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Anesthesiology > Pre-Meds > Flashcards

Pre-Meds Flashcards

1
Q

What does the preanesthetic assessment include?

A
  • identification
  • signalment
  • history
  • blood panel
  • ASA status
  • type of procedure and duration
  • physical exam and temp assessments
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2
Q

What is the ASA classification system and how many categories are there ?

A

its a fast assessment of the patient’s overall health
I) normal
II) mild systematic dz
III) severe systematic dz
IV) severe systematic dz that threatens life
V)moribund patient not expected to survive 24hrs
E) emergency (mostly used in human med)

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3
Q

what do you have to do in order to prep the patient ?

A
  • correct fixable problems (ex: hypoglycemia)
  • assess degree of pain
  • fasting
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4
Q

are fasting protocols the same for pediatric vs adults vs geriatric patients

A

no

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5
Q

a bunch of reasons to use pre anesthetics

A
  • calm patient/ chemical restraint
  • reduce total dose of anesthetic induction + maintenance
  • provides ANALGESIA
  • prevents BRADYCARDIA
  • reduces salivation and airway secretions
  • improves recovery, less delirium
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6
Q

Preanesthetic drug subgroups (6)

A

1) anticholinergics
2) tranquilizers
3) muscle relaxants
4) dissociative
5) neuro active steroids
6) sedative/ analgesics

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7
Q

what do anticholinergics do?

A
  • used to inhibit excessive parasympathetic activity
  • works at muscarinic receptors to clock the action of acetylcholine

-hint: remember that cholinergics mimic Ach

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8
Q

anticholinergics indications (3)

A

1) concurrent use with a drug that promotes vagal tone (opioids)
2) performing surgery in areas of high vagal activity
3) individual patients that have high vagal tone or reliance on heart rate to maintain cardiac output

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9
Q

anticholinergics are NOT recommended for …. (3)

A

1) do not use to “dry up” airway
2) promote arrhythmia formation
3) tachycardia results in increased myocardial O2 demand (so I guess don’t use it to promote tachycardia?)

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10
Q

what are the 2 anticholinergics that we use and their main differences ?

A

1) Atropine : faster onset + shorter duration, induces tachycardia, more arrhythmogenic, less expensive, crosses BBB and placental barrier
2) Glycopyrrolate : slower onset + longer duration, less tachycardia and arrhythmias, $, does NOT cross those 2 barriers, give to pregnant patients!

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11
Q

which tranquilizer do we use an what is its mechanism?

A

acepromazone : reticular activating system to produce CNS depression, antagonize dopamine receptors within CNS, and cause blockade of peripheral alpha-1 adrenoceptors and vasodilation

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12
Q

acepromazine details

A
  • tranquilizer
  • slow onset, long duration
  • dose dependent effect
  • NO reversal agent
  • minimal muscle relaxation and NO analgesia
  • peripheral vasodilation, anti thermo regulation, anti emetic, anti arrhythmic, anti histaminic
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13
Q

acepromazine in boxers and stallions

A

boxers: some strains have intense vasovagal reaction at normal doses

stallions : may show permanent or transient penile paralysis

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14
Q

Muscle relaxants : benzodiazepines

A
  • poor sedation in healthy animals, good on geriatric/neonatal/ pediatric
  • controlled substance (duh ?)
  • minimal cardio - respiratory depression
  • potent anticonvulsant
  • useful sedative or augment others (works well with opioids) in debilitated animal
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15
Q

what is the reversal agent for benzodiazepines ?

A

flumazenil

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16
Q

what are the two benzodiazepines we use and their differences

A

1) diazepam : oily propylene glycol formulation (painful IM), less $, AVOID IN LIVER FAILURE, precipitates when mixed with other drugs except ketamine
2) midazolam: water soluble, does not precipitate when mixed with other drugs, safer in liver failure, $$

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17
Q

what is the one drug that does not cause diazepam to precipitate when mixed with it

A

ketamine

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18
Q

muscle relaxant: guaifenesin (GG)

A
  • used in conjugation with ketamine in horses, small ruminants, and camelids
  • NO reversal, unlike benzodiazepines
  • requires large volume and irritating when administered perivascular
  • mild sedation
  • acts on the internuncial neurons of the spinal cord
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19
Q

what is the “triple drip” in horses

A

GG + ketamine + xylazine

20
Q

dissociatives

A
  • stimulate sympathetic tone, increases HR and RR
  • painful IM injection due to low pH
  • causes delirium, uncoordination, focalization, agitation
  • induces muscle rigidity, salivation, anyway secretions
  • controlled substance
21
Q

what other drugs do we combine dissociatives with for better sedation ? (3)

A

benzodiazepines
alpha 2 agonists
opioids

22
Q

dissociative mechanism

A
  • acts on glutamate binding sites, NMDA and non NMDA receptors
  • potentiates GABA inhibition
  • antagonism of NMDA receptor causes amnesiac and psychosensory effects, analgesia, neutoprotection
23
Q

somatic vs visceral analgesia of dissociatives

A
  • superior somatic

- less visceral

24
Q

what are the 2 dissociatives that we use?

A

1) Ketamine
2) Tiletamine (in Telazol)

Vicky the notes you’re looking for:
(Tiletamine and Zolazepam are in the bottle of Telazol. Zolazepam combats the muscle rigidity that tiletamine (all dissociatives) profuce. Note that because dogs will metabolize the zolazepam faster than the tiletamine in the dose they will not recover as smooth as cats will)

25
Q

neuroactive steroid mechanism

A
  • enhances interaction of GABA receptor complex to produce anesthesia and muscle relaxation
  • analogue of progesterone
26
Q

what is the neuroactive steroid that we use

A

alfaxalone :

  • AVOID in large dogs due to large volume
  • fast onset, short duration
  • respiratory depression, hypotension, mild increase in HR
  • safer for cats with hypertrophic cardiomyopathy
27
Q

T/F : alfaxalone is safer for cats with hypertrophic cardiomyopathy

A

TRUE

28
Q

sedative/ analgesics : alpha 2 agonist

A
  • blocks alpha 2 receptors and inhibits norepinephrine release, leasing to sedation
  • NOT a controlled substance
29
Q

types of alpha 2 agonists

A

1) romifidine
2) detomidine
3) clonidine
4) xylazine
5) dex-medetomidine

30
Q

alpha 2 agonists on the heart

A
  • increases vagal tone leading to AV block
  • dec. HR -> dec. CO, BP(BP increases after time however) and can lower threshold for dysrhythmias
  • Cardiovascular side effects are dose dependent
  • respiratory depression, hypoinsulinemia, hyperglycemia, reduce GI motility, hypothermia, vomiting (especially cats), sweating, inc. intensity of uterine contractions
31
Q

Alpha 2 agonists are more potent the more selective they are to the alpha 2 receptor. The more potent the less volume of drug is needed to produce effect. What is the order of potency of the alpha 2 agonists?

A

Dex(medetomidine)&raquo_space;> Romifidine&raquo_space; Detomidine > Clonidine > Xylazine

32
Q

Which animals are more sensitive to alpha 2 agonists?

A

Ruminants especially, small lab animals are the least sensitive

33
Q

alpha 2 reversal agent?

A

Yohimbine or Tolazoline for Xylazine.

Atipamezole for everything

34
Q

using alpha 2s with horses?

A

Detomidine CRI for standing procedures. Can use Romifidine, xylazine, detomidine, dex for premed. MAC sparing effect on inhalants, Good for smooth recoveries.

35
Q

Most of the alpha 2 ags can be used for small animals and horses except _______ cannot be used in dogs.

A

detomidine

36
Q

opioids mechanism of action

A

inhibits pain transmission at the dorsal horn of the spinal cord. they activate descending inhibitory pathways.

37
Q

opioid receptors

A

mu, kappa, delta G protein receptors.

38
Q

Partial agonists have a __________ effect that plateaus at a lower level of effect than full agonists.

A

dose dependent

39
Q 
How long do they last?
morphine, hydromorphone, methadone?
butorphanol?
buprenorphine?
fentanyl?
naloxone?
A 
2-4 hrs
1-2 hrs
8 h
15-30 min
30-45 min
40
Q

Side-effects of Opioids?

A

bradycardia, vomiting, histamine release, hyperthermia in cats, dysphoria

41
Q

pure mu agonists cause

A

excitement and inhibition of GI activity

42
Q

for ASA I/II use:

A

Ace + Opioid +/- Dex

43
Q

for ASA III/IV/V/E, pediatrics or geriatrics use:

A

Benzodiazepines + Opioid +/- Atropine

44
Q

Crazy cat, what do you want to knock it down with?

A

Alfaxalone + Opioid

45
Q

Ideal pre-meds for horses?

A

Alpha 2 + Opioid

46
Q

2 month puppy in for a spay?

A

Diazepam + Opioid

47
Q

Horse getting a cyptorchidectomy could get ___ which we normally wouldnt give to horses.

A

Acepromazine

Anesthesiology (21 decks)

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