Pharmaco2 Flashcards by B -

Diphenhydramine HCL (Benadryl), chlorpheniramine maleate (Chlor-Trimeton), loratadine (Claritin), and desloratadine (Clarinex) are antihistamines at which histamine receptor site listed below?
• H1-receptor site
• H2-receptor site

H1-receptor site

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Antibiotic regimens for patients with prosthetic implants include all of the following drugs as standard therapy of first choice in patients not allergic to penicillin EXCEPT one. Which one is the EXCEPTION?
• cephalexin
• cephradine
•  amoxicillin
• tetracycline

tetracycline

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Dental Patients with Total Joint Replacement standard prophylaxis ?

Cefazolin (Ancef) 1 g or ampicillin 2 g intramuscularly or intravenously 1 hour prior to the dental procedure

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Which of the following antibiotics exerts its mode of action on the bacterial cell wall? Select all that apply.
• penicillin
• cephalexin
• clindamycin
• tetracycline
• erythromycin
• vancomycin
• chloramphenicol
• sulfonamides
• streptomycin

clindamycin
tetracycline
erythromycin
chloramphenicol
streptomycin

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Mefloquine (Lariam) belongs to a class of drugs which is useful in treating which of the following conditions?
• malaria
• AIDS
• hepatitis
• cancer
• chlamydia

malaria

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Which of the following antibiotics are considered broad-spectrum antibiotics? Select all that apply.
• penicillin VK
• cefaclor (Ceclor)
• ticarcillin
• penicillin G
• piperacillin
• cephalexin (Keflex)

cefaclor (Ceclor)
ticarcillin
piperacillin

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Tetracyclines are the drugs of first choice in the treatment of all of the following EXCEPT one. Which one is the EXCEPTION?
• mycoplasma pneumonia
• chlamydia infections
• rickettsial infections
• staphylococcal infections

staphylococcal infections

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Azithromycin (Z-Pak, Zithromax) is an antibiotic of the:
• macrolide class of antibiotics
• cephalosporin class of antibiotics
• quinolone class of antibiotics
• glycopeptide class of antibiotics

macrolide class of antibiotics (similar to erythromycin, but possess greater intrinsic activity against H. influenzae and Helicobacter pylon)

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Erythromycin is well known to cause adverse:
• CNS effects
• GI effects
• hematologic effects
• renal effects

GI effects - Since they are destroyed by stomach acid, erythromycins are usually enteric coated. This is a term designating a special coating applied to tablets or capsules which prevents their release and absorption of their contents until they reach the intestines.

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Erythromycin is metabolized in ?, excretion is mainly via ?

the liver

* the bile

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The most commonly used aminoglycoside is:
• neomycin
• streptomycin
• tobramycin
• gentamicin

gentamicin - against aerobic, gram-negative bacteria - used in the treatment of severe infections of the abdomen and urinary tract

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Sulfonamides (also known as sulfa drugs) are structurally similar to:
• penicillins
• erythromycins
• acetylsalicyclic acid (Aspirin)
• para-aminobenzoic acid (PABA)

para-aminobenzoic acid (PABA)

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the drug of choice for many urinary tract infections?

Bactrim (is a Sulfonamides)

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Which antibiotic is not only effective against most staphylococci, aerobic and anaerobic streptococci, but is most effective in treating infections due to bacteroides species?
• penicillin VK
• erythromycin
• tetracycline
• cephalexin (Keflex)
• clindamycin (Cleocin)
• vancomycin

clindamycin (Cleocin)

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In dentistry, clindamycin is an alternate antibiotic in the following situations:?

When amoxicillin cannot be used for the standard regimen for prevention of bacterial endocarditis in patients undergoing dental procedures
For treatment of common oral-facial infections caused by aerobic gram-positive cocci and susceptible anaerobes
For prophylaxis for dental patients with total joint replacement

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Which antibiotic may cause bone marrow disturbances (aplastic anemia) and has limited use due to the side effects?
• penicillin
• tetracycline
• chloramphenicol
• doxycycline

chloramphenicol

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The risk of aplastic anemia does not contraindicate the use of chloramphenicol in situations in which it is necessary such as

Typhoid Fever, Bacterial Meningitis, Anaerobic Infections, Rickettsial Diseases, and Brucellosis

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Nitazoxanide (Alinia) is an oral antiprotozoal agent used to treat which of the following conditions?
• leprosy
• malaria
• AIDS
• diarrhea caused by Clostridium difficile
• diarrhea caused by Giardia lamblia

diarrhea caused by Giardia lamblia

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Metronidazole contraindication ?

in pregnancy and use of alcohol

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All of the following drugs are useful for treating which disease?
isoniazid - streptomycin - rifampin - ethambutol - pyrazinamide
• malaria
• AIDS
• rheumatoid arthritis
• tuberculosis

tuberculosis

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The antiviral agent penciclovir (Denavir) is active against which virus?
• herpes zoster
• genital herpes
• herpes simplex type 1 (HSV-1)
• papilloma virus

herpes simplex type 1 (HSV-1) - a cream formulation indicated for the treatment of recurrent herpes labialis (cold sores) in adults

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The following drugs are used to treat which viral disease?
didanosine - zidovudine - ritonavir - indinavir - delavirdine
• herpes
• mumps
• AIDS
• chicken pox

AIDS

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Which of the following is classified as an antifungal agent?
• bacitracin
• amphotericin-B
• polymyxin-B
• neomycin

amphotericin-B

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The drug of choice for treating Candidiasis is:
• penicillin
• erythromycin
• nystatin
• chioramphenicol

nystatin - “swish and swallow”

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``` Which of the following is known as the oiriginal penicillin? • penicillin V • penicillin G • ampicillin • amoxicillin ```

penicillin G

Penicillins are bactericidal; they inhibit ?

cell wall synthesis

? increases blood levels of natural penicillins and may be given concurrently for this purpose.

Probenecid (is a drug used to treat gout)

``` Which penicillin is degraded in stomach acid and is usually given parenterally (by injection)? • penicillin VK • amoxicillin • penicillin G • ampicillin ```

penicillin G

``` The antibiotic of choice for standard prophylactic regimen of antibiotic coverage for the prevention of bacterial endocarditis is: • penicillin VK • tetracycline • erythromycin • amoxicillin ```

amoxicillin

``` Of the drugs listed which is the most preferable antibiotic for the treatment of non-penicillinase-producing gram-positive staphylococcal infections? • tetracycline • clindamycin • ampicillin • cefaclor (Celcor) • penicillin VK ```

penicillin VK

``` Which of the following penicillin antibiotics have the widest spectrum of antibacterial activity? Select all that apply. • penicillin VK • dicloxacillin • ticarcillin • amoxicillin • piperacillin • nafcillin ```

* ticarcillin | * piperacillin

``` Which of the following has a clinically significant drug interaction with Amoxicillin? • triazolam (Halcion) • methotrexate • calcitrol • candesartan ```

methotrexate (used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions) - Amoxicillin in large doses inhibits the renal tubular secretion of methotrexate, thereby causing higher, prolonged serum levels of methotrexate

``` What do all of the following penicillin antibiotics have in common? amoxicillin and clavulanate potassium (Augmentin) ampicillin and sulbactam (Unasyn) cloxacillin dicloxacillin • broad spectrum • penicillinase resistant • active against viruses • they are all aminopenicillins ```

penicillinase resistant

``` Beta-lactamases (enzymes) include which of the following? Select all that apply. • cephalosporinase • penicillinase • ATPase • protein kinase ```

• cephalosporinase • penicillinase Beta-lactamases are enzymes produced and secreted by a wide range of gram-positive and gram-negative bacteria as a defense weapon against cephalosporin and penicillin antibiotics

By combining ? with a penicillin, the beta-lactamase enzyme is permanently inhibited by the acid, and the antibacterial activity of the penicillin is maintained. One popular commercial preparation is ?, which contains amoxicillin and ?

* clavulanic acid * Augmentin * clavulanate potassium

``` Which antibiotic is used cautiously due to its side effects (pseudomembranous colitis, severe GI upset)? • azithromycin (Zithromax; Z-Pak) • clindamycin • penicillin VK • cephalexin (Keflex) ```

clindamycin

``` Which antibiotic/antimicrobial is associated with the highest incidence of drug allergy? • ciprofloxacin (Cipro) • penicillin VK • clindamycin • metronidazole (Flagyl) ```

penicillin VK

? is the most common sign of an allergy to penicillin.

A rash

All of the following are common adverse effects caused by the use of tetracyclines EXCEPT one. Which one is the EXCEPTION? • photosensitivity • nausea • bone marrow disturbances • diarrhea • discoloration of teeth and enamel hypoplasia in young children

bone marrow disturbances (Another common adverse effect is the occurrence of opportunistic (superinfection) infections caused by Candida albicans)

tetracyclines in dentistry ?

as alternatives to penicillin in patients with ANUG (acute necrotizing ulcerative gingivitis) who require antibiotics.

``` Which of the following are referred to as aminopenicillins? Select all that apply. • penicillin VK • ampicillin (Polycillin) • cloxacillin (Cloxapen) • dicloxacillin • nafcillin • amoxicillin (Amoxil) • oxacillin ```

* ampicillin (Polycillin) | * amoxicillin (Amoxil)

Cephalosporins have which of the following modes of action? • affect bacterial cell wall • affect bacterial DNA • affect bacterial protein synthesis • interfere with bacterial metabolic pathways

affect bacterial cell wall (same as Penicillins)

Which of the following is the mode of action of the Tetracyclines? • bacterial cell wall destruction • prevent protein synthesis in the bacterial cell • interfere with nucleic acid synthesis • cause mutations within bacterial DNA

prevent protein synthesis in the bacterial cell

CA++, Mg++, Fe++, and Al+++ ions form ? and thus prevent their absorption. This is why tetracyclines should not be given with milk and dairy products, iron-containing vitamins, mineral supplements containing these irons, or antacids

chelation products with the tetracyclines

The macrolides include?

erythromycin, clarithromycin, and azithromycin

``` Erythromycin is a ? antibiotic which binds to the ? ribosomal subunit of susceptible bacteria. The result is the inhibition of protein synthesis. • bactericidal; 30s • bactericidal; 50s • bacteriostatic; 30s • bacteriostatic; 50s ```

bacteriostatic; 50s

``` Which antimicrobial below is associated with photosensitivity? • tetracycline • penicillin VK • metronidazole (Flagyl) • clindamycin ```

tetracycline - The photosensitivity reaction caused by the tetracycline family of antibiotics results in the appearance of red rashes or blotches over the skin in the presence of sunlight

``` Which of the following antivirals are classified as neuraminidase inhibitors? Select all that apply. • acyclovir (Zovirax) • oseltamivir (Tamiflu) • amantadine (Symmetre!) • rimantadine (Flumadine) • zanamivir (Relenza) ```

• oseltamivir (Tamiflu) • zanamivir (Relenza) both used to treat acute illness due to influenza (A or B) infection. Acyclovir (Zovirax) is an antiviral that inhibits DNA synthesis rather than neuraminidase enzymes.

``` Which drug can be used in the pregnant patient? • tetracycline • doxycycline (Vibramycin) • minocycline (Minocin) • penicillin VK ```

penicillin VK Tetracycline and all members of the tetracycline family are contraindicated in children up to 8 years old and in pregnant women

A patient was given penicillin 15 minutes ago and develops the following signs and symptoms. What kind of reaction is this patient having? • laryngeal edema • urticaria (welts that itch) • severe hypotension • GI disturbances • bronchoconstriction (airway constriction) • shock

anaphylactic reaction (anaphylactic shock) - This reaction most commonly occurs with parenteral administration of penicillin.

``` Antipsychotic drugs include all of the following EXCEPT one. Which one is the EXCEPTION? • the phenothiazines • the thioxanthenes • the butyrophenones • the benzodiazepines ```

the benzodiazepines | the most widely used group of antipsychotic agents used in medicine are the phenothiazines

antipsychotic drugs are thought to work by blocking ? in the hypothalamus

postsynaptic dopamine receptors

Which statement describes the extrapyramidal syndrome (EPS) caused by the phenothiazine-type antipsychotics? • orthostatic hypotension • sedation • headache • dry mouth • muscle spasms of the oral-facial region

muscle spasms of the oral-facial region

Clozapine (antipsychotic drug) is specific for ? and not for striated (muscle) receptors, which explains the low incidence of EPS and TD

limbic receptors

Which of the following are symptoms of acute aspirin toxicity? Select all that apply. • tinnitus • respiratory alkalosis • vertigo (subtype of dizziness in which a patient inappropriately experiences the perception of motion (usually a spinning motion) due to dysfunction of the vestibular system) • muscle twitching • nausea and vomiting • myocardial infarction

* tinnitus * respiratory alkalosis * vertigo * nausea and vomiting

Aspirin inactivates the enzyme known as ?

cyclooxygenase resulting in the inhibition of prostaglandin synthesis

Aspirin is ? and can reduce blood clotting to prolong bleeding

an irreversible platelet inhibitor

Contraindications to the use of aspirin:

* Bleeding disorders (aspirin will increase bleeding time) * Do not use in children with viral infections (i.e., influenza or chickenpox) with or without fever due to a potential association with Reye's syndrome (this syndrome is a serious neurological defect) * Pregnancy (especially during the third trimester) * Peptic ulcers (aspirin may cause bleeding of the GI tract) * Asthma; rhinitis; nasal polyps

``` The main ingredient in Advil is also the main ingredient in which of the following prescription products? • percodan • vicodin ES • motrin • naprosyn ```

motrin - Both Advil and Motrin are available over-the-counter and contain 200 mg of ibuprofen

The traditional NSAIDs such as ibuprofen, naproxen and aspirin inhibit ?. Thus they are effective in reducing pain and inflammation, but are capable of inducing ?. The ? will reduce pain and inflammation without any significant risk of causing gastrointestinal ulcers.

* COX-2 along with COX-1 * gastrointestinal ulcers * COX-2 selective inhibitors

For the traditional NSAIDs such as ibuprofen, naproxen, and aspirin, because they inhibit both COX-1 and COX-2 enzymes, they belong to the category of ?. For ?, because it inhibits COX-2 enzyme only, it belongs to the category of COX-2 selective inhibitors

* non-selective COX inhibitors | * celecoxib (Celebrex)

``` Which non-narcotic analgesics would you most likely use in a patient taking anti-coagulant medication? • ibuprofen (Motrin, Advil) • acetaminophen (Tylenol) • aspirin • naproxen sodium (Aleve) ```

acetaminophen (Tylenol) - Acetaminophen has no effect on bleeding times or prothrombin times even with high doses

Acetaminophen has two major pharmacological actions: ?. Acetaminophen is not effective enough to reduce severe pain, but it is effective in reducing ?. Acetaminophen is a ?

* an analgesic effect and an antipyretic (fever reducer) effect * mild to moderate pain * a weak inhibitor of prostaglandin formation

``` All of the following effects is seen in Aspirin but not in Acetaminophen? Which one is also seen in Acetaminophen? • affect blood clothing • gasterointestinal ulcer • associated with Reye's Syndrome • anti-inflammatory effects • analgesic effects ```

analgesic effects

``` Which agent has anti-inflammatory properties? • codeine • acetaminophen • hydrocodone • ibuprofen ```

ibuprofen - Ibuprofen inhibits the production of prostaglandins, which in turn reduces the inflammatory response, finally results in reduction of perceived pain. (Codeine and hydrocodone are narcotic analgesics that effectively reduce pain but do not reduce inflammation)

``` Your patient has a history of drug abuse. Which agent could be given (if needed in the treatment plan) with no liability to cause an addiction? • phenobarbital • ibuprofen • hydrocodone • meperidine • codeine ```

ibuprofen - is an NSAID and is classified as a non-narcotic analgesic so has no liability for abuse or addiction (Phenobarbital is a barbiturate used as a sedative and to treat epilepsy)

``` NSAIDs reduce the production of ? associated with pain and inflammation. • leukotrienes • cytokines • prostaglandins • interferons ```

prostaglandins - Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the cyclooxygenase step

NSAIDs have ? properties (similar to aspirin).

* analgesic, * antipyretic, * anti-inflammatory

Contraindications to the use of NSAIDs are ?

* impaired renal function, * pregnancy, * GI disease (ulcers).

``` Which of the following agents has little value in treating acute inflammation? • ibuprofen • acetaminophen • aspirin • naproxen • nabumetone ```

acetaminophen - Acetaminophen inhibits central prostaglandin synthesis, it is less effective than salicylates (aspirin) in blocking peripheral prostaglandin synthesis, it has no anti-inflammatory activity

Acute overdosage of acetaminophen can result in ? and is life threatening. Acetominophen is metabolized to a highly toxic intermediate product, which normally is detoxified by ?

* hepatotoxicity | * glutathione

``` Your patient is taking the following medications. Which are used to reduce the signs and symptoms of rheumatoid arthritis? Select all that apply? • amlodipine (Norvasc) • enalapril (Vasotec) • piroxicam (Feldene) • prednisone • fosamax (Alendronate sodium) ```

• piroxicam (Feldene) • prednisone Piroxicam (Feldene) is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. Prednisone is a corticosteroid and has anti-inflammatory actions. Both are used for the treatment of rheumatoid arthritis and osteoarthritis

``` Celecoxib (Celebrex) is a member of which category of drugs? • salicyciates • opiates • COX-2 selective inhibitors • non-selective COX inhibitors • steroidal anti-inflammatories ```

COX-2 selective inhibitors (Cyclooxygenase, or COX, is the enzyme which produces prostaglandins. Two forms of COX exist: COX-1, and COX-2. The COX-1 enzyme produces prostaglandins in the GI Tract. The prostaglandins formed act as a protective substance against the formation of gastrointestinal ulcers)

The COX-2 selective inhibitors (Celecoxib): • Are not salicylates because they are not ? • Are not opiates because they do not work like ? • Are not steroidal anti-inflammatories because they are not ?

* aspirin drugs * morphine * corticosteroids such as hydrocortisone

``` The autonomic nervous system has cholinergic neurons that secrete: • epinephrine • norepinephrine • acetylcholine • dopamine ```

acetylcholine

Preganglionic and postganglionic neurons of both divisions (parasympathetic and sympathetic) are cholinergic or adrenergic?

only postganglionic neurons of the sympathetic division are usually adrenergic (sweat glands and a few blood vessels are exceptions)

* The action of acetylcholine at postganglionic parasympathetic sites is often referred to as ? * The term ? is used to describe the stimulating action of ACh on the ganglia, as well as its action at the neuromuscular junction of skeletal muscle.

* a muscarinic response | * nicotinic response

Which of the following are cholinergic actions? Select all that apply. • slowing of the heart • dilation of the pupils • the stimulation of the smooth muscles of the bronchi, GI tract, gallbladder, bile duct, bladder and ureters • The stimulation of sweat, salivary, tear and bronchial glands

• slowing of the heart • the stimulation of the smooth muscles of the bronchi, GI tract, gallbladder, bile duct, bladder and ureters • The stimulation of sweat, salivary, tear and bronchial glands (also constriction of the pupils (miosis))

Anticholinergic actions ?

* The secretions of all glands in the nose, mouth, pharynx and respiratory tract is inhibited ("dry mouth') * An inhibitory effect on motility throughout the GI tract (may cause constipation and urinary retention) * The heart rate increases (tachycardia) * A rise in body temperature * Dilation of the pupils (mydriasis)

anticholinergic drugs are contraindicated in patients with ?

glaucoma

Nicotinic receptor antagonists (nicotinic blocking agents) are divided into ?

* ganglion-blocking drugs (Ganglionic blockers) | * neuromuscular blocking drugs (Neuromuscular blockers)

Although they are among the most potent agents available, ganglionic-blocking drugs are seldom used because of the annoying and sometimes disabling ?

parasympathetic blockade

``` The currently available ganglionic blocker for clinical use is: • mecamylamine • hexamethonium • tetraethylammonium • trimethaphan ```

mecamylamine - others are no longer available in the U.S. for clinical use.

Mecamylamine (Inversine) is used clinically for ?

* The treatment of severe or malignant hypertension * An emergency hypertensive crisis * A "bloodless field" surgery

The prototype depolarizing neuromuscular blocking agent is:

succinylcholine (Anectine) - important for producing complete skeletal muscle relaxation and facilitate endotracheal intubation, as an adjunct to surgical anesthesia

There are two classes of neuromuscular blockers ?

* Nondepolarizing (competitive) - tubocurare | * Depolarizing (non-competitive) - succinylcholine

The major danger of all of these neuromuscular blocking drugs is ?

too much paralysis (the patient cannot breathe)

Botulinum toxin A (Botox) acts on the motor nerve terminal to prevent the release of ACh. It is used in ?

* ophthalmology to relax the extraocular muscles, | * for muscle dystonias as well as to remove wrinkles

``` All of the following are cholinesterase inhibitors EXCEPT one. Which one is the EXCEPTION? • physostigmine • edrophonium • pyridostigmine • phentolamine • neostigmine ```

phentolamine - is a prototype of non-selective alpha-adrenergic receptor blockers.

some cholinesterase inhibitors are commonly prescribed for ?

Alzheimer's disease

``` All of the following are cholinergic drugs EXCEPT one. Which one is the EXCEPTION? • acetylcholine • methacholine • bethanechol (Urecholine) • dobutamine • carbachol (Isopto-Carbachol) • pilocarpine hydrochloride ```

dobutamine - is an adrenergic agonist

acetylcholine (ACh) is metabolized by ?, located near receptors. In the plasma and other sites, ACh (and many other esters) are metabolized by ?

* acetylcholinesterase | * pseudocholinesterase

In dentistry, a cholinergic drug is used to: • produce a dry field for taking impressions • calm an anxious patient • treat dry mouth by inducing salivation • reduce nausea

treat dry mouth by inducing salivation such as Pilocarpine and Cevimeline

All of the following statements concerning edrophonium are true EXCEPT one. Which one is the EXCEPTION? • It is a direct-acting cholinergic agonist (cholinomimetic) • It is a rapid-acting, short-duration, injectable cholinesterase inhibitor • It is the drug of choice for diagnosing myasthenia gravis because of its rapid onset of action and reversibility • It is also useful in differentiating a myasthenic crisis from a cholinergic crisis

It is a direct-acting cholinergic agonist (cholinomimetic) - edrophonium is an indirect-acting cholinergic agonist (cholinomimetic) (they are all cholinesterase inhibitors)

Typical cholinergic effects caused by stimulation of acetylcholine receptors (cholinergic receptors) include ?

salivation, miosis, excessive sweating, flushing, increased GI motility and bradycardia

``` Poisoning with an organophosphate cholinesterase inhibitor can be treated with: • edrophonium • carbachol • pralidoxime • nicotine ```

pralidoxime - is a cholinesterase reactivator which is used as an antidote (پادزهر) to reverse muscle paralysis

``` The muscarinic effects of cholinergic agonists include all of the following EXCEPT one. Which one is the EXCEPTION? • miosis • flushing • bronchoconstriction • increased GI motility • increased urination • tachycardia • salivation • sweating ```

tachycardia - Bradycardia is a muscarinic effect of cholinergic agonists - Atropine is prototype

Contraindications for using antimuscarinic drugs (Atropine) include ?

* narrow-angle glaucoma, * prostatic hyperplasia, * tachycardia

``` All of the following drugs may be useful in controlling salivary secretions to help in obtaining a dry field EXCEPT one. Which one is the EXCEPTION? • atropine sulfate • carbachol • glycopyrrolate (Robinul) • belladonna derivatives • propantheline bromide (Pro-banthine) ```

carbachol - others are all classified as anticholinergics