NBDHE NBDHE Pharmacology in Dental Hygiene 2 — Questions and Answers
Question 1: A patient taking warfarin requires scaling and root planing. Which drug interaction poses the greatest bleeding risk if prescribed concurrently?
- Amoxicillin
- Ibuprofen (Correct answer)
- Clindamycin
- Acetaminophen
Correct answer: Ibuprofen
Ibuprofen inhibits platelet aggregation and displaces warfarin from plasma proteins, significantly increasing bleeding risk.
Question 2: Which vasoconstrictor is contraindicated in patients taking nonselective beta-blockers due to risk of hypertensive crisis?
- Epinephrine 1:100,000
- Levonordefrin (Correct answer)
- Epinephrine 1:200,000
- Phenylephrine
Correct answer: Levonordefrin
Levonordefrin (neo-cobefrin) is an alpha-agonist that can cause severe hypertension when combined with nonselective beta-blockers because beta-2 vasodilation is blocked.
Question 3: A patient reports taking sildenafil for pulmonary hypertension. Which drug used in dental emergencies is absolutely contraindicated?
- Epinephrine
- Nitroglycerin (Correct answer)
- Diphenhydramine
- Atropine
Correct answer: Nitroglycerin
Nitroglycerin combined with sildenafil (a PDE-5 inhibitor) causes profound, potentially fatal hypotension.
Question 4: Bisphosphonate-associated osteonecrosis of the jaw (BRONJ) most commonly occurs in patients taking which form of bisphosphonate therapy?
- Oral alendronate for osteoporosis
- IV zoledronic acid for cancer (Correct answer)
- Oral risedronate for osteoporosis
- Intranasal calcitonin
Correct answer: IV zoledronic acid for cancer
IV bisphosphonates used in oncology carry a significantly higher risk of BRONJ than oral bisphosphonates used for osteoporosis.
Question 5: Which antibiotic prophylaxis regimen is currently recommended by the AHA for a cardiac patient unable to take oral medications?
- IV or IM ampicillin 2 g
- IV clindamycin 600 mg
- IM cefazolin 2 g or ceftriaxone 1 g (Correct answer)
- IV azithromycin 500 mg
Correct answer: IM cefazolin 2 g or ceftriaxone 1 g
Current AHA guidelines recommend IM/IV cefazolin 2 g or ceftriaxone 1 g for patients who cannot take oral medications and are not allergic to penicillin.
Question 6: A patient using a fentanyl transdermal patch for chronic pain presents for a routine cleaning. The dental hygienist should be most alert for which adverse effect?
- Tachycardia and hypertension
- Xerostomia and caries risk only
- Respiratory depression if additional opioids are given (Correct answer)
- Gingival hyperplasia
Correct answer: Respiratory depression if additional opioids are given
Opioid analgesics given on top of existing fentanyl therapy can cause additive respiratory depression, which is life-threatening.
Question 7: Which antifungal agent is the drug of choice for mild-to-moderate oral candidiasis in an immunocompetent dental patient?
- Amphotericin B oral suspension
- Clotrimazole troches
- Nystatin oral rinse (Correct answer)
- Fluconazole 200 mg daily
Correct answer: Nystatin oral rinse
Nystatin oral rinse is the first-line topical antifungal for mild-to-moderate oral candidiasis in immunocompetent patients due to its safety and local efficacy.
NBDHE NBDHE Pharmacology in Dental Hygiene 2
A patient taking warfarin requires scaling and root planing.
Which drug interaction poses the greatest bleeding risk if prescribed concurrently?