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sx and anes test 2 > Preanesthetic medicatoins and dissociative anesthetics > Flashcards

Preanesthetic medicatoins and dissociative anesthetics Flashcards

1
Q

tranquilizers/anxiolytics

A

relieve anxiety without overt sedation

patient easily aroused and aware of surrounds

neuroleptics, ataractics

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2
Q

sedatives

A

a state of central depression accompanied by drowsiness

makes it easier for patient to fall asleep

not as easily aroused

unaware of surroundings but response to painful stimulation

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3
Q

analgesics

A

drugs use to provide freedom or absence of pain

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4
Q

nacrosis

A

drug induced sleep

detines the sedation produced by opiats and opioids

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5
Q

neuroleptoanalgesia

A

combination of a sedative/tranquilizer and an opioid

provides chemical restraing and greater degree of sedation and analgesia

numerous combination are possible

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6
Q

dissociative anesthesia

A

state induced by drugs that interfere with transmission of nervous impulses between limbic system and thalamocortical areas of the brain

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7
Q

reasons to pre-med (10)

A

reduce anxiety, apprehension, fear and resistance

render the patient more amendable to handling

prevents catecholamine release and CV consequences associated with it

reduces the risk of injury to patient and staff

counterat negative effects of sedative/anesthetic agents

preemptive analgesia

smooth induction of anesthesia

drug sparring

smooth maintenance of anestheia

smooth recovery

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8
Q

considerations for pre meds

A

species

temperatment

desired drug effect and duraiton of action

undesirable effects of drug

degree of pain

health status of animal

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9
Q

classes of common preanesthetic agents

A

phenothiazine

benzodiazepines

alpha-2 adrenergic agonists

opioids

dissociatives

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10
Q

phenothiazines MOA

A

tranquilizers

dopamine antagonist (basal ganglia and limbic system) causes: anxiolysis, antiemetic, antihistamine, antiarrhythmic

block alpha1 addrenoceptors peripherally-causes vasodilation and hypotension, decrease PCV (splenic dilation), hypothermia

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11
Q

acepromazine ADME

A

hepatic metabolism

renal excretion

highly protein bound (>90%)

onset-slow 30 to 45 min (IM), 5 to 15 min (IV)

duration: 3 to 8 hours

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12
Q

what happens when acepromazine is given at a high dose?

A

prolongs duraiton of action but not degree of tranquilization

extrapyramidal effects

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13
Q

acepromazine complications

A

vasodilation–>hypotension

renal hypotension

hypoproteinemic animals-prolonged duration of effect

flaccid paralysis/paraphimosis of penis and priapism in stallions

no antagonist

epinephrine reversal

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14
Q

beznodiazepines MOA

A

anxiolytics-depression of limbic system

muscle relaxants-internuncial neurons at spinal levels

controlled substance-Class Iv

modaulation of GABA mediated neurotransmission-enhances inhibitory neurotransmission

no intrinsic activity at GABA receptors

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15
Q

benzodiazepines

A

minimal CV effects

can cause mild respiratory depression, especially in the presence of other depressant drugs

wide margin of safety

antagonist available

usually used in conjunction with other drugs-effective for pediatrics, geriatrics and debilitated animals

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16
Q

what happens when you give benzodiazepines to young healthy animals?

A

CNS excitement and altered temperament

will make a dog want to bite you since inhibitions are lost

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17
Q

midazolam

A

water soluble base

IM or SQ absorption excellent and No Pain

highly protein bound

greater recept affinity

used in comb with opioids and dissociatives

lasts 1-2 hours

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18
Q

diazepam

A

most commonly use benzo

insoluble in water, contains solvents such as propylene glycol and ehtanol

can cause hypotension if given rapidly IV

don’t mix with diluents

don’t give IM

highly protein bound (liver disease patients)

antagonist available

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19
Q

Flumazenil

A

highlyg selective, competitve benzo antagonist

strong affinity for receptor and minim intrinsic activity

rapidly reverse the sedative, muscle relaxant and behavioral effects of benzo

works well but very expensive

not controlled

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20
Q

alpha 2 agonists

A

reliably produce dose dependent sedation, analgesia and muscle relaxation

can be transietnly aroused and accurately bite or kick under sedation

analgesia similar to opioids and is synergistic with it…mostly visceral

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21
Q

alpha 2 agonist MOA

A

centrally, alpha 2 agonist act via pre-synaptic receptor to inhibit release of NE and decreased sympathetic activity leading to

sedation, muscle relaxation, bradycardia, analgesia

peripherally activation of alpha 2B receptors cause vasoconstriction and reflex bradycardia

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22
Q

alpha 2 agonist effects (10)

A

sedation, analgesia, muscle relaxation, bradycardia, hypertension/hypotesion, hypothermia, emesis, decreased GI motility, hyperglycemia, diuresis

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23
Q

Alpha 2 agonists CV effect

A

Decreased CO

peripheral vasocontriction

hypertension, hypotension

bradycardia

arrhythmias (AV block)

don’t use atropine

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24
Q

alpha2 agonist respiratory effects

A

respiratory depression-slows RR but no change in PaO2

ruminants-bronchoconstricton, increased pulmonary vascular resistance, intra-alveolar hemorrhage and pulmonary edema

brachycephalics-pharyngeal and laryngeal muscle relaxation

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25
Q

alpha 2 agonist hormonal effects

A

decreased ADH secretion

decreased renin secretion

decreased insulin secretion

decreased ACTH secretion

decreased catecholamines release

increased ANP release

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26
Q

alpha 2 agonists GI effects

A

decreased GI motility

decreased lower esophageal tone (regurgitation risk higher)

emesis

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27
Q

alpha 2 agonist considerations

A

species sensitivity

don’t use anticholnergics

highly stressed animal may not sedate

may cause abortion in pregnant cattle

aerophagia in some dogs

not controlled

antagonist available

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28
Q

xylazine

A

least specific

commonly used in horses and cattle

IM, SQ, IV

onset-1 to 2 min IV

duration: dose dependent 20 to 30 min

combined iwth butorphanol for standing restraint in horses

used with ketamine for injectable anesthesia or induction in large and small animals

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29
Q

Romifidine

A

alpha 2 agonist

sedation and analgesia in horses comparable to detomidine

muscle relaxation is comparable to xylazine to detomidine but associated with less ataxia

onset 2 to 10 min

duration of effect: 40 to 80 mins

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30
Q

medetomidine

A

more potent and longer duration of action when compared to xylazine

IV, IM, SQ

dogs and cats, horses (ataxia)

onset 5 to 15 min

duration of 1-2 hours

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31
Q

dexmedetomidine

A

most potent and specific alpha 2 agonist available

profound, long lasting effects

good sedation and analgesia

used in healthy dogs and cats

duration is 1-3 hours

can give IM, SQ, IV

32
Q

dexmedetomidine considerations

A

combine with opioids-decreased dose of both drugs

if used as premed, decrease anesthetic drug doses

used for chemical restraing for minor procedures

use with ketamine for injectable anesthesia

33
Q

alpha 2 antagonists

A

antagonizes both sedation and analgesia

may cause excitement, hypotension, muscle tremors, tachycardia and over-alertness

give IM

34
Q

Yohimbine

A

alpha 2 antagonist for xylazine

ratio of 10:1 (agonist:antagonist)

35
Q

tolazoline

A

alpha 2 antagonist for xylazine

slow

36
Q

atipamezole

A

antagonist for Medetomidine and dexmedetomidine

1:10

37
Q

opioids

A

derived from Papaverum somniferum–>opium

endogenous opioids: enkephalin, endorphins and dinorphins

used primarly for analgesia but also may cause sedation

38
Q

Opioids MOA

A

bind to specific opioid receptors and mimic the effect of endogenous opioids

presynaptic (Ca) and postsynaptic (K) modulation of nociceptors

receptors in brain, spinal cord and periphery

39
Q

mu receptors

A

mediate most of the effects seens with opioid use as well as most of the undesirable effects

40
Q

kappa receptors

A

mediate analgesia in central and peripheral sites but it is weak and has a ceiling effect

41
Q

OP3 or Mu opioid effects

A

analgesia

sedation

euphoria/dysphoria

nausea, vomiting, constipation

respiratory depression

dependence

miosis/mydriasis

42
Q

OP2 or Kappa opioid effects

A

analgesia

sedation

dysphoria

diuresis

miosis

43
Q

OP1 or delta opioid receptor

A

analgesia

44
Q

Opioids CV effects

A

minimal effect on CO, BP and rhythm

bradycardia due to vaggal stimulation may occur and respond readily to anticholinergics if needed

histamine released if used IV-vasodilation and hypotension

45
Q

opioids respiratory effects

A

dose dependent respiratory depression

decreased responsiveness to CO2, compounded by the co-administration of sedatives or anesthesia

46
Q

opioids CNS effects

A

sedation

CNS stimulation and excitement-cats and horses

47
Q

opioids thermoregulation

A

hypothermia

hyperthermia in cats, horses, swine and ruminants

48
Q

opioids emesis

A

nausea and vomiting

dogs> cats

less likely in post op period and in patients that are experiencing pain

49
Q

Opioids GI

A

defection initially

spasm of GI smooth muscle-ileus and constipation

may predispose an animal to colic or tympany

more common in chronic cases

50
Q

Opioids genitourinary effects

A

urinary retention if epidural or intratecal

dose dependent suppression of detrusor contractility and deccreased sensation of urge

51
Q

morphine

A

prototyical opioid

full agonist of all 3 opioid receptors

IM onset: 5 to 15 min

duration: 3-4 hour

use with tranquilizer in horses and cats

inexpensive

Schedule II

52
Q

oxymorphone

A

semisynthetic opioid

full mu agonist

analgesic efficacy and duration of action similar to morphine

less likely to make dogs vomit and to cause excitement

safe to give IV (no histamine release)

excellent premed in pediatric, geriatric and debilitated dogs

expensive

schedule II

53
Q

hydromorphone

A

semisynthetic opioid

full mu agonist, analgesic efficacy and duration similar to morphine

similar characteristics to oxymorphone,

cheaper

less sedation

more likely to cause hyperthermia in cats

schedule II

54
Q

Meperidine

A

synthetic full mu agonnist opioid

similar analgesic efficacy to morphine

causes histamine release–>no IV use

atropine like effects

onset 5 to 10 min

duration-1 hour

schedule II

55
Q

methadone

A

synthetic full mu agonist opioid

much less likely to produce vomiting and histamine release

acts via NMDA receptors as well

duration 2 to 6 hours

similar to morphine

56
Q

buprenorphine

A

partial agonist at mu receptors

antagonist at kappa receptors

analgesic efficacy lower than full mu agonists-mild to moderate pain control

high affinity and slow dissociation from OP3 receptors

slow onset, up to 45 min-1 hr for peak effect

long duration of action 6-8 hour

schedule III

57
Q

butorphanol

A

kappa receptors agonist

Mu antagonist

less effective analgesic and sedative

plateau effect

mild to moderate pain control (viscera)

onset 5 to 7 min

duration: 45 min to 1.5 hours

schedule IV

58
Q

nalbuphine

A

kappa agonist and mu antagonist

mild analgesia, minimal to no sedation

duration: 1 to 2 hours

used to reverse mu agonist effects, maintain some analgesia

not scheduled

59
Q

naloxone

A

pure antagoinst at all opioid receptor

less effective against partial agonists

short acting, re narcoitzation is possible

60
Q

naltrexone

A

long acting derivative of naloxone

useful when a longer acting reversal is needed

61
Q

acepromazine/opioid

A

can be used in healthy, active dogs, husky types, and biting types

used in cats but sedation is minimal

provides neuroleptanalgesia

62
Q

benzodiazepine/opioid

A

providdes neuroleptanalgesia

mild sedation, use if debilitated

CV stability

both drugs can be antagonized

63
Q

alpha 2 agonist/opioid

A

used for chemical restrain in aggressive dogs

horses-standing procedure, premed

can do minor surgical or diagnostic procedure

causes bradycardia

do not use if debiltated

good analgesia

both drugs can be antagonized

64
Q

dissociative drugs

A

provide dose dependent unconsciousness and analgesia

ranging from mild chemical restraint to anesthesia

rapid onset of action due to molecular weight, pKa and lipid solubility

analgesia-subanesthetic doses-greater for somatic pain

65
Q

Dissociatives MOA

A

NMDA recetpor antagonism (glutamate)

interference with transmission of nervous impulses between limbic system and thalamcortical areas of brain-dissociation between subconscious and conscious systems

analgesia NMDA receptors appear to be involved in hyperalgesic states after tissue injury

66
Q

dissociatives CV effects

A

indirect CV stimulation

sympathomimetic by inhibition of neuronal catecholamine uptake

increased CO, HR and BP

CV changes can be reduced by prior administration of benzo, alpha 2 or phenothiazine

67
Q

Dissociatives CNS effects

A

increases intracranial pressure due to respiratory depression, increased muscle tone and decreased venous return

can cause seizure like activity in dogs (used with benzo)

avoid in epileptics and animals prone to seizures

68
Q

DIssociatives respiratory system effects

A

dose and species dependent

dogs may have rate and minute volume transiently decreased but return to normal within 15 minutes

cats may have apneustic, shallow, and irregular pattern at higher doses

increased salivation and respiratory tract secretions

69
Q

dissociatives considerations

A

wide therapeutic index

IM premed-Cats, aggressive dogs, swine, exotic species

IV induction-prior to inhalational agents, used in many species

IM or IV for injectable anesthesia

not IM in horses–>ataxia

70
Q

ketamine

A

used for premed, chemicacl restraint, and dissociative anesthesia ni severeal species

used as induction agent

may cause hyperthermia in cats in recovery

71
Q

tiletamine

telazol

A

1:1 mix of dissociatve tiletamine with benzodiazepine zolazepam

reconstitute with saline, will lose potency over time

similar use to ketamine and benzodiazepine

may have prolonged recovery due to slow metabolism of zolazepam

72
Q

anticholinergics

A

parasymatholytic drugs

decrease parasympathetic tone by binding to muscarinic receptors

primarily CV and GI effects

pre and postsynpatic locations

73
Q

anticholinergics effects

A

used to manage bradycardia and AV blocks caused by tissue manipulation, administration of other drugs, occasionaly used to control excessive secretions

can cause significant tachycardia, increase myocarial work and oxygen consumption, decrease myocardial perfusion

decreases GI motility and decreases lower esophageal sphincter tone

74
Q

atropine

A

non selective anticholinergic

crosses blood brain and placental barriers

onset 5 to 20 min IM, 1-5 min IV

duration-HR increases for approx 30 min

radpily hydrolyzed by atropinase enzymes in rabbits and cats

75
Q

Glycopyrrolate

A

longer duration of action anticholinergic (1 hr)

less likely to cause tachycardia than atropine

may be safer for use in horses under anesthesia

does not alter pupil diameter and influnece IOP

76
Q

anticholinergic considerations

A

can cause transient 2nd degree AV block, esp after IV administration

not routinely used in ruminants or horses

CI with tachyarrhythmias

sx and anes test 2 (5 decks)

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