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year 3 principles > Anaesthesia - drugs > Flashcards

Anaesthesia - drugs Flashcards

1
Q

What anaesthetic agents can be used in food animals?

A

ketamine
thiopental
isoflurane

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2
Q

Injectable anaesthetic agents

A 
propofol
alfaxalone
ketamine
thiopental
etomidate
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3
Q

what injectable agents can you use for long term maintainance?

A

propofol

alflaxalone

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4
Q

what inhalational agents are available today?

A

isoflurane
sevoflurane
desflurane
N2O

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5
Q

what are some considerations with isoflurane and sevoflurane?

A

very vasodilatory

secoflurane may be nephrotoxic

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6
Q

considerations with desflurane

A

expensive

irritant

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7
Q

considerations of nitrous oxide

A
  • cant reach anaesthesia with it alone
  • very insoluble
  • switch it off before end of procedure and put on 100% O2 as can get diffusion hypoxia as it rapidly diffuses into lungs (as insoluble in blood) as end of anaesthesia and decreases oxygen pressure
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8
Q

what anaesthetic agent doesnt cause dose-dependant CVs and resp depression?

A

ketamine as causes catecholamine release which counteracts it

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9
Q

what is TIVA and PIVA?

A

total / partial IV anaesthetic

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10
Q

advantages and disadvantages of intermittent IV maintenance

A
  • simple, less equipment

- swinging plane of anaesthesia, side effects when really deep

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11
Q

advantages and disadvantages of continuous IV maintenance?

A
  • need a syringe driver
  • can control with a computer
  • need to know minimum infusion rate (MRI) where 50% dont respond to stimuli
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12
Q

How is inhalational agent concentration affected by vessel richness of tissues?

A

Vessel rich tissues will reach higher concentrations and be removed faster than vessel poor tissues

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13
Q

what is MAC?

A

minimum alveolar concentration - needed to prevent movement to a painful sitmuli in 50% of animals

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14
Q

what MAC is aimed for?

A

1.25 - 1.5 xMAC

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15
Q

what can decrease MAC?

A 
hypothermia
young / old
hypoxia
hypotension
CVs depressants
pregnancy
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16
Q

what can increase MAC?

A

hyperthermia
healthy and young ish
excitation

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17
Q

What do neuromuscular blocking agents do? What considerations do you need?

A

inhibit ACH binding at NMJ so the AP isnt propogated to the muscle

  • cause relaxation of all skeletal muscles
  • must be able to IPPV as cant breathe
  • hard to monitor as cant asses reflexes
  • use nerve stimulator to measure effect of block
  • antagonise with ACHe and anticholinergic agent to prevent bradycardia from high ACH at muscarinic receptors
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18
Q

How is potency related to MAC?

A

potency = 1/MAC

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19
Q

What are the 4 classes of premed?

A

phenothiazines
butyrphenones
benzodiazepine
a2 agonists

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20
Q

what is the main phenothiazine?

A

acepromazine (ACP)

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21
Q

what does ACP do?

A
  • sedative via dopamine antagonism
  • anti-emetic
  • a1 antagonism = vasodilation and anti-arrhytmic
  • anti-histamine
  • penile priapism
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22
Q

how long does ACP take to work and how long does it last?

A

20-30 mins to work
4-6 hours duration
IM or IV

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23
Q

when is ACP contradicted?

A
  • brachycephalic
  • hypotensive
  • boxers
  • breeding stallions
  • intradermal skin testing
  • organophosphates (be careful is poisoned)
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24
Q

what does ACP potentiate?

A
  • opioids
  • local A
  • GA
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25
Q

how much does ACP affect the respiratory system?

A

not much unless very sick

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26
Q

what is Azaperone?

A

butyrphenones

-pig sedative

27
Q

what are the pharmokinetics of azaperone?

A
  • deep IM
  • dose related sedation
  • 30 mins of quietness to effect
  • 2-3 hr duration
28
Q

what are some examples of benzodiazepines?

A
  • diazepam / valium
  • midazolam / hypnovel
  • diazemuls
29
Q

what do benzodiazepines do?

A
  • potentiate GABA
  • muscle relaxation
  • anti convulsant
  • variable sedative effect
  • appetite stimulant in cats
  • minimal CVS / resp depression
30
Q

what is the pharmacokinetics of benzodiazepines?

A
  • good in very old/young/sick
  • irritant
  • absorbed onto plastic so dont draw up early
  • rapid onset and short duration
  • IV
31
Q

what benzodiazepine can be given IM?

A

midazolam and diazemuls

32
Q

what benzodiazepine is inhibited by erythromycin?

A

miadazolam / hypnovel

33
Q

when are benzodiazepines contraindicated?

A
  • long term in cats as can cause hepatic failure
  • hepatic encephalopathy
  • very excited / aggressive patient
34
Q

what are some a2 agonists?

A

xylazine
detomidine / domosedan
romifidine / sedivet
medetomidine (domitor)and dexmetomidine

35
Q

what do a2 agonists do?

A
  • muscle relaxation
  • initial hypertension from a1 effects post synaptically then get normo/hypo tension
  • bradycardia from herpertension
  • resp depression
  • vomiting
  • inhibit ADH and insulin
  • uterine contraction
36
Q

which a2 can be used in horses?

A

romifidine / sedivet
detomidine / domosedan
xylazine

37
Q

how long do a2 agonists work for?

A

about 2 hrs

38
Q

why do we pre-med?

A
  • help and potentiate anaesthetics
  • relieve anxiety
  • analgesia
  • less anaesthetic dose so less anaesthesia side effects
  • smoother induction and recovery
39
Q

what is a tranquiliser?

A

reduce anxiety but no dullness

40
Q

what is a sedative?

A

reduce anxiety and cause drowsiness

41
Q

what is a hypnotic?

A

anaesthesia inducing

42
Q

what is a benzodiazepine antagonist?

A

flumazanil / sarmazenil

43
Q

what is a a2 antagonist?

A

atipamezole
yolimbine
tolazoine

44
Q

what do anti-chollinergic drugs do?

A 
increase HR
decrease salivation
decrease gut motility
dilate pupil
relax bronchi

atropine, glycopyrollate, hyoscine

45
Q

how do we estimate the brain concentration of inhaled agents?

A

alveoli conc = brain conc

46
Q

what happens with more soluble agents?

A
  • more in the blood so less in lungs / brain
  • longer induction and recovery as takes time to saturate blood first before pressure builds up in brain and lungs
  • more soluble = higher gas partition coefficient
47
Q

what are 5 induction agents?

A 
propofol
propofol plus
alfaxalone
ketamine
thiopentone / thiopental
48
Q

what class is propofol?

A

phenol

49
Q

what can propofol be used for?

A

induction, maintenance, TIVA

50
Q

what induction agent has less cardiopulmonary depression?

A

alfaxalone

51
Q

what induction agent cause CV stimulation?

A

ketamine - hypertension and tachycardia

52
Q

what is an advantage of propofol plus over normal propofol?

A

28d shelf life compared to 1 d shelf life

53
Q

which induction agent causes reflexes to remain?

A

ketamine

54
Q

how is propofol given?

A

IV slowly to effect

55
Q

what cant you use propofol plus for that you can use propfol for?

A

TIVA

56
Q

what is the difference in propofol plus?

A

benzyl alcohol preservative (may cause toxicity)

57
Q

what can alfaxalone be used for?

A

induction and maintenance

-rapid onset and short duration

58
Q

what is a consideration of alfaxalone?

A

difficult recovery

59
Q

what is ketamine used for?

A

induction and maintenance
has analgesic effects
*dont give alone as will be excitatory

60
Q

what is an issue with thiopentone/thiopental?

A

no longer licensed
irritant if extravascular
cumulative in body fat so be careful
slow metabolism

61
Q

what is the issue with propofol in cats?

A

cats cant conjugate glucuronides and have problems metabolising triglycerides so have a very slow recovery and toxic if dose repeated

62
Q

what is the triple combination used in aggressive cats?

A

ketamine + medetomidine + opioid

IM lasts 15 m

63
Q

what is etomidate?

A

minimal CVS and RESP depression so good if very sick

-depresses adrenal function (low cortisol)

64
Q

what combination is used for very sick patients?

A

opioid and benzodiazepine

year 3 principles (20 decks)

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