INBDE Pharmacology and Pain Management 1 — Questions and Answers
Question 1: Which local anesthetic has the longest duration of action?
- Lidocaine
- Mepivacaine
- Bupivacaine (Correct answer)
- Prilocaine
Correct answer: Bupivacaine
Bupivacaine (Marcaine) has the longest duration of pulpal and soft tissue anesthesia among common dental local anesthetics due to its high protein-binding affinity.
Question 2: Epinephrine is added to local anesthetic solutions primarily to:
- Decrease the pH of the solution
- Prolong the duration of anesthesia by causing vasoconstriction (Correct answer)
- Increase the rate of absorption
- Prevent allergic reactions
Correct answer: Prolong the duration of anesthesia by causing vasoconstriction
Epinephrine causes local vasoconstriction, reducing the rate of systemic absorption of the local anesthetic and thereby prolonging its duration and reducing toxicity.
Question 3: A patient taking warfarin requires a dental extraction. The INR is 2.5. The most appropriate management is to:
- Stop warfarin 3 days before extraction
- Proceed with extraction using local hemostatic measures (Correct answer)
- Refer to physician to switch to heparin
- Postpone treatment indefinitely
Correct answer: Proceed with extraction using local hemostatic measures
For patients on warfarin with an INR ≤3.5, routine dental extractions can proceed safely with local hemostatic measures such as pressure and sutures.
Question 4: Which analgesic is contraindicated in patients with aspirin-exacerbated respiratory disease (AERD)?
- Acetaminophen
- Codeine
- Ibuprofen (Correct answer)
- Tramadol
Correct answer: Ibuprofen
NSAIDs like ibuprofen inhibit COX-1, shunting arachidonic acid toward leukotriene production, which triggers bronchoconstriction in patients with AERD.
Question 5: Tetracyclines are contraindicated in children under 8 years of age because they:
- Cause nephrotoxicity
- Cause permanent tooth discoloration and enamel hypoplasia (Correct answer)
- Inhibit bone growth
- Cause hepatic failure
Correct answer: Cause permanent tooth discoloration and enamel hypoplasia
Tetracyclines chelate calcium and incorporate into developing teeth and bone, causing permanent yellow-gray discoloration and enamel hypoplasia in children under 8.
Question 6: Which benzodiazepine is most commonly used for IV conscious sedation in dentistry?
- Diazepam
- Midazolam (Correct answer)
- Lorazepam
- Triazolam
Correct answer: Midazolam
Midazolam is preferred for IV conscious sedation in dentistry due to its rapid onset, short duration, water solubility, and superior amnestic properties.
INBDE Pharmacology and Pain Management 1
Which local anesthetic has the longest duration of action?