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Pain and anxiety > Week 1 > Flashcards

Week 1 Flashcards

1
Q

The pre-anesthetic assessment consists of (3)

A

1) complete medical/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 (5)

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 (4)

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

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6
Q

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

A

True

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7
Q

Acceptable HR’s for adults and children

A

adult: 60-100
child: 75-100
toddler: 120-160

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8
Q

At what BP should you retake and refer for immediate med consult?

A

> 200/>115

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9
Q

At what BP should you consider nitrous for stress reduction?

A

140-159/90-94

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10
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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11
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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12
Q

How does stress affect the body in regards to pain?

A

it decrease the pain reaction threshold

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13
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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14
Q

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

A

fear

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15
Q

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

A

6-14%

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16
Q

*and tends to be a learned response from personal experience or from the experience of others.

A

anxiety

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17
Q

T/F: Fear is long-term

A

false! it’s short-lived

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18
Q

Anxiety is from ______________ or thought of dentistry

A

anticipation

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19
Q

Fear refers to the ___________ occurring in the dental office

A

reaction

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20
Q

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

A

oral, topical, subcutaneous, inhalation

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21
Q

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

A

benzodiazepenes

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22
Q

These are good for mild to moderate pre-treatment anxiety

A

Benzodiazepenes

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23
Q

Which benzos are the most common anxiolytic agents?

A

diazepam and triazolam

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24
Q

Nitrous oxide documentation MUST include.. (4)

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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25
Q

What are some features of nitrous that allow it to provide ideal sedation? (4)

A

-rapid onset of 2-5 mins
-wide safety margin
-quick recovery
-no hangover effect

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26
Q

T/F: Nitrous has low solubility in the blood

A

true

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27
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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28
Q

administration of drug increases the possibility of a life threatening situation =

A

absolute contraindication

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29
Q

administration of drug is preferably avoided due to possible adverse reactions =

A

relative contraindication

30
Q

List some examples of absolute contraindications (5)

A

1) Nasal Obstruction

2) Vit B12 Deficiency (can render B12 inactive)

3) Alcoholic / Recovering Addict

4) Uncommunicative (disability or language barrier)

5) Patient Refusal

31
Q

List some examples of relative contraindications

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

32
Q

Common side effects of nitrous

A

nausea, vomiting, headaches

33
Q

When does the nitrous pressure gauge start to fall?

A

once all the liquid is gone and only gas remains

34
Q

Which button is used to over sedation?

A

flush button

35
Q

Name the safety feature:
N2O flow terminated if O2 delivery pressure falls

A

oxygen fail safe

36
Q

Name the safety feature:
* allows atmospheric air in if flow of gases stops

A

emergency air inlet

37
Q

Name the safety feature:
rapid delivery of high flow O2 to patient (oversedation)

A

oxygen flush button

38
Q

nitrous oxide administration

A
  1. Select appropriatley sized nasal hood
  2. Inflate the bag –> start with 5-6 L/min of 100% O2
  3. Place the nasal hood –> patient adjusts for comfort –> tighten
  4. Instruct patient to breath normally –> adjust flow rate
  5. Gradually titrate N2O- O2 in 10% intervals, watching for signs of sedation –> ask how they feel
  6. Typical pt requires 50% N2O - 50% O2
  7. When treatment is completed –> N2O to zero and incrase O2 to re-establish flow rate –> 100% O2 for 5 MINUTES
  8. Document the procedure
    * NEVER leave the patient unattended
39
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

40
Q

3 main functions of neurons

A

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

41
Q

Describe the structure of a neuron

A

cell body, dendrites, axon

42
Q

What is the terminal end of an axon called?

A

synaptic knob

43
Q

T/F: Nerves are only found in the PNS

A

true

44
Q

CT around an axon

A

endoneurium

45
Q

group of axons

A

fascicle

46
Q

CT around one fascicle

A

perineurium

47
Q

CT around group of fascicles

A

epineurium

48
Q

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

A

TYPE A FIBERS

49
Q

Which A fibers are used for muscle movement

A

alpha

50
Q

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

A

Beta

51
Q

Which A fibers are used for muscle tone?

A

Gamma

52
Q

Which A fibers are used for pain and temperature?

A

Delta

53
Q

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

A

True

54
Q

Where are Type B fibers found?

A

preganglionic ANS
vascular smooth muscle

55
Q

Which are the smallest, most numerous, and unmyelinated fibers

A

Type C fibers

56
Q

Which fibers are responsible for dull, achy pain?

A

Type C

57
Q

What type of fibers are prevalent in the oral cavity?

A

Type A and Type C

58
Q

Which fibers require more anesthetic volume? why?

A

Type A cuz they’re larger

59
Q

Types of stimuli that trigger nerve impulses

A

chemical
thermal
mechanical
electrical

60
Q

Neurons maintain RMP via?

A

1) Sodium-Potassium Pump

2) closed K+ channels

3) closed Na+ channels

61
Q

What causes the absolute refractory period?

A

inactivation of sodium channels during repolarization

62
Q

What causes the relative refractory period?

A

hyper-polarization before RMP is established

63
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

64
Q

2 types of synapses

A

electrical and chemical

65
Q

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

A

1) prevent generation of impulses
2) preven conduction of impulses

66
Q

What do “membrane-stabilizing drugs” do?

A

decrease rate of depolarization

67
Q

Small/large diameter nerve fibers are less/more sensitive to LA’s

A

small; more

68
Q

Small/large diameter nerve fibers require more/less volume of LA’s

A

Large; more volume

69
Q

What are the 2 major routes of LA delivery?

A

1) topical
2) submucosal injection

70
Q

T/F: Submucosal injections are more effective than topical.

A

True

71
Q

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

A

Na+

Pain and anxiety (4 decks)

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