La/exo Lect 6

Front 1

Are Toxic reaction caused by the LA base or the VASOCONSTRICTOR?

Back 1

Either

Front 2

3 symptoms of a MILD overdose reaction to LA

Back 2

Drowsiness
Feeling "weird"
Tremor of the arms and legs

Front 3

TOXIC REACTIONS to LA depend on 5 things... list them

Back 3

1. The type of LA used
2. Whether or not there was a vasoconstrictor
--> does the toxic reaction wear off faster or slower if there is a vasoconstrictor present?
3. Amount given (mg/kg)
4. Age of patient - what are the dangerous AGE groups?
5. Health status - beware of meds and med conditions

Hint 3

2.....Slower

4.....under 16 yrs, over 65 {young and elderly}

Front 4

A larger than recommended dose of LA will increase the duration of action - T/F?

Back 4

FALSE

Administering a larger than recommended dose will NOT increase the DURATION

Front 5

A smaller than recommended dose of LA will decrease the duration of action - T/F?

Back 5

True

Front 6

Name the only ester LA available in australia, and the size of the ampoule.
Is this used by dentists?

Back 6

Procaine 2% No vasoconstrictor
2mL ampoule

NOT used by dentists in oz, only in hospitals.

Front 7

When was Procaine used by dentists?

Back 7

1904-1940

Front 8

Is an ester or an amide more stable in solution?

Back 8

An AMIDE (can refrigerate for 2 years)

Front 9

Where are ester LAs metabolised?
What is the enzyme/s that do this?
Is this a slow or fast process?

Back 9

....

Plasma cholinersterase + other esterases

FAST

Front 10

Why don't we use PROCAIN anymore?

Back 10

hypersensitivity reactions and allergic phenomena

Front 11

What is PABA?

Back 11

para-amino benzoate

Front 12

What is the main breakdown product associated with ester LAs?
why is this a problem?

Back 12

PABA
Associated with HYPERSENSITIVITY REACTIONS

Front 13

What metabolises Amide LAs?

Back 13

HEPATIC AMIDASES

Front 14

Is the metabolism of amide LAs a fast or slow process?

Back 14

SLOW

Front 15

How common are hypersensitivity reactions to Amide LAs?

Back 15

EXTREMELY RARE

Front 16

LA substances usually consists of an __acidic/basic?___ LA and a ___vasodilator/constrictor?

Back 16

LA BASE
+ VASOCONSTRICTOR

Front 17

What is the purpose of an added vasoconstrictor?

Back 17

causes the blood vessels to contract, keeping the LA in the area, which increases the working time

Hint 17

without vasoconstrictor working time decreases a lot

Front 18

If your patient said they were allergic to xylocaine, is this likely, and what are the two things you should consider?

Back 18

INCREDIBLY UNLIKELY
1. If they are elderly and they had LA before the 1940s (ie it was an ester LA and they were allergic to PABA)
2. If they had had a reaction to adrenaline in the past (sweaty, heart racing, felt yucky) and had interpreted this as an allergic reaction.
If it isn't either of these, what would you do?

Hint 18

Send them for a sensitivity test

Front 19

2% procaine (plain) provides
1. pulp anaesthesia for how long?
2. soft tissue anaesthesia for how long?

Back 19

1. THERE IS NO PULP ANAESTHESIA - ouch
2. 30-60 min (that's not long!)

Why are these so crap?

Hint 19

Because it vasodilates the blood vessels --- also made maintaining a clean field impossible (bleeding)

Front 20

List the 6 amide linked LAs used in oz.... (generic names)

Back 20

1. Lignocaine
2. Prilocaine
3. Mepivicaine
4. Bupivicaine
5. Articaine
6. Benzocaine

Hint 20

Bending burping little princes and men

Front 21

what are the 3 trade names for injectable lignocaine?

Back 21

2% Xylocaine (dentsply)
2% Nurocain (dentsply) [Nurocain TAKEN OFF MARKET RECENTLY]
Lignocaine Special 2% (Septodont)

Front 22

what is the US name for lignocaine?

Back 22

lidocaine

Front 23

What is the most commonly used and versatile LA agent?

Back 23

Lignocaine

Front 24

Lignocaine's
onset: rapid or slow?
duration: short or moderate or long?

Back 24

RAPID onset

MODERATE duration

Front 25

Lignocaine has a __short/mod/long__ duration, and if you add a vasoconstrictor the duration _decreases/increases____?

Back 25

Moderate

Increases

Front 26

What concentration/s is lignocaine available in?
Injection range:___%
Topical range: ___%

Back 26

0.5-2% for injection
4- 10% for topical

Front 27

Is lignocaine used for infiltration or for block?

Back 27

Can use for BOTH infiltration or block

Front 28

Dentsuply:
2 types of Injectable lignocaine:
__%_"name"___ with ___ratio___ "name" (vasoconstrictor)__ ?

Back 28

2% xylocaine with adrenaline 1:80,000

2% nurocain with adrenaline 1:100,000 .......why was this amount of adrenaline good?

Hint 28

it was more than adequate as a vasoconstrictor (good working time), but it had less systemic adrenalin effects for patients that are more sensitive to adrenaline... It was good for blocks especially for women and children

Front 29

What procedures can you use 2% xylocaine adrenaline 1:80,000 and nurocaine 1:100,000 for? (4)

Back 29

Exos, infiltration, pulpal procedures, deep scaling (less bleeding), crown and bridge work

Front 30

When you assess the medical history, what are you looking for in terms of choosing an LA?

Back 30

Are they suitable for an LA containing adrenaline

Front 31

What are the topical anaesthetics supplied by dentsply?

Back 31

1. xylocaine 10% special adhesive
2. xylocaine 5% ointment
3. Oraqix (lignocaine 25mg/g + prilocaine 25mg/g) periodontal gel
4. Xylocaine Spray
5. EMLA cream

Front 32

How are topicals administered?

Back 32

gel
patch
spray

Front 33

To what tissue are topicals applied?

Back 33

to mucous membranes (diffuse through), except EMLA which can be applied to intact skin (prior to GA for children)

Front 34

How far/deep does topical numb the tissue?

Back 34

1-2 mm

Front 35

Xylocaine 10% SPECIAL ADHESIVE
- what is the active ingredient
- what can it be used for?
- what must you be careful/aware of?

Back 35

lignocaine
- removing decidous teeth hanging by a thread
- shallow scaling

- USE a SMALL AMOUNT on a cotton bud. When you add injections (2-3 cartridges) you can easily overdose the patient.

Front 36

Should xylocaine 10% special adhesive be used for multiple quadrants or for single points?

Back 36

a single point - single injection, removing baby teeth

What should you use if you want to apply it to multiple quadrants?

Hint 36

xylocaine 5% ointment

Front 37

Do topicals have vasoconstrictors?

Back 37

NO

Front 38

Oraqix periodontal gel is applied with ___ to____

Back 38

an oraqix dispenser to gingival sulcus

Front 39

Xylocaine spray delivers __?mL and the equivalent of ___?mg of lignocaine base.
It is good for (4)

Back 39

0.1mL
10mg
Surface anaesthesia before injection
Numbing throat in gaggers
suture removal
Deep scaling {but gels are better}

Front 40

EMLA cream is applied ___?hr before procedure before ___?procedures.

Back 40

1

painful

Front 41

What is the 2nd most commonly used LA in oz?

Back 41

prilocaine

What is it's trade name (dentsply)?

Hint 41

Citanest

Front 42

Prilocaine has a speed of onset that is similar to what other LA base?

Back 42

lignocaine

Front 43

Does prilocaine/citanest have a high or low vasodilatory action?

Back 43

LOW
What implication does this have?

Hint 43

it can be used without a vasoconstrictor

Front 44

Does citanest/prilocaine have a low/mod/high toxicity?

Back 44

LOW (less than lignocaine) - why?

What does this mean for it's safety margin for HEALHY PEOPLE and medically compromised?

Hint 44

It is rapidly biotransformed

Higher safety margin

Front 45

What is the problem with prilocaine/citanest in HIGH DOSES?
What is a high dose?

Back 45

It can cause methaemoglobinaemia

If you give them more than 8mg/kg

Front 46

What symptoms/signs does the patient show when they have methaemoglobinaemia?

Back 46

They turn BLUE (nails and lips) {cyanosis}

What do you do if they turn blue?

Hint 46

Call the ambulance

Front 47

What will the ambulance give the patient if they have methaemoglobinaemia?

Back 47

IV methylene blue 1mg/kg

Front 48

Where is prilocaine/citanest metabolised?

Back 48

Lungs
Liver
kidney

Front 49

What two things can cause methaemoglobinaemia?

Back 49

Overdose of prilocaine

Combination of more than 600mg of prilocaine + certain meds (sulphonamides, antimalarials, certain nitric compounds)

Front 50

Metabolite o-toluidine turns Hb into methaemoglobin and affects?

Back 50

oxygen uptake

Front 51

Methaemoglovbinaemia incidence:
a) VERY rare incidence: A dose of ___mg of prilocaine/citanest.

b) Recorded incidence (esp in ANAEMIC PATIENTS):
A dose of between _-__mg of prilocaine/citanest

c) Cyanosis reported at >__mg of prilocaine/citanest

Back 51

a) 400mg
b) 400-600mg
c) >600mg

Front 52

Plasma levels of prilocaine decrease less/more rapidly than lignocaine?

Back 52

more

Front 53

Prilocaine/citanest toxicity
- signs of CNS toxicity are briefer/more prolonged and more/less severe than lignocaine?

Back 53

Briefer
Less

Front 54

What is the most commonly used form of citanest/prilocaine in oz?

Back 54

3% citanest with octapressin/felypressin 0.3 IU/mL

Front 55

What are the 4 forms of citanest/prilocaine that are available?

Back 55

1. 4% plain
2. 4% with adrenaline 1:200,000 (citanest forte)
3. 3% with adrenaline 1:300,000
4. 3% with octapress/felypressin 0.03 IU/mL

Front 56

Citanest forte
long/short anaesthesia with the most/least concentrated adrenaline dilution available?

Back 56

Long - pulpal for how long? Soft tissue for how long?
Least - how much adrenaline?

Hint 56

Pulpal: 60-90min
Soft tissue: 3-6 hrs
1:120,000

Front 57

Adrenaline sensitive patients requiring prolonged pulpal anaesthesia - which LA should be used?

Back 57

CItanest plain or citanest 1:200,000 adrenaline

Front 58

What size is a xylocaine/lignocaine special cartridge?

Back 58

2.2mL

Front 59

Which LA has an odd size cartridge?

Back 59

Citanest - what size are their cartridges?
- what does this mean?

Hint 59

1.8mL

- use a RUBBER SPACER after inserting cartridge

Front 60

What is the trade name of Bupivacaine?

Back 60

Marcain

Front 61

What is the main advantage of bupivacaine/marcain?

Back 61

LONG DURATION of sustained anaesthetic when you don't want to keep injecting the patient

Front 62

What is the main problem of bupivicaine/marcain?

Back 62

MOST CARDIOTOXIC LA
(more cardiac effects)

Front 63

What % is bupivacaine available in in oz?

Back 63

0.5% solution for dentists

Front 64

What do we use bupivacaine for?

Back 64

3rd molar extractions
LONG complex OS (ie 7hrs)
Implant placement

Hint 64

Not used in restorative dent
(other anaesthetics are more than sufficient for 3hrs worth of work)

Front 65

Trade name, Aneasthetic and [] vasoconstrictor and []

Back 65

xylocaine 2%, lignocaine, adrenaline 1:80,000

Cartridge size?

Hint 65

2.2mL

Front 66

Trade name, Aneasthetic and [] vasoconstrictor and []

Back 66

2% Nurocain, lignocaine, with adrenaline 1:100,000
Cartridge size?

Hint 66

2.2mL

Front 67

Trade name, Aneasthetic and [] vasoconstrictor and []

Back 67

Citanest 3%, prilocaine, with octapressin 0.03 IU/mL

Cartridge size?

Hint 67

1.8mL

Front 68

Trade name, Aneasthetic and [] vasoconstrictor and []

Back 68

Citanest plain 4%, prilocaine,

NO VASOCONSTRICTOR

Cartridge size?

Hint 68

1.8mL

Front 69

Trade name, Aneasthetic and [], vasoconstrictor and []

Back 69

citanest 3%, prilocaine, with adrenaline 1:300,000

cartridge size?

Hint 69

1.8mL

Front 70

Trade name, Aneasthetic and [], vasoconstrictor and []

Back 70

Citanest 4%, prilocaine with adrenaline 1:200,000

Cartridge size?

Hint 70

1.8mL

Front 71

Trade name, Aneasthetic and [] vasoconstrictor and []

Back 71

Marcain 0.5%, Bupivicaine, adrenaline 1:200,000

Cartridge size?

Hint 71

2.2mL

Front 72

What is the name of septodont's lignocaine product?

Back 72

Lignospan special 2%

What does it contain?

Hint 72

Lignocaine Hydrochloride 20mg/mL

Adrenaline 1:80,000

Front 73

what is the onset of lignospan special?

Back 73

1-3 min

Front 74

What injectible LAs do Septodont supply?

Back 74

lignospan special 2%
septanest 4%

Front 75

What does septanest 4% contain?

Back 75

Articaine hydrochloride 4% and adrenaline 1:100,000

Front 76

What is so special about articaine/septanest?

Back 76

It is VERY SMALL
It is HIGHLY LIPOPHILIC AND HYDROPHILIC
What does this mean?

Hint 76

It penetrates hard and soft tissue better than any other anaesthetic currently available

Front 77

Does septanest/articaine have higher or lower success rates with blocks in adults than other LAs?

Back 77

HIGHER!!!

Front 78

Can septanest/articaine be used for infiltration?

Back 78

YES

Front 79

Septanest/articaine
Infiltration of Maxilla
Which teeth can be anaesthetised?

Back 79

18-28
Can be used on ALL MAXILLARY TEETH

Front 80

Septanest/articaine
Infiltration of MANDIBLE
Which teeth can be anaesthetised?

Back 80

36-46

What do other LA's numb with infiltrations?

Hint 80

33-43 (no premolars

Front 81

You can safely use septanest/articaine on children from ____ age ?

Back 81

4 years

Front 82

Septanest/articaine has poor/excellent hard/soft tissue penetration?

Back 82

EXCELLENT

Hard AND soft tissue

Front 83

Can septanest/articaine be used in areas of low pH/inflammation?

Back 83

YES you can use it in infected areas in the presence of pus or inflammation.
Do you need AB cover afterwards?

Hint 83

Yes

Front 84

Does septanest/articaine have a low or high vasoconstrictor level?

Back 84

Low
- reduces risk from adrenaline,
but still provides haemostasis and long acting anaesthesia.

How long does the anaesthesia last?
pulp?
soft tissue?

Hint 84

Pulp: 60+min
Soft tissue: 3-6hrs

Front 85

Should I use articaine/septanest when there is cellulitis?

Back 85

no

Front 86

Discussion around articaine?

Back 86

damaged nerves - permanent parasthesia

What does apthorpe suggest this is due to?

Hint 86

Operator error

Front 87

Do you use as much articaine/septanest as you would other LAs?

Back 87

No
You use about HALF of what you use of other LAs to get same anasthesia
How much for
- incisor infiltration
- max molars
block

Hint 87

- 0.5mL
- 0.75 mL
- 1-2mL