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Vet. Anesthesiology & Sx proc. > Analgesia > Flashcards

Analgesia Flashcards

1
Q

Pain is the _ vital sign

A

fourth

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2
Q

When pain elicits protective motor actions, what may the dog do?

A

try to bite after an IM injection

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3
Q

When pain elicits learned avoidance, what may it cause in the patient?

A

fear upon second visit to vet hospital

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4
Q

How may pain modify species behavior?

A

Different for individuals: seeking attention vs hiding

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5
Q

Untreated pain can affect

A

Behavior, Physiology, Metabolism, Immune system

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6
Q

What is nociception

A

detection by the nervous system for the potential for tissue injury

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7
Q

What does nociception protect the animal from?

A

painful or noxious stimuli

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8
Q

What is physiologic pain?

A

-Ouch pain
-Little or no tissue injury
-USEFUL: protects from injury

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9
Q

What is pathologic pain?

A

-follows tissue injury
-NO USEFUL FUNCTION: causes suffering
-Acute or chronic

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10
Q

Classifications of pathologic pain based on mechanism

A

Inflammatory, neuropathic, cancer, idiopathic

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11
Q

Classification of pathologic pain based on origin

A

Visceral (organs) or somatic (musculoskeletal- superficial vs deep )

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12
Q

Classifications of pathologic pain based on severity

A

none, mild, moderate, severe

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13
Q

What step of nociception is described?
Transformation of stimuli into sensory electrical signals (action potentials)

A

Step 1: transduction

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14
Q

What step of nociception is described?
Sensory impulses conducted to spinal cord

A

Step 2: transmission

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15
Q

What step of nociception is described?
Impulses are either amplified or suppressed

A

Step 3: modulation

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16
Q

What step of nociception is described?
Impulses are transmitted to the brain where they are processed and recognized

A

Step 4: perception

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17
Q

Drugs can be selected that will target specific receptors and block a specific step of nociception. _ _: targeting two or more of the receptors

A

Multimodal therapy

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18
Q

Why is multimodal therapy preferred?

A

reduces pain signaling by inhibition of multiple receptors and also allows lower drug dosages to be used, which decreases adverse effects and improves safety

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19
Q

What are the following consequences of?
-catabolism and muscle wasting
-immune system suppression
-inflammation and delayed wound healing
-anesthetic risk and increased anesthesia doses
-patient suffering

A

Untreated pain

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20
Q

Pathologic pain can result in

A

peripheral hypersensitivity or Primary Hyperalgesia

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21
Q

Primary hyperalgesia results from

A

tissue damage and constant stimulation of nerves (area close to the site of tissue injury becomes painful when stimulated with non-noxious stimuli)

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22
Q

What is secondary hyperalgesia

A

CNS hypersensitivity or windup

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23
Q

What drug can block secondary hyperalgesia

A

ketamine

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24
Q

What area is hypersensitive with secondary hyperalgesia

A

area further away from site of tissue injury (ex: you fracture your wrist and the forearm is touched)

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25
Q

What does secondary hyperalgesia result from

A

constant stimulation of spinal cord neurons (neurons become hyper excitable and sensitive)

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26
Q

Neuroendocrine changes: can results in a catabolic state and wasting, this looks like:

A

-ACTH release
-Elevated cortisol, norepi, and epi
-Decreased insulin

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27
Q

Sympathetic stimulation: can cause result in cardiac arrhythmias, this looks like:

A

-vasoconstriction
-increased myocardial work
-increased myocardial oxygen consumption

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28
Q

Pain elicits a _ response

A

stress (fight or flights)

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29
Q

The following describes _ _:
-Admin. of pain medications BEFORE pain occurs
-Commonly involves adding analgesic to premedication prior to anesthesia
-Reduces overall requirement for analgesia and duration of admin
-Prevents windup

A

Preemptive analgesia

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30
Q

What patients are less tolerant of pain

A

young

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31
Q

Behavioral responses to pain vary on the presence or absence of _

A

humans

32
Q

Physical evidences of pain

A

-Changes in gait and level of activity
-Reluctant to lie down or constantly shifting position
-Vocalization
-Changes in facial expressions, appearance, and attitude

33
Q

What is immediate postoperative vocalization called

A

Emergence delirium

34
Q

What pain assessment tool is described?
-Absent, mild, moderate, severe
-SUBJECTIVE; no description so its up to the assessor to determine pain severity

A

Simple descriptive scales

35
Q

What pain assessment tool is described?
-Advanced will use physiologic parameters, behavior and response to palpation to assign a #
-More objective

A

Numeric rating scales

36
Q

What pain assessment tool is described?
-Uses a ruler- Left end= no pain , Right end= severe pain

A

Visual analogue scale

37
Q

With effective analgesia, pain-associated behaviors will _

A

recede

38
Q

Perioperative pain management includes:

A

preemptive analgesia and multimodal therapy

39
Q

What stage is analgesia needed at of hospitalization or and tx

A

every stage

40
Q

Choice of analgesic drug depends on

A

-severity and type of pain
-patients general condition
-route of delivery

41
Q

GI effects of using opioids as analgesics

A

initial increased GI activity: nausea, vomiting, defecation followed by a slow down in GI activity: ileus, colic, constipation

42
Q

Morphine is used for

A

moderate to severe visceral or somatic pain

43
Q

What drug is described?
-Greater analgesic potency and sedative effect than morphine
-Fewer side effects and longer duration than morphine
-fewer tendencies to induce vomiting
-expensive schedule II drug

A

Oxymorphone

44
Q

What drug is described?
-Opioid agonist
-Less potency but similar duration of effect compared with oxymorphone
-Will likely cause vomiting if not given IV
-Schedule II drug

A

hydromorphone

45
Q

What drug is described?
-Synthetic opioid
-Characteristics similar to oxymorphone and hydromorphone
-Least likely to cause vomiting in cats and dogs
-Antagonist at the NMDA receptor

A

Methadone

46
Q

What drug is described?
-One of the most potent analgesics
-Rapid onset and short duration of action when admin. IV
-Schedule II drug

A

fentanyl

47
Q

What drug is described?
-Pure opioid agonist w/ less potent analgesic
-Admin. by SQ injection
-Wide margin of safety
-Used mostly as a preanesthetic in combo w/ atropine or ace
-When used w/ a tranquilizer, provides neuroleptanalgesia in puppies
-used w/ injectable NSAIDS
-Schedule II drug

A

Meperidine/ Pethidine

48
Q

What drug is described?
-synthetic opioid agonist antagonist
-not as effective (for severe pain) an analgesic as a pure agonist
-produces less sedation, dysphoria, and respiratory depression
-can be used to reverse the effects of morphine and fentanyl

A

Butorphanol

49
Q

What drug is described?
-A partial agonist
-post op analgesia in cats and dogs
-reverse effects of morphine and fentanyl
-delayed onset of action and longer duration
-used with sedative can prolong sleep times
-at high doses, resp. depression that is difficult to reverse w/ naloxone, may have to add doxapram

A

Buprenorphine

50
Q

What drug is described?
-Agonist antagonist with greater antagonist properties than butorphanol
-weak analgesic and sedative
-used as reversal agent for opioid agonists
-fewer adverse effects
-not a controlled drug in the US

A

nalbuphine

51
Q

Opioids as posted analgesics should be admin IM or SQ _ animal regains consciousness

A

before

52
Q

Disadvantages of opioids as post analgesics

A

short duration of action, potential adverse reactions

53
Q

Opioids used as IV infusion

A

morphine, fentanyl, oxymorphone, hydromorphone, methadone, butorphanol

54
Q

How should IV infusion of opioids be administered?

A

initial loading dose given to effect followed by same dose given over 4 hours through constant flow

55
Q

Opioids given as intraarticular injection are especially useful after _ or _ surgery

A

elbow or stifle

56
Q

What is an opioid epidural injection

A

instillation of opioid into epidural space at lumbosacral junction

57
Q

What are epidural opioid injections used to provide

A

analgesia to hind limbs, abdomen, caudal thorax, pelvis, tail

58
Q

What drug is most commonly used for opioid epidural

A

morphine

59
Q

When should an epidural be administered

A

after induction but before sx procedure

60
Q

What should be done every 2-4 hours after epidural

A

reposition animal to prevent pulmonary atelectasis or prolonged pressure on superficial nerves

61
Q

What do opioids admin. transdermally provide

A

convenient, long term opioid admin

62
Q

What does a fentanyl patch provide?

A

analgesia for postop pain and pain associated with trauma, burns, cancer, and painful abdominal conditions

63
Q

Signs of fentanyl patch overdose

A

ataxia and sedation (dogs); dysphoria and disorientation (cats)

64
Q

What may increase absorption of fentanyl patch

A

heat

65
Q

The following are _ :
-aspirin
-etodolac
-meloxicam
-ketoprofen
-firocoxib
-carprofen
-deracoxib

A

NSAIDS or nonsteriodal antiinflammatory analgesics (NSAAs)

66
Q

How are NSAIDS eliminated

A

kidneys and GI tract

67
Q

What are the most commonly used analgesics

A

opioids and NSAIDS

68
Q

Local anesthetics as analgesics are used to prevent or tx

A

postop pain

69
Q

Advantages of local anesthetics as analgesics

A

-complete anesthesia of affected area
-low toxicity
-rapid onset of action

70
Q

Disadvantages of local anesthetics as analgesics

A

-short duration of action
-CNS and cardiac toxicity with repeated use

71
Q

Alpha2 Agonists are used in _ to provide sedation ,muscle relaxation, and analgesia

A

horses

72
Q

Corticosteroids as analgesics adverse effects

A

ulcerogenic
immunosuppression w/ long term use
hyperadrenocorticism

73
Q

The following are examples of _ _:
-Acetaminophen and codeine (dogs)
-Fentanyl and meloxicam
-Morphine and injectable NSAID
-MLK

A

Multimodal therapy

74
Q

Home analgesia

A

-Fentanyl patches
-NSAIDs
-Oral morphine
-Tylenol w/ codeine (dogs) and butorphanol
-Tramadol

75
Q

The following are _ _:
-Acupuncture
-Transcutaneous electric nerve stim.
-Massage therapy
-Apply cold (acute) or heat (chronic)
-Physiotherapy
-Laser or magnetic therapy
-Homeopathic or herbal remedies

A

nonpharmacologic therapies

Vet. Anesthesiology & Sx proc. (8 decks)

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