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Pain Mgmt > Clinical Actions Of Special Agents — Unit 3 > Flashcards

Clinical Actions Of Special Agents — Unit 3 Flashcards

1
Q

What two groups of people are to be more considered when administering LA?

A

Elders and children.

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2
Q

Name factors that affects the depth and duration of LA

A
  1. State of the tissue 2. Individual response to LA 3. Anatomical variation 4. Type of injection 5. Accuracy of injection
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3
Q

What is a hyperresponder?

A

Someone who reacts with overdose symptoms and signs to levels that are slightly lower than a level that would cause those symptoms

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4
Q

What is a hyporesponder?

A

Someone who does not have adverse reactions with elevated levels of LA until their LA blood level is above normal threshold

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5
Q

What percent of population are hyporesponders?

A

15%

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6
Q

What percent of population are hyperresponders?

A

15%

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7
Q

What percent of population reacts to LA properly?

A

70%

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8
Q

What are the two groups of people that require special consideration when administering LA?

A

Elders and children

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9
Q

For what people are the max calc doses always decreased? And why?

A

Medically compromised, debilitated and elders; due to their liver function, protein binding, and blood volume

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10
Q

What is the gold standard in dentistry and medicine today?

A

Pulpal anesthesia

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11
Q

What is the most common vasoconstrictor today?

A

Epinephrine

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12
Q

What is the second most common vasoconstrictor?

A

Levonordefrin

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13
Q

How potent is levonordefrin compared to epi?

A

1/5th as potent at 1:20,000 concentration. It is less potent, but does the same clinically as epinephrine

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14
Q

What VC is better for hyperresponders?

A

Levonordefrin

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15
Q

What is the simplified dilution ration of the vasoconstrictor?

A

0.01 mg/mL

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16
Q

What is the dilution of ratio?

A

Mg of vasoconstrictor to mL of solution

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17
Q

Max dose of epi for healthy individuals?

A

0.2 mg per appointment

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18
Q

What is the dose for significant cardiovascular compromise? (ASA III and ASA IV)

A

0.04 mg which is 1/5th of the healthy dose

19
Q

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

A

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

20
Q

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

A

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

21
Q

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

A

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

22
Q

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

A

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

23
Q

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

A

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

24
Q

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

A

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

25
Q

What makes articaine special? Hint: chemical makeup

A

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

26
Q

What can articaine and prilocaine cause?

A

Methemoglobinemia

27
Q

Short duration (30 mins) LA?

A

Mepi and prilocaine

28
Q

Intermediate acting (60 mins) LA?

A

Lido, articaine, prilocaine, and mepi

29
Q

Long acting (90 mins) LA?

A

Bupivacaine

30
Q

Describe the impact of buffering with sodium bicarbonate in LA

A

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

31
Q

Discuss LA reversal; its active ingredient, and duration time

A

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.

32
Q

Discuss nasal spray, use, and its limitations

A

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

33
Q

Discuss computer controlled LA delivery system

A

Extremely comfortable system used to deliver precise injections, high success rates with PDL, ASA and MSA

34
Q

Are topicals vasodilators or VC?

A

VD

35
Q

Are topicals more or less concentrated than injections?

A

More

36
Q

Is it slow or fast absorption with topicals?

A

Rapid vascular absorption

37
Q

Levels in blood may soon reach those of IV admin with topics. True or false?

A

True

38
Q

How deep does the topical penetrate?

A

1 mm.

39
Q

What are the brands available for topical benzo?

A

Hurricane, cetacaine, healthyco, gingicaine

40
Q

Is topical lidocaine an ester or an amide? Does it have a higher or lower incidence of allergic reactions?

A

Amide, and less

41
Q

Factors to considering when selecting a topical anesthetic

A

Allergies, flavor agents, the form (gel, spray, liquid), for very slight pain control

42
Q

What is a relative contraindication of benzo?

A

Atypical plasma pseudocholinesterase because of the decreased rate of metabolism

43
Q

What is an absolute contraindication for benzo?

A

Allergy

Pain Mgmt (2 decks)

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