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Clinical Action of specific agents Flashcards

1
Q

Parameters for Selection of a Local Anesthetic

A
  1. Length of time for which pain control is required
  2. Requirement for pain control following the treatment
  3. Need for hemostasis
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2
Q

Duration of Action depends on:

A

AT ITT

  1. Anatomical variation
  2. Type of injection: Infiltration or nerve block
  3. Individual variation
  4. Technique
  5. Tissue status: Vascularity, pH
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3
Q

Duration of action is divided into:

A
  • Pulpal (hard tissue)

- Soft tissue (total)

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4
Q

Doses of local anesthetic drugs are presented in terms of _____ or _____.

A

mg/kg or mg/lb.

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5
Q

Maximum dose

A

Blood level just below the threshold for an overdose reaction.

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6
Q

Patients with potentially increased risk:

A
  • Small child
  • Elderly individual
  • Medically compromise patient
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7
Q

Esters:

A
  • Benzocaine
  • Procaine
  • Propoxicaine
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8
Q

Amides:

A
  • Articaine (Septacaine)
  • Bupivacaine (Marcaine)
  • Etidocaine (Duranest)
  • Lidocaine (Xylocaine)
  • Mepivacaine (Polocaine)
  • Prilocaine (Citanest)
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9
Q

Bisulfite allergy

  • Drugs to Avoid:
  • Type of contraindication:
  • Alternative drug:
A
  • Drugs to Avoid: Vasoconstrictor containing L.A.
  • Type of contraindication:Absolute
  • Alternative drug:L.A. without vasoconstrictor
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10
Q

Atypical plasma cholinesterase

Drugs to Avoid:

  • Type of contraindication:
  • Alternative drug:
A

Drugs to Avoid:Esters

  • Type of contraindication: Relative
  • Alternative drug:
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11
Q

Methemoglobinemia

  • Drugs to Avoid:
  • Type of contraindication:
  • Alternative drug:
A

Drugs to Avoid: Prilocaine

  • Type of contraindication:Relative
  • Alternative drug: Other amides
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12
Q

Significant liver dysfunction

  • Drugs to Avoid:
  • Type of contraindication:
  • Alternative drug:
A

Drugs to Avoid:Amides

  • -Type of contraindication: Relative
  • Alternative drug: Amides or esters but judiciously
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13
Q

Significant cardiovascular

  • Drugs to Avoid:
  • Type of contraindication:
  • Alternative drug:
A

Drugs to Avoid: High concentrations of vasoconstrictors

  • -Type of contraindication: Relative
  • Alternative drug: Low concentration of vasoconstrictors
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14
Q

Clinical hyperthyroidism

  • Drugs to Avoid:
  • Type of contraindication:
  • Alternative drug:
A

-Drugs to Avoid: Vasoconstrictors

  • -Type of contraindication: Relative
  • Alternative drug: Low concentration of vasoconstrictors
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15
Q

Procaine provides _____ (duration) pulpal anesthesia and _____ (duration) soft tissue anesthesia

A
  • no pulpal anesthesia

- 15-30 minutes soft tissue anesthesia

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16
Q

_______ produces the greatest vasodilatation

A

Procaine

NOTE: No longer available

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17
Q

Why is Procaine no longer available

A

High incidence of allergy

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18
Q

_______ (Ester) It is not available alone because of its high toxicity.

A

Propoxycaine

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19
Q

Ravocaine is a Combination of ________+ _______

A

Procaine + Propoxycaine

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20
Q

______ It was useful when amides were contraindicated and has been discontinued since 1996.

A

Ravocaine

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21
Q

Ester-type topical local anesthetic for temporary relief of pain associated with toothache, minor sore throat pain and canker sore.

A

Benzocaine

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22
Q

Lidocaine dental indication

A

Dental: Amide-type injectable local anesthetic and topical local anesthetic

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23
Q

Lidocaine medical indication

A

Medical: Local anesthetic and acute treatment of ventricular arrhythmias from myocardial infarction.

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24
Q

Allergies to amide local anesthetics is virtually nonexistent. T/F

A

T

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25
Q

Lidocaine

-Pregnancy classification:

A

Pregnancy classification: B

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26
Q

Is Lidocaine safe during lactation?

A

Yes

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27
Q

FDA recommends a maximum dosage of Lidocaine

A

7mg/kg or 3.2 mg/lb (max: 500mg)

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28
Q

Lidocaine 2%

-Duration of Pulpal Analgesia:

A

Pulpal: 5-10 min

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29
Q

Lidocaine 2%

-Duration of Soft tissue Analgesia:

A

Soft tissue 60-120 min

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30
Q

Lidocaine 2% with Epi. 1:50,000

-Duration of Pulpal Analgesia:

A

Pulpal: 60 min

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31
Q

Lidocaine 2% with Epi. 1:50,000

-Duration of Soft tissue Analgesia:

A

Soft tissue 3-5 hr

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32
Q

Lidocaine 2% with Epi. 1: 100,000

-Duration of Pulpal Analgesia:

A

Pulpal: 60 min

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33
Q

Lidocaine 2% with Epi. 1: 100,000

-Duration of Soft tissue Analgesia:

A

Soft tissue 3-5 hr

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34
Q

Mepivacaine dental indication

A

Dental:

  • local infiltration anesthesia;
  • injection near nerve trunks to produce nerve block.
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35
Q

Mepivacaine Produces slight vasodilatation. T/F

36
Q

Mepivacaine FDA recommended maximum dosage

A
  1. 6 mg/kg or 3 mg/lb

max: 400mg

37
Q

Mepivacaine

-Pregnancy classification:

A

Pregnancy classification: C

38
Q

Is Mepivacaine safe during lactation?

39
Q

Mepivacaine 3%

-Duration of Pulpal Analgesia:

A

Pulpal: 20-40 min

40
Q

Mepivacaine 2% with Levonordefrin or Neo-Cobefrin 1:20,000

-Duration of Pulpal Analgesia:

A

Pulpal: 60-90 min

41
Q

Mepivacaine 2% with Epi 1: 200,000

-Duration of Pulpal Analgesia:

A

Pulpal: 45-60 min

42
Q

Mepivacaine 2% with epi 1: 100,000

-Duration of Pulpal Analgesia:

A

Pulpal: 60 min

43
Q

Mepivacaine 3%

-Duration of Soft tissue Analgesia:

A

Soft tissue: 2-3 hr

44
Q

Mepivacaine 2% with Levonordefrin or Neo-Cobefrin 1:20,000

-Duration of Soft tissue Analgesia:

A

Soft tissue: 3-5 hr

45
Q

Mepivacaine 2% with Epi 1: 200,000

-Duration of Soft tissue Analgesia:

A

Soft tissue: 2-4 hr

46
Q

Mepivacaine 2% with epi 1: 100,000

-Duration of Soft tissue Analgesia:

A

Soft tissue: 2-5 hr

47
Q

Prilocaine indication

A

Dental: used for local infiltration anesthesia; injection near nerve trunks to produce nerve block.

48
Q

Prilocaine metabolism

A

hydrolyzed in the liver to orthotoluidine and N-propylalanine.(orthotoluidine can induce methemoglobinemia)

49
Q

Prilocaine FDA recommended max dose

A

3.6 mg/lb or 8.0mg/kg to a maximum of 600mg

50
Q

Prilocaine

Pregnancy classification

51
Q

Is Prilocaine safe during lactation?

52
Q

Clinical signs of Methemoglobinemia

A
  • Greyish to slate blue cyanosis of the lips, mucus membranes, and nail beds.
  • May have respiratory and circulatory arrest
53
Q

What levels of methemoglobinemia will cause clinical symptoms?

A
  • 20%

- Normal concentration is 1%

54
Q

The Treatment for Methemoglobinemia

A

1 to 2 mg/kg of 1% methylene blue solution intravenously over a 5 minute period of time

55
Q

Prilocaine is relatively contraindicated in patients with?

A

(HI CAP)
-Hemoglobinopathies (Sickle Cell)

  • Idiopathic or congenital methemoglobinemia
  • Cardiac or Respiratory -Failure evidence by hypoxia
  • Anemia
  • Patient’s receiving acetaminophen or phenacetin
56
Q

Prilocaine 4%

-Duration of Soft tissue Analgesia:

A

Soft issue 1.5-2 hr/inf 2-4hr/block

57
Q

Prilocaine 4%

-Duration of pulpal Analgesia:

A

Pulpal 10 min/inf 60 min/block

58
Q

Prilocaine 4% with Epi 1:200,000

-Duration of Soft tissue Analgesia:

A

Soft tissue 3-8 hr

59
Q

Prilocaine 4% with Epi 1:200,000

-Duration of pulpal Analgesia:

A

Pulpal: 60-90 minutes

60
Q

Articaine dental indication

A

Anesthesia agent for infiltration and nerve block anesthesia in clinical dentistry.

61
Q

Articaine metabolism

A

Degradation occurs in the plasma and liver.

62
Q

Articaine complication

A

Methemoglobinemia is a potential complication.

63
Q

Articaine pregnancy classification

64
Q

Articaine max dose

A

Adult 3.2 mg/lb or 7.0 mg/kg

65
Q

Articaine 4%
with Epi. 1:200,000

-Pulpal?

A

45-60 mins

66
Q

Articaine 4%
with Epi. 1:200,000

-Soft tissue?

67
Q

Articaine 4%
with Epi. 1:100,000

-Pulpal?`

A

60-75 mins

68
Q

Articaine 4%
with Epi. 1:100,000

-Soft tissue

69
Q

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

A

4 % Articaine

4 % Prilocaine

70
Q

Bupivacaine indication

A
  • Lengthy dental procedures

- Management of postoperative pain

71
Q

Bupivacaine max dose

72
Q

Bupivacaine preg classification

73
Q

Is Bupivacaine safe for nursing mothers?

74
Q

(Bupivacaine) Marcaine HCl 0.5 with Epi. 1:200,000

-Pulpal

A

90-180 mins

75
Q

(Bupivacaine) Marcaine HCl 0.5 with Epi. 1:200,000

-Soft tissue?

76
Q

Topical anesthetics

A
  • Benzocaine
  • Lidocaine
  • EMLA
77
Q

Benzocaine topical indications

A

Ester-type topical local anesthetic for temporary relief of pain associated with toothache, minor sore throat pain and canker sore

78
Q

Lidocaine topical indications

A

Local anesthesia of the oral mucosa prior to oral injections and soft-tissue dental procedures

79
Q

EMLA?

A

Eutectic Mixture of Local Anesthesia

80
Q

EMLA composition

A

It is a cream composed of:

  • Lidocaine: 2.5%
  • Prilocaine: 2.5%
81
Q

EMLA indications

A

It is used as a topical anesthetic to be placed on intact skin. Used for starting IV catheters, etc.

82
Q

A patient presents for endodontic treatment on tooth #4. PMHx: Pt has cardiac history and you want to limit the amount of epinephrine to be administered the patient. You have given 2 carpules of 4% Articaine with 1:100,000 epinephrine. During the procedure, the patient starts to complain of some discomfort. You decide that you will administer 3% Mepivacaine without epinephrine. What is the maximum amount of Mepivacaine you can administer to the patient? The patient weighs approximately 60 kg, and each cartridge contains 1.8 cc of local anesthetic. Use FDA Max Doses for Local Anesthetics.

A

Maximum dose is related to the lower of the two maximum doses for the individual local anesthetic agents.

  • Max Dose of Articaine: 7.0 mg/kg
  • Max Dose of Mepivacaine: 6.6 mg/kg
  • So, use 6.6 mg/kg
  • 6.6 mg/kg X 60 kg = 396 mg is the maximum dose that can be administered.
83
Q

Exparel?

A

DepoFoam®technology delivers bupivacaine

over time for extended analgesia

84
Q

Exparel composition

A

of naturally occurring biodegradable

and biocompatible lipids

85
Q

Exparel encapsulates?

A

bupivacaine in a multivesicular liposomal drug delivery technology

86
Q

Exparel releases?

A

bupivacaine over time as lipid membranes reorganize

87
Q

Exparel utilizes?

A

membrane components that are cleared by normal metabolic pathways2,3

Pain (3 decks)

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