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CNS I > Local Anesthetics > Flashcards

Local Anesthetics Flashcards

Describe the mechanism of local anesthetic action in regional anesthesia. Classify local anesthetics based upon their chemical structure. Describe determinants of local anesthetic effects, compare/contrast the clinical effects of local anesthetics, and describe the impact of physiochemical properties of local anesthetics on local anesthetic potency, duration of action, and toxicity. Describe systemic and regional clinical manifestations of local anesthetic toxicity.

1
Q

MOA of local anesthetics

A

bind to sodium channels to reduce na+ permeability and prevent attainment of APs

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2
Q

intermediate potency.short duration LA

A

chloroprocaine

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3
Q

low potency/intermediate duration LA

A

lidocaine

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4
Q

high potency/long duration LA

A

tetracaine

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5
Q

intermediate potency/long duration LA

A

bupivacaine

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6
Q

three main chemical components of LA

A

lipophillic (aromatic ring), linking hydrocarbon chain and ionizable component (possible amine)

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7
Q

amides

A

(2 “i”s) lidocaine, etidocaine, mepivicaine, bupvicane, ropivacaine

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8
Q

esters

A

only one “i” cocaine, chloroprocaine, tetracaine, cocaine

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9
Q

major uses of regional anesthesia

A

topical, local, peripheral nerve blocks, regional, major neuraxial blockade

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10
Q

chemical determinants of clinical effects

A

lipid solubility, protein binding, pKa,

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11
Q

primary determinnt of LA potency

A

lipid solubility

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12
Q

major determination of duration of action

A

lipid solubility

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13
Q

minor determination of LA duration

A

protein binding ability

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14
Q

LAs must be ____ to penetrate nerve membrane, but _____ to block Na+ channel

A

un-ionized/ionized

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15
Q

relation of pKa to onset speed

A

high pKa = slow onset. low pKa = faster onset

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16
Q

increased dose causes _____ duration,and intenstity, and _____ onset time

A

increased, decreased

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17
Q

reason for addition of vasoconstrictors to LA

A

slow onset, prolong duration by slowing distribution

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18
Q

nerves that are acted upon faster by LAs

A

smaller, mylerinated

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19
Q

types of nerves acted upon (in order)

A

pain -> temp -> touch -> pressure

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20
Q

additive to LA that shortens onset and prolongs duration

A

bicarb. facilitates diffusion through membranes by increasing extracellular pH and decreasing intracellular pH

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21
Q

continum of LA toxicity

A

tounge/periorbital numbness –> audio/visual disturbances –> muscle twitching and seziures - > CV collapse and death

22
Q

last major sign of LA toxicity

A

CNS excitatiion followed by CV/CNS depression

23
Q

dependant factors in LA toxicity

A

potency of drug, rate of injection, acid base status, site of administration (major site worse than minor)

24
Q

decreases seizure threshold in LA toxicity

A

hypercarbia/acidocis

25
Q

LA toxicity: which comes first? CNS tox or CV tox?

A

CNS

26
Q

causes CNS tox long before CV tox

A

lidocaine

27
Q

causes CV tox shortly after CNS tox

A

bupivacaine

28
Q

increases suceptibility to bupivacaine tox

A

pregnancy

29
Q

chemical type more likely to cause allergic reactions

A

amino-esters

30
Q

reason amino-esters cause allergic reactions

A

metabolized to PABA derivatives

31
Q

reported to cause lubmbosacral nerve root irritation

A

lidocaine and mepivacaine

32
Q

risk factors for cauda equina syndrome from LA tox

A

high lidocaine concentrations and microbore spinal catheters

33
Q

lidocaine may be no longer appropriate for ____ use

A

spinal use

34
Q

used to treat LA toxicity

A

intralipid

35
Q

Procaine uses

A

infiltratio and differential spinal anesthesia - used to diagnose pain sydromes

36
Q

chloroprocaine uses

A

epidurals

37
Q

problems with chloroprocaine

A

preservitives may cause neuro deficits or back pain

38
Q

tetracaine use

A

spinal and topical anesthestic

39
Q

LA that can be toxic bcause of rapid absportion w/topical dosing

A

tetracaine

40
Q

benzocaine use

A

topical anesthesia only

41
Q

cocaine use

A

potent vasoconstrictor (used in nasal procedures)

42
Q

SE of cocaine

A

sympathetic ANS stimulation

43
Q

Lidocaine use

A

topical, infiltration, nerve blocks, major blockade

44
Q

mepivacaine use

A

infiltration, peripheral nerve block, major blockade

45
Q

LA contraindicated in PB use because it slows fetal metabolism

A

mepivacaine

46
Q

common dental anesthetic

A

mepivicaine

47
Q

comminly used LA for OB use

A

bupivacaine

48
Q

advantage of bupivicane in OB use

A

analgesia WITHOUT motor block

49
Q

uses of ropivacaine

A

Labor, infiltration, peripheral nerve blockade, epidural

50
Q

advantage of ropivicaine over bupivacaine

A

lower cardiac toxicity

51
Q

LA that exists in pure S isomer

A

ropivacaine

CNS I (36 decks)

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