Free NBDE Pharmacology and Pain Control Questions and Answers — Questions and Answers
Question 1: A patient taking long-term opioid therapy for chronic pain reports that while most side effects like sedation have lessened, their constipation persists. Which other adverse effect of opioids shows little to no development of tolerance?
- Nausea and vomiting
- Respiratory depression
- Miosis (pupil constriction) (Correct answer)
- Euphoria
Correct answer: Miosis (pupil constriction)
While tolerance develops to many of the side effects of opioids, such as sedation, respiratory depression, and nausea, it does not develop for miosis (constricted pupils) or constipation. Miosis remains a consistent physiological response even with chronic use.
Question 2: A patient requires a dental extraction and has a history of chronic kidney disease (CKD). Which of the following analgesics is generally considered the safest and most appropriate first-line choice for post-operative pain management in this patient?
- Ibuprofen
- Naproxen
- Aspirin
- Acetaminophen (Correct answer)
Correct answer: Acetaminophen
NSAIDs, including ibuprofen, naproxen, and high-dose aspirin, should be avoided in patients with chronic kidney disease because they can inhibit prostaglandins that are vital for renal blood flow, potentially worsening renal function. Acetaminophen is metabolized by the liver and is considered the safest first-line analgesic for patients with CKD, provided dosing is appropriate for their level of renal function.
Question 3: A patient with a history of a prosthetic heart valve requires a dental procedure involving manipulation of gingival tissue. According to American Heart Association (AHA) guidelines, what is the standard antibiotic prophylactic regimen for this patient if they have no known drug allergies?
- 500 mg Azithromycin 1 hour prior
- 2 g Amoxicillin 30-60 minutes prior (Correct answer)
- 600 mg Clindamycin 1 hour prior
- 500 mg Metronidazole 30-60 minutes prior
Correct answer: 2 g Amoxicillin 30-60 minutes prior
The American Heart Association guidelines recommend a single 2-gram oral dose of amoxicillin, taken 30 to 60 minutes before the procedure, as the standard prophylactic regimen for at-risk patients to prevent infective endocarditis. Azithromycin and clindamycin are alternatives for patients with penicillin allergies.
Question 4: Local anesthetics exert their primary effect by blocking which of the following?
- Potassium efflux during repolarization
- The sodium-potassium ATPase pump
- Calcium influx at the axon terminal
- Sodium influx through voltage-gated channels (Correct answer)
Correct answer: Sodium influx through voltage-gated channels
Local anesthetics work by reversibly binding to and inactivating voltage-gated sodium channels on the inside of the nerve membrane. This action prevents the influx of sodium ions, which is necessary for the depolarization phase of an action potential, thereby blocking nerve impulse conduction.
Question 5: A dentist administers an IV benzodiazepine for conscious sedation. The patient becomes excessively sedated with significant respiratory depression. Which of the following drugs should be administered to reverse the effects of the benzodiazepine?
- Naloxone
- Flumazenil (Correct answer)
- Atropine
- Epinephrine
Correct answer: Flumazenil
Flumazenil is a competitive benzodiazepine receptor antagonist that is specifically indicated for the reversal of sedative effects from benzodiazepine overdose or iatrogenic oversedation. Naloxone is an opioid antagonist, atropine is an anticholinergic, and epinephrine is a sympathomimetic.
Question 6: A patient reports they are taking amitriptyline, a tricyclic antidepressant (TCA). The dentist plans to use a local anesthetic containing epinephrine. Which of the following best describes the potential drug interaction?
- TCAs can antagonize the anesthetic, requiring a higher dose.
- The combination can lead to severe hypotension and bradycardia.
- TCAs can markedly enhance the pressor effects of epinephrine, leading to hypertensive crisis. (Correct answer)
- Epinephrine rapidly metabolizes the TCA, reducing its antidepressant effect.
Correct answer: TCAs can markedly enhance the pressor effects of epinephrine, leading to hypertensive crisis.
Tricyclic antidepressants like amitriptyline inhibit the reuptake of norepinephrine at nerve terminals. This leads to an increased concentration of norepinephrine, which can markedly potentiate the cardiovascular (pressor) effects of sympathomimetics like epinephrine. This interaction can result in a hypertensive crisis and cardiac dysrhythmias.
Free NBDE Pharmacology and Pain Control Questions and Answers
A patient taking long-term opioid therapy for chronic pain reports that while most side effects like sedation have lessened, their constipation persists.
Which other adverse effect of opioids shows little to no development of tolerance?