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Summer Pharm_ > Local Anesthetics - dosages > Flashcards

Local Anesthetics - dosages Flashcards

1
Q
A
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2
Q

List max doses of LAs

Bupivacaine, cocaine, tetracaine, ropivacaine, etidocaine, lidocaine, mepivacaine, choroprocaine

A

Bupivacaine 2.5 mg/kg

Cocaine 3 mg/kg

Tetracaine 3 mg/kg

Ropivacaine 3 mg/kg (3.5 w epi)

Etidocaine 4 mg/kg

Lidocaine 4 mg/kg (7 w epi)

Mepivacaine 4 mg/kg (7 w epi)

Chloroprocaine 12 mg/kg

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3
Q

when do you redose lidocaine (epidural)?

A

lidocaine lasts about 1.5-2 hours etc

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4
Q

Chloroprocaine Max Dose

A

12 mg/kg

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5
Q

Lidocaine Max Dose

A

4 mg/kg

7 mg/kg with epi

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6
Q

Mepivacaine Max Dose

A

4 mg/kg

7 mg/kg with epi

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7
Q

Bupivacaine Max Dose

A

2.5 mg/kg

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8
Q

Ropivacaine Max Dose

A

3 mg/kg

3.5 mg/kg with epi

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9
Q

Etidocaine Max Dose

A

4 mg/kg

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10
Q

Cocaine Max Dose

A

3 mg/kg

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11
Q

Tetracaine Max Dose

A

3 mg/kg

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12
Q

Mepivacaine duration after infiltration

A

1.5 - 3 hr

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13
Q

Bupivacaine/Levobupivacaine/Ropivicaine

duration after infiltration

A

4-8 hrs

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14
Q

Ropivacaine duration after infiltration

A

4-8 hrs

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15
Q

Prilocaine duration after infiltration

A

1 -2 hrs

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16
Q

Chloroprocaine duration after infiltration

A

30 - 60 minutes

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17
Q

Procaine duration after infiltration

A

45 - 60 minutes

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18
Q

Arrange LAs in the order of non-ionization %

  1. cocaine
  2. lidocaine
  3. mepivacaine
  4. chloroprocaine
  5. prilocaine
  6. ropivacaine
  7. tetracaine
  8. procaine
  9. bupivicaine
  10. levobupivicaine
  11. Etidocaine
A
  1. Chloroprocaine 2%
  2. Procaine 3%
  3. Tetracaine and Cocaine 7%
  4. Bupivacaine / Levobupivacaine / Ropivacaine 17%
  5. Lidocaine/Prilocaine 24%
  6. Etidocaine 33%
  7. Mepivacaine 39%
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19
Q

LAs used topically

A
  1. Tetracaine- spinal corneal and topical
  2. Lidocaine - patches, creams, gel
  3. Cocaine - for ENT surgeries
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20
Q

LAs that can be given IV

A

Lidocaine

Prilocaine

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21
Q

LAs that cannot be given in a peripheral block

A

Tetracaine- high toxicity risk, profound mortor block- used in spinal, corneal anesthesia and topicallu

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22
Q

LAs that cannot be give epidurally

A
  1. Procaine - no longer used, was used for infiltration
  2. Tetracaine - high toxicity - spinal, corneal and topical
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23
Q

LAs that are still questionable for a spinal block

A

Chloroprocaine

Lidocaine

Mepivacaine

Prilocaine

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24
Q

LAs with pKa in the ≈7s

A
  1. Mepivacaine = 7.6
  2. Etidocaine = 7.7
  3. Lidocaine/Prilocaine = 7.9
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25
LAs with pKa in the **≈ 8s**
1. **Bupivacaine**/Levobupivacaine/Ropivacaine = **8.1** 2. Cocaine/Tetracaine = **8.5** 3. **Chloroprocaine** = **8.7** 4. Procaine = **8.9**
26
Its metabolite interferes with efficacy of sulfonamide antibiotics
Procaine
27
**_Lidocaine solution concentrations_** 1. topical 2. regional IV 3. PNB 4. Spinal 5. Epidural
1. topical: **4%** 2. regional IV: **0.25-0.5%** 3. PNB: **1-2 %** 4. Spinal: **1.5 - 5%** 5. Epidural:3 **1.5 - 2%**
28
LA not effective topically
Mepivacaine
29
which has more CNS toxicity poptential lidocaine or mepivacaine
mepivacaine
30
LA great for differential nerve block (sensory\>motor) ## Footnote great for OB
Bupivacaine
31
most cardiotoxic LA
Bupivacaine
32
Bupivicaine E½t
**3.5** hrs
33
Bupivicaine solution concentration 1. Spinal 2. Epidural 3. Peripheral Nerve Block
1. Spinal: **0.5 - 0.75%** 2. Epidural: **0.0625 - 0.5%** 3. Peripheral nerve block: **0.25 - 0.5%**
34
Bupivicaine/Levobupivicaine/Ropivicaine max **spinal dose**
**15-20** mg
35
Lidocaine max spinal dose
30-100 mg
36
Bupivacaine DOA after spinal
1.5 to 3.5 hr
37
Bupivacaine onset and DOA w/ epidural
onset 15-20 min DOA 3 - 6 hrs
38
Lidocaine onset and DOA w/ epidural
onset **5-15** min DOA **1.5-2** hours
39
Mepivacaine onset and DOA w/ epidural
onset 2-15 min DOA 1 - 3 hrs
40
Shortest DOA for epidural
Chloroprocaine
41
Chloroprocaine onset and DOA w/ epidural
onset 5-15 min DOA 30-90 min
42
Prilocaine max spinal dose
**100-200** mg
43
Mepivacaine max spinal dose
40-80 mg
44
Tetracaine max spinal dose
5-20 mg
45
Ropivacaine max spinal dose
15-20
46
Long DOA for an ester
Tetracaine 1.5 - 3.5hrs
47
pt cannot have epi what LA is best alternative
Mepivacaine it doesn't vasodilate like lidocaine so can be used when avoiding epi
48
Which LAs have slow, moderate, and fast onsets?
**Slow Onset**: procaine, tetracaine (esters) **Intermediate Onset**: bupivacaine **Fast Onset**: chloroprocaine, lidocaine, etidocaine, mepivacaine
49
Lidocaine uses?
* Regional/ neuraxial block * Cough suppression * Attenuate ICP/BP raise during laryngoscopy * Attenuate reflex bronchospasm that may occur with airway instrumentation * Suppress ventricular dysrhythmias
50
How is cocaine metabolized?
Liver, plasma esterases, and about 10-12% eliminated by kidney careful with renal disease NOT PAVA like the other esters
51
What is chloroprocaine used for?
OB epidurals it has an ultra rapid serum hydrolysis (metabolism) which reduces toxicity risk to mom and baby
52
Does lidocaine have an active metabolite?
YES. 2 Monoethylglycinexylidide (80% activity) (Mono-ethyl-glycine-xylidide) xylidide (10% activity)
53
metabolism of prilocaine.
Rapid metabolism TOXIC metabolite ortho-toluidine Must be avoided in OB due to metabolite Big doses will convert hgb to methemoglobin (treated with methylene blue)
54
What is the dose of Lidocaine for epidural placement?
It depends on the level of blockade required and the density of blockade required. If you want profound motor blockade at T4 for example and the epidural is placed at the L2-3 interspace that is about 10 segments. Say this person is average size – I would give 1.5ml per segments I wanted blocked – so I would give 15cc of 2% lidocaine. 15cc X 20mg/cc = 300mg of lidocaine. I would need to make sure that this amount did not exceed the maximum dose allowed which is 5mg/kg for plain lidocaine. If the patient was 70kg that is 350mg – so 15cc is O.K. If I wanted to give more I might add epi which would increase my maximum dose to 7mg/kg or 490mg.
55
LAs that come in racemic mixtures
Bupivacaine Mepivacaine
56
LAs that come as pure enantiometrs
Ropivacaine Levobupivacaine \*advantage = less toxic, easier to resuscitate in case of toxicity
57
what LAs are highly lipid soluble
Bupivicaine Etidocaine Tetracaine BET
58
what LAs have significant 1st pass effect by the lungs
Bupivicaine Lidoicaine Prilocaine
59
Why is lidocaine avoided in spinals?
Linked to caudal equina syndrome Epidural ok to use
60
Bupivacaine pros and cons?
**Pro** highly protein bound * low incidence of neuro complications with spinal * longer DOA (good for post-op pain and labor) Also, A alpha, beta, and gamma fibers are not completely blocked, so sensory is blocked and motor is not completely blocked. **Con** TOXICITY! very cardio toxic; pressure is still felt, that can freak people out
61
Cocaine toxicity sxs
cocaine ↓ reuptake of NE → leads to ↑ concentrations of NE * restlessness, tremors, seizures & euphoria * tachycardia/MI
62
LA toxicity s/s?
**CNS** circumoral numbness, tinnitus, vision changes, dizzy, slurred speech, restless, muscle twitching (especially in the face), seizures (which cause CNS depression, apnea, hypotension) **CV** hypotension, myocardial depression, AV block Note: bupivacaine is most CV toxic
63
S (or levo) enantiomer of bupivacaine
Ropivacaine less cardio-toxic

Summer Pharm_ (17 decks)

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