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Pharm Decisions > Alternative Analgesia > Flashcards

Alternative Analgesia Flashcards

1
Q

Grapiprant is a non-COX-inhibiting prostaglandin receptor antagonist that specifically blocks which receptor?

A

(EP4, this receptor is found to be upregulated in the joint(s) of dogs with OA and is an important receptor for mediating pain and inflammation)

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2
Q

(T/F) Grapiprant is effective when compared to other NSAIDs.

A

(F, has not been compared to other NSAIDs only to a placebo but it is effective against the placebo and the clinical experience so far is positive, some studies have been done to compare but not in terms of what grapiprant is supposed to be used for (OA))

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3
Q

How long should grapiprant be given before stopping because no improvement was seen?

A

(At least 7 days)

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4
Q

Grapiprant is safe given up to 15x the label dose for a long time but there are possible ADEs, what are the primary ADEs seen with this drug?

A

(Vomiting and diarrhea, diarrhea can sometimes be voluminous and hemorrhagic)

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5
Q

(T/F) Grapiprant should be used with caution in MDR1 dogs.

A

(T, MDR1 dogs so have lower clearance when compared to non-MDR1 dogs, 8 MDR1 dogs were placed on it and 2/8 had vomiting and 1/8 had hypoalbuminemia (honestly doesn’t seem super significant like you can’t use it, just use caution))

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6
Q

(T/F) Grapirant is useless for fevers.

A

(T, EP4 receptors are not involved in generation of pyrexia so grapiprant cannot do anything for a fever)

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7
Q

Where else in the body are EP4 receptors abundantly expressed besides joints in dogs with OA?

A

(The heart, the clinical relevance of this is unknown but use with caution in cardiac dz patients)

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8
Q

EP4 is a vasodilator/vasoconstrictor (choose).

A

(Vasodilator)

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9
Q

EP4 increases/decreases (choose) GI motility.

A

(Decreases, some other GI effects are increased bicarbonate secretion and increased gastric and intestinal healing)

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10
Q

(T/F) Grapiprant is poorly absorbed in cats so concentrations achieved are not therapeutic (when compared to therapeutic concentrations in dogs).

A

(F, cats achieve concentrations similar to therapeutic concentrations in dogs but in one study, more cats needed rescue analgesia on grapiprant compared to carprofen?)

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11
Q

(T/F) Grapirant is not absorbed well in horses and alpacas.

A

(T)

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12
Q

Acetaminophen analgesia is peripherally/centrally (choose) mediated.

A

(Centrally, also multimodal (i.e. does lots of different stuff that you don’t need to know the specifics of))

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13
Q

(T/F) Acetaminophen has been combined with NSAIDs for treatment of pain/lameness, this is a safe combination of drugs.

A

(T, toxicity profiles do not overlap; acetaminophen is liver/blood and NSAIDs are GI/kidney)

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14
Q

Acetaminophen is toxic at doses greater than…

A

(>100 mg/kg, advise owners to not follow bottle/human dosing)

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15
Q

What might go wrong if you give a cat acetaminophen?

A

(Anemia, methemoglobinemia, liver failure, swelling of head/neck)

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16
Q

Why is dipyrone prohibited from use in food animals in the US?

A

(Causes blood dyscrasias in humans)

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17
Q

Dipyrone is FDA approved for the use as an antipyretic but it is also useful for what common disease in horses and why?

A

(Colic, dipyrone is a spasmolytic (inhibit release of intracellular calcium and blocks muscle contraction primarily in the GIT); combined with buscopan (another spasmolytic) in other countries)

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18
Q

(T/F) Higher doses of partial agonist opioids do not result in increased analgesia nor adverse effects.

A

(T)

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19
Q

Why are IM/SC not optimal administration options for opioids?

A

(IM and SC bioavailability of opioids is often incomplete, thought to maybe be because of their high lipophilicity (i.e. they get stuck in the fat and stay there instead of disseminating))

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20
Q

Where are opioids mostly metabolized?

A

(The liver)

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21
Q

Where are opioids mostly eliminated?

A

(The kidneys, exception is fentanyl which is eliminated by the liver)

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22
Q

(T/F) Opioids are good sedatives for all animal species.

A

(F, causes excitation in cats and adult horses when given alone, only a good sedative for dogs)

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23
Q

What are the GI adverse effects opioids can cause?

A

(Emesis (dogs > cats; risk for aspiration especially bc also antitussive), ileus (horses), and constipation)

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24
Q

Explain how the ADE of excitation caused by opioids may be related to the degree of pain an animal is in.

A

(Pain results in an increase in opioid receptors which will be able to bind more drug and allows it to work as intended, i.e. more pain = less excitation)

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25
Q

Opioids cause miosis/mydriasis (choose) for…

  • Dogs
  • Cats
  • Horses
A
  • Dogs (Miosis)
  • Cats (Mydriasis)
  • Horses (Mydriasis)
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26
Q

Opioids increase sympathetic/parasympathetic (choose) tone.

A

(Parasympathetic → cardiovascular depression, 2nd degree AV blocks, more of a worry in humans)

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27
Q

(T/F) If a horse you are giving an opioid to develops severe pruritus, you should lower the dose.

A

(F, you should stop it entirely)

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28
Q

Why is morphine the preferred opioid drug used for epidurals?

A

(It is more hydrophilic so it will stay in the epidural space rather than diffuse out of the spinal cord; make sure to use preservative free)

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29
Q

What side effects can hydromorphone cause that may last up to 24 hours?

A

(Emesis, panting, and dysphoria → warn owner if using in anesthetic protocol)

30
Q

Fentanyl has a short-half life and requires a CRI to maintain appropriate analgesia, why can it become necessary to decrease your CRI rate over time?

A

(Bc fentanyl accumulates over time)

31
Q

(T/F) It will likely take higher and multiple doses of naloxone to reverse buprenorphine if you somehow give enough of it to cause toxicity (hard to do because of ceiling effect but I’m sure some of y’all will figure it out).

A

(T, bup has a high affinity for the mu receptor so it is difficult to antagonize)

32
Q

(T/F) Simbadol is a highly concentrated formulation of buprenorphine used for SQ administration in cats, it can cause sedation, ptyalism, and whining in dogs when it is given IV and IN, but those signs were not seen when it was given SC and OTM to dogs.

A

(F, saw those ADEs with all routes of adm for dogs, IV and IN are associated with a higher chance of ADEs)

33
Q

Butorphanol is an agonist-antagonist, what does it agonize and what does it antagonize?

A

(Kappa agonist, mu antagonist)

34
Q

Tramadol is an opioid in which species?

A

(Humans and cats, not so much in horses and dogs)

35
Q

(T/F) Tramadol is a useful drug in cats.

A

(T, acts like other opioids and studies support efficacy for spays and chronic OA)

36
Q

Tramadol is ineffective in dogs because they do not reliably form the M1 metabolite that actually acts as an opioid, why is it ineffective in horses when they can form that M1 metabolite?

A

(Bc horses are so good at glucuronidation that they just clear the metabolite before it is useful; this is why it works in cats, because they can’t glucuronidate)

37
Q

How are anti-NGF monoclonal antibodies administered?

A

(IM and SC, no oral absorption whatsoever)

38
Q

What are some of the more common ADEs caused by librela?

A

(Increased BUN (not other signs of renal failure tho), increased infections (particularly skin and urinary, maybe immunosuppressive?), skin irritation/rash, pain at injection site, vomiting, and weight loss/anorexia)

39
Q

Besides vomiting and injection site pain, what is another potential ADE associated with solensia?

A

(Cutaneous lesions → pruritus, self trauma, alopecia, ulceration, superficial dermal fibrosis, neutrophilic inflammation; not super common yet but something to keep in mind)

40
Q

Why should anti-NGF monoclonal antibodies not be used in pregnant animals?

A

(They are teratogenic, NGF is essential for nerve survival during embryogenesis)

41
Q

What type of drug is gabapentin and what is it used for?

A

(Calcium channel blocker, thought to have anticonvulsant activity (Dr. Rossmeisl disagrees) and is effective for neuropathic pain)

42
Q

What should you do if you placed a patient on a low dose of gabapentin and there has been no change noted by the owner in 72 hours?

A

(Increase the dose, if still no effect, keep increasing until you hit an effect or the patient becomes sedate, if only get sedation and no help with pain should try something else)

43
Q

What do gabapentin solutions often contain due to its bitterness?

A

(Xylitol, make sure you write your prescriptions with no substitutions if prescribing for a dog, doesn’t matter for a cat)

44
Q

What type of drug is ketamine?

A

(NMDA antagonist, also amantadine and dextromethorphan)

45
Q

Amantadine is typically paired with what other drug for multimodal pain therapy?

A

(NSAIDs, in horses specifically combo’d with bute and gabapentin for laminitis pain)

46
Q

How long can it take to see the beneficial effects of amantadine?

A

(Days to weeks)

47
Q

Which of the following mechanisms of action is pertinent to methadone:

A - Full agonist at mu opioid receptors
B - Some effects at the kappa and delta opioid receptors
C - NMDA antagonist
D - Serotonin and norepinephrine reuptake inhibitor

A

(All the options are mechanisms of action of methadone)

48
Q

Why is methadone becoming more popular to use for control of moderate to severe pain, primarily preanesthetically?

A

(It has fewer adverse GI effects, it causes fewer behavioral effects and hyperthermia episodes in cats)

49
Q

What is the mechanism of action of amitriptyline?

A

(Inhibition of reuptake of norepinephrine, also affects serotonin, histidine, and cholinergic receptors)

50
Q

(T/F) Amitriptyline can be administered with NSAIDs.

A

(T, primarily combined for use in chronic pain cases)

51
Q

What is the primary concern when administering lidocaine epidurally?

A

(It can cause ataxia if you give enough)

52
Q

What is Nocita?

A

(A liposomal bupivacaine formulation that can provide analgesia for up to 72 hours)

53
Q

What are possible ADEs if Nocita is accidentally given IV?

A

(Convulsions at lower doses and cardiovascular collapse at higher doses → make sure to administer correctly and only up to the maximum total animal dose)

54
Q

What other drug can be used to combat Nocita toxicity?

A

(Intralipids, because Nocita is a liposomal formulation, intralipids bind up the drug easily)

55
Q

What is the mechanism of action of maropitant?

A

(NK1-receptor antagonist, prevents substance P from binding)

56
Q

Maropitant is best used for visceral/somatic (choose) pain.

A

(Visceral → abdominal surgery, pancreatitis, interstitial cystitis; not labeled for pain control so will be off label use)

57
Q

(T/F) The purpose of administering bisphosphonates is to trigger osteoclast cell apoptosis.

A

(T, this equates to decreased bone turnover/remodeling which is a major cause of bone pain in cases like OA, cancer, and laminitis)

58
Q

Where do bisphosphonates accumulate and why?

A

(Accumulate in bone because they bind to calcium, will persist there for months and can even be detected in plasma/urine for up to 3 years)

59
Q

Bisphosphonates undergo hepatic/renal (choose) elimination.

A

(Renal, do not use in patients with renal dz)

60
Q

How does the administration of clodronate (Osphos) and tiludronate (Tilden) differ?

A

(Osphos is given IM, Tilden is given slowly and evenly IV)

61
Q

How do bisphosphonates cause colic?

A

(They bind calcium, calcium is needed for GI motility, decreased GI motility leads to gas build up then you get colic; more common with Tilden because of IV route of adm)

62
Q

Why is Tilden sometimes given with IV fluids?

A

(Bc bisphosphonates, particularly Tilden, are nephrotoxic and a way to prevent that from happening is making sure the animal you are giving them to is well hydrated)

63
Q

You have induced colic in a patient by giving them Tilden, what do you want to give them to aid in pain management of the colic?

A

(Xylazine/butorphanol is best (butorphanol really the pain guy here but xylazine prevents freakiness), Tilden cannot be given with NSAIDs and buscopan is an spasmolytic = further decreasing GI motility which we don’t want)

64
Q

Why is bisphosphonate labeled for use in horses 4 years and older?

A

(Bc younger horses have a physiological high bone turnover rate and stopping that may have a detrimental effect so much so it may soon actually be illegal to give these drugs to horses under 48 months of age)

65
Q

What is the primary indication for the use of pamidronate (a bisphosphonate) in dogs?

A

(Pain relief associated with skeletal neoplasia, other option is alendronate)

66
Q

What is the main ADE associated with the use of alendronate in dogs?

A

(If it does not get into the stomach and instead sits in the esophagus, can cause severe ulceration)

67
Q

Why are alpha 2 agonists not a viable choice for chronic pain?

A

(They produce significant sedation and cardiovascular depression, really meant for in hospital use only (acute pain, peri or pre-operative))

68
Q

(T/F) Sileo gel can be prescribed for control of pain in dogs and cats.

A

(F, the alpha 2 agonist oral gels (dormosedan in horses, sileo in dogs and cats) is used as an anxiolytic/sedative, not for pain)

69
Q

Which of the cannabinoid receptors is associated with the antinociceptive effects?

A

(CB2, CB1 is associated with the psychotropic effects)

70
Q

What liver value elevation is often seen when dogs are treated with CBD products?

A

(ALP)

71
Q

Why should adequan not be used in animals with bleeding disorders?

A

(It is a heparin analogue = increased risk of bleeding; should avoid using with COX-1 inhibitors bc of this as well)

Pharm Decisions (13 decks)

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