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?
- They block voltage-gated sodium channels in the nerve membrane, preventing depolarization.
- What are the two chemical classes of local anesthetics?
- Esters and amides.
- Where are ester-type local anesthetics metabolized?
- In the plasma, by pseudocholinesterase (hydrolysis).
- Where are amide-type local anesthetics metabolized?
- In the liver, by microsomal enzymes.
- Name a commonly used ester local anesthetic in dentistry.
- Procaine (or benzocaine).
- Name a commonly used amide local anesthetic in dentistry.
- Lidocaine.
- Why are true allergic reactions more common with ester anesthetics than amides?
- Ester metabolism produces PABA, a known allergen.
- Why is a vasoconstrictor added to a local anesthetic solution?
- To prolong the duration of action and reduce systemic absorption and toxicity.
- What is the most commonly used vasoconstrictor in dental local anesthetics?
- Epinephrine.
- Which local anesthetic is most associated with causing methemoglobinemia?
- Prilocaine.
- How does a lower pKa affect a local anesthetic's onset of action?
- 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?
- 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?
- CNS excitation, such as circumoral numbness, tinnitus, or lightheadedness.
- What is the maximum recommended epinephrine dose for a patient with significant cardiovascular disease?
- 0.04 mg, about two cartridges of 1:100,000 epinephrine.
- What is the mechanism of action of NSAIDs?
- They inhibit cyclooxygenase (COX) enzymes, decreasing prostaglandin synthesis.