Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II Final > Local Anesthetics > Flashcards

Local Anesthetics Flashcards

1
Q

What is the prototype ester local anesthetic?

A

Procaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What local anesthetic has the shortest onset?

A

Cholorprocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the benefits to using Epinephrine in conjunction with a local anesthetic?

A

Can give more local anesthetic, epi slows absorptionProlongs LA due to vasoconstrictionEpi can detect if we are injecting LA in a vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the prototype amide local anesthetic?

A

Lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do amide local anesthetics undergo metabolism?

A

Hepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What factors affect duration of action of a local anesthetic?

A

Protein binding and available blood supply to area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do ester local anesthetics undergo metabolism?

A

Non-specific plasma esterases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the potency ratio of Procaine?

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the potency ratio of Choloroprocaine?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the potency ratio of Tetracaine?

A

16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the potency ratio of Lidocaine?

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the potency ratio of Ropivacaine?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the potency ratio of Bupivacaine?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the max dose of Procaine without Epi?

A

7mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the max dose of Tetracaine without Epi?

A

1-2mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the max dose of Choloroprocaine without Epi?

A

11mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the max dose of Lidocaine without Epi?

A

5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the max dose of Bupivacaine without Epi?

A

2-3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the max dose of Ropivacaine without Epi?

A

3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the max dose of Lidocaine with Epi?

A

7mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the max dose of Tetracaine with Epi?

A

3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the max dose of Choloroprocaine with Epi?

A

14mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the max dose of Bupivacaine with Epi?

A

3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the max dose of Ropivacaine with Epi?

A

3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the duration of action of Procaine?

A

45-60mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the duration of action of Tetracaine?

A

60-180mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the duration of action of Choloroprocaine?

A

35-40mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the duration of action of Lidocaine?

A

60-120mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the duration of action of Bupivacaine?

A

240-480mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the duration of action of Ropivacaine?

A

240-480mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the mechanism of action for local anesthetics?

A

Local anesthetics bind to voltage gated Na channels and block depolarizing Na current through these channels, they prevent or relieve pin by interrupting nerve conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How do local anesthetics prevent the generation of a nerve impulse?

A

They bind to the alpha subunit of the Na channel and prevent the influx of Na into the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What neurons are more easily blocked, those that are active or inactive?

A

Active, more sodium channels are in the ready position

34
Q

How does bicarbonate effect the onset of local anesthetics?

A

Bicarb decreases the onset of local anesthetics

35
Q

What does greater lipid solubility in a local anesthetic indicate?

A

Greater lipid solubility increases both the potency and duration of their action

36
Q

What is the therapeutic index of lipid soluble LA compared to others that aren’t as lipid soluble?

A

Greater lipid solubility also increases toxicity, decreasing the therapeutic index

37
Q

What size nerve fibers are more susceptible to local anesthetics?

A

Smaller nerve fibers are more susceptible to LA than large fibers

38
Q

What type of nerve fibers are more susceptible to Local anesthetics?

A

Myelinated fibers are more easily blocked than non-myelinated, the local anesthetics pools near the axonal membrane

39
Q

What is the first sensation to disappear with local anesthetics?

A

Pain

40
Q

What is the last modality lost with the use of local anesthetics?

A

Motor function

41
Q

What other modalities are lost with spinal anesthesia?

A

Sensation of cold, warmth, touch, deep pressure

42
Q

What is a good way to check if a block is setting up?

A

Check the affected area for temperature sensation, if they can’t feel temperature, in theory they shouldn’t be able to feel pain

43
Q

What factors determine the plasma concentration of local anesthetics?

A

Dose administered
Rate of absorption
Site injectedMetabolism/Elimination of drug
Amount bound to protein

44
Q

How can you tell if the LA is an Ester or an Amine just by looking at the name?

A

One I = EsterTwo I’s = Amine

45
Q

What are the signs of local anesthetic systemic toxicity?

A 
Drowsiness 
Paresthesia in mouth or tongue (metallic taste)
Ringing in ears
Muscular spasm
Seizure
Coma 
Respiratory Arrest
Cardiac Arrest
46
Q

What local anesthetic is associated with cardiovascular toxicity?

A

Bupivacaine (central cardiac depressant)

47
Q

What is often the first sign of bupivacaine toxicity?

A

Cardiac arrest

48
Q

Where is the primary site of action of local anesthetics in the heart?

A

Myocardium, where they decrease electrical excitability, conduction rate and the force of myocardial contraction

49
Q

How do local anesthetics contribute to hypotension?

A

Most LAs cause arteriolar dilation

50
Q

What protein is most associated with local anesthetics?

A

Alpha1 acid glycoprotein (AAG)

51
Q

Why are pregnant women and newborns more susceptible to local anesthetics?

A

Low circulating AAG, avoid bupivacaine

52
Q

What local anesthetic should never be injected IV?

A

Bupivacaine, cardiac specific will cause arrest

53
Q

Where is cocaine derived?

A

Leave of the coca shrub

54
Q

Why type of local anesthetic is cocaine?

A

Ester of benzoic acid

55
Q

What is the clinical action of cocaine?

A

Blockade of nerve impulse and vasoconstriction secondary to inhibition of local norepi re-uptake

56
Q

Why has Cocaine lost favor in practice?

A

Toxicity and potential for abuse

57
Q

What gives cocaine its euphoric properties?

A

Inhibition of catecholamine uptake, particularly dopamine at CNS synapses

58
Q

What is cocaine currently used in practice for?

A

Topical anesthesia, vasoconstrictor (decrease bleeding) and shrinking of the mucosa

59
Q

What local anesthetic has the most rapid onset and metabolism?

A

Choloroprocaine (about 20min motor block)

60
Q

What type of local anesthetic is Choloroprocaine?

A

Ester

61
Q

Why don’t we typically give more than one anesthetic agent at once?

A

The effects are compounded by one another

62
Q

What type of local anesthetic is tetracaine?

A

Ester and considered more toxic

63
Q

When is tetracaine typically utilized?

A

Spinal anesthesia when a long duration is required and topical preparations such as eye drops

64
Q

What is the most versatile local anesthetic agent?

A

Lidocaine

65
Q

What local anesthetic has a similar profile as lidocaine but has lost favor with the exception of peripheral nerve blocks?

A

Mepivacaine (Carbocaine)

66
Q

What is the most common local anesthetic used for post op pain control?

A

Bupivacaine

67
Q

What type of local anesthetic is Bupivacaine?

A

Amide

68
Q

If a patient gets LAST from bupivacaine what is the best option for survival?

A

Cardiac Bypass

69
Q

What type of local anesthetic is Ropivacaine?

A

Amide

70
Q

How do lower concentrations of Ropivacaine compare to Bupivacaine?

A

Ropivacaine is slightly less potent in producing anesthesia when used in lower concentrations

71
Q

Where are opioid receptors present in the spinal cord?

A

Substantia gelatinosa

72
Q

Why don’t opioids have a significant clinical role in peripheral nerve blockade?

A

There are no peripheral receptors, or the effects are negligible

73
Q

What type of drug is Clonidine?

A

Centrally acting selective alpha 2 agonist

74
Q

What is the benefit to using Clonidine in an epidural or spinal compared to opioids?

A

Does not produce depression of ventilation, pruritus, nausea and vomiting

75
Q

What factors should be considered when selecting a local anesthetic?

A

Length of surgery
Speed of onset LA
Need of post-op pain control
Patient-related factors

76
Q

How does the pKa affect the onset of a local anesthetic?

A

The lower the pKa, the shorter the onset of action (exception chloroprocaine)

77
Q

What factors enhance the toxicity of bupivacaine?

A

Pregnancy
Use of CCB
Acidosis
Hypercarbia

78
Q

What is the most common cause of toxic plasma concentrations of local anesthetic?

A

Administration of LA directly into a vessel

79
Q

How does Lidocaine effect ventilatory response to hypoxia?

A

Depresses the response (remember local anesthetics are still anesthetics)

80
Q

What percentage of Lidocaine is typically used in a bier block?

A

0.5%

81
Q

What form of a local anesthetics has the most effect of blocking sodium channels?

A

The charged form

82
Q

What type of local anesthetics are more likely to cross the placenta?

A

Amide

Pharm II Final (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions