Question 1

Some studies have found that the presence of periodontal disease predicts an increase in morbidity and mortality resulting from cardiovascular disease.Other studies have failed to show a relationship.

Accepted Answer

Studies both support and reject such a relationship.Researchers do agree that more studies are needed.Several studies correlate the patient's periodontal condition to cardiovascular disease over time.Researchers and government agencies continue to investigate the possible relationship between periodontal disease and cardiovascular disease.

Question 2

There is a danger of _____ if the dose of anticoagulant is too small.

Accepted Answer

A danger of embolism exists if the dose is too small.Hemorrhage may occur if the dose of the anticoagulant is too large.Chronic obstructive pulmonary disease (COPD)is characterized by irreversible airway obstruction,which occurs with either chronic bronchitis or emphysema.With severe COPD,a patient can develop pulmonary hypertension,increasing the risk for cardiac arrhythmias.Angina pectoris is a common cardiovascular disease characterized by pain or discomfort in the chest radiating to the left arm and shoulder.Most adverse reactions associated with NTG occur because of its effect on vascular smooth muscle.Severe headaches are often reported after the use of NTG.

Question 3

Each of the following agents inhibits platelet function except one.Which is the exception?

Accepted Answer

Dipyridamole is used to prolong the life of platelets in patients with prosthetic heart valves.Clopidogrel,ticlopidine,and aspirin all inhibit adenine dinucleotide phosphate-induced platelet aggregation.

Question 4

Which agent is contraindicated in pregnant women due to the risk of teratogenicity?

Accepted Answer

ACEIs should not be given to women who could be pregnant or could become pregnant due to the risk of teratogenicity.Methyldopa,labetalol,and nifedipine are frequently administered to pregnant women.

Question 5

Each of the following is true for management of the dental patient taking warfarin except one.Which is the exception?

Accepted Answer

According to current recommendations it is not necessary to reduce or discontinue warfarin prior to dental therapy.Avoid aspirin and aspirin-containing compounds;acetaminophen and opioids may be used.Many surgical procedures can be carried out on a patient receiving therapeutic doses of anticoagulants.The patient should be free of infection before scaling and root planing is performed.

Question 6

The presence of _____ in the oral cavity can be a sign of an adverse effect associated with the oral anticoagulants.

Accepted Answer

The most common adverse effects associated with the oral anticoagulants are various forms of bleeding,including hemorrhage.One should look for petechial hemorrhages in the oral cavity.Ecchymoses can occur,even without concomitant trauma.The etiology of lichen planus is unknown,but current hypotheses include a viral infection,an autoimmune disease,and a hypersensitivity reaction to an unknown agent.Linear gingival erythema is associated with immune deficiencies.This form of gingivitis typically does not respond to improved plaque control.Most believe this pattern represents an unusual pattern of candidiasis.The cause of hairy tongue is uncertain.Possible associated factors include antibiotics,poor oral hygiene,general debilitation,radiation therapy,use of oxidizing mouthwashes or antacids,or an overgrowth of fungal or bacterial organisms.

Question 7

GoNitro is administered to the patient as a

Accepted Answer

GoNitro is supplied in single-use packets of powder that contain 0.4 mg of nitroglycerin,which should be stored at room temperature.GoNitro is not supplied as a tablet,spray,or injection.It is a form of sublingual (SL)NTG,meaning it is meant to be placed under the tongue.

Question 8

Blood returning from the peripheral circulation enters the

Accepted Answer

If the right side of the heart fails,then the right ventricle is unable to remove all the blood from the right side of the heart.Right-sided heart failure causes systemic congestion.Blood goes from the peripheral circulation to the right atrium,to the right ventricle,to the lungs for oxygenation,to the left atrium,to the left ventricle,and is then pumped at high pressure into the arteries.If the left side of the heart fails,the blood backs up into the pulmonary circulation (lungs).

Question 9

Which is the treatment of choice for the treatment of heart failure (HF)?

Accepted Answer

ACEIs are now considered first-line therapy and are the cornerstone of HF therapy.An ACEI should be used along with a beta-blocker unless there are contraindications.Current guidelines from the ACC and AHA now recommend prescribing an angiotensin-converting enzyme inhibitor (ACEI)for all patients with symptomatic (stage C)heart failure and for asymptomatic patients with a decreased left ventricular ejection fraction (LVEF)or a history of MI unless there are contraindications to an ACEI.

Question 10

The percentage of Americans diagnosed with hypertension is which percentage according to the new recommendations of the American Heart Association (AHA)?

Accepted Answer

The rise in the number of Americans being diagnosed with hypertension is based upon new scientific guidelines.The percentage of Americans with hypertension will rise to 46% based on the most recent recommendations of the American Heart Association.

Question 11

The therapeutic target international normalized ratio (INR)for most indications,such as thrombophlebitis,is

Accepted Answer

The therapeutic target INR for most indications,such as thrombophlebitis,or atrial fibrillation is between 2 and 3.For patients with a prosthetic heart valve,the target INR is between 2.5 and 3.5.The INR can range from 1 to 4,although it can reach higher levels with overdose.The remaining choices do not correctly depict the target INR for most indications.

Question 12

A patient taking warfarin (Coumadin)may experience interactions with which of the following?

Accepted Answer

Warfarin is notorious for interacting with other drugs.Phenobarbital induces its metabolism and decreases circulating warfarin levels.Erythromycin inhibits its metabolism and increases the risk of bleeding crises.Aspirin can displace warfarin from plasma protein sites and increase warfarin's free serum levels.Aspirin's antithrombotic action is also additive with warfarin's anticoagulant action.

Question 13

Which of the following agents has the most serious drug interaction with warfarin?

Accepted Answer

Patients taking warfarin should not be given aspirin or aspirin-containing products because bleeding episodes or fatal hemorrhages can occur.Aspirin causes hypoprothrombinemia and alters platelet adhesiveness.Aspirin can also irritate the gastrointestinal tract,which might bleed more in a patient taking warfarin.Another factor in the aspirin-warfarin interaction is related to protein binding or drugs.Aspirin displaces bound warfarin.The other choices are not the agent with the most serious drug interaction with warfarin.

Question 14

Based on the most recent recommendations of the American Heart Association (AHA),the percentage of American diagnosed with hypertension will

Accepted Answer

Although the number of people with hypertension will increase based upon the new guidelines,the actual number of patients who will need pharmacologic therapy will not increase significantly.The percentage of Americans diagnosed with hypertension will rise according to the new recommendations.

Question 15

Long chain omega-3 polyunsaturated fatty acids can decrease fasting triglyceride concentrations by

Accepted Answer

They can decrease fasting triglyceride concentrations by 20% to 50% by reducing hepatic triglyceride production and increasing triglyceride clearance.Long-term use may increase HDL levels.The other choices do not depict the decrease in triglyceride concentrations that can be expected with the use of omega-3 polyunsaturated fatty acids found in cold water fish oils.

Question 16

Which antihypertensive agent is associated with a nonproductive cough?

Accepted Answer

ACEIs produce nonproductive cough because of their ability to raise the levels of bradykinin.It occurs because blood levels of bradykinin rise when ACEIs block ACE,the enzyme that normally destroys bradykinin.Angiotensin receptor blockers (ARBs)do not alter the levels of bradykinin.

Question 17

a-Methyldopa (Aldomet)and clonidine (Catapres [TTS])act in the central nervous system (CNS)as

Accepted Answer

a-Methyldopa and clonidine act in the CNS as a-adrenergic agonists.Alpha-adrenergic blocking agents include doxazosin,prazosin,and terazosin.Beta-adrenergic blocking agents include atenolol,betaxolol,bisoprolol,metoprolol,nadolol,propranolol,and timolol.Beta-blockers with alpha-blocking activity include carvedilol and labetalol.

Question 18

Ivabradine (Corlanor)acts by inhibiting an ion channel in the

Accepted Answer

Ivabradine works by inhibiting the If ion channel in the sinoatrial note.Blocking this channel reduces cardiac pacemaker activity and slows the heart rate.Ivabradine does not block an ion channel in the bundle of His,Purkinje fibers,or right or left atrium of the heart.

Question 19

Which of the following drugs is a direct inhibitor of thrombin?

Accepted Answer

Dabigatran (Pradaxa)is a direct thrombin inhibitor.Thrombin enables the conversion of fibrinogen to fibrin during the coagulation cascade,which results in the formation of the clot or thrombus.This drug directly prevents the clot from forming.Rivaroxaban (Xarelto)prevents coagulation by selectively blocking the active site of factor XA and does not require a cofactor (Antithrombin III)for activity.Clopidogrel (Plavix)is an inhibitor of adenosine diphosphate (ADP)-induced platelet aggregation,which results in prolonged bleeding time.Ticlopidine (Ticlid)is an irreversible inhibitor of ADP-induced platelet aggregation,which results in prolonged bleeding time.Alteplase (Activase)is a thrombolytic drug that promotes the conversion of plasminogen to plasmin,the natural clot-resolving enzyme.

Question 20

Of the vitamin K-dependent clotting factors,which has the shortest circulating half-life?

Accepted Answer

Clotting factor VII has a half-life of 6 hours.Endogenous clotting factors II,IX,and X have half-lives that are 60,24,and 40 hours,respectively.Factor VIII has a half-life of 10 to 12 hours.It is not a vitamin K-dependent clotting factor.

Quiz 12: Drugs for the Treatment of Cardiovascular Disease

Some studies have found that the presence of periodontal disease predicts an increase in morbidity and mortality resulting from cardiovascular disease.Other studies have failed to show a relationship.

There is a danger of _____ if the dose of anticoagulant is too small.

Each of the following agents inhibits platelet function except one.Which is the exception?

Which agent is contraindicated in pregnant women due to the risk of teratogenicity?

Each of the following is true for management of the dental patient taking warfarin except one.Which is the exception?

The presence of _____ in the oral cavity can be a sign of an adverse effect associated with the oral anticoagulants.

GoNitro is administered to the patient as a

Blood returning from the peripheral circulation enters the

Which is the treatment of choice for the treatment of heart failure (HF) ?

The percentage of Americans diagnosed with hypertension is which percentage according to the new recommendations of the American Heart Association (AHA) ?

The therapeutic target international normalized ratio (INR) for most indications,such as thrombophlebitis,is

A patient taking warfarin (Coumadin) may experience interactions with which of the following?

Which of the following agents has the most serious drug interaction with warfarin?

Based on the most recent recommendations of the American Heart Association (AHA) ,the percentage of American diagnosed with hypertension will

Long chain omega-3 polyunsaturated fatty acids can decrease fasting triglyceride concentrations by

Which antihypertensive agent is associated with a nonproductive cough?

a-Methyldopa (Aldomet) and clonidine (Catapres [TTS]) act in the central nervous system (CNS) as

Ivabradine (Corlanor) acts by inhibiting an ion channel in the

Which of the following drugs is a direct inhibitor of thrombin?

Of the vitamin K-dependent clotting factors,which has the shortest circulating half-life?