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Pharmacology Exam 4 > Local Anesthetic Part 2 > Flashcards

Local Anesthetic Part 2 Flashcards

1
Q

Average pKa is ___ with LA.

A

8

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2
Q

_______ increases the % of lipid soluble or non-ionized form LAs.

A

Alkalinization

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3
Q

Benefit of Alkalinization of LA solutions:
* _________ onset of action: Peripheral and epidural blocks by 3 to 5 mins.
* Enhances the ________
* Increase the _______ (i.e., epidural)

A
  • Faster
  • depth
  • spread
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4
Q

Dexmedetomidine IV
Increased duration of:
* Both _____ and ______ blocks
* First analgesic request after _______ anesthesia

A
  • motor and sensory
  • spinal
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5
Q

Magnesium:
Increased ________ with SAB with or without opioids

A
  • duration
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6
Q

Clonidine & Ketamine:
___________ regional anesthesia prolonged duration

A
  • pediatric
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7
Q

Dexamethasone:
__________ duration either ____ or mixed with LA.

A
  • Increased
  • IV
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8
Q

Combination of Chloroprocaine & Bupivacaine:
* Produce a _______ onset and ___________.

A
  • rapid
  • tachyphylaxis
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9
Q

__ ml of 8.4% Sodium Bicarb can be added to ___ ml of LA.

A
  • 1 ml
  • 30 ml
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10
Q

When you combine LA’s, their ______ effectives are additive.

A

toxic

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11
Q

Toxic Plasma Concentration of Lidocaine

A

> 5

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12
Q

Toxic Plasma Concentration of Prilocaine

A

> 5

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13
Q

Toxic Plasma Concentration of Mepivacaine

A

> 3

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14
Q

Toxic Plasma Concentration of Ropivacaine

A

> 4

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15
Q

The duration of action of a LA is _______ to the time the drug is in conctact with _______ fibers.

A
  • proportional
  • nerve
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16
Q

Vasodilator and LA:
* 1. The duration of action of a LA is _____________ to the time the drug is in contact with nerve fibers.
2. Produce vasoconstriction.
3. ________ neuronal uptake of LA
4. α-adrenergic effects may have some degree of analgesia
5. No effect on ________ rate of LA
6. Enhanced cardiac _________ with inhaled anesthetics
7. Systemic absorption causes _______ and _________.

A
  • proportional
  • increased
  • onset
  • irritability
  • HTN and Tachycardia
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17
Q

Epinephrine ___ mg or Phenylephrine __ mg is used with Bupivacaine or Lidocaine SAB.

A
  • 0.2 mg
  • 2 mg
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18
Q

LA 25% = ______mgs/mL

A

2.5

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19
Q

LA 0.5% = ____ mgs/mL

A
  • 5
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20
Q

LA 1% = ___ mgs/mL

A
  • 10
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21
Q

LA 2% = ____ mgs/mL

A
  • 20
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22
Q

LA 4% = ____ mgs/mL

A
  • 40
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23
Q

Pharmacokinetics of LA:
* _____________ of LA Solutions
* Adjuvant ________ with LAs
* ___________ LAs
* __________ Use

A
  • Alkalinization
  • Mixed
  • Combining
  • Vasoconstrictor
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24
Q

LA Uses:
* Topical
* _________ Infiltration
* _________ N. Block
* Intravenous
* Epidural
* Spinal
* Tumescent __________.

A
  • Local
  • Peripheral
  • Liposuction
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25
Q

Max Lidocaine single dose is ____ mg or ____ mg with Epi

A
  • 300
  • 500
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26
Q

Max Bupivacaine single dose is ____ mg or ____ mg with Epi

A
  • 175
  • 225
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27
Q

Topical Anesthesia is applies to the ______ membrane of the nose, mouth, __________ tree, esophagus or ______ tract.

A
  • mucous
  • tracheobronchial
  • GU
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28
Q

Topical Anesthesa:
_______ (4% to 10%) > __________ (1% to 2%) or Lidocaine (2% to 4%)

A
  • Cocaine
  • Tetracaine
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29
Q

Cocaine is used for _________ vasoconstriction. It decreases _____ loss and _______ surgical visualization.

A
  • localized
  • blood
  • improves
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30
Q

Lidocaine works great with ______ anesthesia. Inhalation does not alter ______ resistance, but causes __________.

A
  • surface
  • airway
  • vasodilation
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31
Q

_______ and _________ are ineffective as topical anesthesia d/t quick onset and offset.

A
  • Procaine
  • Chloroprocaine
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32
Q

Eutectic Mixture of LA consists of Lidocaine ____ % and ______ 2.5% = 5% LA.

A
  • 2.5%
  • Prilocaine
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33
Q

Eutectic Micture of Lidocaine 2.5% and Prilocaine 2.5% dose is __ to __gms/____ cm2 area.

A
  • 1 to 2 grm
  • 10 cm 2
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34
Q

Eutectic Mixture of Lidocaine 2.5% and Prilociaine 2.5% onset of action is ______ mins.

A

45 mins

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35
Q

Eutectic Mixture used for skin grafting needs to set for ___ hours before the procedure?

A

2

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36
Q

Eutectic Mixture needs to occur ___ mins before the following procedures:
* Cautery of genital warts
* venipuncture, lumbar puncture
* Arterial connulation (Nitroglycernine)
* Myringotomy

A
  • 10 mins
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37
Q

Topical Anesthesia EMLA:
* caution with _________.
* ______ recommended for skin wounds
* C/I with _____ allergies

A
  • methemoglobinemia
  • NOT
  • amide
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38
Q

Other EMLA Preparations are:
* Amethocaine (EMLA-like)
* Tetracaine __% Gel
* ____________ 7%
* Tetracaine __%

A
  • 4% Gel
  • Lidocaine
  • 7%
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39
Q

Lidocaine can be used on nasal trumpets, but not LMA because

A
  • Nasal trumpets are rubber
  • LMAs are silicone and Lido breaks down silicone.
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40
Q

Local Infiltration Extravascular placement of LA is through ________ injection.

A

subcutaneous

41
Q

Local Infiltration for Inguinal Operative Site:
* _______ 1% to 2%
* ____________ 0.25%
* _______________ 0.25%

A
  • Lidocaine
  • Ropivacaine
  • Bupivacaine
42
Q

Duration of a Local Infiltration can be doubled by adding Epi 1: ___________

43
Q

Epi is C/I for Local Infiltration involving what (4) body parts? And Why?

A
  • fingers
  • toes
  • ears
  • nose
  • penis
  • Vasoconstriction, ischemia, necrosis
44
Q

Peripheral Nerve blocks are achieved by LA being injected into tissue surrounding _______ peripheral nerves or nerve _______.

A
  • individual
  • plexus
45
Q

Peripheral Nerve Block MOA is the diffussion from ____ mantle to central _______ of nerve along a _________ gradient.

A
  • outer
  • core
  • concentration
46
Q

Peripheral Nerve Block:
* Onset: _______ affected first, then _______.
* Ending: ______ Comes back first and then ______

A
  • proximal
  • distal
  • proximal
  • diastal
47
Q

Peripheral Nerve Blocks: Smallest ________ and _____ fibers first, and then larger _______ and proprioceptive axons.

A
  • sensory
  • ANS
  • motor
48
Q

For Peripheral Nerve blocks, OOA is dependent on the LA ___.

49
Q

Peripheral Nerve blocks:
* Lidocaine OOA _____ mins
* Bupivacaine OOA _____ mins

50
Q

Peripheral Nerve Blocks _________ depends on the dose of LA
* Bupivacaine w/ Epi/fentanyl/clondine lasts __ to __ hours.

A
  • duration
  • 12
  • 18
51
Q

Peripheral Continuous Infusion Blocks:
* improved ___ control, less _______ and greater satisfaction
* _______ are used.

A
  • pain
  • nausea
  • additives
52
Q

Examples of Perpheral Nerve Blocks are

A
  • Interscalene
  • Axillary
  • Femoral
  • Sciatic
53
Q

Peripheral Nerve Blocks: Nerve Stimulation
* mA __ - ___
* Pinpoint _____.

A
  • 0.1 - 1
  • needles
54
Q

Peripheral Nerve: Ultrasound-guided
* ___- plane vs ___ - ___ -plane

A
  • In - plane
  • Out-of Plane
55
Q

An August Bier Block is an example of a ____ Regional Anesthesia.

56
Q

A Bier Block is an ____ injection of LA into an extremity ______ from the rest of the systemic circulation with a _________.

A
  • IV
  • isolated
  • tourniquet
57
Q

For a IV Regional Anesthesia, the sensation and ___ tone dependent on the __________.

A
  • muscle
  • tourniquet
58
Q

IV Regional Anesthesia ester or amide LA can be used:
* Lidocaine __ Mepivacaine
* Most commonly used is __________.

A
  • <
  • Lidocaine
59
Q

Steps for a Bier
* IV start
* _________
* ______ cuff
* LA injection
* IV D/C

A
  • Exsanguination
  • double
  • LA Infection
60
Q

Sequence of Blockade:
1. _____
2. _____
3. _____

A
  1. SNS
  2. Sensory
  3. Motor
61
Q

Segmental Block in Neuraxial Anesthesia
* Myelinated Preganglionic B fibers (________) (SNS)
* Myelinated __ (medium) and B fibers (faster) > Unmyelinated ___ fibers (small)
* ________ & Temperature (touch/pressure, proprioception, & motor): myelinated A-δ and unmyelinated C fibers

A
  • fastest
  • A
  • C
  • Pain
62
Q

Spinal Anesthesia is Produced by direct injection of LA into ____________.
* _____ is confirmation
* ________ fibers: Principal site of action

A
  • subarachnoid
  • CSF
  • Principle
63
Q

Spinal Block sensory effect is on the same level of _______.
* SNS effect is 2 spinal segments _________ of sensory
* Motor effect is 2 spinal segments _________ sensory

A
  • denervation
  • caudal
  • below
64
Q

Name the (5) LA for a Subarachnoid Block SAB

A
  • Tetracaine
  • Lidocaine
  • Bupivacaine
  • Ropivacaine
  • Levobupivacaine
65
Q

Subarachnoid Block (SAB) Dosages is according to:
* ________ of patient (vol of subarachnoid space)
* _________ level of anesthesia desired
* __________ of anesthesia desired

A
  • Height
  • Segmental
  • Duration
66
Q

For a Subarachnoid Block _______ is more important than ________________ of drug (%) or volume (mL) of solution injection.

A
  • Dose
  • Concentration
67
Q

For a Subarachnoid with Bupivacaine 0.75%:
* ___ ft = 1 mL
* + ____ mL for every inch above for a total of __ cc. (1.5 hours to 2 hours)

68
Q

SAB: The _____ _____ of LA is important in determining spread of the drug.
* Hyperbaric with __________ is additive
* ________ with distilled water as additive.

A
  • Specific Gravity
  • glucose
  • Hypobaric
69
Q

Hyperbaric:
* the specific gravity of LA is _____ than CSF.
* Glucose is additive
* Causes the LA to _______.

A
  • greaters (>)
  • Sinks
70
Q

Hypobaric:
* Specific gravity of LA is _____ than CSF
* distilled water
* Causes the LA to _________

A
  • less (<)
  • float
71
Q

Patient having surgery on right hip and you place the patient on their left side. A ________ additive is added to cause the LA to float up to the Right Hip.

72
Q

Most common Epidural LA is ________.
* Good _____ through tissues and safer.

A
  • Lidocaine
  • diffusion
73
Q

Epidural:
* Levobupivacaine and __________
* less diffusion than bupivaine, but still with _____ and CNS toxicity.

A
  • Ropivacaine
  • Cardiac
74
Q

Epidural:
* Onset: ___ to ____ minutes slow diffusion/delay
* Epi 1: 200,000 with bupivacaine: _____ advantage
* Great with loading dose and then _____ boluses.

A
  • 15 to 30
  • No
  • intermittent
75
Q

Epidurals for OB Labor and C-section:
* ________ placent barrier if not ionized
* Effect on fetus at ___ to ___ hours.
* __________ will cross more than bupivacaine

A

*Crosses
* 24 to 48 hours
* lidocaine

76
Q

Epidural difference with SAB:
* ___ _______ zone of SNS, sensory, and motor blockade
* _____ dose required.

A
  • No differential
  • Large
77
Q

Epidural: ___ are acceptable as additives to both Epidural & SAB synergistic.

78
Q

Tumescent Liposuction: __ infiltration of large volumes (_L or more)

79
Q

Tumescent Liposuction Solutions:
* _____ Lidocaine (0.05 to 0.1%)
* Epinephrine 1: _______

A
  • Diluted
  • 100,000
80
Q

Tumescent Liposuction causes taunt stretching of overlying ____ skin d/t large volume and _________ tumescent.
* Local anesthesia with _________ aspirates and _______ postoperative analgesia

A
  • blanched
  • vasoconstriction
  • bloodless
  • prolonged
81
Q

Tumescent Liposuction:
* LA Plasma Peak is ___ to ___ hours s/p injection
* Where: thigh, _____, hips and _______.

A
  • 12 to 14 hours
  • abdomen
  • buttocks
82
Q

Tumescent Liposuction:
* Regional Anesthesia Lidocaine with Epi: __ mg/kg
* Highly __________ Lidocaine with Epi Tumescent: ___ to __ mg/kg

A
  • 7
  • diluted
  • 35 to 55
83
Q

Tissue Buffering System theory states that ___ gram of ___ tissue can absorb up to ___ mg of Lidocaine.

84
Q

Epinephrine:
1:200,000 Epi

85
Q

Epinephrine:
1: 500,000 Epi

86
Q

Epinephrine:
1: 10,000 Epi

A

100 mcg/mL

87
Q

Epinephrine:
1:1,000 Epi

A

1,000 mcg/mL or 1 mg/mL

88
Q

A- alpha fibers sensitivity to LA

89
Q

A- beta fibers sensitivity to LA

90
Q

A- gamma fibers sensitivity to LA

91
Q

A- Delta fibers sensitivity to LA

92
Q

Beta fibers sensitivity to LA

93
Q

C fibers sensitivity to LA

94
Q

A- alpha: Function (2)

A
  • Innervation of skeletal muscles
  • Proprioception
95
Q

A- Beta: Function (2)

A
  • touch
  • pressure
96
Q

A- gamma: Function (1)

A
  • Skeletal Muscle Tone
97
Q

A- Delta: Function (3)

A
  • Fast Pain
  • Touch
  • Temperature
98
Q

C Fiber: Function (4)

A
  • Slow Pain
  • Touch
  • Temperature
  • Postganglionic sympathetic fibers

Pharmacology Exam 4 (4 decks)

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