Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Tufts Pharm NBDE II > Pharm NBDE II > Flashcards

Pharm NBDE II Flashcards

1
Q

what local anesthetics are esters

A

procaine, tetracaine, cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where are amides metabolized?

A

liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

where are esters metabolized?

A

MAINLY esterase’s in the plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which class of drugs has the most consistency in structure?

A

local anesthetics
they differ only in their immediate chains (ester or amide) that connects the aromatic group to the tertiary amino terminus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what causes methemoglobinemia?

A

prilocaine and acetominophen at high doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does high systemic levels of local anesthetic lead to?

A

cardiovascular collapse due to DIRECT myocardial depression and hypotensive shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how do local anesthetics work?

A

prevent the generation of nerve impulses by interfering with sodium transport into the neuron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what form of LA can penetrate tissue membrane?

A

non-ionized, free-base form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

the duration of lidocaine is increased in the presence of what drug? and why?

A

propranolol
propranolol is a beta blower, slows heart, slows blood delivery to liver so that lido is not metabolized and remains in systemic circulation for longer also they compete for the same enzyme site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

do esters or amides have longer half lives?

A

amides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the most probable cause of a serious severe LA toxic reaction?

A

excessive blood levels due to intravascular injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

initially high levels of LA lead to what?

A

depression of inhibitory neurons on the CNS ** aka cns stimulation (which can lead to convulsion) –> higher levels depress inhibitory and excitatory neurons which leads to overall cans depression which can lead to respiratory depression and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what disease would make the patient most sensitive to epinephrine in LA?

A

Graves- hyperthyroidism results in high levels of circulating thyroid hormone which causes a hyper metabolic state and increases sympathetic activity which would lead to a hypertensive crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the only anesthetic that predictably produces vasoconstriction?

A

cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

given the pKa of a drug, if the pH of body tissue is less (more acidic from inflammation), which form of the drug will predominate?

A

the ionized (charged) form of the drug. This makes it harder for the drug to penetrate the membrane.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what form of LA blocks nerve conduction?

A

positively charged - LA penetrate as unionized into the neuron and then re-equibrilate back to charged and uncharged inside to block conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the AHA limits (in mg) of epi in cardiovascular disease vs. regular patients

A

0.04 mg for cardiovascular disease vs. 0.2 mg in healthy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why is penicillin G injected rather than take orally?

A

sensitive to acid degradation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

which penicillin has the best gram negative spectrum?

A

ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

hat drugs are cross-reactive with penicillin?

A

cephalosporin and ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

which penicillin is useful against penicillanse-producing bugs like staph?

A

dicloxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what Ab is good for pseudomonas infections?

A

carbenicillin because its extended spectrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is given prophylactically for dental procedures to prevent bacterial endocarditis?

A

2g of amoxicillin - clindamycin if allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how do bactericidal agents work?

A

kill bacteria through inhibiting rapidly growing cell wall synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
how do bacteriostatic agents work?
interfere with protein synthesis on bacterial ribosomes - limit growth
26
how do antifungals work?
bing ergosterol on fungal cell walls to weaken the the wall
27
how to sulfonamides work?
sulfonamide is a bacteristatic ab that competes with PABA in folic acid synthesis, thus resulting in a folic acid deficiency
28
what symptoms are associated with penicillins?
dermatitis, stomatitis, bronchoconstriction and cardiovascular collapse
29
what ab produces upset stomach and pseudomonas colitis
clindamycin
30
what type of ab is most likely to cause superinfection? least likely?
broad spec most likely and narrow spec least likely
31
what side effect is associated with the ab chloramphenicol?
aplatic anemia
32
what side effect is associated with the ab tetracycline?
liver damage/hepatoxocicty and photosensitivity
33
what side effect is associated with the ab erythromycin?
allergic cholestatic hepatitis
34
what ab interactions cancel each other out
static/cidal
35
what alters the rate of renal clearance of penicillin?
probenacid
36
what reduces the effectiveness of tetracycline?
antacids or dairy products
37
what type of ab enhances the action of coumarin anticoag and why?
broad spec because they reduce vitamin K sources
38
what ab decreases the effectiveness of oral contraceptives?
ampicillin (maybe others?) due to suppression of normal GI flora that recycles steroids --> leads to excretion of steroids from the body
39
what type of ab inhibit the metabolism of drugs like seldane, digoxin?
macrolides like erythromycin
40
what is the antiviral used for herpes?
acyclovir
41
what antifungals treat candidasis?
fluconazole or ketoconazole - systemic
42
what ab achieves higher concentration in the bone than serum?
clindamycin
43
what ab achieves higher concentration in the gingival fluid than serum?
tetracycline
44
what side effect is associated with the ab streptomycin?
8th cranial nerve damage, affecting balance and hearing
45
what side effect is associated with the anti fungal amphotericin B
nephrotoxicity and hypokalemia
46
what are the 6 different classes of drugs that can act as hypertensive drugs?
diuretics, beta blockers, alpha 1 blockers, centralyl acting adrenergic drugs, neuronal blockers and ACE
47
what drugs can treat angina?
nitrogylcerin, propranolol, ca channel blockers
48
what drugs can treat arrhythmias?
lidocaine, phenytoin, quinidine, verapramil, digitalis, propranolol
49
what does phenytoin do for arrhythmias?
reverses the effect of digitalis
50
what drugs can treat CHF?
glycosides like digitalis, digoxin and ACE inhibitors
51
how does quinine work for antiarrythmatic drugs?
increases refractory period of the cardiac muscles
52
how does lidocaine help antiarrythmatics?
decreases cardiac excitability
53
how does digitalis help antiarrythmatics?
decrease the a-v conduction
54
angina arises from what?
insufficient oxygen to meet the demand of the myocardium
55
how does nitroglycerin help with angina attacks?
increases o2 supply to the heart by a direct vasodilatory action on the smooth mm. in the coronary arteries
56
how does propranolol help with anginas attacks?
reduces the o2 demand by preventing chronotropic responses to endogenous epi, emotions and exercise
57
how do calcium channel blockers help angina attacks?
decreaes o2 demands by reducing after load by reducing peripheral resistance via vasodilation
58
how do ace inhibitors work?
ace inhibitors like lisinopril and catopril block the enzyme which convert angiotensin I to II . Angiotensin II is a potent vasocontrictor
59
how does methyldopa act as an antihypertensive?
by acting centrally as a false neurotransmitter stimulating alpha receptors to reduce sympathetic outflow resulting in vasodilation
60
how does clonidine work as a antihypertensive drug?
selective agonist stimualtes alpha 2 receptors in the CNS to reduce sympathetic outflow outflow to peripheral vessels resulting in vasodilation
61
how does propranolol work as an antihypertensive drug?
nonselective beta blocker that reduces cardiac output and inhibits renin secretion
62
how does metoprolol work as an antihypertensive drug?
selective B 1 blocke, reduces cardiac output
63
how do diuretics work as antihypertensive drugs?
decrease absorption of sodium, resulting in fluid loss and blood volume reduction. this decreases the work that the heart has to do
64
types of diuretics
thiazides (chlorothiazide) high-ceiling/loop (furosemide) potassium sparing (spironalactone)
65
how to cardiac glycosides work?
postive inotropic effect - increase the force of contraction of the heart by inhibiting the sodium, potassium aptase so more calcium can come in the cell
66
what compensatory changes of CHF does digitalis help?
increased heart size, rate and edema
67
what side effect is associated with high-ceiling diuretics?
ototoxicity with deafness
68
what is the mechanism of the analgesic effects of NSAIDS?
inhibits the synthesis of prostglandins
69
what is the mechanism of the antipyretic effects of NSAIDs?
inhibits P synthesis in the hypothalamic temperature regulation center
70
what is the mechanism of the bleeding time in NSAIDs?
inhibits synthesis of thromboxane A2 preventing platelet synthesis
71
what are the therapeutic effects of aspirin?
pain relief, antipyretic effects, anti rheumatic and anti-inflammatory
72
what are the adverse side effects of aspirin?
occult bleeding from GI tract, tinnitus, nausea and vommiting A/B disturbance or metabolic acidosis, decreased tubular reabsorption or uric acid, delirium and hypeventillation
73
what are the differences in acetimenophen and aspirin?
no anti-inflamm, hepatoxocity and does not cause GI upsetness
74
what is the difference in anti-infamy (like prednisone) and aspirin
since prednisone is a steroid they do not act by PG inhibition
75
what is the difference in aspirin and ibuprofen?
ibuprofen does not irritate GI
76
which drug should be avoided in feverish children? why?
aspirin due to reyes syndrome | tylenol is the drug of choice
77
where is the temperature regulation center?
hypothalamus
78
which analgesic has the longest half life?
diflunisal
79
which drug is a mixed agonist-antagonist?
pentazocine and nalbuphine
80
what is used to treat a morphine OD?
naloxone
81
what is used to detox morphine addicts?
methadone
82
side effects of morphine
respiratory depression, euphoria, sedation, dysphoria, analgesia, constipation and urinary retention
83
an overdose of opiates causes what
coma, miosis and respiratory depression
84
what is opiates mechanism of respiratory depression?
loss of sensitivity to the medullary respiratory center to CO2
85
what is demerol?
merperidine, and opiate (analgesiac)
86
what surpasses the cough reflex best?
opiods - codeine
87
how does atropine induce tachycardia?
blocks vagal reflex control of heart rate
88
what are the 3 competitive muscarinic receptor blockers that can be used to control saliva?
atropine, scopolamine and proantheline
89
what are antichlinesterase drugs?
physostigmine and neostigmine
90
which anti cholinesterase acts only on the periphery?
neostigmine
91
what drugs are direct acting cholinergic agonists?
pilocarpine, methacholine
92
what do organophosphates and insecticides do?
irreversibly inhibit cholinesterase - potentiate cholinergic effect
93
what is used in organophosphate toxicity?
parlidoxime - enzyme regenerator
94
what is succinylcholine used to prevent?
laryngospasms
95
what does succinylcholine do? how does it work?
depolarizing neuromuscular junction blocker
96
what is d-turbocurarine?
a non-depolarizing neuromuscular junction blocker
97
what are mecamylamine and hexamethonium?
ganglionic blockers that produce orthostatic hypotension
98
cholinergic stimulation effects
SLUD salivation, lacrimation, urination, defecation plus reduction in intraocular pressure, miosis, bronchoconstriciton, bradycardia, muscle weakness
99
what type of anticholinergics have CNS effects and what are they
tertiary amines (like atropine) restlessness, headache, excitement, hallucinations and delirium
100
how do alpha and beta blockers like prazosin and propranolol work?
by competitive inhibition of adrenergic receptors
101
how does reserpine work?
depletes NE by inhibiting re-uptake
102
how does guantheidine work?
inhibits release of catecholaines
103
how do amphetamine, tyramine and ephedrine work?
adrenergic drugs that work indirectly by stimulating the release of stored NE
104
How do MAOI work?
block enzymatic degradation of adrenergic
105
what is epinephrine reversal?
in the presence of an alpha blocker like parson (or chlorpromazine) epi will cause a decrease in BP rather than an increase because beta mediated vasodilation will predominate
106
what is vagal reflex?
administering a pressor dose of NE may result in a decrease of HR due to activation of baroreceptors that stimulate vagal reflex to reduce heart rate
107
what medication is given to parkinsons patients?
carbidopa and levadopa (carbidopa blocks decarboxylase activity in the periphery to allow the levodopa to pass through BBB)
108
how to measure therapeutic index
lethal dose/effective dose | higher index, safer the drug
109
what is the mechanism of action of benzos?
modulate the activity of the neurotransmitter GABA
110
what are the advantages of benz over barb?
less addiction potential, less profound CNS depression, larger therapeutic index, less respiratory depression
111
what can diazepam cause with IV injection?
irritation like thrombophlebitis due to the glycol propelene that dissolves the fluid
112
are barbitutes analgesics?
NO - they actually might worsen the pain
113
how is thiopental (a barbiturate) terminated?
rapid redistribution from the brain
114
how would a barb overdose kill you?
resp depression
115
what condition are barbs contraindicated in?
patients with porphyria - they enhance porphyria synthesis and aggravate the disease
116
why are barbs problematic as anesthetics?
induce salivation and bronchial secretion - thus give an anticholinergic before
117
example of anti psych drug
phenothiazines like chlorpromazine
118
what is the mechanism of action of anti psych drugs
block dopamine
119
what are the major side effects of anti psych drugs?
anticholinergic and extrapyramidal - results in tradeoff dyskinesia
120
what is clozapine?
2nd generation anti psych blocks dopamine and serotonin receptors *no tardidive dysplasia
121
what are the most commonly used antidepressant med?
TCA
122
what is the drug of choice for a manic depressive?
lithium
123
what influences the rate of induction of GA?
solubility more soluble, more drub needs to be given to reach critical tension in the brain onset of GA is inversely proportional to solubility of anesthetic in the blood
124
what GA is associated with hepatotoxicity?
halothane
125
what are the stages of GA
1- analgesia 2- delirium 3- surgical anesthesia 4- medullary paralysis
126
what are antihistamines H1 useful for?
treating derm manifestations of an allergic response pre-op medication for sedation, antiemetic properties and anticholinergic effects for controlling parkinson symptoms - cholinergic and dopamine pathways interact in the brain so stopping the cholinergic pathways allows the dopamine to be uninterrupted
127
what are antihistamine H2 useful for?
reduce gastric acid secretion (OTC heartburn med) - cimetidine
128
what treats trigemminal neuralgia?
phenytoin and carbamazepine
129
what is the best anticonvulsant?
diazepam (valium)
130
what are the enteral routes of admin?
oral, sublingual, rectal
131
how do you know if a patient is adequately sedated?
verills sign

Tufts Pharm NBDE II (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions