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74 Cards in this Set

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esters
ex: procaine, benzocaine, tetricaine; metab by psudocholinesterase in plasma/liver -> risk of allergy; resulting metabs are inactive
amides
ex: lidocaine; metab in liver; needs hydroxylation and dealkylation; early metabs are active -> higher toxicity risk; delayed allergic rxn
LA working on Na channels
work on alpha subunit; non-covalently binds to AAs on S6 segment -> interferes w/ S4 fxn
S4 segment
lots of lys and arg residues -> positively charged; M gate
bupivicaine
very lipid soluble -> very long acting -> don't use on kids; example of phasic block
felypressin
vasoC that acts like ADH; targets the venous side (others target arterial side)
epi/NE on alpha adrenergics
epi acts on alpha 2 in periphery; NE acts on alpha 1 along symp NS
R activation: epi
activates alpha 1,2 and beta 1,2; B2 causes bronchodilation and periph vasodilation -> no change in BP from local vasoC (alpha2)
R activation: NE
does not activate B2 -> increase BP
R activation: levonordefrin
moderate binding to a1 and B2 Rs -> moderate effect on BP
non-toxic IV range for epi
0.06-0.24 ug/kg-min
4% articaine w/ 1:100 epi
no active metabs; very fast acting; side effect: methemoglobinemia (also associated w/ prilocaine)
2% lido plain
soft tissue infiltration only (e.g. for cysts)
3% mepi plain and 4% prilo plain
no vasoCs but have high efficacies; short duration of action; 3% mepi has high risk of OD in children
0.5% bupivicaine w/ 1:200 epi
very long duration of action; NOT for supraperiosteal injections for pulp of maxillary
2% lido w/ 1:50 epi
only for surgical hemostasis (more vasoC -> decreased bleeding)
general dosage detemrination
0.5 cart per 10 lbs up to 7 cartidges
precise dosage determination
Xcart = (Dmax•Wtkg)/(Canes•1.8mL/cart)
dosage determination values for lidocaine
C= 20 mg/ml (from 2%); D(max)=7mg/kg; D(tot)=500 mg
bacterial endocarditis
antibiotic prophy before PDL injections or intraosseous injections
HTN, hyperthyroidism, atherosclerotic heart disease
minimise vasoC use
hemophiliacs
minimise nerve blocks to avoid artery dmg
pregnancy
avoid mepi, bupi, arti
liver damge
use articaine for jaundiced pts bc its metabolism is not affected
tricyclic antidepressants/SSRIs
blocks reuptake of catecholamines; limit epi dose to 1/3; avoid levonordefrin
nonselective beta blockers
blocks periph vasodilation -> BP increaes; give 1/2 cart L+E -> monitor BP
COMT inhibitors/adrenergic neuron blockers
potential increased effect of vasoC -> use LA cautiously and monitor HR/BP
adverse effects: hematoma
most common w/ PSA block; only arteries cause hematomas
adverse effects: paresthesia
most common w/ IAN block -> avoid using 4% slns in IAN block to avoid permanent dmg
V1 symp/para
para: ciliary ganglion -> pupil constriction; symp: superior cervical plexus
V2 infraorbital n.
gives off MSA (when present) and ASA
V2 MSA (when present)
premolars + MB root of 3/14
V2 ASA
3 anterior teeth
V2 PSA
maxillary molars except MB root of 3/14
V2 pterygopalatine trunks
PPG -> gives off PSN (which gives off nasopalatine), greater and lesser palatine
V2 nasopalatine
from nasopalatine; thru incisive foramen; supplies gingiva or anterior palate; can supply ant teeth
V2 greater palatine
supplies hard palate up to canines + part of soft palate
V2 lesser palatine
supplies soft palate
V2 para fibers
from CN VII via greater superficial petrosal -> goes to lacrimal and other glands
V2 symp fibers
from ICA via deep petrosal n. -> vascular resistance
ideal injection rate
1 cartridge (2 mL) per minute or slower
V2 exits cranium via…
foramen rotundum
V3 exits cranium via
foramen ovale
V3 anterior root
gives off motor ns. then gives off buccal n.
V3 buccal n.
sensory n. of anterior root; supplies buccal mucosa and buccal gingiva of posteriors
V3 posterior root
gives off lingual n. and IAN, which gives off mylohyoid, mental and incisive ns.
V3 lingual n.
para and taste fibers from chorda tympany (CN VII); supplies lingual mucosa, anterior 2/3 of tongue and mucosa of floor of mouth
V3 IAN relationship to lingual n.
IAN runs posterior and lateral to lingual n.
V3 IAN
enters mandibular canal to supply all mandibular teeth
V3 mylohyoid
motor going to ant digastric belly and mylohyoid; sensory going to skin over chin
V3 mental n.
exits mental foramen; supplies lip, labial gingiva of incisors
V3 incisive n.
supplies mandibular anterior teeth
V3 otic ganglion
para from lesser superficial petrosal (CN IX) -> supplies parotid gland
V3 submandibular ganglion
para from chorda tympani (CN VII) via lingual; para and symp supply sublingual/submandibular glands
taste regions
ant 2/3: CN VII via chorda tympani; post 1/3: CN IX; epiglottis: CN X
most common reason for LA failure
IAN injection w/ needle too low or too medial
supplementary injections
short duration (single tooth): PDL, IO; long duration (multiple teeth): gow-gates, akinosi
hot tooth -> swith LA to…
5% lido or 4% articaine
IO (stabident) injeciton site
distal to tooth of interest, 2 mm below gingival margins; avoid midline and mental foramen
AMSA injection
b/w premolars and b/w midline and gingiva; anesthetizes palatal mucosa (not premolars)
P-ASA injection
inject into nasopalatine canal at anterior palate; anesthetizes anterior teeth w/o affecting lip
ASA injection: site? Volume?
apex of canine; 1-1.5 mL
MSA injection: site? Volume?
adjacent to 2nd premolar; 1-1.5 mL
PSA block: site? depth? Volume?
ht of vestibule, distal to zygomatic process (up, in, backwards); 1.5 cm (.5 of long needle); 1-1.8 mL
PSA hematomas
to lateral -> pterygoid venous plexus; to anterior -> PSA artery
infraorbital block: blocks? Site? depth? Volume?
midline to premolars; infraorbital foramen adj to 2nd premolar; 1.5 cm; 1 mL
nasopalatine block: site? depth? Volume?
laterally at edge of incisive papilla; 3-5 mm; 0.2-0.3 mL
greater palatine block: site? depth? Volume?
anterior to gr. palatine foramen (3-4 mm anteiror to palate/alveolar process jxn); 5mm; .25-.5 mL
maxillary nerve block: 2 approaches? depth? Volume?
high tuberosity approach, pterygopalatine canal via gr palatine foramen approach; 2.5-3 cm (entire needle); 1-2 cartidges
mental/incisive block: blocks? Technique?
midline to premolars; target mental foramen, which is below apex of 2nd premolar; insert 1 cm lateral of tooth surface and distal to foramen; advance needle 1cm inferiorly and medially
buccal block: technique? depth? Volume?
insert lateral and distal to last molar @ occusal plane level; 2-3 mm; 0.5 mL
IAN: blocks? technique? depth? Volume?
everything except post buccal gingiva and cheek; thumb on cornoid notch, bisect thumb, lateral to raphe, needle coming from opposite premolar; 2-2.5 cm (hits bone); 1-1.5 mL, w/draw needle 1/2 way, inject rest
gow gates: blocks? Technique? depth? Volume?
IAN area+buccal nerve+maybe auriculotemporal; insert distal to max 2nd molar @ level of ML cusp, come from opposite corner of mouth, aim for intertragic notch; 2.5 cm (hits condyle neck); full cartridge
closed mouth: blocks? Technique? Depth? Volume?
similar to area of GG block; into maxillary vestibule parallel to occusal plane at level of mucogingival jxn; insert to the hub; full cartridge