Pharm Local Anesthetics Ii

Front 1

Which part of the structure of the local determines its anesthetic activity?

Back 1

benzene/lipophillic portion

Front 2

which ester is the only one that has hepatic metabolism?

Back 2

cocaine

Front 3

which group of locals have an active metabolite? what is it?

Back 3

ester; PABA

Front 4

if someone allergic to tetracaine what are they prb. allergic to?

Back 4

PABA

Front 5

Potency of locals dependent on...

Back 5

lipid solubility

Front 6

changing what part of the structure increaes the potency?

Back 6

adding carbons to hydrocarbon chain increases hydrophobicity which increases potency

Front 7

onset of action depends on

Back 7

lipid solubility and pka

Front 8

locals whose pka closer to pH have more

Back 8

nonionized, so cross cell membrane faster, faster onset

Front 9

which more potent, esters or amids?

Back 9

esters

Front 10

some say that if you add bicarb, what happens to onset?

Back 10

increases onset b/c raise pH, noniozized forms

Front 11

How can you increase onset?

Back 11

increase concentration (some say bicarb too)

Front 12

what happens if raise from .25% bubivicaine to .75% bubivicaine?

Back 12

faster onset

Front 13

duration is determined by?

Back 13

plasma protein binding

Front 14

what do locals bind to?

Back 14

NOT albumin; they DO bind to alpha 1Glyco protein

Front 15

does lidocaine have vasodilator properties?

Back 15

yes. decreases its duration of action b/c absorbed in vasculature

Front 16

short acting locals

Back 16

procaine, chloroprocaine

Front 17

intermediate acting

Back 17

ldocaine and prilocaine

Front 18

long acting locals

Back 18

tetracaine and buvicaine

Front 19

which metabolize more slowly, amides or esters?

Back 19

amids

Front 20

which, amides or esters, have more of likelihood for toxitcity?

Back 20

amide, b/c they metabolize more slowly

Front 21

which have a slower metabolism, amides or esters?

Back 21

amides, so risk of toxicity higher

Front 22

if someone has hepatic disease, which local's duration might be increased?

Back 22

amide

Front 23

methemoglobinemia can result from extreme doses of which two local anesthetics?

Back 23

prilocaine and benzocaine

Front 24

if we have 30cc of 1% lidocaine compared to 10 cc of 3% lidocaine, what happens

Back 24

more dermatomes blocked (volume increases number of dermatones)

Front 25

bigger volume leads to

Back 25

bigger block and longer duration

Front 26

treatment of methemoglobinemia

Back 26

2mg/kg methelene blue

Front 27

which are harder to block, motor or sensory?

Back 27

motor

Front 28

which electorlyte imbalances antagonize blocks?

Back 28

increase in potassium or decrease in calcium

Front 29

pulse ox goes to _____ with methemoglobinemia

Back 29

85%

Front 30

absorption depends on

Back 30

vascularity of site, dose administered,presence of epi, properties of drug

Front 31

if you administered same amont of local into intercostal block and brachial plexus block, what would be diff?

Back 31

more absorbed in intercostal b/c highly vascular than brachial ple; more vascular, the more chance of toxicity

Front 32

vascularity of injection sites

Back 32

iv>tracheal>intercostal>caudal>paracervical>epidural>brachial plexus>sciatic>subcutaneous

Hint 32

ITICPEBSS

Front 33

describe effect of epi on onset

Back 33

none

Front 34

toxic dose of lidocaine without epi? with epi?

Back 34

without 5mg/kg; with 7mg/kg

Front 35

toxic dose of bubivicaine with and without epi

Back 35

2.5mg/kg

Front 36

which local has most CV toxicity?

Back 36

bubivicaine