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Flashcards in Anesthetics Deck (47):
1

What is the MOA of local anesthetics?

Directly affects sensitive Na+ channels

2

What are two types of local anesthetics?

Esters
Amides

3

What are some amide local anesthetics?

Mepivacaine
Bupivacaine
Lidocaine
Prilocane
Ropivacaine
Levobupivacaine
*note the i in each*

4

What is an example of an ester local anesthetic?

Procaine (novacaine)

5

What is the onset time of procaine and how long does it last?

2-5 minutes
.25-1 hour

6

What is the time of onset for bupivacaine and how long does it last?

5 minutes
2-4 hours

7

What is the time of onset of lidocaine and how long does it last?

< 2 minutes
.5-1 hours

8

What does the aromatic ring structure do for local anesthetics?

Increased lipid solubility

9

What does the linkage structure do for local anesthetics?

Determines the type of metabolism

10

What kind of metabolism do amide local anesthetics have?

Hepatic metabolism

11

What kind of metabolism do ester local anesthetics have?

Plasma esterases metabolize

12

What do terminal amines do for local anesthetics?

Influence aqueous solubility

13

Why do you combine lidocaine with?

Epinephrine

14

What is lidocaine with epinephrine and what are the advantages of it?

Vasoconstrictor
Prolongs duration of action
Controls bleeding

15

What is the max dosage of lidocaine 2%?

7 mg/kg
Total = 500 mg

16

What concentration of procaine has a shorter duration of action?

10%

17

Which percentage of bupivacaine is most commonly used?

0.25%

18

What local anesthetic is most widely used?

Lidocaine

19

Is the efficacy comparable between all local anesthetics?

Yes

20

What is the "dosage" of 1% solution equivalent to?

10 mg/mL

21

What is the max dosage of lidocaine and its concentration?

50 mL of 1%

22

What is a patch used as local anesthetic?

Lidocaine patch 5% topical

23

How do you administer the lidocaine patch?

On 12 hours
Off 12 hours

24

Can you cut the lidocaine patch?

Yes -> different from other transdermal systems

25

What is the max amount of patches that can be used per day?

3 patches

26

Are true allergies to local anesthetic common or rare?

Rare

27

Which type of local anesthetic MC has allergic reactions?

Ester type

28

If allergic to 1 ester, can you take others?

No, allergic to 1 allergic to all
Switch to amide

29

What are systemic effects of local anesthesia?

Respiratory depression (death)
Seizures

30

What anesthetic is commonly used in epidurals?

Bupivacaine

31

What is EMLA?

Eutectic mixture of local anesthetics

32

What do you combine for EMLAs?

Lidocaine
Prilocaine

33

What population doe you used EMLAs with?

Pediatrics

34

What do we use EMLAs for?

Starting IVs
Bx
Venous, arterial, finger, heel, and lumbar punctures
Removal of staples, sutures, and lines

35

What were the emergent toxicities of general anesthetic chloroform?

Long term liver damage
Sudden death

36

What was the emergent toxicity of general anesthetic methoxyflurane?

Neprhotoxicity

37

What was the problem with general anesthetic ether?

Too flammable

38

What is a problem with nitrous oxide (inhaled)?

Increased post-operative nausea and vomitting

39

What is a problem with halothane (inhaled)?

Hepatoxicity
Arrhythmias

40

What is a problem with enflurane (inhaled)?

Hepato and renal toxicities

41

What is a problem with isoflurane (inhaled)?

Coronary steal
(shunting of blood away from already ischemic myocardium)

42

What is a problem with desflurane (inhaled)?

Tachycardia

43

What is an issue with sevoflurane (inhaled)?

Toxic metabolites

44

When is elimination of an agent and emergence from anesthesia essentially guaranteed?

As long as breathing is satisfactory

45

What are some advantages of inhalational anesthesia?

Completely painless induction
No IV access
Most rapid delivery to blood stream

46

How are the rates of PONV in all generalized inhalation anesthesias?

They are all similar

47

What are the two main differences between inhalational anesthetics?

Metabolism
Effects on the heart