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

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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 17: Psychotherapeutic Agents

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following psychiatric disorders involves a loss of the perception of reality?

 

  1. Bipolar affective disorder
  2. Schizophrenia
  3. Panic disorder
  4. Obsessive-compulsive disorder

 

ANS: b

Schizophrenia is derived from the word meaning “splitting” and, in context, refers to patients splitting from reality. The patient’s ability to function in society is impaired as a result of altered thinking.

 

REF: pp. 223-224

 

  1. The following symptoms are “negative” (passive) symptoms of psychoses except for one. Which one is the exception?

 

  1. Flat affect
  2. Vocalization of feelings of superhuman strength
  3. Abstract thinking difficult
  4. Social withdrawal
  5. Thought and speech impaired

 

ANS: b

Vocalization of feelings of superhuman strength is considered a “positive” or active symptom of psychoses because it represents some action. The negative symptoms represent one form of withdrawal or other (i.e., the inability to do or feel something rather than an ability to do or feel something untoward).

 

REF: p. 224

 

  1. The type of depression that seems to be unrelated to external events is called __________ depression.

 

  1. Involutional
  2. Unipolar
  3. Manic
  4. Exogenous
  5. Reactive

 

ANS: a

Endogenous (involutional) depression seems to be unrelated to external events, whereas exogenous (reactive) depression appears to be related to specific external events. The condition in patients who exhibit only depression is termed unipolar depression. Manic depression is an oxymoron, given that the two terms are opposite one another.

 

REF: p. 224

 

  1. As a group, the atypical antipsychotics produce __________ nausea and __________ anticholinergic and sedative effects compared with conventional antipsychotics.

 

  1. Increased, more
  2. Increased, fewer
  3. Decreased; more
  4. Decreased; fewer

 

ANS: b

The atypical antipsychotics produce increased nausea and fewer anticholinergic and sedative effects than conventional antipsychotics. Many patients are now being treated with the newer “atypical” antipsychotics.

 

REF: p. 225

 

  1. Which of the following agents is classified as an antipsychotic?

 

  1. Celexa
  2. Cephalexin
  3. Zyprexa
  4. Lexapro
  5. Bextra

 

ANS: c

Correct: Zyprexa is the trade name for olanzapine, a newer atypical antipsychotic.

Incorrect Answers: Celexa is the trade name for the antidepressant citalopram, and Lexapro is the trade name for its S-isomer. Cephalexin is a cephalosporin antibiotic, and Bextra is the trade name for valdecoxib, the cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory drug.

 

REF: p. 225

 

  1. In general, lower potency antipsychotic agents will have more: (1) sedation, (2) peripheral side effects, (3) autonomic effects, (4) extrapyramidal effects

 

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

 

ANS: b

Lower potency antipsychotic agents such as chlorpromazine have more sedation, more peripheral side effects, and more autonomic effects. Higher potency agents such as haloperidol have more extrapyramidal effects and less sedation.

 

REF: p. 225

 

  1. Conventional antipsychotics would have little effect on which of the following symptoms of psychosis?

 

  1. Delusions
  2. Unwanted thoughts
  3. Flat affect
  4. Agitation
  5. Disorganized behavior

 

ANS: c

Correct: Conventional antipsychotics are active against the positive effects of psychosis but have little effect on the negative effects. Negative symptoms of psychosis include flat affect, unemotional, apathetic, passivity, abstract thinking difficult, lacking spontaneity and goals, impaired thought and speech, lack of pleasure, and social withdrawal.

Incorrect choices: Positive symptoms of psychosis include hallucinations, delusions, unwanted thoughts, disorganized behavior, agitation, and distorted speech and communication.

 

REF: pp. 224, 226

 

  1. Conventional antipsychotics are primarily __________ antagonists.

 

  1. Acetylcholine
  2. Norepinephrine
  3. Dopamine
  4. Serotonin (5-hydroxytryptamine)

 

ANS: c

Correct: Conventional antipsychotics are primarily dopamine antagonists.

Incorrect choices: Atypical antipsychotic agents have action at more than one receptor, for example, the dopamine, serotonin, and norepinephrine receptors. This results in the improved efficacy of these agents.

 

REF: p. 226

 

  1. Tardive dyskinesia is typically seen in men older than age 40 who have been taking large doses of phenothiazine for 6 months or longer. The onset is gradual and the symptoms are exacerbated on drug withdrawal.

 

  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 statement second is true.

 

ANS: d

Tardive dyskinesia is typically seen in female patients who are more than 40 years of age and have been taking large doses of the phenothiazine for a minimum of 6 months to 2 years or as long as 20 years. The onset is gradual and the movements are coordinated and rhythmic. This effect is exacerbated by drug withdrawal.

 

REF: p. 226

 

  1. Extrapyramidal reactions caused by phenothiazines:

 

  1. Can be treated with anticholinergic agents
  2. Are disorders of muscle control
  3. Include akathisia
  4. All of the above

 

ANS: d

The severity and prevalence of extrapyramidal reactions depends on the balance between acetylcholine and dopamine. Too much dopamine blockade will lead to these side effects. An anticholinergic can partially restore the balance between dopamine and acetylcholine action in specific brain regions associated with muscle control, such as the corpus striatum. Akathisia is an extrapyramidal reaction characterized by increased compulsive motor activity.

 

REF: pp. 226-227

 

  1. Patients taking conventional antipsychotics can experience severe intermittent temporomandibular joint (TMJ) pain. This pain is a consequence of:

 

  1. Hyperalgesia produced by a-adrenergic blockade
  2. Anticholinergic side effects
  3. Dislocation of the mandible
  4. Extrapyramidal side effects

 

ANS: d

Correct: The extrapyramidal side effects of conventional antipsychotics can cause severe intermittent pain in the region of the TMJ. This pain is produced by a spasm of the muscles of mastication.

Incorrect Answers: a-Adrenergic blockade does not produce hyperalgesia, pain is not caused by anticholinergic side effects, and dislocation of the mandible is a possible consequence of a dental practitioner attempting to force open the mouth of a patient who is experiencing a spasm of the muscles of mastication.

 

REF: p. 227

 

  1. Phenothiazines cause hypotension by blocking which receptor?

 

  1. a-Adrenergic
  2. b-Adrenergic
  3. Dopamine
  4. Acetylcholine

 

ANS: a

Phenothiazines, conventional antipsychotics, cause hypotension by blocking a-adrenergic receptors.

 

REF: p. 227

 

  1. Which of the following atypical antipsychotics is associated with agranulocytosis?

 

  1. Aripiprazole
  2. Clozapine
  3. Quetiapine
  4. Risperidone
  5. Ziprasidone

 

ANS: b

Clozapine should be tried only after several trials of other agents have failed because it produces a potentially life-threatening agranulocytosis. With the release of newer atypical antipsychotic agents, use of this agent has decreased.

 

REF: p. 227

 

  1. Epinephrine should not be used to treat vasomotor collapse in patients taking conventional antipsychotics because the conventional antipsychotics are:

 

  1. α-Adrenergic stimulators
  2. α-Adrenergic blockers
  3. β-Adrenergic stimulators
  4. β-Adrenergic blockers

 

ANS: b

Because the conventional antipsychotics are α-adrenergic blockers, epinephrine should not be used to treat vasomotor collapse because it could cause a further decrease in blood pressure. This occurs as a result of the predominant β-agonist activity of epinephrine in the presence of the conventional antipsychotics (α-blockers).

 

REF: p. 227

 

  1. Conventional antipsychotic therapy must often be combined with anti-Parkinson medication of the __________ type to control excessive extrapyramidal stimulation.

 

  1. Adrenergic
  2. Antiadrenergic
  3. Cholinergic
  4. Anticholinergic

 

ANS: d

To control excessive extrapyramidal stimulation, conventional antipsychotic therapy must often be combined with anti-Parkinson medication of the anticholinergic type, for example, benztropine. This combination is likely to exacerbate antimuscarinic peripheral effects such as xerostomia, urinary retention, constipation, blurred vision, and inhibition of sweating.

 

REF: p. 227

 

  1. Which antipsychotic is available as a long-acting injectable for schizophrenic patients who fail to take their oral medication?

 

  1. Chlorpromazine
  2. Loxapine
  3. Thioridazine
  4. Fluphenazine
  5. Quetiapine

 

ANS: d

Correct: Fluphenazine and haloperidol are two antipsychotic agents available in a long-acting injectable form. They are administered intramuscularly as decanoate salts and require dosing every 3 to 4 weeks.

Incorrect Answers: Loxapine, thioridazine, and quetiapine are offered as oral forms only. Chlorpromazine is available as an injectable, but this preparation has a significantly lower duration of action.

 

REF: p. 227

 

 

 

 

  1. Which of the following choices is recommended to counteract the anticholinergic effects of conventional antipsychotics?

 

  1. Caffeine-containing beverages
  2. Alcohol-containing mouth rinses
  3. Sugarless products or artificial saliva
  4. Sugar-containing candy

 

ANS: c

Correct: Conventional antipsychotics are additive with other agents with atropine-like effects. Use of sugarless products or artificial saliva should be encouraged.

Incorrect choices: Patients should be encouraged to stay away from caffeine-containing beverages because they can exacerbate dry mouth. They should also avoid alcohol-containing mouth rinses because alcohol can also exacerbate dry mouth. Patients may use sugar-containing candy to counteract xerostomia. Use of sugarless products is recommended.

 

REF: p. 228

 

  1. Which of the following are anticholinergic effects that may be associated with tricyclic antidepressants?

 

  1. Xerostomia
  2. Bradycardia
  3. Urination
  4. Both a and b
  5. Both b and c

 

ANS: a

Tricyclic antidepressants possess distinct anticholinergic effects resulting in xerostomia, blurred vision, tachycardia, constipation, and urinary retention. Some tolerance can develop with continued use.

 

REF: p. 230

 

  1. Which of the following side effects is the most serious peripheral side effect associated with the use of tricyclic antidepressants?

 

  1. Orthostatic hypotension
  2. Cardiac toxicity
  3. Urination
  4. Bradycardia

 

ANS: b

Correct: The most serious peripheral side effect associated with the tricyclic antidepressants is cardiac toxicity. Myocardial infarction and congestive heart failure have occurred during the course of treatment.

Incorrect choices: Orthostatic hypotension is associated with antipsychotics. Tricyclic antidepressants are associated with anticholinergic effects such as xerostomia, tachycardia, constipation, and urinary retention. Arrhythmias and episodes of tachycardia can be caused by the antimuscarinic effects of the tricyclic antidepressants.

 

REF: p. 230

 

  1. Of the tricyclic antidepressants listed, which one is most sedating?

 

  1. Imipramine
  2. Nortriptyline
  3. Protriptyline
  4. Desipramine
  5. Amitriptyline

 

ANS: e

Of the tricyclic antidepressants listed, amitriptyline is generally the most sedating, with desipramine being the least sedating. When sedation is desired, amitriptyline is used. When less sedation is needed, nortriptyline or protriptyline can be tried.

 

REF: pp. 229-231

 

  1. Which agent is used to treat nocturnal enuresis?

 

  1. Olanzapine
  2. Fluoxetine
  3. Metoclopramide
  4. Imipramine

 

ANS: d

Correct: Imipramine is effective in juvenile bed wetting, likely because of its anticholinergic actions.

Incorrect Answers: Olanzapine, fluoxetine, and metoclopramide are not effective for nocturnal enuresis.

 

REF: p. 231

 

  1. Which of the following tricyclic antidepressants is used for the treatment of obsessive-compulsive disorder?

 

  1. Amitriptyline
  2. Clomipramine
  3. Doxepin
  4. Nortriptyline

 

ANS: b

Correct: Clomipramine is used only in the treatment of obsessive-compulsive disorder. Patients with obsessive-compulsive disorder repeatedly perform certain rituals such as hand washing.

Incorrect choices: Amitriptyline is used when sedation is desired. Doxepin is used when an antianxiety effect is desired. Nortriptyline or protriptyline can be tried when less sedation is needed.

 

REF: p. 231

 

  1. Which of the following types of dental medicaments must be administered with caution to patients taking tricyclic antidepressants?

 

  1. Fluoride
  2. Antibiotics
  3. Anesthetics
  4. Analgesics

 

ANS: c

Vasoconstricting drugs in local anesthetic solution must be administered with caution to patients taking tricyclic antidepressants. They may potentiate vasopressor response to epinephrine. The cardiac dose (0.04 mg) can be safely administered to patients who do not have preexisting arrhythmias.

 

REF: p. 231

 

  1. Which of the following are adverse reactions associated with selective serotonin reuptake inhibitors (SSRIs)?

 

  1. Central nervous system (CNS) depression
  2. Nausea and diarrhea in approximately 15% to 30% of patients
  3. Xerostomia in 10% to 15% of the population
  4. Both a and b
  5. Both b and c

 

ANS: e

SSRIs are associated with nausea and diarrhea in approximately 15% to 30% of patients. Oral side effects include xerostomia in 10% to 15% of the population, taste changes, aphthous stomatitis, glossitis, and (rarely) increased salivation, salivary gland enlargement, and tongue discoloration or edema.

Incorrect choices: SSRIs tend to produce CNS stimulation rather than CNS depression.

 

REF: p. 231

 

  1. Which antidepressant is least likely to cause xerostomia?

 

  1. Bupropion
  2. Sertraline
  3. Chlorpromazine
  4. Amitriptyline
  5. Trazodone

 

ANS: b

Correct: Sertraline, as with other SSRIs, produces a lower incidence of xerostomia than other classes of antidepressants, probably because their anticholinergic activity is significantly weaker.

Incorrect Answers: Bupropion, trazodone, and especially amitriptyline have a greater anticholinergic action and incidence of xerostomia. Chlorpromazine is not an antidepressant.

 

REF: p. 231

 

  1. Bupropion is reserved for patients who are not responsive to other agents because of a potential for:

 

  1. Cardiac arrhythmias
  2. Seizures
  3. Retinopathy
  4. Glaucoma

 

ANS: b

Because of its seizure potential, bupropion is reserved for patients who are not responsive to other agents. Approximately 0.4% of patients treated with bupropion have experienced seizures. This incidence may be four times greater than with tricyclic antidepressants and as much as 10 times greater with tricyclic antidepressants at higher doses.

 

REF: p. 231

 

  1. Which antidepressant drug carries a “black box” warning regarding its potential to cause life-threatening liver failure?

 

  1. Imipramine
  2. Bupropion
  3. Nefazodone
  4. Mirtazapine
  5. Venlafaxine

 

ANS: c

Correct: Of the antidepressant drugs, nefazodone has the potential to cause fatal hepatic dysfunction.

 

REF: p. 232

 

 

  1. Interaction of monoamine oxidase inhibitors (MAOIs) with many drugs such as amphetamines, and with foods such as wines, cheese, and fish, can precipitate:

 

  1. Hair loss
  2. Hypertensive crisis
  3. Gout
  4. Dysgeusia

 

ANS: b

MAOIs interaction with many drugs and foods can precipitate a hypertensive crisis and even death. Patients taking MAOIs have detailed food prohibitions because of this chance of food-drug interactions.

 

REF: p. 232

 

  1. Which of the following medications is used to treat bipolar depression?

 

  1. Haloperidol
  2. Lithium
  3. Clozapine
  4. paroxetine

 

ANS: b

Correct: Lithium is used in the treatment of bipolar depression, which is characterized by cyclic recurrence of mania alternating with depression.

Incorrect choices: Haloperidol is a high-potency conventional antipsychotic. Clozapine is an atypical antidepressant. Paroxetine is an SSRI.

 

REF: p. 232

 

  1. Patients undergoing lithium therapy should be observed for signs of overdose toxicity, including:

 

  1. Hyperpyrexia
  2. Constipation
  3. Muscle rigidity and fasciculations
  4. Loquacious speech

 

ANS: c

Correct: Overdose toxicity may be exhibited by CNS symptoms, including muscle rigidity, hyperactive deep reflexes, excessive tremor, and muscle fasciculations.

Incorrect choices: Side effects of treatment with lithium include polyuria, fine hand tremor, thirst, and in more severe cases, slurred speech, ataxia, nausea, vomiting, and diarrhea.

 

REF: p. 232

 

  1. Which of the following categories of medications has recently been approved for the treatment of bipolar disorder?

 

  1. High-potency conventional antipsychotics
  2. Atypical antipsychotics
  3. SSRIs
  4. MAOIs

 

ANS: b

All of the atypical antipsychotics have been approved for the treatment of bipolar disorder, as well as for the acute treatment of bipolar disorder. Olanzapine and aripiprazole are approved for relapse prevention of bipolar disorder.

 

REF: p. 232

 

TRUE/FALSE

 

  1. Atypical antipsychotics have fewer side effects than conventional antipsychotics.

 

ANS: True

As with conventional antipsychotics, the atypical antipsychotics are effective against the positive effects associated with psychoses. Unlike conventional antipsychotics, however, the atypical antipsychotics are effective against the negative effects.

 

REF: p. 226

 

  1. Force should be exerted to open the patient’s mouth if muscle spasm is present as a result of tardive dyskinesia.

 

ANS: False

Forces should not be exerted to open the patient’s mouth for dental treatment because dislocations of the mandible can occur.

 

REF: p. 227

 

  1. Conventional antipsychotics may be used as a chemical restraint in nursing homes.

 

ANS: False

Use of these agents as chemical restraints in nursing homes is unethical.

 

REF: p. 228

 

  1. The chemoreceptor trigger zone (CTZ) is a site of action for prochlorperazine and promethazine.

 

ANS: True

Correct: Prochlorperazine and promethazine are both phenothiazines. They are antiemetic compounds by virtue of their ability to depress the CTZ.

 

REF: p. 228

 

  1. SSRIs tend to produce CNS stimulation rather than CNS depression.

 

ANS: True

SSRIs do not have the sedative actions found within many tricyclic antidepressants. As a class, they tend to be less sedating, although sedation is sometimes seen with some members of this class (e.g., sertraline).

 

REF: p. 231

 

 

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