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Module 14 > How to Provide Analgesia > Flashcards

How to Provide Analgesia Flashcards

1
Q

what is peripheral sensitization

A

changes in the way we feel pain

how tissues detect and respond to stimulus

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2
Q

what is central sensitization

A

changes in the spinal cord

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3
Q

how does peripheral sensitization produce hypersensitization

A
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4
Q

what is “wind up”

A

responses to persistant or repeated barrages of nociceptive input

–> increase in firing rate in spinal cord neurones

increase in receptive area –> non painful stimuli –> pain (allodynia)

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5
Q

what does ongoing nociceptive discharge cause (4)

A
  1. decreased threshold for nociception
  2. increase perceived pain for given stimulus
  3. hyperalgesia
  4. non-painful stimuli become more painful (allodynia)
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6
Q

what is pre-emptive analgesia

A

the administration of analgesic agents before the onset of nociceptive stimulation

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7
Q

what is multimodal analgesia

A

use of more than one analgesic agent to provide analgesia

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8
Q

where are the areas analgesics can act (4)

A
  1. transduction
  2. transmission
  3. modulation
  4. perception
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9
Q

how do analgesics that act on transduction work and what is an example

A

ex. NSAID

affect the firing of nociceptors

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10
Q

how do analgesics that act on transmission work and what is an example

A

ex. local anesthetics

affect transmission of impulse to the spinal cord

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11
Q

how do analgesics that act on modulation work and what is an example

A

ex. opioids

affect spinal cord/brain

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12
Q

how do analgesics that act on perception work and what is an example

A

anesthesia blocks perception but not the impact of nociception

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13
Q

what are the clinical use of opioids (4)

A
  1. premedication
  2. intermittent bolus (IV/IM/transmucosal)
  3. infusion
  4. epidural
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14
Q

what are the opioids used for infusions

A
  1. morphine: cheap and effective 0.1-0.2 mg/kg/hr
  2. methadone: 0.08-016 mg/kg/hr
  3. fentanyl 2-10 mcg/kg/hr
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15
Q

what are the clinical uses of NSAIDs

A
  1. injectable/oral
  2. longer term use
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16
Q

where do NSAIDs act on the arachidonic acid pathway

A
17
Q

where do steroids act on the arachidonic acid pathway

A
18
Q

what are the clinical use of local anesthetics

A
  1. perineural blocks
  2. epidural
19
Q

what are perineural blocks (2)

A
  1. limb: brachial plexus, RUMM, femoral, sciatic, digital
  2. dental: maxillary, mental, infraorbital, mandibular
20
Q

what are epidural blocks

A
  1. lumbosacral: desensitize perineum, HL, (Abdomen)
  2. coccygeal (caudal): desensitize perineum, tail
21
Q

what is intravenous regional anesthesia

A

common in cattle

with or without GA

tourniquet

usually lidocaine (not bupivacaine)

22
Q

what are combined infusions

A

morphine, lidocaine, ketamine

23
Q

what is the clinical use of alpha 2 agonists (for analgesia) (6)

A
  1. infusion: dexmedetomidine
  2. adjunct to local anesthetic in perineural block: prolongs effect
  3. epidural
  4. where pain is pre-existing
  5. situations predisposed to developing “chronic pain” (amputation)
  6. adjunctive analgesia with difficult to manage pain (bolus, infusion)
24
Q

what are the routes of administration of analgesics

A
  1. oral
  2. SC/IM/IV
  3. transmucosal
  4. transdermal
  5. epidural
25
Q

how is the oral absorption of opioids

A

variable

26
Q

what are transmucosal analgesics

A

buprenorphine in cats

27
Q

what are transdermal drugs

A
  1. fentanyl patches
  2. buprenorphine
  3. lidocaine
28
Q

how do fentanyl patches work

A

aim for 2-4 mcg/kg/hr

effective plasma concentrations after 8-24 hours

lasts for 72 hours

29
Q

what are the factors that affect transdermal drug uptake

A
  1. skin temp
  2. vasodilation
  3. dirt and/or cleaning
  4. subcut fat
30
Q

what other drugs can be used for analgesia (5)

A
  1. maropitant: neurokinin 1 receptor antagonist
  2. grapiprant: EP4 prostaglandin receptor antagonist
  3. amitriptaline: tricyclic antidepressent
  4. amantadine: NDMA antagonism
  5. gabapentin

Module 14 (29 decks)

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