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LA with Perry + Naylor > Chapter 4 > Flashcards

Chapter 4 Flashcards

1
Q

What are the 5 local anesthetics available in North America?

A

Articaine, Bupivacaine, Lidocaine, Mepivacaine, and Prilocaine

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2
Q

Are the local anesthetics we use esters or amides?

A

Amides

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3
Q

Define relative contraindications for local anesthetics

A

If someone has one of the following you can still use LA, just use less of it and use extra caution

Significant liver dysfunction, renal dysfunction, and cardiovascular disease

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4
Q

Is someone is ASA III or IV what don’t we use?

A

Racemic Epinephrine gingival retraction cords

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5
Q

What is an absolute contraindication for local anesthetics?

A

An true documented, reproducible allergy

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6
Q

If someone is allergic to bisulfite what do you do?

A

Don’t use local anesthetic with a vasoconstrictor

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7
Q

If the patient in your chair is allergic to red wine or packaged sliced fruit what local anesthetic should you use?

A

Anything thing that is plain (without a vasoconstrictor), usually 3% Mepivicaine or 4% Prilocaine

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8
Q

Duration of an injection is influenced by what?

A

Individual response, type of injection, accuracy of administration, status of oral tissue, and anatomical variation

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9
Q

In an individual response what do we base the numbers off of?

A

Bell curve

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10
Q

In the bell curve there are 3 types of responses, what are they?

A

Normo-responders: stay numb the appropriate amount of time

Hyper-responders: stay numb longer than normal

Hypo-responders: don’t stay numb as long as expected because the body metabolizes it too quickly

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11
Q

What the 2 types of injections we will be giving?

A

Nerve block & infiltraions

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12
Q

Which injection type has the longer duration?

A

Nerve block

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13
Q

If you use less volume of local anesthetic you ________ duration

A

Decrease

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14
Q

The percentage listed on a carpule of local anesthetic indicates what?

A

The amount of local anesthetic in mg per ml of anesthetic solution (CONCENTRATION)

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15
Q

List the concentrations for the following local anesthetics

4% Articaine
.5% Bupivacaine
2% Lidocaine
2% Mepivicaine
3% Mepicivaine
4% Prilocaine
A 
4% Articaine            --->     40 mg/ml
.5% Bupivacaine     --->     5 mg/ml
2% Lidocaine          --->     20 mg/ml
2% Mepivicaine      --->     20 mg/ml
3% Mepicivaine      --->     30 mg/ml
4% Prilocaine          --->     40 mg/ml
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16
Q

There are _______ per carp of local anesthetic

A

1.8 ml

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17
Q

How do you determine how much of the drug you’re giving per carp of local anesthetic?

A

Determine concentration of the drug X 1.8 ml X number of carps given = Amount of drug given

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18
Q

Determine the concentration of the local anesthetic agent in 2% solution of Lidocaine?

A

2% Lidocaine = 20 mg/ml

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19
Q

If 2 cartridges of 2% Lidocaine are administered to your patient, what quantity of Lidocaine was given?

A
  1. Find concentration
    2% —> 20 mg/ml
  2. Multiply by 1.8 ml to find amount for carp
    20 mg/ml X 1.8 ml = 36 mg of Lidocaine per carp
  3. Multiply amount per carp by the number of carps used
    36 mg X 2 carps = 72 mg of Lidocaine

ANSWER = 72 mg

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20
Q

If 2 cartridges of 3% Mepivicaine plain are administered to your patient, what quantity of Mepivicaine was given?

A

3% —> 30 mg/ml
30 mg/ml X 1.8 ml = 54 mg per carp
54 mg X 2 carps = 108 mg of Mepivicaine

ANSWER = 108 mg

21
Q

What are the maximum recommended doses (MRD) per lb for the 5 local anesthetics used in North America?

A 
Articaine = 3.2 mg/lb 
Bupivacaine = .9 mg/lb
Lidocaine = 3.2 mg/lb
Mepivacaine = 3.0 mg/lb
Prilocaine = 4.0 mg/lb
22
Q

What are the absolute MRD for the 5 local anesthetics used in North America?

A 
Articaine = n/a
Bupivacaine = 90 mg
Lidocaine = 500 mg
Mepivacaine = 400 mg
Prilocaine = 600 mg
23
Q

Calculate MRD in milligrams for 120 lb healthy adult or 3% Mepivacaine

A
  1. What is the MRD per lb for Mepivacaine
    3. 0
  2. Multiply MRD per lb by the weight of the patient
    3. 0 mg/lb X 120 lbs = 360 mg

ANSWER = 360 mg

24
Q

Calculate the MRD in cartridges for a 120 lb healthy patient using 3% Carbocaine

A
  1. What is the MRD per lb for Carbocaine
    3.0
  2. Multiply MRD per lb by the weight of the patietn
    3.0 X 120 = 360 mg
  3. Take the amount of local anesthetic per mg and divide it by the concentration of local anesthetic per carp
    360 mg / (30X1.8) = 6.6 carps

ANSWER = 6.6 carps

25
Q

Calculate MRD for 110 lb healthy patient in cartridges fo .5% Bupivicaine

A

.9 X 110 = 99 mg

99 / (5X1.8) = 11 carps

ANSWER = 11 carps

26
Q

Calculate MRD for 150 lb healthy adult in cartridges for 2% Lidocaine with 1:100,000 epi

A

3.2 X 150 = 480 mg

480 / (20X1.8) = 13.3

But when epi is in the local anesthetic we go off the guidelines for epi which is .2mg per appointment which = 11 carps

ANSWER = 11 carps

27
Q

When should the MRD be decreased?

A

In patients who are debilitated, elderly, and medically compromised

28
Q

What factors should you look for when selecting local anesthetic?

A

Length of time it’s needed, potential for pain afterwards, hemostasis, contraindications, and post mutilation

29
Q

How many carps of 2% Lidocaine with 1:100,000 epi can epi sensitive patients have?

A

2 carps

30
Q

What determines an epi sensitive patient?

A

Cardiovascularly compromised and hyperthyroidism

31
Q

What is the only recommended use for 2% Lidocaine with 1:50,000 epi?

A

Hemostasis

32
Q

For most non-surgical dental procedures in a typical patient, what local anesthetic is used?

A

2% Lidocaine with 1:100,000 epi

33
Q

What local anesthetic do you use for epi sensitive patients?

A

Prilocaine

34
Q

Where is prilocaine biotransformed?

A

Liver and lungs

35
Q

Why don’t you want to use prilocaine with respiratory compromised patients?

A

Reduces the bloods oxygen carrying capacity making it harder to breath

36
Q

What type of injection is used with Articaine?

A

Infiltrations due to paresthesia in nerve blocks

37
Q

Bupivicaine ________ a patients need for post op opioid analgesics

A

Lessens

38
Q

Topical anesthetics are always ______

A

Esters

39
Q

Topical anesthetics come in _______ concentrations compared to injectable anestherics

A

Greater

40
Q

Why do topical anesthetics have such high concentrations?

A

They have to have enough to diffuse through mucous membrane (will go 2-3 mm)

41
Q

What does EMLA stand for?

A

Eutetic Mixture of Local Anesthetic

42
Q

The combination of _________ and _________ make up EMLA

A

Lidocaine and Prilocaine

43
Q

EMLA could eliminate use of _______ during pediatric dental procedures

A

Needles

44
Q

List the proprietary names for Articaine

A

Articadent, Orabloc, Septocaine, and Zorcaine

45
Q

What is the generic name for Citanest?

A

Prilocaine

46
Q

List the proprietary names for Bupivacaine

A

Marcaine and Vivacaine

47
Q

Lignospan, Octocaine, and Xylocaine are brand name for what local anesthetic?

A

Lidocaine

48
Q

List the proprietary names for Mepivacaine

A

Carbocaine, Isocaine, Polocaine, and Scandanest

LA with Perry + Naylor (1 decks)

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