Haveles: Applied Pharmacology for the Dental Hygienist, 5th Edition Test Bank Chapter 24: Pregnancy and

Breast Feeding
MULTIPLE CHOICE 1. The following measures should be taken when prescribing drugs to a pregnant woman, except one. Which is the exception? a No unnecessary drugs should be administered. . b An adequate health history should be taken at each appointment. . c Schedule morning appointments during the first trimester. . d Closely coordinate with the patients obstetrician. . ANS: C Correct: Because of potential morning sickness during the first trimester, it is better to schedule appointments in the afternoon during this period. Incorrect choices: Others are all prudent measures to be followed with the pregnant dental patient. REF: p. 420 2. What are potential consequences of administering a drug to a pregnant woman? a Teratogenicity to the fetus . b Spontaneous abortion . c Delayed and long-term physiologic and psychologic consequences . d Adverse reactions in the near-term fetus . e All of the above . ANS: E

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Incorrect Choices: All of the other answers cover the generally accepted concerns regarding drug administration to a pregnant woman. Spontaneous abortion could occur upon early exposure to a toxic agent, followed by teratogenicity, especially if the drug is present while the organs are forming, followed by adverse reactions to the fully formed fetus. Finally exposure to a drug in utero may lead to adverse consequences that do not emerge until later in life. REF: p. 421 3. The pregnant dental patient is most comfortable during which period? a First trimester . b Second trimester . c Third trimester . d None of the above . ANS: B Correct: The second trimester is a good time to administer prophylaxis and any necessary dental treatment, because the patient is beyond the morning sickness stages that might be experienced during the first trimester, and is still comfort-able reclining in the dentists chair for a moderate duration. REF: p. 421 4. A drug for which animal studies have failed to demonstrate a risk to the fetus, and of which there are no adequate studies in pregnant women, would fall into which FDA pregnancy risk category? a Category A . b Category B . c Category C . d Category D . e Category X . ANS: B Correct: For category A, adequate studies have been performed in humans and animals without demonstrating fetal risk.

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REF: p. 424 5. Which of the following local anesthetics would be the best choice for dental application in the pregnant patient? a Prilocaine . b Lidocaine . c Bupivacaine . d Mepivacaine . ANS: B Correct: Lidocaine is the local anesthetic of first choice for the pregnant woman because it is a category B drug and is not associated with methemoglobinemia, as is prilocaine. Incorrect choices: Unlike lidocaine and prilocaine, bupivacaine and mepivacaine are pregnancy category C. REF: pp. 422, 428 6. Which of the following agents can cause premature closure of the patent ductus arteriosus? a Acetaminophen . b Clindamycin . c Triazolam . d Ibuprofen . ANS: D Correct: Nonsteroidal antiinflammatory agents can cause premature closure of the ductus arteriosus. The other choices do not have this activity. REF: p. 428 7. Which antiinfective agent is least teratogenic? a Clarithromycin .

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Test Bank b Doxycycline . c Cephalexin . d Metronidazole . ANS: C Correct: First and second generation cephalosporins have not been associated with teratogenicity (Category B). Incorrect choices: Clarithromycin is category C. Doxycycline is category D. Metronidazole is category B, however, it has been shown in animals to produce birth defects. REF: pp. 424429

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8. Use of which of the following agents during pregnancy is associated with floppy infant syndrome? a Naproxen . b Diazepam . c Nystatin . d Warfarin . ANS: B Correct: Use of benzodiazepines during pregnancy has produced floppy infant syndrome. Incorrect choices: Neither naproxen, nystatin, nor warfarin, cause floppy infant syndrome. REF: pp. 423427, 429430 9. Use of which of the following agents during pregnancy is associated with producing an abnormal number of digits in the newborn? a Alcohol . b Codeine . c Erythromycin

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Test Bank . d Ketoconazole . ANS: D Correct: Ketoconazole has been shown to be teratogenic in rats, causing syndactyly and oligodactyly, an abnormal number of digits. Incorrect choices: Neither alcohol, codeine, nor erythromycin are commonly known to produce an abnormal number of digits in the newborn. REF: pp. 424429

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10. The following agents have been demonstrated to produce skeletal abnormalities in the fetus except one. Which is the exception? a Doxycycline . b Erythromycin estolate . c Warfarin . d Aspirin . ANS: B Correct: Erythromycin estolate is not teratogenic. Incorrect choices: Doxycycline can inhibit fetal bone growth, warfarin can cause chondrodysplasia and hypoplastic nasal bridge, and aspirin can cause birth defects involving the skeleton. REF: pp. 424428 11. Erythromycin is concentrated in breast milk. A nursing mother should be given erythromycin only if the breast milk is expressed and discarded during treatment and 48 hours after the last dose. a Both statements are true. . b Both statements are false. . c The first statement is true; the second is false. . d The first statement is false; the second is true. .

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ANS: C Correct: While erythromycin is concentrated in the breast milk, it has not been documented to produce problems. REF: pp. 428429 TRUE/FALSE 1. In managing the pregnant patient, it is best to avoid elective dental treatment until the third trimester. ANS: F Correct: The second trimester is the preferred time for dental treatment. REF: pp. 402421 2. Although opioids appear in breast milk when analgesic doses are administered, the small amounts appear have an insignificant effect on the nursing infant. ANS: T Correct: While large doses used by opioid addicts can cause adverse effects on the nursing infant, small analgesic doses appear safe. REF: pp. 424428 3. Aspirin is generally considered to be safe in pregnancy. ANS: F Correct: Aspirin can cause a variety of birth defects involving many organs. Acetaminophen is generally considered safe in pregnancy. REF: p. 428 4. The wives of dental personnel who are exposed to trace amounts of nitrous oxide in the workplace have a higher incidence of spontaneous abortion. ANS: T Correct: Continued exposure to small amounts of nitrous oxide by a man or woman can adversely affect the progress of a subsequent pregnancy. REF: pp. 429430

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