Flashcards in Pharmaco4_Tuft Deck (98):
name of esters local anesthesia? (metabolized in plasma and a little in liver)
name of amide local anesthesia? (metabolized in liver)
Bupivacaine (longer action of duration)
cause of toxic reaction of LA? (hypersensitivity is rare)
• high systemic level of LA in general
• specific agent prilocain causing methemogolobin
high systemic level of LA in blood causes?
• myocardial depression causing cardiovascular collapse
• hypotensive shock
• inhibit CNS inhibitory neurons so causing CNS stimulation proceeding to convulsion
mechanism of action of LA?
prevent the generation of nerve impulses by interfering with sodium transport into the neuron
which form of LA is effective?
non-ionized free-base form
• how many milligram of lidocaine and epinephrine in one mL of 2% solution?
• how many milligram of lidocaine and epinephrine in 1.8ml carpule?
• 20mg lido and .01 mg epi
• 36mg lido and .018 mg epi
The most serious consequence of systemic local anesthetic toxicity is
d. Post depressive central nervous system convulsions
e. Postconvulsive central nervous system depression
Postconvulsive central nervous system depression
Cardiovascular collapse elicited by a high circulating dose of a local anesthetic may be caused by
b. Vagal stimulation
c. Histamine release
d. Myocardial depression
e. Medullary stimulation
High plasma levels of local anesthetics may cause
a. Inhibition of peristalsis
b. stimulation of baroreceptors resulting in severe hypotension
c. Inhibition of the vagus nerve to the heart
d. Depression of inhibitory neurons in the CNS
Depression of inhibitory neurons in the CNS
Hypotensive shock may result from excessive blood levels of each of the following local anesthetics EXCEPT
Cocaine - it is the only vasoconstrictors
Which of the following anesthetic drugs produces powerful stimulation of the cerebral cortex?
Which of the following is true regarding the mechanism of action of local anesthetics?
a. Usually maintain the nerve membrane in a state of
b. Prevent the generation of a nerve action potential
c. Maintain the nerve membrane in a state of depolarization
d. Prevent increased permeability of the nerve membrane to
e. Interfere with intracellular nerve metabolism
Prevent the generation of a nerve action potential
The penetration of a local anesthetic into nervous tissue is a function of the
a. Length of the central alkyl chain
b. Lipid solubility of the ionized form
c. Lipid solubility of the unionized form
d. Ester linkage between the aromatic nucleus and the alkyl chain
e. Amide linkage between the aromatic nucleus and the alkyl chain
Lipid solubility of the unionized form
A recently introduced local anesthetic agent is claimed by the manufacturer to be several times as potent as procaine. The product is available in 0.05% buffered aqueous solution in 1.8 ml. cartridge. The maximum amount recommended for dental anesthesia over a 4-hour period is 30 mg. The amount is contained in approximately how many cartridges?
e. Greater than 36
5%=50mg so 0.05%=0.5mg
for 30mg we need 60ml means 33.3 cartridges
so d is the correct answer
difference of penicillins VK and G?
G is injected while Vk is oral (G is sensitive to Acid) so V is more reliable oral absorption
all of the following antibiotics are considered to have a high rate of allergenicity except?
• Amphotericin B
which of the following antibiotics is the substitute of choice for penicillin sensitive patient?
erythromycin - spectrum of action of it is much closer to penicillin, others are broader
which of the following penicillins has a broader gram negative spectrum than penicillin G?
• Penicillin V
Which of the following antibiotics should be considered the drug of choice in the treatment of infection caused by a penicillinase-producing staphylococcus?
• Penicillin V
Dicloxacillin - the only penicillinase resistance listed
Ampicillin is LEAST effective against penicillinase BUT is extended spectrum
Which of the following is a bactericidal antibiotic used specifically in the treatment of infections caused by Pseudomonas species and indole-positive Proteus species?
• Penicillin V
Carbenicillin - an extended spectrum agent while Ampicillin is ineffective
Chlortetracycline acts by interfering with?
• cell wall synthesis
• nuclear acid synthesis
• protein synthesis on bacterial but not mammalian ribosomes
• protein synthesis on mammalian but not bacterial ribosomes
protein synthesis on bacterial but not mammalian ribosomes
The probable mechanism of the bacteriostatic action of sulfonamides
a. Disruption of the cell membrane
b. Coagulation of intracellular proteins
c. Reduction in oxygen utilization by the cells
d. Inhibition of metabolism by binding acetyl groups
e. Competition with para-aminobenzoic acid in folic acid synthesis
Competition with para-aminobenzoic acid in folic acid synthesis
which of the following statements is true regarding streptomycin?
• it is bactericidal
• it has a gram positive spectrum
• it is usually administered orally
• it disrupts bacterial cell membrane
• it is associated with a low incidence of bacterial resistance
it is bactericidal
Tetracycline reduces the effectiveness of concomitantly administered penicillin by
a. Reducing absorption of penicillin
b. Increasing metabolism of penicillin
c. Increasing renal excretion of penicillin
d. Increasing binding of penicillin to serum proteins
e. None of the above
(e) tetracycline is bacteriostatic and would slow the rapid growth of the microbial population that a bactericidal drug such as penicillin needs to be effective, sine only when rapidly dividing are the cells making cell walls
Which of the following antibiotics is most likely to cause liver damage?
b. Penicillin G
e. Amphotericin B
(a) streptomycin can damage the eighth nerve, affecting both balance and hearing, but is not associated with liver damage. (b) other than allergic reactions, penicillins are extremely safe, with no effect on the liver. (d) the cephalosporins are chemically related to the penicillins and share their relatively nontoxic nature. (e) amphotericin B, is an antifungal agent that produces such adverse side effects as nephrotoxicity and hypokalemia, but not liver toxicity. Thus (c) is the correct answer. Tetracyclines have been shown to be hepatotoxic following high doses in pregnant patients with a history of renal disease.
Which of the following erythromycins associated with an allergic cholestatic hepatitis?
a. Erythromycin base
b. Erythromycin stearate
c. Erythromycin estolate
d. Erythromycin succinate
Symptoms that may be characterized as allergic manifestations during penicillin therapy are
a. Deafness, dizziness and acute anemia
b. Crystalluria, nausea, vomiting and anaphylactic shock
c. Oliguria, hematuria, bronchoconstriction and cardiovascular collapse
d. Dermatitis, stomatitis, bronchoconstriction and cardiovascular collapse
Dermatitis, stomatitis, bronchoconstriction and cardiovascular collapse
Aplastic anemia is a serious toxic effect that occurs particularly after a course of treatment with which of the following antibiotics?
Each of the following is a side effect of prolonged tetracycline hydrochloride therapy EXCEPT:
c. Vestibular disturbances
d. Discoloration of newly forming teeth
e. Gastrointestinal symptoms (when administered orally)
a dental patient with a prosthetic heart valve with no drug allergies should receive prophylactically which drugs?
Ampicillin and Gentamicin - the only dental use of Gentamicin - synergistic effect
The action of which of the following drugs will most likely be impaired by concurrent administration of tetracycline?
Which of the following has the broadest antimicrobial spectrum?
a. Vancomycin (Vancocin )
b. Clindamycin (Cleocin )
c. Erythromycin (Erythrocin )
d. Chlortetracycline (Aureomycin )
e. A third generation cephalosporin
Chlortetracycline (Aureomycin )- remember, tetracyclines are broad spectrum antibiotics effective against both gram-negative and gram-positive cocci and bacilli. Clindamycin has a spectrum of activity similar to erthyromycin and vancomycin, which is less than that of the tetracylines, mainly affecting gram-positive microorganisms. 1st generation cephalosporins are effective against both gram-negative and gram-positive organisms, but the third generation ones have increased activity against gram-negative but greatly decreased activity against gram-positive microorganisms.
Sulfonamides and trimethoprim are synergistic bacteriostatic agents because in bacteria they
a. Both inhibit folic acid synthesis
b. Interfere sequentially with folinic acid production
c. Are both antimetabolites of para-aminobenzoic
d. Are both inhibitors of dihydrofolic acid reductase
e. Are both transformed in vivo into a single active compound
Interfere sequentially with folinic acid production
when broad spectrum antibiotics are administered with coumarin anticoagulants, the anticoagulant action may be?
increased because of reduction of Vit K sources
drugs for angina (insufficient oxygen to meet demands of myocardium)?
• nitroglycerin: direct vasodilatory action on the smooth muscle in the coronary arteries
• propranolol: reduces oxygen demand by preventing chronotropic responces to endogenous epinephrine, emotions and exercise
• calcium channel blockers such as Verapamil
Antiarrhytmics drugs (heart beats irregularly)?
• lidocaine: decrease cardiac excitability - ventricular arrhythmias
• quinidine: increasing the refractory period of cardiac muscle (Supraventricular arrhythmias)
• Verapamil: atrial fibrillation and Supraventricular arrhythmias
• digitalis (used for atrial fibrillation it acts by decreasing the rate of A-V conduction)
• diuretic: decrease the renal absorption of sodium resulting in fluid loss such as furosemide (high ceiling) or thiazides (chlorothiazide)
• beta blocker: propranolol (nonselective beta blocker reduces ccardiac output and inhibits renin secretion) or metoprolol (selective beta1 blocker, reduces cardiac output)
• alpha1 blocker: prazocin- inhibits binding of nerve induced release of NE resulting in vasodilation
• centrally acting adrenergic drugs: methyldopa (acts centrally as a false neurotransmitter stimulating alpha receptors to reduce sympathetic outflow resulting in vasodilation) or clonidine
• neural blockers: guanethidine (reserved for severe hypertension)
• angiotensin converting enzyme inhibitor: Captopril
congestive heart failure drugs?
• digitalis (digoxin): positive inotropic effect increasing the force of contraction of the myocardium
• ACE inhibitor: Captopril
quinidine is principally used to treat?
Supraventricular arrhythmias (ventricular fibrillation)
digitalis (digoxin) is principally used to treat?
congestive heart failure
Verapamil is principally used to treat?
Which of the following drugs can be used in preventing or treating angina pectoris?
each of the following drugs can be used in preventing or treating angina pectoris EXCEPT?
• Isosorbide dinitrate
• Pentaerythritol tetranitrate
Digitalis - useful in congestive heart failure
All of the following drugs are useful in the treatment of hypertension EXCEPT?
• Thiazide diuretics
Digitalis is useful in which of the following conditions?
• Atrial fibrillation
• Congestive heart failure
• Paroxymal atrial tachycardia
all of them
all of the following drugs are useful in the treatment of cardiac arrhythmias EXCEPT?
the drug of choice for initial therapy for mild hypertension is?
• Alpha methyldopa
[Guanethidine is for sever hypertension]
which antihypertensive is usually reserved for treatment of severe antihypertention?
Guanethidine and ganglionic blocking agents
which of the following beta adrenergic receptor blocking agent is thought to be cardioselective?
antiarrhythmic drugs, such as quinidine, suppress certain cardiac arrhythmias by?
• stimulating the beta adrenergic receptor
• suppressing cardiac ATP-ase activity
• increasing ectopic pacemaker activity
• increasing the refractory period of cardiac muscle
increasing the refractory period of cardiac muscle thus slowing the heart down
lidocaine produces its antiaarrhythmic effects by?
• increasing AV conduction
• decreasing cardiac excitability
• increasing cardiac conduction velocity
• increasing spontanious pacemaker activity
decreasing cardiac excitability
when digitalis is used in atrial fibrillation, the therapeutic objective is to
• abolish cardiac decompensation
• inhibit vagal impulses to the heart
• decrease the rate of A-V conduction
• increase the rate of cardiac repolarization
• produce a decrease in the rate of atrial contraction
decrease the rate of A-V conduction
the primary antihypertensive effect of captopril (Capotn) is due to accumulation of ?
• Angiotensin I
• Angiotensin III
• Bradykini metabolites
Bradykini metabolites - Captopril usually inhibits converting of Angiotensin I to II so reducing the BP. Captopril also reduce BP by elevating Bradykini metabolites by blocking its metabolism
which of the following is not characteristics of the thiazide diuretics?
• increase renal excretion of sodium and chloride
• increase renal excretion of potassium
• increase the toxicity of of digitalis
• exacerbate existing diabetes
• cause hypokalemia
• cause hypoglycemia
Digoxin exerts its positive inotroptic effect by
• activation of adenylcyclase
• inhibition of phosphodiesterase
• an agonist effect of - receptor
• inhibition of N+, K+, ATPASE leading to increased calcium influx
• decreasing the amount of calcium available for excitation - contraction coupling
inhibition of N+, K+, ATPASE leading to increased calcium influx
it is used in treatment of congestive heart failure
first option is the way epinephrine works
Digoxin is effective in treatment of cardiac failure because it
• is primarily a diuretic
• reduces the ventricular rate
• decreases abnormal cardiac rhythms
• produces peripheral vasoconstriction
• has a positive cardiac inotropic action
has a positive cardiac inotropic action
the primary action of therapeutic doses of digitalis on cardiac muscle is an increase in
• force of contraction
• ventricular excitability
• refractory period of the atrial muscle
• refractory period of the ventricular muscle
• rate of conduction of immpulse to the muscle
force of contraction
the beneficial effects of digitalis (cardiac glycoside) in congestive heart failure result in part from the fact that digitalis causes
• a decrease in end - diastolic volume
• a decrease in end - diastolic pressure
• an increase in stroke volume and cardiac output
• a decrease in central venous pressure
• a decrease in rate of the hear where tachycardia exists
all of them
the mechanism of action of prazosin, an antihypertensive agent is to?
• block beta adrenergic receptors
• inhibit formation of angiotensin II
• inhibit nerve induced release of NE
• stimulate central inhibitory alpha adrenergic receptors
• inhibit the postsynaptic action of NE on vascular smooth muscle
inhibit the postsynaptic action of NE on vascular smooth muscle
which of the following owes a significant amount of its antihypertensive effect on a central action
Methyldopa and cloidine- stimulating alpha 2 receptors in the brain stem.
(Metoprolol selectively blocks beta1 receptors in the heart. Hydralazine has a direct action on vascular smooth muscle on vasodilation. Propranolol blocks beta receptors in the heart, Guanethidine prevent the release and cause depletion of cathecholamines taken up into storage vesicles and is released like a false transmitter. It does not cross the blood brain barrier)
which of the following drugs is thought to reduce arterial blood pressure by activating alpha receptors in the vasomotor center of the medulla?
Propranolol (Inderal) can be useful in the treatment of hypertension because it blocks?
• alpha1 adrenergic receptors
• sodium reabsorption in the kidney
• the release of renin from juxtaglomerular cells
• the release of NE from nerve terminals
• the reflex tachycardia seen with the use of other antihypertensive
• the release of renin from juxtaglomerular cells
• the reflex tachycardia seen with the use of other antihypertensive
selective beta1 adrenergic antagonists will produce which of the following effects
• increased cardiac output
• decreased diastolic pressure
• decreased peripheral resistance
• relaxation of bronchial smooth muscles
increased cardiac output
ototoxicity with deafness may encountered occasionally in patients taking which of the following diuretic agents?
• high ceiling
symptoms of digitalis toxicity include all of the following EXCEPT?
• Nausea and vomiting
• Yellow - green vision
• A-V conduction block
• Decreased P-R interval
Decreased P-R interval
administration of which of the following drugs increases the likelihood of a toxic response to digitalis?
• Acetylsalcylic acid
chlorothiazide is a diuretic which causes potassium loss or hypokalemia. This results in greater penetration digitalis into the myocardium, and thus potential toxicity
which of the following cardiac depressant is contraindicated in a patient with cardiac arrhythmia?
Propranolol - all of these are used to treat arrhythmia, but Propranolol can sometimes results in congestive heart failure
• Analgesic effects of aspirin:
• Antipyretic effects:
• Bleeding time:
• inhibits the synthesis of prostaglandins
• aspirin inhibits PG synthesis in the hypothalamic temperature regulation center
• inhibit synthesis of thromboxane A2 preventing platelet synthesis
The therapeutic effect of the salicylates is explained on the basis of the ability of the drug to
a. Activate autonomic reflexes
b. Uncouple oxidative phosphorylation
c. Inhibit the synthesis of prostaglandins
d. Competitively antagonize prostaglandins at the receptor site
Inhibit the synthesis of prostaglandins
The mechanism of the antipyretic action of salicylates probably results from
a. Inhibition of prostaglandin synthesis in the CNS affecting hypothalamic temperature regulation
b. Inhibition of bradykinin in the periphery leading to sweating
c. Depression of oxidative enzymes leading to decreased heat production
d. Suppression of cholinergic mediators in the hypothalamus
e. Stimulation of norepinephrine in the hypothalamus
Inhibition of prostaglandin synthesis in the CNS affecting hypothalamic temperature regulation
The antipyretic action of salicylates is explained in part by
a. Analgesia leading to sedation
b. Increased blood flow through the hypothalamus
c. Cutaneous vasodilation leading to increased heat loss
d. Depression of oxidative processes leading to decreased heat production
Cutaneous vasodilation leading to increased heat loss
The focus of action of aspirin's central antipyretic effect is the
a. Brain stem
c. Basal ganglia
d. Limbic system
e. Cerebral cortex
A patient who has been taking large quantities of aspirin might show increased postoperative bleeding because aspirin inhibits
a. Synthesis of thromboxane A2 and prevents platelet aggregation
b. Synthesis of prostacyclin and prevents platelet aggregation
c. Synthesis of prostaglandin and prevents production of blood platelets
d. Thrombin and prevents formation of the fibrin network
e. G.I. absorption of vitamin K and prevents synthesis of blood clotting factors
Synthesis of thromboxane A2 and prevents platelet aggregation
Anti-inflammatory agents, such as aspirin, interfere with hemostasis by
a. Activating antithrombin
b. Preventing vasoconstriction
c. Inhibiting thrombin generation
d. Inhibiting platelet aggregation
e. Inhibiting polymerization of fibrin
Inhibiting platelet aggregation
which of the following antiinflammatory agents does NOT act primarily by inhibiting activity of prostaglandin synthetase?
• Acetylsalcylic acid
Triamcinolone (is a corticosteroid)
prolonged use of which of the following drugs does NOT cause predisposition to gastric irritation and bleeding?
• Acetylsalcylic acid
Phenytoin- all others are NSAID.
Phenytoin is an anticonvulsant and major side effect is gingival side hyperplasia
which of the following is NOT produced by excessive doses of Acetylsalcylic acid
• Delirium (هذیان)
• Tinnitus (وزوز گوش)
• Metabolic acidosis
• Increased in renal excretion of uric acid
• Respiratory alkalosis
• morphine detoxification drug?
• morphine antagonist drug?
• methadone (synthetic opoid, in withdrawal cases)
• naloxone (in overdose cases)
• side effects of morphine?
• overdose of morphine?
• respiratory depression, euophoria, dysphoria, sedation, analgesia and conspitation
• coma, miosis and respiratory depression
morphine causes vomiting by?
• A direct irritant action on the gastric mucosa
• stimulation of the nodose ganglion of the vagus nerve
• Stimulation of the medullary chemoreceptor trigger zone
• Direct stimulation of the gastrointestinal musculature
Stimulation of the medullary chemoreceptor trigger zone
the decrease in ventilation caused by morphine, meperidine and some of the related opiods depends chiefly upon ?
loss of sensitivity of the medullary respiratory center to carbon dioxide
which of the following are pathognomonic symptoms of narcotic overdose?
• Miosis, coma, respiratory depression
• Mydriasis, coma, smooth muscle spasms
• Mydriasis, coma, respiratory depression
• Miosis, convulsion, respiratory depression
• Mydriasis, convulsion, respiratory depression
Miosis, coma, respiratory depression
which of the following is an opiod that has both agonist and antagonist activities?
(Naloxone is just antagonist and others are just agonist)
A heroin dependent patient should not be given nalbuphine (Nubain) for pain because
a. it has no analgesic properties
b. it may produce respiratory depression
c. as a mixed agonist-antagonist, it can elicit withdrawal symptoms
d. the high abuse potential of nalbuphine may add to the patient's problems
as a mixed agonist-antagonist, it can elicit withdrawal symptoms
a patient while not currently taking drugs has a history (6 months ago) of narcotic dependency. Which of the following analgesics should be avoided in this patient?
• None of the above
Pentazocine Important: it is effective only on parenteral administration
Methadone is used in detoxification (drug withdrawal) of patients physically dependent on morphine because methadone?
withdrawal reactions are less intense and stressful than those of morphine
Atropine and propanthine exert their effects on peripheral structures by?
a. preventing release of acetylcholine
b. preventing synthesis of acetylcholine
c. enhancing destruction of acetylcholine
d. competing with acetylcholine for receptors sites
e. producing physiologic effects opposite to those of acetylcholine
competing with acetylcholine for receptors sites - botulinum toxin does (a). hemicholinum does (b). it is impossible to destroy acetylcholine since it is done instantly after release so (c) is wrong.
? are competitive muscarinic receptor blockers?
Atropine and propanthine and scopolamine that some times are used for saliva secretion control
physostigmine and neostigmine are ? that differ in that physostigmine acts ?, neostigmine ?, but neostigmine also has some ? activity at the neuromuscular junction. They are sometimes used in treatment of ?
• reversible acetylcholinesterases inhibitor (parasympathomimetic)
• both centrally and peripherally
• only peripherally
• direct ACh like
organophosphate insecticides and nerve gases inhibit the action of which enzyme?
drugs which are addictive with or potentiate the effects of acetylcholine include?
which of the following drugs is best to administer after poisening by an organophosphate cholinesterase inhibitor?
which of the following compounds is a ganglionic blocking agent?
• gallamine triethodide
neostigmine can stimulate denervate skeletal muscle because it
• is a congener of acetylcholine
• is a competitive blocking agent
• has no effect on acetylcholinesterase
• is more potent than diisopropylfuorophosphate
• is capable of acting directly on the end plate
is capable of acting directly on the end plate
which of the following is used to prevent laryngospasm?
succinylcholine - we need a skeletal muscle relaxant. this requires a drug which acts at the neuromuscular junction. of those listed, only succinylcholine is in this category.
atropine is a cholinergic receptor blocker, epinephrine is an adrenergic agonist, and diazepam is a benzodiazepam and neostigmine is an anticholinesterase
which of the following is most likely to dry secretions in the oral cavity?
propantheline - cholinergic