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Flashcards in Final Sweep 1 Deck (76)
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1
Q

 alpha (Aα), beta (Aβ), gamma (Aγ)

A

 motor, proprioception

2
Q

 B: Preganglionic autonomic (otherwise like

A

a delta

3
Q

 delta (Aδ)

A

 sensory

4
Q

 C: Small, unmyelinated

A

 sensory, postganglionic autonomic

5
Q

 Rapid depolarization closes

A

inactivation gate

6
Q

 Channel must “reset” before reopening

A

 called refractory period

 determined by the time needed for the axon to repolarize

7
Q

 charged agents not effective unless nerve is stimulated =

A

phasic block, with specific receptor theory

8
Q

 Organic:Aqueous Distribution Constant, Q

A

 reflects ability to penetrate hydrophobic tissue

 correlates with duration

9
Q

 Dissociation Constant, pKa
 Proportion of ionized to un-ionized molecules
 correlates with —-

A

onset

10
Q

Susceptibility to Blockade

From most to least affected:

A
	dull pain
	warmth
	cold
	sharp pain
	touch
	pressure
	proprioception
11
Q

More lipophilic =

A

higher % bound

bupivacaine > mepivacaine > lidocaine

12
Q

Conditions decreasing binding:

A

Pregnancy, oral contraceptive use, estrogen supplementation, acidosis, increasing dose

13
Q

(—– has significant extrahepatic metabolism)

A

Prilocaine

14
Q

The more —— an anesthetic is, the greater the proportion of cardiovascular to CNS effects, i.e.
cardiac toxicity becomes a proportionally greater risk.

A

lipophilic

15
Q

Beta 1

A

Found in heart and small intestines

-Produces cardiac stimulation

16
Q

3 classes of sympathomimetic agents

A

Direct Acting  directly on adrenergic receptors
(e.g. Epi)

2) Indirect Acting  use norepinephrine release
3) Mixed  both direct and indirect actions

17
Q

Refractory angina treat in

A

monitored setting

18
Q

Coagulopathy

=

A

 Congenital or acquired

 alter technique to avoid deep blocks

19
Q

 Methemoglobinemia

A

 avoid prilocaine

20
Q

Dialysis patients

A

 treat day after dialysis

21
Q

Cocaine abuse

A

 avoid epinephrine, stress  defer treatment 24 hours

22
Q

 MAO inhibitors

A

 limited concern (because COMT still
works)
 monitor blood pressure

23
Q

Nonselective beta blockers - nonselective

• monitor

A

pressure with epinephrine use

24
Q

Amphetamines/Cocaine

A

Synthetize the adrenergic receptors to sympathomimetics

epinephrine may produce an exaggerated response

25
Q

Supraperiosteal injection site

A

Intersection of LA of tooth and the height of MB fold

26
Q

Sup. injection - The needle tip could be below the

A

apex of the tooth resulting in inadequate anesthesia

27
Q

PSA Point of needle insertion :

A

Height of the MB fold over the second molar

28
Q

PSA -Long needle :

A

½ of its length

29
Q

MSA Point of needle insertion :

A

Height of the Mucobuccal fold above the maxillary second premolar

30
Q

Infraorbital nerve block

A

Nerves to be anesthetized:
1- ASA
2-MSA
3- Infraorbital nerve

31
Q

Infraorbital nerve Point of needle insertion :

A

Over maxillary 1st premolar

32
Q

GP nerve block depth

A

Depth ~ 5mm

33
Q

High tuberosity technique

A

same spot as PSA, 30mm deep however.

34
Q

V2 Nerve Block

A

scary one

35
Q

Long buccal (LB)

A

Buccal mucoperiosteum (soft tissues) of mandibular molars.

36
Q

Lingual nerve

A

Anterior 2/3rds of the tongue and floor of the mouth

2- Lingual mucoperiosteum

37
Q

IANB

A

Place the index finger in the coronoid notch

6-10 mm above the occlusal plane

Finger on the coronoid

Point of entry must be lateral to the pterygomandibular raphe

38
Q

Lingual Nerve Block remove

A

5mm

39
Q

IANB - Inadequate anesthesia ? Why ?

A

1) Mylohyoid (Accessory) Innervation
2) Overlapping fibers of the contralateral IAN
3) Bifid inferior alveolar nerve which would require IANB more inferior to the normal location
4) Poor injection technique

40
Q

Mylohyoid Nerve

Solution :

A

Infiltration on the lingual surface of the tooth posterior to the tooth in question

41
Q

LB nerve block Technique Point of needle insertion:

A

Mucous membrane distal and buccal to the most distal molar tooth in the arch

Parallel but lateral to the occlusal plane

Bone contact

Depth of penetration is approximately 2-4 mm

42
Q

Mental nerve block

A

Anesthetizes buccal mucous membranes anterior to the mental foramen and skin of the lower lip and chin

43
Q

Mental nerve Point of needle insertion :

A

MB between the apices of the 1st and 2nd premolars

44
Q

Gow-Gates Technique

A

Insertion point/Landmark: a line from the intertragic notch to the corner of the mouth, just distal to the maxillary 2nd molar

Target area: lateral side of the condylar neck, just below the insertion of the lateral pterygoid muscle

Height of injection: place needle tip just below the mesiopalatal cusp of the maxillary 2nd molar

Ask patient to open wide to allow the condyle to assume a frontal position

Direct syringe from the corner of the mouth from theoppositesideofmouth

45
Q

Epinephrine sensitive patients:

A

 Limit lidocaine with epinephrine quantity  Mepivacaine 3% without vasoconstrictor
 Difficulty achieving local anesthesia:

 Very short procedures:
 Mepivacaine 3% without vasoconstrictor

46
Q

Presence of primary teeth is a contraindication for

A

PDL injection

47
Q

II- Intra-septal injection

A

Similar to PDL

May be useful when PDL is contraindicated infection/inflammation)

Anesthesia diffuse through the medullary bone

Nerves: Terminal nerve endings

Anesthesia : Bone, soft tissues

48
Q

Intraosseous injection - Inability to perforate the cortical bone drilling——…….change the site

A

> 2 sec.

49
Q

Articaine is classified as an amide but contains a —— instead of a benzene ring like other amide local anesthetics.

A second difference is that it contains an —–

A

thiophene ring

extra ester linkage

50
Q

Articaine - Maximum Recommended Dose:

A

7mg/kg

51
Q

EPT Readings Less Than —-

(Maximum Output) Resulted in Pain During Restorative Procedures.

A

80

52
Q

Mepivacaine has a

A

Higher Concentration and Higher pH than Lidocaine.

Should be Less Painful

53
Q

Increasing the Volume of 2% Lidocaine with 1:100,000 Epinephrine to 3.6 mL

A

Does Not Increase the Incidence of Pulpal Anesthesia with the Inferior Alveolar Nerve Block.

54
Q

If Patient Has Profound Lip Numbness do not repeat

A

IANB

55
Q

Key to Success of the Intraosseous Injection

A

Flow of the Anesthetic Solution Into the Cancellous Space.

56
Q

INtrapulpual injection used as a

A

last resort following intraosseous

57
Q

Needle breakage - Causes:

A

1- “Hubbing the needle”

2- 30-guage short needles

3- Intentional bending before injection

4- Unexpected movements

5- Forceful bone contact

58
Q

Do not use —– for IANB

Do not use ——- for IANB

Do not bend the needle when inserting them in the soft tissues

Extra caution when inserting needles in ———

A

short needles

30-guage needle

children

59
Q

One of the main causes of dental practice litigations

A

prolonged anesthesia/parathesia

60
Q

Causes of prolonged para/anesthesia

1- Needle injury to the ———

2- ——- LA solution (e.g. alcohol)

3- ——-

A

nerve (e.g. inserting the needle to a foramen, bending the sharp edge of the needle )
Electric shock feeling!

Contaminated

LA solution itself
(e.g. 4% Articaine)

61
Q

3- Facial nerve paralysis from

A

injecting LA into parotid gland (IANB, AKINOSI)

62
Q

IAN: to prevent nerve paralysis

A

bone contact at the medial side of the ramus before injecting the LA

63
Q

Trismus causes

Causes:

A

1- Trauma to the muscles (especially in multiple needle punctures)

2- Contaminated solutions irritates the muscles

3- Hemorrhage

4- Infection

64
Q

Trismus Prevention:

A

1- Use sharp needles

2-Proper handling of LA cartilages

3- Adherence to principles to avoid multiple injections

Trismus is not always avoidable

65
Q

Trismus management

A

Management:

1- Heat therapy

2- Warm saline rinses

3- Analgesics

4- Muscle relaxants if necessary

5- Physiotherapy

Consider infection as the cause if >48 hrs. (Abx will be needed in that case)

Trismus can last for average of 6 weeks

66
Q

Burning during injection:

A

1- PH of the LA
2- Rapid injection on dense tissues
3- Alcohol contamination
4- Anesthetic temperature

67
Q

Idiosyncrasy:

A

Abnormal, unexpected response to a drug. Neither overdose or allergic reaction
e.g.: Stimulation that develops after administering a CNS depressant
Hard to predict
Might have genetic predisposition
Treatment : symptomatic ABCs as necessary

68
Q

—— topical anesthesia increase the risk of adverse reaction due to high rate of mucosal absorption

A

Amide

69
Q

Benzocaine

A

(ester) topical anesthesia is poorly absorbed

70
Q

Aspirate in 2 planes

A

rotate and aspirate again

71
Q

MOderate to High reaction to anesthetic -

A

Generalized tonic-clonic seizure activity

72
Q

Epinephrine Overdose

A

Sharply elevated BP (systolic)

Increased heart rate/palpitations

Cardiac tachyarrhythmia

73
Q

Management - v/c overdose

A

Stop dental treatment

Reassure patient, administer O2

Monitor BP and pulse until fully recovered

Get help!!

74
Q

Delayed skin reaction - use

A

Benadryl - 50 mg stat & Q6H X 3-4 days

75
Q

Immediate skin reaction - use

A

Epinephrine 0.3 mg IM or SC
Benadryl - 50 mg IM
Observation, medical consultation
Benadryl - 50 mg Q6H X 3-4 days

76
Q

Bronchial constriction - use

A
O2 - 6 L/min
    Inhaler or Epinephrine 0.3 mg IM or SC
    Benadryl - 50 mg IM
    Observation, medical consultation
    Benadryl - 50 mg Q6H X 3-4 days