Chapter 6 - Topical Anesthetic Agents

. To achieve the optimal anesthetic effect, topical anesthesia should remain at the site of application for _______.

1-2 min

tetracaine hydrochloride - 1.classification 2. concentrations 3. onset of action 4. duration 5. considerations 6. MRD

1. ester 2. 2% 3. slow- peaks at 20 min 4. 45 min 5. plasma metabolized and in kidneys,lactation, lipid soluble, rapidly absorbed in local tissues 6. 20mg; 1mL 2% solution

benzocaine- 1.classification 2. concentrations 3. onset of action 4. duration 5. considerations 6. MRD

1. ester 2. most common is 20% but varies 6-20 3. rapid- 30 sec- peak is 2 min 4. 5-15 min 5.methemoglobinemia, mostly kidney excretion, no kids younger than 2, breast milk 6. none

dyclonine hydrochloride- 1.classification 2. concentrations 3. onset of action 4. duration 5. considerations 6. MRD

1. ketone 2. .5 or 1 % 3. slow- up to 10 min 4. 30 min .. even an hour 5. recommended dose during lactation 6. 200mg

lidocaine- 1.classification 2. concentrations 3. onset of action 4. duration 5. considerations 6. MRD

1. lidocaine 2. 2% or 5% 3. 2-10 min 4. 15-45 min 5. liver and kidneys, breast milk, follow manufacturer directions 6. 200 mg

topical penetrates how far

2-3mm

EMLA: composition? classification? onset action? duration? MRD? excretion?

2.5 lidicaine and 2.5 prilocaine amides 1 hour none for intraoral use not intraoral liver only for intact skin

oraqix: contains? classified as? concentration? onset? duration? mrd? metabolism? considerations?

2.5 lidocaine and 2.5 prilocaine amides 30 sec 20 min 5 cartridges during 1 tx liver do not inject

. A patient who has just been administered Oraqix gel (2.5% lidocaine and 2.5% prilocaine) can expect a comfortable duration of anesthesia of approximately _______.

20 min

Oraqix gel (2.5% lidocaine and 2.5% prilocaine) produces an anesthetic effect within ____________.

30 sec

Drying the mucosa with 2 × 2 gauze, prior to the application of topical anesthesia, assists in _______.

accurate placement of the topical anesthetic and increasing visibility

which topical can cause methemoglobinemia

bencozaine

Which topical anesthetic has the most rapid onset of action?

benzocaine

what topical doesnt always require prescription

benzocaine

cetacaine - contains what?onset? duration? MRD? excretion? classified as

benzocaine, Butamben, Tetracaine very rapid, lipid soluble- 30 sec 30-60 min spray 1 sec 200mg gel or liquid cholinesterase hydrolysis esters

. A toxic overdose of topical anesthetic may result in which of the following?

bradycardia- slow heart beat

localized adverse reactions of topicals are

burning stinging, sloughing, discoloration, irritation, temporary change in taste

concentrations OTC

can be as high as those in office

if plasma concentration are too high, what systems will be affected?

cardio and CNS

combinations used

cetacaine, EMLA, Oraqix

methods of delivery

cotton top applicator, spray, brushes, patches, blunted cannulas, single dose swabs

MRD for topicals

difficult to monitor, patches are a good way to monitor, doesnt exist for all topicals

which is a ketone?

dyclonine hydrochloride

common forms of topical

gel, ointment, spray, cream, liquid, lozenge

considerations for topicals- symptoms OD, whos at risk??

higher risk of toxicity children elderly and medically compromised. pale gray or blue skin, fatigue, shortness of breath, headache and lightheadedness( metho) people with breathing problems also at risk

what isnt benzocaine available as?

injectable

EMLA used for what

intact skin

which topical has US food and drug admin pregnancy category B?

lidocaine/prilocaine

what delivery method decreases metho risk?

metered spray with disposable nozzle

eutectic mixture is

mixture of 2 elements that together have a lower melting temperature than any individually

topical properties

no damage to tissue, acceptable taste, no systemic toxicity, remains at site

properties of topicals

no vasoconstr- ctor and more potent than injectable, block nerve conductions on the surface- decreased permeability of sodium ions to nerve cell- decrease depolarization- blocks nerve impulse

Which of the following is a eutectic mixture that will thicken into a gel once inserted into a periodontal pocket, relieving pain associated with nonsurgical periodontal therapy?

oraqix

benefits of single doses

prevents cross contam, less mess, doses monitored

purpose topicals

provide pain control conventional local anesthetic injections, needle insertion

Allergic reactions to topical anesthetic are _______.

rare

The FDA has released a Public Health Advisory alerting consumers to the potential

risk of life-threatening or fatal reactions to over-the-counter topical anesthetics

toxic OD of topical

seizures, unconsciousness, respiratory arrest, hypotension, cardiac arrest

Topical anesthetics are available in a variety of forms. Which method of delivery is most likely to produce a toxic reaction?

spray

Mild allergic reactions to topical anesthetic can include _______, _______, and _______.

swelling, raised welts, itching

Which topical anesthetic has the longest average duration?

tetracaine hydrochloride

most potent topical

tetracaine hydrochloride