Deck 5: Dental Local Anesthetic Drugs

Question 1

Match the following:

-Articaine

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Answer 1

Sulfur atom in ring structure

Question 2

Match the following:

-Bupivacaine

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Answer 2

Long-acting anesthetic

Question 3

Match the following:

-Epinephrine

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Answer 3

Vasoconstrictor

Question 4

Match the following:

-Levonordefrin

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Question 5

Match the following:

-Lidocaine

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Question 6

Match the following:

-MRD

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Question 7

Match the following:

-Mepivacaine

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Question 8

Match the following:

-Paresthesia

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Question 9

Match the following:

-Prilocaine

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Question 10

Match the following:

-Procaine

A) Ester-type anesthetic
B) First amide available
C) Long-acting anesthetic
D) Available in 4% solution
E) Established safe dose guideline
F) Vasoconstrictor
G) Available 1:20,000
H) Nerve damage
I) Available in 3% solution
J) Sulfur atom in ring structure

Question 11

Match the following:

-Articaine

A) Intermediate
B) Long
C) Short

Question 12

Match the following:

-Bupivacaine

A) Intermediate
B) Long
C) Short

Question 13

Match the following:

-Lidocaine plain

A) Intermediate
B) Long
C) Short

Question 14

Match the following:

-Lidocaine

A) Intermediate
B) Long
C) Short

Question 15

Match the following:

-Mepivacaine plain

A) Intermediate
B) Long
C) Short

Question 16

Match the following:

-Mepivacaine

A) Intermediate
B) Long
C) Short

Question 17

Match the following:

-Prilocaine plain

A) Intermediate
B) Long
C) Short

Question 18

Match the following:

-Prilocaine

A) Intermediate
B) Long
C) Short

Question 19

Match the following:

-Procaine

A) Intermediate
B) Long
C) Short

Question 20

Lidocaine was the first amide local anesthetic drug developed by Lofgren in 1943.

Question 21

Mepivacaine was prepared as an alternative to lidocaine by Lofgren in Sweden, in 1957.

Question 22

Prilocaine was first prepared by Lofgren and Tegner in 1953 and approved by the FDA in 1965.

Question 23

Articaine was synthesized in 1969 by H. Rusching and is the most recently approved dental injectable local anesthetic drug in North America.

Question 24

Articaine is metabolized primarily in the liver.

Question 25

The drug of choice for a patient with significant liver disease is articaine because it is metabolized primarily by plasma cholinesterase.

Question 26

The best local anesthesia drug choice for a nursing mother is prilocaine.

Question 27

3% mepivacaine plain is a better drug choice than 2% lidocaine when a vasoconstrictor is contraindicated because its higher drug content increases the duration of pulpal anesthesia.

Question 28

2% lidocaine with 1:50,000 epinephrine provides excellent hemostasis for periodontal surgery.

Question 29

Prilocaine can reduce the blood's oxygen carrying capacity which may lead to methemoglobinemia.

Question 30

The higher the pKa of a local anesthetic solution, the slower the onset on anesthesia.

Question 31

Allergic reactions to lidocaine have been documented and the drug shows cross-allergenicity with other currently available amides.

Question 32

Prilocaine has demonstrated a higher than typical incidence of inducing methemoglobinemia due to its metabolite, ortho-toluidine.

Question 33

Bupivacaine's high pKa translates into a slow onset time, which explains why it is a long-acting anesthetic.

Question 34

Lidocaine is not available in which of the following formulations?

A) 2% lidocaine, 1:20,000 levonordefrin
B) 2% lidocaine plain
C) 2% lidocaine, 1:100,000 epinephrine
D) 2% lidocaine, 1:50,000 epinephrine

Question 35

The anesthetic duration of lidocaine plain is:

A) 60 minutes pulpal; 60 to 120 minutes soft tissue
B) 10 to 30 minutes pulpal; 60 to 120 minutes soft tissue
C) 5 to 10 minutes pulpal; 180 to 300 minutes soft tissue
D) 5 to 10 minutes pulpal; 60 to 120 minutes soft tissue

Question 36

The maximum recommended dose for lidocaine is:

A) 5 mg/lb
B) 500 mg per appointment
C) 4.4 mg/lb
D) 2.0 mg/kg

Question 37

Which local anesthetic is not available in the United States with 1:200,000 epinephrine?

A) Prilocaine
B) Articaine
C) Lidocaine
D) Bupivacaine

Question 38

The potency of lidocaine as compared to other local anesthetic drugs in dentistry is:

A) Twice as potent as procaine
B) Equal potency to procaine
C) One half potency of bupivacaine
D) One half potency of mepivacaine

Question 39

What is the primary site of biotransformation of lidocaine?

A) Kidney
B) Liver
C) Lungs
D) Blood

Question 40

What percentage of lidocaine is excreted by the kidneys unchanged?

A) 0%
B) 5%
C) 10%
D) 20%

Question 41

What is the maximum recommended dose of mepivacaine?

A) 0.5 mg/lb
B) 1.8 mg/lb
C) 3.0 mg/lb
D) 600 mg per appointment

Question 42

Mepivacaine is available in the following formulation:

A) 2% plain
B) 3% plain
C) 1% with 1:20,000 levonordefrin
D) 3% with 1:20,000 levonordefrin

Question 43

The correct pKa of lidocaine is:

A) 6.5 in lidocaine plain
B) 8.1 in lidocaine with epinephrine
C) 2.4 in lidocaine plain
D) 2.3 to 8.1 in lidocaine with epinephrine

Question 44

Which of the following is the correct onset of action for mepivacaine?

A) 0.5 to 2 minutes
B) 1 to 2 minutes
C) 4 to 6 minutes
D) 6 to 0 minutes

Question 45

What is the maximum recommended dose per appointment for prilocaine?

A) 200 mg
B) 300 mg
C) 400 mg
D) 600 mg

Question 46

Which of the following is available in North America?

A) 4% prilocaine, 1:200,000 epinephrine
B) 3% prilocaine, 1:20,000 levonordefrin
C) 4% prilocaine plain
D) 3% prilocaine, 1:100,000 epinephrine

Question 47

Name the atom present in the ring structure of articaine that helps to make it more lipophilic.

A) Sulfur
B) Calcium
C) Sodium
D) Nitrogen

Question 48

Which formulation of articaine is correct?

A) 2% articaine with 1:50,000 epinephrine
B) 2% articaine with 1:100,000 epinephrine
C) 4% articaine with 1:100,000 epinephrine
D) 4% articaine plain

Question 49

Which one of the following drugs used in dentistry is the least toxic to the CNS and CVS?

A) Lidocaine
B) Mepivacaine
C) Prilocaine
D) Bupivacaine

Question 50

What is the FDA pregnancy category for mepivacaine?

A) A
B) B
C) C
D) A, if minimal doses are administered

Question 51

The correct onset of action for lidocaine is:

A) 30 seconds to 1 minute with vasoconstrictor
B) 2 to 3 minutes
C) 5 to 7 minutes
D) 6 to 10 minutes

Question 52

What is the clinically safest available dilution of vasoconstrictor with lidocaine?

A) 1:50,000
B) 1:100,000
C) 1:200,000
D) 1:1,000,000

Question 53

The elimination half-life of lidocaine is:

A) 6 minutes
B) 16 minutes
C) 96 minutes
D) 300 minutes

Question 54

What is the elimination half-life of mepivacaine?

A) 0.5 hours
B) 1.0 hours
C) 1.6 hours
D) 1.9 hours

Question 55

Which of the following drugs has the shortest duration of action?

A) Mepivacaine 3%
B) Bupivacaine 0.5%, 1:200,000 epinephrine
C) Prilocaine 4%, 1:200,000 epinephrine
D) Lidocaine 2%, 1:100,000 epinephrine

Question 56

Which of the following drugs has the shortest duration of action?

A) Mepivacaine 3% plain
B) Bupivacaine 0.5%, 1:200,000 epinephrine
C) Prilocaine 4%, 1:200,000 epinephrine
D) Lidocaine 2% plain

Question 57

Which anesthetic provides pulpal anesthesia for 10 minutes for an infiltration technique and 60 minutes for a block injection?

A) Lidocaine
B) Mepivacaine, 1:20,000 levonordefrin
C) Prilocaine plain
D) Prilocaine, 1:200,000 epinephrine

Question 58

What is the clinical significance of prilocaine's pKa of 7.9?

A) Stronger vasodilator than mepivacaine
B) Slightly slower onset compared to lidocaine
C) Less toxicity compared to lidocaine
D) Higher risk of methemoglobinemia

Question 59

What is the duration of action of articaine with 1:200,000 epinephrine?

A) 30 to 45 minutes pulpal anesthesia
B) 45 to 60 minutes pulpal anesthesia
C) 60 to 90 minutes pulpal anesthesia
D) 120 to 300 minutes of pulpal anesthesia

Question 60

The correct maximum recommended dose for articaine is:

A) 3.2 mg/lb
B) 4 mg/kg
C) 7 mg/lb
D) 400 mg per appointment

Question 61

What is the clinical significance of the rapid half-life of articaine?

A) There is half the risk for a lingual paresthesia to occur.
B) There is a low allergy potential.
C) Half of its metabolites are excreted unchanged; therefore, there is less risk of toxicity.
D) It can be reinjected sooner than the other dental injectable drugs due to its rapid half-life.

Question 62

Which local anesthetic drug is appropriate for extended periods of postoperative pain control?

A) Bupivacaine
B) Mepivacaine
C) Lidocaine
D) Prilocaine

Question 63

What is the absolute maximum recommended dose of bupivacaine?

A) 25 mg
B) 35 mg
C) 45 mg
D) 90 mg

Question 64

What are the two key considerations that determine the duration of action of bupivacaine?

A) Biotransformation and elimination
B) Distribution and volume
C) Receptor binding strength and vasoactivity
D) Receptor binding and biotransformation

Question 65

What is the FDA pregnancy category of lidocaine?

A) A
B) B
C) C
D) B or C depending on dose administered

Question 66

Which drug can reduce the blood's oxygen-carrying capacity, which may lead to a specific anemia known as methemoglobinemia?

A) Lidocaine
B) Bupivicaine
C) Mepivacaine
D) Prilocaine

Question 67

The risk of methemoglobinemia may be precipitated by which one of the following drugs?

A) Mepivacaine
B) Lidocaine
C) Bupivacaine
D) Prilocaine

Question 68

Which local anesthestic drug is the best choice for a nursing mother?

A) Lidocaine
B) Articaine
C) Mepivacaine
D) Prilocaine

Question 69

Which is the best reason why articaine is the local anesthetic drug of choice for a nursing mother?

A) It is quickly biotransformed in the liver by hepatic enzymes
B) It is quickly biotransformed by pseudocholinesterase
C) It is not available in breast milk
D) It has a half-life of approximately 3 hours

Question 70

What is the best choice of drug(s) for a patient taking a beta blocker for hypertension that will provide the longest duration of action?

A) 2% lidocaine
B) 2% mepivacaine, 1:20,000 levonordefrin
C) 3% mepivacaine
D) 4% articaine; 1:200,000 epinephrine

Question 71

Which one of the following explains why mepivacaine is capable of providing 20 to 40 minutes of pulpal anesthesia without a vasoconstrictor?

A) Low percentage of drug in the cartridge
B) Strong vasodilation activity
C) Weak vasodilation activity
D) Greater potency

Question 72

Which of the following explains why mepivacaine is effective for short durations without a vasoconstrictor?

A) Strong vasodilator property
B) Strong protein binding capacity
C) Weak vasodilator property
D) Equal in potency to lidocaine

Question 73

Mepivacaine is similar to lidocaine although its chemical structure more closely resembles

A) Prilocaine
B) Procaine
C) Articaine
D) Bupivacaine

Question 74

Which of the following drug choices would provide the most vigorous hemostasis for a periodontal surgical procedure?

A) 4% articaine, 1:100,000 epinephrine
B) 2% lidocaine, 1:50,000 epinephrine
C) 2% mepivacaine, 1:20,000 levonordefrin
D) .5% bupivacaine, 1:200,000 epinephrine

Question 75

Which of the following drugs is most appropriate for a patient with significant liver and cardiovascular compromise for a root planing procedure in the lower right quadrant?

A) 4% articaine, 1:200,000 epinephrine
B) 3% mepivacaine, 1, 20, 000 levonordefrin
C) 3% mepivacaine plain
D) 4% articaine, 1:100,000 epinephrine

Question 76

Identify the following local anesthetic drug.

Question 77

Identify the following local anesthetic drug.

Question 78

Identify the following local anesthetic drug.

Question 79

Identify the following local anesthetic drug.

Question 80

Identify the following local anesthetic drug.