Surgery2 Flashcards
Which of the following local anesthetics are available in North America? Select all that apply. • prilocaine • bupivacaine • procaine • lidocaine • tetracaine • articaine
• prilocaine
• bupivacaine
• lidocaine
• articaine these are Amide group not a Ester
(to remember that the drug name contains an i plus Caine (lidocaine, bupivacaine, and bupivacaine). Esters such as procaine, benzocaine, and tetracaine contain no i.) (Most topical local anesthetic ointments and gels contain benzocaine )
? is most commonly used. Allergic reactions are far more common with ?
- Tetracaine
* esters not amides
The drug of choice in management of an acute allergic reaction involving bronchospasm and hypotension is ?
epinephrine
Allergic reactions to local anesthetic are usually caused by ?
an antigen-antibody reaction
Which of the following are appropriate treatments for an impending vasovagal syncopal episode? Select all that apply.
• sit patient in upright position
• place patient in supine position
• monitor vitals
• oxygen administration
• loosen tight clothing
• place a cold compress on patients forehead
- place patient in supine position
- monitor vitals
- oxygen administration
- loosen tight clothing
- place a cold compress on patients forehead
For local anesthetics, for every 1% solution there is: • 0.10 mg/mL of anesthetic • 1 mg/mL of anesthetic • 10 mg/mL of anesthetic • 100 mg/mL of anesthetic
10 mg/mL of anesthetic (For vasoconstrictor, 1;100,000 means 1 gram per 100,000 mL. This equates to 0.01 mg/mL)
each lidocaine capsule 2%, 1;100,000 contains how much of anesthetic or vasoconstrictor ?
- anesthetic = 34mg lido
* vasoconstrictor = .017 mg epi
Which of the following are needed in combination to produce neuroleptanesthesia? Select all that apply.
• narcotic analgesic
• neuroleptic agent
• nitrous oxide
- narcotic analgesic (administration)
- neuroleptic agent (administration)
- nitrous oxide (inhalation)
Neuroleptanesthesia is a state of ?
neuroleptanalgesia (by narcotic analgesic + neuroleptic agent) and unconsciousness (by nitrous oxide)
The most common cause of loss of consciousness in the dental office is: • anaphylaxis • syncope • heart attack • seizure
syncope (never occur when lying)- fainting
Once the blood pressure drops below levels necessary to sustain consciousness, ? occurs
syncope (by stress-induced release of catecholamines that cause the following: a decrease in peripheral vascular resistance, tachycardia, and sweating)
The single most important drug to use in any medical emergency, including chronic obstructive pulmonary disease, is ?
oxygen
The primary airway hazard for an unconscious dental patient in a supine position is ?. Remember ?
- tongue obstruction
* Head tilt/chin lift
Trauma to muscles or blood vessels in the ? is the most common etiological factor in trismus associated with dental injections of local anesthetics. • pterygoid fossa • temporal fossa • submandibular fossa • infratemporal fossa
infratemporal fossa (The medial pterygoid muscle is most often affected)
Management of trismus?
- Apply hot, moist towels to the site for approximately 20 minutes every hour
- Warm saline rinses
- Use analgesics as required
- Benzodiazepine (e.g., diazepam) for muscle relaxation if deemed necessary
- The patient should gradually open and close mouth as a means of physiotherapy
The most common cause of paresthesia of the lower lip is ?
the removal of mandibular third molar (especially horizontally impacted ones).
There are no contraindications for the use of nitrous oxide sedation in asthmatic patients.
Because anxiety is a stimulus for an asthmatic attack, nitrous oxide sedation is actually beneficial for these patients.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
both statements are true
The most common complication associated with nitrous oxide sedation is ?
a behavioral problem (laughing, giddy)
A normal platelet count is: • 15,000 - 45,000/mm3 • 75,000 - 100,000/mm3 • 150,000 - 450,000/mm3 • 450,000 - 600,000/mm3
150,000 - 450,000/mm3
Which of the following pairings are correct regarding the amount of epinephrine in 1.7cc of solution? Select all that apply.
• 2% lidocaine 1:200,000 / .0085 mg epinephrine
• 2% lidocaine 1:200,000 / .017 mg epinephrine
• 2% lidocaine 1:50,000 / .034 mg epinephrine
• 2% lidocaine 1:50,000 /.017 mg epinephrine
- 2% lidocaine 1:200,000 / .0085 mg epinephrine
* 2% lidocaine 1:50,000 / .034 mg epinephrine
The primary site of biotransformation of amide drugs is the: • plasma • lung • kidney • liver
liver (not for ester local anesthetics which are hydrolyzed in the plasma)
Allergic reactions to amide-type local anesthetics are rare but may occur as a result of hypersensitivity to the local anesthetic agent itself or due to an allergy to ?
methylparaben or other preservatives used in many solutions
For those patients allergic to both ester and amide-type local anesthetics, ? is a safe and effective alternative.
diphenhydramine
The initial clinical signs and symptoms of CNS toxicity for local anesthetics are usually excitatory in nature. However, it is also possible that the excitatory phase of the reaction may be extremely brief or may not occur at all. This is true especially with which local aneshetics? Select all that apply. • lidocaine • tetracaine • etidocaine • procaine • bupivacaine
- lidocaine
* procaine
The pH of normal tissue is ?; the pH of an inflamed area is ? • 9.0; 3 to 4 • 7.4; 5 to 6 • 3.6; 8 to 9 • 8.0; 2 to 3
7.4; 5 to 6
Nitrous oxide works on the:
• peripheral nervous system (PNS)
• central nervous system (CNS)
• autonomic nervous system (ANS)
central nervous system (CNS) (main effects on the reticular activating system and the limbic system)
The maximum limitation dose is ? nitrous oxide and 40% oxygen
60%
- The first symptom of nitrous oxide analgesia is ?
* ? is the most common side effect of nitrous oxide analgesia
- tingling of the hands
* Nausea
The primary action of local anesthetics in producing a conduction block is to decrease the permeability of the ion channels to: • calcium ions • chloride ions • potassium ions • sodium ions
sodium ions
Nerve block produced by local anesthetics is called a ? nerve block.
nondepolarizing
? nerve fibers that conduct pain and temperature sensations are affected first, followed by touch, proprioception, and skeletal muscle tone.
Smallest, unmyelinated
Emergence from a local anesthetic nerve block follows the same diffusion patterns as induction; however, it does so in ? order
reverse
Which of the following is the phase of anesthesia that begins with the administration of anesthetic and continues until the desired level of patient unresponsiveness is reached?
• induction
• maintenance
• recovery
induction
The behavior of patients under general anesthesia suggests that the most resistant part of the CNS is the ?
medulla oblongata (cardiac, vasomotor and respiratory centers of the brain).
Volatile liquids require a vaporizer for inhalational administration. Which one additionally requires a heating component to allow delivery at room temperature? • enflurane • halothane • sevoflurane • desflurane • isoflurane
desflurane
inhalation anesthetics means volatile anesthetics
All the potent inhalation agents are capable of triggering ?, a rare inherited disorder that is potentially fatal
malignant hyperthermia (MH)
The optimum site for IV sedation for an outpatient is the: • median basilic vein • median cephalic vein • median antebrachial vein • axillary vein
median cephalic vein
popular drug for IV sedation for an outpatient is ? but is contraindicated for use in a patient with a history of ?
- Valium (diazepam)
* narrow-angle glaucoma
Dissociative anesthesia is a unique method of pain control that reduces anxiety and produces a trancelike state in which the person is not asleep, but rather feels separated from his or her body. The primary medication used is: • demerol • ketamine • pentobarbital • promethazine hydrochloride
ketamine (used for short procedures that are painful, such as changing bandages. This method is safe and lasts only a short time. Because a person does not usually recall the procedure, this method is useful in children)
ketamine used for dissociative anesthesia increases BP, heart rate, and cardiac output , but not ?
respirations
Malignant hyperthermia (MH) is a pharmacogenetic disorder in which a genetic variant in the individual alters that person's response to certain drugs. Which of the following describe the major clinical characteristics of MH? Select all that apply. • rigidity • fever • hypermetabolism • myoglobinuria • alkalosis
- rigidity
- fever
- hypermetabolism
- myoglobinuria
The following signs: nausea, pallor, cold perspiration, widely dilated pupils, eyes rolled up, and brief convulsions are indicative of a patient having a ? reaction. • somatogenic • psychogenic • either of the above • none of the above
psychogenic (caused by psychological factors rather than physical factors such as Vasovagal syncope which clinical signs closely resemble those of shock and readily respond to placing the patient in a supine position)
Postoperative hypotension is usually due to the effect of:
• transfusion reactions
• a fat embolism
• the anesthetic or analgesics on the myocardium
• liver failure
the anesthetic or analgesics on the myocardium (leading to myocardial depression)
Postoperative hypertension is most often due to ?
post-op pain
