local anesthetics Flashcards
what is preservative found in esters
PABA (para-aminobenzoic acid)
what preservative is found in both amide and esters?
methylparaben
what should you do if patient says they are allergic to local?
give an intradermal test dose with PRESERVATIVE-FREE local anesthetic and watch for any s/sx of anaphylaxis!
max single dose of
lidocaine:
lidocaine with epi:
max single dose of
lidocaine: 300 mg
lidocaine with epi: 500 mg
from pharm textbook used spring semester
max single dose of
bupivacaine:
with epi:
max single dose of
bupivacaine: 175 mg
bupivacaine with epi: 225 mg
from pharm textbook used spring semester
what is the dose of methylene blue?
1-2 mg/kg over 5 mins
MAX: 7-8 mg/kg
What determines potency of local anesthetics?
lipid solubility
What determines duration of action of local anesthetics?
protein binding
What determines onset of local anesthetics?
pKa
What is the tx for LAST?
20% Lipid Emulsion Rescue!
What is the BOLUS dose for lipid rescue?
1.5 mL/kg over 1 minute
can repeat bolus q3-5 mins up to 3mL/kg until circulation is restored
What is the INFUSION dose for lipid rescue?
0.25 mL/kg/min for at least 10 mins
increase to 0.5 mL/kg/min if BP declines… continue infusion until hemodynamically stable
What is the MAX total dose for lipid rescue?
8 mL/kg
What else can we do besides CPR for LAST?
give some epi (10-100 mcg) and if no response, CPB!
What electrolyte imbalance promotes seizures with local anesthetics?
hyperkalemia
Which 2 locals use alpha-1 acid glycoprotein as their protein binding?
bupivacaine & ropivacaine
List populations with decreased plasma cholinesterases.
parturients, neonates, elderly, liver disease
List the 5 adjuvants that prolong duration of action of local anesthetics
- dexamethasone
- dexmedetomidine
- clonidine
- magnesium
- ketamine
What is the mechanism of action of local anesthetics?
blocks voltage-gated Na+ channels
- so sodium can’t get in cell, which slows rate of depolarization so can’t reach threshold = no action potential
What is the max dose of
prilocaine:
prilocaine with epi:
max dose of
prilocaine: 6 mg/kg
prilocaine with epi: 8.5 mg/kg
What is the max dose of
mepivacaine:
mepivacaine with epi:
max dose of
mepivacaine: 5 mg/kg
mepivacaine with epi: 7 mg/kg
What is the max dose of
ropivacaine:
ropivacaine with epi:
max dose of
ropivacaine: 3 mg/kg
ropivacaine with epi: 4 mg/kg
What is the max dose of
procaine:
procaine with epi:
max dose of
procaine: 7 mg/kg
procaine with epi: 8.5 mg/kg
What is the max dose of
chloroprocaine:
chloroprocaine with epi:
max dose of
chloroprocaine: 6 mg/kg
chloroprocaine with epi: 14 mg/kg
What is the max dose of
tetracaine:
tetracaine with epi:
max dose of
tetracaine: 3 mg/kg
tetracaine with epi: 3 mg/kg
For CSE labor analgesia from txwes ref guide:
what is concentration of bupivacaine you will use for an epidural?
0.0625 - 0.125%
For CSE labor analgesia from txwes ref guide:
what is the dose of a spinal block using bupivacaine?
1.25 - 2.5 mg
For CSE labor analgesia from txwes ref guide:
what concentration of ropivacaine will be used for epidural?
0.08 - 0.2%
For CSE labor analgesia from txwes ref guide:
what dose of ropivacaine will be used for a spinal block?
2.5 - 4.5 mg
For CSE labor analgesia from txwes ref guide:
what concentration of lidocaine with epi will be used for an epidural test dose?
2% in 5mL bolus
For CSE labor analgesia from txwes ref guide:
how much fentanyl can you give in an epidural?
50-100 mcg
For CSE labor analgesia from txwes ref guide:
how much fentanyl can you give in a spinal block?
10-25 mcg
For CSE labor analgesia from txwes ref guide:
how much sufentanil can you give in an epidural?
5-10 mcg
one-tenth of the fentanyl dose
For CSE labor analgesia from txwes ref guide:
how much sufentanil can you give in a spinal block?
1.5 - 5 mcg
For CSE labor analgesia from txwes ref guide:
what is the dose of morphine that can be administered in a spinal block?
0.1 - 0.2 mg
