Pharmacology, Anesthesia, and Infection Control
Core concepts
Pharmacology: local anesthetics (lidocaine, articaine, mepivacaine), vasoconstrictors, maximum doses, and adverse reactions. Analgesics (NSAIDs, paracetamol, opioids), antibiotics (amoxicillin, clindamycin, metronidazole), and antifungals. Know drug interactions and precautions (epinephrine in cardiac patients, lidocaine in liver disease). Anesthesia: inferior alveolar nerve block landmarks, complications (positive aspiration, nerve injury, trismus), and emergency management (syncope, anaphylaxis, local anesthetic toxicity). Infection control: standard precautions, sterilization (autoclave cycles), hand hygiene, and sharps safety.
Traps
Maximum doses are commonly tested: lidocaine 4.4 mg/kg (max 300 mg), articaine 7 mg/kg (max 500 mg), mepivacaine 6.6 mg/kg. Epinephrine concentration 1:100,000 = 0.01 mg/mL. Antibiotics are not indicated for routine pulpitis or dry socket. Positive aspiration in IANB is most common with the inferior alveolar artery. Sterilization monitoring includes biological (spore) tests, not just chemical indicators.
Worked example
Rule of thumb: "Calculate max dose = mg/kg × weight, then divide by concentration to get mL." A 60 kg patient: lidocaine max = 4.4 × 60 = 264 mg; with 2% lidocaine (20 mg/mL), that is 13.2 mL. For a patient allergic to penicillin, clindamycin is a common alternative. Always confirm emergency drugs and equipment before sedation.