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UM - codes > Local Anesthesia > Flashcards

Local Anesthesia Flashcards

1
Q

name the 4 amides

give the fact for each and the other name it is called

A
  1. lidocaine / xylocaine –> safe, widely available
  2. mepivicaine /carbocaine —> least vasodilation
  3. bupivacaine / marcaine —> carpules not recommended in children - longest duration
  4. articaine (septocaine) –> shortest duration
    * has one ester chain
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2
Q

where are amides metabolized

A

liver

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3
Q

which has least vasodilation

A

mepivicaine aka carbocaine

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4
Q

longest duration?

implication

A

bupivacaine (marcaine)
.5% bupivicaine w/ 1:200,000 epi

*so not recommended in children

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5
Q

which class ester vs amide is more likely to cause allergic and why

A

esters

*more toxic , more known allergies because of methylparaben

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6
Q

ester metabolism?

A

by plasma pseudocholinesterase

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7
Q

name 4 esters

A
  1. procaine
  2. cocaine
  3. tetracaine
  4. benzocaine
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8
Q

red carpule

A

lidocaine

2% with epi 1:100,000

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9
Q

gold 871 carpule

A

articaine 4% with epi 1:100,000

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10
Q

tan 466

A

Mepivicaine 3%

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11
Q

blue 300 carpule

A

Bupivicaine .5% with epi 1:200,000

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12
Q

landmarks for IAN

A
  1. pterygomandibular raphe (posterior border of mandible)
  2. coronoid notch (anterior border of mandible)
  3. occlusal plane of lower teeth
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13
Q

lingual nerve block vs IAN block ***

A

lingual nerve block anesthetizes the lingual soft tissues associated with all teeth in the quadrant and the anterior 2/3 of the hemi-tongue on the side of the block

The IAN ONLY anesthetizes the teeth and bone from central incisor to the third molar and the soft tissues from the central incisor to the BICUSPID ON THE BUCALL SIDE

the IAN does NOT innervate lingual soft tissues and so the block does not anesthetize any soft tissues

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14
Q

maximum recommended dosages of LA (for healthy) that are 7.0 mg/kg

max dose in mg?

A

articaine 4% 1:100,000 epi

articaine 4% 1:200,000 epi
(articaine / septocaine)

lidocaine 2% 1:100,000 epi

lidocaine 2%
1:50,000 epi

7.0 mg/kg OR
500 mg
articaine is determined by weight as well

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15
Q

maximum recommended dosages of LA (for healthy) that are 6.6 mg/kg
what is max dose of these in mg?

A

mepivacaine 2%
1:20,000

mepivacaine 3% without vasoconstrictor

6.6 mg/kg
OR
400 mg max

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16
Q

maximum recommended dosages of LA (for healthy) that are 8.8 mg/kg

max dose in mg?

A

prilocaine 4%
1:200,000 epi

prilocaine 4%
without vasoconstrictor

600 mg max dose
OR the 8.8 mg/kg

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17
Q

max number of carpules for healthy
bupivacaine 0.5%
1:200,000 epi?

max in mg?

A

10 cartridges

90 mg

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18
Q

max number of carpules for healthy of lido 2% 1:100?

lido 2% 1:50

A

lido 2% 1:100
11
lido 2% 1:50
5.5

basically half in 1:50 b/c the epi is more concentrated in this solution

19
Q

max number of carpules for healthy of mepivicaine 2% 1:20,000?
mepivicaine 3% without vasoconstrictor?

A

mepivicaine 2% 1:20,000?
11

mepivicaine 3% without vasoconstrictor?
7

20
Q

max number of carpules for healthy of prilocaine 4% 1:200,000 epi?

prilocaine 4%
without vasoconstrictor

A

8 carpules

21
Q

lbs to kg conversion

A

divide by 2.2

or if in kg multiple by that

22
Q

basic mechanism of LA

A 
bind to receptor within the sodium channel and inhibit the influx of sodium during nerve conduction 
blocking activation and depolarization
* within the sodium channel
considered class D classification of local

CONDUCTION BLOCKADE
- no propagation of action potential or electrical depolarization

this is a NON depolarizing nerve block

23
Q

affect of pKa

A

ONSET
- lower pka results in more rapid onset of action as more RN molecules are present to diffuse through the nerve sheath; thus the onset time is decreased

24
Q

affect of lipid solubility

A

anesthetic POTENCY

- increased lipid solubility results in increased potency

25
Q

affect of protein binding

A

DURATION
- increased protein binding allows anesthetic cations (RNH+) to be more firmly attached to proteins located at receptor sites’ thus the duration of action is increased

26
Q

affect of vasodilatory activity

A

POTENCY AND DURATION
- greater vasodilatory activity results in increased blood flow to the area -resulting in rapid removal of anesthetic molecules from the injection site- thus anesthetic potency and duration would be decreased

27
Q

list of moderateyl acting in terms of duration LA

A

mepivicaine
prilocaine
lidocaine
articaine

28
Q

list o long acting in terms of duration LA

A

bupivicaine

29
Q

articaine

% and color

A

4% articaine with 1:100,000 epi
gold
* shortest duration
less than 60 mins with infilatration

30
Q

bupivicaine %

color

A

.5% bupivicaine 1:200,000 epi aka marcaine
blue
longest
not recommended in children

31
Q

lidocaine %
epi concentrations
color
duration of action

A

2% lidocaine 1:100,000 epi (red)
2% lido 1:200,000 epi

about an hour

32
Q

mepivicaine %
epi concentrations
color
duration

A

3% mepivicaine
tan

least vasodilation

33
Q

which can be used with no vasoconstrictor

A

prilocaine
4% prilocaine
short duration though

34
Q

drug that has been noted to be associated with methemoglobinemia

A

prilocaine

35
Q

% prilocaine

A

4%
no vasoconstrictor
max dose is 8.0 mg/kg OR 600 mg
some say 8.8

36
Q

technique difference when anesthetizing for IAN vs lingual

A

IAN - contact bone

Landmarks are the same: Pterygomandiular raphe, occlusal plain, coronoid notch however depth of injection is DIFFERENT

Lingual Nerve block – AFTER administration of the IAN block, the needle is withdraw 2/3 to ¾ of the way and the needle is aspirated a second time: Solution is deposited with the needle only 1/3 to ¼ advanced into the mucosa in area of Lingual Nerve

37
Q

buccal nerve block?

A

mucosa of 2nd and 3rd lower molar

38
Q

mental nerve and incisive nerve block

A

Mental foramen by apices of premolars
Incisive nerve block
For the actual block of the teeth , hold pressure for 2 mins after injection to force anesthetic into mental foramen
High rate of paresthesia

39
Q

posterior superior alveolar block

A

max molars
16 mm depth (about half the length of the needle)

relatively high hematoma risk

40
Q

local infilatrations mainly used for?

A

maxillary teeth on buccal or palatal

lower premolar, canine, incisor
buccal and lingual

41
Q

mesiobuccal root of first molar innervated by?

A

infraorbital

42
Q

infraorbital nerve innervates?

A

central to mesial buccal cusp of first max molar

43
Q

max dose in mg for bupivicaine

A

1.3 mg/kg

.5% + 1:200,000 epi

44
Q

which drugs max dose is 6.6 mg/kg

A

mepivicaine

UM - codes (18 decks)

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