Prepared by M.L. Thompson, Ph. D., Dept. of General Dentistry, Tufts Dental School
C:\Documents and Settings\mthomp01\Desktop\pharm2007 shortcuts\Boards2005.doc
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Pharmacology Board Review
2005
This list of questions and topics is the result of going through about 10
years worth of old Board Exams in Pharmacology, cutting out all the
questions, categorizing them into topic areas (e.g. antibiotics, local
anesthetics, etc.), and then further grouping them into the type of
information about a category of drugs that was being asked for.
When you do this, you see that many exams repeat questions
(sometimes they reword them a little bit to make them look
different!), but in actuality it is possible to get a feel for the various
facts that you are expected to know, and that there aren't that many
of them. As you go through this handout, you will see that I point out
to you the major facts that tend to get asked over and over again for
the various major drug categories, and I also give you actual
examples of questions (and the reworded versions), as well as the
correct answer. In many cases, I have written out a detailed
explanation of the answer, just to enlighten you further. So good
luck and enjoy.
The downside is that these questions are from old Board exams. Some of
the material is obviously dated, as drugs fall out of fashion, newer
drugs get used instead of older drugs, etc. At the beginning of each
section I will try to indicate some things that have changed and thus
you may want to place less emphasis on some of the questions
here.
On a positive note, there used to be a separate pharmacology section of
100 questions. Nowadays, you might see 25-30 in some versions,
other versions less. Unfortunately, they still can draw from the realm
of pharmacology so you gotta review it all. However, the good thing
is that since they ask fewer questions, and since they are trying to
ask more clinically relevant stuff, if you really focus your efforts on
analgesics, antibiotics, and anesthetics, you should be covered for
the majority of questions.
There are always going to be some random, unpredictable questions that
means you have to review more if you want to do really well. Maybe
you will luck out, and these will be the questions they are testing
and they don’t count.
Local Anesthetics
I. The largest category of LA questions focuses on your ability to
distinguish amide LAs from esters:
(This I hope is deemphasized,
since amide local anesthetics are used almost exclusively now)
esters = procaine, tetracaine, cocaine. All the rest are amides: lidocaine,
mepivacaine, bupivacaine, prilocaine, dibucaine. They also require
you to know that amides are metabolized in the liver, esters mainly by
esterases in plasma. An infrequent question asks which class of
drugs has the most consistency in structure . LAs are the drug group
most consistent in drug structure, because LAs are either amides or
esters, differing only in their structure in the intermediate chain (its
either an amide or an ester) that connects the aromatic group to the
secondary or tertiary amino terminus.
II. The next category of questions has to do with toxic reactions to local
anesthetics, either due to high systemic levels of local anesthetics in
general (cardiovascular collapse due to myocardial depression,
hypotensive shock) or to a specific agent such as prilocaine, which
causes methemoglobinemia.
III. A 3rd class of questions are aimed at your knowledge of the
mechanism of action of local anesthetics: they prevent the generation
of nerve impulses by interfering with sodium transport into the neuron.
IV. The last most frequent type of question regarding local anesthetics
has to do with issues regarding absorption of local anesthetics.
Remember, only the non-ionized (or free base form) form can
penetrate tissue membranes. Inflamed tissue has a lower than
normal pH, which decreases the amount of non-ionized form available
to penetrate.
V. Usually at least one question comes up asking you to calculate how
many mg of local anesthetic a patient has received, e.g. how many mg
of lidocaine in 1.8 ml of a 2% lidocaine solution? 2% lidocaine is 20
gm/100 ml or 20 mg/1 ml, so 36 in 1.8 ml.
1. Which of the following is a local anesthetic subject to inactivation by
plasma esterases?
a. Procaine
b. Lidocaine
c. Prilocaine
d. Mepivacaine
e. Bupivacaine
(a) Proccaine is the only ester listed -- all the rest are amides
2. Procaine differs from lidocaine in that
a. Procaine is a p-aminobenzoic acid ester and lidocaine is not
b. Lidocaine is a meta-aminobenzoic acid ester and procaine is not
c. The duration of action of procaine is longer than that of an equal
total dose of lidocaine
d. Procaine hydrochloride is metabolized into diethylaminoethanol
and benzoic acid.
(a) this is basically a true-false type question. (a) is the only
statement that is true
3. Which of the following local anesthetics would be expected to produce
a sensitization reaction in a patient allergic to lidocaine?
a. Mepivacaine
b. Tetracaine
c. Procaine
d. Prilocaine
e. Dibucaine
i.
(a), (b) and (c)
ii.
(a), (d) and (e)
iii. (b) and (c) only
iv. (b), (c) and (d)
v.
(b), (d) and (e)
(ii) another ester vs. amide type identification question.
Lidoccaine is an amide, thus other amides will be cross-
allergenic - mepivacaine, prilocaine and dibucaine are the other
amides listed. Procaine and tetracaine are esters and will not be
cross-allergenic.
9. The hydrolysis of procaine occurs mainly in the
a. Liver
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