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Local Anesthesia NERB

hinuxaxa's version from 2016-06-01 18:15

Section 1

Question Answer
What happens during depolarization (excitement)Sodium in and Potassium Out
Primary action of LA is producing a conduction blockdecrease sodium's ability to permeate
LA ___________ (decrease/increase) rate of depolarization (aka conduction)Decreases
LA ___________ (decrease/increase) firing thresholdDecreases
Definition of LAblock sensation of pain by blocking nerve conduction to a circumscribed area of the body

Section 2

Question Answer
Why does anesthesia fail to work near an abscessed tooth?2 reasons: 1. Infection lowers pH - which does not allow ionization of sodium molecules 2. Blood difuses the anesthetic away from the injection site by increased absorption
Which LA is metabolized by psuedocholinesteraseEsters
Which anesthetic is not an amideProcaine (Novocaine)
Most common anesthetic without epinephrinemepivicaine (carbocaine/polocaine)
First sign of local anesthesia toxicityCNS excitement

Section 3

Question Answer
Where is epinephrine naturally found in the body? Which system?Found in the adrenal medulla on the kidneys belonging to the endocrine system
Beta Blockers _____ (increase/decrease) BP by lowering heart rate and stroke volumeDecrease
Non selective Beta blockers ___________(increase/decrease) BP in the presence of LA w/epinephrineIncrease- due to nonselective beta blocker interacting with epi and not allowing the epi to vasoconstrict and maintain vasodilation
Four actions of vasoconstrictorsIncrease duration of LA, Decrease bleeding, decrease toxicity, decrease blood flow to reduce amount of LA needed

Section 4

Question Answer
What is the significance of giving an amide to a cirrhosis?Amides are metabolized in the liver, ASA IV relative contraindication- half life is prolonged
Esters are metabolized by________________psuedocholinesterase
Esters are excreted by ________________kidneys
Amides are metabolized in the ___________liver
Amides are excreted by____________kidneys

Section 5

Question Answer
If someone has sulfite allergy- Must give plain anesthetic
Cardiovascular disease (ASA III or IV) or hyperthyroid- epi concentrationLow- 1:200,000
Which LA causes methemoglobinemiaPrilocaine
If a patient is allergic to red wine what LA would you give themNo LA with vasoconstrictor

Section 6

Question Answer
What needle for infiltrations27 gauge short
Number 1 cause of needle breakageBending the needle- but NERB option will be pt movement which
When do you use a long needlePreferred for all injections where the penetration of significant thicknesses of soft tissue is req'd
Injections that are most likely to use a long needleIANB, (MSA, ASA, Buccal- are incorrect choices on the nerb)

Section 7

Question Answer
Smaller Needle gauge equals _____________ (larger/smaller) lumenlarger
What does it mean if a pt receives an electric shock during delivery of anesthestaTouched the nerve sheath
Where do you dispose of used needlesCartridge and needles go in sharps container
Sodium chloride is responsible for isotonicity
sterile water is responsible for volume of the cartridge
Vasopressors (epi and levonordephrine) are responsible forincrease depth and increase duration of anesthetic
Sodium bisulfite is responsible forantioxidant prevents biodegredation of LA (delays deterioration of epi)

Section 8

Question Answer
Burning upon injection is due topH was the NERB answer (other answers that would be correct: inject too fast, cartridge wiped with alcohol or sterilizing solution)
Burning may also be a result ofNormal pH of the drug (other options on the NERB that were wrong- sterilizing solution in cartridge, cartridge with vasopressor or overheated cartridge)
Topical anesthetic is least effective on ___________ tissuekeratinized
Which is true of topical anesthetics?not systemically toxic
When do you aspirate?right before anesthetic is deposited
Benefits of slow deposition rateLess pain, less complications (1.8ml cartridge in 60 seconds to 2 minutes)

Section 9

Question Answer
Difference between block and filtrationBlock- anesthetic is deposited close to main nerve trunk- cover a larger area. filtration- deposited near large terminal nerve endings.
Why do infiltrations work better in the maxillabone density
Which needle for infiltrations25-27 short
Which injection is best for hemostasisinfiltration

Section 10

Question Answer
Injection site for an infiltration of the lingual of #13Near apex of tooth (incorrect options: mucogingival junction, free gingival margin)
Maxillary division of trigeminal nerve isSensory only
What does the posterior superior alveolar nerve innervate?1st, 2nd, and 3rd maxillary molars but may not innervate the MB root of 1st molars

Section 11

Question Answer
Hematoma can occur if needle penetrates into the pterygoid plexus of veins during which injectionPSA
The needle may have been too far ________ (anterior/posterior) during PSA if hematoma resultsposterior (also overinsertion)
Definition of a hematomalaceration of veins from the needle
Visible intraoral hematoma develops within ________________minutes
Hematoma bleeds until _____________pressure of the extravascular bood equals that of the intravascular blood
Treatment for hematomaapply pressure w/gauze for at least 60 seconds up to 2-3 minutes - cold compression for 12 hours

Section 12

Question Answer
What causes a droopy eyelidanesthetizing the facial nerve
What would cause a dry corneaanesthetizing the facial nerve. This occurs if bone is not contacted during IANB and anesthetic is injected into parotid- thus not allowing the eye to blink causing it to be dry
After the ASA or infraorbital injection- the pts cheek turns white- what happenedblanching, or vasoconstriction of the vlood vessels in that area

Section 13

Question Answer
Where does the nasopalatine nerve pass throughIncisive Foramen
A central incisor has a periodontal defect on the lingual root surface, what injection would you usenasopalatine
What injection is needed to anesthetize the entire palate on one sidegreater palatine and nasopalatine
Innervation of the soft palateLesser Palatine Nerve
Where does the mandibular nerve pass throughforamen ovale

Section 14

Question Answer
Landmark for IANBcoronoid notch
How far do you insert the needle on an IANB20-25 mm or 3/4 the length of the needle
What injection uses the pterygomandibular raphe and what nerves are involvedIAN block and the inferior alveolar nerve, the incisive, mental and lingual nerves
Injection point for the long buccal injectiondistal and buccal to the mandibular molar
Which nerve is anesthetized when the anterior 2/3 of tongue is numbLingual nerve

Section 15

Question Answer
Which anesthetics have the highest occurrence of allergic reactionsChoose the ester option
What is trismuslimited opening of mouth- spasm of the jaw muscle
How to manage trismusheat therapy for approx. 20 min. every hour and jaw exercises for 5 min., aspirin, warm saline rinses
Some question about psychogenic painchoose no organic base for the pain

Section 16

Question Answer
Max epi dose for cardiac pt..04mg (.2mg for a normal patient)
How much LA in a 1% cartridge18mg
How much LA in a 2% cartridge36mg
How much LA in a 3% cartridge54mg
How much epi in 1:100,000 in a 1.8 ml cartridge0.18mg
How long can you safely leave on a lidocaine patch15 minutes w/ a concentration of 20%

Section 17


Question Answer
Brand name of Articain 4%Septocaine
Brand name of 0.5% BupivicaineMarcaine
Brand name of Lidocaine 2%Xylocaine
Brand name of 3% Mepivacaine plainCarbocaine
Brand name of 2% Mepivacaine with 1:20,000 LevonordefrinPolocaine
Brand name of prilocaineCitanest