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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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.



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