Local Anesthetics and Neuromuscular Blockers Flashcards
Esters VS Amides
Procaine: SHORTEST halflife (1-2mins)
Ropivacaine: LONGEST halflife (4.2hrs)
Esters: have only 1 i in their names
Tetracaine, Procaine, Benzocaine
Amides: have 2 i’s in their names
Bupivacaine, Ropivacaine, Lidocaine
Why should you NOT inject local anesthetics into an abscess during incision and drainage?
Weak bases in charged/ionized form predominates (below pKa) which will not be able to cross nonpolar membranes.
Relationship of LA with electrolytes
Hyperkalemia enhances LA activity
Hypercalcemia antagonizes LA activity
Effect of LA toxicity to CVS
May cause heart block and arrhythmias
ALL Local anesthetics are VASODILATORS EXCEPT
Cocaine: sympathomimmetic, blocks catecholamine receptors
Local anesthetic (Ester) used in EXTRAVASATION COMPLICATIONS from VENIPUNCTURE, inadvertent intraarterial injections KNOWN to have SHORTEST HALF-LIFE among LAs
AE: Light headedness, sedation, ANTIBODY FORMATION/ALLERGONIC, cvs and pulmo depression
Procaine
SimD: Novocaine
Local anesthetic (Ester) used as TOPICAL ANESTHESIA
AE: Light headedness, sedation, ANTIBODY FORMATION/ALLERGONIC, SKIN IRRIATION, cvs and pulmo depression
Benzocaine
SimD: Butamben
Use CAUTIOUSLY when treating BURNS or large areas of skin
Local anesthetic (Ester)/ DRUG OF ABUSE used as TOPICAL ANESTHESIA
AE: Light headedness, sedation, ANTIBODY FORMATION/ALLERGONIC, cvs and pulmo depression, ABUSE LIABILITY, SEVERE HPN, CEREBRAL HMG, ARRHYTHMIAS, MI
Cocaine
Local anesthetic (Ester) used in SPINAL ANESTHESIA, EPIDURAL ANESTHESIA and TOPICAL OPHTHALMIC ANESTHESIA
AE: Light headedness, sedation, ANTIBODY FORMATION/ALLERGONIC, cvs and pulmo depression
Tetracaine
Local anesthetic (Amide) used as LA and ANTIARRHYTHMIC (Group 1B, used for POST-MI and for digitalis toxicity)
Lidocaine
Toxic dose: 5mg/kg
for any drug solution, 1% = 10mg/mL
Local anesthetic (Amide) used as DENTAL ANESTHESIA which may cause METHEMOGLOBINEMIA
Prilocaine
Prilocaine sound like PiRanha = NGIPIN -> Dental anesthesia
Methylene blue given if methemoglobinemia develops
Local anesthetic (Amide) used in EPIDURAL ANESTHESIA and INTRATHECAL ANESTHESIA
Bupivacaine
BuPI pang ePIdural
Use in CAUTION for PREGNANT WOMEN
Treat cardiotoxicity with INTRALIPID (fat emulsion in TPN)
Local anesthetic (Amide) used in EPIDURAL ANESTHESIA
AE: cardiotoxicity
Ropivacaine
Half-life as LONG as a ROPe
Longest half-life among LA
CI in IV regional anesthesia
Treat cardiotoxicity with INTRALIPID (fat emulsion in TPN)
Neuromuscular paralysis that results from persistent depolarization of the end plate
Depolarizing blockade
Ex. Succinylcholine
Neuromuscular paralysis that results from pharmacologic antagonism at the acetylcholine receptor of the end plate
Non-depolarizing blockade
Ex. Tubocurarine
Nondepolarizing neuromuscular blocker which has the most rapid onset time
Rocuronium (60-120s)
LONG-ACTING nondepolarizing neuromuscular blocker used in intubation and general anesthesia which is relatively CONTRAINDICATED in Myocardial Ischemia
AE: GANGLION BLOCK (Hypertension), RECURARIZATION, respi paralysis, histamine release
Tubocurarine
Reverse effects with NEOSTIGMINE
Tubocurarine: Ang TUBO ay mahaba. (long-acting)
SHORT-ACTING nondepolarizing neuromuscular blocker used in intubation and general anesthesia
Mivacurium
Reverse effects with NEOSTIGMINE
Metabolized by pseudocholinesterase
INTERMEDIATE-ACTING nondepolarizing neuromuscular blocker used in intubation and general anesthesia which may cause BRONCHOSPASM and undergoes HOFFMAN elimination (rapid spontaneous breakdown
Atracurium
SimD: Cistracurium
Ang aso ni Remi na si pATRAsh ay walang ginawa kundi magHOFF! HOFF! HOFF! (tumahol)
Reverse effects with NEOSTIGMINE
INTERMEDIATE-ACTING nondepolarizing neuromuscular blocker used in intubation and general anesthesia which undergoes BILE ELIMINATION
Vecuronium
Potentiated by inhaled anesthetics, aminoglycosides and quinidine
Reverse effects with NEOSTIGMINE
INTERMEDIATE-ACTING nondepolarizing neuromuscular blocker used in intubation and general anesthesia which may cause HYPERSENSITIVITY
Rocuronium
MOST RAPID time of onset (60-120s)
Reverse effects with NEOSTIGMINE
SUGAMMADEX: novel reversal agent for rocuronium
LONG-ACTING nondepolarizing neuromuscular blocker used in intubation, GA, EUTHANASIA, LETHAL INJECTION, STYCHNINE POISONING
AE: respi paralysis, apnea, tachycardia, HPN, RECURARIZATION
Pancuronium
PANcuronium: PANmatagalan (long-acting)
Reverse effects with NEOSTIGMINE
Drugs used in Lethal Injection
Thiopental (5g)
Pancuronium (100mg)
Potassium chloride (100mEq)
Phases of Depolarizing blockade
Phase I DEPOLARIZATION - transient fasciculation followed by paralysis
Phase II DESENSITIZATION - membrane repolarizes but desensitized to Ach
Depolarizing neuromuscular blocker used in intubation and general anesthesia which may cause MUSCLE PAIN, hyperkalemia, increased IOP and intragastric pressure (aspiration) and MALIGNANT HYPERTHERMIA
Succinylcholine
Metabolized by pseudocholinesterase
Potentially life-threatening condition caused by succinylcholine (and tubocurarine) with inhaled anesthetics (halothane)
Malignant hyperthermia
due to massive Calcium release from sarcoplasmic reticulum of skeletal muscles
Early sign of malignant hypertherma and its treatment
Contraction of jaw muscles or Trismus
Treated by rapidly cooling patient and by administration of DANTROLENE
