Local Anesthetics and Adrenergic Drugs

Question 1

List the loss of function in order caused by local anesthetics

Answer 1

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

Question 2

Which fibre is the thickest/most myelinated fibre?

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

Answer 2

a) A fibre

Question 3

Which fibre does not contain myelination?

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

Answer 3

c) C fibre

Question 4

Which amine is not present in a Ester local anesthetics

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

Answer 4

c) quaternary amine

Question 5

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

Answer 5

b) Tertiary amine

Question 6

What is usually the lipophilic group?

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

Answer 6

d) aromatic ring

Question 7

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

Answer 7

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

Question 8

How are esters broken down in systemic circulation?

Answer 8

plasma esterases

Question 9

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

Answer 9

dealkylation and hydrolysis

Question 10

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

Answer 10

True: delays redistribution

Question 11

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

Answer 11

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

Question 12

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

Answer 12

b) benzocaine

Question 13

Which local anesthetic has methemoglobinemia as its toxicity?

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

Answer 13

b) benzocaine

Question 14

Which local anesthetic has high cardiotoxicity?

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

Answer 14

d) bupivacaine

Question 15

How long is the block duration for lidocaine?

Answer 15

90-200 min

Question 16

How long is the block duration of bupvacine?

Answer 16

180-600 min

Question 17

List some adverse effects of local anesthetics?

Answer 17

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

Question 18

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

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

Answer 18

b) sodium channnels

Question 19

List some cardiovascular side effects from local anesthetics

Answer 19

hypotension, CVD collapse, bradycardia, cardiac arrest

Question 20

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

Answer 20

3. 5mL vial
   a) 20kg x 7mg/kg = 140mg
   b) `140mg/20mg/ml = 7 ml needed
   c) 7ml/2ml per vial = 3.5 vials

Question 21

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

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

Answer 21

b) noradrenaline –> acts on adrenergic receptors

Question 22

What neurotransmitter does the sweat gland release?

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

Answer 22

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

Question 23

What neurotransmitter does the kidney release in conjunction with noradrenaline?

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

Answer 23

c) dopamine

Question 24

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

Answer 24

True

Question 25

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

Answer 25

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

Question 26

True or false: epinephrine crosses the blood-brain barrier

Answer 26

False: it doesnt

Question 27

What are some major side effects of epinephrine?

Answer 27

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

Question 28

Which receptor contracts vascular smooth muscle and dilates pupils?

Answer 28

a1 receptor

Question 29

Which receptor blocks the release of noradrenaline?

Answer 29

a2 receptor

Question 30

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

Answer 30

B1 receptor

Question 31

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

Answer 31

B2 ( got 2 lungs)

Question 32

What receptor relaxes the bladder and activates lipolysis?

Answer 32

B3 receptor

Question 33

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

Answer 33

c) A1 + A2 receptors (non selective agonist)

Question 34

List 3 functions of phenylephrine

Answer 34

1. dilates pupils 2. decongestant 3. raise blood pressure

Question 35

Which of the following drugs have a strong affinity for a2 receptors? a) Xylometazoline b) oxymetazoline c) lisinopril d) ramipril

Answer 35

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

Question 36

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

Answer 36

a) a2 selective

Question 37

what is clonidine used for initially? a) hypotensives b) hypertensive c) anti-cholinergic d) anti-memetic

Answer 37

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

Question 38

The side effect of clonidine?

Answer 38

dry mouth, drowsiness, sedation and constipation + blocks acetylcholine

Question 39

is isoproterenol a beta or alpha receptor agonist?

Answer 39

beta receptor agonist

Question 40

Which of the following drugs is a potent vasodilator, and increases cardiac output? a) oxymetazoliine b) isoproterenol c) phenylephrine d) epinephrine

Answer 40

b) isoproterenol

Question 41

Salbutamol selects for which receptor? a) a1 b) b1 c) a2 d) b2

Answer 41

d) b2 receptor

Question 42

Which receptor does mirabegron select for and what is its function? a) a1 b) b1 c) b3 d) b2

Answer 42

b3 --> relaxes bladder

Question 43

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

Answer 43

lower blood pressure | contract pupils and nasal passages

Question 44

Which drug is only selective for a1 receptors, and low affinity for a2 receptors? a) Benedryl b) prazosin c) salbutamol d) oxymetazoline

Answer 44

b) prazosin

Question 45

side effects of prazosin?

Answer 45

tachycardia and hypotension

Question 46

What occurs when you administer a b-receptor antagonist? a) to the heart? b) to the respiratory system

Answer 46

a) decrease cardiac output | b) bronchoconstrict

Question 47

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

Answer 47

both receptors + crosses the BBB

Question 48

What is propranolol used for?

Answer 48

hypertension, angina, migraine, essential tremor.