LOCAL ANESTHETICS Flashcards by Ruvina Ranasinghe

what are the Ester Anesthetics?

Proparacaine
Tetracaine
Benoxinate
Procaine
Benzocaine
Cocaine

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What procedures does Proparacaine uses in?

Tonometry
Gonia 
sutures 
Nasolacrimal massage
Ultrasound

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What procedures does Tetracaine used in?

Tonometry
Gonia 
sutures 
Nasolacrimal massage
Ultrasound

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What procedures does Benoxinate used in?

Tonometry
only available as fluorescein preparation
LEAST corneal compromise
BUT may increase corneal thickness

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What procedures does Procaine used in?

Herpetic neuralgia (injection)

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What procedures does Benzocaine used in?

OTC oral
Dental
cough

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What procedures does Cocaine used in?

otaryln-gology

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What are some characteristics of Proparacaine?

Least sting compared to Tetracaine
Refrigerate once open (discolors)
Potential to transiently increase corneal thickness affecting goldman and pre lasik pachymetry
Most commonly used in eye care

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What are Some characteristics of Tetracaine?

GREATER toxicity/penetration than proparacaine

- Moderate stinging/ burning within installation

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What are characteristics of Benoxinate?

only available as fluorescein preparation
LEAST corneal compromise
BUT may increase corneal thickness

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What are the AMIDE ANESTHETIC drugs?

Lidocaine
Etidocaine
Mepivicaine
Bupivicaine
Prilocaine
Ropivacaine

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What are features of Lidocaine?

Toxicity risk: seizures,
Satruable metabolsim (zero kinetics)
when used TOPICALLY it will not have any visible effect of the corneal epithelium
Its good when injected for regional nerve block for large chalazions
Local and regional Anesthetic
Status eplepticus
Ventricular arrthmia
Forced cuctions

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What are features of MEPIVICAINE

Has no preservatives

Local and regional anesthetic

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what are features of BUPIVICAINE?

Local anesthetic and regional anesthetic

uses is obstetrics

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what are features of ETIDOCAINE?

Local anesthetic

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what are features of PRILOCAINE?

Caution with COPD/ASTHMA

Local anesthetic topical and infiltration

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what are features of ROPIVACAINE?

Local and regional anesthetic

Obstertics

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• Injectable anesthetics are used for?

Sub-conj
Facial nerve block
Retrobulbar block

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What does sub conj uses it for?

Recalcitrant uveitis
cystoid macualr edema
Falling trabeclesctomy
severe corneal ulcer

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What are the adverse effects of cocaine on systemic?

exciement
convusions
rapid palpitations 
Nausea
delirium

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What are the adverse effects of cocaine on ocular?

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Desquamation/debriding (can be used as andvantage in PRK),
MYDRIASIS,
LID RETRACTION (DUE TO MULLERS MUSCLE)

What is a adeverse effect of cocaine on general?

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can lead to hypertension (incrased heart rate with vasocintrction)

what other drugs does cocaine interactions with that could lead to adverse effects?

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TCADs (Tricyclic antidepressants
MAO inhibitors
Guanthidine
Epinephrine
Phenylephrine

what type of inhibitor is TCADs?

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It is a newer selective serotonin reuptake inhibitor
however
it is much less selective for serotonin alone

What about MAO?

monoamine oxidase | a key enzyme invovledi n catecholamine metabolsim

 Guanathidine is a?

antihypertensive that competes with norepinephrine for presynaptic uptake to ultimately occupy sotrage vesicles and dampen norepehineprine

What is RESERPINE?

It is a antipsychotic, antihpertensive that blocks presynaptic monoamine uptake

Desquamation is common in?

``` 50+ patients that has reduced blink rate Reduced tear production Increased evaporation VA may decline 20/80 to 20/100 and healing may take up to 24 hours ```

what are OCULAR ANESTHETIC adverse effects?

``` Desumation corneal edema Cojunctival hyperemia Allergic cojunctivitis Lacrimination ```

what should be avoided if there is a bforeign body injury?

aoid eye rubbing 20/30 min

you shoud avoid this after having anesthetic use

avoid contact lens wear for 1 hour

If use epinephrine with ocular anesthteics what could occur?

local necrosis, particular if you inject it

Lacrimation could occour because?

there is a reflex tearing due to weak base on the eye

What are systemic ANESTHETIC adverse effects?

``` CNS (low/moderate dose): CNS (high dose) cardiovascular: Hypotension cardiac collapse Hypersensiivity ```

What could be seen with CNS(Low/moderate dosage)?

``` Euphoria Dysphoria Insomnia visual and auditory hallucinations Restlessness Tremor ```

What could be seen with CNS(high dose)?

Nystagmus Tremor Depression Death

What could be seen with cardiovascular?

Decrease excitability Decrease cardiac force/conduciton leading to hypotension Cardiac collapse NOTE; THIS IS OPPSITE TO COCAINE

What could be seen with hypersenstivity?

``` Allergic dermattits Angioneuotic edema Urticarial Asthma attack Bronchospasm anaphylaxis ```

What does prilocaine has?

Methemoglbinemia which causes hemoglobin to lose affinity for oxygen so pt wit respiratory problems could have lethal interaction

What are the clinical uses with Local Anesthetics?

Blocks the nerve impulse generation an conduction | But it is completely reversible

What are the properties of Anesthetics?

1) Rapid onset 2) Adequate duration of action 3) Minimal side effects 4) Minimal local tissue damage

Small diameter nerves tend to be?

more active and more sensitive

Myelination influences by how?

Regardless if its small diameter or large diameter, if there is myelination it will enhance sensitivity

Large diameter nerves tend to be?

less sensitivity and recover quickest

What are features of esters?

unstable hydrolyzed by pseudocholinesterases High allergy potential for about 5-10 mints

How should you treat hypersensitivity?

Decongestants and Constriction

How will constriction will help?

- It will reduce metabolism - Keep it localized rather than spreading it to the injection site - Use EPINEPHRINE as small amounts for decongestants - Reduce Absorption

if you have a condition that want the immune system to resolve itself, then you should apply?

Warm compressions | - this will enhance blood flow thorughout the body

If you have a condition such as inflammation, and you dont want to bleed out,, you should apply?

Cold compressions

Warm compressions vs cold compressions

``` Warm = will dilate and relax Cold = will constrict ```

Applying ANESTHETIC + VASOCONTRICTOUR WOULD DO WHAT?

it will help to keep that drug locally without going around systemically 1) reduce absorption/ toxicity 2) reduce bleeding from the injected site 3) sustain a local effect 4) Reduce metabolism

LOCAL ANESTHETICS Flashcards

(51 cards)