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2011-02-12 04:00:14

chapter six start at classification of agents
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  1. what are the 3 structural domains of classifying agents?
    • aromatic
    • ester
    • amide
  2. what group of agents is lipophilic?
    aromatic (thiophene nucleus)
  3. t/f amide group is hydrophilic
  4. agents connected by ester are referred to as what type?
    ester type
  5. agents connected by amides are referred to as what types?
    amide type
  6. where is the site of actie on a mylinated nerve fiber?
    enter into axoplasm at nodes of ranvier
  7. what does the LA act on?
    sodium channels
  8. what is the mechanism of action of the LA
    blocks individual sodium channels in neuronal membranes
  9. 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
  10. what are three purposes of vasoconstrictors?
    • control soft tissue bleeding in local area
    • prolonging duration of local anesthetic
    • delay systemic absorption of local anesthetic
  11. what property serve to keep the LA suspended in water?
  12. what property allows an LA to be distributed through tissues?
  13. the _____ form of the LA molecule is actually the more cactive component of the LA
  14. what causes a pH change making LA less effective? how is it overcome?
    • apical infection
    • dental block
  15. pH change du to apical infection reduces the amout of ____ ____
    free base
  16. how is the ester tyep metabolized?
    takes place primarily in the vascular compartment by plasma cholinesterases
  17. how are amide tyeps metabolized?
    in the liver by CYP450 enzymes with oxidation and hydrolysis
  18. articaine is a ______ and how is it metabolized?
    amide- primarily by plasma carboxylesterase and some hepatic P430 enzymes
  19. what excretes metabolites of ester and amide type LA agents?
  20. what is the major advantage of LA agents?
    produces loss of sensation in local area without loss of consciousness or control of vital functions
  21. Injectable agents currently available are divided into three categories what are they?
    • short
    • intermediate
    • long
  22. what are examples of short injectable agents
    procaine (novocain)
  23. what are some examples of intermediate injectable agents
    • mepivacaine
    • lidocaine
    • prilocaine
    • articaine
  24. what is an example of along term injectable agent?
    bupivacaine (marcaine)
  25. what may the LA be supplemented with to help the pt?
    • oral benzodiaxepine
    • nitrous oxide
    • intravenous sedation
  26. what is used to deliver an LA
    aspirating syringe
  27. what should be done if a cartridge is cloudy?
  28. what should you not expose the cartridge with epi to?
    • sunlight
    • ultraviolet
    • infrared
    • fluorescent light
  29. what is the LA of choice in dentistry?
  30. what four things does the vasoconstrictor in LA do?
    • constrict bloos vessels
    • extend duration of action
    • increase concentration of LA at nerve
    • reduce bleeding
  31. what is the fastest acting amide?
  32. what are the adverse effects of mepivacaine?
    none, not assocaited with unique adverse effects
  33. prilocaine is associated with an increase in the incidence of ______
  34. what may prilocaine produce in susceptible pts?
  35. who are you not supposed to give prilocaine to?
    pt taking APAP
  36. what type of LA can cause permanent paresthesia?
  37. where is it significant to have permanent paresthesia and what type of LA is associated with?
    • mandibular blocks
    • articaine (septocaine)
  38. t/f action of bupivacaine has a longer onset and lidocaine should be used first to acheive anesthesia quickly
  39. what can bupivacaine trigger?
    ventricular arrythmias
  40. what is the secondary line of treatment of an LA
  41. what is the tertiary line of treatme of an LA
  42. what is the LA of choice for individulals with true hypersensitivity to amide type?
  43. what are two most widely used topical anesthetics?
    • benzocaine
    • lidocaine
  44. t/f lidocaine is only used as a topical anethetic
    FALSE! Benzocaine is only used as topical anesthetic
  45. t/f benzocaine is never used as an injected anesthetic
  46. where is topical anesthetic agents applied?
    directly to the oral mucous membrane
  47. what is the safest topcial anesthetic?
  48. if a pt is allergic to ____ type LA the hypersensitive reaction occurs when using benzocaine
  49. what type of LA s most likely to sensitize a pt to allergeries?
    ester LAs
  50. what is the CNS reaction ot LAs?
    management of convulsions and includes IM or IV dizepam
  51. who cannot have vasoconstrictor?
    person recently on cocaine or meth
  52. if there is a BP greater than or equal to 180/110 what should be done?
    use low concentration of vasoconstrictors in that pt
  53. what happens if a pt has an allergic reaction the LA
    use product of different class of LA
  54. what are five mild SNS toxic reactions?
    • restlessness
    • headache
    • tremors
    • dizziness
    • pallor
  55. what are five severe SNS reactions?
    • palpitation
    • tachycardia
    • chest pain
    • ventricular fibrillation
    • cardiac arrest
  56. headache and dizziness are what kind of SNS toxic reaction?
    mild reaction
  57. palpitaion, tachycardia, ventricular fibrillation and cardiac arrest are all examples of what type of SNS toxic reaction
    severe reaction
  58. what FDA pregnancy category is lidocaine in?
  59. who are psychomotor reactions are most commonly seen in ?
    young adults
  60. what is contraindicated if meth or cocaine is used in the last 24 hours
    • cocaine
    • mehtamphetamine
  61. t/f a pt admits to using meth daily , what hsould be done
    use no epi
  62. which LA is indicated for use during pregnancy?
  63. lidocaine has an FDA pregnancy category of a _____
  64. what % with epi is the drug of choice in dentistry with a pregnant pt?
    2% with epid 1:1,00,000