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Ane Class Practice > Pain Exam 1-S4 > Flashcards

Pain Exam 1-S4 Flashcards

1
Q

A drug that in moderate doses dulls the senses, relieves pain and induces profound sleep, but in excessive doses causes stupor, coma or convulsions. Potential for abuse?

A

Narcotic

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2
Q

Narcotic analgesic derived from an opium poppy?
Morphine
Codeine

A

Opiate

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3
Q

A narcotic analgesic that is at least part synthetic, not found in nature?
Heroin
Fentanyl

A

Opioid

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4
Q

What created the 5 schedules (classifications) of drugs which control the manufacture, importation and use/distribution of substances?

A

Controlled Substances Act (CSA)
Established federal us drug policy

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5
Q

Which Schedule has the highest potential for abuse and is no current accepted medical use?

A

Schedule I

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6
Q

This schedule has
-Highest potential for abuse
- NO current accepted medical use
- Lack of accepted Safety for use of the drug.
- No prescriptions may be written
- Heroin
-LSD
-Marijuana
-MDMA

A

Schedule I

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7
Q

This schedule has
- High potential for abuse
- Currently accepted medical use w/ restrictions
- May lead to severe dependence
- 7 day prescription only
- NO refills
- Cocaine, Opium, Fentanyl, Oxycodone, Morphine, methadone

A

Schedule II

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8
Q

Which schedule of drugs can have 7 day prescriptions with up to 90 day supply?

A

Schedule II

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9
Q

This schedule has
- Potential for abuse less than I and II
- Accepted medical use
- Lead to low physical dependence or high psyschological dependence
- Ketamine
- Anabolic Steroids

A

Schedule III

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10
Q

This schedule has
- Low potential for abuse
- Accepted medical use
- May lead to limited physical dependence.
- Benzos
- Tramadol
- Chloral hydrate

A

Schedule IV

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11
Q

This schedule has
- Low potential for abuse
- Accepted medical use
- May lead to limited physical dependence
- Pregabalin
- Cough suppressants
- Atropine (lomotil)

A

Schedule V

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12
Q

APRN (Except psych NP) can prescribe Schedule II controlled substances for how many days?

A

7 days

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13
Q

APRN must complete how many hours of CE every 2 years for prescription authority and is required?

A

3 hours

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14
Q

In 2001 who issued pain management standards that instructed hospitals to measure pain and prioritize its treatment?
5th Vital sign

A

Join Commission

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15
Q

> 60% of drug overdose deaths are caused by what?
78 Americans die every day
Record in 2014

Now more than 28k Americans yearly

A

Fentanyl

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16
Q

T/F
More people die annually of opiod ovderdose than MVA?

A

True

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17
Q

SRNA and CRNA substance abuse rate?

A

Now more than 15%

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18
Q

One of the strongest NSAD pain reliever combinations available is what?
Stronger than oxycodone and percocet

A

200mg ibuprofen and
500mg acetaminophen

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19
Q

Max dose of tylenol daily?

A

3000mg daily or
3 grams

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20
Q

Advil is a combination of ibuprofen 125mg and acetaminophen 250mg.
What is the max dose of Advil Qd?

A

3200mg daily

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21
Q

Uncontrolled chronic pain can lead to what?

A

Disability and despair

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22
Q

Loss of awareness is called ___?

A

Hypnosis

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23
Q

Loss of memory is called ___?

A

Amnesia

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24
Q

Loss of pain is called ___?

A

Analgesia

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25
Q

Loss of movement is called ___?

A

Akinesis

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26
Q

Persistent post-surgical pain is chronic pain that continues beyond the usual healing period of ?

A

1-2 months following surgery

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27
Q

Smoking cessation is to stop smoking __ weeks before procedure?

A

8 weeks

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28
Q

Heat loss caused by IV fluids and laying on the cold table is called?

A

Conduction
(most)

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29
Q

Heat loss caused by oxymask and betadine drying is called?

A

Evaporation

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30
Q

Heat loss caused by cold temperature in the OR coming across the patient?

A

Convection

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31
Q

Heat loss caused by skin exposure in the OR is called?

A

Radiation

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32
Q

What is the average patient temperature decrease in the first 20 mins after induction?

A

1.5 C decrease

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33
Q

Ondasetron(Zofran) works on which receptor?

A

Serotonin 5HT-3
Antagonist

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34
Q

Metoclopramide(Reglan) and Chlorpromazine work on which receptor?

A

Dopamine D2
Antagonist

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35
Q

Scopolamine and hydroxyzine work on which receptor?

A

Anticholinergic and Antihistamine
Antagonist

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36
Q

PONV prophylaxis
Dexamethasone dose?

A

4-12mg IV

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37
Q

PONV prophylaxis
Ondansetron dose?

A

50-200 mcg/kg
4-8mg typical

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38
Q

PONV prophylaxis
Metoclopramide dose?

A

100-250 mcg/kg

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39
Q

What 3 things can minimize postoperative ileus?

A

Hydration
Movement (early movement post-op)
Minimize or remove opioids

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40
Q

Administration of what can ensure better preservation of
- pulmonary function
- early ambulation
- early physical therapy
- lowers risk post operative DVT

A

Local anesthetics

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41
Q

PCA- self administer small doses of narcotics and have
- Lock out periods
- Max PCA dosage
- Basal Rate per Hour
The use of PCA allows what?

A

To objectively assess pain level by number of PCA dose and attempts.

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42
Q

PCA by proxy is used by activating the pump by someone other than the patient and utilized with what patients?

A

Pediatric
Hospice

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43
Q

This headache is a tight band-like pain that is associated with tightness in neck muscles. Gradual and fluctuates
Lasts hours to days.
- Frontal
- Temporal
- Occipital More bilateral than unilateral
Associated with emotional stress or depression.

A

Tension Headache.

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44
Q

This headache is a throbbing or pounding and associated with photophobia, scotoma, N/V.
Lasts 4-72 hours.
Often has localized transient neurological dysfunction (AURA)
- Unilateral pain often
- Frontotemporal location

A

Migraine headache

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45
Q

_____ migraines are preceded by an aura whereas _____ migraines are not?

A

Classic migraine have aura

Common migraine do not

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46
Q

Migraines primarily affect
- Children
- Young adult females
- Family history
- provoked by odor, foods, menses and sleep deprivation.

A

Sleep typically relieves the headache.

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47
Q

-Oxygen
-Sumatriptan(Amitrex) 6mg subq
-IV lidocaine 100mg
- sphenopalatine block
are abortive treatments for what?

A

Rapid abortive treatment for migraines

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48
Q
  • adrenergic blockers
  • CCB
  • Valproic acid
  • amitriptyline
    are prophylactic treatment for what?
A

Prophylactic treatment for migraines

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49
Q

This headache is classically unilateral and periorbital
-one to three attacks a day over 4-8 weeks
- burning or drilling sensation
- can awaken from sleep
- lasts 30-120 mins
- ptosis (horner’s syndrome)
- red eye
- tearing
- nasal stuffiness
- treated with prednisone or lithium

A

Cluster Headache

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50
Q

Which headache affects males (90%) and typically episodic but can become chronic?

A

Cluster headaches

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51
Q

Inflammatory disorder of the extracranial arteries?
- Headache can be bilateral/unilateral
- Dull and boring in quality
- Temporal region
- develops over few hours and lancinating(stabbing)
- worse at night and cold weather

A

Temporal arteritis

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52
Q

Which disorder can lead to blindness if not treated?

A

Temporal arteritis

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53
Q

How is temporal arteritis diagnosed?

A

Temporal artery biopsy

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54
Q

This disease is a vesicular dermatomal rash that lasts 1-2 weeks.
- severe pain
- Affects T3-L3 dermatomes
- Most common in elderly
- can go blind if affects eye

A

Herpes zoster virus

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55
Q

Treatment for Herpes zoster includes?

A

Supportive
Oral analgesics
acyclovir or valacyclovir to reduce the duration

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56
Q

Which type of patients affected by herpes zoster virus require IV acyclovir therapy?

A

Immunocompromised patients

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57
Q

Post-herpetic neuralgia (PHN) is difficult to treat, but ____ and _____ may decrease the incidence of PHN in patients older than 50 yo?

A

Oral corticosteroids
Transdermal lidocaine patch

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58
Q

What is the most common type of neuropathic pain?

A

Diabetic neuropathy

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59
Q

The most common syndrome associated with diabetic neuropathy is ___ _____?
Which results in symmetric numbness “stocking and glove”

A

Peripheral polyneuropathy

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60
Q

Isolated mononeuropathies associated with diabetic neuropathy are ____ ___can have a sudden onset and last a few weeks are reversible?

A

Wrist/Foot drop
Cranial nerve palsy

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61
Q

What affects the gastrointestinal track causing diarrhea, delayed gastric emptying, and delayed esophageal motility?

A

Autonomic neuropathy

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62
Q

The combination of gabapentin and amitriptyline are particularly effective in treating what condition?
Possibly Tramadol for analgesia

A

Diabetic neuropathy

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63
Q

A positive Patrick’s sign is associated with what?

A

Hip pain rather than lower back pain.

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64
Q

Constant pain with localized tenderness over vertebrae, bony destruction, and neural or vascular compression are associated with what?

A

Spinal tumors

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65
Q

What can present like a herniated disk and may rapidly progress to flaccid paralysis if not treated?

A

Epidural or Intradural tumor

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66
Q

Patients with what condition present with chronic back pain without fever or leukocytosis?

A

Spinal tuberculosis

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67
Q

Patients with what condition present with acute back pain, fever and leukocytosis?

A

Epidural abscesses

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68
Q

Patients with what condition present with low back pain associated with early morning stiffness?
Pain is insidious onset, improves with activity but can progress to restricted movement within months/years?

A

Ankylosing spondylitis

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69
Q

Radiographic evidence of sacroiliitis is used to diagnose what condition?
“Bamboo- like” appearance

A

Ankylosing spondylitis

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70
Q

Indomethacin is an NSAID that can reduce early morning stiffness and used to treat what?

A

Ankylosing spondylitis

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71
Q

This disease is associated with symptoms of conjunctivitis, urethritis, and arthritis?

A

Reiter’s syndrome

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72
Q

What disorder is commonly characterized by pain radiating in a fixed pattern that does not follow dermatomes and tight ropy bands over trigger points from acute injury?

A

Myofascial syndrome

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73
Q

Gross trauma or repetitive microtrauma plays a role in initiating what?

A

Myofascial syndromes

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74
Q

The diagnosis of what is pain and palpation of discrete trigger points that reproduce it?

A

Myofascial syndromes

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75
Q

Myofascial syndromes are treated with the use of what two things?

A

Topical cooling with ethyl chloride to cause muscle relaxation and
Local anesthetic injection of trigger area

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76
Q

Cancer pain involves a 3 step approach using what?
1.
2.
3.

A
  1. Nonopioids for mild pain
  2. Weak oral opioids for moderate pain
  3. Stronger opioids for severe pain
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77
Q

A fixed schedule rather than PRN and Antidepressants and other modalities should be used liberally with patients who have this condition?

A

Cancer pain

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78
Q

Clavicle dermatome?

A

C4

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79
Q

Nipple dermatome?

A

T4

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80
Q

Xiphoid dermatome?

A

T6

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81
Q

Umbilicus dermatome?

A

T10

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82
Q

Tibia dermatome?

A

L4-L5

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83
Q

Perineum dermatome?

A

S2-S5

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84
Q

TENS stimulation causes conduction block in which fibers?

A

Conduction block in small afferent pain fibers

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85
Q

The stimulation of large A fibers in the dorsal column of the spinal cord is called what?

A

Spinal cord stimulation or Dorsal column stimulation

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86
Q

What is most effective for neuropathic pain?

A

Spinal cord stimulation

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87
Q

Spinal cord stimulation placement is under what anesthesia?

A

MAC sedation, TIVA
in order to check with patient if placement is working

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88
Q

For Intracerebral stimulation the electrodes are implanted sterotactically into which areas?

A

Periaqueductal and periventricular gray areas

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89
Q

The most serious complications of Intracerebral stimulation are what?

A

Intracranial hemorrhage
Infection

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90
Q

This psychological intervention is based on the principle that patients can be taught to control involuntary physiological parameters?

A

Biofeedback

91
Q

This psychological intervention teaches patients to alter pain perception by having them focus on other sensations?

A

Hypnosis

92
Q

Heat or Cold pain relief?
Decreases joint stiffness and increased blood flow

A

Heat

93
Q

Heat or Cold pain relief?
Vasoconstriction and reduces inflammation

A

Cold

94
Q

Heat or Cold pain relief?

Ideal for chronic or arthritic pain, joint pain, osteoarthritis, pain that is not caused by immediate injury?

A

Heat therapy

95
Q

Heat or Cold pain relief?

Ideal for acute injuries first (48-72hrs) with swelling, pain, and muscle spasms.

A

Cold therapy

96
Q

Acupuncture stimulates ______ because its effects can be antagonized by naloxone?

A

Endogenous opioids

97
Q

Which Block allows assessment of the benefits and risk of neurolytic and neurodestructive blocks?

Typically for patients with severe intractable pain such as cancer pain.

A

Prognostic blocks

98
Q

Which Block is used to define the precise source of pain?

A

Diagnostic blocks

99
Q

Cervicothoracic (Stellate) block is

A

used for patients with head, neck, arm, and upper chest pain.
T5 ganglia

100
Q

Thoracic Sympathetic chain block is

A

lateral to the vertebral bodies and anterior to the spinal nerve roots, but this block is generally not used because of a significant risk of pneumothorax.

101
Q

Celiac plexus block is

A

indicated for patients with pain arising from the abdominal viscera, particularly cancers.
L1

102
Q

Spinal analgesia is primarily mediate by which opioid receptor?

A

Mu-2 receptors

103
Q

Supraspinal analgesia is mediated by all opioid receptors except which one?

A

Mu-2 receptors

104
Q

Which opioid receptor is associated with respiratory depression?

A

Mu-2 receptors

105
Q

These neurons transmit sensory information from the periphery to the CNS?

A

First Order Neurons

106
Q

These neurons communicate with reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus?

A

Second Order Neurons

107
Q

These neurons relay information from the thalamus to the cerebral cortex?

A

Third Order Neurons

108
Q

A sensory unit or ____ ___ ____ is where all somatosensory information from the limbs and trunk share common neurons?

A

Dorsal root ganglion

109
Q

Which pathway crosses the base of the medulla and the anterolateral pathway and relays information to the brain for perceptions, arousal and motor control?

A

Discriminative pathway

110
Q

Which pathway consists of bilateral multisynaptic slow conducting tract and provides sensory NOT of discrete localization or fine discrimination?

A

Anterolateral pathway

111
Q

What is the central integrative mechanisms?

A

Post central gyrus and cerebral cortex

112
Q

Emotional components of pain are experiences where?

A

Limbic system

113
Q

Autonomic nervous system responses are recruited where?

A

Brain stem centers

114
Q

Fast pain fibers?

A

Myelinated A-delta fibers
Acute

115
Q

Slow pain fibers?

A

Unmyelinated C fibers
Chronic

116
Q

Protopathic sensation?

A

Noxious
High threshold receptors
Smaller myelinated A-delta and un-myelinated C nerve fibers

117
Q

Epicritic sensation?

A

Non-noxious
Low threshold receptors
Light touch
Pressure
proprioception
Temperature discrimination
Large myelinated nerve fibers

118
Q

Pain can lead to leukopenia and leukocytosis along with ___ killer T cells and ___ immune function?

A

Decreased

119
Q

What are free nerve endings that sense heat, mechanical and chemical tissue damage?

A

Nociceptors

120
Q

Afferent ____ and Efferent _____

A

Afferent arrives
Efferent exits

121
Q

What type:
Respond to mechanical stimulation such as pressure, vibration or movement?

A

Mechanociceptors

122
Q

What type:
Respond to inflammation?

A

Silent nociceptors

123
Q

What type:
Respond to excessive pressure and temperature?

A

Polymodal mechanoheat and Thermoreceptors

124
Q

These nociceptors are
- most prevalent
- Respond to excessive pressure
- extreme heat
Respond to alogens

A

Polymodal mechanoheat nociceptors

125
Q

Meissner corpuscles (touch) are located which layer of skin?

A

Epidermis

126
Q

Merkel cell complexes (touch) and Ruffini endings (heat) are located which layer of skin?

A

Dermis

127
Q

Pacinian corpuscles (pressure) are located in which layer of skin?

A

Subcutis (beneath the dermis)

128
Q

Kinesthetic receptors do what?

A

Sense where the limbs are located in space and movement

129
Q

Muscle spindles do what?

A

Sensory receptors located in muscles that sense tension “stretch receptors”

Muscle memory

130
Q

In the Gate Theory, the spinal cord and brain stem contain gates, which fibers CLOSE the gates?

A

Large diameter A-beta fibers

131
Q

Which fibers open the gates?

A

A delta and C fibers

132
Q

Local anesthetics block Na channels, which form diffuses across the membrane and which form binds to the receptors?

A

Unionized- diffuses across
Ionized- binds to the receptor to inactivate

133
Q

Which nerve fibers have autonomic function?

A

B fibers

134
Q

These fibers are
5-12 microns
Large, myelinated
Transmit quick
Epicritic sensation
touch, pressure, proprioception

A

A-beta fibers

135
Q

These fibers are
1-5 microns
Myelinated with lipid
Transmit fast
First pain, or acute pain
Sharp, well localized sensation
Protopathic
Releases Glutamate

A

A-delta fibers

136
Q

These fibers are
0.4-1.2 microns
Unmyelinated
Transmit slow
Second pain or Chronic pain
Protopathic sensation of pain, temp, touch
Releases Substance P

A

C fibers

137
Q

Eudynia ?

A

Acute pain

138
Q

Maldynia?

A

Chronic pain

139
Q

This type of pain is due to nociceptive stimuli from skin, subcutaneous, and mucous membranes.
- Well localized
- Sharp, pricking, throbbing, burning.
Hives/Rash

A

Acute Superficial Somatic

140
Q

This type of pain arises from muscles, tendons, joints, or bones.
- Dull, aching quality
- Not well localized

A

Acute Deep Somatic

141
Q

This type of pain is due to disease process or abnormal function of internal organ.
- Dull, aching, diffuse
- Poorly localized

A

Acute Visceral

142
Q

This type of pain refers to a group of neuropathic pain disorders.
Nerve disorder occurs at the site of injury, most often the arms or legs.
- Chronic, severe burning pain.
- Changes in bone and skin, sweating, tissue swelling, and extreme sensitivity.

A

CRPS
Complex regional pain syndrome

143
Q

This typically affects the extremities and follows relatively minor trauma.
- 3 phases
- Can resolve spontaneously
- No nerve injury

A

Reflex sympathetic dystrophy
CRPS type I

144
Q

This typically follows a high velocity injury to large nerves.
- Immediate onset, allodynia, vasomotor and sudomotor dysfunction.
- Pain is exacerbated by fear, anxiety, noise or touch.
- Has nerve injury

A

Causalgia
CRPS type II

145
Q
  • Nociceptors are stimulated
  • Noxious, painful or tissue damaging stimuli affects a peripheral nerve ending.
  • Nerve is depolarized
  • Generates electrical impulse
    Which process?
A

Transduction

146
Q
  • Impulses is transmitted or carried throughout nervous system.
  • Spinothalamic tract is most important pathway for transmission.
    Which process?
A

Transmission

147
Q
  • Subjective interpretation of the pain
  • “How it feels to the patient”
    Which process?
A

Interpretation or perception

148
Q
  • Can either inhibit or facilitate pain.
  • Neural response
  • Many chemical messages are released.
    Which process?
A

Modulation

149
Q

Prostaglandins
Histamine
Bradykinin
Serotonin
Acetycholine
Lactic Acid
Hydrogen ions
Potassium ions
All are what?

A

Endogenous mediators of inflammation

150
Q

What are the 3 major functions of the pain pathway?

A
  1. Conduit for motor information
  2. Conduit for sensory information
  3. Center for coordinating reflexes
151
Q

Ventral?

A

Motor

152
Q

Dorsal?

A

Sensory

153
Q

First order neurons are located where?

A

Dorsal root ganglion

154
Q

Second order neurons are located where?

A

Dorsal horn gray matter

155
Q

Third order neurons are located where?

A

Inner chamber of the thalamus

156
Q

Which lamina make up the dorsal horn?

A

Lamina 1-6
Where all afferent stimuli comes into the spinal cord

157
Q

Lamina II is also called what?
Major site of action for what?

A

Substantia Gelatinosa

Site of action for opioids

158
Q

Lamina III, IV and VI do what?

A

Non-nociceptive sensory input

159
Q

Lamina VII does what?

A

Intermediolateral column, contains preganglionic symathetic neurons

160
Q

Lamina VIII and IX do what?

A

Motor
Anterior horn

161
Q

Lamina X does what?

A

Very small, involved in pain, temperature and visceral sensation.

162
Q

Wide dynamic range neurons are located where?

A

Lamina V

163
Q

Which neurons cause spinal wind up, increase firing rate without having an increase in intensity from stimulation?

A

Wide dynamic range neurons

164
Q

Which spinothalamic tract?
- neospinothalamic tract
- Posterior portion of the thalamus
- Carries pain and temperature up to the brain
- Carries discriminative aspects of pain, such as location, intensity and duration.
- Slow transmission

A

Lateral Tract

165
Q

Which spinothalamic tract?
- Paleospinothalamic tract
- Mediates the autonomic and unpleasant emotional perceptions of pain.

A

Medial tract

166
Q

Which pathway is associated with sensory and transmitting information via the Cuneatus and Gracilis tracts?

A

Ascending Sensory pathway

167
Q

What evaluate the integrity of the brain and spinal cord while monitoring the ascending sensory pathway?

A

Somatosensory Evoked Potentials (SSEPs)

168
Q

Which descending tract modulates pain by activating enkephalin neurons of the substantia gelatinosa?

A

Dorsolateral funiculus

169
Q

Somatic and visceral afferents are connected where?

A

Spinal cord

170
Q

Vasoconstriction
Smooth muscle spasm
Release of Catecholamines
- All mechanisms of what?

A

Chronic pain

171
Q

The most important excitatory peptides are what?
2

A

Substance P (pain) and
Calcitonin Gene related peptide (CGRP)
(arterial vasodilator)

172
Q

What is the most important excitatory amino acid?
1

A

Glutamate
Transmits pain impulses by changing Na ion channels

173
Q

Synthesized and released by First order neuron.
This facilitates ascending transmission in pain pathways.
- Causes a release of histamine from mast cells.
- Causes a release of serotonin from platelets.
Potent vasodilator

A

Substance P

174
Q

This alogen is Released from mast cells and platelets

A

Histamine

175
Q

This alogen is Released from tissues and causes increased vascular permeability, vasodilation and activates nociceptors?

A

Bradykinin

176
Q

Mediated by the release of alogens which contribute to inflammation and sensitivity and pain at the site of damage. Includes Histamine and Bradykinin release?

A

Primary Hyperalgesia

177
Q

Neurogenic inflammation
Triple response of redness, edema and sensitization to stimuli.
Occurs due to the release of prostaglandins and CGRP.

A

Secondary Hyperalgesia

178
Q

Phospholipase A2 enzyme is stimulated by what?

A

Tissue damage

179
Q

Activation of phospholipase A2 causes the release of what?

A

Arachidonic acid

180
Q

This converts arachidonic acid to prostaglandins and prostacyclins which potentiates edema from bradykinin?

A

Cycloxygenase

181
Q

This converts arachidonic acid to leukotrienes which cause increased vascular permeability and release of leukocytes?

A

Lipoxygenase

182
Q

Central modulation DOES NOT respond to which opioid receptor?

A

Kappa

183
Q

____ analgesia occurs when transmission stops at the spinal cord in the substantia gelatinosa?

A

Spinal

184
Q

____ analgesia occurs when transmission stops in the brain (limbic, thalamus, hypothalamus)?

A

Supraspinal

185
Q

____ released from the lamina II interneurons attach to the receptors of the C-fibers nerve terminals and inhibit the release of Substance P?

A

Enkephalins

186
Q

Which nerve innervates above the vocal cords?

A

Internal branch of superior laryngeal nerve

187
Q

Which nerve innervates below the vocal cords?

A

Recurrent laryngeal nerve

188
Q

Which nerve provides sensory to the vallecula and base of tongue?

A

Glossopharyngeal nerve IX

189
Q

Which nerve innervates the pharynx?

A

Glossopharyngeal nerve

190
Q

Which nerve innervates the oropharynx?

A

Vagus, trigeminal and glossopharyngeal

191
Q

Which nerve innervates the larynx?

A

Vagus nerve.
Internal branch above vocal cords and
Recurrent laryngeal nerve below vocal cords

192
Q

Airway blocks are used most often to aid with what?

A

Awake intubation, awake fiberoptics, awake laryngoscopy

193
Q

Which nerve block will abolish the gag reflex or hemodynamic response to laryngoscopy?

A

Superior laryngeal nerve block
Glossopharyngeal block

194
Q

What is defined as an aspiration of 25mL of gastric contents with a pH of less than 2.5.
- Can produce aspiration pneumonia
- Potentially fatal

A

Mendelson’s Syndrome

195
Q

With Local anesthestics, Esters are metabolized by what?

A

Plasma cholinesterase

196
Q

With Local anesthestics, Amides are metabolized by what?

A

Primarily in the liver by CYP enzymes

197
Q

Which locals are most likely to cause an allergic reaction?

A

Esters secondary to Para-aminobenzoic acid (PABA) which is a metabolic end product of esters.

198
Q

Dibucaine number is used to check if patient is incapable of hydrolyzing ester locals?

A

Results in decreased enzyme function

199
Q

Dibucaine =80

A

Normal response
Homozygous typical

200
Q

Dibucaine = 50-60

A

Lengthened by 100%
Heterozygous atypical

201
Q

Dibucaine = 20-30

A

Prolonged 4-8 hours
Homozygous atypical

202
Q

What are mirror images that can not be superimposed on eachother called?

A

Optical isomers (enantiomers)

203
Q

What contains two isomers in equal concentrations?
50:50 ratio?
Which local does this apply to?

A

Racemic Mixture

Bupivacaine is a racemic mixture

204
Q

What determines the potency of local anesthetics?

A

Lipid solubility

As lipid solubility increases so does the ability of the molecule to penetrate the cell membrane.

205
Q

What determines the duration of action of local anesthetics?

A

Protein Binding

206
Q

Local anesthetics exist as a ?

A

Weak base

207
Q

Which form of local anesthetic is lipid soluble and penetrates the cell membrane easily?

A

Un-ionized form

208
Q

Which form of local anesthetic is water soluble and binds to the receptor?

A

Ionized form

209
Q

If pKa is close to the physiological pH then there will be a ____ concentration of non-ionized base and a ____ onset?

A

Higher concentration

Faster onset

210
Q

Adding Sodium Bicarbonate to a Local ane does what?

A

Increases the amount of free base form (Unionized) of the local.
speeds the onset
Prolongs the duration of block
Decreased pain

211
Q

T/F
Local anesthetics alter the resting membrane potential?

A

False
They block propagation of a nerve impulse.

212
Q

Local anesthetics bind more rapidly when the conformational state is in ___ state?

A

Open or inactivated state

213
Q

What is the order of nerve fiber blockage by local anesthetics?

A
  1. SNS response
  2. Temperature perception
  3. Motor response
  4. Proprioception
214
Q

Which local anesthetic toxicity is associated with CV collapse?

A

Bupivacaine

215
Q

Epinephrine is added to local anesthetics for what?

A

To extend the duration of action and limit the drugs absorption.

216
Q

What is the epinephrine dose for locals?

A

5mcg/mL

1g:200,000ml

217
Q

Which system is responsible for the extraction of local anesthetics?

A

Pulmonary system

218
Q

Largest reservoir of local anesthetics is?

A

Skeletal muscles

219
Q

Amide local anesthetics rate of metabolism?
mepivacaine
lidocaine
bupivacaine
ropivacaine
prilocaine

A
  1. prilocaine
  2. lidocaine
  3. mepivacaine
  4. ropivacaine
  5. bupivacaine
220
Q

Amide local anesthetics effects on vasculature?
Which drugs vasodilate and which drugs vasoconstrict

A

Vasodilate- Lidocaine then Bupivacaine

Vasoconstrict- Ropivacaine then Mepivacaine

221
Q

Which LA location has the slowest onset and longest duration?

A

Brachial plexus blockade

222
Q

Which LA location has the quickest onset and shortest duration?

A

Subarachnoid blockade

223
Q

The spread of local anesthetics and depth of epidural/spinal is greatest affected in pregnancy by what?

A

If the patient is a parturient and previously had children.

224
Q

Lipid emulsion therapy to treat LAST dosage?
>70kg and. <70kg

A

> 70kg dose is 100mL bolus over 2 mins then infuse 200-250mL over 15 mins

<70kg dose is 1.5mL/kg bolus over 2 mins then infuse 0.25mL/kg/min ideal body weight

Do not give more than 12mL/kg

Ane Class Practice (26 decks)

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