Applied Pharmacology For The Dental Hygienist 6th Edition By - Test Bank

Applied Pharmacology For The Dental Hygienist 6th Edition By – Test Bank

 

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Haveles: Applied Pharmacology for the Dental Hygienist, 6^th Edition

 

Chapter 05: Nonopioid (Nonnarcotic) Analgesics

 

Test Bank

 

MULTIPLE CHOICE

 

1. Pain:

 

1. Brings people to the dental office
2. Keeps people from the dental office
3. Can be effectively treated with inactive pills (placebos)
4. All of the above

 

ANS: d

Correct: Pain is often the issue that brings the patient to the dental office. Conversely, pain can be the factor that keeps the patient from seeking dental care at the appropriate time. Because many patients respond when given a placebo, the inclusion of a placebo is required for any acceptable analgesic clinical trials.

 

REF: p. 49

 

2. The pain threshold varies greatly in individuals because of different perception of pain.

 

1. Both parts of the statements are true.
2. Both parts of the statements are false.
3. The first part of the statement is true, the second part is false.
4. The first part of the statement is false, the second part is true.

 

ANS: c

Correct: The pain threshold does vary greatly in individuals. However, this variation is because of widely different reactions to pain.

 

REF: p. 49

 

3. Which of the following raises the pain threshold?

 

1. Emotional instability
2. Sympathy
3. Sleep
4. Both a and c
5. Both b and c

 

ANS: e

Correct: A decrease in the pain threshold (a greater reaction to pain) has been said to be associated with emotional instability, anxiety, fatigue, youth, certain nationalities, women, and fear and apprehension. The pain threshold is raised by sleep, sympathy, activities, and analgesics.

 

REF: p. 49

 

4. Synonyms for nonopioid analgesics include:

 

1. Narcotic
2. Central
3. Antipyretic
4. Strong

 

ANS: c

Correct: Nonopioid analgesics are also called nonnarcotic, peripheral, mild, and antipyretic.

Incorrect choices: Opioid analgesics are called narcotic, central, or strong analgesics.

 

REF: p. 50

 

5. Pain relief by nonopioid analgesics is mediated via action:

 

1. At the central nervous system (CNS)
2. At the peripheral nervous system
3. Both centrally and peripherally
4. None of the above

 

ANS: b

Correct: Nonopioid analgesics act primarily at the peripheral nerve endings, although their antipyretic effect is mediated centrally.

 

REF: p. 50

 

6. The action of nonopioid analgesics is related to their ability to inhibit:

 

1. The CNS
2. Prostaglandin synthesis
3. Release of epinephrine
4. Release of acetylcholine

 

ANS: b

Correct: Nonopioid analgesics work by inhibiting prostaglandin synthesis.

Incorrect choices: The opioids affect the response to pain by depressing the CNS.

 

REF: p. 50

 

7. Which of the following choices has antiinflammatory, antipyretic, analgesic and antiplatelet action?

 

1. Acetaminophen
2. Codeine
3. Aspirin
4. Hydrocodone

 

ANS: c

Correct: Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) have antiinflammatory, antipyretic, analgesic, and antiplatelet actions.

Incorrect choices: Acetaminophen has antipyretic and analgesic action. Hydrocodone has analgesic action.

 

REF: p. 51

 

8. Prostaglandins sensitize pain receptors to:

 

1. Diflunisal.
2. Salsalate
3. Bradykinin
4. Ketoprofen

 

ANS: c

Correct: Prostaglandins, which are lipids that are synthesized locally by inflammatory stimuli, can sensitize the pain receptors to substances such as bradykinin. Therefore a reduction in prostaglandin results in a reduction in pain.

Incorrect choices: Diflunisal and salsalate are both salicylates, and ketoprofen is an NSAID.

 

REF: p. 51

 

9. Which of the following statements is true concerning the pharmacokinetics of aspirin?

 

1. Plain, unbuffered aspirin produces its peak effect on an empty stomach in 15 minutes.
2. Buffered aspirin has a slower peak of aspirin than plain aspirin.
3. The half-life of unhydrolyzed aspirin is approximately 90 minutes.
4. Aspirin exhibits zero-order kinetics.

 

ANS: d

Correct: Aspirin exhibits zero-order kinetics, meaning that a constant amount rather than a constant percentage of the drug is metabolized per hour.

Incorrect choices: Plain, unbuffered aspirin produces its peak effect on an empty stomach in 30 minutes. The buffered tablet reaches its peak in approximately 20 minutes. Buffered aspirin preparations have a somewhat quicker peak of action and attain higher blood levels because buffering facilitates dispersion and dissolution. The half-life of unhydrolyzed aspirin is approximately 15 minutes.

 

REF: p. 51

 

10. The ability of aspirin to reduce fever results from its inhibition of prostaglandin synthesis in the:

 

1. Medulla
2. Hypothalamus
3. Pons
4. Cerebellum

 

ANS: b

Aspirin inhibits prostaglandin synthesis in the hypothalamus. Hypothalamic prostaglandin synthesis is caused by elevated blood levels of leukocyte pyrogens induced by inflammation. Increased hypothalamic prostaglandin levels produce increased body temperature.

 

REF: p. 52

 

11. Prostacyclin ___________ aggregation of platelets and thromboxane A₂ _________ aggregation of platelets.

 

1. Stimulates, stimulates
2. Stimulates, inhibits
3. Inhibits, stimulates
4. Inhibits, inhibits

 

ANS: c

Prostacyclin inhibits aggregation of platelets and thromboxane A₂ stimulates aggregation of platelets. Depending on the dose, aspirin can inhibit either prostacyclin or thromboxane A₂. Further studies are needed to determine aspirin’s usefulness and dose in preventing clotting events in different patient populations.

 

REF: p 53

 

12. Which of the following effects is the most common side effect from aspirin?

 

1. Gastrointestinal effects
2. Bleeding
3. Hepatic and renal effects
4. Hypersensitivity

 

ANS: a

Aspirin’s most frequent side effect is related to the gastrointestinal tract. It may be simple dyspepsia, nausea, vomiting, or gastric bleeding. These adverse effects result from direct gastric irritation and inhibition of prostaglandins.

 

REF: p. 53

 

13. Which of the following statements is true regarding aspirin and the clotting mechanism?

 

1. Aspirin reversibly interferes with the clotting mechanism by reducing platelet adhesiveness.
2. Replacement of all of the affected platelets is required to produce normal clotting.
3. With lower doses of aspirin, 1{1/2} days should elapse to obtain normal clotting.
4. Aspirin stimulates production of prothrombin.

 

ANS: c

Correct: 1{1/2} days should elapse to obtain normal clotting with lower doses of aspirin. With large doses of aspirin, the half-life is prolonged.

Incorrect choices: Aspirin irreversibly interferes with the clotting mechanism by reducing platelet adhesiveness. Replacement of all of the affected platelets is not required to produce normal clotting. After approximately 20% of the platelets have been replaced with newly formed platelets, clotting will return to normal by approximately 36 hours. Aspirin inhibits the production of prothrombin, resulting in hypoprothrombinemia.

 

REF: p. 53

 

14. Aspirin can be used most safely in patients who:

 

1. Have arthritis
2. Have gout
3. Have ulcers
4. Are pregnant

 

ANS: a

Correct: Aspirin is commonly used in patients to relieve the pain and inflammation of rheumatoid arthritis.

Incorrect choices: Small doses of aspirin can produce uric acid retention and exacerbate gout. Aspirin may exacerbate preexisting ulcers. Aspirin abuse, or high dose use at near term, can be detrimental to the fetus or the newborn.

 

REF: pp. 53-54

 

15. Which of the following choices is the best to use in pediatric patients for both its analgesic and antipyretic action?

 

1. Aspirin
2. Acetaminophen
3. NSAIDs
4. Codeine

 

ANS: b

Correct: Acetaminophen is used in place of aspirin for pediatric patients for both its analgesic and antiinflammatory action.

Incorrect choices: In children and adolescents with either chickenpox or influenza, the use of aspirin has been epidemiologically associated with Reye syndrome.

 

REF: p. 54

 

16. The incidence of true aspirin allergy is:

 

1. Approximately 10%
2. Between 2% and 5%
3. Less than 1%
4. Not ever been recorded

 

ANS: c

The incidence of true aspirin allergy is less than 1% (0.2%-0.4%). Many patients with “allergy to aspirin” in their charts, on questioning, actually have stomach problems rather than a true allergy. In the patient’s chart, differentiating aspirin’s adverse reactions from its hypersensitivity reactions is important.

 

REF: p. 54

 

17. Which of the following drugs can be substituted for aspirin in patients displaying the aspirin hypersensitivity triad?

 

1. Ibuprofen
2. Naproxen
3. Codeine
4. Piroxicam

 

ANS: c

Correct: Patients displaying the aspirin hypersensitivity triad show cross-hypersensitivity between aspirin and other agents, including the NSAIDs, and they should not be given any NSAIDs.

Incorrect choices: Ibuprofen, naproxen, and piroxicam are all NSAIDs.

 

REF: p. 54

 

18. All of the following are characteristics of aspirin toxicity (salicylism) except:

 

1. Dimness of vision
2. Hyperthermia
3. Electrolyte imbalance
4. Hepatic necrosis
5. Tinnitus

 

ANS: d

Correct: Hepatic necrosis is a characteristic of acetaminophen toxicity and is rarely seen with aspirin use. All the other choices are characteristics of aspirin toxicity.

 

REF: p. 54

 

19. A drug interaction between aspirin and ____________ can result in significant bleeding.

 

1. Probenecid
2. Warfarin
3. Methotrexate
4. Sulfonylureas

 

ANS: b

Correct: The drug interaction between aspirin and warfarin can result in bleeding. Warfarin is an oral anticoagulant that is highly protein bound to plasma protein–binding sites. If aspirin is administered to a patient taking warfarin, it can displace the warfarin from its binding sites, increasing its anticoagulant effect.

Incorrect choices: Aspirin interferes with probenecid’s uricosuric effect and has been reported to precipitate an acute attack of gout. Aspirin can displace methotrexate form its plasma protein–binding sites and can also interfere with its clearance. This results in an increased serum concentration and methotrexate toxicity such as bone marrow depression. Higher doses of salicylates may produce a hypoglycemic effect.

 

REF: p. 55

 

20. What is the usual adult dosage of aspirin for the treatment of pain or fever?

 

1. 250 mg every 4 hours
2. 3 to 6 g per day
3. 650 mg every 4 hours
4. 800 mg every 4 hours
5. 160 mg per day

 

ANS: c

Correct: Two 5-gr tablets every 4 hours.

Incorrect choices: Aspirin doses are generally measured on a per tablet basis (325 mg = 5 gr). The dose for arthritis is 3 to 6 gm per day, and the dose for prevention of myocardial infarction is one half tablet daily.

 

REF: p. 55

 

21. Caffeine is often combined with aspirin because caffeine potentiates the analgesic effect of aspirin and other analgesics.

 

1. Both parts of the statement are true.
2. Both parts of the statement are false.
3. The first part of the statement is true, the second part is false.
4. The first part of the statement is false, the second part is true.

 

ANS: a

Correct: Most proprietary aspirin preparations contain caffeine, and caffeine does significantly potentiate the analgesic effect of aspirin and other analgesics. The caffeine in most proprietary aspirin preparations is at an active level for a single dose.

 

REF: p. 55

 

22. Which of the following agent would be least useful in alleviating fever?

 

1. Piroxicam
2. Acetaminophen
3. Diflunisal
4. Probenecid
5. Aspirin

 

ANS: c

Correct: Of the agents listed, diflunisal does not have clinically useful antipyretic activity. All the others do; it is as effective as the other NSAIDs in the treatment of pain.

 

REF: p. 56

 

23. Which of the following is true concerning NSAIDs?

 

1. Many authors agree that the NSAIDs are the most useful drug group for the treatment of dental pain.
2. Unlike aspirin, NSAIDs do not inhibit the enzyme cyclooxygenase (COX).
3. Most NSAIDs reach a peak blood level in approximately 20 minutes.
4. NSAIDs do not have a significant antiinflammatory effect.

 

ANS: a

Correct: Many authors agree that the NSAIDs are the most useful drug group for the treatment of dental pain.

Incorrect choices: Similar to aspirin, NSAIDs inhibit the enzyme COX (prostaglandin synthase), resulting in a reduction in the formation of prostaglandin precursors and thromboxanes from arachidonic acid. Most NSAIDs peak in approximately 1 to 2 hours. The analgesic, antipyretic, and antiinflammatory actions of the NSAIDs result from the same mechanism as aspirin inhibition of prostaglandin synthesis by inhibiting COX.

 

REF: p. 56

 

 

 

24. Which of the following statements is true concerning adverse reactions of NSAIDs?

 

1. NSAIDs will decrease acid secretion in the stomach.
2. Tolerance develops to the use of NSAIDs.
3. NSAIDs irreversibly inhibit platelet aggregation because they inhibit thromboxane A₂ production.
4. NSAIDs have precipitated renal insufficiency.

 

ANS: d

Correct: NSAIDs have precipitated renal insufficiency. The NSAIDs have little effect on the patient with normal kidney function; however, with renal disease, decreases in both renal blood flow and glomerular filtration rate can occur.

Incorrect choices: Prostaglandin inhibitors, such as NSAIDs, can interfere with the normal protective mechanisms in the stomach and increase acid secretion, causing symptoms or even an ulceration or perforation. These agents are not addicting, tolerance does not develop, and no withdrawal syndrome can be induced. NSAIDs reversibly inhibit platelet aggregation because they inhibit thromboxane A₂ production. In contrast to aspirin, their effect remains only as long as the drug is present in the blood: 1 day for ibuprofen, 4 days for naproxen, and 2 weeks for oxaprozin.

 

REF: p. 58

 

25. Which of the following NSAIDs is designated U.S. Food and Drug Administration (FDA) pregnancy category B?

 

1. Naproxen
2. Diflunisal
3. Tolmetin
4. Mefanamic acid

 

ANS: a

Correct: Naproxen has not been shown to be teratogenic is animal studies and is designated FDA pregnancy category B.

Incorrect choices: The others have been shown to be teratogenic in animals and are designated FDA category C.

 

REF: p. 58

 

26. Which of the following NSAIDs is the drug of choice for treating a nursing woman?

 

1. Naproxen
2. Diflunisal
3. Ibuprofen
4. Fenoprofen

 

ANS: c

Correct: Ibuprofen is the drug of choice for treating a nursing woman.

Incorrect choices: Fenoprofen and mefenamic acid are present in small quantities in breast milk. Small amounts of both naproxen and diflunisal are excreted in breast milk.

 

REF: p. 58

 

27. Which of the following agents is known to have a drug interaction with lithium?

 

1. Aspirin
2. Naproxen
3. Acetaminophen
4. Oxycodone

 

ANS: b

Correct: NSAIDs such as naproxen are known to increase serum levels of lithium.

Incorrect choices: Aspirin, acetaminophen, and oxycodone do not have this interaction with lithium.

 

REF: p. 58

 

28. Dental pain is best managed with which of the following choices?

 

1. Codeine 60 mg
2. Ibuprofen 400 mg
3. Acetaminophen 650 mg
4. Aspirin 650 mg
5. Placebo

 

ANS: b

Correct: In usual prescription doses, NSAIDs can be shown to be statistically significantly better than codeine alone, aspirin, acetaminophen, or placebo.

 

REF: p. 59

 

29. Which of the following NSAIDs is considered the drug of choice for management of dental pain when a NSAID is indicated?

 

1. Naproxen
2. Naproxen sodium
3. Ibuprofen
4. Diflunisal

 

ANS: c

Correct: Ibuprofen is considered the drug of choice for management of dental pain when a NSAID is indicated.

Incorrect choices: Naproxen and naproxen sodium are propionic acid NSAIDs that have slightly longer half-lives than ibuprofen and can be administered on an 8- to 12-hour schedule. Other NSAIDs, such as fenoprofen, ketorolac, or diflunisal, may be used for patients who do not respond to either ibuprofen or naproxen sodium.

 

REF: p. 60

 

30. Oral administration with __________ is indicated only as continuation to intravenous (IV) or intramuscular (IM) therapy.

 

1. Fenoprofen
2. Ketorolac
3. Naproxen sodium
4. Diflunisal

 

ANS: b

Oral administration with ketorolac is indicated only as continuation to IV or IM therapy. Ketorolac is a newer NSAID; it is equivalent in efficacy to the other NSAIDs; however, unlike other NSAIDs, it is available parenterally.

 

REF: p. 60

 

31. Which of the following statements is true of COX II?

 

1. It is a widely distributed constitutive enzyme.
2. It is responsible for the adverse reactions of the NSAIDs.
3. It is synthesized only when inflammation occurs.
4. It is not an enzyme.

 

ANS: c

Correct: COX II is an inducible enzyme that is only synthesized when inflammation occurs.

Incorrect choices: COX I is a widely distributed constitutive enzyme responsible for the adverse reactions of the NSAIDs such as stomach problems, reduced renal function, fluid retention, and reduced platelet adhesiveness.

 

REF: p. 60

 

32. Which of the following choices is currently the most popular COX II–specific agent on the market?

 

1. Celecoxib
2. Rofecoxib
3. Valdecoxib
4. Indomethacin

 

ANS: a

Correct: Celecoxib is currently the most popular COX II–specific agent; it is indicated for arthritis.

Incorrect choices: Rofecoxib and valdecoxib were removed from the U.S. market in 2005 as a result of a high incidence of cardiovascular events associated with these two drugs. Indomethacin is a COX I–specific medication.

 

REF: pp. 60-61

 

33. Which of the following statements is true regarding the pharmacokinetics of acetaminophen?

 

1. Acetaminophen is slowly and incompletely absorbed from the gastrointestinal tract.
2. Acetaminophen is excreted with a half-life of 8 to 12 hours.
3. When large doses of acetaminophen are ingested, an intermediate metabolite is produced that is thought to be hepatotoxic.
4. Acetaminophen is less potent and efficacious than aspirin.

 

ANS: c

Correct: An intermediate metabolite is produced when large doses of acetaminophen are ingested that is thought to be hepatotoxic and possibly nephrotoxic.

Incorrect choices: Acetaminophen is rapidly and completely absorbed from the gastrointestinal tract, achieving a peak plasma level in 1 to 3 hours. After therapeutic doses, it is excreted with a half-life of 1 to 4 hours. Acetaminophen and aspirin are equally efficacious and equally potent.

 

REF: p. 61

 

34. Acetaminophen does not possess any of these clinically significant __________ effects: (1) antipyretic, (2) antiinflammatory, (3) analgesic

 

1. 1, 2, 3
2. 1 and 2
3. 1 and 3
4. 1
5. 2

 

ANS: e

Acetaminophen does have clinically significant antipyretic and analgesic effects; however, it does not possess any clinically significant antiinflammatory effect.

 

REF: p. 61

 

35. Which of the following choices is true regarding these pharmacologic effects of therapeutic doses of acetaminophen? (1) No effect on the cardiovascular system; (2) does not produce gastric bleeding; (3) does not affect platelet adhesiveness; (4) does not affect uric acid excretion

 

1. 1, 2, 3, 4
2. 1, 2, 3
3. 2, 3, 4
4. 1 only

 

ANS: a

Therapeutic doses of acetaminophen have no effect on the cardiovascular or respiratory system. In contrast to aspirin, acetaminophen does not produce gastric bleeding or affect platelet adhesiveness or uric acid excretion.

 

REF: p. 61

 

36. An acute overdose with acetaminophen may damage the:

 

1. Eyes
2. Liver
3. Spleen
4. Kidney

 

ANS: b

Correct: Acute overdose of acetaminophen can lead to the generation of a toxic metabolite that can cause hepatic necrosis and lead to death.

Incorrect choices: Acetaminophen does not damage the eyes or the spleen but can damage the kidney upon chronic administration.

 

REF: p. 61

 

37. Who is most likely to experience the most cases of accidental overdose with acetaminophen?

 

1. Infants
2. Children
3. Young adults
4. Older adults

 

ANS: b

Children experience more cases of accidental overdose with acetaminophen, which occurs because the wrong dose form is used (e.g., infant drops are given to older children or adult doses are given to children). Infant drops are concentrated, and doses for toddlers to 11-year-old children are not the same as doses for infants.

 

REF: p. 61

 

 

 

38. Alcohol consumption stimulates the breakdown of acetaminophen, thereby decreasing the toxic potential of acetaminophen use.

 

1. Both parts of the statement are true.
2. Both parts of the statement are false.
3. The first part of the statement is true, the second part is false.
4. The first part of the statement is false, the second part is true.

 

ANS: c

Correct: Alcohol stimulates the oxidizing enzymes that metabolize acetaminophen to its toxic metabolite. In this way, it increases acetaminophen toxicity.

 

REF: pp. 61-62

 

39. Which of the following agents is intended to treat an acute attack of gout?

 

1. Probenecid
2. Codeine
3. Colchicine
4. Acetaminophen
5. Both a and c

 

ANS: 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: p. 63

 

40. Which of the following agents is a xanthine oxidase inhibitor?

 

1. Colchicine
2. Ibuprofen
3. Allopurinol
4. Probenecid

 

ANS: c

Correct: Allopurinol is the only drug listed that inhibits xanthine oxidase.

 

REF: p. 63

 

TRUE/FALSE

 

41. Two components of pain include perception and reaction.

 

ANS: True

Correct: Perception and reaction are two distinct components of pain.

 

REF: p. 49

 

42. Raising the pain threshold increases one’s reaction to pain.

 

ANS: False

Correct: Lowering the pain threshold increases one reaction to pain.

 

REF: p. 49

 

43. Salicylates’ mechanism of action involves inhibiting prostaglandin synthesis.

 

ANS: True

Correct: Salicylates inhibit the COX enzyme, which produces prostaglandins.

 

REF: p. 51

 

44. Aspirin should not be given to children until they are18 years of age.

 

ANS: True

Administration of aspirin to children with either chickenpox or influenza has been associated with Reye syndrome, which can be fatal.

 

REF: p. 54

 

45. Salicylism is a toxic effect from acetaminophen.

 

ANS: False

Correct: Acetaminophen is not a salicylate and does not cause salicylism.

 

REF: p. 54

 

46. Probenecid and allopurinol both inhibit the synthesis of uric acid.

 

ANS: False

Correct: Allopurinol inhibits the synthesis of uric acid, but probenecid increases the excretion of uric acid.

 

REF: p. 63