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103 Cards in this Set
- Front
- Back
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rate of metabolism of amide LA
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prilocaine>lidocaine>mepivicaine>ropivicaine>bupivicaine
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pts with genetically abnormal pseudocholinestarase difficiency are at a higher risk for toxic side effects of_____
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ester
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_____ +______ are metabolized by paba
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procaine and benzocaine
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methylene blue reduces___ to ___
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fe3 to fe2
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what is the order of differential blockade
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autonomic>sensory>motor
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the axon is sarrounded by____; composed of glial cells
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endoneurium
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individual fibers are gathered into vesciles and sarrounded by
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perineum or connective tissue
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entire peripheral nerve is encased by
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epinurium or dense connective tissue
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nerve fibers are classified according to
___ (3) |
fiber diameter
presence or absence of myelin A/B myelin. C no myelin function |
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repetitive depolarization___the likelyhood of finding an open sodium channel
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increase
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local anes. bind to sodium channels in the ----- state preventing ---- and ----
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inactive closed
preventing channel activation and depolarization |
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during frequency dependent blockade__+____ channels have a greater affinity for anes.
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open and inactivated
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% Non Ionized Fraction
Lidocaine Bupivicane |
Lido 25%
Bupiv 17% |
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w / exception of .....that has an increased degree of concentration of 97% all other forms of non ionized drugs take longer to peak..concentration effect
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chloroprocaine
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for LA
potency= onset= duration= |
potency..lipid solubility
onset..pka duration..VD/protein binding |
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Vasoconstrictors in addition to LA has these effects
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increase neuronal uptake
decrease absorption prevent systemic side effects decrease bleeding enhance density of blockade |
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which amide/ester LA cross the placenta in greater numbers
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amide
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larger VD
amide or esters |
amide
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describe type C sympathetic fibers
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post ganglionic
.3-1.3 diameter no myelinatin .7-2.3 velocty |
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what is the order of blockade
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symp block with peripheral vd and increase in temp
loss of pain/temp/analgesia loss of proprioception loss of touch/pressure motor paralysis VDPPTP |
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order of differentiation blockade
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autonomic, sensory , motor
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local anes bind to na channels in what state
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inactive closed
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local anes consist of a ... and ...connected by....
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hydrophilic and lipophilic group conected by hydrocarbon chain
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...part of la diffuses through the nerve
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B non ion
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--part of la binds to membrane at receptor site
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B+ is ion
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potency is LA is determined structurally b y
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presence of C
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hydrophilic part of LA has a ---- and a ---
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tertiary amine and lone pair of electrons//responsible for water solubility
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---part of la import for anes activity
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lipophilic
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--more likely to cause allrgic reactions. ester/amide
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ester
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PKA
Bupivicaine Lidocaine |
B 8.1
L 7.8 |
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which is more lipid soluble and protein bound, lido or Bupi
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Bupivicaine
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Max dose per mg/kg
of Lidocaine/Bupivicane |
Bupivicaine 3 mg/kg
Lido 4.5 mg/kg |
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Usual Lidocaine intubting dose
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1-1.5 mg/kig
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ropivicaine pka
max dose Lipid solubility/protein binding |
PKA 8.1
Max dose 3 mg/kg not very lipid sol/protein bound |
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chloroprocaine pka
solubility/bindign max dose |
pka 9.0
max dose 12 mg/kg little sol/binding |
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cocaine pka
ls/pb max dose how is it used |
pka 8.7
3 mg/kg moderate ls used topically, intranasal |
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procaine
max dose pka ls/bp when can it not be used |
8.9 pka
12 mg/kg little solubility/pb NO epidural use |
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tetracaine
pka pb/ls max dose use |
pka 8.2
max dose is 3 mg/kg ls/BP is ++++ spinal/topical |
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lido mg/kg max dose w/epi
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7 mg/kg
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lido/bupivicaine can not be sued for
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spinal
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lidocaine pka...% ion @ ph
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7.9 pka, 76% ionized
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procaine is only ....protien bound
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6%
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potency order of esters
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tetracaine>chloroprocaine> procaine
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Lido or Bup/Ropi...faster onset
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Lidocaine
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Max total dose
Lido Bup Rop |
L 300
B 127 R 200 |
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max total dose
procaine chloroprocaine tetracaine |
procaine 500
chloro 600 tetra 100 |
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Non ionized fractin
Lido Bup |
L 24
Bup 15 |
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non ionized fraction
procaine Chlorprocaine tetracaine |
P 3
C 5 T 7 |
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...% bupivicaine in 20 cc solution
...% lido in a 20 cc solution |
0.5% bup
1% lido |
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local anes are prepared commercially as....w ph of .....
but solutions w/epi are more... |
water soluble solutions of hydrochloride salts with ph 6-7
w/epi more acidic w/ph of 4-5 |
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adding bicarb to a solution will
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speed onset, improve quality of block, prolong duration, increase free base and decrease pain on injection.
decrease free base, more non ionized fraction for action! |
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LA order of absorption
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Intrav>tracheal>intercostal> caudal>paracervical>epidural>branchial plexus>sciatic>subq
ITICPEBSS |
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vasoconstrictor have more pronounced effects with.....such as..
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more short acting anes..such as lido
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adding epi is contraindicated when
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there is
unstable angina arrythmias, htn uteroplacental insufficiency lack of collateral circulation , digits, penis IV Regional. |
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esters are metabolized by .... with ...metabolites that are...called.
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esters are metabolized by psedocholinestarase with water soluble metablites that are called PABA
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amides are metabolized by...
this takes... |
microsomal liver enzymes
longer process |
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what increases amide toxicity
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liver/renal failure
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cocaine is an ester that is partially metabolized by the ..
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liver...
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metabolites of what two anes are most likely to convert hg to meth hg
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benzacaine, prilocaine
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what else can cause methylglobenemia
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tyl, lido
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tx for methylglobinemia
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1-2 mg/kg IV of 1% solution over 5 min
of METHYlene blue |
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cv effects of LA
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depress automacity
spont depolarization decrease refractory time VD, hypotension, bradycardia decreased conduction increased qrs/ pr interval |
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...avail as a single isomer w decreased Cv toxicity
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ropivicaineL
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LA decrease or increase the seizure threshold during anes
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decrease
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toxic plasma concentration of lido
bup rob |
Lido 5 ug/kg
Bup 1.5 ug/kg Rob 4 ug/kg |
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Type A nerve fibers are devided into
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Alpha, beta, gama and delta fibers
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Function of Type A, alpha
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proprioception/ motor
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Function of type a, beta
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touch pressure
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function of type a, gamma
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muscle spindles
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function of type a, delta
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pain temp
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Diameter of type A fibers
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alpha 12-20
beta 5-12 delta 3-6 gamm 2-5 |
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Conduction of fastest velocity is ..where..
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Type A, alpha of 70-120 m/ sec
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diameter goes down, sens to blockade..
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increase
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conduction velocity goes down, sens to blockade
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increases
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function of type B nerve fibers,, are they myelinated
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preganglionic autonomic
light meylination |
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type B nerve fibes
size of diameter conduction velocity |
<3 diam
3-15 m/sec |
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type C neve fibers in dorsal horn function
myelination? |
un myelinated
pain, temp, touch |
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type c neve fibers in dorsal horn diam, velocity
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diame... .4-1.2
velocity .5-2.3 |
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Effect on bronchial smooth muscle
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Effective in blocking reflex bronchoconstriction associated with laryngoscopy & intubation
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Post-retrobulbar apnea syndrome
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LA injection into the optic nerve sheath
Depression of medullary center following direct exposure to LA |
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decrease or increase hypoxic drive & response to CO2
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decrease
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Cauda Equina Syndrome/causes
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High concentrations of anesthetic & permanent damage/ lithotomy position/stretching of nerves
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...will terminate associated seizures
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thiopental
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order of cardiac toxicity
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Bupivacaine > Lidocaine vs Ropivacaine & Levobupivacaine
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When .... channels open during an action potential, local anesthetic molecules can enter and reach receptors
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sodium
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IV regional is also called
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beir block
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LA shortest duration
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mepivicaine
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local anest produce ...block
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reversible conduction
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increasing amount of local anesthethic occurs along the
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a,s,m pathway
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axon of the fiber is sarrounded by
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endonurium
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the entire nerve is sarrounded by
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epinurium
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increase in myelin, increases
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increase conduction velocity
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with spinal anesthethic there will be...
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hypotension as a result of autonomic blockade
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the hydrophilic portion of the LA is hydrophilic because of the
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lone pair of electrons on N
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hydrophilic portion is usually ..amines
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tertiary
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difference b/w two types of la releates to ..or...
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allergic potential , type of metabolism they undergo
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LA causes vasoconstriction, HTN
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cocaine
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levobupivicaine has similar properties than....with similar BP and lipid solubility, but a better cardiac profile
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Bupivicaine
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...and...are effective for cns excitation due to la
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hyperventilation and benzodiazapenes
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thiopental...mg/kg will terminate la associated seizures
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1-2 mg/kg
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large volume of cholorprocaine injected into subarachnoid space can be associated with
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severe back pain
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cauda equina syndrome is associated particularly with the use of ..and..
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pooling of drug due to use of high concentrations of la (5% lidocaine) and use of small catheters.
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cauda equina syndrome is associated particularly with the use of ..and..
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pooling of drug due to use of high concentrations of la (5% lidocaine) and use of small catheters.
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