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Flashcards in Esther Anesthetics/topica Deck (22)
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1
Q

What are the general principles for local and ester anesthetics?

A
  • NETCC
  • N=Need
  • E=Efficacy
  • T=Toxcicity
  • C=Compliance
  • C=Cost!
2
Q

What do you need to know for each drug? 9 main concepts

A
  1. Absorption
  2. distribution
  3. metabolism
  4. Mutagenicity
  5. excretion
  6. Effects on pediatric patients
  7. effects on geriatric patients
  8. carcinogenicity
  9. Tetragencitiy or effect on developing fetus
3
Q

What are the 5 classifications of drugs for FDA what do each stand for?

A
  1. FDA class A= completely safe. Almost nothing in dentistry is class A
  2. FDA class B= Generally regarded safe no side effects or dangers in human or animal studies
  3. FDA class C= side effects in animal and human epidimiology studies
  4. FDA class D= the benefits to the mom outweighs benefits to the fetus
  5. FDA class X= always high risk that outweighs the benefits
4
Q

What are the seven Topical anesthetics available?

A
  1. Benzocaine
  2. Combination of benzocain Butamen and terracaine
  3. Dibucaine
  4. Dyclonine
  5. lidocaine, lidocaine+ prilocaine
  6. paramoxine
  7. Tetracaine
5
Q

What are the accepted uses of local anaesthetics?

A
  • anaesthesia of the area prior to instrumentation
  • pain relief
    • Apthous ulcers
    • Herpetic ulcers
    • mucosal inflammation
    • Denture sore spots
    • tooth eruption
    • radiographs
    • periodontal scaling (Should also regard as instrumentation)
    • Inhibition of gag reflex!
6
Q

What is the main distinguishing feature of topical anaesthesia against injectible anaesthesia? What forms can you find them in?

A
  • Most important is the diffusion through the mucosal barrier which many local injectible anaesthesias do not do well!
  • Local anaesthesia comes in higher concentration than injectible as well this might lead to systemic complications
  • Comes in many forms:
    • Foam, Gel, paste, lozenges, aerosols,ointments and rinses
7
Q

What are the 3 forms of topical anaesthesia?

A
  1. Amides linkage
    1. Dibucaine and lidocaine, prolicaine
  2. Esters
    1. Benzocaine
    2. butamen
    3. tetracaine
  3. Unclassified
    1. Dycloconine
    2. Paramoxime
8
Q

How is topical anaesthesia absorbed?

A
  • Either readily in the mucosa via vasculature this can be manipulated by concentration/ volume and duration of exposure
  • Benzocaine on the other hand cannot be readily absorbed in mucosa it utilizes carrier vessels and this can cause senstitivty to those carriers
  • Usually onset of action are 30 seconds- 15 minutes
  • Duration of action is anywhere between 10-4 hours
9
Q

Topical anaesthesia that has 10-20 minutes duration of action?? and the ones with 20-40 minutes duration?

A
  1. Benzocaine and Lidocaine are 10-20 minutes
  2. Cocaine and dyclonine is 20-40 minutes
10
Q

What are some causes of toxicity of topical anaesthesia?

A
  • Cross-sensitivity aka allergy
  • Pregnancy
    • FDA B is lidocaine
    • FDA C is benzocaine and dyclonine
  • Breastfeeding issues with lidocaine
  • Black box warning for pediatric patients under 2 years of age
  • Could also interact with
    • Beta-adrenergic
    • Cimetidine
    • sulfonamides
11
Q

What is Benzocaine derived from? How readily is it absorbed in the mucosa and how likely is it to cause sensitivity?

A
  • PABA derivative Ester type anaesthesia
  • is not readily absorbed by mucosa
  • Agent most likely to cause sensitization (Due to carriers)
    • Available in all forms of topical anaesthesia e.g gels, paste, ointment, lozenges
12
Q
  • What type of linkages do Benzocaine, butane and tetracaine have?
  • How long is the duration of spray should be?
A
  • Theyre all ester types
  • Duration of spray should not be more than 2 seconds
13
Q

What are the uses of Dibucaine and paramoxine?

A

Treat hemorrhoids

14
Q

What did the FDA issue for lidocaine?

A

-Lidocaine had the black box warning which is basically the closest thing to withdrawing it from the market! It can no longer be used for teething pain and can cause seizures, severe brain injury and cardiac events and even death

15
Q

What are some ester anaesthetics?

A
  • Procaine
  • chloroprocaine
  • tetracaine
16
Q

How good of an anaesthetic is procaine? What is its relative toxicity? Is it available in dental carpules?

A
  • Procaine is the gold standard of locals
  • Novocaine is not available in the dental carpules
  • Its relative toxicity is 1 which is lowest out of the other options
17
Q

Whats the pKa of Procaine? Lipid solubility? Protein binding ability? onset? Duration?

A
  • pKa is 8.9
  • low solubility at pH 7.4
  • Very low protein binding
  • Onset is intermediate
  • duration is short 30-60 minutes
18
Q
  • How is procaine metabolised?
  • What can block its effects?
  • What can stop its function?
A
  • its metabolised by plasma cholinesterases PABA by hydrolysis to liver cholinesterase
  • Patients that have cholinesterase inhibitors
    • Myasthenia gravis
  • genetic defects to plasma cholinesterases or atypical forms would lead to reduced or inhibited effects of procaine
19
Q
  • What is the max adult does?
  • What is the max pediatric dose
  • what are the preservatives?
  • What temperature should it be stored in?
  • can it be left in the light?
A
  • 1 g
  • 15 mg/kg
  • the preservatives are chlorobutanol and acetone sodium bisulfate
  • Store between 15 and 30 degrees C
  • should not be left under the light
20
Q
  • Can procaine be autoclaved?
  • When should you not use procaine?
A
  • Can be autoclaved if there is no epinephrine
  • do not use if it’s discoloured or has precipitate
  • Never immerse in antiseptic
21
Q
  • What is another for chloroprocaine?
  • Is it available in dental carpules?
    • whats the pKa?
  • Onset?
  • Duration?
  • What is a major side effect?
  • Whats the maximal adult dosage?
  • Pediatric dosage?
  • What happens with prolonged light exposure?
  • Exposure to cold temperatures?
A
  • Nesacaine
  • no dental carpule just multidose vials
  • Rapid onset 1-6 minutes
  • Short duration 30-60 minutes
  • Uterian artery constriction
    • Neuropathy as well
  • Maximal adult dosage is 800 with out epi
    • 1000 with epi
  • Pediatric dosage
    • Should not exceed 11 mg/kg
22
Q
  • What are the uses of Tetracaine?
A

Tetracaine is not used in a dental setting as an injectable but is used for spinal anaesthesia

-Is used as a topical with a maximal adult dose of 30mg/24 hours but no pediatric dosage established

can be a creme, ointment