Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ANESTHESIA - 2 > 43 – Acute and Chronic Pain Management in Horses > Flashcards

43 – Acute and Chronic Pain Management in Horses Flashcards

1
Q

What are the consequences of pain?

A
  • Anxiety or fear
  • Behavioural changes
  • Contralateral limb laminitis
  • Ileus: cecal impactions
  • QOL concerns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

**Pain pathway

A
  1. Transduction: touching something hot or cold
  2. Transmission: brain gets pain message and transmits it to CNS for appropriate response
  3. Modulation: brain and dorsal horn of SC decides how much to react to transmission
  4. Perception: life experience and cultural environment influence this (ex. males are less pain tolerant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

**How do you recognize and assess pain in horses?

A
  • Stiffly backwards ears
  • Orbital tightening
  • Tension above eye area
  • **Prominent strained chewing muscles
  • Mouth strained and pronounced chin
  • Strained nostrils and flattening of profile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

**Obel laminitis grading scale

A
  • Grade 1: shifts weight at rest, sound at walk
  • Grade 2: stilted at walk, turns with great difficulty, but forelimb can be lifted
  • Grade 3: reluctant to walk, 1 forelimb can only be lifted with great difficulty
  • Grade 4: only moves if forced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Drugs used for mild pain

A
  • NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Drugs used for moderate pain

A
  • NSAIDs
  • Gabapentinoids
  • Opioids
  • Alpha-2 agonists
  • Local anesthetics
  • CRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Drugs used for severe (treatable) pain

A
  • Opioids
  • Opioids + alpha-2 agonists
  • Local anesthetics
  • CRI
  • Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

‘Drugs’ used for severe (uncontrollable) pain

A
  • Euthanasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NSAIDs effects

A
  • Anti-inflammatory
  • Anti-pyretic
  • Analgesic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Examples of NSAIDs in horse med

A
  • Colic
  • Flunixin meglumine (VISCERAL PAIN)
  • Phenylbutazone (MUSCULOSKELTAL PAIN
  • Ketoprofen
  • Firocoxib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Flunixin meglumine (effects and side effects)

A
  • Side effects
    o GI, renal, intestinal healing delayed
  • Anti-endotoxic
  • Anti-inflammatory
  • Prevents intra-abdominal adhesion formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Phenylbutazone (effects and side effects)

A
  • Musculoskeletal pain: acute and chronic
  • Can cause right dorsal colitis: consider weight of patient, RESTRICT owner access
    o Typically, clients overdose (issue if given for a long time!)
  • Side effects
    o GI, renal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fibrocoxib (type and effects)

A
  • COX 2 selective
    o Spares the GI and renal systems
    o Less potential complications/side effects
  • Osteoarthritis pain
  • *Long term pain management
  • Need to use the horse formulation (used to use dog formulation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acetaminophen

A
  • NOT an NSAID
  • Adjunct therapy
  • Analgesic
  • Antipyretic
  • Dose 30mg/kg PO BID
  • Best if used in conjunction with NSAID
  • *laminitis, lameness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are gabapentinoids mechanism of action for pain?

A
  • Changes to VG calcium channels
  • Changes to NDMA receptor expression and binding
  • *gabapentin: poor oral bioavailability in horses
  • Ex. pregabalin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pregabalin

A
  • Better oral bioavailability in horses
  • Chronic pain: laminitis, trauma
  • Dose 2-4mg/kg PO BID – TID
  • Can take a couple of days to see affect
  • Usually start at high dose then taper
  • Can alter mentation (ex. small animal=not as excited to see owner)
17
Q

*Alpha-2 agonists examples and uses

A
  • Xylazine, detomidine, romifidine
  • *Sedatives
  • Visceral analgesics
  • Reduces GI motility
  • CV effects (not a big issue in most cases)
  • *synergism with opioids (ex. alpha-2 agonists + butorphanol)=when they work the best!
18
Q

Alpha-2 agonist sedation effect via

A
  • Activation of CNS alpha-2 receptors
19
Q

Xylazine uses

A
  • Short half life (~30mins)
  • Moderate to severe pain
  • Subjectively assess pain severity (‘diagnostic aid’)
    o If only lasts 15mins=horse is probably more painful then you think
20
Q

Detomidine duration of action

A
  • 1-1.5 hrs
  • If still not working=add butorphanol
21
Q

What is the most commonly used opioid in horse?

A
  • Butorphanol
    o Kappa agonist, mu antagonist
22
Q

Butorphanol uses

A
  • Analgesic
  • Mild to moderate visceral pain (NOT severe pain)
  • Sedative
  • Reduces GI motility
  • Analgesic dose: 0.1-0.2 mg/kg q2-4hrs
  • *cost prohibitive
  • *good for standing procedure (reduces ‘excitability’ due to xylazine)
23
Q

What are the other opioids used in horses?

A
  • Buprenorphine
  • Morphine (full mu agonist)
  • Fentanyl patch (full mu agonist)
  • Hydromorphone (full mu agonist)
24
Q

Buprenorphine in horses

A
  • Partial mu agonist
  • Longer duration of action
  • Local anesthesia: include in nerve blocks
  • Not used often, but can be if needed
25
Q

Morphine in horses

A
  • Intramuscular, CRI, epidural
  • Side effects can be severe if IV
26
Q

What are the side effects with morphine IV in horses?

A
  • Excitement
  • Disorientation
  • Ataxia
  • Ileus
  • If epidural: ‘irritated’: rub hair away
  • *can be administered with alpha-2 agonist or acepromazine
27
Q

NMDA antagonists: ketamine

A
  • Decreases glutamate binding the NMDA receptor in dorsal horn
    o ‘knocks’ out memory of pain
  • *acute and chronic pain (block central sensitization)
  • Intramuscular (low dose), *CRI or epidural
  • Side effects:
    o Excitement (not great for fracture repair), stiff walking
28
Q

Lidocaine uses (MOST COMMON)

A
  • **Potentiates analgesic actions of opioids and alpha-2 agonists
  • Used locally and systemically
  • Prokinetic GI motility (usually works within first 24hrs)
    o Treatment for post-op ileus
    o Anti-inflammatory
  • Decreases requirements for inhalant and infectable anesthetics
  • Concurrent administration with flunixin allows for decrease in flunixin dose (improves intestinal healing)
  • *used for colic surgeries CRI
  • 5-20 mins onset
29
Q

Mepivacaine duration of action

A
  • 2-3 hours
30
Q

Bupivacaine duration of action

A
  • 6hrs
  • Ex. used for lameness exams
31
Q

Routes of administration in horses

A
  • Parenteral
  • IV or IM
  • CRI
  • Trans-dermal: fentanyl
  • Epidural
32
Q

What drugs are given IV or IM?

A
  • NSAIDs
  • Alpha-2 agonists
  • Butorphanol
  • Morphine
  • Buscopan
33
Q

What drugs are given CRI?

A
  • Butorphanol/morphine
  • Lidocaine
  • Ketamine
  • Dexmedetomidine
34
Q

What drugs are used for epidural and what is the location?

A
  • Ketamine
  • Morphine
  • Alpha-2 agonists
  • *C1-C2
  • *epidural catheter (coccygeal vs. cervical)
35
Q

Laminitis

A
  • Common (rotation of coffin bone with capsule=separation of lamina)
    o Sinking or rotation of P3
    o Inflammation has no place to go=challenging to control the pain
  • Don’t need to know specific drugs used
36
Q

How do you decide what to use?

A
  • Acute vs. chronic pain
  • If NSAID not controlling pain=add another medication
  • *multimodal
  • Treat before onset of pain always
    o Pre-op analgesia or local blocks
  • Colic pain: surgical option?
  • Laminitis: how long has it been treated for?
    o Adjunct therapies
    o Treat underlying cause
37
Q

What are some adjunct therapies for laminitis?

A
  • Icing feet
  • Pads
  • Deep bedding (sand)
38
Q

What might be some underlying causes of laminitis?

A
  • Endocrine disease
  • Sepsis
  • Contralimb
39
Q

ADD TREATMENTS FROM CANVA

A

ANESTHESIA - 2 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions