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anesthesiology > Premedication (Garcia) > Flashcards

Premedication (Garcia) Flashcards

1
Q

Acepromazine

A
  • Potent sedative and anxiolytic
  • categorized as an antipsychotic, used for schizophrenia in people
  • anti-emetic
  • Anti-arrythmic properties
  • Dec dose requirement of other drugs
    • blocks domaminergic effects in brain
      • enhances analgesia of opioids
  • don’t give to boxers
    • unless used previously without problems
  • NON-REVERSABLE
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2
Q

Why premed?

A
  • Humane: minimize stress
  • May decrease other drugs: Synergism
    • injectibles
    • inhalents
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3
Q

Example of synergism

A
  • Sedatives + opiods
    • sedative can inc analgesic affect of opiods (phenothiazines: ace)
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4
Q

Neuroleptic def

A
  • Major sedative (also described as antipsychotics)
  • Cause deep sedation
    • Acepromazine
    • alpha-2s
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5
Q

Analgesics

A
  • opioids
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6
Q

Neuroleptoanalgesia

A
  • sedative + opioids
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7
Q

Drug selection

A
  1. Species
  2. Age
  3. Physical status (ASA)
  4. Animal behavior and attitude
  5. Procedure
  6. Duratio of precedure
  7. Experience with drugs used
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8
Q

Anticholinergic drugs

A
  • atropine sulfate
  • glycopyrrolate
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9
Q

About anticholinergics

A
  • Blocks acetylcholine on muscarinic receptors only in central and peripheral nervous system
  • inhibits parasympathetic nerve impulses
  • Uses
    • respiratory disorders
    • sinus bradycardia due to hypersensitive vagus nerve
    • dizziness/motion sickness
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10
Q

Main effect of anticholinergics

A

tachycardia

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11
Q

Primary use of atropine

A

treat bradycardia

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12
Q

Unwanted effect of anticholinergics

A
  • block the feedback receptor for acetylcholine causing a surge in release of acetylcholine
    • Causes initial worsening of bradycardia before an inc in heart rate
    • Causes AV block on EKG (some P waves without QRS)
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13
Q

Giving Atropine dosage info

A
  • ALWAYS GIVE FULL DOSE
    • because if not you will just get that initial acetylcholine surge without the tachycardia you were going for
    • Can commonly inc HR 2x to 3x

*If you only give partial dose and get bradycardia, go ahead and give full dose

*If tx of full dose doesn’t fix bradycardia can give epinephrine

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14
Q

Epinephrine

A
  • adrenergic agonist (inc sympathetic tone)
    • will inc heart rate
    • BUT ALSO severe vasoconstriction/hypertension
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15
Q

Opiods commonly cause

A
  • bradycardia
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16
Q

Other side effects of anticholinergics

A
  1. dec vagal influence on HR
  2. dec secretions (salivary secretions)
  3. Bronchial dilation
  4. inc anatomical and physiologic dead space
  5. dec GI motor and secretorya activity
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17
Q

Ketamine

A
  • sympathomimetic
    • causes tachycardia
    • some people combine ketamine plus atropine (Garcia doesn’t like)
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18
Q

Ruminants and muscarinic blockers

A
  • Ruminants have lots of salivary secretions and atropine can clog up trachea
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19
Q

Horses and anti-muscarinics

A

may cause colic, use carefully

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20
Q

Atropine sulfate

A
  • Tertiary amine molecule
  • High lipid solubility
    • easily crosses BBB and Placental barrier
    • should see effect in 2 minutes
  • reported sedation in people, not animals…

*some prefer glycopyrrolate in preggos

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21
Q

Glycopyrrolate

A
  • Synthetic quaternary ammonium molecule
  • Low lipid solubility
  • Does not cross BBB and placenta
  • No effects on CNS
  • Same peripheral effects as atropine, slower onset, lasts longer

*USE ATROPINE WHEN SHIT HITS FAN

*Maybe less inc in HR than atropin

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22
Q

Major tranquilizers

A
  • Phenothiazines
    • Acepromazine (cheap and reliable)
  • Butyrophenones
    • Droperidol
    • Azaperone
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23
Q

Hit by car dog sequelae

A
  • will have inc circulating catecholamines => inc arrhymogenicity
    • ace can protect from arrhythmias but some gray zones
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24
Q

acepromazine side effects

A
  • alpha-antagonist
    • severe vasodilation & bradycardia (maybe don’t give to Hit by car)
    • cardiac depression
    • decreases adherance of platelets
    • peripheral alpha-2 adrenergic blockade
    • relaxation of vascular smooth muscle
      • don’t give to DCM patients
    • persistent or permanent penile paralysis
      • 1/10,000 in horses
25
Q

Droperidol and azaperone

A
  • preferred to ace in pigs
26
Q

Type of Opioids

A
  • mu-agonist
  • Partial mu-agonist
  • K agonist - mu antagonists
  • antagonists
27
Q

mu agonists

A
  • Drug examples
    • morphine
    • fentanyl
    • methadone
  • Causes
    • respiratory depression (test question)
    • vomiting
    • bradycardia
    • decreased GI motility
  • Linear relationship to response
28
Q

partial mu-agonist

A
  • drug example
    • buprenorphine
  • Ceiling effect
    • can start reversing effects at high doses
29
Q

k agonist - mu antagonist

A
  • Drug examples
    • butorphanol
    • nalbuphine
  • sometimes used to reverse complete agonists respiratory depression while maintaining some analgesia
30
Q

opioid antagonists

A
  • naloxone
  • naltrexone
31
Q

Mu receptors cause the most

A
  • analgesia
  • side-effects: limiting factor
    • respiratory depression (test question)
      • ​causes a lot of death in people
    • vomiting
    • bradycardia
    • decreased GI motility
  • Linear relationship to response
32
Q

Morphine IM

A
  • Sometimes used to make animals puke when they eat a ton of food
  • morphine will almost ALWAYS make an animal barf

*after first dose opioids are an ati-emetic

*apomorphine will cause vomiting

33
Q

If an anticholinergic does not reverse a bradycardia think….

A

hypothermia

34
Q

Potency is…

A
  • dose related
  • nothing to do with strength of analgesia
35
Q

How do we pick opioids

A

Side effects and duration

36
Q

Histamine release as result of morphine and noperadine

A

can get hypotension, vasodilation, urticaria

37
Q

Methadone is an ……….. antagonist

A

NMDA

38
Q

Buprenorphine is very…..

A
  • long lasting
  • moderate pain relief
  • good for cats because of oral bioavalability
  • poor oral bioavailability in dogs
  • binds strongly to receptor
39
Q

Butorphanol

A
  • good sedative
  • mild to moderate analgesia
  • can reverse mu receptor agonism
40
Q

Benzodiazepines

A
  • anterograde amnesia
  • GABA agonist
    • hypothalamus
    • Midbrain
    • Hippocampus
    • Medulla
    • Spinal cord
41
Q

Diazepam

A
  • anxiolytic
  • muscle relaxant
  • anticonvulsant effect
  • rapidly crosses BBB and placental barrier
  • minimal cardiovascular effects
    • dec BP and CO
  • Propylene glycol is base of this drug
    • high lipid solubility => not friendly, and hurts => don’t give IM
42
Q

Diazepam often used with ……

A

ketamine

43
Q

Ketamine + Diazepam (propylene glycol vehicle)

A
  • safe
    • opioids will precipitate with propylene glycol
  • propylene glycol hurts IM
44
Q

Midazolam

A
  • Water soluble
    • becomes lipid soluble at pH > 4
  • Can be given IM
  • More potent, shorter acting than Diazepam
  • Crosses BBB and placental barrier

*Can mix with any opioids in syringe

45
Q

Zolazepam

A
  • most potent benzo used in vetmed
  • available only in Telazol
  • anticonvulsant and muscle relaxant
  • least apt to cause CNS depression
46
Q

Reversal for benzos

A
  • Flumazenil
    • competitive antagonist of benzo receptor
    • very weak agonist effect
      • no anxiety with reversal
47
Q

alpha 2 adrenergic agonists

about……

A
  • anxiolytic
  • sedative and muscle relaxant
  • analgesia
  • dec ADH release = inc urinary output
  • dec insulin release
  • hypertension followed by hypotension
  • reflex bradycardia

*reversal exists

48
Q

alpha 2 adrenergic agonist

cardiovascular effects

A
  • dec HR
    • hypertension
    • dec sympathetic tone
  • dec CO
    • dec myocardial contractility
    • dec HR
  • inc then dec BP
49
Q

Don’t give alpha-2s to

A
  • sick dogs
    • especially cardiovascularly sick dogs
50
Q

Good drug to use with xylazine

A
  • atropine
51
Q

Do not trocharize …….?! dogs with…..

Only with…..

A

dexmetatomidine

Xylazine

52
Q

Xylazine

A
  • Less selective for alpha-2 receptors
    • Dirty: has alpha-1 effects too
  • More ataxia
  • shorter duration
  • 2nd degree AV block….?
53
Q

Detomidine

A
  • Not very selective for alpha-2s
  • Profound sedation compared to xylazine
  • Ataxia
  • large animal
54
Q

Romifidine

A
  • Still not very selective
  • good sedation
  • less ataxia
  • large animal
    • used for recovery
55
Q

Dexmedetomidine

A
  • most selective
  • profound sedation
  • may intubate some dogs
  • quick acting

*causes vasoconstriction give in big muscle….? Quads

56
Q

Reversals for non-selective alpha-2s

A
  • Tolazoline
  • Yohimbine
  • Give only SC or IM
    • May be given IV to Large animals
57
Q

Reversals

alpha-2 selective drugs

A
  • antipamizole for dexmetatomidine
  • give only SC or IM
    • May be given IV to large animals
58
Q

Guaifenesin

A
  • central muscle relaxant
    • different from NMB
  • Used as adjuvant in large animal induction
  • Smothes induction and decreases injectable dose
  • disrupts transmission at spinal cord and brain stem
  • inc RR and dec tidal vol
    • min vent unchanged
59
Q

Ketamine and alfaxolone

A
  • can be used as premed to cause chemical restraint
  • higher doses than used IV
  • used in difficult patients

anesthesiology (14 decks)

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