Pharm II Flashcards
Nerve Fibers
Type A α
Proprioception, skeletal muscle motor
Diameter 12-20 μm
Heavy myelination
Velocity +++++
LAST 4th blocked
Nerve Fibers
Type A β
Touch, pressure
Diameter 5-12 μm
Heavy myelination
Velocity ++++
Intermediate block onset 4th
Nerve Fibers
Type A γ
Skeletal muscle tone
Diameter 3-6 μm
Medium myelination
Velocity +++
Intermediate block onset 3rd
Nerve Fibers
Type A ∆
Fast pain, cold temperature, touch
Diameter 2-5 μm
Medium myelination
Velocity +++
Intermediate block onset 3rd
Nerve Fibers
Type B
Pre-ganglionic autonomic vasomotor ANS fibers
Diameter 3 μm
Light myelination
Velocity ++
EARLY 1st blocked
Nerve Fibers
Type C Sympathetic
Post-ganglionic vasomotor ANS fibers
Diameter 0.3-1.3 μm
NO myelination
Velocity +
Early block onset 2nd
Nerve Fibers
Type C Dorsal Root
Slow pain, warm/cold temperature, touch
Diameter 0.4-1.2 μm
NO myelination
Velocity +
Early block onset 2nd
Nerve Block Onset
B fibers → C fibers → small diameter A fibers γ Δ → large diameter A fibers α β
Pre-ganglionic sympathetic → temperature → fast pain (pinprick) → touch → motor
Benzene Ring
Lipophilic
Permits diffusion through lipid bilayers
Intermediate Chain
Ester -COOCH
OR
Amide (contains Nitrogen)
Determines class, metabolism, & allergic potential
Tertiary Amine
Hydrophilic
Accepts proton H+
Weak base
Lidocaine pKa
7.9
Lidocaine
% Ionized
76% ionized
Lidocaine
% Protein Bound
65% protein bound
Lidocaine
Onset
Fast
Lidocaine
DOA
1.5-2 hours
Lidocaine
Max Dose
4.5 mg/kg OR 300 mg
+ Epi 7 mg/kg OR 500 mg
Mepivacaine
pKa
7.6
Mepivacaine
% Ionized
61% ionized
Mepivacaine
% Protein Bound
75% protein bound
Mepivacaine
Onset
Fast
Mepivacaine
DOA
2-4 hours
Mepivacaine
Max Dose
7 mg/kg OR 400 mg
Prilocaine
pKa
7.9
Prilocaine
% Ionized
76% ionized
Prilocaine
% Protein Bound
55% protein bound
Prilocaine
Max
8 mg/kg
OR
< 70 kg 500 mg
> 70 kg 600 mg
Ropivacaine
pKa
8.1
Ropivacaine
% Ionized
83% ionized
Ropivacaine
% Protein Bound
94% protein bound
Ropivacaine
Onset
Slow
Ropivacaine
DOA
3-6 hours
Ropivacaine
Max Dose
3 mg/kg OR 200 mg
Bupivacaine
pKa
8.1
Bupivacaine
% Ionized
83% ionized
Bupivacaine
% Protein Bound
96% protein bound
Bupivacaine
Onset
Slow
Bupivacaine
DOA
3-6 hours
Bupivacaine
Max Dose
2.5 mg/kg OR 175 mg
+ Epi 3 mg/kg OR 200 mg
Levobupivacaine
pKa
8.1
Levobupivacaine
% Ionized
83% ionized
Levobupivacaine
% Protein Bound
98% protein bound
Levobupivacaine
Max Dose
2 mg/kg OR 150 mg
Exparel
Liposomal Bupivacaine
Max 266 mg (2 vials)
No Lidocaine at least 96 hours
Only admin w/ Bupivacaine
EMLA Cream
50/50
Lidocaine 2.5% + Prilocaine 2.5%
Procaine
pKa
8.9
Procaine
% Ionized
97% ionized
Procaine
% Protein Bound
6% protein bound
Procaine
Onset
Slow
Procaine
DOA
60-90 minutes
Procaine
Max Dose
7-10 mg/kg OR 350-600 mg
Chloroprocaine
pKa
8.7
Chloroprocaine
% Ionized
95% ionized
Chloroprocaine
% Protein Bound
0% protein bound
Chloroprocaine
Onset
Fast
Chloroprocaine
DOA
30-60 minutes
Chloroprocaine
Max Dose
11 mg/kg OR 800 mg
+ Epi 14 mg/kg OR 1,000 mg
Tetracaine
pKa
8.5
Tetracaine
% Ionized
93% ionized
Tetracaine
% Protein Bound
76% protein bound
Tetracaine
Onset
Slow
Tetracaine
DOA
3-6 hours
Tetracaine
Max Dose
3 mg/kg
Cocaine
Max Dose
1.5-3 mg/kg OR 150-200 mg
Benzocaine
pKa
3.5
Most Vascular & Highest Plasma Concentration LA Administration
- IV
- Tracheal
- Interpleural
- Intercostal
- Caudal
- Epidural
- Brachial plexus
- Femoral
- Sciatic
- SQ