NAGELHOUT PHARM 2 PRACTICE EXAM 2026
FULL QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ Amide Local Anesthetics (6). Answer: - Lidocaine
- Prilocaine
- Ropivicaine
- Bupivacaine
- Articaine
- Mepivicaine
(2 "i's" in the name)
◉ Miscellaneous drugs associated with Local Anesthetics. Answer: -
EMLA Cream
- Hyaluronidase
- Oraverse
◉ Three required chemical components of the local anesthetic molecule.
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. Answer: NH (positively
charged) and Carbonyl oxygen (negatively charged) = attracted to each
other → difficult to separate = difficult to metabolize
◉ Ester Intermediate bond characteristics. 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. 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. 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. 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?. 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?. Answer: 1. Yes
2. No
◉ 1. If a patient is allergic to an amide local anesthetic, are they allergic
to all other amide anesthetics?
FULL QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ Amide Local Anesthetics (6). Answer: - Lidocaine
- Prilocaine
- Ropivicaine
- Bupivacaine
- Articaine
- Mepivicaine
(2 "i's" in the name)
◉ Miscellaneous drugs associated with Local Anesthetics. Answer: -
EMLA Cream
- Hyaluronidase
- Oraverse
◉ Three required chemical components of the local anesthetic molecule.
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. Answer: NH (positively
charged) and Carbonyl oxygen (negatively charged) = attracted to each
other → difficult to separate = difficult to metabolize
◉ Ester Intermediate bond characteristics. 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. 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. 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. 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?. 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?. Answer: 1. Yes
2. No
◉ 1. If a patient is allergic to an amide local anesthetic, are they allergic
to all other amide anesthetics?
