Question

Case Study #1

Pete P. is a 45-year-old man who is new to the dental practice. He reports pain from his periodontal debridement last week and wants a prescription for pain medication. He needed nitrous oxide and a pre-appointment anxiolytic before allowing the dental hygienist to proceed with treatment. He states on his medical history that he takes a baby aspirin to prevent heart disease, a multivitamin, Ginkgo biloba, and Xanax for anxiety. He also notes on his health history that he is a recovering alcoholic. The dentist writes a prescription for 800 mg of ibuprofen, but Pete tells his physician that ibuprofen does not work for him and that only OxyContin works for his pain.
1. What is the physician’s primary concern regarding this patient?
a. The hygienist caused undue tissue trauma during the periodontal debridement.
b. The patient may file a malpractice claim because of his suffering.
c. Another dental condition is causing the patient pain.
d. The patient is a “shopper” who is trying to obtain opioids for nontherapeutic use.

2. Which adverse effect could occur if the physician agrees to prescribe the OxyContin to Pete?
a. Pete will have an increased tolerance for opioids.
b. Pete will suffer no additional adverse effects; he is already addicted to OxyContin.
c. Pete could succumb to respiratory depression because of the additive effect of OxyContin and the Xanax he is taking for anxiety.
d. Pete could succumb to central nervous system stimulation and seizure activity due to the additive effect of OxyContin and the Xanax he is taking for anxiety.

3. Pete says that he has an allergic reaction to ibuprofen that includes yawning, tearing, runny nose, nausea and vomiting, racing heart rate, shaking, and chills. Which condition is the most likely cause of these symptoms?
a. Type I immediate hypersensitivity reaction
b. Drug toxicity or overdose
c. Opioid withdrawal
d. Psychogenic shock



4. Which opioid could be used to treat Pete’s opioid addiction?
a. Heroin
b. Codeine
c. Fentanyl
d. Methadone

5. If Pete were to suffer an overdose of OxyContin, which drug should be administered immediately?
a. Methadone
b. Naloxone
c. Flumazenil
d. Diazepam

Case Study #2
Julie W. is a junior dental hygiene student who had the misfortune to puncture her glove with a contaminated instrument. Although her patient tested negative for both hepatitis C and human immunodeficiency virus, the wound became badly infected. Her physician prescribed 500 mg of amoxicillin three times a day for 7 days, but at the end of 3 days, the infection is worse and is spreading. Julie feels too ill to attend classes, and she returns to the college’s health center to see the physician again. Her temperature is 103.4° F, her pulse rate is 110 bpm, and her cervical lymph nodes are swollen. The physician is concerned about the infection and admits Julie to the hospital. Her current medications include oral contraceptive pills and multivitamins.
1. Which bacteria are most likely responsible for the infection?
a. Staphylococcus aureus and Streptococcus viridans
b. Escherichia coli
c. Salmonella sp. and Shigella sp.
d. Clostridium difficile





2. Why has Julia’s infection not responded to the amoxicillin?
a. The amoxicillin should have been administered parenterally.
b. Amoxicillin is effective only against gram-negative organisms.
c. The bacteria have developed resistance to the antibiotic.
d. The dose was insufficient to treat the infection.

3. Laboratory tests show the presence of penicillinase in Julie’s blood. Which antibiotic would be indicated next?
a. Penicillin G
b. Ampicillin
c. Cloxacillin
d. Penicillin VK

4. Within hours after the first dose of cloxacillin, Julie becomes extremely nauseated and starts vomiting. Which type of reaction is she having to the medication?
a. Allergic reaction
b. Toxic reaction
c. Idiosyncratic reaction
d. Therapeutic reaction

5. In spite of the change in antibiotics, Julie’s condition continues to worsen, and the infection becomes life threatening. Her physician tells her family that they are going to administer an intravenous antibiotic that has not developed cross-resistance with other antibiotics because it has a different structure than other antibiotics. The physician also tells her family that this antibiotic is also used as a last resort against methicillin-resistant S. aureus. To which antibiotic is the physician referring?
a. Aminoglycosides
b. Vancomycin
c. Sulfonamides
d. Quinolones (fluoroquinolones)

Answer 1

Case study 1

1.As the pain can usually last for about 3 days and gradually decrease in about a week with adequate pain killers. A pain after a week is a concern.There are high chance a patient to sue the healthcare professionals when they don't get cured or suffers any complications out of a treatment or procedure.

The tissue damage to adjacent area will causes additional symptoms like fever ,headache,etc.,

Another dental condition can occur as a secondary problem

The patient requested for oxycontin which is an opioid analgesic, moreover is recovering from alcoholism, so the chance of addiction is high and if asking specifically for it can concern the dentist other than therapeutic use

Ans:The patient is a shopper for oxycontin who is trying to obtain opioid for non therapeutic use

2.The patient will have side effects like nausea, vomiting, respiratory problems, cardiac problems, constipation.When these two drugs are taken it can cause drowsiness .dyspnea has to be reported immediately

Ans:Peter could succumb to respiratory depression because of additive effects of oxytocin and xanax for anxiety disorder

3.Type 1 immediate hypersensitivity reactions shows breathing difficulties, hypotension, hives,wheals and needs immediate medical help

Drug toxicity will show miosis ,decreased blood pressure, confusion, decreased body temperature, decreased heart rate, decreased breathing

Opioid withdrawal patient usually shows signs and symptoms of frequent yawning ,perspiration, insomnia, anxious,tearing

Psychogenic shock usually causes hypotension, tachycardia, cool and clammy skin

Ans:opioid withdrawal

4.The common drugs used to treat the opioid addiction are naltrexone, methadone and buprenorphine

Here others can increase opioid addiction

Ans:methadone

5.The antidote used for oxycontin is naloxone. The other drugs can cause further addiction and problems

Ans:Naloxone