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Medical Management of Acute Odontogenic Pain
Study Guide
1. What is the mechanism of action of local anesthetic agents?
2. Which local anesthetic agent has intense vasoconstrictive and CNS stimulatory
properties?
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?
4. Why would a local anesthetic agent injected into an infected area produce less
than optimal results?
5. Why vasoconstrictors are often administered together with local anesthetic
agents?
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?
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 selfinflict injuries on anesthetized regions of the body?
8. The use of which local anesthetic agent has been associated with
methemogloninemia in susceptible patients?
9. Which of the available local anesthetic agent has a thiophene nucleus?
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?
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.
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?
13. What are the pharmacological characteristics of acetaminophen (Tylenol)?
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?
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
16. Cyclooxygenase (COX)-1 inhibitors impair platelet adhesion and aggregation
primarily by what mechanism?
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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?
18. What are the pathognomonic signs of opioid overdose?
19. How would you reverse opioid toxicity?
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