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Summer Pharm - Exam 2 > Local Anesthetics > Flashcards

Local Anesthetics Flashcards

1
Q

3 components of the LA molecule

A

lipophilic

intermediate

hydrophilic

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2
Q

aromatic portion of LA molecule

membrane penetration

A

lipophilic

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3
Q

ester/amide portion of LA molecule

metabolic pathway

alter tonicity

A

intermediate

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4
Q

amine portion of LA molecule

ionizable

determine charge

A

hydrophilic

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5
Q

2 types of LA

A

ester A

amide B

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6
Q

at normal body pH, LA are largely in the __ form

A

charged cationic

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7
Q

metabolic pathway of ester A

A

plasma

AND

liver

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8
Q

metabolic pathway of amide B

A

liver → CYP450

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9
Q

LA are classified as weak __

A

bases

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10
Q

uncharged LA are __ and cross membranes

A

lipophilic

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11
Q

injected LA are __ and block Na channels

A

hydrophilic

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12
Q

effect of infxn/inflammation on LA

A

infxn/inflammation → decreases pH → increased cationic/charged LA form → decreased membrane passage → decreased pain relief → increased dose required

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13
Q

t/f: buffered LA are more effective

A

T!

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14
Q

2 esters A

A

tetracaine

benzocaine

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15
Q

3 amides B

A

lidocaine

mepivacaine

bupivacaine

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16
Q

bc esters are metabolized by plasma and liver, they have __ duration than amides

and higher risk for __

A

shorter

allergic rxn

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17
Q

what 2 conditions increase t½ of amides 3x

A

liver dz

HF

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18
Q

3 factors that affect differential nerve block effectiveness

A

fiber size

firing rate of fibers

location of fibers

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19
Q

most important factor in effectiveness of differential nerve block

A

fiber size

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20
Q

which type of fiber is affected first in differential nerve block

A

small

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21
Q

2 smallest pain fibers

A

sensory pain

PG sympathetic

affected 1st in nerve block

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22
Q

what increases the effect of nerve bocks

A

neuron firing rate

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23
Q

what type of pain fiber has the fastest firing rate

A

active sensory pain fibers

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24
Q

what do you think when you see, dose dependent blockade

A

increased effectiveness of nerve block with faster firing rate of active sensory pain fibers

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25
Q

in terms of location, which type of pain fiber is affected first

A

periphery

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26
Q

2 types of pain transmission fibers

A

A delta

C

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27
Q

describe A delta fibers (2)

A

myelinated

big

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28
Q

describe C pain fibers (2)

A

unmyelinated

small

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29
Q

3 factors that decrease absorption of LA

A

oral

topical

intact skin

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30
Q

3 factors that increase absorption of LA

A

broken skin

injxn → SC/IM/IV - not infiltration

vasoconstrictors

31
Q

which has higher distribution, amides or esters

A

amides →

cross bbb/placenta

32
Q

distribution of amides is __ in healthy people,

which causes initial __ blood levels

A

increased

lower

33
Q

esters are metabolized __ than amides,

resulting in __ potential for toxicity

A

faster

lower

34
Q

__ have higher potential for liver toxicity

A

amides

35
Q

blood concentration of LA depends on (4)

A

injxn rate/route/site

dose

liver dz

vasoconstrictors

36
Q

s.e of esters

A

allergic rxn

37
Q

common s.e of lidocaine

A

dizzy

drowsy

38
Q

s.e of lidocaine at higher doses

A

convulsions

CNS dpn

death

39
Q

tx for convulsions caused by lidocaine

A

diazepam

midazopam

40
Q

route of amide administration w. highest risk of methemoglobinemia

A

topical

41
Q

2 LA w. highest risk for methemoglobinemia

A

lidocaine

benzocaine

42
Q

tx for methemoglobinemia

A

IV methylene blue

43
Q

surface use of LA

A

mucous membranes

44
Q

large dose of LA under skin w. epi

A

infiltration

45
Q

regional use of LA

A

nerve block

46
Q

spinal use of LA

A

subarachnoid

47
Q

2 types of epidural

A

lumbar

caudal

48
Q

lumbar LA is used for

A

obstetrics

49
Q

caudal LA is administered __

and used for __

A

above the coccyx

perineal/rectal procedures

50
Q

esters to know

A

cocaine

chloroprocaine

tetracaine

benzocaine

51
Q

least toxic ester

A

chloroprocaine

52
Q

ester w. fastest onset

A

chloroprocaine

53
Q

ester w. slowest onset

A

tetracaine

54
Q

ester w. highest topical value

A

tetracaine

55
Q

administration routes of tetracaine (3)

A

spray

solution

ointment

56
Q

which ester is used topically at the dentist

A

benzocaine

57
Q

s.e of benzocaine

A

methemeoglobinemia

58
Q

which LA can be used topically on intact skin (2)

A

LMX-4

EMLA

59
Q

which has faster onset, LMX-4 or EMLA

A

LMX-4

60
Q

LMX-4 contains

A

lidocaine

61
Q

EMLA contains

A

lidocaine/procaine

62
Q

amides to know

A

lidocaine

mepivicaine

bupivicaine

63
Q

lidocaine is same-same

A

xylocaine

64
Q

which amide is mc administered via infiltration

A

lidocaine

65
Q

meipivicaine is same-same

A

carbocaine

66
Q

which amide has the slowest onset

A

bupivicaine

67
Q

which amide has the longest duration

A

bupivicaine

68
Q

list the amides in order of lowest to highest vasodilatory action

A

mepivicaine

lidocaine

bupivicaine

69
Q

list the amides in order of safety in pregnancy from least to highest

A

mepivicaine

bupivicaine

lidocaine

70
Q

which amide is cardiotoxic

A

bupivicaine

71
Q

3 effects of vasodilation

A

increased blood to injection site

decreased effects locally

increased toxic systemic effects

72
Q

4 effects of vasoconstrictors

A

decreased blood flow to injection site

decreased hemorrhage risk

decreased toxic effects of LA

73
Q

epi dose for ASA I

A

1:100,000

200 mg

74
Q

epi dose for ASA II-III

A

1:100,000

40 mcg

(cardiac comorbidities)

Summer Pharm - Exam 2 (12 decks)

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