• Local Anesthetic

Amides are primarily metabolized in liver; while esters are hydrolyzed by plasma pseudocholinesterase. If the dental clinician doesn't know the magnitude of the patient's liver problem, esters may be the better choice (Benzocaine) as they may lessen the risk of an adverse drug reaction or medical complication. However, studies have shown that the use of lidocaine (an amide), when carried out appropriately, has not been associated with any side effects. Studies have also shown a prolonged effect to local anesthetic agents by alcoholics, and also that long-term heavy drinkers, when sober, are more difficult to anesthetize and have a decreased reaction to barbiturates, sedatives, bonzodiazepines and other similar drugs. The effects are just the opposite when the patient is inebriated, though. Other studies have shown that alcoholics in recovery are not at an increased risk for inadequate pain control with local anesthetic agents.

Systemic complications that affect the patient's cardiovascular system make alcoholic patients susceptible to the stress some experience when undergoing dental treatment. Therefore, it is critical that adequate local anesthesia is used, with vasoconstrictor, to increase the efficacy of the anesthetic and also to diminish its systemic absorption.

 

Ester local anesthetics are primarily metabolized in the liver. Amides are hydrolyzed by plasma pseudocholinesterase. a. the first statement is true, the second statement is true b. the first statement is false, the second statement is true c. the first statement is true, the second statement is false d. the first statement is false, the second statement is false

 

Since dental treatment may be stressful for alcoholic patients, it is advisable to: a. eliminate any stress by delaying dental treatment until they are calm b. use only topical anesthetic for mild anesthesia to avoid the stress of an injection c. use adequate amounts of local anethesia to eliminate pain which can cause stress d. avoid any injections as they are the source of most stress for a patient

 

• Antibiotics

Tetracycline and erythromycin are metabolized by the liver and should therefore be used with caution. Penicillins and cephalosporins are excreted in the urine and are unaffected by liver damage that may be present.

 

Antibiotics that are metabolized by the liver and should be used with caution on an alcoholic patient include: a. tetracycline b. penicillin c. cephalosporin d. erythromycin [mark all correct answers]

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