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Anesthesia Pharm > Exam 3 Part VI > Flashcards

Exam 3 Part VI Flashcards

1
Q

cause of cauda equina syndrome with chloroprocaine

A
  1. high dose 2. low pH 3. preservative sodium metabisulfite
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2
Q

what are the local tissue toxicities that LA can cause

A
  1. cauda equina syndrome 2. transient neurologic syndrome
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3
Q

transient neurologic syndrome is associated with which LA

A

5% single dose spinal lidocaine

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4
Q

sx with transient neurologic syndrome

A
  1. pain in back and lower extremities 2. burning and itching, cramp-like pain that radiates to the anterior posterior thigh 3. no permanent issues 4. only lasts up to 5 days post-spinal
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5
Q

tx of transient neurologic syndrome

A

supportive with NSAIDS

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6
Q

mixing lidocaine 1:1 with ______________ has been found to decrease irritation to the spinal cord decreasing risk of transient neurologic syndrome

A

CSF

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7
Q

lidocaine can be used in what type of blocks

A

all blocks

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8
Q

use of lidocaine in _______________ anesthesia has decreased 2/2 transient neurologic syndrome

A

spinals

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9
Q

Lido + Epi can prolong the DOA by as much as __________%

A

50

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10
Q

lido causes _________________ at most concentrations, but causes ____________ at low doses

A

vasodilation; vasoconstriction

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11
Q

what is the least systemically toxic amide

A

prilocaine

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12
Q

_________________ causes metHb 2/2 metabolite O-toluidine

A

prilocaine

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13
Q

why is epi not needed with prilocaine

A

does not significantly vasodilate

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14
Q

prilocaine is administered what routes

A
  1. infiltration 2. IV 3. regional 4. PNB 5. spinal 6. epidural
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15
Q

routes of lido

A
  1. all block routes 2. topical 3. neb
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16
Q

_________________ is very similar to lido but has a slightly longer DOA

A

mepivacaine

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17
Q

___________________ is c/i with OB bc metabolism is prolonged with fetus and newborn

A

mepivacaine

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18
Q

_________________ is an amide anesthetic can cause sudden cardiac arrest

A

bupivicaine

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19
Q

with bupivicaine the ________________ block lasts longer than the _________

A

sensory; motor

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20
Q

routes of bupivicaine

A
  1. regional 2. local 3. spinal 4. epidural
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21
Q

effects of PNB with bupivicaine last __________________ hours

A

24-Dec

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22
Q

intrathecal anesthesia with bupivicaine has an onset in _________________, with _______________hours of analgesia

A

2-3; 4-6

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23
Q

____________________ is an amide LA that is a racemic mixture used with epi

A

bupivicaine

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24
Q

_____________ is an s-enantiomer of bupivicaine

A

levobupivicaine

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25
Q

benefit of levobupivicaine compared to bupivicaine

A

decreased toxicity –> allows for larger doses

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26
Q

levobupivicaine & ropivacaine, at low doses will cause ______________________

A

vasoconstriction

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27
Q

____________________ is a single enantiomer of bupivacaine with less toxicity, less lipid soluble, less potent than bupiv

A

ropivacaine

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28
Q

epidural use of ropivacaine allows for _________________ > ______________ blockage

A

sensory; motor

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29
Q

____________________ was used in infiltration & spinal blocks before lidocaine became popular

A

procaine

30
Q

___________________ is the ester LA that causes an allergic rxn 2/2 PABA metabolite the most

A

procaine

31
Q

procaine has a ____________ potency and a _____________ duration

A

low; short

32
Q

chloroprocaine has a _____________ potency and a ________________ toxicity

A

low; low

33
Q

what LA is the LEAST toxic of all agents currently in use

A

chloroprocaine

34
Q

______________________ can interfere with subsequent doses of epidural amides or opioids

A

chloroprocaine

35
Q

_____________________ is an ester LA that is used in high concentrations, rapidly metabolized, has virtually no fetal transmission

A

chloroprocaine

36
Q

__________________ is used in C/S with Bicarb for rapid onset of surgical block

A

chloroprocaine

37
Q

tetracaine has a ____________ onset and a ______________ duration

A

slow; intermediate-long

38
Q

T/F: tetracaine has a low potency

A

FALSE

39
Q

current use of __________________ LA is mainly topical via mucous membranes or skin wounds, & sometimes for spinals

A

tetracaine

40
Q

_________________ is VERY toxic and can cause cauda equina syndrome with repeated spinal dosing

A

tetracaine

41
Q

what is the only natural LA

A

cocaine

42
Q

____________________ is a LA that inhibits neuronal reuptake of catecholamines –> HTN, arrhythmias, tachycardia, and potentially cardiac arrest

A

cocaine

43
Q

which LA is a secondary amine

A

benzocaine

44
Q

which LA is permanently non-ionized

A

benzocaine

45
Q

benzocaine has a _____________ onset and a ___________ DOA

A

slow; short

46
Q

benzocaine is limited to _________________ anesthesia

A

topical

47
Q

pKa of benzocaine

A

2.5-3.2 (why it is permanently non-ionized and has a high risk of toxicity/methoglobinemia)

48
Q

dosage guideline of chloroprocaine w/o epi

A

11 mg/kg; max 800 mg total dose

49
Q

dosage guideline of chloroprocaine with epi

A

14 mg/kg; max 1000 mg

50
Q

dosage guideline of lidocaine without epi

A

4-5 mg/kg; max 300 mg

51
Q

dosage guideline of lidocaine with epi

A

7 mg/kg

52
Q

dosage guideline of bupivacaine without epi

A

2.0 mg/kg; max - 175 mg

53
Q

dosage guideline of bupivacaine with epi

A

2.5 mg/kg ; max 225 mg

54
Q

dosage of ropivacaine w/ or w/o epi

A

3 mg; max 200 mg

55
Q

dosage guideline of procaine

A

7 mg/kg max 350-600 mg

56
Q

dosage guideline of mepivacaine

A

7 mg/kg; max 400 mg

57
Q

dosage guideline of prilocaine for body weight less than 70 kg

A

6 mg/kg; max = 500 mg

58
Q

what other receptors other than the VG Na channels have LA been found to work on/effect (however, clinical significance is unclear)

A
  1. GCPR (inflammatory modulation) 2. suppression of polymorphonuclear leukocyte priming (iflammatory modulation) 3. K+ channels 4. Ca++ channels
59
Q

LA binding to K+ or Ca++ channels leads to significantly _____________ potent LA effects

A

less

60
Q

how does diameter & myelination influence sensitivity of LA

A
  1. larger the nerve - longer the onset time 2. greater myelination = greater diffusion barrier to LA
61
Q

which nerve fibers are your largest and most heavily myleinated?

A

A-alpha

62
Q

which nerve fibers have the fastest conduction velocity of ALL fibers

A

A-alpha

63
Q

which fiber(s) have the second fastest conduction

A

A-beta; A-gamma

64
Q

which fiber is responsible for reflexes

A

A-gamma

65
Q

which has the slowest conduction velocity of all alpha fibers

A

A-delta

66
Q

which fiber has the function of preganglionic autonomic vasomotor

A

B fibers

67
Q

which fibers have the function of postganglionic autonomic vasomotor

A

sympathetic C fiber

68
Q

which fibers are responsible for pain, temperature, and touch

A

DRG (C fibers) and A-delta fibers

69
Q

which fibers are responsible for motor tone

A

A-gamma

70
Q

which fibers are repsonsible for motor, touch, and pressure

A

A-beta

71
Q

which fibers are responsible for proprioception and motor

A

A-alpha

72
Q

order in which nerve fibers are affected by LA

A

sympathetic C and B fibers –> DRG C and A - delta –> A-beta –> A-gamma –> A-alpha

Anesthesia Pharm (18 decks)

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