PHARMACOLOGY Sample Questions 2 Flashcards
1
Q
Two drugs, A and B, have the same mechanism of action. Drug A in a dose of 5 mg. produces the same magnitude of response as drug B in a dose of 500 mg. Which of the following statements is correct?
a. Drug A is less toxic
b. Drug A is more efficacious
c. Drug A is 100 times as potent
d. Drug A has a shorter duration of action
e. Drug A is a better drug to use when a maximal response is desired
A
C
2
Q
According to the theory that agonists and antagonists occupy the same receptor site, an effective antagonist should exhibit
a. High intrinsic activity and high affinity
b. Low intrinsic activity and low affinity
c. High intrinsic activity and low affinity
d. No intrinsic activity and high affinity
A
D
3
Q
All of the following statements are true regarding the occupation theory of drug-receptor interaction EXCEPT:
a. The affinity of a drug is dependent on its intrinsic activity
b. The maximum effect of a drug occurs when all receptors are occupied
c. An antagonist has affinity for the receptor but not intrinsic activity
d. The magnitude of the effect of a drug is proportional to the number of receptors occupied
e. It follows the law of mass action
A
A
4
Q
The occupational theory of drug-receptor interaction states that
a. The magnitude of the drug response is proportional to the number of receptors occupied
b. A partial agonist has intrinsic activity but no affinity for the receptor site
c. An antagonist drug has affinity but no intrinsic activity
d. The rate at which the drug-receptor complex associates and dissociates determines drug efficacy
e. The degree of drug action is dependent on the law of mass action
i. (a), (b) and (c)
ii. (a), (c) and (e)
iii. (b), (c) and (d)
iv. (b) and (e)
v. (c), (d) and (e)
A
ii
5
Q
Diazepam is preferred to a barbiturate as an antianxiety agent because diazepam
a. Produces no sedation
b. Has less addiction potential
c. Is a very short-acting drug
d. Is substantially less expensive
e. Does not potentiate the action of CNS depressants
A
B
6
Q
Benzodiazepines produce their antianxiety effects by modulating which of the following neurohumors?
a. GABA
b. Glycine
c. Dopamine
d. Acetylcholine
e. Norepinephrine
A
A
7
Q
Benzodiazepines exert their main effect on
a. Neuromuscular junctions
b. Peripheral reflex synapses
c. Central GABAergic neurons
d. Central serotonergic neurons
e. Central adrenergic nerve endings
A
C
8
Q
All of the following pertain to general anesthesia induced by thiopental EXCEPT:
a. Fast induction
b. Decreased secretions
c. Low therapeutic index
d. Short duration of anesthesia
e. Predisposition to laryngospasm
A
B
9
Q
Which of the following factors contributes to the short duration of action of a single dose of thiopental?
a. rapid biotransformation
b. rapid accumulation in body fat
c. high lipid solubility of the undissociated form
d. ability to enter and leave the brain tissue rapidly
A
D
10
Q
Speed of recovery from short-acting anesthesia with thiopental depends chiefly on the rapidity of
a. Renal tubular secretion
b. Hepatic degradation of the thiopental group
c. Redistribution from the brain to skeletal muscle
d. Reverse diffusion across the blood-brain barrier
e. None of the above
A
C
11
Q
The action of the ultrashort-acting barbiturates is terminated primarily by the process of a. Oxidation b. Redistribution c. Renal excretion d. Plasma protein binding e. Conjugation with sulfate
A
B
12
Q
Which of the following is NOT characteristic of barbiturates?
a. Possess anticonvulsant properties
b. Possess significant analgesic properties
c. Possess serious drug dependence potential
d. Vary in degree of lipid solubility and hypnotic potency
A
B
13
Q
The cause of death from acute barbiturate poisoning is
a. Convulsions
b. Liver damage
c. Renal failure
d. Respiratory failure
e. Cardiovascular depression
A
D
14
Q
Which of the following adverse effects is most commonly associated with administration of an intravenous barbiturate?
a. Hypotension
b. Renal failure
c. Hepatic necrosis
d. Nausea and vomiting
e. Respiratory depression
A
E
15
Q
Important steps in the treatment of barbiturate poisoning include:
a. Maintaining an open airway
b. Increasing the input of afferent stimuli
c. Maintaining respiration
d. Administering a narcotic antagonist
e. Administering a central nervous system stimulant
i. (a) and (b) only
ii. (a), (b), (c) and (e)
iii. (a) and (c) only
iv. (b) and (e) only
v. (d) only
A
ii
16
Q
Which of the following are true regarding barbiturates?
a. Significantly elevates pain thresholds
b. Are metabolized by the liver
c. Are classified according to duration of action
d. Depress all levels of the CNS
e. Cause death by cardiovascular depression
i. (a), (b) and (c)
ii. (a) and (d)
iii. (b), (c) and (d)
iv. (b) and (e)
v. (c), (d) and (e)
A
iii
17
Q
Barbiturates are contraindicated in a dental patient with:
a. Emphysema
b. Hypertension
c. Undiagnosed severe pain
d. Acute intermittent porphyria
i. (a), (c) and (d)
ii. (a) and (d) only
iii. (b) and (c)
iv. (b) only
A
i
18
Q
If diazepam (Valium) is to be given intravenously, it is recommended
that a large vein be used in order to
a. Hasten the onset of action
b. Decrease the risk of thrombophlebitis
c. Offset the vasoconstrictor qualities of diazepam
d. None of the above
A
B
19
Q
The most important therapeutic measure to be taken in a case of barbiturate poisoning is to
a. Alkalinize the urine
b. Aspirate stomach contents
c. Administer a CNS stimulant
d. Assure adequate respiration
e. Administer osmotic diuretics
A
D
20
Q
For oral sedation in the dental setting, the most ideal group of agents is:
a. Narcotics
b. Barbiturates
c. Antihistamines
d. Benzodiazepines
e. Anticholinergics
A
D
21
Q
Which of the following is an advantage of midazolam over diazepam EXCEPT one. Which one is this EXCEPTION?
a. Lesser incidence of thrombophlebitis
b. Shorter elimination half-life
c. No significant active metabolites
d. Less potential for respiratory depression
e. More rapid and predictable onset of action when given intramuscularly
A
D
22
Q
Which of the following drugs best reverses the effects of benzodiazepines?
a. Naloxone
b. Flumazenil
c. Midazolam
d. Aminophylline
e. Physostigmine
A
B
23
Q
Which of the following are pharmacologic properties of antipsychotic drugs?
a. They block the dopamine receptor
b. They affect the hypothalamic temperature regulation system
c. They cause emesis
d. They are synergistic with LSD
e. They cause hypertension
i. (a) and (b) only
ii. (a), (b) and (c)
iii. (b), (c) and (d)
iv. (c), (d) and (e)
v. (d) and (e) only
A
i
24
Q
The antipsychotic effects of the phenothiazines are probably the result
of
a. Release of serotonin in the brain
b. Release of norepinephrine in the brain
c. Blockade of dopaminergic sites in the brain
d. Prevention of the release of norepinephrine from brain neuron
terminals
e. Increase in the dopamine content of the cerebral cortex
A
C
25
The antipsychotic effects of phenothiazines result from
a. Release of serotonin in the brain
b. Release of norepinephrine in the brain
c. Blockade of dopaminergic sites in the brain
d. An increase in the dopamine content of the cerebral cortex
e. Prevention of the release of norepinephrine from brain neuron
terminals
C
26
Chlorpromazine and related drugs are thought at act by blocking which of the following receptors?
a. Adrenergic
b. Muscarinic
c. Dopaminergic
d. Central serotonin
C
27
Which of the following is an irreversible side-effect resulting from long-term administration of phenothiazines?
a. Sedation
b. Xerostomia
c. Infertility
d. Parkinsonism
e. Tardive dyskinesia
E
28
Tardive dyskinesia is a neurological side-effect of which of the following classes of drugs?
a. Alcohols
b. Tricyclic antidepressants
c. Barbiturate antiepileptics
d. Phenothiazine antipsychotics
e. Monoamine oxidase inhibitors
D
29
Which of the following drugs are most likely to cause extrapyramidal stimulation?
a. Antibiotics
b. Salicylates
c. Barbiturates
d. Phenothiazines
e. Benzodiazepines
D
30
Phenothiazine derivatives do NOT produce
a. Jaundice
b. Xerostomia
c. Gingival hyperplasia
d. Postural hypotension
e. Symptoms of parkinsonism
C
31
All of the following actions are associated with the use of chlorpromazine EXCEPT:
a. Jaundice
b. Photosensitivity
c. Excessive salivation
d. Anticholinergic effects
e. Antiadrenergic effects
C
32
The drug most commonly used to treat severe mental depression is
a. Sodium
b. Imipramine
c. Chlorpromazine
d. Tranylcypromine
e. Dextroamphetamine
B
33
Which of the following drugs is most effective as an antidepressant?
a. Diazepam
b. Reserpine
c. Amitriptyline
d. Chlorpromazine
e. Hydroxyzine
C
34
Which of the following is most likely to be the major mechanism of action of the tricyclic antidepressants?
a. Enhanced release of acetylcholine
b. Inhibition of neuronal synthesis of norepinephrine
c. Potentiation of serotonin synthesis in nervous tissue
d. Stimulation of reuptake of norepinephrine from the synaptic cleft
e. Blockade of the reuptake of amine neurotransmitters released into the synaptic cleft
E
35
Tricyclic antidepressants have a prominent side effect that most nearly resembles the usual pharmacological action of
a. Codeine
b. Atropine
c. Ephedrine
d. Propranolol
e. Methacholine
B
36
Which of the following drugs has its primary use in the treatment of the manic phase of depressive psychosis?
a. Lithium
b. Reserpine
c. Imipramine
d. Amphetamine
e. Chlorpromazine
A
37
Lithium carbonate is particularly effective in treating
a. Parkinsonism
b. Hypertension
c. Schizophrenia
d. Acute anxiety
e. Manic-depressive psychosis
E
38
The current drug of choice for treatment of the manic phase of manic-depressive psychosis is
a. Lithium
b. Caffeine
c. Reserpine
d. Imipramine
e. Amphetamine
A
39
Which of the following statements is NOT true regarding the adrenal corticosteroids?
a. Cause retention of sodium and fluid
b. Decrease activity in lymphoid tissue
c. Heighten the immune response to antigens
d. Can produce a diabetes-like syndrome with high blood levels
e. Are therapeutically beneficial when administered orally, parenterally or topically
C
40
Which of the following conditions contraindicate use of corticosteroids in a dental patient?
a. AIDS
b. Candidiasis
c. Tuberculosis
d. Peptic ulcers
i. (a), (b) and (c)
ii. (a), (b) and (d)
iii. (b), (c) and (d)
iv. (c) and (d) only
v. All of the above
v
41
Which of the following does NOT result from prolonged treatment with steroids?
a. Gastric ulcer
b. Osteoporosis
c. Hyperglycemia
d. Myocardial atrophy
e. Redistribution of body fat
D
42
Glucocorticosteroids are useful as secondary treatment of anaphylaxis because they
a. Inhibit the production of antibodies
b. Prevent the union of antigen with antibody
c. Prevent the release of histamine from sensitized cells
d. Suppress the inflammatory response to cell injury
e. Inhibit the release of serotonin from vascular storage sites
D
43
Adrenal steroids are used successfully to treat all of the following conditions EXCEPT
a. Gastric ulcers
b. Addison disease
c. Lupus erythematosus
d. Rheumatoid arthritis
e. Aphthous stomatitis
A
44
Signs and stages of anesthesia are most likely to be seen with a general anesthetic that has a
a. Low potency
b. Slow rate of induction
c. Low Ostwald coefficient
d. High oil-water solubility coefficient
e. High tissue-blood partition coefficient
B
45
All of the following influence the rate of induction during anesthesia EXCEPT:
a. Pulmonary ventilation
b. Blood supply to the lungs
c. Hemoglobin content of the blood
d. Concentration of the anesthetic in the inspired mixture
e. Solubility of the anesthetic in blood (blood-gas partition coefficient, Ostwald coefficient).
C
46
The rapidity of onset of anesthesia with an inhalation anesthetic agent is primarily related to its
a. Molecular weight
b. Degree of blood solubility
c. Temperature in the gas phrase
d. Interaction with preoperative drugs
B
47
Which of the following forms of drug toxicity is associated with the halogenated hydrocarbon general anesthetics?
a. Liver damage
b. Myocardial atrophy
c. Peripheral neuritis
d. Severe hypertension
A
48
The behavior of patients under general anesthesia suggests that the most resistant part of the central nervous system is the
a. Spinal cord
b. Medulla oblongata
c. Cerebral cortex (motor area)
d. Cerebral cortex (sensor area)
B
49
General anesthetics can do all of the following EXCEPT:
a. Produce delirium
b. Stimulate medullary centers
c. Produce a state of unconsciousness
d. Reduce perception of painful stimuli
e. Decrease excitability of the motor cortex
B
50
In general anesthesia, the last part of the CNS to be depressed is the
a. Medulla
b. Cerebrum
c. Midbrain
d. Cerebellum
e. Spinal cord
A
51
General anesthesia with halothane is commonly preceded by administration of atropine to
a. inhibit vagal overactivity commonly caused by halothane
b. induce muscular relaxation by blocking cholinergic receptors
c. reduce salivation and bronchial secretions caused by halothane
d. all of the above.
C
52
Which of the following drugs is useful in treating dermatologic manifestations of an allergic response?
a. Diazepam
b. Atropine
c. Hexylresorcinol
d. Chlorpheniramine
e. Phenoxybenzamine
D
53
Cimetidine is used therapeutically to
a. Stimulate respiration
b. Protect against anaphylaxis
c. Decrease gastric acid secretion
d. Hasten excretion of barbiturates
e. Dilate smooth muscles of the bronchioles
C
54
Gastric acid secretion has been shown to be most effectively reduced with the use of
a. Adrenal steroids
b. Anticholinergic drugs
c. Serotonin antagonists
d. H1-histamine receptor antagonists
e. H2-histamine receptor antagonists
E
55
Drug-mediated inhibition of H2-histamine receptors is most useful in treating
a. Asthma
b. Anaphylaxis
c. Contact dermatitis
d. Gastric hyperacidity
e. Localized allergic reactions
D
56
Which of the following antihistamines is most commonly used as preoperative medication? a. Meclizine
b. Cyclizine
c. Promethazine
d. Dimenhydrinate
e. Chlorpheniramine
C
57
Use of diphenhydramine (Benadryl ) in controlling the symptoms of parkinsonism is based upon which of the following effects?
a. Anticholinergic
b. Local anesthetic
c. Adrenergic-blocking
d. CNS depressant on the midbrain
e. Stimulant to dopaminergic nerves in the basal ganglia
A
58
The mechanism of action of H1 antihistamines is
a. MAO enzyme inhibition
b. competitive antagonism
c. physiologic antagonism
d. noncompetitive antagonism
e. inhibition of release of bound histamine
B
59
```
which of the following drugs is often used to treat trigeminal neuralgia?
A. clonazepam
B. carbamazepine
C. acetazolamine
D. succinylcholine
```
B
60
```
the use of epinephrine for local hemostasis during surgery might result in
A. hypoglycemia
B. cardiac arrhythmia
C. an acute asthma attack
D. a drastic drop in BP
E. any of the above
```
B
61
```
the highest risk associated with use of oral contraceptives is
A. hepatic necrosis
B. permanent sterility
C. cancer of the breast
D. cancer of the uterus
E. thromboembolic disorders
```
E
62
```
factors common to all forms of drug abuse include
A. miosis
B. tolerance
C. physical dependence
D. psychological dependence
E. any of the above
```
D
63
alcoholic euphoria results from
A. increased activity of the cerebellum
B. increased activity of the cerebral areas
C. increased activity of the spinal synapses
D. decreased activity of the medullary centers
E. removal of inhibitory activity of the cortex
E
64
sulfonylureas cause insulin secretion by
A. adrenergic stimulation
B. cholinergic stimulation
C. direct stimulation of pancreatic beta cells
C
65
```
if a patient requiring an extraction reports that he is on dicoumarol therapy, the laboratory test most valuable in evaluating the surgical risk is
A. clotting time
B. bleeding time
C. sedimentation rate
D. complete blood cell count
E. plasma prothrombin time
```
E
66
```
a drug has a half-life of 4 hours. if 2g are given every 4 hrs, what will be the amount in grams in the body immediately after the third dose?
A. 1.5
B. 2.0
C. 3.5
D. 4.0
E. 6.0
```
C
67
```
which of the following combinations represents acceptable agonist-antagonist pairs in antidotal therapy?
A. morphine-naloxone
B. dicoumarol-protamine
C. warfarin-phenylbutazone
D. carbon monoxide-carbon dioxide
```
A
68
The various insulin preparations useful in the treatment of diabetes mellitus differ primarily in
a. locus of action
b. mechanism of action
c. mode of transformation
d. onset and duration of action
e. none of the above
D
69
Displacement of a drug from protein binding sites is expected to increase the
a. drug effect observed
b. duration of drug effect
c. dose required for a given effect
d. none of the above
A
70
In an addisonian crisis (hypoaldosteronism) resulting from stress from a minor dental procedure, the patient should be treated immediately with
a. 0.5 ml norepinephrine
b. 5 mg. prednisolone acetate
c. 1% triamcinolone acetonide
d. 0.5 ml, 1:1000 epinephrine
e. 2 ml (100 mg) hydrocortisone hemisuccinate
E
71
Drug A inhibits the biotransformation of Drug B. The duration of action of drug B in the presence of drug A will usually be
a. shortened
b. prolonged
c. unchanged
B
72
In which of the following groups of drugs is there the most consistency in chemical structure?
a. diuretics
b. antiepileptics
c. local anesthetics
d. general anesthetics
e. nonbarbiturate sedatives
C
73
Cimetidine is administered to
a. aid in sleeping
b. relieve asthma
c. inhibit gastric secretion
d. relieve cold and flu symptoms
C
74
```
which of the following anticancer drugs can be classified as an antimetabolite?
A. cisplatin
B. lomustine
C. vincristine
D. methotrexate
```
D
75
```
which of the following hormones acts to elevate blood concentration of ionic calcium?
A. glucagon
B. parathyroid
C. aldosterone
D. thyrotropin
E. thyrocalcitonin
```
B
76
```
disorientation, confusion, and hallucinations resulting from an overdose of scopolamine are most efficaciously treated by administering
A. atropine
B. levodopa
C. acetylcholine
D. physostigmine
```
D
77
```
developed hyporeactivity to a drug is
A. tolerance
B. antagonism
C. detoxification
D. desensitization
```
A
78
absorption of a drug from the intramuscular site of administration may be slowed by
A. exercise
B. vasoconstriction
C. the presence of congestive heart failure
D. administering the drug as an insoluble complex
i. A and B
ii. B only
iii. B, C, and D
iv. B and D
v. all of the above
iii
79
```
salicylism includes which of the following?
A. nausea
B. tinnitus
C. vomiting
D. gastrointestinal bleeding
i. A, B, and C
ii. A, B, and D
iii. A and C only
iv. B, C, and D
v. all of the above
```
v
80
```
which of the following are important criteria for the adequate clinical evaluation of a new drug?
A. comparison with a placebo
B. evaluation of side effects
C. utilization of control groups
D. comparison with a standard drug
E. double blind experimental design
i. A, B, C, and D
ii. A, B, D, and E
iii. A, C, D, and E
iv. B, C, and E
v. B, D, and E only
vi. all of the above
```
vi
81
Each of the following agents has a long duration of action due to the presence of liver generated active metabolites EXCEPT
a. diazepam
b. oxazepam
c. flurazepam
d. chlordiazepoxide
B
82
Each of the following statements relates to the general aspects of toxicology EXCEPT
a. most drugs exert a single action
b. toxicity is both time and dose dependent
c. toxicity can be due to overdosage of a drug
d. symptoms of toxicity can be anything ranging from nausea to death
e. for some drugs, even a minimal concentration can be harmful
A
83
The central actions of ethyl alcohol are not synergistic with which of the following?
a. diazepam
b. meperidine
c. pentobarbital
d. chlorpromazine
e. methylphenidate
E
84
A heroin dependent patient should not be given nalbuphine (Nubain) for pain because
a. it has no analgesic properties
b. it may produce respiratory depression
c. as a mixed agonist-antagonist, it can elicit withdrawal symptoms
d. the high abuse potential of nalbuphine may add to the patient's problems
D
85
```
All of the following methods of drug biotransformation are classified as
synthetic except:
a. N-alkylation
b. O-dealkylation
c. sulfate conjugation
d. glucuronide conjugation
```
B
86
Which of the following drugs is often administered to treat life-threatening arrhythmias?
a. quinidine
b. lidocaine
c. verapamil
d. propranolol
B
87
A male patient who is receiving Coumadin therapy presents for an elective extraction. His protrhombin time (PT) is prolonged. Which of the following methods is preferred for reducing the PT to an acceptable level?
a. administering vitamin K (Aqua Mephyton)
b. Withdrawing Coumadin for two days
c. reducing Coumadin to one half the usual dose for two days
d. administering a Coumadin antagonist, such as heparin
e. administering a platelet transfusion to enhance coagulability
B
88
Each of the following drugs has a significant anti-inflammatory property except one. Which one is the exception?
a. aspirin
b. cortisol
c. acetaminophen
d. ibuprofen
e. indomethacin
C
89
A patient has a history of significant cardiovascular impairment. The maximum safe dose of epinephrine that can be administered to this patient is:
a. 1 cc, 1: 50,000
b. 2 cc, 1: 50,000
c. 1 cc, 1: 100,000
d. 2 cc, 1: 100,000
B
90
Which of the following is the current drug of choice for status-epilepticus?
a. diazepam (Valium)
b. phenytoin (Dilantin)
c. chlorpromazine (Thorazine)
d. carbamazepine (Tegretol)
e. chlordiazepoxide (Librium)
A
91
Which of the following is an example of an enteral route of administration?
a. oral
b. submucosal
c. inhalation
d. subcutaneous
e. intramuscular
A
92
Propranolol (Inderal) exerts its major antianginal effect by
a. dilating coronary arteries
b. dilating systemic blood vessels
c. increasing cardiac contractility
d. stimulating vagal slowing of the heart
e. blocking beta-adrenergic receptors of the heart
E
93
Bradycardia is MOST commonly treated with which of the following drugs?
a. atropine
b. epinephrine
c. a diuretic
d. a potent vasodilator
A
94
Which of the following best explains why drugs that are highly ionized tend to be more rapidly excreted than those that are less ionized? The highly ionized are
a. less lipid soluble
b. less water soluble
c. more rapidly metabolized
d. more extensively bound to tissue
A
95
Which of the following groups of drugs is CONTRAINDICATED for patients who have glaucoma?
a. adrenergic
b. cholinergic
c. anticholinergic
d. adrenergic blocking
C
96
Low dose aspirin therapy prevents the formation of thromboemboli by
preferentially inhibiting which of the following?
a. phospholipase A2 in the blood vessel walls
b. prostacyclin synthetase in the blood vessel walls
c. thromboxane synthetase in the platelets
d. vitamin K in the liver
C
97
A patient who is receiving an IV diazepam sedation has upper eye-lidptosis (Verill’s sign). The dentist should
a. assist respiration immediately
b. consider the patient to be adequately sedated
c. place the patient in the Trendelenberg position
d. administer one more increment of diazepam and proceed with the
treatment
B
98
A dentist is considering the use of nitrous-oxide conscious sedation for a patient. However, this type of sedation will be CONTRAINDICATED, should the patient have a history of which of the following?
a. dental anxiety
b. psychotic care
c. controlled hypertension
B
99
The correct total liter flow of nitrous oxide- oxygen is determined by
a. a standard 6 liter per minute flow
b. the patient’s metabolic oxygen requirements
c. the amount necessary to keep the reservoir bag 1/3 to 2/3
full
d. the largest volume that the patient can exchange within one minute
C
100
Which of the following sympathomimetic agents is the most potent bronchodilator?
a. amphetamine
b. norepinephrine
c. phenylephrine
d. isoproterenol
e. methoxamine
D
101
Succinylcholine blocks neuromuscular transmission by
a. inhibiting cholinesterase
b. inhibiting the central nervous system
c. depolarizing the motor endplate of skeletal muscle
d. inducing the formation of cholinesterase at the endplate
e. blocking release of acetylcholine at the endplate
C
102
Which of the following effects are common to pentobarbital, diazepam, and meperidine?
a. anticonvulsant and hypnotic
b. analgesia and relief of anxiety
c. sedation and ability to produce dependence
d. amnesia and skeletal muscle relaxation
C
103
The onset of action of a drug is primarily determined by the rate of
a. excretion
b. absorption
c. distribution
d. biotransformation
B
104
Injection of a local anesthetic into an inflamed area usually has a less than optimal result. Which of the following best explains why?
a. the prostaglandins stabilize the nerve membrane
b. inflammation reduces the availability of the free base
c. the drug will be absorbed more rapidly because of the increased blood supply
d. the chemical mediators of inflammation will present a chemical antagonism to the anesthetic
B
105
The major effect of a drug is produced by the amount of the drug that is
a. free in plasma
b. excreted by the kidney
c. detoxified in the liver
d. bound to plasma protein
A
106
A 4 yr old child is shy, timid, and fearful. Which of the following will be MOST appropriate for the restorative appointments for this child?
a. Naloxone
b. Nitrous oxide/oxygen
c. Promethazine
d. Hydroxyzine hydrochloride (atarax) or hydroxyzine pamoate (Vistaril) in divided doses
e. Meperidine (Demerol), promethazine (Phenergan) and chlorpromazine (Thorazine) combined
B
107
A primary advantage of intravenous sedation is which of the following?
a. fewer side effects from the sedation
b. slower biotransformation for prolonged action
c. the ability to titrate individualized dosage
d. a smooth and more gradual onset of sedation
C
108
Each of the following is true regarding drug biotransformation EXCEPT one. Which one is the EXCEPTION?
a. the rate may differ significantly in various animal species
b. it primarily occurs in the liver microsomal enzyme system
c. it usually converts a drug to its lipid soluble, nonionized form
d. it generally involves alterations of the chemical structure of the drug
C
109
Which of the following drugs causes the LEAST CNS depression and impairment of psychomotor skills?
a. diazepam
b. buspirone
c. alprazolam
d. chloral hydrate
B
110
A patient who has which of the following conditions is most likely to have postoperative bleeding after multiple extractions?
a. angina
b. diabetes
c. cirrhosis
d. rheumatic fever
e. chronic bronchitis
C
111
Local anesthetics aid in reducing the flow of saliva during operative procedures by
a. blocking the cholinergic nerve endings
b. blocking innervation to major salivary glands
c. blocking efferent parasympathetic nerve pathways
d. reducing sensitivity and anxiety during tooth preparation
D
112
Which of the following combinations of agents would be necessary to block the cardiovascular effects produced by the injection of a sympathomimetic drug?
a. atropine and prazosin
b. atropine and propranolol
c. prazosin and propranolol
d. phenoxybenzamine and curare
e. amphetamine and propranolol
C
113
When compared therapeutically to penicillin G, penicillin V has a
a. slower renal excretion
b. more reliable oral absorption
c. broader antibacterial spectrum
d. greater resistance to penicillinase
e. lower potential for allergic reaction
B
114
Each of the following is a common side effect of prolonged tetracycline therapy EXCEPT one. Which one is the EXCEPTION?
a. diarrhea
b. superinfection
c. photosensitivity
d. visual disturbance
e. discoloration of newly forming teeth
D
115
To reduce a patient’s salivary flow, a dentist has prescribed atropine. As a result of this medication, the patient might experience which of the following side effects?
a. sedation
b. diarrhea
c. bradycardia
d. blurred vision
e. stomach cramping
D
116
Of the following local anesthetics, which has intrinsic vasoconstrictive actions?
a. cocaine
b. procaine
c. xylocaine
d. bupivacaine
A
117
Which of the following antibiotics is found at much higher concentrations in crevicular fluid than in serum?
a. clindamycin
b. penicillin
c. metronidazole
d. tetracycline
D
118
When administered as oral centrally acting analgesics, which of the following is considered to have the highest dependence liability?
a. codeine
b. oxycodone (in Percodan)
c. propoxyphene (Darvon)
d. pentazocine (Talwin)
B
119
Antibiotics are useful in the treatment of which of the following?
a. herpangina
b. angina pectoris
c. recurrent apthous stomatitis
d. necrotizing ulcerative gingivitis
D
120
Auditory nerve deafness is associated with the use of
a. polymixin B
b. chloramphenicol
c. amphotericin B
d. gentamycin
D
121
The maximal or ceiling effect of a drug is also correctly referred to as the drug’s
a. agonism
b. potency
c. efficacy
d. specificity
C
122
Which of the following agents found in tobacco products cause addiction?
a. tar
b. formaldehyde
c. nicotine
d. carbon monoxide
C
123
```
allergic reactions to local anesthetics are caused by
A. rapid absorption
B. slow detoxification
C. an antigen-antibody reaction
D. improper administration technique
```
C
124
```
Which drug group is the LEAST likely to cause xerostomia?
A. opioids
B. antidepressants
C. antihistamines
D. benzodiazepines
E. anticholinergics
```
A
125
```
currently, the BEST oral sedative drugs for dentistry fall into the class of
A. narcotics
B. barbiturates
C. phenothiazines
D. benzodiazepines
```
D
126
which of the following best describes the drug-receptor activity of naloxone?
A. high affinity, high intrinsic activity
B. low affinity, high intrinsic activity
C. high affinity, no intrinsic activity
D. no affinity, low intrinsic activity
C
127
```
which of the following types of chemical bonding is the least likely to be involved in a drug-receptor interaction?
A. covalent bonding
B. hydrogen bonding
C. dipole-dipole bonding
D. electrostatic bonding
E. van der Waals forces
```
A
128
```
after a threshold stimulus, the cell membrane becomes permanently altered. the liberation of which of the following transmitter substances causes this alteration?
A. acetylcholine
B. cholinesterase
C. hydroxycholine
D. acetylsalicylic acid
```
A
129
```
which of the following compounds is used as an antiviral agent?
A. amantadine (symmetrel)
B. novobiocin
C. miconazole (monistat)
D. amphotericin B
```
A
130
```
with an overdose of a cholinergic drug, one would expect to see each of the following signs EXCEPT one. which is the EXCEPTION?
A. sweating
B. urination
C. mydriasis
D. bradycardia
E. copious serous saliva
```
C
131
cephalosporins are definitely CONTRAINDICATED for penicillin-allergic patients who exhibit
A. immediate-type reactions
B. nausea and vomiting with erythromycin
C. any type of reaction to the penicillins
A
132
```
which of the following is a beta-adrenergic receptor blocking agent used for the treatment of hypertension?
A. prazosin (minipress)
B. clonidine (catapress)
C. atenolol (tenormin)
D. hydralazine (aprezoline)
E. verapamil (calan)
```
C
133
```
in which of the following categories are ephedrine, tyramine, and amphetamine classified?
A. anticholinesterases
B. alpha-adrenergic blocking agents
C. indirect-acting sympathomimetics
D. direct-acting parasympathomimetics
```
C
134
```
thiazides, which are used in the treatment of hypertension, may require supplemental administration of
A. sodium
B. chloride
C. calcium
D. potassium
```
D
135
```
which of the following adverse reactions of oral contraceptives is the most common and the most serious?
A. hypotension
B. hepatotoxicity
C. uterine neoplasia
D. thromboembolic disorder
E. decreased resistance to infection
```
D
136
```
the supraspinal analgesic activity of morphine is mediated primarily through its influence upon which opioid receptor subtype?
A. mu
B. kappa
C. delta
D. sigma
E. epsilon
```
A
137
```
which pair of anesthetics is most likely to show cross-allergenicity?
A. lidocaine-mepivacaine
B. prilocaine-tetracaine
C. procaine-mepivacaine
D. procaine-lidocaine
E. lidocaine-benzocaine
```
A
138
```
thrombophlebitis, which occurs after intravenous administration of diazepam, is usually attributed to which of the following substances in the mixture?
A. benzoic acid
B. ethyl alcohol
C. propylene glycol
D. sodium metabisulfite
```
C
139
each of the following is a pharmacologic effect of phenothiazines EXCEPT one. which one is the EXCEPTION?
A. sedation
B. an antiemetic effect
C. alpha-adrenergic effect
D. potentiation of the action of narcotics
E. an anticonvulsant
E
140
epinephrine antagonizes the effects of histamine by
A. preventing the release of histamine
B. acting on the central nervous system
C. producing physiologic actions opposite to that of histamine
D. competitively blocking histamine at the cellular receptor site
C
141
```
which of the following represents the drug of choice in the treatment of candidiasis for an HIV-infected patient?
A. acyclovir
B. nystatin
C. AZT
D. chlorhexidine
```
B
142
a patient presents for treatment of a large fluctuant mass in the submandibular space as a result of extension of odontogenic infection. eh has a temperature of 38.5 degrees C (101 degrees F). initially, the dentist should treat this patient with which of the following?
A. salicylate therapy to reduce the temperature
B. alternate application of heat and cold to the area to improve circulation
C. incision and drainage and a culture for antibiotic sensitivity
D. antibiotic therapy to reduce the swelling and infection
C
143
The only local anesthetic that increases the pressor activity of both epinephrine and norepinephrine is
a. cocaine
b. procaine
c. dibucaine
d. lidocaine
e. mepivacaine
A
144
Corticosteroid therapy for arthritis is contraindicated for a patient who
also has which of the following conditions?
a. anemia
b. nephritis
c. alcoholism
d. peptic ulcer
e. rheumatic heart disease
D
145
Which of the following is the first symptom that is usually perceived by the patient being administered nitrous oxide?
a. nausea
b. euphoria
c. giddiness
d. tingling of the hands
D
146
Each of the following, EXCEPT one, is a good reason for using sedation. Which one is this EXCEPTION?
a. to allay apprehension, anxiety or fear
b. to decrease the amount of local anesthesia that is required for a given procedure
c. to alleviate stress in a severely medically compromised patient
d. to accomplish certain procedures that a practitioner would not normally be able to do on an anxious patient
B
147
Which of the following is classified as an antianxiety drug?
a. methohexital
b. lorazepam
c. haloperidol
d. pentazocine
e. phenylpropanolamine
B
148
```
which drugs tend to concentrate in body compartments with a high pH?
A. permanently charged drugs
B. drugs that are not charged
C. weak organic acids
D. weak organic bases
E. inorganic ions
```
C
149
```
drug agonists having the same intrinsic activity have the same ___
A. maximal effect
B. potency
C. receptor affinity
D. therapeutic index
E. aqueous solubility
```
A
150
what receptor or signaling pathway is linked MOST directly to alpha-2 adrenoceptor stimulation?
A. G1 and a reduction in cAMP
B. Gs and an increase in cAMP
C. Gq and calcium
D. sodium ion channel
E. membrane receptor containing tyrosine kinase
A
151
```
what tissue or organ has many muscarinic receptors but lack innervation to those receptors?
A. heart
B. parotid gland
C. blood vessels
D. sweat glands
E. urinary bladder
```
C
152
```
which of the following drugs used in the therapy for parkinsonism does NOT cross the BBB?
A. amantadine
B. carbidopa
C. levodopa
D. selegiline
E. tolcapone
```
B
153
```
after an injection, which of the following drugs would be expected to have the longest duration of action (assume no vasoconstrictor was injected with the local anesthetic)?
A. bupivacaine
B. lidocaine
C. mepivacaine
D. prilocaine
E. procaine
```
A
154
```
a very low blood:gass solubility coefficient (partition coefficient = 0.47), analgesic effect, and ability to inhibit methionine synthase BEST describes which drug?
A. ketamine
B. nitrous oxide
C. halothane
D. isoflurane
E. propofol
```
B
155
levonordefrin is added to certain cartridges containing mepivacaine. the desired effect of levonordefrin is due to what pharmacologic effect?
A. inhibition of nicotinic cholinergic receptors
B. inhibition of muscarinic cholinergic receptors
C. stimulation of alpha-adrenergic receptors
D. stimulation of beta-adrenergic receptors
E. stimulation of dopamine receptors
C
156
match each drug with its mechanism of action at the nerve terminal:
A. amphetamine
B. fluoxetine
C. botulinum toxin
D. tranylcypromine
E. physostigmine
1. blocks release of a neurotransmitter
2. inhibits an enzyme that metabolizes a neurotransmitter inside the nerve
3. stimulates the release of a NT from the cytoplasmic pool
4. inhibits the metabolism of a NT at the postjunctional or postsynaptic site
5. prevents the reuptake of a NT
```
A3
B5
C1
D2
E4
```
157
```
what is the mechanism of the analgesic action of aspirin?
A. stimulates mu opioid receptors
B. blocks histamine H2 receptors
C. inhibits COX
D. inhibits lipoxygenase
E. blocks sodium channels in nerves
```
C
158
what is the clinical setting for the use of ketorolac by the oral route?
A. for severe pain
B. for initial treatment of pain
C. to continue therapy after an IV or IM dose of ketorolac
D. only in combination with an opioid
E. only in combination with an NSAID
C
159
```
at what cell type is the use of H2 histamine receptor blockers MOST clinically useful?
A. beta cells of the pancreas
B. basophils
C. mast cells
D. juxtaglomerular cells
E. parietal cells
```
E
160
```
which class of antihypertensive drugs MOST effectively reduces the release of renin from the kidney?
A. beta-adrenergic receptor blockers
B. ACE inhibitors
C. alpha-adrenergic receptor blockers
D. calcium channel blockers
E. angiotensin II receptor blockers
```
A
161
```
the administration of ___ results in "epinephrine reversal" (decrease in blood pressure form epinephrine) if given before administration of epinephrine
A. guanethidine
B. propranolol
C. phentolamine
D. tyramine
```
C
162
what is the mechanism of action of enoxaparin?
A. inhibition of synthesis of clotting factors II, VII, IX, and X
B. activation of antithrombin III with resulting inhibition of clotting factor Xa
C. indirect activation of tissue plasminogen activator
D. direct inhibition of plasminogen with resulting degradation of fibrin
E. dilation of coronary blood vessels
B
163
```
oropharyngeal candidiasis is an adverse effect MOST likely to occur with ___
A. inhaled salmeterol
B. inhaled ipratropium
C. inhaled nedocromil
D. inhaled beclomethasone
E. inhaled methacholine
```
D
164
```
oral antacids are MOST likely to reduce the absorption of which of the following drugs when given orally?
A. clarithromycin
B. clindamycin
C. metronidazole
D. penicillin V
E. tetracycline
```
E
165
```
a decrease in glycogenolysis in the liver would be expected from which of the following drugs?
A. albuterol
B. epinephrine
C. glucagon
D. insulin
E. PTH
```
D
166
what effect does nitroglycerin have on blood vessel smooth muscle?
A. increase in level of intracellular calcium
B. increase in level of cyclic guanosine monophosphate (cGMP)
C. antagonism at alpha-1 adrenergic receptors
D. antagonism at beta-adrenergic receptors
E. inhibition of type 1 calcium channels
B
167
```
clavulanic acid offers an advantage therapeutically because ___
A. it inhibits streptococci at a low MIC
B. it inhibits transpeptidase
C. it inhibits penicillinase
D. it inhibits anaerobes at a low MIC
E. it inhibits DNA gyrase
```
C
168
```
inhibition of which of the following enzymes is MOST responsible for the cell wall synthesis inhibitory effect of penicillin G?
A. beta-lactamase
B. DNA gyrase
C. nitro reductase
D. transglycosylase
E. transpeptidase
```
E
169
```
which of the following drugs is often combined with sulfamethoxazole for the treatment of respiratory tract and urinary tract infections?
A. amoxicillin
B. ciprofloxacin
C. clindamycin
D. metronidazole
E. trimethoprim
```
E
170
which of the following organisms is usually sensitive to clindamycin?
A. candida albicans
B. klebsiella pneumoniae
C. methicillin-resistant staphylococcus aureus
D. viridans streptococci
E. pseudomonas aeruginosa
D
171
```
which anticancer drug inhibits the enzyme dihydrofolate reductase?
A. bleomycin
B. cisplatin
C. doxorubicin
D. 5-fluorouracil
E. methotrexate
```
E
172
a patient has been prescribed glipizide for type 2 diabetes. arrange the following events, leading to a reduction in plasma glucose, in their order of occurrence as a result of this drug.
A. insulin release from beta cells
B. increase in glucose uptake in target cell
C. closing of ATP-sensitive potassium channels
D. movement of GLUT-4 to the plasma membrane
E. stimulation of insulin receptor
C, A, E, D, B
173
what three events would occur after a submucosal injection of phentolamine in the oral cavity?
A. blockade of alpha-adrenergic receptors
B. blockade of beta-adrenergic receptors
C. inhibition of sodium channels
D. blockade of the vasoconstrictor effect of norepinephrine released from neurons
E. inhibition of protein synthesis in oral bacteria
F. antagonism of the vasoconstrictor effect of a subsequent injection of epinephrine in the same area of the oral cavity during the same dental appointment
A, D, F
174
match the proper description with the drug:
A. this is an antimuscarinic drug used to treat overactive bladder
B. this is an alpha-2 adrenergic receptor agonist used for IV sedation
C. this drug blocks serotonin 5-HT and dopamine D2 receptors and is used for schizophrenia
D. this sedative selectively inhibits a benzodiazepine receptor subtype
E. this antiepileptic drug binds to the alpha-2-delta-1 subunit of the high-voltage calcium channel and blocks this channel
1. quetiapine
2. gabapentin
3. solifenacin
4. codeine
5. dexmedetomidine
6. pilocarpine
7. zaleplon
8. carbamazepine
```
A3
B5
C1
D7
E2
```
175
```
match the enzyme with the drug that inhibits it:
A. acetylcholinesterase
B. ACE
C. dipeptidylpeptidase-4
D. DNA-dependent RNA polymerase
E. 14-alpha-demethylase
F. DOPA decarboxylase
G. MAO B
1. sitagliptin
2. terbinafine
3. aliskiren
4. fluconazole
5. neostigmine
6. ciprofloxacin
7. lisinopril
8. lithium
9. carbidopa
10. selegiline
11. rifampin
```
```
A5
B7
C1
D11
E4
F9
G10
```
176
```
select the three drugs that antagonize the effect of pilocarpine on salivary flow rate.
A. rivastigmine
B. benztropine
C. metoprolol
D. tolterodine
E. oxybutynin
F. epinephrine
```
B, D, E
177
```
identify which two drugs are commonly used in the treatment of herpes simplex viral infections
A. ganciclovir
B. indinavir
C. acyclovir
D. ribavirin
E. peniciclovir
F. zidovudine
```
C, E
178
```
match each adverse effect with the drug it is more typically associated with compared with the other drugs listed
A. osteonecrosis of the jaw especially at high doses
B. cough in 10% of patients taking the drug
C. first dose hypotensive effect
D. sedation
E. reye's syndrome in young patients with recent viral infection
F. methemoglobinemia
1. terazosin
2. acetaminophen
3. pamidronate
4. prilocaine
5. lidocaine
6. diphenhydramine
7. aspirin
8. clopidogrel
9. fosinopril
```
```
A3
B9
C1
D6
E7
F4
```
