Articaine Local Anesthetic Overview

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Questions and Answers

Which patient group is more likely to require careful consideration when administering local anesthesia?

Patients with cardiovascular disease (ASA class 3 and 4) (correct)

Patients with a history of allergies

Patients with hypertension

Patients with normal thyroid function

How many milligrams of mepivacaine are in one carpule of 2% Mepivacaine with Epi?

18 mg

72 mg

54 mg

36 mg (correct)

What is the maximum number of carpules per appointment for an adult weighing 70 kg using 3% Mepivacaine without Epi?

6 carpules

7 carpules (correct)

4 carpules

5 carpules

What is the amount of mepivacaine in milligrams found in one carpule of 4% Articaine with Epi?

72 mg Signup and view all the answers

What is a potential interaction in patients receiving MAO inhibitors when using anesthetic agents?

Prevention of breakdown of Epinephrine Signup and view all the answers

What is the primary metabolic pathway for articaine?

In both plasma and liver Signup and view all the answers

Which anesthetic is known for having a vasodilating effect similar to that of lidocaine?

Articaine Signup and view all the answers

What is the maximum recommended dose of articaine for adults?

7.0 mg/kg body weight Signup and view all the answers

Which of the following statements about articaine is correct?

It contains both amide and ester characteristics. Signup and view all the answers

What contraindications are associated with the use of articaine?

Congenital methemoglobinemia and cardiac failure Signup and view all the answers

What is the onset of action for infiltrative administration of articaine?

1 to 2 minutes Signup and view all the answers

Which local anesthetic should be chosen for patients allergic to sulfites?

Mepivacaine 3% plain Signup and view all the answers

What side effect is specifically associated with articaine?

Methemoglobinemia Signup and view all the answers

What is the pregnancy classification of Bupivacaine?

Category C Signup and view all the answers

Which of the following is NOT an indication for the use of Bupivacaine?

Atraumatic needle penetration Signup and view all the answers

What is the primary reason for using more concentrated forms of topical anesthetics?

To enhance clinical efficacy Signup and view all the answers

Which local anesthetic is used in the EMLA cream?

Lidocaine and Prilocaine Signup and view all the answers

What is a contraindication for the use of EMLA?

Infants younger than 12 months receiving methemoglobin inducing agents Signup and view all the answers

What is the duration of action for topical anesthetics generally limited to?

2 to 3 mm Signup and view all the answers

Why should Bupivacaine be avoided in patients with cardiovascular issues?

It may produce toxic effects on the heart Signup and view all the answers

What is a distinguishing characteristic of Benzocaine compared to other anesthetics?

It is poorly soluble in water Signup and view all the answers

What is the maximum recommended dose of epinephrine for a normal healthy patient per appointment?

0.2 mg Signup and view all the answers

Which concentration of epinephrine corresponds to a maximum of 11 cartridges for a normal healthy patient?

1:100000 Signup and view all the answers

What percentage of α-receptor stimulation is contributed by levonordefrin?

75% Signup and view all the answers

Which of the following is a contraindication for the use of vasoconstrictors in dental anesthesia?

Hypertension Signup and view all the answers

The maximum dose of levonordefrin per appointment for all patients is:

1 mg Signup and view all the answers

What are common side effects of levonordefrin compared to epinephrine?

Less CNS stimulation Signup and view all the answers

What is the primary action of vasoconstrictors in a clinical setting?

Decrease bleeding Signup and view all the answers

Which factor is NOT considered when selecting a vasoconstrictor for dental procedures?

Patient's age Signup and view all the answers

In what way is levonordefrin considered in relation to epinephrine?

Less potent as a vasopressor Signup and view all the answers

Which of the following is classified as a catecholamine?

Epinephrine Signup and view all the answers

Which adrenergic receptors are primarily involved in vasoconstriction?

Alpha (α) receptors Signup and view all the answers

Epinephrine produces which of the following systemic effects?

Vasoconstriction of smaller arterioles Signup and view all the answers

What is the role of vasoconstrictors during the use of local anesthetics?

Decreases anesthetic absorption into the cardiovascular system Signup and view all the answers

In what clinical situations is epinephrine commonly used?

Management of anaphylaxis Signup and view all the answers

What type of agents are amphetamine and methamphetamine classified as?

Indirectly acting Signup and view all the answers

What physiological effect does epinephrine have on metabolism?

Increases blood sugar levels Signup and view all the answers

Study Notes

Articaine

Articaine is a hybrid molecule with both amide and ester properties.
It's 1.5 times more potent than lidocaine, but has similar toxicity.
It's the only amide-type local anesthetic with a thiophene group, which enhances lipid solubility for better tissue penetration.
It's metabolized in both plasma and liver, unlike other amides.
It's excreted via the kidneys, with about 5% to 10% unchanged.
It has a vasodilating effect similar to lidocaine.
Available in 4% concentration, it has an onset ranging from 1-2 minutes for infiltration and 2-3 minutes for blocks.
Duration with 1:100,000 epinephrine: 60-75 minutes for pulpal, 180-360 minutes for soft tissue.
Duration with 1:200,000 epinephrine: 45-60 minutes for pulpal, 120-300 minutes for soft tissue.
Maximum recommended dose: 7.0 mg/kg body weight.
Pregnancy classification: C (not safe).
Side Effect: Methemoglobinemia.
Contraindication: Idiopathic or congenital methemoglobinemia, cardiac & respiratory failure, allergy to sulfite-containing drugs.

Bupivacaine

Bupivacaine is a long-acting amide local anesthetic.
It's 4 times more potent than lidocaine.
Available in 0.5% concentration with 1:100,000 or 1:200,000 epinephrine.
Indications: Lengthy procedures (oral surgery, implants, periodontics), postoperative pain management.
Contraindications: Physically & mentally disabled children, patients with cardiovascular issues.
Pregnancy classification: C (not safe).

Topical Anesthetics

Intact skin is a barrier to anesthetic diffusion.
Mucous membranes and injured skin allow topical anesthetics to reach nerve endings.
Topical anesthesia is effective only on surface tissues (2-3 mm).
More concentrated forms are used topically (5% or 10% lidocaine) compared to injection (2%).
Common Topical Agents: Benzocaine, Dyclonine hydrochloride, EMLA, Lidocaine.
Benzocaine 20%: Ester-type, poorly water-soluble, providing prolonged action, not suitable for injection.
Dyclonine Hydrochloride: Ketone derivative, suitable for patients allergic to common anesthetics.

EMLA (Eutectic Mixture of Local Anesthetics)

Contains 2.5% Lidocaine and 2.5% Prilocaine.
Emulsion with eutectic mixture of lidocaine and prilocaine in a 1:1 ratio.
Works on intact skin.
Applied 1 hour prior to procedure.
Contraindications: Congenital or idiopathic methemoglobinemia, infants younger than 12 months on methemoglobin-inducing agents, known sensitivity to amide-type anesthetics.

Vasoconstrictors

Classifications:
- Based on Chemical Structure: Catecholamines (epinephrine, norepinephrine, levonordefrin, isoproterenol, dopamine) and Noncatecholamines (amphetamine, methamphetamine, ephedrine, hydroxyamphetamine, metaraminol, methoxamine, phenylephrine).
- Based on Mode of Action: Directly Acting (epinephrine, norepinephrine, levonordefrin, isoproterenol, dopamine, methoxamine, phenylephrine), Indirectly Acting (amphetamine, methamphetamine, hydroxyamphetamine, tyramine), Mixed Acting (metaraminol, ephedrine).
Action of Vasoconstrictors: Decrease blood flow, slow LA absorption into cardiovascular system, decrease risk of toxicity, increase duration of action, decrease bleeding (hemostasis).
Adrenergic Receptors: Alpha (α) receptors cause vasoconstriction, Beta (β) receptors cause vasodilation, bronchodilation, and cardiac stimulation.

Epinephrine

Mode of action: Directly on alpha (α) and beta (β) adrenergic receptors.
Systemic Effects: Increased heart rate and cardiac output, increased systolic blood pressure, vasoconstriction of smaller arterioles, bronchodilation, not a potent CNS stimulant, increased oxygen consumption, glycogenolysis (increased blood sugar).
Clinical Applications: Anaphylaxis, status asthmaticus, cardiac arrest, vasoconstrictor in local anesthetics, mydriasis.
ASA Classification: System for assessing patient's preoperative physical status.
Recommended Maximum Dosages:
- Normal Healthy Patient (ASA I): 1:50,000 (5.5 carpules), 1:100,000 (11 carpules), 1:200,000 (22 carpules).
- Clinically Significant CVS Disease (ASA III or IV): 1:50,000 (1 carpul), 1:100,000 (2 carpules), 1:200,000 (4 carpules).

Levonordefrin

Mode of action: Primarily through direct α-receptor stimulation (75%), with some β activity (25%).
Systemic Actions: Less cardiac and CNS stimulation compared to epinephrine.
Side Effects and Overdose: Similar to epinephrine but less severe. Higher doses can cause hypertension, ventricular tachycardia, and anginal episodes in patients with coronary artery insufficiency.
Clinical Applications: Vasoconstrictor in local anesthetics.
Maximum Doses: 1 mg per appointment for all patients (1:20,000 dilution - 11 cartridges).

Selection of Vasoconstrictors

Factors considered: Length of procedure, need for hemostasis, postoperative pain control, patient's medical status.

Contraindications of Vasoconstrictors

Benefits and risks of including vasoconstrictors should be weighed against using plain anesthetic solutions.
Specific groups: Patients with significant cardiovascular disease (ASA class 3 and 4), patients with thyroid dysfunction, diabetes, sulfite sensitivity, patients on MAO inhibitors or tricyclic antidepressants.

Calculating Maximum Carpules (Cartridges) Per Appointment

2% Mepivacaine with Epi 1:100,000 (red color): (Body weight x 6.6 mg/kg) / 36 mg/cartridge
3% Mepivacaine without Epi (green color): (Body weight x 6.6 mg/kg) / 54 mg/cartridge
4% Articaine with Epi (blue color): (Body weight x 7 mg/kg) / 72 mg/cartridge

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Description

This quiz covers the essential aspects of Articaine, a potent local anesthetic with unique properties. Learn about its metabolism, dosage, effects, and clinical considerations. Ideal for dental professionals seeking to deepen their understanding of this hybrid anesthetic.