Applied Pharmacology For The Dental Hygienist 7th Edition By Elena – Test Bank

Chapter 11: Antianxiety Agents
Haveles: Applied Pharmacology for the Dental Hygienist, 7th Edition

MULTIPLE CHOICE

1. Antianxiety agents are most commonly orally administered because the effective dose of a particular antianxiety agent is very predictable.
a. Both parts of the statement are true.
b. Both parts of the statement are false.
c. The first part of the statement is true; the second part is false.
d. The first part of the statement is false; the second part is true.

ANS: C
Correct: Orally administered drugs are most commonly used than intravenous agents to provide relaxation for the anxious patient. However, the dose of a particular antianxiety agent effective for a particular patient is quite variable, involving both intrapatient and interpatient variation.
Incorrect choices: Intravenous (IV) administration is used infrequently because it requires more training and experience that most general dentists possess. Most states require a separate certificate to administer IV agents or to provide conscious sedation, and the malpractice insurance is much more expensive. Although orally administered sedatives provide inconsistent or poorly predictable results, practitioners should become familiar with one or two drugs and use them repeatedly.

REF: Introduction | pp. 123-124 OBJ: 1

2. Which of the following agents are the most commonly prescribed antianxiety drugs?
a. Nonbenzodiazepine-nonbarbiturate sedative-hypnotics
b. Nonbenzodiazepine-nonbarbiturate receptor agonists
c. Benzodiazepines
d. Barbiturates

ANS: C
Correct: The benzodiazepines are the most commonly prescribed antianxiety drugs. The members of this group differ mainly in their onset and duration of action, dose, and dose forms available.
Incorrect choices: Nonbenzodiazepine-nonbarbiturate sedative-hypnotics are being used much less often, especially since chloral hydrate is no longer available in the United States. Buspirone is currently the only member of this anxiolytic group. Nonbenzodiazepine-
benzodiazepine receptor agonists are used to treat insomnia rather than anxiety. Because benzodiazepines have a much more acceptable safety profile, they have almost completely replaced barbiturates in clinical use for treating anxiety and insomnia.

REF: Benzodiazepines | p. 124 OBJ: 2

3. Which benzodiazepine would be most suitable for intramuscular (IM) administration?
a. Midazolam
b. Diazepam
c. Alprazolam
d. Flurazepam

ANS: A
Correct: Midazolam is the only benzodiazepine for intramuscular administration.
Incorrect choices: For benzodiazepines other than midazolam, the intramuscular (IM) route gives slow, erratic, and unpredictable results. In contrast, the IV route, for those available in parenteral form, produces a rapid, predictable response.

REF: Benzodiazepines (Pharmacokinetics) | p. 124 OBJ: 2

4. Which benzodiazepine is preferred for use in elderly patients?
a. Benzodiazepines that require phase I metabolism and not phase II metabolism
b. Benzodiazepines that require phase II metabolism and not phase I metabolism
c. Benzodiazepines that require both phase I and phase II metabolism
d. Benzodiazepines that require neither phase I nor phase II metabolism

ANS: B
Correct: Phase II drug metabolism (conjugation) is less affected by age than phase I drug metabolism. Some benzodiazepines, such as lorazepam, oxazepam, and temazepam, do not require phase I metabolism to become inactivated in the body. Caution should still be used when prescribing these drugs for elderly persons.
Incorrect choices: Phase I metabolism is decreased in the elderly, in patients taking certain drugs that inhibit hepatic metabolism, and in the presence of hepatic disease. All benzodiazepines must be metabolized by either phase II metabolism or phase I followed by phase II metabolism.

REF: Benzodiazepines (Pharmacokinetics) | p. 124 OBJ: 2

5. Some benzodiazepines are transformed in the body to active metabolites. The active metabolites are formed by phase II drug metabolism.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.

ANS: C
Correct: Phase I drug metabolism transforms some benzodiazepines to active metabolites.
Incorrect choices: Phase I rather than phase II metabolism results in active metabolites that can accumulate with repeated administration.

REF: Benzodiazepines (Pharmacokinetics) | p. 124 OBJ: 2

6. Benzodiazepines enhance or facilitate the action of the neurotransmitter:
a. acetylcholine.
b. epinephrine.
c. -aminobutyric acid (GABA).
d. serotonin.

ANS: C
Correct: Benzodiazepines enhance or facilitate the action of the neurotransmitter GABA, a major inhibitory transmitter in the central nervous system (CNS). It acts in the limbic, thalamic, cortical, and hypothalamic levels of the CNS. Benzodiazepines act as agonists at the benzodiazepine receptor site, and reduce the symptoms of anxiety.
Incorrect choices: Benzodiazepines do not enhance the function of the remaining listed neurotransmitters. Acetylcholine has been identified as the principal neurotransmitter of the parasympathetic autonomic nervous system. Norepinephrine and epinephrine are the major neurotransmitters of the sympathetic autonomic nervous system. Serotonin is a neurotransmitter that is thought to be involved with sleep cycles.

REF: Benzodiazepines (Mechanism of Action) | p. 125 OBJ: 2

7. The clinical effects of benzodiazepines in humans are _____ at lower doses.
a. drowsiness and sleep
b. drowsiness and anxiety reduction
c. anxiety reduction and panic reduction
d. anxiety reduction and sleep

ANS: C
Correct: The clinical effects of benzodiazepines in humans are anxiety and panic reduction at lower doses. Repeated doses of benzodiazepines reduce rapid-eye-movement sleep. Usual doses produce a marked reduction in stages 3 and 4 sleep (deep sleep), which, after long-term use, can interfere with restorative sleep.
Incorrect choices: Benzodiazepines produce drowsiness and sleep at higher doses.

REF: Benzodiazepines (Behavioral Effects) | p. 125 OBJ: 2

8. Benzodiazepines are indicated for epilepsy because they:
a. reduce the electrical activity in the seizure focus.
b. limit the spread of abnormal activity to other parts of the brain.
c. produce analgesia so the patient does not feel any pain.
d. reduce hallucinations.

ANS: B
Correct: The benzodiazepines prevent the spread of abnormal electrical activity to tissues surrounding the anatomic seizure focus (when such a focus exists).
Incorrect choices: Benzodiazepines have little effect on the discharges at the seizure focus itself. They have antiseizure activity by increasing the seizure threshold. They are not administered to produce analgesia or to reduce hallucinations.

REF: Benzodiazepines (Antiseizure Effects) | p. 125 OBJ: 2

9. When benzodiazepines are used in dentistry to produce conscious sedation, the appearance of __________ is used as an initial endpoint for the dose administered.
a. flushed skin
b. miosis
c. ptosis
d. rapid eye movement

ANS: C
Correct: The appearance of ptosis is used as an initial endpoint for the dose administered. Ptosis is drooping of the upper eyelid. When benzodiazepines are used in dentistry to produce conscious sedation, this side effect of CNS depression is used as the primary effect. The amount of the benzodiazepine used to provide conscious sedation is titrated to the patient’s response.
Incorrect choices: The remaining choices do not represent an initial endpoint for the dose administered. Repeated doses of benzodiazepines reduce rapid eye movement (REM) sleep.

REF: Benzodiazepines (Central Nervous System Effects) | p. 126
OBJ: 2

10. Which of the following parenteral benzodiazepines seems to have the greatest likelihood to produce amnesia?
a. Diazepam (Valium)
b. Midazolam (Versed)
c. Triazolam (Halcion)
d. Eszopiclone (Lunesta)

ANS: C
Correct: Oral triazolam seems to have a greater likelihood to produce amnesia than other oral benzodiazepines. Clinical use has produced episodes of amnesia that can sometimes last several hours. These episodes may occur with several of the benzodiazepines. Patients should be warned not to sign important papers or make important decisions after benzodiazepines are administered.
Incorrect choices: Parenteral benzodiazepines, such as diazepam and midazolam, produce amnesia beginning when the drug is taken; however, these choices are not the benzodiazepine that seems to have the greatest likelihood to produce amnesia. Eszopiclone is not a benzodiazepine, it is a nonbenzodiazepine-benzodiazepine receptor agonist and is used to produce sleep.

REF: Benzodiazepines (Anterograde Amnesia) | p. 126 OBJ: 2