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Pharmacology II > Lecture 11: Premedications > Flashcards

Lecture 11: Premedications Flashcards

1
Q

What is neuroleptoanalgesia

A

Combined sedative and opioid

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2
Q

What is ASA status 1

A

Healthy patient

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3
Q

What is ASA status 2 and some examples

A

Mild systemic disease
Ex: skin tumor, fracture without shock, uncomplicated hernia, cryptorchid, localized infection, compensated cardiac disease

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4
Q

What is ASA stratus 3 and some examples

A

Severe systemic disease
Ex: Hypovolemia, fever, dehydration, anemia, cachexia

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5
Q

What is ASA status 4 and some examples

A

Severe systemic disease that threatens daily life
Ex: severe hypovolemia and dehydration, cardiac disease, very high fever, uremia, toxemia, anemia, emaciation

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6
Q

What is ASA status 5 and some examples

A

Patient won’t severe more than 1 day without tx
Ex: extreme dehydration, shock, terminal malignancy or infection, severe trauma

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7
Q

What is the mechanism of action for acepromazine

A

Dopamine and alpha1 receptor antagonist

Also Muscarinic, histamine and serotonin antagonist

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8
Q

What are the effects of acepromazine on CNS

A

Sedation, muscle rigidity with high doses

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9
Q

What are the cardiovascular effects of acepromazine

A

Vasodilation/hypotension- decrease CO
Anti-arrhythmic- alpha 1

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10
Q

What are the respiratory effects of acepromazine

A

Minimal- decrease RR and increase TV, bronchodilator

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11
Q

What are the hematologic effects of acepromazine

A

Decrease PCV, inhibit platelet aggregation, anti-histamine

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12
Q

What are the GI effects of acepromazine

A

Anti-emetic, decrease LES tone, decrease gastric emptying

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13
Q

What can acepromazine cause in horses

A

Penile prolapse

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14
Q

What does acepromazine do to urethral sphincter

A

Relaxes

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15
Q

Does acepromazine provide analgesia and is there a reversal

A

No to both

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16
Q

What are some side effects of acepromazine

A

Vasodilation-hypotension, decreased platelet aggregation, muscle rigidity, splenic enlargement, hypothermia

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17
Q

What is the onset of action of acepromazine IV and IM

A

IM- 30 minutes
IV-5-10 minutes

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18
Q

What is the duration of effect of acepromazine

A

4-6hrs

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19
Q

When should you reduce dose of acepromazine

A

IV dose, geriatrics, and large breeds

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20
Q

When do you use acepromazine

A

Healthy patients undergoing simple surgeries- spay, neuter, orthopedic

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21
Q

When do you be cautious using acepromazine

A

Bleeding or anemia, stallions, neonates, thrombocytopenia

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22
Q

What species is the most sensitive/requires lowest dose for alpha2 agonists

A

Cattle

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23
Q

What are the effects of alpha2 agonists on CNS

A

Sedation, anxiolytic, bradycardia

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24
Q

What are the cardiovascular effects of alpha2 agonists

A

1st phase- vasoconstriction and bradycardia
2nd phase- vasodilation and bradycardia
Bradyarrythmias- AV block, sinus bradycardia, ventricular arrhythmias
Decrease CO

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25
Q

What are the effects of alpha2 agonist on respiratory system

A

Respiratory depression, increase TV

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26
Q

What are the effects of alpha2 agonists on GI

A

Emesis (xylazine-cats)
Decrease GI motility

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27
Q

What are the effects of alpha2 agonists on urogenital

A

Increase urine production and increase uterine pressure

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28
Q

Do alpha2 agonists cause hyperglycemia or hypoglycemia

A

Hyperglycemia

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29
Q

What is the effect of alpha2 on muscles

A

Muscle relaxers

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30
Q

Do alpha2 agonist provide analgesia and is there a reversal

A

Yes to both

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31
Q

What are some side effects of alpha 2 agonist

A

Ileus, respiratory depression, bradycardia and hypertension, followed by hypotension, hyperglycemia, ataxia

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32
Q

What is the onset of action for alpha2 agonists IV, IM, transmucosal

A

IV: 1-5 mins
IM: 5-20
Transmucosal: 30-40mins

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33
Q

What is the duration of action of alpha2 agonists

A

30-60 minutes

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34
Q

When do you want to treat bradycardia associated with alpha2 agonists

A

Don’t treat in first phase when hypertensive and bradycardia because will increase HR and BP, wait for second phase when hypotension and bradycardia

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35
Q

When should you avoid use of alpha2 agonists

A

Sheep-pulmonary edema- death
Pregnancy- esp. 1st trimester

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36
Q

Zenalpha- medetomidine and vatinoxan: what is it used for and why is it better than just medetomidine alone

A

Approved for dogs for sedation (not undergoing GA)

Vatinoxan is an alpha2 peripheral antagonist so don’t have the CV effects- no hypotension/vasoconstriction and reflex bradycardia

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37
Q

What is the onset time for zenalpha and duration of action

A

Onset: 5-15 minutes
Duration: 30-45 minutes

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38
Q

What is the most and least selective alpha2 agonist

A

Most: dexmedetomidine
Least: xylazine

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39
Q

What are the alpha2 antagonists/ reversals

A

Aitpamezole, yohimbine, tolazoline

40
Q

What are the effects of alpha2 antagonists

A

Reversal of analgesia and sedation

41
Q

What is the mechanism of action of benzodiazepines

A

GABA agonists

42
Q

What are the effects of benzos on CNS

A

Sedation, anxiolytic, amnesia, anticonvulsant, MAC sparing effects

43
Q

What are the effects of benzos on cardiovascular and respiratory systems

A

Minimal

44
Q

T or F: benzos relax muscles

A

True

45
Q

Do benzos provide analgesia and is there a reversal agent

A

No analgesia, yes reversal (flumazenil)

46
Q

What is the onset for IV and IM for benzos

A

IV: 2-5 minutes
IM: 15-20 minutes

47
Q

What is the duration of action for benzos

A

30-45 minutes

48
Q

How does midazolam and diazepam differ in their routes of administration

A

Midaz: IV, IM, or PO
Diazepam: IV or PO
- can’t give diazepam IM because painful and effects are inconsistent

49
Q

Benzodiazepines are good sedation options for what types of patients

A

Neonates, geriatrics, exotics, pigs, small ruminants

50
Q

Benzos can cause paradoxical ___ and disinhibition causing ___

A

Excitation, aggression

51
Q

Benzos are a good muscle relaxant and therefore good co-induction/sedative with ___ and ___

A

Ketamine, etomidate

52
Q

Benzos can be used as an ____ in cats and goats

A

Appetite stimulant

53
Q

In what scenarios should you use caution with benzos

A

Pregnancy- crosses BBB and placentas
Hepatic disease

54
Q

What is the reversal agent for benzos

A

Flumazenil

55
Q

What opioids are full u receptor agonists

A

Morphine, methadone, fentanyl, hydromorphone

56
Q

What opioids are partial u receptor agonists

A

Buprenorphine

57
Q

What opioids are both an agonist/antagonist

A

Butorphanol

58
Q

What are the reversals for opioids

A

Naloxone and naltrexone

59
Q

What is the mechanism of action of opiods

A

U or k receptor agonists

60
Q

What are the effects of opioids on the CNS

A

Sedation, analgesia, MAC sparing, dysphoria, euphoria

61
Q

What are the cardiovascular effects of opioids

A

Bradycardia
Morphine- histamine release- vasodilation/ hypotension

62
Q

What opioid is known to cause release of histamine and vasodilation

A

Morphine

63
Q

What are the respiratory effects of opioids

A

Respiratory depression, tachypnea (panting)-thermoregulation

64
Q

What are the GI effects of opioids

A

Nausea, vomiting, decreased GI motility

65
Q

What opioids do not cause vomiting and nausea

A

Methadone, fentanyl, butorphanol

66
Q

What are the effects of opioids on urogenital system

A

Urinary retention

67
Q

Do opioids cause hypo or hyperthermia in cats and which ones

A

Hyperthermia with hydromorphone, morphine, and buprenorphine

68
Q

What are the effects of opioids on the pupils

A

Dogs, rabbits: miosis
Cats and horses: mydriasis

69
Q

Do opioids provide analgesia and is there a reversal

A

Yes to both

70
Q

What are some side effects of opioids

A

Decrease GI, vasodilation, respiratory depression, tachypnea, euphoria, dysphoria, regurgitation, vomiting, excitement in horses, bradycardia, hyperthermia in cats, histamine release

71
Q

What is the onset of action for opioids IM and IV

A

IM: 5-20 minutes
IV: 1-5 minutes

72
Q

What is the duration of action for morphine, methadone, and hydromorphone

A

4-6hrs

73
Q

What is the duration of action for fentanyl

A

15-30 minutes

74
Q

What is the duration of action for buprenorphine

A

6-8hrs

75
Q

what is the duration of action for butorphanol

A

1hr

76
Q

Methadone is a ____antagonist so also good at treating chronic pain

A

NMDA antagonist

77
Q

Is buprenorphine better at treating pain or causing sedation

A

Mild to moderate tx of pain, not good pre-med because long onset and minimal sedation

78
Q

Is butorphanol better at treating pain or sedation

A

Mild analgesic and good sedation

79
Q

When should you avoid use of opioids

A

Pregnancy, use of more than 1 opioid

80
Q

What species is simbadol approved for and what is duration of effect

A

Cats, 72hrs

81
Q

What species and route is Zorbium approved for and how long is duration of effect

A

Cats, transdermal, 96hrs

82
Q

What is the mechanism of action for alfaxalone

A

GABA agonist

83
Q

What is alfaxalone used for

A

Sedation/immbolization

84
Q

What is a possible side effect of alfaxalone

A

Tremors, rough recovery, vasodilation, hypotension, apnea

85
Q

T or F: alfaxalone is analgesic

A

False

86
Q

What type of anesthesia does ketamine/ tiletamine cause

A

Dissociative anesthesia

87
Q

T or F: ketamine/ tiletamine is analgesic

A

True

88
Q

Which crosses BBB and placenta: atropine or glycopyrolate

A

Atropine

89
Q

What is the drug of choice for CPR

A

Atropine

90
Q

Which produces less profound tachycardia: atropine or glycopyrolate

A

Glyco

91
Q

When do you want to use anticholinergics (atropine, glyco)

A

Bradycardia associated with hypotension, ocular surgery, brachycephalic, pediatrics

92
Q

What are some side effects of anticholinergics

A

Tachycardia, tachyarrhythmias, decrease GI (avoid in horses), reduce secretions but make them thicker, increase of LES

93
Q

When should you use caution with anticholinergics

A

Heart disease, hypothermic patients

94
Q

What antihistamine is commonly used in a premed when there is risk of allergic reactions, MCT, reaction to surgical prep

A

Diphenhydramine

95
Q

When would you want to use GI protectant like famotidine, pantoprazole in premed

A

Brachycephalics and GI sx

96
Q

When do you want to use antiemetics (maripotant, metoclopramide, ondansetron) in premed

A

Brachycephalics and GI sx

97
Q

What drugs can be used for chill protocol and what species

A

Gabapentin- dogs and cats
Trazodone-dogs
Acepromazine- dogs
Melatonin-dogs

Pharmacology II (18 decks)

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