DM1 Pt7-6 Acute Pain Control - NSAIDs

Question 1

What are NSAIDs used for in veterinary medicine?

Answer 1

NSAIDs are used for chronic pain management (e.g. osteoarthritis) and increasingly for acute pain management in cats.

Question 2

How do NSAIDs produce analgesia?

Answer 2

NSAIDs block cyclo-oxygenase enzyme (COX), reducing the production of prostaglandins, which are key mediators in the pain pathway.

Question 3

What role do prostaglandins play in pain?

Answer 3

Prostaglandins sensitize nociceptors for peripheral sensitization and upregulate the pain pathway in the spinal cord and brain for central sensitization.

Question 4

What are common side effects of NSAIDs in cats?

Answer 4

Gastrointestinal ulceration, renal dysfunction, liver dysfunction, and blood clotting abnormalities due to prostaglandin inhibition.

Question 5

What is the difference between COX-1 and COX-2 enzymes?

Answer 5

COX-1 is constitutive and produces housekeeping prostaglandins for normal organ function, while COX-2 is inducible and produces inflammatory prostaglandins in response to tissue damage.

Question 6

What is the significance of COX-2 in pain?

Answer 6

COX-2 mediates the production of inflammatory prostaglandins, contributing to increased sensitivity to pain.

Question 7

What effects do COX-2 selective NSAIDs have?

Answer 7

COX-2 selective NSAIDs (e.g. robenacoxib) may reduce gastrointestinal side effects, but renal side effects can still occur.

Question 8

What is the difference between COX-2 preferential and non-selective NSAIDs?

Answer 8

COX-2 preferential NSAIDs (e.g. carprofen, meloxicam) inhibit COX-2 more than COX-1, while non-selective NSAIDs (e.g. ketoprofen, tolfenamic acid) inhibit both enzymes similarly.

Question 9

What are COX-2 selective NSAIDs and their benefits?

Answer 9

COX-2 selective NSAIDs target COX-2 more, offering fewer gastrointestinal side effects, though other side effects (e.g. renal) may still occur.

Question 10

How do NSAIDs cause gastrointestinal (GI) side effects?

Answer 10

NSAIDs inhibit prostaglandins, which are protective in the GI tract by increasing mucus production and decreasing acid production.

Question 11

What is the effect of COX-1 and COX-2 on gastrointestinal health?

Answer 11

COX-1 prostaglandins protect against GI ulceration, while COX-2 prostaglandins aid in healing damaged mucosal tissue.

Question 12

What is a potential renal side effect of NSAIDs?

Answer 12

NSAIDs can impair renal blood flow and glomerular filtration rate, especially during systemic hypotension.

Question 13

Why is NSAID use around the time of anesthesia debated?

Answer 13

Hypotension during anesthesia can reduce renal perfusion, and NSAIDs may worsen this by inhibiting prostaglandins that maintain renal blood flow.

Question 14

Which NSAIDs are licensed for peri-operative use in cats?

Answer 14

Carprofen, meloxicam, and robenacoxib are licensed for peri-operative administration in normotensive cats.

Question 15

What liver effect is associated with NSAID administration in animals?

Answer 15

Increased liver enzyme concentrations are common in dogs, though hepatopathy has not been reported in cats. Monitoring liver enzymes is recommended for chronic NSAID use.

Question 16

What are central nervous system (CNS) effects of NSAIDs in cats?

Answer 16

Cats may experience dullness or CNS depression after NSAID initiation, though the mechanisms are unclear.

Question 17

How do NSAIDs affect blood clotting?

Answer 17

NSAIDs inhibit Thromboxane A2, a COX-1 prostaglandin that promotes platelet aggregation and blood clotting.

Question 18

How does COX-2 affect blood clotting?

Answer 18

COX-2 prostaglandins are formed in the blood vessel walls and promote blood clotting, balancing with COX-1-derived Thromboxane A2.

Question 19

What blood clotting effect do NSAIDs have in cats and dogs?

Answer 19

Unselective and COX-2 preferential NSAIDs may prolong blood clotting times in cats and dogs.

Question 20

When should NSAIDs not be administered to cats?

Answer 20

NSAIDs should not be given to hypotensive cats or those that are cardiovascularly unstable, shocked, dehydrated, or hypovolaemic until blood pressure is normalized.

Question 21

What should be done if there is a risk of blood loss or cardiovascular instability during anesthesia?

Answer 21

Delay NSAID administration until after recovery from anesthesia when the cat is fully awake and cardiovascularly stable.

Question 22

What caution should be taken when administering NSAIDs to cats with renal disease?

Answer 22

Be very cautious with NSAID administration in the peri-operative period for cats with renal disease.

Question 23

How should NSAID doses be measured and administered?

Answer 23

Draw NSAID doses accurately using appropriately sized syringes (e.g. 1 ml for parenteral solutions) and ensure you use the correct preparation (e.g. cat-specific vs. dog-specific meloxicam).

Question 24

Why should NSAIDs be given with food?

Answer 24

NSAIDs should be given with food to reduce gastrointestinal irritation caused by contact between the NSAID and the gastric wall.

Question 25

What advice should be given to cat owners about dosing NSAIDs?

Answer 25

Owners should be warned to only give the prescribed dose in any 24-hour period and contact a vet if further analgesia is needed.

Question 26

What warning should owners receive about human NSAIDs?

Answer 26

Owners should be informed not to give human NSAIDs to their cat under any circumstances.

Question 27

What should cat owners be told about NSAID side effects?

Answer 27

Owners should be informed about gastrointestinal and CNS side effects and told to stop NSAID administration and contact a vet if any side effects develop.

Question 28

What should owners do if their cat becomes ill while on NSAIDs?

Answer 28

Owners should stop NSAID administration and contact a vet if their cat becomes ill, especially with vomiting, diarrhea, or dehydration.

Question 29

What is recommended for cats receiving NSAIDs?

Answer 29

Cats on NSAIDs should be encouraged to drink plenty of water.