local -2

The flashcards below were created by user ucb160 on FreezingBlue Flashcards.

  1. Which amides are metabolized in the liver?
    • lidocaine
    • prilocaine(and in plasma and kidney)
  2. Why is articane/bupivacaine metabolism more rapid?
    ester hydrolysis more rapid
  3. which enzyme is important for ester hydrolysis?
    • plasma cholinesterase(pseudo)
    • atypical plasma (psudocholinesterase deficiency concern)
  4. epiinephrine/levonorfrine cartiridges
    • 1. 1.8 ml single doses
    • 2. H20 + NaCl
    • 3. acidic pH
  5. local anesthetics can interact with these two items:
    other locals for additive effect(stay below max)

  6. vasocontrictors(6)
    • epi
    • levinodefrin
    • nordefrin
    • norepine
    • phenylephrine
    • felypressin
  7. when to use vasocontriction?
    • increase depth of anesthesia
    • increase duration
    • decrease peak bld levels(also decrease systemic tox)
    • maintain hemostasis
  8. adding epi to lidocaine will...
    increase conc of lidocaine will....
    better efficency anesthethic will stay in area(duration)

    improves via infiltration to other tooth
  9. so peak blood concentration with epi is?
    • lower at same injected dose(mg)
    • can use lower dose local!
  10. epinephrine deceases bld flow
    • down to 25% then goes back up.
    • Usually can cut bld loss by half during perio
  11. adrenergic amine structure(E,NE,LEV)
    just change H to methyl group from NE
  12. receptor activation by 
    1. epi
    2. levdef
    3. NE
    • 1. a1,a2,b1,b2
    • 2. a2
    • 3. a1,a2,b1
  13. alpha1
  14. beta1
    increase automaticity, HR, contractility
  15. beta2
    vasodilation in skeltal muscle, bronchodilation, increase plasma glucose, increase lipolysis
  16. epi will cause
    increase dyssrhmia, HR, increase a lot CO, decrease PR
  17. LEV will cause
    increase dysrrthmia, increase CO, PR
  18. NE will cause
    increase dysrrthmia, decrease HR, increase a lot PR, increase BP
  19. clondine
    a2 receptor agonist, can inhibit NE realse if too much b/c a2 also location at presynaptic terminals
  20. why do a2 agonists acts like a1 agonist to vasoconstrict?
    because a2 receptors are on the endothelial side not activated by post fibers
  21. why is lev administered over epi?
    epi has strong beta-1 effect which increase HR while lev does not affect beta-1 too much (has a2).

    NE is pretty nonselective alpha agonist
  22. alpha2
    vasocontriction in high doses, decrease plasma K
  23. epienphrne has rapid onset and metabolized by
    • COMT?MAO if exogenous,
    • liver if endogenous
    • short duraration, longer intraoral
  24. infusing IV epi would cause
    increase HR, sys BP, decrease PR
  25. in a dental office small boluses of epi are given..how much in CV disease patient
    • if patient cant get up without being breathless...dont
    • if can do moderat excercise(2 cartridges) at 40pg/mL
  26. why would epi with procaine not be beneficial?
    procaine has short duration
  27. a1 vs b2
    • a1 works on main arteries
    • b2 works on smaller in skeletal muscle(dilation)
  28. vasoconstricor interacitons(3)
    • NS beta blockers
    • NE reuptake inhibitors(antidepress, cocain, amphtames)
    • COMT inhibitors
  29. which one interacts w epi and lev?

    beta blockers(non-selective)
    cardiosleective- beta 1 only
    combined alpha and beta
    • non selective beta blockers
    • will affect B1, B2.
    • hypertension and reflex brady

    no effect on a1
  30. tricyclic SNRI antidepressants
    pain management block reuptake of NE to presynaptic cell, longer exaggerated response

    • SO increase in BP, HR possible, but most
    • exogenous metabolized by COMT
  31. NE reuptake inhibitor -ADHD mediation can increase BP. HR
  32. cocaine and ampehtamine that interact w epi can lead to...
    dysrrthmia, BP, HR increase, AVOID

    vasocontriction, myocaridal infarction
  33. COMT inhibitors used in Parkinsons that increases Dopa and exaggerated response to epi.......
    Tolcapone, Entacapone with Sinemet
  34. alpha blockade w/ epi and lev (alpha1)
    • more pronounced with lev b/c alpha2
    • "epinephrine reversal"
    • hypotension and tachy
  35. alpha blockade with
    phenyothianzaines.(neuroleptics)..bp low b/c of the strong b1 effect of epi, bp will drop even lower
  36. concerns with epi do the following
    monitor BP and HR, slow injection, monitor BP, HR 3-5 minutes post injection
  37. If concerned dont do this with epi:
    • never use 1:50000 epi,
    • limit 0.04mg
    • use epi imgregnated retraction cords
    • never use .2 cartidges for CV patient
Card Set:
local -2
2013-08-09 18:53:35

Show Answers: