Pain treatment

Question 1

What is the target for NSAIDs

Answer 1

• COX enzymes
• descending pain pathways (PAG & NRM)

Question 2

How do COX enzymes cause pain?

Answer 2

• after a cell is damaged an enzyme called cycle-oxygenase (COX) is activated
• COX then stimulates the cell to produce prostaglandins which contribute to signs of inflammation, pain, warmth, redness, swelling & fever

Question 3

What do prostaglandins play a role in?

Answer 3

• kidney, CVS, CNS & reproductive systems
• regulation renal blood flow, reducing vascular resistance and enhance organ perfusion

Question 4

What are the commonest SA NSAIDs?

Answer 4

• meloxicam
• carprofen
• robenacoxib
• firocoxib

Question 5

What are the commonest equine NSAIDs?

Answer 5

• phenylbutazone
• flunixin
• meloxicam

Question 6

NSAIDs are contraindicated in pts with…

Answer 6

• renal or hepatic insufficiency
• hypovolaemia
• congestive heart failure & pulmonary disease
• coagulopathies, active haemorrhage
• spinal injuries
• gastric ulceration
• concurrent use of steroids
• shock, trauma
• pregnancy

Question 7

Side effects of NSAID use

Answer 7

• vomiting
• diarrhoea
• renal problems
• clotting distribution

Question 8

What is Grapiprant (Galliprant)?

Answer 8

• new glass of pip rant NSAID
• doesn’t block COX, instead blocks some activity of a specific prostaglandin (the EP4 receptor)
  – it’s a prostaglandin receptor antagonist (PRA), non-COX inhibiting NSAID

Question 9

Mode of action for Grapiprant (Galliprant)

Answer 9

• targets canine OA pain and inflammation, while reducing the impact on GI, kidney and liver homeostasis

Question 10

Use of paracetamol

Answer 10

• blocks central & peripheral COX
• CB1 & TRPV1 actions & antipyretic
• used IV in dogs & horses (no licenced)
• pardale-V (paracetamol & codeine) has licence in dogs
• licenced in pigs

Question 11

Which animal should you never give paracetamol to?

Answer 11

• cats

Question 12

Use of opioids

Answer 12

• use in pre-emptive, multimodal and preventative analgesia

Question 13

Examples of opioids

Answer 13

• morphine
• methadone
• pethidine
• fentanyl
• buprenorphine
• butorphanol

Question 14

Examples of local anaesthetics

Answer 14

• procaine
• lidocaine

Question 15

Why do you need to take care with LAs?

Answer 15

• narrow therapeutic index

Question 16

Effects of alpha-2 agonists

Answer 16

• sedation
• decrease MAC
• analgesia (somatic & visceral)
• hyper then hypotension
• decreased CO & HR, increased SVR
• respiratory depression
• increased urine production
• decreased GI motility
• decreased surgical stress response
• hyperglycaemia
• thermoregulation affected -> sweating

Question 17

Uses of ketamine

Answer 17

• induction agent
• preoperative analgesia
• restrain of fractious cats ( sprayed in mouth)
• combined with other drugs for sedation (IM or IV)