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36 Cards in this Set
- Front
- Back
- 3rd side (hint)
Which part of the structure of the local determines its anesthetic activity?
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benzene/lipophillic portion
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which ester is the only one that has hepatic metabolism?
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cocaine
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which group of locals have an active metabolite? what is it?
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ester; PABA
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if someone allergic to tetracaine what are they prb. allergic to?
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PABA
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Potency of locals dependent on...
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lipid solubility
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changing what part of the structure increaes the potency?
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adding carbons to hydrocarbon chain increases hydrophobicity which increases potency
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onset of action depends on
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lipid solubility and pka
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locals whose pka closer to pH have more
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nonionized, so cross cell membrane faster, faster onset
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which more potent, esters or amids?
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esters
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some say that if you add bicarb, what happens to onset?
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increases onset b/c raise pH, noniozized forms
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How can you increase onset?
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increase concentration (some say bicarb too)
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what happens if raise from .25% bubivicaine to .75% bubivicaine?
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faster onset
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duration is determined by?
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plasma protein binding
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what do locals bind to?
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NOT albumin; they DO bind to alpha 1Glyco protein
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does lidocaine have vasodilator properties?
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yes. decreases its duration of action b/c absorbed in vasculature
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short acting locals
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procaine, chloroprocaine
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intermediate acting
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ldocaine and prilocaine
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long acting locals
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tetracaine and buvicaine
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which metabolize more slowly, amides or esters?
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amids
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which, amides or esters, have more of likelihood for toxitcity?
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amide, b/c they metabolize more slowly
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which have a slower metabolism, amides or esters?
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amides, so risk of toxicity higher
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if someone has hepatic disease, which local's duration might be increased?
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amide
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methemoglobinemia can result from extreme doses of which two local anesthetics?
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prilocaine and benzocaine
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if we have 30cc of 1% lidocaine compared to 10 cc of 3% lidocaine, what happens
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more dermatomes blocked (volume increases number of dermatones)
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bigger volume leads to
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bigger block and longer duration
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treatment of methemoglobinemia
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2mg/kg methelene blue
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which are harder to block, motor or sensory?
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motor
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which electorlyte imbalances antagonize blocks?
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increase in potassium or decrease in calcium
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pulse ox goes to _____ with methemoglobinemia
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85%
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absorption depends on
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vascularity of site, dose administered,presence of epi, properties of drug
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if you administered same amont of local into intercostal block and brachial plexus block, what would be diff?
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more absorbed in intercostal b/c highly vascular than brachial ple; more vascular, the more chance of toxicity
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vascularity of injection sites
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iv>tracheal>intercostal>caudal>paracervical>epidural>brachial plexus>sciatic>subcutaneous
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ITICPEBSS
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describe effect of epi on onset
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none
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toxic dose of lidocaine without epi? with epi?
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without 5mg/kg; with 7mg/kg
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toxic dose of bubivicaine with and without epi
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2.5mg/kg
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which local has most CV toxicity?
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bubivicaine
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