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Clinical Nursing Jan exam > Anaesthesia drugs > Flashcards

Anaesthesia drugs Flashcards

1
Q

List examples of opioids

A 
Fentanyl
Morphine
Methadone
Pethidine
Buprenorphine
Butorphanol
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2
Q

List examples of NSAIDs

A 
Meloxicam
Carprofen 
Ketaprofen
Robenacoxib
Firocoxib
Phenylbutazone
Grapiprant
Flunixin
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3
Q

List examples of local anaesthetics

A 
Procaine
Lidocaine
Bupivacaine
Mepivacaine
Ropivacaine
EMLA/lidocaine and procaine
Proparacaine and tetracaine
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4
Q

List the drugs that are unlicensed for veterinary species pain management

A

Gabapentin
Pregabalin
Amatadine
Amitriptyline

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5
Q

State premed protocol for dogs and cats ASA I and II

A

ACP + opioid

Alpha 2 agonist + opioid

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6
Q

State premed protocol for dogs ASA III

A

ACP + opioid

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7
Q

State premed protocol for cats, dogs and rabbits ASA IV, V

A

Benzodiazepine + opioid
Benzodiazepine + ketamine
Opioid

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8
Q

State premed protocol for cats ASA III

A

Benzodiazepine (midazolam) + ketamine

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9
Q

State premed protocol for rabbits ASA I, II

A

ACP + opioid
Alpha 2 agonist + opioid
Fluanisone +/- benzodiazepine

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10
Q

State premed protocol for rabbits ASA III

A

Benzodiazepine + opioid

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11
Q

State an example of phenothiazines

A

Acepromazine

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12
Q

List examples of alpha 2 agonists

A

Dexmedetomidine
Medetomidine
Romifidine
Xylazine

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13
Q

List examples of benzodiazepines

A

Diazepam

Midazolam

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14
Q

State an example of butyrophenones

A

Fluanisone, in combination with fentanyl

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15
Q

List the injectable anaesthetic agents

A 
Propofol
Ketamine
Alfaxalone
Tiletamine
Zolazepam
Thiopental
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16
Q

State licenced inhalational anaesthetic agents

A

Isoflurane
Sevoflurane
Nitrous

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17
Q

List unlicensed inhalational anaesthetic agents

A

Halothane

Desflurane

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18
Q

What are the licenced drugs for equine sedation?

A 
Acepromazine
Butorphanol
Buprenorphine
Pethidine
Romifidine
Xylazine
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19
Q

How do opioids provide analgesia?

A

Act at endogenous opioid receptors in CNS, mu most effective at providing analgesia

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20
Q

Which opioids are full mu agonists?

A

Methadone
Fentanyl
Morphine
Pethidine

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21
Q

Which opioids are partial agonists?

A

Buprenorphine

Butorphanol

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22
Q

What is the antagonist for opioids?

A

Nalaxone

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23
Q

What is the usual admin method of opioids except pethidine?

A

IV

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24
Q

What are alternative methods of admin of opioids?

A

SC
IM
Oral- does have significant first pass metabolism

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25
Q

List side effects of opioids

A 
Bradycardia
Respiratory depression- DD, more when anaesthetised
Sedation- DD, dogs
Excitement- high doses, premed
Nausea- premed
Urinary effects- epidural
Low GI motility- chronic use
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26
Q

What is fentanyl licenced and used for?

A

Cats and dogs

Cats, dogs, rabbits, horses

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27
Q

When is fentanyl used?

A

Interoperative, short term infusion

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28
Q

How long does fentanyl last?

A

Minutes

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29
Q

What are all opioids other than fentanyl used for?

A

General acute pre-, peri- and post-op pain

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30
Q

What is the licencing and species used in for morphine?

A

No licencing

Cats, dogs, horses

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31
Q

How long does morphine and methadone last?

A

2-4 hours

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32
Q

What is the licencing and use of methadone?

A

Cats and dogs

Cats and dogs

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33
Q

What is pethidine licenced and used for?

A

Cats, dogs, horses

Mainly horses

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34
Q

How long does pethidine last?

A

Minutes

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35
Q

What is the licencing for butorphanol and buprenorphine and what are they used for?

A

Cats, dogs, horses

Cats, dogs, rabbits

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36
Q

How long does buprenorphine last?

A

6 hours

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37
Q

How long does butorphanol last?

A

2 hours

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38
Q

How do NSAIDs cause analgesia?

A

Inhibit prostaglandin production by inhibiting COX and LOX enzymes

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39
Q

Which NSAIDs are licenced for dogs by injection and oral?

A

Meloxicam
Carprofen
Ketaprofen
Robenacoxib

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40
Q

Which NSAIDs are licenced for dogs by oral?

A

Firocoxib
Phenylbutazone
Grapiprant

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41
Q

Which NSAIDs are licenced for cats by injection and oral?

A

Meloxicam
Ketaprofen
Robenacoxib

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42
Q

Which NSAIDs are licenced for cats by injection?

A

Carprofen

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43
Q

Which NSAIDs are licenced for rabbits and which are used?

A

None licenced
Meloxicam
Sometimes carprofen

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44
Q

Which NSAIDs are licenced for horses by injection and oral?

A

Meloxicam
Firocoxib
Flunixin
Phenylbutazone

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45
Q

Which NSAIDs are licenced for horses by injection?

A

Ketaprofen

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46
Q

When do you need to be cautious when using NSAIDs?

A

Hepatic compromise- liver metabolism
Hypotensive
Dehydrated
Only one in multimodal analgesia

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47
Q

What are side effects to NSAIDs?

A

GI ulceration
Renal ischemia
Liver disease- dogs, idiosyncratic
Dullness and lethargy- cats

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48
Q

What are signs dogs or cats need medical attention when taking NSAIDs?

A

General illness
Vomiting
Diarrhoea

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49
Q

What are signs rabbits need medical attention when taking NSAIDs?

A

Anorexia
Bruxism
Depression
Vomiting

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50
Q

What are signs horses need medical attention when taking NSAIDs?

A 
General illness
Colic
Dehydration
Diarrhoea
Weight loss
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51
Q

How do local anaesthetics work within the body?

A

Enter nerve fibres and block voltage gated Na+ channels stabilising the membrane whihc blocks nerve conduction

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52
Q

What is the effect of local anaesthetics on the body?

A

Blocks nociception then proprioception and mechanoreception

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53
Q

What is the rough pH of LAs?

A

Weak base

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54
Q

When do LAs become more ionised?

A

Higher pKa

Lower pH

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55
Q

What is the effect of LAs becoming ionised?

A

Can’t cross lipid membranes

Slower action and less drug effect

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56
Q

What is the effect of LAs becoming more bound?

A

Longer duration of action
Lower toxicity
Less active

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57
Q

What effects the length of action of LAs?

A

Lipid solubility
Strength of binding to channel
Speed of metabolism

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58
Q

Which type of LAs is more stable and has longer half life?

A

Amides

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59
Q

What breaks down amide LAs?

A

Cytochrome P450 liver enzyme

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60
Q

What breaks down ester LAs?

A

Cholinesterase

Forms PABA, can be allergen

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61
Q

What are LAs used for?

A

Balanced anaesthesia
Desensitisation
Post op pain relief
Lameness investigations

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62
Q

How does toxicity of LAs increase?

A

With potency and dose

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63
Q

How can risk of LA toxicity be reduces?

A

Dont exceed max dose
For large volumes dilute
Aspirate before admin

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64
Q

Describe the formulation of LAs

A

Salt solution to make water soluble
Low pH so stings on injection
Added vasoconstrictors to reduce speed of systemic absorption, prolong action, reduce bleeding, reduce toxicity

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65
Q

What are side effects of LAs?

A 
Behavioural changes
Muscle twitching
CNS depression
Death
Hypotension
Dysrhythmias
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66
Q

How do you treat side effects of LAs?

A

Symptomatically as no reversal

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67
Q

What is the licencing and use of procaine and lidocaine?

A

Dogs, cats, horses

Dogs, cats, rabbits, horses

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68
Q

How long does procaine last?

A

50 minutes

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69
Q

Why do licenced versions of procaine have adrenaline added?

A

Vasoconstriction

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70
Q

List LAs from least to most potent

A

Procaine
Lidocaine
Mepivacaine
Bupivacaine

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71
Q

How long does lidocaine last?

A

20-40 minutes

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72
Q

What is the speed of onset of lidocaine?

A

2-5 minutes

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73
Q

Which LAs have lower CVS and CNS toxicity than bupovacaine?

A

Lidocaine

Ropivacaine

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74
Q

What is licencing and use of bupivacaine?

A

No licencing

Cats, dogs, rabbits

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75
Q

How long does bupivacaine and ropivacaine last?

A

6 hours

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76
Q

Which LA does bupivacaine have a slower onset than?

A

Lidocaine

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77
Q

What is licencing and use of mepivacaine?

A

Horses

Horses

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78
Q

How long does mepivacaine last?

A

2 hours

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79
Q

What is the main use of mepivacaine?

A

Digit nerve blocks

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80
Q

What is mepivacaine more potent and toxic than?

A

Lidocaine

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81
Q

What is licencing and use of ropivacaine?

A

No licencing

Small animals

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82
Q

What is licencing and use of EMLA/lidocaine and procaine?

A

No licencing

Rabbits

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83
Q

How long does EMLA last?

A

30-45 minutes

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84
Q

What is EMLA mainly used for?

A

Topical for IV placement

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85
Q

What is licencing and use for proparacaine an tertracaine?

A

No licencing

Cats and dogs

86
Q

How long does proparacaine and tetracaine last in cats and dogs?

A

Cats- 15 minutes

Dogs- 45 minutes

87
Q

What is the main use of proparacaine and tetracaine?

A

Desensitise cornea in ophthalmic preparations

88
Q

What is paracetamol licenced for?

89
Q

Why can’t cats use paracetamol?

90
Q

When is paracetamol given to horses

A

Added to analgesia in extreme pain

91
Q

Why is paracetamol used?

A

When NSAIDs are contraindicated

92
Q

What is licencing and use of tramadol?

A

Dogs- oral and injection

Dogs, cats, rabbits

93
Q

When is tramadol used?

A

Opioid alternative for at home

Second analgesia in chronic pain

94
Q

What can be side effects of tramadol to horses?

A

Reduced GI motility

95
Q

How does tramadol provide analgesia?

A

Acts on mu opioid, noradrenergic and serotonergic systems

96
Q

Why may tramadol not be preferred to be used?

A

Questions about efficacy

97
Q

Why are the unlicensed analgesics used?

A

Second line analgesic in chronic pain

98
Q

How does gabapentin act in the body?

A

Binds voltage gated calcium channels

99
Q

What are the effects produced by gabapentin?

A

Sedation- more when combined with tramadol

100
Q

When is gabapentin toxic?

A

In solution with xylitol

101
Q

What makes pregabalin different to gabapentin?

A

Better oral bioavailability and half life

102
Q

How does amantadine act in the body?

A

NMDA receptor agonist

103
Q

What effect does amantadine have on the body?

A

Antihyperalgesic

104
Q

When is amantadine used?

A

With other analgesics

105
Q

How is amantadine excreted?

106
Q

How do phenothiazines act in the body?

A

Dopamine receptor agonist, CNS

107
Q

What is the effect of phenothiazines?

108
Q

What is ACP used for?

A

Cats and dogs premed or sedation

109
Q

What are the methods of ACP admin?

110
Q

How does time to peak effect of ACP change if IM or IV admin?

A

IM- 30-40 minutes

IV- 10-15 minutes

111
Q

Why cant ACP be given orally?

A

Poor bioavailability

112
Q

How long does ACP last?

113
Q

How is ACP, benzodiazepines, opioids and alpha 2 agonists metabolised?

114
Q

What are side effects of ACP?

A

Peripheral vasodilation which lowers body temperature and BP

115
Q

How do alpha 2 agonists act in the body?

A

Alpha 2 adrenergic receptor in CNS

116
Q

What effects do alpha 2 agonists have on the body?

A

Sedation
Analgesia
Muscle relaxation

117
Q

How is dose of alpha 2 agonists calculated due to its high potency?

A

Body surface area

118
Q

How does speed of effect of alpha 2 agonists differ with IM or IV admin?

A

IM- 15 minutes

IV- 5 minutes

119
Q

What is atipamezole a reversal for?

A

Alpha 2 agonists

120
Q

How long does alpha 2 agonists last when not reversed?

121
Q

What are side effects of alpha 2 agonists?

A 
Bradycardia
Reduced CO
Hypertension then hypotension
2nd degree AV block
Respiratory depression
GI stasis
Hyperglycaemia
Increased urine production
Uterine contractions
122
Q

How do benzodiazepines cause effect in the body?

A

Enhance GABA at GABA receptor

123
Q

What is the effect on the body for benzodiazepines?

A

Sedation
Muscle relaxation
Minor tranquiliser
Anticonvulsant

124
Q

How can sedation from benzodiazepines be improves?

A

Combine with opioid, ketamine, alpha 2 agonist

125
Q

Describe how to administer benzodiazepines

A

Slow IV infusion as rapidly crosses BBB

126
Q

Why does diazepam have longer action than midazolam?

A

Shorter half life but metabolites are active

127
Q

What is the reversal for benzodiazepines and why is it rarely used?

A

Flumazenil

Expensive

128
Q

What are side effects for benzodiazepines?

A

Mild respiratory depression- DD

Minimal CVS effects

129
Q

What is diazepam licenced for?

A

Cats and dogs

130
Q

What is midazolam licenced for?

131
Q

How do butyrophenones act in the body?

A

Dopamine receptor agonist, CNS

Interfere with GABA, norepinephrine, serotonin mediated activity

132
Q

What effects does butyrophenones have on the body?

133
Q

What is fluanisone licenced for?

A

Small furries

134
Q

How long does fluanisone last?`

A

30-60 minutes

135
Q

What is the effect of combining fluanisone and benzodiazepines?

A

20-40 minutes muscle relaxation

136
Q

What is a side effect of fluanisone?

A

Respiratory depression

137
Q

What effects do opioids have on the body?

A

Sedation

Analgesia

138
Q

What are injectable anaesthetics used for?

A 
Induction
Maintenance
TIVA
Triple- short term anaesthesia, alpha 2 agonist, ketamine, opioid IM
Euthanasia
139
Q

What is propofol, tiletamine and zolazepam licenced for?

A

Cats and dogs

140
Q

Why does propofol need to be administered IV?

A

Irritant otherrwise

141
Q

What is propofols drug class?

A

Substituted phenol

142
Q

How does propofol, alfaxalone and zolazepam act in the body?

A

GABA agonist

143
Q

How fast is onset and duration of action of propofol?

A

Rapid

5-10 minutes

144
Q

What effects does propofol havevfrom the anaesthetic triad?

A

Muscle relaxation and narcosis

No analgesia

145
Q

What is propofols binding and solubility like?

A

Highly bound

Lipid soluble

146
Q

How is propofol and alfaxalone metabolised and eliminated?

A

Rapid by liver

147
Q

Why is propofol cumulative in cats and not dogs?

A

Cats lack glucorinidation pathway

148
Q

What are side effects of propofol?

A

Post induction apnoea

Hypotension from myocardial depression and peripheral vasodilation

149
Q

What are preservative and non-preservative propofol used for?

A

Non-preservative- TIVA

Preservative- open for 28 days

150
Q

What is alfaxalone licenced for?

A

Cats, dogs, rabbits

151
Q

Why is alfaxalone administered IV?

A

Irritant IM

152
Q

What drug class is alfaxalone?

A

Neuroactive steroid

153
Q

Describe the formulation of alfaxalone?

A

Clear solution containing cyclodextrin ring to make water solubule

154
Q

What is binding for alfaxaolne?

155
Q

How fast is onset and duration of action of alfaxalone?

A

Rapid

15-30 minutes

156
Q

Is alfaxalone cumulative?

157
Q

What are side effects of alfaxaolne?

A

Respiratory depression
Post induction apnoea
Hypotension causing tachycardia

158
Q

What is ketamine licenced for?

A

Cats, dogs, horses

159
Q

How is ketamine administered?

160
Q

What drug class is ketamine?

A

Phencyclidine derivative

161
Q

How does ketamine and tiletamine act in the body?

A

NMDA antagonist

162
Q

What effects does ketamine have on the body?

A

Analgesia and antihyperalgesia

163
Q

Why is ketamine used in combination?

A

Poor muscle relaxation and reflexes are maintained

164
Q

Why do you need a calm environment when using ketamine?

A

Slow onset

165
Q

What makes ketamine non-cumulative?

A

Active metabolite nor-ketamine by the liver

166
Q

How is ketamine excreted?

167
Q

What is ketamine protein binding?

168
Q

What are side effects of ketamine?

A

Increased IOP and ICP

169
Q

What is ketamine commonly used for?

A

Horses maintainance/TIVA

Cats sedative IM or induction IV

170
Q

How is tiletamine administered?

171
Q

How does thiopental act in the body?

A

Barbiturate at GABA receptor

172
Q

How is thiopental formulated?

A

2.5 or 5% powder in solution

173
Q

What is the rough pH of thiopental?

174
Q

How fast is onset of thiopental?

175
Q

What is the binding like for thiopental?

176
Q

How is thiopental metabilised?

A

After distribution

177
Q

Is thiopental cumulative?

178
Q

What are side effects of thiopental?

A

Perivascular tissue necrosis
Cardiorespiratory depression
Short term ventricular bigeminy

179
Q

What are inhalational anaesthetics used for?

A

Induction

Maintainance

180
Q

What are isoflurane and sevoflurane licenced for?

A

Cats and dogs

181
Q

Is isoflurane irritant?

A

Yes to MM and airways

182
Q

Is isoflurane and sevoflurane toxic?

183
Q

Is isoflurane stable?

A

Yes and non-flammable

184
Q

Is it easy to vaporise isoflurane and sevoflurane?

185
Q

Describe stability and flammability of sevoflurane

A

Stable in sodalime

Flammable in oxygen or nitrous

186
Q

State isoflurane MAC

187
Q

What effects does isoflurane have from anaesthetic triad?

A

Narcosis

Muscle relaxation

188
Q

What are side effects of isoflurane and sevoflurane?

A 
Hypotension
Bronchodilation
Reduced renal and hepatic perfusion
Vasodilation
Respiratory depression
Hypoventilation
Hypercapnia
189
Q

How does uptake and elimination differ with isoflurane and sevoflurane?

A

Iso- slower, 1% metabolic elimination

Sevo- faster, 3% metabolic elimination

190
Q

What is isoflurane and sevoflurane blood gas solubility?

A

Iso- 1.4

Sevo- 0.69

191
Q

State sevoflurane MAC

192
Q

What components of the anaesthetic triad does sevoflurane provide?

193
Q

What effect does nitrous have on the body?

194
Q

Why does nitrous have rapid uptake and elimination?

195
Q

What is nitrous MAC?

196
Q

What ratio with oxygen should nitrous be in rebreathing and non-rebreathing systems?

A

1: 2- non-rebreathing
1: 1- rebreathing

197
Q

How is equine sedation delivered?

A

IV jugular or IM

198
Q

What sedatives are licenced for horses?

A 
Acepromazine
Xylazine
Romifidine
Butorphanol
Buprenorphine
Pethidine
199
Q

What is a common combination for equine sedation?

A

Alpha 2 agonist + opioid

200
Q

What effect does acepromazine have on horses?

A

Mild sedation

201
Q

How long is onset of acepromazine in horses?

A

30 minutes

202
Q

How long does ACP last in horses?

203
Q

How is ACP metabolised in horses?

204
Q

Is ACP vasodilatory in horses?

205
Q

What effects do alpha 2 agonists have on the body in horses?

A

Sedation
Analgesia
Muscle relaxation

206
Q

What are side effects of alpha 2 agonists in horses?

A 
Bradycardia
2nd degree AV block
Hypertension and vasoconstriction then hypotension
Hypoinsulinaemia
Decreased GI motility
207
Q

What effect do opioids have on the body in horses?

A

Synergistic effect on analgesia

Increased sedation and ataxia

208
Q

What drugs are used in equine induction?

A

ACP 30 minutes before
Alpha 2 agonist in induction area
Thiopental and ketamine/diazepam in IV bolus

209
Q

What effect does GGE/guaiphenesin have when given to horses in induction?

A

Muscle relaxant, no analgesia

210
Q

What analgesia is used in horses?

A 
NSAIDs
Opioids
Alpha 2 agonists
Ketamine
Local anaesthetics

Clinical Nursing Jan exam (7 decks)

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