Ocular Pharm Exam 2 Anesthetics

Front 1

How do Anesthetics work?

Back 1

The non-ionized form can go straight into the cell. The more acidic environment which then ionizes it. Whenever it get ionized it then has a higher binding affinity for the Na channel. When it binds to the Na channel it will block Na influx thus causing the stop of neural transmission

Front 2

Chemical structures of Anesthetics

Back 2

Lipophilic groups

intermediate linkages

Hydrophilic groups

Front 3

Which is the most important portion of the anesthetic?

Back 3

The intermediate linkage group

Front 4

Lipophilic group

Back 4

Benzene ring

The more and more Lipophilic increases the potency and duration increases

BUT it can also increase toxicity

Front 5

Intermediate linkage

Back 5

Will be ESTER or AMIDES

Front 6

Esters

Back 6

Unstable, last for a short duration and are broken down by pseudocholinesterases

**ALL common topical anesthetics**

Front 7

Amides

Back 7

Very stable, last a longer duration and are metabolized by the liver

**these are injectable anesthetics**

Front 8

Would you be more likely to have an allergic issue to, Amides or Esters

Back 8

We are more likely to have allergic issues with esters (topicals)

Front 9

Esters

Back 9

Tetracaine

Proparacaine

Benoxinate

**remember these are NOT metabolized by the body but are broken down by Psuedocholinesterases

Front 10

Amides

Back 10

(Remember these ALL have a I in the name that’s not apart of the “caine” portion)

Bupivacaine

Lidocaine

Front 11

What do local anesthetics generally effect?Dur

Back 11

Every nerve!!

Will generally effect the pain receptors last!!

***WIll take A LOT to effect the motor fibers***

Front 12

Duration of Anesthetics

Back 12

directly proportional to time spent on the tissue

For injectable’s anesthetics

-they have a natural vasodilation so they get cleared away from sight quickly so they need to have a vasoconstrictor paired with them (Epinephrine)

Front 13

What is the downside of adding the vasodilator to the anesthetic?

Back 13

They can have some ischemia

Front 14

What can cause anesthetics to stick around longer ?

Back 14

Protein binding!!! (Bupivacaine)

Vasoconstriction

Front 15

Bupivacaine

Back 15

AMIDE

Has naturally MORE protein binding than other amides

Front 16

DRUG durations

Back 16

Short durations

-Procaine, Chlorocaine

Intermediate

-Lidocaine, mepivicaine,prilocaine

Long

-Tetracaine, Bupivacaine, etidocaine

Front 17

Which one of these drugs lasts the longest?

A. Lidocaine

B. Proparacaine

C. Tetracaine

D. All have the same duration

Back 17

C Tetracaine

Front 18

SE of Anesthetics

Back 18

RARE TO HAVE SEVERE REACTION

More common to have minor stuff like DESQUAMOUSATION OF CORNEA

Systemic reaction are rare and generally only happen with Prolonged use

Front 19

True or false, Systemic reaction are likely to happen whenever you use anesthetics?

Back 19

False, they are only used when its prolonged use

Front 20

Overdose doses

Back 20

14 for Proparacaine

7 for Tetracaine

Front 21

What to do whenever corneal melt occurs?

Back 21

Bandage contact

Use an antibiotic for the opened cornea

Use a systemic analgesic

Front 22

Benzocaine

Back 22

The only anesthetic to actually have a known Dermatitis sensitivity

Front 23

Which anesthetic has a known dermatitis sensitivity

Back 23

Benzocaine

Front 24

Tetracaine 0.5%

Proparacaine 0.5%

Back 24

have the same Onset (10-20s)

Have the same duration (10-20min)

and generally provide more anesthesia when given in multiple doses

** so in surgical procedures. you need to give multiple drops to increase the anesthesia

Front 25

Tetracaine 0.5%

Back 25

similar to proparacaine but

has more stinging

has more corneal involvement than propar

*can have cross hypersensitivities with proparacaine

Front 26

Benoxinate

Back 26

0.4% with NaFl- Fluress

0.4% with fluorexon= Flurasafe

Stinging is inbetween Tetra and Propar

Front 27

What is the order to stinging with the esters?

Back 27

Tetracaine>Benoxinate>Proparacaine

Front 28

What makes up fluress?

Back 28

0.4% Benoxinate and NaFl

Front 29

Proparacaine 0.5%

Back 29

Comes in

0.5% solution

0.5% with fluorescein sodium (Fluorocaine, Flucaine)

**low incidence of hypersensitivity

is the DOC because it doesnt sting as much but it does NOT have as good as anesthesia as Tetracaine

Front 30

what is the DOC of anesthesia for us?

Back 30

Proparacaine but it will not have as good of anesthesia compared to Tetracaine

Front 31

Should you use preserved anesthetics when culturing bacteria?

Back 31

No because the preservative will haver a bacteriostatic effect.

Front 32

Of all the anesthetics, which one has the least amount of bacterial inhibition?

Back 32

Proparacaine 0.5%

Front 33

Which anesthetic is best for forced Ductions?

Back 33

Lidocaine Gel 3.5%

Front 34

which type of injection is best for chalazion removals?

Back 34

regional nerve block because it doesnt effect near by tissue

Front 35

Injectable Drugs

Back 35

Lidocaine 0.5-2% w/wo Epi

Bupivacaine 0.5% NO epi

Front 36

true or false, Both Lidocaine and Bupivacaine both are used with Epi?

Back 36

False, only lidocaine is used with epi

Front 37

which one of the injectable drugs acts faster and has a shorter duration?

Lidocaine (0.5-2%) or Bupivacaine 0.5%

Back 37

Lidocaine works faster and has a shorter duration

Bupivacaine generally last must longer and has a slower onset

Remember you can combo Bupivacaine with Lidocaine

Front 38

What to use:

lid lesions

Back 38

pre tarsal block

use lidocaine 1%w epi or with 2% bupivicaine

Front 39

what to use:

Chalazions

Back 39

small to med/ anterior to tarsus

-use pretarsus sub Q- lidocaine 1% with epi or with bupivicaine

Front 40

what to use: Chalazions

Back 40

Post to tarsus

use trans conj approach

=lidocaine 3.5%gel followed by lidocaine 1% with epi

Front 41

When do you use the trans conj approach?

Back 41

when you have a chalazion thats post tarsus

yo would use 3.5% lidocaine gel followed by 1% lidocaine with epi injection

Front 42

what to use: Chalazions

Back 42

Large Chalazions or sensitive pt

just use a regional block!

Front 43

how do you anesthetize the skin?

Back 43

****TOPICAL AMIDES AND ESTERS DO NOT ANESTHETIZE THE SKIN****

-use 2.5% lidocaine and 2.5% prilocaine

Front 44

What are the injectable anesthetics?

Back 44

Lidocaine 0.5-2% with Epi

Bupivicaine- 0.5% without epi

***these can be combod together

Front 45

Can you control pain without opioids?

Back 45

Yes,

500-1000mg tylenol with 400-600 mg of Ibuprofen taken simultaneously has Equivalent analgesia compared to opioids

Front 46

How to manage post herpetic neuralgia

Back 46

Oral antivirals ASAP

Zostrix cream to area 3-4xd (capsaisin OTC)

low done of Try cyclic antidepressants (amytryptylene 25mg/day)

GABApentin for nerve pain (start low it has a huge dose range)

5HT agonists "tryptan drugs

Front 47

which one of these is NOT part of the treatment for Post herpetic neuralgia?

A. Gabapentin

B. Amitriptyline

C. 5HT agonist

D. oral antivirals

E. Zostrix cream

Back 47

ALL of those are treatments for Post herpetic Neuralgia

Front 48

d

Back 48

d

Front 49

;

Back 49

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