LA - Bupivicaine

Question 1

What is the maximum dose of Bupivacaine allowed for infiltration?

A) 150 mg
B) 175 mg
C) 200 mg
D) 225 mg

Answer 1

B) 175 mg
Bupivacaine (Only used with spinal at ARMC)

Question 2

What is the concentration of Bupivacaine used for spinal anesthesia?

A) 0.1%
B) 0.2%
C) 0.5%
D) 0.75%

Answer 2

D) 0.75%

Question 3

What is the onset time of Bupivacaine when used for spinal anesthesia?

A) Slow
B) Moderate
C) Fast
D) Immediate

Answer 3

C) Fast

Question 4

What is the duration of action for Bupivacaine used in spinal anesthesia?

A) 30-60 minutes
B) 60-120 minutes
C) 120-180 minutes
D) 60-240 minutes

Answer 4

D) 60-240 minutes

Question 5

What is the recommended maximum single dose of Bupivacaine for spinal anesthesia?

A) 10 mg
B) 15 mg
C) 20 mg
D) 25 mg

Answer 5

C) 20 mg

Question 6

For a patient who is closer to 5 feet tall, what is the typical spinal dosing volume of Bupivacaine?

A) 1.0-1.2 mL
B) 1.2-1.4 mL
C) 1.4-1.6 mL
D) 1.6-1.8 mL

Answer 6

B) 1.2-1.4 mL

Question 7

For a patient who is closer to 5’5” tall, what is the recommended volume of Bupivacaine for spinal anesthesia?

A) 1.0-1.2 mL
B) 1.2-1.4 mL
C) 1.4-1.6 mL
D) 1.6-1.8 mL

Answer 7

C) 1.4-1.6 mL

Question 8

What is the recommended spinal dosing volume of Bupivacaine for a patient who is closer to 6 feet tall?

A) 1.0-1.2 mL
B) 1.2-1.4 mL
C) 1.4-1.6 mL
D) 1.6-1.8 mL

Answer 8

D) 1.6-1.8 mL

up to T4, no higher! Position patient to facilitate movement

Question 9

How is the duration of action for Bupivicaine extended and its toxicity decreased?

A) By incorporating it into a gel
B) By incorporating it into liposomes
C) By using a higher concentration
D) By administering it with a vasoconstrictor

Answer 9

B) By incorporating it into liposomes

MOA: amide, incorporated into liposomes to prolong the duration of action and decrease toxicity

Question 10

What is the onset time of the Bupivicaine?

A) Fast
B) Moderate
C) Slow
D) Immediate

Answer 10

C) Slow

Question 11

What is the percentage of the Bupivicaine in its non-ionized form at physiological pH (7.4)?

A) 10%
B) 17%
C) 25%
D) 35%

Answer 11

Answer: B) 17%

pK 8.1, 17% non-ionized at physiological pH 7.4, 95% ɑ1-acid glycoprotein.

Question 12

What is the duration of action for the Bupivicaine?

A) 120-180 minutes
B) 180-240 minutes
C) 240-360 minutes
D) 240-480 minutes

Answer 12

D) 240-480 minutes

Question 13

How is the Bupivicaine metabolized in the body?

A) Renal excretion
B) Hepatic CYP450 enzymes
C) Plasma esterases
D) Gastrointestinal absorption

Answer 13

B) Hepatic CYP450 enzymes

Question 14

What metabolic processes are involved in the metabolism of the Bupivicaine?

A) Aromatic hydroxylation, N-dealkylation, amide hydrolysis, and conjugation
B) Glucuronidation, sulfation, and oxidation
C) Ester hydrolysis and N-methylation
D) Acetylation and deamination

Answer 14

A) Aromatic hydroxylation, N-dealkylation, amide hydrolysis, and conjugation

Question 15

What is the elimination half-life (t½) of the Bupivicaine?

A) 90 minutes
B) 120 minutes
C) 150 minutes
D) 210 minutes

Answer 15

D) 210 minutes

Question 16

What are some of the cardiac effects associated with the accidental intravenous injection of this local anesthetic?

A) Bradycardia and hypotension
B) PVCs, widened QRS complex, V Tach, SVT, AV heart block, and ST-T wave changes
C) Atrial fibrillation and coronary artery spasm
D) Myocardial infarction and heart failure

Answer 16

B) PVCs, widened QRS complex, V Tach, SVT, AV heart block, and ST-T wave changes

Precautions: ɑ1-acid glycoprotein and albumin binding are quickly saturated with accidental IV injection, free drug to conducting tissue of heart leads to PVCs, widened QRS complex, V Tach, SVT, AV heart block, and ST-T wave changes. Slower to dissociate off channels than lidocaine therefore is more cardiotoxic. Toxic level 8-10mcg/ml.

Question 17

Precautions:

What happens to the binding of ɑ1-acid glycoprotein and albumin when there is an accidental intravenous injection of the local anesthetic?

A) Binding is enhanced
B) Binding is decreased
C) Binding is quickly saturated
D) Binding remains unaffected

Answer 17

C) Binding is quickly saturated

Question 18

Compared to Lidocaine, how does this local anesthetic affect cardiac tissue?

A) It is less cardiotoxic
B) It is more cardiotoxic
C) It has similar cardiotoxicity
D) It does not affect cardiac tissue

Answer 18

B) It is more cardiotoxic

Question 19

What is the toxic level of this local anesthetic in the blood?

A) 5-7 mcg/mL
B) 6-8 mcg/mL
C) 8-10 mcg/mL
D) 10-12 mcg/mL

Answer 19

Answer: C) 8-10 mcg/mL