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Pain Management 1 > Oral Surgery Test Review > Flashcards

Oral Surgery Test Review Flashcards

1
Q

The following are associated with the extracellular space:

  • Na+
  • K+
  • Cl-
A

Na+

Is there more?

Na+, Cl-, Bicarb

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2
Q

The following are associated with the Intracellular space:

  • Na+
  • Cl-
  • K+
A

K+ and proteins

small amounts of Na+ Cl- and Bicarb
??????

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3
Q

_______ _______ is where local anesthesia exert their pharmacological actions

A

Nerve membrane

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4
Q

______ ______ ______: Local anesthesia bind to specific receptor on the
Na channel

A

SPECIFIC RECEPTOR theory

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5
Q

Nodes of Ranvier: Sodium channel is_______.

A

abundant

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6
Q

How Local Anesthesia Work?

A

• Decrease permeability of ion channels to Na

• Nerve block by local anesthesia is a
Non-depolarizing block

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7
Q

T/F: nerves have a quicker conduction than un-myelinated. AND….
Adelta and A Alpha (about 120 m/sec) are faster than C fibers (1.2 m/sec) .

A

true

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8
Q

Where does local anesthesia work at myelinated nerve?

A

the nodes of ranvier

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9
Q

Is local anesthesia hydrophilic or they like oily stuff?

A

Hydrophillic (injectable)

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10
Q

t/f: only the free base form of LA can diffuse through the wall of the nerve.

A

true

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11
Q

t/f:

↑ pKa translate to slow onset

A

true

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12
Q

t/f:

↓ pKa will have faster onset

A

true

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13
Q

t/f: Extracellular pH determines the ease for nerve blockade

A

true:

So, since: RNH = RN+H+

does the higher pH (more H+ shift the equation to RNH which cannot cross neerve membrane like free base can. This results in less effective LA?

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14
Q

t/f:

Greater lipid solubility relates to intrinsic potency

A

true – Nerve membrane is 90% lipid

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15
Q

t/f:

Increased protein binding will increase duration

A

true – Nerve membrane is 10% protein

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16
Q

Lipid Solubility influences: _______

A

potency

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17
Q

pKA influences: _______

A

onset

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18
Q

Protein Binding influences: ________

A

Duration

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19
Q

↑ Tolerance to drug after repeated administration

A

Tachyphylaxis

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20
Q

what are the Different classes of local anesthesia

A

Ester and Amide

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21
Q

______ most potent vasodilator

A

Procaine

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22
Q

_______ : the only local anesthetic with constrictor effect

A

Cocaine

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23
Q

_____ ______ has greatest % of anesthetics

A

Skeletal muscle

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24
Q

How do you calculate elimination half life?

A

Time needed for 50% reduction in blood level

  • 1st t ½ 50%
  • 2nd t ½ 75%
  • 3rd t ½ 87.5%
  • 4th t ½ 94 %
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25
Q

_______ local anesthetics cross blood-brain barrier, and placenta

A

ALL LA

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26
Q

How ______ metabolize in the body:

  • Hydrolyzed in plasma by pseudocholinesterase into paraaminobenzoic acid (PABA)
A

Ester Metabolism

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27
Q

How ______ metabolize in the body:

  • Primary biotransformation site is Liver
  • Liver function/ hepatic perfusion influence
    Pharmacology of Local Anesthesia Metabolism biotransformation

– Relative contraindication for
• ASA IV to V patient with liver dysfunction, heart failure

A

Amide Metabolism

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28
Q

Would CHF or Liver failure increase Ester availability, but decrease amide availability.

A

Please call or text me. I seriously have no clue.

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29
Q

_______ are primary excretory organ

A

Kidneys

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30
Q

Initial clinical signs/symptoms of CNS toxicity are________!

A

Excitatory

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31
Q

Further______ in toxicity leads to cessation of seizure activity:
 respiratory depression
 reparatory arrest

A

increase

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32
Q

What are the stages/ signs of local anesthesia over dose / toxicity?

A

– 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 drowsiness

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33
Q

the follow are examples of _____ _____:

 Epinephrine
 Norepinephrine
 Dopamine

A

natural catecholamines

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34
Q

The following are examples of ______ ______:

 Isoproterenol
 Levonordefrin

A

synthetic catecholamines

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35
Q

the following are examples of ___-_____:

 Amphetamine, Ephedrine, Methamphetamine

A

Non-catecholamines

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36
Q

All Cathecholamines work on adrenergic receptors with______ acting

A

direct

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37
Q

Adrenoceptors:

Vasoconstriction
increased peripheral resistance
increased BP 
mydriasis 
increased closure of internal sphincter of the bladder
A

Alpha 1

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38
Q

Adrenoceptors:

inhibition of norepinephrine release
inhibitiomn of insulin release

A

alpha 2

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39
Q

Adrenoceptors:

tachycardia
increased lipolysis
increased myocardial contractility

A

beta 1

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40
Q

Adrenoceptors:

vasodilatation
slightly decreased peripheral resistance
bronchodilation
increased muscle and liver glycogenolysis
increased release of glycogen
relaxed uterine smooth muscle

A

beta 2

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41
Q

In a ratio for epinephrine dilution, 1: 100,000

the 1= ______ mg

A

1000 mg

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42
Q

do the following question:

Epinephrine dilution:

a)
1: 300,000

vs.

b)
1: 200,000

Which one is more concentrated

A

a) 0.00333333333 mg/ml
b) 0.005mg/ml

B is more concentrated

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43
Q

_________:

Lack significant B2 actions 
• Intense vasoconstriction
 Almost exclusive alpha action 
• Dramatic elevation of blood pressure
 9X higher than epinephrine
A

norepinephrine

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44
Q

1) Blood pressure in excess of 200 mmHg systolic or 115 mmHg

A

Contraindication of vasoconstrictor

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45
Q

2) Uncontrolled hyperthyroidism

A

Contraindication of vasoconstrictor

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46
Q

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

A

Contraindication of vasoconstrictor

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47
Q

4) Undergoing general anesthesia with halogenated agents

A

Contraindication of vasoconstrictor

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48
Q

5) Patient receiving nonspecific B-blocker, MAOi, Tricyclic antidepressants

A

Contraindication of vasoconstrictor

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49
Q

Using the categories provided, which patients are considered ASA 4 risks and are not normally considered candidates for elective or emergency dental treatment in the office.

 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

A

1-3d

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50
Q

Do patient OD if your exceed MRD?

A

not always but the chances are definitely increased.

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51
Q

t/f: Maximum calculated drug dose should decrease in medically compromised, debilitated, or elderly persons

A

true

That’s correct. Disadvantaged people are slower in metabolizing these
drugs. So you need to decrease the MRD on them

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52
Q

Which drug?

 Onset of action: rapid (2-3 mins)
 Anesthetic t ½ : 1.6 hours

Maximum Recommended Dose (MRD)
 4.4mg/kg (Council on Dental Therapeutics of the ADA and USP convention)
 Absolute maximum 300mg
 8 Cartridges will be the maximum # used on a patient

 Healthy patient, maximum epinephrine is 0.2mg or 200mcg
 Cardio patient , maximum epinephrine is 0.04mg or 40mcg

A

Lidocaine

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53
Q

Which drug?
 Healthy patient, maximum epinephrine is 0.2mg or 200mcg
 Cardio patient , maximum epinephrine is 0.04mg or 40mcg

54
Q

Which Drug?

Maximum Recommended Dose (MRD)
 4.4mg/kg (Council on Dental Therapeutics of the ADA and USP convention)
 Absolute maximum 300mg
 8 Cartridges will be the maximum # used on a patient

55
Q

which drug?

 Onset of action: rapid (2-3 mins)
 Anesthetic t ½ : 1.6 hours

56
Q

Which drug?

 Onset of action: Rapid (1.5 to 2 mins)
 Anesthetic t ½ : 1.9 hours
 Maximum Recommended Dose ( MRD):
 4.4mg/kg
 Absolute maximum 300mg
 5.5 cartridges will be maximum # used on a patient
A

Mepivacaine

57
Q

Which drug?

 Onset of action: Rapid (1.5 to 2 mins)
 Anesthetic t ½ : 1.9 hours

A

Mepivacaine

58
Q

Which drug?

 Maximum Recommended Dose ( MRD):
 4.4mg/kg
 Absolute maximum 300mg
 5.5 cartridges will be maximum # used on a patient

A

Mepivacaine

59
Q

Which Drug?

 Onset of Action: slightly slower (2-4 mins)
 Anesthetic t ½ : 1.6 hours
 Maximum Recommend Dose:
 6.0mg/kg
 Absolute Maximum 400mg
 5.5 cartridges will be the maximum # used on a patient

A

Prilocaine

60
Q 
Which drug? 
 Onset of Action: Longer 6-10 mins
 occasionally similar to lidocaine
 Anesthetic t ½ : 2.7 hours (Long Duration)
 Maximum Recommended Dose:
 1.3mg/kg
 Absolute maximum 90 mg
 10 cartridges is the maximum # used on a patient
A

Bupivacaine

61
Q

Which Drug?

 Onset of Action: slightly slower (2-4 mins)
 Anesthetic t ½ : 1.6 hours

A

Prilocaine

62
Q

Which Drug?

 Maximum Recommend Dose:
 6.0mg/kg
 Absolute Maximum 400mg
 5.5 cartridges will be the maximum # used on a patient

A

Prilocaine

63
Q

Which Drug?

Which drug?
 Onset of Action: Longer 6-10 mins
 occasionally similar to lidocaine
 Anesthetic t ½ : 2.7 hours (Long Duration)

A

Bupivacaine

64
Q

Which Drug?

 Maximum Recommended Dose:
 1.3mg/kg
 Absolute maximum 90 mg
 10 cartridges is the maximum # used on a patient

A

bupivacaine

65
Q

Which Drug?

 Onset of Action:1-2 mins infiltration
 Anesthetic t ½ : 0.5 hours

 Maximum Recommended Dose:
 7mg/kg

66
Q

Which drug?

 Onset of Action:1-2 mins infiltration
 Anesthetic t ½ : 0.5 hours

67
Q

Which Drug?

 Maximum Recommended Dose:
 7mg/kg

68
Q

Articaine is ____% concentrated

A

articaine is 4% concentrated

69
Q

The following are contraindications to which drug?

 Patient allergic to amide type anesthesia (few to none)
 Sulfite sensitivity
 Caution with hepatic disease
 Patient with significant impairments in cardiovascular function
 Children < 4 y/o is not recommended due to insufficient data

70
Q

t/f: Articaine cannot be used on children 4 y/o and younger.

71
Q 
t/f:  After 55 years of clinical use,
2% lidocaine with 1:100,000
epinephrine is still the closest to
the ideal intermediate-duration
local anesthetic in dentistry.
72
Q

t/f:

 Healthy patient, maximum epinephrine is 0.2mg or 200mcg
 Cardio patient , maximum epinephrine is 0.04mg or 40mcg

73
Q

What is the most common cause of failure to acheive adequate anesthesia?

A

anatomical variation and faulty technique

74
Q

t/f: the smaller the gauge the bigger the diameter of the needle

75
Q

Can we use needle on more than one pt?

76
Q

t/f: the needle should be covered with the protective sheath when not in use.

77
Q

What technique do you use to recap the needle?

A

the scoop technique

78
Q

are you ever to bend the needle?

79
Q

t/f: Larger gauge does not = higher gauge.

higher gauge = smaller diameter.

Larger gauge is wider diameter.

super confusing. but high is not a size descriptor.

80
Q

it is recommended to use 25- or at
least 27-gauge needle.

this reduces the chance of needle breakage.

81
Q

Which bacteriostatic agent was removed from LA cartridge in 1984?

A

methylparaben

82
Q

 No manufacturer claim of sterility about exterior surface
of the cartridge
 Bacterial culture tested fail to produce any growth
 Cannot withstand extreme temperature
 No autoclaving especially plastic cartridge
 When heated, vasopressors are destroyed
 Store in room temperature in a dark place
 Study showed no benefit of using cartridge warmer
 Do NOT soak cartridge in alcohol or “cold sterilizing
solution”
 Semipermeable diaphragm permits diffusion of these solution
 Read the drug package insert

A

Care and Handling of Cartridge

83
Q

t/f: never soak cartridge in sterlizing solution

84
Q

t/f: Most common psychogenic reactions
 Vasodepressor syncope
 Hyperventilation

85
Q

Cimetidine + ASAIII CHF = ______
contraindication for amide local anesthesia

or is it (malignant hyperthermia and methemoglobinemia)

A

relative contraindication

86
Q

 Epinephrine-impregnated gingival retraction cord is ______ contraindicated in the cocaine abuser
 Postpone dental treatment, if suspected cocaine
usage within 24 hours

A

absolutely conraindicated

87
Q

_______ Contraindication with local
anesthesia
 Malignant Hyperthermia
 Methemoglobinemia (to Prilocaine)

A

Relative Contraindication

88
Q 
\_\_\_\_\_ \_\_\_\_\_\_ with local
anesthesia
 Malignant Hyperthermia
 Methemoglobinemia (to Prilocaine)
 Cimetidine + ASAIII CHF = relative
contraindication for amide local anesthesia
A

Relative Contraindication

89
Q

Where does the ophthalmic (v1) branch go through?

A

superior orbital fissure

90
Q

where does the maxillary branch (v2) go through the skull?

A

foramen rotundum

91
Q

where does the mandibular (v3) branch of the trigeminal nerve pass through?

A

the foramen ovale

92
Q

One of the branch of CN V (trigeminal nerve), upon exiting cranial base, make a quick 180 degree turn back into cranium. This nerve provides sensory innervations to the dura mater. Its_____________ nerve.

A

middle meningeal nerve

93
Q

the ______ branch of the trigeminal nerve is both sensory and motor.

A

mandibular (v3)

94
Q

psa stand for?

A

posterior superior alveolar

95
Q

PSA Nerve Block Areas Anesthetized;

A

 Maxillary molar tooth pulps
 MB root of 1st molar in (NOT ALWAYS slide says 72%)
 Buccal periodontium and bone

96
Q

Which Maxillary injection procedure is described here:

  1. Insert needle at the height of vestibule
  2. This insertion is 45 degrees upward, backward and in.
  3. insert to 16mm depth
  4. ASPIRATE
  5. if - aspiration, then Inject 0.9ml-1.8ml
  6. if + aspiration, remove slightly and reposition. we want - aspiration
A

Posterior Superior Alveolar Nerve Block

97
Q

t/f: you always aspirate with PSA nerve block

98
Q

t/f: a disadvantage of PSA nerve block is the disfiguring hematoma risk

99
Q 
Which Nerve Block? 
 Present in some patients
 Premolars
 MB root of 1st molar in 28%
 Buccal periodontium and bone
A

Middle Superior Alveolar Nerve block

100
Q

Which Nerve Block technique is described?

  1. insert the needle with the bevel facing the bone well above the premolar apices
  2. apsiration is optional?
  3. inject 0.9-1.2 ml
A

Middle Superior Alveolar Nerve Block (MSA)

101
Q 
Which Nerve Block? 
Areas Anesthetized
 Maxillary central through canine
 Premolars
 MB root of first molar in 28% of patients
 Buccal periodontium and bone
 Lower eyelid, side of nose, upper lip
A

Anterior Superior Alveolar Nerve
(ASA)

aka

Infraorbital Nerve Block

102
Q
  1. Locate the Foramen by Palpation
  2. Foramen ~ 16 mm Above Vestibule
  3. Insertion Depth ~ ½ Long Needle
  4. insertion for this nerve is almost always in line with the pupils.
  5. Orient Needle Bevel Towards Bone
  6. Insert Gently Until Bone Contacted this is the roof of the infraorbital foramen
  7. Aspirate and Inject 0.9 to 1.2 ml
  8. Maintain Pressure During Injection
  9. Maintain Pressure One Minute After Injection
A

ASA

anterior superior alveolar Nerve block

103
Q 
Which injection? 
Areas Anesthetized
 Tooth
 Buccal periodontium
and bone
 Labial or buccal
mucosa
A

Supraperiosteal Injection (Local Infiltration)

104
Q

Which local infiltration is described below:

  1. Insert Superior to Root Apex
  2. Orient Needle Bevel Towards Bone
  3. Inject 0.6 ml of anesthetic
A

Supraperiosteal injection

105
Q 
Which  Nerve Block ? 
Areas Anesthetized
 Posterior portion of hard palate
 Overlying soft tissues
 No anesthesia of teeth
A

Greater Palatine Nerve Block

106
Q 
Which nerve block
 Areas Anesthetized
 Anterior portion of hard palate
 Both hard and soft tissues
 No anesthesia of teeth
A

Nasopalatine Nerve Block

107
Q

Which nerve block is described?

  1. apply topical for 2 min to the soft tissue covering the greater palatine foramen
  2. Move Applicator Over Foramen – Apply Direct Pressure 30 Seconds
  3. Place Needle Bevel Against Tissue and Bow the Needle
  4. Administer a Few Drops of Local
  5. Straighten and Advance the Needle, contact bone, but do not go into foramen
  6. Aspirate, Deposit 0.45 to 0.6 ml
A

Greater Palatine Nerve Block

108
Q

Which nerve block is described?

  1. Apply Topical for Two Minutes
  2. apply direct pressure
  3. Contact Bone, Administer 0.45 ml
A

Nasopalatine Nerve Block

109
Q

What is the name of the other approach to nasopalatine nerve block?

A

Transpapillary Approach

110
Q

Which nerve block?

  1. Apply Topical Lateral to Frenum
  2. Blanching of Labial Tissue
  3. Insert Through Papilla Towards Palate
  4. Administer 0.3 ml Into Papilla
A

nasopalatine nerve block trans-papillary approach

111
Q

t/f: the anterior branch of the mandibular nerve gives rise to the muscles of mastication.

112
Q

t/f: the buccal branch is a branch of the anterior branch, and is in a league of its own. You really have to numb it if you want to take care of buccal tissue around mandibular molars

113
Q

What are the two major branches from the posterior branch of the mandibular nerve?

A

inferior alveolar and the lingual

114
Q

Which Mandibular nerve Block?

Tissues Anesthetized
• Gingiva buccal to molars
• Retromolar pad mucosa
• Buccal mucosa in molar area
• NO hard tissues anesthetized
A

Buccal Nerve Block

115
Q

t/f: The injection site for the buccal nerve block is just buccal to the molars.

116
Q

Which mand Nerve block is described?

  1. find injection site: just buccal to molars (looks like on occlusal plane
  2. Injection – 25 Gauge Long Needle
  3. during injections, stretch the tissue
  4. contact periosteum
A

buccal nerve block

117
Q

________ Innervates Anterior 2/3 of Tongue and Innervates Lingual Mucosa

A

lingual nerve

118
Q

What is the largest branch of the posterior division?

A

inferior alveolar nerve (IA)

119
Q

Which Mandibular nerve block is described?

  1. Syringe at Level of Coronoid Notch
  2. Syringe Directed Across Arch
  3. needle penetrates buccinator muscle and lateral to the Pterygomandibular Raphe
  4. dry injection site
  5. apply topical
  6. wait one or two minutes with topical
  7. Finger on Notch Retracts Cheek and Determines Height of Injection
  8. Barrel of Syringe in Corner of Mouth
  9. Aspirate, Inject 1.5 ml over 60 Sec.
  10. Insert~25mm to Contact Bone
  11. Withdraw Halfway, Deposit 0.1 ml at Lingual Nerve
A

Inferior alveolar nerve block

120
Q

Which nerves are Anesthetized with the Inferior Alveolar Nerve Block?

  • Inferior alveolar
  • Incisive
  • Mental
  • Lingual (usually)
  • All of the above
121
Q

areas Anesthetized with IA nerve block include:

  • entire quqadrant of dentition
  • entire quadrant of lingual mucosa
  • incisor to 2nd pm of buccal mucosa
  • 1/2 of tongue
  • all above
122
Q

which mand nerve block is described?

  1. Palpate the Mental Foramen (xray)
  2. site of injection is the depth of the vestibule
  3. dry and apply topical
  4. bevel to bone
  5. Insert into Tissue Over Foramen.
  6. Deposit 0.6 ml over 20 seconds.
A

Mental nerve block

123
Q

Areas Anesthetized by ____ ____ _____
• Mucosa anterior to foramen
• Skin of the lower lip • Chin

A

mental nerve block

124
Q

In Gow-Gates nerve Block:

the needles contacts ____ __ _____

A

neck of condyle

125
Q

What are the two extra oral landmarks for the gow-gates nerve block?

A

corner of mouth

intertragic notch

126
Q

Which mand Nerve block is described?

  1. Wide Opening, Condyle Moves Forward
  2. Needle Puncture Point Dictated by Intra-oral Landmarks
    (corner of mouth and the intratragic notch)
  3. Advance Until Bone Contacted
  4. Withdraw 1 mm, Aspirate, Inject 1.8 ml
127
Q

_________ Nerve Block Nerves Anesthetized

• Inferior Alveolar • Lingual • Mylohyoid • Auricolotemporal • Buccal (in 75 %)

128
Q

Which mand nerve block is described?

  1. Closed Mouth
  2. Height of Injection: Maxillary Muco- Gingival Line
  3. Direct parallel to ramus
  4. Insert to 25 mm depth
  5. Aspirate, Inject 1.5 to 1.8 ml
A

Vazirani-Akinosi Nerve Block

129
Q

Vazirani-Akinosi Nerve Block Nerves Anesthetized:

• Inferior Alveolar
• Lingual
• Mylohyoid
- all above

130
Q

list the following in order of highest on the condyle?

highest at top of list

A

gow gates
Vazirani-Akinosi Nerve Block
IA

Pain Management 1 (6 decks)

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