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Roomies Collab Deck 3: Surgery, Anesthesiology, Pain, and Urology > Anesethetics (Local) > Flashcards

Anesethetics (Local) Flashcards

1
Q

Local anaesthetic drugs act by causing a _____________ to ____________.

A

reversible block

conduction along nerve fibres

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2
Q

What are the different types of local anesthetic?(7)

A
  1. Topical (surface)
  2. Infiltration
  3. Peripheral nerve block
  4. Intravenous regional anesthesia (Bier’s block)
  5. Plexus block
  6. Epidural (extradural)
  7. Spinal block (intrathecal or subarachnoid
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3
Q

Local anaesthetics may also be used for ____________ pain relief, thereby reducing the need for ____________

A

postoperative

analgesics (such as opioids)

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4
Q

_________________ has a longer duration of action than other local anaesthetics

A

Bupivacaine hydrochloride

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5
Q

_______________ (local anesthetic) has a slow onset of action, taking up to 30 minutes for full effect

A

Bupivacaine hydrochloride

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6
Q

__________________ (local anesthetic) is often used in lumbar epidural blockade and is particularly suitable for continuous epidural analgesia in labour, or for postoperative pain relief

A

Bupivacaine

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7
Q

Bupivacaine is often used in _____________ blockade and is particularly suitable for continuous _______________ in _________, or for ___________ pain relief

A

lumbar epidural

epidural analgesia

labour

postoperative

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8
Q

_______________ is the principal drug used for spinal anaesthesia

A

Bupivacaine

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9
Q

Levobupivacaine is an ___________ of bupivacaine

A

isomer

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10
Q

Levobupivacaine, an isomer of bupivacaine, has _______________ and _____________ properties similar to bupivacaine hydrochloride, but is thought to have fewer ____________ effects.

A

anaesthetic

analgesic

adverse

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11
Q

Lidocaine hydrochloride is effectively absorbed from ______________ and is a useful __________ anaesthetic in concentrations up to 10%.

A

mucous membranes

surface

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12
Q

Except for surface anaesthesia and dental anaesthesia, lidocaine solutions should not usually exceed ____% in strength.

A

1

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13
Q

The duration of the block generated by lidocaine (with adrenaline/epinephrine) is about ________ minutes.

A

90

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14
Q

______________ is a local anaesthetic of low toxicity which is similar to lidocaine hydrochloride.

A

Prilocaine hydrochloride

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15
Q

_______________ is an amide-type local anaesthetic agent similar to bupivacaine hydrochloride

A

Ropivacaine hydrochloride

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16
Q

Ropivacaine hydrochloride is less ___________ than bupivacaine hydrochloride, but also less ___________.

A

cardiotoxic

potent

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17
Q

___________ is rapidly absorbed from mucous membranes and should never be applied to inflamed, traumatized, or highly vascular surfaces

A

Tetracaine

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18
Q

Tetracaine should never be used to provide anesthesia for ____________ or _____________ because lidocaine is a safer alternative

A

Bronchoscopy

Cystoscopy

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19
Q

The dose of local anaesthetic depends on the __________ and the ____________ used.

A

injection site

procedure

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20
Q

In determining the safe dosage of local anesthetic, it is important to take account of the rate of __________ and _________, and of the __________. The patient’s ___________, ___________, __________, and ____________, and the ___________ of the administration site and the duration of administration, must also be considered.

A

absorption

excretion

potency

age

weight

physique

clinical condition

vascularity

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21
Q

Uptake of local anaesthetics into the systemic circulation determines their ____________ and produces ___________.

A

duration of action

toxicity

22
Q

Uptake of local anaesthetics into the _____________ determines their duration of action and produces toxicity.

A

systemic circulation

23
Q

NHS Improvement has advised (September 2016) that, prior to administration, all injectable medicines must be __________________ and should never be ______________.

A

drawn directly from their original ampoule or container into a syringe

decanted into gallipots or open containers

  • This is to avoid the risk of medicines being confused with other substances, e.g. skin disinfectants, and to reduce the risk of contamination.
24
Q

Great care must be taken to avoid accidental ______________; local anaesthetic injections should be given slowly in order to detect inadvertent ______________ administration.

A

intravascular injection

intravascular

25
Q

When prolonged analgesia is required, a ___________ local anaesthetic is preferred to minimise the likelihood of _____________

A

long-acting

cumulative systemic toxicity

26
Q

Local anaesthesia around the oral cavity may impair ___________ and therefore increases the risk of ___________.

A

swallowing

aspiration

27
Q

____________ (local anesthesia) anaesthesia is commonly used during surgery, often combined with general anaesthesia, because of its protective effect against the stress response of surgery. It is often used when good postoperative pain relief is essential

A

Epidural

28
Q

Local anaesthetics cause _____________ of blood vessels. The addition of a _____________ such as ______________ to the local anaesthetic preparation diminishes local blood flow, slowing the rate of absorption and thereby prolonging the anaesthetic effect.

A

dilatation

vasoconstrictor

adrenaline/epinephrine

29
Q

Local anaesthetics cause dilatation of blood vessels. The addition of a vasoconstrictor such as adrenaline/epinephrine to the local anaesthetic preparation diminishes _____________, slowing the rate of _____________ and thereby prolonging the anaesthetic effect.

A

local blood flow

absorption

30
Q

It is not advisable to give adrenaline/epinephrine with a local anaesthetic injection in __________ or ___________ because of the risk of ischaemic necrosis.

A

digits

appendages

31
Q

Adrenaline/epinephrine must be used in a __________ (high/low) concentration when administered with a local anaesthetic

A

Low

32
Q

In patients with severe ____________ or _____________, the use of adrenaline/epinephrine with a local anaesthetic may be hazardous. For these patients an anaesthetic without adrenaline/epinephrine should be used.

A

hypertension

unstable cardiac rhythm

33
Q

_______________ (local anesthetic agent) is widely used in dental procedures

A

Lidocaine hydrochloride; most often used in combination with adrenaline

34
Q

The amide-type local anaesthetics _________ and ___________ are also used in dentistry

A

articaine

mepivacaine

35
Q

In patients with severe hypertension or unstable cardiac rhythm, mepivacaine hydrochloride without _________________ may be used.

A

adrenaline/epinephrine

36
Q

Felypressin can cause __________________ when used at high doses

A

coronary vasoconstriction; limit dose in patients with coronary artery disease

37
Q

What is severe local anesthetic-induced CV toxicity?

A

After injection of a bolus of local anesthetic, toxicity may develop at any time in the following hour

This may involve cardiac toxicity, arrhythmias, and arrest, of which hypotension and braycardia are often the first signs

38
Q

In the event of local anaesthetic-induced cardiac arrest, ______________ should be initiated immediately. __________ must not be used as anti-arrhythmic therapy.

A

standard cardiopulmonary resuscitation

Lidocaine

39
Q

In cases of local anesthetic-induced cardiac arrest that do not respond rapidly to standard procedures, _______________ should be administered

A

Lipid emulsion (20%)

*standard CPR must be maintained throughout lipid emulsion treatment; propofol is not a suitable alternative to lipid emulsion

40
Q

How is dose calculated for bupivacaine admisinstration?

A

Should be calculated based on ideal body-weight

41
Q

What are the contraindications to bupivacaine? (4)

A
  1. Injection into infected tissue
  2. Injection into inflamed tissues
  3. Intravenous regional anesthesia
  4. Preparations containing preservatives should not be used for caudal, epidural, or spinal block
42
Q

What are the common or very common side effects of bupivacaine? (6)

A
  1. Arrhythmias
  2. Dizziness
  3. Hypertension or hypotension
  4. N/V
  5. Paresthesias
  6. Urinary retention
43
Q

Toxic effects after administration of local anaesthetics are a result of ____________; severe toxicity usually results from ____________.

A

excessively high plasma concentrations

inadvertent intravascular injection

44
Q

The systemic toxicity of local anaesthetics mainly involves the ____________ and ___________ systems.

A

central nervous

cardiovascular

45
Q

The onset of toxicity from local anesthetics can be _______________. Monitor as per local protocol for at least ________ minutes after administration.

A

unpredictable and delayed

30

46
Q

Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as __________; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine.

A

tetracaine

47
Q

Large doses of bupivacaine during delivery can cause ____________, __________, and ___________ after epidural block.

A

neonatal respiratory depression

hypotonia

bradycardia

48
Q

Is bupivacaine safe to administer to patients with hepatic and/or renal impairment?

A

Use caution in advanced disease

49
Q

What are the contraindications to IV lidocaine? (3)

A
  1. All grades of AV block
  2. Severe myocardial depression
  3. SA disorders
50
Q

Which drug interactions should be avoided when prescribing lidocaine?

A

Avoid coprescription with beta blockers due to increased risk of CV adverse effects

Roomies Collab Deck 3: Surgery, Anesthesiology, Pain, and Urology (12 decks)

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