NBDHE Pharmacology in Dental Hygiene Questions and Answers — Questions and Answers
Question 1: A patient taking lisinopril for hypertension requires a recommendation for an over-the-counter analgesic following a scaling and root planing procedure. Which of the following is the MOST appropriate recommendation?
- Aspirin
- Ibuprofen
- Naproxen
- Acetaminophen (Correct answer)
Correct answer: Acetaminophen
Acetaminophen is the most appropriate choice because it does not significantly interfere with the antihypertensive effects of ACE inhibitors like lisinopril. NSAIDs, such as ibuprofen, naproxen, and aspirin, can reduce the effectiveness of ACE inhibitors and increase the risk of acute kidney injury when used concurrently. [1, 7, 12, 15, 23]
Question 2: According to the latest American Heart Association (AHA) guidelines, which of the following conditions requires antibiotic prophylaxis before dental procedures that involve manipulation of gingival tissue?
- Mitral valve prolapse with regurgitation
- Prosthetic cardiac valve (Correct answer)
- Previous coronary artery bypass graft (CABG)
- Rheumatic heart disease
Correct answer: Prosthetic cardiac valve
The current AHA guidelines recommend antibiotic prophylaxis only for patients with the highest risk of adverse outcomes from infective endocarditis. This includes patients with prosthetic cardiac valves, a history of infective endocarditis, specific congenital heart diseases, and cardiac transplant recipients with valvulopathy. Mitral valve prolapse, previous CABG, and rheumatic heart disease no longer require routine prophylaxis. [2, 17, 19]
Question 3: A patient with a history of a myocardial infarction 3 months ago requires a restorative procedure. Which of the following is the primary concern when selecting a local anesthetic?
- Using an amide versus an ester type anesthetic
- The concentration of the topical anesthetic
- The gauge of the needle used for injection
- Limiting the dose of the vasoconstrictor (Correct answer)
Correct answer: Limiting the dose of the vasoconstrictor
For patients with a recent history of myocardial infarction (typically within 3-6 months), the primary concern is cardiovascular stability. Vasoconstrictors like epinephrine can increase heart rate and blood pressure. Therefore, the dose should be limited to the minimum effective amount, often the cardiac dose (0.04 mg epinephrine). [3, 9, 11, 30]
Question 4: A patient's prescription for an antimicrobial rinse has the instruction "Sig: 15 mL swish and spit q.i.d. p.c.". What does "q.i.d." indicate for the patient?
- Every 4 hours
- Twice a day
- Four times a day (Correct answer)
- As needed for pain
Correct answer: Four times a day
In pharmacology and prescription writing, the Latin abbreviation "q.i.d." stands for "quater in die," which translates to "four times a day." Other common abbreviations include b.i.d. (twice a day), t.i.d. (three times a day), and p.r.n. (as needed). [4, 22]
Question 5: A 55-year-old patient reports a persistent, non-productive dry cough that started several weeks after they began a new medication. They also note experiencing xerostomia. Which class of medication is MOST likely responsible for these side effects?
- Beta-blockers
- Calcium channel blockers
- Diuretics
- ACE inhibitors (Correct answer)
Correct answer: ACE inhibitors
A persistent dry cough is a well-known and common side effect of Angiotensin-Converting Enzyme (ACE) inhibitors, such as lisinopril or enalapril. While many antihypertensives can cause xerostomia, the combination of a dry mouth and a characteristic dry cough strongly points towards an ACE inhibitor. [10, 14, 29]
Question 6: Which of the following analgesics achieves its therapeutic effect primarily by acting on the central nervous system to increase the pain threshold, and it lacks significant anti-inflammatory properties?
- Ibuprofen
- Naproxen
- Acetaminophen (Correct answer)
- Aspirin
Correct answer: Acetaminophen
Acetaminophen's primary mechanism of action is within the central nervous system, where it is thought to inhibit COX enzymes in the brain, reducing pain and fever. Unlike NSAIDs (ibuprofen, naproxen, aspirin), it has very weak peripheral anti-inflammatory effects. [6, 8, 21, 25, 27]
NBDHE Pharmacology in Dental Hygiene Questions and Answers
A patient taking lisinopril for hypertension requires a recommendation for an over-the-counter analgesic following a scaling and root planing procedure.
Which of the following is the MOST appropriate recommendation?