clinical pharm local anesthetic part 2

Question 1

adverse reactions may occur

Answer 1

1) psychogenic reactions
- syncope is most common
2) allergic reactions (RARE)
3) toxic reactions (uncommon)
4) idiosyndratic reactions
- emotional factors can produce unusual symptoms

Question 2

syncope

Answer 2

1) 76% of adverse dental reactions
2) lay down and give oxygen?

Question 3

allergic reactions

Answer 3

1) get a full history
2) moderate
- asthmatic wheezing (respiratory constriction)
- carry steroid in your kit
3) shock, hypertension
4) FDA
- removed methyl paraben preservative
- no ester anesthetics
- no latex in stopper and diaphragm

Question 4

what is in the cartridge

Answer 4

1) lidocaine HCl 2%
2) epinephrine
3) distilled water
4) NaCl
5) citric acid
6) sodium or potassium metabisulfite

Question 5

signs of adverse reactions

Answer 5

1) sedations + analgesia
2) light headed, slurred speech, drowsy, diplopia
3) disorientation, tremors, respiratory depression
4) coma, respirartty arest, CV collapse

Question 6

factors contributing to adverse reactions

Answer 6

1) plain anesthetic have rapid systemic absorption
2) dosage
3) route of admin

Question 7

limiting total dose

Answer 7

1) limit dose and use anesthetic with vasocontrictors to avoid toxic reactions

Question 8

vasoconstriction

Answer 8

1)vasocontrictors
- slow the rate of uptake into bloodstream
2) epinephrine reaches maximum blood level at 60 minutes after injection and at lower concentration
3) induces local hemostasis
4) increase duration of anesthesia
5) OK to use unless physician says NO
- always aspirate, inject slowly

Question 9

vasoconstrictor contraindications

Answer 9

1) unstable angina
2) MI within 6 months
3) hear surgery in 3 mo
4) arrythmias
4) uncontrolled hypertension
5) uncontrolled heart disease, hyperthyroidism, endocrine

Question 10

patients with stabilized hypertension

Answer 10

1) see how they do

Question 11

epinephrine in LA

Answer 11

1) adrenal glands make 16.66 cartridges per minute in fight and flight

Question 12

four different receptors in CVS are affected

Answer 12

1) alpha 1
2) alpha 2
- both increase localized vasocontraction
3) beta 1
- increase HR and contractile strength
4) beta 2
- skeletal muscle vasodilation

Question 13

on propranol

Answer 13

1) hypertension, unopposed alpha vasoconstriction
2) when you give them epinephrine

Question 14

controlled hypertension

Answer 14

1) use up to 2 carts with epi containing LA
2) can switch to plain anesthetic for additional doses

Question 15

watch out for TCAs

Answer 15

1) epinephrine affects those and causes acute hypertension!!!
2) as well as phenothiazine antipsychotics, non selective beta blockers, methamphetamines

Question 16

levonordefrin

Answer 16

1) not recommended
2) more tachycardial issues

Question 17

vasoconstrictors increase

Answer 17

1) safety!
2) slow rate of uptake into bloodstream

Question 18

liver function

Answer 18

1) if decreased liver function give less LA

Question 19

articaine

Answer 19

1) thiophrene ring rather than benzene
- increase lipid solubility
2) both ester and amide chemical groups
3) hybrid anesthetic
- amide agent
- ester group
4) may be better LA for people with impaired liver
- since 95% metabolized in blood, 5% in liver

Question 20

pregancy

Answer 20

1) no contraindications to using LA
2) however, it is best to
- no elective dental care in 1st trimester
- 2nd and first half of 3rd is best time for dental care
- last half of 3rd trimester, emergency dental care ONLY
3) lidocaine is in FDA category B
- 2% lido with 1:100k epi is the safest LA to use