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Pain & Anxiety > Midterm > Flashcards

Midterm Flashcards

1
Q

Peripheral Nerve Fiber Classification

​Which subtype of Type A fibers is efferent; muscle tone?

A

A(gamma)

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2
Q

How do you prevent Needle Breakage?

A
  • use 25 g or 27 g needles
  • Use long - 32mm needle for IA block
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3
Q

What are the 2 Needle lengths used in Dentistry?

A
  1. Long - 32 mm
  2. Short - 20 mm
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4
Q

Peripheral Nerve Fiber Classification

​Which subtype of Type A fibers is afferent; proprioception, touch, pressure?

A

Type A(beta)

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5
Q

What effect does Sodium bisulfite have on the LA?

A
  • decrease solution pH = more acidic = delayed onset
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6
Q

What is the relative refractory period due to?

A

hyperpolarization before RMP is established

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7
Q

Peripheral Nerve Fiber Classification

​Which subtype of Type A fibers is, the largest; fastest; efferent; muscle movement?

A

A(alpha)

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8
Q

What are the 2 causes of Facial Paralysis?

A
  1. LA deposited in parotid gland
  2. bone not contacted during mandibular block
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9
Q

What LA is not used for hemostasis?

A

Mepivacaine

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10
Q

What is the MRD per appointment for Mepivacaine?

A

Adult = 400mg Child = 300mg

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11
Q

What type of LA should you select if you need hemostasis?

A
  • Epi ONLY (no levonordefrin)
  • 1:50,000 best
    • 1:100,000 is better than 1:200,000
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12
Q

What is the Tx of Paresthesia?

A
  • 3 wks to 3 months, possible 1 yr
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13
Q

Acceptable RR for an Adult?

A

12-20

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14
Q

What are the 3 causes of Edema?

A
  1. Trauma
  2. Contaminated Anesthetic
  3. Allergic rxn to LA/sodium bisulfite
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15
Q

What is the absolute refractory period due to?

A

inactivation of Na+ channels during repolarization

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16
Q

What is the onset time of Bupivacaine?

A

5-10 mins

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17
Q

What are the symptoms of Allergic Reactions?

A
  • Delayed Hypersensitivity = rash; itching
  • Immediate Hypersensitivity = anaphylaxis
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18
Q

What length of needle is ALWAYS required for a Mandibular Block?

A

Long - 32mm

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19
Q

What concentration of Cetacaine is used?

A
  • 14% Benzocaine
  • 2% Butamben
  • 2% Tetracaine
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20
Q

What is the mechanism of action of Topical Anesthetics?

A
  • dec Na+ ion permeability = dec depolarization = blocks nerve impulse
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21
Q

Relative Contraindications of LAs (6)

A
  1. H2-receptor blockers
  2. Beta Blockers
  3. CNS Depressants
  4. Pregnancy
  5. Significant Liver Ds
  6. Renal Dysfunction
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22
Q

How do you prevent a Hematoma?

A
  • Use 27g short - 20mm needle for PSA
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23
Q

What effect does a Vasoconstrictor in LA have on Duration = Potency?

A

dec BF = inc Duration = inc Potency

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24
Q

Acceptable HR for a Child?

A

75-100

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25
Q

What is the MRD per appointment for Bupivacaine?

A

Adult = 90mg Child = 90mg

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26
Q

What is the onset time for Lidocaine?

A

2-3 mins

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27
Q

What Amide LA’s are metabolized in the Liver ONLY (inc toxicity in liver ds)?

A
  • Lidocaine
  • Mepivacaine
  • Bupivacaine
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28
Q

What 3 factors affect the duraction of LA = Potency?

A
  1. Protein binding of specific LA
  2. Vascularity of injection site
  3. Vasoconstrictor in LA
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29
Q

Peripheral Nerve Fiber Classification

  • Largest fibers = fastest impulse conduction
  • Myelinated
  • Afferent or Efferent
A

Type A Fibers

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30
Q

What is the weakest part of the needle?

A

Hub + Needle Adaptor (1 piece)

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31
Q

What size of nerve fibers are MORE sensitive to LAs?

A

Small diameter

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32
Q

Which Amide is the most potent vasodilator?

A

Bupivacaine

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33
Q

What is the effect of inc protein binding of molecules on LA?

A

inc duration

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34
Q

What are the symptoms of Syncope?

A
  • Sweating; nausea, pallor
  • inc HR and inc RR
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35
Q

What is the duration of topical lidocaine?

A

15-45 min

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36
Q

What vasoconstrictor should be used if the pt is taking tricyclic anti-depressants?

A
  • 0.04mg Epi
  • No Levo
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37
Q

Peripheral Nerve Fiber Classification

​Which subtype of Type A fibers is afferent; PAIN; temperature?

A

A(delta)

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38
Q

What is the duration of action of 4% Prilocaine 1:200,000 epi?

A

60-90 mins

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39
Q

What LA is a good choice for readministration, CV ds, and Liver ds pts?

A

Articaine

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40
Q

What is a good choice if a vasoconstrictor is contraindicated?

A

Mepivacaine

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41
Q

What Amide LA’s are metabolized in Liver + Lungs (shorter 1/2 life due to lungs)?

A

Prilocaine

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42
Q

What causes the rapid onset of Nitrous Sedation?

A

low solubility in blood

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43
Q

What Pregnancy Category is Mepivacaine, and is it safe for lactation?

A
  • Category C
  • Lactation Safe
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44
Q

What is the duration of Cetacaine?

A

30-60 min

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45
Q

How do LA’s stabilize the membrane?

A

Decreases the rate of depolarization; membrane remains polarized

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46
Q

What is another name for Benzocaine?

A

Hurricaine

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47
Q

What is the most common cause of a Hematoma?

A
  • Entering the venous Pterygoid Plexus when giving a PSA block

Remember to use a short 20mm, 27g needle @ 45 angles to long axis of tooth and to alveolar bone

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48
Q

Is Cetacaine and Ester or Amide?

A

Ester

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49
Q

Which LA is the best choice for long tx and post-op pain control?

A

Bupivacaine

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50
Q

What is the MRD per appointment for Prilocaine?

A

Adult = 400mg Child = 400 mg

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51
Q

What size of nerve fibers require MORE volume of LAs?

A

Large diameter

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52
Q

What Topical Anesthetic is a good choice for thoose allergic to esters?

A

Lidocaine

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53
Q

What is the active form of the drug that canNOT cross the membrane?

A
  • RNH+ = cations (acid)
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54
Q

Amide LA’s are combined with an acid to form what?

A

HCl Salt = water soluble = stable injectable solution

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55
Q

What is the Tx of Trismus?

A
  • 2-3 days
  • moist heat (20 min on/ 20 min off)
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56
Q

What are the symptoms of Epi Overdose?

A
  • Fight or Flight response - lasts 5-10 mins
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57
Q

What is the primary factor associated with the Induction (diffusion of molecules across membrane) of LA’s?

A
  • Initial concentration
    • inc conc = inc diffusion = rapid onset
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58
Q

How does an inc pKa = inc cations = dec base affect the diffusion across the membrane?

A

Slower onset = slow diffusions

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59
Q

What LA’s are Long-Acting (90min or > pulpal anesthesia)?

A
  • 0.5% Bupivacaine 1:200,000
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60
Q

What is the Tx for Allergic Rxns?

A
  • Delayed = antihistamine, and document
  • Immediate life-threatening Anaphylaxis
    • Stabilize pt
    • Activate EMS
    • Document
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61
Q

What level of LA’s shows initial CNS Stimulation (inc HR, RR, and BP, muscle twitching, tremors)?

A

Moderate Overdose of LA’s

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62
Q

What is the Tx for Epi Overdose?

A
  • Healthy Pts = reassure
  • CV Pts = prepare for medical emergency
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63
Q

What is the duration of action of Prilocaine without epi (4% Prilocaine Plain)?

A

40-60 mins

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64
Q

What is the tx for Hematoma?

A
  • Apply ice/pressure immediately
  • inform pt of swelling/discoloration 7-14 days
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65
Q

What is the primary excretory organ for all LA’s?

A

Kidney

66
Q

What is the Tx for Infection?

A
  • Antibiotics after 3 days
67
Q

What level of LA’s shows CNS Depression, due to vasodilation (dec HR, RR, and BP, convulsions, unconsciousness, progresses to resp arrest)?

A

High Overdose of LA’s

68
Q

What Pregnancy Category is Articaine, and is lactation safe?

A
  • Category B
  • Unknow Lactation Safety
69
Q

How much nerve length must an LA penetrate to block a nerve impulse?

A

8-10mm (3-4 nodes of Ranvier)

70
Q

At what BP range should you retake; refer for med consult before tx?

A

160-199/95-114

71
Q

What pregancy category is Bupivacaine, and is it safe for lactation?

A
  • Category C
  • Unknown Lactation Safety
72
Q

In the reinjection of LA, if nerve fibers are fully recovered (no numbness) what occurs?

A

Tachyphylaxis = tolerance to LA = LA is ineffective

73
Q

Which LA’s are effective topicals?

A
  • Lidocaine
  • Prilocaine
74
Q

LA’s provide what between the source of impulse and the brain so that the impulse never reaches the brain?

A

Chemical Block

75
Q

Peripheral Nerve Fiber Classification

  • Smallest & unmyelinated
  • Most numerous
  • Afferent & Efferent
  • Post-ganglionic ANS; temperature; PAIN
    • Dull, achy pain
A

Type C Fibers

76
Q

Other name for Lidocaine

A

Xylocaine

77
Q

How does a dec pKa = inc anions = inc base, affect the diffusion across the membrane?

A

Rapid onset = fast diffusion

78
Q

What do Type A fibers require more of?

A

MORE anesthetic Volume

79
Q

What are the 3 common Topical Anesthetics used in Dentistry?

A
  1. Benzocaine
  2. Lidocaine
  3. Cetacaine (Benzocaine + Butamben + Tetracaine)
80
Q

What needle is used for Greater Palatine Blocks, and how are they performed?

A
  • 27g needle
  • insertion until bevel is buried ~1/4’’
  • Use 1/4 carpule = 0.25cc or until tissue blanches
81
Q

What is the onset time for Prilocaine?

A

2 mins

82
Q

What is the duration of action of Mepivacaine without epi (3% Mepivacaine)?

A

20-40 mins

83
Q

What is the onset time of Mepivacaine?

A

1.5-2 mins

84
Q

What effect does stronger protein binding have on the duration = potency of specifc LA?

A

stronger binding = inc Duration = inc Potency

85
Q

What Amide LA’s are metabolized 90% in Plasma and 10% in Liver?

A

Articaine

86
Q

What is the affect of inc vasodilation of LA?

A

dec potency + dec duration = inc dose needed

87
Q

What are the primary and secondary factors associated with the Onset of Action of LA’s?

A
  • dec pKa = rapid onset
  • small diameter nerves = rapid onset
88
Q

What is the duration of action of 2% Mepivacaine 1:20,000 levo?

A

60 mins

89
Q

What 5 things are included in the contents of the carpule?

A
  1. LA durg
  2. Sodium hydroxide
  3. Sodium chloride
  4. Vasocontriction = Epi or Levonordefrin
  5. Vasoconstrictor preservative = Sodium bisulfite (allergic rxns)
90
Q

What concentration of Benzocaine is most commonly used?

A

20%

91
Q

What are the 4 causes of Paresthesia?

A
  1. Trauma to nerve sheath (pt feels a “shock”)
  2. Edema/hemorrhage near nerve
  3. Contaminated Anesthetic
  4. Possible association with Articaine
92
Q

If nerve fibers are only partially recovered (pt still numb) for the Reinjection of LA what would be effective?

A

Small volume is effective with Rapid Onset

93
Q

3 Causes of EPi Overdose?

A
  1. 1:50,000 concentration
  2. Intravascular injection
  3. CV pts
94
Q

How far into the tissue should the needle be for a mandibular block?

A
  • 1 inch
  • 2/3 to 3/4 length of long -32mm needle
95
Q

What is the primary factor for the Recovery from LA Block (reversal of LA action)?

A

Degree of binding to receptor site

96
Q

What are the symptoms of LA Overdose?

A
  • Low Overdose = CNS Excitation
  • Higher Overdose = CNS and CV Depression
97
Q

What 4 factors increase Absorption of LA (inc risk of systemic toxicity)?

A
  1. Total Dose Administed (inc dose)
  2. LA concentration (inc conc)
  3. Route of Admin (topical)
  4. Vascularity of Admin site (intravascular injection)
98
Q

Acceptable RR for a Child?

A

18-30

99
Q

In Topical Anesthetics there is an association between Benzocaine Sprays and what?

A

Methemoglobinemia

100
Q

In the Depolarization of the Membrane, what does the threshold (+15-20mV) stimulus trigger?

A
  • Ca+ & Na+ ion channels to open
  • Na+ ions flow INTO neuron = inside becomes + charged
101
Q

At what BP range should you consider N2O for stress reduction?

A

140-159/90-94

102
Q

Other name for Mepivacaine

A

Carbocaine

103
Q

What are the 5 Absolute Contraindications for Nitrous Oxide Sedation?

A
  1. Nasal Obstruction
  2. Vit B12 Def
  3. Alcoholic/Recovering Addict
  4. Uncommunicative
  5. Patient Refusal
104
Q

What LA’s are Short-Acting (30 min pulpal anesthesia)?

A
  • 3% Mepivacaine - plain
  • 4% Prilocaine - plain
105
Q

What are the Topical Ester LA’s?

A
  • Benzocaine
  • Tetracaine
  • Procaine
106
Q

What is the duration of action of 4% Articaine 1:200,00 epi?

A

45-60 mins

107
Q

Other name for Prilocaine

A

Citanest

108
Q

What LA should be used for pts with Significant Liver Ds?

A

Articaine

109
Q

What is the effect of Infection of LA’s?

A

Inadequate Anesthesia

110
Q

What LA has the shortest half life?

A

Articaine

111
Q

What is the onset of Topical Lidocaine?

A

2-10 min

112
Q

Is Benzocaine and Ester or Amide?

A

Ester

113
Q

What is the effect of increased concentration of LA?

A

Inc diffusion through membrane = Rapid onset

114
Q

What CV effects occur with a Mild Overdose of LA’s?

A

slight inc BP, inc HR, inc RR

115
Q

What is the Tx for Edema?

A
  • NONE
  • Resolves within 3-4 days
116
Q

How do neurons maintain RMP polarization?

A
  1. Na/K Pump
  2. OPEN K+ channels
  3. CLOSED Na+ channels
117
Q

Acceptable HR for a Toddler?

A

120-160

118
Q

What is the inactive, lipid soluble form of the drug that crosses the membrane?

A

RN = anions (base)

119
Q

What do Topical LA require?

A
  • Increased concentrations (needed to penetrate mucosa)
  • Increased Toxicity
120
Q

What level of LA’s shows no CNS effects; may have anti-convulsant properties?

A

Low blood levels of LA’s

121
Q

What are the 3 causes of Allergic Rxns?

A

Hypersensitivity Rxn to:

  1. Methylparaben
  2. Sodium bisulfite
  3. ester topical
122
Q

What Pregnancy Category is Lidocaine, and is it safe for lactation?

A
  • Category B
  • Lactation Safe
123
Q

What is the cause of Syncope?

A
  • Drastic drop in BP
  • Emotional Response (to injection)
124
Q

Peripheral Nerve Fiber Classification

  • Slightly myelinated
  • Efferent
  • Preganglionic ANS; vascular smooth muscle
A

Type B Fibers

125
Q

What is the onset time for Articaine?

A

1-3 mins

126
Q

Acceptable HR for an Adult?

A

60-100

127
Q

What is the duration of Benzocaine?

A

5-15 mins

128
Q

Prior to 1984 what was added to LA solutions without Epi?

A

Methylparaben (allergy)

129
Q

Overdose of vasoconstrictors usually occurs via

A

Intravascular injection

130
Q

What is the duration of action of 0.5% Bupivacaine 1:200,000 epi?

A

1.5-3 hrs

131
Q

What factor decreases absorption of LA?

A

increased vasoconstrictor

132
Q

What is the effect of increased Lipid solubility on LA’s?

A
  • inc Potency = dec dose needed
  • inc diffusion through membrane = Rapid onset
133
Q

What is the MRD of Topical Lidocaine?

A

200 mg

134
Q

What CV effects occur with a High Overdose of LA’s?

A

CV Depression (dec HR, RR, and BP, slurred speach, disorientation, unconsciousness, progress to Cardiac Arrest)

135
Q

What are the Absolute Contraindications to LA’s?

A

Allergy

136
Q

What LA is highly lipid soluble and has high diffusion through bone?

A

Articaine

137
Q

What is the least toxic LA in dentistry?

A

Prilocaine

138
Q

What are the 8 Absolute Contraindications for Vasoconstrictors?

A
  1. MI/Coronary Bypass surgery within 3-6 months
  2. Uncontrolled Hypertension
  3. Uncontrolled Angina Pectoris
  4. Uncontrolled Arrhythmias
  5. Uncontrolled Hyperthyroidism
  6. Sulfite allergy
  7. Glaucoma
  8. Cocaine/Meth Use
139
Q

What is the MRD per appointment for Articaine?

A

Child = 500mg

140
Q

What gauge needle is the safe choice in high risk areas?

A

25 g (large diameter) provides reliable aspiration

141
Q

What is the MRD per appointment for Lidocaine?

A

Adult = 500mg Child = 300mg

142
Q

How does LA prevent Na+ ions from moving inside the cell?

A

LA’s bind to Na+ channels inside the cell, preventing them from opening

143
Q

What LA is the best choice for pregnant and CV pts?

A

Prilocaine

144
Q

Acceptable RR for a Toddler?

A

25-32

145
Q

What are the 3 needle gauge sizes used for intraoral injections?

A
  1. 25 g
  2. 27 g
  3. 30 g
146
Q

What LAs should be used if pregnant?

A
  • Prilocaine or Lidocaine
147
Q

At what BP range should you retake; refer for immediate med consult?

A

>200/>115

148
Q

What does Repolarization of the membrane begin with?

A
  • Movement of K+ ions to OUTSIDE
  • Na/K pump moves Na+ ions to OUTSIDE = restores RMP
149
Q

What Pregnancy Category is Prilocaine, and is lactation safe?

A
  • Category B
  • Unknown Lactation Safety
150
Q

What is the onset of Cetacaine?

A

30 sec

151
Q

Other name for Bupivacaine

A

Marcaine

152
Q

What is most commonly used in dentistry for nerve block?

A

Lidocaine

153
Q

What CV effects occur with a Moderate Overdose of LA’s?

A

initial CV Stimulation (inc HR, inc RR, inc RR, headache, lethargy)

154
Q
  • Which LA is the most potent and most toxic LA used in dentistry
  • Highly lipid soluble and binds strongly
A

Bupivacaine

155
Q

What concentration of Topical Lidocaine is used?

A

2-5%

156
Q

Other name for Articane

A

Septocaine

157
Q

What are the 4 functions of Vasoconstrictors in LA’s?

A
  1. Constrict bv’s = dec Dose of LA
  2. inc Duration of LA x6
  3. Hemostatis
  4. dec Absorption rate of LA = dec risk of Toxicity
158
Q

What is the MRD of Cetacaine?

A

200 mg

159
Q

What effect does an increased vascularity of the injection site have on the Duration = Potency of LA?

A

inc vascularity = dec Duration = dec Potency

160
Q

What is the duration of action of 4% Articaine 1:100,00 epi?

A

60-75 mins

161
Q

What is the onset of Benzocaine?

A

Rapid onset = 30sec - 2mins

Pain & Anxiety (3 decks)

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