Systemic Health Considerations Flashcards
Anticonvulsant LA considerations
Avoid higher doses of LA
Antipsychotics LA considerations
Avoid higher doses of LA
**Phenothiazines = vasoconstrictor causes postural hypotension –> Use cardiac limit to epi; do not use 1:50,000
Antidepressant LA considerations
Caution with vasoconstrictor
Tricyclic antidepressant LA considerations
May enhance CV actions of vasopressors
- **Fivefold to tenfold with levonordefrin and norepinephrine
- Avoid levonordefrin - *** Only twofold with epinephrine
- use lowest dose, least concentration of epinephrine
Benzodiazepines LA considerations
Added depressant effects
- Limit LA dose
Glucocorticoid LA considerations
**Stress with LA administration should be low!
Consider supplemental stress reduction protocol:
- Nitrous oxide sedation
- IV sedation
H2 receptor blocker (cimetidine/Tagamet) (Antacid) LA consideration
Modifies biotransformation of lidocaine
**Does not happen with other drugs in this class (pepcid, zantac, etc.)
- Results in increased half-life of circulation lidocaine
- -> Risk for lidocaine overdose!!
Tagamet is a relative contraindication for what LA?
Lidocaine
Sedation with what other drugs may increase risk of developing LA overdose?
Opioid analgesics
What is the effect of administering vasopressor to patients receiving nonselective beta blockers
Increases risk of hypertensive episode followed by secondary reflex bradycardia
T or F, No relevant evidence allows the use of local anesthetics with vasopressors for patients treated with cardioselective beta-blockers
False, no evidence PRECLUDES the use
**Risk only exists for nonselective beta-blocking agents
Vasoconstrictor with street drugs consideration
Cocaine & Meth -> sympathomimetic effects
- *Avoid epinephrine with 24 hours of use
- Produces tachycardia, hypertension, increased CO, etc.
Alcohol and LA
May decrease effectiveness of LA
Alcohol = CNS depressant
Use caution to avoid LA overdose
4 congestive heart failure considerations
ASA III/IV/V
- Cardiac glycosides (digoxin)
- Epinephrine may cause arrhythmias
- Compromised blood flow to kidneys
- Reduced clearance of LA
- Fluid in lungs
- Keep patient semi-supine when administering LA
- ASA IV if symptomatic
- Dental treatment is contraindicated
Sickle cell anemia and LA
No LA or dental txt during crisis
- Limit vasoconstrictors ***Plain drugs are preferred
Respiratory conditions and LA
LA in therapeutic dosages rare affects respiratory system
*Sulfite allergy may trigger asthma attack
Most common adverse reaction = fainting (syncope)
Decreased liver function and LA
Lowest dose, least concentration
Hyperthyroidism and LA
Epinephrine raises risk for thyroid storm
- **ABSOLUTE contraindication if uncontrolled
- *Relative contraindication if controlled
Hypothyroidism and LA
Generally ok, but more sensitive to CNS depressants - minimize LA dose
Pheochromocytoma and LA
Absolute contraindication to vasoconstrictor
Atypical plasma cholinesterase and LA
Avoid ester anesthetics ***Cannot metabolize esters
Methemoglobinemia and LA
Benzocaine and Prilocaine associated with acquired cases.
**Acetaminophen causes risk to increase with prilocaine
What drug might be good to use if liver disease?
Articaine
- majority biotransformed in blood
Allergies to a LA is most likely due to what?
Not amides - rare
**Likely bisulfite sensitivity
Which time during pregnancy is best to treat during?
2nd trimester = safest
- At end of 3rd trimester, some mother may have difficulty metabolizing drugs
