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80 Cards in this Set
- Front
- Back
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The perception of pain is the patient’s emotional or psychologic response to pain and varies greatly from individual to individual. The reaction to pain is the physical component to the message of pain as it is carried through the nervous system and is the same for everyone. |
b. Both statements are false.
Perception is the physical component of pain and is the message of pain as it is carried through the nervous system to the brain. The perception of pain is fairly consistent for most people. Reaction to pain is the psychologic component of pain and varies widely among people. REF: p. 49 |
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The site of action on nonopioid analgesics is:
a. Within the central nervous system b. In the hypothalamus c. At the peripheral nerve endings d. In the brainstem |
c. At the peripheral nerve endings
Nonopioid or nonnarcotic analgesics act primarily at the peripheral nerve endings, although their antipyretic effect is mediated in the central nervous system. Opioid analgesics work primarily within the central nervous system. REF: p. 50 |
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The primary action of the nonopioid analgesics is depression of the central nervous system. The inhibition of prostaglandin synthesis reduces the perception of pain.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
d. The first statement is false; the second statement is true.
The primary action of nonopioid analgesics is to inhibit prostaglandin synthesis at the peripheral nerve endings. REF: p. 50 |
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All of the following are classifications of nonopioid analgesics except one. Which one is the exception?
a. Narcotics b. Salicylates c. Acetaminophen d. Nonsteroidal antiinflammatory drugs (NSAIDs) |
a. Narcotics
Salicylates, acetaminophen, and NSAIDs are three classifications of nonopioid or nonnarcotic analgesics and have similar mechanisms of action. Narcotics are also termed opioids and have a completely different mechanism of pain reduction. REF: p. 50 |
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Which of the following best describes the mechanism of action for the salicylates?
a. Antidyspeptic, antipyretic, antiinflammatory, antiplatelet b. Uricosuric, antipyretic, antiinflammatory, antiplatelet c. Sedative, analgesic, antiinflammatory, antiplatelet d. Analgesic, antitussive, antiinflammatory, antiplatelet |
b. Uricosuric, antipyretic, antiinflammatory, antiplatelet
Aspirin can produce uric acid retention and the formation of uric acid crystals in larger doses. It also reduces fever, inflammation, and platelet adhesion. REF: p. 53 |
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All of the following are adverse drug effects of aspirin except one. Which one is the exception?
a. Gastrointestinal upset and bleeding b. Increased bleeding time c. Reye’s syndrome d. Constipation e. Problems during pregnancy and delivery |
d. Constipation
Constipation is linked to use of opioid analgesics, not aspirin. All of the other conditions are adverse drug effects of aspirin. REF: pp. 53-54 |
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The most common adverse reaction to aspirin is:
a. Tachycardia b. Gastrointestinal upset c. Dizziness d. Headache |
b. Gastrointestinal upset
Gastrointestinal upset is the most common adverse drug effect associated with aspirin. Upset can range from mild dyspepsia to life-threatening gastric bleeding and ulcers. The irritation is caused by the inhibition of protective mucous induced by prostaglandins. REF: p. 53 |
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Dangerous bleeding can occur when which of the following drugs is combined with warfarin?
a. Aspirin b. Ibuprofen c. Acetaminophen d. Codeine |
a. Aspirin
The drug interaction between aspirin and warfarin results in the displacement of warfarin (an oral anticoagulant) from plasma proteins, increasing its anticoagulant effect and causing bleeding and hemorrhage. REF: p. 55 |
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The drug of choice for inflammatory dental pain is:
a. Aspirin b. Ibuprofen c. Acetaminophen d. Codeine |
b. Ibuprofen
Ibuprofen and other NSAIDs are very useful in the management of dental pain. In usual therapeutic doses, NSAIDs have been shown to be superior to either aspirin or acetaminophen combined with 60 mg of codeine and are as effective as moderate-strength opioid combinations. REF: p. 60 |
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NSAIDs and aspirin reduce inflammation by inhibiting the synthesis of:
a. Interleukins b. Prostaglandins c. Cytokines d. Histamine |
b. Prostaglandins
NSAIDs and aspirin are closely structurally related and work by the inhibition of prostaglandin synthase. REF: p. 51 |
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Acetaminophen has all of the following pharmacologic actions except one. Which one is the exception? |
c. Antiinflammatory
Acetaminophen has analgesic, antipyretic, and hepatoxic pharmacologic actions but has no antiinflammatory actions. REF: p. 61 |
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The drug of choice for fever reduction in children is:
a. Aspirin b. Ibuprofen c. Acetaminophen d. Codeine |
c. Acetaminophen
Acetaminophen is the best choice for fever reduction, especially in viral illnesses, because aspirin and NSAIDs have been linked to Reye’s syndrome in pediatric patients. Codeine is an opioid and has no antipyretic action. REF: p. 54 |
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Which of the following analgesics would be best for a patient with asthma for relief of a headache or other mild to moderate pain? |
c. Acetaminophen
Acetaminophen is the best choice for an asthmatic patient because aspirin and ibuprofen and other NSAIDs can exacerbate or trigger asthma. Codeine is an opioid analgesic and is not the best choice for the management of mild to moderate pain caused by central nervous system sedation. REF: p. 54 and 58 |
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Which of the following nonopioid analgesics is recommended for prevention of coronary artery disease and treatment of myocardial infarction? |
a. Aspirin
Aspirin binds irreversibly to platelets and is clinically effective for the prevention of myocardial infarction and coronary artery disease, depending on the dose. Low-dose aspirin is recommended for the prevention of myocardial infarction in adults over 50, and chewing a 325-mg aspirin is recommended if a heart attack is suspected. REF: p. 53 |
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Which of the following statements is true regarding the effects of combining caffeine and aspirin?
a. Caffeine has no effect on the analgesic properties of aspirin. b. Caffeine potentiates the antipyretic properties of aspirin. c. Caffeine potentiates the analgesic properties of aspirin. d. Caffeine decreases the analgesic properties of aspirin |
c. Caffeine potentiates the analgesic properties of aspirin.
The addition of caffeine to aspirin and other analgesics potentiates their pain-relieving effect. Adding 130 mg of caffeine has the same effect as increasing the analgesic dose by one third. REF: p. 55 |
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All of the following statements are true about pain except one. Which one is the exception? |
c. A decrease in the pain threshold or greater reaction to pain has been said to be associated with emotional stability.
A decrease in the pain threshold or a greater reaction to pain has been associated with emotional instability, anxiety, fatigue, youth, certain nationalities, women, and fear and apprehension. Understanding the factors that cause a greater reaction to pain allows the dental health care worker to remove as many of these factors as possible. REF: p. 49 |
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Nonopioid drugs can be divided into the following groups as analgesics:
a. Salicylates (aspirin-like group) b. Acetaminophen c. NSAIDs d. Steroidal antiinflammatory drugs e. All of the above f. a, b, and c only |
f. a, b, and c only
Although steroids provide relief from inflammation, they are not considered analgesics. Salicylates, acetaminophen, and NSAIDs are considered nonopioid analgesic drugs. REF: pp. 50-51 |
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Which of the following groups of analgesics are most closely related?
a. Acetaminophen and the salicylates b. Salicylates and the opioids c. Salicylates and NSAIDs d. Acetaminophen and NSAIDs e. NSAIDs and opioids |
c. Salicylates and NSAIDs
The analgesic, antipyretic, and antiinflammatory actions of the NSAIDs result from the same mechanism as aspirin—the inhibition of prostaglandin synthesis by inhibiting cyclooxygenase. REF: p. 58 |
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Aspirin has all of the following effects except one. Which one is the exception? |
d. Central nervous system depression
Aspirin has analgesic, antipyretic, antiinflammatory, and antiplatelet effects. It does not affect the central nervous system in usual therapeutic doses. REF: p. 51 |
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Aspirin is most effective against what type of pain? |
b. Throbbing or inflammatory
Aspirin is more effective against throbbing pain caused by inflammation and prostaglandin synthesis, than against stabbing neurologic pain. REF: p. 51 |
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Aspirin is absorbed rapidly from the:
a. Blood plasma b. Stomach and small intestine c. Small intestine and large intestine d. Hepatic portal system |
b. Stomach and small intestine
Aspirin is rapidly and almost completely absorbed from the stomach and small intestine, producing its peak effect on an empty stomach in 30 minutes. REF: p. 51 |
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An aspirin tablet applied topically to the oral mucosa is an effective way to treat a toothache. |
b. False
An aspirin tablet should never be applied topically to the oral mucosa to treat a toothache because the high acidity of the aspirin tablet can cause painful mucosal ulceration to occur. REF: p. 51 |
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Aspirin has a long history of use for relief of mild to moderate pain such as a headache or toothache, and aspirin’s worth as an analgesic is well recognized by the lay public.
a. Both parts of the statement are true. b. Both parts of the statements are false. c. The first part of the statement is true; the second part is false. d. The first part of the statement is false; the second part is true. |
c. The first part of the statement is true; the second part is false.
Although the efficacy of aspirin as an analgesic for mild to moderate pain is well documented, the general population often discounts its effectiveness because of its easy accessibility and long history. REF: p. 52 |
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Fever is regulated in which area of the body?
a. Adrenal medulla b. Adrenal cortex c. Hypothalamus d. Spinal cord |
c. Hypothalamus
The ability of aspirin to reduce fever (antipyretic effect) results from its inhibition of prostaglandin synthesis in the hypothalamus of the brain. REF: p. 52 |
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Which of the following statements is most correct regarding the use of aspirin as an antipyretic?
a. Aspirin reduces fever by inducing central vasodilation. b. Aspirin reduces elevated and normal temperatures. c. Aspirin reduces fever by inducing peripheral vasodilation and sweating. d. Aspirin reduces elevated temperature but has no effect on normal body temperature. e. a and b only f. c and d only |
f. c and d only
Aspirin reduces fever by inducing peripheral vasodilation and sweating, and although it reduces an elevated temperature, it has no effect on normal body temperature. REF: pp. 52-53 |
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Aspirin can have adverse drug interactions with which of the following drugs?
a. Probenecid b. Warfarin c. Methotrexate e. Sulfonylureas f. Antihypertensives g. All of the above h. a, b, and d only |
g. All of the above
Aspirin can have dangerous adverse drug interactions with all of the medications listed, which emphasizes the importance of obtaining a complete medical history from patients before recommending additional medications. REF: p. 55 |
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Buffered aspirins claim to produce fewer gastrointestinal adverse effects. Numerous clinical studies support this claim.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
c. The first statement is true; the second statement is false.
Although aspirin combined with buffering agents have claimed to produce fewer gastrointestinal side effects, buffered tablet preparations have never been shown to do so. REF: p. 55 |
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This group of analgesics is believed by many authors to be the most useful in treating dental pain.
a. Narcotics b. Salicylates c. Acetaminophen d. NSAIDs |
d. NSAIDs
Many authors agree that the NSAIDs are the most useful drug group for the treatment of dental pain because they are very effective, and many products are available. REF: p. 56 |
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NSAIDs are similar in their analgesic, antipyretic, and antiinflammatory actions to the salicylates. They differ in their:
a. Platelet binding, adverse gastrointestinal effects b. Platelet binding, effect on serum uric acid c. Effect on serum uric acid, adverse gastrointestinal effects d. Metabolism and excretion |
b. Platelet binding, effect on serum uric acid
NSAIDs bind reversibly to platelets, whereas salicylates bind to the platelets irreversibly. Aspirin adversely affects serum uric acid levels, whereas NSAIDs do not. REF: p. 56 and 58 |
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What is the mechanism by which the salicylates and the NSAIDs cause gastrointestinal irritation, pain, and bleeding problems?
a. Acidity of the medications b. Inhibition of the production of cytoprotective mucus in the stomach c. Directly increase in acid secretion |
b. Inhibition of the production of cytoprotective mucus in the stomach
Prostaglandin inhibitors, such as NSAIDs and salicylates, can interfere with the normal cytoprotective mechanisms in the stomach and increase acid secretion, causing symptoms or even an ulceration or perforation. REF: p. 58 |
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Which of the following statements is true regarding NSAIDs?
a. These agents are addictive. b. Central nervous system side effects include sedation, dizziness, confusion, mental depression, headache, vertigo, and convulsions, which are dose dependent. c. Tolerance to NSAIDs may develop. d. Withdrawal syndrome may occurs with NSAIDs. e. All of the above |
b. Central nervous system side effects include sedation, dizziness, confusion, mental depression, headache, vertigo, and convulsions, which are dose dependent.
Some patients experience dose-dependent central nervous system side effects, but addiction, tolerance, or withdrawal does not occur with NSAIDs. REF: p. 58 |
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How long before the procedure should a patient scheduled for oral surgery avoid ibuprofen?
a. No waiting period b. 1 day c. 2 days d. 3 days e. 2 weeks |
b. 1 day
The NSAIDs reversibly inhibit platelet aggregation because they inhibit thromboxane A2 production. Their effect remains only as long as the drug is present in the blood, which is 1 day for ibuprofen. REF: p. 58 |
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NSAIDs can dangerously decrease renal blood flow and glomerular filtration in what population? |
b. Patients with renal disease
NSAIDs have little effect on the patient with normal kidney function. In persons with renal disease, decreases in renal blood flow and glomerular filtration rate can occur and can lead to renal insufficiency and increased incidence of urinary infections. REF: p. 58 |
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NSAIDs may increase the drug effects and toxicity when given with these medications: |
g. b, c, d, and e only
NSAIDs actually decrease the drug effects of ACE inhibitors and other antihypertensive medications. They increase the drug effects and toxicity of the other medications, however, and consultation with the patient's physician should take place before prescribing NSAIDs with these drugs. REF: p. 58 |
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NSAIDs are indicated for which of the following conditions?
a. Asthma b. Osteoarthritis c. Cardiovascular or renal diseases with fluid retention d. Peptic ulcers e. Ulcerative colitis f. Coagulation problems |
b. Osteoarthritis
NSAIDs are very effective in reducing the pain and inflammation of osteoarthritis, but the other conditions are either contraindications or to be used with extreme caution. REF: p. 58 |
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All of the following drugs are NSAIDs except one. Which one is the exception?
a. Fenoprofen b. Ketorolac c. Naproxen and naproxen sodium d. Ibuprofen e. Phenacetin |
e. Phenacetin
Phenacetin was a member of the acetaminophen family and was removed from the market in 1983 because of toxicity. All of the other drugs listed are in the NSAID family. REF: p. 61 |
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The primary advantage of the cyclooxygenase II (COX II)-specific inhibitors is: |
d. No real therapeutic advantage over nonselective NSAIDs
COX II-specific inhibitors were believed to be less irritating to the stomach. In reality, however, they have significantly higher incidences of serious gastrointestinal adverse events and are much more expensive. Clinically, they are equivalent to nonselective NSAIDs, and rofecoxib (Vioxx) and valdecoxib (Bextra) were removed from the U.S. market in 2005 as a result of a high incidence of cardiovascular events (heart attack) associated with these two drugs. These drugs offer no therapeutic advantage over nonselective NSAIDs. REF: pp. 60-61 |
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Acetaminophen has which of the following therapeutic indication? |
f. a and c only
Acetaminophen is used as an analgesic and antipyretic in children and in adults when aspirin is contraindicated. REF: p. 61 |
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What is the maximal safe dose of alcohol that may be ingested with 2 grams of acetaminophen in a normal adult? |
b. One drink a day |
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The risk of nephrotoxicity increases with what pattern of analgesic usage?
a. Occasional b. Chronic, long term c. Concurrent use of acetaminophen, aspirin, and NSAIDs d. b only e. b and c only |
e. b and c only |
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All of the following terms refer to analgesic drugs that affect the central nervous system except one. Which one is the exception?
a. Opioids b. Opiates c. Narcotics d. Nonsteroidal antiinflammatory drug (NSAIDs) |
d. Nonsteroidal antiinflammatory drug (NSAIDs)
NSAIDs are nonopioid analgesics. Opioids, opiates, and narcotics are terms used to identify analgesics with the ability to depress the central nervous system. REF: p. 65 |
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Opioids are classified according to their chemical structure. Agents with similar chemical structures are most likely to be cross-allergenic.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
a. Both statements are true. |
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Which of the following opioids is considered the prototype (i.e., drug against which all other opioids are measured)?
Codeine Opium Dextromethorphan Morphine Heroin |
d. Morphine
Morphine is the drug against which other opioids are measured. REF: p. 68 |
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All of the following are pharmacologic actions of opioids except one. Which one is the exception?
a. Sedation and euphoria b. Excitation c. Cough suppression d. Decrease intestinal tract motility e. Analgesia |
b. Excitation
Central nervous system excitation rarely occurs. In usual therapeutic doses, opioids produce sedation and relief from pain and anxiety, cough suppression, and peristaltic action reduction. REF: p. 68 |
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The adverse reactions of the opioids are directly related to damage to hepatic, renal, and hematologic tissues. The adverse effects of the opioids are extensions of their pharmacologic effects, which is proportional to their analgesic strength.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
d. The first statement is false; the second statement is true.
The opioids are unique in that they do not directly damage the liver, kidneys, and other tissues. Their adverse effects are extensions of their pharmacologic effect; the stronger the agent is, the more adverse effects will occur, such as depression of the central nervous system, causing coma or death in large doses of morphine. REF: pp. 68-69 |
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The usual cause of death in opioid overdose is:
a. Hepatic failure b. Renal failure c. Depression of respiration d. Cardiac failure e. Hypotension |
c. Depression of respiration
The opioid analgesic agonists depress the respiratory center of the brain in relation to the dose. Rate and depth of respiration are reduced, and the usual cause of death in opioid overdose is respiratory arrest. REF: p. 69 |
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Opioids mimic the action of which of the following endogenous substances by binding to these naturally occurring receptor sites?
a. Histamines, bradykinins, cytokines b. Enkephalins, endorphins, and dynorphins c. Dopamine, norepinephrine, epinephrine d. Acetylcholine, dopamine, epinephrine |
b. Enkephalins, endorphins, and dynorphins
Three groups of endogenous substances produce an opioid-like action in the body. These naturally occurring peptides have analgesic action and have an addiction potential. REF: p. 67 |
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Patients who are given analgesic doses of opioids frequently suffer from nausea and vomiting caused by the stimulation of the chemoreceptor trigger zone in the brain. Reducing this adverse effect can be achieved by:
a. Taking the medication with a meal b. Taking the medication on an empty stomach c. Discouraging movement or ambulation d. Taking antinausea medication with the opioid |
c. Discouraging movement or ambulation
Movement will increase nausea and vomiting; thus having the patient remain quiet will reduce these effects. REF: p. 69 |
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Naloxone is an example of a(an):
a. Opioid agonist b. Partial opioid agonist c. Opioid agonist-antagonist d. Opioid antagonist |
d. Opioid antagonist
Naloxone is an opioid antagonist and can be used to treat an opioid overdose. REF: p. 67 |
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What effect does opioid use have the fetus of a pregnant mother near term?
a. Teratogenic effects and fetal malformation b. Fetal tachycardia and cardiovascular distress c. Fetal respiratory depression and withdrawal symptoms d. Premature closure of the ductus arterious |
c. Fetal respiratory depression and withdrawal symptoms
Opioids are well distributed to the fetus in pregnant women; therefore respiratory depression can be produced if opioids are taken near term. Premature closure of the ductus arterious can occur in pregnant women taking aspirin or NSAIDs near term. REF: p. 68 |
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Which of the following routes of administration will result in a reduction in systemic distribution of opioids?
a. Transdermal b. Parenteral c. Nasal d. Oral |
d. Oral
Opioids undergo first-pass metabolism in the liver or intestinal cell walls, reducing their bioavailability. Depending on the specific drug, as much as one third of the drug reaches systemic circulation. REF: p. 68 |
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Tolerance does not develop to which of the following effects of opioids?
a. Euphoria and sedation b. Cough suppression c. Nausea and vomiting d. Myosis and constipation |
d. Myosis and constipation
Persons who have long-term repeated use of opioids will develop tolerance to the sedative and euphoric effects of opioids, to cough suppression, and to nausea and vomiting. Tolerance does not develop to pupil constriction or to constipation. REF: p. 69 |
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Which of the following factors determines the addiction potential of opioids?
a. Efficacy of the analgesic and frequency of use b. Potency of the analgesic and frequency of use c. Degree of sedation and euphoria d. Condition for which the opioid is given |
b. Potency of the analgesic and frequency of use
The degree of addiction potential of opioids is proportional to their analgesic strength and duration and their frequency of use. REF: p. 69 |
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“Shoppers” are addicts who try to use dentists or physicians who will prescribe their drug of choice. Shoppers are usually willing to try any opioid or controlled substance the physician is willing to provide.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
c. The first statement is true; the second statement is false.
Shoppers are usually very specific about the drug they want, and they may claim allergies or lack of effectiveness of medications that the physician wishes to prescribe. REF: p. 70 |
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The largest group of opioids is the:
a. Morphine/codeine group b. Methadone group c. Morphian group d. Meperidine group |
a. Morphine/codeine group
The largest group is the morphine/codeine group, of which codeine is a member. REF: p. 66 |
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Differences in action of different opioids in tolerance to pain may be the result of variations in the endogenous levels of the neurotransmitters. Differences in the action of different opioids at these and other specific receptors explain some of the variations among the different opioids' adverse reactions.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
a. Both statements are true.
Differences exist in the pharmacologic effects of selected opioid receptors and the effect of some opioids on these receptors. This factor may explain why different people have different adverse reactions to various opioids. REF: p. 67 |
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Which of the following statements are correct concerning opioid receptors?
a. Stimulation of μ-receptors produces analgesia. b. The κ-receptor is responsible for dysphoria. c. Naloxone is an antagonist at the three receptor sites. d. Morphine has no effect on the κ-receptor. e. All of the above f. a, b, and c only |
e. All of the above
All of the statements are true, leading to different reactions, depending on the receptor stimulated and the specific drug being used. REF: p. 67 |
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Which of the following routes of absorption can be used with opioids?
a. Oral b. Absorbed through the mucous membranes of mouth, nose, and lungs c. Transdermal patches d. Parenteral e. All of the above |
e. All of the above
Most opioid analgesic agents are absorbed well when taken orally; absorption occurs from the lungs and from the nasal and oral mucosa and from intact skin through transdermal patches. They are also administered parenterally. REF: p. 68 |
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The major route of metabolism for the opioids is the:
a. Blood plasma b. Liver c. Lungs d. Kidney |
b. Liver
The major route of metabolism for the opioids is conjugation with glucuronic acid in the liver. REF: p. 68 |
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Codeine has all of the following effects in usual therapeutic doses except one. Which one is the exception?
a. Pain threshold increase, pain reaction reduction b. Sedation and euphoria c. Cough suppression d. Central nervous system excitation e. Decreases propulsive contractions and motility of intestinal tract |
d. Central nervous system excitation
In usual therapeutic doses, codeine has analgesic, sedative, antitussive, and antidiarrheal effects. It rarely causes central nervous system excitation. REF: p. 68 |
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Which of the following statements is correct concerning depression of the respiratory center by opioids?
a. Respiratory depression is dose related. b. Opioids decrease the sensitivity of the brainstem to carbon dioxide. c. Opioids decrease the rate and depth of breathing. d. In elderly adults or debilitated persons, the usual therapeutic dose can cause significant reductions in pulmonary ventilation. e. Respiratory depression is not usually a concern with opioid use. f. All of the above g. a, b, c, and d only |
g. a, b, c, and d only
The usual cause of death in opioid overdose is respiratory depression and is therefore a major concern with the use of these drugs. REF: p. 69 |
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Patients with which of the following conditions are least sensitive to the respiratory depression induced by opioids?
a. Head injuries b. Hyperthyroidism c. Hypothyroidism |
b. Hyperthyroidism
Opioids should not be used in patients with head injuries because the opioids could mask central nervous system diagnostic symptoms. Patients with hyperthyroidism are more tolerant of the depression, whereas patients with hypothyroidism are more sensitive. REF: p. 69 |
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Nausea and vomiting with analgesic doses of opioids is caused by:
a. Direct stimulation of chemoreceptor trigger zone in the medulla b. Indirect stimulation of the vestibulocochlear area c. Patient movement d. All of the above e. a and c only |
e. a and c only
The nausea and vomiting often experienced in analgesic doses of opioids is caused by their direct stimulation of the chemoreceptor trigger zone in the medulla of the brain. Movement by the patient will make the nausea worse; therefore patients should be discouraged from being ambulatory when they are taking these medications. REF: p. 69 |
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Small doses of even weak opioids often cause constipation. With continued administration, tolerance will develop to this effect.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
c. The first statement is true; the second statement is false.
The duration of constipation with opioids outlasts their analgesic effect, and even with continued administration, tolerance does not develop to this effect. REF: p. 69 |
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Opioid abuse or overdose can often by diagnosed by which of the following signs?
a. Myosis (pinpoint pupils) b. Mydriasis (dilation of pupils) c. Photophobia |
a. Myosis (pinpoint pupils)
Opioid abuse or overdose causes the pupils to constrict, and tolerance to myosis does not develop. REF: p. 69 |
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Large doses of the opioids have which of the following effects on the cardiovascular system?
a. Postural hypotension, syncope b. Depression of the vagus nerve c. Stimulation of vagus nerve d. Bradycardia e. a, b, and d f. a, c, and d |
f. a, c, and d
In large doses, opioids may depress the vasomotor center, simulating the vagus nerve. Postural hypotension, bradycardia, and even syncope may result. REF: p. 69 |
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Why would a patient who is taking opioids develop a runny nose and itchy eyes?
a. Allergic reaction to the opioids b. Histamine release stimulated by opioids c. Vasoconstriction of capillaries by opioids d. Bronchoconstriction triggered by opioids |
Histamine release stimulated by opioids
Opioids can stimulate the release of histamine; thus itching and urticaria can result from their administration. This effect can occur at the site of intramuscular injection or at remote sites (e.g., itchy nose). REF: p. 69 |
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The rate of development of tolerance and addiction is related to the strength of the opioid and its frequency and length of use. Addiction to opioid analgesics is a common problem when they are used to treat dental-related pain.
a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true. |
c. The first statement is true; the second statement is false.
The degree of tolerance and addiction potential of opioids is proportional to their analgesic strength and frequency and duration of use. Because the duration of use in dentistry is usually short, addiction or tolerance is not usually a problem. REF: p. 69 |
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Opioid withdrawal includes all of the following signs and symptoms except one. Which one is the exception?
a. Yawning, lacrimation, perspiration, and rhinorrhea b.Piloerection c. Drowsiness d. Irritability e. Nausea and vomiting f.Tachycardia g. Tremors and chills |
c. Drowsiness
Persons withdrawing from opioids suffer from irritability and agitation, along with the other symptoms listed except drowsiness, which is uncommon. REF: pp. 69-70 |
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Which opioid is frequently used to help patients discontinue opioid use and is used both short term and long term for maintenance?
a. Codeine b. Methadone c. Naltrexone d. Meperidol |
b. Methadone
Methadone is an opioid that is used short term by substituting the oral form for the injectable opioid and long term for methadone maintenance. Within methadone maintenance, the patient takes supervised large oral doses of methadone on a daily basis. Because the patient develops a tolerance for the effects of the opioids, a block is produced that prevents heroin-like agents from producing the “rush” feeling after injecting. REF: p. 70 |
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Opioids should be used with caution with other central nervous system depressants. The respiratory depression produced by the opioids is additive with that produced by other central nervous system depressants.
a. Both statements are true. c. Both statements are false. d. The first statement is true; the second statement is false. e. The first statement is false; the second statement is true. |
a. Both statements are true.
Opioids have an additive effect when combined with other central nervous system depressants, such as alcohol or sedative-hypnotics, and can cause profound respiratory depression, and even death. REF: p. 70 |
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Your patient states that he is allergic to morphine. Which other opioid would be safe to administer to this patient?
a. Oxycodone b. Hydrocodone c. Codeine d. Meperidine e. Hydromorphone |
d. Meperidine
Oxycodone, hydrocodone, codeine, and hydromorphone are in the same chemical family as morphine, increasing the chance of an allergic reaction with these drugs. Meperidine (Demerol) is in a different opioid family, decreasing the likelihood of a cross-reaction. REF: p. 66 |
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The most commonly used opioid in dentistry is:
a. Oxycodone b. Hydrocodone c. Codeine d. Meperidine e. Hydromorphone |
c. Codeine
Codeine in combination with nonopioid analgesics such as acetaminophen, aspirin, and ibuprofen is the most commonly used opioid in dentistry. REF: p. 71 |
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Tylenol #3 would have how much codeine added to the acetaminophen?
a. 15 mg b. 30 mg c. 60 mg d. 90 mg |
b. 30 mg
The amount of codeine in combination products is designated by Arabic numbers. #2 = 15 mg of codeine, #3 = 30 mg of codeine, and #4 = 60 mg of codeine. Doses greater than 30 to 60 mg usually produce too much nausea to be well tolerated by the patient. REF: p. 72 |
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All of the following statements are true regarding propoxyphene (Darvocet) except one. Which one is the exception?
a. Propoxyphene is no more efficacious than two tablets of aspirin or acetaminophen. b. Propoxyphene is available combined with aspirin and caffeine or acetaminophen. c. Adverse effects include nausea, vomiting, dizziness, and physical dependence. d. Hundreds of deaths have been associated with its overdose, often in combination with alcohol. e. Propoxyphene is so effective that justifying a prescription of propoxyphene is easy. |
e. Propoxyphene is so effective that justifying a prescription of propoxyphene is easy.
With the lack of efficacy and the number of overdose related deaths, many other agents would be safer and more effective; therefore prescribing propoxyphene is not recommended. REF: p. 72 |
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Meperidine (Demerol) is a good choice for oral use because it has a long duration of action and few drug interactions.
a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true; the second part is false. d. The first part of the statement is false; the second part is true. |
b. Both parts of the statement are false.
Use of meperidine (Demerol) has resulted in inadequate pain control and adverse effects for many patients over the years, making it a poor choice for control of oral pain. Its first-pass effect is high, its duration of action is short, and many drug interactions severely limit its use in dentistry. REF: p. 73 |
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Which of the following statements is correct regarding the opioid hydromorphone (Dilaudid)?
a. Only administered parenterally b. Reserved for management of severe pain c. Less potent than morphine d. Favored by addicts because of its strength e. All of the above f. b and d only |
f. b and d only
Hydromorphone (Dilaudid) is an orally effective opioid reserved for the management of severe pain. It is more potent than morphine and better absorbed orally but produces similar adverse reactions. Addicts like to use it because of its strength. REF: p. 73 |
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Methadone (Dolophine) has all of the following advantages over morphine or hydrocodone except one. Which one is the exception?
a. Longer duration of action, easier withdrawal from drug b. Good bioavailability c. Cost effect d. Oral rather than parenteral route of administration e. Great risk for death and life-threatening changes in respiration and heart rate |
e. Great risk for death and life-threatening changes in respiration and heart rate
Methadone is now being used as an analgesic, as well as a maintenance drug for heroin withdrawal, and it has several advantages over morphine and hydrocodone. However, only low doses should be prescribed for pain because life-threatening changes in respiration and heart rate and death have occurred with its use. REF: p. 73 |
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Which of the following opioid family is most commonly used perioperative or during general anesthesia?
a. Morphine/codeine family b. Fentanyl family c. Methadone family d. Morphinan family |
b. Fentanyl family
Fentanyl (Duragesic, Sublimaze), sufentanil (Sufenta), and alfentanil (Alfenta) are short-acting parenterally administered agonist opioid analgesics that are used perioperatively or during general anesthesia. REF: p. 73 |
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Naloxone (Narcan) is an opioid antagonist that is active parenterally. If given to an addict who has overdosed, large doses must be given to counteract the opioid-induced respiratory depression. |
c. The first statement is true; the second statement is false.
Naloxone will reverse opioid-induced respiratory depression. However, small doses must be carefully titrated or opioid withdrawal may be produced. REF: p. 74 |
