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Pharm > Exam 2 LA and general > Flashcards

Exam 2 LA and general Flashcards

1
Q

amides or esters better for LA?

A

amides - less allergenic, better tissue penetration and longer duration of action

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2
Q

which local anesthetic has the longest duration of action?

A

bupivacaine (Marcaine)

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3
Q

Islidocaine or procaine an amide or ester?

A 
lidocaine = amide
procaine = ester
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4
Q

what part of LA is hydrophilic or hydrophobic?

A 
hydrophillic = amino group
hydrophobic = aromatic nucleus (lipophilic)
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5
Q

why a decreased effect of LA if injected into an inflamed tissue?

A

LA is weak bases and inflamed tissue is acidic. So the inflamed tissues low pH will charge the drug and therefore the drug cannot cross the membrane as easily in healthy tissue

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6
Q

general vs local anethetic mechanism

A

general

  • CNS
  • activate GABA A receptors (and glycine), blocks chlorine transfer

LA

  • PNS
  • basic and blocks Na+ channel; Na decreases and depolarization threshold increases
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7
Q

charged or uncharged LA penetrate membranes better?

A

uncharged

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8
Q

List esters and list amides

A

Esters (PABA)

  • Procaine
  • Tetracaine
  • ethyl aminobenzoate
  • benzocaine

Amides

  • Lidocaine (xylocaine)
  • bupivacaine
  • mepivacaine
  • prilocaine
  • articaine (septocaine)
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9
Q

more lipid soluable agents are more ____ with longer but take longer to?

A

more POTENT with longer duration of action but take longer to achieve clinical effect (bupivacaine is more lipid soluble)

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10
Q

esters (such asprocaine) are metabolized into what that causes allergies?

A

PABA (para-aminobenzoic acid)

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11
Q

what is the most important reason that LA is often combined with vasoconstrictors?

A

to INCREASE the duration of action of anesthesia

it also decreases blood flow, rate of systemic absorption and dose needed

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12
Q

Why shouldn’t you warm injections?

A

This can deteriorate the epi and make it ineffective

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13
Q

what LA is safest for pregnancy?

A

Lidocaine

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14
Q

What is the only LA that causes vasoconstriction and can be used as topical?

A

cocaine is the only LA that cause vasoconstirction and can be used for topical for mucous membrane surgery

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15
Q

if you see “methemoglobinemia” think?

A

benzocaine

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16
Q

Lidocaine can be used as an?

A

antiarrhythmic agent

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17
Q

cross allergies occurs in amides or esters?

A

ESTERS! (if you’re allergic to one ester LA you are probably allergic to the next one)

18
Q

Lidocaine should NOT be used for? why?

A

epidurals bc of transient neurological symptoms

19
Q

preservative allergies

A

methylparaben and metabisulfite (used in epi LA)

20
Q

If a patient has a sulfa allergy to preservatives, use?

A

mepivacaine 3% and prilocaine 4%

21
Q

use what to treat convulsions from toxicity?

A

benzodiazepinesie diazepam (Valium)

22
Q

what is OraVerse?

A

an anesthetic reversal agent that reduces time of numbness in half (1:1 ratio to epi)

23
Q

Hanaoka Seishu

A

first surgeon to use general anesthesia using Tsusensan

24
Q

Horace Wells

A

first dentist to use nitrous oxide for tooth extraction

25
Q

Oliver Holmes

A

drug induced reversible state of unconscious for surgery that patient doesn’t feel

26
Q

Two types od general anesthetics?

A

1) complete (halothane, isoflurane, edsflurane)-can reach any stage
2) incomplete (nitrous oxide)- can reach stage 1

27
Q

describe stages of general?

A

1) induction
- end marked by loss of consciousness
- dental procedures
2) excitement
- want to be super fast
3) surgical anesthesia
- opoid used for pain control
4) asystole happens here… bad stage!

recovery
- opposite of induction
emergence - regain consciousness

28
Q

5 primary effects of general?

A 
1 unconsciousness
2 amnesia (memory loss)
3 analgesia (no pain)
4 inhibition of autonomic reflexes
5 skeletal muscle relaxation
29
Q

most general are delivered via?

A

inhalation and IV injection

30
Q

T or F… no general achieve all 5 effects?

A

True. Combo of drugs is used

31
Q

two drugs for anterograde amnesia?

A

1) midaszolam- IV

2) diazepam- IV or PO

32
Q

both H1 and H2 antagonist antihistamines are used to treat and prevent

A

allergic reactions (mainly H1)

33
Q

Name volatile and gasous general anesthetics?

A

volatile

  • halothane (Fluothane) - not used anymore, hepatitis
  • isoflurane (Forane) -
  • sevoflurane (Ultane) - most commonly used in hospital

gaseous is nitrous oxide

34
Q

MAC (minimum alveolar concentration)

A

same as ED50
the LOWER the potency, the higher the #
** alveolar concentration of a gas necessary to prevent a skeletal muscle response to a standard surgical stimulus in 50% of subjects

35
Q

Ostwald Coeffecient

Give example

A

describes the solubility of inhaled general in the blood (ratio IN blood to conc in GAS in contact with blood)

  • the more soluble to blood instead of air, the more it binds to plasma and the higher the conc.
    • so large # means longer induction and recovery

Ex: low solubility (nitrous oxide) = quick induction, less soluble in blood so gas gets to brain quicker
— high solubility takes awhile to get to brain bc it goes to all tissues

36
Q

List 5 general gaseous analthetics and major characteristic

A 
1) desflurane (supane)
   irritates airway
2) halothane (fluothane)
   most potent (smaller MAC=more potent)
3) isoflurane (forane)
    irritates airway
4) sevoflurance (ultane)
    widely used in adults and kids, best for lung disease
5) nitrous oxide
    least potent
37
Q

What is unique about Enflurane (Ethrane) in general?

A

does NOT cause liver probs such as a decrease in portal vein flow

38
Q

if you see malignant hyperthermia think?

A

dantrolene (dantrium) - heritable genetic disorder of skeletal muscle

39
Q

list intravenous general anesthetics

A

1) ketamine (Ketalar)
- dissociative
2) Methohexital sodium (Brevital)
- barbiturates
3) naloxone (Narcane)
- drug antagonist
4) Propofol (Diprivan)
- no analgesic effect
- induction and maintenance of anesthesia
- most pronounced decrease in BP
5) Midazolam (Versed)
- used most for dental, work thru GABA
6) Flumazenil (Romazicon)
- inhibits GABA
- only benzodiazeprine reversal agent

40
Q

ketamine (Ketalar)

A

intravenous general anesthetic

  • blocks action of excitatory nuerotransmitter, produced state of dissociative anesthesia, children, no skeletal muscle relaxant required
  • side effects: increases lecrimation and salivation and causes hallucinations in adults
41
Q

Flumazenil (Romazicon)

A
  • inhibits GABA

- only benzodiazeprine reversal agent

42
Q

Propofol (Diprivan)

A

NO ANALGESIC EFFECT (IV general)

most frequently used drug for induction and maintenance of anesthesia –has replaced barbiturates
* most pronounced decrease in BP

Pharm (15 decks)

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