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Clinical Anesthesia > Injectables/TIVA > Flashcards

Injectables/TIVA Flashcards

1
Q

Why shouldn’t a patient with a coagulopathy who is anemic and hypovolemic recieve acepromazine?

A

it is a vasodilator which also affects platelet aggregation and decreases the number of circulating erythrocytes by causing splenic relaxation

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2
Q

Define pharmacokinetics

A

the study of absorption, distribution, metabolism, and excretion of administered drugs

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3
Q

Define pharmacodynamics

A

The study of the effects caused by a drug to the body

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4
Q

Volume of distribution is what?

A

how much the central compartment of the patient will dilute the drug administered

  • Vd = dose/[plasma concentration after 1 minute of a single bolus]
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5
Q

The central compartment refers to what group of organs/vessels?

A

great vessels, heart, lungs, and aorta

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6
Q

Why is it that liposoluble drugs have a large volume of distribution?

A

due to the first pass uptake from the central circulation (especially the lungs), therefore decreasing final plasma concentration

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7
Q

How do you calculate a bolus dose?

A

Bolus dose = Vd x [Desired Plasma Concentration]

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8
Q

Why is it important to saturate all tissues (other than the target tissue - CNS) prior to setting a CRI?

A

because all of these tissues have some degree of liposolubility and therefore hinder the rise of plasmatic concentration and effect

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9
Q

Which tissues are considered the rich vessel group?

A

Heart, lungs, splanchnic viscera, kidneys and CNS

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10
Q

Why does fat require a very long period of time to significantly change plasma concentrations?

A

because it has a very limited blood supply

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11
Q

What is the purpose of the loading bolus?

A

should be able to bring the plasmatic concentration to the therapeutic level and at the same time saturate all the distribution tissues of the body

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12
Q

What is the principle of a constant rate infusion?

A

To maintain plasmatic concentration of a drug by matching the infusion rate to the elimination rate of the drug

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13
Q

What are the primary side effects of opioids?

A
  • Respiratory depression
  • interfere with thermoregulation: cause paradoxic mild hypothermia (dogs) or hyperthermia (cats)
  • paradoxic excitation (cats, horses, cattle); sedation (dogs, monkeys, people)
  • Nausea and vomiting (>> morphine)
  • miosis (dogs); mydriasis (cats)
  • defecation followed by constipation
  • increase in ADH release (decreased urination); suppression of detrusor muscle/urge sensation (epidural)
  • dose-dependent bradycardia
  • Vasodilation and decr BP (morphine and mepiridine d/t H2 release)
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14
Q

What clinical situations are opioids good for?

A
  • Sick patients
  • Cardiovascular compromised patients
  • Septic patients
  • Elderly patients
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15
Q

In which situations should you be careful using opioids?

A
  • Brain lesions: resp depression, vomiting
  • Sick sinus syndrome
  • Severe AV block
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16
Q

What are the advantages of using opioids?

A
  • great for analgesia
  • minimal deleterious CV effects
  • no decr in myocardial function
  • reversible
17
Q

Why should diazepam not be mixed in the same syringe with any other drugs (with the exception of ketamine)?

A

because it’s propylene glycol saturate may cause precipitation to occur

18
Q

Why might you use benzos?

A
  • Minor tranquilizers causing mild sedation
  • used to reduce dose requirements of other drugs
  • cause mild muscle relaxation
  • have minimal CV or resp side effects
  • reversible
19
Q

Why might midazolam be preferable to diazepam?

A
  • diazepam injections are painful at administration and has unpredictable IM and SQ absorption, so is used only IV; cannot be mixed with other drugs
  • midazolam is water-soluble, can be mixed, and administered IM, SQ or IV
20
Q

What is one downside to benzos?

A

they can cause excitation, particularly in healthy cats (less so in sick animals)

21
Q

T or F: Dissociative agents, such as ketamine and telazol, can be used as premeds as well as induction agent

A

true; can help with chemical restraint in difficult patients as premeds

22
Q

Ketamine is broken down by hepatic metabolism in dogs and horses. Can it still be used in patients with liver failure?

A

yes, as the drug will still be redistributed, so breakdown and clearance will just be much slower; however, do not use ketamine CRIs in liver failure patients

23
Q

What are the side effects of ketamine?

A
  • Sympathetic stimulation —> incr HR and BP
  • Apneustic breathing
  • Apnea
  • Maintain laryngeal reflexes
  • Increase salivation and mucus (DO NOT use atropine to fix)
  • Poor muscle relaxation
24
Q

Ketamine is good to use for what types of patients?

A
  • Young/healthy
  • Difficult (IM) - esp. cats
  • Painful procedures and animals
  • Exotics
25
Q

Ketamine is contraindicated in what situations?

A
  • HCM
  • Renal disease in cats (b/c excreted unchanged)
  • Arrhythmias
  • Head or corneal trauma (increases IOP/ICP)
  • Glaucoma
  • seizures (lowers threshold)
  • emergency patients
26
Q

Due to its moderate somatic analgesia by NMDA antagonism, ketamine reduces release of the neurotransmitter glutamate on the dorsal horn, decreasing what?

A

wind up

27
Q

What are the advantages of propofol?

A
  • Short half-life (quick induction/recoveries)
    • hepatic and extra-hepatic metabolism
  • protects against increases in ICP
  • decreases CMRO2
28
Q

What are some side effects of propofol?

A
  • Sympatholytic effects: decr in BP, CO, SVR (vasodilation)
  • Apnea
  • Seizure-like activity (myoclonus)
  • Splenic engorgement
29
Q

What can happen if a cat receives 6 consecutive days of propofol anesthesia?

A

Malaise and Heinz body anemia

30
Q

What patients/procedures are good for propofol use?

A
  • Lar par (substitute for thiopental)
  • brain tumors (CRI) - due to low cerebral metabolic rate
  • increased ICP or IOP
31
Q

When should you not consider using prop?

A
  • splenectomies
  • laparoscopies
  • CV compromise
  • hypotensive or hypovolemic patients
32
Q

What are the advantages of using Etomidate?

A
  • Minimal CV side effects
  • CNS friendly
33
Q

What are the potential side effects of etomidate?

A
  • Hemolysis (propylene glycol -> high osmolality)
  • Adrenal suppression (Addisonian crisis)
  • Myoclonus
  • Poor muscle relaxation - usually combined w/ benzos or opioids
34
Q

What patients would etomidate be a good choice for?

A
  • Cardiac dz
  • CV instability
  • Brain lesions (increased ICP)
35
Q

When should you consider not using etomidate?

A
  • Sepsis (Euadrenal syndrome)
  • Addisonian crisis
  • Anemia
36
Q

Why might you choose alfaxalone over propofol?

A
  • It can be given IM
  • Induction is smoother
37
Q

What are the side effects of alfaxalone?

A
  • Mild decrease in BP and SVR
  • Increase in HR and increase OR decrease in CO (dose dependent)
  • myclonus and paddling
  • splenic engorgement
  • apnea (EVEN WITH IM INJECTIONS)
38
Q

In what patients is alfaxalone a good choice?

A
  • Most patients for induction
  • ICP and IOP
  • TIVA
39
Q

In which cases should you be careful using alfaxalone?

A
  • Hypotension/hypovolemic
  • Laparoscopy
  • Splenectomy
  • CV compromise

Clinical Anesthesia (15 decks)

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