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Anesthetics
Book Questions Chapter 10 Pharm Evolve
| Term | Definition |
|---|---|
| Amides are the local anesthetics most likely to cause an allergic reaction. This property is a result of their metabolism into para-aminobenzoic acid (PABA). Which statement is true which statement is false? Both True? Both False | BOTH are FALSE - Local anesthetics rarely cause allergic reactions - ESTERS are metabolized into p-aminobenzoic acid (PABA), which is highly allergenic. - Due to the high risk of allergic reaction, esters are not administered parenterally |
| 1. Amides are hydrolyzed in the blood plasma by the enzymes pseudocholinesterase and liver esterases. 2. Patients with an atypical form of pseudocholinesterase may develop an allergic reaction. Which is true / which is false? Both True? Both False | BOTH are FALSE Amides are metabolized in liver Esters are hydrolyzed to PABA by blood plasma pseudocholinesterase and liver esterases. Patients with an atypical form of pseudocholinesterase may develop a systemic toxicity, not an allergic reaction |
| Lidocaine may be administered in by all routes except; which is the exception? Topical Intramuscular Intravenous Infiltration Spinal | Intramuscular - NOT USED - can be used intravenously to treat cardiac arrhythmias during surgery - can be administered as a topical, infiltration, block, spinal, epidural, and caudal anesthesia |
| Which forms of local anesthetic are BEST for tissue absorption? (multiple answers) 1. Weak acid form 2. Weak base form 3. Primarily nonionized 4. Primarily ionized | WEAK BASE and primarily NON-IONIZED |
| Alcoholic patient w/ liver cirrhosis needs extraction. Plan: 2 cartridges of lidocaine 2% 1:100,000 epinephrine. What adjustments in dose? Increased Decreased No change Local anesthetic should not be administered | DECREASED With liver damage / disease / alcoholism - may not be able to metabolize lidocaine (an amide) Amides are metabolized in liver - can accumulate w/ liver disfunction --> systemic toxicity reaction |
| Taking cimetidine (Tagamet) for gastric ulcer. What is effect of drug in combination of lidocaine? up lidocaine metabolism lower lidocaine metabolism No effect on lidocaine metabolism up renal excretion lower renal excretion | Decreases Lidocaine Metabolism Cimetidine decreases hepatic blood flow --> slows metabolism of amides --> systemic toxicity at large doses Cimetidine does NOT effect renal excretion |
| If tissues are inflamed what happens to environmental pH and what effect does this have on local anesthetic? | If the tissue in inflamed the acidic environment causes the pH to drops... ...increasing the ionized portion ... .. making the local anesthetic less effective |
| Important consideration w/ local anesthetic with a vasoconstrictor to a patient w/ methamphetamine abuse? _________ stimulation by the vasoconstrictor _________ blood pressure | Adrenergic stimulation by the vasoconstrictor Increased Blood Pressure / HR Methamphetamine = adrenergic agent - stimulates heart rate and blood pressure Vasoconstrictors = ANS drug = adrenergic agonists/ sympathomimetics= an additive effect |
| All are components of local anesthetics except; which is the exception? Vasoconstrictor Sodium chloride Antioxidant Antihistamine Correct Sodium hydroxide | Antihistamine - although some have weak local anesthetic action |
| Which two vasoconstrictors are added to local anesthetics to decrease systemic toxicity and prolong anesthetic action? | epinephrine levonordefrin |
| If a vasoconstrictor is added, an antioxidant ______, _________, or _________ will be required prevent its breakdown | sodium metabisulfite sodium bisulfite acetone sodium bisulfite |
| These are additives to local anesthetics ______________ to make the solution Isotonic (like body fluids) ______________ to adjust the pH to between 6-7 ______________, an antibacterial agent (for multiple dose cartridges, not used in denistry) | Sodium chloride - isotonic Sodium Hydroxide - pH Propylparaben - antibacterial |
| All of these local anesthetic agents are amides except; which is the exception? Mepivacaine Bupivacaine Procaine Prilocaine Lidocaine | Procaine Procaine is a PABA ester used as an antiarrhythmic agent (procainamide) combined with penicillin to form procaine penicillin G. High rate of allergic reaction |
| All of these local anesthetic agents are esters except; which is the exception? Mepivicaine Procaine Benzocaine Tetracaine | Mepivicaine an amide local anesthetic |
| Are ester local anesthic agents are given parenterally? | NO High risk of allergic reaction applied TOPICALLY |
| Jones had a MI a year ago. His medications include warfarin, Prinivil, atenolol, and Cardizem. Which is safest? Lidocaine 2% with 1:50,000 epinephrine Lidocaine 2% with 1:100,000 epinephrine Mepivicaine 3%, plain Prilocaine 4% plain | Lidocaine 2% with 1:100,000 epinephrine Patients with cardiovascular disease - epinephrine-containing local anesthetic in the lowest possible dose of vasopressor 0.04 mg of epinephrine = the cardiac dose in-adequate pain control w/ "plain" drugs |
| What is considered the safe number of cartridges to give to a pt w/ cardio vascular disease of lidocaine 1:100,000 ? | 2 cartridges Two cartridges of lidocaine 1:100,000 would have 0.04 mg of epinephrine or the cardiac dose of a vasoconstrictor |
| Which is the most common formulation of local anesthetic used in dentistry today? Lidocaine 2% 1:200,000 Mepivicaine 3% plain Lidocaine 2% 1:100,000 Mepivicaine 2% 1:20,000 levonordefrin (Neo-Cobefrin) | Lidocaine 2% with 1:100,000 epinephrine |
| Vasoconstrictors are added to local anesthetics for all purposes EXCEPT; which is the EXCEPTION? Increase depth of anesthesia Shorten duration of action Prolong duration of action Reduce systemic toxicity | Shorten the duration of action |
| What is the most common local adverse reaction to local anesthetic? Lidocaine toxicity Malignant hyperthermia Psychogenic shock or fainting Central nervous system excitation Physical injury at injection site such as a hematoma | Hematoma other reactions listed are all systemic reaction. Lidocaine toxicity is rare in dentistry due to small amount of anesthetic Malignant hyperthermia = inherited disease previously believed to be caused by amide local anesthetics |
| What are the S/S of CNS excitation / stimulation due to lidocaine toxicity. CNS excitation can be followed by ________________ | Restelessness Tremors Convulsions CNS excitation followed by CNS depression -- cardio/resp depression and coma |
| Which is the most commonly used topical anesthetic in dentistry? Lidocaine Mepivicaine Benzocaine Articaine | Benzocaine Benzocaine 6-20%, (Hurricaine, Anbesol, Benzodent, Orabase-B) an ester Lidocaine is the second most used topical agent an amide |
| Mechanism of action of a local anesthetic? Decreases perception of pain Decreases reaction to pain Increases permeability of nerve membrane, facilitating depolarization Decreases permeability of nerve membrane, preventing depolarization | The mechanism of action of local anesthetic is to... block conduction of nerve impulses by... .... decreasing the permeability of nerve membrane to sodium ions... .... preventing depolarization |
| T/ F: Local anesthetics are sometimes referred to as sodium channel blockers | True Local anesthetics attach themselves to the cell membrane and decrease the permeability of the nerve membrane to the flow of sodium ions, interfering with neuron function or acting as a nerve block |
| 1. A rapid rate of injection will increase the rate of absorption at the injection site... 2. ...decreasing local anesthetic blood levels. Which statements are true/false | First statement is FALSE Second statement is TRUE Rapid injection introduces more fluid volume than the tissue can accept, decreasing the amount of local anesthetic entering systemic circulation |
| What is the major advantage of amide local anesthetics over esters? Cost Longer duration Ease of delivery Lack of allergenicity | Lack of allergenicity = advantage of amide local anesthetics |
| Longest duration of action? Prilocaine (Citanest) 4% with 1:200,000 epi Lidocaine (Xylocaine, Octocaine) 2% with 1:100,000 epi Mepivacaine (Carbocaine, Polocaine, Isocaine) 3%, plain Bupivacaine (Marcaine) 0.5% with 1:200,000 epi | Bupivacaine (Marcaine) has the longest duration of action of the amide local anesthetics and is indicated in lengthy dental procedures pulpal anesthesia of 90 to 180 minutes |
| For second trimester of pregnancy, which is indicated Prilocaine 4% with 1:200,000 epinephrine Lidocaine 2% with 1:100,000 epinephrine Correct Mepivacaine 3%, plain Bupivacaine 0.5% with 1:200,000 epinephrine | Lidocaine 2% with 1:100,000 epinephrine in the lowest effective dose |
| Prilocaine has been tested in animals without ______________ effects but has been associated with ____________________ | Prilocaine has been tested in animals without teratogenic effects but has been associated with methemoglobinemia |
| Factor MOST likely to increase toxicity w/ topical anesthetics? Be aware of drug toxicity / concentration Use sprays to provide even application Use smallest volume in the lowest concentration Use least toxic drug that provides efficacy | Using sprays to provide even application = toxicity potential Topical application of anesthetics to the surface of membranes may be rapidly absorbed, especially if the tissue is inflammed. Sprays should be avoided to limit the area of application |
| 1. Articaine (Septocaine) differs from other amide local anesthetics because it has an extra ester linkage. 2. Articaine has a longer half-life and lower toxicity than lidocaine Which are true/which are false | First statement = TRUE derived from thiophene, has extra ester linkage. Has increased lipid solubility / increased action - is metabolized in blood: plasma esterase Second statement = FALSE has shorter half-life, is more toxic due to higher dose |
| Application of __________ and _____________ in gel form, into the periodontal pocket is an injection-free method of administering local anesthetic that is well tolerated in most patients. | lidocaine + prilocaine = gel (Oraquix) duration of approximately 20 minutes Lidocaine provides rapid anesthesia prilocaine has a slower onset of action |
| medications: amiltriptyline (Elavil), alprazolam (Xanax), and ibuprofen. provider plans to use 2% lidocaine, 1:100,000 parts of epinephrine. What adverse reaction could occur due to drug interactions with epinephrine? | Increased Blood Pressure tricyclic antidepressant amiltriptyline (Elavil). In patients taking tricyclic antidepressants, administration of epinephrine may cause an exaggerated increase in pressor response, increasing blood pressure. |
| badly abscessed tooth. Unable to achieve profound anesthesia even after 10 cartridges of lidocaine 2% with 1:100,000 epinephrine. The patient states: feeling ill, and begins to have severe tremors. What is the most likely cause of his condition? | Lidocaine Toxicity most normal adults can safely receive up to 11 cartridges... ...massive inflammation and accompanying vasodilation in abscessed area has greatly increased systemic absorption |
| What are the two main body systems affected by local anesthetic toxicity? | CNS Cardiovascular |
| The local anesthetic agents can produce myocardial __________ and cardiac _______ with peripheral ____________, and disruption of normal heart conduction leading to heart _________________ | The local anesthetic agents can produce myocardial depression and cardiac arrest with peripheral vasodilation, and disruption of normal heart conduction leading to arrhythmias |
Created by:
maiagrodin