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minor oral surgery > Articaine > Flashcards

Articaine Flashcards

1
Q

Articaine was originally synthesised as …

A

carticaine

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2
Q

In what form is articaine available in?

A

4% solution
containing 1:100 000 or 1:120 000 adrenaline

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3
Q

What characteristic of articaine is responsible for its increased lipid solubility and thus increased potency?

A

contains a thiophene ring as opposed to a benzene ring

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4
Q

Briefly outline how articaine is inactivated

A
  • articaine is an amide LA with an ester sidechain hence it can be inactivated by serum esterases; 90% of articaine is hydrolysed
  • the amide linkaage undergoes liver transformation
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5
Q

How is articaine excreted?

A
  • articaine following hydrolysis produces inactive articainic acid
  • it is then excreted via the liver as articainic acid glucoronide
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6
Q

What is the elimination serum half life of articaine?

A

20 minutes

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7
Q

What is the elimination serum half-life of articainic acid?

A

64 minutes

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8
Q

Suggest the reason why articaine is permitted to be used in higher concentrations compared to other amide LAs

A
  • equal analgesic efficacy
  • lower systemic toxicity (a wide therapeutic range)
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9
Q

Suggest a reason for increased duration of activity of articaine

A

high degree of protein binding

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10
Q

There is no correlation between the serum concentration and the local anaesthetic effect of articaine. True or false

A

True

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11
Q

What is anaesthetic success of sound teeth defined as?

A

(in healthy volunteers) it is defined as the ability to achieve 2 or more consecutive EPT readings of 80

EPT- electric pulp testing

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12
Q

What supplemental injection increases the success rate of an IANB for articaine when compared to lidocaine ?

A

a supplemental buccal infiltration

(specifically adjacent to the mandibular 1st molar)

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13
Q

With regards to maxillary extractions, what type of LA may be forgone?

A

palatal infiltrations

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14
Q

Following a meta-analysis, what LA is most likely to achieve anaesthetic succes in the first molar region? What are the issues with this meta-analysis ?

A

articaine

(over lidocaine)

However, the meta-analysis did not take into account
* local inflammation
* varying LA administration techniques e.g. IANB

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15
Q

Why are teeth with irreversible pulpitis more difficult to anaesthetise?

A
  • this is because nerves arising from inflammed tissue have altered resting potentials and decreased excitability thresholds
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16
Q

What does VAS refer to?

A

Visual Analogue scale

17
Q

Articaine has not been shown to be superior to lidocaine or mepivacaine in achieving adequate pain control during endodontic treatment in mandibular teeth with irreversible pulpitis when IANB or Gow-Gates Block is delivered. True or false

A

True

18
Q

VAB refers to …

A

Vazirani Akinosi Block

19
Q

What common adverse articaine reactions have been reported in children?

A
  • soft tissue injury
  • prolonged numbness particularly in those <7
20
Q

What is the age restriction of articaine (imposed by manufacturer)?

A

does not recommend articaine use for children under 4 years old

21
Q

What does the current literature for articaine use on children conclude?

A

that it is safe and effective for clinical procedures in children of all ages

22
Q

Outline some adverse effect of local anaesthetics

A
  • dizziness
  • disorientation
  • tremors
  • convulsions
  • seizures
  • hypotension
  • cardiac and respiratory depression
23
Q

Outline adverse reactions to articaine that have been reported

A
  • hypersensitivity
  • opthalmologic complications
  • ischaemic skin necrosis
  • fever
  • chills
  • arthralgia
24
Q

It has been suggested by some restrospective reports that articaine is most commonly associated with …

A

parasthesia

25
Q

Outline the proposed theories regarding the susceptibility of the lingual nerve to damage

A
  • direct needle trauma
  • intraneural haematoma formation
  • local anaesthetic toxicity
  • fascicular pattern
26
Q

As of 2011 there is more than one RCT comparing articaine with other LAs reporting adverse effects. True or false

A

false

as of 2011 there is only one such RCT

27
Q

There is no conclusive evidence demonstrating neurotoxicity or significantly superior anaesthetic properties of articaine for dental procedures.True or false

A

True

28
Q

At this time, the decision to use articaine cannot be based on evidence of superiority over other LA drugs. What will the decision to usea articaine depend on ?

A
  • personal preference
  • experience of individual clinicians

minor oral surgery (36 decks)

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