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Anesthesia > Premedication > Flashcards

Premedication Flashcards

1
Q

What is dissociative anesthesia

A

Form of general anesthesia characterized by catatonic state

Ketamine – information is processed w/o proper coordination in space/time

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2
Q

What is neuroleptanalgesia

A

State similar to general anesthesia produced by a sedative and an analgesic

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3
Q

What to Anticholinergics do

A

Inhibit parasympathetic nervous system

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4
Q

Anticholinergics are antagonists on which receptors and what are two drug examples

A

Antagonists on muscarinic acetylcholine receptors

Atropine and Glycopyrrolate

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5
Q

How is atropine given, does it cross BBB or placenta

A

IM, SC, PO - absorbs quickly

Crosses both

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6
Q

How does Glycopyrrolate differ from Atropine

A

Absorbs/onset slower
Doesn’t cross BBB/placenta
Dose is half
Water soluble not lipid

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7
Q

What are atropine and Glycopyrrolate used for

A

Increasing heart rate

Decreasing salivation/bronchial secretion

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8
Q

What are the contraindications of atropine and glycopyrrolate

A

Tachycardia, hyperthyroid, heart disease, narrow angle glaucoma

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9
Q

What are the cardiovascular side effects of anticholingergics

A

2nd AV block, bradycardia, cardiac arrest

Tachycardia, hypertension

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10
Q

Anticholinergics easily affect the _____, causing lot’s of ____ waves

A

SA node, lots of P waves

**atrial depolarization

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11
Q

Anticholinergics effect on ____ is weaker and comes later causing ____

A

AV node, AV blocks, bradycardia

**When AV node finally conducts there is excessive tachycardia

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12
Q

What happens when you combine Medetomidine and atropine

A

Vasoconstriction, tachycardia, hypertension

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13
Q

Routine co-administration of anticholinergic with _____ is contraindicted

A

Alpha 2 agonists and anticholinergics combined are contraindicted

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14
Q

What are some other effects of anticholinergics

A 
Relaxes lower esophagus (regurg)
Mydriasis (glaucoma)
Bronchodilation
Dries airway secretions
Intestinal paralysis
CNS toxicity
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15
Q

What group are the strongest sedatives

A

Alpha 2 agonists

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16
Q

Alpha 2 receptors on the presynaptic membrane

A

Suppression of NE release by negative feedback

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17
Q

Effects of alpha 2 on presynaptic

A

Sedation, Analgesia, reduction of sympathetic outflow from brain, reduction of stress response

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18
Q

Alpha 2 receptors on postsynaptic – location

A

In the wall of arteries and veins

** Alpha 1 receptors here also

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19
Q

Alpha 1 and 2 mediate ____

A

vasoconstriction

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20
Q

Alpha 2 receptor extra synaptic sites

A

Pancreas B Cells – Hyperglycemia

Adipocytes

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21
Q

Alpha 2 agonists CNS effects

A

Sedative
Some analgesia
Muscle relaxation

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22
Q

Alpha 2 agonists cause strong ____ leading to high ______

A

Strong vasoconstriction leading to high SVR and BP

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23
Q

Alpha 2 agonists can develop a reflex ____ resulting in ______

A

Reflex bradycardia resulting in low CO and tissue perfusion

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24
Q

Alpha 2 agonists respiratory effects

A

Bronchoconstriction, V/Q mismatch, lung edema and hypoxemia in ruminants

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25
Q

Which alpha 2 agonists are containdicated in sheep

A

Xylazine

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26
Q

Which alpha 2 agonist most commonly causes vomiting in cats

A

Xylazine

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27
Q

Which drug may cause uterine contractions and abortion in cattle

A

Xylazine

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28
Q

Which Alpha 2 antagonist should always be used

A

Atipamezole

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29
Q

Medetomidine is a 50:50 _____

A

Racemic mixture

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30
Q

_______ is the active optical isomer

A

Dexmedetomidine

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31
Q

_______ is the inactive isomer

A

Levomedetomidine

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32
Q

_______ is twice as potent as medetomidine

A

dexmedetomidine

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33
Q

Phenothiazines act as antagonists on which receptors

A

Dopamine
Serotonin
Alpha 1
Histamine

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34
Q

What is a common long acting phenothiazine

A

Acepromazine

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35
Q

CNS effects of phenothiazine

A

Weaker sedative than alpha 2
NO ANALGESIC
Antimetic effect
Mild resp depression

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36
Q

phenothiazine is an antagonist on _____ receptors causing ____ and ____

A

Alpha 1 receptors causing vasodilation and hypotension

***May cause death in hypovolemic patients

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37
Q

phenothiazine can cause _____ in horses

A

penile prolapse

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38
Q

phenothiazine is used for _____ for premedication or post OP

A

Mild sedation for premedication or post OP

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39
Q

phenothiazine can be used for prevention/treatment of _____

A

Opioid dysphoria

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40
Q

What can be used for prevention of emesis caused by morphine

A

phenothiazines

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41
Q

phenothiazine can be used for sedation of dogs with _____

A

laryngeal paralysis

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42
Q

phenothiazines are contraindicatd with

A 
*Hypovolemia, hemodynamic instability
Very young/old
Von-Willebrand dz
*Boxers
Breeding stallions
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43
Q

Two Butyrophenones

A

Droperidol and Azaperone

44
Q

How do butyrophenones differ from acepromazine

A

More likely to cause behavioral side effects

Less hypotensive, stronger antiemetic

45
Q

Benzodiazepines work on what type of receptor

A

GABA receptor agonists

46
Q

Benzodiazepines have what type of effects

A

Sedative, anticonvulsant, muscle relaxant
Minimal CV and resp effects
No analgesia

47
Q

GABA is the main ______ in the CNS

A

Inhibitory neurotransmitter in the CNS

48
Q

GABA receptors are allosterically activated by

A

Benzodiazepines

49
Q

This is the site of most anesthetics

A

GABA receptors

** Ketamine is an exception

50
Q

Benzodiazepine agonists

A

Diazepam

Midazolam

51
Q

Benzodiazepine antagonists

A

Flumazenil

52
Q

Benzodiazepine sedation has a _______ effect

A

species specific effect

53
Q

Benzodiazepines have a better sedative effects in

A

Ruminants, camelids, pigs, birds and ferrets

54
Q

Benzodiazepines sedation causes disorientation in

A

Dogs, cats, horses

55
Q

Benzodiazepines can be used as a premedication when combined with

A

Opioids, alpha 2 agonists or both

56
Q

Benzodiazepines can be used for induction when combined with

A 
Dissociative anesthetics (ketamine)
Barbituates or propofol
57
Q

Benzodiazepines can be used as a treatment for

A

Seizures (Status epilepticus)

58
Q

Diazepam can be formulated in

A

Propylene glycol or lipid emulsion

59
Q

Diazepams chemical compatibility is ____

A

limited

60
Q

Diazepam has poor absorption and is ____ on IM injection

A

Painful

61
Q

Midazolams chemical compatibility is ____, it is ___ potent than diazepam and is ____ acting

A

Chemical compatibility is good, it is more potent than diazepam and is shorter acting

62
Q

Diazepam and Midazolam are both metabolized in the liver but which one has inactive metabolites

A

Midazolam has inactive metabolites

63
Q

Midazolam can be given

A

IM or IV

64
Q

What are opioids

A

exogenous substances that bind to opioid receptors and activate them

65
Q

Opioids are the strongest available _______

A

systemic analgesics

66
Q

Opioids are the best choice of treatment for

A

acute pain such as surgery

67
Q

Opioids decrease the doses of ____

A

Anesthetics

68
Q

Opioids have minimal ____ side effects

A

Minimal CV side effects

69
Q

What are the three Opioid receptors and what they do

A

U - strong analgesia, resp depression
K - weaker analgesia
g - weaker analgesia (human)

70
Q

Where are the locations of Opioid receptors

A

Brain, spinal cord (dorsal horn), peripheral nerves, inflamed organs (arthritis)

71
Q

Four classifications of Opioids

A

Full agonist - full tissue response
Partial agonists - partial response
Antagonists - bind receptors but don’t activate them
Mixed agonist/antagonist - activate one receptor and inhibit another

72
Q

What type of Opioid is butorphanol

A

Antagonist on Mu and agonist on kappa

73
Q

Four drug schedules and an example of each

A

1 - heroin
2 - morphine (mu agonists)
3 - buprenorphine
4 - butorphanol, tramadol

74
Q

Potency tells you the

A

Dose

75
Q

Efficacy tells you the

A

Strength

76
Q

Pharmacokinetics

A

Onset, duration of effect, administration strategy

77
Q

CNS effects of Opioids

A

Analgesia
Decreases MAC of inhalants
(Primates > Dogs > Cats > Pigs > Horses)

78
Q

Opioids sedation depends on

A 
Species (primates and dogs are better)
Pain level (stronger if there was pain)
79
Q

Opioids can cause

A

Excitation (cats), dysphoria, tolerance, dependence

80
Q

Opioids may trigger or inhibit

A

Vomiting – stimulate chemoreceptor trigger zone outside of BBB, after entering brain they inhibit vomit center

81
Q

____ soluble opioids (morphine) enter the brain slowly causing _____

A

Water soluble opioids enter more slowly causing more vomiting

** Fentanyl does the opposite

82
Q

Opioids have minimal ____ effects

A

Cardiovascular effects

83
Q

Opioids have no direct negative ____ or _____

A

No direct negative inotropy or vasodilation

**May indirectly cause reduction in BP/bradycardia

84
Q

Opioids are suitable for most _______

A

Risk patients

85
Q

Opioids can be used for

A

Premedication, perioperative analgesia, treatment of acute and chronic pain

86
Q

As a premedication opioids can be used alone or in combination with

A

Benzodiazpines, ketamine, acepromazine, Alpha 2 agonists

87
Q

Fentanyl is a strong ____ as a _____ agonist

A

Fentanyl is a strong analgesic and is a full Mu agonist

88
Q

Fentanyl has a ___ onset and ____ duration

A

Fast onset and short duration (15-20 min)

89
Q

Remifentanil is similar to fentanyl but is ______ acting

A

Very short acting (5 min)

90
Q

Butorphanol is works on what receptors

A

Antagonist on Mu and agonist on Kappa

91
Q

Butorphanol is ____ and ____ acting analgesic

A

Weak and short acting analgesic

92
Q

Buprenorphine is a ______ agonist

A

Partial Mu agonist

93
Q

Buprenorphine is a ____ analgesic than butorphanol but weaker than _______ agonists

A

Stronger analgesic than butorphanol but weaker than full Mu agonists

94
Q

Tramadol is a ___ analgesic

A

Weak analgesic

95
Q

Tramadol metabolizes in the liver and its metabolite is a ________

A

Mu opioid agonist

96
Q

Tramadol can be given ____ and it inhibits ____ and ____ reuptake

A

Can be given PO, inhibits NE and serotonin reuptake

97
Q

What are two opioid antagonists and what is their duration

A

Naloxone - 30 min

Naltrexone - 10 hours

98
Q

What are two muscle relaxants, are they central or peripheral

A

Guaifenesin - central

Dantrolene - Peripheral

99
Q

Guaifenesin is commonly used in

A

Large animal anesthesia

100
Q

Guaifenesin shouldn’t be used alone because

A

Doesn’t provide any analgesia or unconsciousness

101
Q

Most commonly used concentration of Guaifenesin

A

5% in dextrose

102
Q

> 10% concentration of Guaifenesin can cause

A

Thrombophlebitis

103
Q

What is guaifenesin used for

A

Premed - improve muscle relaxation

Part of TIVA - Triple drip (GG + A2 + ketamine)

104
Q

Dantrolenes site of action

A

muscle cells

105
Q

Dantrolene is used for treatment of

A

Malignant hyperthermia

106
Q

H1 antagonist

A

Diphenhydramine - anaphylactic reaction

107
Q

H2 antagonist

A

Ranitidine, famotidine, cimetidine - increase stomach pH

Anesthesia (7 decks)

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