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Anesthesia > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Describe schedule one drugs and list some examples

A

No currently accepted medical use and a high potential for abuse
Heroin, LSD, Marijuana, ecstasy, peyote

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2
Q

Describe Schedule II drugs and give some examples

A

High potential for abuse
Pure mu agonists- morphine, hydromorphine, oxymorphone, methadone, fentanyl, meperidine,

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3
Q

Describe schedule III drugs and give some examples

A

Moderate to low potential for dependence/ abuse
Ketamine and buprenorphine

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4
Q

Describe schedule IV drugs and give some examples

A

Low potential for abuse
Tramadol, benzodiazepines, butorphanol, alfaxalone

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5
Q

Describe schedule V drugs
Give an example

A

Very low potential for abuse
Cough medicine with less than 200mg of codine

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6
Q

Which drug is a phenothiazine and what is the mechanism of action

A

Acepromazine and sedative effect via antagonism of dopamine receptors

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7
Q

Does acepromazine provide analgesia

A

No

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8
Q

Can you reverse acepromazine

A

No

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9
Q

What are the cardiovascular effects of acepromazine

A

Vasodilation, hypotension, anti-arrhythmic

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10
Q

What GI use can acepromazine have

A

Anti-emetic

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11
Q

What are the four examples of alpha-2 agonists

A

Dexmedetomidine, romifidine, detomidine, xylazine

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12
Q

What is the mechanism of action of alpha-2 agonists

A

Produce sedation and hypnosis by activating the alpha-2 receptors in the locus ceruleus.
ALso decreases norepinephrine centrally and peripherally causing sedation and analgesia

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13
Q

Are alpha-2 agonists scheduled by the DEA

A

No

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14
Q

What are the cardiovascular effects of Alpha-2 agonists

A

Phase 1- vasoconstriction—> increase BP—> reflex bradycardia and decreases cardiac output
Phase 2- resolution of vasoconstriction and persistent low HR—> decreases blood pressure and cardiac output
significant decrease in cardiac output
Arrhythmias

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15
Q

What does alpha-2 agonists do to the GI and urogenital tract

A

Decreased motility and causes patient to urinate

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16
Q

Which alpha-2 agonist causes the largest increase in blood glucose

A

Xylazine

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17
Q

You have a horse and a cow, who will get the larger dose of xylazine most likely

A

The horse, ruminants are very sensitive and get 1/10 the dose that horses get

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18
Q

Which alpha-2 agonist would be good to give to a horse that will be trailered home soon after the procedure (you want to have less ataxia

A

Romifidine

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19
Q

Which alpha-2 agonist is also available in a gel and is used to treat thunderstorm anxiety in small animals

A

Dexmedetomidine (Sileo)

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20
Q

What reverses dexmedetomidine

A

Atipamizole

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21
Q

What reverses xylazine, romifidine, and detomidine

A

Yohimbine

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22
Q

Which alpha-2 agonist has a fast onset, short duration, and is safer and minimizes peripheral adverse effects while maintaining central ones

A

Zenalpha (medetomidine + vatinozan)

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23
Q

Compare the effects of Pure mu, partial mu, and mixed agonist/antagonist opioids

A

Pure mu have profound analgesia with moderate sedation, partial mu have moderate analgesia with mild/no sedation, and mixed have mild analgesia (species dependent) and moderate sedation

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24
Q

What schedules are the drugs that are pure mu, partial mu, and mixed agonists/antagonists

A

Pure Mu- schedule II
Partial Mu- Schedule III
Mixed- schedule IV

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25
Q

How do opioids effect the cardiovascular, respiratory, and GI systems

A

They depress them/ slow them and can cause nausea and vomiting

26
Q

What sedatives cause histamine release so you may see hives, hypotension, hyperthermia, and tachycardia in some patients

A

Opioids

27
Q

Which opioid is the only one that may cause an increase in heart rate (not a histamine release reaction)

A

Meperidine

28
Q

Which opioid can cause tremendous bradycardia

A

Methadone

29
Q

Which opioid is typically given as a CRI because its duration of action is only 30 minutes

A

Fentanyl

30
Q

Which opioid has the longest duration of action

A

Bupernorphine at 6-8 hours

31
Q

Which opioid can actually be used to reverse pure Mu drugs and causes more sedation because it agonizes kappa receptors

A

Butorphanol

32
Q

You are concerned a patient will have a histamine reaction to morphine if you give the drug IV. You elect to give it IM but what should you also give your patient

A

An anti-emetic because giving morphine not IV can cause vomiting (but IV causes more histamine release)

33
Q

What is meant by the phrase “neuroleptic analgesia” and what is the benefit

A

Giving an opioid and a major sedative that work synergistically to provide more effective sedation and more profound analgesia
You can use a lower dose of each drug too

34
Q

What do we typically give to reverse an opioid

A

Naloxone

35
Q

What is the mechanism of action of benzodiazepines

A

Causes sedation and anxiolytics by acting at GABA receptors

36
Q

What is an important fact about how diazepam can not be given

A

It is not water soluble so it can’t be mixed with other drugs (unlike midazolam) with the exception of ketamine. Should also only be given IV

37
Q

Do benzodiazepines provide analgesia

A

No

38
Q

What are the CNS, Cardiovascular, and respiratory effects of benzodiazepines

A

CNS- depress limbic system, thalamus, and hypothalamus- calming effect, anticonvulsant, mild sedation (not super effective in healthy adults), causes muscle relaxation
Minimal respiratory and cardiovascular effects

39
Q

Which pre-med is a good choice for neonates, geriatric, and debilitated patients

A

Benzodiazepines

40
Q

Benzodiazepines are commonly given with what as a co-induction agent

A

NMDA antagonists (ex. Ketamine and Valium

41
Q

Which induction agents augment the GABA receptors (inhibitory pathway)

A

Propofol, alfaxalone, etomidate, barbiturates

42
Q

Which induction agents suppress NMDA (excitatory pathway)

A

Ketamine and tiletamine

43
Q

Which induction drug is metabolized at both hepatic and extrahepatic sites so it is good to use in patients that may have liver problems

A

Propofol

44
Q

Which induction agent is good to use in patients with elevated intracranial pressure and why

A

Propofol because it decreases cerebral oxygen flow, blood flow and intracranial pressure
Also alfaxalone but maybe not because it produces myoclonus

45
Q

What should you always have when inducing with Propofol and why

A

Always should be able to intubate and ventilate a patient, give the dose slowly and titration to effect because it can cause significant respiratory depression

46
Q

What might you do to a patient before giving Propofol

A

Preoxygenate

47
Q

Is Propofol analgesic

A

No

48
Q

Why is Propofol not the best choice to use in a cat that is needing to be anesthetized many times for wet to dry bandage changes on a severe wound, what would be a better choice for an induction agent

A

Propofol can cause oxidative injury and Heinz body anemia in cats if repeated doses are given in a short time frame. Alfaxalone is a better choice

49
Q

What is a good induction agent to use when preforming a c-section and why

A

Propofol because it is rapidly metabolized by the fetus

50
Q

You survived vet school and you finally got a job! One of your associates comes to you, knowing you just graduated from UGA, and says “Hurry! I was about to do a mass removal on this cat and I induced with alfaxalone and now it is having a seizure! You need to call the anesthesia department at UGA and ask them what the heck is going wrong!!” You remember your anesthesia teacher telling you something about this… What can you confidently tell your associate?

A

There is no need to call. Myoclonus (muscle tremors) is a normal reaction for alfaxalone and while it can look like a seizure it isn’t. The animal is fine.

51
Q

What is a major perk of alfaxalone as a premed (hint it has to do with administration)

A

You can give it IM!

52
Q

How does the different administrations of alfaxalone effect how it acts in an animal

A

When given IM it is better as a premed but given IV it acts like Propofol to induce a patient

53
Q

What is a concern unique to using etomidate as an induction agent and knowing this what patients should you definitely not give it to

A

It can inhibit the enzyme which converts cholesterol to cortisol so it can depress the cortisol stress response, don’t give to patients that may have Addison’s because it may push them into an Addisonian crisis

54
Q

What should you use etomidate with if using it as an induction agent

A

A benzodiazepine because it provides poor muscle relaxation

55
Q

What is the induction agent of choice for patients in heart failure and why

A

Etomidate because it has minimal to no change in heart rate, BP, stroke volume, and cardiac output

56
Q

How can the PCP derivatives (ketamine, telazol) be given

A

IV or IM

57
Q

What are the CNS effects of PCP derivatives

A

When given alone without a premed- increased cerebral metabolic requirement for oxygen, increased cerebral blood flow, and increased intracranial pressure
Less effect if patient already under anesthesia or heavily premeditated

58
Q

What is the cardiovascular effect of PCP derivatives (ketamine, telazol)

A

Increased heart rate, blood pressure, and cardiac output and may cause tachycardia and arrhythmias due to sympathetic nervous system stimulation

59
Q

What is a benefit of using PCP derivatives like ketamine for induction in a patient that you may need to remove an oral mass from?

A

Laryngeal function is maintained so the patient could protect their own airway

60
Q

While ketamine by itself doesn’t cause significant respiratory depression, what can it do

A

Exacerbate the respiratory depressant effects of other drugs

61
Q

Why are PCP derivatives (ketamine, telazol) good induction agents for patients with a traumatic injuries or needing painful orthopedic surgery, but what is a draw back so what are they often given with

A

They have a profound analgesia effect by antagonism of the NMDA receptors and work at opioid receptors
However they provide poor muscle relaxation so they are often given with a benzodiazepine

62
Q

What induction agent should you NOT use if you are doing a c-section

A

PCP derivatives (Ketamine, telazol) because they can cross the placental barrier and causes severe fetal depression

Anesthesia (3 decks)

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