Exam 4 - NMBD Reversal, Local Anesthetics, Adjuncts

Question 1

Neostigmine dose

Answer 1

40 to 70 mcg/kg (0.04-0.07 mg/kg)

Question 2

Edrophonium dose

Answer 2

1 to 1.5 mg/kg
Just know 1 mg… per Castillo

Question 3

Atropine

Answer 3

7 to 10 mcg/kg
Matches profile of Edrophonium

Question 4

Glycopyrrolate

Answer 4

7 to 15 mcg/kg (1 mg max)
Matches profile to both Neostigmine and Pyridostigmine

Question 5

Sugammadex dose for…
Moderate Block:
Deep Block:
Extreme Block:

Answer 5

Moderate - 2 mg/kg
Deep - 4 mg/kg
Extreme - 8-16 mg/kg

Question 6

Protein Binding percentages for Bupivacaine, Lidocaine, and Prilocaine?

Answer 6

Bupivacaine - 95%
Lidocaine - 70%
Prilocaine - 55%

Question 7

Lidocaine
Metabolism:
Metabolite:
Max Dose:

Answer 7

Metabolism: Oxidative dealkylation in liver
Metabolite: Xylidide
Max Dose: 300 mg alone and 500 mg w/ Epi

Question 8

Prilocaine
Metabolite:
Max Dose:

Answer 8

Metabolite: Orthotoluidine
Max Dose: 600 mg
Converts hemoglobin to methemoglobin

Question 9

Methylene Blue
Indication:
Dose:

Answer 9

Indication: Methemoglobinemia
Dose: 1 to 2 mg/kg IV over 5 mins
Total dose not to exceed 7 to 8 mg/kg over 24 hours

Question 10

Bupivacaine and Ropivacaine bind to which protein?

Answer 10

α1-acid glycoprotein

Question 11

Procaine metabolite

Answer 11

PABA

Question 12

Benzocaine
Onset:
Duration:
Max Dose:

Answer 12

Onset: Rapid
Duration: 30 to 60 mins
Max Dose: 200 to 300 mg spray

Question 13

Cocaine
Peak:
Duration:
Elimination:

Answer 13

Peak: 30 to 45 mins
Duration: 60 mins after peak
Elimination - Urine

Question 14

Max dose for Lidocaine? With Epi?

Answer 14

300 mg
With Epi = 500 mg

Question 15

Bupivacaine max dose? With Epi?

Answer 15

175 mg
225 mg with Epi

Question 16

Atenolol (Tenormin) dose?

Answer 16

5 mg q 10 mins IV

Question 17

Metoprolol (Lopressor) dose?

Answer 17

1 mg q5mins IV (In blocks of 5 mg)

Question 18

Esmolol (Brevibloc) initial dose? Metabolism?

Answer 18

Initial dose = 20-30 mg IV
Metabolized by plasma esterases in the cytosol

Question 19

What is the IVP dose for Phenylephrine?

Answer 19

100 mcg bolus

Question 20

Labetalol
Dose?
Max effect?

Answer 20

Dose - 2.5-5 mg IV, may increase to 10 mg IV
Max effect - 5-10 mins

Question 21

An epinephrine bolus dose of 2-8 mcg lasts how long?

Answer 21

1-5 mins

Question 22

Epinephrine infusions and the receptors…
1-2 mcg/min?
4 mcg/min?
10-20 mcg/min?

Answer 22

1-2 mcg/min = beta-2
4 mcg/min = beta-1
10-20 mcg/min = Predominately alpha

Question 23

Single IV dose for Ephedrine? Vasopressin? Epinephrine? Phenylephrine?

Answer 23

Ephedrine - 5-10 mg
Vaso - 1-2 units
Epinephrine - 1-2 mcg
Phenylephrine - 50-100 mcg

Question 24

Sodium nitroprusside initial dose?

Answer 24

0.3 mcg/kg/min
Titrated to 2 mcg/kg/min

Question 25

Nitroglycerine initial dose?

Answer 25

5-10 mcg/min infusion and titrate

Question 26

Hydralazine
Dose?
1/2 life?
Peak plasma concentration?

Answer 26

Dose - 2.5 mg IV
1/2 Life - 3-7 hours
Peak - 1 hour

Question 27

Nicardipine (Cardene) dose?

Answer 27

Initial dose 5 mg/hr, increase 2.5 mg/hr x 4 to max dose of 15 mg/hr

Question 28

Procaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 28

Potency - 1
Maximum Single Dose - 500 mg
pK - 8.9
Protein Binding - 6%

Question 29

Chloroprocaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 29

Potency - 4
Maximum Single Dose - 600 mg
pK - 8.7
Protein Binding… no number was given.

Also has a rapid onset

Question 30

Tetracaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 30

Potency - 16
Maximum Single Dose - 100 mg (topical)
pK - 8.5
Protein Binding - 76%

Question 31

Lidocaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 31

Potency - 1
Maximum Single Dose - 300 mg
pK - 7.9
Protein Binding - 70%

Question 32

Prilocaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 32

Potency - 1
Maximum Single Dose - 400 mg
pK - 7.9
Protein Binding - 55%

Question 33

Mepivacaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 33

Potency - 1
Maximum Single Dose - 300 mg
pK - 7.6
Protein Binding - 77%

Question 34

Bupivacaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 34

Potency - 4
Maximum Single Dose - 175 mg
pK - 8.1
Protein Binding - 95%

Question 35

Levobupivacaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 35

Potency - 4
Maximum Single Dose - 175 mg
pK - 8.1
Protein Binding - > 97%

Question 36

Ropivacaine
Potency?
Maximum Single Dose?
pK?
Protein Binding?

Answer 36

Potency - 4
Maximum Single Dose - 200 mg
pK - 8.1
Protein Binding - 94%

Question 37

Eutectic Mixture of LA (EMLA) dose components and dosage?

Answer 37

Lidocaine 2.5% and Prilocaine 2.5%
1 to 2 grams/10 cm^2 area

Question 38

For subarachnoid blocks, dosing for a a 5ft person is _________ of 0.75% Bupivacaine… how much do you increase for each inch above 5ft?

Answer 38

1 ml
Increase by 0.1 mL/inch over 5 ft.