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Intro to OS and Pain Management > Clinical Action of Specific Agents > Flashcards

Clinical Action of Specific Agents Flashcards

1
Q

what are the factors that affect the depth and duration of anesthesia

A
  • individual response to drug is a bell shaped curve
  • accuracy in deposition of local anesthesia
  • tissue status- vascularity and pH
  • anatomical variation
  • types of injection administered- block or infiltration
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2
Q

what are the percentages of normal responders, hyper responders, hypo resonders

A
  • normal: 70%
  • hyper: 15%
  • hypo: 15%
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3
Q

does larger than recommended doses increase duration

A

NO

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4
Q

what is the maximum dosage now

A

no distinction/ adjustment made for inclusion of vasoconstrictor
- recommended by council on dental therapeutics of the ADA and US pharmocopeal convention

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5
Q

maximum calculated drug dose should decrease in_____

A

medically compromised, debilitated or elderly persons

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6
Q

what is the MRD of articaine w/ vasoconstrictor

A

7.0 mg/kg
3.2 mg/lb

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7
Q

what is the MRD of bupivacaine w/ vasoconstrictor

A

1.3 mg/kg
0.6 mg/lb

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8
Q

what is the MRD of lidocaine w/o vasoconstrictor

A

4.4 mg/kg
2.0 mg/lb

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9
Q

what is the MRD of lidocaine w/ vasoconstrictor

A

6.6 mg/kg
3.0 mg/lb

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10
Q

what is the MRD of mepvacaine w/o vasoconstrictor

A

6.6 mg/kg
3.0mg/lb

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11
Q

what is the MRD of mepivacaine w/ vasoconstrictor

A

6.6mg/kg
3.0 mg/lb

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12
Q

what is the MRD of prilocaine w/o vasoconstrictor

A

6.0mg/kg
2.7 mg/lb

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13
Q

what is the MRD of prilocaine w/ vasoconstrictor

A

6.0 mg/kg
2.7 mg/lb

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14
Q

if you exceed MRD does the patient automatically OD?

A

no, when exceeding there is a greater likelihood of OD arising

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15
Q

when would OD happen at the dosage below the calculated MRD

A

hyper responders

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16
Q

how do you determine doses if two drugs are used

A

the total dose of both local anesthetics not exceed the lower of the two maximum doses for the individual agent

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17
Q

what is the potency, metabolism , onset of action and half life of lidocaine

A
  • the standard
  • liver
  • rapid 2-3 mins
  • 1.6 hours
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18
Q

what is the MRD of lidocaine

A

-4.4 mg/kg
- absolute max of 300 mg
- 8 cartridges will be max #

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19
Q

what is the max epinephrine with lidocaine in a healthy patient

A

0.2mg

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20
Q

what is the max epinephrine with lidocaine on a cardio patient

A

0.04 mg

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21
Q

what is the maximum dose of lidocaine with epi limited to

A
  • maximum amount of epinephrine can be given
  • lowest possible dosage of lidocaine needed
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22
Q

what was the first amide to be marketed and replace procaine

A

lidocaine

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23
Q

what is the duration of onset difference between procaine and lidocaine

A

lidocaine is 2-3 mins and procaine is 6-10 mins

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24
Q

is there allergies to amide

A

virtually nonexistent

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25
what is the gold standard for anesthetics
lidocaine
26
what are the types of lidocaine cartridges
- 2% without vasoconstrictor - 2% with 1:50,000 -2% with 1:100,000
27
what is the potency, metabolism, onset of action, half life of mepivacaine
- similar to lidocaine - liver - rapid 1.5 to 2 mind - 1.9 hours
28
what is the MRD of mepivacaine
- 4.4 mg/kg - absolute maximum 300 mg - 5.5 cartridges will be max #
29
describe mepivacaine
- mild vasodilating properties - longer duration vs other agent without vasoconstrictor
30
3% mepivacaine plain provides:
-20-30 mins pulpal anesthesia - 2-3 hours soft tissue anesthesia
31
what is mepivacaine indicated
- when vasoconstrictor is not indicated - pediatric and geriatric patients
32
what are the types of mepivacaine
- 3% without vasoconstrictor (UMKC carbocaine) - 2% with vasoconstrictor (levonodefrin)
33
what is the potency, metabolism, onset of action, half life of prilocaine
- similar to lidocaine - hydrolysed to ortholuidine and N-propylalanine. ortholuidine induce methomoglobin (can cause cyanosis) - slightly slower 2-4 mins - 1.6 hours
34
what is the MRD for prilocaine
- 6.0 mg/kg - absolute maximum 400 mg - 5.5 cartridges will be max #
35
when is prilocaine contraindicated
- idiopathic/congenital methemoglobinemia - hemoglobinopathesis (sickle cell anemia) - anemia - cardiac/ respiratory failure evidenced by hypoxia - patient taking acetaminophen or phenacetin
36
why cant you give prilocaine when a patient is taking acetominophen or phenacetin
produced elevations in methemoglobin level
37
what are the types of prilocaine
-4% with vasoconstrictor - 4% with/o vasocontrictor
38
what is the potency, metabolism , onset of action, half life of bupivacaine
- 4x lidocaine - liver - longer 6-10 mind - 2.7 hours - long duration
39
what is the MRD for bupivacaine
- 1.3 mg/kg - absolute maximum 90mg - 10 cartridges is max #
40
when is bupivacaine indicated
- lengthy dental procuedre > 90 mins pulpal anesthesia is needed - management of postoperative pain to reduce post of opiod anelgesics
41
when is bupivacaine contraindicated
- younger patient - physically/ mentally disabled person
42
what is effective preoperative pain management
pretreatment of 1 or 2 doses of NSAID
43
what is perioperative effective pain management
- local anesthesia - long duration local anesthesia given upon D/C
44
what is the postoperative effective pain management
- continue oral NSAID q X hours for Y days
45
NSAID can be givin within______ of the start of the surgical procedure
1 hour
46
what is the potency, metabolism, onset of action, half life of articaine
- 1.5x lidocaine - only amide type L.A. with ester group. plasms esterase hydrolysis, liver metabolism - 1-2 mins - 0.5 hours
47
what is the MRD of articaine
7mg/kg
48
what does articaine claim
- increased success rates - diffuse soft/ hard tissue reliably - infiltration of mandible resulted pulplal and lingual anesthesia - controlled study failed to substantiate these claims
49
when is articaine contraindicated
- pt allergic to amide type anesthesia - sulfite sensitivity - caution with hepatic disease - patient with significant impairments in cardio function - children younger than 4
50
what are the minimum contents of each articaine
1.7 mL
51
what is the downside of articaine
potential for neuro toxicity of articaine and prilocaine
52
what drugs resulted in more non surgical paresthesia than all other LAs
articaine and prilocaine
53
studies show neuro deficits with _____ lidocaine
5%
54
what is the closest to the ideal intermediate duration local anesthetic
2% lidocaine with 1:100,000 epi
55
topical anesthesia is effectie only on_____
surface tissue of 2-3 mm
56
why are spray devices unreliable
unable to deliver measured doses
57
describe benzocaine
- ester local anesthesia - poor absorption into CVS - not suitable for injection - ester L.A are more allergenic than amide - most commonly used topical anesthesia
58
what is EMLA cream made of
lidocaine 2.5% and prilocaine 2.5%
59
what does EMLA do
provides surface anesthesia of intact skin
60
what is EMLA cream used for
circumcision, leg ulcer debridement and GYN procedures
61
how do you used EMLA cream
- apply 1 hour before procedure - satisfactory numbing of skin occurs 1 hour after application - maximum comfort at 2-3 hours - last 1-2 hours after removal
62
when is EMLA cream contraindicated
- methemoglobinemia - infant < 12 months old had other methemoglobin inducing drugs - amide sensitive
63
what are the 2 forms of topical lidocaine
- lidocaine base: poorly soluble in H2O - lidocaine hydrochloride: water soluble, better tissue penetration but systemic absorption is also greater
64
what is the MRD of topical lidocaine
200mg
65
what are the types of topical lidocaine
- aerosol -ointment - patch - solution
66
describe tetracaine hydrochloride
- long duration ester L.A: injection or topical - usage should limit to small area because rapidly absorbed through mucous membrane - extreme caution because of potential for systemic toxicity
67
what should you consider when choosing L.A
- procedure dependent - postoperative pain control - hemostasis - if there are contraindications
68
what would you give for long duration local anesthesia
bupivacaine or prilocaine
69
what would you give for children/ mentally disabled patients
mepivacaine
70
what would you use with hemostasis
epi with 1:100,000 or 1:50,000
71
what are absolute contraindications
true, documented reproducible allergy
72
what should you do for relative contraindications
find a better substitute
73
what is the duration for 2% lidocaine with epi 1:100,000 for pulpal and soft tissue
-pulpal: 1 hour - soft tissue: 3-5 hour
74
what is the duration for 3% mepivacaine for pulpal and soft tissue
- pulpal: 5-10 mins - soft tissue: 1.5-2 hours
75
what is the duration for 0.5% bupivacaine with epi 1:200,000 for pulpal and soft tissue
-pulpal: greater than 1 hour - soft tissue: 4-12 hours
76
what is the duration for 4% articaine with epi 1:100,000 for pulpal and soft tissue
-pulpal: 0.5 hours - soft tissue: 3-5 hours
77

Intro to OS and Pain Management (9 decks)

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