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35 Cards in this Set

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Name the short acting ester local anesthetic(s).
Procaine
Chloroprocaine
Name the long acting ester local anesthetic(s).
Tetracaine
Name the major topical ester local anesthetic(s).
Cocaine
Name the intermediate acting amide local anesthetic(s).
Lidocaine
Prilocaine
Articaine
Name the long acting amide local anesthetic(s).
Mepivacaine
Bupivacaine
Etidocaine
Ropivacaine
Where are ester local anesthetics metabolized?
In the plasma, by plasma esterases.
Where are the amide local anesthetics metabolized?
In the liver by microsomal enzymes.
Where are modified amide local anesthetics excreted from?
Kidneys
A patient comes in with a history of liver disease. What local anesthetic would you give, and which would you avoid giving?
Give: Esters
Don't give: Amides

Why? Amides are modified in the liver, so if the liver's not functioning well, then you might have problems associated with amide toxicity or something like that.
Procaine's uses include?
(Mainly) Infiltration anestheisa
and
(occasionally) Diagnostic nerve blocks
Hydrolysis of procaine produces?
Paraaminobenzoic acid (PABA), which inhibits sulfonamides.
A patient is taking a large amount of sulfonamide drugs. What drug should you avoid giving and why?
Avoid giving Procaine in patients taking lots of Sulfonamide drugs because Procaine gets hydrolysed to PABA (paraaminobenzoic acid), which inhibits sulfonamides.
Procaine's onset is?
It's DOA is?
Slow
Short (45-60 mins)
Chloroprocaine's onset is?
It's DOA is?
Rapid
Short (30-45 mins)
Chloroprocaine has a reduced acute toxicty, why?
It's rapidly metabolized, so it's not really around long enough to have toxic effects.
Adverse effect(s) of Chloroprocaine?
Increased back pain with EPIDURAL anestheisa.
Tetracaine's onset?
DOA?
Is it potent?
Slow onset
Long(est) (of the esters)
...(60-180 mins)
Very potent
Tetracaine's use(s) include?
SPINAL anesthesia (this is a long procedure)
Adverse effect(s) of Tetracaine include?
Systemic toxicity (possibly due to slow metabolism)

Hypersensitivity reaction?
Yes, so do not use for LOCAL infiltration anesthesia.
Lidocaine's onset?
DOA?
Quick onset
Short-Intermediate DOA (60-120)
Lidocaine can be used how?
Anti-arrhythmic agent

Topically (patch)
Local Infiltration
(any local anesthetic use)
Prilocaine's onset?
DOA?
Slow onset
Short-Intermediate DOA (60-120 min)
Adverse effect(s) of Prilocaine?
Methemoglobinemia in NEONATES
Articane's usually used for what?
How does the onset/DOA relate to this use?
Dental procedures.
Rapid onset
Short/Intermediate DOA
(60 mins)
What local anesthetic drug combination can be used to create an occlusive dressing?
Lidocaine and Prilocaine
Lidocaine and Prilocaine combination is used as an anesthetic prior to?
Venipuncture
Skin graft harvesting
Infiltration of anesthetics into genitalia
Mepivacaine's onset?
DOA?
Slow onset
Long DOA (90-180 min)
Adverse effect(s) of Mepivacaine?

Contraindication(s) of Mepivacaine?
AE: Neonatal toxicity

C/I: Pregnancy/obstetric use.
Bupivacaine's onset?
DOA?
Slow onset
Long DOA (240-480 min)
Bupivacaine's adverse effect(s) include?

Contraindicatino(s) of Bupivacaine include?
AE: Cardiotoxicity

C/I: Cardiac pt for spinal anesthesia
Use(s) of Bupivacaine include?
Labor
Post-operative period

(usually by continuous infusion)

More sensory than motor block (ex: brachial plexus??)
Etidocaine's onset and DOA are?
Slow onset
Long DOA (240-480 min)
Which local anesthetic is no longer used in the USA?
Etidocaine
Ropivacaine's onset and DOA?
Slow onset
Long DOA (240-480 min)
A pt with a history of cardiac problems comes in for long acting pain relief treatment. You believe a local anesthetic would help. Which one would you give, and via what route/use?
Ropivacaine
Via Spinal Anesthesia

(Suitable for both Epidural and Spinal anesthesias)