Local Anesthetics Part 2

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Across
  1. 5. _____ numbness is an early CNS toxicity sign around the mouth.
  2. 7. Myelin allows action potentials to “jump” between nodes; this is _____ conduction.
  3. 8. Encapsulation system that prolongs local anesthetic release.
  4. 10. Short-acting ester historically known as Novocain.
  5. 14. Intralipid can pull lipophilic local anesthetic away from target tissues by acting as a _____ _____. (two words)
  6. 16. First-pass lung uptake of basic lipophilic drugs is _____ _____. (two words)
  7. 21. Sodium _____ alkalinizes local anesthetic solution and can speed onset.
  8. 22. Accidental _____ injection is the most common mechanism for sudden LAST.
  9. 25. _____ increases neuronal excitability by making sodium channels easier to open.
  10. 27. Additive used to make spinal local anesthetic hyperbaric.
  11. 29. Neuraxial local anesthetics should be _____ free.
  12. 30. Protonated drug form that binds sodium channels more strongly.
  13. 31. Drug form that crosses lipid membranes more easily.
  14. 34. Spinal solution less dense than CSF that rises relative to injection site.
  15. 35. _____ _____ is added to make spinal local anesthetic hypobaric.
  16. 39. Amide local anesthetics depend mainly on _____ metabolism.
  17. 42. 20% lipid emulsion rescue therapy for severe LAST.
  18. 43. A _____ mixture contains both R and S enantiomers.
  19. 44. Sodium-channel state with high-affinity, slow-release local anesthetic binding.
  20. 45. Post-spinal low back, buttock, and posterior leg pain is transient neurologic _____.
  21. 47. Greater _____ solubility increases local anesthetic potency.
  22. 48. Local anesthetic class mainly metabolized by the liver.
  23. 50. S-enantiomer amide with less cardiotoxicity than bupivacaine.
  24. 51. _____ binding is directly related to duration of action.
  25. 53. Action potential phase caused mainly by sodium influx.
  26. 55. Topical ester associated with methemoglobinemia risk.
  27. 56. Long-acting ester used in spinal, ophthalmic, ENT, and topical anesthesia.
  28. 57. Short-acting ester with rapid hydrolysis and low systemic toxicity.
  29. 59. Electrolyte abnormality that hyperpolarizes the resting membrane potential.
Down
  1. 1. S-enantiomer of bupivacaine with reduced toxicity.
  2. 2. Injection into CSF is ______ _____. (two words)
  3. 3. Local anesthetic class usually hydrolyzed by plasma cholinesterase.
  4. 4. Severe hypotension, wide QRS, VT, and collapse from bupivacaine reflect _____.
  5. 6. Spinal solution with density similar to CSF.
  6. 9. Local anesthetics block well at nodes of _____, where sodium channels are concentrated.
  7. 11. High-concentration intrathecal pooling can injure the _____ _____. (two words)
  8. 12. Connective tissue layer surrounding individual axons.
  9. 13. Prilocaine metabolite associated with methemoglobinemia is ___________. (two words)
  10. 15. Action potential recovery phase caused largely by potassium efflux.
  11. 17. Cyanosis with impaired oxygen carriage after prilocaine or benzocaine suggests _____.
  12. 18. Local anesthetics bind rapidly to sodium channels in the _____ state.
  13. 19. Ester metabolite linked to higher allergy risk.
  14. 20. Long-acting amide with the greatest cardiotoxic concern.
  15. 23. Property most closely tied to onset because it affects ionized versus unionized drug fraction.
  16. 24. Abbreviation for the minimum blocking concentration needed to stop nerve conduction.
  17. 26. Injection near a nerve or plexus is a _____ _____ _____. (three words)
  18. 28. Additive that slows systemic absorption, prolongs duration, and helps detect intravascular injection.
  19. 32. Ratio of spinal anesthetic solution density to CSF density.
  20. 33. Injection outside the dura is _____ _____. (two words)
  21. 36. Ringing in the ears after local anesthetic injection.
  22. 37. Serious CNS toxicity manifestation treated preferably with benzodiazepines.
  23. 38. Plasma _____ rapidly hydrolyzes many ester local anesthetics.
  24. 40. Local anesthetic that blocks catecholamine reuptake and causes vasoconstriction.
  25. 41. Preferred antiarrhythmic instead of lidocaine during LAST resuscitation.
  26. 46. Spinal solution denser than CSF that sinks with gravity.
  27. 49. Nerve layer that helps form the blood-nerve barrier.
  28. 52. Versatile amide used for infiltration, neuraxial anesthesia, airway topicalization, IV analgesia, and arrhythmias.
  29. 54. Tissue _____ slows onset by trapping more drug in ionized form.
  30. 58. The large sodium-channel _____ subunit forms the pore and contains the local anesthetic binding site.
  31. 60. Abbreviation for local anesthetic systemic toxicity.