Chapter 4
Which of the following choices represents potential cardiac effects of anticholinergic agents?
Bradycardia exclusively Tachycardia exclusively Variable; bradycardia predominates with small doses and tachycardia with large doses No cardiac effect from the use of these agents
Correct: This variable response in the heart rate occurs because heart rate is a function of both direct and indirect effects. This effect has been used therapeutically to prevent cardiac slowing during general anesthesia.
Incorrect choices: Bradycardia predominates with small doses; however, with large therapeutic doses, the anticholinergic agents can produce vagal blockade, resulting in tachycardia.
REF: Parasympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 39
OBJ: 3
Aspirin has a long history of use for relief of mild to moderate pain such as a headache or toothache, and aspirin's worth as an analgesic is well recognized by the lay public.
true, true false, false true, false false, true
The first part of the statement is true; the second part is false. Although the efficacy of aspirin as an analgesic for mild to moderate pain is well documented, the general population often discounts its effectiveness because of its easy accessibility and long history.
REF: CHAPTER FIVE – SALICYLATES (PHARMACOLOGIC EFFECTS) - PAGE 4
OBJ: 2
Which of the following opioids is used primarily in the treatment of opioid addicts?
propoxyphene
meperidine
hydromorphone
methadone
Correct: Methadone is used either to withdraw the patient gradually or for methadone maintenance. Because it has a longer duration of action, withdrawal from methadone is easier than from heroin. Because it is an opioid analgesic, however, the risk for dependence still exists.
Incorrect choices: Propoxyphene is in Darvocet N-100; its analgesic efficacy has been questioned, and it is certainly no more efficacious than two tablets of aspirin or acetaminophen. Meperidine is intended for the acute management of moderate-to-severe pain. Hydromorphone is reserved for the management of severe pain.
REF: Specific Opioids (Methadone) | p. 67
OBJ: 4
Which of the following antibiotics is available mixed with clavulanic acid?
ampicillin
amoxicillin
carbenicillin
azithromycin
Correct: Augmentin is amoxicillin mixed with clavulanic acid. Clavulanic acid combines with and inhibits the β-lactamases produced by bacteria. Therefore the amoxicillin is protected from enzymatic inactivation. This combination can be taken with penicillinase-producing organisms. It has had some use in the management of certain periodontal conditions.
Incorrect choices: The other antibiotics are not mixed with clavulanic acid.
REF: Penicillins (Ampicillins) | p. 77
OBJ: 4
What does Matthew like to do in his off time?
woodworking
Which of the following is a catecholamine?
Isoproterenol, Norepinephrine, Epinephrine, Both b and c, All of the above
Correct: The term catecholamine is made up of two terms that relate to their structure. Catechol refers to 1,2-dihydroxybenzene. Amine refers to the chemical structure –NH2. Norepinephrine, epinephrine, and dopamine are endogenous sympathetic neurotransmitters that are catecholamines.
Incorrect choices: Isoproterenol (Isuprel) is an exogenous catecholamine.
REF: Sympathetic Autonomic Nervous System | p. 40
OBJ: 4
Dental pain is best managed with which of the following choices?
codeine 60mg
ibuprofen 400mg
acetaminophen 650mg
aspirin 650mg
Correct: In usual prescription doses, NSAIDs can be shown to be statistically significantly better than codeine alone, aspirin, acetaminophen, or placebo.
Incorrect choices: Usual analgesic doses of NSAIDs have been shown to be as effective as 650 mg of aspirin or acetaminophen plus 60 mg of codeine and even as effective as the intermediate-strength opioid combinations.
REF: Nonsteroidal Antiinflammatory Drugs (Ibuprofen) | p. 55
OBJ: 3
Which opioid analgesic is most likely to produce dysphoria?
merperidine
codeine
pentazocine
oxycodone
hydrocodone
Correct: Of the agents listed, pentazocine has the greatest propensity for causing dysphoric reactions. It is a mixed agonist-antagonist opioid, and produces CNS effects not unlike the opioid agonists, including analgesia, sedation, and respiratory depression. The type of analgesia it produces is somewhat different from that produced by the agonist opioids. This may be a result of its agonist action on kappa and delta receptors and its antagonist action at the mu receptor. References differ whether sigma or delta opioid receptors may be responsible for the dysphoria.
Incorrect choices: Meperidine, codeine, oxycodone, and hydrocodone are opioid agonists. They are not the primary opioid associated with dysphoria.
REF: Mechanism of Action | p. 61
OBJ: 5
Which of these agents do not inhibit bacterial cell-wall synthesis?
vancomycin
erythromycin
penicillin g
cefazolin
Correct: Erythromycin is a bacteriostatic agent that inhibits bacterial protein synthesis.
Incorrect choices: Vancomycin, penicillin G, and cefazolin all inhibit cell-wall synthesis. They are bactericidal.
REF: Macrolides (Mechanism and Spectrum) | p. 78
OBJ: 4
How does Matthew feel about plagiarism?
DON'T DO IT!!
α-Adrenergic agonists cause:
vasoconstriction, vasodilation, tachycardia, miosis
Correct: α-Adrenergic receptors are found on blood vessels and stimulation of them causes vasoconstriction.
Incorrect choices: α-Adrenergic agonists cause vasoconstriction and mydriasis. β-adrenergic agonists, but not á-adrenergic agonists, cause tachycardia.
REF: Sympathetic Autonomic Nervous System (a-Receptors) | p. 40
OBJ: 4
Acetaminophen does not possess any of these clinically significant _____ effects: (1) antipyretic, (2) antiinflammatory, (3) analgesic.
1, 2, 3 1, 2 1, 3 1 2
Correct: Acetaminophen this thought to produce analgesia by elevating the pain threshold. Its potential mechanism of action may involve inhibiting the nitric oxide pathway, which is mediated by a variety of neurotransmitter receptors. Its antipyretic effects may be the result of inhibition of endogenous pyrogens on the heat-regulating centers of the brain by blocking the formation and release of prostaglandins in the central nervous system.
Incorrect choices: Acetaminophen does have clinically significant antipyretic and analgesic effects; however, it does not possess any clinically significant antiinflammatory effect.
REF: Acetaminophen (Pharmacologic Effects) | p. 56
OBJ: 4
Which of the following types of pain medications is the best choice for management of most dental pain?
antidepressants
nonsteroidal anti-inflammatory drugs
aspirin
acetaminophen
Correct: The advent of the NSAIDs has produced a change in the use of the opioids in dental practice. Most dental pain can be better managed by the use of NSAIDs. In the patient in whom NSAIDs are contraindicated, the dentist has a wide range of opioids from which to choose.
Incorrect choices: Antidepressants are not the best choice for management of most dental pain although low doses of antidepressants may be used along with NSAIDs and muscle relaxants to treat TMD. Aspirin and acetaminophen are not the first choice for dental pain.
REF: Dental Use of Opioids | p. 68
OBJ: 7
Azithromycin and clarithromycin:
cause lysis of the bacterial cell wall.
are not effective against anaerobes.
have a higher incidence of adverse reactions than erythromycin.
may be used as alternative antibiotics for the prophylaxis of endocarditis and prosthetic joint infections.
D
Correct: These macrolides can be used as alternative antibiotics when amoxicillin and clindamycin cannot be used for the prophylaxis of endocarditis and prosthetic joint infections.
Incorrect choices: Azithromycin and clarithromycin inhibit RNA-dependent protein synthesis by binding to the 50S ribosomal subunit. In contrast to erythromycin, azithromycin and clarithromycin have variable action against some anaerobes. The incidence of adverse reactions is lower with azithromycin and clarithromycin compared with erythromycin.
REF: Macrolides (Azithromycin and Clarithromycin) | p. 79
OBJ: 4
roles of dental hygienist
interrogator
friend
advocate
detective
clinician
Sympathomimetic agents will stimulate salivary flow from which of the following salivary glands: (1) parotid, (2) submandibular, (3) sublingual?
1, 2, 3 1, 2 1, 3 2, 3
2, 3 Correct: The mucus-secreting cells of the submandibular gland and sublingual gland are stimulated by the sympathomimetic agents to release a small amount of thick, viscous saliva.
Incorrect choices: Because the parotid gland has no sympathetic innervation (only parasympathetic) and the sympathomimetics produce vasoconstriction, the flow of saliva is often reduced, resulting in xerostomia.
REF: Sympathetic Autonomic Nervous System (Pharmacologic Effects) | p. 42
OBJ: 5
Which of the following agents is intended to treat an acute attack of gout?
probenecid
codeine
colchisine
acetaminophen
both a and c
Correct: Colchicine is used for acute attacks of gout.
Incorrect choices: Probenecid is used in prevention of a gout attack. Codeine and acetaminophen are not recommended for treating gout.
REF: Drugs Used to Treat Gout | p. 58
OBJ: 5
Codeine activates the chemoreceptor trigger zone.
T/F
Correct: Codeine can cause nausea and vomiting by acting on this medullary structure.
REF: Adverse Reactions (Nausea and Emesis) | p. 63
OBJ: 2
Which of the following agents is most closely associated with the development of pseudomembranous colitis as a toxicity that limits its general use?
erythromycin
clindamycin
penicilling vk
metronidazole
B
Correct: A historical association exists between clindamycin use and pseudomembranous colitis, which limits its use relative to other eligible antibacterial agents.
Incorrect choices: Pseudomembranous colitis is a possible consequence related to the use of other antibacterials in addition to the antibiotic most closely associated. Other antibiotics include tetracycline, ampicillin, and the cephalosporins.
REF: Clindamycin (Gastrointestinal Effects) | p. 82
OBJ: 4
what do you need to submit to get more chocolate?
Rx
Patients pretreated with _____ agents are prone to epinephrine reversal.
cholinergic, anticholinergic, α-adrenergic, α-adrenergic blocking
Correct: The α-adrenergic blocking agents competitively inhibit the vasoconstricting effects of the adrenergic agents. This reduces the sympathetic tone in the blood vessels, producing a decrease in the total peripheral resistance. The resulting decrease in blood pressure stimulates the vagus, thereby producing a reflex tachycardia. Patients who are pretreated with α-adrenergic blocking agents and given epinephrine exhibit a predominance of beta effects, which lowers blood pressure.
Incorrect choices: Epinephrine reversal is caused by adrenergic blocking agents.
REF: Sympathetic Autonomic Nervous System (a-Adrenergic Blocking Agents) | p. 43
OBJ: 5
Two components of pain include perception and reaction.
T/F
Correct: Perception and reaction are two distinct components of pain.
REF: Pain | p. 46
OBJ: 1
A patient who feels nauseated after taking codeine is allergic to it.
T/F
F
Correct: Nausea is a normal pharmacologic action of codeine on the chemoreceptor trigger zone in the brain.
REF: Adverse Reactions (Nausea and Emesis) | p. 63
OBJ: 2
Which of the following statements is true of vancomycin?
Vancomycin is related to the cephalosporins.
Vancomycin is usually administered only intravenously for a systemic effect.
Vancomycin is bacteriostatic.
Vancomycin has a broad spectrum of action against a wide variety of gram-positive and gram-negative organisms.
B
Correct: Because vancomycin has very poor gastrointestinal absorption and causes irritation when used intramuscularly, it is usually administered only intravenously for a systemic effect.
Incorrect choices: Vancomycin is unrelated to any other antibiotic currently marketed. It is bactericidal and has a narrow spectrum of activity against many gram-positive cocci, including both staphylococci and streptococci.
REF: Antimicrobial Agents for Nondental Use (Vancomycin) | p. 84
OBJ: 5
what do you want from school?
Education?
Experience?Job?
Money?
Career?