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Pharm II > Test 3: Local Anesthetics Specific Drugs to Know > Flashcards

Test 3: Local Anesthetics Specific Drugs to Know Flashcards

1
Q

Which is the most widely used LA?

A

Lidocaine

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2
Q

Why has spinal use of Lidocaine declines?

A

Due to TNS

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3
Q

What does Lidocaine due to the vasculature depending on concentration?

A

-Vasodilates at most concentrations.
-Vasoconstricts at low doses.

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4
Q

Epi + Lido can prolong the DOA by as much as?

A

50%

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5
Q

Which LA is the least systemically toxic amide?

A

Prilocaine

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6
Q

Why does Prilocaine cause Methemoglobinemia?

A

Due to it’s metabolites: O-toluidine (oxidizing agent)

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7
Q

Can you use Mepivacaine in OB?

A

C/I in OB because its metabolism is prolonged in fetus and newborns.

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8
Q

What are the uses of Lidocaine?

A

-Can be used for all blocks
-Can be given topically or nebulized.

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9
Q

What type of molecule is Bupivacaine?

A

A racemic mixture

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10
Q

What is Bupivacaine used in?

A

-Regional
-Local
-Spinal
-Epidural

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11
Q

With Bupivacaine, ___ block outlasts ____ block.

A

Sensory block outlasts motor block.

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12
Q

How long can Bupivacaine last in a PNB vs Intrathecal?

A

-PNB: 12-24 hours
-SAB: 2-3 hours with 4-6 hours of analgesia
-Used with Epi

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13
Q

What is the biggest risk with Bupivacaine?

A

Can cause sudden cardiac arrest.

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14
Q

What concentration of Bupivacaine is C/I in OB?

A

0.75%

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15
Q

How does Ropivacaine compare to Bupivacaine?

A

-Structure is similar
-Ropi is a single enantiomer with less toxicity
-Can be administered in larger doses
-Less lipid soluble and less potent than Bupiv
-Vasoconstricts at low doses

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16
Q

Epidural use of Ropivacaine allows for what?

A

Sensory > Motor blockage.

17
Q

Why does procaine cause allergic reactions?

A

Due to PABA metabolite

18
Q

Which agent is the least toxic of all agents currently in use?

A

Chloroprocaine
-Low potency & low toxicity
-Used in high concentrations
-Rapidly metabolized
-Used in combo with longer acting LAs

19
Q

When is Chloroprocaine most commonly used?

A

In C/S with bicarb for rapid onset of surgical block.
-Virtually no transmission to the fetus

20
Q

What is important to know regarding Chloroprocaine and subsequent doses of another agent?

A

Chloroprocaine can interfere with subsequent doses of epidural amides or opioids.

21
Q

What is unique about Tetracaine?

A

It is very toxic.
-Cauda Equina syndrome appears with repeated spinal dosing.

22
Q

Which agent is the only natural LA?

A

Cocaine

23
Q

What are the CV effects of Cocaine?

A

Inhibits the neuronal reuptake of catecholamines resulting in HTN, dysrhythmias, tachycardia, and potentially cardiac arrest.

24
Q

What is the pKa of Benzocaine?

A

2.5 - 3.1. Very unusual.
-Almost permanently non-ionized.
-High potential for toxicity.

25
Q

What are the pharmacokinetics of Benzocaine?

A

-A secondary amine
-Permanently non-ionized
-Slow onset
-Short DOA
It penetrates the lipid bilayer and can directly inhibit the Na v without entering the axoplasm first.

26
Q

What toxicity is associated with Benzocaine?

A

Methemoglobinemia.

27
Q

What blocks is Benzocaine used in?

A

Topical anesthesia only.

28
Q

What is the DOA of Chloroprocaine?

A

Short: 15 - 30 minutes

29
Q

What is the max dosing of Chloroprocaine?

A

-Without Epi: 11 mg/kg not to exceed 800 mg
-With Epi: 14 mg/kg not to exceed 1000 mg

30
Q

What is the DOA of Lidocaine?

A

Medium: 30 - 60 minutes
-With Epi: 120 - 360 minutes

31
Q

What is the max dosing of Lidocaine?

A

-Without Epi: 4.5 mg/kg not to exceed 300 mg
-With Epi: 7 mg/kg

32
Q

What is the DOA of Bupivacaine?

A

-Long: 120 - 240 minutes
-With Epi: 180 - 420 minutes

33
Q

What is the max dosing of Bupivacaine?

A

-Without Epi: 2 mg/kg not to exceed 175 mg
-With Epi: 2.5 mg/kg not to exceed 225 mg

34
Q

What is the DOA of Ropivacaine?

A

Long: 120 -360 minutes

35
Q

What is the max dosing of Ropivacaine?

A

-3 mg, not to exceed 200 mg (with or without epi)

Pharm II (24 decks)

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