Part 3-Anesthetic AgentsONE

Question 1

IN THIS COUNTRY! we only inject _____ type LAs

Answer 1

amide

Question 2

IN THIS COUNTRY! we use _____ type LAs for topical purposes

Answer 2

ester

Question 3

How long do short acting anesthetics last?

Answer 3

20-40 min

Question 4

How long do intermediate acting anesthetics last?

Answer 4

up to 70 min

Question 5

How long do long acting anesthetics last?

Answer 5

up to 8 freakinnnn hours man

Question 6

Please tell me the duration of action: Lidocaine 2%

Answer 6

short

Question 7

Please tell me the duration of action: Mepivacaine 3%

Answer 7

short

Question 8

Please tell me the duration of action: Prilocaine 4% (infiltration)

Answer 8

short

Question 9

Please tell me the duration of action: Prilocaine 4% (nerve block)

Answer 9

intermediate

Question 10

Please tell me the duration of action: Lidocaine 2% with epinephrine 1:50,000

Answer 10

intermediate

Question 11

Please tell me the duration of action: Lidocaine 2% with epinephrine 1:100,000

Answer 11

intermediate

Question 12

Please tell me the duration of action: Mepivacaine 2% with levonordefrin 1:20,000

Answer 12

intermediate

Question 13

Please tell me the duration of action: Articaine 4% with epinephrine 1:100,000

Answer 13

intermediate

Question 14

Please tell me the duration of action: Articaine 4% with epinephrine 1:200,000

Answer 14

intermediate

Question 15

Please tell me the duration of action: Prilocaine 4% with epinephrine 1:200,000

Answer 15

intermediate

Question 16

Please tell me the duration of action: Bupivacaine 0.5% with epinephrine 1:200,000

Answer 16

Long

Question 17

What are the 4 factors in selecting a LA agent?

Answer 17

1.Length of time needed 2.post-tx pain control 3.hemostasis 4.possible contraindications

Question 18

_________ = effect lasts beyond what is expected

Answer 18

Hyper-responders

Question 19

__________ = effect dissipates quickly

Answer 19

Hypo-responders

Question 20

What is a hypo-responder NOT attributed to?

Answer 20

not related biotrans/elimination…just a receptor reaction

Question 21

Deposition ________ to nerve provides GREATER depth and duration

Answer 21

CLOSER

Question 22

Depth of anesthesia will be ______ in less vascular regions

Answer 22

GREATER

Question 23

_________ provides longer duration of both pulpal and soft tissue anesthesia compared to supraperiosteal infiltration

Answer 23

Nerve block

Question 24

Larger than recommended doses do NOT increase _______

Answer 24

DURATION…saturation principle

Question 25

What are our 2 BEST LAs for LONG duration? (post-op pain expected)....

Answer 25

1.bupivacaine 0.5% (8-12hr soft tissue) 2.Prilocaine 4% w/ 1:200,000 epi (5-8 hours soft tissue)

Question 26

What are 2 go-to's for LAs with SHORT duration? (pets/IDs)....

Answer 26

1.mepivacaine 3% 2.prilocaine 4% (infiltration)...NOTICE no vasoconstrictor present

Question 27

How much epi should be in my LA if I am really shooting for HEMOstasis??

Answer 27

1:50,000 or 1:100,000 epi (do local infiltration)

Question 28

What are the only 2 ABSOLUTE contraindications we discussed in class to LAs?

Answer 28

1. True, documented, reproducible allergy...very rare with amides 2.Cocaine use w/in 24 hrs

Question 29

For people with possible relative contraindications-have ___ different drugs of varying duration of action available.

Answer 29

2

Question 30

What was the FIRST synthetic LA? (generic and brand please)

Answer 30

pro-caine...NOVOcaine

Question 31

What LA produces the GREATEST vasodilation of all currently used LAs?

Answer 31

Procaine (novocaine)

Question 32

Does procaine have a high or low pKa? What does that mean for onset?

Answer 32

HIGH pKa so SLOW onset

Question 33

BACK in the day, what was procaine paired with for those with absolute contraindication to amide LAs? (ONLY combo ester!)

Answer 33

procaine HCl + PRO-POXY-caine

Question 34

What was the end result of adding procaine, proxycaine and norepi?

Answer 34

necrosis..yeah, they stopped.

Question 35

What was the 1st amide LA to be marketed?

Answer 35

Lidocaine HCl

Question 36

Compare the potency of Lidocaine and Procaine:

Answer 36

Lido is 2x as potent as procaine

Question 37

Which LA is the GOLD STANDARD that the other LAs are compared to?

Answer 37

Lidocaine HCl

Question 38

How is lido metabolized? (hint: 2/3 in one way, 1/3 in another)

Answer 38

2/3 liver...1/3 hydolysis

Question 39

How is lido excreted?

Answer 39

kidneys

Question 40

Compare lidocaine and prilocaine in their vasodilation abilities...

Answer 40

lido more vasodilating than prilocaine

Question 41

What is the onset of lidocaine?

Answer 41

Rapid 2-3min

Question 42

What is the effective [ ] of lidocaine HCl?

Answer 42

2%

Question 43

Can you use lido topically?

Answer 43

yes! the [ ] can go up to 10% for this purpose

Question 44

What is the FDA pregnancy category for lidocaine? Is it safe during lactation?

Answer 44

B...safe, does not enter milk

Question 45

What are the three formulations of lidocaine?

Answer 45

1.lidocaine 2% (plain-blueFEW applications c/o vasodilation) 2.lidocaine 2% with epi 1:50,000 (green) 3.lidocaine with epi 1:100,000 (red)

Question 46

Lidocaine: _______ and ________ of anesthesia is equivalent with lidocaine 2% with epinephrine 1:50,000 or 1:100,000

Answer 46

Duration and depth

Question 47

lidocaine 2% with epinephrine 1:______ is preferred drug for most dental procedures

Answer 47

1:100,000....1:50,000 is concentration of choice but is risky for Heart DIsease

Question 48

Signs and Symptoms of lidocaine toxicity: CNS ________ followed by CNS _______

Answer 48

stimulation followed by depression

Question 49

Signs and Symptoms of lidocaine toxicity: First signs and symptoms of overdose may be drowsiness, leading to loss of consciousness and ________ arrest

Answer 49

respiratory

Question 50

Umm side note? Lidocaine possesses anticonvulsant properties...Prevents/terminates seizures by decreasing ________ of cortical neurons (raises seizure threshold)

Answer 50

excitability