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TEST BANK For Applied Pharmacology for the
Dental Hygienist 9th Edition
by Elena Bablenis Haveles, Chapters 1 - 26
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Chapter 01: Information Sources, Regulatory Agencies, Drug Legislation, and Prescription
Writing
Haveles: Applied Pharmacology for the Dental Hygienist, 9th Edition
MULTIPLE CHOICE
1. Knowledge of pharmacology aids the dental professional in
a. obtaining a patient’s health history.
b. administering drugs in the office.
c. handling emergency situations.
d. selection of a nonprescription medication.
e. All of the above.
ANSWER: E
All of the choices are true. Because many of our patients are being treated with drugs, knowledge of
pharmacology helps in understanding and interpreting patients’ responses to health history questions.
Knowledge of the therapeutic and adverse effects of medications obviously helps in their proper
administration in the office. Emergency situations may be caused by drugs or treated by drugs; thus,
knowledge of pharmacology is of great help, especially because a rapid response is sometimes
required. A clear understanding of the concepts of drug action, drug handling by the body, and drug
interactions will allow the dental practitioner to make proper judgments and grasp the concepts
relevant to new drug therapies on the market.
DIF: Application
REF: Role of the Dental Hygienist (Medication/Health History), Role of the Dental Hygienist (Medication
Administration), Role of the Dental Hygienist (Emergency Situations), Role of the Dental Hygienist
(Nonprescription Medication) | pp. 2-3
OBJ:
1
TOP: NBDHE, 6.0. Pharmacology
2. Which of the following statements is true regarding planning appointments?
a. Whether or not patients are taking medication for systemic diseases is of little
consequence in the dental office.
b. Asthmatic patients should have dental appointments in the morning.
c. Diabetic patients usually have fewer problems with a morning appointment
compared with afternoon appointments.
d. Both B and C are true.
ANSWER: D
Asthmatic patients who experience dental anxiety should schedule their appointments when they are
not rushed or under pressure early in the morning. Diabetic patients usually have relatively fewer
problems with a morning appointment. Patients taking medication for systemic diseases may require
special handling in the dental office.
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DIF: Comprehension
REF: Role of the Dental Hygienist (Appointment Scheduling) | p. 3
OBJ: 1
TOP: NBDHE, 6.0. Pharmacology
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3. Nutritional or herbal supplements
a. carry the U.S. Food and Drug Administration (FDA) approval for disease states.
b. are not drugs.
c. can cause adverse effects.
d. will not interact with other drugs the patient may be taking.
ANSWER: C
Nutritional or herbal supplements are quite capable of causing adverse effects. The majority of
nutritional or herbal supplements do not carry FDA approval for treating disease states. These
supplements are drugs and can cause adverse effects and interact with different drugs.
DIF: Comprehension
REF: Role of the Dental Hygienist (Nutritional or Herbal Supplements) | p. 3
OBJ: 1
TOP: NBDHE, 6.0. Pharmacology
4. Which type of drug name usually begins with a lowercase letter?
a. Brand name
b. Code name
c. Generic name
d. Trade name
ANSWER: C
Before any drug is marketed, it is given a generic name that becomes the “official” name of the drug.
Each drug is assigned only one generic name selected by the U.S. Adopted Name Council, and the
name is not capitalized. The brand name is equivalent to the trade name and is capitalized. Although
the brand name is technically the name of the company marketing the product, this term is often used
interchangeably with the trade name. The code name is the initial term used within a pharmaceutical
company to refer to a drug while it is undergoing investigation and is often a combination of capital
letters and numbers, the letters representing an abbreviation of the company name.
DIF: Comprehension REF: Drug Names | p. 4 OBJ: 3
NBDHE, 6.0. Pharmacology
TOP:
5. A drug’s generic name is selected by the
a. pharmaceutical company manufacturing it.
b. Food and Drug Administration (FDA).
c. U.S. Adopted Name Council.
d. Federal Patent Office.
ANSWER: C
Each drug is assigned only one generic name (e.g., ibuprofen). It is selected by the U.S. Adopted
Name Council. The generic name is not selected by the FDA or the Federal Patent Office. The
pharmaceutical company manufacturing the drug clearly has an influence on the generic name given
its drug, but the final decision is not the company’s.
DIF: Recall
REF: Drug Names | p. 4
TOP: NBDHE, 6.0. Pharmacology
OBJ: 3
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6. Which of the following is true concerning generic and trade names of drugs?
a. A drug may only have one generic name and one trade name.
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b. A drug may only have one generic name, but it may have several trade names.
c. A drug may have several generic names, but it may only have one trade name.
d. A drug may have several generic names and several trade names.
ANSWER: B
Each drug has only one generic name but may have several trade names. For each drug, there is only
one generic name. It is not capitalized, and it becomes the “official” name of the drug. The
pharmaceutical company discovering the drug gives the drug a trade name. The trade name is
protected by the Federal Patent Law for 20 years from the earliest claimed filing date, plus patent
term extensions. Although the brand name is technically the name of the company marketing the
product, it is often used interchangeably with the trade name.
DIF: Comprehension REF: Drug Names | p. 4 OBJ: 3
NBDHE, 6.0. Pharmacology
TOP:
7. Two drugs that are found to be chemically equivalent, but not biologically equivalent or
therapeutically equivalent are said to differ in
a. potency.
b. efficacy.
c. bioavailability.
d. therapeutic index.
ANSWER: C
A preparation can be chemically equivalent yet not biologically or therapeutically equivalent. These
products are said to differ in their bioavailability. The potency of a drug is a function of the amount of
drug required to produce an effect. The efficacy is the maximum intensity of effect or response that
can be produced by a drug. The therapeutic index is the ratio of the lethal dose for 50% of the
experimental animals divided by the effective dose for 50% of the experimental animals. If the value
of the therapeutic index is small, toxicity is more likely.
DIF: Recall
OBJ: 4
REF: Drug Names (Drug Substitution) | p. 5
TOP: NBDHE, 6.0. Pharmacology
8. How many years must pass after a drug patent expires before other drug companies can market
the same compound as a generic drug?
a. 20 years
b. 17 years
c. 7 years
d. 0 years
ANSWER: D
Once a drug patent expires, competing companies may immediately market the same compound in
generic form. The pharmaceutical company discovering the drug gives the drug a trade name. The
trade name is protected by the Federal Patent Law for 20 years from the earliest claimed filing
date, plus the patent term extensions.
DIF: Application
OBJ: 4
REF: Drug Names (Drug Substitution) | p. 5
TOP: NBDHE, 6.0. Pharmacology
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9. Two drug formulations that produce similar concentrations in the blood and tissues after drug
administration are termed
a. chemically
b. biologically
c. therapeutically
equivalent.
ANSWER: B
Biologic equivalence refers to identical pharmacokinetic parameters of two drug formulations
(bioequivalence, for short). Chemical equivalence indicates that two formulations of a drug meet the
chemical and physical standards established by the regulatory agencies. Therapeutic equivalence
means that two formulations produce the same therapeutic effects over the same duration.
DIF: Application
OBJ: 4
REF: Drug Names (Drug Substitution) | p. 5
TOP: NBDHE, 6.0. Pharmacology
10. The federal body that determines whether a drug is considered a controlled substance and to which
schedule it belongs is the
a. Food and Drug Administration (FDA).
b. Federal Trade Commission (FTC).
c. Drug Enforcement Administration (DEA).
d. U.S. Pharmacopeia (USP).
ANSWER: C
The DEA regulates the manufacture and distribution of substances with abuse potential. Hence
prescriber DEA numbers must appear on prescriptions for controlled substances. The FDA does not
have any special powers in regard to drugs of abuse. The FTC regulates commerce and advertising
claims of foods, over-the-counter (OTC) products, and cosmetics. The USP regulates the uniformity
and purity of drugs.
DIF: Comprehension
REF: Federal Regulations and Regulatory Agencies (US Drug Enforcement Administration) | p. 5
OBJ: 5
TOP: NBDHE, 6.0. Pharmacology
11. Which federal regulatory agency decides which drugs require a prescription and which drugs may be
sold over-the-counter (OTC)?
a. FDA
b. OSHA
c. FTC
d. DEA
ANSWER: A
The Food and Drug Administration (FDA) is part of Department of Human and Health Services (DHHS),
and determines what drugs may be sold by prescription and OTC and regulates the labeling and
advertising of prescription drugs. The Occupational Safety and Health Administration (OSHA) ensures
the safety and health of workers in the United States by setting and enforcing standards. The Federal
Trade Commission (FTC) regulates the trade practices of drug companies and prohibits the false
advertising of foods, nonprescription (OTC) drugs, and cosmetics. The Drug Enforcement Administration
(DEA) is a part of the Department of Justice and regulates the manufacture and
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distribution of substances that have a potential for abuse, including opioids, stimulants, and sedatives.
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DIF: Recall
REF: Federal Regulations and Regulatory Agencies (US Food and Drug Administration) | p. 5
OBJ: 5
TOP: NBDHE, 6.0. Pharmacology
12. Which federal regulatory body regulates the trade practices of drug companies and prohibits
false advertising of foods, nonprescription drugs, and cosmetics?
a. FDA
b. FTC
c. DEA
d. OBRA
ANSWER: B
Consumers who refer to care labels on their clothes, product warranties, or stickers showing the energy
costs of home appliances are using information required by the FTC. Businesses must be familiar with
the laws requiring truthful advertising and prohibiting price fixing. These laws are also administered
by the FTC. When the FTC was created in 1914, its purpose was to prevent unfair methods of
competition in commerce. Over the years, the U.S. Congress has passed additional laws giving the
agency greater authority to police anticompetitive practices. The FDA grants approval so that drugs
can be marketed in the United States. Before the FDA can approve a drug, the drug must be
determined to be both safe and effective. The DEA regulates the manufacture and distribution of
substances that have a potential for abuse. OBRA (Omnibus Budget Reconciliation Act) is not a
regulatory body; it is an act that mandates that pharmacists must provide patient counseling.
DIF: Recall
REF: Federal Regulations and Regulatory Agencies (Federal Trade Commission) | p. 5
OBJ: 5
TOP: NBDHE, 6.0. Pharmacology
13. An investigational new drug application (INDA) is submitted
a. before preclinical trials
b. before phase 1 clinical trials
c. after phase 2 clinical trials
d. before phase 3 clinical trials
.
ANSWER: B
Preclinical testing usually lasts about 3 years. After the preclinical trials have been completed, an
INDA must be filed with the FDA before a drug company can commence phase 1 clinical trials. Animal
testing data must be accumulated from preclinical trials before filing an INDA. Phase 1 is the first trial
using patients, and phases 2 and 3 follow phase 1. An INDA must be filed before any testing in
humans can commence.
DIF: Recall
OBJ: 6
ANSWE
REF: Clinical Evaluation of a New Drug | p. 5
TOP: NBDHE, 6.0. Pharmacology
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14. Phase 1 clinical trials involve all of the following except which one?
a. Safe dose range
b. Toxic effects of the drug
c. Metabolism
d. Effectiveness
ANSWE
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In phase 1 clinical trials, small and then increasing doses are administered to a limited number of
healthy human volunteers, primarily to determine safety. This phase determines the biologic effects,
metabolism, safe dose range in humans, and toxic effects of the drug. The main purpose of phase 2 is
to test effectiveness. Biologic effects, metabolism, safe dose range in humans, and toxic effects of the
drug are, in fact, goals of phase 1 clinical trials.
DIF: Comprehension REF: Clinical Evaluation of a New Drug | p. 5 OBJ: 6
NBDHE, 6.0. Pharmacology
TOP:
15. Which of the following is determined during a phase 3 clinical evaluation of a new drug?
a. Effectiveness
b. Safety and efficacy
c. Dosage
d. Both A and B
e. Both B and C
ANSWER: E
Both safety and efficacy must be demonstrated during phase 3 of the clinical evaluation of a new drug.
Dosage is also determined during this phase. During phase 3, clinical evaluation takes place involving
a large number of patients who have the condition for which the drug is indicated. The main purpose
of phase 2 clinical evaluation is to test a drug’s effectiveness.
DIF: Recall
OBJ: 6
REF: Clinical Evaluation of a New Drug | p. 6
TOP: NBDHE, 6.0. Pharmacology
16. Which of the following is a Schedule II controlled substance?
a. Heroin
b. Propranolol
c. Amphetamine
d. Dextropropoxyphene (Darvon)
ANSWER: C
Amphetamine, oxycodone, morphine, and secobarbital are all schedule II controlled substances. Heroin
is a schedule I substance. Propranolol is a nonscheduled prescription drug.
Dextropropoxyphene is a schedule IV substance.
DIF: Recall
REF: Drug Legislation (Scheduled Drugs [Table 1.2: Schedules of Controlled Substances]) | p. 6
OBJ: 6
TOP: NBDHE, 6.0. Pharmacology
17. Controlled substances in schedule
and do not permit refills.
ANSWE
require a written prescription with the provider’s signature
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a.
b.
c.
d.
e.
II, III, and IV
II and III
III and IV
II only
III only
ANSWE
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Controlled substances in schedule II require a written prescription with the provider’s signature and do
not permit refills. Any prescription for schedule II drugs must be written in pen or indelible ink or typed.
A designee of the dentist, such as the dental hygienist, may write the prescription, but the prescriber
must personally sign the prescription in ink and is responsible for what any designee has written.
Prescriptions for controlled substances in both schedule III and schedule IV may be telephoned, and no
more than five prescriptions in 6 months are permitted.
DIF: Comprehension REF: Drug Legislation (Scheduled Drugs) | p. 6 OBJ: 7
NBDHE, 6.0. Pharmacology
TOP:
18. Schedule III controlled substances may be telephoned to the pharmacist and may be refilled no more
than five times in 6 months.
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.
ANSWER: A
Both parts of the statement are true. Schedule III controlled substances may be telephoned to the
pharmacist and may be refilled as many as five times in 6 months. Both parts of the statement are true
for schedule III and schedule IV controlled substances. Schedule I controlled substances have no
accepted medical use. Schedule II controlled substances require a written prescription with the
provider’s signature, and no refills are permitted. Schedule V controlled substances can be bought
OTC in some states.
DIF: Recall
OBJ: 7
REF: Drug Legislation (Scheduled Drugs) | p. 6
TOP: NBDHE, 6.0. Pharmacology
19. What is the purpose of a “black box warning” on a package insert?
a. It is used to reconstruct the events leading to a fatality resulting from a medication
error.
b. It is issued by the Drug Enforcement Administration (DEA) to indicate
medications that may be used to manufacture illicit drugs such as
methamphetamine.
c. It is used to draw attention to potentially fatal, life threatening, or disabling
adverse effects for different medications.
d. It means that the effects of the drug have not yet been determined.
ANSWER: C
A black box warning is about a drug the FDA has required a manufacturer to prominently display in a
box in the package insert. The intent of the black box is to draw attention to the specific warning and
make sure that both the prescriber and patient understand the serious safety concerns associated with
that drug. A black box on an airplane is used to reconstruct events prior to a tragedy; however, the
black box warning on a medication package insert is used to warn about safety concerns with the drug.
A black box is not used as a warning about illicit use of medications. All drugs must go through
preclinical and clinical trials prior to being marketed.
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DIF: Recall
OBJ: 7
REF: Drug Legislation (Black Box Warning) | pp. 6-7
TOP: NBDHE, 6.0. Pharmacology
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20. An “orphan drug” is
a. not related to any other medication currently available.
b. developed specifically to treat a rare medical condition.
c. a drug that has been on the market for longer than 20 years and generic
substitution is permitted.
d. no longer available for use as newer, more effective medications are available.
ANSWER: B
Rare medical conditions with orphan status refer to diseases that occur in fewer than 200,000 people in
the United States. Orphan drugs may be related to other medications. Orphan drug status is not
related to the time the drug has been available. Many newer drugs have been assigned orphan status.
DIF: Recall
OBJ: 7
REF: Drug Legislation (Orphan Drugs) | p. 7
TOP: NBDHE, 6.0. Pharmacology
21. The word stat on a prescription means
a. before meals.
b. at bedtime.
c. immediately.
d. every.
ANSWER: C
The word stat on a prescription means immediately (now). The abbreviation ac means before meals, hs
means at bedtime, and q means every.
DIF: Recall
OBJ: 7
REF: Table 1.3: Abbreviations Commonly Used in Prescriptions | p. 8
TOP: NBDHE, 6.0. Pharmacology
22. The abbreviation used on prescriptions for four times a day is
a. bid.
b. qid.
c. qd.
d. ud.
ANSWER: B
qid is the abbreviation for quarter in die, or four times a day. bid stands for twice a day, qd stands for
every day, and ud stands for as directed.
DIF: Recall
REF: Prescription Writing (Prescription Label Regulations [Table 1.3: Abbreviations Commonly Used in
Prescriptions]) | pp. 8-9
OBJ:
7
TOP:
NBDHE, 6.0. Pharmacology
23. The heading of a prescription contains the following information except the
ANSWE
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a.
b.
c.
d.
e.
name and address of the prescriber.
name and address of the patient.
telephone numbers of the patient and the prescriber.
date of birth of the prescriber.
date of the prescription.
ANSWE
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Including the date of birth of the patient on the prescription is important, both to determine the proper
dose for age and also the patient is not confused with another family member (i.e., mother or
daughter). The heading of a prescription contains the name, address, and telephone number of the
prescriber, as well as the name, address, age, and telephone number of the patient, and the date of
the prescription.
DIF: Comprehension REF: Prescription Writing (Prescriptions [Format]) | p. 7 OBJ: 7
NBDHE, 6.0. Pharmacology
TOP:
24. Which of the following is located in the body of the prescription?
a. The date of the prescription
b. The amount of the drug to be dispensed
c. Directions to the prescriber
d. Refill instructions
ANSWER: B
The Rx symbol, name and dose size or concentration of the drug, amount to be dispensed, and
directions to the patient are all found in the body of the prescription. The date of the prescription is
found in the heading. The directions to the patient rather than prescriber are found in the body of the
prescription. Refill instructions are found in the closing of the prescription.
DIF: Recall
OBJ: 7
REF: Prescription Writing (Prescriptions [Format]) | p. 8
TOP: NBDHE, 6.0. Pharmacology
25. Where is the information regarding the prescriber DEA number commonly found on the prescription?
a. Superscription
b. Heading
c. Body
d. Closing
ANSWER: D
The signature area of the prescription is found in the closing. It should also include a space for the DEA
number. The superscription is a classical description for where the patient information and the symbol
Rx are found. The heading contains prescriber and patient contact information, the patient’s date of
birth, and the date of prescription. The body contains the Rx symbol, dosage instructions, and directions
to the patient.
DIF: Recall
OBJ: 7
ANSWE
REF: Prescription Writing (Prescriptions [Format]) | p. 8
TOP: NBDHE, 6.0. Pharmacology
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26. On a prescription, the directions to the patient are preceded by
a. Rx.
b. Sig.
c. #.
d. Disp.
ANSWE
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Sig. is the abbreviation for the Latin word signa, or write. This word precedes the instructions to the
patient. Rx means take thou and precedes the prescription instructions, # denotes the number of tablets,
capsules, and so forth to be dispensed. Disp. is short for dispense and precedes the amount to be
dispensed, analogous to #.
DIF: Recall
OBJ: 7
REF: Prescription Writing (Prescriptions [Format]) | p. 8
TOP: NBDHE, 6.0. Pharmacology
27. Each is an advantage of electronic and fax prescribing except one. Which is the exception?
a. It reduces the likelihood of errors in reading handwritten prescriptions.
b. It reduces the patient’s ability to tamper with a prescription.
c. There is no record of the prescription in the patient’s record.
d. Prescriptions can be faxed to the pharmacy.
ANSWER: C
A written record of the prescription is kept in the patient’s record. Electronic prescribing is the
electronic transmission of a prescription to a pharmacy, which reduces the incidence of errors in
reading handwritten prescriptions and the patient’s ability to tamper with a prescription. Prescriptions
can be faxed to the pharmacy.
DIF: Comprehension
REF: Prescription Writing (Prescriptions [Electronic and Fax Prescribing]) | p. 9
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
28. Which drug legislation act was instrumental for the growth of electronic prescribing?
a. Controlled Substance Act
b. Medicare Modernization Act
c. Food, Drug and Cosmetic Act
d. Harrison Narcotic Act
ANSWER: B
The inclusion of e-prescribing in the Medicare Modernization Act of 2003 (MMA) gave momentum to its
use in provider practices across the country. The MMA expanded Medicare to include a drug benefit
program (Medicare Part D), which began in 2006. Electronic prescribing of controlled substances as
mandated by the federal SUPPORT Act of 2018 went into effect in January of 2021.
This federal mandate affects Medicare Part D prescription plans. Any prescription for a controlled
substance written for a Medicare Part D patient must be electronically prescribed. Many states have
passed legislation that mandates that any opioid prescription (regardless of insurer) must be
electronically prescribed. This legislation has been passed in an attempt to prevent prescription
diversion and tampering. The Controlled Substance Act of 1970 replaced the Harrison Narcotic Act of
1914, and the Drug Abuse Control Amendments (1965) to the Food, Drug and Cosmetic Act (1938).
DIF: Comprehension
REF: Prescription Writing (Prescriptions [Electronic and Fax Prescribing]) | p. 9
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
29. What would be an advantage for a dentist to call the pharmacy with a prescription for Tylenol #3
rather than hydrocodone for a patient who calls late at night requesting medication for pain following
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root canal therapy?
a. Tylenol #3 is available over-the-counter and does not require a prescription.
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b. Tylenol #3 is a not a controlled substance and hydrocodone is a controlled
substance.
c. A prescription for Tylenol #3 (Schedule III) may be telephoned, whereas
hydrocodone (Schedule II) requires a written prescription.
d. Tylenol #3 has greater potency than hydrocodone.
ANSWER: C
Tylenol #3 has moderate abuse potential and prescriptions may be telephoned. Hydrocodone has high
abuse potential and requires a written prescription with the provider’s signature. Tylenol #3 is a
Schedule III controlled substance. It is not available over-the-counter and requires a prescription.
Hydrocodone has more potency and a higher abuse potential than Tylenol #3.
DIF: Application
REF: Drug Legislation (Scheduled Drugs [Table 1.2: Schedules of Controlled Substances]) | p. 6
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
30. Clinical studies of drugs first involve human volunteers during which phase of drug testing?
a. Phase 1
b. Phase 2
c. Phase 3
d. Phase 4
ANSWER: A
Clinical studies of drugs involve humans’ right from the start of Phase 1 clinical trials. In Phase 1 clinical
trials, small and then increasing doses of the prospective drug are administered to a limited number of
healthy human volunteers, primarily to determine safety. Larger groups of humans are given the drug
in Phase 2 clinical trials, but humans were involved in Phase 1 clinical trials. Phase 3 involves a large
number of patients who have the condition for which the drug is indicated. Phase 4 involves
postmarketing surveillance.
DIF: Recall
OBJ: 6
REF: Clinical Evaluation of a New Drug | p. 5
TOP: NBDHE, 6.0. Pharmacology
MULTIPLE RESPONSE
1. How are computer and online resources enhancing printed books as a source of information about
drugs? (Select all that apply.)
a. Web-based physicians can diagnose patient conditions and prescribe medication
over the Internet.
b. Tablet computers and smart phones may be used for medication information
databases.
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c. Some publishers have apps that can be downloaded to smart phones.
d. Websites such as WebMD have decision trees whereby patients can identify their
own health condition and determine appropriate treatment and medication.
e. Older editions of textbooks have been placed in the public domain and are
useful for information about medications and drug interactions.
ANSWER:
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Tablet computers and smart phones are being used more and more for recording, storing patient
information, calculating drug doses, and using medication information databases. Some online
websites have apps that can be downloaded to smart phones as well as computer-based online sites.
There are many legal issues with health care professionals dispensing advice over the Internet. For
example, a health care provider may not be licensed to practice in the state where the person asking
for information resides. Websites do not provide the means for patients to determine their own health
condition. There are many sites with useful information, but most have a disclaimer recommending that
the person seek help from a qualified practitioner. Medications change rapidly, and it is important to
use current sources of information.
DIF: Comprehension
REF: Sources of Information (Computers and Online Resources) | p. 4
OBJ: 2
TOP: NBDHE, 6.0. Pharmacology
2. Which of the following are true of an off-label use of a drug? (Select all that apply.)
a. Prescribers are allowed to use drugs for off-label use under certain circumstances.
b. The FDA approves the use of drugs for specific indications, which are listed or
labeled on the package insert of the drug.
c. Drug manufacturers have much useful information regarding off-label uses of their
drugs on their websites.
d. Off-label use of drugs is not permitted in the United States.
e. Off-label drugs are repackaged for sale by clandestine organizations outside
the United States and are illegal to transport or distribute.
ANSWER: A, B
Practitioners are allowed to use off-label drugs if good medical practice justifies their use, the use is
well documented in the medical literature, and the drug meets the current standard of medical care.
The FDA approves the use of drugs for specific indications, and they are listed or labeled on the
package insert of the drug. Drug manufacturers are not allowed to bring up off-label uses when
speaking with the prescribing practitioner, nor can they distribute written material regarding off-label
uses. The off-label use of drugs is permitted in the United States provided that several rules are
followed.
DIF: Comprehension
REF: Drug Legislation (Labeled and Off-Label Uses) | p. 7
TOP: NBDHE, 6.0. Pharmacology
OBJ: 7
3. Which of the following are associated with increased patient nonadherence to medication therapy?
(Select all that apply.)
a. Some patients may fear of the side effects of the medication.
ANSWER:
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b. A longer duration of drug therapy is associated with the risk for nonadherence with
medication therapy.
c. Increased dosing frequency is associated with nonadherence with medication
therapy.
d. The issue of nonadherence to medication therapy is not important, as patients
reliably take their medication as prescribed.
ANSWER:
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Many factors are associated with nonadherence to medication therapy. These include poor
understanding of the disease and a need for medication to treat it, fear of side effects of the
medication, distrust of health care professionals, economic factors, or forgetfulness. Longer duration of
drug therapy and the number of times a day the patient must take a prescription increase the chances
that a patient will not adhere to the regimen. For example, patients are more compliant with twice-aday dosing than they are with four-times-a-day dosing. Statistics reveal that only a minority of patients
will take their medication as prescribed.
DIF: Comprehension
REF: Prescription Writing (Role of the Dental Hygienist and Patient Adherence to Medication Therapy) | p. 9
OBJ:
7
TOP:
NBDHE, 6.0. Pharmacology
TRUE/FALSE
1. The body of a prescription includes directions to the patient.
ANSWER: T
The body of the prescription contains the Rx symbol, name, and dose size or concentration of the drug,
amount to be dispensed, and directions to the patient.
DIF: Recall
OBJ: 7
REF: Prescription Writing (Prescriptions [Format]) | p. 8
TOP: NBDHE, 6.0. Pharmacology
2. Refill instructions are found in the body of a prescription.
ANSWER: F
Refill instructions are found in the closing, rather than body, of the prescription.
DIF: Recall
OBJ: 7
REF: Prescription Writing (Prescriptions [Format]) | p. 8
TOP: NBDHE, 6.0. Pharmacology
Chapter 02: Drug Action and Handling
Haveles: Applied Pharmacology for the Dental Hygienist, 9th Edition
MULTIPLE CHOICE
1. A drug is defined as a biologically active substance that can modify
a. the environment.
b. the pH of tissue.
c. cellular function.
d. immune response.
ANSWER: C
A drug can modify cellular function. A general understanding of drug action allows the dental
hygienist to make informed decisions regarding possible drug interactions or adverse reactions for the
patient. It is a concern that discarded drugs may be affecting the environment, but this is not the
definition of a drug. Some drugs may have the capacity to modify body compartment pH; however,
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this is not the definition for a drug. Some drugs may have the capacity to modify the immune response,
but this is not the definition of a drug.
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DIF: Recall
REF: Introduction | p. 11
TOP: NBDHE, 6.0. Pharmacology
OBJ: 1
2. In comparing two drugs, the dose-response curve for the drug that is more efficacious would
a. be closer to the y-axis.
b. be farther from the y-axis.
c. have a greater curve height.
d. have a higher median effective dose (ED50).
ANSWER: C
Efficacy is an expression of maximum intensity of effect or response that can be produced by a drug.
The other choices refer to indicators of drug potency, not efficacy. The potency of a drug is a function
of the amount of drug required to produce an effect. The potency of drug is shown by the location of
that drug’s curve along the log-dose axis (x-axis).
DIF: Comprehension REF: Characterization of Drug Action (Efficacy) | p. 11 OBJ: 1
NBDHE, 6.0. Pharmacology
TOP:
3. Administering a drug of greater potency is better because drugs of greater potency do not require
as high a dose.
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.
ANSWER: D
The first part of the statement is false, the second part is true. The absolute potency of a drug is
immaterial as long as the appropriate dose is administered. If equally efficacious, both drugs will
produce the same effect. Both meperidine and morphine, for example, have the ability to treat severe
pain, but approximately 100 mg of meperidine would be required to produce the same action as 10
mg of morphine. The dose of meperidine needed to produce pain relief is larger than that for
morphine.
Less potent drugs require higher doses to produce therapeutic effects whereas more potent drugs can
reach toxic levels at lower doses.
DIF: Application
OBJ: 1
REF: Characterization of Drug Action (Potency) | p. 11
TOP: NBDHE, 6.0. Pharmacology
4. Which of the following statements is true regarding the therapeutic index (TI) of a drug?
a. A drug with a large TI is more dangerous than a drug with a small TI.
b. The formula for TI is ED50/LD50.
c. ED50 is 50% of the effective clinical dose.
d. TI is the ratio of the median lethal dose to the median effective dose.
ANSWER: D
LD50 is the dose causing death in 50% of test animals and ED50 is the dose required to produce the
desired clinical effect in 50% of test animals. The greater the TI, the safer the drug. The formula is TI
= LD50/ED50. The ED50 is the dose required to produce the desired clinical effect in 50% of test
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animals, not 50% of the effective clinical dose.
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DIF: Comprehension
REF: Characterization of Drug Action (Therapeutic Index) | p. 12
OBJ: 1
TOP: NBDHE, 6.0. Pharmacology
5. Which of the following statements is true concerning the mechanism of action of drugs?
a. Drugs are capable of imparting a new function to the organism.
b. Drugs either produce the same action as an exogenous agent or block the action of
an exogenous agent.
c. Drugs either produce the same action as an exogenous agent or block the action of
an endogenous agent.
d. Drugs either produce the same action as an endogenous agent or block the action
of an endogenous agent.
ANSWER: D
Drugs either produce the same action as an endogenous agent or block the action of an endogenous
agent. Drugs do not impart a new function to the organism; they merely either produce the same action
as an endogenous agent or block the action of an endogenous agent.
DIF: Comprehension REF: Mechanism of Action of Drugs | pp. 12-13 OBJ: 2
NBDHE, 6.0. Pharmacology
TOP:
6. When different drugs compete for the same receptor sites, the drug with the stronger affinity for the
receptor will bind to
a. more receptors than the drug with the weaker affinity.
b. fewer receptors than the drug with the weaker affinity.
c. all of the available receptors.
d. none of the available receptors.
ANSWER: A
When different drugs compete for the same receptor sites, the drug with the stronger affinity for the
receptor will bind to more receptors than the drug with the weaker affinity. More of the drug with
weaker affinity will be required to produce a pharmacologic response. Drugs with a stronger affinity
for receptor sites are more potent than drugs with weaker affinities for the same site.
DIF: Recall
OBJ: 2
REF: Mechanism of Action of Drugs (Receptors) | p. 13
TOP: NBDHE, 6.0. Pharmacology
7. When a drug has affinity for a receptor and produces no effect, it is called a(n)
a. agonist.
b. competitive antagonist.
c. competitive agonist.
d. physiologic agonist.
DIF:
Recall
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ANSWER: B
A competitive antagonist has affinity for a receptor, combines with the receptor, competes with the
agonist for the receptor, and produces no effect. An agonist has affinity for a receptor, combines with
the receptor, and produces an effect. Competitive agonist is nonsensical terminology. A physiologic
antagonist has affinity for a site different from that of the agonist in question.
DIF:
Recall
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REF: Mechanism of Action of Drugs (Receptors [Agonists and Antagonists]) | p. 13
OBJ: 2
TOP: NBDHE, 6.0. Pharmacology
8. A noncompetitive antagonist
a. binds to the same receptor site as the binding site for the agonist.
b. causes a shift to the right in the dose-response curve.
c. enhances the maximal response of the agonist.
d. reduces the maximal response of the agonist.
ANSWER: D
A noncompetitive antagonist reduces the maximal response of the agonist. Noncompetitive antagonists
bind to a receptor site that is different from the binding site for the agonist. A competitive antagonist
will cause a shift to the right in the dose-response curve.
DIF: Recall
REF: Mechanism of Action of Drugs (Receptors [Agonists and Antagonists]) | p. 13
OBJ: 2
TOP: NBDHE, 6.0. Pharmacology
9. Which of the following is not a subject of pharmacokinetics?
a. Physiologic action of drugs
b. Metabolism of drugs
c. Elimination of drugs
d. Absorption of drugs
ANSWER: A
The physiologic action of drugs is a subject of pharmacology, not pharmacokinetics. Pharmacokinetics
does have to do with the subjects of absorption, distribution, metabolism, and excretion of drugs.
DIF: Comprehension REF: Pharmacokinetics | p. 14 OBJ: 3
NBDHE, 6.0. Pharmacology
TOP:
10. Which of the following statements is (are) true concerning passage across body membranes?
a. The membrane lipids make the membrane relatively permeable to ions and polar
b.
c.
d.
e.
molecules.
The lipid molecules orient themselves so that they form a fluid bimolecular leaflet
structure with the hydrophobic ends of the molecules shielded from the surrounding
aqueous environment.
Membrane carbohydrates make up the structural components of the membrane and
help move the molecules across the membrane during the transport process.
Both A and B are true.
Both B and C are true.
ANSWER: B
DIF:
Comprehension
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The lipid molecules orient themselves so that they form a fluid bimolecular leaflet structure with the
hydrophobic ends of the molecules shielded from the surrounding aqueous environment. The
hydrophilic ends are in contact with water. The membrane lipids make the membrane relatively
impermeable to ions and polar molecules. Membrane proteins make up the structural components of
the membrane and help move the molecules across the membrane during the transport process.
DIF:
Comprehension
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REF: Pharmacokinetics (Passage Across Body Membranes) | p. 14
OBJ: 3
TOP: NBDHE, 6.0. Pharmacology
11. Which of the following choices is the process by which a substance is transported against a
concentration gradient?
a. Passive transfer
b. Active transport
c. Facilitated diffusion
d. Filtration
ANSWER: B
Active transport is a mechanism for movement of substances, often against a concentration gradient,
that uses the energy of the cell to actively pump the substance from one side of a membrane to the
other. Passive transfer and filtration entail the passage of substances in a manner proportional to their
concentration on each side of the membrane. The substances move without any assistance. Facilitated
transport uses a carrier protein but cannot transport substances against a gradient.
DIF: Recall
REF: Pharmacokinetics (Passage Across Body Membranes [Specialized Transport]) | p. 14
OBJ: 3
TOP: NBDHE, 6.0. Pharmacology
12. Drugs that are weak electrolytes will cross body membranes best when they are (1) nonionized, (2)
ionized, (3) polar, (4) nonpolar, (5) lipid soluble, (6) water soluble.
a. 1, 3, 5
b. 1, 3, 6
c. 1, 4, 5
d. 1, 4, 6
e. 2, 4, 5
ANSWER: C
Drugs that are weak electrolytes will cross body membranes best when they are nonionized, nonpolar,
and lipid soluble. These drugs dissociate in solution and equilibrate into a nonionized form and an
ionized form. The nonionized, or uncharged, portion acts as a nonpolar, lipid-soluble compound that
readily crosses body membranes. The ionized portion of drugs that are weak electrolytes will traverse
membranes with greater difficulty because they are less lipid soluble.
DIF: Comprehension
REF: Pharmacokinetics (Passage Across Body Membranes [Effect of Ionization]) | p. 15
OBJ: 3
TOP: NBDHE, 6.0. Pharmacology
13. Increasing the pH of a solution will cause
ANSWE
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a.
b.
c.
d.
e.
a greater percentage of a weak base in the solution to be in the ionized form.
a greater percentage of a weak acid in the solution to be in the un-ionized form.
the hydrogen ion concentration to increase.
a greater percentage of a weak base in the solution to be in the un-ionized form.
no change in the relative ionization of weak acids or weak bases.
ANSWE
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Weak bases become ionized at low pH and un-ionized at higher pH. If the pH of the site rises, the
hydrogen ion concentration will fall. For weak bases, this results in the un-ionized form (B), which can
more easily penetrate tissues. Conversely, if the pH of the site falls, the hydrogen ion concentration will
rise. This results in an increase in the ionized form (BH+), which cannot easily penetrate tissues.
DIF: Comprehension
REF: Pharmacokinetics (Passage Across Body Membranes [Effect of Ionization]) | p. 15
OBJ: 4
TOP: NBDHE, 6.0. Pharmacology
14. When the acidity of the tissue increases, as in instances of infection, the effect of a local anesthetic
decreases; therefore, the local anesthetic is a weak acid.
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.
ANSWER: C
The first part of the statement is true, the second part is false. Infections lead to an accumulation of
acidic waste products, which lowers the pH of the local area. Local anesthetics must penetrate the
nerve cell membrane to cause their action. They become more ionized as the pH drops. This property is
a characteristic of weak bases, not weak acids. Local anesthetics are weak bases. Weak bases are
better absorbed when the pH is greater than the pKa. A weak base is associated and ionized when
the pH is less than the pKa.
DIF: Comprehension
REF: Pharmacokinetics (Passage Across Body Membranes [Effect of Ionization]) | p. 15
OBJ: 4
TOP: NBDHE, 6.0. Pharmacology
15. Which of the following is true regarding basic principles of drug distribution in the bloodstream?
a. All drugs in the blood are either bound to plasma proteins or free.
b. Only the drug that is bound to plasma proteins can exert the pharmacologic effect.
c. Only the drug that is bound to plasma proteins can pass across cell membranes.
d. The free drug is a reservoir for the drug.
ANSWER: A
All drugs in the blood are either bound to plasma proteins or free. Only the drug that is free can exert
the pharmacologic effect. Only the free drug can pass across cell membranes. The bound drug is a
reservoir for the drug.
DIF: Comprehension
REF: Pharmacokinetics (Distribution [Basic Principles]) | p. 15
OBJ: 3
TOP: NBDHE, 6.0. Pharmacology
ANSWE
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16. The movement of a drug from one site in the body to other sites is called
a. distribution.
b. disruption.
c. dispersion.
d. active transport.
ANSWE
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Distribution is the movement of a drug from the site of absorption or injection to other sites. Disruption
is the initial destruction of a tablet coating or capsule during oral absorption. Dispersion is the spread
of concentrated drug particles throughout the stomach or intestines. Active transport is a process
involved in the passage of certain agents, including some drugs, across membrane barriers and may
be involved in not only drug redistribution but also drug absorption, distribution, or excretion.
DIF: Comprehension
REF: Pharmacokinetics (Distribution [Basic Principles]) | p. 15
OBJ: 3
TOP: NBDHE, 6.0. Pharmacology
17. The distribution of a drug is determined by
a. blood flow to the organ.
b. presence of certain barriers.
c. plasma protein–binding capacity.
d. solubility of the drug.
e. All of the above.
ANSWER: E
All of the above choices are correct. If the blood circulation to an organ is low, it will receive less drug.
The more membranes and barriers a drug needs to cross, the slower the rate at which it will reach the
organ in question. The binding of drugs to plasma proteins reduces the concentration of drug that can
leave the circulation and be taken up by an organ. The relative level of fat or water solubility of a
drug will influence where and how rapidly a drug will distribute. The distribution of a drug is
determined by several factors, such as the size of the organ, the blood flow to the organ, the solubility
of the drug, the plasma protein–binding capacity, and the presence of certain barriers (e.g., bloodbrain barrier, placenta).
DIF: Recall
OBJ: 3
REF: Pharmacokinetics (Distribution [Basic Principles]) | p. 15
TOP: NBDHE, 6.0. Pharmacology
18. If one dose of a drug is administered and the drug’s half-life in the body is 3 hours, what percentage of
the drug would be left after four half-lives?
a. 50%
b. 6.25%
c. 2%
d. Insufficient information to determine
ANSWER: B
The half-life is the time required for a drug level to fall to one half of its concentration. The drug
concentration would go to 50%
25%
12.5%
6.25% in four half-lives. The information
given is more than sufficient to answer the question. One needs merely to count the number of half-lives
and divide the percentage drug in half for every half-life passed since the drug was administered.
DIF: Application
OBJ: 5
REF: Clinical Pharmacokinetics (Half-Life) | p. 18
TOP: NBDHE, 6.0. Pharmacology
19. One dose of a drug is administered that has a half-life of 8 hours. Assuming first-order kinetics, how
much time is needed for this drug to be over 96% eliminated from the body?
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a. 8 hours
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b. 40 hours
c. 60 hours
d. 120 hours
ANSWER: B
Assuming first-order kinetics, 40 hours would be required for this drug to be over 96% eliminated
from the body. Five half-lives are needed to reduce the levels of a drug to 3.125% of the original
levels, or eliminate over 96%. For a drug with an 8-hour half-life, this amounts to five half-lives
8
hours per half-life, or 40 hours.
DIF: Application
OBJ: 5
REF: Clinical Pharmacokinetics (Kinetics) | p. 18
TOP: NBDHE, 6.0. Pharmacology
20. The half-life of a drug is most related to its
a. onset.
b. duration.
c. safety.
d. time to peak concentration.
ANSWER: B
Half-life is the amount of time required for a drug to fall to one half of its blood level. It is an
expression of how long the drug lasts in the body. Onset is the time at which a drug starts to take
effect. The half-life does not predict the relative safety of a drug; safe drugs can have long or short
half-lives. Time to peak concentration refers to how much time is required for a drug to reach effective
levels in the body, not how long a drug lasts in the body.
DIF: Comprehension REF: Clinical Pharmacokinetics (Half-Life) | p. 18 OBJ: 5
NBDHE, 6.0. Pharmacology
TOP:
21. Enterohepatic circulation of a drug involves the secretion of a metabolized drug into the intestine. If
enterohepatic circulation is blocked, the level of the drug in the serum will fall.
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.
ANSWER: A
Both statements are true. Enterohepatic circulation involves the secretion of a metabolite, such as a
conjugated drug, via the bile into the intestine. While in the intestine, the metabolite is broken down
(deconjugated), and the active drug can be reabsorbed into the circulation. If this process is blocked,
then the reactivated drug cannot reenter the circulation, and the serum level will fall accordingly. Both
of the statements are true as written. The circular pattern continues with some drug escaping with each
passing. This process prolongs the effect of a drug.
DIF: Comprehension
REF: Pharmacokinetics (Distribution [Enterohepatic Circulation]) | p. 16
OBJ: 3
TOP: NBDHE, 6.0. Pharmacology
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22. If redistribution occurs between specific sites and nonspecific sites, a drug’s action will be
a. prolonged.
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b. extended.
c. decreased.
d. terminated.
ANSWER: D
If redistribution occurs between specific sites and nonspecific sites, a drug’s action will be terminated.
Redistribution of a drug is the movement of a drug from the site of action to nonspecific sites of action.
A drug’s duration of action can be affected by redistribution of the drug from one organ to another.
DIF: Recall
OBJ: 4
REF: Pharmacokinetics (Redistribution) | p. 16
TOP: NBDHE, 6.0. Pharmacology
23. The
is the most common site for biotransformation.
a. kidney
b. blood plasma
c. liver
d. small intestine
ANSWER: C
The liver is the most common site for biotransformation. Biotransformation is the body’s way of
changing a drug so that the kidneys can more easily excrete it. The liver rather than kidney, blood
plasma, or small intestine is the most common site for biotransformation.
DIF: Comprehension
REF: Pharmacokinetics (Metabolism (Biotransformation)) | p. 16
OBJ: 3
TOP: NBDHE, 6.0. Pharmacology
24. The metabolite formed during metabolism (biotransformation) is usually
polar and
lipid
soluble than its parent compound.
a. more; more
b. more; less
c. less; more
d. less; less
ANSWER: B
The metabolite is usually more polar and less lipid soluble than its parent compound, meaning that
renal tubular reabsorption of the metabolite will be reduced because reabsorption favors lipid-soluble
compounds. Metabolites are also less likely to bind to plasma or tissue proteins and less likely to be
stored in fat tissue. Drugs must pass through various membranes such as cellular membranes, blood
capillary membranes, and intracellular membranes. The lipid in the membranes makes them relatively
impermeable to ions and polar molecules. Decreased renal tubular absorption, decreased binding to the
plasma or tissue proteins, and decreased fat storage cause the metabolite to be excreted more easily.
DIF: Recall
OBJ: 3
REF: Pharmacokinetics (Metabolism (Biotransformation)) | p. 16
TOP: NBDHE, 6.0. Pharmacology
25. All of the following choices are true with regard to cytochrome P-450 hepatic microsomal enzymes
except that they
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a. can be induced to speed up drug metabolism.
b. can be inhibited to slow down drug metabolism.
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c. exist as numerous isoenzymes.
d. inactivate drugs through conjugation reactions.
ANSWER: D
Cytochrome P-450 hepatic microsomal enzymes inactivate drugs but not through conjugation. They are
involved in phase I metabolism and metabolize drugs through oxidation, reduction, and hydrolysis
reactions. Phase II reactions involve conjugation with glucuronic acid, sulfuric acid, acetic acid, or an
amino acid. Cytochrome P-450 hepatic microsomal enzymes can be induced to speed up drug
metabolism or inhibited to reduce or slow down drug metabolism. They exist as numerous isozymes
that have specificity for certain drugs. Examples of isoenzymes include cytochrome P-450 and 3A4.
DIF: Application
REF: Pharmacokinetics (Metabolism (Biotransformation) [First-Pass Effect]) | p. 16 | Pharmacokinetics
(Metabolism (Biotransformation [Cytochrome P-450 Induction and Inhibition]) | p. 16 OBJ:
4
NBDHE, 6.0. Pharmacology
TOP:
26. Which of the following reactions is considered to be in the category of phase II drug metabolism?
a. Conjugation
b. Reduction
c. Hydrolysis
d. Oxidation
ANSWER: A
Phase II reactions involve conjugation with glucuronic acid, sulfuric acid, acetic acid, or an amino acid.
The most common conjugation occurs with glucuronic acid. Reduction, hydrolysis, and oxidation are all
examples of phase I drug metabolism.
DIF: Recall
REF: Pharmacokinetics (Metabolism (Biotransformation) [First-Pass Effect]) | p. 16
OBJ: 4
TOP: NBDHE, 6.0. Pharmacology
27. If a drug displays zero-order elimination kinetics
a. elimination increases as the dose of the drug is increased.
b. a constant amount is eliminated per unit time.
c. the drug is not eliminated and is retained in the body.
d. the elimination of the drug cannot be predicted mathematically.
ANSWER: B
With zero-order kinetics, the metabolism or excretion mechanisms for a drug in the body are saturated,
meaning that they are at their maximal level. If more drug is given, then the body cannot keep up, and
the drug levels will increase. The body cannot adjust to more drug, and elimination of a drug will
remain the same as the dose of the drug is increased. If the drug is eliminated but a longer time is
required, then it would for a first-order elimination. The elimination of the drug can be mathematically
predicted.
DIF: Comprehension REF: Clinical Pharmacokinetics (Kinetics) | p. 18 OBJ: 5
NBDHE, 6.0. Pharmacology
TOP:
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28. Which of the following processes in the kidney can result in retention of a drug in the body?
a. Glomerular filtration
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b. Active tubular secretion
c. Passive tubular diffusion
d. All of the above
ANSWER: C
Passive tubular diffusion is a process whereby solutes such as drugs, which are concentrated in the
renal tubular fluid, can diffuse out of the tubule and back into the circulation. The drugs must be unionized and lipid soluble to passively diffuse back to the circulation. Glomerular filtration and active
tubular secretion are ways in which drugs and their metabolites enter the renal tubular fluid on their
way to the collecting duct and the urine.
DIF: Application
OBJ: 3
REF: Pharmacokinetics (Metabolism (Biotransformation) [Excretion]) | p. 17
TOP: NBDHE, 6.0. Pharmacology
29. Which is true regarding excretion when tubular urine is more alkaline?
a. Both weak acids and weak bases are excreted more rapidly.
b. Weak acids are excreted more rapidly, and weak bases are excreted more slowly.
c. Weak acids are excreted more slowly, and weak bases are excreted more rapidly.
d. Both weak acids and weak bases are excreted more slowly.
ANSWER: B
The process of passive tubular diffusion favors the reabsorption of nonionized, lipid-soluble
compounds. The more ionized, less lipid-soluble metabolites have more difficulty penetrating the cell
membranes of the renal tubules and are likely to be retained in the tubular fluid and eliminated in the
urine. When tubular urine is more alkaline, weak acids are excreted more rapidly and weak bases are
excreted more slowly. When the tubular urinary pH is more acid than the plasma, weak acids are
excreted more rapidly and weak bases are excreted more slowly.
DIF: Recall
OBJ: 3
REF: Pharmacokinetics (Metabolism (Biotransformation) [Excretion]) | p. 17
TOP: NBDHE, 6.0. Pharmacology
30. Which term refers to the time required for a drug to begin to have its effect?
a. First pass
b. Duration
c. Onset
d. Efficacy
ANSWER: C
Onset is the time at which a drug starts to take effect. First pass refers to the metabolism of drugs by
the liver during their movement from the gastrointestinal tract to the systemic circulation via the portal
circulation. Duration is the amount of time the drug is active in the body. Efficacy is an assessment of
the effectiveness of a drug and does not refer to how quickly or how long a drug acts in the body.
DIF: Recall
REF: Routes of Administration and Dose Forms (Routes of Administration) | p. 19
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
31. An enteral route of administration would be
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a. intravenous.
b. oral.
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c. sublingual.
d. transdermal.
ANSWER: B
Enteral means situated or occurring inside of the gastrointestinal tract (intestines). Intravenous,
sublingual, and transdermal routes of administration bypass the gastrointestinal tract.
DIF: Recall
REF: Routes of Administration and Dose Forms (Routes of Administration) | p. 19
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
32. What of the following choices is considered the safest, least expensive, and most convenient route for
administering drugs?
a. Inhalation
b. Rectal
c. Oral
d. Subcutaneous
ANSWER: C
Oral administration requires no sophisticated devices, is slow enough in onset to gauge reactions and
stop the next dose, and is easy for a patient to administer without assistance. Inhalation and
subcutaneous administration require devices, such as inhalers and needles, and the drug is irretrievable
once administered. Rectal dosing has lower patient acceptance, and absorption can be variable.
DIF: Recall
REF: Routes of Administration and Dose Forms (Routes of Administration) | p. 19
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
33. Advantages of oral administration of a drug include all the following except
a. large surface area for drug absorption.
b. many different dose forms that may be administered orally.
c. more predictable response than intravenous administration.
d. the simplest way to introduce a drug into the body.
ANSWER: C
Intravenous administration offers a more predictable response than the oral route because the drug is
injected directly into the bloodstream, bypassing many physiologic barriers, the hostile environment of
the gastrointestinal tract, and drug-metabolizing enzymes that are encountered during oral absorption
of a drug. Others are all characteristics of oral administration.
DIF: Comprehension
REF: Routes of Administration and Dose Forms (Routes of Administration [Oral Route]) | p. 19
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
34. Which organ is involved in the first-pass effect after oral administration of a drug?
a. Kidney
b. Lungs
c. Liver
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d. Spleen
ANSWER: C
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On oral administration, drugs are absorbed and are carried via the portal circulation to the liver,
where a percentage of the drug may be metabolized before entering the systemic circulation. After
oral dosing, drugs reach the kidney, lungs, and spleen after passing through the liver.
DIF: Comprehension
REF: Pharmacokinetics (Metabolism (Biotransformation) [First-Pass Effect]) | p. 16
OBJ: 4
TOP: NBDHE, 6.0. Pharmacology
35. Which of the following routes of drug administration produces the most rapid drug response?
a. Intravenous
b. Intramuscular
c. Subcutaneous
d. Intradermal
ANSWER: A
Intravenous administration produces the most rapid drug response, with an almost immediate onset of
action. Because the injection is made directly into the blood, the absorption phase is bypassed. The
intramuscular route, subcutaneous route, and intradermal route all have slower drug response rates
than intravenous drug administration.
DIF: Recall
REF: Routes of Administration and Dose Forms (Routes of Administration [Intravenous Route]) | p. 20 OBJ:
7
TOP:
NBDHE, 6.0. Pharmacology
36. What route is used to administer the tuberculosis skin test?
a. Intramuscular
b. Intradermal
c. Intravenous
d. Subcutaneous
ANSWER: B
Intradermal administration is used to provide local, rather than systemic, action. Local anesthetics are
also given this way. The other routes are all chosen when systemic action is desired. Intramuscular,
intradermal, and subcutaneous routes of administration are not used to administer the tuberculosis skin
test.
DIF: Recall
REF: Routes of Administration and Dose Forms (Routes of Administration [Intradermal Route]) | p. 22
OBJ:
7
TOP:
NBDHE, 6.0. Pharmacology
37. What type of administration involves the injection of solutions into the spinal subarachnoid space?
a. Intrathecal route
b. Intraperitoneal route
c. Intravenous route
d. Intradermal route
ANSWER: A
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The intrathecal route is used for injection of solutions into the spinal subarachnoid space.
Intraperitoneal route refers to placing fluids into the peritoneal cavity. Intravenous route refers to
administering drugs directly into the blood circulation. Intradermal route refers to injecting a drug just
under the skin.
DIF: Recall
REF: Routes of Administration and Dose Forms (Routes of Administration [Intrathecal Route]) | p. 22 OBJ:
7
TOP: NBDHE, 6.0. Pharmacology
38. Drug preparations may be administered for local or systemic effects. Which is an example of a dose
form used for a local effect?
a. Sublingual tablet
b. Transdermal patch
c. Ophthalmic ointment
d. Subcutaneous injection
ANSWER: C
Ophthalmic ointments and drops are used specifically for treating the eye, not for treating a systemic
disorder. Administration of a sublingual tablet leads to rapid entry of the drug into the systemic
circulation. A transdermal patch is a specialized dose form for the controlled delivery of a drug into the
systemic circulation. A subcutaneous injection is applied into the subcutaneous areolar tissue to gain
access to the systemic circulation.
DIF: Comprehension
REF: Routes of Administration and Dose Forms (Routes of Administration [Topical Route]) | p. 22
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
39. Application of a transdermal patch is an example of parenteral administration because the drug is
delivered in a manner that bypasses the gastrointestinal tract.
a. Both parts of the statements are true.
b. Both parts of the statements 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.
ANSWER: A
Both parts of the statement are true. A transdermal patch is designed to provide continuous controlled
release of medication through a semipermeable membrane over a given period after application to the
intact skin. Drugs given by the enteral route are placed directly into the gastrointestinal tract by oral or
rectal administration. Parenteral means situated or occurring outside of the gastrointestinal tract
(intestines). Examples of routes that bypass the gastrointestinal tract include various injection routes,
inhalation, and topical administration. In practice, the term parenteral usually refers to an injection.
DIF: Comprehension
REF: Routes of Administration and Dose Forms (Routes of Administration) | p. 19
OBJ: 7
TOP: NBDHE, 6.0. Pharmacology
40. A patient’s perception that a pill without active ingredients is having a pharmacologic effect is termed
a. tachyphylaxis.
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IF YOU WANT THIS TEST BANK OR SOLUTION MANUAL
EMAIL ME donc8246@gmail.com TO RECEIVE ALL
CHAPTERS IN PDF FORMAT