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Oral Medicine > Local Anesthesia > Flashcards

Local Anesthesia Flashcards

1
Q

3 parts of local anesthesia

A

aromatic group
intermediate linkage
amine group

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2
Q

aromatic group

A

lipophilic properties

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3
Q

intermediate linkage

A

spacial separation between lipophilic and hydrophilic ends

connects them with ester or amide

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4
Q

amine group

A

affects pKa and speed of onset

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5
Q

difference between amide and ester

A

amide - union of carboxylic acid and amine (peptide bond is amide)

ester -union of carboxylic acid and alcohol

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6
Q

except for procaine, all injectable dental locals are (amines or esters)

A

amines

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7
Q

topicals are mostly (amines or esters)

A

esters

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8
Q

the amine portion is the ____

A

base

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9
Q

what is special about free bases?

A

the amine portion is a free base

only free bases can cross the cell membranes, so onset of action is faster for lower pKa’s (stronger acids) because they give up their protons more easily and become uncharged “free bases”

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10
Q

onset is faster for ____

A

low pKa’s (strong acids)

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11
Q

acidic environments like inflamed tissue…

A

have slow onset, since the base remains protonated in the low pH environment (impedes local anesthesia development)

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12
Q

locals stabilize ________

A

membranes

decrease rate of depolarization and repolarization

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13
Q

locals prevent _____

A

rapid sodium influx

needed to make an AP

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14
Q

why are the pharmacokinetics of locals unique?

A

they become ineffective when absorbed into the system / blood stream

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15
Q

local anesthetics wear off when…

A

redistributed throughout the body to all tissues (when the numbness goes away)

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16
Q

metabolic half life is not related to _________ but is related to ______

A

duration of anesthesia
toxicity

17
Q

why does metabolism affect overall toxicity?

A

because it’s balance between rates of absorption at injection site and rate of removal from the blood

18
Q

duration of action is related to _____ (not _______)

A

protein bonding of local

metabolic transformation

19
Q

locals are all (vasoconstrictors or vasodilators)

A

vasodilators

20
Q

which local anesthetic is not a vasodilator? (exception!)

A

cocaine!

21
Q

what is needed in locals to slow the distribution?

A

vasoconstrictors

22
Q

_____ anesthesia takes the longest to develop (and leaves first)

A

pulpal

23
Q

which type of anesthesia lasts longest? Nerve blocks or infiltration?

A

nerve blocks

24
Q

primary site of metabolism for amides

A

liver

25
Q

excretion of LA

A

kidney for LA agents and metabolites

26
Q

when do local anesthetics lose their effect?

A

when they are absorbed into the bloodstream

27
Q

rate at which local is removed from the plasma is expressed as its

A

metabolic half life

28
Q

duration of action of local anesthetics (shortest to longest) in terms of type of tissue

A

shortest = pulpal anesthesia
longest = soft tissue anesthesia

29
Q

duration of action of local anesthetics (shortest to longest) in terms of type of LA

A

carbocaine (mepivacaine)
xylocaine (lidocaine)
septocaine (articaine)
marcaine (bupivacaine)

30
Q

which anesthetic is not recommended in pedo or in cognitiviely impaired adults?

A

marcaine (bupivacaine)

31
Q

methamoglobin

A

hemoglobin in which the iron ion has been oxidized to the ferric instead of the ferrous state

does not bind O2

32
Q

methamoglobin is produced by which local

A

articaine / prilocaine

33
Q

max does for lidocaine with epi

A

4.4 mg / kg per malamed

34
Q

max dose for mepivacaine

A

4.4 mg / kg

35
Q

max dose for bupivicaine

A

1.3 mg / kg

36
Q

max dose for septocaine

A

7mg / kg

37
Q

epinephrine max recommended dose for non-cardiac patient

A

0.2 mg

38
Q

epinephrine max recommended dose for cardiac patient

A

0.04 mg

39
Q

lidocaine 2% has 34 mg of local in carpule. what is do

A

Oral Medicine (2 decks)

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