clinical pharm local anesthetic part 2 Flashcards
adverse reactions may occur
1) psychogenic reactions
- syncope is most common
2) allergic reactions (RARE)
3) toxic reactions (uncommon)
4) idiosyndratic reactions
- emotional factors can produce unusual symptoms
syncope
1) 76% of adverse dental reactions
2) lay down and give oxygen?
allergic reactions
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
what is in the cartridge
1) lidocaine HCl 2%
2) epinephrine
3) distilled water
4) NaCl
5) citric acid
6) sodium or potassium metabisulfite
signs of adverse reactions
1) sedations + analgesia
2) light headed, slurred speech, drowsy, diplopia
3) disorientation, tremors, respiratory depression
4) coma, respirartty arest, CV collapse
factors contributing to adverse reactions
1) plain anesthetic have rapid systemic absorption
2) dosage
3) route of admin
limiting total dose
1) limit dose and use anesthetic with vasocontrictors to avoid toxic reactions
vasoconstriction
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
vasoconstrictor contraindications
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
patients with stabilized hypertension
1) see how they do
epinephrine in LA
1) adrenal glands make 16.66 cartridges per minute in fight and flight
four different receptors in CVS are affected
1) alpha 1
2) alpha 2
- both increase localized vasocontraction
3) beta 1
- increase HR and contractile strength
4) beta 2
- skeletal muscle vasodilation
on propranol
1) hypertension, unopposed alpha vasoconstriction
2) when you give them epinephrine
controlled hypertension
1) use up to 2 carts with epi containing LA
2) can switch to plain anesthetic for additional doses
watch out for TCAs
1) epinephrine affects those and causes acute hypertension!!!
2) as well as phenothiazine antipsychotics, non selective beta blockers, methamphetamines
levonordefrin
1) not recommended
2) more tachycardial issues
vasoconstrictors increase
1) safety!
2) slow rate of uptake into bloodstream
liver function
1) if decreased liver function give less LA
articaine
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
pregancy
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