PHARMACOLOGY - Case Report
Reprinted with permission, General Dentistry, Jan.-Feb. 1999 issue.

Continuing Dental Education Self Instruction: Registration and answers for Exercise No. 67 must be received by May 20, 1999. Subject code: 016

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Exercise No. 67

The 15 questions for this exercise are based on the article, "Atropine sulfate: A current review of a useful agent for controlling salivation during dental procedures" by Craig R. Sherman, MD and Beryl R. Sherman, DDS. The article appears on pages 56-60. This exercise was developed by Karl F. Woodmansey, DDS, FAGD, a member of the General Dentistry Program in Self-Instruction Subcommittee. Answers for this exercise will be published in the May/June 1999 issue.

Learning Objectives

When you successfully complete this exercise, you will be able to:

• discuss problems associated with salivary contamination of an operative dental field;
• describe techniques for the control of salivation during dental procedures;
• explain the advantages and disadvantages of each technique described in the article; and
• properly prescribed atropine sulfate as an antisialogogue.

Select the most correct answer to each question. You must answer at least 12 of the 15 questions correctly (80 percent) in order to receive credit.

1. Which is the practical dosing guideline for atropine sulfate?

1. One tablet per 65 pounds of body weight
2. One tablet per 75 pounds of body weight
3. Two tablets every four hours
4. None of the above

2. What is the dosing regimen of atropine sulfate for children?

1. 0.1 mg/kg, not to exceed 4.0 mg in 4 to 6 hours
2. 0.01 mg/kg, not to exceed 0.4 mg in 4 to 6 hours
3. 0.001 mg/kg, not to exceed 0.004 mg in 4 to 6 hours
4. Equivalent to adult dosing
5. 1 tablet per hour of procedural time

3. According to the authors, which are benefits of atropine sulfate? 1. Low cost per unit dose, 2. Increased productivity, 3. Reduction of laryngospasm, 4. Increased patient comfort

1. 1 and 3 only
2. 2 and 3 only
3. 2 and 4 only
4. 2, 3, and 4 only

4. Which are moisture-control techniques cited by the authors?

1. Absorption with cotton rolls
2. Isolation with rubber dams
3. Temporary inhibition of salivary flow with anticholinergic agents
4. All of the above

5. Where is atropine sulfate metabolized?

1. Kidney
2. Liver
3. Bloodstream
4. Small Intestine

6. Atropine sulfate is excreted by the _________.

1. Kidney
2. Liver
3. Salivary Glands
4. Epithelium

7. Which are contraindications for administration of atropine sulfate? 1. Glaucoma, 2. Ocular adhesions, 3. Cataracts, 4. Asthma, 5. Emphysema

1. 1 and 3
2. 4 and 5
3. 1, 2, and 3
4. 1, 2, and 4
5. 2, 3, and 5

8. What is the minimal dose of atropine most adults require before a real mouth drying effect is noted clinically?

1. 0.4 mg
2. 0.6 mg
3. 2.0 mg
4. One tablet

9. After oral administration of atropine sulfate, approximately when does inhibition of salivary flow peak?

1. Immediately
2. At 5 minutes
3. At 30 minutes
4. At 60 minutes
5. At 2 hours

10. Some practitioners advise patients not to wear contact lenses or exercise for a few hours after taking atropine sulfate. This advice is due to temporary reduction in tear and sweat secretions.

1. Both statements are true.
2. The first statement is true; the second is false.
3. The first statement is false; the second is true.
4. Both statements are true.

11. Which are pharmaceutical antisialogogues? 1. Methantheline bromide, 2. Pro-Tropine, 3. Sal-Banthine, 4. Propantheline bromide

1. 1 and 2
2. 1 and 4
3. 2 and 3
4. 3 and 4
5. All of the above

12. Which of the following describe atropine sulfate:

1. Has the ADA seal of acceptance
2. Can be used as an adjunctive treatment for peptic ulcers
3. Blocks the attachment of acetylcholine to receptors in the salivary glands
4. All of the above

13. Which route of administration is reported to inhibit salivation with the lowest dose of atropine sulfate?

1. Oral
2. Intravenous
3. Intramuscular
4. Suppository

14. Which side effects may be encountered with a 5 mg dose of atropine sulfate? 1. Headache, 2. Blurred vision, 3. Difficulty swallowing, 4. Hallucinations, 5. Coma

1. 1 and 3
2. 2 and 3
3. 1, 2, and 3
4. 1, 2, 3, and 4
5. All of the above

15. Which properties describe atropine sulfate?

1. Tasteless
2. Insoluble
3. Competitive agonist of the muscarinic actions of acetylcholine
4. Competitive antagonist of the nicotinic actions of acetylcholine

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ANSWERS TO THE MOST COMMONLY ASKED QUESTIONS ABOUT THE SELF-INSTRUCTION PROGRAM

HOW DO I REGISTER FOR THE PROGRAM?
To register by mail, complete the coupon on page 106 and enclose a check or provide credit card information. To register by phone, call 1-888-AGD-DENT, ext. 385. A letter confirming your subscription will be sent approximately four weeks after registration. Exercises may be submitted upon payment of registration fee prior to receipt of confirmation letter.

HOW DO I SUBMIT ANSWERS TO EXERCISE QUESTIONS?
Answers to exercise questions are entered onto electronically scannable answer forms mailed to every program participant upon registration. Easy-to-follow instructions are included with each set of answer forms. Answer forms must be completed as directed in the instructions; otherwise, they will not be processed.

HOW IS CREDIT EARNED?
Participants must answer correctly a minimum of 12 of the 15 questions (80 percent) in order to earn two CE credits.

WHAT IF I FAIL?
A letter will be sent to all participants (AGD members as well as nonmembers) who score less than 80 percent.

DUE DATE
Answers are due no later than 3 months and 20 days after date of publication of the issue in which the exercise appears. For the January/February 1999 issue of General Dentistry, published on or around February 1, 1999, answers to Exercise No. 67 must be postmarked on or before May 20, 1999. CREDIT WILL NOT BE AWARDED FOR EXERCISES POSTMARKED AFTER THE DUE DATE.

HOW IS CREDIT REGISTERED FOR MEMBERS?
The results of the exercises of Self-Instruction participants who are members of the Academy of General dentistry are entered directly into their CDE (Continuing Dental Education) records maintained by the AGD¹s Dental Education Department. A printout of this report is mailed to members once a year in the spring. AGD members will not receive a letter acknowledging successful completion of each exercise. However, they may request a printout of their CDE record at any time during the year.

HOW IS CREDIT REGISTERED FOR NONMEMBERS?
Nonmembers will be notified by letter of the results of their successfully completed exercises. These letters may be submitted to the appropriate state board or agency for licensure purposes.

This exercise is due on or before May 20, 1999.