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Pharma 2 > Local_Anesthetics_Flashcards > Flashcards

Local_Anesthetics_Flashcards

1
Q

Which of the following is a long-acting local anesthetic? A. Procaine B. Bupivacaine C. Lidocaine D. Prilocaine

A

B. Bupivacaine. Explanation: Bupivacaine is a long-acting amide local anesthetic, often used in epidural anesthesia. Procaine and Lidocaine have shorter durations, and Prilocaine is intermediate-acting.

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2
Q

Local anesthetic molecules consist of: A. Lipophilic group linked by an ester or amide chain. B. Lipophilic group linked by an ester and amide chain to an amine substitute. C. Lipophilic group linked by an ester or amide chain to an amine substitute. D. Lipophilic group linked to an amine substitute.

A

C. Lipophilic group linked by an ester or amide chain to an amine substitute. Explanation: This structure allows the anesthetic to penetrate membranes (lipophilic group) and bind to sodium channels (amine substitute).

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3
Q

All the following are true about local anesthetics (L.A.), EXCEPT: A. L.A. activity is increased at alkaline pH when the proportion of the ionized part is low. B. Bupivacaine is an amide-linked L.A. that has a cardiotoxic effect. C. Felypressin is used as a vasoconstrictor in cardiovascular patients. D. Procaine causes methemoglobinemia as a result of its metabolite.

A

D. Procaine causes methemoglobinemia as a result of its metabolite. Explanation: Methemoglobinemia is caused by Prilocaine, not Procaine. Procaine is metabolized to PABA, which may cause allergic reactions.

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4
Q

All the following are TRUE about epidural anesthesia, EXCEPT: A. Suitable for catheter use. B. It has longer action than spinal anesthesia. C. Commonly used in obstetric surgery. D. Commonly causes hypotension.

A

D. Commonly causes hypotension. Explanation: Epidural anesthesia is associated with less hypotension compared to spinal anesthesia because the drug is injected outside the dura and affects fewer nerve roots.

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5
Q

The most common side effect of spinal local anesthetics is: A. Spinal injury B. Headache due to CSF leakage C. Septic meningitis D. Tremor

A

B. Headache due to CSF leakage. Explanation: CSF leakage after spinal anesthesia often causes postural headaches, which are the most common side effect. Spinal cord injury and meningitis are rare.

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6
Q

The local anesthetic with a short duration of action is: A. Lidocaine B. Procaine C. Tetracaine D. Mepivacaine

A

B. Procaine. Explanation: Procaine is an ester-linked local anesthetic with a short duration of action due to rapid metabolism by plasma cholinesterase.

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7
Q

The local anesthetic with significant vasoconstriction effect is: A. Cocaine B. Procaine C. Bupivacaine D. Tetracaine

A

A. Cocaine. Explanation: Cocaine is the only local anesthetic that causes vasoconstriction, making it ideal for ENT procedures.

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8
Q

The local anesthetic recommended as an antiarrhythmic is: A. Lidocaine B. Procaine C. Mepivacaine D. Tetracaine

A

A. Lidocaine. Explanation: Lidocaine is used intravenously to treat arrhythmias, especially ventricular arrhythmias, due to its membrane-stabilizing properties.

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9
Q

Local anesthetic (L.A.) activity is increased at alkaline pH when: A. The proportion of extracellular non-ionized form of L.A. is high. B. The proportion of extracellular non-ionized form of L.A. is low. C. The proportion of extracellular ionized form of L.A. is high. D. The proportion of intracellular ionized form of L.A. is low.

A

A. The proportion of extracellular non-ionized form of L.A. is high. Explanation: The non-ionized form is lipid-soluble and can cross the nerve membrane. In alkaline environments, more of the anesthetic exists in the non-ionized form.

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10
Q

All the following are TRUE about local anesthetics (L.A.), EXCEPT: A. Lidocaine is an amide-linked L.A. that also has antiarrhythmic effects. B. Bupivacaine is an amide-linked L.A. that has cardiotoxic effects. C. Felypressin is used as a vasoconstrictor in cardiovascular patients. D. Prilocaine is safely used in obstetric analgesia.

A

D. Prilocaine is safely used in obstetric analgesia. Explanation: Prilocaine is contraindicated in obstetric analgesia due to its potential to cause neonatal methemoglobinemia.

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11
Q

Which local anesthetic is commonly used for antiarrhythmic therapy? A. Lidocaine B. Bupivacaine C. Tetracaine D. Procaine

A

A. Lidocaine. Explanation: Lidocaine is used intravenously as an antiarrhythmic, particularly for ventricular arrhythmias, due to its ability to stabilize cardiac membranes.

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12
Q

Which ester-linked local anesthetic has significant vasoconstrictive properties? A. Procaine B. Cocaine C. Tetracaine D. Benzocaine

A

B. Cocaine. Explanation: Cocaine is unique among local anesthetics for causing vasoconstriction, making it particularly effective in ENT procedures.

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13
Q

Why is Prilocaine contraindicated in obstetric analgesia? A. It causes tachycardia. B. It leads to neonatal methemoglobinemia. C. It is cardiotoxic. D. It has a short duration of action.

A

B. It leads to neonatal methemoglobinemia. Explanation: Prilocaine’s metabolite, O-toluidine, can cause methemoglobinemia, reducing oxygen transport in newborns, making it unsafe for obstetric use.

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14
Q

How does the pH of inflamed tissue affect local anesthetic efficacy? A. Reduces the proportion of unionized drug, decreasing efficacy. B. Increases the proportion of unionized drug, enhancing efficacy. C. Reduces the ionized drug proportion, increasing penetration. D. Does not affect drug efficacy.

A

A. Reduces the proportion of unionized drug, decreasing efficacy. Explanation: In inflamed tissue (acidic pH), the amount of unionized form decreases, reducing the drug’s ability to penetrate the nerve membrane.

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15
Q

What is the role of vasoconstrictors like epinephrine in local anesthetic formulations? A. Increases systemic absorption and toxicity. B. Reduces systemic absorption, prolonging the anesthetic effect. C. Enhances anesthetic potency directly. D. Prevents allergic reactions to the anesthetic.

A

B. Reduces systemic absorption, prolonging the anesthetic effect. Explanation: Vasoconstrictors reduce blood flow in the area, slowing systemic absorption and prolonging the anesthetic’s duration while reducing toxicity.

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16
Q

Which local anesthetic is commonly used topically for mucous membranes but has high systemic toxicity? A. Lidocaine B. Tetracaine C. Cocaine D. Benzocaine

A

C. Cocaine. Explanation: Cocaine is used topically on mucous membranes, especially in ENT procedures, but carries risks of systemic toxicity and addiction.

17
Q

Which metabolite is responsible for allergic reactions caused by ester local anesthetics like Procaine? A. O-toluidine B. PABA (para-aminobenzoic acid) C. Acetylcholine D. Epinephrine

A

B. PABA (para-aminobenzoic acid). Explanation: Ester local anesthetics are metabolized to PABA, which can trigger allergic reactions in sensitive individuals.

18
Q

What is the role of sodium bicarbonate in local anesthetic formulations? A. Decreases the unionized form of the drug. B. Reduces systemic absorption. C. Increases the unionized form, enhancing penetration. D. Enhances ionized form, increasing potency.

A

C. Increases the unionized form, enhancing penetration. Explanation: Sodium bicarbonate alkalinizes the environment, increasing the unionized form of the anesthetic, which can cross the nerve membrane more effectively.

19
Q

Which local anesthetic is commonly used for spinal anesthesia due to its long duration of action? A. Lidocaine B. Bupivacaine C. Tetracaine D. Procaine

A

C. Tetracaine. Explanation: Tetracaine is preferred for spinal anesthesia because of its long duration and potency, although it has higher systemic toxicity.

20
Q

Which local anesthetic is contraindicated in patients with a history of cardiac arrhythmias? A. Lidocaine B. Bupivacaine C. Prilocaine D. Procaine

A

B. Bupivacaine. Explanation: Bupivacaine is cardiotoxic and can induce ventricular arrhythmias, making it unsafe for patients with pre-existing cardiac conditions.

21
Q

What is the most common side effect associated with spinal anesthesia? A. Nausea B. CSF leakage headache C. Septic meningitis D. Spinal cord injury

A

B. CSF leakage headache. Explanation: Post-dural puncture headaches, caused by CSF leakage, are the most common side effect of spinal anesthesia.

22
Q

What is the primary reason vasoconstrictors like epinephrine are avoided in end-artery areas like fingers or toes? A. Increased systemic absorption. B. Risk of ischemia and necrosis. C. Reduced anesthetic duration. D. Poor efficacy in these areas.

A

B. Risk of ischemia and necrosis. Explanation: Vasoconstrictors can significantly reduce blood flow in end-artery areas, causing ischemia and possible necrosis.

23
Q

Which of the following is true about lidocaine? A. It is ester-linked. B. It is used only for topical anesthesia. C. It can also be used as an antiarrhythmic. D. It is cardiotoxic.

A

C. It can also be used as an antiarrhythmic. Explanation: Lidocaine, an amide local anesthetic, is also used intravenously as an antiarrhythmic for ventricular arrhythmias.

24
Q

What property makes Bupivacaine preferred for obstetric anesthesia? A. Short duration. B. Reduced systemic toxicity. C. Long duration and high potency. D. Low protein binding.

A

C. Long duration and high potency. Explanation: Bupivacaine is preferred for epidural and obstetric anesthesia because of its long duration of action and high potency.

25
Q

What metabolite of ester local anesthetics can cause allergic reactions? A. O-toluidine B. PABA (para-aminobenzoic acid) C. Epinephrine D. Histamine

A

B. PABA (para-aminobenzoic acid). Explanation: Ester local anesthetics are metabolized to PABA, which is responsible for allergic reactions in sensitive individuals.

26
Q

Which local anesthetic has significant vasoconstrictive properties making it ideal for ENT procedures? A. Cocaine B. Lidocaine C. Bupivacaine D. Procaine

A

A. Cocaine. Explanation: Cocaine uniquely causes vasoconstriction, which is advantageous in ENT surgeries to reduce bleeding.

27
Q

What is the mechanism of action of local anesthetics? A. Block sodium channels in the resting state. B. Block sodium channels in the activated and inactivated states. C. Enhance potassium channel activity. D. Decrease calcium influx.

A

B. Block sodium channels in the activated and inactivated states. Explanation: Local anesthetics block sodium channels, preventing depolarization and nerve conduction.

28
Q

Which local anesthetic is most likely to cause methemoglobinemia? A. Prilocaine B. Lidocaine C. Procaine D. Bupivacaine

A

A. Prilocaine. Explanation: Prilocaine is metabolized to O-toluidine, which can cause methemoglobinemia.

29
Q

Which local anesthetic is preferred for obstetric anesthesia due to its long duration and reduced motor block? A. Bupivacaine B. Lidocaine C. Tetracaine D. Ropivacaine

A

D. Ropivacaine. Explanation: Ropivacaine provides prolonged analgesia with less motor block, making it ideal for obstetric use.

30
Q

What is the primary factor determining the potency of a local anesthetic? A. Lipid solubility B. Protein binding C. Ionization D. pH

A

A. Lipid solubility. Explanation: Higher lipid solubility allows better penetration of nerve membranes, increasing potency.

31
Q

Which local anesthetic is commonly used in dental procedures? A. Articaine B. Bupivacaine C. Lidocaine D. Prilocaine

A

A. Articaine. Explanation: Articaine is popular in dentistry due to its excellent penetration and rapid metabolism.

32
Q

Why is epinephrine added to local anesthetic formulations? A. To prevent allergic reactions. B. To enhance systemic absorption. C. To prolong the duration of action. D. To increase drug metabolism.

A

C. To prolong the duration of action. Explanation: Epinephrine reduces systemic absorption, prolonging the anesthetic effect and minimizing toxicity.

33
Q

What property of ester local anesthetics makes them less suitable for prolonged procedures? A. High systemic toxicity B. Rapid metabolism by plasma cholinesterase C. Low lipid solubility D. Poor protein binding

A

B. Rapid metabolism by plasma cholinesterase. Explanation: Ester local anesthetics are quickly broken down, limiting their duration.

34
Q

Which local anesthetic is contraindicated in patients with pseudocholinesterase deficiency? A. Procaine B. Lidocaine C. Bupivacaine D. Prilocaine

A

A. Procaine. Explanation: Procaine, an ester local anesthetic, depends on pseudocholinesterase for metabolism, making it unsafe in deficiency.

35
Q

What effect does inflammation have on the efficacy of local anesthetics? A. Increases ionized form, reducing effectiveness. B. Decreases ionized form, enhancing effectiveness. C. Increases drug penetration. D. Does not affect efficacy.

A

A. Increases ionized form, reducing effectiveness. Explanation: Inflammation lowers pH, increasing ionized drug and reducing nerve membrane penetration.

Pharma 2 (2 decks)

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