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Treatment > Block 1 > Flashcards

Block 1 Flashcards

1
Q

What is the physical status?

A

This is the assessment of systemic risk in relation to ASA standards

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2
Q

What is level 1 ASA?

A

Healthy patient

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3
Q

What is level 2 ASA

A

Patient with mild system disease

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4
Q

What is level 3 ASA?

A

Severe systemic disease but well controlled

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5
Q

What is level 4 ASA?

A

Severe systemic disease but threat to life

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6
Q

What is level 5 ASA?

A

Not expected to live for more than 24h without intervention

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7
Q

What is level 6 ASA?

A

Patient is being used for organ donation

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8
Q

What do agonists do?

A

Activate that specific receptor

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9
Q

What do antagonists do?

A

Block that specific ligand

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10
Q

What are 4 mechanisms of action of acepromazine?

A

Blockade of dopamine receptors in forebrain
Serotonin antagonist (5-HT1, 5-HT2)
Blockade of alpha-1 adrenergic receptors in vasculature
Inhibitory effect on P-glycoproteins and alter uptake of other drugs into brain

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11
Q

What a potential genetic issue with acepromazine?

A

Dogs with MDR1 mutation may increase toxicity due to ATP-binding transporters

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12
Q

What is dopamine 1 receptor?

A

Post-synaptic and causes vasodilation of splenic and renal circulations

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13
Q

What is dopamine 2 receptor?

A

Pre-synaptic and causes norepinephrine release

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14
Q

What causes vasodilation with acepromazine?

A

alpha 1 adrenergic receptor blockade

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15
Q

How long will vasodilation with acepromazine last?

A

Longer than the sedation because the alpha-1 receptor affinity is greater than the dopamine receptor affinity. So sad

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16
Q

What is the horse penis side effect of acepromazine

A

Paraphimosis

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17
Q

What kidney issue may occur due to acepromazine

A

Decreased systemic vascular resistance causes increased renal perfusion

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18
Q

What happens with the spleen with acepromazine?

A

Splenic engorgement causing a decrease in PCV by 20-30%

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19
Q

What happens with histamines with acepromazine?

A

Antihistaminic effect due to an H1 receptor blockage

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20
Q

Where is acepromazine metabolized?

A

The liver

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21
Q

Does acepromazine have analgesic effect?

A

No but can enhance analgesic effect of other drugs

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22
Q

What happens to the muscles during acepromazine?

A

Muscle relaxant, may see 3rd eyelid prolapse

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23
Q

How can you administer acepromazine?

A

Any way

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24
Q

Is acepromazine reversible?

A

NOT REVERSIBLE!

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25
Q

What is the time to clinical effect of acepromazine IM and IV?

A

IM: 30min
IV: 10-15min

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26
Q

Is acepromazine an antiemetic?

A

Yes!

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27
Q

What are the 2 most common alpha-2 agonists?

A

Xylazine and dexmedotomine

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28
Q

What is the main mechanism of action of alpha 2

A

Bind to alpha 2 and 1 receptors in CNS and PNS

Activation causes hyper polarization of cells causing decreased cellular activity

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29
Q

What is the ligand for alpha 2?

A

norepinephrine

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30
Q

Which receptor specifically causes sedation and supra spinal analgesia for alpha 2 receptor?

A

Alpha 2A (maybe alpha 2D in certain species)

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31
Q

How are alpha 2 agonists metabolized?

A

Liver and excreted in urine

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32
Q

What are the 4 cardio effects of alpha 2 agonist?

A

Vasoconstriction and hypertension (alpha 2B) then vasodilation (alpha 2A)
Peripheral vasoconstriction (alpha 1 receptor)
HR decreases (baroreceptor reflex)
Decreased CO (30-50%)

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33
Q

What are 2 respiratory effects of alpha 2 agonists?

A

Decreased respiratory rate
Stridor or dyspnea from muscle relaxation

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34
Q

What are 2 musculoskeletal effects of alpha 2 agonist?

A

Great muscle relaxers
Base-wide stance in horses

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35
Q

What happens to salivation with alpha 2 agonists?

A

Decreased salivation but a suppressed swallow reflex (more saliva in mouth)

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36
Q

What happens to blood glucose with alpha 2 agonist?

A

Increased due to a suppression of insulin release

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37
Q

What are 2 urinary effects of alpha 2 agonists

A

Anti-ADH and decreased tubular reabsorption of sodium causing low urine specific gravity
Decreased renal perfusion due to vasoconstriction

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38
Q

What is the main contraindication of alpha 2 agonist?

A

Heart disease (vasoconstriction)

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39
Q

What is the ratio of tolazoline with alpha1:alpha2

A

1:1

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40
Q

What happens if you reverse tolazoline in a camelid

A

Death

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41
Q

How are alpha 2 agonists reversed?

A

With alpha 2 antagonists

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42
Q

What is the alpha 2 antagonist used for xylazine?

A

Yohimbine

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43
Q

What is the alpha 2 antagonist used for dexmeditomidine/

A

Atipamezole

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44
Q

Who is most and least sensitive to xylazine?

A

Most: Ruminants (100x)
Least: Pigs

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45
Q

What is a stronger alpha 2 agonist for horses?

A

Detomidine (dormosedan)

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46
Q

What are 5 main affects of benzodiazepines?

A

Sedation
Relaxation (anxiolytics)
Anticonvulsants
Muscle relaxant
Amnesia

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47
Q

What receptor do benzos work on?

A

GABA

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48
Q

What subunit does the sedative effects come from on the GABAa?

A

Alpha-a

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49
Q

What subunit does the anxiolytic effects come from on the GABAa?

A

Alpha-b

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50
Q

What subunit does the muscle relaxation effect come from on the GABAa?

A

Either a or b

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51
Q

Which benzodiazepine has a shorter onset and a more potent effect due to greater affinity for receptor?

A

Midazolam

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52
Q

Which benzo is more lipid soluble?

A

Diazepam (brain?)

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53
Q

How is midazolam metabolized?

A

hepatic, intestinal

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54
Q

Is midazolam excretion affected by renal failure?

A

NO!

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55
Q

How is diazepam metabolized?

A

Hepatic (excreted in urine)

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56
Q

What is the toxicity associated with diazepam?

A

Long term use of diazepam has seen hepatic necrosis

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57
Q

What are the cardiovascular effects using benzodiazepines

A

None

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58
Q

What are the respiratory effects using benzodiazepines

A

Depression of swallow reflex

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59
Q

What are the musculoskeletal effects using benzodiazepines

A

Muscle relaxation

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60
Q

What are the GI effects using benzodiazepines

A

appetite stimulant in cats and goats
delayed gastric emptying in cats

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61
Q

What behavioral thing can be seen in benzodiazepines?

A

Paradoxical effect - excitement

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62
Q

Is there analgesia with benzodiazepines?

A

No!!!

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63
Q

What is the reversal (antagonist) for benzodiazepines

A

Flumazenil

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64
Q

How is flumazenil metabolized?

A

Hepatic

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65
Q

How can you administer midazolam?

A

IV, IM, or PO

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66
Q

How can you administer diazepam?

A

IV or PO

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67
Q

What is neuroleptanalgesia

A

Combination of an opioid with a sedative or tranquilizer

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68
Q

What is the benefit of neuroleptanalgesia?

A

Increase sedative and analgesic effect
Decrease dosage of both

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69
Q

What is the main effect of opioids?

A

Analgesia

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70
Q

What are the 2 opioid receptors?

A

Mu and Kappa

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71
Q

What are the 4 classifications of opioids?

A

Opioid agonists
Opioid partial agonists
Opioid agonist-antagonist
Opioid Antagonist

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72
Q

What classification of opioids stimulate all types of receptors?

A

Opioid agonists and partial agonists

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73
Q

What classifications of opioid receptors stimulate some receptors and block others?

A

Opioid agonist-antagonists

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74
Q

What classification of opioid receptors block all receptors?

A

Opioid antagonists

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75
Q

What are 4 opioid agonists?

A

Fentanyl
Hydromorphone
Morphine
Methadone

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76
Q

Of the full agonists, which one is not used for premed because it is short acting?

A

Fentanyl

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77
Q

Which opioid classification provides the highest level of analgesia but also the highest incidence of side effects?

A

Full agonists

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78
Q

How long does fentanyl last?

A

20 minutes

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79
Q

How long do other full agonists last?

A

3-4 hours

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80
Q

Why do partial agonists last longer?

A

Bind very tightly to mu receptor causing longer lasting effects

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81
Q

How long does buprenorphine last?

A

6-8 hour (roughly 2x as long as full)

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82
Q

What are the receptors of a agonist/antagonist?

A

Kappa agonist / Mu antagonist

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83
Q

What is the length of kappa/mu?

A

Short duration (1-2h)

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84
Q

What species are kappa/mu usually used in?

A

Large animal

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85
Q

What happens to full agonist with kappa/mu?

A

Bind tightly to mu receptor and will reverse full mu agonist (because its an antagonist)

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86
Q

What are some side effects to dogs on opioids?

A

Miotic pupils, hypothermia, dysphoria

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87
Q

What are some side effects to cats on opioids?

A

Dysphoria, hyperthermia

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88
Q

What are some side effects to horses on opioids?

A

Stall pacing, dysphoria

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89
Q

What are the 4 opioid agonists?

A

Morphine
Hydromorphone
Fentanyl
Methadone

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90
Q

What is the relevant partial agonist?

A

Buprenorphine

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91
Q

What is the relevant opioid agonist-antagonist?

A

Butorphanol

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92
Q

What is the relevant opioid antagonist?

A

Naloxone

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93
Q

What is the main effect of opioids on the cardiovascular system?

A

Bradycardia
Blood pressure

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94
Q

How to reduce bradycardia associated with opioids?

A

Anticholinergics

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95
Q

What causes some blood pressure decreases with opioids?

A

Morphine causes histamine release resulting vasodilation

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96
Q

What is the respiratory affect of opioids?

A

Depressed, primarily if animal is unconscious (rate and tidal volume)

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97
Q

Why do opioids reduce respiratory function?

A

Higher paCO2 is tolerated before respiration is increased
Cough is suppressed

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98
Q

What are 3 very important GI affects of opioids?

A

Increased salivation
Emetic (except methadone)
GI slows down -> ileus

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99
Q

Why should you use caution with opioids in horses?

A

Since GI slows down, increase chance of colic

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100
Q

What is the main effect of opioids on urinary system?

A

Increased release of ADH causing a decrease in urination

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101
Q

How are opioids metabolized?

A

In the liver

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102
Q

What are 2 benefits of a partial agonist or a agonist-antagonist?

A

Less addictive
Less hard on cardiopulmonary system

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103
Q

What does a partial agonist or agonist-antagonist look like?

A

Analgesia remains but sedation is lessened and cardiopulmonary depression is lessened

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104
Q

What happens when an opioid antagonist is given?

A

Sedation is reversed but analgesia remains

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105
Q

Rank ace, alpha 2 agonist, and bentos in order of how much sedation you expect to be given

A

1 alpha 2

#2 Benzo
#3 Ace

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106
Q

Of the sedatives, dex and xylazine produce the highest level of sedation

A
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107
Q

What is the purpose of neuroleptanalgesia?

A

Mix a sedation with a tranquilizer

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108
Q

When is the use of epidural opioids an option?

A

When the patient is inpatient

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109
Q

What is the best opioid to use for epidurals?

A

Preservative free morphine

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110
Q

How long does a opioid epidural take to kick in?

A

1-2 hours

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111
Q

How long with an opioid epidural last?

A

8-12 hours

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112
Q

Where is the epidural in a small animal placed and what are the landmarks?

A

Between L7 and S1
Between ileal wings

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113
Q

What species is Zorbium used in?

A

Cats!

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114
Q

What are the 4 things that anesthesia can be used for?

A

Surgery
Diagnostics
Long term ICU ventilation
Physical exam if needed

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115
Q

What is the anesthesia triad?

A

Muscle relaxation
Unconsciousnes
Analgesia

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116
Q

What are the 3 big things to be assessed prior to anesthesia?

A

Cardio
Pulmonary
CNS

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117
Q

What are 2nd tier things to be assessed for anesthesia?

A

Renal and hepatic

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118
Q

What is the minimum required at OSU CVM before put under general anesthesia?

A

PCV TP

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119
Q

What are the 6 components to anesthetic plan?

A

physical exam
premed
induction
maintenance
monitoring
recovery

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120
Q

What are the 3 reasons to premed?

A

Easier induction
Easier placement of IV catheter
Smoother recovery

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121
Q

Remember:
Ace is not reversible
Dex is reversible

A

Ace increases blood flow to kidneys
Ace is dose dependent

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122
Q

Remember:
Ace is a vasodilator
Dex is a vasoconstrictor

A

Dex provides analgesia
Dex increases sedation level

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123
Q

Remember:
In horses, xylazine lowers head. Detomadine is a great premed in them
Ace is a muscle relaxer, dex is an emetic

A

In dogs with heart disease, dont use drugs that cause bradycardia (opioids and alpha 2)

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124
Q

What premed drugs can cause bradycardia?

A

Opioids and alpha 2

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125
Q

What do you see in older patients in terms of dosing?

A

Less drug needed

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126
Q

What is different about greyhound pre med?

A

Take longer to wake up
Lower heart rate so don’t use drugs that will decrease HR too much

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127
Q

What is the most common drug sedative to cause hypoventilation?

A

Alpha 2

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128
Q

What is the most common drug sedative to cause hypotension?

A

Ace

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129
Q

What drug should you avoid if you are worried about histamine release?

A

Morphine (histamine release)W

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130
Q

what is an additional anesthetic concern with horses under general?

A

Hypoxemia

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131
Q

Remember when using a full mu agonist with horses (morphine), it will slow GI and may cause colic

A

Reminder:
Methadone is not an opioid emetic, good for patients at risk of vomiting

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132
Q

When should you throw away a propofol bottle?

A

6-12 hours after opening

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133
Q

What channels does propofol work on?

A

GABA receptor (same as benzos and same mechanism I think)

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134
Q

How long does propofol last?

A

5-15 min

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135
Q

How is propofol metabolized

A

Both hepatic and extra hepatic

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136
Q

How can you infuse propofol?

A

IV ONLY

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137
Q

How can you decrease side effects with propofol?

A

Injection over a long period of time

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138
Q

What is another way you can use propofol for total IV anesthesia?

A

CRI IV

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139
Q

What are the 4 cardio effects of propofol?

A

Hypotension
Vasodilation
Compensatory increase in HR
Decrease in myocardial contractility

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140
Q

What patient should you be cautious about giving propofol to?

A

Hypovolemic patients (due to hypotension and vasodilation)

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141
Q

What are 2 respiratory affects of propofol?

A

Severe respiratory depression
Apnea or hypoventilation (dose dependent)

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142
Q

Does propofol have analgesia?

A

No

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143
Q

What does propofol cause in cats in the blood?

A

Heinz bodies

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144
Q

What urine outcome of propofol happens that is not a concern?

A

Green urine

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145
Q

How long will alfaxalone last in the container?

A

28 days

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146
Q

Is alfaxalone a controlled drug?

A

Yes

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147
Q

What is the mechanism of alfaxalone?

A

Binds GABAa cell surface receptors and modulates neuronal chloride ion transport

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148
Q

How long does alfaxalone last?

A

5-20 min

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149
Q

How is alfaxalone metabolized?

A

Liver

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150
Q

How is alfaxalone excreted?

A

Bile and urine

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151
Q

What are the cardiovascular side effects of alphaxalone?

A

Dose dependent!
Hypotension
Vasodilation

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152
Q

What are the respiratory side effects of alphaxalone?

A

Dose dependent respiratory depression
Severe hypoventilation and apnea if a lot given

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153
Q

Tell me about alphaxalone in c sections

A

Alphaxalone saw better puppy vigor after c section than propofol

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154
Q

Is there analgesia with alphaxalone

A

No!

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155
Q

What type of steroid is alfaxalone?

A

Neuroactive (nonhormonal)

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156
Q

Etomidate is ______ soluble at acidic pH

A

water

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157
Q

Etomidate is _______ soluble at physiologic pH

A

lipid

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158
Q

Etomidate is classified as a _____

A

Hypnotic

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159
Q

What is the mechanism of action of etomidate?

A

GABAa selective modulator

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160
Q

How is etomidate metabolized?

A

Liver

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161
Q

How is etomidate excreted?

A

Urine and bile

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162
Q

How fast do propofol, alfaxalone, and etomidate cause unconsciousness?

A

Immediately

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163
Q

How is the induction of etomidate?

A

Rapid but can be rough
(Smooth recovery tho)

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164
Q

What are the cardiovascular side effects of etomidate?

A

Minimal to no effects on blood pressure, cardiac output, or heart rate!
Great for heart patients

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165
Q

What are respiratory side effects of etomidate?

A

Minimal to no respiratory effect!

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166
Q

What is an important side effect of etomidate?

A

Decrease in cortisol, corticosterone, and aldosterone (adrenal suppression)

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167
Q

What dog do you NEED to avoid giving etomidate?

A

Addison dogs!

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168
Q

What are 2 other common side effects of etomidate?

A

Myoclonus (twitching)
Retching during induction

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169
Q

What is the original cyclohexylamine and most potent?

A

Phencyclidine

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170
Q

What is the least potent?

A

Ketamine

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171
Q

What is telazol?

A

Tiletamine + zolazepam

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172
Q

How does dissociative anesthesia work?

A

An interruption from the unconscious to conscious parts of the brain

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173
Q

Describe the dissociative state in 4 ways

A

Cataleptoid state
Opened eyes
dilated pupils
Palpebral reflex

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174
Q

What are the 2 carbon atoms in ketamine bottle?

A

S(+) and R(-)

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175
Q

Which carbon is more potent and just better?

A

S(+)

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176
Q

What is the mechanism of action of ketamine?

A

Non-competative antagonist of NMDA receptor preventing binding of glutamate and glycine. Results in depressed activity

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177
Q

Where are NMDA receptors

A

In nerve cells

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178
Q

Ketamine has what affect on bronchials?

A

Bronchodilation
It is a muscarinic with sympathomimetic action!!

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179
Q

Does analgesic outlast anesthetic effect?

A

Yes!

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180
Q

Ketamine wears off faster than its excreted

A

Duration of action related to redistribution to lean body tissues and fat

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181
Q

How is ketamine metabolized?

A

In liver

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182
Q

Norketamine is metabolized in which species?

A

dogs and horses

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183
Q

Norketamine is not metabolized (and just excreted) in which species?

A

Cat

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184
Q

What ways can you administer ketamine?

A

IV or IM

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185
Q

What must be combined with ketamine to give muscle relaxation?

A

A muscle relaxant (maybe midazolam, propofol)

By itself, it has 0 muscle relaxation

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186
Q

What are the 2 cardiovascular effects of ketamine?

A

Causes an increase in BP, HR, and CO due to the sympathomimetic effect
Eventually it wears off to a myocardial depression

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187
Q

What is the respiratory side effect of ketamine?

A

Mild respiratory depression

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188
Q

What does ketamine always need to be used with?

A

A muscle relaxant

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189
Q

What is an additional side effect of ketamine (2 actually)?

A

-Increased brain and eye pressure
-Increased salivation

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190
Q

What type of patient should ketamine not be used on?

A

Brain tumor patient

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191
Q

What is telazol a mixture of?

A

1:1 mixture of tiletamine and zolazepam

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192
Q

In cats, does tiletamine or zolazepam last longer?

A

Zolazepam

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193
Q

In dogs, does tiletamine or zolazepam last longer?

A

Tiletamine

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194
Q

What type of induction is telazol usually associated with?

A

Rough inductions

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195
Q

What species are telazol commonly used in?

A

Horses, dogs, cats, pigs

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196
Q

What is the mixture in large animal that involves telazol?

A

TKX = Telazol, ketamine, xylazine

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197
Q

What cardiovascular side effects does telazol have?

A

Similar increase of HR, CO, and BP as ketamine

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198
Q

What side effect does telazol not have that ketamine does?

A

Increase in brain and eye pressure

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199
Q

What type of breathing pattern does ketamine cause?

A

Apneustic (large breaths, then short breaths, then large breaths, etc) breathing pattern

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200
Q

What happens to excretion of alfaxalone in cats?

A

Has a potential to accumulate

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201
Q

What are the 4 basic components to an anesthesia machine?

A

Gas source
Vaporizer
Flow meter
Pressure regulator

202
Q

What is the letter for a small tank?

A

E

203
Q

What is the letter for a large tank?

A

H

204
Q

When should you replace the oxygen tank?

A

When it falls below 200psi

205
Q

How do you calculate the volume in an oxygen tank?

A

Volume = pressure (psi) / 3

206
Q

How many psi are in a full tank?

A

1900 psi

207
Q

How many liters are in a full tank?

A

660L

208
Q

When are you in the high pressure system?

A

In the tank, manometer

209
Q

What transitions gas from high pressure system to intermediate pressure system?

A

The pressure reducing valve (regulator)

210
Q

What transitions gas from intermediate pressure to low pressure system?

A

Flow control valve

211
Q

When does the house pipeline come in?

A

In the intermediate pressure system

212
Q

What is the flow control valve and what system is it in?

A

It is the knob on the flowmeter.
Knob is in the intermediate system but the flowmeter is in low system

213
Q

What system is the oxygen flush valve in?

A

Intermediate system!

214
Q

Where do you read the sphere?

A

In the middle

215
Q

Where do you read the diamond?

A

At the top

216
Q

How often should a machine be services?

A

Once a year

217
Q

How does the soda lime work in rebreathing system?

A

CO2 is an acid and soda lime is a base so when air flows through, CO2 is removed and gas is recycled

218
Q

How do you determine how big your reservoir bag should be?

A

5 x TV
Or (50-100 mL/kg)

219
Q

How do you know if it is a rebreathing system or not?

A

If there is a canister -> rebreathing
If no sodalime canister -> Not rebreathing

220
Q

What do you need to ensure on the one way valves?

A

That they are dry and not warped (especially on CO2 rebreathing)

221
Q

What happens if there is an incompetent one way valve?

A

Movement of CO2 up the inspiratory limb and then there will be consumption of CO2 on next breath from that limb

222
Q

How can you tell if a one way valve is bad?

A

Can see both opening at the same time

223
Q

What does new sodalime feel like?

A

Moist and crumbly

224
Q

What does exhausted sodalime feel like?

A

Dry and hard
Color is not reliable

225
Q

How should the pop off valve be left?

A

OPEN!!!

226
Q

When should you use non-rebreathing system?

A

in smaller patients (<5kg)

227
Q

What is the minimum volume to meet vaporizer fresh gas flow needs in a rebreathing system?

A

500mL/min

228
Q

What is the fresh gas flow rate of rebreathing system?

A

20mL/kg/min

229
Q

What is the fresh gas flow rate of non rebreathing system?

A

200mL/kg/min

230
Q

Where is gas waste vented from?

A

APL valve

231
Q

What is active scavenging?

A

Negative pressure is generated by vacuum pump and gases are actively removed from exhausted port

232
Q

What is passive scavenging?

A

Into charcoal canister and released

233
Q

Veterinarians are at higher risk of pregnancy loss
Make sure ETT cuff is always properly inflated
Only turn vaporizer on after cuff is inflated
Make sure appropriate scavenging is used
Make sure anesthesia machine is checked before each case

A

After breaking iso, evaluate area, ventilate area, treat as hazardous waste, wash area with water, avoid skin and eyes, collect in plastic bags with respirators and gloves

Small spills can let evaporate, ventilate area, evacuate personnel

234
Q

Which induction drug is least likely to cause apnea?

A

Etomadine and ketamine

235
Q

Which induction drug does not require hepatic metabolism

A

Propofol

236
Q

Is propofol 28 labeled for cats?

A

NO!!!

237
Q

What patient might you be worried about using propofol in?

A

A puppy with a non developed liver
A portosystemic shunt dog

238
Q

What drug should you avoid in heart diseased patients?

A

Ketamine!

239
Q

What is physiological pain?

A

Pain where no or minimal tissue injury occurs (ouch pain - protective warning system)

240
Q

What is pathologic pain?

A

Pain following tissue injury

241
Q

What is spontaneous pain?

A

Pathologic pain in absence of noxious stimulus

242
Q

What is allodynia

A

Pathologic pain in response to normally innocuous stimulus

243
Q

What is hyperalgesia?

A

Exaggerated pathologic pain in response to a noxious stimuli.

244
Q

Pain may be ______ or ________

A

Somatic or visceral

245
Q

What are the phases of nociception in order?

A

Transduction
Transmission
Modulation
Projection
Perception

246
Q

What are the 2 types of fibers peripherally?

A

A-delta
C fibers

247
Q

Which is responsible for fast pain and which long pain?

A

A-delta (myelinated) short pain
C fibers (unmyelinated) long pain

248
Q

Where are the nerve bodies for transmission?

A

In the spinal cord dorsal root ganglia

249
Q

What are the areas of the brain that are responsible for perception of pain?

A

Periaqueductal grey matter
Reticular activating system
Thalamus

250
Q

What does CNS plasticity do?

A

Cause hypersensitivity to acute and chronic pain

251
Q

What is sensitizing soup and what does it do?

A

A bunch of inflammatory cells and nerve growth factors and substance P that increase sensitivity to nociceptors

252
Q

What is wind up also known as?

A

Temporal summation

253
Q

What is the cellular physiology being temporal summation (wind up)

A

Unblocking of NMDA-receptors leading to hypersensitivity

254
Q

What is the definition of an animal that is enduring pain?

A

Suffering

255
Q

What are the 3 types of visceral pain?

A

Stretch
Hypoxemia
Inflammation

256
Q

What is neuropathic pain

A

damage of the nervous system leading to hypersensitivity and Spontaneous Activity to non-noxious, non-painful stimuli

257
Q

What are some things in the inflammatory soup?

A

Prostaglandins (released by COX1 and 2), histamine, serotonin, nerve growth factor, cytokines

258
Q

What are the 3 A’s of evaluating pain?

A

Attitude, appetite, activity

259
Q

What is the downside of relying on HR, BP, and RR for pain?

A

Will level with chronicity

260
Q

What are the 4 parts of taxonomy of pain?

A

Location (somatic-deep or superficial /visceral)
Severity
Mechanism (inflammatory, neuropathic, or idiopathic)
Severity

261
Q

What is the visual analogue scale?

A

Graph with no pain to worst pain

262
Q

What is simple descriptive pain?

A

Check boxes that define your pain pre and post op as none, mild, moderate, or severe

263
Q

What is the scale for the Colorado Pain Scale?

A

0-4

264
Q

What is Glasgow Composite Pain Scale? (GCPS)

A

Pain score from 0-20 from 7 different domains

265
Q

When should you give analgesia?

A

As preemptive analgesia

266
Q

What do opioids decrease the release of in pain management?

A

Glutamate

267
Q

What 3 things do opioids provide?

A

Analgesia, sedation, euphoria

268
Q

What 3 things do alpha 2 agonists provide?

A

Analgesia, muscle relaxation, sedation

269
Q

Which species are alpha 2 agonists good for?

A

Equine

270
Q

What part of pain does NMDA antagonists (ketamine) act on?

A

Treats wind-up pain (central sensitization)

271
Q

How do local anesthetics work?

A

Block nerve transmission by blocking inflow of Na+ - sodium channel blockers

272
Q

What are the 4 types of local anesthetics?

A

Lidocaine, ropivacine, bupivacain, mepivicaine

273
Q

What is known as kitty magic?

A

Dexmedetomidine
Ketamine
Butorphanol

274
Q

What 3 things can NSAIDs do?

A

Anti inflammatory
Antipyretic (lowers fever)
Analgesic

275
Q

What 4 things are activated during inflammation?

A

Phopholipase A
COX
LOX
Nuclear factor kappa beta

276
Q

How do NSAIDs act?

A

Act against COXs

COX-1 is constitutive
COX-2 is constitutive and inducible
Mostly inducible tho
COX-3 is inducible

277
Q

What are the 4 side effect of NSAIDs?

A

Antithrombic
Gastric defect
Renal damage
Hypersensitivity runs
(chance of hepatopathy in dogs)

278
Q

When should you NOT USE NSAIDS?!

A

Patient is concurrently on steroids

279
Q

Which NSAID is toxic to animals?

A

Acetaminophen

280
Q

What NSAID does not inhibit COX? What does it target?

A

Galliprant
Prostaglandin EP4 receptor

281
Q

What type of local anesthetic is not metabolized in the liver?

A

Amino esters (procaine)

282
Q

Why do local anesthetics not work well at inflamed tissues?

A

Venules and capillaries are dilated in inflamed tissues causing increased blood flow to the area which promotes absorption and removal of the local anesthetic

283
Q

What local anesthetic lasts the shortest and the longest?

A

Lidocaine the shortest
Bupivacaine the longest

284
Q

What local anesthetic takes the longest to start working?

A

Lidocaine shortest
Bupivacaine longest

285
Q

What can cause a local anesthetic to last longer?

A

Adding a vasoconstrictor like epinephrine

286
Q

What needs to be considered when the patient is pregnant with local anesthetics?

A

There is a lot of placenta transfer from mother to fetus

287
Q

What decreases transfer of local anesthetic from mother to fetus?

A

High protein binding

288
Q

What local anesthetic should be used?

A

Bupivacaine
Longest protein binding

289
Q

What local anesthetic has the highest risk of toxicity if it goes IV?

A

Bupivacaine

290
Q

Lidocaine can go IV

A

Lidocaine causes vasodilation

291
Q

What local anesthetic is used in horses?

A

Mepivacaina aka carpocaine

292
Q

For local anesthetics, will CNS or cardiovascular toxicity appear first?

A

CNS!

293
Q

For bupivacaine, will CNS or cardiovascular signs appear first?

A

Cardio can show first

294
Q

How much higher does dose need to be to cause myocardial toxicity with local anesthetics?

A

4x

295
Q

How do you treat cardiovascular toxicity of local anesthetic?

A

Ventilation
Epinephrine

296
Q

How do you treat cardiovascular toxicity of bupivacaine?

A

CPR
Intralipid bolus**

297
Q

What local anesthetic should you use for an instratesticular block?

A

Lidocaine
Scrotal approach - cat
Prescrotal approach - dog

298
Q

Where does lidocaine go with the intratesticular block?

A

Somatic chord

299
Q

Do local anesthetics delay healing or increase risk of infection?

A

NO!

300
Q

What can you do if the maximum dose is reached on a line block?

A

Add saline

301
Q

What does the infraorbital block block? lol

A

Infraorbital nerve and rostral maxillary alveolar nerve

302
Q

Where is the needle inserted in the infraorbital block?

A

doral to the 3rd premolar

303
Q

What teeth are blocked in infraorbital block?

A

Premolars forward

304
Q

What needs to be considered when doing infraorbital block on cats or brachycephalic dogs?

A

Puncturing the orbit

305
Q

what is a different technique that can be used on brachycephalic and cats?

A

Perpendicular approach

306
Q

What does the maxillary block block?

A

Maxillary branch of trigeminal

307
Q

What does the maxillary branch innervate?

A

Nose, upper lip, upper teeth, maxilla

308
Q

What is the approach for maxillary block?

A

Behind last molar perpendicular

309
Q

What does the inferior alveolar (mandibular) block block?

A

Mandibular branch of trigeminal

310
Q

What structures are blocked with the inferior alveolar block?

A

Lower teeth

311
Q

What does the mental block block?

A

Just the chin…
Not teeth!

312
Q

What is most preferred epidural drug?

A

Opioid - preservative free morphine

313
Q

What is the tallest spinous process that should be used for locating L7?

A

L6

314
Q

What are the 3 indications that you are in the right spot when placing the epidural?

A
  1. You feel a pop, meaning you passed through the ligamentum flavum
  2. Saline is sucked
  3. You feel a change in resistance
315
Q

What if there is CSF or blood in hub?

A

Too lateral, reposition

316
Q

What are the 3 nerves blocked in a nerve block?

A

Radial
Median
Ulnar (doral and palmar)

317
Q

What nerves are blocked in the proximal paravertebral nerve block?

A

L1, L2, L3

318
Q

What nerves are blocked in the distal paravertebral nerve block?

A

L1, L2, L4

319
Q

For food animal epidural, where do you block between?

A

Co1 and Co2

320
Q

Where does the spinal cord end in cows, goats, sheep, and pigs?

A

S1

321
Q

Where does the spinal cord end in horses?

A

S2

322
Q

Where does the spinal cord end in dogs?

A

L6-L7

323
Q

Where does the spinal cord end in cats?

A

L7-S3

324
Q

What is the mechanism of action of inhaled anesthetics?

A

Inhibiting GABA and glycine receptors and slowing acetylcholine and glutamate receptors

325
Q

What is the solubility represent?

A

Speed of induction and recovery

326
Q

What does lower solubility represent?

A

faster induction and recovery

327
Q

What does MAC stand for?

A

Minimal alveolar concentration

328
Q

What is MAC equal to?

A

how much should I use

329
Q

How does solubility change with temperature?

A

4% increase per celsius

330
Q

What happens with hypothermic patients?

A

Solubility is increased which causes them to take longer to wake up from anesthesia

331
Q

What should you start a patient at?

A

2 x MAC

332
Q

What level are most patients adequately anesthetized at?

A

1.2-1.5x MAC

333
Q

What species has a higher MAC?

A

Cats

334
Q

What are a couple factors that decrease MAC (less anesthetic)

A

Hypothermia
Pregnancy
Old

335
Q

What is a factor that increases MAC (more anesthetic)?

A

Hyperthermic
Excited animals (high catecholamines)

336
Q

MAC is not affected by sex, hypertension, or duration of anesthesia

A
337
Q

What is MAC for most dogs and horses on Iso?

A

1.3
(sevo = 2.3)

338
Q

What is MAC for most cats on iso>

A

1.6

339
Q

What pressure produces the anesthesia?

A

The brain

340
Q

What is most important factor from producing anesthesia?

A

Blood:gas solubility

341
Q

What happens with high CO2?

A

Takes longer to induce patient. Excited patients producing a lot of CO2 will take longer to induce

342
Q

How does most inhalant leave the body?

A

Through breathing it out

343
Q

What are the side effects of inhalants on respiratory and cardio systems?

A

Respiratory depression
Increase in intracranial pressure
Vasodilation
Decrease in cardiac output due to myocardial contractility

344
Q

Are inhalants nephrotoxic?

A

NO!

345
Q

Where does central sensitization occur?

A

In the spinal cord

346
Q

Avoid alpha 2 with heart disease

A

Ketamine alone has no muscle relaxant
Medazolam is a good muscle relaxant
Ketamine not used in HCM cats???

347
Q

What 3 things need to be monitored under anesthesia?

A

Depth of anesthesia
Cardiovascular system
Respiratory system

348
Q

How many stages are in the Guedel Classification?

A

4

349
Q

What is stage 1?

A

Analgesia and amnesia. Induction to loss of consciousness

350
Q

What is stage 2? Not commonly seen

A

Delirium and unconsciousness. From loss of consciousness to onset of automatic breathing

351
Q

What is stage 3?

A

Surgery anesthesia. Automatic respiration to respiratory paralysis

352
Q

What is stage 4?

A

Respiratory paralysis to death

353
Q

What are the CNS changes in response to depth?

A

Movement in response to surgery
Ocular reflex
Pedal reflex (flex to move away from pain)
Anal tone

354
Q

What are the muscle relaxation changes associated with anesthesia plane?

A

Jaw tone

355
Q

What does palpebral reflex tell us?

A

Too light = blink response
Just right = no blink
Too deep = no blink

356
Q

Where should dog and cat’s eyes be under surgical plane?

A

Ventromedially

357
Q

Where should a horse’s eye be in surgical plane?

A

One rostral, one central
If waking up, maybe nystagmus

358
Q

What happens if the animal is too deep?

A

Eyes are central with dilated pupils

359
Q

Can you check for surgical planes with jaw tone (too deep, too light, and appropriate depth)

A

Yes!

360
Q

What does a high HR and BP mean for the plane?

A

Too light

361
Q

What does a high HR and low BP mean for the plane?

A

getting deeper

362
Q

What does a low HR and BP mean for the plane?

A

Deep

363
Q

What are 2 other ways to check cardiovascular system?

A

Mucous membrane color
Capillary refill time

364
Q

What lead is usually read on ECG?

A

lead II

365
Q

What does hyperthyroidism due to heart rate under anesthesia?

A

Increases (tachycardia)

366
Q

What are the 2 stages of Cushings reflex

A

Stage 1 = tachycardia + hypertension
Stage II = bradycardia + hypertension + abnormal respiration pattern

367
Q

What are 2 devices to monitor BP noninvasive?

A

Doppler
Oscillometric (cuff)

368
Q

What is hypotension in SA?

A

below 60

369
Q

What is hypotension in horses?

A

Below 70

370
Q

Which 3 types of drugs cause hypotension

A

Ace
Inhalants
Propofol

371
Q

What 3 types of drugs cause hypertension

A

Ketamine
Alpha 2
Catecholamines

372
Q

What is capnometry?

A

Continuous measurement of inspired and expired gases of CO2

Non-diverting or diverting (takes a little longer) are available

373
Q

Need to look at screenshot of capnograph on iPad

A
374
Q

What is phase 1 of capnograph?

A

Inhalation phase

375
Q

What is phase 2 of capnograph?

A

CO2 coming from upper airways (breathing out)

376
Q

What i phase 3 of capnograph?

A

CO2 coming from the alveoli

377
Q

What is phase 4 of capnograph

A

Beginning of inhalation (breathing in)

378
Q

What is the CO2 measurement that should be considered?

A

PaCO2

379
Q

What might exhausted sodalime cause?

A

Hypercarbia

380
Q

What is the minimum PCV?

A

20%

381
Q

What are some factors that may interfere with pulse oximeter?

A

Vasoconstriction
Shivering
Pigmentation

382
Q

How long do you have to intubate before desaturation in healthy animals?

A

3 minutes

383
Q

What is normal tidal volume?

A

10-15ml/kg

384
Q

During inhalation, blood flows into the thorax due to a decreased intrathoracic pressure (just like air does)

A
385
Q

What happens to blood flow to chest with assisted ventilation?

A

Less blood flow due to lack of negative intrathoracic pressure

386
Q

When should ventilation be considered?

A

When PaCO2 is greater than 60

387
Q

What is after load

A

Aortic pressure

388
Q

What is a PEEP used for?

A

Help prevent collapse of the dependent lung
Decrease work of breathing

389
Q

What do all preganglionic neurons secrete?

A

Acetylcholine

390
Q

parasympatholytics = AntiSLUD

A

SLUD is salivation urination and defication

391
Q

What is the definition of hypotension in mean and systolic?

A

Systolic <80
Mean < 60

392
Q

Which machine only monitors systolic BP?

A

Doppler

393
Q

What is the most common complication in veterinary anesthesia?

A

Hypotension

394
Q

What 5 meds cause hypotension?

A

Ace
Propofol
Alphax
Inhalants
Phenoxybenzamine

395
Q

Can severe hypercapnia cause hypotension?

A

Yes

396
Q

What are the 4 basic causes of hypotension?

A

Vasodilation
Bradycardia
Decreased inotropy
Hypovolemia

397
Q

Do histamines cause hypotension?

A

Yes!

398
Q

What drug can you use to treat vasodilation?

A

Norepinephrine

399
Q

In which patients is hypotension more of a concern?

A

Renal patients

400
Q

What is definition of hypertension?

A

Systolic above 180
Mean above 140

401
Q

What drug may cause hypertension?

A

Alpha 2 agonists (also renal disease)

402
Q

What can hypercapnia cause?

A

Hypertension

403
Q

What is the most common arrhythmia in patients under anesthesia?

A

Sinus bradycardia

404
Q

What drugs can cause bradycardia?

A

Alpha 2 agonist
Opioids
Inhalants

405
Q

How to treat bradycardia?

A

Atropine (anticholinergic)

406
Q

What drug can cause tachycardia?

A

Ketamine
Anticholinergics

407
Q

How are temperature signals transmitted? (Same as pain)

A

A delta and C fibers
Cold through A delta
Warm through C

408
Q

What is the definition of hypothermia?

A

Below 98

409
Q

What are the 4 mechanisms of heat lost?

A

Radiation
Conduction
Convection
Evaporation

410
Q

What is radiation?

A

Heat loss from skin

411
Q

What is conduction?

A

Heat to surrounding, like a cold surface

412
Q

What is convection?

A

Air currents

413
Q

What is evaporation?

A

In feces and urine

414
Q

What are the 2 most common ways to lose heat?

A

Convection
Radiation

415
Q

What is the definition of hyperthermia?

A

Above 102.2

416
Q

What is the complication with hyperthermia?

A

Organ failure

417
Q

What is the definition of hypoventilation (hypercapnia)

A

PaCO2 greater than 60
Et greater than 55

418
Q

What is weird about hypercapnea?

A

It can lead to both hypertension and hypotension

419
Q

How to treat hypoventilation?

A

Decrease anesthetic depth
Increase O2 flow rate

420
Q

What is definition of hyperpnea?

A

Abnormal increase in rate and depth

421
Q

What is definition of tachypnea?

A

Rapid, shallow respiration

422
Q

What does hypocapnia cause?

A

respiratory alkalosis

423
Q

What does hypoxemia cause?

A

Lactic acidosis
Causes blue mm, increase in HR, increase in RR

424
Q

What are causes of hypoxemia?

A

Hypoventilation
R-L shunt
V/Q mismatch

425
Q

What is something easy you can do to reduce hypoxemia?

A

Pre-oxygenation

426
Q

Should low Sp02 be treated by increasing O2?

A

No, already breathing 100% O2

427
Q

Need to be within 4cm for flu-by oxygen to have nay affect

A
428
Q

Getting the tongue wet does not increase accuracy of pulse oximetry

A
429
Q

44% of dogs die within 3 hours of anesthesia and 62% of cats

A
430
Q

What are the 3 main reason for small animals to have a rough recovery?

A

Emergence delirium (wake up and freak out)
Opioid-induced dysphoria
Pain

431
Q

What is the affect on preload when the patient is vasodilated?

A

Blood is pooling in areas of the body so this decreases preload

432
Q

What is the dose of xylazine compared to that of horse?

A

1/10

433
Q

What should you do in a patient if their PaO2 is low?

A

Give a bronchodilator

434
Q

What should you do in a patient if their PaCO2 is high?

A

Ventilate

435
Q

Does propofol cause vasodilation or vasoconstriction?

A

Vasodilation

436
Q

Which of the induction drugs dont metabolize fully in the liver?

A

Just propofol

437
Q

What is apeneic?

A

Involuntary pause in breathing

438
Q

What can a 2nd degree AV block be caused by?

A

When dex is given

439
Q

What should be considered when irregular rhythms are seen?

A

Anticolanergic

440
Q

What should not be done in renal disease patients to treat hypotension?

A

Be given a fluid bolus quickly

441
Q

True or false: Most animals do not need fluids under anesthesia

A

True

442
Q

What are the 2 common types of drip sets?

A

10 drops/mL
60 drops/mL

443
Q

What crystalloid fluid does not have Ca: LRS, plasmalyte, saline

A

Plasmalyte

444
Q

What are common crystalloid fluid rate for dogs and cats?

A

Dogs: 5mL/kg/hour
Cats: 3mL/kg/hour

445
Q

What does OSU require before every surgery at <5 within 24 hr?

A

PCV/TP

446
Q

What does OSU require for patients >5 within 30 days and then within 24 hours?

A

CBC/Chem
PCV/TP

447
Q

How do you calculate the size of the reservoir bag?

A

10 x kg x 5

448
Q

What is the maintenance for a dog?

A

10-40 mL/kg/min

449
Q

How do you calculate the amount of liters left in a tank based off of the psi?

A

psi/3 = L

450
Q

Calculate maintenance for a 50kg dog?

A

~20 x 50kg = 1000mL = 1L

451
Q

If the tank has 466L and the maintenance is 1L/min, how many minutes doe the tank have left?

A

466-200L (always leave 200 left in it) = 266 minutes

452
Q

What is the maintenance rate for a non-rebreathing tube?

A

100-400. so use 200 (10x more than rebreathing)

453
Q

How long should adult cattle be fasted?

A

18-24 hours

454
Q

Why should you not starve a ruminant more than 24 hours?

A

Development of ketosis

455
Q

What are the top 2 worries for ruminant with anesthesia?

A

Bloat
Aspiration

456
Q

How much saliva do cattle produce a day?

A

50-150L

457
Q

Why are anticholinergics not indicated to reduce saliva in ruminants?

A

It reduces only the watery part of saliva and leaves the viscous part which is worse

458
Q

Where should the head be during sedation of cows?

A

Head down
Leave in sternal when possible

459
Q

Why should you never tie the endotracheal tube over the nose in ruminants?

A

It will stop breathing

460
Q

Head elevated but nose down

A
461
Q

What are 3 reasons endotracheal tube placement in ruminants is hard?

A

Small opening of the mouth
Lingual torus
Narrow and long oral cavity

462
Q

What is the most sensitive species to xyalzine?

A

Goats

463
Q

Where can you go to find recommendations for drugs off label?

A

FARAD

464
Q

What is a unique concern in some breeds of pigs for anesthesia?

A

Malignant hyperthermia

465
Q

What triggers malignant hyperthermia?

A

Inhalants and stress

466
Q

What is common in pigs during endotracheal intubation?

A

Laryngospasm (use lidocaine)

467
Q

What is sedation commonly used in pigs?

A

TKX
Telazol
Ketamine
Xylazine

468
Q

What should be watched in all species in neonates?

A

Hypoglycemia!

469
Q

What are 4 things that a make anesthesia of horses difficult?

A

Flight animals
Colic potential
Obligate nasal breathers
Depth of anesthesia may change quickly

470
Q

What is the best drug to use for equine sedation?

A

Alpha 2

471
Q

What are the 3 criteria for properly sedated horses?

A

Reluctant to move
Not interested in surroundings
Head down

472
Q

What is important to never to with horse sedation?

A

NEVER induce anesthesia in a horse that is not adequately sedate

473
Q

How are induction drugs given, different from other animals?

A

Rapidly
Horses get nervous and try to run around if not

474
Q

How do you put a horse back to the surgical depth if it begins to wake up?

A

Injectable needed on hand

Inhalation is too slow

475
Q

How can you prolong anesthesia in the field for horses (what drug can you use on a drip)?

A

Guaifenesin, Ketamine, Xylazine back

476
Q

What do you need to do post-recovery for horses?

A

Muzzle for 1-3 hours to prevent esophageal obstruction

477
Q

What drugs are collies, herding breeds sensitive to and what is the mutation?

A

Ace and butorphinol
MDR1

478
Q

Do overweight patients need more or less dosage?

A

LESS!

479
Q

**What are the 4 parts of BOAS?

A

Elongated soft palate
Stenotic nares
Hypoplastic trachea
Everted saccules

480
Q

What is the equation for mean arterial pressure?

A

CO x SVR

481
Q

What are the 3 things that depend on stroke volume?

A

Preload, after load, contractility

482
Q

What does low after load mean
high after load?

A

Low = easier to pump blood forward
High = harder to pump blood forward

483
Q

What may cause a high after load?

A

Vasoconstriction

484
Q

What type of dog is most likely to get mitral valve disease?

A

Old small breed dogs

485
Q

What type of dog is most likely to get DCM?

A

Large breed dogs

486
Q

What are cardioprotective sedatives and analgesics?

A

Benzos and opioids

487
Q

What induction drug is bad for dogs with Addison’s?

A

Etomidate

488
Q

How should you premed a HCM cat?

A

Low dose dex or midazolam

489
Q

How many minutes should you pre oxygenate?

A

3 min

490
Q

What do you fill when you pre oxygenate?

A

FRC

491
Q

What does FRC stand for?

A

Functional residual capacity

492
Q

What 2 things make up the FRC?

A

Expiratory reserve volume
Residual volume

493
Q

What happens if you have low albumin in a patient?

A

Low albumin means less proteins for the drug to bind to and thus more free proteins to activate causing higher affect

494
Q

What do you reverse a benzodiazepines with?

A

Flumazenil

495
Q

What should not be used in patients with renal disease?

A

Vasodilators
May decrease renal blood flow

496
Q

Does vomiting increase brain pressure?

A

Yes, be careful during intubation

497
Q

What are the 3 contents of the skull?

A

Brain matter
CSF
Blood

498
Q

What is the Monro-Kellie Doctrine

A

If one of the 3 things in the brain increase, something else must decrease

499
Q

What table position should nervous system patients be in?

A

Reverse trendelenburg position

500
Q
A

Treatment (8 decks)

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