You are commenting using your Google account. You are commenting using your Twitter account. You are commenting using your Facebook account. Notify me of new comments via email. Notify me of new posts via email. NBDE Dental Decks Oral pathology booklet, containing 96 case images of common oral pathological conditions; to help correlate the clinical findings of dental conditions.
The document is based off of previous board exam questions, and teaches students how to interpret and successfully answer almost any pharmacology related question. It is highly recommended to study this document thoroughly. These released questions are essential in helping you understand and get a feel of the type of questions you can expect in your Exam. Remember me on this computer.
Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Download Free PDF. Pharmacology Board Review Allison Scanlon. A short summary of this paper. Download Download PDF. Translate PDF. Prepared by M. Thompson, Ph. A 3rd class of questions are aimed at your knowledge of the mechanism of action of local anesthetics: they prevent the generation of nerve impulses by interfering with sodium transport into the neuron.
This list of questions and topics is the result of going through about 10 years worth of old Board Exams in Pharmacology, cutting out all the IV. The last most frequent type of question regarding local anesthetics questions, categorizing them into topic areas e. Inflamed tissue has a lower than When you do this, you see that many exams repeat questions normal pH, which decreases the amount of non-ionized form available sometimes they reword them a little bit to make them look to penetrate.
Usually at least one question comes up asking you to calculate how of them. As you go through this handout, you will see that I point out many mg of local anesthetic a patient has received, e. In many cases, I have written out a detailed explanation of the answer, just to enlighten you further.
So good luck and enjoy. Which of the following is a local anesthetic subject to inactivation by plasma esterases? The downside is that these questions are from old Board exams. Some of a. Procaine the material is obviously dated, as drugs fall out of fashion, newer b. Lidocaine drugs get used instead of older drugs, etc.
At the beginning of each c. Prilocaine section I will try to indicate some things that have changed and thus d. Mepivacaine you may want to place less emphasis on some of the questions e. Bupivacaine here. Nowadays, you might see in some versions, other versions less. Unfortunately, they still can draw from the realm 2. Procaine differs from lidocaine in that of pharmacology so you gotta review it all. However, the good thing a.
Procaine is a p-aminobenzoic acid ester and lidocaine is not is that since they ask fewer questions, and since they are trying to b. Lidocaine is a meta-aminobenzoic acid ester and procaine is not ask more clinically relevant stuff, if you really focus your efforts on c. The duration of action of procaine is longer than that of an equal analgesics, antibiotics, and anesthetics, you should be covered for total dose of lidocaine the majority of questions.
Procaine hydrochloride is metabolized into diethylaminoethanol and benzoic acid. There are always going to be some random, unpredictable questions that means you have to review more if you want to do really well. Maybe a this is basically a true-false type question. Which of the following local anesthetics would be expected to produce a sensitization reaction in a patient allergic to lidocaine?
Mepivacaine b. Tetracaine Local Anesthetics c. Procaine d. Prilocaine I. The largest category of LA questions focuses on your ability to e. Dibucaine distinguish amide LAs from esters: This I hope is deemphasized, since amide local anesthetics are used almost exclusively now i. All the rest are amides: lidocaine, iv.
They also require v. An infrequent question asks which class of ii another ester vs. LAs are the drug group Lidoccaine is an amide, thus other amides will be cross- most consistent in drug structure, because LAs are either amides or allergenic - mepivacaine, prilocaine and dibucaine are the other esters, differing only in their structure in the intermediate chain its amides listed.
Procaine and tetracaine are esters and will not be either an amide or an ester that connects the aromatic group to the cross-allergenic. The next category of questions has to do with toxic reactions to local anesthetics, either due to high systemic levels of local anesthetics in 9. The hydrolysis of procaine occurs mainly in the general cardiovascular collapse due to myocardial depression, a.
Lungs c. Plasma Bupivacaine Marcaine has all of the following properties relative to d. Kidneys a. Is more toxic b. Is an ester-type local anesthetic c procaine is an ester; esters are metabolized predominately c. Has a slower onset of action by pseudocholinesterases in the plasma. Has a longer duration of action d According to textbooks, local anesthetics fall into the following classes in terms of duration of action: short: procaine; Which of the following is local anesthetic subject to inactivation by moderate: prilocaine, mepivacaine, lidocaine; long: bupivacaine, plasma esterases?
Statements a , 3, and 4 would be true if a. Lidocaine the question was comparing mepivacaine to bupivacaine, which b. Prilocaine are structurally similar; but the comparison is to lidocaine. The c. Tetracaine only difference that applies is duration of action d , d.
Mepivacaine bupivacaine is longer. Bupivacaine c esters are metabolized by plasma esterases - tetracaine is the only ester listed, all the rest are amides Amide-type local anesthetics are metabolized in the a.
Serum b. Liver c. Spleen The activity of procaine is terminated by d. Kidney a. Elimination by the kidney e. Axoplasm b. Storage in adipose tissue c.
Metabolism in the liver only b don't forget: esters in plasma; amides in liver d. Metabolism in the liver and by pseudocholinesterase in the plasma The duration of action of lidocaine would be increased in the presence of which of the following medications? Prazosin question, but worded a little differently to throw you off. Again, b. Propranolol procaine is an ester; esters are metabolized predominately by c.
Hydrochlorothiazide pseudocholinesterases in the plasma, but also to some extent d. Lisinopril by esters in the liver. Digoxin b this is an interaction I tested you on several times — now you All of the following factors are significant determinants of the duration know why!
Propranolol interacts with lidocaine in two ways. Degree of vasodilatation caused by the local anesthetic remains in the systemic circulation longer, and can potentially c. Blood plasma cholinesterase levels accumulate to toxic levels. Propranolol and lidocaine also d. Blood flow through the area of conduction block compete for the same enzyme in the liver, thus metabolism of e. Concentration of the injected anesthetic solution lidocaine can be reduced.
Severe liver disease least affects the biotransformation of which of true-false type question with 4 true statements and 1 false the following? In this case, a. Lidocaine you just have to remember that plasma cholinesterase levels b.
Procaine are only important for the duration of action of ester-type LAs, c. Prilocaine not amides, which are metabolized in the liver. All the other d.
Mepivacaine statements are variables which affect duration of the block, but apply to both esters and amides. Local anesthetics are of one of two types, either esters or amides. Ester types are subject to hydrolysis in the plasma and thus have short half lives. Amides Which of the following is contraindicated for a patient who had an are metabolized primarily in the liver and have longer half lives.
Thus the biotransformation e. Nerve block with lidocaine using a different word to confuse you, even though they are b. Topical application of lidocaine asking the same basic question of an amide type local c. Topical application of tetracaine anesthetic would be the most altered in the presence of sever d. Infiltration with an antihistamine liver disease.
The key word here is "least". Of the drugs listed, only procaine is an ester. The rest are amides. Since procaine is an ester, only another ester LA would be cross-allergenic. In this list the only ester listed is tetracaine. A patient has been given a large volume of a certain local anesthetic solution and subsequently develops cyanosis with The first sign that your patient may be experiencing toxicity from too methemoglobinemia.
Which of the following drugs most likely was much epinephrine would be administered? Cardiovascular collapse a. Procaine b. Convulsions b. Prilocaine c. Elevated pulse rate c.
Dibucaine d. Slurred speech d. Lidocaine e. Mepivacaine c it is a sympathomimetic after all. All the other reactions are related to elevated lidocaine levels b strictly memorization Which disease condition would make the patient most sensitive to the epinephrine in the local anesthetic? Use of prilocaine carries the risk of which of the following adverse b. Diabetes effects?
HIV a. Porphyria d. Alcoholism b. Renal toxicity e. Schizophrenia c. Gastric bleeding d. Methemoglobinemia hormone result in a hypermetabolic state with heightened may result from a toluidine metabolite of prilocaine, sympathetic activity, which combined with injected epinephrine orthotoluidine. Cardiovascular collapse elicited by a high circulating dose of a local anesthetic may be caused by The most probable cause for a serious toxic reaction to a local a.
Syncope anesthetic is b. Vagal stimulation a. Psychogenic c. Histamine release b. Deterioration of the anesthetic agent d. Myocardial depression c. Hypersensitivity to the vasoconstrictor e. Medullary stimulation d. Hypersensitivity to the local anesthetic e. Excessive blood level of the local anesthetic d Cardiovascular collapse is due to a direct action of the local anesthetic on the heart muscle itself LA's in toxic doses e Most toxic reactions of a serious nature are related to depress membrane excitability and conduction velocity , thus excessive blood levels arising from inadvertent intravascular d is the correct answer.
All of the other alternatives are indirect injection. This is a case where option e is the "best" answer, because it is more likely than the other alternatives, which might be true, but are not as likely e. Vertigo b. Hypertension c. Hyperventilation High plasma levels of local anesthetics may cause d. Post depressive central nervous system convulsions a. Inhibition of peristalsis e. Postconvulsive central nervous system depression b. Inhibition of the vagus nerve to the heart e Of the options listed, this is the one that will kill the patient, d.
Depression of inhibitory neurons in the CNS which I guess makes it the most serious. At higher Hypotensive shock may result from excessive blood levels of each of doses, they inhibit both inhibitory and excitatory neurons, the following local anesthetics EXCEPT leading to a generalized state of CNS depression which can a. Cocaine result in respiratory depression and death. Procaine c. Lidocaine 20a. Unfortunately, you injected your lidocaine intra-arterially.
The first d. Tetracaine sign of lidocaine toxicity that might be seen in the patient would be e. Mepivacaine a. Elevated pulse rate b. Sweating a All the listed local anesthetics except cocaine are c.
CNS excitation vasodilators, especially ester-ctype drugs such as proccaine d. Cardiovascular collapse and the amide lidocaine. Cocaine is the only local anesthetic e. CNS depression that predictably produces vasoconstriction. Cocaine is also the only local anesthetic to block the reuptake of NE into adrenergic c same question as above just worded differently.
The intra- neurons, and thus potentiate the NE that has been released arterial injection would result in the high plasma levels from nerve endings mentioned in the previous question.
Questions regarding pH effects on absorption of local anesthetics Which of the following anesthetic drugs produces powerful stimulation of the cerebral cortex? If the pH of an area is lower than normal body pH, the membrane a. Cocaine theory of local anesthetic action predicts that the local anesthetic b. Procaine activity would be c. Lidocaine a. Greater, owing to an increase in the free-base form of the drug d. Tetracaine b. Greater, owing to an increase in the cationic form of the drug e.
Mepivacaine c. Less, owing to an increase in the free-base form of the drug d. Less, owing to a decrease in the free-base form of the drug a see explanation above e. None of the above d the next three or four questions are all versions of the same thing — see the explanation below Questions regarding mechanism of action: A local anesthetic injected into an inflamed area will NOT give Local anesthetics block nerve conduction by maximum effects because a.
Depolarizing the nerve membrane to neutrality 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 c. The chemical mediators of inflammation will present a chemical e. An important one was the role of pH and ionization factors. Remember, the free base or nonionized form is the form that passes through membranes, Which of the following is true regarding the mechanism of action of yet once inside the neuron only the ionized form is effective.
Inflamed tissue has a lower pH than normal tissue and will shift a. Usually maintain the nerve membrane in a state of the equilibrium of the LA solution such that most of it remains hyperpolarization ionized and thus unavailable to penetrate 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 The penetration of a local anesthetic into nervous tissue is a function potassium ions of the e. Interfere with intracellular nerve metabolism a.
Length of the central alkyl chain b. Lipid solubility of the ionized form b this should be really obvious! 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 Local anesthetic agents prevent the generation of nerve impulses by a. Decreasing threshold for stimulation c only options b and c are relevant here - the others have b. Decreasing resting membrane potential nothing to do with LA penetration into membranes.
Membrane c. Decreasing inward movement of sodium ion permeability is affected by whether or not the molecule is d. Only the latter form passes readily through membranes. Remember the fact and you can cover the repolarization and inactivity occurs when potassium moves out. Local anesthetics interfere with the transport of which of the following b.
Sodium d. Calcium c. Chloride c the ratio of ionized to unionized forms is given by the d. In this instance the difference e. Magnesium between pH and pKa is 0. Thus lidocaine will exist as an equal mixture so c is correct.
Most local anesthetics are weak a see how many different ways they can ask the same bases with pKa ranging from 7. The slightly lower pH of small nerves b.
The greater surface-volume ratio of small nerves The maximum allowable adult dose of mepivacaine is mg. How c. Smaller nerves usually having a higher threshold maximal dosage in an adult patient? Who cares? Small d. Make sense? 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. Which of the following statements are true regarding onset, degree The maximum amount recommended for dental anesthesia over a 4- and duration of action of local anesthetics? The amount is contained in approximately how a. The greater the drug concentration, the faster the onset and the many cartridges?
Local anesthetics block only myelinated nerve fibers at the nodes b. The larger the diameter of the nerve fiber, the faster the onset of d.
Greater than 36 d. The faster the penetrance of the drug, the faster the onset of effect d 0. To give 30 mg, you have to give i. The cartridge is 1. In this 2 ml you would have 1 gm of the local anesthetic. You need to give 30 gms, which would ii if you knew the fact above about small nerves, then this require 30 cartridges. The alternative that meets this answer is question basically becomes a true false type thing, and c is the d.
Don't get tricked by the placement of the decimal point- false statement. You have your pick of rather than 0. A dentist administers 1. How many b. And below the 0. Antibiotics The most frequently asked type of question requires you to be able to a. For example: d. Penicillin V vs. Caveat: our clinic questions guidelines, should they differ from these, are also considered correct answers b.
Which penicillin has the best gram-negative spectrum: ampicillin Required Not Required c. Which drugs from a list are or are not cross-allergenic with Extractions Restorative Procedures penicillin: most usually asked about ones are: cephalosporins Periodontal Surgery Intracanal endodontic treatment and ampicillin are, erythromycin isn't d. Which penicillin is useful against penicillinase-producing bugs Implants Taking Of Impressions such as staphylococcus: dicloxacillin e.
Bacteriostatic agents such as tetracycline limit population growth, but do not kill bugs by interfering with protein synthesis Keflex, 2 g, 4 X mg , PO 1 hr before treatment. Many questions are asked regarding side effects or toxicities of penicillins, tetracyclines, clindamycin, etc: Previous Rheumatic fever without valvular a. What are symptoms seen during allergic reactions to penicillins: endocarditis dysfunction dermatitis, stomatitis, bronchoconstriction and cardiovascular collapse Pulmonary Mitral valve prolapse without shunts valvular regurgitation b.
What agent produces GI upset and pseudomonas colitis: clindamycin c. Which agents are most likely or least likely to cause superinfection: most: broad spectrum agents such as tetracyclines; least: narrow spectrum agents such as penicillin G d. Aplastic anemia is associated with chloramphenicol e. Liver damage or hepatotoxicity is associated with tetracycline f. Potency 4. Questions involving interactions between antibiotics and other drugs: b. Toxicity a. Tetracycline and penicillin cidal-static interaction cancel each c.
Duration of action other out due to opposing mechanisms of action d. Antibacterial spectrum e. Diffusion into the cerebrospinal fluid b. Probenecid alters the rate of renal clearance of penicillin c.
Effectiveness of tetracyclines is reduced by concurrent c again, just asking you to know something about the various ingestion of antacids or dairy products forms of penicillin. Since in most cases you are going to use Pen VK orally, this question is an old one showing its age and probably d.
Broad spectrum antibiotics enhance the action of coumarin not likely to appear anymore on board excams anticoagulants because of the reduction of Vitamin K sources e. Antibiotics such as ampicillin decrease the effectiveness of oral contraceptives due to suppression of normal Gl flora involved in the recycling of active steroids from bile conjugates, Which of the following antibiotics is cross-allergenic with penicillin leading to more rapid excretion of the steroids from the body and should NOT be administered to the penicillin-sensitive patient?
Ampicillin f. Macrolides such as erythromycin inhit the metabolism of drugs b. Erythromycin such as seldane, digoxin, etc. Clindamycin d. Lincomycin e. Tetracycline 5. More and more questions these days are being asked about antivirals and antifungals, so review a ampicillin sort of sounds like penicillin so it must be the answer a. Acyclovir: an antiviral used for various forms of herpes b. Fluconazole or ketoconazole: systemic-acting antifungals useful for treating candidiasis Which of the following antibiotics may be cross-allergenic with penicillin?
Neomycin Frequently asked questions on antibiotics: b. Cephalexin c. Clindamycin 5. For treating most oral infections, penicillin V is preferred to penicillin G d.
Erythromycin because penicillin V e. All of the above a. Is less allergenic b. Is less sensitive to acid degradation b This is a memorization question, with b the correct c.
Has a greater gram-negative spectrum answer. You have to remember that the cephalosporins like d. Has a longer duration of action cephalexin are chemically related to the penicillins. The others e. Is bactericidal, whereas penicillin G is not are not chemically related and thus cross-allergenicity is unlikely b memorization: basically the only difference The sole therapeutic advantage of penicillin V over penicillin G is a.
Greater resistance to penicillinase c. Broader antibacterial spectrum d. More reliable oral absorption e. Slower renal excretion e. None of the above b just slightly reworded version of the above question, but with some different alternatives thrown in. Obviously, if you can c reworded version of the above recognize whther or not a drug is a penicillin or a cephalosporin , and you remember that these are the classes that show cross- 7.
Which of the following penicillins is administered ONLY by deep allergenicity, then you can handle any rewording of this question. Ampicillin b. Dicloxacillin sodium Which of the following groups of antibiotics is related both structurally c. Penicillin G procaine and by mode of action to the penicillins? Penicillin V potassium a. Polymyxins b.
Cycloserines c Answer is c - a , b and d are all used orally. Penicillin G c. Cephalosporins is destroyed by acid in the stomach resulting in variable and d. Chloramphenicols irregular absorption. Penicillin V is acid stable and available for oral use. Penicillin G procaine is typically given intramuscularly c see above in repository form, yielding a tissue depot from which the drug is absorbed over hours. In this form, it cannot be given IV or subcutaneously. Taking a thorough medical history c.
Placing a drop of penicillin on the eye d. Having the patient inhale a penicillin aerosol Which of the following antibiotics should be considered the drug of e. Injecting a small amount of penicillin intravenously choice in the treatment of infection caused by a penicillinase- producing staphylococcus? Once a. Neomycin sensitized, even a small amount can cause an allergic b. Skeletons And Exoskeletons download pdf. Some general theorems of considerable use in the higher parts of mathematics.
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