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Pharm III Unit 1 > Local Anesthetic and Muscle Relaxant > Flashcards

Local Anesthetic and Muscle Relaxant Flashcards

1
Q

Spinal anesthesia

A

CSF in lumbar region→ blocks sympathetic fibers in subarachnoid space

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2
Q

Epidural anesthesia

A

injection into epidural space

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3
Q

Nerve block

A

Injection into peripheral nerve endings/ trunks

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4
Q

Infiltration anesthesia

A

Injection into tissue

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5
Q

Disadvantage of infiltration anesthesia

A

Requires large amount of drugs

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6
Q

Anesthesia w/o disrupting normal body function

A

Infiltration anesthesia

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7
Q

Bier’s block

A

IV regional anesthesia

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8
Q

Esters differ from amides b/c

A

Esters: shorter duration of action and increase systemic toxicity

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9
Q

Local anesthetic: weak acid or weak base

A

Weak base

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10
Q

LA: Predominantly ionized or non-ionized

A

Ionized

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11
Q

Hydrophobic pathway: In order for LA to cross the membrane, it must be ____ and once inside it becomes _____ (binds to Na+ ch)

A

Non-ionized, ionized

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12
Q

The closer the pka is to physio pH, the higher the concentration of the drug in the _____

A

non-ionized form (faster membrane transport –> faster onset of action)

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13
Q

Drug always in the non-ionized form; very lipphilic

A

Benzocaine

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14
Q

Topical use only

A

Benzocaine

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15
Q

Makes pH more basic and increase non-ionized drug concentration

A

Bicarbonate

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16
Q

LA: more effective in resting axon or rapidly firing axon

A

Rapidly firing axon

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17
Q

Potency of the LA drugs are correlated to

A

Lipid solubility and duration of action

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18
Q

LA duration of action is dependent on

A

site of action

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19
Q

LA toxic effects are dependent on

A

half life

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20
Q

Absorption is affected by:

A

dosage, site of injection, drug-tissue binding, chemical properties of the drug, local blood flow, vasoconstricting agents (epinephrine)

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21
Q

Vasoconstricting agent would do what to LA

A

Decrease diffusion of drug –> prolong duration of action
Decrease systemic absorption
Decreases risk of systemic toxicity

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22
Q

Amides metabolized by

A

CYP450s in the liver

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23
Q

Esters metabolized by

A

Butyrycholinesterases in the plasma

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24
Q

Metabolites of esters and amides excreted via

A

renal

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25
Q

Pt w/ hepatic dz (reducing their hepatic blood flow) requires LA, do you give them an ester or amide?

A

Ester

26
Q

Block not limited to intended site

A

Differential block

27
Q

More sensitive: small diameter or large?

A

Small

28
Q

More sensitive: myelinated or unmyelinated

A

Unmyelinated

29
Q

More sensitve: fast or slow conduction velocity

A

slow conduction

30
Q

Allergic rxn more common for: amides or esters?

A

Esters

31
Q

How to decrease cardiovascular toxicity when using bupivacaine

A

IV lipid administration “lipid sink”

32
Q

Produces methemoglobinemia

A

Prilocaine, benzocaine

33
Q

Transient neurological symptoms (transient pain and dysethesia) seen in

A

lidocaine use for spinal anesthesia

34
Q

Esters LA (4)

A

Procaine, tetracaine, benzocaine, cocaine

35
Q

Procaine use

A

infiltration anesthesia and diagnostic nerve block

36
Q

LA Shortest duration of action

A

Procaine

37
Q

16x more potent and more toxin than procaine

A

Tetracaine

38
Q

Tetracaine uses

A

DOC: retrobulbar ophthalmic use

Spinal anesthesia→ with 10% dextrose to increase specific gravity→ more dense than CSF→ hyperbaric

39
Q

Lidocaine uses

A

infiltration blocks and epidural anesthesia

40
Q

Highest rate of clearance of the amides

A

Prilocaine

41
Q

Do not use prilocaine in pt w/

A

methemoglobinemia, cardiac or respiratory dz

42
Q

Amide w/ greatest cardiotoxicity

A

Bupivacaine

43
Q

Why bupivacaine causes greater cardiotoxicty than other amides

A

diffuse away from cardiac channels slower

44
Q

Drug use as epidural during labor and childbirth

A

Bupivacaine

45
Q

S-enantiomer, less lipid soluble (more rapid clearing) than bupivacaine

A

Ropivacaine

46
Q

vaso-constricting effects at clinical dose

A

Ropivacaine

47
Q

DOC pierpheral block

A

Mepivacaine

48
Q

Inverse differential block→ causes motor block before or without sensory block

A

Etidocaine

49
Q

Drug w/ both amide and ester group

A

articaine

50
Q

Largely use in dental medicine

A

Articaine and prilocaine

51
Q

Centrally-acting spasmolytic

A

Baclofen, cylcobenzaprine, diazepam, tizanidnie

52
Q

Direct-acting spasmolytic

A

Dantrolene, botulinum toxin

53
Q

Spasmolytic target proteins

A

GABA(a), GABA(b), alpha2, Ca2+ ch

54
Q

Muscle relaxant w/ both pre and post synaptic inhibition of spinal cord

A

Tizanidine

55
Q

Tizanidine SE

A

Sedation, hepatotoxicity

56
Q

Muscle relaxant w/ limited muscle weakness

A

Tizanidine

57
Q

Tx for neuroleptic malignant syndrome

A

Dantrolene

58
Q

Tx for malignant hyperhtermia

A

Dantrolene

59
Q

Drug that interferes w/ excitation-contraction coupling of actin and myosin

A

Dantrolene

60
Q

Drug that is injected locally to control muscle spasm following stroke or neurological injury

A

Botox

61
Q

Inhibits pain transmission in dorsal horn via alpha2 receptors

A

Tizanidine

Pharm III Unit 1 (9 decks)

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