7/8: Preanesthetic Meds Flashcards
What are advantages of using anticholinergics as part of pre-anesthetic meds?
Prevention of salivation, airway secretions, bradycardia
What are advantages of using maropitant as a pre-anesthetic med?
Prevention of nausea and vomiting;
It also provides adjuct analgesia (NK-1 antagonist) and decreases inhalant requirements
What are 5 general advantages to using pre-anesthetic meds?
- Chemical restraint
- Decreased stress/anxiety –> decreased catecholamines –> decreased risk of arrhythmias
- Decreased induction and inhalant anesthetic doses
- Pre-emptive analgesia
- Smooth recovery
What is pre-emptive analgesia?
Treatment initiated before surgery in order to prevent the establishment of central sensitization evoked by incisional and inflammatory injuries occurring during surgery and in the early post-op period.
What are 4 disadvantages to using pre-anesthetic meds?
- Bradycardia
- Hypotension
- Excitement/dysphoria
- Nausea/vomiting
What pre-anesthetic med types cause bradycardia?
Alpha-2 agonsists, opioids
What pre-anesthetic med types cause hypotension?
Acepromazine, alpha-2 agonists
What pre-anesthetic med types cause excitement/dysphoria?
Opioids, benzos
What pre-anesthetic med types cause nausea/vomiting?
Mu-agonist opioids, dexmedetomidine
What are 6 factors to consider when selecting a pre-anesthetic medication?
- Species
- Health status of patient
- Pain (existing and expected)
- Temperament
- Duration of procedure
- Anticipated side effects of drugs administered
What 4 drug types can be used as analgesics?
- Opioids
- Dissociatives
- NSAIDs
- Alpha-2 agonists, maropitant
What 2 drugs can be used as anticholinergics?
- Atropine
- Glycopyrrolate
What 3 drug types can be used as tranquilizers/sedatives (neuroleptics)?
- Phenothiazines
- Alpha-2 agonists
- Benzos
What 3 categories of drugs are used for premeds?
Opioids, sedatives/tranquilizers, anticholinergics
What 5 opioid drugs are pure mu agonists?
- Hydromorphone
- Fentanyl
- Morphine
- Methadone
- Oxymorphone
What opioid drug is a mixed kappa agonist/mu antagonist?
butorphanol
What opioid drug is a partial mu agonist?
Buprenorphine
What opioid drugs are full mu antagonists?
Naloxone, naltrexone
What are the 3 opioid receptors?
mu, kappa, delta
Where are opioid receptors located?
In peripheral and central nervous systems
What is the mechanism of action for opioids?
Opioid receptors are coupled with inhibitory G-proteins (GPCRs) which activate 2nd messenget systems in cells
What are the 2nd messenger systems that are activated by G-proteins?
- Closing of Ca channels
- Efflux of K –> hyperpolarization
- Decreased cAMP production
What are 4 overall results that opioids have on cells?
- Hyperpolarization
- Decreased neuronal excitability
- Decreased neurotransmitter release
- Decreased transmission of nerve impulses
Naxolone is such a weak mu _____ that we consider it an _____.
agonist, antagonist
Effects of mu/kappa agonists are _____ dependent, and there is no _____ effect.
dose, ceiling
What are some clinical side effects cause by mu agonists?
- Analgesia
- Inhalant sparing
- Mild to profound sedation
- Bradycardia
- Respiratory depression
- GI: nausea, vomiting, decreased motility
- Urinary retention
- Hyperthermia in cats
What does it mean if a drug has a ceiling effect?
Increased dose does not = increased analgesia
What 2 opioid types have a ceiling effect?
Partial mu agonists (Buprenorphine)
K agonist/mu antagonist (Butorphanol)
What can Butorphanol be used with?
Dexmedetomidine
What type of analgesia do opioids provide?
Somatic and visceral
When do opioids provide mild sedation?
When used alone
What mild CV effects do opioids have?
- Decreased HR due to increased vagal tone –> anticholinergic
- Little/no effect on vasculature (histamine release)
- Little/no effect on cardiac contractility
Opioids _____ the MAC of inhalant.
decrease
When should you use full mu agonists?
With moderate to severe pain
What is the duration of action of hydro/oxymorphone?
2-4 hours
What is the duration of action of morphine/methadone?
4-6 hours
Methadone is an NMDA _____.
antagonist
What effects can morphine have on vasculature?
Histamine release
A side effect of full mu agonists is ______ to ______ analgesia.
moderate, severe
What is a CV side effect that mu agonists cause?
bradycardia
What GI side effects do mu agonists cause?
Nausea, vomiting, defecation
What do mu agonists cause in cats specifically? (side effect)
hyperthermia
What can you give together with hydromorphone to mitigate the side effects?
fentanyl
What type of drug is fentanyl?
pure mu agonist
What is the duration of fentanyl?
15-30 min
What is done to mitigate the short duration of fentanyl?
Given IV as a CRI
What is a CV side effect of fentanyl?
Bradycardia (> other mu agonists)
What are GI side effects of fentanyl?
No vomiting; may cause nausea
Fentanyl can cause respiratory _____.
depression
What should be monitored intra-op when fentanyl is on board?
EtCO2, IPPV
What should be monitored post-op when fentanyl is on board?
SpO2
What are 3 ways that we use fentanyl?
- Induction agent in critically ill SA patients
- Intra-op and post-op CRI
- Patch (post-op)
Buprenorphine produces _____ sedation, and _____ to _____ analgesia.
mild, mild, moderate
What is the onset of buprenorphine?
30-45 min (slow)
What is the duration of buprenorphine in dogs and cats?
Dogs = 4-10 hours
Cats = 6-12 hours
Buprenorphine has a strong _____ for the mu receptor.
affinity
When should you not use buprenorphine as a pre-med?
If the procedure is painful
What is a disadvantage of buprenorphine?
It is difficult to reverse
What is the SA dose of buprenorphine?
0.01 - 0.04 mg/kg
How does buprenorphine compare to mu agonists?
It has LESS:
- Respiratory depression
- Panting
- Bradycardia
- Analgesia, MAC sparing
- No nausea, vomiting
What is the new, long acting formulation of buprenorphine approved for cats?
Simbadol - 0.24 mg/kg SQ SID
Because butorphanol is a mu antagonist, it is a partial _____ _____.
reversal agent
Butorphanol provides _____ sedation and analgesia.
mild
How long does sedation with butorphanol last? Analgesia?
Sedation = 1-2 hours
Analgesia = ~90 min
How does butorphanol compare to mu agonists?
It has LESS:
- Respiratory depression
- Panting (seen at higher doses)
- Bradycardia
- Analgesia, MAC sparing
- No nausea/vomiting