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A U E R S & T > Chapter 24 - Equine Pain Management > Flashcards

Chapter 24 - Equine Pain Management Flashcards

1
Q

What stimulates neuroendocrine responses in animals?

A

Tissue damage

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2
Q

Which hormones increase due to trauma or surgery?

A
  1. ACTH,
  2. cortisol,
  3. renin
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3
Q

What two adverse clinical effects can pain cause in the gastrointestinal system?

A

Colic, weight loss

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4
Q

What cardiovascular changes result from increased sympathetic tone?

A

Increased heart rate

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5
Q

What long-term adverse consequence can acute pain lead to?

A

Chronic pain

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6
Q

What types of pain may horses experience simultaneously (3)?

A
  1. Physiological
  2. Inflammatory
  3. chronic
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7
Q

What receptors are activated in response to acute pain?

A

Nociceptors

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8
Q

What two fiber types transmit superficial pain signals to the spinal cord (2)?

A
  1. Aδ
  2. C fibers
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9
Q

Which tract transmits superficial pain signals from somatic structures to the brain? And from deep?

A

Spinocervicothalamic tract for superficial and
spinoreticular tract for the deep

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10
Q

What part of the brain perceives pain?

A

Somatosensory cortex

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11
Q

Where do descending inhibitory pathways originate in the brain?

A

Periaqueductal grey, ventromedial medulla

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12
Q

Name 5 neurotransmitters involved in descending inhibitory pathways.

A
  1. Glutamate
  2. Gama-aminobutyric acid (GABA)
  3. Endogenous opioids
  4. Norepinephrine
  5. Serotonin
    - GEENS -
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13
Q

What theory explains the balance between excitatory and inhibitory pain inputs?

A

Gate theory

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14
Q

What can peripheral sensitization lead to clinically?

A

Allodynia

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15
Q

What inflammatory mediators are released during peripheral sensitization?

A

Prostaglandins, bradykinin

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16
Q

What is the primary neurotransmitter involved in central sensitization?

A

Glutamate

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17
Q

Which receptor’s stimulation is key in central sensitization?

A

NMDA receptor

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18
Q

What term describes an exaggerated response to a noxious stimulus?

A

Hyperalgesia

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19
Q

What occurs in the surrounding non-injured area in central sensitization?

A

Secondary hyperalgesia

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20
Q

Why is pain control more difficult after central sensitization?

A

Enhanced transmission

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21
Q

What plays a key role in the development of chronic pain?

A

Central sensitization

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22
Q

What is the main welfare implication of chronic pain in horses?

A

Difficult diagnosis

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23
Q

Which common equine condition is associated with chronic pain?

A

Laminitis

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24
Q

What can reduce the incidence of chronic pain post-surgery?

A

Preemptive analgesia

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25
Q

What chronic condition can lead to humane destruction of a horse due to severe pain?

A

Laminitis

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26
Q

Why is it challenging to assess pain in horses using physiological variables alone?

A

Poor correlation

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27
Q

What facial feature changes are part of the equine “pain face”?

A

Ear position, tense stare, nostril dilation

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28
Q

Which scale is used to detect pain in horses following castration?

A

Horse Grimace Scale (HGS)

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29
Q

Name two subtle signs of pain that may not be visible from a distance.

A

Bruxism, muscle fasciculations

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30
Q

What should be monitored to assess pain in cases of dental pain?

A

Food and water consumption

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31
Q

What tool is used to assess induced back pain in horses?

A

Algometer pressure quantification

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32
Q
A

Pressure algometry in a horse. The algometer is applied to the horse’s skin in the area of interest and pressure is applied until a response (skin twitch, local muscle contraction, or movement of the horse) is observed: “threshold pressure.” The algometer is removed from the skin as soon as the response is observed.

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33
Q

Which class of drugs is recommended for preemptive analgesia on the morning of surgery?

A

NSAIDs

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34
Q

Name two drugs commonly used in multimodal analgesia for horses.

A

Opioids, ketamine

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35
Q

What non-pharmacological factors assist with pain management?

A

Immobilization, surgery

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36
Q

What role do NSAIDs play in equine pain management?

A

They inhibit cyclooxygenase (COX) enzymes, particularly effective against inflammatory pain.

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37
Q

What are the two types of COX enzymes, and how do they differ?

A

COX-1 is constitutive; COX-2 is inducible after tissue trauma.

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38
Q

Which NSAIDs are commonly used in horses?

A

Phenylbutazone, flunixin meglumine, and ketoprofen.

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39
Q

Other NSAIDS used in horses?

A

vedaprofen, suxibuzone (precursor of phenylbutazone), carprofen

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40
Q

What gastrointestinal issues can arise from NSAID administration in horses?

A

Gastric ulceration and right dorsal colitis.

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41
Q

Why should care be taken when administering NSAIDs to sick horses?

A

Due to their relatively low therapeutic index.

42
Q

What is the recommended loading dose for firocoxib in horses?

A

0.3 mg/kg before the maintenance dose of 0.1 mg/kg once daily.

43
Q

What form of diclofenac is FDA-approved for use in horses?

A

Liposome-based diclofenac cream (Surpass Topical Cream).

44
Q

How do opioids produce analgesia?

A

By binding to mu (μ), kappa (κ), or delta (δ) receptors in the spinal cord and brain.

45
Q

After surgery under general anesthesia, horses that received buprenorphine had lower pain scores than those that received butorphanol TRUE or FALSE

A

TRUE

46
Q

What common side effect is observed with opioid administration in pain-free horses?

A

Excitement due to CNS stimulation.

47
Q

What is a potential adverse effect associated with morphine in horses?

A

Postanesthetic colic.

48
Q

What opioid is a μ-agonist and κ-antagonist and has shown promise for analgesia in horses?

A

Buprenorphine.

49
Q

What method of opioid administration can be used for “needle-shy” horses?

A

Transmucosal or transdermal routes.

50
Q

What is the advantage of using α2-adrenoceptor agonists in pain management?

A

They provide analgesia and sedation, enhancing multimodal analgesic techniques.

51
Q

How do local anesthetics function in pain management?

A

By blocking sodium channels in excitable membranes, preventing nociceptive information transfer.

52
Q

What is a common local anesthetic technique used for flank laparotomies in horses?

A

Paravertebral anesthesia.

53
Q

What new method has been developed for long-term analgesia of the distal thoracic limb?

A

Continuous perineural blockade of palmar nerves.

54
Q

What are potential adverse effects of segmental thoracolumbar anesthesia?

A

Ataxia of the pelvic limbs.

55
Q

Floriano et al 2023 JAVMA The dilutional volume of morphine and xyla administered caudal epidural kt affects cranial spread of anesthesia in healthy standing horses - What substances were tested for epidural analgesia?

A

Morphine and xylazine with 0.2 mg/kg morphine and 0.2 mg/kg xylazine diluted to 20, 35, 50, 75, and 100 mL.

56
Q

How many volumes of injectate were tested?

A

Five volumes

57
Q

Main conclusion of Floriano et al 2023 JAVMA?

A

epidural volumes caused significant changes in thermal threshold testing at location hindlimb dorsal pasterns but only the largest volume resulted in a significant TT testing change at location withers.

58
Q
A

**An 18-gauge to 20-gauge spinal needle (bevel facing craniad) is inserted through the skin (Figure 24-3). The angle of insertion may need to be altered to ensure that the needle passes through the interspinous and interarcuate ligaments and into the epidural space. A change in resistance to needle advancement may be appreciated as the epidural space is entered. The needle should be withdrawn approximately 5 mm if the floor of the vertebral canal is encountered. Needle placement can be verified by the “hanging drop” technique;

59
Q

What is lidocaine often used for post-surgery in horses?

A

Reduce ileus

60
Q

What is the dosage for conscious experimental horses to achieve antinociceptive effects in lidocaine?

A

2 mg/kg

61
Q

What may prolong recovery during anesthesia with lidocaine?

A

Increased dosage

62
Q

When should lidocaine infusion be terminated during anesthesia?

A

30 min befofre

63
Q

What type of receptors does ketamine act on?

A

NMDA receptors

64
Q

What adverse effects were noted during ketamine infusion in horses?

A

None detected

65
Q

What are the conflicting results regarding tramadol in horses?

A

Efficacy uncertain

66
Q

What is the dosage for tramadol that did not produce antinociception?

A

Up to 3 mg/kgbut the dosage is 10 mg/kg BID PO

67
Q

What is the CRI dosage of ketamine in awake horseS?

A

0.4-0.8 mg/kg/hr

68
Q

What may improve tramadol analgesia in chronic laminitis?

A

Co-administration with Low-dose ketamine

69
Q

What does gabapentin modulate to reduce hyperalgesia? dosage?

A

Calcium channels
2.5 mg/kg

70
Q

Butorphanol is what type of opioid? Pain dosage?

A

κ-receptor agonist and μ-receptor antagonist activity
dosage recommended for analgesia (0.1 mg/kg) is approximately 5 to 10 times that recommended for sedation.

71
Q

Classify accordingly to κ-receptor agonist or μ-receptor agonist

A

Morphine μ-receptor agonist
Burprenorphine μ-receptor agonist
Fentanyl μ-receptor agonist
Butorphanol μ-receptor antagonist

72
Q

What effect does intraarticular morphine have in horses?

A

Analgesic and antiinflammatory

73
Q

What are the two sites for epidural injections in horses?

A

Lumbosacral space (cranial),
1st coccygeal interspace (caudal)

74
Q

What is a contraindication for caudal epidural administration?

A

Infection
coagulopathies (risk of bleeding within spinal canal)
ataxia
neuro disease
septicemia (risk of spread infection into epidural space)

75
Q

What technique verifies needle placement in the epidural space?

A

Hanging drop technique

76
Q

Paravertebral anesthesia is performed at what level?

A

18th thoracic and 1/2nd o,bar dorsal and ventral branches

77
Q

In the paravertebral anesthesia which structures are desensitized?

A

Skin, muscles and peritoneum of the flank region

78
Q

What types of drugs are administered into the epidural space in horses?

A

Local anesthetics, opioids

79
Q

What is recommended regarding drug solutions for epidural use?

A

Preservative free

80
Q

What volume of local anesthetic should be limited to in a 500-kg horse?

A

8 to 9 mL

81
Q

Which opioids can be preservative-free for epidural use?

A

Morphine, methadone

82
Q

What dosage of morphine produced lower pain scores post-surgery?

A

0.1 mg/kg

83
Q

What are potential adverse effects of epidural morphine in horses?

A

Pruritus, wheals

84
Q

How long does analgesia last with epidural xylazine?

A

2 to 3 hours

85
Q

What are the dosages of xylazine and detomidine for epidural analgesia?

A

0.17 mg/kg, 0.06 mg/kg

86
Q

What is a useful combination for multimodal analgesia post-surgery?

A

Morphine and xylazine

87
Q

What do acupuncture and electroacupuncture increase in cerebrospinal fluid?

A

β-endorphin concentration

88
Q

Which ligaments do you have to pass during epidural analgesia?

A

Through interspinous
Interacurate ligaments

89
Q

What are the indications of epidural?

A

Obstetric surgery,
Tail and perineum
Urogenital
Posoperative pain management

90
Q

What condition was notably studied for ESWT effectiveness?

A

Navicular disease

91
Q

de Oliveira et al EVJ 2020 Postop pain beahviour associated with surgical castration in donkeys - What was the only specific pain behavior observed in donkeys after castration?

A) Head shaking
B) Ear movements
C) Lifting pelvic limbs
D) Tail movements

A

C) Lifting pelvic limbs

92
Q

de Oliveira et al EVJ 2020 Postop pain beahviour associated with surgical castration in donkeys -Which behavior increased after administering analgesia to the donkeys?

A) Pelvic limb lifting
B) Feeding and water intake
C) Head shaking
D) Ear movements

A

B) Feeding and water intake

93
Q

de Oliveira et al EVJ 2020 Postop pain beahviour associated with surgical castration in donkeys -What were the main confounding factors influencing the expression of pain behaviors in donkeys?

A) Weather conditions and temperature
B) Dirty stall and insects
C) Time of surgery
D) Type of analgesic used

A

B) Dirty stall and insects

94
Q

Mercer et al 2022 EVJ Pharmacokinetics and clinical efficacy of acetaminophen
(paracetamol) in adult horses with mechanically induced
lameness - What was the maximum plasma concentration (Cmax) of acetaminophen at 30 mg/kg?

A) 20.01 μg/ml
B) 30.02 μg/ml
C) 10.5 μg/ml
D) 25.5 μg/ml

A

B) 30.02 μg/ml

95
Q

Mercer et al 2022 EVJ Pharmacokinetics and clinical efficacy of acetaminophen
(paracetamol) in adult horses with mechanically induced
lameness -At which time points was heart rate for acetaminophen 30 mg/kg significantly lower than phenylbutazone?
A) 1 and 3 hours
B) 2, 3, 4.5, and 7 hours
C) 0.5 and 2 hours
D) 6 and 8 hours

A

B) 2, 3, 4.5, and 7 hours

96
Q

Mercer et al 2022 EVJ Pharmacokinetics and clinical efficacy of acetaminophen
(paracetamol) in adult horses with mechanically induced
lameness - What was the main limitation of the study?

A) High cost of treatments
B) Lack of objective lameness measurement
C) Inconsistent dosing schedules
D) Use of non-reversible lameness model

A

B) Lack of objective lameness measurement

97
Q

Mercer 2021 EVE Which receptors are primarily involved in pain modulation within the endocannabinoid system?

A) CB1 and CB2
B) CB3 and CB4
C) GABA and serotonin receptors
D) Dopamine and norepinephrine receptors

A

A) CB1 and CB2

98
Q

Mercer 2021 EVE What is the main issue with cannabinoid product manufacturing in terms of dosing?

A) Over-regulation of CBD concentrations
B) Inconsistent CBD concentrations
C) Lack of THC in products
D) High cost of production

A

B) Inconsistent CBD concentrations

99
Q

Mercer 2021 EVE Which animal has shown increased sensitivity to cannabinoids due to higher cannabinoid receptor distribution in the brain?

A) Horses
B) Cats
C) Dogs
D) Rats

A

C) Dogs

100
Q

Fogle 2021 EVE Ex vivo Cox1 and Cox2 inhibition - What is the primary advantage of COX-2 selective NSAIDs like firocoxib?

A) They completely inhibit COX-1.
B) They avoid COX-1 inhibition and reduce side effects.
C) They have a shorter half-life.
D) They only inhibit COX-1.

A

B) They avoid COX-1 inhibition and reduce side effects.

101
Q

Fogle 2021 EVE Ex vivo Cox1 and Cox2 inhibition -Which NSAID had the longest plasma half-life in this study?

A) Phenylbutazone
B) Flunixin meglumine
C) Meloxicam
D) Firocoxib

A

D) Firocoxib
plasma half-lives of the drugs were 5.97 hours for pbz 4.74 hours for fluni 8.24 hours for meloxicam, and 47.42 hours for firocoxib.

102
Q

Fogle 2021 EVE Ex vivo Cox1 and Cox2 inhibition - Which of the following drugs showed significantly higher TXB2 levels after the third dose compared to flunixin meglumine and phenylbutazone?

A) Firocoxib and phenylbutazone
B) Meloxicam and firocoxib
C) Phenylbutazone and meloxicam
D) Flunixin meglumine and phenylbutazone

A

B) Meloxicam and firocoxib

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