Local Anesthetics

Question 1

First, naturally occurring LA

Answer 1

Cocaine - ester

Question 2

First, synthetic LA

Answer 2

Procaine [Novocaine] - ester; metabolized to PABA –> allergies

Question 3

Obstetric anesthesia, rapid onset, short half-life

Answer 3

Nesacaine/2-Chloroprocaine

Question 4

First potent, long acting - spinal anesthesia

Answer 4

Tetracaine [Pontocaine] - ester; high pKa (slow onset) + high lipid solubility (prolonged duration)

Question 5

Only weak ACID in LA

Answer 5

Benzocaine (Oralbase) - ester, rapid onset, topical

Question 6

First amide LA

Answer 6

Lidocaine [Xylocaine] - intermediate potency, toxicity, onset, duration

Question 7

Most common alternative to Lidocaine

Answer 7

Prilocaine [Citanest] - produces methemoglobinemia

Question 8

Amide LA designed to be more potent + longer acting

Answer 8

Etidocaine [Duranest] - amide, high lipid solubility, increased potency + CNS toxicity, potent vasodilator

Question 9

Long duration LA

Answer 9

Bupivicaine [Marcaine] - amide, high pKA (= slower onset), high protein binding (= long duration); analgesisa = motor block ratio very good, but cardiotoxicity

Question 10

Most widely used local anesthetic agent in dentistry in Europe

Answer 10

Articaine [Septocaine] - amide, high lipid solubility (= rapid onset), high protein binding (= prolonged duration)

Question 11

New Amide Local Anesthetics

Answer 11

Ropivacaine [Naropin] and Mepivacaine [ Carbocaine] - weak vasoconstrictors, similar toxicity to Bupivicaine, but less protein binding

Question 12

First LA marketed as pure S-enantiomer

Answer 12

Ropivacaine [Narcopin] - lower cardiotoxicity than Mepivacaine, and less protein binding than Bupivicaine