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Anesthesiology (Spring 2015) > L4: Premedication (Garcia-Pereira) > Flashcards

L4: Premedication (Garcia-Pereira) Flashcards

1
Q

neuroleptics are major sedatives

A

:)

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2
Q

analgesics include:

A

opioids

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3
Q

neuroleptoanalgesia includes:

A

sedatives and opioids

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4
Q

factors involved in drug selection

A 
species
age 
physical status (ASA)
animal behavior and attitude
procedure
duration of procedure
experience with drugs used!
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5
Q

name 3 anticholinergics

A

atropine sulfate
glycopyrrolate
scopolamine

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6
Q

Ach present in which receptors?

A

muscarinic

nicotinic

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7
Q

MOA of anticholinergics**

A
  • inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells
  • may see worsening of bradycardia right at the beginning as receptor is blocked, then competitive effect decreases bradycardic effect of parasympathetics so that sympathetic overrides –> tachycardia
  • will see transition of bradycardia –> 2nd degree AV block –> tachycardia**
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8
Q

physiological effects of anticholinergics

A
  • dec. vagal influence in HR
  • dec. secretions; harder to clear airway
  • bronchial dilation
  • inc. anatomical and physiological dead space
  • dec. GI motor and secretory activity
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9
Q

chars. of Atropine sulfate

A
  • an anticholinergic
  • tertiary amine molecule
  • high lipid solubility; easily crosses BBB and placental barrier
  • used in emergency situations to inc. HR
  • doesn’t last as long as glycopyrolate
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10
Q

chars. of glycopyrolate

A
  • an anticholinergic
  • synthetic quaternary ammonium molecule
  • low lipid solubility
  • does NOT cross BBB, placenta
  • no effects on CNS
  • same peripheral effects as atropine
  • lasts longer than atropine
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11
Q

major tranquilizers

A

Phenothiazines (acepromazine, chlorpromazine, levomepromazine)
Butyrophenones (droperidol, azaperone)

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12
Q

chars. of Acepromazine maleate

A
  • Potent sedative and anxiolytic (inhibits anxiety)
  • Anti-emetic
  • Anti-arrhythmic properties
  • dec. dose requirement of other drugs
  • enhances analgesia of opioids
  • Boxers sensitive (can cause severe hypotension/bradycardia)
  • no reversal!
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13
Q

side effects of Acepromazine

A
  • dec. BP and vasomotor reflex
  • cardiac depression
  • peripheral alpha2-adrenergic blockade
  • relaxation of vascular smooth m.
  • persistent or permanent penile paralysis
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14
Q

chars. of droperidol and azaperone

A
  • similar effects as ace

- better sedatives than ace in PIGS

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15
Q

name 2 mu-agonist (full agonists) opioids

A 
morphine 
fentanyl: can be used at CRI
methadone
hydromorphone
-provide more analgesia than kappa agonists but have more side effects including resp. depression, vomiting, bradycardia, and decreased GI motility
-side effects limit dose
-morphine longer acting than fentanyl
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16
Q

name a partial agonist opioid

A

buprenorphine

  • good for mild to moderate pain
  • effect plateaus even with increasing dose
  • long onset of action and long duration of action
  • good oral availability in cats but not dogs
17
Q

name a kappa agonist/mu antagonist opioid

A 
butorphanol
nalbuphine
-good for mild to mod analgesia
-short-acting
-can be used to reverse side effects of u-agonists
18
Q

name 2 opioid antagonists

A

naloxone
naltrexone
(reverse opioid effects)

19
Q

T/F: humans more sensitive to opioids than animals

20
Q

specific side effects of morphine

A

hypotension

urticaria (hives)

21
Q

specific side effects of hydromorphone

A

feline hyperthermia (?)

22
Q

rank duration of action of mu-agonist opioids

A

morphine, hydromorphine, methadone: 4-6hrs

fentanyl: 20-30min.

23
Q

rank potency of mu-agonist opioids

A

fentantyl > hydromorphone > methadone > morphine

24
Q

locations of GABA receptors

A 
hypothalamus
cerebellum
midbrain
hippocampus
medulla
spinal cord
25
chars. of benzodiazepines
- act on GABA receptors (agonist) - cause anterograde amnesia - include diazepam, midazolam, zolazepam
26
chars. of diazepam
- benzo - anxiolytic - muscle relaxant - anticonvulsant effect - rapidly crosses BBB and placental barrier - minimal CV effects (de. BP and CO) - propylene glycol (high lipid solubility)
27
chars. of midazolam
- water soluble (becomes lipid soluble at pH>4) - can be given IM - more potent but shorter acting than diazepam - similar effects as diazepam - crosses BBB/placenta
28
chars. of zolazepam
- most potent benzo - available only in telazol - anticonvulsant and m. relaxant - least apt to cause CNS effects - expensive
29
flumazenil
- competitive antagonist of benzodiazepine receptor (GABA antagonist) - very weak agonist effect (no anxiety w/ reversal) - reverses effects of benzos
30
alpha2-adrenergic agonists
- anxiolytic - sedative and m. relaxant - analgesia - dec. ADH, insulin release - causes hypertension followed by hypotension - reflex bradycardia - high CV tole
31
CV effects of alpha2-adrenergic agonists
- dec. HR (hypertension, dec. sympathetic tone --> vasodilation) - dec. CO (dec. myocardial contractility, dec. HR) - increased then dec. BP
32
graph slide 27
:)
33
name 4 alpha2-adrenergic agonists
xylazine detomidine romifidine dexmedetomidine
34
chars. of xylazine
- an alpha2-adrenergic agonist - less selective to alpha2 receptors - causes more ataxia - shorter duration
35
chars. of detomidine
- an alpha2-adrenergic agonist - not very selective to alpha2 receptors - causes profound sedation - ataxia - mainly used in LA
36
chars. of romifidine
- an alpha2-adrenergic agonist - not very selective to alpha2 receptors - good sedation - less ataxia than other alpha2-adrenergic agonists - mainly used in LA
37
chars. of dexmedetomidine
- an alpha2-adrenergic agonist - most selective - profound sedation - may be used to intubate some dogs - mostly used in SA - never use with xylazine!
38
alpha2-adrenergic agonist REVERSALS
Non-selective: Tolazoline, Yohimbine (SC or IM) Selective: Atipamizole (SC or IM) (may be given IV to LA)
39
Guaifenesin
- central muscle relaxant - used as adjuvant in LA induction - smoothes induction and decreases injectable dose - disrupts trans. at spinal cord and brain stem - increases RR and dec. tidal volume

Anesthesiology (Spring 2015) (13 decks)

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