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Drugs- Pain, Pre-med > Drugs- Pain, Pre-med > Flashcards

Drugs- Pain, Pre-med Flashcards

1
Q

Acepromazine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A 
phenothiazine
IV/IM
onset 5-20 min IV.        30-45min IM
Duration: 6-8 hours
metabolized by liver, excreted by urine
- sedation, anti-emetic, lowers seizure threshold, hypotension, anti-arrhythmic, anti spasmodic, anti emetic, increase risk of regurg., anti histamine, hypothermia
- paralysis of retractor penis muscle horse
- no reversile agent
-overdose: NO adrenaline, give fluids
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2
Q

Xylazine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • alpha 2 agonist
  • IM, IV, SC, PO, Intranasal, perineurally, epidurally
  • duration of action 15 minutes
  • metabolized by liver, excreted by urine/feces
  • good spasmolytic analgesic for colic in horse
  • No small ruminants, small animal
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3
Q

Detomidine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • alpha 2 agonist
  • give IV, oral in horses
  • longer acting, 40 min duration of action
  • liver metabolism and urine/fecal excretion
  • suitable for pregnant cattle
  • no small animal
  • do not use with sulphonamides in horses
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4
Q

Romifidine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • alpha 2 agonist
  • IV
  • longest duration of action
  • least ataxia in seen in horses, good analgesia
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5
Q

Dexmedetomidine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • alpha 2 agonist
  • IV, IM
  • sedation is dose dependent and can taper to desired effect IV. 1-2 ug/kg (40min), 5ug/kg (60min)
  • analgesia, vomiting
  • reduces larygeal fxn
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6
Q

Medetomidine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • alpha 2 agonist
  • IV, IM
  • sedation without severe cardiovascular effects
  • do not use in dogs
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7
Q

Diazepam

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • benzodiazepines
  • IV, PO, PR, IM (not emulsion prep)
  • rapid onset IV
  • hepatic metabolism
  • decreases neuronal transmission via GABA receptor
  • anxiolysis, sedation, little respiratory depression, muscle relaxant, anti-convulsant, appetite stimulant in cats, anti convulsant
  • reversed with Flumazenil
  • overdose CS: long lasting sedation, CNS depression and coma
  • can be used with ketamine premed, diazepam induction in horses
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8
Q

Midazolam

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • benzodiazepine
  • IV,IM,SC, intanasal
  • rapid onset, short duration
  • metabolism by liver
  • anxiolytic, sedation, little resp depression, muscle relaxant, anti convulsant, appetite stimulant in cat, no analgesia
  • reversed with Flumazenil
  • overdose - long lasting sedation, CNS depression, coma
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9
Q

Azaperone

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • butyrophenones
  • onset of action 5-10 min IM (pigs)
  • duration 2-4 hours
  • metabolism via liver, excreted in urine and feces
  • anti-emetic, sedation, alpha 1 receptor blockade may result in hypotension. Antiarrhythmic. may protect against catecholamine induced arrhythmias, no analgesia, excitement in horses
  • ## AE: pigs can have transient salivation, piling, panting, and shivering
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10
Q

Morphine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • full Mu agonist opioid
  • IV, IM, SC, oral, epidural, intrathecal, intra-articular
  • onset 30 min IM, faster IV
  • duration 4-6 hours
  • analgesia, sedation, bradycardia, bronchospasm (no asthma patients), nausea, vomiting, constipation
    AE: hypotension, dysphoria, sedation, constipation
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11
Q

Methadone

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A
  • full Mu agonist
  • IV, IM, SC
  • onset of action IM 10-20 min
  • duration of action 4 hours
  • NMDA antagonist, analgesia, sedation, bradycardia, NO histamine release, panting, vomiting if there is no pain present
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12
Q

Pethidine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A 
full Mu agonist
IM ONLY, IV large histamine release
onset of action 15-20min
duration 90min
causes mydiasis, sedation, increased HR, severe hypotension if histamine release, no vomiting, spasmolytic effect in block cats, decreased salivary and respiratory secretions
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13
Q

Fentanyl

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A 
pure mu agonist
metabolized by lungs and liver
give IV, IM, SC
onset of action <2 min IV
duration of action 20 min 
analgesia, sedation, excitement (cats), anti-emetic, bradycardia, hypoventilation
No horses
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14
Q

Buprenophine

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A 
partial Mu agonist
IM,IV,SC, OTM
onset slow 20min IV, 40 min IM
duration 6-8hrs
metabolism hepatic
sedation, bradycardia, weak base (pKa 8.4), feline saliva pH is high --> unionized fraction of drug is high, good absorption no first pass metabolism
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15
Q

Butorphanol

  • drug type
  • route of administration
  • onset of action
  • duration of action
  • metabolism and excretion
  • pharmodynamics
  • cautions
A 
mixed agonist/antagonist opioid 
IM, IV
Duration: 1.5-2hrs
hepatic metabolism, renal excretion
good sedation, potentiates axn of acepromazine and alpha 2 agonsit, some analgesia, less depression than morphine
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16
Q

Tramadol

A 
atypical opioid - NOT opioid 
IV, IM, epidural, PO 
t1/2 life in dog 4-6hrs, longer cats
centrally acting analgesia
sedation, analgesia, trembling, ataxia, seizures, bradycardia, nausea, anorexia
AE: serotonin
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17
Q

Phenylbutazone “Bute”

A 
NSAIDS
PO, IV, irritating to tissue
non selective COX inhibitor
used common for acute pain
horse analgesia (colic), anti-inflammatory, anti-endotoxic
NO food animal or dog
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18
Q

Flunixin

A

NSAID
PO, IV
non selective COX inhibitor
use in horses - colic

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19
Q

Meloxicam

A

PO, SC
COX2 selective
chronic pain management
licensed dogs, cats, horses, cattle

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20
Q

Carprofen

A

PO,IV, IM, SC
COX2 selective
dogs, cats, horses
idiosyncratic liver failure in dogs- labs

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21
Q

Robenacoxib

A

PO,SC
high oral bioavailability
long duration
highly COX2 selective
perioperative use in dogs and cats- ensure good BP
decrease renal affects if given loop diuretic

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22
Q

Paracetamol/acetaminophen

A

NSAID like drugs
oxidative metab –> NAPQi active metabolite AM404
weak COX1 and COX2 inhib
antiarrhythmic
can cause hepatic necrosis
cats have limited glutathione pathway that is rapidly overcome by paracetamol

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23
Q

Gabapentin

A 
NSAID like drug
PO bioavail good >80% oral
duration 6-9hrs
hepatic met, renal excretion
anti epileptic, works on neuropath pain, useful pre-med for cats.
No pregnant animals
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24
Q

Amitriptyline- tricyclic antidepressant

A

antidepressant
PO only
hepatic metabolism, renal excretion
SSRI –> increase serotonin and noradrenaline –> improved descending pain control
causes: hypersalivation, sedation, serotonin syndrome, tachycardia, fatal ventricular tachycardia, Vomiting, wt gain, FLUTD, neuropathic pain and chronic laminitis
CI: serotonin syndrome: excessive amounts cause change in mentation/aggression, confusion, coma, autonomic dysfunction (hypertension, tachycardia, hyperthermia), neuromuscular signs (muscle rigidity, tremors)
Tx for SS: gastric lavage, defecation promotion, supportive care

25
Q

Amantadine

A

PO only
slow onset
minimal hepatic metabolism, renal excretion
Dopamine agonist , NMDA antagonist, Na channel blocker
overestimation, serotonin syndrome risk
Used for chronic pain, weight gain, arthritis, neuropathic pain, NO IR

26
Q

Memantine

A

PO only
min hepatic metabolism, renal excretion
non competitive inhibitor of NMDA receptors - reduces abnormal NT mediated activation of the R
used for cognitive dysfunction in dog, similar to amantadine but in IRE
AE: serotonin syndrome

27
Q

Procaine/ adrenocaine

A 
LOCAL
SQ
duration of action: 30-60min
rapid hydrolysis in blood
can be combined with adrenaline
Uses: LA- horn blocks, line blocks
also used with penicillin to extend effect
NOT for extremities
28
Q

Lidocaine

A 
LOCAL
IV (no cats)
extradural, epidural, IVRA, topical
onset 2-5 min
duration 90 min
2x potent then procaine
hepatic metabolism, renal excretion
uses: analgesia, neuropathic pain, nerve blocks, IV for visceral pain, anti arrhythmic class 1 (ventricular arrhythmia), prokinetic, anti-inflammatory, anti endotoxic, intubation of cat, REDUCE MAC
29
Q

Lidocaine + adrenaline

in EMLA

A

LOCAL
injectable
used for dehorning
NO distal limb– necrosis

30
Q

Prilocaine

A 
LOCAL
EMLA cream
topical numbing
takes 60min for full effect
infiltrated peripheral nerves, IVRA in LA
31
Q

Prilocaine and Lidocaine =

A

EMLA cream
No MM very toxic
keep animals from licking
60min to take effect topical

32
Q

Mepivacaine

A 
LOCAL
onset of action 11min
duration of action 130 min
hepatic metabolism
Diagnostic limb blocks, 
NOT food animals in IRE
33
Q

Bupivacaine

A 
LOCAL
NO IV
infiltration, extradural, epidural, spinal anesthesia
onset 30 min 
duration 8 hrs (95% protein bound)
hepatic metabolism
vasoconstriction, reduced motor blockade intensity, reduced cardiotoxicity, 
toxicity at 2.5mg/kg low dose for cats
cardiotoxic if given IV
34
Q

Ropivacaine

A 
LOCAL
onset moderate
duration 8 hrs
hepatic metabolism
used in IR with special license
given via epidural catheter
less toxic
35
Q

Propofol

A 
Injectables- PHENOL
IV ONLY, can give CRI
onset 1 min
duration short
metabolism hepatic and extrahepatic
renal excretion
enhances inhibitory effect of GABA
act on CA channel blockers --> vasodialtion --> hypotension
causes: CNS depression, NO analgesia, anticonvulsant, antioxidant decrease O2 consumption, decrease intracranial pressure, hypotension, central depression, bronchodilation, apnea, 
CROSSES placenta
SA and Horse uses 
AE: cats can get Heinz body anemia, NO cardiac patients will decrease resistance with no compensation
36
Q

Alfaxalone

A 
Injectable- NEUROSTERIOD
IV or IM
induction agent
onset rapid
duration short
renal and biliary metabolism, CP450 
enhance inhibitory effects of GABA
CS: rapid relaxation, induction, poor recovery, no hypotension, mild tachycardia (response to vasodilation), Resp depression if injected fast, muscle relaxant, increase intraocular pressure
SA, cat, neonates
not metabolized by glucuronidation in cats so no heinz body anemia like propofol
37
Q

Ketamine

A

injectable- CYCLOHEXAMINE
IV, IM< PO
onset of action and duration longer then Propofol and alfaxalone
metabolized by liver to active form
excreted renal
antagonist of NMDA
causes: dissociative anesthesia, increases CMR, CBF, excites, increases HR, BP, increase ICP, negative inotrope to heart, increase salivation, bronchodilation, sound sensitivity, muscle rigidity
NO cats with renal dysfucntion, never used alone for anesthesia, ulcerative cystitis

38
Q

Tiletamine

A

ketamine analogue with zolazepam
recover can be violent
only use in darts for wildlife

39
Q

Thiopentone

A

Barbiturate
IV via catheter only
short acting 15 min
metabolized hepatic CYP450, renal excretion
binds GABA, enhances inhibitory action, increases chloride channel opening
uses: induction agent, gradual depression of CNS, hypnosis, decrease oxygen demand, decrease CMR, decrease CBF, decrease ICP, vasodilation, hypotension, tachycardia (reflex), arrhythmias, respiratory depression (INTUBATE), decrease renal blood flow
used in small and large medicine for quick procedures IV admin, emergency management of moving anesthised horse, convulsions, increase ICO, snail pellet toxicity
high pH so skin slough if extravascular

40
Q

Pentobarbitone

Euthasol

A 
barbiturates
IV
slow onset 2 min
duration longer then thiopentone
extensive hepatic metabolism
cs: loss of consciousness, anticonvulsant, hypotension, tachycardia, depression
can be used for euthanasia
toxicity in dogs fed with euthanized animal meat
41
Q

Phenobarbitone

A

PO, IV
oxybarbiturate
anticonvulsant
NOT for anesthesia

42
Q

Etomidate

A 
Imidazole
IV- be carful!
onset fast
duration short
transient depression of HPA- inhibits conversion of cholesterol to cortisol 
can paddle during induction
used for EXOTICS
no IRE
43
Q

Atropine

A 
anticholinergic
IV, IM
onset 1-5 min
duration 2--40min
hydrolysed to inactive form
increases ACh --> decrease RRm mydriasis, decrease salivation, tachycardia, increase HR (reflex to decrease BP)
crosses BBB, placenta
can use glycopyrrolate and neostigmine to reverse
AE: can cause 2nd degree AV Block
44
Q

Glycopyrrolate

A 
anticholinergic
onset slower then atropine
duration 1-2 hours
controlled increase HR, cannot cross BBB
no mydriasis
good for increasing BP
45
Q

Dopamine

A

CRI only - IV
hepatic met and renal
dose dependent effects. acts on adrenergic and dopaminergic receptors
effects: increase perfusion hear, increase HR, increase inotropy, vasodilation, improve O2 delivery, bronchodilation, increased renal and mesenteric blood flow,
risks of ventricular fib

46
Q

Adrenaline

A

sympathomimetic
IV or IM, bolus or CRI, Nebulization
hepatic and renal met
stimulates alpha and beta receptors
increase HR, inotropy, promotes coronary arterial flow during diastole –> determines survival of arrest, bronchodilation, increases glucose, lactate, FFA
Uses: CPR, anaphylaxis, severe hypotension (sepsis), added to local anesthetic to increase duration, splash to decrease bleeding, decrease airway edema

47
Q

Noradrenaline (NA)

A

only give with invasive BP monitoring
stimulates alpha and beta receptors
causes: profound vasoconstriction, increase BP, decrease CO, increase O2 consumption, can cause increase vasoconstriction in lungs, tissue ischemia reflex bradycardia
AI: necrosis at pt of administration

48
Q

Ephedrine

A

sympathomimetic
cats can be bolus
directly stim alpha 1 and beta 2
indirectly stim beta1
increase BP, positive inotrope
some bronchodilation, decrease blood flow, decrease GFR
AE: tachyphylaxis- indirect mechanism from noradrenaline depletion

49
Q

Dobutamine

A

Positive inotope
excreted in urine
non selective beta receptor agonist
no change TPR, increase conduction velocity through nodal tissue. arrhythmias rare, arrhythmias rare

50
Q

Phenylephrine

A 
vasopressor
IM- onset 1hr
nasal spray for horses - most common
NEED invasive BP monitor
hepatic metabolism
alpha 1 agonist
vasoconstriction, decrease perfusion, reflex bradycardia, nasal edema, splenic contraction, correct neophrosplenic entrapment
AE: reflex bradycardia, hypoperfusion
special license needed in IR
51
Q

Vasopressin

A

simulates the release of catecholamines
increased contractility and refractory hypotension
most potent vasopressor
NOT IN IRE

52
Q

Salbutamol

A

bronchodilator
inhaled rapid onset, slow metabolism so long duration of action
hepatic met and renal excretion
beta2 agonist in lungs and heart
Na/K + ATPase stim –> K decrease
CS: tachycardia at high dose, bronchodilation, relaxes smooth muscle of lungs, reversed hypoxic pulmonary vasoconstriction (horses), can cause tremors
AE: tachycardia. can increase shunting of blood from heart and may cause hypoxia –> always admin with O2 when nebulizing

53
Q

Terbutaline

A

bronchodilator
injectable, inhaled
injectable used for BAL or bronchoscopy

54
Q

Doxapam

A

sympathomimetic
IV onset <2 min, duration short
hepatic met, renal excretion
CNs simulant at all levels, direct stim of medullary resp centers
transient increase minute ventilation but no increase arterial oxygen tension. Not a substitute for approp respiratory support –> doesnt fix hypoxia
AE: dont use in hypertensive patients, can cause persistant fetal circulation –> hypoxia

55
Q

Succinylcholine

A

neuromuscular blocker- depolarizing agent
IV
duration 3 min, recovery in 10-12 min
metabolized in blood
cs: bradycardia (stimulation of muscarinic receptor in SA node); increase K –> arrhythmias, increase intra ocular pressure

Used to stop breathing for thoracic surgery
Lots of undesired effects

56
Q

Atracurium

A

no AP generation, paralysis w/o musc cxn
does nto cross BBB

other non depolarizing agents: cis-atracurium, mivacurium, vecuronium, rocuronium

57
Q

Edrophonium

A 
anticholinesterase
ADMIN with atropine
onset fast, duration short
hepatic metabolism
used to diagnose myasthenia gravis 
Ach esterase antagonist
58
Q

Neostigmine

A

admin with glycopyrrolate, onset slower, duration longer

same as edrophonium

59
Q

Sugammades

A 
fast acting
gamma cylodextrin, hydrophilic surface
use to reverse aminosteriods
avoid muscarinic effects
cost prohibitive- NOT USED

Drugs- Pain, Pre-med (2 decks)

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