Med Notes Flashcards
DO NOT use _____ or _______ in dogs with heart issues?
anticholinergics; alpha 2 adrenergic agonists (but are good for cats with HCM)
what do we use in p coding/asystole?
Epi and atropine together
What drugs are good for p with heart issues?
Benzodiazepines and opioids (and local blocks)
What drug is not usually rec. in p with cardiac dysfunction but good with cats with HCM?
Alpha-2 adrenergic agonists
How is alpha-2 adrenergic agonists good for cats with HCM?
reduced HR with increased afterload improves CO
DO NOT USE ____ or ________ in p with HCM?
Dissociative; inotropes
but can use Alpha-2 adrenergic agonists
P with what cardiac condition need inotropes usually?
DCM
What drugs to premed with for severeeeee valvular insuff or stenosis p?
Opioid + benzo
induce with ketamine/diazepam and fentanyl
What if a cat has HCM, what to premed with?
Alpha-2 agonist and +/- opioid
DCM- premed and induce with….
premedicate with opioid and benzo, induce with fentanyl or ketamine/diazepam
or fent plus prop
be prepared to use inotropes to support blood pressure
what do we do anesthetic plan for puppy with PDA?
Opioid + ace or benzo
Give and anticholinergic to maintain heart rate
induce with porp, or alphaxalone, or ketamine/diazepam
ketamine is a ____ _____ causing dissociative anesthetic agent
NMDA antagonist
what are the side effects of ketamine?
increased HR, contractility, BP, and intracranial pressure can occur, increased muscle tone, delirium
___ is an antiseizure med used in managing neuropathic pain
gabapentin
diazepam or mid is more irritating to tissues?
Diazepam is more irritant to the tissue so better to avoid giving it IM
do not give ____ or ____ fast bc anaphylaxis rxn
morphine and antibiotics
What drugs are good for brachycephalics reducing the risk of respiratory depression?
Benzos and butorphanol + opioids
____ may cause increased HR, CO, salivation, and increased muscle rigidity
ketamine
advantages of ventilators:
prevents atelectasis, keeps asleep even w long procedures, helps w ventilation, can still take a breath on their own
Glycopyrrolate at too low of a dose can cause….
second degree AV block
escape beats and VPC’s can look similar but what is a clear ID of which is which?
low HR= escape beats
higher HR= VPC’s
ETCO2 low on the expired side (to the left) means….
leak (looks like shark fin)
bucking against vent means what in the p…
waking up or painful
BP n of medium dog is-
60-120 bpm
Systolic should be more than 80 and diastolic should be more than 40
what is the MAP automatically if you feel strong peripheral pulses?
MAP is AT LEAST 60
our vent is positive pressure ventilation T/F
TRUEE
escape beats tx with ____ VPC’s tx with ____
atropine; lidocaine
kitty magic consists of what drugs
Butorphanol, dexmedetomidine, and ketamine
ketamine and midazolam without propofol or other induction agents are good for injection in healthy p T/F
Trueeee
so you thought your procedure was nonpainful like a dental without extractions so you chose butorphanol but now they are doing extractions so now what do you/can you do?
you can only give more butorphanol or highhhh full mu like fent which sucks ass for pain
brachial plexus blocks from where to where
elbow to paw.
LRS bolus in dog is =
Colloid bolus in dogs is =
LRS bolus in dogs= 3mL x kg
Colloid bolus in dogs= 4mL x kg (mL/kg is mL TIMES kg)
how do local blocks work?
the neuron is positive outside of it and neg inside, so the action potential is generated when Na (which is positive charged) enters the inside which is negatively charged. The local block works to prevent Na from getting inside and no actional potential is generated
Why can we not use morphine in GDV’s?
more GI motility
what do we do for c section dogs?
no premeds, just prop, iso and O2 and can give dexmed after pups are out
horse with bilateral arthro anesthetic meds:
xylazine, butorphanol IV
ketamine and midazolam IV
dexmed q 1 hour IV
Bilateral elbow arthroscopy dog anesthetic meds:
Dexmedetomidine and methodone IM
propofol IV
fent CRI 5mcg/kg/hour
bronchoscopy procedure dog anesthetic meds:
no premeds, already on shit ton of meds and NSAIDs
fentanyl 5mcg/kg + prop + midazolam
no fent CRI
Upper GI scope dog anesthetic meds:
Dexmed + butorphanol IV
cerenia IV
Propofol IV
debulking digit FB on healthy, young dog anesthetic meds:
Acepromazine + hydromorphone IM
propofol IV
Conjunctivial graft dog anesthetic meds:
dexmed + methadone
propofol
atracarium
fent CRI 5mcg/kg/hour
TPLO anesthetic meds:
Dexmed and methadone im
propofol IV
epidural with bup and morphine
fentanyl 5mcg/kg/hr
fx paw dog anesthetic meds:
Dexmed and methadone IM
Prop and midazolam IV
LS epidural with bup and morphine
fent CRI if needed
already on Trazadone and Tylenol 4
mean doggo
nadir is the…
lowest glucose in the day
goals with MMVD dog?
reduce preload and afterload, maintain contractility but avoid increases in myocardial O2 demands, avoid tachycardia
why would ALT and BUN be increased in MMVD dog?
usually increased in dogs w mitral valve insuff bc renal and hepatic perfusion are altered so elevated enzymes are a result of congestion of these organs
what drugs are absolutely C/I in MMVD p?
alpha-2 agonists bc they vasocontrict and can cause pulm. edema in these heart patients due to increased preload
best to use midazolam and ketamine combo
IVDD small dog anesthetic meds:
Dexmedetomidine + fentanyl IV
propofol
CRI of fent 5mcg/kg/hr and ketamine 3mcg/kg or Lidocaine
spay anesthetic meds
dexmed + methadone IM
Prop IV
could also do ace+ hydro IM
propofol IV
what is good about positive ionotropes?
used to increase CO but not increase HR
What drug should we avoid with MDR1 mutant dog? What could we use instead?
Acepromazine, we could use dexmedetomidine instead
why are we concerned about using propofol in p with low albumin/total proteins?
Propofol is protein bound but this does not change a lot if total protein in p is wonky (low TP for example a regular dose of proofol may cause overdose) GIVE TO effect SLOWLY to avoid overdosing this p because she has low total protein
Alfaxalone will be about the same he said
Tell me about a cyanotic dog, what would its hgb be?
Patient will only be cyanotic if hgb is less than 5, dog may die pink because has bad hypoxemia but high than 5 Hgb count
V/Q mismatch- how does it happen?
it happens when part of your lung receives O2 without bf or bf without O2
V/Q mismatch causes….
hypoxia (which is low O2 in your blood) and can lead to resp. failure
V/Q
V means
Q means
V means ventilation, air breathed in
Q means perfusion, which is blood perfusion
MOA for dorzolamide eye meds:
Meds to lower intraocular pressures- dorzolamide DROPS, the drops do not impact anesth. But the oral does.
Affects acid/base effects, causes metabolic acidosis, can impact bloodwork
Decreases production of water to drop the pressures of the eye (aqueous humor of the eye, it inhibits carbolic anhydrase which splits carbonic acid into CO2 and H2O so decreases H2O and bicarb is lost which is why it cause metabolic acidosis due to low HCOX3- in the blood, beware can be a lot worse when they are also diabetic)
Ocular cardiac reflex–
ocular trigeminal reflex where it can push on the optic nerve and send efferent impulse to the phrenic nerve and decrease the HR and can be very dangerous, tx with atropine or glycopyrrolate (anticholinergic drugs)
Because eye is so close to CNS it can impact all of anesthesia
___ has acetate to balance alkalosis
plasmalyte
What fluids do we use for craniotomies?
mannitol/hypertonic saline
What is the rule when giving hypertonic fluids???
If you give hypertonic saline, you are shrinking all of the cells and need to give another fluid to balance and replace deficits
Do not give more than ___mL/kg/day of colloids
15
Why do colloids not help with hydration status improvement?
Colloids do not help with hydration bc so efficient at staying in vasculature that it ignores all of the other compartments, volume expansion is very effective
When should you avoid using colloids??
avoid in head trauma p, renal p, and metabolic acidosis p
also avoid LRS in renal p too
in head p- use hypertonic saline or mannitol only with increased intracranial pressure
Key number for blood volume loss is acute loss of __-__% blood loss means you need to do what?
15-20% blood loss means you need a blood transfusion
HR _____ and BP ____ with increased blood loss
HR increases and BP decreases
What fluids have crystalloid + lactate?
LRS fluids
How are fluids distributed?
5% intravascular
15% interstitial
40% intracellular
LRS has ____ while plasmalyte and normalsol do not
calcium
what fluids do we want to use if p is in metabolic alkalosis?
0.9% NaCl
____ is used for absolute hypovolemia
colloids
____ for dehydration and use _____ for hypovolemia
crystalloids; colloids
What is the difference between SPO2 and PaO2 (PO2)?
PaO2 (PO2) is the measurement of actual O2 in the arterial blood and SPO2 is oxygen saturation which is the % of Hgb binding sites in the blood that are carrying O2
can you give glyco with dexmed?
only in ER sit, not ideal at all
Horses with high potassium, what do you give and why?
Give calcium bc it does not solve the issue but it will delay neg effects
Give______ and _____ and ____ to correct high potassium
Dextrose with insulin and sodium bicarb
increased PaCO2 means hyper or hypoventilation?
Hypoventilation
if ETCO2 is too high what do we want to do with our vent?
increase rate and volume
ped p depend on HR for BP so what drugs do we like to use with them and why??
We use dexmed and ketamine bc ketamine helps offset bradycardia from dexmed by sympathetic stimulation
what is the cushing reflex?
vasopressor response, physiological nervous system response to acute elevations on intracranial pressure (ICP) resulting in cushing’s triad of
-increased BP
-bradycardia
-resp. effort
how can you tx the cushings reflex?
Mannitol but most die quickly
How much of CO come from the atria?
20-30% (less than half is the key to know)
What kind of heart diseases lead to A fib?
DCM because heart is so dilated and stretchy, ectopic foci are stretched out and unhappy and cause major conduction abn
DCM dogs have faster HR than other dogs because decreased CO because cannot contract as well so compensating with rate
Medications usually fix the rate but not the A fib entirely (beta blockers)
How can we tx VPC’s?
Tx with: Lidocaine blocks sodium channels leading to reversible block of action potentials
Every other beat being a VPC is called ____
bigeminy
In order for it to be VPC or V tach there is specific things
Wide and weird and early= premature
Normal looking and premature= atrial premature
Abn and looking premature= ventricular premature
AKA triplets
Not V tach unless rate is above ___-__
180-200
What rhythms do we get with no pulse?
Pulse-less electrical activity (PEA) (you see stuff on ECG but patient does not have a pulse)
○ Barely a rhythm but ventricles are trying= escape beats, atrioventricular rhythm
○ If you treat this with lidocaine it will die supperrr fast
Give atropine
Ventricular arrhythmias where no pulse and fast= tx with lidocaine and epinephrine
what if you have slow rhythm or nothing?
If you have slow rhythm or nothing= CPR and use atropine and epinephrine
can you use ace in heart dogs?
yup apparently but not in HCM cat/patients
