dental drug interaction with LA and Vasopressors Flashcards
cimetidine
others within this category?
cimetidine is a H2 receptor blocker
clinically relevant interaction in that the metabolism of amide LA’s in the liver breakdown both cimetidine and the LA - thus higher levels of LA can be achieved as not metabolized
relative contraindication in a patien who is ASA 3 and has CHF.
other H2 receptor blockers
-ranitidine and famotidine
sulfonamides
contraindication with the use of ester type LA –> as the LA may inhibit the bacteriostatic action of the sulfonamide
like procaine and tetracaine
methemoglobinemia is most associated with which LA?
prilocaine
TCA’s
examples and implication with LA’s?
amitriptyline, doxepin, imipramine
- may enhance the effects of vasoconstrictors resulting in hypertensive crisis as TCA’s may enhance cardiovascular actions of exogenously administered vasopressors
- avoid use of levonordefrin or norepi in these patients
They block specific serotonin (SERT or 5-HTT) and norepinephrine transporters (NET). When affected, these transporters cannot play their part in the reuptake of neurotransmitters, which increases the concentration and ultimately has an effect on mood
epi can be administered but dose is suggested to be limited to 0.05mg
propranolol selective or non selective b-blocker
non selective
* 0.04 mg epi is max in these patients
use of non selective and selective beta blockers and LA
interaction between epi and these drugs has a higher chance of causing increases in the BP
- likely to result in serious BP elevation with reflex bradycardia
non selective beta blockers
carvediloc pindolol timolol sotalol nadolol propranolol labetalol
carving pins takes such nice perfect labor
selective beta blockers
atenolol betaxolol metoprolol acebutolol esmolol bisoprolol
abbey bet mikaela about eating bison
monoamine oxidase inhibitors mechanism and list
prescribed in the management of major depression, certain phobic-anxiety states, and OCD.
they can potentiate the actions of vasopressors used in dental local anesthetics by inhibiting the biodegradation by the enzyme monoamine oxidase at the presynaptic neuron level
MAOIs act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability. There are two isoforms of monoamine oxidase, MAO-A and MAO-B
fluoxetine selegiline clorgline isocarboxazid phenelzine tranylcpromine trimipramine
vasoconstrictor with cocaine significance
MOA of cocaine and use with LA
never use epi with cocaine user or suspected within at least 24 hours.
significant stimulatory effects on CNS and CVS
cocaine stimulates norepi release and inhibits its reuptake in adrenergic nerve terminals, thus producing a state of catecholamine hypersensitivity
thus tachycardia and htn are observed following administration
CO and oxygen consumption increase which can result in ischemia and lethal dysrhythmias, angina pain, and MI
vasoconstriction with adrenergic neuronal blocker
example and mechanism
example
sympathomimetic effects may be enhances so vasoconstrictors used cautiously
phenothiazines - psychotropic drugs usually prescribed for the management of serious psychotic disorders
chlorpromazine
promethazine
*they supress the vasoconstricting actions of epi - permitting its milder vasodilating actions to work unapposed and could result in postural hypotension
epi released from
adrenal medulla
- hormone acting
epi released from
adrenal medulla
- hormone acting
phenylephrine
alpha- 1 agonist
alpha 1 in nasal airways
used in nasal congestion
mydriasis
norepi affanity
alpha >beta 1
causing vasoconstriction
increases MAP
SVR and HR
increases contractility in heart (beta-1)
