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254 Cards in this Set
- Front
- Back
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Trade name for Diphenhydramine?
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Benadryl
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Diphenhydramine drug class?
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Antihistamine
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Diphenhydramine dose, onset, duration?
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Dose: 10-50 mg IV/IM q 2-3 hours (Max 400mg/day)
Onset:5 min. IV; 20-30 min. IM Duration: 4-8 hours |
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Diphenhydramine use?
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Relief of allergic symptoms caused by histamine release
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Diphenhydramine MOA?
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H1 Antagonist
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Diphenhydramine Metabolism?
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95% hepatic metabolism
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DiphenhydramineContraindications?
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Hypersensitivity, Acute Asthma attacks, use with caution in Glaucoma, Prostatic Hypertrophy
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Trade name for Dolasetron?
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Anzemet
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Dolasetron, drug class?
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Antiemetic
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Dose of Dolasetron?
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12.5 mg given 15 min. before cessation of anesthesia or as soon as N/V begins
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Onset & duration of Dolasetron?
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Onset: Variable
Duration: up to 24 hours |
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Dolasetron use?
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Prevention & treatment of PONV & N/V associated with anesthesia or emetogenic chemotherapy
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Dolasetron MOA?
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5-HT3 Antagonist at vagal terminals and at chemoreceptor trigger zones
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Dolasetron contraindications?
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Hypersensitivity, cardiac conduction defects, prolonged QT
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Dolasetron metabolism?
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Hepatic CYP3A4, Prodrug, Metabolized to hydrodolasteron, the active metabolite
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Granisetron trade name?
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Kytril
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Granisetron drug class?
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Antiemetic
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Granisetron dose, onset & doa?
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Dose: 1 mg IV rapid IVP
Onset: Rapid Duration: up to 24 hours |
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Granisetron use?
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(Unlabeled) Management of PONV & N/V associate with emetogenic chemotherapy
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Granisetron MOA?
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5-HT3 Antagonist
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Granisetron drug interactions?
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Concurrent use of drugs that cause EPS increase risk of EPS reaction, Apomorphine
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Granisetron metabolism?
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Hepatic N-demethylation; 15% excreted unchanged in urine
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Methylene Blue dose and MOA?
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1-2 mg/kg as treatment for Methemoglobinemia.
Accelerates reduction of methemoglobin to hemoglobin |
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Ketorolac trade name?
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Toradol
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Ketorolac drug class?
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NSAID
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Ketorolac dose?
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30mg IV q6o (Max 120mg/day); >65 or renal impairment decrease dose by 50%
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Ketorolac onset and doa?
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Onset: 10 min.
Duration: 6 hours |
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Ketorolac use?
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Short term management of pain (5 days or less all routes combined)
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Ketorolac MOA?
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COX inhibitor (COX-1 > COX-2)
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Ketorolac SE?
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Pt. with Asthma, nasal polyps have an increased risk for hypersensitivity reaction
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Ketorolac drug interactions?
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Aspirin may decrease effect, Additive adverse GI effects with NSAIDS/ETOH/K+ supplements/Corticosteroids, Increased risk of Lithium toxicity, Increased risk of bleeding
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Ketorolac metabolism?
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Hepatic; 92% excreted in urine
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Ketorolac equianalgesic dose?
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30mg IM Equianalgesic to 12 mg IM Morphine
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Metoclopramide trade name?
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Reglan
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Metoclopramide drug class?
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Antiemetic
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Metoclopramide dose, onset, doa?
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Dose: 10-20 mg IV/IM
Onset: 1-3 min. Duration: 1-2 hours |
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Metoclopramide use?
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Treatment and prevention of PONV when NG suction is undesirable
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Metoclopramide MOA?
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Antagonism of D2 receptors in CNS
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Metoclopramide Drug Interactions?
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Drug Interactions: Additive CNS depression with other CNS depressants (ETOH, Sedative/Hypnotics, Opioids, Antihistamines, Antidepressants)
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Metoclopramide contraindications?
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GI obstruction/hemorrhage, Seizures, Pheochromocytoma, PD
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Metoclopramide metabolism?
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Hepatic, 85% excreted unchanged in urine
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Ondansetron trade name?
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Zofran
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Ondansetron
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antiemetic
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Ondansetron dose, onset, & doa?
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Dose: 4 mg IV before induction or postoperatively
Onset: Rapid Duration: 4-8 hours |
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Ondansetron use?
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Prevention & treatment of PONV
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Ondansetron MOA?
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5-HT3 Antagonist
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Ondansetron side effects?
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Headache, Constipation, Diarrhea
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Ondansetron Contraindications?
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Hypersensitivity, PO tabs have aspartame - contraindicated in Phenylketonurics
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Ondansetron metabolism?
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Hepatic, 5% excreted unchanged in urine
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Midazolam trade name?
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Versed
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Midazolam drug class?
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Benzodiazepine/Amnestic
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Midazolam premed, induction & maint doses?
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Premedication: 1-2mg IVInduction: 0.1-0.3 mg/kg
Maint. 0.02-.1 g/kg/hr Conscious Sedation 1-15mg/hr |
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Midazolam IV onset & doa?
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Onset: IV 3-5min
Duration: IV/IM 2-6hr |
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Midazolam uses?
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Preop medication, IV sedation, IV induction of anesthesia, suppress seizure activity
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Midazolam MOA?
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Attaches to alpha subunit of GABAA receptor & enhances Cl- channel activity & hyperpolarizes cell
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Midazolam side effects?
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drowsiness
fatigue lethargy ↓ CBF ↓ CMRO2, dose-dependent ↓ BP (magnified with hypovolemia) & ↑ HR due to ↓ SVR |
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Midazolam drug interactions?
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Synergistic effects w/ opioids and propofol enhance resp. depression, effect is potentiated with antimycotics and erythromycin (CYP3A4 inhibitors)
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Midazolam contraindications?
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Shock & Pregnancy
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Midazolam metabolism?
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Hepatic CYP3A4
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Antidote for Midazolam?
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Flumazenil is antidote, Midazolam has less pain on injection (lipid & water soluble)
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Lorazepam premedication dose?
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IV/IM 0.05mg/kg up to total of 4mg
PO 2-6mg |
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Lorazepam DOA?
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IV/IM/PO 12-24hr
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Lorazepam use?
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Pre-op sedation, anxiolytic, sedative-hypnotic; less commonly used in anesthesia due to its slower onset of action and prolonged duration of action
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Lorazepam MOA?
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MOA: Attaches to subunit of GABAA receptor & enhances Cl- channel activity & hyperpolarizes cell
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Lorazepam adverse effects?
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drowsiness, fatigue,lethargy, dose-dependent ↓ BP ↑HR, dose-dependent ↓ in ventilation
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Lorazepam drug interactions?
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Synergistic effect when combined with opioids
Cimetidine/Propranolol/Metoprolol decreases elimination Increases effect of Digoxin |
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Lorazepam MOA?
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Hepatic to inactive compound
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Lorazepam antidote?
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Lorazepam burns on injection (2o propylene glycol solvent)
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Diazepam trade name and drug class?
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Valium, benzo/amnestic
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Diazepam dose, onset & doa?
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Dose: 2-10mg IV
Onset: 1-2 min IV Duration: 3-4 hours IV |
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Diazepam use?
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pre-op sedation, anxiolytic, skeletal muscle relaxant, delirium tremens, chronic/acute management of muscular pain/spasm
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Diazepam MOA?
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Attaches to subunit of GABAA receptor & enhances Cl- channel activity & hyperpolarizes cell
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Diazepam adverse effects?
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drowsiness, lethargy, fatigue; dose dependent ↓ in ventilation; less cardiac effects than midazolam
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Diazepam drug interactions?
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Cimetidine/Propranolol/Metoprolol delays the hepatic clearance of Diazepam
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Diazepam metabolism?
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Hepatic, T ½ 20-40hr
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Diazepam antidote?
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Flumazenil is antidote; Diazepam burns on injection (insoluble in water)
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Flumazenil trade name?
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Romazicon
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Flumazenil dose?
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.2 mg IV to reverse benzodiazepine w/ additional 0.1 mg doses q 1 min. as needed, total dose of 0.5 to 1 mg should completely abolish effect of therapeutic dose of benzodiazepine. If no response to 5mg of Flumazenil, other intoxicants are present
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Flumazenil onset and doa?
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Onset: 2 minutes
Duration: 20 min., monitor patient as re-sedation may occur |
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Flumazenil use?
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Treats delayed awakening/overdose in patients treated with benzodiazepines
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Flumazenil MOA?
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MOA: competitively inhibits binding of benzodiazepines to GABAA receptor complex, reverses benzodiazepine-induced respiratory depression from combined benzo/opioid administration, weak agonist activity
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Flumazenil metabolism?
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Metabolism: Hepatic, T1/2 7-10 mins
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STP induction dose for adults, peds, L&D?
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Adult 3-5 mg/kg IV
Peds 2-7 mg/kg L&D: 3-4 mg/kg |
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STP onset and DOA?
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Onset: 30 sec. (Highly lipid soluble)
Duration: 5-10 min., longer with repeated or cont. infusion |
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STP pH & concentration
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pH: 10.5
Packaged:25mg/ml in 20ml vial stored in powder form (don’t reconstitute w/ LR) |
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STP uses?
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Induction agent
Anticonvulsant decrease ICP to protect from ischemia |
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STP MOA?
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Enhanced postsynaptic GABAA receptor activation.
Increased frequency of Cl- channel activity hyperpolarizes postsynaptic cell & inhibits neuronal cell excitation, depresses RAS |
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Systemic Neuro effects of STP?
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Neuroprotective effects, dec ICP) due to dec CBF (up to 50%) & CMRO2, causes inverse steal (max. dilation of injured vessels)
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Systemic CV effects of STP?
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Mild dec in BP due to vasodilation (will exacerbate hypovolemia), mild dec in HR
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Systemic Respiratory effects of STP?
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Dose dependent dec in hypoxic respiratory drive; No effect on uterine tone, not harmful to fetus at convention doses, babies are more depressed vs. regional approach
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Protein binding of STP?
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Protein Binding: 83%
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Adverse effects of STP?
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Intra-arterial injection causes vasoconstriction and can lead to gangrene, extravasation causes irritation; treat by dilution with sterile saline & lidocaine
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STP contraindications?
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Acute intermittent porphyria (genetic-failed heme metabolism & accumulation of porphyrins), Potential airway reactivity/Asthma (due to histamine release) severe abdominal Pain, neuro/psych issues, severe CV disease
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STP metabolism?
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Hepatic P450; 10-20% per hour
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Propofol induction, sedation, GA dose for adults ?
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Induction: 1.5-2.5mg/kg
Sedation: 25-75 mcg/kg/min GA: 75-200 mcg/kg/min. |
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Propofol onset and DOA?
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Onset: LOC in 30 sec
Duration: 5-8 min. no analgesic properties |
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Propofol concentrations?
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10mg/ml
(1% emulsion-10% soybean oil, 2.25% glycerol, 1.2% egg phosphatide) in 20 or 50 ml bottles |
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Propofol use?
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Induction & maintenance of anesthesia
Sedation Antiemetic Anxiolytic RSI |
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Propofol MOA?
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Hyperpolarization of neuron mediated through GABAA receptor
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Propofol systemic CV effects?
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Systemic Effects: CV: Dose dependent dec BP (dec SVR, contractility, & preload) Hypotension > than STP, Hypotension inc in rapid inj., lg. dose, & elderly; Impairs baroreceptor reflex to hypotension; Infusions dec myocardial blood flow & O2 consumption
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Resp effects of Propofol?
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Apnea
dec hypoxic drive dec TV but not RR |
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Neuro effects of Propofol?
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Dec CBF, CMRO2, & ICP (Neuroprotective effect is = to STP)
Anticonvulsant properties Dec IOP |
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Propofol contraindications?
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(Relative) egg allergy (yolk); Hypersensitivity; Don’t give generic to Asthma patient
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Propofol metabolism?
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Hepatic and lungs (30%), <3% excreted unchanged in urine
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What is the technique to blunt the pain associated with Propofol administration?
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Use within 6 hours of opening; pain on injection (due to glycerol) so premedicate with opioids or Lidocaine, dilute, or mix w/ Lidocaine (5cc of 1% Lidocaine in 20ml Propofol)-push when BP cuff is inflating
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Antiemetic/antipruritic dose.
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Antiemetic/antipruritic dose 10-20mg IV
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Trade name for Ketamine?
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Ketalar
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Ketamine drug class?
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NMDA antagonist/Induction Agent
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What is the IV & IM induction dose, sedation or analgesic dose and L & D dose of Ketamine?
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Induction
1-2 mg/kg IV, 3-5 mg/kg IM Sedation/Analgesia: 0.2-0.8 mg/kg L&D: 0.2-0.5 mg/kg w/ no resp. depression Infusion: 0.5-3 mg/kg/hr |
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What is the onset and DOA of Ketamine?
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30-60 sec IV or 4 min IM (Highly lipid soluble)
Duration: 10-15 min. (conc. Returns) |
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Ketamine uses?
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Dissociative anesthesia, analgesia, opioid tolerance
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What is the MOA for Ketamine induction?
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Non-competitive antagonist at NMDA receptor; Inhibition of thalamocortical pathway & stimulation of limbic system.
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What is the MOA for Ketamine's analgesic effect?
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Agonist at opioid receptor, cross tolerance
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What are the systemic effects of Ketamine?
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Increased HR, BP, SVR, CBF by 60%, CMRO2 & tracheobronchial secretions (SNS resp. due to Inh. reuptake of NE), may see decreased BP/HR/SVR in adrenal insufficiency
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What systemic effects may be seen with adrenal insufficiency?
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May see decreased BP, HR, & SVR in adrenal insufficiency
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What % of Ketamine is protein bound?
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Protein Binding: 12% -only IV anesthetic with low protein binding
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Describe the adverse effects associated with Ketamine.
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Emergence reaction/delirium – hallucinations, euphoria, distorted sensation
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Ketamine contraindications?
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Psychiatric disorders, increased ICP/IOP, CV disease, HTN, Liver failure
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Ketamine metabolism?
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Hepatic P450, Norketamine-active metabolite 1/3 potency; Renal 4%, Fecal 5%
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Etomidate (Amidate) induction dose.
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0.2-0.3 mg/kg
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Etomidate IV/IM onset & DOA
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Onset: 60 sec. IV or 2-4 min. IM DOA: 3-8 min
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Etomidate MOA?
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Depression of RAS through potentiation of GABAA Cl- currents & hyperpolarization of neuron
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Etomidate systemic effects?
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Systemic Effects: decreased BP, CO2 response, CBF, CMRO2, ICP, IOP, Increased N/V
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Etomidate protein binding?
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77% (check albumin)
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Etomidate drug interactions?
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Fentanyl decreases elimination & inc. plasma levels.
Enhance NDNMB |
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Etomidate adverse effects?
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Myoclonic activity Extrapyramidal motor activity
Apnea w/ rapid IV administration Adrenocortical suppression for 4-8 hours after induction dose, PONV |
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Etomidate contraindications?
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Siezures
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Etomidate metabolism?
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Plasma esterase hydrolysis, hepatic miscrosomal & excretion in urine
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Methohexitol (Brevital) induction dose?
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1-1.5 mg/kg IV
6.5-10mg/kg IM 20-30 mg/kg rectally |
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Methohexitol onset and DOA?
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Onset: 30 sec.
Duration: 4-7 mins. |
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Methohexitol use?
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Gold standard for ECT (potentiates seizures)
Ind. of anesthesia w/young & uncooperative pts. |
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Methohexitol MOA?
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Enhanced postsynaptic GABAA receptor activation & Cl- ion channel activity hyperpolarizes postsynaptic cell membrane and inhibits neuronal cell excitation
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Methohexitol MOA
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Adverse Effects: Not as popular as Thiopental due to myoclonic movements on induction, pain on injection, hiccup, and seizures
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Methohexitol contraindications?
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Same at STP; Seizures
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Methohexitol metabolism?
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Hepatic clearance dependent on CO & hepatic blood flow; 3-4x > clearance than STP
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Methohexitol potency compared to STP?
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2.5x more potent than Thiopental; Less lipid soluble
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Precedex dose?
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0.5-1 mcg/kg IV over 15 min. followed by an infusion of 0.2-0.7 mcg/kg/hr
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Precedex use?
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Short-term sedation of intubated and ventilated patients in the ICU setting
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Precedex MOA?
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Activation of alpha2 CNS receptors decreases dose requirements for inhaled and injected anesthetics patients remain sedated when undisturbed but arouse readily with stimulation.
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Precedex systemic effects?
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Small to Moderate change in TV/RR; Moderate decreases in HR & SVR due to weak 1 agonist effect
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Precedex drug interactions?
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Co-administration of dexmedetomidine with sevoflurane, isoflurane, propofol, alfentanil, and midazolam may result in enhancement of sedative, hypnotic, or anesthetic effects
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Precedex metabolism?
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Hepatic; Glucuronidation, aliphatic hydroxylation by CYP2A6, and N-methylation
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Precedes warning/adverse reaction?
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Abrupt cessation after long term use (>48 hours) can cause hypertensive crisis
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Nitrous Oxide MAC?
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105%
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Nitrous Oxide BGC & VP
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BGC: 0.46
VP(20o C): 37,000 |
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Nitrous Oxide properties?
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Gaseous at STP, Supports combustion, Only inorganic compound in use, 35x more soluble than N2 in blood & will expand air cavities (Pneumothorax)
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Nitrous Oxide systemic effects?
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N/V (?) due to solubility, Pregnancy – May inhibit B12 metabolism (neural tube defect),
Bone marrow suppression |
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Nitrous Oxide contraindications?
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Abdominal surgery, bleb on CXR, Existing pneumothorax, Ear surgery, Pregnancy
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Nitrous Oxide. Organic or Inorganic?
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Only inorganic compound used, Prime component in 2nd gas effect. N2O facilitates absorption of 2nd gas (other agent) that has slower onset. Absorption of N2O increases concentration of 2nd gas which increases concentration gradient in alveoli and increases diffusion. Can cause diffusion hypoxia.
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Halothane
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MAC: 0.75%
BGC: 2.4 VP: 244mmHg (20C) |
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Halothane in 70% N2O?
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MAC in 70% N20: 0.23%
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Halothane properties?
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Halogenated alkane, nonflammable (C-F),
preserved with thymol, most common agent used worldwide, inexpensive, “sweet” odor, can use to bag down |
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Halothane systemic CV effects?
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2 MAC = 50% decrease in BP/CO, Sensitizes heart to arrhythmias (epi dose > 1.5 mcg/kg)
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Halothane sytemic respiratory effects?
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increases apneic threshold
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Halothane systemic respiratory effects?
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MH trigger
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Halothane systemic hepatic effects?
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Hepatitis w/ repeated exposures (increased risk w/ # of exposures)
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Halothane CO2 absorbent reaction?
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CO2 Absorbent reaction: Formation of compound A in soda lime and baralyme, use AMSORB
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Halothane drug interactions?
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B blockers increase cardiac dysfunction vent. arrhythmias w/ aminophylline
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Halothane contraindications?
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Liver disease
Intracranial mass (due to inc. ICP) Severe hypovolemia |
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Halothane metabolism?
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Exhaled primarily, but significant liver metabolism (20-50%)
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Isoflurane MAC, BGC, VP and MAC with 70% N2O.
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MAC: 1.2%
BGC: 1.4 VP: 240 mmHg MAC in 70% N20: 0.36% |
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Isoflurane properties?
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Pungent, ether-like odor (not good to bag down), Isomer of enflurane
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Isoflurane systemic CV effects?
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Systemic Effects: CV- minimal CV depression, dose dependent dec in HR, dec SVR, Coronary steal with unusual anatomy
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Isoflurane systemic Resp effects?
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Pungency is irritant to upper airway (asthmatics)
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Isoflurane cerebral effects?
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1 MAC increases CBF/ICP & decreases CMRO2
2 MAC = silent EEG |
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Isoflurane adverse reaction?
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MH trigger
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Isoflurane CO2 absorbent reaction?
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Formation of CO in desiccated absorbent
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Isoflurane metabolism?
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Exhaled
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Sevoflurane Mac, BGC & VP?
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MAC: 2.0%
BGC: 0.65 VP(20o C): 160 mmHg MAC in 70% N20: 0.60% |
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Sevoflurane properties?
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Halogenated w/ F, non-pungent (can mask down)
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Sevoflurane systemic CV effects?
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Mild myocardial depression, little effect on HR, decreaseCO, May prolong QT interval (unknown reason)
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Sevoflurane systemic hepatic effects?
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No change in total BF
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Sevoflurane CO2 Absorbent reaction?
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Formation of compound A in Baralyme & soda lime, decrease risk with low FGF (always run at 2 L/min), ensure fresh CO2 absorbent or use AMSORB
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Sevoflurane CO2 absorbent reaction?
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Formation of compound A in Baralyme & soda lime,always run at least 2 L/min, ensure fresh CO2 absorbent or use AMSORB
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Sevoflurane drug interactions?
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Beta blockers increase cardiac dysfunction, vent. arrhythmias w/ aminophylline
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Sevoflurane contraindications?
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Avoid with current/prior renal dysfunction due to compound A
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Sevoflurane metabolism?
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Hepatic 5%, Exhaled
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Sevoflurane and peds?
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Produces adequate muscle relaxation for intubation in PEDS, can cause seizures in children
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Desflurane MAC, BGC, VP?
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MAC: 6.0%
BGC: 0.42 VP(20o C): 670 mmHg MAC in 70% N20: 1.8% |
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Desflurane properties?
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Halogenated w/ F, high vapor pressure, pungent
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Desflurane systemic CV effects?
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CO relatively unchanged, dose dependent transient increase in HR, dose dependent decrease in SVR, no increase in coronary BF
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Desflurane systemic respiratory effects?
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May precipitate breath holding / Laryngospasm
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Desflurane systemic hepatic effects?
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Repeated dosing can cause hepatitis
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Desflurane CO2 absorbent reaction?
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Significant formation of CO in old Baralyme, change regularly to decrease risk
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Desflurane metabolism?
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Exhalation
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Tetracaine trade name?
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Pontocaine
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Tetracaine pKa?
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pKa: 8.2
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Tetracaine dose?
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1.5 mg/kg plain
2.5 mg/kg w/ Epi 20 mg max. topical dose |
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Tetracaine onset and DOA?
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Onset: Slow.
Duration: 3 hours (Longest duration of all spinal agents) |
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Tetracaine uses?
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Spinal anesthesia, epidural and peripheral nerve block, perineum, lower extremities
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Tetracaine MOA?
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Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
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Tetracaine adverse effects?
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Convulsions, LOC, Myocardial depression, cardiac arrest, dysrhythmias, status asthmaticus, respiratory arrest, anaphylaxis
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Tetracaine contraindications?
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Hypersensitivity to Tetracaine or aminobenzoic acid or its derivatives, severe liver disease, heart block.
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Tetracaine Metabolism?
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Metabolized by plasma pseudocholinesterase, excreted in urine.
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Mepivicaine trade name?
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Carbocaine
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Mepivicaine
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Local & Regional Dose: 4-5mg/kg. (Max 400mg) w/ Epi 7mg/kg
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Mepivicaine pKa, onset & DOA?
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pKa: 7.6
Onset: 15 min Duration: 3 hours |
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Mepivicaine uses?
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Axillary or peripheral nerve block
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Mepivicaine MOA?
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Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
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Mepivicaine adverse effects?
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Convulsions, LOC, Myocardial depression, cardiac arrest, dysrhythmias, fetal bradycardia, status asthmaticus, respiratory arrest, anaphylaxis
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Mepivicaine drug interactions?
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Ergot drugs (concurrent administration of vasopressor drugs and of ergot-type oxytocic drugs may cause severe, persistent hypertension or CVA), Antipsychotics (Phenothiazines and butyrophenones)
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Mepivicaine contraindications?
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Hypersensitivity or any local anesthetic of the amide type, child<12yr, elderly, severe liver disease
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Mepivicaine metabolism?
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Metabolized by hepatic amidases, metabolites excreted in urine
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Lidocaine trade name?
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Xylocaine
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Lidocaine dose?
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Max Dose:
5mg/kg 7mg/kg (w epi) |
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Lidocaine pKa, onset & DOA?
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pKa: 7.8
Onset: 5-15 min. Duration: 3-6 hours |
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Lidocaine use?
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Peripheral nerve block, caudal anesthesia; epidural, spinal, surgical anesthesia, adjunct w/ Propofol injection
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Lidocaine MOA?
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Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
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Lidocaine adverse effects?
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Convulsions, LOC, Myocardial depression, cardiac arrest, dysrhythmias, status asthmaticus, respiratory arrest, anaphylaxis
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Lidocaine drug interactions?
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Dysrhythmias (epi, halothane, enflurane), HTN (MAOI's, TCA, phenothiazines), decreased action of Lidocaine (Chloroprocaine)
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Lidocaine contraindications?
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Hypersensitivity or aminobenzoic acid or its derivatives, child <12 yr, elderly, severe liver disease, do not use if patient has Stokes-Adams syndrome or severe SA, AV or intraventricular block in the absence of an artificial pacemaker
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Lidocaine metabolism?
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90% is metabolized by hepatic amidases and 10% is excreted in urine unchanged
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Lidocaine safety?
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Higher margin of safety than Bupivicaine
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Ropivicaine trade name?
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Naropin
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Ropivicaine dose?
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Max Dose: 2.5 mg/kg. or 300mg
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Ropivicaine pKa, onset & DOA?
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pKa: 8.1
Onset: 1-15 mins. (Slow) Duration: 2-6 hours |
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Ropivicaine uses?
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Epidural, Peripheral nerve block; Popular in OB because pain is controlled but motor is spared; Causes vasoconstriction (only Ropivicaine & Cocaine) so we don’t give with Epi
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Ropivicaine MOA?
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Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
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Ropivicaine adverse effects?
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Hypotension, nausea, vomiting
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Ropivicaine drug interactions?
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Use with caution in patients receiving other local anesthetics that are structurally similar to amide-type because the toxic effects of the drugs are additive
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Ropivicaine contraindications?
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Hypersensitivity to Ropivacaine or to any local anesthetic agent of the amide type
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Ropivicaine metabolism?
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Metabolized by hepatic amidases
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Ropivicaine note.
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s-isomer of bupivicaine + a propyl group, but it is not an isomer
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Bupivicaine trade name?
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Marcaine
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Bupivicaine dose?
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Max Dose: 2-3 mg/kg
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Bupivicaine pKa, onset & DOA?
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pKa: 8.1
Onset: 2-10 min. (Slow) Duration: 3-6 hours |
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Bupivicaine use?
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Infiltration, Neuroaxial blocks, Peripheral blocks
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Bupivicaine MOA?
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Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
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Bupivicaine adverse effects?
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Cardiotoxicity (small therapeutic window)
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Bupivicaine contraindications?
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Hypersensitivity to drug or to any local anesthetic agent of the amide type
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Bupivicaine metabolism?
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Metabolized by hepatic amidases
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Chloroprocaine trade name?
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Nesacaine
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Chloroprocaine dose?
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11mg/kg (Max 800mg)
14 mg/kg w/ Epi to max of 1g |
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Chloroprocaine pKa, onset & DOA?
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pKa: 9.0
Onset: 6-12 min. (Fastest onset; exception to rule of pKa & onset) Duration: 30-60 min. (Shortest duration) |
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Chloroprocaine use?
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Primarily epidurals & peripheral nerve blocks; low systemic toxicity allows use of high concentrations (3%) to increase speed of onset; Popular in OB due to high concentrations used and quick onset
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Chloroprocaine MOA?
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MOA: Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
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Chloroprocaine adverse effects?
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Injection site burning, pruritus
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Chloroprocaine drug interactions?
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Impairs epidural analgesia of epidural bupivicaine and opioids
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Chloroprocaine contraindications?
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Hypersensitivity to ester locals, Infection at injection site
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Chloroprocaine metabolism?
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Hydrolysis by plasma psudocholinesterases
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Chloroprocaine notes.
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Can supplement “spotty” epidural block or to dose for perineal pain during delivery
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Procaine trade name?
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Novocain
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Procaine dose?
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11mg/kg (Max 800mg)
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Procaine pKa, onset & DOA?
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pKa: 8.9
Onset: Rapid Duration: 30-60 min. (Shortest duration) |
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Procaine use?
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Primarily epidurals & peripheral nerve blocks; low systemic toxicity allows use of high concentrations (3%) to increase speed of onset; Popular in OB due to high concentrations used and quick onset
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Procaine MOA?
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Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
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Procaine adverse effects?
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Adverse Effects: Injection site burning, pruritus
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Procaine drug interactions?
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Drug Interactions: Impairs epidural analgesia of epidural bupivicaine and opioids
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Procaine contraindications?
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Contraindications: Hypersensitivity to ester locals, Infection at injection site
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Procaine metabolism?
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Metabolism: Hydrolysis by plasma psudocholinesterases
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Procaine notes?
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Can supplement “spotty” epidural block or to dose for perineal pain during delivery
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Esters are metabolized to what?
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PABA
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Esters should be avoided in pt's allergic to what?
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PABA
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What preservative is used with amides?
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Amides in multi-dose vials have PABA as preservative
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