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11 Cards in this Set
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- 3rd side (hint)
What is the best-known trade name for lidocaine?
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Xylocaine
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Lidocaine was first marketed in 1949, it has also been called "lignocaine".
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What is the functional class of lidocaine?
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Class Ib antidysrhythmic (sodium channel blocker)
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Other Ib antidysrhythmics include phenytoin (Dilantin) and mexiletine (Mexitil).
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What is the mechanism of action of lidocaine?
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Suppresses depolarization and automaticity in the His-Purkinje system. Also suppresses ventricular ectopy and increases the ventricular threshold for dysrhythmias; however it decreases the ventricular threshold for defibrillation.
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Lidocaine blocks the fast voltage gated sodium (Na⁺) channels.
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What are the listed indications for lidocaine?
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- VF
- Pulseless VT - VT with a pulse - Malignant PVCs: -- More than six unifocal PVCs a minute -- Multifocal PVCs -- Couplets -- R-on-T phenomena |
Lidocaine also has significant use as a local anesthetic, including during IO insertion. It is also used as an inhaled antitussive.
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What are the listed contraindications for lidocaine?
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- Hypersensitivity
- Supraventricular dysrhythmias - Untreated sinus bradycardia - 2nd Degree Mobitz II AV Block - 3rd Degree AV Block - Stokes-Adams syndrome |
Some sources also include AIVR, the presence of an artificial pacemaker and the use of class I antidysrhythmics.
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What are the listed precautions for lidocaine?
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CNS depression may occur in doses greater than 300mg/hour
- Liver or renal disease - CHF - Hypovolemia - Shock - Myasthenia gravis. |
Some sources state that lidocaine should not be used in patients with congenital or idiopathic methemoglobinemia or with pseudocholinesterase deficiency.
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What are the listed side effects for lidocaine?
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- Altered mental status including confusion
- Bradycardias, - Hypotension - Seizures |
Prolonged use may produce permanent corneal opacification and ulceration with accompanying loss of vision.
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What are the listed interactions for lidocaine?
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Use caution when administered with beta blockers or procainamide as drug toxicity may result.
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Cimetidine may increase serum levels of lidocaine due to reduced hepatic circulation.
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What is the dosage and route of lidocaine for cardiac arrest?
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Adult:
- 1 - 1.5mg/kg IVP, repeat at half the initial dose (0.5 - 0.75mg/kg IVP) q 5 minutes up to a maximum of 3mg/kg Note: a single dose of 1.5 mg/kg IVP in cardiac arrest is acceptable if moving on to amiodarone - 2 - 4mg/kg ETT q 3 - 5 minutes Pedi: - 1 mg/kg IVP/IO/ETT |
Interestingly, lidocaine has no proven short-term or long-term efficacy in cardiac arrest.
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What is the dosage and route of lidocaine for a patient with a pulse?
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Adult:
- 1 - 1.5mg/kg IVP, repeat at half the initial dose (0.5 - 0.75mg/kg IVP) q 5 - 10 minutes up to a maximum of 3mg/kg - Infusion: 1 - 4 mg/minute using the "+1 Rule" |
The infusion and bolus should be administered together so no lag occurs.
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What are the pharmacokinetics of lidocaine?
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Absorption = 3 minutes
Duration = 10 - 20 minutes Half-Life = 1.5 - 2 hours |
The elimination half-life of lidocaine is approximately 90-120 minutes in most patients. This may be prolonged in patients with hepatic impairment (average 343 minutes) or congestive heart failure (average 136 minutes). - Ann. Intern. Med. 1973 Apr; 78(4):499-508.
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