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Year 2 Pharmacology > Local anesthesia > Flashcards

Local anesthesia Flashcards

1
Q

what are the disadvantages of spinal block?

A

time limited, no titration, not reversible

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2
Q

where is a spinal block administered?

A

into CSF in lumbar subarachnoid space to reach spinal roots

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3
Q

what are the advantages of an epidural block?

A

not time limited, can be used 4-7 days post-op, titratable

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4
Q

what is the disadvantage of an epidural block?

A

less reliable block compared to spinal

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5
Q

what is the primary mechanism of action of local anesthetics?

A

blockage of voltage gated sodium channels - inhibits depolarization and repolarization

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6
Q

biotoxins act at what site?

A

external sodium channel

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7
Q

lidocaine acts at what site?

A

internal sodium channel

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8
Q

benzocaine acts at what site?

A

embed in lipid bilayer in vicinity of receptor and disrupt geometry of lipid bilayer - causes receptor to lose conformation and function

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9
Q

local anesthetics exist in what two forms?

A

protonated and non-protonated form

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10
Q

which form of local anesthetics get through the membrane?

A

non-protonated

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11
Q

which form of local anesthetics bind to the internal portion of the sodium receptor?

A

protonated

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12
Q

how are local anesthetics characterized chemically?

A

weak bases

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13
Q

what are the amide local anesthetics?

A
  1. lidocaine
  2. articaine
  3. bupivacaine
  4. ropivacaine

have two “i”s

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14
Q

what are the ester local anesthetics?

A
  1. cocaine
  2. procaine
  3. benzocaine
  4. tetracaine
  5. chloroprocaine

have one “i”

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15
Q

what is the most active form of local anesthetic at the sodium receptor?

A

cationic (protonated)

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16
Q

which has a longer half life - amide or ester local anesthetics? why?

A

amides - metabolized in liver

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17
Q

what are the factors that influence LA onset and recovery?

A
  1. fiber size
  2. site of deposition
  3. pH
  4. nerve stimulation rate
  5. calcium concentration
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18
Q

which fiber size is most sensitive?

19
Q

are myelinated or nonmyelinated fibers more sensitive?

A

myelinated

20
Q

in terms of blocking, which fibers are blocked first? last?

A

first - beta fibers

last - A alpha

21
Q

how does pH influence minimum anesthetic concentration?

A

high pH - lower Cm

22
Q

which nerve frequency is more sensitive - high or low?

23
Q

how does calcium influence minimum anesthetic concentration?

A

increased calcium concentration - increased Cm

24
Q

which drug is used as a vasoconstrictor to reduce systemic absorption and increase duration of LA action?

25
Q

what are the factors that affect reversal of LA?

A
  1. dilution by ECF
  2. absorption into circulation
  3. redistribution to other areas
  4. use of vasoconstrictors
26
Q

what is the most important factors affecting reversal of LA?

A

absorption into circulation

27
Q

where are amide LAs metabolized?

28
Q

where are ester LAs metabolized?

29
Q

amide LAs are metabolized to what chemical compound?

A

inactive metabolite

30
Q

ester LAs are metabolized to what chemical compound? what is the clinical significant?

A

inactive metabolite - PABA moiety

prone to allergic reactions

31
Q

patients who are allergic to ester LAs are actually allergic to what specific compound?

A

methylparaben (perservative)

32
Q

are amide or ester LAs more prone to systemic toxicity? why?

A

amides - circulate in blood until metabolism in liver (longer half life too)

33
Q

which LA has systemic toxicity that targets the heart?

A

bupivicaine

34
Q

what is the treatment for LAST (LA toxicity)? what does it do?

A

IV lipid emulsion (IntraLipid) - forms a lipid sink to absorb circulating lipophilic toxin

35
Q

which amide LA can be given both topically and IV?

36
Q

what are the main clinical uses for bupivicaine?

A
  1. epidural transfusion used for labor analgesia and post-op pain
  2. excellent spinal anesthetic
37
Q

what is the primary use for articaine?

A

dental anesthetic

38
Q

what is the main clinical use of cocaine?

A

topical anesthetic for ENT procedures

39
Q

what is the primary use for benzocaine?

A

topical use only due to enhanced lipid solubility

40
Q

what are the clinical uses for chloroprocaine? why?

A

epidural for labor anesthesia (C-section) due to lower risk of systemic toxicity or fetal exposure

41
Q

what is exparel-liposome?

A

encased bupicicaine that provides relief for up to 72 hours

42
Q

what is EMLA?

A

eutectic mixture of LA

mixture of high concentration of LAs in oil-water emulsions - lidocaine and prilocaine

use - topical anesthetic on intact skin

43
Q

what is TAC? what is the use?

A

tetracaine - adrenalin - cocaine

topical in pediatric ERs

Year 2 Pharmacology (70 decks)

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