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Pain Management > PM final > Flashcards

PM final Flashcards

1
Q

Nerve block injection

A

Disposition near a major nerve trunk at a greater distance from the area of treatment, which provides wider areas of anesthesia

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2
Q

PDL injection

A

And intraosseous injection technique for single tooth, for supplemental anesthesia of individual teeth and other techniques have failed to provide profound anesthesia, when widespread anesthesia is contra indicated, and when total doses need to be minimum

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3
Q

Interseptal technique

A

The interseptal technique provides pain management for the periodontium lingual to a tooth and can be particularly useful when palatal tissues require anesthesia and clinicians and or patients wish to avoid palatal injections

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4
Q

Infiltration injection

A

The disposition of local anesthetic drug directly at or near small terminal nerve endings in the immediate area of treatment

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5
Q

Diffusion hypoxia

A

Decreased O2 saturation levels in the blood caused by the rapid exit of nitrous on its termination

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6
Q

Partial pressure gradients

A

Inhaled agents act on the body by moving across partial pressure gradients

Move from a higher to a lower pressure gradient

The difference between the partial pressure of a gas any liquid indicated how quickly the agent crosses the pulmonary membrane and enters into the bloodstream (blood-gas partition coefficient)

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7
Q

Anxiety

A

An emotional response to a threat or danger that is not immediately present or is unclear

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8
Q

Fear

A

An emotional response to an immediate threat or danger

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9
Q

Phobia

A

A persistent, irrational fear of a specific object or situation the results in a compelling desire to either avoid the situation or to endure it with dread

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10
Q

Sensoring neurons

A

Carry incoming signals (impulses) from the body to the central nervous system for processing

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11
Q

Motor neurons

A

Carry impulses from the central nervous system to cells, tissues, and organs

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12
Q

Dendritic zones

A

Sites of nerve impulses initiation of sensory neurons in response to stimulation

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13
Q

Axons

A

Terminal zones of nerve axons (synapse) contain organelles that release neurotransmitters that send information to tissues

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14
Q

Terminal arborizations

A

Impulses are transmitted to processing nuclei called ganglia

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15
Q

What are nerve membranes composed of

A

A bi- layered phospholipid membrane that functions as a barrier

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16
Q

What are lipid membrane is composed of

A

Phospholipids having both lipophilic and hydrophilic ends. The membranes are held together by the attraction of the lipophilic ends at the center

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17
Q

Myelin

A

A protective covering for nerves produced by Schwan cells. The primary function of myelin it to provide electrical insulation to nerves to increase their conduction efficiency

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18
Q

Schwann cells

A

Produce myelin. Function to protect the neuron and facilitate healing in the event of an injury. Composed a lipid, protein, carbohydrates

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19
Q

C fibers

A

Most numerous of peripheral nervous system, nonmyelinated, conduct more slowly. Provide sensation of dull and aching pain

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20
Q

A fibers

A

Lately myelinated, conduct more rapidly. Provide sensation of sharp, stabbing pain

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21
Q

What are the two most significant barriers to the diffusion of anesthetic solution in the development of anesthesia

A

Perilemma and the perineurium

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22
Q

Maxillary plexus

A

Derives from terminal branches of the second division of the trigeminal nerve

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23
Q

Mandibular plexus

A

Derives from the terminal branches of the third division of the trigeminal nerve

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24
Q

What is the difference in the electrical charge across the membrane

A

-70 mV (resting state electrical potential)

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25
Q

What happens when the nerve is stimulated

A

The ion channels open their gates in response to it.

Calcium ions

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26
Q

Slow depolarization

A

Occurs until the axoplasm as depolarized approximately: 15-20mV, From -70 to somewhere between -55 to -50 mV = the firing threshold!!!!

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27
Q

Repolarization

A

Recovery phase

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28
Q

Refractory state

A

Following a nerve impulse generation, a subsequent impulse generation is either temporarily impossible or more difficult

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29
Q

What kind of nerves do local anesthetic drugs work on

A

Sensory and motor

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30
Q

What nerves, sensory or motor, are lost first

A

Loss of sensory nerves before loss of motor nerves

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31
Q

Child does for local anesthetic

A

Adult dose X Child’s age / (12+child’s age)

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32
Q

Child dose for nitrous

A

4-5 L/min

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33
Q

Tidal flow

A

Refers to the automatic, regular ad and flow movement of air – similar to the ocean tide

The amount of gas in the lungs – title volume – depends on the physical size and fitness of the person

Male lung volumes are about 25% greater than females

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34
Q

What is the largest and most complex cranial nerve

A

The trigeminal nerve. It has three major branches; opthalmic, maxillary, mandibular

Mandibular is the largest

ASA is the terminal brands of the maxillary division of the trigeminal nerve

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35
Q

Accessory nerve

A

A cranial nerve that controls the sternocleidomastoid and trapezius muscles. It is considered the 11th cranial nerve.

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36
Q

Aberrant nerve

A

Nerve fibers, blood vessels, or lymphatic which follow a usual route deviating from what is normal or typical. Most failures due to aberrant innervations result in a complete lack of anesthesia of the targeted tissues.

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37
Q

Nociceptive pain

A

Caused by injury or disease in the body tissues. Can be constant or intermittent and can increase with movement

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38
Q

Two categories of nociceptive pain

A

Somatic and visceral

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39
Q

Somatic pain

A

Occurs in superficial structures like skin or muscles and is caused by traumatic injuries. Pain is sharp, aching, or throbbing

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40
Q

Visceral pain

A

Occurs in internal body cavities and is caused by compression, expansion, stretching, infiltration. Pain is a squeezing or nawing sensation

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41
Q

What are nocicptors

A

Sensory receptors that detect injury

They are unique in that they never adapt to stimulation. This is the key aspect in the protective response to pain

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42
Q

PSA penetration site

A

Height of the mucobuccal fold, distal to the zygomatic process of the maxilla, above the maxillary second molar. Generally superior to the distal buckle root of maxillary second molar

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43
Q

MSA penetration site

A

Height of the mucobuccal fold over the second premolar

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44
Q

ASA penetration site

A

Height of the mucobuccal bold just mesial to the canine. The height of the mucobuccal fold anterior to the canine eminence. Area called the canine fossa

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45
Q

Supraperiosteal penetration site

A

Height of mucobuccal fault, above the apex of the tooth to be anesthetized

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46
Q

IO penetration site

A

Height of the musical buckle fold directly over first bicuspid. Locating infra orbital Freeman: move finger downward into the concave area of that infra orbital Freeman. Apply gentle pressure, feel that outline of the Freeman

47
Q

NP penetration Saint

A

Palatal mucosa lateral to the midline of the insides of papilla

48
Q

GP penetration site

A

Soft tissue slightly anterior to the greater palatine Freeman. To locate Palitine freeman, please cons wobble at the junction of maxillary alveolar process and hard palate just distal to the first molar. Move swab posteriorly until it falls into greater Palatine foremen usually just lingual to the second molar

49
Q

IA penetration site

A

Medial to internal oblique Ridge, lateral to pterygoimandibular raphe at or above the height of the coronoid notch

50
Q

LB penetration site

A

Buckle fold just distal and buckle to the most posterior molar for which soft tissue anesthesia is required

51
Q

Mental and incisive penetration site

A

Miko buckle fold just superior to the mental foramen. Depth of mucobuccal fold superior to foramen

52
Q

Infiltration penetration site

A

At the height of the mucobuccal fold near the apex of a single tooth. Visualize the long axis of the tooth and locate the apex for the penetration site. Use radiographs as a guide

53
Q

Gow gates penetration site

A

Established using extra in intro oral landmarks. In mucobuccal membrane, directly posterior to maxillary second molar at the level of the mesial lingual cusp

54
Q

Vazirani akinosi penetration site

A

Used for a closed mouth technique. Soft tissue medial to the Remus, directly adjacent to maxillary tuberosity. At height of mucogingival Junction a maxillary molars

55
Q

What kind of fibers have been found in dental pulps

A

A and C fibers

56
Q

Which fibers, a or C, are greater distributed

A

C fibers

57
Q

Minimal sedation (anxiolysis)

A

Drug-induced state where patient responds normally to verbal commands. Seen with nitrous concentrations less than 50%. Cognitive functions and coordination may be impaired. Breathing in cardiovascular functions are unaffected

58
Q

Moderate sedation

A

Drug induced depression of consciousness during which patients respond purposely to verbal commands. Airway and cardiovascular function maintained. Achieved with nitrous concentrations over 50%

59
Q

Deep sedation

A

Drug induced depression of consciousness during which patients cannot be easily roused respond purposefully after repeated or painful stimulation. Independent airway maintenance may be impaired. Cardiovascular function maintained

60
Q

Conscious sedation

A

Induced state of sedation characterized by a minimally depressed consciousness such that the patient is able to continuously and independently maintain a patent airway, retain protective reflexes, and remain responsive to verbal commands and physical stimulation

61
Q

General anesthesia

A

Drug-induced loss of consciousness during which patients are not arousable even buy painful stimulation. Independent airway maintenance may be impaired in patient requires assistance to keep a patent airway and need positive pressure ventilation

62
Q

Titration

A

Prices of administering a drug incrementally to a specific level or endpoint of sedation. Allows for the exact amount of the drug necessary to be delivered to every patient at every appointment

63
Q

Where are amides metabolized

A

In the liver

64
Q

Where are esters metabolized

A

Cholinesterase

65
Q

Where are ketones of metabolized

A

They are not oxidized in the liver, but are carried to the skeletal and cardiac muscles where, under normal circumstances, they are rapidly metabolized

66
Q

Where is nitrous metabolized

A

99% of nitrous is eliminated due to long without biotransformation and is not metabolized through the liver. .004% metabolized in the G.I. tract by the anaerobic bacteria pseudomonas

67
Q

Soluble drugs

A

Defuse immediately into the blood and gets distributed throughout the body.

Blood – gas partition will be high

More drug and/or more time will be needed to achieve equilibrium

Blood brain barrier will be crossed rapidly
Onset of clinical action is rapid

68
Q

Insoluble drugs

A

nitrous which is a relatively insoluble drug.

It remains unchanged in the blood and does not combined with any other blood elements

Onset is slow and blood brain barrier is crossed slowly

Less time will be needed to achieve equilibrium
Blood-gas partition will be low

69
Q

Nitrous effects on the cardiovascular system

A

Blood pressure affects maybe does related, can see a decrease in blood pressure

70
Q

Nitrous effects on the respiratory system

A

If a patient has a condition where it is hard to breathe out of the nose, insufficient amounts of nitrous will enter respiratory system.

For those with other deliberated respiratory conditions, nitrous may be considered a relative contraindication

71
Q

Nitous effects on the central nervous system

A

Has the ability to depress the central nervous system. Evidence to injury to the central nervous system with chronic exposure.

Can be used on patients that have a history of stroke, seizure disorder, and Parkinson’s disease

72
Q

Nitrous effects on the hematopoietic system

A

Megaloblastic bone marrow changes have been found in patients exposed to high concentrations over a prolonged period

73
Q

Nitrous effects on the gastrointestinal system

A

If you’re patient suffers from a bowel obstruction, postpone nitrous due to the risk of expansion, pressure and discomfort

74
Q

Nitrous effects on the reproductive system

A

Do not use in the first trimester of pregnancy, it crosses the placental barrier

75
Q

Nitrous effects on the neuromuscular system

A

Nitrous does not provide direct skeletal muscle relaxation. Gives muscles rigidity with higher levels.

Can be used safely with patients with multiple sclerosis, muscular dystrophy, cerebral palsy, myasthenia gravis

76
Q

Nitrous effects on mind altering conditions

A

Patients should be able to understand the procedure and it’s effects. Discretion should be taken when using with a recovering addict or mental illness. Severe phobics may not benefit from it, can make the situation worse

77
Q

Malignant hyperthermia

A

A disease passed down through families that cause a fast rising body temperature snd severe muscle contractions when the affected person gets general anesthesia

Life threatening condition

78
Q

Importance of obtaining health histories

A

Comprehensive patient assessment is necessary in order to minimize adverse events related to receiving local anesthesia

79
Q

Relative contraindications for nitrous

A

Dry air asthma, substance abuse, alcoholism, claustrophobia, post dramatic stress disorder, Leap text sensitivity, current CNS depressant use, patients with colostomy vague or bowel obstruction, cystic fibrosis, autism, pregnancy in the second and third trimesters

80
Q

Absolute contraindications for nitrous

A

Hypoxic – driven, advanced chronic obstruction pulmonary disease, active respiratory infections, first trimester pregnancy, intraocular gas injection within 8 to 12 weeks, severe psychosis, latex allergy if non-latex nitrous sedation systems are unavailable, recent typanic membrane graphing, treatment involving the injection of gases into any body cavity

81
Q

Armamentarium

A

Refers to all equipment, materials, devices, and method is used during the delivery of local anesthetic agents

82
Q

What is the most important step in the delivery of local anesthetic

A

Aspirating

83
Q

What is the second most important step in delivering local anesthetics

A

Slow delivery

84
Q

ASA I

A

A normal, healthy patient

85
Q

ASA II

A

Patient with mild systemic disease

86
Q

ASA III

A

A patient with severe systemic disease, or more likely to experience adverse events

May still be considered for elective dental procedures with local anesthetic. Modify treatment for safety.

87
Q

ASA IV

A

A patient with severe systemic disease that is a constant threat to life

Elective dental care is contra indicated for these patients

88
Q

Local complications

A

Ocher more frequently than systemic complications. Examples are:

Post operative soreness, prolong anesthesia, soreness at area of injection, syncope, pain from self injury, mild inflammation following muscle penetrations

89
Q

Systemic complications

A

Toxicity: occur less frequently but are generally more serious. Examples are:

Overdose, allergy, idiosyncratic response

90
Q

Hematoma complication

A

Form when a blood vessel gets nicked during injections in blood leaks into the surrounding tissue

Development can be rapid in dramatic, most common site is the PSA, avoid by aspirating, keeping needle straight, minimizing needle penetrations, avoiding moving needle around in tissues, discontinue treatment, apply pressure in ice, tell patient to avoid aspirin, advise patient of what to expect

91
Q

Trismus

A

Motor disturbance of the trigeminal nerve – inability to open mouth

Most frequently occurs in the medial pterygoid muscle, followed by the lateral pterygoids and the temporalis

92
Q

Causes of trismus

A

Tetanus-lock jaw-, tumors, bony ankylose, foreign bodies, fracture, facial space infections, in large coronoid processes, hemorrhage in muscle trauma following injection, drama to Needle movements, local anesthetic toxicity,

93
Q

Prevention of trismus

A

Minimize the number of needle penetrations, change needles frequently, endure needle contamination does not occur

94
Q

Management of trismus

A

Apply hot, moist towel for 20 minutes every hour, use analgesics as needed, open/close mouth gradually/repeatedly, monitor for signs of infection, if signs/symptoms worsen, contact oral surgeon or position

95
Q

Causes a needle fractures

A

Unexpected movements, too small of lumen, bending needle at the hub, inserting needle too far, all the needles, excessive force and repositioning, excessive number of penetrations with the same needle

96
Q

Management of needle fractures

A

Have sterile forceps nearby, do not allow patient to close mouth, if needle is visible remove with a hemostat, if needle isn’t visible inform impatient, immediately referred to an oral surgeon and keep a detailed record

97
Q

Paresthesia

A

And altered sensation and/or persistent partial or complete numbness. Occurs most frequently in the lingual nerve

98
Q

Hyperesthesia

A

Increased sensitivity to stimuli following nerve injury

99
Q

Dysesthesis

A

The sensation of pain from non-noxious stimuli that may follow local anesthetic procedures

100
Q

Ageusia

A

Absolute loss of ability to perceive sweet, sour, bitter or salt substances due to chorda tympani injury

101
Q

Hypogeusia

A

Relative loss

102
Q

Possible causes a paresthesis

A

Direct trauma from surgery or injury, drug-induced – neurotoxicity –, detergent effects of drugs, pressure from localized Adema, hire local anesthetic drug concentration, vascoconstrictors and their preservatives

103
Q

Prevention of paresthesia

A

Slow disposition, reduce volumes for 4% drugs by 50%, for articaine, use my block techniques – GG or VA –, in pallet, limit volumes to less than .9 mL, examine your needle for barbs

104
Q

Managing paresthesia

A

Speak with the patient personally, reassure the patient, schedule to evaluate the patient ASAP, document the conversation, determine a record the extent and degree, diagram field of altered sensation, explain that it may last a while, update map at follow up appointments

105
Q

Allergy

A

Can be local or systemic reactions, systemic allergic reactions can be life-threatening, can be an allergy to and amide or the sulfite preservative for Vascoconstrictors

106
Q

Angioedema

A

Localized swelling brought about by the rapid release of histamine’s

107
Q

The pathway of biotransformation in the liver is known as what

A

Hepatic p450 isoenzyme system

108
Q

Metabolism in the blood by enzymes is called what

A

Cholinesterase or plasma Cholinesterase

109
Q

Eutectic mixtures

A

Provide more rapid onset, greater depth of penetration on skin and mucous membranes,

110
Q

Anxiolytic

A

Sedative effects

Ability to cope with the procedure depends on factors such as age, gender, previous experiences and personality characteristics

111
Q

Amnestic

A

Patients often state they cannot recall the severity of their pain or anxiety or its duration. Patient receives the time passed quickly

112
Q

Analgesic

A

Pain control. Reduces fear which can help reduce pain

113
Q

A mixture of 20% nitrous to 80% oxygen has the same analgesics as what

A

15 mg of morphine

Pain Management (3 decks)

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