5 Locals

Question 1

Myelination of nerve fibers most to least

Answer 1

Heavy: aalpha, a beta, med: a delta, light: b, none: c

Question 2

Function of a nerve fibers

Answer 2

A alpha motor and propriocep, a beta touch and pressure, a delta fast pain, temp, and touch

Question 3

Func of b and C fibers

Answer 3

B Preganglionic ans, c postganglionic ans and slow pain, temp, touch

Question 4

Block onset first to last of nerve fibers

Answer 4

B fiber, C fiber, a delta, a alpha/beta

Question 5

When local can and cant bind sodium channels

Answer 5

Can bind in active/open and in inactive/closed refractory states. Can’t bind in resting state

Question 6

What regulates and what doesnt effect RMP/threshold potential

Answer 6

Locals dont effect either. K reg rmp, ca reg threshold potential

Question 7

The ____ conjugate _____ binds to the local site on the ___ of the voltage gated na channel

Answer 7

Ionized, acid, inside

Question 8

Allergic potential higher in which class

Answer 8

Ester, paba

Question 9

Things that effect local onset

Answer 9

Pka, dose, concentration

Question 10

Things that effect potency

Answer 10

Lipid sol, intrinsic vasodilation ability

Question 11

Duration of action factors

Answer 11

Pb, lipid sol, intrinsic vasodilating

Question 12

Amide pka hi to low

Answer 12

Bup and rop 8.1, lido and prilo 7.9, mepiv 7.6

Question 13

Amide protein binding hi to low

Answer 13

Bup 96, rop 94, lido 65 prilo 55 mepiv 78

Question 14

Ester pka hi to low

Answer 14

Procaine 8.9, chlorpro 8.7, tetra 8.5

Question 15

Protein binding hi to low esters

Answer 15

Tetra 76, procaine 6, chlorpro 0

Question 16

Hi to low vascularity of local sites, mnemonic

Answer 16

I think illogical imposters cant educate but fab schools should. IV, Tracheal, intrapleural, intercostal, caudal, epidural, brachial plexus, femoral, sciatic, sq

Question 17

Max allowable dose Mepiv, prilo, procaine, chlorpro

Answer 17

7, 8, 7, 11

Question 18

Mcg/ml lido: analgesia. Tinnitus/numbness/vertigo

Answer 18

1-5. 5-10

Question 19

Mcg/ml lido: sz/loc, coma, cv collapse

Answer 19

Sz: 10-15. Coma 15-25. Cv >25

Question 20

Factors that inc risk CNS toxicity

Answer 20

Hypercarbia, hyperkalemia, metab acidosis

Question 21

What inc risk bupivicaine toxicity

Answer 21

Preg, bb, Ccb, dig

Question 22

What to give in coke toxicity

Answer 22

Nitroglycerin, labetolol

Question 23

Max dose cocaine

Answer 23

1.5-3 mg/kg, max 150-200 mg

Question 24

Acls modifications w local toxicity

Answer 24

Try to avoid epi. If give epi <1mcg/kg. Avoid vaso. Amio agent of choice in vent arrhythmias

Question 25

Max dose of intralipid

Answer 25

10 ml/kg first 30 min

Question 26

What drugs enhance local induced cardiac disturbances

Answer 26

Bb and ccb

Question 27

Max dose lido in tumescent

Answer 27

55 mg/kg

Question 28

When can do mac v general if tumescent used

Answer 28

Mac if small amt, general if >2-3L used

Question 29

S/s methemoglobinemia

Answer 29

Hypoxia, cyanosis, choc blood, hi hr and rr, mental changes

Question 30

Locals that cause methgb

Answer 30

Benzocaine, cetacei e, prilocaine, emla (prilo and lido)

Question 31

Methylene blue dose and max dose

Answer 31

1-2 mg/kg over 5 min. Max 8 mg/kg

Question 32

How to calc max dose of emla

Answer 32

50/50 mix of lido and prilo (if 5%= 2.5% of each)

Question 33

Which local metab to o toluidine

Answer 33

Prilocaine

Question 34

Dose Recs emla: 0-3mo/<5 kg, 3-12 mo >5 kg

Answer 34

1g 10cm2. 2g 20cm2

Question 35

Dose reqs emla: 1-6 yr >10 kg, 7-12 yr and >20kg

Answer 35

10g, 100cm2. 20g, 200 cm2

Question 36

Drugs that prolong doa locals

Answer 36

Epi, decadron, dextran