Local anesthetics, analgesics, and antibiotics commonly prescribed in dental practice tested on the INBDE.
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- What is the mechanism of action of local anesthetics?
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They block voltage-gated sodium channels in the nerve membrane, preventing depolarization.- What are the two chemical classes of local anesthetics?
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Esters and amides.- Where are ester-type local anesthetics metabolized?
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In the plasma, by pseudocholinesterase (hydrolysis).- Where are amide-type local anesthetics metabolized?
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In the liver, by microsomal enzymes.- Name a commonly used ester local anesthetic in dentistry.
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Procaine (or benzocaine).- Name a commonly used amide local anesthetic in dentistry.
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Lidocaine.- Why are true allergic reactions more common with ester anesthetics than amides?
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Ester metabolism produces PABA, a known allergen.- Why is a vasoconstrictor added to a local anesthetic solution?
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To prolong the duration of action and reduce systemic absorption and toxicity.- What is the most commonly used vasoconstrictor in dental local anesthetics?
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Epinephrine.- Which local anesthetic is most associated with causing methemoglobinemia?
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Prilocaine.- How does a lower pKa affect a local anesthetic's onset of action?
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It produces a faster onset, since more drug exists in the un-ionized, lipid-soluble form at tissue pH.- What structural feature makes articaine unique among amide anesthetics?
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It has a thiophene ring and an additional ester linkage, allowing partial metabolism in the plasma.- What is an early sign of local anesthetic systemic toxicity?
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CNS excitation, such as circumoral numbness, tinnitus, or lightheadedness.- What is the maximum recommended epinephrine dose for a patient with significant cardiovascular disease?
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0.04 mg, about two cartridges of 1:100,000 epinephrine.- What is the mechanism of action of NSAIDs?
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They inhibit cyclooxygenase (COX) enzymes, decreasing prostaglandin synthesis.
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