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Pain Management 1 > Local anesthesia two > Flashcards

Local anesthesia two Flashcards

1
Q

t/f: if local anesthesia enters into the circulatory system it will cease to provide the desired effect.

A

true

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2
Q

t/f: Most local anesthetics have vasodilatation effect

A

true

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3
Q

_____ is the most potent vasodilator

A

Procaine:

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4
Q

the increase of absorption into the blood may lead to _____ _____ ______

A

potential systemic overdose

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5
Q

the only local anesthetic with constrictor

effect

A

cocaine

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6
Q

______ leads to Inhibition of catecholamine re-uptake

A

cocaine

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7
Q

_____ _____ has a poorly absorbed result except for cocaine.

A

Oral route of local anesthetics

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8
Q

____ _____ leads to Rapid absorption to mucous membrane

A

topical route

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9
Q

____ ____ has greatest % of anesthetics because it is the largest tissue mass in the body.

A

skeletal muscle

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10
Q

what are the two routes of drug elimination?

A

metabolic and excretory

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11
Q

t/f: ALL local anesthetics cross blood-brain barrier, and placenta

A

true

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12
Q

_____ _____ ____ is Hydrolyzed in plasma by pseudocholinesterase into paraaminobenzoic acid (PABA) .

A

ester local anesthesia

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13
Q

_______ is related to Allergic reaction

A

PABA (paraaminobenzoic acid)

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14
Q

____ ____ is about 1/2800 people and may lead to potential for toxicity of ester local anesthesics

A

Atypical pseudocholinesterase

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15
Q

t/f: the liver is the Primary biotransformation site for Amide local anesthetics

A

true

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16
Q

for a ASA IV to V patient with liver dysfunction, heart failure ____ _____ ____ are a relative contraindication

A

Amide local anesthetics

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17
Q

Blue Baby Syndrome
• Inherited blood disorder
• Atypical hemoglobin
– Unable to deliver oxygen efficiently

– Primary metabolite of Prilocaine can be
the cause 
– S/S of patient:
• Easily tired 
• Bluish tint on lip or skin
A

Methemoglobinemia

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18
Q

t/f: Kidneys are primary excretory organ of local anes.

A

true

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19
Q

in _____:
– Procaine appears as PABA (90%)
– 10% cocaine found

A

urine

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20
Q

t/f: Local anesthesia readily cross blood-brain barrier

A

true

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21
Q

Pharmacological of local anestheisa action is CNS_______

A

depression

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22
Q

Signs of CNS toxicty:

A
  1. Initial clinical signs/symptoms of CNS toxicity are Excitatory!!
    – Numbness of tongue and circumoral region (symptoms)
    – Slurred speech, shivering, A/V disturbances, Disorientation, tremor.. (signs)
    – Luckily, lidocaine don’t have these s/s but mild sedation or drowsines

2) Higher level of CNS toxicity –> Tonic-clonic convulsion

3) Further increase
– cessation of seizure activity–> respiratory depression —> reparatory arrest

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23
Q

the following are systemic actions of local anesthesia on the _____ ____.

  1. Direct action on myocardium
    – Produce myocardial depression
    – Therapeutic advantage
    – Management of hyper-excitable myocardium
    • Premature Ventricular Contraction (PVC)
    • Ventricular tachycardia
A

cardiovascular system

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24
Q

t/f: LA (local anesthetics) have a direction action on peripheral vasculature.

A

true

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25
Q

t/f: Cocaine and Ropivacaine are vasoconstrictors

A

true

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26
Q

t/f: All other local anesthetics are vasodilators

A

true

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27
Q

t/f: Skeletal muscle are more sensitive to local irritant properties

A

true

28
Q

t/f: Respiratory is generally unaffected unless near overdose

A

true

29
Q 
t/f:  No documented cases in
medical or dental literature
(past 25 years) supporting
the concept of amide
anesthetics triggering
malignant hyperthermia
A

true

30
Q
  • ↓ Perfusion to site of administration
  • Slow the absorption of L.A. into Cardiovascular system
  • Minimize the risk of systemic toxicity
  • ↑Duration of action for L.A.
  • ↓Hemorrhage
A

importance of vasoconstrictors

31
Q

 Epinephrine
 Norepinephrine
 Dopamine

are ______ catecholamines

A

natural catecholamines

32
Q

 Isoproterenol
 Levonordefrin

are______ catecholamines

A

Synthetic catecholamines

33
Q

 Amphetamine, Ephedrine, Methamphetamine

are ____-_______

A

Non-catecholamines

34
Q

What are the three modes of action?

A

 Direct acting
 Indirect acting
 Mixed acting

35
Q

t/f:  All Cathecholamines work on adrenergic receptors with

direct acting

A

true

36
Q

the following are actions of ______ adrenergic Recptors

  • vasoconstriction
  • increased perpherial resistance
  • increased blood pressure
  • mydriasis
  • increased closure of internal sphincter of the bladder
A

Alpha 1

37
Q

the following are actions of ______ adrenergic Recptors

  • inhibition of norepinephrine release
  • inhibition of insulin release
A

alpha 2

38
Q

the following are actions of ______ adrenergic Recptors

  • TACHYCARDIA
  • increased lipolysis
  • increased myocardial contractility
A

beta 1

39
Q

the following are actions of ______ adrenergic Recptors

  • vasodialtion
  • slightly decreased peripheral resistance
  • bronchodilation
  • increased muscle and liver glycogenolysis
  • relaxed uterine smooth muscle
A

beta two

40
Q

______ = vasoconstriction

A

alpha 1

41
Q

_______= post synaptic inhibitory

A

alpha 2

42
Q

______=located at heart at intestine

A

beta 1

43
Q

_____= Vasodilatation (found in the Bronchi, Vascular beds)

A

beta 2

44
Q

______ is commonly referred to as ratio

A

Dilution

45
Q

Concentration of 1:1000 means?

A
  • 1gram (1000mg) of solute (drug) in 1000ml solution

So 1000mg / 1000ml = 1.0mg/ml of solution

46
Q

______ is the most used vasoconstrictor

A

Epinephrine

47
Q

____ ____ Sodium Bisulfite (antioxidant) is added to delay deterioration of epine.

A

Sodium Bisulfite (antioxidant) is added to delay deterioration

48
Q

t/f: Shelf life of L.A. with Epi is ~ 18 months and Epi can be synthetic or obtained from adrenal medulla

A

true

49
Q

____ _ is more sensitive to epinephrine

A

Beta 2

50
Q

_______ is a Potent bronchiole smooth muscle dilator  treat acute asthma

A

Epinephrine

51
Q

t/f: Epinephrine plasma level does increase after “usual” intra oral injection despite of aspiration

A

true

52
Q

Intravascular injection of 0.015mg can cause what?

A

 Increase heart rate from 25 bpm to 75 bpm
 Systolic blood pressure from 20mmHg to 70mmHg

BE AWARE OF REACHING STROKE LEVELS.

53
Q

________ lacks significant B2 actions resulting in Intense vasoconstriction and Dramatic elevation of blood pressure.

A

Norepinephrine

54
Q

What Most closely resemble norepinephrine?

A

Levonordefrin

55
Q

When selecting a vasoconstrictor it is Dependent on the time needed for the procedure:

 Without epi ~ ___ mine
 With epi ~ __ mins

A

 Without epi ~10 mins

 With epi ~60 mins

56
Q

t/f: Epinephrine produces rebound vasodilatory effect

A

ture

57
Q

t/f: Norepinephrine produces cases of tissue necrosis and
slough.
 Disadvantage outweigh its advantages, so it is not used.

A

true

58
Q

What is the ASA classifcation: Normal healthy patient

A

asa1

59
Q

What is the ASA classifcation: Mild systemic disease

A

asa2

60
Q

What is the ASA classifcation:
Severe systemic disease that limits activity.
(Mild diabetes, controlled hypertension, obesity)

A

asa3

61
Q

What is the ASA classifcation:

incapacitating disease that is a constant threat to life
CHF, Renal Failure

A

asa4

62
Q

What is the ASA classifcation: Moribund patient not expected to survive 24 hours
(Ruptured aneurysm)

A

asa5

63
Q

What is the ASA classifcation:

Brain-dead patient whose organs are being
harvested.

A

asa6

64
Q

1) Blood pressure in excess of 200 mmHg systolic or 115 mmHg
2) Uncontrolled hyperthyroidism
3) Severe cardiovascular disease
a) Less than 6 months after myocardial infarction
b) Less than 6 months after cerebrovascular accident
c) Daily episodes of angina pectoris or unstable angina
d) Cardiac dysrhythmias despite appropriate therapy
e) Postcoronary artery bypass surgery (CABG), less than 6 months
4) Undergoing general anesthesia with halogenated agents
5) Patient receiving nonspecific B-blocker, MAOi, Tricyclic antidepressants

Patients in categories 1 to 3a through 3d are classified as ASA 4 risks and NOT normally considered candidates for elective or emergency dental
treatment in the office

A

Medical Status of the Patient Contraindications to Vasoconstrictor

65
Q

t/f:

Key tips in delivering LA:

-Multiple aspirations
- Slow administration
-Minimum concentration of both
• Vasoconstrictor
• Local anesthetic

A

true

Pain Management 1 (6 decks)

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