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Pain & Anxiety Control > Module 6 > Flashcards

Module 6 Flashcards

1
Q

what does a green band indicate

A

2% 1: 50,000 epi LIDOCAINE

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2
Q

what does the red band indicate

A

2% 1 : 100,000 epi LIDOCAINE

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3
Q

what does the tan band indicate

A

3% plain MEPIVACAINE

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4
Q

what does the brown band indicate

A

2% 1 : 20,000 levo MEPIVACAINE

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5
Q

what does the black band indicate

A

4% plain PRILOCAINE

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6
Q

what does the yellow band indicate

A

4% 1 : 200,000 epi PRILOCAINE

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7
Q

what does the gold band indicate

A

4% 1 : 100,000 epi ARTICAINE

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8
Q

what does the silver band indicate

A

4% 1 : 200,000 epi ARTICAINE

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9
Q

what does the blue band indicate

A

0.5% 1 : 200,000 epi BUPIVACAINE

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10
Q

what is the most common trade name of lidocaine

A

xylocaine

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11
Q

what is the most common trade name of mepivacaine

A

carbocaine

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12
Q

what is the most common trade name of prilocaine

A

citanest

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13
Q

what is the most common trade name of articaine

A

septocaine

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14
Q

what is the most common trade name of bupivacaine

A

marcaine

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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
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16
Q

if someone is allergic to these things then you assume bisulfite allergy? what are those things

A
  • wine
  • dried fruit
  • dried potatoes
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17
Q

what percent of asthmatics are allergic to bisulfites

A

10%

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18
Q

what vasoconstrictor must be used with a need for hemostasis

A

EPI only, not levo

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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

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20
Q

how long do short acting local anesthetics last

A

30 min

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21
Q

how long do intermediate acting local anesthetics last

A

60 min

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22
Q

how long do long acting local anesthetics last

A

90 min or more

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23
Q

what local anesthetic is long acting & what is the label color

A

0.5% bupivacaine 1 : 200,000 epi

blue

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24
Q

what local anesthetics are short acting & what are the associated label colors

A
  • 3% plain mepivacaine = tan
  • 4% plain prilocaine = black
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25
Q

what local anesthetics are intermediate acting & what are the associated label colors

A
  • 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
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26
Q

what is the most commonly used local anesthetic for dentistry for a nerve block

A

lidocaine

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27
Q

lidocaine is a ___ vasodilator

A

potent

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28
Q

lidocaine has a __ toxicity risk

A

low

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29
Q

what is the onset of lidocaine

A

2-3 min

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30
Q

what is the MRD for lidocaine

A

500 mg

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31
Q

what is the dosage for lidocaine

A

3.2 mg / lb

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32
Q

in regards to pregnancy what category does lidocaine hold and is it safe or unsafe for lactation

A

category B & safe

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33
Q

when is mepivacaine a good choice

A

if vasoconstrictor is contraindicated

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34
Q

when is mepivacaine not used

A

for hemostasis

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35
Q

mepivacaine is a ___ vasodilator

A

weak

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36
Q

mepivacaine has a __ toxicity risk

A

low

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37
Q

T/F mepivacaine is an effective topical anesthetic

A

false - NOT effective

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38
Q

what is the onset of mepivacaine

A

1.5 - 2 min

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39
Q

what is the dosage of mepivacaine

A

3.0 mg / lb

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40
Q

what is the MRD of mepivacaine

A

400 mg

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41
Q

in regards to pregnancy what category does mepivacaine hold and is it safe or unsafe for lactation

A

category C & safe

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42
Q

what is the least toxic local anesthetic in dentistry

A

prilocaine

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43
Q

what is the best choice of local anesthetics for pregnancy and cardiovascular patients

A

prilocaine

44
Q

prilocaine is a __ vasodilator

A

weak

45
Q

prilocaine has a ___ toxicity risk

A

very low

46
Q

if prilocaine is used over MRD what is there a risk of

A

methemoglobinemia

47
Q

when is prilocaine an effective topical anesthetic

A

when combined with lidocaine

48
Q

what is the onset of prilocaine

A

2 min

49
Q

what is the dosage of prilocaine

A

4.0 mg / lb

50
Q

what is the MRD for prilocaine

A

600 mg

51
Q

in regards to pregnancy what category does prilocaine hold and is it safe or unsafe for lactation

A

category B & unknown safety

52
Q

articaine is ___ lipid soluble & ___ diffusive through bone

A

highly, highly

53
Q

what local anesthetic is a good choice for re-administration for cardiovascular disease patients or liver disease patients

A

articaine

54
Q

articaine is a __ vasodilator

A

potent

55
Q

articaine has ___ toxicity risk

A

low

56
Q

t/f articaine is not an effective topical agent

A

true

57
Q

what is the onset of articaine

A

1-3 min

58
Q

what is the dosage of articaine

A

3.2 mg /lb

59
Q

what is the MRD for articaine

A

none

60
Q

in regards to pregnancy what category does articaine hold and is it safe or unsafe for lactation

A

category c & unknown safety

61
Q

what is there a possible risk of with use of articaine

A

IA nerve injury (parasthesia)

62
Q

what is the most potent and most toxic local anesthetic used in dentistry

A

bupivacaine

63
Q

when is bupivacaine the best choice for a treatment

A

when there is a long treatment with need for post op-pain control

64
Q

bupivacaine is the ___ vasodilator

A

most potent

65
Q

T/F bupivacaine is available without epi

A

false - NOT available without epi

66
Q

bupivacaine has a __ toxicity risk

A

high

67
Q

T/F bupivacaine is NOT an effective topical anesthetic

A

true

68
Q

what is the onset of bupivacaine

A

5-10 min

69
Q

what is the recommended dosage for bupivacaine

A

none

70
Q

what is MRD for bupivacaine

A

90 mg

71
Q

in regards to pregnancy what category does bupivacaine hold and is it safe or unsafe for lactation

A

category C & unknown safety

72
Q

which local anesthetic has a risk for methemoglobinemia when the MRD (maximum recommended dose) is exceeded?

a - lidocaine
b - prilocaine
c - articaine
d - bupivacaine

A

b - prilocaine

73
Q

why is the CNS very sensitive to high blood levels of local anesthetics

A

because they readily cross the blood-brain barrier

74
Q

what effects does low blood levels of local anesthetics have on the CNS

A

none

may have anti-convulsant properties

75
Q

what effects does moderate overdose of local anesthetics have on the CNS

A

initial CNS stimulation –> INCREASED HR, RR, & BP; muscle twitching; and tremors

76
Q

what effects does high overdose of local anesthetics have on the CNS

A

CNS depression –> DECREASED HR, RR, & BP; convulsions; unconsciousness; progresses to respiratory arrest

77
Q

what effects does mild overdose of local anesthetics have on the cardiovascular system

A

slight increase in BP, HR, & RR

78
Q

what effects does moderate overdose of local anesthetics have on the cardiovascular system

A

initial CV stimulation –> INCREASED HR, RR, & BP; headache, lethargy

79
Q

what effects does high overdose of local anesthetics have on the cardiovascular system

A

CV depression –> DECREASED HR, RR, & BP; slurred speech, disorientation, unconsciousness, progresses to cardiac arrest

80
Q

what are the two vasoconstrictors used in the US

A
  • epinephrine
  • levonordefrin
81
Q

what are the functions of vasoconstrictors

A
  • 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
Q

which vasoconstrictor acts 50 / 50 on alpha & beta receptors

A

epinephrine

83
Q

which vasoconstrictor acts 75% on alpha and 25% on beta receptors

A

levonordefrin

84
Q

which adrenergic receptors are the LEAST sensitive to levonordefrin?

a - beta
b - alpha

A

a - beta

85
Q

what is epinephrine’s MRD in healthy & CV diseased patients

A

healthy = 0.2 mg
CV disease = 0.04 mg

86
Q

what is levonordefrin’s MRD in healthy & CV diseased patients

A

healthy = 1.0 mg
CV disease = 0.2 mg

87
Q

when does vasoconstrictor overdose usually occur

A

via intravascular injection

88
Q

what are the symptoms of vasoconstrictor overdose

A
  • dysrhythmias
  • dramatic increase in HR
  • increased BP
  • throbbing headache
  • tremors
  • anxiety / apprehension
89
Q

what is the onset of vasoconstrictor overdose symptoms

A

60 seconds

90
Q

how long does it take for the body to clear the vasoconstrictor drug

A

5-10 minutes

91
Q

In CV disease patients vasoconstrictor overdose can lead to __

A

cardiac arrest

92
Q

what is an absolute contraindication to local anesthetics

A

allergy

93
Q

what are the relative contraindications of local anesthetics

A
  • taking H2 - receptor blocker
  • taking beta blockers
  • taking CNS depressants
  • pregnancy
  • significant liver disease
  • renal dysfunction
94
Q

in the case of a patient taking H2-receptor blocker how should you adjust the treatment

A

decrease the dosage of lidocaine

95
Q

in the case of a patient taking a beta blocker how should you adjust the treatment

A

decrease the dosage of all amide local anesthetics

96
Q

in the case of a patient taking CNS depressants how should you adjust the treatment

A

decrease the dosage of all amide local anesthetics

97
Q

in the case of a pregnant patient how should you adjust the treatment

A

use prilocaine or lidocaine

98
Q

in the case of a patient with significant liver disease how should you adjust the treatment

A

use articaine or decrease the dose of amide anesthetics

99
Q

in the case of a patient with renal dysfunction how should you adjust the treatment

A

use local anesthetics with care

100
Q

what are the absolute contraindications for vasoconstrictors

A
  • 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
Q

what is the cardiac protocol

A
  • 0.04 mg EPI
  • 0.2 mg LEVO
102
Q

what are the relative contraindications of vasoconstrictors

A
  • cardiovascular disease patients
  • taking tricyclic anti-depressants
  • taking nonselective beta blocker
  • taking digitalis
103
Q

in the case of a patient with cardiovascular disease how should you adjust the vasoconstrictor treatment

A

use the cardiac protocol

104
Q

in the case of a patient taking tricyclic anti-depressants how should you adjust the vasoconstrictor treatment

A
  • no LEVO
  • 0.04 mg of EPI
105
Q

in the case of a patient taking nonselective beta blocker how should you adjust the vasoconstrictor treatment

A

use the cardiac protocol

106
Q

in the case of a patient taking digitalis how should you adjust the vasoconstrictor treatment

A

consult physician

Pain & Anxiety Control (12 decks)

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