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Pain Management 1 > Local Anesthesia > Flashcards

Local Anesthesia Flashcards

1
Q

In the U.S. approximately___`% of the population avoid dental care due to fear

A

10

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2
Q

What are the desirable Properties for local anesthesia?

A

1) No Irritation to tissue
2) No permanent alteration
3) Low systemic toxicity
4) Effective if injected into tissue or mucous membranes 5) Short onset
6) Long of enough duration of action for the procedure
7) Potent yet not harmfully concentrated
8) Not elicit allergic reaction
9) Readily undergo biotransformation
10) Sterile or capable of being sterilized by heat without deterioration

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3
Q

____ ____ is the cornerstone of all anesthesia?

A

Local anesthesia

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4
Q

____ _____ Prevents generation and /
or conduction of a nerve
impulse

A

Local anesthesia

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5
Q

The least experience of pain which a subject can recognize

A

Pain threshold

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6
Q

The greatest level of pain which a subject is prepared to tolerate

A

Pain Tolerance

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7
Q

the __________ fluid is more positively charged.

A

extracellular fluid

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8
Q

The _________ fluid is more negatively charged

A

intracellular fluid

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9
Q

What are the five stages of Nerve Impulse Transmission?

A
  1. resting phase channel closed
  2. Fibre stimulated, channel opens sodium enters
  3. Cell depolarized, channel closes.
  4. Potassium exits down concentration and electrical gradients.
  5. Fibre repolarized Na/K pump restores balance.
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10
Q

Where do local anesthetics work ?

A

Nerve membrane is where local anesthesia

exert their pharmacological actions

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11
Q

– Local anesthesia binds to specific receptor on the

Na channel, preventing from opening.

A

Specific Receptor Theory

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12
Q

__ Fiber conducts pain signals?

A

C fiber

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13
Q

Which fibers are faster A delta and Alpha OR C fibers

A

A alpha and delta

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14
Q

_____ ____ insulates axons electrically

and pharmacologically

A

Myelin sheath

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15
Q

Where are sodium channels most abundant?

A

Nodes of ranvier

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16
Q

- nodes needs to be blocked and - mm length needed to ensure effective anesthesia

A

2-3 nodes

8-10 mm

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17
Q

How does local anesthesia work?

A
  • Decrease permeability of ion channels to Na

• Nerve block by local anesthesia is a
Non-depolarizing block

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18
Q

majority form of local anesthesia are _______ ______.

A

tertiary amine

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19
Q

What two Local anesthetics are 2ndary amines?

A

prilocaine and hexylcaine

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20
Q

t/f: All local anesthetics are amphipathic

except…benzocaine

A

true

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21
Q

Antihistamine and anticholinergics have______

local anesthetic properties

A

weak

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22
Q

What are the two types of Local anesthetics?

A

Amides and esters

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23
Q

Resist hydrolysis, excrete unchanged in urine

A

amide

24
Q

Readily hydrolyzed in aqueous solution

A

ester

25
Q 
All of the following are examples of \_\_\_\_\_\_\_: 
– Procaine
– Propoxycaine
– Tetracaine
– Cocaine
– Benzocaine
– Dyclonine
A

Esters

26
Q 
All of the following are examples of \_\_\_\_\_\_\_: 
– Lidocaine
– Etidocaine
– Mepivacaine
– Bupivacaine
– Prilocaine
– Articaine
A

Amides

27
Q

______ doesn’t have hydrophilic group Therefore, its not suitable for injection but nice topical !!

A

Benzocaine

28
Q

Local Anesthesia combine with acids to form local anesthetic salt (HCl). This makes them ______ basic compunds

A

WEAK

29
Q

dissociation constant

A

pKa

30
Q

Relative proportion of ionic form depends on_____.

A

pKa

31
Q

t/F: When pH of solution = pKa, you have 50/50 RN/RNH+

A

true

32
Q

What two Factors are involved in the action of local anesthesia

A

1) Diffusion through nerve sheath

2) Binding at receptor site

33
Q

______ ____ is able to freely diffuse across the neuron axon membrane and into the axoplasm.

A

free base

34
Q

t/F; Once in the axoplasm, the free base is then changed back into the ionized form and the process continues until all of the anesthetic is in the axoplasm.

A

true

35
Q

t/f: increased translates to slow onset because few free base molecule available to diffuse

A

true

36
Q

decreased pKa will have_____ onset

A

faster

37
Q

_______ pH determines the ease for nerve blockade

A

Extracellular

38
Q

Inflamed or infected tissue is much more difficult to get

adequate anesthesia b/c _____ or ______

A

lower pH or ↑H+

39
Q

t/f: Keep low pH equates ↑effective shelf live of local anesthesia

A

true

40
Q

Most local anesthesia have pH ____ to ___

A

5.5 to 7

41
Q

from the innermost to the outermost, what is the composition of peripheral nerve

A

Endoneurium –> Perineurium —> Epinerium

42
Q

_______ is greatest barrier for diffusion because Slower diffusion is dependent on the thickness

A

Perineurium

43
Q

______ fiber tends to innervate proximal region (molars)

A

Mantle

44
Q

______ fiber innervates more distal points (incisors)

A

Core

45
Q

Complete conduction blockade requires ______ and ______.

A

Volume and Concentration.

46
Q

What happen to injected drug?

A

– Absorbed by nonneural tissue
– Diluted by interstitial fluid
– Removed by capillaries and lymphatic system
– For Ester-type: immediate enzymatic hydrolysis

47
Q

_____ pKa posses rapid onset of action

A

Lower

48
Q

t/f: Greater lipid solubility relates to intrinsic potency because the nerve membrane is 90% lipid.

A

true

49
Q

t/f: Increased protein binding will increase duration because nerve membrane is 10% protein.

A

true

50
Q

the result of the following is?

– “reverse” of anesthetic induction pattern
– Intraneural concentration exceeds extraneural concentration

A

recovery from nerve block.

51
Q

Recurrence of Immediate profound anesthesia results in what two things?

A

– Reduced concentration at mantle fibers

– Residual local + newly deposited supply =
immediate profound anesthesia

52
Q

– ↑ Tolerance to drug after repeated administration

A

Tachyphylaxis

53
Q

What factors can increase the tolerance to drug after repeated administration?

A 
– Edema
– Localized hemorrhage
– Clot formation
– Transudation
– Hypernatremia
– ↓pH of the tissue
54
Q

t/f: lipid solubility influences potency.

A

true

55
Q

t/f: pKa influences onset

A

true

56
Q

t/f: protein binding influences duration

A

true

Pain Management 1 (6 decks)

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