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chapter 6 local anesthetics
what is the most common drug used in dentistry?
what are 4 uses of local anesthetics?
used to manage pain
reduces stress related to pain
promotes continuation of care
a relative reduction in polarity of the nerve membrane allwoing for impluse conduction
the injection of a local anesthetic solution directly into or adjacent to the tissue to be treated
a reversible loss of sensation in a defined area associated with the transient inhibition of peripheral nerve conduction
the injection of a local anesthetic agent into or around peripheral nerve trunks or the nerve plexus
nerve block anesthesia
numbness or tingling following return of sensation to an area or following injury to a nerve
the first drug in a class of drugs to which all other drugs in the same calss are compared
para aminobenzoic acid
Los Angelos....or Local Anesthetic
t/f cocaine is a sympathomimetric
what does it mean that cocaine is a sympathomimetric?
it produces central nervous system excitation
is cocaine a vasoconstrictor or vasodialator?
t/f cocaine has profound cardiac depression
false! has profound cardiac stimulation
what is considered to be the prototype or gold standard LA agent?
what was used as an alternative to cocaine but is no longer used? why is it no longer used?
short duration, high allergic reaction
what was the worlds first LA?
what are five ideal characteristics of local anesthetics?
profound local anesthesia
satisfactory duration of action
a local anesthetic should have a ______ local anesthesia, ______ effect, ______ onset, satisfactory _______ of action, and minimal _____
local anesthetics are a mixture of what 5 things?
local anesthetic agent
what is always present if a vasoconstrictor is in the anesthetic?
what are two examples of antioxidants in local anesthetic/
what is sodium hydroxide an example of in anesthetics?
what is the isotoner in local anesthetics?
with an antioxidant in the local anesthetic what is a type of patient you want to watch? why?
sulfite + vasoconstrictor increases wheezing/chest tightness
what is the mechanism of action of the local anesthetics?
block peripheral never conduction by decreasing permeability of ion channels to sodium ions
locak anesthtics block what type of channel?
local anesthetic agents inhibit the influx of _____ ions by competing with _____ for binding sites
local anasthetic agents DEcrease the rate of _____ and prolong the rate of _______
local anesthetics prlong what period?
local anesthetic does NOT prevent the efflux of what ion in the nerve cell?
what type of nerve fiber does the anesthetic effect first mylinated or unmylinated?
what is the order of which nerves are affected (6)
what order do you regain function in your nerves (6)
t/f you regain funciton to nerves in the reverse order they are affected
where do ester type anesthetics metabolize?
what are the two groups of local anesthetics?
ester and amides
what group of anesthetics have a greater potential for allergic reactions?
t/f no esters are available topically
FALSE! none available in dental cartridges
what are ester types primarily used for?
what are four examples of ester types?
where do amides metabolize?
what type of anesthetic metabolizes in the liver?
what type of anesthetic is it uncommon to have an allergic reaction?
if an amide has an allergic reaction what is the cause?
what are 5 examples of amides?
prilocaine (citanest, citanest forte)
what type of amide provides a profound anesthesia with a medium duration?
t/f liodcaine can also be used as a topical anesthetic
what class of a drug is lidocaine? what does that mean?
class B, safe in pregnancy
t/f mepivicaine is effective topically
FALSE ha sucka
does mepivicaine have a shorter or longer duration than lidocaine?
how is mepivicaine available?
plain or with vasoconstrictor (levonordefrin/neocobefrin)
how does prilocaine compare to lidocaine?
longer duration and lower epi
what is contraindicated for prilocaine?
pts with oxygenation problems (emphysema, asthma, pnemonia
sickle cell anemia and other anemias
pt on acetominophen
what type of amide is contraindicated for metheglobinemia
what is metheglobinemia?
iron in hemoglbin does not carry oxygen effectively
t/f prilocaine is recommened for pt with sickle cell anemia
FALSE-DONT DO IT!
what has the longest duration of amides?
when is bupivicaine indicated?
post operative pain expected
what type of amide has an increased paresthesia?
what is the duration of the amides shortest to longest?
what is the duration of amides longest to shortest?
why is vasoconstrictors added to local anesthetics (4)
prolong anesthetic action
reduce anesthetic toxicity
in 2% anesthetic solution how much anesthetic is per cartridge?
in 1:100,000 epi how much epi is per cartridge
how many ml of solution is there per cartridge
what is the max number or carpules containing 1:100K epi is allowed for a hypertensive pt?
for an ASA I or II what is the limit for epi
.2 mg per appt
for ASA II or IV what is the maximum safe dose per appt?
what is the most common used topical anesthetic?
how do you avoid toxic reaction of topical anesthetic agents?
only used amount necessary
is a gel or spray more toxic for topical anesthetics?
if there is an allergic reaction to benzocaine what kind of topical do you swtich to?
t/f LAs are weak bases and work poorly in inflamed tissues
true because acidic environment
what do you use to reduce systemic toxicity?
______ is NOT contraindicated in a controlled hyerptensive pt
t/f epi is not contraindicated in a controlled hypertensive pt
when is epi contraindicated?
with an UNCONTROLLED hypertensive pt