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Local Anesthetic Pharm (EB) Flashcards

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1
Q

Local anesthetic amides (5)

A

lidocaine Bupivacaine Ropivacaine Mepivacaine Prilocaine

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2
Q

Local anesthetic esters (4)

A

cocaine Procaine Tetracaine Amethocaine

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3
Q

Myelin layer of B nerve fibers? Function? Order of block? Effect?

A

Myelin layer = light Function = autonomic, preganglionic, sympathetic Order of block = 1 Effect = warmth (vasodilation)

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4
Q

Myelin layer of C nerve fibers? Function? Order of block? Effect? ?

A

Myelin layer = none Function = pain Order of block =2 Effect = loss of pain sensation

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5
Q

Myelin layer of Adelta nerve fibers? Function? Order of block? Effect? ?

A

Myelin layer = light Function = pain, temp Order of block = 2 Effect = loss of pain and temp sensation

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6
Q

Myelin layer of Agamma nerve fibers? Function? Order of block? Effect? ?

A

Myelin layer = moderate Function = muscle tone Order of block = 3 Effect = loss of proprioception

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7
Q

Myelin layer of Abeta nerve fibers? Function? Order of block? Effect? ?

A

Myelin layer = moderate Function = touch, pressure Order of block = 4 Effect = loss?

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8
Q

Myelin layer of Aalpha nerve fibers? Function? Order of block? Effect? ?

A

Myelin layer = heavy Function = motor Order of block = 5 Effect = paralysis

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9
Q

How does frequency of stimulation influence the onset of blockade?

A

traumatized tissue more sensitive to local anes blockade

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10
Q

Order of regional local anes blocking?

A

proximal regions are blocked sooner than distal regions

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11
Q

Which kind of fibers are blocked first (conventionally)

A

small sensory fibers are blocked before larger sensory and motor fibers

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12
Q

potency of a local anes is closely correlated to

A

lipid solubility

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13
Q

What are nerve membranes made out of to help with the potency of local anes?

A

lipids

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14
Q

What influences the speed of onset of a local anes?

A

pKa

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15
Q

PKa of local anes

A

weak bases = 7.6 - 9.1

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16
Q

At tissue pH of 7.4, < 50% of local anesthetics are

A

nonionized

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17
Q

What form of local anesthetics diffuses across the cell membrane

A

non-ionized

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18
Q

pH _ in infected tissues?

A

decreases

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19
Q

Because pH decreases in infected tissues, what happens to the non-ionized fraction of local anes? What happens to the action of localed anes?

A

reduced non-ionized fraction. Reduced or absent local anes action

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20
Q

Protein binding and duration of action of bupivacaine?

A

95% protein bound, Long duration

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21
Q

Protein binding and duration of action of lidocaine

A

65% protein bound, Short duration

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22
Q

Effect of action of local anes on vessels? What effect does this have on the drug?

A

vasodilation&raquo_space; fastens uptake of drug, shortens duration of effect

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23
Q

Additives to a local anesthetic (3)

A

vasoconstrictors (epinephrine) Hyaluronidase Bicarbonate

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24
Q

Why is epinephrine added to a local anesthetic?

A

delayed absorption, prolonged action

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25
Con of adding epinephrine to a local anesthetic?
localized ischemia possible
26
Why is hyaluronidase added to a local anesthetic?
increasing tissue permeability Facilitates diffusion Rapid onset
27
Why is bicarbonate added to a local anesthetic?
buffers G+ Faster diffusion Shortens onset and duration *Injection less painful*
28
What metabolized local anes esters into inactive compounds?
plasma cholinesterases
29
NB to a long IV infusion of amide local anes?
slowly metabolized by the liver so can accumulate after long IV infusion
30
Pros of loco-regional use of local anesthetics (3)
easy to use Effective and reliable analgesia Minimal systemic effects
31
CV effects of loco-regional use of local anesthetic
decreased CV responses to surgical stimulation
32
Effect of loco-regional use of a local anesthetic on the MAC
decreases
33
How are local anesthestics systemically given?
lidocaine CRI
34
How can lidocaine reduce hyperalgesia?
central analgesic effect when given CRI
35
Effect of lidocaine CRI on MAC
MAC sparing effect
36
Effect of lidocaine CRI on GI tract in horses?
prokinetic activity
37
CV effect of lidocaine CRI
anti-arrythmic properties
38
Effect of lidocaine CRI on inflammation
anti-oxidant and inflammatory modulator activity
39
CNS effects of local anes
initial CNS tox >> Sedation, disorientation, ataxia Muscle tremor, convulsions, respiratory depression
40
CV effects of local anesthestics
CV toxicity>> Depress myocardial contractility Profound hypotension Arrhythmias CV collapse
41
What local anesthetics cause methamglobinemia?
prilocaine Benzocaine
42
Why should you not give 5% lidocaine
causes an irreversible block within minutes
43
Problems of high concentrations of local anesthetics?
tissue irritation Neurotoxicity
44
Problem with given epinephrine
tissue ischemia
45
Problem with given ester local anesthetics
allergic rxns
46
How do you avoid toxicity with local anesthetics (4)
know the toxic doses Weigh the pt calculate dose avoid unintentional IV inj
47
The toxicity of local anesthetics is _
additive
48
How do you tx seizures causes by local anes
benzos Propofol CRI
49
How do you tx CNS depression caused by local anes
*supportive care* Mechanical ventilation
50
How do you tx cardiac problems caused by local anes
*supportive care* Fluids O1 Atropine Antiarrythmic
51
How does lipid rescue work to tx local anes systemic tox?
remove lipophilic toxins from affected tissue Surrounds local anesthetic molecules in plasma
52
Onset of lidocaine
rapid (5 min)
53
duration of lidocaine
short (1-2 hrs)
54
uses of lidocaine
nerve block Epidural/spinal Infiltration CRI(IV)
55
What cardiac thing can lidocaine be used to tx?
ventricular tachycardia Arrhythmias
56
What animal is more sensitive to the toxic effects of lidocaine?
cats
57
What is the side effect of using lidocaine as a spray in order to ET tube a car?
laryngeal edema (due to additives)
58
duration and onset of mepivicaine?
rapid onset (5 minutes), Short duration (1-2 hrs)
59
routes of administration of mepivicaine
SC Local infiltraton Intra-articular
60
Why is mepivicaine preferred for equine nerve blocks?
less irritant than lidocaine
61
What major use does mepivicaine have over lidocaine?
can be used for intra-synovial analgesia
62
Onset of bupivacaine
slow (20-30 minutes)
63
Duration of bupivacaine
long duration (4-6 hours)
64
What drug has a higher cardiotoxicity than lidocaine?
bupivacaine
65
Uses of bupivacaine
nerve block Epidural/spinal
66
Which isomer of bupivacaine is less tocic?
L-bupivacaine
67
What drug damages articular cartilage?
bupivacaine
68
What entantiomer of ropivacaine is available?
S
69
Is ropivicaine more or less soluble than ropivacaine?
less
70
What LA: has a faster return to motor function? Why?
ropivacaine Less impact on muscle fibers
71
What is EMLA cream?
eutectic mixture of local anesthetics 2.5% lidocaine and 2.5% prilocaine
72
What is the main use of EMLA cream?
skin anesthesia prior to IV catheter
73
Onset of action of EMLA cream?
20-30 minutes
74
Why use opioids with a local anesthetic?
increase efficacy and extend duration of block
75
What blocks is morphine used in?
intra-articular and epidural blocks
76
Which a2 agonists may extend the duration and increase efficacy of local blocks?
medetomidine Dexmedetomidine
77
Why is ketamine use with LA?
epidural anesthesia

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