Grant CRNA Local Anesthetics Quiz Review

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Grant CRNA Local Anesthetics Quiz Review - Quiz

About This Quiz

Are you a nurse anesthetist and want to put your knowledge to the test? The Grant CRNA local anesthetics quiz review below is set to help advance and gauge your knowledge. Take it up and see how it goes.

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2.

The pKa's of local anesthetics range from 7.6-9.1 with one exception of chloroprocaine which has a really high pKA. Chloroprocaine still has a very fast onset of action due to being used in high concentrations (3%).
- True
- False
Correct Answer

A. True

Explanation

Locals are weak bases prepared as hydrochloride salts.

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3.

How do we increase the pH of a local anesthetic in order to increase the amount of drug in the nonionized form when injected into tissue?
- The addition of sodium bicarbonate
- Hyperventilate the patient
Correct Answer

A. The addition of sodium bicarbonate

Explanation

Another benefit of adding NaHCO3 = less pain on injection.

Bupivicaine may precipitate with NaHCO3 addition
Use lower amounts of bicarb
0.1mEq/20 mL of bup vs. 1 mEq/10 mL of lido – not on test but for regionals

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4.

Lipid solubility will ______ potency and duration of action.
- Increase
- Decrease
- Not affect
Correct Answer

A. Increase

Explanation

Direct correlation

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5.

Various concentrations of local anesthetics will provide various types of blocks. For example: 0.125% Bupivicaine only blocks _______ while 0.5% blocks sensory and motor

Correct Answer
sensory

Explanation
Different concentrations of local anesthetics can produce different types of blocks. In this case, a concentration of 0.125% Bupivicaine only blocks sensory function, while a concentration of 0.5% blocks both sensory and motor function.

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6.

Voltage gated Na+ channels are found only in the nerve’s _____.
- Axon
- Dendrites
- Soma
Correct Answer

A. Axon

Explanation

Voltage gated Na+ channels are found only in the nerve's axon. This is because the axon is responsible for transmitting electrical signals, known as action potentials, from one neuron to another. Voltage gated Na+ channels play a crucial role in generating and propagating these action potentials. They open in response to a change in voltage, allowing Na+ ions to flow into the axon and depolarize the membrane. This depolarization triggers the opening of voltage gated K+ channels, leading to repolarization and the propagation of the action potential along the axon. Therefore, voltage gated Na+ channels are specifically located in the axon to facilitate efficient and rapid transmission of electrical signals.

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7.

Increased lipid solubility correlates with increased protein binding, increased potency, longer duration of action and a higher tendency for severe _______ (especially cardiac).
- Toxicity
- Anaphylaxis
- Great outcomes
- Cases of the Monday's
Correct Answer

A. Toxicity

Explanation

Increased lipid solubility allows a drug to easily cross cell membranes and distribute throughout the body, leading to increased protein binding. This binding can enhance the drug's potency and prolong its duration of action. However, it also increases the drug's potential for toxicity, particularly in organs such as the heart. Therefore, drugs with high lipid solubility are more likely to cause severe toxicity, especially cardiac toxicity.

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8.

CNS depression associated with CNS toxicity reflects selective depression of inhibitory cortical neurons, leaving excitatory pathways unopposed.
- True
- False
Correct Answer

A. True

Explanation

The statement is true because CNS depression associated with CNS toxicity occurs when inhibitory cortical neurons are selectively depressed, which means they are not functioning properly. This leads to excitatory pathways being unopposed, meaning they are not balanced or regulated by the inhibitory neurons. As a result, there is an increase in excitatory activity in the CNS, leading to symptoms of CNS toxicity.

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9.

Chemically, local anesthetics have three characteristic traits:1. An intermediate carbon group separates2. an unsaturated “aromatic” ring system from3. a tertiary amine. The aromatic ring provides lipophilic characteristics, whereas the amine gives hydrophilicity to the molecule.
- True
- False
Correct Answer

A. True

Explanation

This type of linkage is important clinically because it has implications for metabolism and allergic potential

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10.

Higher max doses of local anesthetic are allowed with vasoconstrictor added.
- True
- False
Correct Answer

A. True

Explanation

The addition of a vasoconstrictor to a local anesthetic allows for higher maximum doses to be used. Vasoconstrictors, such as epinephrine, constrict blood vessels at the site of administration, reducing blood flow and delaying the systemic absorption of the local anesthetic. This reduces the risk of toxicity and allows for higher doses to be used safely.

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11.

Esters are metabolized almost exclusively in the liver by the microsomal cytochrome-P-450
- True
- False
Correct Answer

A. False

Explanation

This describes amides.

Patients w/liver disease or reduced liver blood flow may have prolonged effects.
P450 is INHIBITED by anesthesia gases, propanolol, and cimetidine.

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12.

The non-ionized form diffuses into the nerve axon while the ionized form binds to receptors on sodium channels when the channel is in the inactivated state.
- True
- False
Correct Answer

A. True

Explanation

The explanation for the given correct answer is that the non-ionized form of a substance is able to easily pass through the cell membrane and diffuse into the nerve axon. On the other hand, the ionized form of the substance binds to specific receptors on sodium channels, but only when the channel is in the inactivated state. This means that both forms of the substance have different mechanisms of action, but they are both involved in the transmission of signals within the nerve axon. Therefore, the statement is true.

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13.

Esters are mostly eliminated via metabolism by:
- Pseudocholinesterase
- Kidneys
- Lungs
- Liver
Correct Answer

A. Pseudocholinesterase

Explanation

Cocaine is also metabolized by liver esterases

Avoid the use of ester LA's with pseudocholinesterase deficiency.

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14.

Containing a preservative is an absolute contraindication to administering a LA into a neuraxial compartment.
- True
- False
Correct Answer

A. True

Explanation

Administering a local anesthetic (LA) into a neuraxial compartment, such as the epidural or intrathecal space, is contraindicated if it contains a preservative. Preservatives can cause neurotoxicity and other adverse effects when injected into these compartments. Therefore, it is important to ensure that the LA being administered is preservative-free to avoid potential harm to the patient.

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15.

LA _______ non-depolarizing muscle relaxant blockade.
- Potentiate
- Inhibit
Correct Answer

A. Potentiate

Explanation

The word "potentiate" means to increase the effect or strength of something. In the context of the given question, the blank is asking for a word that completes the sentence and relates to the non-depolarizing muscle relaxant blockade. By choosing "potentiate" as the correct answer, it suggests that the action being described is the enhancement or strengthening of the blockade caused by the non-depolarizing muscle relaxant.

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16.

Which of the following local anesthetics is 95% protein bound and has the greatest duration of action?
- Bupivicaine
- Mepivicaine
- Lidocaine
- Chloroprocaine
Correct Answer

A. Bupivicaine

Explanation

Chloroprocaine has NO (0%) protein binding – very short DOA – half life is 6 minutes

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17.

The addition of epinephrine or, less commonly, phenylephrine causes ______ rate of absorption and of peak plasma concentrations.
- Decreased
- Increased
- No change to
Correct Answer

A. Decreased

Explanation

Toxicity is based on peak plasma levels.

The addition of vasoconstrictors facilitates neuronal uptake, enhancing the quality of analgesia, and limits toxic side effects.

**Always assume you could accidentally inject into the blood stream.

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18.

What is the MOST LIKELY cause of local anesthetic toxicity?
- Accidental intravascular injection
- Inclusion of a vasoconstrictor
- Tracheal injection site
- Using a large dose
Correct Answer

A. Accidental intravascular injection

Explanation

The other three are factors that can produce LA toxicity but most likely due to an accidental IV injection.

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19.

You are performing a nerve block on your patient when they begin having a tonic clonic seizure. Initial seizure treatment includes providing O2, airway control, midazolam and ________ their respiratory rate.
- Increasing
- Decreasing
Correct Answer

A. Increasing

Explanation

Hyperventilation helps to decrease the chance of ion trapping the LA in the brain.

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20.

This type of local anesthetics are broken down to para-aminobenzoic acid (PABA) which is a known allergen potentially causing localized edema, urticaria, bronchospasm, and anaphylaxis.
- Esters
- Amides
Correct Answer

A. Esters

Explanation

Esters are a type of local anesthetics that are broken down into para-aminobenzoic acid (PABA), which is a known allergen. This can potentially cause localized edema, urticaria, bronchospasm, and anaphylaxis. Therefore, the correct answer is Esters.

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21.

Local anesthetics must bind with at least ______ successive nodes of Ranvier to be effective.

Correct Answer
3
three

Explanation
Local anesthetics need to bind with a minimum of three successive nodes of Ranvier in order to be effective. The nodes of Ranvier are small gaps in the myelin sheath that surrounds nerve fibers. By binding to these nodes, local anesthetics can block the transmission of nerve signals, effectively numbing the area. Binding to fewer than three nodes may not provide enough coverage to fully block the nerve signals, resulting in incomplete anesthesia.

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22.

____________ is ideally suited for topical anesthesia. It has a pKa of 3.5, making it completely ionized in a pH of 7.4 It comes in a 20% solution, delivering 200-300 mg per brief spray. Methemoglobinemia may occur with doses over 300 mg.

Correct Answer
Benzocaine
hurricane spray

Explanation
Benzocaine is ideally suited for topical anesthesia because it has a pKa of 3.5, which means it is completely ionized in a pH of 7.4. This allows it to easily penetrate the skin and provide effective anesthesia. Additionally, it comes in a 20% solution, delivering 200-300 mg per brief spray, which is a suitable dosage for topical anesthesia. However, it is important to note that doses over 300 mg can lead to methemoglobinemia, a condition where the blood is unable to carry oxygen effectively.

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23.

Cocaine has vasoconstrictive properties because of its ability to block the reuptake of _________.

Correct Answer
norepinephrine
norepi
NE

Explanation
Cocaine has vasoconstrictive properties because it blocks the reuptake of norepinephrine. Norepinephrine is a neurotransmitter that plays a role in regulating blood vessel constriction. When cocaine inhibits its reuptake, norepinephrine remains in the synaptic cleft for a longer period, leading to increased stimulation of alpha-adrenergic receptors and causing vasoconstriction. This narrowing of blood vessels can result in increased blood pressure and reduced blood flow to certain areas of the body.

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24.

Nerve conduction is determined mainly by 2 factors: nerve fiber diameter and the degree of ________, which determines conduction velocity.

Correct Answer
myelination

Explanation
Nerve conduction is determined mainly by two factors: nerve fiber diameter and the degree of myelination. Myelination refers to the presence of a myelin sheath, which is a fatty substance that surrounds and insulates nerve fibers. This insulation allows for faster and more efficient conduction of electrical impulses along the nerve fibers. Therefore, the degree of myelination directly affects the conduction velocity of the nerve.

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25.

When considering duration of action, the lipid solubility of a drug is more important than its protein binding.
- True
- False
Correct Answer

A. False

Explanation

Protein binding, however, is more important than lipid solubility when it comes to duration of action

When a drug is bound to protein it is not available to be metabolized by the liver or plasmaesterases.

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26.

Echthiophate, neostigmine, pyridostigmine, and edrophonium are for drugs that ________ ester LA activity.
- Prolong
- Shorten
- Have no effect
Correct Answer

A. Prolong

Explanation

The drugs mentioned in the question, echthiophate, neostigmine, pyridostigmine, and edrophonium, are known to prolong ester LA (local anesthetic) activity. This means that these drugs increase the duration of the effects of local anesthetics, making them last longer.

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27.

The rate of metabolism of amides is agent dependent.
- True
- False
Correct Answer

A. True

Explanation

Prilocaine>lidocaine>mepivacaine>ropivacaine>bupivacaine

Mnemonic:
Please lease my rusty bus.

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28.

________ is the most toxic ester due to it being hydroloyzed more slowly than other esters.

Correct Answer
Tetracaine

Explanation
Tetracaine is the most toxic ester because it undergoes hydrolysis at a slower rate compared to other esters. Hydrolysis is a chemical reaction in which a compound is broken down by water. In the case of esters, hydrolysis leads to the release of toxic byproducts. Since tetracaine is hydrolyzed more slowly, it remains in the body for a longer time, increasing its toxicity.

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29.

Pregnancy, liver diseases, the 1st 6 months of life, and atypical plasma cholinesterase all ________ the DOA of ester local anesthetics.
- Increase
- Decrease
- Have no effect
Correct Answer

A. Increase

Explanation

Via decreasing plasma cholinesterase activity.

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30.

All of the following increase the risk of LA toxicity except?
- Pregnancy
- Hypoxemia
- Respiratory acidosis
- Respiratory alkalosis
Correct Answer

A. Respiratory alkalosis

Explanation

Respiratory alkalosis does not increase the risk of LA (local anesthetic) toxicity. Local anesthetics are weak bases, and they exist predominantly in the ionized form in an alkaline environment. In respiratory alkalosis, there is a decrease in carbon dioxide levels, resulting in increased blood pH. This alkalotic state decreases the ionization of local anesthetics, reducing their toxicity. On the other hand, pregnancy, hypoxemia, and respiratory acidosis increase the risk of LA toxicity as they all lead to an acidic environment, promoting the ionization of local anesthetics and increasing their toxicity.

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31.

The Cm (minimum blocking concentration) or motor fibers is about ____ that of sensory fibers.
- 2x
- 1/2
- 1/4
- 10x
Correct Answer

A. 2x

Explanation

The minimum blocking concentration (Cm) for motor fibers is approximately twice that of sensory fibers. This means that it takes a higher concentration of a blocking agent to inhibit the function of motor fibers compared to sensory fibers.

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32.

If a local anesthetic is injected into venous system, less drug gets to systemic circulation due to uptake by the _____ (first pass uptake).

Correct Answer
Lungs

Explanation
When a local anesthetic is injected into the venous system, it bypasses the liver, which is responsible for metabolizing drugs before they enter systemic circulation. Instead, the drug travels directly to the lungs, where it undergoes first-pass uptake. This means that a significant amount of the drug is taken up by the lungs before it can enter systemic circulation, resulting in less drug reaching the rest of the body.

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33.

Ropivacaine, lidocaine, and cocaine are vasoconsctrictors
- True
- False
Correct Answer

A. True

Explanation

Ropivacaine, lidocaine, and cocaine are all drugs that have vasoconstrictor properties. Vasoconstrictors are substances that cause the narrowing of blood vessels, leading to a decrease in blood flow. This can be beneficial in certain medical procedures, such as local anesthesia, as it helps to reduce bleeding and prolong the effects of the anesthetic. Therefore, the statement that ropivacaine, lidocaine, and cocaine are vasoconstrictors is true.

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34.

All of the following are symptoms of methemoglobinemia EXCEPT:
- Brownish-gray cyanosis
- Tachypnea
- Bradycardia
- Metabolic acidosis
Correct Answer

A. Bradycardia

Explanation

Causes tachycardia.

Patients w/severe anemia or heart failure cannot tolerate the reduced O2 carrying capacity.

Tx w/1-2 mg/kg of 1% methylene blue.

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35.

Local Anesthetics that have a longer duration of action preferentially bind to the _____ protein chain of the nerve and less to albumin

Correct Answer
alpha
Alpha 1-acid

Explanation
Alpha 1-acid glycoprotein (remember – weak base)

Therefore, less metabolism of the drug since it is staying at the site of action (less likely cleared by blood flow)

Ester local anesthetics usually have a shorter duration of action than amides

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36.

Which of the following receives the greatest amount of LA from distribution due to its greater tissue mass?
- Brain
- Liver
- Muscle
- Fat
Correct Answer

A. Muscle

Explanation

Increased lipid solubility = greater plasma protein binding and greater tissue uptake

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37.

Which of the following describes the correct order of nerve fiber blockade?
- Autonomic, sensory, then motor.
- Sensory, autonomic, then motor.
- Sensory, motor, then autonomic.
- Motor, autonomic, then sensory.
Correct Answer

A. Autonomic, sensory, then motor.

Explanation

The correct order of nerve fiber blockade is autonomic, sensory, then motor. This means that the autonomic nerves, which control involuntary bodily functions, are blocked first. Then, the sensory nerves, responsible for transmitting sensations such as pain, are blocked. Finally, the motor nerves, which control movement, are blocked. This order ensures that the patient does not feel pain or discomfort during a procedure, while still allowing them to maintain some motor function.

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38.

The addition of epinephrine to bupivacaine, ropivacaine, or etidocaine has which effect on their duration of action?
- Increase
- Decrease
- No change
Correct Answer

A. No change

Explanation

Epi is effective for increasing DOA of short acting and intermediate acting drugs, clinically does not really effect DOA of long acting drugs because they are already long

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39.

The arrhythmogenic effect of bupivacaine is probably a result of the ________ of both fast Na+ and slow Calcium channels.
- Inhibition
- Excitation
Correct Answer

A. Inhibition

Explanation

Typically will cause v-fib/v-tach

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40.

Local anesthetics produce reversible binding at the site of sodium channels in nerves in all of the following states EXCEPT:
- Closed/Resting
- Open
- Inactivated
Correct Answer

A. Closed/Resting

Explanation

Local anesthetics work by binding to sodium channels in nerves, blocking the conduction of nerve impulses and producing a reversible loss of sensation. They primarily bind to the open and inactivated states of the sodium channels, preventing the influx of sodium ions and inhibiting nerve cell depolarization. However, they do not bind to the closed/resting state of the sodium channels, as this is the state in which the channels are not actively conducting impulses. Therefore, local anesthetics do not have an effect on the closed/resting state of sodium channels.

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41.

0.5-2mg/kg of _______ terminates seizure activity.

Correct Answer
propofol

Explanation
Propofol is a medication commonly used for anesthesia induction and maintenance, as well as for terminating seizure activity. It is administered intravenously in a dose range of 0.5-2mg/kg. This dosage is effective in stopping seizures and restoring normal brain activity. Propofol works by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces neuronal excitability. By increasing GABA's activity, propofol helps to control and terminate seizure activity.

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42.

What is the max dose of epinephrine your are able to mix with your local anesthetic?
- 200-250 mcg or 3-5 mcg/kg
- 100-175 mcg or 1.5-2.5 mcg/kg
- 50-100 mcg or 0.5-1 mcg/kg
- 250-500 mcg or 5-10 mcg/kg
Correct Answer

A. 200-250 mcg or 3-5 mcg/kg

Explanation

Use the 1:200,000 concentration (5 mcg/mL)

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43.

Which of the following are contraindications to the addition of epi to your LA?
- Unstable angina
- Cardiac dysrhythmias
- Uncontrolled HTN
- Uteroplacental insufficiency
- Areas that lack collateral blood flow such as the fingers/toes
Correct Answer(s)

A. Unstable angina
A. Cardiac dysrhythmias
A. Uncontrolled HTN
A. Uteroplacental insufficiency
A. Areas that lack collateral blood flow such as the fingers/toes

Explanation

The addition of epi to local anesthesia should be avoided in patients with unstable angina, cardiac dysrhythmias, uncontrolled hypertension, uteroplacental insufficiency, and areas that lack collateral blood flow such as the fingers/toes. These conditions can increase the risk of adverse cardiovascular events or compromise blood flow to vital organs or extremities, making the use of epi in local anesthesia contraindicated.

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44.

Metabolites of prilocaine, which accumulate after large doses of drug (>10mg/kg), convert hemoglobin to __________.

Correct Answer(s)
methemoglobin

Explanation
Benzocaine can also cause methemoglobinemia.

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45.

The greatest systemic absorption of local anesthetics occurs with _______ nerve blocks followed by caudal then epidural.

Correct Answer(s)
intercostal

Explanation
Peripheral nerve blocks are a less likely source of systemic absorption unless accidentally injecting IV - always aspirate prior to injection.

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46.

LA produce a differential blockade in which different modes of nerve transmission are interrupted in an equal fashion. Which list below demonstrates the correct order:
- Motor function, proprioception, sharp pain
- Proprioception, light touch, temperature sensation
- Sharp pain, motor function, light touch
- Temperature sensation, sharp pain, light touch
Correct Answer

A. Temperature sensation, sharp pain, light touch

Explanation

LA stands for local anesthetics. Local anesthetics produce a differential blockade, meaning that they interrupt different modes of nerve transmission in an equal fashion. In this case, the correct order of nerve transmission interruption by LA is temperature sensation, sharp pain, and light touch.

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47.

Symptoms of LOCAL local anesthetic toxicity include all of the following except:
- Pain, hematoma, and abscess
- Ecchymosis
- Tissue necrosis
- Visual disturbances
Correct Answer

A. Visual disturbances

Explanation

Symptoms of local anesthetic toxicity can include pain, hematoma, abscess, ecchymosis, and tissue necrosis. However, visual disturbances are not typically associated with local anesthetic toxicity. Visual disturbances may be a side effect of other medications or conditions, but they are not a characteristic symptom of local anesthetic toxicity.

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48.

_____________ is the most cardiac toxic LA.

Correct Answer
Bupivacaine

Explanation
Also: etidocaine and ropivacaine (dissociates faster)

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49.

}The Cmin for local anesthetics can be defined as the lowest concentration of drug that is needed for blocking impulse propagation. The Cmin value can very depending on the temperature, pH or _____ concentration of the bathing solution.

Correct Answer
Calcium
Ca

Explanation
Cm requirements go up with temperature and hypercalcemia.

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Grant CRNA Local Anesthetics Quiz Review

Quiz Preview

The pKa's of local anesthetics range from 7.6-9.1 with one exception of chloroprocaine which has a really high pKA. Chloroprocaine still has a very fast onset of action due to being used in high concentrations (3%).

How do we increase the pH of a local anesthetic in order to increase the amount of drug in the nonionized form when injected into tissue?

Lipid solubility will ______ potency and duration of action.

Various concentrations of local anesthetics will provide various types of blocks. For example: 0.125% Bupivicaine only blocks _______ while 0.5% blocks sensory and motor

Voltage gated Na+ channels are found only in the nerve’s _____.

Increased lipid solubility correlates with increased protein binding, increased potency, longer duration of action and a higher tendency for severe _______ (especially cardiac).

CNS depression associated with CNS toxicity reflects selective depression of inhibitory cortical neurons, leaving excitatory pathways unopposed.

Chemically, local anesthetics have three characteristic traits:1. An intermediate carbon group separates2. an unsaturated “aromatic” ring system from3. a tertiary amine. The aromatic ring provides lipophilic characteristics, whereas the amine gives hydrophilicity to the molecule.

Higher max doses of local anesthetic are allowed with vasoconstrictor added.

Esters are metabolized almost exclusively in the liver by the microsomal cytochrome-P-450

The non-ionized form diffuses into the nerve axon while the ionized form binds to receptors on sodium channels when the channel is in the inactivated state.

Esters are mostly eliminated via metabolism by:

Containing a preservative is an absolute contraindication to administering a LA into a neuraxial compartment.

LA _______ non-depolarizing muscle relaxant blockade.

Which of the following local anesthetics is 95% protein bound and has the greatest duration of action?

The addition of epinephrine or, less commonly, phenylephrine causes ______ rate of absorption and of peak plasma concentrations.

What is the MOST LIKELY cause of local anesthetic toxicity?

You are performing a nerve block on your patient when they begin having a tonic clonic seizure. Initial seizure treatment includes providing O2, airway control, midazolam and ________ their respiratory rate.

This type of local anesthetics are broken down to para-aminobenzoic acid (PABA) which is a known allergen potentially causing localized edema, urticaria, bronchospasm, and anaphylaxis.

Local anesthetics must bind with at least ______ successive nodes of Ranvier to be effective.

____________ is ideally suited for topical anesthesia. It has a pKa of 3.5, making it completely ionized in a pH of 7.4 It comes in a 20% solution, delivering 200-300 mg per brief spray. Methemoglobinemia may occur with doses over 300 mg.

Cocaine has vasoconstrictive properties because of its ability to block the reuptake of _________.

Nerve conduction is determined mainly by 2 factors: nerve fiber diameter and the degree of ________, which determines conduction velocity.

When considering duration of action, the lipid solubility of a drug is more important than its protein binding.

Echthiophate, neostigmine, pyridostigmine, and edrophonium are for drugs that ________ ester LA activity.

The rate of metabolism of amides is agent dependent.

________ is the most toxic ester due to it being hydroloyzed more slowly than other esters.

Pregnancy, liver diseases, the 1st 6 months of life, and atypical plasma cholinesterase all ________ the DOA of ester local anesthetics.

All of the following increase the risk of LA toxicity except?

The Cm (minimum blocking concentration) or motor fibers is about ____ that of sensory fibers.

If a local anesthetic is injected into venous system, less drug gets to systemic circulation due to uptake by the _____ (first pass uptake).

Ropivacaine, lidocaine, and cocaine are vasoconsctrictors

All of the following are symptoms of methemoglobinemia EXCEPT:

Local Anesthetics that have a longer duration of action preferentially bind to the _____ protein chain of the nerve and less to albumin

Which of the following receives the greatest amount of LA from distribution due to its greater tissue mass?

Which of the following describes the correct order of nerve fiber blockade?

The addition of epinephrine to bupivacaine, ropivacaine, or etidocaine has which effect on their duration of action?

The arrhythmogenic effect of bupivacaine is probably a result of the ________ of both fast Na+ and slow Calcium channels.

Local anesthetics produce reversible binding at the site of sodium channels in nerves in all of the following states EXCEPT:

0.5-2mg/kg of _______ terminates seizure activity.

What is the max dose of epinephrine your are able to mix with your local anesthetic?

Which of the following are contraindications to the addition of epi to your LA?

Metabolites of prilocaine, which accumulate after large doses of drug (>10mg/kg), convert hemoglobin to __________.

The greatest systemic absorption of local anesthetics occurs with _______ nerve blocks followed by caudal then epidural.

LA produce a differential blockade in which different modes of nerve transmission are interrupted in an equal fashion. Which list below demonstrates the correct order:

Symptoms of LOCAL local anesthetic toxicity include all of the following except:

_____________ is the most cardiac toxic LA.

}The Cmin for local anesthetics can be defined as the lowest concentration of drug that is needed for blocking impulse propagation. The Cmin value can very depending on the temperature, pH or _____ concentration of the bathing solution.

Various concentrations of local anesthetics will provide various types of blocks. For example: 0.125% Bupivicaine only blocks _______ while 0.5% blocks sensory and motor