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DATB > elm 11.1 > Flashcards

elm 11.1 Flashcards

1
Q

what is the most commonly used local anaesthetic?

A

lidocaine

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2
Q

local anaesthesia is what

A

analgesia of limited part of body. which the patient remains conscious

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3
Q

the first local anaesthetic was what

A

cocaine

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4
Q

close to the spinal cord, a spinal nerve divides into ____ and ___ branches

A

sensory
motor

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5
Q

dorsal root ganglion neurones differ from general neurone structure - their cell bodies have a single ___ that splits with one branch going to ____ and other into _____

A

axon
periphery
spinal cord

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6
Q

the peripheral axon terminal of nociceptors is a _______ that possesses reeptors for ________ stimuli (e.g. _________, and mediators such as __ and ____ that are released by damaged tissue)

A

bare nerve ending
noxious
high or low temp
H+
ATP

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7
Q

______ can also respond directly to mechanical stimuli

A

nociceptors

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8
Q

activation of receptors to noxious stimuli generates ______ that are transmitter from the ______ to the _______

A

action potentials
periphery
spinal cord

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9
Q

the generatino of action potential involves the acivation of ___ channels

A

NA+

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10
Q

the termination of action potential involves the inactvtion of ___ channnels and the delayed activation of ___ channels

A

na+
k+

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11
Q

local anaesthetics act by blocking ______ channels
local anaesthetics therefore block _______, and therefore block______

A

sodium
action potential
nociception

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12
Q

Voltage gated sodium channels - open when the membrane is__________

A

depolarized

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13
Q

all voltage gated sodium channels are _______ selective

A

cation

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14
Q

there are ____________ around mouth of voltage gated channels

A

rings of (negateive) charge

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15
Q

a hydration shell is what

A

ring of water molecules that positive or negative ion attracts

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16
Q

amide linked local anaesthetics are broken down in the __________

A

liver

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17
Q

Amine group means that local anaesthetics can become________ - gives them_____ charg

A

protonated
positive

18
Q

Charged and uncharged forms are in equilibrium and the amount of the protonated form present will depend on the [] of_______ - pH dependent

A

protons

19
Q

Lower the pH, the _____ local anaesthetics block sodium channels

A

Lower the pH, the less well local anaesthetics block sodium channels

20
Q

________- form of local anaesthetic binds to sodium channel

A

Uncharged

21
Q

________ form of local anaesthetic - acting from inside the cell - dugs has to first cross the cell membrane

A

Charged

22
Q

there are two possibilites examined using a compound called QX314 - has four groups on its nitrogen

A

permanent positive charge
does not block Na channeles when applied to outside of cells

23
Q

These experiments showed that local anaesthetics like lidocaine - _________ from the inside and that the charged form acts on the channel

A

block sodium channels

24
Q

Uncharged form is also important - necessary to allow the local anaesthetics to __________ - once inside, local anaesthetics become_________ again and it is the________ form that blocks the channel

A

pass through membrane
protonated
charged

25
Q

Sodium channels are blocked more strongly when they are in the __________ states - gives rise to phenomenon known as ‘__________’ - channels are more active are blocked more strongly than resting channels

A

open or inactivated
use dependence

26
Q

topical anaesthesia

A
  • Blocking the transmission of signals close to, or at the peripheral nerve terminal
    • Variation = EMLA (eutectic mixture of local anaesthetics)
    • Can be used for pain relief from minor conditions - sore throats, mouth ulcers, etc..
      Also be used in minor procedures or to reduce pain caused by insertion of hypodermic needle
27
Q

Infiltration anaesthesia

A
  • Injected into tissue around area that needs to be numbed - usually only affects more distal parts of the nerve - terminal branches
    • Important to avoid injecting into bloodstream - local anaesthetics have serious systemic effects
    • Possible to add vasoconstrictor such as adrenaline to injected local anaesthetic in order to prolong duration of anaesthesia
      Used for minor procedures - suturing a wound, or dentistry
28
Q

Nerve block

A
  • Anaesthetic is injected around spinal nerve trunk - everything distal to this point will be numbed
    • Vasoconstricting drugs - e.g. adrenaline - often added to injected anaesthetic in order to extend duration of anaesthesia
    • Needle is guided into place with the aid of ultrasound
      Gives better pain relief than infiltration or topical anaesthesia - allowed for complicated surgeries like knee replacements
29
Q

IV regional anaesthesia

A
  • Pressure cuff to cut off blood supply to limb - local anaesthetic is injected and then wait 20 min
    Wait time is important to allow anaesthesia to develop and reduce [] of local anaesthetic in blood vessels (avoids system toxicity)
30
Q

spinal anaesthesia

A
  • Local anaesthetic = injected into subarachnoid space just above spinal cord
    • Results in pain sensation being lost from all regions supplied by nerves that emerge from spinal cord below level of injection
    • Often used for surgery on lower body but can only be used in bottom part of spinal column - this is where subarachnoid space is large enough to avoid damage to spinal cord when placing the needle
    • Less versatile than epidural anaesthesia - also tends to produce more motor block than epidural
      Faster onset and less anaesthetic needed than epidural
31
Q

epidural anaesthesia

A
  • Local anaesthetic = injected into epidural space - just below vertebral column
    • Performed via a catheter - can be left in place to facilitate further doses being administered
    • Epidural space is larger volume than subarachnoid space - more anaesthetic is needed and the onset of anaesthesia is slower
    • Placement of epidural needle is easier than spinal needle and can be performed anywhere along spinal column
    • Used for analgesia alone - e.g. during childbirth
    • Or for treatment of chronic pain
    • Do not tend to affect motor function as much as spinal anaesthesia - advantage in childbirth
    • Common in procedures where it is desired to keep patient awake during surgery
      C-section
32
Q

IV lidocaine

A
  • Sometimes used as post-operative pain management strategy
    • Advantage is that it allows the use of opioids to be reduced
      Must be carefully monitored to make sure that they are not showing signs of local anaesthetic toxicity
33
Q

3 things of differential blockade

A

degree of myelination
fibre diameter
position with the nerve

34
Q

The cells that provide the insulation around A alpha fibres are the:
a. myocytes
b. Leydig cells
c. Schwann cells
d. oligodendrocytes

A

c
oligodendrocytes for CNS

35
Q

Select a local anaesthetic with an amide linker group:
a. cocaine
b. lidocaine
c. procaine
d. tetracaine

A

B

36
Q

The pH of inflammed tissue is frequently lowered. This means that local anaesthetics will be:
a. less protonated and thus less potent
b. less protonated and thus more potent
c. more protonated and thus less potent
d. more protonated and thus more potent

A

C

37
Q

Cocaine is no longer used for spinal anaesthesia due to its effects on the CNS. The psychotropic effects of cocaine on the CNS are due to:
a. activation of mu-opioid receptors
b. block of noradrenaline reuptake
c. block of sodium channels on excitatory neurones
d. block of sodium channels on inhibitory neurones

A

B

38
Q

Adrenaline is often added to local anaesthetic injections in order to:
a. keep the patient awake
b. maintain the patient’s heart rate
c. restrict blood flow to the area
d. increase the diffusion of local anaesthetic into the blood

A

c

39
Q

Which of the following types of local anaesthesia is most likely to produce block of motor function in a patient?
a. Infiltration
b. Spinal
c. Epidural
d. Topical

A

b

40
Q

Spinal nerve fibres show the following sensitivities to local anaesthetics
a. A delta > A alpha > B > C
b. B = C > A delta > A alpha
c. A delta > C = B > A alpha
d. C > B > A delta > A alpha

A

b

41
Q

A low dose of local anaesthetic entering the brain is likely to cause
a. coma
b. convulsions
c. long-lasting anaesthesia
d. pronounced loss of motor function

A

b

DATB (24 decks)

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