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VT 230 Anesthesiology > Analgesia > Flashcards

Analgesia Flashcards

1
Q

Define: Analgesia

A

Absence of awareness of pain

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2
Q

Define: Pain

A

An unpleasant sensory & emotional experience associated with actual or potential tissue damage
*Untreated pain leads to patient suffering & prolongs recovery from surgery

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3
Q

Define: Nociception

A

The nerve cells involved in the detection of actual or potential tissue injury (pain) by the central nervous system

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4
Q

What are the 4 stages of pain perception?

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Perception
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5
Q

Transduction refers to?

A
  • Tissue injury from physical trauma including burns/chemical burns
  • Transformation of noxious thermal, chemical, or mechanical stimuli into action potentials by peripheral A-Delta & C fibers
    *Essentially once you get hurt pain receptors are notified & nerve fibers send the pain response to the spinal cord/brain
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6
Q

A Delta Nerve Fibers are found & are generally used in response to what type of pain?

A
  • Found Joints & Skin
  • Sharp Distinct Pain
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7
Q

C Nerve Fibers are found where & are used in response to what type of pain?

A
  • Found: Internal Organs especially the abdominal cavity
  • Dull achy throbbing pain
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8
Q

Transmission refers to what?

A

Conduction of sensory electrical impulse to the spinal cord.
*When the pain response moves through to the spinal cord

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9
Q

Modulation

A

Neurons in the spinal cord amplify or suppress the sensory impulse received from the peripheral nociceptors

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10
Q

Perception

A

Sensory impulse is transmitted to the brain where it is processed & recognized as pain

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11
Q

Multimodal Analgesia

A

Using a combination of analgesic drugs, each with a different mechanism of action to control different pain

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12
Q

Pain may be classified as?

A
  1. Adaptive Pain
  2. Maladaptive Pain
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13
Q

Adaptive Pain

A

Is the normal sensory response caused by tissue damage/injury & inflammation
*Acute & Chronic

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14
Q

Maladaptive Pain

A
  • Results from physical changes that occur in the normal spinal cord & brain if adaptive pain is not managed appropriately
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15
Q

Increased nociceptor sensitivity can lead to?

A

Increase nociceptor stimuli caused by non-noxious stimuli

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16
Q

Define:

A

HyperalgesiaIncreased sensitive to noxious stimuli

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17
Q

Allodynia

A

Pain produced by non-noxious stimuli

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18
Q

Windup

A

CNS hypersensitive to noxious & non-noxious stimuli

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19
Q

Somatic Pain

A

Arising from skin, sc tissue, muscles, bones & joints

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20
Q

Visceral Pain

A

C fibers transmit this pain
Arising from internal organs

21
Q

Neuropathic Pain

A

Pain arising from direct damage to peripheral nerves or the spinal cord

22
Q

Acute Pain

A

Typically adaptive pain
Sudden onset w/ short duration

23
Q

Chronic Pain

A

Slow onset w/ longer lasting effect

24
Q

Preemptive Analgesia

A

◦ Administration of an analgesic before tissue damage occurs or the patient has awareness of pain
◦ Reduces the analgesic requirements as well as how long the patient will need analgesics for pain control
◦ Opioids
◦ Alpha 2 Agonists
◦ Local Anesthestics
◦ Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)

25
Q

Postoperative Analgesia:

A

◦ Administration of analgesic agents for a few hours to a few days following surgery
◦ Repeated doses of oral or parenteral analgesic agents may need to be administered over an extended period of time
◦ Opioids
◦ NSAIDs
◦ Local Anesthestics
◦ Ketamine
◦ Alpha-2 Agonists

26
Q

What common anagelsia drugs are administered by CRI?

A
  1. Diazepam
  2. Dobutamine
  3. Dopamine
27
Q

Why are CRI’s becoming more popular?

A

◦ Provides stable plane of analgesia
◦ No peaks or troughs
◦ Lower drug dosage delivered ay any point in time
◦ Greater control over drug administration

28
Q

What analgesics drugs can be used for CRI’s?

A
  1. Opioids - Morphine & Fentanyl
  2. Lidocaine *Pain relief abdominal surgery
  3. Ketamine *Maladaptive pain
  4. Alpha-2 Agonist *Dexmedetomidine - helps w/ restlessness after surgery
29
Q

What are common opioids used for moderate to severe pain control?

A
  1. Morphine
  2. Oxymorphone
  3. Hydromorphone
  4. Fentanyl
30
Q

What are common opioids used for mild to moderate pain control?

A
  1. Buprenorphine
  2. Butorphanol
  3. Meperidine
  4. Nalbuphine
31
Q

Morphine works by?

A

Binding mU & Kappa receptors

32
Q

Morphine is most commonly used in what species?

A
  1. Dogs
  2. Cats
  3. Horses
33
Q

Morphine can be administered what route?

A
  1. IV
  2. IM
  3. SC
  4. Epidural
  5. By Mouth
34
Q

Morphine side effects?

A
  1. Dysphoria *Cats & Horses
  2. Salivation
  3. Vomiting
  4. Defection
  5. Panting *Dogs
  6. Bradycardia
  7. Colic in Horses
  8. Respiratory Depression
  9. Histamine Release *IV
  10. Excessive sedation
35
Q

What opioid is prescribed when a strong pain relief is need that has a longer lasting affect?

A

Oxymorphone & Hydromorphone

36
Q

Oxymorphone & Hydromorphone bind with what receptors?

A

MU

37
Q

If you need to give a large dose of an opioid via IV what drug has a lower chance of a histamine release?

A

Oxymorphone & Hydromorphone

38
Q

Buprenorphine is a partial?

A

MU receptor agonist
*Binds with the receptors but the effects aren’t as prominent as a drug that binds completely with the mU receptor

39
Q

Butorphanol is what type of receptor?

A

Kappa receptor agonist

40
Q

Butorphanol is used to?

A

reverse the mU receptor analgesia drug effects

41
Q

Ketamine is

A

◦ Dissociate Anesthetic
◦ Block the N-methyl-D-aspartate (NMDA) receptors that are in the spinal cord
◦ Used for animals experiencing chronic pain with no relief from other drugs
◦ Windup: Increased pain hypersensitivity
◦ Can be prescribed with opiods which will address the pain & the ketamine with prevent the maladaptive pain that can develope after a painful surgical procedure
◦ Administration
‣ SQ in small doses to chronic pain patients
‣ IV - CRI

42
Q

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)

A

◦ Acts as an anti-inflammatory to help relieve pain & decrease inflammation
◦ All relieve somatic pain control
◦ Some visceral pain relief
◦ Adverse effects:
‣ GI issues
‣ Renal/Kidney issues
◦ Do NOT use in combination w/ glucocorticoids

43
Q

• Local Anesthetics
◦

A

Prevent transduction & transmission of pain impulses
◦ This is the only drugs that affects transmission of the nerve pain response/impulses
◦ Short duration of action - the affects do not last a long time
◦ Potential for toxicity with repeated doses
◦ Most commonly administered in clinic versus sending home

44
Q

• Alpha 2 Agonists

•

A

◦ Provide good analgesia properties
◦ Use is limited by 3 factors:
‣ 1: Short duration of effect
‣ 2: Profound sedative effect
‣ 3: Potential adverse effects on the respiratory & Cardiovascular systems
◦ Best analgesia is through CRI in hospital
◦ Animals must have a healthy cardiovascular system before administration

45
Q

Tramadol
◦
•

A

Nonopiate drug
◦ Stimulates the mU receptor
◦ Decreased use in vet med due - as other drugs have greateer analgesia effects
‣ Study shows that it does not provide good analgesia in animals
◦ Administration:
‣ PO (By Mouth) for continuation of pain management at home

46
Q

Gabapentin

A

Mechanism of Action:
‣ Not well understood
‣ Appears to decrease secretion of excitatory neurotransmitters
• Norepinephrine
• Substance P
◦ Reduces windup pain
◦ Used for chronic pain management in dogs & cats
◦ Also used for refractory seizures & sedation in dogs & cats
◦ Used to treat arthritis
◦ Used in cats for spicy cats at vet visits
‣ 1 dose the night before & another dose 2-3 hours before appt
◦ Can be prescribed in Dogs but it’s more common to prescribe Trazodone
‣ Can prescribe Gabapentin & Trazodone to dogs for behavioral issue

47
Q

• Amantadine

A

A NMDA receptor antagonist similar to

48
Q

Ketamine

A

◦ Reduced windup pain
◦ Used for chronic pain management in dogs & cats

49
Q

Glucocorticoids

A

◦ Provide analgesia by reducing inflammation
◦ Do not use in combination with a n NSAID

VT 230 Anesthesiology (14 decks)

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