which of the following is a pure opioid antagonist
unlike chloral hydrate and barbiturates benzodiazepines bind/function at the receptor only in th epresence of ____________. this explains why barbiturates at high doses are lethal
GABA
what pain management drug should be avoided during breast feeding due ti infantile lethargy, difficulty feeding and death
codeine
which of the following is an analgesic most often used orally in conjuction with a non-narcotic analgesic
codeine (tylenol with codeine)
what is the most common place to get a positive aspiration
inferior alveolar nerve injuection
the target of the gow gates is the
intertragic notch of the ear on the side being anesthetized
what is a potential true emergency that can result from IV sedation if not properly administered
intra-arterial injection
which of the following is least likely to be used together iwth an NSAID or acetominophen in treating pain
ioperamide
nitrous oxide is contraindicated in the case of bowel obstruction because of what
it will diffuse into pocets of trapped gas and potentially rupture the intestine
common names for mandibular block
gow gates, intraoral v3
for patients hyperventilating what is the best thing to do
coach breathing, breath CO2 (paper bag)
what is the recommended maximum dosage fo epinephrin
0.2 mg
proper technique of administering a mental nerveblock
1/2 carpule inserted into the incisive fossa and massaged in
how much local anesthetic is there in a 1.8ml carpule if the local anesthetic concentration is 3%
162mg
how many carps of 2% lidocaine 1:100,000 epi can you give a 75 year patient whos med hx includes type II diabetes and a pacemaker inserted 2 years ago. (100kg)
2.2 carps
what is the maz foes of epinephrine for a healthy individueal
200ug
what is the proper size of needle for an IA block
25 gauge long
what needle shouldbe used for infraorbital blocks
25 gauge long
what is the mazimum dosage of lidocaine per appointment
2mg/lb or 8 carpules
the majority of the time the mental foramen of the mandible is normally found along the axis of the
2nd premoplar
the proper needle length for pdl injection
30 gauge short
which is not a proper needle choice for the post sup alveolard block
30 gauge short
how long is a 25g long needle
32mm
how much epinephrine in 2 cartrighes 2% lidocaine 1:100,000 epinephrine
36ug
what is the max epi for heart patients
40ug
what isthe daily limit of tylenol/acetominophen after which hepato toxicity is seen
4g/day
the patient complains of a watery itchy eyes and urticaria after using latex gloves on her what should you do
50mg benedryl and 50mg q6h x2-3days
ceiling effects of tylenol are such that additional dose will not increase the analgesia effects. what is the ceiling effective dose for tylenol
650-1000mg
true or false opioids act to decrease release of pain neurotransmitters like substance P and glutamate by allowing increased calcium into the cell presynaptically
False
v3 of the trigeminal passes through what foramen
foramen ovale
the TENS unit acts as an analgesic in two ways. Initially it blocks pain through the _______ mechanism. after a while it encourages the release of enkephalins and seotonin that acts to increase the pain threshold through central descending inhibition. therefore, encourage your patients to eat turkey before appointments to up their 5-hydroxy-tryptophan
Gate Control (inhibits pain perception in the thalamus)
gow gates anesthetizes what nerves
IA, lingual nerve, mylohyoid, long buccal
which of the follwoing is true 1. morphine 6-glucuronide has high affinity for the U opioid receptor 2. codein is more potent as an analgesic than morephine c. pentaxocine is a full agonist at the u opioid receptor d. B-endorphin is a synthetic drug similar in structure to morphine
Morphine 6-glucuronide has a high affinity for the U opioid receptor
which of the following have the best pain relief properties. NSAIDS, antihistamines, opioids, benzodiazepines
NSAIDS (ibuprofen is a great pain reliever)
combining two classes of drugs yeilds a greater analgesic effect than either alone. what two can be used together
NSAIDs and acetaminophen
what are the five steps (BLS) for a medical emergency
Position Airway Breathing Circulation Diagnosis
which of the folloing is a kappa opiod agonist
Talwin
which opiod receptor is the most associated with respiratory depression a. k b. u c. delta d. sigma
U
sodium bisulfite has which of these properties a. atioxidant b. present with vasopressors c. cross sensitivity with sulfa d. used in ester preparations without epinephrine e. preservative
a. antioxidant b. present with vasopressors c. corss sensitivity with sulfer e. preservative
which is the only injection where you place the needle with the bevel away from the bone
akinosi
all of the following are potential complications of exodontia except a. nerve injury b. sinus exposure dry socket, infection, bleeding
all of the above are complications
all of the following ar epotential complications of an IANB except what
all of the above are true (trismus, facial paralysis, hematoma, syncopal episodes)
a person begins to show hiveszuritica, itching/pruritis and swelling angioedema in the oral cavity one hour after you injected with procaine as a local anesthetic. what is the likely cause of this.
an allrgic reaction
stimulation by agonists at opioid receptors results in what
an increase in membrane potassium conductance
injection of a local anesthetic like lidocain into a tissue epzperiencing infection and a low ph would result in what effect on the drug
an increase in the proportion of the drug that is charged
all of the following are typical effects of morphine like opioids except what 1. constipation 2. histamine release 3. anticonvulsant 3. respiratory depression
anticonvulsant
which syringe has a harpoon
aspirating
in a properly administered gow gates block, the hub of the needle will be where
at the distopalatal aspect of the maxillary 2nd molar
in addition to being a u opioid receptor agonist what other pharmacological effect of tramadol (ultram) is thought to mediate analgesic effects
block reuptake of norepinephrine and serotonin in dorsal horn
tolerance develops to some of the effects of opioids given chronically, to which effect does tolerance develop the least if at all. a. analgesia c. miosis (pinpoint pupils) b. sedation d. respiratory depression
c. miosis pinpoint pupils (tolerance also does not develop to constipation and convultions)
trigeminal neuralgia is most successfully treated in most patients with which of the following
carbamazepine
if youre patient has an allergy to sodium bisulfite what should be altered about the way you treat them. what can be given instead
carbocaine (contains bisulfite to preserve the epi)
a severe allergic rxn including wheezing nausea cramping and hypotensions/dizziness insues, what shoul dyou do for your patient
check for ABCs and call 911, admminiseter 0.3mg epinephrine, O2, fluids, and benedryl
epinepherine is added to anesthetics to do what
decrease the toxic effects of th edrug
which of the following is an antitussive with no agonist
dextromthorphan
sensory nerves from the skin in the abdominal area synapse directly with other nerves at what location
dorsal horn of spinal cord
all of the following have anesthetic effect except what
epinephrine
systemic manifestations of overdose of local anesthetic include all of the following except
excitable agitated or irritated
true or false itis not safe to use oral sedationon cardiovascular patients
false
true or false overdosese of local anethetic can cause hypertension in most individuals
false
true or false, recapping can only be accomplished with the scoop technique
false
which of the following analgesics is most potent and is sometimes supplied in a topical patch for analgesia
fentanyl
if a patient gets nauseated with narcotics what alternative could we prescribe for post-op pain
fiorinal
what is the reversal drug that can be given in the case of benzodiazepine oral sedation overdose
flumazenil
if a patinet is pregnant and is pre-syncope what should you do
lay them left lateral
which of the following is an amide
lidocaine
what best describes the mechanismof local anesthetics at the sodium channel
local anesthetics bind to and stabilize the inactivated state of the receptor
besides the inferior alveolar nerve what nerve should you anesthetize when extracting posterior mandibular teeth
long buccal
the pdl injection i smost appropriate for which teeth
mandibular teeth
syncope is more common in which gender
men
which of the following roots as listed in class may be inervated by the PSA or MSA nerve
mesiobuccal root of the maxillary first molar
which of the following is an endogenous opioid natural to the body
met-enkephalin
withdrawal in a person physically dependent on heroin will occur when one administers each of the following except a. naloxone b. methadone c. pentazocine d. buprenorphine
methadone (all dugs iwth naloxone will cause withdrawal)
benzocaine if given in too high of dose in mucous membranes can cause
methemoglobinemia
which of the following is absorbed from the GI tract in the lowest percentage codein oxycodone morphine pentazocine
morphine
centrally acting muscle relaxants are sometimes useful in treating what type of pain.
myofascial pain dysfunction
what drug can be used in the case of reversal of narcotics
naloxone
which of the following is a pure opioid antagonist
naloxone
carbamazepine is most useful for treating what type of pain
neuropathic pain
which of the following statements is false 1. opiod-mediated pain releaf is both presynaptic and post synaptic. 2. kappa opioid receptor stimulation tends to cause dysphoria. 3. opioids increase propolsive tone in the GI tract 4. opioids tend to cause histamine release
opioids increase propolsive tone in the gi
all of the following are advantages of oral sedation except
predictable druge effects
you nicked a vessel during an IANB and the patient has intraoral swelling and redness what should you do
pressure and ice
which of the following anesthetics is an ester
procaine
what is the bony landmark for the gow gates
pterygoid fovea
what is th efirst thing you should do when a patient is looking pale sweating and figety, saying I don't feel well
put the patient supine with the thighs up, possibly O2
you inject into the parotid giving an IANB the patient has anesthesia of VII what should you do
remove contact and tape the eye closed
mortality and morbidity associated with concious sedation is usually the result of unrecognized what
respiratory depression
what is the key to painless injection
slow injections
what is the disadvantage of a gow gates block
slow onset of action
the most common cause of allergic reactions is
sodium bisulfate
what drug can be used if the coval cords start to laryngospasm along with pharyngeal suction
succinylcholine
the most common medical emergency encoutered with local anesthetic is what
syncope
what aprt of the dental syringe is used for aspiration
the harpoon
lidocain inhibits nerve conduction by binding to what
the ion channel
which fo the following is false concerning components of a dental cartridge
the latex diaphragm should never be used for patients with latex allergies
in an infiltration blockthe bevel of the needle should be facing away or toward the bone
toward the bone
true or false hypnosis capitalizes on hypersuggestibility and gives suggestions to achieve a goal
true
true or false it is important to use pulse oximetry at all times during concious sedation
true
tylenol with codein is prescribed with varying increments of codein what would be dose that would give you a ceiling effect if the patient took two capsules
tylenol #3 (3omg codein with 300mg apap)
all of the following are potential locations for starting an IV except
ventral wrist
hyperventilation is more common in women or men
women