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OCULAR PHARM > LOCAL ANESTHETICS > Flashcards

LOCAL ANESTHETICS Flashcards

1
Q

what are the Ester Anesthetics?

A 
Proparacaine
Tetracaine
Benoxinate
Procaine
Benzocaine
Cocaine
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2
Q

What procedures does Proparacaine uses in?

A 
Tonometry
Gonia 
sutures 
Nasolacrimal massage
Ultrasound
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3
Q

What procedures does Tetracaine used in?

A 
Tonometry
Gonia 
sutures 
Nasolacrimal massage
Ultrasound
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4
Q

What procedures does Benoxinate used in?

A

Tonometry
only available as fluorescein preparation
LEAST corneal compromise
BUT may increase corneal thickness

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5
Q

What procedures does Procaine used in?

A

Herpetic neuralgia (injection)

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6
Q

What procedures does Benzocaine used in?

A

OTC oral
Dental
cough

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7
Q

What procedures does Cocaine used in?

A

otaryln-gology

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8
Q

What are some characteristics of Proparacaine?

A
  • Least sting compared to Tetracaine
  • Refrigerate once open (discolors)
  • Potential to transiently increase corneal thickness affecting goldman and pre lasik pachymetry
  • Most commonly used in eye care
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9
Q

What are Some characteristics of Tetracaine?

A
  • GREATER toxicity/penetration than proparacaine

- Moderate stinging/ burning within installation

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10
Q

What are characteristics of Benoxinate?

A

only available as fluorescein preparation
LEAST corneal compromise
BUT may increase corneal thickness

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11
Q

What are the AMIDE ANESTHETIC drugs?

A 
Lidocaine
Etidocaine
Mepivicaine
Bupivicaine
Prilocaine
Ropivacaine
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12
Q

What are features of Lidocaine?

A
  • Toxicity risk: seizures,
  • Satruable metabolsim (zero kinetics)
  • when used TOPICALLY it will not have any visible effect of the corneal epithelium
  • Its good when injected for regional nerve block for large chalazions
  • Local and regional Anesthetic
  • Status eplepticus
  • Ventricular arrthmia
  • Forced cuctions
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13
Q

What are features of MEPIVICAINE

A

Has no preservatives

Local and regional anesthetic

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14
Q

what are features of BUPIVICAINE?

A

Local anesthetic and regional anesthetic

uses is obstetrics

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15
Q

what are features of ETIDOCAINE?

A

Local anesthetic

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16
Q

what are features of PRILOCAINE?

A

Caution with COPD/ASTHMA

Local anesthetic topical and infiltration

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17
Q

what are features of ROPIVACAINE?

A

Local and regional anesthetic

Obstertics

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18
Q

• Injectable anesthetics are used for?

A

Sub-conj
Facial nerve block
Retrobulbar block

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19
Q

What does sub conj uses it for?

A

Recalcitrant uveitis
cystoid macualr edema
Falling trabeclesctomy
severe corneal ulcer

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20
Q

What are the adverse effects of cocaine on systemic?

A 
exciement
convusions
rapid palpitations 
Nausea
delirium
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21
Q

What are the adverse effects of cocaine on ocular?

A

Desquamation/debriding (can be used as andvantage in PRK),
MYDRIASIS,
LID RETRACTION (DUE TO MULLERS MUSCLE)

22
Q

What is a adeverse effect of cocaine on general?

A

can lead to hypertension (incrased heart rate with vasocintrction)

23
Q

what other drugs does cocaine interactions with that could lead to adverse effects?

A 
TCADs (Tricyclic antidepressants
MAO inhibitors
Guanthidine
Epinephrine
Phenylephrine
24
Q

what type of inhibitor is TCADs?

A

It is a newer selective serotonin reuptake inhibitor
however
it is much less selective for serotonin alone

25
Q

What about MAO?

A

monoamine oxidase

a key enzyme invovledi n catecholamine metabolsim

26
Q

 Guanathidine is a?

A

antihypertensive that competes with norepinephrine for presynaptic uptake to ultimately occupy sotrage vesicles and dampen norepehineprine

27
Q

What is RESERPINE?

A

It is a antipsychotic, antihpertensive that blocks presynaptic monoamine uptake

28
Q

Desquamation is common in?

A 
50+ patients that has reduced blink rate 
Reduced tear production
Increased evaporation
VA may decline 20/80 to 20/100 
and healing may take up to 24 hours
29
Q

what are OCULAR ANESTHETIC adverse effects?

A 
Desumation
corneal edema
Cojunctival hyperemia
Allergic cojunctivitis
Lacrimination
30
Q

what should be avoided if there is a bforeign body injury?

A

aoid eye rubbing 20/30 min

31
Q

you shoud avoid this after having anesthetic use

A

avoid contact lens wear for 1 hour

32
Q

If use epinephrine with ocular anesthteics what could occur?

A

local necrosis, particular if you inject it

33
Q

Lacrimation could occour because?

A

there is a reflex tearing due to weak base on the eye

34
Q

What are systemic ANESTHETIC adverse effects?

A 
CNS (low/moderate dose):
CNS (high dose)
cardiovascular: 
Hypotension
cardiac collapse
Hypersensiivity
35
Q

What could be seen with CNS(Low/moderate dosage)?

A 
Euphoria
Dysphoria
Insomnia
visual and auditory hallucinations
Restlessness
Tremor
36
Q

What could be seen with CNS(high dose)?

A

Nystagmus
Tremor
Depression
Death

37
Q

What could be seen with cardiovascular?

A

Decrease excitability
Decrease cardiac force/conduciton leading to hypotension
Cardiac collapse
NOTE; THIS IS OPPSITE TO COCAINE

38
Q

What could be seen with hypersenstivity?

A 
Allergic dermattits
Angioneuotic edema
Urticarial
Asthma attack
Bronchospasm
anaphylaxis
39
Q

What does prilocaine has?

A

Methemoglbinemia which causes hemoglobin to lose affinity for oxygen so pt wit respiratory problems could have lethal interaction

40
Q

What are the clinical uses with Local Anesthetics?

A

Blocks the nerve impulse generation an conduction

But it is completely reversible

41
Q

What are the properties of Anesthetics?

A

1) Rapid onset
2) Adequate duration of action
3) Minimal side effects
4) Minimal local tissue damage

42
Q

Small diameter nerves tend to be?

A

more active and more sensitive

43
Q

Myelination influences by how?

A

Regardless if its small diameter or large diameter, if there is myelination it will enhance sensitivity

44
Q

Large diameter nerves tend to be?

A

less sensitivity and recover quickest

45
Q

What are features of esters?

A

unstable
hydrolyzed by pseudocholinesterases
High allergy potential for about 5-10 mints

46
Q

How should you treat hypersensitivity?

A

Decongestants and Constriction

47
Q

How will constriction will help?

A
  • It will reduce metabolism
  • Keep it localized rather than spreading it to the injection site
  • Use EPINEPHRINE as small amounts for decongestants
  • Reduce Absorption
48
Q

if you have a condition that want the immune system to resolve itself, then you should apply?

A

Warm compressions

- this will enhance blood flow thorughout the body

49
Q

If you have a condition such as inflammation, and you dont want to bleed out,, you should apply?

A

Cold compressions

50
Q

Warm compressions vs cold compressions

A 
Warm = will dilate and relax
Cold = will constrict
51
Q

Applying ANESTHETIC + VASOCONTRICTOUR WOULD DO WHAT?

A

it will help to keep that drug locally without going around systemically

1) reduce absorption/ toxicity
2) reduce bleeding from the injected site
3) sustain a local effect
4) Reduce metabolism

OCULAR PHARM (4 decks)

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