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Anesthesiology > Premedication (part 2) > Flashcards

Premedication (part 2) Flashcards

1
Q

What are the three opioid receptors and where are they located?

A

u, k, d

- CNA & peripheral

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2
Q

Can opioids safely be used in patients with CV disease?

A

YES, it has minimal CV effect

- do not use in those with life- threatening bradyarrhythmias.

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3
Q

What opioids are most likely to cause vomit? and why?

A

Morphine and hydromorphone

- Least Lipophilic

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4
Q

Can pain cause ileus?

A

YES

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5
Q

Opiods work by…

A

acting on spinal, supraspinal & peripheral receptors to modulate pain transmission to brain (signal gets to brain- just confuses brain)

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6
Q

Opioids side effects

A

analgesia, sedation/excitation, respiratory depression, anti-tussive, bradycardia ( minimal CV effect), nausea/vomiting, urinary retension, hypothermia/ hyperthermia & histamine release.

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7
Q

What spp. feel hyperthermia with opioids?

A

cats & ferrets, also pigs, horses & wild

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8
Q

Why use opioids as a premed?

A

Sedation, provides peri-operative analgesia, spp. dependent MAC sparing effect, minimal CV effect & contribute to smooth pain-free recovery

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9
Q

What opioid is a full u agonist and NMDA receptor antagonist?

A

Methadone

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10
Q

When is full u agonist opioid used alone?

A

calm or sick dog

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11
Q

When is full u agonist opioid used with ace or a2 agonist?

A

excited or young animals

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12
Q

Which 2 opioid is rarely used as a premed?

A

Remifentanil- but iy is appropriate for patients with severe liver disease!
Tramadol

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13
Q

Since tramadol is a weak u agonist, why does it work in cats?

A

because produce an active metabolite (o-desmetyltramadol) which is more potent u agonist

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14
Q

When should a full u agonist be used?

A

moderate or severe pain

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15
Q

When should a partial agonist be used?

A

for mildly painful procedures; good post op!

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16
Q

Effects of buprenorphine

A

Long lasting ( 8 hr commitment), less effective analgesic, minimal sedation/ resp. depression with NO vomiting or nausea!

17
Q

Examples of full u agonist?

A

Morphine, hydromorphone, oxymorphone, methadone, fentanyl, remifentanil, tramadol & ultrapotent opioids

18
Q

Example of partial u agonist?

A

Buprenorphine

19
Q

Butorphanol MOA

A

K receptor agonist and u receptor antagonist

20
Q

When should you use butorphanol?

A

Non painful procedure (scope, imaging) BUT NOT a good choice if pt needs SX

21
Q

Butorphanol effects

A

Limited analgesic effect (use in horse to limit ileus), good sedative, good anti-tussive and does not cause emesis

22
Q

What is used to reverse the side effects of full u agonist?

A

Naloxone ( can reverse analgesia)

others- butorphanol and buprenorphone can reverse side effects while retaining analgesia!

23
Q

NSAID effect

A

GI injury, kidney injury, ischemia, hepatotoxicity, coagulation

24
Q

What does prostaglandin do?

A

increases blood flow to GI mucosa and increases mucus secretion/ bicarb!
It also regulates GFR & Renal blood flow

25
Q

What should be done before starting a pt on NSAIDs?

A

PE, BWK + Urinalysis

26
Q

If NSAIDs are given perioperatively, what should you monitor?

A

blood pressure!

27
Q

Healthy (ASA I or II) Dog IM sedation

A

Sedative (a2 agonist) OR tranquilizer + opioid+/- hypnotic (aggressive)

28
Q

ASA >III (neonatal or geriatric) Dog sedation (IV)

A

combo with minimal CV effect=

opioid + benzodiazepine

29
Q

Healthy (ASA I or II) Cat IM sedation

A

Typically higher dose than dog

Sedative (a2 agonist, ace only works with well behaved cats!) + opioid+/- hyponotic (agressive)

30
Q

ASA >III (neonatal or geriatric) cat sedation (IV)

A

combo with minimal CV effect=

opioid + benzodiazepine

31
Q

Sedating an aggressive horse

A

A2 agonist +/- butorphanol (IV), detomidine (PO),

Telazol & a2 agonist (very aggressive)

32
Q

T/F

Horses need to be very well sedated before induction of general anesthesia?

A

True, even if they are sick make sure you sedate!

33
Q

How do you know a horse is adequately sedated?

A

o Lowered head ( below shoulder), uninterested in surrounding ( not responding to noise), ptosis/ glazed eyes, can pull tongue or don’t chew finger when placed in mouth!

34
Q

Sedating Small ruminant

A

o Combination of opioid + benzodiazepine; a2 agonist can cause pulmonary edema (SO USE LOW DOSE!)

35
Q

Sedating calf

A

combo of opioid + benzodiazepine

36
Q

Sedating adult cow:

A

combo low dose xylazine + opioid

37
Q

Sedating pig

A

Premed with hypnotic (ketamine or alfaxalone), Sedate with benzo (ex. pre med with dexmed+ ketamine+ midazolam) & include anti-emetic because they are prone to nausea/vomiting

Anesthesiology (12 decks)

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