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drugs Flashcards

1
Q

t/f - diffusion rate is dependent on concentration gradient and lipid solubility

A

true

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2
Q

t/f - diffusion rate is dependent on concentration gradient and lipid solubility

A

true

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3
Q

when is the concentration gradient of isoflurane greatest?

A

at initial induction

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4
Q

when is the concentration gradient of isoflurane greatest?

A

at initial induction

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5
Q

what does lipid solubility have to do with cell walls?

A

determines entry of isoflurane into the cells

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6
Q

when is the concentration gradient of isoflurane greatest?

A

at initial induction

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7
Q

what does tissue distribution of isoflurane depend on?

A

blood supply

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8
Q

t/f - depth of anesthesia is dependent on partial pressure of the anesthetic blood and alveoli

A

true

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9
Q

what is the mode of administration of isoflurane?

A

mixture of carrier and anesthetic delivered via mask or ET tube

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10
Q

when would you use an anticholinergic in your anesthetic procedure?

A

premedication (no longer recommended)

inter-op if needed for bradycardia

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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

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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

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13
Q

when would you use an anticholinergic in your anesthetic procedure?

A

premedication

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14
Q

what effects are associated with anticholinergics?

A 
limited CNS 
prevent bradycardia 
bronchodilation 
decreased secretions 
eye midriasis 
corneal drying
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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

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16
Q

what routes of administration are possible for anticholinergics?

A

IV
IM
IT

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17
Q

what are some examples of anticholinergics?

A

atropine

glycopyrrolate

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18
Q

atropine has a _____ onset when compared with glyco

A

faster

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19
Q

t/f - acepromazine is a controlled drug

A

false - it is not controlled

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20
Q

why would you reach for atropine interop?

A

cardiac arrest

low blood pressure

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21
Q

acepromazine maleate belongs to what class of drug?

A

phenothiazines

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22
Q

t/f - acepromazine is a controlled drug

A

false - it is not controlled

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23
Q

what effect can ace have on induction and recovery?

A

eases induction and recovery

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24
Q

what class of drugs can be combined for use with acepromazine for minor procedures?

A

opioids (i.e. hydro and ace)

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25
Q

what species is acepromazine approved for use in?

A

horses
dogs
cats

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26
Q

t/f - acepromazine has a reversal agent

A

false - there is NO reversal agent

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27
Q

what effect does acepromazine have on a patient’s coordination motor responses?

A

ace has no effect on coordination motor responses

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28
Q

acepromazine does ____ in relation to the dose of GA

A

decreases

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29
Q

what is the mode of action of acepromazine?

A

inhibits central dopaminergic receptors to cause sedation and tranquilization

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30
Q

what effect does acepromazine have on a patient’s coordination motor responses?

A

ace has no effect on coordination motor responses

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31
Q

t/f - animals will not arouse easily under acepromazine sedation

A

false - animals can be aroused easily on ace

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32
Q

what modes of administration are available for acepromazine?

A

IV
IM
PO

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33
Q

what needs to be considered when using an oral dose of acepromazine? how might this affect its use in sx?

A

slower onset than IV admin; cannot be used for premed - prescribed to aggressive patients

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34
Q

what is the half life (IV) of acepromazine in dogs? horses?

A

dogs - 4.5hrs

horses - 2.6hrs

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35
Q

what precaution is recommended when dosing acepromazine?

A

dose lower than label dose

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36
Q

what category of anesthetic medication does acepromazine fall under?

A

tranquilizer/sedative

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37
Q

what contraindications are associated with acepromazine?

A

patients with liver disease - metabolized by liver
no pregnant patients - slowly crosses placenta
breeding stallions - penile prolapse

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38
Q

what are adverse effects associated with acepromazine?

A

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

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39
Q

what are breed-specific considerations associated with acepromazine?

A

australian shepherds - prolonged sedation
giant breeds, boxers, greyhounds - bradycardia and hypotension
terriers and cats - more resistance

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40
Q

what contraindications are associated with acepromazine?

A

patients with liver disease - metabolized by liver
no pregnant patients - slowly crosses placenta
breeding stallions - penile prolapse

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41
Q

does acepromazine have analgesic effects?

A

no - sedation only NO pain relief at all

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42
Q

what characteristics can be associated with benzodiazepines?

A 
rapid onset 
varying duration w/ drug 
no analgesia 
not effective for sedation 
**typically used in conjunction w/ other drugs**
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43
Q

what effects are associated with benzodiazepines?

A 
calming, anti-anxiety 
anticonvulsant 
skeletal muscle relaxation 
potentiates GA 
appetite stimulation (cats/ruminants)
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44
Q

what adverse effects are associated with benzodiazepines?

A

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

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45
Q

t/f - diazepam is highly water soluble, and that is why it can’t be mixed with other drugs

A

false - diazepam is poorly water soluble t/f it can’t be mixed with anything but ketamine

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46
Q

what can happen if your feline patient is given oral diazepam?

A

liver failure!!!

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47
Q

t/f - diazepam can be mixed with any drug, it’s safe and reliable like that !

A

false - diazepam can ONLY EVER be mixed with ketamine

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48
Q

t/f - diazepam is highly water soluble, and that is why it can’t be mixed with other drugs

A

false - diazepam is poorly water soluble t/f it can’t be mixed with anything but ketamine

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49
Q

what needs to be considered r/e storage of diazepam?

A

it is light sensitive and binds to plastic - cannot be stored in syringes, IV lines or bags

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50
Q

what is the half life of diazepam?

A

3.2hrs - fast onset and long lasting drug

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51
Q

what is the route of administration for diazepam?

A

slow IV

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52
Q

t/f - like diazepam, midazolam is poorly water soluble

A

false - midazolam is water soluble

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53
Q

what species is midazolam commonly used in?

A

swine
ferrets
rabbits
birds

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54
Q

what routes of administration are available for midazolam?

A

IV

IM

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55
Q

can diazepam be administered in all the same ways as midazolam?

A

no - can ONLY be administered IV where midazolam can be given both IV and IM

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56
Q

what is the half life of midazolam?

A

1hr - slower absorption than diazepam

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57
Q

what is clonazepam commonly used for in vet med?

A

behaviour modification

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58
Q

what are some examples of alpha2 agonists?

A

xylazine
dexmededetomidine
detomidine
romifidine

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59
Q

what needs to be considered if your patient is on clonazepam for 6 days?

A

need to be weaned off

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60
Q

what is special about dosing clonazepam in cats?

A

dosed in mg/CAT (0.125-0.25)

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61
Q

what are some examples of alpha2 agonists?

A

xylazine
dexmededetomidine
detomidine
romifidine

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62
Q

what characteristics are associated with alpha2s?

A 
sedation 
analgesia
muscle relaxation 
rapid sedation - dependent on spp. and drug 
reversible
not controlled
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63
Q

are alpha2s more commonly reached for in large or small animal medicine?

A

large animal

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64
Q

t/f - xylazine lasts longer than detomidine in horses

A

false - detomidine lasts longer (40min) vs. xylazine (20min)

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65
Q

do alpha2s have reliable analgesic effect?

A

no - the analgesic effects of alpha2s are questionable

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66
Q

what would you use to reverse an alpha2 if necessary?

A

alpha2 antagonist

67
Q

what modes of administration can be used for alpha2s?

A

IV

IM

68
Q

why would you administer an alpha2?

A

prior to small procedures that may be uncomfortable for the patient

69
Q

you administered dexdomitor IV to your feline patient; as you’re trimming its nails, the cat vomits. why?

A

immediate vomiting response to alpha2 - biggest negative side effect associated with the drugs

70
Q

what effects are associated with alpha2s?

A 
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
Q

what effects can be seen on the cariovascular system with administration of alpha2s? is it the same throughout effect?

A 
2 phases of effect 
early: dose-dependent vasoconstriction - decreased HR 
hypertension 
bradycardia 
late: decreased cardiac output 
hypotension 
further bradycardia
72
Q

you administered dexdomitor IV to your feline patient; as you’re trimming its nails, the cat vomits. why?

A

immediate vomiting response to alpha2 - biggest negative side effect associated with the drugs

73
Q

what is the trade name(s) for xylazine?

A

rompun

anased

74
Q

t/f - it is okay to administer an alpha2 to a pregnant cow in her last trimester

A

false - alpha2s can cause premature parturition in cattle

75
Q

what considerations are associated with alpha2s?

A 
avoid use in: 
geriatric 
diabetic
pregnant 
pediatric 
ill - strain on the heart 
liver patients - metabolized by liver
76
Q

what is the scientific name for dexdomitor?

A

dexmededetomidine

77
Q

t/f - there is only one concentration of xylazine available for use

A

false - there are 2
2% sol’n SA
10% sol’n EQ

78
Q

t/f - cattle require a stronger dose of xylazine than horses

A

false - cattle need a 1/10 dilution of 10% xylazine (equine conc.)

79
Q

dex is ___ in strength and safety in comparison to xylazine

A

more potent and safer than xylazine

80
Q

t/f - dexmededetomidine is used in the drug combination commonly referred to as “kitty magic”

A

true

81
Q

what are the three components that make up “kitty magic”?

A

dex
opioid - hydromorphone or butorphanol
ketamine

82
Q

what considerations should be kept in mind when using dexmededetomidine?

A

pale mm - d/t peripheral vascular constriction
bradycardia
decreased resp rate
initial increase in BP - later decrease returning to norm

83
Q

t/f - dex does not require flow by oxygen during sx

A

false - must always have flow by oxygen when using dex

84
Q

what considerations should be kept in mind when using dexmededetomidine?

A

pale mm - d/t peripheral vascular constriction
bradycardia
decreased resp rate
initial increase in BP - later decrease returning to norm

85
Q

what contraindications are associated with dexmededetomidine?

A 
dogs w/ existing heart problems 
respiratory problems 
liver problems 
kidney problems 
shock 
hypotension 
hypoxia 
bradycardia 
not ideal for older animals
86
Q

how is dosing of dex based?

A

on body surface area

87
Q

in what species might you use detomidine?

A

equine

88
Q

detomidine lasts ___ in relation to xylazine

A

longer - 2x duration of xylazine

89
Q

what benefit is associated with romifidine?

A

less ataxia

90
Q

t/f - detomidine and hydromorphone produce standing sedation

A

false - standing sedation produced with detomidine and butorphanol

91
Q

what benefit is associated with romifidine?

A

less ataxia

92
Q

t/f - alpha2 antagonists reverse only the bad effects of alpha2s

A

false - when reversal administered ALL effects of the drug are reversed

93
Q

what effects of overdose can be seen on the neurological, cardiovascular and gastrointestinal systems?

A

neuro - excitement and muscle tremors
cardio - hypotension and tachycardia
gastro - salivation and diarrhea

94
Q

can you administer a reversal IV in any patient?

A

only emergency - administered IM normally

95
Q

what drug reverses dexdomitor?

A

atipamezole (antisedan)

96
Q

what drug reverses xylazine?

A

yohimbine

97
Q

what effects are produced by the opioid family of drugs?

A

sedation

analgesia

98
Q

what are some common uses of opioids in surgical procedures?

A

preanesthetic - may be used alone or in conjunction w/ tranqs/sedatives
analgesia - prevent and treat postop pain; used w/ tranquilizer to produce neuroleptanalgesia

99
Q

t/f - opioids have a wide margin of safety

A

true

100
Q

what are some common uses of opioids in surgical procedures?

A

preanesthetic - may be used alone or in conjunction w/ tranqs/sedatives
analgesia - prevent and treat postop pain; used w/ tranquilizer to produce neuroleptanalgesia

101
Q

what opioids are best used for moderate to severe pain?

A 
agonists 
morphine 
hydromorphone 
oxymorphone 
fentanyl
102
Q

what receptors do agonists bind to?

A

mu and kappa

103
Q

what partial agonist is used in vetmed?

A

buprenorphine

104
Q

t/f - buprenorphine binds to and stimulates mu and kappa receptors

A

true

105
Q

what modes of administration are available for opioids?

A 
IV 
IM 
SQ
PO
rectal 
TD
epidural
106
Q

antagonists ___ to mu and kappa but do not ____

A

bind

stimulate - do not

107
Q

what modes of administration are available for opioids?

A 
IV 
IM 
SQ
PO
rectal 
TD
epidural
108
Q

what adverse effects are associated with opioids?

A 
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
Q

what effects are associated with opioids?

A 
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
Q

what adverse effects are associated with opioids?

A 
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
Q

why would you use an opioid antagonist?

A

reverse undesirable effects
wake up patient after sedation
emergency/overdose
reviving c-section neonates - if dam received opioids

112
Q

what effects are associated with opioid antagonists?

A

reverse effects of opioids

113
Q

are adverse effects commonly seen with opioid antagonists?

A

no - sudden loss of analgesia can cause excitement, anxiety and SNS stimulation

114
Q

how would you administer an opioid reversal?

A

IM - slow IV in emergency

115
Q

what might you need to consider when giving naloxone as reversal r/e opioid half life?

A

duration of action - naloxone lasts 30-60 min and opioids tend to last longer - will need follow up dosing

116
Q

how long does it take naloxone to reverse an opioid when given IM?

A

5 minutes

117
Q

what are some examples of opioids and sedatives that can be combined to achieve neuroleptanalgesia?

A 
opioids - 
morphine 
buprenorphine
hydromorphone 
sedatives - 
acepromazine 
diazepam 
midazolam 
xylazine 
demedetomidine
118
Q

define neuroleptanalgesia

A

a profound state of sedation and analgesia induced by simultaneous administration of an opioid and a sedative

119
Q

what are some examples of opioids and sedatives that can be combined to achieve neuroleptanalgesia?

A 
opioids - 
morphine 
buprenorphine
hydromorphone 
sedatives - 
acepromazine 
diazepam 
midazolam 
xylazine 
demedetomidine
120
Q

what might you use an anxiolytic drug like trazadone?

A 
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
Q

what is the mode of action for trazodone?

A

multiple serotonin effects - modulator

blocks serotonin reuptake into presynaptic neuron

122
Q

why is gabapentin used in vet med?

A

analgesia - neurologic pain
anxiolytic qualities
safe in conjunction w/ NSAIDs

123
Q

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

A

false - if on rx long term the patient needs to be weaned off trazodone

124
Q

what is the mode of action for gabapentin?

A

inhibits excitatory neurotransmitters

decreases calcium influx

125
Q

what adverse effects are associated with gabapentin?

A

renal dysfunction - use low dose
HUMAN ORAL LIQUID SHOULD NEVER BE GIVEN - contains xylitol toxic to cats and dogs
ataxia

126
Q

how would antacids affect gabapentin administration?

A

reduce absorption

127
Q

how would antacids affect gabapentin administration?

A

reduce absorption

128
Q

what is the drug name for cerenia?

A

maropitant

129
Q

what might you use cerenia for?

A 
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
Q

what off label use is seen with cerenia?

A

for coughing associated w/ collapsed trachea

131
Q

what are adverse effects associated with cerenia?

A

stings on injection
caution w/ hepatic dysfunction
use in puppies and kittens is off label

132
Q

what category of drugs does propofol fall under?

A

induction agents

133
Q

what are some characteristics of propofol?

A 
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
Q

what solutions is propofol available in?

A

egg lecithin
glycerin
soybean oil

135
Q

what is the onset of action for propofol?

A

30-60 seconds

136
Q

t/f - when administering propofol, you inject the entire calculated dose in one shot

A

false - propofol is administered to effect

137
Q

propofol is highly protein bound - what patient would you NOT induce with this drug?

A

hypoproteinemic

138
Q

what is the total recovery time from propofol in dogs and cats?

A

dogs - 20 min

cats - 30 min

139
Q

aside from IV to effect use for induction, how else might you administer propofol to your surgical patient?

A

IV bolus or cri pump

140
Q

what are some effects associated with propofol?

A

dose dependent CNS depression - sedation to GA
muscle relaxation
antiemetic effect
transient hypotension

141
Q

what are some adverse effects associated with propofol?

A 
possible apnea 
bradycardia 
hypovolemia 
seizure-like activity on induction 
pain IV injection 
cardiac depressant 
paddling, muscle twitching, nystagmus
muscle tremors
142
Q

how is propofol administered?

A

slowly to effect

143
Q

t/f - propofol is the #1 recommended induction agent for cats

A

false - not usually used in cats d/t heinz body formation, diarrhea, anorexia and prolonged recovery (w/ prolonged use)

144
Q

what are some species considerations associated with propofol?

A

sighthounds - prolonged recovery

145
Q

why is propofol administered to effect?

A

to lower risks like -
apnea
bradycardia
hypovolemia

146
Q

what is the trade name for alfaxalone?

A

alfaxan

147
Q

does alfaxalone have a long or short duration of action?

A

short

148
Q

t/f - alfaxalone can only be given IV

A

false - can be given both IV or IM

149
Q

when might you see excitement from your patient when using alfaxalone?

A

during recovery

150
Q

what effects are associated with alfaxalone?

A

dose-dependent CNS depression
minimal cardiac effect
muscle relaxation

151
Q

what are some adverse effects associated with alfaxalone?

A

apnea

hypotension - esp when used w/ inhalants

152
Q

what is the duration of action for alfaxalone?

A

dogs 10-15 min

cats 15-20 min

153
Q

are barbituates a controlled class of drugs?

A

yes

154
Q

what common procedure would you see use of barbituates with?

A

euthenasia

155
Q

what barbituates did we talk about?

A

pentobarbital

thiopental

156
Q

what characteristics are associated with dissociative anesthetic drugs?

A

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
Q

what drug can be squirted into the mouth of fractious cats?

A

ketamine

158
Q

are dissociative anesthetics controlled?

A

yes

159
Q

why would you reach for a dissociative (in combination with other drugs)?

A 
short procedures
anesthetic induction/intubation 
chemical restraint - cats 
immboilization - LA and exotics 
pain control
160
Q

t/f - the patient will lose their reflexes when given dissociatives

A

false - reflexes remain intact when using dissociative anesthetics

161
Q

you induced your patient with ketval - what do you expect their eyes to look like?

A

eyes will remain open - must lubricate!!!

central dilated pupils

162
Q

what are some behavioural effects to keep in mind with use of dissociative anesthetics?

A

sensitive to sensory stimuli - may jump
potential for bizarre behaviour
may produce nystagmus

163
Q

how do dissociative anesthetics affect the heart?

A

increased HR
increased cardiac output
increased mean BP
may cause cardiac arrhythmias

SGT (5 decks)

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