Random Pharm Ch. 4-8

The anatomy of what system contains long preganglionic nerves and short postganglionic nerves?

Parasympathetic autonomic

The parasympathetic fibers originate in the nuclei of the

Sacral and lumbar segments of the spinal cord

A drug with anticholinergic side effects except

Salivation

Indications for the use of anticholinergic agents include

Treatment in combination with levodopa for patients with Parkinson disease

The action of norepinephrine is terminated by which of the following choices

-Uptake into the presynaptic nerve terminal by an amine-specific pump -Action of catechol-O-methyltransferase (COMT) -Action of monoamine oxidase (MAO)

Ipratropium is found in a(n) __________ inhaler used to treat asthma

. Anticholinergic

Patients pretreated with __________ are prone to epinephrine reversal.

α-Adrenergic blocking agents

34. All currently available interferons are parenteral.

ANS: True REF: p. 110

33. Acyclovir can prevent the postherpetic neuralgia produced by shingles.

ANS: False REF: p. 109

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

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

31. Most antiviral agents are protein synthesis inhibitors.

ANS: False Correct: Most antiviral agents are either purine or pyrimidine analogues that inhibit DNA synthesis. REF: p. 107

30. A patient who feels nauseated after taking codeine is allergic to it.

ANS: False Correct: Nausea is a normal pharmacologic action of codeine on the chemoreceptor trigger zone in the brain. REF: p. 70

80. There is no evidence that antibiotic prophylaxis prior to a dental procedure will prevent infective endocarditis in those at risk for developing it.

ANS: True A comprehensive review of published studies found there was no compelling evidence in the medical and dental literature that antibiotic prophylaxis before a dental procedure would prevent infective endocarditis in those at risk for developing it. REF: p. 98

79. Daily activities, such at toothbrushing, are more likely to produce infective endocarditis than dental procedures.

ANS: True A comprehensive review of published studies suggest that infective endocarditis is more likely to occur from bacteria entering the bloodstream as a result of daily activities than from a dental procedure. REF: p. 98

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

32. No acyclovir products are approved for the treatment of recurrent herpes labialis in the immunocompetent patient.

ANS: True Correct: Although available literature does not support the use of topical acyclovir for management of herpes labialis in dentistry, it is used extensively. REF: p. 107

31. Opioids are not indicated for the treatment of chronic pain, such as temporomandibular joint and muscle disorders.

ANS: True Correct: Because of their dependence liability, opioids should not be prescribed for patients with chronic pain (unless they are terminally ill). REF: p. 75

28. Codeine activates the chemoreceptor trigger zone.

ANS: True Correct: Codeine can cause nausea and vomiting by acting on this medullary structure. REF: p. 69

27. Morphine is stronger than oxycodone.

ANS: True Correct: Morphine has greater efficacy (analgesic power) than oxycodone. REF: pp. 66, 71

41. Two components of pain include perception and reaction.

ANS: True Correct: Perception and reaction are two distinct components of pain. REF: p. 49

30. Oral candidal infections are often treatable with oral antifungal lozenges and rinses.

ANS: True Correct: Preparations of nystatin and clotrimazole are available to treat oral candidiasis in a nonsystemic manner. REF: pp. 102-104

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

ANS: True Correct: Salicylates inhibit the COX enzyme, which produces prostaglandins. REF: p. 51

29. Combining an opioid with a nonopioid analgesic produces an additive analgesic effect with fewer adverse reactions.

ANS: True Correct: These agents work at two different levels on pain and produce an additive analgesic effect. In combination products, lower doses of each analgesic may be used, and a potential exists for a reduction in adverse reactions. REF: p. 70

77. Antiinfectives are not needed in oral cavity infections if drainage of the infected area can be established.

ANS: True For most localized dental infections, if adequate drainage can be obtained, antiinfective agents are not indicated unless the patient is immunocompromised. REF: p. 76

78. Metronidazole has antiinflammatory activity.

ANS: True Metronidazole affects neutrophil motility, lymphocyte action, and cell-mediated immunity. REF: p. 90

20. Which of the following groups of penicillins is considered to be the natural penicillin? a. Penicillin G b. Penicillinase-resistant penicillins c. Amoxicillin d. Extended-spectrum penicillins

ANS: a Although many naturally occurring penicillins have been produced, only penicillin G is of use today. The various semisynthetic penicillins are formed by substituting other groups at the R position. REF: p. 82

12. Which of the following effects is the most common side effect from aspirin? a. Gastrointestinal effects b. Bleeding c. Hepatic and renal effects d. 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

23. Which of the following agents allows the use of amoxicillin to treat penicillinase-producing organisms? a. Clavulanic acid b. Divalent cations c. Corticosteroids d. Disulfiram

ANS: a Clavulanic acid serves as an inhibitor, which allows the use of amoxicillin to treat penicillinase-producing organisms. REF: p. 83

3. If an infection is just beginning, the organisms most likely to be present are: a. Gram-positive cocci b. Gram-negative cocci c. Gram-positive anaerobes d. Gram-negative anaerobes

ANS: a Gram-positive cocci are most likely to present if the infection is just beginning. After a short time, the gram-positive infection begins to include a variety of both gram-positive and gram-negative anaerobic organisms. With additional time and no treatment, the infection progresses until it consists of predominantly anaerobic flora. REF: p. 77

13. Which of the following statements is true concerning a culture and sensitivity test? a. An antibiotic disk with a zone around it shows sensitivity. b. An antibiotic disk with no zone around it shows sensitivity. c. Antibiotic therapy should not be initiated until the results of the test are available. d. One to two weeks are required before the results of this test are available.

ANS: a Correct: A zone of inhibition around the disk shows the organism is sensitive to the agent. After the organism is identified, it is grown on culture medium. Observing whether the organisms are sensitive or resistant to certain test antibiotics assists in determining which antibiotic to use in difficult infections. Incorrect choices: One to two days are required before the results of the test are available. Although antibiotic therapy can start before this time, it may be changed after the results are available. If clinical response has been adequate, the original antibiotic is often continued despite sensitivity results. REF: p. 79

20. Which of the following is true of acyclovir? a. It works by inhibiting replication of deoxyribonucleic acid (DNA). b. It should be taken on an empty stomach because food affects the drug's absorption. c. 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. d. The most common adverse effects associated with oral acyclovir are anorexia and a funny taste in the mouth.

ANS: a Correct: Acyclovir works by inhibiting replication of DNA. Incorrect: Food does not affect the drug's absorption. The antiviral action of acyclovir includes various herpesviruses, including HSV-1 and HSV-2, varicella-zoster, Epstein-Barr, Herpesvirus simiae (B virus), and cytomegalovirus. One of the most common adverse effects associated with oral acyclovir is headache (13%). Anorexia and a funny taste in the mouth have been reported rarely. REF: p. 107

29. Which drug should be used before oral prophylaxis for a patient who has rheumatic heart disease with no known drug allergies? a. Amoxicillin b. Tetracycline c. Clindamycin d. Erythromycin

ANS: a Correct: Amoxicillin is the standard treatment of choice if no complicating factors are present, such as allergy to penicillins. Incorrect choices: Tetracycline is never indicated for infective endocarditis prophylaxis just before dental procedures because it is likely to produce bacteremia. Clindamycin is a recommended alternative to amoxicillin if penicillin allergies exist, and erythromycin analogues azithromycin and clarithromycin are also good alternatives. REF: p. 85

14. Aspirin can be used most safely in patients who: a. Have arthritis b. Have gout c. Have ulcers d. 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

32. Which of the following choices is currently the most popular COX II-specific agent on the market? a. Celecoxib b. Rofecoxib c. Valdecoxib d. 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

50. A cephalosporin would be most closely related to which of the following agents? a. Penicillin VK b. Clarithromycin c. Ciprofloxacin d. Doxycycline e. Clindamycin

ANS: a Correct: Cephalosporins and penicillins have similarities in structure; they are both β-lactam antibiotics. They also have the same mechanism of action. Incorrect choices: Clarithromycin is a macrolide, ciprofloxacin is a fluoroquinolone, doxycycline is a tetracycline, and clindamycin is analogue of lincomycin, not structurally related to any others. Its mechanism of action is similar to that of macrolides. REF: p. 92

26. HIV-2 is only transmitted: a. From a woman to her child while the child is in the womb b. Via sexual intercourse c. By intravenous substance abuse d. By sharing of bodily fluids

ANS: a Correct: HIV-2 is different from HIV-1 in that it is only transmitted from a woman to her child while the child is in the womb. This particular form of the virus appears to be centralized in western Africa. Incorrect choices: HIV-1 is transmitted via sexual intercourse, sharing of bodily fluids, and intravenous substance abuse, and during pregnancy and childbirth. REF: p. 110

9. Similar to the MAC of general anesthesia, the MIC is a measure of potency. The lower the MIC is, the higher the potency will be. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second statement is false. d. The first statement is false, the second statement is true.

ANS: a Correct: MAC and MIC are both measures of pharmacologic potency, and as with the MAC, the lower the MIC is, the higher the potency will be. MIC is the minimal inhibitory concentration of an antibacterial; MAC is the maximal alveolar concentration. REF: p. 78

23. Which of the following is true concerning NSAIDs? a. Many authors agree that the NSAIDs are the most useful drug group for the treatment of dental pain. b. Unlike aspirin, NSAIDs do not inhibit the enzyme cyclooxygenase (COX). c. Most NSAIDs reach a peak blood level in approximately 20 minutes. d. 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

4. Although morphine has its most potent action on the __________ classes of opioid receptors, pentazocine has its most potent action on the __________ classes of opioid receptors. a. Mu, kappa b. Mu, delta c. Sigma, delta d. Kappa, mu e. Delta, kappa

ANS: a Correct: Morphine is a mu-receptor agonist, and pentazocine is a kappa-receptor agonist. REF: p. 67

21. Caffeine is often combined with aspirin because caffeine potentiates the analgesic effect of aspirin and other analgesics. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true, the second part is false. d. 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

14. Which is an advantage of the nonsteroidal antiinflammatory drugs (NSAIDs) over the opioids? a. They are not addictive. b. They are antitussive. c. They are all useful if the patient is pregnant. d. They cause less fluid retention (edema).

ANS: a Correct: NSAIDs are not addictive, tolerance does not develop, and no withdrawal syndrome can be induced. Incorrect choices: NSAIDs are not antitussive, some are less useful than others in pregnant women, and NSAIDs can cause decreased renal function, leading to peripheral edema formation. REF: p. 69

25. Which of the following NSAIDs is designated U.S. Food and Drug Administration (FDA) pregnancy category B? a. Naproxen b. Diflunisal c. Tolmetin d. 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

2. Which of the following agents has poor oral absorption? a. Nystatin b. Itraconazole c. Terbinafine d. Griseofulvin

ANS: a Correct: Nystatin is not absorbed from the mucous membranes or through intact skin; taken orally, it is poorly absorbed from the gastrointestinal tract. Incorrect choices: Itraconazole, terbinafine, and griseofulvin all have good oral bioavailability. REF: p. 103

68. The drug whose future use may include organisms found in periodontal disease is: a. Ofloxacin b. Sulfamethoxazole c. Macrodantin d. Streptomycin

ANS: a Correct: Ofloxacin's spectrum of action most closely parallels the spectrum of microbes found in dental infections. Incorrect choices: Sulfa drugs have no use in dentistry. Macrodantin is used for UTIs. Streptomycin was formerly used prophylactically for heart valve replacement; however, orally active agents are now recommended. REF: p. 95

28. Which of the following statements is true regarding penicillinase-resistant penicillins? a. Penicillinase-resistant penicillins should be reserved for use against only penicillinase-producing staphylococci. b. Penicillinase-resistant penicillins are more effective against penicillin G-sensitive organisms when compared with penicillin G. c. Penicillinase-resistant penicillins produce fewer side effects when compared with penicillin G. d. Patients allergic to penicillin are not also allergic to the penicillinase-resistant penicillins.

ANS: a Correct: Penicillinase-resistant penicillins should be reserved for use against only penicillinase-producing staphylococci. Incorrect: The penicillinase-resistant penicillins are less effective against penicillin G-sensitive organisms when compared with penicillin G. Penicillinase-resistant penicillins produce more side effects when compared with penicillin G. Patients allergic to penicillin are also allergic to the penicillinase-resistant penicillins. REF: p. 84

10. Which one of the following conditions can be managed or treated with opioids? a. Diarrhea b. Depression c. Infections d. Hypertension

ANS: a Correct: The opioids produce constipation by producing a tonic contraction of the gastrointestinal tract. They are used for the treatment of diarrhea. Incorrect choices: Opioids are not used for depression, infections, or hypertension. REF: p. 68

26. Which of the following salts of penicillin G produces the most rapid and highest blood level? a. Potassium salt given intravenously b. Potassium salt given intramuscularly c. Benzathine salt given intramuscularly d. Procaine salt intramuscularly

ANS: a Correct: The potassium salt given intravenously produces the most rapid and highest blood level. The penicillin's duration of action is inversely proportional to the solubility of the penicillin form: the least soluble is the longest acting. Incorrect choices: The benzathine salt given intramuscularly produces the lowest and most sustained blood level. The potassium and procaine salts, given intramuscularly, produce intermediate blood levels and durations of action. REF: p. 84

13. A patient presents with itching and urticaria after codeine administration. This response most likely represents a: a. Pharmacologic action of codeine b. Hypersensitivity reaction to codeine c. Placebo effect from receiving codeine d. Reaction unrelated to codeine administration

ANS: a Correct: The response is a pharmacologic action of codeine. Opioids can stimulate the release of histamine. Itching and urticaria can result from their administration. Incorrect choices: Although possible, true opioid allergy is very uncommon. Although a placebo effect may be observed with any drug, this choice is less likely. The reaction is probably related and a pharmacologic action of codeine. REF: p. 69

19. Viruses are difficult to treat because they cooperate with the host's cells. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true, the second part is false. d. The first part of the statement is false, the second part is true.

ANS: a Correct: The search for drugs useful in the treatment of viral infections has posed the greatest problem of all infectious organisms, which is because viruses are obligate intracellular organisms that require cooperation from their host's cells. Therefore, to kill the virus, often the host's cell must also be harmed. REF: p. 106

15. Tolerance occurs to the following effects of the opioids except one. Which one is the exception? a. Miosis b. Analgesia c. Respiratory depression d. Nausea e. Histamine release

ANS: a Correct: Tolerance will not develop to miosis and constipation. It can develop to all of the other listed effects. REF: p. 69

23. 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. a. One half day b. 2 days c. 5 days d. 7 to 10 days

ANS: a Docosanol 10% has been shown to decrease healing time by about one half day in patients with recurrent orolabial herpes when started within 12 hours of the appearance of prodromal symptoms. REF: p. 109

15. Which of the following is the first antifungal agent to be effective in the treatment of onychomycosis of the toenail or fingernail? a. Itraconazole b. Ketoconazole c. Fluconazole d. Clotrimazole

ANS: a Itraconazole is the first antifungal agent to be effective for the treatment of onychomycosis. It is used to treat blastomycosis, histoplasmosis, and aspergillosis. REF: p. 105

46. Administration of metronidazole for dental infections during pregnancy is: a. Contraindicated b. Permitted only during the second trimester c. Permitted during the last half of pregnancy d. Permitted without restriction

ANS: a Metronidazole is contraindicated during pregnancy. Nursing mothers should not be given metronidazole unless milk is expressed and discarded beginning when the metronidazole is taken and continuing for 48 hours after discontinuing the drug. REF: p. 90

22. The oral form of acyclovir is indicated in the treatment of initial herpes genitalis and management of recurrent herpes genitalis infections in: a. Both immunocompromised and nonimmunocompromised patients b. Immunocompromised but not nonimmunocompromised patients c. Nonimmunocompromised but not immunocompromised patients d. Neither immunocompromised nor nonimmunocompromised patients

ANS: a The oral form of acyclovir is indicated in the treatment of initial herpes genitalis and management of recurrent herpes genitalis infections in both immunocompromised and nonimmunocompromised patients. It is effective in the prophylaxis of recurrent herpes genitalis infections in both patient groups. It is not indicated for the suppression of recurrent herpes genitalis in patients with mild infections. REF: p. 107

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 a. 1, 2, 3, 4 b. 1, 2, 3 c. 2, 3, 4 d. 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

54. Which of the following antibiotics would be the best choice to attack the anaerobes in a stage 2 infection? a. Clindamycin or metronidazole b. Ampicillin or amoxicillin c. Amoxicillin or augmentin d. Ciprofloxacin

ANS: a To attack the anaerobes, an antiinfective with good anaerobic coverage is needed. The two antibiotics with the most anaerobic coverage are clindamycin and metronidazole. Penicillin V also has anaerobic coverage. REF: p. 92

69. Rupture of the Achilles tendon is associated with the use of: a. Tetracyclines b. Quinolones c. Rifampin d. Mupirocin

ANS: b An unusual reaction affecting the Achilles tendon has become fairly common in patients taking quinolones. These agents can produce tendonitis or tendon rupture in the Achilles tendon, so exercise should be limited. REF: p. 95

10. The ability of aspirin to reduce fever results from its inhibition of prostaglandin synthesis in the: a. Medulla b. Hypothalamus c. Pons d. 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

31. Which of the following antibiotics is available mixed with clavulanic acid? a. Ampicillin b. Amoxicillin c. Carbenicillin d. Azithromycin

ANS: b Augmentin is amoxicillin is mixed with clavulanic acid. Clavulanic acid combines with and inhibits the β-lactamases produced by bacteria. Therefore the amoxicillin is protected from enzymatic inactivation. This combination can be taken with penicillinase-producing organisms. It has had some use in the management of certain periodontal conditions. REF: 85

37. Which of the following agents is the drug of first choice against infections cause by aerobic microorganisms in penicillin-allergic patients? a. Metronidazole b. Erythromycin c. Doxycycline d. Clindamycin

ANS: b Because erythromycin is active against essentially the same aerobic microorganisms as penicillin, it is the drug of first choice against these infections in penicillin-allergic patients. Erythromycin is not effective against the anaerobic Bacteroides species implicated in many dental infections. REF: p. 86

37. Who is most likely to experience the most cases of accidental overdose with acetaminophen? a. Infants b. Children c. Young adults d. 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

5. The main advantage of nystatin pastilles over the aqueous suspension is that: a. The pastilles do not contain sugar like the suspension. b. 15 minutes are required for the lozenge to dissolve in the mouth. c. The pastilles have twice rather than four times dosing a day as in the suspension, improving compliance. d. The pastilles are swallowed, whereas the suspension should be spit out.

ANS: b Correct: 15 minutes are needed for the lozenge to dissolve in the mouth, thus bathing lesions in the antifungal agent for a longer period. Incorrect choices: Both the suspension and the pastilles contain sugar, and both are used four times daily. The directions to the patient for the aqueous suspension are to swish, swirl, spit or swallow 5 ml four times daily. REF: p. 104

44. Which of the following agents causes pseudomembranous colitis as a toxicity that limits its general use? a. Erythromycin b. Clindamycin c. Penicillin VK d. Metronidazole

ANS: b Correct: A historical association exists between clindamycin use and pseudomembranous colitis, which limits its use relative to other eligible antibacterial agents. Incorrect choices: Pseudomembranous colitis is associated with other antibacterials. These are tetracycline, ampicillin, and the cephalosporins. REF: p. 89

15. Which of the following choices is the best to use in pediatric patients for both its analgesic and antipyretic action? a. Aspirin b. Acetaminophen c. NSAIDs d. 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

36. An acute overdose with acetaminophen may damage the: a. Eyes b. Liver c. Spleen d. 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

7. What do aspirin, acetaminophen, ibuprofen, and codeine have in common? a. They are all antiinflammatory. b. They are all analgesic. c. They all inhibit platelet aggregation. d. They are all antipyretic.

ANS: b Correct: All of them are analgesic. Incorrect choices: Aspirin and ibuprofen are analgesic, antipyretic, and antiinflammatory, and they inhibit platelet aggregation. Acetaminophen is analgesic and antipyretic. Codeine is analgesic. REF: p. 68

57. Aminoglycosides: a. Are bacteriostatic b. Are used primarily to treat aerobic gram-negative infections when other agents are ineffective c. Are indicated for stage 1 infections d. Inhibit cell wall synthesis

ANS: b Correct: Aminoglycosides are used primarily to treat aerobic gram-negative infections when other agents are ineffective. They have little action against gram-positive anaerobic or facultative bacteria. Incorrect choices: The aminoglycosides are bactericidal. Because they have little action against gram-positive anaerobic or facultative bacteria, aminoglycosides would not be the drug of choice for treatment of a stage 1 infection. Rather, the drug of choice in patients without a penicillin allergy is penicillin V 500 mg every 6 hours for 5 to 7 days. Aminoglycosides appear to inhibit protein synthesis and to act directly on the 30S subunit of the ribosome. REF: p. 93

7. Ketoconazole: a. Will not cross the placenta nor be excreted in breast milk b. Requires an acidic environment for adequate systemic absorption c. Is excreted primarily by the kidneys d. Is the drug of choice for treatment of tinea

ANS: b Correct: An acidic environment is required for the adequate systemic absorption of ketoconazole. Medications that interfere with the normal production of stomach acid, such as histamine-2 (H2)-blockers or H2-receptor antagonists and proton pump inhibitors, reduce the absorption of ketoconazole. Incorrect choices: Ketoconazole crosses the placenta and is excreted in breast milk. Ketoconazole is metabolized in the liver, and approximately 13% is excreted by the kidney, with a half-life between 2 and 8 hours. Ketoconazole is not the drug of choice for the treatment of tinea unless traditional agents have failed. REF: pp. 104-105

25. Which of the following statements is true regarding penicillin allergy? a. Allergic reactions with oral penicillin are more common than with parenteral penicillin. b. Anaphylactic reactions are more frequent in patients pretreated with β-blockers and subsequently given oral penicillin c. The treatment of anaphylaxis caused by penicillin is the immediate administration of corticosteroids. d. Estimates indicate that 10,000 to 30,000 deaths occur annually in the United States because of an allergic reaction to penicillin.

ANS: b Correct: Anaphylactic reactions are more frequent in patients pretreated with β-blockers and subsequently given oral penicillin. Anaphylactic reactions in these patients have been reported to be difficult to treat. Incorrect choices: Allergic reactions with parenteral penicillin are more common than with oral penicillin. The treatment of anaphylaxis caused by penicillin is the immediate administration of parenteral epinephrine. An estimated 100 to 300 deaths occur annually in the United States because of an allergic reaction to penicillin. REF: p. 84

55. Which of the following statements is true of vancomycin? a. Vancomycin is related to the cephalosporins. b. Vancomycin is usually administered only intravenously for a systemic effect. c. Vancomycin is bacteriostatic. d. Vancomycin has a broad spectrum of action against a wide variety of gram-positive and gram-negative organisms.

ANS: b Correct: Because vancomycin has very poor gastrointestinal absorption and causes irritation when used intramuscularly, it is usually administered only intravenously for a systemic effect. Incorrect choices: Vancomycin is unrelated to any other antibiotic currently marketed. It is bactericidal and has a narrow spectrum of activity against many gram-positive cocci, including both staphylococci and streptococci. REF: p. 93

33. Clavulanic acid is used to fight infections with which of the following resistance mechanisms? a. Decreased permeability to the agent b. Production of drug-inactivating enzymes c. Alteration in the site of action d. Any of the above

ANS: b Correct: Clavulanic acid is an inhibitor of penicillinase (β-lactamase), an enzyme produced by bacteria that can inactivate β-lactam-containing enzymes. Incorrect choices: Clavulanic acid is not effective in circumventing resistance mechanisms. REF: p. 85

8. Which opioid is commonly used as an antitussive? a. Propoxyphene b. Dextromethorphan c. Diphenoxylate d. Pentazocine

ANS: b Correct: Dextromethorphan is commonly used as an antitussive (designated by the DM on cough syrup labels). Incorrect choices: Propoxyphene is found in Darvocet N-100. Diphenoxylate is in Lomotil, which is used to treat diarrhea. Pentazocine produces central nervous system (CNS) effects not unlike the opioid agonists, including analgesia, sedation, and respiratory depression. REF: p. 68

14. All of the following antifungal agents are useful in dentistry except: a. Miconazole b. Fluconazole c. Clotrimazole d. Ketoconazole

ANS: b Correct: Fluconazole is used for oropharyngeal and esophageal candidiasis. The others are used in dentistry. REF: p. 105

18. Experts recommend taking which of the following antifungal agents with a fatty meal? a. Clotrimazole b. Griseofulvin c. Amphotericin B d. Nystatin

ANS: b Correct: Griseofulvin bioavailability is greater than the other choices when administered with a fatty meal. Incorrect choices: Oral administration is not an effective route for systemic absorption of clotrimazole, amphotericin B, or nystatin. REF: p. 106

28. Dental pain is best managed with which of the following choices? a. Codeine 60 mg b. Ibuprofen 400 mg c. Acetaminophen 650 mg d. Aspirin 650 mg e. 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

27. Which of the following agents is known to have a drug interaction with lithium? a. Aspirin b. Naproxen c. Acetaminophen d. 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

25. Which of the following choices is the drug of choice to treat a patient who has taken an overdose of an opioid? a. 2-pralidoxime b. Naloxone c. N-acetylcysteine d. Activated charcoal e. Methadone

ANS: b Correct: Naloxone is an opioid antagonist that will block the therapeutic and toxic actions of opioids; the others are not. Methadone is an opioid used in treatment of addiction, but will exacerbate symptoms of an opioid overdose. REF: p. 74

25. Which of the following agents is a nonnucleoside reverse transcriptase inhibitor used to treat HIV infection? a. Saquinavir b. Nevirapine c. Zidovudine d. Amantadine

ANS: b Correct: Nevirapine is a nonnucleoside reverse transcriptase inhibitor specific for HIV-1. It inhibits the same enzymes as the nucleoside analogues but does not require bioactivation. Incorrect choices: Saquinavir is an HIV protease inhibitor. Zidovudine is a nucleoside reverse transcriptase inhibitor. Amantadine inhibits the penetration of the adsorbed virus into the host's cells or inhibits the uncoating of the influenza A viruses. REF: p. 110

5. Pain relief by nonopioid analgesics is mediated via action: a. At the central nervous system (CNS) b. At the peripheral nervous system c. Both centrally and peripherally d. 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: a. The CNS b. Prostaglandin synthesis c. Release of epinephrine d. 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

73. Infective endocarditis prophylaxis with an antiinfective is indicated for patients who have had: a. Coronary artery bypass surgery b. Prosthetic heart valve c. Functional murmur d. Cardiac pacemaker

ANS: b Correct: Patients with prosthetic heart valves constitute a population at risk for developing infective endocarditis. Incorrect choices: Coronary artery bypass surgery, functional murmur, and cardiac pacemaker are all conditions that most clinicians believe do not require prophylactic antibiotic coverage. REF: p. 99

23. Analgesia and respiratory depression are known to increase in parallel with increasing dose for the following opioid analgesics, except one. Which one is the exception? a. Morphine b. Pentazocine c. Heroin d. Methadone

ANS: b Correct: Pentazocine is a mixed agonist-antagonist opioid. Unlike the agonist opioids, increasing the dose of pentazocine does not result in a commensurate increase in respiratory depression; that is, respiratory depression is nonlinear. REF: p. 73

16. Which is the major symptom of opioid overdose? a. Miosis b. Respiratory depression c. Urticaria d. Mydriasis

ANS: b Correct: Respiratory depression occurs with opioid overdose, and this symptom can lead to death. Incorrect choices: Opioids cause miosis, not mydriasis, but the former is not a life-threatening symptom. Urticaria can be caused by opioids, but this is not life threatening in an overdose situation either. REF: p. 69

16. Which agent, when systemically administered, has the poorest safety profile? a. Griseofulvin b. Amphotericin B c. Fluconazole d. Terbinafine

ANS: b Correct: The adverse reactions associated with amphotericin are wide ranging and potentially serious, but it is often the only effective treatment for certain serious systemic fungal infections. Because of its side effects, it has earned the nickname "amphoterrible." Incorrect choices: Although by no means innocuous, the adverse effects of griseofulvin, fluconazole, and terbinafine are tolerable enough that they are often used systemically for long-term treatment of tinea infections and onychomycosis. REF: p. 105

70. Which of the following combinations of three drugs are administered concurrently in all active cases of tuberculosis (TB)? a. Pyrazinamide (PZA), rifapentine, and Rifater b. Isoniazid (INH), rifampin, and pyrazinamide c. Ethambutol, isoniazid (INH), and Rifater d. Rifampin, PZA, and streptomycin

ANS: b INH, rifampin, and PZA are combined for the treatment of pulmonary TB. INH and rifampin are continued every day for 9 to 12 months. PZA is continued for 2 months. With susceptible organisms, a patient, if compliant, usually becomes noninfective within 2 to 3 weeks. REF: p. 96

6. Which of the following statements is true concerning the pharmacokinetics of opioid analgesics? a. Absorption may occur through mucous membranes of the nose but is not possible through intact skin. b. The oral-to-parenteral ratio determines the difference in bioavailability between an opioid administered orally and one given parenterally. c. Given orally, opioids have vastly different durations of action for analgesia, ranging from 1 to almost 12 hours. d. Metabolized opioids are excreted in urine; however, the unchanged drug is not.

ANS: b Correct: The difference in bioavailability between an opioid administered orally and one given parenterally is determined by the oral-to-parenteral ratio. For example, the ratio is 0.2 to 0.3 for morphine, 0.25 to 0.70 for meperidine, and 0.4 to 0.7 for codeine. Incorrect choices: Absorption occurs through the mucous membranes of the nose and the intact skin. Given orally, most opioids have a similar duration of action for analgesia—4 to 6 hours. Metabolized opioids and the unchanged drug are excreted in the urine. REF: p. 68

19. A drug interaction between aspirin and ____________ can result in significant bleeding. a. Probenecid b. Warfarin c. Methotrexate d. 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

11. Which of the following conditions is an adverse reaction to the opioids? a. Diarrhea b. Miosis c. CNS excitation d. Hepatotoxicity

ANS: b Correct: The opioid analgesics cause miosis, an important sign (pinpoint pupils) in diagnosing an opioid overdose or identifying an addict. Incorrect choices: Opioids produce constipation and sedation. They do not produce hepatotoxicity. REF: p. 69

5. Oral bioavailability of opioids is primarily limited by: a. Incomplete absorption b. First-pass metabolism c. Side effects of nausea and vomiting d. Enterohepatic circulation e. Rapid renal excretion

ANS: b Correct: The opioids undergo variable first-pass metabolism in the liver or intestinal cell wall, which reduces their bioavailability. Incorrect choices: Most opioid analgesic agents are absorbed well when taken orally. Opiates need to be available before they cause the side effects of nausea and vomiting. Most opioids are excreted through the kidneys, but this action does not selectively affect their availability after oral administration. REF: p. 68

24. Which of the following statements is true of zidovudine? a. It prevents cells containing human immunodeficiency virus (HIV) from replicating. b. The toxicity of zidovudine is related to bone marrow depression. c. It has no effect on the number and frequency of opportunistic infections. d. Both a and b are true. e. Both b and c are true.

ANS: b Correct: The toxicity of zidovudine is related to bone marrow depression, which can lead to anemia, granulocytopenia, and thrombocytopenia. Incorrect choices: It has no effect on cells already containing HIV. Opportunistic infections are reduced in both number and frequency. REF: p. 109

2. Enkephalins, endorphins, and dynorphins probably function as __________, although their exact function has not been elucidated. a. Prostaglandins b. Neurotransmitters c. Sedative-hypnotics d. Enzymes

ANS: b Enkephalins, endorphins, and dynorphins probably function as neurotransmitters. They may be involved in the analgesic action of a placebo and the enhancement of well-being that occurs with running. REF: p. 67

18. __________ has the highest incidence of gastrointestinal complaints of any of the antibiotics. a. Penicillin b. Erythromycin c. Clindamycin d. Metronidazole

ANS: b Erythromycin has the highest incidence of gastrointestinal complaints. More serious gastrointestinal complaints, such as pseudomembranous colitis, which has been historically linked with clindamycin, are now known to occur not only with a wide variety of antiinfective agents, but also in the absence of any antimicrobial agents. REF: p. 81

34. Which of these agents do not inhibit bacterial cell-wall synthesis? a. Vancomycin b. Erythromycin c. Penicillin G d. Cefazolin

ANS: b Erythromycin is a bacteriostatic agent which inhibits bacterial protein synthesis. Incorrect choices: Vancomycin, penicillin G, and cefazolin all inhibit cell-wall synthesis. They are bactericidal. REF: pp. 82, 85

53. When a patient with a stage 1 infection is allergic to penicillin V, the best alternative would be: a. Penicillin G or ampicillin b. Erythromycin ethylsuccinate or clindamycin c. Tetracycline or metronidazole d. Vancomycin

ANS: b For a patient with a stage 1 infection who is allergic to penicillin, erythromycin ethylsuccinate or clindamycin may be used. REF: p. 92

10. Gynecomastia is an adverse effect that is specific to: a. Clotrimazole b. Ketoconazole c. Fluconazole d. Itraconazole

ANS: b Gynecomastia is specific to ketoconazole. Ketoconazole, in higher doses, inhibits the secretion of the corticosteroids and lowers the serum levels of testosterone. In men, this effect can produce gynecomastia and impotence. REF: p. 105

40. Tetracyclines should not be used in children younger than __________ years of age. a. 6 b. 9 c. 12 d. 15

ANS: b If tetracycline is administered between 2 months and 7 or 8 years of age, the permanent teeth will be affected. The mechanism involves the deposition of tetracycline in the enamel of the forming teeth. These stains are permanent and darken with age and exposure to light. They begin as a yellow fluorescence and progress with time to brown. REF: p. 87

45. Which of the following is the most common adverse reaction to administration of metronidazole? a. Central nervous system effects b. Gastrointestinal effects c. Renal toxicity d. Oral effects

ANS: b Metronidazole's most common adverse reactions involve the gastrointestinal tract. This side effect occurs in 12% of patients taking metronidazole. It includes nausea, anorexia, diarrhea, and vomiting. Epigastric distress and abdominal cramping have also been reported. REF: p. 90

30. Oral administration with __________ is indicated only as continuation to intravenous (IV) or intramuscular (IM) therapy. a. Fenoprofen b. Ketorolac c. Naproxen sodium d. 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

42. Which of the following antibiotics is associated with photosensitivity? a. Erythromycin b. Tetracycline c. Metronidazole d. Aminoglycosides (e.g., streptomycin)

ANS: b Patients taking tetracyclines who are exposed to sunlight sometimes react with exaggerated sunburn. REF: p. 88

2. Which of the following choices is the dental health care team's biggest problem in the adult patient? a. Caries b. Periodontal disease c. Localized dental infection d. Systemic dental infection

ANS: b Periodontal disease is the dental health care team's biggest problem in the adult patient. With an increase in knowledge about antiinfective agents, dental teams will be better able to understand and administer new treatments properly for this disease, such as tetracycline fibers. REF: p. 76

49. Large doses of cephalosporins often produce a Coombs reaction, which means: a. High blood pressure is exacerbated. b. The immune mechanism is attacking the patient's own red blood cells. c. Degeneration of neural glial cells occurs. d. Nephritis of the kidneys occurs.

ANS: b The Coombs reaction means the immune mechanism is attacking the patient's own red blood cells, which can lead to a significant degree of hemolysis. REF: p. 92

58. Which of the following antimicrobial agents is associated with ototoxicity? a. Vancomycin b. Aminoglycosides c. Nitrofurantoin d. Quinolones

ANS: b The aminoglycosides are toxic to the eighth cranial nerve, which can lead to auditory and vestibular disturbances, or ototoxicity. Patients may have difficulty maintaining equilibrium and can develop vertigo. Hearing impairment and deafness, which can be permanent, have resulted from the administration of these agents. The side effect is more common in patients with renal failure because the drug accumulates in the body. REF: p. 93

9. The most serious adverse reaction associated with ketoconazole is: a. Tachycardia b. Hepatotoxicity c. Hypotension d. Achlorhydria

ANS: b The most serious adverse reaction is hepatotoxicity. Its incidence is at least 1:10,000. It is usually reversible on discontinuation of the drug but, occasionally, it has been fatal. With extended use, the patient should have periodic liver function tests. REF: p. 105

9. __________ is usually the cause of death with an overdose of opioids. a. Tachycardia b. Respiratory depression c. Electrolyte imbalance d. Cellular necrosis

ANS: b The opioid analgesic agonists depress the respiratory center in a dose-related manner. This action is usually the cause of death with an overdose. The depression is related to a decrease in the sensitivity of the brainstem to carbon dioxide. Both the rate and the depth of breathing are reduced. REF: p. 69

8. The primary route of excretion for ketoconazole is: a. Urinary b. Biliary c. Salivary d. Exocrine

ANS: b The primary route of excretion for ketoconazole is biliary. Patients with hepatic impairment may require a lower dose. REF: p. 105

52. Which of the following antibiotics would be the best choice for treatment of an acute abscess or cellulitis? a. Metronidazole b. Erythromycin c. Penicillin V d. Clindamycin

ANS: c Acute abscess and cellulitis are primarily the result of gram-positive organisms. The drug of choice in patients without a penicillin allergy is penicillin V 500 mg every 6 hours for 5 to 7 days. REF: p. 92

4. An aqueous suspension of nystatin should remain in the mouth for __________ for the best effect. a. 10 seconds b. 30 seconds c. 2 minutes d. 5 minutes

ANS: c An aqueous suspension of nystatin should remain in the mouth for 2 minutes for the best effect. The aqueous suspension (100,000 U/ml) contains 50% sucrose. The directions to the patient are to swish, swirl, and spit or swallow 5 ml four times daily. REF: p. 104

59. The sulfonamides competitively inhibit the bacterial enzyme that incorporates para-aminobenzoic acid (PABA) into an immediate precursor of: a. Biotin b. Thiamine c. Folic acid d. Riboflavin

ANS: c Because of their structural similarity to PABA, the sulfonamides competitively inhibit dihydropteroate synthetase, the bacterial enzyme that incorporates PABA into dihyrofolic acid, an immediate precursor of folic acid. Unlike humans, many bacteria are unable to use preformed folic acid, which is essential for their growth. They must synthesize folic acid from PABA. REF: p. 94

32. Clavulanic acid is: a. Bacteriostatic b. Bactericidal c. Used in combination with amoxicillin d. Both a and c e. Both b and c

ANS: c Clavulanic acid is a penicillinase (β-lactamase) inhibitor. It is not an antibacterial. It inhibits the ability of bacteria to break down β-lactam-containing antibiotics. REF: p. 85

5. Which of the following antibiotics is associated with pseudomembranous colitis? a. Penicillin b. Erythromycin c. Clindamycin d. Metronidazole

ANS: c Clindamycin is associated with pseudomembranous colitis. Historically, oral surgeons have been comfortable using clindamycin, but other dentists have avoided it. Clindamycin affects both gram-positive cocci and gram-positive and gram-negative anaerobes. REF: p. 77

71. If a person with active TB seeks oral health care: a. Use standard precautions and treat him or her just as everyone else is treated. b. Schedule him or her as the last patient of the day. c. Contact that person's physician and delay health care until the disease is no longer in the active state. d. Refer the patient to a hospital with a dental suite for treatment.

ANS: c Contact that person's physician and delay health care until the disease is no longer in the active state. REF: p. 96

13. Which of the following statements is true regarding aspirin and the clotting mechanism? a. Aspirin reversibly interferes with the clotting mechanism by reducing platelet adhesiveness. b. Replacement of all of the affected platelets is required to produce normal clotting. c. With lower doses of aspirin, 1{1/2} days should elapse to obtain normal clotting. d. 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

38. Alcohol consumption stimulates the breakdown of acetaminophen, thereby decreasing the toxic potential of acetaminophen use. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true, the second part is false. d. 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

40. Which of the following agents is a xanthine oxidase inhibitor? a. Colchicine b. Ibuprofen c. Allopurinol d. Probenecid

ANS: c Correct: Allopurinol is the only drug listed that inhibits xanthine oxidase. REF: p. 63 TRUE/FALSE

6. An __________ agent is a chemical substance produced by a microorganism that has the capacity, in dilute solutions, to destroy or suppress the growth or multiplication of organisms or to suppress their action. a. Antiinfective b. Antibacterial c. Antibiotic d. Antimicrobial

ANS: c Correct: An antibiotic is a chemical substance produced by a microorganism. Incorrect choices: The difference among the terms antibiotic, antiinfective, and antibacterial is that antibiotics are produced by microorganisms, whereas the other agents may be developed in a chemistry laboratory and not from a living organism. This difference is largely ignored in general conversation, and antiinfectives are often called antibiotics. REF: p. 78

33. Which of the following statements is true regarding the pharmacokinetics of acetaminophen? a. Acetaminophen is slowly and incompletely absorbed from the gastrointestinal tract. b. Acetaminophen is excreted with a half-life of 8 to 12 hours. c. When large doses of acetaminophen are ingested, an intermediate metabolite is produced that is thought to be hepatotoxic. d. 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

72. Antibiotic prophylaxis is considered reasonable for which of the following dental procedures? a. Oral radiographs b. Routine anesthetic injections through uninfected tissues c. Routine prophylaxis d. Shedding of deciduous teeth

ANS: c Correct: Antibiotic prophylaxis is considered reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of the teeth or perforation of the oral mucosa. Incorrect choices: Antibiotic prophylaxis is not necessary for routine anesthetic injections through uninfected tissues, oral radiographs, placement of removable prosthodontic or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth, and bleeding from trauma to the lips or oral mucosa. REF: p. 99

7. Which of the following choices has antiinflammatory, antipyretic, analgesic and antiplatelet action? a. Acetaminophen b. Codeine c. Aspirin d. 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

14. Which of the following statements is true concerning antibiotic resistance? a. Natural resistance occurs when an organism that was previously sensitive to an antimicrobial agent develops resistance. b. An increase in the use of an antibiotic in a given population decreases the proportion of resistant organisms in that population. c. Bacterial resistance can occur by the transfer of deoxyribonucleic acid (DNA) genetic material from one organism to another. d. The transfer of genetic material from one organism to another may only occur among organism of the same species.

ANS: c Correct: Bacterial resistance can occur by the transfer of DNA genetic material from one organism to another via transduction, transformation, or bacterial conjugation. Incorrect choices: Natural resistance occurs when an organism has always been resistant to an antimicrobial agent because of the bacteria's normal properties, such as lipid structure in the cell wall. Acquired 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 increases the proportion of resistant organisms in that population. The transfer of genetic material from one organism to another may occur among very different microorganisms, including transfer from nonpathogenic bacteria to pathogenic bacteria. REF: p. 80

1. The mechanism of action of nystatin involves binding to: a. The 30S ribosomal subunit b. The 50S ribosomal subunit c. Sterols in the fungal cell membrane d. Penicillin-binding proteins on the bacterial cell membrane

ANS: c Correct: Binding to sterols in the fungal cell membrane produces an increase in membrane permeability and allows leakage of potassium and other essential cellular constituents. Incorrect choices: Because bacteria do not contain sterols in their cell membranes, nystatin is not active against these organisms. REF: p. 103

31. Which of the following statements is true of COX II? a. It is a widely distributed constitutive enzyme. b. It is responsible for the adverse reactions of the NSAIDs. c. It is synthesized only when inflammation occurs. d. 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

18. Which of the following products is the most commonly used opioid in dentistry? a. Hydrocodone b. Morphine c. Codeine d. Propoxyphene

ANS: c Correct: Codeine is the most commonly used opioid in dentistry. REF: p. 71

39. Which of the following agents is intended to treat an acute attack of gout? a. Probenecid b. Codeine c. Colchicine d. Acetaminophen e. 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

3. Beta-endorphin is a naturally occurring peptide with opioid-like action. It possesses analgesic action but has no addiction potential. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second statement is false. d. The first statement is false, the second statement is true.

ANS: c Correct: Endorphins, enkephalins, and dynorphins are naturally occurring peptides. They all possess analgesic action and have addiction potential. REF: p. 67

29. Which of the following NSAIDs is considered the drug of choice for management of dental pain when a NSAID is indicated? a. Naproxen b. Naproxen sodium c. Ibuprofen d. 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

26. Which of the following NSAIDs is the drug of choice for treating a nursing woman? a. Naproxen b. Diflunisal c. Ibuprofen d. 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

39. Which of the following statements is true of the tetracyclines? a. They are bactericidal. b. Tetracyclines interfere with the synthesis of bacterial protein by binding at the 50S subunit of bacterial ribosomes.. c. In the study of sensitivity or organisms isolated from dental infections, one fifth to two fifths of Staphylococcus aureus were found to be resistant to tetracycline. d. Tetracyclines are not prone to enterohepatic circulation.

ANS: c Correct: In the study of sensitivity or organisms isolated from dental infections, one-fifth to two fifths of S. Aureus and one fifth to three fifths of Streptococcus viridans were found to be resistant to tetracycline. Incorrect choices: The tetracyclines are bacteriostatic and interfere with the synthesis of bacterial proteins by binding at the 30S subunit of bacterial ribosomes. Enterohepatic circulation prolongs the action of the tetracyclines after they have been discontinued. REF: p. 87

8. The nonhomeostatic multiplication of organisms with the body is called: a. Resistance b. Superinfection c. Infection d. Virulence

ANS: c Correct: Infection is an unchecked increase in the number of pathogenic bacteria in the body. Incorrect choices: Resistance is the ability of an organism to be immune to the effects of an antiinfective agent. Superinfection is an opportunistic infection that arises as a consequence of treatment. Virulence is the disease-producing power of the microorganism. REF: p. 78

11. The following statements are true of ketoconazole except one. Which one is the exception? a. It is effective against a wide variety of mucocutaneous and systemic infections. b. It inhibits the metabolism of digoxin. c. It has a masculinizing effect by increasing testosterone levels. d. It is shown to produce embryotoxicity in animals. e. It can produce potentially fatal hepatotoxicity.

ANS: c Correct: Ketoconazole actually lowers the serum levels of testosterone. This effect can, in men, produce gynecomastia and impotence. Incorrect choices: Ketoconazole does have a broad spectrum of activity and is used both topically and internally. It inhibits the metabolism of many drugs, is classified as FDA pregnancy category C, and can cause fatal hepatotoxicity. REF: p. 105

15. Which of the following periodontal diseases is usually not treated with antimicrobials? a. Periodontal abscess b. Localized juvenile periodontitis c. Adult periodontitis d. Rapidly advancing periodontitis

ANS: c Correct: No antimicrobial agents are usually required for treatment of adult periodontitis or acute necrotizing ulcerative gingivitis. Incorrect choices: The drug of choice for periodontal abscess is penicillin VK, with tetracycline as an alternative. For localized juvenile periodontitis, either doxycycline or tetracycline are the drugs of choice with amoxicillin + metronidazole, or Augmentin as alternative drugs. Rapidly advancing periodontitis (RAP) may be treated with doxycycline, tetracycline, or metronidazole. Amoxicillin + metronidazole are the alternative drugs for treating RAP. REF: p. 80

4. Synonyms for nonopioid analgesics include: a. Narcotic b. Central c. Antipyretic d. 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

22. Which of the following agent would be least useful in alleviating fever? a. Piroxicam b. Acetaminophen c. Diflunisal d. Probenecid e. 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

22. Which opioid analgesic is most likely to produce dysphoria? a. Propoxyphene b. Codeine c. Pentazocine d. Oxycodone e. Hydrocodone

ANS: c Correct: Of the agents listed, pentazocine has the greatest propensity for causing dysphoric reactions; it is a mixed agonist-antagonist, and its action on sigma or delta opioid receptors may be responsible for the dysphoria. REF: p. 73

17. Which of the following drugs can be substituted for aspirin in patients displaying the aspirin hypersensitivity triad? a. Ibuprofen b. Naproxen c. Codeine d. 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

4. Which of the following agents is the drug of choice for an early dental infection unless the patient is allergic to it? a. Erythromycin b. Clindamycin c. Penicillin d. Metronidazole

ANS: c Correct: Penicillin is the drug of choice unless the patient is allergic to it. Amoxicillin is most often used because it is less irritating to the stomach than other drugs and can be taken with food or milk. Incorrect choices: In patients allergic to penicillin, alternatives might include erythromycin or clindamycin. When the infection is at the mixed stage, agents effective against either gram-positive or anaerobic organisms may be successful. Metronidazole is effective for anaerobic organisms. REF: p. 77

24. Which of the following agents is the only mixed opioid available for oral use? a. Dezocine b. Nalbuphine c. Pentazocine d. Butorphanol

ANS: c Correct: Pentazocine is the only mixed opioid available for oral use. Butorphanol, available as a nasal spray, is also in this group. Incorrect choices: Dezocine, nalbuphine, and butorphanol are parenterally available agonist-antagonists. Dezocine has agonist action at the κ-receptor and antagonist action at the µ-receptor. REF: p. 73

8. Prostaglandins sensitize pain receptors to: a. Diflunisal. b. Salsalate c. Bradykinin d. 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

47. __________ is associated with a severe drug interaction with alcohol. a. Erythromycin b. Tetracycline c. Metronidazole d. Aminoglycosides (e.g., streptomycin)

ANS: c Metronidazole is unique among antiinfectives in that it causes a disulfiram-like reaction with alcohol. REF: p. 90

65. Quinolones: a. Must be administered parenterally and cannot be taken orally b. Have no use in dentistry c. Are bactericidal against most gram-negative organisms and many gram-positive organisms d. Have cross-resistance with many other antimicrobial agents

ANS: c Correct: Quinolones are bactericidal against most gram-negative organisms and many gram-positive organisms. Incorrect choices: The quinolones are orally effective. This group may have potential use in dentistry because of their spectrum of action. No cross-resistance occurs with other antimicrobial agents. REF: p. 95

21. Which of the following statements is true concerning the pharmacokinetics of penicillin? a. Penicillin may be administered orally, parenterally, or topically. b. Penicillin G is better absorbed orally than penicillin V; thus penicillin G is used for administration of oral penicillin. c. Penicillin V and amoxicillin can be taken without regard to meals. d. Penicillin does not cross the placenta and will not appear in breast milk.

ANS: c Correct: The highest blood levels are obtained if the patient takes the penicillin orally at least 1 hour before or 2 hours after meals, but penicillin V and amoxicillin can be taken without regard to meals. Incorrect choices: Penicillin can be administered either orally or parenterally but should not be applied topically because its allergenicity is greatest by that route. Penicillin V is better absorbed orally than penicillin G; thus penicillin V is used for administration of oral penicillin. Penicillin crosses the placenta and appears in breast milk. REF: p. 82

60. The most common adverse reaction to the sulfonamides is: a. Liver damage b. Suppressed renal function c. An allergic skin reaction d. Blood dyscrasias

ANS: c Correct: The most common adverse reaction to the sulfonamides is an allergic skin reaction. These reactions may manifest as rash, urticaria, pruritus, fever, a fatal exfoliative dermatitis, or periarteritis nodosa. Incorrect choices: Liver damage, depressed renal function, blood dyscrasias, and precipitation of lupus erythematosus are seen less often. REF: p. 94

2. The pain threshold varies greatly in individuals because of different perception of pain. a. Both parts of the statements are true. b. Both parts of the statements are false. c. The first part of the statement is true, the second part is false. d. 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

1. A patient with a true allergy to codeine should not be given: a. Propoxyphene b. Pentazocine c. Oxycodone d. Buprenorphine

ANS: c Correct: The patient should not be given oxycodone because oxycodone, hydromorphone, hydrocodone, and dihydrocodone are all members of the same morphine and codeine group. Incorrect choices: Propoxyphene is a member of the methadone group, pentazocine is a member of the morphinan group, and buprenorphine is not a member of any of the other known groups. REF: p. 66

21. Topical acyclovir: a. Has been effective in the treatment of recurrent herpes genitalis in nonimmunocompromised patients b. Has been effective in the treatment of herpes labialis infections in nonimmunocompromised patients c. Does not prevent the transmission of infection and does not prevent recurrence d. Both a and b e. Both b and c

ANS: c Correct: Topical acyclovir does not prevent the transmission of infection, and it does not prevent recurrence. Incorrect choices: Topical acyclovir has not been effective in the treatment of recurrent herpes genitalis or herpes labialis infections in nonimmunocompromised patients. It does produce a limited shortening in the duration of viral shedding in male patients by a few hours. REF: p. 107

20. What is the usual adult dosage of aspirin for the treatment of pain or fever? a. 250 mg every 4 hours b. 3 to 6 g per day c. 650 mg every 4 hours d. 800 mg every 4 hours e. 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

19. Tylenol #3 contains __________ mg of codeine. a. 7.5 b. 15 c. 30 d. 60

ANS: c Correct: Tylenol #3 contains 30 mg of codeine. Generally, doses greater than 30 to 60 mg of codeine are poorly tolerated by the patient (too much nausea). In pain studies, showing that 30 mg of codeine is any better than a placebo is difficult, and 60 mg of codeine has an analgesic strength approximately the same as 650 mg of aspirin, 650 mg of acetaminophen, or 200 mg of ibuprofen. Incorrect choices: Tylenol #1 contains 7.5 mg of codeine, Tylenol #2 contains 15 mg of codeine, and Tylenol #4 contains 60 mg of codeine. REF: p. 72

16. Superinfection describes a(n): a. Nonsystemic, superficial infection b. Exaggerated infection caused by treating a resistant pathogen c. Opportunistic infection that arises as a consequence of treatment d. Infection by multiple pathogens

ANS: c Correct: When antiinfectives disturb the normal flora of the body, the emergence of organisms unaffected by or resistant to the antibiotic used can occur. Incorrect choices: Superinfection can be superficial or nonsuperficial. It is an infection that does not require treatment of a resistant pathogen to occur. Superinfection can be an infection by one or more pathogens. REF: p. 81

1. Dental caries is caused by an infection with: a. Porphyromonas gingivalis b. Eikenella corrodens c. Streptococcus mutans d. Fusobacterium

ANS: c Dental caries is produced by Streptococcus mutans. It is the first important dental infection of the newly erupting teeth of the young patient. Incorrect choices: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, Fusobacterium spp., and Campylobacter rectus are all periodontal microbes. REF: pp. 76-77

74. The standard antibiotic drug regimen prior to dental procedures requiring immunoprophylaxis in a patient with no allergies to penicillin or amoxicillin is: a. 1 gram of amoxicillin 1 hour before the procedure b. 1 gram of amoxicillin 2 hours before the procedure c. 2 grams of amoxicillin 1 hour before the procedure d. 2 grams of amoxicillin 2 hours before the procedure

ANS: c For a patient with no allergies to penicillin or amoxicillin, the standard prophylactic drug regimen is 2 grams of amoxicillin 1 hour before the procedure.

3. Nystatin is used for both the treatment and the prevention of __________ in susceptible cases. a. Blastomycosis b. Histoplasmosis c. Oral candidiasis d. Tinea

ANS: c Nystatin is used both for the treatment and prevention of oral candidiasis in susceptible cases. Although Candida albicans is a frequent inhabitant of the oral cavity, it produces disease only under unusual circumstances. Patients affected are often immunocompromised. REF: p. 104

22. Penicillinase inactivates the penicillin moiety by: a. Sublimation b. Desiccation c. Cleaving the β-lactam ring d. Cleaving the S-containing thiazolidine ring.

ANS: c Penicillinase inactivates the moiety by cleaving the β-lactam ring. The penicillin structure includes a β-lactam ring fused to a five-member, S-containing thiazolidine ring. Neither of these rings has much antimicrobial action alone. When the β-lactam ring is broken, such as in the presence of penicillinase, the antimicrobial activity of the compound is lost. REF: pp. 82-83

11. Prostacyclin ___________ aggregation of platelets and thromboxane A2 _________ aggregation of platelets. a. Stimulates, stimulates b. Stimulates, inhibits c. Inhibits, stimulates d. 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

64. __________ are the first orally active agents against certain Pseudomonas species. a. Aminoglycosides b. Sulfonamides c. Quinolones d. Tetracyclines

ANS: c Quinolones are the first orally active agents against certain Pseudomonas species. REF: p. 95

56. 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? a. Augmentin b. Metronidazole c. Vancomycin d. Chloramphenicol

ANS: c Red man syndrome is an adverse reaction noted with intravenous use of vancomycin. Hypotension accompanied by flushing, chills, and drug fever are also associated with vancomycin. REF: p. 93

12. Ketoconazole should not be used with __________ because it renders the blood level of ketoconazole undetectable. a. Penicillin V b. Metronidazole c. Rifampin d. Acyclovir

ANS: c Rifampin renders the blood level of ketoconazole undetectable. Isoniazid, phenytoin, and theophylline can decrease ketoconazole serum levels. Ketoconazole may decrease the effect of oral contraceptives. Ketoconazole may produce a disulfiram-like reaction or enhance hepatotoxicity with alcohol. REF: p. 105

24. Some studies indicate that __________% of patients receiving penicillin will have an allergic reaction. a. 0.05 to 0.10 b. 0.5 to 1.0 c. 5 to 10 d. 20 to 25

ANS: c Some studies indicate that 5% to 10% of patients receiving penicillin will have an allergic reaction. REF: p. 83

76. Both the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) continue to recommend that all patients receive antibiotic prophylaxis before certain dental procedures during the first __________ after total joint replacement. a. 6 months b. 1 year c. 2 years d. 7 years

ANS: c The ADA and AAOS recommend that all patients receive antibiotic prophylaxis before certain dental procedures during the first 2 years after total joint replacement. Whether the use of antibiotics is indicated after the patient is 2 years postreplacement surgery should be determined by those involved most closely with the patient's condition. REF: p. 99 TRUE/FALSE

27. Which of the following groups of drugs used to treat HIV can interfere with the action of the HIV-infected cells? a. Nucleoside reverse transcriptase inhibitors b. Nonnucleoside reverse transcriptase inhibitors c. Protease inhibitors d. Both a and b e. Both b and c

ANS: c The difference between the protease inhibitors and the other two groups is that the protease inhibitors can interfere with the action of the HIV-infected cells. Its adverse reactions include rash, hyperglycemia, and paresthesias. REF: p. 110

75. If a patient requires premedication with antibiotics before a dental procedure and they are allergic to penicillins or ampicillin but can take oral medication, the drug of choice is: a. Tetracycline b. Metronidazole c. Cephalexin d. Amoxicillin

ANS: c The drug of choice is 2 grams of cephalexin. Alternatively, 600 mg of clindamycin, or 500 mg of azithromycin, or 500 mg of clarithromycin may be prescribed. REF: p. 100

16. The incidence of true aspirin allergy is: a. Approximately 10% b. Between 2% and 5% c. Less than 1% d. 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

51. Oral-cavity infections are generally understood to advance through three stages. The three stages are (1) mixed aerobic and anaerobic infection, (2) aerobic infection, (3) anaerobic infection. In what order do these stages occur? a. 1, 2, 3 b. 1, 3, 2 c. 2, 1, 3 d. 3, 1, 2 e. 3, 2, 1

ANS: c The organisms responsible for a dental infection are primarily aerobic gram-positive cocci, such as Streptococcus viridans. After a short time, the gram-positive infection begins to include a variety of both gram-positive and gram-negative anaerobic organisms, such as Peptostreptococcus (Peptococcus) and Bacteroides (Porphyromonas and Prevotella species). At this point the infection is termed a mixed infection. Over time, the proportion of organisms that are anaerobic increases. REF: p. 92

36. Which of the following condition is the most common adverse reaction from the administration of erythromycin? a. Anaphylaxis b. Skin rash c. Gastrointestinal effects d. Miosis

ANS: c The side effects most often associated with erythromycin administration are gastrointestinal and include stomatitis, abdominal cramps, nausea, vomiting, and diarrhea. In one study, at least one gastrointestinal side effect occurred in an average of approximately 50% of patients, with approximately 20% discontinuing their medication because of side effects. REF: p. 86

13. Thrush is: a. An allergic reaction b. An idiosyncrasy c. Oropharyngeal candidiasis d. A serious systemic fungal infection

ANS: c Thrush is oropharyngeal candidiasis. REF: p. 105

41. __________ can cause black pigmentation of mandibular and maxillary alveolar bone and the hard palate. a. Penicillin V b. Erythromycin c. Minocycline d. Clindamycin

ANS: c With discontinuation of minocycline, the pigmentation becomes less intense but is usually not completely reversible. When viewed through the mucosa, the pigment appears bluish. Other cases of oral pigmentation have been said to involve the crowns of the permanent teeth and the gingival mucosa. The incidence of this oral pigmentation in adults is 10% after 1 year and 20% after 4 years of therapy. REF: p. 88

28. Which of the following antiviral agents is used prophylactically for prevention of an influenza A viral infection or for treatment to reduce the symptoms of the infection? a. Zidovudine b. Nevirapine c. Saquinavir d. Amantadine

ANS: d Amantadine can be used prophylactically for prevention of an influenza A viral infection or for treatment to reduce the symptoms of the infection. It is used in institutional patients to prevent the spread of infection during outbreaks. A new relative of amantadine with similar action is rimantadine (Flumadine). Resistance to both drugs is widespread, and as a result, the use of both drugs is limited. REF: p. 110

30. __________ is the drug of choice for prophylaxis for bacterial endocarditis before a dental procedure. a. Penicillin G b. Penicillin c. Ampicillin d. Amoxicillin

ANS: d Amoxicillin is the drug of choice. Amoxicillin is used to treat upper respiratory tract infections, and meningitis. Otitis media in children is often treated with amoxicillin. REF: p. 85

67. Unlike other antiinfective agents, an additive action may result when __________ is combined with other antimicrobial agents. a. Vancomycin b. Chloramphenicol c. Nitrofurantoin d. Ciprofloxacin

ANS: d An additive action may result when ciprofloxacin is combined with other antimicrobial agents. The emergence of organisms resistant to the fluoroquinolones and the cross-resistance among the fluoroquinolones is increasing. REF: p. 95

43. Which of the following statements is true concerning clindamycin? a. Clindamycin is distributed throughout most body tissues, including bone. b. Cross-resistance between clindamycin and erythromycin is often noted. c. The indications for treatment with clindamycin are limited to a number of infections caused by aerobic organisms. d. Both a and b are true. e. Both b and c are true.

ANS: d Clindamycin is distributed throughout most body tissues, including bone but not to cerebrospinal fluid. Cross-resistance between clindamycin and erythromycin is often noted. An antagonistic relationship has been observed between clindamycin and erythromycin because of competition for the same binding site (50S subunit) on the bacteria. REF: p. 89

61. Which of the following agents is bacteriostatic in action? a. Amoxicillin b. Streptomycin c. Vancomycin d. Trimethoprim

ANS: d Correct: Antibacterials can be bacteriostatic or bactericidal. Trimethoprim is bacteriostatic—it inhibits the growth of bacteria. Incorrect choices: Amoxicillin, streptomycin, and vancomycin are all bactericidal agents. They kill bacteria. REF: p. 94

26. The following statements are false of tramadol except one. Which one is the exception? a. It binds to mu opioid receptors. b. It inhibits reuptake of serotonin and norepinephrine. c. It modifies ascending pain pathways. d. It causes mydriasis. e. Its analgesic efficacy is equivalent to that of codeine.

ANS: d Correct: As in opioids, tramadol causes miosis. Incorrect choices: Tramadol does in fact bind mu opioid receptors, inhibits reuptake of serotonin and norepinephrine, and modifies ascending pain pathways. Its analgesic efficacy is equivalent to that of codeine. REF: p. 74 TRUE/FALSE

9. Which of the following statements is true concerning the pharmacokinetics of aspirin? a. Plain, unbuffered aspirin produces its peak effect on an empty stomach in 15 minutes. b. Buffered aspirin has a slower peak of aspirin than plain aspirin. c. The half-life of unhydrolyzed aspirin is approximately 90 minutes. d. 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

66. Which agent inhibits DNA gyrase? a. Penicillin G b. Erythromycin c. Metronidazole d. Ciprofloxacin

ANS: d Correct: Ciprofloxacin. The mechanism of action of the quinolones is unique and involves antagonism of the A subunit of DNA gyrase; the enzyme is involved in DNA synthesis. Incorrect choices: Penicillin G inhibits cell wall synthesis, erythromycin inhibits protein synthesis, and metronidazole disrupts DNA's helical structure independent of DNA gyrase. REF: p. 95

6. Which of the following statements is true concerning clotrimazole? a. It is available in the form of an aqueous suspension for oral use. b. It is the only antifungal for oral use that does not contain sugar. c. Clotrimazole has been reported to produce elevated liver enzyme levels in approximately 85% of patients. d. Systemic clotrimazole has been assigned to U.S. Food and Drug Administration (FDA) pregnancy category C

ANS: d Correct: Clotrimazole is assigned to FDA category C. Very high doses have been embryotoxic in rats and mice. High doses have caused impaired mating and a decrease in both the number and survival of the young. No teratogenic effects have been found in several other species tested. No carcinogenicity has been demonstrated in rats. Incorrect choices: Clotrimazole is available in the form of a slowly dissolving, sugar-containing lozenge for oral use. It has been reported to produce elevated liver enzyme levels in approximately 15% of patients. REF: p. 104

35. Which of the following statements is true concerning the pharmacokinetics of erythromycin? a. Erythromycin is broken down in gastric fluid and absorbed through the stomach wall. b. Erythromycin is not available in a topical preparation because of allergenicity. c. Erythromycin is available in oral but not injectable forms. d. Erythromycin should be administered 2 hours before or 2 hours after meals.

ANS: d Correct: Erythromycin should be administered 2 hours before or 2 hours after meals. Although food reduces the absorption of erythromycin, administering it with food may be necessary to minimize its adverse gastrointestinal effects. Incorrect choices: Because erythromycin is broken down in gastric fluid, it is formulated as an enteric-coated tablet, capsule, or insoluble ester to reduce degradation by stomach acid. Erythromycin is administered orally as tablets and capsules, oral suspensions in intravenous and intramuscular forms, and in topical preparations. REF: p. 86

21. Which of the following agents is a potent, short-acting, parenterally administered opioid that is commonly used during general anesthesia? a. Dynorphin b. Hydromorphone c. Nalmefene d. Fentanyl e. Tramadol

ANS: d Correct: Fentanyl is a short-acting, parenterally administered agonist opioid analgesic that is used perioperatively or during general anesthesia. Incorrect choices: Dynorphin is an endogenous opioid. Hydromorphone is reserved for the management of severe pain. Nalmefene is an opioid antagonist. Tramadol is an orally administered nonopioid with weak analgesic activity. REF: p. 73

17. The following agents act by a mechanism involving fungal sterols (ergosterol) except: a. Amphotericin B b. Itraconazole c. Terbinafine d. Griseofulvin

ANS: d Correct: Griseofulvin disrupts the cell's mitotic spindle structure, arresting cell division in metaphase. Incorrect choices: Amphotericin B binds sterols in the membrane and alters membrane permeability. Itraconazole and terbinafine inhibit ergosterol synthesis at two different points in the pathway. REF: p. 106

18. All of the following are characteristics of aspirin toxicity (salicylism) except: a. Dimness of vision b. Hyperthermia c. Electrolyte imbalance d. Hepatic necrosis e. 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

20. Which of the following opioids is used primarily in the treatment of opioid addicts? a. Propoxyphene b. Meperidine c. Hydromorphone d. Methadone

ANS: d Correct: Methadone is used either to withdraw the patient gradually or for methadone maintenance. Because it has a longer duration of action, withdrawal from methadone is easier than from heroin. Because it is an opioid analgesic, however, the risk for dependence still exists. Incorrect choices: Propoxyphene is in Darvocet N-100; its analgesic efficacy has been questioned, and it is certainly no more efficacious than two tablets of aspirin or acetaminophen. Meperidine is intended for the acute management of moderate-to-severe pain. Hydromorphone is reserved for the management of severe pain. REF: p. 73

24. Which of the following statements is true concerning adverse reactions of NSAIDs? a. NSAIDs will decrease acid secretion in the stomach. b. Tolerance develops to the use of NSAIDs. c. NSAIDs irreversibly inhibit platelet aggregation because they inhibit thromboxane A2 production. d. 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

63. Which of the following statements is true regarding nitrofurantoin? a. Nitrofurantoin has a narrow spectrum of action against anaerobic bacteria. b. Nitrofurantoin is bactericidal. c. Nitrofurantoin is associated with red man syndrome. d. Nitrofurantoin can cause a brownish discoloration of urine.

ANS: d Correct: Nitrofurantoin can cause a brownish discoloration of urine. Incorrect choices: Nitrofurantoin possesses a wide antibacterial spectrum including both gram-positive and gram-negative bacteria. It is bacteriostatic against many common urinary tract pathogens, including Escherichia coli. Vancomycin is associated with red man syndrome. REF: p. 95

1. Pain: a. Brings people to the dental office b. Keeps people from the dental office c. Can be effectively treated with inactive pills (placebos) d. 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

7. Which of the following antiinfective agents is bacteriostatic rather than bactericidal? a. Cephalosporins b. Metronidazole c. Penicillins d. Tetracyclines e. Vancomycin

ANS: d Correct: Tetracyclines—chloramphenicol, spectinomycin, sulfonamides, and trimethoprim—are all bacteriostatic. Clindamycin and macrolides also are bacteriostatic, but may be bactericidal against some organisms at higher blood levels. Incorrect choices: Aminoglycosides—bacitracin, cephalosporins, metronidazole, penicillins, polymyxin, quinolones, rifampin, and vancomycin—are all bactericidal antiinfective agents. REF: p. 78

48. Which of the following statements is true of the cephalosporins? a. They are active against gram-positive but not gram-negative organisms. b. Those available for oral use are susceptible to penicillinase. c. They are bacteriostatic. d. Their mechanism of action is inhibition of cell wall synthesis..

ANS: d Correct: The mechanism of action of the cephalosporins is like that of the penicillins: inhibition of cell wall synthesis. Incorrect choices: Cephalosporins are active against a wide variety of both gram-positive and gram-negative organisms. Those available for oral use are relatively acid stable and highly resistant to penicillinase. The cephalosporins, which are bactericidal, are active against most gram-positive cocci, penicillinase-producing staphylococci, and some gram-negative bacteria. REF: p. 91

12. The following are conditions for which opioid analgesics should be used with extreme caution or not at all, except one. Which one is the exception? a. Head injury b. Nausea c. Respiratory disease d. Hypertension e. Near-term pregnancy

ANS: d Correct: Use of opioids is not contraindicated in hypertensive patients. Incorrect choices: Opioids are contraindicated for patients with head injury, nausea, respiratory depression, and near-term pregnancy. REF: p. 69

38. Azithromycin and clarithromycin: a. Cause lysis of the bacterial cell wall b. Are not effective against anaerobes c. Have a higher incidence of adverse reactions than erythromycin d. May be used as alternative antibiotics for the prophylaxis of endocarditis and prosthetic joint infections

ANS: d Correct: When amoxicillin and clindamycin cannot be used for the prophylaxis of endocarditis and prosthetic joint infections, these macrolides can be used as alternative antibiotics. Incorrect choices: Azithromycin and clarithromycin inhibit RNA-dependent protein synthesis by binding to the 50S ribosomal subunit. In contrast to erythromycin, azithromycin and clarithromycin have variable action against some anaerobes. The incidence of adverse reactions is lower with azithromycin and clarithromycin compared with erythromycin. REF: p. 86

12. Which of the following statements is true concerning infection and host resistance? a. Host resistance should be considered as having both local and systemic components. b. Drugs such as steroids are capable of reducing a patient's immunity. c. Juvenile diabetes may reduce a patient's immunity; however, insulin-dependent diabetes mellitus (IDDM) does not reduce immunity. d. Both a and b e. Both b and c

ANS: d Host resistance should be considered as having both local and systemic components. Drugs such as steroids are capable of reducing a patient's immunity. Diseases such as acquired immunodeficiency syndrome and IDDM may reduce a patient's immunity and increase the chance of an infection. REF: p. 79

17. Antiinfective agents can potentiate the effect of oral anticoagulants by interfering with the production of vitamin: a. A b. D c. E d. K

ANS: d Oral anticoagulants are vitamin K inhibitors; thus interference with the production of vitamin K could increase the anticoagulant effect. Bacterial flora in the intestine produce most of the vitamin K in human bodies. Antiinfective agents reduce the bacterial flora that produce vitamin K. With the vitamin K reduced, the oral anticoagulant's effect is increased. REF: p. 81

62. Sulfamethoxazole and trimethoprim: a. Are bacteriostatic b. Act by sequential inhibition of folic acid synthesis c. Are used to treat urinary tract infection (UTI) d. All of the above

ANS: d Sulfamethoxazole and trimethoprim are folate synthesis inhibitors used to treat UTI. This action is bacteriostatic. REF: p. 94

10. Superinfection is more often caused by __________-spectrum antibiotics and increases when taken for a __________ time period. a. Narrow; shorter b. Narrow; longer c. Broad; shorter d. Broad; longer

ANS: d Superinfection is more often caused by broad-spectrum antibiotics and increases when taken for a longer time period. In this case, a reduction in the number of gram positive and gram-negative bacteria allows the overgrowth of the fungus Candida albicans. REF: p. 78

11. The pathogenic organisms emerging in a superinfection generally are __________ difficult to eradicate than the original organism and __________ likely to exhibit resistance. a. Less, less b. Less, more c. More, less d. More, more

ANS: d The pathogenic organisms emerging in a superinfection generally are more difficult to eradicate than the original organism and more likely to exhibit resistance. REF: p. 78

27. The usual adult dose of penicillin V for treatment of an infection is: a. 250 mg twice a day (bid) b. 250 mg four times a day (qid) c. 500 mg twice a day (bid) d. 500 mg four times a day (qid)

ANS: d The usual adult dose is 500 mg qid for the treatment of an infection for a minimum of 5 days and preferably for 7 to 10 days. REF: p. 84

34. Acetaminophen does not possess any of these clinically significant __________ effects: (1) antipyretic, (2) antiinflammatory, (3) analgesic a. 1, 2, 3 b. 1 and 2 c. 1 and 3 d. 1 e. 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

3. Which of the following raises the pain threshold? a. Emotional instability b. Sympathy c. Sleep d. Both a and c e. 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

17. Which of the following drugs can be used to treat heroin addiction? a. Hydromorphone b. Methadone c. Naltrexone d. Both a and c e. Both b and c

ANS: e Correct: Methadone is used by substituting methadone for heroin and then tapering off or maintaining the addict on oral methadone. Naltrexone, a long-acting opioid antagonist, is used to block the action of usual doses of opioid administered illicitly. REF: p. 70

19. Which of the following antibiotics are not associated with any teratogenicity and are often used in pregnant women? a. Penicillin b. Tetracyclines c. Erythromycin d. Metronidazole e. Both a and c

ANS: e Correct: Penicillin and erythromycin have not been associated with teratogenicity and are often used in pregnant women. Incorrect choices: Tetracyclines are contraindicated during pregnancy because of their effect on developing teeth and skeleton. Metronidazole is not usually used during pregnancy, but exceptions exist. REF: p. 81

29. The most common used of the interferons are for the treatment of: a. Hepatitis B b. Hepatitis C c. Multiple sclerosis d. Both a and c e. Both b and c

ANS: e The most common used of the interferons are for the treatment of hepatitis C and multiple sclerosis. REF: p. 110 TRUE/FALSE

The neurotransmitter released from a preganglionic neuron in the sympathetic division of the ANS is:

Acetylcholine

Which agent is an indirect-acting sympathetic agonist

Amphetamine

Sympathomimetic agents should be used with caution in patients with (1) angina, (2) hypertension, (3) hypothyroidism

Angina, hypertension

Which ANS agent can cause an acute rise in intraocular blood pressure in patient with narrow-angle glaucoma

Anticholinergic

Sarin was used on a subway in Japan to poison riders. Sarin is a(n):

Anticholinesterase

What substances will block the action of acetylcholine at the postganglionic endings in the PANS

Atropine

The autonomic nervous system (ANS) functions as a(n) __________ system for many bodily functions

Automatic modulating

Agents such albuterol (Proventil, Ventolin) cause bronchodilation by binding to __________ receptors.

Beta2

The acronym SLUD denotes adverse reactions associated with administration of __________ agents

Cholinergic

A combination of pralidoxime and atropine is used to treat an overdose of __________ inhibitors

Cholinesterase

Anticholinergics:

Decrease esophageal and gastric motility

Glycopyrrolate is an α-adrenergic agonist used to produce a dry field before some dental procedures

False

Pathways innervating smooth muscles and glands are considered afferent pathways

False

Salivation, lacrimation, urination, and defecation refer to toxic effects seen with adrenergic agents

False

The fight or flight response refers to activation of the parasympathetic nervous system in response to stress

False

What would occur during a generalized discharge of the sympathetic nervous system

Glycogen breakdown

What is not a relative contraindication or caution with the use of cholinergic agents

Hypothyroidism

What is true concerning the organization of the autonomic nervous system (ANS)?

If a tissue receives both innervations, the response will be equal to the sum of excitatory and inhibitory influences of the two divisions of the ANS.

What is true concerning direct- and indirect-acting cholinergic agents

Inhibiting the enzyme that normally destroys acetylcholine results in stimulation of the PANS

On administration of an agent, heart rate increases because of a direct effect on the heart. However, total peripheral resistance decreases dramatically. As a consequence, systolic blood pressure increases only slightly, and mean arterial pressure typically falls. This agent is

Isoproterenol

What are catecholamines?

Isoproterenol Norepinephrine Epinephrine

What is not true of d-tubocurarine

It precipitates malignant hyperthermia in susceptible patients when combined with halothane

Which sympathomimetic agent is commonly used in dentistry

Levonordefrin

Tertiary anticholinergic agents are:

Lipid soluble and easily penetrate the brain

When the SANS is stimulated, the adrenal __________ into the systemic circulation

Medulla releases primarily epinephrine

What is true concerning the pharmacologic effects associated with cholinergic agents

Miosis

The direct effect of acetylcholine on the heart is

Negative chronotropic and negative inotropic

In the ANS, the target organ is innervated by the __________ neuron

Postganglionic efferent

Anticholinergic agents prevent the action of acetylcholine at the __________ endings

Postganglionic parasympathetic

What is used in the treatment of an overdose of acetylcholinesterase inhibitors

Pralidoxime

What is being used to produce methamphetamine

Pseudoephedrine

The primary objective of drug therapy in the treatment of glaucoma is

Reducing intraocular pressure

What agent is known to deplete endogenous norepinephrine

Reserpine

Stimulation of β2-receptors results in

Smooth-muscle relaxation

Sympathomimetic agents will stimulate salivary flow from which of the following salivary glands? (1) parotid, (2) submandibular, (3) sublingual

Submandibular, sublingual

What is true concerning the organization of the sympathetic division of the autonomic nervous system (SANS

The preganglionic fibers exit the spinal column to enter the sympathetic chain located along each side of the vertebral column.

Tertiary (ammonium) agents cross the blood-brain barrier better than quaternary (ammonium) agents

True

Neostigmine is a cholinergic agent that is classified as (1) indirect acting and (2) irreversible

True, False

What represents potential cardiac effects of anticholinergic agents

Variable; bradycardia predominates with small doses and tachycardia with large doses

α-Adrenergic agonists cause

Vasoconstriction

Which drug would be best to treat xerostomia

c. Pilocarpine

The S in SLUD stands for

salivation