Chapter 31: Drugs Used to Treat Oral Disorders

The nurse is assessing a patient's mouth and notes white, milk curd-appearing plaques attached to the oral mucosa. Which condition is present? a. Thrush b. Canker sores c. Cold sores d. Mucositis

ANS: A Thrush is characterized by white, milk curd-appearing plaques that are attached to the oral mucosa. Canker sores can appear as ulcers 0.5 to 2 cm in diameter on surfaces that are not attached to bone, such as the tongue, gums, or inner lining of the cheeks and lips. Cold sores ("fever blisters") are most commonly found at the junction of the mucous membrane and the skin of the lips or nostrils, although they can occur inside the mouth, especially affecting the gums and roof of the mouth. Mucositis is a general term used to describe a painful inflammation of the mucous membranes of the mouth.

What is the primary pharmacologic therapy for Candida albicans? a. Steroids b. Antifungal agents c. Topical anesthetics d. Topical anti-inflammatory agents

ANS: B Candida albicans is the most common oral infection appearing in extremely debilitated patients. Medications that predispose a person to C. albicans infections are those that depress the immune system and those that cause xerostomia. Candida albicans is a fungus and therefore is treated with antifungal agents such as nystatin (Mycostatin). Steroids, topical anesthetics, and topical anti-inflammatory agents are not used to treat C. albicans.

8. Which infection is often called the "disease of the diseased" because it appears in debilitated patients? a. Aspergillosis b. Candidiasis c. Trichomoniasis d. Brucellosis

ANS: B Candidiasis is a fungal infection caused by C. albicans, the most common organism associated with oral infections. It is often called the "disease of the diseased" because it appears in debilitated patients and patients taking a variety of medicines. Aspergillosis is caused by the fungus Aspergillus, which is commonly found growing on dead leaves, stored grain, or compost piles, or in other decaying vegetation. Although it is similar to candidiasis in its occurrence in debilitated patients, it is not as common. Trichomoniasis is a common parasitic sexually transmitted disease. Brucellosis is a zoonotic infection transmitted from animals to humans by the ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols.

A patient is being treated with topical amlexanox paste 5% (Zilactin). Which statement by the patient indicates a knowledge deficit? a. "This medicine will help control discomfort." b. "I will apply the paste before meals." c. "The paste will be applied to each lesion." d. "Healing will be promoted."

ANS: B It is best to apply amlexanox paste 5% (Zilactin) after meals. Discomfort is controlled with this medication; it is applied to each lesion and promotes healing.

Which medication helps prevent or reduce mucositis in patients undergoing chemotherapy or radiation treatment? a. Amlexanox paste (Aphthasol) b. Palifermin (Kepivance) c. Docosanol (Abreva) d. Nystatin (Mycostatin)

ANS: B Palifermin is a recombinant human keratinocyte growth factor approved specifically for preventing and treating the mucositis that develops in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation. Amlexanox paste is used to treat canker sores. Docosanol is used to treat cold sores. Nystatin is used to treat thrush.

Which local anesthetic is used for inflammation of oral mucous membranes? a. Chlorhexidine (Peridex) b. 2% viscous lidocaine c. Nystatin (Mycostatin) d. Hydrogen peroxide

ANS: B Two percent viscous lidocaine is used as a topical anesthetic for pain associated with oral inflammation. Care must be taken so that the patient does not accidentally burn himself or herself because the drug anesthetizes the entire mouth and throat. Chlorhexidine, nystatin, and hydrogen peroxide are not local anesthetics.

Which instruction by the nurse is most important when educating a patient about using viscous lidocaine (Xylocaine) for mucositis? a. "Cleanse the oral cavity after using." b. "This medication can be used as a gargle." c. "After using, wait for 30 minutes before eating." d. "Your sense of taste will be diminished."

ANS: C Caution the patient not to take food or drink for approximately 30 minutes after the medication because of the risk of aspiration from the absence of the gag reflex. The oral cavity is cleansed before administration. The medication can be used as a gargle and the sense of taste is diminished, but these are not the most imp

What is the most common cause of most tooth, gum, and periodontal disease? a. Sugar b. Halitosis c. Plaque d. Smoking

ANS: C Plaque is the primary cause of most tooth, gum (gingiva), and periodontal disease. Plaque, the whitish yellow substance that builds up on teeth and gum lines, is thought to originate from saliva. Plaque forms a sticky meshwork that traps bacteria and food particles. If not removed regularly, it thickens, and bacteria proliferate. Sugar is not a cause of dental disease as such but becomes a problem when poor oral hygiene allows it to collect in the oral cavity. Halitosis is a symptom of poor oral hygiene but is not a cause of dental disease. Although smoking can contribute to periodontal disease through vasoconstriction, it is not a cause of dental disease.

Which condition is treated by saliva substitutes? a. Caries b. Mucositis c. Xerostomia d. Halitosis

ANS: C Xerostomia, or lack of saliva, originates from nonoral causes. Xerostomia is treated by discontinuing medications that dry the mucous membranes or by artificial saliva products. Dentifrices are used to treat caries. Saliva substitutes are not used to treat mucositis. Mouthwash is used to treat halitosis, along with dentifrices.

Which information will the nurse include when teaching a patient about cold sores? a. Use of drying agents prevents the spread of secretions. b. Erupted lesions are not contagious. c. Eruptions are related to breaks in personal hygiene. d. Pus-filled lesions indicate a secondary bacterial infection.

ANS: D Cold sore lesions first become visible as small red papules that later develop into 1- to 3-mm diameter fluid-filled blisters. Over the following 10 to 14 days, a crust develops as the vesicles that burst coalesce into larger lesions. The liquid from the vesicles contains the live virus that can be transferred to other people by direct contact. The base of the lesions is erythematous. If pus develops in the vesicles or under the crust of a cold sore, a secondary bacterial infection may be present and the patient should seek medical attention. Drying agents are not used to treat cold sores. Cold sores are contagious. Eruptions are not necessarily related to poor personal hygiene.

A patient with chronic obstructive pulmonary disease (COPD) uses a corticosteroid inhaler bid. Which adverse effect is associated with this medication? a.Mucositis b. Plaque c. Xerostomia d. Candidiasis

ANS: D Medications that predispose a patient to candidiasis are those that suppress the immune system, including immunosuppressants, corticosteroids, cytotoxics, and broad spectrum antibiotics. Educating patients on the importance of oral hygiene following prescribed inhalation dosages will assist in decreasing this complication. Mucositis, plaque, and xerostomia are not associated with steroid inhaler use.

The nurse is assisting with care of a patient on chemotherapy with severe mucositis. The patient reports mucous membrane pain level to be "8" on the pain scale. The priority nursing diagnosis for this patient is: a. altered nutrition: less than body requirements. b. risk for aspiration. c. fluid volume deficit. d. pain.

ANS: D Pain is the nursing priority. A score of "8" indicates severe pain and comfort measures would take priority. Altered nutrition: less than body requirements, risk for aspiration, and fluid volume deficit are not the priorities at this time.

12. A patient using carbamide peroxide (Gly-Oxide) to treat multiple canker sores develops tissue irritation and black hairy tongue. The patient asks the nurse what can be done to soothe the pain. The nurse will first encourage use of: a. Milk of Magnesia. b. viscous lidocaine 2%. c. Salivart. d. saline rinses.

ANS: D Saline rinses may be soothing and can be used before topical application of carbamide peroxide (Gly-Oxide). They would be encouraged prior to other measures. Milk of Magnesia, viscous lidocaine 2%, and Salivart are not used to soothe this side effect.