Term
| What are some desirable effects of local anesthetics? |
|
Definition
-potent
-rapid onset
-good duration
-reversible
-good penetration of tissues
-easily metabolized and excreted
-no localized, systemic, or allergic reaction
-low cost
-stable solution
-can be steralized |
|
|
Term
| Why do we want a potent local anesthetic? |
|
Definition
| because an increased potency requires a lower dose |
|
|
Term
| Why do we want local anesthetics to be reversible? |
|
Definition
| because we do not want the person to loose sensation to the area permanently |
|
|
Term
| Why do we want a local anesthetic that penetrates the skin really well? |
|
Definition
| so that it can get to the nerves |
|
|
Term
| Which local anesthetic is more potent: 2% or 5%? |
|
Definition
|
|
Term
| What are the two chemical structures of local anesthetics? |
|
Definition
|
|
Term
| What is a bad thing about esters? |
|
Definition
| they have a higher allergen potential than amides |
|
|
Term
| What are some examples of ester anesthetics? |
|
Definition
1.procaine
2.benzocaine
3.tetracaine
4.cocaine |
|
|
Term
| Which of these esters is the only one still on the market? |
|
Definition
|
|
Term
| What is procain(Novacain)? |
|
Definition
| an ester anesthetic no longer on the market |
|
|
Term
| WHat are some examples of amide anesthetics? (5) |
|
Definition
1.lidocaine
2.prilocaine
3.mepivscaine
4.articaine
5.bupivacaine |
|
|
Term
| What is the mechanism of action of local anesthetics? |
|
Definition
| block voltage-gated Na+ channels in peripheral nerves |
|
|
Term
|
Definition
| the membrane to not be able to easily depolarize and this prevents transmission of pain signals to the CNS |
|
|
Term
| Are smaller or larger fibers affected by local anesthetics first? |
|
Definition
|
|
Term
| All local anesthetics are... |
|
Definition
|
|
Term
| Are local anesthetics ionized at the normal oral pH? |
|
Definition
| no, they are nonionized at normal pH |
|
|
Term
| Is this a good thing? (that local anesthetics are nonionized at oral pH) |
|
Definition
| yes because this allows them to cross tissue membrane to get to the nerve (allows them to penetrate tissue) |
|
|
Term
| What is the absorption of local anesthetics? |
|
Definition
| depends on the tissue at the site of application(works well at neutral or basic pH, works bad at acidic pH) |
|
|
Term
| What is the distribution of local anesthetics? |
|
Definition
| lipophilic so throughout the body, can easily cross membranes |
|
|
Term
| What is the metabolism of local anesthetics(esters and amides)? |
|
Definition
esters-metabolized by the plasma and liver
amides-metabolized by liver |
|
|
Term
| What is the excretion of local anesthetics? |
|
Definition
|
|
Term
| What happens to local anesthetics given to someone with an infection? |
|
Definition
| drug is more ionized, so it cannot cross tissues to get to the nerves |
|
|
Term
| What is the best thing to do when someone with an infection needs a local anesthetic? |
|
Definition
| treat the infection first and then go get the work done that needs the anesthetics or use higher dose |
|
|
Term
| What do infections do to the body's overall pH? |
|
Definition
|
|
Term
| What do lower doses of local anesthetics effect? |
|
Definition
|
|
Term
| What are some common CNS adverse effects of local anesthetics? |
|
Definition
-Stimulation(tremors)
-depression(respiratory, cardiovascular) |
|
|
Term
| What are some adverse cardiovascular effects of local anesthetics? |
|
Definition
|
|
Term
| What are some adverse local effects of local anesthetics? |
|
Definition
| hematoma(bruising), increased systemic effects |
|
|
Term
| What are some adverse effects associated with pregnancy and local anesthetics? |
|
Definition
|
|
Term
| What are some allergic reactions that can occur with local anesthetics? |
|
Definition
| full range from rash to anaphalaxis |
|
|
Term
| What is in local anesthetics that used for in dentistry? |
|
Definition
1.the local anesthetic itself
2.as a vasoconstrictor
3.as an antioxidant
4.sodium hydroxide
5.sodium chloride |
|
|
Term
| How does the vascoconstritor effect of local anesthetics help in dentistry? |
|
Definition
| helps decrease systemic absoprtion, prolongs duration |
|
|
Term
| How does a local anesthetic being an antioxidant help in dentistry? |
|
Definition
| it prolongs the shelf life of the anesthetic |
|
|
Term
| How does a local anesthetic having sodium hydroxde help in dentistry? |
|
Definition
| helps adjust pH appropriately, makes local anesthetic have a basic pH so it can cross membranes |
|
|
Term
| How does a local anesthetic having sodium chloride help in dentistry? |
|
Definition
| to make sodium isotonic to tissues |
|
|
Term
|
Definition
| a common dental amide anesthetic, almost always paired with epinephrine |
|
|
Term
| What are some brand names of lidocaine? |
|
Definition
|
|
Term
| What is the % solution for injections of lidocaine? |
|
Definition
| 2%, varies for other formulations |
|
|
Term
| Who is lidocaine preferred for? |
|
Definition
|
|
Term
| What is the onset like with lidocaine? What about the duration? |
|
Definition
-rapid onset
-medium duration(60-90 mins after injection) |
|
|
Term
| Does lidocaine work well? WHat are some adverse effects? |
|
Definition
-good anesthetic effect
-hypotension
-sedation
-positional headache
-shivering
-CNS depression
-cardiovascular effects |
|
|
Term
| What is the % lidocaine with epinephrine for injections? |
|
Definition
| 2% w/epinephrine, for infiltration and blocks |
|
|
Term
| What is the % lidocaine with topical use? What is the onset like? |
|
Definition
|
|
Term
| What is the % lidocaine with topical(viscious)? |
|
Definition
|
|
Term
| What is the % lidocaine with spray? |
|
Definition
|
|
Term
| What is the % lidocaine with a patch? How long does it take to work? |
|
Definition
|
|
Term
|
Definition
| another common dental amide anesthetic |
|
|
Term
| What are some brand names of mepivacaine? |
|
Definition
|
|
Term
| Is Carbocaine paired with a vascoconstritor? Why does it have side effects? |
|
Definition
| no, it has side effects because it is a 3% drug |
|
|
Term
| What is Isocaine paired with? What % is it? |
|
Definition
| paired with levondefrin as a vascoconstrictor at 2% |
|
|
Term
| What is mepivacaine similar to? Is it as effective for topical use? |
|
Definition
| similar to lidocaine, but not effective for topical use |
|
|
Term
| What are the benefits of a plain solution of mepivacaine rather than having it paired with a vascoconstrictor? |
|
Definition
-shorter duration of action
-more likely to cause systemic effects |
|
|
Term
|
Definition
| another common amide anesthetic used in dental offices |
|
|
Term
| What are the brand names of prilocaine? |
|
Definition
-Citanest
-Citanest-Forte |
|
|
Term
| Is Cinanest paired wih epinephrine? What % is it? |
|
Definition
|
|
Term
| Is Citanest-Forte paired with epinephrine? What % is it? |
|
Definition
| yes, 4%, 1:200,000 epinephrine |
|
|
Term
| How does prilocaine compare to lidocaine? (3) |
|
Definition
-less potent
-longer duration of action
-fewer cardiac effects |
|
|
Term
| What can prilocaine cause at high doses? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the brand name for articaine? Is it paired with epinephrine? |
|
Definition
-Septocaine
-4% solution, 1:100,000 epinephrne |
|
|
Term
| What is articaine like compared to other amide anesthetics? |
|
Definition
| more lipophilic, good anesthetisa effect |
|
|
Term
| What is the 1/2 life of articaine? Where is it primarily metabolized? |
|
Definition
~20 mins
-primarily metabolized in the blood |
|
|
Term
| Is there a high risk of toxicity seen with articaine when reinjected? |
|
Definition
| no, there is a low risk of toxicity when reinjected |
|
|
Term
|
Definition
| another common dental amide anesthetic |
|
|
Term
| What are the brand names of bupivacaine? (2) Are these paired with epinephrine? |
|
Definition
-Marcaine
-Vivacaine
**both paired with epinephrine** |
|
|
Term
| What is the potency of the brand names of bupivacaine? |
|
Definition
-Marcaine(0.5%, 1:200,000 epinephrine)
-Vivacaine(0.5%, 1:200,000 epinephrine) |
|
|
Term
| What is the duration of action like with bupivacaine? |
|
Definition
| long duration of action seen with low toxicity, effects seen long after surgery |
|
|
Term
| What type of procedures is bupivacaine good for? |
|
Definition
long procedures like:
-full mouth reconstruction
-implants
-extensive periodontal treatments |
|
|
Term
| How do local anesthetics work? What will an increase in local anesthetic do? |
|
Definition
-block neurons from sending pain signals, so there is no pain felt
-block voltage gated Na+ channels
-increase in anesthetic will diffuse away from area quickly |
|
|
Term
| What do vascoconstrictors do when paired with anesthetics? (4) |
|
Definition
-increase duration of action at injection site
-decrease systemic distribution
-reduces bleeding
-may allow for lower dose of local anesthetic |
|
|
Term
| What are two types of vascoconstrictors? |
|
Definition
-epinephrine
-levonodefirin |
|
|
Term
| What do both of these bascoconstrictors do? What type of drug are they? |
|
Definition
-both agonists
-both stimulate sympathetic system effectors |
|
|
Term
| What causes vascoconstriction with epinephrine? |
|
Definition
| Beta2 stimultion at low doses |
|
|
Term
| What causes vascoconstriction of smooth muscle at high doses with epinephrine? |
|
Definition
|
|
Term
| What is epinephrine used at? |
|
Definition
-1:50,000
-1:100,000
-1:200,000 |
|
|
Term
| What does epinephrine used at 1:50,000 cause? |
|
Definition
| hemostasis(stops bleeding) |
|
|
Term
| What does Levonordefrin cause? |
|
Definition
-alpha 1 stimulation that produces vascoconstriction
-increased blood pressure(this is why is it not used as much) |
|
|
Term
| What is Levonordefrin used at? |
|
Definition
| 1:20,000, it is a lower potency so it is given in higher doses |
|
|
Term
| What dose of vascoconstrictors should a cardiac patient stay under?` |
|
Definition
| 0.04 mg vascoconstrictor, this is 2 cartridges of local+1:100,000 epinephrine |
|
|
Term
| Which conditions should we wait to get under better control before undergoing elective procedures? |
|
Definition
-severe cardiovascular disease
-uncontrolled high blood pressure
-MI or stroke within 6 months |
|
|
Term
| What are some medical conditions that contridict the use of vascoconstrictors or local anesthetics? |
|
Definition
-recent MI(<1 month)
-high risk arrhythmia
-severe or uncontrolled hypertension
-unstable angina
-pts taking digoxin
-uncontrolled diabetes
-uncontrolled hyperthyroidism
-mod-severe asthma
-allergy
-phenochromocytoma
-drug abuse |
|
|
Term
| What are some antidepressant drugs that interact with epinephrine? (2) Why? |
|
Definition
-tricyclic antidepressants
-MAOI antidepressants
**can cause increased blood pressure** |
|
|
Term
| What are some tricyclic antidepressants that react with epinpehrine? |
|
Definition
-Amitriptyline(Elavil)
-Imipramine(Tonfranil) |
|
|
Term
| What are some tricyclic antidepressants that react with epinpehrine? |
|
Definition
-Amitriptyline(Elavil)
-Imipramine(Tonfranil) |
|
|
Term
| What are some MAOI antidepressants that interact with epinpehrine? |
|
Definition
-phenelzine(Nardil)
-isocarboxazid(Marplan) |
|
|
Term
| What is an example of a Beta blocker that reacts with epinephrine? What does it cause? |
|
Definition
-propranolol (Inderal)
**causes increased blood pressure and bradycardia** |
|
|
Term
| What are two examples of a antidiabetic medication that reacts with epinephrine? What does it cause? |
|
Definition
-metformin(Glucophage)
-sulfonylureas
**caused increased blood glucose** |
|
|
Term
| Do topical anesthetics usually cause allergic reactions? |
|
Definition
|
|
Term
| What are three topical anesthetics? |
|
Definition
1.Benzocaine
2.Lidocaine
3.Lidocaine+prilocaine |
|
|
Term
| What are some brand names of benzocaine? (4) |
|
Definition
-Hurricaine
-Obabase-B
-Orajel
-Anbesol |
|
|
Term
| What is the onset/duration of benzocaine products? |
|
Definition
-onset is ~1 min
-duration is 15-45 mins |
|
|
Term
| What are some brand of lidocaine? What is the onset and duration like? What is the concentration like compared to benzocaine? |
|
Definition
-Xylocaine
-onset 2-5 mins
-duration 15-45 mins
-lower concentration than benzocaine |
|
|
Term
| What is the brand of lidocaine+prilocaine? |
|
Definition
|
|
Term
| What is the onset and duration of Oraquix? |
|
Definition
-onset is ~30 seconds
-duration 15-30 mins |
|
|
Term
| What type is anesthesia id Oraquix used for? |
|
Definition
| intrapocket anesthesia, best for those who perceive scaling as painful |
|
|
Term
| **see math for calculations of anesthetic doses** |
|
Definition
|
|
