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    Pharmacology Local Anesthetics

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    alianaeem839
    Local anesthetics work by blocking nerve conduction of sensory impulses and at higher concentrations motor impulses. They are administered topically, via infiltration, spinal block, or epidural block. Bupivacaine can cause both hypotension and arrhythmias due to its cardiotoxic effects. Procaine metabolizes hemoglobin to methemoglobin. Treatment for local anesthetic toxicity involves oxygen therapy, diazepam for convulsions, and supportive care.

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    Pharmacology Local Anesthetics

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    alianaeem839
    23 views60 pages
    Local anesthetics work by blocking nerve conduction of sensory impulses and at higher concentrations motor impulses. They are administered topically, via infiltration, spinal block, or epidural block. Bupivacaine can cause both hypotension and arrhythmias due to its cardiotoxic effects. Procaine metabolizes hemoglobin to methemoglobin. Treatment for local anesthetic toxicity involves oxygen therapy, diazepam for convulsions, and supportive care.

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    Concise overview of pharmacology of local anesthetics

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    Local anesthetics work by blocking nerve conduction of sensory impulses and at higher concentrations motor impulses. They are administered topically, via infiltration, spinal block, or epidural block. Bupivacaine can cause both hypotension and arrhythmias due to its cardiotoxic effects. Procaine metabolizes hemoglobin to methemoglobin. Treatment for local anesthetic toxicity involves oxygen therapy, diazepam for convulsions, and supportive care.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    23 views60 pages

    Pharmacology Local Anesthetics

    Uploaded by

    alianaeem839
    Local anesthetics work by blocking nerve conduction of sensory impulses and at higher concentrations motor impulses. They are administered topically, via infiltration, spinal block, or epidural block. Bupivacaine can cause both hypotension and arrhythmias due to its cardiotoxic effects. Procaine metabolizes hemoglobin to methemoglobin. Treatment for local anesthetic toxicity involves oxygen therapy, diazepam for convulsions, and supportive care.

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    of 60

    Local anesthetics

    Local Anesthesia
    • Local anesthetics block nerve conduction of
    sensory impulses and in higher concentration
    block motor impulses from periphery to CNS.
    Delivery techniques
    • Topical administration
    • Infiltration
    • Spinal block
    • Epidural block
    Classification of drugs
    Mechanism of action
    Indications
    Lidocaine
    Side effects
    Complications of local anesthetics
    • Pain on injection
    • Burning on injection
    • Failure to obtain anesthesias
    • Soft tissue injury
    • Hematoma
    • Infections
    Toxicity
    • CNS effects :
    1. Lightheadedness
    2. Sedation
    3. Restlessness
    4. Nystagmus
    5. Tonic clonic convulsions
    6. Severe convulsions followed by respiratory and
    cardiovascular depression.
    Cardiovascular side effects
    • With the exception of cocaine all causes
    vasodilation(hypotension)
    • Can convert heart disease into heart blocks
    (arrythmias)
    Imp mcq
    Which drug are cardiotoxic
    1. Bupivacaine (both
    hypotension and
    arrythmias )
    2. Ropivicaine
    • Imp

    Which Drug effects the hemoglobin in


    blood ?
    • Prolicaine is metabolized to by hepatic
    enzymes into orthotoludine, an agent that
    converts Hemoglobin into methemoglobin
    Management of toxicity (imp)
    • Treatment is symptomatic
    • No antidotes used
    • Oxygen therapy to treat hyperventilation
    • Convulsions are treated with IV diazepam
    Alcohol
    Mechanism of action
    • Enhance inhibitory action of GABA
    • INHIBITS Activating effect on NMDA
    Glutamate receptors
    • Modify the activity of adenyl cyclase ,
    phospholipase C and ion channels.
    Ethanol
    Effects of alcohol
    Dose related effects
    Acute effects
    1. 60_80 mg /dl:
    • Impairment of driving in non tolerant person
    • Slurring of speech
    • Ataxia
    • 120_130 mg/dl
    Increase sedation
    Decrease mental acuity
    • Greater than 300 mg/dl
    1. Loss of consciousness
    2. Profound respiratory depression
    3. Profound cardiovascular reaction
    4. coma
    • Greater than 500 mg /dl
    Lethal
    Chronic effects
    1. Liver disease
    2. Peripheral neuropathy
    3. Wernicke’s encephalopathy
    4. Pancreatitis and gastritis
    5. Heart disease
    6. Fetal alcohol syndrome
    Fetal alcohol syndrome
    • Ethanol used in pregnancy is associated with
    teratogenic effects that includes
    1. Mental retardness
    2. Growth deficiencies
    3. Microcephaly
    4. Undevelopment of midface region.
    Acute alcohol intoxication(
    Management)
    1. Maintenance of vital signs and prevention of
    aspiration after vomiting.
    2. Thiamine administration to treat Wernicke’s
    Korsakoff syndrome.
    3. Correction of electrolyte imbalance.
    Alcohol withdrawal syndrome
    Management of Alcohol withdrawal
    Syndrome
    • Correction of electrolyte imbalance
    • Administration of thiamine
    • Long acting bezodiazepene ( diazepam)
    • If liver is not normal then give lorazepam.
    Treatment of alcoholism
    • Opioid receptor antagonist Naltrexone
    • Acamprosate an NMDA glutamate receptor
    antagonist is FDA approved for treatment of
    alcoholism.
    • DISULFIRAM ( Alcohol dehydrogenase
    inhibitor)
    DISULFIRAM LIKE REACTION
    Alcohol dehydrogenase inhibitor
    Methanol poisoning
    Ethylene glycol poisoning
    • Renal damage
    • Severe acidosis
    Skeleton muscle relaxant
    Neuromuscular blocking agents

    • Depolarizing Succinylcholine
    Mechanism of action
    Pharmacokinetics
    • Parental : Short duration of action (IV)
    • Inactivated by plasma esterases
    Adverse effects
    Imp mcq
    • Which is most common
    side effect of
    succinylcholine ?
    • Hyperkalemia
    Vimp point
    • Which drug is used to treat
    malignant hyperthermia ?
    • Dantrolene
    Non depolarizing Skeleton muscle
    relaxant
    Adverse effect
    • Histamine
    release
    (mivacurium
    and
    tubocurarine)
    Centrally acting skeleton
    muscle relaxants
    Hofmann elimination ( proff viva
    question)
    • Which drug is used for acute muscle
    spasm?
    Cyclobenzaprine ( act by interfering with
    postsynaptic reflexes that maintain
    skeleton muscle tone)
    Side effect of Cyclobenzaprine
    • Confusion
    • Visual hallucinations

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