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Pain and anxiety > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Brand name for lidocaine

A

Xylocaine

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2
Q

Brand name for Mepivacaine

A

Carbocaine

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3
Q

Brand name for prilocaine

A

Citnest

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4
Q

Brand name for articaine

A

septocaine

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5
Q

Brand name for bupivacaine

A

Marcaine

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6
Q

What LA’s are good for hemostasis

A

Lidocaine

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7
Q

What LA is NOT good for hemostasis

A

Mepivacaine

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8
Q

What LA’s are an effective topical

A

lidocaine
Prilocaine (with lidocaine)

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9
Q

Lidocaine and pregnancy

A

Category B
Lactation safe

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10
Q

Mepivacaine and pregnancy

A

Category C
Lactation safe

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11
Q

Prilocaine and pregnancy

A

Category B
Lactation safety unknown

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12
Q

Articaine and pregnacy

A

Category C
Lactation safety unkownn

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13
Q

Bupivacaine and pregnancy

A

Category C
Lactations safety unknown

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14
Q

MRD lidocaine

A

500 mg

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15
Q

MRD mepivacaine

A

400 mg

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16
Q

MRD prilocaine

A

600 mg

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17
Q

MRD articaine

A

None

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18
Q

MRD Bupivacaine

A

90 mg

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19
Q

Good choice of LA if a vasoconstrictor is contraindicated

A

Mepivacaine (weak vasodilator)

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20
Q

No Epi in what LA

A

Mepivacaine
Prilocaine

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21
Q

Least toxic LA

A

Prilocaine

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22
Q

Risk for methemoglobinemia

A

Prilocaine
Benzocaine (topical)

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23
Q

Highly soluble LA and high diffusion through bone

A

Articaine

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24
Q

Good choice for re-administration, CV or liver disease

A

Articaine

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25
Q

Most potent/ toxic LA

A

Bupivacaine

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26
Q

Not available without Epi

A

Bupivacaine

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27
Q

In terms of diffusion of drug through the nerves, what will a greater lipid solubility do

A

Enhance diffusion

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28
Q

Great lipid solubility =

A

more potent = need less of the drug

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29
Q

High overdose of LAs causes CNS

A

depression

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30
Q

Moderate overdose of LAs, initial CV

A

stimulation

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31
Q

High overdose of LAs, CV

A

depression

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32
Q

2 vasoconstrictors

A

epinephrine
levonordefrin

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33
Q

Do vasoconstrictors increase or decrease duration of LA

A

increase

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34
Q

What provides hemostasis at injection site

A

vasoconstrictors

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35
Q

Vasoconstrictors lower absorption rate of LA which leads to less

A

risk of toxicity

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36
Q

More effect of α receptors

A

levonordefrin

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37
Q

Mostly affects beta receptors

A

epinephrine

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38
Q

MRD of epinephrine

A

0.2 mg (healthy)
0.04 (CV ds)

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39
Q

MRD of levonordefrin

A

1.0 mg (healthy)
0.2 mg (CV ds)

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40
Q

Absolute contraindication of LA

A

allergy

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41
Q

If taking a H2 blocker

A

lower dosage of lidocaine

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42
Q

If taking a CNS depressant

A

Lower all amides

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42
Q

If taking a beta blocker

A

lower all amides

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43
Q

If patient is pregnant

A

Use lidocaine or prilocaine

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44
Q

If the patient has liver disease use

A

articaine

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45
Q

Absolute contraindications for vasodilators (8)

A

MI/coronary bipass
uncontrolled hypertension
uncontrolled angina pectoris
uncontrolled arrhythmias
uncontrolled hyperthyroidism
sulfite allergy
glaucoma
cocaine / meth use

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46
Q

Cardiac protocol for vasoconstrictors

A

0.04 mg EPI / 0.2mg LEVO

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47
Q

Vasoconstrictor contraindications: cardiovascular disease patients

A

Use Cardiac protocol

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48
Q

Vasoconstrictor contraindications: tricyclic antidepressants

A

No Levo, use 0.04mg EPI

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49
Q

Vasoconstrictor contraindications: Nonselcetive beta blocker

A

cardiac protocol

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50
Q

Vasoconstrictor contraindications: Digitalis

A

Physician consult

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51
Q

New FDA law with carpules

A

Label as 1.7 ml if can not guarantee all carples have exactly 1.8 ml

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52
Q

2% solution, how many mg/carpule

A

2% = 20mg/ml X 1.8ml/carpule = 36 mg/carpule

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53
Q

What are the two buffering agents in a carpule

A

sodium chloride
sodium hydroxide

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54
Q

What is the vasoconstrictor in the carpule

A

EPI or Levonordefrin

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55
Q

Vasoconstrictor preservative that causes allergic reactions

A

Sodium bisulfate

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56
Q

Prior to 1984 LA solutions without EPI added what as a preservative

A

methylparaben (high allergic reactions)

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57
Q

LAs cause reversible local anesthesia by preventing what 2 things

A

generation and conduction of impulses

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58
Q

LAs provide a chemical

A

block

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59
Q

LAs are membrane

A

stabilizing drugs

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60
Q

LAs inhibit and bind what channel

A

Na+ channels

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61
Q

LAs are a __ dependent blockade

A

state (only binds what firing)

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62
Q

What nerves are more sensitive to LAs

A

Small diameter nerves

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63
Q

What nerves require more volume of LAs

A

Large diameter nerves

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64
Q

Topical delivery of LAS have higher what

A

concentration and toxicity

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65
Q

What type of delivery of LA is more effective

A

Submucosal (concentrations are lower because placed right on nerve)

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66
Q

2 groups of LAs

A

esters and amides

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67
Q

Which type of LA has more allergic reactions

A

esters

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68
Q

What type of LA is metabolized in the blood via pseudocholinesterase

A

Esters

69
Q

All injectable dental LAs are

A

amides

70
Q

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

A

penetrates membrane
ester / amide
binds to receptor sites
active

71
Q

All LAs are vaso__

A

vasodilators

72
Q

What occurs with a decrease in pKa of the LA

A

increase anions
increase base
rapid onset

73
Q

What occurs with an increase in pKa of the LA

A

increase in cations
decrease in base
slower onset

74
Q

Why is there inadequate anesthesia when an LA is given in a infection

A

Both the infections and the LA are acidic so less molecules cross the membrane

75
Q

If the nerve is larger what do we have to change with the LA

A

increase the volume

76
Q

An increase in lipid solubility of an LA increases what

A

potency
so you decrease the dose
enhances diffusion through the nerve

77
Q

If there is an increase in protein binding, there is an increase in

A

duration

78
Q

If a nerve fiber is fully recovered and you reinject the LA what occurs

A

tachyphylaxis (tolerance to LA) –> LA is ineffective

79
Q

3 factors that increase duration of LA = potency

A

protein binding
vascularity of injection site ( if high less duration)
vasoconstrictor in LA

80
Q

What are the 3 ester LAs as topicals

A

Benzocaine
Tetracaine
Procaine

81
Q

Documentation of NO2 must include

A

Informed consent
% administered
length of time sedated
flow rate of gases
(indication for use and patient response/tolerance as well)

82
Q

What provides ideal sedation

A

Nitrous oxide

83
Q

Nitrous oxide produces what 2 effects

A

analgesic and anxiolytic

84
Q

N20 has a __ safety margin and __ recovery time

A

wide
quick

85
Q

Nitrous oxide has a __ solubility in blood =

A

low = rapid onset

86
Q

Nitrous oxide can induce __ at high concentrations

A

unconsciousness

87
Q

Does nitrous have an effect on HR or BP

A

No

88
Q

Nitrous crosses the

A

blood brain barrier (and placenta)

89
Q

Equivalent to a therapeutic dose of morphine

A

Nitrous oxide

90
Q

Absolute contraindications of nitrous oxide

A

Nasal obstruction
Vit B12 deficiency
Alcoholic/ recovering addict
Uncommunicative (disability or language barrier)
Patient refusal

91
Q

Relative contradictions of nitrous oxide sedation

A

middle ear infection
balance disorder
motion sickness
claustrophobia
pulmonary diseases
immunocompromised
pregnancy
psychiatric disorders/bipolar
Marijuana or hallucinogenic drug use

92
Q

Side effects of nitrous

A

nausea
vomiting
headache

93
Q

Oxygen is __ nitrous oxide is __

A

green
blue

94
Q

Fills reservoir bag with O2, can be used for over-sedation

A

flush button

95
Q

Oxygen fail safe mechanism = O2 at __ min and N2O at __ max

A

30%
70%
shuts off if O2 flow stops

96
Q

What form is N2O in within the cylinder

A

gas and liquid state
(will show full as long as liquid remains)
(O2 cylinder is only gas)

97
Q

Makes it so you cannot inadvertently reverse tanks

A

Pin index safety system

98
Q

N2O flow terminated if O2 delivery pressure falls

A

oxygen fail safe

99
Q

allows atmospheric air in if flow of gases stops

A

emergency air inlet

100
Q

Rapid delivery of high flow O2 to patient (oversedation)

A

Oxygen flush button

101
Q

Nitrous oxide administration

A

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
Q

What causes syncope during an injection

A

Rapid drop in BP, emotional response

103
Q

Treatment for syncope

A

supine position with legs higher than head
ammonia capsule / oxygen

104
Q

Local anesthetic overdose cause

A

injecting into a vessel
dose too large
metabolism / excretion too slow

105
Q

How to prevent local anesthetic overdose (3)

A

aspirate 2 plane
MRD
inject slowly
(decrease toxicity)

106
Q

Cause of epinephrine overdose (3)

A

1:50,000 concentration
intravascular injection
CV pt

107
Q

Prevention of epinephrine overdose

A

aspirate in 2 planes

108
Q

Allergic reactions of LA can be

A

delayed or immediate

109
Q

Cause of allergic reactions to LAs

A

methylparaben
sodium bisulfite
ester topical

110
Q

How to avoid needle breakage

A

do not bend
do not insert to the hub
do not force
use long needle for IAN
use 25 or 27 g needles

111
Q

How to prevent pain during injection

A

inject slow
use topical
use sharp needle
anesthetic room temp

112
Q

Cause of burning during injection

A

contaminated / expired anesthetic
poor technique
heated anesthetic solution

113
Q

Cause of hematoma (3)

A

puncture of blood vessel
poor technique
multiple needle penetrations

114
Q

Hematoma prevention

A

use 27 short needle for PSA
know anatomy

115
Q

Treatment for hematoma

A

apply ice/pressure immediately
swelling and discoloration for 7-14 days
document

116
Q

cause of facial paralysis

A

LA deposited in parotid gland
bone not contacted during mandibular block

117
Q

Cause of paresthesia (4)

A

trauma to nerve sheath
edema/ hemorrhage near nerve
contaminated anesthetic
possible association with articaine

118
Q

Cause of trismus (2)

A

muscle trauma from multiple needle insertions
contaminated anesthetic

119
Q

How to treat trismus

A

moist heat

120
Q

If there is infection from a contaminated needle / cartridge or administering in an infected area we treat with

A

antibiotics after 3 days

121
Q

Cause of edema (3)

A

trauma
contaminated anesthetic
allergic reaction to LA

122
Q

Local anesthesia of the maxilla is working with what division of what nerve

A

V2 division of CN V / trigeminal nerve

123
Q

What are the major branches of V2

A

PSA
MSA
ASA
GP
NP
IO

124
Q

What does PSA nerve innervate

A

all maxillary molars minus the mesiobuccal cusp of the 1st
buccal gingiva in molar regions

125
Q

Target area for PSA nerve injection

A

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
Q

How much carpule do you give for PSA

A

1/2
(insert 1/2 needle)

127
Q

For MSA nerve what is the innervation

A

maxillary premolars
mesiobuccal cusp of 1st molar
buccal gingiva of above teeth regions

128
Q

Target area for MSA nerve injection

A

slightly apical to either of the premolars
penetration is around the apex of the premolars and along the long axis of the tooth

129
Q

How much of the carpule do you add for MSA

A

1/2
(1/3 to 1/2 needle)

130
Q

For ASA nerve what does it innervate

A

all maxillary anterior teeth
labial mucosa up to the midline

131
Q

target area for ASA

A

apical and slightly distal to the canine
penetration is along the long axis of the canine

132
Q

How much carpule for ASA

A

1/2
(1/3 to 1/2 needle)

133
Q

Greater palatine nerve innervation

A

palatal soft tissue of the secondary palate/distal to the canine
palatal bone of same area

134
Q

Target site for greater palatine

A

great palatine foramen
penetration is anterior to the greater palatine foramen (max 2nd molar)

135
Q

How much carpule for greater palatine

A

1/4 carpule or until tissue blanches
(insert until bevel is buried)

136
Q

Nasopalatine nerve innervation

A

palatal soft tissue of the primary palate/ anterior to the canine
palatal bone of same area

137
Q

Target area for nasopalatine

A

incisive foramen
penetration is just lateral and in posterior portion of incisive papilla

138
Q

How much carpule for nasopalatine

A

1/4 or until blanching
(until bevel is buried)

139
Q

Innervation of infraorbital nerve

A

Encompasses both ASA and PSA
buccal gingiva associated with teeth
Lower eyelid, upper lip, lateral aspect of nose

140
Q

Target area for infraorbital

A

near the infraorbital foramen inferior to the orbital rim
Penetration is parallel to the 1st premolar and towards in infraorbital foramen

141
Q

How much carpule for infraorbital

A

3/4 a carpule
(insert until bone ~ half the needle)

142
Q

Local infiltration innervation

A

used for 1-2 teeth and surrounding soft tissue with a high success rate

143
Q

Target area for local infiltration

A

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
Q

How much carpule for a local infiltration

A

1/3

145
Q

Paresthesia: what nerve is most commonly effected

A

lingual nerve
can linger for weeks to months

146
Q

How long do you leave topical on for

A

1-2 minutes

147
Q

Larger diameter needle gives more reliable what

A

positive aspiration tests (25 is larger than 30)

148
Q

How do you decide what length of needle to use

A

Depth of tissue you wish to penetrate

149
Q

Diffusion hypoxia

A

hangover effect after nitrous oxide use
(100% O2 for 5 min to prevent)

150
Q

Depositing LA slowly is for what reason

A

more comfortable
no micro tearing
decreases risk of toxicity

151
Q

Mechanism of action for topical anesthetic

A

Decrease Na+ permeability = block nerve impulse (same as injectable LA)

152
Q

Anesthesia tissue depth with topical

A

2-3mm

153
Q

3 common topical anesthetics

A

Benzocaine
Lidocaine
Combination –> Benzocaine + Butamben + tetracaine

154
Q

Hurricaine is

A

benzocaine

155
Q

Is benzocaine an ester or an amide

A

ester

156
Q

Benzocaine pregnancy category

A

category C
lactation safety unknown

157
Q

Benzocaine is associated with

A

methemoglobinemia

158
Q

Good choice for topical if ester allergy

A

Lidocaine

159
Q

Is lidocaine and ester or an amide

A

Amide

160
Q

MRD of benzocaine

A

None

161
Q

MRD of lidocaine topical

A

300 mg –> 200mg safely

162
Q

Lidocaine topical and pregnancy

A

Category B
Lactation (small amount enters)

163
Q

Benzocaine+ Butamben + tetracaine =

A

cetacaine

164
Q

Cetacaine is an ester or an amide

A

ester

165
Q

MRD of cetacaine

A

200 mg

166
Q

Cetacaine and preganancy

A

Category C
lactation use caution

167
Q

DO topical have vasoconstrictors

A

no

168
Q

CNS and CV effects of topicals

A

CNS: excitation –> depression (biphasic)
CV: decrease HR and BP
(both are the same as injectable LAs)

169
Q

Avoid what to decrease toxic reactions of topicals

A

sprays

Pain and anxiety (4 decks)

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