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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS
 
Applied Pharmacology for the Dental Hygienist 7th Edition  by Elena Bablenis Haveles – Test Bank
Sample  Questions      

Chapter 01: Information Sources, Regulatory Agencies, Drug Legislation, and Prescription Writing

Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. Knowledge of pharmacology aids the dental professional in:
a. obtaining a patient’s health history.
b. administering drugs in the office.
c. handling emergency situations.
d. lifelong learning.
e. all of the above.

 

 

ANS:  E

Correct: All of the choices are true.

Incorrect choices: Because many of our patients are being treated with drugs, knowledge of pharmacology helps in understanding and interpreting patients’ responses to health history questions. Knowledge of the therapeutic and adverse effects of medications obviously helps in their proper administration in the office. Emergency situations may be caused by drugs or treated by drugs; thus, knowledge of pharmacology is of great help, especially because a rapid response is sometimes required. A clear understanding of the concepts of drug action, drug handling by the body, and drug interactions will allow the dental practitioner to make proper judgments and grasp the concepts relevant to new drug therapies on the market.

 

REF:   Role of the Dental Hygienist | pp. 3-4                             OBJ:   1

 

  1. Which of the following statements is true regarding planning appointments?
a. Whether or not patients are taking medication for systemic diseases is of little consequence in the dental office.
b. Asthmatic patients should have dental appointments in the morning.
c. Diabetic patients usually have fewer problems with a morning appointment compared with afternoon appointments.
d. Both b and c are true.

 

 

ANS:  C

Correct: Diabetic patients usually have relatively fewer problems with a morning appointment.

Incorrect choices: Asthmatic patients should have afternoon appointments. Patients taking medication for systemic diseases may require special handling in the dental office.

 

REF:   Role of the Dental Hygienist (Appointment Scheduling) | p. 3

OBJ:   1

 

  1. 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.

 

 

ANS:  C

Correct: Nutritional or herbal supplements are quite capable of causing adverse effects.

Incorrect choices: 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.

 

REF:   Role of the Dental Hygienist (Nutritional or Herbal Supplements) | pp. 3-4

OBJ:   1

 

  1. Which type of drug name usually begins with a lowercase letter?
a. Brand name
b. Code name
c. Generic name
d. Trade name

 

 

ANS:  C

Correct: 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.

Incorrect choices: 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.

 

REF:   Drug Names | p. 5                           OBJ:   3

 

  1. A drug’s generic name is selected by the:
a. pharmaceutical company manufacturing it.
b. Food and Drug Administration (FDA).
c. U.S. Adopted Name Council.
d. Federal Patent Office.

 

 

ANS:  C

Correct: Each drug is assigned only one generic name (e.g., ibuprofen). It is selected by the United States Adopted Name Council.

Incorrect choices: The generic name is not selected by the FDA or the Federal Patent Office. The pharmaceutical company manufacturing the drug clearly has an influence on the generic name given its drug, but the final decision is not the company’s.

 

REF:   Drug Names | p. 5                           OBJ:   4

 

  1. 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.

 

 

ANS:  B

Correct: Each drug has only one generic name but may have several trade names.

Incorrect choices: For each drug, there is only one generic name. It is not capitalized, and it becomes the “official” name of the drug. The pharmaceutical company discovering the drug gives the drug a trade name. The trade name is protected by the Federal Patent Law for 20 years from the earliest claimed filing date, plus patent term extensions. Although the brand name is technically the name of the company marketing the product, it is often used interchangeably with the trade name.

 

REF:   Drug Names | p. 4                           OBJ:   3

 

  1. Which of the following is the most common reference book in the dental office?
a. United States Pharmacopeia-Drug Information (USP DI)
b. Physicians’ Desk Reference (PDR)
c. Mosby’s Dental Drug Reference
d. Lexi-Comp’s Drug Information Handbook for Dentistry

 

 

ANS:  B

Correct: The PDR is the most common reference book in the dental office because of its historically inexpensive price. Information provided comes directly from the manufacturer’s package insert.

Incorrect choices: The USP DI provides the health professional with necessary information regarding basic pharmacology and pharmacokinetics, dosing, adverse reactions, and drug interactions. Mosby’s Dental Drug Reference provides access to information on drugs commonly taken by patients. Lexi-Comp’s Drug Information Handbook for Dentistry contains concise lists of drug attributes and sections relevant to dentistry for each drug.

 

REF:   Box 1-2: Pharmacologic References and Resources Recommended for the Dental Office | p. 4

OBJ:   2

 

  1. How many years must pass after a drug patent expires before other drug companies can market the same compound as a generic drug?
a. 20 years
b. 17 years
c. 7 years
d. 0 years

 

 

ANS:  D

Correct: Once a drug patent expires, competing companies may immediately market the same compound in generic form.

Incorrect choices: After 17 years, the patent of the original drug expires, and other companies can market the same compound under a generic name.

 

REF:   Drug Names (Drug Substitution) | p. 5                             OBJ:   4

 

  1. Two drug formulations that produce similar concentrations in the blood and tissues after drug administration are termed _____ equivalent.
a. chemically
b. biologically
c. therapeutically

 

 

ANS:  B

Correct: Biologic equivalence refers to identical pharmacokinetic parameters of two drug formulations (bioequivalence, for short).

Incorrect choices: Chemical equivalence indicates that two formulations of a drug meet the chemical and physical standards established by the regulatory agencies. Therapeutic equivalence means that two formulations produce the same therapeutic effects over the same duration.

 

REF:   Drug Names (Drug Substitution) | p. 5                             OBJ:   4

 

  1. 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. United States Pharmacopeia (USP).

 

 

ANS:  C

Correct: The DEA regulates the manufacture and distribution of substances with abuse potential. Hence prescriber DEA numbers must appear on prescriptions for controlled substances.

Incorrect choices: The FDA does not have any special powers in regard to drugs of abuse. The FTC regulates commerce and advertising claims of foods, over-the-counter (OTC) products, and cosmetics. The USP regulates the uniformity and purity of drugs.

 

REF:   Federal Regulations and Regulatory Agencies (Drug Enforcement Administration) | p. 5

OBJ:   5

 

  1. Which federal regulatory body is part of the U.S. Department of Health and Human Services (DHHS)?
a. FDA
b. OTC
c. FTC
d. DEA

 

 

ANS:  A

Correct: Of the legitimate agencies listed, only the FDA is part of DHHS.

Incorrect choices: OTC is a nonsense answer. It is an abbreviation for “over-the-counter” as in medications that may be purchased without a prescription. The FTC is an independent agency that reports to the U.S. Congress on its actions. The DEA is a part of the Department of Justice.

 

REF:   Federal Regulations and Regulatory Agencies (Food and Drug Administration) | p. 5

OBJ:   5

 

  1. Which federal regulatory body regulates the trade practices of drug companies and prohibits false advertising of foods, nonprescription drugs, and cosmetics?
a. FDA
b. FTC
c. DEA
d. OBRA

 

 

ANS:  B

Correct: Consumers who refer to care labels on their clothes, product warranties, or stickers showing the energy costs of home appliances are using information required by the FTC. Businesses must be familiar with the laws requiring truthful advertising and prohibiting price fixing. These laws are also administered by the FTC. When the FTC was created in 1914, its purpose was to prevent unfair methods of competition in commerce. Over the years, the U.S. Congress has passed additional laws giving the agency greater authority to police anticompetitive practices.

Incorrect choices: The FDA grants approval so that drugs can be marketed in the United States. Before the FDA can approve a drug, the drug must be determined to be both safe and effective. The DEA regulates the manufacture and distribution of substances that have a potential for abuse. OBRA (Omnibus Budget Reconciliation Act) is not a regulatory body; it is an act that mandates that pharmacists must provide patient counseling.

 

REF:   Federal Regulations and Regulatory Agencies (Federal Trade Commission) | p. 5

OBJ:   5

 

  1. An investigational new drug application (INDA) is submitted _____ trials.
a. before preclinical
b. before phase 1 clinical
c. after phase 2 clinical
d. before phase 3 clinical

 

 

ANS:  B

Correct: Preclinical testing usually lasts about 3 years. After the preclinical trials have been completed, an INDA must be filed with the FDA before a drug company can commence phase 1 clinical trials.

Incorrect choices: Animal testing data must be accumulated from preclinical trials before filing an INDA. Phase 1 is the first trial using patients, and phases 2 and 3 follow phase 1. An INDA must be filed before any testing in humans can commence.

 

REF:   Clinical Evaluation of a New Drug | p. 6                         OBJ:   6

 

  1. Phase 1 clinical trials involve all of the following except which one?
a. Safe dose range
b. Toxic effects of the drug
c. Metabolism
d. Effectiveness

 

 

ANS:  D

Correct: In phase 1 clinical trials, small and then increasing doses are administered to a limited number of healthy human volunteers, primarily to determine safety. This phase determines the biologic effects, metabolism, safe dose range in humans, and toxic effects of the drug. The main purpose of phase 2 is to test effectiveness.

Incorrect choices: Biologic effects, metabolism, safe dose range in humans, and toxic effects of the drug are, in fact, goals of phase 1 clinical trials.

 

REF:   Clinical Evaluation of a New Drug | p. 6                         OBJ:   6

 

  1. Which of the following is determined during a phase 3 clinical evaluation of a new drug?
a. Effectiveness
b. Safety and efficacy
c. Dosage
d. Both a and b
e. Both b and c

 

 

ANS:  E

Correct: Both safety and efficacy must be demonstrated during phase 3 of the clinical evaluation of a new drug. Dosage is also determined during this phase. During phase 3, clinical evaluation takes place involving a large number of patients who have the condition for which the drug is indicated.

Incorrect choices: The main purpose of phase 2 clinical evaluation is to test a drug’s effectiveness.

 

REF:   Clinical Evaluation of a New Drug | p. 6                         OBJ:   6

 

  1. Which of the following is a schedule II controlled substance?
a. Heroin
b. Propranolol
c. Amphetamine
d. Dextropropoxyphene (Darvon)

 

 

ANS:  C

Correct: Amphetamine, oxycodone, morphine, and secobarbital are all schedule II controlled substances.

Incorrect choices: Heroin is a schedule I substance. Propranolol is a nonscheduled prescription drug. Dextropropoxyphene is a schedule IV substance.

 

REF:   Table 1-2: Schedules of Controlled Substances | p. 7      OBJ:   6

 

  1. Controlled substances in schedule _____ require a written prescription with the provider’s signature and do not permit refills.
a. II, III, and IV
b. II and III
c. III and IV
d. II only
e. III only

 

 

ANS:  D

Correct: Controlled substances in schedule II require a written prescription with the provider’s signature and do not permit refills. Any prescription for schedule II drugs must be written in pen or indelible ink or typed. A designee of the dentist, such as the dental hygienist, may write the prescription, but the prescriber must personally sign the prescription in ink and is responsible for what any designee has written.

Incorrect choices: Prescriptions for controlled substances in both schedule III and schedule IV may be telephoned, and no more than five prescriptions in 6 months are permitted.

 

REF:   Table 1-2: Schedules of Controlled Substances | p. 7      OBJ:   6

 

  1. Schedule III controlled substances may be telephoned to the pharmacist and may be refilled no more than five times in 6 months.
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.

 

 

ANS:  A

Correct: Both parts of the statement are true. Schedule III controlled substances may be telephoned to the pharmacist and may be refilled as many as five times in 6 months.

Incorrect choices: Both parts of the statement are true for schedule III and schedule IV controlled substances. Schedule I controlled substances have no accepted medical use. Schedule II controlled substances require a written prescription with the provider’s signature, and no refills are permitted. Schedule V controlled substances can be bought OTC in some states.

 

REF:   Drug Legislation (Scheduled Drugs) | p. 7                       OBJ:   6

 

  1. What is the purpose of a “black box warning” on a package insert?
a. It is used to reconstruct the events leading to a fatality resulting from a medication error.
b. It is issued by the Drug Enforcement Administration (DEA) to indicate medications that may be used to manufacture illicit drugs such as methamphetamine.
c. It is used to draw attention to potentially fatal, life threatening, or disabling adverse effects for different medications.
d. It means that the effects of the drug have not yet been determined.

 

 

ANS:  C

Correct: A black box warning is about a drug the FDA has required a manufacturer to prominently display in a box in the package insert. The intent of the black box is to draw attention to the specific warning and make sure that both the prescriber and patient understand the serious safety concerns associated with that drug.

Incorrect choices: A black box on an airplane is used to reconstruct events prior to a tragedy; however, the black box warning on a medication package insert is used to warn about safety concerns with the drug. A black box is not used as a warning about illicit use of medications. All drugs must go through preclinical and clinical trials prior to being marketed.

 

REF:   Drug Legislation (Black Box Warning) | p. 7                   OBJ:   7

 

  1. An “orphan drug” is:
a. not related to any other medication currently available.
b. developed specifically to treat a rare medical condition.
c. a drug that has been on the market for longer than 20 years and generic substitution is permitted.
d. no longer available for use as newer, more effective medications are available.

 

 

ANS:  B

Correct: Rare medical conditions with orphan status refer to diseases that occur in fewer than 200,000 people in the United States.

Incorrect choices: Orphan drugs may be related to other medications. Orphan drug status is not related to the time the drug has been available. Many newer drugs have been assigned orphan status.

 

REF:   Drug Legislation (Orphan Drugs) | p. 7                            OBJ:   7

 

  1. The word stat on a prescription means:
a. before meals.
b. at bedtime.
c. immediately.
d. every.

 

 

ANS:  C

Correct: The word stat on a prescription means immediately (now).

Incorrect choices: The abbreviation ac means before meals, hs means at bedtime, and q means every.

 

REF:   Table 1-3: Abbreviations Commonly Used in Prescriptions | p. 9

OBJ:   7

 

  1. The abbreviation used on prescriptions for four times a day is:
a. bid.
b. qid.
c. qd.
d. ud.

 

 

ANS:  B

Correct: qid is the abbreviation for quarter in die, or four times a day.

Incorrect choices: bid stands for twice a day, qd stands for every day, and ud stands for as directed.

 

REF:   Table 1-3: Abbreviations Commonly Used in Prescriptions | p. 9

OBJ:   7

 

  1. The heading of a prescription contains the following information except the:
a. name and address of prescriber.
b. name and address of the patient.
c. telephone numbers of the patient and the prescriber.
d. date of birth of the prescriber.
e. date of the prescription.

 

 

ANS:  D

Correct: Having the date of birth of the patient on the prescription is important, both to determine the proper dose for age and so the patient is not confused with another family member (i.e., mother or daughter).

Incorrect choices: The heading of a prescription contains the name, address, and telephone number of the prescriber, as well as the name, address, age, and telephone number of the patient and the date of the prescription.

 

REF:   Prescription Writing (Format) | p. 8                                 OBJ:   7

 

  1. Which of the following is located in the body of the prescription?
a. The date of the prescription
b. The amount of the drug to be dispensed
c. Directions to the prescriber
d. Refill instructions

 

 

ANS:  B

Correct: The Rx symbol, name and dose size or concentration of the drug, amount to be dispensed, and directions to the patient are all found in the body of the prescription.

Incorrect choices: The date of the prescription is found in the heading. The directions to the patient rather than prescriber are found in the body of the prescription. Refill instructions are found in the closing of the prescription.

 

REF:   Prescription Writing (Format) | p. 8                                 OBJ:   7

 

  1. Where is the information regarding the prescriber DEA number commonly found on the prescription?
a. Superscription
b. Heading
c. Body
d. Closing

 

 

ANS:  D

Correct: The signature area of the prescription is found in the closing. It should also include a space for the DEA number.

Incorrect choices: The superscription is a classical description for where the patient information and the symbol Rx are found. The heading contains prescriber and patient contact information, the patient’s date of birth, and the date of prescription. The body contains the Rx symbol, dosage instructions, and directions to the patient.

 

REF:   Prescription Writing (Format) | p. 9                                 OBJ:   7

 

  1. On a prescription, the directions to the patient are preceded by:
a. Rx.
b. Sig.
c. #.
d. Disp.

 

 

ANS:  B

Correct: Sig. is the abbreviation for the Latin word signa, or write. This word precedes the instructions to the patient.

Incorrect choices: 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 #.

 

REF:   Prescription Writing (Format) | pp. 8-9                            OBJ:   7

 

MULTIPLE RESPONSE

 

  1. How are computer and online resources enhancing printed books as a source of information about drugs? (Select all that apply.)
a. Web-based physicians can diagnose patient conditions and prescribe medication over the Internet.
b. Tablet computers and smart phones may be used for medication information databases.
c. Some publishers have apps that can be downloaded to smart phones.
d. Websites such as WebMD have decision trees whereby patients can identify their own health condition and determine appropriate treatment and medication.
e. Older editions of textbooks have been placed in the public domain and are useful for information about medications and drug interactions.

 

 

ANS:  B, C

Correct: Tablet computers and smart phones are being used more and more for recording, storing patient information, calculating drug doses, and using medication information databases. Some online websites have apps that can be downloaded to smart phones as well as computer-based online sites.

Incorrect choices: There are many legal issues with health care professionals dispensing advice over the Internet. For example, a health care provider may not be licensed to practice in the state where the person asking for information resides. Websites do not provide the means for patients to determine their own health condition. There are many sites with useful information, but most have a disclaimer recommending that the person seek help from a qualified practitioner. Medications change rapidly, and it is important to use current sources of information.

 

REF:   Sources of Information (Computers and Online Resources) | p. 4

OBJ:   2

 

  1. Which of the following are true of an off-label use of a drug? (Select all that apply.)
a. Prescribers are allowed to use drugs for off-label use under certain circumstances.
b. The FDA approves the use of drugs for specific indications, which are listed or labeled on the package insert of the drug.
c. Drug manufacturers have much useful information regarding off-label uses of their drugs on their websites.
d. Off-label use of drugs is not permitted in the United States.
e. Off-label drugs are repackaged for sale by clandestine organizations outside the United States and are illegal to transport or distribute.

 

 

ANS:  A, B

Correct: Practitioners are allowed to use off-label drugs if good medical practice justifies their use, the use is well documented in the medical literature, and the drug meets the current standard of medical care. The FDA approves the use of drugs for specific indications, and they are listed or labeled on the package insert of the drug.

Incorrect choices: Drug manufacturers are not allowed to bring up off-label uses when speaking with the prescribing practitioner, nor can they distribute written material regarding off-label uses. The off-label use of drugs is permitted in the United States provided that several rules are followed.

 

REF:   Drug Legislation (Labeled and Off-Label Uses) | p. 7     OBJ:   7

 

  1. Which of the following are associated with increased patient nonadherence to medication therapy? (Select all that apply.)
a. Some patients may fear of the side effects of the medication.
b. A longer duration of drug therapy is associated with the risk for nonadherence with medication therapy.
c. Increased dosing frequency is associated with nonadherence with medication therapy.
d. The issue of nonadherence to medication therapy is not important, as patients reliably take their medication as prescribed.

 

 

ANS:  A, B, C

Correct: Many factors are associated with nonadherence to medication therapy. These include poor understanding of the disease and a need for medication to treat it, fear of side effects of the medication, distrust of health care professionals, economic factors, or forgetfulness. Longer duration of drug therapy and the number of times a day the patient must take a prescription increase the chances that a patient will not adhere to the regimen. For example, patients are more compliant with twice-a-day dosing than they are with four-times-a-day dosing.

Incorrect choices: Statistics reveal that only a minority of patients will take their medication as prescribed.

 

REF:   Prescription Writing (Role of the Dental Hygienist and Patient Adherence to Medication Therapy) | p. 10           OBJ:               7

 

TRUE/FALSE

 

  1. The body of a prescription includes directions to the patient.

 

ANS:  T

Correct: The body of the prescription contains the Rx symbol, name and dose size or concentration of the drug, amount to be dispensed, and directions to the patient.

 

REF:   Prescription Writing (Format) | p. 8                                 OBJ:   7

 

  1. Refill instructions are found in the body of a prescription.

 

ANS:  F

Correct: Refill instructions are found in the closing, rather than body, of the prescription.

 

REF:   Prescription Writing (Format) | pp. 8-9                            OBJ:   7

Chapter 03: Adverse Reactions

Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. A genetically related abnormal drug response is called a(n):
a. toxic reaction.
b. idiosyncratic reaction.
c. side effect.
d. drug allergy.

 

 

ANS:  B

Correct: An idiosyncratic reaction is a genetically related abnormal drug response.

Incorrect choices: A toxic reaction is an adverse drug reaction that is an extension of the pharmacologic effect of the drug. Side effects are dose-related effects on nontarget organs. Drug allergy refers to the interaction of the immune system with the drug. None of these incorrect choices are limited to describing abnormal or genetically related responses.

 

REF:   Definitions and Classifications | p. 26                             OBJ:   1

 

  1. A drug effect that is neither predictable nor dose related is called a:
a. therapeutic effect.
b. toxic reaction.
c. side effect.
d. drug allergy.
e. Both b and d are correct.

 

 

ANS:  D

Correct: Unlike other adverse reactions, allergic reactions are neither predictable nor dose related.

Incorrect choices: Approved pharmaceuticals are available for use because they produce a predictable and dose-related therapeutic response. Toxic reactions and side effects are dose-related effects, the former on the target organ and the latter on nontarget organs. They might be surprising when they arise, for instance, in patients who are especially sensitive to a drug’s effects. However, they are predictable based on the drug’s dose-response relationship.

 

REF:   Definitions and Classifications | p. 26                             OBJ:   1

 

  1. The following choices refer to adverse reactions involving exaggerated effects on target tissues except:
a. overreaction of a sensitive patient.
b. administration of too large a dose.
c. caused by a nontherapeutic action of a drug.
d. possibly resulting from liver or kidney disease.

 

 

ANS:  C

Correct: This answer is typical of an adverse effect caused by action on nontarget tissues.

Incorrect choices: Exceptional sensitivity to a normal dose and administration of too large a dose for a patient are common actions that lead to exaggerated effect. Liver or kidney disease may reduce metabolism or excretion, respectively.

 

REF:   Clinical Manifestations of Adverse Reactions (Exaggerated Effect on Target Tissues) p.26 | Clinical Manifestations of Adverse Reactions (Effect on Nontarget Tissues) | p. 26

OBJ:   2

 

  1. A dose-related reaction that produces undesirable effects caused by the action on nontarget organs is called a:
a. therapeutic effect.
b. toxic reaction.
c. side effect.
d. drug allergy.

 

 

ANS:  C

Correct: A side effect is a predictable, dose-related drug effect that acts on nontarget organs.

Incorrect choices: Therapeutic effect is the desired effect of the drug. Toxic reaction is a predictable, dose-related drug effect that acts on nontarget organs and produces an adverse reaction. In a drug allergy, the immune system of an individual responds to a drug, resulting in an allergic reaction. Drug reactions are not dose related or predictable.

 

REF:   Definitions and Classifications | p. 26                             OBJ:   2

 

  1. An agent for which data are insufficient in animals or women to ensure safety during pregnancy would be classified in which U.S. Food and Drug Administration category for teratogenic drugs?
a. X
b. A
c. C
d. B

 

 

ANS:  C

Correct: Some older drugs may be classified as C because data are insufficient to place them in higher categories.

Incorrect choices: X means never use if someone might get pregnant. A means best or least teratogenic. B means that no demonstrated risk to the fetus in laboratory animals has been found or that animal studies show a risk that cannot be substantiated by studies in pregnant women.

 

REF:   Clinical Manifestations of Adverse Reactions (Effect on Fetal Development [Teratogenic Effect]) | pp. 26-27           OBJ:               2

 

  1. The greatest risk to the fetus from exposure to drugs occurs:
a. just before birth.
b. during the third trimester.
c. during the second trimester.
d. before pregnancy status is known.

 

 

ANS:  D

Correct: Early in pregnancy (first trimester) the organs in the fetus are forming, which is considered the most critical time for teratogenicity.

Incorrect choices: Drugs at these stages may affect the newborn, but the fetus is fully developed. Fetal organogenesis has already occurred; therefore, critical stages in fetal development have passed.

 

REF:   Clinical Manifestations of Adverse Reactions (Effect on Fetal Development [Teratogenic Effect]) | p. 27           OBJ:               2

 

  1. An acute, life-threatening allergic reaction characterized by hypotension, bronchospasm, laryngeal edema, and cardiac arrhythmias is what type of hypersensitivity?
a. Type I
b. Type II
c. Type III
d. Type IV

 

 

ANS:  A

Correct: Type I hypersensitivity, or immediate-type hypersensitivity, is a rapidly produced response targeting the bronchioles, the respiratory system, and the skin. Types II, III, and IV reactions are all slower than type I reactions.

Incorrect choices: Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed, causing arthralgia, urticarial skin eruptions, and so forth, with little or no lung involvement. Type IV hypersensitivity, or delayed-type hypersensitivity, is generally manifested as skin eruptions.

 

REF:   Clinical Manifestations of Adverse Reactions (Hypersensitivity [Allergic Reaction]) | p. 27

OBJ:   2

 

  1. Which hypersensitivity reaction causes antibody-antigen (immune complex) deposition?
a. Type I
b. Type II
c. Type III
d. Type IV

 

 

ANS:  C

Correct: Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed and deposited, causing arthralgia, urticarial skin eruptions, and so forth.

Incorrect choices: Type I hypersensitivity, or immediate-type hypersensitivity, involves drug antigen or allergen binding to immunoglobulin E (IgE) antibodies on inflammatory cells. Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type IV hypersensitivity, or delayed-type hypersensitivity, generally manifests as skin eruptions.

 

REF:   Clinical Manifestations of Adverse Reactions (Hypersensitivity [Allergic Reaction]) | p. 27

OBJ:   2

 

  1. Which hypersensitivity reaction is termed delayed-type hypersensitivity and is mediated by sensitized T lymphocytes and macrophages?
a. Type I
b. Type II
c. Type III
d. Type IV

 

 

ANS:  D

Correct: Type IV hypersensitivity, or delayed-type hypersensitivity, generally manifests as skin eruptions, such as in poison ivy.

Incorrect choices: Type I hypersensitivity, or immediate-type hypersensitivity, involves drug antigen or allergen binding to IgE antibodies on inflammatory cells. Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed and deposited, causing arthralgia, urticarial skin eruptions, and so forth.

 

REF:   Clinical Manifestations of Adverse Reactions (Hypersensitivity [Allergic Reaction]) | pp. 27-29         OBJ:    2

 

  1. Type _____ hypersensitivity is mediated by IgE antibodies.
a. I
b. II
c. III
d. IV

 

 

ANS:  A

Correct: Type I hypersensitivity, or immediate-type hypersensitivity, involves drug antigen or allergen binding to IgE antibodies on inflammatory cells.

Incorrect choices: Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed and deposited, causing arthralgia, urticarial skin eruptions, and so forth. Type IV hypersensitivity, or delayed-type hypersensitivity, generally manifests as skin eruptions, such as in poison ivy.

 

REF:   Clinical Manifestations of Adverse Reactions (Hypersensitivity [Allergic Reaction]) | p. 27

OBJ:   2

 

  1. Approximately 10% of male African Americans develop a severe hemolytic anemia when given the antimalarial drug primaquine. Such a response is categorized as a(n):
a. idiosyncratic reaction.
b. drug side effect.
c. genetically determined abnormal reaction.
d. allergic reaction.
e. Both a and c are correct.

 

 

ANS:  E

Correct: Primaquine-induced hemolytic anemia is a genetically determined abnormal reaction, also known as a drug idiosyncrasy.

Incorrect choices: Idiosyncratic reactions are not drug side effects; they are genetically related abnormal drug responses. Idiosyncratic reactions might involve an immune mechanism but are not considered allergic responses, such as type I through type IV hypersensitivity reactions.

 

REF:   Clinical Manifestations of Adverse Reactions (Idiosyncrasy) | p. 29

OBJ:   2

 

  1. A dose of a drug that kills 50% of experimental animals is termed:
a. ED50.
b. minimally effective dose.
c. LD50.
d. therapeutic index.

 

 

ANS:  C

Correct: By definition, the LD50 is the median lethal dose, that is, a dose level that leads to death in 50% of the animals tested.

Incorrect choices: ED50 is the median effective dose, a dose that produces a therapeutic effect in 50% of the subjects tested. A minimally effective dose should not cause death unless death is the desired endpoint. In this case, the incidence of death should be lower to be designated minimal. The therapeutic index is the ratio of LD50 to ED50.

 

REF:   Toxicologic Evaluation of Drugs | p. 29                          OBJ:   3

 

  1. In an assessment of drug action for a certain therapeutic agent, results indicate that the ED50 is 3 mg/kg, and the LD50 is 300 mg/kg. What is the therapeutic index for this agent?
a. 3
b. 300
c. 0.01
d. 100

 

 

ANS:  D

Correct: If the value of the TI is small, then toxicity is more likely. If the TI is large, then the drug will be safer. A drug with a wide TI will have a large LD50 and a small ED50 (the distance between these curves is large). A TI of greater than 10 is usually needed to produce a therapeutically useful drug.

Incorrect choices: One must divide the LD50 value by the ED50 value. The LD50 value (300) divided by the ED50 value (3) equals 100.

 

REF:   Toxicologic Evaluation of Drugs | p. 29                          OBJ:   3

 

  1. Although drug A and drug B have the same ED50, drug B has a wider therapeutic index (TI); therefore, drug A has a greater LD50 than drug B.
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.

 

 

ANS:  C

Correct: Drug B has a wider therapeutic index. This means that drug B must be safer than drug A and that the amount of drug needed to be lethal to 50% of test animals must be greater for drug B than for drug A. Therefore, drug B has a greater LD50 than drug A.

Incorrect choices: The therapeutic index is the ratio of the LD50 to ED50. A wide therapeutic index means a greater difference between the LD50 and the ED50 and therefore a greater ratio. If drug B has a wider therapeutic index than drug A and the two drugs have an equivalent ED50, then the LD50 of drug B must be greater.

 

REF:   Toxicologic Evaluation of Drugs | p. 29                          OBJ:   3

 

  1. Which of the following is the recommended solution for the adverse effect of nausea following administration of a drug?
a. Cease taking the drug.
b. Go outside and get some fresh air.
c. Take the drug with food or milk.
d. Take the drug at bedtime.
e. Seek medical attention.

 

 

ANS:  C

Correct: Nausea can usually be alleviated by taking the drug with food or milk.

Incorrect choices: It is important to continue taking drugs as prescribed unless the patient has consulted with the prescriber. Some adverse effects, such as headache or upset stomach, normally do not require medical attention. Sedation can be minimized by taking the drug at bedtime. Other adverse effects require medical attention.

 

REF:   Recognizing Adverse Drug Effects | p. 29                                 OBJ:    2

 

  1. What should the dental hygienist do first if a patient reports a suspected adverse drug effect?
a. Administer epinephrine.
b. Determine what drugs the patient is taking.
c. Have that patient drink a sugary liquid such as apple juice.
d. Call 9-1-1.
e. Drive the patient to the nearest hospital emergency room.

 

 

ANS:  B

Correct: Determine what drugs the patient is taking. Once a list of drugs is identified, it is important to determine which drug or drugs may be causing the adverse effect. If the patient is taking multiple drugs the dental hygienist should determine when the patient is taking each drug. Also, determine whether or not the symptoms of the adverse effect occurred after beginning drug therapy and how long after the patient took the drug.

Incorrect choices: Epinephrine is administered for anaphylaxis. Drugs used in dentistry that can produce anaphylaxis include the penicillins, ester local anesthetics, and aspirin. Drinking a sugary liquid is useful for a patient with hypoglycemia. Calling 9-1-1 is useful for a severe allergic reaction or heart attack; however, a drug allergy accounts for less than 5% of all adverse reactions. It is better to call emergency medical services (EMS) if transportation to the hospital is required as there are liability issues with driving the patient to the hospital.

 

REF:   Recognizing Adverse Drug Effects | p. 29                                 OBJ:    2

 

TRUE/FALSE

 

  1. Drug allergy and a side effect are two examples of dose-related responses.

 

ANS:  F

Correct: A side effect of a drug may be dose related, but drug allergy is neither predictable nor dose related.

 

REF:   Definitions and Classifications | p. 26                             OBJ:   1

 

  1. Tetracycline, nonsteroidal antiinflammatory drugs (NSAIDs), and the benzodiazepines are safe to administer to a pregnant patient.

 

ANS:  F

Correct: Tetracycline, NSAIDs, and the benzodiazepines are examples of drugs used in dentistry that are contraindicated during pregnancy.

 

REF:   Clinical Manifestations of Adverse Reactions (Effect on Fetal Development [Teratogenic Effect]) | p. 27           OBJ:               2

 

  1. The greater the therapeutic index is, the greater the toxicity will be.

 

ANS:  F

Correct: The therapeutic index is the ratio of the LD50 to ED50. The smaller the ratio is, the closer the LD50 is to the ED50 and therefore the closer a deadly dose is to the therapeutic dose. Consequently, the lesser the therapeutic index is, the greater the toxicity will be.

 

REF:   Toxicologic Evaluation of Drugs | p. 29                          OBJ:   3

Chapter 09: Local Anesthetics

Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. All of the following are characteristics of the ideal local anesthetic except:
a. sterilization by autoclave.
b. slow onset.
c. reversible.
d. absence of local reactions.

 

 

ANS:  B

Correct: For dentistry, a local anesthetic with a relatively rapid onset of action is desired so that the time between administration of the anesthetic and the commencement of a dental procedure can be minimized.

Incorrect choices: Dental local anesthetic solutions are not sterilized by autoclave before use. Reversibility of the actions of the agent is necessary so that the patient can regain normal sensation in the tissue. Local reactions such as irritation are considered untoward and undesirable.

 

REF:   Box 9-1: Properties of the Ideal Local Anesthetic | p. 102         OBJ:    1

 

  1. Which portion of the chemical structure of a typical local anesthetic is considered lipophilic (lipid soluble)?
a. Aromatic nucleus
b. Amino group
c. Both a and b
d. Neither a nor b

 

 

ANS:  A

Correct: The aromatic nucleus of the local anesthetic contains no positive or negative charges. This feature allows it to mix with and pass through lipid environments, such as the plasma membrane of a nerve cell.

Incorrect choices: The amino group is considered water soluble or hydrophilic. At a certain pH, it can gain a charge, which will enhance its solubility in water and prohibit its solubility in lipids.

 

REF:   Chemistry | p. 102                          OBJ:   1

 

  1. The mechanism of local anesthetics involves action on:
a. myelinated nerve.
b. axons.
c. sodium channels.
d. both a and c.
e. both b and c.

 

 

ANS:  E

Correct: Local anesthetics bind to sodium channels found in the axons of nerves. They stop the propagation of the electrical impulse along the axon.

Incorrect choices: Local anesthetics’ primary mode of action does not include myelinated nerve.

 

REF:   Mechanism of Action (Action on Nerve Fibers) | p. 102 OBJ:   2

 

  1. Repolarization of a nerve occurs by:
a. influx of potassium.
b. influx of sodium.
c. efflux of potassium.
d. efflux of calcium.
e. none of the above.

 

 

ANS:  C

Correct: During depolarization, an inward flux of sodium into the nerve occurs. During repolarization, an efflux of potassium out of the nerve occurs. The outward flow of potassium ions repolarizes the membrane and closes the sodium channels.

Incorrect choices: The depolarization of a nerve involves a slow calcium influx. Calcium ions are bound to receptor sites within the ion channels of cell membranes during the resting stage of nerve conduction. Ca++ ions are displaced during depolarization and are believed to be the most significant factor responsible for the influx of sodium into the nerve.

 

REF:   Mechanism of Action (Action on Nerve Fibers) | p. 102 OBJ:   2

 

  1. The following states are characteristics of the salt form of a local anesthetic except which one?
a. Charged, cation (ionized)
b. Alkaline
c. Crystalline solid
d. Stable

 

 

ANS:  B

Correct: The salt form of a local anesthetic is a form that has a positive charge and is complexed with an acid, such as hydrochloric acid, in the dose form. The positive charge is the result of the addition of a hydrogen ion to the molecule, making it an acid, not an alkaline base. The salt form more readily crystallizes, which creates a stable complex.

Incorrect choices: The salt form of local anesthetic is crystalline solids, water soluble, stable, acidic, charged, cation (ionized), active at the site of action, and is the form present in the dental cartridge.

 

REF:   Table 9-2: Properties of Base and Salt Forms of Local Anesthetics | p. 104

OBJ:   2

 

  1. In the presence of an acidic environment, such as infection or inflammation, the amount of free base is reduced; therefore _____ of the local anesthetic is in the ionized form, making anesthesia _____ difficult.
a. more; more
b. more; less
c. less; more
d. less; less

 

 

ANS:  A

Correct: In an acidic environment, more of the local anesthetic is in the ionized form, making anesthesia more difficult. Other reasons include dilution by fluid, inflammation, and vasodilation in the area.

Incorrect choices: The local anesthetic agent is a weak base. Bases are dissociated and nonionic in a basic environment, which means there is more free base to pass through the lipid cell membrane. Bases are associated and ionic in an acidic environment.

 

REF:   Mechanism of Action (Ionization Factors) | p. 104         OBJ:   2

 

  1. The cationic form of a local anesthetic is needed to penetrate the nerve membrane, and the free base form exerts blocking action by binding to the specific receptor site.
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.

 

 

ANS:  B

Correct: The uncharged (nonionized) free base form of a local anesthetic is needed to penetrate the nerve membrane; however, the charged cationic (ionized) form exerts blocking action by binding to the specific receptor site.

Incorrect choices: The cationic form is charged (ionized). It will not pass through the lipid nerve membrane. Remember that oil and water do not mix. The free base uncharged (nonionized) form is needed to pass through the membrane; however, it is the cationic form that is active at the site of action.

 

REF:   Mechanism of Action (Ionization Factors) | p. 104         OBJ:   2

 

  1. Reducing the rate of systemic absorption of a local anesthetic is important when it is used in dentistry because:
a. otherwise, too large an area would be anesthetized.
b. if not, the anesthesia would not last long enough to complete a dental procedure.
c. the chance of systemic toxicity is reduced.
d. local anesthesia is associated with respiratory depression.

 

 

ANS:  C

Correct: The chance of systemic toxicity is reduced with a reduced rate of absorption. A vasoconstrictor is often added to the local anesthetic to reduce the rate of absorption. The vasoconstrictor reduces the blood supply to the area, limits systemic absorption, and reduces systemic toxicity.

Incorrect choices: The local anesthetic agents by themselves are vasodilators. This will increase the chances of systemic toxicity. Dental local anesthetics without vasoconstrictor have the shortest duration of action.

 

REF:   Pharmacokinetics (Absorption) | p. 104                          OBJ:   2

 

  1. Addition of vasoconstrictor to local anesthetic (1) reduces blood supply to the area, (2) increases blood supply to the area, (3) limits systemic absorption, (4) increases systemic absorption, (5) reduces systemic toxicity, and (6) increases systemic toxicity. Which of these are correct?
a. 1, 3, 5
b. 1, 4, 5
c. 2, 3, 5
d. 2, 3, 6
e. 2, 4, 6

 

 

ANS:  A

Correct: The vasoconstrictor reduces the blood supply to the area, limits systemic absorption, and reduces systemic toxicity. When a local anesthetic solution does not contain a vasoconstrictor, the anesthetic drug is more quickly removed from the injection site and distributed into systemic circulation than if the solution contained a vasoconstrictor. Plain anesthetics will exhibit a shorter duration of action and result in a more rapid buildup of a systemic blood level. Therefore, any anesthetic given without a vasoconstrictor is more likely to be toxic than those given with a vasoconstrictor.

Incorrect choices: The remaining choices do not reflect the pharmacokinetic effects of adding a vasoconstrictor to a dental local anesthetic.

 

REF:   Pharmacokinetics (Absorption) | p. 104                          OBJ:   2

 

  1. Local anesthetics cross:
a. the placenta and blood-brain barrier.
b. the placenta but not the blood-brain barrier.
c. the blood-brain barrier but not the placenta.
d. neither the placenta nor the blood-brain barrier.

 

 

ANS:  A

Correct: Local anesthetics cross the placenta and blood-brain barrier.

Incorrect choices: The other choices are not correct. Although the placenta may act as a selective barrier against a few drugs, most drugs pass easily across the placental barrier. Lipid-soluble drugs penetrate this membrane most easily. The passage of a drug across the blood-brain barrier is related to the drug’s lipid solubility and degree of ionization.

 

REF:   Pharmacokinetics (Distribution) | p. 104                         OBJ:   2

 

  1. Amide local anesthetics are metabolized:
a. by being hydrolyzed by plasma pseudocholinesterases.
b. primarily by the liver.
c. in the spleen.
d. minimally and are excreted virtually unchanged.

 

 

ANS:  B

Correct: Amide local anesthetics are metabolized primarily by the liver. In severe liver disease, or with alcoholism, amides may accumulate and produce systemic toxicity.

Incorrect choices: Esters are hydrolyzed by plasma pseudocholinesterases and liver esterases. Procaine is hydrolyzed to para-aminobenzoic acid (PABA), a metabolite that may be responsible for its allergic reactions.

 

REF:   Pharmacokinetics (Metabolism) | p. 104                          OBJ:   2

 

  1. Procaine (Novocaine) is metabolized primarily by the:
a. liver.
b. lungs.
c. plasma.
d. kidneys.

 

 

ANS:  C

Correct: Procaine is an ester local anesthetic and is metabolized primarily by plasma pseudocholinesterase.

Incorrect choices: Amide local anesthetics rely on cytochrome P450 mixed-function oxidases. These enzymes are found mainly in the liver, but they can be found in other tissues, such as the kidney and lungs.

 

REF:   Pharmacokinetics (Metabolism) | p. 104                          OBJ:   2

 

  1. Which of the following local anesthetic agents have the potential to cause methemoglobinemia as an adverse effect?
a. Prilocaine and lidocaine
b. Lidocaine and mepivacaine
c. Prilocaine and mepivacaine
d. Prilocaine and articaine
e. Mepivacaine and articaine

 

 

ANS:  D

Correct: Prilocaine (by virtue of its orthotoluidine metabolite) and articaine have been demonstrated to produce methemoglobinemia when administered in high doses.

Incorrect choices: No reports have been documented of lidocaine or mepivacaine producing methemoglobinemia.

 

REF:   Pharmacokinetics (Metabolism) | p. 104 | Local Anesthetic Agents (Articaine) | p. 109

OBJ:   2

 

  1. Which nerve function is the most sensitive to inhibition by local anesthetic agents?
a. Touch
b. Warmth
c. Pressure
d. Autonomic
e. Pain

 

 

ANS:  D

Correct: Sensitivity to inhibition by local anesthetics is a function of nerve diameter and myelination. Postganglionic autonomic nerves are of small diameter and unmyelinated.

Incorrect choices: The correct order of sensitivity is autonomic, warmth, pain, touch, and pressure.

 

REF:   Box 9-3: Common Order of Nerve Function Loss | p. 105

OBJ:   2

 

  1. The maximal safe dose of lidocaine 2% with 1:100,000 epinephrine is approximately _____ cartridges.
a. 3
b. 6.5
c. 8.5
d. 11.5

 

 

ANS:  C

Correct: The maximal safe dose of lidocaine 2% with 1:100,000 epinephrine or 1:200,000 epinephrine is approximately 8.5 cartridges. For lidocaine 2% with 1:50,000 epinephrine, the maximum is approximately 5.5 cartridges.

Incorrect choices: The other choices are not the absolute maximum safe dose of lidocaine 2% with 1:100,000 epinephrine.

 

REF:   Table 9-3: Maximum Safe Dose (MSD) of Local Anesthetics | p. 105

OBJ:   2

 

  1. Which of the following agents are the most likely to precipitate malignant hyperthermia: (1) halothane, (2) lidocaine, (3) mepivacaine, (4) succinylcholine?
a. 1, 2, 3, 4
b. 2, 3, 4
c. 2, 3
d. 1, 4

 

 

ANS:  D

Correct: Halothane, the inhalation anesthetic, and succinylcholine, the neuromuscular blocking agent, are the most common agents precipitating malignant hyperthermia.

Incorrect choices: In the past, the belief was that the amide local anesthetics might precipitate malignant hyperthermia, but they are currently no longer implicated. Patients with a family history of malignant hyperthermia can be given amide local anesthetic agents.

 

REF:   Adverse Reactions (Malignant Hyperthermia) | p. 106    OBJ:   2

 

  1. Which of the following local anesthetics is safest to use for dental treatment for a pregnant woman?
a. Mepivacaine
b. Lidocaine
c. Articaine
d. Bupivacaine

 

 

ANS:  B

Correct: Both lidocaine and prilocaine are Food and Drug Administration (FDA) pregnancy category B drugs. If a local anesthetic is needed, lidocaine in the smallest effective dose should be used.

Incorrect choices: Mepivacaine, articaine, and bupivacaine are FDA pregnancy category C drugs.

 

REF:   Adverse Reactions (Pregnancy and Nursing Considerations) | p. 106

OBJ:   2

 

  1. Which of the following components of an injected amide local anesthetic agent may produce a hypersensitivity reaction that exhibits itself as an acute asthmatic attack?
a. The vasoconstrictor
b. The antioxidant for the vasoconstrictor
c. The sodium hydroxide
d. The sodium chloride

 

 

ANS:  B

Correct: Amide local anesthetics with vasoconstrictors also contain a sulfite that serves as an antioxidant preservative. In sulfite-sensitive patients, the sulfites may produce a hypersensitivity reaction that exhibits itself as an acute asthmatic attack. This reaction is the same as the “salad bar” syndrome, a hypersensitivity reaction to sulfites.

Incorrect choices: The remaining choices are not the components of an amide local anesthetic cartridge that are associated with triggering an allergic reaction.

 

REF:   Adverse Reactions (Allergy) | p. 106                                         OBJ:    2

 

  1. Epinephrine is combined with local anesthetics so as to:
a. enhance absorption.
b. prolong duration.
c. delay onset.
d. increase potency.

 

 

ANS:  B

Correct: Epinephrine restricts the diffusion of the local anesthetic away from the site of injection which allows the local anesthetic to stay at the site longer, producing a longer duration of action.

Incorrect choices: Epinephrine does not enhance absorption, delay onset, or increase the potency of the local anesthetic agent with which it is combined.

 

REF:   Adverse Reactions (Allergy) | p. 106                                         OBJ:    3

 

  1. The correct ADA color code for lidocaine 2% with epinephrine 1:100,000 is:
a. black.
b. green.
c. red.
d. gold.
e. brown.

 

 

ANS:  C

Correct: The color code for lidocaine 2% with epinephrine 1:100,000 is red.

Incorrect choices: Prilocaine 4% plain is black, lidocaine 2% with epinephrine 1:50,000 is green, articaine 4% with epinephrine 1:100,000 is gold, and mepivacaine 2% with levonordefrin 1:20,000 is brown.

 

REF:   Composition of Local Anesthetic Solutions | p. 106        OBJ:   3

 

  1. Lidocaine with epinephrine 1:100,000 provides a _____ duration of pulpal anesthesia.
a. 30-minute
b. 30- to 60-minute
c. 60- to 90-minute
d. 90-minute or more

 

 

ANS:  C

Correct: Lidocaine with epinephrine 1:100,000 provides a 1- to 1.5-hour duration of pulpal anesthesia. Soft-tissue anesthesia is maintained for 3 to 4 hours. Lidocaine with epinephrine 1:50,000 is used for hemostasis during surgical procedures.

Incorrect choices: The remaining choices do not provide an accurate estimate of the duration of pulpal anesthesia one can expect when lidocaine with epinephrine 1:100,000 is used.

 

REF:   Box 9-5: Local Anesthetic Cartridge Color | p. 107         OBJ:   3

 

  1. Which of the following statements is true of mepivacaine?
a. Cross-allergenicity has been demonstrated between mepivacaine and other currently available amides.
b. Mepivacaine is effective topically.
c. Mepivacaine can be used as a 3% solution without a vasoconstrictor.
d. The benefit of a shorter duration of anesthesia warrants eliminating the vasoconstrictor.

 

 

ANS:  C

Correct: Because mepivacaine produces less vasodilation than lidocaine, it can be used as a 3% solution without a vasoconstrictor. It can be used for short procedures when a vasoconstrictor is contraindicated. Caution should be exercised when using the increased concentrations of the local anesthetic without a vasoconstrictor because systemic toxicity is more likely.

Incorrect choices: No cross-allergenicity between the amide mepivacaine, other currently available amides, or the esters has been documented. Mepivacaine is not effective topically; however, it is used for infiltration, block, spinal, epidural, and caudal anesthesia. Except in unusual cases, the benefit of a shorter duration does not warrant eliminating the vasoconstrictor, especially when the concentration of the drug is increased.

 

REF:   Local Anesthetic Agents (Lidocaine) | p. 107                  OBJ:   3

 

  1. Levonordefrin is commonly combined with which local anesthetic?
a. Lidocaine
b. Procaine
c. Mepivacaine
d. Bupivacaine

 

 

ANS:  C

Correct: Mepivacaine is the only local anesthetic listed that is available in combination with levonordefrin.

Incorrect choices: Lidocaine and bupivacaine are available with epinephrine, not levonordefrin. Procaine is an ester local anesthetic that is not used in dentistry today.

 

REF:   Local Anesthetic Agents (Mepivacaine) | p. 107             OBJ:   3

 

  1. Several cases of methemoglobinemia have been reported after the use of:
a. lidocaine.
b. mepivacaine.
c. prilocaine.
d. articaine.

 

 

ANS:  C

Correct: Although the toxicity of prilocaine is 60% of that occurring with lidocaine, several cases of methemoglobinemia have been reported after its use. Prilocaine is metabolized to orthotoluidine and, in large doses, can induce some methemoglobinemia. Although the small doses required in dental practice are not likely to present a problem in healthy, nonpregnant adults, prilocaine should not be administered to patients with any condition in which problems of oxygenation may be especially critical.

Incorrect choices: Methemoglobinemia is a rare hereditary condition in which there is an inability of the blood to bind to oxygen. It is not associated with the remaining choices of dental local anesthetic.

 

REF:   Local Anesthetic Agents (Mepivacaine) | p. 107             OBJ:   3

 

  1. Prilocaine plain has a duration of action slightly _____ than mepivacaine plain, and prilocaine with epinephrine has a duration of action slightly _____ than lidocaine with epinephrine.
a. shorter; shorter
b. shorter; longer
c. longer; shorter
d. longer; longer

 

 

ANS:  D

Correct: Prilocaine plain has a duration of action slightly longer than mepivacaine plain, and prilocaine with epinephrine has a duration of action slightly longer than lidocaine with epinephrine. Prilocaine’s niche in dentistry involves situations in which the desired duration of action is somewhat longer than that obtained with mepivacaine either with or without a vasoconstrictor.

Incorrect choices: The other choices do not correctly describe the duration of action of prilocaine.

 

REF:   Local Anesthetic Agents (Prilocaine) | p. 108                  OBJ:   3

 

  1. Which of the following local anesthetics has the longest duration of action?
a. Lidocaine
b. Mepivacaine
c. Prilocaine
d. Bupivacaine

 

 

ANS:  D

Correct: The major advantage of bupivacaine is its greatly prolonged duration of action. It is indicated in lengthy dental procedures when pulpal anesthesia of greater than 1.5 hours is needed or when postoperative pain is expected. It is used most frequently in the offices of oral surgeons and endodontists. Compared with lidocaine with epinephrine, the onset of bupivacaine with epinephrine is slightly longer, but the duration is at least twice that of lidocaine.

Incorrect choices: The remaining local anesthetics do not have the longest duration of action.

 

REF:   Local Anesthetic Agents (Prilocaine) | p. 108                  OBJ:   3

 

  1. Which local anesthetic agent is derived from thiophene?
a. Tetracaine
b. Bupivacaine
c. Articaine
d. Propoxycaine

 

 

ANS:  C

Correct: Articaine is unique from the other amide and ester local anesthetics in that it is derived from thiophene. This allows for greater lipid solubility and ability to cross lipid barriers such as nerve membranes.

Incorrect choices: Tetracaine and propoxycaine are esters of PABA. Bupivacaine is an amide of xylidine.

 

REF:   Local Anesthetic Agents (Bupivacaine) | p. 108              OBJ:   3

 

  1. Which of the following local anesthetic agents is both an ester and an amide?
a. Benzonatate
b. Articaine
c. Bupivacaine
d. Dyclonine

 

 

ANS:  B

Correct: Articaine differs from other amide local anesthetics because it also has an ester linkage. This causes articaine to be hydrolyzed by plasma esterase.

Incorrect choices: Benzonatate is an ester, bupivacaine is an amide, and dyclonine is neither an ester nor an amide.

 

REF:   Local Anesthetic Agents (Articaine) | p. 108                   OBJ:   3

 

  1. Approximately _____% of articaine is metabolized by the liver.
a. 5 to 10
b. 20 to 25
c. 50 to 75
d. 90

 

 

ANS:  A

Correct: The liver metabolizes only 5% to 10% of articaine; the other 90% to 95% is metabolized in the blood. Its major metabolite is articainic acid, and the extent of activity of this metabolite is unclear.

Incorrect choices: The other choices do not reflect the percentage of articaine that is metabolized by the liver. The ester linkage that occurs in articaine causes it to be hydrolyzed by plasma esterase, which reduces the amount metabolized in the liver.

 

REF:   Local Anesthetic Agents (Articaine) | p. 108                   OBJ:   3

 

  1. Which of the following dental local anesthetics is associated with an increased incidence of paresthesia following an inferior alveolar (IA) block?
a. Lidocaine 2% with epinephrine 1:100,000
b. Lidocaine 2% with epinephrine 1:50,000
c. Mepivacaine 2% with levonordefrin 1:20,000
d. Prilocaine 4% with epinephrine 1:200,000
e. Articaine 4% with epinephrine 1:100,000

 

 

ANS:  E

Correct: Paresthesia is a persistent anesthesia beyond the expected duration of the local anesthetic. Since being introduced in 2000 there have been many reports of paresthesia after the IA block when the 4% solution of articaine is used.

Incorrect choices: The other dental local anesthetics have not been associated with an increased chance of paresthesia when used for an inferior alveolar block.

 

REF:   Local Anesthetic Agents (Articaine) | p. 108                   OBJ:   3

 

  1. _____ is an ester local anesthetic.
a. Prilocaine (Citanest)
b. Tetracaine (Pontocaine)
c. Bupivacaine (Marcaine)
d. Lidocaine (Xylocaine)

 

 

ANS:  B

Correct: The chemical structure of tetracaine contains an ester linkage. It is not available in a dental cartridge. Tetracaine is available in various sprays, solutions, and ointments for topical application.

Incorrect choices: The other agents listed contain amide linkages.

 

REF:   Local Anesthetic Agents (Articaine) | p. 109                   OBJ:   3

 

  1. Which local anesthetic agent is neither an ester nor an amide?
a. Propoxycaine
b. Dyclonine
c. Articaine
d. Lidocaine

 

 

ANS:  B

Correct: Dyclonine is a topical local anesthetic that is neither an ester nor an amide. The solution and topical product are available in 0.5% and 1% concentrations.

Incorrect choices: Propoxycaine is an ester local anesthetic, articaine has both amide and ester bonds, and lidocaine is an amide dental local anesthetic.

 

REF:   Local Anesthetic Agents (Tetracaine) | p. 109                 OBJ:   3

 

  1. Which of the following dental local anesthetic agents is available in a 1.7 ml dental cartridge unlike the more common 1.8 ml dental cartridge?
a. Lidocaine (Xylocaine, Octocaine)
b. Bupivacaine (Marcaine)
c. Mepivacaine (Carbocaine, Isocaine)
d. Prilocaine (Citanest)
e. Articaine (Septocaine)

 

 

ANS:  E

Correct: Articaine is available as a 4% concentration with 1:100,000 epinephrine in a 1.7 ml dental cartridge. Articaine has been available in Europe since the mid-1970s.

Incorrect choices: The other agents are available in a 1.8-ml dental cartridge.

 

REF:   Local Anesthetic Agents (Dyclonine) | p. 109                 OBJ:   3

 

  1. The vasoconstrictors are members of the autonomic nervous system drugs called the:
a. adrenergic agonists
b. adrenergic antagonists
c. cholinergic agonists
d. cholinergic antagonists

 

 

ANS:  A

Correct: Vasoconstrictors are called adrenergic agonists or sympathomimetics.

Incorrect choices: Cholinergic antagonists function most like adrenergic agonists; however, vasoconstrictors are not categorized as cholinergic antagonists. Vasoconstrictors do not belong to any of the other categories of neurotransmitters of the autonomic nervous system.

 

REF:   Local Anesthetic Agents (Articaine) | p. 109                   OBJ:   3

 

  1. Plain anesthetics without vasoconstrictor will exhibit a _____ duration of action and result in a _____ rapid buildup of a systemic blood level.
a. shorter; less
b. shorter; more
c. longer; less
d. longer; more

 

 

ANS:  B

Correct: Plain anesthetics will exhibit a shorter duration of action and result in a more rapid buildup of a systemic blood level. Therefore, any anesthetic given without a vasoconstrictor is more likely to be toxic than those given with a vasoconstrictor. Any advantage gained by eliminating the vasoconstrictor must be weighed against the potential for adverse effects from the epinephrine.

Incorrect choices: The remaining “either/or” choices do not properly describe the duration of action of a plain anesthetic without vasoconstrictor.

 

REF:   Vasoconstrictors (Overview) | p. 109                                         OBJ:    3

 

  1. Patients with uncontrolled high blood pressure, hyperthyroidism, angina pectoris, and cardiac arrhythmias and those who have had a myocardial infarction or cerebrovascular accident in the past _____ should make an appointment for elective dental treatment only after their medical condition is under control.
a. 6 weeks
b. 3 months
c. 6 months
d. 12 months

 

 

ANS:  C

Correct: Patients with any of the preceding conditions in the past 6 months should make an appointment for elective dental treatment after their medical condition is under control. For patients who have had a myocardial infarction or cerebrovascular accident, the time span would be 6 months after the cardiovascular or cerebrovascular event.

Incorrect choices: The recommended time interval is very specific and the remaining choices are not correct.

 

REF:   Vasoconstrictors (Overview) | p. 109                                         OBJ:    3

 

  1. The maximal safe dose of epinephrine for the cardiac patient is _____ mg.
a. 0.02
b. 0.04
c. 0.2
d. 0.4

 

 

ANS:  B

Correct: The maximal safe dose of epinephrine for the cardiac patient is 0.04 mg. This is about the amount in two cartridges of lidocaine with epinephrine 1:100,000.

Incorrect choices: For the healthy patient, the maximal safe dose is 0.2 mg.

 

REF:   Vasoconstrictors (Overview) | p. 109                                         OBJ:    3

 

  1. Which agent has the greater proportion of a-adrenergic activity to b-adrenergic activity?
a. Levonordefrin
b. Epinephrine
c. Neither—they have equivalent proportions.

 

 

ANS:  A

Correct: The a/b ratio of levonordefrin is 75/25, whereas the a/b ratio is 50/50 for epinephrine.

Incorrect choices: One of these agents has a greater proportion of a-adrenergic activity than the other.

 

REF:   Vasoconstrictors (Overview) | p. 110                                         OBJ:    3

 

  1. A cardiac patient can be given _____ cartridges of a dental anesthetic with epinephrine 1:100,000 without exceeding the cardiac dose for the vasoconstrictor.
a. 0.5
b. 2
c. 4
d. 6

 

 

ANS:  B

Correct: A cardiac patient can be given 2 cartridges of a dental anesthetic with epinephrine 1:100,000 without exceeding the cardiac dose. The anesthetic should be administered in the lowest possible dose by means of the best technique, including aspiration and a very slow injection rate to minimize systemic absorption.

Incorrect choices: A healthy person can tolerate about 11 cartridges with epinephrine 1:100,000, but the amount a cardiac patient can tolerate is far less.

 

REF:   Table 9-5: Vasoconstrictors: Maximum Safe Dose (MSD) in Normal and Cardiac Patients | p. 111      OBJ:    3

 

  1. Which two agents are known to cause clinically significant drug interactions when combined with epinephrine?
a. Selective serotonin reuptake inhibitors and b-adrenergic antagonists
b. b-Adrenergic antagonists and phenothiazines
c. Tricyclic antidepressants and monoamine oxidase inhibitors
d. b-Adrenergic antagonists and tricyclic antidepressants
e. Benzodiazepines and monoamine oxidase inhibitors

 

 

ANS:  D

Correct: b-Adrenergic antagonists cause hypertension followed by reflex bradycardia when combined with epinephrine, and tricyclic antidepressants may cause an exaggerated increase in pressor response.

Incorrect choices: Monoamine oxidase inhibitors and phenothiazines can interact with epinephrine, but the results are usually not clinically significant. Benzodiazepines do not significantly interact with epinephrine.

 

REF:   Vasoconstrictors (Overview) | p. 110                                         OBJ:    3

 

  1. Which of the following agents is the most common topical local anesthetic?
a. Lidocaine
b. Benzocaine
c. Tetracaine
d. Dyclonine

 

 

ANS:  B

Correct: Benzocaine, an ester, is the most commonly used topical local anesthetic

Incorrect choices: Lidocaine, an amide, is the second most commonly used topical local anesthetic. Tetracaine is an ester of para-aminobenzoic acid (PABA) and has a slow onset and long duration. In view of this drug’s high toxicity and the rapidity with which it is absorbed from mucosal surfaces, great care must be exercised if it is used for topical anesthesia. Dyclonine is a topical local anesthetic that is neither an ester nor an amide.

 

REF:   Vasoconstrictors (Drug Interactions) | p. 110                  OBJ:   4

 

  1. Which of the following local anesthetics may be combined for injection-free local anesthesia?
a. Articaine and bupivacaine
b. Lidocaine and prilocaine
c. Benzocaine and tetracaine
d. Lidocaine and articaine

 

 

ANS:  B

Correct: The combination of lidocaine and prilocaine gel (Oraqix) applied into the periodontal pocket offers pain relief during scaling and root planing procedures. This combination, in gel form, provides a duration of action of approximately 20 minutes. The onset of action is approximately 30 seconds after application.

Incorrect choices: This product is applied with a unique applicator. It is a liquid in the proprietary cartridge and becomes more viscous when applied. It is not indicated for patients who are hypersensitive to local anesthetics. It should not be used with patients who have congenital or idiopathic methemoglobinemia.

 

REF:   Topical Anesthetics | p. 113           OBJ:   4

 

MULTIPLE RESPONSE

 

  1. Which of the following dental local anesthetics are available without vasoconstrictor? (Select all that apply.)
a. Mepivacaine
b. Prilocaine
c. Articaine
d. Bupivacaine

 

 

ANS:  A, B

Correct: Because mepivacaine (0.8) and prilocaine (0.5) have less vasodilating effect than lidocaine (1), they can be used without vasoconstrictor.

Incorrect choices: Articaine and bupivacaine (2.5) produce too much vasodilation to be used without a vasoconstrictor.

 

REF:   Choice of Local Anesthetic | p. 112                                           OBJ:    3

 

TRUE/FALSE

 

  1. The rate of local anesthetic absorption is increased by the presence of local inflammation.

 

ANS:  F

Correct: Local inflammation causes a decrease in the pH of the tissue extracellular fluid and drives more of the local anesthetic into the ionized form, which is less able to penetrate nerves.

 

REF:   Mechanism of Action (Ionization Factors) | p. 104         OBJ:   2

 

  1. Use of skin testing to determine local anesthetic allergies is not reliable.

 

ANS:  T

Correct: Skin testing for local anesthetic allergies is unreliable because it can give both false-positive and false-negative results.

 

REF:   Adverse Reactions (Allergy) | p. 6  OBJ:   2

 

  1. Patients who are allergic to procaine are not likely to display cross-hypersensitivity to lidocaine.

 

ANS:  T

Correct: Procaine is an ester of para-aminobenzoic acid (PABA). Ester local anesthetics have a much greater allergic potential than amides. Lidocaine is an amide. Allergy to lidocaine is unlikely, and cross-hypersensitivity with procaine is even less likely because of the different chemical structures.

 

REF:   Local Anesthetic Agents (Lidocaine) | pp. 106-107 | Local Anesthetic Agents (Procaine) | p. 109        OBJ:    3

 

  1. For lengthy dental procedures, bupivacaine is recommended over lidocaine because bupivacaine has a longer duration of action.

 

ANS:  T

Correct: Bupivacaine is the longest lasting local anesthetic used in dentistry.

 

REF:   Local Anesthetic Agents (Bupivacaine) | p. 108              OBJ:   3

 

  1. The recommended concentration of epinephrine to combine with a local anesthetic is 1:200,000 for most procedures.

 

ANS:  T

Correct: Epinephrine 1:100,000 and 1:200,000 have been shown to produce about the same amount of vasoconstriction. A 1:50,000 dose is used in cases in which local hemostasis is needed.

 

REF:   Vasoconstrictors (Overview) | p. 109                                         OBJ:    3

 

  1. No justification exists for the use of epinephrine in a concentration greater than 1:200,000, except in cases in which hemostasis is needed.

 

ANS:  T

Correct: It has been shown that 1:100,000 and 1:200,000 produce about the same amount of vasoconstriction and the same distribution of the local anesthetics.

 

REF:   Vasoconstrictors (Overview) | p. 109                                         OBJ:    3

 

  1. A patient can produce endogenous epinephrine far in excess of that administered in dentistry in the presence of inadequate anesthesia.

 

ANS:  T

Correct: This sometimes occurs when vasoconstrictors are avoided. Medical consults often recommend that epinephrine be avoided because physicians are more familiar with the dose used in medicine.

 

REF:   Vasoconstrictors (Overview) | p. 109                                         OBJ:    3

 

  1. Levonordefrin is more potent than epinephrine.

 

ANS:  F

Correct: Levonordefrin has one-fifth the pressor potency of epinephrine.

 

REF:   Table 9-5: Vasoconstrictors: Maximum Safe Dose (MSD) in Normal and Cardiac Patients | p. 111      OBJ:    3

Chapter 17: Drugs for the Treatment of Central Nervous System Disorders

Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. Which of the following psychiatric disorders involves a loss of the perception of reality?
a. Bipolar affective disorder
b. Schizophrenia
c. Panic disorder
d. Obsessive-compulsive disorder

 

 

ANS:  B

Correct: Schizophrenia is derived from the word meaning “splitting” and, in context, refers to patients splitting from reality. The patient’s ability to function in society is impaired as a result of altered thinking.

Incorrect choices: The other forms of psychiatric disorders do not involve a loss of perception of reality.

 

REF:   Psychiatric Disorders | p. 202         OBJ:   1

 

  1. All of the following symptoms are “negative” (passive) symptoms of psychoses except for which one?
a. Flat affect
b. Vocalization of feelings of superhuman strength
c. Abstract thinking difficult
d. Social withdrawal
e. Thought and speech impaired

 

 

ANS:  B

Correct: Vocalization of feelings of superhuman strength is considered a “positive” or active symptom of psychoses because it represents some action.

Incorrect choices: The negative symptoms represent one form of withdrawal or other (i.e., the inability to do or feel something rather than an ability to do or feel something untoward).

 

REF:   Box 17-1: Symptoms of Psychoses | p. 203                               OBJ:    1

 

  1. The type of depression that exhibits alternating periods of depression and excitation have a(n) _____ disorder.
a. endogenous
b. exogenous
c. manic-depressive
d. reactive

 

 

ANS:  C

Correct: Patients who exhibit alternating periods of depression and excitation (mania, elation) have bipolar depression, also known as manic-depressive disorder.

Incorrect choices: Endogenous (involutional) depression seems to be unrelated to external events. Exogenous (reactive) depression appears to be related to specific external events.

Major depressive disorder or depression is the result of biologic, psychological, and social factors. Biologic factors are the result of low levels of the neurotransmitters serotonin, norepinephrine, and dopamine levels or a combination of the three in the brain. Psychological and social factors are related to specific external life events.

 

REF:   Psychiatric Disorders | p. 203         OBJ:   1

 

  1. The amount of any drug prescribed for a depressed patient should not exceed a _____-day supply.
a. 1
b. 3
c. 7
d. 14

 

 

ANS:  C

Correct: Usually a 1-week supply is the maximum recommended amount.

Incorrect choices: Depressed patients may attempt suicide. The amount of any drug prescribed at one time should not exceed the amount required for a lethal dose, which is usually a 1-week supply.

 

REF:   Box 17-3: Management of the Dental Patient Taking Antidepressant Agents | p. 210

OBJ:   2

 

  1. Which of the following agents is classified as an antipsychotic?
a. Celexa
b. Cephalexin
c. Zyprexa
d. Lexapro
e. Bextra

 

 

ANS:  C

Correct: Zyprexa is the trade name for olanzapine, a newer second-generation antipsychotic.

Incorrect Answers: Celexa is the trade name for the antidepressant citalopram, and Lexapro is the trade name for its S-isomer. Cephalexin is a cephalosporin antibiotic, and Bextra is the trade name for valdecoxib, the cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory drug.

 

REF:   Table 17-1: Antipsychotic Agents | p. 204                                 OBJ:    3

 

  1. 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

 

 

ANS:  B

Correct: Chlorpromazine will have more sedation, orthostatic hypotension, and autonomic effects than haloperidol.

Incorrect choices: 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.

 

REF:   Table 17-1: Antipsychotic Agents | p. 204                                 OBJ:    3

 

  1. First-generation antipsychotics would have little effect on which of the following symptoms of psychosis?
a. Delusions
b. Unwanted thoughts
c. Flat affect
d. Agitation
e. Disorganized behavior

 

 

ANS:  C

Correct: First-generation antipsychotics are active against the positive effects of psychosis but have little effect on the negative effects. Negative symptoms of psychosis include flat affect, unemotional, apathetic, passivity, abstract thinking difficult, lacking spontaneity and goals, impaired thought and speech, lack of pleasure, and social withdrawal.

Incorrect choices: Positive symptoms of psychosis include hallucinations, delusions, unwanted thoughts, disorganized behavior, agitation, and distorted speech and communication. Second-generation antipsychotics are effective against the negative effects.

 

REF:   Antipsychotic Agents | pp. 203-204                                           OBJ:    3

 

  1. First-generation antipsychotics are primarily _____ antagonists.
a. acetylcholine
b. norepinephrine
c. dopamine
d. serotonin (5-hydroxytryptamine)

 

 

ANS:  C

Correct: First-generation antipsychotics are primarily dopamine antagonists.

Incorrect choices: Second-generation antipsychotic agents have action at more than one receptor, for example, the dopamine, serotonin (5-HT), and norepinephrine (NE) receptors. This results in the improved efficacy of these agents.

 

REF:   Antipsychotic Agents (Mechanism of Action) | p. 204    OBJ:   3

 

  1. 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.

 

 

ANS:  D

Correct: 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.

Incorrect choices: Akathisia is increased compulsive motor activity. Parkinsonism is characterized by symptoms of resting tremor, rigidity, and akinesia. Akinesia is a loss of voluntary muscle activity.

 

REF:   Antipsychotic Agents (First-Generation Antipsychotics) | p. 205

OBJ:   3

 

  1. Extrapyramidal reactions such as an acute spasm of the mandible caused by first-generation antipsychotics such as phenothiazines:
a. can be treated with anticholinergic agents.
b. are disorders of muscle control.
c. include akathisia.
d. All of the above are correct.

 

 

ANS:  D

Correct: Alternatives may include decreasing the dose of the patient’s medication, adding an anticholinergic medication to counteract the spasm, or changing the patient’s antipsychotic medication to one that produces fewer extrapyramidal effects. The anticholinergics used to counteract the extrapyramidal side effects of the antipsychotics include benzotropine (Cogentin) and trihexyphenidyl (Artane).

Incorrect choices: The severity and prevalence of extrapyramidal reactions depends on the balance between acetylcholine and dopamine. Too much dopamine blockade will lead to these side effects. An anticholinergic can partially restore the balance between dopamine and acetylcholine action in specific brain regions associated with muscle control, such as the corpus striatum. Akathisia is an extrapyramidal reaction characterized by increased compulsive motor activity.

 

REF:   Antipsychotic Agents (First-Generation Antipsychotics) | p. 205

OBJ:   3

 

  1. Patients taking first-generation antipsychotics can experience severe intermittent temporomandibular joint (TMJ) pain. This pain is a consequence of:
a. hyperalgesia produced by a-adrenergic blockade.
b. anticholinergic side effects.
c. dislocation of the mandible.
d. extrapyramidal side effects.

 

 

ANS:  D

Correct: The extrapyramidal side effects of first-generation antipsychotics can cause severe intermittent pain in the region of the TMJ. This pain is produced by a spasm of the muscles of mastication.

Incorrect Answers: a-Adrenergic blockade does not produce hyperalgesia, pain is not caused by anticholinergic side effects, and dislocation of the mandible is a possible consequence of a dental practitioner attempting to force open the mouth of a patient who is experiencing a spasm of the muscles of mastication.

 

REF:   Antipsychotic Agents (First-Generation Antipsychotics) | p. 205

OBJ:   3

 

  1. Phenothiazines cause orthostatic hypotension by blocking which receptor?
a. a-Adrenergic
b. b-Adrenergic
c. Dopamine
d. Acetylcholine

 

 

ANS:  A

Correct: Phenothiazines, first-generation antipsychotics, cause orthostatic hypotension by blocking a-adrenergic receptors.

Incorrect choices: These agents depress the central sympathetic outflow and block the peripheral adrenergic receptors; they can produce orthostatic hypotension that is additive with other CNS depressants. When a patient rises rapidly from the supine position, a compensatory tachycardia can accompany the orthostatic hypotension.

 

REF:   Antipsychotic Agents (First-Generation Antipsychotics) | p. 205

OBJ:   3

 

  1. Which of the following second-generation antipsychotics is associated with agranulocytosis?
a. Aripiprazole
b. Clozapine
c. Quetiapine
d. Risperidone
e. Ziprasidone

 

 

ANS:  B

Correct: Clozapine causes agranulocytosis or granulocytopenia in about 1% of patients taking it. With the release of newer second-generation antipsychotic agents, use of this agent has decreased.

Incorrect choices: Clozapine should be tried only after several trials of other agents have failed because it produces a potentially life-threatening agranulocytosis. Frequent white blood cell counts with differential are required during therapy.

 

REF:   Antipsychotic Agents (Second-Generation Antipsychotics) | p. 205

OBJ:   3

 

  1. Epinephrine should not be used to treat vasomotor collapse in patients taking first-generation antipsychotics because the first-generation antipsychotics are:
a. a-adrenergic stimulators.
b. a-adrenergic blockers.
c. b-adrenergic stimulators.
d. b-adrenergic blockers.

 

 

ANS:  B

Correct: The first-generation antipsychotics are a-adrenergic blockers.

Incorrect choices: Epinephrine should not be used to treat vasomotor collapse in patients taking first-generation antipsychotics because it could cause a further decrease in blood pressure. This occurs as a result of the predominant b-agonist activity of epinephrine in the presence of the first-generation antipsychotics (a-blockers).

 

REF:   Antipsychotic Agents (Epinephrine) | p. 206                             OBJ:    3

 

  1. First-generation antipsychotic therapy must often be combined with _____ drugs such as benztropine to control excessive extrapyramidal stimulation.
a. adrenergic
b. antiadrenergic
c. cholinergic
d. anticholinergic

 

 

ANS:  D

Correct: To control excessive extrapyramidal stimulation, first-generation antipsychotic therapy is often combined with anticholinergic drugs such as benztropine (Cogentin) and trihexyphenidyl (Artane).

Incorrect choices: This combination is likely to exacerbate antimuscarinic peripheral effects such as xerostomia, urinary retention, constipation, blurred vision, and inhibition of sweating.

 

REF:   Antipsychotic Agents (Anticholinergic Agents) | p. 206  OBJ:   3

 

  1. Which of the following choices is recommended to counteract the anticholinergic effects of first-generation antipsychotics?
a. Caffeine-containing beverages
b. Alcohol-containing mouth rinses
c. Sugarless products or artificial saliva
d. Sugar-containing candy

 

 

ANS:  C

Correct: First-generation antipsychotics are additive with other agents with atropine-like effects. Use of sugarless products or artificial saliva should be encouraged.

Incorrect choices: Patients should be encouraged to stay away from caffeine-containing beverages because they can exacerbate dry mouth. They should also avoid alcohol-containing mouth rinses because alcohol can also exacerbate dry mouth. Patients may use sugar-containing candy to counteract xerostomia. Use of sugarless products is recommended.

 

REF:   Antipsychotic Agents (Anticholinergic Effects) | p. 206  OBJ:   3

 

  1. Which of the following are adverse reactions associated with selective serotonin reuptake inhibitors (SSRIs)?
a. Central nervous system (CNS) depression
b. Nausea and diarrhea in approximately 15% to 30% of patients
c. Xerostomia in 10% to 15% of the population
d. Both a and b
e. Both b and c

 

 

ANS:  E

Correct: SSRIs are recommended as first line therapy for the treatment of major depression. They are associated with nausea and diarrhea in approximately 15% to 30% of patients. Oral side effects include xerostomia in 10% to 15% of the population, taste changes, aphthous stomatitis, glossitis, and (rarely) increased salivation, salivary gland enlargement, and tongue discoloration or edema.

Incorrect choices: SSRIs tend to produce CNS stimulation rather than CNS depression.

 

REF:   Antidepressant Agents (Adverse Reactions) | p. 207       OBJ:   4

 

  1. Which antidepressant is least likely to cause xerostomia?
a. Bupropion
b. Sertraline
c. Chlorpromazine
d. Amitriptyline
e. Trazodone

 

 

ANS:  B

Correct: Sertraline, as with other SSRIs, produces a lower incidence of xerostomia than other classes of antidepressants, probably because their anticholinergic activity is significantly weaker.

Incorrect choices: Bupropion, trazodone, and especially amitriptyline have a greater anticholinergic action and incidence of xerostomia. Chlorpromazine is not an antidepressant.

 

REF:   Table 17-3: Commonly Used Antidepressants | p. 208    OBJ:   4

 

  1. Abrupt withdrawal of serotonin norepinephrine reuptake inhibitors (SNRIs) can lead to symptoms of:
a. urinary retention.
b. anxiety.
c. tachycardia.
d. sweating.

 

 

ANS:  B

Correct: Abrupt discontinuation can lead to withdrawal characterized by symptoms of anxiety, which may be attributed to their short half-lives.

Incorrect choices: Adverse effects of SNRIs can include sweating, tachycardia, and urinary retention.

 

REF:   Antidepressant Agents (Serotonin-Norepinephrine Reuptake Inhibitors) | p. 207

OBJ:   5

 

  1. 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

 

 

ANS:  A

Correct: Tricyclic antidepressants possess distinct anticholinergic effects resulting in xerostomia, blurred vision, tachycardia, constipation, and urinary retention. Some tolerance can develop with continued use.

Incorrect choices: The extension of cholinergic effects are: salivation, lacrimation, urination, and defecation. Anticholinergic effects would be the opposite.

 

REF:   Antidepressant Agents (Adverse Reactions) | pp. 208-209

OBJ:   7

 

  1. Which of the following side effects is the most serious peripheral side effect associated with the use of tricyclic antidepressants?
a. Orthostatic hypotension
b. Cardiac toxicity
c. Urination
d. Bradycardia

 

 

ANS:  B

Correct: The most serious peripheral side effect associated with the tricyclic antidepressants is cardiac toxicity. Myocardial infarction and congestive heart failure have occurred during the course of treatment.

Incorrect choices: Orthostatic hypotension is associated with antipsychotics. Tricyclic antidepressants are associated with anticholinergic effects such as xerostomia, tachycardia, constipation, and urinary retention. Arrhythmias and episodes of tachycardia can be caused by the antimuscarinic effects of the tricyclic antidepressants.

 

REF:   Antidepressant Agents (Adverse Reactions) | p. 209       OBJ:   7

 

  1. Of the tricyclic antidepressants listed, which one is most sedating?
a. Imipramine
b. Nortriptyline
c. Protriptyline
d. Desipramine
e. Amitriptyline

 

 

ANS:  E

Correct: Amitriptyline is used when sedation is desired.

Incorrect choices: Of the tricyclic antidepressants listed, amitriptyline is generally the most sedating, with desipramine being the least sedating. When less sedation is needed, nortriptyline or protriptyline can be tried.

 

REF:   Table 17-3: Commonly Used Antidepressants | p. 208    OBJ:   7

 

  1. Which of the following types of dental medicaments must be administered with caution to patients taking tricyclic antidepressants?
a. Fluoride
b. Antibiotics
c. Anesthetics
d. Analgesics

 

 

ANS:  C

Correct: The cardiac dose (0.04 mg) of local anesthetics can be safely administered to patients who do not have preexisting arrhythmias.

Incorrect choices: Vasoconstricting drugs in local anesthetic solution must be administered with caution to patients taking tricyclic antidepressants. They may potentiate vasopressor response to epinephrine.

 

REF:   Antidepressant Agents (Sympathomimetic Amines) | p. 210

OBJ:   7

 

  1. Bupropion is reserved for patients who are not responsive to other agents because of a potential for:
a. cardiac arrhythmias.
b. seizures.
c. retinopathy.
d. glaucoma.

 

 

ANS:  B

Correct: Because of its seizure potential, bupropion is reserved for patients who are not responsive to other agents.

Incorrect choices: Approximately 0.4% of patients treated with bupropion have experienced seizures. This incidence may be four times greater than with tricyclic antidepressants and as much as 10 times greater with tricyclic antidepressants at higher doses.

 

REF:   Antidepressant Agents (Bupropion) | p. 210                              OBJ:    8

 

  1. Which antidepressant drug carries a “black box” warning regarding its potential to cause life-threatening liver failure?
a. Imipramine
b. Bupropion
c. Nefazodone
d. Mirtazapine
e. Venlafaxine

 

 

ANS:  C

Correct: Nefazodone has the potential to cause fatal hepatic dysfunction.

Incorrect choices: The remaining choices do not have a “black box” warning regarding the potential for causing liver failure.

 

REF:   Antidepressant Agents (Nefazodone, Mirtazapine, and Vilazodone) | p. 210

OBJ:   8

 

  1. Interaction of monoamine oxidase inhibitors (MAOIs) with many drugs such as amphetamines, and with foods such as wines, cheese, and fish, can precipitate:
a. hair loss.
b. hypertensive crisis.
c. gout.
d. dysgeusia.

 

 

ANS:  B

Correct: Patients taking MAOIs have detailed food prohibitions because of this chance of food-drug interactions.

Incorrect choices: MAOIs interaction with many drugs and foods can precipitate a hypertensive crisis and even death. MAOIs are used as drugs of last choice. Patients taking MAOIs should not be given any drug unless the prescriber has first consulted a reference source on drug interactions.

 

REF:   Antidepressant Agents (Monoamine Oxidase Inhibitors) | p. 209

OBJ:   6

 

  1. Dental local anesthetic with vasoconstricting agents must be limited to the cardiac dose for patients taking:
a. selective serotonin reuptake inhibitors (SSRIs).
b. serotonin norepinephrine reuptake inhibitors (SNRIs).
c. tricyclic antidepressants (TCAs).
d. trazodone (Desyrel).

 

 

ANS:  C

Correct: TCAs may potentiate vasopressor response to epinephrine. The sympathomimetic amines present in a dental local anesthetic solution can be safely administered to patients without preexisting arrhythmias. Caution should be used if epinephrine is necessary in a patient receiving the SSRIs citalopram (Celexa) or escitalopram (Lexapro).

Incorrect choices: Vasoconstricting drugs in the local anesthetic solution must be administered with caution to patients taking TCAs.

 

REF:   Antidepressant Agents (Sympathomimetic Amines) | p. 210

OBJ:   8 | 2

 

  1. Which of the following medications is used to treat bipolar depression?
a. Haloperidol
b. Lithium
c. Clozapine
d. Paroxetine

 

 

ANS:  B

Correct: Lithium is used in the treatment of bipolar depression, which is characterized by cyclic recurrence of mania alternating with depression.

Incorrect choices: Haloperidol is a high-potency first-generation antipsychotic. Clozapine is a second-generation antidepressant. Paroxetine is an SSRI.

 

REF:   Drugs for Treatment of Bipolar Disorder (Lithium) | p. 210

OBJ:   9

 

  1. Patients undergoing lithium therapy should be observed for signs of overdose toxicity, including:
a. hyperpyrexia.
b. constipation.
c. muscle rigidity and fasciculations.
d. loquacious speech.

 

 

ANS:  C

Correct: Overdose toxicity may be exhibited by CNS symptoms, including muscle rigidity, hyperactive deep reflexes, excessive tremor, and muscle fasciculations.

Incorrect choices: Side effects of treatment with lithium include polyuria, fine hand tremor, thirst, and in more severe cases, slurred speech, ataxia, nausea, vomiting, and diarrhea.

 

REF:   Drugs for Treatment of Bipolar Disorder (Lithium) | p. 210

OBJ:   9

 

  1. Which of the following categories of medications has recently been approved for the treatment of bipolar disorder?
a. High-potency first-generation antipsychotics
b. Second-generation antipsychotics
c. SSRIs
d. MAOIs

 

 

ANS:  B

Correct: Olanzapine and aripiprazole are approved for relapse prevention of bipolar disorder.

Incorrect choices: All of the second-generation antipsychotics have been approved for the treatment of bipolar disorder, as well as for the acute treatment of bipolar disorder.

 

REF:   Drugs for Treatment of Bipolar Disorder (Second-Generation Antipsychotics) | p. 211

OBJ:   9

 

MULTIPLE RESPONSE

 

  1. Which of the following are true of second-generation antipsychotics in contrast to first-generation antipsychotics? (Select all that apply.)
a. Second-generation antipsychotics are used more frequently than first-generation antipsychotics.
b. Second-generation antipsychotics are better tolerated than first-generation antipsychotics.
c. Second-generation antipsychotics are more effective against the negative effects of psychosis than first-generation antipsychotics.
d. Second-generation antipsychotics are primarily dopamine antagonists, whereas first-generation antipsychotics were dopamine agonists.

 

 

ANS:  A, B, C

Correct: The second-generation antipsychotics are now used more commonly than the first-generation antipsychotics even though clinical trials have not demonstrated a clear advantage in efficacy, except for clozapine and possible olanzapine. However, second-generation antipsychotics are better tolerated. Like the first-generation antipsychotics, the second-generation antipsychotics are effective against the positive effects associated with psychoses. Unlike the first-generation antipsychotics, however, the second-generation antipsychotic agents are effective against the negative effects.

Incorrect choices: The first-generation antipsychotic agents were primarily dopamine antagonists. The second-generation agents have action at more than one receptor, for example, the dopamine, serotonin (5-HT), and norepinephrine (NE) receptors.

 

REF:   Antipsychotic Agents | pp. 203-204                                           OBJ:    3

 

  1. Serotonin norepinephrine reuptake inhibitors (SNRIs): (Select all that apply.)
a. are considered first line therapy for the treatment of depression.
b. are considered superior to selective serotonin reuptake inhibitors (SSRIs).
c. can induce withdrawal symptoms is abruptly discontinued.
d. are antipsychotic agents.

 

 

ANS:  A, C

Correct: SNRIs and SSRIs are both considered first line therapy for the treatment of depression. These drugs should be slowly tapered off to reduce the risk of withdrawal.

Incorrect choices: It is not clear if SNRIs offer any advantage over SSRIs. SNRIs are antidepressants, not antipsychotics.

 

REF:   Antidepressant Agents (Serotonin-Norepinephrine Reuptake Inhibitors) | p. 207

OBJ:   5

 

TRUE/FALSE

 

  1. Second-generation antipsychotics have fewer side effects than first-generation antipsychotics.

 

ANS:  T

Correct: As with first-generation antipsychotics, the second-generation antipsychotics are effective against the positive effects associated with psychoses. Unlike first-generation antipsychotics, however, the second-generation antipsychotics are effective against the negative effects.

 

REF:   Antipsychotic Agents (Mechanism of Action) | pp. 204-205

OBJ:   3

 

  1. Force should be exerted to open the patient’s mouth if muscle spasm is present as a result of tardive dyskinesia.

 

ANS:  F

Correct: Forces should not be exerted to open the patient’s mouth for dental treatment because dislocations of the mandible can occur.

 

REF:   Antipsychotic Agents (First-Generation Antipsychotics) | p. 205

OBJ:   3

 

  1. Intractable hiccups have been successfully treated with first-generation antipsychotics.

 

ANS:  T

Correct: Hiccups and certain drug withdrawals have been treated with first-generation antipsychotics.

 

REF:   Antipsychotic Agents (Other Uses) | p. 206                               OBJ:    3

 

  1. The chemoreceptor trigger zone (CTZ) is a site of action for prochlorperazine and promethazine.

 

ANS:  T

Correct: Prochlorperazine and promethazine are both phenothiazines. They are antiemetic compounds by virtue of their ability to depress the CTZ.

 

REF:   Antipsychotic Agents (First-Generation Antipsychotics) | p. 205

OBJ:   3

 

  1. SSRIs tend to produce CNS stimulation rather than CNS depression.

 

ANS:  T

Correct: SSRIs do not have the sedative actions found within many tricyclic antidepressants. As a class, they tend to be less sedating, although sedation is sometimes seen with some members of this class (e.g., sertraline).

 

REF:   Antidepressant Agents (Adverse Reactions) | p. 207       OBJ:   4

 

  1. All antidepressants will carry a boxed warning about the potential for patient suicide.

 

ANS:  T

Correct: 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.

 

REF:   Antidepressant Agents (Suicide and Antidepressants) | p. 210

OBJ:   8