LA StudentRDH Flashcards
A local anesthetic overdose affects the _____ before the _______.
CNS; CVS
What are the signs and symptoms of CNS excitation?
excitation, agitation, confusion, twitching, seizure, talkativeness
Signs and symptoms of CNS depression
drowsiness, cessation of seizure activity, respiratory arrest
What emerging condition occurs most w/local anesthetic injections?
syncope
What is an absolute contraindication when using vasoconstrictor?
an allergy to sulfites
Forceful contact of needle to bone may cause _____.
paresthesia **
Anesthesia or altered sensation persisting beyond the expected duration of anesthesia is referred to as_____.
paresthesia
Category ___ drugs are safer than category ____ drugs.
B; C
What are some examples of category B drugs?
Citanest (Prilocaine)
Xylocaine (Lidocaine)
What are some examples of category C drugs?
Carbocaine (Mepivacaine)
Marcaine (Bupivacaine)
Septocaine (Articaine)
What helps alleviate trismus?
- heat for 20 mins every hour
- warm saline rinse
- analgesics and muscle relaxers
- exercise the jaw for 5 mins every 3 hours
Why do ester drugs occasionally cause allergic reactions?
they produce para-aminobenzoic acid
What unwanted qualities are produced by vasodilators?
- increased absorption
- increased adverse reactions
- decreased depth and duration of local anesthesia
- increased bleeding
What type of reaction is produced by vasoconstrictors?
- decreased absorption
- increased depth
- decreased bleeding
The ratio 1: 100,000 refers to the concentration of the _____ in the cartridge. It means that there is __ gram of vasoconstrictor in every 100,000 mL of solution.
vasoconstrictor; 1
What are the concentrations of epinephrine available in the U.S.
1:50,000; 1:100,000; 1:200,000
The ____ the number on the right side of the of the cartridge, the ____ the amount of vasoconstrictor present.
higher; lesser
What is the MRD of vasoconstrictors for a healthy patient?
0.2 mg of epi/appt or
1 mg of levo/appt
What is the MRD of vasoconstrictors for a patient with cardiovascular disease?
0.04 mg of epi/appt or 0.2 mg of levo/appt
To calculate how many cartridges can be used, _____ the MRD of the _____ by the number of ___ in a cartridge.
divide; vasoconstrictor; mg
How many cartridges of anesthetic containing 1:100,000 epinephrine can be given to a healthy patient?
11.1 cartridges
How many cartridges of anesthetic containing 1:100,000 epinephrine can be given to a patient with CVD?
2.2
A local anesthetic used with caution has a ______ contraindication.
relative
A local anesthetic that should never be given has an ______ contraindication.
absolute
An allergy to an ester is an absolute contraindication for the use of _______.
benzocaine
HBP is a relative contraindication for the use of ______.
local anesthetics with epinephrine
What is a sudden drop in blood pressure, breathing problems, weak pulse, skin rash, nausea and vomiting are all signs of?
anaphylaxis
Demerol and Dilantin can affect the biotransformation of what LA?
lidocaine
If anesthetic is deposited into the parotid gland, the ___ nerves can also be anesthetized (facial nerve paralysis).
It can lead to a “drooping” of the patients face.
facial
What can happen if the needle does not contact the bone above the mandibular foramen when administering tan IANB?
Facial nerve paralysis can occur.
The addition of ______ lowers the pH of the LA and makes the weak base solution water soluble and stable.
hydrochloride salt
The addition of _____ acts as a preservative to a vasoconstrictor.
sodium bisulfite
When providing LA for a child, _____ should be given with caution as they are higher concentrations compared to injectable anesthetics.
topical anesthetics
A patient is currently taking Elavil, a tricyclic antidepressant (TCA). What should be avoided when administering local anesthesia?
vasoconstrictors (epinephrine and levonordefrin)
______ is a term used for chest pain caused by reduced blood to the heart muscles. The pain may radiate through the arm, neck, and jaw. It typically resolves in ___ minutes.
angina; 3 mins
______ aka heart attack refers to “death of the heart muscle.”
This occurs when one of the coronary (heart) arteries delivering oxygenated blood to the heart becomes blocked.
Myocardial infarction
How can you differentiate between a patient experiencing angina and a patient experiencing a MI?
the difference lies in whether the condition resolves itself within 3 -5 mins.
A patient who experiences angina on a daily basis is contraindicated for the use of ______.
vasoconstrictors
A ____ is the condition of blood outside a blood vessel resulting from a needle puncture
hematoma; treat by immediately applying pressure and ice on the affected area for at least 2 mins.
Should resolve in 7-14 days
The weakest part of the needle is the ____.
What is the most common cause of needle breakage?
hub; sudden pt movement
With which injections is needle breakage most common?
IANB
PSANB
A genetic condition that limits the ability to supply O2 to parts of the body, remove CO2, and regulate body temperature.
Malignant hyperthermia
A genetic disorder characterized by abnormal blood plasma enzymes that inhibits the production of pseudocholinesterase.
A patient with this disorder s at a higher risk for toxicity with ____ drugs.
Atypical pseudocholinesterase; ester
Esters are hydrolyzed in the blood by the enzyme _________.
pseudocholinesterase
A blood disorder in which there is an abnormal amount of methemoglobin in the blood.
(Methemoglobin is a form of hemoglobin that attaches O2 more firmly, this prevents O2 from being released to the tissues normally.)
methemoglobinemia
Liver diseases such as ___ and hepatitis impair biotransformation of amide drugs.
cirrhosis
Elimination of drugs occurs in the ___.
kidneys
Kidney function may be disturbed by _____.
Preganancy
What are the categories of drugs according to the FDA?
Category A: Best
Category B: Amoxicillin, lidocaine, prilocaine, etc..
Category C: Acetaminophen, mepivacaine, septocaine
Category D: Aspirin, phenytoin, tetracycline
Category X: Temazepam
Excessively prolonged periods of bleeding is more severe if a patient uses _____, or ______ and NSAIDs.
blood thinners (Coumadin); aspirin (antiplatelet)
A platelet count of fewer than 50,000 cells/mm.
Von Williebrand’s disease
Thrombocytopenia
What should be done to stop the bleeding of a patient with blood disorder?
- apply pressure for 15 mins until clot forms
- instruct patient to avoid drinking through straws on the day of the appointment
_______ is a preservative used for vasoconstrictors
sodium bisulfite
For a mind allergic response use _____.
an antihistamine
What position should a patient be in if they are having an asthma attack?
seated position
Asthma attacks are generally managed with ______ bronchodilator.
short-acting
1-2 puffs every 4-6 hours
____ is indicated for all emergency situations except for hypeventillation.
Oxygen
Condition if the heart working excessively to supplement the inadequate amount of oxygenated blood, which is caused by narrowed coronary arteries.
Patient should be placed in a ______ position and provided nitroglycerin tablets _____ every 3-5 mins (up to 15 mins)
Angina; semi-supine; sublingually
Electrical seizure of the brain.
seizure
A non-convulsive seizure characterized by a short blank stare (1-2 mins) but with no change in posture.
Petit mal
A seizure characterized by the loss of consciousness and violent muscle contractions/stiffness.
Grand mal aka generalized tonic-clonic seizure
If a patient experiences a seizure, when convulsions happen, leave the patient in the _____ position clear of dangerous objects.
supine
Pre-seizure signs include an ___ felt by the patient. This can be a change of taste, headache, loss of consciousness, etc…
aura
When syncope occurs, place your patient in a _____ position with feet higher than the head.
Trendelenburg
Hemostasis
the stopping of blood flow
What type of injection should be used for hemostasis?
LA infiltration with a vasoconstrictor
____ provides the longest duration of anesthesia (up to 12 hours)
Bupivacaine
____ provides the longest duration of anesthesia (up to 12 hours)
Bupivacaine
Infected tissues have a lower pH. This acidity ____ the ability of local anesthetics to be effective.
decreases
To minimize the influence of infection/inflammation on local anesthesia, use _____.
This increases the chance for successful anesthesia and reduces the risk of spreading the infection
nerve blocks instead of infiltrations.
MRD is calculated if a persons body weight is ____.
less than 150 lbs
What are some absolute contraindications for vasoconstrictors?
- MI within 6 months
- Coronary bypass surgery within 6 months
- Uncontrolled HBP, Hyperthyroidism, diabetes
- Daily angina
- sulfite allergies
- pheochromocytoma
- use of cocaine or meth within 24 hours
(ASA III)
Most adverse reactions occur within __ to __ minutes of injection.
5 to 10
______ is the most common adverse reaction.
Overdose
What is the abnormal response to a drug unrelated to its usual pharmacologic actions?
Idiosyncratic reaction
What is the emergency condition that occurs most frequently with LA injections?
syncope
_______ is a liquid solution that increases the amount of blood flow to the target area. This allows the tissue to recover more rapidly.
OraVerse
What can cause parasthesia?
- Hemorrhage around the nerve
- contaminated solutions
- trauma to the nerve by needle penetration
___ is defined as anesthesia or altered sensation persisting beyond the expected duration of anesthesia. Occurs when a nerve is pressured or irritated.
Paresthesia
Usually resolves in 8 weeks
Names of Ester drugs have __ “i(s)”.
one
Name of amide drugs have ___ ‘i(s)”.
two
____are biotransformed in the blood.
Esters
Why are esters are more likely to cause allergic reactions compared tp amides?
esters produce a drug called para aminobenzoic acid. PABA is formed when the drug is metabolized in the blood plasma by pseudocholinesterase
Amide drugs are biotransformed in the _____ with the exception of _____ which is biotransformed in the blood and the liver.
Articaine (Septocaine)
Lidocaine: _______.
Metabolized in the _____.
Pregnancy Category __
Xylocaine; liver; B
Mepivacaine:_______.
Metabolized in the ______.
Pregnancy Category __.
Carbocaine; liver; C
Prilocaine: _______.
Metabolized in the _____.
Pregnancy Category __.
Citanest; liver, lungs, kidney; B
_______ can form as a result of prilocaine metabolism. SIgns and symptoms of this can cause observable pale to bluish lips, mucous membranes and nails.
Methemoglobinemia
Which LA is contraindicated with idiopathic of congenital methemoglobinemia?
This LA is alo reported to cause higher incidences of paresthesia with the IA nerve block.
prilocaine
Articaine: ____.
Metabolized in the _____.
Pregnancy Category is __.
Septocaine; liver and blood plasma; C
Which LA amide is biotransformed faster than others because of its dual metabolism?
Articaine
Bupivacaine:______.
Metabolized in the ______.
Pregnancy Category __.
Marcaine; liver; C
Which LA is 4 times more potent and toxic compared to lidocaine and mepivacaine? It is only used for longer procedures and post-op pain management.
Bupivacaine
Electrical impulses carried by nerves are initiated by chemical, ______, mechanical, or electrical stimuli.
thermal
There are two types of nerurons_____ (_____) and motor (___).
Think “SAME”
sensory (afferent); efferent
_____ neurons transmit sensation from body parts to the CNS
Sensory
_____ neurons transmit impulses from the CNS to parts of the body
Motor
Myelin sheaths are specialized forms of ____.
Schwann cells
Constrictions called ____ are located at regular intervals along the myelinated nerve fiber and expose the nerve membrane.
Nodes of Ranvier
____ fibers are bundles of nerve fibers located near the surface of the nerve cell. They are exposed to higher concentration of drugs compared to the core fibers and are more ___ affected by anesthetics
Mantle; rapidly
Which fiber bundles innervate regions closer to the root trunk and remain anesthetized for longer periods of time?
Mantle fibers
______ fibers innervate regions farther away from the toot trunk.
Core
In a ___ neuron, the impulse leaps from one node to another in a process called ______.
myelinated; saltatory conduction
_______ conduction is much faster and more efficient compared to the nerve conduction of an unmyelinated neuron of the same size.
Saltatory
When a neuron is not sending a signal it is “at rest” and _____.
polarized
In a polarized state, the outside of the neuron is ____ charged with excess sodium ions, and the inside of the neuron is ___ charged with excess potassium ions.
positively; negatively
During the ___ the sodium and potassium ions are returning to their original state. While this process takes place, the neuron DOES NOT respond to any incomining stimuli.
refractory period
The ____ occurs immediately after a nerve conduction. During this time, a nerve is unable to respond for a period of time.
absolute refractory period
The ____ occurs _____ the absolute refractory period. A new impulse that can be initiated by a stimulus that is stronger than normal.
Fix this card!
reflective refractory period
_____ are added to the anesthetic to make a water-soluble and injectable solution.
Hydrochloride salts
LA’s are weak ___.
bases
LA’s work by ___ the rate of depolarization.
The molecules bind to the protein receptor site and block the sodium channels on the cell membrane.
As a result _____ do not enter the neuron effectively and the nerve does not depolarize enough to reach its threshold potential. Because of this, the brain does not recognize the stimuli as pain.
decreasing; sodium ions
What are some ways that LA’s work to affect the nerve?
- Altering the resting potential of the nerve membrane
- Raising the threshold potential
- Prolonging the rate of repolarization
What is the period from deposition of the anesthetic solution to complete conduction blockade called?
Induction time
