Chapter 4, 5, 6,

Local Anestethics

Local Anesthetic, sedation and general anesthesics, drugs for pain

control, (+ corticosteroids)
Simple complement type questions
Instructions: Each of the questions below contains 5 possible answers, one of which is
correct.

Question 1
Acetylsalicylic acid has the following contraindication, with one exception.

a) patients with gastric ulcer

b) patients with bleeding tendencies
c) patients with renal disease
d) patients with ischemic cardiomyopathy
e) asthmatic patients
Correct answer: d.

Question 2
Which of the following dosages of aspirin is recommended for men to prevent stroke and
heart attack (p. 92)?
a. 81 mg/day
b. 325 mg every 3 months
c. 650 mg/day
d. 3g/day
e. 500 mg/day
Correct answer: a.

Question 3 (p. 69)

The concentration (in mg’s) of epinephrine in one (1.7 ml) cartridge of lidocaine 2% with
1:50,000 epinephrine is
a. 0.018.
b. 0.017.
c. 0.09.
d. 0.36.
e. 0.034.
Correct answer: e
Question 4 (p. 69)
The concentration (in mg) of epinephrine in one (1.7 ml) cartridge of lidocaine 2% with
1:100,000 epinephrine is
a. 0.018.
b. 0.017.
c. 0.036.
d. 0.36.
e. 0.054.
Correct answer: b

Question 5
Which of the adverse reaction mentioned below, don’t occur due to long term administration
of cortisone medication?
a) Peptic ulcer
b) Psychiatric disorder
c) Osteoporosis
d) Hypercalcemia
e) Hyperglycaemia
Correct answer: d.

Question 6
Which of the following drugs may interact with OrthoNovum? (pp. 282)
a. Aspirin
b. Tetracycline
c. Chlorhexidine
d. Ibuprofen
e. Vitamin C
Correct answer: d.

Question 7
The following chemical local anaesthetic is used as an antiarrhythmic drug.
a) Procaine
b) Prilocaine
c) Bupivacaine
d) Lidocaine
e) Etidocaine
Correct answer: d

Question 8
Which of the following is the most common medication used to treat patients with
hypothyroidism? (p. 275)
a. Levothyroxine
b. Thyroid USP
c. Liotrix
d. Iodide
e. Propranolol
Correct answer: a

Question 9
Which of the following toxic effects occur with high doses of morphine? (p. 99)
a. Cardiac failure
b. Respiratory depression
c. Muscle paralysis
d. Allergic reaction
e. Hypertension
Correct answer: b

Question 10
Corticosteroids are used for the following affections treatment.
a) Peptic ulcer
b) Osteoporosis
c) Infection treatment
d) Systemic lupus erythematosus (SLE)
e) Diabetes mellitus

Correct answer: d.

Grouped complement type questions

Instructions: Each of the questions below contains 5 response suggestions, of which 2 or 3
may be correct. Mark as:
A, if a, b, c are corect;
B, if a, c, d are correct;
C, if b, d are correct;
D, if a, e is correct.

Question 11
Aspirin has the following drug-drug interactions. (p.93)
a) With anticoagulants
b) Antacids
c) With some oral antidiabetic agents
d) With some antihypotensive medication
e) Antipshycotic medication
Correct answer: A (a,b,c).

Question 12
Which of the following opioids is used for heroin addiction or in narcotic overdose? (p. 99)
a. Naloxone
b. Fentanyl
c. Hydrocodone
d. Morphine
e. Buprenorphine
Correct answer: D (ae)

Question 13
Estrogen is used as:

a) Oral contraceptives in combination with progestins.

b) Treatment of hypercolesterolemia.
c) Prevention and treatment of osteoporosis.
d) Treatment of skin lesions (e.g., acne)
e) treatment of xerostomia.

Correct answer: B (a,c,d).

Question 14
Vasoconstrictor agents are used in combination with local anaesthetics will.
a) Slow the absorption of the agent into the bloodstream
b) Decrease the level of anaesthetic in excess
c) Prolonge the duration of action
d) Decrease the blood flow to the site of injection
e) Has intrinsic analgesic action
Correct answer: B (a,c,d)

Question 15
The following statements on local anaesthetics are correct:
a) The degree of local anesthesia obtained is dependent on the method of administration
b) Local anesthetics are weak acids
c) Absorption into the general circulation is influenced by the level of inflammation
d) Amide local anesthetics are metabolized mainly in the liver by microsomal enzymes
 e) The more the local anaesthetic is water-soluble, the greater the distribution in the
body.
Correct answer: B (a, c, d)

Question 16
Moderate sedation (previously known as conscious sedation) refers to the administration of drugs for the
purpose of

a. sedation (sleepiness),
b. lack of awareness of surroundings (narcosis),
c. amnesia (loss of memory),
d. general analgesia,
e. not responding to physical stimuli during stressful dental/medical procedures.

Correct answer: A

Question 17
Which of the following conditions can be seen in patients taking oral bisphosphonates for the
management of osteoporosis? (pp. 285, 286)

a. Pain or swelling in the area

b. Aphthous ulcer
c. Burning mouth
d. Ulcerative lichen planus
e. Irregular mucosal ulcer with exposed bone in the maxillofacial area
Correct answer: D (a, e)

Question 18
Which of the following anesthetics contains ephinefrin as a vasoconstrictor? (p. 68)

a. Lidocaine
b. Prilocaine
c. Bupivacaine
d. Mepivacaine
f. Benzocaine
Correct answer: A

Question 19
The following statements based on aspirin intoxication are correct.
a) First signs in adults are tinnitus (ringing in the ear) and lost of hearing
b) In children, toxicity is seen with 1 g (1,000 mg)
c) In adults, initially shall be installed respiratory alkalosis
d) In children, precocious shall be installed bradycardia
e) Treatment measures include acidification of the urine
Correct answer: A

Question 20
Aspirin’s pharmacological effects
a) Increases the excretion of uric acid
b) Gastric irritation is more moderate than other salicylates
c) Anti-inflammatory is similar to acetaminophen
d) An increase in glomerular filtration being indicated as adjuvant in renal failure
e) Antalgic action is comparable to paracetamol

Correct answer: D (a, e)

Simple association type questions

Instructions: Choose for each of the notions marked with numbers from 1 to 5,
the most appropriate statement from the ones marked from a to e.
Question 21
1. Methadone
2. Codeine
3. Dextromethorphan
4. hydrocodone
5. Fentanyl
a) is used primarily in anesthesiology.
b) It’s an alkaloid extracted from opium
c) Vicodin is a combination of that drug and acetaminophen
d) is an opioid without any analgesic activity but high antitussive effects
e) Long-Acting Opioid Agonists
Correct answer: 1-e;2-b;3-d;4-c;5-a

Question 22
1. Morphine
2. Codeine
3. Aspirin
4. Acetaminophen
5. Tramadol
a) Synthetic opioid analgesic with low risk of addiction
b) Replace aspirin to treat the moderate intensity pain in patients with history of ulcer
c) May be used in myocardial infarction pain
d) Used for very good antitussive effect
e) The use of buffered preparations slightly diminishes the gastric irritant effect
Correct answer: 1-c;2-d;3-e;4-b;5-a.
Question 23
1. Hydrocortisone
2. Tamoxifen
3. Thyroid USP
4. Dexamethasone
5. Cortisone
a) is naturally occurring
b) has the greatest antiinflammatory activity among steroids
c) Has the least anti-inflammatory effect among steroids
d) is an anti-estrogen drug
e) is derived from animals
Correct answer: 1-c;2-d;3-e;4-b; 5-a.
Question 24 (p.67)
1. Benzocaine
2. Articaine
3. Bupivacaine
4. Prilocaine
5. Mepivacaine
a) Is an analogue of prilocaine
b) is usually used for lengthy dental procedures
c) is an ester local anesthetic
d) brand name is Citanest
e) brand name is Carbocaine
Correct answer: 1-c;2-a;3-b;4-d;5-e.
Question 25
Associate the local anaesthetic with the corresponding pKa:
1. Bupivacaine 0,5%
2. Lidocaine 2%
3. Articaine 4%
4. Prilocaine 4%
5. Mepivacaine 2%
a) 7.9
b) 7.6
c) 7.9
d) 8.1
e) 7.8
Correct answer: 1-d;2-a;3-e;4-c;5-b.
Question 26 (p.65, 68)
Duration of action (with vasoconstrictor) (infiltration) (pulpal anesthesia) of the following local
anestethic is:
 1. Lidocaine 2% (Xylocaine)
2. Bupivacaine
3. Prilocaine
4. Levonordefrin (Neo-Cobefrin)
5. Epinephrine
a) has no cardiac effect on the healthy individual
b) is half as potent a vasoconstrictor as epinephrine
c) is used in medicine as an anti-arrhythmic to control cardiac (heart) excitability.
d) can cause cardiotoxicity (e.g., ventricular arrhythmias)
e) It is metabolized (converted) to O-toluidine
Correct answer: 1-c;2-d;3-e;4-b;5-a.
Question 27
1. Halothane
2. Ketamine
3. Thiopental
4. Droperidol
5. Etomidate
a) Narcotic injectable general anesthetic
b) Sedative/hypnotic injectable general anesthetic
c) volatile liquid general anesthetic
d) Barbiturate injectable general anesthetic
e) Dissociative injectable general anesthetic
Correct answer:
Question 28
1. Aspirin
2. Diflunisal
3. Paracetamol
4. Celecoxib
5. Sulindac
a) is contraindicated in patients with sulfonamide (sulfa) allergy
b) Also known as acetaminophen
c) Is a derivate of acetylsalicylic
d) in high doses (600–900 mg) stimulates the depth and rate of respiration
(hyperventilation).
e) Is an indol derivate.
Correct answer: 1-d;2-c;3-b;4-a;5-e.
Question 29
Associate each drug with the adequate chemical family.
1. Indomethacin
2. Diflunisal
3. Piroxicam
 4. Diclofenac
5. Ketoprofen
a) Salicylates
b) Phenylalkoanoic Acid Derivatives
c) Fenamates
d) Indols
e) Oxicams
Correct answer: 1-d; 2-a; 3-e; 4-c; 5-b.
Question 30 (p.65,
1. Lidocaine
2. Bupivacaine
3. Articaine
4. Etidocaine
5. Mepivacaine
a) It has a unique structure, containing both an amide linkage and as ester side chain
b) is a potent vasodilator
c) It has a rapid onset of action (1½–2 minutes)
d) Maximum recommended dose is 0.6 g/lb or 1.3 mg/kg of body weight for adults with
a maximum dose of 90 mg in
e) The brand name is Duranest

Correct answer: 1-b; 2-d; 3-a; 4-e; 5-c.

COMPOSES ASSOCIATION TYPE QUESTIONS

Instructions: Choose for each notion denoted in letters from a) to e) the appropriate sentences
marked
with 1 and 2. Mark with:
A if 1 matches;
B, if 2 matches;
C, if both 1 and 2 matches;
D, if neither 1 or 2 matches.

Question 31
1. used in the treatment of opioid addiction
2. narcotic agonist
a) Buprenorphine
b) Methadone
c) Tramadol
d) Codeine
e) Naltrexone
Correct answer: a-A; b-A; c-B; d-B; e-A
Question 32
1. Corticosteroid medication
 2. Acetaminophen
a) May cause gastroduodenal ulcer
b) Depress the respiration
c) Exclusively oral administered
d) Anti-inflammatory effect
e) Dislocate drugs on plasma proteins
correct answer: a-A; b-D; c-C; d-A; e-D.

Question 33

1. stimulates both mu () receptors

2. stimulates both kappa () receptors

a) Pentazocine
b) Morphine
c) Buprenorphine
d) Naloxone
e) Methylprednisolone
correct answer: a-A; b-C; c-A; d-D; e-D

Question 34
1. Has amidic structure
2. Has esteric structure
a) Benzocaine
b) Novocaine
c) Mepivacaine
d) Lidocaine
e) Adrenaline
correct answer: a-B; b-B; c-A; d-A; e-D

Question 35
1. It belongs to the pregnancy category C
2. It belongs to the pregnancy category B
a) Articaine
b) Mepivacaine
c) Prilocaine
d) Bupivacaine
e) Lidocaine
correct answer: a-A; b-A; c-B; d-A; e-B
Question 36 (p 74, 308)
1. Clasified as C pregnacy category
2. It is a local anaesthetic with ester structure
a) Etidocaine
b) Bupivacaine
c) Lidocaine 2% (Xylocaine), injectable with EPI 1:100,000
d) Mepivacaine
e) Articaine

correct answer: a-D; b-A; c-D; d-A; e-A.

Question 37 (p. 67, 74)

1. is contraindicated in patients taking a sulfa drug
2. It is a local anaesthetic with ester structure
a) Procaine
b) Lidocaine
c) Benzocaine
d) Tetracaine
e) Cocaine
correct answer: a-B; b-D; c-C; d-C; e-B.

Question 38 (p.78, 83)

1. does not cause respiratory depression and hypotension
2. Can be administered intravenously
a) Enflurane
b) Midazolam
c) Nitrous oxide
d) Halotane
e) Isoflurane
correct answer: a-D; b-B; c-A; d-D; e-D.
Question 39
1. Ibuprophen
2. Acetaminophen
a) is a poor inhibitor of cyclooxygenase in the tissues
b) is a derivative of para-amino phenol
c) Has an indirect analgesic effect by inhibiting the production of prostaglandins
d) high risk for ulcer development in patients with previous GI problems
e) Selectively inhibits cyclooxygenase
correct answer: a-B; b-B; c-C; d-A; e-D.

Question 40
1. Blocks the activity of cyclooxygenase 1 and cyclooxygenase 2
2. Has anti-inflammatory action
a) Aspirin
b) Indomethacin
c) Acetaminophen
d) Pentazocine
e) Celecoxib

Correct answer: a-C; b-C; c-A; d-D; e-B.

CAUSE-EFFECT TYPE QUESTIONS

Instructions: Each of the questions below consists of a phrase composed of 2 sentences joined by an
expression that signifies a causal relationship. Show if each of the two sentences is true and the
causal relationship is real. Mark with:
A, if both sentences are correct and the causal relationship is real
B, if both sentences are correct, but the causal relationship is not real
C if the first sentence is correct and the second is incorrect
D if the first sentence is incorrect and the second is correct
E if both sentences are incorrect

Question 41
Buprenorphine is used the management of opiate addiction because buprenorphine is a
derivative of thebaine, an extract of opium.
Correct answer: B.

Question 42 (p.96)
All NSAIDs are highly plasma protein bound therefore may be associated with warfarin.
Correct answer: C
Question 43 (p.64)
Local anaesthetics are not effective tissues with low pH (when inflamed pH is around 6 or
lower) because when there is a very large difference between the pKa of the local anaesthetic
and the pH of the target tissue, the non-ionized fraction of the drug is very low, insufficient
for action.
Correct answer: A
Question 44 (p.64)
Ester agents have replaced the use of amides because amide agents have lower incidence of
allergies.
Correct answer: D
Question 45 (p.279)
Prednisone is usually the first systemic glucocorticosteroid drug of choice because of low
cost and fewer adverse side effects (sodium and water retention).
correct answer: A.
Question 46
Articaine is usualy not associated with a vasoconstrictor substance because Articaine is a
potent vasoconstrictor? (p. 67)
Correct answer: D
Question 47
Local anaesthesia of poor vascularised areas requires the association of vasoconstrictor
substances because vasoconstrictor substances administered concomitantly with local
anaesthetics can cause local necrosis.
Correct answer: D
Question 48 (p.89)
Non-steroidal anti-inflammatory drugs are used in alergic reactions because inhibition of
leukotriene production prevents bronchocostriction.
Correct answer: C
Question 49
Aspirin can cause gastrointestinal bleeding because aspirin selectively inhibits
cyclooxygenase 2.
Correct answer: B
Question 50 (p.79)
Nitrous oxide (N2O) may be used as an unique anaesthetic agent in surgical anesthesia
because N20 has analgesic properties and lack of major cardiovascular or respiratory
depression.
correct answer: D.