Lecture 3 - Anaesthetics

Question 1

What is the clinical use of LA?

Answer 1

Reversible blockage of nerve impulse generation and conduction

Question 2

What are the 4 desireable properties?

Answer 2

Rapid Onset, Adequate duration of action, Minimal side effects, and Minimal local tissue damage

Question 3

What is the activity of LA?

Answer 3

Myelinated enhances and highly active small diameter nerves respond more favourably. (Bind quicker and less LA needed to bind due to small diameter)

Vs.

Unmyelinated nerve

Note: Large diameter nerves are less sensitive and recover quickest

Question 4

Are all chemical structures lipophillic or hydrophillic?

Answer 4

Lipophilic, since it crosses the blood brain barrier and gets into the CNS

Question 5

True or False, Due to the Amine terminal of an LA, it is also water soluable?

Answer 5

True

Question 6

What is the main target used for activity for an individual who needs LA?

Answer 6

Pain.

Note: Motor is the least

Question 7

What was the first LA Anesthetic created?

Answer 7

Cocaine - schedule 2

Note: Toxicity of Cocaine, let the development of Procaine and Lidocaine

Question 8

Which drug would you consider using if a pt. is allergic to proparacaine?

Answer 8

PABA drug type

Tetracaine, Benzocaine, Procaine and Benoxinate

Question 9

True or False, A LA will produce a dry eye when administered?

Answer 9

True, in away the corneal tight junctions are broken down and different layers of the cornea start to break down

Question 10

What are the 2 types of effects that can occur if a topical fluid is administered prior to a LA?

Answer 10

Blink reflex and tear film

Question 11

What is Pachymetry?

Answer 11

It is a test by probing the eye

Question 12

What do you must do when conducting Schirmer 1?

Answer 12

Anesthetic measure is needed. Measured by Nasal and Basal tearing

Question 13

How is schirmer 2 evaulated?

Answer 13

evaluates reflex tearing by irritating the nasal mucosa w/ a cotton swab after strip insertion; wetting that exceeds Schirmer I is normal and suggests lacrimal gland is intact

Question 14

What is forced duction?

Answer 14

If a pt. has had a TED or blunt trauma will allow you to move the eye in certain direction to find out what muscle is being inforced upon

Question 15

What type of LA will likely to not aggravate a dry eye

Answer 15

Lidocaine

Question 16

If corneal epithelial debridement needs to occur?

Answer 16

Use Cocaine.

Note: The tight junctions are effected thus damaging the corneal epithelial cells

Question 17

If a pt. has basement membrane complications what type of surgical procedure must occur?

Answer 17

Corneal puncture

Question 18

Tonometry, gonio, sutures, nasolacrimal massage, ultrasound, what type of LA would you use?

Answer 18

Proparacaine or Tetracaine

Question 19

What LA can be used for Benoxinate?

Answer 19

Tonometry

Question 20

What LA is used for Herpetic Neuralgia (injection)?

Answer 20

Procaine

Question 21

What LA is used for OTC oral, dental, cough?

Answer 21

Benzocaine

Question 22

What type of Amide is used for LA, RA, Chalazion surgery?

Answer 22

Lidocaine

Note: 3.5% for Chalazion surgery

Question 23

What are injectable anesthetics needed for?

Answer 23

Nerve blockage, macular edema and uveitis

Question 24

What is the onset and duration of anesthetics for topicals?

Answer 24

0.5 minutes and 1/4 hr for duration

Question 25

What is the onset and duration for Lidocaine and Procaine?

Answer 25

L - 4 to 6 and 2/3-1 | P - 7-8 and 1/2 - 2/4

Question 26

What anesthetic is doubled when used with epinephrin for vasconstriction?

Answer 26

Lidocaine

Question 27

An anesthetic has intrinsic vasodilation but what specific health problem should be considered, according to Dr. McNaughton when analyzing anesthetics?

Answer 27

Allergy or intrinsic effect

Question 28

What are 4 benefits of an anesthetic and vasoconstrictor being used?

Answer 28

Reduce abosorption/systemic toxicity, reduce metabolism, sustain a local effect and reduce bleeding at the injection site

Question 29

How many milligrams of drop of 100,000 of Epi?

Answer 29

Epinephrine 1:100,000

Question 30

What are the systemic effects of Cocaine?

Answer 30

Excitement, convulsions, rapid palpitations, nausea and Delirium Note: Only one that causes VASOCONSTRICTION and causing the cardiac system to work hard, thus not getting adequate nourishment

Question 31

What are the ocular effects of Cocaine?

Answer 31

Desquamation (outer epithelial cells fall off), mydriasis and lid retraction

Question 32

What muscle is stimulated in the eye, for an individual who was on Cocaine?

Answer 32

Muellers muscle - lid retraction

Question 33

If you have an individual who is a pass cocaine abuser and you would like to administer NOR-EPI which drugs would you avoid?

Answer 33

Guanethidine and Resperine

Question 34

What is the cause of conjunctival hyperemia?

Answer 34

Anesthetics don't allow for nerve junctions to function

Question 35

What will cause an allergic reaction with anesthetics?

Answer 35

Amides

Question 36

What is Lacrimation caused by?

Answer 36

Difference in pH from the eye

Question 37

True or False, Anesthetic combination: toxicity is not additive?

Answer 37

True

Question 38

What age is desquamation common and causing a reduced blink rate?

Answer 38

50+. Note: Make sure to give lubricating drops to help with dry eye. Also make sure pt. does not rub there eye, may tear off corneal epithelium

Question 39

True or False. Esters will most likely cause an allergic reaction of hypersensitivity compared to amides.

Answer 39

True. Note: A perservative could also cause the allergic reaction

Question 40

What is a vaso vagal syncope?

Answer 40

Vagus nerve get intiated and can supress oxygen to the brain, thus causing fainting

Question 41

True or False, Hypothyroidism pt, is an adverse effect of an anesthetic adverse effect?

Answer 41

False. It has to be hyperthyroidism

Question 42

What is the key effect of anesthetic abuse syndrome?

Answer 42

Retard mitosis and cell migration

Question 43

What is one sign to be pathopnumonic, what would be a sign for topical anesthtic abuse syndrome?

Answer 43

1 degree sign: yellow white stromal ring @ active site