
5. Occurence of which of the followin is LEAST
characteristic of narcotic ingestion.8
d. Gastric ulceration
e. Respiratory alkalosis
a. Vomiting
( c ) Renlentber, ncetnnrirto hert (tylerrol) is nrt aspirirt b. Diarrhea
1: 1
alternntioc. Alterrtntiz~es 4, 5 nre side e ects of aspirirr-
type dru s. Tlle populnrity of acetantittop l e r r as nrt
c. Urinary retention
d. Bronchiolar constriction
aspirin a$ferrlntive is becnrrse the irtcidertt of srcch effects e. Increase in intracranial pressure
wrtli tliis drug is z)ery low. However, becnrtse
ncetnnrirtoplmr cnrt rtrrdergo biotrartsfornlntiort to n toxic (b) Atrswer is (b)- Agnitz, the key word is l e e Nnrcotics,
irrternredinte, hepatic nrrd rertnl rrecrosis llnve beerr in tlle form of pnregoric (tirrctrrre of opium), and Lontotil
reported, especinlly nfter very ltiglr doses. (c), lrepntic (lopernmide) are over the cortrlter ornl preparatiorts for
necrosis is tlre nrost prontirrertt. tlle trentnlertt of diarrllen. Opintcs act ort receptors irt tlle
grit to prodrrce corrstipntiorr. Tltrts (b) is obzjiorlsly wrorrg.
All of tlle other nrrszuers nre side effects of opinte
ndnrtrtistratiorl.
23. LYhich of the follois- in^ anti-inflammator agents does NOT
act primaril by inhibiting the activity o?cyclooxygenase?
?
a. Ibu ro en
b. ~ifkunisal
6. Therapeutic doses of mor hine administered
intramuscularly may p r J u c e
c. kednisone a. Constipation
d. Indomethacin b. Euphoria
e. Phenylbutazone c. D sphoria
d. d n t a l clouding
( c ) Arrszuer is (c)- (n), 2, 4 , nruf 5 nre NSAIDS tltnf red~tce e. Decreased response to pain
i. (a) and (b) only
ii. (a), (b) and (d)
iii .(a), (d) and (e)
iv. (c), (dl and (e)
v. All of the above

7. Which of the folIowing drugs acts to suppress the cough


reflex?
a. ASA
Analgesics - morphine b. Codeine
c. Meperidine
d. Acetaminophen
e. Phenyibutazone
1. One of the most frequently asked questions concerns
-
mixed-agonist-anatagonists (MAA) they ask you to
identify which drugs out of a list of 5 is an MAA. The one
they usually exptxt you to know is pentazocine, but
sometimes nalbuphine. 8. Which of the following are pharmacologic effects of
mor hine?
2. Additional drug identifications they always ask involve a. %espiratory depression
knowing that naloxone is an antagonist used to treat . b. Eu horia
overdose, and that methadone is used in detoxification of c. ~ J a t i o n
morphine addicts. d. Constipation
3. Some uestions ive you a list of pharmacological effects e. Dysphoria
and a 2 you to ijentify which is not an effect of morphine. - i. (a), (b) and (c)
sedation, 4s
Morphine roduces respiratory d e ression, euphona,
d'
horia, analgesia, an constipation. The
substitution tEey often make is diarrhea for constiipation.
ii. (a), (b) and (d)
iii.(a) and (e)
iv. (c), (dl an2 (el
4. The last most frequent1 asked type of uestion regarding v. All of the above
2'
opiates concerns over ose of toucity. I n overdose
morphine causes coma, miosis, and respiratory depression.
Sometimes they ask the mechanism of respiratory
Prepared by M.L.l l o i ~ ~ p s oPh.
n , D..Dept. Of Pharmacology, Tufts Medical Scl~ool
. .

9. Morphine causes vomiting by and antagonistic activities?


a. A direct irritant action on the astric mucosa a. Cdeine
b. Stimulation of the nodose gan %on of the \ l a p s nerve b. Methadone
c. Stimulation of the medullary cjernorece tor trig er zone c. Naloxone
d. Direct stimulation of the gastrointestina!muxukture d. Meperidine
e. Pentazocine
(el This is an exanrple of the type of qrrestiolr wllere tlre
drug clnss is girjen. Yort are asked to trot otrly irletrtifi a
10. The decrese in ventilation caused by mro hine, mepridine drrtg from tile list as beit18 fronr titis clnss, but
and some of the related opioids depends cRiefly upon addrtroltally tllat it has tlle roperties titat are give11 i l l
a. Depression of cortical activity f l u questiotr tlvlt distbrgtris! it from tlre other drugs o
b. Penpheral blockade of chemoreceptor impulses the class tlzat are listed as altenratives. In this exanlpk,
c. An Increase in carbon dioxide concentration in the tllere is orrly orre drug wlriclr nreets this criteriorr. All are
blood drugs wlrich act via opiate receptors, but 3 are agotrists
d. Blockade of afferent autonomic impulses from the lungs ((a), (b), (dl), I is atr alrtagottist orrly ((c)). (e) pelrtnzocitre
e. Loss of sensitivity of the medullary respiratory center is the olrly drrrg which lurs botlr types ofactio~r,atld is tlre
to carbon dioxide otre drrcg left b y tlre process of elrmitmt iolr.
( e ) Atrsr~veris (el- nrcnrori:ntiort. Dotr't befooled b (0)-
t l w drugs nrc salRtbrg, but this lvls lrotlrilrg to
t l u decrense in respirntoy mte.
2
zoitlr
15. A heroinde endent atient should NOT tw given
nalbuphine h u b a i n ffor pain because
a. It has no analgesic properties
b. It may produce respiratory depression
11. Small doses of barbiturates and morphine depress c. As a mixed agonist-antagonist, it can elicity withdrawal
respiration primarily by
a. A arasym athomlnetic action
b. 1nRibiting tRe ~ e r i n e - ~ u e ureflex
er
d. r"?
he i6h abuse potential of nalbuphine may add to the
patient s problems
c. Rendering the aortic chemoreceptor system insensitive
to 0 2
d. Rendering the respiratory center less sensitive to
changes in C 0 2
e. A specific effect at myoneural junctions of phrenic and 16. A patient while not currently taking drugs has a history (6
intercostal nerves months ago) of narcotic de ndency. Which of the following
analgesics should be avoi& in this patient?
( d ) Atlsz~ieris (dl- 1 toM yorr this ilr nry lcctirrc olr a. Aspirin
nrorplritre-if yorr nriss this yorr '11 lrrrrt nry fcelitlgs. b. Pentazcine
P$KZK,"K;'
Ze. Acetaminophen
12. Which of the following are pathognomonic symptoms of f. None of the above
narcotic overdose?
a. Miosis, coma and depressed respiration
b. Mydriasis, coma and smooth muscle spasms
c. Mydriasis, coma and de ressed respiration
d. Miosis, convulsions anBde ressed respiration 17. Which of the following statements does NOT characterize
e. Mydriasis, convulsions anldepressed respiration pentazocine?
a. It is equianalgesic with codeine
b. It is a partial opioid antagonist
c. Its abuse otential is less than that of heroin
d. It may infuce dysphoria and mental aberrations
13. The cause of death with opioid intoxication is e. It is effective only on parenteral administration
a. Oxy en apnea
b. ~ a r f i a carrest
c. Terminal convulsions
d. Circulatory collapse
e. Respiratory depression 18. The antagonist of choice in the treatment of opioid
overdosage is
-
(e) agaitr, n nrenrorizatiotr questiotr.. Wlzat lvlppetrs is a. Naloxone
tllat opioids decrense the response o respirato cetrters b. Nalorphine
itr tlre braitrstem to t l r cnrbotr dioxide tensiotr o7the blood, c. Pentazocine
artd also depresses pontine and medrtlln y cetrters d. Levallorphan
regulating respirato y freqrtetrcy. Opioids do not cause e. Propoxyphene
oxygot r(pttca, (&I), t h y col~be co~~tutbive, huf 110t
fernrirral y so ((c)), Il nre stnbiJizirrg otr tlre lzenrt ntrd
sonle are actrrnlly u J i t 1 opelr-lmrt s s r ery ((b)),artd
t l q no not cause circrr,ntoy collnpsc ((41 19. Which of the folowing is a complete anta onist of the
opioid receptor and the atent of choice in t i e treatment of
narcotic overdose?
14. Which of the following is an opioid that has both agonistic a. Naloxone

in
b. Nalorphine organophosphate toxicity
c. Cyclazocine f. succinylcholine is a depolarizing neuromuscular
d. Levallor han junction blocker, subject to rapid inactivation by
e. None of &e above plasma pseudocholinestease: it is used to prevent
aryngospasm
g. d-tubocurarine is a nondepolarizing neuromuscular
junction blocker
h. mecarnylamine and hexamethonium are ganglionic
20. Methadone is used in detoxification (drug withdrawal) of blockers that produce orthostatic hypotension
patients physically dependent on morphine because
methadone 2. The 2nd type of question has to do with physiological effects
a. Precipitates withdrawal reactions of choliner ic stimulation, blockade, or overdose toxicity
b. Antagonizes the depressant actions of morphine situations &nd what drug you would give to reverse the
c. Will not in itself produce physical dependence toxicity).
d. Withdrawal reactions are less intense and stressful a. cholinergic crisis symptoms: bradycardia, lacrimation,
than those of morphine salivation, voluntary muscle weakness, diarrhea,
bronchoconstriction-treat by giving atropine
( d ) This is nrt exantple of t l kirrd
~ of qrcestiotl tllnt b. sco olamine overdose: disorientation, confusion,
reqltires tlz17t V O I ~llnzte nlenlonied n fact nbotrt n pnrticltlnr Ra~lucinations,burning dry mouth, hyperthennia: treat
drug, irl tltis knse tlte fnct is (d). Metlrdotre yorr will with physostigmine
renxnrber is trot ntl atltngotrist like rlnloxorlc- it is n f~rll c. An additional fact that often gets asked about atropine has to
a ortist with nrlnlgesic propertks, jrst like nto . do with the fact that it blocks va a1 reflexive control of
fillctl tnkert ornlly it is ,rot elrpllorlc it1 addicts, 11t ncts heart rate, resulting in tachycarbja.
just like nlo llitle to prodltce tolerntlce arrd pllysicnl
dePetldettce.%tldrnrunl is less severe tllntl rurtlr
nlorpltitle becnlrse ntetlmdotre Irns n nlllcll lotrger lmlf life.
Fncts 1, 2, nrld 3 zootrM be met by ntl nrltngotrtst stlclt ns
t~nloxorle,or perllnys ezwl n nlixed ngotrist-nrttngottist Frequentlg asked questions about
slrcll ns perltnzocitle.
Clr o linergics:
21. Which of the followin drugs is currently \\.idely used in
treating opioid-depenfent individuals? Identification and mechanism of action
a. Codeine
b. Methadone questions:
c. Alphaprodine
d. Pentazocine
e. Meperidine
1. Atropine and propantheline exert their effects on peripheral
structures by
a. preventing release of acetylcholine
b. preventing synthesis of acetylcholine
c. enhancing destruction of acetylcholine
d. com eteing with acetylcholine for receptor sites
e. p J u c i n g physiologic effects opposite to those of
Autonornics: acetylcholine
(d) - (a) is wrorlg- botltlitrrrnt toxirl does this. (b) is
wrortg-lrenricllolinr~rnl works this w n ~ (. c ) is wrotlg- ACIl
Clr o l inergics is broker1 dowrt alnrost instatltntreolrsly, so it is alnrost
inrpossible to enllnnce its destruction. (e) is wrong-these
1. Drug identification type questions that involve mechanism of drugs dotr't have a n y actiotrs of their owtt, t l q just
action. You need to know the following types of facts: prevent ACh effects by blockilrg receptors: atropirie attd
a. atropine, scopolamine, propantheline are competitive ropntttheline are postgarlglionic rnuscarinic receptor
muscarinic receptor blockers which sometimes are used [lockers-thas ib answer is (d).
to control salivary secretions. An additional fact that
often ets asked about atropine has to do with the fact
that it%locks vagal reflexive control of heart rate,
resulting in tachycardia. 2. Neostigmineproduces its effst by
b. physosti ine and neosti ine are reversible a. de ressing acetylcholinesterase release
antichocesterases that %er in that physostigmine b. in&biting acetylcholinesterase activity
acts both centrally and peripheral1 neostigmine on1 c. increasing the rate of acetylcholine synthesis
ripherally, but neostigmine also t a s some direct Azh
E e activity at the neuromuscular junction, in addition
to prolonpng the activity of endogenous ACh. They
a
d. acting like acetylcholine at gan lionic sites
e. increasing the amount of acetylc oline released from
nerve terminals
sometimes see use in treating xerostomia.
c. pilocarpine, methacholine, etc. are direct acting
cholinergic a onists. May be used for xerostomia.
d. organophospkates and insecticides irreversibly inhibit
cholinesterase 3. Organo hosphate insecticides and nerve ares inhibit the
e. pralidoxime is an enzyme regenerator used in action of which of the following enzymes?
a. adenylate cyclase
Prepared by M.L.Thontpson, Ph. D., Dept. Of Pharn~acology,Tufts Medical School

b. monoamine oxidase b. is a c o m r i t i v e blockin agent


c. phosphdiesterase P;
c. has no e ect on acetylc olinesterase
d. is more potent than diiso ropylfluoro hosphate
d. acetylcholinesterase
e. carbonic anhydrase e. is capab e of acting directry on the en$late

4. Drugs which are addictive with or potentiate the effects of 10. Which of the following is used to prevent laryngospasm?
acetylcholine include a. atropine
b. epinephrine
(a) metacholine c. diazepam (Valium)
d, neoshgmine ( b t i g m i n e )
(c) pra idoxime e. succinylcholine (Anectine)
(d) n e o s t i p h e
(e) pilocarpine ( e ) W l a t is needed is a skeletnl muscle relaxant. This
re uires a dru wiricir acts at the neuromusculnr junctio~r.
I.(a), Co), and (c) 07 those listetf only succin icholine ( e ) is it1 this
2. (a), (c), and (dl category. (a) atropba is a ciolitrergic receptor blocker, (h)
3. (a), (dl and (el epi~lephrincis an adrettergic ngonrst, and (c) dinzepnnr is
4.(b),(d1, and (el n benzodinzepirre, nrld (dl is nrr nnticlrolirlesterase.
5. (c), (dl and (el
(3 1 11. In treating xerostomia, which of the following might be
prescribed?
a. atropine
5. \Yhich of the follor\.ing drugs is k s t to administer after b. ephedrine
poisoning by an organophosphate cholinesterase inhibitor? c. neosti mine
a. atropine d. scopo!amine
b. phen toin e. mecarnylamine
c. pralidoxime
d. propan teline (c)
e. phenobarbital
(c) 12.Which of the following drugs is most likely to dry secretions
in the oral cavity?
a. diazepam
6. Which of the following compounds is a ganglionic blocking b. prometazine
agent?
a. curarine
b. edrophonium
d. physostir
c. ropant ehne
e. c!iphenhydrarnine
C. mecamylarnine
d. succinylcholine (d)
e. gallamine tricthodide
(c) 13.The most useful drug to induce salivation is one which has
properties that are
a. adrenergic
7. Which of the following acts by antagonizing cholinesterase? b. cholinergic
a. atropine c. ganglionic blocking
b. muscarine d .adrenergic blocking
c. neostigmine e. cholinergic blocking
d. p i l o c a ~ i n e
e. acetylc oline (b)

14. Drugs which are commonly used in the control of excessive


salivation include
8. When neostipine is administered before acetylcholine, the (a) meprobamate
action of acetylcholine will be (b) atropine
a. blocked (c) methantheline
b. enhanced and prolonged (d) cudeine
c. less intense and of shorter duration (e) chlorpromazine
d. none of the above. The action of acetylcholine is not
affected by neostipine I. (a) and (b)only
2. (a), (b),and (c)
3. (b)and (c) only
4.Co), (c), and (dl
5. (dl and (el
9. Neostipine can stimulate denervate skeletal muscle because
it
a. is a congener of acetylcholine
19. Based on its known mechanism and sites of action,
Questiorzs regarding physiological actiorzs of sco lamine should theoretically be useful in
(acreatment of peptic ulcer
clz o linergic drugs: (b) providing euphoria and amnesia prior to surgery
(c.) relieving bronchoconstriction
(d) relieving some of the symptoms of Parkinson disease
15. Administration of ganglionic blocking agents will result in (e) visualization of the retina
a. miosis
b. diarrhea 1..(a), (b), (dl and (e)
c. copious salivation 2.. (a), (b), and (e) only
d. orthostatic hypotension 3. (a),and (c)
e. enhanced activity of the parasympathetic nenrous system 4. (b) and (e) only
5. All of the above

16. Tach cardia in a patient administered with atropine or


scopoLmine results from Questions regarding toxicity of clzo linergic
a. release of adrenal catecholamines
b. blockade of vagus nerve activity drugs:
c. blockade of the nicotinic cholinergic receptor
d. stimulation of the alpha adrenerpc receptor
e. stimulation of the beta adrenergic receptor 20. Symptoms of risoning by an organophosphate onsecticide
include all of t e followin except:
(b) Artsroer is (bl- Atropirre nlrd scoyohntirte nre
b. excessive salivation
B
a. skeletal muscle fasicu ation
nttrscnrirtic clrolirter ic receptor blockers. ]tist krtoroirtg
tlmt elinrirrntes nN t f e nlterrmthss except (bl. Blrt yntr c. bronchoconstriction
sltorrld nlso renrenrber tlrnt lrenrt rnte is k t rrrrder tigltt d. hot, dry skin
%
reflexizre cort trol: nlry slrddcrr irtcrense irt R ttsltnlly e. diarrhea
stinrrrlntes bnroreceptors to sard n siptnl to tlre zrn pis
trerve to stinrttlate tlte llenrf to sloro rt bnck dorurr. 111s
reflex is cholitrergicnlly ntedinted, nrtd toil1 be blocked by
cltolirrer 'c blockers suclt ns atropirtc. Ezperr uyltert giver1
irt the ngerrce of higlter tlrnrr rrornrnl lrenrt rnte, ntropirre All of the followin6 symptoms are associated with
will block the trornml cltolirrergic corrtrol ozper the lrenrt, neostipine poisoning except
lenvitrg tlte syntpntlretic systent ilt clmrge zoitlr n a. diarrhea
restt ltrrtg tncltycndin. b. salivation
c. convulsions
d. bonchiolar constriction
e. skeletal muscle paralysis
17. All of the following are possible effects of cholinomimetic
drugs except
a. mydriasis
b. bradycardia
c. increased peristalsis 22. Symptoms of atropine poisoning in man include
d. stimulation of sweat glands (a) decreased intraocular pressure
e. increased secretion by bronchial glands (b) burning dry mouth
(c) nausea, vomiting and diarrhea
(n) Atrswer is ( 0 ) - Tlte first tlrirtg yorr lmrle to krtoro is tllnt (d) h rthermia
n cholit~onrintcticdru is orte rulric'lr nrinrics tlte nctiort of (e) oxostatic hypotension
ncetylclrolit~e,tlre ett&notls ttettrotmrantitter it1 tlze
parasyntpntlletic or cholitter 'c ttervorrs systen~.Tlle 1. (a) and (c)
ncron rn for ren~enrberhgt E effects of cholitlergic 2. (b) and (d)
stinitryatioti is SLLILI, or fitcreased salilmtion. lncrintation, 3. (b), (d), and ( 4
defeation, arrd rrrittntiotl. The henrt is the exceptiotr it1 4. (d) and (e)
that activity or ltenrf rate is decren,d (brndycardia)- thtts 5. All of the above
1
sitrce tlre questiotr nsks or ntt efect wllicll does trot occur
with chol~ner 'c stin111atiott, t tat lenves (n) as tlle otlly
possibility. h80sis. not mydrinsis, occrrrs witlr
clrolitrergic st imulntiotr.
23. The most likely signs or symptoms of overdosage with
atro ine are
18. A para1 zing dose of succinylcholine initially elicits
a,ENS excitation and tachycardia
b. intestinal cramps and diarrhea
a. ~ N J d e ~ r e s s i o n c. skin rash and cutaneous itching
b. CNS depression d. ptyalism and increased sweating
c. decreased salivation e. constriction of the pupils and blurring of vision
d. muscle fasiculation
e. extrapyramidal reactions
Prepared by M.L. Thompson, Ph. D., D q t . 01'Phannacolop~,Tufts Medical School

.4. Disorientation, confusion and hallucinations resulting from mediated vasodilation predominates
an overdose of scopolamie are most efficaciuosly treated by b. vagal reflex: injection of a pressor dose of NE ma
administering result in decreased heart rate d u e to activation o r
a. atropine baroreceptors which stimulate va a1 reflex to reduce
b. levodo a heart rate. Vagal reflex is b l o c k d b y atropine
c. acety~c~o1ine
d. phsostigmine
Thus you must be familiar with the effects of alpha or beta
receptor stimulation or block. The most important ones to
remember are:
23. The immediate cause of death from irreversible
cholinesterase inhibitors is
a. shock a. Alpha-1 receptor stimulation: vasoconstriction, urinary
b. convulsion retention, mydriasis
c. cardiac arrhythmia b. beta rece tor stimulation: increased heart rate (Bl),
d. respiratory aralysis bronchochation (BZ), vasodilation (B2)
e. dehydration ! o m vomiting and diarrhea
c. Alpha-1 block: vasodilation
( d ) Arrswer is (d)- rolrile sonle 01 tllese nre irldeed d. beta block: decreasd heart rate (Bl),
associnted wit11 orgnrr oplrospllnte toxicity, tlle inln~edinfe bronchoconstriction (B2)
cartsc oJ deotll is drte to ( d ) , wlricll results Jronr the
sfinrrtbtio~roJ ?licofirric recqttors nf the rrelironr~lscrllnr
jrlrrctio?r resrlltirlg i ~ tpnrnlysis oJ skeletnl nrllscles. 3. They usually throw in a question regarding the use of
levodopa in the treatment of Parkinson's: remember,
Parkinson's is DA deficiencv in brain. Remedv is to
increase DA in brain. 1njeAed DA doesn't crdss BBB, but
26. Each of the follo~\.ingis a symptom of cholinergic crisis levodopa, a precursor to DA does cross BBB. Carbidopa
exce t is given with levodopa to block dopa decarboxylase
a. gradycardia activity in periphery, which in the absence of carbidopa,
b. lacrimation converts the levodo a to DA in the periphery, decreasin
c. vasoconstriction the amount of l e v o ~ o p athat ends u p in the brain. You ayso
d. extreme salivation need to remember that levodopa is sympathornimetic, and
e. weakness of voluntary muscles will produce sym athetic stimulation in the peripher)..
Development of agnormal facial movement, nausea and
vomiting, cardiac arrthymias, and mental disturbances are
all associated with levodopa therapy.

Adrenergics: Adrenergics - Mechanism of Action


1. Drug identification type questions that involve mechanism 4. Alpha or beta-adrenergic blocking drugs act by
of action. You need to know the following types of facts: a. Inhibiting s nthesis of norepinephrine.
b. Increasing tKe metabolism of norepinephrine
a. Receptor blockers: alpha or beta adrenergic drugs such c. Competitive inhibition of postjunctional adrenergic
as prazosin or propranolol act by competitive receptors
inhibition of postjunctional adrenergic receptors d. A local anesthetic effect on the adrenergic nerve
terminal
b. Drugs which inhibit the action of adrenergic nerves: e. Depleting norepinephrine ffom adwnergic nerve
i. Reserpine: depletes NE by inhibiting reuptake terminals
ii. Guanethidine: inhibits the release of catecholamines
iii. Alpha methyldopa: acts centrally as a false
neurotransm~tterwhich ets taken u into storage 5. A mechanism for the antiadrenergic action of guanethidine is
vesicles and released wih NE,thus !ecreasing
sympathetic activity a. Inhibition of d o a decarboxylase
b. Inneased rate ofmetabolism of norepinephrine
iv. Clonidine: stimulates alpha2 receptors in CNS with c. De letion of norepinephrine from the nerve terminals
a resulting decrease in sympathetic outflow d. sugstitution for norepinephrine and subsequent action
c. Indirect acting drugs: amphetamine, tyramine, and a s a false transmitter
e. Uncouplin of the action potential from the
ephedrine act by stimulating the release of stored NE n o r e p i n e p k e release mechanism

2. Physiological action questions: Many of these questions


involve actions of epinephrine in the presence of either an
alpha or beta blocker, such as:
6 . Which of the followins statements most accurately describes
a. "Epinephrine reversal": in the presence of an alpha the effectiveness of act~onof methyldopa?
blocker (usually they ive prazosin, but drug such as
9
chlorpromazine may a so be given) epi causes decrease
in blood pressure rather than increase because beta
a. It causes marked cardiac slowing
b. It directly relaxes vascular smooth muscle
c. It causes rapid depletion of norepinephrine from action of norepinephrine at beta-adrenergic receptors?
-
adrenergic nerve terminals a. Atropine
d. It causes formation of a false transmitter which is b. Naloxone
released at vascular smooth muscle c. Propranolol
e. It produces a false transmitter, the effect of which is d. Phcntolamine
primarily at central nuclei e. Hexarnethoniurn

7. The mechanism of action of reserpine is to 12. Pretreatment with reserpine prevents a response to which
a. Inhibit monoamine oxidase of the following agents?
b. Inhibit catechol-O-methyltransferase a. Amphetamine
c. Block the assage of the nerve action potential in the b. E ine hrine
ost angEonic nerve fibers c. PRen$ePhrine
d. Etabfiize the axon terminal membrane thus preventing d. Isoproterenol
release of norepinephrine d. Norepinephrine
(a) reserpitte causes depletion of NE front storage sites,
tlttrs it cattttot be r e l e n d by an1 letantine. All of t l e
others listed act postsyttnptical~.
8. Am hetamineactsby
a. gromoting storage of the mediator
b. Causing a rapid release of the mediator
c. Causing a slobvdepletion of the mediator 13. Each of the followin dru s is considered to be a direct-
d. Combining with a receptor substance on the effector cell acting c a t e c h o l a m i n e % ~ ~ f ~ ~
e. Interfering with the response of the receptor to the a. Epinephrine
mediator b. Amphetamine
c. Isoproterenol
(b) d. Norepinephrine

9. Which of the following characterizes the mechanism of


action on levodopa?
a. It acts through a direct anticholinergic action
b. It stimulates s ecific Ldopa receptors in basal ganglia
c. It replenishes t i e otherwise deficient dopamine in Effects
atients with parkinsonism
d. increases concentrations of norepinephrine in the
brain to counterbalance an otherwise overactive 14. After pretreatment with hentolamine, intravenous
cholinergic system adrninlstration of e inepKrine should result in
a. Relaxation orbronchial smooth muscle
b. Positive chronotropic and inotropic effects
c. S lanchnic vasoconstriction
d. &lation of skeletal muscle vascular beds
10. Which of the following combinations of agents would be e. Secretion of a mucoid viscous saliva
necessary to block the cardiovascular effects produced by
the injection of a syrnpathomimeticdrug? i. a, and b only
a. Atropine and prazosin ii. a, b and d
b. Atropine and propranolol iii. a, d and e
c. Prazosin and propranolol iv canddonly
d. Phenoxybenzamine and curare v. c, d and e
e. Amphetamine and propranolol
(ii) plmltolamine is art alpltn blocker, thus the
(c) - The itljectiorr of a synlpathominletic (e.g. a drtrg it1 hrine will stimulate beta receptors primarily, witlt
which acts like N E ) stinlulates both alpItn and beta
receptors. Alplta receptor st imulatiott produces
7'7
t te e ects listed in option (ii)
z~asoconstrictioir,ittcrensed s stolic and diastolic
ressure and reflex tachycarjia. These effects cat1 be
!locked by a1 ha nttd beta rec tor blockers. the otlly 15. Which of the following changes produced by intravenous
alternatiw t%t lists both a,, &ha fprarosin) and beta administration of epinephrine result from stimulation of
ro rarrolol) blocker is (c). Atropi~teis n muscarinic beta-adrenergic receptors?
? 'f'.lnergic ) receptor blocker tltnt would accelerate tlte
cho a. Respiratory inhibition
b. Cardiac acceleration
Ireart, the opposite effect tlrat you watrt, thtrs (a) atld 2 are
wrottg. Phenoxybetlznntine is at1 a1 ltn blocker, but curare c. Dilation of the upil
is a nicotbic rec tor blocker, not geta receptor- tlrlrs (d) d. Increased systoyic pressure
. As f ~ r T 5 an1
, Ietan~itleis at1 itldirect acthtg e. Decreased diastolic pressure
synlpnt R
is wro"fronlin~tic,t ~ o at locker, thlrs (el is wrorlg.
i. a, band c
ii. a, b and d
iii. band e
11. Which of the following drugs competitively blocks the iv. c, d and e
Prepared by M.L.Thompson, Ph. D., Dept. Of Pharmacology, Tufts Medical School

v, c and e only 20. Alpha-adrenergic agonists are used in combination with


local anesthetics to
a. Stimulate myocardial contraction
b. Reduce vascular absorption of the local anesthetic
c. Increase the rate of liver metabolism of the local
anesthetic
16. M'hich of the following is NOT an action of epinephrine d. Increase the concentration of the local anesthetic at its
when administered intravenous1 in a high dose? receptor site

r
a. Increases liver 61 cogeno ysisT e. Anta onize the vasodilating effects of the local
aneshet ic
b. Causes bronchi0 ar constriction
c. Produces a rise in b l o d pressure
d. Evokes extrasystoles in the heart i. (a), (b) and (c)
e. P r d u c e s restlessness and anxiety ii. (b), (c) and (d)
iii . (b), (d) and (e)
iv. (c), (d) and (e)
v. (d) and (e) only
(iii) Anstuer is (c)- Alplra-adretrergic ngotlists srtclr ns
"Epinephrine reversal" of blood ressure can best ke epirreplrrine produce vnsocotrstrictron, which worrld
demonstrated by injecting epinepRrine intravenously afier acconrplislt botlr "b" atrd "en. # 3 is the otrly altentntive
pretreatment with tllat itrcllides both b ntrd e tlrlis yotr dotr't Itnve to know
a. Prazosin ntrythitlg else. "a" atid "c" nre'fnlse. Vnsocotrstrictors nre
b. Atropine itrclride r r r locnl ntrestltetic repnrntiotrs to ( I ) prolottg nrrd
c. Propranolol
d. Neostigmine
e. Isoproterenol
brcrense tlw d 111 of nttestf,&in
(3 retabrhl tlre
ntrestlletic irt t E nren i t r j e c t ~ , reduce t i e toxic efect
of tlle drlig b y delnyitrg its absorptiott itrto tlre getrernl
circlilntiotr attd (3) to retlder tlte nren of ittjectiotr less
(n) epitleplrritre is n poteltt stinrlrlntor of botlr nlplln ntrd henrorrlrngic.
bctn receptors. Itlject ro11 of epi risltnlly cnrtses n rise it1
blood presslrre dric to I ) nryocnrdinl stinllthtiotr tlmt
illcreases vetttricrtlnr cotttrnctiott, 2 ) ntr itlcrense it1 llenrt 21. Administration of an otherwise effective pressor dose of
rate, atrd most inrportnrlt, 3 ) z~nsocotlstrictiotl dlre to nlplm epinephrine could cause an "e inephrine reversal" in a
receptor stin~lihtioti.However, blood flotu to skeletnl patient taking which of the foKowlng drugs?
ntrtscles is itlcrensed drie to ozclerflil betn-2 receptor a. Reserpine
vnsodibtor actiott tltnt is or16 pnrtinlly colitlterbnlntlced b. Propranolol
b n z~nsocottstrictornctiott ott tlre nlplln receptors tlmt nre c. Am hetamine
ayso presettt it1 tlre z~nsclrlnrbed. Wlretl gizwtl 61 tile d. ~ h L r ~ r o m a z i n e
presetlce of nlr nlpltn blocker, betn-reccptor n d i n t e d e. Lithium carbonate
zmsodihtiott is more prottoritrced, tlle totnl pcriplternl
resistatrce is decrensed ntrd tlle n m t t blood pressrire fnlls. ( d ) CPZ is n potnrt alplla blocker like prnzositt.
This decrense it1 blood pressttre is cnlled 'epitreplrrrtle
reversnl". Tlle otrly nlplla-blocker listed is prnzositt,
atlszuer (n). Atroprrle ts n cllolittergic nr~tscnritticreccptor
blocker, proprnttolol is n betn-blocker, treostipritte is n 22. Of the following sympathomimetic agents, the most potent
cl~olitresternse itrllibitor, ntrd isoyroteretrol 1s n bronchodilator is
predonritrntely betn receptor ngottist. a. Amphetamine
b. Norepinephrine
c. Phenylephnne
d. Iso roterenol
18. Each of the following is a predictable adverse effect of e. h4eLoxamine
drugs that block the sym athetic nervous system EXCEPT
a. Gastrointestinal Jsturbance ( d ) Atls~ueris (d)- W l a t is tteded for brottclrodilatiotr is
b. Postural hypotension relaxntiott of brottdtial smootli nrrtscles. This is
c. Nasal congestion accontplislud with beta2 receptor stimulatiotr.
d. Urinary retention Isoproterenol is the on1 drug listed with poterrt betn2
e. Miosis nctiorr. (a) stimulates a$hn receptors in the C N S , (b) NE
stimrtlates alphn and beta1 receptors ntore than beta2, (c)
pherryleplrrine is a n alplm receptor agonist, while (e)
methoxnmine is a vasocotrstrictor that stinrulates alpha
19. In ion of a pressor dose of norepinephrine may result in a receptors preferentially.
g r e a s e d heart rate because of
a. Activation of barorece tor reflexes
b. Direct stimulation of a&ha receptors
c. Direct stimulation of beta-1 receptors Administration of which of the following d r u s would
d. Direct stimulation of beta-2receptors produce vasomnst riction of the gingival vessef s?
e. Direct stimulation of muscarinic receptors a. Levonordefrin
b. Phentolarnine
(n) Atrswer is (n)- alterttntives 2-4 nll itrcrense lrenrf mte, c. Epinephrine
while N E ltns 110 e f i c t at ntuscnrinic receptors ((e)), d. Propranolol
wlliclr nre specific for clrolitrergic drrtgs. e. Phenylephrine
i. (a) and (b)
ii. (a) and (c) only seer1 iir or11 a snlnll perccrrtnge of pntie~rts.lrrcrensed
iii. (a), (c) and (el irr cideirce o/Ynrrllythnrhs is also a problenr. Letjodopn nlso
iv. (b), (dl and (el serrsitizes the iteart to epitteplrrirre irrdrtced arrltytiznrins.
v. (b) and (dl only

General Principles of Drug Action

24. Carbidopa, a dopadecarbxylase inhibitor, is often used in


Remember this section of the course? This is
the treatment of arkinsonism because it where we defined a bunch of terms that described
a. Potentiates t i e central action of dopamine how drugs interact with receptors to produce their
b. Potentiates the central action of norepinephrine effects. Most of you yawned and thought "What
c. Decreases the pen heral metabolism of levcdopa
d. Inhibits the peripReral stimulatory fibers from the the hell do we need to know this stuff for - just tell
central nervous system us about antibiotics!" Well the Great Board Gods
e. Increases the permeability of the blood-brain barrier to want you to know some of this stuff - that's why I
levcdopa
put it in the course. Your apologies are graciously
accepted, as always!

Of the followin one of the most effective treatments I . A pharmacologic agonist is a chemical substance that
currently availagle in the US.for most patients suffering a. Binds to a specific receptor and produces a response
from parkinsonism involves oral administration of b. Elicits a pharmacologic response without binding to a
a. Dopamine receptor
b. Amantadine c. Possesses the property of affinity but not of intrinsic
c. Benztropine activity
d. Levcdopa alone d. Exhibits no activity except to oppose the effect of an
e. Levodopa plus carbidopa antagonist

26. Levcdo a therap for Parkinson disease may result in each 2. When comparing drugs with respect to intensit&of r e s r n s e ,
of the foiowing eiects EXCEPT: the drug that produces the greatest maximum e ect is t e one
a. Development of abnormal, involuntary movements, with the highest
especially in the face a. Affinity
b. Extreme sensitivity to sympathomimetic drugs b. Potency
c. Exacerbation of an acute psychosis c. Efficacy
d. Nausea and vomiting d . Therapeutic index
e. Extreme sedation

3. If dru has a greater efficacy than drug B, then drug A


27. Adverse effects of levodopa include: a. I! more toxic than dru B
a. Arrh thmias b. Has a greater affinity for the receptor than drug B
b. Psyc{otic disturbances c. Has a reater margin of safety than drug B
c. Nausea and vomiting d. Is capa%le of producing a greater maximum effect than
d. Abnormal involuntary movements drug B
i. (a), (b), and (c)
ii. (a), (b) and (d)
iii. (a), (c) and (d)
iv. (b),(c) and (dl 4. A drug with a high L D g and a low ED50 has a
v. All of the above a. High therapeutic index and is, therefore, very dangerous
(v) Arrswer is (e)- Lerrodopn is tixprinlnrydru used to b. High therapeutic index and is, therefore, relatively safe
t r u t pnrkinson's diunse, which results from afirormally c. Low therapeutic index and is, therefore, very dangerous
low levels o d o amine in the braiti. Leoodopa, or L- d. Low therapeutic index and is, therefore, relatively safe
D O P A is t L L r e d precursor of do amine (which cnn't
be used hecnrrse it doesn't cross the hood brairr harrier- L-
D O P A does and is converted to D O P A it1 the brain) is
ztsai to incrense dopnmine irz the brain. All of tlte efects
are establisid side effecis of L - D O P A therapy, thus the 5. The ratio of the median lethal dose ( L D s ) to the median
arrswer is (e). Abrtornrnl involurrtay rnovenlerrts (AlMS) effective dose (EDSO)is the
nre tite most prevalerrt atrd troublesome "extrapymnridal" a. Morbidity index
side effects, typicnlly involving the orofncinl b. Mortality index
nrusarlnture. Nnusen nnd vonrrtitrg nre seetr duritrg tire c. Anesthetic ratio
first piuse of tizernpj but tolernr~cedevelops to tlzese d. Therapeutic index
effects. Tire psyclrot zc effects nre nrrrclr less prevaletrt ,
Prepared by M.L.Thompson, Ph. D., Dept. Of Pharmacology, Tufts Medical School

6. The therapeutic index of a drug is the ratio of


a. The effective dose to the toxic dose
b. Half the toxic dose to half the effective dose
c. The maximum tolerated do= to the minimum effective
11. In which of the follorrrinp airs
of drugs is the
pharmacolo ic activity o t e first drug diminished or
dose anta onized%y the second drug?
d. The lethal dose for 50%of animals to the effective dose a. histamineepinephrine
for 50% of animals b. Penicillin-erythromycin
c. Morphine-naloxone
d. Procaine-sulfanilamide
e. Aspirin-phenylbutazone
The phenomenon in which two drugs produce op i. (a), (c) and (dl
effects on a physiologic system but do not act at t K Z K e ii. (a), (c) and (e)
rece tor site is iii.(b) and (d)
a. $otentiation
b. Chemical Antagonism iv. (d)
v. (c) OnllY
on y
c. Competitive antagonism
d. Physiologic antagonism
e. Noncompehtive antagonism
12. Which of the following responses is least predictable in
occurrence?
a. Toxicit
8. Epine hrine anta onizes the effects of histamine by b. ~ i d e - e f L t s
a. Reventing tRereleaseofhistamine c. Idiosvncrasv
b. Acting on the central nenpoussystem d. ~ a c h b h ~ l d x i s
c. Producing physiologic actions opposite to that of e. Therapeutic effects
histamine
d. Competitively blocking histamine at the cellular (c) A~rsroeris (c)- Idiosy~~crntic renctioirs nre selreticnlly
receptor site deternti~rednbirornlnl respolrses to n drttg. Tlrev nre tlre
nrost rt~r redictable in occrtrrettce becatise t l e ietreticnlly-
(c) epi~r hrirte ncts ns n plrvsiolopc nittngo~rist.It b n d d6ererrce resportsible for sltclr a reactio~rto n drug
,roirspec&nlly n,ttngorrizes lristnnri~teby exertirtg its nrny ,tot beconte evtdnrt until tlte drti is take11for tlre
oro~tdistilrct effects, for exnnt le, t~nsocorrslrictioit, first time by the patietrt. Typically, t& effect is orte of
brorrcltodilntiorr, n~rddecrensJG1 ntotility. It does wot nb~tornlalseirsitizlity to a drti ,suclr thnt a tlternpetittc
reverse tlte e fect o ltistnntitte by blockirrg nt n specific effect is presetrt at doses nttic% lower tlln~tttornlally ttsed,
receptor ((d){ RS td antilristnntilres. It does ,rot prar,rt wltile tlte nornlnl dose ntay result i ~ at toxic reactiotr. At1
the reknse of lristnnri~tens does n drtt sriclt ns cronrolvn exnnrple is tlte respolrse to sticciirylcholi~re i l l patieuts
((n), by prezwrrtbr nlnst cell degrnlrrrkliort). A,rsirler (b) witlt ntvpical plnsnrn cltoli~testernse.Tltese pntiettts don't
I
is ,rot rclmnat, wfile (n) is tlre nteclm,risnt o ncfiort for
cronrolylt, tolriclr idribits nrnst cell dcgrn~rrintiolr..
nretnbolize srtcci~r~lcltolitre
nt tlte sane rate, n~rdtlrtis
sltoro n prolo~rgeddnt nctiorr nlrd itrcrensed se~rsitizlityto
tlte drrtg. Tlte otlter aier,mtizJes nre typicnlly relnted to
tlte dose of the drtig and becntise tlte nlnjority of t l e
populntio~rdo tot possess all atypicnl ge~tettcbnsis for tlre
9. Interaction between nitroglycerin and epinephrine is what respolrse to tlte drug, the effects are predictnble gizjetr tlte
type of antagonism? dose alrd krrowledge of wlwt the drrig does.
a. Allosteric
b. Physiologic
c. Biochemical 13. Idiosyncrasies to drugs are'related to
d. Competitive
e. Pharmacologic Pies
b. enetic factors
a.
c. A e of the patient
(b) A~tsweris (b)- epilreplrriue uforild stinttilate nlplrn d. Afl of the above
adrenergic recqptors to produce vasoco~tstrictio~r,
wltereas nit rog ycerin relaxes z~ascrtlnrsntooth nruscle.
n t t i s the two drttgs wottld lmve o oshrg actiotts.
H o w w r , tlte nclions m e p r ~ d u c 8 ythe drrtgs acthr or1
differetrt meclmttisnrs; tritroglyceritt does not act at a&lm 14. Two drugs, A and B, have the same mechanism of action.
1"
receptors as does epin rine. If it did, tlte interadio~r
wottM be conrpetittz~e. 11 this case tlte i~tternctiolris vin
competiirg physiological effects.
Drug A in a dose of 5 mg. produces the same magnitude of
nse as drug B in a dose of 500 mg. Which of the
E E w i n g statements is correct:
a. Drug A is less toxic
b. Drug A is more efficacious
10. When the combined action of two drugs is greater than the c. Drug A is 100 times as potent
sum of their individual actions, this is d. Drug A has a shorter duration of action
a. Induction e. Drug A is a better drug to use when a maximal response
b. Synergism is desired
c. Idiosyncrasy
d. Hypersensitivity
e. Cumulative action
4.Other points to remember: A)many BDZs form active
15. According to the theory that agonists and antagonists metabolites; B)N injection of diazepam can cause
occu y the same receptor site, an effective antagonist should
g
exhi it
irritation such as thrombophlebitis d u e to the solvent the
BDZ is dissolved in.
a. High intrinsic activity and high affinity
b. Low intrinsic activity and low affinity
c. High intrinsic activity and low affinity Barbif ura fes:
d. No intrinsic activity and high affinity
1. (a) question in occurrence about barbs is always
regarding thiopental. Remember, thiopental's action is
terminated by redistribution of the dru out of the brain-it
16. All of the following statements are true regardin the
occu ation theory of drug-receptor interaction &CEPT:
di
enters the brain rapidly and exits rapi y, thus quick
onset and short duration of action.
a. h e affinity of a drug is dependent on its intrinsic
activity
b. The maximum effect of a drug occurs when all receptors 2.(b) question wants you to remember that barbs are not
are occupied
c. An antagonist has affinity for the receptor but not
-
analgesic this is usually in the form of a list of actions
and they want you to indicate which is not true.
intrinsic activity
d. The ma itude of the effect of a drug is proportional to
the num%r of receptors cxcupied 3. Questions about toxicity -
e. It follows the law of mass action
a. Barbiturate overdose kills you because of
respiratory depression
b. Barbs are contraindicated in a patient with
17. The occupational theory of drug-receptor interaction states intermittent orphyria - barbs enhance p o r ~ h y r i n
that synthesis an$ thus will aggravate the disease
a. The ma itude of the drug response is proportional to
the numKr of receptors cxcupied Sedatives
b. A partial agonist has intrinsic activity but no affinity
for the receptor site
c. An antagonist dru has affinity but no intrinsic activity 1. Diaze am is preferred to a barbiturate as an antianxiety
d. The rate at which t i e drug-receptor complex associates agent gecause diazepam
and dissociates determines drug efficacy a. Produces no sedation
e. The degree of drug action is dependent on the law of b. Has less addiction potential
mass action c. Is a very short-acting drug
d. Is substantially less expensive
i. (a), (b) and (c) e. Does not potentiate the action of CNS depressants
ii. (a), (c) and (el
iii. (b), (c) and (dl
iv. (b) and (e)
v. (c), (d) and (el
2. Benzodiazepines produce their antianxiety effects by
modulatin which of the following neurohumors?
a. GAB!
b. Glycine
Sedatives c. Doparnine
d . Acetylcholine
e. Norepinephrine
This category consists of mostly questions regarding
benzodiazepines and barbiturates, and requires you
to know the differences between the two types of
drugs in terms of mechanism of action, therapeutic 3. Benzodiazepines exert their main effect on
a. Neuromuscular junctions
actions and adverse side effects and toxicities. b. Peripheral reflex synapses
Here's a capsule review: c. Central GABAergic neurons
d. Central serotonergic neurons
e. Central adrenergic nerve endings
Benzodiazepines:
(c) Answer is (c)- memorizntiorr- BDZ8s birrd to sites on
the GABA receptor.
1.Examples: diazepam, chlordiazepoxide, etc.
2.Mechanism of action: modulate the activity of the
inhibitory neurotransmitter, GABA 4. All of the followin pertain to general anesthesia induced by
3.Advanta es vs. barbs: less addiction potential, less thio ntal E X C E ~ :
profounfi CNS depression, larger therapeutic index, less a. E s t induction
respiratory depression b. Decreased secretions
Prepared by M.L. Thompson, Ph. D.,Dept. Of Pharmacology, Tufb Medical School

c. Low therapeutic index a. Hypotension


d . Short duration of anesthesia b. Renal failure
e. Predisposition to laryngospasm c. Hepatic necrosis
d. Nausea and vomiting
( b ) Bnrbittlrntes nre problentntic ns nttestltetics becnlrsc e. Respiratory depression
t l q often ittd~rceexcessiae snlizntiort nrtd brortchinl
secrettorr, tistinlly reqrtirirtg tlte tise of ntr nrtticltolirtergic
drri to be adnrirtistered to redttce tllese secretiorts. Tlrtis
(b) fins to be tlte jalse stntentertt.
10. Im ortant steps in the treatment of barbiturate poisoning
incide:
31. Which of the following factors contributes to the short a. Maintainin an open airway
duration of action of a single dose of thiopental? b. Increasing t i e input of afferent stimuli
a. rapid biotransformation c. Maintaining respiration
b. rapid accumulation in body fat d. Administemg a narcotic antagonist
c. high lipid solubility of the undissociated form e. Administering a central nervous system stimulant
d. ability to enter and leave the brain tissue rapidly
i. (a) and (b) only
(dl is correct - tltioperttnl is tlle clnssic exnntple nlzunys ii. (a), (b), (c) and (el
5
giver1 o a drug wltose dltrntiort of ncliort is deterntitterl by
redistrr utiort nuwy front its site o/ nctiort irt tlle brnirt to
less well perfiised ttssiles. Tltey lenzw otlt t l ~ ezvord
iii.(a) and (c) only
iv. (b) and (e) only
v. (d) only
redistribrltiott front tlte nrtsruer to cort/tlsc yorl -tlley btoro
tltis is tlte rony yo11 lenrtted it.

11. \Yhich of the following are true regarding barbiturates?


3. Speed of recovery from short-acting anesthesia with a. Significant1 elevates pain thresholds
thiopental d e nds chiefly on the rapidity of b. Are metaboKzed by the liver
a. Renal t u c l a r secretion c. Are classified according to duration of action
b. He atic degradation of the thiopental group d. Depress all levels of the CNS
c. ~existributionfrom the brain to skeletal muscle e. Cause death by cardiovascular depression
d. Reverse diffusion across the blood-brain barrier
e. None of the above i. (a), Cb) and (c)
ii. (a) and (d)
iii.Cb), (c) and (d)
iv. Cb) and (el
v. (c), (dl and (e)
6 . The action of the ultrashort-acting barbiturates is
terminated primarily by the process of (iii) Artswer is (c)- Bnrbitlirntes nre ttot nrmlgesics, tlttis
a. Oxidation nrry nnswer witlt "a" srlclt ns (n) cart be elinritrnted.. "b" is
b. Redistribution true, tltlis tlle arrswer ntrtst contniri "b" as one of tile
c. Renal excretion nlterrrntives, tltris (d) aitd (e) are eliniiimterl.. "c" is also
d. Plasma protein bindin trtre, barbiturates nre alwnys clnssified nccorditig to
e. Conjugation with sulkte dtirntioir of actiorr (tltiopeittnl- ultra-short actiitg;
plrertobnrbitnl-loit -uctirtg, etc.). Tltis eliniinntes # 3 so tlle
nitsruer ntust k (f).Of course, ori should lmve been nble
to rnpidly elintirtnte a r t s w s (c! 4, arrd 5 because
bnrbrtrlrntes cartse dentlt by respirntory depressiotr, trot
7. Which of the following is NOT characteristic of cnrdioz~nsculnr depressiort.
barbiturates?
a. Possess anticonvulsant properties
b. Possess significant analgesic properties 12. Barbiturates are contraindicated in a dental patient with:
c. Possess serious drug dependence potential a. Emphysema
d. Vary in degree of lipid solubility and hypnotic potency b. Hy rtension
c. LJngaPosed severe pain
d. Acute intermittent porphyria
i. (a), (c) and (dl
8. The cause of death from acute barbiturate poisoning is ii. (a) and (d) only
a. Convulsions iii.(b) and (c)
b. Liver damage iv. (b) only
c. Renal failure
d. Respiratory failure ( i ) Answer is (a)- "d" is the absolute contraiirdicatiotr for
e. Cardiovascular depression barbiturate use, sitrce these drugs stinlulate t k syntltesis
I
o ertzynles involved in the s y n t k s i s of porphyritrs and
t rus will a g p a w t e this d i m . Tlrus the answer must
coirtairt "d' ,eliminating (c) and (d). Sittce both (a) ntrd (b)
difler only by alternative c, that is the second fact you
9. Which of the following adverse effects is most commonly must h o w . Barbiturates are not annlgesics, but d n t i v e s .
associated with administration of an intravenous Witetr pain is present, they nmy evert nrake tile pairr
barbiturate?
ziyorse, resrrltifrg i ~ rnrozrsnl, rnge ntrd perllnps delirilrnr it1 antips chotic drugs?
tlre pntietrt. Tlrlrs, "c" wolrld seen1 to be n pretty stro~lg . a. d e y block the dopamine receptor
co~rtrni~tdicntio~l, nrnki~rs(n) tlze right nfrs1rver. b. They affect the hypothalamic temperature regulation
c. G E a u s e emesis
13. If diazepam (Valium ) is to be iven intravenously, it is d. They are synergistic with LSD
e. They cause hypertension
k
recommended that a lar e vein k e used in order to
a. Hasten the onset o action
b. k e a s e the risk of thrombophlebitis i. (a) and (b) only
c. Offset the vasoconstrictor qualities of diazepam ii. (a), (b) and (c)
d. None of the above iii.(b), (c) and (d)
iv. (c), (dl and (e)
(b) (b) is correct. This is one oj tlze adverse side efiects oj v. (dl and (el only
IV diazepnnr. None oj tlre otlrer nlter~~ntiz~esnpply.

14. The most important therapeutic measure to be taken in a


case of barbiturate poisoning is to
a. Alkalinize the urine
b. As irate stomach contents
c. Aiminister a CNS stimulant
d. Assure adequate res iration
e. Administer osmotic guretics 2. The anti sychotic effects of the phenothiazines arc probably
the resug of
a. Release of serotonin in the brain
b. Release of norepinephrine in the brain
c. Blockade of d o aminergic sites in the brain
d. Prevention of tKe release of norepinephrine from brain
neuron terminals
Psychopharmacology: Antidepressants e. Increase in the dopamine content of the cerebral cortex
and Antipsychotics

Antipsychotics questions are usually about 3. The antipsychotic effects of phenothiazines result from
phenothiazines and usually about chlorpromazine. They a. Release of serotonin in the brain
ask for: b. Release of norepinephrine in the brain
c. Blockade of do aminergic sites in the brain
a. Mechanism of antipsychotic action: blockade of d. An increase in tRe doparnine content of the cerebral
dopaminergic sites in the brain cortex
b. Major side effects: i) anticholinergic effects, ii) e. Prevention of the release of norepinephrine from brain
extrapyramidal stimulation resulting in tardive neuron terminals
dyskinesia

2. Antidepressant questions are usually about tric clic


antidepressants such as imiprarnine or amitriptyine- 4. Chlorpromazine and related drugs are thought at a d by
usually of the t ...which of the followin is used to treat block~ngwhich of the following receptors?
depression? ... fGs are the most commonf used a. Adrenergic
antidepressant medication, but remember tlat MA0 b. Muscarinic
inhibitors such as tran l w r o m i n e or phenylene are also c. Dopaminergic
used. 2nd eneration dlugs are fluoxetineand trazodone. d. Central serotonin
I8
The drug the cpestions may ask for:
( c ) Answer is (c)- Clrlorpronlazine is the rototypic
a. Mechanism of action: blockade of amine reuptake or phenothiazble, an antipsychotic drug u d i n t p
alterations of receptor number t r a t nlent 01 schizophrenia. O t l w ntrtips chotzc drugs
used jor thls purpose are haloperidol anhhioridazine.
b. Side effect: anticholinergic or atropine side effects These drugs act via dopaminergic receptors.

3. The last type of uestion, again a dru LD asks that you


1
remember that lit ium is the drug of cioioice for the manic
phase of manic depression.
Side Effects
5. Which of the following is an irreversible side-effect resulting
Antipsyclzotics - from long-term administration of phenothiazines?
a. Sedation
Meclzanisnr of Action b. Xerostomia
c. Infertility
1. Which of the following are pharmacologic properties of
d. Parkinsonism
e. Tardive dyskinesia
Prepared by M.L. Thompson, Ph. D., Dept. Of Pharmacology, Tufk Medical School
,

b. Photosensitivity
c. Excessive salivation
d. Anticholinergic effects
6 . Tardive dyskinesia is a neurolo ica1 sideeffect of which of e. Antiadrenergic effects
the following classes of drugs. 9
a. Alcohols
b. Tricyclic antidepressants
c. Barbiturate antiepileptics AIZtidepressants
d. Phenothiazine antipsychotics
e. Monoamine oxidase inhibitors
10. The drug most commonly 4 to treat severe mental
( d ) Tardizw dyski~tesinis atr irrezjersible cotrditiolr tlrnt d e ression is
consists of irtzjolurrtn nrovenrerrt of skeletnl nrttscles, n a. L i u m
cottditiort whiclr mny?e u e t t followbrg prolorrged use of b. Imi rarnine
drugs. This is typicnlly n dopnnriirergic nledinted effect. c. ~ h P o rromazine
Tlle llerzothinztrre ant;psyclrotics nre tlle ottly drrigs d. ~ r a n ~ b r o m i n e
1 i s t J w h i c h nct vin dopantine. T l u otlrers, s u c l ~ns~ e. Dextroamphetamine
tricyclics nrtd M A 0 itrlribitors nffect ndretter
PC
tra~tsntissiott,bnrbittimtes act zjin GABA, ns oes nlcollol. ( b ) this qrlestiott is obviorisl ront tlle enrly 80's; you
would see a different list o#u s todny, so review your
sylbbris otr antidepressnnts. ~ 0 you % wotrld
~ probnhly
see sonrethirrg like prozac. Trnrt Icypromirte is tlle ottly
7. \Yhich of the following drugs are most likely to cause o t h r nntidepressnttt listed (~li%rpronmzitreis nrr
extrapyramidal stimulation? nttti sycltotic used to trent scltizoplrrettin), brrt is ntt M A 0
a. Antibiotics inhtkitor. n ~ s are e 2nd cltoice dnigs drce to side effects.
b. Salicylates
c. Barbiturates
d. Phenothiazines 11. Which of the following drugs is most effective as an
e. Benzodiazepines antidepressant?
a. Diazepam
( d ) - Extmpymntidnl side effects nre the nrnjor side b. Reserpine
e fects of n~rtipsyclloticnredicntiott nttd itrclude c. Amitriptyline
darkirtsotr-like effects ns rue11 ns tnrdiis dyskit~esin(from d. Chlorpromazine
dez~elopnlerrtof sripersettsitirjity reslr lt itlg front clt rot1ic e. Hydroxyzine
blocknde of doynnrtr~ereceptors in bnsnl gnrrglinl-
nbtrornrnl mpid nltertrntittg ntoz~enrerrtsof totrglre nrtd
perioral areas, fncinl grinrncitt , etc. Pllettotlrlnrirlcs nre
the ortly ntttipsyc,totrc nrlrgs i s t e n .
Meclzanisnr of action
8. Phenothiazine derivatives d o NOT produce
a. Jaundice Which of the following is most likely to be the major
b. Xerostomia mechanism of action of the tricyclic antidepressants?
c. Gingival hyperplasia a. Enhanced release of acetylcholine
d. Postural hypotension b. Inhibition of neuronal synthesis of norepinephrine
e. Symptoms of parkinsonism c. Potentiation of serotonin synthesis in nervous tissue
d . Stimulation of reuptake of norepinephrine from the
( c ) A~rsweris (c)- # 3 sltouM stntrd orrt irtrnrulintel~ s naptic cleft
beulise this is alnrost nlwnvs nletttiotted ns n side elect of e. dockade of the reuptake of amine neurotransmitters
dilarrtitt, wlticlr is )rot n plle;rothinrirle, but ntr nrlti- released into the synaptic cleft
co~tvtilsnnt.Pllettothinzitte deriz)ntiz~esnre nrrtipsyclrotic
dru s sudr as hnloperidol (Hnlcyort) or clrlo ronmzttte
f
u s d i n the treatment o disorders such as sc%zo lrrenia.
Yolr slrould rentenrber t rnt t l u ntost troublirtg sic! cffect
o these drugs is t l prodtidiort
~ of tnrdive dyskinesra a t d
Side Effects

* +
t1* arkinsotlian-like extrapyramufal disorders. Thus t 5
is e k i n a t d . A s rr rule tltese drugs k v e anticltoliner ic
and anti-a1 lta adretter ic side effects, wluc t wou 13. Tricyclic antidepressants have a rominent side effect that
eliminate xerostonrtn, an postural hypotension (due to an most nearly resembles the usuafpharmacological action of
an ti-ad renergic depressant elfect on both vasomotor a. Codeine
centers and the autonomic rtervotis systent) as possible b. Atropine
B
answers. Iaundice is a less fre tient side e ect than tlte
e x t r a ~ r a m i d n lsyn~ptoms,am! ofterl rese ts from art
allergrc readiotr to tllese drrigs. n t u s the arlswer is (c).
c. Ephedrine
d. Pro ranolol
e. ~ e K a c h o l i n e

9. All of the followin actions are associated with the use of


chlorpromazine%~c~IT:
a. Jaundice Antimanics
b. Candidiasis
c. Tuberculosis
14. Which of the follo\vins drugs has its primary use in the d. Peptic ulcers
treatment of the manic phase of depressive psychosis?
a. Lithium i. (a), (b) and (c)
b. Reserpine ii. (a), (b) and (d)
c. Imipramine iii. (b), (c) and (d)
d. Am hetarnine iv. (c) and (d) only
e. ~hPor~romazine v. All of the above
( v ) Artswer is (e)- Corticosteroids nre antiirtflnntnmtoy
drugs used topically, orally attd pnrertterallv. However,
they suppress the imnilrne systent of the body. Tltey lrave
13. Lithium carbonate is particularly effective in treating beat btown to cause peptic ulcers, as well as nlask tlze
a. Parkinsonism syntptorns of an ulcer, and perforntion arrd lzemorrlmge
b. Hypertension m y result. Thus "dmhas to be in the answer, eliminating
c. Schizophrenia (a). Because they are immunosuppressive, they would
d. Acute anxiety obviotrs make an AIDS ptient, w to already has a
e. Manic-depressive psychosis conrprontised intmurte s stenr, worse. Sintrlarl , laterrt
&
tubercnlosis could also reuctivnted. 711~sY Jarid (dl
car1 be elirnirtated. Use of corticosteroids in irtlzalers or
astltnta, while adrpantageous in rcducirrg the side e k c t s
res~tltirtgfront s stenttc ndntirlistrntiort, hns led to nn
16. The current drug of choice for treatment of the manic phase itrcrensc irr prob&nts witlt Cattdidinsis, so "b" lras to he it1
of manic-depressive psychosis is the nnszuer. (e) is tlle orlly arrswer tlmt nteets all tllese
a. Lithium req~tirenlerrts.
b. Caffeine
c. Reserpine
d. Irniprarnine 3. Which of the following does NOT result from prolonged
e. Amphetamine treatment with steroids?
a. Gastric ulcer
b. Osteoporosis
c-
d. Hpglycemia
yocardial atro hy
e. Redistribution orbody fat
Anti-inflammatory Drugs:
In general, you need to remember that 4. Glucocorticosteroids are useful as secondary treatment of
1. These are corticosteroids or glucocorticoids and that they anaphylaxis because they
suppress the immune system m addition to their a. Inhibit the production of antibodies
antiinflammatory activity. Thus latent infections such as b. Prevent the union of antigen with antibody
tuberculosis may go systemic or opportunistic infections c. Prevent the release of histamine from sensitized cells
such as Candidiasis may become more of a problem d. Su ress the inflammatory response to cell injury
e. 1n;iit the release of serotonin from vascular storage
2. Side effect profilejastric ulcers, immunosuppression, sites
acute adrenal ins ficiency, osteoporosis, hyperglycemia,
redistribution of body fat (d) Arlswer is (dl- Glucocorticoids such as
ltydrocortisone are classed as antiirtfirnrnntories,
irtl~ibitirtge v e y step of the inflantntatoy process.- tltus
( d ) is the correct answer. The otlzer alternatives are
Frequently asked questions on anti- single steps along the pathway, that are handled by otlter
inflammatory drugs; drugs that are more selective than glucocorticoids.

1. Which of the following statements is NOT true regarding the


adrenal corticosteroids? 5. Adrenal steroids are used successfully to treat all of the
a. Cause retention of sodium and fluid following conditions EXCEPT
b. Decrease activity in lymphoid tissue a. Gastric ulcers
c. Heighten the immune responw to antigens b. Addison disease
d. Can roduce a diabetes-like syndrome with high blood c. Lupus erythernatosus
leveL
r
e. Are therapeuticall beneficial when administered
orally, parenteral y or topically
d. Rheumatoid arthritis
e. Aphthous stomatitis

i
2. Which of the follohin conditions contraindicate use of
corticosteroids in a ental patient?
a. AIDS
Prepared by M.L. Thompson, Ph. D.,Dept. Of Pharmacology, Tufts Medical School

that the most resistant part of the central nervous system is


General Anesthetics: the
a. S inal cord
1. Questions always come u p re arding factors that influence b. d d u l l a oblongata
i?
the rate of induction. Remem er that onset of anesthesia is c. Cerebral cortex (motor area)
d . Cerebral cortex (sensor area)
inversely proportional to solubility of the anesthetic in
the blood. The more soluble the agent is in blood, the more
must be given to reach critical tension in the brain.
2. A second set of questions has to d o with adverse side
effects of various general anesthetics. Halothane is 6. General anesthetics can d o all of the following EXCEPT:
associated with hepatotoxicity. a. Produce delirium
b. Stimulate medullary centers
3. Some questions are based on the pro ressive depression of c. Produce a state of unconsciousness
CNS function leading to anesthesia %at characterized d. Reduce perception of painful stimuli
older anesthetic agents. Remember the 4 stages of e. Decrease excitability of the motor cortex
anesthesia:
Stage I: analgesia
Stage Il: delirium
Stage In: sur ical anesthesia 7. In ~ e n e r aanesthesia,
l the last part of the CNS to be depressed
Stage lV: m d u l l a r y paralysis is the
a. Medulla
b. Cerebnun
c. Midbrain
Frequently asked questions: d. Cerebellum
e. Spinal cord
1. Signs and stages of anesthesia are most likely to be seen ~\.ith
a eneral anesthetic that has a
a. $w potenc
b. Slow rate ofYinduction
c. Low Ostwald coefficient 49. General anesthesia with halothane is commonly preceded by
d . High oil-water solubility coefficient administration of atropine to
e. High tissue-blood partition coefficient
inhibit vagal overactivity commonly caused by
halothane
induce muscular relaxation by blocking cholinergic
receptors
2. All of the followin influence the rate of induction during c. reduce salivation and bronchial secretions caused by
anesthesia EXC~PT: halothane
a. Pulmonary ventilation d. all of the above.
b. Blood su ply to the lun s Ausroer is (c)- illis is i l ~ eclnssic clitriul use of atropitle
c. ~ e m o ~ l o %content
ln of &e blood and oue yorr slrolrld ltnzle conlnritfed to menrory. Atropitre
d . Concentration of the anesthetic in the inspired mixture does )rot induce nrlrsclrlnr rehxatio~r-iltnt worrld be a
e. Solubility of the anesthetic in blood (blood-gas ttettronrrisc~tlnrjrrrtctiott blocker srrclr ns curare, thus (b)
partition coefficient, Ostwald coefficient). ntrd ( d ) nre wrong. #! might colrfirx yotr. Atropirre is used
to ozjerride vn a1 nctizjity, but tlmt is trot tlie reasorr it is
givett before hlotlmt1e.

3. The rapidity of onset of anesthesia with an inhalation


anesthetic agent is primarily related to its
a. Molecular wei ht
b. Degree of bloo% solubilit
c. Temperature in the gas pLase
d. Interaction with preoperative drugs Questions regarding antihistamines generally want ou to
know what H1 and H2 antihistamines are u s d f o r :

H1 antihistamines are useful for: .


4. Which of the following forms of drug toxicity is associated 1. Treating dermatologic manifestations of an allergic
with the halogenated hydrocarbon general anesthetics? response. (ex. chlorpheniramine)
a. Liverdama e
b. ~ ~ o c a r d i a k a t r o ~ h ~ 2. Preoperative medication for sedation, antiemetic
c. Peripheral neuritis properties, anticholinergic effects. (ex. promethatine)
d. Severe hypertension 3. For controlling the symptoms of parkinsonism (ex.
d iphenhydramine)

5. The behavior of patients under general anesthesia suggests H2 antihistamines such as cimetidine are used to reduce gastric
acid secretion (ex. cimetidine)
(n) Renlenlber tllnt Parkirrsorrisnr is
oj D A i l l tlle brairl, nrld is clrrrerrtly
.. Which of the followin d r u ~ iss useful in treating arrd mrbidopn. However, prior to tllese, ntrt
P
dermatologic mani estations of an allergic response?
a. Diazepam
drugs ruere tkeftrst drrigs folrrrd to be
jor trentnletrt o this disense, in tllat clroliner 'c ntl
b. Atropine dopanritrergic lrncts b,teracf itr tlze braitt, a n f t h u s
c. Hexylresorcinol reducing cholinergic activity vin anticl~olitlergicdrugs
d. Chlorpheniramine inrproves or enhatrces dopnminergic fxr nctiotr, sug estitrg
e. Phenoxybenzamine otre is inhibitory to f l u otlzer. Drugs witlr atrticltoitrergic
actizjity are often still tlle first drug tried. Atltilristanrine
( d ) Anstuer is (e)- Tlze inrplid drug clnss is drugs suclr ns diphetlhydramine oftett h z j e strottg
Ti
atrtihistnnrirres. 0 tlle drugs gizpetl orrly 2, (c), ntrd (e) nre
d
nnt ilristnnritres. here nre two chsses o ant ilristnnrirres,
HI and H2. H2, represetrted by cinreti itle, nre used to
atrtrclrolitrergic act izpity, wlliclr nccounts for their
eflectivetress in drying nasnl secretiotls associated with a
cold. Therejore, the answer is (a). (e) is there to confxtse
treat ulcers not skirr conditions. HI atrt ilristnntirres nre you, but don't be. Diphenlrydranritle does not stinrlrlate
used to trent nllergic renctiotrs, ntrd chlorplrerrirnnritre is dopanrinergic nerves in the bnsal ganglia. Ad retrergic
nrr HI drrig. Thlrs tlle atrswer is ( e l blockers ((c))do see sonre use in tlle treatntent of
Pnrkitrson's, but d i lletllr drnnlitre has no adretrergic
blockitrg act izjit . &pherl~yirnnritre does llaw t l u act iorrs
2. Cimetidine is used therapeutically to git~etritr (b) atrX(d), but tllese nre 11ot respotrsible jor its
a. Stimulate respiration ejFcacy itr Parkitlson's..
b. Protect against anaphylaxis
c. Decrease gastric acld secretion
d. Hasten excretion of barbiturates 41. The mechanism of action of HI antihistamines is
e. Dilate smooth muscles of the bronchioles a. M A 0 enzyme inhibition
b. competitive antagonism
c. physiologic antagonism
d. noncom~titiveantagonism
e. inhibition of release of bound histamine
3. Gastric acid secretion has been shown to be most effectively
reduced with the use of (b) Atrszoer is (b)- nlenrorizntiotr - HI ntltillistnnlitres are
a. Adrenal steroids conrpetitizpe histanlitre receptor blockers. Mnny stlrdetlts
b. Anticholinergic drugs nrrswer (e), brtt this is tlle nrecltnrrisnr ojnctiotr oj
c. Serotonin antagonists cronrol 11. (c) nlso dratus sonle arrswers, birt is wrorrg-
d. HI-histamine receptor antagonists epitrepfritle is tlle pl~ysiological ntltngotrist oj histnnritre.

Miscellaneous questions from a variety


4. Drug-mediated inhibition of Hz-histamine receptors is most
useful in treating of categories that are not asked quite
a. Asthma
b. Anaphylaxis
as frequently as the ones above:
c. Contact dermatitis
d. Gastric h peracidity 24. Which of the followin drugs is often used to treat
e. Localizedlallergic reactions tri eminal neuralgia. Fs
a. cfonazepam
b. carbamazepine
c. acetazolamlne
d. succinylcholine
5. Which of the following antihistamines is most commonly used
as reo erative medication? Answer is (b)- This is a memorization question.
a. RlecPuine Carbamazepine, as well as phenytoin, are the ?in drugs
b. Cyclizine used to treat trigeminal neuralgia. Clona a m zs a
c. Promethazine betlzodiaupine, succinylcholine is a d e p x r i z i n g
d . Dimenh yd rinate neurontuscular blockin agent, while acetazolanttne is an
e. Chlorpheniramine ant icotrvulsant like ca%anxuzepine.

1. The use of epinephrine for local hemostasis during surgery


might result in
6. Use of diphenh drarnine (Benadryl ) in controlling the a. hypo~lycemia
symptoms o?pzrkinronism is based upon which of the b. cardiac arrthymia
following effects? c. an acute asthma attack
a. Anticholinergic d. a drastic drop in blood pressure
b. Local anesthetic e. any of the above
c. Adrenergic-blockin
d. CNS depressant on Phe midbrain The answer is (b), Cardiac arrthynrias are the main bad
e. Stimulant to doparninergic nerves in the basal ganglia side effect o j epinephrine as a vnsoconstrictor. Epi
Prepared by M.L.Thompson, Ph. D., Dept. Of Pharmacology, Tufts Medical School

slinrrrhles bollr nlplrn n ~ r dheh receyIors. Betn recqwtors


nre forrird iir tlre l ~ ~nird
r t stinrrrlntioir of betn receptors
iircrenses lrenrt mte, force of coirtmctioir, cnrdinc orttprrt 37.If a patient requiring an extraction reports that he is on
n~doxyserl iliiliznfiort. ( R ) is rurorlg, epi elezmfes blood dicoumarol therapy, the laboratory test most valuable in
glrrcose. (c) is wron - betn stinrulntroit iit snrootlr ntlrscle evaluating the surgical risk is
f
nird broitclti cnrrses roircltodilntioit, n~rdis tltrrs n drrtg of
cltoice for ncrrte nstlrnrntic nttncks. ( d ) is obzliorrsly wroitg-
a. clotting time
b. bleeding time
n decrense iir blood pressure wortld itot resrtlt front c. sedimentation rate
adreilergic stintulatioil, iitcrensed blood pressrtre is tlre d. complete blood cell count
rrtle. e. plasma prothrombin time
Airswer is (e)- Dicortnrnrol is an oral anticoagulant. Thus
tlle risk iir air extrnctioir is thnt the patient may bleed
4. The highest risk associated with use of oral contraceptives is excessively, or thnt a serious iilteraction witlr a drttg t h t
a. hepatic necrosis yo11 might require in your nlanagemeitt of the atieirt,
b. permanent sterility such as barbiturates or salicylates may occur. fou may
c. cancer of the breast net4 to adjust the anticoagulant activity to withiit a safe
d. cancer of the uterus range for stt rgicnl p r o d u r e s . Since dicou mnrol prez)etrts
e. thromboembolic disorders blood clotting by prezreittiitg the conz~ersioirof Vitamill K
to prothronrbin, (el is tlle oirly appropriate test.
Tlle two nrn'or side effects nre srtspected cnrciiro eiricity
nitd tlte teiideitcy to produce tkronrboentbolisnts. i w rf
fiorctioir cnii be nltered brrt this is rez~ersible.Resenrclr lrns
f n i M to prove tlre li~tkbetweeit estrogeit nild brenst 42. A drug has a half-life of 4 hours. If 2 gms are given every 4
cnitcer, nird reprodlrctiz~efirirctioir ezleirtlmlly retrtrits hrs what will be the amount in p s in the body
~tpoitcessntioir of tllernpy. Tlle nirswer nccordiirg to tlre immediately after the third dose?
gods of tlre testiirg bonrd is (e). Anteit. a. 1.5
b. 2.0
c. 3.5
d. 4.0
#9.Factors common to all forms of drug abuse include e. 6.0
a. miosis
b. tolerance
c. physical dependence
d. psychological dependence
Airswer is (c)- 2 t nt 0 ltr, at 4 ltrs 112 fronr rst
6
iiljectioir is goite, g u i l t I gnr iit tlte body air yort iilject
2 nrore for n totnl after ire secoitd iirjectioit of 3. At tlre
e. any of the above third dose, 112 of 3 is goile, h o b r g 1.5 p o t yrt iirject 2
nrore for a total of 3.5 intntediately riper tlle t rird dose.
The niiswer is (dl. Miosis ((n)) is n clroliirergic effect
t picnlly observed zuitlr opintes. Cocniire doesit't cnltse
txis kiid of cflect for exnnrple. (b), tolemirce, is conmtoir to 43. LVhich of the following combinations represents acceptable
nrnit drugs sltclt ns o intes, bnrbitrrrntes nnd sdntizjes, agonist-antagonist pairs in antidotal therapy?
but h s trot becir clenrb denroitstrnted for nll nbltsed a. morphine-naloxone
drrtgs. (c), pltysicnl depeitdeitce, is ltsrrnlly tlrorrglrt to be b. dicoumarol-protarnine
true 011ly for ntorphiite, nlcolrol, c#iite, nird perllnps c. warfarin-phenylbu tazone
cocatire. d. carbon monox~de-carbondioxide
(n) slrorrld be inrnredintely obviorts- go iro furtlzer, do trot pnss go,
27.Alcoholic eu horia results from do not collect $200. ( b ) is wrong-Protnmiile is air ni~tngoirist
a. increadactivity of the cerebellum of lwpariil, not dicounrnrol. (c): plleitylbutnwire eillzailces the
b. increased activity of the cerebral areas toxicity of wnr nrirr by displaciirg it front lasnla protein
c. increased activity of the spinal synapses (d):
birtdiilg sites. ltyperbnric o x a e i t w o r t i be a useful
d. decreased activity of the medulla centers treat nteit t for carboit nloitoxide porsoitiitg, ?lot C 0 2
e. removal of inhibitory activity of x e cortex
Anszuer is (e)- Alcolrol iithibits the C N S , thus elintiitntiirg 46. The various insulin reparations useful in the treatment of
(a), (b), nnd (c), lenviirg the choice betweeir 4 and 5. diabetes mellitus %ffer primarily in
Alcohol hns beeir postrtlated to inhibit G A B A elfects, the a. locus of action
ntajor inltibito transmitter in the C N S , especrnlly iit the b. mechanism of action
cortex. Thus ( 3 i s t h answer. c. mode of transformation
d. onset and duration of action
e. none of the above
28. Sulfon 1 ureas cause insulin secretion by
a. aAnergic simulation Answer is (d)- remember, diabetes medicatioits cait be
b. cholinergic stimulation or anized into 3 groups based on their onset and duration
c. direct st~mulationof pancreatic beta cells
Airszoer is (c)- nlenroriznt ioir- nlplln ngoir ists decrense
I.8.
ofiction: 1 ) ast-actii, : insuliit injection, 2 ) internrediate
actiitg: Isop lane rnsu rn suspetrsion, and 3) lottg acting:
protanrille zinc insulin suspeirsioit
iirsulin release, betn ngonists iitcrense it. Thus becarrse
both of these nre adreitergic stinrulatioi1, (a) cail't be the 48. Displacement of a drug from protein binding sites is expected
airswer. (b)- nlltscnriiric ngoirists iircrense iirsulilr relense, to increase the
d
brtt tlris is not tlte nlecltairtsnt o sulfoitylureas. They
cnrtse iirsuliir r e h s e hj (c), nir are tlle primary ornl
a. drug effect observed
b. duration of drug effect
c. dose required for a given effect tised iit a cnse of adreitnl nrdtilln iits~ifficieircy.
d. none of the above
59. Drug A inhibits the biotransformation of Drug B. The
duration of action of drug B in the presence of drug A will
usually be
a. shortened
b. prolonged
c. unchanged

f
Answer is (b)- uslinlly biotraits ornlatiort results it1 a
ntore wnter soluble, ntore readi y excreted form of tlze
pareilt drug. lit ntost ca.se.5 tltis rnactivates tlre drug, but
tlrere are some except ioits whiclt inzjolue tlre formation of
ntetabolites with activir ( d i n ~ a n ror ) wllot an innctive
prodrug is given (levo opa) w tch becontes active after
the first step in tlle biotraitsformatiorr pathway (DOPA)
52. In Fig. 1, three different doses of drug A are tested for sonletimes are asked in questions of tilts form.
activity. In Fig. 2, three doses of drug B are tested for
activit in the same test system. In Fi .3, three doses of
drug Kare tested in the presence of t t e high dose of drug B. 61. In which of the following groups of drugs is there the most
Based upon the responses seen, which of the follotving consistency in chemical structure?
statements best describe drugs A and B? a. diuretics
a. drug A is a partial agonist; dru B is an antagonist b. antiepileptics
b. drug A is an antagonist; drug #is a partial agonist c. local anesthetics
c. drug A is an agonlst; drug B is an antagonist d. general anesthetics
d. drug A is a agonist; drug B an partial agonist e. nonbarbiturate sedatives
e. drug A is an agonist; drug B is neither an agonist or an
antagonist Artswer is (c)- Rentenlber that lour1 ntresthetics nre eitller
esters or nntides. A11 of tlw other nlterilntizjes dizjerge
(5) sorry cnlr't reproduce the f i lire. Brit 1 tllillk t l q give widely i r l tlleir structures.
P
yoli n copy of this exnnt, dotl't t$?lf ,lot, look this u trl
yotir course syllabtis. You still lmz~eyorir colirse syl nbtis,
dort't you?Artstuer is (e)- drug A depicts n dose respottse 64. Cimetidine is administered to
curzje for a bill ngorlist- tlte typicnl signtoidnl dose a. aid in slee ing
resporlse curz)e goiitg front 0-100% resporlse, tlllis (b) is b.relieve a s t h a
elintinnted fronl furtller cortsideratiort. Tlle dose res orlse c. inhibit gastric secretion
6
ctirve or drug B is Ft-iro resportre nt nll. Drtig B t i i s
catt 't e a pnrtinl ngoitist, tulticit nrenrts (d) is wrottg. It
ntrist eitller be nn arttngortist or iteitller nrt ngorrist or
d. relieve cold and flu symptoms
Artswer is (c)- Rentember, cinletidirte or "Taganret" is ait
nrrtngortist in tlris systent. Tlte fact tlrnt it doesrl't secnt to HZ nrttiltistnmine nre used tllera euticnlly to irlhibit
alter tlre dose respottse c1irz)efor Drtig A irl Fig. 3 gnstric secretioit ((c)) iit cases o$pTtic ulcer. This is its
iirdiurtes it cnrt't be ntt atttn ortist- t:le clirzJewotiM be otlly clirtical rise. Yori migltt see it trt a questiotr regardin
sintilnr Lt slmpe except shlffld to the right. Tlre nrtsiuer is drug nutabolisnr- it is also a poteitt iitlttbitor of tlle m i x d
tlrtis (el. fr!nctiorr oxidase drug metabolirirtg ettzynte systent in the
Itver. The other alterrtntives are to coirfuse you because
YOU probably at least renrentber tlmt it is ail antiltistamirte,
56. In an addisonian crisis (hypoaldosteronism) resulting from but ori don't kitow tlre differerrce betweert HI artd H2
stress from a minor dental procedure, the patient should be nrtt Xistantines.
treated immediate1 with
a. 0.5 ml norepineplrine
b. 5 mg. prednisolone acetate 65. Which of the following anticancer drugs can be classified as
c. 1% triamcinolone acetonide an antimetabolite?
d. 0.5 ml, 1:1000 epinephrine a. cisplatin
e. 2 ml(100 mg) hydrocortisone hemisuccinate b. lomustine
c. vincristine
/
Answer is (el- Addison's disuse resrrlts from ailure of
tile adrennl cortices to roduce adrertocortical tormortes
sucit as aldosterone. ~Pdosteroneis a mirteralocorticoid
d. methotrexate
Aitswer is (d)- I would guess ( d ) because its the only one
that controls sodiunr retention aitd potassiunl excretion. I've e w r heard of, aird since this wasn't covered in class
Lack of aldosterone results it1 electrolyte imbalnnces, with you mi ht be one to guess it also. Wow, we ot it ri ht!
tlre major problem being hyponat remta (sodium loss).
Similar sym toms may also be seen when a patient is
B
Actual y, ifyou look the others up, (a) b. (bfare al&latirtg
agents, (c) ts an alkaloid derived from plants. (d) is a
withdrawn ;om chronic adrenal steroid therapy. Due to folate antagonist, which acts as an antimetabolite. Just for
depressed adreital function, patients cart 't respottd to your future edification, most cancer chemotherapy dru s
stressful situatiotts (such as dental procedures)
adequately, artd art adrertal crisis ntay occur. Tile
recommertded treatment is (el, I00 nlg of ltydrocortisotte
6r
cause cell death by p ecting the abilit of cells to divid.
The drugs thus rnhr rt oite or more pLses of the cell
cycle or prevent a cell in Go (the nortdividing phase)
ilemisuccirlnte. Of the other corticostero~dsgiuelt, ire dose from entering into the cycle of cell division.
giver1 for rdnisoloite ((b)) is too low, while Arttimetabolttes may act iit 2 ways ( I ) by incorporntion .
triamcirtoEne lncb arty e ects ort soditrnt reterttion. NE into a nletabolic pathwny and formation of a false
nnd Epi would not be us!J irr titis situntiotr- t l q ntigitt be
Prepared by M.L. Thompson, Ph. D., Dept. Of Pharmacology, Tufts Medical School

!
nrdnbolite wlriclr is 1rotr c~rctiolrnlor ( 2 ) by irrlribitiolr of
tlte cntnlytic jlrirctiorr o nn e~rzynreor elizynte systent.
Metltotrexnte is nrr exnnrple of n cell cvcle spectfic
2. b only
3. b, c, and d
4. b and d
nltfinretnbolite ttrnt i~lfribrtsD N A sy~rt)resisdlrrrlrg tlre S 5. all of the above
phnse. Viircristitle ncts d~rrirlgthe nritotic plmse
Alrszcler is (c)- "n" cn11't be rigllt becnrtse exercise irtcrenses blood
flow throrrglr nnlscles nlrd tlrrcs intproves nbsorption. Thus #
66. Which of the following hormones acts to elevate blood
concentration of iomc calcium? worrld also resrtlt i ~ reduced
t Bd
I is wroltg. "b" is obviolrsly ri ltt or tlre sante rensotr. "c"
b oo flow so slower nbso
worrld also be a problenr. "d" is oftell used for prolovge andTion
b. gluca%?
a. parat yroid steady drug release so it also is true. Tlre attswer nittst thus
c. aldosterone be (c).
d. thyrotropin
e. thyrocalcitonin
78. Salicylism includes which of the following?
Answer is (b)- maintaining the concentration of Ca++ in a. nausea
extracellular fluid by re ulating the deposition and b. tinnitus
mobiliza Son of calcium from bone, absorption from the c. vomiting
GI tract, excretion etc. is the main function of d. gastrointestinal bleeding
arathyroid hormone. Thyrocalcitonin is another name
k r calcitonin. They hope to confuse you because there l.a,b,andc
is a correlation between calcitonin and calcium, except 2. a, b, and d
that calcium concentrations regulate the synthesis and 3. a and c only
release of calcitonin. Gluca on is a pancreatic hormone 4. b, c, and d
that stimulates glucose prJuction, thyrotropin is there 5. all of the above
to confuse you with parath oid hormone, and
aldosterone regulates Na+ cvels not Ca++. A11szc)eris (e)- "Snlict/lisnr" is n niild toxic renctiolr to
nspiri~r (ncetylsnlicy~cncid), rrsunlly occrlrrbtg nfter
prololt~ed trentnze~rttoit11 hrpe doses. Nnrrsen, fililrittrs,
67. Disorientation, confusion, and hallucinations resulting from i~onrithgaird GI bleeding ar; nll synrptonrs of snlicyli.snr.
an overdose of scopolamine are most efficaciously treated Other ~rotnbleside eJIects of nspiri~ttulriclt res~lltfrom
by administering ingestiorr of n si~rglelnrge dose nre disturbnnces of ncid-
a. atropine base imbalance (acidosis or nlhlosis), fever,
b. levodo a h po lycenrin. Remember, aspirin, is iorr traindicnted i~r
c. acetylcRoline cirlJen srifieri~rgfront irrJluenut or chicken pox: aspirirr
d. physostipine lms been in~plicaterlitr tlte dezlelopntelrt of Renee's
syrrdronte.
A~rstveris (d)- scopolnnr i~reis n nrriscnririic receptor
blocker sinrilnr to ntropi~re,tlrrls (n) is wrolrg. Lmodopn
llns nothi~rgto do zvith tlris qrtestiolr. To corirrternct n 82. Which of the following are important criteria for the
conrpdititle nrrlscnrirric receptor block, yo11 Ired to adequate clinical evaluation of a new drug?
ilrcrense tlte 1ez)els of ngorr is!, ill tlris cnse acet lclioli~re. a. comparison with a lacebo
However, yo11 cn~l't gitr AClt becnrise it is brorerr down b. evaluation of side e k t s
nlntost i~rstnrrtnneorrslyby ncet lclro1irresternse. The c. utilization of control groups
mrswer is to gitr R drrl wllicb Locks out the
B
ncet lcholi~resternse,a lowirrg endoge?rousl relensed
A c X t o nccrrnrelate to ozrrconv tlle nctiolr o/scopobnrbre.
d. comparison with a standard drug
e. double blind experimental design
Tlre drug wlriclr will do tlris is plrysostignri~re. 1. a, b, c, and d
2. a, b, d, and e
3. a, c, dl and e
69. Developed hyporeactivity to a drug is 4. b, c, and e
a. tolerance 5. b, d and eonly
b. antagonism 6 . all of the above
c. detoxification
d. desensitization Atistver is #6- A ginrnte-this is just conrrnon sense.
A~rsweris (a)- your clroices are betwee11 toleralrce and
desensitiuttion, (n) and (d). T l v latter re/ers to sonte 84. Each of the following a ents has a lon duration of action
alteration oj receptors that lends to dintrnished respoltse to due to the presence of h e r g e n e r a t d a d h e metabolites
tlre d r ~ t,and is really a meclmltisnl whereby tolera~lcentay EXCEPT
occur. ?hus the Gods of the Board questio,o have decreed a. diazepam
tlut tlre atrswer slull be (a). b. oxazepam
c. flurazepam
d. chlordiazepoxide
77. Absorption of a drug from the intramuscular site of
administration may be slowed by Answer is (b)- This is a pure memorization questiotl. All
a. exercise
b. vasoconstriction
c. the presence of con estive heart failure
of these drugs are benzodiazepines, which typicall have
a long duratron of action baause !hey a!e convert to K
pharmacologically active metabolttes wrth long half-lives.
d. administering the drug as an insoluble complex Oxazeprn, midazolnrn, and lorazepam are exceptions that
are not converted to active metabolites. The altswer is
exceptiori- it will rrot precipitnte witldrawnl becarise it is
orrly n zucnk niir aritngoriist .
86. Each of the following statements relates to the general
aspects of toxicology EXCEPT 99. All of the followin methods of drug biotransformation are
a. most drugs exert a single action %
classified as synt etic except:
b. toxicity is both time and dose dependent a. N-alkylation
c. toxicity can be due to overdosage of a drug b. Odealkylation
d. symptoms of toxicity can be anything rangng from c. sulfate con'ugation
nausea to death d. g~ucuronideconjugation
e. for some drugs, even a minimal concentration can be
harmful Arrswer is (b)- Norrsyrrthetic renctiorrs (plmse I reactiorrsl
include the various trarisformatioris of molecular
Ariswer is (a)- If yoir learned airythirrg froni structure: oxidation, reduction, and hydrolysis; tl
plmrmacology, you should iristaiitly be nble to idortib (0) represerif the first stage of biotransforniatiorr. S rizetic
s /
as tlle correct answer. Tlle coristnrit uest o pltarnmcology
as a science is to design or iderrfib rirgs t mt lmzpe as
narrow or specific rarige of actiorr as possible, but rrot to
(phase II) rolctions consist of the con -u ation ofdrugs or
6"
their nretabolites with nctional *.!he
nlturrntives, (c) nrid ( ) are corijugat~orireactions, arid
many sirigle action drirgs hnve been i d e r i t i w . flirts are wrott because tliey are synthetic reactiorrs.
Alterriatives (c) arrd (b) sliould reniirid yorr of plirases Altenvtive (a? is tricky. It is nude to sound like N -
sudr as dose-resporlse curves arid tlteraperrtic index (the dealkylatiorr, which is a nonsyritlletic or llnse I oxidatizle
ratio o a toxic or letlml dose to a thernperrtic dose, reaction. Tltere is no reaction urlled N-a$htiori. Tliirs

B d
LD50/ED50). A toxic e fect cnrl be brondly defirred ns nriy
irrrdesired e ect of tlw rlrg, thrrs # 4 cnri't be tlle
exceptiorr. o rirle orrt # 5, tlririk of nerzle gns.
(b), art oxkhtive plmse I rendioii is left ns tlle riglit
aiiswer

92. The central actions of eth 1 alcohol are not synergistic with
which of the following. 2'
a. diazepam
b. meperidine
c. pentobarbital
d. chlorpromazine
e. methylphenidate
Answer is (el- Tlte cerrtrnl nctioirs of nlcolrol nre
depressnrlt. nirrs tlre clioice of correct nrrswer conres
dowri to fnrowirig wlliclr of tlte dru s listed is trot n CNS
!epressnrit. Ditzepnnr is a berlzo$nzepirle, perrtobnrbitnl
is n barbitrrrate. Both nre sedatirig. Meperidirle is nrr
opiate, wltile chlorprontnziile is n plrerrotlrinzirre
nritips chotic. Both o tllese clnsses of drir s nre also
typicn$ saintbig. Ale correct nrtsluer is fe),
niethylplleriidnte (Ritnliir). Ritnlirr is nrr itrdirect act irrg
s nr ntkoniinretic, arm ncts sinrilnr to nnrplletnnlirre irr tlre
2' 4-
N it is a stinirrlnrrt.

97. A heroin de ndent atient should not be given nalbuphine


(Nubain) E r pain L a u s e
a. it has no analgesic properties
b. it may produce respiratory depression
c. as a mixed agonist-antagonist, it can elicit withdrawal
d . x G x b u s e potential of nalbuphine may add to the
patient's problems
Answer is (d)- Nalbuphine is a nrixed agoriist-antagonist
tlrnt is anal esically equipoterit with nio lrine (thus # I
is ruled out?. However, analgesia is prolZ)uced by its
agonistic e ects at kappa o ioid receptors. It has
pronotrn~aritagoriistice g c t s at the mu rec tor, and
can be uwd clintwlly to reverse respirato Tepression
(b blocking nirr receptors) without a loss &nnl esic
e{ets (by stimulntiri kappa receptors). Thus, # is 3
rulcd out. # 4 is not fkely. The nrixed a ortist*ritngoriists
were designed to conibine artalgesia w i t i enou 11
antagonistic properties to prevent t W r abusc. fhus, # 3
is the right answer. Typicall these drugs car1 mimic the
efiect of nrorphirre hi a drug )ke patierit, but arrtngoriize
opiate actiott in a depetident pat rerrt, thus r r e c p a t ing
witldrawnl. Of this chss of drugs, butorp rnrio is tlre
Prepared by M. L. Thompson. Ph.D., Dept. Of General Dentistry, Tufts Dental School

1993 Board Exam Review 36. Each of the following side effects can occur as
a result of systemic absorption of lidocaine
Addendum - EXCEPT one. Which one is the EXCEPTION?
a. increased gastric motility
b. tonic-clonic convulsions
c. decreased cardiac output
1. The therapeutic index (T.I.) of a drug is defined d. respiratory depression
( A ) tlre sytemic effects of lidoairre that are
problematic are its effects on the
cardiovnsculnr system and tlre C N S (irritnl
excitatiorr stich as cont)ulsiorrs followed by
C N S depressior~involz~ingcollapse of the
respiratory artd carioz~sacularsystenrs)
(E) And yori worrderd wlry 1 nude yoti
nreniorize c m like this! Renrenrber, TI is art
indicator of t L safety of a dnig, with safety 39. A 43 year old patient who has mitral stenosis,
nefirrd ns n ratio of tlre dose tltnt ruorild h secondary to rheumatic fever, requests
letltnl to 5070 of tlre extraction of two eriodontally involved
P
dose tltnt is e ectizie
the grenter t te differcrtce
mandibular teeth.%utially, the dentist should
a. premedicate the patient with cephalos
doses, tlre snfer t l dnig.
~ b. premedicate the patient with amoxicil in in
c. premedicate the patient with ampicillin and
por
gentarnicin
11. Which of the follow in^ classes of dru sf when d. consult with the patient's physician to
combined with a narcotic anal esic, is t%e determine the ant~bioticof choice.
MOST like1 to produce a fataf drug
interaction. Y ( B ) pnticrrt's corzditiorr cnlls for errdocnrditis

F
a. cardiac glycosides ro ltylnxis reginrerr, of whiclr anroxicillirr
b. oral anticoagulants rst clzoice, ~irrlcsspntierrt is PCN
c. tricyclic antidepressants nl ergic.
d. oral antidiabetic agents
e. monoamine oxidase inhibitors
44. Which of the followin is a nonsteroidal anti-
( E ) Tlris is just n reworded runv of nski~rgtlre inflammatory agent wit! a tendency to produce
nrepeririinc (Denrerol) - M A O ~ blood dyscrasias?
(trartylcypronrirre or plrerrylzirre) drrs-drrrg a. indomethacin (Indocin)
irrternctrorr qriestiorr- tlre roblent is excessrzie
7
respirntory d ressiorr. CLS excitntio,r,
colt zpri lsiorrs, typerpyrexin, etc.
b. Ibuprofen (Motrin)
c. Ketorolac (Toradol)
d. Acetaminophen
e. Aspirin
19. Aspirin is CONTRAINDICATED with which (n) tlre lnst two nreb't N S A I D S , so tltey carr't be
of the followin drugs? right. Of tlre N S A I D S listed, I less ori are
a. ~ o u m a r i fcournadin)
n
b. Triazolam (Halcyon)
b
)list supposed to hatie nrr irrcrex? ible a ility to
nrenrorize arid renrenrber tllat irrdonrethaci1~
c. Barbiturates (Phenobarbital) is tlie orrl orre tllat does tlris, nrost likely
d. Pentobarbital (Nembutal) becarise t L otlier have rezrrsible effects orr
c. Methylprednisolone (Medrol) prostnglnrrdin synt llesis, wltile t h t of
r lrdontet llacirr is irreversible.
( A ) aspirirt irtterferes witlt plntelet
aggregnt iotr, incrensirrg bleedirrg t inre, wlrile
countnrirr is nrt arrticongrilnrrt d n i 52. Which of the followin drugs is often
irrteractior~would be excessitr b i s i F g administered to treat lik-threatening
arrhythmias?
a. quinidine
27. Which of the followin barbiturates MOST b. lidocaine
readil penetrates the hmd-brain barrier? c. verapa.mil
a. d r b i t a l d. propranolol
b. Phenobarbital
c. Secobarbital
d. ThiopentaI
e. Pentobarbital
58. A male patient who is receiving Coumadin
(D)tltnts w h y tlrioperrtnl is l ns ari IV
i d
thera y presents for an elective extraction. His
irrdtictiorr agent. It is the nrost lipid soluble of protrRombin time (m) is prolonged. Which of
tlrose listed arid eriters nrrd leaz~estlre brairr the following methods is preferred for reducing
rnpiiily, qtiickly rerrderirrg tlre patierrt the PT to an acceptable level?
irrrcortsciotrs. Methollexital (Brevitnl), riot a. administering vitamin K (Aqua Mephyton)
listed, is sin~ilnr. b. Withdrawing Coumadin for two days
c. reducing Coumadin to one half the usual
Prepared by M. L. Thompson, Ph.D., Dept. Of General Dentistry, Tufts Dental School

dose for two days (a) erlteral ntearts zpin GI tmct-only rorrte listed
d. administering a Coumadin antagonist, such tlrat goes directly itrto GI tract ;s (a) ornl.
as heparin
e. administerin a latelet transfusion to
enhance coaguf;ab&ty 93. Propranolol (Lnderal) exerts its major
antian inal effect by
a. dfating coronary arteries
b. dilating systemic blood vessels
62. Each of the following drugs has a significant c. increasing cardiac contractility
anti-inflammatory prperty except one. Which d. stimulating vagal slowing of the heart
one is t h exception?
~ e. blocking beta-adrenergic receptors of the
a. aspinn heart
b. cortisol
c. acetaminophen (e) my god, if you don't renzenlber pro ratrolol
d. ibuprofen as the protot pe nonspecific beta a L n e r g i c
e. indomethacin receptor blocrrr, ou shouldn't be taking this
test. h angina, t& goal is to reduce the
(c) eer, they keep repentbtg this questiott year oxygen denrands oj the heart, since it urtr't
n h r yenr after year - if yori do11 t get etrou It. (a) and (b) are usefir1 actiotts in
intnzedintely brow t l s t the nilswer is an na, fut are the wa that ttitro lyceritr
ncetnntitroplzerr, I loill cnll Mr. Flenrittg attd a n f u k i u n , clumtrel bcckers w o r l not
clwtr e yottr grnde in Plmrnlncology to 011 propmrr 0101, whiclt ncts to decrease urrdiac
"F".B orrtput ntld coittrnctility (so (c) is obviotisly
wrotlg- this is at1 nct iott that is needed itt
72. A patient has a history of significant lrmrt jnilure patietrts, tlot aitgitra)
cardiovascular impairment. The maximum safe
dose of epinephrine that can be administered to
this patient is: 99. Bradycardia is MOST commonly treated with
a. 1 cc, 1: 50,000 which of the following drugs?
b. 2 cc, 1:50,000 a. atropine
c. 1 cc, 1: 100,000 b. epinephrine
d. 2 cc, 1: 100,000 c. a diuretic
d. a potent vasodilator
(b) tlre rule is ..04 nrg oj epi nrnx it1 CV
pntietlts. TIE ensiest wny to ji lire this oitc (n) bradycnrdin is n reflexive slowed lzenrt mte,
I
out is to renrenrber oti sltortl il't 'z~enrore
thntt 2.2 carpriles oyxylocnbre wity
coittrolled by z q n l ~irprrtto tlre llenrt, nltd is
cholitrergicnlly nredinted, whiclt nzeaits you
1:100,000 i - yotrr ristinl cltoicc ns n locnl t t d a clrolirrer 'c receptor blocker to
nttesthetic.?wo cn riles is 3.6 cc. Tlris reduce the va a f $ f e c t . Atropitre is tlze ot1ly
elinrirmtes o lions ?i!) nrrd (d), sbrce t l q
would be snJ h i t ttot nsxinml. Sitrce
drug listed w f ich is a cholinergic agent.
T l q tlrrew it1 epinephritte as a tease,
1:50,000 is twice ns concet~trntedns because if you brew bradycardin was cnrdinc
1:I 00,000, 1 cc of 1:50,000 (optiotr (n)) is tlre slowitrg, you nliglrt be tent ted to think epi,
snnre ns 2 cc oj 1:100,000 so still trot close to which usually speeds up t R hmrt, would be
nlnx, so (b) hns to be tlze right nttswer. 0 tlre right answer- but you've got to block tlre
course, ou corrld htpe first renanr berel zrngal ittprrt, epi wotl't work.

nrnx oj .04 ntg.


(6
I:100,0~0eqtrnls .O1 ntg rr cc, so 1:5O,OOO
eqsnls .02 ntg per cc, so wotrld eqrrnl tlre
103. Which of the following best ex lains why
drugs that are hi hly ioruzed ten&o be more
rapidly excretedgthan those that are less
75. Which of the following is the current drug of ionized? The hi hl ionized are
choice for status-e ilepticus? a. less lipid s8ub;e
a. diazepam ( ~ J u m ) b. less water soluble
b. phenytoin (Dilantin) c. more rapidly metabolized
c. chlorpromazine (Thorazine) d. more extensively bound to tissue
d. carbamate~ineflearetol)
(n) n o n i n i d forms oj drugs cross membranes
more readily and are highly lipid soluble,
(a) nrenrorize, mentonk. AN are and tend to get stored in jat tissue from
anticonvulsatlts, btrt dinzepanr is drug oj wlzere they are only slowly released. Thus
choice. hi hl iotrized drugs, whtch are less lipid
sofubye don't get stored in jatty tissue and
are subject to more rapid excretion.
83. Which of the following is an example of an
enteral route of administration?
a. oral 110. Which of the followin groups of d ~ g iss
b. submucosal CONTRAINDICATED k r patients who have
c. inhalation glaucoma?
d. s u h t a n e o u s a. adrenergic
e. intramuscular b. choliner~ic
c. anticholinergic
Prepared by M. L. Thompson, Ph.D., Dept. Of General Dentistry, Tufts Dental School

d. adrenergic blocking d. the largest volume that the patient can


exchange within one miunte
(c) orre o j tlre tlrirrgs yotr lrnd to nrenrorize nbortf
n troprrre, tlte prototype nrrticlrolirrergic drrrg (c) I didrr't know this- I hope yolr did! I hope
wns dorl't use it with ghrrconln pntierrts, ns rt sonlcorre tenclres tlris sonrewqlwre irr tlle
will irrcrease irr t rnocrtlnr pressrrre, mlticlr is ctrrricrtlum!
nlrendy f l u problenr 7oitlr glnrrconln pntie~lts.
Drrr s irr categories ( b ) alrd ( d ) nre nctrrnlly
r r - d t o trcnt lnrrconrn, so they ore obaiously 139. Which of the following sympathomimetic
)tot co?rtrniltl! icnted. Obr)iorrsly, (n) 7uorrlrlrr't agents is the most potent bronchodilator?
lrelp either. a. amphetamine
b. norepine hrine
c. phenylepkke
125. Low dose aspirin therap revents the d. iso rotereol
formation of thromboembos Ey
preferentially e. met!oxamine
inhibiting which of the follow~ng?
a. phospholipase A2 in the blood vessel ( d )for bronchodilntiorr yort want R potort beta-2
walls ndretrer ic receptor a onist- of tlte drugs
b. prostacyclin synthetase in the blood vessel
walls
listed(A is t l u best. %etboxnntbre a d
plwrryleplrrine are alplm-1 agorrists,
c. thromboxane synthetase in the platelets aniplwtnnri~reis an illdirect acting a ouist
d. vitamin K in the liver tlra, cnrrses tlte relense of rrorepirrepfrirre,
rulriclr is less poteirt nt betn receptors tllnrr
(c) plntelct nggrcgn ti011 is coirt rolled by t luo isoprotererrol.
fncfors, prostncyclin, rc*lriclr dccrenscs it, ntrd
tlrroniboxnrrc, rcllriclr elrlmrlccs it. Lorc dose
nspirirl blocks the lntter, so ( c ) is riglrt, (n) is 148. Succinylcholine blocks neuromuscular
tlre nleclut~ii_cnlof ncfiolr of corticosferoid transmission by
dnrgs, ( d ) is the meclmrrisnr of nctioll of a. inhibiting cholinesterase
nrrtrcongrrlnrrt drrrgs like corrnmdirr. b. inhibiting the central nervous system
c. depolarizing the motor endplate of skeletal
muscle
128. A patient who is receiving an N diazepam d. inducin the formation of cholinesterase at
sedation has uper eye-lid ptosis (Verill's sign). the end$ate
The dentist should e. blocking release of acetylcholine at the
a. assist respiration immediately end plate
b. consider the patient to be adequately
sedated ( c ) See- yorr knew those d n r i list defirritiorrs I
c. place the patient in the Trendelenberg nrnde yorr nrenrorize ~ U O Jconte
~ ! rn rtseftrl!
position Nerr ronrrtscrrlnr trnrrsnrissio~r reqrrires the
d. administer one more increment of diazepam nctiorr of acetylclrolirle at the tricot irr ic
and proceed with the treatment receptors orr t l u irertrontrtscrtlar jrrnctiorr
endplnfe. TIE two drrigs rlsed clrnically to
( b ) nrcnrorize - tlris is tlre s i p yorr look or to do this are crrrnre nrrd sltccirrylcholiire.
fell t l u pntierrt is adcqrmfeli sednfed! Curare is n nicotiuic receptor blocker,
srtccirrylclroline acts to overstinlulate the
receptor, tlwreby causirrg its srrbseqrterrt
132. A dentist is considering the use of nitrous- clepolnniatiorr of t l u nacrorr arrd a block of
oxide conscious sedation for a patient. rrrrscle activity. (el is how spider verronls
However, this t of sedation will be nrld srrnke toxilrs work, trot srtccitrylclroli~re.
CONTRAINDI?~~EED, should the atient have (n) wortld errlmtrce narronrrrsculnr actiott,
a history of which of the following. 5' arid is actually made use of clirticnlly witlr
a. dental anxiety nrynstllerr in gravis patients. ( d ) isn't
b. psychotic care possible.
c. controlled hypertension

L
( b )ever1 I you didn't blow tltnt tritroris cart
alter t patie~rt'ssense of renlity (tltnt's
wlry yotr dorr't give it nlorre irr yorrr office,
153. Which of the following effects are common to
pentobarbital, diazepam, and meperidine?
a. anticonvulsant and hypnotic
tlley nriglrt Jnntnsize tllnt yorr lrad olrr way b. analgesia and relief of anxiety
witlt t k n r wlwn you didn't!) by elntinntion c. sedat~onand ability to produce dependence
( b ) llns to be tlte right nriswer sirrce (a) aird d. amnesia and skeletal muscle relaxation
(c) nre irrdicatiorrs for t l u rtse of nitrous
(c) tlte only definition which covers all three
dru s. (a) applies orrly to pentobarbital, (b)
137. The correct total liter flow of nitrous oxide- nppf'es only to meperidinr, arrd ( d ) epplics
oxygen is determined by orrly to dinteparn.
a. a standard 6 liter er minute flow
b. the patient's metagolic oxygen
requirements 154. The onset of action of drug is primarily
c. the amount necessary to keep the reservoir determined by the rate of
bag 113 to 2/3 full a. excretion
Prepared by M. L. Thompson. Ph.D.. Dept. Of General Dentistry, Tufts Dental School

b. absorption c. it usually converts a drug to its lipid


c. distribution soluble, nonionized form
d. biotransformation d. it generally involves alterations of the
chemical structure of the drug
( b ) obvioztsly - dnig Itns to be obsorbed before
nrr of the otller nctiorrs cnrt take plnce. The
ot&rs 1~701tldLternririe dlr rntiorr of nctiort,
rrot ortset.
191. Which of the following drugs causes the
LEAST CNS d e ression and impairment of
168. Injection of a local anesthetic into an psychomotor s&lls?
inflammed area usual1 has a less than optimal a. diazepam
result. Which of the fofiowing best explains b. buspirone
why? c. al razolam
a. the prostaglandins stabilize the nerve d . c&oral hydrate
mebrane
b. inflammation reduces the availability of
the free base
c. the drug will be absorbed more rapidly
because of the increased blood supply Test 27/28, 1993
d. the chemical mediators of inflammation
will present a chemical antagonism to the
anesthetic
16. A patient who has which of the following
conditions is most likely to have
postoperative bleeding after multiple
extractions?
174. The major effect of a drug is produced by the
amount of the drug that is
a. free in plasma
tc. g$:?es
cirrhosis
b. excreted by the kidney d. rheumatic fever
c. detoxified in the liver e. chronic bronchitis
d. bound to plasma protein

176. A 4 yr old child is shy, timid, and fearful. 42. Local anesthetics aid in reducing the flow of
Which of the following will be MOST saliva during operative procedures by
appropriate for the restorative appointments a. blocking the cholinergic nerve endings
for this child? b. blockins innervation to major salivary
a. Naloxone glands
b. Nitrous oxide/oxygen c. blocking efferent parasympathetic nerve
c. Promethazine pathways
d. Hydroxyzine hydrochloride (atarax) or d. reducing sensitivity and anxiety during
hydroxyzine pamoate (Vistaril) in divided t w t h preparation
doses
e. Meperidine (Demerol), promethazine ( d ) locnls don't have actiorls (a), (b), or
(Phenergan) and chlorpromazine (c)!Nerz~ouspnt iertts, however, do salivnte
(Thoraz~ne)combined niore.

49. Which of the following combinations of agents


would be necessary to block the
177. A primary advanta e of intravenous cardiovascular effects produced by the
sedation is which of t i e followin ? injection of a sym thomimetic drug?
a. fewer side effects fmm the sdation
b. slower biotransformation for prolonged
8"
a. atropine an prazosin
b. atropine and propranolol
action c. prazosin and propranolol
c. the ability to titrate individualized dosage d .phenoxybenzarnine and curare
d. a smooth and more gradaual onset of e. amphetamine and propranolol
sedation

74. Accordin to the American Heart Association,


179. Each of the followin is true re arding drug which okthe following prophylactic
biotransformation E X ~ E P Tone. h i c h one is antibiotic regimens is recommended for a 20-
the EXCEPTION? kg child who has con enital heart disease?
a. the rate may differ significantly in various
animal species
4
a. 1.0 gram amoxicl lin orally one hour
before the dental medurn and 500
b. it primarily occurs in the liver microsomal mg 4 times a day g r 2 days
enzyme system postoperatively
Prepared by M. L. Thompson. Ph.D., Dept. Of General Dentistry, Tufts Dental School

b. 1.0 gram enicillin V oral1 one hour 118. Which of the following antibiotics is found
2
before g e dental proce ure and 500
mg orally 6 hours later
at much higher concentrations in crevicular
fluid than in serum?
c. 1.0 gram amoxicillin orally one hour a. clindamycin
before the dental procedure and 500 b. penicillin
mg orally 6 hours later c. metronidazole
d. 3.0 gram amoxicillin orall one hour- d. tetracycline
before the dental p r o c d ~ r and
e 1.J
grams orally 6 hours later

When administered as oral centrally acting


analgesics, which of the following is
75. When com ared therapeutically to penicillin considered to have the highest dependence
G,penici~inV has a liabilit ?
a. slower renal excretion a. J e i n e
b. more reliable oral absorption b. oxycodone (in Percodan)
c. broader antibacterial spectrum c. propoxyphene (Darvon)
d. reater resistance to enicillinase d . pentazocine (Talwin)
P R
e. ewer potential for a ergic reaction

135. Antibiotics are useful in the treatment of


89. Each of the follo~~~ing
is i; common side effect which of the following?
of prolon ed tetrac cline thera EXCEPT a. herpangina
one. hi& one is tKe EXCEP$&?
a. diarrhea
b. angina pectoris
c. recurrent apthous stomatitis
b. superinfection d. necrotizing ulcerative gingivitis
c. photosensitivity
d. visual disturbance (d)
e. discoloration of newly forming teeth
136. Audito nerve deafness is associated with
the use o?'
a. polymixin B
106. Which of the follorving drugs produces b. chloramphenicol
sufficient CNS depression to cause a state of c. amphotericin B
sleep from which one may be aroused? d .gentarnycin
a. a sedative
b. a hypnotic
c. an opiate
d. an anesthetic
151. The maximal or ceiling effect of a drug is also
correctly referred to as the drug's
a. agonism
b. potency
110. To reduce a patient's salivary flow, a c. efficacy
dentist has prescribed atropine. As a result of d. specificity
this medication, the patient mi ht experience
which of the followng side eaects?
a. sedation
b. diarrhea
c. bradycardia 168. Which of the following a ents found in
d. blurred vision tobacco products cause aidiction?
e. stomach cramping a. tar
b. formaldehyde
c. nicotine
d .carbon monoxide
112. Of the following local anesthetics, which (c)
has intrinsic vasoconstrictive actions?
a. cocaine
b. procaine 172. Aller ic reactions to local anesthetics are
c. xylocaine cauAby
d. bupivacaine a. rapid absorption
b. slow detoxification
(a) c. an antigen-antibod y reaction
d. improper administration technique
Prepared by M. L. Thompson, Ph.D., Dept. Of General Dentistry, Tufts Dental School

36. With an overdose of a cholinergic drug, one


to see each of the following
184. Which drug group is the LEAST likely to
cause xerostomia. ?:%
i 8?r
E~CEPTION?
one, Which one is the
a. opioids
b. antidepressants a. sweating ,

c. antihistamines b. urination
d . benzod iazepines c. mydriasis
e. anticholinergics d. bradycardia
e. copious serous saliva

187. Currently, the BEST oral sedative drugs for


dentistry fall into the class of 42. Ce halos rins are definitely
a. narcotics C~NT&NDICATED for penicillin-allergic
b. barbiturates patients who exhibit
c. henothiazines a. immediate-type reactions
d .!enzodiazepines b. nausea and vomiting with erythromycin
c. any type of reaction to the penicillins
(dl
(a)
189. Which of the following best describes the
drug-receptor activity of naloxone? 46. Which of the following is a beta-adrenergic
receptor blockin agent used for the treatment
Affinity Intrinsic Activity of hypertension. !
a. prazosin (Minipress)
a. high high b. clonidine (Catapress)
b. low high c. atenolol (Tenomin)
c.high none d. hydralazine (Aprezoline)
d.none low e. verapamil (Calan)

200. U'hich of the following types of chemical


bonding is the least likely to be involved in a 50. In which of the follo~cin categories are
drug-receptor interaction? e hedrine, tyramine, antamphetamine
a. covalent bonding c&ssified?
b. hydrogen bonding a. anticholinesterases
c. dipoledipole bonding b. a1 ha-adrenergic blocking agents
d. electrostatic bonding c. iniinxt-acting sympathomimetics
e. van der Waal's forces d . d ired-act ins parasjm pathomimetics

57. Thiazides, which are used in the treatment of


Test 21/22 1993 hypertension, ma require supplemental
administration
a. sodium
07
b. chloride
After a threshold stimulus, the cell membrane c. calcium
becomes permanently altered. The liberation d. potassium
of which of the followin transmitter
substances causes this aqteration?
a. acet lcholine
b. cholnesterase
c. hydroxycholine Which of the followin adverse reactions of
d. acetylsalicylic acid P
oral contraceptives is t e most common and
the most serious?
a. hypotension
b. hepa totoxicity
23. Which of the following compounds is used as c. uterine neo Iasia
an antiviral agent? d. thromboemgolic disorder
a. amantadine (Symmetrel) e. decreased resistance to infection
b. novobiocin
c. miconazole (monistat)
d. amphotericin B
80. The supraspinal anal esic activit of
rnorphme is rnediatJprimarily tfLough its
Prepared by M. L. Thompson. Ph.D.. Dept. Of General Dentistry. Tufts Dental School

c. producing hysiologic actions opposite


influence upon which opioid receptor to that orhistamine
subtype? d. com titively blocking histamine at the
a. mu ceKlar receptor site
b. ka pa e-
c. deKa (c) exnctly why I kept asking yo11 oil erlenj
d. sigma exnnr to give nte arr exnn~pleof
e. epsilon pl~ysiologicalatttagonisnt as a drtrg-
drug interncfion sestiotr. N does trot act
via (0). which is Row chon~olyrr(ltrtal)
works. or by ( d ) wlricl~is how
atttilristamrtles work.
83. Which pair of anesthetics is most likely to
show cross-allergenicity?
a. lidocaine-mepivacaine 121. Which of the following represents the drug-
b. prilocaine-tetracaine
ofchoice in the treatment of candidiasis for
dP
c. procaine-me ivacaine
d. rocaine-li ocaine an HN-infected patient?
a. acyclovir
e. fdocaine-benzocaine
b. n statin
(n) yo14 nye lookirlg for nr1 nntide - antiric c.Ah
pntrtrl or nit ester - ester pnirirtg. d. chlorhexidine
O i ~ l fa)
y nteets this criterioit. procnirte,
( b ) cnitdidinsis is n furl nl irtfcctiort t h t
betrzocnirle nr~dtctrncnirte nre esters,
lidocnii~e,prilocnirtc nrtd nleyir~ncniire R
treecis to be treate with nit nrttifitr~gal
ngertt like tlystntitt. ( 0 )ntrd (c) nre
nre nn~idcs.
ar~tizjirnldrlcgs risen to trent HIV, wlrilc
clrlorkexidirte is n nrtt inticrobinl
107. Thrombophlebitis, which occurs after n~olrt II wnslr
intravenous administration of diazepam, is
usually attributed to which of the folloi\.ing
substances in the mixture? 132. A patient presents for treatment of a large
a. benzoic acid fluctuant mass in the submandibular s ace as
b. ethyl alcohol a result of extension of odontogenic inpection.
c pro ylene glycol He has a temperature of 38.5 degrees C (101
d..dm metabisulfite degrees F).Initially, the dentist should treat
this patient with which of the following?
(c) nlenrorite fltis picky little fnct ylense! a. salicylate therapy to reduce the
temperatun?
b. alternate application of heat and cold to
170. Each of the following is a harmacolo ic the area to improve circulation
efect of phenothiazines E X ~ E P one.
T 8hich c. incision and drainage and a culture for
one is the EXCEPTION? antibiotic sensitivity
a. sedation d. antibiotic therapy to reduce the swelling
b. an antiemetic effect and infection
c. alpha-adrenergic effect
d. potentiation of the action of narcotics ( c ) arrtibiotic t h r a p y wotr8t be very effectiz~e
e. an anticonvulsant if yo11 dotr8t itrcise ar~ddrnirl first. (rt)
arrd (b) are allintioe nctiorrs tlte ntierlt
(e) see, t l q do nsk yo11 q~iestiorrsnbo~ct drugs car1 take at L n t e , not nctions for t L
tltnt yo11 dor~'tt~ornrnllyuse eve dny. derttist.
Actior~sa, c. nrtd d nre 011 ~lhticn?;~
trseflil nctior~so tlle pllertotlriazirres,
/
wlrrclr yo11 nri rt rentenrber were
discussed n t r z r t l ~ ecntegonj of
146. The only local anesthetic that increases the
pressor activity of both epinephrine and
nrrtipsyclrotic drugs. Blrt wnit- norepinephrine is
Prornetltnzitre (Plrettergan) is used it1 a. cocaine
dentistry as n d a t i r l e , ofterr itr b. rocaine
conrbiiratiotr wit11 Denrerol because it c. Xibucaine
reduces tlte trausea associated witlr the d. lidocaine
e. mepivacaine
(a) I q , why do 11 always ask some dumb
~ u e siotr
t like?& about cocaine-lrke vou
uys use it ctlr day it; your oficed
&OU k11erno/!f dny onJ ri~mk(
119. Epinephrine antagonize the effects of cocdif~e1; an ifidireddrl;n ddrenerg/c
histamne bv agonist, acting b y causing
a. p ~ ~ p e n hthe
n release of histamine adreneric neurotransmitters nsrelurse
well aso/
b. acting on fhe central nervous system blocking their reuptake, thereby
prolot? !ng their activity. The ootlvr
f
drugs rsfrd are just local arrestltetics
Prepared by M. L. Thompson. Ph.D., Dept. Of General Dentistry. Tufts Dental School

flmt dolr't lmtle tlris nctiotr - tlrey jrrsf ntrtips~cltc~ic,petrtnzocitre art opioirl,
block sodirrnr itrflrcx info flre lrerrrotr. ntrd p~re~:;rlpro~nnolnnrilre is n
decorrgestattf irrqd itr cold nredicntiorrs.
155. Corticosteroid therapy for arthritis is - % *
contraindicated for a patient who also has
which of the following conditions?
a. anemia
b. nephritis
c. alcoholism
d. peptic ulcer
e. rheumatic heart disease
( d ) patielrf s usirrg corf icosferoids for
arthritis oftelr dct)elop jr lcers becartse
these drug block prosfnglnlrdilr nctiorr irr
the stomaclr, thereby itrcrensing acid
secret ioti wlrile dccrensilrg tlre
protect itle nrrrcosnl bnrrier of tlre
stonrnclr.

160. Which of the following is the first symptom


that is usual1 perceived by the patient being
administerdnitrous oxide?
a. nausea
b. eu horia
B
c. gi diness
d . tingling of the hands
(dl tlle first tlrrce are nll sigrrs flat f l ~ e
pntietrt is geft itrg too nril~rclrtritrorrs.

176. Each of the following, EXCEPT one, is a ood


reason for using sedation. Which one is tRis
EXCEPTION?
a. to allay apprehension, anxiety or fear
b. to decrease the amount of local
anesthesia that is required for a given
procedure
c. to alleviate stress in a severely
meedically compromised patient
d. to accomplish certain prmedures that a
practicioner would not normally be able
to d o on an anxious patient
( b ) sedntiolr docs not decrcnsc tlre locnl
nlrestltetic reqrrircnrclrt, tlle pntielrt tuill
still feel pnitr. Sedntitjes, tuitlr tlle
exc ti011of nitrorrs oxide, luzje lro
7
n n z e s i c e ect -bnrbit rrrnte w i n titles
nray nrnke t re patient nrore se1rsitit)e to
pnrn.

179. Which of the following is classified as an


antianxiety drug?
a. methohexital
b. lorazepam
c. haloperidol
d. pentazocine
e. phen ylpropanolamine
(b) olily berrzodiazepilres nre nctrrnlly
classifid as nntinlrxiety dnrgs,
althorrglr other drrcgs, srtclr as opioids
lrntw nlrtin~ixietynctiolis itr addttiolr to
h
their otlrer clinrcnlly rise ul nctiolrs. (b)
lorazepanr is tlre ot~lyB Z listed.
nreflrollexitnl is a barbiturate - tlrese are
classified as seatit)cs. Hnloperidol is nlr