Local Anesthetics

Question 1

Name the esters (3)

Answer 1

Procaine
Chloroprocaine
Tetracaine

Question 2

Name the amides (4)

Answer 2

Lidocaine
Mepivacaine
Ropivacaine
Bupivacaine

Question 3

Procaine pka, ionized, protein binding, onset, DOA

Answer 3

8.9
97
6
Slow
60-90m

Question 4

Chloroprocaine pka, onset, DOA

Answer 4

8.5
Fast
30 - 60m

Question 5

Tetracaine pka, ionized, protein binding, onset, DOA

Answer 5

8.5
93
94
slow
180 - 600

Question 6

Lidocaine pka, ionized, protein binding, onset, DOA

Answer 6

7.9
76
64
Fast
90 - 120

Question 7

Mepivacaine onset, DOA

Answer 7

fast

120 - 240m

Question 8

Ropivacaine onset, DOA

Answer 8

slow

180 - 600m

Question 9

Bupivacaine pka, ionized, protein binding, onset, DOA

Answer 9

8.1
83
95
slow
180 - 600

Question 10

Caudal epidural dosing

Answer 10

2 mL/segment

Question 11

Lumbar epidural dosing

Answer 11

1 mL/segment

Question 12

Thoracic epidural dosing

Answer 12

0.7 mL/segment

Question 13

Epidural Epinephrine

Answer 13

alpha 1 agonist
1: 200,000 (5 mcg/mL)
prolong effect

Question 14

Epidural Clonidine

Answer 14

selective alpha 2 agonist - potential direct action on nerves

synergism w/lidocaine or bupivacaine for labor analgesia

Question 15

Opioids

Answer 15

must be preservative free

fentanyl or morphine!

Question 16

Epidural Fentanyl

Answer 16

high lipid solubility
Dose: 50 - 100 mcg
Onset: 3 -5m
DOA: 1 -2h

Question 17

Epidural morphine

Answer 17

HIGHLY POLARIZED
Dose: 2 - 4 mg
Onset: 10 - 15m
DOA: 8 - 10h

Question 18

Morphine ADR

Answer 18

itching & urinary retention

Question 19

Epinephrine spinal

Answer 19

alpha 1 agonist
o 0.1 – 0.2 mL of 1: 1000 solution
o Greatest effect with tetracaine

Question 20

Phenylephrine spinal

Answer 20

alpha adrenergic agonist, slightly more effective than epi
o 0.05 – 0.2 mL of 1% (0.5 – 2 mg) added to LA
o Greatest effect with tetracaine

Question 21

Clonidine spinal

Answer 21

(NOT A VASOCONSTRICTOR)
o Used when epinephrine is c/i
o Synergism w/lidocaine & bupivacaine
o Central action helps with tourniquet pain

Question 22

Fentanyl spinal

Answer 22

high lipid solubility, binds directly to lipid elements of spinal cord. Less drug available to diffuse systemically
	Profound analgesia
	Dose: 12.5 – 25 mcg w/LA
	Onset: 5 – 10m
	DOA: 2 – 4h

Question 23

Morphine spinal

Answer 23

highly polarized, not lipid soluble. Drifts freely into CSF. 6 – 8 hours it will rise to respiratory center.
 Profound analgesia
 Dose: 0.1 – 0.25 mg mixed w/LA
 Onset: 60 – 90m
 DOA: 24h
 ADR: itching, urinary retention, delayed respiratory depression

Question 24

lidocaine max dosing

Answer 24

4/7 mg/kg

Question 25

mepivacain max dosing

Answer 25

4/7 mg/kg

Question 26

bupivacaine max dosing

Answer 26

3 mg/kg

Question 27

ropivacaine max dosing

Answer 27

3 mg/kg

Question 28

procaine

Answer 28

12 mg/kg

Question 29

chloroprocaine

Answer 29

11 / 14 mg/kg

Question 30

prilocaine

Answer 30

7/ 8.5 mg/kg

Question 31

tetracaine

Answer 31

3 mg/kg