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Anesthesiology > Premedication > Flashcards

Premedication Flashcards

1
Q

Aims of premedication (6)

A 
• Relieve anxiety,/,fear,
• Facilitate,handling,
• Counteract side effects of anesthetic agents,
– Nausea/Vomiting/Salivation,
– Excessive mm tone
– Bradycardia
• Reduce the dose of anesthetics
• Contribute to perioperative analgesia
• Contribute to smooth recovery
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2
Q

5 types of PMs

A
  • sedatives and tranquilizers
  • analgesics
  • anticholinergics
  • anti-emetics and GI protectants
  • hypnotics
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3
Q

3 sedative/tranquilizer examples

A
  • phenothiazines
  • benzodiazepines
  • alpha 2 adrenergic agonists
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4
Q

2 analgesic categories

A
  • opiods

- NSAIDs

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5
Q

Anti-emetics and GI protectants (6)

A
  • NK-1 antagonists
  • D2 antagonists
  • 5-HT antagonists
  • PPIs
  • Anti-H2
  • buffers
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6
Q

3 hypnotic examples

A
  • alfaxalone
  • ketamine
  • tiletamine
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7
Q

Anticholinergic MOA

A

competative antagonist M AchR

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8
Q

2 anticholinergics

A
  • atropine

- glycopyrrolate

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9
Q

anticholinergic side effects

A
  • paradoxical bradycardia
  • ↑ HR
  • bronchodilation
  • ↓ secretions (increased viscosity)
  • Mydriasis
  • ileus
  • antisialogue
  • sedation/hallucinations
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10
Q

Which anticholinergic does NOT cross the BBB and placenta

A

Glycopyrrolate

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11
Q

atropine metabolism

A
  • Dog and human = hydrolysis + excreted unchanged
  • Cat + small ruminants = hepatic and renal esterases
  • Atropinase: 30% of rabbits
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12
Q

glycopyrrolate metabolism

A

excreted unchanged in urine

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13
Q

Why use anticholinergics as PM (3)

A
  • prevent bradycardia
  • reduce salivation
  • reduce bronchial secretions
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14
Q

Why not use anticholinergics as PM?

A
  • Thickening, of, saliva, and, bronchial secretions,
  • Decreased ,GI motility,
  • Increased, myocardial, oxygen consumption /arrhythmias
  • No study to prove benefit
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15
Q

Effects of Phenothiazines

A
  • tranquilization
  • ↓ MAC
  • vasodilation
  • hypothermia
  • antiemetic
  • relax LES
  • ↓ HCT and PLT aggregation
  • antihistaminic
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16
Q

Phenothiazine MOA

A

D2, alpha 1, H1, and M Ach R antagonists

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17
Q

Acepromazine should be avoided in what patients?

A
  • pediatric
  • geriatric
  • debilitated
  • hepatic dysfunction
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18
Q

Can ace be antagonized?

A

no

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19
Q

________ can cause priaprism in breeding stallions and bulls

A

acepromazine

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20
Q

benzodiazepine MOA

A

allosteric modulator of GABA a receptors

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21
Q

effects of benzodiazepines (4)

A
  • sedation
  • anxiolysis
  • anticonvulsant
  • mm relaxants
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22
Q

benzodiazepines are reliable sedatives in what patients?

A
  • very young
  • very old
  • very sick
  • small ruminants
  • pigs
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23
Q

benzos need to be associated with _________ or ________ for reliable sedative effect

A
  • opioids

- hypnotics

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24
Q

side effects of propylene glycol (found in Diazepam)

A
  • hemolysis
  • pain
  • thrombophlebitis
  • erratic IM/SQ absorption
  • hepatic failure w/ chronic PO use
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25
Q

Benzodiazepines

A
  • Diazepam
  • Midazolam
  • Zolazepam
  • Flumazenil
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26
Q

_______ and ______ experience a smooth recovery with Telazol (Zolazepam) but _____ and ______ have a rough recovery

A
  • cats and pigs

- dogs and horses

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27
Q

_______________: competative antagonist of benzodiazepines

A

Flumazenil

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28
Q

What is the drawback of Flumazenil?

A

Can cause seizures

29
Q

Effects of alpha-2 adrenergic agonists

A
  • sedation
  • MAC reduction
  • emesis
  • ileus
  • CO reduction
  • decreased ability to thermoregulate
  • biphasic CV effects
  • mild respiratory depressant
  • cyanosis
  • uterine ecbolic effect
  • ↑ urine production
  • suppression of stress response
  • insulin suppresion (hyperglycemia and hyperkalemia in large felids?)
30
Q

advantages of alpha-2 agonists

A
  • reliable sedatives
  • can be reversed
  • analgesics
  • not controlled
  • variety of administration routes
31
Q

do NOT give alpha 2 agonists to ______ or _______

A
  • neonatal patients (rely on HR for CO maintenance)

- sheep/goats (fulminant pulmonary edema)

32
Q

_______ is used as a pro-emetic in cats

A

xylazine

33
Q

__________ causes fulminant pulmonary edema in sheep/goats (mediated by macrophages)

A

alpha-2 agonists

34
Q

_________ is an alpha 2 agonist avaliable as an oral gel

A

Detomidine

35
Q

alpha-2 agonist which may be used as a CRI

A

Dexmedetomidine

36
Q

3 uses of alpha 2 antagonists

A
  • to terminate sedation
  • to treat overdose
  • after capture of wild animals
37
Q

Considerations before using alpha-2 antagonists

A
  • analgesia will be reversed too
  • ketamine convulsive action may be revealed
  • CV side effects
38
Q

3 alpha-2 antagonists

A
  • Tolazoline
  • Yohimbine
  • atipamezole
39
Q

_________ alpha-2 antagonists is licensed IM only

A

Atipamezole

40
Q

Tolazoline side effects

A
  • fasciculations
  • hypotension
  • ventricular arrhythmias
  • death
41
Q

3 antiemetics

A
  • Maropitant
  • Metoclopramide
  • Ondansetron
42
Q

3 antiacids

A
  • Famotidine
  • Omeprazole
  • Na citrate
43
Q

_________ antacid must be given orally

A

Na citrate

44
Q

Need to be careful with Na citrate as an antiacid in patients with __________ or __________

A
  • CKD (metabolic alkalosis)

- cardiac disease (risk of CHF due to Na overload)

45
Q

Opioids undergo hepatic metabolism, with the exception of _________

A

Remifentanil

46
Q

3 places opioids act on

A
  • dorsal horn
  • supra-spinal
  • peripheral nerves
47
Q

Sedation effects of opioids

A
  • may cause dysphoria (horses) or euphoria (cats)

- MAC sparing

48
Q

effects of opioids

A
  • mild respiratory depression
  • anti-tussive
  • bradycardia/AV blocks
  • miosis (mydriasis in cats)
  • both anti-emetics and pro-emetics
  • ileus
  • urinary retention
  • immune suppression
  • histamine release
  • hypothermia in dogs
  • hyperthermia in cats, ferrets, swine, and horses
49
Q

the more_______ an opioid is , the faster they reach the emetic center and the less likely they are to cause vomiting

A

lipophilic

50
Q

____________ is an opioid antagonist

A

Methylnaltrexone

51
Q

9 common side effects of opiods

A
  • dysphoria
  • respiratory depression
  • bradycardia
  • N/v
  • aspiration pneumonia
  • ileus
  • urinary retention
  • hyper/hypothermia
  • can induce hyperalgesia
52
Q

4 reasons to use opioids as PM

A
  • sedatives
  • contribute to intra-operative analgesia
  • MAC sparing effects
  • minimal CV effects
  • can contribute to a smooth, pain-free recovery
53
Q

full mu agonist opiods

A
  • morphine
  • hydromorphone
  • oxymorphone
  • methadone
  • fentanyl
  • remifentanil
  • tramadol
  • Etorphine
  • Carfentanil
54
Q

________is an opioid that also acts as an NMDA antagonist

A

Methadone

55
Q

__________ is an IV only opiod used in patients with severe liver disease

A

Remifentanil

56
Q

Does Tramadol work better in cats or dogs?

A

dogs

57
Q

________ is 4,000 times more potent than morphine and is antagonized with Diprenorphine

A

Etorphine

58
Q

________ is 10,000 times more potent than morphine and is antagonized with Naltrexone

A

Carfentanil

59
Q

_________ is a partial mu agonist

A

Buprenorphine

60
Q

_________ is an opioid agonist-antagonist

A

Butorphanol

61
Q

benefits of Butorphenol

A
  • good sedative
  • good anti-tussive
  • does not cause emesis
62
Q

3 opioid antagonists

A
  • Naloxone
  • Naltrexone
  • Diprenorphine
63
Q

________ and ___________ can be used to reverse the side effects of full mu agonists while retaining analgesia

A
  • Butorphanol

- Buprenorphine

64
Q

NSAIDs inhibit _______ production by inhibiting COX

A
  • eicosanoids
65
Q

Side effects of NSAIDs

A
  • GI injury (gastritis, enteritis, ulceration, perforation)
  • kidney injury
  • hepatotoxicity
  • coagulation
66
Q

Contraindications for NSAID therapy

A
  • pre-existing GI disease
  • pre-esisting kidney disease
  • hepatic insufficiency, increased LEs?
  • ↓ effective circulating volume
  • concurrent or recent corticosteroid administration
  • concurrent or recent administration of a different NSAID
  • concurrent use of other potentially nephrotoxic drugs
  • MCT
  • coagulopathies
  • pediatric patients
67
Q

NSAIDs

A
  • carprofen
  • meloxicam
  • Robenacoxib
  • Firocoxib
  • Deracoxib
  • Flunixin meglumine
  • Phenylbutazone
68
Q

Signs of adequate sedation in horses

A
  • head is lowered, below the shoulder (5 legged stance)
  • not interested in their surroundings
  • ptosis
  • glazed eyes
  • don’t protest if you stick your fingers into their mouth
  • don’t attempt to withdraw their tongue if you pull it out
69
Q

what will happen to cows once you give them xylazine (unlike horses)

A

they are likely to go down

Anesthesiology (13 decks)

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