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Local Anesthsia CH. 10 Physical and Psychological Evaluation PG. 139-156

Before starting any dental therapy, what must be determined? If the patient can tolerate, both physically and psychologically, the planned dental procedures in a relative safety.
Local anesthetic actions include depressant effects on excitable membranes like what? CNS and CVS
What are the two most common occurring psychogenic reactions? Vasopressor syncope and hyperventilation.
As a general standard of care, what does the dentist have the patient do? Complete a medical history at initial office appointment and update regularly every 6 months.
When is it more difficult to achieve adequate analgesia? Chronic pain or inflammation is present.
What is prudent to include in the medical history along prescription medications? Nonprescription drugs, and herbal remidies
ASA IV patients who demonstrate disability, undue fatigue, shortness of breath at rest
ASA III unable to complete normal functions without disability
ASA III and IV are more likely to demonstrate some degree of what? Liver perfusion leading to increase half-life of amide local anesthetics.
ASA III and IV heart failure patients are less tolerant to what, having a decreased functional reserve? Stress
What is the ideal positioning for a patient receiving local anesthetics? supine
When should myocardial patients (ASA IV) not receive dental elective dental care? 6 months of an MI because reinfarction is more likely to occur during this time?
Angina Pectoris Transient chest pain produced by myocardial ischemia, relieved by rest of the administration of a vasodilator.
What may provoke an anginal episode? anxiety, or inadequate pain control that increases myocardial oxygen requirements
Are vasopressors in local anesthetics contraindicated in stable angina? No, can use a judicious amount.
T/F Hypertensive patients should have their blood pressure monitored at each appointment and be manages according to the most recent reading True
Who are acceptable for risk of dental care including use of local anesthetics with vasopressors? Patients with mild to moderate elevations in systolic or diastolic pressure
The presence of a prosthetic heart valve indicates the need for what? Antibiotic prophylaxis before any dental care.
The presence of methemoblobinemia congenital or idopathic represents a relative contraindication to what local anesthetic? Prilocaine
Use of minimal effective doses of local anesthetic with vasoconstrictors is indicated with what? Cerebrovascular accident (CVA), transient ischemic attack (TIA)
Patients who are clinically hyperthyroid are sensitive to what? catecholamines and may demonstrate an exaggerated response to vasopressors included in local anesthetic solutions.
If a patient may be unable to open his or her mouth adequately thus making some injection technique impossible, what do you do? Vazirani-Akinosi, closed mouth mandibular block or extraoral nerve blocks
What is significant with liver dysfunction and local anesthetics? The half life of the amide local anesthetics may be significantly prolonged, thereby increasing the risk of overdose.
What can severe overdose reactions of local anesthetics manifest themselves as? Generalized tonic-clonic convulsions
If local anesthetics are carefully administered they could be used as what? anticonvulsants in a patient during grand mal seizures.
T/F Malignant Hyperthermia (MH) represents a relative contraindication to dental care True
Atypical plasma cholinesterase represents a relative contraindication to what type of anesthetics? Ester
When is there a relative contraindication to pregnancy? During the first trimester
T/F Local anesthetics and vasopressors are not teratogens and may be administered to pregnant patients during any trimester. True
What are the six vital signs? blood pressure, heart rate and pulse, respiratory rate, temperature, height, and weight.
A person with a blood pressure of 200.115 should not do what? Not undergo invasive elective dental treatment until BP is under a safe limit.
What could the administration of local anesthetics do to a patient if they have extreme high blood pressure? Further elevate the blood pressure of an already anxious patient.
A relative contraindication to administering epinephrine containing local anesthetics is what? Cardiac dysrythmias unresponsive to medical treatments
Epinephrine and catecholamines may provoke what leading to a lethal dysrythmias? irritability
What does cimetidine (H2-receptor blocker) modifies the biotransformation of lidocaine by competing with it for binding to hepatic oxidative enzymes resulting in what? Increase in half-life of the circulating local anesthetics.
Interaction between amide local anesthetics and cimetidine might be of greater clinical significance in the history of CHF why? Percentage of cardiac output delivered to the liver falls while the percentage of cardiac output to the brain increases. Local anesthetic overdose is also increased.
T/F Minimal local anesthetics should be administered with patients with cimetidine, ASA III + CHF True
What type of anesthetics can inhibit the bacteriostatic action of the sulfonamides? Ester local anesthetics
Methemoglobin results when what is administered in excessive dosages? Prilocaine
The administration of norepinephrine and levonordefrin should be avoided in patients taking what? TCA's (Tricyclic Antidepressants)
Administration of vasopressors in patients being treated with nonselective b-blockers increase the likelihood of what? serious elevation of the blood pressure accompanies by a reflux bradycardia.
Local anesthetics containing a vasopressor should not be administered to a patient that has done what on the day of their dental appointment? Cocaine
Malignant Hyperthemia (MH) is a relative contraindication what what type of local anesthetics? Amides
Atypical plasma cholinesterase represents what type of contraindication to ester local anesthetics? Relative contraindication
What topical anesthetic can cause methemglobinemia to occur? Benzocaine
What is the diagnosis of methemglobinemia? cyanosis and a distinctive brown color of arterial blood.
Created by: daisenmurray