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FCP > Analgesia > Flashcards

Analgesia Flashcards

1
Q

What is COX and when is it activated?

A
  • Cyclooxygenase enzyme
  • Activated after cell damage
  • Stimulates the release of prostaglandins
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2
Q

Important functions of prostaglandins

A
  • Maintaining the lining of the stomach
  • Maintaining blood flow to the kidneys
  • Supporting platelet function
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3
Q

Describe the action of NSAIDs

A
  • NSAIDs are COX inhibitors
  • NSAIDs also target descending pain pathways (PAG=peri-aqueductal grey, NRM=nucleus raphe magnus)
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4
Q

Commonly used small animal NSAIDs

A
  • Meloxicam
  • Carprofen
  • Robenacoxib
  • Firocoxib
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5
Q

Commonly used equine NSAIDs

A
  • Phenylbutazone
  • Meloxicam
  • Fluxinin meglumine
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6
Q

Commonly used farm animal NSAIDs

A
  • Meloxicam
  • Ketoprofen
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7
Q

For which common procedures should farm animals receive NSAIDs

A
  • Castration
  • Disbudding
  • Assisted calving
  • Foot care
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8
Q

When are NSAIDs contraindicated?

A

In patients with:

  • Renal/hepatic insufficiency
  • Hypovolaemia
  • Congestive heart failure
  • Pulmonary disease
  • Coagulopathies, active haemorrhage
  • Spinal injuries
  • Gastric ulceration
  • Shock, trauma
  • Pregnancy
  • Concurrent use of steroids

Sometimes NSAIDs must be used for welfare even when there is a comorbidity; need to weight up benefit vs. risk.

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9
Q

What are some likely side effects of NSAIDs?

A
  • Vomiting
  • Diarrhoea
  • Renal problems
  • Clotting dysfunction
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10
Q

Describe the action of Gapriprant compared to traditional NSAIDs

A
  • Gapriprant is a more selective, new class of NSAID
  • It does not block COX; instead it works lowers down the inflammatory pathway by blocking some activity of a prostaglandin (at the EP4 receptor)
  • Mode of action targets canine oesteoarthritic pain and inflammation while reducing the impact on gastric, renal and hepatic homeostasis
  • This is a selective drug that allows the kidney and gut to be spared from damage
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11
Q

Describe the action of paracetamol

A
  • Blocks central and peripheral COX
  • Has CB1 and TRPV1 receptor action
  • It is antipyretic
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12
Q

Which species can paracetamol be used in?

A
  • Paracetamol is licensed in pigs
  • Can be used IV in dogs and horses (off-licence)
  • Pardale-V (paracetamol + codeine) is licensed in dogs
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13
Q

Which species should paracetamol never be used in?

A
  • Cats
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14
Q

Differentiate between opioids and opiates

A
  • Opioids: naturally occurring or synthetic substances with morphine-like activity
  • Opiates: drugs derived directly from opium e.g. morphine, codeine
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15
Q

True/false: some opioids have both agonist and antagonistic activity but at different receptors.

A

True

e.g. Buprenorphine is an agonist at mu but an antagonist at kappa

Butorphanol is the reverse of this

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16
Q

Where are opioid receptors found and what do they do?

A
  • Found throughout the CNS in somatic and visceral sensory neurones
  • Found in the periphery (GI tract and joints)
  • Present especially after inflammation
  • All mediate inhibition of pain
17
Q

Agonists of which opioid receptor are recommended for moderate to severe pain/procedures where noxious stimulation will be high?

A

Mu (µ) receptor agonists

e.g. Methadone is a full agonist at mu, kappa and delta receptors

18
Q

Birds and reptiles have an increased number of which opioid receptors compared to dogs and cats?

A

Kappa

This means for optimal pain management, we may opt for kappa-agonist opioids in these species

19
Q

Which species is morphine licensed in?

A

None

But it can be used on cascade in certain situations e.g. epidurals

20
Q

Which species is pethidine licensed for?

A

Dogs

Horses

21
Q

Which species is fentanyl licensed for?

A

Dogs

22
Q

What scenarios/kind of pain are opioids suitable for?

A

Wide variety - opioids are effective and very versatile. For example:

  • Management of acute trauma patients
  • Patients undergoing surgical/diagnostic procedures
  • Patients suffering from chronic pain (e.g. cancer)
23
Q

True/false: butorphanol is a potent analgesic.

A

False

It is not very potent

24
Q

What types of chemicals are local anaesthetics? Where are they metabolised?

A
  • Typically amides e.g. lidocaine or esters
    • Esters are hydrolysed in blood plasma by cholinesterases
    • Amides are metabolised in the liver
25
Q

Describe the mechanism of action of local anaesthetics

A
  • They exist in equilibrium between ionised and non-ionised form
  • The receptor they interact with is located within the pore of the sodium channel
  • Only the ionised form can interact with the receptor
  • The local anaesthetic is injected close to the nerve and leads to a neural blockade
26
Q

What is a nerve locator and how does it work?

A
  • Nerve locator = hollow needle through which current can be passed
  • When close to the nerve, we see a twitching of the muscle mass
  • Switch off the current and inject the local anaesthetic at this location
27
Q

Describe the mode of action of alpha-2 agonists and their effects

A
  • They interact with alpha-2 receptors at the presynaptic membrane
  • They provide potent but short-lived analgesia (~1 hr)
  • They also provide sedation, and decrease HR
28
Q

Describe the mode of action of ketamine as an analgesic

A
  • NMDA receptor antagonist
  • May also interact with other receptors
29
Q

What are some example of opioids?

A

Methadone Fentanyl Pethidine Buprenorphine Butorphanol Morphine (not licensed)

FCP (34 decks)

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