Cardiovascular Pharmacology/TBQs Flashcards

Question

NSAIA's ______ the effects of **Angiotensin II receptor blockers** and are not to be used in cases of \_\_\_\_\_.

Answer 1

decrease; pregnancy

Answer 2

Clonidine (Catapres)

Answer 3

1. hypertension **2. withdrawal symptoms** 3. Migraine prophylaxis **4. ADHD**

Answer 4

carvedilol (Coreg)

Answer 5

bradycardia.

Answer 6

E) All of the above *All of the choices are true. Because many of our patients are being treated with drugs, knowledge of pharmacology helps in understanding and interpreting patients’ responses to health history questions. Knowledge of the therapeutic and adverse effects of medications obviously helps in their proper administration in the office. Emergency situations may be caused by drugs or treated by drugs; thus, knowledge of pharmacology is of great help, especially because a rapid response is sometimes required. A clear understanding of the concepts of drug action, drug handling by the body, and drug interactions will allow the dental practitioner to make proper judgments and grasp the concepts relevant to new drug therapies on the market.*

Answer 7

D) Both B and C are true. *Asthmatic patients who experience dental anxiety should schedule their appointments when they are not rushed or under pressure early in the morning. Diabetic patients usually have relatively fewer problems with a morning appointment. Patients taking medication for systemic diseases may require special handling in the dental office.*

Answer 8

C) can cause adverse effects. *Nutritional or herbal supplements are quite capable of causing adverse effects. The majority of nutritional or herbal supplements do not carry FDA approval for treating disease states. These supplements are drugs and can cause adverse effects and interact with different drugs.*

Answer 9

C) Generic name *Before any drug is marketed, it is given a generic name that becomes the “official” name of the drug. Each drug is assigned only one generic name selected by the U.S. Adopted Name Council, and the name is not capitalized. The brand name is equivalent to the trade name and is capitalized. Although the brand name is technically the name of the company marketing the product, this term is often used interchangeably with the trade name. The code name is the initial term used within a pharmaceutical company to refer to a drug while it is undergoing investigation and is often a combination of capital letters and numbers, the letters representing an abbreviation of the company name.*

Answer 10

C) U.S. Adopted Name Council. *Each drug is assigned only one generic name (e.g., ibuprofen). It is selected by the U.S. Adopted Name Council. The generic name is not selected by the FDA or the Federal Patent Office. The pharmaceutical company manufacturing the drug clearly has an influence on the generic name given its drug, but the final decision is not the company’s.*

Answer 11

B) A drug may only have one generic name, but it may have several trade names.

Answer 12

C) bioavailability. ## Footnote *A preparation can be chemically equivalent yet not biologically or therapeutically equivalent. These products are said to differ in their bioavailability. The potency of a drug is a function of the amount of drug required to produce an effect. The efficacy is the maximum intensity of effect or response that can be produced by a drug. The therapeutic index is the ratio of the lethal dose for 50% of the experimental animals divided by the effective dose for 50% of the experimental animals. If the value of the therapeutic index is small, toxicity is more likely.*

Answer 13

B) biologically ## Footnote *Biologic equivalence refers to identical pharmacokinetic parameters of two drug formulations (bioequivalence, for short). Chemical equivalence indicates that two formulations of a drug meet the chemical and physical standards established by the regulatory agencies. Therapeutic equivalence means that two formulations produce the same therapeutic effects over the same duration.*

Answer 14

C) Drug Enforcement Administration (DEA). *The DEA regulates the manufacture and distribution of substances with abuse potential. Hence prescriber DEA numbers must appear on prescriptions for controlled substances. The FDA does not have any special powers in regard to drugs of abuse. The FTC regulates commerce and advertising claims of foods, over-the-counter (OTC) products, and cosmetics. The USP regulates the uniformity and purity of drugs.*

Answer 15

A) FDA *The Food and Drug Administration (FDA) is part of Department of Human and Health Services (DHHS), and determines what drugs may be sold by prescription and OTC and regulates the labeling and advertising of prescription drugs. The Occupational Safety and Health Administration (OSHA) ensures the safety and health of workers in the United States by setting and enforcing standards. The Federal Trade Commission (FTC) regulates the trade practices of drug companies and prohibits the false advertising of foods, nonprescription (OTC) drugs, and cosmetics. The Drug Enforcement Administration (DEA) is a part of the Department of Justice and regulates the manufacture and distribution of substances that have a potential for abuse, including opioids, stimulants, and sedatives.*

Answer 16

ANS: C Amphetamine, oxycodone, morphine, and secobarbital are all schedule II controlled substances. Heroin is a schedule I substance. Propranolol is a nonscheduled prescription drug. NURSINGTB.COM Dextropropoxyphene is a schedule IV substance.

Answer 17

C) immediately. *The word **stat** on a prescription means immediately (now). The abbreviation **ac** means before meals, **hs** means at bedtime, and **q** means every.*

Answer 18

B) qid. ***qid** is the abbreviation for quarter in die, or _four times a da_y. **bid** stands for twice a day, **qd** stands for every day, and **ud** stands for as directed.*

Answer 19

B) Sig. ***Sig.** is the abbreviation for the Latin word signa, or write. This word precedes the instructions to the patient. **Rx** means take thou and precedes the prescription instructions, **#** denotes the number of tablets, capsules, and so forth to be dispensed. **Disp.** is short for dispense and precedes the amount to be dispensed, analogous to #.*

Answer 20

A) Prescribers are allowed to use drugs for off-label use under certain circumstances. B) The FDA approves the use of drugs for specific indications, which are listed or labeled on the package insert of the drug. *Practitioners are allowed to use off-label drugs if good medical practice justifies their use, the use is well documented in the medical literature, and the drug meets the current standard of medical care. The FDA approves the use of drugs for specific indications, and they are listed or labeled on the package insert of the drug. Drug manufacturers are not allowed to bring up off-label uses when speaking with the prescribing practitioner, nor can they distribute written material regarding off-label uses. The off-label use of drugs is permitted in the United States provided that several rules are followed.*

Answer 21

A) Some patients may fear of the side effects of the medication. B) A longer duration of drug therapy is associated with the risk for nonadherence with medication therapy. C) Increased dosing frequency is associated with nonadherence with medication therapy. *Many factors are associated with nonadherence to medication therapy. These include **poor understanding** of the disease and a need for medication to treat it, **fear of side effects** of the medication, distrust of health care professionals, economic factors, or forgetfulness. **Longer duration** of drug therapy and the **number of times a day** the patient must take a prescription increase the chances that a patient will not adhere to the regimen. For example, patients are more compliant with twice-a-day dosing than they are with four-times-a-day dosing. Statistics reveal that only a minority of patients will take their medication as prescribed.*

Answer 22

C) cellular function. *A drug can modify cellular function. A general understanding of drug action allows the dental hygienist to make informed decisions regarding possible drug interactions or adverse reactions for the patient. It is a concern that discarded drugs may be affecting the environment, but this is not the definition of a drug. Some drugs may have the capacity to modify body compartment pH; however, this is not the definition for a drug. Some drugs may have the capacity to modify the immune response, but this is not the definition of a drug.*

Answer 23

C) have a greater curve height. ***Efficacy** is an expression of maximum intensity of effect or response that can be produced by a drug. The other choices refer to indicators of drug potency, not efficacy. The **potency** of a drug is a function of the amount of drug required to produce an effect. The potency of drug is shown by the location of that drug’s curve along the log-dose axis (x-axis).*

Answer 24

D) The first part of the statement is false; the second part is true. ## Footnote *The first part of the statement is false, the second part is true. The absolute potency of a drug is immaterial as long as the appropriate dose is administered. If equally efficacious, both drugs will produce the same effect. Both meperidine and morphine, for example, have the ability to treat severe pain, but approximately 100 mg of meperidine would be required to produce the same action as 10 mg of morphine. The dose of meperidine needed to produce pain relief is larger than that for morphine. Less potent drugs require higher doses to produce therapeutic effects whereas more potent drugs can reach toxic levels at lower doses.*

Answer 25

D) TI is the ratio of the median lethal dose to the median effective dose. *LD50 is the dose causing death in 50% of test animals and ED50 is the dose required to produce the desired clinical effect in 50% of test animals. The greater the TI, the safer the drug. The formula is TI = LD50/ED50. The ED50 is the dose required to produce the desired clinical effect in 50% of test animals, not 50% of the effective clinical dose.*

Answer 26

D) Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent. *Drugs either produce the same action as an endogenous agent or block the action of an endogenous agent. Drugs do not impart a new function to the organism; they merely either produce the same action as an endogenous agent or block the action of an endogenous agent.*

Answer 27

A) more receptors than the drug with the weaker affinity. ## Footnote *When different drugs compete for the same receptor sites, the drug with the stronger affinity for the receptor will bind to more receptors than the drug with the weaker affinity. More of the drug with weaker affinity will be required to produce a pharmacologic response. Drugs with a stronger affinity for receptor sites are more potent than drugs with weaker affinities for the same site.*

Answer 28

B) competitive antagonist. *A competitive antagonist has affinity for a receptor, combines with the receptor, competes with the agonist for the receptor, and produces no effect. An agonist has affinity for a receptor, combines with the receptor, and produces an effect. Competitive agonist is nonsensical terminology. A physiologic antagonist has affinity for a site different from that of the agonist in question.*

Answer 29

D) reduces the maximal response of the agonist. *A noncompetitive antagonist reduces the maximal response of the agonist. Noncompetitive antagonists bind to a receptor site that is different from the binding site for the agonist. A competitive antagonist will cause a shift to the right in the dose-response curve.*

Answer 30

A) Physiologic action of drugs *The physiologic action of drugs is a subject of pharmacology, not pharmacokinetics. Pharmacokinetics does have to do with the **subjects of absorption**, **distribution**, **metabolism**, and **excretion** of drugs.*

Answer 31

B) The lipid molecules orient themselves so that they form a fluid bimolecular leaflet structure with the hydrophobic ends of the molecules shielded from the surrounding aqueous environment. *The **lipid molecules** orient themselves so that they form a fluid bimolecular leaflet structure with the hydrophobic ends of the molecules shielded from the surrounding aqueous environment. The **hydrophilic** ends are in contact with water. The **membrane lipids** make the membrane relatively impermeable to ions and polar molecules. **Membrane proteins** make up the structural components of the membrane and help move the molecules across the membrane during the transport process.*

Answer 32

B) Active transport ***Active transport** is a mechanism for movement of substances, often against a concentration gradient, that uses the energy of the cell to actively pump the substance from one side of a membrane to the other. **Passive transfer** and **filtration** entail the passage of substances in a manner proportional to their concentration on each side of the membrane. The substances move without any assistance. **Facilitated transport** uses a carrier protein but cannot transport substances against a gradient.*

Answer 33

C) 1, 4, 5 *Drugs that are weak electrolytes will cross body membranes best when they are **nonionized**, **nonpolar**, and **lipid soluble**. These drugs dissociate in solution and equilibrate into a nonionized form and an ionized form. The _nonionized, or uncharged,_ portion acts as a nonpolar, lipid-soluble compound that readily crosses body membranes. The _ionized portion_ of drugs that are weak electrolytes will traverse membranes with greater difficulty because they are less lipid soluble.*

Answer 34

D) a greater percentage of a weak base in the solution to be in the un-ionized form. *Weak bases become ionized at low pH and un-ionized at higher pH. If the pH of the site rises, the hydrogen ion concentration will fall. For weak bases, this results in _the **un-ionized form** (B), which can_ _more easily penetrate tissues._ Conversely, if the pH of the site falls, the hydrogen ion concentration will rise. This results in an _increase in the **ionized form** (BH+), which cannot easily penetrate tissues._*

Answer 35

C) The first part of the statement is true; the second part is false. *The first part of the statement is true, the second part is false. Infections lead to an accumulation of acidic waste products, which lowers the pH of the local area. Local anesthetics must penetrate the nerve cell membrane to cause their action. They become more ionized as the pH drops. This property is a characteristic of weak bases, not weak acids. Local anesthetics are weak bases. Weak bases are better absorbed when the pH is greater than the pKa. A weak base is associated and ionized when the pH is less than the pKa.*

Answer 36

A) All drugs in the blood are either bound to plasma proteins or free. *All drugs in the blood are either bound to plasma proteins or free. Only the drug that is free can exert the pharmacologic effect. Only the free drug can pass across cell membranes. The bound drug is a reservoir for the drug.*

Answer 37

A) distribution. ## Footnote ***Distribution** is the movement of a drug from the site of absorption or injection to other sites. **Disruption** is the initial destruction of a tablet coating or capsule during oral absorption. **Dispersion** is the spread of concentrated drug particles throughout the stomach or intestines. **Active transport** is a process involved in the passage of certain agents, including some drugs, across membrane barriers and may be involved in not only drug redistribution but also drug absorption, distribution, or excretion.*

Answer 38

E) All of the above *All of the above choices are correct. If the blood circulation to an organ is low, it will receive less drug. The more membranes and barriers a drug needs to cross, the slower the rate at which it will reach the organ in question. The binding of drugs to plasma proteins reduces the concentration of drug that can leave the circulation and be taken up by an organ. The relative level of fat or water solubility of a drug will influence where and how rapidly a drug will distribute. The distribution of a drug is determined by several factors, such as the size of the organ, the blood flow to the organ, the solubility of the drug, the plasma protein–binding capacity, and the presence of certain barriers (e.g., blood-brain barrier, placenta).*

Answer 39

B) 6.25% *The half-life is the time required for a drug level to fall to one half of its concentration. The drug concentration would go to 50% → 25% → 12.5% → 6.25% in four half-lives. The information given is more than sufficient to answer the question. One needs merely to count the number of half-lives and divide the percentage drug in half for every half-life passed since the drug was administered.*

Answer 40

B) 40 hours *Assuming first-order kineticsN, 40 hours would be required for this drug to be over 96% eliminated from the body. Five half-lives are needed to reduce the levels of a drug to 3.125% of the original levels, or eliminate over 96%. For a drug with an 8-hour half-life, this amounts to five half-lives x 8 hours per half-life, or 40 hours.*

Answer 41

B) duration. *Half-life is the amount of time required for a drug to fall to one half of its blood level. It is an expression of how long the drug lasts in the body. Onset is the time at which a drug starts to take effect. The half-life does not predict the relative safety of a drug; safe drugs can have long or short half-lives. Time to peak concentration refers to how much time is required for a drug to reach effective levels in the body, not how long a drug lasts in the body.*

Answer 42

C) liver *The liver is the most common site for biotransformation. Biotransformation is the body’s way of changing a drug so that the kidneys can more easily excrete it. The liver rather than kidney, blood plasma, or small intestine is the most common site for biotransformation.*

Answer 43

B) more; less *The metabolite is usually more polar and less lipid soluble than its parent compound, meaning that renal tubular reabsorption of the metabolite will be reduced because reabsorption favors lipid-soluble compounds. Metabolites are also less likely to bind to plasma or tissue proteins and less likely to be stored in fat tissue. Drugs must pass through various membranes such as cellular membranes, blood capillary membranes, and intracellular membranes. The lipid in the membranes makes them relatively impermeable to ions and polar molecules. Decreased renal tubular absorption, decreased binding to the plasma or tissue proteins, and decreased fat storage cause the metabolite to be excreted more easily.*

Answer 44

B) a constant amount is eliminated per unit time. *With zero-order kinetics, the metabolism or excretion mechanisms for a drug in the body are saturated, meaning that they are at their maximal level. If more drug is given, then the body cannot keep up, and the drug levels will increase. The body cannot adjust to more drug, and elimination of a drug will remain the same as the dose of the drug is increased. If the drug is eliminated but a longer time is required, then it would for a first-order elimination. The elimination of the drug can be mathematically predicted.*

Answer 45

C) Onset *Onset is the time at which a drug starts to take effect. First pass refers to the metabolism of drugs by the liver during their movement from the gastrointestinal tract to the systemic circulation via the portal circulation. Duration is the amount of time the drug is active in the body. Efficacy is an assessment of the effectiveness of a drug and does not refer to how quickly or how long a drug acts in the body.*

Answer 46

B) oral. ## Footnote *Enteral means situated or occurring inside of the gastrointestinal tract (intestines). Intravenous, sublingual, and transdermal routes of administration bypass the gastrointestinal tract.*

Answer 47

C) Oral *Oral administration requires no sophisticated devices, is slow enough in onset to gauge reactions and stop the next dose, and is easy for a patient to administer without assistance. Inhalation and subcutaneous administration require devices, such as inhalers and needles, and the drug is irretrievable once administered. Rectal dosing has lower patient acceptance, and absorption can be variable.*

Answer 48

C) more predictable response than intravenous administration. ## Footnote *Intravenous administration offers a more predictable response than the oral route because the drug is injected directly into the bloodstream, bypassing many physiologic barriers, the hostile environment of the gastrointestinal tract, and drug-metabolizing enzymes that are encountered during oral absorption of a drug. Others are all characteristics of oral administration.*

Answer 49

C) Liver *On oral administration, drugs are absorbed and are carried via the portal circulation to the liver, where a percentage of the drug may be metabolized before entering the systemic circulation. After oral dosing, drugs reach the kidney, lungs, and spleen after passing through the liver.*

Answer 50

A) Intravenous *Intravenous administration produces the most rapid drug response, with an almost immediate onset of action. Because the injection is made directly into the blood, the absorption phase is bypassed. The intramuscular route, subcutaneous route, and intradermal route all have slower drug response rates than intravenous drug administration.*

Answer 51

B) Intradermal *Intradermal administration is used to provide local, rather than systemic, action. Local anesthetics are also given this way. The other routes are all chosen when systemic action is desired. Intramuscular, intradermal, and subcutaneous routes of administration are not used to administer the tuberculosis skin test.*

Answer 52

A) Intrathecal route *The intrathecal route is used for injection of solutions into the spinal subarachnoid space. Intraperitoneal route refers to placing fluids into the peritoneal cavity. Intravenous route refers to administering drugs directly into the blood circulation. Intradermal route refers to injecting a drug just under the skin.*

Answer 53

C) Ophthalmic ointment *Ophthalmic ointments and drops are used specifically for treating the eye, not for treating a systemic disorder. Administration of a sublingual tablet leads to rapid entry of the drug into the systemic circulation. A transdermal patch is a specialized dose form for the controlled delivery of a drug into the systemic circulation. A subcutaneous injection is applied into the subcutaneous areolar tissue to gain access to the systemic circulation.*

Answer 54

A) Both parts of the statements are true. *Both parts of the statement are true. A transdermal patch is designed to provide continuous controlled release of medication through a semipermeable membrane over a given period after application to the intact skin. Drugs given by the enteral route are placed directly into the gastrointestinal tract by oral or rectal administration. Parenteral means situated or occurring outside of the gastrointestinal tract (intestines). Examples of routes that bypass the gastrointestinal tract include various injection routes, inhalation, and topical administration. In practice, the term parenteral usually refers to an injection.*

Answer 55

C) Inactive to active *An inactive parent drug (prodrug) may be transformed into an active compound. Active to active occurs when an active parent drug is converted to a second active compound, which is then converted to an inactive product. When an active metabolite is formed, the action of the drug is prolonged. Active to inactive is the most common type of reaction in drug biotransformation. Inactive to inactive is not one of the mechanisms of metabolism. A placebo may be an example.*

Answer 56

ANS: A Drugs with stronger affinity for receptor sites are more potent than drugs with weaker affinities for the same sites. An antagonist counteracts the action of the agonist. There are three types of antagonists: competitive antagonist, noncompetitive antagonist, and physiologic antagonist. An agonist is a drNug tRhatIhasGaffiBni.tyCforMa receptor, combines with the receptor, and produces an effect.

Answer 57

A) both the onset and duration of response. *Onset refers to the time required for the drug to begin to have its effect. Duration is the length of a drug’s effect. Both onset and response are affected by the route of administration. The routes of administration may be categorized as enteral when placed in the gastrointestinal tract, or parenteral, which usually means an injection.*

Answer 58

B) Aspirin *A few drugs, such as aspirin and alcohol, exhibit zero-order kinetics. The enzymes that metabolize these drugs can become saturated at usual therapeutic doses. Small changes in the dosage of these drugs may produce a large change in concentration in blood serum. There are few drugs that are eliminated with zero-order kinetics, namely aspirin and alcohol.*

Answer 59

ANS: A With high doses, the metabolism of the drug cannot increase and the duration of action of the drug can be greatly prolonged. Zero-order kinetics occurs because the enzymes that metabolize these drugs can become saturated at usual therapeutic doses. If the dose of the drug is increased, the metabolism cannot increase above its maximum rate.

Answer 60

A) Drug receptors appear to consist of many large molecules that exist either on the cell membrane or within the cell itself. B) A specific drug will usually bind with a specific receptor in a lock-and-key fashion. *Drug receptors may exist either on the cell membrane or within the cell. Usually, a specific drug will bind with a specific receptor. More than one receptor type or identical receptors can be found at the site of action. Many drug-receptor interactions consist of weak chemical bonds, and the energy formed during the interaction is very low. As a result, the bonds can be formed and broken easily. Once a bond is broken, another drug molecule immediately binds to the receptor.*

Answer 61

True *This statement represents an example of drug metabolism (converting a drug from inactive to active).*

Answer 62

True *Weak bases will become ionized in an acid environment and will not be able to passively diffuse out of the kidney tubule.*

Answer 63

True Onset refers to the time required the drug to begin to have its effect. Duration is the length of a drug’s effect.

Answer 64

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

Answer 65

A) Type I *Type I hypersensitivity, or immediate-type hypersensitivity, is a rapidly produced response targeting the bronchioles, the respiratory system, and the skin. Type II, III, and IV reactions are all slower than type I reactions. Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed, causing arthralgia, urticarial skin eruptions, and so forth, with little or no lung involvement. Type IV hypersensitivity, or delayed-type hypersensitivity, is generally manifested as skin eruptions.*

Answer 66

ANS: A ## Footnote *Type I hypersensitivity, or immediate-type hypersensitivity, involves drug antigen or allergen binding to IgE antibodies on inflammatory cells. Type II hypersensitivity causes cytolytic reactions, such as hemolytic anemia. Type III hypersensitivity is a reaction in which soluble antibody-antigen complexes are formed and deposited, causing arthralgia, urticarial skin eruptions, and so forth. Type IV hypersensitivity, or delayed-type hypersensitivity, generally manifests as skin eruptions, such as in poison ivy*

Answer 67

C) LD50. *By definition, the LD50 is the median lethal dose, that is, a dose level that leads to death in 50% of the animals tested. ED50 is the median effective dose, a dose that produces a therapeutic effect in 50% of the subjects tested. A minimally effective dose should not cause death unless death is the desired endpoint. In this case, the incidence of death should be lower to be designated minimal. The therapeutic index is the ratio of LD50 to ED50.*

Answer 68

D) 100 ## Footnote *If the value of the TI is small, then toxicity is more likely. If the TI is large, then the drug will be safer. A drug with a wide TI will have a large LD50 and a small ED50 (the distance between these curves is large). A TI of greater than 10 is usually needed to produce a therapeutically useful drug. One must divide the LD50 value by the ED50 value. The LD50 value (300) divided by the ED50 value (3) equals 100.*

Answer 69

C) The first statement is true, the second is false. *Drug B has a wider therapeutic index. This means that drug B must be safer than drug A and that the amount of drug needed to be lethal to 50% of test animals must be greater for drug B than for drug A. Therefore, drug B has a greater LD50 than drug A. The therapeutic index is the ratio of the LD50 to ED50. A wide therapeutic index means a greater difference between the LD50 and the ED50 and therefore a greater ratio. If drug B has a wider therapeutic index than drug A and the two drugs have an equivalent ED50, then the LD50 of drug B must be greater.*

Answer 70

C) Take the drug with food or milk. *Nausea can usually be alleviated by taking the drug with food or milk. It is important to continue taking drugs as prescribed unless the patient has consulted with the prescriber. Some adverse effects, such as headache or upset stomach, normally do not require medical attention. Sedation can be minimized by taking the drug at bedtime. Other adverse effects require medical attention.*

Answer 71

B) Determine what drugs the patient is taking.

Answer 72

b. Epinephrine ## Footnote *Epinephrine blocks the action of histamine during an allergic reaction. Macrolides will not block the action of histamine; however, they will raise the plasma levels of many drugs. Anticonvulsants do not block the action of histamine, although they can increase or decrease the metabolism of many drugs and each other, leading to either increased or decreased plasma levels of these drugs. Benzodiazepines and first-generation antihistamines will increase the level of sedation, but will not block the action of histamine.*

Answer 73

c. Penicillin * Penicillin and erythromycin, acetaminophen, and lidocaine are considered to be among the safest; however, even these drugs should be administered only if there is clear need. Tetracycline, NSAIDs, and the benzodiazepines are examples of drugs used in dentistry that are contraindicated during pregnancy.*

Answer 74

d. Dyspepsia ## Footnote *Drugs taken orally can produce gastrointestinal symptoms, such as nausea or dyspepsia, because of their local actions on the gastrointestinal tract. A drug allergy is an immunologic response to a drug resulting in a reaction such as rash or anaphylaxis. The targets of this reaction are the bronchioles, resulting in anaphylactic shock; the respiratory system, resulting in rhinitis and asthma; and the skin, resulting in urticaria and dermatitis.*

Answer 75

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

Answer 76

False ## Footnote *The therapeutic index is the ratio of the LD50 to ED50. The smaller the ratio is, the closer the LD50 is to the ED50 and therefore the closer a deadly dose is to the therapeutic dose. Consequently, the lesser the therapeutic index is, the greater the toxicity will be.*

Answer 77

E) Diuretic ## Footnote *Most patients with HF have edema or fluid retention. Diuretics are used in these patients to relieve the symptoms of HF. The American College of Cardiology and the American Heart Association recommend that all patients who have evidence of fluid retention and for most patients with a history of fluid retention be prescribed a diuretic. Diuretics should be combined with angiotensin-converting enzyme inhibitors, beta-blockers, angiotensin receptor antagonists, or aldosterone antagonists.*

Answer 78

B) Digoxin prolongs the refractory period of the atrioventricular (AV) node. ## Footnote *Digoxin prolongs the refractory period of the AV node. By prolonging the refractory period of the AV node, fewer impulses will be transmitted to the ventricle, and the heart rate will fall. These effects are useful in the treatment of certain arrhythmias. Digoxin slows AV conduction and decreases the rate of the SA node. This effect is desired; however, an overdose may cause excessive slowing of the heart. The pulse must always be taken prior to administering a dose. The medication should not be given if the dose is below 60 beats per minute.*

Answer 79

b. Digoxin * Early signs of digoxin toxicity include anorexia, nausea and vomiting, and copious salivation. A reduction in the dose level of digoxin usually alleviates these adverse reactions. None of the other choices cause hypersalivation as a sign of toxicity. Clonidine is most likely to cause xerostomia and enalapril the least likely (oral manifestations include dry cough and dysgeusia). Nifedipine and hydrochlorothiazide can produce mild to moderate xerostomia.*

Answer 80

A) Nitroglycerin (NTG, Nitrostat, Nitrolingual)

Answer 81

D) and excessive salivation.

Answer 82

B) PDE5 inhibitor

Answer 83

D) Hypertension

Answer 84

C) hypokalemia and hyperuricemia.

Answer 85

B) Nonsteroidal antiinflammatory drugs (NSAIDs)

Answer 86

D) an increase in cardiac contractility.

Answer 87

C) Calcium channel blockers

Answer 88

B) angiotensin-converting enzyme inhibitors (ACEIs)

Answer 89

A) Angiotensin-converting enzyme inhibitors (ACEIs)

Answer 90

b. Clonidine

Answer 91

d. Potassium-sparing diuretics

Answer 92

c. Clonidine

Answer 93

D) Both A and B are correct.

Answer 94

C) simvastatin to niacin.

Answer 95

D) All of the above

Answer 96

b. Aspirin

Answer 97

**B) Calan (verapamil)**

Cardiovascular Pharmacology/TBQs Flashcards

(125 cards)