Deck 6: Vasoconstrictors in Dentistry

Question 1

Match the following:

-Adrenergic

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Answer 1

Tissues or cellular receptors that respond to adrenaline

Question 2

Match the following:

-Alpha receptor

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Answer 2

Smooth muscle contraction

Question 3

Match the following:

-Beta1 receptor

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Answer 3

Cardiac stimulation

Question 4

Match the following:

-Beta2 receptor

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Question 5

Match the following:

-Catecholamines

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Question 6

Match the following:

-Epinephrine

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Question 7

Match the following:

-Levonordefrin

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Question 8

Match the following:

-Norepinephrine

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Question 9

Match the following:

-Sympathomimetic

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Question 10

Match the following:

-Vasopressors

A) Adrenaline
B) Mimics sympathetic mediators
C) Smooth muscle relaxation
D) Vasoconstrictor not used in dentistry
E) Tissues or cellular receptors that respond to adrenaline
F) Synthetic catecholamine
G) Cardiac stimulation
H) Adrenal gland neurotransmitters
I) Epinephrine and norepinephrine
J) Smooth muscle contraction

Question 11

Epinephrine, levonordefrin, and phenylephrine are catecholamines.

Question 12

All vasoconstrictors in dentistry stimulate adrenergic receptors.

Question 13

Epinephrine and norepinephrine are indirect-acting sympathomimetic drugs.

Question 14

Epinephrine provides almost equal alpha and beta effects; however, beta effects initially predominate to vasoconstrict vessels.

Question 15

All vasopressors stimulate adrenergic receptors.

Question 16

Vasoconstrictors speed the absorption of local anesthetic drugs.

Question 17

Signs and symptoms of epinephrine overdose include confusion and drowsiness, and are short lived due to the efficiency of epinephrine metabolism.

Question 18

Vasoconstrictors have been associated with more drug interactions than any other drugs in dentistry.

Question 19

Most adverse effects with the use of vasoconstrictors are short lived and easily managed.

Question 20

High blood pressure is always a contraindication to the use of vasoconstrictors in dentistry.

Question 21

Epinephrine may be contraindicated for patients with a previous history of stroke, radiation therapy, or brittle diabetes.

Question 22

Levonordefrin is one-tenth as potent as epinephrine.

Question 23

Cardiac stimulation from levonordefrin is less compared to epinephrine.

Question 24

Levonordefrin is a stronger vasoconstrictor compared to epinephrine because its primary action is 75% alpha.

Question 25

Levonordefrin is less potent than epinephrine therefore it is formulated as 1:20,000.

Question 26

The two vasopressors routinely used in dental local anesthetic drugs in North America are ________ and ________.

Question 27

Epinephrine is an example of a ________ sympathomimetic drug.

Question 28

________ receptors are responsible for smooth muscle contraction in peripheral arteries and veins.

Question 29

________ receptors are responsible for cardiac stimulation.

Question 30

________ receptors are responsible for smooth muscle relaxation such as bronchodilation and vasodilatation.

Question 31

Two receptors contribute to the potential for cardiac dysrhythmias. They are ________ and ________.

Question 32

When vasoconstrictors are used, care should be taken to avoid ________ or injection into vessels.

Question 33

The maximum dose of epinephrine for a healthy adult is ________ per appointment.

Question 34

The maximum dose of epinephrine for a patient with cardiovascular compromise is ________ per appointment.

Question 35

Norepinephrine has a greater tendency to induce tissue necrosis compared with epinephrine and levonordefrin, especially on the ________.

Question 36

Which of the following best explains why vasoconstrictors are effective in increasing durations for local anesthesia?

A) Primary action on alpha receptors causes contraction of smooth muscles in blood vessels
B) Primary action on alpha and beta receptors causes contraction of smooth muscles in blood vessels
C) Primary action of beta receptors causes initial contraction of smooth muscles in blood vessels followed by vasodilation of blood vessels
D) Primary action on alpha receptors causes initial vasodilation of the smooth muscle

Question 37

Which formulation of local anesthetic drug with levonordefrin is available in the United States today?

A) 2% lidocaine; 1:20,000 levonordefrin
B) 4% prilocaine; 1:20,000 levonordefrin
C) 2% mepivacaine; 1:20,000 levonordefrin
D) 3% mepivacaine; 1:20,000 levonordefrin

Question 38

Which statement correctly describes the adrenergic actions of levonordefrin?

A) 50% alpha, 50% beta
B) 75% alpha, 25% beta
C) 25% beta, 75% alpha
D) 90% alpha, 10% beta

Question 39

Epinephrine is metabolized by:

A) COMT and MOA
B) hepatic enzymes
C) renal isoenzymes
D) COMT only

Question 40

Levonordefrin is biotransformed by:

A) COMT and MOA
B) hepatic enzymes
C) renal 450 isoenzymes
D) COMT primarily

Question 41

A one-hour root planing appointment is planned for a patient with significant cardiovascular compromise. Which of the following drugs would be safest and still have adequate duration?

A) 3% mepivacaine plain
B) 4% prilocaine, 1:200,000 epinephrine
C) 2% lidocaine, 1:50,000 epinephrine
D) 2% mepivacaine, 1:20,000 levonordefrin

Question 42

Which of the following is not an indication for the use of a vasoconstrictor?

A) Reducing the risk of toxicity of local anesthetic drugs
B) Prolonging the duration of local anesthetic drugs
C) Providing hemostasis
D) Providing vasodilatation following treatment

Question 43

Which of the following vasoconstrictors is the most useful in providing hemostasis?

A) Levonordefrin
B) Felypressin
C) Epinephrine
D) Phenylephrine

Question 44

What is the maximum dose of epinephrine per appointment for a healthy adult?

A) 1.8 mg
B) 0.2 mg
C) 0.4 mg
D) 4.0 mg

Question 45

What is the maximum dose of epinephrine a patient with significant cardiovascular disease should receive in an appointment?

A) 1.8 mg
B) 0.2 mg
C) 0.04 mg
D) 0.004 mg

Question 46

Which of the following drugs would be the safest for a patient with cardiovascular disease?

A) 4% articaine, 1:200,000 epinephrine
B) 2% mepivacaine,1:20,000 levonordefrin
C) 2% lidocaine, 1:50,000 epinephrine
D) 4% prilocaine plain

Question 47

Which of the following medical conditions does not require precautions when using vasoconstrictors?

A) Liver disease
B) Diabetes with significant cardiovascular disease
C) Radiation therapy of the jaws
D) Cerebrovascular accident/stroke

Question 48

Which of the following is not a sign or symptom of an epinephrine overdose reaction?

A) Nausea
B) Heart racing
C) Bronchospasm
D) Weakness

Question 49

Which vasoconstrictor should be considered for a patient with diabetes and poorly-controlled blood sugar levels when hemostasis is not needed?

A) Epinephrine 1:50,000
B) Epinephrine 1:100,000
C) Levonordefrin 1:20,000
D) Felypressin

Question 50

A crown preparation for tooth 19 is planned for a patient who takes a tricyclic antidepressant. Which of the following drugs represents the best choice for this procedure?

A) 4% prilocaine, 1:200:000 epinephrine
B) 4% articaine, 1:100,000 epinephrine
C) 2% mepivacaine, 1:20,000 levonordefrin
D) 0.5% bupivacaine, 1:200,000 epinephrine

Question 51

Which one of the following patients has a relative contraindication for vasoconstrictor?

A) Heart attack 2 years ago with no current complications
B) Controlled hyperthyroid condition
C) Non-selective beta blocker medication
D) Controlled blood sugars

Question 52

Compare the potency of levonordefrin to the potency of epinephrine.

A) Levonordefrin is one fourth as potent
B) Levonordefrin is one sixth as potent
C) Levonordefrin is twice as potent
D) Levonordefrin is six times as potent

Question 53

A patient calls approximately six hours after a tooth extraction to report an increase in bleeding. What is a likely cause of the increased bleeding?

Question 54

How do vasoconstrictors enhance the effects of local anesthetic drugs?

Question 55

Explain why the avoidance of vasoconstrictor may cause increase risk for a patient with high blood pressure?

Question 56

Explain why the lack of profound anesthesia can result in a spike in blood pressure?