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Nursing > Quiz Lect 4-6 (2) > Flashcards

Quiz Lect 4-6 (2) Flashcards

1
Q

What are five types of injectable anesthetics

A 
Barbiturates 
Propofol, 
disassociative anesthetics, 
neuroleptoanalgesia, 
alfaxalone
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2
Q

What does barbiturates do

A

Induce Anesthesia

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3
Q

What does propofol do

A

Induce or maintain Anesthesia

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4
Q

What do disassociative anesthetics do

A

They don’t produce unconsciousness alone

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5
Q

What is guaifenisin used for

A

Large animals only

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6
Q

How are barbiturates classed

A

Based on the duration of action.

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7
Q

Describe thiobarbiturates

A

High Lipid solubility, rapid effect, 30 to 60 second onset, 10 to 20 minute duration, short recovery time due to redistribution

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8
Q

What is the action and pharmacodynamics of barbiturates

A

Depresses nerve impulses in the cerebral cortex resulting in central nervous system depression and a loss of consciousness. This affect is terminated when the agent leaves the brain and is either metabolized excreted or redistributed

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9
Q

What is lipid solubility

A

Tendency of a drug to dissolve in fats, oils or lipids

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10
Q

Describe highly lipid soluble drugs

A

Thiopental, passes into brain cells more quickly causing a faster onset of action as compared with drugs with low lipid solubility

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11
Q

Describe drugs with a moderate lipid solubility

A

Pentobarbital, largely metabolized by the liver, a process that takes longer than redistribution

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12
Q

What is the name of the process where highly lipid soluble drugs are removed from the brain

A

Redistribution

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13
Q

Describe the duration of action with drugs with low lipid solubility

A

Phenobarbital, primarily excreted by the kidneys. A very long process

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14
Q

Describe the process of redistribution after Iv administration

A

Within 60 seconds of IV injection, thiopental is disbursed throughout the body via bloodstream. Large amounts of drugs rapidly reach the brain. Animal loses consciousness within 30 seconds. Once the thiopental concentration in the blood falls below that in the brain tissue the drug begins to leave the brain and reenter the circulation

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15
Q

Describe Thiopental absorption in the vessel rich group

A

Make up about 10% of total body weight but receive 75% of total blood flow

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16
Q

Describe thiopental absorption in muscle

A

Muscle makes up about 50% of body weight but receives only 20% of blood flow

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17
Q

Describe thiopental absorption in fat

A

Fat makes up 20% of body weight but receives 5% of blood flow

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18
Q

What can happen with repeat administration of thiopental

A

Prolonged recovery due to saturation of the tissues

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19
Q

What are barbiturates used for

A

An induction agent to allow et intubation followed by inhalent anesthetic

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20
Q

What are the effects of barbiturates on the central nervous system

A

Cause a full range of central nervous system depression, from mild sedation and hypnosis to complete unconsciousness. At low doses it can also cause central nervous system excitement

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21
Q

What are the effects of barbiturates on the cardiovascular system

A

Does direct depression of myocardial cells resulting in decreased cardiac output and causing hypotension immediately. There’s also a possibility of apnea, can also cause cardiac arrhythmias and rarely cardiac arrest

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22
Q

How do you minimize negative effects on the central nervous system by barbiturates

A

Injecting a barbiturate slowly over 10 to 15 seconds, using dilute solutions, avoiding use in patients with cardiac disease

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23
Q

Describe the effects of barbiturates on the respiratory system

A

Decreased respiratory rate, title volume, plus or minus respiratory arrest. A brief period of apnea is common after IV administration. Can cause respiratory center to become relatively insensitive to increased PaCO2

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24
Q

Why are barbiturates contra indicated in sight hounds

A

Due to small amounts of body fat’s causing oversaturation of tissues

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25
Q

What are injectable anesthetics

A

Drugs characterized by their ability to producer unconsciousness when given alone. Do not provide all the effect of general anesthesia. Must be used with other agents to produce the complete spectrum of affects for general and the seizure

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26
Q

In which patients should you avoid giving barbiturates

A

With hepatic disease, renal disease, hypothermia, hypotensive patients, shock patients

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27
Q

What happens if you inject barbiturates perivascular

A

Can cause tissue sloughing.

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28
Q

What do you do if you give barbiturates perivascular

A

Inject saline in the infiltrated area at least an equal volume to dilute the solution. 1 to 2 mL of 2% lidocaine without epinephrine may be added to the saline. Lidocaine causes vasodilation absorption of barbiturate a neutralization of the drug.

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29
Q

What can commonly happens during induction if barbiturates are given perivascular early or very slow

A

May result in stage two excitement

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30
Q

What happens if the barbiturates are not used within two weeks if refrigerated

A

They lose their potency

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31
Q

Are barbiturates able to give analgesia

A

No

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32
Q

How quick is the onset of action for thiopental

A

30 to 60 seconds

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33
Q

How long is the duration of thiopental

A

10 to 15 minutes

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34
Q

How long is the recovery for thiopental

A

Within 1 to 2 hours

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35
Q

Why is thiopental used

A

Used as an induction agents in small animal anesthesia or as a sole anesthetic for brief procedures

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36
Q

What is the shelf life for thiopental if refrigerated

A

1 to 2 weeks

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37
Q

What is the shelf life for thiopental at room temperature

A

Three days

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38
Q

What does 2% in mg/ml

A

20mg/ml

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39
Q

Why do you avoid injecting air when reconstituting thiopental

A

It can cause precipitate

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40
Q

What does the dosage of thiopental depend on

A

Concurrent use of other agents, depth of Anesthesia required

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41
Q

Is repeated doses cumulative for thiopental

A

Yes

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42
Q

What is the class of propofol

A

Hypnotic, ultra short acting non-barbiturate injectable anesthetic

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43
Q

Describe the mode of action and pharmacology for propofol

A

Minimally water-soluble. Appears to affect GABA receptors in a similar manner to barbiturates. Propofol is rapidly taken up by vessel rich tissues but very quickly redistributed to muscle and fat.

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44
Q

Where is propofol metabolized

A

Primarily in the liver but also can be in the lungs if liver is compromised

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45
Q

Where is propofol excreted from

A

The metabolites are excreted in the urine

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46
Q

What is the onset of action for propofol

A

30 to 60 seconds

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47
Q

What is the duration for propofol

A

5 to 10 minutes

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48
Q

How long is the complete recovery for dogs for propofol

A

20 minutes

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49
Q

How long is the complete recovery for cats for propofol

A

30 minutes

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50
Q

Describe the effects of propofol on the central nervous system

A

Dose-dependent central nervous system depression ranging from sedation to general anesthesia

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51
Q

Describe the effects of propofol on the cardiovascular system

A

Bradycardia, decreased CO2, increased vascular resistance, transient hypotension

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52
Q

Describe the effect of propofol on the respiratory system

A

Potential respiratory depressant, causes transient Apnea after rapid IV injection. Give Bolus slowly

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53
Q

What are the adverse affects of propofol on the central nervous system

A

Transient excitement and muscle tremors, paddling muscle twitching, nystagmus and seizures

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54
Q

What are the adverse affects on the cardiovascular system of propofol

A

Hypotension

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55
Q

What are the adverse affects of propofol on the respiratory system

A

Apnea

56
Q

Why is propofol used

A

Brief procedures of sedation such as x-rays, induction agent prior to intubation, maintenance of anesthesia via repeated IV bolus, maintenance of Anesthesia via constant rate infusion

57
Q

How is propofol given

A

Intravenously

58
Q

Describe the IV injection technique of propofol

A

Pre-oxygenate for 3 to 5 minutes. Give propofol slowly one fourth every 30 seconds.

59
Q

What are the advantages to using propofol

A

Wide margin of safety, many uses, no atropine premedication needed, repeated injection noncumulative

60
Q

What is propofol suitable for induction

A

In patients with severe renal or liver disease, young puppies or sight hounds, healthy bitches requiring C-section, asthmatic patients

61
Q

What are the disadvantages to giving propofol

A

Apnea, cardiovascular effects, muscle tremors, Poor analgesia, high cost

62
Q

What are the contraindications with propofol

A

Avoided in patients with cardiac disease, hypertension, avoid with opioids

63
Q

What is the mode of action and pharmacology of disassociative anesthetics

A

Disruption of the nervous system pathways within the cerebrum and the stimulation of the RAC causing selective CNS stimulation.

64
Q

What do disassociative anesthetics cause

A

The cataleptoid state, intact reflexes, ocular affects, increased muscle tone, Analgesia, sensitivity to light and sound

65
Q

What is the cataleptoid state

A

Patient does not respond to external stimuli and has a variable degree of muscle rigidity

66
Q

What reflexes remain intact with disassociative anesthetics

A

Palpebral, corneal, pedal reflexes, pupillary light reflex, laryngeal, swallowing reflex

67
Q

What are the ocular affects of disassociative anesthetics

A

Stay open resulting in increased drying so lubricants must be used. Pupils are central and dilated

68
Q

Describe the effects of muscle tone when on disassociative anesthetic

A

Increased muscle tone with some spontaneous random movement

69
Q

What are disassociative agents usually combined with

A

A tranquilizer to avoid excitement and improve muscle relaxation

70
Q

Describe the effects of disassociative agents on the cardiovascular system

A

Increased heart rate, CO2, blood pressure

71
Q

Describe the effects of disassociative agents on the respiratory system

A

High doses can apneustic respiration

72
Q

What are the adverse affects of disassociative agents on the central nervous system

A

Potential for seizure activity, may increase cerebral spinal fluid pressure, may cause temporary personality changes may induced nystagmus

73
Q

Describe the adverse effects of disassociative agents on the cardiovascular system

A

Increased risk of arrhythmias

74
Q

Describe the adverse affects of disassociative agents on the respiratory system

A

May cause respiratory depression or rest, causes increased salivation and respiratory tract secretions

75
Q

Why are dissociative anesthetics used

A

High margin of safety, maybe used for brief procedures when given with a tranquilizer, useful for restraint of fractious animals

76
Q

Why do we only give ketamine IV in dogs

A

Due to possibility of seizures after Im injections

77
Q

How is ketamine eliminated in the dog

A

By hepatic metabolism

78
Q

How is ketamine eliminated in the cat

A

Renal excretion

79
Q

What are the advantages to combining ketamine and diazepam

A

Minimal cardiac depression, good muscle relaxation, superior recovery

80
Q

What is neuroleptoanalgesia

A

Combination of an opioid and a tranquilizing agent that can produce a state of profound sedation

81
Q

What are the commonly used opioid agents in neuroleptoanalgesia

A

Morphine, buprenorphine butorphanol, Hydromorphone

82
Q

What are the commonly used tranquilizing agents in neuroleptoanalgesia

A

Acepromazine, diazepam, midazolam xylazine, medetomidine

83
Q

What is neuroleptoanalgesia used for

A

For induction of general anesthesia and dogs, to do sedation in patients undergoing minor procedures.

84
Q

When do neuroleptoanalgesics have a profound effect

A

In high risk or debilitated dogs.

85
Q

What can rapid infusion of neuroleptoanalgesia cause

A

Severe hypotension and cns stimulation. Can also cause severe respiratory depression

86
Q

What is referred pain

A

Pain felt in a place other than which it is situated

87
Q

What is hyperesthesia

A

Increased Sensitivity to heat, cold, touch

88
Q

What is pain

A

An aversive sensitory reaction that elicits a protective motor action and results in learned avoidance.

89
Q

How often do you assess pain in an animal during surgery

A

Hourly

90
Q

How often do you assess patients pain levels with chronic pain

A

Less often than major surgical patients.

91
Q

How do we obtain perioperative analgesia

A

Preemptive analgesia and multimodal therapy

92
Q

What are the benefits to multimodal analgesia

A

each individual drug dose is reduced
Overall anesthetic drug requirements are reduced
Overall risk of toxicity and adverse effects are reduced

93
Q

Describe animals who received premedication

A

Avoid windup

Less general anesthetic is needed for surgery

94
Q

How long before a surgery should a fentanyl patch be administered in small animals

A

6-12hrs

95
Q

NSAIDs affect blood flow to what organ which affects excretion

A

Kidneys

96
Q

How do we know if it’s safe to administer NSAIDs

A

PAP and check blood pressure during surgery. Can cause hypotension

97
Q

What is the mechanism of pain relief of opioids

A

Works at the brain and spinal cord

98
Q

What is the mode of action of NSAIDs

A

Tissue and brain level, reducing release of PG

99
Q

What is the mode of action of local anesthetics

A

Works at the level of the nerves. Blocks transmission of pain by sensory pathways

100
Q

What is the mode of action of an alpha 2 adrenergic agonist

A

Activates alpha 2 adrenergic receptors both centrally and at the periphery

101
Q

What is the mode of action of ketamine

A

Blocks the ndma receptor in the cns at the level of the spinal cord.

102
Q

What is the mode of action of corticosteroids

A

Tissue level, blocking pg production

103
Q

What is the mode of action of tramadol

A

Works at the brain level, inhibition of NE and serotonin uptake

104
Q

What is the mode of action of a tranquilizer

A

Perpetuates the actions of opioids in some patients

105
Q

How is the type of analgesia for surgery decided

A

By the severity, the type of pain and the animals general condition

106
Q

How can pharmacologic analgesia be achieved

A

Opioid agents
NSAIDs
Local anesthetics, alpha 2, ketamine, corticosteroids, tramadol, tranquilizer

107
Q

Why are opioids combined with a tranquilizer

A

Diminish windup if preemptive

Analgesia

108
Q

Why are opioids given postoperativly

A

To reduce pain

109
Q

If you have moderate to severe pain which opioid do you give

A

Morphine, fentanyl, Hydromorphone, oxymorphone

110
Q

When you have mild to moderate pain what do you give

A

Buprenorphine, butorphanol

111
Q

What are opioids metabolized by

A

The liver

112
Q

What are the disadvantage to giving opioid

A

Short duration when given by injection, cross the placental barrier, have potential for bad side effects

113
Q

What is the duration of morphine with severe pain

A

2-3hrs.

114
Q

What is the duration of morphine with mild to moderate pain

A

4-6hrs

115
Q

What is the duration of morphine oral

A

4-12hrs

116
Q

What are the routes of morphine

A

Slow iv in dogs. Im or sc.

117
Q

Why do you give dogs slow iv of morphine

A

Sudden release of histamine a

118
Q

What is particular about morphine given im

A

It doesn’t cause hypotension but it burns and is painful

119
Q

What are the adverse effects of morphine in dogs and cats

A 
Initial gi stimulation 
Potential respiratory depression 
Excitement 
Bradycardia 
Urinary retention 
Miosis
Hyperthermia
120
Q

How often do you have to give hydro for analgesia

A

Q4-6hr

121
Q

What is the difference between Hydromorphone and morphine

A

Hydro induces more vomiting

122
Q

How rapid is the onset when fentanyl is given iv

A

2 min

123
Q

What is the duration of fentanyl Iv

A

30 mins

124
Q

What is butorphanol good for

A

Moderate visceral pain

125
Q

What is the use of butorphanol

A

Preanesthetic, sedative, postop analgesia,

126
Q

What is the duration of butorphanol in dogs

A

1-2hrs

127
Q

What is the duration of butorphanol in cats

A

4hr after im or sc

128
Q

How is butorphanol given

A

Sc, im, iv, cri, oral

129
Q

What are the adverse effects of butorphanol

A

Some respiratory depression

130
Q

What is the duration of buprenorphine

A

6-12hrs

131
Q

Do you cut or trim the fentanyl patch

A

No never

132
Q

Where do you apply the fentanyl patch

A

Between the shoulder blades

133
Q

How long do you need to hold the fentanyl patch in place

A

2-3 mins

134
Q

Why are fentanyl patches used

A

Post op surgery, orthopaedic procedures etc

135
Q

How long are fentanyl patches good for

A

3 days

136
Q

What are the adverse effects of fentanyl

A

Constipation, miosis, muscle rigidity

137
Q

What should you avoid wth a fentanyl patch

A

Heat, don’t discharge a patient with the patch

Nursing (16 decks)

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