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Pharmacology Exam 4 > LA Complications and Rescue > Flashcards

LA Complications and Rescue Flashcards

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1
Q

Allergic Rxns with LAs and Recsues
* _____: <1%
* Attributed to manifestations of excess ____ levels
* Esters (PABA) ___ Amides

A
  • Rare
  • plasma
  • >
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2
Q

Allergic Rxn can be caused by:
* ________: preservative in esters and amides
* similiar in structure to ______
* Use preservation ______ if you are concerned about allergic reactions.

A
  • Methylparaben
  • PABA
  • free
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3
Q

Their is no cross-sensitivity between _____ and _____.

A
  • esters
  • amides
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4
Q

IgE anaphylaxis can cause rash, urticaria, and ______ edema with or without hypotension and __________.
* __________ test using preservative-free LA.

A
  • laryngeal
  • bronchospasm
  • Intradermal
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5
Q

L.A.S.T acronym

A
  • LA
  • Systemic
  • Toxicity
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6
Q

LAST: LA Systemic Toxicity:
* due to excess ____ concentration of the drug
* Entrance into the systemic circulation from _____ tissue redistribution and _______ metabolism.
* Accidental direct ___ injection.

A
  • plasma
  • inactive
  • clearance
  • IV
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7
Q

Other factors of LAST are:
* patient ________
* medications, location and ______ of block.
* LA used and ______.

A
  • co-morbidities
  • technique
  • dose
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8
Q

Systemic Toxicity: Magnitude of systemic absorption depends on:
1. dose
2. _______ of site
3. _______________ use
4. Physicochemical _________

A
  • Vascularity
  • epinephrine
  • properties
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9
Q

Systemic Toxicity CNS Effects:
* Drowsiness, _____ twitch prior to seizure
* Monitor _____ levels of ________ epidural > 900 mgs
* __________ promotes seizures w/ LAs

A
  • facial
  • plasma
  • lidocaine
  • Hyperkalemia
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10
Q

Plasma Lidocaine Concentration of 1-5 mcg/mL symptoms

A
  • Analgesia
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11
Q

Plasma Lidocaine Concentration of 5 - 10 mcg/mL

A
  • Circumoral numbness
  • Tinnitus
  • Skeletal Muscle Twitching
  • Systemic HoTN
  • Myocardial depression
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12
Q

Plasma Lidocaine Concentration of 10 -15 mcg/mL

A
  • Seizures
  • Unconsciousness
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13
Q

Plasma Lidocaine Concentration of 15 - 25 mcg/mL

A
  • Apnea
  • Coma
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14
Q

Plasma Lidocaine Concentration of > 25 mcg/mL

A
  • Cardiovascular Depression
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15
Q

Systemic Toxicity: Cardiovascular System Effects
* Lidocaine @ __ mcg/mL with _____ numbness but NO CV
* High concentrations = block cardiac ___ channels.
* Accidental ___ Bupivacaine

A
  • 5
  • circumoral
  • sodium
  • IV
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16
Q

High Plasma Levels of LA:
* Block Cardiac ____ Channels
* ______ conduction of cardiac impulses causing prolonged _____ interval and _____ widening.

A
  • Sodium
  • Slow
  • PR
  • QRS
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17
Q

Accidental IV Bupivacaine causes:
* Precipitous _______, AV Block.
* Cardiac Dysrhythmias: SVTs, ST - ___ wave changes, PVC, ______ of QRS, and V-tach.

A
  • Hypotension
  • T wave
  • widening
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18
Q

Toxicity Cardiovascular Effect Predisposing Factors:
* ___________
* Arterial _______, acidosis, or hypercarbia (animals)
* ______ Blockers, _______ preparations, Ca+ Channel Blockers
* Epinephrine and _____________

A
  • Pregnancy
  • hypoxemia
  • Beta
  • Digatalis
  • Phenylephrine
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19
Q

Name the (3) LAs that cause cardiovascular toxicity in order from most to least

A
  • Bupivacaine > Ropivacaine > Lidocaine
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20
Q

Treatment of Systemic Toxicity Goals:
1. Prompt ______ Management
2. ________ support
3. Removal of LA from ________ site.

A
  • airway
  • Circulatory
  • receptor
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21
Q

Treatment of CNS Systemic Toxicity:
1. 100% O2 inhibits hypoxemia and _____ acidosis
2. hyperventilation
3. ___________
4. Benzodiazepines
5. Epinephrine as ________.

A
  • metabolic
  • barbiutates
  • additive
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22
Q

Systemic Toxicity Seizure Management:
* Supplemental _____
* benzodiazepine (____ or ______)
* ________: if hemodynamically stable
* Muscle Relaxant (______ or NMDA)
* _______: Lipid Emulsion

A
  • Oxygen
  • Midazolam or diazepam
  • Propofol
  • Succinylcholine
  • Intralipid
23
Q

MOA of Intralipid Lipid Emulsion: creates _____ compartment; provides _____ for ______ metabolism.

A
  • lipid
  • fat
  • myocardial
24
Q

Intralipid~ Lipid Emulsion:
* Bolus: ____ mL/kg of 20% lipid emulsion
* Infusion: _____ ml/kg/min for ____ minutes
* 1st 30 mins: ____ ml/kg (1.2 to 6 mL/kg)

A
  • 1.5
  • 0.25
  • 3.8
25
Q

If Intralipid~ Lipid Emulsion does not work:
* Epinephrine dose: __ to ___ mcg
* No Response: __________ ___________.

A
  • 10 to 100 mcgs
  • Cardiopulmonary Bypass
26
Q

Lipid Rescue for LAST: If Unresponsive to therapy in addition to CPR.
1. Bolus ______ 20% IV 1.5 mL/kg over 1 min
2. Intralipid 20% ____ mL/kg/min
3. Continue CPR to circulate lipids
4. repeat bolus q __- 5 mins up to ___mL/kg.
5. Increase infusion up to ___ mg/kg/min if BP declines. Continue infusion until hemodynamically stable
6. MAC total dose __ mL/kg

A
  • Intralipid
  • 0.25
  • 3
  • 3
  • 0.5
  • 8
27
Q

Neural Tissue Toxicity aka Neurotoxicity can be either ________ or _________ neurological injury.

A
  • Transcient
  • Permanent
28
Q

Three Categories of Neurotoxicity include:
* _____ Neurological Symptoms
* _______ _______ Syndrome
* _____ Spinal Artery Snydrome

A
  • Transcient
  • Caudal Equina
  • Anterior
29
Q

Transcient Neurological Synptoms is moderate to severe _________ (lower back, buttocks and posterior thighs) within ___ to ___ hours after uneventful single-shot _____.

A
  • pain
  • 6 to 36
  • SAB
30
Q

Causes of Transient Neurologic Symptoms are ________, but though to be b/c of _________ more than any other LA.

A
  • unknown
  • lidocaine > other LAs
31
Q

Treatment for Transient Neurological Symptoms include _____ point injections and ______.

A
  • Trigger
  • NSAIDs
32
Q

Recovery of Transient Neurologic Symptoms takes ________

A
  • 1 to 7 days
33
Q

Cauda Equina Syndrome is caused by a diffuse injury at ______ plexus, causing varying degrees of _____ anesthesia and ___ and _______ sphincter dysfunction and paraplegia.

A
  • lumbosacral
  • sensory
  • bowel and bladder
34
Q

Caudal Equina is associated with large ___ disc herniation, prolapsed or sequestration with ______ retention.

A
  • lumbar
  • urinary
35
Q

Causes of Caudal Equina is __________

A

unknown

36
Q

Anterior Spinal Syndrome is _____ extremity paresis with a variable ______ deficit.

A
  • lower
  • sensory
37
Q

Anterior Spinal Artery Syndrome: uncertain if its ______ or ________ of the bilateral anterior spinal artery

A
  • thrombosis
  • spasm
38
Q

Other Etiologies of Anterior Spinal Syndrome include:
* Effects of ______ or ______ drugs
* PVD
* Spinal Cord compression d/t Epidural absess or ______.

A
  • HoTN
  • Vasoconstrictor
  • hematoma
39
Q

Methemoglobinemia is a potenially _____-threatening complication d/t ________ O2 carrying capacity. ( metHGB > ___%)

A
  • life
  • decreased
  • 15%
40
Q

Methemoglobinemia is caused by:
* _______, _______> Lidocaine
* Nitroglycerine
* _______
* Sulfonamides

A
  • Prilocaine
  • Benzocaine
  • Phenytoin
41
Q

Treatment of Methemoglobin is __________ ______
* Reverals of met Hgb (Fe 3+) to Hgb (Fe 2+) in ___ to ____ mins

A
  • methylene Blue
  • 20 to 60 mins
42
Q

Methylene Blue dose/max

A
  • 1 mg/kg over 5 mins
  • 7 to 8 mg/kg
43
Q

Ventilatory Response to Hypoxia
* Lidocaine __________ the ventilary response to arterial hypoxemia.
* Suseptible Patients: ______ retainers

A
  • depresses
  • CO2
44
Q

Hepatoxicity:
* caused by continous or intermittent epidual ________ to treat postherpetic neuralgia.
* Stop infusion —-> normalize liver transaminase ________

A
  • bupivacaine
  • enzyme
45
Q

Cocaine Toxicity:
* 2009: Europe __ million
* 2010: US ____ million

A
  • 4
  • 1.5
46
Q

Cocaine MOA is the SNS stimulation by blocking _______ uptake of NE and dopamine increased ________ levels

A
  • presynaptic
  • postsynaptic
47
Q

Cocaine Adverse Effects:
* last up to ___ weeks
* CV: HTN, tachycardia, coronary ____, MI, ventricular dysrythmias (v-___)
* Parturient: decreased Uterine Blood Flow (UBF) causes ______ hypoxemia
* Hyperpyrexia causes _________

A
  • 6 weeks
  • vasospasm
  • fetal
  • seizures
48
Q

Cocaine associated chest pain is treated with ____ and _______.

A
  • ASA
  • Benzodiazepines
49
Q

Cocaine Associated persistent Hypertension is treated with:
* ____ Nitroglycerine
* _______________
* Phentolamine

A
  • IV
  • Nitroprusside
50
Q

Cocaine Toxicity, High Risk w/ STEMI presentation gets a __________ _______

A
  • Primary PCI
51
Q

Cocaine Toxicity, High Risk w/ NSTE ACS presentation gets a _________ ______________.

A
  • Cardiac Catherization
52
Q

Cocaine Toxicity, Low-Moderate, you observe in a ______ _______ unit

A

Chest pain

53
Q

You want to avoid giving _______ _________ and acutely __________ and ___________ medications to anyone with Cocaine Toxicity.

A
  • Beta Blockers
  • antithrombin
  • antiplatelet
54
Q

Cocaine Toxicity discharge therapy includes:

A
  • ASA
  • clopidogrel
  • statin
  • ACE-I
  • Beta Blockers
  • Drug abuse counseling

Pharmacology Exam 4 (4 decks)

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