Module 6

Question 1

Tade Name: Carbocaine

Answer 1

Mepivicaine

Question 2

Trade name: Xylocaine

Answer 2

Lidocaine

Question 3

Trade name: Citanest

Answer 3

Prilocaine

Question 4

Trade name: Septocaine

Answer 4

Articaine

Question 5

Trade name: Marcaine

Answer 5

Bupivicaine

Question 6

If the patients is allergic to wine, dried fruit, dried potatoes then you want to assume what allergy as well?

Answer 6

Sodium bisulfite

Question 7

What percent of asthmatics are allergic to bisulfites?

Answer 7

10%

Question 8

True allergy to LA is actually very rare, its less than 1%. (T/F)

Answer 8

True

Question 9

What should be used if you need hemostasis (blood control) ?

Answer 9

EPI only (not levonordefrin)

Question 10

What is the highest concentration of EPI?

Answer 10

1:50,000

(will give you the best hemostasis)

Question 11

What is the duration of action for short acting, intermediate acting, and long acting LAs?

Answer 11

Short - 30 min pulpal anesthesia
Intermediate - 60 min pulpal anesthesia (most fall under this category)
Long acting - 90 min or more pulpal anesthesia

Question 12

Lidocaine
1.) _______ ____________ _________ __ ___________
2.) good for ___________ if 1:50,000 epi
3.) _________ vasodilator
4.) pulpal anesthesia without epi = ____________ minutes (NOT avaialble in the US)
5.) 1:100,000 = ______ minute
1:50,000 = ______ minutes
6.) ______ toxicity risk
7.) ____ documents allergic rxns

Answer 12

1.) most commonly used in dentistry
2.) good for hemostasis if 1:50,000 epi
3.) potent vasodilator
4.) pulpal anesthesia without epi = 5-10 minutes (NOT available in the US)
5.) 1:100,000 = 60 minute
1:50,000 = 60 minutes
6.) low toxicity risk
7.) No documents allergic rxns

Question 13

Lidocaine
8.) anticonvulsant properties
9.) ______________ anesthetic (only made in _____ ___________)
10.) pka = ________ ph = __________
11.) onset = _______________ min
12.) Metabolsim = _________ Half life = _____________
13.) Excretion = ______________
14.) Dosage = ___________ MRD = ___________
15.) available formulation = _________ and _______
16.) pregnancy = category ____ lactation ________

Answer 13

Lidocaine
8.) anticonvulsant properties
9.) topical anesthetic (only made in amide topical)
10.) pka = 7.7 ph = 3.3 -3.5 with epi
11.) onset = 2-3 min
12.) Metabolism = liver Half life = 1.6 hours
13.) Excretion = kidney
14.) Dosage = 2.3 mg/lb MRD = 500 mg
15.) available formulation = 2% Lido 1:50,000 epi (green band) and 2% Lido 1:100,000 epi (red band)
16.) pregnancy = category B lactation safe

Question 14

What LA is a good choice if vasoconstrictor is contraindicated?

Answer 14

Mepivacaine (carbocaine)

Question 15

What LA is not used for hemostasis?

Answer 15

Mepivacaine (carbocaine) b/c no EPI/vasoconstrictor

Question 16

Mepivacaine
1. ________ vasodilator
2. pulpal anesthesia without epi ____________ minutes
3. 1:20,000 levo = ________ minutes of pulpal anesthesia
4. ________ toxicity risk
5. NO documented allergic rxns
6. anticonvulsant properties
7. pka= 7.6-7.7 ph = 3.0-3.5 w/ levo ph = 4.5-6.8 w/out levo

Answer 16

1. weak vasodilator
2. pulpal anesthesia without epi 20-40 minutes
3. 1:20,000 levo = 60 minutes of pulpal anesthesia
4. low toxicity risk

Question 17

Mepivacaine is NOT an effective topical (True or False)

Answer 17

True

Question 18

Mepivacaine
1. onset = ______ min
2. metabolism = _________ half life = ________
3. Excretion = __________
4. dosage = _______ MRD =
5. available formulation = __________ and _______
6. pregancy category = ___ lactation _________

Answer 18

1. onset = 2-3 min
2. metabolism = liver half life = 1.9 hrs
3. Excretion = kidneys
4. dosage = 3.0mg/lb MRD= 400 mg
5. available formulation = 2% Mep 1:20,000 levo (brown band) 3% Mep plain (tan band)
6. pregnancy category = C lactation safe

Question 19

What is the least toxic LA in dentistry today?

Answer 19

Prilocaine (citnest)

Question 20

What LA is the best choice for pregnancy and CV patients?

Answer 20

Prilocaine (citnest)

Question 21

Prilocaine
1. ________ (strong/weak) vasodilator
2. pulpal anesthesia without epi ____________ minutes
3. 1:200,000 epi = ________ minutes of pulpal anesthesia
4. ________ toxicity risk
5. lowe risk for allergic rxns
6. effective _______ _________ when combined with lidocaine
7. pka= 7.7-7.9 ph = 3.0-4.0 w/ epi ph = 4.5-6.8 plain

Answer 21

Prilocaine
1. weak vasodilator
2. pulpal anesthesia without epi 40-60 minutes
3. 1:200,000 epi = 60-90 minutes of pulpal anesthesia
4. very low toxicity risk
5. lower risk for allergic rxns
6. effective topical anesthetic when combined with lidocaine
7. pka= 7.7-7.9 ph = 3.0-4.0 w/ epi ph = 4.5-6.8 plain

Question 22

Which LAs do NOT have anticonvulsant properties?

Answer 22

Prilocaine (citnest), Articaine (septocaine), Bupivacaine (Marcaine)

Question 23

What risk does prilocaine have if over MRD?

Answer 23

Methemoglobinemia

Question 24

Prilocaine

1. onset = ______ min
2. metabolism = _________ half life = ________
3. Excretion = __________
4. dosage = _______ MRD =
5. available formulation = __________ and _______
6. pregancy category = ___ lactation _________

Answer 24

1. onset = 2 min
2. metabolism = Lungs + small amount in liver half life = 1.6 hours
3. Excretion = kidneys
4. dosage = 4.0 mg/lb MRD = 600 mg
5. available formulation = 4% prilocaine (black band) and 4% prilocaine 1:200,000 (yellow band)
6. pregnancy category = B lactation unknown safety

Question 25

What LA is highly lipid soluble and has a high diffusion through bone?

Answer 25

Articaine (septocaine)

Question 26

What LA is a good choice for re-administration +CV disease + liver disease?

Answer 26

Articaine (septocaine)

Question 27

Articaine (septocaine)
1. ________ vasodilator
2. 1:100,000 epi = ________ minutes of pulpal anesthesia; 1:200,000 epi = ______ minutes of pulpal anesthesia
4. ________ toxicity risk
5. lowe risk for allergic rxns possible risk for IA neve injury
7. pka= 7.78 ph = 4.4-5.2

Answer 27

Articaine (septocaine)
1. potent vasodilator
2. 1:100,000 epi = 60-75 minutes of pulpal anesthesia; 1:200,000 epi = 45-60 minutes of pulpal anesthesia
4. low toxicity risk
5. low risk for allergic rxns possible risk for IA neve injury
7. pka= 7.78 ph = 4.4-5.2

Question 28

T/F Articaine is available without a vasoconstrictor.

Answer 28

FALSE

Question 29

T/F Articaine is not an effective topical

Answer 29

True

Question 30

Articaine
1. onset = ______ min
2. metabolism = _________ half life = ________
3. Excretion = __________
4. dosage = _______ MRD =
5. available formulation = __________ and _______
6. pregnancy category = ___ lactation _________

Answer 30

1. onset = 1-3 min
2. metabolism = plasma 90% + liver half life = 45 min
3. Excretion = kidneys
4. dosage = 3.2 mg/lb MRD = NONE
5. available formulation = 4% articaine 1:100,000 epi (gold band) and 4% 1:200,000 epi (silver band)
6. pregnancy category = C lactation unknown safety

Question 31

What is the most potent and toxic LA in dentistry?

Answer 31

Bupivacaine (Marcaine)

Question 32

What LA is highly lipid soluble and bind strongly?

Answer 32

Bupivacaine (Marcaine)

Question 33

What LA is the best choice for long tx + post op pain control?

Answer 33

Bupivacaine (Marcaine)

Question 34

What LA is the most potent vasodilator of all amides?

Answer 34

Bupivacaine (Marcaine)

Question 35

T/F Bupivacaine is not available without EPI.

Answer 35

True

Question 36

What LAs are not available without EPI?

Answer 36

articaine and bupivacaine

Question 37

Bupivacaine
1. 1:200,000 epi = _________ hours of pulpal anesthesia
2. _______ toxicity
3. low risk for allergic rxns
4. _______ effective topical anesthetic
5. pka = 8.1 (highest amide) pH= 3.0-4.5 (w/ epi)

Answer 37

1. 1:200,000 epi = 1.5 - 3 hours of pulpal anesthesia
2. HIGH toxicity
3. low risk for allergic rxns
4. NOT an effective topical anesthetic
5. pka = 8.1 (highest amide) pH= 3.0-4.5 (w/ epi)

Question 38

Bupivacaine (marcaine)
1. onset = ______ min
2. metabolism = _________ half life = ________
3. Excretion = __________
4. dosage = _______ MRD =
5. available formulation = __________
6. pregnancy category = ___ lactation _________

Answer 38

Articaine
1. onset = 5-10 min
2. metabolism = liver half life = 2.7 hours
3. Excretion =kidneys
4. dosage = none MRD = 90 mg
5. available formulation = 0.5% bupivacaine 1:200,000 epi (blue band)
6. pregnancy category = C lactation unknown safety

Question 39

Why is the CNS sensitive to high blood levels of LAs?

Answer 39

b/c LAs cross the BBB

Question 40

These are all symptoms for what kind overdose of LAs
- initial CNS stimulation
- Initial CV stimulation: increase in HR, RR, BP
- muscle twitching
- tremors
- headache
- lethargy

Answer 40

Moderate overdose of LAs

Question 41

These are all symptoms for what kind overdose of LAs
- CNS and CV depression
- decrease in HR, RR, BP
- convulsion
- unconsciousness
- progresses to resp and cardiac arrest
- slurred speech
- disorientation

Answer 41

High overdose of LAs

Question 42

2 vasocontstrictors that are used in the US

Answer 42

1. Levonordefrin
2. Epinephrine

Question 43

What are the 4 functions of vasocontristors?

Answer 43

1. Constric blood vessel
   2.. increase duration of action
2. hemostasis
3. decrease absorption = decrease risk of toxicity