question

pain perception

answer

fear of pain, keeps seeking dental care

question

What are 2 ways we control pain in dentistry?

answer

1. Behavioral Method 2. Pharmacological Method

question

What is behavioral Method?

answer

breathing exercise, meditation, acupuncture

question

What are some pharmacological methods?

answer

1. LA 2. Inhalation (nitrous) 3. sedation oral premedication (valium) 4. conscious sedation 5. IV sedation 6. general anesthesia

question

Local anesthesia is for?

answer

pain control

question

Inhalation sedation is for ?

answer

help control fear

question

what is armamentarium and the components?

answer

equipment to administer LA 1. syringe 2. needle 3. cartridge 4. topical

question

type of syringes?

answer

1.non disposable 2. disposable 3. safety 4. intraosseous systems 5. computer controlled LA delivery system

question

What are the 5 types of NON DISPOSABLE SYRINGES?

answer

1. breech loading metallic cartridge, aspirating 2. Breech loading, plastic cartridge, aspirating 3. breech loading metallic cartridge, self aspirating 4. pressure 5. jet injector

question

in SCCC we use which type of syringe?

answer

breech loading metallic cart. aspirating

question

breech loading means?

answer

cartridge isolated from the side

question

there are 5 components of a syringe what are they?

answer

1. Needle adapter 2. syringe barrel 3. piston and harpoon 4. finger grip 5. thumb ring

question

The thumb ring traps and controls the syringe as well as ?

answer

move the piston

question

the finger grip is for what?

answer

grasp and control syringe

question

the piston connects what two things?

answer

thumb ring and harpoon

question

The harpoon allows for what kind of pressure within cartridge? to check what?>

answer

negative pressure to check location of lumen of needle

question

5 advantages of breech loading metallic cart. aspirating syringe?

answer

1. visible cart 2. one hand aspirating 3. autoclavable 4. rust resistant 5. long lasting

question

what are disadvantage of breech loading metallic cart, aspirating syringe?

answer

1. weight 2. too big 3. infection if improper care

question

should a non aspirating syringe be used?

answer

never

question

a non aspirating syringe has risk for?

answer

intravascular drug administration

question

what type of syringe is the standard of care?

answer

aspirating

question

what are the type of needle lengths in dentistry? 3 types and mm length?

answer

LONG which is 32mm Short 25mm and ultrashort is 12 mm only in 30 gauge

question

5 parts to a needle?? draw and label

answer

Bevel shaft hub syringe adapter cart penetration end

question

2 factors to consider about shaft?

answer

diameter lumen length from point to hub

question

what is a gauge?

answer

diameter of lumen. smaller greater diameter

question

colors of needles? 25? 27? 30? which is largest lumen?

answer

25 red is the largest 27 yellow 30 blue

question

which needle is recommended for inj posing high risk positive aspiration?

answer

red 25 gauge

question

which needle recommended for injection where positive aspiration is low and tissue penetration is minimal?

answer

yellow 27 guage

question

4 advantage of using larger gauge?

answer

1. less deflection 2. greater accuracy 3. less chance breakage 4. aspiration easier and more reliable

question

what is deflection?

answer

needle deflects away target area, from bevel larger needles less deflection more accuracy

question

change the needle after how many penetrations?

answer

3-4

question

draw and name parts of cartridge?

answer

cylindrical glass tube plunger Aluminum cap neck diaphragm

question

which component of cart is made of latex?

answer

diaphragm

question

what are the components of a cartridge?

answer

local anesthetic drug Vasoconstrictor Preservative for vaso sodium chloride distilled water

question

each cart is made of how much soln?

answer

1.8ml or 1.8cc

question

packaging of cart can come in 2 types and number in each?

answer

vacuum sealed*50 sealed blister 10

question

cart should store in light or dark place? why?

answer

dark cause deterioration mainly vaso. decrease duration of anesth

question

can you immerse cart in disinfectant? why?

answer

never, contamination and corrode cap

question

topical effective into how much tissue?

answer

2-3 mm not deep or hard tissue

question

what causes leakage during injection?

answer

off center perforation of diaphragm

question

what causes broken cart?

answer

worn syringe, bent harpoon excess force needle bend not engaged

question

what causes disengagement of harpoon?

answer

dull harpoon excess force during aspiration

question

what happens if piston doesn't move?

answer

at syringe end, needle no perforated to diaphragm

question

pain on insertion due to?

answer

dull needle change 3-4 times

question

pain on withdraw due to?

answer

fishhook barbs caused by manufacturing, or contact bone

question

what causes injury to pt or operator?

answer

sudden unexpected movement pt

question

There is a small bubble in cartridge. What is the bubble made of and result of it? can we use?

answer

nitrogen gas manufacturing process yes

question

What do large bubbles in cart indicate? can we use and why?

answer

was frozen can't use, not sterile

question

what does a extruded stopper with large bubbles indicate?

answer

soln frozen, soln not sterile

question

what does extruded stopper without bubbles indicate?

answer

contaminated in disinfectant soln

question

what does a corroded cap indicate?

answer

immersion in disinfectant soln that contain ammonium salts

question

what does rust on cap indicate?

answer

one of carp leaked

question

sticky stoppers were common when manufactures used what to lubricate stopper? and now we use what?

answer

paraffin wax silicone

question

what are 4 reason it may burn on inj?

answer

1. normal response pH 2. contain sterilizing soln 3. over heart cart 4. vaso

question

how to position pt at an inj?

answer

head and heart parallel to floor, feet slt. elevated

question

supine position helps prevent ______. which is also the most common medical emergency with injections

answer

syncope (or fainting)

question

local infiltration is?

answer

small nerve endings, interproximal papilla

question

field block is an injection of where? also called two other names?

answer

is injection above apex also called infiltration and supraperiosteal inj

question

A nerve block, anesthetizes what?

answer

main nerve trunk

question

Draw and name the nerve origin starting from the Central nerve?

answer

CN V : trigeminal opthalmic maxilary mand PSA pterygpalatine IO GP NP MSA ASA

question

the maxillary division of central nerve #?

answer

5 trigeminal

question

CN V then exits through the _______ _____ which is located in the _______ _______ of ________ bone

answer

foramen rotundum greater wing of sphenoid bone

question

supraperiosteal or field block .. numbs the region innervated by the terminal branches of the _____ _____ including: (what does it anesthetize?)

answer

dental plexus including: pulp and root area of specific tooth, buccal periodontium tissues, mucous membrane

question

when to use field block?

answer

1-2 teeth

question

contraindications for field block?

answer

inflammation or infection dense bone over apex

question

what is site of deposition for field block?

answer

apex tooth, height muccobuccal fold, tip at apex

question

ASA innervates? (what it anesthetizes)

answer

pulp max central, lateral, and canine buccal periodontium PDL and overlying bone upper lip and lower nose

question

can ASA cross the midline and innvervate opposite side?

answer

yes

question

what % of population can ASA originate premolars and MB root of max 1st molar. but not be numbed in those teeth

answer

72%

question

contraindication of ASA?

answer

infection or acute inflammation

question

what gauge use for ASA and area to inject?

answer

27 short or 25 short in canine fossa between lateral and canine height muccobuccal fold needle parallel to long axis of canine, follow contour maxilla bone

question

depth of insertion of ASA?

answer

3-6mm

question

Site of deposition of ASA?

answer

well above apex canine in canine fossa

question

deposit how much for ASA?

answer

0.9-1.2 ml soln

question

The IO inj anesthetizes which nerves?

answer

ASA MSA

question

MSA anesthetizes?

answer

pulp 1st and 2nd premolar and MB root first molar buccal periodontium overlying bone

question

MSA use what gauge and area of injection?

answer

27 short or 25 short above 2nd premolar at height muccobuccal fold

question

If patient has 1 premolar where do u do a MSA?

answer

apex of that premolar

question

depth of insertion for MSA?

answer

5-8mm

question

Deposit how much for MSA?

answer

0.9-1.2ml

question

Amides metabolizes in what?

answer

liver

question

Esters metabolizes in the ?

answer

plasma

question

what are the 5 types of amide LA? and which is gold standard?

answer

articane bupivacaine Lidocaine** gold standard Mepivacaine Prilocaine

question

what are the 2 esters of LA? no longer used

answer

procaine (novocane) and propoxycaine

question

what is important to know about LA agents prior to administer them to patient?

answer

duration of action MRD contrindications

question

short duration lasts how many min? and which LA are included?

answer

less than 30 pulpal Lido 2% Mepivacaine 3% Prilocaine 4% (infiltration) all plain.. no epi

question

Intermediate duartion is __min pulpal?

answer

60

question

long duration is how many min pulpal? which LA?

answer

90 + Bupivacaine .5% 1:200,000 epi

question

when a lot of s0ft tissue must be penetrated to get to the nerve it is harder to maintain accuracy of deposition which can INCREASE OR DECREASE the duration??

answer

decrease

question

inflammation, infection or pain INCREASES OR DECREASES duration anest.?

answer

decreases

question

increased vascularity decreases the duration because?

answer

drug absorbed rapidly

question

Lidocaine onset of action

answer

2-3 min

question

duration of lido plain..pulpal and soft tissue

answer

5-10 min pulpal 1-2 hrs soft tissue

question

duartion lido 2% 1:50,000 epi

answer

60 min pulap 3-5 hrs soft tissue

question

duration lido 2% 1:100,000 epi

answer

60 min pulpal 3-5 hrs soft tissue

question

mepivacaine 3% plain onset? duartion?

answer

onset 1.5-2 min 20-40 in pulpal 2-3 hrs soft tissue

question

which anesth recc for pt when a vaso is not indicated? and the least vasodialating

answer

mepivacaine

question

prilocaine plain onset?

answer

2-4 min

question

prilocaine plain duration for field block?

answer

10-15 min pulpal 1.5-2hrs soft tissue

question

prilocaine plain duration nerve block ?

answer

40-60 min pulpal 2-4 hrs soft tissue

question

prilocaine 1:200,000 epi duration?

answer

60-90 min pulpal 3-8 hr soft tissue

question

Which LA does metabolism occur in both the plasma and liver?

answer

Articaine

question

Articaine onset?

answer

1-3 min

question

articaine 4% 1:200,000 epi duration?

answer

45-60 min pulpal 2-5 hr soft tissue

question

articaine 4% 1:100,000 epi duration?

answer

60-75 min pulpal 3-6 hr soft tissue

question

DO NOT use articaine on patients with what kind of sensitivities?

answer

SULFITE

question

Bupivacaine .5% 1:200,000 onset and duration?

answer

onset 6-10 min 90-180 min pulpal 4-9 hr soft tissue

question

which LA is the most toxic and most vasodialating of the amides???

answer

bupivacaine

question

For palatine injection place topical for a full __ min?

answer

2

question

for palatine injections do you use pressure anesth. before or during injection?

answer

both

question

The GP anesth which areas?

answer

posterior hard palate overlying soft tissues premolar region medial to midline palate

question

what are contraindications of GP?

answer

inflammation or infection smaller areas of therapy

question

What gauge do you use for GP? and area to insert?

answer

27 short palatal soft tissue anterior greater palatal foramen

question

What is path of insertion for GP?

answer

syringe from opposite side of mouth at right angle target area

question

the GP foramen is usually located distal to the ?

answer

max 2nd molar

question

what is the depth of insertion and amount of LA for a GP?

answer

4-6mm and .45-.6 ml

question

true or false? in order to give an accurate injection of GP you need to enter th GP foramen?

answer

false. very painful

question

Gp has what % success rate?

answer

95%

question

with a GP anesthesia of the palatal area of the ___ ____ may be inadeq. due to the NP fibers overlapping

answer

1st premolar

question

what are some complications with a GP?

answer

ischemia ( lack blood supply) causing necrosis when highly concentrated vasoconstrictors are used over long period * necrosis. will look like ulceration heal in 2 wks

question

Nasopalatine area to anesthetize?

answer

anterior hard palate and overlying tissues, mesial of right 1st premolar and mesial left 1st premolar

question

yes or no NP has pulpal anesth?

answer

no

question

yes or no hemostasis for np?

answer

no

question

NP gauge? and area of insertion?

answer

27 short palatal mucosa lateral incisive papilla

question

how much deposit on a NP?

answer

0.45 ml

question

Local anesthesia is the ____ of _______ in an area of the body caused by a ______ of _______ in nerve endings or an inhibition of the conduction of a nerves ________

answer

loss of sensation depression of excitation impulse

question

neurophysiology is a roadblock of the source of the impulse and the _____, preventing the ________ of ______

answer

brain, interpretation of pain

question

A nerve impulse or neuron carries messages from one part of the body to ____? These messages are called?

answer

to another called, electrical action protentials or impulses

question

A neuron or nerve cell are??

answer

the structural unit of the neuron system

question

There are 2 basic neurons that are present. Name the 2 types:

answer

sensory or afferent neurons motor or efferent neurons

question

The sensory or afferent neuron conduct impulses from the ____ to the ______

answer

periphery to the CNS

question

The motor neuron conducts impulses from the ____ to the _____

answer

CNS periphery

question

Draw and label the structure of a sensory neuron

answer

dendritic zone in the periphery axon cell body or soma terminal arborization for the synapse with the CNS

question

Draw and label parts of the motor or effect neuron

answer

cell body axon dendritic zone

question

true or false.. sensory nerves are afferent, going from the CNS to periphery

answer

false. periphery to CNS

question

Peripheral nerves are made up of many axons bundled together in groups called??

answer

fasciculi

question

The outer region of the nerve is called?

answer

mantle

question

the fasciculi in the mantle are called the?

answer

mantle bundles

question

the center portion of the nerve is called? which contains the ____ _____ of the fasciculi

answer

core core bundles

question

peripheral nerve anatomy: the fibers of the mantle innervate areas _____ to them while the fibers of core innervate sites _____ _____

answer

close further away

question

A nerve that carries messages from one part of the body to another in form of impulses are called??

answer

action potential

question

action potential: depolarization of the nerve membrane results from a _____ in the membrane permeability to ___ and ____

answer

increase potassium and sodium

question

what 4 stimuli initiates a IMPULSE?

answer

chemical stimuli thermal stimuli mechanical electrical

question

What are the 3 phases of a nerve conduction?

answer

resting state depolarization repolorization

question

which phase of the nerve conduction is the non conducting nerve occur?

answer

resting state

question

which phase of nerve conduction does the membrane excitation occur?

answer

depolorization

question

Name 2 parts of the repolarization phase

answer

absolute refractory period relative refractory period

question

A negative electrical potential ___mv exits across the nerve membrane . this is produced by differing concentrations of ions on either side of membrane

answer

-70mv

question

the interior of the is ____ relative to the exterior. negative or positive??

answer

negative

question

during the resting state the nerve membrane is slightly permeable to _____ freely permeable to ___ and ___

answer

sodium potassium and chloride

question

DEPOLORIZATION: stimulus excites the nerve causing more permeability to ___ *influx of ___ causes nerve to undergo depolarization depolarization results in initiation and spread of an impulse along the nerve to the _____

answer

Na Na CNS

question

depolarization begin slow/fast?

answer

slowly

question

depolarization: ______ ______ occurs when the nerve membrane changes by 15mv then ____ _____ is now -50 to -60mV

answer

firing potential membrane potential

question

depolarization: In a normal nerve the ____ ____ remains constant?

answer

firing thershold

question

exposure to a local anesthetic raises/lowers? a nerves firing thershold

answer

raises because a lot Na+ pass membrane to decrease to a level where depolarization occurs

question

depolarization: firing potential is reached, nerve is more freely permeable to? * ___ begin to diffuse out *the influx of Na ions cause the nerve to undergo ____ _____ * at the end of depolarization the transmembrane electrical potential is ___mv

answer

Na K+ rapid depolarization +40

question

which phase? action potential is terminated when the membrane ______ caused by an inactivation to sodium *nerve returns to resting state

answer

repolarization

question

repolarization: SODIUM PUMP the ____ ions remain in axoplasm (inside cell) the ____ ions remain in extracellular fluid *metabolic activity begins: sodium pump moves remaining __ out of nerve sodium pump moves __ from the outside to inside cell

answer

Na K+ Na k

question

what period of repolarization phase? nerve is unable to respond to a stimulus regardless of its strength? time when a new impulse can be initiated but only by a stronger than normal stimulus ?

answer

absolute refractory period relative refractory period

question

sensory neurons are myelinated, not unmyelinated. t/f?

answer

false they are both

question

myelinated neurons are what type of delta fibers? is it a sharp, bright pain or slow burning pain?

answer

A delta fiber sharp bright pain

question

unmyelinated neurons are what type fiber? sharp, bright pain or slow burning pain?

answer

c fibers slow burning pain

question

A delta fibers and C fibers are responsible for transmitting ____ input from the dental and periodontal tissues. Both are in pump, there is more __ fibers than _ fibers

answer

sensory c a

question

what are nodes of ranvier?

answer

allow nerve impulse to go much faster in comparison to unmyelinated nerve

question

In a myelinated nerve the impulse leaps from node to node. What is this called?

answer

salutatory conduction

question

When the nerve is myelinated, conduction more rapid and energy efficient. Greater the ____ of the axon, thicker the myelin sheath. therefore salutatory conduction occurs more rapidly in thicker axon

answer

diameter

question

______ fiber which is myelinated. transmit a sharp stabbing type pain while the unmyelinated ___ fiber transmit slow, burning pain

answer

A delta C

question

Local anesthesia is a ___ of sensation in a circumscribed area of the body caused by a _________ of excitation in nerve endings.

answer

Loss Depression

question

What is is called when local anesthetics achieve their effects by binding to specific receptors within the sodium channels of a nerve thereby altering nerve condution.

answer

Conduction blockage

question

How much of the nerve should local anesthetic cover to ensure its effects?

answer

8-10mm

question

In a myelinated nerve, the anesthetic must block the action potential in at least how many nodes of ranvier?

answer

2-3 consecutive nodes

question

What are some properties of an ideal anesthetic?

answer

Sterile Non-irritating to tissues Reversible (it will wear off) Low systemic toxicity Effective when injected as well as topically Quick onset Sufficient duration Non-Allergenic Readily metabolized Adequate potency without use of harmful concentrations

question

What is the composition of an anesthetic carpule?

answer

Vasoconstrictor (optional) -Epinephrine -Levonordefrin Antioxidant/preservative (sodium sulfite) -only present when there's a vasoconstrictor Alkalining agent- adjusts the pH & makes solution more basic Sodium chloride- makes solution isotonic for surrounding tissue Sterile water- provides volume to solution (main component)

question

What are the two categories of local anesthetics?

answer

Esters (mainly used as topical) Amides

question

Why aren't esters used as an injectable drug in the US?

answer

They are associated with a higher risk for allergies

question

The three components of local anesthetics are:

answer

Lipophilic Intermediate chain Hydrophilic

question

True/False: local anesthetics either have a liphophilic component or a hydrophilic component, but not both.

answer

False- Local anesthetics contain both lipophilic and hydrophilic components.

question

Esters and amides are classified according to its __________.

answer

Chemical linkage

question

____________ ________ determines the classification.

answer

Intermediate chain

question

Local anesthetics must diffuse through ______ __________ and ________.

answer

Nerve Membrane Tissue

question

True/False: Local anesthetics can either be lipid or water soluble.

answer

False- it must be both. Lipid soluble- gets through the membrane Water soluble- gets through the tissues

question

Lipophilic component contains a _________ _____ which enables penetration of lipid-rich nerve sheath and is responsible for lipid solubility.

answer

Benzene ring

question

Lipid solubility of the local anesthetic is determined by __________.

answer

it's potency

question

Hydrophilic component, when combined with __________ _____, allows anesthetic to diffuse through _________ _______ in the tissues to reach the nerve.

answer

Hydrochloric acid (HCl) Interstitial fluid

question

What is an esters mode of biotransformation?

answer

Metabolized in the plasma

question

What is an amides mode of biotransformation?

answer

Metabolized in the liver

question

Esters were developed first but mainly used as _________ and it's name is _________.

answer

topical Benzocaine

question

Amides are commonly used in dentistry. What are the names of anesthetics that contain amides?

answer

Lidocaine Mepivacaine Prilocaine Bupivacaine Etidocaine Articaine

question

In their original form, local anestetics are basic compounds that are poorly ________ in water, ________ to air, and not clinically valuable. When combined with ___________ _____, they form local anesthetic salts that are ________ in water (sterile saline). This makes anesthetic stable and clinically effective.

answer

soluble unstable Hydrocholic acid soluble

question

How many ionic forms does local anesthetic salts have and what are they?

answer

2 RN RNH+

question

The RN ionic form is the _____ and is uncharged. It is ______-soluble and enables diffusion through the nerve sheath. The RNH+ ionic form is the _______ and is charged. It _____ to receptors sites in _______ channels, blocking nerve conduction.

answer

base lipid cation binds sodium

question

Each ionic form of local anesthetic is dependent on the _____ and ____ of the solution or surrounding enviornment.

answer

pKa pH

question

What is pKa?

answer

dissociation constant. It's the molecule's affinity for hydrogen atoms. Drug with high pKa has affinity for hydrogen atoms & water soluble Drug with low pKa does not have affinity for hydrogen atoms & fat soluble

question

In order for a drug to be both water and fat soluble, it must have two separate forms. What are they?

answer

RN (base) fat soluble form RNH+ (cation) water soluble form

question

For the amount of RN and RNH+ to balance, what does it depend on?

answer

pH

question

What is the pH of normal tissue

answer

pH 7.4

question

Why are anesthetics more acidic than normal tissue?

answer

In order for anesthetics to get through soft tissue, there's a need for more RNH+ (water solubility).

question

At the nerve sheath, only ___ molecules go through the lipid membrane. Inside the neuron, the ___ molecules change to the ____ for; the _____ ions block the sodium channels. Gradually, most of the ____ form outside the nerve changes to the ___ form allowing passage through the nerve sheath.

answer

RN RN RNH+ RNH+ RNH+ RN

question

What is the pH of inflamed tissue?

answer

pH 5-6

question

Inflammation makes the tissues have a lower pH than normal. the LA solution will have less available RN base form to go through the nerve sheath. Will the anesthetic solution penetrate the nerve membrane and why?

answer

Because inflamed tissues are more acidic, the RNH+ does not convert into RN which is why there isn't much RN available to penetrate the nerve membrane.

question

Inflamed tissue has more ______ blood vessels causing absorption and uptake of the LA.

answer

dilated

question

What are some characteristics of local anesthetics with epinephrine?

answer

Have low pH (anything with a vasoconstrictor) Makes it burn on injection Slower onset (more acidic, basic LAs work faster)

question

What causes inadequate concentrations of LA in nerve fibers?

answer

Inaccurate site of deposition Rapid absorption of solution in blood stream (due to inflammation) Decreased pH of tissues surrounding the nerve (due to inflammation)

question

What are factors that influence blood levels of LA?

answer

Uptake Distribution and redistribution Metabolism of ester linked anesthetics Metabolism of amide linked anesthetics Excretion

question

The rate of LA is related to __________ of tissues. Route of administration ______ rate of absorption. Absorption is governed by _________ injected regardless of concentration.

answer

Vascularity alters quantity

question

Once absorbed into the blood, LA is distributed to all body tissues such as:

answer

brain lung liver kidney muscle fat bone tissues with higher blood content have higher blood levels of LA

question

Blood levels of anesthetic reflects:

answer

The rate at which the drug is absorbed in the CVS The rate at which the drug is distributed to the tissue and The elimination of the drug through metabolism or excretion

question

The rate that the drug is removed from the blood is the ___________ _____-______. It tells you how long a drug stays in your system.

answer

Elimination half-life

question

________ binding may prolong the time that the drug is in the blood.

answer

Protein (other drugs a person may be taking)

question

Metabolism of an ester and hydrolysis occurs in the plasma through _________________.

answer

Pseudocholinesterase

question

True/False: Allergy of esters are related to para-aminobenzoic acid (PABA) which is why ester injectable anesthetics are no longer common.

answer

True

question

Metabolism of an amide is primarily metabolized by ________ _________.

answer

Microsomal enzymes

question

True/False: Both prilocaine and articaine are metabolized in the liver and lungs.

answer

False: Prilocaine is metabolized in the liver and lungs Articaine is metabolized in the liver and blood

question

Hepatic dysfunction or hepatic disease cause the inability to metabolize _______ at a normal rate.

answer

Amides

question

Which organ is a primary excretory organ of both esters and amides?

answer

Kidney

question

What are patients with kidney problems at risk for when given LA?

answer

Toxicity because the drug is not excreted as effectively and the drug stays in the blood longer.

question

True/False: Both esters and amides cross the placenta in significant quantity.

answer

True Be careful with pregnant patients

question

What are some factors that influence toxicity?

answer

Type of drug Concentration Route of administration Vascularity of tissue Vasoconstrictor Weight of patient Rate of metabolism and excretion

question

What are some adverse effects of LA?

answer

Administration into vascular tissue (injecting into a blood vessel) Giving too high a dosage Giving the anesthetic too quickly Poor drug clearance from the body (people with poor liver/kidney problems)

question

Why is it important to aspirate?

answer

The higher the blood level, the greater the chance for systemic toxicity.

question

At toxic levels, the CNS pharmacological action is __________ and things slow down.

answer

depression

question

True/False: Toxic or overdose levels of LA present CNS depression and tonic-clonic episodes.

answer

True Seizures are primary clinical manifestation

question

What can happen to the CVS when toxicity occurs?

answer

Decrease electrical excitability of myocardium and electrical conduction rate and form of contraction. Hypotension at overdose levels Complete collapse of cardiovascular system at lethal levels (stops heart)

question

Allergic reactions are rare with LA that contain amides, but what are signs of an allergy? What causes the reaction?

answer

Mild rash to anaphylaxis Sulfites

question

How deep into the tissue can topical take its effects and aids in comfortable needle penetration?

answer

2-3mm into tissue

question

Topical anesthetics aid in a _________ injection.

answer

comfortable

question

Topical gel contains what kind of anesthetic?

answer

Benzocaine

question

True/False: Topical anesthetic anesthetizes deep tissue or hard tissues.

answer

False- it only anesthetizes 2-3 mm of tissues

question

Topical anesthetics come in ______ concentration thatn local anesthetic to facilitate _________ of the drug.

answer

Higher Diffusion

question

True/False: Topical anesthetics have a greater chance for toxicity than injectable anesthetics and cause most cases of toxicity.

answer

First statement is true, Second statement is false. Though topical anesthetics have a greater chance for toxicity, it is poorly absorbed in the CVS in topical forms.

question

Topical anesthetics do not contain _____________ and are rapidly absorbed into the bloodstream and have vasodilating properties.

answer

vasoconstrictors

question

True/False: It's okay to administer topical gel to patients with ester allergies because it's not absorbed systemically and doesn't cause any reaction.

answer

False: it is not okay to administer topical anesthetic to patients who have ester allergies. It causes a localized allergic response such as blister/hive at the spot applied.

question

What types of topical are available?

answer

Gel Ointment Liquid Spray Bioadhesive Matrix

question

Topical anesthetic sprays should be metered spray dose. If the spray is unmetered, the risk of _________ is much greater. A problem with sprays is keeping the nozzle _______.

answer

overdose sterile

question

Topical anesthetic bioadhesive matrix contains 46.1mg of __________ and last for ___ mins. It helps prevent ______ by keeping blood concentrations very low.

answer

lidocaine 30 toxicity

question

What are some precautions to topical anesthetics?

answer

Place topical at injection site only Apply to no more than 3 teeth at a time Full quadrant application not indicated and could lead to an overdose Spray forms doses cannot be monitored

question

What is the procedure for placing topical?

answer

Explain what and why Dry site Apply to site and do not rub (causes sloughing and higher dosage) Wipe off excess after 1-2 mins

question

What are the major differences between benzocaine and lidocaine as topical anesthetics?

answer

Benzocaine: Higher incidence of localized allergy, not suitable for injection

question

True/False: Most undesirable reactions to LA are a response to the drugs itself and not the act of getting an injection.

answer

False- Most undesirable reactions to LA are response to the ACT of getting an injection and not the drug itself.

question

What are the two common undesirable reactions to LA?

answer

Vasodepressor syncope Hyperventilation

question

What should be done prior to treatment?

answer

Determine patients tolerance Make modifications as necessary Review medical history Take vital signs Review dental questionnaire

question

A medical/dental questionnaire should be done. What are some things that should be known about a patient?

answer

Presence of pain Anxiety Past dental experiences Hospitalization Under care of physician History of bleeding History/presence of medical condition Allergic reactions to medication Allergic reaction to other substances Medications or drugs taking now or previously

question

A patients ____ status determine any modifications to treatment. _____ status I-III may receive vasoconstrictors in LA.

answer

ASA ASA

question

True/False: ASA IV Cardiovascular risk patient are good candidates for elective dental treatment.

answer

False- ASA IV and beyond are not good candidates for dental treatment. They are too compromised.

question

Patients who are ASA III-IV with congestive heart failure (choose all that apply): a) have decreased liver perfusion b) do not metabolize the anesthetic as readily c) increase the half-life of amide anesthetics d) increased risk of overdose e) should not have a medical consult f) stress reduction protocol with nitrous oxide g) modification of positioning- risk of orthopnea

answer

All EXCEPT E. The patient SHOULD have a medical consult.

question

Myocardial infarction during the past 6 months is considered ASA ___. Elective dental treatment is ___________. After 6 months, ASA status is considered ASA ____. Vasoconstrictors are ______ after 6 month period.

answer

IV contraindicated III limited

question

Vasoconstrictors are ok when angina is ______. Anxiety may precipitate an attack. Unstable angina represents ASA ____ and cannot be treated. Medical consult may be ________.

answer

stable IV indicated

question

Blood pressure should be take at _______ appointment. With mild to moderate elevated BP, clinician should ________ vasoconstrictors.

answer

Every limit

question

Patients with heart operation, heart murmur, congenital heart lesion, rheumatic fever, and scarlet fever should all get what before dental treatment?

answer

Medical consultation- determination of antibiotic premedication

question

Guidelines say that these cases still need antibiotic premedication. Which are they: a) artificial heart valves b) history of infective endocarditis c) mitral valve prolapse d) certain, specific, serious congenital heart conditions e) cardiac transplant that develops a problem in a heart valve d) bicuspid valve disease

answer

a, b, d, e Mitral valve prolapse bicuspid valve disease rheumatic heart disease calcified aortic stenosis heart pacemakers congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy no longer need antibiotic premedication

question

Cardiovascular- compromised patient can have ____mg of epinephrine per appointment. The maximum catridges of 4ml of a 1:100,000 is ___ or 8ml of a 1:200,000 is ___.

answer

.04mg 2 cartridges 4 cartridges

question

Acetaminophen can _______ methemoglobin levels and is a relative contraindication to what type of anesthetic?

answer

elevate Articaine (lower amount)

question

Cimetidine (Tagamet and Peptol) increase the ____-____ of amide anesthetics. It is only an issue if a patient is ASA ____ and has congestive heart failure. __________ dose of amides should be used.

answer

half-life III Minimal

question

What should be done with non-selective beta blockers

answer

Monitor heart rate, rhythm and BP Strictly limit vasoconstrictors Limit usage of lidocaine

question

Patients taking Tricyclic Antidepressants, avoid ____________: tricyclics can increase the vasoconstricting properties by 5-10 times. Limit _____________: tricyclics can increase vasopressor effects by 2x.

answer

levenordefrin epinephrine

question

Phenothiazines can decrease vasopressor effects and create hypotension if injected intravascularly. Limit usage of ____________.

answer

Vasoconstrictors

question

If a patient is using cocaine, what can it do?

answer

CNS & CVS stimulant If vasoconstrictor is given, can cause significant dysrhythmias, myocardial infarction, or cardiac arrest Reschedule if taken within 24 hours

question

If a patient is using methamphetamine, what can it do?

answer

If vasoconstrictor is given, it can cause heart attack, stroke, hypertensive crisis. Reschedule if taken within 24 hours

question

If a patient is using marijuana, what may happen when given LA?

answer

It will be harder for the patient to receive the benefits of anesthetic.

question

True/False: Giving a patient with a sodium bisulfite or metabisulfite allergy a carpule of lidocaine with epinephrine is the best decision.

answer

False: Epinephrine is the vasoconstrictor. Anesthetics with vasoconstrictors contain sulfite as its preservative. Patients with sulfite allergies can only receive plain anesthetics.

question

A patient who is allergic to methylparaben (PABA) should ________ the use of an ester topical.

answer

Avoid

question

True/False: Patients with latex allergies should not be given anesthetics because of the latex diaphragms.

answer

False: Theoretically is it a contraindication, but there are no cases reported of an allergic reaction due to the latex diaphragm.

question

Where does the Mental Nerve Exit?

answer

Mental Foramen

question

Where is the Incisive nerve located and what does it innervate?

answer

Continues a long in the Mandibular Canal and innervates the premolars and anteriors.

question

TRUE/FALSE :Incisive nerve block is a bilateral injection.

answer

FALSE: It is a unilateral injection meaning that it will only anesthetize the area being injected.

question

What teeth are anesthetized with the Incisive nerve block?

answer

-Mandibular 1st and 2nd premolar, canine, lateral incisor, and central incisor.

question

What area of the Gingiva is anesthetized with Incisive nerve block?

answer

Mandibular buccal gingiva from the mental foramen to the midline.

question

What other areas are anesthetized with Incisive nerve block?

answer

-PDL from 2nd premolar to central incisor -bone overlying these teeth -Mandibular Buccal Mucosa -lower lip and skin of chin to midline.

question

What is being anesthetized in a Incisive nerve block? (Nerves)

answer

-Incisive and Mental nerve

question

TRUE/FALSE: The lingual tissue will not get numb with the Incisive block.

answer

TRUE: only the IABL anesthetizes the lingual nerve.

question

What are contraindicatoins with Incisive nerve block?

answer

-Infection or Inflammation

question

What are some advantages/disadvantages for the Incisive Nerve block?

answer

Advantages: Highly Successful -Provides pulpal and hard tissue without having the tongue numb Disadvantages: -No lingual anesthesia

question

What is the percentage aspiration for the Incisive nerve block?

answer

5.7 %

question

What are some complications with this injection?

answer

-Hematoma -Trauma to the nerves if the needle enters the foramen

question

What are reasons why the Incisive nerve block will lack pulpal anesthesia?

answer

-Inadequate solution in the mental foramen -Not enough extra oral pressure

question

What is needed to provide pulapal anesthesia?

answer

Anesthetic needs to enter the foramen, by achieving this pressure must be applied to the area for 2 minutes. Do not rub the area.

question

Where is the mental foramen Located?

answer

-Can visually be seen in radiographs in between the 1st and 2nd premolar.

question

How can you locate the mental foramen?

answer

Palpation

question

What gauge is used for the Incisive nerve block and what area?

answer

25 or 27 gauge short Muccobuccal fold in the area between the 1st and 2nd premolar.

question

Depth of Penetration?

answer

5-6mm

question

deposit of solution for incisive?

answer

0.6-0.9ml

question

What happens if pressure is not provided after the injection?

answer

You will only give a mental nerve block and will only get soft tissue numb.

question

What nerve is the largest of the Trigeminal Nerve?

answer

Mandibular Nerve

question

TRUE/FALSE: Mandibular nerve only has sensory roots.

answer

FALSE: Mandibular nerve consist of both sensory and motor roots

question

Where does the mandibular nerve exit?

answer

Foramen Ovale

question

What are the muscles of the anterior division (motor branches) that innervate the muscles of mastication?

answer

Masseter Temporalis Lateral Pterygoid

question

What are the sensory nerves of the posterior division?

answer

Auriculotemporal nerve Lingual nerve Inferior alveolar nerve Incisive and mental nerve

question

What nerve is the largest branch of the mandibular nerve?

answer

Inferior Alveolar Nerve

question

TRUE/FALSE: The IA is the most used injection in dentistry.

answer

TRUE

question

What other nerve are also Anesthetized besides the IA?

answer

Lingual and Buccal Nerve

question

What is the clinical failure rate for the IABL?

answer

15-20%

question

Teeth anesthetized for IABL?

answer

From the mandibular molars to the midline anteriors

question

Structures that are anesthetized for IA/Lingual?

answer

Anterior 2/3 of tongue Lingual soft tissue from molar to midline Buccal gingiva anterior to 1st molar

question

What are indication for the IABL?

answer

Dental procedure requiring multiple teeth in one quadrant Lingual soft tissue anesthesia is required

question

What are some contraindications for IABL?

answer

Infection or inflammation of tissue Hemophiliacs Patient at risk for self injury Hemostasis, rather than pain control, is needed

question

disadvantages for IABL?

answer

Anatomy is not consistent High failure rate 15-20%

question

What is the percentage of positive aspiration?

answer

10-15% highest of all injections

question

What are complication associated with the IABL?

answer

Trismus Hematoma Transient Facial Paralysis Electric Shock due to contact with lingual nerve

question

What is Trasient Facial Paralysis and why does it occur?

answer

Occurs when the needle is over inserted and solution is deposited in the parotid gland which causes numbness of the facial nerve. This happens when bone is not contacted and the solution is deposited.

question

Alternative techniqes for IABL?

answer

Gow Gates Nerve block Mental/Incisive Nerve block

question

What gauge is used?

answer

25 gauge long

question

Anatomical landmarks for the IABL?

answer

Coronoid Notch Pterygomandibular Raphe

question

What is the Coronoid Notch?

answer

Where the external oblique ridge begins to curve upward. Also lined up with the mandibular foramen. Allow operator to inert at a site higher than the foramen which will anesthetize around the nerve before entering the foramen.

question

What is the pterygomandibular raphe?

answer

Band of attachment of the buccinator muscle to the superior constrictor muscle of the pharynx

question

Where is the height of the injection?

answer

Slightly superior to the apex of the raphe triangle or 2 to 3 mm higher than the level of the coronoid notch. 6-10 mm above the occlusal plane of the mandibular molars 1/2 to 2/3 of the raphe

question

Where is the syringe placed?

answer

At the corner of the mouth on the opposite side that is being injected over the contralateral premolars.

question

Depth of Penetration and how much of needle should be visible?

answer

20-25mm depth of penetration 7-12 mm of needle should be showing

question

How much solution should be administered for the IA, Lingual, and Buccal?

answer

IA: 1.5mL Lingual: 0.2 cc Buccal: 0.2-0.3 cc

question

What happens when you are too shallow and how do you correct it?

answer

You hit bone too early and the needle is located too anteriorly on the ramus. To correct move the syringe more anterior over the canine. Once depth has been reach move syringe back over premolars.

question

How do you correct if you are too deep?

answer

Withdraw the needle slightly and leave about 5mm of needle in tisssue and reposition barrel over the molar and continue until bone is contacted.

question

After the IA has been given, the Lingual block is given next. How many mm of the needle is withdrawed from the tissue?

answer

About half way 8-10 mm of the needle should be left in tissue.

question

TRUE/FALSE: When giving anesthetic to the lingual, no need to aspirate since the injection site is the still the same.

answer

FALSE: Aspiration is always done even with slight movement.

question

What areas does the buccal nerve anesthetize?

answer

Buccal gingiva and periosteum of the mandibular molars Skin of the cheek Mucosal membranes in the area of the mandibular molars

question

Syringe alignment for the Buccal nerve?

answer

Parallel to the occlussal plane Distal and buccal to the last molar

question

Depth of penetration for the buccal nerve?

answer

3-4mm

question

What are complications for this injections?

answer

Minimal positive aspiration Hematoma may occur

question

Should topical be placed at different times?

answer

No, topical should be placed at the same time for both injections since recapping is not necessarry to give both the IA/L and buccal

question

What are some useful tips for pediatric anesthesia?

answer

-Never lie to the child -Tell them what to expect -Make sure child know you are in charge -Use topical -Do not show needle -Avoid palatal injections -Give slow injections

question

TRUE/FALSE: The depth of penetration is not less in children.

answer

FALSE: The depth of penetration is less since the bone in less dense and more porous. *Short needles should be used for both arches

question

Why are PDL injections contraindicated in primary teeth?

answer

Enamel Hypolplasia can be caused on the underlying permanent teeth.

question

What can help prevent Toxicity?

answer

Use LA with vasoconstrictor when treating more than one quadrant. LA without vaso can be used if appointments are short and confined

question

Why is the PSA not necessary?

answer

Zygomatic process closer to maxilla in children ( a risk for hematoma) Infiltration will be very effective

question

When is the ASA necessary?

answer

Multiple restorations are needed The depth of penetration is just slightly deeper than infiltration

question

TRUE/FALSE: Is the Nasopalatine done the same way as an adult

answer

TRUE, but palatal injections not recommended unless necessary

question

Where is the Greater Palatine located?

answer

Visualize imaginary line from most posterior erupted tooth to the midline. If 1st permanent molar is not erupted penetrate 10 mm behind the last primary molar.

question

How are papillary injections done in children?

answer

Similar to adults, insert horizontally into buccal papilla and advance needle towards palatal side

question

Why are infiltrations effective in mandible?

answer

Less dense and more porous. When child gets older the bone becomes dense.

question

What makes the Inferior Alveolar very successful in children?

answer

The mandibular foramen lies distal and inferior to the occlusal plane.

question

When the child ages, about how much does the foramen move?

answer

About 7mm

question

Where is the syringe barrel placed for the IA in children?

answer

Over the primary molars on the opposite side of the mouth.

question

IA depth penetration and needle used for kids?

answer

Depth: 15 mm Needle: 25 or 27 gauge short Don't forget to evaluate the size of the child and mandible Buccal is done the same as adults

question

What will the mental/incisive anesthetize?

answer

All 5 primary teeth in a quadrant

question

Where is the mental foramen located in children?

answer

In between the two primary molars

question

What are sign and symptoms of overdose toxicity?

answer

-Restleness -Tremors -Sweating -V omitting -Decrease in BP and cardiac output -CNS and CVS depression

question

How to prevent Overdose?

answer

-Inject slowly -Aspirate -a needle that reliably aspirates -use LA with vaso

question

Clarks Rule

answer

Child Weight in lbs x Adult MRD = Child Dose ------------------------------------------- 150

question

How many carpules of 2% lidocaine with 1:100,000 epinephrine can safely be administered to a 50 lb child?

answer

2.5 carpules

question

How many carpules of 3% Mepivicaine without a vasoconstrictor can safely be administered to a 50 lb child?

answer

1.5 carpules

question

How to avoid injuries?

answer

-Watch for cheek biting -select appropriate anesthetic for duration procedures -advise patient and guardian -put a warning sticker on forehead or hand -use cotton roll to protect lip

question

When discovered nitrous oxide?

answer

Joseph Priestly in 1772

question

What year was it first used in dentistry?

answer

1844

question

In _________ it was combined with __________ for use in pain control.

answer

1868 oxygen

question

What are the reasons for use?

answer

Helps patients relax Provides pain control for procedures that are slightly moderate to painful.

question

Nitrous Oxide is a ________ anesthetic but _________ analgesic.

answer

weak strong

question

TRUE/FALSE: Nitrous oxide does not raise a person's threshold.

answer

FALSE

question

What are the goals of N2O Sedation?

answer

-Relieves anxiety and fear -Stress reduction -Reduce pain Perception -Amnesia and analgesia effects -Light sedation and mood alteration -Patient remains conscious with protective reflexes intact

question

What are the advantages of N2O?

answer

-Simple and Safe -No allergies -Reduction in gag reflex -Onset & recover are fast -Time and perception can be altered

question

What are the disadvantages of N2O?

answer

-Vertigo, nausea, vomitting -Extreme behavior problems -Equipment is cubersome -Mask gets in the way -Long term exposure may cause health problems

question

What are some indications for patients?

answer

-Asthma -Epilepsy -Cardiovascular or cerebrovascular disease -Parkinson's disease Cerebral palsy, Multiple Sclerosis, Muscular dystrophy -Fainting Spells

question

What are some contraindications?

answer

- Communication and cooperation difficulty -COPD (Emphysema, Bronchitis) -Nasal Obstruction (cold, allergies, sinus infection) -Patient don't want N2O -Middle ear disturbances (increase pressure on tympanic membrane) -Pregnancy (N2O crosses the Placenta, avoid 1st trimester) -Personality disorder and emotional instability -Claustrophobia -Sever behavior problems -May need a medical consultant with physician to determine whethere there is a sensitivity to N2O.

question

Can you use Nitrous on a patient with a cold?

answer

No, obstruction not able to breath in and out.

question

Your patient had a stroke 12 months ago. Can you safely administer Nirtous Oxide?

answer

Yes

question

Does Nitrous Oxide lower a patient's threshold for pain?

answer

No, it raises it.

question

Will nitrous help reduce gagging?

answer

Yes

question

Nitrous is stored as a ____________ and is delivered as a ___________. Oxygen is strored as a Gas.

answer

Liquid Gas

question

TRUE/FALSE: Both oxygen and nitrous are colorless and odorless.

answer

FALSE Nitrous is colorless, but it has a sweet odor.

question

Nitrous is stored in a __________cylinder and oxygen is stored in a _________ cylinder.

answer

Blue Green

question

Full tank is nitrous is at ______ psi and oxygen is at _______psi.

answer

750 2100

question

Nitrous is relatively ________ in blood and is rapidly eliminated from blood to __________.

answer

insoluble lungs

question

Will nitrous have an effect on blood pressure, hear rate, liver or kidney function?

answer

No, it will not just as long as there is an adequate amount of oxygen that is administered at the same time.

question

Nitrous has affects on sensations as ________, _________, ____________, and _____________.

answer

hearing, touch, pain, warmth

question

Nitrous is a ________ depressant. It affects the _________, __________, __________, and ____________.

answer

cerebral cortex, thalamus, hypothalamus, reticular activating system.

question

TRUE/FALSE: Pain perception is blocked, LA is not needed to manage pain

answer

FALSE, anesthetic is needed to help reduce pain.

question

What happens when there is too much nitrous oxide and not following up with proper oxygenation?

answer

Diffusion Hypoxia

question

TRUE/FALSE: Nitrous oxide administration can increase a patient's blood pressure.

answer

FALSE, it does not have an effect

question

What is stage I?

answer

Analgesia/Sedation: Patient feels pain but does not care

question

What is stage II?

answer

Excitement/Delirium: Hyper responsive to stimuli, exaggerated response, loss of conciousness

question

What is stage III?

answer

Surgical Anesthesia: Oral Surgery

question

What is stage IV?

answer

Medullary Paralysis/Death: Major surgery in a hospital setting

question

What are sign and symptoms of early to ideal sedation?

answer

-Facial muscl relax -light- headedness -Tingling/numbness -light or floating feeling -mouth remains opened -Vital signs are normal -Regular Breathing -Skin has a slight flush

question

What are sign and symptoms of heavy sedation to slight overdose?

answer

-Hearing acute -Visual images confused -Sleepiness -Laughing, crying, dreaming -Nausea -Mouth tends to close -Less likely to respond

question

What are signs and symptoms of over sedation?

answer

-Nausea/vomiting -Mouth breathing -Patient is uncomfortable -Uncooperative -Uncoordinated movements -Patients responds irrationally

question

What are the management of over sedation?

answer

reduce N2O by 1 lpm. Use 100% of O2 flush if necessary, turn off N2O, use basic life support and call 911 if needed.

question

What to do when a patient vomits?

answer

Turn the patients head to the side to help clear the pharynx, turn off nitrous, and give 100% oxygen for 5 minutes.

question

Concentration of ____ to ____ % will have a response of body warmth, tingling of hands, and feet.

answer

10 to 20%

question

Concentration of _____ to ____% will have a response of cummoral numbness and numbness of the thighs.

answer

20 to 30 %

question

What is the ideal level of sedation (% percentage) and the responses?

answer

20 to 40 % Numbness of tongue, hands and feet Mild sleepiness Analgesia Euphoria Feeling of heaviness or lightness of body

question

What are adverse reactions and side effects to N2O?

answer

-Diffusion Hypoxia -Nausea and Vomiting -Corneal Irritation -Behavioral Problems

question

What causes Corneal Irritation?

answer

Leakage of gas from mask, causes dry eyes. If patient has contact lenses ask them to remove or keep their eyes clothes.

question

What will cause equipment malfunction?

answer

-ill-fitting mask -faulty conduction tube -poor scavenger system -inadequate ventilation

question

What have studies have shown of hazards to personnel?

answer

-spontaneous abortions -birth defects -bone marrow suppression -anemia -hepatic and renal diseases -cancer

question

How to reduce N2O concentration?

answer

-use a well fitting mask -discourage talking -use a fan -have proper ventilation -open a window -wear a badge

question

What is scavengin?

answer

Removes excess nitrous oxide and minimizes the trace amounts of nitrous before, during, and after use.

question

What happens when the patient does not breath through their nose?

answer

Nitrous is not getting into their system and nitrous ends up in the atmosphere where it is unscavenged.

question

What are indications that your patient has reached an undesirable level of nitrous oxide sedation include which of the following: a) flushing of the skin b) slight dizziness c) uncontrollable laughing d) mild perspiration

answer

C) uncontrollable laughing

question

Patient was on N2O for 45 minutes. At the end of the appointment, the patient complains of headache and nausea. What is the cause of this? a) received nitrous too long b) did not receive 100% O2 for sufficient time after nitrous c) received too much 100% oxygen after nitrous d) it has nothing to do with administration of N2O

answer

b) did not receive 100% O2 for sufficient time after nirtous

question

The ideal stage of sedation for dental hygiene care is : a) stage I b) stage II c) stage III d) stage IV

answer

a) stage I

question

Your patient complains of a " hung over" feeling following of N2O administration. What is the cause? a) nausea b) corneal irritation c) diffusion hypoxia d) scavenger system

answer

c) diffusion hypoxia

question

What are the 5 parts of the equipment?

answer

-Flow meter -Pressure gauge -Yoke - Gas Hole - Reservoir Bag

question

What is needed to in order to prevent leakage of nitrous?

answer

Appropriate mask size

question

The sterilized nose mask connects to two hoses. The larger adaptor connects to the __________ and the smaller adaptor connects to the the _______________.

answer

Gas hose high-speed suction system

question

TRUE/FALSE: The clinician should always check and record health history, blood pressure, and pulse of the patients before proceeding.

answer

TRUE

question

TRUE/ FALSE: If a patients has been on substance for the past 48 hours a clinician can give nitrous to the patient.

answer

FALSE

question

What is the total tidal volume?

answer

6 L/min

question

When should you place a gauze on the area?

answer

-If the mask is too big -when mask is impinging on a sensitive area of the face

question

If patient feels that he/she is short of breath ______ the volume of oxygen. If patient feels that there is too much air coming into the mask ________ the oxygen volume.

answer

Increase Decrease

question

What is the average adult tidal volume?

answer

6-8 liters

question

When should you check with the patient after adjusting the tidal volume?

answer

Every 90 seconds

question

TRUE/ FALSE: If nitrous volumes goes up, oxygen volume must go down.

answer

TRUE

question

If patient is not at ideal sedation after 90 seconds, how much should you adjust?

answer

1/2 a liter after every 90 seconds

question

What is titration?

answer

When the flow of nitrous has reached the patients ideal sedation.

question

At what level should a clinician never reduce oxygen below while in use?

answer

2-3 Liters

question

What is the ideal level of sedation for 70% of people?

answer

30 to 40 %

question

What is the maximum level of Nitrous should not go over?

answer

42%

question

How long should the patient be on 100% oxygen after their treatment?

answer

For every 15 minutes on N2O the patient should receive 5 minutes of oxygen.

question

TRUE/FALSE: After treatment nitrous oxide needs to be turned off and oxygen needs to be turned back up to 6 lpm.

answer

TRUE

question

Why is it important to administer oxygen for at least 5 minutes to a patient following N2O sedation?

answer

To prevent diffusion hypoxia

question

What is the percentage of N2O if N2O is 1.5 lpm and O2 is 4.5 lpm?

answer

25% 1.5 /6 = 25% N2O

question

What properties does all injectable local anesthetic have?

answer

Vasodilating properties

question

Which LA have the least vasodilation?

answer

Mepivacain plain

question

What are the benefits for vasoconstrictors?

answer

1. Decrease blood flow to site of injection (vasoconstrict vessels) 2. Slows absorption of local anesthetic into CVS 3. Decreases blood level = lower toxcicity 4. LA remains around nerve longer (prolongs) 5. Smaller amount of LA can be used 6. Provides hemostasis (controls bleeding)

question

Vasoconstrictors are what kind of drugs?

answer

Sympathomimetic or Adrenergic Drugs (it "mimics" the action of "sympathetic" nervous system mediators)

question

What are sympathomimetic drugs termed?

answer

CATECHOLAMINES

question

What are the two vasoconstrictors currently used?

answer

Epinephrine and Levonordefrin

question

Epinephrine is a synthetic drug, Levonordefin is a natural drug. True or false?

answer

Both are false

question

What are the two main receptors for LA

answer

Alpha and Beta (B1 and B2)

question

Alpha receptors produces _____ through ______ of smooth muscle in blood vessles. It helps ______.

answer

1. Vasoconstrictors 2. Contractions 3. Hemostasis

question

B2 receptors produces what through smooth muscle relaxation?

answer

Vasodilation and bronchodilation

question

B2 produces what?

answer

Cardiac stimulation (increases heart rate and strength of contraction)

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