Pain Assessment and Treatment

Question 1

What are some behaviors K9’s exhibit when in pain?

Answer 1

Lameness, praying position, head tilt, guarding, behavior change

Question 2

What are some behaviors felines exhibit when in pain?

Answer 2

Hiding, decreased appetite, decreased grooming, excessive licking, missing the box, squinting eyes and aggression

Question 3

What are some behaviors equines exhibit when in pain?

Answer 3

Lameness, standing at back of stall, decreased social interaction, decreased appetite, pain face

Question 4

What is “pain face” in equine?

Answer 4

Low ears, angled eyes, dilated nostrils, tension of muzzle

Question 5

What are ruminant pain behaviors?

Answer 5

Teeth grinding, hypersalivation, abnormal facial expression, decreased rumination/appetite, decreased milk production and isolation from herd

Question 6

What are biomarkers for pain?

Answer 6

Cortisol, glucose, catecholamines, endorphins, and lactic acid

Question 7

Signs of pain under GA are?

Answer 7

Movement, trembling, increased HR, increased RR, and increased BP

Question 8

How do local anesthetics help with pain management?

Answer 8

Block Na-gated channels preventing action potential

Question 9

What is used for perioperative pain treatment?

Answer 9

Opioids

Question 10

What receptors do opioids act on?

Answer 10

Mu, Kappa and delta

Question 11

What receptors do these drugs act on? Morphine, hydromorphone, oxymorphone, fentanyl, methadone and meperidine

Answer 11

Mu agonists

Question 12

What receptor does buprenorphine act on?

Answer 12

Partial mu agonist

Question 13

What kind of receptors do butorphanol act on?

Answer 13

Mu antagonist and kappa agonist

Question 14

Which drug is a weak mu opioid inhibiting serotonin reuptake?

Answer 14

Tramadol

Question 15

What do NSAIDs work on?

Answer 15

COX-1 and COX-2 enzymes

Question 16

Which COX enzyme is constitutive and which is inducible?

Answer 16

COX-1: constitutive –> prostaglandin production for GI/renal protection and platelet function
COX-2: inducible- produce prostaglandins in response to pain and inflammation

Question 17

Where are the NMDA receptors located?

Answer 17

Spinal cord

Question 18

What would you use for a ASA I K9 OHE?

Answer 18

Pure mu agonist with premed and one injectable NSAID (continue 4-5 days post-op)

Question 19

What would you use for ASA I feline OHE?

Answer 19

Pure mu agonist or buprenorphine with premed. One injectable NSAID after recovery from anesthesia. Continue buprenorphine 3 days post-op

Question 20

What would you use for ASA I K9 neuter?

Answer 20

Same as spay but add lidocaine for testicular block. NSAID 2-3 days post-op

Question 21

What would you use for dental extractions?

Answer 21

Pure mu agonist (pre-med), injectable NSAID if no systemic disease, local blocks with bupivicaine and post-op NSAID