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MODULE 14 - Patient Support > CLINICAL PHARMACOLOGY - Choosing Appropriate Premedication and Analgesia > Flashcards

CLINICAL PHARMACOLOGY - Choosing Appropriate Premedication and Analgesia Flashcards

1
Q

What is premedication?

A

Premedication is the administration of medication before a treatment or procedure

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2
Q

What are the five potential reasons for premedication?

A

To provide a calming effect, or sedation
To provide analgesia
To reduce the doses of other drugs required
To allow for a more smooth induction and recovery
To counteract unwanted effects of other drugs

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3
Q

What are the two main purposes of combining drugs for premedication?

A

Combine drugs with different effects (i.e. sedation and analgesia)
Combine drugs with the same effect to allow for synerism (i.e. two sedative drugs to enhance the sedative effect)

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4
Q

When can it be benefical to administer sedatives at the time of recovery?

A

The administration of sedatives at the time of recovery can allow for a smoother, calmer recovery for the animal

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5
Q

Which factors should you consider when determining which sedative you should choose for premedication?

A
  1. How much sedation is needed (consider patient temperament and the procedure taking place)
  2. Patient health (any contraindications, or alternatively any side effects that may benefit the patient)
  3. Pharmacokinetics
  4. Controlled drug legislation and veterinary medicine register
  5. Affordability for the client
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6
Q

When would sedation be unnecessary for premedication?

A

If the animal is calm/handelable
If the effects of the sedative drug are undesirable

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7
Q

What is pain?

A

Pain is the unpleasant sensory and emotional experience associated with actual or potential noxious stimuli

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8
Q

Describe the pain pathway

A

Stimulation of nociceptors generates an action potential which is transmitted along afferent (sensory) neurones to the dorsal horn of the spinal cord, where the information is then transmitted to several regions of the brain to achieve the conscious perception of pain

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9
Q

What is peripheral sensitisation?

A

Peripheral sensitisation is when there is increased stimulation of nociceptors by inflammatory mediators which increases neuronal firing and decreases neuronal firing threshhold, resulting in sensitisation and an amplified pain response being transmitted to the central nervous system (CNS)

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10
Q

What is central sensitisation?

A

Central sensitisation is when the neurones in the dorsal horn of the spinal cord have an increase in neuronal firing and a decrease in neuronal firing threshhold (sensitisation) due to repetitive or prolonged noxious stimulation

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11
Q

What is hyperalgesia?

A

Hyperalgesia is an increased sensitivity to noxious stimuli

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12
Q

What is allodynia?

A

Allodynia is the perception of non-noxious stimuli as noxious

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13
Q

What is pre-emptive analgesia?

A

Pre-emptive analgesia is the administration of analgesic agents prior to the onset of nociceptive stimulation

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14
Q

What is mutimodal analgesia?

A

Multimodal analgesia is the administration of a combination of analgesic drugs which act on different levels of the pain pathway

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15
Q

What are the five main analgesic drug classifications?

A

Opioids
NSAIDS
Local anaesthetics
α2 adrenoreceptor agonists
Ketamine

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16
Q

What are the four clinical uses of opioids as analgesics?

A

Premedication
Intermittent boluses
Infusions
Epidurals

17
Q

What is the most common opioid to be used as an infusion?

A

Fentanyl

18
Q

Why is fentanyl a good choice of opioid for infusions?

A

Fentanyl has a very short duration of action (approx 30 mins) which reduces the risk of drug accumulation in the body

19
Q

What are the clinical uses of NSAIDS as analgesics?

A

NSAIDS are used for management of long term, chronic pain

20
Q

What are the eight clinical uses of local anaesthetics as analgesics?

A

Perineural blocks
Dental blocks
Epidurals
Intravenous regional anaesthesia
Infusions
Topical anaesthesia
Local infiltrations
Cavity instillations

21
Q

What are perineural anaesthetic blocks?

A

Perineural anaesthetic blocks involve injecting local anaesthetic around the nerves to provide desensitisation to the surrounding structures

22
Q

What kind of perineural anaesthetic block could you do to desensitise the forelimb?

A

Brachial plexus block

23
Q

What kind of perineural anaesthetic block could you do to desensitise the hindlimb?

A

Femoral and sciatic block

Good for hindlimb amputations

24
Q

What kind of perineural anaesthetic block could you do to desensitise the digits?

A

Digital block

25
Q

What are the two main regions used for local anaesthetic epidurals?

A

Lumbosacral
Coccygeal

26
Q

Which regions of the body are desensitised by a lumbosacral local anaesthetic epidural?

A

Perineum
Hindlimbs
Abdomen depending on the drug volume administered

Good for hindlimb amputations

27
Q

Which regions of the body are desensitised by a coccygeal local anaesthetic epidural?

A

Periuneum
Tail

28
Q

How do you carry out intravenous regional anaesthesia?

A

Inject the local anaesthetic distal to a tourniquet to prevent the local anaesthetic from spreading into the systemic circulation

29
Q

Which local anaesthetic can you used for intravenous regional anaesthesia?

A

Adrenaline free preparation of lidocaine

30
Q

Which local anaesthetic drug should you NEVER use for intravenous regional anaesthesia?

A

Bupivicaine

31
Q

Which local anaesthetic drug can be used as an infusion?

A

Adrenaline free preparation of lidocaine

32
Q

When are lidocaine infusions indicated?

A

Lidocaine infusions can be useful for managing visceral pain

33
Q

Why should you never use lidocaine infusions in cats?

A

Cats are more prone to drug accumulation and toxicity

34
Q

Which three analgesic drugs are commonly used for combined infusions?

A

Morphine
Lidocaine
Ketamine

35
Q

Why are α2 adrenoreceptor agonists not very effective as analgesics?

A

α2 adrenoreceptor agonists are not very effective analgesics as the have a profound sedative effect which tends to outlast the analgesic effects

36
Q

When can α2 adrenoreceptor agonists be useful adjunctive drugs?

A

α2 adrenoreceptor agonists can be used adjunct to local anaesthetics in perineural blocks to prolong their effect

α2 agonists cause vasoconstriction which will limit the blood flow to the area which will decrease the volume of blood that can wash the drug away which will increase the length of time the local anaesthetic can enter surrounding tissues

37
Q

What are the three clinical uses for ketamine as analgesics?

A

Useful when there is pre-existing pain
In situations predisposed to the development of chronic pain
Adjunctive analgesia for difficult to manage pain

MODULE 14 - Patient Support (25 decks)

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