Neuraxial pharmacology- Exam 1

Question 1

Which class of LA has two “I’s” in the name?

Answer 1

Amides

Question 2

The aromatic ring of the LA is ___

Answer 2

Lipophillic

Question 3

The intermediate chain of the LA is significant because

Answer 3

It determines the drug class, metabolism and allergic potential

Question 4

The tertiary amine group of the LA is ___

Answer 4

Hydrophillic

Question 5

Which LA class has more allergic reactions? why?

Answer 5

Esters –> PABA

Question 6

Which gate do LA block on sodium channels?

Answer 6

Inner / H gate

Question 7

Most LA are weak ___

Answer 7

bases

Benzocaine is a weak acid

Question 8

What factors influence the vascular uptake and plasma concentration of local anesthetics

Answer 8

-Site of injection
-Tissue blood flow
-Addition of vasoconstrictor
-Metabolism
-Physiochemical properties

STAMP

Question 9

Name the sites that result in the highest LA blood concentrations from most to least

Answer 9

Question 10

How does an isobaric LA solution behave?

Answer 10

Stays in place where it is injected

Question 11

How does an hyperbaric LA solution behave?

Answer 11

Sinks, moves downward

Question 12

How does an hypobaric LA solution behave?

Answer 12

Rises, moves upwards

Question 13

In the supine position, what are the two high points (apexes) of the spine

Answer 13

C3 and L3

Question 14

In the supine position, what are the two low points (trough) of the spine

Answer 14

T6 and S2

Question 15

With a SAB, spinal cord uptake of LA occurs due to ____ ____ nature of the drug

Answer 15

Lipid soluble

Question 16

With a SAB, the spread of an LA occurs in a ___ and ___ direction from the site of injection simultaneously

Answer 16

Cephalad
Caudad

Question 17

With SAB, how are LAs eliminated?

Answer 17

Reuptake via vascular reabsorption in the vessels of the pia mater

Question 18

With SAB, why do lipophilic drugs have a slow uptake?

Answer 18

They have a high affinity for epidural fat

Question 19

We do incremental dosing with 5 mL with an epidural because it avoids these 3 things

Answer 19

-Accidental high spinal
-Hypotension from autonomic blockade (cardiac arrest)
-Local anesthetic toxicity

Question 20

What can be added to your epidural meds as an IV marker?

Answer 20

Epinephrine

Question 21

This ester LA is popular in OB due to its rapid onset and short duration

Answer 21

2-Chloroprocaine

Question 22

How does alkalinization impact an epidural block?

Answer 22

-Increases speed of onset
-Increases the concentration of the nonionized (active) drug
-Increases rate of diffusion of the drug

Question 23

With an epidural, the ____ of the LA is crucial for how high the anesthetic block reachers

Answer 23

volume

Question 24

The initial epidural dose is __-__ mL per segment of the spine

Answer 24

1-2 mL

Question 25

With an epidural, the top up dose should be __-__% of the initial dose

Answer 25

50-75%

Question 26

It is time for a top-up dose when the block decreases more than __ dermatomes

Answer 26

2

Question 27

The epidural space varies. Is the thoracic or lumbar space bigger?

Answer 27

Lumbar | Because thoracic is smaller, spread is greater in thoracic

Question 28

With an epidural, the concentration determines the block _____

Answer 28

Duration

Question 29

In regards to neuraxial pharmacologic adjuncts, how do opioids impact the block?

Answer 29

Provides postop analgesia and improves density | NO extension of duration

Question 30

In regards to neuraxial pharmacologic adjuncts, how do Alpha-2 agonists impact the block?

Answer 30

Improves density, duration and analgesia

Question 31

In regards to neuraxial pharmacologic adjuncts, how do vasopressors impact the block?

Answer 31

extend duration ONLY

Question 32

In regards to neuraxial pharmacologic adjuncts, what opioids are used?

Answer 32

-Fentantyl -Morphine -Sufentanil | Also diluadid and meperidine apparently (different slide)

Question 33

Opioids are catergorized into ___ or ___ in regards to neuraxial pharmacologic adjuncts

Answer 33

* Hydrophillic * Lipophillic

Question 34

Which opioids stay in CSF longer, the hydrophillic or lipophillic ones?

Answer 34

Hydrophillic

Question 35

Compare hydrophillic vs lipophillic opioids: Which lasts longer? Which spreads wider? Which spreads more rostral? Which takes longer? Which lasts longer? Which has less systemic absorption? Which stays longer in CSF? Which one has late respiratory depression?

Answer 35

Hydrophillic

Question 36

The ____ nature of morphine causes cephalad spread. Therefore, intrathecal morpgine requires ___ monitoring

Answer 36

-Hydrophillic -Apnea

Question 37

When vasoconstrictors are added to tetracaine, there is a ___ increase in the duration of the block What about with lidocaine?

Answer 37

-Profound -Variable

Question 38

Patients on anticoagulants should avoid neuraxial anesthesia due to the risk of ____

Answer 38

Epidural hematoma

Question 39

What is the treatment for an epidural hematoma?

Answer 39

Surgical decompression within 8 hours to optimize recovery chances

Question 40

Unfractionated heparin potentiates ____ which inhibits factor ___ as well as factors __, __, __, and ___

Answer 40

* Antithrombin * Factor 2 (thrombin) * 9 * 10 * 11 * 12

Question 41

LMWH inhibits factor __

Answer 41

10a

Question 42

Vitamin K dependent clotting factors that are impaired by warfarin

Answer 42

2, 7, 9, 10

Question 43

Thrombolytic agents (streptokinase, alteplase and urokinase) work by activating ____

Answer 43

plasminogen

Question 44

Direct avting oral anticoagulants inhibit factor ___

Answer 44

10a