quiz 4

what is a normal BP?

<120/<80

what is an elevated BP?

120-129/<80

what is stage 1 hypertension?

130-139 or 80-89

what is stage 2 hypertension?

140+ or ≥ 90

what BP is treatment refused for?

180/110

what BP is considered a hypertensive crisis?

>180/>120

what is the epi dose for a healthy patient?

0.2mg

what is the epi dose for a cardiac/restricted patient?

0.04

what is the epi dose approximately equal to?

2 cartridges of 1:100,000 epi

what are absolute LA contraindications?

allergies to the anesthetic

what are relative LA contraindications?

1. liver disease

2. kidney disease

3. beta blockers

4. tagamet (cimetidine)

5. CNS depressants

6. hepatitis

what should be done for liver disease as a LA contraindication?

reduce amide dose

what is the best drug for liver disease?

articaine

what is malignant hyperthermia?

1. genetic disorder

2. relative contraindication to amides

what are signs of methemoglobinemia?

1. cyanosis

2. chocolate blood

3. respiratory distress

what should NOT be used for methemoglobinemia?

1. prilocaine

2. benzocaine

what is atypical plasma cholinesterase?

cannot metabolize esters

what can be used for atypical plasma cholinesterase?

amides

what cannot be used in atypical plasma cholinesterase?

esters

what are absolute vasoconstrictors contraindications?

1. recent MI (<6 months)

2. daily angina

3. uncontrolled hypertension

4. uncontrolled diabetes

5. sulfite allergy

6. cocaine/meth use within 24 hours

what are relative vasoconstrictors contraindications?

1. controlled hypertension

2. stable angina

3. controlled diabetes

4. controlled hyperthyroidism

5. glaucoma

6. beta blockers

what are rules for usage of vasoconstrictor relative contraindications?

1. lowest effective dose

2. cardiac dose

3. aspirate

4. slow injection

what is considered the gold standard?

lidocaine

what pregnancy group is lidocaine?

group b

what organ is involved with lidocaine?

liver (metabolism)

what pregnancy group is mepivacaine?

c

what are advantages of mepivacaine?

1. least vasodilation

2. good when epi contraindicated

what is the least toxic LA agent?

prilocaine

what are advantages of prilocaine?

1. good without epi

2. livers and lungs metabolism

what organs are involved with prilocaine?

liver and lungs

what should be avoided on prilocaine?

1. methemoglobinemia

2. anemia

3. tylenol use

what pregnancy group is prilocaine?

category b

what is prilocaine associated with?

lingual nerve paresthesia (4%)

what LA agent is best for diffusion?

articaine

what are advantages of articaine?

1. bone penetration

2. plasma metabolism

3. best for liver and kidney disease

what pregnancy category is articaine?

category c

who should articaine be avoided for?

children under 4

what is articaine associated with

paraesthesia

what is the longest acting LA agent?

bupivacaine

what is bupivacaine used for?

1. endo

2. implants

3. long procedures

4. post op pain

what pregnancy group is bupivacaine?

category c

what is the most toxic LA agent?

bupivacaine

which LA agent has the slowest onset?

bupivacaine

who should avoid bupivacaine?

children under 12

which LA agent last for a short amount of time?

mepivacaine

what should MRD never exceed?

manufacturer’s absolute maximum dose

how to find limiting factor?

1. calculate LA and vasoconstrictor MRD

2. whichever is smaller is the limiting factor