5 Locals Flashcards
Myelination of nerve fibers most to least
Heavy: aalpha, a beta, med: a delta, light: b, none: c
Function of a nerve fibers
A alpha motor and propriocep, a beta touch and pressure, a delta fast pain, temp, and touch
Func of b and C fibers
B Preganglionic ans, c postganglionic ans and slow pain, temp, touch
Block onset first to last of nerve fibers
B fiber, C fiber, a delta, a alpha/beta
When local can and cant bind sodium channels
Can bind in active/open and in inactive/closed refractory states. Can’t bind in resting state
What regulates and what doesnt effect RMP/threshold potential
Locals dont effect either. K reg rmp, ca reg threshold potential
The ____ conjugate _____ binds to the local site on the ___ of the voltage gated na channel
Ionized, acid, inside
Allergic potential higher in which class
Ester, paba
Things that effect local onset
Pka, dose, concentration
Things that effect potency
Lipid sol, intrinsic vasodilation ability
Duration of action factors
Pb, lipid sol, intrinsic vasodilating
Amide pka hi to low
Bup and rop 8.1, lido and prilo 7.9, mepiv 7.6
Amide protein binding hi to low
Bup 96, rop 94, lido 65 prilo 55 mepiv 78
Ester pka hi to low
Procaine 8.9, chlorpro 8.7, tetra 8.5
Protein binding hi to low esters
Tetra 76, procaine 6, chlorpro 0
Hi to low vascularity of local sites, mnemonic
I think illogical imposters cant educate but fab schools should. IV, Tracheal, intrapleural, intercostal, caudal, epidural, brachial plexus, femoral, sciatic, sq
Max allowable dose Mepiv, prilo, procaine, chlorpro
7, 8, 7, 11
Mcg/ml lido: analgesia. Tinnitus/numbness/vertigo
1-5. 5-10
Mcg/ml lido: sz/loc, coma, cv collapse
Sz: 10-15. Coma 15-25. Cv >25
Factors that inc risk CNS toxicity
Hypercarbia, hyperkalemia, metab acidosis
What inc risk bupivicaine toxicity
Preg, bb, Ccb, dig
What to give in coke toxicity
Nitroglycerin, labetolol
Max dose cocaine
1.5-3 mg/kg, max 150-200 mg
Acls modifications w local toxicity
Try to avoid epi. If give epi <1mcg/kg. Avoid vaso. Amio agent of choice in vent arrhythmias
Max dose of intralipid
10 ml/kg first 30 min
What drugs enhance local induced cardiac disturbances
Bb and ccb
Max dose lido in tumescent
55 mg/kg
When can do mac v general if tumescent used
Mac if small amt, general if >2-3L used
S/s methemoglobinemia
Hypoxia, cyanosis, choc blood, hi hr and rr, mental changes
Locals that cause methgb
Benzocaine, cetacei e, prilocaine, emla (prilo and lido)
Methylene blue dose and max dose
1-2 mg/kg over 5 min. Max 8 mg/kg
How to calc max dose of emla
50/50 mix of lido and prilo (if 5%= 2.5% of each)
Which local metab to o toluidine
Prilocaine
Dose Recs emla: 0-3mo/<5 kg, 3-12 mo >5 kg
1g 10cm2. 2g 20cm2
Dose reqs emla: 1-6 yr >10 kg, 7-12 yr and >20kg
10g, 100cm2. 20g, 200 cm2
Drugs that prolong doa locals
Epi, decadron, dextran
