Farm Final :) Flashcards
1
Q
______: Derived from microorganisms ex: penicillin
A
Antibiotics
2
Q
_______: Ability to kill bacteria (irreversible)
A
Bactericidal
3
Q
_______: Synthetic (made in a laboratory) (ex: Sulfonamides)
A
Antibacterial agents
4
Q
______: Range of anti-infective properties
A
Spectrum
5
Q
______: Ability of organism to be unaffected by an anti-infective agent. (May be natural or acquired)
A
Resistance
6
Q
_______: Ability to inhibit the growth of bacteria. (reversible)
A
Bacteriostatic
7
Q
A ____ may be narrow or wide.
A
spectrum
8
Q
________: Appearance of a new infection with other than the original organism while the patient is taking an antimicrobial agent. An example of this would be candidiasis as a result of taking tetracycline.
A
Suprainfection (super infection)
9
Q
The word stat on a prescription means
a. before meals.
b. at bedtime.
c. immediately.
d. every.
A
c. immediately.
The word stat on a prescription means immediately (now). The abbreviation ac means before meals, hs means at bedtime, and q means every.
10
Q
On a prescription, the directions to the patient are preceded by
a. Rx.
b. Sig.
c. #.
d. Disp.
A
b. Sig.
* Sig. is the abbreviation for the Latin word signa, or write. This word precedes the instructions to the patient. Rx means take thou and precedes the prescription instructions, # denotes the number of tablets, capsules, and so forth to be dispensed. Disp. is short for dispense and precedes the amount to be dispensed, analogous to #.*
11
Q
______(Cleocin) is an antibacterial agent used in patients who are penicillin-allergic. Its mechanism of action is ______ or ____ depending on the dose. It _____ bacterial protein synthesis and retards bacterial growth and reproduction.
A
Clindamycin; bactericidal or bacteriostatic; inhibits
12
Q
_____ occurs when the effect of two agents used together is lesser.
A
Antagonism
13
Q
The mechanism of action for ______ inhibits bacterial cell wall synthesis so it is _______.
A
penicillin; bacteriocidal
14
Q
_____ have a 10% cross-sensitivity with penicillin.
A
Cephalosporins
15
Q
______(Cleocin) is an antibacterial agent used in patients who are penicillin-allergic. Its mechanism of action is ______ or ____ depending on the dose. It _____ bacterial protein synthesis and retards bacterial growth and reproduction.
A
Clindamycin; bacteriacidal or bacteriistatic; inhibits
16
Q
What antibacterial agents are the first line of treatment?
A
Penicillin and Amoxicillin
17
Q
What antibacterial agent is the first line of treatment when a ‘cilin cannot be used?
A
Clindamycin
18
Q
What is the adjunctive agent used with ‘cilin antibacterial agents?
A
metronidazole
19
Q
True or False Bacteriostatic and bactericidal antibiotics should not be used together because its effectiveness will be reduced.
A
True
20
Q
Penicillin is a _____ -spectrum antibiotic, whereas, amoxicillin is a ________ -spectrum antibiotic
A
narrow; broad
21
Q
______ is bactericidal and causes bacterial DNA to lose its structure. It is important that alcohol is not consumed with this antibiotic.
A
Metronidazole (Flagyl)
22
Q
A patient care consideration for ________ is pseudomembranous colitis. This is associated with C. dif.
A
clindamycin
23
Q
Nutritional or herbal supplements
a. carry the U.S. Food and Drug Administration (FDA) approval for disease states.
b. are not drugs.
c. can cause adverse effects.
d. will not interact with other drugs the patient may be taking.
A
c. can cause adverse effects.
* Nutritional or herbal supplements are quite capable of causing adverse effects. The majority of nutritional or herbal supplements do not carry FDA approval for treating disease states. These supplements are drugs and can cause adverse effects and interact with different drugs.*
24
Q
Which type of drug name usually begins with a lowercase letter?
a. Brand name
b. Code name
c. Generic name
d. Trade name
A
c. Generic name
* Before any drug is marketed, it is given a generic name that becomes the “official” name of the drug. Each drug is assigned only one generic name selected by the U.S. Adopted Name Council, and the name is not capitalized. The brand name is equivalent to the trade name and is capitalized. Although the brand name is technically the name of the company marketing the product, this term is often used interchangeably with the trade name. The code name is the initial term used within a pharmaceutical company to refer to a drug while it is undergoing investigation and is often a combination of capital letters and numbers, the letters representing an abbreviation of the company name.*
25
Which of the following is true concerning generic and trade names of drugs?
a. A drug may only have one generic name and one trade name.
b. A drug may only have one generic name, but it may have several trade names.
c. A drug may have several generic names, but it may only have one trade name.
d. A drug may have several generic names and several trade names.
b. A drug may only have one generic name, but it may have several trade names.
26
The federal body that determines whether a drug is considered a controlled substance and to
which schedule it belongs is the
a. Food and Drug Administration (FDA).
b. Federal Trade Commission (FTC).
c. Drug Enforcement Administration (DEA).
d. U.S. Pharmacopeia (USP).
c. Drug Enforcement Administration (DEA).
27
Which federal regulatory agency decides which drugs require a prescription and which drugs may be sold over-the-counter (OTC)?
a. FDA
b. OSHA
c. FTC
d. DEA
a. FDA
28
Which of the following is a schedule II controlled substance?
a. Heroin
b. Propranolol
c. Amphetamine
d. Dextropropoxyphene (Darvon)
c. Amphetamine
* Amphetamine, oxycodone, morphine, and secobarbital are all schedule II controlled substances. Heroin is a schedule I substance. Propranolol is a nonscheduled prescription drug. Dextropropoxyphene is a schedule IV substance.*
29
A drug is defined as a biologically active substance that can modify
a. the environment.
b. the pH of tissue.
c. cellular function.
d. immune response.
c. cellular function.
30
Administering a drug of greater potency is better because drugs of greater potency do not
require as high a dose.
a. Both parts of the statement are true.
b. Both parts of the statement are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.
d. The first part of the statement is false; the second part is true.
31
Cannabis is falls under what level of scheduled controlled substances?
A) schedule V
B) schedule II
C) schedule III
D) schedule I
D) schedule I
32
Which of the following statements is true regarding the therapeutic index (TI) of a drug?
a. A drug with a large TI is more dangerous than a drug with a small TI.
b. The formula for TI is ED50/LD50.
c. ED50 is 50% of the effective clinical dose.
d. TI is the ratio of the median lethal dose to the median effective dose.
d. TI is the ratio of the median lethal dose to the median effective dose.
33
Which of the following statements is true concerning the mechanism of action of drugs?
a. Drugs are capable of imparting a new function to the organism.
b. Drugs either produce the same action as an exogenous agent or block the action of an exogenous agent.
c. Drugs either produce the same action as an exogenous agent or block the action of an endogenous agent.
d. Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent.
d. Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent.
34
When a drug has affinity for a receptor and produces no effect, it is called a(n)
a. agonist.
b. competitive antagonist.
c. competitive agonist.
d. physiologic agonist.
b. competitive antagonist.
35
Which of the following is not a subject of pharmacokinetics?
a. Physiologic action of drugs
b. Metabolism of drugs
c. Elimination of drugs
d. Absorption of drugs
a. Physiologic action of drugs
36
In comparing two drugs, the dose-response curve for the drug that is more efficacious would
a. be closer to the y-axis.
b. be farther from the y-axis.
c. have a greater curve height.
d. have a higher median effective dose (ED50)
c. have a greater curve height.
37
Increasing the pH of a solution will cause
a. a greater percentage of a weak base in the solution to be in the ionized form.
b. a greater percentage of a weak acid in the solution to be in the un-ionized form.
c. the hydrogen ion concentration to increase.
d. a greater percentage of a weak base in the solution to be in the un-ionized form.
e. no change in the relative ionization of weak acids or weak bases.
d. a greater percentage of a weak base in the solution to be in the un-ionized form.
38
The movement of a drug from one site in the body to other sites is called
a. distribution.
b. disruption.
c. dispersion.
d. active transport.
a. distribution.
39
\_\_\_\_\_\_ can be bactericidal or bacteriostatic depenting on the dose. The mechanism of action for this antibacterial agent is the inhibition of bacterial protein synthesis.
It is used in the treatment of upper respiratoy infections.
Its patient care consideration is that it can cause ventricular \_\_\_\_\_\_\_.
An example of this agent is ___________ (Zithromax).
Macrolide; arrhythmias; azithromycin
40
If a drug displays zero-order elimination kinetics
a. elimination increases as the dose of the drug is increased.
b. a constant amount is eliminated per unit time.
c. the drug is not eliminated and is retained in the body.
d. the elimination of the drug cannot be predicted mathematically.
b. a constant amount is eliminated per unit time.
41
Application of a transdermal patch is an example of parenteral administration because the
drug is delivered in a manner that bypasses the gastrointestinal tract.
a. Both parts of the statements are true.
b. Both parts of the statements are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.
a. Both parts of the statements are true.
42
The route of administration of a drug affects
a. both the onset and duration of response.
b. the onset, but not the duration of response.
c. the duration, but not the onset of response.
d. neither the onset nor the duration of response.
a. both the onset and duration of response.
43
\_\_\_\_\_ are bacteriostatic agents that inhibit bacterial protein synthesis. It is used to treate dermatologic conditions and periodontitis.
Doxycycline and minocycline are examples of this agent.
(Not really used in dentistry anymore)
Tetracyclines
44
An adverse side effect of tetracycline and sulfanoamides is \_\_\_\_\_\_\_\_.
Photosensitivity
45
Calcium, iron, aluminum, magnesium and cations can \_\_\_\_\_\_the drug availability of \_\_\_\_\_\_\_\_.
reduce; tetracyclines
46
Drugs that are weak electrolytes will cross body membranes best when they are (1) nonionized, (2) ionized, (3) polar, (4) nonpolar, (5) lipid soluble, (6) water soluble.
a. 1, 3, 5
b. 1, 3, 6
c. 1, 4, 5
d. 1, 4, 6
e. 2, 4, 5
c. 1, 4, 5
47
Tetracyclines used in dentistry are _____ and \_\_\_\_\_.
Artidox (doxycycline hyclate gel) and Arestin (minicycline microspheres)
48
\_\_\_\_\_ are antibacterial agents that are very similar to penicllin. It inhibits bacteria cell wall synthesis, therefore, it is \_\_\_\_\_.
It is organized into "generations" based on its width of spectrum.
Cephalosporins; bactericidal
49
\_\_\_\_\_ have a 10% cross-sensitivity with penicillin.
Cephalosporins
50
\_\_\_\_\_\_ are bacteriacidal agents that antagonize bacterial DNA and promotes breakage of the DNA molecule.
Examples of this agent are Ciproflaxacin (Cipro) and Levoflaxacin.
Notable advese effect associated with this drug is spontaneous rupture of the \_\_\_\_\_\_,and insomnia
Fluroquinolones; achilles tendon
51
If one dose of a drug is administered and the drug’s half-life in the body is 3 hours, what percentage of the drug would be left after four half-lives?
a. 50%
b. 6.25%
c. 2%
d. Insufficient information to determine
b. 6.25%
* The half-life is the time required for a drug level to fall to one half of its concentration. The drug concentration would go to 50% → 25% → 12.5% → 6.25% in four half-lives. The information given is more than sufficient to answer the question. One needs merely to count the number of half-lives and divide the percentage drug in half for every half-life passed since the drug was administered.*
52
\_\_\_\_ are a \_\_\_\_\_antibacterial agent that inhibits bacterial folic acid synthesis.
It is not as effective when compared to other antibacterial agents.
Sulfonamides; bacteriostatic
53
One dose of a drug is administered that has a half-life of 8 hours. Assuming first-order
kinetics, how much time is needed for this drug to be over 96% eliminated from the body?
a. 8 hours
b. 40 hours
c. 60 hours
d. 120 hours
ANS: B
*Assuming first-order kinetics, 40 hours would be required for this drug to be over 96% eliminated from the body. Five half-lives are needed to reduce the levels of a drug to 3.125% of the original levels, or eliminate over 96%. For a drug with an 8-hour half-life, this amounts to five half-lives x 8 hours per half-life, or 40 hours.*
54
\_\_\_\_\_ is when 2 antibodies are used together to increase\_\_\_\_\_.
An example of this is Bactrim/Septra.
Synergism
55
The half-life of a drug is most related to its
a. onset.
b. duration.
c. safety.
d. time to peak concentration.
b. duration
56
What of the following choices is considered the safest, least expensive, and most convenient
route for administering drugs?
a. Inhalation
b. Rectal
c. Oral
d. Subcutaneous
c. Oral
57
Advantages of oral administration of a drug include all the following except
a. large surface area for drug absorption.
b. many different dose forms that may be administered orally.
c. more predictable response than intravenous administration.
d. the simplest way to introduce a drug into the body.
c. more predictable response than intravenous administration.
58
"RIPE", an acronym used to help recall drugs associated with ____ stands for \_\_\_\_\_, \_\_\_\_\_\_, \_\_\_\_\_\_\_, \_\_\_\_\_\_\_?
Tuberculosis
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
59
What type of administration involves the injection of solutions into the spinal subarachnoid
space?
a. Intrathecal route
b. Intraperitoneal route
c. Intravenous route
d. Intradermal route
a. Intrathecal route
60
Drug preparations may be administered for local or systemic effects. Which is an example of a
dose form used for a local effect?
a. Sublingual tablet
b. Transdermal patch
c. Ophthalmic ointment
d. Subcutaneous injection
c. Ophthalmic ointment
61
Which organ is involved in the first-pass effect after **oral** administration of a drug?
a. Kidney
b. Lungs
c. Liver
d. Spleen
c. Liver
62
\_\_\_\_ is an antifungal agent whose mechanism of action is to bind to ergosterol in membranes. It is topical and is not absorbed into general circulation.
It is used to treat skin, oral, and vaginal \_\_\_\_\_.
Nystatin; candidiasis
63
Azoles are antifungal agents that inhibit ergosterol via fungal P450 enzymes. An example of an Azole is _____ (fluconazole).
Adverse reactions are headache and potential for serious _____ damage.
Diflucan; liver
64
Which drug is eliminated with zero-order kinetics?
a. Probenecid
b. Aspirin
c. Allopurinol
d. Penicillin
e. Naproxyn sodium
b. Aspirin
65
With zero-order kinetics, the
a. same amount of drug is metabolized and eliminated from the body per unit of time regardless of dose.
b. same percentage of drug is metabolized and eliminated from the body per unit of time.
c. drug is irreversibly bound to receptor sites.
d. drug is not bound to receptor sites.
a. same amount of drug is metabolized and eliminated from the body per unit of time regardless of dose.
## Footnote
*With high doses, the metabolism of the drug cannot increase and the duration of action of the drug can be greatly prolonged. Zero-order kinetics occurs because the enzymes that metabolize these drugs can become saturated at usual therapeutic doses. If the dose of the drug is increased, the metabolism cannot increase above its maximum rate.*
66
\_\_\_\_\_\_ are used in the treatment of herpes simplex infections and varicella zoster infections. Its mechanism of action incorporates into and terminates viral DNA.
Examples of this type of agent are acyclovir are Valtrex.
Antiviral agents
67
Nucleoside Reverse Transcriptase Inhibitors and Non-Neucleoside Reverse Transcriptase Inhibitors are antiviral agents used to treat \_\_\_\_\_.
HIV
68
\_\_\_\_ are used for the treatment of HIV viral infections. The mechanism of action inhbits the enzyme converting viral RNA to DNA. (May cause oral ulcers.)
\_\_\_\_\_ inhibitors decrease the production of viral proteins in an HIV postive host. (May buccal mucosa ulcerations.)
RT inhibitors; Protease inhibitors
69
Neuraminidase Inhibitors are used to treat \_\_\_\_\_\_. This antiviral agent is moderately effective.
An example of this is Tamiflu.
infuenza
70
Gastric Pathologies are treated by either blocking ________ receptors in the stomach wall, inhibiting _______ at the parietal cell in the stomach wall, or by simply taking an \_\_\_\_\_\_.
histamine-2; proton-pump; antacid
71
The mechanism of action of the Proton-Pump inhibitor is to inhibit the action of the "proton pump" at the ______ in the stomach wall.
parietal cell
72
Gastric pathologies are realated to the presence of \_\_\_\_\_\_\_\_
Helicobacter pylori (H. Pylori)
(this bacereia causes stomach ulcers)
73
The ___ is used for short-term treatment of active duodenal ulcers, GERD, and erosice esophagitis.
PPI
74
Gastroesophageal Reflux Disease (GERD) caused when contents of the stomach "\_\_\_\_\_\_" into the esophagus leading to _______ tissue damge.
reflux (spill); esophageal
75
Histamine-2 receptors are responsible for which bodily function?
Stimulating gastric acid secretion
76
The mechanism of action for the histamine-2 receptor antagonist is to block _______ receptors in stomach wall and decrease acid production.
histamine-2
77
\_\_\_\_\_\_ end with 'ine.
Histamine-2 receptors
cimetidine (Tagament)
famotidine (Pepcid)
nizatidine (Axid)
ranitidine (Zantac)
78
\_\_\_\_\_\_end with 'prazole and may cause flatulence and halitosis.
Proton-Pump Inhibitors
omeprazole (Prilosec)
lansoprazole (Prevacid)
rabeprazole (Aciphex)
esomeprazole (Nexium)
pantoprazole (Protonix)
79
Tums is an example of an ____ that neutralizes stomach acid preventing the absorption of Ca. In excess, this can cause kidney stones.
antacid
80
Antacids provide temporary symptomatic relief of hyperacidity, but their use can cause constipation, diarrhea and \_\_\_\_\_\_\_\_\_.
rebound hyperacidity
81
H+/K+ ATPase is in reference to what system?
PPI
82
\_\_\_\_\_ is defined as a reversible airway obstruction due to inflammation which causes a reduction in the ability to exhale air from the lungs.
Asthma
83
\_\_\_\_\_\_\_ and ______ are two types of Chronic Obstructive Pulmonary Disease (COPD) which are considered irreversible airway obstructions.
Emphysema; Chronic Bronchitis
84
\_\_\_\_\_\_ is a type of COPD where alveolar destruction occurs.
Emphysema
85
\_\_\_\_\_\_ another type of COPD, results in chronic inflammation of the airways and excessive sputnum production.
Chronic Bronchitis
86
Which of the following agents is the drug of choice for an early dental infection unless the patient is allergic to it?
a. Erythromycin
b. Clindamycin
c. Penicillin
d. Metronidazole
c. Penicillin
* Penicillin is the drug of choice unless the patient is allergic to it. Amoxicillin is most often used because it is less irritating to the stomach than other drugs and can be taken with food or milk. In patients allergic to penicillin, alternatives might include erythromycin or clindamycin. When the infection is at the mixed stage, agents effective against either gram-positive or anaerobic organisms may be successful. Metronidazole is effective for anaerobic organisms.*
## Footnote
DIF: Comprehension REF: Dental Infection "Evolution" | p. 68 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology
87
Which of the following choices is the dental hygienist’s biggest dental problem in the adult patient?
A) Caries
B) Periodontal disease
C) Localized dental infection
D) Systemic dental infection
B) Periodontal disease
*Periodontal disease is the dental hygienist’s biggest dental problem in the adult patient. Current research suggests that periodontal disease may be associated with coronary heart disease. With an increase in knowledge about antiinfective agents, the dental hygienist and dentist will be better able to understand and properly administer the appropriate drug therapy. Use of fluoridated water, local physical removal of bacterial plaque biofilm from teeth on a regular basis, and sealants have reduced the rate of caries. While it certainly is true that local and systemic dental infections are of great concern, they are not the biggest problem in an adult patient for a dental hygienist to manage.*
## Footnote
*DIF: Recall REF: Introduction | p. 68 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
88
Which of the following statements is true of the cephalosporins?
A) They are active against gram-positive but not gram-negative organisms.
B) Those available for oral use are susceptible to penicillinase.
C) They are bacteriostatic.
D) Their mechanism of action is inhibition of cell wall synthesis.
D) Their mechanism of action is inhibition of cell wall synthesis.
*The mechanism of action of the cephalosporins is like that of the penicillins: inhibition of cell wall synthesis. Cephalosporins are active against a wide variety of both gram-positive and gram-negative organisms. Those available for oral use are relatively acid stable and highly resistant to penicillinase. The cephalosporins, which are bactericidal, are active against most gram-positive cocci, penicillinase-producing staphylococci, and some gram-negative bacteria.*
DIF: Comprehension REF: Cephalosporins (Mechanism of Action) | p. 75 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology
89
A cephalosporin would be most closely related to which of the following agents?
A) Penicillin VK
B) Clarithromycin
C) Ciprofloxacin
D) Doxycycline
E) Clindamycin
A) Penicillin VK
*Cephalosporins and penicillins have similarities in structure; they are both -lactam antibiotics. They also have the same mechanism of action. Clarithromycin is a macrolide, ciprofloxacin is a fluoroquinolone, doxycycline is a tetracycline, and clindamycin is an analogue of lincomycin, not structurally related to any others. Its mechanism of action is similar to that of macrolides.*
## Footnote
*DIF: Comprehension REF: Cephalosporins | p. 75*
90
Unlike other antiinfective agents, an additive action may result when _____ is combined with other antimicrobial agents.
a. vancomycin
b. chloramphenicol
c. nitrofurantoin
d. ciprofloxacin
d. cipro**floxacin**
## Footnote
*An additive action may result when ciprofloxacin is combined with other antimicrobial agents. The emergence of organisms resistant to the fluoroquinolones and the cross-resistance among the fluoroquinolones is increasing. Use of fluoroquinolones in chickens may be partially responsible for increasing resistance. The other choices do not have an additive action when combined with other antimicrobial agents.*
*DIF: Recall
REF: Antimicrobial Agents for Nondental Use (Quinolones (Fluoroquinolones) [Spectrum]) | p. 83 OBJ: 7 TOP: NBDHE, 6.0. Pharmacology*
91
Which of the following are true about sulfamethoxazole (SMX) and trimethoprim (TMP)? (Select all that apply.)
A) They are bactericidal.
B) They act by sequential inhibition of folic acid synthesis.
C) They are used to treat urinary tract infections (UTIs).
D) They are often used to treat refractory periodontitis.
A) They are bactericidal.
B) They act by sequential inhibition of folic acid synthesis.
*Sulfamethoxazole and trimethoprim are folate synthesis inhibitors. They are commonly used in combination as co-trimoxazole, SMX-TMP, Bactrim, or Septra. This drug is indicated for the treatment of selected urinary tract infections and selected respiratory and gastrointestinal infections. It is used to treat acute otitis media in children. SMX-TMP is bacteriostatic against a wide variety of gram-positive bacteria and some gram-negative bacteria. SMX-TMP has no documented use in dentistry. Pediatric patients coming to the dental office may be taking it to prevent chronic ear infections.*
*DIF: Recall
REF: Antimicrobial Agents for Nondental Use (Sulfamethoxazole-Trimethoprim) | p. 83 OBJ: 7 TOP: NBDHE, 6.0. Pharmacology*
92
Which of the following combinations of three drugs are administered concurrently in active cases of pulmonary tuberculosis (TB)?
A) Pyrazinamide (PZA), rifapentine, and Rifater
B) Isoniazid (INH), rifampin, and pyrazinamide
C) Ethambutol, isoniazid (INH), and Rifater
D) Rifampin, PZA, and streptomycin
B) Isoniazid (INH), rifampin, and pyrazinamide
## Footnote
* INH, rifampin, and PZA are combined for the treatment of pulmonary TB. INH and rifampin are continued every day for 9 to 12 months. PZA is continued for 2 months. With susceptible organisms, a patient, if compliant, usually becomes noninfective within 2 to 3 weeks. These choices do not represent the combination of three drugs that are administered in active cases of tuberculosis.*
* DIF: Recall REF: Antituberculosis Agents | p. 84 OBJ: 8 TOP: NBDHE, 6.0. Pharmacology*
93
Which of the following agents has poor oral absorption?
a. Nystatin
b. Itraconazole
c. Terbinafine
d. Griseofulvin
a. Nystatin
* Nystatin is not absorbed from the mucous membranes or through intact skin; taken orally, it is poorly absorbed from the gastrointestinal tract. Itraconazole, terbinafine, and griseofulvin all have good oral bioavailability.*
## Footnote
*DIF: Comprehension REF: Antifungal Agents (Nystatin) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
94
Which antifungal agent for oral candidiasis is available as an aqueous suspension?
a. Clotrimazole
b. Ketoconazole
c. Fluconazole
d. Nystatin
d. Nystatin
* Nystatin is available as an aqueous suspension, and also as vaginal tablets, cream, ointment, or pastilles. Clotrimazole is available as a troche, ketoconazole, and fluconazole are available as oral tablets.*
## Footnote
*DIF: Recall
REF: Antifungal Agents (Nystatin) | p. 90 | Antifungal Agents (Imidazoles [Clotrimazole]) | p. 91 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
95
Why would a patient ever take a vaginal tablet of nystatin orally?
A)The vaginal tablet is dosed once per day, which is less frequently than the oral pastille.
B) The vaginal tablet does not contain sugar
C) The vaginal tablet does not require a prescription
D) Vaginal tablet has better flavor than the oral tablet.
E) Only if they did not read the directions and did not know any better.
B) The vaginal tablet does not contain sugar.
## Footnote
* The vaginal tablet does not contain sugar. The aqueous suspension contains 50% sucrose. This can be important for a diabetic patient. The vaginal tablet for oral use is dosed 4 times per day. Nystatin requires a prescription regardless of the delivery form. The vaginal tablet is not flavored for oral use.*
* DIF: Application REF: Antifungal Agents (Nystatin) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
96
All of the following are antifungal agents that are useful in dentistry except
a. miconazole.
b. docosanol.
c. clotrimazole.
d. ketoconazole.
b. docosanol.
* Docosanol is an antiviral used to treat recurrent orolabial herpes. The other choices listed are used in dentistry.*
## Footnote
*DIF: Recall REF: Antifungal Agents (Imidazoles) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
97
Which of the following statements is true concerning antibiotic resistance?
A) Natural resistance occurs when an organism that was previously sensitive to an antimicrobial agent develops resistance.
B) An increase in the use of an antibiotic in a given population decreases the proportion of resistant organisms in that population.
C) Bacterial resistance can occur by the transfer of deoxyribonucleic acid (DNA) genetic material from one organism to another.
D) The transfer of genetic material from one organism to another may only occur among organism of the same species.
C) Bacterial resistance can occur by the transfer of deoxyribonucleic acid (DNA) genetic material from one organism to another.
## Footnote
Bacterial resistance can occur by the transfer of DNA genetic material from one organism toanother via transduction, transformation, or bacterial conjugation. N*atural resistance occurswhen an organism has always been resistant to an antimicrobial agent because of thebacteria’s normal properties, such as lipid structure in the cell wall. Acquired resistance occurs when an organism that was previously sensitive to an antimicrobial agent develops resistance. An increase in the use of an antibiotic in a given population increases the proportion of resistant organisms in that population. The transfer of genetic material from one organism to another may occur among very different microorganisms, including transfer from nonpathogenic bacteria to pathogenic bacteria.*
98
Which of the following agents is a nonnucleoside reverse transcriptase inhibitor used to treat HIV infection?
a. Saquinavir
b. Nevirapine
c. Zidovudine
d. Raltegravir
b. Nevirapine
* Nevirapine is a nonnucleoside reverse transcriptase inhibitor specific for HIV-1. It inhibits the same enzymes as the nucleoside analogues but does not require bioactivation. Saquinavir is an HIV protease inhibitor. Zidovudine is a nucleoside reverse transcriptase inhibitor. Raltegravir is an integrase inhibitor.*
## Footnote
*DIF: Recall
REF: Antiviral Agents (Acquired Immunodeficiency Syndrome [Nonnucleoside Reverse*
*Transcriptase Inhibitors]) | p. 94 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology*
99
Which of the following groups of drugs used to treat HIV can interfere with the action of the HIV-infected cells?
A) Nucleoside reverse transcriptase inhibitors
B) Nonnucleoside reverse transcriptase inhibitors
C) Protease inhibitors
D) Both A and B
E) Both B and C
C) Protease inhibitors
*The difference between the protease inhibitors and the nucleoside analogs or nucleoside/nucleotide reverse transcriptase inhibitors is that the protease inhibitors can interfere with the action of the HIV-infected cells. Its adverse reactions include rash, hyperglycemia, and paresthesias. The remaining groups of drugs used to treat HIV do not interfere with the action of HIV-infected cells.*
## Footnote
*DIF: Application
REF: Antiviral Agents (Acquired Immunodeficiency Syndrome [Protease Inhibitors]) | p. 95 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology*
100
Which of the following types of HIV drugs are also used to treat hepatitis B? (Select all that apply.)
A) Nucleoside analog or nucleoside/nucleotide reverse transcriptase inhibitors
B) Nonnucleoside analogs or nonnucleoside reverse transcriptase inhibitor
C) Protease inhibitor
D) Fusion/entry inhibitor
E) ntegrase inhibitor
A) Nucleoside analog or nucleoside/nucleotide reverse transcriptase inhibitors
Several oral nucleoside/nucleotide analogs are available for the treatment of chronic hepatitis B. The protease inhibitors boceprevir and telaprevir were approved by the Food and Drug Administration (FDA) for use in combination with peginterferon and ribavirin for the treatment of chronic hepatitis C genotype1 infection. The remaining types of HIV drugs are not currently used to treat hepatitis B.
DIF: Application
REF: Antiviral Agents (Chronic Hepatitis [Nucleoside/Nucleotide Analogs]) | p. 97 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology
101
Most ulcers are due to excess stomach acid from worrying.
True
False
False
## Footnote
*Most ulcers are related to the presence of Helicobacter pylori. Many ulcers can now be cured by using a combination of one or more antibiotics and an H2-blocker or a proton-pump inhibitor (PPI) to reduce stomach acid*
102
Low doses of Sedative/Hypnotic Agents will \_\_\_\_\_, while high does can lead to \_\_\_\_.
sedate; sleep
103
\_\_\_\_\_\_ is an inhibitory neurotransmitter that is targeted for the treatment of anxiety and insomnia.
There should be more here.... CNS handout, slide 5!
GABA
104
Inhaled ______ reduce inflammation and hypersensitivity or the airway to allerens. They are used in the treatment of ____ and COPD.
They may cause _____ and pharyngitis.
corticosteroids; asthma; candidiasis
105
If an inhaled corticosteroid is used withan inhaled beta-2 agonist, the inhaled _______ is used first because it opens the airway.
beta-2 agonist
106
\_\_\_\_\_\_\_ inhibit the response to allergens by blocking the action of leukotrienes.
This can lead to an increased risk of \_\_\_\_.
Leukotriene Receptor Antagonists; infection
107
The mechanism of action for antidepressant agents is to inhibit reuptake of norepinephrine/serotonin.
The different classes of antidepressants are ______ such as amitriptyline (Elavil) , _______ such as
venlafaxine (Effexor) and _______ such as escitalopram (Lexapro).
• fluoxetine (Prozac)
Tricyclic antidepressant; SNRIs; SSRIs
108
A major dental related patient consideration for antidepressants is \_\_\_\_\_\_.
bruxism/clenching
109
The mechanism of action for \_\_\_\_psychotherapeutic agents inhibit dopamine receptors, whereas _______ inhibit dopamine/serotonin receptors.
These drugs are used to treat schizophrenia and bipolar disorder.
Typicals; Atypicals
110
An important patient care consideration to note if taking a psychotherapeutic agent is ______ which is dystonia of tongue, jaw and neck. It is characterized by a loss of muscle control and involuntary spasms. The patient may constantly open/close mouth, smack lips, etc,..
It may progress to **tardive dyskinesia.**
Extrapyramidal symptoms (EPS)
111
What drug does lithium interact with?
Motrin
112
The mechanism of action of _______ is to increase seizure threshold and decrease abnormal depolarization.
Dilantin (causes gingival hyperplasia), a drug used for this condition, _____ liver function.
Anticonvulsant Agents; speeds up
113
Anticonvulsant agents are used for seizure prophylaxis and the ...
1. Treatment of \_\_\_\_\_\_
2. Treatment of mood disorders
3. Treatment of \_\_\_\_\_\_\_
4. Treatment of _______ (Tegretol)
5. Migraine headache prophylaxis (Topamax)
1. bipolar disorder
3. ADHD
4. trigeminal neuralgia
114
The mechanism of Action of agents used to treat neuropathic pain is to ____ pain neurotransmitters in the CNS.
Medication used for this are **gabapentin** (Neurontin) pregabalin **(Lyrica).**
inhibit
115
Agents used to treat migraine headaches end with '\_\_\_\_\_\_\_ and may cause **neck and throat pain**.
'triptan
116
*donepezil*, the drug used to treat Alzheimer's Disease causes \_\_\_\_\_\_.
Drugs used to treat parkinson's disease cause **hallucinations** and **EPS**.
drooling
117
When you think of medications used to treat Alzheimer's Disease think _______ (PANS Agonists).
SLUD
118
\_\_\_\_\_Inhibitors target pathologic prostaglandins and reduce pain sensation, inflammation and leukocytosis.
On the other hand, _____ Inhibitors target physiologic prostoglandins and causes a loss of GI and renal protection. The ability to have smooth muscle relaxation and blood clotting is also lost. This is _NOT_ good!
COX-2; COX 1
119
Although not as good as an NSAIA, Aspirin can be used as an:
## Footnote
1. ______ : Used to reduce platelet aggregation
2. ______ : Lowers body temp if above normal
3. ______ : Used to treat mild to moderate pain
4. ______ : Decreases pain, redness and swelling
1. Antiplatelet
2. Antipyretic
3. Analgesic
4. Antiinflammatory
120
Patient considerations when taking Asprin is ______ which causes hepatotoicity and encephalopathy.
Reye's syndrome
121
An adverse reaction of Asprin is ____ ulceration.
GI
122
What drug has increased effectiveness when taken in conjunction with Aspirin?
double check this card!
Coumadin (warfarin)
123
What is the greatest concern for a patient has an Aspirin sensitivity?
cross-sensitivity with NSAIDs
124
Pharmacologic effects of NSAIDs are:
1. _______ : Lower body temp if above normal
2. _______ : Treatment of mild to moderate pain; More effective if administered before pain
3. _______ : Treatment of inflammatory joint disease; Treatment of dysmenorrhea
1. Antipyretic
2. Analgesic
3. Anti-inflammatory
125
Patients who take a _______ a day should take extra precaution when using NSAIDS.
baby asprin
126
A serious adverse reaction for\_\_\_\_\_\_\_, an antipyretic and analgesic is \_\_\_\_\_\_.
*acetaminophen* (Tylenol); hepatotoxicity
127
Adverse reactions of taking tylenol are exacerbated by liver-enzyme inducers such as alcohol, ____ and drugs like Dilantin, with a delayed reaction orf 3-4 days after acute intoxication.
smoking
128
The mechanism of opioid analgesic relies on \_\_\_\_\_\_. This is a is a neurotransmitter that facilitates the transfer of pain impulse from peripherial neurons to CNS signaling neurons.
Substance P
129
When a patient takes an opioid analgesic, ______ bind to opiate receptors on the peripherial pain neuron to inhibit the relearse of substance P.
endogenous opiates (endorphins)
130
The pharmacologic effects of Opioid Analgesics is:
1. ______ : Treatment of moderate to severe pain
2. ______ : Treatment of severe non-productive coughs
3. ______ :Treatment of diarrhea and traveler’s sickness
1. Analgesia
2. Cough suppression
3. GI hypo-motility
131
Adverse reactions of A contraindication for opioids use is \_\_\_\_\_\_. This is because these drugs increase the risk of additive CNS depression.
An adverse reation is constipation.
COPD
132
Treatments of Opioid Analgesic Addiction are:
1. ________ : Administered once-monthly via IM injection and blocks effects if opioids are taken
2. ________ : Administered once-monthly via SC injection and blocks effects if opioids are taken
3. ________ : Taken sublingually by patient and blocks effects if opioids are taken
1. Vivitrol (naltrexone)
2. Sublocade (buprenorphine)
3. Suboxone (buprenorphine plus naloxone)
133
Factors that ____ the pain threshold and contribute to a lesser reaction to pain are sleep, empathy, and placebo effect.
raise
134
Adverse reactions to aspirin are \_\_\_\_\_\_\_\_, decreased protective prostaglandins, \_\_\_\_\_\_\_\_, increased gastric acid secretion, nausea and vomiting.
gastrointestinal ulceration; decreased protective mucous
135
\_\_\_\_\_\_\_ are more effective if administered before pain.
NSAIDs
136
Factors that \_\_\_\_\_\_the pain threshold are fear, depression, anxiety, and fatigue.
"lower"
137
Adverse effects when taking ______ is osteoporosis (muscle wasting), increased risk of infection (decreased wound healing), hyperglycemia, water retention and increased gastric acid.
Patient care considerations are risk of adrenal crisis with abrupt withdrawal; thre is Increased adverse effects with use of \_\_\_\_\_\_
Adrenocorticosteroids; NSAID's
138
Treatment for _____ stimulates insulin production, reduces cellular insulin resistance, decreases hepatic glucose production, increases cellular sensitivity to insulin, inhibits breakdown of ingested carbohydrates, mimics the action of incretin hormones, and inhibits the breakdown of incretin hormones.
Examples: Actos, \*Metformin: they ______ insulin resistance)
type 2 diabetes; shut off
139
Metformin shuts off \_\_\_\_\_\_. It's easy to become hypoglycemic.
gluconeogenisis
140
The mechanism of action for _____ is the replacement of endogenous insulin. It can lead to hypoglycemia and weight gain.
Insulin
141
\_\_\_\_\_\_ is the inability of the thyroid gland to secrete enough (too little thyroid hormone). The diagnosis is ____ TSH (thyroid stimulating hormone).
Symptoms are fatigue, and _____ intolerance.
Treatment: Levothyroxine (T4) (Synthroid) ,Liothyronine (T3) (Cytomel)
Hypothyroidism (T4); elevated; cold
142
\_\_\_\_\_ is excessive production of thyroid hormone. Symptoms of this are heat intolerance, increased sensitivity to pain, and excessive sympathetic activity.
Treatment
Examples: Propylthiouracil (PTU), Methimazole (Tapazole)
Hyperthyroidism
143
Use caution for patients who have hyper thyroidism when using anesthetic with \_\_\_\_.
If they have uncontrolled hyperthyroidism, they cannot he given ______ because this may lead to a possible “thyroid storm”.
epinephrine; epinephrine
144
Adverse effects for ___ are GI upset, edema, weight gain, hypertension, increased risk of some cancers, thromboembolic disorders (esp if a smoker).
estrogen
145
\_\_\_\_\_\_\_ shut off osteoclast activity and causes increased bone density. Patient considerations when using thi drug is \_\_\_\_\_\_\_\_\_, atypical femur fractures and esophagitis or esophageal cancer.
Bisphosphonates; osteonecrosis of the jaw
146
The mechanism of action for ______ help interfere with reproductive cycle of malignant cells.
antieoplastic agents
| (formerly referred to as chemotherapy)
147
The mechanism of action for ___ is the supression of an overactive T-cell response, and\_\_\_\_\_\_\_, the reduction/prevention of joint damage, and the preservation of joint structure and function.
anti-rheumatic agents; inflammation
148
REVIEW Handouts for endocine system slide 12
149
What is not used to treat osteoporosis?
A) Fosamax
B) Actonel
C) Boniva
D) Reclast
E) Byetta
E) Byetta
## Footnote
*(Antidiabetic)*
150
What kind of drug is Zovirax® (Acyclovir)?
antiviral
151
Adverse reactions of the antineoplastic drugs include?
A) Gastrointestinal distress
B) Hair loss
C) Increased risk of infection
D) Decreased Immunity
E) All of the above
E) All of the above
152
Humulin R insulin is characterized by delayed onset of action and long duration of action.
True
False
False
153
Since orally administered corticosteroids have no effect on the adrenal glands, **long term** administration of these drugs can be discontinued abruptyl if necessary.
True
False
False
154
Which of the following statements concerning anticonvulsants is false?
A) Used in the treatment of trigeminal neuralgia
B) Used in prophylaxis of migraine headaches
C) Used in the treatment of ADHD
D) Used in the treatment of bipolar disorder
E) None of the above
E) None of the above
155
Prozac (fluoxetine) selectively inhibits the reuptake of ___________ in the brain.
A) acetylcholine
B) nicotine
C) serotonin
D) bradykinin
E) dopamine
C) serotonin
156
Which of the following is used as **adjunctive** therapy for the treatment of dental infections?
A) Amoxicillin
B) Clindamycin
C) Azithromycin
D) Metronidazole
E) None of the above
D) Metronidazole
157
Which of the following is the antibacterial of choice for **penicillin-allergic** patients?
A) Amoxicillin
B) Clindamycin
C) Azithromycin
D) Metronidazole
E) None of the above
B) Clindamycin
158
Azithromycin is NOT considered a first-line treatment for dental infection.
True
False
True
159
Which of the following is considered an adverse reaction associated with the opioids?
A) Respiratory depression
B) Constipation
C) Sedation
D) Nausea and vomiting
E) All of the above
E) All of the above
160
In acute overdose, aceteminophen adversely affects the liver.
True
False
True
161
Pain may be both a powerful motivator and de-motivator for patients to seek help from their dental professional.
True
False
True
162
\_\_\_\_\_ is an unpleasant sensory and emotional experience in which the body is made urgently aware of actual or _____ tissue damage.
Pain; potential
163
Pick out the Factors that “_lower_” the pain threshold
## Footnote
A) Fear
B) Sleep
C) Depression
D) Anxiety
E) Fatigue
F) Sleep
G) Placebo Effect
A) Fear
C) Depression
D) Anxiety
E) Fatigue
164
Which of the following factors _does not_ "raise" the pain thresshold?
A) Sleep
B) Anxiety
C) Empathy
D) Placebo effect
B) Anxiety
165
Chemical agents that occur naturally in the environment of pain receptors after acute tissue damage are ______ substances.
## Footnote
These include:
1. adenosine
2. adenosine triphosphate
3. serotonin
4. histamine
5. bradykinin
6. cytokines
7. \_\_\_\_\_\_\_\_
algogenic; *prostaglandins*.
166
Aspirin Equianalgesic doses that equal 650mg of aspirin
* ___ mg of ibuprofen
* ___ mg acetaminophen
* ___ mg of naproxen
200mg ibuprophen
650mg acetaminophen
275mg naproxen
167
**Reye's syndrome** is a rare disorder that causes brain and liver damage that occurs in children with a recent viral infection. Taking _____ to treat such an infection greatly _increases_ the risk of Reye's syndrome.
aspirin
## Footnote
*(**Hepatotoxicity** (from hepatic toxicity) implies chemical-driven liver damage. "**Encephalopathy**" means damage or disease that affects the brain.*
168
If a patient has a cross-sensitivity with NSAIDs, they have a _____ chance of having an allergy reaction to \_\_\_\_\_.
90% greater; aspirin
169
Maximum daily dose of **ibuprofen** is \_\_\_\_\_\_
3200mg
## Footnote
*Max effective does is 75% of the daily dose??*
170
Name three adverse reactions to opioid analgesics.
1. Constipation (OIC)
2. Nausea and emesis (vomiting)
3. Dermatological reactions
171
COX Inhibition Phospholipids Arachidonic Acid (COX-1) (COX-2) Physiologic Prostaglandins Pathologic Prostaglandins ????
* GI protection
* Pain sensitization
* Renal protection
* Inflammation
* Smooth muscle relaxes
* Leukocyte
* Regulate blood clotting
172
Factors that ____ the pain threshold and contribute to a lesser reaction to pain are **sleep**, **empathy**, and **placebo effect**.
raise
173
\_\_\_\_\_\_\_\_\_\_ increase risk of overdose and toxicity.
Zero-order kinetics
174
Adverse reactions to aspirin are \_\_\_\_\_\_\_\_, decreased protective prostaglandins, \_\_\_\_\_\_\_\_, increased gastric acid secretion, nausea and vomiting.
gastrointestinal ulceration; decreased protective mucous
175
Contraindications for taking aspirin are \_\_\_\_\_\_\_, pregnancy, gout, \_\_\_\_\_\_\_\_, history of hypersensitivity, \_\_\_\_\_\_\_\_.
peptic ulcer, hemophilia, cross-sensitivity with NSAIDs
176
Pharmacologic effects of NSAIDs are \_\_\_\_\_, analgesic, and \_\_\_\_\_\_.
antipyretic; anti-inflammatory
177
\_\_\_\_\_\_\_ are more effective if administered before pain.
NSAID's
178
\_\_\_\_\_\_\_ is an adverse reaction to acetaminophen (APAP).
Hepatotoxicity
## Footnote
*(because it is converted to a liver-toxic metabolite)*
179
APAP can cause possible liver failure with either ______ ingestion of supratherapeutic doses; or ______ ingestion of high therapeutic doses.
acute; chronic
180
Contraindications for the use of opioid analgesics are \_\_\_\_, head injuries, hepatic, _____ impairment, prostatic hypertrophy, constipation.
Chronic respiratory disease (COPD); renal function
181
Name the three main drugs that are used to treat Opiod Addiction
* Vivitrol *(naltrexone)*
* Sublocade *(buprenorphine)*
* Suboxone *(buprenorphine plus naloxone)*
182
Anti-anxiety agents like the benzodiazepines, are known as sedative-hypnotic agents since they produce anxiety reduction as low doses and drowsiness & sleep at high doses.
True
False
True
183
Asthma is characterized by _____ airway obstruction and is associated with reduction in _____ airflow.
A) reversible; inspiratory
B) reversible; expiratory
C) irreversible; inspiratory
D) irreversible; expiratory
B) reversible; expiratory
*Asthmatics trap air due to constriction of bronchiolar smooth muscle. A few hours later, inflammation occurs, resulting in an increase in secretions in the lungs and swelling in the bronchioles. Asthma is characterized by reversible airway obstruction and is associated with a reduction in expiratory airflow. The reversible airway obstruction is in contrast to chronic obstructive pulmonary disease (COPD), which is characterized by irreversible airway obstruction, which occurs with either chronic bronchitis or emphysema.*
184
Asthma may be precipitated by (1) allergens, (2) exercise, (3) stress.
A) 1, 2, 3
B) 1, 2
C) 1, 3
D) 2, 3
A) 1, 2, 3
*The dental health care worker should treat dental patients with asthma so that minimal stress is induced. Asthma may be precipitated by allergens, pollution, exercise, stress, or upper respiratory tract infection.*
185
\_\_\_\_\_ is a concern when administering local anesthetics with sulfiting agents as a preservative for the vasoconstrictor.
A) Tardive dyskinesia
B) Bronchoconstriction
C) Tachycardia
D) Emesis
B) Bronchoconstriction
***Sulfites** are used in local anesthetic solutions to prevent oxidation of the vasoconstrictor. The group of people most susceptible to allergic reactions caused by sulfites includes the 9 to 11 million persons in the United States in whom asthma has been diagnosed. Sulfiting agents in local anesthetic agents with vasoconstrictor can lead to **bronchoconstriction**.*
186
Patients with asthma should bring their fast-acting _____ inhaler to be used prophylactically or in the management of an acute asthmatic attack in the dental office.
A) 𝑢-agonist
B) 𝐵1-agonist
C) 𝐵1-antagonist
D) 𝐵2-agonist
E) 𝐵2-antagonist
D) 𝐵2-agonist
## Footnote
*The stimulation of 2-receptors results in smooth-muscle relaxation. Because the blood vessels of the skeletal muscle are innervated with 2-receptors, stimulation causes vasodilation. Relaxation of the smooth muscles of the bronchioles, also containing 2-receptors, results in bronchodilation. A fast-acting 2-agonist should be available to manage an acute asthmatic attack in the dental office. Signs of asthma include shortness of breath and wheezing.*
187
Which of the following respiratory diseases is associated with irreversible airway obstruction?
A) Asthma
B) Chronic bronchitis
C) Emphysema
D) Both A and B
E) Both B and C
E) Both B and C
## Footnote
*Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airway obstruction, which occurs with either chronic bronchitis or emphysema. Asthma is characterized by reversible airway obstruction and is associated with reduction in expiratory airflow.*
188
Which of the following groups of medications are considered first-line treatment for chronic obstructive pulmonary disease (COPD)?
A) 𝐵-adrenergic agonists
B) Methylxanthines
C) Anticholinergics
D) Leukotriene (LT) antagonists
C) Anticholinergics
*Inhaled anticholinergic drugs appear to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine. This then causes bronchodilation. Ipratropium bromide (Atrovent) is a short-acting anticholinergic agent available for oral inhalation for people with COPD. Anticholinergics are considered first-line treatment for chronic bronchitis and emphysema, but -adrenergic agonists and methylxanthines are also used to produce bronchodilation in these patients. In many instances, patients receive a combination metered-dose inhaler (MDI) with an anticholinergic drug and a 2-adrenergic agonist.*
189
The drive for ventilation is stimulated by a(n) _____ in the partial pressure of _____ in the normal person.
A) depression; carbon dioxide (PaCO2)
B) elevation; carbon dioxide (PaCO2)
C) depression; oxygen (PaO2)
D) elevation; oxygen (PaO2)
B) elevation; carbon dioxide (PaCO2)
*The _drive_ for ventilation is stimulated by a rise in **carbon dioxide**. Swimmers are told not to hyperventilate before swimming under water for this reason. In the normal person, the drive for ventilation is stimulated by an elevation in PaCO2. The PaO2 can vary widely without stimulating ventilation in the normal patient.*
190
Which of the following respiratory diseases is associated with irreversible airway obstruction?
A) Asthma
B) Chronic bronchitis
C) Emphysema
D) Both A and B
E) Both B and C
E) Both B and C
## Footnote
*Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airway obstruction, which occurs with either **chronic bronchitis** or **emphysema**. **Asthma** is characterized by reversible airway obstruction and is associated with reduction in expiratory airflow.*
191
Asthma is characterized by __________ airway obstruction, and chronic bronchitis by __________ airway obstruction.
A) reversible; reversible
B) reversible; irreversible
C) irreversible; reversible
D) irreversible; irreversible
B) reversible; irreversible
## Footnote
***Asthma** is characterized by reversible airway obstruction and **chronic** **bronchitis** is characterized by irreversible airway obstruction. **Asthma** is characterized by reversible airway obstruction. There have been many famous Olympic champions who were asthmatic. **Chronic** **bronchitis** and **emphysema** are forms of chronic obstructive pulmonary disease that are characterized by irreversible airway obstruction.*
192
Which respiratory disease is characterized by destruction of lung alveoli?
A) Asthma
B) Upper respiratory tract infection
C) Chronic bronchitis
D) Emphysema
D) Emphysema
***Emphysema** is characterized by _alveolar destruction_ with air space enlargement and airway collapse. **Asthma** is characterized by _inflammation and swelling_ in the bronchioles. Patients with upper respiratory tract infections have inflammation and swelling as well. **Chronic bronchitis** is a result of chronic inflammation of the airways and _excessive sputum_ production.*
193
Adrenergic agonists produce bronchodilation by stimulating which type of receptors?
A) Alpha
B) Beta-1
C) Beta-2
D) Neuromuscular junction
C) Beta-2
## Footnote
With the development of selective 𝘉2-agonists, bronchodilation with fewer cardiac side effects can be achieved. Stimulation of alpha receptors causes peripheral vasoconstriction. Stimulation of 𝘉1-receptors causes an increase in cardiac output. Stimulation of neuromuscular junction receptors causes muscle movement.
194
Which of the following statements represents the primary advantage of the use of metered-dose inhalers (MDIs)?
A) The inhaled dose can be accurately measured.
B) They are difficult to use properly, and they can be abused.
C) The onset of action is unpredictable.
D) The bronchodilator effect is less than that of a comparable oral dose.
A) The inhaled dose can be accurately measured.
*The inhaled dose can be accurately measured. MDIs are difficult to use properly (particularly for children) and they can be abused, with a resultant decrease in response. The onset of action is rapid and predictable (versus unpredictable response with orally administered agents). The bronchodilator effect is greater than a comparable oral dose.*
195
A spacer is often placed between the metered-dose inhaler and the mouth to decrease the amount of drug delivered to the lungs.
True
False
False
## Footnote
*The **spacer** **increases** the amount of drug delivered to the lungs.*
196
Albuterol is a bronchodilator that can be administered via a metered-dose inhaler (MDI). It is recommended in prophylactically treating (preventing) chronic asthma.
A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.
C) The first statement is true; the second statement is false.
## Footnote
***Albuterol** (ProAir HFA, Proventil HFA, Ventolin HFA), metaproterenol (generic), levalbuterol (Xopenex HFA), and pirbuterol (Maxair Autohaler) are **short**-**acting** 𝘉2-agonists. Inhaled **corticosteroids** are the most effective long-term treatment for control of symptoms in all patients with mild, moderate, or severe persistent asthma. Albuterol is a bronchodilator administered via inhaler. However, it is recommended to treat acute asthma attacks, not in the prevention of asthma. One major mistake that many asthmatics make is to rely on the albuterol inhaler and omit using the steroid inhaler.*
197
Which of the following drugs used to treat respiratory diseases carries a black box warning about a higher risk of asthma-related deaths as a result of a high number of asthma-related deaths reported with _salmeterol_ therapy during a clinical trial?
A) Mast cell degranulation inhibitors
B) Anti-immunoglobulin E (IgE) antibodies
C) Short-acting 𝐵2-agonist
D) Long-acting 𝐵2--agonist
D) Long-acting 𝐵2--agonist
***Long-acting** 𝐵2-agonists are best administered in a fixed-dose combination in the same inhaler with an inhaled corticosteroid. **Long-acting** 𝐵2-agonists are combined with corticosteroid inhalers so that two different drugs, at lower doses, can be used to treat persistent asthma. Long-acting 𝐵2-agonists carry a black box warning.*
198
Which of the following agents is the drug of choice for an early dental infection unless the patient is allergic to it?
a. Erythromycin
b. Clindamycin
c. Penicillin
d. Metronidazole
c. Penicillin
* Penicillin is the drug of choice unless the patient is allergic to it. Amoxicillin is most often used because it is less irritating to the stomach than other drugs and can be taken with food or milk. In patients allergic to penicillin, alternatives might include erythromycin or clindamycin. When the infection is at the mixed stage, agents effective against either gram-positive or anaerobic organisms may be successful. Metronidazole is effective for anaerobic organisms.*
## Footnote
DIF: Comprehension REF: Dental Infection "Evolution" | p. 68 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology
199
An _____ agent is a substance that destroys or suppresses the growth or multiplication of bacteria.
a. antiinfective
b. antibacterial
c. antibiotic
d. antimicrobial
b. antibacterial
* An antibacterial is a broader category than an antibiotic. There are antibacterial agents that are not antibiotics that can act against bacterial infections. Historically, an antibiotic was a chemical substance produced by a microorganism that has the capacity, in dilute solutions, to destroy or suppress the growth or multiplication of another organism or to suppress its action. Although many early antibiotics were derived from natural sources, most are synthesized in laboratories. This difference is largely ignored in general conversation, and antiinfectives and antibacterial agents are often called antibiotics.*
200
Which of the following choices is the dental hygienist’s biggest dental problem in the adult patient?
A) Caries
B) Periodontal disease
C) Localized dental infection
D) Systemic dental infection
B) Periodontal disease
*Periodontal disease is the dental hygienist’s biggest dental problem in the adult patient. Current research suggests that periodontal disease may be associated with coronary heart disease. With an increase in knowledge about antiinfective agents, the dental hygienist and dentist will be better able to understand and properly administer the appropriate drug therapy. Use of fluoridated water, local physical removal of bacterial plaque biofilm from teeth on a regular basis, and sealants have reduced the rate of caries. While it certainly is true that local and systemic dental infections are of great concern, they are not the biggest problem in an adult patient for a dental hygienist to manage.*
## Footnote
*DIF: Recall REF: Introduction | p. 68 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
201
Which of the following statements is true of the cephalosporins?
A) They are active against gram-positive but not gram-negative organisms.
B) Those available for oral use are susceptible to penicillinase.
C) They are bacteriostatic.
D) Their mechanism of action is inhibition of cell wall synthesis.
D) Their mechanism of action is inhibition of cell wall synthesis.
*The mechanism of action of the cephalosporins is like that of the penicillins: inhibition of cell wall synthesis. Cephalosporins are active against a wide variety of both gram-positive and gram-negative organisms. Those available for oral use are relatively acid stable and highly resistant to penicillinase. The cephalosporins, which are bactericidal, are active against most gram-positive cocci, penicillinase-producing staphylococci, and some gram-negative bacteria.*
DIF: Comprehension REF: Cephalosporins (Mechanism of Action) | p. 75 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology
202
A cephalosporin would be most closely related to which of the following agents?
A) Penicillin VK
B) Clarithromycin
C) Ciprofloxacin
D) Doxycycline
E) Clindamycin
A) Penicillin VK
*Cephalosporins and penicillins have similarities in structure; they are both -lactam antibiotics. They also have the same mechanism of action. Clarithromycin is a macrolide, ciprofloxacin is a fluoroquinolone, doxycycline is a tetracycline, and clindamycin is an analogue of lincomycin, not structurally related to any others. Its mechanism of action is similar to that of macrolides.*
## Footnote
*DIF: Comprehension REF: Cephalosporins | p. 75*
203
Unlike other antiinfective agents, an additive action may result when _____ is combined with other antimicrobial agents.
a. vancomycin
b. chloramphenicol
c. nitrofurantoin
d. ciprofloxacin
d. cipro**floxacin**
## Footnote
*An additive action may result when ciprofloxacin is combined with other antimicrobial agents. The emergence of organisms resistant to the fluoroquinolones and the cross-resistance among the fluoroquinolones is increasing. Use of fluoroquinolones in chickens may be partially responsible for increasing resistance. The other choices do not have an additive action when combined with other antimicrobial agents.*
*DIF: Recall
REF: Antimicrobial Agents for Nondental Use (Quinolones (Fluoroquinolones) [Spectrum]) | p. 83 OBJ: 7 TOP: NBDHE, 6.0. Pharmacology*
204
Which of the following are true about sulfamethoxazole (SMX) and trimethoprim (TMP)? (Select all that apply.)
A) They are bactericidal.
B) They act by sequential inhibition of folic acid synthesis.
C) They are used to treat urinary tract infections (UTIs).
D) They are often used to treat refractory periodontitis.
A) They are bactericidal.
B) They act by sequential inhibition of folic acid synthesis.
*Sulfamethoxazole and trimethoprim are folate synthesis inhibitors. They are commonly used in combination as co-trimoxazole, SMX-TMP, Bactrim, or Septra. This drug is indicated for the treatment of selected urinary tract infections and selected respiratory and gastrointestinal infections. It is used to treat acute otitis media in children. SMX-TMP is bacteriostatic against a wide variety of gram-positive bacteria and some gram-negative bacteria. SMX-TMP has no documented use in dentistry. Pediatric patients coming to the dental office may be taking it to prevent chronic ear infections.*
*DIF: Recall
REF: Antimicrobial Agents for Nondental Use (Sulfamethoxazole-Trimethoprim) | p. 83 OBJ: 7 TOP: NBDHE, 6.0. Pharmacology*
205
Which of the following combinations of three drugs are administered concurrently in active cases of pulmonary tuberculosis (TB)?
A) Pyrazinamide (PZA), rifapentine, and Rifater
B) Isoniazid (INH), rifampin, and pyrazinamide
C) Ethambutol, isoniazid (INH), and Rifater
D) Rifampin, PZA, and streptomycin
B) Isoniazid (INH), rifampin, and pyrazinamide
## Footnote
* INH, rifampin, and PZA are combined for the treatment of pulmonary TB. INH and rifampin are continued every day for 9 to 12 months. PZA is continued for 2 months. With susceptible organisms, a patient, if compliant, usually becomes noninfective within 2 to 3 weeks. These choices do not represent the combination of three drugs that are administered in active cases of tuberculosis.*
* DIF: Recall REF: Antituberculosis Agents | p. 84 OBJ: 8 TOP: NBDHE, 6.0. Pharmacology*
206
If a person with active TB seeks oral health care
A) use standard precautions and treat him or her just as everyone else is treated.
B) schedule him or her as the last patient of the day.
C) contact that person’s physician and delay health care until the disease is no longer in the active state.
D) refer the patient to a hospital with a dental suite for treatment.
C) contact that person’s physician and delay health care until the *disease is no longer in the active state.
Contact that person’s physician and delay health care until the disease is no longer in the active state. This person should be in the dental office only for evaluation of his or her dental condition and in order to make a referral. These choices do not represent Centers for Disease Control (CDC) recommendations for management of a patient with active tuberculosis.*
## Footnote
*DIF: Recall REF: Antituberculosis Agents | p. 84 OBJ: 8 TOP: NBDHE, 6.0. Pharmacology*
207
Which of the following agents has poor oral absorption?
a. Nystatin
b. Itraconazole
c. Terbinafine
d. Griseofulvin
a. Nystatin
* Nystatin is not absorbed from the mucous membranes or through intact skin; taken orally, it is poorly absorbed from the gastrointestinal tract. Itraconazole, terbinafine, and griseofulvin all have good oral bioavailability.*
## Footnote
*DIF: Comprehension REF: Antifungal Agents (Nystatin) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
208
Which antifungal agent for oral candidiasis is available as an aqueous suspension?
a. Clotrimazole
b. Ketoconazole
c. Fluconazole
d. Nystatin
d. Nystatin
* Nystatin is available as an aqueous suspension, and also as vaginal tablets, cream, ointment, or pastilles. Clotrimazole is available as a troche, ketoconazole, and fluconazole are available as oral tablets.*
## Footnote
*DIF: Recall
REF: Antifungal Agents (Nystatin) | p. 90 | Antifungal Agents (Imidazoles [Clotrimazole]) | p. 91 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
209
Why would a patient ever take a vaginal tablet of nystatin orally?
The vaginal tablet is dosed once per day, which is less frequently than the oral pastille.
A) The vaginal tablet does not contain sugar.
B) The vaginal tablet does not require a prescription.
C) The vaginal tablet has better flavor than the oral tablet.
D) Only if they did not read the directions and did not know any better.
B) The vaginal tablet does not require a prescription.
## Footnote
* The vaginal tablet does not contain sugar. The aqueous suspension contains 50% sucrose. This can be important for a diabetic patient. The vaginal tablet for oral use is dosed 4 times per day. Nystatin requires a prescription regardless of the delivery form. The vaginal tablet is not flavored for oral use.*
* DIF: Application REF: Antifungal Agents (Nystatin) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
210
All of the following are antifungal agents that are useful in dentistry except
a. miconazole.
b. docosanol.
c. clotrimazole.
d. ketoconazole.
b. docosanol.
* Docosanol is an antiviral used to treat recurrent orolabial herpes. The other choices listed are used in dentistry.*
## Footnote
*DIF: Recall REF: Antifungal Agents (Imidazoles) | p. 90 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology*
211
Which of the following statements is true concerning antibiotic resistance?
Natural resistance occurs when an organism that was previously sensitive to an
antimicrobial agent develops resistance.
An increase in the use of an antibiotic in a given population decreases the
proportion of resistant organisms in that population.
Bacterial resistance can occur by the transfer of deoxyribonucleic acid (DNA)
genetic material from one organism to another.
The transfer of genetic material from one organism to another may only occur
among organism of the same species.
ANS: C
Bacterial resistance can occur by the transfer of DNA genetic material from one organism to
another via transduction, transformation, or bacterial conjugation. Natural resistance occurs
when an organism has always been resistant to an antimicrobial agent because of the
bacteria’s normal properties, such as lipid structure in the cell wall. Acquired resistance
occurs when an organism thaNt waRs pIreviGouslBy.seCnsiMtive to an antimicrobial agent develops USNT O
resistance. An increase in the use of an antibiotic in a given population increases the proportion of resistant organisms in that population. The transfer of genetic material from one organism to another may occur among very different microorganisms, including transfer from nonpathogenic bacteria to pathogenic bacteria.
DIF: Comprehension REF: Resistance | p. 70 OBJ: 1 TOP: NBDHE, 6.0. Pharmacology
212
Which of the following agents is a nonnucleoside reverse transcriptase inhibitor used to treat HIV infection?
a. Saquinavir
b. Nevirapine
c. Zidovudine
d. Raltegravir
b. Nevirapine
* Nevirapine is a nonnucleoside reverse transcriptase inhibitor specific for HIV-1. It inhibits the same enzymes as the nucleoside analogues but does not require bioactivation. Saquinavir is an HIV protease inhibitor. Zidovudine is a nucleoside reverse transcriptase inhibitor. Raltegravir is an integrase inhibitor.*
## Footnote
*DIF: Recall
REF: Antiviral Agents (Acquired Immunodeficiency Syndrome [Nonnucleoside Reverse*
*Transcriptase Inhibitors]) | p. 94 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology*
213
Which of the following groups of drugs used to treat HIV can interfere with the action of the HIV-infected cells?
A) Nucleoside reverse transcriptase inhibitors
B) Nonnucleoside reverse transcriptase inhibitors
C) Protease inhibitors
D) Both A and B
E) Both B and C
C) Protease inhibitors
*The difference between the protease inhibitors and the nucleoside analogs or nucleoside/nucleotide reverse transcriptase inhibitors is that the protease inhibitors can interfere with the action of the HIV-infected cells. Its adverse reactions include rash, hyperglycemia, and paresthesias. The remaining groups of drugs used to treat HIV do not interfere with the action of HIV-infected cells.*
## Footnote
*DIF: Application
REF: Antiviral Agents (Acquired Immunodeficiency Syndrome [Protease Inhibitors]) | p. 95 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology*
214
Which of the following types of HIV drugs are also used to treat hepatitis B? (Select all that apply.)
A) Nucleoside analog or nucleoside/nucleotide reverse transcriptase inhibitors
B) Nonnucleoside analogs or nonnucleoside reverse transcriptase inhibitor
C) Protease inhibitor
D) Fusion/entry inhibitor
E) ntegrase inhibitor
A) Nucleoside analog or nucleoside/nucleotide reverse transcriptase inhibitors
Several oral nucleoside/nucleotide analogs are available for the treatment of chronic hepatitis B. The protease inhibitors boceprevir and telaprevir were approved by the Food and Drug Administration (FDA) for use in combination with peginterferon and ribavirin for the treatment of chronic hepatitis C genotype1 infection. The remaining types of HIV drugs are not currently used to treat hepatitis B.
DIF: Application
REF: Antiviral Agents (Chronic Hepatitis [Nucleoside/Nucleotide Analogs]) | p. 97 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology
215
The pain threshold varies greatly in individuals because of different perceptions of pain.
a. Both parts of the statements are true.
b. Both parts of the statements are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.
c. The first part of the statement is true; the second part is false.
## Footnote
*The pain threshold does vary greatly in individuals. However, this variation is because of
widely different reactions to pain. The two components of pain are perception and reaction.
Perception is the physical component of pain and involves the message of pain that is carried
through the nerves eventually to the cortex. Reaction is the psychological component of pain
and involves the patient’s emotional response to pain. Although individuals are surprisingly
uniform in their perception of pain, they vary greatly in their reaction to it.*
216
Which of the following raises the pain threshold?
a. Emotional instability
b. Sympathy
c. Sleep
d. Both A and C
e. Both B and C
e. Both B and C
*The pain threshold is raised by sleep, sympathy, activities, and analgesics. A decrease in the
pain threshold (a greater reaction to pain) has been said to be associated with emotional
instability, anxiety, fatigue, youth, certain nationalities, women, and fear and apprehension.
Analgesic therapy must be selected for the individual. A level of discomfort that may not
require drug treatment in one person may demand extreme therapy in another.*
217
The mechanism of action of nonopioid analgesics is due to
a. depression of the central nervous system (CNS).
b. decrease in the pain threshold.
c. inhibition of prostaglandin synthesis.
d. stimulation of synthesis of prostaglandins.
c. inhibition of prostaglandin synthesis.
*Prostaglandins sensitize pain receptors to substances such as bradykinin. The action of the
nonopioid analgesics is related to their ability to inhibit prostaglandin synthesis. Opioid
analgesics are called narcotic, central, or strong analgesics. Opioid analgesics depress the
central nervous system, nonopioid analgesics act primarily at the peripheral nerve endings.
Prostaglandins can lower the pain threshold to painful stimuli, cause inflammation and fever,
and affect vascular tone and permeability. Analgesics work by raising the pain threshold.*
218
Prostaglandins sensitize pain receptors to
a. diflunisal.
b. salsalate.
c. bradykinin.
d. ketoprofen.
c. bradykinin.
*Prostaglandins, which are lipids that are synthesized locally by inflammatory stimuli, can
sensitize the pain receptors to substances such as bradykinin. Prostaglandins can also lower
the pain threshold to painful stimuli, cause inflammation and fever, and affect vascular tone
and permeability, which results in edema. Therefore a reduction in prostaglandin results in a
reduction in pain. Diflunisal and salsalate are both salicylates, and ketoprofen is an NSAID.*
219
Which of the following is the most common side effect from aspirin?
a. Gastrointestinal effects
b. Bleeding
c. Hepatic and renal effects
d. Hypersensitivity
a. Gastrointestinal effects
*Gastrointestinal effects may be simple dyspepsia, nausea, vomiting, or gastric bleeding. These
adverse effects result from direct gastric irritation and inhibition of prostaglandins. Because
prostaglandins are responsible for inhibition of gastric acid secretion and stimulation of the
cytoprotective mucus in the stomach, aspirin counteracts these effects. Aspirin’s most
frequent side effect is related to the gastrointestinal tract.*
220
Which of the following choices has antiinflammatory, antipyretic, analgesic, and antiplatelet
action?
a. Acetaminophen
b. Codeine
c. Aspirin
d. Hydrocodone
c. Aspirin
*Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) have antiinflammatory,
antipyretic, analgesic, and antiplatelet actions. Acetaminophen has antipyretic and analgesic
action. Hydrocodone has analgesic action.*
221
Aspirin should not be given to a child until he or she is 18 years of age because
a. the tablets are too difficult to swallow.
b. there is a risk of Reye syndrome.
c. aspirin is a narcotic and requires a prescription.
d. aspirin has been associated with hepatotoxicity.
b. there is a risk of Reye syndrome.
*Administration of aspirin to children with either chickenpox or influenza has been associated
with Reye syndrome, which can be fatal. The reason is due to Reye syndrome, not tablet size.
Aspirin is not a narcotic, it is a nonnarcotic analgesic and does not require a prescription.
Hepatotoxicity is associated with acetaminophen rather than aspirin. It is rare to see
hepatotoxicity associated with the use of aspirin.*
222
Aspirin should not be given to children until they are 18 years of age.
True
False
True
*Administration of aspirin to children with either chickenpox or influenza has been associated
with Reye syndrome, which can be fatal.*
223
Which of the following is the best to use in pediatric patients for both its analgesic and
antipyretic action?
a. Aspirin
b. Acetaminophen
c. NSAIDs
d. Codeine
b. Acetaminophen
*Acetaminophen is used in place of aspirin for pediatric patients for both its analgesic and
antiinflammatory action. In children and adolescents with either chickenpox or influenza, the
use of aspirin has been epidemiologically associated with Reye syndrome.*
224
The most serious adverse reaction associated with ketoconazole is
a. tachycardia.
b. hepatotoxicity.
c. hypotension.
d. achlorhydria.
b. hepatotoxicity.
*The most serious adverse reaction is hepatotoxicity. Its incidence is at least 1:10,000. It is
usually reversible on discontinuation of the drug, but, occasionally, it has been fatal. With
extended use, the patient should have periodic liver function tests. The other choices do not
represent the most serious adverse reaction with use of ketoconazole. Tachycardia is a rapid
heart rate, hypotension is low blood pressure, and achlorhydria is a lack of hydrochloric acid
from gastric contents of the stomach.*
225
A patient taking warfarin (Coumadin) may experience interactions with which of the
following?
a. Phenobarbital
b. Erythromycin
c. Aspirin
d. All of the above
d. All of the above
*Warfarin is notorious for interacting with other drugs. Phenobarbital induces its metabolism
and decreases circulating warfarin levels. Erythromycin inhibits its metabolism and increases
the risk of bleeding crises. Aspirin can displace warfarin from plasma protein sites and
increase warfarin’s free serum levels. Aspirin’s antithrombotic action is also additive with
warfarin’s anticoagulant action.*
226
A drug interaction between aspirin and _____ can result in significant bleeding.
a. probenecid
b. warfarin
c. methotrexate
d. sulfonylureas
b. warfarin
## Footnote
*The drug interaction between aspirin and warfarin can result in bleeding. Warfarin is an oral
anticoagulant that is highly protein bound to plasma protein–binding sites. If aspirin is
administered to a patient taking warfarin, it can displace the warfarin from its binding sites,
increasing its anticoagulant effect. Aspirin interferes with probenecid’s uricosuric effect and
has been reported to precipitate an acute attack of gout. Aspirin can displace methotrexate
from its plasma protein–binding sites and can also interfere with its clearance. This results in
an increased serum concentration and methotrexate toxicity such as bone marrow depression.
Higher doses of salicylates may produce a hypoglycemic effect.*
227
Which of the following agents has the most serious drug interaction with warfarin?
a. Omeprazole
b. Aspirin
c. Digitalis
d. Lomotil
b. Aspirin
Patients taking warfarin should not be given aspirin or aspirin-containing products because
bleeding episodes or fatal hemorrhages can occur. Aspirin causes hypoprothrombinemia and
alters platelet adhesiveness. Aspirin can also irritate the gastrointestinal tract, which might
bleed more in a patient taking warfarin. Another factor in the aspirin-warfarin interaction is
related to protein binding or drugs. Aspirin displaces bound warfarin. The other choices are
not the agent with the most serious drug interaction with warfarin.
228
Each of the following is true for management of the dental patient taking warfarin except one.
Which is the exception?
a. Use of aspirin should be avoided.
b. Most dental procedures do not require a change in the dose of warfarin.
c. Insure the patient is free of infection before scaling/root planing is performed.
d. Ask the patient to stop taking warfarin 3 days before the procedure.
d. Ask the patient to stop taking warfarin 3 days before the procedure.
*According to current recommendations it is not necessary to reduce or discontinue warfarin
prior to dental therapy. Avoid aspirin and aspirin-containing compounds; acetaminophen and
opioids may be used. Many surgical procedures can be carried out on a patient receiving
therapeutic doses of anticoagulants. The patient should be free of infection before scaling and
root planing is performed.*
229
All NSAIDs carry a warning to avoid use during pregnancy.
True
False
True
230
Which of the following statements is true regarding the pharmacokinetics of acetaminophen?
a. Acetaminophen is slowly and incompletely absorbed from the gastrointestinal
tract.
b. Acetaminophen is excreted with a half-life of 8 to 12 hours.
c. When large doses of acetaminophen are ingested, an intermediate metabolite is
produced that is thought to be hepatotoxic.
d. Acetaminophen is less potent and efficacious than aspirin.
c. When large doses of acetaminophen are ingested, an intermediate metabolite is
produced that is thought to be hepatotoxic.
*An intermediate metabolite is produced when large doses of acetaminophen are ingested that
is thought to be hepatotoxic and possibly nephrotoxic. Acetaminophen is rapidly and
completely absorbed from the gastrointestinal tract, achieving a peak plasma level in 1 to 3
hours. After therapeutic doses, it is excreted with a half-life of 1 to 4 hours. Acetaminophen
and aspirin are equally efficacious and equally potent.*
231
An acute overdose with acetaminophen may damage the
a. eyes.
b. liver.
c. spleen.
d. kidney.
b. liver.
*Acute overdose of acetaminophen can lead to the generation of a toxic metabolite that can
cause hepatic necrosis and lead to death. The acute ingestion of more than 12 g of
acetaminophen in single ingestion is considered a toxic dose and can pose a high risk for liver
damage. Acetaminophen does not damage the eyes or the spleen but can damage the kidney
upon chronic administration.*
232
Who is most likely to experience the most cases of accidental overdose with acetaminophen?
a. Infants
b. Children
c. Young adults
d. Older adults
b. Children
## Footnote
*In children, the acute ingestion of 250 mg/kg poses a high risk for liver damage and the acute
ingestion of 350 mg/kg can cause severe hepatotoxicity if not immediately treated. Children
experience more cases of accidental overdose with acetaminophen, which occurs because the
wrong dose form is used (e.g., infant drops are given to older children or adult doses are given
to children). Infant drops are concentrated, and doses for toddlers to 11-year-old children are
not the same as doses for infants. Parents may give the infant liquid to the older child and pour
it in the measuring cup, not realizing that they have overdosed their child.*
233
Alcohol consumption stimulates the breakdown of acetaminophen, thereby decreasing the
toxic potential of acetaminophen use.
a. Both parts of the statement are true.
b. Both parts of the statement are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.
c. The first part of the statement is true; the second part is false.
## Footnote
*Depending on the amount of alcoholic beverages consumed, the maximum dose of
acetaminophen varies. The normal maximum dose of acetaminophen (4 g) may be used in
patients who usually do not drink alcohol. The dose should be restricted to 2 g if a patient is a
moderate drinker (less than three alcohol beverages daily). Alcohol stimulates the oxidizing
enzymes that metabolize acetaminophen to its toxic metabolite. In this way, it increases
acetaminophen toxicity.*
234
Enkephalins, endorphins, and dynorphins probably function as \_\_\_\_\_, although their exact
function has not been elucidated.
a. prostaglandins
b. neurotransmitters
c. sedative-hypnotics
d. enzymes
b. neurotransmitters
*Enkephalins, endorphins, and dynorphins are endogenous substances with opioid-like action.
They probably function as neurotransmitters. They may be involved in the analgesic action of
a placebo and the enhancement of well-being that occurs with running. Prostaglandins are
produced in the body in response to many different stimuli. Prostaglandins are thought to be
mediators of the inflammatory response in oral soft tissues and may be involved in the initial
stage of periodontal disease. Sedative-hypnotics produce varying degrees of central nervous
system (CNS) depression depending on the dose administered. Examples include
benzodiazepines, barbiturates, and nonbenzodiazepine-nonbarbiturate sedative-hypnotics. An
enzyme is a substance that catalyzes a chemical reaction without being changed by it.*
235
Prescribing _____ for analgesia is best when treating a dental patient who abuses opioids.
a. Tylenol #3 with codeine
b. Vicodin
c. Percocet
d. nonsteroidal antiinflammatory drugs (NSAIDs)
d. nonsteroidal antiinflammatory drugs (NSAIDs)
*Alleviating the cause of the pain first and then prescribing NSAIDs for analgesia is best.
Because an opioid abuser develops tolerance to the analgesic effects of any opioid, treating
pain with opioids is ineffective and can cause a recovering addict to begin using opioids
again.*
236
\_\_\_\_\_ is usually the cause of death with an overdose of opioid analgesics.
a. Tachycardia
b. Respiratory depression
c. Electrolyte imbalance
d. Cellular necrosis
b. Respiratory depression
The opioid analgesic agonists depress the respiratory center in a dose-related manner. This
action is usually the cause of death with an overdose. The depression is related to a decrease
in the sensitivity of the brainstem to carbon dioxide. Both the rate and the depth of breathing
are reduced. Opioids may depress the vasomotor center and stimulate the vagus nerve.
Postural hypotension, bradycardia, and even syncope may result with high doses. Opioids can
increase the smooth muscle tone in the urinary tract and cause urinary retention; however, this
is not the primary cause of death. Cellular necrosis occurs following an injury and is not the
predominant cause of death due to an overdose of opioids.
237
What do aspirin, acetaminophen, ibuprofen, and codeine have in common?
a. They are all antiinflammatory.
b. They are all analgesic.
c. They all inhibit platelet aggregation.
d. They are all antipyretic.
b. They are all analgesic.
*All of them are analgesic. Aspirin and ibuprofen are analgesic, antipyretic, and
antiinflammatory, and they inhibit platelet aggregation. Acetaminophen is analgesic and
antipyretic. Codeine is analgesic. **(Pain revleivers)***
238
Which one of the following conditions can be managed or treated with opioids?
a. Diarrhea
b. Depression
c. Infections
d. Hypertension
a. Diarrhea
*The **opioids produce** _constipation_ by producing a tonic contraction of the gastrointestinal tract.
They are used for the treatment of diarrhea. Opioids are not used for the treatment of
depression, infections, or hypertension.*
239
Codeine activates the chemoreceptor trigger zone.
True
False
True
Codeine can cause nausea and vomiting by acting on this medullary structure.
240
Which antidepressant is least likely to cause xerostomia?
a. Bupropion (Know)
b. Sertraline
c. Chlorpromazine
d. Amitriptyline
e. Trazodone
b. Sertraline
Sertraline, as with other SSRIs, produces a lower incidence of xerostomia than other classes of antidepressants, probably because their anticholinergic activity is significantly weaker. Bupropion, trazodone, and especially amitriptyline have a greater anticholinergic action and incidence of xerostomia. Chlorpromazine is not an antidepressant
241
Which antidepressant is associated with priapism?
A) Bupropion
B) Tricyclic antidepressants
C) Trazodone
D) Nefazodone
E) Mirtazapine
C) Trazodone
*Trazodone is highly sedative and has been associated with priapism requiring surgical intervention and leaving some patients permanently impotent. Bupropion is associated with seizures. Tricyclic antidepressants are associated with anticholinergic effects and cardiac toxicity. Nefazodone carries a black box warning regarding the potential to cause life-threatening liver failure. Mirtazapine causes somnolence, weight gain, constipation, and dry mouth.*
## Footnote
*DIF: Recall REF: Antidepressant Agents (Other Antidepressants [Trazodone]) | p. 182 OBJ: 5 TOP: NBDHE, 6.0. Pharmacology*
242
All antidepressants will carry a black box warning about the potential for patient suicide.ANS: T
True
## Footnote
* There is an increased risk of suicidality in children, adolescents, and young adults, which are included in the package inserts. All depressed children, adolescents, and adults should be monitored for suicidal ideation and behavior regardless of antidepressant or nontherapy.*
* DIF: Recall REF: Antidepressant Agents (Suicide and Antidepressants) | p. 182 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology*
243
Which of the following are anticholinergic effects that may be associated with tricyclic antidepressants?
A) Xerostomia
B) Bradycardia
C) Urination
D) Both A and B
E) Both B and C
A) Xerostomia
## Footnote
*Tricyclic antidepressants possess distinct anticholinergic effects resulting in xerostomia, blurred vision, tachycardia, constipation, and urinary retention. Some tolerance can develop with continued use. The extension of cholinergic effects are salivation, lacrimation, urination, and defecation. Anticholinergic effects would be the opposite.*
*DIF: Comprehension
REF: Antidepressant Agents (Tricyclic Antidepressants [Adverse Reactions]) | p. 181 OBJ: 4 TOP: NBDHE, 6.0. Pharmacology*
244
**Tardive dyskinesia** is characterized by
A) increased compulsive motor activity.
B) resting tremor and rigidity.
C) akinesia.
D) involuntary, repetitive body movements involving the tongue, lips, face, and jaw.
D) involuntary, repetitive body movements involving the tongue, lips, face, and jaw.
*All first-generation antipsychotics produce extrapyramidal effects. Tardive dyskinesia is an irreversible dyskinesia involving the tongue, lips, face, and jaw. These involuntary movements can make home care difficult if not impossible. Performing oral prophylaxis is difficult because of the strength of the oral facial and tongue muscles. Akathisia is an increased compulsive motor activity. Parkinsonism is characterized by symptoms of resting tremor, rigidity, and akinesia. Akinesia is a loss of voluntary muscle activity.*
## Footnote
*DIF: Recall
REF: Antipsychotic Agents (Pharmacologic Effects [First-Generation Antipsychotics]) | p. 177 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology*
245
Which of the following medications is used to treat bipolar depression?
a. Haloperidol
b. Lithium
c. Clozapine
d. Paroxetine
b. Lithium
* Lithium is used in the treatment of bipolar depression, which is characterized by cyclic recurrence of mania alternating with depression. Haloperidol is a high-potency first-generation antipsychotic. Clozapine is a second-generation antidepressant. Paroxetine is an SSRI.*
## Footnote
*DIF: Recall REF: Drugs for Treatment of Bipolar Disorder | p. 182 OBJ: 6 TOP: NBDHE, 6.0. Pharmacology*
246
In general, lower potency first-generation antipsychotic agents such as chlorpromazine (Thorazine) will have more of which of the following effects in contrast to the higher potency first-generation antipsychotic agents such as haloperidol (Haldol): (1) sedation, (2) orthostatic hypotension, (3) autonomic effects, (4) extrapyramidal effects?
A) 1, 2, 3, 4
B) 1, 2, 3
C) 2, 3, 4
D) 1, 2
E) 3, 4
B) 1, 2, 3
*Chlorpromazine will have more sedation, orthostatic hypotension, and autonomic effects than haloperidol. Lower potency first-generation antipsychotic agents such as chlorpromazine have more sedation, more peripheral side effects, and more autonomic effects. Higher potency first-generation antipsychotics agents such as haloperidol have more extrapyramidal effects and less sedation.*
## Footnote
*DIF: Application REF: Antipsychotic Agents | p. 175 OBJ: 3 TOP: NBDHE, 6.0. Pharmacology*
247
Which type of agent such as donepezil (Aricept) has been FDA approved for the treatment of dementia?
A) Cholinergic agents
B) Anticholinergic agents
C) Adrenergic agents
D) Adrenergic blocking agents
A) Cholinergic agents
*Indirect acting, reversible acetylcholinesterase inhibitors are being used to treat Alzheimer Disease (AD) dementia. They have been shown to produce modest improvements in dementia symptoms but they do not slow down, stop, or reverse disease progression. At one time anticholinergic agents were commonly used to reduce tremors associated with Parkinson disease, but at present they are only used occasionally. Some adrenergic agonists have been used to treat attention-deficit disorder (ADD) and narcolepsy.*
## Footnote
*DIF: Comprehension
REF: Parasympathetic Autonomic Nervous System (Cholinergic (Parasympathomimetic) Agents [Uses]) | p. 38 OBJ: 2 TOP: NBDHE, 6.0. Pharmacology*
248
Indications for the use of anticholinergic agents include
A) stimulation of salivary secretion for xerostomic patients.
B) treatment of gastrointestinal disorders associated with decreased motility.
C) treatment in combination with levodopa for patients with Parkinson disease.
D) use as an antipsychotic.
C) treatment in combination with levodopa for patients with Parkinson disease.
At present, anticholinergic agents are used occasionally in combination with levodopa for thetreatment of Parkinson disease. Before the introduction of levodopa, anticholinergic agentswere commonly used to reduce the tremors and rigidity associated with Parkinson disease.Patients treated with these agents predictably experienced the side effects of dry mouth and blurred vision. Anticholinergic agents inhibit the secretions of saliva and bronchial mucus thatcan be stimulated by general anesthesia. Many types of gastrointestinal disorders associated with increased motility or aciNd seRcreItionGhavBe.bCeenMtreated with anticholinergic agents. Anticholinergic agents, such as trihexyphenidyl and benztropine, are often administered concurrently with the phenothiazines to reduce rigidity and tremor; however, anticholinergics themselves are not antipsychotic medications.
DIF: Comprehension
REF: Parasympathetic Autonomic Nervous System (Anticholinergic (Parasympatholytic) Agents [Contraindications]) | p. 38 | Parasympathetic Autonomic Nervous System (Anticholinergic
(Parasympatholytic) Agents [Uses]) | p. 38 TOP: NBDHE, 6.0. Pharmacology
249
Which of the following benzodiazepines is the drug of choice for treatment of repetitive,
intractable seizures that require IV therapy?
a. Chlordiazepoxide (Librium)
b. Diazepam (Valium)
c. Zolpidem (Ambien)
d. Eszopiclone (Lunesta)
b. Diazepam (Valium)
*Diazepam (Valium) or lorazepam (Ativan) are the drugs of choice for treatment of repetitive,
intractable seizures (status epilepticus) that require IV therapy. They also are used for
treatment of seizures caused by local anesthetic toxicity. Orally administered diazepam is of
little value, even as a maintenance anticonvulsant. Oral **clonazepam** is used as an adjunct to
other anticonvulsants for some difficult-to-control types of seizures. Chlordiazepoxide is not
used for status epilepticus that requires IV therapy. Zolpidem and eszopiclone are not
benzodiazepines. They are categorized as nonbenzodiazepine-benzodiazepine receptor
agonists.*
250
Which of the following are anticholinergic effects that may be associated with tricyclic
antidepressants?
a. Xerostomia
b. Bradycardia
c. Urination
d. Both A and B
e. Both B and C
a. Xerostomia
## Footnote
*Tricyclic antidepressants possess distinct anticholinergic effects resulting in xerostomia,
blurred vision, tachycardia, constipation, and urinary retention. Some tolerance can develop
with continued use. The extension of cholinergic effects are salivation, lacrimation, urination,
and defecation. Anticholinergic effects would be the opposite.*
251
Which choice represents the current most commonly prescribed antidepressant agent?
a. Monoamine oxidase inhibitor (MAOI)
b. Tricyclic antidepressant (TCA)
c. Selective serotonin uptake inhibitor (SSRI)
d. Second-generation antipsychotic
c. Selective serotonin uptake inhibitor (SSRI)
*SSRIs are recommended as first-line therapy for the treatment of major depression. They are
generally well tolerated, safe, and effective. MAOIs are used as drugs of last choice because
of the potential for life-threatening situations. TCAs are no longer first-line therapy and are
reserved for patients with moderate to severe treatment-resistant depression. Several
second-generation antipsychotics have been FDA-approved for adjunctive treatment of major
depressive disorder.*
252
Tardive dyskinesia is characterized by
a. increased compulsive motor activity.
b. resting tremor and rigidity.
c. akinesia.
d. involuntary, repetitive body movements involving the tongue, lips, face, and jaw.
d. involuntary, repetitive body movements involving the tongue, lips, face, and jaw.
*All first-generation antipsychotics produce **extrapyramidal** effects. Tardive dyskinesia is an
**irreversible** dyskinesia involving the tongue, lips, face, and jaw. These i**nvoluntary
movements** can make home care difficult if not impossible. Performing oral prophylaxis is
difficult because of the strength of the oral facial and tongue muscles. Akathisia is an
increased compulsive motor activity. Parkinsonism is characterized by symptoms of resting
tremor, rigidity, and akinesia. Akinesia is a loss of voluntary muscle activity.*
253
Clonazepam (Klonopin) is
a. a chemical analogue carbamazepine.
b. used parenterally to treat status epilepticus.
c. used as an adjunct to treat ethosuximide-resistant absence seizures.
d. not effective in akinetic seizures.
e. an inhibitor of sodium channels.
c. used as an adjunct to treat ethosuximide-resistant absence seizures.
*Clonazepam is effective alone or as an adjunct in the treatment of petit mal seizures.
Clonazepam is a benzodiazepine, whereas carbamazepine is a chemical analogue of tricyclic
antidepressants and phenothiazines. Clonazepam is not used parenterally. Clonazepam, as
with other benzodiazepines, has activity against a wide variety of seizures, including akinetic
seizures. The benzodiazepines do not inhibit sodium channels. They bind to the GABA
receptor complex and facilitate the entry of chloride into postsynaptic nerve terminals.*
254
A deficiency of adrenocorticosteroids is \_\_\_\_\_\_\_\_, and an excess is \_\_\_\_\_\_\_\_\_\_.
a. Addison disease; Cushing disease
b. Addison disease; Cushing syndrome
c. Addison syndrome; Cushing syndrome
d. Addison syndrome; Cushing disease
b. Addison disease; Cushing syndrome
*Addison disease is the disease or condition caused by a deficiency of adrenocorticosteroids.
Cushing syndrome is produced by an excess of adrenocorticosteroids. It is Addison disease
and Cushing syndrome.*
255
Tepid baths and aspirin are indicated for
a. myocardial infarction.
b. thyroid storm.
c. acute adrenocortical insufficiency.
d. all of the above.
e. none of the above.
b. thyroid storm.
* One symptom of thyroid storm is hyperpyrexia. To reduce body temperature, aspirin and tepid baths are indicated. An aspirin tablet is indicated for myocardial infarction but not a tepid bath. Neither aspirin nor tepid bath is indicated for acute adrenocortical insufficiency.*
256
Estrogens are used to treat menstrual disturbances such as uterine bleeding. Estrogen is also used to reduce the symptoms of menopause.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
a. Both statements are true.
* In addition to their presence in oral contraceptives, estrogens are used to treat menstrual disturbances (dysmenorrhea, dysfunctional uterine bleeding), osteoporosis, atrophic vaginitis, nondevelopment of the ovaries, hirsutism, cancer, and symptoms of menopause. Estrogens are used to treat uterine bleeding and to reduce the symptoms of menopause.*
