Lesson 2

Question 1

The risk of an ADR increases as the

Answer 1

The risk of an ADR increases as the number of drugs the patient is
taking increases.

Question 2

———-of older adults take an average of three
medications.

Answer 2

40 percent

Question 3

ADRs occurring in elders are often due to

Answer 3

ADRs occurring in elders are often due to polypharmacy.
• The risk increases for those who are malnourished or have renal or
hepatic diseases, diabetes, asthma or other systemic diseases.

Question 4

ADR risk with 2 drugs 5 drugs and 8 or more drugs

Answer 4

The risk of an adverse reaction rises from 6% with two drugs, to 50%
with five, and 100% with eight or more medications

Question 5

Allergic

Answer 5

Administration of the drug causes an undesirable immunological response (e.g., rash, anaphylaxis), often unpredictable

Question 6

Side Effect

Answer 6

undesirable but expected or predictable effect at therapeutic doses (e.g., nausea, dry mouth). Side effects are the most common

Question 7

Drug Toxicity*

Answer 7

Occurs when a drug dose is high enough to damage a physiological system, usually exceeding therapeutic levels. Most common in children and frail elders.

Question 8

Drug–Drug Interaction*

Answer 8

The absorption, distribution, metabolism, or excretion of one drug is altered by another (e.g., erythromycin increasing digoxin levels, NSAIDs + methotrexate causing renal failure). Usually predictable.

Question 9

Drug–Physiology Interaction

Answer 9

drug at therapeutic levels adversely affects a physiological system (e.g., Clindamycin causing colitis/diarrhoea). May overlap with side effects. Usually predictable.

Question 10

Drug–Laboratory Test Interaction

Answer 10

drug causes false-positive or false-negative test results without affecting the physiological system (e.g., amoxicillin causing false-positive urine glucose tests). Usually predictable

Question 11

Idiosyncratic

Answer 11

Unpredicted physiological/psychological responses at therapeutic doses, unique to an individual.

Question 12

Another reason ADRs occur in older adults is

Answer 12

Another reason ADRs occur in older adults is lack of compliance or
inability to comply with a complicated drug regimen. This may result in
either under or overuse of prescribed medications.
• A thorough health history, increased care when prescribing certain drug
classes and careful monitoring of the patient can prevent most of these
adverse drug reactions, whether they are secondary to compliance issues
or some other reason.

Question 13

There are six issues to consider when managing and prescribing for older
patients taking medications:

Answer 13

Medication as an indicator of medical conditions.
Current medical conditions and medications as they impact dental
care.
Oral side effect of medications.
Pharmacodynamics as it impacts dental management.
Current medical conditions and medications as they impact dental
prescribing.
Non-compliance to medication use

Question 14

Could any of these drugs be required during a medical emergency?**

Answer 14

?**
e.g., Nitroglycerin – angina, inhalers – COPD exacerbation.

Question 15

Why is the patient taking these particular medications? Group by category to aid in assessing overall risk in patient care and management.**

Answer 15

Antihypertensive, anticoagulant, immunosuppressive, antidepressant, etc.*

Question 16

Do any drugs have the potential to contribute to a complication or even create an emergency situation

Answer 16

Warfarin – excessive bleeding, prednisone – adrenal insufficiency, insulin – hypoglycemia, bisphosphonates – osteonecrosis.*

Question 18

Could any of these drugs compromise our desired treatment outcome?*

Answer 18

g., Vincristine – delayed healing, echinacea – potentiates inhibition of liver enzymes from erythromycin and ketoconazole.*

Question 19

Do any of these drugs have potential oral side effects?**

Answer 19

e.g., Dilantin, nifedipine – gingival hyperplasia; chlorthiazide diuretics – lichenoid reactions; antihistamines – xerostomia.

Question 20

Could any of the medications compromise our treatment outcomes?

Answer 20

the healing time or risk of infection increased because the patient is on
an immunosuppressant such as prednisone or a cancer chemotherapeutic
agent
o is there a risk of osteonecrosis because the patient is taking an oral
bisphosphonate (e.g. Fosamax) for osteoporosis or an intravenous
bisphosphonate (e.g. Zometa) for the treatment of bone pathology
secondary to cancer.

Question 21

What oral management problems can anticoagulants like aspirin and warfarin cause?

Answer 21

Excessive bleeding

Question 22

What complications can corticosteroids and other immunosuppressants cause in oral health?

Answer 22

Increase risk of bacterial nd fungal infections poor stress response

Question 23

Which patients are most likely to be on immunosuppressants?

Answer 23

A: Organ transplant recipients or those with autoimmune conditions

Question 24

How can chemotherapeutic drugs like vincristine affect dental treatment?

Answer 24

Delayed healing and mucositis

Question 25

What risks do sedatives like Valium or narcotics like codeine pose in dental care? Acetaminophen with codeine Valium Demerol

Answer 25

can cause respiratory suppression and increase fall risk, especially in older adults.

Question 26

Why should dentists be cautious with patients taking insulin or sulfonylureas?

Answer 26

These drugs can cause hypoglycemia, which may lead to emergencies during long procedures.

Question 27

What oral complications are linked to bisphosphonates (e.g., Fosamax, Zometa)? Zoledronic acid pamedronate aledronate

Answer 27

cause delayed bone healing and osteonecrosis of the jaw.

Question 29

ACE inhibitors and other drugs are associated with

Answer 29

Iichenoid reactions

Question 30

Diuretics and antidepressants often contribute to

Answer 30

Diuretics and antidepressants often contribute to salivary hypofunction and xerostomia

Question 31

Calcium channel blockers and some anti-seizure and immunosuppressant drugs can cause

Answer 31

Gingival hyperplasia

Question 32

Salivary hypofunction and xerostomia are frequently caused by medications and can cause a host of oral-pharyngeal side effects, such as

Answer 32

Salivary hypofunction and xerostomia are frequently caused by medications and can cause a host of oral-pharyngeal side effects, such as increase in caries and an increased susceptibility to oral fungal infection

Question 33

Dry mouth can alter

Answer 33

reduce or alter the sensation of taste, as well as impair speech and swallowing function. The dentist should consider consulting with the patient’s physician about changing one xerostomic medication to another with similar indications but fewer side effects. • However, for patients on numerous medications that cause xerostomia, palliative therapy (e.g. salivary substitutes, lubricants) may be the only possible treatments. • In dentate patients with polypharmacy-induced salivary hypofunction, caries prevention is critica

Question 34

Which drug class commonly causes xerostomia, and what is an example medication and its use?

Answer 34

Antihistamines** (e.g., Claritin/Loratadine) used to treat **hay fever** can cause xerostomia and salivary hypofunction. Diuretics furoemide and calcium channel blocker amilodipine and antidepressants sertaline for OCD

Question 35

Name a drug class that may lead to oral fungal infections, along with an example and its therapeutic use.

Answer 35

Antibiotics tetracycline for periodontitis immunosuppressants** (e.g., Cortan/Prednisone for **rheumatoid arthritis**) can increase the risk of fungal infections.

Question 37

What drug used in cancer treatment causes mucositis, and what condition does it treat

Answer 37

Anti-neoplastic drugs** like Adrucil (5-Fluorouracil), used for **breast cancer**, can lead to mucositis.

Question 39

Which antibiotic may cause tooth discoloration, and what is it prescribed for?

Answer 39

**Minocin (Minocycline)**, an antibiotic for **H. pylori-induced gastric ulcers**, can discolor teeth.

Question 40

Dysgeusia (Altered Taste)** **Q:** Which medication is linked to dysgeusia?

Answer 40

Antihypertensive ace inhibitor enalapril for hypertension **Glucotrol (Glipizide)**, an **oral hypoglycemic** for **diabetes**, may cause altered taste.

Question 41

Name three drug classes that can cause gingival overgrowth, with examples and uses.

Answer 41

Anticonvulsants**: Dilantin (Phenytoin) for **epilepsy**. - **Calcium channel blockers**: Procardia (Nifedipine) for **hypertension**. - **Immunosuppressants**: Sandimmune (Cyclosporin) to **prevent transplant rejection**.

Question 43

What hypertension drug is associated with stomatitis?

Answer 43

Antihypeertensive

Question 44

**Q:** Which diuretic can trigger oral lichenoid reactions, and what is its primary use?

Answer 44

Thiazide diuretics** (e.g., HCTZ) for **hypertension** may cause lichenoid mucosal lesions. *ACE inhibitors** like Capoten (Captopril) for **hypertension** may cause stomatitis.

Question 46

How can aspirin lead to mucosal burns, and what condition might it treat

Answer 46

If dissolved orally, **Ecotrin (Aspirin)** for **osteoarthritis** can cause chemical burns to the mucosa.

Question 47

How is renal function assessed for drug dosing adjustments?

Answer 47

**A:** Through **Glomerular Filtration Rate (GFR)** measurements: - **Normal:** >50 mL/min - **Moderate impairment:** 10–50 mL/min - **Severe impairment:** <10 mL/min

Question 48

How should amoxicillin be dosed in patients with renal dysfunction?

Answer 48

**A:** - **GFR >50 mL/min:** Standard dose every 8 hours. - **GFR 10–50 mL/min:** Reduce to one dose every 8–12 hours. - **GFR <10 mL/min:** Further reduce to one dose every 24 hours

Question 49

What other antibiotics require renal dosing adjustments? protocols.

Answer 49

**A:** Cephalosporins and penicillins follow similar GFR-based dosing protocols.

Question 50

How is hepatic impairment evaluated for drug safety?

Answer 50

**A:** Via **Liver Function Tests (LFTs)**, including **AST/ALT (liver transaminases)**. - **Critical threshold:** >4 times normal values → Avoid hepatotoxic drugs.

Question 51

Which drugs should be avoided in severe liver impairment?

Answer 51

Analgesics:** Acetaminophen, codeine. - **Sedatives:** Diazepam, lorazepam. - **Antimicrobials:** Erythromycin, ketoconazole. - **NSAIDs:** Ibuprofen. - **Others:** Lidocaine, prednisone.

Question 52

Older adults are at increased risk of experiencing the respiratory depressive effects of some medications such as

Answer 52

benzodiazepines and opioids. • They may be less able to compensate quickly for medications that alter cardiovascular function, such as epinephrine, and they may have an atypical adverse drug response such as altered mental status

Question 53

decrease in dosage for aged individuals maybe recommended for

Answer 53

recommended for some medications commonly used in dentistry. • Due to normal physiological changes in elimination associated with aging and altered distribution as a result of decreased body mass, dosage of these drugs should be reduced by 50%, or to the lowest therapeutic dose for individuals under 100 pounds (45.45 kg) and patients over 85 years of age

Question 54

Taking penicillin as resulted in

Answer 54

Skin rash

Question 55

When can nsaids not be given

Answer 55

Git ulcers liver disease

Question 56

Erythromycin reduce warfarin clearance by

Answer 56

30 %

Question 57

Elderly have decreased ability to eliminate

Answer 57

Cephalosporin Penicillin Erythromycin

Question 58

Prednisolone can result in

Answer 58

Non compliance patient failing to take prescr8ibe dose can cause adrenal crisis

Question 59

Non-compliance to medication use

Answer 59

inadequate communication between providers and patients. • Patients with mild to severe cognitive impairments or physical impairments are at risk for drug non- compliance. • Other patients may develop a dependence on a medication and take more than prescribed. • Some patients may not be able to afford the medication prescrib

Question 60

two most susceptible populations to local anaesthesia overdose are the

Answer 60

two most susceptible populations to local anaesthesia overdose are the paediatric and geriatric populations, mostly due to their low body mass. • In the elderly, the nerve axon function deteriorates, nerve morphology changes and the surrounding fatty tissue disappears leading to an increased sensitivity to the local anaesthetics, necessitating smaller doses. • Cardiovascular disease comorbidity can also make the geriatric patient susceptible to hypertensive crises, congestive heart failure, angina and arrhythmias.

Question 61

patients with pre-existing cardiac and cardiopulmonary diseases, it has been suggested that the maximum amount of epinephrine that should be administered is

Answer 61

0.4 mg

Question 62

total amount of local anaesthetic agent that can be administered is dependent on the

Answer 62

on the patient’s weight, the volume in each carpule and the percent volume of the anaesthetic. • A relatively safe amount of anaesthetic agent that can be administered to the geriatric patient is approximately 70% of the maximum dose reported by the manufacturer

Question 63

Surgical risk and outcome in patients aged 65 and older depend mostly on four important factors:

Answer 63

Surgical risk and outcome in patients aged 65 and older depend mostly on four important factors: (1) age (2) the patient’s physiological status and coexisting disease (ASA class) (3) whether the surgery is elective or urgent and (4) the type of procedure. • The most important factor in preventing complications was a preoperative review by the patient’s physician

Question 64

Nitrous oxide is a

Answer 64

Nitrous oxide is a colourless, odourless, tasteless, nonflammable, nonirritating, inorganic gas. • It is noninvasive, easily adjustable, and quickly reversible. • Inhalation sedation and analgesia utilizing nitrous oxide is generally considered a safe method for pain and anxiety management in the elderly because of its rapid elimination and minimum effect on the cardiovascular system. • A preoperative mental evaluation should be done to assess cognitive function because of the commonly occurring episodic dementia

Question 65

Oral sedation • The pharmacological agents used most commonly include

Answer 65

The pharmacological agents used most commonly include antihistamines, benzodiazepines and opioids. • The use of oral sedation in the elderly can often be difficult due to the difficulty in titration of an effective but safe dose. • Polypharmacy in the elderly is very common and can make it difficult to accurately assess the patient’s metabolism and their current medical regimens. • Complications that occur can result in hypotension, apnea and unconsciousness resulting from cardiovascular compromise and respiratory depression

Question 66

• Intravenous sedation is a generally safe and effective procedure

Answer 66

• Intravenous sedation is a generally safe and effective procedure for both the healthy and frail elderly. • As with any sedation, the patient should not have anything to eat or drink after midnight the night before surgery. • At the consultation appointment, the patient should be counselled to continue their normal medical regimen and that it is acceptable to have a small sip of water to swallow their medication. • Monitoring is required before, during and after procedures. • Essential monitoring includes pulse-oximeter, ECG, blood pressure monitoring and a continuous recording of vital sign. As with many medications, titration of the sedative agents is recommended, allowing more time for peak effect under lower doses. Medications that are generally used are benzodiazepines, specifically midazolam. • Midazolam is a short acting, water soluble benzodiazepine, which is a safe and effective anxiolytic, with the added benefit of retrograde amnesia. • There are many other agents that can be given intravenously, although, as mentioned previously, cardiac and pulmonary suppression should be avoided in patients with coexisting cardiovascular diseases. • Postoperative monitoring must be administered during recovery time because of the risk of postoperative delirium and increased risk of fall