Specific Agents

Question 1

T/F if you use a longer acting LA during a procedure there is less of a need to provide pain medication post -op?

Answer 1

TRUE

Question 2

5 major parameters when selecting an LA?

Answer 2

1. length of time needed to control pain
2. Requirement for pain control following the procedure
3. possibility of self-mutilation in the postoperative period
4. requirement for hemostasis (vasoconstrictors)
5. presence of any contraindications

Question 3

duration of action is divided into two categories

Answer 3

1. pulpal (hard tissue)

2. soft tissue )total)

Question 4

Duration of LA depends on what 5 things

Answer 4

1. individual variation
2. technique’
3. tissue status (vascularity and pH)
4. anatomical variation
5. type of injection (infiltration/block)

Question 5

highly vascular?

Answer 5

LA washes away and doesn’t stay around as long

Question 6

low ph?

Answer 6

acidic environment and not as much of a base form to go into nerve

Question 7

which type of LA injection lasts longer?

Answer 7

Block > local infiltrate

Question 8

dosages for LA are given in what?

Answer 8

mg/kg or mg/lb

Question 9

maximum dose definition?

Answer 9

LA blood level jsut BELOW the threshold for an overdose rxn

Question 10

hyporesponders?

Answer 10

15% of the lower portion of the bell shaped curve in which pulpal anesthesia lasts less than normal

Question 11

Hyperresponders?

Answer 11

15% of the upper portion of the bell shaped curve in which pulpal anesthesia lasts longer than normal

Question 12

Articaine aka and what type

Answer 12

Amides aka septacaine - 2nd most popular after lidocaine (xylocaine)

Question 13

lidocaine aka

Answer 13

(xylocaine)

Question 14

intermediate acting?

Answer 14

articaine (septacaine) + lidocaine (xylocaine)

Question 15

Mepivocaine used with vascocontrisctor?

Answer 15

usually not

Question 16

esters metabolized where?

Answer 16

PLASMA

Question 17

Procaine - type and details

Answer 17

Ester – provides essentially no pulpal anesthesia and 15-30 minutes of soft tissue anesthesia

GREATEST VASOCONSTRICTOR - BUT NO LONGER AVAILABLE

high incidence of allergy

Question 18

prpoxycaine

Answer 18

ester– not available alone because hight toxicity

Question 19

Benzocaine - type and details

Answer 19

ESTER – topical local anasthetic for temporary relief of pain associated with toothache, minor sore throat pain and canker sore

Question 20

ravocaine type and details

Answer 20

Combination of procaine and propoxycaine – not availabel anymore and was useful when amides were contraindicated

Question 21

lidocaine type and details for dental and medical

Answer 21

AMIDE type

Dental – injectable local anesthetic + topical LA

Medical - LA and acute tx of ventricular arrhythmias from myocardial infarction

little/ no allergies to amide LA

Question 22

max dosage of lidocaine

Answer 22

7mg/kg OR 3.2 mg/lb

max=500 mg

Question 23

duration of lidocaine w/ and w/out epi

Answer 23

with pulpal = 60-120 minutes
soft tisssue =3-5 hours

withOUT
pulpal = 5-10 minutes
soft tissue = 60-120 minutes

Question 24

Which one has more epi? 1:50,000 or 1:100,000? implications on duration of LA? use of one vs the other?

Answer 24

1:50,000 has more epi

Same duration of LA on the soft tissues (3-5 hours) and pulpal tissue (60-120 mins) BUT MORE EPI will be used in situations where need to control bleeding more (more invasive surgeries)

Question 25

max dosage of epi to cardiac? to hea;thy?

Answer 25

0. 04 max to cardiac pt. | 0. 2 to healthy pt

Question 26

max dosage of mepivicaine

Answer 26

6.6mg/kg or 3mg/lb (max 400 mg)

Question 27

duration of mepivicaine

Answer 27

Pulpal 20-40 minutes Soft tissue: 2-3 hours causes slight vasodilation

Question 28

clinical signs of methemoglobinemia

Answer 28

greyish blue cyanosis of the lips, mucus membranes, and nail beds may have respiratory and circulatory arrest

Question 29

prilocain max dosage =

Answer 29

8.0 mg/kg or 3mg/lb (max 400 mg) max - 600 g

Question 30

what levels of methemoglobinemia will cause symptoms?

Answer 30

20%

Question 31

treatment for methhemoglobinemia

Answer 31

1-2 mg/lg of 1% methylene blue solution intravenously over a 5 minute period

Question 32

Prilocaine is RELATIVELY contraindicated by pt's with?

Answer 32

* Idoipathic or congenital methemoglobinemia * Sickle cell * Anemia * Cardiac or respiratory failure by hypoxia * Patients receiving acetaminophen or phenacetin

Question 33

duration of action of prilocaine 4%

Answer 33

Pulpal 10 min infiltrate 60 minutes = block Soft tissue 1-5-2 hours infiltrate 2-4hr/ block

Question 34

prilocaine duration of 4% with epi?

Answer 34

pulpal = 60-90 minutes soft tissue = 3-8 hours

Question 35

articaine max dosage

Answer 35

3.2 mg/lb or 7.0mg mg/kg

Question 36

potential complication with articaine?

Answer 36

methehomoglobin

Question 37

metabolism of articaine

Answer 37

liver and plasma (more liver)

Question 38

duration of articaine 4% with and without epi

Answer 38

4% without pulpal = 45-60 minutes soft tissue =2-5 hours with pulpal =60-75 minutes soft tissue = 3-6 hours

Question 39

which local anesthetic agents are noted to have a higher incidence of lingual paresthesia?

Answer 39

4% articaine 4% prilocaine due to higher concentration

Question 40

long acting?

Answer 40

bupivaciane and marcaine

Question 41

indications to use Bupivacaine

Answer 41

lengthy dental procedures management of post op pain

Question 42

duration of bupivacaine

Answer 42

Pulpal = 90-180 minutes Soft tissue =4-9 hours

Question 43

max dosage of bupicacaine

Answer 43

90 mg

Question 44

concentrations of drugs in topicals?

Answer 44

have to be at higher concentrations

Question 45

two topical anasthetics used

Answer 45

Benzocaine = ester lidocaine = amide

Question 46

EMLA

Answer 46

Eutectic mixture of LA cream composed of lidocaine 2.5% and prilocaine 2.5 % used as a topical anesthetic to be placed on INTACT skin. -- like starting an IV catheriers, etc.

Question 47

which dose do you use for calculating max dosage with pt. using two LA's?

Answer 47

Max dosage of the LA with the LOWER max dose example using Articaine and mepivicaine articaine = 7.0 mg/kg and mepivicaine = 6.6 mg/kg so will use max dosage of 6.6 for the pt. because it is MORE TOXIC /CONCENTRATED