Clinical Actions Of Special Agents — Unit 3

Question 1

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

Answer 1

Elders and children.

Question 2

Name factors that affects the depth and duration of LA

Answer 2

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

Question 3

What is a hyperresponder?

Answer 3

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

Question 4

What is a hyporesponder?

Answer 4

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

Question 5

What percent of population are hyporesponders?

Answer 5

15%

Question 6

What percent of population are hyperresponders?

Answer 6

15%

Question 7

What percent of population reacts to LA properly?

Answer 7

70%

Question 8

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

Answer 8

Elders and children

Question 9

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

Answer 9

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

Question 10

What is the gold standard in dentistry and medicine today?

Answer 10

Pulpal anesthesia

Question 11

What is the most common vasoconstrictor today?

Answer 11

Epinephrine

Question 12

What is the second most common vasoconstrictor?

Answer 12

Levonordefrin

Question 13

How potent is levonordefrin compared to epi?

Answer 13

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

Question 14

What VC is better for hyperresponders?

Answer 14

Levonordefrin

Question 15

What is the simplified dilution ration of the vasoconstrictor?

Answer 15

0.01 mg/mL

Question 16

What is the dilution of ratio?

Answer 16

Mg of vasoconstrictor to mL of solution

Question 17

Max dose of epi for healthy individuals?

Answer 17

0.2 mg per appointment

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

What makes articaine special? Hint: chemical makeup

Answer 25

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

Question 26

What can articaine and prilocaine cause?

Answer 26

Methemoglobinemia

Question 27

Short duration (30 mins) LA?

Answer 27

Mepi and prilocaine

Question 28

Intermediate acting (60 mins) LA?

Answer 28

Lido, articaine, prilocaine, and mepi

Question 29

Long acting (90 mins) LA?

Answer 29

Bupivacaine

Question 30

Describe the impact of buffering with sodium bicarbonate in LA

Answer 30

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

Question 31

Discuss LA reversal; its active ingredient, and duration time

Answer 31

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.

Question 32

Discuss nasal spray, use, and its limitations

Answer 32

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

Question 33

Discuss computer controlled LA delivery system

Answer 33

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

Question 34

Are topicals vasodilators or VC?

Answer 34

VD

Question 35

Are topicals more or less concentrated than injections?

Answer 35

More

Question 36

Is it slow or fast absorption with topicals?

Answer 36

Rapid vascular absorption

Question 37

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

Answer 37

True

Question 38

How deep does the topical penetrate?

Answer 38

1 mm.

Question 39

What are the brands available for topical benzo?

Answer 39

Hurricane, cetacaine, healthyco, gingicaine

Question 40

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

Answer 40

Amide, and less

Question 41

Factors to considering when selecting a topical anesthetic

Answer 41

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

Question 42

What is a relative contraindication of benzo?

Answer 42

Atypical plasma pseudocholinesterase because of the decreased rate of metabolism

Question 43

What is an absolute contraindication for benzo?

Answer 43

Allergy