Gianina Camille S.

Gamboa, DMD

The optimal dose of a drug administered to a px refers to:

A. Minimum dose needed for therapeutic

relief B. Maximum dose needed for therapeutic relief C. Relative dose needed for therapeutic relief D. Any of these since it varies from person to person

Minimize adverse drug reactions and side effects

The ratio of LD50 and ED50 is:

A. Potency B. Toxicity Index

C. Efficacy
D. Therapeutic index

TERMS
ED 50

POTENCY

Amount of drug required to produce a therapeutic effect Dose of the drug required to produce a therapeutic effect in 50% of the population The dose of the drug required to produce a toxic effect on 50% of the population Maximum intensity of effect or response that can be produced by a drug

LD 50

EFFICACY

Which of the following compounds after being metabolized to form ACETAMINOPHEN is an active analgesic and antipyretic agent?
A. Propoxyphene
B. Aminopyrine C. ASA

D. Phenacitin
E. Phenylbutazone

D. Phenacitin
A drug with similar effects to that of

paracetamol Withdrawn from the market due to its toxic side effects: NEPHROTOXICITY AND METHEMOGLOBULINEMIA P-PHENETEDINE: metabolic by-product responsible for Methemoglobinemia

PROBENICID is given in combination w/ Amoxicillin in order to:

A. Reduce the severity of diarrhea B. Prolong the half-life of amoxicillin C. Extend amoxicillin antibacterial

spectrum D. Treat patients under stress

B. Prolong the half-life of amoxicillin

Probenicid
Uricosuric drug Competitively inhibits renal excretion of

some drugs

Clavulanic Acid
Extends antibiotic spectrum Attaches to the beta-lactam ring to

resist beta-lactamase degradation

Which of the following characterize nitrous oxide? (all that apply)

A. Slow recovery B. Good analgesia C. Respiratory rate stimulation D. Poor skeletal muscle contraction

E. Rapid induction at an 80%

concentration

B. Good analgesia D. Poor skeletal muscle relaxation E. Rapid induction at an 80% concentration
Induction rates for nitrous oxide vary based

on reference between 70-80%

Which is true about Methotrexate?

A. Inhibits RNA and DNA synthesis
B. Blocks the ability of tubulin to

polymerize into microtubules C. Binds to sites on the enzyme dihydrofolate reductase D. Alkylating agent

Inhibits formation of RNA, DNA, and proteins

The dental usefulness of H1receptor blockers is based on their:

A. Sedative and anti-emetic action B. Reduction of diziness and vertigo C. Reduction of salivary flow D. Reduction of post-operative swelling

A. Sedative and anti-emetic action

Antihistaminic drugs

Side effect of which is anti-emesis and mild sedation

H2-receptor blockers
Used to block the action of histamine

on the parietal cells of the stomach Treatment of dyspepsia and gastritis Ranitidine

Death from overdosage of strong nacotic analgesics usually result from:

A. Cardiac arrest

B. Shock
C. Anaphylaxis

D. Respiratory arrest

Depresses Ventilation

In therapeutic doses, Digitaliss acts primarily on cardiac muscles by increasing the:

A. Rate of impulse conduction

B. Refractory period of atrial muscles

C. Refractory period of ventricular

muscles D. Force of contraction

Digitalis has a positive inotropic effect on cardiac muscles

The primary antihypertensive effect of captopril is due to the accumulation of:

A. Serotonin B. Angiotensin I C. Angiotensin II

D. Bradykinin metabolites

ACE Inhibitor

Most common side effect of propantheline in the tx of peptic ulcers is:

A. Urinary retention

B. Mydriasis
C. Xerostomia D. Bradycardia

What are the classic features of ATROPINE poisoning?

A. Pale skin, sweating, slow heart rate

B. Red, dry skin, fast heart rate

C. Pale, dry skin, fast heart rate

D. Red, dry skin, slow heart rate

B. Red, dry skin, fast heart rate

ATROPINE POISONING HOT as a HARE BLIND as a BAT DRY as a BONE RED as a BEET MAD as a HATTER MORPHINE POISONING COMA DEPRESSED RESPIRATION PINPOINT PUPILS

Streptomycin and other aminoglycosides inhibit bacterial protein synthesis by binding to:
A. DNA
B. Messenger RNA C. 30s ribosomal particle D. 50s subunit

ANTIBIOTIC GROUP
Aminoglycosides (Amikacin, Gentamicin) Cephalosporins (Cefalexin, Cefuroxime)

MECHANISM OF ACTION
Irreversibly binds to 30s subunit Inhibits bacterial cell wall peptidoglycan synthesis

Chloramphenicol
Lincosamides (Clindamycin) Macrolides (Azithromycin, Clarithromycin)

Reversibly binds to 50s subunit Acts on 50s subunit

Reversibly binds to 50s subunit

ANTIBIOTIC GROUP Penicillins (Amoxicillin, Ampicillin, Methicillin) Quinolones (Ciprofloxacin, Ofloxacin) Sulphonamides (Sulfamethoxazole) Tetracyclines (Minocycline, Doxycycline)

MECHANISM OF ACTION Inhibit synthesis of peptidoglycan causing osmotic lysis Inhibits DNA synthesis and replication Inhibits Folic acid synthesis by acting as a PABA analogue Reversibly binds to 30s subunit

Which of the following drugs should not be administered to pxs with Myasthenia Gravis?
A. Atropine

B. Curare
C. Insulin D. Digitalis

E. Prostigmine

Non-depolarizing neuromuscular blocking drug

Which of these drugs used in the treatment of tuberculosis has ototoxic effects?
A. Rifampicin B. Ethambutol C. Isoniazid D. Streptomycin

ADVERSE EFFECTS Streptomycin Chloramphenicol Ototoxicity Aplastic Anemia Gray Baby Syndrome Erythromycin Estolate Cholestatic Jaundice Sulfonamides Kernicterus Clindamycin Pseudomembranous Colitis

Second generation antipsychotic drugs bind to which receptors?

A. D2

B. D3
C. 5-HT

D. 3-HT

D. 5-HT
Increased affinity for serotonin receptors
Inability to produce extra-pyramidal

symptoms and tardive dyskinesia Examples: risperidone, clozapine

Patients on bishydroxycoumadin should be monitored with which laboratory test prior to surgery:
A. Bleeding time
B. Prothrombin time C. Partial thromboplastin time D. Clotting time

Ability to supress the formation of factors II, VII, IX, X

Which of the following penicillins is readily inactivated by betalactamase?

A. Pen G

B. Phenoxymethyl Penicillin
C. Methicillin

D. Ampicillin
E. Cloxacillin

A. Pen G
B. Phenoxymethyl Penicillin

D. Ampicillin

Nitroglycerin dilates the coronary arteries in angina pectoris by:

A. Decreasing the heart rate reflexly B. Increase metabolic work of the atrium C. Direct action on the smooth muscle in the vessel walls D. Increase the refractory period of the atrium E. Blockade of beta-adrenergic receptors

If a narcotic agent were chosen for IV sedation which of the ff. drugs should be available as antagonist of choice?
A. Naloxone

B. Dantrolene Sodium
C. Pentazocine

D. Flumasenil

The most probable cause for a serious toxic reaction to a local anesthetic is:
A. Psychogenic

B. Deterioration of the anesthetic agent

C. Hypersensitivity to vasoconstrictor D. Hypersensitivity to local anesthetic E. Excessive blood levels of the local

anesthetic

Intravascular injections

The only local anesthetic which increases the pressor activity of both epinephrine and norepinephrine:
A. Procaine

B. Lidocaine
C. Cocaine D. Mepivacaine E. Tetracaine

The penetration of the local anesthetic into nervous tissue is a function of the:
A. Length of the alkyl chain

B. Lipid solubility of the ionized compound

C. Lipid solubility of the unionized

compound D. Ester linkages in the anesthetic E. Amide linkages in the anesthetic

C. Lipid solubility of the

unionized compound
Unionized: penetration into the nerve

Ionized movement of the anesthetic

from the injection site towards the nerve tissue

Inhalation general anesthetics possess a relatively low therapeutic index but their clinical safety is greatly increased by:
A. Rapid renal excretion B. Rapid liver metabolism C. Extreme ease in reversing tissue concentration D. Ready effect reversal by antagonists E. NOTA F. AOTA

Which of the following drugs is most often used to dry secretions in the oral cavity?
A. Diazepam

B. Promethazine
C. Physostigmine D. Propantheline E. Diphenhydramine

Anticholinergic drug

Which of the following non-steroidal anti-inflammatory drugs should be avoided when treating alcoholic dental patients?
A. Mefenamic acid
B. Naproxen

C. Acetaminophen
D. Aspirin

Norepinephrine is an unlikely substitute for epinephrine in treating severe allergic reactions because it is:
A. Ineffective in improving blood

pressure B. Ineffective in relaxing bronchial smooth muscle C. Dilates the pulmonary arterioles D. All of these

Which of the following prevents laryngospasms?

A. Succinylcholine

B. Diazepam
C. Flumasenil

D. Dantrolene Sodium

Skeletal muscle relaxant

Monoamine oxidase inhibitors can be used concurrently with all of the following except:
A. Alpha adrenergic blocking agent

B. Acetylsalicylic acid
C. Sulfonamides

D. Tricyclic antidepressants

Result to overstimulation when used simultaneously

This theory describes the pain as a straight-through channel from the skin to the brain
A. Gate Control Theory by Melzack and Well

B. Specificity Theory by Descartes

C. Pattern Theory by Goldscheider D. Transelectric Nerve Stimulation Theory

Pattern Theory
Pain results when

Gate Control Theory

The brain receives

the total output of impulse exceeds the critical level Summation theory

messages about injury by way of the gate control system which is influenced by injury signals, impulses and descending control

Which sensation is first lost when a local anesthestic is injected into a mixed nerve?
A. Pain B. Pressure C. Temperature

D. Proprioception

A. Pain
Pain Temperature Pressure Proprioception

In local anesthesia, for maximum effect, the injected anesthetic drugs must come in contact with at least how many mm of the nerve to be blocked:
A. 4-6 mm
B. 6-8 mm C. 8-10 mm D. 10- 12 mm

In local anesthesia, for the maximum effect to be achieved, the injected anesthetic solution must block at least how many nodes of ranvier:
A. 1-2 B. 2-3 C. 3-4 D. 6-8

Local anesthesia uses which method of pain control:

A. Blocking pain pathways

B. Raising the pain threshold

C. Depression of the cerebral cortex D. Removal of the cause

Raising Pain Threshold Depression of the cerebral cortex

Drugs with analgesic properties (i.e. narcotics) General anesthesia

A patient allergic to carbocaine should not be given which of the following drugs as an anesthetic:
A. Marcaine

B. Novocaine
C. Pontocaine

D. Ravocaine

ESTERS
Benzoic Acid Esters Cocaine Benzocaine PABA Esters Procaine (Novocaine) Propoxycaine (Ravocaine) Tetracaine (Pontocaine) 2-chloroprocaine (Nesacaine)

AMIDES
Prilocaine (Citanest) Lidocaine (Xylocaine) Etidocaine (Duranest) Mepivacaine (Carbocaine) Bupivacaine (Marcaine) Articaine (Primacaine)

a. b. c. d.

Pontocaine Ravocaine Prilocaine Tetracaine

ESTERS

AMIDES

Biotransformed in PLASMA Biotransformed in the LIVER plasma cholinesterase Not affected by plasma cholinesterase

a. It is biotransformed through plasma

cholinesterase b. Biotransformation through the liver is better c. Its action and properties are very similar to lidocaine d. Its biotransformation occurs both in the general circulation and in the liver

a. b. c. d.

Propoxycaine Lidocaine Etidocaine Mepivacaine

Patients with malignant hyperthermia can only be administered ESTER-type anesthetics

a. b. c. d.

Novocaine Propoxycaine Lidocaine Nesacaine

Ultra Short Acting (less than 30 mins) Procaine w/o VC 2% Lidocaine w/o VC 4% Prilocaine w/o VC

Medium-Acting (90-150 mins) 4% Prilocaine w/ 1:200,000 epinephrine Lidocaine+ Mepivacaine with v.c.

Short-Acting (45 to 75 mins) 2% Lidocaine with 1:100000 epinephrine 2% mepivacaine with 1:20000 levonordefrin 4% Prilocaine Long-Acting (180 mins or longer) 0.5% Bupivacaine 1.5% Etidocaine

a. b. c. d.

Lidocaine Contamination Methylparaben Epinephrine

Lidocaine Methylparaben

Epinephrine Sodium Chloride Distilled Water

Anesthetic Germicide/preservativ e, can cause an allergic reaction Vasoconstrictor Makes solution ISOTONIC Used to obtain the desired anesthetic volume

a. b. c. d.

Sodium bisulfate Potassium bisulfate Potassium bisulfite Sodium bisulfite

a. Gamma-toluidine b. Beta-toluidine c. Ortho-toluidine

d. Levo-toluidine

ESTERS
Benzoic Acid Esters Cocaine parent, vasoconstrictor, powerful
stimulant of cerebral cortex

AMIDES
3% Prilocaine (Citanest) ortho toluidine and sodium
nitrate methlmoglobinemia; liver and kidney

Benzocaine topical PABA Esters Procaine (Novocaine) least duration of action Propoxycaine (Ravocaine) most potent toxic LA in current use 0.4% Tetracaine (Pontocaine) sinasama sa procaine

Lidocaine (Xylocaine) Etidocaine (Duranest) Mepivacaine (Carbocaine) Bupivacaine (Marcaine) (Sensorcaine) long-acting Articaine (Primacaine) both plasma and liver

a. b. c. d.

Speed up the effect of local anesthetics Maintain potency of local anesthetics Delay absorption rate of local anesthesia Accelerate destruction of local anesthetics

a. b. c. d.

95% NO2, 5% O2 70% NO2, 30% O2 70% O2, 30% NO2 50% NO2, 50% O2

All of the following are relative contraindications for N2O/O2 sedation except
a. hypersensitive gag reflex b. severely claustrophobic patients c. current upper respiratory infection

d. first trimester of pregnancy

e. alcohol intoxication or drug use

a. b. c. d.

Stage I Stage II Stage III Stage IV

Stage I II III IV

Description Amnesia and analgesia Delirium and excitement Surgical anesthesia Medullary paralysis

a. b. c. d.

Nerve block Field block Local Infiltration Topical

Types of Regional Anesthesia

Nerve Block main trunk Field Block large nerve terminal Infiltration small nerve terminal Topical mucosa

Which of the following is a method of true mandibular nerve block?

a. Lingual Nerve Block

b. Akinosi Technique
c. Classical IAN Block d. Gow-Gates Technique

The following are the nerves to be anesthetized when extracting tooth #26, except
a. Greater Palatine Nerve

b. Lesser Palatine Nerve

c. Middle Superior Alveolar Nerve d. Posterior Superior Alveolar Nerve

Innervates the soft palate, tonsils, and uvula

The following are landmarks used when giving a maxillary nerve block, except
a. Midpoint of zygomatic arch
b. Infraorbital notch c. Coronoid process d. Lateral pterygoid plate

a. b. c. d.

Quadratus labii superioris Triangularis Risorius Mentalis

a. b. c. d.

0.57 mm 0.51 mm 0.45 mm 0.37 mm

Needle Diameter
Gauge 23
Gauge 24 Gauge 25 Gauge 27 Gauge 30

0.57 mm 0.51 mm 0.45 mm ~0.4 mm ~0.3 mm

a. 11
b. 9 c. 7 d. 5

Computation:
60 kg 7 mg x kg X 20 mg 1 ml X 1 cartridge 1.8 ml = 11.6 11 cartridges

Patients weight in kg Maximum Concentration allowable dose in in 1 cartridge Volume adults Maximum allowable dose in children = 5mg/kg