Systemic Health Considerations

Question 1

Anticonvulsant LA considerations

Answer 1

Avoid higher doses of LA

Question 2

Antipsychotics LA considerations

Answer 2

Avoid higher doses of LA

**Phenothiazines = vasoconstrictor causes postural hypotension –> Use cardiac limit to epi; do not use 1:50,000

Question 3

Antidepressant LA considerations

Answer 3

Caution with vasoconstrictor

Question 4

Tricyclic antidepressant LA considerations

Answer 4

May enhance CV actions of vasopressors

• **Fivefold to tenfold with levonordefrin and norepinephrine
  - Avoid levonordefrin
• *** Only twofold with epinephrine
  - use lowest dose, least concentration of epinephrine

Question 5

Benzodiazepines LA considerations

Answer 5

Added depressant effects

- Limit LA dose

Question 6

Glucocorticoid LA considerations

Answer 6

**Stress with LA administration should be low!
Consider supplemental stress reduction protocol:
- Nitrous oxide sedation
- IV sedation

Question 7

H2 receptor blocker (cimetidine/Tagamet) (Antacid) LA consideration

Answer 7

Modifies biotransformation of lidocaine
**Does not happen with other drugs in this class (pepcid, zantac, etc.)

• Results in increased half-life of circulation lidocaine
• -> Risk for lidocaine overdose!!

Question 8

Tagamet is a relative contraindication for what LA?

Answer 8

Lidocaine

Question 9

Sedation with what other drugs may increase risk of developing LA overdose?

Answer 9

Opioid analgesics

Question 10

What is the effect of administering vasopressor to patients receiving nonselective beta blockers

Answer 10

Increases risk of hypertensive episode followed by secondary reflex bradycardia

Question 11

T or F, No relevant evidence allows the use of local anesthetics with vasopressors for patients treated with cardioselective beta-blockers

Answer 11

False, no evidence PRECLUDES the use

**Risk only exists for nonselective beta-blocking agents

Question 12

Vasoconstrictor with street drugs consideration

Answer 12

Cocaine & Meth -> sympathomimetic effects

• *Avoid epinephrine with 24 hours of use
• Produces tachycardia, hypertension, increased CO, etc.

Question 13

Alcohol and LA

Answer 13

May decrease effectiveness of LA
Alcohol = CNS depressant

Use caution to avoid LA overdose

Question 14

4 congestive heart failure considerations

Answer 14

ASA III/IV/V

1. Cardiac glycosides (digoxin)
   
   • Epinephrine may cause arrhythmias
2. Compromised blood flow to kidneys
   
   • Reduced clearance of LA
3. Fluid in lungs
   
   • Keep patient semi-supine when administering LA
4. ASA IV if symptomatic
   
   • Dental treatment is contraindicated

Question 15

Sickle cell anemia and LA

Answer 15

No LA or dental txt during crisis

- Limit vasoconstrictors ***Plain drugs are preferred

Question 16

Respiratory conditions and LA

Answer 16

LA in therapeutic dosages rare affects respiratory system
*Sulfite allergy may trigger asthma attack

Most common adverse reaction = fainting (syncope)

Question 17

Decreased liver function and LA

Answer 17

Lowest dose, least concentration

Question 18

Hyperthyroidism and LA

Answer 18

Epinephrine raises risk for thyroid storm

• **ABSOLUTE contraindication if uncontrolled
• *Relative contraindication if controlled

Question 19

Hypothyroidism and LA

Answer 19

Generally ok, but more sensitive to CNS depressants - minimize LA dose

Question 20

Pheochromocytoma and LA

Answer 20

Absolute contraindication to vasoconstrictor

Question 21

Atypical plasma cholinesterase and LA

Answer 21

Avoid ester anesthetics ***Cannot metabolize esters

Question 22

Methemoglobinemia and LA

Answer 22

Benzocaine and Prilocaine associated with acquired cases.

**Acetaminophen causes risk to increase with prilocaine

Question 23

What drug might be good to use if liver disease?

Answer 23

Articaine

- majority biotransformed in blood

Question 24

Allergies to a LA is most likely due to what?

Answer 24

Not amides - rare

**Likely bisulfite sensitivity

Question 25

Which time during pregnancy is best to treat during?

Answer 25

2nd trimester = safest

- At end of 3rd trimester, some mother may have difficulty metabolizing drugs