Pharm Winter Exam 2 Local Anesthetics

Front 1

Toxicity of Local Anesthetics

CNS

Back 1

Sleepiness, Visual and auditory disturbances,
circumoral and tongue numbness,
nystagmus, twitching, tonic-clonic convulsion, death

Front 2

Toxicity of Local Anesthetics

Peripheral nervous system

Back 2

Prolonged sensory and motor deficits following high doses

Front 3

Toxicity of Local Anesthetics

Cardiovascular

Back 3

1) Inhibition of Na and Ca channels
2) Arrythmias
3) Neg. Inotropic (not Cocaine)
4) Vasodilation-hypotension (not cocaine)

Front 4

Toxicity of Local Anesthetics

Cardiovascular- Bupivacaine

Back 4

more toxic than others due to increased binding to resting channels, Broadening QRS

Front 5

Toxicity of Local Anesthetics

Cardiovascular- Cocaine

Back 5

Increased sympathetic tone:
1) Vasoconstriction,
2) Hypertension
3) Local ischemia(necrosis of mucous membranes)
4) Arrythmias

Front 6

Toxicity of Local Anesthetics

Blood

Back 6

Prilocaine metabolite may produce methemoglobinemia

Treat with methylene blue

Front 7

Toxicity of Local Anesthetics

Allergic Reaction

Back 7

Ester type (PABA) rare with amide type.

Front 8

Procaine (Novocaine)

Back 8

1) Short acting
2) PABA
3) Inhibits action of Sulfonamides
4) No topical administration
5) With or without Epinephrine
6) Epi increases duration of anesthesia

Front 9

Tetracaine (Pontocaine)

Back 9

1) Long acting, Slow onset
2) Spinal anesthesia/opthamology
3) Use with dextrose to increase specific gravity. Keep it in the bottom of spinal cord
4) 10 times more potent and toxic than procaine
5) Topical administration also

Front 10

Benzocaine

Back 10

1) Topical only
2) Sunburn
3) Minor trauma
4) Pruritis
5) OTC

Front 11

Cocaine

Back 11

1) Intermediate acting
2) Topical for mucous membranes
3) Systemic Block reuptake of catecholamines

Front 12

Cocaine

CNS

Back 12

1) Euphoria and poststimulatory depression
2) Sometimes dysphoria
3) CNS stimulation: reslessness, tremor, seizure

Front 13

Cocaine

Cardiovascular

Back 13

Tachycardia
Vasoconstriction
Hypertension
Arrythmias

Front 14

Cocaine

Adverse effects

Back 14

1) Tolerance, abuse overdose toxicity
2) Hyperpyrexia
3) Anorexia
4) Use cautiously in hypertension, CVD, or thyrotoxicosis or other drugs that potentiate catecholamine

Front 15

Lidocaine (Xylocaine)

Back 15

1) Uses: infiltration blocks and epidurals
2) P450 metabolism,
3) Rapid onset
4) Long duration, and greater potency than procaine
5) Topical with or without EPI
6) IV antiarrythmatic

Front 16

Prilocaine (Citanest)

Back 16

1) Intermediate duration of action longer than Lidocaine
2) Don't use: Cardiac or respiratory disease, methemoglobinemia, topically, or subarachnoid space

Front 17

Bupivacaine (Marcaine, Sensorcaine)

Back 17

1) Long duration of action
2) Infiltration blocks and epidurals
3) Greater cardiac toxicity than other amides.

Front 18

Ropivacaine( Naropin)

Back 18

1) S enantiomer of Bupivocaine
2) Long acting
3) Less lipid soluble and cleared via liver rapidly = less adverse events
4) Drug interactions: alfentanyl, throphylline, fluvoxamin, cimetidine