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338 Cards in this Set
- Front
- Back
what was the first local anesthetic?
|
Cocaine
|
|
who isolated cocaine out of the coca plant?
|
Niemann
|
|
what is trephining
|
was to release evil spirits thought to be caused by mental illness or epilepsy.
|
|
the oldest surgery was ___
|
trephining
|
|
who noted cocaine placed in eyes resulted in complete anesthesia?
|
Ophthalmologist, Karl Koller
|
|
Who invented Coco-Cola in 1888?
|
John S Pemberton
|
|
what was the first synthetic local anesthetic developed in 1905?
|
Procaine (used cocaine as a building block)
|
|
lidocaine (xylocaine) was synthesized in what year?
|
1952
|
|
what local anesthetic was synthesized in 1960?
|
mepivacaine (carbocaine)
|
|
know ideal properties of local anesthetic
|
potent, reversible, absence of local and systemic reactions, absence of allergic reactions,
|
|
what are the two major chemical groups of local anesthetics?
|
esters and amides
|
|
cross-hypersensitivity between amides and esters in local anesthetics is _________?
|
unlikely
|
|
what three parts make up the structure of local anesthetics?
|
aromatic nucleur (R)
Linkage Amino group |
|
the aromatic nucleus (R) is _______
the amino group is __________ |
lipophilic, hydrophilic
|
|
all the LAs end in the suffix?
|
caine
|
|
all amide type LAs have the letter __ in the part of the generic name before the suffix. esters do not follow this rule.
|
i
|
|
for the following decide whether the LA is an amide or an ester.
cocaine, mepivacaine, ropivacaine, propoxycaine, tetracaine, bupivacaine |
ester, amide, amide, ester, ester, amide
|
|
what is the main clinical effect of LAs
|
reversible blockage of peripheral nerve conduction
|
|
what is the site of action of LAs?
|
nerve membrane
|
|
local anesthetics act as
|
sodium channel blockers
|
|
if sodium cannot flow out of the neuron in a action potential then __________ cannot flow out thus inhibiting the depolarization of the nerve
|
potassium
|
|
the active ingredient of local anesthetic is called the __________ which is a weak base
|
anesthetic base
|
|
lipid soluble free base is the carrier which ________ the nerve membrane
water-soluble hydrochloride salt binds to the receptors causing the ______ action |
penetrates
blocking |
|
pH is equal to pKa of LA
pKa is related to _____ __ ______ |
onset of action
|
|
out healthy tissue pH is usually about __________
the la carpule solution has an acidic pH of __________. it penetrates well in to the tissue and changes rapidly to the tissue pH |
7.4
4.5 |
|
the _______ the pKa the longer the onset of action
|
higher
|
|
what has the longest onset of action for local anesthetics
|
bupivacaine
|
|
Inflamed tissue (hot red swollen and painful) tends to be acidic in nature. does this make local anesthesia work easier or harder?
|
harder because the asethesia is pH sensitive. it is harder for it to diffuse into the fibers of the tissue so you use a lot more anesthesia to have the same effect as healthy tissue
|
|
rate of these factors depends on tissue vascularity and amount of free base in LA (nonionized)
|
absorption
|
|
a ________ is added to the local anesthetic to reduce absorption (epinephrine most common)
|
vasoconstrictor
|
|
bupivacaine in 0.5% solution is about ______ more lipid soluble than2% lidocaine
|
10 times
|
|
pseudo means
|
false
|
|
what is the only amide that is primarily metabolized in the plasma and not the liver
|
articaine
|
|
amides are metabolized in the ________
|
liver
|
|
esters are metabolized in the _______
|
plasma
|
|
articaine is an amide or a ester? it is metabolized where?
|
amide metabolized in the plasma
|
|
LAs are excreted from the
|
kidneys
|
|
The unconscious perception of movement and spatial orientation arising from stimuli within the body itself.
|
proprioception
|
|
LAs can cause vasodilation so a __________ is added to stop that and also to keep it localized
|
vasoconstriction
|
|
what portion of the population is more susceptible to adverse reactions of LA
|
children and elderly
|
|
what are the two main systems affected by toxicity of LAs?
|
Central nervous system
cardiovascular system |
|
inherited disease characterized by often fatal hyperthermia with rigidity of the muscles occurring in affected people exposed to certain anesthetic agents
|
malignant hyperthermia
|
|
what two anesthetic agents are most connected with malignant hyperthermia
|
halothane and succinylcholine
|
|
LAs esters or amides have the highest allergic potential
|
esters are higher allergic potential
|
|
composition of LA solutions. this is added to LA to retard absorption reduce systemic toxicity and prolong its duration of action
|
vasoconstrictor (usually epinephrine)
|
|
the most commonly used dental administered drugs for relaxation of an anxious patient is _____ adminestered drugs
|
orally
|
|
nitrous oxide used in dentistry as an antianxiety agent is classified as what
|
a general anesthetic
|
|
true or false
intravenous is used often as an antiaxiety in the dental office |
false
|
|
sedative-hypnotic agents depress
|
CNS
|
|
what is the range of sedative hypnotics effects with increasing doses from lowest to highest
|
selhad
sedative/anxiety, euphoric, lethargic, hypnosis, anesthetic/coma, death |
|
the absence of all sensation
|
anesthesia
|
|
what are the three groups of drugs classified as sedative-hypnotics
|
benzodiazepines-most common
barbiturates nonbenzodiazepines-nonbarbiturates |
|
which benzodiazepine was synthesized in 1955 (first one)
|
chlordiazepoxide (Librium
|
|
valium (diazepam) is a _________
|
benzodiazepine (antianxiety agent)
|
|
usual suffix for benzodiazepines
|
azepam or azolam
|
|
benzodiazepines controlled substance rating
|
IV
|
|
most benzodiazepines are rated what for pregnancy
|
D some X and C
|
|
Benzodiazepines are well absorbed when administered by the ______ route
|
oral
|
|
Lorazepam oxazepam, temazepam are metabolized by phase II (glucoronidation) only so they may be better tolerated in the _______ patient
|
elderly and liver impaired
|
|
phase I metabolism in benzodiazepines is ______ metabolism
phase II is ________ metabolism |
hard - effected by external factors such as other drugs and hepatic disease
easy - unaffected by factors such as age other disease or hepatic disease |
|
what mineral is affected by benzodiazepines
|
chlorine
|
|
what minerals do local anesthetics effect
|
sodium, potassium
|
|
where are benzodiazepines excreted
|
kidneys
|
|
long half-lives = _________ side effects
|
more
|
|
the most common side effect of benzodiazepines is
|
depression of CNS manifested as fatigue drowsiness muscle weakness and ataxia
|
|
this is common with benzodiazepines causes muscle spasms
|
pitosis
|
|
date rape drug
|
flunitrazepam (rohypnol)
|
|
Halcion (triazeolam) in oral form greater likelihood of what
|
anterograde amnesia
|
|
single object viewed as two ( double vision)
|
diplopia
|
|
rhythmic oscillation of the eyeballs (rapid eye movement)
|
nystagmus
|
|
benzodiazepines can have what dental effects
|
xerostomia, increased salivation, swollen toungue, and a bitter or metallic taste
|
|
imflammation of the venous vessels
|
thrombophlebitis
|
|
benzodiazepines antagonist that is used for overdose (IV administration)
|
flumazenil (romazicon)
|
|
dopamine deficiency may have parkinsons may take levodopa benzodiazepines may ____ the effects of levodopa
|
reduce
|
|
what are uses for benzodiazepines
|
anxiety control, insomnia management, treatment of epilepsy (seizures), treatment of alcoholism, control of muscle spasms
|
|
what neurotransmitter does benzodiazepines enhance or facilitate
|
GABA (y-aminobutyric acid)
|
|
drug of choice for marilyn monroe
|
barbiturates
|
|
benzodiazepines replaced _________ in treating anxiety, insomnia, and panic because it is safer
|
barbiturates
|
|
________- are still used to treat seizure disorders and induce general anesthesia
|
barbiturates
|
|
absorption of barbiturates are pretty good except for with _--
|
intramuscular
|
|
barbiturates work with which neurotransmittor
|
GABA receptor binding
|
|
what is main effect of barbiturates
|
CNS depression
|
|
there is an absolute contraindication of barbiturates if a patient has
|
porphyria- a group of disorders involving heme biosynthesis.
|
|
use of barbiturates can stimulate and increase the synthesis of ______which is already in excess in what disease
|
porphyrins, porphyria
|
|
nonbenzodiazepine-nonbarbiturate sedative hypnotics are mostly used with
|
children
|
|
________ ________ is not useful alone as a general anesthetic
|
nitrous oxide
|
|
which drug was the first general anesthetic used in 1846 by William Morton at the Massachussetts general hospital
|
ethyl ether
|
|
blocking the conscious sensation of pain
|
analgesia
|
|
producing unconsciousness
|
hypnosis
|
|
preventing memory formation
|
amnesia
|
|
preventing unwanted movement or muscle tone
|
paralysis
|
|
preventing exaggerated autonomic reflexes
|
obtundation of reflexes
|
|
who created a system of stages and planes to describe the effects of anesthesia in 1920
|
Guedel
|
|
what are the four stages of Guedel's stages and planes of anesthesia
|
stage 1 analgesia
stage II delirium or excitement stage III surgical anesthesia ( divided into four planes based upon eye movement, depth of respiration, and muscle relaxation) stage IV respiratory or medullary paralysis |
|
which stage of Guedel's stages and planes of anesthesia is the stage where general surgery is performed?
|
stage III surgical anesthesia
|
|
what are the current levels of anesthesia
|
Induction
Maintenance Recovery |
|
term in the current levels of anesthesia that is used to refer to the quick cahnge in the patient's state of consciousness from stage I to III
|
Induction
|
|
this level of the current levels of anesthesia beginswhen the patient has achieved a depth of anesthesia sufficient for surgery to begin and ends upon the completion of the surgical procedure
|
maintenance
|
|
this is the level of the current levels of anesthesia at the termination of the surgical procedure and continues throughout the postoperative recovery period until the patient is fully responsive to his/her environment
|
recovery
|
|
inhalation volatile liquids (liquids that easily evaporate) in general anesthesia end in the suffix
|
rane
|
|
what is MAC
|
minimal alveolar concentration
|
|
is a way of measuring and comparing the potency of inhalational anesthetics (the inspired concentration of the inhaled anesthesia required to induce surgical anes. in 50% of patients)
|
MAC minimal alveolar concentration
|
|
agents with ____MACs are less potent than agents with ______MACs
|
high, low
|
|
who discovered nitrous oxide,
who was the first dentist to use nitrous oxide |
Joseph Priestly in 1700
Dr Horace Wells |
|
a colorless, tasteless gas with little or no odor, administered with oxygen
|
Nitrous oxide
|
|
what colour tank is Nitrous Oxide
|
blue
|
|
what colour tank is oxygen
|
green
|
|
very good for conscious sedation (used in dental offices for anxiety and slight analgesia)
|
Nirtous oxide
|
|
after nitrous oxide is discontinued what should the patient be placed on for five minutes
|
oxygen
|
|
vomiting and nausea have been reported with nitrous oxide how long do they recommend you don't eat before an appointment
|
3 hours
|
|
what is the average concentration of nitrous oxide for analgesia to occur
|
35%
|
|
chronic use of nitrous oxide interferes with bs12 in the body and can cause b12 deficiency which can mimic
|
pernicious anemia
|
|
Thiopental (Pentothal)
Methohexital (Brevital) Thiamylal (Surital) are examples of what |
Ultrashort-acting barbiturates (general anesthetics)
|
|
what general anesthetic did Michael Jackson die of
|
Propofol (Diprivan)
|
|
ketamine is also known as what
|
angel dust
|
|
what two local anesthetics have been linked or associated with causing malignant hyperthermia
|
none trick question
|
|
recurrent herpes appears intraorally on __________ tissue
|
keratinized
|
|
Other names for candidiasis
|
moniliasis, thrush
|
|
cyclosporine treats
|
antirejection drug for transplants
|
|
defined as the use of drugs for nonmedical purposes, usually with the intent of altering consciousness
|
drug abuse
|
|
a state of mind in which a person believes that he or she is unable to function without a specific drug
|
psychological dependance
|
|
the altered physiologic state that results from constantly increasing drug concentrations
|
physical dependance
|
|
tobacco cessation drugs
|
varenicline,blocks nicotine receptor busPIROne non benzodiazepine (antianxiety agent)not for tobacco cessation , buPROPion antidepressant used in an anti tobacco regiment
|
|
which of the following is a tobacco cessation drug bupropion, buspirone
|
bupropion
|
|
when is physical dependence determined to exist?
|
when the person experiences withdrawal symptoms
|
|
the need for dose increases in order to achieve the desired effect or if the same dose produces a diminished effect
|
tolerance
|
|
characterized by a desire to continue to use a drug for its effect
|
habituation and addiction
|
|
what is a better term to replace habituation and addiction
|
dependence
|
|
a state of psychological or physical desire to use a drug
|
dependence
|
|
time required to produce physical dependence, when comparing drugs, is ______---- with a rapidly metabolized drug and ________ with a slowly metabolized drug
|
shortest
longest |
|
the ______ the half life of a drug the quicker the withdrawal reaction
|
shorter
|
|
in an addiction to ______ (opiod) other opioids can prevent withdrawal
|
heroin
|
|
___________ cannot be substituted for an opioid and vice versa
|
barbiturates
|
|
what are the most commonly abused drugs in the U.S
|
alcohol, tobacco and caffeine
|
|
t or f 1 in 10 people abuse alcohol
|
true-
|
|
aspirin and NSAID use may need to be avoided because of the increased risk of GI adverse effects in whom
|
drug abuse pt's
|
|
______ is the primary organ of drug metabolism so it must be considered when prescribing drugs
|
liver
|
|
Delirium temens (DTs) is what
|
withdrawal from alcohol
|
|
which drug produces significant bad side effects if alcohol is ingested
|
disulfiram (antabuse)
metronidazole also causes a disulfiram reaction |
|
which drug (oral opioid antagonist) is used to reduce alcohol cravings
|
naltrexone
|
|
how many cases of alcohol are reported each year in the united states? how many people die each week from alcohol poisoning
|
50000
1 |
|
what is considered binge drinking
|
five or more drinks at one sitting
|
|
what do these signs point to
mental confusion stupor coma or person can't be roused vomiting seizures slow breathing (fewer then 8 a minute) irregular breathing (10 sec or more between breaths) hypothermia, bluish skin color, paleness |
alcohol poisoning
|
|
permanent dilation of the capillaries and small blood vessels
|
telangiectasia
|
|
synonym for squamous cell carcinoma
|
epidermoid carcinoma
|
|
FAS patients have no ______
|
philtrum
|
|
what is the most commonly abused illicit drug
|
marijuana
|
|
major psychoactive ingredient in marijuana
|
THC delta-9-tetrahydrocannabinol
|
|
how long can THC be detected in urine after being stored in body fat
|
60 days
|
|
what is dronabinol (marinol)
|
a synthetic THC approved by FDA schedule III drug prescription drug
|
|
what is the triad of narcotic (opioid analgesics heroin methatdone etc) overdose that is treated with nalaxone
|
respiratory depression
pinpoint pupils coma |
|
GHB (gamma hydroxybutyrate) is also known as?
Can be used for treatment of |
liquid ecstasy
narcolepsy |
|
what is the most widely used social drug?
|
caffeine
|
|
methamphetamine is a medicine to do what?
|
curb appetite
|
|
methamphetamine may be synthesized from what
they are adronergic agonists |
pseudoephedrine or ephedrine
|
|
methamphetamine abusers get xerostomia with ____ saliva
|
ropey
|
|
methamphetamine has been described as teh
|
mother of all dopamine releases
|
|
basometabolic rate (BMR) is increased by
|
methamphetamine
|
|
what is the most potent hallucinogen
|
LSD
|
|
this is a spreading ulcer that has both bacteriologic (spirochetes) and environmental factors
|
ANUG acute necrotizing ulcerative gingivitis
|
|
what drugs should be used for pain and fever associated with anug
|
acetaminophen or other nonopioid pain relievers
|
|
what are cold sores or feverblisters caused by?
|
herpes symplex type 1 virus
|
|
what type of tissue does recurrent herpes appear on intraorally
|
keratinized
|
|
what would be used to treat pain associated with cold sores
|
aspirin ibuprofen or acetaminophen
|
|
what topical antiviral drugs would be used to treat herpes simplex type 1 virus?
|
penciclovir and docosanol 10?
|
|
what would be used to treat cold sores if the pt. was immunocompromised
|
acyclovir
|
|
oral candidiasis, or thrush is the result of what fungus?
|
candida albicans
|
|
what antifungal drug is used to treat candidiasis?
|
nystatin
|
|
what oral disease is characterized by redness, fissures, erosions, and ulcers at the corners of the mouth?
|
angular cheilitis, or Cheilosis
|
|
what causes angular cheilitis
|
can be candida albicans, bacteria, drugs, and a vitamin B deficiency
|
|
what oral disease is the result of a loss of necrosis or blood clot after an extraction that exposes bone
|
alveolar osteitis or dry socket
|
|
treatment for what oral disease includes packing the socket, analgesics, antibiotics if necessary, supportive therapy, and debridment and the disease is characterized by pain fever lymphadenopathy and malodor
|
alveolar osteitis
|
|
dry socket also known as
|
alveolar osteitis
|
|
proper name for canker sore
|
aphthous stomatitis
|
|
aphthous stomatitis is found in __________ areas of the mouth
|
nonkeratinized
|
|
what is the last resort treatment of canker sores?
|
immunosuppressants
|
|
what is a new topical antiinflammatory that is used to decrease duration of healing and ulcer pain in aphthous stomatitis
|
aphthasol (amlexanox)
|
|
a skin lesion that often involves lesions on the oral mucous membranes
|
lichen planus
|
|
which classic lesion appears bilaterally on buccal mucosa as white lacy lines?aka wickhams striae
|
lichen planus
|
|
oral cavity appears normal but pt describes pain that increases through the day
|
burning mouth or tongue syndrome
|
|
inflammation of the tissue around the crown of the tooth
|
pericoronitis
|
|
where does pericoronitis most often occur?
|
around the partially erupted third molars as a possible response to food or bacteria that has becom trapped between the operculum and the tooth
|
|
actinic lip changes are caused by constant exposure to the sun what is long term irreversible changes knows as?
|
actinic cheilitis or solar keratosis
|
|
what topical is recommended keratotic changes have occured to the lips?
|
topical 5-fluorouracil is indicated
|
|
what drug is used to treat xerostomia?
|
pilocarpine (for pt's with fuctioning parotid glands)
|
|
what should be avoided from a pt who has xerostomia
|
alcohol, caffeine beverages
|
|
what three terms mean an increase of production of saliva
|
sialosis, sialism, sialorrhea
|
|
what cholinergic agent causes sialorrhea?
|
pilocarpine
|
|
what is the most common drug that is associated with eruptions that resemble lichen planus
|
hydrochlorothiazide (HCTZ)
|
|
what color are minocyclines thought to produce in the bone in adult teeth
|
blue-gray
|
|
chlorhexidine rinse and liquid iron preperations can cause
|
extrinsic staining
|
|
phenytoin, cyclosporine, calcium channel blockers, carbamazepine, and valproic acid can cause what
|
gingival enlargement
|
|
what enzyme primarily metabolizes esters in which portion of the body
|
pseudocholinesterase in the bloodstream (plasma)
|
|
what is the process of metabolizing esters known as?
|
ester hydrolysis
|
|
what is the most rapidly hydrolyzed and least toxic LA ester
|
chloroprocaine
|
|
how many times slower is tetracaine then chloroprocaine
|
16 times
|
|
what is the most toxic ester
|
tetracaine
|
|
what is the most common cause of allergic reactions in esters
|
PABA para-aminobenzoic acid
|
|
what is the by-product of ester metabolism that is the most common cause of allergic reactions
|
PABA para-aminobenzoic acid
|
|
what are the only type of LAs used parenterally (injections)
|
amides
|
|
what is the most commonly used LA in dental office
|
lidocaine (xylocaine, octocaine)
|
|
lidocaine is used in an IV to treat what?
|
cardiac arrhythmias
|
|
mepivicaine is not effective by which route of entrance?
|
TOPICALLY
|
|
Mepivicaine is used with what vasoconstrictor
|
levonordefrin
|
|
t or f mepivacaine can be used plain because it produces less vasodilation than lidocaine
|
true
|
|
blood cells that carry oxygen to the blood
|
methhemoglobin
|
|
what disease is associated with prilocaine?
|
methhemoglobinemia
|
|
prilocaine should not be administered to patients with problems of what
|
oxygenation
|
|
prilocaine plain is faster then what
prilocaine with epinephrine has a duration slightly longer than what? |
mepivacaine
lidocaine |
|
how much shorter is bupivicaine then lidocaine
|
trick question
bupivicaine has twice the prolonged duration than lidocaine |
|
prilocaine should not be administered to patients with problems of what
|
oxygenation
|
|
bupivicaine (marcaine) has what effect after sensation occurs
|
analgesic
|
|
prilocaine plain is faster then what
prilocaine with epinephrine has a duration slightly longer than what? |
mepivacaine
lidocaine |
|
articaine like prilocaine may cause what if administered in very high doses
|
methhemoglobinemia
|
|
how much shorter is bupivicaine then lidocaine
|
trick question
bupivicaine has twice the prolonged duration than lidocaine |
|
bupivicaine (marcaine) has what effect after sensation occurs
|
analgesic
|
|
articaine like prilocaine may cause what if administered in very high doses
|
methhemoglobinemia
|
|
articaine has an extra what?
|
ester linkage
|
|
articaine is metabolized where?
|
5-10% in liver 90-95 in blood
|
|
what is articaine derived from?
|
thiophene
|
|
what is the slowest LA
|
mepivicaine
|
|
what is the longest duration LA
|
bupivacaine
|
|
are amides or esters more likely to cause an allergic reaction
|
esters
|
|
what is the most commonly used topical ester LA
|
benzocaine
|
|
epinephrine is an
|
vasoconstrictor
|
|
how long must one wait to use epinephrine to make sure not to increase the risk of hypertension and cardiac arrhythmias after the use of cocaine
|
twenty four hours
|
|
what ester produces the greatest vasodialtion of all LA
|
procaine
|
|
why is procaine not often used in dentistry today?
|
high rate of allergic reactions
|
|
what are people usually allergic to in procaine?
|
PABA
|
|
how much more potent and toxic is tetracaine compared to procaine
|
ten times
|
|
what is a topical anesthetic that is neither an ester nor an amide?
|
dyclonine
|
|
which LA has antitussive properties?
|
benzonatate
|
|
why are vasoconstricting agents included in LAs
|
prolongs action of LAs, increases depth of anesthesia to local area, makes toxicity less likely, produces hemostasis
|
|
what is the most common concentration of vasoconstrictors
|
1:100000
|
|
what concentration of vasoconstrictor would most likely be used if patient was bleeding profusely
|
1:50000
|
|
what is the safe dose for cardiac patients of epinephrine
|
0.04mg
|
|
what is the max. safe dose of epinephrine for healthy patient
|
0.2mg
|
|
which two anesthetic solutions are sold with or without vasoconstrictor because they have less vasodilating properties than other LAs
|
mepivocaine and prilocaine
|
|
what are the two most important drug interactions with epinephrine
|
tricyclic antidepressants
nonselective B-blockers |
|
what reaction may happen with combining epinephrine and nonselective B-blockers
|
may result in hypertension and reflex bradycardia
|
|
what reaction may happen with combining epinephrine and tricyclic antidepressants
|
may result in increase in blood pressure
|
|
what is slowness of the heart rate usually fewer than 60 beats per minute known as
|
bradycardia
|
|
duration of action of LA is usually related to what
|
its protein binding capacity not its half life
|
|
what determines the potency of a local anesthetic agent
|
lipid solubility
|
|
what two general factors will determine choice of anesthetic in a patient
|
duration of procedure and patient-specific information
|
|
mepivacaine and prilocaine can be used without a what
|
vasoconstrictor
|
|
which has the highest vasodilating effect lidocaine mepivacaine or prilocaine
|
lidocaine
|
|
lidocaine and bupivacaine produce too much vasodioation to be used without a what
|
vasoconstrictor
|
|
what is the reversal agent for residual soft-tissue anesthesia?
|
OraVerse- phentolamine mesylate
|
|
what is the downside to oraverse
|
cost
|
|
how much faster is recovery from anesthesia with oravers
|
cuts time in half
|
|
what kind of drug is oraverse
|
an adrenergic alpha-blocking drug and its vasodilating
|
|
what drug would be used in a cocaine overdose (MAOI crises)
|
Regitine (phentolamine)
|
|
what is the most commonly used topical anesthetic
|
benzocaine
|
|
what is the second most commonly used topical anesthetic
|
lidocaine
|
|
which LA is neither an ester nor an amide
|
Dyclonine
|
|
what is the topical needle free anesthetic placed in gingival sulcus
|
Oraqix half lidocaine half prilocaine (2.5%/2.5%)
|
|
what are some OD reactions to local anesthetics
|
decreased BP heart rate and respiratory rate, generalized CNS depression, and tonic-clonic seizures
|
|
the term used in general anesthesia to describe the quick change in the pt's state of consciousness from stage I to stage III
|
induction
|
|
the term in general anesthesia used to describe when the pt has achieved a depth of anesthesia sufficient to allow the surger to begin and ends upon completion of surgical procedure
|
maintenance
|
|
a term used in general anesthesia used when termination of surgical procedure and continues thorughout the postoperartive recovery period until pt is fully responsive to his or her environment
|
recovery
|
|
liquids that easily evaporate
|
volatile anesthetics
|
|
what are the most popular volatile liquids in use
|
enflurane and isoflurane
|
|
what ultrashort-acting barbiturate is also known as truth serum
|
thiopental (pentothal)
|
|
what are some serious adverse effects to Ultrashort-acting barbiturates?
|
bronchospasm and laryngospasm
|
|
when are Ultrashort-acting barbiturates contraindicated
|
in prphyria and status asthmaticus
|
|
what is it called when you abruptly discontinue nitrous oxide?
|
diffusion hypoxia
|
|
what can nitrous oxide cause in the pregnant patient?
|
spontaneous miscarriage
|
|
suffix for ultrashort-acting barbiturates
|
tal or lal
|
|
if repeagted dose of ultrashort-acting barbiturates are given where does the drug accumulate? Causing what?
|
in the body tissues resulting in prolonged recovery
|
|
what is the inspired concentration of the inhaled anesthetic required to induce surgical anesthesia in 50% of people known as ?
|
minimal alveolar concentration or MAC
|
|
MAC (minimal alveolar concentration) is used to compare the potency of
|
inhalational anesthetics
|
|
what is the primary part of dental office conscio0us sedation
|
nitrous oxide
|
|
what is the best indicator of sedation with nitrous oxide?
|
pt's response to questions
|
|
why is nitrous oxide contraindicated for the pregnant women (particulary in first trimester)
|
high incidence of spontaneous miscarriage
|
|
why is nitrous oxide contraindicated for the COPD pt
|
COPD depends on low O2 concentrations as primary stimulant for respirations. use of hgh oxygen dose cances out this system and can cause respiration to cease
|
|
what are the main contraindicators for nitrous oxide
|
COPD, Pregnancy, treatment with bleomycin sulfate
|
|
what vitamin does chronic use of nitrouss oxid interfere with and what does it cause
|
b12 and pernicious enemia
|
|
what is the most commonly used halogenated agent
|
isoflurane
|
|
suffix for halogenated hydrocarbons
|
ane
|
|
three examples of ultrashort-acting barbiturates
|
thiopental, methohexital, thiamylal
|
|
what is the drug unrelated to other general anesthetics used for day surgery that has a very high rapid onset makes pt feel better faster
|
propofol
|
|
what is the drug chemically related to phencyclidine also known as angel dust
|
ketamine
|
|
what drugs are related to general anesthetics and are given during induction phase and surgery to provide analgesia
|
opioid analgesics
|
|
what combination of drugs produces neuroleptoanalgesia which is a wakeful anesthetic state
|
droperidol plus fentanyl
|
|
which type of drugs are used as an integral pard of conscious sedation in general anesthetics
|
benzodiazepines
|
|
what are two muscle relaxants used with general anesthetics
|
succinylcholine and pipecuronium
|
|
what is mortality rate of malignant hyperthermia
|
fifty percent
|
|
what is malignant hyperthermia treated with
|
dantrolen sodium and a quick trip to intensive care.
|
|
nitrous oxide is used in dentistry as a what?
|
antianxiety agent
|
|
sedative hypnotic agents - depress _____
|
cns
|
|
what are the three groups of drugs classified as sedative-hypnotics
|
benzodiazepines, barbiturates, nonbenzodiazepines-nonbarbiturates
|
|
what is the most commonly used group of drugs classifed as sedative-hypnotics
|
BENZODIAZEPINES
|
|
benzodiazepines are named according to there what
|
structure
|
|
benzodiazepines are the most commonly used drugs to treat what
|
anxiety
|
|
what are the suffixes of benzodiazepines
|
azepam or azolam
|
|
which route is best for benzodiazepines
|
oral
|
|
which three benzodiazepines are metabolized by phase II glucuronidation only?
|
lorazepam, oxazepam, temazepam
|
|
this type of benzodiazepine metabolism involves oxidation, reduction, hydrolysis and is considered hard metabolism because it is affected by external factors
|
phase 1 metabolism
|
|
benzodiazepines bind to benzodiazepine receptors in the CNS and act as what
|
agonists
|
|
what inhibitory neurotransmittor does benzodiazepines act upon
|
GABA or y-aminobutyric acid
|
|
benzodiazepines and GABA allow what to flow into cell causing hyperplarization of the excitatory neurotransmitters which blocks their function and decreases excitation?
|
Chloride
|
|
diazepam's long half-,life and metabolism to an active metabolite prolongs its what
|
duration of action
|
|
where is the date rape drug available
|
europe
|
|
what is the most common side effect of benzodiazepines?
|
depression manifested as fatigue, drowsiness, muscle weakness, and ataxia. (as in depression of these things)
|
|
which benzodiazepine has an greater chance likelihood of anterograde amnesia in oral form
|
halcion
|
|
what benzodiazepine may cause thrombophlebitis because propylene glycol is used to solubulize it
|
parenteral diazepam
|
|
what benzodiazepine is soluble in water and less likely to cause thrombophlebitis
|
midazolam
|
|
which benzodiazepines are classified as x in pregnancy category
|
triazolam and temazepam
|
|
near term administration of the antianxiety agents temazepam and triazolam have resulted in what baby syndrome
|
floppy infant syndrome
|
|
true or false benzodiazepines have a wider therapeutic index then barbiturates
|
true
|
|
t or f barbiturates have a higher abuse potential then benzodiazepines
|
true
|
|
wide therapeutic index = wide range of
|
safe dose
|
|
the act of vomiting
|
emesis
|
|
what benzodiazepines are the drug of choice for epilepsy (seizures)
|
diazepam or lorazepam
|
|
what benzodiazepine is used in the dental office to allay apprehension
|
diazepam
|
|
parenteral benzodiazepines have been associated with what when used for conscious sedation
|
respiratory depression and arrest
|
|
valium =
|
diazepam
|
|
barbiturates are not used
|
intramuscularly
|
|
how do barbiturates produce their pharmocologic effect?
|
by enhancing GABA receptor binding
|
|
t or f barbiturates are a pain releaver
|
f
|
|
what is the main effect of barbiturates
|
cns depression
|
|
which barbiturates is controlled substance III
|
butabarbital
|
|
barbiturates are absolutely contraindicated in patients with what? why
|
Porphyria-a group of disorders involving heme biosynthesis.
barbiturates can stimulate and increase the synthesis of porphyrins which are already in excess with this disease |
|
barbiturates are stimulators of liver what
|
microsomal enzyme production
|
|
an increase of microsomal enzyme production can increase what and decrease what
|
rate of drug destruction
and decrease duration of action |
|
ultrashort-acting barbiturates are used intravenously for induction of what
|
general anesthesia
|
|
long-acting barbiturates are used for treatment of what?
|
epilepsy
|
|
what nonbenzodiazepine-nonbarbiturate sedative-hyupnotic is used in dentistry for preoperative sedation of children
|
chloral hydrate (Noctec)
|
|
what nonben-nonbarb sed-hyp is unique in structure and action and does not affect ability to drive
|
buspirone
|
|
what nonben-nonbarb sed-hyp does not produce tolerance or dependence and produces less CNS depression
|
buspirone
|
|
what is the latest group of drugs to treat insomnia?
|
nonben-ben receptor agonists
|
|
what are three nonben-ben receptor agonists and what do those do
|
zolpidem, zaleplon(sonata) and eszopiclone (lunesta)
make you sleep |
|
what has the longest half life of the non ben-ben receptor agonists?
|
eszopiclone (lunesta)
|
|
what nonben ben receptor agonists are rapid acting, less potent, shorter action compared to ambien (zolpidem
|
zaleplon (sonata)
|
|
what is an example of a melatonin receptor agonist and what does it treat
|
ramelteon (rozerem)
insomnia |
|
what condition is common with centrally acting muscle relaxants?
|
xerostomia
|
|
what is the the strongest and most sedating muscle relaxant
|
cyclobenzapine (flexeril)
|