drugs Flashcards
1
Q
t/f - diffusion rate is dependent on concentration gradient and lipid solubility
A
true
2
Q
t/f - diffusion rate is dependent on concentration gradient and lipid solubility
A
true
3
Q
when is the concentration gradient of isoflurane greatest?
A
at initial induction
4
Q
when is the concentration gradient of isoflurane greatest?
A
at initial induction
5
Q
what does lipid solubility have to do with cell walls?
A
determines entry of isoflurane into the cells
6
Q
when is the concentration gradient of isoflurane greatest?
A
at initial induction
7
Q
what does tissue distribution of isoflurane depend on?
A
blood supply
8
Q
t/f - depth of anesthesia is dependent on partial pressure of the anesthetic blood and alveoli
A
true
9
Q
what is the mode of administration of isoflurane?
A
mixture of carrier and anesthetic delivered via mask or ET tube
10
Q
when would you use an anticholinergic in your anesthetic procedure?
A
premedication (no longer recommended)
inter-op if needed for bradycardia
11
Q
what are adverse effects associated with isoflurane?
A
increased intracranial pressure w/ head trauma or brain tumor
hypothermia
decreased blood pressure (may decrease renal b/f)
variable effects on HR
dose-dependent hypoventilation
carbon dioxide retention
respiratory acidosis
12
Q
what are adverse effects associated with anticholinergics?
A
CARDIAC ARRHYTHMIAS - contraind in heart patients
temporary bradycardia - atropine at low doses will increase vagal tone (decreases HR)
thickened resp/salivary secretions - may lead to blockages in felines and ruminants
intestinal peristalsis inhibition - cna lead to colic and bloat
13
Q
when would you use an anticholinergic in your anesthetic procedure?
A
premedication
14
Q
what effects are associated with anticholinergics?
A
limited CNS prevent bradycardia bronchodilation decreased secretions eye midriasis corneal drying
15
Q
what are adverse effects associated with anticholinergics?
A
CARDIAC ARRHYTHMIAS - contraind in heart patients
temporary bradycardia - atropine at low doses will increase vagal tone (decreases HR)
thickened resp/salivary secretions - may lead to blockages in felines and ruminants
16
Q
what routes of administration are possible for anticholinergics?
A
IV
IM
IT
17
Q
what are some examples of anticholinergics?
A
atropine
glycopyrrolate
18
Q
atropine has a _____ onset when compared with glyco
A
faster
19
Q
t/f - acepromazine is a controlled drug
A
false - it is not controlled
20
Q
why would you reach for atropine interop?
A
cardiac arrest
low blood pressure
21
Q
acepromazine maleate belongs to what class of drug?
A
phenothiazines
22
Q
t/f - acepromazine is a controlled drug
A
false - it is not controlled
23
Q
what effect can ace have on induction and recovery?
A
eases induction and recovery
24
Q
what class of drugs can be combined for use with acepromazine for minor procedures?
A
opioids (i.e. hydro and ace)
25
what species is acepromazine approved for use in?
horses
dogs
cats
26
t/f - acepromazine has a reversal agent
false - there is NO reversal agent
27
what effect does acepromazine have on a patient's coordination motor responses?
ace has no effect on coordination motor responses
28
acepromazine does ____ in relation to the dose of GA
decreases
29
what is the mode of action of acepromazine?
inhibits central dopaminergic receptors to cause sedation and tranquilization
30
what effect does acepromazine have on a patient's coordination motor responses?
ace has no effect on coordination motor responses
31
t/f - animals will not arouse easily under acepromazine sedation
false - animals can be aroused easily on ace
32
what modes of administration are available for acepromazine?
IV
IM
PO
33
what needs to be considered when using an oral dose of acepromazine? how might this affect its use in sx?
slower onset than IV admin; cannot be used for premed - prescribed to aggressive patients
34
what is the half life (IV) of acepromazine in dogs? horses?
dogs - 4.5hrs
| horses - 2.6hrs
35
what precaution is recommended when dosing acepromazine?
dose lower than label dose
36
what category of anesthetic medication does acepromazine fall under?
tranquilizer/sedative
37
what contraindications are associated with acepromazine?
patients with liver disease - metabolized by liver
no pregnant patients - slowly crosses placenta
breeding stallions - penile prolapse
38
what are adverse effects associated with acepromazine?
paradoxical aggression/excitement
peripheral vasodilation - leading to hypotension, increased HR and hypothermia
decreased PCV - d/t splenic engorgement
penile prolapse - horses
worsens respiratory depression effect of other drugs
increased potency and duration in geriatrics, neonates, debilitated
may increase cerebral blood flow and intracranial pressure
39
what are breed-specific considerations associated with acepromazine?
australian shepherds - prolonged sedation
giant breeds, boxers, greyhounds - bradycardia and hypotension
terriers and cats - more resistance
40
what contraindications are associated with acepromazine?
patients with liver disease - metabolized by liver
no pregnant patients - slowly crosses placenta
breeding stallions - penile prolapse
41
does acepromazine have analgesic effects?
no - sedation only NO pain relief at all
42
what characteristics can be associated with benzodiazepines?
```
rapid onset
varying duration w/ drug
no analgesia
not effective for sedation
**typically used in conjunction w/ other drugs**
```
43
what effects are associated with benzodiazepines?
```
calming, anti-anxiety
anticonvulsant
skeletal muscle relaxation
potentiates GA
appetite stimulation (cats/ruminants)
```
44
what adverse effects are associated with benzodiazepines?
paradoxical disorientation and excitement - young, healthy dogs
dysphoria and aggression - cats
muscle fasciculation - horses
ataxia and recumbency - LA
slow clearance - lasts a long time - CAUTION WITH REPEAT DOSING
45
t/f - diazepam is highly water soluble, and that is why it can't be mixed with other drugs
false - diazepam is poorly water soluble t/f it can't be mixed with anything but ketamine
46
what can happen if your feline patient is given oral diazepam?
liver failure!!!
47
t/f - diazepam can be mixed with any drug, it's safe and reliable like that !
false - diazepam can ONLY EVER be mixed with ketamine
48
t/f - diazepam is highly water soluble, and that is why it can't be mixed with other drugs
false - diazepam is poorly water soluble t/f it can't be mixed with anything but ketamine
49
what needs to be considered r/e storage of diazepam?
it is light sensitive and binds to plastic - cannot be stored in syringes, IV lines or bags
50
what is the half life of diazepam?
3.2hrs - fast onset and long lasting drug
51
what is the route of administration for diazepam?
slow IV
52
t/f - like diazepam, midazolam is poorly water soluble
false - midazolam is water soluble
53
what species is midazolam commonly used in?
swine
ferrets
rabbits
birds
54
what routes of administration are available for midazolam?
IV
| IM
55
can diazepam be administered in all the same ways as midazolam?
no - can ONLY be administered IV where midazolam can be given both IV and IM
56
what is the half life of midazolam?
1hr - slower absorption than diazepam
57
what is clonazepam commonly used for in vet med?
behaviour modification
58
what are some examples of alpha2 agonists?
xylazine
dexmededetomidine
detomidine
romifidine
59
what needs to be considered if your patient is on clonazepam for 6 days?
need to be weaned off
60
what is special about dosing clonazepam in cats?
dosed in mg/CAT (0.125-0.25)
61
what are some examples of alpha2 agonists?
xylazine
dexmededetomidine
detomidine
romifidine
62
what characteristics are associated with alpha2s?
```
sedation
analgesia
muscle relaxation
rapid sedation - dependent on spp. and drug
reversible
not controlled
```
63
are alpha2s more commonly reached for in large or small animal medicine?
large animal
64
t/f - xylazine lasts longer than detomidine in horses
false - detomidine lasts longer (40min) vs. xylazine (20min)
65
do alpha2s have reliable analgesic effect?
no - the analgesic effects of alpha2s are questionable
66
what would you use to reverse an alpha2 if necessary?
alpha2 antagonist
67
what modes of administration can be used for alpha2s?
IV
| IM
68
why would you administer an alpha2?
prior to small procedures that may be uncomfortable for the patient
69
you administered dexdomitor IV to your feline patient; as you're trimming its nails, the cat vomits. why?
immediate vomiting response to alpha2 - biggest negative side effect associated with the drugs
70
what effects are associated with alpha2s?
```
dose-dependent sedation
short acting analgesia - at high doses
early and late phase cardio effects
dose dependent respiratory depression
muscle relaxation
increased effects of other anesthetic agents
transient hyperglycemia
```
71
what effects can be seen on the cariovascular system with administration of alpha2s? is it the same throughout effect?
```
2 phases of effect
early: dose-dependent vasoconstriction - decreased HR
hypertension
bradycardia
late: decreased cardiac output
hypotension
further bradycardia
```
72
you administered dexdomitor IV to your feline patient; as you're trimming its nails, the cat vomits. why?
immediate vomiting response to alpha2 - biggest negative side effect associated with the drugs
73
what is the trade name(s) for xylazine?
rompun
| anased
74
t/f - it is okay to administer an alpha2 to a pregnant cow in her last trimester
false - alpha2s can cause premature parturition in cattle
75
what considerations are associated with alpha2s?
```
avoid use in:
geriatric
diabetic
pregnant
pediatric
ill - strain on the heart
liver patients - metabolized by liver
```
76
what is the scientific name for dexdomitor?
dexmededetomidine
77
t/f - there is only one concentration of xylazine available for use
false - there are 2
2% sol'n SA
10% sol'n EQ
78
t/f - cattle require a stronger dose of xylazine than horses
false - cattle need a 1/10 dilution of 10% xylazine (equine conc.)
79
dex is ___ in strength and safety in comparison to xylazine
more potent and safer than xylazine
80
t/f - dexmededetomidine is used in the drug combination commonly referred to as "kitty magic"
true
81
what are the three components that make up "kitty magic"?
dex
opioid - hydromorphone or butorphanol
ketamine
82
what considerations should be kept in mind when using dexmededetomidine?
pale mm - d/t peripheral vascular constriction
bradycardia
decreased resp rate
initial increase in BP - later decrease returning to norm
83
t/f - dex does not require flow by oxygen during sx
false - must always have flow by oxygen when using dex
84
what considerations should be kept in mind when using dexmededetomidine?
pale mm - d/t peripheral vascular constriction
bradycardia
decreased resp rate
initial increase in BP - later decrease returning to norm
85
what contraindications are associated with dexmededetomidine?
```
dogs w/ existing heart problems
respiratory problems
liver problems
kidney problems
shock
hypotension
hypoxia
bradycardia
not ideal for older animals
```
86
how is dosing of dex based?
on body surface area
87
in what species might you use detomidine?
equine
88
detomidine lasts ___ in relation to xylazine
longer - 2x duration of xylazine
89
what benefit is associated with romifidine?
less ataxia
90
t/f - detomidine and hydromorphone produce standing sedation
false - standing sedation produced with detomidine and butorphanol
91
what benefit is associated with romifidine?
less ataxia
92
t/f - alpha2 antagonists reverse only the bad effects of alpha2s
false - when reversal administered ALL effects of the drug are reversed
93
what effects of overdose can be seen on the neurological, cardiovascular and gastrointestinal systems?
neuro - excitement and muscle tremors
cardio - hypotension and tachycardia
gastro - salivation and diarrhea
94
can you administer a reversal IV in any patient?
only emergency - administered IM normally
95
what drug reverses dexdomitor?
atipamezole (antisedan)
96
what drug reverses xylazine?
yohimbine
97
what effects are produced by the opioid family of drugs?
sedation
| analgesia
98
what are some common uses of opioids in surgical procedures?
preanesthetic - may be used alone or in conjunction w/ tranqs/sedatives
analgesia - prevent and treat postop pain; used w/ tranquilizer to produce neuroleptanalgesia
99
t/f - opioids have a wide margin of safety
true
100
what are some common uses of opioids in surgical procedures?
preanesthetic - may be used alone or in conjunction w/ tranqs/sedatives
analgesia - prevent and treat postop pain; used w/ tranquilizer to produce neuroleptanalgesia
101
what opioids are best used for moderate to severe pain?
```
agonists
morphine
hydromorphone
oxymorphone
fentanyl
```
102
what receptors do agonists bind to?
mu and kappa
103
what partial agonist is used in vetmed?
buprenorphine
104
t/f - buprenorphine binds to and stimulates mu and kappa receptors
true
105
what modes of administration are available for opioids?
```
IV
IM
SQ
PO
rectal
TD
epidural
```
106
antagonists ___ to mu and kappa but do not ____
bind
| stimulate - do not
107
what modes of administration are available for opioids?
```
IV
IM
SQ
PO
rectal
TD
epidural
```
108
what adverse effects are associated with opioids?
```
anxiety
disorientation
excitement
dysphoria
pronounced bradycardia - high doses
decreased respiration and tidal volume
decreased PaO2 and PaCO2
ceiling effect w/ some agents
salivation and vomiting
intial diarrhea, vomiting
gi stasis - following initial stimulation
facial swelling
increased intraocular and intracranial pressure
```
109
what effects are associated with opioids?
```
varying CNS effects
miosis - dogs
mydriasis - cats, horses, ruminants
hypothermia - dogs
hyperthermia - cats
increased responsiveness to noise
sweating - horses
decreased urine production and retention
narcosis - dogs
bizarre behaviour/dysphoria - cats, horses, rum
```
110
what adverse effects are associated with opioids?
```
anxiety
disorientation
excitement
dysphoria
pronounced bradycardia - high doses
decreased respiration and tidal volume
decreased PaO2 and PaCO2
ceiling effect w/ some agents
salivation and vomiting
intial diarrhea, vomiting
gi stasis - following initial stimulation
facial swelling
increased intraocular and intracranial pressure
```
111
why would you use an opioid antagonist?
reverse undesirable effects
wake up patient after sedation
emergency/overdose
reviving c-section neonates - if dam received opioids
112
what effects are associated with opioid antagonists?
reverse effects of opioids
113
are adverse effects commonly seen with opioid antagonists?
no - sudden loss of analgesia can cause excitement, anxiety and SNS stimulation
114
how would you administer an opioid reversal?
IM - slow IV in emergency
115
what might you need to consider when giving naloxone as reversal r/e opioid half life?
duration of action - naloxone lasts 30-60 min and opioids tend to last longer - will need follow up dosing
116
how long does it take naloxone to reverse an opioid when given IM?
5 minutes
117
what are some examples of opioids and sedatives that can be combined to achieve neuroleptanalgesia?
```
opioids -
morphine
buprenorphine
hydromorphone
sedatives -
acepromazine
diazepam
midazolam
xylazine
demedetomidine
```
118
define neuroleptanalgesia
a profound state of sedation and analgesia induced by simultaneous administration of an opioid and a sedative
119
what are some examples of opioids and sedatives that can be combined to achieve neuroleptanalgesia?
```
opioids -
morphine
buprenorphine
hydromorphone
sedatives -
acepromazine
diazepam
midazolam
xylazine
demedetomidine
```
120
what might you use an anxiolytic drug like trazadone?
```
anxiety prone patients
those in need of cage confinement
preop - reduce stress
post op - better recovery
used w/ other behaviour mods while waiting for them to work (4-6wks)
```
121
what is the mode of action for trazodone?
multiple serotonin effects - modulator
| blocks serotonin reuptake into presynaptic neuron
122
why is gabapentin used in vet med?
analgesia - neurologic pain
anxiolytic qualities
safe in conjunction w/ NSAIDs
123
t/f - if your patient has been on trazodone long term and the owner no longer wants the treatment, they can suddenly stop giving the trazodone in one day
false - if on rx long term the patient needs to be weaned off trazodone
124
what is the mode of action for gabapentin?
inhibits excitatory neurotransmitters
| decreases calcium influx
125
what adverse effects are associated with gabapentin?
renal dysfunction - use low dose
HUMAN ORAL LIQUID SHOULD NEVER BE GIVEN - contains xylitol toxic to cats and dogs
ataxia
126
how would antacids affect gabapentin administration?
reduce absorption
127
how would antacids affect gabapentin administration?
reduce absorption
128
what is the drug name for cerenia?
maropitant
129
what might you use cerenia for?
```
antiemetic
motion sickness
prevents vomiting caused by premed w/ opioids and dex
helps patients return to eating postop
analgesic w/ visceral pain
reduces MAC
```
130
what off label use is seen with cerenia?
for coughing associated w/ collapsed trachea
131
what are adverse effects associated with cerenia?
stings on injection
caution w/ hepatic dysfunction
use in puppies and kittens is off label
132
what category of drugs does propofol fall under?
induction agents
133
what are some characteristics of propofol?
```
ultra short acting anesthetic
short term maintenance anesthesia
no analgesic effect
minimally water soluble
available in multiple sol'ns
milky appearance - ok to give
highly fat soluble - t/f fast onset
```
134
what solutions is propofol available in?
egg lecithin
glycerin
soybean oil
135
what is the onset of action for propofol?
30-60 seconds
136
t/f - when administering propofol, you inject the entire calculated dose in one shot
false - propofol is administered to effect
137
propofol is highly protein bound - what patient would you NOT induce with this drug?
hypoproteinemic
138
what is the total recovery time from propofol in dogs and cats?
dogs - 20 min
| cats - 30 min
139
aside from IV to effect use for induction, how else might you administer propofol to your surgical patient?
IV bolus or cri pump
140
what are some effects associated with propofol?
dose dependent CNS depression - sedation to GA
muscle relaxation
antiemetic effect
transient hypotension
141
what are some adverse effects associated with propofol?
```
possible apnea
bradycardia
hypovolemia
seizure-like activity on induction
pain IV injection
cardiac depressant
paddling, muscle twitching, nystagmus
muscle tremors
```
142
how is propofol administered?
slowly to effect
143
t/f - propofol is the #1 recommended induction agent for cats
false - not usually used in cats d/t heinz body formation, diarrhea, anorexia and prolonged recovery (w/ prolonged use)
144
what are some species considerations associated with propofol?
sighthounds - prolonged recovery
145
why is propofol administered to effect?
to lower risks like -
apnea
bradycardia
hypovolemia
146
what is the trade name for alfaxalone?
alfaxan
147
does alfaxalone have a long or short duration of action?
short
148
t/f - alfaxalone can only be given IV
false - can be given both IV or IM
149
when might you see excitement from your patient when using alfaxalone?
during recovery
150
what effects are associated with alfaxalone?
dose-dependent CNS depression
minimal cardiac effect
muscle relaxation
151
what are some adverse effects associated with alfaxalone?
apnea
| hypotension - esp when used w/ inhalants
152
what is the duration of action for alfaxalone?
dogs 10-15 min
| cats 15-20 min
153
are barbituates a controlled class of drugs?
yes
154
what common procedure would you see use of barbituates with?
euthenasia
155
what barbituates did we talk about?
pentobarbital
| thiopental
156
what characteristics are associated with dissociative anesthetic drugs?
should not be given alone
mixed with opioid to produce GA
trancelike state - animal appears awake but not moving
can use in combination with tranquilizers
wide margin of safety
157
what drug can be squirted into the mouth of fractious cats?
ketamine
158
are dissociative anesthetics controlled?
yes
159
why would you reach for a dissociative (in combination with other drugs)?
```
short procedures
anesthetic induction/intubation
chemical restraint - cats
immboilization - LA and exotics
pain control
```
160
t/f - the patient will lose their reflexes when given dissociatives
false - reflexes remain intact when using dissociative anesthetics
161
you induced your patient with ketval - what do you expect their eyes to look like?
eyes will remain open - must lubricate!!!
| central dilated pupils
162
what are some behavioural effects to keep in mind with use of dissociative anesthetics?
sensitive to sensory stimuli - may jump
potential for bizarre behaviour
may produce nystagmus
163
how do dissociative anesthetics affect the heart?
increased HR
increased cardiac output
increased mean BP
may cause cardiac arrhythmias
