Anesthetics

Question 1

What is the MOA of local anesthetics?

Answer 1

Directly affects sensitive Na+ channels

Question 2

What are two types of local anesthetics?

Answer 2

Esters

Amides

Question 3

What are some amide local anesthetics?

Answer 3

Mepivacaine
Bupivacaine
Lidocaine
Prilocane
Ropivacaine
Levobupivacaine
*note the i in each*

Question 4

What is an example of an ester local anesthetic?

Answer 4

Procaine (novacaine)

Question 5

What is the onset time of procaine and how long does it last?

Answer 5

2-5 minutes

.25-1 hour

Question 6

What is the time of onset for bupivacaine and how long does it last?

Answer 6

5 minutes

2-4 hours

Question 7

What is the time of onset of lidocaine and how long does it last?

Answer 7

< 2 minutes

.5-1 hours

Question 8

What does the aromatic ring structure do for local anesthetics?

Answer 8

Increased lipid solubility

Question 9

What does the linkage structure do for local anesthetics?

Answer 9

Determines the type of metabolism

Question 10

What kind of metabolism do amide local anesthetics have?

Answer 10

Hepatic metabolism

Question 11

What kind of metabolism do ester local anesthetics have?

Answer 11

Plasma esterases metabolize

Question 12

What do terminal amines do for local anesthetics?

Answer 12

Influence aqueous solubility

Question 13

Why do you combine lidocaine with?

Answer 13

Epinephrine

Question 14

What is lidocaine with epinephrine and what are the advantages of it?

Answer 14

Vasoconstrictor
Prolongs duration of action
Controls bleeding

Question 15

What is the max dosage of lidocaine 2%?

Answer 15

7 mg/kg

Total = 500 mg

Question 16

What concentration of procaine has a shorter duration of action?

Answer 16

10%

Question 17

Which percentage of bupivacaine is most commonly used?

Answer 17

0.25%

Question 18

What local anesthetic is most widely used?

Answer 18

Lidocaine

Question 19

Is the efficacy comparable between all local anesthetics?

Answer 19

Yes

Question 20

What is the “dosage” of 1% solution equivalent to?

Answer 20

10 mg/mL

Question 21

What is the max dosage of lidocaine and its concentration?

Answer 21

50 mL of 1%

Question 22

What is a patch used as local anesthetic?

Answer 22

Lidocaine patch 5% topical

Question 23

How do you administer the lidocaine patch?

Answer 23

On 12 hours

Off 12 hours

Question 24

Can you cut the lidocaine patch?

Answer 24

Yes -> different from other transdermal systems

Question 25

What is the max amount of patches that can be used per day?

Answer 25

3 patches

Question 26

Are true allergies to local anesthetic common or rare?

Answer 26

Rare

Question 27

Which type of local anesthetic MC has allergic reactions?

Answer 27

Ester type

Question 28

If allergic to 1 ester, can you take others?

Answer 28

No, allergic to 1 allergic to all | Switch to amide

Question 29

What are systemic effects of local anesthesia?

Answer 29

``` Respiratory depression (death) Seizures ```

Question 30

What anesthetic is commonly used in epidurals?

Answer 30

Bupivacaine

Question 31

What is EMLA?

Answer 31

Eutectic mixture of local anesthetics

Question 32

What do you combine for EMLAs?

Answer 32

Lidocaine | Prilocaine

Question 33

What population doe you used EMLAs with?

Answer 33

Pediatrics

Question 34

What do we use EMLAs for?

Answer 34

Starting IVs Bx Venous, arterial, finger, heel, and lumbar punctures Removal of staples, sutures, and lines

Question 35

What were the emergent toxicities of general anesthetic chloroform?

Answer 35

Long term liver damage | Sudden death

Question 36

What was the emergent toxicity of general anesthetic methoxyflurane?

Answer 36

Neprhotoxicity

Question 37

What was the problem with general anesthetic ether?

Answer 37

Too flammable

Question 38

What is a problem with nitrous oxide (inhaled)?

Answer 38

Increased post-operative nausea and vomitting

Question 39

What is a problem with halothane (inhaled)?

Answer 39

Hepatoxicity | Arrhythmias

Question 40

What is a problem with enflurane (inhaled)?

Answer 40

Hepato and renal toxicities

Question 41

What is a problem with isoflurane (inhaled)?

Answer 41

Coronary steal | shunting of blood away from already ischemic myocardium

Question 42

What is a problem with desflurane (inhaled)?

Answer 42

Tachycardia

Question 43

What is an issue with sevoflurane (inhaled)?

Answer 43

Toxic metabolites

Question 44

When is elimination of an agent and emergence from anesthesia essentially guaranteed?

Answer 44

As long as breathing is satisfactory

Question 45

What are some advantages of inhalational anesthesia?

Answer 45

Completely painless induction No IV access Most rapid delivery to blood stream

Question 46

How are the rates of PONV in all generalized inhalation anesthesias?

Answer 46

They are all similar

Question 47

What are the two main differences between inhalational anesthetics?

Answer 47

Metabolism | Effects on the heart