Exam 1 Flashcards
List the Anticholinergic drugs.
Atropine
Glycopyrolate
Pralidoxime (2-PAM)
Atropine
-- Anticholinergic What is it used for? -Preanestehtic -Increases heart rate -Mydriatic: Dilates pupils -Organophosphate antidote
Does it have a reversal agent? No
Is it a controlled substance? No
Glycopyrolate
– Anticholinergic
What is it used for?
-Preanesthetic
-Increases heart rate
Does it have a reversal agent? No
Is it a controlled substance? No
Peralidoxime (2-PAM)
–Anticholineric
What is it used for?
-Treats organophosphate toxicity
Is it a controlled substance? No
Does it have a reversal agent? No
List the Phenothiazine Drugs.
- Acepromazine
- Propofol
Acepromazine
–Phenothiazine drug
What is it used for?
- Preanesthetic
- Causes Sedation/ relieves anxiety
Does it have a reversal agent? No
Is it a controlled substance? No
Propofol
–Phenothiazine Drug
Is it a controlled substance? No
Does it have a reversal agent? No
List the Adrenergic Drugs.
(emergency drugs)
- Epinephrine
- Norepinepherine
- Dopamine
- Dobutamine
Epinephrine
–Adrenergic drug
What is it used for?
-increases cardiac output/stimulates the heart to beat
-Vasoconstrictor: Increases blood pressure
-Treat anaphylaxis
Does it have a reversal agent? No
Is it a controlled substance? No
Norepinepherine
–Adrenergic Drug
What is it used for?
-Increases Cardiac output
-Vasoconstrictor: increases blood pressure
Does it have a reversal agent? No
Is it a controlled substance? No
Dopamine
–Adrenergic Drug
What is it used for?
-Vasoconstrictor: increases blood pressure
Does it have a reversal agent? No
Is it a controlled substance? No
Dobutamine
–Adrenergic Drug
What is it used for?
-Vasoconstrictor: Increases blood pressure
-Increases cardiac output
Does it have a reversal agent? No
Is it a controlled substance? No
List the Dissociative drugs.
- Ketamine
- Tiletamine(Found in Telezol)
Ketamine
--Dissociative drug What is it used for? -Dissociative -Anesthetic -sedative
Controlled Substance: Schedule C-III
Does it have a reversal Agent? No
Tiletamine
-Dissociative drug
-Found in Telezol
What is it used for?
-Dissociative
-Anesthetic
-sedative
Controlled Substance: C-III
Does it have a reversal agent? No
List the Opiod Drugs
- Morphine
- Hydromorphone
- Oxymorphone
- Meperidine
- Fentanyl
- Buprenophine
- Butorphanol
Biggest Side Effect: respiratory depression
Morphine
--Opiod drug What is it used for? -Mu agonist -Analgesic -Preanesthetic -Emetic
Controlled Substance: C-II
Reversal Agent: Naloxone & Butorphanol
Hydromorphone
--Opiod drug What is it used for? -Mu agonist -Analgesic -Preanestheic Reversal Agent: Naloxone & Butorphanol
Oxymorphone
--Opiod drug What is it used for? -Mu agonist -Analgesic -Preanesthetic
Reversal Agent: Naloxone & Butorphanol
Controlled Substance: C-II
Meperidine
–Opiod Drug
What is it used for?
- Mu agonist
-Analgesic
Reversal Agent: Naloxone & Butorphanol
Controlled Substance: C-II
Fentanyl
--Opiod Drug What is it used for? -Mu agonist -Analgesic -Pre anesthetic
Reversal Agent: Naloxone & Butorphanol
Controlled Substance: C-II
Buprenophine
–opiod drug
What is it used for?
-Partial Mu agonist
Reversal Agent: Naloxone
Controlled Substance: C-III
Butorphanol
--opiod drug What is it used for? -Mu agonist -Kappa Agonist -SEDATIVE -Analgesia (minimal) -Antitussive: Cough suppressant
Reversal Agent: Naloxone (partial reversal)
Controlled Substance: C-IV
List the Benzodiazepine drugs.
(anti anxiety drugs)
- Diazepam(Valium)
- Midazolam
- Alprazolam(Xanax)
- Zolazepam(found in Telazol)
Diazepam(Valium)
--Benzodiazepine drug What is it used for? -sedative -anticonvulsant -preanesthetic
- Anti-anxiety
- appetite stimulant in cats
Reversal Agent: Flumazenil
Controlled Substance: C-IV
Midazolam
--Benzodiazepine drug What is it used for? -sedative -anticonvulsant -preanesthetic
*anti-anxiety
Reversal Agent: Flumazenil
Controlled Substance: C-IV
Alprazolam(xanax)
–Benzodiazepine drug
What is it used for?
-sedative
-preanesthetic
*anti-anxiety
Reversal Agent: Flumazenil
Controlled Substance: C-IV
Zolazepam
–Benzodiazepine drug
What is it used for?
-sedative
-preanesthetic
*anti-anxiety
Reversal Agent: Flumazenil
Controlled Substance: C-III
What is a Prescription?
A drug that is limited to use under the supervision of a veterinarian because of potential danger, difficulty of administration, or other considerations.
What is a non-prescription drug?
A non-prescription drug is an over-the-counter (OTC) drug. It can be purchased without supervision of a veterinarian.
They do not have a significant potential for toxicity or require special administration(Ex- aspirin, benadryl)
What is a package insert?
A package insert contains the trade and generic name, controlled substance notation, dosage administration, warnings, side effects, storage, etc.
What is an Extra-Label?
An extra-label is used for drugs that are used in a manner that is not specifically designed on the FDA- approved label.
-It is allowed under the Animal Medicinal Drug use clarification Act of 1994 ( AMDUCA)
Federal Controlled Substance Act
- 1970 comprehensive drug abuse, prevention, and controlled act.
- controlled substance defined under law
- regulates manufacturing, distribution, & dispensing
- 5 schedules
FDA
food and drug administration
DEA
drug enforcement administration
Schedule I
drugs used with high abuse potential and no accepted medical use.
Schedule II
high abuse potential and accepted medical use
Schedule III
moderate abuse potential and accepted medical use
Schedule IV(4)
low abuse potential and accepted medical use
Schedule V(5)
limited abuse potential and accepted medical use
B.I.D
twice a day
g (gm)
gram
gr
grain
gtt
drop
h (hr)
hour
IM
intramuscular
IP
intraperitoneal
IV
intravenous
L
liter
mg
milligram
mL
milliliter
OD
right eye
OS
left eye
OU
both eyes
PO
by mouth
prn
when needed
q
every
q4h
every 4 hours
q8h
every 8 hours
qd
every day
qh
every hour
q.i.d.
4 times daily
q.o.d.
every other day
s.i.d.
once a day
SQ/SC
subcutaneous
t.i.d.
three times daily
EOD
every other day
Compounding drugs
manipulation of a drug that is not provided for in an FDA approved drug label.
- to add flavoring
- alternative route of administration
Solution
mixture of substances made by dissolving solids into liquids or liquids into liquids
Solvent
the dissolving substance
Solute
substance dissolved in a solvent(liquid) to form a solution
Dilution
reduction of a concentration of a substance
Diluent
agent that dilutes
Receptors of the SNS(adrenergic)
Alpha 1
Alpha 2
Beta 1
Beta 2
Alpha 1 receptor
increases force of heart contraction, increases blood pressure, and causes mydriasis.
- stimulatory
- adrenergic
Alpha 2 receptor
inhibits release of norepinephrine and dilutes blood vessels, producing hypotension
- stimulatory
- adrenergic
Beta 1 receptor
increases heart rate and force of heart contraction
- inhibitory
- adrenergic
Beta 2 receptor
dilates bronchioles and relaxes the gastrointestinal tract
- inhibitory
- adrenergic
Primary neurotransmitters:
norepinephrine, epinephrine, dopamine
receptors of the PSNS(cholinergic)
- nicotinic
- muscarinic
Neurotransmitter is: acetylcholine which binds with both receptor types
I: ANS Agents
Cholinergics
- Parasympathomimetics
- Mimic acetylcholine action (direct) or inhibit its breakdown (indirect)
Side effects: bradycardia, hypotension, increased intestinal activity, SLUD Uses: Stimulate GI motility Control vomiting Treat urinary retention Antidote for neuromuscular blockers Reduce IOP in glaucoma Aid diagnosis of myasthenia gravis
Direct Acting cholinergics
Dosage forms:
- Metoclopromide(reglan)
- used to control vomitting and promote gastric emptying
- Bethanechol(urecholine)
- To treat GI and urinary tract
- Pilocarpine
- reduces IOP associated with glaucoma
Indirect acting cholinergics
=Anticholinesterase agents
Dosage Forms:
- Edrophonium (Tensilon®)
- Diagnose myasthenia gravis
- Neostigmine and Physostigmine
- Urinary retention, GI atony, and antidote for n-euromuscular blocking agents
- Organophosphates
- Insecticide dips
Cholinergic blocking agents
-Anticholinergic (parasympatholytic) drugs
Uses:
- Treat vomiting and diarrhea by ↓GI motility
- Preanesthetic to dry secretions and prevent -bradycardia
- Dilate pupils (mydriatic)
- Relieve ciliary spasm
- Increase heart rate
Side effects: tachycardia, constipation, photophobia, drowsiness
Cholinergic Blocking Agents(prt2)
Dosage Forms:
-Atropine
Preanesthetic, mydriatic, OP antidote
-Glycopyrrolate
preanesthetic
-Amimopentamide (Centrine®)
Control vomiting & diarrhea in dogs and cats
-Propantheline (Pro-Banthine®)
Treat diarrhea and reduce colonic peristalsis in
horses
-Pralidoxime (2-PAM)
Treat OP toxicity by reactivating acetylcholinesterase
Adrenergic Drugs
-Sympathomimetics
Uses:
- Cardiac arrest
- Anaphylaxis
- Hypotension
- Allergic reaction
- Prolong effects local anesthetics
Side effects: tachycardia, hypertension, arrhythmias
Adrenergic Drugs
Dosage Forms:
- Epinephrine
- Norepinephrine
- Isoproterenol
- Dopamine
- Dobutamine
- Phenylpropanolamine- for urinary incontinence
- Albuterol and Terbutaline – bronchodilators
- Xylazine and Medetomidine
Adrenergic blocking agents
Sympatholytics; block effects to adrenergic NT’s
- Act as antagonists to alpha- and beta- receptors
- Include alpha blockers and beta blockers
Alpha Blockers
- Uses: promote vasodilation and decrease BP
- Side Effects: tachycardia, hypotension, muscle tremors
Dosage Forms:
Phenoxybenzamine
Yohimbine and Atipamezole (Antisedan®)
Beta Blockers
- Uses: decrease heart rate and BP; treat glaucoma
- Side effects: bradycardia and hypotension
Dosage forms:
Propanolol
Atenolol
Timolol - treat glaucoma
II: CNS Agents
A. Tranquilizers B. Barbiturates C. Dissociatives D. Opioids E. Neuroleptanalgesics F. Anticonvulsants G. Inhalant anesthetics
Tranquilizers and Sedatives
- Tranquilizers calm animals and used to reduce anxiety and aggression
- Sedatives decrease irritability and excitement and are used to quiet animals
- Both produce a relaxed state but do NOT produce significant analgesia so animals can respond quickly and viciously to painful stimuli
Phenothiazine Derivatives
-Work by unknown mechanism
Cause sedation, relieve fear and anxiety, do not provide analgesia, depress CRTZ and prevent vomiting
- Uses: anti-emetic, prevent motion sickness, sedation, preanesthetic
- Side effects: hypotension, lowering seizure threshold, protrusion of nictitating membrane, paraphymosis (retraction of prepuce) in horses
Phenothiazine Derivatives
Dosage forms: Acepromazine maleate (PromAce®)
Benzodiazepines
- Anti-anxiety drugs, anticonvulsant activity, muscle relaxation, appetite stimulants
- Uses: sedation, seizures, appetite stimulant in cats, combined with ketamine for anesthesia
- Side effects: CNS excitement
- Reversal agent: Flumazenil
Dosage Forms: Diazepam (Valium®) Midazolam Alprazolam (Xanax®) Zolazepam (found in Telazol ®)
Alpha-2 agonists
Bind to alpha-2 receptors that normally release norepinephrine –>NE decreased (normally maintains alertness) so absence NE produces sedation; produce calming, some analgesia, and muscle relaxation
- Uses: sedation, analgesia, induction vomiting in cats
- Side effects: bradycardia, heart block, hypotension, respiratory depression
NOTE: ruminants, especially cattle, are extremely sensitive so dose with caution (use 1/10th the dose)
Alpha-2 Agonists
Dosage forms:
Xylazine (Rompun®)
Reversal agents are alpha adrenergic blocking agents:
Yohimbine (Yobine ®)
Detomidine (Dormosedan®)
Used in horses
Better analgesia than xylazine
Severe respiratory and cardiovascular side effects
Dexmedetomidine (Dexdomitor®)
For dogs as sedative and analgesic
Used for minor surgical procedures
-SE: bradycardia and decreased respiration
-Reversal agent: Atipamezole (Antisedan®)
-Note: anticholinergics not recommended because of chance of arrhythmias
Barbiturates
CNS depressants
-Uses: anticonvulsants, anesthetics, euthanasia
Classified according to duration of action: ultra short-acting, short-acting, long-acting
Barbiturates
-Phenobarbital
Long acting, 8-12 hours
C-IV controlled substance
anticonvulsant
-Pentobarbital
Short acting, 1-2 hours
C-II
Anticonvulsant and euthanasia solution
-Thiopental Ultrashort acting induction agent C-III Caution with thin animals and sighthounds Currently not available in US
Dissociatives
Belong the Cyclohexamine family
- Cause muscle rigidity (catalepsy), amnesia, and mild analgesia, pharyngeal/laryngeal reflex remains intact, blink reflex absent, still have deep abdominal pain
- Uses: sedation, restraint, anesthesia
- Side effects: burning at injection site; convulsions, respiratory depression, corneal drying (must instill lubricant)
Dosage Forms: Ketamine (Ketaset®) C-III Tiletamine (in combination with zolazepam in Telazol ®) C-III
Opiods
- Analgesics reduce the sensation of pain
- Analgesics can be narcotic or nonnarcotic
- Nonnarcotic analgesics act on peripheral NS, less potent, and non-addictive
- Narcotics used for moderate to severe pain in smooth muscles, organs, and bones
- Sedative and analgesic properties
- Narcotic refers to opioid (natural) or opioid-like (synthetic) and are controlled substances
Narcotic Analgesics
-Classes of opioid receptors
Mu, kappa, sigma
-Type of interaction with receptor
Full agonists
Partial agonists
Antagonists
Uses: Analgesia Sedation Anesthesia Restraint Antitussive Antidiarrheal
Side Effects Respiratory depression ↓ C.O. Nausea and vomiting constipation-↓ GI motility Excitement – cats and horses Tolerance & dependency
Naturally Occuring Narcotics
-Morphine
Potency of all others are compared with morphine
C-II controlled substance
Used to treat severe pain; also as preanesthetic or
anesthetic
Synthetic narcotics
-Hydromorphone C-II
-Oxymorphone C-II
-Meperidine C-II
-Fentanyl (Duragesic® transdermal patch)
C-II
Must apply with gloves; fur is clipped, skin is
cleansed and dried over dorsal neck area or on limb
Do not allow animal to lick or chew
Remain for 3 days and bandaged
Do not heat patch, caution if animal has fever
-Methadone C-II
Causes less vomiting than the other pure agonists
Better choice for painful ophthalmic surgeries
-Buprenorphine (Buprenex®)
Potent and long-term analgesic (8-12 hrs.)
Partial agonist
Can be used buccally in cats
C-III
-Hydrocodone (Hycodan ®)
Antitussive
C-III
-Etorphine
1000 times more potent than morphine
C-II
Used in zoo animals
Diprenorphine is antagonist; lethal in people
-Butorphanol
Torbutrol®-antitussive in dogs, analgesic and
preanesthetic in dogs and cats
Torbugesic®-analgesic in horses, tranquilizer in
horses
C-IV controlled substance
-Apomorphine
GI drug: emetic
Can be place in conjunctival sac to induce emesis
Opioid Antagonist
-Naloxone (Narcan®)
Pure opioid antagonist
Given IV or IM
Few side effects
Neuroleptanalgesia
-Tranquilizer + opioid
Effects: CNS depression and analgesia, May or may not produce unconciousness
Side effects: Very sensitive to sound, bradycardia, panting
-Often compounded in clinic
Acepromazine + morphine
Xylazine + butorphanol
Anticonvulsants
Seizure: recurrent abnormal electrical activity in brain= altered brain function: loss of consciousness, muscle tone and movement, altered sensations
- Recurrent seizures of unknown cause = idiopathic epilepsy
- Status epilepticus = ongoing seizures
Anticonvulsants(drugs)
-Phenobarbital
-Drug of choice for long-term control in dogs & cats
-Long acting barbiturate
-C-IV controlled substance
-Enzyme induction–> drug concentrations decrease
-Initially sedation and ataxia but diminish over time
PP, PU, PD
-Primidone
Converted to phenobarbital by liver
-Diazepam (Valium®)
Drug of choice for status epilepticus; short-term
control
Give IV
C-IV controlled substance
-Potassium bromide, KBr
Used as adjunct when phenobarbital or primidone
alone cannot control seizures
Powder is sprinkled on food or liquid is squirted in
mouth
Must be compounded
Inhalant Anesthetics
-Volatile anesthetics (liquids) delivered by a vaporizer (converted to gas) and inhaled into lungs; diffuse from high concentration in alveoli into area of low concentration in blood–> well perfused brain; when vaporizer turned off, anesthetic moves from blood to alveoli and is expired
-Compared by minimum alveolar concentration (MAC) value
measure of potency
MAC is lowest concentration of an anesthetic that p
produces no response to painful stimuli in 50%
patients
Lower MAC=less gas to produce anesthesia=more
potent anesthetic
Inhalant Anesthetics (drugs)
Exposure to waste gas is health hazard: reproductive, hepatic, and renal effects
Uses: induce and maintain general anesthesia
Most common are:
-Isoflurane (Isoflo®) pungent odor so difficult to ‘mask down’
-Sevoflurane (SevoFlo®) odorless so good for mask induction; very rapid recovery; useful high risk patients;
expensive
-Halothane-older agent, sensitizes heart to catecholamines –>arrhythmias; malignant hyperthermia=sudden onset elevated temp –>brain damage or death, pigs, horses, occas. dogs & cats
-Nitrous oxide
‘Laughing gas’
Inhalant analgesic used to decrease amount of other
anesthetic used
Blue cylinder
Diffuses rapidly and can enter gas-filled
compartments (stomach, intestines)
At end surgery, leave on pure oxygen 10 minutes to
prevent diffusion hypoxia when it rapidly diffuses out
tissues –>bloodalveoli
Miscellaneous
CNS stimulants
Doxapram (Dopram V®)
-stimulates respiratory centers. Used to reverse CNS depression in neonates after C-section; administer sublingually via umbilical cord in neonates
Propofol (PropoFlo28 ®)
-White colored emulsion, “milk of amnesia”
Uses: anesthetic induction agent, Short-acting general anesthetic; give slowly IV
Side effects: apnea if given to quickly
Glyceryl Guiacolate or Guifenasin
-Equine “triple drip”: medetomidine, ketamine, guifenasin
Alfaxalone
- IV injectable neuroactive steroid molecule used as an induction agent
- Negligible analgesic effects
- Respiratory depression and apnea biggest concerns if given too rapidly IV
Behavioral agents: Antianxiety meds
Benzodiazepines:
- Diazepam
- Alprazolam (Xanax®)
Buspirone:
to control urine spraying in cats
Behavioral agents: Antidepressants
-Tricyclics (TCAs)
Uses: separation anxiety, obsessive disorders
Side effects: sedation, tachycardia, decrease lacrimation
Dosage forms:
Amitriptyline
Clomipramine (Clomicalm®)
-Serotonin Reuptake Inhibitors (SSRIs)
Uses: variety of behavioral disorders
Side effects: lethargy, anorexia
Dosage form:
Fluoxitine (Reconcile®)
-Monoamine Oxidase Inhibitors (MAOIs)
Block breakdown of dopamine
Uses: old-dog dementia = canine cognitive
dysfunction
Dosage Form:
Selegiline (Anipryl ®)
Euthanasia agents
Euthanasia solutions:
-Humanely end life
-Pentobarbital sodium (Sleepaway ®) C-II
-Pentobarbital sodium and phenytoin (Euthasol®);
(Beuthanasia D ®) with blue dye C-III
Expectorants
- increase the coughing up of material from lungs which is either swallowed of spit out
- increasing the fluidity (liquefy) mucus
- PRODUCTIVE COUGHS
- more effective to maintain systemic hydration and humidify inspired air
Guaifenesin: acts by irritating gastric mucosa and stimulating PSNS which ups respiratory secretions
- SE: nausea - "GG"- equine triple-drip general anesthesia to produce muscle relaxation
DO NOT COMBINE EXPECTORANTS WITH ANTITUSSIVES
Mucolytics
Infection/inflammation can cause dry, thick & sticky (inspissated) mucus –>mucociliary apparatus becomes less effective
-Used to break up mucus and ↓ viscosity
Acetylcysteine (Mucomyst®)
- Administered by nebulization or by mouth
- SE: nausea if oral
Acetylcysteine
** Also used to treat acetaminophen toxicity in cats
- given IV
- helps metabolize the hepatotoxic acetaminophen
- metabolite to a nontoxic metabolite and helps prevent the conversion of hemoglobin to nonfunctional methemoglobin
Antitussives
- Block cough reflex
- Centrally acting only type used vet med (peripherally acting = lozenges or cough drops)
- These drugs are only indicated for patients with hacking, unproductive coughs
Butorphanol (Torbutrol ®)
Centrally acting opioid cough suppressant (narcotic)
- C-IV controlled substance
- Used as antitussive, analgesia and anesthetic
- SE: sedation and ataxia, nausea, appetite suppression
Codeine
C-II (pure codeine) through C-V (codeine + cold preparations) controlled substance
- Component of many human preparations
- SE: sedation and constipation (opioids slow GI motility and secretions)
