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D2 Summer > Pain and Anxiety Week 1 > Flashcards

Pain and Anxiety Week 1 Flashcards

1
Q

The pre-anesthetic assessment consists of

A

1) complete medial/dental history
2) physical examination
3) psychological examination

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2
Q

List what should be included in the complete medical/dental history

A

1) current conditions
2) past conditions
3) OTC drugs, supplements
4) adverse reactions to meds
5) problems with previous dental treatment

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3
Q

What are concomitant meds?

A

2+ meds taken on same day which can alter efficacy and safety of LA’s

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4
Q

Physical examination includes

A

1) visual exam
2) BP
3) Pulse and RR
4) patient’s weight

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5
Q

The patient’s weight is used to determine the ____________ ____________ _________ of LA’s

A

maximum recommended dose (MRD)

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6
Q

What does stress increase?

A

Pulse rate
Respiratory rate

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7
Q

What do LAs increase?

A

BP

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8
Q

BP of 140-159/90-94

A

Consider N2O for stress reduction

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9
Q

BP of 160-199/95-114

A

Retake; refer for med consult before tx

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10
Q

BP of >200/>115

A

Retake; refer for med consult before tx

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11
Q

T/F: We have to decrease the MRD for children because they have immature livers

A

True

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12
Q

Acceptable HR’s for adults and children

A

Adult: 60-100
Child: 75-100
Toddler: 120-160

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13
Q

Acceptable RR’s for adults and children

A

Adult: 12-20
Child: 18-30
Toddler: 25-32

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14
Q

Unfounded fear of dental tx associated with traumatic, painful past dental tx

A

Dental phobia

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15
Q

What are some signs of moderate anxiety?

A

1) stiff posture
2) nervous “play”
3) “white knuckle” syndrome
4) sweating
5) “too cooperative”
6) nervous conversation
7) quick answers

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16
Q

What are 3 things we can do for stress reduction protocol?

A

1) adequate pain control
2) decrease pain of injection
3) select LA of appropriate duration

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17
Q

How does stress affect the body in regards to pain?

A

It decrease the pain reaction threshold

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18
Q

Risk assessment ABCDE

A

A → antibiotics; anesthesia; anxiety; allergy
B → bleeding
C → chair positioning
D → drugs; devices
E → equipment; emergencies

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19
Q

An unpleasant often strong emotion caused by anticipation or awareness of danger

A

Fear

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20
Q

What % of people in the population avoid dental care b/c of fear?

A

6-14%

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21
Q

Not eliminated as easily, tends to be a learned response from personal experience or from the experience of others

A

Anxiety

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22
Q

T/F: Fear is long-term

A

False! it’s short-lived

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23
Q

Anxiety is from ______________ or thought of dentistry

A

anticipation

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24
Q

Fear refers to the ___________ occurring in the dental office

A

rxn

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25
Q

What are the most relevant routes of drug administration in dentistry?

A

oral, topical, subcutaneous, inhalation

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26
Q

Technique of communication between the dentist and the pt that creates a bond of trust and confidence

A

Iatrosedation

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27
Q

Non-drug psychosedative techniques

A

Hypnosis, acupuncture, audioanalgesia

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28
Q

Which drug is most effective and most popular drugs for anxiety management in dentistry

A

benzodiazepenes

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29
Q

These are good for mild to moderate pre-treatment anxiety

A

Benzodiazepenes

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30
Q

Which benzos are the most common anxiolytic agents?

A

Diazepam and triazolam

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31
Q

Nitrous oxide documentation MUST include…

A

1) Informed consent obtained and documented in chart

2) Percentage of N2O administered

3) Length of time the patient was sedated

4) Flow rate of gases during administration

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32
Q

Nitrous oxide documentation SHOULD also include…

A

1) Indication for use

2) Pt response/tolerance

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33
Q

What are some features of nitrous that allow it to provide ideal sedation? (5)

A

-produces analgesic and anxiolytic effects
-rapid onset of 2-5 mins
-wide safety margin
-quick recovery
-no hangover effect

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34
Q

T/F: Nitrous has low solubility in the blood

A

True

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35
Q

T/F: Nitrous can’t cross the placenta

A

FALSE; it can which is why you need a med consult if you have a pregnant pt

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36
Q

At what % can nitrous oxide induce unconsciousness?

A

70% or higher

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37
Q

Nitrous oxide has no effect on….

A

HR and BP

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38
Q

What is nitrous oxide equivalent to?

A

Therapeutic dose of morphine

39
Q

Nitrous oxide is excreted ____________ through the _________, so it is ___________ in blood

A

unchanged; lungs; insoluble

40
Q

Indications for nitrous oxide

A
  1. Anxiety
  2. Tendency to faint
  3. Strong gag reflex
  4. Medically compromised pts (angina pectoris, post MI, most CVA)
  5. Long procedures
  6. Inadequate local anesthesia
41
Q

Administration of drug increases the possibility of a life threatening situation

A

Absolute contraindication

(do NOT administer under any circumstances)

42
Q

Administration of drug is preferably avoided due to possible adverse reactions

A

Relative contraindication

(administer judiciously)

43
Q

Absolute contraindications of nitrous oxide

A
  1. Nasal Obstruction
  2. Vitamin B12 Deficiency (can render B12 inactive)
  3. Alcoholic / Recovering Addict
  4. Uncommunicative (disability or language barrier)
  5. Patient Refusal
44
Q

Relative contraindications of nitrous oxide (9)

A
  1. Middle ear infection
  2. Balance disorder
  3. Susceptibility to Motion Sickness
  4. Claustrophobia
  5. Pulmonary Diseases (med consult)
  6. Immunocompromised (med consult)
  7. Pregnancy (med consult)
  8. Psychiatric Disorders/Bipolar (med consult)
  9. Marijuana or Hallucinogenic Drug Use
45
Q

Most common side effects of nitrous

A

Nausea, vomiting, headaches

46
Q

What are some risks of long term exposure to nitrous oxide?

A

Bone marrow suppression
Reproductive system disturbances (spontaneous abortion, premature delivery, infertility)
Neurological defects (numbness, difficulty concentrating, etc)
Hepatotoxicity

47
Q

What color is oxygen on nitrous oxide equipment?

A

Green

48
Q

What color is nitrous on nitrous oxide equipment?

A

Blue

49
Q

When does the nitrous pressure gauge start to fall?

A

Once all the liquid is gone and only gas remains

50
Q

Which button is used for over sedation and fills the reservoir bag?

A

Flush button

51
Q

Name the safety feature:

N2O flow terminated if O2 delivery pressure falls

A

Oxygen fail safe mechanism

52
Q

What is the minimum % of oxygen?

A

30%

53
Q

What is the maximum % of nitrous oxide?

A

70%

54
Q

Name the safety feature:

Allows atmospheric air in if flow of gases stops

A

Emergency air inlet

55
Q

Name the safety feature:

Rapid delivery of high flow O2 to patient (over sedation)

A

Oxygen flush button

56
Q

Name the safety feature:

Cannot inadvertently reverse tanks

A

Pin index safety system

57
Q

Steps of nitrous oxide administration

A
  1. Select proper sized nasal hood
  2. Flush reservoir bag (start w/ 5-6 L/min flow rate of 100% O2)
  3. Place nasal hood; pt. adjusts for comfort; tighten
  4. Tell pt. to breathe normally; adjust flow rate
  5. Gradually titrate in 10% intervals; watching for signs of sedation
  6. Typical pt requires 50% N2O/50% O2
  7. When tx is over, put N2O to zero and increase O2; 100% O2 for 5 mins
  8. Document procedure
  9. NEVER leave pt. unattended!!!
58
Q

Nervous system breakdown

A

-divided into CNS and PNS
-CNS and PNS divided into afferent and efferent
-PNS divided into somatic and autonomic
-Autonomic divided into sympathetic and parasympathetic

59
Q

3 main functions of neurons

A

1) receive info
2) process info
3) send response

60
Q

Structure of a neuron

A

Cell body, dendrites, axon

61
Q

What is the terminal end of an axon that allows the impulse to travel to another neuron via NTs called?

A

Synaptic knob

62
Q

T/F: Nerves are only found in the PNS

A

True

63
Q

What is a nerve made up of?

A

Many axons, an artery, and a vein

64
Q

CT around an axon

A

Endoneurium

65
Q

Group of axons

A

Fascicle

66
Q

CT around one fascicle

A

Perineurium

67
Q

CT around group of fascicles

A

Epineurium

68
Q

Which fibers are the largest and have the fastest impulse generation?

A

Type A fibers

69
Q

What are the 4 subtypes of Type A fibers?

A

A alpha
A beta
A gamma
A delta

70
Q

Which A fibers are the largest, fastest, efferent, and used for muscle movement?

A

Alpha

71
Q

Which A fibers are afferent and used for proprioception, touch, and pressure?

A

Beta

72
Q

Which A fibers are efferent and used for muscle tone?

A

Gamma

73
Q

Which A fibers are afferent and used for pain and temperature?

A

Delta

74
Q

T/F: Type A and C fibers can be afferent or efferent while Type B fibers are only efferent.

A

True

75
Q

Where are Type B fibers found?

A

Preganglionic ANS
Vascular smooth muscle

76
Q

Describe the myelination of Type A, B, and C fibers

A

Type A = myelinated
Type B = slightly myelinated
Type C = unmyelinated

77
Q

Which are the smallest, most numerous, and unmyelinated fibers?

A

Type C

78
Q

Which fibers are responsible for dull, achy pain?

A

Type C

79
Q

What type of fibers are prevalent in the oral cavity?

A

Type A and Type C

80
Q

Which fibers require more anesthetic volume? Why?

A

Type A (they’re larger)

81
Q

Types of stimuli that trigger nerve impulses

A

Chemical
Thermal
Mechanical
Electrical

82
Q

Neurons maintain RMP via?

A

1) Sodium-Potassium Pump
2) closed K+ channels
3) closed Na+ channels

83
Q

What causes the absolute refractory period?

A

Inactivation of Na+ channels during repolarization

84
Q

What causes the relative refractory period?

A

Hyper-polarization before RMP is established

85
Q

T/F: An action potential cannot be generated in the relative refractory period

A

False! it can be if a larger stimulus is applied

86
Q

2 types of synapses

A

Electrical and chemical

87
Q

What are the 2 ways that LA’s cause reversible local anesthesia?

A

prevents generation and conduction of impulses

88
Q

What do “membrane-stabilizing drugs” do?

A

Decrease rate of depolarization

89
Q

Small/large diameter nerve fibers are less/more sensitive to LAs

A

small; more

90
Q

Small/large diameter nerve fibers require less/more volume of LAs

A

Large; more

91
Q

What are the 2 major routes of LA delivery?

A

1) topical
2) submucosal injection

92
Q

T/F: Submucosal injections are more effective than topical

A

True

93
Q

Topical requires _______ concentrations and causes _________ chances of toxicity

A

greater; greater

94
Q

Which ion channels do LA’s bind to inside the cell?

A

Na+

D2 Summer (37 decks)

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