Anek

Question 1

Guedel’s stages of general anesthesia

Answer 1

1. amnesia and analgesia
2. unconscious/delirium /unstable
3. surgical anesthesia/ desirable stage/ stable
4. respiratory depression

Question 2

Anes has the capacity to oxidize but the most commonly cited anes related to methemoglobinemia is? it is converted into?

Answer 2

Prilocaine (Citanest) is converted into orthotuluidine (cause methemoglobinemia)

**Risk of methemoglobinemia is also increased in articaine above recommended dose

Question 3

Maximum dosage of epi for normal patients

Answer 3

0.2mg (200 micrograms)

Question 4

Maximum dosage of epi for cardiovascular-compromised patients

Answer 4

0.04mg (40 micrograms)

Question 5

Only anesthesia that is a vasoconstrictor

Answer 5

Cocaine - not used in dentistry

Question 6

Safest local anesthesia

Answer 6

Lidocaine (Xylocaine, Lignocaine)

Question 7

Amide Local anesthesia usally without vasoconstrictor since it is a weak vasodilator, SHORTEST acting amide

Answer 7

Mepivacaine (Marcaine)

Question 8

Metabolized both by liver and plasma, specially designed for dentists, increased risk of paresthesia

Answer 8

Articaine

Question 9

amide local anesthetics combined to produce topical anesthesia

Answer 9

Lidocaine + prilocaine (Eutectic Mixture of L. A.)

Question 10

1st synthetic LA

Answer 10

procaine (novocaine)

Question 11

shortest acting LA

Answer 11

procaine (novocaine)

Question 12

Preservatives of LA that can cause allergic reactions

Answer 12

Methyparaben - prevent microbial contamination

Question 13

antioxidant of vasoconstrictors of LA (reducing agent)

Answer 13

Sodium bisulfites - prevent oxidation

Question 14

Max dose of lidocaine with epi (adult)

Answer 14

7mg of lidocaine / kg

Pero max daily pa rin 500mg

Question 15

total max daily dose (lidocaine w. epi)

Answer 15

500mg

Question 16

Total max daily dose (lidocaine w/o epi)

Answer 16

300mg -lidocaine w/o epi is more toxic

Question 17

needle used in Md block in pedo px

Answer 17

27 (short -20mm)

Question 18

needle used for intraligamentary injection

Answer 18

30 gauge (ultra short <20mm)

Question 19

bubble in the LA is primarily due to what molecule

Answer 19

nitrogen

Question 20

Reference point for TRUE ASAN block

Answer 20

distal of canine, 1st PM

Question 21

injection site for greater palatine nerve block

Answer 21

bet mx 1st and 2nd molar

Question 22

Tissue that can be punctured during Classic Md block

Answer 22

buccinator
medial pterygoid muscle
sphenomandibular ligament

Question 23

considered the TRUE md nerve block

Answer 23

Gow-gates technique - more accurate but technique sensitive

Question 24

closed mouth md blocking

Answer 24

akinosi-vazirani

Question 25

Max dosage for norepinephrine and usual concentration on anes

Answer 25

0.34mg (n), 0.14mg (cvd) 1:30 000 **Can cause local ischemic effect (4mL)

Question 26

Levonordefrin (Neo-cobefrin) Max Dosage, conc

Answer 26

Dosage: 1mg (n) 0.4mg (cvd) 1:20 000 Arteriolar constriction

Question 27

Phenylephrine max dose and conc

Answer 27

1:2500 Dose: 4mg (n), 1.6mg (cvd) Longer lasting effect Most stable, weakest

Question 28

Analog of vasopressin, NONsympathomimetic amine?? max dose??

Answer 28

Felypressin (Octapressin) Venous microcirculation only Safer for hyperthyroidism, MAO, TCA Dose: 0.27 UI (9ml of 0.03IU)

Question 29

Methods of Termination of vasoconstriction action

Answer 29

Reuptake and restorage Deactivation by extraneuronal enzymes (Catechol O methyl transferase -COMT) Uptake by blood stream Intraneural enzymatic destruction (Monoamine oxidase)

Question 30

Difference of esters and amides in chemical structure

Answer 30

Both has aromatic (lipophilic) and secondary/tertiary amino (hydrophilic) ends. Sa intermediate nagkakaiba. Ester and amide group

Question 31

MRD of 2% procaine + 0.4% propoxycaine

Answer 31

6.6mg /kg

Question 32

Amide type LA contraindicated with pxs receiving acetaminophen

Answer 32

Prilocaine 4% with 1:200 000 MRD: 6.0mg/kg

Question 33

LA that can be used without vasoconstrictor

Answer 33

Prilocaine - can be for epi sensitive px (slight vasodilator) Mepivacaine - slight vasodilator (short duration?)

Question 34

Has delayed onset and long lasting anes

Answer 34

Bupivacaine Not for children

Question 35

LA that is usually associated with paresthesia

Answer 35

Articaine and prilocaine

Question 36

Amide LA contraindicated to px allergic to sulfur containing drugs

Answer 36

Articaine

Question 37

Depth of penetration of topical anesthetics

Answer 37

Only on surface of tissues (2-3mm)

Question 38

Water insoluble vs water soluble topical anes and examples

Answer 38

Water insoluble - safer because it is not readily absorbed into ciculation Benzocaine or **ethyl aminobenzoate** Lidocaine base (5%) -indicated for ulcerated, abraded, lacerated tissues Water soluble Benzyl alcohol -shorter acting, very irritating on injection into the tissues Tetracaine HCl - long duration ester, rapidly absorbed through mucous membrane --systemic toxicity Lidocaine Hcl (2%) systemic absorption is greater than lido base thus higher toxicity

Question 39

LA with 7-8times potency than procaine

Answer 39

Propoxycaine thus not used alone 4% Procaine + 0.4% propoxycaine - for allegic to amide anes

Question 40

Long duration amide anes but faster onset

Answer 40

Etidocaine

Question 41

Articaine lipophilic portion

Answer 41

Thiophene ring. Articaine is the only amide type LA that contains thiophene group

Question 42

Dissociation constant

Answer 42

pKa - half ionized half unionized Low pH ▶️ inc H+ ▶️ inc RNH+ / dec RN RN - lipid soluble, nonionized, free base

Question 43

Drug of choice for intranasal sedation in pediatrics

Answer 43

Midazolam Intranasal onset same as IM and as effective

Question 44

Jorgensen technique

Answer 44

Barbiturates + opioids + anti-cholinergic drugs

Question 45

Neurolept anesthesia is produced by?

Answer 45

Neuroleptic agent (Droperidol) + narcotic (Fentanyl) + nitrous oxide Neurolept anes is production of tranquility and mental detachment without marked soporific effect