Pharm Exam 8 Book Questions Ch. 21, 22 & 23

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.

A dental health care worker should be familiar with drug abuse for all reasons except: Drug abusers may seek drugs from the dental office. Knowledge of drug abuse may allow the dental health care worker to avoid detection. Patients may be drug abusers. Friends and relatives may abuse drugs. Fellow dental health care workers may be abusing drugs.

Teratogen Medications that produce fetal malformations or defects in developments are called teratogens. Abortifacients are drugs that cause spontaneous abortions or miscarriages. Phocomelia is a malformation of hands or feet that are poorly developed and that may have been caused by ingestion of the drug thalidomide during pregnancy. Syndactyly is the congenital fusion of one or more fingers or toes.

A medication or drug that produces a defect in fetal development is called a(n) Syndactyly Phocomelia Abortifacient Teratogen

nystatin (Mycostatin) Nystatin is the safest to use during pregnancy to treat oral Candida infections, and is not absorbed into systemic circulation when applied topically or taken orally. Clotrimazole is absorbed in small amounts, and although no abnormalities have been observed, nystatin is considered safer. Ketonazole is a FDA category C drug, shown to be teratongic in rats. Metronidazole can produce birth defects and animals, and should be used with caution in the first trimester.

A pregnant patient reports that she has "thrush"in her mouth, and asks for medication to treat the condition. Which agent would be safest for her to use? nystatin (Mycostatin) clotrimazole (Mycelex) ketonazole (Nizoral) metronidazole (Flagyl)

The first statement is true; the second statement is false. The first statement is true; the second statement is false. The FDA has developed pregnancy categories A, B, C, D, and X. Each drug that is the subject of FDA regulation for pregnancy labeling is given a category based on its known potential for risk. Category A is the safest, and category X should not be used in pregnant women.

According to the FDA, medications can be categorized according to safety during pregnancy. Drugs considered safest during pregnancy are rated category X. The first statement is false; the second statement is true. Both statements are true. Both statements are false. The first statement is true; the second statement is false.

Both statements are false. 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.

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. The first statement is true; the second statement is false. The first statement is false; the second statement is true. Both statements are true.

Urine Lungs 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.

Alcohol is excreted in the (multi select) Tears Urine Sweat Lungs All of the above.

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, and nitrous oxide. The central nervous system stimulants include cocaine, methamphetamine, bath salts, caffeine, tobacco, and other amphetamines. The hallucinogens include lysergic acid, diethylamide (LSD), phencyclidine (PCP), marijuana, and mescaline.

All are categories of abused drugs except: Psychedelics/Hallucinogens Central nervous system moderators ("middlers") Central nervous system depressants ("downers") Central nervous systems stimulants ("uppers")

Bradycardia, increased respiration The patient with hypoglycemia has a rapid pulse and decreased respiration. He or she may become very talkative and may appear confused or even intoxicated. Hunger, dizziness, weakness, and tremors may occur. The patient may break out in a "cold sweat," become nauseated, and lapse into unconsciousness or seizures.

All are symptoms of hypoglycemia except: -Hunger, dizziness, tremors -Nausea, mental confusion -Diaphoresis, cold, clammy skin -Tachycardia, decreased respiration -Bradycardia, increased respiration

Failure to follow standards of care Even when standards of care are followed, the aging population—with an increased demand for dental population, longer and more complex dental procedures, with complex medical issues—have increased the number of medical emergencies seen in dental offices.

All factors contribute to the increasing numbers of emergencies occurring in dental offices except: Failure to follow standards of care The aging of the population, with increased retained dentition as they age More medically compromised patients seeking dental treatment Dental administration of more complex drug regimens Longer, more complex dental procedures

Lidocaine Thalidomide, isotretinoin, antineoplastic agents, tetracyclines, oral anticoagulants, lithium, and many other medications are known teratogens. Lidocaine is considered a U.S. Food and Drug Administration (FDA) category B medication, which is not considered to have teratogenic effects.

All medications are known teratogens except: Antineoplastic agents Tetracycline Lidocaine Thalidomide Isotretinoin (vitamin A analogues)

Metronidazole In animals, metronidazole can produce birth defects. Although it could be used carefully during the first trimester, encountering a dental situation in which the risk to the fetus would not be greater than the benefit to the mother would be difficult. Animal studies show metronidazole to be carcinogenic, so nursing mothers should only be given this drug if the breast milk is expressed and discarded during treatment and for 48 hours after the last dose.

All of these antiinfective agents are considered safe during pregnancy except: Clindamycin Erythromycin Metronidazole Amoxicillin Cephalosporin

Hyperglycemia Patients who have extremely high plasma levels of glucose will lapse into a coma. Epilepsy, hypoglycemia, and toxic reaction to a local anesthetic agent can all lead to convulsions.

All of these medical conditions can lead to seizures except: Toxic reaction to local anesthetic Epilepsy Hyperglycemia Hypoglycemia

Both parts of the statement are false. Both parts of the statement are false. In FDA pregnancy category C drugs, animal studies have shown an adverse effect on the fetus and no adequate studies have been conducted in humans or no studies are available in either animals or women. Potential benefits may warrant its use. Some drugs in this category include epinephrine, aspirin, atropine, theophylline, and prednisone.

An FDA pregnancy category C drug means that animal studies have failed to demonstrate a risk to the fetus, and adequate studies have been conducted in pregnant women to demonstrate the drug's safety. The first part of the statement is true; the second part is false. Both parts of the statement are true. The first part of the statement is false; the second part is true. Both parts of the statement are false.

Both statements are false. 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.

Chronic nitrous oxide use is associated with physical dependence. Reversible mental dysfunction and neurologic deficiencies may occur with chronic abuse. Both statements are false. The first statement is false; the second statement is true. The first statement is true; the second statement is false. Both statements are true.

Both statements are false. 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.

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 true. The first statement is false; the second statement is true. The first statement is true; the second statement is false. Both statements are false.

The first statement is true, the second statement is false. The first statement is true, the second statement is false. Epinephrine is the drug of choice for anaphylaxis and serious allergic reactions, acting as a physiologic antagonist to the massive mediator release that causes bronchoconstriction and decreased oxygen exchange. The use of epinephrine should be followed by administration of hydrocortisone, given intramuscularly or intravenously. Hydrocortisone reduces the inflammation associated with anaphylaxis and serious allergic reactions, but has a slow onset of action.

Epinephrine is the drug of choice for anaphylaxis and serious allergic reactions. The use of epinephrine should be followed by atropine. The first statement is false, the second statement is true. Both statements are false. The first statement is true, the second statement is false. Both statements are true.

Shock Epinephrine should not be used in the treatment of shock because it can cause decreased venous return with increased ischemia and can precipitate ventricular fibrillation. Epinephrine is included in the dental office emergency kit for the treatment of cardiac arrest, anaphylaxis, or acute asthmatic attack. It can be administered by intravenous or intracardiac routes if the personnel have been properly trained. Dental personnel may find injection into the frenulum under the tongue to be more convenient.

Epinephrine must be included in the dental office emergency kit for treatment of all conditions except: Anaphylaxis Cardiac arrest Shock Acute asthmatic attack

Both statements are false. 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.

Ethyl alcohol, or ethanol, is a stimulating drug that is used socially. Because of its legality, it is the least abused drug. The first statement is true; the second statement is false. Both statements are true. The first statement is false; the second statement is true. Both statements are false.

-Facial dysmorphology -Growth retardation -Central nervous system abnormalities FAS involves prenatal and postnatal growth retardation, central nervous system abnormalities (neurologic or intellectual), and facial dysmorphologic abnormalities, including microcephaly, microphthalmia or short palpebral fissures, and flat maxillary area or a thin lip. These infants exhibit more tremors, hypertonia, restlessness, crying, and abnormal reflexes compared with infants whose mothers did not drink.

Fetal alcohol syndrome (FAS) is associated with excessive maternal intake of alcohol during pregnancy and produces which problems in infants born to these mothers? (multi select) -Facial dysmorphology -Lethargy and excessive sleep -Excessive growth -Growth retardation -Central nervous system abnormalities

The first statement is false; the second statement is true. The first statement is false; the second statement is true. Almost all drugs given to the mother can pass into the breast milk in varying concentrations, depending on the plasma concentration of the drug, lipid solubility, degree of ionization, and binding to plasma proteins. Drugs without strong indications should not be used, and as during pregnancy, the risk-to-benefit ratio should be carefully considered before any drugs are given to the nursing mother.

Few drugs given to the mother can pass into the breast milk. The amount of drug that appears in the milk depends on the plasma concentration of the drug, lipid solubility, degree of ionization, and binding to plasma proteins. Both statements are true. The first statement is false; the second statement is true. The first statement is true; the second statement is false. Both statements are false.

The first statement is true; the second statement is false. The first statement is true; the second statement is false. Patients who are extremely anxious or apprehensive about dental treatment may hyperventilate or breathe rapidly. Tachypnea, tachycardia, and paresthesia, as well as nausea, faintness, perspiration, acute anxiety, lightheadedness, and shortness of breath can occur. Once the determination has been made that the patient is hyperventilating, 100% oxygen should not be used. Use calm reassurance, place the patient in an upright position, loosen tight clothing, and work with the patient to control his or her breathing.

Hyperventilation is often triggered by emotional upset associated with dental treatment. The treatment for hyperventilation is to administer 100% oxygen. The first statement is false; the second statement is true. Both statements are false. The first statement is true; the second statement is false. Both statements are true.

-Belief that the person is unable to maintain optimal performance without the drug -Increasingly greater doses of the drug to maintain the same effect 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.

In a person with psychological dependence, discontinuing the drug produces which responses? (multi select) -Abstinence or withdrawal syndrome -Emotional abnormalities and drug-seeking behaviors -Belief that the person is unable to maintain optimal performance without the drug -Increasingly greater doses of the drug to maintain the same effect

Steroids, antibiotics, aminophylline Aspiration may cause acute airway obstruction, usually as a result of a foreign body, such as a crown or vomitus, entering the airway. Treatment of aspiration includes placing the patient in the Trendelenburg position on the right side and encouraging coughing. The patient should not be allowed to sit up. The use of suction, intubation, and ventilatory assistance along with steroids, antibiotics, and aminophylline are the treatments of choice for aspiration. If drug-induced laryngospasm occurs, succinylcholine, a neuromuscular blocking agent, and positive-pressure oxygen are the treatments of choice. A β2-agonist such as albuterol would be used to relieve the bronchospasm of an acute asthma attack. Parenteral epinephrine 1:1000 would be used to treat anaphylaxis or an asthma attack that does not respond to bronchodilator therapy.

Medications used in the treatment of aspiration include: Steroids, antibiotics, aminophylline Succinylcholine, positive pressure oxygen Parenteral epinephrine 1:1000 β2-agonists such as albuterol

-Determine that he is having a myocardial infarction and call 9-1-1 for transport to the hospital. -Administer oxygen. -Administer an aspirin tablet and an opioid narcotic. A myocardial infarction can be differentiated from an angina attack if no relief occurs after three administrations of sublingual nitroglycerin. Treatment includes administration of oxygen, an aspirin tablet (chewed), an opioid analgesic, and transfer to a hospital.

Mr. Hypertensive is your dental patient and complains of severe chest pain and pressure in his chest. He takes three doses of his sublingual nitroglycerin tablets but receives no relief. What should you do next? (multi select) -Determine that he is having a myocardial infarction and call 9-1-1 for transport to the hospital. -Give him another nitroglycerin tablet. -Administer oxygen. -Administer an aspirin tablet and an opioid narcotic. -All of the above.

Opioid overdose Mrs. Jones is suffering from an opioid overdose caused by self-medication with her husband's drugs and the OxyContin the dentist gave her. The most common symptoms of overdose from the opioids are shallow and slow respiration and pinpoint pupils. The drug of choice for opioid overdose is an opioid antagonist, such as naloxone (Narcan). She does not indicate a history of diabetes, which could lead to hypoglycemia or hyperglycemia. Local anesthetic toxicity would cause central nervous system excitation.

Mrs. Jones has been up all night with a toothache and visits your office for an emergency extraction. She seems a little groggy and tells you that she took some medicine left over from her husband's back surgery, but it did not help, and she is still suffering. After reclining her in the dental chair, administering local anesthetic, and giving her two OxyContin tablets for the pain, her breathing slows and she becomes unresponsive to verbal commands. What is the most likely cause of her symptoms? Hypoglycemia Cardiac arrest Local anesthetic overdose Opioid overdose Hyperglycemia

-Determine if a cause for his pain exists. -Prescribe a nonsteroidal antiinflammatory drug for pain control. 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.

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? (multi select) -Determine if a cause for his pain exists. -Refer Peter to the emergency department at the hospital. -Prescribe the OxyContin to alleviate his pain. -Prescribe a nonsteroidal antiinflammatory drug for pain control.

Naltrexone (ReVia) Disulfiram (Antabuse) 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.

Pharmacologic treatment for alcoholism includes which drugs? (multi select) Oxycodone Chlordiazepoxide Naltrexone (ReVia) Disulfiram (Antabuse)

-Missing work and problems with personal relationships -Shaking when unable to drink -Drinking at inappropriately early times -Blackouts when drinking 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. *

Signs of alcohol abuse include which of the following? (multi select) -Missing work and problems with personal relationships -Shaking when unable to drink -Drinking at inappropriately early times -Unusual nervousness and hyperactivity -Blackouts when drinking

-Treatment of acute angina attack -Premedication before a stressful dental appointment Premedication with sublingual nitroglycerin before a stressful dental situation may prevent an acute angina attack and may be used to treat an acute angina attack. If the angina is not relieved by administration of nitroglycerin, emergency medical services should be activated. Nitroglycerin should not be used to prevent acute angina attack if the patient has taken a medication to treat erectile dysfunction within the past 24 hours. If the patient has taken this type of medicine, he should be treated in the hospital for the acute angina attack. Once a myocardial infarction has occurred, sublingual nitroglycerin alone is insufficient to treat the condition.

Sublingual nitroglycerin is used in which situation? (multi select) -Treatment of acute angina attack -Treatment of myocardial infarction -Premedication before a stressful dental appointment

Anaphylactic shock in response to latex gloves Susan is probably experiencing an anaphylactic reaction to latex gloves, which is not uncommon among persons who have had multiple surgeries for spina bifida. Her reaction began shortly after exposure to your gloves (the antigen), and she experienced a profound decrease in blood pressure, dyspnea and severe bronchial constriction, and a weak, rapid pulse. She did not indicate a history of asthma, and her blood pressure and pulse rate would increase in an asthma attack or episode of hyperventilation. Difficulty breathing is not associated with psychogenic shock or fainting due to anxiety.

Susan, your patient, starts to have difficulty breathing, and her pulse is rapid and weak. Her blood pressure is now 80/40 mm Hg, although it was 120/80 mm Hg at the start of the dental appointment, and she lapses into unconsciousness. Her medical history indicates she has had multiple surgeries to repair a spinal cord defect (spina bifida). Which is the most likely reason for her symptoms? Anaphylactic shock in response to latex gloves Hyperventilation Asthmatic attack in response to latex gloves Psychogenic shock

-Glossitis, angular/labial cheilosis, atrophy of tongue papilla -Increased incidence of leukoplakia and ulceration 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 hygienist should be aware of the signs and symptoms of alcohol abuse, including: (multi select) -Increased carious lesions -Xerostomia -Glossitis, angular/labial cheilosis, atrophy of tongue papilla -Painless, bilateral enlargement of the submandibular glands -Increased incidence of leukoplakia and ulceration -All of the above

Decreased drug dosages Increased healing time 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 dental treatment of the alcoholic patient may require which modifications? Decreased drug dosages Prescribed salivary substitute Increased bleeding times Increased drug dosages Increased healing time

Both statements are false. Both statements are false. Diabetic coma is caused by elevated blood sugar and usually takes place over a longer period of time than hypoglycemia. Diabetic coma is rarely seen in the dental office because the patient is usually too ill to come in for a dental appointment. Signs and symptoms of hyperglycemia include frequent urination, loss of apetitie, hypercapnia (too much carbon dioxide in the blood caused by inadequate respiration), nausea, vomiting, thirst. Acetone (sweet) breath, warm dry skin, rapid pulse, and a decrease in blood pressure can occur.Treatment with insulin should occur only in a hospital setting after laboratory results reveal blood glucose levels.

The diabetic coma is commonly seen in the dental setting. The treatment of choice is administration of injected insulin. Both statements are false. The first statement is true; the second statement is false. Both statements are true. The first statement is false; the second statement is true.

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 an inappropriate 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.

The goal of any drug treatment program is to establish: Abstinence syndrome Dependence syndrome Enabling syndrome Tolerance syndrome

Both statements are false. Both statements are false. Amoxicillin is the most common antiinfective agent used in dentistry today and is considered safe during pregnancy. Using amoxicillin for a dental infection that is not controlled by local measures would be acceptable. All tetracyclines are contraindicated during pregnancy because of the potential for adversely affecting the fetus's developing teeth.

The most common antiinfective agent used in dentistry is tetracycline. Authorities generally agree that tetracycline is safe to use during pregnancy. Both statements are false. Both statements are true. The first statement is false; the second statement is true. The first statement is true; the second statement is false.

The first statement is false; the second statement is true. 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.

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 first statement is true; the second statement is false. Both statements are false. Both statements are true.

-Phenothiazine -Tricyclic antidepressant -Short-acting sympathomimetic blocker 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.

Treatment of an overdose of a central nervous system (CNS) stimulant such as methamphetamine or cocaine may include which drugs? (multi select) -Phenothiazine -Tricyclic antidepressant -Naloxone (Narcan) -Flumazenil (Romazicon) -Short-acting sympathomimetic blocker

Both statements are false. Both statements are false. First-trimester use of the benzodiazepines (chlordiazepoxide and diazepam) has been reported to increase the risk of congenital malformations. Cleft palate and lip and neural tube defects have been seen during the first trimester only, given that this period of fetal development is when they would occur. Temazepam and triazolam are FDA pregnancy category X drugs, and alprazolam, halazepam, and lorazepam are category D drugs. Chronic ingestion of benzodiazepines may produce physical dependence in the infant. Floppy infant syndrome, or neonatal flaccidity, may occur in the infant at birth, with inadequate sucking reflex or apnea. There are no dental indication benzodiazepines during pregnancy, and the only indication for benzodiazepines during pregnancy is for status epilepticus.

Use of benzodiazepines in the first trimester is considered safe. Use in the third trimester has been linked to an increased risk of cleft palate and lip and neural tube defects. The first statement is true; the second statement is false. Both statements are true. The first statement is false; the second statement is true. Both statements are false.

A smaller-than-normal dose should be used to protect the fetus. Small doses of epinephrine, administered carefully, have similar effect to naturally produced catecholamines. Large doses could produce adverse effects in the fetus, including anoxia from vasoconstriction. With short procedures, local anesthetics without epinephrine are preferred.

When using a local anesthetic with epinephrine during pregnancy, which of statement is most correct? A smaller-than-normal dose should be used to protect the fetus. No change in the dose is necessary. A greater-than-normal dose should be used to compensate for fetal metabolism. Epinephrine should never be used during pregnancy.

Increased incidence of spontaneous abortion Operating room personnel exposed to trace amounts of nitrous oxide have a significantly higher incidence of spontaneous abortion and birth defects in their children, regardless of whether the man or woman was exposed. Pregnant dental health care workers should be aware of the nitrous oxide levels present in the dental office in which they practice, and all workers should be careful in limiting the environmental exposure to nitrous oxide to the lowest possible levels. Aspirin and the nonsteroidal antiinflammatory agents given near term can cause premature closure of the patent ductus arterious, increased gestational time, and increased hemorrhage during labor and delivery.

Which adverse effects are linked to chronic nitrous oxide exposure and the pregnant dental health care worker? Increased incidence of spontaneous abortion Increased gestational time Increased hemorrhage during labor and delivery Premature closure of the patent ductus arterious

-Relief of tension and anxiety with use of phenothiazines or benzodiazepine -Psychotropic agents for management of comorbid psychiatric conditions -Substitution of a physiologically equivalent drug such as methadone 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 approaches may be used to manage opioid withdrawal? (multi select) -Substitution of a psychologically equivalent drug such as oxycodone -Relief of tension and anxiety with use of phenothiazines or benzodiazepine -Psychotropic agents for management of comorbid psychiatric conditions -Substitution of a physiologically equivalent drug such as methadone -All of the above

-Patient requests specific drug, stating allergy or ineffectiveness of analgesic not wanted -History of sexually transmitted diseases "Shoppers" interact with health care workers in an attempt to obtain controlled substances for illegitimate uses. Most shoppers present as a typical patient, and suggest need for specific drugs, or a history of allergy to the drug suggested by the health care practitioner. Intravenous drug users are more likely to have sexually transmitted diseases, hepatitis B, hepatitis C, be HIV positive or have AIDS, be infected with multidrug-resistant tuberculosis, and to have altered heart valves.

Which are ways a health care worker can identify a drug "shopper?" (multi select) -Patient requests specific drug, stating allergy or ineffectiveness of analgesic not wanted -Poor hygiene, long sleeve shirts, sunglasses -History of sexually transmitted diseases -All of the above

All of the above. 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.

Which considerations should be used in the dental treatment of a patient who is abusing methamphetamine (meth)? -Local anesthetics with vasoconstrictors should be used with caution. -Extensive restorative treatment may be indicated. -Fluoride and salivary stimulants should be prescribed. -Bruxism may require mouth guard fabrication. All of the above.

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.

Which drug may be used to prevent withdrawal symptoms from alcohol abuse? Cross-tolerant amphetamine (methamphetamine) Cross-tolerant opioid (methadone) Cross-tolerant opioid (morphine) Cross-tolerant benzodiazepine (chlordiazepoxide)

tobacco alcohol 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.

Which drugs, when abused, causes more medical problems than all other drugs of abuse combined? (multi select) Cocaine Tobacco Heroin Alcohol

Syncope The most common emergency encountered in the dental office is syncope, fainting, transient unconsciousness, or vasomotor collapse. The anxiety and fear that many patients have of the dental office can precipitate syncope. The dental health care worker can prevent syncope by exhibiting a calm, confident demeanor and reducing patient apprehension.

Which is the most common emergency encountered in the dental office? Seizures Hypoglycemia Asthma attack Syncope Heart attack

Hypoglycemia Hypoglycemia is the most common medical emergency in the diabetic patient, and the most common cause of hypoglycemia is an excessive dose of insulin. If patients injected their insulin but do not eat or ate only a small quantity, their blood sugar can drop dangerously low. Careful review of the medical history to determine the dose and type of insulin and food intake before the appointment can help prevent a hypoglycemic emergency. Signs and symptoms of hypoglycemia include rapid pulse, decrease respiration, hunger, dizziness, and weakness. The patient may become very talkative or combative. Diaphoresis(sweating), nausea, mental confusion, and occasionally hand tremors. If the signs of hypoglycemia are recognized early, the patient can be given a sugary drink or oral glucose. If the patient has lost consciousness, dextrose must be given intravenously.

Which is the most common medical emergency in the diabetic patient? Syncope Hyperglycemia Hypoglycemia Coma

First trimester During the first trimester, the organs in the fetus are forming. This trimester is considered the most critical time for birth defects.

Which is the most critical period in fetal development? First trimester Birth Third trimester Second trimester

Acetaminophen In normal doses, acetaminophen is considered safe during pregnancy. Aspirin and ibuprofen taken in the third trimester can prolong gestation, complicate delivery, decreases placental efficiency, and increase the risk of hemorrhage to both mother and baby; premature closure of the patent ductus arterious may also occur. Opioids given near term may cause respiratory depression in the infant or, in an addicted mother, withdrawal symptoms after birth.

Which is the safest analgesic to use during pregnancy? Acetaminophen Ibuprofen Opioids Aspirin

Second trimester The second trimester is best time for the patient to receive elective dental treatment. The patient is most comfortable during this trimester. During the first trimester, the patient may experience nausea or feel ill because of morning sickness; during the third trimester, the weight of the baby makes lying in one position for any length of time difficult for the mother.

Which is the safest time for the pregnant patient to receive dental treatment? First trimester Third trimester Second trimester After birth

-Protecting the patient from self-harm -Turning the patient's head to the side to prevent aspiration -Administering intravenous diazepam Convulsions are usually self-limiting; thus, protecting patients from harming themselves and turning their head to the side to prevent aspiration of vomitus are usually sufficient responses. If the seizure does not stop or if one seizure follows another in rapid succession, serious harm can occur and is treated with the intravenous administration of diazepam.

Which is the treatment of choice for a convulsion that is not self-limiting? (multi select) -Protecting the patient from self-harm -Administering epinephrine 1:1000 -Administering sublingual glucose gel -Turning the patient's head to the side to prevent aspiration -Administering intravenous diazepam

-Placing the patient in the -Trendelenburg position -Inhalation of spirits of ammonia Syncope can be treated by administering spirits of ammonia by inhalation (smelling salts) and increasing blood flow to the brain by placing the patient in the Trendelenburg position with the head lower than the feet.

Which is the treatment of choice for syncope? (multi select) -Administration of insulin -Placing the patient's head between the legs -Placing the patient in the -Trendelenburg position -Administration of epinephrine 1:1000 -Inhalation of spirits of ammonia

-Flumazenil (Romazicon) -Bupropion (Wellbutrin, Zyban) -Nicotine chewing gum, patches, or nasal spray 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. *

Which pharmacologic agents may be used to assist withdrawal from tobacco? (multi select) -Varenicline (Chantix) -Flumazenil (Romazicon) -Bupropion (Wellbutrin, Zyban) -Nicotine chewing gum, patches, or nasal spray

All of the above Susan's precipitous drop in blood pressure and loss of consciousness makes this situation a life-threatening emergency; therefore, parenteral epinephrine 1:1000 is the drug of choice and must be injected immediately in the deltoid muscle or under the tongue. Once she has regained consciousness, the bronchoconstriction can be treated with albuterol administered by inhalation, and 100% oxygen can be given. After the life-threatening symptoms have been controlled, intravenous corticosteroids, intramuscular diphenhydramine, and aminophylline may also be used.

Which treatments should Susan receive? Parenteral epinephrine 1:1000 Pure (100%) oxygen Inhaler containing β2-agonists such as albuterol Intravenous corticosteroids and intramuscular diphenhydramine All of the above

-Psychological addiction -Tolerance develops very quickly 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.

Which two characteristics contribute to periodic, rather than continuous, abuse of psychedelics or hallucinogenic drugs? (mulit select) -Physical addiction -High cost -All of the above -Psychological addiction -Predictable response to drug -Tolerance develops very quickly

Food service employees Dental personnel 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.

Who are the primary abusers of nitrous oxide? (multi select) Food service employees Medical personnel Dental personnel Party-going adolescents

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.

___________ is the opioid most commonly administered parenterally. Methadone Hydromorphone Heroin Oxycodone Meperidine