4. local anesthetics Flashcards
(112 cards)
1
Q
What are the types of prescriptions?
A
Written, Oral, Fax
2
Q
What is critical for effective prescription writing?
A
Legibility
3
Q
What should be avoided in prescription writing?
A
Abbreviations and Decimals
4
Q
What should be specified clearly in a prescription?
A
Dosage Times
5
Q
What should be included in a prescription besides dosage?
A
Purpose of Medication
6
Q
What is prohibited regarding Schedule I controlled substances?
A
Possession and supply
7
Q
What defines Schedule II controlled substances?
A
Accepted medical use with high abuse potential
8
Q
What is a characteristic of Schedule III controlled substances?
A
Moderate abuse potential
9
Q
What is the abuse potential of Schedule IV controlled substances compared to Schedule III?
A
Less abuse potential
10
Q
What distinguishes Schedule V controlled substances?
A
Less abuse potential than Schedule IV
11
Q
What is a chemical name?
A
Complete description of chemical structure
12
Q
What is a generic name?
A
Shortened scientific name based on active ingredient
13
Q
What is the brand/trade name?
A
Name given by pharmaceutical company to distinguish their drug products
14
Q
What does Active Pharmaceutical Ingredient (API) refer to?
A
Substance intended to be used in the manufacture of a pharmaceutical product
15
Q
What is a dosage form?
A
The drug product type that contains a drug substance
16
Q
What is an excipient?
A
An ingredient added intentionally to the drug substance which should not have pharmacological properties
17
Q
What are side effects?
A
Secondary unwanted effects that occur due to drug therapy
18
Q
What are adverse effects?
A
Noxious, unintended pharmacologic effects that occur when a medication is administered correctly
19
Q
What does indication refer to in drug product information?
A
FDA-approved clinical use of a drug product
20
Q
What is the mode of administration?
A
The manner and site where the drug product is to be introduced
21
Q
What does pharmacologic category refer to?
A
Classification of the drug product based on its therapeutic action
22
Q
What are warnings in drug product information?
A
Statements regarding potential hazards and undesirable effects
23
Q
What is a precaution in drug use?
A
Special care required to avoid undesired effects
24
Q
What is a contraindication?
A
Conditions wherein the use of the drug product may cause harm
25
What percentage of prescriptions are filled according to noncompliance statistics?
25% to 50% of patients do not adhere
26
What are common errors in compliance?
Overuse, underuse, incorrect timing, improper usage
27
What is the most serious form of noncompliance?
Failure to fill prescriptions
28
What are major causes of noncompliance?
Complex drug regimens, lack of understanding, misinterpretation of instructions, lack of patient education
29
What are strategies to improve compliance?
Ensure comprehension, demonstrate proper technique, use good communication, encourage patient participation, utilize compliance aids
30
What is the importance of proper medication use?
Medication is only beneficial if used correctly
31
What are the fundamentals of patient counseling?
* Correct Patient Usage
* Purpose of Medication
* Medication Name
* Proper Usage Instructions
* Administration Schedule
* Treatment Duration
* Maximum Daily Dose
* Adverse Effects
* Drug Interactions
* Storage Requirements
* Additional Instructions
32
What enhances patient education?
Verbal counseling and supplemental materials
33
What is the legal duty of doctors regarding informed consent?
To disclose warnings, findings, and pertinent information
34
What is the doctrine of informed consent?
No treatment can occur without the patient’s consent
35
What must be disclosed to patients for informed consent?
* Hazards and risks of treatment
* Possible complications
* Expected and unexpected outcomes
36
What is the duty to warn in relation to therapeutic agents?
Practitioners must inform patients about the risks of ophthalmic drug use
37
What should be documented if dilation is needed for a high-risk patient?
Risks and benefits discussed and recorded
38
What are the risks associated with topical anesthetics?
Rare toxic reactions leading to corneal epithelial damage
39
What should patients be informed about regarding mydriatics?
Potential angle-closure glaucoma in at-risk patients
40
What should be recorded if patients refuse diagnostic drugs?
Refusals should be recorded in patient files
41
What is the risk factor for therapeutic agents that increases the duty to warn?
Long treatment duration increases risk
42
What should elderly patients with glaucoma signs be informed about?
The need for tonometry.
43
What should patients with floaters and flashes be warned about?
Potential retinal detachment risks.
44
What must be documented regarding refusals in patient files?
Refusals should be recorded, and signed forms may be used.
45
What is the higher duty to warn in relation to therapeutic agents?
Due to extended patient use and risk of misuse.
46
What should patients be informed about concerning long-term use of drugs?
Potential adverse effects.
47
What are key risk factors that increase the duty to disclose?
* Long treatment duration increases risk.
* Higher dosages require greater disclosure.
48
What are high-risk therapeutic drugs that optometrists should be aware of?
* Topical steroids (risk of increased intraocular pressure and cataracts).
* Systemic steroids (potential systemic side effects).
* β-blockers & miotic antiglaucoma agents (cardiovascular and respiratory side effects).
* Oral carbonic anhydrase inhibitors (CAIs) (metabolic and electrolyte disturbances).
49
What should be clearly communicated to patients regarding high-risk drugs?
Risks should be clearly communicated.
50
What must clinicians document regarding treatment alternatives?
Discussions of treatment alternatives in the patient’s medical record.
51
What is the obligation to explain diagnostic findings?
Clinicians must inform patients about ambiguous or suspicious results.
52
What is a legal case example related to failure to inform about elevated IOP?
A 58-year-old woman diagnosed with open-angle glaucoma after not being informed about elevated IOP.
53
What responsibilities do optometrists have regarding test results?
* Discuss test results with patients.
* Recommend further evaluation when necessary.
* Document patient decisions in medical records.
54
What is essential for documentation under informed consent?
Communications must be documented in the patient record.
55
What is a key takeaway regarding documentation and warnings?
Inadequate documentation can result in legal liability.
56
What are common allegations in negligence claims against optometrists?
* Failure to diagnose major conditions (e.g., open-angle glaucoma).
* Misdiagnosis in therapeutic drug use.
57
What is the definition of negligence?
The failure to exercise reasonable care, leading to harm.
58
What are the four elements of negligence that must be proven?
* Duty
* Breach of Standard of Care
* Injury
* Proximate Cause
59
What must optometrists document to minimize legal risks?
Patient interactions thoroughly.
60
What must optometrists stay updated on regarding drug use?
New developments, drug efficacy, and reported adverse effects.
61
What is the importance of using the right drug?
To avoid preventable harm.
62
What is a key takeaway regarding managing side effects?
Optometrists must not ignore patient complaints related to drug reactions.
63
What is the responsibility of optometrists with diagnostic ophthalmic drugs?
Be aware of adverse effects and manage complications.
64
What are the risks associated with anesthetics like Proparacaine?
Possible allergic or toxic response.
65
What should be documented regarding drug history and usage?
All drugs used for diagnosis or treatment and warnings given.
66
What is essential for legal protection in optometry?
Thorough documentation.
67
What must optometrists ensure during follow-up appointments?
Schedule specific recall dates and confirm appointments.
68
What should be documented in consultations?
All consultations and correspondence with consultants.
69
What is the importance of keeping patient records?
They serve as key evidence in defending against negligence claims.
70
What is the purpose of thorough documentation in medical practice?
Helps defend against malpractice claims as long as the care follows medical standards.
## Footnote
Failure to document properly can significantly increase liability risks.
71
Define Anesthesia (General).
A reversible state of central nervous system (CNS) depression, causing loss of response to and perception of stimuli.
72
What are the five important benefits of anesthesia for patients undergoing procedures?
* Sedation and reduced anxiety
* Lack of awareness and amnesia
* Skeletal muscle relaxation
* Suppression of undesirable reflexes
* Analgesia
73
What occurs during Stage 1 of Anesthesia?
Begins with the administration of anesthetic and ends with loss of consciousness, including sedation, analgesia, and amnesia.
74
What characterizes Stage 2 of Anesthesia?
Excited and delirious activity following loss of consciousness, with erratic breathing and heart rate, nausea, pupil dilation, and breath-holding.
75
What happens in Stage 3 of Anesthesia?
Muscles relax, vomiting stops, breathing is depressed, and the patient is ready for surgery.
76
Describe Stage 4 of Anesthesia.
Occurs with an overdose of anesthetic, leading to brainstem or medullary suppression, resulting in respiratory and cardiovascular collapse.
77
How is the depth of anesthesia assessed?
* Respiration: Patterns and depth of breathing
* Reflexes: Presence or absence of reflexes
* Muscle Tone: Changes in muscle tone
* Pupils: Pupil size and reactivity
* Heart Rate and Blood Pressure: Changes in heart rate and blood pressure
78
What are the structural features of local anesthetics?
* Aromatic Hydrophobic Portion
* Intermediate Linkage Site
* Hydrophilic Amine
79
What does the Intermediate Linkage Site in local anesthetics determine?
Metabolism, classified as either Ester (-C-O-) or Amide (-N-C-).
80
What are the clinical implications of ester-based and amide-based anesthetics?
* Ester-based anesthetics are used in topical ocular applications.
* Amide-based anesthetics are preferred for injectable formulations due to stability.
81
What is the importance of ionization in local anesthetics?
Nonionized form crosses cell membranes; weak bases ionize in acidic solutions, affecting anesthetic effectiveness.
82
How do general anesthetics affect GABAA receptors?
Increase sensitivity to GABA, leading to increased chloride ion influx and hyperpolarization of neurons.
83
Name factors that affect the duration of action of local anesthetics.
* Prolonged contact with nerve tissue
* Vasoconstrictors
* Intrinsic vasodilator activity
* Protein binding
84
What is the role of epinephrine in local anesthesia?
Prolongs anesthesia duration and reduces local bleeding.
85
What are the general principles of topical anesthetics?
* Efficacy determined by suppression of corneal sensitivity.
* Each drug has a maximum effective concentration.
* Combining multiple anesthetics is not recommended.
86
What are common maximum effective concentrations for topical anesthetics?
* Proparacaine: 0.5%
* Tetracaine: 1%
* Cocaine: 20%
87
What unique properties does cocaine have among anesthetics?
Anesthetic and adrenergic agonist properties; used for Horner’s syndrome diagnosis.
88
What are the contraindications and risks associated with cocaine use?
* Hypertension or use of adrenergic drugs
* Systemic effects: restlessness, headache, tachycardia, nausea, convulsions
* Severe corneal toxicity
89
What are the side effects of tetracaine?
* Greater corneal toxicity than proparacaine
* Burning/stinging sensation
* Potential allergic reactions
90
What is Benoxinate primarily used for?
Applanation tonometry.
91
What are the side effects of Proparacaine?
* Rare allergic reactions
* Possible involvement in Stevens-Johnson syndrome
* Allergic contact dermatitis
92
What are the general safety and reactions to topical anesthetics?
* Severe local reactions are rare
* Systemic reactions are even less common
* Higher risk in patients with drug allergies or certain diseases
93
What are the key signs of toxicity from prolonged use of topical anesthetics?
* Persistent non-healing epithelial defect
* Yellowish-white stromal ring
* Corneal edema
94
What should be avoided when microbial culture is needed?
Anesthetic instillation, as preservatives may alter test results.
95
What alternative anesthetic delivery methods are available?
* Topical EMLA (Eutectic Mixture of Local Anesthetics)
* 1% diphenhydramine diluted with sterile saline
96
What is the composition of EMLA?
Contains 2.5% lidocaine and 2.5% prilocaine.
97
What is the composition of Topical EMLA?
2.5% lidocaine + 2.5% prilocaine
## Footnote
Topical EMLA is used for anesthesia in superficial procedures.
98
How should Topical EMLA be applied for optimal absorption?
In a thick layer (1–2 g/10 cm²) covered with Tegaderm or plastic wrap
## Footnote
This enhances the absorption of the anesthetic.
99
How long does it take for Topical EMLA to achieve anesthesia?
1–2 hours
## Footnote
This is the time required before performing procedures.
100
What is the effectiveness rate of Topical EMLA in excisional surgery?
87% success
## Footnote
This indicates a high level of effectiveness for the intended procedures.
101
What caution should be taken when using Topical EMLA?
Should not be used on mucous membranes
## Footnote
Rapid absorption on mucous membranes can lead to increased side effects.
102
What is Iontophoresis used for?
Enhancing penetration of lidocaine-soaked sponges through the skin
## Footnote
It uses mild electric current for this purpose.
103
What is the anesthetic depth provided by Iontophoresis?
1–2 cm
## Footnote
Achieved within 15–30 minutes.
104
Why is Iontophoresis rarely used?
Due to cost and inconvenience
## Footnote
These factors limit its application in practice.
105
What is the primary use of Lidoderm Patches?
Postherpetic neuralgia
## Footnote
These patches are specifically designed for this condition.
106
How many Lidoderm Patches can be used at a time?
Up to three patches
## Footnote
They can be used for a maximum of 12 hours per day.
107
Is the efficacy of Lidoderm Patches for ophthalmic procedures studied?
Unstudied
## Footnote
There is no research available on their effectiveness for ophthalmic procedures.
108
What is the assignment related to ocular pharmacology?
Find 1 legal case displaying negligence or improper documentation
## Footnote
Discuss its important parts and resolution.
109
What is the deadline for the assignment related to ocular pharmacology?
April 4
## Footnote
This is the due date for the assignment.
110
What is the final project requirement regarding index cards?
Create a summarized version of lessons and organize them with a binder ring
## Footnote
Creativity and handwritten work will earn extra points.
111
What is the deadline for the final project?
June 6, 2025
## Footnote
This is the due date for the final project submission.
112
What references are provided for the study of ocular pharmacology?
* Ocular Drug Delivery PPT by Crisfel R. Del Mundo, MSc, RPh
* Ocular Drug Delivery System PPT and Video by AV Badari Nath
* Clinical Ocular Pharmacology by Jimmy D. Bartlett & Siret D. Jaanus
## Footnote
These resources are relevant for understanding ocular pharmacology.
