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Pharm Exam 6 > Local anesthetics > Flashcards

Local anesthetics Flashcards

1
Q

Physiologic pH local anesthetics are

A

Charged (cationic)

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2
Q

The lower the pKa

A

The more uncharged species

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3
Q

Most local anesthetics have a higher Pka

A

more likely to be charged

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4
Q

Mechanism of action

A

Block open Na+ channels

only in periphery (no loss of consciousness)

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5
Q

Dose dependent effects

A

Ability to generate AP is dependent on dose

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6
Q

Work best on

A

Rapidly firing or chronically firing

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7
Q

Order of nerves blocked

A

CBA
Smaller C and B fibers
Small A-Delta and A-gamma
A-alpha blocked last

Pain blocked first
Sensation fibers
Motor function
same thickness = myelinated > unmyelinated

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8
Q

When block is reversed which sensation returns last?

A

Pain

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9
Q

Which local ester anesthetic is more potent? Procaine or Tetracaine?

A

Tetracaine

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10
Q

Which amide anesthetic is more potent?

Mepivacaine or Bupivacaine

A

Bupivacaine

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11
Q

Which local anesthetic is used for labor?

A

Bupivacaine

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12
Q

The addition of epinephrine is used to

A

vasoconstrict at the site

double the duration of action

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13
Q

block that is administered directly to wound

A

Infiltration

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14
Q

Block that surrounds the wound

A

Infiltration (surround)

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15
Q

Block that is a peripheral nerve block

A

Infiltration (peripheral)

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16
Q

Block that is applied to the spine, epidural, or caudal region

A

Infiltration (spinal)

17
Q

Which type of local anesthetic is hydrolyzed/metabolized faster? Ester or amide?

A

Ester (choline esterases breakdown esters in the blood plasma)

18
Q

Metabolite of ester LA metabolism?

A

Para-amino benzoic acid

19
Q

What metabolite causes allergic reactions in many people (allergic dermatitis, asthma, anyphylactic shock)?

A

Para-amino benzoic acid

due to breakdown of ester LA

20
Q

Amide LAs are broken down by?

A

Liver CYP450

21
Q

Toxicity of LAs

A

Systemic

Neurotoxicity

22
Q

Systemic toxicity

A

Hypersensitivity Para-aminobenzoic acid
CNS effects
Cardiovascular

23
Q

Which LA causes cardiac effects?

A

Bupivacaine

24
Q

How do you prevent cardiac toxicity w/ bupivacaine?

A

Inject with lipid

25
Q

Rare, severe pain exceeding surgical procedure that can occur with neuraxial administration of LAs

A

Transient Neurological Symptoms (TNS)

26
Q

Which LAs are associated with TNS?

A

Lidocaine Procaine Mepivacaine

27
Q

Local anesthetics can be used to treat chronic pain

A

magnitude lower than required for blockade of AP in normal nerves without adverse effects

28
Q

Early symptom of local anesthetic toxicity

A

Circumoral and tongue numbness

Metallic taste

29
Q

Later stage high concentration local anesthetic toxicity symptoms

A

Nystagmus
Muscular twitiching
Tonic clonic convulsions

Pharm Exam 6 (8 decks)

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