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Pharmacology > Pre-med > Flashcards

Pre-med Flashcards

1
Q

what are the 3 components of an ideal anesthetic technique

A

analgesia, stability of organs/systems and loss of consciousness

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1
Q

what is general anesthesia

A

reversible process of depression of the CNS with drugs that produce unconsciousness

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2
Q

what is a balanced technique

A

administration of different drugs together to create the ideal anesthetic state

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3
Q

what is the objective of an ideal balanced technique

A

uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of desired effects and reducing the likelihood of its side effects

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4
Q

what do we want to achieve with pre-medication (3)

A

sedation, anxyolisis, muscle relaxant

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5
Q

why do we premed patients (9)

A

-Decrease stress and facilitate patient handling
-Staff safety (especially important in aggressive patients and wildlife)
-Facilitate restrain and catheter placement
-Provide preventive analgesia prior to surgery
-Facilitate monitoring and pre-oxygenation before induction
-Decrease doses of induction agents
-Smoother anesthetic inductions
-Lower inhalant requirements
-Better recoveries for short procedures

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6
Q

what are some advantages of giving preventative analgesia prior to surgery

A

-Reduction of noxious stimuli reaching the central nervous system during surgery
-Reduction of peripheral inflammation
-Reducing the dose of anesthetic required during surgery
-Less analgesia needed post-op
-More rapid hospital discharge

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7
Q

what is the purpose of giving preventative analgesia prior to surgery

A

attempt to block nociceptive input through the application of several analgesic agents, acting at different sites (multimodal analgesia) starting prior to surgery and continuing for several hours or days following surgery

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8
Q

dose dependent combiniation of propofol and alfaxalone

A

dose dependent hypotension and respiratory depression

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9
Q

dose dependent issue with inhalants

A

dose dependent vasodilation and hypotension

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10
Q

what are some disadvantages of pre-meding patients? (4)

A

-possibly cost; depending on drug used since you decrease the amount of induction and maintenance drugs

-time; onset of action is slower when IM or SQ routes are used

-some sedatives arent appropriate for sick patients (There is no safe or perfect premedication protocol acceptable for ALL ANIMALS, All drugs cause side effects that are usually dose-dependent)

-Heavy sedation protocols carry higher risk of cardiovascular side effects, respiratory depression or airway obstruction

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11
Q

what type of drug do we use to achieve sedation/anxyolisis

A

anesthetic agent

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12
Q

what type of drug do we use to achieve muscle relaxation

A

sedative agent

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13
Q

what type of drug do we use to achieve analgesia

A

opioid

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14
Q

what are some features of an ideal pre-anesthetic protocol (5)

A

-Provide reliable and consistent sedation, anxiolysis and/or immobilization
-None or minimal side effects
* Cardiorespiratory
* Other systems

-Provide adequate analgesia
-Reversible
-Reduce the dose of other sedative, anesthetics

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15
Q

what is a common drug in the phenothiazine class

A

acepromazine

16
Q

what are common drugs in the alpha-2 agonist class (2)

A

medetomidine and dexmedetomidine

17
Q

what is a common drug in the benzodiazepine class (2)

A

diazepam and midazolam

18
Q

what is a common drug in the opioid class

A

pure agonists= morphine, hydromorphone, methadone, meperidine, fentanyl)

partial agonists= buprenorphine

kappa agonists = butorphanol

19
Q

what is a common drug in the anesthetics class

A

-ketamine IM
-alfaxone IM
-subanesthetic doses propofol or alfaxalone IV

20
Q

what is a common drug in the oral sedatives class

A

trazadone and gabapentin

21
Q

what is a common drug in the anticholinergics class

A

atropine and glycopyrrolate

22
Q

what are the three categories of opioids

A

pure agonist
partial agonist
kappa agonist

23
Q

what is the goal of neuroleptic combinations?

A

Achieving the desire degree of sedation, anxiolysis, immobilization and analgesia while decreasing
doses and therefore side effects of every drug chosen

24
Q

features of neuroleptic combinations (3)

A
  • Combination of drugs with synergistic actions
  • Lower doses of all agents = less side effects
  • More realizable sedation or analgesia, quicker onset, longer duration…
25
Q

what are 8 general considerations you need to think about when choosing a protocol

A

-ASA status of your patient and specific pathophysiology of diseases present
-what degree of sedation do i need
-what degree of analgesia do i need
-onset and length of effects needed; dose and route of administration
-drugs and doses must be tailored to the specific patient (pre-mixtures not recommended)
-knowing drug pharmacology and expected side effects for every drug is crucial
-always monitor patients closely after pre-med specifically if heavy sedation is needed
-mild sedation is usually safer, heavier sedation may result in more side effects

26
Q

what do you need to think about regarding ASA status when choosing a protocol

A
  • ASA (I-V) used to determine anesthetic risk
  • Age (Neonate, Pediatric, Adult, Geriatric)
  • Patient condition and health status (Hepatic disease, Renal disease, Cardiac disease)
27
Q

what determines the degree of sedation used in your protocol

A
  • Procedure to be performed
  • Personality of the animal
  • Resources available in clinic/setting
28
Q

what type of opioid class should you use for diagnostics and non-invasive things

A

partial -agonists/antagonists like butorphenol or buprenorphine

29
Q

what type of opioid class should you use for minor procedures

A

partial u-agonists/ u-pure agonists

30
Q

what type of opioid class should you use for surgery or an already painful condition

A

u-pure agonist

31
Q

advantages and disadvantages of using opioid alone

A
  • Advantages: minimal cardiorespiratory depression, more sedation in sick patients
  • Disadvantages: Only mild sedation in healthy patients
32
Q

what class of sedatives would you use if you wanted a mild sedation

A

opioids, benzodiazepines, low dose acepromazine

33
Q

what class of sedatives would you use if you wanted a moderate sedation

A

Acepromazine, low dose α2-agonists or Alfaxalone

34
Q

what class of sedatives would you use if you wanted a profound sedation

A

α2-agonists, ketamine, Alfaxalone combinations

35
Q

can you use a sedative alone

A

its not recommended

36
Q

what is one of the most important things to think about when giving a sedative to a patient

A

ask yourself if any of the agents are contraindicated in that specific patient and case

37
Q

sedation scoring 1-4

A

1 = no effect
2 = mild sedation; quiet but still active and alert
3 = quiet, reluctant to move, slightly ataxic but able to walk
4 = animal recumbant, unable to walk

Pharmacology (16 decks)

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