W4: Pharmacology of Local Anaesthetics Flashcards

1
Q

What is the chemical origin of cocaine?

A

From coca plant
Is an alkaloid
Contains a amine group (weak base) and an ester bond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the naming stem for local anaesthetics?-

A

Suffix caine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the chemistry of most local anaesthetics?

A

Are amine - weak base linked to an aromatic group
Either contain an amide link such as lidocaine
Or an ester link such as procaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do local anaesthetics with an ester link vary from thoses with an amide link?

A

Ester link - shorter duration of action
Metabolised by plasma esterases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the physiological effects of local anaesthetic?

A

Prevent the generation of an action potential and transmission of impulses along nerve fibres.
More effective as smaller diamater fibres such as A-delta and C fibres.
Therefore sensitivity varies among neurons, so higher concentration of LA can have other variable effects, as affects any neurons/tissue that have voltage gated Na+ channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What tissue function is most sensative to the use of local anaesthetics?

A

MOST
Pain
Sensory
Autonomic neurons
Motor function
LEAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does the diameter of the nerve fibre effect its function and vulnerability to local anaesthetics?

A

Larger diameter - faster electrical impulses
Smaller diameter - more sensitive to local anaesthetics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the basic pharmacology of local anaesthetic (cocaine)?

A

Targets voltage gated sodium ion channels, acts as a channel blocker.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does the Hodgkin-Huxley model shown about membrane potential and membrane current?

A

Completed an experiment - looking at flow of sodium ions.
Shows that when a depolarisation (control value) is applied to the membrane (increased voltage), originally there is a rapid activation due to increased current (measured value), this then changes to become slower inactivation.
Inactivation will remain immediately afterwards even if the depolarising pulse is still present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the two different gates present in the voltage gated sodium ion channel?

A

m gate or activation gate
h gate or inactivation gate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are the different gates within the voltage gated sodium ion channel affected by resting membrane potential?

A

M gate - activation gate is closed at rest
H gate - inactivation gate is open at rest
The channel is at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How are the different gates within the voltage gated sodium ion channel affected by depolarisation?

A

Depolarisation causes rapid opening of m gate
Depolarisation causes slow closing of h gate. Now the channel is termed inactivated.
Interval between M opening and H closing allows sodium ions to flow across the channel and into the neuron contributing to further depolarisation. The channel is open.
Therefore both these gates are voltage sensitive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the physiology undermining resting membrane potential?

A

Na+ K+ ATPase - 3Na+ out and 2K in - generates a Na+/K+ chemical gradient
Selective permeability to K+ allows K+ to move out down chemical gradient, however membrane is relatively impermeable to Na+ at rest
This generates an electrical gradient with more positive charge outside the neuron than inside.
The Em is around 70mV, this is near the Ek (electrical and chemical gradient near point of balance for K+)
The m gate is closed and the h gate is open CGNaC is closed or resting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Explain what changes occur at the neuron membrane during action potential.

A

M gate opens rapidly in response to increased voltage
M gate and H gate are now open, VGNaC is open
Na+ influx further depolarised the neuron - action potential is generated around +30mV
Action potential is propagated along the neuron.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What changes happen in the neuron and VGNaC during repolarisation?

A

H gate closed slowly due to depolarisation
M gate is still open but the H gate is slowed = VGNaC is deemed inactivated
No Na+ current
K+ efflux down an electrochemical gradient causes repolarisation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe how the VGNaC is reactivated after repolarisation.

A

m gate closes rapidly as voltage decreases
m gate is closed and h gate closed - VGNaC is closed but reactivating
H gate opens slowly in response to decreased voltage (same that closed m gate)
M gate is closed and H gate open - VGNaC is closed (resting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe how the resting membrane potential is restored after an action potential generation.

A

VGNa+ channels are resting and activatable
Intra and extra-cellular concentration of Na+ and K+ do not change greatly during the action potential.
Na+ K+ pump preserves the chemical gradients and resting membrane potential is restored.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does an inactivation curve show about the properties of voltage gated sodium ion channels?

A

When a channel is more depolarised before an action potential stimuli is applied there is less flow of current all channels were in inactivated state.
In contract when the channel is more hyperpolarised before an action potential is applied there is more flow of current as all channels are in resting state.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do local anaesthetics acts preferentially based on channel state?
Why?

A

Different channel states have different channel structures - this alters the affinity for the drug
The affinity for LA is higher in the inactivated state
Preferentially act on inactivated state channels (when H gate is closed and M gate is open initially after action potential - during the repolarisation state)

20
Q

What is the effect of local anaesthetics at the VGNaC level?

A

LA have a higher affinity for VGNaC in the inactivated state
As as a channel blocker
Increases the number of channels stuck in the refractory/inactivated state by stabilising the channel it binds to
This shift the inactivation curve to the left, as a greater proportion of VGNaC are inactivated at any voltage/

21
Q

What factors influence the usefulness of local anaesthetics?

A

Are use dependent - influence channel state
pH dependent
Voltage dependent - influence channel state

22
Q

Why are local anaesthetics described as use dependent?

A

Repeated stimulation of the neuron leads to increased inactivation state of channel for a longer period of time.
Leading to increased inhibitory effects of the local aneasthetic.
This is because the local aneasthetic is more effective when VGNaCs are opened then inactivated.

23
Q

Why are local anaesthetics described as pH dependent?

A

Are weak bases
pKa of 8-9
Onset of block is slower at acidic pH - as LA acts as a base to accept H+ and becomes protonated/charged.
Low pH greater proportion HB+ than B.
When charged is more difficult to cross the cell membrane by hydrophilic method.
So is unable to effect the channel, as effects channel from the cytoplasmic side
This is clearly shown be lidocaine.

24
Q

Why are local anaesthetics adapted to working at higher pH?

A

Are weak bases have a pKa of 8-9.
At a high pH there is a greater proportion of B to HB+.
This uncharged form finds it easier to cross the cell membrane by hydrophilic methods so is is able to act of the VGNaC from the cytoplasmic side.
This is cleary shown by lidocaine

25
Q

How does benzocaine go against the normal pattern of effectiveness of local anaesthetics?

A

has a lower Pka - so is less effective at accepting H+ from acids.
Therefore there is always a greater proportion of B to HB+ even in acidic pH.
Therefore is no pH dependence - must access bding site via a hydrophobic pathway
Also has minimal use dependence

26
Q

What are the different access routes of local aneasthetics to theri target sites?

A

Open channel gate on the inner surface of the membrane by charged species - hydrophilic pathway.
Or directly through the membrane via fenestration in the channel wall by uncharged species - hydrophobic pathway.

27
Q

Why are local anaesthetics described as voltage dependence?

A

Are more effective at more depolarised potentials
Charge disturbance provides electrical force, positively charged LA driven from cytoplasm into open channel
Strong depolarisation increases the rate of onset of the block.

28
Q

What is the molecular biology of VGNaCs?

A

Has a principle alpha subunit with four domain, each consisting of six alpha helicial transmembrane spanning regions
S4 region of each region contains positivly charged residues
III-IV loop contain lysine residues
IVS6 contains binding site for LA
Variable regulatory Beta subunits found at each end

29
Q

What is the specific beinding site of local anaesthetics within the voltage gated Na+ Channel?

A

IVS6 contains the binding site.

30
Q

How does the speed of activation alter the function of the channel?

A

SLower activation - opening of M gate
But function of H gate remains the same
Results in lower peak current - as channel is fully open for shorter period of time

31
Q

How does the rate of inactivation effect the function of the channel?

A

Reduced inactivation (longer for h gate to close) results in greater current

32
Q

Describe the location of the different gates within the VGNaC?

A

Activation gate is within the S4 spanning region of each of the four homologous domains
The inactivation gate is between third and fourth domain

33
Q

What is the clinical use of local anaesthesia?

A

Reduce sensation for:
Therapeutic
Facilitation
Diagnosis

Use good anti-epileptic drugs and anti-dysrhythmic drugs

34
Q

what are the different thereupeutic effects of local anaesthesia?

A

Reduce pain/discomfort - often anorectal, cough, mouth ulcers or teething

35
Q

What are the different facilitative uses of local anaesthesia?

A

Avoidance of general anaesthesia in surgery
Often used in dental and opthalamology

36
Q

What are the facilitative uses of local anaesthetics?

A

For an epidural
Cathetierisation
Intubation
Endoscopy

37
Q

Why can local anaesthetics be used as anti-epileptic

A

Selectivity due to use dependent properties
More neuronal firing from the neurons involved in epislepsy
Are more selecitivy blocked
This selectivity is most effective at lower doses (higher dose would block all excitable tissue)

38
Q

What drugs are commonly used as anti-epileptic drugs from a local anaesthetic origin?

A

Phenytoin
Carbamazepine
Lamotrigine

39
Q

What is the treatment recommendation for anti-dysrhythmis drugs?

A

Local anaesthetics are the class 1 of anti-dysrhythmic drugs - used to treat abnormal cardiac rhythms.

Other classes include Beta blockers, K+ channel blockers and Ca2+ channel blockers

40
Q

How does damage to the heart cause problems via VGNaC?

A

Electrical activity in heart is due to VGNaC.
Area of tissue damage - less hyperpolarised/depolarised membrane potential - leads to increased inactivation of VGNaC - leads to slower conduction.
One passed through damaged area electrical activity can resume rapid speed but can pass in any direction due to loss of electrical front - can cause ectopic beat or fibrillation
Or unable to pass through damage tissue - re-entrance mechanism - can cause fibrilation

41
Q

Why are local anaesthetics are effective anti-dysrhythmic drugs?

A

Damaged tissue areas have a higher proportion of inactivated VGNaC
These are preferntiallly blocked by local anaesthetics
This suppresses conduction in the affected area completely
Dose dependent
Ensures only normal conduction can continue to occur in the other area of the heart.

42
Q

What are some concerns around local aneasthetics being pH dependent and their use?

A

Inflammed tissue can be acidic
LA preparation are frequently acidic in order to increase solubility.

43
Q

What are the different subtypes of VGNaC?
Why is this useful pharmacologically?

A

There are atleast 9 different subtypes
Nav1.1-1.9
These offer potential targets for more selective drug targets
Each subtype will have different affinities for LAs
Each subtype will have a different distribution across the human body.
Drugs with different potency at different channels will have different physiological effects.

44
Q

What other drugs target VGNaC?

A

Pyrethroids - insecticides, targets activated channel - keeps open - kills insect - can irriate human skin
Tetrodotoxin - from puffer fish (Fugu) is an external channel blocker, is highly toxic and not dependent on ph, use or voltage - can be fatal if consumed in food (Chefs who serve Fugu must be specially trained)

45
Q

What are channelopathies?
Some examples.

A

Defects that arise due to changes/amlfunction in ion channels may be congenital or acquired
Epilepsy
Arrythmias - long QT sydrome, Brugada syndrome
Gain of function mutations - Hypokalaemic Periodic Paralysis
Loss of function mutations - Dravet syndrome