10- Future Trends, Consultations, Rx writing
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Questions and Answers

What is the composition of Eutectic Mixture of Local Anesthetics (EMLA)?

  • 7% cream containing 35 mg/g lidocaine and 35 mg/g prilocaine
  • 2% cream containing 10 mg/g lidocaine and 10 mg/g prilocaine
  • 5% cream containing 25 mg/g lidocaine and 25 mg/g prilocaine (correct)
  • 10% cream containing 50 mg/g lidocaine and 50 mg/g prilocaine

    • When should EMLA be applied to the skin?

  • 2 hours prior to the anticipated procedure
  • Just before the anticipated procedure
  • 1 hour prior to the anticipated procedure (correct)
  • 30 minutes after the anticipated procedure

    • In which patients is EMLA contraindicated?

  • Patients over 1 year of age
  • Patients over 6 months of age
  • Patients under 6 months of age (correct)
  • Patients of any age

    • What is the purpose of Onpharma?

    <p>To provide rapid onset of analgesia and less injection pain</p> Signup and view all the answers

    When is Onpharma added to Lidocaine with Epinephrine?

    <p>Immediately prior to administration</p> Signup and view all the answers

    Who is not recommended to use OraVerse (phentolamine mesylate)?

    <p>Children less than 3 years of age or weighing less than 15 Kg</p> Signup and view all the answers

    What is the maximum dose of 0.5% ropivacaine for nerve blocks and infiltration?

    <p>200 mg, or about 3 mg/kg</p> Signup and view all the answers

    Which enzyme subcategory is responsible for the metabolism of ropivacaine?

    <p>Cytochrome oxidase liver enzymes subcategory 1A2</p> Signup and view all the answers

    What is a potential advantage of ropivacaine over bupivacaine for dental procedures?

    <p>Lower cardiovascular toxicity</p> Signup and view all the answers

    What is the limiting factor for the introduction of ropivacaine as a popular choice for routine dental local anesthesia administration?

    <p>Not available in dental cartridges</p> Signup and view all the answers

    What is the maximum dose of EXPAREL for single dose administration?

    <p>266 mg</p> Signup and view all the answers

    At what age can EXPAREL be used to produce postsurgical anesthesia?

    <p>6 years</p> Signup and view all the answers

    What is the maximum recommended dose of EXPAREL based on patient's weight?

    <p>4mg/kg</p> Signup and view all the answers

    What gauge needle is recommended for injecting EXPAREL into soft tissue sites?

    <p>25 gauge needle</p> Signup and view all the answers

    What is the recommended waiting time after administrating other non-bupivacaine based local anesthetics before administering EXPAREL into the same site?

    <p>20 minutes</p> Signup and view all the answers

    What are the most common adverse reactions associated with EXPAREL administration?

    <p>Nausea, constipation, and vomiting</p> Signup and view all the answers

    How should EXPAREL be dosed for a patient undergoing extraction of 4 impacted third molars?

    <p>2-4 ml for maxillary and 6-8 ml for mandibula</p> Signup and view all the answers

    What is the purpose of Kovanaze?

    <p>To provide pulpal anesthesia from 1st premolar to 1st premolar</p> Signup and view all the answers

    What is the composition of Kovanaze?

    <p>Tetracaine and Oxymetazoline</p> Signup and view all the answers

    What did patients undergoing ENT procedures note when using Tetracaine?

    <p>Their upper teeth felt 'numb'</p> Signup and view all the answers

    What is the purpose of evaluating the latest PT/INR for a patient on Coumadin?

    <p>To evaluate the extrinsic pathway and common pathway of coagulation</p> Signup and view all the answers

    What is the significance of an international normalization ratio (INR) <3.0 while a patient is on Coumadin?

    <p>It is usually safe to extract 1 to 2 teeth</p> Signup and view all the answers

    What is the primary concern with a patient with liver problems before the dental extraction procedure?

    <p>a and b</p> Signup and view all the answers

    What potential issue might arise with the metabolism of medications in a patient with an unspecified 'liver problem'?

    <p>Altered drug effectiveness due to liver metabolism</p> Signup and view all the answers

    What information should be included under 'Disp' when writing a prescription for medication?

    <p>Number of tablets, capsules, to be dispensed</p> Signup and view all the answers

    What does 'Sig' refer to in prescription writing?

    <p>Direction on how the drug is to be taken</p> Signup and view all the answers

    What information is required to be included in a prescription?

    <p>a and c</p> Signup and view all the answers

    What does 'hs' stand for in prescription writing?

    <p>At bedtime</p> Signup and view all the answers

    What does 'prn' indicate in medical terminology?

    <p>As needed</p> Signup and view all the answers

    What does 'bid' signify in the context of medication instructions?

    <p>Twice a day</p> Signup and view all the answers

    Which medication is recommended for mild post-operative dental pain?

    <p>Aspirin and ibuprofen</p> Signup and view all the answers

    For which type of procedures may the use of an opioid be required for post-operative pain relief?

    <p>Surgical procedures</p> Signup and view all the answers

    What information is important to consider when writing a prescription for post-operative pain relief?

    <p>Duration of pain relief needed</p> Signup and view all the answers

    What is the maximum daily dose of Motrin recommended in a 24 hour period?

    <p>3.2 grams</p> Signup and view all the answers

    Which adverse reaction is associated with Motrin usage in the cardiovascular system?

    <p>Fluid retention</p> Signup and view all the answers

    What is a potential drug interaction with Motrin that could increase the risk of adverse gastrointestinal reactions?

    <p>Aspirin</p> Signup and view all the answers

    What is the recommended APAP dosage for adults?

    <p>325 to 650 mg P.O. every 4 to 6 hours</p> Signup and view all the answers

    How does acetaminophen (APAP) relieve fever?

    <p>By central action in the hypothalamic heat regulating center</p> Signup and view all the answers

    What is the mechanism of action of acetaminophen (APAP) as an analgesic?

    <p>Inhibiting prostaglandin synthesis in the CNS</p> Signup and view all the answers

    What is the reported daily dose of acetaminophen (APAP) that may induce hepatic toxicity if exceeded?

    <p>4000 mg</p> Signup and view all the answers

    What is not the comparative oral dosing equivalent of 5mg of oxycodone?

    <p>15 mg hydrocodone</p> Signup and view all the answers

    What is the purpose of including a nonopioid as a component of the formulation in orally administrated analgesics?

    <p>To provide added analgesia</p> Signup and view all the answers

    Which of the following medications contains acetaminophen and Oxycodone?

    <p>Percocet</p> Signup and view all the answers

    What is the active ingredient in Tylenol #3?

    <p>Codeine</p> Signup and view all the answers

    Which medication combines Tylenol (acetaminophen) with Hydrocodone?

    <p>Norco</p> Signup and view all the answers

    How does amoxicillin act against bacteria?

    <p>It inhibits cell-wall synthesis during bacterial multiplication</p> Signup and view all the answers

    How do bacteria resist amoxicillin?

    <p>By producing penicillinases</p> Signup and view all the answers

    What is the recommended adult dosage of amoxicillin?

    <p>250 – 500mg P.O. every 8 hours</p> Signup and view all the answers

    Study Notes

    Eutectic Mixture of Local Anesthetics (EMLA)

    • Composed of lidocaine and prilocaine in a 1:1 ratio.
    • Should be applied 1 to 2 hours prior to procedures requiring local anesthesia.
    • Contraindicated in patients with methemoglobinemia or hypersensitivity to local anesthetics.

    Onpharma Usage

    • Added to lidocaine with epinephrine to facilitate faster onset and extended duration of anesthesia.

    OraVerse (phentolamine mesylate)

    • Not recommended for use in patients with a history of hypersensitivity to phentolamine.

    Ropivacaine Administration

    • Maximum dose for nerve blocks and infiltration is 3 mg/kg.
    • Metabolized by CYP1A2 subcategory of enzymes.

    Ropivacaine Advantages

    • Offers a lower risk of cardiotoxicity compared to bupivacaine, making it a potential advantage for dental procedures.
    • Its cost and availability are limiting factors for its routine use in dental anesthesia.

    EXPAREL Information

    • Maximum dose for single administration is 266 mg.
    • Can be used for postsurgical anesthesia in patients aged 6 years and older.
    • Recommended dose is 3 mg/kg based on patient's weight.
    • 21-gauge needle is recommended for injection into soft tissue.
    • Recommended waiting time before administering EXPAREL after other non-bupivacaine anesthetics is 20 minutes.
    • Common adverse reactions include pain at the injection site, nausea, and constipation.
    • For extraction of 4 impacted third molars, dosage is typically 20 mL (267 mg).

    Kovanaze and Tetracaine

    • Kovanaze is used for nasal anesthesia in dental procedures.
    • Composition includes tetracaine and oxymetazoline.
    • Patients undergoing ENT procedures reported effective pain relief with tetracaine.

    Coumadin (Warfarin) Monitoring

    • Evaluating PT/INR is essential for assessing bleeding risk before procedures.
    • An INR <3.0 signifies an acceptable risk for dental procedures while on Coumadin.

    Liver Problems Concerns

    • Patients with liver issues may have altered drug metabolism, increasing the risk of anesthesia-related complications.

    Prescription Writing Guidelines

    • 'Disp' section requires the quantity of medication to be dispensed.
    • 'Sig' indicates the directions for medication use.
    • Essential information in a prescription includes patient name, date, medication name, dosage form, strength, quantity, directions, and provider information.
    • 'hs' refers to taking medication at bedtime.
    • 'prn' indicates medication should be taken as needed.
    • 'bid' signifies the medication should be taken twice daily.

    Post-Operative Pain Management

    • Mild post-operative dental pain can be managed with ibuprofen (Motrin).
    • Opioids may be required for severe pain relief following major surgeries.
    • Important information for prescriptions includes potential interactions and patient history.

    Motrin Safety

    • Maximum daily dose of Motrin is 3200 mg within 24 hours.
    • Associated cardiovascular adverse reaction includes increased risk of heart attack or stroke.
    • Potential interaction with anticoagulants raises the risk of gastrointestinal bleeding.

    Acetaminophen (APAP)

    • Recommended adult dosage of APAP is 650-1000 mg every 4-6 hours, max 3000 mg/day.
    • Relieves fever through action on the hypothalamic heat-regulating center.
    • Mechanism as an analgesic involves inhibiting prostaglandin synthesis in the CNS.
    • Exceeding 4000 mg/day may cause hepatic toxicity.

    Oxycodone and Combination Medications

    • 5 mg of oxycodone is not equivalent to 5-10 mg of hydromorphone.
    • Non-opioid components in analgesic formulations enhance pain relief and reduce opioid dosage requirements.
    • Combination medications with acetaminophen and oxycodone include Percocet.
    • Tylenol #3 contains acetaminophen and codeine.
    • Hydrocodone combination medication includes Vicodin or Norco.

    Amoxicillin and Bacterial Resistance

    • Amoxicillin acts by inhibiting bacterial cell wall synthesis.
    • Bacteria may resist it through the production of beta-lactamase enzymes.
    • Recommended adult dosage for amoxicillin is 500 mg every 8 hours or 875 mg every 12 hours.

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    Description

    Test your knowledge about Eutectic Mixture of Local Anesthetics (EMLA) with this quiz. Explore the application, components, and contraindications of EMLA, a topical anesthetic cream commonly used in medical procedures. Ideal for healthcare professionals and students seeking to enhance their understanding of pediatric anesthesia and pain management.

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