question

T/F Local anesthesia can be physically and psychologically demanding.

answer

True

question

What is the foundation for the safe delivery of local anesthetic drugs?

answer

Comprehensive patient assessment

question

When should the clinician monitor the patient when administration of local anesthetic agents are used? A. Before B. During C. After D. All of the above

answer

All of the above

question

What does ASA stand for?

answer

American Society of Anesthesiologists

question

Who states that patient safety is the most important goal in the delivery of anesthesia?

answer

American Society of Anesthesiologists

question

T/F Anesthesiology in all of its forms, including regional anesthesia, is the practice of medicine.

answer

True

question

Regional anesthesia involves :

answer

- Diagnostic assessment - Consideration of indications and contraindications - Prescription of drugs - Institution of corrective measures and TX in response to complications

question

According to the ASA, clinicians who administer regional local anesthesia must conform to a prescribed?

answer

Sequence of care ( Elements of the ASA Medical Component of Care)

question

The majority of medical emergencies in the dental office are associated with?

answer

Administration of local anesthesia

question

All of the following are elements of the ASA medical components of care except one, which one is the exception? A. Pre-anesthetic evaluation of the patient B. Prescription of the anesthetic plan C. Proper armamentarium used for the delivery of local anesthetic agents D. Personal participation in the technical aspects of the regional anesthetic E. Following the course of the anesthetic

answer

Proper armamentarium used for the delivery of local anesthetic agents

question

All of the following are elements of the ASA medical components of care except one, which one is the exception? A. Remaining physically available for the immediate diagnosis and treatment of emergencies B. Proper references available when emergency situations should arise C. Providing indicated post-anesthesia care D. Pre-anesthetic evaluation of the patient E. Prescription of the anesthetic plan

answer

Proper references available when emergency situations should arise

question

Which of the following ASA Physical status classification system defines a normal healthy patient? A. ASA I B. ASA II C. ASA III D. ASA IV

answer

ASA I

question

Which of the following ASA Physical status classification system defines a patient with mild systemic disease? A. ASA I B. ASA II C. ASA III D. ASA IV

answer

ASA II

question

Which of the following ASA Physical status classification system defines a patient with severe systemic disease? A. ASA I B. ASA II C. ASA III D. ASA IV

answer

ASA III

question

Which of the following ASA Physical status classification system defines a patient with severe systemic disease that is a constant threat to life? A. ASA I B. ASA II C. ASA III D. ASA IV

answer

ASA IV

question

Which of the following ASA Physical status classification system defines a patient a moribund patient who is not expected to survive without the operation? A. ASA I B. ASA V C. ASA III D. ASA IV

answer

ASA V

question

Which of the following ASA Physical status classification system defines a patient who has been declared brain dead, whose organs are being removed for donor purposes? A. ASA I B. ASA V C. ASA VI D. ASA IV

answer

ASA VI

question

What is a key factor in determining the safety of local anesthesia administration in advance of procedures?

answer

ASA Physical status classification system

question

The majority of healthy patients are classified as?

answer

ASA I or ASA II; TX modifications are few, and serious adverse events are uncommon for these patients

question

What type of patients are more likely to experience adverse events, these patients may still be considered for elective dental procedures with local anesthesia?

answer

ASA III; TX modifications to ensure patient safety are frequently necessary.

question

Elective dental care is contraindicated for what type of ASA classification ?

answer

ASA IV

question

Since local anesthesia is stressful for many patients, the assessment process should include a determination of?

answer

Psychological tolerance

question

What would be a good tool to use to measure anxiety and fear of a patient?

answer

Dental fears questionnaires and dental anxiety scales

question

Treatment modification with an appropriate ________________ can reduce psychogenically generated medical emergencies.

answer

Stress Reduction Protocol (SRP)

question

Information gained from medical and dental histories includes:

answer

- Known medical conditions (past and current) - Prescription medications - Over the counter products (dietary and herbal supplements)

question

T/F Previous experiences with local anesthesia can provide valuable insight.

answer

True

question

T/F Prior to the administration of local anesthetics drugs it is NOT necessary to know what other drugs a patient is taking.

answer

False

question

Drugs that are in a patients system when local anesthetics are administered are referred to as?

answer

Concomitant

question

Drugs taken from a patient may influence the choice of local anesthetic drugs and the quantities administered due to their influence on the?

answer

- Efficacy - Metabolism - Elimination of anesthetic drug

question

What should the patients drug record documentation have for prescription medications?

answer

1. Drug name (trade and generic) 2. Drug classification 3. Purpose for taking the drug 4. Prescribed dose and schedule 5. Side effects and adverse reactions 6. Precautions or contraindications with dental care 7. Drug interactions 8. Treatment modifications indicated

question

What should the patients drug record documentation have for nonprescription drugs, vitamins, minerals and herbals?

answer

1. Product name (trade and generic) 2. Product classification 3. Purpose for taking the product 4. Prescribed dose and schedule 5. Side effects and adverse reactions 6. Precautions with dental care if indicated

question

Objective information about a patients physical condition can be obtained from an evaluation of?

answer

- Vital signs - BP - Pulse - Respiration - Weight

question

Which of the following clinical examinations is critical when determining appropriate doses of drugs, especially for childern and small adults before local anesthesia administration? A. Blood pressure B. Pulse C. Respiration D. Weight

answer

Weight

question

It is especially important for what type of patient to have had appropriate and adequate nutrition prior to appointments?

answer

Patients with diabetes

question

T/F In order to optimize safety, a consultation with a patient's physician is sometimes necessary prior to local anesthesia.

answer

True

question

Medical conditions requiring consultations with the patients physician are as follows:

answer

- Heart conditions (heart attacks, stroke) - Recent surgeries - Uncontrolled high blood pressure - Psychological conditions - Compromised liver and kidney function - Immune system compromise

question

Prior to the administration of local anesthesia, a comprehensive health history, including a thorough review of systems, is indicated, this review includes?

answer

- Cardiovascular - Respiratory - Nervous - Metabolic - Excretory systems

question

The systemic effects of local anesthesia include effects on which two structures?

answer

Cardiac and Vascular structures

question

The experience of stress from WHAT is likely to increase blood pressure, pulse, and possibly respiration?

answer

Local anesthesia procedure

question

What serves as a baseline comparisons in response to adverse events that may develop after local anesthetics are administered?

answer

Vitals

question

Individuals who are at exceptional risk of developing infective endocarditis (IE) require WHAT before dental treatment?

answer

Antibiotic prophylaxis

question

Which of the following are individuals are at risk of developing infective endocarditis (IE)? A. Artificial heart valves B. Congenital heart disease C. Previous history of IE D. All of the above

answer

All of the above

question

T/F Most local anesthetic injections through tissue are considered to be noninvasive and do NOT require premedication.

answer

True

question

Patients with what type of disorders may require modifications to the types of injections, types of drugs and doses of local anesthesia they may receive?

answer

Patients with hemophilia and clotting disorders, and patients on blood thinning medications such as warfarin.

question

What type of cardic accidents need to delay elective dental treatment, including local anesthesia?

answer

Recent mayocardial infarctions or cerebrovascular

question

According to the American Dental Association ADA, endocarditis prophylaxis is reasonable for:

answer

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.

question

All of the following procedures and events do Not need prophylaxis but one, which one is the exception? A. Routine anesthetic injections through non infected tissue B. Taking dental radiographs C. Placement of removable prosthodontic or orthodontic appliances D. Endodontic treatment

answer

Endodontic treatment

question

All of the following procedures and events do Not need prophylaxis but one, which one is the exception? A. Extraction of third molars B. Placement of orthodontic brackets C. Shedding of deciduous teeth D. Adjustment of orthodontic appliance

answer

Extraction of third molars

question

All of the following procedures and events do Not need prophylaxis but one, which one is the exception? A. Taking dental radiographs B. Placement of removable prosthodontic or orthodontic appliances C. Performing oral surgey D. Bleeding from trauma to the lips or oral mucosa

answer

Performing oral surgey

question

The systemic effects of local anesthesia on the respiratory system are typically ___________.

answer

Minimal

question

What acts on beta adrenergic receptors of the smooth muscles of the bronchial circulation to dilate the vessels?

answer

Epinephrine

question

What may be induced by allergy, including sulfite sensitivity and physiological and psychological stress related to local anesthesia administration, all of which may decrease a patient's respiratory capacity?

answer

Asthma

question

What typically provokes asthmatic episodes with childern?

answer

Anxiety

question

What typically provokes hyperventilation with adults?

answer

Anxiety

question

What impairs lung function, particularly in the pulmonary vessels where blood accumulates ( congestion in the lungs)?

answer

Congestive heart failure (CHF)

question

What can lead to pulmonary HYPERtension and compromises both heart and lung function, which may necessitate modifications for local anesthesia?

answer

Congestive heart failure (CHF)

question

Patients diagnosed with CHF should NOT be placed in what position, which can quickly lead to serious pulmonary edema?

answer

Supine position

question

Local anesthetics are central nervous system depressants. This depression would act as what to any preexisting CNS depression?

answer

Additive

question

When a patient has taken a large dose of narcotic drugs prior to anesthesia administration, the local anesthetic can what type of effect on the CNS? A. Lesser effect B. More profound effect C. No effect

answer

More profound effect

question

Patients with compromised liver function may not be able to metabolize what type of local anesthetic drugs efficiently? A. Amides B. Esters C. both A and B

answer

Amides

question

T/F Because the liver is the primary source of cholinesterase, ester metabolism may also be compromised.

answer

True

question

What is recommended, regardless of the anesthetic selected with a patient who has extensive liver damage?

answer

Articaine, shorter appointments with fewer milligrams of drug administered

question

Metabolic issues play a key role in treatment planning for what type of patient?

answer

Diabetics

question

Due to a diabetics daily schedule for meals and insulin, what time would be best to schedule an appointment that are usually best?

answer

Mornings

question

What should one ask or do before administering local anesthesia, regarding a diabetic patient?

answer

Blood sugar levels should be evaluated and patients should be questioned as to when they last ate and took their medication.

question

Epinephrine in what type of individuals can cause dangerous elevations in blood sugers?

answer

Cardiac-compromised, brittle diabetics ASA III , these patients lack effectuve blood sugar control and swing frequently from hypo to hyper glycemic states.

question

Patients with hyperthyroidism have an increased risk of developing?

answer

Thyrotoxicosis

question

Patients with hyperthyroidism have an increased risk of developing thyrotoxicosis which can result in what is known as?

answer

Thyrotoxic crisis, or more commonly called thyroid strom

question

What is known to increase the risk of thyrotoxic crisis which can be a life threatening medical emergency?

answer

Epinephrine

question

Epinephrine is ____________ contraindicated for patients with poorly controlled or uncontrolled hyperthyroidism. A. Relative B. Absolutely

answer

Absolutely; May not be possible to safely treat these individuals even without the use of epinephrine until their condition is controlled.

question

What are the primary excretory organs for local anesthetics?

answer

Kidneys

question

Patients with kidney failure have inadequate excretion of LA and their metabolic by products may increase possibly to?

answer

Toxiv levels, and contribute to hypertension.

question

Assessment results giude clinicians when determining the extent of the contraindications, which may be classified as ?

answer

Either relative or absolute

question

Situations in which local anesthetic or vasoconstrictor drugs may NOT be administered safely are known as ?

answer

Absolute contraindications

question

For local anesthesia procedures are those in which local anesthetics may be given with caution is called?

answer

Relative contraindications

question

If a patient has had a cerebrovascular accident (CVA), local anesthesia may be absolutely contraindicated for a minimum of how many months?

answer

6 months

question

After a period of 6 months of a CVA or an appropriate time determined by a physician, the administration of LA would be considered only a ?

answer

Relative contraindication

question

Impairs a patient's ability to effectively metabolize ester-type local anesthetics in any form, injectable or topical, this condition is genetic ( autosomal recessive) and has a frequency of approximately 1 in 3000 patients?

answer

Atypical plasma cholinesterase

question

What type of patient might have signs and symptoms of an ester local anesthetic overdose are more likely to occur when normal doses are administered?

answer

Atypical plasma cholinesterase; would use amides

question

Patients with Atypical plasma cholinesterase is classified as? A. Relative contraindication B. Absolute contraindication

answer

Relative contraindication

question

What is a genetic or acquired condition that reduces the oxygen carrying capacity of blood?

answer

Methemoglobinemia

question

Acquired methemoglobinemia has been reported following the administrations of?

answer

- Benzocaine topical - Excessive prilocaine - Articaine ( only if greater than recommended doses have been administered)

question

Clinical anoxia may result from methemoglobin levels above what percent demonstrated by signs of reduced oxygenation and cyanosis?

answer

10%

question

T/F Administering doses that exceed 4.0 mg/lb or 400 mg absolute maximum of prilocaine has been linked to the development of methemoglobinemia in adults.

answer

True

question

The risk of acquired methemoglobinemia is increased in patients with known medical conditions involving?

answer

- enzyme deficiencies - patients taking oxidant drugs such as - sulfonamide - anti-malarial - acetaminophen - nitrite containing medications

question

T/F Patients with underlying breathing problems, such as asthma or emphysema, heart disease and those who smoke may be more susceptible to inquire methemoglobinemia.

answer

True

question

Oxygen saturation of blood can be monitored during an appointment with a ?

answer

Pulse oximeter attached to a patient's finger, can be used to detect methemoglobinemia.

question

If the blood methemoglobin concentration exceeds 30%, the patient will nedd an intravenous infusion of what to reverse this potentially lethal condition?

answer

Methylene blue

question

What does cyanosis mean?

answer

Bluish coloring

question

What are the initial signs of acquired Methemoglobinemia?

answer

Bluish coloring (cyanosis) of the skin, buccal mucous membranes, lips, and nail beds.

question

All of the following are signs and symptoms of Methemoglobinemia except one, which one is the exception? A. Central cyanosis B. CNS depression C. Dizziness D. Drooling

answer

Drooling

question

All of the following are signs and symptoms of Methemoglobinemia except one, which one is the exception? A. Dyspnea B. Dysrhythmia C. Fatigue D. Hives E. Headache

answer

Hives

question

All of the following are signs and symptoms of Methemoglobinemia except one, which one is the exception? A. Hypertension B. Lethargy C. Seizures D. Shock E. Syncope

answer

Hypertension

question

Significant liver or kidney dysfunction in category ASA III is classified as what for local anesthesia? A. Relative contraindication B. Absolute contraindication

answer

Relative contraindication

question

Patients with significant liver disease which of the following would be the best choice? A. Articaine B. Prilocaine C. Bupivicaine D. Mepivacaine

answer

Articaine; largely avoids liver metabolic pathways when used for oral injections

question

Active liver or kidney disease is a relative contraindication for LA because?

answer

Biotransformation- metabolism- excretion

question

Patients in category ASA III with cardiovascular disease and controlled hyperthyroidism may present as what type of classification for high levels of vasoconstrictors? A. Relative contraindication B. Absolute contraindication

answer

Relative contraindication

question

Although not reported to have been observed in humans, literature from manufacturers cautions against the use of WHAT when acetaminophen has been ingested?

answer

Prilocaine

question

Vasoconstrictors may be used in pt's with cardiovascular disease and controlled hyperthyroidism but at very low levels, which are?

answer

0.04mg of epinephrine and 0.2mg of Levonordefrin or plain anesthetics without vasoconstrictors may be selected.

question

Recent cardiovascular events such as a myocardial infarct within the previous six months is what type of classification to local anesthesia and to elective dental treatment? A. Relative contraindication B. Absolute contraindication

answer

Absolute contraindication

question

The first 6 months following a severe cardiovascular event are the most critical, it is within this period that the patient is at greatest risk for a repeat attack, during this time the patient is considered ASA? A. II B. III C. IV D. VI

answer

ASA IV

question

T/F Any history of MI should require a medical consult prior to any invasive procedure.

answer

True

question

What is a temporary stroke/clot in the CNS?

answer

TIA

question

What is a temporary stroke/clot in the CVS?

answer

CVA

question

How long should a patient who has suffered a TIA or CVA should waite for local anesthesia or elective dental procedures post episode?

answer

6-12 months

question

T/F Any history of CVA or TIA should require a medical consult prior to any invasive procedure.

answer

True

question

What ASA would be considered controlled hypertension no contraindications to using anesthetics?

answer

ASA II 120/80 <160/100

question

What ASA level, recommended dental treatment may be initiated provided that intraoperative monitoring of blood pressure for upper levels is considered and patients are reffered to physicians promptly( within one month)?

answer

ASA III >160/100

question

What blood pressure value are all elective treatment should be deferred and patients should be referred to a physician as soon as possible?

answer

>180/110

question

Allergies to specific local anesthetic drugs or to Bisulfite preservatives are? A. Relative contraindication B. Absolute contraindication

answer

Absolute contraindication

question

Which of the following would you use to treat a patient with an allergy to Bisulfite? A. Articaine B. Prilocaine C. 3% Mepivicaine D. 2% Mepivicaine

answer

3% Mepivicaine

question

If a patient is allergic to esters, which of the following topiclas can be used? A. Benzocaine B. Lidocaine C. Tetracaine D. Prilocaine E. B and D only

answer

B and D only

question

All local anesthetics drugs with vasoconstrictors conatin what type of preservatives?

answer

Bisulfite

question

Is there such a thing of a true allergy to epinephrine?

answer

No, same as what our bodies already produce

question

Reactions to the administration of epinephrine instead are classified as WHAT such as heart palpitations, hypertensions, anxiety, and general agitation?

answer

nonallergic Adverse Drug Events (ADR

question

Patients who are pregnant, when should you avoid any elective dental procedures? A. 1st trimester B. 2nd trimester C. 3rd trimester

answer

1st trimester

question

Patients who are pregnant, when should it be ok for treatment, use minimal LA when possible? A. 1st trimester B. 2nd trimester C. 3rd trimester

answer

2nd trimester

question

Patients who are pregnant, when should you postpone hwen possible due to metabolism issues, orthostatic hypotension and simply not comfortable? A. 1st trimester B. 2nd trimester C. 3rd trimester

answer

3rd trimester

question

Why would a patient with middle to later dementia are not good candidates for local or regional anesthesia?

answer

Because they have difficulty cooperating, understanding directions and keeping still.

question

T/F Many prescribed drugs and other substances can affect the pharmacology of local anesthetics. Local anesthetics in return can alter the actions and metabolism of a number of medications and other substances.

answer

Both ststements are true

question

On which receptors does epinephrine work on?

answer

Alpha and Beta receptors

question

Which receptor has an effect on peripheral vasoconstriction which increases blood pressure?

answer

Alpha receptors

question

Which receptor is associated with fight or flight increases HR, BP and cardiac output, dilates lung tissue for increased oxygen?

answer

Beta receptors

question

Beta blockers are prescribed for what type of problems?

answer

CV problems

question

What can happen if too much epinephrine is given to someone who is on beta blockers?

answer

Increased risk of a serious hypertensive episode along with reflex bradycardia due to their unopposed Alpha adrenergic stimulation. Beta receptors are all blocked

question

Which of the following are Non selective beta blockers? A. Proranolol (Inderal) B. Nadolol (Corgard) C. Timolol (Blocadren) D. All of the above

answer

All of the above

question

Which of the following medications slows lidocaines metabolism? A. Proranolol (Inderal) B. Nadolol (Corgard) C. Timolol (Blocadren) D. All of the above

answer

Proranolol

question

Literature suggests waiting ________ hours after cocaine usage before giving local anesthetic.

answer

6-24 hours

question

How long should you waite to treat someone how was under the infulence of meth?

answer

25 hours

question

The delivery of local anesthesia requires both medical and technical skills. Which one of the following is not one of the six elements of the ASA medical compnents of Care associated with regional anesthesia? A. Pre-anesthetic evaluation of the patient B. Comprehensive tooth charting C. Remain present during the course of the anesthesia D. Providing indicated postanesthesia care

answer

Comprehensive tooth charting

question

The ASA physical Status classification system categorizes patients based on thier overall health. Classification P3 describes which one of the following? A. Normal healthy patient B. Severe systemic disease C. Moribund patient D. Severe systemic disease( constant threat to life)

answer

Severe systemic disease

question

Which of the following is not considered a main tool for patient assessment when planning for local anesthesia?

answer

Drugs MRDs

question

Your patient has identified or you suspect that your patient has used methamphetamines approximately 20 hours ago, Which of the following would be the most appropriate action when considering the use of local anesthetics?

answer

Consider postponing care for a full 24 hours.

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