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D2: 625 Clinical Skills III > Lab Manual: LA General > Flashcards

Lab Manual: LA General Flashcards

1
Q

What topical Anesthesia is used to prior to injections?

A

Benzocaine 20%

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2
Q

What is the chemical structure of Benzocaine

A

Ester

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3
Q

What needs to be done to the tissue before applying the benzocaine?

A

Area must be dry

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4
Q

What is the general chemical structure of an LA molecule?

A

Aromatic group + Intermediate Chain + Amine Group

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5
Q

What are the two possibilities for the intermediate chain portion of the LA molecule?

A

Amines or Esters

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6
Q

Where are ester LA’s metabolized?

A

In the plasma

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7
Q

Where are amine LA’s metabolized?

A

In the Liver

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8
Q

What is the % and parts epi for Lidocaine?

A

2%

1:100,000 epi

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9
Q

What are the 3 brand names for Lidocaine 2%

A

Xylocaine
Octocaine
Lignospan

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10
Q

What is the MRD for Lidocaine 2%

A

4.4 mg/kg

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11
Q

How many pounds are in 1 kg?

A

2.2 lbs/kg

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12
Q

How many kgs are in 1 lbs?

A

0.454 kg/lb

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13
Q

Calculate the MRD of lidocaine for a 186 pound patient

A

186 * .454 = 84.444 kgs * 4.4 mg/kg = 371.5 mg Lidocaine

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14
Q

What is the Specific Receptor Theory in terms of a LA’s mechanism of Action?

A

LA works by binding to receptor sites within sodium channels preventing nerve depolarization and conduction

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15
Q

What is the most common % and epi ratio for Prilocaine?

A

4%

1:200,000 epi

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16
Q

What is the brand name of Prilocaine?

A

Citanest

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17
Q

What is the expected onset time of Citanest/Prilocaine?

A

Fast, 2-4 mins

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18
Q

What is the duration of Citanest/Prilocaine?

A

Short to Intermediate

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19
Q

What is the MRD for Citanest/Prilocaine?

A

6 mg/kg

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20
Q

What is a possibility with Citanest/Prilocaine to look out for?

A

Persistent parathesia

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21
Q

When is Prilocaine/Citanest the least painful?

A

When it is used without epi

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22
Q

What is the common % and epi ratio for Articaine?

A

4%

1:100,000

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23
Q

What is the brand name for Articaine?

A

Septocaine

24
Q

What is the MRD for Septocaine/Articaine?

25
Q

What is the expected duration for Septocaine/Articaine

A

Intermediate

26
Q

What block can you never use Articaine/Septocaine for?

27
Q

What can Articaine/Septocaine use on the IAN cause?

A

Neurotoxicity

28
Q

In general “i+caines” are

A

amide LA’s

29
Q

What is the common % and epi ratio for Mepivacaine?

A

3%

No vasoconstrictor used

30
Q

What are the 3 common brand names for Mepivacaine?

A

Carbocaine
Polocaine
Scandonest

31
Q

What patients are typically prescribed Mepivacaine?

A

Cardiac pts

Epi sensitive patients

32
Q

What is the trade off for Mepivacaine’s lack of epinephrine?

A

Short duration

Less profound anesthesia

33
Q

What is the % and epi ratio for Bupivacaine?

A
  1. 5%

1: 200,000

34
Q

When is Bupivacaine used?

A

Long duration surgery

Acute pain

35
Q

What is the MRD for Bupivacaine?

A

90 mg (10 carpules)

36
Q

What is the brand name for Bupivacaine?

37
Q

What is an additional antioxidant vasoconstrictor sometimes used as an injection additive?

A

Sodium metabisulfite

38
Q

What additive is an allergen and a preservative?

A

Methyparaben

39
Q

How many mLs of solution are in each carpule?

40
Q

How much LA is in 1 carpule for 2%, 3%, 4%, and 0.5% solutions?

A 
2% = 36 mg
3% = 54 
4% = 72
.5% = 9 mg
41
Q

How much epi is in 1 carpule for 1:100k and 1:200k?

A

1: 100 = 0.018 mg
1: 200 = 0.009 mg

42
Q

What is the MRD of epi for a healthy patient?

A

.20 mg or about 10 carpules

43
Q

What is the MRD of epi for a cardiac patient?

A

.04 mg or about 2 carpules

44
Q

What is the widest gauge of needle?

45
Q

What is the narrowest gauge of needle?

46
Q

What is the middle gauge of needle?

A

Yellow = 27

47
Q

What is the expected time of onset for the maxilla?

A

3-5 minutes

48
Q

What is the expected time of onset for the mandible?

A

3-5 minutes

7-10 minutes for a block

49
Q

How does inflammation effect the LA’s effectiveness?

A

Inflamed tissue is more acidic so more of the solution is in its cationic form which cannot penetrate the membrane of the neuron so it is less effective

50
Q

Which drugs should you avoid epi with?

A

Tricyclic Antidepressants
Non-selective Beta Blockers
Cocaine

51
Q

What condition must you avoid Prilocaine with?

A

Methemoglobinemia

52
Q

How do you treat Trismus?

A

Alternating hot/cold
NSAIDs
Rest

53
Q

What causes a hematoma?

A

Nicking vessels

Tx: Moist heat and Abx if needed

54
Q

How can you avoid an intravascular injection?

A

Aspirating the needle

55
Q

What are the symptoms of a needle tract infection?

A

Delayed onset of fever, chills, tenderness

Tx: Abx

56
Q

What LA is the most common cause of Persistent Anesthsia?

A

Articaine blocks

D2: 625 Clinical Skills III (5 decks)

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