Mepivacaine MCQs With Answer

Mastering mepivacaine is essential for B.Pharm students preparing for exams and clinical practice. This focused set of Mepivacaine MCQs With Answer explores mechanism of action, physicochemical properties (amide class, pKa, lipid solubility), pharmacokinetics (absorption, hepatic metabolism, half‑life), clinical uses, formulations (plain versus with epinephrine), dosing considerations, adverse effects and management of toxicity. Questions progress from foundational concepts to applied scenarios requiring calculation and clinical reasoning, reinforcing safe administration, monitoring and emergency responses such as lipid rescue. Use these items to deepen your understanding of local anesthetic pharmacology and improve exam readiness. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which class of local anesthetic does mepivacaine belong to

• Isoester class of local anesthetics
• Amide class of local anesthetics
• Synthetic opioid local anesthetic
• Ester-prodrug local anesthetic

Correct Answer: Amide class of local anesthetics

Q2. What is the primary molecular target of mepivacaine in nerve cells

• Voltage-gated calcium channels
• Voltage-gated sodium channels
• GABA-A receptors
• Nicotinic acetylcholine receptors

Correct Answer: Voltage-gated sodium channels

Q3. How does mepivacaine produce local anesthesia at the nerve membrane level

• By increasing potassium conductance
• By stabilizing the inactive state of sodium channels and preventing depolarization
• By blocking acetylcholine release at neuromuscular junctions
• By antagonizing NMDA receptors

Correct Answer: By stabilizing the inactive state of sodium channels and preventing depolarization

Q4. Mepivacaine has a pKa of approximately 7.6. How does this pKa affect its onset of action compared with an anesthetic with pKa 8.1

• Higher pKa gives faster onset
• Lower pKa results in a larger fraction of nonionized drug at physiological pH and therefore faster onset
• pKa does not influence onset
• Lower pKa results in slower onset due to reduced potency

Correct Answer: Lower pKa results in a larger fraction of nonionized drug at physiological pH and therefore faster onset

Q5. Which property primarily determines the potency of mepivacaine

• pKa value
• Lipid solubility
• Protein binding in plasma
• Presence of epinephrine

Correct Answer: Lipid solubility

Q6. Compared with lidocaine, mepivacaine is best described as

• An ester with slower onset
• A more cardiotoxic amide with extremely long duration
• An amide local anesthetic with similar onset and intermediate duration
• An opioid analgesic used for regional blocks

Correct Answer: An amide local anesthetic with similar onset and intermediate duration

Q7. The addition of epinephrine to a mepivacaine solution primarily results in

• Increased systemic absorption and shorter duration
• Vasodilation at the injection site
• Reduced systemic absorption and prolonged duration of action
• Direct antagonism of sodium channel block

Correct Answer: Reduced systemic absorption and prolonged duration of action

Q8. Which route of metabolism is most relevant for mepivacaine elimination

• Hydrolysis by plasma cholinesterases
• Hepatic microsomal metabolism (amide biotransformation)
• Renal tubular secretion of unchanged drug only
• Intestinal bacterial hydrolysis

Correct Answer: Hepatic microsomal metabolism (amide biotransformation)

Q9. A key clinical sign of local anesthetic systemic toxicity (LAST) that should alert a clinician is

• Gradual onset hypertension only
• Tinnitus, perioral numbness, and metallic taste followed by CNS excitation
• Isolated skin rash without neurologic symptoms
• Delayed wound healing at injection site

Correct Answer: Tinnitus, perioral numbness, and metallic taste followed by CNS excitation

Q10. First-line initial treatment for severe cardiac toxicity from mepivacaine includes

• High-dose benzodiazepines only
• Immediate intravenous lipid emulsion therapy in addition to advanced cardiac life support measures
• Oral activated charcoal
• Topical vasoconstrictor application

Correct Answer: Immediate intravenous lipid emulsion therapy in addition to advanced cardiac life support measures

Q11. Which statement about allergic reactions to mepivacaine is correct

• Paraben preservatives are the most common cause of allergy to amide anesthetics
• Amide anesthetics like mepivacaine commonly cause PABA-mediated allergies
• True IgE-mediated allergy to amide local anesthetics is rare
• All amide anesthetics are contraindicated in patients with sulfa allergy

Correct Answer: True IgE-mediated allergy to amide local anesthetics is rare

Q12. Which clinical factor increases the risk of systemic toxicity from mepivacaine

• Injecting into highly vascular tissue or intravascular injection
• Adding vasoconstrictor such as epinephrine
• Using the smallest effective dose
• Using slow incremental injection with aspiration checks

Correct Answer: Injecting into highly vascular tissue or intravascular injection

Q13. The order of loss of nerve function during local anesthesia is best described as

• Motor, touch, pain, temperature
• Pain, temperature, touch, motor
• Touch, pain, motor, temperature
• Temperature, motor, pain, touch

Correct Answer: Pain, temperature, touch, motor

Q14. Which physicochemical parameter explains why mepivacaine diffuses into nerve membranes effectively

• High molecular weight only
• Lipid solubility allowing membrane penetration
• Very high water solubility prevents membrane entry
• Complete plasma protein binding prevents tissue penetration

Correct Answer: Lipid solubility allowing membrane penetration

Q15. In a patient with severe hepatic impairment, mepivacaine dosing should be

• Unchanged because renal excretion is the main route
• Adjusted lower due to reduced hepatic metabolism and increased systemic exposure
• Increased because of decreased protein binding
• Switched to an ester local anesthetic because amides are safer

Correct Answer: Adjusted lower due to reduced hepatic metabolism and increased systemic exposure

Q16. Which structural feature distinguishes mepivacaine from ester local anesthetics

• Presence of an ester linkage in the intermediate chain
• Amide bond linking aromatic and tertiary amine groups
• Absence of a tertiary amine
• Conjugated double bonds in the aromatic ring

Correct Answer: Amide bond linking aromatic and tertiary amine groups

Q17. A pharmacist is counseling about mepivacaine use. Which statement about onset and duration is correct

• Mepivacaine has extremely slow onset and very short duration
• Mepivacaine typically has a rapid to intermediate onset and intermediate duration
• Mepivacaine onset is slower than bupivacaine and lasts much longer
• Mepivacaine provides permanent nerve blockade after a single dose

Correct Answer: Mepivacaine typically has a rapid to intermediate onset and intermediate duration

Q18. Which is the most appropriate monitoring after a large-dose mepivacaine regional block

• No monitoring is necessary for healthy adults
• Continuous cardiac and respiratory monitoring for early detection of LAST
• Only blood pressure every 24 hours
• Only routine wound checks at 1 week

Correct Answer: Continuous cardiac and respiratory monitoring for early detection of LAST

Q19. Which of the following increases the fraction of nonionized mepivacaine and speeds onset

• Lowering tissue pH (acidosis)
• Using an anesthetic with higher pKa
• Alkalinization of the anesthetic solution or raising tissue pH
• Increasing temperature of the solution to 0°C

Correct Answer: Alkalinization of the anesthetic solution or raising tissue pH

Q20. Which laboratory finding would suggest decreased protein binding of mepivacaine increasing free drug fraction

• Hypoalbuminemia
• Elevated hemoglobin
• Hyperalbuminemia
• Normal plasma protein levels

Correct Answer: Hypoalbuminemia

Q21. In dental local anesthesia, mepivacaine is sometimes preferred because it

• Has an exceptionally long motor block useful for dental surgery
• Provides adequate anesthesia without a vasoconstrictor and has a moderately long duration
• Is an ester and rapidly hydrolyzed in saliva
• Always causes less pain on injection than other agents

Correct Answer: Provides adequate anesthesia without a vasoconstrictor and has a moderately long duration

Q22. Which statement about mepivacaine and pregnancy is most appropriate for B.Pharm students to remember

• Mepivacaine is absolutely contraindicated in all pregnant patients
• Local anesthetics cross the placenta; benefits and risks must be weighed and dosing adjusted when necessary
• Mepivacaine does not cross the placenta at all
• No monitoring is needed for mother or fetus after administration

Correct Answer: Local anesthetics cross the placenta; benefits and risks must be weighed and dosing adjusted when necessary

Q23. Which clinical scenario is most likely to increase risk of intravascular injection during mepivacaine administration

• Use of ultrasound-guided nerve block with incremental aspiration
• Injection into highly vascular tissue without aspiration or incremental dosing
• Use of small-volume subcutaneous infiltration only
• Topical application on intact skin

Correct Answer: Injection into highly vascular tissue without aspiration or incremental dosing

Q24. Which of the following best describes one pharmacokinetic advantage of adding epinephrine to mepivacaine

• Epinephrine increases renal excretion of mepivacaine
• Epinephrine decreases local blood flow, reducing systemic absorption and prolonging local effect
• Epinephrine converts mepivacaine into a prodrug with longer action
• Epinephrine reduces hepatic metabolism directly

Correct Answer: Epinephrine decreases local blood flow, reducing systemic absorption and prolonging local effect

Q25. Which symptom indicates progression from CNS excitation to CNS depression in LAST

• Restlessness and disorientation followed by seizures and then respiratory depression
• Only mild itching with no neurologic signs
• Sustained hypertension without neurologic signs
• Improvement of symptoms without treatment

Correct Answer: Restlessness and disorientation followed by seizures and then respiratory depression

Q26. Which factor does NOT significantly affect the clinical duration of a mepivacaine nerve block

• Use of a vasoconstrictor
• Lipid solubility of the drug
• Size of nerve fibers blocked
• Ambient room lighting

Correct Answer: Ambient room lighting

Q27. Which metabolite elimination route is most relevant after hepatic metabolism of mepivacaine

• Excretion of metabolites in urine
• Exhalation via lungs unchanged
• Fecal elimination of unchanged parent drug only
• Metabolites trapped in adipose tissue indefinitely

Correct Answer: Excretion of metabolites in urine

Q28. For intrathecal or epidural anesthesia, mepivacaine should be used with caution because

• Its systemic toxicity profile and dosing must be carefully controlled to avoid high spinal or LAST
• It is inactive in spinal spaces
• It always causes irreversible spinal cord damage
• It is rapidly inactivated by cerebrospinal fluid esterases

Correct Answer: Its systemic toxicity profile and dosing must be carefully controlled to avoid high spinal or LAST

Q29. Which monitoring parameter is most sensitive for early detection of cardiovascular toxicity from mepivacaine

• Capillary refill time only
• Continuous ECG monitoring for arrhythmias and conduction changes
• Daily liver function tests
• Complete blood count once a week

Correct Answer: Continuous ECG monitoring for arrhythmias and conduction changes

Q30. In therapeutic decision-making, the pharmacist advises that mepivacaine should be avoided or dosage reduced in patients with which condition

• Mild, well-controlled seasonal allergies
• Severe hepatic impairment with reduced metabolic capacity
• History of minor skin abrasion
• Controlled hypothyroidism with stable replacement therapy

Correct Answer: Severe hepatic impairment with reduced metabolic capacity

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