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Veterinary Nursing Anaesthesia and Analgesia > Pre-Medications > Flashcards

Pre-Medications Flashcards

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1
Q

Why give pre-meds?

A
  • Provide sedation and analgesia
  • Calm the patient for smooth induction
  • Reduce dose of induction and maintenance agents required
  • May help reduce some adverse effects of the anaesthetic or surgical procedure
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2
Q

What is balanced anaesthesia?

A
  • Using multiple drugs in combo to achieve anaesthesia
  • Provide better quality of anaesthesia
  • Minimise total doses of agents used whereby reducing potential side affects
  • All tailored to the individual patient
  • Balance out side effects with other drugs
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3
Q

What are the golden rules to using Pre-meds

A
  • correct does tailored to the individual animal!
  • Should be given and left in a quiet environment
  • Give enough time for the drug to take effect
  • note the route of admin (may impact time to reach effect and duration of effect)
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4
Q

How long do most pre-meds take to cause an effect?

A

30 minutes

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5
Q

What are Alpha-2-Agonists ?

A

Drugs that bind to alpha-2 receptors in the brain and spinal cord

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6
Q

How do Alpha-2-agonists work ?

A

Block transmission of nociceptive impulses

Exact mechanisms not fully understood

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7
Q

What do Alpha-2-Agonists provide?

A

Sedation and Analgesia

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8
Q

Name 2 Alpha-2-Agonists

A

Medetomidine

Dexmedetomidine

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9
Q

What are Alpha-2-Agonists used for?

A
  • Sedation
  • Pre-medication
  • Anaesthesia
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10
Q

What other drug to Alpha-2-Agonists work with for sedation?

A

Opioids (usually buprenorphine)

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11
Q

What is a major benefit when using Alpha-2-Agonists as pre-medication

A

Can achieve a profound sparing effect which lowers the doses of other agents required for induction and maintenance

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12
Q

What other drug is commonly used with Alpha-2-Agonists for anaesthesia

A

Ketamine - especially in cats

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13
Q

What analgesic approach can Alpha-2 Agonists be used as a part of

A

multi-modal analgesic approach

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14
Q

Name 4 potential side effects with Alpha-2-Agonists

A
  • Causes vasoconstriction
  • Can cause profound bradycardia
  • Causes respiratory depression
  • Reduces liver blood flow
  • May cause vomiting
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15
Q

What patients should you not use Alpha-2-Agonists on or have extreme caution in using on

A
  • Patients with cardiovascular disease
  • Patients with liver disease
  • Patients where vomiting would be risky
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16
Q

Name 4 advantages of Alpha-2-Agonists

A
  • There is a reversal drug (Atipamezole)
  • Profound drug sparing effect
  • Provides muscle relaxation
  • Provides Analgesia
  • Duration and level of sedation are dose dependent
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17
Q

What are opioids?

A

Analgesics

Light sedative effects

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18
Q

How do opioids work?

A

Act by combining with specific receptors in the brain and spinal cord (OP3 most commonly) and decrease the transmission of noxious stimuli

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19
Q

What are the three kinds of Opioids?

A

Full agonists
Partial Agonists
Antagonists

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20
Q

How do full agonist opioids work and when would you use it?

A

Produce maximal effect and bind all receptors

Used for moderate to severe pain e.g. bitch spay

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21
Q

Give an example of a full agonist opioid

A

Morphine, methadone, pethidine, fentanyl

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22
Q

What other drugs are used in combo with partial agonist opioids

A

Alpha-2’s or phenothiazine

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23
Q

What form of pain is a partial agonist opioid use in and give an example of a partial agonist

A

Mild to moderate pain

Example: Buprenorphine

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24
Q

What is the function of an antagonist opioid?

A

Work against the analgesic effects of the agonist - can be used as an antidote

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25
Q

Give an example of an antagonist and where it is commonly found

A

Naloxone (‘Narcan’)

Often found in emergency crash kits

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26
Q

What kind of Pre-meds are opioids usually combined with

A

sedatives

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27
Q

Name 2 schedule 2 opioids

A

Morphine, fentanyl

28
Q

Name 2 schedule 3 opioids

A

Buprenorphine, tramadol

29
Q

Benefits of using an opioid?

A
  • provide analgesia and euphoria, sedation
  • Little effect on respiration at correct dose
  • Drug sparing effect
  • Little effect on CVS but can cause bradycardia
  • Pain relief provided may improve ventilation in cases of thoracic wall injury
30
Q

What negatives are associated with the use of opioids?

A
  • High doses lead to profound respiratory depression
  • Contraindicated in animals with increased ICP
  • Vomiting may occur due to morphine
  • Constipation
  • Antitussive effect (suppress coughing)
  • Urinary retention if given spinally
31
Q

What are Benzodiazepines?

A

Tranquilisers

32
Q

How do benzodiazepines work?

A

They enhance the neurotransmitter GABA

33
Q

Name 2 examples of benzodiazepines?

A

Diazepam

Midazolam

34
Q

What other pre-med is usually given in combination with benzodiazepines?

A

Opioids

35
Q

When will benzodiazepines be given alone as a pre-med

A

when patients are very sick - may cause excitement if given alone in healthy patients

36
Q

Why are benzodiazepines not given alone to healthy patients

A

May cause excitement

37
Q

Name 3 benefits of benzodiazepines

A
  • safe
  • minimal effects on cardiovascular system
  • minimal effects on the respiratory system
  • Good muscle relaxation
  • Anti-epileptic action
  • Appetite stimulation
38
Q

What benzodiazepine is good for anti-epileptic action and how would it be administered

A

Diazepam

Given IV

39
Q

What negatives are associated with benzodiazepines?

A
  • Can be unpredictable action
  • Not sufficient premedication if used alone in healthy animals
  • Diazepam is painful by I/M injection
40
Q

What benzodiazepine should be given IV and what one should be given IM

A

IV - diazepam

IM - midazolam

41
Q

How do Anti-muscarinics work?

A

Decrease the parasympathetic tone by blocking transmission via acetyl choline

42
Q

Name 2 anti-muscarinics

A

Atropine

Glycopyrrolate

43
Q

What nerve is the closely associated with the parasympathetic system?

A

Vagas Nerve

44
Q

What do anti-muscarinics do?

A
  • antagonise the parasympathetic nervous system
  • prevent bradycardia
  • dry up secretions
  • Counteract high parasympathetic activity
45
Q

Why did anti-muscarinics first become popular? And why are they less commonly used now?

A

Previous inhalational drugs would cause increase the activity of the parasympathetic system (bradycardia, increased secretions)
Our current inhalational drugs do not cause these side effects

46
Q

Which anti-muscarinic is most commonly used?

A

Atropine

47
Q

When are anti-muscarincs used? (name 3)

A
  • eye surgery
  • Laryngeal surgery
  • Brachycephalics
  • When reversing muscle relaxants
  • Only when needed
48
Q

What benefits are there with Anti-muscarinics (name 2)

A
  • reduces salivation and bronchial secretion
  • counteracts bradycardia
  • helps prevent ‘vagal events’ during reversal of muscle relaxants
49
Q

Name 3 negatives associated with anti-muscarinics?

A
  • Caused increased heart rate
  • Causes increased metabolic rate
  • May cause arrhythmias
  • Thickens bronchial secretions
  • Gastrointestinal ileus
  • Pupil dilations causing visual disturbance
  • May have long lasting effects of a couple of hours
50
Q

What do phenothiazine’s provide?

A
  • Provide tranquilisation (sedation at higher dose)

- Do not provide analgesia

51
Q

What are phenothiazines commonly used with?

A

Synergistically with Opioids

52
Q

Name a phenothiazine

A

Acetylpromazine (ACP)

53
Q

What is ACP commonly used with

A

Opioids

Buprenorphine or methadone

54
Q

What forms do ACP come in

A

Tablet or injectable form

55
Q

How long does ACP last

A

6 hours

56
Q

How quickly does ACP come into effect

A

30-35 minutes

57
Q

What does increasing the dose of ACP cause

A

prolonged period of sedation

NOT the deepening of sedation

58
Q

What animals are more resistant to the effects of ACP ?

A

small dogs and cats - dosage is usually higher in them

59
Q

What animals are usually more sensitive to ACP?

A

Big dogs and brachycephalics - smaller doses

60
Q

What patients should phenothiazines be used with caution in?

A
  • brachycephalics
  • Epileptics
  • Bradycardics
  • Large breeds
  • Hypo-volaemic or dehydrated patients
61
Q

Benefits of phenothiazines? (name 3)

A
  • Anti-emetic
  • Smooth muscle relaxation
  • Mild anti-histamine effect
  • Relatively safe for respiratory system
  • Relatively safe for cardiovascular system
  • Usually a smooth recovery
62
Q

What side effects are associated with phenothiazines? (name 2)

A
  • Causes vasodilation and will lead to hypotension
  • May cause hypothermia
  • Controversial but some believe it may decrease seizure threshold
  • Boxers have a habit of fainting due to large bread, brachycephalic, and suffer from hypotension
63
Q

What negatives are associated with phenothiazines? (name 2)

A
  • Slow peak effect
  • Long duration of action
  • No analgesia
  • Unpredictable side effects
64
Q

What is hypnorm licensed for use in?

A

Rabbits

65
Q

What is hypnorm usually combined with

A

Opioid - fentanyl

makes it a composite drug

66
Q

What does hypnorm contain that makes it behave the same way as phenothiazines?

A

Butyrophenone fluanisone

Veterinary Nursing Anaesthesia and Analgesia (25 decks)

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