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peripheral vasodilators2 > local # 2 > Flashcards

local # 2 Flashcards

1
Q

structure of local anesthetic

A

aromatic end, intermediate chain, amine end

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2
Q

amide

A

0=c-n-r

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3
Q

ester

A

0=c-or

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4
Q

infiltration long and short acting

A

bupivicaine long acting, tetracaine short acting

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5
Q

peripheral block long and short acting

A

short-lidocaine, long- bupivicaine

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6
Q

SAB long and short acting

A

short- idocaine/procaine, long- bupivicaine or tetracaine with epi

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7
Q

epidural long and short acting

A

long- bupivicaine or ropivicaine with epi, short chloroprocaine

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8
Q

mechanism of action of locals

A

inhibit na+ influx through na specific ion channels in neuronal cell membrane.

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9
Q

what must locals be to cross cell membrane and exert action?

A

non-ionized and lipophilic,then ionized binds to sodium channel

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10
Q

pka procaine and onset

A

8.9 onset- slow

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11
Q

tetracaine pka

A

8.6 slow onset

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12
Q

bupivicaine and ropivicaine pka

A

8.1, moderate onset

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13
Q

pka chloroprocaine

A

9.1, but fast onset

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14
Q

lidocaine/etidocaine pka

A

7.7, fast onset

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15
Q

mepivicaine pka

A

7.6 fast onset

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16
Q

decreased pka =

A

fast onset

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17
Q

problem with local toxicity is when

A

local gets into plasma

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18
Q

higher absorption

A

intercostal>caudal>epidural>brachial plexus>sciatic nerve

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19
Q

elimination of locals

A

prilocaine>etidocaine>lidocaine>mepivacaine>bupivacaine

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20
Q

what can be excreted ionized or unionized

A

unionized are not excreted

21
Q

liver disease and metabolism locals

A

decreased blood flow, increased metabolism time

22
Q

increased extracellular calcium does what to LA

A

antagonizes

23
Q

what does increased extracellular potassium lead to

A

increased action locals

24
Q

protein binding and bupivicaine, lidocaine and procaine

A

bupivicaine- 95%
lidocaine- 65%
procaine- 6%
protein binding deals with duration. greater protein binding, greater duration

25
Q

cns signs early to late

A 
circumoral numbness
tongue paresthesia
tinnitus
blur vision/dizziness
agitation
slurred speech/unconcious
seizures
respiratory arrest/death
26
Q

cardiovascular effects locals

A

depression of myocardial automaticity, abnormal pacer activity, decreased excitability, decreased contraction and conduction and arterial dilation

27
Q

if sodium channels are completely closed what happens

A

absolutely nothing

28
Q

which local is most toxic

A

bupivicaine

29
Q

what is treatment for bupivicaine toxicity

A

lipids

30
Q

respiratory effects of local

A

respiratory depression, decrease hypoxic drive, relaxation of smooth muscle, blok bronchospasm during intubation

31
Q

allergies with amides

A

very rare- due to methylparaben (preservative)

32
Q

allergies to esters

A

more common, due to PABA

33
Q

what do you do if there is an allergic reaction

A 
d/c drug, 100% o2, epi 0.01-0.5 iv/im
fluids 1-2L
benadryl
hydrocortisone
intubation
34
Q

what can prilocaine levels greater then 10mg cause?

A

methemoglobinemia

35
Q

cauda equina from

A

lidocaine spinal- neuronal damage

36
Q

what channel is responsible for depolarization of neuronal cells?

A

voltage gated sodium channels

37
Q

local anesthetics work

A

on inside of cell, no action on outer

38
Q

weak bases will have more drug available

A

at ph higher then physiological, bases love bases

39
Q

1% lidocaine

A

10mg/ml

40
Q

2% lidocaine

A

20mg/ml

41
Q

1:100,000 epi

A

10mcg/ml

42
Q

1:200,000 epi

A

5mcg/ml

43
Q

.1% lidocaine

A

1mg/ml

44
Q

local anesthetic with pka closer to physiologic ph will have

A

greater concentration of nonionized base that can pass through nerve cell membrane and rapid onset

45
Q

what must la be to cross membrane

A

uncharged to penetrate membrane, then ionized to chared binds

46
Q

pka

A

50% unionized, 50% unionized at that ph

47
Q

if ph is lower then pk

A

more ionized then unionized

48
Q

if ph is higher then pka

A

more unionized

49
Q

decreased ph equals

A

greater h+ concentration

peripheral vasodilators2 (10 decks)

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