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Week 2&3 FCP > Premediacations > Flashcards

Premediacations Flashcards

1
Q

What is a pre-med

A

A combination of drugs, or sometimes a single agent, given prior to anaesthesia.

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2
Q

Name the 2 types of anaesthesia which do not require a pre-med

A

Triple and quad anaesthesia for cats undergoing neutering

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3
Q

Name the different classes of drugs which can be used as part of a pre-med and give an example of each (x7)

A

Opioid e.g. methadone
Alpha 2 agonist e.g. medatomidine
Benzodiazepine e.g. midazolam
Ketamine
Phenothiazine e.g. ACP
Alfaxalone
Anticholinergic e.g. atropine

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4
Q

Give 6 reasons why we premedicate

A
  1. Balanced anaesthesia
  2. Sedation
  3. Agent/MAC sparing
  4. Provides preemptive analgesia
  5. Stress reduction
  6. Improved recovery
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5
Q

In what situation might you use an anticholinergic in the premed and why

A

BOAS undergoing respiratory tract surgery
Helps to reduce tract secretions

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6
Q

Give examples of opioids licensed in veterinary (x5)

A

Methadone
Fentanyl
Buprenorphine
Butorphanol
Pethidine

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7
Q

What does an opioid provide as part of a premed

A

Sedation
Analgesia

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8
Q

Name the 4 opioid receptors

A

Mu - full or partial mu agonists
Kappa
Delta
Nociceptin

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9
Q

Give 3 examples of a full mu agonist

A

Methadone, Fentanyl, pethidine

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10
Q

Give an example of a partial mu agonist

A

Buprenorphine

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11
Q

Name an opioid which is a mu antagonist and a kappa agonist, and what does this mean

A

Butorphanol
Good sedation, poor and short-lived analgesia

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12
Q

How do opioids affect: cardiovascular system, respiratory system, GI motility, gastric emptying

A

Minimal cardiovascular depression
Minimal respiratory depression - more so with fentanyl
Reduced GI motility
Decreased gastric emptying

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13
Q

Name the drug which antagonises opioids

A

Naloxone

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14
Q

Give some examples of alpha 2 agonists (x5)

A

Medetomidine
Dexmedetomidine
Detomidine
Xylazine
Romifidine

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15
Q

Which 2 alpha 2 agonists are most commonly used in small animal practice

A

Medetomidine
Dexmedetomidine

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16
Q

Why is Xylazine used less in small animals practice than other alpha 2 agonists

A

Relatively poor affinity for the alpha 2 receptor
Therefore has more side effects

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17
Q

Which 3 alpha 2 agonists are licensed in horses

A

Xylazine
Romifidine
Detomidine

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18
Q

What effects do alpha 2 agonists have

A

Profound dose-dependant sedation
Analgesia via alpha 2 receptors in the spinal cord (short-lived)
Marked drug-sparing effects
- MAC sparing

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19
Q

How do alpha 2 agonists affect blood flow to the CNS and why is this important

A

Increase the amount of time taken for injectables to reach the CNS
Be careful not to inject too quickly if given an alpha 2

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20
Q

How do alpha 2 agonists affect blood flow to the liver and and why is this important

A

Reduce blood flow to the liver
Reduce hepatic metabolism of other agents you have given

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21
Q

How do alpha 2 agonists affect the cardiovascular and respiratory system, and describe

A

Cause minimal respiratory depression
Cause significant cardiovascular effect
- Initially, peripheral vasoconstriction => increased BP, reflex bradycardia
- after 15-20 mins BP and HR return to normal

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22
Q

Name some potential bad effects of alpha 2 agonists

A

Reduction in endogenous insulin production => transient hyperglycaemia
Cause emesis
Increased urine production

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23
Q

Name the antagonist for alpha 2 agonists

A

Atipamezole

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24
Q

Give an example of a phenothiazine used in veterinary (x1)

A

Acepromazine (ACP)

25
Q

What effects does acepromazine have as part of a premed

A

Sedation
NO analgesia

26
Q

How does acepromazine cause its effects (think receptors it acts on)

A

Centrally acting
Dopamine antagonist - blocks DI and D2 receptors
Blocks alpha 1, muscarinic and H1 receptors

27
Q

How long does it take for acepromazine to take effect IM

A

Slow!!
30-40 mins

28
Q

What potential bad effects can acepromazine cause in small animals

A

Vasodilation mediated by alpha 1 antagonism => hypotension and hypothermia
Boxers have a high sensitivity => fainting/passing out

29
Q

Name the antagonist for acepromazine

A

There isn’t one!

30
Q

Give examples of benzodiazepines (x2) and which species are they licensed in

A

Diazepam - dogs and cats
Midazolam - horses, commonly used in small animal too

31
Q

Why is it better to give diazepam IV compared to IM

A

Cause pain on IM injection and poorly absorbed

32
Q

What receptor do benzodiazepines act on

A

GABA-A receptor

33
Q

What effects do benzodiazepines have as part of a premed

A

Causes sedation, hypnosis and anxiolysis
NO analgesia
Poor level of sedation in a healthy animal - normally only given to sick patients

34
Q

Why are benzodiazepines good to use in sick/compromised patients

A

Cause minimal cardiovascular and respiratory depression
Reduce amount of induction and inhalation agent needed
Anti-convulsants

35
Q

What drug antagonises benzodiazepines and why isn’t it used in first opinion practice

A

Flumazenil
Short-lived - needs to be repeated
Very expensive

36
Q

What type of drug is ketamine

A

NMDA receptor antagonist

37
Q

Which 2 opioids demonstrate some NMDA receptor antagonism

A

Methadone
Pethidine

38
Q

In what ways is ketamine dose dependant

A

High doses - a dissociative anaesthetic
Low doses - sedation

39
Q

Why is ketamine good in a premed

A

Drug sparing - inhalation and induction
Good cardiovascular stability
Can cause dose dependant respiratory depression - only of concern at anaesthetic doses

40
Q

What effects on parameters does ketamine have, and when is this an important consideration

A

Causes a transient increase in cardiac output and blood pressure
Can cause a reduction in BP in some sick patients
Some animals may not be able to cope with the stimulation produced by higher doses => think about use in cats with hypertrophic cardiomyopathy (HCM))

41
Q

How long do the effects of ketamine last

A

30-45 mins

42
Q

Is ketamine a good muscle relaxant

A

No - use in combination with a drug which causes good muscle relaxation e.g. midazolam or alpha 2

43
Q

What is the effect of ketamine on the eyes

A

Drying to the corneas
The eye can be centralised even when the animal is fully anaesthetised as it preserves cranial nerve reflexes

44
Q

Give examples of anticholinergics (x2)

A

Atropine
Glycopyrrolate

45
Q

What are the effects of anticholinergics as part of a pre-med
which drugs should you never use them with

A

Reduce bradycardia - sometimes used in response to a drop in HR (DON’T if used alpha 2)
Reduce respiratory tract secretions

46
Q

What are some unwanted effects of anticholinergics (x3)

A

Mydriasis (pupil dilation)
Reduced gut motility
Bronchodilation

47
Q

What class of drug is alfaxalone

A

Neuroactive steroid

48
Q

What are the effects of alfaxalone when used in a premed

A

Induction agent
Sometimes used to sedate sick patients

49
Q

What system does alfaxalone have adverse effects on

A

Cardiovascular system,

50
Q

What are the 3 pharmacokinetic properties required of drugs used in premeds

A

Relatively rapid onset - readily absorbed
Centrally acting - distributes to the brain
Relatively short acting - short elimination time

51
Q

What is the time of onset and the duration of action of alpha 2 agonists

A

Rapid onset of action e.g. 5 mins for Xylazine in cattle
Short duration of action e.g. 40 mins for detomidine in horses

52
Q

Which alpha 2 agonist has the greatest selectivity for the alpha 2 receptor

A

Dexmedetomidine > medetomidine > Xylazine

53
Q

Which 2 of the 4 opioid receptor types are we most interested in for analgesia and sedation

A

Mu and Kappa receptors

54
Q

Do phenothiazines (ACP) cross the BBB and placenta

A

Yes

55
Q

Do phenothiazines (ACP) have a long or short duration of action and onset of action

A

Released slowly from fat - longer onset of action
Slow elimination, half-life of 24-48 hours - longer duration on action

56
Q

What properties of benzodiazepines allows them to be absorbed orally and by IM

A

High lipid solubility

57
Q

What organ metabolises benzodiazepines

A

Liver

58
Q

How long after ketamine administration will the patient begin to regain consciousness

A

15-20 mins

Week 2&3 FCP (20 decks)

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