Packet 4: Ocular Anesthetics

Question 1

Novocain: Other name

Answer 1

Procaine

Question 2

esters are broken down by ?

Answer 2

pseudocholinesterase: in most tissues

Question 3

amides are broken down by?

Answer 3

liver

Question 4

benoxinate:

Answer 4

esters of PARA-amino benzoic

Question 5

tetracaine:

Answer 5

ester of PARA- amino benzoic

Question 6

Proparacaine:

Answer 6

ester of META

Question 7

Lidocaine: ester or amide?

Answer 7

Amide

Question 8

xylocaine:

Answer 8

lidocaine

Question 9

other name for lidocaine:

Answer 9

xylocaine & akten

Question 10

what percentage can be used for procaine?

Answer 10

.5%

Question 11

what percentage can be used for benzocaine?

Answer 11

20-30%

Question 12

where do LA work?

Answer 12

INSIDE the cell:

Question 13

what do LA do?

Answer 13

block the Na+ channel = no cell membrane depolarization

Question 14

order of loss of sensation:

Answer 14

pain, temp, touch (vibration), pressure, motor

Question 15

what is the order to recover?

Answer 15

motor, pressure, touch, temp, pain

Question 16

what effects differential sensitivity?

Answer 16

more sensitive:

• unmylentated,
• smaller neurons (diameter)

Question 17

2 things to use LA for (that are not obvious)

Answer 17

funds cl exam & electroretinography

Question 18

what is ionizable?

Answer 18

N group

Question 19

does combining two LA’s increase effectiveness?

Answer 19

No, combining will not increase their effect beyond additive

Question 20

max concentration for proparacine:

Answer 20

.5%

Question 21

max conc. for benoxinate?

Answer 21

.5%: but not really used

Question 22

max conc. for tetracaine?

Answer 22

1% - but not commercially used at this dosage

Question 23

max conc. for cocaine?

Answer 23

20% - but not commercially used at this dosage

Question 24

what conc is benoxiate used at ?

Answer 24

.4% commercially, but .5% max

Question 25

when will the LA be less effective?

Answer 25

if there is inflammation and we have a more acidic environment or if inflamed conj so more is pulled into the conj systemically

Question 26

LA are bad to use with schemer's. why?

Answer 26

because it decreases tear secretion up to 40% but the lid margins are still sensitive so it could increase tear flow = difficult to interpret.

Question 27

T/F: we can use LA to treat long term abrasion?

Answer 27

False, this decreases healing and an ulcer can develop at the site of original damage

Question 28

when can we see folds in descemets?

Answer 28

epithelial toxicity: usually 1 per 1000

Question 29

when do we see more epi damage?

Answer 29

above 50

Question 30

when will healing start again after using LA?

Answer 30

usually 30 minutes

Question 31

what allergic hypersensitivity can you see with LA?

Answer 31

type 4: delayed allergic hypersensitivity

Question 32

T/F: no systemic allergic reactions have been reported after topical ocular use?

Answer 32

True

Question 33

LA's are ?

Answer 33

Central Depressant Drugs

Question 34

what do central depressants show up like?

Answer 34

1st: excitatory 2nd: depressive

Question 35

what dose should you not exceed with tetracaine?

Answer 35

5 mg

Question 36

what dose should you knot exceed with proparaciane?

Answer 36

10 mg

Question 37

T/F more concentrations will linearly increase toxicities?

Answer 37

FALSE: toxicities are geometric progression, more than linearly

Question 38

when should you use LA's more conservatively?

Answer 38

with myasthenia graves and glaucoma

Question 39

Take culture before/after LA?

Answer 39

BEFORE

Question 40

what LA's are preserved with cholobutanol?

Answer 40

tetracaine, benoxinate

Question 41

what is cocaine preserved with?

Answer 41

nothing

Question 42

what is proparacine hydrochloride preserved with ?

Answer 42

benzakonium chloride

Question 43

what is proparacine hydrochloride with fluorescein sodium preserved with?

Answer 43

thimerosol

Question 44

what is fluress?

Answer 44

benoxinate hydrochloride with fluorescein sodium

Question 45

which is a prototype drug?

Answer 45

tetracaine

Question 46

which has the least irritation?

Answer 46

proparacaine

Question 47

ophthaine: other name

Answer 47

proparacaine

Question 48

proparacaine: other name

Answer 48

ophthaine

Question 49

is allergy common or uncommon with tetracaine?

Answer 49

uncommon

Question 50

propane with fluorescein is preserved with?

Answer 50

thimerosal

Question 51

who has a greater response with LA? older or younger

Answer 51

above 40 = even .125% was therapuetic

Question 52

which is a good bactericidal?

Answer 52

benoxinate

Question 53

what is fluress?

Answer 53

benoxinate with flouresceine preserved with benzokonium chloride

Question 54

akten: other name

Answer 54

lidocaine

Question 55

which is used as a gel?

Answer 55

lidocaine

Question 56

lidocaine available in what form?

Answer 56

3.5% gel formulation

Question 57

onset time of lidocaine gel?

Answer 57

60 seconds

Question 58

cross reaction of lidocaine with esters?

Answer 58

no because lidocaine is an amide

Question 59

how is cocaine available?

Answer 59

4& and 10% solutions for topical use

Question 60

which is most toxic to the cornea?

Answer 60

cocaine

Question 61

does epi work with epinephrine?

Answer 61

no benefit in longer acting i.e. bupivacaine

Question 62

hyaluronidase: what does it do

Answer 62

use when treating larger area with lots of connective tissue and it will break down intersitiatl matrix and make more effectiveness in that area.

Question 63

epipherine: what does it do to chances of systemic toxicities?

Answer 63

decreases them; because less gets out into the systemic area

Question 64

____ metabolism is slowed with AchE inhibitors

Answer 64

Esters