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LOCAL ANESTHETIC AGENTS| QUESTIONS &
ANSWERS|LATEST UPDATE 2025|A+ GRADED
What is the most commonly used local anesthetic in dentistry? "The gold standard" Lidocaine A cartridge of local anesthetic contains more than the anesthetic agent, it will contain what other two things? Vasoconstrictors and Preservatives Vasoconstricts are added to the solution in a carpule in order to:
- ______ duration of the anesthetic
- ______ the systemic toxicity
- control _____ at the site of action
- ________ the vasodilatory properties of the local anesthetic
- Include _______ and ________
- are unstable, have short-shelf life, so preservatives are added to the solution increase
decrease bleeding counteract epinephrine and levonordefrin ____ _______ is one of the most common preservatives added to vasoconstrictors. It decreases the pH. Sodium Bisulfate _____ ____ and ____ _____ are buffers that increase pH Sodium hydroxide Sodium Chloride 10% of patients with ____ are allergic to sodium bisulfate. Monitor for potential symptoms asthma
Prilocaine is metabolized in the ____ and ___ liver and lungs Injectable ______ are not available for dental use. Mainly used in topical local anesthetics. esters _____ (______) is an example of an ester that is used as an antiarrhythmic; provides no pulpal anesthesia Procaine (novocaine) generic names are ______ proprietary named are ________ lower case capitalized generic:
____________
Proprietary: Novocaine generic: procaine Proprietary:
generic:
Proprietary: Ravocaine generic: propoxycaine Proprietary:
generic:
Proprietary:
____________
___________
__________
____________
_________
generic:
Proprietary: Citanest generic: prilocaine Proprietary:
generic:
Proprietary: Septocaine Articadent
generic: articaine Proprietary:
generic:
Proprietary: Marcaine generic: bupivacaine Proprietary:
Ester or Amide? procaine (Novocaine) Ester
Ester or Amide? articaine (Septocaine, Articadent) Amide Ester or Amide? bupivacaine (Marcaine) Amide Things to consider when selecting local anesthetic Type of injection Length of procedure Post tx pain control Med hx Allergies Need for homeostasis If a patient is allergic to something in the anesthetic agent, it is likely to be an allergy to the __________ preservative
Describe the consideration you make when choosing the type of injection infiltration versus nerve block, nerve block will last longer than infiltration How does the length of the procedure play a role in selecting local? Anesthetic needs to be able to block the pain for the amount of time needed Post treatment pain control is considered when selecting local anesthetic because.. In some cases, a patient may need pain control for a period of time after the procedure It is important to review the patient's medical history to ensure the patient does not have a condition that could limit what? the amount of local vasoconstrictor that they can have
If post treatment pain control is an issue, due to either the procedure or the patient, What should occur? Consult with the dentist! Longer post tx duration should not be used with ______ children Longer acting post treatment drugs that are good for longer acting durations 0.5% bupivacaine 1:200,000 epinephrine 4% prilocaine 1:200,000 epinephrine Proprietary names: Xylocaine, Alphacaine, Octocaine Was the first amide local anesthetic suitable for nerve blocks in dentistry Most commonly used local anesthetic in dentistry Is twice as potent as procaine and produces greater depth of anesthesia lidocaine
lidocaine uses (2) -Has anticonvulsant properties and sedative effects -Is effective topically and is currently the only amide topical on the market Lidocaine is metabolized in the ______ liver Do not use lidocaine 1:50,000 epinephrine for pts with significant ______ or ______ patients sensitive to epinephrine CVD or elderly Dosage for lidocaine 3.2 mg/lb or 7.0 mg/kg Absolute Maximum Recommend Dose of lidocaine: 500 mg
mepivacaine dose: 3.0 mg/lb or 6.6 mg/kg mepivacaine absolute maximum recommended dose 400 mg Proprietary name: Citanest Pharmacologically similar to lidocaine and mepivacaine The least toxic anesthetic used Provides a slightly longer duration of action than lidocaine Like mepivacaine, it produces very little vasodilation and is an effective plain anesthetic Manufactured as 4% prilocaine Prilocaine uses (5) -When longer duration is needed than that of mepivacaine and lidocaine -When a lower concentration is needed for cardiovascular patients
-For patient with liver dysfunction -The best choice for pregnancy -As a topical, found in combination with lidocaine in products such as oraquix and ELMA Where is prilocaine metabolized? first in the lungs, then in the liver prilocaine dosage 3.6 mg/lb or 8.0 mg/kg prilocaine absolute maximum recommended dose: 600 mg Describe the limiting factor with prilocaine -Methemoglobinemia occurs when prilocaine is metabolized to ortho- toluidine.
90-95% in blood, only 5-10% in liver articaine dose 3.2 mg/lb or 7 mg/kg Absolute maximum recommended dose of articaine: None listed Describe the limiting factor of articaine? -Articaine is delivered as a 4% solution (compared to lidocaine 2%). It has been proven that local anesthetic induced nerve damage occurs with higher concentrations of local anesthetic. -Some choose not to use Articaine for mandibular blocks because of the potential of paresthesia Proprietary name: Marcaine Is the most potent, toxic, with longest duration Has high pKa; onset of action slower, but duration almost double that of lidocaine
Is a potent vasodilator, second only to procaine, and is formulated only with epinephrine Overdose has equal effects on CNS and CVS, plus it has a lengthy half life. This increases the risk for systemic toxicity bupivacaine Indications for bupivacaine use (2) -When long pulpal anesthesia is needed and or postoperative pain control is anticipated -For patients with significant cvd and long duration needed Bupivacaine should not be used for patients prone to... For patients prone to self mutilation (special needs patients or children) Where is bupivacaine metabolized? liver Bupivacaine dosage
