Question 1

Local anesthetics easily cross the blood-brain barrier.

Accepted Answer

A) True 
 B)False  True

Question 2

What does the membrane expansion theory of the action of local anesthetics suggest?

Accepted Answer

A)  Anesthetics that are highly hydrophilic cause the matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. 
B)  Anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. 
C)  Anesthetics cause the sodium channels to expand, thus allowing the increase in protein binding within the channels. 
D)  All of the above 
A)  Anesthetics that are highly hydrophilic cause the matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. 
B)  Anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. 
C)  Anesthetics cause the sodium channels to expand, thus allowing the increase in protein binding within the channels. 
D)  All of the above B

Question 3

What is the inability to hydrolyze ester local anesthetics and other chemically related drugs called?

Accepted Answer

A)  Atypical pseudocholinesterase 
B)  Low hepatic dysfunction 
C)  Para-aminobenzoic acid intolerance 
D)  None of the above 
A)  Atypical pseudocholinesterase 
B)  Low hepatic dysfunction 
C)  Para-aminobenzoic acid intolerance 
D)  None of the above A

Question 4

Answer the following questions based upon the following case study.
Sam, a businessman who travels extensively, has been in your dental chair for 2 hours for extensive nonsurgical perio procedures. He insisted on having a long appointment in order "to get everything done at one time." A review of Sam's health history reveals that he is taking medications for high blood pressure; has no known allergies; recently quit smoking; and is a recovering alcoholic. He mentions that he is going through a divorce and that he is leaving for China within the week. You explain to Sam that, because of the long appointment and the amount of work that you need to accomplish, you will use a long-lasting local anesthetic to ensure his comfort. You apply topical benzocaine to all injection sites on the right side. You choose to administer the local anesthetic bupivacaine because of its long-lasting effect. Although Sam is a good-natured patient, you experience difficulty in achieving the desired level of anesthesia in order to keep Sam comfortable. Within 5 minutes of the administration of yet another cartridge of anesthetic, Sam begins to complain of a headache and you notice that he is slurring his words. You quickly retake his blood pressure only to discover that it has actually gone down since the beginning of the appointment. What thoughts should be going through your mind at this time?
-Why do you think Sam's blood pressure decreased from the beginning of the appointment?

Accepted Answer

A)  Sam became more comfortable during the appointment. 
B)  Symptoms of a CNS and CVS overdose are biphasic. 
C)  Symptoms of a possible overdose change from a depression phase to a stimulation phase. 
D)  Some combination of the above 
A)  Sam became more comfortable during the appointment. 
B)  Symptoms of a CNS and CVS overdose are biphasic. 
C)  Symptoms of a possible overdose change from a depression phase to a stimulation phase. 
D)  Some combination of the above

Question 5

Intravascular injections significantly increase the possibility of an overdose.

Accepted Answer

A) True 
 B)False

Question 6

Tachyphylaxis is a term used to describe what phenomenon?

Accepted Answer

A)  An increased tolerance to a drug that is administered repeatedly. 
B)  If the dental procedure lasts longer than the duration of the anesthetic and the mantel and core fibers have fully recovered, the reinjection of local anesthetic will be ineffective. 
C)  Once the mantel fibers return to function, the patient experiences pain yet administration of anesthetic does not alleviate the pain. 
D)  All of the above 
A)  An increased tolerance to a drug that is administered repeatedly. 
B)  If the dental procedure lasts longer than the duration of the anesthetic and the mantel and core fibers have fully recovered, the reinjection of local anesthetic will be ineffective. 
C)  Once the mantel fibers return to function, the patient experiences pain yet administration of anesthetic does not alleviate the pain. 
D)  All of the above

Question 7

The higher the pKa of an anesthetic,the faster the onset of action.

Accepted Answer

A) True 
 B)False

Question 8

Why is lipid solubility an important characteristic of local anesthetic drugs?

Accepted Answer

A)  A greater lipid solubility enhances the diffusion of the anesthetic drug through the nerve. 
B)  A greater lipid solubility indicates a higher potency of the anesthetic drug. 
C)  A greater lipid solubility allows for a lower effective dose of the local anesthetic drug. 
D)  All of the above. 
A)  A greater lipid solubility enhances the diffusion of the anesthetic drug through the nerve. 
B)  A greater lipid solubility indicates a higher potency of the anesthetic drug. 
C)  A greater lipid solubility allows for a lower effective dose of the local anesthetic drug. 
D)  All of the above.

Question 9

Which organs of the body will have higher concentrations of anesthetics?

Accepted Answer

A)  High vascular organs 
B)  Low vascular organs 
C)  Brain, heart, liver, kidneys, lungs 
D)  Some combination of the above 
A)  High vascular organs 
B)  Low vascular organs 
C)  Brain, heart, liver, kidneys, lungs 
D)  Some combination of the above

Question 10

Local anesthetics are vasoconstrictors and decrease the absorption of the drug by the blood.

Accepted Answer

A) True 
 B)False

Question 11

Which component of the local anesthetic molecule renders the molecule water soluble?

Accepted Answer

A)  Hydrophilic amino group 
B)  Intermediate hydrocarbon ester or amide chain 
C)  Lipophilic aromatic ring 
D)  All of the above 
A)  Hydrophilic amino group 
B)  Intermediate hydrocarbon ester or amide chain 
C)  Lipophilic aromatic ring 
D)  All of the above

Question 12

What does the specific protein receptor theory of the action of local anesthetics suggest?

Accepted Answer

A)  The specific protein receptor theory suggests that anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. 
B)  The method by which the impulses travel down the length of the nerve affects whether nodes of Ranvier are stimulated or not. 
C)  Displaced Ca++ and local anesthetic drugs compete to bind to receptor sites within the ion channels of cell membranes. 
D)  All of the above 
A)  The specific protein receptor theory suggests that anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization. 
B)  The method by which the impulses travel down the length of the nerve affects whether nodes of Ranvier are stimulated or not. 
C)  Displaced Ca++ and local anesthetic drugs compete to bind to receptor sites within the ion channels of cell membranes. 
D)  All of the above

Question 13

Why is protein binding an important characteristic of local anesthetic drugs?

Accepted Answer

A)  Increased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. 
B)  Increased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. 
C)  Decreased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. 
D)  Decreased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. 
A)  Increased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. 
B)  Increased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. 
C)  Decreased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action. 
D)  Decreased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action.

Question 14

What factor/factors determine the severity of an overdose reaction to local anesthetic?

Accepted Answer

A)  Degree of drop in blood pressure 
B)  Time lapse between the administering of the local anesthetic to the overdose 
C)  Number of symptoms patient experiences 
D)  All of the above 
A)  Degree of drop in blood pressure 
B)  Time lapse between the administering of the local anesthetic to the overdose 
C)  Number of symptoms patient experiences 
D)  All of the above

Question 15

What characteristic of local anesthetic drugs determines the speed of nerve recovery?

Accepted Answer

A)  The concentration of the local anesthetic 
B)  The degree of lipid solubility 
C)  The degree of protein binding 
D)  The nonnervous tissue diffusibility 
A)  The concentration of the local anesthetic 
B)  The degree of lipid solubility 
C)  The degree of protein binding 
D)  The nonnervous tissue diffusibility

Question 16

What is the significant clinical difference between esters and amides?

Accepted Answer

A)  Potential for allergic reactions 
B)  Cross-hypersensitivity 
C)  Lipid solubility 
D)  Drug potency 
A)  Potential for allergic reactions 
B)  Cross-hypersensitivity 
C)  Lipid solubility 
D)  Drug potency

Question 17

What is the purpose of adding a vasoconstrictor to the local anesthetic?

Accepted Answer

A)  To increase the rate of absorption of the anesthetic 
B)  To reduce the rate of absorption of the anesthetic 
C)  To reduce systemic toxicity 
D)  To increase hemostasis 
A)  To increase the rate of absorption of the anesthetic 
B)  To reduce the rate of absorption of the anesthetic 
C)  To reduce systemic toxicity 
D)  To increase hemostasis

Question 18

What is another name for the elimination of the local anesthetic from the blood and tissues?

Accepted Answer

A)  Tachyphylaxis 
B)  Dissociation constant 
C)  Half-life 
D)  Distribution barriers 
A)  Tachyphylaxis 
B)  Dissociation constant 
C)  Half-life 
D)  Distribution barriers

Question 19

What factor/factors influence the duration of the effects of local anesthetics?

Accepted Answer

A)  Degree of protein binding 
B)  Vascularity of injection site 
C)  Addition or absence of a vasoconstrictor 
D)  All of the above 
A)  Degree of protein binding 
B)  Vascularity of injection site 
C)  Addition or absence of a vasoconstrictor 
D)  All of the above

Question 20

Answer the following questions based upon the following case study.
Sam, a businessman who travels extensively, has been in your dental chair for 2 hours for extensive nonsurgical perio procedures. He insisted on having a long appointment in order "to get everything done at one time." A review of Sam's health history reveals that he is taking medications for high blood pressure; has no known allergies; recently quit smoking; and is a recovering alcoholic. He mentions that he is going through a divorce and that he is leaving for China within the week. You explain to Sam that, because of the long appointment and the amount of work that you need to accomplish, you will use a long-lasting local anesthetic to ensure his comfort. You apply topical benzocaine to all injection sites on the right side. You choose to administer the local anesthetic bupivacaine because of its long-lasting effect. Although Sam is a good-natured patient, you experience difficulty in achieving the desired level of anesthesia in order to keep Sam comfortable. Within 5 minutes of the administration of yet another cartridge of anesthetic, Sam begins to complain of a headache and you notice that he is slurring his words. You quickly retake his blood pressure only to discover that it has actually gone down since the beginning of the appointment. What thoughts should be going through your mind at this time?
-Considering Sam's health history,what anesthetic drug may have been a better choice?

Accepted Answer

A)  Procaine 
B)  Articaine with epinephrine 
C)  Lidocaine 
D)  Mepivacaine 
A)  Procaine 
B)  Articaine with epinephrine 
C)  Lidocaine 
D)  Mepivacaine

Local anesthetics easily cross the blood-brain barrier.

What does the membrane expansion theory of the action of local anesthetics suggest?

What is the inability to hydrolyze ester local anesthetics and other chemically related drugs called?

Intravascular injections significantly increase the possibility of an overdose.

Tachyphylaxis is a term used to describe what phenomenon?

The higher the pKa of an anesthetic,the faster the onset of action.

Why is lipid solubility an important characteristic of local anesthetic drugs?

Which organs of the body will have higher concentrations of anesthetics?

Local anesthetics are vasoconstrictors and decrease the absorption of the drug by the blood.

Which component of the local anesthetic molecule renders the molecule water soluble?

What does the specific protein receptor theory of the action of local anesthetics suggest?

Why is protein binding an important characteristic of local anesthetic drugs?

What factor/factors determine the severity of an overdose reaction to local anesthetic?

What characteristic of local anesthetic drugs determines the speed of nerve recovery?

What is the significant clinical difference between esters and amides?

What is the purpose of adding a vasoconstrictor to the local anesthetic?

What is another name for the elimination of the local anesthetic from the blood and tissues?

What factor/factors influence the duration of the effects of local anesthetics?

Local Anesthesia in Dental Hygiene Practice: an Introduction

Neurophysiology

Pharmacology of Vasoconstrictors

Local Anesthetic Agents

Topical Anesthetic Agents

Preanesthetic Assessment

Determining Drug Doses

Armamentariumsyringe Preparation

Anatomic Considerations for the Administration of Local Anesthesia

Basic Injection Techniques

Maxillary Nerve Anesthesia

Mandibular Nerve Anesthesia

Local Anesthetic Complications

Legal Considerations and Risk Management

Filters

Exam 3: Pharmacology of Local Anesthetic Agents

Local anesthetics easily cross the blood-brain barrier.

What does the membrane expansion theory of the action of local anesthetics suggest?

What is the inability to hydrolyze ester local anesthetics and other chemically related drugs called?

Intravascular injections significantly increase the possibility of an overdose.

Tachyphylaxis is a term used to describe what phenomenon?

The higher the pKa of an anesthetic,the faster the onset of action.

Why is lipid solubility an important characteristic of local anesthetic drugs?

Which organs of the body will have higher concentrations of anesthetics?

Local anesthetics are vasoconstrictors and decrease the absorption of the drug by the blood.

Which component of the local anesthetic molecule renders the molecule water soluble?

What does the specific protein receptor theory of the action of local anesthetics suggest?

Why is protein binding an important characteristic of local anesthetic drugs?

What factor/factors determine the severity of an overdose reaction to local anesthetic?

What characteristic of local anesthetic drugs determines the speed of nerve recovery?

What is the significant clinical difference between esters and amides?

What is the purpose of adding a vasoconstrictor to the local anesthetic?

What is another name for the elimination of the local anesthetic from the blood and tissues?

What factor/factors influence the duration of the effects of local anesthetics?

Local Anesthesia in Dental Hygiene Practice: an Introduction

Neurophysiology

Pharmacology of Vasoconstrictors

Local Anesthetic Agents

Topical Anesthetic Agents

Preanesthetic Assessment

Determining Drug Doses

Armamentariumsyringe Preparation

Anatomic Considerations for the Administration of Local Anesthesia

Basic Injection Techniques

Maxillary Nerve Anesthesia

Mandibular Nerve Anesthesia

Local Anesthetic Complications

Legal Considerations and Risk Management

Filters