Secrets Flashcards
Why is artisans different?
Contains both ester and amide.
How are anesthetics metabolized?
Amides metabolized in liver i.e. Lidocaine liver
Esters metabolized in plasma
Why is epinephrine and levonordefrin added to anesthetics?
Vasoconstrictor which limits uptake of th anesthetics into the vasculature and increase duration of anesthetic and limit dim isn’t effects
Max dose of epi delivered to 70kg pt?
.04 mg
What determines duration of local anesthetic?
Degree of protein binding. More protein binding causes longer duration
What determines onset of time for anesthetics
PKa of local anesthetics. The close the pKa of anesthetic is to ph of tissue (7.4) the more rapid the onset.
Why are local infections often ineffective when injecting into infection?
Anesthetics exist in ionized and non-ionized form. If acidic tissue infection is present then the un-ionized form may be neutralized. The base form I necessary for passage of anesthetics into nerve membranes.
How does lidocaine toxicity affect cns?
Depressor effect on myocardium. Causes subs Bradycardia and increase refractory duration relative to AP duration. Toxic lidocaine administered… Impaired cardiac in intractability and hypotension seen.
What are 10 ways to help achieve adequate anesthesia.
- Allow adequate time to have anesthetic take effect.
- Read administer at higher level on ramus
- Innvervation of mylohyoid nerve.
- Another injection at highest point (gow gates)
- Intraosseous injection
- Higher pH anesthetic without vasoconstrictor to help overcome acidity of infection
- Neutralize anesthetic by adding sodium bicarbonate
- Use larger amount without exceeding max dosage
- Sedate ot with narcotics, or nitrous
- Place pt on ABX and reschedule another time.
Types of anesthetic on pregnant or lactating pregnant?
Local Anesthetics can cross placenta barrier but generally don’t cause any harm without moderate dosage. Category B drugs best ( lido, prilo, etidocaine). Ph of mother 7.4 and fetus 7.2 excessive anesthetic dangerously lower ph for fetus (ion trapping)
Easy way to remember important points about lido?
2,3,4,5,6,7,8
Molec weight 234
Protein binding 56%
PKa 7.8
How are local anesthetics classified?
Aromatic ring linked to either amide or ester groups.
Amide- I + caine (lidocaine, meoivicane, bupivicaine)
Ester- NO i (benzocAine, marcaine, novocaine, procaine)
Older man presents with urinary problems, back pain, fatigue, malaise, weight loss and he of bone fractures. What is dz and drug of choice
Prostate cancer with mets to spinal cord. Tx is to stop testosterone with lupron (lhrh antagonist)
Most common dz of AIDS?! How to treat?
PCP!! Pneumocystis pneumonia. demonstrates AIDS and you see cysts containing sporozites with silver stain prep in lungs. Asymptommatic. Xray shows intestinal infiltrates.
