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Pharm Test 2

Pharm Test 2 Ch. 12 Local Anesthetics

the goal of local anesthetics (LAs)? block afferent neural transmission along the peripheral nerve
where do LAs work? peripheral nerve
If given in a specific spot in the spine can the LA travel throughout the body? yes
What has a faster recovery time and less residual effects, LAs or GAs? LAs
T/F LAs mess w/ cardio, respiratory &/or renal functions? false
Do they take effect quickly? no
Can LAs be used to treat analgesia? yes
How can PTs use LAs? iontophoresis and phonophoresis
What is phonophoresis? using ultrasound to enhance the topical drug
What is iontophoresis? using electrical current to penetrate drugs into the body through skin
Do Las contain lipophilic and hydrophilic groups connected by an intermediate chain? yes
How are LAs chosen? -operative site -nature of the procedure -type of regional anesthesia desired -Pt's size and general health -duration needed
What is the common ending of LAs? -caine
Pharmokinetics of LAs injections
Are vasoconstrictors used with some of these drugs? If so why? If not why? yes and to prevent washouts
How are these drugs eliminated? by hydrolyzing or breaking apart the molecule - catalyzed by hepatic enzymes or enzymes in circulation of the plasma - KINDEYS EXCRETE
What are the types of LAs? Topical, transdermal, infiltration
Infiltration is? injecting directly into the tissue
What are the types of infiltration anesthesia? peripheral nerve block central nerve block Sympathetic blockade IV
Peripheral Nerve Block (PNB) is done where? mostly done close to the nerve trunk but can be done near nerve plexus - dental procedures
How many types of PNBs are there? 2; minor and major
Minor nerve block is when? 1 nerve is blocked
Major nerve block is when? more than 1 nerve is blocked
Can PNBs be given after surgery? yes by a small catheter
Prolonged use of PNB can lead to? necrosis and pain
Central Nerve Block (CNB) are given where? spaces surrounding the spinal cord -epidural
Where is the epidural? between the bony vertebral column and the dura mater
T/F CNB can be given in the sacral hiatus true
Intrathecal anesthesia is also known as spinal nerve block within the subarachnoid space
Intrathecal anesthesia is given when? when larger regions need analgesia
intrathecal anesthesia is normally given between what vertebrae? L3-4 or L4-5
Where does the spinal cord in? L2
Which is easier to perform, epidural or intrathecal? epidural
Which is more rapid epidural or spinal? spinal
Which has the higher risk, spinal or epidural? spinal
T/F Local anesthetics are neurotoxic when given in large amounts. True
Sympathetic Blockades are given to do what? disrupt sympathetic discharges
Reflex sympathetic dystrophy syndrome (RSDS) is also known as... central regional pain syndrome (CRPS) or causalgia
CRPS involves sympathetic or parasympathetic discharge? sympathetic; often causing increased pain and dysfunction of distal part of extremity
How is sympathetic blockade administered? injected into the area surrounding the sympathetic chain ganglion that innervates the affected limb
Where is sympathetic blockades mainly given? Stellate ganglion for upper L2 for lower extremity
How often is this treatment given to a Pt? 10 days of 5 injections on every other day
T/F Sympathetic blockades can be given IV or subcutaneously true
IV regional anesthesia is also known as.. Beir Blocker
Where are IV regional anesthesia administered? peripheral vein located in arm or leg
Must a tourniquet be used for the IV regional anesthetic? yes
Where should the tourniquet be placed for IV? proximal to prevent it from leaving the area
Mechanisms of Action LOOK AT NOTES!
Differential Nerve Blocks are used for what? to block specific nerve fiber groups depending on the size of the fiber (diameter)
Which nerve fibers are more sensitive, large or small? small
What type of fiber transmits pain? type C
Type A fibers are large or small? large
WHat do type A fibers do? skeletal motor
which fiber is 1st to be affected and which is last? C then A; temp., touch, proprioception is 2nd
the main importance for a differential nerve block is sensory or motor? sensory
Local anesthetic systemic toxicity (LAST) is when? the LA is given & sometimes being absorbed into the general circulation
LAs can effect organs when get into general circulation? yes
Virtually all LAs stimulate what initially, brain or body? brain
T/F central excitation is followed by CNS depression true
does heart rate and force of contraction go up or down when on LAs? down
Early signs of LA toxicty ringing of the ears, agitation, restlessness, decreased sensation of the tongue, bradycardia, cardiac depression
What can be given to treat LAST? lipid rescue or lipid resuscitation
Lipid rescue or lipid resuscitation is given how? injection
What is injected in lipid rescue? emulsified lipid compounds that soak up the lipophilic LA molecules
Created by: hfillingim
 

 



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