Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

OS & Pain Management > Study Guide > Flashcards

Study Guide Flashcards

1
Q

Know which ions (Na, K, Cl…) are associated with extra or intra cellular space.

A

Extracellular space  Na, Cl

Intracellular space  K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do local anesthetics exert their pharmacological action on nerve (which part of the nerve?) and how Local anesthetics work (which ion channel?)?

A

Location: local anesthetics act on the nerve membrane

“How”: they act by the “specific receptor theory” which states the local anesthetic binds to a specific receptor on the Na channel to prevent channel from opening (therefore no action potential and no pain for the patient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3) Myelinated nerve vs unmyelinated nerve
a. Speed of signal conduction

A

Myelinated Speed of conduction: 120 m/sec
Unmyelinated Speed of conduction: 1.2 m/sec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

3) Myelinated nerve vs unmyelinated nerve
b. Where does local anesthesia work at myelinated nerve?

A

Location: local anesthetic works at the Nodes of Ranvier (abundance of sodium channels located here)
- To work you need to have 2-3 nodes (8-10mm) of the nerve blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

4) Know the following local anesthetic agents:
a. Lidocaine
onset time of action (minutes)
duration time (t 1/2 in hours)
mg/kg of maximum dose

A

2-3
1.6, 1 hour of pulpal and 3-5 hours of soft tissue for 2% solution
4.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

b. Prilocaine
onset time of action (minutes)
duration time (t 1/2 in hours)
mg/kg of maximum dose

A

2-4
1.6
6.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

c. Mepivacaine
onset time of action (minutes)
duration time (t 1/2 in hours)
mg/kg of maximum dose

A

1.5-2
1.9, 20-40 minutes of pulpal and 2-3 hours of soft tissue anesthesia
4.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

d. Bupivacaine
onset time of action (minutes)
duration time (t 1/2 in hours)
mg/kg of maximum dose

A

6-10
2.7, used when more than 90 minutes of pulpal anesthesia needed or to reduce postoperative pain
1.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

e. Articaine
onset time of action (minutes)
duration time (t 1/2 in hours)
mg/kg of maximum dose

A

1-2
0.5, 0.5 hours of pulpal and 3-5 hours of soft tissue for 4%
7.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

f. Cocaine

A

immediate onset time of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

g. Procaine

A

6-10 min onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

4) Know the following local anesthetic agents: a. Lidocaine b. Prilocaine c. Mepivacaine d. Bupivacaine e. Articaine f. Cocaine g. Procaine

Onset order:

A

Cocaine > Articaine > Mepivacaine > Lidocaine > Prilocaine > Bupivacaine > Procaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4) Know the following local anesthetic agents: a. Lidocaine b. Prilocaine c. Mepivacaine d. Bupivacaine e. Articaine f. Cocaine g. Procaine

Duration order:

A

Bupivacaine > Mepivacaine > Lidocaine = Prilocaine > Cocaine > Articaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5) How does pH influence local anesthesia?
(2)

A

Low tissue pH (high acidity/H+) is harder to anesthetize (usually associated with inflamed or infected tissues)

Low anesthetic pH leads to higher effective shelf life
- Average pH of local anesthetics  5.5-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5) How does pH influence local anesthesia?
How pH affects local?

A

If the pH of the environment does not allow the free base form (what enters the nerve membrane) of the anesthetic to exist, numbing will not occur
- The further the pH is from the ideal for that specific anesthetic, the lower the percentage of that local anesthetic will be present in the free base form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

6) Is local anesthesia hydrophilic or hydrophobic?

A

Amphipathic (both hydrophilic and hydrophobic)
- With the exception of Benzocaine; doesn’t have hydrophilic group. Good topical but not good for injections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

7) Organic components of local anesthesia (how they change from charged to non-charged form)

A

Only the free base form (“ninja”) of the anesthetic can enter the nerve, the sodium channel must be blocked from the inside
- Anesthesia is injected as an ionized cation that cannot cross the nerve cell membrane (but can become a non-ionized free base, which can diffuse into the membrane)
- Once in the nerve, the free base can become it’s ionized version again and bind to the specific receptor to prevent Na channel from opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

8) Relationship of pKA vs local anesthesia

A

High pKA  slow onset (few free bases available)
Low pKA  rapid onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

9) How does lipid solubility influence local anesthesia?

A

With increased lipid solubility, the drug is more potent
With decreased lipid solubility, the drug is less potent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

10) What does protein binding have to do?

A

With increased protein binding, the drug has longer duration
With decreased protein binding, the drug has shorter duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nerve membrane = –% lipid
Nerve membrane = –% protein

A

90
10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

11) Vasoactivity of different kinds of local anesthetic agents? (which agent has the most profound vasoconstrictive property and which has the most profound vasodilatation property?)

A

Alpha 1 = most profound vasoconstriction activity
- Epinephrine is most used vasoconstrictor
- Cocaine is the only local anesthetic with vasoconstrictive effect

Beta 2 = most profound vasodilation activity
- Procaine is the most potent vasodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

12) Different classes of local anesthesia
a. Ester and Amide (answer)

A

AMIDES: resist hydrolysis and excreted unchanged in urine
- Trick: drugs with an “I” that comes before “caine” is an amide (i.e. articaine)
ESTERS: readily hydrolyzed in aqueous solution
- Trick: drugs without an “I” that comes before “caine” is an ester (i.e. lidocaine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

13) How esters or amides metabolize in the body? (and their effect on individuals with cirrhosis and CHF)

A

Amide metabolism
Liver: primary biotransformation site
Can cause cirrhosis/CHF or hypotension

Ester metabolism
Hydrolyzed in plasma by pseudocholinesterase into paraaminobenzoic acid (PABA)
- PABA = usually what individuals have a reaction to

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the relationship between cirrhosis patient and metabolism of local anesthetics?
Liver function/hepatic perfusion influence biotransformation
26
How do cirrhosis and/or CHF interfere with the amount of your local anesthesia injection? Does this disease state increase the availability of this drug or decrease the availability?
Amide LAs are chemically modified (metabolized) in the body in the liver, so since the liver is not functioning as well (doesn’t have the full metabolic capacity), then less LA should be administered. This disease increases the available (will be available longer) due to the liver not being able to biotransform the drug. Therefore we give them less LA
27
14) Which organ in the body has the greatest concentration of local anesthesia?
Skeletal muscle
28
15) What is Tachyphylaxis?
Increased tolerance to drug due to repeated administration
29
16) Know how to calculate elimination half-life (t 1⁄2)
Elimination half life = time needed for 50% of the drug to be reduced in blood level Equation: (t ½): ln 2/k (where k= reaction rate constant)
30
Different Half-lives: 1st half-life: 2nd half-life: 3rd half-life: 4th half-life:
50% eliminated there is 50% of the drug left...half of 50 is 25. Add 25 to the previous 50 you have eliminated 75% you have eliminated 75%, there is 25% left, 25/2= 12.5 add that to 75=87.5% eliminated you have eliminated 87.5% up to this point. There is 12.5% left. Half of that is 6.25 add that to 87.5= 94% eliminated
31
17) Do all local anesthesia readily cross the BBB and placenta?
Yes
32
18) What are the stages/ signs of local anesthesia over dose / toxicity? Caused by: - Initially = - Eventually =
over injection or repeated injections into the blood stream and systemic circulation (why it’s important to aspirate!) causes excitatory response (numbness of tongue and circumoral region slurred speech, shivering, AV disturbances, tremor, etc.) o if you ignore initial signs, patient can go into a seizure o if you keep loading them up with more local anesthesia, they will stop breathing depressive response on CNS with a lesser CV effect as well as agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, etc.)
33
19) Catecholamine vs non-catecholamine? Catecholamine
Natural: epinephrine, norepinephrine, dopamine Synthetic: isoproterenol, levonordefrin Contain hydroxyl group on benzene ring. Work directly on adrenergic receptors (alpha 1,2 and beta 1,2)
34
19) Catecholamine vs non-catecholamine? Non-catecholamines
Amphetamine, methamphetamine, ephedrine Do not contain hydroxyl group on benzene ring
35
20) What does epinephrine dilution mean? If someone ask you what’s 1:300,000 mean.
___:____ = gram (or mg) of drug: ml of solution (so 1:300,000 would be 1 g (1000 mg) of drug per 300k ml of solution - To calculate mg/ml of solution, just divide. Here would be 1000mg/300,000ml = 0.0033 mg/ml of solution - When comparing: the lower the second number (ml of solution), the higher the concentration (i.e. 1:100,000 is more concentrated than 1:200,000)
36
21) Maximum dose for epinephrine in healthy patient vs unhealthy patient
Healthy = 0.20mg (or 200 mcg) Cardiac/unhealthy = 0.04 (or 40 mcg)
37
22) Which agent (catecholamine) lacks significant B2 actions thus produces intense peripheral vasoconstriction with possible dramatic elevation of blood pressure?
Norepinephrine - is associated with a side effect ratio 9X higher than that of epinephrine? That’s one of the big reasons why this agent is NOT available in the U.S.
38
23) Contraindications for vasoconstrictor administration
- High blood pressure (200mmHg systolic OR 115mmHg diastolic) - Uncontrolled hyperthyroidism - Severe cardiovascular disease o Less than 6 months after MI or cerebrovascular accident o Less than 6 months after cerebrovascular accident o Less than 6 months post-coronary artery bypass surgery o Daily episodes of angina pectoris or unstable angina o Cardiac dysrhythmias despite therapy - Undergoing general anesthesia WITH halogenated agents - Other drugs: Patient receiving non-specific beta-blocker, MAOi, tricyclic antidepressants
39
24) Do patients OD if you exceed MRD?
Not necessarily, but exceeding the MRD leads to greater likelihood of OD arising (which is why is is a thing!) - OD can occur below the MRD if the patient is a hyper-responder
40
25) Do we need to decrease the maximum calculated drug dose on medically compromised, debilitated, or elderly persons?
Yes (unable to metabolize anesthetic as efficiently)
41
26) What’s the most common cause of failure to achieve adequate anesthesia?
Anatomic variation and faulty technique
42
27) Articaine is ____ % concentration.
Articaine = 4% solution - Has potential for neurotoxicity, resulting in more non-surgical paresthesia’s than all of local anesthetics (despite fewer injections given)
43
27) What is its contraindication? (4)
patient allergy to amides, sulfite sensitivity, hepatic disease, significant cardiovascular function impairments
44
27) Can Articaine used on children under 4 years of age?
**cannot be used on children under 4 years of age - Insufficient data
45
28) Needle gauge types (in relation to diameter and other characters associated with each)
Smaller the gauge  bigger the diameter - 25 gauge: greater internal diameter - 30 gauge: smaller diameter o Less deflection, greater accuracy in injection. Less chance of needle break, easier aspiration
46
29) Total of 4ml of 3 % Mepivacaine without epinephrine has been used. What is the total mg used in this case? The MRD for this local anesthesia is 4.4mg/kg (MPD)
120mg 4ml x 0.03% = 0.12 0.12 x 1000 = 120mg
47
30) Billy Jean is going through special diet, and after 2 months she only weight 20kg. She is here at University of Miracle KC, College of Dentistry for some dental work. You picked 2% lidocaine with epinephrine 1:100,000 as your anesthetic agent (b/c it has red label on it). What is the maximum mg that you can give for her?
(remember 4.4 is MPD for lidocaine) 4.4 mg/kg x 20 kg = 88 mg
48
31) Facts about the needle (5)
- Do not reuse needle - Needle should be covered with protective sheath when not in use - Use scoop technique recap the needle - Do not bend the needle - Dispose of needle in sharps and biohazard containers after use
49
32) Which agent is a bacteriostatic and was removed from local anesthesia cartridge on 1984 due to reported allergic reactions
Methylparaben
50
33a) Study the “care and handling” of a cartridge
No manufacturer claim of sterility about exterior surface of the cartridge - Bacterial culture tested fail to produce nay growth Cannot withstand extreme temperature - No autoclaving especially plastic cartridge - When heated, the vasopressors are destroyed Store in room temperature in a dark place - Studies shoes no benefit from using cartridge warmer Do not soak cartridge in alcohol or cold sterilizing solution - Semipermeable diaphragm permits diffusion of these solution
51
skipped 33b) Problems that can occur with cartridge (6)
Bubble in the cartridge -Small bubble (1-2mm) is usually just nitrogen gas -Large bubble (>2mm) occurs due to extruded stopper or frozen cartridge Corroded cap -If immersed in disinfection solution -Only sterilization needed is  91% isopropyl alcohol and 70% ethyl alcohol Rust on the cap -Rust from “tin” container Leakage during injection -Eccentric needle puncture of diaphragm Broken cartridge -Returned damaged boxed upon receiving -Shatter cartridge occurs due to improper loading -Bent harpoons Burning on injection -Due to mishandled or defective cartridges (pH, alcohol, heat, expired, etc.)
52
34) What are the most common psychogenically induced reactions people have upon local anesthesia injection?
vasodepressor syncope, hyperventilation - Others: tonic clonic convulsions, bronchospasms, angina pectoris
53
35) List out and study which situation is absolutely contraindicated for local anesthesia administration and which situation is relatively contraindicated? Absolute contraindication means
that event or substance could cause a life-threatening situation
54
35) List out and study which situation is absolutely contraindicated for local anesthesia administration and which situation is relatively contraindicated? Relative contraindication means
that caution should be used when two drugs or procedures are used together. (It is acceptable to do so if the benefits outweigh the risk.)
55
Relative contraindications (5)
-Pregnant women in first trimester -Malignant hyperthermia -ASA III CHF patient taking cimetidine (increases half life of circulating LA) -CHF (can be ASA IV or III) may demonstrate decreased liver perfusion and increase half lie -Methemoglobinemia to prilocaine
56
Absolute contraindications (3)
-ASA IV (CV risk patient) Recent (<6 mo) or repeated MI increases risk -Tricyclic antidepressants (TCAs) -Cocaine abuser (because it stimulates NE release and inhibits reuptake). Can cause MI Need 72 hours of cocaine clearance Epinephrine-impregnated gingival retraction cord is absolutely contraindicated
57
36) Basic local anesthesia injection technique main points (4)
- MUST ASPIRATE for PSA and Inferior Alveolar nerve blocks - Apply topical for 2 minutes before injection - Place the bevel of the needle on the tissue (in the direction you want to go) and then inject - twist needle a you insert it to keep the needle from deflection in one direction
58
37) Know the division of Trigeminal nerve and where they come out or entering of cranium. OPTHALAMIC (V1)
- Sensory - Enter cranium at superior orbital fissure
59
37) Know the division of Trigeminal nerve and where they come out or entering of cranium. OPTHALAMIC (V1)
- Sensory - Enter cranium at superior orbital fissure
60
37) Know the division of Trigeminal nerve and where they come out or entering of cranium. MAXILLARY (V2)
- Sensory - Enters cranium at foramen rotundum
61
37) Know the division of Trigeminal nerve and where they come out or entering of cranium. MANDIBULAR (V3)
- Sensory and motor - Enter cranium at foramen ovale
62
38) One of the branch of V2 (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.
Middle meningeal nerve
63
39) Which division of Trigeminal nerve is sensory and/or motor?
MANDIBULAR (V3)
64
3 major Types of Anesthesia
Local infiltration Field Block Nerve Block
65
Local infiltration
Numbs one tooth
66
Field Block
Numbs about 2 teeth
67
Nerve Block
Numbs entire area. injecting the nerve bundle
68
Infiltration (supraperiosteal injection)
Preformed if numbing one tooth. (premolar) Needle is entered adjacent to bone apical to apex - Maxillary labial bone is porous, allows infiltration of anesthetic (anesthetic diffuses into the bone Areas anesthetized: single tooth, buccal periodontium and bone, mucosa (labial or buccal)
69
Posterior Superior Alveolar Nerve Block (PSA) Description
Needle is entered into the height of the vestibule a 45° angle to the occlusal plane - Needle is inserted in about 16 mm **MUST ASPIRATE (aspiration rate is 3%) **Can cause hematoma if there is positive aspiration
70
Posterior Superior Alveolar Nerve Block (PSA) Areas Anesthetized (3)
- Maxillary molar tooth pulps - MB root of 1st molar in 72% - Buccal periodontium and bone (not palatal)
71
Middle Superior Alveolar Nerve Block (MSA) Description
Needle is injected well above premolar apices (bevel facing bone)
72
Middle Superior Alveolar Nerve Block (MSA) Areas Anesthetized (3)
- Maxillary premolars - MB root of 1st molar in 28% - Buccal periodontium and bone (not palatal)
73
Anterior Superior Alveolar Nerve Block (ASA) Description
Needle contacts roof of infraorbital foramen (which is located about 16 mm above vestibule) - Anesthetic is directed into canal - Insert about ½ the needle length, orient needle bevel towards bone and insert until bone is contacting needle - Maintain pressure during injection and 1 minute after
74
Anterior Superior Alveolar Nerve Block (ASA) Areas Anesthetized (5)
- Maxillary central incisor through canine - Premolars - MB root of first molar in 28% - Buccal periodontium and bone - Lower eyelid, side of nose, and upper lip
75
Greater Palatine Description
Needle is aiming for greater palatine foramen area (not into the foramen) and contacts bone
76
Greater Palatine Areas Anesthetized (3)
- Posterior portion of hard palate (canine to last molar) - Overlying soft tissues - **no anesthesia of teeth
77
Nasopalatine Description
Needle contacts bone lateral to incisive papilla - First, needle is placed bevel against tissue and bow the needle - Then, straighten needle and advance Can also do “trans-papillary approach”. Insert needle through papilla between 8 and 9 towards palate
78
Nasopalatine Areas Anesthetized (3)
- Anterior portion of hard palate (Canine to canine) - Both hard and soft tissues - **no anesthesia of teeth
79
Buccal nerve Description
Use 25 gauge long needle, stretch tissue, and contact periosteum - Large area of nerve coverage, just need to aim in general area This is the only way to get the buccal mucosa of molars. A lot of anesthesia is needed to numb this
80
Buccal nerve Areas (or nerves) Anesthetized (4)
Tissue: - Gingival buccal to molars - Retromolar pad mucosa - Buccal mucosa in molar area - **no hard tissues anesthetized
81
Mental Nerve block Description
This nerve exits out of the mental foramen. Palate the mental foramen (near premolars) to determine site of injection - Inject into tissue over foramen Possible hematoma (positive aspiration rate of 5.7%)
82
Mental Nerve block
- Mucosa anterior to foramen - **Skin of the lower lip - chin
83
Inferior alveolar block Description
Largest branch of posterior division protected by the sphenomandibular ligament Syringe is directed across arch (from contralateral side) at level of coronoid notch. Place finger on notch to locate it and determine height of injection - Needle penetrated buccinator muscle and is lateral to pterygomandibular raphe - Contacts bone **MUST aspirate
84
Inferior alveolar block Areas (or nerves) Anesthetized (4)
Nerves anesthetized: inferior alveolar, incisive, mental, lingual (usually) - Wide area with only a little of anesthetic - Entire unilateral side from midline - Lingual mucosa, tongue, teeth
85
Gow-Gates Block (true mandibular nerve block) Description
Needle contacts neck of condyle - Extraoral landmarks  intertragic notch and corner of the mouth - Patient should open wide so condyle moves forward - **must aspirate
86
Gow-Gates Block (true mandibular nerve block) Areas (or nerves) Anesthetized
Nerves anesthetized: inferior alveolar, lingual, mylohyoid, auriculotemporal, buccal (usually, 75%)
87
Vazirani-Akinosi Nerve Block (closed mouth mandibular nerve block) Description
Height of injection is at maxillary muco-gingival line - Insert needle to 35 mm in depth - Path of insertion is parallel to ramus - No bony contact
88
Vazirani-Akinosi Nerve Block (closed mouth mandibular nerve block) Areas (or nerves) Anesthetized
Nerves anesthetized: inferior alveolar, lingual, mylohypoid

OS & Pain Management (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions