Pharm Exam 4

Front 1

T/F. Amides produce rare allergic reactions, esters produces more common allergic reactions

Back 1

T

Front 2

Propoxycaine is what type of LA?

Back 2

ester

Front 3

Local anesthetic actions bind to

Back 3

intracellular side of sodium channels

Front 4

Shortest infiltration = 20 min =

Back 4

mepivacaine 3% with no vasoconstrictor

Front 5

mepivacaine 3% with no vasoconstrictor duration is?

Back 5

2.25 – 3 hours

Front 6

T/F. Can you use lidocaine on preggers?

Back 6

T

Front 7

1. This local anesthetic has both an amide and an ester group in its structure.

Back 7

Articaine (septocaine ) is an ester and an amide and rapidly broken down in blood

Front 8

2. The mechanism of action of local anesthetics on nerve function is best explained by binding selectively to:

Back 8

intracellular surface of neuronal channels to block influx of sodium into the axon

Front 9

1. List the incidence of paresthesias by prilocaine and articaine per million injections according to Haas study –

Back 9

Articaine: 2.27:1,000,000 injections. Prilocaine = 1.7/1 million

Front 10

2. According to Haas incidence of paresthesia due to Septocaine (Articaine) in number of cases per millions was:

Back 10

2.27

Front 11

3. Put these in order of loss: temp, propri, skeletal muscle tone, pain, touch

Back 11

Patient loses pain, then temp, then touch, then proprioception, then skeletal muscle tone (There’s only one answer choice with pain first and that’s the correct one.)

Front 12

4. Phentolamine the active ingredient of Oraverse typically decreases numbness by ___%

Back 12

50

Front 13

5. Oraverse should be used is adults and children 6 yrs or older and weighting 15kg(33 lbs) or more. T/F?

Back 13

TRUE

Front 14

6. Know oraqix is for _____________ and is composed of _____________

Back 14

Know oraqix is for periodontal stuff and scaling and root planning and is composed of lidocaine and prilocaine

Front 15

7. Patient is allergic to ester anesthetics, which one would you avoid administering?

Back 15

The answer choice with only one “i” is the correct one, think it was benzocaine.

Front 16

Carbamazepine = effective against

Back 16

simple and complex partial seizures

Front 17

Phenytoin = effective for

Back 17

tonic clonic seizures, is teratogenic, does gingival hyperplasia

Front 18

1. Is Methotrexate used alone or in combination with other drugs?

Back 18

Methotrexate is not used alone, in combination with other drugs. It is a Disease Modifying antirheumatoid Drug

Front 19

3. What is Anakinra?

Back 19

Know anakinra (kineret) is an IL-1 receptor antagonist. Human recombinant construct, half life = 4-6hrs. Administration = 100mg/d sc. Side effects = increase chance for infxn.

Front 20

4. What is Tocilizumab (actemra)?

Back 20

Know tocilizumab (actemra) is a monoclonal antibody inhibiting IL-6

Front 21

5. What are the targets of antiarthritics?

Back 21

Know many targets for antiarthritics – TNF alpha, IL1, IL6, inhibitors. T-cell co-stimulators. B-cell targeted therapies.

Front 22

6. Man biologics have problems with what?

Back 22

Know many biologics have problems with upper respiratory infections

Front 23

7. What is Abatacept (Orencia)?

Back 23

Abatacept(Orencia) is a new class = selective co-stimulator modulator – blocks T cells

Front 24

Corticosteroids are made from

Back 24

cholesterols

Front 25

Prednisone =

Back 25

treats rheumatoid arthritis

Front 26

Corticosteroids =

Back 26

reduces PGE and leukotrines, suppresses migration of PMNs, osteoporosis, NOT hypotension

Front 27

1. Approximately 0.2% of population is allergic to aspirin, T/F?

Back 27

TRUE. What percentage of people are allergic to aspirin? 0.2% allergic to aspirin

Front 28

2. The mechanism of the anti-platelet effect of aspirin is attributed to the inhibition of what substance or substances listed below?

Back 28

Thromboxane A2 (TXA2)

Front 29

3. Acetaminophen may cause hepatic cell necrosis due to which mechanism below?

Back 29

At high doses, it is converted to a reactive metabolite which overloads the pathways of normal metabolic protection

Front 30

4. T/F. Acetaminophen can be given to a patient on an anticoagulant without any effect on the efficacy of the anticoagulant.

Back 30

True

Front 31

5. What are the pharmacological effect or effects of acetaminophen?

Back 31

Pharmacological effect or effects of acetaminophen: antipyretic, analgesic

Front 32

6. Aspirin can be taken for what? Not taken for what?

Back 32

Aspirin can be taken for heart attacks/myocardial infarctions BUT NOT for angina

Front 33

7. Antripyretic effect of aspirin is due to its effect on reducing production of:

Back 33

PGE2. What is antipyretic effect a result of? Antipyretic effect is from reduction of PGE2 (PGE2 and PGF2 for pain)

Front 34

8. Aspirin mainly causes _________ problems, but also ___________

Back 34

Aspirin mainly causes GI Problems, but also thrombocytopenia

Front 35

9. Acetaminophen max daily is how much per day?

Back 35

Acetaminophen max daily is 4g per day (4000mg)

Front 36

10. T/F. Acetaminophen onset is less than 1 hr.

Back 36

True. (Aspirin: 1-2 hrs.)

Front 37

11. Which one is a therapeutic effect of acetaminophen:

Back 37

Analgesia, the other two choices I think were anticoagulant and anti-inflammatory which are not effects of acetaminophen. And then there was like two of the above, all the above.

Front 38

1. T/F. The mechanism of anti-inflammatory action of ibuprofen states that it inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclo-oxygenase, which results in decreased formation of prostaglandin precursors.

Back 38

True

Front 39

2. ___________ is considered a major and relatively frequent adverse effect caused by use of ibuprofen.

Back 39

Abdominal pain

Front 40

3. This NSAID has relatively selective inhibition on COX-2 enzyme with little or no inhibition on COX-1 enzyme.

Back 40

Celecoxib (Celebrex)

Front 41

4. Lithium and ibuprofen =

Back 41

Lithium and ibuprofen = mental confusion

Front 42

5. Question about Ibuprofen and cross-interaction with Lithium. Either it went like; this medical condition in which you should avoid Iburofen is what?

Back 42

Answer is Maniac depression OR the patient who has the medical condition manic depression should not be given Ibuprofen because of interaction with? Answer would be lithium.

Front 43

6. Don’t use ibuprofen under what circumstances?

Back 43

Don’t use ibuprofen if preterm infants with unproven infection, 3rd trimester pregnancy, pre operative pain in setting of coronary bypass surgery

Front 44

1. this agent is the rescue agent for patients suffering asthma attacks:

Back 44

Albuterol. Asthmatic attack rescue medication = albuterol

Front 45

2. Patients expressing an allergic predisposition to bisulfites found in the local anesthetics containing epinephrine most likely have a history of what medical condition below:

Back 45

asthma

Front 46

3. Montelukast belongs to which class of drugs used to reduce bronchoconstriction of asthma:

Back 46

Leukotriene Antagonist. Montelukast (Singulair): inhibits leukotrienes

Front 47

4. Popular corticosteroid used in treatment of asthma:

Back 47

again don’t remember the exact name of drug but it’s the one ending with –ONE…I think it was triamcinolone(Azmacort). Corticosteroid inhalants = trimcinolone (Azmacort)

Front 48

5. Cromolyn belongs to which class drugs used to reduce the likelihood of asthmatic attacks?

Back 48

Antihistamine

Front 49

1. Which of the following is an anti-tussive: Hycrocodone, Codeine, Dextrometorphan.

Back 49

All the above. Non narcotic antitussive = dextromethorphan

Front 50

2. Guaifenesin (robitussin) is avalilable in combination with hydrocodone. Hydrocodone as what?

Back 50

Antitussive. These two together = Hycotuss. Hydrocodone + chlorpheniramine = Tussionex. Guaifenesin is an expectorant (dissolves thick mucus and helps relieve respiratory difficulties).

Front 51

1. Mu opiod receptors are for what?

Back 51

Mu opiod receptors for respiratory depression

Front 52

2. This (these) narcotic analgesic(s) all cause nausea as a side effect.
naloxone (Narcan)
codeine
hydrocodone
all the above
b and c only

Back 52

b and c only (Codeine and hydrocodone)

Front 53

3. True morphine agonist

Back 53

morphine

Front 54

4. The G-coupled opiod receptor they OPEN CHANNELS for Potassium so Potassium can flow out of the neuron. This outflow of K makes the presynaptic neuron

Back 54

lose its capability of action potentials and the presynaptic neuron stops releasing “pain” neurotransmitters.

Front 55

5. Vicoden ES (extra strength) =

Back 55

Hydrocodone 7.5mg, acetaminophen 750mg

Front 56

6. What are the side effects of morphine?

Back 56

Drowsiness, respiratory depression, nausea, ADH increase (water retention), constipation, myosis

Front 57

7. Nortriptyline (brand name Pamelor) is considered a miscellaneous class of analgesic and has a dental use of treatment for

Back 57

Burning Mouth Syndrome

Front 58

8. Which drug below has a mechanism of action of binding to alpha 2 – delta subunit of voltage gated calcium channels?

Back 58

pregabalin (Lyrica)

Front 59

9. This (these) narcotic analgesic(s) all cause sedation
a. hydrocodone
b. codeine
c. oxycodone
d. all the above
e. none of the above cause sedation

Back 59

d. all the above

Front 60

10. True for the opiate receptor
a. coupled to G-protein; when stimulated result is opening of potassium channels
b. couple to G-protein; when stimulated result is opening of chloride channels
c. is ligand-gated channel which results in opening of potassium channels
d. is ligand-gated channel which results in opening of chloride channels

Back 60

a. coupled to G-protein; when stimulated result is opening of potassium channels

Front 61

11. The actions of this narcotic pain reliever includes “unlimited” analgesia:

Back 61

morphine.

Front 62

12. This(these) narcotic analgesic(s) caused unlimited analgesia:

Back 62

ALL THE ABOVE, think the choices were codeine, hydro and oxycodone.

Front 63

13. A narcotic agent which antagonizes at both the mu and kappa opiate receptors is known as:

Back 63

pure antagonist.

Front 64

1. Inhibits sodium tubular reabsorption primarily within the distal portion of the nephron.

Back 64

Thiazide diuretics

Front 65

2. This diuretic does not require potassium supplementation

Back 65

Triameterene (Dyrenium)

Front 66

3. This diuretic can cause hypokalemia to result in increased thirst and dry mouth:

Back 66

furosemide (Lasix). Loop diuretic = furosemide (Lasix)

Front 67

4. Best describes the actions of diuretics such as hydrochlorothiazide in treating congestive heart failure:

Back 67

Reduces overall fluid volume within the circulatory system and reduces fluid congestion in the lungs

Front 68

1. Which is the “cardioselective” beta adrenergic receptor blocker?

Back 68

Atenolol. Cardioselective beta blockers = atenolol, labetolol, metoprolol. REMEMBER THAT ANY BETA BLOCKER THAT STARTS WITH LETTERS A THROUGH M IS CARDIOSELECTIVE.

Front 69

2. Know cardioselective and non cardioselective beta blockers

Back 69

Cardioselective beta blocker – atenolol. Noncardioselective beta blocker?

Front 70

3. Non selective beta blockers =

Back 70

nadolol, propranolol, timolol

Front 71

4. This Beta blocker has the potential to cause significant increase in blood pressure as a result of interacting with local anesthetics:

Back 71

answer was either Propranolol or Nadolol. Slide 56 of Local anesthetics, KNOW IT!!!!

Front 72

5. Stops angiotensin I to II and aldosterone production –

Back 72

angiotensin converting enzyme inhibitor – ends in pril – enalapril

Front 73

6. The action of this class of antihypertensives is mainly to reduce heart rate and cardiac output:

Back 73

Beta adrenergic blockers.

Front 74

14. ACE (Angiotensin Converting enzyme) inhibitor blocks

Back 74

the conversion of Angiotensin I to Angiotensin II which then decreases blood pressure.

Front 75

15. Blocks angiotension converting enzyme –

Back 75

ACE inhibitor

Front 76

1. This class of antiarrhythmic drugs act by blocking potassium channels in myocardial cells:

Back 76

Class III antiarrhythmic drugs. Class III antiarrhythmic drugs interfere with potassium channels

Front 77

2. This class of antiarrhythmic drugs is also known as beta-adrenergic receptor blockers:

Back 77

Class II antiarrhythmic drugs.

Front 78

3. This antiarrhythmic drug works by blocking Angioentsion II receptors:

Back 78

whatever that ended with SARTAN.

Front 79

4. Best describes the actions of digitalis in treating congestive heart failure:

Back 79

Overcomes the weakened heart muscle to allow for a more efficient pumping action

Front 80

5. Erythromycin antibiotics can enhance the ability of this drug to cause muscle pain, and break down muscle protein –

Back 80

any statin – simvastatin (Zocor)

Front 81

6. Acts by inhibiting the enzyme which controls the formation of cholesterol in liver. This enzyme is called hydroxyl-methylglutaryl Co-enzyme A reductase (HMG-CoA Reductase for short):

Back 81

simvastatin(Zocor)

Front 82

7. Nitroglycerin causes an increase in the levels of cGMP which results in:

Back 82

de-phosphorylation of the myosin light chain in smooth muscle vascular cells resulting in vascular smooth muscle relaxation. NOT SURE WHICH ONE WAS ASKED ON THE EXAM BUT KNOW AMYL NITRIE IS THE ONLY NITRIE FORM OF NITROGLYCERINE AND ISOSORBIDE DINITRATE IS THE LONG ACTING NITROGLYCERINE.

Front 83

8. Which is the true statement relative to tolerance to nitroglycerin
a. never occurs
b. can be restored through brief “nitrate-free” periods (Nitrate free periods will allow for the patient to better tolerate the effects of nitroglycerin when taken again)
c. a serious effect which prevents the use of long acting nitroglycerin tablets
d. is the cause of headache

Back 83

b. can be restored through brief “nitrate-free” periods (Nitrate free periods will allow for the patient to better tolerate the effects of nitroglycerin when taken again)

Tolerance to nitroglycerine is very common which is overcome by: Nitrate free intervals during the day.

Front 84

12. One Major adverse effect of Nitroglycerine is its hepatotoxicity or some other shit. T/F?

Back 84

It’s FALSE because its adverse effect is headache

Front 85

1. Classes of drugs used to prevent angina pectoris EXCEPT:

Back 85

cardiac glycosides

Front 86

2. This drug, used to treat angina, has a significant incidence of gingival hyperplasia

Back 86

Nifedipine

Front 87

1. Bleeding times and platlet aggregation are measures of effect of this “blood thinner’

Back 87

(aspirin and) clopidogrel (plavix)

Front 88

2. Take clopidogrel

Back 88

once a day -75mg for acute coronary syndrome, unstable angina

Front 89

1. Prasugrel is for

Back 89

Strent thrombosis events

Front 90

2. Dilostazole and dipyridamole (Aggrenox) are

Back 90

reversible platelet inhibitors

Front 91

3. Cilostazole (Pletal) is for

Back 91

peripheral vascular disease

Front 92

1. Dabigatran (Pradaxa) inhibits clot formation by

Back 92

directly inhibiting thrombin. direct competitive inhibitor of thrombin (iia)

Front 93

2. The mechanism of action of warfarin (Coumadin) is best described by which statement below:

Back 93

interferes with hepatic synthesis of vitamin-K dependent coagulation factors. Warfarin (coumadin) – vita K antagonist

Front 94

3. Heparin is an anticoagulant that works by:

Back 94

activates antrithormbin III. Heparin activates antithrombin III to bind to and inhibit thrombin

Front 95

4. The anticoagulant Enoxaparin (Lovenox) belongs to the drug class:

Back 95

Factor Xa inhibitors. Enoxaparin = low MW heparin = inhibits factor Xa. Others are (dalteparin (Fragmin)

Front 96

5. T/F question about lower the dose of anticoagulants prior to dental therapy for patients taking such drugs:

Back 96

you usually DO NOT lower the dose. If it said don’t mess with the dose it’s true, if its said lower the dose, it’s false.

Front 97

1. Inhibits absorption of dietary cholesterol at the brush border of the small intestine.

Back 97

Ezetimibe (Zetia). Zetia = Ezetimibe, blocks dietary cholesterol absorption in GI tract

Front 98

2. This cholesterol lowering drug works by binding bile acids in intestine to form insoluble complexes which are eliminated in feces:

Back 98

Cholestyramine resin (Questran) or Colestipol (Colestid). Don’t remember the exact name but anything that had Chol or Col in it. Sequesters bile acids = cholestyramine or colesevelam (WelChol)

Front 99

3. Name the Fibric acids =

Back 99

clofibrate, gemfibrozil, fenofibrate

Front 100

4. It is thought that this drug lowers cholesterol by inhibiting synthesis of the lipoproteins that carry cholesterol in the blood stream.

Back 100

Niacin