Adjuvant or Adjunct Analgesics

Question 1

what are adjuvant analgesics?

Answer 1

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

Question 2

what might adjuvant analgesics be used for?

Answer 2

acute pain
chronic pain
neuropathic pain
cancer pain

Question 3

what can you use antidepressants for?

Answer 3

chronic pain

Question 4

how do tranquilizers or anxiolytics modify pain signals?

Answer 4

target descending modulation of pain

Question 5

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

Answer 5

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

Question 6

what is the NMDA receptor responsible for?

Answer 6

induction and maintenance of central sensitization (wind up)

Question 7

what drugs are available for NMDA receptor antagonists?

Answer 7

ketamine
amantadine
memantine

Question 8

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

Answer 8

up to 6 weeks

Question 9

what can gabapentin do with preexisting neurologic weakness?

Answer 9

may exacerbate weakness

Question 10

how does renal insufficiency affect gabapentin?

Answer 10

half life and accumulation of metabolites increases with renal insufficiency

Question 11

is tramadol labeled for use in veterinary species?

Answer 11

no

Question 12

how do tricyclic antidepressants work?

Answer 12

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

Question 13

what are the types of adjuvant analgesics?

Answer 13

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

Question 14

what are adjuvant analgesics used for?

Answer 14

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

Question 15

are adjuvant analgesics harder to dose?

Answer 15

often yes

Question 16

how are corticosteroids used?

Answer 16

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

Question 17

what is ketamine useful for?

Answer 17

acute and chronic pain
prevents central sensitization

Question 18

is ketamine given alone at a low dose CRI?

Answer 18

no

Question 19

do low doses of ketamine cause dissociative effects?

Answer 19

no

Question 20

what is amantadine studied to do?

Answer 20

chronic osteoarthritis pain

Question 21

what is amantadine?

Answer 21

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

Question 22

what are the side effects of amantadine in animals?

Answer 22

appetite suppression
agitation
diarrhea

Question 23

what is the metabolism of amantadine?

Answer 23

negligible

Question 24

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

Answer 24

neuropathic pain
chronic pain

Question 25

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

Answer 25

yes

Question 26

how long does gabapentin take to help?

Answer 26

can be 24 hours chronic pain might take a long time

Question 27

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

Answer 27

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

Question 28

should you taper when you stop gabapentin?

Answer 28

yes

Question 29

is gabapentin proven to work for acute pain?

Answer 29

no do not know doses for acute or chronic pain

Question 30

what does tramadol do?

Answer 30

weak mu opioid agonist inhibitory effects on serotonin and norepinephrine reuptake

Question 31

how is metabolism of tramadol to its active form achieved?

Answer 31

polymorphic cytochrome P450 2D6 isozyme varies with genetics

Question 32

does tramadol work well in cats?

Answer 32

yes- if can get into

Question 33

what should you not give tramadol with?

Answer 33

tricyclic amines serotonin reuptake inhibitors monoamine oxidase inhibitors

Question 34

do serotonin reuptake inhibitors work well for analgesia?

Answer 34

no- only potentiate one of pathways

Question 35

how do tricyclic antidepressants work?

Answer 35

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