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Pharm > Anesthetics > Flashcards

Anesthetics Flashcards

1
Q

What is the MOA of local anesthetics?

A

Directly affects sensitive Na+ channels

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2
Q

What are two types of local anesthetics?

A

Esters

Amides

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3
Q

What are some amide local anesthetics?

A 
Mepivacaine
Bupivacaine
Lidocaine
Prilocane
Ropivacaine
Levobupivacaine
*note the i in each*
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4
Q

What is an example of an ester local anesthetic?

A

Procaine (novacaine)

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5
Q

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

A

2-5 minutes

.25-1 hour

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6
Q

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

A

5 minutes

2-4 hours

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7
Q

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

A

< 2 minutes

.5-1 hours

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8
Q

What does the aromatic ring structure do for local anesthetics?

A

Increased lipid solubility

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9
Q

What does the linkage structure do for local anesthetics?

A

Determines the type of metabolism

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10
Q

What kind of metabolism do amide local anesthetics have?

A

Hepatic metabolism

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11
Q

What kind of metabolism do ester local anesthetics have?

A

Plasma esterases metabolize

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12
Q

What do terminal amines do for local anesthetics?

A

Influence aqueous solubility

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13
Q

Why do you combine lidocaine with?

A

Epinephrine

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14
Q

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

A

Vasoconstrictor
Prolongs duration of action
Controls bleeding

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15
Q

What is the max dosage of lidocaine 2%?

A

7 mg/kg

Total = 500 mg

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16
Q

What concentration of procaine has a shorter duration of action?

A

10%

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17
Q

Which percentage of bupivacaine is most commonly used?

A

0.25%

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18
Q

What local anesthetic is most widely used?

A

Lidocaine

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19
Q

Is the efficacy comparable between all local anesthetics?

A

Yes

20
Q

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

A

10 mg/mL

21
Q

What is the max dosage of lidocaine and its concentration?

A

50 mL of 1%

22
Q

What is a patch used as local anesthetic?

A

Lidocaine patch 5% topical

23
Q

How do you administer the lidocaine patch?

A

On 12 hours

Off 12 hours

24
Q

Can you cut the lidocaine patch?

A

Yes -> different from other transdermal systems

25
Q

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

A

3 patches

26
Q

Are true allergies to local anesthetic common or rare?

A

Rare

27
Q

Which type of local anesthetic MC has allergic reactions?

A

Ester type

28
Q

If allergic to 1 ester, can you take others?

A

No, allergic to 1 allergic to all

Switch to amide

29
Q

What are systemic effects of local anesthesia?

A 
Respiratory depression (death)
Seizures
30
Q

What anesthetic is commonly used in epidurals?

A

Bupivacaine

31
Q

What is EMLA?

A

Eutectic mixture of local anesthetics

32
Q

What do you combine for EMLAs?

A

Lidocaine

Prilocaine

33
Q

What population doe you used EMLAs with?

A

Pediatrics

34
Q

What do we use EMLAs for?

A

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

35
Q

What were the emergent toxicities of general anesthetic chloroform?

A

Long term liver damage

Sudden death

36
Q

What was the emergent toxicity of general anesthetic methoxyflurane?

A

Neprhotoxicity

37
Q

What was the problem with general anesthetic ether?

A

Too flammable

38
Q

What is a problem with nitrous oxide (inhaled)?

A

Increased post-operative nausea and vomitting

39
Q

What is a problem with halothane (inhaled)?

A

Hepatoxicity

Arrhythmias

40
Q

What is a problem with enflurane (inhaled)?

A

Hepato and renal toxicities

41
Q

What is a problem with isoflurane (inhaled)?

A

Coronary steal

shunting of blood away from already ischemic myocardium

42
Q

What is a problem with desflurane (inhaled)?

A

Tachycardia

43
Q

What is an issue with sevoflurane (inhaled)?

A

Toxic metabolites

44
Q

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

A

As long as breathing is satisfactory

45
Q

What are some advantages of inhalational anesthesia?

A

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

46
Q

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

A

They are all similar

47
Q

What are the two main differences between inhalational anesthetics?

A

Metabolism

Effects on the heart

Pharm (32 decks)

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