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ER 1 > Pharm - topical anesthetics > Flashcards

Pharm - topical anesthetics Flashcards

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1
Q

amide anesthetics

A
  • lidocaine (MC)
  • mepivacaine
  • bupivacaine
  • ropivacaine
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2
Q

ester anesthetics

A
  • procaine
  • 2-chloroprocaine
  • teracaine
  • benzocaine
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3
Q

what determines potency and time to onset of anesthetics

A
  • *lipid solubility

- those w/ greater lipid solubility are able to permeate nerve membranes more rapidly

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4
Q

effects of alkalinization on the percent nonionized local anesthetic molecules

A
  • Sodium bicarbonate increases the fraction of nonionized local anesthetic molecules
  • decreases onset time of local anesthetic effect
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5
Q

Identify the effect of injection site on speed of onset

A
  • SC/tissue infiltration: onset almost immediate
  • Intrathecal injection for spine: onset very rapid
  • Brachial plexus block: prolonged
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6
Q

short acting local anesthetics

A
  • chloroprocaine

- procaine

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7
Q

moderate-acting local anesthetics

A
  • lidocaine

- mepivacaine

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8
Q

long acting local anesthetics

A
  • bupivacaine
  • ropivavoine
  • tetracaine
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9
Q

What is the order of function lost after a nerve block?

A
  • 1st: sympathetic function
  • 2nd: loss of sensation of sharp pain, temp, pressure
  • last: motor function
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10
Q

What is the purpose of adding epi to local anesthetics?

A
  • to decrease absorption of local anesthetics from tissues

- slow absorption can decrease potential toxicity and prolong duration of drug

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11
Q

dosage for lidocaine w/ vs. w/o epi

A

-lidocaine w/o: 4 mg/kg
MAX: 300 mg
-lidocaine w/: 7 mg/kg
MAX: 500 mg

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12
Q

lidocaine

  • onset
  • duration
A
  • onset: w/i 2-5 min
  • duration: 30 min - 2 hrs
  • 3 hrs if epi added
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13
Q

bupivicaine

  • onset
  • duration
A
  • onset: 5-10 min

- duration: up to 6 hrs

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14
Q

mepivacaine

  • onset
  • duration
A
  • onset: 2-5 min
  • duration: up to 2 hrs
  • 3 hrs if epi added
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15
Q

What is the most potent amide anesthetic?

A

bupivacaine

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16
Q

In what situations is bupivacaine an advantage?

A
  • longer procedures
  • pts w/ CIs to epi injections
  • in situation where there will be a delay b/w infiltration of anesthetic and procedure
  • instances where prolonged post-procedure pain control is preferred
17
Q

what anesthetics are CI in pregnancy? (2)

A
  • bupivacaine

- mepivacaine

18
Q

Indications for local anesthetics

A

Effective for pain control during procedures including:

  • skin surgeries
  • open wound repairs
  • abscess drainage
  • FB removal
  • vascular access procedures
  • LP
19
Q

what does the choice of agent depend on?

A
  • duration of procedure
  • need for hemostasis
  • pt sensitivity to catecholamines
  • pt allergy to local anesthetics
20
Q

allergy CI to the use of local anesthetics

A
  • true allergy is a CI for that anesthetic and others in it’s class - local admin of one from another class is usu ok as long as previous rxn wasn’t urticaria/anaphylaxis
  • try using preservative free
  • consult allergy specialist for life threatening rxns
21
Q

medical condition CIs to local anesthetics

A
  • large wounds in pts w/ conditions that may be exacerbated by systemic epi effects (hyperthyroid, pheochromocytoma, severe HTN, CAD)
  • digital anesthesia in pts w/ compromised digital circulation
  • periorbital inflitration in pts w/ narrow angle glaucoma
  • not recommended for management of large/multiple lacs where total dose needed for good effect is close to max dose
22
Q

drug interactions

A
  • lurasidone - hypotension
  • ergot alkaloids - extensive HTN
  • beta blockers
  • MAOIs
  • tricyclic andtidepressants
23
Q

methods that can be used to decrease injection pain

A
  • buffering w/ bicarb
  • patient distraction
  • gentle pinching/vibration adjacent to site of injection
  • use of small needles
  • slow rate of injection
  • subQ rather than IM
  • reduce pressure of injection w/ small volume syringes
  • inject needle at 90 degrees rather than 45 when penetrating intact skin
24
Q

complications secondary to local anesthetic use

A
  • systemic toxicity: if dose is exceeded, major vessel inadvertently injected
  • CNS effects: metallic taste, tinnitus, tingling of lips, agitation, seizures
  • CV effects: bradycardia, decreased myocardial contractility, AV block, vasodilation, ventricular arrhythmias, cardiac arrest

ER 1 (18 decks)

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