Module 6 Flashcards
1
Q
what does a green band indicate
A
2% 1: 50,000 epi LIDOCAINE
2
Q
what does the red band indicate
A
2% 1 : 100,000 epi LIDOCAINE
3
Q
what does the tan band indicate
A
3% plain MEPIVACAINE
4
Q
what does the brown band indicate
A
2% 1 : 20,000 levo MEPIVACAINE
5
Q
what does the black band indicate
A
4% plain PRILOCAINE
6
Q
what does the yellow band indicate
A
4% 1 : 200,000 epi PRILOCAINE
7
Q
what does the gold band indicate
A
4% 1 : 100,000 epi ARTICAINE
8
Q
what does the silver band indicate
A
4% 1 : 200,000 epi ARTICAINE
9
Q
what does the blue band indicate
A
0.5% 1 : 200,000 epi BUPIVACAINE
10
Q
what is the most common trade name of lidocaine
A
xylocaine
11
Q
what is the most common trade name of mepivacaine
A
carbocaine
12
Q
what is the most common trade name of prilocaine
A
citanest
13
Q
what is the most common trade name of articaine
A
septocaine
14
Q
what is the most common trade name of bupivacaine
A
marcaine
15
Q
what are the components that determine the selection of local anesthetics
A
- duration of desired pain control
- post-op pain control
- patient’s helath
- allergy
- hemostasis
16
Q
if someone is allergic to these things then you assume bisulfite allergy? what are those things
A
- wine
- dried fruit
- dried potatoes
17
Q
what percent of asthmatics are allergic to bisulfites
A
10%
18
Q
what vasoconstrictor must be used with a need for hemostasis
A
EPI only, not levo
19
Q
which is the highest concentration of epinephrine?
a - 1 : 50,000
b - 1 : 100,000
c - 1 : 200,000
A
a - 1 : 50,000
20
Q
how long do short acting local anesthetics last
A
30 min
21
Q
how long do intermediate acting local anesthetics last
A
60 min
22
Q
how long do long acting local anesthetics last
A
90 min or more
23
Q
what local anesthetic is long acting & what is the label color
A
0.5% bupivacaine 1 : 200,000 epi
blue
24
Q
what local anesthetics are short acting & what are the associated label colors
A
- 3% plain mepivacaine = tan
- 4% plain prilocaine = black
25
what local anesthetics are intermediate acting & what are the associated label colors
- 2% 1 : 50,000 epi lidocaine = green
- 2% 1 : 100,000 epi lidocaine = red
- 2% 1 : 20,000 levo mepivacaine = brown
- 4% 1 : 200,000 epi prilocaine = yellow
- 4% plain prilocaine = black
- 4% 1 : 100,000 epi articaine = gold
- 4% 1 : 200,000 epi articaine = silver
26
what is the most commonly used local anesthetic for dentistry for a nerve block
lidocaine
27
lidocaine is a ___ vasodilator
potent
28
lidocaine has a __ toxicity risk
low
29
what is the onset of lidocaine
2-3 min
30
what is the MRD for lidocaine
500 mg
31
what is the dosage for lidocaine
3.2 mg / lb
32
in regards to pregnancy what category does lidocaine hold and is it safe or unsafe for lactation
category B & safe
33
when is mepivacaine a good choice
if vasoconstrictor is contraindicated
34
when is mepivacaine not used
for hemostasis
35
mepivacaine is a ___ vasodilator
weak
36
mepivacaine has a __ toxicity risk
low
37
T/F mepivacaine is an effective topical anesthetic
false - NOT effective
38
what is the onset of mepivacaine
1.5 - 2 min
39
what is the dosage of mepivacaine
3.0 mg / lb
40
what is the MRD of mepivacaine
400 mg
41
in regards to pregnancy what category does mepivacaine hold and is it safe or unsafe for lactation
category C & safe
42
what is the least toxic local anesthetic in dentistry
prilocaine
43
what is the best choice of local anesthetics for pregnancy and cardiovascular patients
prilocaine
44
prilocaine is a __ vasodilator
weak
45
prilocaine has a ___ toxicity risk
very low
46
if prilocaine is used over MRD what is there a risk of
methemoglobinemia
47
when is prilocaine an effective topical anesthetic
when combined with lidocaine
48
what is the onset of prilocaine
2 min
49
what is the dosage of prilocaine
4.0 mg / lb
50
what is the MRD for prilocaine
600 mg
51
in regards to pregnancy what category does prilocaine hold and is it safe or unsafe for lactation
category B & unknown safety
52
articaine is ___ lipid soluble & ___ diffusive through bone
highly, highly
53
what local anesthetic is a good choice for re-administration for cardiovascular disease patients or liver disease patients
articaine
54
articaine is a __ vasodilator
potent
55
articaine has ___ toxicity risk
low
56
t/f articaine is not an effective topical agent
true
57
what is the onset of articaine
1-3 min
58
what is the dosage of articaine
3.2 mg /lb
59
what is the MRD for articaine
none
60
in regards to pregnancy what category does articaine hold and is it safe or unsafe for lactation
category c & unknown safety
61
what is there a possible risk of with use of articaine
IA nerve injury (parasthesia)
62
what is the most potent and most toxic local anesthetic used in dentistry
bupivacaine
63
when is bupivacaine the best choice for a treatment
when there is a long treatment with need for post op-pain control
64
bupivacaine is the ___ vasodilator
most potent
65
T/F bupivacaine is available without epi
false - NOT available without epi
66
bupivacaine has a __ toxicity risk
high
67
T/F bupivacaine is NOT an effective topical anesthetic
true
68
what is the onset of bupivacaine
5-10 min
69
what is the recommended dosage for bupivacaine
none
70
what is MRD for bupivacaine
90 mg
71
in regards to pregnancy what category does bupivacaine hold and is it safe or unsafe for lactation
category C & unknown safety
72
which local anesthetic has a risk for methemoglobinemia when the MRD (maximum recommended dose) is exceeded?
a - lidocaine
b - prilocaine
c - articaine
d - bupivacaine
b - prilocaine
73
why is the CNS very sensitive to high blood levels of local anesthetics
because they readily cross the blood-brain barrier
74
what effects does low blood levels of local anesthetics have on the CNS
none
may have anti-convulsant properties
75
what effects does moderate overdose of local anesthetics have on the CNS
initial CNS stimulation --> INCREASED HR, RR, & BP; muscle twitching; and tremors
76
what effects does high overdose of local anesthetics have on the CNS
CNS depression --> DECREASED HR, RR, & BP; convulsions; unconsciousness; progresses to respiratory arrest
77
what effects does mild overdose of local anesthetics have on the cardiovascular system
slight increase in BP, HR, & RR
78
what effects does moderate overdose of local anesthetics have on the cardiovascular system
initial CV stimulation --> INCREASED HR, RR, & BP; headache, lethargy
79
what effects does high overdose of local anesthetics have on the cardiovascular system
CV depression --> DECREASED HR, RR, & BP; slurred speech, disorientation, unconsciousness, progresses to cardiac arrest
80
what are the two vasoconstrictors used in the US
- epinephrine
- levonordefrin
81
what are the functions of vasoconstrictors
- constricts blood vessels at site of injection to decrease the necessary dose of local anesthetic
- increases duration
- provides hemostasis at injection site
- decreases absorption rate and decreases risk of toxicity
82
which vasoconstrictor acts 50 / 50 on alpha & beta receptors
epinephrine
83
which vasoconstrictor acts 75% on alpha and 25% on beta receptors
levonordefrin
84
which adrenergic receptors are the LEAST sensitive to levonordefrin?
a - beta
b - alpha
a - beta
85
what is epinephrine's MRD in healthy & CV diseased patients
healthy = 0.2 mg
CV disease = 0.04 mg
86
what is levonordefrin's MRD in healthy & CV diseased patients
healthy = 1.0 mg
CV disease = 0.2 mg
87
when does vasoconstrictor overdose usually occur
via intravascular injection
88
what are the symptoms of vasoconstrictor overdose
- dysrhythmias
- dramatic increase in HR
- increased BP
- throbbing headache
- tremors
- anxiety / apprehension
89
what is the onset of vasoconstrictor overdose symptoms
60 seconds
90
how long does it take for the body to clear the vasoconstrictor drug
5-10 minutes
91
In CV disease patients vasoconstrictor overdose can lead to __
cardiac arrest
92
what is an absolute contraindication to local anesthetics
allergy
93
what are the relative contraindications of local anesthetics
- taking H2 - receptor blocker
- taking beta blockers
- taking CNS depressants
- pregnancy
- significant liver disease
- renal dysfunction
94
in the case of a patient taking H2-receptor blocker how should you adjust the treatment
decrease the dosage of lidocaine
95
in the case of a patient taking a beta blocker how should you adjust the treatment
decrease the dosage of all amide local anesthetics
96
in the case of a patient taking CNS depressants how should you adjust the treatment
decrease the dosage of all amide local anesthetics
97
in the case of a pregnant patient how should you adjust the treatment
use prilocaine or lidocaine
98
in the case of a patient with significant liver disease how should you adjust the treatment
use articaine or decrease the dose of amide anesthetics
99
in the case of a patient with renal dysfunction how should you adjust the treatment
use local anesthetics with care
100
what are the absolute contraindications for vasoconstrictors
- MI / coronary bypass surgery w/in 3 - 6 months
- uncontrolled hypertension
- uncontrolled angina pectoris
- uncontrolled arrhythmias
- uncontrolled hyperthyroidism
- sulfite allergy
- glaucoma
- cocaine / methamphetamine use
101
what is the cardiac protocol
- 0.04 mg EPI
- 0.2 mg LEVO
102
what are the relative contraindications of vasoconstrictors
- cardiovascular disease patients
- taking tricyclic anti-depressants
- taking nonselective beta blocker
- taking digitalis
103
in the case of a patient with cardiovascular disease how should you adjust the vasoconstrictor treatment
use the cardiac protocol
104
in the case of a patient taking tricyclic anti-depressants how should you adjust the vasoconstrictor treatment
- no LEVO
- 0.04 mg of EPI
105
in the case of a patient taking nonselective beta blocker how should you adjust the vasoconstrictor treatment
use the cardiac protocol
106
in the case of a patient taking digitalis how should you adjust the vasoconstrictor treatment
consult physician
