Module 7 Flashcards
for what status of patients should you use the lowest effective dose
- elderly
- children
- medically-compromised
what is MRD based on
- maximum dosage per appointment
- patient’s weight
what is the maximum per appointment or AMD for lidocaine
500 mg
what is the maximum per appointment or AMD for mepivacaine
400 mg
what is the maximum per appointment or AMD for prilocaine
600 mg
what is the maximum per appointment or AMD for articaine
none
what is the maximum per appointment or AMD for bupivacaine
90 mg
what is lidocaines MRD or mg / lb
3.2
what is mepivacaines MRD or mg / lb
3.0
what is prilocaines MRD or mg / lb
4.0
what is articaines MRD or mg /lb
3.2
what is bupivacaines MRD or mg / lb
0.9
what is the first step of calculating MRD of local anesthetics
determine amount of local anesthetic in 1 carpule as mg / carpule
1 - change % of local anesthetic to mg/ml
2 - multiply mg/ml by 1.8 ml/carpule
what is the short cut for the first step of calculating MRD of local anesthetics
% x 10
what is the second step of calculating MRD of local anesthetics
determine MRD of local anesthetic in mg for patient’s weight
how many milligrams of articaine are in a carpule of 4% articaine with 1:100,000 epi? Septodont, the manufacturer of Septocaine (articaine), manufactures this in 1.7 ml carpules?
a - 72 mg
b - 68 mg
c - 36 mg
b - 68 mg
steps:
- 4% x 10
- 40 mg/ml x 1.7
what is the third step of calculating MRD of local anesthetics
determine maximum number carpules for patinet’s weight
max dose / (mg / carpule)
Imagine you’ve been chosen to give the Tiger King a smile makeover (lucky you!). He weighs 170 lbs. How many carpules of 2% lidocaine with 1:100,000 epi can you give him? He has an unremarkable health histroy.
a - 15.1 carpules
b - 11.1 carpules
c - 10 carpules
d - carole baskin says give him 20!
b - 11.1 carpules
170 lb x 3.2 mg/lb = 544 mg
MRD = 500 mg so use 500
500 mg / (36 mg/carpule) = 13.8 carpules
BUT
MRD for epi is 0.2 mg
0.2 mg / 0.018 mg = 11.1 carpules
EPI = rate limiting
how do you calculate the amount of local anesthetic administered
(# of carpules used) x ( mg of anesthetic / carpule)
what are the steps for switching to a different local anesthetic when reinjecting
1 - calculate MRD of 2nd local anesthetic
2 - compare MRD of 2nd to 1st & use the LOWEST MRD
3 - subtract dose administered from lowest MRD
4 - calculate # of carpules for patient’s weight using remaining maximum dose
So if a 110 lb patient has received 2 carpules of 2% lidocaine. The stock room is out of lidocaine. How many carpules of 4% prilocaine can you now administer?
110 x 3.2 =352
110 x 4.0 = 440
so use 352 because smaller dose
352 - 72 (the two carpules used already) =280
280 is the remaining max dose
280 / 72 (1 carpule of 4% prilocaine) = 3.8 carpules of prilocaine can be given
originally patient could have been given 9 carpules of lidocaine but with adjustments now patient can only receive 5.8 carpules (2 lidocaine & 3.8 prilocaine)
During your smile makeover of the Tiger King, you give him 3 carpules of 2% lidocaine with 1:100.000 epi on the mandible, but you decided to use 4% articaine with 1:100,000 epi on the maxilla. How many carpules of articaine can you give him? recall he weighs 170 lbs.
a - 4.8 carpules
b - 5.7 carpules
c - 6.4 carpules
d - 5.3 carpules
b - 5.7 carpules
20 x 1.8 x 3 = 108 lidocaine used
170 x 3.2 = 544
170 x 3.2 = 544
use 500 bc AMD for lidocaine is 500 which is smaller than the MRDs
500 - 108 = 392 remaining max dose
392 / 68 (1 carpule of 4% articaine that comes in 1.7 ml) = 5.7 carpules of articaine can be given
what is the MRD of epinephrine in a healthy pateint
0.2 mg
what is the MRD of levonordefrin in a healthy patient
1.0 mg
