Module 6 Flashcards
what does a green band indicate
2% 1: 50,000 epi LIDOCAINE
what does the red band indicate
2% 1 : 100,000 epi LIDOCAINE
what does the tan band indicate
3% plain MEPIVACAINE
what does the brown band indicate
2% 1 : 20,000 levo MEPIVACAINE
what does the black band indicate
4% plain PRILOCAINE
what does the yellow band indicate
4% 1 : 200,000 epi PRILOCAINE
what does the gold band indicate
4% 1 : 100,000 epi ARTICAINE
what does the silver band indicate
4% 1 : 200,000 epi ARTICAINE
what does the blue band indicate
0.5% 1 : 200,000 epi BUPIVACAINE
what is the most common trade name of lidocaine
xylocaine
what is the most common trade name of mepivacaine
carbocaine
what is the most common trade name of prilocaine
citanest
what is the most common trade name of articaine
septocaine
what is the most common trade name of bupivacaine
marcaine
what are the components that determine the selection of local anesthetics
- duration of desired pain control
- post-op pain control
- patient’s helath
- allergy
- hemostasis
if someone is allergic to these things then you assume bisulfite allergy? what are those things
- wine
- dried fruit
- dried potatoes
what percent of asthmatics are allergic to bisulfites
10%
what vasoconstrictor must be used with a need for hemostasis
EPI only, not levo
which is the highest concentration of epinephrine?
a - 1 : 50,000
b - 1 : 100,000
c - 1 : 200,000
a - 1 : 50,000
how long do short acting local anesthetics last
30 min
how long do intermediate acting local anesthetics last
60 min
how long do long acting local anesthetics last
90 min or more
what local anesthetic is long acting & what is the label color
0.5% bupivacaine 1 : 200,000 epi
blue
what local anesthetics are short acting & what are the associated label colors
- 3% plain mepivacaine = tan
- 4% plain prilocaine = black
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
what is the most commonly used local anesthetic for dentistry for a nerve block
lidocaine
lidocaine is a ___ vasodilator
potent
lidocaine has a __ toxicity risk
low
what is the onset of lidocaine
2-3 min
what is the MRD for lidocaine
500 mg
what is the dosage for lidocaine
3.2 mg / lb
in regards to pregnancy what category does lidocaine hold and is it safe or unsafe for lactation
category B & safe
when is mepivacaine a good choice
if vasoconstrictor is contraindicated
when is mepivacaine not used
for hemostasis
mepivacaine is a ___ vasodilator
weak
mepivacaine has a __ toxicity risk
low
T/F mepivacaine is an effective topical anesthetic
false - NOT effective
what is the onset of mepivacaine
1.5 - 2 min
what is the dosage of mepivacaine
3.0 mg / lb
what is the MRD of mepivacaine
400 mg
in regards to pregnancy what category does mepivacaine hold and is it safe or unsafe for lactation
category C & safe
what is the least toxic local anesthetic in dentistry
prilocaine
what is the best choice of local anesthetics for pregnancy and cardiovascular patients
prilocaine
prilocaine is a __ vasodilator
weak
prilocaine has a ___ toxicity risk
very low
if prilocaine is used over MRD what is there a risk of
methemoglobinemia
when is prilocaine an effective topical anesthetic
when combined with lidocaine
what is the onset of prilocaine
2 min
what is the dosage of prilocaine
4.0 mg / lb
what is the MRD for prilocaine
600 mg
in regards to pregnancy what category does prilocaine hold and is it safe or unsafe for lactation
category B & unknown safety
articaine is ___ lipid soluble & ___ diffusive through bone
highly, highly
what local anesthetic is a good choice for re-administration for cardiovascular disease patients or liver disease patients
articaine
articaine is a __ vasodilator
potent
articaine has ___ toxicity risk
low
t/f articaine is not an effective topical agent
true
what is the onset of articaine
1-3 min
what is the dosage of articaine
3.2 mg /lb
what is the MRD for articaine
none
in regards to pregnancy what category does articaine hold and is it safe or unsafe for lactation
category c & unknown safety
what is there a possible risk of with use of articaine
IA nerve injury (parasthesia)
what is the most potent and most toxic local anesthetic used in dentistry
bupivacaine
when is bupivacaine the best choice for a treatment
when there is a long treatment with need for post op-pain control
bupivacaine is the ___ vasodilator
most potent
T/F bupivacaine is available without epi
false - NOT available without epi
bupivacaine has a __ toxicity risk
high
T/F bupivacaine is NOT an effective topical anesthetic
true
what is the onset of bupivacaine
5-10 min
what is the recommended dosage for bupivacaine
none
what is MRD for bupivacaine
90 mg
in regards to pregnancy what category does bupivacaine hold and is it safe or unsafe for lactation
category C & unknown safety
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
why is the CNS very sensitive to high blood levels of local anesthetics
because they readily cross the blood-brain barrier
what effects does low blood levels of local anesthetics have on the CNS
none
may have anti-convulsant properties
what effects does moderate overdose of local anesthetics have on the CNS
initial CNS stimulation –> INCREASED HR, RR, & BP; muscle twitching; and tremors
what effects does high overdose of local anesthetics have on the CNS
CNS depression –> DECREASED HR, RR, & BP; convulsions; unconsciousness; progresses to respiratory arrest
what effects does mild overdose of local anesthetics have on the cardiovascular system
slight increase in BP, HR, & RR
what effects does moderate overdose of local anesthetics have on the cardiovascular system
initial CV stimulation –> INCREASED HR, RR, & BP; headache, lethargy
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
what are the two vasoconstrictors used in the US
- epinephrine
- levonordefrin
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
which vasoconstrictor acts 50 / 50 on alpha & beta receptors
epinephrine
which vasoconstrictor acts 75% on alpha and 25% on beta receptors
levonordefrin
which adrenergic receptors are the LEAST sensitive to levonordefrin?
a - beta
b - alpha
a - beta
what is epinephrine’s MRD in healthy & CV diseased patients
healthy = 0.2 mg
CV disease = 0.04 mg
what is levonordefrin’s MRD in healthy & CV diseased patients
healthy = 1.0 mg
CV disease = 0.2 mg
when does vasoconstrictor overdose usually occur
via intravascular injection
what are the symptoms of vasoconstrictor overdose
- dysrhythmias
- dramatic increase in HR
- increased BP
- throbbing headache
- tremors
- anxiety / apprehension
what is the onset of vasoconstrictor overdose symptoms
60 seconds
how long does it take for the body to clear the vasoconstrictor drug
5-10 minutes
In CV disease patients vasoconstrictor overdose can lead to __
cardiac arrest
what is an absolute contraindication to local anesthetics
allergy
what are the relative contraindications of local anesthetics
- taking H2 - receptor blocker
- taking beta blockers
- taking CNS depressants
- pregnancy
- significant liver disease
- renal dysfunction
in the case of a patient taking H2-receptor blocker how should you adjust the treatment
decrease the dosage of lidocaine
in the case of a patient taking a beta blocker how should you adjust the treatment
decrease the dosage of all amide local anesthetics
in the case of a patient taking CNS depressants how should you adjust the treatment
decrease the dosage of all amide local anesthetics
in the case of a pregnant patient how should you adjust the treatment
use prilocaine or lidocaine
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
in the case of a patient with renal dysfunction how should you adjust the treatment
use local anesthetics with care
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
what is the cardiac protocol
- 0.04 mg EPI
- 0.2 mg LEVO
what are the relative contraindications of vasoconstrictors
- cardiovascular disease patients
- taking tricyclic anti-depressants
- taking nonselective beta blocker
- taking digitalis
in the case of a patient with cardiovascular disease how should you adjust the vasoconstrictor treatment
use the cardiac protocol
in the case of a patient taking tricyclic anti-depressants how should you adjust the vasoconstrictor treatment
- no LEVO
- 0.04 mg of EPI
in the case of a patient taking nonselective beta blocker how should you adjust the vasoconstrictor treatment
use the cardiac protocol
in the case of a patient taking digitalis how should you adjust the vasoconstrictor treatment
consult physician
