Clinical Pharm Dental Pain

Front 1

What is the mechanism of action of local anesthetic agents?

Back 1

-transient blockage of Na channels, disrupting the transmission of electrical impulses, from cytosolic side

Front 2

Which local anesthetic agent has intense vasoconstrictive and CNS stimulatory properties?

Back 2

Cocaine

Front 3

3. If a local anesthetic agent is available in a 0.5% aqueous solution and the maximum safe dose over a 4-hour period is 30 mg, how may milliliters of the formulation can be administered to the patient within a 4-hour period?

Back 3

-9mg/cartridge -> ~3 cartridges

Front 4

4. Why would a local anesthetic agent injected into an infected area produce less than optimal results?

Back 4

-infected areas have a lower pH, so the LA will not be buffered to the nonionized form, which will prevent it from crossing the membrane & blocking the Na channels
-increased vascularity washed the LA away from the site more quickly
-inflammatory mediators sensitize the nerve

Front 5

5. Why vasoconstrictors are often administered together with local anesthetic agents?

Back 5

-to reduce the speed at which the LA is washed away from the site of administration

Front 6

6. If the maximum recommended dose of mepivacaine (Carbocaine) for a given patient is 300 mg, how many milliliters of 3% mepivacaine may be administered to that patient during an appointment?

Back 6

-54 mg/cartridge -> ~5cartridges -> ~9mL
1.8 mL per cartridge

Front 7

7. Which local anesthetic agent is potentially the most cardiotoxic (triggers arrhythmias) and may also be the most problematic in the management of children, the mentally retarded or otherwise debilitated patients who may self-inflict injuries on anesthetized regions of the body?

Back 7

bupivicaine

Front 8

8. The use of which local anesthetic agent has been associated with methemogloninemia in susceptible patients?

Back 8

-articaine & prilocaine (benzocaine as topical can accelerate the rate)

Front 9

9. Which of the available local anesthetic agent has a thiophene nucleus?

Back 9

Articaine (Septocaine)

Front 10

10. Your patient relates a history of cardiovascular disease. Based on this evidence and the functional capacity of the patient you have determined that the maximum safe dose of epinephrine for this patient should not exceed 0.04 mg. What are the dosages of the various currently available formulations, which represent the maximum safe dose of a 2 % local anesthetic agent with epinephrine or levonordefrin?

Back 10

-1:50,000: 1 cartridges
-1:100K: 2 cartridges
-1:200K: 4 cartridges

Front 11

11. Recognize the signs and symptoms associated with adverse reactions to local anesthetics, such as allergic reactions, vasopressor response, epinephrine-induced sympathetic reaction, and toxic reaction.

Back 11

-allergic reactions: angioedema, urticaria; epithelial: edema, desquamation, necrosis; nervous: anesthesia, paresthesia, neuritis
-vasopressor response: (adrenergic) pallor, tachycardia, hyperventilation, mydariasis, clonic activity, (cholinergic) perspiration, salivation, nausea, bradycardia, hypotension, syncope
-epi-induced sympathetic reaction: (mild) restlessness, HA, tremor, dizziness, pallor; (severe) palpitation, tachycardia, chest pain, ventricular fibrillation, cardiac arrest
-toxic reaction: lightheadedness, tremors, disorientation, altered mood, slurred speech, visual & auditory disturbances, clonic seizure, sedation, lethargy, coma, respiratory depression, bradycardia, hypotension, cardiac arrest

Front 12

12. Which analgesics is a weak inhibitor of peripheral prostaglandin synthesis, although it does appear to be a more effective COX-inhibitor in the CNS?

Back 12

Acetaminophen

Front 13

13. What are the pharmacological characteristics of acetaminophen (Tylenol)?

Back 13

-COX3 inhibitor (anti-pyretic)

Front 14

14. The conclusion that the COX-1 inhibitor ibuprofen alone, or in combination with APAP, should be the drug of choice for the management of moderate-to-severe (somatic) odontogenic pain is based on what evidence?

Back 14

-they have different mechanisms & metabolism; ibuprofen has been shown to be the most effective against odontogenic pain (which is mostly inflammation-related) & Tylenol has been shown to be effective for breakthrough pain

Front 15

15. The conclusion that the COX-1 inhibitor ibuprofen in combination with oxycodone, should be the drug of choice for the management of severe (visceral) odontogenic pain is based on what evidence

Back 15

-more effective for treating odontogenic pain than codeine w/ Tylenol

Front 16

16. Cyclooxygenase (COX)-1 inhibitors impair platelet adhesion and aggregation primarily by what mechanism?

Back 16

-arachidonic acid breakdown product TXA is involved in activating platelet aggregation

Front 17

17. Which analgesics should be used with caution in patients with severe hepatic disease, vitamin K deficiency, during treatment with anticoagulants, and in patients with hemophilia because severe hemorrhage may result?

Back 17

-acetaminophen

Front 18

18. What are the pathognomonic signs of opioid overdose?

Back 18

-miosis & respiratory depression & constipation

Front 19

19. How would you reverse opioid toxicity?

Back 19

-opioid antagonist (naloxone, naltrexone)