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Pain Control > Specific Agents > Flashcards

Specific Agents Flashcards

1
Q

T/F if you use a longer acting LA during a procedure there is less of a need to provide pain medication post -op?

A

TRUE

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2
Q

5 major parameters when selecting an LA?

A
  1. length of time needed to control pain
  2. Requirement for pain control following the procedure
  3. possibility of self-mutilation in the postoperative period
  4. requirement for hemostasis (vasoconstrictors)
  5. presence of any contraindications
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3
Q

duration of action is divided into two categories

A
  1. pulpal (hard tissue)

2. soft tissue )total)

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4
Q

Duration of LA depends on what 5 things

A
  1. individual variation
  2. technique’
  3. tissue status (vascularity and pH)
  4. anatomical variation
  5. type of injection (infiltration/block)
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5
Q

highly vascular?

A

LA washes away and doesn’t stay around as long

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6
Q

low ph?

A

acidic environment and not as much of a base form to go into nerve

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7
Q

which type of LA injection lasts longer?

A

Block > local infiltrate

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8
Q

dosages for LA are given in what?

A

mg/kg or mg/lb

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9
Q

maximum dose definition?

A

LA blood level jsut BELOW the threshold for an overdose rxn

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10
Q

hyporesponders?

A

15% of the lower portion of the bell shaped curve in which pulpal anesthesia lasts less than normal

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11
Q

Hyperresponders?

A

15% of the upper portion of the bell shaped curve in which pulpal anesthesia lasts longer than normal

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12
Q

Articaine aka and what type

A

Amides aka septacaine - 2nd most popular after lidocaine (xylocaine)

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13
Q

lidocaine aka

A

(xylocaine)

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14
Q

intermediate acting?

A

articaine (septacaine) + lidocaine (xylocaine)

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15
Q

Mepivocaine used with vascocontrisctor?

A

usually not

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16
Q

esters metabolized where?

A

PLASMA

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17
Q

Procaine - type and details

A

Ester – provides essentially no pulpal anesthesia and 15-30 minutes of soft tissue anesthesia

GREATEST VASOCONSTRICTOR - BUT NO LONGER AVAILABLE

high incidence of allergy

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18
Q

prpoxycaine

A

ester– not available alone because hight toxicity

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19
Q

Benzocaine - type and details

A

ESTER – topical local anasthetic for temporary relief of pain associated with toothache, minor sore throat pain and canker sore

20
Q

ravocaine type and details

A

Combination of procaine and propoxycaine – not availabel anymore and was useful when amides were contraindicated

21
Q

lidocaine type and details for dental and medical

A

AMIDE type

Dental – injectable local anesthetic + topical LA

Medical - LA and acute tx of ventricular arrhythmias from myocardial infarction

little/ no allergies to amide LA

22
Q

max dosage of lidocaine

A

7mg/kg OR 3.2 mg/lb

max=500 mg

23
Q

duration of lidocaine w/ and w/out epi

A

with pulpal = 60-120 minutes
soft tisssue =3-5 hours

withOUT
pulpal = 5-10 minutes
soft tissue = 60-120 minutes

24
Q

Which one has more epi? 1:50,000 or 1:100,000? implications on duration of LA? use of one vs the other?

A

1:50,000 has more epi

Same duration of LA on the soft tissues (3-5 hours) and pulpal tissue (60-120 mins) BUT MORE EPI will be used in situations where need to control bleeding more (more invasive surgeries)

25
Q

max dosage of epi to cardiac? to hea;thy?

A
  1. 04 max to cardiac pt.

0. 2 to healthy pt

26
Q

max dosage of mepivicaine

A

6.6mg/kg or 3mg/lb (max 400 mg)

27
Q

duration of mepivicaine

A

Pulpal 20-40 minutes

Soft tissue: 2-3 hours

causes slight vasodilation

28
Q

clinical signs of methemoglobinemia

A

greyish blue cyanosis of the lips, mucus membranes, and nail beds

may have respiratory and circulatory arrest

29
Q

prilocain max dosage =

A

8.0 mg/kg or 3mg/lb (max 400 mg)

max - 600 g

30
Q

what levels of methemoglobinemia will cause symptoms?

A

20%

31
Q

treatment for methhemoglobinemia

A

1-2 mg/lg of 1% methylene blue solution intravenously over a 5 minute period

32
Q

Prilocaine is RELATIVELY contraindicated by pt’s with?

A
  • Idoipathic or congenital methemoglobinemia
  • Sickle cell
  • Anemia
  • Cardiac or respiratory failure by hypoxia
  • Patients receiving acetaminophen or phenacetin
33
Q

duration of action of prilocaine 4%

A

Pulpal 10 min infiltrate
60 minutes = block

Soft tissue 1-5-2 hours infiltrate
2-4hr/ block

34
Q

prilocaine duration of 4% with epi?

A

pulpal = 60-90 minutes

soft tissue = 3-8 hours

35
Q

articaine max dosage

A

3.2 mg/lb or 7.0mg mg/kg

36
Q

potential complication with articaine?

A

methehomoglobin

37
Q

metabolism of articaine

A

liver and plasma (more liver)

38
Q

duration of articaine 4% with and without epi

A

4% without pulpal = 45-60 minutes
soft tissue =2-5 hours

with pulpal =60-75 minutes
soft tissue = 3-6 hours

39
Q

which local anesthetic agents are noted to have a higher incidence of lingual paresthesia?

A

4% articaine

4% prilocaine

due to higher concentration

40
Q

long acting?

A

bupivaciane and marcaine

41
Q

indications to use Bupivacaine

A

lengthy dental procedures

management of post op pain

42
Q

duration of bupivacaine

A

Pulpal = 90-180 minutes

Soft tissue =4-9 hours

43
Q

max dosage of bupicacaine

A

90 mg

44
Q

concentrations of drugs in topicals?

A

have to be at higher concentrations

45
Q

two topical anasthetics used

A

Benzocaine = ester

lidocaine = amide

46
Q

EMLA

A

Eutectic mixture of LA
cream composed of lidocaine 2.5% and prilocaine 2.5 %

used as a topical anesthetic to be placed on INTACT skin. – like starting an IV catheriers, etc.

47
Q

which dose do you use for calculating max dosage with pt. using two LA’s?

A

Max dosage of the LA with the LOWER max dose

example using Articaine and mepivicaine
articaine = 7.0 mg/kg and mepivicaine = 6.6 mg/kg

so will use max dosage of 6.6 for the pt.
because it is MORE TOXIC /CONCENTRATED

Pain Control (12 decks)

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