Applied Pharmacology for The Dental Hygienist 6th Edition By  – Test Bank

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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Applied Pharmacology for The Dental Hygienist 6th Edition By  – Test Bank

 

Sample  Questions

 

Haveles: Applied Pharmacology for the Dental Hygienist, 6th Edition

 

Chapter 03: Adverse Reactions

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A genetically related abnormal drug response is called a/an:

 

  1. Toxic reaction
  2. Idiosyncratic reaction
  3. Side effect
  4. Drug allergy

 

ANS: b

Correct: An idiosyncratic reaction is a genetically related abnormal drug response.

Incorrect choices: A toxic reaction is an adverse drug reaction that is an extension of the pharmacologic effect of the drug. Side effects are dose-related effects on nontarget organs. Drug allergy refers to the interaction of the immune system with the drug. None of these incorrect choices are limited to describing abnormal or genetically related responses.

 

REF: pp. 28-29

 

  1. A drug effect that is neither predictable nor dose related is called a:

 

  1. Therapeutic effect
  2. Toxic reaction
  3. Side effect
  4. Drug allergy
  5. Both b and d

 

ANS: d

Correct: Unlike other adverse reactions, allergic reactions are neither predictable nor dose related.

Incorrect choices: Approved pharmaceuticals are available for use because they produce a predictable and dose-related therapeutic response. Toxic reactions and side effects are dose-related effects, the former on the target organ and the latter on nontarget organs. They might be surprising when they arise, for instance, in patients who are especially sensitive to a drug’s effects. However, they are predictable based on the drug’s dose-response relationship.

 

REF: pp. 28-29

 

 

 

  1. The following choices refer to adverse reactions involving exaggerated effects on target tissues except:

 

  1. Overreaction of a sensitive patient
  2. Administration of too large a dose
  3. Caused by a nontherapeutic action of a drug
  4. Possibly resulting from liver or kidney disease

 

ANS: c

Correct: This answer is typical of an adverse effect caused by action on nontarget tissues.

Incorrect choices: Exceptional sensitivity to a normal dose and administration of too large a dose for a patient are common actions that lead to exaggerated effect. Liver or kidney disease may reduce metabolism or excretion, respectively.

 

REF: p. 29

 

  1. A dose-related reaction that produces undesirable effects caused by the action on nontarget organs is called:

 

  1. Therapeutic effect
  2. Toxic reaction
  3. Side effect
  4. Drug allergy

 

ANS: c

Correct: A side effect is a predictable, dose-related drug effect that acts on nontarget organs.

Incorrect choices: Therapeutic effect is the desired effect of the drug. Toxic reaction is a predictable, dose-related drug effect that acts on nontarget organs and produces an adverse reaction. In a drug allergy, the immune system of an individual responds to a drug, resulting in a allergic reaction. Drug reactions are not dose related or predictable.

 

REF: p. 29

 

  1. An agent for which data are insufficient in animals or women to ensure safety during pregnancy would be classified in which U.S. Food and Drug Administration category for teratogenic drugs?

 

  1. X
  2. A
  3. C
  4. B

 

ANS: c

Correct: Some older drugs may be classified as C because data are insufficient to place them in higher categories.

Incorrect choices: X means never use if someone might get pregnant. A means best or least teratogenic. B means that no demonstrated risk to the fetus in laboratory animals has been found or that animal studies show a risk that cannot be substantiated by studies in pregnant women.

 

REF: pp. 29-30

 

  1. The greatest risk to the fetus from exposure to drugs occurs:

 

  1. Just before birth
  2. During the third trimester
  3. During the second trimester
  4. Before pregnancy status is known

 

ANS: d

Correct: Early in pregnancy (first trimester) the organs in the fetus are forming, which is considered the most critical time for teratogenicity.

Incorrect choices: Drugs at these stages may affect the newborn, but the fetus is fully developed. Fetal organogenesis has already occurred, therefore critical stages in fetal development have passed.

 

REF: pp. 29-30

 

  1. An acute, life-threatening allergic reaction characterized by hypotension, bronchospasm, laryngeal edema, and cardiac arrhythmias is what type of hypersensitivity?

 

  1. Type I
  2. Type II
  3. Type III
  4. Type IV

 

ANS: a

Correct: Type I hypersensitivity, or immediate-type hypersensitivity, is a rapidly produced response targeting the bronchioles, the respiratory system, and the skin. Types II, III, and IV reactions are all slower than type I reactions.

Incorrect choices: Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed, causing arthralgia, urticarial skin eruptions, and so forth, with little or no lung involvement. Type IV hypersensitivity, or delayed-type hypersensitivity, is generally manifested as skin eruptions.

 

REF: pp. 30-31

 

  1. Which hypersensitivity reaction causes antibody-antigen (immune complex) deposition?

 

  1. Type I
  2. Type II
  3. Type III
  4. Type IV

 

ANS: c

Correct: Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed and deposited, causing arthralgia, urticarial skin eruptions, and so forth.

Incorrect choices: Type I hypersensitivity, or immediate-type hypersensitivity, involves drug antigen or allergen binding to immunoglobulin E (IgE) antibodies on inflammatory cells. Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type IV hypersensitivity, or delayed-type hypersensitivity, generally manifests as skin eruptions.

 

REF: pp. 30-31

 

  1. Which hypersensitivity reaction is termed delayed-type hypersensitivity and is mediated by sensitized T-lymphocytes and macrophages?

 

  1. Type I
  2. Type II
  3. Type III
  4. Type IV

 

ANS: d

Correct: Type IV hypersensitivity, or delayed-type hypersensitivity, generally manifests as skin eruptions, such as in poison ivy.

Incorrect choices: Type I hypersensitivity, or immediate-type hypersensitivity, involves drug antigen or allergen binding to IgE antibodies on inflammatory cells. Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed and deposited, causing arthralgia, urticarial skin eruptions, and so forth.

 

REF: pp. 30-31

 

  1. Type __________ hypersensitivity is mediated by IgE antibodies.

 

  1. I
  2. II
  3. III
  4. IV

 

ANS: a

Correct: Type I hypersensitivity, or immediate-type hypersensitivity, involves drug antigen or allergen binding to IgE antibodies on inflammatory cells.

Incorrect choices: Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed and deposited, causing arthralgia, urticarial skin eruptions, and so forth. Type IV hypersensitivity, or delayed-type hypersensitivity, generally manifests as skin eruptions, such as in poison ivy.

 

REF: pp. 30-31

 

  1. Approximately 10% of male African Americans develop a severe hemolytic anemia when given the antimalarial drug primaquine. Such a response is categorized as a(n):

 

  1. Idiosyncratic reaction
  2. Drug side effect
  3. Genetically determined abnormal reaction
  4. Allergic reaction
  5. Both a and c

 

ANS: e

Correct: Primaquine-induced hemolytic anemia is a genetically determined abnormal reaction, also known as a drug idiosyncrasy.

Incorrect choices: Idiosyncratic reactions are not drug side effects; they are genetically related abnormal drug responses. Idiosyncratic reactions might involve an immune mechanism but are not considered allergic responses, such as type I through type IV hypersensitivity reactions.

 

REF: pp. 30-31

 

  1. A dose of a drug that kills 50% of experimental animals is termed:

 

  1. ED50
  2. Minimally effective dose
  3. LD50
  4. Therapeutic index

 

ANS: c

Correct: By definition, the LD50 is the median lethal dose, that is, a dose level that leads to death in 50% of the animals tested.

Incorrect choices: ED50 is the median effective dose, a dose that produces a therapeutic effect in 50% of the subjects tested. A minimally effective dose should not cause death unless death is the desired endpoint. In this case, the incidence of death should be lower to be designated minimal. The therapeutic index is the ratio of LD50 to ED50.

 

REF: pp. 31-32

 

 

  1. In an assessment of drug action for a certain therapeutic agent, results indicate that the ED50 is 3 mg/kg, and the LD50 is 300 mg/kg. What is the therapeutic index for this agent?

 

  1. 3
  2. 300
  3. 0.01
  4. 100

 

ANS: d

Correct: One must divide the LD50 value by the ED50 value. The LD50 value (300) divided by the ED50 value (3) equals 100.

 

REF: pp. 31-32

 

  1. Although drug A and drug B have the same ED50, drug B has a wider therapeutic index; therefore drug A has a greater LD50 than drug B.

 

  1. Both parts of the statement are true.
  2. Both parts of the statement are false.
  3. The first part of the statement is true, the second part is false.
  4. The first part of the statement is false, the second part is true.

 

ANS: c

Correct: The therapeutic index is the ratio of the LD50 to ED50. A wide therapeutic index means a greater difference between the LD50 and the ED50 and therefore a greater ratio. If drug B has a wider therapeutic index than drug A and the two drugs have an equivalent ED50, then the LD50 of drug B must be greater.

 

REF: pp. 31-32

 

TRUE/FALSE

 

  1. Drug allergy and a side effect are two examples of dose-related responses.

 

ANS: False

Correct: A side effect of a drug may be dose related, but drug allergy is neither predictable nor dose related.

 

REF: p. 29

 

  1. Tetracycline, nonsteroidal antiinflammatory drugs (NSAIDs), and the benzodiazepines are safe to administer to a pregnant patient.

 

ANS: False

Correct: Tetracycline, NSAIDs, and the benzodiazepines are examples of drugs used in dentistry that are contraindicated during pregnancy.

 

REF: p. 30

 

  1. The greater the therapeutic index is, the greater the toxicity will be.

 

ANS: False

Correct: The therapeutic index is the ratio of the LD50 to ED50. The smaller the ratio is, the closer the LD50 is to the ED50 and therefore the closer a deadly dose is to the therapeutic dose. Therefore the lesser the therapeutic index is, the greater the toxicity will be.

 

REF: p. 32

Haveles: Applied Pharmacology for the Dental Hygienist, 6th Edition

 

Chapter 05: Nonopioid (Nonnarcotic) Analgesics

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Pain:

 

  1. Brings people to the dental office
  2. Keeps people from the dental office
  3. Can be effectively treated with inactive pills (placebos)
  4. 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

 

  1. The pain threshold varies greatly in individuals because of different perception of pain.

 

  1. Both parts of the statements are true.
  2. Both parts of the statements are false.
  3. The first part of the statement is true, the second part is false.
  4. 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. Which of the following raises the pain threshold?

 

  1. Emotional instability
  2. Sympathy
  3. Sleep
  4. Both a and c
  5. 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

 

  1. Synonyms for nonopioid analgesics include:

 

  1. Narcotic
  2. Central
  3. Antipyretic
  4. 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

 

  1. Pain relief by nonopioid analgesics is mediated via action:

 

  1. At the central nervous system (CNS)
  2. At the peripheral nervous system
  3. Both centrally and peripherally
  4. 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

 

  1. The action of nonopioid analgesics is related to their ability to inhibit:

 

  1. The CNS
  2. Prostaglandin synthesis
  3. Release of epinephrine
  4. 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

 

  1. Which of the following choices has antiinflammatory, antipyretic, analgesic and antiplatelet action?

 

  1. Acetaminophen
  2. Codeine
  3. Aspirin
  4. 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

 

  1. Prostaglandins sensitize pain receptors to:

 

  1. Diflunisal.
  2. Salsalate
  3. Bradykinin
  4. 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

 

  1. Which of the following statements is true concerning the pharmacokinetics of aspirin?

 

  1. Plain, unbuffered aspirin produces its peak effect on an empty stomach in 15 minutes.
  2. Buffered aspirin has a slower peak of aspirin than plain aspirin.
  3. The half-life of unhydrolyzed aspirin is approximately 90 minutes.
  4. 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

 

  1. The ability of aspirin to reduce fever results from its inhibition of prostaglandin synthesis in the:

 

  1. Medulla
  2. Hypothalamus
  3. Pons
  4. 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

 

  1. Prostacyclin ___________ aggregation of platelets and thromboxane A2 _________ aggregation of platelets.

 

  1. Stimulates, stimulates
  2. Stimulates, inhibits
  3. Inhibits, stimulates
  4. 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

 

  1. Which of the following effects is the most common side effect from aspirin?

 

  1. Gastrointestinal effects
  2. Bleeding
  3. Hepatic and renal effects
  4. 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

 

  1. Which of the following statements is true regarding aspirin and the clotting mechanism?

 

  1. Aspirin reversibly interferes with the clotting mechanism by reducing platelet adhesiveness.
  2. Replacement of all of the affected platelets is required to produce normal clotting.
  3. With lower doses of aspirin, 1{1/2} days should elapse to obtain normal clotting.
  4. 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

 

  1. Aspirin can be used most safely in patients who:

 

  1. Have arthritis
  2. Have gout
  3. Have ulcers
  4. 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

 

  1. Which of the following choices is the best to use in pediatric patients for both its analgesic and antipyretic action?

 

  1. Aspirin
  2. Acetaminophen
  3. NSAIDs
  4. 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

 

  1. The incidence of true aspirin allergy is:

 

  1. Approximately 10%
  2. Between 2% and 5%
  3. Less than 1%
  4. 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

 

  1. Which of the following drugs can be substituted for aspirin in patients displaying the aspirin hypersensitivity triad?

 

  1. Ibuprofen
  2. Naproxen
  3. Codeine
  4. 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

 

  1. All of the following are characteristics of aspirin toxicity (salicylism) except:

 

  1. Dimness of vision
  2. Hyperthermia
  3. Electrolyte imbalance
  4. Hepatic necrosis
  5. 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

 

  1. A drug interaction between aspirin and ____________ can result in significant bleeding.

 

  1. Probenecid
  2. Warfarin
  3. Methotrexate
  4. 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

 

  1. What is the usual adult dosage of aspirin for the treatment of pain or fever?

 

  1. 250 mg every 4 hours
  2. 3 to 6 g per day
  3. 650 mg every 4 hours
  4. 800 mg every 4 hours
  5. 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

 

  1. Caffeine is often combined with aspirin because caffeine potentiates the analgesic effect of aspirin and other analgesics.

 

  1. Both parts of the statement are true.
  2. Both parts of the statement are false.
  3. The first part of the statement is true, the second part is false.
  4. 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

 

  1. Which of the following agent would be least useful in alleviating fever?

 

  1. Piroxicam
  2. Acetaminophen
  3. Diflunisal
  4. Probenecid
  5. 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

 

  1. Which of the following is true concerning NSAIDs?

 

  1. Many authors agree that the NSAIDs are the most useful drug group for the treatment of dental pain.
  2. Unlike aspirin, NSAIDs do not inhibit the enzyme cyclooxygenase (COX).
  3. Most NSAIDs reach a peak blood level in approximately 20 minutes.
  4. 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

 

 

 

  1. Which of the following statements is true concerning adverse reactions of NSAIDs?

 

  1. NSAIDs will decrease acid secretion in the stomach.
  2. Tolerance develops to the use of NSAIDs.
  3. NSAIDs irreversibly inhibit platelet aggregation because they inhibit thromboxane A2 production.
  4. 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

 

  1. Which of the following NSAIDs is designated U.S. Food and Drug Administration (FDA) pregnancy category B?

 

  1. Naproxen
  2. Diflunisal
  3. Tolmetin
  4. 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

 

  1. Which of the following NSAIDs is the drug of choice for treating a nursing woman?

 

  1. Naproxen
  2. Diflunisal
  3. Ibuprofen
  4. 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

 

  1. Which of the following agents is known to have a drug interaction with lithium?

 

  1. Aspirin
  2. Naproxen
  3. Acetaminophen
  4. 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

 

  1. Dental pain is best managed with which of the following choices?

 

  1. Codeine 60 mg
  2. Ibuprofen 400 mg
  3. Acetaminophen 650 mg
  4. Aspirin 650 mg
  5. 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

 

  1. Which of the following NSAIDs is considered the drug of choice for management of dental pain when a NSAID is indicated?

 

  1. Naproxen
  2. Naproxen sodium
  3. Ibuprofen
  4. 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

 

  1. Oral administration with __________ is indicated only as continuation to intravenous (IV) or intramuscular (IM) therapy.

 

  1. Fenoprofen
  2. Ketorolac
  3. Naproxen sodium
  4. 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

 

  1. Which of the following statements is true of COX II?

 

  1. It is a widely distributed constitutive enzyme.
  2. It is responsible for the adverse reactions of the NSAIDs.
  3. It is synthesized only when inflammation occurs.
  4. 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

 

  1. Which of the following choices is currently the most popular COX II–specific agent on the market?

 

  1. Celecoxib
  2. Rofecoxib
  3. Valdecoxib
  4. 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

 

  1. Which of the following statements is true regarding the pharmacokinetics of acetaminophen?

 

  1. Acetaminophen is slowly and incompletely absorbed from the gastrointestinal tract.
  2. Acetaminophen is excreted with a half-life of 8 to 12 hours.
  3. When large doses of acetaminophen are ingested, an intermediate metabolite is produced that is thought to be hepatotoxic.
  4. 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

 

  1. Acetaminophen does not possess any of these clinically significant __________ effects: (1) antipyretic, (2) antiinflammatory, (3) analgesic

 

  1. 1, 2, 3
  2. 1 and 2
  3. 1 and 3
  4. 1
  5. 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

 

  1. 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

 

  1. 1, 2, 3, 4
  2. 1, 2, 3
  3. 2, 3, 4
  4. 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

 

  1. An acute overdose with acetaminophen may damage the:

 

  1. Eyes
  2. Liver
  3. Spleen
  4. 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

 

  1. Who is most likely to experience the most cases of accidental overdose with acetaminophen?

 

  1. Infants
  2. Children
  3. Young adults
  4. 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

 

 

 

  1. Alcohol consumption stimulates the breakdown of acetaminophen, thereby decreasing the toxic potential of acetaminophen use.

 

  1. Both parts of the statement are true.
  2. Both parts of the statement are false.
  3. The first part of the statement is true, the second part is false.
  4. 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

 

  1. Which of the following agents is intended to treat an acute attack of gout?

 

  1. Probenecid
  2. Codeine
  3. Colchicine
  4. Acetaminophen
  5. 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

 

  1. Which of the following agents is a xanthine oxidase inhibitor?

 

  1. Colchicine
  2. Ibuprofen
  3. Allopurinol
  4. Probenecid

 

ANS: c

Correct: Allopurinol is the only drug listed that inhibits xanthine oxidase.

 

REF: p. 63

 

TRUE/FALSE

 

  1. Two components of pain include perception and reaction.

 

ANS: True

Correct: Perception and reaction are two distinct components of pain.

 

REF: p. 49

 

  1. 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

 

  1. Salicylates’ mechanism of action involves inhibiting prostaglandin synthesis.

 

ANS: True

Correct: Salicylates inhibit the COX enzyme, which produces prostaglandins.

 

REF: p. 51

 

  1. 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

 

  1. Salicylism is a toxic effect from acetaminophen.

 

ANS: False

Correct: Acetaminophen is not a salicylate and does not cause salicylism.

 

REF: p. 54

 

  1. 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

Haveles: Applied Pharmacology for the Dental Hygienist, 6th Edition

 

Chapter 07: Antiinfective Agents

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Dental caries is caused by an infection with:

 

  1. Porphyromonas gingivalis
  2. Eikenella corrodens
  3. Streptococcus mutans
  4. 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

 

  1. Which of the following choices is the dental health care team’s biggest problem in the adult patient?

 

  1. Caries
  2. Periodontal disease
  3. Localized dental infection
  4. 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

 

  1. If an infection is just beginning, the organisms most likely to be present are:

 

  1. Gram-positive cocci
  2. Gram-negative cocci
  3. Gram-positive anaerobes
  4. 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

 

  1. Which of the following agents is the drug of choice for an early dental infection unless the patient is allergic to it?

 

  1. Erythromycin
  2. Clindamycin
  3. Penicillin
  4. 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

 

  1. Which of the following antibiotics is associated with pseudomembranous colitis?

 

  1. Penicillin
  2. Erythromycin
  3. Clindamycin
  4. 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

 

  1. 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.

 

  1. Antiinfective
  2. Antibacterial
  3. Antibiotic
  4. 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

 

  1. Which of the following antiinfective agents is bacteriostatic rather than bactericidal?

 

  1. Cephalosporins
  2. Metronidazole
  3. Penicillins
  4. Tetracyclines
  5. 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

 

  1. The nonhomeostatic multiplication of organisms with the body is called:

 

  1. Resistance
  2. Superinfection
  3. Infection
  4. 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

 

  1. 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.

 

  1. Both statements are true.
  2. Both statements are false.
  3. The first statement is true, the second statement is false.
  4. 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

 

  1. Superinfection is more often caused by __________-spectrum antibiotics and increases when taken for a __________ time period.

 

  1. Narrow; shorter
  2. Narrow; longer
  3. Broad; shorter
  4. 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

 

  1. The pathogenic organisms emerging in a superinfection generally are __________ difficult to eradicate than the original organism and __________ likely to exhibit resistance.

 

  1. Less, less
  2. Less, more
  3. More, less
  4. 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

 

 

 

  1. Which of the following statements is true concerning infection and host resistance?

 

  1. Host resistance should be considered as having both local and systemic components.
  2. Drugs such as steroids are capable of reducing a patient’s immunity.
  3. Juvenile diabetes may reduce a patient’s immunity; however, insulin-dependent diabetes mellitus (IDDM) does not reduce immunity.
  4. Both a and b
  5. 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

 

  1. Which of the following statements is true concerning a culture and sensitivity test?

 

  1. An antibiotic disk with a zone around it shows sensitivity.
  2. An antibiotic disk with no zone around it shows sensitivity.
  3. Antibiotic therapy should not be initiated until the results of the test are available.
  4. 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

 

  1. Which of the following statements is true concerning antibiotic resistance?

 

  1. Natural resistance occurs when an organism that was previously sensitive to an antimicrobial agent develops resistance.
  2. An increase in the use of an antibiotic in a given population decreases the proportion of resistant organisms in that population.
  3. Bacterial resistance can occur by the transfer of deoxyribonucleic acid (DNA) genetic material from one organism to another.
  4. 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. Which of the following periodontal diseases is usually not treated with antimicrobials?

 

  1. Periodontal abscess
  2. Localized juvenile periodontitis
  3. Adult periodontitis
  4. 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

 

  1. Superinfection describes a(n):

 

  1. Nonsystemic, superficial infection
  2. Exaggerated infection caused by treating a resistant pathogen
  3. Opportunistic infection that arises as a consequence of treatment
  4. 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. Antiinfective agents can potentiate the effect of oral anticoagulants by interfering with the production of vitamin:

 

  1. A
  2. D
  3. E
  4. 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

 

  1. __________ has the highest incidence of gastrointestinal complaints of any of the antibiotics.

 

  1. Penicillin
  2. Erythromycin
  3. Clindamycin
  4. 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

 

  1. Which of the following antibiotics are not associated with any teratogenicity and are often used in pregnant women?

 

  1. Penicillin
  2. Tetracyclines
  3. Erythromycin
  4. Metronidazole
  5. 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

 

  1. Which of the following groups of penicillins is considered to be the natural penicillin?

 

  1. Penicillin G
  2. Penicillinase-resistant penicillins
  3. Amoxicillin
  4. 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

 

  1. Which of the following statements is true concerning the pharmacokinetics of penicillin?

 

  1. Penicillin may be administered orally, parenterally, or topically.
  2. Penicillin G is better absorbed orally than penicillin V; thus penicillin G is used for administration of oral penicillin.
  3. Penicillin V and amoxicillin can be taken without regard to meals.
  4. 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

 

  1. Penicillinase inactivates the penicillin moiety by:

 

  1. Sublimation
  2. Desiccation
  3. Cleaving the β-lactam ring
  4. 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

 

  1. Which of the following agents allows the use of amoxicillin to treat penicillinase-producing organisms?

 

  1. Clavulanic acid
  2. Divalent cations
  3. Corticosteroids
  4. Disulfiram

 

ANS: a

Clavulanic acid serves as an inhibitor, which allows the use of amoxicillin to treat penicillinase-producing organisms.

 

REF: p. 83

 

  1. Some studies indicate that __________% of patients receiving penicillin will have an allergic reaction.

 

  1. 0.05 to 0.10
  2. 0.5 to 1.0
  3. 5 to 10
  4. 20 to 25

 

ANS: c

Some studies indicate that 5% to 10% of patients receiving penicillin will have an allergic reaction.

 

REF: p. 83

 

  1. Which of the following statements is true regarding penicillin allergy?

 

  1. Allergic reactions with oral penicillin are more common than with parenteral penicillin.
  2. Anaphylactic reactions are more frequent in patients pretreated with β-blockers and subsequently given oral penicillin
  3. The treatment of anaphylaxis caused by penicillin is the immediate administration of corticosteroids.
  4. 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

 

  1. Which of the following salts of penicillin G produces the most rapid and highest blood level?

 

  1. Potassium salt given intravenously
  2. Potassium salt given intramuscularly
  3. Benzathine salt given intramuscularly
  4. 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

 

  1. The usual adult dose of penicillin V for treatment of an infection is:

 

  1. 250 mg twice a day (bid)
  2. 250 mg four times a day (qid)
  3. 500 mg twice a day (bid)
  4. 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

 

  1. Which of the following statements is true regarding penicillinase-resistant penicillins?

 

  1. Penicillinase-resistant penicillins should be reserved for use against only penicillinase-producing staphylococci.
  2. Penicillinase-resistant penicillins are more effective against penicillin G–sensitive organisms when compared with penicillin G.
  3. Penicillinase-resistant penicillins produce fewer side effects when compared with penicillin G.
  4. 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

 

  1. Which drug should be used before oral prophylaxis for a patient who has rheumatic heart disease with no known drug allergies?

 

  1. Amoxicillin
  2. Tetracycline
  3. Clindamycin
  4. 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

 

  1. __________ is the drug of choice for prophylaxis for bacterial endocarditis before a dental procedure.

 

  1. Penicillin G
  2. Penicillin
  3. Ampicillin
  4. 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

 

  1. Which of the following antibiotics is available mixed with clavulanic acid?

 

  1. Ampicillin
  2. Amoxicillin
  3. Carbenicillin
  4. 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

 

  1. Clavulanic acid is:

 

  1. Bacteriostatic
  2. Bactericidal
  3. Used in combination with amoxicillin
  4. Both a and c
  5. 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

 

  1. Clavulanic acid is used to fight infections with which of the following resistance mechanisms?

 

  1. Decreased permeability to the agent
  2. Production of drug-inactivating enzymes
  3. Alteration in the site of action
  4. 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

 

  1. Which of these agents do not inhibit bacterial cell-wall synthesis?

 

  1. Vancomycin
  2. Erythromycin
  3. Penicillin G
  4. 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

 

  1. Which of the following statements is true concerning the pharmacokinetics of erythromycin?

 

  1. Erythromycin is broken down in gastric fluid and absorbed through the stomach wall.
  2. Erythromycin is not available in a topical preparation because of allergenicity.
  3. Erythromycin is available in oral but not injectable forms.
  4. 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

 

  1. Which of the following condition is the most common adverse reaction from the administration of erythromycin?

 

  1. Anaphylaxis
  2. Skin rash
  3. Gastrointestinal effects
  4. 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

 

  1. Which of the following agents is the drug of first choice against infections cause by aerobic microorganisms in penicillin-allergic patients?

 

  1. Metronidazole
  2. Erythromycin
  3. Doxycycline
  4. 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

 

  1. Azithromycin and clarithromycin:

 

  1. Cause lysis of the bacterial cell wall
  2. Are not effective against anaerobes
  3. Have a higher incidence of adverse reactions than erythromycin
  4. 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

 

  1. Which of the following statements is true of the tetracyclines?

 

  1. They are bactericidal.
  2. Tetracyclines interfere with the synthesis of bacterial protein by binding at the 50S subunit of bacterial ribosomes..
  3. 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.
  4. 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

 

  1. Tetracyclines should not be used in children younger than __________ years of age.

 

  1. 6
  2. 9
  3. 12
  4. 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

 

  1. __________ can cause black pigmentation of mandibular and maxillary alveolar bone and the hard palate.

 

  1. Penicillin V
  2. Erythromycin
  3. Minocycline
  4. 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

 

 

 

  1. Which of the following antibiotics is associated with photosensitivity?

 

  1. Erythromycin
  2. Tetracycline
  3. Metronidazole
  4. Aminoglycosides (e.g., streptomycin)

 

ANS: b

Patients taking tetracyclines who are exposed to sunlight sometimes react with exaggerated sunburn.

 

REF: p. 88

 

  1. Which of the following statements is true concerning clindamycin?

 

  1. Clindamycin is distributed throughout most body tissues, including bone.
  2. Cross-resistance between clindamycin and erythromycin is often noted.
  3. The indications for treatment with clindamycin are limited to a number of infections caused by aerobic organisms.
  4. Both a and b are true.
  5. 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

 

  1. Which of the following agents causes pseudomembranous colitis as a toxicity that limits its general use?

 

  1. Erythromycin
  2. Clindamycin
  3. Penicillin VK
  4. 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

 

  1. Which of the following is the most common adverse reaction to administration of metronidazole?

 

  1. Central nervous system effects
  2. Gastrointestinal effects
  3. Renal toxicity
  4. 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

 

  1. Administration of metronidazole for dental infections during pregnancy is:

 

  1. Contraindicated
  2. Permitted only during the second trimester
  3. Permitted during the last half of pregnancy
  4. 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

 

  1. __________ is associated with a severe drug interaction with alcohol.

 

  1. Erythromycin
  2. Tetracycline
  3. Metronidazole
  4. Aminoglycosides (e.g., streptomycin)

 

ANS: c

Metronidazole is unique among antiinfectives in that it causes a disulfiram-like reaction with alcohol.

 

REF: p. 90

 

  1. Which of the following statements is true of the cephalosporins?

 

  1. They are active against gram-positive but not gram-negative organisms.
  2. Those available for oral use are susceptible to penicillinase.
  3. They are bacteriostatic.
  4. 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

 

  1. Large doses of cephalosporins often produce a Coombs reaction, which means:

 

  1. High blood pressure is exacerbated.
  2. The immune mechanism is attacking the patient’s own red blood cells.
  3. Degeneration of neural glial cells occurs.
  4. 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

 

  1. A cephalosporin would be most closely related to which of the following agents?

 

  1. Penicillin VK
  2. Clarithromycin
  3. Ciprofloxacin
  4. Doxycycline
  5. 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

 

  1. 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?

 

  1. 1, 2, 3
  2. 1, 3, 2
  3. 2, 1, 3
  4. 3, 1, 2
  5. 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

 

  1. Which of the following antibiotics would be the best choice for treatment of an acute abscess or cellulitis?

 

  1. Metronidazole
  2. Erythromycin
  3. Penicillin V
  4. 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

 

  1. When a patient with a stage 1 infection is allergic to penicillin V, the best alternative would be:

 

  1. Penicillin G or ampicillin
  2. Erythromycin ethylsuccinate or clindamycin
  3. Tetracycline or metronidazole
  4. 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

 

  1. Which of the following antibiotics would be the best choice to attack the anaerobes in a stage 2 infection?

 

  1. Clindamycin or metronidazole
  2. Ampicillin or amoxicillin
  3. Amoxicillin or augmentin
  4. 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

 

  1. Which of the following statements is true of vancomycin?

 

  1. Vancomycin is related to the cephalosporins.
  2. Vancomycin is usually administered only intravenously for a systemic effect.
  3. Vancomycin is bacteriostatic.
  4. 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

 

  1. 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?

 

  1. Augmentin
  2. Metronidazole
  3. Vancomycin
  4. 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

 

  1. Aminoglycosides:

 

  1. Are bacteriostatic
  2. Are used primarily to treat aerobic gram-negative infections when other agents are ineffective
  3. Are indicated for stage 1 infections
  4. 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

 

  1. Which of the following antimicrobial agents is associated with ototoxicity?

 

  1. Vancomycin
  2. Aminoglycosides
  3. Nitrofurantoin
  4. 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

 

 

 

  1. The sulfonamides competitively inhibit the bacterial enzyme that incorporates para-aminobenzoic acid (PABA) into an immediate precursor of:

 

  1. Biotin
  2. Thiamine
  3. Folic acid
  4. 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

 

  1. The most common adverse reaction to the sulfonamides is:

 

  1. Liver damage
  2. Suppressed renal function
  3. An allergic skin reaction
  4. 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

 

  1. Which of the following agents is bacteriostatic in action?

 

  1. Amoxicillin
  2. Streptomycin
  3. Vancomycin
  4. 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

 

  1. Sulfamethoxazole and trimethoprim:

 

  1. Are bacteriostatic
  2. Act by sequential inhibition of folic acid synthesis
  3. Are used to treat urinary tract infection (UTI)
  4. All of the above

 

ANS: d

Sulfamethoxazole and trimethoprim are folate synthesis inhibitors used to treat UTI. This action is bacteriostatic.

 

REF: p. 94

 

  1. Which of the following statements is true regarding nitrofurantoin?

 

  1. Nitrofurantoin has a narrow spectrum of action against anaerobic bacteria.
  2. Nitrofurantoin is bactericidal.
  3. Nitrofurantoin is associated with red man syndrome.
  4. 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. __________ are the first orally active agents against certain Pseudomonas species.

 

  1. Aminoglycosides
  2. Sulfonamides
  3. Quinolones
  4. Tetracyclines

 

ANS: c

Quinolones are the first orally active agents against certain Pseudomonas species.

 

REF: p. 95

 

  1. Quinolones:

 

  1. Must be administered parenterally and cannot be taken orally
  2. Have no use in dentistry
  3. Are bactericidal against most gram-negative organisms and many gram-positive organisms
  4. 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

 

  1. Which agent inhibits DNA gyrase?

 

  1. Penicillin G
  2. Erythromycin
  3. Metronidazole
  4. 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

 

  1. Unlike other antiinfective agents, an additive action may result when __________ is combined with other antimicrobial agents.

 

  1. Vancomycin
  2. Chloramphenicol
  3. Nitrofurantoin
  4. 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

 

  1. The drug whose future use may include organisms found in periodontal disease is:

 

  1. Ofloxacin
  2. Sulfamethoxazole
  3. Macrodantin
  4. 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

 

  1. Rupture of the Achilles tendon is associated with the use of:

 

  1. Tetracyclines
  2. Quinolones
  3. Rifampin
  4. 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

 

  1. Which of the following combinations of three drugs are administered concurrently in all active cases of tuberculosis (TB)?

 

  1. Pyrazinamide (PZA), rifapentine, and Rifater
  2. Isoniazid (INH), rifampin, and pyrazinamide
  3. Ethambutol, isoniazid (INH), and Rifater
  4. 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

 

  1. If a person with active TB seeks oral health care:

 

  1. Use standard precautions and treat him or her just as everyone else is treated.
  2. Schedule him or her as the last patient of the day.
  3. Contact that person’s physician and delay health care until the disease is no longer in the active state.
  4. 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

 

  1. Antibiotic prophylaxis is considered reasonable for which of the following dental procedures?

 

  1. Oral radiographs
  2. Routine anesthetic injections through uninfected tissues
  3. Routine prophylaxis
  4. 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

 

  1. Infective endocarditis prophylaxis with an antiinfective is indicated for patients who have had:

 

  1. Coronary artery bypass surgery
  2. Prosthetic heart valve
  3. Functional murmur
  4. 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

 

  1. The standard antibiotic drug regimen prior to dental procedures requiring immunoprophylaxis in a patient with no allergies to penicillin or amoxicillin is:

 

  1. 1 gram of amoxicillin 1 hour before the procedure
  2. 1 gram of amoxicillin 2 hours before the procedure
  3. 2 grams of amoxicillin 1 hour before the procedure
  4. 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.

 

  1. 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:

 

  1. Tetracycline
  2. Metronidazole
  3. Cephalexin
  4. 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

 

  1. 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.

 

  1. 6 months
  2. 1 year
  3. 2 years
  4. 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

 

  1. 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

 

  1. Metronidazole has antiinflammatory activity.

 

ANS: True

Metronidazole affects neutrophil motility, lymphocyte action, and cell-mediated immunity.

 

REF: p. 90

 

  1. 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

 

  1. 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

 

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