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SUMMER PHARM > Local Anesthetics > Flashcards

Local Anesthetics Flashcards

(89 cards)

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1
Q

What 3 kinds of blocks do LA’s providE?

A

autonomic, somatic sensory, somatic motor

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2
Q

_______ nerve roots contain the cell bodies of the Afferent neurons. These are _________ neurons.

A

Dorsal

Sensory

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3
Q

________ nerve roots contain the cell bodies of Efferent neurons. These are _______ neurons.

A

Ventral

Motor

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4
Q

A ___________ cell wraps itself around a myelinated nerve fiber

A

Schwann Cell

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5
Q

Extracellularly is a high concentration of _____ and low concentration of _________.

A

Na

K

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6
Q

The velocity an impulse travels is ___________ to the diameter of the fiber

A

proportional

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7
Q

LA’s will keep ion channel in the ________ state

A

inactive

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8
Q

_____ is the more permeable ion

A

K

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9
Q

Are A fibers myelinated or unmyelinated? What is their size? How fast are they?

A

Myelinated
1-22microns
fastest of all of the fibers

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10
Q

Which is faster? Aalpha or A delta

A

A alpha

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11
Q

What is the size of B fibers?

A

1-3 micrometers

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12
Q

What is the size of C fibers? are they myelinated or unmyelinated?

A

.1 - 2.5 micrometers

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13
Q

Which is the slowest fiber?

A

C

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14
Q

Which fibers are PREganglionic auntonomic

A

B

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15
Q

Which fibers deal with pain, temperature, and touch

A

A delta

and C with dull pain

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16
Q

Which fibers are POSTganglionic autonomic

A

C

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17
Q

CLINICALLY, Which type of blockade will you see first? Last?

A

autonomic

motor

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18
Q

The sequence of onset and recovery from a LA block in a mixed peripheral nerve relies heavily on ______________________________

A

Where is it located

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19
Q

What # is RMP?

A

-70mv

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20
Q

___________ is he difference in the concentration of + and - ions when the cell is at rest

A

RMP

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21
Q

Intracellular space has a relative ________ charge compared to the extracellular space. This is bc ______ ion is impermeable to the resting cell membrane

A

negative

Na

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22
Q

The membrane is more permeable to ______

A

K

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23
Q

It is the movement of _____ that establishes and maintains RMP

A

K

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24
Q

An AP occurs when what 4 physiologic stimuli is received b the nerve receptor?

A

mechanical, thermal, chemical, pressure

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25
As an AP is propagated, the stimulus causes _____ channels on the membrane to open.
Na
26
During an AP, influx of _____ causes membrane potential to increase to ____-____ mv
Na | 20-40mV
27
Local Anesthetics change ______________________________
The ability to reach threshold
28
LA's bind the Na Channel ________ subunit when it is in the _______________ state
Alpha | Inactivated Closed State
29
LAs access nerve cell Na channels during the _____________ state
activated open
30
A _________ nerve is less sensitive to block.
resting (versus a repetitively stimulated nerve)
31
LAs have a _______________ head made, a ______________ chain, and a _____________ tail.
lipophilic intermediate hydrophilic
32
NH represents a ____________ and COO- represents a ______________
amide | ester
33
Is lidocaine an amide or an ester?
amide (2 I's)
34
How are Esters metabolized/broken down?
Hydrolyzed by non-specific esterase in the pasha and tissues
35
How are Amides metabolized/broken down?
in the liver
36
Highly lipid soluble anesthetics are more or less potent than water soluble anesthetics
MORE SOLUBLE
37
An increase in the length in the chain, tail, or head increases _________________
Potency and toxicity
38
Are bupivacaine and mepivacaine pure S enantiomers or racemic?
RACEMIC
39
Exparel is an extended release _________ injection. Max dose is ________mg
Liposome | 266 (20ml)
40
Cm refers to the ____________________ of LAs
minimum blocking concentration
41
An impulse can make it through ___ blocked nerves but not ____... this becomes an issue with ___ fibers
2 not 3 | A
42
The distance between nodes in a myelinated nerve fiber contributes to: _______________
Differential Nerve Blockade
43
A differential Nerve Block is a __________ block with incomplete __________ block
sensory | motor
44
The Pain conducting fibers are:
A Delta and C fibers
45
____________ was the first LA shown to produce a beneficial differential block
bupivacaine
46
What is the order from highest to lowest of absorption by type of block?
Intravenous, Tracheal, intercostal, caudal, pericervical, epidural, brachial plexus, subarachnoid/spinal, subcutaneous
47
Do ionized or non-ionized cross a lipid membrane more readily?
non-ionized
48
The non-ionized form is favored when you have an acidic drug in a ____________ environment or a basic drug in a ___________ environment
acidic | basic
49
All LA's are weak ________ with pka values between ____-____
bases | 7.5-9
50
What is the ideal pka?
7.4
51
The __________ form binds and blocks the Na channel
ionized
52
The __________ form penetrates the nerve sheath and axon membrane to reach the site of action
non ionized
53
_______ is the most important property in determining onset of LAs
pKa
54
Which pKa will provide a faster onset in a LA? A pKa of 7.5 or 9?
7.5 because the closer the pKa is to physiologic pH, the faster the onset
55
How can we increase the amnt of non-ionized form so that we can speed up the onset?
increase the pH (add BICARB)
56
Adding _________ to a block increases the onset, enhances block depth, and increases the spread of the block
bicarb!
57
A _________ temperature reduces drug absorption across the nerve membrane
decreasing
58
Lipid solubility is directly related to __________ for LAs
potency
59
The 3 most potent LAs are:
Etidocaine, bupivacaine, tetracaine
60
Potency: ________ as onset: ___________ as duration: _________
lipid solubility pKa protein binding
61
The most important factor in determining DOA for LAs is: ________________
protein binding
62
What 3 purposes does adding epi to a LA serve?
1. inhibit systemic absorption 2. prolong effects 3. detect IV injection
63
____________ is a LA similar to lidocaine but without the intrinsic vasodilator effect
mepivicaine (so won't need epi)
64
Which 3 LAs have uptake by the lungs?
Bupivicaine, lidocaine, prilocaine
65
How are esters metabolized?
hydrolyzed by pseudocholinesterases
66
Which LA's have a metabolite? whats it's name?
Esters, | PABA - its inactive but allergenic
67
How is cocaine metabolized?
by the liver
68
With LA toxicity, muscle twitching in the face means......
seizures are imminent
69
____________ increases the risk of LA toxicity and ___________ decreases the risk
hyperkalemia | hypokalemia
70
The _____________ system is more resistant to toxic effects of LAs
Cardiovascular system
71
_________________ is the most CV toxic and cardiac arrest may occur at lower levels of toxic doses
bupivicaine
72
____________ and ____________ decrease hepatic blood flow and therefore decrease clearance of amide LAs
propranolol | cimetidine
73
_________ blocks NE and dopamine reuptake
cocaine
74
________ is an ester with a short DOA and a slow onset
procaine
75
________ is an ester with a very long DOA (6hrs) and slow onset.
tetracaine
76
__________ is an ester that is popular with OB anesthesia d/t its ultra rapid serum hydrolysis
Chloroprocaine
77
Monoethylglycinexylidide is the active metabolite for _______________
lidocaine
78
T/F Lidocaine can be used in all routes of administration
F - shouldn't use with spinal d/t cauda equina syndrome
79
_____________ has the highest unionized fraction @ physiologic pH
mepivicaine
80
______________ is a good amide LA to consider when use of a vasoconstrictor is contraindicated
mepivicaine
81
Ortho-toluidine is the toxic metabolite of _____________
prilocaine
82
Avoid the use of _____________ in OB
prilocaine
83
Methemoglobinemia can be an issue mainly with ______________ but also also
prilocaine | lidocaine - topical
84
Methemoglobinemia can occur in prilocaine doses >________ and is treated with _____________
600mg | methylene blue 1-2mg/kg iv over 5mins
85
_____________ is popular for differential nerve blocks. ________>_________
bupivacaine | sensory > motor
86
Bupivacaine is high protein bond to _________________
alpha 1 glycoprotein
87
The bad s/e of bupivacaine is ___________
very cardio toxic
88
___________ and _________ are S-enantiomers of bupivacaine.
ropivacaine and levobupivacaine
89
For epidural blocks, you give _____-_____ml/per segment desired
1.25 - 1.6

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