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FCP week 2 > 2- Types of premeds > Flashcards

2- Types of premeds Flashcards

1
Q

List the 6 drug groups of pre-medications

A

Opioids
Alpha-2 agonist
Phenothiazines
Benzodiazepine
NMDA Receptor antagonists
Anticholinergics

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2
Q

Give 3 examples of an opiod

A

Methadone
Fentanyl
Pethidine
Buprenorphine
Butorphanol

(Morphine - but not licensed)

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3
Q

Why is an opioid included in a pre-med?

A

Provide sedation & analgesia

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4
Q

What are the 4 receptors opioids act at?

A

MU
Kappa
Delta
Nociception

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5
Q

What receptors does butorphanol act at and What is its limitation?

A

MU antagonist & Kappa agonist

Provides good sedation but is has poor and short-lived analgesia

Would be ideal for non-painful procedures

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6
Q

T/F Methadone and Fentanyl are Full MU agonsits

A

True

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7
Q

Which types of opioids have the most analgesic effects

A

Full Mu agonists
methadone, fentanyl, pethidine and morphine

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8
Q

What effect does an opioid have on the GI system?

A

Reduce motility & decreases gastric emptying

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9
Q

What effects do opioids have on cardiovascular system

A

cause minimal cardiovascular depression and are often used in very sick patients

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10
Q

What drug antagonises opioids?

A

Naloxone

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11
Q

Give 2 examples of an alpha-2 agonist

A

Medetomidine
Dexmedetomidine
Xylazine
Detomidine
Romifidine

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12
Q

Which alpha-2 agonists are most commonly used in small animal practice

A

Medetomidine and dexmedetomidine

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13
Q

Why is xylazine less commonly used in small animals?

A

Poor affinity for alpha 2- receptors thus more side effects

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14
Q

What is the aim of an alpha-2 agonist?

A

Profound dose dependant sedation & good analgesia (short-lived)

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15
Q

What is detomidine licensed for

A

is licenced in horses and cattle

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16
Q

What effect do alpha-2 agonists have on the liver?

A

reduced blood flow to the liver & hepatic metabolism , shouldn’t use it in liver disease patients

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17
Q

Alpha 2 agonists have significant effects on what system?

A

Cardiovascular

18
Q

Why wouldn’t you use an alpha 2 agonist in a unstable diabetic patient?

A

Reduces endogenous insulin secretion = causes transient hyperglycaemia

19
Q

What drug do you use to antagonise an alpha-2 agonist?

A

Atipamezole

20
Q

What effect does alpha-2 agonist have on MAC

A

They have marked drug sparing effects
they reduce MAC and therefore the amount of inhalation agent required and the amount of induction agent.

21
Q

What can alpha-2 agonist do in cats

A

They can cause emesis, particularly in cats if used alone

22
Q

What is the only licensed phenothiazine? & what is its aim?

A

Acepromazine (ACP) - contributes to sedation & provides anxiolytics

NO ANALGESIC PROPERTIES

23
Q

What receptors do phenothiazines work out?

A

Centrally acting by antagonising D1/D2 receptor

Also act on alpha-1 muscarinic & H1 receptors

24
Q

What role does alpha-1 antagonism have on blood vessels? & why is this a problem with phenothiazines

A

Vasodilation

Antagonise alpha 1 receptors = use causes vasodilation causing hypotension & hypothermia

Also can’t antagonise this drug which means this effect can be difficult to manage

25
Q

How long does it take for phenothiazines to take effect

A

relatively slow to effect taking about 30-40 minutes when administered by IM injection and lasts about 6-8 hours in healthy animals

26
Q

Define Neuroleptanalgesia

A

is the combination of an opioid and a tranquilizer or sedative and reduces the amount of each required and results in improved sedation.

So this is what you’d get if you combined an opioid and acepromazine.

27
Q

List the 2 Benzodiazepines and what animals they are licensed in

A

Midazolam (horses) & Diazepam (Dogs/cats)

28
Q

What receptor do benzo’s work at?

A

GABA-A receptor

29
Q

What is the aim of benzos?

A

Anxiolysis, sedation & hypnosis
(Not an analgesic)

The degree of sedation is poor - not something you’d give to healthy patient.

Good for sicker patients as minimal resp and cardio depression

30
Q

Benzos are also used for..

A

seizing patients as they are anti-convulsants

31
Q

What is the antagonist called for benzodiazepines?

A

Flumazenil

32
Q

What drug class is Ketamine under?

A

NMDA receptor antagonists

33
Q

At high doses ketamine is a …

A

Dissociative anaesthetic

34
Q

At low doses ketamine results in…

A

Sedation

35
Q

When ketamine is used alone it is a poor…..thus we combine it with….

A

Muscle relaxant = Miadazolam(benzo) or alpha 2

36
Q

How long does ketamine tend to last

A

It’s relatively short acting (30-45 minutes)

37
Q

What effects do anticholinergics have?

A

Reduce bradycardia, respiratory tract secretions

38
Q

Name some examples of anticholinergics

A

Atropine, Glycopyrrolate

39
Q

What are the side effects of anticholinergics in the premed

A

mydriasis, reduced gut motility, bronchodilation etc.
so not routinely used in premed

40
Q

What Is alfaxalone?

A

Neuroactive steroid

41
Q

What type of receptors do birds have a high proportion of

A

kappa receptors
means that butorphanol which is a MU agonist and kappa agonist could be a good choice for pre-med in birds

42
Q

Which animals should alpha-2 agonists not be used in

A

need to be careful in blocked animals
sick animals due to cardio effects
unstable diabetics

FCP week 2 (40 decks)

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