LA.txt

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Author:
emm64
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164435
Filename:
LA.txt
Updated:
2012-07-30 13:16:23
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Local Anesthesia LA
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Local Anesthesia LA
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  1. ´╗┐Which beta blockers interact with vasodilators?
    • non-selective bb: propandolo, nadolol
    • leads to unopposed alpha vasoconstriction with both epi and levoordefrin
    • NO interaction likely iwht cardio-selective b1 or combined a & b blockers
  2. Which antidepressants interact with vasodilators?
    • Tricyclic & SNRI antidepressants: cause exaggerated resonse to EPI at synaptic cleft
    • tricyclic: elavil, sinequan, pamelor, tofranil
    • SNRI: effexor, cymbalta, pristiq, savella
    • both used for pain management
    • possible increased BP & HR but most still metabolized by COMT
  3. What is atomoxetine (Strattera)?
    • NE reuptake inhibitor for ADHD
    • can increase BP & HR with vasoconstrictors.
  4. What is the interaction of cocaine/amphetamines and vasoconstrictors?
    • NE reuptake inhibitors & presynaptic release of NE
    • cardiac dysrhythmia
    • inc BP
    • avoid concurrent use wait at least 12 hours
  5. Which drugs for parkinson's has potential interactions with vasoconstrictors?
    • COMT inhibitors: tolcapone & entacapone
    • used for Parkinson's pts taking Sinemet (l-dopa/carbidopa metabolism)
    • exaggerated response to EPI
  6. What are the vasoconstrictor interactions with pts w BPH?
    • alpha blockers, phenothiazines, butyrophenones (at high doses)
    • epinephrine reversal: hypotension(b2 no a1) and tachycardia(b1)
    • more pronounced iwth levonordefrin than epi at low doses
    • alphablockers: prazosin, terazosin
    • phenothiazines: thorazine, prolixin
    • butyrophenones: haldol
  7. What is the protocol for pts sensitive to Epi?
    • monitor BP & HR preop and 3-5 mins post injection, continue to monitor
    • minimize epi, may readminister if BP & HR stable
    • never use 1:50,000 concentration
    • limit of 0.04mg
    • never use epi impregnated retraction cord (.5mg/inch)
  8. How do you calculate doses of vasoconstrictors?
    • ratio concentrations represent grams per mL
    • 1:100,000 = .01mg/mL or 10ug/mL (.018 mg / cartridge)
    • 1:200,000 = .005mg/mL or 5ug/mL (.009 mg / cartridge)
    • 1:50,000 = .02 mg/mL or 20 ug/mL (.036 mg / cartridge)
    • 1 cartridge(1.8mL) of 1:100,000 epi contains .018 mg epi
    • 1:20,000 (Levonordefrin (Neocobefrin) = 90 ug = .09 mg
  9. What are suggested limits of epi and levonordefrin?
    • epi = .05mg
    • levonordefrin = .2mg (2 cartridges of 1:20,000)
  10. What is felypressin?
    • non-sympathomimetic amin: analogue of vasopressin (ADH)
    • vasoconstriction primarily, little direct myocardium effect
    • not available in US
    • less adverse effects
    • less hemostasis
    • used for cardiac or drug interactions
    • max 5 cartridges
    • 0.03IU/mL
  11. Describe the LA preparations.
    • 1.8 mL single-dose
    • Pyrogen-free distilled H20 with NACL added for osmotic balance
    • range of pH (3-6) to enhance stability of epinephrine or levonordefrin
    • citric acid and Na metabisulfite (antioxidant) to prevent vasoconstrictor breakdown
    • methylparaben (anti-bacterial) now removed b/c allergenicity
  12. Lidocaine prep
    • 1948
    • pKa: 7.9
    • pH plain: 6.5
    • pH w/VC: 5.0-5.5
    • onset: 2-3 min
    • half-life: 90 mins
    • 2% (1:100,000 or 1:50,000)
    • trade names: xylocaine, octocaine, lignospan
    • lidostesim (w NE)
    • novocol (w/ phenylephrine)
    • xylestesin (plain)
  13. Mepivacaine prep
    • 1960
    • pKa: 7.6
    • pH plain: 4.5
    • pH w/VC: 3.0-3.5
    • onset: 1.5-2 min
    • half-life: 1.9 hours
    • 3% plain
    • 2% (w 1:20,000 levo, 1:100,000 epi)
    • trade names: carbocaine, isocaine, polocaine
  14. Prilocaine
    • 1965
    • pKa: 7.9
    • pH plain: 4.5
    • pH w/VC: 3.0-4.0
    • onset: 2-4 min
    • half-life: 90 mins
    • 4% plain
    • 4% (1:200,000 epi)
    • trade names: citanest plain/forte, prilonest, citanest (w/felypressin)
    • lower lipid solubility therefore doesn't cross BBB and can have higher conc
  15. Bupivacaine
    • 1972
    • pKa: 8.1
    • pH plain: 4.5-6.0
    • pH w/VC: 3.0-4.5
    • onset: 6-10 min
    • half-life: 2.7 hours
    • highest pKa and longest half-life
    • 0.5% w 1:200,000 epi
    • trade name: marcaine
  16. Articaine
    • 1983
    • pKa: 7.8
    • pH w/VC: 4.4-5.4
    • onset: 2-3 mins
    • half-life: 30 mins
    • amide anesthetic metabolized like ester
    • 4% w (1:100,000 or 1:200,000)
    • trade names: septocaine, astracaine, ultracain, zorcaine
  17. Procaine
    • 1904
    • no longer available
    • pKa 9.1
    • onset: 6-10 mins
    • half-life: 6 mins
    • tradename: novocaine
  18. What is topical anesthetics?
    • conc of LA applied topically is typically greater than injection
    • higher conc facilitates diffustion through mucous membrane
    • yet increases risk of toxicity both locally and systemically
    • effective only surface 2 to 3mm
    • benzocaine and lidocaine base insoluble in H20
    • so usually prepared in alcohol, propylene glycol, polyethlylene glycol etc.
    • benzocaine (up to 200mg/ML) aerosol, gel, ointment, soln
    • lidocaine (up to 50mg/mL) aerosol, gel ointment, soln
    • others: cocaine (nasal intubation), tetracaine( too toxic), EMLA (eutectic mix of LA) prilocaine and lidocaine
  19. Describe the order of LA duration of maxillary infiltration
    • SHORTER THAN MANDIBULAR
    • name-pulp-soft tissue
    • priolocaine plain: 20, 90-110
    • mepivacaine plain: 25, 60-90
    • prilocain +epi: 40, 140
    • mepivacain +levo: 50, 180-300
    • lidocaine +epi: 60, 150
    • articaine +epi: 60, 120-360
    • bupivacaine + epi: 60, 250-540
  20. Describe the order of LA duration of mandibular block
    • LONGER THAN MAXILLARY
    • name-pulp-soft tissue
    • priolocaine plain: 55, 190
    • mepivacaine plain: 40, 120-180
    • prilocain +epi: 60, 220
    • mepivacain +levo: 75, 180-300
    • lidocaine +epi: 85, 180-300
    • articaine +epi: 90, 120-360
    • bupivacaine + epi: 240, 240-540
  21. What LA preps are used for most procedures requireing 20-30 mins of pulpal anesthesia especially the maxilla?
    • 2% Lidocaine w 1:100,000 epi max (60,170) mand (85,190)
    • 2% mepivacaine w 1:20,000 levo max (50, 130) mand (75, 185)
    • 4% articaine w 1:100,000 epi max (60,190) mand (90,200)
    • 4% articaine w 1:200,000 epi
    • Prilociane + epi max (40,140) mand (60,220)
  22. Which LA preps are used for short procedures?
    • 3% mepivacaine plain max (25,90) mand (40,165)
    • 4% prilocaine plain max (20, 105) mand (55,190)
    • L + epi max(60,170) mand (85,190)
  23. Which LA preps are used for long and painful procedures?
    • 0.5% bupivacaine w 1:200,000 epi max(60,340) mand(240,440)
    • L + epi max(60,170) mand (85,190)
  24. Which LA preps are used for surgical hemostasis?
    • 2% Lidocaine with 1:50,000 epi
    • less than 1/2 blood loss of 2% L + 1:100,000 epi
    • 2% L and 1:80,000 epi less than 1/2 blood loss than mepivacaine plain or placebo
    • but:
    • incresed postop bleeding & pain
    • delayed wound healing
    • possible vasoconstrictor toxicity
  25. What are the LA selection criteria?
    • duration
    • allergy
    • drug interactions
  26. Which LA's are class B pregnancy?
    • lidocain and prilocaine
    • everything else class C
  27. What are the pregnancy classifications of topical anesthetics?
    • benzocaine C
    • lidocaine B
  28. What is epinephrine pregnancy FDA class?
    • C (high does)
    • levonordefrin not ranked

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