Clinical Action of Specific Agents Flashcards
what are the factors that affect the depth and duration of anesthesia
- 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
what are the percentages of normal responders, hyper responders, hypo resonders
- normal: 70%
- hyper: 15%
- hypo: 15%
does larger than recommended doses increase duration
NO
what is the maximum dosage now
no distinction/ adjustment made for inclusion of vasoconstrictor
- recommended by council on dental therapeutics of the ADA and US pharmocopeal convention
maximum calculated drug dose should decrease in_____
medically compromised, debilitated or elderly persons
what is the MRD of articaine w/ vasoconstrictor
7.0 mg/kg
3.2 mg/lb
what is the MRD of bupivacaine w/ vasoconstrictor
1.3 mg/kg
0.6 mg/lb
what is the MRD of lidocaine w/o vasoconstrictor
4.4 mg/kg
2.0 mg/lb
what is the MRD of lidocaine w/ vasoconstrictor
6.6 mg/kg
3.0 mg/lb
what is the MRD of mepvacaine w/o vasoconstrictor
6.6 mg/kg
3.0mg/lb
what is the MRD of mepivacaine w/ vasoconstrictor
6.6mg/kg
3.0 mg/lb
what is the MRD of prilocaine w/o vasoconstrictor
6.0mg/kg
2.7 mg/lb
what is the MRD of prilocaine w/ vasoconstrictor
6.0 mg/kg
2.7 mg/lb
if you exceed MRD does the patient automatically OD?
no, when exceeding there is a greater likelihood of OD arising
when would OD happen at the dosage below the calculated MRD
hyper responders
how do you determine doses if two drugs are used
the total dose of both local anesthetics not exceed the lower of the two maximum doses for the individual agent
what is the potency, metabolism , onset of action and half life of lidocaine
- the standard
- liver
- rapid 2-3 mins
- 1.6 hours
what is the MRD of lidocaine
-4.4 mg/kg
- absolute max of 300 mg
- 8 cartridges will be max #
what is the max epinephrine with lidocaine in a healthy patient
0.2mg
what is the max epinephrine with lidocaine on a cardio patient
0.04 mg
what is the maximum dose of lidocaine with epi limited to
- maximum amount of epinephrine can be given
- lowest possible dosage of lidocaine needed
what was the first amide to be marketed and replace procaine
lidocaine
what is the duration of onset difference between procaine and lidocaine
lidocaine is 2-3 mins and procaine is 6-10 mins
is there allergies to amide
virtually nonexistent
what is the gold standard for anesthetics
lidocaine
what are the types of lidocaine cartridges
- 2% without vasoconstrictor
- 2% with 1:50,000
-2% with 1:100,000
what is the potency, metabolism, onset of action, half life of mepivacaine
- similar to lidocaine
- liver
- rapid 1.5 to 2 mind
- 1.9 hours
what is the MRD of mepivacaine
- 4.4 mg/kg
- absolute maximum 300 mg
- 5.5 cartridges will be max #
describe mepivacaine
- mild vasodilating properties
- longer duration vs other agent without vasoconstrictor
3% mepivacaine plain provides:
-20-30 mins pulpal anesthesia
- 2-3 hours soft tissue anesthesia
what is mepivacaine indicated
- when vasoconstrictor is not indicated
- pediatric and geriatric patients
what are the types of mepivacaine
- 3% without vasoconstrictor (UMKC carbocaine)
- 2% with vasoconstrictor (levonodefrin)
what is the potency, metabolism, onset of action, half life of prilocaine
- similar to lidocaine
- hydrolysed to ortholuidine and N-propylalanine. ortholuidine induce methomoglobin (can cause cyanosis)
- slightly slower 2-4 mins
- 1.6 hours
what is the MRD for prilocaine
- 6.0 mg/kg
- absolute maximum 400 mg
- 5.5 cartridges will be max #
when is prilocaine contraindicated
- idiopathic/congenital methemoglobinemia
- hemoglobinopathesis (sickle cell anemia)
- anemia
- cardiac/ respiratory failure evidenced by hypoxia
- patient taking acetaminophen or phenacetin
why cant you give prilocaine when a patient is taking acetominophen or phenacetin
produced elevations in methemoglobin level
what are the types of prilocaine
-4% with vasoconstrictor
- 4% with/o vasocontrictor
what is the potency, metabolism , onset of action, half life of bupivacaine
- 4x lidocaine
- liver
- longer 6-10 mind
- 2.7 hours - long duration
what is the MRD for bupivacaine
- 1.3 mg/kg
- absolute maximum 90mg
- 10 cartridges is max #
when is bupivacaine indicated
- lengthy dental procuedre > 90 mins pulpal anesthesia is needed
- management of postoperative pain to reduce post of opiod anelgesics
when is bupivacaine contraindicated
- younger patient
- physically/ mentally disabled person
what is effective preoperative pain management
pretreatment of 1 or 2 doses of NSAID
what is perioperative effective pain management
- local anesthesia
- long duration local anesthesia given upon D/C
what is the postoperative effective pain management
- continue oral NSAID q X hours for Y days
NSAID can be givin within______ of the start of the surgical procedure
1 hour
what is the potency, metabolism, onset of action, half life of articaine
- 1.5x lidocaine
- only amide type L.A. with ester group. plasms esterase hydrolysis, liver metabolism
- 1-2 mins
- 0.5 hours
what is the MRD of articaine
7mg/kg
what does articaine claim
- increased success rates
- diffuse soft/ hard tissue reliably
- infiltration of mandible resulted pulplal and lingual anesthesia
- controlled study failed to substantiate these claims
when is articaine contraindicated
- pt allergic to amide type anesthesia
- sulfite sensitivity
- caution with hepatic disease
- patient with significant impairments in cardio function
- children younger than 4
what are the minimum contents of each articaine
1.7 mL
what is the downside of articaine
potential for neuro toxicity of articaine and prilocaine
what drugs resulted in more non surgical paresthesia than all other LAs
articaine and prilocaine
studies show neuro deficits with _____ lidocaine
5%
what is the closest to the ideal intermediate duration local anesthetic
2% lidocaine with 1:100,000 epi
topical anesthesia is effectie only on_____
surface tissue of 2-3 mm
why are spray devices unreliable
unable to deliver measured doses
describe benzocaine
- ester local anesthesia
- poor absorption into CVS
- not suitable for injection
- ester L.A are more allergenic than amide
- most commonly used topical anesthesia
what is EMLA cream made of
lidocaine 2.5% and prilocaine 2.5%
what does EMLA do
provides surface anesthesia of intact skin
what is EMLA cream used for
circumcision, leg ulcer debridement and GYN procedures
how do you used EMLA cream
- 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
when is EMLA cream contraindicated
- methemoglobinemia
- infant < 12 months old had other methemoglobin inducing drugs
- amide sensitive
what are the 2 forms of topical lidocaine
- lidocaine base: poorly soluble in H2O
- lidocaine hydrochloride: water soluble, better tissue penetration but systemic absorption is also greater
what is the MRD of topical lidocaine
200mg
what are the types of topical lidocaine
- aerosol
-ointment - patch
- solution
describe tetracaine hydrochloride
- 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
what should you consider when choosing L.A
- procedure dependent
- postoperative pain control
- hemostasis
- if there are contraindications
what would you give for long duration local anesthesia
bupivacaine or prilocaine
what would you give for children/ mentally disabled patients
mepivacaine
what would you use with hemostasis
epi with 1:100,000 or 1:50,000
what are absolute contraindications
true, documented reproducible allergy
what should you do for relative contraindications
find a better substitute
what is the duration for 2% lidocaine with epi 1:100,000 for pulpal and soft tissue
-pulpal: 1 hour
- soft tissue: 3-5 hour
what is the duration for 3% mepivacaine for pulpal and soft tissue
- pulpal: 5-10 mins
- soft tissue: 1.5-2 hours
what is the duration for 0.5% bupivacaine with epi 1:200,000 for pulpal and soft tissue
-pulpal: greater than 1 hour
- soft tissue: 4-12 hours
what is the duration for 4% articaine with epi 1:100,000 for pulpal and soft tissue
-pulpal: 0.5 hours
- soft tissue: 3-5 hours
