Exam 2; Local Anesthetics and Spasmolytics

Question 1

This is any agent that can reversibly block the electrical activity of excitable tissues

Answer 1

local anesthetic

Question 2

What are the two actions of local anesthetics

Answer 2

decrease neuronal conduction

block impulse conduction in the heart

Question 3

How are local anesthetics used as painkillers

Answer 3

temporary analgesia without loss of consciousness

Question 4

All local anesthetics have what two ends

Answer 4

automatic (lipophilic)

amino (hydrophilic)

Question 5

This part of the local anesthetic can get though the neuronal membrane

Answer 5

lipophilic

Question 6

This part of the local anesthetic is inside the membrane or cell, this end gets ionized

Answer 6

amino

Question 7

Local anesthetics in the non-ionized form get through the neuronal membrane and once inside, what occurs

Answer 7

the hydrophilic side is ionized and binds to a specific site on the sodium channel of the excitable membrane/tissue; blocking the Na channel

Question 8

What are the three events of local anesthetics blocking the Na channels

Answer 8

decreases neuronal conduction
decreases repolarization rate
increases refractory period

Question 9

What will increase effect of the local anesthetic

Answer 9

Na channels are open; neurons not fire more rapidly

will have open channels more often and affected more

Question 10

Which size of neurons are generally more susceptible to local anesthetics

Answer 10

smaller neurons

pain more susceptible than motor neurons

Question 11

Which type of myelination of neurons is more susceptible to local anesthetics

Answer 11

myelinated neurons

Question 12

Which speed of firing is more susceptible to local anesthetics

Answer 12

faster the firing rate the more susceptible

Question 13

What is the sensitivity ranking regarding, warm, cold, pain, motor, and touch/pressure

Answer 13

pain > cold > warm > touch/pressure > motor

Question 14

What is the major distinction between local anesthetics

Answer 14

their duration of action

Question 15

This type in linkage has a relatively short duration

Answer 15

ester linkage

Question 16

The ester is metabolized by what

Answer 16

plasma cholinesterase

Question 17

What is the half like of ester linked LAs

Answer 17

minutes

Question 18

This type of linkage is fairly long

Answer 18

amide linkage

Question 19

The amide is metabolized by what

Answer 19

in the liver by CYP450

Question 20

What is the half life of amide linked LAs

Answer 20

hours

Question 21

Local anesthetics are weak bases or acids

Answer 21

bases

Question 22

In an acidic environment, the local anesthetic will be what

Answer 22

more ionized

Question 23

In infected tissues which tend to be more acidic, what happens to the local anesthetic

Answer 23

the molecules don’t readily enter the cell and LA activity is decreased

Question 24

Repeated use of an epidural anesthetic can do what

Answer 24

lower pH and cause tachyphalaxis

Question 25

These are used with local anesthetics to increase duration of action (except for cocaine)

Answer 25

vasoconstrictors (like Epi.)

Question 26

What are the three topical routes of administration of a LA

Answer 26

skin mucosa eye

Question 27

What are the three routes of administration of injection of LA

Answer 27

infiltration direct nerve block spinal or epidural

Question 28

Regardless of route of administration, all local anesthetics can be what

Answer 28

systemically absorbed

Question 29

Which linkage of LA is more likely to cause an allergic reaction

Answer 29

esters

Question 30

This ester LA inhibits the re-uptake of NE in the CNS

Answer 30

cocaine

Question 31

What is cocaine used for

Answer 31

ophthalmic; nasal surgery

Question 32

This is an ester LA with low solubility so a long duration of action and is used topically

Answer 32

benzoxaine

Question 33

This ester LA has a short half-life and is not used topically because it doesn't readily pass through the mucous membranes

Answer 33

procaine

Question 34

These are ester LAs that are used in the eye

Answer 34

benoxinate and proparacaine

Question 35

These is an amino amide LA used IV for cardiac arrthymia and produces a lupus like syndrome in slow acetylators

Answer 35

procainamide

Question 36

This is the most common amino amide LA and is used IV for arrthymias

Answer 36

lidocaine

Question 37

What are some CNS side effects of lidocaine

Answer 37

tremors slurred speech drowsiness

Question 38

What is it that distinguishes the amino amide LAs

Answer 38

all the names contain "two i's" and "-caine" articaine mevpicane

Question 39

What are the six CNS side effects of local anesthetics

Answer 39

``` disorientation drowsiness slurred speech tongue numbness tinnitus (ringing in the ears) burred vision ```

Question 40

What is the side effect on the cardiovascular system of LAs

Answer 40

alter the heart rhythm

Question 41

What are the two specific side effects of cocaine

Answer 41

vasoconstrictor | CNS effects

Question 42

This is an irreversible sodium channel blocker that can cause muscle weakness, respiratory paralysis, and death

Answer 42

tetrodotoxi

Question 43

This is an irreversible sodium channel blocker that can cause muscle weakness, respiratory paralysis, and death; from the red tide

Answer 43

saxitoxin

Question 44

This is excessive muscle contraction; muscle hypertonia

Answer 44

spasticity

Question 45

What results in spasticity

Answer 45

neuronal damage; injury, stroke, MS, CP, ALS

Question 46

What is the treatment for spasticity

Answer 46

either alter the innervating neurons or act directly on muscle

Question 47

This is a GABA agonist that increases the activity of inhibitory neurons; treatment for spasticity

Answer 47

baclofen

Question 48

This is a minor tranquilizer and muscle relaxant that increases GABA activity; treatment for spasticity

Answer 48

diazepam and other benzodiazepines

Question 49

This is an α2 agonist; inhibiting motor neurons; treatment for spasticity

Answer 49

tizanidine

Question 50

This is a treatment for spasticity; neuronal effects

Answer 50

botulinum toxin

Question 51

This acts directly on muscle cells and inhibits the stimulus induced release of Ca from the muscle SR; decreasing availability of Ca for muscle; treatment for spasticity

Answer 51

dantrolene

Question 52

What are two side effects of dantrolene

Answer 52

muscle weakness | hepatitis