INBDE Pharmacology and Pain Management 2 — Questions and Answers
Question 1: Which local anesthetic is safest for a patient with a true amide allergy?
- Lidocaine
- Mepivacaine
- Prilocaine
- Procaine (Novocain) (Correct answer)
Correct answer: Procaine (Novocain)
Procaine is an ester-type local anesthetic and can be used in patients with confirmed allergy to amide local anesthetics, as the two classes are chemically distinct.
Question 2: Methemoglobinemia is a rare but serious side effect associated with which local anesthetic?
- Lidocaine
- Bupivacaine
- Prilocaine (Correct answer)
- Articaine
Correct answer: Prilocaine
Prilocaine's metabolite o-toluidine oxidizes hemoglobin to methemoglobin; this is clinically significant at doses above 400 mg.
Question 3: A patient taking a MAO inhibitor should NOT receive which drug?
- Amoxicillin
- Ibuprofen
- Meperidine (Demerol) (Correct answer)
- Lidocaine
Correct answer: Meperidine (Demerol)
Meperidine combined with MAO inhibitors can cause a serotonin syndrome, characterized by hyperthermia, seizures, and death.
Question 4: The maximum recommended dose of lidocaine with epinephrine in a healthy adult is:
- 3.0 mg/kg (max 200 mg)
- 4.4 mg/kg (max 300 mg)
- 7.0 mg/kg (max 500 mg) (Correct answer)
- 10 mg/kg (max 600 mg)
Correct answer: 7.0 mg/kg (max 500 mg)
The maximum dose of lidocaine with epinephrine is 7.0 mg/kg up to a maximum of 500 mg in a healthy adult patient.
Question 5: Flumazenil is used as an antagonist for which drug class?
- Opioids
- Benzodiazepines (Correct answer)
- Barbiturates
- Antihistamines
Correct answer: Benzodiazepines
Flumazenil is a competitive benzodiazepine receptor antagonist used to reverse the sedative effects of benzodiazepines in overdose or post-procedure.
Question 6: Which antibiotic is the first-line prophylaxis for patients at high risk of infective endocarditis undergoing dental procedures?
- Metronidazole
- Clindamycin
- Amoxicillin (Correct answer)
- Doxycycline
Correct answer: Amoxicillin
Amoxicillin 2 g orally one hour before the procedure is the AHA-recommended first-line prophylaxis for high-risk cardiac patients undergoing dental procedures.
INBDE Pharmacology and Pain Management 2
Which local anesthetic is safest for a patient with a true amide allergy?