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AHT 1170 > premeds, induction agents, Inhalation Anesthetics > Flashcards

premeds, induction agents, Inhalation Anesthetics Flashcards

1
Q

Anesthetic agent

A

any drug used to induce a loss of sensation w/ or w/out unconsciousness

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2
Q

Adjunct

A

not true anesthetic but used during anesthesia to produce other desired effects- sedation, muscle relax, analgesia, reversal, neuromuscular block

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3
Q

Pharmacokinetics

A

effect body has on a drug incl movement of drug within the body

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4
Q

Pharmacodynamics

A

effect a drug has on the body; drug action

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5
Q

Agonists

A

drug that binds to and stimulates tissue receptors

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6
Q

Antagonists

A

drug that binds to but doesn’t stimulate tissue receptors

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7
Q

Partial agonists

A

drug that binds to but only partly stimulates tissue receptors

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8
Q

Agonist-antagonist

A

drug that binds to >1 receptor site, simultaneously stimulating at least one and blocking at least 1

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9
Q

Why dispense Premedication

A

○ To calm or sedate
○ To minimize adverse effects of other drugs
○ To reduce dose of other drugs
○ To produce smoother inductions
○ To decrease pain
○ To produce muscle relaxation

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10
Q

Classes of Premedication

A

● Anticholinergics
● Phenothiazines
● Benzodiazepines
● Alpha 2 adrenergic agonists
● Opioids

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11
Q

what are Anticholinergics

A

● Block the binding of acetylcholine at the muscarinic receptor (parasympathetic system)
○ Allow ‘fight or flight’ to predominate

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12
Q

anticholinergics effects

A

○ Prevents bradycardia
○ Reduces salivation and secretions of lacrimal, GI, and respiratory
tract
○ Mydriasis
○ Bronchodilation

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13
Q

anticholinergics adverse effects

A

○ May induce first or second degree AV block resulting in
sinus tachycardia
○ Atropine may induce temporary bradycardia if given at
low doses
○ Increased viscosity of salivary and respiratory
secretions

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14
Q

common anticholinergics

A

atropine, glycopyrolate

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15
Q

Atropine characteristics

A

○ Onset is 5 min. IM, and 1 min. IV
○ Peak effect in 10-20 min IM and 3-4 min IV
○ Duration of 60-90 min
○ Choice for CPCR (Cardiopulmonary cerebral resuscitation, CPR)

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16
Q

glycopyrolate characteristics

A

○ Peak effect in 30-45 min
○ Duration of 2-3 hrs
○ Less likely to induce arrhythmias
○ Suppresses salivation more effectively
○ Minimally crosses placental barrier

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17
Q

common phenothiazines

A

● Acepromazine maleate (‘ace’ or ‘acepromazine’)

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18
Q

routes for ACE

A

IV, IM, SQ, oral

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19
Q

is there reversal for ACE

A

no

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20
Q

ACE onset of action, duration

A

● Onset of action
○ 15 min if given IM in dogs or IV in horses
○ Peak effect in 30-60 min
● Duration
○ 4-8 hrs in small animals
○ 1-3 hrs in horses
○ Longer in sick, old, or debilitated animals

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21
Q

ACE effects

A

● Major effects:
○ Sedation
○ Peripheral vasodilation
■ Hypotension
■ Increased HR
■ Increased heat loss
○ Antiarrhythmic
○ Antiemetic

● Mild effects
○ No respiratory depression, but worsens resp depression of other agents
○ Antihistamine
○ No analgesia

Adverse effects
○ Reduction of seizure threshold
○ Hypotension
○ Penile prolapse
○ Reduced PCV
■ Caused by increased uptake of RBC by spleen

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22
Q

ACE use
or who not to use it on

A

● Remember! - Effects are dose dependent, higher doses
causes increased hypotension without increased sedation
● Increased potency is noted in geriatrics, neonates, liver
and cardiac patients
● Collies, Aussies, sighthounds, boxers and giant breeds
can be more sensitive to effects

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23
Q

Benzodiazepines examples

A

○ Diazepam
○ Midazolam
○ Zolazepam
○ Lorazepam
○ Alprozolam

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24
Q

routes for benzodiazepines

A

IV, IM (not diazepam), oral

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25
Q

Reversal available for benzodiazepines?

A

Yes- flumazenil
○ Not used commonly due to expense and infrequency of need

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26
Q

benzodiazepines onset/ duration

A

● Onset of action
○ 15 min given IM
● Duration
○ 1-4 hrs

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27
Q

which benzodiazepine is not water soluable

A

diazapam

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28
Q

what should diazapam only be mixed with

A

.ketamine

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29
Q

Benzodiazepines effects

A

● Major effects
○ Antianxiety and calming effect
○ Anticonvulsant
○ Muscle relaxation
○ Appetite stimulant in cats and ruminants

● Minor effects
○ No analgesia
○ Minimal effects on respiratory or cardiovascular systems
■ Good use for anesthetic of high-risk and geriatric patients

● Adverse effects
○ Produce unreliable sedation in young healthy animals (dysphoria, excitement, ataxia)
○ Large animals may become ataxic or recumbent, horses may have muscle tremors/twitching
○ Can cross placental barrier, therefore may see CNS depression in neonates
○ Diazepam given rapidly IV can cause pain, bradycardia, hypotension, and apnea
○ Cats receiving oral diazepam can develop hepatic failure

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30
Q

what is diazapam soluble in

A

plastic

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31
Q

Diazepam and midazolam sensitive to what

A

light

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32
Q

why are Benzodiazepines used with other agents

A

to help achieve safe,
smooth induction to anesthesia

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33
Q

Midazolam used for what

A

commonly in protocols for pocket pets
and birds

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34
Q

what is diazepam used for

A

used for behavior modification

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35
Q

are benzodiazepines controlled substances

A

yes

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36
Q

Alpha 2 Adrenoceptor
Agonists (A-2 agonists) examples

A

Drugs
○ Xylazine
○ Medetomidine
○ Dexmedetomidine
○ Detomidine
○ Romifidine

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37
Q

how to administer A2 agonists

A

IV, IM, (SQ - not as reliable)

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38
Q

are reversals available for A2’s

A

yes

39
Q

onset/ durations for A2’s

A

● Onset of action
○ 5-15 min if given IV
○ 15-30 min if given IM

● Duration
○ Approx 1-2 hrs

40
Q

effects of A2’s

A

● Major effects
○ Cause dose-dependent sedation that is profound
■ Horses often lower their head and droop their lower lip
○ Have analgesic properties (lasts ~ 20 min in xylazine)
○ Major cardiovascular effects
■ After injection patient experiences vasoconstriction, hypertension and bradycardia (pale mm)
■ May have arrhythmias during this time
■ This phase followed by phase of hypotension and further bradycardia (not seen in medetomidine/dexmedetomidine)
■ Effects more severe if given IV
○ Depression of respiratory system (dose-dependent effect) that is most notable in ruminants
○ Muscle relaxation
○ Vomiting in cats (some dogs) that is most common with xylazine

● Minor effects
○ Hyperglycemia due to reduced secretion of insulin by pancreas
○ Hypothermia occurs due to loss of thermoregulation
○ Markedly reduces amounts of other agents required

Adverse effects (most profound if given IV)
○ May become hyper responsive or aggressive
(especially if excited prior to injection)
○ Horses may become more likely to kick
○ Cattle may lie down (very sensitive to a2s)
○ Dramatic decrease in HR, BP, & CO
○ Brachycephalics or animals with upper airway obstruction may suffer dyspnea
○ Diuresis
○ GI effects: bloat, increased salivation, regurgitation
○ Late stage abortion in ruminants
○ Sweating in horses
○ Intra-arterial injection can cause seizures or collapse

41
Q

are A2’s absorbed by the skin

A

Absorbed through open skin or mucous
membranes

42
Q

who should use A2’s

A

For young, healthy patients!

43
Q

can you use A2’s with anticholinergics

A

Co-administration with an anticholinergic will increase the workload of the heart and myocardial oxygen consumption
○ You will not be allowed to use anticholinergics with A-2s

44
Q

Xylazine characteristics

A

○ Available in two concentrations
○ Very out of flavor in small animal medicine
○ Used in combinations with horses

45
Q

Dexmedetomidine/Medetomidine characteristics

A

○ Used in small animals
○ Dexdomitor vs domitor
○ Greater potency and adverse effects are less
pronounced than xylazine
○ Recommend dosing based on body surface area
○ Often mixed with other agents
○ Can be used alone for minor procedures
■ Rads, ultrasound (can be aroused with stimuli)

46
Q

Detomidine characterisitcs

A

Used for equine
○ Has twice the duration of xylazine
○ Used in horses for sedation, analgesia, and muscle relaxation
○ Often combined with other agents
○ Most potent of the a-2s

47
Q

Romifidine characteristics

A

○ Used for equine
○ Has longest duration of action
○ Produces least ataxia and head droop

48
Q

Alpha 2 Antagonists drugs

A

○ Tolazoline
○ Yohimbine
○ Atipamezole

49
Q

how are A2 antagonist drugs administered

A

○ IM (IV, SQ)

50
Q

A2 antagonist onset timing

A

5-10 min

51
Q

Alpha 2 Antagonists effects

A

● Adverse effects
○ Amount given should be based on amount of agonist
given
○ If >30 min since injection of agonist, amount of
antagonist should be recalculated
○ Overdose can cause excitement, muscle tremors,
hypotension, tachycardia, salivation and diarrhea

52
Q

Use of A2 antagonists

A

○ Tolazoline most used to reverse xylazine in ruminants
○ Yohimbine most used to reverse xylazine in cats, dogs, horses, and exotics
○ Atipamezole used to reverse dexmedetomidine
○ Will reverse sedation and analgesia

53
Q

IV atipamezole recommended?

A

no

54
Q

opioid agonists

A

○ Morphine
○ Hydromorphone
○ Oxymorphone
○ Fentanyl
○ Meperidine

55
Q

opioid Partial agonists

A

Buprenorphine

56
Q

opioid Agonist-antagonists

A

Butorphanol

57
Q

opioid Antagonists

A

Naloxone

58
Q

opioid routes

A

IV, IM, SQ, oral, rectal, transdermal, epidural

59
Q

opioid reversal

A

Naloxone

60
Q

opioid duration

A

○ In general ½ - 3 hrs
○ Buprenorphine = 6-8 hrs
○ Morphine = 6-8 hrs

61
Q

opioid effects

A

● Major effects
○ Can cause sedation or excitement
○ Analgesia
○ Bradycardia
○ Minimal decrease in resp rate and tidal volume
○ May cause panting
○ May be hyper responsive

● Minor effects
○ Dogs may become hypothermic
○ Cats become hyperthermic
○ Sweating in horses
○ Decreased urine production with urine retention

● Adverse effects
○ Anxiety, dysphoria
○ Bradycardia - from increased vagal tone
○ Decreased resp rate and tidal volume - this is dose dependent and worsens if given with other respiratory depressant drugs
○ Salivation and vomiting
○ Initial increased peristalsis then ileus
○ Addiction
○ Caution in use with head traumas or CNS disorders

62
Q

opioid uses

A

○ Analgesic
○ Premed
○ Neuroleptanalgesia

63
Q

optioids controlled substances?

A

yes, except naloxone

64
Q

Neuroleptanalgesia

A

A state of profound sedation and analgesia induced by the simultaneous administration of an opioid and
tranquilizer
○ Can be used for sedation for minor procedures or to induce anesthesia
○ Do not give rapidly IV

65
Q

Opioid Antagonists

A

Naloxone

66
Q

Opioid Antagonists route

A

IM.IV

67
Q

opioid antagonist onset, duration

A

● Onset of action
○ 2 min IV
○ 5 min IM

● Duration
○ 30-60 min

68
Q

Opioid Antagonists effects

A

○ Reverses desirable and undesirable effects of opioids

69
Q

Opioid Antagonists uses

A

○ In cases of overdoses
○ Emergencies
○ Reversal of neuroleptanalgesia
○ Neonates delivered by c-section

70
Q

Induction Agents loss of consciousness

A

○ Unconsciousness is achieved once sufficient brain
levels obtained
○ Movement of agent from blood to brain occurs via concentration gradients
○ Speed of induction and recovery determined by the lipid solubility of agent
○ Drugs that are highly lipid soluble cross cell
membranes faster (faster onset and recovery)

71
Q

how do induction agents work

A

Upon injection of agent
○ High levels of drug in blood
○ These drugs rapidly are taken up by brain
○ Low level in muscle, fat, and organs

Once injection is completed
○ Levels in blood drop
○ Agent leaves brain because of concentration gradient
○ Agent leaves blood and enters tissues

Recovery occurs
○ Once levels in brain become low enough, the animal recovers consciousness
○ The drug however is still in the fat, muscle, and tissues
○ Different drugs excreted differently but patient not fully recovered until all agent has left body (may take >24 hrs)

72
Q

Propofol characteristics

A

● Ultra-short acting
● Nonbarbiturate
● Used for induction and maintenance of anesthesia
● Also used for treatment of status epilepticus
● Pharmacology
○ Minimal water solubility
○ Milky, but can be given IV

73
Q

is profol controlled

A

● Non Controlled - but many practices will still record in drug log as a precaution.

74
Q

onset and duration

A

● Onset of action
○ 30-60 sec

● Duration
○ 5-10 min

75
Q

Propofol effects

A

● Major effects
○ Dose dependent CNS depression
○ Cardiac depression - bradycardia, decreased CO, hypotension
○ Respiratory depressant - APNEA
○ Twitching during induction
○ Muscle relaxation

● Minor effects
○ Relatively safe for animals with liver and kidney dysfunction
○ Appetite stimulant at low doses
○ Antiemetic
○ Decreases intracranial and intraocular pressure

● Adverse effects
○ Excitement during induction if injection is too slow
○ Hypotension - may be prolonged if patient previously
hypotensive
○ Induction apnea
○ Irritating when given SQ
○ Heinz body formation in repeated dosing to cats

76
Q

propofol uses

A

○ Give does slowly to effect (bolus first half, then give to effect)
○ Can also be used as CRI to maintain GA
○ Manufacturer recommends discarding product after 6 hrs of opening
○ Cost is 4X that of ket/val

77
Q

Alfaxalone characteristics

A

● Ultrashort-acting injectable anesthetic
● Wide margin of safety
● Relatively new in Canada
● Can be given IV or IM
● Works similar to propofol

78
Q

Alfaxalone effects

A

● Effects
○ Dose-dependent CNS depression & resp depression
■ Apnea
○ Hypotension (especially when used with inhalant)
○ Muscle relaxation
○ No analgesia
○ Cardio system depression minimal
○ Smooth induction, no excitement
○ Not irritating in inadvertently given perivascular

79
Q

Alfaxalone use

A

○ Given similar to propofol - bolus ~ half, then to effect
○ Duration 5-10 min
○ Repeated dose does not prolong recovery, therefore CRIs are possible
○ Better shelf life

80
Q

what Dissociative Anesthetics are used

A

○ Ketamine
○ Ketamine-Diazepam combo

81
Q

ketamine onset, duration

A

● Onset of action
○ 1-2 min IV
○ 10 min IM
● Duration
○ 20-30 min
○ Higher dose increases duration, not depth

82
Q

ketamine effects

A

● Effects
○ Cataleptic state - patient does not respond to stimulus and maintains muscle rigidity
○ Intact reflexes - difficult to assess depth
○ Central eye that has mydriatic pupils and open lids
○ Normal or increased muscle tone
○ Analgesia to skin and limbs, limited to viscera
○ Amnesia - humans
○ Increased sensory stimuli
○ Do not become bradycardic

● Adverse effects
○ Stimulation to sound, light, etc
○ Abnormal behaviors in recovery
○ Nystagmus
○ Decrease contractility - patient with heart disease can not compensate
○ Predispose to development of arrhythmias
○ Increase salivation and resp secretions
○ Tissue irritation if given perivascular
○ Increased intracranial and intraocular pressure

83
Q

ketamine dosing

A

Can be given IM or IV

84
Q

ketamine use

A

○ IM use is limited to fractious cats
○ Can be given orally to fractious cats
○ If given repeated doses can increase risk of seizure activity and prolong recovery
○ Undergoes hepatic metabolism and renal excretion - use caution if renal or hepatic disease

85
Q

Ketamine-Diazepam use

A

○ IV induction for cats and dogs
○ Equal volumes of each mixed in same syringe (watch for precip)
○ Give to effect
○ Duration: 5-10 min
○ Minimal cardiac depression
○ Good muscle relaxation
○ Superior recovery
○ Some analgesia

86
Q

Guaifenesin (GGE) characteristics

A

● Not an anesthetic on its own - given in combination with other agents
● Needs to be reconstituted

87
Q

Guaifenesin (GGE) effects

A

● Effects
○ Muscle relaxation
○ Minimal cardiopulmonary effects

● Adverse effects
○ Can cause thrombophlebitis or tissue reaction if given perivascular

88
Q

Guaifenesin (GGE) use

A

○ Used in combination with other agents for induction and maintenance of anesthesia
○ Given rapidly IV after premed until signs of knuckling noticed, then induction agent given

89
Q

why Inhalation Anesthetic Agents used

A

○ Easier to control depth
○ Elimination through lungs
■ Less dependent on liver and kidneys
○ Less expensive than injectables

90
Q

inhalation agents cons

A

○ Expensive equipment required
○ Waste gas pose risk to patient and staff

91
Q

Inhalation Anesthetic Agents characteristics

A

● Liquids at room temperature
● Stored in vaporizer
○ Evaporate in the oxygen that
flows through
● Eliminated through the body via the
lungs
○ Provided the animal continues to
breathe!
● Minimal liver metabolism

92
Q

inhalation anesthetic agents CNS effects

A

Dose related, reversible depression (to a point)
○ Hypothermia
○ No analgesia
○ Increased intracranial pressure, especially if poor
ventilation and CO2 levels increase
○ Paddling, excitement and muscle tremors on recovery (counteract with premed)

93
Q

Isoflurane characteristics

A

○ Most commonly used agent
○ Fewest cardiovascular effects of halogenated
compounds
○ Depressed respiratory system
○ Eliminated through lungs
○ Adequate muscle relaxation
○ No analgesia
○ Rapid induction/recovery
○ Pungent aroma

94
Q

Sevoflurane characteristics

A

○ Very rapid induction and recovery
○ Minimal cardiovascular depression
○ Eliminated by lungs
○ Adequate muscle relaxation
○ Some paddling on recovery

AHT 1170 (8 decks)

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