Test Bank Ch 25

33. Bupropion is an effective treatment for alcoholism.

ANS: False Bupropion is used for tobacco cessation. REF: pp. 317-318

34. Chewing tobacco will not lead to cancer because the tobacco is not burned nor the smoke inhaled.

ANS: False Smokeless tobacco use poses significant oral health hazards, including cancer. REF: p. 317

30. Abuse is the use of a drug for a disease state in a way considered inappropriate.

ANS: False The use of a drug for a disease state in a way considered inappropriate is misuse. REF: p. 309

31. During drug withdrawal, symptoms appear that are opposite of the symptoms of drug use.

ANS: True For instance, excessive parasympathetic action such as diarrhea, lacrimation, and piloerection ("cold turkey") can occur when withdrawing from the opioids. REF: p. 309

32. Drug withdrawal from sedative-hypnotic agents can be more life threatening than withdrawal from opioids.

ANS: True Sedative-hypnotic agent withdrawal can lead to life-threatening seizures. REF: p. 316

15. Which of the following statement is true of alcoholism? a. A genetic link for alcoholism exists. b. Inpatient detoxification is required for most alcoholics. c. Penicillin is known to produce a disulfiram-like reaction. d. A patient will vomit if he or she takes naltrexone while consuming alcohol.

ANS: a Correct: A genetic link for alcoholism has been found; children of alcoholics are at much greater risk for becoming alcoholics. Genetic testing may someday be able to identify at-risk children and target this population for intense educational and social intervention for prevention. REF: p. 311

18. Which drug is associated with a deficiency of coagulation factors II, VII, IX, and X after chronic abuse? a. Ethyl alcohol b. Nicotine c. Cocaine d. Nitrous oxide

ANS: a Correct: Because of ethyl alcohol-induced hepatic failure, the liver is able to store less vitamin K, which is required for the synthesis of coagulation factors II, VII, IX, and X. Incorrect choices: The other agents do not produce a deficiency in these clotting factors. REF: p. 313

12. Which of the following choices is not a symptom of ethyl alcohol intoxication? a. Constricted pupils b. Impairment of judgment c. Ataxia d. Emotional lability

ANS: a Correct: Moderate acute intoxication with ethyl alcohol produces dilated pupils, not constricted pupils. Incorrect choices: The other choices are all characteristic of ethyl alcohol intoxication. REF: p. 310

24. The triad of narcotic overdose is: a. Respiratory depression, pinpoint pupils, and coma b. Hyperactive behavior, dilated pupils, and cardiac arrhythmias c. Elevated blood pressure, blank stare, and rigidity d. Respiratory depression, cardiac depression, and sleep

ANS: a Correct: Respiratory depression, pinpoint pupils, and coma are key signs of opioid overdose. Incorrect choices: The other sets of signs are characteristic of amphetamine overdose, of phencyclidine overdose, and of sedative-hypnotic overdose, respectively. REF: p. 314

14. Chronic alcohol use increases the risk of cancer of the mouth, pharynx, larynx, esophagus, and liver, which may occur with tobacco use in a __________ effect. a. Additive b. Synergistic c. Negative d. Canceling

ANS: b Chronic alcohol use increases the risk of cancer of the mouth, pharynx, larynx, esophagus, and liver, which may occur with tobacco use to make the risk higher than with alcohol alone. REF: p. 311

8. Which of the following statement is true regarding addiction, habituation, and dependence? a. When comparing drugs of the same group, the time required to produce physical dependence is longest with a rapidly metabolized drug and shortest with a slowly metabolized drug. b. Cross-tolerance may be either partial or complete and is determined more by the pharmacologic effect of the drug than by its chemical structure. c. The longer the half-life of the drug is, the quicker the withdrawal will be. d. A barbiturate can be substituted for an opioid, and vice versa.

ANS: b Correct: Cross-tolerance may be either partial or complete and is determined more by the pharmacologic effect of the drug than by its chemical structure. Incorrect choices: When comparing drugs of the same group, the time required to produce physical dependence is shortest with a rapidly metabolized drug and longest with a slowly metabolized drug. The shorter the half-life is, the quicker the withdrawal will be. If a person is addicted to heroin, an opioid, then other opioids, such as morphine, can prevent withdrawal. However, a barbiturate cannot be substituted for an opioid, and vice versa. REF: pp. 309-310

5. The following statements are descriptive of psychologic dependence except one. Which one is the exception? a. It may vary from mild desire to compulsive obsession. b. It is not as strong as physical dependence. c. It often involves drug-seeking behavior. d. It is a state in which the person feels unable to maintain optimal performance without the drug.

ANS: b Correct: Even though some highly abused drugs have only psychologic dependence, the "need" to use these drugs can be as strong or stronger than drugs with a physical dependence. Incorrect choices: All other statements are characteristic of psychologic dependence. REF: p. 309

13. At which stage of ethyl alcohol withdrawal are hallucinations most prevalent? a. Stage 1 b. Stage 2 c. Stage 3 d. Ethyl alcohol withdrawal is not associated with hallucinations

ANS: b Correct: Stage 2 withdrawal includes hallucinations, paranoid behavior, and amnesia. Incorrect choices: Although overlap in symptoms can be considerable, hallucinations generally occur after stage 1 and before stage 3. REF: pp. 310-311

1. The potential for abuse of a drug is greatly increased by the following factors except one. Which one is the exception? a. Very potent b. Long duration of action c. Inexpensive d. Easy to distribute

ANS: b Correct: The abuse potential of a drug is increased if it has a quick onset of action. The duration of action of the drug is less important, and a longer duration often reduces the opportunity for a subsequent "rush" and the cycle of repetitive use. Incorrect choices: Potency, cost, and ease of access are all incentives to maintain a drug habit. REF: p. 308

21. Which drug syndrome produces symptoms resembling pernicious anemia? a. Chronic alcoholism b. Chronic nitrous oxide use c. Opioid withdrawal d. Chronic tobacco use

ANS: b Correct: The neurologic deficiency seen with chronic nitrous oxide use is similar to that seen in pernicious anemia. Incorrect choices: Chronic alcoholism, opioid withdrawal, and chronic tobacco use do not cause these symptoms. REF: p. 314

17. Which of the following drugs may be used to reduce alcohol craving? a. Metronidazole b. Naltrexone c. Chlordiazepoxide d. Vitamin K

ANS: b Naltrexone is used to reduce alcohol craving. Because naltrexone is partially effective in decreasing craving from alcohol, the logical conclusion is that alcohol stimulates some of the opioid receptors. REF: p. 312

11. The incidence of alcoholism in the United States is approximately __________. a. 5% b. 10% c. 15% d. 20%

ANS: b The incidence is approximately 10%. Because alcohol is legal, its availability makes it the most often abused drug. The best use of resources for addiction would be to deal with alcoholism as soon as it can be identified. REF: p. 310

7. Tolerance is characterized by the need to __________ the dose continually to achieve a desired effect or providing the same dose that produces a __________ effect. a. Increase, increasing b. Increase, diminishing c. Decrease, increasing d. Decrease, diminishing

ANS: b Tolerance is characterized by the need to increase the dose continually to achieve a desired effect or providing the same dose that produces a diminishing effect. In terminal patients, this tolerance requires ever-increasing doses of opioids even if the pain remains constant. REF: p. 309

10. Abuse of __________ is the number one public health problem in the United States? a. Opioids b. Stimulants c. Alcohol d. Hallucinogens

ANS: c Alcohol abuse is the number one public health problem in the United States and is associated with many major medical problems. Many "accidental" deaths are associated with the use of alcohol. Two fifths of traffic fatalities involve alcohol. REF: p. 310

20. Nitrous oxide abuse: a. Can lead to physical dependence b. Is primarily seen in food service employees c. Can cause infertility d. Can cause myelocytosis

ANS: c Correct: Chronic use can cause mental dysfunction and infertility. Incorrect choices: Nitrous oxide use does not cause physical dependence. Abuse is primarily by dental personnel. Nitrous oxide causes myeloneuropathy, not myelocytosis. REF: p. 314

3. A physical and/or psychologic state characterized by a compulsion to take a drug is termed: a. Enabling b. Psychologic dependence c. Drug dependence d. Tolerance e. Abstinence syndrome

ANS: c Correct: Drug dependence can be physical or psychologic and is characterized by a compulsion to take a drug to obtain its effects or prevent the abstinence syndrome. Incorrect choices: Enabling is the behavior of family or friends that allow the drug-dependent person to continue his or her habit. The definition applies to more than psychologic dependence. Tolerance often occurs before or during but is not equivalent to drug dependence. Abstinence syndrome or withdrawal is a set of physical and psychologic symptoms that occurs when a drug-dependent person stops taking a drug. One symptom might be the compulsion to take the drug. REF: p. 309

29. All of the following are true of marijuana use except one. Which one is the exception? a. A common adverse reaction is a panic attack. b. The agent can cause xerostomia. c. Physical dependence, tolerance, and withdrawal symptoms are common. d. Marijuana is effective as an antiemetic.

ANS: c Correct: Physical dependence, tolerance, and withdrawal symptoms are rare. Incorrect choices: Marijuana can cause panic attacks and xerostomia. It also has recognized antiemetic activity. REF: p. 318

2. Agents capable of changing behavior and/or inducing a psychosis-like reaction are termed: a. Psychedelic b. Hallucinogenic c. Psychoactive d. Psychotomimetic

ANS: c Correct: The statement is the definition of psychoactive, which includes drugs with therapeutic value and those without therapeutic value. Incorrect choices: Psychedelic drugs are the subset of psychoactive drugs that have no therapeutic value. Hallucinogenic drugs may produce hallucinations and psychotic-like behavior and are categorized with psychedelic drugs. Psychotomimetic drugs produce effects that mimic psychoses; they exclude several psychoactive drugs that do not mimic psychoses. REF: p. 308

19. Advanced periodontal disease, jaundice, and palmar erythema are signs of: a. Smokeless tobacco use b. Wernicke encephalopathy c. Advanced alcoholic liver disease d. Chronic nitrous oxide use

ANS: c Correct: These three signs point to alcoholic's poor oral hygiene, liver damage, and peripheral vasodilation. Incorrect choices: Smokeless tobacco use would cause periodontal disease but not the other symptoms. Wernicke encephalopathy would cause amnesia. Chronic nitrous oxide use does not produce these signs. REF: pp. 312-313

4. Enabling is an inappropriate behavior that requires family therapy because it involves the actions that family or friends take to supply the addict with the drug. a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but not related. c. The statement is correct, but the reason is not. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct.

ANS: c Enabling is the behavior of family or friends who associate with the addict that results in continued drug abuse. It may have nothing to do with providing the addict with the drug. Thus, because this dysfunctional behavior is counterproductive, the statement is true. However, enabling is much more subtle than actually supplying the drug. REF: p. 309

28. Signs and symptoms of an acute overdose of amphetamines include: a. Pinpoint pupils b. Hypothermia c. Diaphoresis d. Excessive salivation

ANS: c Signs and symptoms of an acute overdose include dilated pupils, elevated blood pressure, rapid pulse, and cardiac arrhythmias. The patient may exhibit diaphoresis, hyperthermia, fine tremors, and hyperactive behavior. Oral adverse reactions include xerostomia and bruxism. REF: p. 316

9. Approximately __________ of incarcerated individuals are there because of drug abuse problems. a. 20% b. 40% c. 60% d. 80%

ANS: d Approximately 80% are incarcerated because of problems with drug abuse. REF: p. 310

25. Prescribing __________ for analgesia is best when treating a dental patient who abuses opioids. a. Tylenol #3 with codeine b. Vicodin c. Percocet d. Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS: d Correct: Alleviating the cause of the pain first and then prescribing NSAIDs for analgesia is best. Incorrect choices: Because an opioid abuser develops tolerance to the analgesic effects of any opioid, treating pain with opioids is ineffective and can cause a recovering addict to begin using opioids again. REF: p. 315

16. Disulfiram is an agent used in the treatment of: a. Ethyl alcohol withdrawal b. Opioid withdrawal c. Barbiturate overdose d. Alcoholism

ANS: d Correct: Disulfiram (Antabuse) hinders alcohol metabolism and leads to a rise in acetaldehyde in drinkers. This property acts as a deterrent to drinking and as an incentive to stay sober. Incorrect choices: Disulfiram is not effective in any of the other conditions. REF: p. 312

22. Which agent produces a state described as a complete satiation of all drives? a. Ethyl alcohol b. Cocaine c. Nitrous oxide d. Morphine e. Methaqualone

ANS: d Correct: Opioids, such as morphine, elevate the user's mood, cause euphoria, relieve fear and apprehension, and produce a feeling of peace and tranquility. They also suppress hunger, reduce sexual desire, and diminish the response to provocation. Incorrect choices: None of the other drugs mentioned produce the satiation of drives and sense of well-being that opioids can produce. REF: p. 314

23. Which agent has a withdrawal syndrome characterized by yawning, rhinorrhea, and chills that alternate with excessive sweating? a. Amphetamine b. Diazepam c. Nicotine d. Heroin

ANS: d Correct: The first signs of heroin withdrawal are yawning, lacrimation, rhinorrhea, and diaphoresis, followed by a restless sleep. With further abstinence, anorexia, tremors, irritability, weakness, and excessive gastrointestinal activity occur. The heart rate is rapid, blood pressure is elevated, and chills alternate with excessive sweating. Incorrect choices: Amphetamine withdrawal causes ravenous appetite, aching muscles, and long periods of sleep. Diazepam withdrawal causes insomnia, hyperthermia, and convulsions. Nicotine withdrawal causes drowsiness, headaches, and increased appetite. REF: p. 314

27. For which of the following agents does treatment of withdrawal involve replacement of the abused drug with an equivalent drug, followed by gradual withdrawal of the equivalent drug? a. Opioid analgesics b. Sedative-hypnotics c. Alcohol d. All of the above e. None of the above

ANS: d The described regimen is an accepted one for all three of the drugs mentioned. REF: pp. 312, 315-316

26. Dental health care workers should have heightened awareness of the issues of drug abuse because: a. Their coworkers may abuse drugs in the workplace. b. "Shoppers" may interact with health care workers in an effort to obtain controlled substances. c. Patients who abuse drugs intravenously are more likely to contract sexually transmitted or blood-borne diseases that are transmissible to the dental health care worker. d. Dentist's offices have prescriptions and abusable substances that need to be safely monitored. e. All of the above

ANS: e All statements are true. REF: p. 315

6. Physical dependence: a. Is a state of mind in which a person believes that he or she is unable to maintain optimal performance without having taken a drug b. Is established by withdrawal syndrome c. Refers to the altered physiologic state that results from constantly increasing drug concentrations d. Both a and b e. Both b and c

ANS: e Physical dependence refers to the altered physiologic state that results from constantly increasing drug concentrations as opposed to psychologic dependence, which is a state of mind in which a person believes that he or she is unable to maintain optimal performance without having taken a drug. It is established by withdrawal syndrome, a combination of many drug-specific symptoms that occur on abrupt discontinuation of drug administration. REF: p. 309