Local Anesthetics **Drug Cards**

Question 1

Procaine (Novocain) is only used for what type of anesthesia?

Answer 1

spinal anesthesia

Question 2

Procaine (Novocain) dose, max dose, onset, duration:

Answer 2

dose: 75mg (T10), 125mg (T6), 200mg (T4)

max dose plain: 100mg or 1.5 mg/kg

max dose w/epi: 200mg or 2.5 mg/kg

onset: 2 - 5 min

duration plain: 30 - 45 min

duration w/epi: 60 - 75 min

Question 3

Procaine mechanism of action.

Answer 3

just like the other locals: stabilizes the neuronal membrane and prevents the initiation and transmission of nerve impulses, thereby effecting local anesthesia.

Question 4

What type of local anesthetic is procaine?

Answer 4

an amino-ester

Question 5

How is procaine metabolized?

Answer 5

by plasma cholinesterase

to aminobenzoic acid and diethylaminoethanol

Question 6

Is procaine safe for fetuses?

Answer 6

it has not been established, so use cautiously when performing spinal anesthesia on fetuses

Question 7

Procaine should not be used when a sulfonamide drug is also being used. Why?

Answer 7

the aminobenzoic acid metabolite of procaine inhibits the action of sulfonamides

(knowledge!)

Question 8

Procaine should be used cautiously in what types of patients?

Answer 8

severe distrubances of cardiac rhythm

shock

heart block

Question 9

Adverse effects of procaine:

Answer 9

Excitatory CNS effects: nervousness, dizziness, blurred vision, tremors

Cardiovascular system: reactions include depression of the myocardium, hypotension (or sometimes hypertension), bradycardia, and even cardiac arrest.

Question 10

Indication for tetracaine (Pontocaine)

Answer 10

Spinal anesthesia for procedures requiring 2-3 hours of anesthesia

Question 11

Dose (spinal doses here) of tetracaine

Answer 11

4-8 mg (0.5%) lower limbs; 10-12 mg (0.5%) lower abd; 10-16 mg (0.5%) upper abd

Question 12

Max Dose of tetracaine

Answer 12

1.2-1.5 mg/kg; 3 mg/kg w epi (or 20 mg in a single spinal dose/ 100 mg in a single topical dose)

Question 13

Onset of tetracaine

Answer 13

Slow (per S&H; this may be for topical application) Rapid (per DailyMed)

Question 14

Duration of tetracaine

Answer 14

Up to 2-3 hrs (spinal)

Question 15

MOA of tetracaine

Answer 15

Parenteral administration of tetracaine hydrochloride stabilizes the neuronal membrane and prevents initiation and transmission of nerve impulses thereby effecting local anesthesia

Question 16

Tetracaine: what type of LA?

Answer 16

Ester

Question 17

Metabolism of tetracaine?

Answer 17

Hydrolyzed by plasma cholinesterase

Question 18

Tetracaine: Safe for fetus?

Answer 18

Preg Cat C: No evidence of teratogenicity

Question 19

Adverse CNS effects of tetracaine?

Answer 19

nervousness, dizziness, blurred vision, or tremors, followed by drowsiness, convulsions, unconsciousness, and possibly respiratory and cardiac arrest. Since excitement may be transient or absent, the first manifestation may be drowsiness, sometimes merging into unconsciousness and respiratory and cardiac arrest. Other central nervous system effects may be nausea, vomiting, chills, constriction of the pupils, or tinnitus

Question 20

Adverse CV effects of tetracaine?

Answer 20

depression of the myocardium, blood pressure changes (usually hypotension), and cardiac arrest

Question 21

Contraindication of tetracaine?

Answer 21

Tetracaine or ester-type hypersensitivity, heart block

Question 22

Do not use tetracaine with what medicine?

Answer 22

Tetracaine hydrochloride should not be used if the patient is being treated with a sulfonamide because aminobenzoic acid inhibits the action of sulfonamides