ADEX Pharmacology and Pain Management 2 — Questions and Answers
Question 1: Which analgesic mechanism is responsible for the anti-inflammatory, antipyretic, and analgesic effects of ibuprofen?
- Opioid receptor agonism
- Inhibition of cyclooxygenase (COX) enzymes and prostaglandin synthesis (Correct answer)
- Blockade of sodium channels
- Inhibition of serotonin reuptake
Correct answer: Inhibition of cyclooxygenase (COX) enzymes and prostaglandin synthesis
NSAIDs like ibuprofen inhibit COX-1 and COX-2 enzymes, blocking arachidonic acid conversion to prostaglandins that mediate inflammation and pain.
Question 2: A patient taking warfarin requires post-operative analgesia after a dental hygiene procedure. Which analgesic is safest to recommend?
- Aspirin
- Ibuprofen
- Naproxen
- Acetaminophen (Correct answer)
Correct answer: Acetaminophen
Acetaminophen does not inhibit platelet function or significantly affect INR, making it the safest OTC analgesic for patients on anticoagulant therapy.
Question 3: Which drug interaction should a dental hygienist be aware of when a patient reports taking a monoamine oxidase inhibitor (MAOI)?
- Avoid lidocaine; substitute bupivacaine
- Avoid epinephrine in local anesthetic; use plain mepivacaine (Correct answer)
- Avoid all NSAIDs; use opioids instead
- Avoid fluoride varnish application
Correct answer: Avoid epinephrine in local anesthetic; use plain mepivacaine
MAOIs inhibit catecholamine breakdown, and epinephrine can cause dangerous hypertensive crisis; plain anesthetics without vasoconstrictors are recommended.
Question 4: Which antibiotic is the first-line prophylaxis recommendation for patients with cardiac conditions requiring infective endocarditis (IE) prevention before dental procedures?
- Clindamycin 600 mg
- Amoxicillin 2 g orally 30–60 minutes before the procedure (Correct answer)
- Metronidazole 500 mg
- Azithromycin 500 mg
Correct answer: Amoxicillin 2 g orally 30–60 minutes before the procedure
The AHA recommends amoxicillin 2 g orally 30–60 minutes before high-risk dental procedures as the first-line IE prophylaxis in adults.
Question 5: Chlorhexidine gluconate (0.12%) mouth rinse used in the dental setting is classified as which type of agent?
- Analgesic
- Broad-spectrum antibacterial and antiplaque agent (Correct answer)
- Fluoride remineralizing agent
- Salivary stimulant
Correct answer: Broad-spectrum antibacterial and antiplaque agent
Chlorhexidine is a cationic bisguanide with broad antibacterial activity; it binds to oral tissues (substantivity) and disrupts bacterial cell membranes.
Question 6: A patient taking bisphosphonates (e.g., alendronate) for osteoporosis should be counseled regarding which potential oral complication?
- Increased caries rate
- Medication-related osteonecrosis of the jaw (MRONJ) (Correct answer)
- Xerostomia
- Gingival hyperplasia
Correct answer: Medication-related osteonecrosis of the jaw (MRONJ)
Bisphosphonates inhibit osteoclast activity and impair bone remodeling, increasing the risk of osteonecrosis following invasive dental procedures.
ADEX Pharmacology and Pain Management 2
Which analgesic mechanism is responsible for the anti-inflammatory, antipyretic, and analgesic effects of ibuprofen?