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Local Anesthesia > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Length of Nerve affected needed for anesthesia to occur?

A

8-10mm

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2
Q

3 structural component of LA

A 
Lipophilic part (benzoic acid derivative)
Hydrocarbon chain
Hydrophilic part (amino derivative of EtOH/AceH
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3
Q

In Low pH, which form of LA predominates

A

More cationic form RNH+

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4
Q

In High pH, which form of LA predominates

A

more basic form RN

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5
Q

Does the basic or cationic LA from have greater tissue perfusion?

A

Basic does

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6
Q

What does the cationic form bind?

A

It binds Na+ protein receptor sites

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7
Q

What is the greatest barrier to penetration by LAs?

A

the perineurium

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8
Q

Which fiber bundles are more apt to not be fully blocked?

A

The core fibers

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9
Q 
How does increasing each of the following affect LA duration?
Concentration Gradient
Lipid Solubility
Protein binding
Vasoactivity
A

top three increase the duration

vasoactivity-vasodilators remove the LA from the area more quickly so that shortens the LA effective time

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10
Q

The only LA that is a vasoconstrictor is _______?

A

Cocaine

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11
Q

How does Luke like it?

a. Rough
b. Hardcore
c. In the butt
d. All by himself

A

D is correct

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12
Q

Once absorbed into the blood, where are highest concentrations of LA found?

A

In highly perfused organs: Heart, brain, liver, kidney, lungs, spleen

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13
Q

Tissue that contains largest percentage of LA?

A

Skeletal muscle b/c it has greatest mass is all

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14
Q

Esters: where are they metabolized?

A

in the plasma

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15
Q

Esters: what metabolizes them?

A

Pseudocholinesterase

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16
Q

Esters: What breakdown product is likely cause of allergic reactions associated with esters?

A

PABA (para-aminobenzoic acid) Side note: excreted unchanged in the urine pg 6 of first handout

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17
Q

Consequences of Atypical Pseudocholinesterase?

A

(affects 1/2800 ppl) prolonged levels of LA in blood

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18
Q

Primary site amides are metabolized at?

A

Liver

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19
Q

what 2 diseases/conditions can lead to toxicity if amide LAs are used?

A

Hypotension and Congestive Heart Failure (CHF)

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20
Q

What organ excretes both amides and esters primarily?

A

Kidneys

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21
Q

What system shows first clinical signs of overdose?

A

CNS

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22
Q

Signs of Overdose (4)

A 
Slurred Speech
Shivering
Muscle Twitching
Tremors of face/extremeties
*Excitatory symptoms
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23
Q

Does Lidocaine cause inhibitory or excitatory symptoms?

A

Inhibitory, it is the exception. Mild sedation/drowsiness can be experienced

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24
Q

Do CNS or cardiovascular symptoms appear first in an LA overdose?

A

CNS, CV will appear later if LA concentration continues

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25
Q

Benefits of Vasoconstrictors? (4)

A

Decreased blood flow to injection site
Slower CV absorption
LA remains localized
Decreased bleeding at surgery site

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26
Q

Fxn of Beta1?

A

Cardiac Stimulation

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27
Q

Functions of Alpha 1/2?

A

Vasoconstriction of smooth muscles in vessels

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28
Q

Fxn of Beta 2?

A

Bronchodilation in bronchi

Vasodilation of vascular beds

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29
Q

what does 1:1,000 mean?

A

1 gram in 1000 mL or 1mg/mL

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30
Q

Where is epinephrine produced in animals?

A

Adrenal Medulla

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31
Q

What receptors does Epinephrine act upon? Which is dominant?

A

Both Alpha and Beta (dominant is beta though)

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32
Q

Low dose of Epinephrine affects blood pressure how?

A

Raises Systolic

Decreases Diastolic

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33
Q

High dose of Epinephrine affects blood pressure how?

A

Raises Systolic AND diastolic

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34
Q

As Epinephrine lvls decrease from an area, what activity dominates?

A

Beta2 begins to dominate over Beta1 and vasodilation occurs

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35
Q

Can rebound bleeding be expected with epinephrine?

A

Yes, it can occur up to 6 hours following surgery

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36
Q

(T/F) Epinephrine increases oxygen consumption in all tissues?

A

True

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37
Q

4 LA cartridges of 1:100,000 elicit what response in the liver and skeletal muscles?

A

Glycogenolysis via Beta action

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38
Q

Two step process to terminate epinephrine?

A
  1. Uptake by adrenergic nerves

2. Inactivated by COMT or MAO in liver/blood

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39
Q

Common side effects of epinephrine overdose?

A

Apprehension
Tachycardia
Sweating
Palpation

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40
Q

Epinephrine has 3 concentrations available for dentists, list them.

A

1: 50,000
1: 100,000
1: 200,000

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41
Q

Epinephrines 3 dilutions and their abilities for anesthetic duration?

A

All are equivalent

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42
Q

Epinephrines 3 dilutions and their hemostatis abilities?

A

1:50,000 has a strong reaction that does the other weaker dilutions

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43
Q

Maximum epinephrine dose in a healthy patient? How many cartridges?

A

0.2mg

11 cartidges or 20mL of 1:100,000

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44
Q

Max epinephrine dose in cardiovascular diseased patient?

A

0.04mg

2 cartridges or 4mL of 1:100,000

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45
Q

Norepinephrine produced where?

A

Adrenal Medulla

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46
Q

Mode of action of norepi?

A

90% alpha and some beta1

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47
Q

Norepi’s affect on heart rate?

A

Bradycardia

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48
Q

Norepi’s affect on blood pressure?

A

increase in both b/c of peripheral vasoconstriction

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49
Q

Levonordefrin, aka

A

Neo-cobefrein

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50
Q

Levonordefrin, mode of action (which receptors)

A

75% alpha

25% beta

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51
Q

Dose concentration of levonordefrin? and max dosage?

A

1:20,000

max dose is 1mg for all patients (20 mL or 11 cartridges)

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52
Q

Levonordefrin is the active ingredient in what LA?

A

Mepivacaine

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53
Q

Acidifying vasoconstrictors does what to shelf life?

A

Increases it to 18 months

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54
Q

Why is sodium bisulfate added to vasocontrictors?

A

It is an antioxidant, but this lowers pH so it burns more during injection

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55
Q

If patients are taking Beta-Blockers, why is this a concern if giving epinephrine? *2 exceptions though

A

Beta’s are blocked so no vasodilation can occur. Therefore, only alpha vasoconstriction occurs and blood pressures increases.
*Metoprolol and Atenolol

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56
Q

Patient has sulfite allergy, can we use an LA with vasoconstrictor?

A

NOPE, shit out of luck, work fast beotch.

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57
Q

Cocaine interferes with reuptake of what?

A

Norephinephrine, induces catecholamine sensitivity

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58
Q

If patient doesn’t lie, and states they have taken cocaine within the past 24 hours, can dental procedures still be done?

A

Not recommended, postpone dental treatment.

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59
Q

What two groups of people are at a greater risk to overdosing?

A

Small Children

Debilitated Elderly

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60
Q

If two different LA’s are used, how is max dosage figured out?

A

Use the lower of the two.

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61
Q

Lidocaine, trade name?

A

Xylocaine

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62
Q

Lidocaine, class?

A

Amide

63
Q

Lidocaine, metabolized

A

Liver

64
Q

% of lidocaine excreted from kidneys that is unchanged?

A

10% (hmmm, wonder what would happen if someone where to drink said urine…)

65
Q

Lidocaine, onset of action time?

A

2-3 minutes

66
Q

Lidocaine: Duration w/o vasoconstrictor?

A

5-10 minutes (no clinical uses)

67
Q

Lidocaine: duration w/ vasoconstrictor? Pulp and soft tissure

A

Pulp: 60 minutes
ST: 3-5 hours

68
Q

Lidocaine max dosage (I feel like he said he would give us the conversion factor)

A

Max dose is 500mg

69
Q

Look at pg 14 for maximum dosage example

A

lakjflksdjfldsjkf

70
Q

Lidocaine, topical usage or not?

A

yes, it puts the topical on the skin or it gets the hose again.

71
Q

Lidocaine overdose signs?

A

Drowsiness, then loss of consciousness and respiratory arrest

72
Q

Mepivicain, trade name we have to know

A

Carbocaine

73
Q

Mepivicaine, class?

A

amide

74
Q

Mepivicaine, metabolized where?

A

liver

75
Q

Mepivicaine, % unchanged upon excretion

A

1-16%…okay Dr. Harn, way to be precise there

76
Q

Mepivicaine, vasoactivity?

A

slight vasodilation

77
Q

Mepivicaine onset time?

A

1.5-2 minutes

78
Q

Mepivicaine concentrations? (2)

A

2% with vasoconstrictor

3%without vc

79
Q

Mepivicaine anesthesia duration:
2%, pulp/soft tissue
3% pulp/st

A

2%- pulp-60 minutes
st- 3-5 hours
3%-pulp-20minute infiltration or 40 min nerve block
st-2-3 hours

80
Q

Max dosage of Mepivicaine?

A

400mg?

81
Q

Mepivicaine topical usage?

A

nope

82
Q

Prilocaine, trade name?

A

Citanset

83
Q

Prilocaine, CLass?

A

amide

84
Q

Prilocaine, metabolized where? breakdown products?

A

liver
kidneys/lungs a little bit
*Orthotoluidine

85
Q
  1. Orthotoluidine can induce what?
    2 How long after Prilocaine injection does it take to appear?
    3 How long does it persist?
  2. How is it reversed?
A
  1. methemoglobin formation (look for cyanosis with respiratory distress)
  2. 3-4 hours after injection
  3. 12 hrs
  4. IV methylene blue
86
Q

Prilocaine onset of action?

A

2-4 min

87
Q

Prilocaine toxicity compared to Lidocaine

A

less toxic

88
Q

Prilocaine concentration?

A

4%

89
Q

Prilocaine duration?

  1. w/o vasoconstritctor
  2. with vc
A
  1. Pulp- infiltration for 10 minutes, block for 60 minutes
  2. pulpal- 60-80minutes
    st- 3-8 hours
90
Q

Prilocaine max dosage?

A

600mg

91
Q

Prilocaine topical usage?

A

nope

92
Q

Articaine trade name

A

Septocaine

93
Q

Articaine, class, why is this class unique?

A

Amide, unique derivative from thiophene which makes it more lipid soluble and has an extra ester linkage

94
Q

Articaine, metabolized where?

A

90% plasma, 10% liver

95
Q

Articaine can be reinjected how often? why?

A

every 30 minutes. it has a short half-life of 20 minutes

96
Q

Articaine onset?

A

1-2minutes

97
Q

Articaine duration?

A

Pulp- 45-60 minutes

Soft tissure- 2-5 hours

98
Q

Bupivicain trade name

A

Marcaine

99
Q

Bupivicaine class

A

amide

100
Q

Bupivicaine metabolized where?

A

liver

101
Q

Bupivicaine onset time?

A

6-10 minutes

102
Q

Bupivicaine concentration?

A

0.5%

103
Q

Bupivicaine duration?

A

Pulp-90-180 minutes

Soft Tissue- 4-12 hours

104
Q

Bupivicaine max dose?

A

90mg

105
Q

Bupivicaine toxicity compared to Lidocaine?

A

4 times less

106
Q

Main problem with bupivicaine?

A

Little kids are idiots and will self-mutilate themselves and then you’ll get a lawsuit by the parents and apparently “you can’t fix stupid” isn’t a viable defense…ugh…sigh…

107
Q

Benzocaine class?

A

Ester

108
Q

Benzocaine given how?

A

Only as a topical, NOT AN INJECTABLE DRUG

109
Q

Lidocaine concentration as a topical?

A

5% in the base from (recommended)

2% water soluble form also exists

110
Q

Oraverse, what does it do?

A

It blocks alpha adrenergic receptors so LA can be removed quickly since no vasoconstriction going on (55-62% reduction)

111
Q

Onpharma, purpose?

A

Sodium Bicarbonate added to this LA so pH is 7.35 instead of 3-5 and injection hurts less.

112
Q

Oraverse, chemical name

A

Phentolamine Mesylate (this was a test question on the pharmacy pharmacology test for 2nd years last week)

113
Q

If Harpoons disengages, what happens?

A

Can’t aspirate.

114
Q

Needles 25 vs 27 vs 30 comparisons?

A

25 is the biggest and most accurate and easiest to aspirate with (patients can’t even notice difference b/w the 3 sizes)

115
Q

Length of Long needle?

A

32mm

116
Q

Length of short needle

A

20mm

117
Q

How often should needles be changed?

A

every 3-4 insertions or sooner if bone was hit hard

118
Q

What could be the issue if pain is felt when pulling the needle out of the mouth?

A

Fish hook barbs on the tip from striking the bone.

119
Q

Is the diaphragm permeable or not?

A

It is semi-permeable

120
Q

Can cartridges be autoclaved?

A

Nope

121
Q

Can cartridges be soaked/stored in a solution?

A

Nope

122
Q

What does sunlight do to cartridges?

A

It increases oxidation which will lower pH. Lower pH causes more pain on injection and decreases permeability of the LA (cationic form present more)

123
Q

What can cause a large bubble in cartridge?

A

Freezing cartridge

124
Q

Is no bubble good or bad?

A

bad, it means a disinfectant was absorbed into the cartridge and will sting worse if injected

125
Q

Why shouldn’t tincture be used as a topical anesthetic?

A

It contains alcohol. It will burn more.

126
Q

Step to prep a syring (5)

A 
Retract piston
insert cartridge
engage harpoon and gently push it
attach needle
expel some solution
127
Q

How to insert a second cartridge?

A

same steps, but must strike piston with a sharp blow to embed the harpoon

128
Q

2 techniques for injecting that should be avoided?

A
  1. Using no handrest

2. Using the patient shoulders/arms (they will jerk these first upon pain)

129
Q

During the insertion of the needle, what direction should palm be facing?

A

Palms up, easier to inject

130
Q

Aspirating technique?

A

Aspirate and then rotate 45 degrees and aspirate some more

131
Q

Length of time to inject single cartridge?

A

60 seconds

132
Q

3 types of local anesthetic injections

A

Local Infiltration
Field Block
Nerve Block

133
Q

Local Infiltration?

A

Solution into area to be treated

134
Q

Field Block?

A

Solution near larger terminal nerve giving circumscribed area

135
Q

Nerve Block?

A

Solution deposited at main nerve trunk at a distance from area of treatment

136
Q

Supraperiosteal injection classification?

A

Field block by definition

137
Q

Supraperiosteal inj success rate?

A

95%

138
Q

PSA inj classification?

A

Nerve Block

139
Q

PSA success rage

A

90%

140
Q

PSA area numbed?

A

maxillary molars (MB root of 1st molar on MSA 28%)

141
Q

PSA average penetration?

A

16mm

142
Q

PSA technique

A
  1. 25 gauge short needle
  2. above maxillary 2nd molar at muccobuccal fold
  3. Up, in, and back at 45 degrees
143
Q

PSA, if bone contacted early, how to adjust?

A

It means too great of an angle towards midline, angle needle more towards teeth and keep going

144
Q

PSA common complications? (2)

A 
Hematoma from pterygoid plexus
v3 anesthesia (too lateral)
145
Q

MSA area numbed?

A

Max 1/2 premolars and MB root of 1st molar 28%

146
Q

MSA technique?

A
  1. 25 gauge short needle
  2. above second premolar at mucobuccal fold
  3. advance needle to apex of tooth
  4. aspirate
  5. deposit
147
Q

ASA aka?

A

Infraorbital nerve block

148
Q

ASA area numbed?

A

Central and Lateral Incisor
Canine/Cuspid
1st n 2nd Premolars 72% of the time

149
Q

When is ASA done?

A

When the supraperiosteal injection was ineffective.

150
Q

ASA technique?

A
  1. 25 gauge long
  2. insert needle at 1st premolar at mucobuccal fold
  3. Insert 16mm after infraorbital notch found
  4. Aspirate
  5. Inject
  6. Put pressure on infraorbital foramen for 1-2 minutes.
151
Q

Greater Palatine Technique

A
  1. Place cotton swab on greater palatine foramen
  2. Around the 1st molar region
  3. Page 5 (lots of tiny detail on bevel placement…i’m lazy..sorry..)
152
Q

Greater Palatine success rate?

A

95%

153
Q

Nasopalatine area numbed?

A

Anterior portion of hard palate

154
Q

Nasopalatine injection methods?

A

single needle penetration

multiple needle penetration

Local Anesthesia (1 decks)

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