NBDHE NBDHE Pharmacology in Dental Hygiene 4 — Questions and Answers
Question 1: A patient on chronic SSRI therapy undergoing periodontal surgery should be monitored for which drug interaction if an NSAID is prescribed post-operatively?
- Reduced NSAID efficacy due to enzyme induction
- Increased risk of GI bleeding due to synergistic platelet inhibition (Correct answer)
- Serotonin syndrome risk from combined therapy
- NSAID-induced hypertension masked by SSRI
Correct answer: Increased risk of GI bleeding due to synergistic platelet inhibition
SSRIs inhibit platelet serotonin uptake, impairing aggregation; NSAIDs also inhibit platelets, creating a synergistic risk of GI and post-operative bleeding.
Question 2: Epinephrine in local anesthetic solutions is classified as which type of adrenergic agonist?
- Selective alpha-1 agonist
- Selective beta-2 agonist
- Non-selective alpha and beta agonist (Correct answer)
- Selective alpha-2 agonist
Correct answer: Non-selective alpha and beta agonist
Epinephrine stimulates both alpha (vasoconstriction) and beta (cardiac stimulation, bronchodilation) adrenergic receptors in a non-selective manner.
Question 3: Which benzodiazepine reversal agent should be available when oral sedation with triazolam is used in the dental office?
- Naloxone
- Flumazenil (Correct answer)
- Physostigmine
- Atropine
Correct answer: Flumazenil
Flumazenil is a competitive benzodiazepine receptor antagonist used to reverse CNS depression caused by benzodiazepines such as triazolam.
Question 4: A nursing mother requires antibiotic therapy for a dental infection. Which drug is considered safest with minimal transfer to breast milk?
- Tetracycline
- Ciprofloxacin
- Amoxicillin (Correct answer)
- Metronidazole
Correct answer: Amoxicillin
Amoxicillin has low transfer to breast milk and is generally considered safe for nursing mothers, unlike tetracycline or fluoroquinolones which are contraindicated.
Question 5: A patient taking monoamine oxidase inhibitors (MAOIs) requires dental care. Which drug combination poses the greatest risk?
- Lidocaine with epinephrine (Correct answer)
- Mepivacaine without vasoconstrictor
- Articaine with epinephrine
- Prilocaine with felypressin
Correct answer: Lidocaine with epinephrine
Epinephrine combined with MAOIs can cause a hypertensive crisis because MAOIs inhibit the breakdown of catecholamines, amplifying sympathomimetic effects.
Question 6: Which property of articaine distinguishes it from most other amide local anesthetics used in dentistry?
- It contains an ester linkage in addition to its amide bond (Correct answer)
- It is metabolized exclusively by the liver
- It has the lowest pKa of all dental anesthetics
- It requires the highest volume for effective block anesthesia
Correct answer: It contains an ester linkage in addition to its amide bond
Articaine uniquely contains both an amide bond and an ester linkage (thiophene ring with ester group), allowing partial metabolism by plasma esterases in addition to hepatic metabolism.
Question 7: Which topical anesthetic agent is available in the highest concentration for dental use and must be used cautiously to avoid systemic toxicity?
- Benzocaine 20% (Correct answer)
- Lidocaine 5%
- Tetracaine 0.5%
- Prilocaine 4%
Correct answer: Benzocaine 20%
Benzocaine is available in concentrations up to 20% for dental topical use; excessive application can cause methemoglobinemia, particularly in children and patients with G6PD deficiency.
NBDHE NBDHE Pharmacology in Dental Hygiene 4
A patient on chronic SSRI therapy undergoing periodontal surgery should be monitored for which drug interaction if an NSAID is prescribed post-operatively?