Question 1

If the _____ tablet of sublingual nitroglycerin (NTG)does not stop the anginal attack,the patient should be taken to the emergency room.

Accepted Answer

The dental office should have a supply of sublingual NTG for acute emergencies.One tablet can be administered at once,followed in 5 minutes by another,and in another 5 minutes by a third tablet.If these tablets do not stop the anginal attack,the patient should be taken to the emergency room.The recommendation for the number of tablets of sublingual nitroglycerin to be administered before the patient is taken to the emergency room is specific.Only one of these choices is correct.

Question 2

Which of the following is a b-adrenergic blocking drug that also has a-receptor blocking activity?

Accepted Answer

Labetalol and Carvedilol are both b-blockers with a-blocking activity.Atenolol is a b-adrenergic blocker.Doxazosin is an a-adrenergic blocker.Minoxidil is a vasodilator.

Question 3

b₁-Receptor stimulation is associated with

Accepted Answer

b₁-Receptor stimulation is associated with an increase in heart rate,cardiac contractility,and AV conduction.Stimulation ofβ₂-receptors produces vasodilation in skeletal muscles and bronchodilation in the pulmonary tissues.An easy way to remember this is that humans have one heart and two lungs.

Question 4

Which b-adrenergic blocking agent has partial agonist activity and causes some â-stimulation while blocking catecholamine action?

Accepted Answer

Pindolol and acebutolol have partial agonist activity and cause some b-stimulation while blocking catecholamine action.Pindolol is nonselective,whereas acebutolol is beta-1 selective.Atenolol and metoprolol are b₁-selective full antagonists.Carvedilol is a nonspecific b-blocker with a-blocking activity as well.

Question 5

Essential hypertension is

Accepted Answer

Approximately 85% to 90% of patients diagnosed with hypertension have essential,idiopathic,or primary hypertension,which tends to be familial and may be the result of the interaction between environmental and genetic factors.These terms all stand for hypertension from an unknown cause.Iatrogenic hypertension would be hypertension caused as a consequence of treatment.Hypertension precipitated by another disorder would be secondary hypertension.A rapidly developing hypertension is malignant hypertension.

Question 6

Which of the following statement is true concerning the use of b-adrenergic blocking agents for the treatment of angina pectoris?

Accepted Answer

The net result of the use of b-adrenergic blocking agents for the treatment of angina pectoris is a reduced myocardial oxygen demand.b-adrenergic blocking agents block the beta response to catecholamine stimulation,thereby reducing both the chronotropic and inotropic effects.b-adrenergic blockers are effective in reducing both exercise- and stress-induced anginal episodes.Adverse effects of b-adrenergic blocking agents include bradycardia,heart failure,headache,dry mouth,blurred vision,and unpleasant dreams.

Question 7

Which of the following agents can worsen asthma?

Accepted Answer

In usual doses,the selective,or specific,beta-adrenergic receptor blocking drugs,such as metoprolol,block the beta 1-receptors more than the beta 2-receptors.The selective beta-blockers have some advantages in patients who may have preexisting bronchospastic disease,such as asthma,because they do not block the airway's bronchodilating action.Propranolol is a nonselective beta-adrenergic antagonist.It can inhibit lung beta 2-receptors,which are involved in bronchodilation.

Question 8

Which of the following groups of diuretics are called the "puny" diuretics?

Accepted Answer

Potassium-sparing diuretics are "puny" diuretics with "potassium-catching" ability.Individual members of this group have different mechanisms of action,but all have weak diuretic action.The potassium-sparing diuretics act at different sites in the kidney than the thiazide diuretics.The thiazide diuretics are among the most commonly used agents for the treatment of hypertension.Thiazides can cause hypokalemia and sensitize the myocardium to developing arrhythmias.Loop diuretics are considered the "strong cousins" of the thiazide diuretics.Like thiazides,loop diuretics inhibit the reabsorption of sodium with a concurrent loss of fluids.

Question 9

Before administering nitroglycerine (NTG),the dental team should make sure that the patient has not used a _____ within the past 24 hours.

Accepted Answer

The administration of any of these drugs with either daily or intermittent doses of any nitrate is contraindicated.If the patient has used one of these drugs,then NTG cannot be given.The dental team should make sure that the patient has not used a phosphodiesterase 5 (PDE5)inhibitor within the past 24 hours.

Question 10

Which of the following is the most important dental drug interaction with the thiazide diuretics?

Accepted Answer

The most important dental drug interaction with the thiazides is interaction with the NSAIDs.NSAIDs can reduce the antihypertensive effect of the thiazide diuretics.This interaction takes a few days to develop,and therefore a few doses of an NSAID can safely be used for acute pain control.A longer duration of use should be undertaken with blood pressure monitoring.The other choices are not representative of the most important dental drug interaction with thiazide diuretics.

Question 11

Approximately _____% of people with hypertension are properly treated.

Accepted Answer

Only approximately 50% of those with known hypertension are properly treated.Early detection and treatment with drug therapy reduces the possibility of damage to vital organs and extends the patient's lifetime.About half of the people with known hypertension are properly treated.If hypertensive patients are properly treated,meaning their blood pressure is normalized,their risk of complications is equal to that of the patient without hypertension.

Question 12

Which of the following categories of antihypertensive agents end in the suffix -dipine?

Accepted Answer

Many calcium channel blockers end in the suffix -dipine.These agents are used to treat hypertension and other cardiac conditions such as arrhythmias and angina.Common calcium channel blockers include the drugs verapamil,nifedipine,and diltiazem.Thiazide diuretics end in the suffix -thiazide.Examples include chlorothiazide and hydrochlorothiazide.b-Adrenergic blockers end in the suffix -olol.Examples include atenolol,metoprolol,and propranolol.ARBs end in the suffix -artan.Examples include losartan,olmesartan,and valsartan.

Question 13

Which of the following statements is true regarding hypertension?

Accepted Answer

High blood pressure damages organs and untreated hypertensive patients are more likely to have kidney and heart disease and cardiovascular problems.Complications of hypertension are greatly increased with concomitant smoking.In approximately 10% of hypertensive patients,the cause can be identified and associated with a specific disease process involving the endocrine or renal systems.

Question 14

Which diuretic acts at the ascending loop of Henle of the kidney nephron to cause rapid diuresis?

Accepted Answer

Furosemide is considered a "loop diuretic" because it works at the ascending loop of Henle.It acts before the other diuretics listed and can cause a more rapid and pronounced diuresis.Hydrochlorothiazide primarily works in the distal convoluted tubule,whereas triamterine and spironolactone have their site of action in the late distal convoluted tubule and collecting duct.

Question 15

Which of the following is the most common cardiovascular disease?

Accepted Answer

Hypertension is the most common cardiovascular disease,affecting some 70 million Americans and over 1 billion individuals worldwide.The prevalence of hypertension increases with age and is higher among women than men.Data from the recent Framingham Heart Study suggested that individuals with normal blood pressure at age 55 have a 90% lifetime risk for developing hypertension.Statistically,it is likely that many dental patients will be suffering from hypertension as 68% of patients with diagnosed hypertension are being treated.

Question 16

Eating bananas when taking thiazide diuretics will

Accepted Answer

A characteristic adverse effect of thiazide diuretics is the loss of potassium and potential hypokalemia.Bananas are rich in potassium and are effective at replenishing this ion.Bananas do not deplete calcium,prevent diuresis,or inhibit the metabolism of thiazide diuretics.

Question 17

Nonselective b-blockers can have a drug interaction with epinephrine,causing a two- to fourfold increase in vasopressor response.A gingival retraction cord containing epinephrine may be used,however.

Accepted Answer

In patients with cardiovascular disease or higher blood pressure,the amount of epinephrine given to patients taking nonspecific b-blockers should be limited to the cardiac dose unless careful blood-pressure monitoring accompanies the use of larger doses.Neither gingival retraction cord containing epinephrine nor 1:50,000 epinephrine should be used.The amount of caution required with this drug interaction depends on the patient's underlying cardiovascular disease,if any increase in blood pressure,and the dose of the b-blocker the patient is taking.The dentist should avoid using gingival retraction cord that contains epinephrine because these cords contain epinephrine that is highly concentrated.It can be quickly absorbed into sulcular tissue and lead to tachycardia and elevated blood pressure.

Question 18

Common adverse reactions associated with thiazides include

Accepted Answer

Common adverse reactions associated with thiazides include hypokalemia secondary to sodium-potassium exchange and hyperuricemia due to inhibition of uric acid secretion.Hyperglycemia,hyperlipidemia,and hypercalcemia and anorexia are other side effects.The thiazide diuretics inhibit the resorption of sodium from the distal convoluted tubule and part of the ascending loop of Henle from the kidney.Water and chloride ions passively accompany the sodium,producing diuresis.Because more sodium is presented to the site of sodium-potassium exchange,there is also an increase in potassium excretion,producing hypokalemia.Hyperuricemia is due to an inhibition of uric acid secretion.

Question 19

b-Adrenergic blockers lower blood pressure primarily by

Accepted Answer

b-Adrenergic blockers lower blood pressure primarily by decreasing cardiac output.Other effects that may contribute to their antihypertensive effect include a lowering of plasma renin levels,a reduction in plasma volume and venous return,a decrease in sympathetic outflow from the central nervous system (CNS),and a reduction in peripheral resistance.

Question 20

_____ should not be given to persons taking potassium supplements because hyperkalemia will occur.

Accepted Answer

ACEIs can cause hyperkalemia,and potassium supplements and potassium-sparing diuretics should not be used with these drugs.ACEIs should not be given to persons taking potassium supplements.Patients taking potassium supplements should be questioned about their use of diuretics,and the possibility of cardiovascular disease should be explored when a drug history is taken.

Quiz 12: Drugs for the Treatment of Cardiovascular Disease

If the _____ tablet of sublingual nitroglycerin (NTG) does not stop the anginal attack,the patient should be taken to the emergency room.