All of the following for the use of cocaine as a local anesthetic are true except: (Select all that apply, one, some, or all)

A. Amide local anesthetics (e.g., lidocaine, bupivacaine, ropivacaine) have a very low risk of allergic reactions. True allergies are rare and usually related to preservatives rather than the amide molecule itself.

B. Ester local anesthetics (e.g., procaine, chloroprocaine, tetracaine) pose a higher risk of allergic reactionsbecause they are metabolized to para-aminobenzoic acid (PABA), which is a known allergen. Patients may develop urticaria, rash, or, rarely, anaphylaxis.

C. Lidocaine is an amide anesthetic, and allergic reactions are extremely rare. Most reported reactions are side effects or sensitivity to preservativesrather than true allergy to the drug.

D. Chloroprocaine is an ester-type local anesthetic, which carries a higher risk of allergic reactionscompared with amide anesthetics. Allergies are uncommon but possible due to PABA metabolites.

E. Cocaine is an ester-type local anestheticand is more likely to cause allergic reactionscompared with amides. Additionally, cocaine has sympathomimetic effectsthat can complicate its use, including cardiovascular stimulation.

A. Trulicity (dulaglutide)is a glucagon-like peptide-1 (GLP-1) receptor agonistused to treat type 2 diabetes mellitus. It is administered via subcutaneous injection once weekly, which can cause patients or even some healthcare providers to mistakenly think it is insulin. Unlike insulin, Trulicity does not directly replace or provide exogenous insulin. Instead, it works through several mechanisms: it stimulates glucose-dependent insulin secretion, suppresses inappropriate glucagon release, slows gastric emptying, and promotes satiety, which helps reduce postprandial and fasting blood glucose. Because it is an injectable agent, proper education about its mechanism, dosing schedule, and differences from insulinis essential to prevent confusion, overdosing, or missed doses.

B. Levemir (insulin detemir)is a long-acting insulin analog. It is actual insulin, so it is not mistaken for insulin; it functions exactly like basal insulin, maintaining glucose control between meals and overnight.

C. Novolog (insulin aspart)is a rapid-acting insulinused for postprandial glucose control. Since it is true insulin, it is not a medication that is “mistaken for insulin.”

D. NPH insulin (neutral protamine Hagedorn)is an intermediate-acting insulin. Like Levemir and Novolog, it is actual insulin and therefore cannot be confused for another class of medication.