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Anesthesia > Analgesia > Flashcards

Analgesia Flashcards

1
Q

What is analgesia

A

the absence of the awareness of pain achieved through the use of drugs or other modes of therapy

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2
Q

The goal of anesthetist

A

anticipate pain
recognize pain
provide for pain management

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3
Q

What is nociception

A

perception of a painful stimulus

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4
Q

What is nociceptor

A

a receptor that is stimulated by unwanted or painful stimulus

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5
Q

Nerve impulses are transmitted by chain/series of neurons also called the

A

Pain pathway

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6
Q

3 Types of stimuli

A

chemical
thermal
mechanical

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7
Q

4 main steps of the pain pathway

A

Transduction
Transmission
Modulation
Perception

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8
Q

What is transduction

A

noxious stimuli from receptors transformed into electrical signals AP

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9
Q

What is transmission

A

the sensory impulses are conducted from the nociceptors to the spinal cord

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10
Q

What is modulation

A

Occur s in neurons in the spinal cord and acts ot either suppress or amplify the initial stimuli

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11
Q

What is perception

A

the final step, involves the transmission and processing/recognition of the impulses by the brain

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12
Q

Acute pain

A

Abrupt onset and relatively short duration (most surgical pain), treated with analgesic drugs

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13
Q

Chronic pain

A

Slower onset, longer duration (osteoarthritis, cancer) may be more difficult to manage, may be unresponsive
to drug therapy (or become unresponsive)

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14
Q

Somatic pain

A

Pain arising from skin, subcutaneous tissues, muscle, bones and joints
Tends to be more easily localized and characterized as stabbing, throbbing or aching

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15
Q

Visceral pain

A

Pain arising from internal organs
More difficult to localize and characterized as cramping, burning or gnawing

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16
Q

Stress Leukogram (CBC)

A

Neutrophils Up
Lymphocytes Down
Monocytes Up
Eosinophils Down

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17
Q

GDV

A

Gastric dilation volvulus

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18
Q

Pyometra

A

Uterine infection

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19
Q

IVDD

A

Intervertebral disc disease

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20
Q

TECA-BO

A

Ear canal removal

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21
Q

OPIOIDS

A

*Act on receptors in both spinal cord and brain
*Various doses, routes and duration of effect
* Thomas & Lerche text: pg. 266 Table 8-3
*Commonly used in premedication, often in combination with other medications
*Neuroleptanalgesia = tranquilizer + opiod

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22
Q

Opioids

A
  • Morphine
  • Hydromorphone, (dilaudid)
  • Oxymorphone (numorphan®)
  • Butorphanol (torbugesic®)
  • Meperidine (demerol®)
  • Fentanyl (duragesic®)
23
Q

Pure agonists

A

▪ Always stimulate receptors
▪ Eg. Oxymorphone

24
Q

Pure antagonists

A

▪ Block all receptors
▪ Eg. Naloxone

25
Q

Mixed agonist/ antagonist

A

▪ Stimulate some types of receptors and block other types
▪ Eg. Butorphanol

26
Q

Opioid Side Effects

A

▪Bradycardia
▪Respiratory depression
▪Excitement (dysphoria)
▪Panting
▪Nausea
▪Vomiting

27
Q

Butorphanol (aka Torbugesic)

A

*Used more for mild/moderate pain (visceral
pain)
*Both agonist and antagonist properties
(mixed)
*Cough suppressant + anti-histaminic
*Widely used in pre-medications
*Not for use in epidural
*Short duration of action (1-2 hours after IM, SC
injection)
*Little adverse side effects

28
Q

HYDROMORPHONE (aka Dilaudid)

A

*Pure agonist
*Used for moderate/severe pain
*Stronger and lasts longer than butorphanol
*Can be used in epidurals
*2mg/ml or 10 mg/ml
*Longer duration of effect (4-6 hours)
*Potential for side effects including:
* Vomiting
* Panting
* Excessive sedation
* Excitement/dysphoria

29
Q

Fentanyl (aka Duragesic)

A

▪very potent analgesic
▪rapid onset ( 2 minutes IV)
▪short duration of effect in small animals (30 minutes
IV)
▪Most commonly form = TRANSDERMAL PATCH
▪Long term opioid administration
▪Reservoir of fentanyl enclosed in plastic, applied to
clipped area of skin and may remain for several days
▪Differing concentrations of patches based on size/wt of
animal and provides constant rate infusion
▪Still need to monitor for pain management and adjust
as necessary

30
Q

Non- Steroidal Anti inflammatories (NSAIDs)

A

▪Drugs that reduce pain, inflammation and fever
▪Most good for somatic pain, some visceral too
▪Examples:
▪carprofen (Rimadyl)
▪meloxicam (Metacam)
▪ketoprofen (Anafen)
▪deracoxib (Deramaxx)

31
Q

Non- Steroidal Anti inflammatories (NSAIDs) How they work

A
  • Reduce production of COX -1 and COX- 2 enzymes
  • These are precursor enzymes to a hormone called
    Prostaglandin (PG)
    *There are many types of prostaglandins in the body
    *There are good and bad PGs:
    *Good guys: normal body homeostasis
    *Bad guys: increase pain and inflammation
32
Q

Cox 1 is responsible for:

A

Prostaglandins that mostly do
GOOD THINGS
*Protect GI mucosa
*Maintain kidney blood flow
*Increase platelet aggregation

33
Q

Cox 2 is responsible for:

A

Prostaglandins that mostly do
BAD THINGS
*Increase pain and
inflammation

34
Q

NSAIDs are classed as either:

A

Non- selective
Selective

35
Q

Non- selective

A
  • Suppress both COX 1 and COX 2 equally
  • Ex. Ratio cox1: cox2 = 50:50
  • Examples of drugs: aspirin (not recommended)
36
Q

Selective

A
  • Suppress COX 2 more
  • Still suppresses some cox 1
  • Ex. Ratio cox 1:cox 2 = 1:1000
  • Examples of drugs:
  • meloxicam
  • carprofen
  • deracoxib
37
Q

Cox 2

A
  • Normal in some tissues
  • Increases prostaglandins that aid in
    function of
  • Central nervous system
  • Kidneys
  • Reproductive tract
  • Eyes
  • Is inducible
  • Meaning it doesn’t elevate UNLESS we
    aggravate it
38
Q

Meloxicam

A
  • Our most common NSAID in
    clinical practice
  • Trade names:
  • Apo- meloxicam
  • Rheumocam
  • Metacam
  • Etc
  • How does it work?
  • Cox 2 selective NSAID
  • Meaning it reduces cox 2 more than cox 1
39
Q

Benefits of Meloxicam

A
  • Better analgesia
  • Decrease inflammation
  • Reduce adverse risks of over suppressing cox 1
40
Q

What happens if we overly suppress Cox 1?

A
  • Gastro-intestinal ulcers and bleeding
  • Kidney hypoxia
  • Blood clots should read bleeding?
41
Q

When to avoid NSAIDs:

A

*Known hypersensitivity to NSAIDs
*Known liver or renal disease
*Any gastrointestinal disorder
*Patients taking corticosteroids
*Patients taking any mediations that may adversely affect the liver or kidneys
*Patients with dehydration or hypotension
*Within 24 hours of trauma or until hemorrhage controlled
*Conditions with low circulating volume (CHF, ascites, use of diuretics)

42
Q

Benefits of NSAIDs

A

*No cardiovascular or respiratory depression
*Not controlled drug
*Relatively inexpensive
*Readily available in injectable and oral forms
*Absorbed well orally
* Have convenient dosing syringes based on
weight to go home with owner
* All owner needs to know is weight
*For very small dogs can dose by the DROP
* 1 drop = 0.1cc

43
Q

Local Anesthetic Agents

A

*Lidocaine (xylocaine)
(5-10 min to act, lasts 90-200 min)
*Bupivacaine (marcaine)
(10-20 min to act, 180-600 min duration)

44
Q

ALPHA-2 AGONISTS

A
  • minor analgesia provided
  • pain control limited by short duration of analgesic effect (30-90 minutes), profound sedative effects and
    potential for adverse side effects (bradycardia, hypotension, respiratory depression)
  • eg. dexmedetomidine
45
Q

TRAMADOL

A
  • non-opiate drug that has action on mu receptor (1 of the opiate receptors)
  • Promoters serotonin
  • Was used for post operative pain management at home (tablet/oral form)
  • Recently been debunked as effective pain medication, more of an anti-anxiety
46
Q

Ketamine

A
  • Dissociative anesthetic
  • Block NMDA receptors in spinal cord
  • Prevents windup
  • Very low dose for just analgesia
    *IV Bolus or CRI
  • Administer with other drugs (ex. Morphine and lidocaine)
  • Not in dogs or cats with renal disease or heart disease
  • Adverse effects:
  • Tachycardia
  • Hypertension
  • IOP increase
  • ICP increase
  • Seizures
  • SALIVATION
47
Q

Other NMDA Agonists

A

*Amantadine
* Neuropathic pain
* Chronic pain
* Used with other drugs
* Side effects: GI Upset and Agitation
*Dextromethorphan

48
Q

Gabapentin

A

*Anti-seizure
*Neuropathic pain
*Chronic pain
*Oral form
* Tablet
* Don’t use liquid – XYLITOL!

49
Q

Corticosteroids

A
  • Anti-inflammatory
    *Ex. Prednisone, dexamethasone
    *Injectable, oral and long acting depoinjections
    *Decrease prostaglandin activity
    *DO NOT USE with NSAIDs
  • Causes stomach ulcers
50
Q

Other ways to mediate pain

A

▪Acupuncture
▪Supplements
▪Glucosamine/ MSM/ Chondroitin Sulfate
▪Cartrophen
▪Cold laser therapy
▪Animal rehabilitation/ physiotherapy
▪Chiropractic

51
Q

Acupuncture

A

*Ancient Chinese medicine
*Numerous benefits
*Large and small animal
*Very good for
* OA/DJD
* IVDD
* Muscle pain/ spasm

52
Q

Animal Rehabilitation

A
  • Similar to human physiotherapy
    *Stretching and exercise based
    *Excellent post surgery
    *Some treatments
  • Underwater treadmill
  • Cold laser therapy
  • Ultrasound therapy
  • Etc
    *High demand for performance animals
53
Q

Cold laser therapy

A

▪Anti-inflammatory
▪More clinics are using units
▪Good post-surgery
▪Multiple visits

54
Q

Catrophen

A

▪ Nutraceutical
▪Anti-inflammatory

Anesthesia (2 decks)

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