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NZ Vet Nursing: Anesthesia > Medications > Flashcards

Medications Flashcards

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1
Q

Is Propofol induction or maintenance?

A

Both

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2
Q

Is Alfaxalone induction or maintenance?

A

Both

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3
Q

Is Ketamine induction or maintenance?

A

Both

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4
Q

Is Diazepam induction or maintenance?

A

Both

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5
Q

Is Isoflurane induction or maintenance?

A

Both

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6
Q

What’s the duration of action for Propofol?

A

2-5 minutes

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7
Q

What’s the duration of action for Alfaxalone?

A

5-10 minutes

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8
Q

What’s the duration of action for Diazepam?

A

20 minutes

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9
Q

What’s the duration of action for Isoflurane?

A

Until exhaled (3-5 minutes)

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10
Q

What are the side effects of Propofol?

A

Drops blood pressure, apnoea

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11
Q

What are the side effects of Alfaxalone?

A

Minimal effects on blood pressure or heart rate. Can cause apnoea, but this isn’t common.

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12
Q

What are the side effects of Ketamine?

A

Elevates blood pressure and heart rate, eyes remain fixed forward so they require lubrication.

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13
Q

What are the side effects of Diazepam?

A

Elevates blood pressure and heart rate, eyes remain fixed forward so they require lubrication.

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14
Q

What are the side effects of Isoflurane?

A

Drops blood pressure, irritant to eyes, nose and throat if given by mask

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15
Q

What is the speed of induction of Propofol?

A

Rapid

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16
Q

What is the speed of induction of Alfaxalone?

A

Rapid

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17
Q

What is the speed of induction of Ketamine/Diazepam?

A

Rapid

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18
Q

What is the speed of induction of Isoflurane?

A

Slow

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19
Q

What are the drugs in the class Anticholinergics?

A

Atropine

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20
Q

What are the drugs in the class Opioids (aka Narcotics)?

A

Buprenorphine, Morphine, Butorphanol and Fentanyl

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21
Q

What are the drugs in the class Phenothiazines?

A

Acepromazine

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22
Q

What are the drugs in the class Benzodiazepines?

A

Diazepam and Midazolam

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23
Q

What are the drugs in the class Dissociatives?

A

Ketamine

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24
Q

What are the drugs in the class Alfa Agonists?

A

Medetomidine

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25
Q

What are the drugs in the class Antibiotics?

A

wip

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26
Q

What are the drugs in the class NSAIDs?

A

wip

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27
Q

What are the drugs in the class Steriods?

A

wip

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28
Q

What else should be known about Propofol?

A

Must be kept sterile as no preservative. Lasts 6 hours when opened before needing to be disposed of. Must be kept in the fridge due to milk/lipid base. The solution containing benzyl alcohol preservative should not be used for maintenance of anaesthesia by continuous rate infusion due to the risk of toxicity caused by prolonged administration. In dogs, propofol is rapidly metabolized, in cats recovery is less rapid.

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29
Q

What else should be known about Alfaxalone?

A

The dose is different for dogs and cats. Stings if given perivascularly. The drug should be given slowly and to effect in order to prevent inadvertent overdose.

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30
Q

What else should be known about Ketamine?

A

Stings if given perivascularly

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31
Q

What else should be known about Buprenorphine?

A

Need to give IM to cats as is not well absorbed. If given SQ to Dogs, it will absorb. Will reverse effects of morphine and fentanyl. It has minimal side effects compared with the other opioids. Metabolized in the liver; some prolongation of effect may be seen with impaired liver function.

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32
Q

What else should be known about Morphine?

A

Do not give if vomiting would be a problem. Consider giving with Atropine. Watch breathing. Mania in cats can be seen at higher doses. Methadone should be used in preference to morphine as the licensed alternative for single or repeated bolus administration to dogs and cats. Morphine can be given as a constant rate infusion to provide analgesia intraoperatively and in the postoperative period.

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33
Q

What else should be known about Butorphanol?

A

It is short-acting, it wears off in 30-120 minutes.
Will reverse effects of Morphine and Fentanyl.
Stings when injected. Butorphanol is metabolized in the liver and some prolongation of effect may be seen with impaired liver function.

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34
Q

What else should be known about Fentanyl?

A

Very short-acting (minutes). Given as continuous infusion in fluids or via a skin patch. Mania in cats can be seen at higher doses.

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35
Q

What else should be known about Acepromazine?

A

Brachycephalics can have worsened airway blockage; Boxers may have a sudden airway collapse. Should be avoided in patients with heart disease.

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36
Q

What else should be known about Diazepam?

A

Oral forms have been linked to liver issues In cats. Can cause excitement when given
IV so best to give other drugs first. They are considered to be relatively “heart safe”. Stings if given perivascularly

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37
Q

What else should be known about Medetomidine?

A

Do not give atropine with this drug, even though heart rates may be quite low. Reversed with atipamizole. Should be avoided in patients with heart disease. Use in geriatric patients is not advisable. Do not use in pregnant animals. Do not use when vomiting is contraindicated. Not recommended in diabetic animals.

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38
Q

What else should be known about Ketamine?

A

Stings when you give it (other than IV). Can be given as a constant infusion to help with post op pain control. Should be avoided in CATS with heart disease.

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39
Q

What else should be known about Atropine?

A

Do not give these if the patient has an elevated heart rate. Should be given “as needed” for heart rates below normal/expected values.

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40
Q

What is Buprenorphine used for?

A

Analgesia

41
Q

What is Morphine used for?

A

Analgesia and sedation

42
Q

What is Butorphanol used for?

A

Analgesia and sedation

43
Q

What is Fentanyl used for?

A

Analgesia and sedation

44
Q

What is Acepromazine used for?

A

Sedation or pre-anaesthetic medication

45
Q

What is Diazepam?

A

Sedation and muscle relaxant

46
Q

What is Ketamine used for?

A

Deep sedation or general anesthetic

47
Q

What is Medetomidine used for?

A

Moderate to deep sedation

48
Q

What is buprenorphine also called?

A

Temgesic

49
Q

What’s the duration of action for Ketamine?

A

20 minutes

50
Q

What are some pros about Acepromazine?

A

ACP raises the threshold for cardiac arrhythmias and has antiemetic properties. Great sedation.

51
Q

What are some cons about Acepromazine?

A

Hypotension due to shock, trauma or cardiovascular disease. Avoid in animals <3 months and animals with liver disease. Use cautiously in anaemic animals as it will exacerbate the anaemia by sequestration of red blood cells in the spleen. In Boxers, spontaneous fainting and syncope can occur due to sinoatrial block caused by excessive vagal tone; use low doses or avoid. Rarely, healthy animals may develop profound hypotension following the administration of phenothiazines. Supportive therapy to maintain body temperature and fluid balance is indicated until the animal is fully recovered.

52
Q

What’s the onset for Acepromazine?

A

Onset of sedation is 20–30 minutes after i.m. administration

53
Q

What’s the duration of Acepromazine?

A

Clinical doses cause sedation for up to 6 hours.

54
Q

What is Alfaxalone used for?

A

Induction agent used before inhalational anaesthesia, or as a sole anaesthetic agent for examination or surgical procedures.

55
Q

What are some cons about Alfaxalone?

A

An increase in heart rate can occur immediately after i.v. injection as a compensatory response to maintain blood pressure in the face of mild hypotension. This effect can be minimized by slow i.v. injection. As with all anaesthetic drugs, respiratory depression can occur with overdoses. Can cause a bad wake up.Does not contain an antimicrobial preservative; thus it is recommended that the remainder of an opened bottle is discarded after single use.

56
Q

What’s the duration for Alfaxalone?

A

5-10 minutes

57
Q

What are some pros about Alfaxalone?

A

Less adverse effects than propofol

58
Q

What is Atropine used for?

A

Prevent or correct bradycardia and bradyarrhythmias, to dilate pupils, in the management of organophosphate and carbamate toxicities, and in conjunction with anticholinesterase drugs during antagonism of neuromuscular blockade

59
Q

What is Buprenorphine used for?

A

Relief of mild to moderate perioperative pain.

60
Q

What’s the onset for Buprenorphine?

A

Onset of action of buprenorphine may be slower than methadone (>15 min).

61
Q

What’s the duration of Buprenorphine?

A

Duration of effect is approximately 6 hours in cats and is likely to be similar in dogs.

62
Q

What are some pros about Buprenorphine?

A

Side effects are rare after clinical doses. side effects are rare after clinical doses.

63
Q

What are some cons about Buprenorphine?

A

Buprenorphine crosses the placenta and may exert sedative effects in neonates born to bitches and queens treated prior to parturition. Combination with full mu agonists is not recommended for analgesia; therefore, do not use for premedication when administration of potent opioids during surgery is anticipated.

64
Q

What’s the onset for Butorphanol?

A

Butorphanol has a very rapid onset

65
Q

What are some cons about Butorphanol?

A

Contradicts animals with diseases of the lower respiratory tract associated with copious mucus production. side effects such as respiratory depression, bradycardia and vomiting are rare after clinical doses.

66
Q

What is Butorphanol used for?

A

Management of mild perioperative pain. Butorphanol is unlikely to be adequate for the management of severe pain.

67
Q

What’s the duration of Butorphanol?

A

In different models analgesia has been shown to last between 45 minutes and 4 hours.

68
Q

What’s the onset for Fentanyl?

A

Rapid, within minutes

69
Q

What is Fentanyl used for?

A

Very potent opioid analgesic (50 times more potent than morphine) used to provide profound intraoperative analgesia in dogs and cats. Can also be used at low dose rates for postoperative analgesia. It can be used intraoperatively to provide analgesia by intermittent bolus doses or by a continuous rate infusion.

70
Q

What’s the duration of Fentanyl?

A

Short duration of action (10–20 min depending on dose).

71
Q

What are some pros about Fentanyl?

A

Very potent opioid analgesic (50 times more potent than morphine). After prolonged administration (>4 hours) or high doses, its duration of action is significantly prolonged as the tissues become saturated. Very fast-acting

72
Q

What are some cons about Fentanyl?

A

Rapid i.v. injection can cause severe bradycardia, even asystole, therefore, the drug should be given slowly. A reduction in heart rate is likely whenever fentanyl is given, atropine can be administered to counter bradycardia if necessary. Apart from the effects on heart rate, fentanyl has limited other effects on cardiovascular function when used at clinical dose rates.

73
Q

What are some side effects of isoflurane?

A

Isoflurane causes dose-dependent hypotension by causing vasodilation, particularly in skeletal muscle. This adverse effect does not wane with time. Isoflurane is a more potent respiratory depressant than halothane, respiratory depression is dose-dependent.

74
Q

What is Ketamine used for?

A

Provision of chemical restraint or dissociative anaesthesia. Ketamine may also provide profound visceral and somatic analgesia and inhibits central sensitization, used to provide perioperative analgesia as an adjunctive agent, although optimal doses to provide analgesia have not been elucidated.

75
Q

What are some cons about Ketamine?

A

Dissociative anaesthesia is associated with mild stimulation of cardiac output and blood pressure, modest respiratory depression and the preservation of cranial nerve reflexes. For example, the eyes remain open during anaesthesia and should be protected using a bland ophthalmic ointment. Not recommended for animals whose eyes are at risk of perforation or who have raised intraocular pressure. Not recommended in animals with raised intracranial pressure. Cardiovascular depression, rather than stimulation, and arrhythmias may arise in animals with a high sympathetic nervous system tone (e.g. animals in shock or severe cardiovascular disease). Tachycardias can also arise after administration of high i.v. doses. Respiratory depression may be marked in some animals. Ketamine may result in spacey, abnormal behaviour for 1–2 hours during recovery. Prolonged administration of ketamine by infusion may result in drug accumulation and prolong recovery.

76
Q

What is Medetomidine used for?

A

Dose-dependent sedation, muscle relaxation and analgesia. Provides sedation and premedication when used alone or in combination with opioid analgesics.

77
Q

What are some cons about Medetomidine?

A

causes marked changes in the cardiovascular system including an initial peripheral vasoconstriction that results in an increase in blood pressure and a compensatory bradycardia. After 20–30 min, vasoconstriction wanes while blood pressure returns to normal values. fall in cardiac output; central organ perfusion is well maintained at the expense of redistribution of blood flow away from the peripheral tissues. Respiratory system function is well maintained; respiration rate may fall but is accompanied by an increased depth of respiration.

78
Q

What are some pros about Medetomidine?

A

Reversal of sedation or premedication with atipamezole shortens the recovery period, which may be advantageous.

79
Q

What is Meloxicam used for?

A

limiting the production of prostaglandins involved in inflammation. Alleviation of inflammation and pain in both acute and chronic musculoskeletal disorders and the reduction of postoperative pain and inflammation following orthopaedic and soft tissue surgery.

80
Q

What else should be known about Meloxicam?

A

Do not administer concurrently or within 24 hours of other NSAIDs and glucocorticoids. Do not administer with other potentially nephrotoxic agents. Do not give to dehydrated, hypovolaemic or hypotensive patients or those with GI disease or blood clotting problems. Liver disease will prolong the metabolism of meloxicam leading to the potential for drug accumulation and overdose with repeated dosing. Administration to animals with renal disease must be carefully evaluated. Do not give to pregnant animals or animals <6 weeks of age. All NSAIDs should be administered cautiously in the perioperative period as they may adversely affect renal perfusion during periods of hypotension. If hypotension during anaesthesia is anticipated, delay meloxicam administration until the animal is fully recovered from anaesthesia and normotensive.

81
Q

What are some cons about Meloxicam?

A

GI signs may occur in all animals after NSAID administration. Stop therapy if this persists beyond 1–2 days. Stop therapy immediately if GI bleeding is suspected.

82
Q

What is Methadone used for?

A

Management of moderate to severe pain in the perioperative period. Incorporation into sedative and pre-anaesthetic medication protocols to provide improved sedation and analgesia.

83
Q

What is the duration of Methadone?

A

3–4 hours in dogs and cats

84
Q

What else should be known about Methadone?

A

similar pharmacological properties to morphine, and is useful in similar situations. Methadone may be administered epidurally to provide analgesia; the duration of analgesia, epidurally is approximately 8 hours in dogs. Severe adverse effects can be treated with naloxone.

85
Q

What are some pros about Methadone?

A

Methadone can be given i.v. without causing histamine release and does not cause vomiting when given to animals preoperatively. Respiratory function should be monitored when given i.v. to anaesthetized patients.

86
Q

What are some cons about Methadone?

A

Respiratory depression may occur when given i.v. during general anaesthesia due to increased depth of anaesthesia. Vomiting is rare, although methadone will cause constriction of GI sphincters. and may cause a reduction in GI motility when given over a long period. Methadone crosses the placenta and may exert sedative effects in neonates born to bitches treated prior to parturition.

87
Q

What is Morhpine used for?

A

Management of moderate to severe pain in the perioperative period.

88
Q

What are some pros about Morhpine?

A

It provides profound analgesia and forms the mainstay of postoperative analgesic protocols in humans. Is also a sedative. Preservative-free morphine can be administered into the epidural space where it will provide analgesia for up to 24 hours. Severe adverse effects can be treated with naloxone.

89
Q

What are some cons about Morhpine?

A

In dogs it has a short duration of action and needs to be given frequently to be effective. Morphine causes histamine release when given rapidly i.v., so it should be diluted and given slowly i.v. It commonly causes vomiting when given to animals preoperatively that are not in pain, therefore morphine should be avoided when vomiting is contraindicated ransient excitation may occur when morphine is given i.v. Respiratory depression may occur, may cause a reduction in GI motility when given over a long period. Morphine crosses the placenta and may exert sedative effects in neonates born to bitches treated prior to parturition.

90
Q

What is the duration of Morphine?

A

3–4 hours

91
Q

What is Propofol used for?

A

Induction of anaesthesia and maintenance of anaesthesia using intermittent boluses or a continuous rate infusion. Injection i.v. produces a rapid loss of consciousness as the CNS takes up the highly lipophilic drug. Over the next few minutes propofol distributes to peripheral tissues and the concentration in the CNS falls such that, in the absence of further doses, the patient wakes up. Propofol does not have analgesic properties

92
Q

What are some cons about Propofol?

A

Considerable care must be taken with administration in hypovolaemic animals and those with diminished cardiopulmonary, hepatic and renal reserves. The rapid injection of large doses causes apnoea, cyanosis, bradycardia and severe hypotension. Problems are less likely when injection is made over 30–60 seconds. Muscle rigidity, paradoxical muscle movements and tremors can sometimes occur in dogs immediately after i.v. administration. Propofol is not irritant to tissues but a pain reaction is commonly evident during i.v. injection.

93
Q

What is Diazepam used for?

A

Anticonvulsant, anxiolytic and skeletal muscle relaxant urethral muscle spasm and tetanus). Diazepam is the drug of choice for the short-term emergency control of severe epileptic seizures and status epilepticus in dogs and cats. Can be used with opioids and/or acepromazine for pre-anaesthetic medication in the critically ill.

94
Q

What are some cons about Diazepam?

A

Sedation, muscle weakness and ataxia are common. Benzodiazepines should be avoided in patients
with CNS depression, respiratory depression, severe muscle weakness or hepatic impairment (as may worsen hepatic encephalopathy). It provides very poor sedation or even excitation when used alone in healthy animals. In the short term, repeated doses of diazepam or a constant rate infusion will lead to drug accumulation and prolonged recovery in both species but particularly in cats in which it may also cause liver injury.

95
Q

Lidocaine (Lignocaine)
(EMLA, Intubeaze, Lignadrin, Lignol, Locaine, Locovetic,
Lidoderm*) POM-V
Formulations: Injectable: 1%, 2% solutions (some contain
adrenaline). Topical: 2% solution (Intubeaze), 4% solution (Xylocaine);
2.5% cream with prilocaine (EMLA); 5% transdermal patches
(Lidoderm).
Action: Local anaesthetic action is dependent on reversible
blockade of the sodium channel, preventing propagation of an action
potential along the nerve fibre. Sensory nerve fibres are blocked
before motor nerve fibres, allowing a selective sensory blockade at
low doses. Lidocaine also has class 1b antiarrhythmic actions,
decreasing the rate of ventricular firing, action potential duration and
absolute refractory period, and increasing relative refractory period.
Lidocaine has a rapid onset of action and intermediate duration of
action. Addition of adrenaline to lidocaine increases the duration of
action by reducing the rate of systemic absorption.
Use: Provision of local or regional analgesia using perineural,
infiltration, local i.v. or epidural techniques. Intratesticular lidocaine
has been shown to reduce haemodynamic responses to castration in
dogs and cats and is recommended to provide intraoperative
analgesia during castration and reduce the requirement for inhalant
anaesthetic agents. It is generally recommended that adrenaline-free
solutions be used for epidural administration. Also used to provide
systemic analgesia when given i.v. by continuous rate infusion.
First-line therapy for rapid or haemodynamically significant
ventricular arrhythmias. May also be effective for some
supraventricular arrhythmias, such as bypass-mediated
supraventricular tachycardia, and for cardioversion of acute-onset or
vagally-mediated atrial fibrillation. Widely used topically to
desensitize mucous membranes (such as the larynx prior to
intubation). EMLA cream is used to anaesthetize the skin before
vascular cannulation. It must be placed on the skin for approximately
45–60 minutes to ensure adequate anaesthesia; covering the skin
with an occlusive dressing promotes absorption. EMLA is very useful
to facilitate venous catheter placement in small puppies and kittens.
The pharmacokinetics of transdermal lidocaine patches have been
evaluated in dogs and cats; bioavailability of transdermal lidocaine is
low in cats and dogs compared with humans. The analgesic efficacy
and clinical usefulness of transdermal lidocaine has not yet been
evaluated in either species. Infusions of lidocaine reduce the inhaled
concentrations of anaesthetic required to produce anaesthesia and
prevent central sensitization to surgical noxious stimuli. Systemic
lidocaine is best used in combination with other analgesic drugs to
achieve balanced analgesia. Lidocaine will accumulate after
prolonged administration, leading to a delayed recovery. Cats are
very sensitive to the toxic effects of local anaesthetics, therefore, it is
important that doses are calculated and administered accurately.
Safety and handling: Normal precautions should be observed.
Contraindications: Do not give to cats by continuous rate infusion
during the perioperative period due to the negative haemodynamic
effects. Do not give lidocaine solutions containing adrenaline i.v. Do
not use solutions containing adrenaline for complete ring block of an
extremity because of the danger of ischaemic necrosis.
Adverse reactions: Depression, seizures, muscle fasciculations,
vomiting, bradycardia and hypotension. If reactions are severe,
decrease or discontinue administration. Seizures may be controlled
with i.v. diazepam or pentobarbital.

A

wip

96
Q

What is Lidocaine used for?

A

wip

97
Q

What are some cons about Lidocaine?

A

wip

98
Q

What are some pros about Lidocaine?

A

wip

NZ Vet Nursing: Anesthesia (10 decks)

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