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JT- PHARM > Local Anesthetics 3/31 (Exam 3) > Flashcards

Local Anesthetics 3/31 (Exam 3) Flashcards

(75 cards)

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1
Q

What anesthetic is the slowest rate of hydrolysis among aminoesters?

A

Tetracaine has the slowest rate of hydrolysis but its half-life is still shorter than any of the amidesTetracaine

.

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2
Q

What are the excellent properties of Tetracaine?

A

Excellent topical properties; particularly for topical ophthalmologic anesthesia

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3
Q

What limits the use of Tetracaine?

A

Toxicity concerns limit use by epidural, peripheral nerve, or IVRA

Tetracaine’s toxicity profile restricts its application in certain types of anesthesia.

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4
Q

What is a unique characteristic of Cocaine?

A

Intense vasoconstriction and local anesthetic.

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5
Q

What is the maximum single dose of Cocaine?

A

150 mg

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6
Q

What is the concentration of Cocaine used?

A

4-10% solution prior to nasopharyngeal or otolaryngologic manipulation

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7
Q

What limits the use of Cocaine?

A

Low therapeutic index and abuse potential limit its use to topical only

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8
Q

What makes benzocaine different from others in aminoesters class?

A
  • It possesses a secondary amine and is a weak acid with pKa of 3.5
  • Unchanged form at physiologic pH.
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9
Q

What is the maximum single dose of Benzocaine?

A

200 mg

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10
Q

What is the ideal application method for Benzocaine?

A

Topical application to mucous membranes prior to endoscopy or bronchoscopy

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11
Q

What concentration of Benzocaine is used for topical application?

A

20% solution

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12
Q

What is the onset and duration of action for Benzocaine?

A

Rapid onset with duration of 30-60 minutes

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13
Q

What condition can occur with doses of 200-300 mg of Benzocaine?

A

Methemoglobinemia

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14
Q

What are the symptoms of methemoglobinemia caused by Benzocaine?

A

Cyanosis with decrease in oxygen carrying capacity

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15
Q

Which population is at the most risk for methemoglobinemia when using Benzocaine?

A

Neonates

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16
Q

How can methemoglobinemia be treated?

A

1% methylene blue 1-2 mg/kg over 20 minutes

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17
Q

How does Benzocaine differ from other local anesthetics?

A

It possesses a secondary amine and is a weak acid

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18
Q

What is the potency of lidocaine among aminoamides?

A

Lidocaine has the least potency among amides.

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19
Q

What is the recommended max single dose of lidocaine?

A

The recommended dose is 4.5 mg/kg or 300 mg (7 mg/kg or 500 mg with epinephrine).

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20
Q

What concentration of lidocaine provides rapid onset anesthesia?

A

A concentration of 0.5-1% provides rapid onset anesthesia with a duration of 60-120 minutes.

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21
Q

What is the concentration of topical lidocaine?

A

The concentration of topical lidocaine is 4%.

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22
Q

What is tumescent lidocaine?

A

Tumescent lidocaine involves large volumes of dilute lidocaine/epinephrine injected into subcutaneous tissue; useful for liposuction.

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23
Q

What is the onset time for tumescent lidocaine?

A

Peak effects may not occur for 10-12 hours.

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24
Q

What is IVRA in the context of lidocaine?

A

IVRA involves administering 50 ml of 0.5% lidocaine to provide 45-60 minutes of anesthesia for upper extremity surgery.

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25
What are the uses of spinal/epidural lidocaine?
* Spinal/epidural lidocaine is popular for dense sensory anesthesia and motor block for surgery of the trunk and lower extremities. * Controversial neurotoxicity with spinal use, max single dose 100 mg.
26
What is the maximum single dose for spinal lidocaine?
The maximum single dose for spinal lidocaine is 100 mg.
27
What is the use of intravenous or laryngotracheal administration of lidocaine?
It is used to blunt the effects of tracheal intubation (2-2.5 mg/kg) and prevents elevations in IOP, ICP, and IAP.
28
What is the recommended dose of lidocaine for Dave?
The recommended dose for Dave is 1-1.5 mg/kg.
29
What are the clinical uses of lidocaine?
* Lidocaine suppresses ventricular ectopy; administered as a 100-200 mg bolus followed by a 1-4 mg/min infusion. * can also be used as a systemic analgesic for acute postoperative and chronic neuropathic pain, with a dosage of 1-5 mg/kg. * Transdermal - very effective (5% transdermal)
30
What are the characteristics of prilocaine?
* Prilocaine is similar to lidocaine but has less vasodilation, so it doesn't require co-administration with epinephrine. * The maximum single dose of prilocaine is 600 mg.
31
What is a common use for prilocaine?
Prilocaine is often used topically, especially in combination with lidocaine. ## Footnote This combination is effective for local anesthesia.
32
What is Prilocaine used for?
Anesthesia for painful procedures (e.g., vascular cannulation or spinal puncture) after 60-90 minutes under occlusive dressing.
33
What is a key characteristic of Prilocaine's metabolism?
Rapid metabolism, making it the least toxic of amides.
34
What condition can Prilocaine's metabolite o-toluidine cause?
Methemoglobinemia.
35
How does Mepivicaine compare to Lidocaine?
Mepivicaine is similar to Lidocaine but has a slightly longer duration.
36
What is the maximum single dose of Mepivicaine?
400 mg (500 mg with epinephrine and 100 mg for spinal anesthesia).
37
What is the concentration and onset time for Mepivicaine in epidural anesthesia?
1.5-2% provides surgical anesthesia within 10-15 minutes with a duration of 70-90 minutes.
38
What is the concentration and duration for Mepivicaine in peripheral block?
1-1.5% provides anesthesia for 2-4 hours.
39
What is a risk associated with Mepivicaine in obstetrics?
Increased toxicity risk due to poor metabolism in the fetus.
40
41
Can Mepivicaine be used in obstetrics?
No, it cannot be used in obstetrics.
42
What is Bupivicaine known for?
* Long acting * Slow onset (30 min or greater) * (except for infiltration and spinal) very poten local anesthetic, but drawback is increased risk of toxicity. Used in: infiltration into surgical wounds, spinial, continuous epidural use in labor and postop, peripheral block.
43
What is the maximum single dose of Bupivicaine?
The max single dose is 2.5 mg/kg or 175 mg (3 mg/kg or 200 mg with epi)
44
What is the concentration of Bupivicaine for infiltration into surgical wounds?
0.25%.
45
How quickly does Bupivicaine act in spinal anesthesia?
Bupivicaine has a fast onset within 5 minutes lasting 1-4 hours.
46
What is Bupivicaine ideal for?
Bupivicaine is ideal for continuous epidural use in labor and post-operatively.
47
What happens to the degree of motor block with Bupivicaine?
The degree of motor block decreases below a concentration of 0.25%; 0.1% provides sensory analgesia with minimal motor block.
48
What is the duration of peripheral block with Bupivicaine?
The duration of peripheral block is 4-12 hours, may last up to 24 hours.
49
What are the characteristics of Etidocaine?
Etidocaine is a potent, highly lipophilic anesthetic with rapid onset and duration similar to Bupivicaine.
52
What are the clinical uses of Etidocaine?
Infiltration, epidural, peripheral nerve block. ## Footnote Similar to bupivicaine but less lipophilic.
53
What is the maximum single dose of Etidocaine?
300 mg (400 mg with epinephrine).
54
What type of blockade does Etidocaine provide?
Selective more potent motor blockade than sensory anesthesia.
55
How is Ropivicaine structurally similar to other anesthetics?
It has a 3-carbon substitution on the tertiary amine, similar to mepivicaine (methyl) and bupivicaine (butyl).
56
What is the lipid solubility of Ropivicaine compared to Bupivicaine?
Decreased lipid solubility over bupivicaine with less motor block.
57
How does Ropivicaine's cardiotoxicity compare to Bupivicaine?
30-40% less cardiotoxic than bupivicaine.
58
What is the maximum single dose of Ropivicaine?
200 mg or 3 mg/kg.
59
What concentration of Ropivicaine is typically used for epidural labor analgesia?
0.1-0.25%.
60
What effect does Ropivicaine have on blood vessels?
Causes vasoconstriction.
61
Which local anesthetics cause vasoconstriction?
Levobupivacaine, Ropivacaine, Cocaine
62
What are the clinical uses of Aminoamides-levobupivscaine?
Levobupivacaine is an S-enantiomer of racemic bupivacaine with similar potency.
63
What is the systemic toxicity of Levobupivacaine?
It has 30-40% less systemic toxicity compared to racemic bupivacaine.
64
What is the maximum single dose of Levobupivacaine?
150 mg or 2 mg/kg.
65
What concentration of Levobupivacaine is used for labor analgesia in epidurals?
0.125-0.25%.
66
67
What is the focus in the horizons of local anesthesia?
* Rather than looking for new local anesthetics, an emphasis has been placed on delivery systems including ambulatory pumps, encapsulation with liposomes, microspheres, or polymers with slow degradation and release. * Use of Exparel (liposomal bupivacaine)
68
What should Exparel not be mixed with?
Exparel (liposomal bupivacaine) should not mix with anything.
69
What is the treatment for local anesthetic-induced cardiac arrest?
LIPD RESCUE - Intralipid 20% should be given i.v. in a specific dose regime. Intralipid 20% 1.5 mL/kg over 1 minute * Follow immediately with an infusion at a rate of 0.25 mL/kg/min * Continue chest compressions (lipid must circulate) * Repeat bolus every 3-5 minutes up to 3 mL/kg total dose until circulation is restored * Continue infusion until hemodynamic stability is restored. Increase * the rate to 0.5 mL/kg/min if BP declines * A maximum total dose of 10 mL/kg is recommended
70
What is the initial bolus dose of Intralipid 20%?
1.5 mL/kg over 1 minute. ## Footnote This is a bolus dose!
71
What is the infusion rate of Intralipid 20% after the bolus?
0.25 mL/kg/min.
72
What should be continued during the administration of Intralipid?
Continue chest compressions (lipid must circulate).
73
How often can the bolus of Intralipid be repeated?
Every 3-5 minutes up to a total of 3 mL/kg until circulation is restored.
74
When should the infusion rate of Intralipid be increased?
Increase the rate to 0.5 mL/kg/min if BP declines.
75
What is the maximum total dose of Intralipid recommended?
10 mL/kg.
76
What is the procedure for resuscitating a 70kg adult using Intralipid?
* Take a 500ml bag of Intralipid 20% and a 50ml syringe. * Draw up 50ml and give stat i.v., X2. * Then attach the Intralipid bag to an iv administration set and run it i.v. over the next 15 minutes. * Repeat the initial bolus up to twice more if spontaneous circulation has not returned.
77
What should you do after using Intralipid for local anesthetic toxicity?
Report it at www.lipidrescue.org and remember to restock the lipid.

JT- PHARM (9 decks)

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