Notes in 16 Local Anesthetics

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Published	12/13/2023	Local anesthetics bind to the {{c1::alpha}} subunit of of voltage gated Na channels.
Published	12/13/2023	In {{c1::phasic (use-dependent)}} blockade, local anesthetics have a faster onset with {{c2::frequent depolarization}} of a nerve.…
Published	12/13/2023	Smaller diameter nerve fibers are {{c1::more::more/less}} sensitive to local anesthetics.
Published	12/13/2023	A-alpha fibers are {{c1::less::more/less}} sensitive to local anesthetics than A-delta fibers.
Published	12/13/2023	Small unmyelinated C fibers are relatively {{c1::resistant::sensitive/resistant}} to inhibition by local anesthetics compared to large myelinated fibe…
Published	12/13/2023	Local anesthetics contain a {{c1::lipophilic}} benzene ring, {{c2::hydrophilic}} amine group, and an {{c3::ester}} or {{c3::amide}} intermediate chain…
Published	12/13/2023	The lipophilic group of local anesthetics are usually {{c1::benzene rings}}.
Published	12/13/2023	The hydrophilic group of local anesthetics are usually {{c1::tertiary amines}}.
Published	12/13/2023	Local anesthetics are {{c1::weak::strong/weak}} {{c2::bases::acids/bases}}.
Published	12/13/2023	The {{c1::nonionized}} form of local anesthetics is the form that crosses the neuronal membrane.
Published	12/13/2023	The {{c1::ionized}} form of local anesthetics is the form that binds the voltage-gated Na+ channel.
Published	12/13/2023	Highly {{c2::lipid}} soluble local anesthetics have a {{c1::longer::longer/shorter}} duration of action.
Published	12/13/2023	There is increased {{c1::systemic}} absorption with increased vascularity of the injection site.
Published	12/13/2023	The sites of injection ranked according to {{c11::vascularity and systemic absorption}} (greatest to least) can be memorized with the mnemonic IT…
Published	12/13/2023	The addition of epinephrine to local anesthesia prolongs the uptake of {{c1::shorter}} acting agents like tetracaine and lidocaine.
Published	12/13/2023	Epinephrine and clonidine can augment analgesia by local anesthetics through activation of {{c1::α2}} receptors.
Published	12/13/2023	{{c2::Ester}} local anesthetics are predominantly metabolized by {{c1::pseudocholinesterases}}.
Published	12/13/2023	Amide local anesthetics are metabolized by CYP-{{c1::3A4}} and {{c3::1A2}}.
Published	12/13/2023	Oral symptoms of local anesthetic toxicity include {{c1::circumoral}} numbness, paresthesias of the {{c2::tongue}}, and a {{c3::metallic}} taste.&nbsp…
Published	12/13/2023	At {{c3::high::high/low}} concentrations, local anesthetics cause vaso{{c2::dilation}}, except {{c1::cocaine}}.
Published	12/13/2023	{{c1::Neurologic::CV/Neuro}} signs and symptoms of local anesthetic toxicity occur BEFORE {{c1::cardiovascular::CV/Neuro}} ones.
Published	12/13/2023	{{c2::Bupivacaine}} is a local anesthetic that is associated with severe {{c1::cardiovascular}} toxicity
Published	12/13/2023	What populations are at increased risk for bupivacaine toxicity?{{c1::Pregnant women and children}}
Published	12/13/2023	First line treatment for local anesthetic toxicity should be {{c1::20% lipid emulsion}}, which sequesters local anesthetics and reduces plasma co…
Published	12/13/2023	Ropivacaine produces {{c1::less::more/less}} motor blockade than bupivacaine.
Published	12/13/2023	Ester local anesthetics are {{c1::more::more/less}} likely to induce an allergic reaction than amide.
Published	12/13/2023	{{c2::2-Chloroprocaine}} antagonitzes {{c1::μ and κ}} opioid receptors in the spinal cord.
Published	12/13/2023	Which nerve fibers are unmyelinated? {{c1::C fibers}}
Published	12/13/2023	Which nerve fibers are initially affected by local anesthetics?{{c1::B nerve fibers}}
Published	12/13/2023	What modalities do the B nerve fibers serve?{{c1::Preganglionic sympathetic fibers}}
Published	12/13/2023	Which fibers are the first fibers to recover from spinal anesthesia?{{c1::A-alpha}}
Published	12/13/2023	What modalities do the A-alpha fibers serve?{{c1::Motor control (efferent)}}
Published	12/13/2023	What modalities do the A-beta fibers serve?{{c1::Touch}} and {{c1::pressure}}
Published	12/13/2023	What modalities do the A-gamma fibers serve?{{c1::Proprioception (muscle spindles)}}
Published	12/13/2023	What modalities do the A-delta fibers serve?{{c1::temperature}} and {{c1::pain}}
Published	12/13/2023	What modalities do the C fibers serve?{{c1::temperature}}, {{c1::pain}}
Published	12/13/2023	What fibers are responsible for sensing pain?{{c1::A-delta, C}}
Published	12/13/2023	What fibers are responsible for sensing temperature?{{c1::A-delta, C}}
Published	12/13/2023	What fibers are responsible for proprioception?{{c1::A-gamma}}
Published	12/13/2023	What fibers are responsible for motor control?{{c1::A-alpha}}
Published	12/13/2023	The potency of local anesthetics is directly proportional to the {{c1::lipid solubility}}.
Published	12/13/2023	The duration of action of local anesthetics is directly proportional to the {{c1::degree of protein binding}}.
Published	12/13/2023	Local anesthetics with a {{c1::pKa}} closest to physiologic pH have the {{c2::fastest::slowest/fastest}} onset of action.
Published	12/13/2023	Bupivacaine is a local anesthetic with an {{c1::amide}} structure.
Published	12/13/2023	Lidocaine is a local anesthetic with an {{c1::amide}} structure.
Published	12/13/2023	Tetracaine is a local anesthetic with an {{c1::ester}} structure.
Published	12/13/2023	Allergic reactions to {{c2::ester}} local anesthetics are from the compound {{c1::PABA}}.
Published	12/13/2023	Allergic reactions due to {{c2::amide}} local anesthetics are from the compound {{c1::methylparaben}}.
Published	12/13/2023	Blurred vision, tinnitis, dizziness, metallic taste, and altered levels of conciousness are neurological signs of {{c1::local anesthetic}} toxici…
Published	12/13/2023	What size of nerve fiber, small or large diameter, is affected first by local anesthetics?{{c1::Small-diameter fibers}}
Published	12/13/2023	Which nerve fibers (size, myelination) are affected first by local anesthetics?{{c1::Small, myelinated fibers}}
Published	12/13/2023	What type of local anesthetics are procaine, cocaine, tetracaine, and benzocaine?{{c1::Esters}}
Published	12/13/2023	Would a small, unmyelinated or large, myelinated fiber be affected first by local anesthetics?{{c1::Small, unmyelinated}}
Published	12/13/2023	What type of nerve fiber, myelinated or unmyelinated, is affected first by local anesthetics?{{c1::Myelinated fibers}}
Published	12/13/2023	What type of local anesthetic are lidocaine, mepivacaine, and bupivacaine?{{c1::Amides}}
Published	12/13/2023	What type of local anesthetics should be given to a patient who is allergic to ester local anesthetics (e.g. procaine)?{{c1::Amide anesthetics (e.g. l…
Published	12/13/2023	What drugs increases the risk of bupivacaine toxicity (3)?{{c1::β-blockersCalcium channel blockersDigoxin}}
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