Chapter 26: Study Guide

The goal of any drug treatment program is to establish which of the following?

Abstinence syndrome Abstinence syndrome is the state of being free of drugs, which is the goal of any treatment program. Enabling is inappropriate behavior of family members or friends who associate with the addict, resulting in continued drug abuse. This is a coping mechanism, which requires therapy to overcome. Drug dependence (dependence syndrome) is a state that can be physical, psychological, or both, and it occurs as a consequence of the interaction between the patient and the drug. Drug dependence is characterized by the compulsion to take the drug to obtain its effects or to prevent abstinence syndrome. Habituation is the physiologic tolerance to or psychological dependence on a drug but is short of addiction. Tolerance occurs when the dose of a drug must be increased to produce the same effect with subsequent dosing.

Which drugs, when abused, causes more medical problems than all other drugs of abuse combined?

Alcohol and tobacco abuse causes more medical problems than all the other drugs of abuse combined, filling over half the hospital beds in the United States

Alcohol is excreted in the

Alcohol is excreted from the lungs and in urine. It is not excreted in sweat or in tears. Because of the zero-order kinetics of alcohol, excessive intake of alcohol can produce a prolonged effect.

Which pharmacologic agents may be used to assist withdrawal from tobacco?

Approximately 26% of adult Americans smoke, although it has been well established that chronic tobacco use is casually related to many serious diseases including coronary artery disease and oral and lung cancers. Dental hygienists are especially suited to help patients with tobacco cessation based on their role in encouraging patients to adopt healthy habits. Informing the patient of options to help suppress the symptoms of tobacco withdrawal may be the help a patient needs to motivate him or her to stop using tobacco. Pharmacologic agents include nicotine substitutes in the form of nicotine chewing gum (Nicorette, Nicorette DS), nicotine patches (NicoDerm, Nicotrol, and Habitrol), and nicotine nasal spray (Nicotrol NS). These products help to reduce irritability and difficulty in concentrating, but they are less effective in controlling insomnia, hunger, and the craving for tobacco. Another agent used is bupropion (Wellbutrin, Zyban), which is an antidepressant, to reduce cravings. Dentists can prescribe bupropion but should also encourage behavior modification. Varenicline (Chantix) is the new tobacco cessation agent. Varenicline is a nicotine-receptor blocker that binds to the receptor and prevents tobacco from reaching the site, limiting the amount of dopamine that reaches the brain. It is thought that the dopamine release is responsible for the feeling of pleasure associated with tobacco use. Varenicline cannot be used in conjunction with other smoking cessation products.

Chronic nitrous oxide use is associated with physical dependence. Reversible mental dysfunction and neurologic deficiencies may occur with chronic abuse.

Both statements are false. Chronic nitrous oxide use is associated with psychological but not physical dependence. Chronic abuse of nitrous oxide can lead to sensory and motor myelopathy with symptoms pathognomonic for abuse of this drug. Numbness and paresthesias of the extremities, clumsiness, and loss or reflex may occur. The neurologic symptoms are similar to those seen in the spinal cord degeneration in pernicious anemia. Parenteral administration of vitamin B12 improves neurologic problems, but it is controversial whether it improves the myelopathy. If abuse is discontinued early, clinical improvement may occur. Longer abuse is associated with irreversible mental dysfunction and neurologic deficiencies

Cocaine, methamphetamine, and "bath salts" produce euphoria and a sense of omnipotence and self-confidence by acting as central nervous system depressants. The most common cause of death with these drugs is respiratory depression.

Both statements are false. Cocaine, methamphetamine, and "bath salts" produce euphoria and a sense of omnipotence and self-confidence by acting as central nervous system stimulants. These drugs induce sympathetic autonomic nervous system stimulation, causing elevated blood pressure, rapid pulse, and cardiac arrhythmias. Deaths due to cardiac arrhythmias have occurred.

Ethyl alcohol, or ethanol, is a stimulating drug that is used socially. Because of its legality, it is the least abused drug.

Both statements are false. Ethyl alcohol is a central nervous system depressant, not a stimulant. It is widely used socially, and because it is legal, its availability makes it the most often abused drug.

Agents that are capable of changing behavior or inducting psychosis-like reactions (psychoactive agents) have no therapeutic value. Use of these agents is always illegal.

Both statements are false. Psychoactive agents can be divided into those that also have therapeutic value (opioids and sedative-hypnotics) and those that have no proven therapeutic value (psychedelics). Some agents, such as marijuana, move from one category to another. When used recreationally, marijuana leads to impairment and is illegal. It is now used for treatment of chemotherapy-associated nausea and glaucoma, although more controlled studies are required to establish true efficacy.

All are categories of abused drugs except which of the following?

Central nervous system moderators ("middlers") The abused drugs are divided into the following groups: central nervous system depressants (downers), central nervous system stimulants (uppers), and hallucinogens. Some drugs, depending on the dose, may fall into more than one group. The central nervous system depressants include the sedative-hypnotics such as ethanol alcohol, barbiturates, benzodiazepines, opioids, marijuana, and nitrous oxide. The central nervous system stimulants include cocaine, methamphetamine, bath salts, caffeine, and other amphetamines. The hallucinogens include lysergic acid, diethylamide (LSD), phencyclidine (PCP), and mescaline

Which drug may be used to prevent withdrawal symptoms from alcohol abuse?

Cross-tolerant benzodiazepine (chlordiazepoxide) A cross-tolerant benzodiazepine (chlordiazepoxide) may be used to prevent withdrawal symptoms. Cross-tolerant opioid (morphine) and cross-tolerant amphetamine (methamphetamine) are not used to prevent withdrawal symptoms from alcohol abuse. Cross-tolerant opioid (methadone) is used as a substitution for heroin in patients addicted to that drug

Pharmacologic treatment for alcoholism includes which drugs?

Disulfiram (Antabuse) and naltrexone (ReVia) are oral medications that can be given to alcoholics who voluntarily wish to stop drinking. Disulfiram causes severe adverse effects such as vomiting, tachycardia, and throbbing headaches if alcohol is ingested. Naltrexone is an opioid antagonist that reduces alcohol cravings. Chlordiazepoxide can be used to prevent symptoms of alcohol withdrawal. Oxycodone is an opioid that has no indication for treatment of alcoholism and is itself a highly addictive drug.

__ is the opioid most commonly administered parenterally.

Heroin Heroin is the opioid most commonly administered parenterally. Incidence of illicit heroin use has increased dramatically because of the stricter regulation of prescription opioid drugs. In addition, heroin is cheaper than opioid analgesics. Methadone is a long-acting oral opioid that is used in treatment of heroin addiction. Hydromorphone, oxycodone, and meperidine are examples of prescription opioid drugs that may be abused.

A dental health care worker should be familiar with drug abuse for all reasons except which of the following?

Knowledge of drug abuse may allow the dental health care worker to avoid detection. Drug abuse in our society is epidemic, and drug abuse is a community issue. The dental health care worker should be familiar with the signs and symptoms of abuse. Friends, family members, coworkers, patients, and especially adolescents are potential drug abusers, and awareness of this problem is important.

Who are the primary abusers of nitrous oxide?

Nitrous oxide is abused primarily by dental personnel due to its ready availability. Food service employees sometimes become nitrous oxide abusers because it is available in the aerosol of canned whipping cream products.

Which of the following approaches may be used to manage opioid withdrawal?

Patients in withdrawal can be made comfortable with methadone, a long-acting oral opioid that can replace heroin and then be gradually withdrawn. A phenothiazine or a benzodiazepine is often administered to relieve tension, and other psychotropic agents may be helpful in managing the alcoholic patient because of the high incidence of comorbidity of psychiatric conditions.

Which considerations should be used in the dental treatment of a patient who is abusing methamphetamine (meth)?

Patients with "meth mouth" suffer from a variety of dental problems. The combination of xerostomia and bruxism combined with poor nutrition, high sugar intake, and poor oral hygiene can result in rampant caries and tooth loss, fractures, and enamel erosion. Treatment with local anesthetics with vasoconstrictors can be dangerous due to the combined sympathetic nervous system effects. The dental professional should prescribe fluoride and salivary stimulants to prevent caries and treat xerostomia. Nutritional and oral hygiene counseling as well as restorations of damaged teeth should occur.

Peter Painful is a 54-year-old who is new to your practice. He complains of "unbearable pain" and exhibits recurrent bleeding from his periodontal debridement last week, for which he needed nitrous oxide and a preappointment anxiolytic. He had an excessive bleeding response to periodontal instrumentation. He takes baby aspirin for prevention of myocardial infarction, a multivitamin, Ginkgo biloba, and Xanax. He has noted on his history that he is a recovering alcoholic. The physician suggests 800 mg of ibuprofen, but Peter says that ibuprofen does not work for him, and he demands OxyContin for pain because he says it is the only pain medication that helps. What actions should the dental team take to deal with Peter in this situation?

Peter has a history of alcohol abuse, and using an opioid could trigger his abusive behavior again. The best course of action is to alleviate the cause of the pain first and then prescribe a nonsteroidal antiinflammatory drug for analgesia.

Which two characteristics make psychedelics or hallucinogens particularly contribute to periodic, rather than continuous, abuse of these drugs?

Psychedelic-induced dependence is psychological, not physical, and tolerance develops quickly. These two characteristics combined with the unpredictable response contribute to periodic, rather than continuous, abuse of these drugs. Prolonged used can cause long-lasting mental disturbances varying from panic reactions to depression to schizophrenic reactions.

Signs of alcohol abuse include which of the following?

Signs of alcohol abuse include drinking at an inappropriately early time, shaking when unable to drink, blackouts when drinking, and missing work; problems in personal relationships also occur. Unusual nervousness and hyperactivity may be indicators of amphetamine abuse.

The dental hygienist should be aware of the signs and symptoms of alcohol abuse, including which of the following?

The dental hygienist should be alert for signs and symptoms of alcoholism, which could impact dental treatment and the overall health of the patient. Oral signs and symptoms include glossitis, loss of papilla of the tongue, angular cheilosis, Candida infection, and bleeding that may be difficult to control. Alcoholic patients may present with sweet, musty breath, poor oral hygiene, and painless bilateral enlargement of the parotid (not submandibular) glands. Alcohol and tobacco use are comorbidities for oral squamous cell carcinoma, so the dental hygienist should check the oral cavity carefully for areas of ulceration and leukoplakia. The lateral border of the tongue, the floor of the mouth, and the tonsillar region are common sites of malignancies and should be carefully examined. Xerostomia and increased carious lesions are not signs of alcohol abuse

The dental treatment of the alcoholic patient may require which modifications?

The dental treatment of the alcoholic patient may require some modifications, depending on the severity of the disease. Most alcoholics have poor oral hygiene, so extra attention should be focused on this area. The major problems alcoholics face are difficulties with liver function. Hepatic failure decreases the liver's ability to store vitamin K, which is necessary for formation of clotting factors. Alcoholics often have bleeding tendencies, including spontaneous gingival bleeding. Healing after surgery may be slow and bleeding difficult to control. As liver function is reduced, the liver is less able to effectively metabolize drugs. Levels of drugs that are metabolized in the liver, such as amide local anesthetics and oxidized benzodiazepines, do not fall as rapidly as in normal patients, so dosage reductions are required.

The primary cause of death in opioid overdose is respiratory stimulation. Treatment for opioid overdose is naloxone (Narcan).

The first statement is false; the second statement is true. The primary cause of death in opioid overdose is respiratory depression, not stimulation. The triad of narcotic overdose includes respiratory depression, coma, and pinpoint pupils. Naloxone (Narcan), an opioid antagonist, should be administered immediately to prevent serious brain damage. If the patient does not respond to the naloxone, it is unlikely that the respiratory depression was caused by opioid overdose.

In a person with psychological dependence, discontinuing the drug produces which of the following responses?

The person has cravings but no physiologic symptoms, although he or she believes that maintaining top performance without the drug is impossible. Psychological dependence differs from physical dependence in that it does not produce abstinence or withdrawal syndrome as will, or require increasingly greater doses of the drug to maintain the same effect.

Treatment of an overdose of a central nervous system (CNS) stimulant such as methamphetamine or cocaine may include which drugs?

Treatment of an overdose of a CNS stimulant is symptomatic. It may include phenothiazine for psychotic symptoms, a short-acting sympathomimetic blocker if hypertension is severe, and a tricyclic antidepressant if severe depression occurs. Naloxone (Narcan) is an opioid antagonist used to treat an overdose of narcotics, which are CNS depressants. Flumazenil (Romazicon) is a benzodiazepine antagonist given to treat overdose with the benzodiazepine sedative-hypnotics.