E-Portfolio Checkpoint #2: Pharmacology

1. I have chosen pharmacology as my next course to review. I found pharmacology challenging

because there was so much information to learn in a short period of time. I felt it was mainly a
memorizing type of course and I was not able to put in as much study time as I would have liked.
I need to understand common medications that I am likely to see being used by my clients and I
do not feel prepared.
2. I’ve decided to focus my review on antianxiety agents and drugs for cardiovascular diseases. I
feel becoming more familiar with these drugs will help me in the clinical setting. I want to have a
deeper understanding how these drugs affect the oral cavity and the contraindications relating to
dental treatment to be aware of.

3. Antianxiety Agents

Sedative vs. hypnotic: a sedative will calm a healthy person down while a hypnotic
induces sleep in a healthy person. A normal dosage of sedative may not be enough to
produce calmness in a client with dental anxieties, but a hypnotic will achieve the desired
degree of sedation for someone experiencing dental anxiety.
Anxiolytic effect: to reduce anxiety.
I made cue cards on Quizlet to help me study antianxiety medications. The link is below:
https://quizlet.com/_9ciam4?x=1qqt&i=2inxtv (Haveles, 2020)

Here is the editable version of my Quizlet cue cards:

1. What are the most common drugs prescribed for anxiety?

Answer: benzodiazepines
2. Two benzodiazepines that can also be used an antiseizure drug
Answer: diazepam & lorazepam

3. Side effects from benzodiazepines are most likely to happen in people who are:
Answer: Elderly

4. Benzodiazepines oral effects are:

Answer: xerostomia or increased salivation, swollen tongue, and a bitter/metallic taste

5. True or false: It is safe for a pregnant woman to take benzodiazepines?

Answer: False: it is not safe, especially during the first trimester. A client’s pregnancy status
should be determined before taking.

6. Severe drug interactions with benzodiazepines are:

Answer: opioids, alcohol, and other CNS depressants
7. True or false: benzodiazepines are used for long term treatment of anxiety
Answer: False: used for short-term treatment for anxiety, panic attacks, insomnia, alcohol
withdrawal, acute seizures, conscious sedation, general anesthesia, and during surgery.

8. Benzodiazepines can be used to relax _________ in people with multiple sclerosis and
cerebral palsy.

Answer: muscles

9. Half-Life
Answer: half the amount of drug concentration within the body compared to the starting
dosage

10. Benefits of benzodiazepines

Answer: has the least addiction potential compared to other antianxiety drugs, has a wide
range of safe dose, can treat more than just anxiety, has a fast onset of action, and has a
short half-life (good for after dental procedures)

11. What are the original sedative-hypnotic agents?

Answer: barbiturates

12. True or false: you can become tolerant to a lethal dose of antianxiety drugs
Answer: false: no matter how much tolerance a person develops for antianxiety drugs, once
the lethal dose is reached, it will cause life-threatening adverse effects.

13. For the treatment of insomnia and anxiety relief, barbiturates have now been replaced by:
Answer: benzodiazepines

14. A barbiturate commonly used in treating epilepsy.

Answer: phenobarbital

15. What nonbenzodiazepine-nonbarbiturate sedative-hypnotic takes a week before the onset

of action?

Answer: buspirone

16. Benefits of buspirone:

Answer: produces much less CNS depression compared to other agents, does not affect
driving skills, does not cause tolerance or dependence, does not appear addictive, and does
not cause withdrawal.

17. What does it mean for a drug like buspirone to be anxioselective?

Answer: buspirone has selective antianxiety action. It does not contain hypnotic,
anticonvulsant, or muscle relaxant properties.
 18. True or false: all antianxiety drugs are unsafe for pregnant women.
Answer: True: unless the potential benefit to the mother outweighs the risk of the fetus

19. What drugs treat insomnia only?

Answer: nonbenzodiazepines: zolpidem (Ambien), zaleplon (Sonata), and eszopiclone
(Lunesta)

20. What is the strongest and most sedating muscle relaxant?

Answer: cyclobenzaprine (Flexeril)

Drugs for the Treatment of Cardiovascular Disease

I have created a practice quiz, covering content from chapter 12 (Haveles, 2020).

1. Clients who have suffered a myocardial infarction (MI) should wait how many months before
visiting the dental hygienist?
a. 3 months
b. 4 months
c. 6 months
d. 8 months
2. Most clients with heart failure (HF) will be taking a diuretic. What is the purpose of a diuretic?
a. To help flush out the toxins in the blood that is causing heart failure:
b. To relieve fluid retention in the body and lower blood pressure
c. To allow the body to stay hydrated
d. To create extracellular fluid volume to enhance the heart’s ability to function
3. An oral side effect from Digoxin (a digitalis glycoside) is:
a. burning tongue
b. clinical attachment loss of the PDL
c. Increased gag reflex
d. Ulcers
4. This drug allows increased strength and force of the myocardium, resulting in increased cardiac
output:
a. Nitroglycerin
b. Ramipril
c. Amlodipine
d. Digoxin
5. A symptom of angina pectoris:
a. Lower jaw pain that may feel like a toothache
 b. Increased need to urinate
c. Pain radiating down the left leg
d. Blurred vision with pain in the eyes
6. True or False: angina may be triggered by stress, anxiety, or physical activity?
a. true
b. false
7. Nitroglycerin is a:
a. Vasodilator
b. Vasoconstrictor
c. Diuretic
d. Calcium channel blocker
e. B-adrenergic blocker
(Answer: vasodilator: used to manage acute anginal episodes. It relaxes the smooth muscles
resulting in the dilation of veins and arteries, and lowering the heart’s workload)

8. The loss of taste is commonly reported in client who are taking an angiotensin-converting
enzyme inhibitor called:
a. Benazepril
b. Enalapril
c. Ramipril
d. Captopril
9. What drugs should thiazides (diuretic) not interact with due to a reduction of antihypertensive
effects?
a. NSAIDs
b. Opioids
c. Nonopioids
d. Antianxiety drugs
10. Out of all the calcium channel blockers, this drug is most commonly reported to cause gingival
enlargement:
a. Verapamil
b. Diltiazem
c. Nifedipine
d. Amiloride

(Answer: all CCBs may cause gingival inflammation, but especially nifedipine)

11. Gingival enlargement caused by calcium channel blockers will begin to show how long after
beginning the medication?
a. Immediately
b. One week
c. One month
d. One month or more
12. True or False: NSAIDs do not cause reduced antihypertensive effects when combined with
calcium channel blockers:
a. True
b. False
(Answer: True: CCBs are one of the few antihypertensive drugs that does not have reduced effectiveness
when interacting with NSAIDs)

13. What are some oral effects common when taking clonidine or methyldopa?
a. Ulcers, gingival enlargement, and sloughing tissue
b. Xerostomia, swollen parotid gland, and dysgeusia
c. Altered taste, increased salivation, and oral candidiasis
d. Bone resorption, TMJ pain, and xerostomia
14. What central a-Adrenergic agonist drug may cause lupus-like symptoms during a toxic reaction?
a. hydralazine
b. Reserpine
c. Doxazosin
d. Labetalol
15. A client who is taking an antihypertensive medication and suddenly rises to an upright position
after lying supine for a long period of time will experience a sudden drop in blood pressure.
What is this called?
a. A fainting spell
b. hypotension
c. Stroke
d. Orthostatic hypotension

(Answer: orthostatic hypotension: this can lead to dizziness and/or fainting. Exercise and alcohol
can exaggerate the effects)

16. True or False: low-density lipoproteins (LDL) are more preferred in the body than high-density
lipoproteins (HDL):
a. False
b. True

(Answer: False: LDL is the bad cholesterol because it leaves cholesterol attached to artery walls. HDL is
good because it contains the lowest amount of cholesterol and helps carry cholesterol away from blood
vessels.)

17. What is hyperlipidemia and hyperlipoproteinemia?

a. Increased concentration of adipose fat in the tissue above the accepted normal range
b. Decreased concentrations of plasma lipids below the accepted normal range
c. Increased concentration of plasma lipids above the accepted normal range
d. Decreased concentration of adipose fate in the tissue below the accepted normal range
18. What drug has a serious interaction with Aspirin?
a. warfarin
b. heparin
c. enoxaparin
d. clindamycin

(answer: warfarin: this also includes any products that may contain aspirin, like cold medicine.
This interaction may cause serious bleeding episodes and lead to fatal hemorrhaging)
19. If a client is taking warfarin, what serious reaction should the clinician look out for in the mouth?
a. Bleeding
b. Tissue sloughing
c. Petechial hemorrhages
d. Leukoplakia

(Answer: petechial hemorrhages: serious reactions can easily occur while using warfarin because
of its narrow therapeutic index and its numerous interactions with other drugs)

20. True or False: Many people require more than one drug to control their hypertension:
a. True
b. False

(Answer: True: many people require two drugs. The combination of both agents allows lessened
side effects compared to an individual agent)

(Haveles, 2020).

4. I feel more prepared to have a client in my chair who is taking antianxiety or cardiovascular
medications. I did have a bit of confusion with my pharmacology book because it says to wait 6
months after a heart attack before visiting the dental hygienist, but in the CDHO factsheet, it
says to wait only 4-6weeks and also to consult with the client’s specialist. I will follow the
CDHO’s guidelines as a future dental hygienist, but 6 months is a drastically longer waiting
period than 2 months (CDHO, 2019).

5. I learned a lot that I can apply as a clinician. I now know calcium channel blockers, especially
nifedipine, is commonly known to cause gingival enlargement as an adverse effect. If I see a
client who is taking this medication, I should be aware of this and let the client know gingival
inflammation might show up after a few months of taking the medication.
Benzodiazepines, which are commonly prescribed for anxiety, may cause xerostomia, or
opposite, increased salivation. I find this interesting since these effects are exact opposite. As
well, it is important to never assume a client is taking benzodiazepines to treat anxiety. It is also
used as a muscle relaxant for M.S and cerebral palsy. That is why each medication a client takes
should be inquired for the purpose of finding out what conditions a client has.

References
CDHO knowledge network. (2019, September 6). Retrieved February 13, 2021, from
https://www.cdho.org/my-cdho/practice-advice/the-knowledge-network

Haveles, E. B. (2020). Applied pharmacology for the dental hygienist. St. Louis, MO: Elsevier.