WorksheetsPharmacology Chapters 1-11 Midterm Review PART 2
Total questions: 220
Worksheet time: 4hrs 40mins
Enkephalins, endorphins, and dynorphins probably function as _____, although their exact function has not been elucidated.
prostaglandins
neurotransmitters
sedative-hypnotics
enzymes
Beta-endorphin is a naturally occurring peptide with opioid-like action. It possesses analgesic action but has no addiction potential.
Both statements are true.
Both statements are false.
The first statement is true; the second statement is false.
The first statement is false; the second statement is true.
Morphine has its most potent action on the _____ class of opioid receptors, and pentazocine has its most potent action on the _____ class of opioid receptors.
mu; kappa
mu; delta
sigma; delta
kappa; mu
delta; kappa
Oral bioavailability of opioids is primarily limited by
incomplete absorption.
first-pass metabolism.
side effects of nausea and vomiting.
enterohepatic circulation.
rapid renal excretion.
Which of the following statements is true concerning the pharmacokinetics of opioid analgesics?
Absorption may occur through mucous membranes of the nose but is not possible through intact skin.
The opioids are bound to plasma proteins to varying degrees and distributed throughout the body.
Given orally, opioids have vastly different durations of action for analgesia, ranging from 1 to almost 12 hours.
Metabolized opioids are excreted in urine; however, the unchanged drug is not.
What do aspirin, acetaminophen, ibuprofen, and codeine have in common?
They are all antiinflammatory.
They are all analgesic.
They all inhibit platelet aggregation.
They are all antipyretic.
Which opioid is commonly used as an antitussive?
Propoxyphene
Codeine
Diphenoxylate
Pentazocine
_____ is usually the cause of death with an overdose of opioid analgesics.
Tachycardia
Respiratory depression
Electrolyte imbalance
Cellular necrosis
Which one of the following conditions can be managed or treated with opioids?
Diarrhea
Depression
Infections
Hypertension
Which of the following conditions is an adverse reaction to the opioids?
Diarrhea
Miosis
CNS excitation
Hepatotoxicity
The following are conditions for which opioid analgesics should be used with extreme caution or not at all except which one?
Head injury
Nausea
Respiratory disease
Hypertension
Near-term pregnancy
A patient presents with itching and urticaria after codeine administration. This response most likely represents a
pharmacologic action of codeine.
hypersensitivity reaction to codeine.
placebo effect from receiving codeine.
reaction unrelated to codeine administration.
Which is an advantage of the nonsteroidal antiinflammatory drugs (NSAIDs) over the opioids for the management of dental pain in an opioid addict?
They are not addictive.
They are antitussive.
They are all useful if the patient is pregnant.
They cause less fluid retention (edema).
Tolerance occurs to the following effects of the opioids except which one?
Miosis
Analgesia
Respiratory depression
Nausea
Histamine release
Which is the major symptom of opioid overdose?
Miosis
Mydriasis
Urticaria
Respiratory depression
Which of the following drugs can be used to treat heroin addiction?
Hydromorphone
Methadone
Naltrexone
Both A and C
Both B and C
Which of the following opioids is a metabolite of oxycodone that is three times more potent than oral morphine?
Codeine
Hydrocodone
Hydromorphone
Oxymorphone
Which of the following products is the most commonly used opioid in dentistry?
Hydrocodone (Vicodin)
Morphine
Codeine
Oxymorphone
Tylenol #3 contains _____ mg of codeine.
7.5
15
30
60
Which of the following opioids is used primarily in the treatment of opioid addiction?
Propoxyphene
Meperidine
Hydromorphone
Methadone
Which of the following agents is a potent, short-acting, parenterally administered opioid that is commonly used during general anesthesia?
Dynorphin
Hydromorphone
Nalmefene
Fentanyl
Tramadol
Which opioid analgesic is most likely to produce dysphoria?
Meperidine
Codeine
Pentazocine
Oxycodone
Hydrocodone
How does adding naloxone to pentazocine reduce the addiction potential of orally administered pentazocine?
Naloxone is an opioid agonist that is effective orally but not parenterally.
Naloxone is an opioid agonist that is effective parenterally but not orally.
Naloxone is an opioid antagonist that is effective orally but not parenterally.
Naloxone is an opioid antagonist that is effective parenterally but not orally.
Naloxone is a nonsteroidal antiinflammatory.
Which of the following agents is the only mixed opioid available for oral use?
Dezocine
Nalbuphine
Pentazocine
Butorphanol
Which of the following choices is the drug of choice to treat a patient who has taken an overdose of an opioid?
2-pralidoxime
Naloxone
N-acetylcysteine
Activated charcoal
Methadone
Tapentadol is an oral opioid receptor _____ and a _____ reuptake inhibitor.
agonist; norepinephrine
agonist; acetylcholine
antagonist; norepinephrine
antagonist; acetylcholine
The following statements are true of tramadol except which one?
It binds to mu opioid receptors.
It inhibits reuptake of serotonin and norepinephrine.
It modifies ascending pain pathways.
It causes mydriasis.
Its analgesic efficacy is equivalent to that of codeine.
Dentists prescribed about _____% of all immediate-release opioids prescribed in the United States.
2
12
22
32
42
Which of the following types of pain medications is the best choice for management of most dental pain?
Antidepressants
Nonsteroidal antiinflammatory drugs (NSAIDs)
Aspirin
Acetaminophen
Which opioid analgesic is a Schedule II controlled substance?
Pentazocine (in Talwin HX)
Hydrocodone (in Vicodin, Lortab, Lorcet)
Codeine (in Tylenol #3, Empirin #3)
Dihydrocodeine (in Synalgos-DC)
Codeine may cause nausea and vomiting by activating the chemoreceptor trigger zone in the
thalamus
hypothalamus
medulla
frontal lobe.
Which opioid agonist provides a strength of analgesic action between codeine and morphine?
Acetaminophen
Aspirin
Oxycodone (in Percodan, Percocet)
Dihydrocodone (in Synalgos-DC)
Children should not receive codeine after a tonsillectomy due to an increased risk for
central nervous system depression.
respiratory depression.
postural hypotension.
constipation
What is the primary advantage of oxycodone ER over previous formulations?
It is formulated to help deter substance abuse.
It is not a controlled substance.
It is a liquid for administration to patients who have difficulty swallowing.
It is a Schedule III narcotic, so it is easier to prescribe.
Each of the following contains naltrexone except one. Which is the exception?
Embeda
Targiniq ER
Xtampza
Troxyca
Which is true regarding naloxone access laws?
Federal law restricts the use of naloxone to emergency medical services (EMS) teams.
The law requires criminal prosecution for persons who need to use of naloxone.
Many states have passed laws making naloxone available to first responders, family members, and close friends of persons taking or abusing opioids.
Naloxone will potentiate effects of a narcotic and should be used strictly to prevent withdrawal.
Morphine is stronger than oxycodone.
True
False
Codeine activates the chemoreceptor trigger zone.
True
False
Combining an opioid with a nonopioid analgesic produces an additive analgesic effect with fewer adverse reactions.
True
False
A patient who feels nauseated after taking codeine is allergic to it.
True
False
Opioids are the first choice for the treatment of chronic pain, such as temporomandibular joint and muscle disorders.
True
False
Dental caries is caused by an infection with
Porphyromonas gingivalis.
Eikenella corrodens.
Streptococcus mutans.
Fusobacterium.
Which of the following choices is the dental hygienist’s biggest dental problem in the adult patient?
Caries
Periodontal disease
Localized dental infection
Systemic dental infection
If an infection is just beginning, the organisms most likely to be present are
gram-positive cocci.
gram-negative cocci.
gram-positive anaerobes.
gram-negative anaerobes.
Which of the following agents is the drug of choice for an early dental infection unless the patient is allergic to it?
Erythromycin
Clindamycin
Penicillin
Metronidazole
Which of the following antibiotics is associated with pseudomembranous colitis?
Penicillin
Erythromycin
Clindamycin
Metronidazole
An _____ agent is a substance that destroys or suppresses the growth or multiplication of bacteria.
antiinfective
antibacterial
antibiotic
antimicrobial
Which of the following antiinfective agents is bacteriostatic, but may be bactericidal at higher dose levels?
Cephalosporins
Metronidazole
Penicillins
Erythromycin
Vancomycin
The disease-producing power of the microorganism is called
resistance
superinfection.
infection
virulence
Superinfection is more often caused by _____-spectrum antibiotics and increases when taken for a _____ time period.
narrow; shorter
narrow; longer
broad; shorter
broad; longer
The possibility of superinfection can be minimized by use of the _____ specific antiinfective agent, the _____ effective course of therapy, and adequate doses.
least; shortest
least; longest
most; shortest
most; longest
Which of the following statements is true concerning infection and host resistance?
Host resistance should be considered as having both local and systemic components.
If a patient has diabetes mellitus it can reduce the resistance to an infection.
Drugs such as steroids are capable of enhancing a patient’s immune response.
Both A and B.
Both B and C.
The misuse of antibiotics has contributed to antibiotic resistance. The solution to reducing the incidence of antibiotic-resistant bacteria is to write more prescriptions for antibiotics.
Both statements are true.
Both statements are false.
The first statement is true, the second is false.
The first statement is false, the second is true.
Which of the following statements is true concerning antibiotic resistance?
Natural resistance occurs when an organism that was previously sensitive to an antimicrobial agent develops resistance.
An increase in the use of an antibiotic in a given population decreases the proportion of resistant organisms in that population.
Bacterial resistance can occur by the transfer of deoxyribonucleic acid (DNA) genetic material from one organism to another.
The transfer of genetic material from one organism to another may only occur among organism of the same species.
Which of the following periodontal diseases is usually not treated with antimicrobials?
Periodontal abscess
Localized juvenile periodontitis
Adult periodontitis
Rapidly advancing periodontitis
Superinfection describes a(n)
nonsystemic, superficial infection.
exaggerated infection caused by treating a resistant pathogen.
opportunistic infection that arises as a consequence of treatment.
infection by multiple pathogens.
Antiinfective agents can potentiate the effect of oral anticoagulants by interfering with the production of vitamin
A
D
E
K
_____ has the highest incidence of gastrointestinal complaints of any of the antibiotics.
Penicillin
Erythromycin
Clindamycin
Cephalosporin
Which of the following antibiotics are not associated with any teratogenicity and are often used in pregnant women?
Penicillin
Tetracyclines
Erythromycin
Metronidazole
Both A and C
Which of the following statements is true concerning the pharmacokinetics of penicillin?
Penicillin may be administered orally, parenterally, or topically.
Penicillin G is better absorbed orally than penicillin V; thus, penicillin G is used for administration of oral penicillin.
Penicillin V and amoxicillin can be taken without regard to meals.
Penicillin does not cross the placenta and will not appear in breast milk.
Penicillinase inactivates the penicillin moiety by
sublimation
desiccation
cleaving the β-lactam ring.
cleaving the S-containing thiazolidine ring.
Which of the following agents allows the use of amoxicillin to treat penicillinase-producing organisms?
Clavulanic acid
Divalent cations
Corticosteroids
Disulfiram
Some studies indicate that _____% of patients receiving penicillin will have an anaphylactic reaction.
0.05 to 0.10
0.5 to 1
5 to 10
20 to 25
Which of the following statements is true regarding penicillin allergy?
Allergic reactions with oral penicillin are more common than with parenteral penicillin.
Anaphylactic reactions are more frequent in patients pretreated with β-blockers and subsequently given oral penicillin.
The treatment of anaphylaxis caused by penicillin is the immediate administration of corticosteroids.
Estimates indicate that 10,000 to 30,000 deaths occur annually in the United States because of an allergic reaction to penicillin.
Which of the following salts of penicillin G produces the most rapid and highest blood level?
Potassium salt given intravenously
Potassium salt given intramuscularly
Benzathine salt given intramuscularly
Procaine salt intramuscularly
The usual adult dose of penicillin V for treatment of an infection is
250 mg twice a day (bid).
250 mg four times a day (qid).
250 to 500 mg twice a day (bid).
250 to 500 mg four times a day (qid).
Which of the following statements is true regarding penicillinase-resistant penicillins?
Penicillinase-resistant penicillins should be reserved for use against only penicillinase-producing staphylococci.
Penicillinase-resistant penicillins are more effective against penicillin G-sensitive organisms when compared with penicillin G.
Penicillinase-resistant penicillins produce fewer side effects when compared with penicillin G.
Patients allergic to penicillin are not also allergic to the penicillinase-resistant penicillins.
Which drug should be used before oral prophylaxis prior to dental treatment for a patient who has rheumatic heart disease with no known drug allergies?
Amoxicillin
Tetracycline
Clindamycin
Erythromycin
None of the above
_____ is the drug of choice for prophylaxis to prevent bacterial endocarditis before a dental procedure.
Penicillin G
Penicillin V
Ampicillin
Amoxicillin
Which of the following antibiotics is available mixed with clavulanic acid?
Ampicillin
Amoxicillin
Carbenicillin
Azithromycin
Clavulanic acid is
a bacteriostatic antibiotic.
a bactericidal antibiotic.
a β-lactamase inhibitor.
Both A and C.
Both B and C.
Clavulanic acid is used to fight infections with which of the following resistance mechanisms?
Decreased permeability to the agent
Production of drug-inactivating enzymes
Alteration in the site of action
Any of the above
Which of the following statements is true of the cephalosporins?
They are active against gram-positive but not gram-negative organisms.
Those available for oral use are susceptible to penicillinase.
They are bacteriostatic.
Their mechanism of action is inhibition of cell wall synthesis.
Large doses of cephalosporins often produce a Coombs reaction, which means
high blood pressure is exacerbated.
the immune mechanism is attacking the patient’s own red blood cells.
degeneration of neural glial cells occurs.
nephritis of the kidneys occurs.
A cephalosporin would be most closely related to which of the following agents?
Penicillin VK
Clarithromycin
Ciprofloxacin
Doxycycline
Clindamycin
Which of these agents do not inhibit bacterial cell-wall synthesis?
Vancomycin
Erythromycin
Penicillin G
Cefazolin
Which of the following statements is true concerning the pharmacokinetics of erythromycin?
Erythromycin is broken down in gastric fluid and absorbed through the stomach wall.
Erythromycin is not available in a topical preparation because of allergenicity.
Erythromycin is available in oral but not injectable forms.
Erythromycin should be administered 2 hours before or 2 hours after meals.
Which of the following conditions is the most common adverse reaction from the administration of erythromycin?
Anaphylaxis
Skin rash
Gastrointestinal effects
Miosis
Which of the following agents is the drug of first choice against infections caused by aerobic microorganisms in penicillin-allergic patients?
Metronidazole
Erythromycin
Doxycycline
Clindamycin
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.
Which of the following statements is true of the tetracyclines?
They are bactericidal.
Tetracyclines interfere with the synthesis of bacterial protein by binding at the 50S subunit of bacterial ribosomes.
In the study of sensitivity or organisms isolated from dental infections, one-fifth to two-fifths of Staphylococcus aureus (S. aureus) were found to be resistant to tetracycline.
Tetracyclines are not prone to enterohepatic circulation.
Tetracyclines should not be used in children younger than _____ years of age.
6
9
12
15
_____ can cause black pigmentation of mandibular and maxillary alveolar bone and the hard palate.
Penicillin V
Erythromycin
Minocycline
Clindamycin
Which of the following antibiotics is associated with photosensitivity?
Erythromycin
Tetracycline
Metronidazole
Aminoglycosides (e.g., streptomycin)
Which of the following statements is true concerning clindamycin?
Clindamycin is distributed throughout most body tissues, including bone.
Cross-resistance between clindamycin and erythromycin is often noted.
The indications for treatment with clindamycin are limited to a number of infections caused by aerobic organisms.
Both A and B are true.
Both B and C are true.
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
Penicillin VK
Metronidazole
Which of the following is the most common adverse reaction to administration of metronidazole?
Central nervous system effects
Gastrointestinal effects
Renal toxicity
Oral effects
Administration of metronidazole for dental infections during pregnancy is
contraindicated.
permitted only during the second trimester.
permitted during the last half of pregnancy.
permitted without restriction.
_____ is associated with a severe drug interaction with alcohol.
Erythromycin
Tetracycline
Metronidazole
Aminoglycosides (e.g., streptomycin)
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.
An erythematous rash on the face and upper body known as red man syndrome is associated with use of which of the following antimicrobial agents?
Augmentin
Metronidazole
Vancomycin
Chloramphenicol
Aminoglycosides
are bacteriostatic.
are used primarily to treat aerobic gram-negative infections when other agents are ineffective.
are indicated for stage 1 infections.
inhibit cell wall synthesis.
Which of the following antimicrobial agents is associated with ototoxicity?
Vancomycin
Aminoglycosides
Nitrofurantoin
Quinolones
Oral-cavity infections are generally understood to advance through three stages. The three stages are (1) mixed aerobic and anaerobic infection, (2) aerobic infection, and (3) anaerobic infection. In what order do these stages occur?
1, 2, 3
1, 3, 2
2, 1, 3
3, 1, 2
3, 2, 1
Which of the following antibiotics would be the best choice for treatment of an acute abscess or cellulitis in a patient who is not allergic to penicillin?
Metronidazole
Erythromycin
Amoxicillin
Clindamycin
When a patient with a stage 1 infection is allergic to penicillin V, the best alternative would be
penicillin G or ampicillin.
erythromycin ethylsuccinate or clindamycin.
tetracycline or metronidazole.
vancomycin
Which of the following antibiotics would be the best choice to attack the anaerobes in a stage 2 infection?
Clindamycin or metronidazole
Ampicillin or amoxicillin
Amoxicillin or augmentin
Ciprofloxacin
The sulfonamides competitively inhibit the bacterial enzyme that incorporates para-aminobenzoic acid (PABA) into an immediate precursor of
biotin
thiamine
folic acid.
riboflavin
The most common adverse reaction to the sulfonamides is
liver damage.
suppressed renal function.
an allergic skin reaction.
blood dyscrasias.
Which of the following agents is bacteriostatic in action?
Amoxicillin
Streptomycin
Vancomycin
Trimethoprim
Which of the following statements is true regarding nitrofurantoin?
Nitrofurantoin has a narrow spectrum of action against anaerobic bacteria.
Nitrofurantoin is bactericidal.
Nitrofurantoin is associated with red man syndrome.
Nitrofurantoin can cause a brownish discoloration of urine.
_____ are the first orally active agents against certain Pseudomonas species.
Aminoglycosides
Sulfonamides
Quinolones
Tetracyclines
Quinolones
must be administered parenterally and cannot be taken orally.
have no use in dentistry.
are bactericidal against most gram-negative organisms and many gram-positive organisms.
have cross-resistance with many other antimicrobial agents.
Which agent inhibits DNA gyrase?
Penicillin G
Erythromycin
Metronidazole
Ciprofloxacin
Unlike other antiinfective agents, an additive action may result when _____ is combined with other antimicrobial agents.
vancomycin
chloramphenicol
nitrofurantoin
ciprofloxacin
The drug whose future use may include organisms found in periodontal disease is
ofloxacin
sulfamethoxazole
macrodantin
streptomycin.
Rupture of the Achilles tendon is associated with the use of
tetracyclines
quinolones.
rifampin
mupirocin.
Which of the following combinations of three drugs are administered concurrently in active cases of pulmonary tuberculosis (TB)?
Pyrazinamide (PZA), rifapentine, and Rifater
Isoniazid (INH), rifampin, and pyrazinamide
Ethambutol, isoniazid (INH), and Rifater
Rifampin, PZA, and streptomycin
If a person with active TB seeks oral health care
use standard precautions and treat him or her just as everyone else is treated.
schedule him or her as the last patient of the day.
contact that person’s physician and delay health care until the disease is no longer in the active state.
refer the patient to a hospital with a dental suite for treatment.
Antibiotic prophylaxis to prevent endocarditis is considered reasonable for which of the following dental procedures?
Oral radiographs
Routine anesthetic injections through uninfected tissues
Routine prophylaxis
Shedding of deciduous teeth
Infective endocarditis prophylaxis with an antiinfective is indicated for patients who have had
coronary artery bypass surgery.
a prosthetic heart valve.
functional murmur.
a cardiac pacemaker.
The standard antibiotic drug regimen prior to dental procedures requiring immunoprophylaxis in a patient with no allergies to penicillin or amoxicillin is _____ g of amoxicillin _____ hour(s) before the procedure.
1; 1
1; 2
2; 1
2; 2
If a patient requires premedication with antibiotics before a dental procedure and he or she is allergic to penicillins or ampicillin but can take oral medication, the drug of choice is
tetracycline.
metronidazole
cephalexin
amoxicillin
Both the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) recommend that which type of patients with joint replacements should receive antibiotic prophylaxis before dental procedures that can lead to bacteremia?
All patients for the rest of their lives
All patients for 2 years
Patients with weakened immune systems
No patients
Penicillin kills bacteria by attacking the
50S subunit of the ribosome.
30S subunit of the ribosome.
cell wall.
a subunit of DNA gyrase.
Which antibiotic is useful in the treatment of many anaerobic periodontal infections?
Metronidazole
Penicillin VK
Erythromycin
Azithromycin
The American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) recommend for dentists to prescribe antibiotic prophylaxis for patients with joint replacements. The American Dental Association Council on Scientific Affairs demonstrated the benefits of antibiotic prophylaxis outweigh potential harm.
Both statements are true.
Both statements are false.
The first statement is true, the second statement is false.
The first statement is false, the second statement is true.
Infective endocarditis is more likely to occur from bacteria entering the bloodstream as a result of daily activities than from a dental procedure. There is no evidence that antibiotic prophylaxis prior to a dental procedure will prevent infective endocarditis in those at risk for developing it.
Both statements are true.
Both statements are false.
The first statement is true, the second statement is false.
The first statement is false, the second statement is true.
An allergic reaction to penicillin will most likely appear as
anaphylaxis
a rash.
delayed serum sickness.
hemolytic anemia.
interstitial nephritis.
Which type of penicillin is most likely to be administered to a patient in the dental office?
Penicillin G
Penicillin V
Penicillinase-resistant penicillin
Ampicillin
Ticarcillin
Which is a penicillinase-resistant penicillin?
Ampicillin
Amoxicillin
Cloxacillin
Ticarcillin
Piperacillin
The frequency of cross-hypersensitivity between penicillin and cephalosporins is about __%.
10
20
30
40
Which is a macrolide antibiotic?
Azithromycin
Cefixime
Doxycycline
Ciprofloxacin
Neomycin
Tetracycline antibiotics are associated with development of ______ in patients with dentures?
medication related osteonecrosis of the jaw (MRONJ)
bone resorption
osteogenic sarcoma
Kaposi sarcoma
candidiasis
Which antibiotic is utilized particularly due to effectiveness against anaerobic bacteria?
Penicillin
Erythromycin
Metronidazole
Clindamycin
Tetracycline
Which of the following statements are true concerning antibiotic-resistant infections? (Select all that apply.)
More than 10% of patients with antibiotic-resistant infections in the United States each year will die from their infection.
Natural resistance occurs when an organism that was previously sensitive to an antimicrobial agent develops resistance.
Microbial organisms have the ability to transfer genetic material from one to another so that an organism may become resistant to an antibiotic without ever having been exposed to the antibiotic.
The development of new antibiotics has greatly reduced the number of antibiotic-resistant bacteria over the past 10 years.
Which of the following groups of penicillins are most commonly used in dentistry? (Select all that apply.)
Penicillin G and V
Penicillinase-resistant penicillins
Amoxicillin
Extended-spectrum penicillins
Which of the following are true of a stage 3 infection? (Select all that apply.)
Most patients will require the use of antibiotics.
The infection contains both gram-positive and gram-negative organisms.
Clindamycin and metronidazole are useful antibiotics.
The organisms have coalesced into one area.
Which of the following are true about sulfamethoxazole (SMX) and trimethoprim (TMP)? (Select all that apply.)
They are bactericidal.
They act by sequential inhibition of folic acid synthesis.
They are used to treat urinary tract infections (UTIs).
They are often used to treat refractory periodontitis.
Prophylactic antibiotics are recommended for which procedure? (Select all that apply.)
Dental x-ray images
Routine injections of dental anesthetic
Dental prophylaxis
Placement of orthodontic brackets
Periodontal probing
Antiinfectives are not needed in oral cavity infections if drainage of the infected area can be established.
True
False
Metronidazole has antiinflammatory activity.
True
False
The mechanism of action of nystatin involves binding to the
30S ribosomal subunit of bacterial rRNA.
50S ribosomal subunit of bacterial rRNA.
sterols in the fungal cell membrane.
enzymes in the nucleus of molds.
Which of the following agents has poor oral absorption?
Nystatin
Itraconazole
Terbinafine
Griseofulvin
Nystatin is used for both the treatment and the prevention of _____ in susceptible cases.
blastomycosis
histoplasmosis
oral candidiasis
tinea
The main advantage of nystatin pastilles over the aqueous suspension is that
the pastilles do not contain sugar like the suspension.
15 minutes are required for the lozenge to dissolve in the mouth.
the pastilles have twice rather than four times dosing a day as in the suspension, improving compliance.
the pastilles are swallowed, whereas the suspension should be spit out.
Which of the following statements is true concerning clotrimazole?
It is available in the form of an aqueous suspension for oral use.
It is the only antifungal for oral use that does not contain sugar.
Clotrimazole has been reported to produce elevated liver enzyme levels in approximately 85% of patients.
Systemic clotrimazole should not be administered to a pregnant woman.
The most frequent adverse reaction(s) associated with ketoconazole is (are)
diarrhea
nausea and vomiting.
xerostomia.
premature ventricular contractions.
The most serious adverse reaction associated with ketoconazole is
tachycardia
hepatotoxicity.
hypotension
achlorhydria.
Which of the following is not an imidazole?
Clotrimazole
Ketoconazole
Fluconazole
Nystatin
The following statements are true of ketoconazole except which one?
Ketoconazole is an imidazole that is used in dentistry.
Hepatotoxicity subsequent to the administration of ketoconazole is thought to be an idiosyncratic reaction.
Ketoconazole has a masculinizing effect by increasing testosterone levels.
At least 2 hours should pass between the ingestion of an antacid and the administration of ketoconazole.
Ketoconazole is available as a cream.
Ketoconazole should not be used with _____ because it could reduce the absorption of ketoconazole.
penicillin V
metronidazole
anticholinergic agents
acyclovir
Thrush is
an allergic reaction.
an idiosyncrasy.
oropharyngeal candidiasis.
a serious systemic fungal infection.
All of the following are antifungal agents that are useful in dentistry except
miconazole
docosanol.
clotrimazole.
ketoconazole
Which of the following is used prophylactically against candidiasis in immunocompromised patients or for the treatment of candidal infections that do not respond to other agents?
Nystatin
Ketoconazole
Fluconazole
Clotrimazole
Which of the following is the usual adult dose of ketoconazole for the treatment of Candida species?
5 ml of aqueous suspension (100,000 U/ml) four times daily
200 to 400 mg orally daily
One pastille four to five times daily
One troche one to five times daily
Which of the following antifungal agents is produced by Streptomyces noursei?
Fluconazole
Clotrimazole
Ketoconazole
Nystatin
Which of the following is a synthetic antifungal agent available in the form of a slowly dissolving, sugar-containing lozenge for oral use?
Clotrimazole
Ketoconazole
Fluconazole
Nystatin
Viruses are difficult to treat because they cooperate with the host’s cells.
Both statements are true.
Both statements are false.
The first statement is true, the second is false.
The first statement is false, the second is true.
Which of the following is true of acyclovir?
It works by inhibiting replication of deoxyribonucleic acid (DNA).
It should be taken on an empty stomach because food affects the drug’s absorption.
The antiviral action of acyclovir includes herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2), but it is not effective against varicella-zoster virus or Epstein-Barr virus.
The most common adverse effects associated with oral acyclovir are anorexia and a funny taste in the mouth.
Topical acyclovir
will prevent the transmission of herpes labialis.
has been effective in the treatment of herpes labialis infections in nonimmunocompromised patients.
does not prevent the recurrence of herpes labialis.
Both A and B are correct.
Both B and C are correct.
Which dose form of acyclovir has been effective for the treatment of herpes labialis in an immunocompromised person?
Oral
Topical
Pastille
Troche
Docosanol 10% has been shown to decrease healing time by about _____ in patients with recurrent orolabial herpes when started within 12 hours of the appearance of prodromal symptoms.
one half day
2 days
5 days
7 to 10 days
A patient reports a sudden onset of illness with a fever of 102 Fahrenheit, chills, a dry cough, body aches, and a sore throat. They deny the loss of sense of taste or smell. The symptoms indicate it most likely is
environmental allergies.
seasonal influenza or COVID-19.
wheat gluten allergy.
the common cold.
Which is a polymerase acidic (PA) endonuclease inhibitor indicated for treatment of acute, uncomplicated symptoms of influenza in persons older than 12 years of age?
Oseltamivir phosphate (Tamiflu)
Zanamivir (Relenza)
Baloxavir marboxil (Xofluza)
Molnupiravir
__________ is a monoclonal antibody drug that may be used to treat COVID-19.
Oseltamivir phosphate (Tamiflu)
Casirivimab plus imdevimab (REGEN-COV)
Molnupiravir
Baloxavir marboxil (Xofluza)
Which of the following statements is true of zidovudine (AZT, Retrovir)?
It prevents cells containing human immunodeficiency virus (HIV) from replicating.
The toxicity of zidovudine is related to bone marrow depression.
It has no effect on the number and frequency of opportunistic infections.
Both A and B are true.
Both B and C are true.
Which of the following agents is a nonnucleoside reverse transcriptase inhibitor used to treat HIV infection?
Saquinavir
Nevirapine
Zidovudine
Raltegravir
HIV-2 is only transmitted
from a woman to her child while the child is in the womb.
via sexual intercourse.
by intravenous substance abuse.
by sharing of bodily fluids.
Which of the following groups of drugs used to treat HIV can interfere with the action of the HIV-infected cells?
Nucleoside reverse transcriptase inhibitors
Nonnucleoside reverse transcriptase inhibitors
Protease inhibitors
Both A and B
Both B and C
Which of the following classes of drugs used to treat human immunodeficiency virus (HIV) block the progression from HIV infection to AIDS by preventing the passage of the virus across the human cell membrane?
Integrase inhibitor
Nonnucleoside reverse transcriptase inhibitor
Nucleoside/nucleotide reverse transcriptase inhibitor
Entry inhibitor
Protease inhibitor
What is integrase in the context of infection with human immunodeficiency virus?
It measures the CD4 lymphocyte count to determine the health of the patient.
It is a viral enzyme that inserts the viral genome into the DNA of the host cell.
It prevents the cleavage of viral protein precursors needed to generate functional structural proteins in and modulation of reverse transcriptase activity.
It terminates the synthesis of viral DNA.
Which of the following two types of hepatitis account for almost two-thirds of all cases of hepatitis?
A and B
A and C
B and C
C and D
A person with hepatitis _____ is most likely to develop chronic hepatitis.
A
B
C
D
Which antifungal agent for oral candidiasis is available as an aqueous suspension?
Clotrimazole
Ketoconazole
Fluconazole
Nystatin
Most antiviral agents are either purine or pyrimidine analogues that inhibit synthesis of
tRNA
mRNA
rRNA
DNA
Which type of herpes virus is transmitted to humans primarily by a monkey bite?
Herpes simplex type 1
Herpes simplex type 2
Herpes B virus
Varicella-zoster
Topical acyclovir will prevent transmission of herpes labialis. Topical acyclovir will prevent recurrence of herpes labialis.
Both statements are true.
Both statements are false.
The first statement is true, the second is false.
The first statement false, the second is true.
Each of the following is a consequence of the interaction of interferon with cells except one. Which is the exception?
Alteration of the state of cellular differentiation
Stimulation of oncogene expression
Induction of gene transcription
Inhibition of cellular growth
A dental hygienist should receive postexposure prophylaxis within __ hours following exposure to the HIV virus?
24
48
72
96
Zero hours because the medication must be adminstered prior to exposure
Why would a patient ever take a vaginal tablet of nystatin orally?
The vaginal tablet is dosed once per day, which is less frequently than the oral pastille.
The vaginal tablet does not contain sugar.
The vaginal tablet does not require a prescription.
The vaginal tablet has better flavor than the oral tablet.
Only if they did not read the directions and did not know any better.
Oral candidiasis infections are often treatable with oral antifungal lozenges and rinses.
True
False
Most antiviral agents are protein synthesis inhibitors.
True
False
No acyclovir products are approved for the treatment of recurrent herpes labialis in the immunocompetent patient.
True
False
Topical acyclovir can prevent the recurrence of herpes labialis.
True
False
All currently available interferons are parenteral.
True
False
Antianxiety agents are most commonly administered orally because the effective dose of a particular antianxiety agent is very predictable.
Both statements are true.
Both statements are false.
The first statement is true, the second is false.
The first statement is false, the second is true.
Which of the following agents are the most commonly prescribed type of antianxiety drugs?
Nonbenzodiazepine-nonbarbiturate sedative-hypnotics
Nonbenzodiazepine-nonbarbiturate receptor agonists
Benzodiazepines
Barbiturates
Which is the primary adverse reaction associated with the use of benzodiazepines for conscious sedation?
Anterograde amnesia
Retrograde amnesia
Spiking blood pressure
Respiratory depression
Which benzodiazepine is preferred for use in elderly patients?
Benzodiazepines that require phase I metabolism and not phase II metabolism
Benzodiazepines that require phase II metabolism and not phase I metabolism
Benzodiazepines that require both phase I and phase II metabolism
Benzodiazepines that require neither phase I nor phase II metabolism
Some benzodiazepines are transformed in the body to active metabolites. The active metabolites are formed by phase II drug metabolism.
Both statements are true.
Both statements are false.
The first statement is true, the second is false.
The first statement is false, the second is true.
Benzodiazepines enhance or facilitate the action of the neurotransmitter
acetylcholine.
epinephrine.
γ-aminobutyric acid (GABA).
serotonin
The clinical effects of benzodiazepines in humans are _____ at lower doses.
drowsiness and sleep
drowsiness and anxiety reduction
anxiety reduction and panic reduction
anxiety reduction and sleep
Benzodiazepines are indicated for epilepsy because they
reduce the electrical activity in the seizure focus.
limit the spread of abnormal activity to other parts of the brain.
produce analgesia so the patient does not feel any pain.
reduce hallucinations.
When benzodiazepines are used in dentistry to produce conscious sedation, the appearance of __________ is used as an initial endpoint for the dose administered.
flushed skin
miosis
ptosis
rapid eye movement
Which of the following parenteral benzodiazepines seems to have the greatest likelihood to produce amnesia?
Diazepam (Valium)
Midazolam (Versed)
Triazolam (Halcion)
Eszopiclone (Lunesta)
The therapeutic index of benzodiazepines is _____ that of the barbiturates.
wider than
narrower than
the same as
None of the above are correct
_____ may be used to reverse some of the effects of a benzodiazepine.
Ramelteon (Rozerem)
Phenobarbital (Luminal)
Flumazenil (Romazicon)
Carisoprodol (Soma)
Which of the following agents may decrease the effectiveness of benzodiazepines?
Tobacco
Omeprazole
Valproic acid
Fluoxetine
______ is an intravenously (IV) administered benzodiazepine that is used for conscious sedation in oral health care.
Chlordiazepoxide (Librium)
Lorazepam (Ativan)
Triazolam (Halcion)
Midazolam (Versed)
Which of the following sleep stages is enhanced with the use of benzodiazepines?
Latency period
Rapid eye movement (REM) sleep
Nonrapid eye movement (NREM) sleep stages 3 and 4
Nonrapid eye movement (NREM) sleep stage 2
The benzodiazepines are preferable to the barbiturates as hypnotics because the risk of physical addiction or serious poisoning is much less. The efficacy of the benzodiazepines in the treatment of chronic insomnia has been demonstrated for longer than 2 years.
Both statements are true.
Both statements are false.
The first statement is true, the second is false.
The first statement is false, the second is true.
All of the following habits should be followed to minimize insomnia except for one. Which one is the exception?
Light snack (warm milk) at bedtime
Awake at 6 AM even if sleep only began at 5 AM
Exercise within 3 hours of bedtime
Remaining in bed no longer than 20 minutes without sleeping
No smoking within 8 hours of bedtime
Which of the following benzodiazepines is the drug of choice for treatment of repetitive, intractable seizures that require IV therapy?
Chlordiazepoxide (Librium)
Diazepam (Valium)
Zolpidem (Ambien)
Eszopiclone (Lunesta)
Which of the following agents used for dental anxiety has a fast onset and short half-life?
Triazolam
Diazepam
Lorazepam
Alprazolam
Barbiturates act on nerves by enhancing the binding of which neurotransmitter to its receptor?
Glutamate
Serotonin
GABA
Chloride
Although a lethal dose of barbiturates can only be approximated, severe poisoning will follow the ingestion of _____ times the hypnotic dose.
5
10
15
20
Chronic use of barbiturates can lead to _____ dependence.
both physical and psychologic
physical but not psychologic
psychologic but not physical
neither physical nor psychologic
The use of barbiturates is absolutely contraindicated in patients with a positive family history of
high blood pressure.
diabetes.
porphyria
adrenal insufficiency.
Barbiturates reduce the effects of the following drugs except which one?
Propoxyphene
Chlorpromazine
Warfarin
Phenytoin
Doxycycline
Which of the following is the longest acting barbiturate?
Methohexital (Brevital)
Pentobarbital (Nembutal)
Secobarbital (Seconal)
Phenobarbital (Luminal)
Which agent has selective anxiolytic action without hypnotic, anticonvulsant, or muscle-relaxant properties?
Zolpidem
Flumazenil
Meprobamate
Buspirone
Tizanidine
Which of the following nonbenzodiazepine-benzodiazepine receptor agonists has the shortest half-life?
Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
Which of the following agents is a melatonin receptor agonist?
Buspirone
Zaleplon
Chloral hydrate
Ramelteon
Tizanidine
Which of the following is considered to be the strongest centrally acting skeletal muscle relaxant?
Carisoprodol (Soma)
Methocarbamol (Robaxin)
Cyclobenzaprine (Flexeril)
Orphenadrine (Norflex)
Which of the following muscle relaxants has peripheral rather than central action?
Carisoprodol
Cyclobenzaprine
Tizanidine
Baclofen
Dantrolene
What percentage of Americans only seek oral health care when absolutely necessary?
0%
5%
10%
20%
A sedative-hypnotic agent can produce varying degrees of central nervous system (CNS) depression. The same drug may be either a sedative or a hypnotic.
Both statements are true.
Both statements are false.
The first statement is true, the second is false.
The first statement is false, the second is true.
Most patients with generalized anxiety disorder and panic attacks are being treated with
benzodiazepines
barbiturates
nonbenzodiazepine-nonbarbiturate sedative-hypnotics.
antidepressants.
Which is best for all types of anxiety and muscle strain?
Barbiturates
Meprobamate
Benzodiazepines
Placebo
What should be done once a patient being treated with a benzodiazepine for “dental appointment” insomnia sees there is no reason to fear the appointment?
Cut the dose by one-half.
Switch to a nonbenzodiazepine, benzodiazepine receptor agonist such as eszopiclone.
Utilize nonpharmacologic sleep measures prior to the next appointment.
Don’t make any changes in the prescription.
Each of the following is true of melatonin except one. Which is the exception?
Melatonin is a naturally occurring hormone.
Melatonin is a scheduled drug that requires a prescription.
Melatonin may cause daytime sedation.
Melatonin has been shown to have no benefit over a placebo in several clinical trials.
Suvorexant (Belsomra) works by
facilitating the action of γ-aminobutyric acid (GABA).
blocking orexin neuropeptides from binding to their receptors.
enhancing GABA-receptor binding.
binding to serotonin in the CNS.
The nonbenzodiazepine receptor hypnotics are used to treat
panic attacks.
generalized anxiety.
insomnia.
seizures
Anxiety control is only necessary for the first third of a dental appointment.
True
False
Use of antianxiety agents in the dentist’s office should be discouraged because it encourages addiction.
True
False
Benzodiazepines are contraindicated in wide-angle glaucoma.
True
False
Barbiturates have no significant analgesic effects.
True
False
Barbiturates can cause fetal harm if administered to a pregnant woman.
True
False
Sedatives potentiate analgesic agents.
True
False
