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RUSVM Pharmacology Spring 2017 > Local anesthetics/amides/esters > Flashcards

Local anesthetics/amides/esters Flashcards

1
Q

What are nociceptors?

A

Free nerve endings of primary afferent neurons

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2
Q

What is the difference between pain and nociception?

A

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, whereas nociception is the detection of a noxious stimulus at the tissue level by nociceptors.

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3
Q

What are the 5 nociception pathways?

A

transduction, transmission, modulation, projection, perception.

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4
Q

What nociceptors are present on the distal terminus of primary sensory nerve fibers?

A

ABeta fibers, A-delta fibers, and C fibers

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5
Q

Which nociceptors are responsible for sensing “first pain”?

A

A-delta fibers

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6
Q

What is chronic pain?

A

pain that persists longer than is providing protection.

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7
Q

Neuron alteration occurs through which 2 main changes?

A

peripheral sensation and central sensitization.

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8
Q

What is hyperalgesia?

A

exaggerated perception of pain produced by a noxious stimulus.

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9
Q

What is allodynia?

A

non-noxious stimulus that elicits pain.

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10
Q

Where does central sensitization occur and what receptors does it involve?

A

It ooccurs in the dorsal horn of the spinal cord and involves NMDA receptors.

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11
Q

Does central pain sensitization occur in chronic and acute pain, or just chronic?

A

chronic and acute

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12
Q

What enables low intensity stimuli to produce pain?

A

changes in sensory processing in the spinal cord.

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13
Q

What receptor plays a central role in chronic pain?

A

NMDA

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14
Q

What is the result of increased glutamate in the synaptic cleft?

A

activates normally closed NMDA receptors.

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15
Q

What parts of the pain pathway are affected by local anesthetics?

A

transduction, modulation, and transmission.

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16
Q

Perception is affected by what type of anesthetics?

A

general anesthetics

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17
Q

What are the main effects of local anesthetics?

A

they cause the reversible blockade of transmission in peripheral nerves or spinal cord to stop pain signaling from progressing.

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18
Q

T/F: local anesthetics are any drugs that cause the reversible blockade of nerve impulse conduction when applied locally to nerve tissue.

A

True.

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19
Q

What are 2 classes of local anesthetics?

A

Amides and esters

20
Q

T/F: all local anesthetics are weak acids.

A

False. They are weak bases.

21
Q

What is the mechanism of action of local anesthetics?

A

neurologic blockade occurs by preventing depolarization and blocking the propagation of an action potential by inhibiting the influx of sodium through voltage-dependent Na+ channels.

22
Q

How is the duration of action of local anesthetics usually terminated?

A

By redistribution.

23
Q

What affects the onset of action of local anesthetics?

A

physiochemical properties, site of administration, and drug dose.

24
Q

What affects the duration of action of local anesthetics?

A

lipophilicity, ability to bind the sodium channel, underlying disease, and drug to drug interactions.

25
Q

Where are amides mainly metabolized?

A

liver

26
Q

what breaks downs esters?

A

plasma esterases

27
Q

T/F: amide local anesthetics have short half lives.

A

False. Their half life is long because they are metabolized by the liver.

28
Q

What are some routes of administration for local anesthetics?

A

topical, local infiltration, or IV regional anesthesia

29
Q

What are some examples of regional analgesia?

A

Brachial plexus block or an intercostal nerve block.

30
Q

When would a wound soaker catheter be used?

A

After surgery requiring regional analgesia.

31
Q

What are some contraindications of epidurals and epidural catheters?

A

coagulopathy, anatomy, skin infection/sepsis, and neurologic disease.

32
Q

What are some complications/adverse effects of epidurals?

A

local irritation, CNS stimulation, CNS depression, cardiovascular depression, and other less common effects.

33
Q

This drug is the most commonly used local anesthetic in vet med, has a rapid onset of action, and is metabolized by the liver.

A

Lidocaine.

34
Q

About how long does it take lidocaine cream to take effect?

A

20-30 minutes.

35
Q

Would you use epi with lidocaine when using lidocaine systemically?

A

No.

36
Q

What other use does lidocaine have?

A

antiarrhythmic (ventricular arrhythmias)

37
Q

T/F: lidocaine is used to stimulate intestinal motility in the horse.

A

True

38
Q

This local anesthetic is potent, has a longer duration of action, and is the most cardiotoxic of the local anesthetics.

A

Bupivacaine.

39
Q

When should you be weary of using bupivacaine?

A

in post-op pericardectomy patients.

40
Q

How is bupivacaine infused?

A

through thoracostomy tubes or soaker catheters.

41
Q

What is mepivacaine used for?

A

diagnosing nerve blocks in horses and for epidurals.

42
Q

This drug is less irritating and has a longer duration of action than lidocaine, and is preferred for distal limb/intraarticular injections.

A

Mepivacaine.

43
Q

This drug is an ester, is used topically, has a rapid onset, and allows for corneal and conjunctival manipulation.

A

Proparacaine.

44
Q

T/F: proparacaine can be used intranasally for nasal-oral feeding tube placement.

A

True.

45
Q

This ester is not used as a local anesthetic, but is a class 1a antiarrhythmic.

A

Procainamide

46
Q

Is procaine used as a local anesthetic?

A

No, but it is present in some penicillin G preparations.

RUSVM Pharmacology Spring 2017 (10 decks)

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