Local anesthesia two

Question 1

t/f: if local anesthesia enters into the circulatory system it will cease to provide the desired effect.

Answer 1

true

Question 2

t/f: Most local anesthetics have vasodilatation effect

Answer 2

true

Question 3

_____ is the most potent vasodilator

Answer 3

Procaine:

Question 4

the increase of absorption into the blood may lead to _____ _____ ______

Answer 4

potential systemic overdose

Question 5

the only local anesthetic with constrictor

effect

Answer 5

cocaine

Question 6

______ leads to Inhibition of catecholamine re-uptake

Answer 6

cocaine

Question 7

_____ _____ has a poorly absorbed result except for cocaine.

Answer 7

Oral route of local anesthetics

Question 8

____ _____ leads to Rapid absorption to mucous membrane

Answer 8

topical route

Question 9

____ ____ has greatest % of anesthetics because it is the largest tissue mass in the body.

Answer 9

skeletal muscle

Question 10

what are the two routes of drug elimination?

Answer 10

metabolic and excretory

Question 11

t/f: ALL local anesthetics cross blood-brain barrier, and placenta

Answer 11

true

Question 12

_____ _____ ____ is Hydrolyzed in plasma by pseudocholinesterase into paraaminobenzoic acid (PABA) .

Answer 12

ester local anesthesia

Question 13

_______ is related to Allergic reaction

Answer 13

PABA (paraaminobenzoic acid)

Question 14

____ ____ is about 1/2800 people and may lead to potential for toxicity of ester local anesthesics

Answer 14

Atypical pseudocholinesterase

Question 15

t/f: the liver is the Primary biotransformation site for Amide local anesthetics

Answer 15

true

Question 16

for a ASA IV to V patient with liver dysfunction, heart failure ____ _____ ____ are a relative contraindication

Answer 16

Amide local anesthetics

Question 17

Blue Baby Syndrome
• Inherited blood disorder
• Atypical hemoglobin
– Unable to deliver oxygen efficiently

– Primary metabolite of Prilocaine can be
the cause 
– S/S of patient:
• Easily tired 
• Bluish tint on lip or skin

Answer 17

Methemoglobinemia

Question 18

t/f: Kidneys are primary excretory organ of local anes.

Answer 18

true

Question 19

in _____:
– Procaine appears as PABA (90%)
– 10% cocaine found

Answer 19

urine

Question 20

t/f: Local anesthesia readily cross blood-brain barrier

Answer 20

true

Question 21

Pharmacological of local anestheisa action is CNS_______

Answer 21

depression

Question 22

Signs of CNS toxicty:

Answer 22

1. Initial clinical signs/symptoms of CNS toxicity are Excitatory!!
   – Numbness of tongue and circumoral region (symptoms)
   – Slurred speech, shivering, A/V disturbances, Disorientation, tremor.. (signs)
   – Luckily, lidocaine don’t have these s/s but mild sedation or drowsines

2) Higher level of CNS toxicity –> Tonic-clonic convulsion

3) Further increase
– cessation of seizure activity–> respiratory depression —> reparatory arrest

Question 23

the following are systemic actions of local anesthesia on the _____ ____.

1. Direct action on myocardium
   – Produce myocardial depression
   – Therapeutic advantage
   – Management of hyper-excitable myocardium
   • Premature Ventricular Contraction (PVC)
   • Ventricular tachycardia

Answer 23

cardiovascular system

Question 24

t/f: LA (local anesthetics) have a direction action on peripheral vasculature.

Answer 24

true

Question 25

t/f: Cocaine and Ropivacaine are vasoconstrictors

Answer 25

true

Question 26

t/f: All other local anesthetics are vasodilators

Answer 26

true

Question 27

t/f: Skeletal muscle are more sensitive to local irritant properties

Answer 27

true

Question 28

t/f: Respiratory is generally unaffected unless near overdose

Answer 28

true

Question 29

``` t/f: No documented cases in medical or dental literature (past 25 years) supporting the concept of amide anesthetics triggering malignant hyperthermia ```

Answer 29

true

Question 30

- ↓ Perfusion to site of administration - Slow the absorption of L.A. into Cardiovascular system - Minimize the risk of systemic toxicity - ↑Duration of action for L.A. - ↓Hemorrhage

Answer 30

importance of vasoconstrictors

Question 31

 Epinephrine  Norepinephrine  Dopamine are ______ catecholamines

Answer 31

natural catecholamines

Question 32

 Isoproterenol  Levonordefrin are______ catecholamines

Answer 32

Synthetic catecholamines

Question 33

 Amphetamine, Ephedrine, Methamphetamine are ____-_______

Answer 33

Non-catecholamines

Question 34

What are the three modes of action?

Answer 34

 Direct acting  Indirect acting  Mixed acting

Question 35

t/f:  All Cathecholamines work on adrenergic receptors with | direct acting

Answer 35

true

Question 36

the following are actions of ______ adrenergic Recptors - vasoconstriction - increased perpherial resistance - increased blood pressure - mydriasis - increased closure of internal sphincter of the bladder

Answer 36

Alpha 1

Question 37

the following are actions of ______ adrenergic Recptors - inhibition of norepinephrine release - inhibition of insulin release

Answer 37

alpha 2

Question 38

the following are actions of ______ adrenergic Recptors - TACHYCARDIA - increased lipolysis - increased myocardial contractility

Answer 38

beta 1

Question 39

the following are actions of ______ adrenergic Recptors - vasodialtion - slightly decreased peripheral resistance - bronchodilation - increased muscle and liver glycogenolysis - relaxed uterine smooth muscle

Answer 39

beta two

Question 40

______ = vasoconstriction

Answer 40

alpha 1

Question 41

_______= post synaptic inhibitory

Answer 41

alpha 2

Question 42

______=located at heart at intestine

Answer 42

beta 1

Question 43

_____= Vasodilatation (found in the Bronchi, Vascular beds)

Answer 43

beta 2

Question 44

______ is commonly referred to as ratio

Answer 44

Dilution

Question 45

Concentration of 1:1000 means?

Answer 45

- 1gram (1000mg) of solute (drug) in 1000ml solution So 1000mg / 1000ml = 1.0mg/ml of solution

Question 46

______ is the most used vasoconstrictor

Answer 46

Epinephrine

Question 47

____ ____ Sodium Bisulfite (antioxidant) is added to delay deterioration of epine.

Answer 47

Sodium Bisulfite (antioxidant) is added to delay deterioration

Question 48

t/f: Shelf life of L.A. with Epi is ~ 18 months and Epi can be synthetic or obtained from adrenal medulla

Answer 48

true

Question 49

____ _ is more sensitive to epinephrine

Answer 49

Beta 2

Question 50

_______ is a Potent bronchiole smooth muscle dilator  treat acute asthma

Answer 50

Epinephrine

Question 51

t/f: Epinephrine plasma level does increase after “usual” intra oral injection despite of aspiration

Answer 51

true

Question 52

Intravascular injection of 0.015mg can cause what?

Answer 52

 Increase heart rate from 25 bpm to 75 bpm  Systolic blood pressure from 20mmHg to 70mmHg BE AWARE OF REACHING STROKE LEVELS.

Question 53

________ lacks significant B2 actions resulting in Intense vasoconstriction and Dramatic elevation of blood pressure.

Answer 53

Norepinephrine

Question 54

What Most closely resemble norepinephrine?

Answer 54

Levonordefrin

Question 55

When selecting a vasoconstrictor it is Dependent on the time needed for the procedure:  Without epi ~ ___ mine  With epi ~ __ mins

Answer 55

 Without epi ~10 mins |  With epi ~60 mins

Question 56

t/f: Epinephrine produces rebound vasodilatory effect

Answer 56

ture

Question 57

t/f: Norepinephrine produces cases of tissue necrosis and slough.  Disadvantage outweigh its advantages, so it is not used.

Answer 57

true

Question 58

What is the ASA classifcation: Normal healthy patient

Answer 58

asa1

Question 59

What is the ASA classifcation: Mild systemic disease

Answer 59

asa2

Question 60

What is the ASA classifcation: Severe systemic disease that limits activity. (Mild diabetes, controlled hypertension, obesity)

Answer 60

asa3

Question 61

What is the ASA classifcation: | incapacitating disease that is a constant threat to life CHF, Renal Failure

Answer 61

asa4

Question 62

What is the ASA classifcation: Moribund patient not expected to survive 24 hours (Ruptured aneurysm)

Answer 62

asa5

Question 63

What is the ASA classifcation: Brain-dead patient whose organs are being harvested.

Answer 63

asa6

Question 64

1) Blood pressure in excess of 200 mmHg systolic or 115 mmHg 2) Uncontrolled hyperthyroidism 3) Severe cardiovascular disease a) Less than 6 months after myocardial infarction b) Less than 6 months after cerebrovascular accident c) Daily episodes of angina pectoris or unstable angina d) Cardiac dysrhythmias despite appropriate therapy e) Postcoronary artery bypass surgery (CABG), less than 6 months 4) Undergoing general anesthesia with halogenated agents 5) Patient receiving nonspecific B-blocker, MAOi, Tricyclic antidepressants Patients in categories 1 to 3a through 3d are classified as ASA 4 risks and NOT normally considered candidates for elective or emergency dental treatment in the office

Answer 64

Medical Status of the Patient Contraindications to Vasoconstrictor

Question 65

t/f: Key tips in delivering LA: -Multiple aspirations - Slow administration -Minimum concentration of both • Vasoconstrictor • Local anesthetic

Answer 65

true