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Pain Management 1 > Local anesthesia three > Flashcards

Local anesthesia three Flashcards

1
Q

 Individual response to drug is a Bell shaped curve phenomenon
 Accuracy in deposition of local anesthesia
 Tissue status (vascularity, pH)
 Anatomical variation
 Types of injection administered (block or infiltration)

A

Factors affecting both depth and duration of anesthesia

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2
Q

t/f: Larger than recommended doses do NOT increase duration !!!

A

true

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3
Q

Determining Maximum Recommended Dosages:

 Different mg/kg MRDs dependent on inclusion of vasoconstrictor
 Manufacturer’s recommendation

A

Old Days

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4
Q

Determining Maximum Recommended Dosages:

No distinction / adjustment made for inclusion of vasoconstrictor
 Council on Dental therapeutics of the American Dental Association
 United States Pharmacopeal Convention

A

Currently

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5
Q

Maximum calculated drug dose should_____ in medically

compromised, debilitated, or elderly persons

A

decrease

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6
Q

t/f: when exceeding MRD, there is a greater likelihood of OD arising

A

true, but it doesn’t guarantee an OD.

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7
Q

t/f: OD may arise at the dosage below the calculated MRD (hyper-responders)

A

true

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8
Q

How to determine doses, if two drugs are used?

A

 The total dose of both local anesthetics not exceed the lower of the two
maximum doses for the individual agent.

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9
Q 
Drug Information: 
 Potency: the standard
 Metabolism: liver
 Onset of action: rapid (2-3 mins)
 Anesthetic t ½  : 1.6 hours
A

Lidocaine

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10
Q

What is the MRD of Lidocaine?

A

 Maximum Recommended Dose (MRD)
 4.4mg/kg (Council on Dental Therapeutics of the ADA and USP convention)
 Absolute maximum 300mg
 8 Cartridges will be the maximum # used on a patient

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11
Q

What are other limiting factors of Lidocaine?

**BOARDS****

A

 Healthy patient, maximum epinephrine is 0.2mg or 200mcg
 Cardio patient , maximum epinephrine is 0.04mg or 40mcg
 Conclusion:

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12
Q

What is the sequence of limiting the maximum dose of lidocaine?

A
  • First: maximum amount of epinephrine can be given

* Second: lowest possible dosage of lidocaine needed

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13
Q

First Amide to be marketed and replaced procaine (Novocain) as
the drug of choice

A

lidocaine

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14
Q

t/f: Allergy to amide (lidocaine) is virtually nonexist

A

true

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15
Q

What is the most common type of cartridge of lidocaine?

A

2% w 1:100,000

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16
Q

Drug Info:

 Potency: similar to lidocaine
 Metabolism: Liver
 Onset of action: Rapid (1.5 to 2 mins)
 Anesthetic t ½ : 1.9 hours

A

Mepivacaine

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17
Q

What is the Maximum Recommended Dose ( MRD) of Mepivacaine?

A

 4.4mg/kg
 Absolute maximum 300mg
 5.5 cartridges will be maximum # used on a patient

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18
Q

t/f: Mepivacaine has mild vasodialating properties

A

true

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19
Q

_______ has a Longer duration vs other agent w/o vasoconstrictor

A

Mepivacaine

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20
Q

3% _______ plain provides
 20-40 mins pulpal anesthesia
 2-3 hours soft tissue anesthesia

A

Mepivacaine

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21
Q

When is Mepivacaine indicated?

A

 When vasoconstrictor is NOT indicated

 Most often used in pediatric / geriatric patient

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22
Q

Drug Info:

 Potency: similar to Lidocaine
 Metabolism:
 Hydrolyzed to orthotoluidine and N-propylalanine
 Orthotoluidine induce methemoglobin • May cause observable cyanosis
 Onset of Action: slightly slower (2-4 mins)
 Anesthetic t ½ : 1.6 hours

A

Prilocaine

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23
Q

What is the MRD of Prilocaine?

A

 6.0mg/kg
 Absolute Maximum 400mg
 5.5 cartridges will be the maximum # used on a patient

24
Q

________ is relatively contraindicated when:

 Idiopathic / congenital methemoglobinemia
 Hemoglobinopathies (Sickle cell anemia)
 Anemia
 Cardiac / Respiratory failure evidenced by hypoxia
 Patient taking Acetaminophen or Phenacetin
• Produce elevations in methemoglobin level

A

prilocaine

25
Q

What are the two types of Prilocaine?

A

 4% w/o vasoconstrictor

 4% w vasoconstrictor

26
Q

Drug Info:

 Potency: 4X lidocaine
 Metabolism: Liver
 Onset of Action: Longer 6-10 mins
 occasionally similar to lidocaine
 Anesthetic t ½ : 2.7 hours (Long Duration)
A

Bupivacaine

27
Q

What is the MRD of Bupivacaine?

A

 1.3mg/kg
 Absolute maximum 90 mg
 10 cartridges is the maximum # used on a patient

28
Q

_________ has been available in U.S. since 1983

A

Bupivacaine

29
Q

What is a primary indication that Bupivacaine should be utilized?

A

 Lengthy dental procedure >90 mins pulpal anesthesia is
needed
 Management of postoperative pain
• Reduce post-op opioid analgesics

30
Q

What demographic is Bupivacaine not recommended on?

A

Younger pt and Physically / mentally disabled person

31
Q

the following combination is the run down to effective manage ______.

 Preoperative
 pretreatment of 1 or 2 doses of NSAID
 Perioperative
 Local anesthesia
 Long-duration local anesthesia given upon D/C
 Postoperative
 Continue oral NSAID q X hours for Y days

A

Pain

32
Q

Drug Info:

 Potency: 1.5X lidocaine
 Metabolism:
 Only amide type L.A. with ester group
• Plasma esterase hydrolysis
• Liver metabolism
 Onset of Action:1-2 mins infiltration
 Anesthetic t ½ : 0.5 hours
 Maximum Recommended Dose:
 7mg/kg
A

Articaine

33
Q

The following are claims for _______ use.

 Increased success rates ( don’t miss often)
 Diffuse soft / hard tissue reliably
 Infiltration of mandible resulted pulpal and lingual anesthesia
 Controlled study failed to corroborate these claim !!!

A

Articaine

34
Q

the following are contraindications for _______ use:

 Patient allergic to amide type anesthesia (few to none)
 Sulfite sensitivity
 Caution with hepatic disease
 Patient with significant impairments in cardiovascular function
 Children < 4 y/o is not recommended due to insufficient data

A

Articaine

35
Q

______ and _____ resulted in
more non-surgical paresthesias than
all of the local anesthetics, despite
being used for fewer injections.

A

Articaine and prilocaine

36
Q 
After 55 years of clinical use,
2% \_\_\_\_\_\_\_ with 1:100,000
epinephrine is still the closest to
the ideal intermediate-duration
local anesthetic in dentistry.
A

lidocaine

37
Q 
t/f: Topical anesthesia is effective only on
surface tissue (2-3mm)
A

true

38
Q

Are spray devices able to deliver measured

doses?

A

NO

39
Q

Drug Info:

 Ester local anesthesia
 Poor absorption into cardiovascular system
 Not suitable for injection
 Ester local anesthesia are more allergenic than amide
 Most commonly used topical anesthesia

A

Benzocaine

40
Q

EMLA stands for what?

A

Eutectic Mixture of Local Anesthesia

41
Q

What is the composition of EMLA?

A

 Lidocaine 2.5% + Prilocaine 2.5%

42
Q

What does the following?

 Provides surface anesthesia of intact skin
 Usage
 Circumcision, Leg ulcer debridement and GYN procedures

A

EMLA

43
Q

The following are directions for ____?

A

EMLA

44
Q

EMLA is contraindicated when:

A

 Methemoglobinemia
 Infant <12 months old had other methemoglobin-inducing drugs
 Amide sensitive

45
Q

What are the two forms of lidocaine topical?

A

 Lidocaine base
• Poorly soluble in H2O

 Lidocaine hydrochloride
• Water soluble
• Better tissue penetration but systemic absorption is also greater

46
Q

What is the MRD of Lidocaine topical?

A

 Maximum recommend dose is 200mg

47
Q

Drug information:

 Long-duration ester local anesthetic
 Injection or topical application
 Usage should limit to small area
 Rapidly absorbed through mucous membrane
 Extreme caution urged b/c great potential for systemic
toxicity

A

Tetracaine Hydrochloride

48
Q

Which two local anesthetics have long duration for post opt pain control?

A

Bupivacaine or Prilocaine

49
Q

What is the recommended local anesthetic for post opt pain control for Children / mentally disabled?

A

Mepivacaine

50
Q

What is important for picking a LA that also needs to maintain hemostasis?

A

Use epi with 1:100,000 or 1:50,000

51
Q

_______ contraindicatipon: true, documented reproducible allergy

A

Absolute

52
Q

_______ contraindication: find a better substitute (ex: amide for atypical
pseudocholinesterase patient)

A

relative

53
Q

For pulpal anesthesia ______ lasts 1 (h)

A

2% Lidocaine + Epi 1:100,000

54
Q

For Soft tissue anesthesia _______ lasts 3-5 hours

A

2% Lidocaine + Epi 1:100,000

55
Q

3% Mepivacaine lasts

5-10 (mins) for ______ and 1.5-2 (h) for ___ ____.

A

pulpal: 5-10 (mins)

Soft Tissue: 1.5-2 (h)

56
Q
  1. 5% Bupivacaine +Epi
    1: 200,000

> 1 h for _____ and 4-12 hr for ____ ____

A

Pulpal: >1 h

Soft tissue: 4-12 hr

57
Q

Articaine 4% + epi 1:100,000

______ :0.5(h)
______ _____ : 3-5 (h)

A

Pulpal: 05 H

Soft Tissue: 3-5 hours

Pain Management 1 (6 decks)

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