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HEENT > Local Anesthetics and Adrenergic Drugs > Flashcards

Local Anesthetics and Adrenergic Drugs Flashcards

1
Q

List the loss of function in order caused by local anesthetics

A

1) temperature/Pain
2) Touch
3) Proprioception (joint position)
4) Motor control

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2
Q

Which fibre is the thickest/most myelinated fibre?

a) A fibre
b) B fibre
c) C fibre

A

a) A fibre

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3
Q

Which fibre does not contain myelination?

a) A fibre
b) B fibre
c) C fibre

A

c) C fibre

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4
Q

Which amine is not present in a Ester local anesthetics

a) primary amine
b) tertiary amine
c) quaternary amine
d) secondary amine

A

c) quaternary amine

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5
Q

In amide local anesthetics, which type of amine does the R group have?

a) primary amine
b) tertiary amine
c) secondary amine
d) quaternary amine

A

b) Tertiary amine

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6
Q

What is usually the lipophilic group?

a) R group
b) ester group
c) amide
d) aromatic ring

A

d) aromatic ring

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7
Q

Summary of Structure Activity Relationship (read or try to recall)

A

Need a lipophilic group (aromatic ring)
Lipophilic and hydrophilic groups are linked by an amide or ester group
The hydrophilic group can be a primary, secondary, or tertiary amine

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8
Q

How are esters broken down in systemic circulation?

A

plasma esterases

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9
Q

Amides are broken down by a 2 processes in the liver called _____________ and _______

A

dealkylation and hydrolysis

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10
Q

True or false: injecting lidocaine with epinephrine will lengthen block duration?

A

True: delays redistribution

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11
Q

List the 4 groups of anesthetics and classify them according to the functional group of Esters or amide

A

1) procaine = ester
2) benzocaine = ester
3) lidocaine = amide
4) bupivacaine = amide

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12
Q

Which local anesthetic has a block duration based on only being in contact for it to work?

a) procaine
b) benzocaine
c) lidocaine
d) bupivacaine

A

b) benzocaine

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13
Q

Which local anesthetic has methemoglobinemia as its toxicity?

a) procaine
b) benzocaine
c) lidocaine
d) bupivacaine

A

b) benzocaine

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14
Q

Which local anesthetic has high cardiotoxicity?

a) procaine
b) benzocaine
c) lidocaine
d) bupivacaine

A

d) bupivacaine

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15
Q

How long is the block duration for lidocaine?

A

90-200 min

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16
Q

How long is the block duration of bupvacine?

A

180-600 min

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17
Q

List some adverse effects of local anesthetics?

A

CNS side effects: dizziness, blurred vision and tremors (often missed)
-later drowsiness, convulsions, unconsciousness, respiratory arrest

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18
Q

Which channel is affected by the adverse effects of local anesthetics?

a) calcium channels
b) sodium channels
c) potassium channels
d) Magnesium channels

A

b) sodium channnels

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19
Q

List some cardiovascular side effects from local anesthetics

A

hypotension, CVD collapse, bradycardia, cardiac arrest

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20
Q

What is the maximum safe number of lidocaine ampules that could be infiltrated around a large scalp wound in a 20kg, 6-year-old girl

Lidocaine max local dose = 7mg/kg
2% lidocaine in 2ml vials

A
  1. 5mL vial
    a) 20kg x 7mg/kg = 140mg
    b) `140mg/20mg/ml = 7 ml needed
    c) 7ml/2ml per vial = 3.5 vials
21
Q

What does the effector neuron release in the sympathetic nervous system?

a) acetylcholine
b) noradrenaline
c) epinephrine
c) norepinephrine

A

b) noradrenaline –> acts on adrenergic receptors

22
Q

What neurotransmitter does the sweat gland release?

a) acetylcholine
b) noradrenaline
c) norepinephrine
d) epinephrine

A

a) acetylcholine (anti-cholinergic drugs stop you from sweating)

23
Q

What neurotransmitter does the kidney release in conjunction with noradrenaline?

a) epinephrine
b) acetylcholine
c) dopamine
d) histamine

A

c) dopamine

24
Q

True or false: Epinephrine is a non-selective agonist that activates alpha and beta receptors

A

True

25
Q

What is epinephrine used for and how can it be given?

A

reducing blood blow (surgery, local anesthesia )
cardiac arrest
bronchial asthma
anaphylactic shock, angioedema, and severe hypotension.
can be given locally or intravenously

26
Q

True or false: epinephrine crosses the blood-brain barrier

A

False: it doesnt

27
Q

What are some major side effects of epinephrine?

A

mydriasis (pupil dilation), nervousness (indirect)
CVD: vasoconstriction, vasodilates skeletal muscles, systolic high blood pressure
Resp: bronchodilation
GI: decreased use
Urinary: decrease urge to urinate
Glands: sweating, pallor

28
Q

Which receptor contracts vascular smooth muscle and dilates pupils?

A

a1 receptor

29
Q

Which receptor blocks the release of noradrenaline?

A

a2 receptor

30
Q

Which receptor pushes the heart to work harder (positive chronotrope)
(hint: only got 1 heart)

A

B1 receptor

31
Q

What receptor is in charge of bronchodilation in the respiratory system?

A

B2 ( got 2 lungs)

32
Q

What receptor relaxes the bladder and activates lipolysis?

A

B3 receptor

33
Q

Phenylephrine activates

a) A1 receptors
b) A2 receptors
c) A1 + A2 receptors
d) B1 + B2 receptors

A

c) A1 + A2 receptors (non selective agonist)

34
Q

List 3 functions of phenylephrine

A
  1. dilates pupils
  2. decongestant
  3. raise blood pressure
35
Q

Which of the following drugs have a strong affinity for a2 receptors?

a) Xylometazoline
b) oxymetazoline
c) lisinopril
d) ramipril

A

b) oxymetazoline –> drops blood pressure if used too much

36
Q

Clonidine is

a) a1 selective
b) a2 selective
c) b1 selective
d) b2selective

A

a) a2 selective

37
Q

what is clonidine used for initially?

a) hypotensives
b) hypertensive
c) anti-cholinergic
d) anti-memetic

A

a) hypertensive + alcohol and nicotine withdrawal, analgesic, vasoconstriction

38
Q

The side effect of clonidine?

A

dry mouth, drowsiness, sedation and constipation + blocks acetylcholine

39
Q

is isoproterenol a beta or alpha receptor agonist?

A

beta receptor agonist

40
Q

Which of the following drugs is a potent vasodilator, and increases cardiac output?

a) oxymetazoliine
b) isoproterenol
c) phenylephrine
d) epinephrine

A

b) isoproterenol

41
Q

Salbutamol selects for which receptor?

a) a1
b) b1
c) a2
d) b2

A

d) b2 receptor

42
Q

Which receptor does mirabegron select for and what is its function?

a) a1
b) b1
c) b3
d) b2

A

b3 –> relaxes bladder

43
Q

What will occur to blood pressure if the alpha receptor is blocked (AKA administering a receptor antagonist) ?

A

lower blood pressure

contract pupils and nasal passages

44
Q

Which drug is only selective for a1 receptors, and low affinity for a2 receptors?

a) Benedryl
b) prazosin
c) salbutamol
d) oxymetazoline

A

b) prazosin

45
Q

side effects of prazosin?

A

tachycardia and hypotension

46
Q

What occurs when you administer a b-receptor antagonist?

a) to the heart?
b) to the respiratory system

A

a) decrease cardiac output

b) bronchoconstrict

47
Q

Propanolol blocks one or both beta receptors and does it cross the BBB

A

both receptors + crosses the BBB

48
Q

What is propranolol used for?

A

hypertension, angina, migraine, essential tremor.

HEENT (14 decks)

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