LAs

Question 1

max dose: cocaine

Answer 1

3 mg /kg

Question 2

anomalies with cocaine:

Answer 2

Heavily liver metabolized
Excreted unchanged by kidneys at higher percentage
Overall longer metabolism than most esters

Vasoconstriction! Unique among LAs

Causes SE of euphoria and increased SNS outflow

Question 3

max dose: procaine

Answer 3

7 mg / kg

Question 4

Special notes on procaine:

Answer 4

Increased incidence of CNS effects
increased PO-Nausea
Metabolites interfere with sulfa abx

Question 5

max dose: Tetracaine

Answer 5

3 mg /kg

Question 6

Special notes Tetracaine:

Answer 6

primarily used in spinal / corneal anesthesia

Very long DOA for ester r/t increased protein binding

Higher risk for TNS

Question 7

max dose: chloroprocaine

Answer 7

12 mg/kg

Question 8

onset of chloroprocaine:

pKa

Answer 8

onset: fast
pKa = 8.7

given at higher concentrations 2-3%

Question 9

Notes on chloroprocaine:

Answer 9

great for OB anesthesia r/t minimal protein binding = rapid metabolism

Question 10

Max dose: Mepivicane

Answer 10

max dose: 4mg/kg or with epi 7mg/kg

Question 11

notes on Mepivicaine:

Answer 11

less vasodilatory than Lido but similar drug

more CNS effects than lido

Question 12

Max dose: etidocaine

Answer 12

4 mg/kg

Question 13

Max dose: lidocaine

Answer 13

4 mg/kg or with epi 7 mg/kg

Question 14

Notes on lidocaine:

Answer 14

spinal use associated with CE

2 active metabolites !

Question 15

Max dose: Prilocaine

Answer 15

600 mg

Question 16

Notes on prilocaine:

Answer 16

toxic metabolite: ortho-tuolidine -> r/f metheglobinemia

Question 17

Max dose: Bupivicaine

Answer 17

2.5 mg/kg

Question 18

spinal dose: Bupivicaine

Answer 18

15 - 20 mg

Question 19

Notes on bupivicaine:

Answer 19

low incidence of CNS effects

VERY CARDIOTOXIC

great at differential blocks

Long duration (95%) protein bound

Question 20

Max Dose: Levobupivicaine

Answer 20

Max dose: 2mg/kg

Question 21

Spinal dose: Levobupivicaine:

Answer 21

15 - 20 mg

Question 22

Notes levobupivicaine

Answer 22

S enantiomer of bupivicane

less of a half life

less cardiotoxic

Question 23

Max dose: Ropivicaine

Answer 23

3 mg/kg, 3.5 mg/kg* with epi

Question 24

spinal dose: ROPIVICAINE

Answer 24

15 - 20 mg

Question 25

Notes on ropivicaine

Answer 25

s enantiomer of bupivicane homolog. less cardio toxic. more vasoconstriction 2 active metabolites *shortest half life of levo/bu/ro

Question 26

mepivicaine has a longer DOA than lido because

Answer 26

it has less vasodilatory effects .

Question 27

mepivicaine is structurally similar to

Answer 27

bupivicane

Question 28

mepivicaine is clinically similar to

Answer 28

lidocaine

Question 29

Spinal concentration, dose, volume, duration for lidocaine,

Answer 29

1.5% or 5% 30-100mg 1-2mL 30-90 min

Question 30

spinal concentration, dose, volume, duration for mepivacaine

Answer 30

4% 40-80 mg 1-2 mL 30-90 min

Question 31

spinal concentration, dose, volume, duration for tetracaine

Answer 31

0.25 - 1 % 5 - 20 mg 1 - 4 mL 90 - 200 min

Question 32

spinal concentration, dose, volume, duration, for bupivacaine

Answer 32

0.5% 15-20 mg 3-4 mL 90-200 min

Question 33

spinal concentration, dose, volume, duration, for ropivacaine

Answer 33

0.75% 15-20 mg 2-3 mL 90-200 min

Question 34

spinal concentration, dose, volume, duration for levobupivacaine

Answer 34

0.75% 15-20 mg 2-3 mL 90-200 min

Question 35

LAs: with active metabolites:

Answer 35

ropivicane (2) lidocaine (2) prilocaine (1)

Question 36

higher concentration =

Answer 36

faster onset b/c more molecules

Question 37

systemic effects are more likely with

Answer 37

amides

Question 38

seizures in CNS toxicity are followed by

Answer 38

CNS depression | possibly hypotension, apnea

Question 39

population at increased risk of CV collapse with bupivocaine

Answer 39

pregnancy hypoxia pH abnormalties CV modulating drugs [propofol, volatile agents]

Question 40

lipid for bupivacaine

Answer 40

intralipid 20% 1.5 mL/lg rapid bolus immediately. follow with infusion 0.25 ml/kg/min x 10 minutes

Question 41

drugs implicated in CE

Answer 41

lidocaine 5%, tetracaine, chloroprocaine (preservative?)

Question 42

factors that increase the risk of CNS toxicity

Answer 42

hypercarbia (increases CBF) hyperkalemia (increases resting membrane potential) metabolic acidosis (decreases convulsions threshold and favors ion trapping in the brain)

Question 43

difficulty of CPR with OD

Answer 43

bupivacaine > levobupivacaine > ropivacaine > lidocaine

Question 44

site of injection and blood flow:

Answer 44

IV > tracheal > intrapleural > intercostal > caudal > epidural > brachial plexus > femoral > sciatic > SubQ