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Pharm Exam II > Sedatives (Analgesia, Anesthesia) > Flashcards

Sedatives (Analgesia, Anesthesia) Flashcards

1
Q

tranquilizer (neuroleptic, anxiolytic)

A
  • induces state of behavioral change wherein anxiety is relieved and patient is relaxed although aware of surroundings
  • NO ANALGESIA or ANESTHESIA
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2
Q

sedative

A

induces state characterized by CNS depression and drowsiness, decreased awareness of surroundings

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3
Q

hypnotic

A

induces sleep

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4
Q

analgesic

A
  • attenuate nociceptive input leading to reduction in pain sensation
  • STOP TRANSDUCTION AND TRANSMISSION
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5
Q

antihyperalgesics

A
  • decrease central sensitization to pain

- DO NOT BLOCK TRANSMISSION OF STIMULUS

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6
Q

antinociception

A

diminished ability to perceive pain

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7
Q

narcotic

A

induces analgesia and stupor bordering on general anesthesia

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8
Q

neuroleptanalgesia

A
  • ANALGESIA and AMNESIC state produced by administration of a neuroleptic + narcotic
  • deep sedation achievable, unconciousness may occur
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9
Q

premedication

A

drug(s) given before a medical, surgical, or invasive procedure to induce sedation, analgesia, and relieve anxiety

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10
Q

blood-brain barrier

A
  • tight capillary endothelial junctions
  • sealed off by glial cells
  • active transport mechanism for removal of organic acids or bases (i.e. p-glycoprotein efflux pump)
  • constant flow of CSF into venous drainage
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11
Q

excitatory NTs

A
  • glutamate (NMDA receptor)

- acetylcholine

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12
Q

inhibitory NTs

A
  • GABA

- glycine (spinal cord)

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13
Q

what are the main effects of neuroleptics (tranquilizers)?

A
  • sedation and hypnosis
  • emotional quietness
  • dissociation from surroundings
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14
Q

what class of tranquilizers have analgesic effects?

A

alpha-2 agonists

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15
Q

what is the most common phenothiazine?

A

acepromazine

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16
Q

why might you want to be careful in using a phenothiazine with a nursing or late-term pregnant animal?

A
  • phenothiazines increase prolactin release which is normally inhibited by dopamine
  • dopamine is necessary for pregnant animals, at normal concentrations there is no milk letdown
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17
Q

what is the chemoreceptor trigger zone (CRTZ)?

A

= vomiting center

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18
Q

are there reversal agents for phenothiazines?

A

no because they act in a lot of places, you just have to ride out the clinical effects (2-4 hrs)

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19
Q

what breeds are more sensitive to CNS effects of phenothiazines?

A

-boxers, brachycephalics, MDR1 mutants, large breed dogs, sighthounds

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20
Q

what would you be care using phenothiazines on patients in need of a splenectomy?

A

they reduce hematocrit leading to splenomegaly

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21
Q

what can a phenothiazine mask in a patient?

A

a hypersensitivity reaction

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22
Q

what animals would you practice caution in using acepromazine with?

A
  • boxers, large breed dogs, sighthounds, MDR1 gene mutations (increased CNS effects)
  • stallions (w/ possibility of seeing mare, penile prolapse and injury)
  • cattle (rumenal regurg, not approved in food)
  • aggressive dogs (startle more easily, increased)
  • excited patients
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23
Q

what other drug would you take precaution in using with acepromazine?

A

epinephrine, stimulates a1, a2, b1, and b2 so if a1 is blocked then b2 vasodilation is unopposed

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24
Q

what are phenothiazines typically combine with?

A

analgesics

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25
Q

what is the number one adverse cardiovascular/respiratory effect of phenothiazines?

A

hypotension

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26
Q

what drug antagonizes benzodiazepine agonists such as diazepam, midazolam, and alprazolam?

A

flumazenil

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27
Q

full agonist

A

full effect triggered when bound

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28
Q

partial agonist

A

less effect triggered when bound, may be saturable (“ceiling effect”)

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29
Q

antagonist

A
  • binds to a receptor and blocks effects of any agonists

- may reverse the effect of previously given agonist

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30
Q

inverse agonist

A
  • binds to receptor and causes an effect that is opposite of an agonist
  • reverse of what is seen w/ the agonist
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31
Q

competitive binding

A

REVERSIBLE effect

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32
Q

non-competitive binding

A

IRREVERSIBLE binding

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33
Q

what receptor are benzodiazepine binding sites on and what do benzodiazepines binding there cause?

A
  • GABAa receptors
  • cause hyperpolarization of neurons leading to a higher threshold (less likely to fire)
  • agonize GABA leads to suppressing the CNS
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34
Q

between diazepam and midazolam which route of administration, IV or IM, would you give which drug?

A
  • diazepam give IV, slowly (hypotension w/ rapid inj)

- midazolam give IM

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35
Q

what can diazepam cause in cats if given orally?

A

hepatic necrosis

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36
Q

what benzodiazepine works well for thunder storm anxiety?

A

alprazolam

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37
Q

what is the most reliable sedative for ruminants?

A

benzodiazepines

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38
Q

what class of drugs can have paradoxical excitation?

A

benzodiazepines, NOT reliable on its own

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39
Q

what drug is a specific reversal for benzodiazepines?

A

flumazenil = competitive antagonist

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40
Q

what class of drug is often the MOST reliable as sedatives for very young, very old, or very sick patients?

A

benzodiazepines

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41
Q

what are some contraindications of diazepam injections?

A
  • IM = painful
  • IV given fast shows hypotension
  • large IV doses can cause hemolysis
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42
Q

T/F: benzodiazepines can serve as an anticonvulsant

A

TRUE! great for emergency treatment of seizures (i.e. diazepam given rectally) and status epilepticus

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43
Q

what are the analgesic effects on nociception for a2-agonists?

A

perception, modulation, transmission

44
Q

what are the analgesic effects on nociception for benzodiazepines?

A

perception and modulation

45
Q

what are the analgesic effects on nociception for phenothiazines?

A

perception

46
Q

do benzodiazepines have analgesic effects?

A

no! benzodiazepines have no analgesia

47
Q

what group of animals are most sensitive to xylazine?

A

ruminants, give smaller doses

48
Q

what animals would you use dexmedetomidine used for?

A

dogs, cats, exotics

49
Q

what animals would you use xylazine for?

A

horses, deer, elk (increased morbidity in dogs/cats)

50
Q

what are two alpha-2 antagonists?

A

atipamezole and yohimbine

51
Q

what is the specific competitive antagonist of dexmedetomidine?

A

atipamezole (antisedan)

52
Q

what is the specific competitive antagonist of xylazine?

A

yohimbine

53
Q

what are two major alpha-2 agonists?

A

dexmedetomidine and xylazine

54
Q

what alpha-2 agonist is the most alpha-2selective? least?

A 
dexmedetomidine = most
xylazine = least
55
Q

what is the emetic of choice for cats?

A

xylazine

56
Q

why are alpha-2 agonists useful as an emetic?

A

because they stimulate the alpha-2 receptors in the emetic center and CRTZ

57
Q

what are the two phases of the “bi-phasic effect” in the CVS that occurs with alpha-2 agonists?

A

phase 1 (peripheral phase)

  • mediated by alpha-1 receptors
  • peripheral vasoconstriction which leads to reflex bradycardia

phase 2 (central phase)

  • mediated by alpha-2 receptors
  • decreased sympathetic tone (decreased NE) so heart rate stays low
  • leads to hypotension and bradycardia
58
Q

how much can CO decrease with alpha-2 agonists?

A

30-50%!

59
Q

what would happen if you gave anticholinergics when a patient is in phase 1 and shows reflex bradycardia?

A

CONTRAINDICATED, you will increase the myocardial work load and oxygen demand which can exacerbate pre-existing heart disease and make arrhythmias worse

60
Q

can bradyarrhythmias occur when alpha-2 agonists are given?

A

yes, incomplete AV blocks (secondary most common)

61
Q

would you treat cardiovascular effects for patients given alpha-2 agonists?

A

no! you can reverse all CVS effects

62
Q

what might you worry about with giving alpha-2 agonists to sheep and goats and how it effects their respiratory system?

A

increase respiratory rate, increase CO2, hypoxemia, pulmonary edema

63
Q

why might you take care in giving alpha-2 agonists to hyperglycemic (diabetic) patients?

A

transient hyperglycemia can be an effect due to decrease in the release of insulin

64
Q

what animal is the most sensitive to sedative and analgesic effects? least?

A

goats are most sensitive

pigs are the lease sensitive

65
Q

what could occur if you gave an intra-arterial injection of alpha-2 agonist to a horse?

A

excitement! potential for seizure

66
Q

why is it contraindicated to give alpha-2 agonists to critically ill & patients with shock syndrome?

A

because of all the vasoconstriction to vital organs that can occur

67
Q

what drugs do you NOT use concurrently w/ alpha-2 agonists?

A

epinephrine and atropine, can result in hypertension and increased afterload which makes the heart angry

68
Q

what alpha-2 antagonist is most selective for alpha-2 receptors? least?

A 
atipamezole = most
tolazoline = least
69
Q

what alpha-2 antagonist is used as a reversal for horses?

A

tolazoline

70
Q

why is it recommended to give an alpha-2 antagonist (reversal) IM?

A

because the reversal would go to the periphery first (phase 1!) and selects for vasodilation first while the heart rate lags behind which could lead to CV collapse

71
Q

a dog eats an amitraz tick collar, what would you see and how do you treat it?

A

alpha-2 CNS effects, use an alpha-2 antagonist

72
Q

general anesthesia

A

drug-induced CNS depression resulting in unconciousness in which patient can’t be aroused by painful stimuli and sensory, motory and autonomic reflex functions are attenuated

73
Q

dissociative anesthesia

A

drug-induced dissociation of the thalamocortical and limbic systems resulting in a catatonic state, sensory input is dissociated from perception

74
Q

what are the stages of anesthesia?

A
  1. analgesia (voluntary motor excitement and analgesia)
  2. excitement phase (involuntary excitation or delirium)
  3. surgical anesthesia (4 planes of anesthetic depth)
  4. medullary paralysis (paralysis of vital centers in medulla)
  5. death (respiratory failure and/or CV collapse)
75
Q

what are the analgesic effects on nociception of dissociative anesthetics?

A

modulation

76
Q

what species has more renal excretion than others?

A

cats

77
Q

is consciousness completely lost with dissociative anesthetics?

A

no! only induces stages I & II anesthesia, don’t disturb the animal, may flex or open eyes

78
Q

what are the overall CV effects of dissociative anesthetics?

A

-INCREASED CO, CVP, HR, ICP, IOP

79
Q

what sort of patients would you NOT want to use dissociative anesthetics for?

A

patients undergoing procedures that are contraindicated due to dissociative anesthetics causing increased ICP & IOP (i.e. craniotomy, ocular surgeries and/or brain injury or ocular trauma)

80
Q

what drug has been known to have excitatory side effects at anesthetic doses? (hint: causes hallucinations in people)

A

ketamine

81
Q

can you use ketamine as a sole analgesic?

A

NOT RECOMMENDED

82
Q

what class of drugs do you use with ketamine at subanesthetic doses in acute pain setttings?

A

opioids (shown to reduce tolerance)

83
Q

whats a good dissociative anesthetic to use with wildlife?

A

tiletamine/zolazepam (telazol)

84
Q

is telitamine/zolazepam reversible?

A

ONLY zolazepam, recovery for combo drug is LONG

85
Q

what is the only induction agent with analgesic properties/

A

dissociative anesthetics

86
Q

kitty magic =

A

ketamine + dexmedetomidine + buprenorphine

87
Q

what situations might you use “kitty magic” for?

A
  • high-volume spay/neuter clinics
  • fractious cats
  • looking under a cat’s tongue for string
88
Q

triple drip =

A

guaifenesin + xylazine + ketamine

  • used for large animals
  • form of total intravenous anesthesia (TIVA)
89
Q

FLK =

A

fentanyl + lidocaine + ketamine

-combination used as CRI for analgesia

90
Q

MLK =

A

morphine + lidocaine + ketamine

-combination use for CRI for analgesia

91
Q

T/F: anesthetic drugs that potentiate GABA will create a dose-dependent CNS depression

A

TRUE! sedation> hypnosis> anesthesia> coma> death

92
Q

T/F: propofol’s binding site is on GABAa receptors

A

FALSE, not 100% sure where receptor is

93
Q

T/F: the end result of chloride entry into the cell is hypopolarization

A

FALSE, hyperpolarization

94
Q

what is the best route of administration for barbiturates?

A

IV and orally, IM and SQ can cause tissue damage

95
Q

how does the rate of distribution of barbiturates vary for thin animals?

A

slower, rate of distribution depends on lipid solubility

96
Q

what are the three main effects for barbiturates?

A

sedation, hypnosis, and anesthesia

97
Q

T/F: barbiturates act as anticonvulsants

A

true! they increase seizure threshold

98
Q

how do barbiturates affect the brain?

A
  • decrease intracranial pressure
  • decrease brain metabolism
  • neuroprotective
99
Q

what can occur with accidental intra-arterial injections of thiobarbiturates?

A

vasoconstriction and gangrene

100
Q

what animal is more sensitive to respiratory depression with the use of barbiturates?

A

cats

101
Q

why does propoflo need to be discarded w/in 12-24 hrs?

A

contains eggs and soybean oil, perfect environment for bacterial growth

102
Q

T/F: propoflo 28 is used in cats

A

FALSE, can interfere w/ RBCs coming out of bone marrow

103
Q

what can cause heinz body anemia in cats if used for more than 5 days?

A

propofol (non-barbiturate)

104
Q

how does etomidate depress the CNS?

A

enhances GABA!! best to use for cardiac patients

105
Q

where is etomidate excreted?

A

metabolites are excreted in the kidney and bile

106
Q

what non-barbiturate would be contraindicated for a patients w/ hypoadrenocorticism?

A

etomidate b/c it inhibits cortisol synthesis

Pharm Exam II (6 decks)

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