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254 Cards in this Set

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Trade name for Diphenhydramine?
Benadryl
Diphenhydramine drug class?
Antihistamine
Diphenhydramine dose, onset, duration?
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
Diphenhydramine use?
Relief of allergic symptoms caused by histamine release
Diphenhydramine MOA?
H1 Antagonist
Diphenhydramine Metabolism?
95% hepatic metabolism
DiphenhydramineContraindications?
Hypersensitivity, Acute Asthma attacks, use with caution in Glaucoma, Prostatic Hypertrophy
Trade name for Dolasetron?
Anzemet
Dolasetron, drug class?
Antiemetic
Dose of Dolasetron?
12.5 mg given 15 min. before cessation of anesthesia or as soon as N/V begins
Onset & duration of Dolasetron?
Onset: Variable
Duration: up to 24 hours
Dolasetron use?
Prevention & treatment of PONV & N/V associated with anesthesia or emetogenic chemotherapy
Dolasetron MOA?
5-HT3 Antagonist at vagal terminals and at chemoreceptor trigger zones
Dolasetron contraindications?
Hypersensitivity, cardiac conduction defects, prolonged QT
Dolasetron metabolism?
Hepatic CYP3A4, Prodrug, Metabolized to hydrodolasteron, the active metabolite
Granisetron trade name?
Kytril
Granisetron drug class?
Antiemetic
Granisetron dose, onset & doa?
Dose: 1 mg IV rapid IVP
Onset: Rapid
Duration: up to 24 hours
Granisetron use?
(Unlabeled) Management of PONV & N/V associate with emetogenic chemotherapy
Granisetron MOA?
5-HT3 Antagonist
Granisetron drug interactions?
Concurrent use of drugs that cause EPS increase risk of EPS reaction, Apomorphine
Granisetron metabolism?
Hepatic N-demethylation; 15% excreted unchanged in urine
Methylene Blue dose and MOA?
1-2 mg/kg as treatment for Methemoglobinemia.
Accelerates reduction of methemoglobin to hemoglobin
Ketorolac trade name?
Toradol
Ketorolac drug class?
NSAID
Ketorolac dose?
30mg IV q6o (Max 120mg/day); >65 or renal impairment decrease dose by 50%
Ketorolac onset and doa?
Onset: 10 min.
Duration: 6 hours
Ketorolac use?
Short term management of pain (5 days or less all routes combined)
Ketorolac MOA?
COX inhibitor (COX-1 > COX-2)
Ketorolac SE?
Pt. with Asthma, nasal polyps have an increased risk for hypersensitivity reaction
Ketorolac drug interactions?
Aspirin may decrease effect, Additive adverse GI effects with NSAIDS/ETOH/K+ supplements/Corticosteroids, Increased risk of Lithium toxicity, Increased risk of bleeding
Ketorolac metabolism?
Hepatic; 92% excreted in urine
Ketorolac equianalgesic dose?
30mg IM Equianalgesic to 12 mg IM Morphine
Metoclopramide trade name?
Reglan
Metoclopramide drug class?
Antiemetic
Metoclopramide dose, onset, doa?
Dose: 10-20 mg IV/IM
Onset: 1-3 min.
Duration: 1-2 hours
Metoclopramide use?
Treatment and prevention of PONV when NG suction is undesirable
Metoclopramide MOA?
Antagonism of D2 receptors in CNS
Metoclopramide Drug Interactions?
Drug Interactions: Additive CNS depression with other CNS depressants (ETOH, Sedative/Hypnotics, Opioids, Antihistamines, Antidepressants)
Metoclopramide contraindications?
GI obstruction/hemorrhage, Seizures, Pheochromocytoma, PD
Metoclopramide metabolism?
Hepatic, 85% excreted unchanged in urine
Ondansetron trade name?
Zofran
Ondansetron
antiemetic
Ondansetron dose, onset, & doa?
Dose: 4 mg IV before induction or postoperatively
Onset: Rapid
Duration: 4-8 hours
Ondansetron use?
Prevention & treatment of PONV
Ondansetron MOA?
5-HT3 Antagonist
Ondansetron side effects?
Headache, Constipation, Diarrhea
Ondansetron Contraindications?
Hypersensitivity, PO tabs have aspartame - contraindicated in Phenylketonurics
Ondansetron metabolism?
Hepatic, 5% excreted unchanged in urine
Midazolam trade name?
Versed
Midazolam drug class?
Benzodiazepine/Amnestic
Midazolam premed, induction & maint doses?
Premedication: 1-2mg IVInduction: 0.1-0.3 mg/kg
Maint. 0.02-.1 g/kg/hr
Conscious Sedation 1-15mg/hr
Midazolam IV onset & doa?
Onset: IV 3-5min
Duration: IV/IM 2-6hr
Midazolam uses?
Preop medication, IV sedation, IV induction of anesthesia, suppress seizure activity
Midazolam MOA?
Attaches to alpha subunit of GABAA receptor & enhances Cl- channel activity & hyperpolarizes cell
Midazolam side effects?
drowsiness
fatigue
lethargy
↓ CBF
↓ CMRO2,
dose-dependent ↓ BP (magnified with hypovolemia) & ↑ HR due to ↓ SVR
Midazolam drug interactions?
Synergistic effects w/ opioids and propofol enhance resp. depression, effect is potentiated with antimycotics and erythromycin (CYP3A4 inhibitors)
Midazolam contraindications?
Shock & Pregnancy
Midazolam metabolism?
Hepatic CYP3A4
Antidote for Midazolam?
Flumazenil is antidote, Midazolam has less pain on injection (lipid & water soluble)
Lorazepam premedication dose?
IV/IM 0.05mg/kg up to total of 4mg
PO 2-6mg
Lorazepam DOA?
IV/IM/PO 12-24hr
Lorazepam use?
Pre-op sedation, anxiolytic, sedative-hypnotic; less commonly used in anesthesia due to its slower onset of action and prolonged duration of action
Lorazepam MOA?
MOA: Attaches to  subunit of GABAA receptor & enhances Cl- channel activity & hyperpolarizes cell
Lorazepam adverse effects?
drowsiness, fatigue,lethargy, dose-dependent ↓ BP ↑HR, dose-dependent ↓ in ventilation
Lorazepam drug interactions?
Synergistic effect when combined with opioids

Cimetidine/Propranolol/Metoprolol decreases elimination

Increases effect of Digoxin
Lorazepam MOA?
Hepatic to inactive compound
Lorazepam antidote?
Lorazepam burns on injection (2o propylene glycol solvent)
Diazepam trade name and drug class?
Valium, benzo/amnestic
Diazepam dose, onset & doa?
Dose: 2-10mg IV
Onset: 1-2 min IV
Duration: 3-4 hours IV
Diazepam use?
pre-op sedation, anxiolytic, skeletal muscle relaxant, delirium tremens, chronic/acute management of muscular pain/spasm
Diazepam MOA?
Attaches to  subunit of GABAA receptor & enhances Cl- channel activity & hyperpolarizes cell
Diazepam adverse effects?
drowsiness, lethargy, fatigue; dose dependent ↓ in ventilation; less cardiac effects than midazolam
Diazepam drug interactions?
Cimetidine/Propranolol/Metoprolol delays the hepatic clearance of Diazepam
Diazepam metabolism?
Hepatic, T ½ 20-40hr
Diazepam antidote?
Flumazenil is antidote; Diazepam burns on injection (insoluble in water)
Flumazenil trade name?
Romazicon
Flumazenil dose?
.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
Flumazenil onset and doa?
Onset: 2 minutes
Duration: 20 min., monitor patient as re-sedation may occur
Flumazenil use?
Treats delayed awakening/overdose in patients treated with benzodiazepines
Flumazenil MOA?
MOA: competitively inhibits binding of benzodiazepines to GABAA receptor complex, reverses benzodiazepine-induced respiratory depression from combined benzo/opioid administration, weak agonist activity
Flumazenil metabolism?
Metabolism: Hepatic, T1/2 7-10 mins
STP induction dose for adults, peds, L&D?
Adult 3-5 mg/kg IV
Peds 2-7 mg/kg
L&D: 3-4 mg/kg
STP onset and DOA?
Onset: 30 sec. (Highly lipid soluble)
Duration: 5-10 min., longer with repeated or cont. infusion
STP pH & concentration
pH: 10.5
Packaged:25mg/ml in 20ml vial
stored in powder form (don’t reconstitute w/ LR)
STP uses?
Induction agent
Anticonvulsant
decrease ICP to protect from ischemia
STP MOA?
Enhanced postsynaptic GABAA receptor activation.
Increased frequency of Cl- channel activity
hyperpolarizes postsynaptic cell & inhibits neuronal cell excitation, depresses RAS
Systemic Neuro effects of STP?
Neuroprotective effects, dec ICP) due to dec CBF (up to 50%) & CMRO2, causes inverse steal (max. dilation of injured vessels)
Systemic CV effects of STP?
Mild dec in BP due to vasodilation (will exacerbate hypovolemia), mild dec in HR
Systemic Respiratory effects of STP?
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
Protein binding of STP?
Protein Binding: 83%
Adverse effects of STP?
Intra-arterial injection causes vasoconstriction and can lead to gangrene, extravasation causes irritation; treat by dilution with sterile saline & lidocaine
STP contraindications?
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
STP metabolism?
Hepatic P450; 10-20% per hour
Propofol induction, sedation, GA dose for adults ?
Induction: 1.5-2.5mg/kg
Sedation: 25-75 mcg/kg/min
GA: 75-200 mcg/kg/min.
Propofol onset and DOA?
Onset: LOC in 30 sec
Duration: 5-8 min.
no analgesic properties
Propofol concentrations?
10mg/ml
(1% emulsion-10% soybean oil, 2.25% glycerol, 1.2% egg phosphatide) in 20 or 50 ml bottles
Propofol use?
Induction & maintenance of anesthesia
Sedation
Antiemetic
Anxiolytic
RSI
Propofol MOA?
Hyperpolarization of neuron mediated through GABAA receptor
Propofol systemic CV effects?
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
Resp effects of Propofol?
Apnea
dec hypoxic drive
dec TV but not RR
Neuro effects of Propofol?
Dec CBF, CMRO2, & ICP (Neuroprotective effect is = to STP)
Anticonvulsant properties
Dec IOP
Propofol contraindications?
(Relative) egg allergy (yolk); Hypersensitivity; Don’t give generic to Asthma patient
Propofol metabolism?
Hepatic and lungs (30%), <3% excreted unchanged in urine
What is the technique to blunt the pain associated with Propofol administration?
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
Antiemetic/antipruritic dose.
Antiemetic/antipruritic dose 10-20mg IV
Trade name for Ketamine?
Ketalar
Ketamine drug class?
NMDA antagonist/Induction Agent
What is the IV & IM induction dose, sedation or analgesic dose and L & D dose of Ketamine?
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
What is the onset and DOA of Ketamine?
30-60 sec IV or 4 min IM (Highly lipid soluble)
Duration: 10-15 min. (conc. Returns)
Ketamine uses?
Dissociative anesthesia, analgesia, opioid tolerance
What is the MOA for Ketamine induction?
Non-competitive antagonist at NMDA receptor; Inhibition of thalamocortical pathway & stimulation of limbic system.
What is the MOA for Ketamine's analgesic effect?
Agonist at opioid receptor, cross tolerance
What are the systemic effects of Ketamine?
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
What systemic effects may be seen with adrenal insufficiency?
May see decreased BP, HR, & SVR in adrenal insufficiency
What % of Ketamine is protein bound?
Protein Binding: 12% -only IV anesthetic with low protein binding
Describe the adverse effects associated with Ketamine.
Emergence reaction/delirium – hallucinations, euphoria, distorted sensation
Ketamine contraindications?
Psychiatric disorders, increased ICP/IOP, CV disease, HTN, Liver failure
Ketamine metabolism?
Hepatic P450, Norketamine-active metabolite 1/3 potency; Renal 4%, Fecal 5%
Etomidate (Amidate) induction dose.
0.2-0.3 mg/kg
Etomidate IV/IM onset & DOA
Onset: 60 sec. IV or 2-4 min. IM DOA: 3-8 min
Etomidate MOA?
Depression of RAS through potentiation of GABAA Cl- currents & hyperpolarization of neuron
Etomidate systemic effects?
Systemic Effects: decreased BP, CO2 response, CBF, CMRO2, ICP, IOP, Increased N/V
Etomidate protein binding?
77% (check albumin)
Etomidate drug interactions?
Fentanyl decreases elimination & inc. plasma levels.
Enhance NDNMB
Etomidate adverse effects?
Myoclonic activity Extrapyramidal motor activity
Apnea w/ rapid IV administration
Adrenocortical suppression for 4-8 hours after induction dose, PONV
Etomidate contraindications?
Siezures
Etomidate metabolism?
Plasma esterase hydrolysis, hepatic miscrosomal & excretion in urine
Methohexitol (Brevital) induction dose?
1-1.5 mg/kg IV
6.5-10mg/kg IM
20-30 mg/kg rectally
Methohexitol onset and DOA?
Onset: 30 sec.
Duration: 4-7 mins.
Methohexitol use?
Gold standard for ECT (potentiates seizures)
Ind. of anesthesia w/young & uncooperative pts.
Methohexitol MOA?
Enhanced postsynaptic GABAA receptor activation & Cl- ion channel activity hyperpolarizes postsynaptic cell membrane and inhibits neuronal cell excitation
Methohexitol MOA
Adverse Effects: Not as popular as Thiopental due to myoclonic movements on induction, pain on injection, hiccup, and seizures
Methohexitol contraindications?
Same at STP; Seizures
Methohexitol metabolism?
Hepatic clearance dependent on CO & hepatic blood flow; 3-4x > clearance than STP
Methohexitol potency compared to STP?
2.5x more potent than Thiopental; Less lipid soluble
Precedex dose?
0.5-1 mcg/kg IV over 15 min. followed by an infusion of 0.2-0.7 mcg/kg/hr
Precedex use?
Short-term sedation of intubated and ventilated patients in the ICU setting
Precedex MOA?
Activation of alpha2 CNS receptors decreases dose requirements for inhaled and injected anesthetics patients remain sedated when undisturbed but arouse readily with stimulation.
Precedex systemic effects?
Small to Moderate change in TV/RR; Moderate decreases in HR & SVR due to weak 1 agonist effect
Precedex drug interactions?
Co-administration of dexmedetomidine with sevoflurane, isoflurane, propofol, alfentanil, and midazolam may result in enhancement of sedative, hypnotic, or anesthetic effects
Precedex metabolism?
Hepatic; Glucuronidation, aliphatic hydroxylation by CYP2A6, and N-methylation
Precedes warning/adverse reaction?
Abrupt cessation after long term use (>48 hours) can cause hypertensive crisis
Nitrous Oxide MAC?
105%
Nitrous Oxide BGC & VP
BGC: 0.46
VP(20o C): 37,000
Nitrous Oxide properties?
Gaseous at STP, Supports combustion, Only inorganic compound in use, 35x more soluble than N2 in blood & will expand air cavities (Pneumothorax)
Nitrous Oxide systemic effects?
N/V (?) due to solubility, Pregnancy – May inhibit B12 metabolism (neural tube defect),
Bone marrow suppression
Nitrous Oxide contraindications?
Abdominal surgery, bleb on CXR, Existing pneumothorax, Ear surgery, Pregnancy
Nitrous Oxide. Organic or Inorganic?
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.
Halothane
MAC: 0.75%
BGC: 2.4
VP: 244mmHg (20C)
Halothane in 70% N2O?
MAC in 70% N20: 0.23%
Halothane properties?
Halogenated alkane, nonflammable (C-F),
preserved with thymol,
most common agent used worldwide, inexpensive, “sweet” odor, can use to bag down
Halothane systemic CV effects?
2 MAC = 50% decrease in BP/CO, Sensitizes heart to arrhythmias (epi dose > 1.5 mcg/kg)
Halothane sytemic respiratory effects?
increases apneic threshold
Halothane systemic respiratory effects?
MH trigger
Halothane systemic hepatic effects?
Hepatitis w/ repeated exposures (increased risk w/ # of exposures)
Halothane CO2 absorbent reaction?
CO2 Absorbent reaction: Formation of compound A in soda lime and baralyme, use AMSORB
Halothane drug interactions?
B blockers increase cardiac dysfunction vent. arrhythmias w/ aminophylline
Halothane contraindications?
Liver disease
Intracranial mass (due to inc. ICP)
Severe hypovolemia
Halothane metabolism?
Exhaled primarily, but significant liver metabolism (20-50%)
Isoflurane MAC, BGC, VP and MAC with 70% N2O.
MAC: 1.2%
BGC: 1.4 VP: 240 mmHg
MAC in 70% N20: 0.36%
Isoflurane properties?
Pungent, ether-like odor (not good to bag down), Isomer of enflurane
Isoflurane systemic CV effects?
Systemic Effects: CV- minimal CV depression, dose dependent dec in HR, dec SVR, Coronary steal with unusual anatomy
Isoflurane systemic Resp effects?
Pungency is irritant to upper airway (asthmatics)
Isoflurane cerebral effects?
1 MAC increases CBF/ICP & decreases CMRO2
2 MAC = silent EEG
Isoflurane adverse reaction?
MH trigger
Isoflurane CO2 absorbent reaction?
Formation of CO in desiccated absorbent
Isoflurane metabolism?
Exhaled
Sevoflurane Mac, BGC & VP?
MAC: 2.0%
BGC: 0.65
VP(20o C): 160 mmHg
MAC in 70% N20: 0.60%
Sevoflurane properties?
Halogenated w/ F, non-pungent (can mask down)
Sevoflurane systemic CV effects?
Mild myocardial depression, little effect on HR, decreaseCO, May prolong QT interval (unknown reason)
Sevoflurane systemic hepatic effects?
No change in total BF
Sevoflurane CO2 Absorbent reaction?
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
Sevoflurane CO2 absorbent reaction?
Formation of compound A in Baralyme & soda lime,always run at least 2 L/min, ensure fresh CO2 absorbent or use AMSORB
Sevoflurane drug interactions?
Beta blockers increase cardiac dysfunction, vent. arrhythmias w/ aminophylline
Sevoflurane contraindications?
Avoid with current/prior renal dysfunction due to compound A
Sevoflurane metabolism?
Hepatic 5%, Exhaled
Sevoflurane and peds?
Produces adequate muscle relaxation for intubation in PEDS, can cause seizures in children
Desflurane MAC, BGC, VP?
MAC: 6.0%
BGC: 0.42
VP(20o C): 670 mmHg
MAC in 70% N20: 1.8%
Desflurane properties?
Halogenated w/ F, high vapor pressure, pungent
Desflurane systemic CV effects?
CO relatively unchanged, dose dependent transient increase in HR, dose dependent decrease in SVR, no increase in coronary BF
Desflurane systemic respiratory effects?
May precipitate breath holding / Laryngospasm
Desflurane systemic hepatic effects?
Repeated dosing can cause hepatitis
Desflurane CO2 absorbent reaction?
Significant formation of CO in old Baralyme, change regularly to decrease risk
Desflurane metabolism?
Exhalation
Tetracaine trade name?
Pontocaine
Tetracaine pKa?
pKa: 8.2
Tetracaine dose?
1.5 mg/kg plain
2.5 mg/kg w/ Epi
20 mg max. topical dose
Tetracaine onset and DOA?
Onset: Slow.
Duration: 3 hours (Longest duration of all spinal agents)
Tetracaine uses?
Spinal anesthesia, epidural and peripheral nerve block, perineum, lower extremities
Tetracaine MOA?
Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
Tetracaine adverse effects?
Convulsions, LOC, Myocardial depression, cardiac arrest, dysrhythmias, status asthmaticus, respiratory arrest, anaphylaxis
Tetracaine contraindications?
Hypersensitivity to Tetracaine or aminobenzoic acid or its derivatives, severe liver disease, heart block.
Tetracaine Metabolism?
Metabolized by plasma pseudocholinesterase, excreted in urine.
Mepivicaine trade name?
Carbocaine
Mepivicaine
Local & Regional Dose: 4-5mg/kg. (Max 400mg) w/ Epi 7mg/kg
Mepivicaine pKa, onset & DOA?
pKa: 7.6
Onset: 15 min
Duration: 3 hours
Mepivicaine uses?
Axillary or peripheral nerve block
Mepivicaine MOA?
Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
Mepivicaine adverse effects?
Convulsions, LOC, Myocardial depression, cardiac arrest, dysrhythmias, fetal bradycardia, status asthmaticus, respiratory arrest, anaphylaxis
Mepivicaine drug interactions?
Ergot drugs (concurrent administration of vasopressor drugs and of ergot-type oxytocic drugs may cause severe, persistent hypertension or CVA), Antipsychotics (Phenothiazines and butyrophenones)
Mepivicaine contraindications?
Hypersensitivity or any local anesthetic of the amide type, child<12yr, elderly, severe liver disease
Mepivicaine metabolism?
Metabolized by hepatic amidases, metabolites excreted in urine
Lidocaine trade name?
Xylocaine
Lidocaine dose?
Max Dose:
5mg/kg
7mg/kg (w epi)
Lidocaine pKa, onset & DOA?
pKa: 7.8
Onset: 5-15 min.
Duration: 3-6 hours
Lidocaine use?
Peripheral nerve block, caudal anesthesia; epidural, spinal, surgical anesthesia, adjunct w/ Propofol injection
Lidocaine MOA?
Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
Lidocaine adverse effects?
Convulsions, LOC, Myocardial depression, cardiac arrest, dysrhythmias, status asthmaticus, respiratory arrest, anaphylaxis
Lidocaine drug interactions?
Dysrhythmias (epi, halothane, enflurane), HTN (MAOI's, TCA, phenothiazines), decreased action of Lidocaine (Chloroprocaine)
Lidocaine contraindications?
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
Lidocaine metabolism?
90% is metabolized by hepatic amidases and 10% is excreted in urine unchanged
Lidocaine safety?
Higher margin of safety than Bupivicaine
Ropivicaine trade name?
Naropin
Ropivicaine dose?
Max Dose: 2.5 mg/kg. or 300mg
Ropivicaine pKa, onset & DOA?
pKa: 8.1
Onset: 1-15 mins. (Slow)
Duration: 2-6 hours
Ropivicaine uses?
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
Ropivicaine MOA?
Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
Ropivicaine adverse effects?
Hypotension, nausea, vomiting
Ropivicaine drug interactions?
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
Ropivicaine contraindications?
Hypersensitivity to Ropivacaine or to any local anesthetic agent of the amide type
Ropivicaine metabolism?
Metabolized by hepatic amidases
Ropivicaine note.
s-isomer of bupivicaine + a propyl group, but it is not an isomer
Bupivicaine trade name?
Marcaine
Bupivicaine dose?
Max Dose: 2-3 mg/kg
Bupivicaine pKa, onset & DOA?
pKa: 8.1
Onset: 2-10 min. (Slow)
Duration: 3-6 hours
Bupivicaine use?
Infiltration, Neuroaxial blocks, Peripheral blocks
Bupivicaine MOA?
Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
Bupivicaine adverse effects?
Cardiotoxicity (small therapeutic window)
Bupivicaine contraindications?
Hypersensitivity to drug or to any local anesthetic agent of the amide type
Bupivicaine metabolism?
Metabolized by hepatic amidases
Chloroprocaine trade name?
Nesacaine
Chloroprocaine dose?
11mg/kg (Max 800mg)
14 mg/kg w/ Epi to max of 1g
Chloroprocaine pKa, onset & DOA?
pKa: 9.0
Onset: 6-12 min. (Fastest onset; exception to rule of pKa & onset)
Duration: 30-60 min. (Shortest duration)
Chloroprocaine use?
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
Chloroprocaine MOA?
MOA: Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
Chloroprocaine adverse effects?
Injection site burning, pruritus
Chloroprocaine drug interactions?
Impairs epidural analgesia of epidural bupivicaine and opioids
Chloroprocaine contraindications?
Hypersensitivity to ester locals, Infection at injection site
Chloroprocaine metabolism?
Hydrolysis by plasma psudocholinesterases
Chloroprocaine notes.
Can supplement “spotty” epidural block or to dose for perineal pain during delivery
Procaine trade name?
Novocain
Procaine dose?
11mg/kg (Max 800mg)
Procaine pKa, onset & DOA?
pKa: 8.9
Onset: Rapid
Duration: 30-60 min. (Shortest duration)
Procaine use?
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
Procaine MOA?
Blocks transmission of action potentials by inhibiting voltage-gated Na+ channels in the activated /open or inactivated/closed state
Procaine adverse effects?
Adverse Effects: Injection site burning, pruritus
Procaine drug interactions?
Drug Interactions: Impairs epidural analgesia of epidural bupivicaine and opioids
Procaine contraindications?
Contraindications: Hypersensitivity to ester locals, Infection at injection site
Procaine metabolism?
Metabolism: Hydrolysis by plasma psudocholinesterases
Procaine notes?
Can supplement “spotty” epidural block or to dose for perineal pain during delivery
Esters are metabolized to what?
PABA
Esters should be avoided in pt's allergic to what?
PABA
What preservative is used with amides?
Amides in multi-dose vials have PABA as preservative