Theme: «Drugs Affecting the Afferent Innervation: Local Anaesthetics, Astringent, Covering,

Adsorbing and Irritative Drugs.»

1. Tests of the control of knowledge.
1. Indicate drugs which inhibit the sensitive nerve endings.
1. Astringent drugs. 2. Irritative drugs. 3. Adsorbing drugs. 4. Anaesthetics. 5. Covering drugs.
2. Indicate drugs which have adsorbing properties.
1. Procaine (novocainum). 2. Active carbon. 3. Talc. 4. Tannin. 5. Turpentine. 6. Zinc oxide.
3. What are the aims of therapy by irritative drugs?
1. Reflex stimulation of bulbar centres. 2. Slight analgesic effect as a result of distracting action. 3.
Dilation of skin vessels. 4. Improvement of inner organ trophicity. 5. Inhibition of inner organ functions.
4. Indicate drugs used for infiltration anaesthesia.
1. Benzocaine (anaesthesinum). 2. Lidocaine. 3. Tetracaine (dicainum). 4. Procaine (novocainum). 5.
Trimecainum.
5. Indicate drugs which belong to irritative agents.
1. Ammonia solution. 2. Sinapisms (mustard plasters). 3. Turpentine. 4. Menthol. 5. Active carbon. 6.
Bismuth subnitrate. 7. Tannin.
6. Indicate the main effect of procaine (novocainum).
1. Inhibitory action upon the CNS. 2. Ganglion blocking action. 3. Covering action. 4. Astringent action.
5. Anaesthetic action. 6. Hypotensive action.
7. Indicate the main effects of astringent drugs.
1. Decrease of nerve ending sensibility. 2. Reduction of hyperemia of mucous membranes due to
vasoconstriction. 3. Relief of pain. 4. Decrease of synthesis of histamine. 5. Decrease of gland secretion.
8. Indicate the factors which increase and prolong the action of anaesthetics.
1. Alkaline environment. 2. Acid environment. 3. Ischemia of tissues. 4. Increase of blood supply. 5.
Increase of temperature. 6. Presence of purulent exudate.
9. Indicate the anaesthetic agents used for terminal anaesthesia.
1. Trimecaine. 2. Sovcaine. 3. Lidocaine. 4. Tetracaine (dicainum). 5. Benzocaine (anaesthesinum).
10. Indicate agents used for spinal anaesthesia.
1. Trimecainum. 2. Sovcaine. 3. Lidocaine. 4. Tetracaine (dicainum). 5. Procaine (novocainum).
11. Indicate the mechanism of action of astringent drugs.
1. Blockade of receptors. 2. Creation of protective layer upon the mucous membranes. 3. Coagulation of
proteins of superficial layer of mucous membranes.
12. Indicate the mechanism of action of covering drugs.
1. Blockade of receptors. 2. Creation of protective layer upon the mucous membranes. 3. Coagulation of
proteins of superficial layer of mucous membranes.
13. Indicate the succession of inhibition of sensibility upon the action of anaesthetics.
1. Tactile. 2. Pain. 3. Temperature.
14. Indicate the mechanism of action of local anaesthetics.
1. Inhibition of the CNS. 2. Blockade of specific receptors of cell membranes. 3. Decrease of permeability
of membrane sodium channels. 4. Increase of threshold of pain sensibility of neurones in the CNS. 5.
Inhibition of impulse transmission in the CNS.
15. Indicate the types of anaesthesia the following drugs are used for.
1. Procaine (novocainum). 2. Tetracaine (dicainum). 3. Benzocaine (anaesthesinum). 4. Trimecainum. 5.
Lidocaine. 6. Cocaine.
2. To solve the pharmacological problems.
PROBLEM 1. Determine the following drug.
A derivative of para-amino benzoic acid, well-soluble in water, non-suitable for the terminal anaesthesia.
It is used for infiltration and conduction anaesthesia as well as for the resorptive action upon the
organism. It decreases the synthesis of acetylcholine, exerts ganglion blocking and spasmolytic action. It
also reduces the excitability of myocardium and of the motor zones of the brain cortex.

PROBLEM 2. Determine the following groups of drugs by their mechanisms of action:

1. They cause the blockade of receptor formations and nerve fibers. 2. They coagulate proteins of the
superficial layer of mucous membranes. 3. They form the protective layer upon the surface of mucous
membranes.

PROBLEM 3. Determine the group of substances:

They dilate the blood vessels of skin, exert the "distractive" action. they improve the trophicity of inner
organs, muscles, joints, by reflex way stimulate the bulbar centres.

PROBLEM 4. Determine the group of substances:

In application upon the skin and mucous membranes they adsorb different chemical substances upon their
surfaces, mechanically protect the endings of sensitive nerves. They are used in poisonings, meteorism,
diarrhea.

PROBLEM 5. Determine the drug:

A derivative of quinoline. It is used for spinal anaesthesia. This drug is 15-25 times more active and toxic
than procaine (novocainum). In the subarachnoid introduction it causes the decrease of arterial pressure.
 PROBLEM 6. Determine the drug:
The drug is suitable for any kind of local anaesthesia. The anaesthetic activity and the duration of action
are higher than in procaine (novocainum)). The toxicity of the drug is a little more than in procaine.

PROBLEM 7. Determine the drug:

It belongs to alkaloids, exerts high anaesthetic activity, narrows blood vessels. In the resorptive action it
stimulates the central nervous system. In long taking (by inspiration through nose, chewing) the drug
dependence is developed.
PROBLEM 8. Determine the drug:
It differs from other anaesthetics by poor solubility in water (it is soluble in oils). Owing to this the drug
is used only for the terminal anaesthesia in the form of ointments, pastes, powders (for example, in skin
diseases accompanied by significant itch), in suppositories (in the affection of rectum). It also introduced
PO in the form of powders (in stomach-ache, vomiting).

PROBLEM 9. Determine the group of substances:

In application upon the mucous membranes they cause the coagulation of the proteins of mucus and
consolidate the superficial layer of the mucous membranes. The created dense protein coat protects the
cells of tissues and the endings of sensitive nerve fibers from the action of irritative substances. This
effect is especially beneficial in the inflammation of mucous membranes.

PROBLEM 10. Determine the drug:

Exciting the receptor formations the drug is able to cause various reflex reactions. For example, in the
inspiration of the drug vapours the receptors of upper respiratory ways are irritated and the reflex
stimulation of the CNS is observed. It's necessary to remember that high amounts of vapours can cause
undesirable reflexes, for example, sudden slowing down of cardiac contractions, arrest of breathing.

3. To solve the situation problems.

PROBLEM 1. A patient was delivered to the surgical department in relation with acute appendicitis. He
was proposed to make appendectomy under the local anaesthesia. But from his medical history was
known that he had severe allergic reactions upon drugs. A physician has got at his disposal procaine,
tetracaine (tetracaine (dicainum)) and lidocaine.
Questions: choose from the indicated drugs the most preferable for the infiltration anaesthesia in this situation. What's
the mechanism of its action? In what concentration and what amount can this solution be used in the operation?

PROBLEM 2. A patient was delivered to the ophthalmologic department in relation with trauma of the
eye as a result of hitting of metallic shaving. Edema of the eye, significant hyperemia, hyperlacrimation,
pain in nictation are observed. The removal of the foreign body is possible under the local anaesthesia
only.
Questions: choose the type of local anaesthesia, the drug, its concentration and the way of its introduction.

PROBLEM 3. A patient with traumatic damage of the facial bones was delivered to the traumatology
department. As it was impossible to carry out the inhaled anaesthesia the surgeon decided to make the
operation under the infiltration anaesthesia.
Questions: choose the anaesthetic, its concentration in solution and the way of prolongation of its action taking into
account the well vascularization in the operation area.

PROBLEM 4. A patient addressed to a doctor with complaints of abdominal distention, increased

passage of flatus, abdominal pain. These symptoms were increased in eating of the food with high amount
of carbohydrates (bread, vegetables, fruits).
Questions: what drug may be administered to the patient to relieve the meteorism? Explain the mechanism of its action.
In what cases is it used?

PROBLEM 5. A patient addressed to a doctor with complaints of dry cough which had arisen after
endured influenza. Into the course of treatment the doctor included the sinapisms. The patient moistened
them in hot water and applied them to the back and chest. But the sinapisms did not exert the expected
effect.
Questions: why there was no effect from application of sinapisms? What mistake was made by the patient? What is the
mechanism of action of sinapisms?

PROBLEM 6. Before the operation in relation with tooth extraction the conduction anaesthesia was
made to a patient. Suddenly his skin became covered with red stains, the increased sweating, tachycardia,
edemas of the mucous membranes of nose, eyes, lips, difficulty of breathing were observed. Urgently the
intravenous injections of some drugs were made. The patient's condition became better.
Questions: what is the reason of arisen complications? What local anaesthetic most commonly cause this kind of
complications? What are the measures of prophylaxis and first aid in these complications?

4. To fulfil problems on pharmacotherapy. To prescribe the following drugs.

1. A drug for the terminal anaesthesia of mucous membranes. 2. A drug for infiltration anaesthesia. 3. A
drug for conduction anaesthesia. 4. A drug for spinal anaesthesia. 5. A local anaesthetic which is used in
dermatology in the form of powders, ointments, pastes. 6. An astringent drug which is used in burns,
ulcers, cracks, decubitus. 7. An adsorbent which is used in poisonings, meteorism. 8. An irritative drug. 9.
A drug for all types of anaesthesia. 10. A drug for inspiration in syncope.