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what is the most common drug used in dentistry?
local anesthetics
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what are 4 uses of local anesthetics?
- used to manage pain
- reduces stress related to pain
- promotes continuation of care
- enhances safety
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a relative reduction in polarity of the nerve membrane allwoing for impluse conduction
depolarization
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the injection of a local anesthetic solution directly into or adjacent to the tissue to be treated
infiltration anesthesia
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a reversible loss of sensation in a defined area associated with the transient inhibition of peripheral nerve conduction
local anesthesia
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the injection of a local anesthetic agent into or around peripheral nerve trunks or the nerve plexus
nerve block anesthesia
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numbness or tingling following return of sensation to an area or following injury to a nerve
paresthesia
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the first drug in a class of drugs to which all other drugs in the same calss are compared
prototype
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PABA
para aminobenzoic acid
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LA
Los Angelos....or Local Anesthetic
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t/f cocaine is a sympathomimetric
true
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what does it mean that cocaine is a sympathomimetric?
it produces central nervous system excitation
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is cocaine a vasoconstrictor or vasodialator?
vasoconstrictor
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t/f cocaine has profound cardiac depression
false! has profound cardiac stimulation
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what is considered to be the prototype or gold standard LA agent?
lidocaine
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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
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what was the worlds first LA?
cocaine! YUM
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what are five ideal characteristics of local anesthetics?
- profound local anesthesia
- reversible effect
- rapid onset
- satisfactory duration of action
- minimal ADEs
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a local anesthetic should have a ______ local anesthesia, ______ effect, ______ onset, satisfactory _______ of action, and minimal _____
- profound
- reversible
- rapid
- duration
- ADEs
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local anesthetics are a mixture of what 5 things?
- local anesthetic agent
- antioxidant
- alkalizing agent
- sodium chloride
- preservative
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what is always present if a vasoconstrictor is in the anesthetic?
antioxidant
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what are two examples of antioxidants in local anesthetic/
- sodium metabisulfate
- sodium bisulfate
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what is sodium hydroxide an example of in anesthetics?
alkalizing agent
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what is the isotoner in local anesthetics?
sodium chloride
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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
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what is the mechanism of action of the local anesthetics?
block peripheral never conduction by decreasing permeability of ion channels to sodium ions
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locak anesthtics block what type of channel?
sodium channel
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local anesthetic agents inhibit the influx of _____ ions by competing with _____ for binding sites
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local anasthetic agents DEcrease the rate of _____ and prolong the rate of _______
- DEpolarization
- repolarization
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local anesthetics prlong what period?
refractory period
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local anesthetic does NOT prevent the efflux of what ion in the nerve cell?
potassium
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what type of nerve fiber does the anesthetic effect first mylinated or unmylinated?
unmylinated
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what is the order of which nerves are affected (6)
- autonomic
- temperature
- pain
- touch/pressure
- vibration
- motor
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what order do you regain function in your nerves (6)
- motor
- vibration
- touch/pressure
- pain
- temperature
- autonomic
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t/f you regain funciton to nerves in the reverse order they are affected
TRUE!
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where do ester type anesthetics metabolize?
blood
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what are the two groups of local anesthetics?
ester and amides
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what group of anesthetics have a greater potential for allergic reactions?
esters
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t/f no esters are available topically
FALSE! none available in dental cartridges
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what are ester types primarily used for?
topical (benzocaine)
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what are four examples of ester types?
- benzocaine
- procaine
- propoxycaine
- tetracaine
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where do amides metabolize?
liver
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what type of anesthetic metabolizes in the liver?
amides
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what type of anesthetic is it uncommon to have an allergic reaction?
amides
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if an amide has an allergic reaction what is the cause?
preservatives (sulfites)
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what are 5 examples of amides?
- lidocaine (xylocaine)
- mepivicaine (carbocaine)
- prilocaine (citanest, citanest forte)
- bupivicane (marcaine)
- articaine (septocaine)
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what type of amide provides a profound anesthesia with a medium duration?
lidocaine (xylocaine)
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t/f liodcaine can also be used as a topical anesthetic
true dat
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what class of a drug is lidocaine? what does that mean?
class B, safe in pregnancy
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t/f mepivicaine is effective topically
FALSE ha sucka
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does mepivicaine have a shorter or longer duration than lidocaine?
shorter
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how is mepivicaine available?
plain or with vasoconstrictor (levonordefrin/neocobefrin)
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how does prilocaine compare to lidocaine?
longer duration and lower epi
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what is contraindicated for prilocaine?
- pts with oxygenation problems (emphysema, asthma, pnemonia
- metheglobinemia
- sickle cell anemia and other anemias
- pt on acetominophen
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what type of amide is contraindicated for metheglobinemia
prilocaine
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what is metheglobinemia?
iron in hemoglbin does not carry oxygen effectively
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t/f prilocaine is recommened for pt with sickle cell anemia
FALSE-DONT DO IT!
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what has the longest duration of amides?
bupivicaine (marcaine)
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when is bupivicaine indicated?
- long appt
- post operative pain expected
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what type of amide has an increased paresthesia?
articaine (septocaine)
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what is the duration of the amides shortest to longest?
- mepivicaine
- lidocaine
- prilocaine
- aricaine
- bupivicane
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what is the duration of amides longest to shortest?
- bupivicaine
- articaine
- prilocaine
- lidocaine
- mepivicaine
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why is vasoconstrictors added to local anesthetics (4)
- prolong anesthetic action
- reduce anesthetic toxicity
- delays absorption
- decrease bleeding
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in 2% anesthetic solution how much anesthetic is per cartridge?
36 mg
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in 1:100,000 epi how much epi is per cartridge
.018 mg
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how many ml of solution is there per cartridge
1.8 ml
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what is the max number or carpules containing 1:100K epi is allowed for a hypertensive pt?
two
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for an ASA I or II what is the limit for epi
.2 mg per appt
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for ASA II or IV what is the maximum safe dose per appt?
.04
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what is the most common used topical anesthetic?
benzocaine (ester)
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how do you avoid toxic reaction of topical anesthetic agents?
only used amount necessary
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is a gel or spray more toxic for topical anesthetics?
spray
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if there is an allergic reaction to benzocaine what kind of topical do you swtich to?
lidocaine
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t/f LAs are weak bases and work poorly in inflamed tissues
true because acidic environment
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what do you use to reduce systemic toxicity?
aspriating syringe
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______ is NOT contraindicated in a controlled hyerptensive pt
epi
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t/f epi is not contraindicated in a controlled hypertensive pt
true
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when is epi contraindicated?
with an UNCONTROLLED hypertensive pt
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