chapter 1 test pharm

Drugs that are weak electrolytes will cross body membranes best when they are (1) nonionized (2) ionized (3) polar (4) nonpolar (5) lipid soluble (6) water soluble

1, 4, 5 Drugs that are weak electrolytes will cross body membranes best when they are nonionized, nonpolar, and lipid soluble. These drugs dissociate in solution and equilibrate into a nonionized form and an ionized form. The nonionized, or uncharged, portion acts as a nonpolar, lipid-soluble compound that readily crosses body membranes. The ionized portion of drugs that are weak electrolytes will traverse membranes with greater difficulty because they are less lipid soluble.

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

100 If the value of the TI is small, then toxicity is more likely. If the TI is large, then the drug will be safer. A drug with a wide TI will have a large LD50 and a small ED50 (the distance between these curves is large). A TI of greater than 10 is usually needed to produce a therapeutically useful drug. One must divide the LD50 value by the ED50 value. The LD50 value (300) divided by the ED50 value (3) equals 100.

How many years must pass after a drug patent expires before other drug companies can market the same compound as a generic drug?

20 years Once a drug patent expires, competing companies may immediately market the same compound in generic form. After 20 years, the patent of the original drug expires, and other companies can market the same compound under a generic name.

One dose of a drug is administered that has a half-life of 8 hours. Assuming first-order kinetics, how much time is needed for this drug to be over 96% eliminated from the body?

40 hours Assuming first-order kinetics, 40 hours would be required for this drug to be over 96% eliminated from the body. Five half-lives are needed to reduce the levels of a drug to 3.125% of the original levels, or eliminate over 96%. For a drug with an 8-hour half-life, this amounts to five half-lives × 8 hours per half-life, or 40 hours.

If one dose of a drug is administered and the drug's half-life in the body is 3 hours, what percentage of the drug would be left after four half-lives?

6.25% The half-life is the time required for a drug level to fall to one half of its concentration. The drug concentration would go to 50% → 25% → 12.5% → 6.25% in four half-lives. The information given is more than sufficient to answer the question. One needs merely to count the number of half-lives and divide the percentage drug in half for every half-life passed since the drug was administered.

Which of the following is true concerning generic and trade names of drugs?

A drug may only have one generic name, but it may have several trade names. Each drug has only one generic name but may have several trade names. For each drug, there is only one generic name. It is not capitalized, and it becomes the "official" name of the drug. The pharmaceutical company discovering the drug gives the drug a trade name. The trade name is protected by the Federal Patent Law for 20 years from the earliest claimed filing date, plus patent term extensions. Although the brand name is technically the name of the company marketing the product, it is often used interchangeably with the trade name.

Which is true of a drug with a stronger affinity for a receptor site versus a drug with a weaker affinity for the same site?

A drug with stronger affinity is more potent than a drug with weaker affinity. Drugs with stronger affinity for receptor sites are more potent than drugs with weaker affinities for the same sites. An antagonist counteracts the action of the agonist. There are three types of antagonists: competitive antagonist, noncompetitive antagonist, and physiologic antagonist. An agonist is a drug that has affinity for a receptor, combines with the receptor, and produces an effect.

What would be an advantage for a dentist to call the pharmacy with a prescription for Tylenol #3 rather than hydrocodone for a patient who calls late at night requesting medication for pain following root canal therapy?

A prescription for Tylenol #3 (Schedule III) may be telephoned, whereas hydrocodone (Schedule II) requires a written prescription. Tylenol #3 has moderate abuse potential and prescriptions may be telephoned. Hydrocodone has high abuse potential and requires a written prescription with the provider's signature. Tylenol #3 is a Schedule III controlled substance. It is not available over-the-counter and requires a prescription. Hydrocodone has more potency and a higher abuse potential than Tylenol #3.

Which of the following choices is the process by which a substance is transported against a concentration gradient?

Active transport Active transport is a mechanism for movement of substances, often against a concentration gradient, that uses the energy of the cell to actively pump the substance from one side of a membrane to the other. Passive transfer and filtration entail the passage of substances in a manner proportional to their concentration on each side of the membrane. The substances move without any assistance. Facilitated transport uses a carrier protein but cannot transport substances against a gradient.

Which of the following is true regarding basic principles of drug distribution in the bloodstream?

All drugs in the blood are either bound to plasma proteins or free. All drugs in the blood are either bound to plasma proteins or free. Only the drug that is free can exert the pharmacologic effect. Only the free drug can pass across cell membranes. The bound drug is a reservoir for the drug.

Knowledge of pharmacology aids the dental professional in obtaining a patient's health history. administering drugs in the office. selection of a nonprescription medication. handling emergency situations. All of the above

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

The distribution of a drug is determined by blood flow to the organ. solubility of the drug. plasma protein-binding capacity. presence of certain barriers. Correct! All of the above

All of the above choices are correct. If the blood circulation to an organ is low, it will receive less drug. The more membranes and barriers a drug needs to cross, the slower the rate at which it will reach the organ in question. The binding of drugs to plasma proteins reduces the concentration of drug that can leave the circulation and be taken up by an organ. The relative level of fat or water solubility of a drug will influence where and how rapidly a drug will distribute. The distribution of a drug is determined by several factors, such as the size of the organ, the blood flow to the organ, the solubility of the drug, the plasma protein-binding capacity, and the presence of certain barriers (e.g., blood-brain barrier, placenta).

Which of the following is a schedule II controlled substance?

Amphetamine Amphetamine, oxycodone, morphine, and secobarbital are all schedule II controlled substances. Heroin is a schedule I substance. Propranolol is a nonscheduled prescription drug. Dextropropoxyphene is a schedule IV substance.

Which drug is eliminated with zero-order kinetics?

Aspirin A few drugs, such as aspirin and alcohol, exhibit zero-order kinetics. The enzymes that metabolize these drugs can become saturated at usual therapeutic doses. Small changes in the dosage of these drugs may produce a large change in concentration in blood serum. There are few drugs that are eliminated with zero-order kinetics, namely aspirin and alcohol.

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

Both parts of the statement are true. Both parts of the statement are true. Schedule III controlled substances may be telephoned to the pharmacist and may be refilled as many as five times in 6 months. Both parts of the statement are true for schedule III and schedule IV controlled substances. Schedule I controlled substances have no accepted medical use. Schedule II controlled substances require a written prescription with the provider's signature, and no refills are permitted. Schedule V controlled substances can be bought OTC in some states.

Application of a transdermal patch is an example of parenteral administration because the drug is delivered in a manner that bypasses the gastrointestinal tract.

Both parts of the statements are true. Both parts of the statement are true. A transdermal patch is designed to provide continuous controlled release of medication through a semipermeable membrane over a given period after application to the intact skin. Drugs given by the enteral route are placed directly into the gastrointestinal tract by oral or rectal administration. Parenteral means situated or occurring outside of the gastrointestinal tract (intestines). Examples of routes that bypass the gastrointestinal tract include various injection routes, inhalation, and topical administration. In practice, the term parenteral usually refers to an injection.

Where is the information regarding the prescriber DEA number commonly found on the prescription?

Closing The signature area of the prescription is found in the closing. It should also include a space for the DEA number. The superscription is a classical description for where the patient information and the symbol Rx are found. The heading contains prescriber and patient contact information, the patient's date of birth, and the date of prescription. The body contains the Rx symbol, dosage instructions, and directions to the patient.

Which of the following reactions is considered to be in the category of phase II drug metabolism?

Conjugation Phase II reactions involve conjugation with glucuronic acid, sulfuric acid, acetic acid, or an amino acid. The most common conjugation occurs with glucuronic acid. Reduction, hydrolysis, and oxidation are all examples of phase I drug metabolism.

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

Correct! Both B and C are true. Asthmatic patients who experience dental anxiety should schedule their appointments when they are not rushed or under pressure early in the morning. Diabetic patients usually have relatively fewer problems with a morning appointment. Patients taking medication for systemic diseases may require special handling in the dental office.

What should the dental hygienist do first if a patient reports a suspected adverse drug effect?

Determine what drugs the patient is taking. Determine what drugs the patient is taking. Once a list of drugs is identified, it is important to determine which drug or drugs may be causing the adverse effect. If the patient is taking multiple drugs the dental hygienist should determine when the patient is taking each drug. Also, determine whether or not the symptoms of the adverse effect occurred after beginning drug therapy and how long after the patient took the drug. Epinephrine is administered for anaphylaxis. Drugs used in dentistry that can produce anaphylaxis include the penicillins, ester local anesthetics, and aspirin. Drinking a sugary liquid is useful for a patient with hypoglycemia. Calling 9-1-1 is useful for a severe allergic reaction or heart attack; however, a drug allergy accounts for less than 5% of all adverse reactions. It is better to call emergency medical services (EMS) if transportation to the hospital is required as there are liability issues with driving the patient to the hospital.

Which will block the action of histamine during an allergic reaction?

Epinephrine Epinephrine blocks the action of histamine during an allergic reaction. Macrolides will not block the action of histamine; however, they will raise the plasma levels of many drugs. Anticonvulsants do not block the action of histamine, although they can increase or decrease the metabolism of many drugs and each other, leading to either increased or decreased plasma levels of these drugs. Benzodiazepines and first-generation antihistamines will increase the level of sedation, but will not block the action of histamine.

The federal body that determines whether a drug is considered a controlled substance and to which schedule it belongs is the

Drug Enforcement Administration (DEA). The DEA regulates the manufacture and distribution of substances with abuse potential. Hence prescriber DEA numbers must appear on prescriptions for controlled substances. The FDA does not have any special powers in regard to drugs of abuse. The FTC regulates commerce and advertising claims of foods, over-the-counter (OTC) products, and cosmetics. The USP regulates the uniformity and purity of drugs.

Which of the following statements is true concerning the mechanism of action of drugs?

Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent. Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent. Drugs do not impart a new function to the organism; they merely either produce the same action as an endogenous agent or block the action of an endogenous agent.

Which is least likely to be a true allergic reaction?

Dyspepsia Drugs taken orally can produce gastrointestinal symptoms, such as nausea or dyspepsia, because of their local actions on the gastrointestinal tract. A drug allergy is an immunologic response to a drug resulting in a reaction such as rash or anaphylaxis. The targets of this reaction are the bronchioles, resulting in anaphylactic shock; the respiratory system, resulting in rhinitis and asthma; and the skin, resulting in urticaria and dermatitis.

Phase 1 clinical trials involve all of the following except which one?

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

Which federal regulatory agency decides which drugs require a prescription and which drugs may be sold over-the-counter (OTC)?

FDA The Food and Drug Administration (FDA) is part of Department of Human and Health Services (DHHS), and determines what drugs may be sold by prescription and OTC and regulates the labeling and advertising of prescription drugs. The Occupational Safety and Health Administration (OSHA) ensures the safety and health of workers in the United States by setting and enforcing standards. The Federal Trade Commission (FTC) regulates the trade practices of drug companies and prohibits the false advertising of foods, nonprescription (OTC) drugs, and cosmetics. The Drug Enforcement Administration (DEA) is a part of the Department of Justice and regulates the manufacture and distribution of substances that have a potential for abuse, including opioids, stimulants, and sedatives.

Which federal regulatory body regulates the trade practices of drug companies and prohibits false advertising of foods, nonprescription drugs, and cosmetics?

FTC Consumers who refer to care labels on their clothes, product warranties, or stickers showing the energy costs of home appliances are using information required by the FTC. Businesses must be familiar with the laws requiring truthful advertising and prohibiting price fixing. These laws are also administered by the FTC. When the FTC was created in 1914, its purpose was to prevent unfair methods of competition in commerce. Over the years, the U.S. Congress has passed additional laws giving the agency greater authority to police anticompetitive practices. The FDA grants approval so that drugs can be marketed in the United States. Before the FDA can approve a drug, the drug must be determined to be both safe and effective. The DEA regulates the manufacture and distribution of substances that have a potential for abuse. OBRA (Omnibus Budget Reconciliation Act) is not a regulatory body; it is an act that mandates that pharmacists must provide patient counseling.

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

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

Refill instructions are found in the body of a prescription.

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

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

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

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

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

Which type of drug name usually begins with a lowercase letter?

Generic name Before any drug is marketed, it is given a generic name that becomes the "official" name of the drug. Each drug is assigned only one generic name selected by the U.S. Adopted Name Council, and the name is not capitalized. The brand name is equivalent to the trade name and is capitalized. Although the brand name is technically the name of the company marketing the product, this term is often used interchangeably with the trade name. The code name is the initial term used within a pharmaceutical company to refer to a drug while it is undergoing investigation and is often a combination of capital letters and numbers, the letters representing an abbreviation of the company name.

Most drugs are excreted through which mechanism?

Glomerular filtration Either the unchanged drug or its metabolites are filtered through the glomeruli and concentrated in the renal tubular fluid. This process depends on the amount of plasma protein binding and the glomerular filtration rate. The gastrointestinal tract is an extrarenal route of excretion, along with the lungs, bile, sweat, saliva, and breast milk. Active secretion transports the drug from the bloodstream across the renal tubular epithelial cells and into the renal tubular fluid. Passive tubular diffusion favors the reabsorption of un-ionized, lipid-soluble compounds.

Controlled substances in schedule _____ require a written prescription with the provider's signature and do not permit refills.

II only Controlled substances in schedule II require a written prescription with the provider's signature and do not permit refills. Any prescription for schedule II drugs must be written in pen or indelible ink or typed. A designee of the dentist, such as the dental hygienist, may write the prescription, but the prescriber must personally sign the prescription in ink and is responsible for what any designee has written. Prescriptions for controlled substances in both schedule III and schedule IV may be telephoned, and no more than five prescriptions in 6 months are permitted.

A prodrug is an example of which type mechanism of metabolism?

Inactive to active An inactive parent drug (prodrug) may be transformed into an active compound. Active to active occurs when an active parent drug is converted to a second active compound, which is then converted to an inactive product. When an active metabolite is formed, the action of the drug is prolonged. Active to inactive is the most common type of reaction in drug biotransformation. Inactive to inactive is not one of the mechanisms of metabolism. A placebo may be an example.

What route is used to administer the tuberculosis skin test?

Intradermal Intradermal administration is used to provide local, rather than systemic, action. Local anesthetics are also given this way. The other routes are all chosen when systemic action is desired. Intramuscular, intradermal, and subcutaneous routes of administration are not used to administer the tuberculosis skin test.

What type of administration involves the injection of solutions into the spinal subarachnoid space?

Intrathecal route The intrathecal route is used for injection of solutions into the spinal subarachnoid space. Intraperitoneal route refers to placing fluids into the peritoneal cavity. Intravenous route refers to administering drugs directly into the blood circulation. Intradermal route refers to injecting a drug just under the skin.

Which of the following routes of drug administration produces the most rapid drug response?

Intravenous Intravenous administration produces the most rapid drug response, with an almost immediate onset of action. Because the injection is made directly into the blood, the absorption phase is bypassed. The intramuscular route, subcutaneous route, and intradermal route all have slower drug response rates than intravenous drug administration.

What is the purpose of a "black box warning" on a package insert?

It is used to draw attention to potentially fatal, life threatening, or disabling adverse effects for different medications. A black box warning is about a drug the FDA has required a manufacturer to prominently display in a box in the package insert. The intent of the black box is to draw attention to the specific warning and make sure that both the prescriber and patient understand the serious safety concerns associated with that drug. A black box on an airplane is used to reconstruct events prior to a tragedy; however, the black box warning on a medication package insert is used to warn about safety concerns with the drug. A black box is not used as a warning about illicit use of medications. All drugs must go through preclinical and clinical trials prior to being marketed.

A dose of a drug that kills 50% of experimental animals is termed

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

Which organ is involved in the first-pass effect after oral administration of a drug?

Liver On oral administration, drugs are absorbed and are carried via the portal circulation to the liver, where a percentage of the drug may be metabolized before entering the systemic circulation. After oral dosing, drugs reach the kidney, lungs, and spleen after passing through the liver.

Which term refers to the time required for a drug to begin to have its effect?

Onset Onset is the time at which a drug starts to take effect. First pass refers to the metabolism of drugs by the liver during their movement from the gastrointestinal tract to the systemic circulation via the portal circulation. Duration is the amount of time the drug is active in the body. Efficacy is an assessment of the effectiveness of a drug and does not refer to how quickly or how long a drug acts in the body.

Drug preparations may be administered for local or systemic effects. Which is an example of a dose form used for a local effect?

Ophthalmic ointment Ophthalmic ointments and drops are used specifically for treating the eye, not for treating a systemic disorder. Administration of a sublingual tablet leads to rapid entry of the drug into the systemic circulation. A transdermal patch is a specialized dose form for the controlled delivery of a drug into the systemic circulation. A subcutaneous injection is applied into the subcutaneous areolar tissue to gain access to the systemic circulation.

tolerance is most closely associated with which category of drug?

Opioids Tolerance is associated with sedative-hypnotics and opioids. Tolerance is associated with narcotics.

What of the following choices is considered the safest, least expensive, and most convenient route for administering drugs?

Oral Oral administration requires no sophisticated devices, is slow enough in onset to gauge reactions and stop the next dose, and is easy for a patient to administer without assistance. Inhalation and subcutaneous administration require devices, such as inhalers and needles, and the drug is irretrievable once administered. Rectal dosing has lower patient acceptance, and absorption can be variable.

Which is safe to administer to a pregnant patient?

Penicillin Penicillin and erythromycin, acetaminophen, and lidocaine are considered to be among the safest; however, even these drugs should be administered only if there is clear need. Tetracycline, NSAIDs, and the benzodiazepines are examples of drugs used in dentistry that are contraindicated during pregnancy.

Clinical studies of drugs first involve human volunteers during which phase of drug testing?

Phase 1 Clinical studies of drugs involve humans' right from the start of Phase 1 clinical trials. In Phase 1 clinical trials, small and then increasing doses of the prospective drug are administered to a limited number of healthy human volunteers, primarily to determine safety. Larger groups of humans are given the drug in Phase 2 clinical trials, but humans were involved in Phase 1 clinical trials. Phase 3 involves a large number of patients who have the condition for which the drug is indicated. Phase 4 involves postmarketing surveillance.

Which of the following is not a subject of pharmacokinetics?

Physiologic action of drugs The physiologic action of drugs is a subject of pharmacology, not pharmacokinetics. Pharmacokinetics does have to do with the subjects of absorption, distribution, metabolism, and excretion of drugs.

On a prescription, the directions to the patient are preceded by

Sig. Sig. is the abbreviation for the Latin word signa, or write. This word precedes the instructions to the patient. Rx means take thou and precedes the prescription instructions, # denotes the number of tablets, capsules, and so forth to be dispensed. Disp. is short for dispense and precedes the amount to be dispensed, analogous to #.

Which of the following is the recommended solution for the adverse effect of nausea following administration of a drug?

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

Which of the following is located in the body of the prescription?

The amount of the drug to be dispensed The Rx symbol, name and dose size or concentration of the drug, amount to be dispensed, and directions to the patient are all found in the body of the prescription. The date of the prescription is found in the heading. The directions to the patient rather than prescriber are found in the body of the prescription. Refill instructions are found in the closing of the prescription.

Administering a drug of greater potency is better because drugs of greater potency do not require as high a dose.

The first part of the statement is false; the second part is true. The first part of the statement is false, the second part is true. The absolute potency of a drug is immaterial as long as the appropriate dose is administered. If equally efficacious, both drugs will produce the same effect. Both meperidine and morphine, for example, have the ability to treat severe pain, but approximately 100 mg of meperidine would be required to produce the same action as 10 mg of morphine. The dose of meperidine needed to produce pain relief is larger than that for morphine. Less potent drugs require higher doses to produce therapeutic effects whereas more potent drugs can reach toxic levels at lower doses.

When the acidity of the tissue increases, as in instances of infection, the effect of a local anesthetic decreases; therefore, the local anesthetic is a weak acid

The first part of the statement is true; the second part is false. The first part of the statement is true, the second part is false. Infections lead to an accumulation of acidic waste products, which lowers the pH of the local area. Local anesthetics must penetrate the nerve cell membrane to cause their action. They become more ionized as the pH drops. This property is a characteristic of weak bases, not weak acids. Local anesthetics are weak bases. Weak bases are better absorbed when the pH is greater than the pKa. A weak base is associated and ionized when the pH is less than the pKa.

The body of a prescription includes directions to the patient.

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

An acute, life-threatening allergic reaction characterized by hypotension, bronchospasm, laryngeal edema, and cardiac arrhythmias is what type of hypersensitivity?

Type I Type I hypersensitivity, or immediate-type hypersensitivity, is a rapidly produced response targeting the bronchioles, the respiratory system, and the skin. Type II, III, and IV reactions are all slower than type I reactions. Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed, causing arthralgia, urticarial skin eruptions, and so forth, with little or no lung involvement. Type IV hypersensitivity, or delayed-type hypersensitivity, is generally manifested as skin eruptions.

Which hypersensitivity reaction is termed delayed-type hypersensitivity and is mediated by sensitized T lymphocytes and macrophages?

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

A drug's generic name is selected by the

U.S. Adopted Name Council. Each drug is assigned only one generic name (e.g., ibuprofen). It is selected by the U.S. Adopted Name Council. The generic name is not selected by the FDA or the Federal Patent Office. The pharmaceutical company manufacturing the drug clearly has an influence on the generic name given its drug, but the final decision is not the company's.

If a drug displays zero-order elimination kinetics

a constant amount is eliminated per unit time. With zero-order kinetics, the metabolism or excretion mechanisms for a drug in the body are saturated, meaning that they are at their maximal level. If more drug is given, then the body cannot keep up, and the drug levels will increase. The body cannot adjust to more drug, and elimination of a drug will remain the same as the dose of the drug is increased. If the drug is eliminated but a longer time is required, then it would for a first-order elimination. The elimination of the drug can be mathematically predicted.

Immune-complex disease reactions are aggregations of antibodies and

antigens. Usually there are more antibodies than antigens. When there is a large amount of antigens or the immune system is not clearing antigens, then the antigen:antibody ratio increases. When the number of antibodies is comparable to the amount of antigens then the immune-complex can form. Antigens are proteins against which antibodies are formed. Plasma cells are derived from B-cell lymphocytes.

An investigational new drug application (INDA) is submitted _____ trials.

before phase 1 clinical trials Preclinical testing usually lasts about 3 years. After the preclinical trials have been completed, an INDA must be filed with the FDA before a drug company can commence phase 1 clinical trials. Animal testing data must be accumulated from preclinical trials before filing an INDA. Phase 1 is the first trial using patients, and phases 2 and 3 follow phase 1. An INDA must be filed before any testing in humans can commence.

The greatest risk to the fetus from exposure to drugs occurs

before pregnancy status is known. Early in pregnancy (first trimester) the organs in the fetus are forming, which is considered the most critical time for teratogenicity. Drugs at these stages may affect the newborn, but the fetus is fully developed. Fetal organogenesis has already occurred; therefore, critical stages in fetal development have passed.

Two drugs that are found to be chemically equivalent, but not biologically equivalent or therapeutically equivalent are said to differ in

bioavailability. A preparation can be chemically equivalent yet not biologically or therapeutically equivalent. These products are said to differ in their bioavailability. The potency of a drug is a function of the amount of drug required to produce an effect. The efficacy is the maximum intensity of effect or response that can be produced by a drug. The therapeutic index is the ratio of the lethal dose for 50% of the experimental animals divided by the effective dose for 50% of the experimental animals. If the value of the therapeutic index is small, toxicity is more likely.

Two drug formulations that produce similar concentrations in the blood and tissues after drug administration are termed _____ equivalent.

biologically Biologic equivalence refers to identical pharmacokinetic parameters of two drug formulations (bioequivalence, for short). Chemical equivalence indicates that two formulations of a drug meet the chemical and physical standards established by the regulatory agencies. Therapeutic equivalence means that two formulations produce the same therapeutic effects over the same duration.

The route of administration of a drug affects

both the onset and duration of response. Onset refers to the time required for the drug to begin to have its effect. Duration is the length of a drug's effect. Both onset and response are affected by the route of administration. The routes of administration may be categorized as enteral when placed in the gastrointestinal tract, or parenteral, which usually means an injection.

Nutritional or herbal supplements

can cause adverse effects. Nutritional or herbal supplements are quite capable of causing adverse effects. The majority of nutritional or herbal supplements do not carry FDA approval for treating disease states. These supplements are drugs and can cause adverse effects and interact with different drugs.

The following choices refer to adverse reactions involving exaggerated effects on target tissues except

caused by a nontherapeutic action of a drug. This answer is typical of an adverse effect caused by action on nontarget tissues. Exceptional sensitivity to a normal dose and administration of too large a dose for a patient are common actions that lead to exaggerated effect. Liver or kidney disease may reduce metabolism or excretion, respectively.

A drug is defined as a biologically active substance that can modify

cellular function A drug can modify cellular function. A general understanding of drug action allows the dental hygienist to make informed decisions regarding possible drug interactions or adverse reactions for the patient. It is a concern that discarded drugs may be affecting the environment, but this is not the definition of a drug. Some drugs may have the capacity to modify body compartment pH; however, this is not the definition for a drug. Some drugs may have the capacity to modify the immune response, but this is not the definition of a drug.

The heading of a prescription contains the following information except the

date of birth of the prescriber. Including the date of birth of the patient on the prescription is important, both to determine the proper dose for age and also the patient is not confused with another family member (i.e., mother or daughter). The heading of a prescription contains the name, address, and telephone number of the prescriber, as well as the name, address, age, and telephone number of the patient, and the date of the prescription.

An "orphan drug" is

developed specifically to treat a rare medical condition. Rare medical conditions with orphan status refer to diseases that occur in fewer than 200,000 people in the United States. Orphan drugs may be related to other medications. Orphan drug status is not related to the time the drug has been available. Many newer drugs have been assigned orphan status.

The movement of a drug from one site in the body to other sites is called

distribution. Distribution is the movement of a drug from the site of absorption or injection to other sites. Disruption is the initial destruction of a tablet coating or capsule during oral absorption. Dispersion is the spread of concentrated drug particles throughout the stomach or intestines. Active transport is a process involved in the passage of certain agents, including some drugs, across membrane barriers and may be involved in not only drug redistribution but also drug absorption, distribution, or excretion.

A drug effect that is neither predictable nor dose related is called a

drug allergy. Unlike other adverse reactions, allergic reactions are neither predictable nor dose related. Approved pharmaceuticals are available for use because they produce a predictable and dose-related therapeutic response. Toxic reactions and side effects are dose-related effects, the former on the target organ and the latter on nontarget organs. They might be surprising when they arise, for instance, in patients who are especially sensitive to a drug's effects. However, they are predictable based on the drug's dose-response relationship.

The need for an increasingly larger dose of a drug to obtain the same effects as the original dose is

drug tolerance. Tolerance is a phenomenon in which the body changes in some way so that the same dose of drug has a weaker effect over time. Persons who display drug dependency may also display tolerance, but they are two different phenomena. Insufficiency is not a term used to describe the tolerance phenomenon. Craving, similar to tolerance, may occur alongside drug dependence, but the desire to have more drug is not synonymous with tolerance to a drug's effects.

The half-life of a drug is most related to its

duration Half-life is the amount of time required for a drug to fall to one half of its blood level. It is an expression of how long the drug lasts in the body. Onset is the time at which a drug starts to take effect. The half-life does not predict the relative safety of a drug; safe drugs can have long or short half-lives. Time to peak concentration refers to how much time is required for a drug to reach effective levels in the body, not how long a drug lasts in the body.

In comparing two drugs, the dose-response curve for the drug that is more efficacious would

have a greater curve height. Efficacy is an expression of maximum intensity of effect or response that can be produced by a drug. The other choices refer to indicators of drug potency, not efficacy. The potency of a drug is a function of the amount of drug required to produce an effect. The potency of drug is shown by the location of that drug's curve along the log-dose axis (x-axis).

A genetically related abnormal drug response is called a(n)

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

The word stat on a prescription means

immediately. The word stat on a prescription means immediately (now). The abbreviation ac means before meals, hs means at bedtime, and q means every.

An enteral route of administration would be

oral. Enteral means situated or occurring inside of the gastrointestinal tract (intestines). Intravenous, sublingual, and transdermal routes of administration bypass the gastrointestinal tract.

The abbreviation used on prescriptions for four times a day is

qid. qid is the abbreviation for quarter in die, or four times a day. bid stands for twice a day, qd stands for every day, and ud stands for as directed.

All of the following choices are true with regard to cytochrome P-450 hepatic microsomal enzymes except that they

inactivate drugs through conjugation reactions. Cytochrome P-450 hepatic microsomal enzymes inactivate drugs but not through conjugation. They are involved in phase I metabolism and metabolize drugs through oxidation, reduction, and hydrolysis reactions. Phase II reactions involve conjugation with glucuronic acid, sulfuric acid, acetic acid, or an amino acid. Cytochrome P-450 hepatic microsomal enzymes can be induced to speed up drug metabolism or inhibited to reduce or slow down drug metabolism. They exist as numerous isozymes that have specificity for certain drugs. Examples of isoenzymes include cytochrome P-450 and 3A4.

The _____ is the most common site for biotransformation.

liver The liver is the most common site for biotransformation. Biotransformation is the body's way of changing a drug so that the kidneys can more easily excrete it. The liver rather than kidney, blood plasma, or small intestine is the most common site for biotransformation.

Advantages of oral administration of a drug include all the following except

more predictable response than intravenous administration. Intravenous administration offers a more predictable response than the oral route because the drug is injected directly into the bloodstream, bypassing many physiologic barriers, the hostile environment of the gastrointestinal tract, and drug-metabolizing enzymes that are encountered during oral absorption of a drug. Others are all characteristics of oral administration.

When different drugs compete for the same receptor sites, the drug with the stronger affinity for the receptor will bind to

more receptors than the drug with the weaker affinity. When different drugs compete for the same receptor sites, the drug with the stronger affinity for the receptor will bind to more receptors than the drug with the weaker affinity. More of the drug with weaker affinity will be required to produce a pharmacologic response. Drugs with a stronger affinity for receptor sites are more potent than drugs with weaker affinities for the same site.

The metabolite formed during metabolism (biotransformation) is usually _____ polar and _____ lipid soluble than its parent compound.

more; less The metabolite is usually more polar and less lipid soluble than its parent compound, meaning that renal tubular reabsorption of the metabolite will be reduced because reabsorption favors lipid-soluble compounds. Metabolites are also less likely to bind to plasma or tissue proteins and less likely to be stored in fat tissue. Drugs must pass through various membranes such as cellular membranes, blood capillary membranes, and intracellular membranes. The lipid in the membranes makes them relatively impermeable to ions and polar molecules. Decreased renal tubular absorption, decreased binding to the plasma or tissue proteins, and decreased fat storage cause the metabolite to be excreted more easily.

A patient's perception that a pill without active ingredients is having a pharmacologic effect is termed

placebo effect. Placebo effect is the term used to report when a patient perceives a pharmacologic effect after administration of a medication without active ingredients. Tachyphylaxis is a rapid loss of drug sensitivity, akin to tolerance; the other choices are nonsensical answers. Compliance is the ability of a patient to adhere to the instructions of his or her physician.

With zero-order kinetics, the

same amount of drug is metabolized and eliminated from the body per unit of time regardless of dose. With high doses, the metabolism of the drug cannot increase and the duration of action of the drug can be greatly prolonged. Zero-order kinetics occurs because the enzymes that metabolize these drugs can become saturated at usual therapeutic doses. If the dose of the drug is increased, the metabolism cannot increase above its maximum rate.

A dose-related reaction that produces undesirable effects caused by the action on nontarget organs is called a

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