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Pharmacology Test 3 > Case series (Gatson) > Flashcards

Case series (Gatson) Flashcards

1
Q

Hyperthyroidism can be controlled with

A

Methimazole

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2
Q

Physiologic concerns geriatric patients

A

Dogs & Cats > 12 years old => 7 fold inc risk morbidity/mortality related to anesthesia

Decreased physiologic reserve of organ systems

Exaggerated response to drugs

  • Dec albumin
  • Dec skeletal m. Inc fat
  • Reduced total plasma volume (loss of totaly body water)

Prolonged duration of action renally/hepatically excreted drugs

Painful pre-existing conditions (osteoarthritis)

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3
Q

Cats

Glucoronidation

A

Alteration in Phase 2 Hepatic Enzymes

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4
Q

Cats

Differences in drug metabolism

A

Differences in drug metabolism - phenolic compounds

  • propofol => Heinz body anemia with repeated doses
  • Acetaminophen => highly toxic in cats
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5
Q

Cats and opioids

A

Can cause hyperthermia during anesthesia

Opioid mania - high doses

  • Pupillary dilation
  • dysphoria

Less MAC reduction with opioids compared to dogs

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6
Q

Cats and sedatives

A

Ace: sedation in dogs >>cats

Benzodiazepines

  • cause excitement in cats
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7
Q

Cats and obesity

A

Cats > 6kg are 3 X more likely to die perianesthetically

Dose at lean body weight, and titrate to effect

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8
Q

Vomiting and Nausea

Opioids

A

Greatest:

  • Morphine
  • Hydromorphone
  • Oxymorphone
  • Meperidine
  • Apomorphine (IM)

Least:

  • Methadone
  • Buprenorphine
  • Butorphanol
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9
Q

Vomiting and Nausea

Alpha-2 Agonists

A

Xylazine

Dexmeditomidine

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10
Q

Acepromazine

A

Anti-emetic (cats only?)

Phenothiazine Tranquilizer

  • Antagonist:
    • Dopamine (low dose)
    • Serotonin Receptors (low dose)
  • Anticholinergic
    • Emetic Center (high dose)
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11
Q

Cerenia

A

Neurokinin - 1 receptor antagonist

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12
Q

Higher Centers

Vomiting and Nausea

A

Psychogenic

Trauma

Intracrania

Pressure

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13
Q

Vestibular Apparatus

Vomiting and Nausea

A

Motion Sickness

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14
Q

Emetic Center

Vomiting and Nausea

A

CTZ

  • Blood-borne
  • Drugs
  • Toxins
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15
Q

Peripheral Receptors

Vomiting and Nausea

A

Abdominal and thoracic organs

Irritation

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16
Q

Ace vs cerenia as a premed

A

Ace

  • 30-50% reduction in vx if given 20 min before morphine or hydro

Cerenia

  • 70-100% reduction in vx if given 20-45 min before morphine or hydro
17
Q

Hyperthyroidism concerns

Cardiovascular

A

Cardiomyopathy

  • reduced stroke volume
  • reduced CO

Hypertension

Tachycardia

Arrhythmias

Inc myocardial O2 consumption

18
Q

Drugs to avoid with hyperthyroidism

A

Drugs that cause

  • tachycardia
  • inc myocardial O2 consumption

No ketamine

No anticholinergics

avoid stress

consider subclinical HCM

19
Q

Ideal PREMED

A

Short acting/reversable

Does not cause vx

Does not bind heavily to plasma proteins

Causes minimal changes to cardiovascular system

Allows easy passage of endoscope into SI

Acts on visceral pain

20
Q

Sugar Daddy anesthetic plan

12 y/o MC DSH

Vomiting past 2 months

Anorexic and lethargic for 1 week

Hyperthyroidism: controlled with methimazole

A

Anesthetic plan

Premed: Methadone + Maropitant

Induction: Alfaxalone

Maintenance: Sevoflurane

Intra-op / Post-op: Methadone

21
Q

Major functions of the Liver

1.

2.

3.

4.

5.

6.

7.

A
  1. Nutrient storage and supply
  • fat
  • carbs
  • protein metabolism
  1. Protein homeostasis
  • albumin => oncotic pressure
  • clotting factors
  1. Biotransformation
  2. Biliary excretion
  3. Removal of ammonia
  4. Urea production
  5. Host defense from bacteria / toxins from portal circulation
22
Q

Characteristics of ideal drugs for liver disease

1.

2.

3.

4.

A
  1. Doesn’t depend on liver for metabolism
  2. Doesn’t alter hepatic blood flow
  3. Has minimal protein binding
  4. Is reversible
23
Q

Neuromuscular Blocking Agents

w/ Extra-hepatic Metabolism

A

Atracurium (Ester hydrolysis and/or Hofman elimination)

Succinylcholine (Plasma Cholinesterases…but made by liver)

24
Q

Opioids

w/ Extra-hepatic Metabolism

A

Remifentanil (Plasma esterases)

Fentanyl, Alfentanil, Sufentanil (liver + plasma esterases)

25
Q

Inhalants

w/ Extra-hepatic Metabolism

A

Don’t rely on liver/kidneys

Desflurane (least liver metabolism) > Isoflurane > Sevoflurane

Isoflurane: least effect on hepatic blood flow (think)

26
Q

Drug reversals

  1. Dexmeditomidine:
  2. Hydromorphone:
  3. Butorphanol:
  4. Midazolam:
  5. Acepromazine:
A
  1. Dexmeditomidine: Atipamazole
  2. Hydromorphone: Naloxone
  3. Butorphanol: Naloxone
  4. Midazolam: Flumazenil
  5. Ace: Nada
27
Q

Jack Perro: Anesthetic plan

5 y/o MC Labrador

Previously completely healthy

Acute history of vomiting, lethargy, inappetence

Owners noticed yellowed eyes and gums

Lives on 5 acres, runs around unsupervised

A

Anesthetic Plan

Premedication: Methadone

Induction: Propofol

Maintenance: Isoflurane

Intra-op / Post-op: Remifentanil

28
Q

Jack Perro

Additional concerns

A

Maintain blood glucose w/in reference range

Test clotting factors (may need plasma)

Avoid NSAIDS

Benzodiazepines, Phenothiazines, Opioids

  • Prolonged duration of action
29
Q

Mast Cell Tumors

Signs under general anesthesia

Treatment

A

Signs

  • redness of skin
  • hives
  • hypotension
  • reflex tachycardia

TX

  • Crstalloid fluid bolus
  • Epinephrine
30
Q

ABCB1 Mutation

(formerly MDR-1)

A

Codes for p-glycoprotein and multi-drug resistent-related protein

Significantly affects drug distribution / elimination

  • mutant allele can cause excessive drug conc into brain

Drugs that use p-glycoprotein

  • macrocyclic lactones (ivermectin, milbemycin)
  • chemotherapeutic agents
  • loperamide
  • ace
  • butorphanol
  • morphine
  • ondansetron
31
Q

Schmidty Anesthetic Plan

9 y/o Female Collie

Breeding award-winning show dog

Mass on front right digit (possible mast cell tum)

Normal physical exam and bloodwork from RDVM

Owners interested in surgical removal

Surgery requests CT of thorax and right front limb to rule out metastatic dz

A

Anesthetic Plan

Premedication: Benadryl + Dexmeditomidine + low dose Butorphanol

Induction: Propofol

Maintenance: Isoflurane

Intra-op / Post - op: nothing

Consider reversing

32
Q

Dalek Anesthetic Plan

15 y/o Quaterhorse mare

Non-healing corneal ulcer

Fungal keratitis

Many ophthalmic meds +

  • Fluconazole
  • TMS
  • Banamine
  • Gastrogard

Keratectomy OS

A

Anesthetic Plan

Premedication: Xylazine + Butorphanol

Induction: Ketamine + Propofol

Maintenance: Isoflurane

Intra-op / Post-op: Xylazine

33
Q

Drugs that induce liver metabolism

A

Phenobarb induces cytochrome P450 liver enzymes

  • faster drug metabolism
  • shortened pharmacologic action
34
Q

Drugs that inhibit liver metabolism

A

Fluconazole inhibits CYP3A4

  • This enzyme metabolizes many anesthetic agents
    • midazolam
35
Q

Things that inc IOP

A

Intubation

Head Extension

Occluding jugulars

Hypercapnia

Hypoxemia

Drugs:

  • Ketamine
  • Propofol (dogs)
  • Etomidate
  • Succinylcholine
36
Q

Things that decrease IOP

A

Hypocapnia

Drugs:

  • Ketamine?
  • Barbiturates
  • Propofol (horses)
  • Alpha-2 Agonists
  • Benzos
  • Opioids
  • Inhalants
  • Nondepolarizing NMBA
37
Q

Mr. Wiggelsworth Anesthetic Plan

3 y/o MC Husky

Completely torn left cranial cruciate ligament

No medications

Normal BW

Aggressive

A

Anesthetic Plan

Premedication: Dexmeditomidine + Hydromorphone

Induction: Ketamine + Diazepam

Maintenance: Sevoflurane

Intra-op / Post-op: LS Epidural (Morphine + Bupivacaine) + Post-op carprofen

Pharmacology Test 3 (12 decks)

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