FINAL EXAM Flashcards
1
Q
what is the pH of commercial lidocaine?
A
3.9
2
Q
why is the pH of amide local anesthetic acidic compared to the tissue pH?
A
this enhances the solubility of the anesthetic salts to prolong the shelf life
3
Q
what are the two forms of the anesthetic salt?
A
- the uncharged, de-ionized or ACTIVE free base form- lipid soluble
- the charged or ionized cationic form which is not lipid soluble.
4
Q
what form of the anesthetic salt is important in penetrating into the nerve membrane?
A
the DEIONIZED form-because its lipid soluble and can more readily penetrate the nerve membrane to enter nerve axon.
5
Q
how much lidocaine does a 1.7 ml carpule of 2% lidocaine 1:100K epi have and how much epi?
A
34 mg lid and .017 mg epi
6
Q
if you have 3% lido how many mg?
A
3%=30 mg/ml * 1.7 ml/carpule = 51 mg. easy
7
Q
what is the max dose of EPI you should memorize???
A
4.4 mg/kg
(although you should still take into account rate of absorption, patient health status, tissue conditions, age considerations, etc.)
8
Q
where is the mandibular foramen in a child relative to an adult?
A
in a child, it is slightly below the plane of occlusion
9
Q
if the patient has an infection, what can you do to
A
give preoperative ibuprofen, 1 hour before the local anesthesia injection.
10
Q
what is the risk of anesthesia and opioids?
A
higher risk of epi toxicity
11
Q
describe symptoms of anesthesia overdose?
A
- CNS excitation
- CNS depression
- CVS excitation
- Cardiac arrest
12
Q
this occurs when iron in hemoglobin is changed from its ferrous to its ferric form
A
methemoglobinemia.
CANNOT ACCEPT oxygen to carry to tissues
13
Q
methemoglobin concentration greater than ___ of total hemoglobin can cause cyanosis
A
10-15%
14
Q
what is it in the local anesthetic that can cause methemoglobinemia?
A
the nitrates and aniline derivitaves which are part of all local anesthetics
15
Q
what its the major cause of deaths due to local anesthetic administration?
A
overdose
16
Q
what is the purpose of sodium bisulfite?
A
added with vasoconstrictors to increase the shelf life.
so if patient has allergies/sensitivites, should NOT recieve anesthetic with a vasoconstrictor
17
Q
what part of the topical anesthetic may cause an allergic reaction?
A
PABA- the metabolite that’s used
18
Q
where are amides metabolized? except which one?
A
in the liver!
PRIOLCAINE is expcetion- it’s in the kidney and plasma
19
Q
What if your patient has atypical pseudocholinesterase…what should you be aware of?
A
esters! topical anesthetic
20
Q
what is the purpose of the buffer?
A
increases the pH and produces more DEIONIZED fom of anesthetic to cross the lipid barrier.
Sodium bicarbonate is used as the buffer
*patients physiology is generally the buffer???**
21
Q
canines emerge when __ of the root if formed.
A
3/4
22
Q
premolars emerge when __ - ___ of the root if formed?
A
1/2-3/4
23
Q
for each mm of alveolar bone overlying a succedaneous tooth, approx ___ months of eruption should be anticipated
A
6 months
24
Q
most space loss occurs within the first __ - __ months?
A
4-6 months
25
what are the indications for band and loop space maintainer?
loss of ONE primary MOLAR
26
what is the disadvantage of band and loop?
the opposing tooth may super erupt
27
what is the advantage of denovo band and loop?
it's better for reduced space?
28
advantage of an upper holding arch?
NO acrylic button
29
disadvantages of an upper palatal holding arch?
may interfere with occlusion
30
what is a groper appliance?
can replace missing incisors -- good for a pedi partial if patient doesn't want to be completely edentulous!
31
what are the indications for a distal shoe?
loss of Es prior to the eruption of maxillary and mandibular MI or ectopic eruption of M1
32
what are the contraindications for the distal shoe?
- immuocompromised patients
- require SBE prophylaxis
- have diseases that affect healing in general
- cannot cooperate
33
advantage of the distal shoe?
maintains the 2nd primary molar space
34
disadvantages of the distal shoe?
difficult to make, and poor oral hygiene may cause infection
35
what do you use if you are missing two maxillary molars?
nance
TPA
Band and loop
36
This device prevents the rotation of M1?
nance
37
if A and J are missing, can you use NANCE?
no, because M1 will tip mesially
38
describe what primary teeth roots look like?
ribbon like- thin and divergent
39
does the absence of pain indicate the absence of pulp pathology?
no!
40
is percussion and palpation reliable in primary teeth?
no, or traumatized and immature permanent teeth. difficult to diagnose
41
can you use electric pulp testing in primary teeth?
hail no
| **or traumatized and immature permanent** = no, nos
42
what does pulp calcification reflect?
acute and rapid response to pulp irritation
43
where do anterior teeth feature resorption initially?
on the root's lingual surface! so it's difficult to tell the apical foramen vs. the anatomic apex
44
primary teeth with yellow discoloration often have what associated?
radiographic pulp canal calcification but low incidence pulp necrosis
45
injured primary teeth with gray discoloration have necrotic pulps in what percentage of cases?
50-80% of cases
46
what is the diagnosis of pulp necrosis in primary incisors primary based on?
dark gray color change and radiographic pathology
47
what are the options if the tooth is vital but traumatized?
protective base
indirect pulp cap
direct pulp cap
pulpotmoy
48
non vital options for immature permanent teeth?
apexification
pulpectomy (RTC)
Regeneration
49
do you need a protective base following restorative procedures?
no, because it is mild and transitory = doesn't require protective base
50
describe decal as a protective base
- weak and soluble
- DON"T put amalgam over
- no composite placed over- thus cannot be acid etched
- So why use it??
51
*carious dentin left overlying pulp to prevent exposure?
IPC indicated.
| if the decay is >1 mm from coronal pulp, prognosis is good
52
if yu have a deep carious lesion, no clinical/radiographic pulp deregulation, and symptom free, what might you use?
Direct pulp cap`
*so indirect leaves a little dentin in place?*
53
what is the one base you should NEVER use during pulpotomy procedure?
DO NOT USE CaOH!!!!
| you can you ZOE, IRM, MTA... that's all
54
what is the "Gold Standard"?
formocresol
Ferric sulfate can be used though as well?
55
what is the purpose of ferric sulfate?
- could be used as astringent
- Hemostatic-- coagulation reaction of blood with ferric and sulfate ions.
- the agglutinated blood proteins occlude capillary orrifices
56
if patient has pulp calcifications, can you perform a pulpotomy?
no
57
apexogenesis vs.apexification?
```
apexogenesis = vital therapy
Apexificaiton= non vital therapy.
```
58
what is the gold standard for treating the open apex purples tooth?
MTA
| also used for apexogenesis in vital teeth
59
is the BL or MD the last site of apical closure?
BL
60
is the BL or MD width generally greater in most roots?
BL is usually greater
61
when is apical closure determined?
determined but the time of tooth eruption- because radiographs show MD, not BL, and BL is the last to close
62
if there is pulp exposure to HEALTHY pulp, would you perform IPC or DPC?
IPC
63
how long odes it take for clinical action of Nitrous oxide?
2-3 min
64
how many minutes does it take for peak clinical effect of Nitrous?
3-4 mins
65
how fast is recovery after N2o?
3-5 mins after 100% O2 inhalation and patient is able to function normally afterwards
66
how many seconds does it take for N2O to go from Pulmonary circulation to the brian?
20 seconds
67
Can you use Nitrous oxide if patient has sickle cell disease?
NO! may cause neuropathy in conjunction with low vitamin B12 levels and prolonged administration
68
Describe relative contraindications to N2O?
- Some COPD-- apnea can result if patient is on hypoxic drive
- medications that induce sleep
- Nasal congestions- URI, allergies
- Pulmonary HYPETENSION
- Cobalamin deficiency
- vomitting
- sinus or ENT infection
- Pneumothorax (collapsed lung)
- BOWEL OBSTRUCTION
- recent pneumoencaphalography
69
What are the ABSOLUTE CONTRAINDICATIONS????
- 1st trimester of PREGNANCY
- Methylenetretrahydrofolate reductase deficiency
- Bleomycin sulfate therapy (this is a chemotherapeutic antibiotic used in the tx of scc, testicular, and lymphomatous cancers)
70
what is bleomycin sulfate therapy, and why is this relative?
it's a chemotherapeutic antibiotic
-if O2 admin > 25% can lead to interstitial pneumonia and PO respiratory failure.
**so if patient had preexisting pulmonary damage, exposure within the past 1-2 months, dose > 450, or creatine clearance
71
what are some pharmacological agents that potentiate the effects of other sedatives? name 3?
- Chloral hydrate (+ N2O= deep not conscious sedation in children)
- Diazepam- may augment the effect of diazepam section of young children.
- Midazolam- appears to provide more comfort to pediatric patients
72
what happens to pain threshold and O2 consumption with anxiety?
they both increase
73
what happens to anxiety and O2 consumption with nitrous oxide?
they both decrease
74
does nitrous oxide produce any significant physiologic changes?
no, minimal depression in cardiac output. Peripheral resistance is UP so the BP is the same
75
If patient has atherosclerosis, anginga pectoris, myocardial infarction, bleeding diathesis- can you use N2O?
YES
76
if patient has pneumothorax, can you give N2O?
no, postpone till resolved
77
if patient has COPD, what should you do before giving N2O?
must consult with physician first
78
Can you use N2O with anemia, sickel cell anemia, leukemia, hemophilia etc?
yes...
79
can you use N2O with hepatic disease?
yes
80
can you use N2O if patient has bowel obstructions?
NO! postpone till resolved.
81
Does N2O have negative effects o the GI/REPRO system?
no
82
If patient has a suspected or known V12 deficiency - from vegan diet or PKU related, what should you do before giving nitrous?
consult with physician
83
If patient has metabolic disease, can you administer N2O?
careful evaluation is necessary
84
If patient is having middle ear disturbances can you give N2O?
pressure changes can cause damage, so you want to postpone until its resolved.
If patient had a recent ENT infection, consult physician first
85
Allergies to N2O?
no reported allergies since last 150 years!
86
Can you use N2O if patient has CNS problems?
YES...can be given with conditions such as seizure disorder, fainting spells, parkinson's disease, MS, Cpm etc
IF NO CARDIOMYOPATHY (disease of the heart muscle)
87
why is the mechanism action of N2O on the gas containing spaces of body?
N2O enters the body cavity MORE RAPIDLY than N2 exits== expansive nature of gas insufflates closed spaces
88
can you give N2O sedation after 1st trimester?
Postponement of N2O sedation is recommended.
89
If N2O is needed during pregnancy, what percent O2 must be delivered?
20% O2.
| always consult obstetrician before administration
90
Is N2O soluble in the blood?
NO - insolbule
91
Does N2O combine with blood elements?
NO! otherwise you would have major issues
92
Is the O2 molecule from N2O available for use in tissues?
no! again, that would be no bueno
93
N2O is rapildy absorbed into pulmonary circulation, and replaces __ in the blood?
replaces N2 in blood
94
N2O is __ times more soluble than N2?
35 x
95
can N2O produce GA ?
only when combined with other sedative/analgesix agents and should be used with caution
IN GENERAL though, you only want to use with local/regional anesthetics
96
what is the MAC of N2O?
105%
97
what is 50% N2O = to mg morphine?
15 mg morphine
98
what is the purpose of the scavenging system?
ambinent air hygiene
collects the exhaled and leaking gases
-must be calibrated to 45LPM
99
what is the minimum O2?
30%
100
what is the purpose of the reservoir bag functions?
monitor device for proper breathing
- means of providing O2 during assisted ventilation
- positive pressure ventilation is possible with a tight fitting mask
101
Once nasal hood is placed on nose, start __ flow at ____ L/Min for 1-2 mins?
O2 flow at 3-4 L/min for 1-2 mins
102
determine proper flow rate by monitoring _____ bag?
reservoir bag
**it should pulsate with the patients breathing
103
what do you adjust the N2O flow rate depending on?
depends on the patients behavior
104
what is important about N2O and reflexes?
N2O depresses cough, gag, and swallowing reflexes and can blunt protective laryngeal reflexes
105
BP and HR slightly (increase or decrease) and then go back to normal?
increase
106
Flushing of extremities and face is caused by what?
peripheral vasodilation
107
signs and symptoms of heavy sedation?
HR and BP are UPPPP!
| otherwise signs are like they're on drugs
108
is excessive perspriation a concern?
no...if not accompanied by decrease BP and increase HR
109
what is the shivering caused by?
vasodilation
110
at the end of treatment, what do you do to the flow of N2O?
TERMINATE- do NOT titrate out
111
how long should patient breath O2?
100% for less than 4 mins
112
what happens if N2O is terminated abrubtly and no O2 is administered?
More CO2 than normal is removed as the N2O rushes out= depression of respiration
O2 dilution in the alveolus = headaches
113
what is the benefit of rapid induction of N2O?
saved resources
TIME AND WITH RAPID!
