USMLE Step 2 Review 18 08 Drugs of Choice Local Anesthetics

USMLE Step 2 Review 18 08 Drugs of Choice Local Anesthetics

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Play USMLE Audio MP3 18 08 Drugs of Choice Local Anesthetics Below

 

Begin 18 08 Drugs of Choice Local Anesthetics Transcription

What is the local anesthetic of choice for numbing up most areas of skin for minor surgeries?

  • Lidocaine.

And what is sometimes combined with the Lidocaine for vasoconstriction in the field of operation, both reducing bleeding at the surgery site and prolonging the action of Lidocaine?

  • Epinephrine.

However, in some areas of low perfusion, what is the danger of using Epinephrine?

  • Necrosis of tissue due to hypoxia.

Now, what are the 5 areas of the body where epinephrine should not be used as an additive to Lidocaine?

  • Fingers, toes, nose, penis, pinna of the ear.

Again- 5 areas where adding epinephrine to Lidocaine is contraindicated?

  • Fingers, toes, nose, penis, pinna of the ear

Lidocaine injection with or without epinephrine is usually quite painful. Some patients say that they would rather not have it. What are 4 strategies for substantially reducing the pain of Lidocaine injection?

  • Buffer the acidity, warm it up, use 25 gauge or finer needle, go slow.

What is used to neutralize the acidity of Lidocaine?

  • Sodium bicarb. It can be added to the bottle or the syringe.

How warm should you warm up the filled syringe?

  • To body temperature- about 40° C.

And why does warming up the syringe reduce the pain of injection?

  • Under stress, the brain misinterprets cold as pain.

To avoid accidentally numbing the heart, what safety precautions should you use when injecting Lidocaine?

  • Aspirate frequently to avoid injecting into an artery.

If despite your precautions, the injection suddenly causes the patient severe pain, what has likely happened?

  • You’ve penetrated a nerve.

If this happens, why is it important that you back out a little to get out of the nerve and go in at a slightly different angle?

  • You can damage or even kill the nerve.

Lidocaine lasts for about how long as a local anesthetic?

  • About 30-60 minutes.

What alternative is the local anesthetic of choice when a much longer duration of action is needed?

  • Bupivacaine with or without epinephrine.

How long can Bupivacaine last?

  • Up to 7 hours.

What quality of Bupivacaine can make it even more painful to inject than Lidocaine?

  • It’s even more acidic than Lidocaine.

What is the drug of choice for treating prostatic hypertrophy directly?

  • Finasteride.

And what’s the trade name for Finasteride?

  • Proscar.

What is the mechanism of action of Finasteride/Proscar?

  • It’s a 5-alpha reductase inhibitor.

Now, what does the 5-alpha reductase enzyme normally do in the prostate?

  • Converts testosterone to dihydrotestosterone.

And what is the difference in activity between testosterone and dihydrotestosterone?

  • The dihydro form is much more active.

What can be the main side effect of treatment with Finasteride/Proscar?

  • Impotence.

What class of cardiac drug is used to treat the urinary retention caused by prostatic hypertrophy by relaxing the prostatic urethra?

  • Alpha-1 adrenergic blockers.

And what is the alpha-1 adrenergic blocker most commonly used for prostatic hypertrophy?

  • Terazosin.

And the trade name for Terazosin?

  • Hytrin.

What is the drug of choice for obsessive-compulsive disorder?

  • Clomipramine.

And the trade name for Clomipramine?

  • Anafranil.

What class of drug is Clomipramine/Anafranil?

  • Tricyclic.

What is the class of drug that is an indicated good alternative to the tricyclic Clomipramine/Anafranil?

  • A 5HT reuptake inhibitor/serotonin reuptake inhibitor.

What 2 5HT reuptake inhibitors are currently FDA approved for treating obsessive compulsive disorder, although any of the SRIs would probably work?

  • Fluoxetine and Fluvoxamine.

And the trade name for Fluoxetine?

  • Prozac.

And the trade name for Fluvoxamine?

  • Luvox.

What cancer is COP therapy used for?

  • Non-Hodgkin’s Lymphoma.

What does COP stand for?

  • Cyclophosphamide, Oncovin, Prednisone.

What generic does the trade name Oncovin stand for?

  • Vincristine.

****END OF TRANSCRIPTION****

 

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