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INTRODUCTION

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HIGH ALERT

anesthetics (topical/mucosal) benzocaine (ben-zoe-kane)

Americaine, Americaine Anesthetic Lubricant, Americaine Hemorrhoidal, Image not available.Baby Orajel, Canker Pain Relief, Children's Chloraseptic Lozenges, Image not available.Dentocaine, Dent-Zel-Ite, DermaFlex, Endocaine, Hurricaine, Lagol, Lanacane, Orajel Mouth-Aid, Orabase Gel, Medicone, Maximum Strength Anbesol, Mycinettes, Numzident, Num-Zit Lotion, Image not available.Orajel Liquid, Shield Burnasept Spray, Spec-T Sore Throat Anesthetic

dibucaine (dye-byoo-kane)

Nupercainal

dyclonine (dye-klon-een)

Sucrets Children's Sore Throat, Dyclone, Sucrets Maximum Strength, Vapor Lemon Sucrets

pramoxine (pra-mox-een)

Fleet Relief, ProctoFoam NS, Tronolane, Tronothane

tetracaine (tet-ra-kane)

Pontocaine, Viractin

Classification

Therapeutic: anesthetics (topical/local)

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Indications
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Topical: Relief of pruritus or pain associated with minor skin disorders, including burns, abrasions, bruises, insect stings/bites, dermatitis, hemorrhoids, or other forms of skin irritation. Mucosal: Provide local anesthesia to mucosal surfaces before instrumentation, minor procedures, or endoscopy. Decrease irritation caused by minor mouth and throat conditions, including sore throat, gingivitis, stomatitis, or teething. Also used to suppress the gag reflex during endoscopy or intubation.

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Action
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Inhibit initiation and conduction of sensory nerve impulses. Therapeutic Effects: Local anesthesia with subsequent loss of sensation or relief of pain and/or pruritus.

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Adverse Reactions/Side Effects
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EENT: mucosal use: decreased or absent gag reflex. Derm: topical use: burning, edema, irritation, stinging, tenderness, urticaria. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, bronchospasm, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • When applied topically, assess the site of application and monitor any skin reactions such as tenderness, irritation, burning, swelling, or itching. Report severe or prolonged skin reactions to the physician.

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Patient/Client-Related Instruction
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  • Instruct patient and family/caregivers to use the product as directed, and avoid excessive or unnecessary use.

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Pharmacokinetics
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Absorption: Benzocaine is poorly absorbed through intact skin. Other agents may be readily absorbed. Degree of absorption increases with surface area; presence of lesions, cuts, or abrasions; and amount of agent applied.

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Distribution: Unknown.

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Metabolism and Excretion: Ester-type agents (para-aminobenzoic acid [PABA] derivatives, benzocaine, tetracaine) are metabolized by plasma and liver cholinesterases. Small amounts of amide-type agents (dibucaine) that may be absorbed are mostly metabolized by the liver.

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Half-life: Unknown.

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TIME/ACTION PROFILE (mucosal anesthetic effects)

ROUTE ONSET PEAK DURATION
Benzocaine about 1 min unknown 15–20 min
Dibucaine within 15 min unknown 2–4 hr
Dyclonine up to 10 min unknown 60 min
Pramoxine 3–5 min unknown unknown
Tetracaine 3–10 min unknown 30–60 min

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity. Cross-sensitivity may occur among related agents (amide types— dibucaine; ester ...

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