Unit 4: LA Drugs specifically

Question 1

lidocaine undergoes ____ metabolism in the liver

Answer 1

Metabolism: Oxidative dealkylation in liver, then hydrolysis. ​

metabolite is Xylidide

Question 2

max infiltration dose of lidocaine is ____

Answer 2

300 mgs plain & 500 mgs /c EPI​

Question 3

you will have prolonged clearance of lidocaine with what?

Answer 3

preg induced hypertension

Question 4

Prilocaines main metabolite is ____. what does it convert to?

What is the dose of the treatment drug?

Answer 4

Orthotoluidine
converts to Methemoglobinemia​

Dose > 600 mgs​

S/Sx: Cyanosis d/t decreased 02 carrying capacity​

TX: Methylene Blue ​

1 to 2 mgs/kg IV over 5 mins​

Total dose not to exceed 7 to 8 mg/kg​

Question 5

What is the max for methylane blue?

Answer 5

7-8mg/kg

Question 6

mepivacaine has a ___ duration of action

Answer 6

longer

you can use for longer surgeries

not used in OB

90-180 minutes

Question 7

bupivacaine is metabolized thru ____

What protein does it bind to?

Answer 7

Metabolism: aromatic hydroxylation, N-dealkylation, amide hydrolysis, and conjugation​

Protein (95%) binding site: α1-Acid glycoprotein​

Question 8

Ropivacaine​

Metabolism: ___
Metabolites: _____

Lesser system toxicity than ______​

Protein Binding: ______

Answer 8

Ropivacaine​

Metabolism: Hepatic cytochrome P450 enzymes​

Metabolites: can accumulate with uremic patients​

Lesser system toxicity than Bupivacaine​

Protein Binding: α1-acid glycoprotein​

Question 9

Dibucaine​

Metabolism: _____​

MOA: inhibits the activity of normal _______ (plasma cholinesterase) by more than 70%​

​

Answer 9

Dibucaine​: we dont use this because it would effect the metabolism of most of the other drugs we give

will use to diagnose prolongation of sux block

Metabolism: Liver​

MOA: inhibits the activity of normal butyrylcholinesterase (plasma cholinesterase) by more than 70%​

​

Question 10

Procaine​

Metabolite:

Answer 10

Procaine​

Metabolite: PABA, excreted unchanged in urine​

Question 11

Chloroprocaine​

Metabolism: Plasma ____ (3.5x faster)​

Pregnancy ______ plasma cholinesterase by 40%​

Answer 11

Chloroprocaine​

Metabolism: Plasma cholinesterase (3.5x faster)​

Pregnancy decreases plasma cholinesterase by 40%​

Question 12

Tetracaine​

Metabolism:

​

***Hydrolysis: chloroprocaine > procaine > tetracaine​

Answer 12

Tetracaine​

Metabolism: Slower than procaine​

​

***Hydrolysis: chloroprocaine > procaine > tetracaine​

Question 13

Benzocaine​

Unique: Weak _____ (pKa 3.5)​

Uses: Topical anesthesia of mucous membranes:​

Tracheal intubation, Endoscopy, Transesophageal echocardiography (TEE), Bronchoscopy​

Onset: _____​

Duration: ______ minutes​

Dose: Brief spray (20%) = ___ to ____ mgs​

Answer 13

Benzocaine​

Unique: Weak acid (pKa 3.5)​

Uses: Topical anesthesia of mucous membranes:​

Tracheal intubation, Endoscopy, Transesophageal echocardiography (TEE), Bronchoscopy​

Onset: rapid​

Duration: 30 to 60 minutes​

Dose: Brief spray (20%) = 200 to 300 mgs​

Question 14

if you give too much benzocaine you can cause ______

Answer 14

methemoglobinemia

• TX of 7-8 mg/kg

Question 15

Cocaine​

Metabolism: Plasma and liver ______​

Peak: _______​

Duration: _____ minutes after peak​

Elimination: ____ (24 to 36 hours)​

Caution: ??

Answer 15

Cocaine​

Metabolism: Plasma and liver cholinesterases​

Decreased in: Parturients, Neonates, Elderly, Severe Hepatic Disease​

Peak: 30 to 45 mins​

Duration: 60 minutes after peak​

Elimination: Urine (24 to 36 hours)​ (10-12% in the urine)

Caution: Coronary vasospasm, ventricular dysrhythmias, HTN, tachycardia, CAD​

Question 16

List the doses for these routes of lidocaine

Answer 16

Question 17

List the doses for these routes of administration of this drug

Answer 17

Question 18

List the doses for these routes of administration of this drug

Answer 18

everything is 600mg

Question 19

List the doses for these routes of administration of this drug

Answer 19

Question 20

List the doses for these routes of administration of this drug

Answer 20

Question 21

What drugs cause Methemoglobinemia

Answer 21

prilocaine
benzocaine
EMLA
lidocaine, nitroglycerine, phenytoin, & sulfonamides​

Question 22

What drugs cause tachyphylaxis? Include all the drugs we have spoken about for exam 4

Answer 22

Beta antag​onist

Chloroprocaine & Bupivacaine​

Labetolol​

Ephedrine​

Nitroglycerin​

EMLA​

​