(With various obtuse comments from your humble typist)
Jim Middleton, The Animating Apothecary
PO Box 1325, Battle Creek MI 49016

 PHARMACOLOGY for Dental Hygiene

1. Which of the following may result from an overdose of insulin?Clickety Click!
   a. glycosuria
   b. convulsions
   c. hyperglycemia
   d. diabetes insipidus
The general reaction to insulin in the body is to lower blood glucose (sugar) levels (known as hypoglycemia).  Therefore, “a,” glycosuria--the presence of glucose in the urine--would not be appropriate.  Glucose appears in the urine only after blood glucose levels start topping 180mcg/ml; if glucose is present in the urine, it would be a sign of hyper-, not hypoglycemia, or “c” which is also not an appropriate answer.  Diabetes insipidus is a condition that has nothing to do with the pancreas or blood glucose levels--it deals with misaligned levels of ADH— antidiuretic hormone.  When ADH is inhibited to excess, it can result in great volumes of urinary output.  By the way, alcohol is a very effective inhibitor of ADH, explaining why some people feel you never really buy a beer, you only rent it.

2. A drug that causes xerostomia is
   a. a cholinergic agent
   b. an anticholinergic agent
   c. an antiadrenergic agent
   d. a cholinesterase inhibitor
   e. an alpha-adrenergic blocking drug
Xerostomia means "dry mouth," so you'd look for an agent that is used to dry up secretions.  Cholinergic agents actually increase secretions, that SLUD response, you remember.... a cholinesterase inhibitor would also increase secretions because it would reduce the metabolism of acetylcholine (remember that the -ase suffix denotes an enzyme!).  So you'd go for an ANTICHOLINERGIC drug, a drug such as atropine or scopolamine, with emphasis on atropine.

3. Precautions must be taken when drugs are administered to geriatric patients because elderly people
   a. may metabolize drugs less rapidly
   b. may not be able to excrete drugs as rapidly
   c. will usually require greater than average adult doses
   d. all of the above
   e. only (1) and (2) above
The elderly population is hit with a double whammy, physiologically speaking--(1) the liver reduces the amounts of enzymes it produces, thereby slowing metabolism of food and drugs (this is why grandpa isn't always as hungry as you might think he should be); also, the whole GI/GU systems seem to enter a slowdown as well.  Since most drugs are excreted renally, and the renal system is working at a slower rate, drugs and their metabolites tend to hang around in the body for greater time periods.

4. Protracted use ("prolonged use") of sulfa drugs may produce symptoms of vitamin K deficiency because sulfa drugs
   a. are detoxified in the liver
   b. combine chemically with vitamin K
   c. inhibit growth of intestinal bacteria
   d. interfere with the conversion of prothrombin to thrombin
   e. inhibit calcium absorption which is essential to enzyme systems
This argument can be used for ANY antibiotic, by the way.  If you are killing off pathogenic invaders of the human body, you generally run the risk of killing off the body’s natural “flora” (far more poetic a term than E. Coli deserves).  The body’s “flora” is responsible for manufacturing most of the Vitamin K that we have, and it is mainly produced in your large intestine. Joy unbounded!  Dead bacteria, by the way, swell up in the colon, and have no where to go but out, dragging copious fluids with them.  This is the post-therapy diarrhea that many patients complain about when taking an antibiotic.

5. The letters "prn" appearing on a prescription indicate that a medication is to be administered
   a. at bedtime
   b. after meals
   c. by a registered nurse
   d. when needed
This is one of the more clever questions I've come across on past boards.  Per RN as "PRN" almost sounds logical.  PRN stands for "Pro Re Nata" or "as the need arises" or, here, "when needed."

6. The abbreviation "TID" on a prescription means
   a. three times daily
   b. twice daily
   c. take into dentist office
   d. once daily

7. Which of the following is not an action of aspirin?
   a. analgesic
   b. obtundent
   c. antipyretic
   d. antiinflammatory
Remember the BIG THREE "As" of aspirin.  Also be aware of its fourth "a," namely, anti-coagulant.  The "a" not shared by acetaminophen is "anti-inflammatory."

8. When performing deep scaling procedures, prophylactic antibiotic therapy is necessary for patients with each of the following conditions EXCEPT
   a. a prosthetic hip
   b. a prosthetic heart valve
   c. coronary heart disease
   d. rheumatic heart disease
   e. congenital heart disease
In this case, you are looking for situations where either invasion (ie surgery) has taken place, or where scarring may be a potential problem on the heart walls.  Prostheses can stimulate the body to send out antibodies against soft tissues (this means antibiotic therapy is indicated in “a” and “b.”  Rheumatic heart disease comes following rheumatic fever, where the body also attacks its own soft tissues--heart valves being in that category.  Congenital heart disease usually implies some sort of surgical correction, but it can result in cardiac rhythm abnormalities that may lead to scarring.  Any time you have scarring, deep scaling procedures can cause the introduction of Streptococci into the bloodstream, and they love to attach to scars in the cardiac walls.
 Now to add a bit of confusion to all of this, understand that there is some controversy about the routine use of antibiotics prior to dental procedures.  Some studies are trying to imply that they are unnecessary.  I think more work needs to be done before their use is completely discounted.

9. Salicylates are NOT the drug of choice for patients
   a. with gastric ulceration
   b. with hemorrhagic disorders
   c. with rheumatoid arthritis
   d. on anticoagulant therapy
Salicylates--and they mean ASPIRIN here--cause GI bleeding, can expand anticoagulant activity to the point of toxicity, and can make hemorrhagic disorders more pronounced.  Salicylates would also not be a drug of choice in patients suffering from asthma or with sensitivity to NSAIDs.

10.The action of epinephrine when combined with a local anesthetic is to
   a. increase the amount of local anesthetic needed for effect
   b. decrease the relative length of action of an anesthetic
   c. enhance circulation and wash the anesthetic from the site of action more quickly
   d. increase the duration of anesthesia
When added to a local anesthetic, epinephrine causes vasoconstriction of the blood vessels, keeping the anesthetic in place for a longer period of time.

11. Postoperative dressings placed after root planing may
   a. inhibit the bacterial flora adjacent to the tooth
   b. increase the tendency for postoperative bleeding
   c. reduce postoperative discomfort
   d. accelerate healing

12. Staining of carious and pre-carious tooth surfaces occurs with the use of
   a. stannous fluroide
   b. sodium monoflurophosphate
   c. sodium fluoride
   d. sodium silicofluoride
   e. acidulated phosphate fluoride

13.Repeated topical applications of a fluoride agent will NOT produce mottling because
   a. the fluoride concentration of the solution is weak
   b. the applied fluoride is neutralized by the saliva
   c. excessive amounts of fluoride are removed when the teeth are polished
   d. it is not fluoride that produces the mottling seen in fluorosis
   e. the teeth are already calcified and cannot be altered in this fashion

14.Use of a topical anesthetic spray is limited by which of the following disadvantages?
   a. it is difficult to control the quantity administered
   b. it is difficult to confine the effect to a small area
   c. sufficient amounts could be inhaled to cause a toxic reaction
   d. larger amounts are needed than with a topical solution
This is an example of the occasional multiple-multiple choice question that has appeared in the past.  This type of question has occurred less frequently with the computerized question format of recent boards.  But they may figure out how to re-introduce the concept!

15. Topical anesthetic agents are most effective when applied to
   a. skin
   b. palatal mucosa
   c. keratinized epithelium
   d. nonkeratinized soft tissue
   e. areas of acute inflammation
A good example of KERATINIZED tissue would be a stereotypical farmer's foot.  Acute inflammation represents a region of pH variance that will give you an IONIZED local anesthetic (and you remember of course that an ionized local anesthetic is less likely to be well absorbed).  Skin absorbs drugs pretty well, as exemplified by the popularity of topical drug patches--NicoDerm, et al-- but isn't quite the "sponge" that some portray it.  This is one of those questions whose answer can be determined via the usual process of administration.

16. The effective use and application of a topical anesthetic solution is dependent on
   a. a review of the patient's history
 To determine allergies
   b. an explanation of the procedure to the patient
 To allay fear and apprehension
   c. a generous application to a large surface
 Icky-bad idea--can result in sensitization to the local anesthetic
   d. application to a surface that is dried with a gauze sponge or cotton roll
 A dry surface is an absorbant surface
   e. performance of clincial services immediately after application
 All good things take time, especially local anesthesia...

17. Use of the following shows considerable promise as a means of plaque prevention?
   a. fluroide
   b. penicillin
   c. chlorhexidine
   d. dextransucrase
   e. pulsating irrigation

18. Stomatitis caused by use of dentifrices containing certain detergents is generally treated by
   a. discontinuing use of the dentifrice
   b. administering antihistamines
   c. administering anti-inflammatory agents
   d. periodic rinsing with sodium bicarbonate solutions

19. Each of the following is a property of an ideal chemical disinfectant EXCEPT
   a. heatability
   b. long shelf life
   c. solubility in water
   d. activity against vegetative microbes

20.Which of the following is NOT a reason to premedicate patients before induction of general anesthesia
   a. relieve anxiety
   b. prolong induction
   c. prevent adverse effects of the anesthetic agent
   d. potentiate or supply an effect not produced by the anesthetic
   e. shorting duration of anesthesia from a single injection
Again, remember the idea for premedicating patients is to make them comfortable and reduce their anxiety during the procedure.  You want to induce general anesthesia as quickly as possible.  Prolonging induction does no one any good.

21. The mechanism of action of local anesthetics is to
   a. block nerve synapes
   b. coagulate nerve protein reversibility
   c. depolarize persistently the nerve membrane
   d. block nerve conduction by preventing nerve depolarization
The "d" choice appears in varying phrasings.

22. Which of the following actions is not caused by epinephrine?
   a. tremor
   b. miosis
   c. anxiety
   d. headache
   e. palpitations
Miosis is a closing of the pupil; epinephrine causes mydriasis, or pupil dilation.

23. Which of the following drugs can be substituted for aspirin in a patient with an aspirin allergy?
   a. pentazocine (Talwin)
   b. Darvon Compound 65
 a combination of propoxyphene (Darvon), aspirin, and caffeine
   c. Percodan
 a combination of oxycodone and aspirin-- a combination of oxycodone and acetaminophen is called Tylox or Percocet
   d. acetaminophen (Tylenol)
   e. APC
 an old combination of aspirin, phenacetin, and caffeine-- it was also called Empirin compound.  Phenacetin was removed from the market in the early 1980s because it caused methemoglobinemia.
   f. Midol caplets
 contains aspirin and antihistamine compounds
   g. Empirin Compound with codiene
 contains aspirin
   h. phenacetin (Acetophenetidin)
 not on the market
   i. Darvocet N-100
 combination of propoxyphene napsylate and acetaminophen

24. A patient allergic to lidocaine (Xylocaine) should NOT be given which of the related drugs as an anesthetic?
   a. procaine (Novocain)
   b. propoxycaine (Ravocaine)
   c. mepivicaine (Carbocaine)
   d. tetracaine (Pontocaine)

25. An infection in an area can prevent the accumulation of effective concentrations of local anesthetic solution because of
   a. low tissue pH
   b. excessive dilution with tissue fluids
   c. the intense stimulation of pain due to the infection
   d. rapid absorption of the solution into the systemic circulation
Again, remember that the basic--low--pH can covert a local anesthetic to a primarily ionized state, which will decrease its ability to cross cell membranes.

26. Of the following, nitrous oxide-oxygen analgesic is contraindicated in a patient who
   a. is overweight
   b. has hypertension
   c. has a history of emphysema
   d. has an upper respiratory infection
   e. has just ingested a large meal
Nitrous oxide can be a problem if the patient has any time of respiratory compromise.  Remember that it takes quite a lot of Nitrous Oxide to be an effective analgesic, and the increased concentrations of nitrous oxide come at the expense of oxygen.  Many people become nauseated while on the combination of gases as well, so you want to avoid this route of analgesia with someone who has just eaten.  Vomitus can be aspirated, and that can land someone into the ICU very quickly.

27. Camphorated parachlorophenol is used primarily in
   a. endodontics
   b. orthodontics
   c. oral surgery
   d. periodontics

28. A patient taking digitalis probably has
   a. angina pectoris or atherosclerosis
   b. atheroslerosis or congestive heart failure
   c. congestive heart failure or atrial fibrillation
   d. atrial fibrillation or essential hypertension
The primary indications for digitalis (ie digoxin or Lanoxin) usage would be congestive heart failure or atrial fibrillation.)

29. Acute psychoses, peptic ulcers, chronic heart failure and edema are classic contraindications for which of the following drugs?
   a. cortisone
   b. digitalis
   c. penicillin
   d. nitromersol
Cortisone belongs to the class of drugs known as glucocorticoids.  They have been known to cause "steroid psychosis" in women, ulcers (even when given topically or by injection), and the edema from sodium retention would certainly not be welcome in a patient already suffering from edema secondary to congestive heart failure.

30. The cause of death from overdose of any central nervous system depressant is usually
   a. renal failure
   b. thromboembolism
   c. hepatic necrosis
   d. respiratory depression
   e. cardiovascular depression

31. The greatest danger in using nitrous oxide for analgesia is
   a. hyperventilation
   b. a gas embolus
   c. oxygen deprivation
   d. cardiac arrhythmia
   e. foreign body aspiration
Also see question #26.

32. A patient states "I'm allergic to Novocaine."  When questioned further, he describes his experience as "shortness of breath, palpitations, cold perspiration and fainting for a few moments."  From this information the dental hygienist should suspect that the patient is
   a. a drug addict
   b. apprehensive about receiving dental care
   c. likely to experience anaphylactic shock if injected with Novocaine
   d. suffering from an undiagnosed systemic disturbance and should be referred to a physician for consultation
Also, you need to determine the precise nature of the drug allergy, since "novocaine" is often misused as a generic term for any topical anesthetic.

33. A sedative dose of a barbiturate produces all of the following EXCEPT
   a. analgesia
   b. sleepiness
   c. CNS depression
   d. slowed reaction time

34. When a local anesthetic containing epinephrine is mistakenly injected into a blood vessel, the patient could demonstrate
   a. watery saliva
   b. bradycardia
   c. an elevation in blood pressure
   d. contraction in the muscles of mastication
Bradycardia means a slowed heart rate; tachycardia would be the likely outcome of epinephrine in the blood system. This has recently been called into doubt as to whether the therapeutic levels necessary to achieve this effect can be reached; rather, it is now considered a patient sensitivity when such a reaction takes place.

35. A patient who is allergic to penicillin will have an allergic reaction to which of the following drugs?
   a. neomycin
   b. cefalexin
   c. erythromycin
Again, remember to look for any antibiotic ending in a “cillin” or starting with a “cef” or “ceph.”

36. Tachycardia is characterized by
   a. rise in body temperature
   b. decrease in pulse rate
   c. an increase in pulse rate
   d. an increase in blood pressure
The term also used is "positive chronotropic" agent

37. Which medication could result in profuse hemorrhaging that fails to subside during root planing procedures?
   a. steroids
   b. vitamin K
   c. amyl nitrate
   d. dicumarol
   e. thiazide diuretics
Dicumarol is a rarely used anticoagulant agent.  It is in the same class as Coumadin (warfarin).  You may also see the term “coumarins” used, as well as “coumarols.”  With the exception of Coumadin or warfarin (its generic name), these are antiquated terms that again show the nasty nature of these examiners.

38. The drug of choice for immediate treatment of an anaphylactic reaction of a local anesthetic is
   a. morphine
   b. thiopental
   c. epinephrine
   d. pentobarbital
   e. diphenhydramine
Diphenydramine, the generic name for Benadryl, is used in allergic reactions, but is not an “immediate treatment.”  Another choice that may appear in the list could be a steroid, such as hydrocortisone or methylprednisolone.  These also are not for immediate treatment of anaphylaxis, but can be useful follow-up therapies.

39. Which of the following does NOT delay the absorption of a drug from its site of injection?
   a. massage of the injection area (increasing blood flow to the area enhances its absorption)
   b. suspension of the active drug in oil (this is used to create a sustained release, or “depo” injection)
   c. occlusion of the circulation in the area of the injection (this keeps the drug in the area)
   d. incorporation of a vasoconstrictor with the drug to be injected (think epinephrine and lidocaine)
   e. implantation of the drug in a solid pellet form under the skin (again, long term therapies here--think of the 5 year birth control implants popular until just recently)

40. Which of the following is the initial treatment of syncope in a dental office?
   a. administer 100% oxygen
   b. administer aromatic spirits of ammonia
   c. position the head lower than the feet
   d. position the patient's head upright and slightly tilt it
 This is a test to see if you know what the word "syncope" means.  It means the patient is lightheaded and is feeling dizzy.  This patient may be on an anti-hypertensive agent and as a result may be more prone to "orthostatic hypotension," another term that may be used in place of "syncope."

41. A histamine-type reaction can be combated with all of the following compounds EXCEPT
   a. penicillin (antibiotics are of no value in an allergic reaction)
   b. epinephrine (drug of choice in anaphylaxis)
   c. prednisolone (a steroid, useful in follow up)
   d. chlorpheniramine maleate (an antihistamine; you may know it as the OTC Clortrimeton; you could see brompheniramine maleate here, you could see diphenhydramine here, you could see any number of antihistamines)

42. Which of the following should be readily made available to alleviate the symptoms of an acute asthmatic attack
   a. aspirin (nope! Asthmatics are frequently allergic to aspirin, and besides, aspirin won’t be of much use)
   b. atropine (anticholinergics can dry out mucus membranes, leaving mucus plugs--the cause of many an attack--even harder to budge)
   c. propranolol (a beta blocker! That -olol suffix! Beta blockers and asthma don’t mix!)
   d. epinephrine
   e. hydrochlorothiazide (a diuretic! What were they thinking!)

43. Gelatin sponge (Gelfoam) a useful hemostatic agent because it
   a. can be implanted in tissues
   b. acts as a framework for fibrin strands
   c. is eventually reabsorbed
   d. coagulates hemoglobin
It's a pity that Pharmacia-Upjohn no longer offers tours of its plants.  This was one of the highlights--little blue haired lunchroom ladies in hairnets carefully slicing up thin layers of Gelfoam...

44. A two-year old boy contracts an infection that requires antibiotic therapy.  With this information alone, which drug below wouldn't you use?
   a. penicillin
   b. erythromycin
   c. tetracycline
   d. cephalothin
That tooth thing again!  Also, you wouldn't want to use any antibiotic in the tetracycline class, including doxycycline and minocycline.

45. Which of the following factors determines the dose of a drug to be administered?
   a. patient's age
   b. patient's weight
   c. patient's physical condition
   d. route of administration

46. Which of the following are indicated when using a topical anesthetic during scaling and curettage?
   a. preventing frequent rinsing
   b. drying the tissue before application
   c. isolating the area to prevent dilution
   d. allowing the anesthetic to flow interproximally

47. Local anesthetics produce their primary effects by
   a. inhibiting inflammation
   b. blocking nerve conduction
   c. constricting blood vessels
   d. depressing the reticuloactivating system (RAS)
See question 21 for the same thing with different phrasing.

48. The desensitizing agent most often recommended for hypersensitive teeth is
   a. eugenol
   b. zinc oxide
   c. silver nitrate
   d. sodium fluoride paste

49. Which of the following agents is not used in desensitizing root surfaces?
   a. formaldehyde
   b. amyl nitrate
   c. stannous fluoride
   d. acidulated phosphate fluoride
Amyl nitrate hasn’t been in general use for many years.  It was once used as an inhaled (via the nose) alternative to sublingual nitroglycerin to treat angina attacks.

50. Mouthwashes containing commonly used systemic antibiotics make ideal mouthwashes because systemic antibiotics show little tendency toward antibiotic sensitization when used topically.

51. Microbial drug resistance is an example of
 a. attenuation
 b. fluctuation change
 c. autotrophic variation
 d. mutation and selection

52. The most serious side effect of narcotic analgesics is their ability to
 a. produce nausea
 b. depress appetite
 c. increase blood pressure
 d. depress respiratory function
Another version of question 30.

53. If a patient develops tolerance to a drug, that means he has
 a. had an unexpected side effect
 b. obtained maximum response to the drug
 c. need for an increase in dosage to produce the usual effect of the drug

54. A patient suffering an episode of coronary thrombosis several years ago returns for a recall appointment.  Which of the following medications could result in potential hemorrhage problems?
 a. a steroid
 b. dicumarol or warfarin sodium
 c. amyl nitrate
Watch for the terms "courmarin" or brand name "Coumadin" as well.

55. Use of which of the following is most successful as a means of treating plaque?
 a. tetracycline
 b. sulfonamides
 c. chlorhexidine
 d. dextranase

56. When the combined action of two drugs is greater than the sum of their individual actions, it is known as
 a. additive
 b. idiosyncracy
 c. cumulative action
 d. synergy

57. Which of the following is a sympathomimetic drug that can increase blood pressure?
 a. atropine
 b. epinephrine
 c. scopolamine
 d. phenylephrine
Sympathomimetic drugs are those which mimic the sympathetic (fight or flight) system, also known as the “adrenergic” system.  The mediator for this system is epinephrine.  That would be the MAJOR choice.  Phenylephrine is in the nasal product "NeoSynephrine" and MAY cause a slight increase in blood pressure with protracted use.... but that is rare and is not the main thrust of the question posed.

58. Phenobarbital is often used in low doses as an
 a. antiemetic
 b. antihistamine
 c. anticonvulsant
 d. anticholinergic
It can also be used in "high" doses for this purpose as well, although respiratory depression becomes a potential problem. It is also used in low doses as an anxietolytic.

59. Which of the following analgesics raise pain thresholds (meaning, increasing pain tolerance or reducing pain) without impairing alertness or judgement?
 a. salicylates
 b. barbiturates
 c. amphetamines
 d. synthetic opiates

60. Antihistamines work by
 a. chemically inactivating histamine
 b. reversing the effects of histamine
 c. blocking synthesis of histamine
 d. competitively inhibiting histamine at the receptor sites
Antihistamines do nothing to reduce the amounts of histamine already released by the body.

61. When used in patients with hypertension and congestive heart failure, a diuretic is likely to
 a. decrease body weight
 b. increase urinary volume
 c. increase urinary sodium
 d. all of the above
You may also see listed “decrease serum potassium.”  This is the case with most diuretics, especially the thiazide class of diuretics.

62. A histamine type reaction can be combated by administration of any of the following drugs except...
 a. penicillin
 b. epinephrine
 c. prednisolone (or prednisone or methylprednisolone)
 d. diphenhydramine (Benadryl)
Again, a variation of the earlier question.

63. Which of the following is a drug reaction characterized by laryngeal edema, bronchoconstriction, and severe hypotension (shock)?
 a. pruritis (itching)
 b. urticaria (hives)
 c. anaphylaxis or anaphylactic shock
 d. serum sickness

64. Which of the following drugs is used to treat an infection with CANDIDA ALBICANS (a fungal infection):
 a. nystatin (Mycostatin)
 b. gentamicin
 c. tetracycline
 d. penicillin G or V
The only antifungal listed here is nystatin.  The other antibiotics could actually cause a fungal “superinfection.”  In addition to nystatin, you might see the drugs DIFLUCAN (generic name FLUCONAZOLE) , SPORANOX (generic name ITRACONAZOLE), NIZORAL (generic name NIZORAL) or GRISEOFULVIN.  These are other antifungal agents.

65. Which of the following drugs can stimulate gingival hyperplasia (enlargement)?
 a. morphine
 b. quinidine (Duraquin)
 c. pentazocine (Talwin)
 d. hydromorphone (Dilaudid)
 e. phenytoin (Dilantin)

66. Ibuprofen (Motrin) is a useful
 a. CNS stimulant
 b. antidepressant
 c. uriosuric agent
 d. nonsteroidal anti inflammatory agent
So far, ibuprofen (ie Motrin, Advil, et al) has been the only NSAID that the boards have asked about, but be ready for others--especially the new OTCs like ketoprofen (Orudis) and naproxen (Alleve).

67. Which of the following vitamins is synthesized by intestinal flora?
 a. A
 b. B12
 c. E
 d. K
And remember what will happen to vitamin K levels  when you take lots of sulfa drugs...and remember what happens when Vitamin K levels drop.

68. Long term exposure to low doses of nitrous oxide has been shown to increase the incidences of
 a. myeloneuropathy
 b. multiple sclerosis
 c. spontaneous abortion
Make sure those scavengers are in full and proper operation!

69. Fungal infections of the oral cavity can develop with systemic administration of
 a. insulin
 b. antibiotics
 c. antipyretics
 d. corticosteroids (due to immune suppression from steroids)
 e. antihistamines
 f. tricyclic antidepressants (or any drug that can cause xerostomia--dry gums, irritation, and bingo! Thrush!)

70. Aspirin acts as an
 a. obtundent
 b. antipyretic
 c. antiinflammatory
 d. analgesic
 e. anticoagulant
This is an example of how the board has been making the standard "3 As" of aspirin into the new! improved! "4 As" of aspirin.

71. Which of the following types of drugs might appropriately be prescribed by a physician for the treatment of hypertension?
 a. a diuretic (for knocking out excessive fluids)
 b. an analgesic
 c. a sympatholytic (something that works against the sympathetic system. Remember that the sympathetic or adrenergic system can cause increases in blood pressure)
 d. a sympathomimetic (epinephrine)
 e. a ganglionic blocking agent (for the really tough cases)
 f. a beta blocker drug (you could see a drug listed here with an “-olol” suffix)
 g. an ACE inhibitor (these are becoming very popular for hypertension therapy--they usually end in a “-pril” suffix, like “enalapril,” “lisinopril,” etc)

72. Which of the following actions is NOT a potential side effect of epinephrine?
 a. anxiety/nervousness
 b. headache
 c. tachycardia
 d. bronchospasm
 e. bronchodilation

73. Which of the following local anesthetics can be administered intravenously to treat cardiac arrhythmias?
 a. lidocaine
 b. benzocaine
 c. prilocaine
 d. propoxycaine

74. Which of the following BEST represents the reason that nitroglycerin is effective in treating anginal pain?
 a. causes general vascular dilation
 b. possesses central analgesic actions
 c. produces specific coronary vasodilation
 d. increases the efficiency of the myocardium
 e. has a negative chronotropic action on the heart
The general vascular dilation is often so pronounced that the patient may suffer symptoms similar to a migraine headache... but at least the chest pain is gone!  Anginal pain is caused by myocardial ischemia–or in other words, a decrease in the amount of oxygen available to the heart muscle.  The general vasodiilation also pools the blood and reduces the venous return to the heart, reducing the heart’s workload.

75. Fluorides are chiefly eliminated through which of the following?
 a. liver
 b. kidneys
 c. pancreas
 d. small intestine
 e. large intestine
Fluoride obeys the standard rules of ADME characteristics–it is eliminated by the chief organ of excretion, the kidneys

76. After receiving a local anesthetic injection, the patient experiences anaphylaxis.  To treat this condition immediately, you use which drug of choice?
 a. morphine
 b. thiopental
 c. epinephrine
 d. pentobarbital
 e. diphenhydramine
The drug of choice for initial treatment of anaphylaxis is epinephrine, the sympathetic mediator.  Morphine, thiopental, and pentobarbital are all CNS depressants and will do nothing for the reaction.  Diphenhydramine, more commonly known as “Benadryl,” is useful AFTER the initial crisis has passed.

77. The most common adverse reaction to fluoride toxicity is (are):
 a. nausea
 b. diarrhea
 c. abdominal cramping
 d. respiratory distress
 e. cardiac irregularities
Nausea, vomiting, hypersalivation, abdominal pain, and diarrhea are signs of acute fluoride toxicity.  In severe cases, symptoms can include bronchospasm, cardiac arrest, and hypocalcemia.  Apparently the examiners were after the MOST common adverse effect listed above, which would be nausea.

78. A patient reports a serious allergic reaction to Oil of Cloves.  Which of the following cements should be avoided?
 b. glass ionomer
 c. phosphoric acid
 d. ethoxybenzoic acid
 e. Zinc oxide-eugenol
Eugenol is another name for “Oil of Cloves.”  A pharmacognosy quesiton!

79. An excess of which of the following hormones can be associated with an increased sensitivity to epinephrine?
 a. insulin
 b. thyroid
 c. estrogen
 d. parathyroid
 e. testosterone

80. Jane Wallace has been taking aspirin for rheumatoid arthritis for the past two years.  Prior to periodontal debridement, a dental hygienist evaluates the patient’s physical condition and notices large bruises on the patient’s arms.  The patient reports this occurred when she was moving furniture and bumped herself.  Which of the following is the BEST course of action?
 a. refer the patient for hospital dentistry
 b. ask patient to discontinue aspirin and reappoint
 c. request a complete blood workup by the patient’s physician
 d. assess the patient’s gingival tissues for bleeding and proceed as usual
 e. notify the appropriate authorities regarding the possibility of physical abuse
Aspirin increases bleeding time by inhibiting platelet activity.  Bruising is more likely, and gingival tissues might me more prone to bleeding.

81. Current research suggests that antimicrobial agents do each of the following except:
 a. alter the bacterial cell wall
 b. reduce the formation of pellicle
 c. change the metabolism of bacteria
 d. increase the specificity of microbes
 e. decrease the bacteria’s attachment to the tooth surfaces
Increasing the specificity of the microbe would be a means to increase microbial resistance to an antibiotic.

82. Which of the following is the MOST effective antitussive medication?
 a. codeine
 b. Demerol (meperidine)
 c. morphine
 d. methadone
 e. nalorphine
Morphine and the opiate based analgesics all possess some degrees of antitussive (anti-cough) activity; however, codeine is the best choice for this question.

83. Anatomy question time: Which of the following portions of the brain controls respiration?
 a. medulla oblongata
 b. cerebrum
 c. thalamus
 d. cerebellum
 e. spinal cord

84. Which of the following, when taken with antacids, can result in as much as a 50% DECREASE in intestinal absorption of the medication?
 a. codeine
 b. meperidine
 c. acetaminophen
 d. penicillin VK
 e. tetracycline

85. Exopthalmos, nervousness, tachycardia, heat intolerance, and hypertension MOST likely suggest which of the following conditons?
 a. hypothyroidism
 b. hyperthyroidism
 c. hypoparathyroidism
 d. hyperparathyroidism

86. Secretion of intrinisic factor by gastric mucosa is required to absorb
 a. calcium
 b. phosphorus
 c. vitamin D
 d. vitamin K
 e. vitamin B-12

87.  Which of the following parts of an antibody will combine with the antigen?
 a. Fc
 b. Fab
 c. hinge region
 d. disulfide bond
This is the manner that Digifab or Digibind work in treating digoxin (Lanoxin) overdosage.  The amino acid sequence Fab has a lot of diversity for binding in its structure.

88. Which of the following cells synthesize antibodies?
 a. mast
 b. stem
 c. plasma
 d. fibroblasts
 e. macrophages
Plasma cells actively secrete and synthesize antibodies

89. Which of the following hormones is released in response to hyperglycemia?
 a. insulin
 b. estrogen
 c. thyroxine
 d. glucagon
 e. epinephrine

90. Which of the following genera are gram-negative, comma-shaped rods that inhabit the intestinal tract and mouth of humans?
 a. Treponema
 b. actinomyces
 c. camplobacter
 d. staphylococcus
Camplobacter is the only gram-negative microbe listed; when there is too much of camplobacter (as from contaminated chicken), it can result in GI ulceration.

91. During periodontal debridement, the patient in #90 demonstrates sweating, tachycardia, and confusion.  Which of the following is the BEST course of action?
 a. begin CPR
 b. administer oxygen
 c. administer insulin
 d. administer oral carbohydrate
 e. direct the patient to breathe into a paper bag
Hypoglycemia is common among Type I diabetics, especially if stressors are introduced into the a trip to the dentist.  This is another reason why careful patient histories are vital.  Glucose rich fluids are the quickest solution until blood glucose levels can be determined.

92. You detect an acetone or fruity breath on the patient.  What could this represent?
 a. pipe smoking
 b. hyperglycemia
 c. high fat diet
 d. insulin overdose
 e. poor oral hygiene
The breakdown of fats for energy in the diabetic can result in ketoacidosis, with the resulting by product of acetone, excreted via the lungs.

93. Which of the following substances can contribute to a patient’s stomach ulcers?
 a. cimetidine (Tagamet)
 b. aspirin
 c. cigarettes
 d. thyroid medication
 e. oral contraceptives
This is somewhat arguable, with cigarette smokers having an increased incidence in GI ulceration, but aspirin would be the MOST likely cause with its history of blood loss with every dose taken.

94. Methotrexate, used for severe forms of arthritis, or for chemotherapy for cancer, can be responsible for which of the following oral conditions?
 a. edema
 b. recession
 c. ulceration
 d. sensitivity
 e. gingival hyperplasia

95. Xerostomia with a dry pebbly appearance of the palate and gums can be caused by
 a. sulindac (Clinoril)
 b. metoprolol (Lopressor)
 c. amitriptyline (Elavil)
 d. beclomethasone (Beconase)
Amitriptyline (Elavil), a tri-cyclic antidepressant, possesses anti-cholinergic activity.  A classic anti-cholinergic effect is xerostomia.

96. Which of the following is MOST likely to cause an increase in bleeding during periodontal debridement?
 a. sulindac (Clinoril)
 b. metoprolol (Lopressor)
 c. amitriptyline (Elavil)
 d. beclomethasone (Beconase)
 e. diphenhydramine (Benadryl)
Nearly any non-steroidal anti-inflammatory drug (NSAID) can cause an increase in bleeding.  This time, the examiners chose a relatively obscure and not-often used NSAID.  The list is HUGE, as you may recall.

97. Lichen planus can be treated topically by which of the following medications?
 a. tetracycline
 b. rifampin (Rifadin)
 c. metronidazole (Flagyl)
 d. nifedipine (Procardia)
 e. dexamethasone (Decadron)
Decadron is used primarily for its anti-inflammatory activity.  Technically, it is a glucocorticoid, making it a STEROIDAL anti-inflammatory

98. Which oral condition could result from the administration of a glucocorticoid?
 a. candida albicans
 b. linea alba
 c. lichen planus
 d. brown hairy tongue
 e. gingival inflammation
The immunosuppression possible from glucocorticoid (steroid) administration could result in a “hairy tongue.”  I’m not sure if other shades are available.  Check with your Clairol representative.

This is a general sampling of some very simple questions.  Many more can be derived from the same material.  This is only to be considered a general guide and not a definitive listing; this section shall be enlarged as time and space permit.

Contact and instructor: Jim Middleton
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