Nagelhout - Pharm 2 Exam 2 questions with verified and
answers A+ Grade 2026\2027
Ester Local Anesthetics (5)
- correct answer - Cocaine
- Procaine
- Chloroprocaine
- Tetracaine
- Benzocaine
(only 1 "i" in the name)
Amide Local Anesthetics (6)
- correct answer - Lidocaine
- Prilocaine
- Ropivicaine
- Bupivacaine
- Articaine
- Mepivicaine
(2 "i's" in the name)
Miscellaneous drugs associated with Local Anesthetics
- correct answer - EMLA Cream
- Hyaluronidase
- Oraverse
Three required chemical components of the local anesthetic molecule
- correct answer 1. Lipophilic portion (Benzene ring)
2. Hydrophilic portion (Quarternary amine)
,3. Separated by an Intermediate Chain (either an Ester or Amide chain)
Amide Intermediate bond characteristics
- correct answer NH (positively charged) and Carbonyl oxygen (negatively charged) = attracted to each
other → difficult to separate = difficult to metabolize
Ester Intermediate bond characteristics
- correct answer Oxygen (negatively charged) and Carbonyl oxygen (negatively charged) = repel each
other → open bond = easy to metabolize
All local anesthetics take on these 2 forms to be non-ionized or ionized depending on the pH
- correct answer 1. Quarternary amine (charged nitrogen group) → water soluble
2. Tertiary Amine (non-charged nitrogen group) → lipid soluble
Ester metabolism
1. Metabolized by
2. Metabolized in
3. Fast or slow metabolism
4. Duration of action
5. Longest acting Ester
- correct answer 1. (Location specific) Esterases
2. Everywhere
3. Fast
4. Short
5. Tetracaine
Amide metabolism
1. Metabolized by
2. Metabolized in
3. Fast or slow metabolism
4. Duration of action
, 5. Risk with Amide local anesthetic metabolism
- correct answer 1. Liver enzymes (CYP1A2 and CYP3A4)
2. Liver
3. Slow
4. Long: highly protein bound and liver metabolism
5. Rapid absorption can lead to significant blood level → toxicity
Which local anesthetic type has a higher allergy probability?
- correct answer Esters
1. If a patient is allergic to an ester local anesthetic, are they allergic to all other ester anesthetics?
2. Are they allergic to the amides?
- correct answer 1. Yes
2. No
1. If a patient is allergic to an amide local anesthetic, are they allergic to all other amide anesthetics?
2. Are they allergic to the esters?
- correct answer 1. No
2. No
Local anesthetic mechanism of action (except Benzocaine)
- correct answer 1. Inject local anesthetic into tissue
2. Non-ionized form crosses the membrane
3. In new pH of the cytoplasm, some of the non-ionized LA becomes ionized
4. Ionized LA enters the sodium channel and blocks sodium influx
Benzocaine mechanism of action
- correct answer 1. Inject local anesthetic into tissue
2. Ionized form of the drug enters the sodium channel of the neuron and blocks sodium influx
answers A+ Grade 2026\2027
Ester Local Anesthetics (5)
- correct answer - Cocaine
- Procaine
- Chloroprocaine
- Tetracaine
- Benzocaine
(only 1 "i" in the name)
Amide Local Anesthetics (6)
- correct answer - Lidocaine
- Prilocaine
- Ropivicaine
- Bupivacaine
- Articaine
- Mepivicaine
(2 "i's" in the name)
Miscellaneous drugs associated with Local Anesthetics
- correct answer - EMLA Cream
- Hyaluronidase
- Oraverse
Three required chemical components of the local anesthetic molecule
- correct answer 1. Lipophilic portion (Benzene ring)
2. Hydrophilic portion (Quarternary amine)
,3. Separated by an Intermediate Chain (either an Ester or Amide chain)
Amide Intermediate bond characteristics
- correct answer NH (positively charged) and Carbonyl oxygen (negatively charged) = attracted to each
other → difficult to separate = difficult to metabolize
Ester Intermediate bond characteristics
- correct answer Oxygen (negatively charged) and Carbonyl oxygen (negatively charged) = repel each
other → open bond = easy to metabolize
All local anesthetics take on these 2 forms to be non-ionized or ionized depending on the pH
- correct answer 1. Quarternary amine (charged nitrogen group) → water soluble
2. Tertiary Amine (non-charged nitrogen group) → lipid soluble
Ester metabolism
1. Metabolized by
2. Metabolized in
3. Fast or slow metabolism
4. Duration of action
5. Longest acting Ester
- correct answer 1. (Location specific) Esterases
2. Everywhere
3. Fast
4. Short
5. Tetracaine
Amide metabolism
1. Metabolized by
2. Metabolized in
3. Fast or slow metabolism
4. Duration of action
, 5. Risk with Amide local anesthetic metabolism
- correct answer 1. Liver enzymes (CYP1A2 and CYP3A4)
2. Liver
3. Slow
4. Long: highly protein bound and liver metabolism
5. Rapid absorption can lead to significant blood level → toxicity
Which local anesthetic type has a higher allergy probability?
- correct answer Esters
1. If a patient is allergic to an ester local anesthetic, are they allergic to all other ester anesthetics?
2. Are they allergic to the amides?
- correct answer 1. Yes
2. No
1. If a patient is allergic to an amide local anesthetic, are they allergic to all other amide anesthetics?
2. Are they allergic to the esters?
- correct answer 1. No
2. No
Local anesthetic mechanism of action (except Benzocaine)
- correct answer 1. Inject local anesthetic into tissue
2. Non-ionized form crosses the membrane
3. In new pH of the cytoplasm, some of the non-ionized LA becomes ionized
4. Ionized LA enters the sodium channel and blocks sodium influx
Benzocaine mechanism of action
- correct answer 1. Inject local anesthetic into tissue
2. Ionized form of the drug enters the sodium channel of the neuron and blocks sodium influx
