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Intro to OS and Pain Management > Clinical Action of Specific Agents > Flashcards

Clinical Action of Specific Agents Flashcards

1
Q

what are the factors that affect the depth and duration of anesthesia

A
  • individual response to drug is a bell shaped curve
  • accuracy in deposition of local anesthesia
  • tissue status- vascularity and pH
  • anatomical variation
  • types of injection administered- block or infiltration
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2
Q

what are the percentages of normal responders, hyper responders, hypo resonders

A
  • normal: 70%
  • hyper: 15%
  • hypo: 15%
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3
Q

does larger than recommended doses increase duration

A

NO

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4
Q

what is the maximum dosage now

A

no distinction/ adjustment made for inclusion of vasoconstrictor
- recommended by council on dental therapeutics of the ADA and US pharmocopeal convention

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5
Q

maximum calculated drug dose should decrease in_____

A

medically compromised, debilitated or elderly persons

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6
Q

what is the MRD of articaine w/ vasoconstrictor

A

7.0 mg/kg
3.2 mg/lb

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7
Q

what is the MRD of bupivacaine w/ vasoconstrictor

A

1.3 mg/kg
0.6 mg/lb

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8
Q

what is the MRD of lidocaine w/o vasoconstrictor

A

4.4 mg/kg
2.0 mg/lb

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9
Q

what is the MRD of lidocaine w/ vasoconstrictor

A

6.6 mg/kg
3.0 mg/lb

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10
Q

what is the MRD of mepvacaine w/o vasoconstrictor

A

6.6 mg/kg
3.0mg/lb

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11
Q

what is the MRD of mepivacaine w/ vasoconstrictor

A

6.6mg/kg
3.0 mg/lb

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12
Q

what is the MRD of prilocaine w/o vasoconstrictor

A

6.0mg/kg
2.7 mg/lb

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13
Q

what is the MRD of prilocaine w/ vasoconstrictor

A

6.0 mg/kg
2.7 mg/lb

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14
Q

if you exceed MRD does the patient automatically OD?

A

no, when exceeding there is a greater likelihood of OD arising

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15
Q

when would OD happen at the dosage below the calculated MRD

A

hyper responders

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16
Q

how do you determine doses if two drugs are used

A

the total dose of both local anesthetics not exceed the lower of the two maximum doses for the individual agent

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17
Q

what is the potency, metabolism , onset of action and half life of lidocaine

A
  • the standard
  • liver
  • rapid 2-3 mins
  • 1.6 hours
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18
Q

what is the MRD of lidocaine

A

-4.4 mg/kg
- absolute max of 300 mg
- 8 cartridges will be max #

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19
Q

what is the max epinephrine with lidocaine in a healthy patient

A

0.2mg

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20
Q

what is the max epinephrine with lidocaine on a cardio patient

A

0.04 mg

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21
Q

what is the maximum dose of lidocaine with epi limited to

A
  • maximum amount of epinephrine can be given
  • lowest possible dosage of lidocaine needed
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22
Q

what was the first amide to be marketed and replace procaine

A

lidocaine

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23
Q

what is the duration of onset difference between procaine and lidocaine

A

lidocaine is 2-3 mins and procaine is 6-10 mins

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24
Q

is there allergies to amide

A

virtually nonexistent

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25
Q

what is the gold standard for anesthetics

A

lidocaine

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26
Q

what are the types of lidocaine cartridges

A
  • 2% without vasoconstrictor
  • 2% with 1:50,000
    -2% with 1:100,000
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27
Q

what is the potency, metabolism, onset of action, half life of mepivacaine

A
  • similar to lidocaine
  • liver
  • rapid 1.5 to 2 mind
  • 1.9 hours
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28
Q

what is the MRD of mepivacaine

A
  • 4.4 mg/kg
  • absolute maximum 300 mg
  • 5.5 cartridges will be max #
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29
Q

describe mepivacaine

A
  • mild vasodilating properties
  • longer duration vs other agent without vasoconstrictor
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30
Q

3% mepivacaine plain provides:

A

-20-30 mins pulpal anesthesia
- 2-3 hours soft tissue anesthesia

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31
Q

what is mepivacaine indicated

A
  • when vasoconstrictor is not indicated
  • pediatric and geriatric patients
32
Q

what are the types of mepivacaine

A
  • 3% without vasoconstrictor (UMKC carbocaine)
  • 2% with vasoconstrictor (levonodefrin)
33
Q

what is the potency, metabolism, onset of action, half life of prilocaine

A
  • similar to lidocaine
  • hydrolysed to ortholuidine and N-propylalanine. ortholuidine induce methomoglobin (can cause cyanosis)
  • slightly slower 2-4 mins
  • 1.6 hours
34
Q

what is the MRD for prilocaine

A
  • 6.0 mg/kg
  • absolute maximum 400 mg
  • 5.5 cartridges will be max #
35
Q

when is prilocaine contraindicated

A
  • idiopathic/congenital methemoglobinemia
  • hemoglobinopathesis (sickle cell anemia)
  • anemia
  • cardiac/ respiratory failure evidenced by hypoxia
  • patient taking acetaminophen or phenacetin
36
Q

why cant you give prilocaine when a patient is taking acetominophen or phenacetin

A

produced elevations in methemoglobin level

37
Q

what are the types of prilocaine

A

-4% with vasoconstrictor
- 4% with/o vasocontrictor

38
Q

what is the potency, metabolism , onset of action, half life of bupivacaine

A
  • 4x lidocaine
  • liver
  • longer 6-10 mind
  • 2.7 hours - long duration
39
Q

what is the MRD for bupivacaine

A
  • 1.3 mg/kg
  • absolute maximum 90mg
  • 10 cartridges is max #
40
Q

when is bupivacaine indicated

A
  • lengthy dental procuedre > 90 mins pulpal anesthesia is needed
  • management of postoperative pain to reduce post of opiod anelgesics
41
Q

when is bupivacaine contraindicated

A
  • younger patient
  • physically/ mentally disabled person
42
Q

what is effective preoperative pain management

A

pretreatment of 1 or 2 doses of NSAID

43
Q

what is perioperative effective pain management

A
  • local anesthesia
  • long duration local anesthesia given upon D/C
44
Q

what is the postoperative effective pain management

A
  • continue oral NSAID q X hours for Y days
45
Q

NSAID can be givin within______ of the start of the surgical procedure

A

1 hour

46
Q

what is the potency, metabolism, onset of action, half life of articaine

A
  • 1.5x lidocaine
  • only amide type L.A. with ester group. plasms esterase hydrolysis, liver metabolism
  • 1-2 mins
  • 0.5 hours
47
Q

what is the MRD of articaine

A

7mg/kg

48
Q

what does articaine claim

A
  • increased success rates
  • diffuse soft/ hard tissue reliably
  • infiltration of mandible resulted pulplal and lingual anesthesia
  • controlled study failed to substantiate these claims
49
Q

when is articaine contraindicated

A
  • pt allergic to amide type anesthesia
  • sulfite sensitivity
  • caution with hepatic disease
  • patient with significant impairments in cardio function
  • children younger than 4
50
Q

what are the minimum contents of each articaine

A

1.7 mL

51
Q

what is the downside of articaine

A

potential for neuro toxicity of articaine and prilocaine

52
Q

what drugs resulted in more non surgical paresthesia than all other LAs

A

articaine and prilocaine

53
Q

studies show neuro deficits with _____ lidocaine

A

5%

54
Q

what is the closest to the ideal intermediate duration local anesthetic

A

2% lidocaine with 1:100,000 epi

55
Q

topical anesthesia is effectie only on_____

A

surface tissue of 2-3 mm

56
Q

why are spray devices unreliable

A

unable to deliver measured doses

57
Q

describe benzocaine

A
  • ester local anesthesia
  • poor absorption into CVS
  • not suitable for injection
  • ester L.A are more allergenic than amide
  • most commonly used topical anesthesia
58
Q

what is EMLA cream made of

A

lidocaine 2.5% and prilocaine 2.5%

59
Q

what does EMLA do

A

provides surface anesthesia of intact skin

60
Q

what is EMLA cream used for

A

circumcision, leg ulcer debridement and GYN procedures

61
Q

how do you used EMLA cream

A
  • apply 1 hour before procedure
  • satisfactory numbing of skin occurs 1 hour after application
  • maximum comfort at 2-3 hours
  • last 1-2 hours after removal
62
Q

when is EMLA cream contraindicated

A
  • methemoglobinemia
  • infant < 12 months old had other methemoglobin inducing drugs
  • amide sensitive
63
Q

what are the 2 forms of topical lidocaine

A
  • lidocaine base: poorly soluble in H2O
  • lidocaine hydrochloride: water soluble, better tissue penetration but systemic absorption is also greater
64
Q

what is the MRD of topical lidocaine

A

200mg

65
Q

what are the types of topical lidocaine

A
  • aerosol
    -ointment
  • patch
  • solution
66
Q

describe tetracaine hydrochloride

A
  • long duration ester L.A: injection or topical
  • usage should limit to small area because rapidly absorbed through mucous membrane
  • extreme caution because of potential for systemic toxicity
67
Q

what should you consider when choosing L.A

A
  • procedure dependent
  • postoperative pain control
  • hemostasis
  • if there are contraindications
68
Q

what would you give for long duration local anesthesia

A

bupivacaine or prilocaine

69
Q

what would you give for children/ mentally disabled patients

A

mepivacaine

70
Q

what would you use with hemostasis

A

epi with 1:100,000 or 1:50,000

71
Q

what are absolute contraindications

A

true, documented reproducible allergy

72
Q

what should you do for relative contraindications

A

find a better substitute

73
Q

what is the duration for 2% lidocaine with epi 1:100,000 for pulpal and soft tissue

A

-pulpal: 1 hour
- soft tissue: 3-5 hour

74
Q

what is the duration for 3% mepivacaine for pulpal and soft tissue

A
  • pulpal: 5-10 mins
  • soft tissue: 1.5-2 hours
75
Q

what is the duration for 0.5% bupivacaine with epi 1:200,000 for pulpal and soft tissue

A

-pulpal: greater than 1 hour
- soft tissue: 4-12 hours

76
Q

what is the duration for 4% articaine with epi 1:100,000 for pulpal and soft tissue

A

-pulpal: 0.5 hours
- soft tissue: 3-5 hours

77
Q
A

Intro to OS and Pain Management (9 decks)

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