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Pharmacology & Anesthesiology > Sedatives > Flashcards

Sedatives Flashcards

1
Q

tranquilizers induce __________, whereas sedatives induce _____________

A

calmness; sleepiness

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2
Q

what are the 3 main types of chemical restraint agents

A

1) tranquilizers/sedatives
2) anesthetics
3) opiods

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3
Q

what are the 3 types of sedatives

A

1) phenothiazines
2) alpha-2 agonists
3) benziodiazepines

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4
Q

what is a huge caution regarding many IV CNS depressants

A

accidental injection into the carotid artery (instead of the jugular vein) can be fatal -> immediate convulsive seizures and death

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5
Q

sedated patients require (higher/lower) doses of induction agents, often on the order of ______ the dose required to induce an un-premedicated patient, and also often require (higher/lower) doses of inhalant anesthetic

A

lower; half; lower

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6
Q

T/F sedatives allow a smoother recovery from general anesthetics, but only if the procedure performed was painful

A

F; will smooth recovery regardless of pain as recovery from general anesthesia can be rough

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7
Q

what is the major phenothiazine sedative used

A

acepromazine

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8
Q

acepromazine is the phenothiazine of choice for all species except:

A

pigs

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9
Q

what are 4 effects of acepromazine

A

1) reduces fear and anxiety
2) reduces responses to stimuli
3) induces lethargy
4) relaxes muscles

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10
Q

onset of sedatives is fastest in what kind of environment

A

quiet (ex. cage rest for 15 min)

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11
Q

what is the main use of acepromazine

A

restraint (ex. pre-op)

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12
Q

what is the time to clinical effect for acepromazine for the following routes:
1) IV
2) IM
3) Oral

A

1) 15 min
2) 30 min
3) 60 min

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13
Q

what is the mechanism of action of acepromazine

A

Main action: blocks D2 (dopamine) receptors in the brain -> dopamine needed for wakefulness and motor activity -> sedation, reduced anxiety

Note: also blocks peripheral α1 receptors

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14
Q

what are the side effects of acepromazine (and other phenothiazines) and how does this happen

A

hypotension and sphincter relaxation; due to α1 receptor antagonism on the blood vessels and sphincters

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15
Q

T/F acepromazine can cause hyperthermia, regurgitation in all species and excessive vagal tone in all breeds but brachycephalic breeds

A

F:
- causes hypothermia
- regurgitation in ruminants
- excessive vagal tone uncommon except for in brachycephalic breeds

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16
Q

what is a concern regarding acepromazine and male horses

A

retractor penis muscles are adrenergic, so acepromazine causes penile prolapse -> can last long enough for edema to occur -> constriction of blood supply -> ischemic necrosis

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17
Q

what are some contraindications for acepromazine (phenothiazine) use

A

1) hypovolemic/shocky patients
2) breeding stallions
3) organophosphate poisoning
4) boxers
5) herding breeds with specific mutations (p-gp and MDR1)

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18
Q

T/F acepromazine should not be given to epileptic patients because it can promote seizures

A

FALSE

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19
Q

what is used in place of acepromazine for pigs and why

A

azaperone; has a 1 day withdrawal time (vs 7 days)

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20
Q

T/F azaperone can be used to stop fighting in pigs

A

F; just prolongs the fighting

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21
Q

what are the 4 alpha-2 agonists we discuss; which is the least potent

A

1) xylazine
2) detomidine
3) dexmetetomidine
4) romifidine

xylazine is the least potent

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22
Q

what is unique about xylazine compared to other alpha-2 agonists

A

the analgesic effect lasts only approx 30 min

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23
Q

how long does xylazine sedation last

A

2h (dose-dependent)

24
Q

what is the mechanism of action of xylazine and what are the 5 main effects

A

α2 agonist -> opens K channels -> inhibit NT release in brain pathways for:
- wakefulness (sedation)
- pain (analgesia)
- BP control (hypotension)
- motor activity (muscle relaxation)
- respiration (drop in O2)

25
Q

what animals are most prone to respiratory side-effects of xylazine and why

A

small ruminants, calves, sick cattle; via degranulation of pulmonary intravascular macrophages in ruminants

26
Q

what is a transient side effect of alpha-2 agonists, such as xylazine and how is it mediated

A

transient vasoconstriction and increased bp - via stimulation of peripheral alpha 1 and alpha 2b receptors on blood vessels

27
Q

what is a potential adverse effect of xylazine in large animals; why not in small animals?

A

hypotension (due to transient hypertension from alpha 1/2b receptors) followed by bradycardia (due to alpha 2a receptors); small animals tend to have normal or high bp

28
Q

what is a side effect of xylazine in cats that can be used clinically

A

induces vomiting in 2-5 min

29
Q

the effects of xylazine can be reversed by what drugs

A

alpha 2 antagonists:
- atipamezole
- yohimbine

30
Q

what species is highly sensitive to alpha-2 agonists and why; what dose do we give them

A

domestic ruminants; possess an alpha-2D receptor other species lack; get 1/10th regular dose

31
Q

how would you use xylazine in large animals in the following cases:
- for restraint
- for general anesthesia
- for a short surgical procedure

A
  • alone
  • with ketamine
  • with opioid
32
Q

detomidine is approved for what species

A

horses only

33
Q

if a horse is still kicking when given detomidine, what can you do

A

can give guaifenesin if animal is light, or add an opioid

34
Q

when would you choose detomidine over a xylazine for treating horses

A

if pain is greater (as analgesic effects last as long as sedative effects) or if a longer effect is desired

35
Q

peak detomidine sedation occurs in

A

5-20 min

36
Q

dexmetetomidine is used in what species

A

dogs and cats

37
Q

peak dexmetetomidine sedation occurs in

A

20-30 min

38
Q

T/F dexmetetomidine worsens the respiratory depression caused by opioids

A

T

39
Q

romifidine:
- approved for what species
- main benefit compared to other sedatives

A
  • horses
  • less head droop and ataxia
40
Q

what is a controversy of romifidine

A

analgesic effect is questionable

41
Q

what are the reversal agents for alpha-2 agonists

A

atipamezole, yohimbine

42
Q

how is atipamezole or yohimbine given and why

A

intramuscularly; giving IV can be fatal

43
Q

T/F atipamezole is more specific to α1 than α2

A

F; other way around

44
Q

what is the main benzodiazepine

A

diazepam

45
Q

what are the 3 effects of diazepam

A
  • muscle relaxant
  • sedative
  • anticonvulsant
46
Q

how does diazepam/ other benzodiazepines work

A

inhibits APs by stimulating the activity of GABA

47
Q

T/F benzodiazepines can be safely used with other CNS depressants

A

F; VERY BAD, DO NOT DO

48
Q

T/F when used alone benzodiazepines have little effect on the cardiovascular system

A

T

49
Q

you accidentally overdose a patient on diazepam (oops!) - what do you give them to reverse the effects

A

flumazenil

50
Q

benzodiazepines cause dose-dependent ______________ depression

A

respiratory

51
Q

what happens if you give a cat benzodiazepines chronically

A

they get an idiosyncratic Type B ADR that causes fulminant (aka severe and sudden) hepatic necrosis

52
Q

what is a clinical use of benzodiazepines in cats

A

appetite stimulation

53
Q

what is a potential behavioural problem observed when giving dogs and horses benzodiazepines

A

aggression and excitement

54
Q

what is a common induction mixture in small animal medicine involving benzodiazepines

A

1:1 ketamine: diazepam

55
Q

if you want a rapidly effective benzodiazepine, what do you choose and why

A

midazolam over diazepam; water soluble so better for IM use

56
Q

what is a benefit of guaifenesin over alpha-2 agonists and opioids

A

little to no cardiovascular or respiratory depression

57
Q

what type of drug is added to IV and crystallizes at room temperature, making it look like a bag full of styrofoam

A

guaifenesin

Pharmacology & Anesthesiology (12 decks)

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