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FINAL EXAM Flashcards

1
Q

What brand name was procaine sold under?

A

Novocaine

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1
Q

What was the first local anesthetic discovered and what was the main issue with this?

A

Cocaine - it was addictive

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2
Q

Why was procaine not an ideal local anesthetic and is is currently available in the United States?

A

Not ideal because it wore off quickly and many people had allergies to it

No - not available in the US

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3
Q

Which local anesthetic agent revolutionized pain control in dentistry?

A

Lidocaine

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4
Q

What is general supervision?

A

need dentist permission

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5
Q

What is indirect supervision?

A

need the dentist’s permission and presence

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6
Q

What is direct supervision?

A

need the dentist’s permission, presence, and evaluation of the task

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7
Q

What level of supervision do dental hygienists fall under in the state of Minnesota?

A

General

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8
Q

In general, what is the difference in local anesthesia training in the United States?

A

there is not a specific rule or time frame one must practice to be certified

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9
Q

Define pain.

A

unpleasant sensory and emotional experience

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10
Q

Define a pain reaction threshold.

A

when pain is not tolerated and a reaction may occur

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11
Q

What influences pain reaction threshold an dhow do these affect pain reaction threshold?

A
  • age
  • emotional state
  • stress
  • culture
  • fear/apprehension
  • fatigue

they all higher the likelihood of the pain reaction threshold to occur

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12
Q

T/F: a large percentage of people have dental phobia

A

true

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13
Q

What are signs of dental anxiety?

A
  • cold
  • sweaty palms
  • high BP
  • nervous conversation
  • muscle tightness
  • quick responses
  • restlessness
  • previous canceled appointment
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14
Q

Identify stress reduction protocol.

A
  • build rapport
  • N2O
  • morning appointments
  • short wait times
  • sedation
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15
Q

What is an axon?

A

a single nerve fiber

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16
Q

Where are mantle bundles located?

A

bundles toward the outside

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17
Q

Where are core bundles located?

A

bundles toward the inside

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18
Q

What is the nerve membrane composed of?

A

a lipid layer

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19
Q

At rest, the fluid outside the nerve has what charge?

A

+

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20
Q

At rest, the fluid inside the nerve has what charge?

A

-

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21
Q

At rest, there are more ___ ions on the outside of the nerve.

A

Na+

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22
Q

At rest, there are more ___ ions on the inside of the nerve.

A

K+

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23
Q

After returning to a resting state, ___ ions are transported out of the nerve trough.

A

K+

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24
_______________ ___________________ refers to the nerve conduction of myelinated nerves.
Saltatory conduction
25
T/F: unmyelinated nerve conduction is slower than myelinated nerve conduction
true
26
T/F: the Node of Ranvier is covered with myelin
true
27
What are the two major groups of local anesthetics?
esters and amides
28
In which major group of local anesthetics is allergy more likely to occur?
esters
29
T/F: all local anesthetics available today are esters
false - amides
30
Local anesthetics are dispensed as __________. WHY?
salts; water-soluble and more stable
31
What are the two forms of local anesthetic molecules? Describe them.
- charged form (cation) = RNH+ - water soluble - uncharged form (base) = RN - lipid soluble
32
Which local anesthetic form block sodium channels?
topical, charged
33
Which local anesthetic form enters the lipid membrane of the nerve?
injectable, uncharged
34
All local anesthetic solutions are _______________.
acidic
35
the more acidic the solution = more _______________ molecules the less acidic the solution = _________________ molecules
charged, uncharged
36
The normal pH of the body tissue is 7.4. Is the pH of infected tissue more or less acidic?
more acidic
37
How does the pH of local anesthetics affect the proportion of charged and uncharged local anesthetic molecules?
38
What is the most widely accepted theory for how local anesthetics work?
specific protein receptor theory
39
Local anesthetic molecules bind to receptors in the _________ _____________.
40
Smaller diameter nerve trucks get numb __________ than larger ones.
faster
41
Mantle bundles numb more ____________ areas.
proximal (remember MN vs CA)
42
Core bundles numb more ______________ areas.
distal (remember CA vs MN)
43
You may need to _____________ local anesthetic if the duration of the procedure is longer than the duration of anesthesia.
reinject
44
Ideal to reinject before ______________ have fully recovered.
mantle bundles
45
If mantle and core bundles have fully recovered, reinjection may not be ___________.
effective
46
What is tachyphylaxis?
increased tolerance to a drug that is administered repeatedly
47
Vasoconstrictors decrease vascularity by constricting __________ ____________.
blood vessels
48
Vasoconstrictors ____________ absorption outside of the nerve
reduces
49
Vasoconstrictors ____________ systemic toxicity of anesthesia.
reduces
50
Vasoconstrictors ____________ duration of anesthesia/
increases
51
Esters are metabolized in the ____________.
plasma
52
Amides are excreted in the ____________.
kidneys
53
Children and older adults are more susceptible adverse reaction related to total dose children older adult
54
Which system is most sensitive to high blood levels of local anesthetics?
central nervous system
55
CNS effects from local anesthetics are ____________.
rare - low levels of local anesthetic show no clinically significant effects noted
56
Local anesthetic overdose manifests as CNS ____________.
depression
57
At low blood levels, local anesthetics produce no ____________ ____________ on the CNS.
58
What are benefits of vasoconstrictors?
- decreased blood flow to site of administration - less anesthetic need to produce profound anesthesia - increased duration of action - decreased absorption of local anesthetics to other systems - decreased bleeding at site of administration
59
Discuss the impact of stress on levels of epinephrine.
stress releases epinephrine in the body that can exceed levels when local anesthetic with vasoconstrictor is used
60
What is an absolute contraindication?
under NO circumstance should the patient receive anesthetic
61
What is a relative contraindication?
the patient can receive anesthetic but the dose should be modified
62
When should a vasoconstrictor be used?
- length of dental procedure - medical status of patient - need for hemostasis - consider rebound vasodilation effect
63
Epinephrine dilutions are referred to as ____________.
64
Identify the concentration of epinephrine with the least amount of epinephrine 1:50,000 1:100,000 1:200,000
1:200,000
65
What determines selection of a vasoconstrictor?
- length of the procedure - medical status of the patient - need for homeostasis
66
Why is sodium bisulfite added to local anesthetics that contains epinephrine?
prevents oxidation (made more acidic) of epinephrine and synthetic epinephrine is not stable
67
What effect does epinephrine have on blood pressure?
increases blood pressure
68
What effect does epinephrine have on the respiratory system?
a bronchial dilator - makes breathing easier by relaxing the muscles in the lungs and widening the airway
69
What effect does epinephrine have on CVS?
stimulates the CVS by increasing HR, CO, and SV
70
What effect does epinephrine have on the respiratory system?
bronchial dilator - makes breathing easier by relaxing the muscles in the lungs and widening the airway
71
What effect does epinephrine have on the CNS?
stimulates at excessive doses
72
T/F: Concentrations of anesthetic is higher in topical anesthetics than in local anesthetics
true
73
2. Topical anesthetics penetrate _________ mm of the mucosal surface.
2-3 mm
74
Which is the most frequently used topical anesthetic?
Benzocaine
75
T/F: Topical benzocaine has a high risk of systemic overdose.
False
76
Why will you typically see topical tetracaine mixed with other topical anesthetics?
77
T/F: Topical tetracaine is an intermediate duration agent.
True
78
Cetacaine is a mixture of: a. Esters b. Amides c. None of the above d. Both of the above
A. esters
79
Identify absolute contraindications for epinephrine.
- sulfite allergy - uncontrolled angina - BP 195/100 - heart attack less than 6 months ago - sulfa allergy - cocaine/meth use
80
Identify medication classes that have a relative contraindications for epinephrine.

LOCAL ANATOMY (3 decks)

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