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Dental Pharmacology Review




This site is sponsored by the Department of Biochemistry at Temple University School of Medicine. Its purpose is to help prepare students for the final examination in Dental Prmacology as well as a review in preparation for the Dental Board Exam. Please send any corrections, additions or suggestions to the Webmaster.

produced in 1997 by Jerome L. Gabriel Department of Biochemistry, Temple University School of Medicine and Gerald Sterling, Department of Pharmacology, Temple University School of Medicine


Using the web page: Once you have selected your answer, click on the corresponding letter. You will then see the following message if your answer is correct or incorrect. Please view BOTH messages in order to initialize the web page and avoid color coding the answers.


Selected Topics in Dental Pharmacology







GENERAL PRINCIPLES


1. All of the following statements are true in regard to excretion of drugs EXCEPT:


2. Which ONE of the following routes is most likely to undergo first pass biotransformation?


3. The drug constant known as the apparent volume of distribution (Vd) has the value 700L for the heart drug, digoxin. This value is equivalent to which of the following?


4. If the drug above (digoxin) is given intravenously in a single dose of 0.5mg = 500ug, the peak plasma concentration is approximately


5. If the half-life of digoxin is 2 days in a particular patient (with a normal kidney) it may be assumed that after a single dose the drug is gone in approximately


6. If digoxin is continuously infused in the above patient, the time to achieve a steady-state plasma concentration is about


7. Patients with chronic liver disease are most likely to have which of the following problems of drug handling?


8. In patients with severe renal insufficiency, which ONE of the following general principles regarding drug therapy is appropriate?


9. The initial plasma concentration following an i.v. dose of 100 mg depends on the drug's


10. A drug with a clearance of 20 ml/min is infused at a rate of 20 mg/min. The steady-state plasma concentration attained is


11. All of the following drug interactions are referred to as 'pharmacokinetic' in type except for one which is 'pharmacodynamic' in type. Identify that which is pharmacodynamic.


12. Factors enhancing the rate of drug absorption include all of the following EXCEPT:


13. Factors increasing the rate of passive absorption of drug from the small intestine include all of the following EXCEPT:


14. A drug with volume of distribution Vd = 35 L is given intravenously in a single dose of 100 mg. The approximate initial plasma concentration is


15. The drug above (Problem 25 ) has a half life of 3 hr. With the dose given above (100 mg), the minimum time necessary for the drug to be effectively eliminated is approximately



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AUTONOMIC DRUGS


16. Acetylcholine can produce


17. Selective stimulation of beta-2 adrenergic receptors produces


18. Blockade of muscarinic receptors by atropine produces all of the following EXCEPT:


19. Therapeutic uses of cholinergic agonists include all of the following EXCEPT:


20. Precursor of endogenous norepinephrine:


21. Alpha-adrenoceptor agonist:


22. A man in his twenties was brought to the emergency room by his friends who said that he had suddenly become restless, confused, and uncoordinated after taking some pills. Physical examination revealed increased body temperature, tachycardia, cutaneous flush and widely dilated pupils unresponsive to light. The patient complained of dryness of the mouth. He probably ingested which ONE of the following drugs?


23. Xerostomia in patients with some functional salivary glands can be treated with


24. The purpose of including epinephrine in lidocaine preparations is to


25. d-Tubocurarine provides muscle relaxation by


26. Acetylcholine is released by the presynaptic terminal at the neuromuscular junction when


For Questions 27 to 29: Match each numbered item with the SINGLE, MOST APPROPRIATE LETTER. A LETTER MAY BE USED ONCE OR NOT AT ALL.


27. A short-acting acetylcholinesterase inhibitor; often used as a diagnostic agent for myasthenia gravis. (A, B, C, D, E)

28. A competitive muscarinic antagonist; is very effective against motion sickness. (A, B, C, D, E)

29. Used to regenerate acetylcholinesterase from phosphorylated enzyme in the poisoning with organophosphate cholinesterase inhibitor. (A, B, C, D, E)


30. Stimulation of muscarinic cholinergic receptors by acetylcholine


31. Which ONE of the following is an alpha adrenoceptor antagonist?


32. Stimulation of beta-1 adrenergic receptors produces


33. Which ONE of the following is a beta-adrenoceptor agonist?


34. Vasoconstriction is produced by stimulation of


35. Which ONE of the following is degraded by pseudocholinesterase?


36. Botulinum Toxin


37. Which ONE of the following neuromuscular blockers releases the most histamine?


38. A patient who has increased gut motility, excessive salivation, miosis and bronchoconstriction may have been given which one of the following drugs?


For Questions 39 to 42: For each numbered description, select the most appropriate lettered drug. Use each letter only once.


39. Inhibits acetylcholinesterase; is used in the long-term treatment of myasthenia gravis. (A, B, C, D, E)

40. Causes mydriasis; is used in ophthalmology. (A, B, C, D, E)

41. Is used in the treatment of xerostomia (dry mouth) in patients who still have some functional salivary glands. (A, B, C, D, E)

42. Nondepolarizing neuromuscular blocker; action reversed by administration of cholinesterase inhibitor. (A, B, C, D, E)


For Questions 43 to 46: For each numbered description, select the most appropriate lettered drug. Use each letter only once.


43. Acts directly on muscarinic receptors; is used in the treatment of nonobstructive atony of the bladder. (A, B, C, D, E)

44. Used in agriculture as insecticide. (A, B, C, D, E)

45. Is used to treat intoxication by organophosphate insecticides; regenerates acetylcholinesterase. (A, B, C, D, E)

46. Short acting cholinesterase inhibitor, used in diagnosis of myastenia gravis. (A, B, C, D, E)


47. Stimulation of alpha adrenergic receptors by phenylephrine may produce


48. All of the following effects are produced by muscarinic receptor agonists EXCEPT:


49. All of the following therapeutic uses are due to the corresponding mechanism EXCEPT:


50. Which ONE of the following binds covalently to the site(s) specified?



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CENTRAL NERVOUS SYSTEM DRUGS


51. The primary mechanism of action of local anesthetics is


52. Which ONE of the following local anesthetics is highly lipid-soluble with a long duration of action?


53. The potency of general anesthetics is best related to which ONE of the following?


The following table may be used to help answer the next two questions, 54 and 55.

Agent

.......... Blood/gas P.C. .......... MAC
Nitrous oxide

0.47

110.0

Cyclopropane

0.46

9.2

-------------

Isoflurane

1.4

1.15

Enflurane

1.9

1.68

Halothane

2.3

0.75

-------------

Ether

12.1

1.92

Methoxyflurane

13.0

0.16


54. Which ONE of the following has the most rapid rate of induction?


55. Which ONE of the following is most potent?


56. Which statement best describes the general anesthetic halothane?


57. Nitrous oxide is a drug that has been abused because


58. Sinemet, a combination of L-dopa and carbidopa, is used to treat Parkinsonism. Carbidopa is important in this preparation because


59. An example from the phenothiazine class of antipsychotic agents is:


60. All of the following statements apply to chlorpromazine EXCEPT:


61. Lithium carbonate is of value in the treatment of which disease?


62. The concurrent use of foods containing tyramine and ONE of the agents listed below can result in a hypertensive crisis. Indicate which agent.


For Questions 63 to 65: Match each numbered statement with the SINGLE, MOST APPROPRIATE LETTERED ITEM, USING FACH LETTER ONLY ONCE.


63. L-Dopa (A, B, C, D)

64. Amantadine (A, B, C, D)

65. Atropine (A, B, C, D)


66. Nausea which results when alcohol is ingested after disulfiram has been taken, is due to an increase in blood _________


67. Indicate which effect occurs with alcohol ingestion.


68. Methanol produces its toxic effects due to a build up of


69. All of the following statements are true of mixed opioid agonists/antagonists EXCEPT:


70. Valproic acid:


71. Flumazenil reverses the effects of which ONE of the following?


72. The chief disadvantage of nitrous oxide as a general anesthetic is:


73. Amantadine is used in the treatment of Parkinsonism because it


74. Identify ONE drug from the list that can produce Parkinson-like symptoms.


75. Which ONE of the following statements concerning opioids is true?


76. The antidepressant action of fluoxetine can be attributed to which ONE of the following possibilities?


77. Which ONE of the following drugs is effective in controlling the manic phase of manic depression?


78. Dietary control is advisable to avoid hypertensive crises with which ONE of the following drugs?


79. Which ONE of the following statements applies to imipramine?


80. Dynorphin A is thought to be the endogenous ligand for the


81. Methyl alcohol is metabolized in the body __________ ethyl alcohol.


82. The potency of general anesthetics is best related to which ONE of the following?


83. The ONLY local anesthetic agent which produces vasoconstriction:


84. Ultrashort-acting barbiturate useful intravenously for induction of anesthesia, or to maintain anesthesia for short procedures:


85. Morphine induces


86. Methadone is used as pharmacotherapy for heroin addiction because it is a(n)


87. An example of a pure opioid antagonist:


88. Barbiturates, but NOT benzodiazepines, have been or are presently used


89. All of the following may be produced by lidocaine EXCEPT:


For Questions 90 to 93: For each of the following numbered options, match the most appropriate drug from the list below. Use each letter only once.


90. Centrally-acting stimulant. (A, B, C, D, E)

91. Centrally-acting opioid. (A, B, C, D, E)

92. Analgesic, antipyretic, not anti-inflammatory. (A, B, C, D, E)

93. Analgesic; contraindicated in children with influenza. (A, B, C, D, E)


94. Ultrashort acting intravenous anesthetic useful for minor surgical procedures or induction of general anesthesia.


95. A non-opioid analgesic, useful to reduce elevated body temperature, but is NOT anti-inflamrnatory.


96. Pure opioid antagonist, useful by injection for acute heroin overdose.


97. Inhalation general anesthetic, rapid onset and recovery, useful for minor dental procedures or induction of anesthesia.


98. Codeine may produce all of the following EXCEPT:


For Questions 99 to 101. Match the following statements with the most appropriate drug of abuse from the list below.

99. Status epilepticus may occur with abrupt withdrawal. (A, B, C, D, E)

100. Stimulant drug generally used by "snorting" or intravenous administration, potent vasoconstrictor, local anesthetic actions. (A, B, C, D, E)

101. CNS depressant, safest of this group of drugs in terms of lethality. Problems usually arise only when combined with other drugs. (A, B, C, D, E)


102. All of the following are true about drugs used in production of anesthesia EXCEPT:


103. Benzodiazepines


104. The primary neurotransmitter thought to be involved in schizophrenia is


105. Which ONE of the following drugs is a selective serotonin-uptake inhibitor?


106. All of the following are characteristics of morphine-like opioid analgesics EXCEPT:


107. The side effects of morphine-like opioid analgesics include


108. Which ONE of the following has the HIGHEST abuse potential and may lead to severe dependence?


109. Disulfiram is useful in the treatment of addiction to



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CARDIOVASCULAR - HEMATOLOGY


110. Characteristics of Cholestyramine include all of the following EXCEPT:


111. All of the following are actions or properties of the digitalis glycosides EXCEPT:


For Questions 112 to 115: MATCH EACH OF THE ANTIHYPERTENSIVE DRUGS WITH THE ACTION OR PROPERTY THAT BEST APPLIES.

112. Alpha-adrenergic blocker (A, B, C, D, E)

113. Ca+2 channel blocker (A, B, C, D, E)

114. Inhibitor of angiotensin converting enzyme (A, B, C, D, E)

115. Block of beta-adrenergic receptors. (A, B, C, D, E)


116. Oral ferrous sulfate is the most appropriate treatment for


117. Iron is most efficiently absorbed from the diet as:


118. Vitamin B12 is required for:


119. Heparin acts as an anticoagulant by


120. Streptokinase causes clot lysis by


121. Warfarin is an oral anticoagulant of the coumarin type. It acts to


122. Mechanism of action of captopril:


123. The mechanism of action of digoxin:


124. All of the following are true about digitalis glycosides EXCEPT:


125. Heparin


126. Warfarin


127. Bile acid sequestering agent:


128. Inhibits the enzyme 3-hydroxy-3-methylglutaryl CoA reductase:


129. Megaloblastic anemia, due to decreased DNA synthesis and increased mRNA accumulation in bone marrow cells is caused by a deficiency of


130. Which ONE of the following drugs binds bile acids in the intestine, thereby preventing their return to the liver, via the enterohepatic circulation?


131. All of the following are TRUE about antiarrhythmic agents EXCEPT:


132. Digoxin actions and/or properties include all of the following EXCEPT:


133. Which ONE of the following drugs may be useful in the treatment of hypochromic microcytic anemia?


134. Diuretic used in-treatment of hypertension:


135. Causes activation of plasminogen to plasmin:


For Questions 136 and 137: Concerning the statements about antithrombotic drugs, select the ONE lettered heading that is most closely associated with it. USE EACH LETTER ONLY ONCE.

136. Parental administration provides immediate anticoagulation. (A, B, C, D, E)

137. Is strongly bound to plasma proteins. (A, B, C, D, E)


138. An inhibitor of sodium influx; useful in-treatment of-acute ventricular fibrillation and as a local anesthetic:


139. All of the following are attributes or properties of nitroglycerin EXCEPT:



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RENAL PHARMACOLOGY


140. Which ONE of the following is a carbonic anhydrase inhibitor which may produce systemic acidosis?


141. All of the following are "potassium sparer" diuretics EXCEPT:


142. All of the following would be categorized as "loop diuretics" EXCEPT:


143. Which ONE of the following would be LEAST likely to produce hypokalemia?


144. Which ONE of the following is MOST likely to produce hypokalemia, hyperglycemia, hyperuricemia and hypercalcemia.


145. Which ONE of the following would be LEAST likely to produce a systemic alkalosis?


146. Which ONE of the following is an aldosterone antagonist with natriuretic and potassium sparing properties?



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GASTROINTESTINAL PHARMACOLOGY


147. Which ONE of the following is NOT blocked by H1 receptor antagonists.


148. Which ONE of the following antacids would be MOST likely to disrupt acid-base balance?


149. Which ONE of the following is the antacid MOST likely to cause diarrhea?


150. Which ONE of the following would be LEAST likely to have antiemetic properties?


151. A small plastic disk for administration of scopolamine through the skin is available for the treatment of motion sickness. This approach


152. All of the following are correctly paired EXCEPT:


153. All of the following are effective as antidiarrheal agents EXCEPT:


154. Non-systemic antacid; saline laxative; may cause acid "rebound"; may interfere with absorption of other agents taken simultaneously:


155. Antisialagogue; antiemetic; useful in treatment of motion sickness; causes sedation:


156. Useful in ulcer therapy; acts primarily by H2 (histamine 2) receptor antagonism:


157. Effective in ulcer therapy; forms protective coating on mucosa; prevents digestive action of pepsin and acid; may cause constipation:


158. Which ONE of the following laxatives, when administered, would be MOST likely to produce a watery evacuation?



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RESPIRATORY PHARMACOLOGY


159. Your dental patient, on chronic therapy with propranolol, informs you that he/she is also now taking a drug for his/her bronchial asthma. Which ONE of the following would be MOST effective in this case?


160. Which ONE of the following bronchodilators would be expected to be clinically MOST effective in the presence of propranolol?


161. Which ONE of the following would be LEAST likely to cause histamine release?


162. Which ONE of the following would be contraindicated in an asthma patient?


163. While you are performing a dental procedure, your patient has a severe asthmatic attack. What would be the most judicious approach for this emergency?


164. Centrally-acting antitussive; non-opioid; may release histamine


165. All of the following are characteristic of opioid antitussives EXCEPT:


166. Characteristics of cromolyn include all of the following EXCEPT:


167. All of the following are useful in the treatment of bronchial asthma EXCEPT:


168. Which ONE of the following would have the MOST beta-2 adrenergic receptor selectivity?


169. All of the following are correctly paired EXCEPT:


170. All of the following are characteristics of opioid antitussives EXCEPT that they




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ANTIMICROBIAL AGENTS


171. All of the following are indications for prophylactic use of antibiotics in dental practice EXCEPT:


172. Penicillin V is used orally in dentistry in preference to penicillin G because:


173. Which ONE of the following antibiotics would be your first choice in treating common orodental infections in a patient allergic to penicillin?


174. Which ONE of the following antibiotics is useful in treating bone infections?


175. Which ONE of the following is an inhibitor of ergosterol synthesis and is useful in treatment of oropharyngeal candidiasis ?


For Questions 176 to 179: Match each of the following drugs listed below with the most appropriate description, using each letter only once.


176. Thymidine analog useful for topical treatment in the eye for herpes keratitis. (A, B, C, D, E)

177. Binds to ergosterol to disrupt fungal cell membranes; can produce renal toidcity. (A, B, C, D, E)

178. Used for prophylaxis of influenza A; stimulates dopamine release. (A, B, C, D, E)

179. Converted to its triphosphate which selectively inhibits viral DNA polymerase; used in treatment of genital herpes. (A, B, C, D, E)


180. Which ONE of the following is effective against gram positive bacteria:


181. Which ONE of the following is available as a topical oral form (troche) for treatment of oropharyngeal candidiasis ?


182. All of the following are true about Amphotericin B EXCEPT:


For Questions 183 to 185: Match each of the statements below to the most appropriate antiviral agent

183. Guanine analog converted to triphosphate which selectively inhibits viral DNA polymerase. Useful in treatment of genital herpes. (A, B, C, D, E)

184. Metabolized to triphosphate which inhibits reverse transcriptase. Inhibits growth of HIV. (A, B, C, D, E)

185. Useful in prophylaxis of Influenza A and treatment of Parkinsonism. (A, B, C, D, E)


For Questions 186 to 188: For each of the following infections, choose the most appropriate combination for therapy listed below.


186. Pneumocystis carinii pneumonia (A, B, C, D)

187. Tuberculosis (A, B, C, D)

188. Bacterial endocarditis (A, B, C, D)


189. Which ONE of the following binds to ergosterol in fungal cell membranes, thus disrupting membrane function.


190. All of the following antiviral agents are matched with the appropriate use EXCEPT:


191. Which ONE of the following is an inhibitor of ergosterol synthesis which is available for treatment of dermatophytes, vaginal and oropharyngeal candidiasis:


192. Methotrexate and trimethoprim used orally as antibacterial or anticancer agents may cause megaloblastic anemia together with leukopenia and reduced numbers of platelets by




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CANCER CHEMOTHERAPY and IMMUNOPHARMACOLOGY


193. All of the following compounds are immunosuppressants EXCEPT:


194. All of the following are correctly paired EXCEPT:


195. The agent MOST prone to induce oral pain symptoms simulating pulpal pain or toothache is


196. Oral bleeding during chemotherapy may result from


For Questions 197 to 200: Match each chemotherapeutic agent listed below with its major mode of action, using each letter only once.


197. Alkylation of N7 of guanine, resulting in cross-linking of DNA. (A, B, C, D, E)

198. Intercalation in DNA. (A, B, C, D, E)

199. Catalyzes breakdown of an essential metabolite required by some leukaemic cells. (A, B, C, D, E)

200. Cross-linking of DNA without alkylation. (A, B, C, D, E)


For Questions 201 to 203: For each of the following statements, choose the most appropriate drug from the list below.


201. Synthetic compound that stimulates T cell-mediated immunity. (A, B, C, D)

202. Natural product that inhibits T helper cells. (A, B, C, D)

203. Antimetabolite that blocks both cell-mediated and humoral immunity. (A, B, C, D)


For Questions 204 to 206: For each of the numbered descriptions, match the most appropriate lettered drug listed below.


204. Converted to a nucleotide which inhibits thymidylate synthetase. (A, B, C, D, E)

205. Intercalates into the DNA molecule, inhibiting DNA and RNA synthesis. (A, B, C, D, E)

206. Inhibits dihydrofolate reductase thereby reducing the provision of one carbon units for synthesis of nucleic acids and proteins. (A, B, C, D, E)


For Question 207 to 209: For each of the following adverse reactions, match the most appropriate drug listed below.


207. Cumulative cardiac toxicity. (A, B, C, D, E)

208. Pulmonary toxicity, sometimes leading to pulmonary fibrosis. (A, B, C, D, E)

209. Very mild side effects, useful for therapy of breast cancer. (A, B, C, D, E)


210. All of the following statements about immunosuppressive agents are true EXCEPT:


211. Which ONE of the following is an estrogen receptor blocker used in treatment of estrogen-dependent breast cancer:




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ENDOCRINE PHARMACOLOGY


212. All of the following are true about levothyroxine EXCEPT:


213. All of the following are true about insulin EXCEPT:


214. Chlorpropamide:


215. Which ONE of the following is an antiestrogen, useful as an ovulation-inducing agent?


216. Which ONE of the following is a drug which binds to hydroxyappetite, thus inhibiting bone turnover and is useful in treatment of Paget's Disease ?


217. Glipizide:


218. Which ONE of the following is a weak testosterone analog useful in treatment of endometriosis


219. All of the following factors increase the need for insulin in a diabetic patient EXCEPT:


220. All of the following are true about levothyroxine EXCEPT:


221. All of the following are true about estrogens EXCEPT:


222. All of the following statements are true regarding prednisone EXCEPT:


223. All of the following statements regarding androgens are true EXCEPT:




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TOXICOLOGY


224. "Anaphylactoid" reactions to drugs such as local anesthetics are


225. Overdose with acetaminophen may be lethal because of the effect of the drug on which organ?


226. Which ONE of the following interventions has been found to significantly improve the outcome of ethylene glycol ingestion?


227. The harmful effects associated with the following intoxications result from generation of toxic metabolites from the parent compound EXCEPT:


228. The MOST serious result of acetaminophen overdose is


229. Each of the following approaches utilized in drug overdose situations has the effect of reducing the quantity of drug in the circulation EXCEPT:


230. Which ONE of the following interventions is commonly used in ethylene glycol (antifreeze) ingestion to lessen the effects of the ingestion?




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MISCELLANEOUS


231. Which ONE of the following may elicit histamine release?


232. A prescription calls for the use of one tablespoon of a liquid preparation four times a day. This is equivalent to a total daily dose of


233. All of the following are true of the use of drugs in geriatric patients EXCEPT:


234. How many grams of glucose would be required to prepare 250ml of a 5% glucose solution?


235. In an emergency you reach for a vial of epinephrine labeled "Epinephrine 1:1000". You administer 0.25ml of the contents. How many mg of epinephrine did you use?


For Questions 236 and 237:

The suggested starting dose of a drug which you are planning to use for your patient is 2.5 mg/Kg of body weight of the patient. The patient weighs 70 Kg.


236. How many mg of the drug will be required?


237. The drug in question is available in solution form and is labeled "2.5% sterile solution". How many ml of this 2.5% solution will you need to achieve the 2.5mg/Kg starting dose for your 70 Kg patient?


238. Which ONE of the following would have the LEAST "effective antiseptic action"?


239. Both gram positive and gram negative bacteria are sensitive to all of the following antiseptics and disinfectants EXCEPT:


240. Which ONE of the following is a phenol derivative, a component of dental pastes, an analgesic, and an active ingredient in oil of cloves?


241. How many grams of NaCl would be required to prepare 350 milliliters of physiological saline"?


242. Your dental patient experiences a severe asthmatic attack while in your office. You reach for an ampoule of epinephrine labeled "EPINEPHRINE 1:1000" and you administer 0.25 milliliter of this preparation. How much epinephrine did you give?


243. The package insert which accompanies the new drug which you plan to use lists a suggested starting dose of 5 milligrams per kilogram of body weight. The patient weighs 75 kilograms. How many milligrams of this drug will be needed?


244. Many physiological functions involved in drug clearance and distribution are immature at birth. Immaturity of which ONE of the following factors would tend to cause a faster clearance of the drug from the infant than in the mature person?


245. All of the following are actions of histamine EXCEPT:


246. All of the following are H2 receptor blockers EXCEPT:


247. All of the following are characteristic of fluoride EXCEPT:


248. All of the following are correctly paired EXCEPT:


249. Among the actions of histamine, you would include all of the following EXCEPT:


250. All of the following abbreviations are correct on prescriptions EXCEPT:


251. In the elderly patient, changes in the ratio of body fat/lean body weight will cause a lipid-soluble drug to




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last update: July, 1997