- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
40 Cards in this Set
- Front
- Back
|
This NSAID can be used for severe pain.
-Reported to be as effective as morphine for moderate pain **EXAM** |
Ketoralac
|
|
Why should you only use Ketoralac for 5 days?
*** |
NSAID
-decreases kidney function |
|
IV acetaminophen has become available in the last year, explain its general use and some of the advantages.
** |
-Usually used to decrease pain after surgery
-Decreases opioid use -Rapid analgesia is achieved -LIVER TOXICITY an issue |
|
MOA of NSAIDs?
**** |
e inhibition of synthesis of prostaglandins (PG’s) by inhibiting
cyclooxygenase. Decreasing PGs knocks out pain and fever! |
|
Your patient is allergic to ester local anesthetics. Which of the following could you give her?
procaine tetracaine mepivacaine benzocaine cocaine ***EXAM*** |
mepivacaine
**AMIDES have 2 EYES** |
|
Ester vs. Amide LAs:
lidocaine mepivacaine bupivacaine etidocaine ropivacaine |
Amide LAs
**AMIDES have 2 EYES** |
|
Ester vs. Amide LAs:
procaine tetracaine benzocaine cocaine |
Ester LAs
|
|
Which one of the following is likely to be cardiotoxic?
• cocaine • benzocaine • procaine • tetracaine • lidocaine • mepivacaine • bupivacaine • prilocaine • ropivicaine |
Bupivacaine
|
|
Which one of the following is most widly used clinically
• cocaine • benzocaine • procaine • tetracaine • lidocaine • mepivacaine • bupivacaine • prilocaine • ropivicaine |
Lidocaine
|
|
Which one of the following is more likely to induce CNS sedation?
• cocaine • benzocaine • procaine • tetracaine • lidocaine • mepivacaine • bupivacaine • prilocaine • ropivicaine |
Lidocaine
|
|
Which one of the following drugs is only used topically?
• cocaine • benzocaine • procaine • tetracaine • lidocaine • mepivacaine • bupivacaine • prilocaine • ropivicaine |
Cocaine
(corneal or nasopharyngeal) |
|
Which is the most likely to produce vasocontriction effects?
• cocaine • benzocaine • procaine • tetracaine • lidocaine • mepivacaine • bupivacaine • prilocaine • ropivicaine |
Cocaine
(Don't give epi with coacaine!!) |
|
Which types of neurons are most sensitive to local anesthetics?
**EXAM** |
Type A-delta
Type B Type C (dorsal root and Sympathetic) |
|
3. describe the site and proposed mechanism(s) of action of local anesthetics.
|
bind to INTRACELLULAR voltage gated sodium channel prevent axonal conduction by a functional blockade
**Greatest affinity for OPEN and INACTIVATED Na channels** ↓ Slows return to RESTING STATE |
|
Ester vs. Amide LAs
-rapidly metabolized in the plasma by cholinesterase |
Esters
|
|
Ester vs. Amide LAs:
-slowly destroyed by liver microsomal p450 enzymes |
Amide
|
|
The __ form of LAs crosses the membrane to get to intracellular receptors
**EXAM** |
Unionized (Cationic/Uncharged)
|
|
The __ form of LAs binds to intracellular receptors to inactivate Na+ channels
**EXAM** |
Ionized (Charged)
|
|
How does local inflammation affect LAs?
|
Inflammation makes the area acidic!!
-LAs become ionized BEFORE crossing the membrane -They can get carried off and act on other areas of the body!! |
|
What is the rate limiting factor for LA onset?
|
Time to cross membranes into the myelin sheath!!
|
|
Do LAs with higher PKAs or lower PKAs tend to have a faster onset?
|
LAs with PKAs nearer to 7.4 (lower) tend to have the fastest onset!
|
|
LAs are ______
A) Strong Bases B) Weak Bases C) Strong Acids D) Weak Acids |
Weak Bases
|
|
LAs with higher or lower lipid solubility have faster onset times?
|
higher solubility = faster onset
|
|
How does vasodilation affect LA onset?
|
Vasodilation carries LAs away from local area!!
**Use Epi or Alpha-2 agonists** |
|
6. explain the rationale for inclusion of vasoconstrictors in local anesthetic
*** |
Vasoconstrictors (Epi, Alpha-2 Agonists):
- decrease systemic absorption and toxicity -increase local drug concentration -increase local duration of action |
|
Contraindications of vasocontrictor use with LA?
|
DON'T USE in toes, fingers, ears or penis
-tissue necrosis -systemic toxicity |
|
which physiological system is most sensitive to systemic effects of local anesthetics and which system is second most sensitive?
|
1st = CNS
2nd = Cardiovascular |
|
8. indicate in what ways cocaine differs from most local anesthetics with regards to CNS and vascular effects.
|
CNS = euphoria
Vascular = vasocontriction** |
|
10. list two agents that are not classified as local anesthetics but have local anesthetic properties.
|
propranolol
diphenhydramine |
|
11. indicate which local anesthetic is almost 100% uncharged at physiological pH and used in many OTC preparations as a surface anesthetic.
|
Benzocaine
|
|
12. Lidocaine and prilocaine are quite similar in many respects, indicate two advantages that prilocaine has over lidocaine.
|
**Prilocaine**
-causes significantly less vasodilation than lidocaine -less toxic than lidocaine (rapidly metabolized) |
|
13. Indicate what EMLA is, local anesthetics used in this product, and some of the general uses.
|
EMLA = eutectic mixture of local anesthetics
lidocaine + prilocaine Used for dermal anesthesia -->catheter insertion |
|
Ropivacaine and Bupivacaine are very similar structurally. Which has the least cardiovascular toxicity?
|
Ropivacaine
(No topical effectiveness only is "S" stereoisomer) |
|
-Some LAs have significant oxidizing effects
-may cause a significant conversion of hemoglobin to methemoglobin and compromize ability to carry oxygen What is this? Which LAs are most likely to cause it? |
Methemoglobinemia
-Prilocaine**, benzocaine, lidocaine |
|
What is the treatment for Methemoglobinemia?
*** |
Oxygen and ethylene blue
|
|
16. Indicate the earliest signs of lidocaine’s CNS toxicity.
|
visual disturbances
|
|
17. Oraverse is a new local anesthesia reversal agent. How does it work?
|
Alpha antagonism of epi vasoconstriction to increase vascular dilation
(block's epi's effects!!!) |
|
What is the most toxic and potent ester LA?
-10x more toxic than procaine **EXAM** r |
tetracaine
|
|
This LA is a popular choice during labor because it causes sensory analgesia with minimal motor block
**EXAM** r |
Bupivacaine
|
|
This LA:
Effective by all routes except topical Similar onset and duration as lidocaine **More toxic to neonates** so not used in obstetrical anesthesia **EXAM** r |
Mepivacaine
|
