Assessment task 1 Flashcards

1
Q

commonly used local anesthetics

max doses

A

1 Lidocaine hydrochloride 1%

  • non proprietary - (no trade name)
  • 10 mg/ml
  • Rapid onset
  • duration: 1,5 hours
  • max dose 200 mg - 20 ml of 1% solution

2 Bupivacaine hydrochloride, Levobupivacaine similar

  • Marcaine, Chirocaine
  • 2,5 mg/ml or 5mg/ml
  • slow onset
  • Duration 4-6 hours
  • max dose 150 mg - 30ml of 0,5% solution

3 Procaine hydrochloride 2%

  • nonproprietary
  • 20 mg/ml
  • Moderate rate of onset
  • duration 30 min
  • max dose 1g - 200ml od 0,5% solution
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2
Q

commonly used

A

1 Hydrocortisone acetate

  • Hydrocortistab
  • 25mg/ml - 1ml ampoule
  • potency 1
  • least prolonged

2 Prednisolone acetate

  • Deltastab
  • 40mg/ml - 1ml ampoule
  • potency 4
  • second least prolonged

3 Methylprednisolone acetate

  • Depomedrone
  • 40mg/ml 1,2 and 3 ml vials
  • potency 5
  • most prolonged

4 Triamcinalone acetonide

  • Adcortyl
  • 10mg/ml - 1ml ampoules
  • potency 1
  • second most prolonged

5 Triamcinalone acetonide

  • Kenalog
  • 40mg/ml - 1ml vials
  • potency 5
  • second most prolonged
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3
Q
A
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4
Q

LA actions

A
  • systemic absorption after intraarticular or intralesional injection is slow/small
  • produce a reversible abolition of nerve conduction
  • small diameter, nonmyelinated fibres most easily blocked - nociceptors and sympathetic
  • order of blockade:
    • pain
    • temperature
    • touch
    • proprioception
    • motor
  • Duration varies with type of LA
  • penetrates nerve sheath in non-ionised (lipophilic) form
  • once inside cell, some molecules become ionised and then block sodium channels in cell membrane by binding to receptor site within channel
  • opening and closing of sodium channels is required for depolarisation and repolarisation for initiation and transmission of impulses
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5
Q
A
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6
Q

Corticosteroids

actions

A
  • All aspects of inflammatory response depressed
    • acute (reduced pain, heat, redness, swelling)
    • chronic (proliferation and modelling affected)
  • Not suitable for acute inflammation
    • protective aspects inhibited
    • delay in fibre formation
    • some exceptions (bursitis)
  • chronic inflamatory phase - the balance of collagen synthesis is interrupted with inflammation and proliferation continuing side by side. Corticosteroid can be beneficial in reducing/abolishing the low grade inflammatory component.
  • The unwanted effect on collagen synthesis in the proliferation and remodelling phase is disrupted in:
    • topical steroids
    • long term large doses suppress collagen
    • intermittent doses - no effect
    • intralesional corticosteroids
    • keloid regression - inhibition of fibroblast activity
    • decreased collagen synthesis
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7
Q

LA

side effects

A
  • CNS
  • Cardiovascular
  • Allergic
  • Type A reactions
  • Type B reactions
  • Contraindications
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8
Q

corticosteroids

side effects

local

A
  • Post injection flare, transient post injection pain 12-24 hours
  • subcutaneous fat atrophy
  • skin depigmentation (use hydrocortisone)
  • infection (1:14.000-50.000) (complication of procedure)
    • poor technique
    • adjacent infections
    • haematogenous spread
    • previous trauma
    • contaminated
  • Tendon weakening/rupture
  • steroid atrophathy
    • more from oral steroids
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9
Q
A
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10
Q

corticosteroids side effects systemic

A
  • Flushing
  • Impaired diabetic control
  • Mood changes
  • Menstrual disturbance

With repeated high doses:

  • immunosuppression
  • Hypothalamic-pituitary-adrenal axis(HPA-axis) suppression
  • Iatrogenic Cushing´s syndrome

Allergic reactions & anaphylaxis (more with LA)

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11
Q

Routes of elimination

A

Renal - mainly for smaller molecules

  • most common route
  • usually simple filtration
  • more reabsorption from tubules if lipid soluble
  • some drugs actively excreted by tubules
  • effects of age - decreased renal function (>65)

Biliary - mainly larger molecules

  • Concentrated in bile => bowel
  • may be reabsorbed - entero hepatic circulation

Other routes

  • lungs
  • sweat
  • tears
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12
Q

LA Indications

A

Usually used in combination with steroid in MSM

  • to give pain relief during and after an injection
  • to increase volume of injection
  • to distribute steroid
  • maybe distension effect

diagnostic use

  • re-examine after injection to see if signs reduced or abolished
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13
Q

Corticosteroid indications

A
  • Arthritis - especially inflammatory
  • Capsulitis
  • Bursitis
  • Tenosynovitis
    • Tendinosis
      • mechanism of action:
      • element of low grade inflammation
      • pain relief - allows more normal use and other therapies
      • collagen effects
    • Trigger finger
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