Final Exam Flashcards
(170 cards)
1
Q
Brand name for lidocaine
A
Xylocaine
2
Q
Brand name for Mepivacaine
A
Carbocaine
3
Q
Brand name for prilocaine
A
Citnest
4
Q
Brand name for articaine
A
septocaine
5
Q
Brand name for bupivacaine
A
Marcaine
6
Q
What LA’s are good for hemostasis
A
Lidocaine
7
Q
What LA is NOT good for hemostasis
A
Mepivacaine
8
Q
What LA’s are an effective topical
A
lidocaine
Prilocaine (with lidocaine)
9
Q
Lidocaine and pregnancy
A
Category B
Lactation safe
10
Q
Mepivacaine and pregnancy
A
Category C
Lactation safe
11
Q
Prilocaine and pregnancy
A
Category B
Lactation safety unknown
12
Q
Articaine and pregnacy
A
Category C
Lactation safety unkownn
13
Q
Bupivacaine and pregnancy
A
Category C
Lactations safety unknown
14
Q
MRD lidocaine
A
500 mg
15
Q
MRD mepivacaine
A
400 mg
16
Q
MRD prilocaine
A
600 mg
17
Q
MRD articaine
A
None
18
Q
MRD Bupivacaine
A
90 mg
19
Q
Good choice of LA if a vasoconstrictor is contraindicated
A
Mepivacaine (weak vasodilator)
20
Q
No Epi in what LA
A
Mepivacaine
Prilocaine
21
Q
Least toxic LA
A
Prilocaine
22
Q
Risk for methemoglobinemia
A
Prilocaine
Benzocaine (topical)
23
Q
Highly soluble LA and high diffusion through bone
A
Articaine
24
Q
Good choice for re-administration, CV or liver disease
A
Articaine
25
Most potent/ toxic LA
Bupivacaine
26
Not available without Epi
Bupivacaine
27
In terms of diffusion of drug through the nerves, what will a greater lipid solubility do
Enhance diffusion
28
Great lipid solubility =
more potent = need less of the drug
29
High overdose of LAs causes CNS
depression
30
Moderate overdose of LAs, initial CV
stimulation
31
High overdose of LAs, CV
depression
32
2 vasoconstrictors
epinephrine
levonordefrin
33
Do vasoconstrictors increase or decrease duration of LA
increase
34
What provides hemostasis at injection site
vasoconstrictors
35
Vasoconstrictors lower absorption rate of LA which leads to less
risk of toxicity
36
More effect of α receptors
levonordefrin
37
Mostly affects beta receptors
epinephrine
38
MRD of epinephrine
0.2 mg (healthy)
0.04 (CV ds)
39
MRD of levonordefrin
1.0 mg (healthy)
0.2 mg (CV ds)
40
Absolute contraindication of LA
allergy
41
If taking a H2 blocker
lower dosage of lidocaine
42
If taking a CNS depressant
Lower all amides
42
If taking a beta blocker
lower all amides
43
If patient is pregnant
Use lidocaine or prilocaine
44
If the patient has liver disease use
articaine
45
Absolute contraindications for vasodilators (8)
MI/coronary bipass
uncontrolled hypertension
uncontrolled angina pectoris
uncontrolled arrhythmias
uncontrolled hyperthyroidism
sulfite allergy
glaucoma
cocaine / meth use
46
Cardiac protocol for vasoconstrictors
0.04 mg EPI / 0.2mg LEVO
47
Vasoconstrictor contraindications: cardiovascular disease patients
Use Cardiac protocol
48
Vasoconstrictor contraindications: tricyclic antidepressants
No Levo, use 0.04mg EPI
49
Vasoconstrictor contraindications: Nonselcetive beta blocker
cardiac protocol
50
Vasoconstrictor contraindications: Digitalis
Physician consult
51
New FDA law with carpules
Label as 1.7 ml if can not guarantee all carples have exactly 1.8 ml
52
2% solution, how many mg/carpule
2% = 20mg/ml X 1.8ml/carpule = 36 mg/carpule
53
What are the two buffering agents in a carpule
sodium chloride
sodium hydroxide
54
What is the vasoconstrictor in the carpule
EPI or Levonordefrin
55
Vasoconstrictor preservative that causes allergic reactions
Sodium bisulfate
56
Prior to 1984 LA solutions without EPI added what as a preservative
methylparaben (high allergic reactions)
57
LAs cause reversible local anesthesia by preventing what 2 things
generation and conduction of impulses
58
LAs provide a chemical
block
59
LAs are membrane
stabilizing drugs
60
LAs inhibit and bind what channel
Na+ channels
61
LAs are a __ dependent blockade
state (only binds what firing)
62
What nerves are more sensitive to LAs
Small diameter nerves
63
What nerves require more volume of LAs
Large diameter nerves
64
Topical delivery of LAS have higher what
concentration and toxicity
65
What type of delivery of LA is more effective
Submucosal (concentrations are lower because placed right on nerve)
66
2 groups of LAs
esters and amides
67
Which type of LA has more allergic reactions
esters
68
What type of LA is metabolized in the blood via pseudocholinesterase
Esters
69
All injectable dental LAs are
amides
70
LAs contain an aromatic ring that is inactive but __, an intermediate linkage that determines if the LA is __, and a hydrophilic terminal amine that __ in its __ form
penetrates membrane
ester / amide
binds to receptor sites
active
71
All LAs are vaso__
vasodilators
72
What occurs with a decrease in pKa of the LA
increase anions
increase base
rapid onset
73
What occurs with an increase in pKa of the LA
increase in cations
decrease in base
slower onset
74
Why is there inadequate anesthesia when an LA is given in a infection
Both the infections and the LA are acidic so less molecules cross the membrane
75
If the nerve is larger what do we have to change with the LA
increase the volume
76
An increase in lipid solubility of an LA increases what
potency
so you decrease the dose
enhances diffusion through the nerve
77
If there is an increase in protein binding, there is an increase in
duration
78
If a nerve fiber is fully recovered and you reinject the LA what occurs
tachyphylaxis (tolerance to LA) --> LA is ineffective
79
3 factors that increase duration of LA = potency
protein binding
vascularity of injection site ( if high less duration)
vasoconstrictor in LA
80
What are the 3 ester LAs as topicals
Benzocaine
Tetracaine
Procaine
81
Documentation of NO2 must include
Informed consent
% administered
length of time sedated
flow rate of gases
(indication for use and patient response/tolerance as well)
82
What provides ideal sedation
Nitrous oxide
83
Nitrous oxide produces what 2 effects
analgesic and anxiolytic
84
N20 has a __ safety margin and __ recovery time
wide
quick
85
Nitrous oxide has a __ solubility in blood =
low = rapid onset
86
Nitrous oxide can induce __ at high concentrations
unconsciousness
87
Does nitrous have an effect on HR or BP
No
88
Nitrous crosses the
blood brain barrier (and placenta)
89
Equivalent to a therapeutic dose of morphine
Nitrous oxide
90
Absolute contraindications of nitrous oxide
Nasal obstruction
Vit B12 deficiency
Alcoholic/ recovering addict
Uncommunicative (disability or language barrier)
Patient refusal
91
Relative contradictions of nitrous oxide sedation
middle ear infection
balance disorder
motion sickness
claustrophobia
pulmonary diseases
immunocompromised
pregnancy
psychiatric disorders/bipolar
Marijuana or hallucinogenic drug use
92
Side effects of nitrous
nausea
vomiting
headache
93
Oxygen is __ nitrous oxide is __
green
blue
94
Fills reservoir bag with O2, can be used for over-sedation
flush button
95
Oxygen fail safe mechanism = O2 at __ min and N2O at __ max
30%
70%
shuts off if O2 flow stops
96
What form is N2O in within the cylinder
gas and liquid state
(will show full as long as liquid remains)
(O2 cylinder is only gas)
97
Makes it so you cannot inadvertently reverse tanks
Pin index safety system
98
N2O flow terminated if O2 delivery pressure falls
oxygen fail safe
99
allows atmospheric air in if flow of gases stops
emergency air inlet
100
Rapid delivery of high flow O2 to patient (oversedation)
Oxygen flush button
101
Nitrous oxide administration
start with 5-6 L/min of 100% O2
Gradually titrate N2O - O2 in 10% intervals
Typical 50/50 N2O to O2
When treatment is completed --> N2O to zero and increase O2 to re-establish flow: 100% O2 for 5 minutes
102
What causes syncope during an injection
Rapid drop in BP, emotional response
103
Treatment for syncope
supine position with legs higher than head
ammonia capsule / oxygen
104
Local anesthetic overdose cause
injecting into a vessel
dose too large
metabolism / excretion too slow
105
How to prevent local anesthetic overdose (3)
aspirate 2 plane
MRD
inject slowly
(decrease toxicity)
106
Cause of epinephrine overdose (3)
1:50,000 concentration
intravascular injection
CV pt
107
Prevention of epinephrine overdose
aspirate in 2 planes
108
Allergic reactions of LA can be
delayed or immediate
109
Cause of allergic reactions to LAs
methylparaben
sodium bisulfite
ester topical
110
How to avoid needle breakage
do not bend
do not insert to the hub
do not force
use long needle for IAN
use 25 or 27 g needles
111
How to prevent pain during injection
inject slow
use topical
use sharp needle
anesthetic room temp
112
Cause of burning during injection
contaminated / expired anesthetic
poor technique
heated anesthetic solution
113
Cause of hematoma (3)
puncture of blood vessel
poor technique
multiple needle penetrations
114
Hematoma prevention
use 27 short needle for PSA
know anatomy
115
Treatment for hematoma
apply ice/pressure immediately
swelling and discoloration for 7-14 days
document
116
cause of facial paralysis
LA deposited in parotid gland
bone not contacted during mandibular block
117
Cause of paresthesia (4)
trauma to nerve sheath
edema/ hemorrhage near nerve
contaminated anesthetic
possible association with articaine
118
Cause of trismus (2)
muscle trauma from multiple needle insertions
contaminated anesthetic
119
How to treat trismus
moist heat
120
If there is infection from a contaminated needle / cartridge or administering in an infected area we treat with
antibiotics after 3 days
121
Cause of edema (3)
trauma
contaminated anesthetic
allergic reaction to LA
122
Local anesthesia of the maxilla is working with what division of what nerve
V2 division of CN V / trigeminal nerve
123
What are the major branches of V2
PSA
MSA
ASA
GP
NP
IO
124
What does PSA nerve innervate
all maxillary molars minus the mesiobuccal cusp of the 1st
buccal gingiva in molar regions
125
Target area for PSA nerve injection
apical to the root of the 3rd molar
Penetration is made going at a 45 degree angle from the long axis of the 2nd molar and positioning 45 degrees medially
126
How much carpule do you give for PSA
1/2
(insert 1/2 needle)
127
For MSA nerve what is the innervation
maxillary premolars
mesiobuccal cusp of 1st molar
buccal gingiva of above teeth regions
128
Target area for MSA nerve injection
slightly apical to either of the premolars
penetration is around the apex of the premolars and along the long axis of the tooth
129
How much of the carpule do you add for MSA
1/2
(1/3 to 1/2 needle)
130
For ASA nerve what does it innervate
all maxillary anterior teeth
labial mucosa up to the midline
131
target area for ASA
apical and slightly distal to the canine
penetration is along the long axis of the canine
132
How much carpule for ASA
1/2
(1/3 to 1/2 needle)
133
Greater palatine nerve innervation
palatal soft tissue of the secondary palate/distal to the canine
palatal bone of same area
134
Target site for greater palatine
great palatine foramen
penetration is anterior to the greater palatine foramen (max 2nd molar)
135
How much carpule for greater palatine
1/4 carpule or until tissue blanches
(insert until bevel is buried)
136
Nasopalatine nerve innervation
palatal soft tissue of the primary palate/ anterior to the canine
palatal bone of same area
137
Target area for nasopalatine
incisive foramen
penetration is just lateral and in posterior portion of incisive papilla
138
How much carpule for nasopalatine
1/4 or until blanching
(until bevel is buried)
139
Innervation of infraorbital nerve
Encompasses both ASA and PSA
buccal gingiva associated with teeth
Lower eyelid, upper lip, lateral aspect of nose
140
Target area for infraorbital
near the infraorbital foramen inferior to the orbital rim
Penetration is parallel to the 1st premolar and towards in infraorbital foramen
141
How much carpule for infraorbital
3/4 a carpule
(insert until bone ~ half the needle)
142
Local infiltration innervation
used for 1-2 teeth and surrounding soft tissue with a high success rate
143
Target area for local infiltration
apical to the roots of the teeth wanting to be anesthetized
Insertion made at the height of the mucogingival fold and advanced towards the apical region of the tooth
144
How much carpule for a local infiltration
1/3
145
Paresthesia: what nerve is most commonly effected
lingual nerve
can linger for weeks to months
146
How long do you leave topical on for
1-2 minutes
147
Larger diameter needle gives more reliable what
positive aspiration tests (25 is larger than 30)
148
How do you decide what length of needle to use
Depth of tissue you wish to penetrate
149
Diffusion hypoxia
hangover effect after nitrous oxide use
(100% O2 for 5 min to prevent)
150
Depositing LA slowly is for what reason
more comfortable
no micro tearing
decreases risk of toxicity
151
Mechanism of action for topical anesthetic
Decrease Na+ permeability = block nerve impulse (same as injectable LA)
152
Anesthesia tissue depth with topical
2-3mm
153
3 common topical anesthetics
Benzocaine
Lidocaine
Combination --> Benzocaine + Butamben + tetracaine
154
Hurricaine is
benzocaine
155
Is benzocaine an ester or an amide
ester
156
Benzocaine pregnancy category
category C
lactation safety unknown
157
Benzocaine is associated with
methemoglobinemia
158
Good choice for topical if ester allergy
Lidocaine
159
Is lidocaine and ester or an amide
Amide
160
MRD of benzocaine
None
161
MRD of lidocaine topical
300 mg --> 200mg safely
162
Lidocaine topical and pregnancy
Category B
Lactation (small amount enters)
163
Benzocaine+ Butamben + tetracaine =
cetacaine
164
Cetacaine is an ester or an amide
ester
165
MRD of cetacaine
200 mg
166
Cetacaine and preganancy
Category C
lactation use caution
167
DO topical have vasoconstrictors
no
168
CNS and CV effects of topicals
CNS: excitation --> depression (biphasic)
CV: decrease HR and BP
(both are the same as injectable LAs)
169
Avoid what to decrease toxic reactions of topicals
sprays
