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Anesthesia and Analgesia > Adjuvant or Adjunct Analgesics > Flashcards

Adjuvant or Adjunct Analgesics Flashcards

1
Q

what are adjuvant analgesics?

A

drugs with a primary indication other than pain, but with analgesic properties under certain circumstances

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2
Q

what might adjuvant analgesics be used for?

A

acute pain
chronic pain
neuropathic pain
cancer pain

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3
Q

what can you use antidepressants for?

A

chronic pain

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4
Q

how do tranquilizers or anxiolytics modify pain signals?

A

target descending modulation of pain

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5
Q

how can sub-anesthetic doses of alpha 2 agonists be used?

A

added to epidural opioids or local anesthetics to prolong and increase analgesia for acute pain
postoperative or post trauma “micro dose” infusions

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6
Q

what is the NMDA receptor responsible for?

A

induction and maintenance of central sensitization (wind up)

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7
Q

what drugs are available for NMDA receptor antagonists?

A

ketamine
amantadine
memantine

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8
Q

how long can it take for the effects of amantadine to be notable?

A

up to 6 weeks

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9
Q

what can gabapentin do with preexisting neurologic weakness?

A

may exacerbate weakness

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10
Q

how does renal insufficiency affect gabapentin?

A

half life and accumulation of metabolites increases with renal insufficiency

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11
Q

is tramadol labeled for use in veterinary species?

A

no

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12
Q

how do tricyclic antidepressants work?

A

potentiate descending spinal inhibitory pathways by blocking presynaptic re-uptake of 5HT and norepinephrine

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13
Q

what are the types of adjuvant analgesics?

A

NMDA receptor antagonists: acute and chronic
antiepileptic drugs: acute and chronic
antidepressants: chronic
alpha2 agonists: acute
corticosteroids: acute and chronic
muscle relaxants: acute and chronic
bisphosphonates: chronic bone tumor pain

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14
Q

what are adjuvant analgesics used for?

A

chronic, maladaptive or cancer pain
sometimes acute
neuropathic and nociceptive pain
rarely used as first-line/alone

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15
Q

are adjuvant analgesics harder to dose?

A

often yes

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16
Q

how are corticosteroids used?

A

local irritations/inflammations, autoimmune disease, cancer, nerve damage
nerve or joint injection

17
Q

what is ketamine useful for?

A

acute and chronic pain
prevents central sensitization

18
Q

is ketamine given alone at a low dose CRI?

A

no

19
Q

do low doses of ketamine cause dissociative effects?

A

no

20
Q

what is amantadine studied to do?

A

chronic osteoarthritis pain

21
Q

what is amantadine?

A

release of dopamine from nerve terminals
stimulation of norepinephrine response
weak NMDA antagonist
anticholinergic

22
Q

what are the side effects of amantadine in animals?

A

appetite suppression
agitation
diarrhea

23
Q

what is the metabolism of amantadine?

A

negligible

24
Q

what can anti-epileptic (gabapentin) drugs be used for?

A

neuropathic pain
chronic pain

25
Q

is the starting dose of gabapentin for seizures higher than that for pain?

A

yes

26
Q

how long does gabapentin take to help?

A

can be 24 hours
chronic pain might take a long time

27
Q

how often should gabapentin be given to a dog to maintain targeting plasma concentrations?

A

several times a day- 3 times
every 6 hours for cats

28
Q

should you taper when you stop gabapentin?

A

yes

29
Q

is gabapentin proven to work for acute pain?

A

no
do not know doses for acute or chronic pain

30
Q

what does tramadol do?

A

weak mu opioid agonist
inhibitory effects on serotonin and norepinephrine reuptake

31
Q

how is metabolism of tramadol to its active form achieved?

A

polymorphic cytochrome P450 2D6 isozyme
varies with genetics

32
Q

does tramadol work well in cats?

A

yes- if can get into

33
Q

what should you not give tramadol with?

A

tricyclic amines
serotonin reuptake inhibitors
monoamine oxidase inhibitors

34
Q

do serotonin reuptake inhibitors work well for analgesia?

A

no- only potentiate one of pathways

35
Q

how do tricyclic antidepressants work?

A

potentiate descending spinal inhibitory pathways by blocking presynaptic re-uptake of 5HT and NE

Anesthesia and Analgesia (19 decks)

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