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2011-02-11 22:44:34

chapter 6 local anesthetics
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  1. what is the most common drug used in dentistry?
    local anesthetics
  2. what are 4 uses of local anesthetics?
    • used to manage pain
    • reduces stress related to pain
    • promotes continuation of care
    • enhances safety
  3. a relative reduction in polarity of the nerve membrane allwoing for impluse conduction
  4. the injection of a local anesthetic solution directly into or adjacent to the tissue to be treated
    infiltration anesthesia
  5. a reversible loss of sensation in a defined area associated with the transient inhibition of peripheral nerve conduction
    local anesthesia
  6. the injection of a local anesthetic agent into or around peripheral nerve trunks or the nerve plexus
    nerve block anesthesia
  7. numbness or tingling following return of sensation to an area or following injury to a nerve
  8. the first drug in a class of drugs to which all other drugs in the same calss are compared
  9. PABA
    para aminobenzoic acid
  10. LA
    Los Angelos....or Local Anesthetic
  11. t/f cocaine is a sympathomimetric
  12. what does it mean that cocaine is a sympathomimetric?
    it produces central nervous system excitation
  13. is cocaine a vasoconstrictor or vasodialator?
  14. t/f cocaine has profound cardiac depression
    false! has profound cardiac stimulation
  15. what is considered to be the prototype or gold standard LA agent?
  16. what was used as an alternative to cocaine but is no longer used? why is it no longer used?
    • procaine (novocain)
    • short duration, high allergic reaction
  17. what was the worlds first LA?
    cocaine! YUM
  18. what are five ideal characteristics of local anesthetics?
    • profound local anesthesia
    • reversible effect
    • rapid onset
    • satisfactory duration of action
    • minimal ADEs
  19. a local anesthetic should have a ______ local anesthesia, ______ effect, ______ onset, satisfactory _______ of action, and minimal _____
    • profound
    • reversible
    • rapid
    • duration
    • ADEs
  20. local anesthetics are a mixture of what 5 things?
    • local anesthetic agent
    • antioxidant
    • alkalizing agent
    • sodium chloride
    • preservative
  21. what is always present if a vasoconstrictor is in the anesthetic?
  22. what are two examples of antioxidants in local anesthetic/
    • sodium metabisulfate
    • sodium bisulfate
  23. what is sodium hydroxide an example of in anesthetics?
    alkalizing agent
  24. what is the isotoner in local anesthetics?
    sodium chloride
  25. with an antioxidant in the local anesthetic what is a type of patient you want to watch? why?
    • asthmatic patients
    • sulfite + vasoconstrictor increases wheezing/chest tightness
  26. what is the mechanism of action of the local anesthetics?
    block peripheral never conduction by decreasing permeability of ion channels to sodium ions
  27. locak anesthtics block what type of channel?
    sodium channel
  28. local anesthetic agents inhibit the influx of _____ ions by competing with _____ for binding sites
    • sodium
    • calcium
  29. local anasthetic agents DEcrease the rate of _____ and prolong the rate of _______
    • DEpolarization
    • repolarization
  30. local anesthetics prlong what period?
    refractory period
  31. local anesthetic does NOT prevent the efflux of what ion in the nerve cell?
  32. what type of nerve fiber does the anesthetic effect first mylinated or unmylinated?
  33. what is the order of which nerves are affected (6)
    • autonomic
    • temperature
    • pain
    • touch/pressure
    • vibration
    • motor
  34. what order do you regain function in your nerves (6)
    • motor
    • vibration
    • touch/pressure
    • pain
    • temperature
    • autonomic
  35. t/f you regain funciton to nerves in the reverse order they are affected
  36. where do ester type anesthetics metabolize?
  37. what are the two groups of local anesthetics?
    ester and amides
  38. what group of anesthetics have a greater potential for allergic reactions?
  39. t/f no esters are available topically
    FALSE! none available in dental cartridges
  40. what are ester types primarily used for?
    topical (benzocaine)
  41. what are four examples of ester types?
    • benzocaine
    • procaine
    • propoxycaine
    • tetracaine
  42. where do amides metabolize?
  43. what type of anesthetic metabolizes in the liver?
  44. what type of anesthetic is it uncommon to have an allergic reaction?
  45. if an amide has an allergic reaction what is the cause?
    preservatives (sulfites)
  46. what are 5 examples of amides?
    • lidocaine (xylocaine)
    • mepivicaine (carbocaine)
    • prilocaine (citanest, citanest forte)
    • bupivicane (marcaine)
    • articaine (septocaine)
  47. what type of amide provides a profound anesthesia with a medium duration?
    lidocaine (xylocaine)
  48. t/f liodcaine can also be used as a topical anesthetic
    true dat
  49. what class of a drug is lidocaine? what does that mean?
    class B, safe in pregnancy
  50. t/f mepivicaine is effective topically
    FALSE ha sucka
  51. does mepivicaine have a shorter or longer duration than lidocaine?
  52. how is mepivicaine available?
    plain or with vasoconstrictor (levonordefrin/neocobefrin)
  53. how does prilocaine compare to lidocaine?
    longer duration and lower epi
  54. what is contraindicated for prilocaine?
    • pts with oxygenation problems (emphysema, asthma, pnemonia
    • metheglobinemia
    • sickle cell anemia and other anemias
    • pt on acetominophen
  55. what type of amide is contraindicated for metheglobinemia
  56. what is metheglobinemia?
    iron in hemoglbin does not carry oxygen effectively
  57. t/f prilocaine is recommened for pt with sickle cell anemia
  58. what has the longest duration of amides?
    bupivicaine (marcaine)
  59. when is bupivicaine indicated?
    • long appt
    • post operative pain expected
  60. what type of amide has an increased paresthesia?
    articaine (septocaine)
  61. what is the duration of the amides shortest to longest?
    • mepivicaine
    • lidocaine
    • prilocaine
    • aricaine
    • bupivicane
  62. what is the duration of amides longest to shortest?
    • bupivicaine
    • articaine
    • prilocaine
    • lidocaine
    • mepivicaine
  63. why is vasoconstrictors added to local anesthetics (4)
    • prolong anesthetic action
    • reduce anesthetic toxicity
    • delays absorption
    • decrease bleeding
  64. in 2% anesthetic solution how much anesthetic is per cartridge?
    36 mg
  65. in 1:100,000 epi how much epi is per cartridge
    .018 mg
  66. how many ml of solution is there per cartridge
    1.8 ml
  67. what is the max number or carpules containing 1:100K epi is allowed for a hypertensive pt?
  68. for an ASA I or II what is the limit for epi
    .2 mg per appt
  69. for ASA II or IV what is the maximum safe dose per appt?
  70. what is the most common used topical anesthetic?
    benzocaine (ester)
  71. how do you avoid toxic reaction of topical anesthetic agents?
    only used amount necessary
  72. is a gel or spray more toxic for topical anesthetics?
  73. if there is an allergic reaction to benzocaine what kind of topical do you swtich to?
  74. t/f LAs are weak bases and work poorly in inflamed tissues
    true because acidic environment
  75. what do you use to reduce systemic toxicity?
    aspriating syringe
  76. ______ is NOT contraindicated in a controlled hyerptensive pt
  77. t/f epi is not contraindicated in a controlled hypertensive pt
  78. when is epi contraindicated?
    with an UNCONTROLLED hypertensive pt