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71 terms
Terms | Definitions |
|---|---|
 amides | (have 2 i's) lidocaine, mepivicaine, & bupivacaine its hydrolyzed by the liver |
| esters | (only 1 i) procaine & benzocaine its hydrolyzed by plasma |
| pts who have a reaction to an agent in one group is likely to | have a reaction to other agents in the SAME group |
| cross hypersensitivity is | unlikely (amides and esters) |
| Absorption depends on | degree of inflammation, vasodilating properties of local anesthetic, presence of heat, use of message, route of vascularity of tissues |
| you can reduce absorption by adding a | vasoconstrictor |
| distribution is | throughout the body |
| highly vascular organs have | higher concentrations of anesthetic |
| do local anesthetics cross the placenta and blood-brain barrier | yes |
| lipid solubility affects | the potency |
| 0.5% of bupivacaine is ___________ than 2% lidocaine | 10 times more soluble (the lower the % the greater the effect) |
| 1st place Peripheral Nerve conduction loses function | autonomic |
| 2nd place Peripheral Nerve conduction loses function | cold |
| 3rd place Peripheral Nerve conduction loses function | warmth |
| 4th place Peripheral Nerve conduction loses function | pain |
| 5th place Peripheral Nerve conduction loses function | Touch |
| 6th place Peripheral Nerve conduction loses function | Pressure |
| 7th place Peripheral Nerve conduction loses function | Vibration |
| 8th place Peripheral Nerve conduction loses function | Motor |
| Antiarrhythmic Effects | Block sodium channels & depresses abnormal cardiac pacemaker activity, excitability and conduction |
| are useful for intravenous tx of arrhythmias | Antiarrhythmic effects |
| Toxicity of LA | CNS depression, cardiovascular effects (myocardial depression and cardiac arrest w/peripheral vasodialation) Local effects (hematoma) Malignant hyperthermia (not related to amides) |
| rate of ________effects toxicity | injection |
| LA during pregnancy can cause possible | fetal bradycardia |
| pregnancy category B | lidocaine & prilocaine |
| pregnancy category C | mepivacaine & bupivacaine |
| LA during nursing __________affect the health of the normal nursing infant | will not |
| Allergy of LA | rash up to anaphylactic reaction |
| greatest allergic potential | ester |
| least allergic potential | amides |
| antihistamine (benadryl) | can be used as local anesthetic |
| sulfite | an antioxidant-it can produce an acute asthmatic attack w/sulfite sensitivity (no cross hypersensitivity w/sulfa drugs) |
| in LA Vasoconstrictors | 1. prolong the duration of action 2. increase the depth of the anesthesia 3. delay systemic absorption 4. reduce toxic effect in the systemic circulation 5. reduce bleeding in the area of injection |
| example of vasoconstrictor | epinephrine |
| in LA Antioxidants | retard oxidation of the vasoconstrictor |
| in LA Sodium Hydroxide | adjusts solution ph to 6 or 7 |
| in LA Sodium Chloride | makes injectable solution isotonic |
| Methaylparaben &Propylparaben | preservatives, no dental cartridges currently contain them |
| Amides are the | only class of LA used parenterally |
| most commonly used anesthetic used in dental offices | lidocaine (Xylocaine,Octocaine) |
| lidocaine 1:100,000 epinephrine | pulpal anesthesia lasts 1-1.5 hours soft tissue last 3-4 hours |
| lidocaine 1:50,000 | provides homeostasis for surgical procedures |
| not effective topically like lidocaine | mepivacaine (Carbocaine, Prolocaine) |
| produces less vasodialation than lidocaine | mepivacaine (Carbocaine, Prolocaine) |
| mepivacaine can be used as a | plain solution (3%carbocaine) |
| mepivacaine is used for | short duration procedures when vasoconstriction is contradicted |
| systemic toxicity is more likely if used | plain |
| Priolocaine (Citanest, Citanest Forte) | less potent and less toxic than lidocaine, longer duration of action |
| can produce methemoglobinemia | prilocaine |
| if prilocaine is used with epinephrine pt is exposed to _________the amount of epinephrine compared to lidocaine w/epinephrine | half |
| bupivacaine (Marcaine) | more potent but less toxic than other amides, has prolonged duration of action |
| Should not be used in pt's prone to self-mutilation | bupivacaine (Marcaine) |
| indicated for use in lengthy dental procedures (pulpal anestheia lasts 1.5+ hrs w/expected postoperative pain) | bupivacaine (Marcaine) |
| bupivacaine (Marcaine) is available in dental cartridges as a | 0.5 solution w/1:2000,000 epinephrine |
| articaine (Septocaine) | duration lasts about 1 hr, rapid onset, lower toxicity levels |
| higher chance of parasthesia | articaine (Septocaine) |
| articaine (Septocaine) is available in | latex free carpules |
| Lidocaine is available in | 2% epi 1:50,000 & 2% 1:100,000 |
| Mepivacaine is available in | 3%plain & 2% levonordefrin 1:20,000 |
| Priolocaine is available in | 4%plain &4%epi1:200,000 |
| Bupivacaine is available in | 0.5% epi 1:200,000 |
| Articaine is available in | 4% epi 1:100,000 |
| procaine (Novocaine) | one of the safest LA (not used in dentistry today) |
| proxycaine (Ravocaine) | not used today |
| tetracaine (Pontocaine) | 10x potency of procaine |
| myocardial infraction &cerebrovascualr accident pt should wait | 6mo before schedualing apt |
| epi dose for cardiac pt | 0.04mg |
| epi dose for healthy pt | 0.2mg |
| topical anesthetics (amdies) | lidocaine-available as a base (jelly or topical solution) or a hydrochloride salt(ointment, oral topical or oral aerosal) |
| lidocaine/prilocaine topical | no longer used due to long onset of action |
| topical anesthetics (esters) | benzocaine- available OTC, poorly absorbed, lack of systemic toxicity, hypersensitivity reactions possible; cocaine-naturally occuring ester, no dental application |
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