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FreakinLOCALanesthesia!!! > Part 3-Anesthetic AgentsTWO > Flashcards

Part 3-Anesthetic AgentsTWO Flashcards

1
Q

What LA am I???? Available in 3% solution without vasoconstrictor (tan) and a 2% solution with the vasoconstrictor levonordefrin 1:20,000 (brown)

A

Me-Piv-A-Caine

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2
Q

WHAT is the ONLY LA with LecoNordephrine as the vasoconstrictor?

A

Me-Piv-A-Caine

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3
Q

Chemically, MePivAcaine is very similar to ________, but pharmacologically, its actions are very similar to _______

A

bu-piv-a-caine…lidocaine (lacks duration of bupivacaine)

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4
Q

Which LA is the WEAKEST vasodilator of all the injectables?

A

MePivAcaine

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5
Q

Like lidocaine, _________ possesses anticonvulsant

properties

A

MePivAcaine

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6
Q

How does the potency of MePivAcaine compare to lidocaine and prilocaine?

A

EQUAL

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7
Q

What is the onset of action? In fact, here’s something interesting….some clinicians inject 3% solution to take effect prior to administration of bupivacaine which has much slower onset

A

RAPID 1-2min

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8
Q

Me-Piv-A-caine use caution with prego and lactating women…a category ___ drug

A

C

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9
Q

When first brought to market, it was thought that _______ could provide similar clinical effectiveness as lidocaine with significantly decreased toxicity

A

Pri-lo-caine

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10
Q

Review: which LA caused methemoglobinemia again?

A

Pri-lo-caine

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11
Q

What is the distinguishing studtural difference between prilocaine and lido/mepivacaine?

A

Aromatic ring is linked to a SECONDARY amine (the others are linked to a tertiary amine)

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12
Q

What is the major end product of prilocaine metabolism?

A

Carbon Dioxide

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13
Q

Which LA can turn the patient blue??

A

Pri-lo-caine! (methemglobinemia)

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14
Q

Which LA has the FASTEST RENAL CLEARANCE???

A

PRI-LO-CAINE

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15
Q

What are the three places for biotrans of prilocaine?

A

liver, kidney, lungs

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16
Q

What are the two available formulas for Prilocaine?

A

Prilocaine 4% (plain-black)…prilocaine 4% with epi 1:200,000 (yellow)

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17
Q

Is prilocaine a weak or a strong vasodilator?

A

weak! not as weak as mepivacaine

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18
Q

Which LA has the least epi concentration?

A

Prilocaine-it is a weak vasodilator

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19
Q

Please list the following drugs in order of potency from weakest (6) to strongest (1): Lidocaine, bupivicaine, prilocaine, procaine, mepivacanine, articaine.

A
  1. procaine 5.lidocaine (t) 4.mepivacaine (t) 3. prilocaine (t) 2.articaine 1. bupivicaine
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20
Q

FDA pregnancy category for Prilocaine?

A

B

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21
Q

This LA used to be known as “carticaine”….what is special about its structure?

A

ARTICAINE- it has sulfur AND an ester side chain on the aromatic ring…MORE LIPID SOLUBLE!!

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22
Q

How is articaine biotransformed?

A

Since its a little of both worlds….ester-plasma, amide-liver

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23
Q

What is unique about articaine’s half life?

A

Its SHORT!-20 minutes

24
Q

How does articaine’s onset compare to the 5 other LAs?

A

FASTEST!!

25
Q

What are the two formulas for articaine in the US?

A

articaine 4% with epi 1:100,000 (gold)…articiaine 4% with epi 1:200,000 (silver)

26
Q

Because articaine has a rapid metabolism….what is its toxicity level?

A

LESS risk for system toxicity

27
Q

What are the two CONTROVERSIAL side effects of the metabolism of articaine?

A

1.PABA allergy (sulfer) 2.methmoglobemia but NO cases reported

28
Q

Whats the pregnancy category for articaine?

A

C

29
Q

What are the 2 indications in dentistry for BUPIVACAINE?

A
  1. Long procedures 2.manage post-op pain
30
Q

How does bupivacaine’s onset compare to the other 5? What is its relative pKa?

A

SLOWEST onset (6-10min)….HIGHEST pKa

31
Q

What type of patients are at risk for use of bupivacaine because of the prolonged anesthesia?

A

kids and Int. Disabled

32
Q

How does bupivacaine’s vasodilation compare to the other amides? how about the ester (procaine)?

A

most potent vasodilator of the amides, not as potent as procaine

33
Q

While bupivacaine toxicity is RARE because we use it in LOW doses in dentistry, what is the MAIN target of toxicity?

A

CARDIOtoxic

34
Q

What is the ONLY formulation of bupivacaine?

A

bupivacaine 0.5% with epi 1:200,000 (blue)

35
Q

Whats the prego risk for bupivacaine?

A

C may enter breast milk

36
Q

Concentration for the same drug applied topically is ______ than what is used via injection

A

HIGHER

37
Q

The purpose for topical is for _______ injection technique (fancy!)

A

atraumatic injection technique

38
Q

Local anesthetics are _________ = topical agents do not contain _________

A

vasodilators….vasoconstrictors

39
Q

What is the ONLY injectable LA that we discussed that can also carryover to topical?

A

lidocaine!

40
Q

What is available as a topical anesthetic, but is NOT recommended in dentistry because it is a schedule II drug?

A

co-caine

41
Q

What type of LA is benzocaine?

A

ESTER

42
Q

What LA is found in Orajel?

A

Benzocaine

43
Q

Why could localized allergic reactions occur with benzocaine?

A

PABA is a metabolite! (along with articaine and prilocaine)

44
Q

What is our only KETONE LA (topical)?

A

DY-CLO-NINE hydro-chloride

45
Q

What drug shares the same potency as a topical to dyclonine hydrochloride?

A

co-caine

46
Q

What is the onset like for dyclonine?

A

SLOW-10 min, but lasts an hour

47
Q

Which drug is in one of MY personal fav’s…CEPACOL

A

dyclonine hydrochloride

48
Q

What are the two preps for topical lidocaine? What is the main difference?

A

1.Lidocaine base-not water soluble 2.Lidocaine hydrochloride-water soluble

49
Q

What is the MOST potent dental topical anesthetic?

A

TETRAcaine hydrochloride

50
Q

What is the onset for TETRAcaine?

A

SLOW-long duration (45min)

51
Q

WOAH! What are the three magic esters in CETAcaine? How is it applied?

A

benzocaine, tetracaine, and butamben…a spray (remember the nasty not sterile spray tip??

52
Q

Are eutectic mixtures fast or slow on skin?

A

SLOW..better on mucous membranes

53
Q

What is the specially formed EMLA (eutectic mix) used in Dentistry? What 2 LAs are in it?

A

OraQix….2.5% lidocaine, 2.5% prilocaine

54
Q

What is the main area we use the EMLA-OraQix?

A

INTRAPOCKET!

55
Q

What is the onset and duration for the EMLA-OraQix? HEY! YOU’VE seen this used before!!

A

onset-1 min…duration 20 min

56
Q

Dr. S recommends that we avoid ______ administered topical.

A

spray

FreakinLOCALanesthesia!!! (11 decks)

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