Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > LO 13 - Part 2 LA > Flashcards

LO 13 - Part 2 LA Flashcards

Local Anesthetics

1
Q

List historical local anesthetic treatments in order

A
  1. Indigenous South American people chewed leaves that made them feel better (loss of pain and taste)
  2. Koller noticed that cocaine in the eye produced complete anesthesia
  3. Einhorn synthesized procaine in 1905; many years later, its use became common in dentistry
  4. The amide lidocaine (Xylocaine) was released in 1952
  5. mepivacaine (Carbocaine) was released in 1960
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the characteristics of the ideal LA agent

A
  1. potent
  2. reversible
  3. no local or systemic reactions
  4. no allergies
  5. fast recovery
  6. low cost
  7. long duration
  8. long shelf life
  9. easily metabolized
  10. easily excreted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe LA agents, including metabolism and excretion

A
  1. LA solutions are weak bases.
  2. Inflammation is acidic, so more LA carpules must be used when swelling is present
  3. Metabolism: (2 types) - Esters: plasma; Amides: liver (can be an issue in liver disease)
  4. Excretion - kidneys via urine (can be an issue in kidney disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the pharm effects of a peripheral nerve conduction blocker (reversible) in order of nerve function sensation LOSS

A
  1. cold
  2. heat
  3. pain
  4. touch
  5. pressure
  6. Vibration
  7. Proprioception
  8. Motor

*Order of nerve function sensation regain is the opposite of above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Other than local anesthetic, what condition can lidocaine be used for?

A
  1. Anti-arrhythmia - Na+ channel blockers (review arrhythmia lecture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What determines how far down the list of nerve sensation loss you get and how far do you typically want to get in dental?

A
  1. The AMOUNT of LA injected
  2. Only want to get to pain, which is 3rd on the list. If Pt loses sensation of touch or pressure, you have injected too much
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the adverse reactions of LA

A
  1. CNS and CVS toxicity
  2. Local effects - pain (injecting too quickly), hematoma, necrosis
  3. Malignant hyperthermia (genetic) - this is more for GA, not LA
  4. Pregnant/Nursing moms - lidocaine is ok, but other LAs are not
  5. Allergy (esp. to esters)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a client has an allergic reaction to an amide LA, what is the allergy likely to and what can be done about it?

A
  1. If amide LA, it is likely sulfite allergy (use plain - i.e no epinephrine)
  2. If epinephrine is needed (i.e. in procedures with a lot of bleeding), prepare DPHA 1% with 1:100,000epin solutions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you choose the right LA for the client - what conditions need to be considered?

A
  1. Procedure specific - what is the length of the procedure (and t1/2 of drug)?, is vasoconstriction needed (i.e. a lot of bleeding expected?)
  2. CVS disease - max dose of epinephrine should be respected
  3. Diabetes - Epin in LA can spike blood sugar
  4. Liver disease/ alcohol dependance - decrease amount of amide LA (metabolized in liver)
  5. Kidney/renal disease - avoid esters (metabolized in the plasma)
  6. Pregnancy/nursing - only lidocaine is “safe”
  7. Allergy or uncontrolled/severe asthma - use plain LA carp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the composition of an LA carpule?

A
  1. Vasoconstrictor (epin 1:50,000 - 1:100,000 - 1:200,000)
  2. Anti-oxidants
  3. NaCl
  4. NaOH
  5. LA agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When weighing the pros and cons of using epinephrine, what other than client condition should be considered?

A
  1. Patient can produce endogenous epinephrine far in excess of that administered in dentistry in the presence of inadequate anesthesia
  2. Epinephrine can prolong duration, decrease systemic absorption, and control bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drugs can interact with LA?

A
  1. Tricyclic Antidepressants
  2. α-blocker, β-blocker
  3. Oral hypoglycemics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Compare healthy patient versus cardiac patient max epinephrine dose

A
  1. Healthy - 0.2mg
  2. Cardiac - 0.04 mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe anti-oxidants used in LA carps

A
  1. Sulfites are added to prolong shelf life when vasoconstrictor is used.
  2. not present in plain carpules
    caution!! - asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 3 categories of amide LAs and the generics under their umbrella

A
  1. Xylidine - lidocaine, mepivacaine, bupivacaine
  2. Toluidine - prilocaine
  3. Articaine - articaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the trade names for lidocaine?

A
  1. Xylocaine
  2. Octacaine
17
Q

What are the trade names for mepivacaine?

A
  1. Carbocaine
18
Q

What are the trade names for bupivacaine?

A
  1. Marcaine
19
Q

What are the trade names for prilocaine?

A
  1. Citanest
20
Q

What are the trade names for articaine?

A
  1. Septocaine
  2. Septanest
21
Q

Describe lidocaine

A
  1. Topical or injectable (2% plus epin 1:100,000 1.8ml carpule) preparations
  2. Number one choice for LA
  3. Duration - 45min-1hr
  4. Fast onset
  5. Safe during pregnancy
  6. Trade names - Xylocaine, Octacaine
  7. Under Xylidine umbrella
  8. No option for plain
22
Q

Describe mepivacaine

A
  1. Injection only - plain 3% OR
    2% plus 1:20,000 levonordephrin
  2. 1.8ml carpule
  3. Short duration - 20-30mins
  4. plain is safe in asthmatics
  5. Trade name - Carbocaine
    6.Under Xylidine umbrella
23
Q

Describe bupivacaine

A
  1. Never used in dental hygiene because duration is too long
  2. 0.5% solution with 1:200,000 epin
  3. 1.8ml carpule
  4. very long duration - good for long surgical procedures & post op pain
  5. longer onset
  6. Do not use in children or mentally ill clients
  7. Trade name - Marcaine
    8.Under Xylidine umbrella
24
Q

Describe prilocaine

A
  1. Plain 4% or plus 1:200,000 epin
  2. 1.8ml carpule
  3. Duration is Moderate (plain 30-40 min, with epin 1hr)
  4. Do not use in patients with blood disorders - Methemoglobinemia
  5. Trade name - Citanest
  6. Under the Toluidine umbrella
25
Q

Describe articaine

A
  1. 4% concentration with 1:100,000 epin
  2. 1.7ml carpule
  3. Amides with ester group=>Mostly metabolized by blood plasma => Use when
    et-OH/liver disease
  4. Do not use for Mandibular block (Q3/4) - may result in parasthesia
  5. Do not use in patients with blood disorders - Methemoglobinemia
  6. Trade names - Septocaine, Septanest
26
Q

What 3 esters have been historically used as LA agents?

A
  1. Benzocaine (topical 20%) allergy alert (only one still used)
  2. cocaine (CNS stimulant)
  3. procaine/(e.g. Novocaine is no longer used due to high allergy incidence)
27
Q

Describe topical anesthetics used in dental

A
  1. Benzocaine 20%, an ester, most commonly used topical anesthetic - do not use if allergic to Novocaine
  2. Lidocaine, an amide, second most commonly topical - available as base(jelly/solution) and hydrochloride salt (ointment, aerosol)
  3. The patient should be instructed to avoid eating for 1 hour after application to oral mucosa so that the gag reflex can become fully functional
  4. Oraqix: 20min duration, only effective up to 5mm pockets - combo of lidocaine (fast onset) + prilocaine (longer duration)
28
Q

Describe Oraqix

A
  1. Combo of lidocaine (fast onset) + prilocaine (longer duration)
  2. Common side effects include pain, soreness, irritation, edema or redness at the area of application, and taste changes
  3. no injection = no fear!
29
Q

How are doses of LA and vasoconstrictor determined?

A
  1. The amounts of local anesthetic and vasoconstrictor contained in a certain volume of solution can be calculated from the concentration of that solution - The maximal safe dose for each component should not be exceeded
  2. Each dose should be recorded in the patient’s chart as soon as possible after the injection - Information recorded should include the strength of both ingredients and the volume of solution used or the number of milligrams of each given
  3. Note: 2% Vs 4% carpules = 2g/100ml vs. 4g/100ml
30
Q

What are the factors influencing LA toxicity

A
  1. Drug: inherent toxicity and amount of vasodilation
  2. Concentration
  3. Route of administration
  4. Rate of injection
  5. Vascularity
  6. Patient’s weight
  7. Rate of metabolism and excretion
31
Q

What is the only 1.7ml carpule?

A

articaine/Septocaine/Septanest

Pharmacology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions