Local Anesthesia Board Review 2012

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130 terms · Board Questions for Dental Hygienists.

What part of the syringe indicates it is an aspirating syringe?

Harpoon

What tissue is topical anesthetic least effective on?
A.) Non-keratinized
B.) Keratinized
C.) Ulcerated areas

Keratinized (palatal)

What LA is metabolized by pseudocholiesterase?

Esters

What antiseptics do you not use with local anesthesia?

alcohol

What is the landmark for the IANB injection?

Coronoid notch and pterygomandibular raphe

What is a possible cause of pain upon removal of the needle?

Needle Barb

How does a self-aspirating syringe work?

When you let off the pressure it aspirates

An organic base is used for psychogenic pain. True or False

False

What is the max. dose of epi for a normal patient?

.2mg (11 carpules)

What is the max. dose of epi for a cardiac patient?

.04mg (2 carpules)

Superior Orbital Fissure is classified as what division? And Sensory or Motor?

VI Ophthalmic Division (Trigeminal) and Sensory

Rotundum is classified into what division? Sensory or Motor?

V2 Maxillary Division, Sensory

Ovale is part of what division? Sensory or Motor?

V3 Mandibular Division, Sensory AND Motor

Mandibular Foramen is part of what nerve(s)?

IAN and Incisive

Mental Foramen is part of what nerves?

Mental and incisive nerve

Topical anesthetic benzocaine is not absorbed systemically. T or F

True

What injection would numb the lower lip?

Mental/Incisive Nerve Block

What cause would you expect if a patient had a lesion on the lower lip?

Bit their lip

This injection anesthetizes the anterior portion of the hard palate (soft and hard tissues) from the mesial of the right first premolar to the mesial of the left premolar.

Nasopalatine (Incisive papilla)

How far is the needle inserted for an IA injection?

Bone must be contacted, average is 20-25mm, or 2/3-3/4 the length of the long needle

What happens during depolarization?

Reverse polarity, sodium in, potassium out

How does LA decrease depolarization phase of the action potential?

It blocks the sodium channel.

This dendrite is the most distal segment of sensory neuron. It responds to stimulation and provokes an impulse transmitted centrally along the axon.

Free Nerve Ending

Myelinated nerves help local currents travel ____ than an unmyelinated nerve. It occurs by current leaps from node to node called _______ conduction.

Faster, Saltatory

What is the least preferable way to re-cap a needle?

2 handed method

Re-capping needle is safer by using what technique?

scoop technique

How is bevel of needle to be oriented during injection?

Bevel should be towards the bone

What is the Trade Name for Lidocaine?

Xylocaine

What is the Trade Name for Mepivacaine?

Carbocaine,and Polocaine

Trade name for Prilocaine?

Citanest Forte

Trade name for Articaine?

Septocaine

Bupivacaine (Generic Name)-Trade name is?

Marcaine (Trade Name)

Which LA is an amide and an ester?

Articaine (Septocaine)

Which LA should be used for short appointments? Good for children and produces pulpal anesthesia.

Mepivacaine (carbo/polo)

Which LA is used for short appointments and methemoglobinemia occurs most often with this?

Prilocaine (Citanest)

This LA biotransforms in the liver, kidney, and lung. Less toxic than other amides. Good for EPI Sensitive Patients requiring prolonged pulpal anesthesia (greater than 60 mins)

Prilocaine Plain or Prilocaine w/epi

1.5xs more potent than Lidocaine. Biotransforms in plasma and liver. Reports of paresthesia. Not used on children under 4 or for blocks.

Articaine (septo)

For long dental procedues where pulpal anesthesia is necessary of 90 minutes and for management of post op. pain. Rarely used on children or mentally handicapped.

Bupivacaine (Marcaine)

Name a topical anesthetic

Benzocaine

What is the max dose for Oraqix?

5 cartridges

When do you aspirate?

Just before deposition of LA

Beta Blocker increase or decrease blood pressure?

decreases

A response to the act of drug administration not the drugs is called _____. Two most common types are?

psychogenic pain
Vasodepressor syncope and hyperventilation

This can occur when an infraorbital nerve block is administrated or when maxillary canines are infiltrated.

Facial Nerve Paralysis

Muscle droop can occur when LA is administered into the deep lobe of the _____ where the terminal branches of the facial nerve extend. (IANB or VaziraniAkinosi NB)

parotid gland

For what injections are long needles used?

For all injection techniques with significant thickness of soft tissue- IA, Gow-Gates mandibular, Akinosi mandibular, infraorbital, sometimes Buccal

What causes a hematoma and where is it most common?

Arterial or venous puncture after PSA or IANB. Common in the pterygoid plexus following PSA.

What is the volume of a single cartridge of LA? How much is in two?

1.8ml, 3.6ml

What is the needle gauge and which lumen is smallest?

The gauge is the diameter of the lumen of the needle. The smaller the number the greater the diameter of the lumen. 30 gauge has a smaller lumen than a 25-gauge needle.

What sensation is lost after an injection?

Pain

What function does sodium chloride provide to LA solutions?

It makes the solution isotonic with the tissues of the body.

What antioxidant prevents biodegrading of LA?

sodium bisulfite

All of the following are true regarding actions of vasopressors except:
A.) Constrict blood vessels, decreasing blood flow to site of administration
B.) Absorption of LA into cardiovascular system is decreased
C.)LA blood levels are lowered, minimizing risk of LA toxicity
D.)Decrease bleeding at site of administration
E.)Increased amount of LA remain around nerve for longer periods increasing duration of action of most LA.
F.) LA blood levels are increased

F

Maxillary nerves are Sensory or Motor?
Mandibular Nerves are?

Sensory
Sensory and Motor

Prolonged tetanic spasm of the jaw muscles by which normal opening of the mouth is restricted. Caused by muscles, blood vessels in infratemporal fossa, hemorrhage, or infection after injection

Trismus

How do you treat trismus?

Heat therapy, warm saline rinses, analgesics and if needed, muscle relaxants. Patients should initiate physiotherapy of opening and closing the mouth and lateral excursions of the mandible. In severe cases, referral to oral surgeon.

What would cause a dry cornea?

Anesthetizing the facial nerve. If bone is not contacted during the IANB and the solution is deposited into the parotid gland. Temporary bell's palsy would not allow the patients eyelid to close or blink.

An injection that is deposited close to a main nerve trunk is called ____. Also, name 3 of the injections pertaining to this.

Nerve Block (IA, PSA, Nasopalatine)

An injection where small terminal nerve ends are flooded with LA solution is called?

Infiltration

What would you do for a patient with post op infection?

immediate treatment of heat and analgesics, muscle relaxant if needed and physiotherapy. If infection persists, patient should get on a 7-10 day course of antibiotics like penicillin V or erythromycin if allergic to penicillin.

Name the injection site for MSA

mucobuccal fold of 2nd premolar

Name injection site for PSA

mucobuccal fold of 2nd molar, DB root, 45 degree angles, *Pterygoid plexus

Name injection site for Greater palatine

Ant. to foramen lingual to 2nd molar *cotton tip

Posterior and lateral to the incisive papilla *cotton tip

Nasopalatine

Name injection site for Long Buccal injection

mucobuccal fold, DB to last molar, inject parallel and inferior to occlusal plane

Injection site for Lingual

withdraw needle from IA until 1/2, reaspirate and inject

Injection site for mental/incisive

mucobuccal fold anterior to the mental foramen

How much epi is in a cartridge of 2% lidocaine with 1:100,000?

2%=20mg
20mg x 1.8ml=36mg lidocaine/cartridge
Epi 1:100,000=.01mg
.01 x 1.8= .018mg epi/cartridge

Acute inflammation of the laryngeal mucosa due to infection, allergy or inhalation of irritant materials, causes obstruction of airflow

Laryngeal edema

What is the cause of needle breakage?

Sudden movement by the patient

Patient receives electric shock during delivery of LA. What happened?

It touched the nerve sheath.

Why does filtration work better in the maxilla than in the mandible?

Bone is less dense in the maxilla.

How much epi is in one cartridge of 1:100,000?

.018ml in one cartridge

How much epi is in 2 cartridges?

.036ml

Where is epi naturally found in the body?

Found in the medulla of the adrenal glands located in the kidneys. The endocrine system/urinary system

Ongoing numbness of the anterior part of the tongue is caused by which nerve being anesthetized?

Lingual

What anesthetic is not an amide?

Procaine (Novocain)

How long can you safely leave on a lidocaine patch?

15 minutes for a concentration of 20%

What is the most common LA without Epi?

Mepivacaine (carbo/polocaine)

What needle gauge is used for infiltration? 27 or 30?

27

If a patient has liver disease, you would use caution with an amide because....

Amides are metabolized/biotransformed in the liver

What is the benefit of slow deposit rate?

Less pain and less complications

After the infraorbital injection, the patient's cheek turns white. What happened?

Blanching or vasoconstriction of the blood vessels in that area.

Why does LA fail to work near an abscessed tooth?

infection causes lower pH

If asked about allergic reaction to LA, choose the ester option

Benzocaine

Innervation of the soft palate is what palatine nerve?

Lesser

What causes a droopy eyelid?

Anesthesia of the facial nerve

Which root is not anesthetized with the PSA injections?

Mesialbuccal root of the maxillary first molar

Where do you dispose of the used needles?

In a contaminated or sharps container

Burning on injection could be due to:

injecting too fast or a
*lower pH from a vasoconstrictor

What is the injection site for lingual infiltration of maxillary molars?

The attached gingiva 5-10mm from the free gingival margin

If you want hemostasis, what is the infiltration procedure of choice?

2% Lidocaine with 1:50,000 EPI injected directly into surgical site to stop bleeding.

How would you manage a delayed reaction a patient has to EPI?

Benadryl. Delayed skin reactions are managed by oral histamine blocker such as diphenhydramine or chlorpheniramine. Delayed rxns develops hours to days after exposure.

Immediate skin reactions is managed by:

epi and IM histamine blocker. This reaction develops within seconds to hours of exposure.

This injection is for the lingual of max. anteriors

Nasopalatine

To inject the entire palate on one side you would do what injections?

Greater Palatine and Nasopalatine

What post op instructions would you give to a patient with a hematoma?

Cold compression's and pressure to bleeding site, common for pterygoid plexus of veins during PSA

What needle size would you use for an infiltration?

27 short

What is the first sign of toxicity?

CNS Excitement

Where do you infiltrate?

near the apex of the tooth

#15 has an abscess. You already gave a PSA. What other injection could you give to numb the lingual?

Greater Palatine

When scaling #13 and you want to give an injection, where do you infiltrate?

The apex of #13

If the central incisor has a defect on the root, what injection would you give?

Nasopalatine

What is the shelf-life of LA?

Expiration date on the cartridge. Plain is 36 months and with EPI is 18 months

If you administer LA 1ml per minute, what would happen?

no problems

If a patient is allergic to sulfite (sulfa) which LA don't you give?

Articaine w/Epi (Any with epi)

If a patient has an allergy to red wine, what LA should you use?

Mepivacaine 3% plain or Prilocaine 4% Plain NO EPI

Cc, mL, mg.- ml is ______
mg is ______
1 gram=_____mg

solution
solute
1000

Place ASA Classification in order from 1-5
A.)Severe systemic disease-BP over 160/95, history of MI, Diabetes 1, heart failure etc.
B.)Normal, healthy, can walk up 2 flights of stairs or 2 city blocks w/o being winded
C.)Moribound-not expected to live 24hrs
D.)Mild systemic disease-BP over 140/90, epilepsy, diabetes II, pregnant, etc.
E.)Incapacitating systemic disease-uncontrolled diabetes, epilepsy or angina, heart failure, shortness of breath at rest etc.

B, D, A, E, C

LA are what type of injection?

Subcutaneous

Where do you give an injection for Max. incisors?

Mucobuccal fold of supraperiosteal

Pt. experienced no pain until LA was deposited. Why?

Rapid deposition of LA, solution not sterile, or solution too hot or too cold.

Where does the mandibular nerve pass through in the skull?

Foraman Ovale

Where does the nasopalatine nerve pass through?

The incisive papilla

Name a sulfa antibiotic

Bactrim

Some topicals contain preservatives like methylparaben which may cause an allergy to ________.

Local anesthetic

There is a greater chance of an overdose with this type of LA

Amide

What is the mount of epi in a 1%, 2%, and 3% solution?

1.) 10 x 1.8 (or 1.7)= 18mg (or 17mg)
2.) 20 x 1.8= 36mg (or 34mg)
3.) 30 x 1.8= 54mg (or 51mg)

If you want hemostasis, what injection is best?

Infiltration

What best describes topical anesthetics?
A.) works on mucous membranes
B.) limited systemic toxicity
C.) works on keratinized tissue

works on mucous membranes

How many milligrams of
mepivacaine are contained within 2
cartridges of mepivacaine 3%?

3% mepivacaine = 30mg/cc
1 cartridge = 1.8 cc
2 cartridges = 3.6 cc
(30 mg/cc)x(3.6 cc) = 108 mg

Compute the number of cartridges of 2% lidocaine for a 32 year old, healthy male, 175 pounds.

2% x 1.8=36mg
2% x 175= 350mg/lb
350/36=9.7 cartridges (Round down)

Another name for alkalinizing agent is_____.

Sodium hydroxide

LA agents work by inhibiting the influx of ___ions by competing with ____ for binding sites.
LA affect small unmyelinated fibers first then large myelinated last.

sodium; calcium
LA decreases the rate of depolarization and prolong the rate of repolarization. Does NOT prevent the efflux of potassium in nerve cell.

Nerves affected in this order:
autonomic, temperature, pain, touch/pressure, vibration and _____ last!

MOTOR last!!*** Last to be lost, first to be regained.

What anesthetic is safe in pregnancy?

Lidocaine(Xylocaine)

What anesthetic should you not use in patients with oxygen problems?

Prilocaine (Citanest)

Put the amides in order from shortest to longest duration.
1-
2-
3-
4-
5-

1-Mepivacaine(shortest)
2-Lidocaine
3-Prilocaine
4-Articaine
5-Bupivacaine (longest duration)

All of the following are true regarding vasoconstrictors added to anesthetics except:
a) Prolong anesthetic action
b) Reduce anesthetic toxicity
c) LA blood levels are increased
d) delays absorption
e) decrease bleeding

C

Max number of carpules containing 1:100,000 epi allowed for a hypertensive patient:

2; EPI is not contraindicated in a CONTROLLED hypertensive patient.

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