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What is the cardiac dose of epinephrine? 0.04mg
When giving the PSA injection and the syringe is parallel to the occlusal plane, what is the most likely complication? contact with pterygoid plexus
Where does epinephrine and levonorderfrin metabollize? liver
Case study: Older women with high blood pressure, overwirght, being treated for being overweight, etc. What is the limiting factor? vasoconstrictor
A patient received 3 carps of 4% Priolocaine with 1:200,000 epi. How many mg. of LA did she receive? 216mg
How many carps of 2% Lido with 1:100,000 epi can you give a healthy 200 lbs man? 8 carps
What is administered in the case of anaphylactic shock? epinephrine and oxygen
What are signs and symptoms of acute generalized anaphylactic shock? Bronchoconstriction
Where is the lingual nerve located in relation to the IA nerve? Anterior and medial
If you are using a 30 gauge short needle for the mandibular block, what is the potential complication? Cannot reach target area, needle too short, breakage
If the patient feels an "electric shock" during an injection, what happened? contacted nerve membrane
What local anesthetic agent would you give to a patient with uncontrolled hyperthyroidism? 3% Mepivacaine
The normal dose of epinephrine can be administered to the following patient? -MI within 6 months -Daily angina -cardiac pacemaker cardiac pacemaker
What anesthetizes the mandibular 1st premolar? mental
You administer an IA injection and the patient does not get numb but cannot close their eye and complains her face feels numb. What happened? Injected into parotid gland
How would you avoid injecting into the parotid gland? contact bone before depositing
If you need 60 min of anesthesia, what anesthetic would you use? Medium length anesthetic; 2% lido, 2% mepivicaine, 4%Prilocaine, 4% Articaine, Procaine
A healthy patient comes in late for your appointment with heavy calculus, gingival bleeding and history of cancelled appointments. You administer 1 carp of 2% Lido with 1:100,00 epi and patient looses consciousness. What happened? Syncope
Next to the mental, which injection has the next highest aspiration rate? IA
After administering 6 carps of 3% Mepivacaine the patient's arms and legs start to twitch, breathing is short and rapid, heart rate is elevated. What is the cause? LA overdose
How do you treat a local anesthetic overdose? Monitor vitals and oxygen
How much epi is in 2% Lido with 1:100,000 epi when compared to 2% Lido with 1:50,000 epi? 1/2 or 0.018 mg compared to 0.036mg
What would a patient be allergic to in a carpule of anesthetic? Sodium Bisulfite
What is the preservative in 3% Mepivacaine? none
How would you treat someone who stopped breathing? Positive pressure (CPR) and oxygen
If a patient presents with facial trauma and trismus and cannot open for the IA what is an alternative injection? Vasirani-Akinosi
What is the metabolic byproduct of esters? PABA
When inflammation is present, why is it difficult to get the patient numb? Iflammation causes the tissues to become more acidic=lower pH=higher pKa=more water soluable
What happens to anesthetic when it is injected into an inflammed area? Ineffective
Which anesthetic id appropriate for long lasting pain/procedure? 0.5% Bupivacaine
How much anesthetic is given for the PSA? 0.9mL to 1.8mL (1/2 to 1 carp)
When giving the right IA, what gets numb? Buccal gingiva from the premolar to central and teeth 25-32.
When giving a GP, what gets numb? Palatal tissue of molars and premolars (distal of canine)
You give an injection and the patients' face distends and edema sets in at the site of injection. What is the most likely cause? Hematoma
How much anesthetic is given for the the left IA? 1.3 mL to 1.5 mL (2/3 to 3/4 carp)
When giving the left IA, you contact while only inserting 1/4 the length of the needle. What should you do? Withdrawl slightly, redirect barrel more anterior over the incisors, advance the needle, reposition barrel over premolars and advance until bone is contacted
You administer 2 carps of 3% Mepivacaine for an IA and the patient does not get numb. What happened? Injection too low
What is the advantage of a vasoconstrictor? reduce toxicity
What injection is appropriate for treatment on the maxillary cuspid? ASA
You have just given a left IA and the central and lateral are not numb. Why? crossover
A patient presents with pressure and cold sensitivity on #15. The radiograph indicates a periodontal abscess. What injections should you give? PSA, GP
What is a contraindication for the PSA Hemophilia
You administer 6 carps of 2% lido with 1:50,000 epi to a patient. Shortly after he complains of a headache and shakiness. What happened? Epi overdose
What is the most common reaction to epinephrine? Fear and enxiety
After administering anesthetic the patient complains of substernal tightness and itching. The patient begins to make wheezing noises. What is the most likely cause? Anaphylaxis
If you inject into the parotid glad during an IA, if results in anesthetizing what nerve? Facial nerve (VII)
What is the primary sensory nerve for the teeth? Trigeminal (V)
What happened when a carp has a distended stopper and bubble? it has been frozen
If a patient has an allergy to preservatives, what could she be allergic to in a carp of anesthetic? Sodium bisulfite
Where to local anesthetics take action? on the nerve sheaths (membrane)
What is the term when a patient losses numbness, you administer anesthesia again, and still doesn't get numb tachyphylaxis
What property of anesthesia accounts for it's potency? lipid solubility
What is a true allergic reaction to LA? Ananphylaxis, uticaria
Which system is most susceptible to the actions of LA? CNS
After giving an injection, the site of penetration becomes blueish. What is the likely cause? Hematoma
True or False: Levonodefrin is absolutely contraindicated for people take tricyclic antidepressants. True
Patient has pain in their chest and left side of their neck and subsides in 3-5 min. What is the situation? Angina
How do you treat angina? If no response from the 1st dose of nitro, you can give another dose in 2 min. (max. 3 doses). If then no response, call 911.
A 55 lbs child can receive how many carps of Mepivacaine 3%? 2 carps
A 100 lbs person received 3 carps of 2% lido. Now the DDS wants to give Mepivacaine. How many more mg can the patient receive? 200-108=92mg
How many carps of 2% lido with 1:100,000 epi can you give an ASA III cardiac patient? 2 carps
Patient is anxious and running late to her appointment. A minute or so after given anesthetic, patient has cold hands and fingers. What is the problem? Syncope
How do you treat a patient in syncope? Supine position with legs above heart, ammonia, oxygen, 911 if needed
How can you prevent syncope from happening? Recognize anxiety of patient, and reassure
What is an allergic reaction to topical? Tissue sloughing and angioedema
IF you have a positive aspiration what you indicate the need to withdrawl and change carp? If you are unable to see the next aspiration results
When giving a long buccal, what gets numb? buccal mucosa of molars
Where do you inject for the long buccal? distal and buccal to the most posterior molar
When you give an IA and all the teeth get numb EXCEPT the 1st molar. What is the issue? How do you correct it? innervated my the mylohyoid nerve, use the Gow Gates
What gets numb when anesthesia is directed toward the incisive foramen? NP, palatal tissues central to canine
How do you treat a hemotoma? Direct pressue for 2+ min, ice, aspirin for soreness, will reside in 7-14 days
Where is the lingual nerve in relation to the IA nerve? medial and inferior
After receiving and injection, the patient feels jittery and anxious. What is the the cause? Injected into the blood stream, LA toxicity
What do you do if a patient state they have an allergy to LA? assume patient is truely allergic, don't use any similar drugs, refer to Dr to be tested. No tx until know if it's a true allergy
Most common reaction to dental anesthesia? Positive and negative Positive reaction: CNS depressant Negative reaction: vasodepressor, syncope, hyperventilation
If you give an IA injection of 3% Mepivacaine and the patient feels pain when dental tx begins. What is the problem? Deposition site is too low
Why would you not give a patient an amide if their liver is comprimised? Since amides are metabolized in the liver, they have a higher potential for toxicity
You give a GP and the patients' throat feels numb. What caused this? LA dripped down throat or hit the medial palatine nerve
What foramen is for Trigeminal 2? Trigeminal 3? Trigeminal 2: Rotundum Trigeminal 3: Ovale
Patient begins breathing rapidly and hands and fingers get cold. What is it? Hyperventilation
How do you treat hyperventilation? Stop tx., position patient upright, BLS if needed, remove items from mouth, cup hands and breath into hands (no paper bag)
You gave a patient 3 carps of 2% lido. How much anesthetic did they receive in mg? 108mg
How many carps of 2% Lido with 1:50,000 epi can a 140 lbs person receive? 5.5 carps
What is the purpose of a vasoconstrictor? counteracts the effects of the vasodilating LA, keeps anesthetic in target area, promotes depth and duration to anesthesia
Which ingredient is the main cause of allergic reaction in anesthetic? Sodium bisulfite
What factor reduces systemic toxicity? Slow injections and negative aspirations
What steps do you do for the GP injection? 27 gauge needle, clean, dry, topical for 2 min., apply pressure for 30 sec, insert anterior to GP foramen, deposit small amount until blanching occurs.
If 300 mg is the healthy dose of 3% Mepivacaine 1:20,000 levo, how many carpules can a 173 lbs man safely receive? 8 carps
How much vasoconstrictor is given with 8 carps of 3% Mepivacaine with 1:20,000 levo 0.72 mg
Prior to giving an injection, you notice small 1-2 mm bubbles in the cartridge. What does this indicate? Nitrogen gas, no concern
What is the primary nerve for the mandibular 1st molar? IA
A patient has asthma, allergies to cosmetics, etc. What topical can safely be administered? Lidocaine - patch
Signs and symptoms of acute generalized anaphylaxis? Pallor, palpitations, bronchospasm, tachycardia, tight chest
Which of the following cause vasodilation? -lidocaine -articaine -mepivacaine -procaine All are vasodilating but esters are more vasodilating - Procaine
What injection is most appropriate for hemostasis when scaling 12 and 13? MSA field block
How many mg of vasoconstrictor can a healthy adult receive? 0.2mg
What anesthetic would you choose for a patient with uncontrollable hyperthyroid? Anything without epi
What is a pertinent contraindication for a patient with a recent MI? No tx. for 6 months
What is the preservative in 3% Mepivacaine? There is no preservative in 3% Mepivacaine
The nerve that exits the mandibular foramen is a branch of what greater nerve? IA
The maximum depth and angle on a PSA is where in regards to the pterygoid plexus? Anterior
Where do you insert the needle for the MSA? Height of the mucobuccal fold over the 2nd premolar
The DDS would like you to give 2% Mepivacaine to a 55 lbs child. How many carpules can you give them? 55/150 x 8 = 2.9 2.5 carps
What is a relative contraindication for hyperthyroidism? Sensitive to catecholamines
Patient with smaller facial features. What should you do to prevent a hematoma? Less depth, don't penetrate into the pterygoid plexus
A patient is contraindicated to receive a vasoconstrictor. What anesthetic can be given? 3% Mepivacain (plain), 4% Prilocaine (Citanest plain)
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