NBDHE Test Pharmacology in Dental Hygiene 1

Question 1

According to the American Heart Association guidelines, what is the recommended first-line antibiotic for prophylaxis against infective endocarditis prior to dental procedures in at-risk patients who can take oral medications?

Accepted Answer

Amoxicillin 2 g

Answer

Amoxicillin 2 g orally 30–60 minutes before the procedure is the AHA first-line recommendation because it achieves high, sustained serum levels and is well absorbed. Clindamycin was removed from the AHA guidelines in 2021 due to risk of Clostridioides difficile colitis.

Question 2

A patient taking propranolol (a non-selective beta-blocker) receives 2 carpules of 2% lidocaine with 1:100,000 epinephrine. What is the PRIMARY cardiovascular concern?

Accepted Answer

Hypertensive crisis from unopposed alpha-adrenergic stimulation

Answer

Non-selective beta-blockers block beta-2 (vasodilatory) receptors while leaving alpha-1 (vasoconstrictive) receptors unblocked. Epinephrine then causes unopposed alpha-1 stimulation, leading to a sharp rise in blood pressure and a reflex bradycardia — potentially a hypertensive crisis.

Question 3

Tetracycline and its derivatives are contraindicated in children under age 8 primarily because they cause:

Accepted Answer

Permanent intrinsic discoloration of developing teeth

Answer

Tetracyclines chelate calcium ions and are incorporated into mineralizing tooth structure, producing permanent yellow-gray-brown intrinsic staining in teeth that are still developing (up to approximately age 8). This affects both primary and permanent dentition depending on the child's age.

Question 4

A patient prescribed metronidazole (Flagyl) for a periodontal infection asks what to avoid while taking the medication. Which of the following is MOST important to counsel?

Accepted Answer

Alcohol, which can cause a disulfiram-like reaction

Answer

Metronidazole inhibits acetaldehyde dehydrogenase, the same enzyme blocked by disulfiram (Antabuse). If a patient consumes alcohol, acetaldehyde accumulates, causing flushing, nausea, vomiting, and palpitations. Patients must avoid all alcohol — including mouthrinses — during and for 48 hours after therapy.

Question 5

A 65-year-old patient has been taking oral alendronate (Fosamax) for osteoporosis for seven years. She requires extraction of a non-restorable molar. The dental hygienist should be aware that her GREATEST drug-related risk is:

Accepted Answer

Medication-related osteonecrosis of the jaw (MRONJ)

Answer

Bisphosphonates are incorporated into bone and suppress osteoclast activity, impairing the bone remodeling necessary for healing after invasive procedures. Long-term oral bisphosphonate use — especially over three years — significantly raises the risk of MRONJ, particularly following tooth extraction or other dento-alveolar surgery.

NBDHE Test Practice Test

NBDHE Test Practice Test

NBDHE Test Pharmacology in Dental Hygiene 1