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APM- Pharmacology > pharm of LA > Flashcards

pharm of LA Flashcards

1
Q

Define anaesthesia

A

Without feeling or sensation

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2
Q

Define local anaesthesia

A

Loss of feeling restricted to a particular region

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3
Q

When is local anaesthesia used?

A

To enable minor or major operative procedures to be carried out To provide relief from prolonged severe pain

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4
Q

What can local anaesthesia be produced by?

A
  1. Local anaesthesia can be produced by:2. Cooling with ethyl chloride (block of neuronal conduction at 8-10°C)3. Pressure (used to reduce discomfort from injection in palatal tissue)4. Hypoxia5. Irreversible blockade (phenol ethanol, radiofrequency lesion)6. true local anesthetics
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5
Q

Give examples of irreversible blockers used as local anaesthetics

A

Phenol ethanol| Radiofrequency lesion

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6
Q

Describe true local anaesthetics

A

A substance applied to any nerve fibre in sufficient concentration will produce reversible blockade of axonal conduction without depolarisation

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7
Q

What is a local anaesthetic?

A

A local anaesthetic is a drug that causes reversible local anaesthesia and a loss of nociception (the neural processes of encoding and processing noxious stimuli)

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8
Q

Define nociception

A

The neural processes of encoding and processing noxious stimuli

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9
Q

How do local anaesthetics work?

A

They reversibly block impulse conduction along nerve axons and other excitable membranes that utilise sodium channels as the primary means of generating action potentials

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10
Q

What is the result of using local anaesthetics on specific nerve pathways?

A

Effects such as analgesia and paralysis can be achieved

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11
Q

Define analgesia

A

Loss of pain sensation

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12
Q

Loss of pain sensation

A

Loss of muscle power

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13
Q

Name some techniques local anaesthetics are used in?

A
  1. Topical application2. Subcutaneous injection 3. Nerve block 4. Epidural 5. Intrathecal
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14
Q

Where is a topical anaesthetic applied?

A

Around the gums, cornea and skin prior to venipuncture

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15
Q

What is a Subcutaneous injection?

A

An infiltration anesthesia can be one or more injections

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16
Q

Where is a nerve block applied?

A

Around the nerve

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17
Q

Where is an epidural given?

A

Into the epidural space; child birth

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18
Q

Where is an intrathecal anesthetic given?

A

Into subarachnoid space| It is a form of spinal anesthesia

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19
Q

List some ideal properties of local anesthetic

A
  • stable in solution, (requires no additive)* non-irritating to tissues* no permanent damage to nerves* no systemic toxicity* no allergic response* potent* rapid onset of action* predictable duration of action* Must be a sensory not a motor block* Must have no active metabolites
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20
Q

On what day is the first recorded use of general anaesthetics?

A

October 16th 1846

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21
Q

What did Dr Karl koller notice?

A

That the end of his tongue went numb when he tasted cocaine| He then dropped some cocaine dissolved in water into his eye – noticed its tissue-numbing capabilities

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22
Q

What did Dr Koller demonstrate in 1884?

A

The potential for cocaine to be used as a local anaesthetic in eye surgery

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23
Q

What is Dr Kollers nick name?

A

Coca Koller

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24
Q

What replaced cocaine as a local anaesthetic and when?

A

In the 20th century, other agents such as lidocaine replaced cocaine as a local anaesthetic

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25
Q

What is the aromatic terminal of LA’s described as and why?

A

Lipophilic as is contains no positive or negative charges

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26
Q

Define lipophilic

A

Lipid soluble

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27
Q

Why is the aromatic terminal essential for LA’s?

A

In order for them to penetrate fatty tissues such as the lipid sheath of nerves in order to gain access to the nerve cell membranes to reach its site of action

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28
Q

What is the amino terminal in local anaesthetics described as?

A

Water soluble or hydrophilic

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29
Q

Why is solubility in water essential for LA’s?

A
  1. To allow for the dissolution in a solvent to permit injection 2. To allow penetration through interstitial fluid allowing administration
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30
Q

How does the amide structure of articaine differ from other local anaesthetics?

A

The amide structure is similar but the molecular structure differs through the presence of a thiophene ring instead of a benzene ring

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31
Q

Name some ester linked agents

A

Cocaine| Procaine

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32
Q

Describe what cocaine does and when it was used?

A

It was first used in 1884, It is a good penetratorIt is not used as much now as it is a drug of abuse, It blocks sodium re uptake

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33
Q

What are the major disadvantages of cocaine?

A

Cocaine is an intense vasoconstrictor and has a potential to cause cardiovascular toxicity

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34
Q

Describe what procaine does and when it was used?

A

First used in 1905 as a nerve blockerHas low potent and last for a short duration Not used much now

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35
Q

Name the type of procaine given as an epidural during childbirth

A

2-chloroprocaine

36
Q

Name some amide linked agents

A
  1. Lidocaine 2. Prilocaine3. Mepivacaine4. Bupivacaine 5. Ropivacaine 6. Articaine
37
Q

What does lidocaine do?

A

It is used as a vasodilator It reduces cardiac excitability Affects the central nervous system in large doses

38
Q

Name the most commonly used amid linked LA used in dent?

A

Articaine

39
Q

Name the ketone type agent we use as an LA

A

Dyclonine

40
Q

What is dyclonine used as?

A

A liquid topical anaesthetic agent

41
Q

Heat properties does dyclonine have

A

Has bactericidal and fungicidal properties

42
Q

What is the pKa of most LAs and what does this mean?

A

Between 8.0 -9.0| This means at pH 7.4about 5 - 20% of the LA will be in the non ionised form

43
Q

What does a pKa value indicate?

A

It is the acid dissociation constant| It indicates the pH at which the ionised and non ionised forms of the substance are at equal concentrations

44
Q

Why must a high concentration of LA be administered?

A

As only a small fraction of LA molecules will reach the target site

45
Q

Name some of the major determinant of how well the LA will penetrate the tissues

A
  1. Site of administration 2. the lipid solubility of the drug 3. The pKa of the drug4. Pathophysiological factors eg inflammation
46
Q

What are sodium channels?

A

They are integral membrane proteins that form ion channels| These channels allow sodium ions to pass through the cells plasma membrane

47
Q

What is the trigger for voltage gated sodium channels to open?

A

Voltage change

48
Q

How do local anaesthetic drugs affect sodium channels?

A

They inhibit the influx of Na+ ions through ththe voltage gated sodium Channels This means an action potential cannot be generated so conduction inhibited

49
Q

What is an action potential?

A

It is a self regenerating wave of electrochemical activity that allow excitable cells to carry a signal over a distance

50
Q

When are sodium channels closed?

A

When the channel is fully polarised

51
Q

What happens as you increase the concentration of LA to thte nerve fibre?

A
  1. Threshold for excitation increases2. Impulse conduction slows 3. Rate of the rise of the action potential declines 4. Actionable potential amplitude decreases 5. Ability to generate action potential is abolished
52
Q

What is the sensitivity to inhibition by LAs a function of?

A

Nerve diameter| Myelination

53
Q

Describe post ganglion is autonomic nerves

A

They have a small diameter and are unmyelinated

54
Q

State the order of sensitivity to LA inhibition

A

Autonomic > warmth > pain> touch > pressure

55
Q

Do sodium channels in the rested state or activated state have a higher affinity to LA?

A

Channels in the activated state

56
Q

Which LA blocks only the sodium ion channels in their resting state?

A

Benzocaine

57
Q

What is acidosis?

A

An increased acidity of the blood plasma

58
Q

When does acidosis occur?

A

When arterial p( falls below 7.35

59
Q

When does alkalosis occur?

A

When arterial pH is over 7.45

60
Q

What does acidosis do?

A

It can partly reduce the action of LA

61
Q

Why does acidosis reduce the action of LA?

A

Because most of the anaesthetic is ionised and therefore can not cross the cell membrane to reach the cytoplasmic facing site of action on the sodium channel

62
Q

Local anaesthetic in which form can cross the cell membrane?

A

Only the non ionised for of LA can cross the cell membrane to reach the cytoplasmic facing site of action on the sodium channel

63
Q

Describe characteristic of neurones that are more sensitive to blockage by LA

A
  1. Short axons 2. Nerves which are not in their resting state 3. Small myelinated nerves 4. motor nerves are usually blocked first in large mixed nerves
64
Q

What happens to the level of inhibition when there are long intervals between nerve impulses?

A

The level of inhibition of each impulse will be the same (tonic blockade)

65
Q

What happens to the level of inhibition when there are short intervals between nerve impulses?

A

The level of inhibition increases with each impulse (phasic blockade)

66
Q

List the sites we can administer LA from fastest to slowest absorption rate

A
  1. Intravenous 2. Mucous membrane3. Intercostal block4. Causal block5. Epidural block6. Brachial plexus block7. Peripheral nerve block8. Subcutaneous infiltration
67
Q

What us hypersensitivity a result of?

A

Anaphylactic reaction (allergic reaction) to LA

68
Q

Hypersensitivity is associated with which toe of LA?

A

Esters and very rarely with amides

69
Q

How can LA toxicity affect the CNS?

A

Initial effects are excitatory with involuntary muscle activity Later effect is depressant which may lead to unconsciousness

70
Q

How can LA toxicity affect the Heart?

A

Possible feduction in cardiac output may lead to circulatory collapse (Rare)

71
Q

What is a toxic effect of prilocaine and articaine?

A

Methaemoglobinaemia

72
Q

What are some of the symptoms of Methaemoglobinaemia?

A
  1. Cyanosis 2. Lethargy 3. Respiratory distress which doesn’t respond to oxygen
73
Q

What is the treatment for Methaemoglobinaemia?

A

Administer methylene blue intravenously 1-2mg/kg

74
Q

Is Methaemoglobinaemia a concern in the dental practice?

A

No because we use small amounts of LA

75
Q

What do vasoconstrictors do?

A

They restrict the diffusion of the LA away from the site of injection and thus allows the LA to stat at rhs site for longer producing a longer duration of action

A- reduced local anaesthetic systemic absorption
B- increased anaesthetic concentration near nerve fibres

76
Q

Wh6 are LAs frequently given with vasoconstrictors?

A

To:1. prolong action2. reduce plasma levels (less risk of CNS effects?)3. ‘greater anaesthesia’ or reduced dose4. reduced operative haemorrhage

77
Q

Which vasoconstrictors is usually used?

A

epinephrine (adrenaline) 1:200,000, or norepinephrine (noradrenaline) 1:100,000

78
Q

When are vasoconstrictors not administered with LA?

A

when injected into extremities (fingers & toes) since, with a more limited circulation, there is a risk of tissue hypoxia

79
Q

What happens if the sodium current is blocked?

A

over a critical length of the nerve, propagation across
the blocked area is no longer possible

80
Q

Why do action potentials jump down axon

A
  1. As charge spreads down an axon, myelination (via Schwann cells) prevents
    ions from leaking out across
    the plasma membrane.
  2. Charge spreads
    unimpeded until it reaches an unmyelinated section of the axon, called the node of Ranvier, which is packed with Nat channels.
  3. In this way, electrical signals continue to jump
    down the axon much raster
    than rhey can move down
    an unmvelinated cel
81
Q

What is frequency dependant block ?

A

the effect of local anaesthetic at a given concentration is more marked in rapidly firing axons than in resting fibres

82
Q

Agents w vasoconstriction activity

A

cocaine and bupivacaine constrict blood vessels

83
Q

Adrenaline (epinephrine)

A

stimulation of a adrenoceptors constrict blood vessels (also stimulates cardiac B1 adrenoreceptors)
most common dental LA in UK is 2% lidocaine + 1:80,000 adrenaline. Other countries use 1:100,000 or 1:200,000
Dose equivalent to 28 mg; plasma concentration in patients awaiting dental surgery 0.027 mg/m

84
Q

Effectiveness of felypressin (analogue of vasopressin)

A

-Vasoconstriction, but less effective than adrenaline
-no effect on heart, conduction/contraction

85
Q

What is frequency dependence?

A

degree of block produced at a given concentration of local anaesthetic agent is markedly dependent upon the recent frequency of nerve stimulation or use

  • resting nerve is far less sensitive due to the requirement for the inner gates of the sodium channel to be open for the local anaesthetic to gain access to the binding site
  • small diameter C and AS pain fibres that participate in high frequency pain transmission, are blocked earlier and sooner with low concentrations of local anaesthetic than are the Ad fibres
86
Q

Hierarchy of LA effects on sensory function

A

Sensory function lost in the following general order
1. Cold
2. Warmth
3. Pain (‘first pain’ (A-delta fibres), then ‘second pain’ (C fibres)
4. Touch
5. Deep pressure
6. Motor function (relatively resistant, possible for LAs to block nociception with little effect on motor function)

APM- Pharmacology (5 decks)

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