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Anesthesia > Premeds > Flashcards

Premeds Flashcards

1
Q

What is the MOA of Atropine and Glycopyrrolate

A

Anticholinergics. Competitive Antagonists of MAchR (anti-muscarinics) increase HR by blocking muscarinic receptors

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2
Q

Effects of Anticholinergics

A

Increase HR-used to treat bradycardia. Bronchodilation, reduced, thicker secretions. Mydriasis, increase IOP. dec motility/ileus. Sedation, hallucinations

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3
Q

Atropine Metabolism

A

Excreted unchanged in dogs. Hepatic and renal esterase’s in cats, small ruminants. Will not affect 30% of rabbits so use Glycopyrrolate.

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4
Q

Advantages and Disadvantages Anticholinergics (Atropine, Gylcopyrrolate) as pre-meds?

A

Ad: Used to treat bradycardia + hypotension, reduce salivation, reduce bronchial secretions

Disadv: Thickening of secretions (risk for airway obstruction), decrease GI motility, increase myocardial O2 consumption/arrhythmias

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5
Q

Phenothiazine (Acepromazine) MOA

A

D2, a1, H1 MachR antagonists
CNS: tranquilization, Neuroleptoanalgesia (if given with opioids) decreased MAC
Vasodilation
Hypothermia (will loose heat)
Antiemetic, relaxes LES, delay gastric emptying
Dec. HCT, dear. PLT aggregation

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6
Q

Acepromazine uses

A

Use in healthy, normal patients
Good Antiemetic
Lasts long (don’t use if patient needs to go home)
CANT be REVERSED
Giving more won’t increase sedation, use low doses
DON’T use in: young,old, hepatic dysfunction patient
Less reliable (Don’t use in aggressive/excited)
Decreases BP (Don’t use in hypovolemic)
Causes Priapism (Don’t use in breeding stallions, bull)
CV collapse in boxers

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7
Q

Benzodiazepine MOA/effects

A

GAGA receptor agonist, makes less excitable

Effects: sedation, anxiolysis, anticonvulsant, MM relaxants

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8
Q

What type of patient should you use Benzodiazepine for?

A

Good sedative for young, old, sick, small ruminants, pigs

Don’t use in healthy patients, may cause excitement

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9
Q

3 Benzodiazepines

A

Diazepam, Midazolam, Zolazepam

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10
Q

Benefits of Benzodiazepines

A

min CV effects, dose dependent respiratory depressant, reduced anesthetic required, CAN REVERSE/antagonize, must give with opioids/hypnotic, undergo hepatic metabolism

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11
Q

Diazepam ingredients

A

35% propylene glycol
ONLY IV
Insoluble in water
light sensitive-cant leave out in syringe

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12
Q

Midazolam ingredients

A

IM, SQ or IV
water soluble (only at ph 3.5)
lipid soluble (at physiologic pH)
Comes alone, no propylene glycol

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13
Q

Zolazepam ingredients

A 
\+tiletamine=Telazol
Powder-reconstituted
Smooth recovery in cats, pigs
Rough recovery in dogs, horses
Used for wild, aggressive animals
*Tigers experience prolonged recovery, ataxia, seizures, death*
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14
Q

What is Flumazenil?

A

Antagonist of Benzodiazepines. Reversal drug

can cause seizures

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15
Q

Alpha-2 Agonists MOA

A

Mimic negative feedback
Decrease NE release, Dec Ca conductance
Also act on a1 receptors & imidazoline I2 (not xylazine)
Medetomidine (most selective)> Detomidine> Xylazine(least selective)

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16
Q

a-2 Agonists effects

A 
Sedation, analgesia, MAC reduction
causes vomit, dec. motility 
Biphasic: hypertension then hypotension
up to 66% CO reduction
dec. thermoregulation
Cyanosis
hyperglycemia, insulin suppression
Hyperkalemia in big cats
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17
Q

What causes Fulminant pulmonary edema in ruminants?

A

Alpha-2 Agonists (don’t use)

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18
Q

What causes hyperkalemia in large cats (they can die)

A

Alpha-2 Agonists

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19
Q

Advantages of a-2 Agonists

A

reliable does-dependent sedatives -the more given, the more sedated (unlike ACE)
horses stay on their feet
REVERSIBLE
Analgesic
Not controlled
Can be administered all routes (IM, IV, SQ, oral, neuraxial)

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20
Q

What are the side effects of a-2 Agonists

A

Bradycardia, hypotension, dec. CO
Do not use in neonates, only healthy patients!
Dec. temp
Emesis
Dec. GI motility
Hyperglycemia (suppresses insulin production)

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21
Q

Xylazine uses

A

a-2 Agonist (not commonly used in small animals)
Pro emetic in cats
Seizures in horses if injected via carotid

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22
Q

Detomidine uses

A

a-2 agonist
Used in horses, pigs
more potent than xylazine, longer lasting

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23
Q

Romifidine uses

A

a-2 agonist
Licensed for horses
Lasts longer than xylazine

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24
Q

Medetomidine uses

A

a-2 agonist

For wild animal capture

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25
Q

Dexmedetomidine

A

a-2 agonist
Dexter-rotatory isomer
Twice as potent as medetomidine (doses are half)
Used as CRI-analgesia, sedation

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26
Q

a-2 Antagonists uses

A

ends sedation, treats over-dose, to reawaken wild animals
Reverses analgesia too
Side effects: CV effects, seizure w/ ketamine, will not help bradycardia from a2-antagonists

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27
Q

What are three a-2 adrenergic antagonists

A

Tolazoline
Yohimbine
Atipamezole (IM ONLY)

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28
Q

Do a-2 antagonists have side effects?

A

Yes
Tolazoline can cause hypotension, arrhythmias, death
Atipamezole can cause sudden death, CV collapse, H release

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29
Q

If after giving Dexmedetomidine (a-2 agonist) your patient is bradycardia + hypertensive, what do you do?

A

Nothing, increase halogenate, or reverse

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30
Q

If after giving Dexmedetomidine (a-2 agonist) your patient is bradycardia + normotensive, what do you do?

A

nothing

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31
Q

If after giving Dexmedetomidine (a-2 agonist) your patient is bradycardia + hypotensive, what do you do?

A

Give Anticholinergic! Atropine or Glycopyrrolate

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32
Q

Maropitant MOA

A

Antiemetic, NK1 antagonist
Give PO before premed to reduce a-2 agonist induced vomit
Don’t give SQ, painful

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33
Q

Metoclopramide MOA

A

Antiemetic
5H3 (serotonin) antagonist, D2 (Dopamine) antagonist
Pro kinetic & antiemetic
may be used as CRI

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34
Q

Ondansetron MOA

A

Antiemetic

5H3 antagonist

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35
Q

Name 3 Antacids

A

Famotidine
Omeprazole
Na Citrate

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36
Q

Famotidine use

A

Antacid

H2 antagonist

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37
Q

Omeprazole use

A

Antacid
Proton Pump inhibitor
increases pH

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38
Q

NA Citrate uses

A

buffer, antacid
Oral ONLY
Don’t use in patients with CKD (can cause metabolic alkalosis), or heart problems

39
Q

Opioids undergo what type of metabolism?

A

Hepatic metabolism (except Remifentanil)

40
Q

Where are opioid receptors located?

A

CNS +peripheral (almost everywhere in the body)

41
Q

3 Analgesia effects of Opioids

A
  1. Dorsal horn
  2. Suprea-spinal
  3. Peripheral
42
Q

Which Full u agonist can be given all routes and can cause vomiting and H release so give it slowly?

A

Morphine

43
Q

Name 4 drugs that can be used to pre-medicate calm, sick dogs. (Can also be used in combo with ACE or a2 agonist)

A

Morphine
Hydromorphone
Oxymorphone
Methadone

44
Q

Which Full u Agonist is also a NMDA antagonist?

A

Methadone

45
Q

What is an opioid, Full u agonist, that is given IV, epidurally, or trans-dermal patches?

A

Fentanyl

46
Q

Which opioid is most commonly associated with hyperalgesia, and can be given IV only through CRI (lasts 3-5 min)

A

Remifentanil

47
Q

Which Full u agonist opioid is mostly used post-anesthesia and is a NE & serotonin reuptake inhibitor?

A

Tramadol

48
Q

What are two ultra potent opioids used for capture?

A

Etorphine (antagonized w/ diprenorphine)

Carfentanil (antagonized w/ naltrexone)

49
Q

Partial Agonist used for mild pain procedures. Good for post-op pain management.

A

Buprenorphine

50
Q

Agonist-Antagonist used for non-painful procedures (imaging, endoscopes, bronchoscopy, BAL) in horses

A

Butorphanol

51
Q

Name 3 Antagonists & what they reverse

A

Naloxone -reverses Full u Agonists
Naltrexone- reverses Carfentanil
Diprenorphine- reverses Etorphine

52
Q

What do you give a healthy ASA I or II ?

A
  1. a2 agonist or Acepromazine (tranquilizer) to sedate
  2. Opioid
    • Hypnotic if aggressive
53
Q

What do you give a ASA >III (neonate or geriatric)

A
  1. Don’t need sedation to place IVC

2. Pick a combo of opioid + benzodiazepine with minimal CV effects

54
Q

What happens to adult cattle when given hyaline as part of the premeds with an opioid.

A

Cows will go down! (as opposed to horses)

55
Q

Swine sedate well using what?

A

Benzodiazepines (Dexmedetomidine, Ketamine, Midazolam)

56
Q

What are the three most important distribution tissues?

A

Splanchnic viscera, muscles, fat

57
Q

Fast acting injectable Anesthetic, can give perivascular
Short CV depression
Apnea, respiratory depression
Protects brain (CNS friendly)
Must throw away after 6hrs of opening
Benzyl Alcohol prolongs shelf life to 28 days

A

Propofol

58
Q 
Injectable Anesthetic 
Increases sympathetic tone (inc. HR, BP)
Poor muscle relaxant
Often combined with Benzos for induction
Increases myocardial work load
Increases ICP, CBF, IOP (don't use in glaucoma patients)
Rough recoveries
Apneustic breathing, apnea
Maintained reflexes
A

Ketamine

59
Q

Injectable anesthetic stimulates sympathetics (inc. HR, BP)
Similar effects as ket/diaz.
Smaller volume
Rough recoveries
Can be reconstituted with Ketamine and alpha2

A

Telazol

60
Q

Injectable anesthetic used in patients with CV disease
Minimal cardiovascular changes so good for cardio patients
Adrenal suppression
Poor muscle relaxant
Combine with opioid or benzo for induction
Expensive

A

Etomidate

61
Q

What are two Opioids used as injectable anesthetics?
Dec. HR and ventilation
No myocardial depression
Reversible, analgesic

A

Fentanyl (short acting)

Hydromorphone

62
Q 
Fast acting injectable anesthetic 
Can give perivascular and IM
Cardiovascular depression
Apnea, respiratory depression
CNS friendly
A

Alfaxalone

63
Q

Can you be hypoxic without being hypoxemic?

A

Yes.

Examples: Thrombus, vasoconstriction, hypotension, low cardiac output, arrhythmia, low BP

64
Q

Below normal oxygen levels in blood

A

Hypoxemia

65
Q

Below normal oxygen levels in tissues

A

Hypoxia

66
Q

Causes of Hypoxemia

A

Low FiO2
Hypoventilation
ventilation: profusion mismatch
AV shunt (PDA)

67
Q

Why is it easy to become hypoxemic during the recovery period?

A
  1. Going from 100% FiO2 to room air 21% FiO2 (low FiO2)
  2. Drugs (opioids, propofol) cause hypoventilation
  3. Untreated pain may cause hypoventilation (high PaCO2)
68
Q

2 causes of Atelectasis (deflated alveoli)

A
  1. Absorption (from using 100% O2 with no N to keep alveoli open)
  2. Compression
69
Q

What causes High V/Q

A

Hypotension (alveolus ventilated but not perfused)

70
Q

What causes low V/Q

A

Atelectasis (alveolus perfused but not ventilated)

71
Q

If pop-off valve (APL) is left closed during surgery, what should you do?

A

Tell someone &

Monitor for pneumothorax hours after anesthesia is over!

72
Q

What is a drug used to treat malignant hyperthermia?

A

Dantrolene

73
Q

What should a capnograph read to indicate adequate chest compressions?

A

> 10 mmHg

74
Q

What three things should you have for advanced life support (ALS)?

A

Drug administration + monitoring

ECG, Doppler, Capnograph

75
Q

Which drugs can be administered during advanced life support

A

Atropine (in case vagal arrest)

Epinephrine (low dose)

76
Q

What is an important reason for selecting Glycopyrrolate over atropine?

A

Gylcopyrrolate does not cross the BBB or placenta

77
Q

Morphine, if given quickly IV, may potentiate hypotensive crisis by causing…

A

the release of Histamine

78
Q

An apneustic breathing pattern can be seen after giving…

A

Ketamine

79
Q

The anesthetic with the least cardiovascular affects in the dog is

A

Etomidate

80
Q

What happens if you give a local anesthetic in an infected area. Ex: Lidocaine

A

The drug will become less lipid soluble, ionized, ion trap in the acidic environment and won’t work

81
Q

What is EMLA cream used for?

A

Skin desensitization
A topical anesthetic mixture of lidocaine and prilocaine
for venipuncture or small mass removal
long onset of action, short duration

82
Q

What is a common complication of an inferior alveolar n. block (mandibular n.)

A

May block the lingual nerve! (Dog will chew on tongue)

83
Q

What are the target nerves of the Lumbar paravertebral block?

A

T13, L1, L2

84
Q

Interarcuate ligament (flavum)

A

the roof of the epidural space

Epidural space is between this and dura matter

85
Q

What space do you approach to give an epidural in large animals?

A

the Sacrococcygeal space

86
Q

What are 5 clinical signs of hypovolemia?

A 
Tachycardia
hypotension
weak pulses
prolonged CRT
cool extremities
87
Q

Pre-Op: Alfaxan, Dexmedetomidine, opioid+benzo

Intra-Op: Etomidate, isoflurane, Phenylephrine

A

HCM

88
Q

Pre-Op: Atropine, Acepromazine, opioid +benzo

Intra-op: Etomidate, isoflurane, ketamine, dopamine, dobutamine

A

Degenerative Valve Disease

89
Q

Butorphanol, Acepromazine
Induce with propofol only
Dexamethasone, cerenia

A

Respiratory disease

90
Q

Reversible opioids + bentos
morphine, ketamine
Inotropes to inc. CO

A

Chronic renal insufficiency

91
Q

Remifentanil, propofol, isoflurane

A

Liver Disease

92
Q

Midazolam, Mannitol, cerenia, Propofol only

A

Elevated ICP

93
Q

What are two things hypoventilation causes?

A

Hypoxemia

Hypercapnia

Anesthesia (1 decks)

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