Clinical Action of specific agents Flashcards
(87 cards)
1
Q
Parameters for Selection of a Local Anesthetic
A
- Length of time for which pain control is required
- Requirement for pain control following the treatment
- Need for hemostasis
2
Q
Duration of Action depends on:
A
AT ITT
- Anatomical variation
- Type of injection: Infiltration or nerve block
- Individual variation
- Technique
- Tissue status: Vascularity, pH
3
Q
Duration of action is divided into:
A
- Pulpal (hard tissue)
- Soft tissue (total)
4
Q
Doses of local anesthetic drugs are presented in terms of _____ or _____.
A
mg/kg or mg/lb.
5
Q
Maximum dose
A
Blood level just below the threshold for an overdose reaction.
6
Q
Patients with potentially increased risk:
A
- Small child
- Elderly individual
- Medically compromise patient
7
Q
Esters:
A
- Benzocaine
- Procaine
- Propoxicaine
8
Q
Amides:
A
- Articaine (Septacaine)
- Bupivacaine (Marcaine)
- Etidocaine (Duranest)
- Lidocaine (Xylocaine)
- Mepivacaine (Polocaine)
- Prilocaine (Citanest)
9
Q
Bisulfite allergy
- Drugs to Avoid:
- Type of contraindication:
- Alternative drug:
A
- Drugs to Avoid: Vasoconstrictor containing L.A.
- Type of contraindication:Absolute
- Alternative drug:L.A. without vasoconstrictor
10
Q
Atypical plasma cholinesterase
Drugs to Avoid:
- Type of contraindication:
- Alternative drug:
A
Drugs to Avoid:Esters
- Type of contraindication: Relative
- Alternative drug:
11
Q
Methemoglobinemia
- Drugs to Avoid:
- Type of contraindication:
- Alternative drug:
A
Drugs to Avoid: Prilocaine
- Type of contraindication:Relative
- Alternative drug: Other amides
12
Q
Significant liver dysfunction
- Drugs to Avoid:
- Type of contraindication:
- Alternative drug:
A
Drugs to Avoid:Amides
- -Type of contraindication: Relative
- Alternative drug: Amides or esters but judiciously
13
Q
Significant cardiovascular
- Drugs to Avoid:
- Type of contraindication:
- Alternative drug:
A
Drugs to Avoid: High concentrations of vasoconstrictors
- -Type of contraindication: Relative
- Alternative drug: Low concentration of vasoconstrictors
14
Q
Clinical hyperthyroidism
- Drugs to Avoid:
- Type of contraindication:
- Alternative drug:
A
-Drugs to Avoid: Vasoconstrictors
- -Type of contraindication: Relative
- Alternative drug: Low concentration of vasoconstrictors
15
Q
Procaine provides _____ (duration) pulpal anesthesia and _____ (duration) soft tissue anesthesia
A
- no pulpal anesthesia
- 15-30 minutes soft tissue anesthesia
16
Q
_______ produces the greatest vasodilatation
A
Procaine
NOTE: No longer available
17
Q
Why is Procaine no longer available
A
High incidence of allergy
18
Q
_______ (Ester) It is not available alone because of its high toxicity.
A
Propoxycaine
19
Q
Ravocaine is a Combination of ________+ _______
A
Procaine + Propoxycaine
20
Q
______ It was useful when amides were contraindicated and has been discontinued since 1996.
A
Ravocaine
21
Q
Ester-type topical local anesthetic for temporary relief of pain associated with toothache, minor sore throat pain and canker sore.
A
Benzocaine
22
Q
Lidocaine dental indication
A
Dental: Amide-type injectable local anesthetic and topical local anesthetic
23
Q
Lidocaine medical indication
A
Medical: Local anesthetic and acute treatment of ventricular arrhythmias from myocardial infarction.
24
Q
Allergies to amide local anesthetics is virtually nonexistent. T/F
A
T
25
Lidocaine
| -Pregnancy classification:
Pregnancy classification: B
26
Is Lidocaine safe during lactation?
Yes
27
FDA recommends a maximum dosage of Lidocaine
7mg/kg or 3.2 mg/lb (max: 500mg)
28
Lidocaine 2%
-Duration of Pulpal Analgesia:
Pulpal: 5-10 min
29
Lidocaine 2%
-Duration of Soft tissue Analgesia:
Soft tissue 60-120 min
30
Lidocaine 2% with Epi. 1:50,000
-Duration of Pulpal Analgesia:
Pulpal: 60 min
31
Lidocaine 2% with Epi. 1:50,000
-Duration of Soft tissue Analgesia:
Soft tissue 3-5 hr
32
Lidocaine 2% with Epi. 1: 100,000
-Duration of Pulpal Analgesia:
Pulpal: 60 min
33
Lidocaine 2% with Epi. 1: 100,000
-Duration of Soft tissue Analgesia:
Soft tissue 3-5 hr
34
Mepivacaine dental indication
Dental:
- local infiltration anesthesia;
- injection near nerve trunks to produce nerve block.
35
Mepivacaine Produces slight vasodilatation. T/F
T
36
Mepivacaine FDA recommended maximum dosage
6. 6 mg/kg or 3 mg/lb
| max: 400mg
37
Mepivacaine
| -Pregnancy classification:
Pregnancy classification: C
38
Is Mepivacaine safe during lactation?
Yes
39
Mepivacaine 3%
-Duration of Pulpal Analgesia:
Pulpal: 20-40 min
40
Mepivacaine 2% with Levonordefrin or Neo-Cobefrin 1:20,000
-Duration of Pulpal Analgesia:
Pulpal: 60-90 min
41
Mepivacaine 2% with Epi 1: 200,000
-Duration of Pulpal Analgesia:
Pulpal: 45-60 min
42
Mepivacaine 2% with epi 1: 100,000
-Duration of Pulpal Analgesia:
Pulpal: 60 min
43
Mepivacaine 3%
-Duration of Soft tissue Analgesia:
Soft tissue: 2-3 hr
44
Mepivacaine 2% with Levonordefrin or Neo-Cobefrin 1:20,000
-Duration of Soft tissue Analgesia:
Soft tissue: 3-5 hr
45
Mepivacaine 2% with Epi 1: 200,000
-Duration of Soft tissue Analgesia:
Soft tissue: 2-4 hr
46
Mepivacaine 2% with epi 1: 100,000
-Duration of Soft tissue Analgesia:
Soft tissue: 2-5 hr
47
Prilocaine indication
Dental: used for local infiltration anesthesia; injection near nerve trunks to produce nerve block.
48
Prilocaine metabolism
hydrolyzed in the liver to orthotoluidine and N-propylalanine.(orthotoluidine can induce methemoglobinemia)
49
Prilocaine FDA recommended max dose
3.6 mg/lb or 8.0mg/kg to a maximum of 600mg
50
Prilocaine
| Pregnancy classification
B
51
Is Prilocaine safe during lactation?
Caution
52
Clinical signs of Methemoglobinemia
- Greyish to slate blue cyanosis of the lips, mucus membranes, and nail beds.
- May have respiratory and circulatory arrest
53
What levels of methemoglobinemia will cause clinical symptoms?
- 20%
| - Normal concentration is 1%
54
The Treatment for Methemoglobinemia
1 to 2 mg/kg of 1% methylene blue solution intravenously over a 5 minute period of time
55
Prilocaine is relatively contraindicated in patients with?
(HI CAP)
-Hemoglobinopathies (Sickle Cell)
- Idiopathic or congenital methemoglobinemia
- Cardiac or Respiratory -Failure evidence by hypoxia
- Anemia
- Patient’s receiving acetaminophen or phenacetin
56
Prilocaine 4%
| -Duration of Soft tissue Analgesia:
Soft issue 1.5-2 hr/inf 2-4hr/block
57
Prilocaine 4%
-Duration of pulpal Analgesia:
Pulpal 10 min/inf 60 min/block
58
Prilocaine 4% with Epi 1:200,000
-Duration of Soft tissue Analgesia:
Soft tissue 3-8 hr
59
Prilocaine 4% with Epi 1:200,000
-Duration of pulpal Analgesia:
Pulpal: 60-90 minutes
60
Articaine dental indication
Anesthesia agent for infiltration and nerve block anesthesia in clinical dentistry.
61
Articaine metabolism
Degradation occurs in the plasma and liver.
62
Articaine complication
Methemoglobinemia is a potential complication.
63
Articaine pregnancy classification
C
64
Articaine max dose
Adult 3.2 mg/lb or 7.0 mg/kg
65
Articaine 4%
with Epi. 1:200,000
-Pulpal?
45-60 mins
66
Articaine 4%
with Epi. 1:200,000
-Soft tissue?
2-5hrs
67
Articaine 4%
with Epi. 1:100,000
-Pulpal?`
60-75 mins
68
Articaine 4%
with Epi. 1:100,000
-Soft tissue
3-6 hrs
69
Which local anesthetic agents are noted to have a higher incidence of lingual nerve? paresthesia?
4 % Articaine
| 4 % Prilocaine
70
Bupivacaine indication
- Lengthy dental procedures
| - Management of postoperative pain
71
Bupivacaine max dose
90 mg
72
Bupivacaine preg classification
C
73
Is Bupivacaine safe for nursing mothers?
Caution
74
(Bupivacaine) Marcaine HCl 0.5 with Epi. 1:200,000
| -Pulpal
90-180 mins
75
(Bupivacaine) Marcaine HCl 0.5 with Epi. 1:200,000
| -Soft tissue?
4-9 hrs
76
Topical anesthetics
- Benzocaine
- Lidocaine
- EMLA
77
Benzocaine topical indications
Ester-type topical local anesthetic for temporary relief of pain associated with toothache, minor sore throat pain and canker sore
78
Lidocaine topical indications
Local anesthesia of the oral mucosa prior to oral injections and soft-tissue dental procedures
79
EMLA?
Eutectic Mixture of Local Anesthesia
80
EMLA composition
It is a cream composed of:
- Lidocaine: 2.5%
- Prilocaine: 2.5%
81
EMLA indications
It is used as a topical anesthetic to be placed on intact skin. Used for starting IV catheters, etc.
82
A patient presents for endodontic treatment on tooth #4. PMHx: Pt has cardiac history and you want to limit the amount of epinephrine to be administered the patient. You have given 2 carpules of 4% Articaine with 1:100,000 epinephrine. During the procedure, the patient starts to complain of some discomfort. You decide that you will administer 3% Mepivacaine without epinephrine. What is the maximum amount of Mepivacaine you can administer to the patient? The patient weighs approximately 60 kg, and each cartridge contains 1.8 cc of local anesthetic. Use FDA Max Doses for Local Anesthetics.
Maximum dose is related to the lower of the two maximum doses for the individual local anesthetic agents.
- Max Dose of Articaine: 7.0 mg/kg
- Max Dose of Mepivacaine: 6.6 mg/kg
- So, use 6.6 mg/kg
- 6.6 mg/kg X 60 kg = 396 mg is the maximum dose that can be administered.
83
Exparel?
DepoFoam® technology delivers bupivacaine
| over time for extended analgesia
84
Exparel composition
of naturally occurring biodegradable
| and biocompatible lipids
85
Exparel encapsulates?
bupivacaine in a multivesicular liposomal drug delivery technology
86
Exparel releases?
bupivacaine over time as lipid membranes reorganize
87
Exparel utilizes?
membrane components that are cleared by normal metabolic pathways2,3
