Pain management Quiz 3 EVERYTHING

Limiting drug

which drug (LA or Vaso) reaches the MRD first, 99% of the time, its the LA in healthy patients and vasoconstrictor in compromised patients

Absolute MRD

MRD regardless of weight and calculations

Tricyclic antidepressants

severe depression meds, avoid levonordefrin and epinephrine (VC)

Cardiac dose

2 cartridges

Nonselective beta blockers/digitalis

med to lower bp, vasoconstrictors cause hypertension and bradycardia, cardiac dose (VC)

Psychotic disorder drug

phenothiazide, two carts (VC)

Illegal drugs

cocaine, meth, absolute contraindication for vasoconstrictors (VC)

Diabetes

cardiac dose if uncontrolled (VC)

Cardiovascular disease

ASA III use two cartridges, ASA IV no vasoconstrictor (absolute) (VC)

ASA IV patients

these patients should not receive elective dental procedures OR vasoconstrictors until their disease is controlled (VC)

Hyperthyroidism

sensitive to catecholamines, uncontrolled no vasoconstrictor, controlled do cardiac dose (VC)

Asthma

up to 10% of patients have an allergy to bisulfate which will cause an attack (VC)

is this right?

Sickle cell anemia, pregnancy, and asthma

requires medical clearance (VC)

Sulfonamide antibiotic drugs

do not use topical esthers, it will deactivate this medication

Atypical plasma cholinesterase

these patients cant metabolize esthers, use amides instead

Beta/histamine blockers

impact on breakdown of lidocaine in lover, use caution with large doses (AM)

Malignant hyperthermia

avoid general anesthesia drugs, medical clearance required (AM)

Methemoglobemia

relative contraindication to prilocaine, perhaps benzocaine (AM)

Liver disease

use prilocaine or articaine instead (AM)

Kidney disease

for pts with significant renal dysfunction, use minimum effective dose (AM)

Pregnancy

medical clearance even tho fr its fine. 2nd trimester is best (AM)

Bleeding disorders

avoid nerve blocks, use infiltration only

Systemic complication definition

less common than local complications, usually caused by high plasma concentrations in LA or excessive dose, involve CNS, cardio, and immune system

90%

percent of life threatening reactions to LA that could be prevented by RDH doing good job

Local anesthetic overdose cause

health problems, gave too much, injected into a blood vessel

Impact of LA overdose

convulsion, unconscious, coma, respiratory, depression, and cardiovascular depression

Signs of LA overdose

chest pain, sweating, fainting, SOB (make sure they're breathing)

Epinephrine overdose cause

cardiovascular disease, high concentration, didnt aspirate

Epinephrine overdose response

only lasts 5 to 10 minutes, no tx in healthy patients

Management of allergic reactions

sudden reactions are bad, use epipen. If reaction takes 60 mins, use benadryl

How to prevent overdoses

aspirate, check med history, stay under maximum recommended dose

Local anesthetic system toxicity (LAST)

starts as excitation (increased heart rate and BP), then depression (vasodilation and fall in BP) then bradycardia and cardiac arrest (THIS IS KIDS)

Child injections

short needle, supraperiostial is most effective because of low bone density

AMSA Block

numbs all max teeth in one quadrant, commonly used for cosmetics, but not adequate for dental hygiene purposes

Nasopalatine

numbs soft tissue from canine to canine, (this one hurt), inject lateral to incisive papilla NO TEETH

Greater palatine block

numbs premolar/molar soft tissue and hard palate in one quadrant, NO TEETH, apply pressure with cotton swab on hard palate only

Incisive nerve block

numbs teeth, periodontium, and facial soft tissue anterior to premolars. Inject anterior to mental foramen at depth of mucobuccal fold, massage the tissue to force solution into mental foramen to get the teeth!

Mental block tee hee

numbs lower lip and chin to midline as well as facial gingival tissue anterior to mental foramen (no teeth)

Incisive vs Mental

Incisive requires the tissue be massaged in order to anesthetize teeth, Mental is literally exactly the same but you don't massage. Same injection site and angle

Inferior alveolar block (IA)

most commonly used injection in dentistry, numbs so much stuff. 1 quad of teeth, 1 quad of lingual tissue, 1 quad of buccal tissue except mand molars

IA complications

15 to 20% failure rate, can cause lingual shock

Buccal block

numbs cheek and buccal gingival tissue, administered immediately after IA (bit your cheek). Inject buccal/distal to last molar at height of occlusal plane, make sure not to poke your thumb