Anaesthesia drugs Flashcards
List examples of opioids
Fentanyl Morphine Methadone Pethidine Buprenorphine Butorphanol
List examples of NSAIDs
Meloxicam Carprofen Ketaprofen Robenacoxib Firocoxib Phenylbutazone Grapiprant Flunixin
List examples of local anaesthetics
Procaine Lidocaine Bupivacaine Mepivacaine Ropivacaine EMLA/lidocaine and procaine Proparacaine and tetracaine
List the drugs that are unlicensed for veterinary species pain management
Gabapentin
Pregabalin
Amatadine
Amitriptyline
State premed protocol for dogs and cats ASA I and II
ACP + opioid
Alpha 2 agonist + opioid
State premed protocol for dogs ASA III
ACP + opioid
State premed protocol for cats, dogs and rabbits ASA IV, V
Benzodiazepine + opioid
Benzodiazepine + ketamine
Opioid
State premed protocol for cats ASA III
Benzodiazepine (midazolam) + ketamine
State premed protocol for rabbits ASA I, II
ACP + opioid
Alpha 2 agonist + opioid
Fluanisone +/- benzodiazepine
State premed protocol for rabbits ASA III
Benzodiazepine + opioid
State an example of phenothiazines
Acepromazine
List examples of alpha 2 agonists
Dexmedetomidine
Medetomidine
Romifidine
Xylazine
List examples of benzodiazepines
Diazepam
Midazolam
State an example of butyrophenones
Fluanisone, in combination with fentanyl
List the injectable anaesthetic agents
Propofol Ketamine Alfaxalone Tiletamine Zolazepam Thiopental
State licenced inhalational anaesthetic agents
Isoflurane
Sevoflurane
Nitrous
List unlicensed inhalational anaesthetic agents
Halothane
Desflurane
What are the licenced drugs for equine sedation?
Acepromazine Butorphanol Buprenorphine Pethidine Romifidine Xylazine
How do opioids provide analgesia?
Act at endogenous opioid receptors in CNS, mu most effective at providing analgesia
Which opioids are full mu agonists?
Methadone
Fentanyl
Morphine
Pethidine
Which opioids are partial agonists?
Buprenorphine
Butorphanol
What is the antagonist for opioids?
Nalaxone
What is the usual admin method of opioids except pethidine?
IV
What are alternative methods of admin of opioids?
SC
IM
Oral- does have significant first pass metabolism
List side effects of opioids
Bradycardia Respiratory depression- DD, more when anaesthetised Sedation- DD, dogs Excitement- high doses, premed Nausea- premed Urinary effects- epidural Low GI motility- chronic use
What is fentanyl licenced and used for?
Cats and dogs
Cats, dogs, rabbits, horses
When is fentanyl used?
Interoperative, short term infusion
How long does fentanyl last?
Minutes
What are all opioids other than fentanyl used for?
General acute pre-, peri- and post-op pain
What is the licencing and species used in for morphine?
No licencing
Cats, dogs, horses
How long does morphine and methadone last?
2-4 hours
What is the licencing and use of methadone?
Cats and dogs
Cats and dogs
What is pethidine licenced and used for?
Cats, dogs, horses
Mainly horses
How long does pethidine last?
Minutes
What is the licencing for butorphanol and buprenorphine and what are they used for?
Cats, dogs, horses
Cats, dogs, rabbits
How long does buprenorphine last?
6 hours
How long does butorphanol last?
2 hours
How do NSAIDs cause analgesia?
Inhibit prostaglandin production by inhibiting COX and LOX enzymes
Which NSAIDs are licenced for dogs by injection and oral?
Meloxicam
Carprofen
Ketaprofen
Robenacoxib
Which NSAIDs are licenced for dogs by oral?
Firocoxib
Phenylbutazone
Grapiprant
Which NSAIDs are licenced for cats by injection and oral?
Meloxicam
Ketaprofen
Robenacoxib
Which NSAIDs are licenced for cats by injection?
Carprofen
Which NSAIDs are licenced for rabbits and which are used?
None licenced
Meloxicam
Sometimes carprofen
Which NSAIDs are licenced for horses by injection and oral?
Meloxicam
Firocoxib
Flunixin
Phenylbutazone
Which NSAIDs are licenced for horses by injection?
Ketaprofen
When do you need to be cautious when using NSAIDs?
Hepatic compromise- liver metabolism
Hypotensive
Dehydrated
Only one in multimodal analgesia
What are side effects to NSAIDs?
GI ulceration
Renal ischemia
Liver disease- dogs, idiosyncratic
Dullness and lethargy- cats
What are signs dogs or cats need medical attention when taking NSAIDs?
General illness
Vomiting
Diarrhoea
What are signs rabbits need medical attention when taking NSAIDs?
Anorexia
Bruxism
Depression
Vomiting
What are signs horses need medical attention when taking NSAIDs?
General illness Colic Dehydration Diarrhoea Weight loss
How do local anaesthetics work within the body?
Enter nerve fibres and block voltage gated Na+ channels stabilising the membrane whihc blocks nerve conduction
What is the effect of local anaesthetics on the body?
Blocks nociception then proprioception and mechanoreception
What is the rough pH of LAs?
Weak base
When do LAs become more ionised?
Higher pKa
Lower pH
What is the effect of LAs becoming ionised?
Can’t cross lipid membranes
Slower action and less drug effect
What is the effect of LAs becoming more bound?
Longer duration of action
Lower toxicity
Less active
What effects the length of action of LAs?
Lipid solubility
Strength of binding to channel
Speed of metabolism
Which type of LAs is more stable and has longer half life?
Amides
What breaks down amide LAs?
Cytochrome P450 liver enzyme
What breaks down ester LAs?
Cholinesterase
Forms PABA, can be allergen
What are LAs used for?
Balanced anaesthesia
Desensitisation
Post op pain relief
Lameness investigations
How does toxicity of LAs increase?
With potency and dose
How can risk of LA toxicity be reduces?
Dont exceed max dose
For large volumes dilute
Aspirate before admin
Describe the formulation of LAs
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
What are side effects of LAs?
Behavioural changes Muscle twitching CNS depression Death Hypotension Dysrhythmias
How do you treat side effects of LAs?
Symptomatically as no reversal
What is the licencing and use of procaine and lidocaine?
Dogs, cats, horses
Dogs, cats, rabbits, horses
How long does procaine last?
50 minutes
Why do licenced versions of procaine have adrenaline added?
Vasoconstriction
List LAs from least to most potent
Procaine
Lidocaine
Mepivacaine
Bupivacaine
How long does lidocaine last?
20-40 minutes
What is the speed of onset of lidocaine?
2-5 minutes
Which LAs have lower CVS and CNS toxicity than bupovacaine?
Lidocaine
Ropivacaine
What is licencing and use of bupivacaine?
No licencing
Cats, dogs, rabbits
How long does bupivacaine and ropivacaine last?
6 hours
Which LA does bupivacaine have a slower onset than?
Lidocaine
What is licencing and use of mepivacaine?
Horses
Horses
How long does mepivacaine last?
2 hours
What is the main use of mepivacaine?
Digit nerve blocks
What is mepivacaine more potent and toxic than?
Lidocaine
What is licencing and use of ropivacaine?
No licencing
Small animals
What is licencing and use of EMLA/lidocaine and procaine?
No licencing
Rabbits
How long does EMLA last?
30-45 minutes
What is EMLA mainly used for?
Topical for IV placement