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N929: Advanced Pharmacology > All about Lidocaine! > Flashcards

All about Lidocaine! Flashcards

1
Q

What year was Lidocaine discovered?

A

1943

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2
Q

Who discovered Lidocaine?

A

Nils Lofgren

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3
Q

What list is lidocaine on?

A

the World Health Organization’s list of essential medications

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4
Q

What class is lidocaine in?

A

Amide local anesthetics

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5
Q

Is lidocaine an acid or a base?

A

weak base

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6
Q

What is the pKa of lidocaine?

A

slightly above physiologic pH

7.9

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7
Q

Is lidocaine fast or slow?

A

fast d/t less ionized drug at physiologic pH

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8
Q

Is lidocaine long or short acting?

A

short (fairly) 90-120min

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9
Q

What is the protein binding of lidocaine?

A

64-70%

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10
Q

Where is lidocaine metabolized?

A

in the liver

- it is an amide local anesthetic

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11
Q

What is the % of ionized lidocaine at physiologic pH?

A

76%

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12
Q

What is the duration of action of lidocaine?

A

90-120min

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13
Q

What formulation of lidocaine is used to “test dose”? and where is this test dose injected?

A

Lidocaine 1.5% with 1:200,000 epi

2cc into the spinal or epidural needle/catheter

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14
Q

What formulations of Lidocaine are available?
5 pure
2 with epi

A 
Lidocaine 0.5%
Lidocaine 1%
Lidocaine 1.5% with 1:100,000 epi
Lidocaine 1.5% with 1:200,000 epi
Lidocaine 2%
Lidocaine 4%
Lidocaine 5%
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15
Q

Lidocaine 1% is what concentration of medication?

A

10mg/mL

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16
Q

Lidocaine 2% is what concentration of medication?

A

20mg/mL

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17
Q

Lidocaine 0.5% is what concentration of medication?

A

5mg/mL

18
Q

Lidocaine 4% is what concentration of medication?

A

40mg/mL

19
Q

Lidocaine 5% is what concentration of medication?

A

50mg/mL

20
Q

What is the maximum dose of lidocaine?

A

4mg/kg without epi

7mg/kg with epi

21
Q

What is the maximum dose of lidocaine with epi?

A

7mg/kg

22
Q

What are the 6 ways lidocaine can be administered/used?

A
  1. antiarrhythmic
  2. topical
  3. induction
  4. nebulized
  5. multimodal pain management
  6. regional anesthetic
23
Q

How does lidocaine work as an antiarrhythmic?

Hint: what does it depress?

A

depresses myocardial automaticity

24
Q

What class of antiarrhythmic agent is lidocaine?

A

Class 1b

25
Q

In treatment of VF/VT what is the initial dosage of IV/IO lidocaine?

A

1-1.5mg/kg

26
Q

When treating refractory VF/VT after initial dose of lidocaine, what are subsequent doses?

A

0.5-0.75mg/kg

27
Q

What is the total max dose of IV/IO lidocaine when used as an antiarrhythmic (VF/VT)

A

3mg/kg

28
Q

What is the maintenance infusion dose of lidocaine?

in mg/min & mcg/kg/min

A

1-4mg/min (30-50mcg/kg/min)

29
Q

What is EMLA cream?

A

1:1 Lidocaine:Procaine

30
Q

What are the 4 patients or locations EMLA is contraindicated in?

A
  1. open skin
  2. mucous membrane
  3. infants <1 month
  4. Hx methemoglobinemia
31
Q

What are the 3 reasons lidocaine is administered during induction of anesthesia?

A
  1. decrease pain of propofol
  2. attenuate CV response to intubation (SNS response)
  3. attenuate any ↑ICP
32
Q

Is lidocaine dosed on TBW or IBW?

A

IBW

33
Q

How can lidocaine be administered to block pain of propofol injection?

A

tourniquet on the arm
give lidocaine
wait 60 seconds
remove tourniquet

34
Q

What is the administration dose/onset of lidocaine for attenuation of the SNS response to DL?

A

1-1.5mg/kg 1-3 min prior to DL

35
Q

What 2 pressures are effected by IV lidocaine administration pre-induction?

A
  1. hypertension

2. increased ICP

36
Q

When used via ETT cuff, how is lidocaine administered/process/onset?

A
  1. use manometer & air to inflate cuff to 15-20mmHg
  2. remove air and note volume
  3. alkalized lidocaine
    Low dose 40mg Lido (2mL)
    1-2mL sodium bicarb
    Use NS to get to target volume

**needs at least 60 minutes to work

37
Q

What % lidocaine is used in nebulized airway block?

A

4%

38
Q

What % lidocaine is used in a trans-tracheal block?

A

4%

39
Q

When used in multimodal analgesia, what are the bolus and infusion does of lidocaine?

A

bolus: 1.5mg/kg
infusion: 2mg/kg/hr

40
Q

What are the 2 possible target MOA of lidocaine as an analgesic?

A
  • sodium channels

- blockage of the priming of polymorphonuclear granulocytes

41
Q

What 3 drugs, used as part of a multimodal analgesia approach can cause ↓BP?

A

Mg/Lido/General anesthesia

42
Q

How are exparel and lidocaine mixed?

A

THEY ARE NOT!!!

N929: Advanced Pharmacology (6 decks)

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