-
what are the 3 structural domains of classifying agents?
-
what group of agents is lipophilic?
aromatic (thiophene nucleus)
-
t/f amide group is hydrophilic
true
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agents connected by ester are referred to as what type?
ester type
-
agents connected by amides are referred to as what types?
amide type
-
where is the site of actie on a mylinated nerve fiber?
enter into axoplasm at nodes of ranvier
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what does the LA act on?
sodium channels
-
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
- B. 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?
hydrophilic
-
what property allows an LA to be distributed through tissues?
lipophilic
-
the _____ form of the LA molecule is actually the more cactive component of the LA
cationic
-
what causes a pH change making LA less effective? how is it overcome?
- apical infection
- dental block
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pH change du to apical infection reduces the amout of ____ ____
free base
-
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?
kidney
-
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
procaine (novocain)
-
what are some examples of intermediate injectable agents
- mepivacaine
- lidocaine
- prilocaine
- articaine
-
what is an example of along term injectable agent?
bupivacaine (marcaine)
-
what may the LA be supplemented with to help the pt?
- oral benzodiaxepine
- nitrous oxide
- intravenous sedation
-
what is used to deliver an LA
aspirating syringe
-
what should be done if a cartridge is cloudy?
discard
-
what should you not expose the cartridge with epi to?
- sunlight
- ultraviolet
- infrared
- fluorescent light
-
what is the LA of choice in dentistry?
Lidocaine
-
what four things does the vasoconstrictor in LA do?
- constrict bloos vessels
- extend duration of action
- increase concentration of LA at nerve
- reduce bleeding
-
what is the fastest acting amide?
mepivacaine
-
what are the adverse effects of mepivacaine?
none, not assocaited with unique adverse effects
-
prilocaine is associated with an increase in the incidence of ______
paresthesia
-
what may prilocaine produce in susceptible pts?
methemolglobinemia
-
who are you not supposed to give prilocaine to?
pt taking APAP
-
what type of LA can cause permanent paresthesia?
articaine
-
where is it significant to have permanent paresthesia and what type of LA is associated with?
- mandibular blocks
- articaine (septocaine)
-
t/f action of bupivacaine has a longer onset and lidocaine should be used first to acheive anesthesia quickly
true
-
what can bupivacaine trigger?
ventricular arrythmias
-
what is the secondary line of treatment of an LA
bupivacaine
-
what is the tertiary line of treatme of an LA
procaine
-
what is the LA of choice for individulals with true hypersensitivity to amide type?
procaine
-
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
true
-
where is topical anesthetic agents applied?
directly to the oral mucous membrane
-
what is the safest topcial anesthetic?
benzocaine
-
if a pt is allergic to ____ type LA the hypersensitive reaction occurs when using benzocaine
ester
-
what type of LA s most likely to sensitize a pt to allergeries?
ester LAs
-
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?
- restlessness
- headache
- tremors
- dizziness
- pallor
-
what are five severe SNS reactions?
- palpitation
- tachycardia
- chest pain
- ventricular fibrillation
- cardiac arrest
-
headache and dizziness are what kind of SNS toxic reaction?
mild reaction
-
palpitaion, tachycardia, ventricular fibrillation and cardiac arrest are all examples of what type of SNS toxic reaction
severe reaction
-
what FDA pregnancy category is lidocaine in?
B
-
who are psychomotor reactions are most commonly seen in ?
young adults
-
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
-
lidocaine has an FDA pregnancy category of a _____
B
-
what % with epi is the drug of choice in dentistry with a pregnant pt?
2% with epid 1:1,00,000
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