NBDE Part II – Pharm – Tufts

What local anesthetics are Amides?
All the rest

Where are Esters metabolized?
Plasma

Where are Amides metabolized?
Liver

Short acting LAs
Procaine

Moderate acting LAs
Prilocaine, mepivacaine, lidocaine

Long acting LAs
Bupivacaine, tetracaine, etidocaine

What local anesthetics are Esters?
Procaine
Tetracaine

The duration of lidocaine would be increased in the presence of what medication?
Propanolol – competes for the same enzyme in the liver

Methemoglobinemia is a possible side effect of what local anesthetic?
Prilocaine

What disease would make a patient hypersensitive to the epinephrine in local anesthetic?
Graves disease. Graves disease causes hyperthyroidism -> hypermetabolic -> more sensitive to epinephrine

What is the only local anesthetic that is a vasoconstrictor rather than a vasodilator?
Cocaine

Does the ionized or non-ionized form of LA enter the nerve cell more readily?
Non-ionized form (aka free base)

Does a low or a high pH promote the non-ionized (free base) form?
A low pH will promote the ionized form of a molecule – harder to enter the cell

Which penicillin has the best gram-negative spectrum?
Ampicillin

Which drugs are cross-allergenic with penicillin (will also react with patients who have a penicillin allergy)?
Cephalosporins
Ampicillin

Which drugs are not cross-reactive with penicillin?
Erythromycin, Clindamycin

Which penicillin is useful against penicillinase-producing bugs such as staphylococcus?
Dicloxacillin

What antibiotic drug is specific for Pseudomonas infections?
An extended spectrum such as carbenicillin

Mechanism of action of bacteriocidal antibiotics – give an example of one
Inhibit cell wall synthesis – Penicillin

Mechanism of action of Bacteriostatic antibiotics – give an example of one
Interfere with protein synthesis on bacterial ribosomes – Tetracycline

Mechanism of action of antifungals – give an example of one
Bind to ‘ergosterol’ in fungal cell walls to weaken the wall – Nystatin

Mechanism of action of Bacteriostatic antibiotics (sulfonamides)
Compete with PABA in folic acid synthesis, thus resulting in folic acid deficiency

What are symptoms seen during allergic reactions to penicillins?
Dermatitis, stomatitis, bronchoconstriction and cardiovascular collapse

What agent produces GI upset and pseudomonas colitis?
Clindamycin

Which agents are most likely to cause superinfections?
broad spectrum agents such as tetracyclines

Which agents are least likely to cause superinfections?
Narrow spectrum agents such as penicillin G

Aplastic anemia is associated with which antibiotic?
chloramphenicol

Liver damage or hepatotoxicity is assiciated with which antibiotic?
Tetracycline

Which drug is associated with allergic cholestatic hepatitis?
Erythromycin estolate

Which two antibiotics cancel each other out due to opposing mechanisms of action?
Tetracycline and penicillin

What affect does the drug Probenecid have on Penicillin?
alters the rate of renal clearance

The effectiveness of what antibiotic is altered by concurrent ingestion of antacids or dairy products?
Tetracyclines

Broad spectrum antibiotics enhance the action of coumarin anticoagulants because of what action?
The reduction of vitamin K sources

What antibiotic decreases the effectiveness of oral contraceptives? (there are more than one, but give the most commonly known one)
Ampicillin

Why do drugs like ampicillin decrease the effectiveness of oral contraceptives?
They suppress the GI flora involved in the recycling of active steroids from bile conjugates, leading to more rapid excretion of the steroids from the body

Macrolides, such as erythromycin, inhibit the metabolism of drugs such as what?
Seldane and Digoxin

What is a drug commonly used to treat herpes?
Acyclovir

What two drugs are commonly used drugs for treating candidiasis?
Fluconazole or Ketoconazole

What is the difference between Penicillin V and Penicillin G?
PenG is more sensitive to acid degradation and thus is usually injected rather than taken orally

Which antibiotic has a broader gram-negative spectrum than penicillin G?
Ampicillin – considered an extended spectrum form of penicillin

Give two examples of Benzodiazepine drugs
Diazepam (valium), Chlordiazepoxide

How do Benzodiazepine drugs work?
Benzodiazepines work by increasing the efficiency of a natural brain chemical, GABA, to decrease the excitability of neurons. This reduces the communication between neurons and, therefore, has a calming effect on many of the functions of the brain.

What are the advantages of benzodiazapines over barbiturates?
Less addiction potential, less profound CNS depression, larger therapeutic index, less respiratory depression

Do barbiturates have an analgesic effect?
No

What is a main barbiturate used? Name one other one
Thiopental, phenobarbital

Why is thiopental a short acting drug?
Because it is doesn’t work when it is not actually in the brain. It enters the brain rapidly then exits rapidly.

Why does a barbiturate overdose kill you?
Respiratory depression

Barbiturates are contraindicated in patients with which disease?
Porphyria – barbs enhance porphyrin synthesis and thus aggravate the disease

What is an adverse side effect of thiopentol?
Increased secretions – salivation, etc

What are the major antipsychotic drugs asked about?
Phenothiazines, Chlorpromazine, Clozapine and Haloperidol

How do antipsychotic drugs work?
Block dopamine receptors in the brain

What are the major side effects of antipsychotic drugs?
Anticholinergic effects, Tardive Dyskinesia (uncontrolled body movements)

Clozapine blocks dopamine receptors and what other type of receptors?
Serotonin receptors

What is an advantage of clozapine?
Doesn’t cause tardive dyskinesia

What is the second most commonly used type of antidepressant?
TCA’s – Tricyclic antidepressants

What are two TCA drug names?
Imipramine and Amitriptyline

MAOI (Monoamine oxidase inhibitors) drugs are also used as antidepressants – Name two
Tranylcypromine and Phenylene

What is the most commonly used type of antidepressant?
SSRI’s – Selective serotonin reuptake inhibitors

Name an SSRI
Fluoxetine (prozac)

How do Antidepressant drugs work?
Blocks amine reuptake or alterations of receptor number (SSRI’s block serotonin reuptake selectively)

What are common side effects of Antidepressants?
Anticholinergic – similar to atropine

What is the drug of choice for the manic phase of manic depression?
Lithium

Which drug is well known to cause gingival hyperplasia?
Dilantin – an anti-convulant

What are the side-effects of anti-inflammatory drugs?
Immunosuppression – could cause some diseases like tuberculosis to go systemic. Gastric ulcers, acute adrenal insufficiency, osteoporosis, hyperglycemia, redistribution of body fat

What are the three things H1 antihistamines are used for? And name the drug used in each situation
1. Treating dermatologic manifestations of an allergic response – Chlorpheniramine
2. Preoperative medication for sedation, antiemetic properties, anticholinergic effects – Promethazine
3. For controlling the symptoms of parkinsonism – Diphenhydramine

What are H2 antihistamines used for?
Reduce gastric acid secretion – Cimetidine

What are two common drugs used to treat trigeminal neuralgia?
Carbamazepine and Phenytoin

What is a risk associated with using oral contraceptives?
Thromboembolisms

Name three drugs that will increase sympathetic activity by stimulating the release of stored NE
Amphetamine
Tyramine
Ephedrine

What drug do you treat a benzodiazapine overdose with?
Flumazenil

Name the two most common Benzodiazepines
Diazepam
Chlordiazepoxide

Name the two most common Barbiturates
Thiopental
Phenobarbital

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