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robbypowell's version from 2016-08-30 01:28

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Question Answer
define: agents capable of producing transient loss of sensation in regional area of body WITHOUT producing loss of consciousnessLocal Anesthetic agents
what was the first Local Anesthetic?Cocaine
"synthetic cocaine" invented in 1904 by EinhornProcaine
Local anesthetics have ____ ____ (lipophilic) but also have a proton on _______ _______ that makes it hydrophilic ... so they are amphiphilicaromatic ring; tertiary amide
All local anesthetics are tertiary amides except for _______ which is a secondary aminePrilocaine
All LA's are amphipathic except _______Benzocaine
_______ is long-lasting LA that has been approved for liposomal delivery as of 2011Bupivicaine
________ vesicles carrying bupivicaine allow for longer duration of effectLiposomal vesicles
There are 2 types of Local Anesthetic _____ and ______Amides and Esters
All ______ have the letter "i" before the word "caine"Amides
Lidocaine, mepivicaine, prilocaine, bupivicaine, etidocaine, and articaine are all what type of LA?Amides (all have letter "i" before "caine")
Procaine, benzocaine, tetracaine and propoxycaine are all what type of LA?Esters
Two LA's that can be used topicallyLidocaine & Benzocaine
Amides are broken down by _______ in what organ?Amidase; In Liver
higher octanol/buffer distribution of a local anesthetic means they are more _____ (can cross cell membranes and get incorporated into myocardium faster)Lipophilic
Higher the buffer distribution coefficient of a LA the (more/less) you need to give to get the same effectLess
Lidocaine has a buffer distribution coefficient of _____110
Bupivicaine and Tetracaine have buffer capacity _____ times that of Lidociane5x
Lower pKa of a LA affects it how?Faster onset
which mode of action theory for LA is: LA goes into CM due to lipophilicity and prevents opening of pores/passage of electrolytesMembrane expansion theory (physiochemical they)
which mode of action theory for LA is: LA change receptors → occlude Na channel, allosterically mediate conformational change, distort local electric fieldReceptor Mechanism theory
Local anesthetic agents are weak (acids/bases)Bases (think about how they taste)
Lido has a pH of _____7.8 pH
pH = pKa + log (B/BH) is what formulaHenderson Hasselbach
which form of LA's can cross the cell membrane... B or BH?B
which form of LA's blocks sodium channel within the cell?BH
t/f: LA can enter the CNS, cross placenta and cause cardiac depression in the fetusTrue
list 3 LA's that were listed by FDA in the pregnancy risk categoryLidocaine, Prilocaine, and Etidocaine
______ type LA's are metabolized in the plasma by cholinesteraseEster
People with ________ defects are at greater risk for toxicity from ester type LA'sPseudocholinesterase
severe liver disease can cause systemic intolerance/toxicity risk to what type of LA?Amide (bc metabolized in liver)
Lidocaine and some other amides have a half-life of ____-_____ hours1.5-3.5 hours
Articaine has a half-life of ______ minutes25 minutes
O-toluidine, a metabolite of ______, causes methemoglobinemiaPrilocaine
two metabolites of Lidocaine that can be toxicMonoethylglycinexlidide and glycinexlidide
Renal clearance of LA is _____ (directly/inversely) relate to protein binding capacity and ______ (directly/inversely) related to urine pHInversely; inversely
______ is an Amide, but unique because it has a Thiophene ring and ester linkage on aromatic ring... also has a higher risk of paresthesiaArticaine
t/f: LA's depress myocardial contractility in a dose-dependent mannerTrue
highly ______ LA's such as Bupivicaine or Etidocaine are cardiotoxic (can cause arrhythmias, CV collapse)Lipophilic
T/f: Local anesthetics (except for cocaine) inhibit myogenic activity and autonomic tone of peripheral vasculature --> vasodilationtrue
contraindications for epinephrine with LAHyperthyroidism & Cardiac problems
allergies are usually only a concern for Ester type LA's due to the preservative ______metabisulfide
Malignant hyperthermia and methemoglobinemia can be concerns for what 3 LA's?Prilocaine, articaine & Benzocaine
_____ rule is based on patient's body weight (child's dose = wt in lbs / adult dose)Clark's rule
memorize
_____ rule is based on patient's age (Child dose = (age in years x adult dose)/(age + 12)))
Question Answer
for obese children, is it alright to exceed to recommended max child dose?No
what is the "recommended" or max dose for children of epi?400-500mg epi
if no epi... then we can give (more/less) LA to childrenLess (doesn't stay local)
.5% Bupivacaine + 1:200K epi has a max dose for children of _____mg / kg2mg/kg
2% lido (no epi) has a max dose for children of ____mg/kg3 mg/kg
2% lido + 1:100K epi has a max dose for children of ___mg/kg7 mg/kg
ecgonine methyl ester, benzoylecogonine are metabolites of ______cocaine
monoethylyglycinexylidide, glycinexylidide are metabolites of ______lidocaine
t/f: you can't test for cocaine if someone has been administered lidocaineTrue
what can you give for epinephrine reversal to act as an A1 blocker (that leads to hypotension)Prazosin
what can you give as a B1/B2 blocker with epi that leads to hypertension?Propranolol
alpha-adrenergic blocking agent, REVERSES LA effect; (DOESN’T reverse CNS/CV/Resp manifestations of LA overdose/toxicity no matter how much you give)Phentolamine mesyltate, oraverse
competetive antagonist of alpha adrenegicsPhentolamine mesylate (oraverse)
t/f: you should include topical applied anesthetic agents in calculation of total administered dose?true
_____ can be used topically for LA for SRP procedures and cause a 50% decrease in painOraqix (EMLA)
memorize

adrenergic receptor site and effect of epinephrine

Question Answer
A1Blood vessels --> increase BP, vasoconstriction
B1Heart --> increase HR, inc force of contraction
B2BV, tracheobronchilar tree --> vasodilation & bronchodilation
memorize

action potential phases

Question Answer
resting... -70mV, voltage dependent Na channels closedphase 0
fiber is stimulated, Na channels open and Na enters cellPhase 1
increase in potential, depolarization =+20mV, Na channels closePhase 2
K leaves and potential falls to -40mVPhase 3
fiber repolarizesPhase 4
LA block which phase of action potential on axolemma?Phase 1 (opening of Na channels)
____ concentration within the cell increases several thousand fold during AP, ____ conductance increases 30x during later stagesNa; K
memorize

major effects of LA

Question Answer
differential nerve blockage give loss of _____ influence and blockage of ______ sensationautonomic; general
(smaller/larger) diameter nerve fibers are easier to give nerve blockSmaller
loss of autonomic function causes what effect?Vasodilation
we give ______ to increase sympathetic tone and prevent systemic drug uptakeVasoconstrictor
two LA drugs that don't need vasoconstrictorXylocaine & Cocaine
memorize

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