Pharmaco1 Flashcards
All of the following sites are generally accepted for IM injections EXCEPT one. Which one is the EXCEPTION?
- the buttocks
- the biceps muscle
- the deltoid muscle
- the anterior thigh
the biceps muscle (For young children, the anterior thigh is usually the place to give IM injections), Never go beyond two-thirds of the needle length
Which term refers to a drug that binds to physiological receptors to result in specific cellular effects producing a predictable pharmacologic response?
- pharmacologic agonist
- pharmacologic antagonist
pharmacologic agonist (An antagonist is a drug which binds to the physiologic receptor but does not trigger an effect. When antagonist is present, the agonist drug cannot reach the receptor site to produce an effect)
Which of the following routes of drug administration is generally used for local drug effects? • topical administration • oral ingestion • subcutaneous injection • intravenous injection
topical administration
The most important enzyme systems for the biotransformation of drug molecules are found in: • lungs • liver • brain • kidneys • gastrointestinal tract
liver
implicit in the interaction of a drug with its physiological receptor is that the drug ? create effects, but rather, modulates ? physiological cell functions. • does; extrinsic • does not; extrinsic • does; intrinsic • does not; intrinsic
does not; intrinsic
The safest and easiest route for drug administration is: • oral • IV • rectal • inhalation
oral (abbreviated P.O., but the most unpredictable and least effective)
A major advantage of IV administration of a drug is it allows for ? of the drug. Other advantages of IV administration include ?
- titration
* rapid onset
The majority of drugs penetrate biomembranes by ? through membrane phospholipids. • active transport • facilitated diffusion • filtration • simple diffusion
simple diffusion
A teaspoon can hold what volume of liquid? • 5 milliliters • 10 milliliters • 15 milliliters • 20 milliliters
5 milliliters
Which of the following drugs are known to produce orthostatic hypotension as an adverse reaction. Select all that apply. • levodopa (Larodopa, Dopar) • prazosin (Minipress) • indomethacin (Indocin) • morphine
• levodopa (Larodopa, Dopar) = Antiparkinson drugs
• prazosin (Minipress) = Antihypertensives
• morphine
Indomethacin (Indocin) is an NSAID which may cause GI bleeding, ulcers and possible stomach perforation
Pain that has no organic basis and is fixed upon some portion of the anatomy is referred to as: • intractable pain • referred pain • psychogenic pain • phantom pain
phantom pain (the sensation of pain felt in a limb, although that limb has been amputated. Intractable pain: is pain that is resistant or refractory to ordinary analgesic agents)
Which schedule of drugs would include a drug that is considered to have a strong potential for abuse or addiction, but which has legitimate (قانوني) medical use? • schedule I • schedule II • schedule III • schedule IV • schedule V
schedule II Schedule I (not considered legitimate for medicinal use such as heroin, and marijuana) Schedule III (considered to have less potential for abuse or addiction such as acetaminophen codeine) Schedule IV (have less potential for abuse or addiction such as diazepam or lorazepam) schedule V (a small potential for abuse or addiction such as medications that contain a small amount of Codeine)
A drug with a high LD50 and a low ED50 has a:
• high therapeutic index and is, therefore, very dangerous
• high therapeutic index and is, therefore, relatively safe
• low therapeutic index and is, therefore, very dangerous
• low therapeutic index and is, therefore, relatively safe
high therapeutic index and is, therefore, relatively safe (LD=lethal dose, ED=Effective dose)
The term bioavailability of a drug refers to:
• the movement of a drug into the body tissues over time
• the dissolution of a drug in the GI tract
• the measurement of the rate and amount of therapeutically active drug that reaches the systemic circulation
• the relationship between the physical and chemical properties of a drug and the systemic absorption of the drug
• the amount of drug destroyed by the liver prior to systemic absorption from the GI tract
the measurement of the rate and amount of therapeutically active drug that reaches the systemic circulation (The bioavailability of a drug is affected by:
• The dissolution of a drug in the GI tract
• The destruction of a drug by the liver)
Factors influencing hepatic drug metabolism include which of the following? • microsomal enzyme inhibition • microsomal enzyme induction • plasma protein binding • genetic factors • liver disease • all of the above
all of the above (Most drugs are given at lower doses in hepatically impaired individuals)
The urinary elimination of drugs is controlled by which of the following? Select all that apply.
• glomerular filtration
• microsomal enzyme induction
• renal tubular reabsorption
• active transport through renal tubular cells
- glomerular filtration
- renal tubular reabsorption
- active transport through renal tubular cells
The average time for the onset of drug effect after subcutaneous administration is: • immediate • 5 minutes • 15 minutes • 30 minutes
15 minutes
Oral route 30 minutes, Intramuscular injection 5 minutes
Which term is a compulsive, uncontrollable dependence on a substance, habit or practice to such a degree that cessation causes severe emotional, mental or physiological/ reactions? • habituation • tolerance • addiction • none of the above
addiction
Which of the following refers to the efficacy of a drug?
• the relative concentrations of two or more drugs that produce the same drug effect
• the ability of a drug to produce a desired therapeutic effect regardless of dosage
• the dose of a drug that will kill a patient
the ability of a drug to produce a desired therapeutic effect regardless of dosage (A drug with high efficacy needs to stimulate only a small percentage of receptors)
- ? is a measure of the tightness that a drug binds to the receptor.
- ? is a measure of the ability of a drug once bound to the receptor to generate an effect activating stimulus and producing a change in cellular activity
- Affinity
* Intrinsic activity
? is the relative concentrations of two or more drugs that produce the same drug effect. Drug #1 in a dose of 10 mg produces the same magnitude of response as Drug #2 in a dose of 50 mg. The following is true: Drug #1 is five times as potent as Drug #2.
Potency
When a drug is administered repeatedly, a higher concentration of the drug than is desired may be achieved. The effect of this excessive accumulation is known as: • additive effect • synergistic response • cumulative action • diosyncrasy
cumulative action
When two drugs having similar effects are administered in combination, and the resulting response is the sum of the individual actions of each drug when given alone, then this result is referred to as: • an additive effect • a synergistic response • an antagonistic effect • cumulative action
an additive effect (A synergistic response occurs when the combined action of two drugs having similar pharmacological effects is greater than the sum of the individual actions. Alcohol is synergistic with the Valium family of drugs)
Amphetamines are sympathomimetic amines that cause rapid release of? Select all that apply. • dopamine in the brain • serotonin in the brain • norepinephrine in the brain • acetylcholine in the brain
• dopamine in the brain
• serotonin in the brain
• norepinephrine in the brain
(used in ADHD) The physical effects of amphetamines (e.g., increased blood pressure, bronchodilation) are largely due to the adrenergic effects of norepinepherine.
The psychological effects of amphetamines (e.g., dependence, addiction, euphoria) are largely due to increases in dopamine and serotonin
The following effects result from what type of pharmacological agent:
lower blood pressure
vasodilation
orthostatic hypotension
• an alpha-adrenergic receptor blocker (alpha-blocker)
• a beta-adrenergic receptor blocker (beta-blocker)
an alpha-adrenergic receptor blocker (alpha-blocker)
Alpha1-blockers cause orthostatic hypotension, also known as postural hypotension, adverse effects include tachycardia and dry mouth.
A drug that reduces the actors of the sympathetic nervous system is called a: • sympathomimetic • sympatholytic • sympathetic amine • adrenergic agent
sympatholytic - Also called adrenergic blocking agent or adrenergic receptor blockers, all used to treat hypertension
The following drugs belong to which pharmacologic category? epinephrine (Adrenalin) phenylephrine (Neo-Synephrine) albuterol (Proventil; Ventolin) isoproterenol • adrenergic agonists • adrenergic antagonists
adrenergic agonists The adrenergic receptors are divided into the subtypes of:
• α1 and α2
• β1 and β2
α1 and β2 are most common
Adrenaline (epinephrine) stimulates?
both α1,2 and β1,2 receptors
Ali of the following drugs are indirect-acting adrenergic agonists, EXCEPT one. Which one is the EXCEPTION? • tyramine • amphetamine • epinephrine • methamphetamine • hydroxyamphetamine
epinephrine (direct and indirect-acting adrenergic agonists means direct and indirect-acting sympathomimetic agents)
All of the following drugs are alpha-adrenergic receptor blockers EXCEPT one. Which one is the EXCEPTION?
• doxazosin (Cardura)
• phenoxybenzamine hydrochloride (Dibenzyline)
• phentolamine hydrochloride (Regitine)
• prazosin (Minipress)
• propranolol (Inderal)
• terazosin (Hytrin)
propranolol (Inderal) - it is a beta-blocker
Alpha-blockers are medications that act by ?
inhibiting the action of catecholamines at the alpha receptor site. They act on blood vessels, causing them to relax. Alpha-blockers are commonly used to reduce high blood pressure and to treat an enlarged prostate
The heart is generally considered to have predominantly which type of adrenergic receptors?
β1 receptors
Alpha adrenergic receptors are located on: • vascular smooth muscle • presynaptic nerve terminals • blood platelets • fat cells • neurons in the CNS • all of the above
all of the above
There are two main types of adrenergic receptors:
• Alpha (a) receptors responsible for ?
• Beta (B) receptors — responsible for ?
- most of the excitatory effects such as vaso-constriction and contraction of the uterus and spleen.
- most of the inhibitory effects such as vasodilation and relaxation of respiratory smooth muscle (exception: some beta receptors mediate increases in the force and rate of contractions of the heart)
All of the following neurons are cholinergic EXCEPT one. Which one is the EXCEPTION? • preganglionic sympathetic neurons • preganglionic parasympathetic neurons • postganglionic sympathetic neurons • postganglionic parasympathetic neurons
postganglionic sympathetic neurons (others are cholinergic that secret acetylcholine)
What substance produces all of the following physiologic actions?
constricts arteriolar blood vessels (vasoconstriction)
relaxes bronchial smooth muscle (bronchodikition)
decrease blood volume in nasal tissues
causes a hypertensive response
produces physiological actions opposite to that of histamine
• serotonin
• epinephrine
• dopamine
• acetylcholine
epinephrine
Therapeutic indications for epinephrine:
Epinephrine should be used with caution in patients with high blood pressure and hyperthyroidism
- To alleviate symptoms of an acute asthma attack
- To treat bronchospasm associated with hypotension, as in anaphylaxis
- To treat hypersensitivity reactions
- Agent of choice for anaphylactic reactions (given sublingually or subcutaneously)
- It is added to local anesthetics as a vasoconstrictor to prolong the activity of the local anesthetic solutions, by decreasing the rate of diffusion and absorption from the injection site
- To restore cardiac activity in cardiac arrest
- To relieve congestion of the nose, sinuses, and throat
Epinephrine is the agent of shoke for treating an anaphylactic reaction because of its stimulatory effects on both alpha and beta adrenergic receptors.
All of the following are desirable effects of epinephrine that make it the agent of choice for treating an anaphylactic reaction.
it has vasopressor activity
it has bronchodilator properties
it causes increased cardiac output
it has a rapid onset of action
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
both statements are true
"Epinephrine reversal" is a predictable result of the use of epinephrine in a patient who has received a/an: • beta-blocker • alpha-blocker • adrenergic agonist • all of the above
alpha-blocker (In the absence of blocking agents, epinephrine and norepinephrine both cause the blood pressure to rise. After the alpha-receptors have been blocked by an alpha-blocker, the pressor effect of norepinephrine is reduced or abolished while epinephrine brings about a fall in blood pressure.
This is because epinephrine stimulates both alpha and beta-receptors in the cardiovascular system but norepinephrine only stimulates alpha-receptors (norepinephrine lacks beta2 effects). After blockage of the alpha-receptors, only the beta-receptors can be stimulated)
Of the following, which is a clinically significant adverse reaction due to Metoprolol? • drowsiness • hallucinations • arthralgia • dry mouth
drowsiness - the most common side effects of beta1-blockers (cardioselective) are weakness and drowsiness such as Metoprolol, Atenolol and Propranolol. Atenolol is the least.
If norepinephrine or epinephrine were to stimulate or combine with the alpha receptors in the eye, which response would you expect?
• miosis (contraction of the pupil)
• mydriasis (dilation of the pupil)
• neither of the above; norepinephrine and epinephrine do not stimulate or combine with alpha receptors in the eye
mydriasis (dilation of the pupil)
All of the following drugs are bronchodilators EXCEPT one. Which one is the EXCEPTION? • epinephrine • levalbuterol (Xopenex) • albuterol (Proventil) • salmeterol (Serevent) • metaproterenol (Alupent) • histamine • aminophylline
histamine
? is the drug of choice as a “rescue” agent during an acute asthmatic attack
Albuterol
Pharmaceutic& agents that bring about tissue responses resembling those produced by stimulation of the sympathetic nervous system are called? • cholinomimetic • antiadrenergic • parasympathomimetic • sympathomimetic
sympathomimetic (adrenergic agonists and adrenergic agents are almost always synonymous)
? is the agent of choice for reversing anaphylactic reactions and is used to restore cardiac activity in cardiac arrest, also treat bronchospasm and hypersensitivity reactions
Epinephrine
The medical uses of a drug having adrenergic agonist actions would include which of the following? • reverse an anaphylactic reaction • treat hypertension • prevent angina pectoris • reduce anxiety • all of the above
reverse an anaphylactic reaction (Epinephrine)
A fear reaction activates the sympathetic division of the autonomic nervous system to result in: • miosis • bradycardia • hypertension • increased salivation
hypertension
The amide local anesthetics are metabolized primarily in the: • lungs • plasma • liver • kidney
liver (but Esters are metabolized by the plasma enzyme)
? has the longest duration of action of any dental anesthetic presently available.
Bupivacaine
What are some adverse side effects of local anesthetics?
mostly in Ester type not Amides:
• Effects resulting from toxicity
1) The CNS effects include: restlessness, stimulation, tremors, convulsive seizures followed by CNS depression, slowed respiration and even coma
2) The cardiovascular effects include: bradycardia and reduction of cardiac output
• Effects resulting from allergy
• Hypersensitivities, Asthmatic wheezing syndromes, nasolabial swelling, itching, and oral mucosal swelling
Which statement best describes the mechanism of action of local anesthetics on the nerve axon?
• decreases sodium uptake through sodium channels of the axon
• increases potassium outflow from inside to outside the nerve
• increases the membrane’s permeability to sodium
• increases the excitability of the nerve axon
decreases sodium uptake through sodium channels of the axon (Local anesthetics have no effects on potassium at the nerve axon)
Which form of a local anesthetic can readily penetrate tissue membranes?
• ionized form
• nonionized free-base form
• both ionized and nonionized free-base forms
nonionized free-base form (the higher the pH of the solution or injected tissues, the more free-base will be available.
Once the local anesthetic is injected the buffering capacity and pH of the tissues (normally 7.4) shifts the equilibrium in favor of free-base formation. At physiologic pH of 7.4 approximately 5-20% of the local anesthetic is in free-base form which is enough to penetrate and cause anesthesia. If infection or inflammation is present, the pH of the tissues may be acidic and there is a significant reduction in the concentration of the free-base form. In this situation, the local anesthetic may not be effective)
Which of the following are sedatives often used in the management of anxious pediatric dental patients? Select all that apply. • midazolam • diazepam • hydroxyzine • pentobarbital • secobarbital • chloral hydrate • meperidine
- midazolam
- diazepam
- hydroxyzine
- chloral hydrate
- meperidine
Chloral hydrate as a sedative is rapidly absorbed after oral administration with an onset of ? minutes. Its duration of action is about ?. For use in children, chloral hydrate is available as a ?. The usual dose for a child is ?. Important: Children will often enter a period of ? before becoming sedated.
- 15 to 30
- 4 hours
- 500 mg/5 ml solution
- 50 mg/kg up to a maximum of 1 g
- excitement and irritability
Ester-type local anesthetics are metabolized where? • liver • lungs • plasma • kidneys
plasma (mainly available as topical anesthetics such as benzocaine)
Which of the following is a contraindication or precaution to the use of Prilocaine? • biliary tract disease • type II diabetes • rheumatoid arthritis • hepatic disease
hepatic disease - All amides are metabolized primarily in the liver, and the metabolites are then renally excreted
Prilocaine can produce methemoglobinemia
Prilocaine is about one-half as toxic as Lidocaine, but since methemoglobinemia is a possible reaction, Prilocaine is not used for patients with ?
hypoxic conditions of any kind
Which local anesthetic has no place in the routine practice of dentistry? • articaine • cocaine • lidocaine • bupivacaine • prilocaine
cocaine - causes definite vasoconstriction (all other local anesthetics are vasodilators)
Local anesthetics theoretically should be less effective in acutely inflamed tissue than in normal tissue because in inflamed tissue what happens?
• the pH rises, thus inactivating the anesthetic
• the pH rises, thus decreasing available free base
• the pH decreases, thus decreasing available free base
• the pH remains the same, the extracellular fluid dilutes the anesthetic
the pH decreases, thus decreasing available free base
A dental anesthetic carpule contains 1.8 ml of a 2% solution of lidocaine with 1:100,000 epinephrine. How much lidocaine and epinephrine does the carpule contain?
• 3.6 mg lidocaine and 0.18 mg epinephrine
• 3.6 mg lidocaine and 0.018 mg epinephrine
• 36 mg lidocaine and 0.18 mg epinephrine
• 36 mg lidocaine and 0.018 mg epinephrine
36 mg lidocaine and 0.018 mg epinephrine (1 ml of a 2% solution of lidocaine with 1:100,000 epinephrine contains 20 mg of lidocaine and 0.010 mg of epinephrine)
The maximal recommended adult dose of Lidocaine is 300 mg. How many milliliters of 2% Lidocaine need to be given to reach this level? • 7.5 milliliters • 10 milliliters • 15 milliliters • 20 milliliters
15 milliliters - 8.3 carpules (8 carpules of 2% Lidocaine can be used, 1.8mL each)
The maximum recommended dose of a local anesthetic that can be administered to a child
weight - a dosage of 4.4 mg/kg should not be exceeded (maximum is 300 mg)
Local anesthetics depress which of the following nerve fibers first? • large myelinated fibers • small unmyelinated fibers • small myelinated fibers • large unmyelinated fibers
small unmyelinated fibers (these conduct pain and temperature)
The maximum dose of articaine (Septocaine) that is recommended in one appointment is expressed as mg per kilogram body weight rather than total milligrams. Which dose is the maximum recommended dose for articaine in children and adults? • 7 mg/kg • 100 mg/kg • 1 mg/kg • 300 mg/kg
7 mg/kg
Which is the most frequently utilized route of administration for sedation in pediatric patients? • oral • inhalation • IV • lM
inhalation - nitrous oxide must always be coupled with no less than 30% oxygen, the patient be maintained on oxygen for 5 to 10 minutes after the sedation period
Nitrous oxide has ? on the cardiovascular system and ? skeletal muscle relaxant properties
- minimal depressant effects
* no
Which of the following are true regarding the use of nitrous oxide analgesia? Select all that apply.
• rapid onset of action
• lowers pain threshold
• produces euphoria
• respiratory irritant
• titratable
• slow recovery time
• virtually no adverse effects in absence of hypoxia
• therapeutic sedative for many medically compromised patients
• generally suitable for all ages
- rapid onset of action
- produces euphoria
- titratable
- virtually no adverse effects in absence of hypoxia
- therapeutic sedative for many medically compromised patients
- generally suitable for all ages
The first symptom of nitrous oxide onset is ?
tingling of the hands
When nitrous oxide is used heavily and over an extended period of time, ? will probably become a major problem, as it can cause brain and nerve damage.
vitamin B12 depletion
All the following are considered to be what type of anesthetic? • halothane • enflurane • isoflurane • sevoflurane • desflurane
inhalation anesthetics - Vaporization of these liquids occurs in a vaporizer and delivery to the patient occurs through an anesthesia machine via a nasal mask
Which of the following are reasons why epinephrine is included in dental local anesthetics? Select all that apply.
• it prolongs the duration of local anesthesia
• to increase the local pH and therefore increase the available free base form of the local anesthetic
• to provide local hemostasis
• to delay the absorption of anesthetic into the systemic circulation thus reducing the chance of systemic toxicities
- it prolongs the duration of local anesthesia
- to provide local hemostasis
- to delay the absorption of anesthetic into the systemic circulation thus reducing the chance of systemic toxicities
Which stage of general anesthesia begins with nconsciousness? • stage I • stage II • stage III • stage IV
stage II
stage III = Surgical anesthesia
Stage IV = Medullary paralysis
Nitrous oxide is used as a single agent to produce general anesthesia. Nitrous oxide is used to produce sedation and mild analgesia.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
the first statement is false, the second is true
Which component of a lidocaine local anesthetic solution causes an allergy? • water • bisulfites • lidocaine • epinephrine (vasoconstrictor)
bisulfites - Bisulfites are present in only those commercial preparations containing vasoconstrictor. Preparations without vasoconstrictor such as mepivacaine 3% (Carbocaine 3%) do not contain bisulfites
• Methylparaben is another local anesthetic preservative that may cause an allergic reaction
Of the amide-type local anesthetics, which is/are metabolized in the blood-stream rather than the liver? Select all that apply. • articaine (Septocaine, Zorcaine) • mepivacaine (Carbocaine) • lidocaine (Xylocaine) • prilocaine (Citanest) • bupivacaine (Marcaine)
articaine (Septocaine, Zorcaine) - is an amide-type local anesthetic. However, it is chemically unique in that it has an ester group attached to its molecule which can be acted upon by plasma cholinesterase to render it ineffective
When phentolamine mesylate (Ora Verse) is given after a dental procedure to reverse the local anesthetics effects, approximately how fast is the return to normal nerve sensation compared to the normal time for the anesthetic to wear off?
• 10% decrease in the time for normal sensation to return
• 25% decrease in the time for normal sensation to return
• 50% decrease in the time for normal sensation to return
• 80% decrease in the time for normal sensation to return
50% decrease in the time for normal sensation to return - lidocaine with epinephrine normally takes about 180 minutes to wear off then it takes 90 minutes
OraVerse (solution for injection/dental cartridge) is administered as ?
a submucosal injection
Phentolaine mesylate (Ora Verse) is a drug used to reverse soft tissue anesthesia and the associated functional deficits resulting from a local dental anesthetic containing a vasoconstrictor. Which statement best describes its mechanism of action?
• prevents the influx of sodium into the neuron by blocking neuronal channels
• causes vasodilation and increased blood flow in injection area
• prevents the efflux of sodium out of the neuron
• causes vasoconstriction and decreased blood flow in injection area
causes vasodilation and increased blood flow in injection area - is an alpha1-adrenergic receptor blocker
All of the following drugs are benzodiazepines EXCEPT one. Which one is the EXCEPTION? • chlordiazepoxide (Librium) • diazepam (Valium) • flurazepam (Da'mane) • midazolam (Versed) • aiprazolam (Xanax) • zolpidem (Ambien) • triazolam (Halcion) • oxazepam (Serax) • temazepam (Restoril) • clorazepate (Tranxene)
zolpidem (Ambien)
The benzodiazepines are used as oral preparations to ?, and intravenously to cause ? for outpatient surgery
- alleviate anxiety and to induce sleep (tranquilizer)
* conscious-sedation
The most common adverse effects associated with the benzodiazepines include all of the following EXCEPT one. Which one is the EXCEPTION?
• CNS depression (drowsiness and sedation)
• GI disturbances (nausea, vomiting and diarrhea)
• confusion
• respiratory depression
• disorientation
• ataxia
respiratory depression (The benzodiazepines have clinically useful antianxiety, sedative-hypnotic, anticonvulsant and skeletal muscle relaxant properties)
? are considered to be major tranquilizers and ? are considered to be minor tranquilizers
- Antipsychotic agents
* antianxiety agents (benzodiazepines)
Buspirone (BuSpar) is a partial agonist at a specific:
• GABA (gamma-aminobutyric acid) receptor
• norepinephrine receptor
• dopamine receptor
• serotonin receptor
serotonin receptor - is an orally administered antianxiety agent with a short half-life (24 hours). It is not chemically related to the benzodiazepines
Buspirone has shown no potential for causing addiction. Examples include ?
Zolpidem (Ambien)
Which of the following side effects are most common with the use of Diazepam (Valium)? • rash, itch • mouth, throat ulcers • drowsiness, fatigue • difficulty with urination
drowsiness, fatigue
Diazepam is prescribed in the treatment of ?. Contraindication to use ?
- anxiety, nervous tension, muscle spasm, and as an anticonvulsant
- Acute narrow angle glaucoma
Diazepam can be locally irritating to tissue and may produce ? when given intravenously.
local thrombophlebitis
The barbiturates Phenobarbital (Luminal), Mephobarbital (Mebaral), and Primidone (Mysoline) are classified as what type of barbiturate? • ultrashort-acting • short-acting • intermediate-acting • long-acting
long-acting 6-10 hours (The length of action can be related to the lipid solubility with the ultrashort being the most lipid soluble and the long acting having the least lipid solubility. They are metabolized in the liver)
The brief duration of general anesthetic action of an ultra-short-acting barbiturate is due to what factor?
• rapid rate of metabolism in the liver
• low lipid solubility, resulting in a minimal concentration in the brain
• high degree of binding to plasma proteins
• rapid rate of redistribution from the brain to peripheral tissues
• slow rate of excretion by the kidneys
rapid rate of redistribution from the brain to peripheral tissues (Because of their high lipid solubility, these agents will rapidly leave the brain for other tissues; thus the patient wakes up within a few minutes of administration)
Which of the following statements concerning barbiturates are true? Select all that apply.
• barbiturates may increase the half-lives of drugs metabolized by the liver
• barbiturates depress neuronal activity by increasing membrane ion conductance (primarily chloride), reducing glutamate-induced depolarizations and potentiating the inhibitory effects of GABA
• compared with benzodiazepines, the barbiturates exhibit a steeper dose-response relationship
• barbiturates may precipitate acute porphyria in susceptible patients
• barbiturates depress neuronal activity by increasing membrane ion conductance (primarily chloride), reducing glutamate-induced depolarizations and potentiating the inhibitory effects of GABA
• compared with benzodiazepines, the barbiturates exhibit a steeper dose-response relationship
• barbiturates may precipitate acute porphyria in susceptible patients
(arbiturates may decrease the half-lives of drugs metabolized by the liver)
The most widely used tricyclic antidepressant (TCA) drug is: • imipramine (Tofranil) • amitriptyline (Elavil) • desipramine (Norpramin) • nortriptyline (Pamelor) • doxepin (Sinequan)
amitriptyline (Elavil) - inhibit the neuronal re-uptake of norepinephrine and serotonin in the brain
among antidepressant drug Amitriptyline displays the greatest ? effect
anticholinergics effects (especially xerostomia)
Which drug is the current drug of choice for the treatment of the manic phase of bipolar disorder (or manic-depressive syndrome)? • phenobarbital • imipramine • lithium • haloperidol
lithium
Approximately 25% of patients who suffer from mania do not respond to lithium. ? may be effective in some refractory cases
Carbamazepine (an anticonvulsant) and valproic acid (also an anticonvulsant)
Monoamine Oxidase (MAO) inhibitors are often used as third-line agents in cases of refractory and atypical depression. Which of the following drugs are MAO inhibitors? • citalopram (Celexa) • fluoxetine (Prozac) • tranylcypromine (Parnate) • phenelzine (Nardil) • doxepin (Sinequan) • imipramine (Tofranil)
• tranylcypromine (Parnate)
• phenelzine (Nardil)
the increased level of monoamines (epinephrine, norepinephrine, dopamine, and serotonin) in the brain is responsible for the antidepressant effect of the MAO inhibitors
Local anesthetics ? in patients who are taking MAO inhibitors
containing epinephrine are generally contraindicated
The vasoconstrictor epinephrine in local anesthetic injections must be used cautiously in patients taking all of the following antidepressant drugs EXCEPT one in order to avoid transient and significant increases in blood pressure. Which one is the EXCEPTION?
• tricyclic antidepressants (i.e., Elavil)
• selective serotonin reuptake inhibitors (i.e., Prozac and Paxil)
• serotonin and norepinephrine reuptake inhibitors (i.e., Effexor and Cyrnbalta)
selective serotonin reuptake inhibitors (i.e., Prozac and Paxil)
Which TWO groups of antidepressant drugs has the highest incidence of dry mouth (xerostomia)?
• tricyclic antidepressants (i.e., Elavil)
• selective serotonin reuptake inhibitors (i.e., Prozac and Paxil)
• serotonin and norepinephrine reuptake inhibitors (i.e., Effexor and Cymbalta)
• monoamine oxidase inhibitors (i.e., Nardil)
• tricyclic antidepressants (i.e., Elavil)
• serotonin and norepinephrine reuptake inhibitors (i.e., Effexor and Cymbalta)
(must be treated palliatively with artificial salivary substitutes)
All of the following are H1-receptor blockers EXCEPT one. Which one is the EXCEPTION?
• diphenhydramine HCL (Benadryl)
• chlorpheniramine maleate (Chlor-Trimeton)
• cimetidine (Tagamet)
• loratadine (Claritin)
• desloratadine (Clarinex)
cimetidine (Tagamet) - Cimetidine is an antihistamine H2-receptor blocker.
Antihistamines are antagonizing agents that compete for receptor sites with natural histamine, which is stored preformed in cytoplasmic granules of ?. It is released in response to ?
- tissue mast cells and blood basophils
* IgE-mediated (immediate) allergic reactions
All of the H1-receptor blockers ? the release of histamine but rather compete with free histamine for binding at H1-receptor sites
do not prevent
For which of the following conditions can Ranitidine be used? • prostatitis • GERD (heartburn) • toxic-shock syndrome • renal failure
GERD (heartburn) - stands for gastroesophageal reflux disease
H2-receptor antagonists compete with histamine only in ?. Inhibition of histamine at the parietal cell interferes with one of several mediators for signaling the parietal cell to secrete acid.
H2-blockers are all reversible competitive antagonists of the actions of histamine on H2-receptors. These agents are used to treat ?
- the GI tract
- acid-peptic disease, especially duodenal ulcers and occasionally gastric peptic ulcers. These drugs are also used to treat Zollinger-Ellison syndrome (a hypersecretory disease) and gastroesophageal reflux disease (GERD).
