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BALA lectures Flashcards

1
Q

What is the recommended max dose of 4% articaine with 1:200k epi for a 70kg adult?

a. 280mg
b. 250mg
c. 49mg
d. 490mg

A

D. 490mg

articaine max dose is 7mg/kg

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2
Q

Which of the local anesthetics has the slowest onset time?

a. lidocaine
b. prilocaine
c. bupivicaine
d. mepivicaine

A

C. bupivicaine

bupivicaine has slowest onset but longest duration

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3
Q

Which of the following is a generic name for Carbocaine?

a. mepivicaine
b. citanest
c. marcaine
d. xylocaine

A

a. mepivicaine

mepivicaine=Carbocaine
prilocaine= Citanest
bupivicaine= Marcaine
lidocaine= Xylocaine

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4
Q

The lipid solubility of a local anesthetic determines its:

a. duration of anesthesia
b. onset time
c. potency
d. toxicity

A

c. potency

pKa affects onset
lipid solubility affects potency
protein binding affects duration
vasodilator activity affects anesthetic potency & duration

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5
Q

Which of the following is the final cardiovascular manifestation of lidocaine toxicity?

a. premature ventricular contractions (PVCs)
b. bradycardia
c. tachycardia
d. prolonged QT

A

B. bradycardia

**not prolonged QT because lidocaine toxicity will not mess with the waveform of EKG but more like…more or less of the waveform (brady vs tachy)

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6
Q

Local anesthesia with epi is an absolute contraindication in patients with which medical condition?

a. Hypertension
b. Cushing’s disease
c. hypothyroidism
d. hyperthyroidism

A

D. hyperthyroidism

worried about thyroid storm

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7
Q

The duration of local anesthesia is related to:

a. protein binding
b. pKa
c. lipid solubility
d. onset time

A

a. protein binding

protein binding affects duration
pKa affects onset
lipid solubility affects potency
vasodilator activity affects anesthetic potency & duration

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8
Q

A PACU nurse calls you one hour after you finished your last GA case because your 3yo ASA 1, 15kg pt has severe nausea and is unable to tolerate PO liquids. The pediatrician recommends the pt be admitted for overnight observation and wants your orders for the patient. What type and rate of IV fluid titration/maintenance will you prescribe your pt?

a. Ringers lactate solution–55mL/hr
b. IV dextrose/saline–60mL/hr
c. IV dextrose–55mL/hr
d. normal saline–50mL/hr

A

d. normal saline–50mL/hr

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9
Q

You didn’t check to see if your assistant was giving you septocaine or lidocaine and because the mother complained in between that he “wasn’t numb enough” you accidentally administered 2 carpules of 4% septocaine to a 20lb child. You have already monitored their vitals and instituted BLS measures. What rescue medication will you request for initially?

a. sodium dantrolene
b. diazepam
c. succinylcholine
d. rocuronium

A

b. diazepam

sodium dantrolene is used for malignant hyperthermia (1.5mg/kg)

Succinylcholine–SHORT acting depolarizing agent; used for laryngospasms; AVOID IN muscular dystrophies such as Duchenne’s

Rocuronium–LONG acting depolarizing agent; paralytic

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10
Q

After administering 4% septocaine to a patient, the mother complains that her child is numb 1 day after the procedure. According to the AAPD guidelines, what is the patient’s risk of paresthesia?

a. 1: 200,000
b. 1: 2,000,000
c. 1: 500,000
d. 1: 5,000,000

A

c. 1: 500,000

lidocaine= 1: 2,000,000

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11
Q

In LA, if you’re trying to calculate mg of anesthetic, it’s based on % and mL of anesthetic.

Ex. If you have 3cc of 2% lido with 1:100k epi, how many mg of anesthetics did you give?

A

%=g/mL

2%= 2g/100mL–> 20mg/mL

3cc=3mL so 20mg/mL x 3mL= 60mg

60mg of 2% lidocaine with 1:100k epi

shortcut: % x 10 x cc

2x10x3= 60mg

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12
Q

4cc of 3% prilocaine plain, how many mg are in the 4cc ?

A

3%=3g/100mL= 3000mg/100mL= 30mg/mL x 4 mL =
120mg of 3% prilocaine plain

**shortcut: % x 10 x cc

so…
3 x 10 x 4 = 120mg

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13
Q

1.5mL of 2% lidocaine with 1:100k epi, how many mg of lidocaine did you give the pt?

How much epi did you give?

A

30mg of lidocaine
(2x1.5x10)

1:100k epi= 1mg/100mL x 1.5mL= 0.015 epi

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14
Q

1.5mL of 4% articaine with 1:100k epi, how many mg of articaine did you give the pt?

How much epi did you give?

A

60mg of articaine
(4x1.5x10)

1:100k epi= 1mg/100mL x 1.5mL = 0.015 epi

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15
Q

For LA, to do epi calculations, it’s also still g/mL but use the ratio.

ex. 1: 100k is 1g/100,000mL
ex. 1: 200, is 1g/200,000mL

If you gave 1.7mL of 4% articaine with 1:200k epi, how much epi did you give the pt?

A

1: 200k= 1g/200,000mL= 1000mg/200,000mL = 1mg/200mL solution x 1.7mL= 0.0085mg of epi

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16
Q

1.8cc of 4% articaine with 1:50k epi, how much epi did you give the pt?

A

1:50k=1mg/50mL x 1.8mL = 0.036 epi

17
Q

Where are amides and esters metabolized?

A

amides in the liver

esters by the plasma pseudocholinesterase

18
Q 
max doses of:
mepivicaine
prilocaine
bupivicaine
articaine
lidocaine
A 
mepivicaine= 4.4mg/kg
prilocaine =6mg/kg
bupivicaine = 1.3mg/kg
articaine= 7mg/kg
lidocaine= 4.4mg/kg
19
Q 
max doses of:
xylocaine
marcaine
septocaine
citanest
carbocaine
polocaine
A 
xylocaine-- 4.4mg/kg
marcaine--1.3mg/kg
septocaine--7mg/kg
citanest--6mg/kg
carbocaine--4.4mg/kg
polocaine--4.4mg/kg

carbo and polo are both mepivicaines

20
Q

How does pKa affect onset?

A

lower pKa of the anesthetic means molecule dissociates faster through the nerve sheath and therefore onset is faster

21
Q

How does lipid solubility affect potency?

A

the more lipid soluble the local anesthesia is, the more concentration it absorbs, therefore the more potent.

22
Q

How does protein binding affect duration?

A

the longer it can bind to a protein (stronger pull), the longer the LA will be.

23
Q

How does vasodilation affect potency and duration?

A

vasodilation decreases potency and duration

24
Q

36kg child under a long GA case. What amount of IV fluid replacement is needed per hour to keep the patient hydrate?

A

4x10kg= 40
2x 10kg= 20
1 x 16kg= 16

soooo…76mL/hr

4:2:1 rule for calculating fluid replacement in mL/hr for a patient.
first 10kg, multiply by 4
2nd 10kg, multiply by 2
remaining kg, multiply by 1
add them up!
25
Q

18kg child under a long GA case. What amount of IV fluid replacement is needed per hour to keep the patient hydrate?

A

10x4=40mL
8x2=16mL

sooo…56mL/hr needed

4:2:1 rule for calculating fluid replacement in mL/hr for a patient.
first 10kg, multiply by 4
2nd 10kg, multiply by 2
remaining kg, multiply by 1
add them up!

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