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Clinical Pharmacology > Pain Management Lecture > Flashcards

Pain Management Lecture Flashcards

1
Q

Treatment for cat diagnosed with pancreatitis and Stage 1 CKD (lower creatinine, non-proteinuric, nonhypertensive) with low to moderate pain score

A
  • Cerenia

- Gabapentin

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2
Q

Conservation of pain pathway

A
  • Physiology of sympathetic nerve stimulation and adrenocortical axis is largely the same for humans and animals
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3
Q

Types of pain

A
  • Somatic, visceral, neuropathic, emotional, acute, chronic
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4
Q

Hormones involved in pain mediation

A
  • Cortisol and epinephrine (from adrenal medulla)
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5
Q

Cortisol and epinephrine for pain in physiologic doses and supra-physiologic and sustained levels

A
  • great at physiologic doses (life-saving)

- Supra-physiologic and sustained may have confusing/detrimental effects

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6
Q

Cortisol potency

A
  • Very potent
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7
Q

Cortisol release

A
  • Release augmented by trauma, infection, heat/cold, surgery, disease, restraint, injection, epi/norepinephrine
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8
Q

Cortisol effects

A
  • anti-inflammatory effects
  • Stimulates gluconeogenesis
  • Decreases glucose utilization in the cell
  • Promotes mobilization of FA from adipose tissue
  • Promotes AA mobilization from muscle
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9
Q

Epinephrine and cortisol

A
  • Cortisol potentiates release of epinephrine
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10
Q

Epinephrine side effects

A
  • ileus (slowing down parasympathetic system)
  • Decreased urine output
  • Acts on Alpha and Beta adrenergic receptors (mydriasis, tachycardia, hypertension, tachypnea, hyper aware)
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11
Q

Pain pathway parts

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Perception
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12
Q

Traditional origin of pain

A
  • Acute occurrences
  • Trauma
  • Injury
  • Post surgical
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13
Q

Medical pain

A
  • Underestimated
  • Chronic, insidious
  • Progressive/regressive
  • e.g. pancreatitis, gastroenteritis, hepatitis, cholangitis, arthritis, dermatitis, neoplastic
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14
Q

Unintentional pain

A
  • Brief, temporary
  • Discomfort
  • Day to day operation of a hospital
  • Movement and techniques unrealized
  • Sources of unintentional pain: palpation, restraint, catheter placement, injections, shaving/clipper sites, rectal exams, otic/ophthalmic exams, endsocopic evaluations
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15
Q

Concurrent diseases to consider with pain dosing

A
  • Arthritis, immune-mediated condition, GI disease, liver disease, kidney disease
  • Dose reduction or escalation
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16
Q

Concurrent medications to consider dose reduction

A
  • Corticosteroids
  • NSAIDs
  • Alternative Immune suppressants
  • Serotonin Re-uptake inhibitors
  • Maybe if you have a hyperadrenocorticism dog with pain, don’t regulate it as well
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17
Q

Acute or adaptive pain

A
  • Nociceptive (high-threshold noxious stimuli, e.g. Tissue injury)
  • INflammatory (tissue damage produces sensitivity of tissue associated with inflammatory response)
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18
Q

Chronic or maladaptive pain

A
  • Last 3-6 months in humans
  • Central plasticity or central windup: lasts autonomously after stimulus has been discontinued or is sustained with low level nociceptor input from periphery
  • NOT protective
  • Pathologic pain driven by dysfunction or malfunction of the nociceptive system
  • Neuropathic: damage to neural tissue
  • Inflammatory
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19
Q

Painful characteristics

A
  • Diminished activity
  • Changed interest in eating/drinking
  • Difficulty standing, walking, or jumping
  • Decreased grooming
  • Changes in urination/defecation habits
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20
Q

Pain assessment validated methods

A
  • Glasgow Composite measure pain scale
  • UNESP-BOTUCATU multi-dimensional composite pain scale
  • ACUTE pain only
21
Q

Traditional analgesics

A
  1. Opioids
  2. NSAIDs
  3. Local anesthetics
  4. Dexmedetomidine
22
Q

Fentanyl MOA

A
  • Mu agonist very potent
23
Q

Fentanyl routes

A
  • CRI in hospital
  • At home can be given as a patch
  • The patch may be eaten which would be bad
24
Q

Simbadol overview

A
  • FDA approved for buprenorphine

- Partial mu agonist

25
Q

Duration of simbadol

A
  • 24 hours

- Some extended release formulations too

26
Q

Administration of Simbadol

A
  • SQ administration easier in some cats
27
Q

Simbadol dose adjustments

A
  • Don’t be afraid

- e.g. geriatric, sick patients; aggressive multimodal analgesia

28
Q

Bad aspect of simbadol

A
  • If you give too much, they will be like that for 24 hours
29
Q

Tramadol in dogs bioavailability

A
  • 65 +- 38%

- Little to no production of active metabolite

30
Q

Elimination of tramadol in dogs

A
  • Rapid
31
Q

Tramadol in dogs use

A
  • Analgesia may be from SNRI rather than opioid pathway
  • Use as part of MULTIMODAL analgesia
  • Not appropriate to give as a monotherapy
32
Q

Cat bioavailability of tramadol

A
  • 93 +/- 7%

- Produce an active metabolite

33
Q

Use of tramadol in ats

A
  • More likely to provide analgesia, but cats don’t like the taste
  • Can use for cats in feeding tube
34
Q

Cyclo-oxygenase Inhibitors overview for pain

A
  • Reduces production of prostaglandins (TXA2, PGI2, PGE1/PGE2)
  • Not tissue specific
  • COX-nonselective
  • COX 2 inhibitor
35
Q

Types of Nonsteroidal anti-inflammatory drugs

A
  • *Carprofen, Deracoxib, Firoxicb, Robenacoxib, Meloxicam, Grapiprant
36
Q

Adverse signs for NSAIDs

A
  • Vomiting
  • Diarrhea
  • Melena
  • Icterus
  • Liver enzyme elevation
  • Kidney injury
  • She will not do in azotemic animals
37
Q

Lidocaine

A
  • As CRIs helps with pain
38
Q

Lidocaine CRI indication

A
  • Antiarrhythmic, analgesic, anti-hyperalgesic, anti-inflammatory, anti-endotoxic
  • Promotes GI motility and return to normal bowel function
  • Facilitates rehabilitation
  • Protection against ischemia-reperfusion injury
39
Q

Gabapentin

A
  • Anti-epileptic
  • $, easy to give, wide dosing range
  • Elimination through kidney
40
Q

Gabapentin MOA

A
  • Inhibit L-type calcium channel to decrease release of neurotransmitters (GABA)
41
Q

Elimination of Gabapentin

A
  • Urine

- Dose reduction in kidney disease?

42
Q

Main adverse effect of Gabapentin

A
  • Sedation
  • Can enhance other drug-induced sedation
  • Can use a 4x recommended dose before they get to the hospital
43
Q

Ketamine infusions/amantadine MOA

A
  • NMDA receptor antagonist

- can use in combo with tramadol, gabapentin, NSAID

44
Q

Maropitant

A
  • Neurokinin-1 receptor antagonist
  • Stops visceral bain and blocks the emetic center
  • NK-1 receptor agonist = substance P
  • No drug interactions reported
45
Q

Amitriptyline

A
  • Tricyclic antidepressant
  • A lot of kitties that have issues with FIC or lower urinary tract disease may be given this to chill them out if they fail environmental modification
  • Can be used for obstructed ureters
  • Also a pain medication
46
Q

Non-pharmacologic therapy

A
  • Acupuncture, massage, laser, etc.
47
Q

Treatment considerations for an inappetence and lethargic cat with history of cholangiohepatitis, pancreatitis, and hepatic lipidosis

A
  • Cerenia x 2 weeks
  • Simbadol in hospital
  • Amantadine or Gabapentin
48
Q

Boxer with acute suppurative necrotizing pancreatitis, suppurative hepatitis, and moderate eosinophilic enteritis pain treatment

A
  • Icing
  • Fentanyl
  • Dexmedetomidine CRI
  • Epidural

Clinical Pharmacology (7 decks)

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