9) Local Anesthetics

Question 1

What is the class for Ester anesthetic

Answer 1

Ester

Question 2

What is the mechanism for Ester anesthetic

Answer 2

Nonionized form crosses axonal membrane; ionized form (active form) blocks intracellular portion of inactive (refractory) voltage-gated sodium channel

Question 3

What are the therapeutics for Ester anesthetic

Answer 3

Local anesthesia

Question 4

What are the important side effects for Ester anesthetic

Answer 4

Local: transient neurologic symptoms (basically, really bad pain), neuronal injury. Systemic (more common with long-acting local anesthetics): CNS (early excitation: decreased inhibition, sensory disturbances, restlessness, tremor, tinnitus; later depression: lethargy, hypotension, seizures), cardiovascular (reduced conductivity, excitability, and contractility; arrhythmias (QRS widening an early sign); indirect vasodilation and bradycardia.

Question 5

What are the other side effects for Ester anesthetic

Answer 5

Methemoglobinemia (primarily with benzocaine and prilocaine)

Question 6

What are the miscellaneous for Ester anesthetic

Answer 6

Cocaine, procaine, benzocaine more likely to have allergic reaction than amides due to containing PABA derivitives; used less frequently than amides; metabolized by plasma esterases

Question 7

What is the class for Amide anesthetic

Answer 7

Amide

Question 8

What is the mechanism for Amide anesthetic

Answer 8

Nonionized form crosses axonal membrane; ionized form (active form) blocks intracellular portion of inactive (refractory) voltage-gated sodium channel

Question 9

What are the therapeutics for Amide anesthetic

Answer 9

Local anesthesia

Question 10

What are the important side effects for Amide anesthetic

Answer 10

Local: transient neurologic symptoms (basically, really bad pain); neuronal injury Systemic (more common with long-acting local anesthetics): CNS (early excitation: decreased inhibition, sensory disturbances, restlessness, tremor, tinnitus; later depression: lethargy, hypotension, seizures); cardiovascular (reduced conductivity, excitability, and contractility; arrhythmias (QRS widening an early sign); indirect vasodilation and bradycardia

Question 11

What are the other side effects for Amide anesthetic

Answer 11

Methemoglobinemia (primarily with benzocaine and prilocaine)

Question 12

What are the miscellaneous for Amide anesthetic

Answer 12

Lidocaine, mepivicaine, bupivicaine, etidocaine, prilocaine, ropivicaine, dibucaine (names have 2 or more “i”s; metabolized in liver, cleared by kidneys