Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
             as the 
ASA class 3 cardiovascular disease patient, 
may receive up to four cartridges (36 μg) of 
prilocaine with epinephrine 
 
plain 
prilocaine 
or 
prilocaine 
with 
epinephrine 
1:200,000 
is 
strongly 
recommended for:  
 
● epinephrine-sensitive patients 
● requiring 
prolonged 
pulpal 
anaesthesia (≥60 minutes) 
Why ? —>  
 
● rapidly biotransformed. 
● So considered to be a safe LA. 
● lower toxicity. 
 
Prilocaine is relatively contraindicated in 
patients with : 
 
1. idiopathic 
or 
congenital 
methemoglobinemia. 
2. Hemoglobinopathies 
(sickle 
cell 
anaemia). 
3. Anaemia. 
4. Cardiac or respiratory failure. 
(evidenced 
by 
hypoxia 
because  
methemoglobin 
levels 
are 
increased, 
decreasing oxygen-carrying capacity)  
5. receiving 
acetaminophen 
or 
phenacetin (both of which produce 
elevations in methemoglobin levels) 
 
It has been claimed that 4% prilocaine 
hydrochloride solution (with or without a 
vasopressor) is associated :  
 
● With a higher risk of paresthesia, 
primarily of the lingual nerve. 
● More 
neurotoxic 
than 
other 
commonly used LA formulations 
 
 
 
Articaine Hydrochloride 
Classification 
Hybrid molecule. Classified as an amide; 
however, it possesses both amide and ester 
characteristics 
Potency 
1.5 times that of lidocaine. 
 1.9 times that of procaine. 
Toxicity 
Similar to that of lidocaine and procaine 
Metabolism 
occurs in both :  
1. Plasma —> hydrolysis by plasma 
esterase ( like other ester LA). 
2. Liver —> hepatic microsomal 
enzymes ( like other amide LA). 
Excretion 
Via the kidneys; approximately 5% to 10% 
unchanged, approximately 90% metabolites 
Vasodilating properties 
vasodilating effect equal to that of 
lidocaine. 
Procaine is slightly more vasoactive 
pKa 
7.8 
pH of vasoconstrictor-containing solution 
4.0 to 5.5 
Onset of action 
onset within 1 to 9 minutes of injection 
 
Pulpal anaesthesia:  
● lasts approximately 1 hour for 
infiltrations 
● up 
to 
approximately 
2 
hours 
following nerve block 
Effective dental concentration 
4% with epinephrine 1:100,000 / 1:200,000. 
Anaesthetic half-life 
0.5 hours (27 minutes) 
Pregnancy classification 
C 
Nursing mothers 
Not known whether articaine is excreted in 
human milk however When using articaine, 
nursing mothers may choose to pump and 
discard breast milk for approximately 4 hours 
(based on plasma half-life) following an 
injection of articaine (to minimise infant 
ingestion) and then resume breastfeeding. 
Paediatric use 
● Safety and efficacy  in paediatric 
patients < 4 years have not been 
established 
● In children aged 4 to 16 years —> 
quantity to be injected should be 
determined by the age and weight of 
the child and the magnitude of the 
operation 
● The maximum dose of 4% articaine 
hydrochloride should not exceed 7 
mg/kg. 
Maximum recommended dose 
The FDA MRD is 7.0 mg/ kg body weight, or 
3.2 mg/lb body weight, for the adult patient. 
Comments 
 
1. Clinically, it is claimed that following 
maxillary buccal

            Quiz: