Reading 1 (Group 2) Flashcards

1
Q

How accessible was opium in the 19th century?

A
  • Vials of raw opium were available at any English pharmacy or grocery store by the 19th century .
  • Opium-based ‘soothing syrup’ was sold as a cure for colic and almost all common infant ailments.
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2
Q

When was morphine first isolated? What was it named after?

A

1805

named after the Greek god of dreams, Morpheus.

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2
Q

how many tons of morphine are isolated each year?

A

Over one thousand tons of morphine is isolated from opium each year.

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3
Q

What is most opium converted to?

A

codeine

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4
Q

what is opium gum? What can it be filtered/made into?

A

(dried substance obtained from the opium poppy)

can be filtered into a morphine base and synthesized into heroin.

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5
Q

When was morphine first injected into the epidural space? When was it first used in an epidural infusion for pain relief during labour?

A

1979

1980

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6
Q

Since 199, what has happened to the amount of prescription opiods sold in the US? What does this correspond with?

A

it has almost quadrupled

a corresponding dramatic increase in deaths from opiate overdoses.

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7
Q

When was cocaine first discovered? by who? Where?

A

In 1860s, cocaine, one of the naturally occurring local anesthetic, was first discovered by Albert Niemann in Germany.

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7
Q

Who were the first people to notice cocaine’s anesthetic affect?

A

Freud and his colleague, Karl Kollar, first noticed cocaine’s anesthetic effect.

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7
Q

How many years after the introduction and subsequent mass use of opioids for epidural pain relief during childbirth, did the trend of opioid perscriptions and death start in the US?

A

20 years

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7
Q

What is an opioid?

A

An opioid is any substance that acts on the opioid receptors of the body. These are opium-like substances that bind to one or more of the different types of opioid receptors of the body. Opioids can be naturally occurring or synthetic.

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7
Q

What followed the development of Procaine? In what year? What was it used for?

A

lidocaine in 1943, which was widely used during World War II.

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7
Q

Who first introduced the injection of cocaine into a sensory nerve for surgical anesthesia? When?

A

Dr. William Stewart Halsted was the first who introduced the injection of cocaine into a sensory nerve for surgical anesthesia in 1884

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7
Q

When was cocaine first clinically used? Why? By who?

A

Cocaine was clinically used for the first time in 1884 by Sigmund Freud who used it on a patient with morphine addiction.

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8
Q

What is procaine? When was it developed?

A

Procaine is the first synthetic derivation of cocaine that was developed in 1904

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9
Q

What is a narcotic?

A

Narcotic is defined as “any psychoactive compound with sleep inducing properties” and is a central nervous system depressant.

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10
Q

How quick is the onset of cocaine and how is it administered?

A

Cocaine has very rapid onset and has many different ways of administration.

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11
Q

What is cocaine considered in the UK? How does this differ from what cocaine is considered in the US?

A

In the UK, cocaine is considered a Class A drug and is illegal to buy, sell, or possess under any circumstances. In the US, cocaine is a Schedule II drug and is highly controlled but can be used as a local anesthetic in certain medical procedures.

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12
Q

Who is albert neimann?

A

Albert Niemann was a graduate student at Göttingen University in Germany.

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13
Q

In what year did albert neimann isolate cocaine? From what?

A

1859 from coca leaves

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14
Q

What did albert neimann say was cocaine’s solutions (characteristics)?

A

a bitter taste, promote the flow of saliva, and leave a peculiar numbness, followed by a sense of cold when applied to the tongue

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15
Q

What was the beginning of coca leaf usage? how is it used? Why? Is it still used?

A

The coca leaf has been chewed and brewed traditionally for centuries among indigenous people in the Andean region.

hen chewed, coca acts as a mild stimulant and suppresses hunger, thirst, pain, and fatigue. Coca chewing and drinking of coca tea is carried out daily by millions of people in the Andes and is considered sacred within indigenous cultures.

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16
Q

What was the first recorded use of an epidural?

A

The first recorded use of an epidural involved injecting cocaine into the back of patient in New York in 1885.

17
Q

What is the most common local anesthetic in epidurals? What is the most common opioid in epidurals?

A

At present, bupivacaine is one of the most common local anesthetics found in epidurals and fentanyl is one of the most common opioids found in epidurals.

18
Q

What is the historical timeline of local anesthetics?

A

1921: Lumbar epidural anesthesia
1942: Obstetric deliveries using continuous caudal anesthesia with a semi-flexible needle and catheter
1949: Continuous epidural block for surgical procedures and continuous epidural block for labor, delivery and C-section
1979: Opioid in epidural space
1980: Opioid in epidural space for labor pain
1988: Patient-controlled epidural analgesia for labor pain
1993: Local anesthetic combined with opioids for labor analgesia (still used today)

19
Q

Is there more than one way to administer local anesthetics?

A

yes.

20
Q

What’s the most common way of delivering local anesthetics in dentistry? What is also common in dental procedures? how is this different from the most common way?

A
  • One of the most commonly used in dentistry is Topical anesthesia (e.g. over the counter tooth gel), which is applied externally and has a rapid onset with high concentration.
  • Infiltration anesthesia is also commonly used during dental procedure. However, unlike topical anesthesia, infiltration anesthesia is applied through injection and it is used for minor surgical procedures.
21
Q

How can opioids be delivered?

A

Opioids can be delivered orally, transdermally (through skin, e.g. patch), intravenously (into blood), subcutaneously (lower layer of skin), or injected into the epidural or subarachnoid space as described below.

22
Q

What type of anesthesia is widely used in childbirth? Where is the name derived from?

A

In childbirth, epidural anesthesia is widely used. The name derives from the location where the local anesthetic is injected, namely, the space immediately outside the dura matter (epi-dural, meaning ‘around dura’ – although more accurately epidural anesthesia is sometimes called ‘extradural anesthesia’, because it is infused in the space outside the dura enclosure).

23
Q

What does spinal anesthesia refer to?

A

Spinal anesthesia (also known as a spinal block, subarachnoid anesthesia or intrathecal anesthesia) involves injecting medication into the subarachnoid space (CSF)

24
Q

What is neuraxial blockade?

A

Neuraxial blockade refers to local anesthetics being delivered around the nerves of the CNS and includes both spinal and epidural anesthesia.

25
Q

What can drugs in the epidural space do?

A
  • Diffuse across spinal meninges
  • Exit invertebral foramina to reach muscle space
  • Diffuse into epidural fat
  • Diffuse into ligaments
26
Q

What does diffusion depend mainly on?

A

Diffusion depends mainly on fat solubility (whether the substance mixes better with fat or water).

27
Q

Is epidurally administered morphine more or less effective than systematically (IV) adminsitered morphine?

A

Epidurally administered morphine is more effective than systemically (e.g. IV) administered morphine,

28
Q

What type of epidural is more powerful than morphine epidurals?

A

an epidural with morphine and bupivacaine is more effective than morphine alone

29
Q

Where does local anesthetic have to cross to work?

A

Local anesthetics must cross the spinal meninges to the spinal cord in order to work.

30
Q

How do local anesthetics work?

A

Local anesthetics work by reversibly binding to the sodium channels on membranes of the nearby neurons. By binding to the sodium ion channels, they prevent the sodium ions from coming inside the neuron and as a result, the action potentials of those neurons are inhibited and they can no longer transmit pain signals.

31
Q

Do local anesthetics have a greater or lesser effect on neural fibres that are actively transmitting compared to those that are not? What implications does this have for A-delta vs C fibres?

A

Local anesthetics have a greater effect on neural fibers that are actively transmitting than on those that are not, which makes neural fibers with faster firing rates more susceptible to local anesthetics.

32
Q

Other than transmission, what is another factor that can make fibres more susceptible to local anesthetic?

A

Another factor that can make a fiber more susceptible is its size

33
Q

What is the order in which different types of neurons are affected?

A

1) Autonomic
2) Temperature
3) Pain
4) Touch
5) Pressure
6) Vibration
7) Proprioception
8) Motor.

34
Q

Which functions do local anesthetics effect more than motor functions?

A

Although local anesthetics reduces autonomic and sensory functions more than motor functions, they nonetheless affect all of them at least to some extent.

35
Q

How do opioids work? What do the opioid receptors generally respond to? What do opioid receptors have effects on?

A

Opioids work by binding to different types of opioid receptors (e.g. mu, kappa, and delta opioid receptors) found in the brain, spinal cord, and nervous tissue.

These receptors generally respond to endogenous opioids like enkaphalins and endorphins and have various effects, including analgesia, sedation, and other central nervous system depression (respiratory depression and low blood pressure are known potential risks of epidurals).

36
Q

Is fentanyl fat soluble? What does it primarily act through? Is it slowly absorbed by the body? What is the difference between blood levels of fentanyl after epidural administration compared to IV administration?

A

Fentanyl is highly fat-soluble and acts primarily through supraspinal or systemic effects (i.e., it has its effects on the brain, rather than the spinal cord). It is quickly absorbed by the body. Blood levels of fentanyl after epidural administration can reach those of IV administered fentanyl.

37
Q

Is morphine soluble? What does it primarily act through? How likely is it to be absorbed into the epidural space compared to fentanyl?

A

Morphine is highly water- soluble and acts primarily through direct spinal effects. It is more likely than fentanyl to be absorbed in the epidural space.

38
Q

Can local anesthetics be toxic? When?

A

Local anesthetics can be toxic if administered inappropriately.

39
Q

What happens when local anesthetic is absorbed in the injection site? What might this lead to? Which local anesthetic is most likely to cause these effects?

A

When the local
anesthetic is absorbed in the injection site, the peripheral nervous system (PNS) and
central nervous system (CNS) are depressed in a dose dependent manner.

The CNS depression can potentially lead to respiratory depression or cardiac arrest. Although all
local anesthetics carry comparable risk for CNS toxicity, bupivacaine exhibits greater
potential for direct cardiac toxicity than other agents

40
Q

When is Bupivacaine markedly toxic? What are some symptoms? what can/has happened?

A

Bupivacaine is markedly toxic if inadvertently given intravenously, causing excitation, nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, or seizures, followed by depression: drowsiness, loss of consciousness, respiratory depression and apnea. Bupivacaine has caused several deaths by cardiac arrest when epidural anesthetic has been accidentally inserted into a vein instead of the epidural space).

41
Q

How does fentanyl delivered epidurally affect the fetus and mother’s blood? What does repeated administration increase the likelihood of?

A

Fentanyl delivered epidurally diffuses into maternal blood and reaches the fetus through free transport across the placenta

Repeated administration increases the likelihood of fentanyl being taken up by fetal tissues

42
Q

In what dose of fentanyl do children and adults show respiratory depression? How does this compare to babies?

A

Children and adults show respiratory depression when levels of fentanyl are greater than 2ng/ml concentration in blood.

The concentration it takes to reach respiratory depression is assumed to be lower in babies, but there is no consensus on what that concentration is

43
Q

Can acute exposure to fentanyl through epidurals be linked to problems with the fetus?

A

Acute exposure to fentanyl through epidurals has been linked to problems with the fetus in case reports

44
Q

What are known risks involved with fentanyl epidurals?

A

known risks include:
* Prolonged labor (opioid and local anesthetic epidural may reduce uterine activity, Behrens, 1993)
* Increased need for forceps and C-section (Goodfellow et al, 1993)
* Fetal and maternal respiratory depression
* Problems with breast feeding (may be due to disrupted oxytocin release in labor)
* Maternal hypotension (low blood pressure)

45
Q

Is there is a small risk of adverse reaction to opioids? If so, what are they?

A

There is a small risk of adverse reaction to opioids that includes nausea/vomiting, urinary retention, and itching

46
Q

If administered improperly, what might the epidural do? What is the most serious known risk?

A

if administered improperly, the epidural may puncture the dura and cause an extended headache

47
Q

What is the most serious known risk of epidurals? How does this occur?

A

The most serious known risk is respiratory depression. This occurs through opioid action at chemoreceptors in the medulla that are involved in the control of breathing.

48
Q

What are the risks associated with different opioids dependent on?

A

Different opioids will have different effects on the respiratory and cardiovascular system depending on their solubility (fat versus water) and the receptors they target.

49
Q

What is the difference between potential risks from fentanyl and morphine?

A

Fentanyl may cause early-onset respiratory depression, while morphine can cause both early and late onset respiratory distress.

49
Q
A