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Veterinary Pharmacology > Smalltest nr 3 part 2 > Flashcards

Smalltest nr 3 part 2 Flashcards

1
Q

Definitions:
General Anaesthesia

A
  • Injectable or inhalation
  • Injectable has 1 exception, in which it has a painkiller effect and can be used as a premed: ketamine
  • But remember! Ketamine causes muscle rigidity!!! Mustn’t be given on its own!

(BDZ and ⍺-2 agonist combined with ketamine)

  • Also, remember that its analgesic effect isn’t strong as e.g. fentanyl
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2
Q

Definitions:
Balanced anaesthesia

A

There is no one substance that can provide all 3 requirements of surgery

  1. Total unconsciousness
  2. Total muscle relaxation
  3. Total analgesia

Balanced = a combination of drugs

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3
Q

Definitions:
TIVA

A
  1. Total intravenous anaesthesia
  • Must maintain pressure because ↓ BP during anesthesia, which can lead to:
  • acute renal failure (must keep BP above a certain level, 90mmHg. This can be done via catheter)
  • Can also inject certain injectable anaesthetics via IM,
    • however, it will give you a less safe anaesthesia
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4
Q

Definitions:
Neuroleptanalgesia

A
  • Tranquilisers + opioids
  • Muscle relaxation and analgesia
  • Ø total unconsciousness!
  • Used in minor procedures
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5
Q

Definitions:
Ataranalgesia

A
  • Benzodiazepine + opioid
  • Less deep than neuroleptanalgesia
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6
Q

Anesthesia during surgery
Premedication
AIMS

A
  • Sedation
  • Potentiation (Lowers needed dose for anesthesia and painkillers used later on)
  • Avoidance of pre-excitmentation
  • Avoidance of histamine (HA) release
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7
Q

Anesthesia during surgery
Induction
AIMS

A
  • Get rid of reflex so that you can put an endotracheal tube down the trachea to provide oxygen during surgery as well as
  • maintain trachea diameter (some breeds are more prone to trachea collapse during surgery)
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8
Q

Anesthesia during surgery
Maintenance
AIMS

A

Fulfill the 3 requirements

  1. Total unconsciousness
  2. Total muscle relaxation
  3. Analgesia

Once fulfilled → can begin the procedure

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9
Q

Anesthesia during surgery
Premedications
SUBSTANCES

A
  1. Tranquilizers → potentiate analgesics and anti-HA (acepromazine)
  2. ⍺-2 agonists → analgesia potentiation, some analgesic effect
  3. BDZ → pre/post narcotic effect
  4. Opioids → analgesia
  5. Ketamine → premed (subhypnotic dose) and maintenance, potentiates anaesthesia and has analgesic effect (desensitization of pain)
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10
Q

Anesthesia during surgery
Induction
SUBSTANCES

A
  1. Injectables

- Propofol
(use lower dose because of premed potentiators)
- Thiopental (eq)

  1. Inhalations

- Sevoflurane → doesn’t cause irritation

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11
Q

Anesthesia during surgery
Maintenance
SUBSTANCES

A
  1. Inhalation (isoflurane, sevoflurane, etc)
  2. Injectables (IV)​

Use combinations, e.g.

Ketamine + BDZ
Ketamine + ⍺-2 agonists

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12
Q

Anesthesia during surgery
Premedication
IMPLEMENTATION COMMENTS

A
  1. ⍺-2 agonists have painkilling effect, but not enough for maintenance (potentiate analgesic effect)
  2. Morphine → must wait ~30 min before beginning the procedure
  3. Buprenorphine and butorphanol are not enough for painful surgeries. They’re also partial agonists!!
    • Mustn’t be used if you’re planning to use full agonists (morphine/fentanyl) later on!!
  4. Fentanyl → not used as premed
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13
Q

Anesthesia during surgery
Induction
IMPLEMENTATION COMMENTS

A
  • Isoflurane → nephrotoxic and causes irritation

(due to irritation, it’s not used for this step since animals, especially rabbits, will be too irritated to inhale)

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14
Q

Injectable anaesthetics and opioids can be given as bolus dose

A

→ repeat bolus when required to maintain depth of anaesthesia (otherwise the animal will wake up on the surgery table).

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15
Q

Injectable anaesthetics
More safe

A

More safe would be to use the continuous rate infusion
( dose per hour/BWkg), however, keep in mind that if it’s stopped suddenly, it’ll be eliminated much faster

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16
Q

Anticonvulsants
Definitions:

A
  1. Sudden
  2. Transient
  3. Repetitive brain malfunction
  • Convulsions or tic
  • Depends on severity and area of brain affected
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17
Q

Anticonvulsants
Epilepsy

A
  • Malfunction of motor neuron
  • Can be due to several different causes
  1. - Toxicosis
  2. - Liver failure
  3. - Metabolism disease
  4. - Trauma (lesions)
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18
Q

Anticonvulsants
Idiopathic epilepsy

A

Idiopathic epilepsy → seen in dogs <6 years

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19
Q

Anticonvulsants
Aim of treatment

A

→ to eliminate or decrease frequency/gravity of epileptic episodes

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20
Q

Anticonvulsants
When to start treatment:

A
  1. Convulsions last longer than 5 minutes
  2. 3+ generalised convulsions in 24 hrs
  3. 2+ convulsions within 6 months
  4. When postictal symptoms can still be seen for more than 1 day after an epileptic episode

= (vocalization and/or other strange behaviours)

21
Q

Active agents for status epilepticus treatment

A
  1. Diazepam
  2. Phenobarbital
  3. Pentobarbital
  4. Levetiracetam
  5. Propofol
  6. Isoflurane, (sevoflurane)
  7. Ketamin
22
Q

Diazepam
Administration

A
  • *IV or rectal**
  • *Diazepam** solution → vehicle’s absorption via IM is bad
23
Q

Diazepam
Comment

A

Midazolam, lorazepam

→ can be given IM (better absorption, but onset = longer)

24
Q

Phenobarbital
Administration

A

IV (onset = 20-30 min)

25
Q

Pentobarbital
Administration

A
  • IV
  • Trace amount used (micrograms!)
26
Q

Levetiracetam
Administration

A
  • IV
  • Rectal
27
Q

Propofol
Administration

A
  • IV
  • Bolus, or
  • continuous infusion
28
Q

Isoflurane, (sevoflurane)
Administration

A

Inhalation

29
Q

Ketamin
Comment

A

In certain cases
Causes muscle rigidity, use after diazepam, phenobarbital

30
Q

What is If seizures proceed even afterwards

A
  • Then give continuous rate infusion of diazepam or propofol, (ketamine?)
  • keep the animal sedated as long as needed.
  • Withdrawal drugs from time to time to see if the animal can manage,
  • if seizure comes back,
  • sedate the animal again.
31
Q

Active agents to prevent epilepsy, epilepsy control:
Test type I

A

Phenobarbital (A)
Imepitoin (A)
Potassium bromide (B)

I= controlled trials;
II= case-control or cohort study;
III= case reports or series;
IV= expert opinion
Recommendation levels
A= high;
B= moderate;
C= low;
D= not recommended

32
Q

Active agents to prevent epilepsy, epilepsy control:
Test type II

A

Primidone (D)

I= controlled trials;
II= case-control or cohort study;
III= case reports or series;
IV= expert opinion
Recommendation levels
A= high;
B= moderate;
C= low;
D= not recommended

33
Q

Active agents to prevent epilepsy, epilepsy control:
Test type III

A

Zonisamide (C)

I= controlled trials;
II= case-control or cohort study;
III= case reports or series;
IV= expert opinion
Recommendation levels
A= high;
B= moderate;
C= low;
D= not recommended

34
Q

Active agents to prevent epilepsy, epilepsy control:
Test type IV

A

Levetiracetam (C)

I= controlled trials;
II= case-control or cohort study;
III= case reports or series;
IV= expert opinion
Recommendation levels
A= high;
B= moderate;
C= low;
D= not recommended

35
Q

What if you want to change drug

A
  • To change drugs, you must do it gradually!
  • New drug, begin with a low dose and increase until therapeutic range, and at the same time,
  • You decrease the dose of the current drug.
36
Q

Phenobarbital
in general
administration

A
  • *First line!**
  • *Success: ~80%**
  • *Administration:**
  • IV or
  • Orally (Po absorption is good with slow onset of reaction)
37
Q

Phenobarbital
On set of action
Measure of blood levels
Half life

A
  1. Onset = slow (20-30 min); takes 2-3 weeks to reach steady plasma state, thus have to wait 2-3 weeks to evaluate its effectiveness (must warn the owner about this)
  2. Measure blood levels:
  • If phenobarbital blood level is below range → ↑dose
  • If above the range and the patient is still experiencing seizures, then phenobarbital ≠ effective. Either combine or change drug
  • It there’s no epileptic episode for 6-12 months and phenobarbital blood level is above range, then you can ↓ dose
  1. Half-life = 2-3 days (admin. 2x daily)
38
Q

Phenobarbital
General

A
  • Anticonvulsant at subhypnotic doses
  • Enzyme inducer of CYP450!

(responsible for the metabolism of other drugs!! Thus, have to increase their doses) → autoinduction (induces its own metabolism via activating liver enzymes → increases the rate of metabolism)

  • Does not exert its effects immediately → so if the dog has a seizure the following day of 1st administration, do not change the drug immediately (2-3 weeks)
39
Q

Phenobarbital
Side effects

A

Side effects:

  1. Sedation & ataxia → last only a few days after admin.
  2. Polyphagia → increase appetite ⇒ weight gain
  3. Polyurea → increase drinking ⇒ increase urine volume
  4. Ca → sensitivity (liver damage) → idiosyncratic reaction
40
Q

Potassium Bromide
General

A

Potassium bromide

  • Ø fe! (lethal lung oedema)
  • Success: 50-70%
  • Can be a first line drug
  • Failure → combination (phenobarbital as a combination partner)
  • It’s a salt, so there is no metabolism in the liver
  • Elimination → via kidney

If the patient suffers from kidney failure,

  • lower dose (by 25%) to avoid the accumulation of salt
  • Can induce vomiting, can reduce this by splitting the dose to 2x a day with food

Half-life = 35-46 days (admin. 1x daily),

Plasma steady-state = 3 months

41
Q

Potassium Bromide
Side effectss

A

Side effects:

  1. Polyphagia
  2. Pruritus (itchy)
  3. Paraparesis (weakness of HL)
  4. Pancreatitis (pancreas inflammation)
42
Q

Imepitoin

A
  1. First line
  2. Failure → combination
  3. Quite safe
  4. Kidney failure → lower dose
43
Q

Levetiracetam

A
  1. Second line (in combinations
  2. Oral tablet (3x a day, sometimes 4x)

Side effects:

  1. Sedation
  2. Ataxia
  3. Loss of appetite
44
Q

Diazepam

A
  • Ø recommended long term in fe

(individuals can be very sensitive! It’s hepatotoxic and can induce irreversible liver damage if given ~7 days)

  • Ca → appropriate dose can be effective

Side effects:

  1. Polyphagia (fe, ca)
  2. Ø depth perception
  3. Sedation
45
Q

Zonisamide

A
  • Success: limited date (~60%), used mostly in Humans
  • Second line (in combinations)

Side effects:

  1. Sedation
  2. Ataxia
46
Q

Other alternatives

A
  1. N. vagus stimulation → implant (Hu), placed near or on N. vagus so that it doesn’t stimulate repetitive muscle contractions
  2. CBD, Gabapentin → supportive
  3. The ketogenic diet (high fat, moderate protein, low carbohydrates)
  • Not proven to be safe and effective
  • Pancreatitis!! (Ø recommended)
  1. . Acupuncture, homeopathy: NO!
47
Q

Not recommended substances

A
  1. 1. Primidone
    • Very hepatotoxic
  3. 2. Lamotrigine
    • Hepatotoxicity
  5. 3. Phenytoin
    • Myocardial damages
  7. 4. Carbamazepine
    • Bad pharmacokinetics
  9. 5. Oxcarbazepine
    • Bad pharmacokinetics
  11. 6. Vigabatrin
    • Not enough data
  13. 7. Tiagabine
    • Not enough data
48
Q

Situation task 1
Dog with severe trauma
Stabile general condition (3 years old, no known disease)
Amputation inevitable
Which drugs should we use?

A
  • *Phenothiazine** → potentiate analgesic effect
  • *⍺-2 agonist** → increase pain killing efficacy
  • *Benzodiazepines** → can prevent pre & post anesthesia excitement
  • *Ketamine** → IV & has analgesic effect (NMDAr antagonist), given at a continuous rate (at subanesthetic dose), decreases sensitization of pain
  • *Lidocaine** → local anaesthetic, use around nerve where you’re going to cut the leg off
49
Q

Situation task 2
Dog with severe liver failure
Idiopathic epilepsy
Phenobarbital was administered earlier
What kind of agents can be used for monotherapy of epilepsy control?
Potassium bromide

A

Potassium bromide

Veterinary Pharmacology (21 decks)

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