what are the 3 structural domains of classifying agents?
what group of agents is lipophilic?
aromatic (thiophene nucleus)
t/f amide group is hydrophilic
agents connected by ester are referred to as what type?
agents connected by amides are referred to as what types?
where is the site of actie on a mylinated nerve fiber?
enter into axoplasm at nodes of ranvier
what does the LA act on?
what is the mechanism of action of the LA
blocks individual sodium channels in neuronal membranes
all of the following are ideal characteristics of local anesthetic except one
a. profound reverisble local anesthesia
b. rapid onset
c. moderaet ionization
d. satisfactory duration of action
e. minimal adverse effect
c. moderate ionization
local anesthetic agents should have moderate lipid solubility which allows an anesthetic agent to diffuse across lipid membranes
what are three purposes of vasoconstrictors?
control soft tissue bleeding in local area
prolonging duration of local anesthetic
delay systemic absorption of local anesthetic
what property serve to keep the LA suspended in water?
what property allows an LA to be distributed through tissues?
the _____ form of the LA molecule is actually the more cactive component of the LA
what causes a pH change making LA less effective? how is it overcome?
pH change du to apical infection reduces the amout of ____ ____
how is the ester tyep metabolized?
takes place primarily in the vascular compartment by plasma cholinesterases
how are amide tyeps metabolized?
in the liver by CYP450 enzymes with oxidation and hydrolysis
articaine is a ______ and how is it metabolized?
amide- primarily by plasma carboxylesterase and some hepatic P430 enzymes
what excretes metabolites of ester and amide type LA agents?
what is the major advantage of LA agents?
produces loss of sensation in local area without loss of consciousness or control of vital functions
Injectable agents currently available are divided into three categories what are they?
what are examples of short injectable agents
what are some examples of intermediate injectable agents
what is an example of along term injectable agent?
what may the LA be supplemented with to help the pt?
what is used to deliver an LA
what should be done if a cartridge is cloudy?
what should you not expose the cartridge with epi to?
what is the LA of choice in dentistry?
what four things does the vasoconstrictor in LA do?
constrict bloos vessels
extend duration of action
increase concentration of LA at nerve
what is the fastest acting amide?
what are the adverse effects of mepivacaine?
none, not assocaited with unique adverse effects
prilocaine is associated with an increase in the incidence of ______
what may prilocaine produce in susceptible pts?
who are you not supposed to give prilocaine to?
pt taking APAP
what type of LA can cause permanent paresthesia?
where is it significant to have permanent paresthesia and what type of LA is associated with?
t/f action of bupivacaine has a longer onset and lidocaine should be used first to acheive anesthesia quickly
what can bupivacaine trigger?
what is the secondary line of treatment of an LA
what is the tertiary line of treatme of an LA
what is the LA of choice for individulals with true hypersensitivity to amide type?
what are two most widely used topical anesthetics?
t/f lidocaine is only used as a topical anethetic
FALSE! Benzocaine is only used as topical anesthetic
t/f benzocaine is never used as an injected anesthetic
where is topical anesthetic agents applied?
directly to the oral mucous membrane
what is the safest topcial anesthetic?
if a pt is allergic to ____ type LA the hypersensitive reaction occurs when using benzocaine
what type of LA s most likely to sensitize a pt to allergeries?
what is the CNS reaction ot LAs?
management of convulsions and includes IM or IV dizepam
who cannot have vasoconstrictor?
person recently on cocaine or meth
if there is a BP greater than or equal to 180/110 what should be done?
use low concentration of vasoconstrictors in that pt
what happens if a pt has an allergic reaction the LA
use product of different class of LA
what are five mild SNS toxic reactions?
what are five severe SNS reactions?
headache and dizziness are what kind of SNS toxic reaction?
palpitaion, tachycardia, ventricular fibrillation and cardiac arrest are all examples of what type of SNS toxic reaction
what FDA pregnancy category is lidocaine in?
who are psychomotor reactions are most commonly seen in ?
what is contraindicated if meth or cocaine is used in the last 24 hours
t/f a pt admits to using meth daily , what hsould be done
use no epi
which LA is indicated for use during pregnancy?
lidocaine has an FDA pregnancy category of a _____
what % with epi is the drug of choice in dentistry with a pregnant pt?