Local Anesthetic Pharmacology

Question 1

where is regional anesthesias principle site of action?

Answer 1

in the neuraxial

Question 2

what are the 2 types of regional anethesia?

Answer 2

1. spinal
2. epidural

Question 3

what are the 4 aminoesters?

Answer 3

1. chloroprocaine
2. cocaine
3. procaine
4. tetracaine

Question 4

what are the 4 aminoamides?

Answer 4

1. bupivacaine
2. lidocaine
3. mepivacaine
4. ropivacaine

Question 5

what structures are hydrolyzed by pseudocholinesterases?

Answer 5

esters

Question 6

what structures are enzymatically transformed in the liver?

Answer 6

amides

Question 7

what is there an inflow of in depolarization?

Answer 7

sodium

Question 8

what is there an outflow of in repolarization?

Answer 8

potassium

Question 9

the closer the pka to tissue pH the _____ the onset

Answer 9

faster

Question 10

true or false: ionized forms have a faster onset

Answer 10

false

Question 11

which aminoamide is a more potent vasodilator?

Answer 11

lidocaine

Question 12

______ solubility increases potency

Answer 12

lipid

Question 13

what aminoamide has hih=gh lipid solubility?

Answer 13

etidocaine

Question 14

an increase in protein binding = _____ duration of action

Answer 14

increased

Question 15

rank the following aminoamides in order of most to least protein binding:
lidocaine, bupivacaine, ropivacaine

Answer 15

bupivacaine> ropivacaine> lidocaine

Question 16

where should you not use epinephrine?

Answer 16

in places with no collateral blood flow

Question 17

what is the max dose used for bupivicaine?

Answer 17

2.5 mg/kg

Question 18

what is the max dose for lidocaine +/- epinephrine?

Answer 18

7 mg/kg

Question 19

what is the max dose used for procaine?

Answer 19

7 mg/kg

Question 20

how are the aminiamides given?

Answer 20

as a single subcutaneous shot

Question 21

what is the order of blockade (simple terms)?

Answer 21

1. pain
2. temperature
3. deep pressure
4. motor function

Question 22

what is the motor of blockade?

Answer 22

1. C. fiber
2. A-delta
3. A-beta
4. A-alpha

Question 23

what is a major SE of bupivaciane?

Answer 23

severe ventricular arrhythmias

Question 24

what aminoamide had an increased therapeutic index?

Answer 24

ropivacaine

Question 25

what does dibucaine inhibit?

Answer 25

pseudocholinesterase

Question 26

if there are lower levels of dibucaine, what is deficient?

Answer 26

pseudocholinesterase

Question 27

what structures are more likely to cause allergic reactions?

Answer 27

esters

Question 28

what do the derivatives of para-aminobenzoic acid contain?

Answer 28

methylparaben

Question 29

what are 6 side effects of the local anesthetics?

Answer 29

1. CNS
2. cardiovascular
3. neurotoxicity
4. methemoglobinemia
5. immunologic
6. myotoxicity

Question 30

what local anesthetic is methemoglobinemia seen with?

Answer 30

prilocaine

Question 31

how do you treat methemoglobinemia?

Answer 31

methylene blue

Question 32

what is a presentation of methemoglobinemia?

Answer 32

cyanosis

Question 33

what type of anesthesia is a better choice?

Answer 33

spinal