Exam 1

Question 1

Pain

Answer 1

An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage

Question 2

Components of Pain

Perception

Answer 2

Physical component, message of pain carried through the nerves to the cortex, transmitted as an impulse, can be affected by disease

Question 3

Components of Pain

Reaction

Answer 3

Psychologic component, patients emotional response, varies greatly

Question 4

Pain Threshold

Answer 4

Point of increasing perception of a stimulus at which pain begins to be felt by the individual, interpretation of the stimulus, varies greatly

Question 5

Decreased Pain Threshold

Answer 5

Greater reaction to pain. Anxiety, fatigue, youth, female gender, fear

Question 6

Increased Pain Threshold

Answer 6

Reduced reaction to pain. Sleep, sympathy, actitivies

Question 7

Fear and Anxiety

Answer 7

Fear= an emotion induced by perceived danger or threat, physiological changes
Anxiety= your body’s natural response to stress, feeling of fear about what’s to come
BOTH LOWER THE PAIN THRESHOLD

Question 8

LA Pharmacologic Effects

Answer 8

Peripheral nerve blocker, road block for the nerve transmission, prevents brain from interpreting the impulse as pain

Question 9

Membrane Expansion Theory

Answer 9

LA molecules diffuse to hydrophobic regions of membranes, preventing an increase in permeability to sodium ions, decreased diameter of sodium channels

Question 10

Specific Receptor Theory

Answer 10

Most favored theory, LA act by binding to specific receptors on the sodium channel, action of the drug is direct, LA gains access to the receptors and permeability to sodium ions is decreased

Question 11

Vasoactivity of LA

Answer 11

All anesthetic produce some level of vasodilation. Ester drugs are potent vasodilators, procaine most powerful vasodilator, cocaine vasoconstriction

Question 12

Vasodilation

Answer 12

An increase in the rate of absorption of the LA into the blood, dresses duration and quality of pain control, increases the anesthetic blood concentration

Question 13

Greatest Percentages of LA Areas in Body

Answer 13

Skeletal muscles

Question 14

Blood level of LA Influenced by (3)

Answer 14

1. Rate of absorption
2. Rate of distribution of drug from vascular compartment to tissues. More quickly in healthy patients
3. Elimination of drug through metabolic or excretory pathways

Question 15

Metabolism of LA

Answer 15

A balance between its rate of absorption into the bloodstream and its rate of removal from the blood through tissue uptake and metabolism

Question 16

Absolute Contraindication

Answer 16

Under no circumstance should the drug be administered as the possibility of potentially toxic or lethal reactions is increased

Question 17

Relative Contraindication

Answer 17

Drug may be administered after weighing the risk associated with the use of the drug, smallest clinically effective dose is used

Question 18

Metabolism of Ester Drugs

Answer 18

Hydrolyzed in the plasma by the enzyme pseudocholinesterase, procaine undergoes hydrolysis to PABA (metabolic product), allergic reactions are related to PABA not the drug itself

Question 19

Atypical Pseudocholinesterase

Answer 19

Hereditary trait 1 in every 2,800 people, inability to hydrolyze an ester, increases toxicity potential

Question 20

Relative Contradiction of Ester Drugs

Answer 20

Atypical pseudocholinesterase and PABA allergy

Question 21

Metabolism of Amide Drugs

Answer 21

Biotransformation occurs in the liver, lidocaine, mepivacaine, etidocaine, and bupivacaine.

Question 22

Amide Drug Prilocaine

Answer 22

Primary metabolism in the liver, some in the lung

Question 23

Amide Drug Articaine

Answer 23

Contains both ester and amide components, metabolism in both the blood (primarily) and the liver

Question 24

Increased Risk of Toxicity Amide Drugs

Answer 24

Patients with lower than normal hepatic blood flow and poor lover function. Unable to biotransform amide drug at a normal rate

Question 25

Methemoglobinemia

Answer 25

Condition in which a cyanosis like state develops in the absence of cardiac abnormalities, blood levels become elevated with it

Question 26

Relative Contraindication of Amide Drugs

Answer 26

Liver dysfunction ASA 4 or 5, heart failure ASA 4 or 5, methemoglobinemia (prilocaine)

Question 27

Blood Level of the LA depends on (4)

Answer 27

Rate of uptake, rate of distribution, rate of biotransformation (in liver), processes to remove drug from blood

Question 28

Anti-convulsive Level

Answer 28

0.5-4

Question 29

Pre-seizure Signs and Symptoms

Answer 29

4.5-7
Signs: talkative, sweating, vomiting, elevated heart rate
Symptoms: dizziness, metallic taste, warm, sensation of twitching

Question 30

Tonic-clonic Seizure

Answer 30

> 7.5

Signs: generalized CNS depression, depressed blood pressure, heart rate and respiratory rate