Wolverton Chapter 47: Local Anesthetics

Front 1

What are the 2 main groups of local anesthetics?

Back 1

Amides and Esters

Front 2

Name the 3 injectable Amide local anesthetics

Back 2

1) Bupivacaine
2) Lidocaine
3) Mepivacaine

Front 3

What are the 2 trade names for the amide Bupivacaine?

Back 3

Marcaine and Sensorcaine

Front 4

What is the trade name for Lidocaine?

Back 4

Xylocaine

Front 5

What is the trade name for Mepivacaine?

Back 5

Carbocaine

Front 6

What is the only injectable Ester local anesthetic?

Back 6

Procaine

Front 7

What is the trade name for the only injectable ester local anesthetic?

Back 7

Novacaine

Front 8

Name the 3 topical amide local anesthetics

Back 8

1) Dibucaine (Nupercainal)
2) Lidocaine
3) Mixture of Lidocaine and Prilocaine

Front 9

EMLA is what?

Back 9

Mixture of Lidocaine and Prilocaine (Topical amide local anesthetics)

Front 10

What is the only topical Ester local anesthetic?

Back 10

Benzocaine

Front 11

What are the 2 trade names for the only topical local ester anesthetic Benzocaine?

Back 11

Solarcaine and Lanacane

Front 12

What is the only topical local Ether anesthetic?

Back 12

Pramoxine

Front 13

Name the 5 classes of topical anesthetics

Back 13

1) Amides
2) Esters
3) Ether
4) Antihistamines
5) Substance P depletors

Front 14

Name the only topical anesthetic that is a Substance P depletor?

Back 14

Capsaicin

Front 15

What is the trade name for Capsaicin?

Back 15

Zostrix

Front 16

What are the 2 topical antihistamine anesthetics?

Back 16

1) Benadryl
2) Doxepin

Front 17

What are the 4 main drugs in the group of Ester anesthetics?

Back 17

1) Cocaine
2) Procaine
3) Tetracaine
4) Benzocaine

Front 18

Name the 5 drugs in the group of Amide anesthetics

Back 18

1) Lidocaine
2) Mepivacaine
3) Bupivacaine
4) Etidocaine
5) Prilocaine

Front 19

PABA is the primary metabolite of which ester anesthetic?

Back 19

Procaine

Front 20

Without epinephrine how long do the effects of lidocaine last?

Back 20

30-60 minutes

Front 21

The duration of action of lidocaine with epinephrine is how long?

Back 21

120-360 minutes

Front 22

Which drug of which class is the longest lasting local anesthetic?

Back 22

Bupivacaine (Marcaine) in the Amide class

Front 23

How are amides metabolized?

Back 23

In the liver, hydrolyzed by hepatic microsomal enzymes

Front 24

If you use an amide anesthetic in someone with liver dysfunction what are you putting them at risk for?

Back 24

Patients with liver disease will have decreased metabolism of amide anesthetics and are at risk for systemic toxicity

Front 25

Lidocaine is specifically metabolized by hepatic microsomal enzymes of what pathway?

Back 25

Cytochrome P-450 (CYP) 3A4 system

Front 26

This group of local anesthetics are hydrolyzed in the blood by pseudocholinesterase to form aromatic acids and amino alcohols

Back 26

Ester local anesthetics

Front 27

Patients with deficiency in what will have impaired metabolism of ester anesthetics?

Back 27

Pseudocholinesterase deficiency

Front 28

Patients with pseudocholinesterase deficiency should be careful with general anesthesia with what neuromuscular blocking agent?

Back 28

It can prolong the effect of Succinylcholine

Front 29

What is the maximum dose of lidocaine without epinephrine?

Back 29

300mg total dose or (4.5mg/kg)

Front 30

What is the maximum dose of lidocaine with epinephrine?

Back 30

500mg total dose or (7mg/kg)

Front 31

When using a local anesthetic patients may still feel what?

Back 31

Pressure

Front 32

What 2 systems are affected most with lidocaine toxicity?

Back 32

CNS and Cardiovascular system

Front 33

Bupivacaine toxicity can cause what life threatening dysrhythmia?

Back 33

V-fib

Front 34

Allergy to what 2 preservatives in Amide anesthetics are considered "true"

Back 34

Parabens or Sulfites

Front 35

Epinephrine is pregnancy class what?

Back 35

Class B

Front 36

What should you avoid when using local anesthetic in pregnancy women?

Back 36

Epinephrine

Front 37

What is the most serious adverse effect of EMLA?

Back 37

Methemoglobinemia

Front 38

Methemoglobinemia, the most serious adverse effect of EMLA is due to what?

Back 38

Prilocaine

Front 39

What is the first symptoms of Methemoglobinemia?

Back 39

Hypoxemia

Front 40

How long does it take to achieve the maximum vasoconstriction effects of lidocaine?

Back 40

15 minutes

Front 41

Epinephrine bines to what receptors on the cutaneous vascular smooth muscle cells that allows for vasoconstriction?

Back 41

Alpha-adrenergic receptors

Front 42

A patient with allergy to PABA is more at risk for having a reaction to amides or esters?

Back 42

Ester class