clinical pharm part 1

Question 1

how do local anesthestics work

Answer 1

1) BH+ acidic, ionized
- cant pass through nerve membrane (water soluble)
2) basic unionized can pass through

Question 2

the lower the pKa of the anesthetic

Answer 2

1) it is easier it is for the body to buffer it to the unionized form

Question 3

lipid solubility

Answer 3

1) articaine is the most lipid soluble
- faster, better, and fewer failures
2) mepivacaine is the least

Question 4

onset

Answer 4

1) depends on anesthetic agent
- lipid solubility and protein binding to receptor sites
2) delivery technique
- infiltration faster onset
- block as longer duration

Question 5

troubleshooting local anesthesia

Answer 5

1) the binding sites are within the sodium channels
2) sodium channels do not open to allow anesthetic access until the RECOVERY phase after stimulation of the nerve
- so you can stick them in the gingiva

Question 6

infiltration

Answer 6

1) faster onset, simple, safe, hemostasis
2) disavantages are multiple injections for multiple teeth, shorter duration
3) 1/2 -3/4 cartridge for adults

Question 7

IA colume

Answer 7

1) 3/4 -1 for IA

Question 8

anesthetic success

Answer 8

1) EPT, endo ice

Question 9

reasons for anesthetic failure

Answer 9

1) anatomical, physiological variation
2) technical administration error
3) inflammation and infection

Question 10

inflammation and infection

Answer 10

1) pH is 5-3
2) more injected anesthetic is unionized

Question 11

the hot tooth

Answer 11

1) infected teeth with pulpitis
2) severed periodontal infection
3) hypoplastic teeth
4) trauma, bruxing
–
can antibiotics reduce the acidity and allow normal disassociation of anesthetic?
- if not, give block injection first, well away from local site
- needle should not be inserted into active infection

Question 12

infiltration anesthesia

Answer 12

1) buccal and lingual