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Flashcards in Local Anesthetics Deck (55)
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1

Local Anesthetics are classified by their linkage what are the 2 classes

Esters and Amides

2

List 4 esters

Chloroprocaine, Procaine, cocaine, tetracaine

3

List 5 Amides

Lidocaine, Mepivicaine, Bupivicaine, Prilocaine, Ropivicaine

4

Name 4 short acting Locals

Procaine, Chloroprocaine, Lidocaine, Tetracaine

5

Name 3 longer acting Locals

Mepivacaine, Bupivicaine, Ropivicaine

6

Local anesthetics MOA

Na+ inhibition the the Na+ Ion channels

7

Which portion of the drug crosses the membrane?

Non-ionized

8

pKa equated to what - potency, onset, or duration?

Onset

9

Lipid solubility equates to what- potency, onset, or duration?

Potency

10

Protein binding equates to what - potency, onset, or duration?

Duration

11

max dose of Lidocaine and Mepivacaine per Kg with and without Epi

4.5 mg/kg without and 7 mg/kg with epi

12

Max dose of Bupivacaine or Ropivacaine with and without epi?

2.8 mg/kg without and 3.2mg/kg with epi

13

Max toxic dose for Lidocaine and Mepivacaine without epi

300 mg

14

Max toxic dose for Lidocaine and Mepivacaine with epi

500 mg

15

Max dose of Bupivacaine and Ropivacaine without epi

175 mg

16

Max dose of Bupivacaine and Ropivacaine with epi

225 mg

17

Which Locals have a fast onset or closer to physiologic Ph? There is one exception to this?

Lidocaine pKa 7.7 Mepivacaine pKa 7.6 Chloroprocaine Pka 9.1 (THE EXCEPTION)

18

Which Locals have a slower onset or are further away from physiologic Ph?

Procaine pKa 8.9 Tetracaine pKa 8.6

19

Which Locals have a moderate onset?

Bupivacaine pKa 8.1 Ropivacaine pKa 8.1

20

Know this Chem formula

21


Absorption is influenced by?


Dosage, site of injuection, Vasoconstriction, and Pharmacologic properties

22


When the vessel is in the nerve bundle will you have ? Increased or Decreased uptake of the LA?


Increased

23


Cocaine causes vasocontstiction by affecting ?


Dopaimine  and norepinephrine decreasing reuptake

24


Will epi extend short acting or longer acting LA for a longer time period?


It will extend longer acting LA for a longer time period because Longer acting LA are more Lipophilic which is directly related to durration 

25


Amides have a wider distribution because


Increased storage in the tissues because of rapid uptake of highly perfused tissues like the  the brain, liver kidneys and heart and a slower uptake from the moderately perfused tissues lik the gut and muscles

LONG ANSWER IT SUCKS

26


Esters have a shorter duration because


They are broken down by plasma esterase

27


Which Locals are best for stat C Sections?


Chloroprocaine and procaine

Because they are ESTERS it get hydrolized in < 1 min

28


LA are excreated in what form Ionized or Nonionized


Nonioinzed -  the renal tubules do not reabsorb charged metabolites

29


MOA of LA

Mechanism of Action:
1. Diffusion of the base form across the across the nerve sheath and nerve membrane                                                             2. Re-equilibration  between the base and cationic forms in the axoplasm
3. Penetration of the cation into and attachment to a receptor site within the sodium channel.
4. Blockade of the sodium channel
5. Inhibition of sodium conduction
6. Decrease in the rate and degree of the depolarization phase of the action potential
7. Failure to achieve the threshold potential
8. Lack of development of a propagated action potential
9. Blockade of impulse conduction

30


La block conduction in the following order?


Small myelinated axons

non myelinated axons

Large myelinated axons