ADEX Pharmacology and Pain Management 1 — Questions and Answers
Question 1: Which local anesthetic has the longest duration of action and is most appropriate for lengthy dental hygiene procedures?
- Lidocaine 2%
- Mepivacaine 3%
- Bupivacaine 0.5% (Correct answer)
- Prilocaine 4%
Correct answer: Bupivacaine 0.5%
Bupivacaine has the longest duration of pulpal anesthesia (up to 90 minutes) among commonly used dental local anesthetics due to its high protein binding.
Question 2: A patient reports an allergy to sulfa drugs. Which local anesthetic should be avoided due to its ester linkage and potential cross-reactivity with PABA metabolites?
- Lidocaine
- Articaine
- Procaine (Correct answer)
- Mepivacaine
Correct answer: Procaine
Ester anesthetics like procaine are metabolized to para-aminobenzoic acid (PABA), which can cause allergic reactions in patients sensitive to sulfonamides.
Question 3: What is the maximum recommended dose of lidocaine with epinephrine for a healthy adult patient in dental procedures?
- 2 mg/kg up to 100 mg
- 4.4 mg/kg up to 300 mg (Correct answer)
- 7 mg/kg up to 500 mg
- 1 mg/kg up to 50 mg
Correct answer: 4.4 mg/kg up to 300 mg
The maximum recommended dose of lidocaine with vasoconstrictor is 4.4 mg/kg with an absolute maximum of 300 mg to prevent systemic toxicity.
Question 4: Which vasoconstrictor concentration is most commonly found in dental local anesthetic cartridges in the United States?
- 1:10,000 epinephrine
- 1:50,000 epinephrine
- 1:100,000 epinephrine (Correct answer)
- 1:200,000 epinephrine
Correct answer: 1:100,000 epinephrine
1:100,000 epinephrine is the standard concentration in most dental cartridges, providing adequate vasoconstriction with minimal cardiovascular risk.
Question 5: Which block technique anesthetizes the lingual nerve, inferior alveolar nerve, and long buccal nerve with a single injection?
- Gow-Gates mandibular block (Correct answer)
- Inferior alveolar nerve block (Halstead)
- Mental nerve block
- Incisive nerve block
Correct answer: Gow-Gates mandibular block
The Gow-Gates block targets the mandibular nerve trunk at the condylar neck, anesthetizing all three nerves supplying the mandibular arch with one injection.
Question 6: Paresthesia following an inferior alveolar nerve block is most often associated with which local anesthetic?
- Lidocaine 2%
- Mepivacaine 3%
- Articaine 4% (Correct answer)
- Prilocaine 4%
Correct answer: Articaine 4%
Articaine 4% has been associated with a higher incidence of paresthesia compared to other anesthetics, particularly when used for inferior alveolar nerve blocks.
ADEX Pharmacology and Pain Management 1
Which local anesthetic has the longest duration of action and is most appropriate for lengthy dental hygiene procedures?