Notes in 14 Local Anesthetics

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Published	12/13/2023	The conversion from Fe2+ to Fe3+ is called {{c1::oxidation}}.
Published	12/13/2023	A {{c2::acid}} is a proton {{c1::donor}}, while a {{c2::base}} is a proton {{c1::acceptor}}.
Published	12/13/2023	An acid placed in a basic solution will exist primarily in an {{c1::ionized}} form.
Published	12/13/2023	A typical membrane resting potential is {{c1::-70}} to {{c1::-90}} mV (but varies from tissue to tisue).
Published	12/13/2023	The four phases of nerve action potentials are:{{c4::Resting}} → {{c2::Depolarization}} → {{c1::Overshoot}} → {{c3::Repolarization}}
Published	12/13/2023	At the {{c1::resting membrane}} potential, the membrane is polarized.
Published	12/13/2023	During the repolarization stage, voltage-gated Na+ channels enter the {{c1::inactivated}} state, and voltage-gated {{c2::K+}} channels open.&nbsp…
Published	12/13/2023	Na+ channel {{c1::inactivation}} gates will not reopen until the cell reaches the {{c2::resting membrane potential}}.
Published	12/13/2023	Depolarization can only occur after the {{c1::threshold}} potential is reached.
Published	12/13/2023	Cocaine, imipramine, and amitriptyline prevent re-uptake of {{c1::choline}} and {{c2::norepinephrine}}.
Published	12/13/2023	Cocaine, imipramine, and amitriptyline produce sympatho{{c1::mimetic}} effects.
Published	12/13/2023	The {{c1::intra}}cellular environment contains a greater fraction of local anesthetics.
Published	12/13/2023	{{c1::Alkyl}}-group subsutition on the {{c2::amide group}} and {{c2::benzene ring}} of a local anesthetic increases the {{c3::lipid solubility}}.&nbsp…
Published	12/13/2023	At {{c3::low::high/low}} concentrations, local anesthetics cause vaso{{c2::constriction}} via {{c1::nitric oxide inhibition}}.
Published	12/13/2023	Lidocaine undergoes a relatively fast rate of vascular uptake due to its intrinsic {{c1::vasodilating}} effects.
Published	12/13/2023	Physiologic pH is {{c1::7.4}}
Published	12/13/2023	Bupivacaine, levo-bupivacaine, and ropivacaine have a pKa of {{c1::8.1}}.
Published	12/13/2023	Lidocaine has a pKa of {{c1::7.9}}.
Published	12/13/2023	Prilocaine has a pKa of {{c1::7.9}}.
Published	12/13/2023	Mepivacaine has a pKa of {{c1::7.6}}.
Published	12/13/2023	Procaine has a pKa of {{c1::8.9}}.
Published	12/13/2023	Chloroprocaine has a pKa of {{c1::8.7}}.
Published	12/13/2023	Tetracaine has a pKa of {{c1::8.5}}.
Published	12/13/2023	Bupivacaine has a protein binding of {{c1::96}}%.
Published	12/13/2023	Levo-bupivacaine has a protein binding of {{c1::98}}%.
Published	12/13/2023	Ropivacaine has a protein binding of {{c1::94}}%.
Published	12/13/2023	Lidocaine has a protein binding of {{c1::65}}%.
Published	12/13/2023	Prilocaine has a protein binding of {{c1::55}}%.
Published	12/13/2023	Mepivacaine has a protein binding of {{c1::77}}%.
Published	12/13/2023	Procaine has a protein binding of {{c1::6}}%.
Published	12/13/2023	Tetracaine has a protein binding of {{c1::94}}%.
Published	12/13/2023	Benzocaine has a pKa of {{c1::3.5}}
Published	12/13/2023	{{c1::Benzocaine}} is used for topical anesthesia of {{c2::mucus membranes}} because it is {{c3::non-ionized}} at physiologic pH.
Published	12/13/2023	{{c2::Dexamethasone}} is a vaso{{c3::constrictor}} that can be used to extend the duration of a {{c1::brachial plexus}} block.
Published	12/13/2023	Rapid uptake of a local anesthetics predisposes a patient to {{c1::toxicity}}.
Published	12/13/2023	What plasma concentration of lidocaine is associated with coma?{{c1::15-25 mcg/mL}}
Published	12/13/2023	What plasma concentration of lidocaine is associated with respiratory arrest?{{c1::15-25 mcg/mL}}
Published	12/13/2023	What plasma concentration of lidocaine is associated with cardiovascular collapse?{{c1::>25 mcg/mL}}
Published	12/13/2023	{{c1::Hypercarbia}} increases the risk of CNS toxicity from local anesthetics by increasing cerebral blood flow.
Published	12/13/2023	{{c1::Hyper}}kalemia increases the risk of CNS toxicity from local anesthetics
Published	12/13/2023	{{c1::Metabolic acidosis}} increases the risk of CNS toxicity from local anesthetics by favoring ion trapping inside the brain.
Published	12/13/2023	What local anesthetic should be avoided with MAOIs, TCAs, or sympathomimetic drugs?{{c1::Cocaine}}
Published	12/13/2023	The best treatment for cocaine toxicity is {{c1::vasodilators (e.g. /nitroglycerin)}}.
Published	12/13/2023	What is the metabolic effect of 20% lipid emulsions?{{c1::Enhanced myocardial fatty acid metabolism}}
Published	12/13/2023	What is the cardiac effect of 20% lipid emulsions?{{c1::Increased inotropy}}
Published	12/13/2023	The most common cause of death during a liposuction is {{c1::pulmonary embolism}}.
Published	12/13/2023	The maximum dose of lidocaine for tumescent anesthesia is {{c1::55}} mg/kg.
Published	12/13/2023	The concentration of lidocaine during tumescent anesthesia peaks at {{c1::12}} hours.
Published	12/13/2023	{{c1::General}} anesthesia is used for tumescent anesthesia if > {{c2::2-3}} L of tumescent is injected.
Published	12/13/2023	What antiseizure medication is associated with methemoglobinemia?{{c1::Phenytoin}}
Published	12/13/2023	What local anesthetics are associated with the development of methemoglobinemia?{{c1::Benzocaine}}{{c1::Prilocaine}}
Published	12/13/2023	Methylene blue is metabolized by {{c2::methemoglobin reductase}} to form {{c1::lecuomethylene blue}}.
Published	12/13/2023	Patients with {{c1::glucose-6-phosphate reductase}} deficiency do not possess {{c2::methemoglobin reductase}}, so treatment of methemoglobinemia requi…
Published	12/13/2023	{{c2::Neonates::population}} are at higher risk for {{c1::methemoglobinemia}} because fetal hemoglobin is deficient in methemoglobin reductase.
Published	12/13/2023	The onset of EMLA cream is {{c1::1}} hour(s).
Published	12/13/2023	The application of {{c1::nitroglycerin}} simultaneously with EMLA will hasten absortion of EMLA.
Published	12/13/2023	Prilocaine is metabolized to {{c1::o-toluidine}}, which predisposes children to toxicity.
Published	12/13/2023	In children {{c2::0-3 months::age}} or {{c3::< 5 kg::weight}}, the maximum dose of EMLA is {{c1::1}} g, and the maximum area of application is {{c1…
Published	12/13/2023	In children {{c2::3-12 months::age}} and {{c2::> 5 kg::weight}}, the maximum dose of EMLA is {{c1::2}} g, and the maximum area of application is {{…
Published	12/13/2023	In children {{c2::1-6 years::age}} and {{c2::> 10 kg::weight}}, the maximum dose of EMLA is {{c1::10}} g, and the maximum area of application is {{…
Published	12/13/2023	In children {{c2::7-12 years::age}} and {{c2::> 20 kg::weight}}, the maximum dose of EMLA is {{c1::20}} g, and the maximum area of application is {…
Published	12/13/2023	What low-molecular weight molecule decreases systemic uptake of local anesthetics?{{c1::Dextran}}
Published	12/13/2023	What local anesthetic reduces opioid effectiveness in the epidural space?{{c1::Chloroprocaine}}
Published	12/13/2023	{{c1::Hyaluronic}} acid is present in the interstitial matrix and hinders the spread of substances through tissue.
Published	12/13/2023	When used for opthalmic blocks, hyaluronidase reduces {{c1::hematoma}} size and risk of postoperative {{c2::strabismus}}.
Published	12/13/2023	How does a local anesthetic's intrinsic vasodilating activity affect potency?{{c1::Decreased potency (due to increased uptake)}}
Published	12/13/2023	How does a local anesthetic's intrinsic vasodilating activity affect duration?{{c1::Decreased duration (due to increased uptake)}}
Published	12/13/2023	What plasma protein do local anesthetics preferentially bind to?{{c1::Alpha1-acid glycoprotein (AAG)}}
Published	12/13/2023	{{c1::Protein binding}} of local anesthetics limits peak plasma concentration.
Published	12/13/2023	Pancreatitis may be caused by hyper-{{c1::lipidemia}}.
Published	12/13/2023	The presence/absence of {{c1::fade}} distinguishes a phase I and phase II block.
Published	12/13/2023	What is the goal tidal volume to assess recovery from neuromuscular blockade?{{c1::> 5 mL/kg}}
Published	12/13/2023	What is the goal vital capacity to assess recovery from neuromuscular blockade?{{c1::> 20 mL/kg}}
Published	12/13/2023	The presence of 4/4 twitches with no fade indicates that < {{c1::70}}% of receptors are blocked.
Published	12/13/2023	A sustained head lift indicates that < {{c1::50}}% of receptors are blocked.
Published	12/13/2023	Succinylcholine causes {{c1::bradycardia}} via stimulation of the {{c2::M2}} receptor.
Published	12/13/2023	Burn patients will demonstrate a {{c1::prolonged}} blockade with succinylcholine.
Published	12/13/2023	What class of drug does dibucaine belong to?{{c1::Amide local anesthetics}}
Published	12/13/2023	How does acidosis affect Hofmann elimination?{{c1::Slower}}
Published	12/13/2023	How does hypothermia affect Hofmann elimination?{{c1::Slower}}
Published	12/13/2023	How does hyperthermia affect Hofmann elimination?{{c1::Faster}}
Published	12/13/2023	How does alkalosis affect Hofmann elimination?{{c1::Faster}}
Published	12/13/2023	How does furosemide affect neuromuscular blockade?{{c1::Potentiates}}
Published	12/13/2023	How does hypocalcemia affect neuromuscular blockade?{{c1::Potentiates}}
Published	12/13/2023	How does hypokalemia affect neuromuscular blockade?{{c1::Potentiates}}
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