DENT 550 – Review Questions

1. Which of the following chemicals is the primary neurotransmitter at afferent sensory neurons?

a. Histamineb. Bradykininc. Glutamate d. Adenosine triphosphate

2. Pain, which arises slowly after injury, and is characterized as burning, aching, dull, poorly localized, and persistent, is most likely to be due to the activation of

a. A-delta fibers.b. C fibers.c. B fibers.d. A-gamma fibers.

3. The rate and extent of absorption of local anesthetic agents from the site of administration is a function of

a. their inherent chemical characteristics.b. pKa of the drug.c. pH at the site of injection.d. all of the above.

4. Of the following local anesthetic agents, which one has intense vasoconstrictive and CNS stimulatory properties?

a. Cocaineb. Lidocaine (Xylocaineâ)c. Mepivacaine (Carbocaineâ)d. Prilocaine (Citanestâ)

5. Local anesthetic agents block nerve conduction bya. reducing the permeability of nerve membrane to potassium.b. increasing the permeability of nerve membrane to chloride.c. increasing the permeability of nerve membrane to calcium.d. reducing the permeability of nerve membrane to sodium.

6. Which of the following statements is correct in reference to the addition of a vasoconstrictor to local anesthetic agents? Vasoconstrictors

a. slow the rate of absorption of LA from the injection site.b. increase the concentration of LA around the nerve and increase its duration of

action. c. decrease the maximal concentration of LA that will reach the systemic circulation

and decreases its systemic toxicity.d. All of the above are correct

7. If the maximum recommended dose of mepivacaine (Carbocaineâ) for a given patient is 300 mg, how many milliliters of 3% mepivacaine may be administered to that patient during an appointment?

a. 5 mLb. 10 mLc. 15 mLd. 20 mL

8. Which of the following local anesthetic agents is potentially the most cardiotoxic (triggers arrhythmias) and may also be the most problematic in the management of children, the mentally retarded, or otherwise debilitated patients who may self-inflict injuries on anesthetized regions of the body?

a. Lidocaine (Xylocaineâ)b. Mepivacaine (Carbocaineâ)c. Bupivacaine (Marcaineâ)d. Prilocaine (Citanestâ)

9. Paresthesia following the administration of a local anesthetic agenta. is most commonly associated with mandibular nerve blocks.b. most commonly affects the lingual nerve.c. is most common with 4% prilocaine and 4% articaine.d. All of the above are correct.

10. Your patient relates a history of cardiovascular disease. Based on this evidence and the functional capacity of the patient you have determined that the maximum safe dose of epinephrine for this patient should not exceed 0.04 mg. All of the following formulations represent the maximum safe dose of a local anesthetic agent with epinephrine or levonordefrin except which one?

a. 8 cc with levonordefrin 1:20,000b. 2 cc with epinephrine 1:50,000c. 4 cc with epinephrine 1:100,000d. 8 cc with epinephrine 1:200,000

11. High doses of circulating adrenergic amines may elicit adverse effects characterized bya. restlessness, headache, tremors, dizziness, pallor, palpitation, tachycardia, chest

pain, and potentially cardiac arrest.b. pallor, diaphoresis, salivation, nausea, bradycardia, hypotension, syncope, and in

some patients clonic seizure.c. weakness, dizziness, flushing, urticaria, followed by rapid progression of the

reaction characterized by stridor (laryngeal edema), wheezing (bronchospasm), hypotension, tachycardia, and vascular collapse.

d. sedation, lethargy, come, dyspnea, respiratory depression, bradycardia, hypotension, and potentially cardiac arrest.

12. Most allergic reactions to local anesthetic agents or their constituents are the result ofa. Type I reactions or anaphylaxis.b. Type II or cytotoxic reactions.c. Type IV or delayed hypersensitivity reactions.d. Type III or Arthus reactions.

13. Cyclooxygenase inhibitors block the synthesis of prostaglandins, which are known to produce all of the following physiological events except which one? Prostaglandin PGE2

a. produce vasodilatation and increase vascular permeability.b. modulate the inflammatory response and body temperature.c. increase nociception. d. activate platelets.

14. All of the following statements are correct about the metabolism and excretion of cyclooxygenase inhibitors except which one?

a. The metabolism of traditional therapeutic doses normally follows first-order kinetics.

b. After larger than the traditional therapeutic doses, the enzymes responsible for their metabolism become saturated, and their half-lives increase significantly.

c. Their metabolites are excreted primarily by the liver.d. In therapeutic concentrations, they have dose-dependent half-lives that vary from

2 to 12 hours.

15. Cyclooxygenase (COX)-1 inhibitors impair platelet adhesion and aggregation primarily by inhibiting the synthesis of

a. thromboxane A2.b. Prostacycline PGI2.c. Prostaglandin PGE2.d. leukotrienes.

16. All of the following statements are correct regarding acetaminophen (Tylenolâ) except which one? Acetaminophen

a. has a significant antipyretic property.b. appears to act as a prodrug for N-arachidonoyl-phenolamine that indirectly

activates CB1 receptors to produce its analgesic effect. c. is not cross-allergenic with NSAIDs. d. has a therapeutically significant anti-inflammatory property.

17. The conclusion that the COX-1 inhibitor ibuprofen alone, or in combination with APAP, should be the drug of choice for the management of moderate-to-severe odontogenic pain is based on the rationale that

a. Other COX-1 inhibitors offer no apparent advantage over ibuprofen.b. Ibuprofen has been shown to be as effective as or more effective than oral codeine

or hydrocodone even in combination with ASA or APAP.c. COX-2 inhibitors may reduce some of the adverse effects associated with

ibuprofen, however, the recent evidence of potential cardiovascular events associated with COX-2 inhibitors mandates caution in their use.

d. All of the above are correct

18. The conclusion that the COX-1 inhibitor ibuprofen in combination with oxycodone, should be the drug of choice for the management of severe odontogenic pain is based on the rationale that

a. Ibuprofen has been shown to be as effective as or more effective than oral codeine and hydrocodone even in combination with ASA or APAP.

b. Oxycodone, 5 mg, with ibuprofen, 400 mg, is more effective than oxycodone, 5 mg, with acetaminophen 325 mg.

c. Oxycodone, 5 mg, with ibuprofen, 400 mg, is more effective than hydrocodone, 7.5 mg, with acetaminophen, 500 mg.

d. All of the above are correct

19. Nausea and vomiting that are associated with the administration of opioid analgesics is the result of direct stimulation of the

a. limbic system.b. vomiting center.c. chemoreceptor trigger zone.d. opioid receptors in the G.I. tract.

20. Which of the following analgesics should be used with caution in patients with severe hepatic or renal disease, vitamin K deficiency, during treatment with anticoagulants, and in patients with hemophilia because severe hemorrhage may result?

a. Opioids b. Acetaminophen (Tylenolâ)c. NSAIDs d. Tramadol (Ultramâ)

21. Which of the following are pathognomonic signs of opioid overdose?a. Miosis, respiratory depression, and coma.b. Nausea, vomiting, diarrhea, anorexia, abdominal pain, hepatic necrosis, and

hepatic coma.c. Tinnitus, dizziness, sweating, hyperventilation, dehydration, and hyperthermia.d. Restlessness, incoherent speech, delirium, convulsions, and coma.

22. All of the following are adverse effects attributable to opioids except which one?a. Respiratory depressionb. Emesisc. Constipationd. Mydriasis

23. When administered orally, which of the following opioids is considered to have the highest dependence liability?

a. Codeineb. Oxycodone c. Hydrocodone d. Pentazocine

24. Which of the following drugs is an opioid antagonist, which may be used to reverse opioid toxicity?

a. Pentazocine (Talwinâ)b. Celecoxib (Celebrexâ)c. Naloxone (Narcanâ)d. Methadone (Dolophineâ)

25. Adjuvant pain medications includea. caffeine w/ibuprofen and acetaminophen.b. hydroxyzine with opioids. c. corticosteroids in some patients with inflammatory disease.d. All of the above are correct

26. Based on their metabolic characteristics, bacteria may be classified asa. cocci or rods.b. Gram-positive or Gram-negativec. aerobic, anaerobic, or facultative.d. bactericidal or bacteriostatic.

27. Microorganisms responsible for odontogenic infections (pulpal, periodontal, pericoronal) are primarily

a. Gram-positive facultative cocci accompanied by Gram-negative strict anaerobic rods.

b. Gram-positive aerobes cocci accompanied by Gram-negative aerobic rods.c. Gram-negative aerobic bacilli accompanied by Gram-positive anaerobic rods.d. Gram-positive strict anaerobes accompanied by Gram-negative aerobic rods.

28. Which of the following antibacterial agents does not target bacterial enzymes that synthesize protein from the mRNA code and is bactericidal?

a. Macrolidesb. Clindamycin c. Tetracyclinesd. Vancomycin

29. Which of the following pharmacological properties is not characteristic of penicillin V? a. Good activity against most facultative Gram + cocci and most Gram - oral

anaerobes. b. Inhibits bacterial cell wall synthesis and activates bacterial autolytic enzymes.c. Beta-lactamase resistance.d. Formulated for oral administration.

30. Which of the following beta-lactam antibacterial agents is effective against Gram-positive and Gram-negative organisms, including anaerobes, and is mostly beta-lactamase resistant?

a. Penicillin Gb. Penicillin Vc. Amoxicillin w/clavulanated. Cephadrine

31. Which of the following antibacterial agents alters the conformation of bacterial DNA, is bactericidal, is beta-lactamase resistant, has good activity against oral facultative and obligate anaerobes, and is available in an oral formulation?

a. Metronidazoleb. Vancomycinc. Sulfonamides and trimethoprimd. Ciprofloxacin

32. Which of the following macrolides has an extended spectrum against facultative and some obligate anaerobes, has a once a day dosage schedule, and is the least likely macrolides to produce an adverse drug effect?

a. Clarithromycinb. Erythromycin ethyl succinate c. Erythromycin based. Azithromycin

33. All of the following antibacterial agents are bactericidal except which one?a. Penicillinsb. Cephalosporinsc. Clindamycin d. Vancomycin

34. All of the following statements are true about mutational drug resistance EXCEPT which one? Mutational drug resistance

a. requires an initial exposure to the antibacterial agent.b. has been related to the synthesis of beta-lactamases.c. has been related to changes in proteins associated with cell membrane

permeability and porins affecting the uptake of beta-lactams. d. has been related to modification of penicillin-binding-proteins, which preclude the

beta-lactams to interact with their receptors.

35. The transfer of plasmid DNA by direct cell-to-cell contact between the donor and recipient microorganism takes place by

a. transposition.b. conjugation.c. mutation.d. transduction.

36. Many oral Gram-negative anaerobes appear to be inherently resistant to macrolides because the structure of the outer bacterial cell membrane restricts entry of the drug. This drug resistance is an example of

a. acquired drug resistance.b. natural or intrinsic drug resistance.c. mutational drug resistance.d. biofilm-related drug resistance.

37. Certain bacteria block ribosomal receptors, a mechanism responsible for macrolide resistance; because macrolide-related microsomal receptors overlap with the receptor site for …………., these bacteria are multi-drug resistant.

a. penicillin V.b. clindamycin.c. metronidazoled. tetracyclines.

38. Certain bacteria may develop macrolide resistance by activating efflux pumps. These activated efflux pumps can also affect the intracellular concentration of

a. clindamycin.b. metronidazole.c. beta-lactams.d. beta-lactamases.

39. All of the following statements are true in regard to biofilms EXCEPT which one?a. Once in a biofilm, bacteria appear to be 1000-fold more resistant to antibacterial

agents than when they are in their planktonic form.b. Planktonic bacteria are recruited into the ecosystem of a biofilm by quorum

sensing.c. Antibacterial agents fail to penetrate beyond the surface layers of the biofilmd. In zones of nutrient depletion or waste product accumulation within the biofilm,

antibiotic action is amplified.

40. All of the following statements are true in regard to resistance and its clinical relevance EXCEPT which one?

a. With each dose of an antibacterial agent, the fraction of resistant bacteria in the individual, and potentially in the community, increases.

b. With prolonged antibacterial chemotherapy there is a risk of destroying the normal flora.

c. Following antibacterial chemotherapy, the resistant flora tends to maintain a survival advantage.

d. The resistant flora must allocate energy to maintain resistance trait.

41. Unless the patient has an allergy to beta-lactam antibacterial agents, the empirical drug of choice for the initial treatment of an odontogenic infection is

a. amoxicillin.b. penicillin V.c. amoxicillin with clavulanic acid.d. cephalexin.

42. When treating an odontogenic infection with penicillin V and significant improvement is not noted within 48 to 72 hours, the empirical addition of ____________ is reasonable because its beta-lactamase resistance and anaerobic spectrum.

a. clindamycinb. metronidazolec. azithromycind. clarithromycin

43. When a patient presents with a severe odontogenic infection or an unresolved odontogenic infection following treatment with a beta-lactam antibacterial agent, the empirical antibacterial drug of choice would be

a. Metronidazoleb. Vancomycinc. Clindamycind. Azithromycin

44. All of the following statements are correct about azole antifungal agents (ketoconazole, itraconazole, voriconazole, and fluconazole,) EXCEPT which one?

a. They inhibit the 14a-sterol demethylase enzyme and the synthesis of ergosterol, which leads to structural and functional damage to fungal plasma membrane and cell death.

b. They are not entirely selective for the fungus-specific CYP450 and also inhibit hepatic CYP450 enzymes and are responsible for many drug-drug interactions.

c. Renal toxicity is their major adverse effect.d. The bioavailability of fluconazole after oral administration is nearly 100%.

45. Because of severe systemic toxicity, the use of nystatin is strictly limited to the treatment of superficial infections of

a. skin.b. oral mucosa.c. vaginal mucosa.d. A, B, and C are correct.

46. All of the following drugs are nucleoside analogues, which inhibit HSV genome replication EXCEPT which one?

a. Acyclovirb. Ganciclovirc. Valacyclovird. Famciclovir

47. Which of the following drugs inhibits sodium reabsorption and increase the excretion of water, but has a potassium sparing effect?

a. Furosemide (Lasix)b. Hydrochlorothiazidec. Triamterened. Potassium chloride (Klor-Con 10, Klor-Con M20)

48. All of the following adverse drug effects are attributable to treatment with a diuretic EXCEPT which one?

a. Xerostomiab. Dehydrationc. Hypotensione. Gingival hyperplasia

49. Which of the following antihypertensive drugs may block the early clinical manifestations of hypoglycemia?

a. 1-adrenergic receptor blocking agentsb. AT II-receptor antagonistsc. Calcium-channel blocking agentsd. Angiotensin converting enzyme inhibitors

50. Which of the following antihypertensive drugs may produce angioedema? a. Selective 1-receptor blocking agentsb. AT II-receptor antagonistsc. Calcium-channel blocking agentsd. Angiotensin converting enzyme inhibitors

51. Which of the following antihypertensive agents have been associated with the “cardiac steal” syndrome?

a. Selective 1-adrenergic receptor blocking agentsb. AT II-receptor antagonistsc. Calcium-channel blocking agentsd. Angiotensin converting enzyme inhibitors

52. A patient, who has recently been prescribed an antihypertensive medication, is now experiencing frequent episodes of acute asthma even though she is compliant with her anti-asthma drug regimen. The most likely antihypertensive drug taken by this patient is

a. a nonselective 1-adrenergic receptor blocking agentb. a calcium-channel blocking agentc. an angiotensin converting enzyme inhibitorsd. an AT II-receptor antagonist

53. A patient may take all of the following drugs with coronary artery disease for the prevention of angina pectoris except which one?

a. A 1-adrenergic receptor blocking agentsb. A calcium-channel blocking agentc. Nitroglycerin (prn)d. Dioxin (Lanoxin®, Digitek®)

54. Which of the following drugs blocks ADP-dependent platelet aggregation?a. Acetylsalicylic acid (Aspirin®)b. Heparinc. Warfarin (Coumadin®)d. Clopidogrel (Plavix®)

55. Before invasive dental procedures, an assessment of the patient’s INR is imperative to ensure values that may preclude problematic bleeding yet maintain therapeutic anticoagulation. These goals may be best achieved if on the day of the procedure the patient’s INR is

a. < 2.b. 2 to 3.c. 3 to 4. d. > 4.

56. Which of the following local hemostatic agent is effective as an oral rinse? a. Absorbable gelatin sponge (Gelfoam)b. Oxidized regenerated cellulose (Surgicel)c. Microfibrillar collagen hemostat (Avitene)d. Tranexamic acid (Cyklokapone)

57. Which of the following drugs inhibits the conversion of angiotensin I to angiotensin II, produces vasodilatation, suppresses aldosterone synthesis, and potentiates the vasodilatating effects of bradykinins and prostaglandins?

a. Benazepril (Lotensinâ)b. Irbesartan (Avaproâ)c. Amlopidine (Norvascâ)d. Carvedilol (Coregâ)

58. All of the following pharmacological effects are attributable to calcium channel blocking agents EXCEPT which one?

a. Relaxation of vascular smooth muscleb. Relaxation of the myocardiumc. Increased conduction velocityd. Increased myocardial oxygen delivery

59. Adverse drug effects associated with calcium-channel blocking agents include all of the following EXCEPT which one?

a. Gingival hyperplasiab. Hypotensionc. Paradoxical angina pectoris (coronary steal syndrome)d. Recurrent hypoglycemia in susceptible patients

60. Which of the following drugs inhibits the sodium/potassium ATPase pump, increasing intracellular calcium ion concentrations and cardiac contractility (positive inotropic effect)?

a. Atenolol (Tenorminâ)b. Digoxin (Lanoxinâ)c. Benzapril (Lotensinâ)d. Valsartan (Diovanâ)

61. All of the following statements are true with respect to insulin EXCEPT which one? Insulin

a. is synthesized by pancreatic beta-cells. b. stimulates cellular glucose uptake. c. increases hepatic glycogenolysis and stimulates gluconeogenesis. d. is a hypoglycemic agent.

62. All of the following statements are true with respect to glucose EXCEPT which one? a. Glucose is an optional fuel in most tissues. b. Most cells can utilize proteins and triglycerides to satisfy their energy (glucose)

requirements. c. Glucose is an obligate fuel in the CNS. d. Brain cells can synthesize and store glucose that can meet their energy needs for

hours.

63. Which of the following laboratory studies reflects glucose levels in a patient over the previous 6 to 12 weeks?

a. Fasting plasma glucose >126 mg/dL following no caloric intake for at least 8 hours.

b. Plasma glucose >100 mg/mL without regard to time since last meal.c. Glycohemoglobin (HbA1c) concentration.d. 2 h plasma glucose >200 mg/mL during an oral glucose tolerance test.

64. Chronic, long-term consequences of undiagnosed or undertreated diabetes mellitus include

a. persistent fungal and/or bacterial infections.b. microvascular and macrovascular disease.c. sensory and autonomic neuropathy.d. All of the above are correct

65. All of the following are complications of hyperglycemia EXCEPT which one?a. Obesity, i.e., body mass index ≥25 kg/m2

b. Periodontal diseasec. Reduced salivary flowd. Oropharyngeal candidiasis

66. The clinical manifestations of hypoglycemia include all of the following signs and symptoms EXCEPT which one?

a. Dry, flushed skinb. Dizziness, faintness, weaknessc. Anxiety, tremor, tachycardiad. Mental confusion, loss of consciousness

67. All of the following statements are true with respect to the dental management strategies for patients with diabetes mellitus EXCEPT which one?

a. The association between uncontrolled or poorly controlled diabetes mellitus and increased susceptibility to oral infections is well established; however, no studies directly support the prophylactic use of antibacterial agents.

b. Dental appointments should be timed so that the patient is treated prior to peak activity of hypoglycemic agents.

c. Profound local anesthesia of adequate duration provides the greatest margin of safety when treating patients with diabetes mellitus.

d. Epinephrine in concentrations commonly used in dentistry significantly increase plasma glucose concentrations and the specter of hyperglycemia.

68. Thyroid hormones a. increase oxygen utilization.b. enhance tissue sensitivity to catecholamines, e.g., increased beta-adrenergic

receptor activity.c. act synergistically with epinephrine, e.g., increase glycogenolysis and

gluconeogenesis.d. All of the above are correct

69. Signs and symptoms associated with hypothyroidism include all of the above EXCEPT which one?

a. Coarse facial features, dry hair, cold skin, b. Slow speech, lethargy, memory impairment c. Increased sensitivity to coldd. Increased rate of respiration

70. Cardiovascular complications of hypothyroidism includea. Bradycardia, hypotensionb. Coronary artery diseasec. Cardiomyopathyd. All of the above are correct

71. Signs and symptoms associated with hyperthyroidism include all of the above EXCEPT which one?

a. Warm, moist skin b. Increased appetite with weight loss c. Lethargy, depressiond. Osteoporosis

72. Thyroid storm represents the extreme life-threatening complications of hyperthyroidism and may result in all of the following signs and symptoms EXCEPT which one?

a. Diaphoresis b. Hypothermiac. Tachycardia d. Severe hypertension

73. Which of the following statements are correct relative to the dental management of patients with hypothyroidism?

a. There is no evidence to justify deferring needed surgery (dental care) in patients with mild to moderate hypothyroidism.

b. There is no evidence of adverse effects associated with epinephrine infusion in patients with mild to moderate hypothyroidism.

c. Cardiac risk is increased in patients unable to meet a 4-MET demand for oxygen; to ensure profound anesthesia use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity.

d. All of the above are correct

74. Which of the following statements are correct relative to the dental management of patients with hyperthyroidism?

a. Increased cardiac output may limit cardiac reserve during surgery (dental care).b. Thyroid hormones act synergistically with epinephrine, undiagnosed/undertreated

hyperthyroidism may carry a perioperative cardiac risk.c. Cardiac risk is increased in patients unable to meet a 4-MET demand for oxygen;

to ensure profound anesthesia use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity.

d. All of the above are correct

75. All of the following statements are true in relation to the physiological effects of glucocorticosteroids EXCEPT which one? Glucocorticosteroids

a. regulate cell metabolism at the level of translation and transcription. b. promote gluconeogenesis.c. are the primary regulators of sodium and water retention in the distal convoluted

tubule of the kidney.d. have pronounced anti-inflammatory and immunomodulatory effects.

76. All of the following medical conditions may be treated with a glucocorticosteroid EXCEPT which one?

a. Lymphocytic leukemiab. Cushing’s diseasec. Asthmad. Allergic rhinitis

77. Hypoadrenocorticism is characterized by all of the following clinical manifestations except which one?

a. Lethargyb. Anorexia, nausea, and weight lossc. Sodium loss leading to hypotension and cardiac arrhythmiad. Hyperglycemia

78. An Addisonian crisis characterized by severe hypotension and cardiogenic shock results from the combined effects of all of the following except which one?

a. Cortisol deficiencyb. Extracellular fluid depletionc. Increased gluconeogenesisd. Aldosterone deficiency

79. All of the following may be a clinical manifestation of Cushing syndrome except which one?

a. Mucocutaneous pigmentationb. Advanced dental agec. Acne, moon face, and hirsutismd. Increased gluconeogenesis

80. All of the following statements are appropriate considerations in developing strategies for corticosteroid supplementation in association with dental care EXCEPT which one?

a. The literature recommends that clinicians prescribe “stress dose” glucocorticoids in the amount equivalent to the normal physiological response to procedure-related “stress”.

b. Based on available evidence, the risk of an Addisonian crisis in association with a dental procedure is low or very low.

c. Based on the anticipated level of perioperative stress in patients undergoing dental care under local dental anesthesia corticosteroid supplementation is not justified.

d. Topical and inhaled corticosteroids can suppress the HPA axis and often cause clinical adrenal insufficiency.

81. All of the following statements relative to bone remodeling are correct except which one? a. Bone remodeling responds adaptively to shear stress.b. The rate of trabecular bone remodeling is at a rate of about 25% per year.c. Bone remodeling is directed by osteocytes (mechanoreceptors).d. In bone remodeling osteoblasts and osteoclasts act independently of each other.

82. Based on the pharmacological properties of drugs available, which of the following drug(s) appears to have a better overall risk-benefit ratio in the prevention and treatment of osteoporosis?

a. Estrogenb. Estrogen/progestin combinationc. Vitamin D Raloxifened. Bisphosphonates

83. Which of the following mechanisms appear to explain bisphosphonate-associated osteonecrosis? BPs

a. are internalized by osteoclasts and inhibit a step in the mevalonate pathway essential for the activation of osteoblasts.

b. induce osteoclast apoptosis.c. are cytotoxic and antiangiogenic.d. All of the above are correct.

84. All of the following statements relative to BP-related osteonecrosis are correct except which one?

a. Bone markers are reliable predictors of patient-response to surgical procedures, i.e., they are good prognosticators.

b. Patients who have been treated with IV BPs have about a 20% chance of developing osteonecrosis.

c. Patients who have been treated with oral BPs have a 0 to 0.4% chance of developing osteonecrosis.

d. Based on available evidence, for patients who are taking oral BPs a drug holiday would not reduce the chance of osteonecrosis.

85. Which of the following statements relative to the dental management of patients on oral bisphosphonates is correct?

a. While it may be prudent to proceed conservatively, routine dental treatment generally should not be modifies.

b. Crowns, FPDs, RPDs, complete dentures are preferable to implant placement.c. Removable prostheses should be adjusted for fit promptly to prevent ulceration

and possible bone exposure.d. All of the above are correct.

86. Which of the following statements relative to the dental management of patients on oral bisphosphonates is correct?

a. The treatment of periodontal disease should include appropriate forms of no-surgical therapy followed by conservative surgical treatment.

b. Consider endodontic treatment of nonrestorable teeth followed by removal of clinical crown – allow for passive exfoliation of the root tip.

c. Antibiotic use should be based on the risk of an infection and not history of bisphosphonate use.

d. All of the above are correct

87. All of the following statements related to the use of anxiolytic agents are correct except which one?

a. The use of short-acting benzodiazepines appear to be potentially inappropriate in older adults, independent of diagnosis or condition, when daily doses exceed the suggested maximum, i.e., smaller doses of may be effective as well as safer.

b. The use of the anxiolytic agent zolpidem (Ambien) appears to be potentially inappropriate in older adults, independent of diagnosis or condition, because age-related changes in GABAA-receptor-zolpidem complex interactions are responsible for high sensitivity of elderly patients to zolpidem.

c. Long-acting benzodiazepines appear to be potentially inappropriate drugs when used in older adults, independent of diagnosis or condition, because in elderly patients they produce prolonged sedation and increase the risk of falls.

d. The use of benzodiazepines should be considered potentially inappropriate in older adults in association with certain diagnoses or conditions, i.e., stress incontinence, depression, COPD, and history of syncope and falls because the benzodiazepines Ý incontinence, Ý depression, ß respiration, and Ý ataxia and Ý the risk of syncope and falls, respectively.

88. Prior to the initiation of therapy in patient with a history of seizure disorder, the oral healthcare provider should confirm compliance with anticonvulsant regimen and determine baseline vital signs because

a. anticonvulsants depress the CNS.b. respiratory depression is a potential serious complication of a seizure attack.c. anticonvulsants are additive with anxiolytic agents, local anesthetic agents, and

opioid analgesics.d. all of the above are correct.

89. Prior to the initiation of therapy in patient with a history of major depressive disorder (MDD) or bipolar disorder (BPD), the oral healthcare provider should confirm compliance with depressant regimen and determine baseline vital signs because

a. antipsychotic agents are CNS stimulants.b. serotonin syndrome (tachycardia, cardiac arrhythmia, hypertensive syndrome,

stroke, hyperthermia, muscle rigidity, and fluctuations in mental state) is a potential serious complication of treatment with antidepressants.

c. antidepressants are additive with sympathomimetic amines, such as vasoconstrictors in local anesthetic agents.

d. all of the above are correct.

90. The most common shared oral adverse effect associated with anxiolytic, anticonvulsant, antipsychotic, and antidepressant drugs is xerostomia, which may treated with

a. pilocarpine HCl (Salagen). b. cevimeline HCl (Evoxac). c. bethanechol chloride (Urecholine).d. All of the above are correct

91. First-generation antihistamines are additive with other CNS depressants, such as anxiolytic agents, local anesthetics, opioid analgesics, by virtue of their higher lipid solubility (in comparison to second-generation antihistamines), which increases the likelihood of first-generation antihistamines interacting with which of the following receptors?

a. H1-receptorsb. H2-receptorsc. H3-receptorsd. All of the above are correct

92. All of the following statements are correct relative to patients taking an H2-receptor antagonist (ranitidine) and/or a proton pump inhibitor (esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole) except which one?

a. The patient may be treated for gastroesophageal reflux disease or peptic ulcer disease

b. Clinical examination of the patient may reveal chemical erosion of teeth or pallor of oral soft tissues.

c. A patient taking these drugs may relate a history of substernal burning pain mimicking pain of cardiac origin

d. In managing pain in these patients, NSAIDs provide the best safety profile

93. A patient with asthma will most likely to be using daily………….for the prevention of an acute attack.

a. albuterol.b. inhaled corticosteroids.c. leukotriene (LT1) inhibitor, such as montelukast (Singulair).d. ipratropium/albuterol (Combivent).