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LOCAL ANATOMY > FINAL EXAM > Flashcards

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
Q

_______________ ___________________ refers to the nerve conduction of myelinated nerves.

A

Saltatory conduction

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25
Q

T/F: unmyelinated nerve conduction is slower than myelinated nerve conduction

A

true

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26
Q

T/F: the Node of Ranvier is covered with myelin

A

true

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27
Q

What are the two major groups of local anesthetics?

A

esters and amides

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28
Q

In which major group of local anesthetics is allergy more likely to occur?

A

esters

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29
Q

T/F: all local anesthetics available today are esters

A

false - amides

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30
Q

Local anesthetics are dispensed as __________. WHY?

A

salts; water-soluble and more stable

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31
Q

What are the two forms of local anesthetic molecules? Describe them.

A
  • charged form (cation) = RNH+ - water soluble
  • uncharged form (base) = RN - lipid soluble
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32
Q

Which local anesthetic form block sodium channels?

A

topical, charged

33
Q

Which local anesthetic form enters the lipid membrane of the nerve?

A

injectable, uncharged

34
Q

All local anesthetic solutions are _______________.

A

acidic

35
Q

the more acidic the solution = more _______________ molecules
the less acidic the solution = _________________ molecules

A

charged, uncharged

36
Q

The normal pH of the body tissue is 7.4. Is the pH of infected tissue more or less acidic?

A

more acidic

37
Q

How does the pH of local anesthetics affect the proportion of charged and uncharged local anesthetic molecules?

A
38
Q

What is the most widely accepted theory for how local anesthetics work?

A

specific protein receptor theory

39
Q

Local anesthetic molecules bind to receptors in the _________ _____________.

A
40
Q

Smaller diameter nerve trucks get numb __________ than larger ones.

A

faster

41
Q

Mantle bundles numb more ____________ areas.

A

proximal (remember MN vs CA)

42
Q

Core bundles numb more ______________ areas.

A

distal (remember CA vs MN)

43
Q

You may need to _____________ local anesthetic if the duration of the procedure is longer than the duration of anesthesia.

A

reinject

44
Q

Ideal to reinject before ______________ have fully recovered.

A

mantle bundles

45
Q

If mantle and core bundles have fully recovered, reinjection may not be ___________.

A

effective

46
Q

What is tachyphylaxis?

A

increased tolerance to a drug that is administered repeatedly

47
Q

Vasoconstrictors decrease vascularity by constricting __________ ____________.

A

blood vessels

48
Q

Vasoconstrictors ____________ absorption outside of the nerve

A

reduces

49
Q

Vasoconstrictors ____________ systemic toxicity of anesthesia.

A

reduces

50
Q

Vasoconstrictors ____________ duration of anesthesia/

A

increases

51
Q

Esters are metabolized in the ____________.

A

plasma

52
Q

Amides are excreted in the ____________.

A

kidneys

53
Q

Children and older adults are more susceptible adverse reaction related to total dose

children
older adult

A
54
Q

Which system is most sensitive to high blood levels of local anesthetics?

A

central nervous system

55
Q

CNS effects from local anesthetics are ____________.

A

rare - low levels of local anesthetic show no clinically significant effects noted

56
Q

Local anesthetic overdose manifests as CNS ____________.

A

depression

57
Q

At low blood levels, local anesthetics produce no ____________ ____________ on the CNS.

A
58
Q

What are benefits of vasoconstrictors?

A
  • 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
Q

Discuss the impact of stress on levels of epinephrine.

A

stress releases epinephrine in the body that can exceed levels when local anesthetic with vasoconstrictor is used

60
Q

What is an absolute contraindication?

A

under NO circumstance should the patient receive anesthetic

61
Q

What is a relative contraindication?

A

the patient can receive anesthetic but the dose should be modified

62
Q

When should a vasoconstrictor be used?

A
  • length of dental procedure
  • medical status of patient
  • need for hemostasis
  • consider rebound vasodilation effect
63
Q

Epinephrine dilutions are referred to as ____________.

A
64
Q

Identify the concentration of epinephrine with the least amount of epinephrine

1:50,000
1:100,000
1:200,000

A

1:200,000

65
Q

What determines selection of a vasoconstrictor?

A
  • length of the procedure
  • medical status of the patient
  • need for homeostasis
66
Q

Why is sodium bisulfite added to local anesthetics that contains epinephrine?

A

prevents oxidation (made more acidic) of epinephrine and synthetic epinephrine is not stable

67
Q

What effect does epinephrine have on blood pressure?

A

increases blood pressure

68
Q

What effect does epinephrine have on the respiratory system?

A

a bronchial dilator - makes breathing easier by relaxing the muscles in the lungs and widening the airway

69
Q

What effect does epinephrine have on CVS?

A

stimulates the CVS by increasing HR, CO, and SV

70
Q

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

71
Q

What effect does epinephrine have on the CNS?

A

stimulates at excessive doses

72
Q

T/F: Concentrations of anesthetic is higher in topical anesthetics than in local anesthetics

A

true

73
Q
  1. Topical anesthetics penetrate _________ mm of the mucosal surface.
A

2-3 mm

74
Q

Which is the most frequently used topical anesthetic?

A

Benzocaine

75
Q

T/F: Topical benzocaine has a high risk of systemic overdose.

A

False

76
Q

Why will you typically see topical tetracaine mixed with other topical anesthetics?

A
77
Q

T/F: Topical tetracaine is an intermediate duration agent.

A

True

78
Q

Cetacaine is a mixture of:

a. Esters
b. Amides
c. None of the above
d. Both of the above

A

A. esters

79
Q

Identify absolute contraindications for epinephrine.

A
  • sulfite allergy
  • uncontrolled angina
  • BP 195/100
  • heart attack less than 6 months ago
  • sulfa allergy
  • cocaine/meth use
80
Q

Identify medication classes that have a relative contraindications for epinephrine.

A

LOCAL ANATOMY (3 decks)

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