Clinical Actions Of Special Agents — Unit 3 Flashcards
What two groups of people are to be more considered when administering LA?
Elders and children.
Name factors that affects the depth and duration of LA
- State of the tissue 2. Individual response to LA 3. Anatomical variation 4. Type of injection 5. Accuracy of injection
What is a hyperresponder?
Someone who reacts with overdose symptoms and signs to levels that are slightly lower than a level that would cause those symptoms
What is a hyporesponder?
Someone who does not have adverse reactions with elevated levels of LA until their LA blood level is above normal threshold
What percent of population are hyporesponders?
15%
What percent of population are hyperresponders?
15%
What percent of population reacts to LA properly?
70%
What are the two groups of people that require special consideration when administering LA?
Elders and children
For what people are the max calc doses always decreased? And why?
Medically compromised, debilitated and elders; due to their liver function, protein binding, and blood volume
What is the gold standard in dentistry and medicine today?
Pulpal anesthesia
What is the most common vasoconstrictor today?
Epinephrine
What is the second most common vasoconstrictor?
Levonordefrin
How potent is levonordefrin compared to epi?
1/5th as potent at 1:20,000 concentration. It is less potent, but does the same clinically as epinephrine
What VC is better for hyperresponders?
Levonordefrin
What is the simplified dilution ration of the vasoconstrictor?
0.01 mg/mL
What is the dilution of ratio?
Mg of vasoconstrictor to mL of solution
Max dose of epi for healthy individuals?
0.2 mg per appointment
What is the dose for significant cardiovascular compromise? (ASA III and ASA IV)
0.04 mg which is 1/5th of the healthy dose
Describe lidocaine
1. Classification
2. Concentration
3. VC available
4. Onset of Action
5. Half-life
6. Duration
7. Uses
8. Max dose
9. Brand names
Amide; 2%; 50 and 100; 2 to 3 mins; 1.6 HL; ~60 mins; Golden standard for LA; 3.2 mg/lb or 500 mg or 300 mg according to Malamed; Xylocaine, octocaine, alphacaine
Describe Mepivicaine
1. Classification
2. Concentration
3. VC available
4. Onset of Action
5. Half-life
6. Duration
7. Uses
8. Max dose
9. Brand names
Amide; 2 or 3%; 20k for levo or 100k for epi; similar onset to lidocaine; HL = NA; 20 to 40 without VC for PA and 2 to 3 hrs for ST, 60 to 90 mins with levo for PA and 3 to 5 for ST, 60 mins with epi; ST with epi is 2 to 4 hours; Short procedures, contraindications to vasoconstrictors; 3.0 mg/lb or 400 mg; scandonest, carbocaine, polocaine
Describe bupivacaine
1. Classification
2. Concentration
3. VC available
4. Onset of Action
5. Half-life
6. Duration
7. Uses
8. Max dose
9. Brand names
Amide; 0.5%; 200k; 6 to 10 mins; 2.7 HL; 1.5 to 3 hrs for PA and 4 to 9 hrs until 12 for ST; Long procedures, post op pain, full mouth reconstruction, endo, perio, surgical; 0.9 mg/lb or 90 mg; Marcaine
Describe Prilocaine
1. Classification
2. Concentration
3. VC available
4. Onset of Action
5. Half-life
6. Duration
7. Uses
8. Max dose
9. Brand names
10. Contraindications
Amide; 4%; Without epi, 200k; 2 to 4 mins; 1.6 HL; 200k is 60 to 90 mins, 3 to 8 hours for ST, without epi = 10 mins, for ST 1.5 to 2 for infiltration, 2 to 4 for block; epi sensitive patients, 60 to 90 mins of anesthesia with lower concentration of epi, EMLA; congenital methhemoglobinemia, sickle cell anemia, anemia, and cardiac or respiratory failure; high rates of paresthesia; citanest
Describe etidocaine
1. Classification
2. Concentration
3. VC available
4. Onset of Action
5. Half-life
6. Duration
7. Uses
8. Max dose
9. Brand names
Same as bupivacaine, except it is a faster onset
(1.5 to 3 mins) and max dose is 3.6 mg or 400 total and concentration is 1.5%; duranest
Describe articaine
1. Classification
2. Concentration
3. VC available
4. Onset of Action
5. Half-life
6. Duration
7. Uses
8. Max dose
9. Brand names
Amide; 4%; 100k; 1 to 3 mins (infil and block); 1.6 HL; 60 to 75 mins; 3.2 for adults, 2.27 for children; great diffusive properties
What makes articaine special? Hint: chemical makeup
It has a thiopene ring, which is a 5-ring with a sulfur attached to it. All other LA has a benzene ring. It allows it to easily diffuse through soft and hard tissue
What can articaine and prilocaine cause?
Methemoglobinemia
Short duration (30 mins) LA?
Mepi and prilocaine
Intermediate acting (60 mins) LA?
Lido, articaine, prilocaine, and mepi
Long acting (90 mins) LA?
Bupivacaine
Describe the impact of buffering with sodium bicarbonate in LA
Allows for faster onset, more patient comfort, and less tissue injury. It has to do with mixing LA immediately prior to giving the anesthetic. It is produced by onpharma, and it is costly
Discuss LA reversal; its active ingredient, and duration time
It reverses the effect of LA to reduce the amount of time the patient is numb (decreases the residual anesthesia), it takes 45 mins to kick in, and the active ingredient is phentolamine mesylate, and it is costly. Oraverse is the company name or brand.
Discuss nasal spray, use, and its limitations
FDA approved for pedo. Numbs the entire primary dentition, teeth 4 to 13 buccal and palatal region without numbing the lips and extra oral area, kids 80 pounds, nose congestion after it starts to wear off from the Afrin
Discuss computer controlled LA delivery system
Extremely comfortable system used to deliver precise injections, high success rates with PDL, ASA and MSA
Are topicals vasodilators or VC?
VD
Are topicals more or less concentrated than injections?
More
Is it slow or fast absorption with topicals?
Rapid vascular absorption
Levels in blood may soon reach those of IV admin with topics. True or false?
True
How deep does the topical penetrate?
1 mm.
What are the brands available for topical benzo?
Hurricane, cetacaine, healthyco, gingicaine
Is topical lidocaine an ester or an amide? Does it have a higher or lower incidence of allergic reactions?
Amide, and less
Factors to considering when selecting a topical anesthetic
Allergies, flavor agents, the form (gel, spray, liquid), for very slight pain control
What is a relative contraindication of benzo?
Atypical plasma pseudocholinesterase because of the decreased rate of metabolism
What is an absolute contraindication for benzo?
Allergy
