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test 1 Flashcards

1
Q

what are six considerations that are crucial before anesthetic procedures?

A
  1. minimum patient database
  2. proper patient fasting
  3. pre-induction patient care
  4. supplies available
  5. equipment working
  6. pre-anesthetic medication
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2
Q

before the patient comes in for surgery, what 3 things do you need to ensure?

A
  1. full history has been collected
  2. patient fasted
  3. proper documentation completed
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3
Q

what is the purpose of the minimum patient database?

A

to make patient care decisions and uncover potential anesthetic risks

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4
Q

what does the minimum patient database include?

A
  1. patient history (incl. signalment
  2. complete PE findings
  3. results of preanesthetic diagnostic workup
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5
Q

when should the minimum patient database be completed? why?

A

the patient should be scheduled for an appointment several days before the planned procedure; if problems come up they can be addressed prior to surgery

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6
Q

why is it important to verbally confirm the scheduled procedure before beginning?

A

can prevent tragic accidents; anesthetizing the wrong patient, performing an unnecessary procedure, not performing a required procedure

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7
Q

as a technician, what do you need to obtain from the client regarding patient history?

A
  1. signalment
  2. current/past illnesses
  3. current medications
  4. allergies and/or drug reactions
  5. status of preventative care (vaccines, S/N, etc.)
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8
Q

why is the signalment so important to know before performing an anesthetic procedure?

A

there are unique species reactions and sensitivities to anesthetic agents

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9
Q

t/f - horses and cats are not sensitive to opioids

A

false - they ARE sensitive to opioids

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10
Q

t/f - cats produce excess airway secretions under anesthesia

A

true

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11
Q

what drug produces sensitivity in boxers and giant breeds?

A

acepromazine

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12
Q

what dog breed is resistant acepromazine?

A

terriers

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13
Q

what specific type of horse should you not administer acepromazine to?

A

contraindicated for use in stallions

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14
Q

xylazine is contraindicated for use in pregnant ___ and ___ ?

A

cows and ewes

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15
Q

what unique response can be seen in cats after administration of ketamine?

A

prolonged recovery

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16
Q

what might happen to a dog after being sedated with acepromazine?

A

may see behavioural changes

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17
Q

what details of past/current illnesses should be acquired with patient hx?

A
  1. preexisting disease
  2. changes in behaviour
  3. exercise intolerance
  4. weakness
  5. fainting and/or seizures
  6. unexplained bleeding
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18
Q

why would it be important to use a consistent technique when doing physical assessments?

A

to avoid missing any areas of the body - need to examine the entire patient

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19
Q

what four factors of patient appearance should be assessed?

A
  1. symmetry
  2. mentation
  3. posture/gait
  4. hydration status
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20
Q

t/f - patient dose is based on lean body weight

A

true

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21
Q

how can you assess the hydration status of a patient?

A
  1. skin turgor
  2. placement of eye in orbit
  3. mucous membrane colour, capp. refill time
  4. heart rate//pulse strength
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22
Q

once the hydration is assessed, what must be done before anesthesia?

A

must correct any hydration abnormalities

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23
Q

when taking TPR values, what is important to observe with patient respiration?

A

what the character of respiration is - how much effort are they exerting to breathe?

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24
Q

what exterior surfaces would you assess on PE?

A
  1. hair coat
  2. skin
  3. lymph nodes/mammary glands
  4. body openings (odours, discharge)
  5. eyes, ears, nose, throat
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25
Q

what is it called when the pupils are normally two different sizes?

A

anesicoria

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26
Q

why would you want to assess the patient’s haircoat?

A

hair loss can be proof of infectious and non-infectious conditions

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27
Q

how does thoracic auscultation differ from taking the heart rate?

A

listens for murmurs, arrhythmias, crackles, wheezes, etc.

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28
Q

t/f - thoracic auscultation is performed by an RVT prior to anesthesia

A

true - h/e the DVM should also perform prior to anesthesia

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29
Q

why is it important to listen over each valve of the heart?

A

there can be turbulence in blood flow through only one valve or multiple, need to assess all for heart murmurs

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30
Q

t/f - patient resps are proportional to body size

A

false - patient resps are inversely proportional to body size - small animal, higher resp rate

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31
Q

what is “stertor” ?

A

brachycephalic noise caused by their elongated/thickened soft palate

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32
Q

what is stridor?

A

brachycephalic laryngeal noise

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33
Q

what is dyspnea?

A

shortness of breath

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34
Q

what is cyanosis?

A

blueish colour to mucous membranes

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35
Q

what do crackles indicate? (in lung sounds)

A

moisture in the airways

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36
Q

how many quadrants need to be examined when ascultating the lungs?

A

four

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37
Q

what preanesthetic diagnostic tests/procedures need to be completed?

A
  1. CBC
  2. urinalysis
  3. blood chemistry
  4. blood coagulation screens
  5. electrocardiogram (ECG)
  6. radiography
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38
Q

how do you determine the physical status classification of a patient?

A

based on evaluation of the MPD

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39
Q

what does the physical status classification represent?

A

rates patient anesthetic risk

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40
Q

what are the levels of patient risk and what do they represent?

A 
PS1 - minimal risk 
PS2 - low risk 
PS3 - moderate risk 
PS4 - high risk 
PS5 - extreme risk
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41
Q

define anesthesia

A

loss of sensation; one extreme in a continuum level of CNS depression

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42
Q

define general anesthesia

A

reversible state of unconsciousness, imobility, muscle relaxation and loss of sensation

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43
Q

define surgical anesthesia

A

analgesia and muscle relaxation; eliminates pain and patient movement

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44
Q

define local anesthesia

A

targets a small, specific area of the body; drug is infiltrated into desired area to cause loss of sensation

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45
Q

define topical anesthesia

A

applied to body surface or wound; produces a superficial loss of sensation

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46
Q

define regional anesthesia

A

loss of sensation to a limited area of the body; examples are nerve blocks and epidural anesthesia

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47
Q

what is balanced anesthesia?

A

using multiple drugs in smaller quantities for anesthesia

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48
Q

what are the two main advantages to balanced anesthesia?

A
  1. maximizes benefits of drugs

2. minimizes adverse effects

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49
Q

what is an RVT’s role as an anesthetist?

A
  1. prep/operate/maintain anesthetic machine
  2. administer anesthetic agents
  3. perform endotracheal intubation
  4. patient monitoring
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50
Q

what are some challenges and risks associated with anesthesia?

A
  1. dose calculation and rate adjustment
  2. vital signs and anesthetic depth
  3. assessing multiple pieces of information
  4. patient management
  5. accidents
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51
Q

why is it so crucial to monitor the patient’s cariovascular and pulmonary systems during anesthesia?

A

drugs may cause changes in the systems which can in turn be lethal

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52
Q

what is an endotracheal tube and what does it do?

A

flexible tube placed in the trachea; delivers anesthetic gases directly from the machine to the lungs

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53
Q

what are some advantages of using an endotracheal tube?

A
  1. opens airway
  2. less anatomical dead space
  3. precision administration of anesthetic agent
  4. prevents aspiration
  5. responds to respiratory emergencies
  6. monitors respirations
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54
Q

what are some different kinds of ET tubes?

A
  1. murphy tubes - beveled end and side holes; possible cuff

2. cole tubes - no side hole or cuff; used in birds and reptiles

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55
Q

why would a polyvinyl chloride ET tube be preferable over a red rubber?

A

the polyvinyl are clear and stiffer where the red rubber may kink or collapse in the patient

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56
Q

why would silicone ET tubes be a good choice?

A

it is pliable, strong, less irritating and resists collapse

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57
Q

how and why are tube cuffs used?

A

high volume/low pressure; used for short term intubation - pressure is distributed evenly along the cuff length

low volume/high pressure; potential tissue damage

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58
Q

why are cuffless tubes on non-inflated cuffs used?

A

used in small animals to reduce the risk of tracheal damage

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59
Q

what is a laryngoscope?

A

a tool used to increase visibility of the larynx while placing an ET tube

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60
Q

t/f - the same laryngoscope can be used for both small and large animals

A

false - small animals use 0-5 inch blade; large animals use up to an 18 inch blade

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61
Q

what does a subglottic airway device do?

A

allows airway management without invading the tracheal lumen

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62
Q

what are some advantages to a SAD?

A
  1. decrease in laryngospasm
  2. resistance to breathing
  3. decreased risk of airway trauma
  4. no post-op coughing
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63
Q

t/f - masks are used to administer oxygen and anesthetic gases to intubated patients

A

false - masks are used when the patient is not intubated

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64
Q

what are the four components of the anesthetic machine?

A
  1. compressed gas supply
  2. anesthetic vaporizer
  3. breathing circuit
  4. scavenging system
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65
Q

what oxygen level is required to maintain cellular metabolism under anesthesia?

A

30% oxygen

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66
Q

what purpose does the compressed gas supply (oxygen) serve?

A

used to increase inspired air to at least 30% O2

used to carry vaporizedd anesthetic to patient

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67
Q

what is the difference between E tanks and H tanks?

A

E tanks - small, attached directly to anesthetic machine

H tanks - large, attached remotely to anesthetic machine

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68
Q

where is the control valve located?

A

on top of the tank

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69
Q

what is the control valve used for?

A

an outlet port; can be loosened or tightened

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70
Q

what does the pressure reducing valve do?

A

reduces outgoing pressure to a usable level

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71
Q

when should the primary and secondary oxygen supplies be checked?

A

at the beginning and ending of every day

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72
Q

t/f - the compressed gas valve is turned counter clockwise to open

A

true

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73
Q

what happens when the valve stem is turned completely clockwise?

A

gas flow stops

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74
Q

how do you release line pressure?

A

depress the O2 flush valve or open the valve until all gas is vented

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75
Q

what are some safety issues associated with compressed gas?

A
  1. combustability
  2. yoke attachment
  3. high-pressure release
  4. storage
  5. colour coding (knowledge)
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76
Q

what colour are oxygen cylinders in canada?

A

white

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77
Q

what kind of gas is contained within a blue cylinder?

A

nitrous oxide

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78
Q

what is the tank pressure gauge used for?

A

to indicate the pressure of gas remaining in the cylinder; determines the number of liters remaining in a tank

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79
Q

what does the pressure-reducing valve do?

A

reduces gas pressure to a constant 40-50 psi

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80
Q

what is another name for the pressure-reducing valve?

A

pressure regulator

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81
Q

what does the line pressure gauge do?

A

indicates pressure in the gas line between the pressure-reducing valve and the flowmeter

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82
Q

what should the line pressure gauge read when the oxygen tank is opened?

A

40-50 psi

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83
Q

what must you do after turning the tank off?

A

evacuate line pressure until the gauge reads 0 psi using the oxygen flush valve

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84
Q

what does the flowmeter do?

A
  1. indicates gas flow expressed in liters per minute (L/min)
  2. reduces pressure of gas to 15 psi
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85
Q

who controls the flow rate during anesthetic procedures?

A

the anesthetist (RVT)

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86
Q

what is the purpose of the oxygen flush valve?

A
  1. delivers a short, large burst of pure oxygen directly into the rebreathing circuit or common gas outlet
  2. bypasses vaporizer and flowmeter
  3. used to refill breathing bag or to dilute anesthetic gas remaining in circuit at the end of anesthesia
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87
Q

when should you NEVER use the oxygen flush valve?

A

when the patient is hooked up to the breathing circuit

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88
Q

what does the anesthetic vaporizer do?

A

converts liquid anesthetic agent to a gaseous state; adds a controlled amount of vaporized agent to the carrier gas

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89
Q

how does the gas mixture leave the vaporizer?

A

through the outlet port

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90
Q

what is fresh gas?

A

mixture of vaporized anesthetic agent and carrier gas that enters the breathing circuit

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91
Q

how does the carrier gas (oxygen) get into the vaporizer to create fresh gas?

A

vaporizer inlet port; the oxygen exits the flowmeter into the inlet port

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92
Q

what are the different kinds of anesthetic vaporizers?

A
  1. non-precision

2. precision

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93
Q

t/f - non-precision vaporizers are safer, and used more often than precision

A

false - non-precision vaporizers deliver low pressure vapor based on estimation

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94
Q

how are precision vaporizers used?

A

deliver a precise amount of anesthetic to the patient; high vapor pressure that is controlled by the anesthetist

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95
Q

what factors affect vaporizer output?

A
  1. vaporizer setting
  2. carrier gas flow
  3. temperature (most modern vaporizers are compensated)
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96
Q

what color indicates isoflurane vaporizer?

A

purple

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97
Q

what colour indicated sevoflurane vaporizer?

A

yellow

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98
Q

what are the induction and maintenance rates of isoflurane and sevoflurane?

A

isoflurane - 3-5% induction; 1.5-2.5% maintenance

sevoflurane - 4-6% induction; 2-4.5% maintenance

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99
Q

what do you do to turn on the vaporizer?

A
  1. depress safety lock

2. turn dial to desired level (measured in percent concentration)

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100
Q

how full should the vaporizer be kept? what can happen if the level is incorrect?

A

should be at least half-full; if over full can result in overdose, if underfull can cause difficulty to keep patient anesthetized

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101
Q

what happens at hte vaporizer outlet port?

A
  1. oxygen/anesthetic exits vaporizer

2. connected to the common gas outlet or directly into breathing circuit

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102
Q

what happens at the common gas outlet?

A

fresh gas outlet; connected to the vaporizer outlet port and breathing circuit

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103
Q

what does the breathing circuit do?

A
  1. carries anesthetic and oxygen from the fresh gas inlet to the patient
  2. conveys expired gases away from the patient
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104
Q

what are the two types of breathing circuits?

A
  1. rebreathing

2. non rebreathing

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105
Q

how does a rebreathing system work?

A
  1. circle system
  2. not used on very small animals
  3. carbon dioxed is removed from exhaled air (in canister)
  4. exhaled air is inhaled again with added oxygen and anesthetic
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106
Q

how does air flow through a rebreathing system?

A
  1. inhalation unidirectional valve
  2. inhalation tube
  3. animal
  4. exhalation tube
  5. exhalation unidirectional valve
  6. carbon dioxide absorber canister
  7. past reservoir bag
  8. pop-off valve
  9. pressure manometer
  10. inhalation unidirectional valve
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107
Q

how is a closed rebreathing system different from a semi-closed rebreathing system?

A

closed is a total system; pop-off valve is nearly or completely closed; oxygen flow is low - used mostly for large animal

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108
Q

how is a semi-closed rebreathing system different from a closed rebreathing system?

A

partial system; pop-off valve is open and oxygen flow is high - excess air is released into scavenging system

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109
Q

t/f - it is rare to come across semi-closed rebreathing system in modern practice

A

false - semi-closed rebreathing is the most common configuration

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110
Q

what are the parts that compose a rebreathing system?

A
  1. fresh gas inlet
  2. unidirectional valves
  3. reservoir bag
  4. pop-off valve (pressure relief)
  5. carbon dioxide absorber canister
  6. pressure manometer
  7. air intake valve
  8. corrugated breathing tubes
  9. y-piece
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111
Q

what do unidirectional valves do?

A
  1. control the direction of gas flow (inspiratory, expiratory)
  2. open and close as patient breathes
  3. monitor respiratory rate and depth
  4. monitor for sticking due to condensation
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112
Q

what does the pop-off valve allow for?

A
  1. excess carrier and/or anesthetic gases to exit the breathing circuit and enter the scavenging system
  2. prevents excessive pressure or gas volume in the circuit
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113
Q

what position should the pop-off valve be in when manually ventilating a patient?

A

closed

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114
Q

what does the reservoir bag do?

A
  1. provides a flexible air storage reservoir
  2. indicates respiratory rate and depth
  3. confirms proper endotracheal tube placement
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115
Q

t/f - the reservoir bag can deliver anesthetic gases or pure oxygen to the patient

A

true

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116
Q

why would you manually ventilate a patient?

A

to force fresh gas into alveoli to normalize gas exchange; this normalizes the respiratory rate

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117
Q

t/f - manual ventilation minimizes atelectasis

A

true

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118
Q

how often should you ventilate the patient when bagging them?

A

every 5-10 minutes

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119
Q

what is contained within the carbon dioxide absorber canister? what happens when carbon dioxide is absorbed?

A

contains absorbent granules (calcium hydroxide) - granules react with carbon dioxide to form calcium carbonate

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120
Q

what should the capnograph read if the cannister is expired?

A

anything greater than zero indicates an expired cannister

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121
Q

what does the pressure manometer do?

A

indicates the pressure of gases within the breathing circuit

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122
Q

what unit does the pressure manometer express?

A

centimeters of water

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123
Q

how many centimeters of water are used when ventilating small and large animals, respectively?

A

small animals - 20 cm H2O

large animals - 40 cm H2O

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124
Q

what does the pressure manometer do when bagging a patient?

A

prevents excessive pressure in the lungs

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125
Q

what does the air intake valve do?

A

aka negative pressure relief valve - admits room air into the circuit if negative pressure is detected in the breathing circuit

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126
Q

what is a sure sign of negative pressure in the circuit?

A

collapsed reservoir bag

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127
Q

what will the patient develop if negative pressure enters the circuit ?

A

hypoxemia

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128
Q

t/f - negative pressure is sometimes okay when performing anesthesia

A

false - we NEVER want negative pressure

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129
Q

how many sizes do breathing tubes come in? what are they?

A

three; 50mm, 22mm and 15mm

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130
Q

what does the breathing tube connect to?

A

unidirectional valve and y-piece

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131
Q

what size patient requires a non-rebreathing system?

A

<7 kg

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132
Q

how does a semi-open system work?

A

exhaled gas is evacuated by the scavenging system, fresh gas is routed to the patient directly from the vaporizer - no carbon dioxide absorber canister, pressure manometer or unidirectional valves

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133
Q

components of a semi-open non-rebreathing sytstem?

A

endotracheal tube connector, fresh gas inlet, reservoir bag, overflow valve, scavenger tube and scavenger system

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134
Q

what are the two main configurations of non-rebreathing circuits?

A
  1. bain coaxial circuit

2. ayres t-piece

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135
Q

what is the benefit of a coaxial circuit?

A

exhaled gas comes through the outside tube - this warms the inhaled air slightly

136
Q

what is the animal’s dead space?

A

the space from the mouth down to the lungs

137
Q

what is considered the machine’s dead space?

A

all the way through the animal to the inspired gas

138
Q

what is the danger with resistance?

A

any increased resistance to inspiration or expiration will cause an anaesthetized animal to breathe less effectively

139
Q

what causes resistance on inspiration?

A
  1. gas level too low

2. tube is kinked

140
Q

what causes resistance on expiration?

A
  1. kink in the tube
  2. wrong bag
  3. pop off isn’t open
  4. natural resistance through canister
141
Q

t/f - smaller diameter greatly increases resistance

A

true

142
Q

what is circuit drag?

A

the weight of hoses, machinery, etc. can cause the endotracheal tube to come out of the patient

143
Q

t/f - when choosing an endotracheal tube you want to pick the smallest option

A

false - you want to place the largest tube possible without causing trauma

144
Q

how do you calculate bag size?

A

tidal volume x 6

tidal volume - 10-20ml/kg

145
Q

do non-rebreathing systems require high or low flow rates?

A

high flow rates based on patient body weight

146
Q

calculate flow rate ?

A

200-300 ml/kg/min

147
Q

what is the minimum flow rate?

A

500 ml/min

148
Q

define an anesthetic agent

A

any drug used to induce a loss of sensation with or without unconsciousness

149
Q

define adjunct

A

a drug that is not a true anesthetic but that is used during anesthesia to produce other desired effects such as sedation, muscle relaxation, analgesia, reversal, neuromuscular blockade or parasympathetic blockade

150
Q

t/f - inhalants are the first drugs given during anesthetic procedures

A

false - inhalants are the last drugs administered

151
Q

what happens if inhalants are used on their own?

A

patient recovery will be stormy, no pain control

152
Q

what are some examples of inhalant anesthetics?

A
  1. isoflurane, sevoflurane and desflurane
  2. nitrous oxide
  3. halothane
  4. diethyl ether
153
Q

is diethyl ether still used in anesthetic procedures?

A

no

154
Q

t/f - halogenated organic compounds (like isoflurane) are stored as vapor at room temperature?

A

false - they are liquid at room temperature and vaporized in oxygen that flows through

155
Q

what are some adverse effects of halogenated organic compounds?

A
  1. increased intracranial pressure (head trauma/brain tumors)
  2. hypothermia
  3. decreased blood pressure
  4. hypoventilation (dose dependent)
  5. carbon dioxide retention/respiratory acidosis
156
Q

what are some important properties to consider with inhalant anesthetics?

A
  1. vapor pressure
  2. partition coefficient
  3. minimum alveolar concentration
  4. rubber solubility
157
Q

what is vapor pressure?

A

the tendency of an inhalation anesthetic to vaporize to its gaseous state; how readily an inhalation anesthetic will evaporate in the anesthetic machine vaporizer

158
Q

t/f - volatile agents require high pressure

A

true

159
Q

what are some examples of volatile agents?

A
  1. isoflurane
  2. sevoflurane
  3. desflurane
160
Q

t/f - volatile agents are delivered from a non-precision vaporizer

A

false - volatile agents are delivered from precision vaporizers only

161
Q

what kind of vapor pressure is required for non-volatile agents?

A

low vapor pressure

162
Q

what is the blood-gas partition coefficient?

A

the measure of solubility of an inhalation anesthetic in blood compared to air (alveolar gas)

163
Q

what does the blood-gas partition coefficient indicate?

A

the speed of induction and recovery

164
Q

t/f - a low blood-gas partition coefficient means a slower expected induction and recovery

A

false - low blood-gas is indicative for faster expected induction and recovery

165
Q

is it more desirable to have a low blood-gas partition coefficient or a high blood-gas? why?

A

it is more desirable to have low blood-gas becuase the agent is more soluble in alveolar gas than blood - this means more drug is inhaled and less is absorbed by blood and tissues

166
Q

why might a high blood-gas coefficient cause a slower induction and recovery?

A

because the drug is more soluble in the blood than alveolar gas, it takes longer for the patient to receive drug because more is being absorbed into the tissues

167
Q

how does a low solubility coefficient work?

A

inhalant builds up to high concentrations in the pulmonary alveoli - steep diffusion gradient between alveoli and tissues - this causes a rapid entry into blood stream and passage into the brain - rapid induction and recovery

168
Q

t/f - low solubility coefficient inhalants have a long time interval to change anesthetic depth

A

false - they have a short time interval to change anesthetic depth

169
Q

what is an example of a low solubility coefficient inhalant?

A

isoflurane

170
Q

why are high solubility coefficient inhalants less effective than low?

A

inhalant builds up quickly in blood and tissues but is widespread with less concentration in the brain

171
Q

what does MAC stand for ?

A

minimum alveolar concentration

172
Q

what is the MAC used for?

A

to measure a drug’s potency - used to determine the average setting on the vaporizer to produce anesthesia

173
Q

t/f - a lower MAC would indicate a less potent agent and lower vaporizer setting

A

false - a lower MAC is indicative of a more potent agent (and lower vaporizer setting)

174
Q

what two species is isoflurane approved for use in?

A

dogs and horses

175
Q

what are the physical and chemical properties to be aware of for isoflurane?

A
  1. high vapor pressure; precision vaporizer
  2. low blood-gas PC; rapid induction/recovery
  3. MAC 1.3-1.63%
  4. low rubber solubility
  5. stable at room temp
  6. fewest adverse cardiovascular effects
  7. depresses respiratory system
  8. maintains cerebral bloodflow
  9. almost completely eliminated through the lungs
  10. induces adequate muscle relaxation
176
Q

what might isoflurane producde if exposed to desiccate carbon dioxide absorbent?

A

carbon monoxide

177
Q

what properties should be considered for sevoflurane?

A
  1. high vapor pressure; precision vaporizer
  2. low blood-gas
  3. high controllability of depth of anesthesia
  4. MAC 2.34-2.58%
178
Q

how are anesthetic agents and adjuncts classified?

A
  1. route of administration

2. time of administration

179
Q

what are agonists?

A

most anesthetic drugs; bind to and stimulate target tissue

180
Q

what are antagonists?

A

reversal agents; bind to target tissue but don’t stimulate

181
Q

how are opioids different than agonists or antagonists?

A

they can be partial agonists, agonist-antagonists and can block pure agonists

182
Q

t/f - if a drug combination develops a precipitate when mixed in a syringe you can still administer it

A

false - never administer a drug if a precipitate forms

183
Q

t/f - you can mix drugs in a single syringe if they are compatible

A

true

184
Q

what drug can only ever be mixed with ketamine?

A

diazepam - it is not compatible with any other drug available

185
Q

is diazepam water soluble?

A

no

186
Q

is midazolam water soluble?

A

yes

187
Q

what is the purpose of preanesthetic medications?

A
  1. calm or sedate excited animal
  2. minimize adverse drug effects
  3. reduce dose of concurrent drugs
  4. smoother induction and recovery
  5. analgesia
  6. muscle relaxation
188
Q

what are preanesthetic anticholinergics?

A

parasympatholytic drugs - they work against the parasympathetic system to prevent and treat bradycardia - increases heartrate and decreases secretions

189
Q

what do parasympatholytic drugs block?

A

acetylcholine

190
Q

what are two examples of preanesthetic anticholinergics?

A
  1. atropine

2. glycopyrrolate

191
Q

when might atropine be used?

A

when animal is arresting

192
Q

what are some adverse effects of anticholinergics?

A
  1. cardiac arrhythmia
  2. temporary bradycardia
  3. thickened respiratory and salivary secretions
  4. intestinal peristalsis inhibition
193
Q

what kinds of drugs fall under tranquilizers and sedatives?

A
  1. phenothiazines
  2. benzodiazepines
  3. alpha 2-adrenoceptor agonists
  4. alpha 2-antagonists
194
Q

what species are approved for use of acepromazine?

A

horses, dogs and cats

195
Q

what family of drug is acepromazine related to>

A

phenothiazines

196
Q

t/f - acepromazine has a reversal agent

A

false

197
Q

where is acepromazine metabolized? what patients might this be a concern for?

A

metabolized by liver; contraindicated for use in patients with liver disease

198
Q

what is the half life of acepromazine in canines?

A

4.5 hrs

199
Q

how does acepromazine effect the body?

A
  1. calming effect on CNS ; decreased interest in surroundings
  2. protects cardiovascular system against arrhythmias and decreases cardiac output
  3. mild antiemetic effects
200
Q

what are some adverse effects of acepromazine?

A
  1. may produce aggression or excitement
  2. peripheral vasodilation (hypotension, increased heart rate, hypothermia)
  3. penile prolapse (horses)
201
Q

what special consideration is given to drugs ending in -epam?

A

these are controlled drugs

202
Q

what reversal agent is used for benzodiazepines?

A

flumazenil (limited availability)

203
Q

t/f - benzodiazepines have a rapid onset of action

A

true

204
Q

do all benzodiazpenes have the same duration of action?

A

no - duration varies with drug

205
Q

what receptors do benzodiazepines act on?

A

gaba receptors

206
Q

what are some effects of benzodiazepines?

A

calming and anti-anxiety, anticonvulsant

207
Q

adverse effects of benzodiazepines?

A
  1. disorientation and excitement (young dogs) 2. dysphoria and aggression (cats)
208
Q

t/f - diazepam can be given by rapid IV

A

false - diazepam must be given by IV slowly !

209
Q

what can happen if cats are given oral diazepam?

A

fatal liver necrosis

210
Q

what drug is commonly administered with diazepam to induce anesthesia in small animals?

A

ketamine

211
Q

what makes midazolam unique from diazepam?

A

it is water soluble

212
Q

does diazepam or midazolam have a shorter half life?

A

midazolam - 1 hr (vs. diazepam - 3 hrs)

213
Q

are alpha 2 agonists controlled agents?

A

no; they are non-controlled

214
Q

what effects do alpha 2 agonists produce?

A
  1. sedation
  2. analgesia
  3. muscle relaxation
215
Q

what agents readily reverse alpha 2 agonists?

A

alpha 2 antagonists

216
Q

what are some examples of alpha 2 agonists?

A
  1. xylazine
  2. dexmedetomidine (dexdomitor)
  3. detomidine (dormosedan)
  4. romifidine (sedivet)
217
Q

how do alpha 2 agonists act on the body?

A

take away fight or flight response by decreasing the release of norepinephrine

218
Q

where are alpha 2 agonists metabolized? excreted?

A

the liver; urine

219
Q

do alpha 2 agonists cause rapid or slow sedation?

A

rapid; duration depends on species and drug of choice

220
Q

how do alpha 2 agonists effect the cardiovascular system? (early phase)

A
  1. vasoconstriction and hypertension
  2. bradycardia
  3. arrhythmias
221
Q

how do alpha 2 agonists effect the cardiovascular system? (late phase)

A
  1. decreased cardiac output

2. hypotension

222
Q

t/f - alpha 2’s cause an immediate vomiting response in dogs and cats

A

true

223
Q

what are some adverse effects of alpha 2’s ?

A
  1. change in behviour
  2. increased myocardial O2 consumption
  3. decreased cardiac output
  4. increased systemic vascular resistence
  5. respiratory depression
  6. increased urination
  7. bloat
  8. premature parturition (cattle)
  9. absorbed through skin abrasions and MM
  10. sweating (horses)
224
Q

what patients should alpha 2’s be avoided in?

A

geriatric, diabetic, pregnant, pediatric or ill

225
Q

t/f - dexdomitor (dexmedetomidine) is safer and more potent than xylazine

A

true

226
Q

what antagonist is used to reverse dexmedetomidine?

A

atipamazole (antisedan)

227
Q

can dexdomitor be safely combined with other drugs?

A

yes

228
Q

what combination is commonly referred to as “kitty magic”?

A
  1. ketamine
  2. opioid (hydromorphone or butorphanol)
  3. dexdomitor
229
Q

what species do we use detomidine in?

A

horses

230
Q

is detomidine longer or shorter acting than xylazine?

A

longer - 2x duration

231
Q

what is important to remember if administering an alpha 2 antagonist?

A

they reverse ALL effects of alpha 2 agonists - beneficial and detrimental

232
Q

when should the dose of antagonist be reduced?

A

if more than 30 minutes has passed since administering the agonist

233
Q

what is yohimbine used to reverse?

A

xylazine

234
Q

how long does it take to see the effects of atipamezole (antisedan) after administration?

A

5-10 minutes

235
Q

what are some commonly used opioids? what are their classifications?

A
  1. agonists
    - morphine
    - hydromorphone
    - oxymorphone
    - fentanyl
    - meperidine
  2. partial agonist
    - buprenorphine
  3. agonist-antagonists
    - butorphanol
    - nalbuphine
  4. antagonists
    - naloxone
    - etorphine
    - carfentenil
236
Q

t/f - opioids do not have a wide margin of safety

A

false - they do have a wide margin of safety

237
Q

where do opioids act on the body?

A

on mu, kappa and delta receptors; action on the receptors and spinal cord

238
Q

what type of opioids act on mu and kappa receptors?

A

agonists

239
Q

what level of pain is ideal for agonists?

A

moderate to severe pain

240
Q

agonist-antagonists bind to mu and kappa receptors but only stimulate one - which is it?

A

agonist-antagonists stimulate kappa receptors

241
Q

what effects do opioids cause in dogs?

A
  1. sedation

2. narcosis

242
Q

what is narcosis?

A

narcotic-induced sleep

243
Q

what effects do opioids have on cats/horses/ruminants?

A
  1. CNS stimulation

2. bizarre behaviour/dysphoria

244
Q

what specific type of agonists are most effective against severe pain?

A

pure agonists

245
Q

opioids can effect the pupils of dogs, cats and horses - what are their respective effects?

A

dogs - miosis (small pupils)

cats/horses - mydriasis (large pupils)

246
Q

t/f - opioids can cause dogs to become hyperthermic

A

false - can cause dogs to become hypothermic

247
Q

do opioids cause temperature changes in cats?

A

yes - can cause hyperthermia in cats

248
Q

t/f - opioids cause increased urine production

A

false - cause decreased urine production

249
Q

what are some adverse effects of opioids?

A
  1. anxiety/disorientation/dysphoria
  2. bradycardia
  3. decreased respiration
  4. ceiling effect (some agents)
  5. salivation and vomiting
250
Q

what is the biggest respiratory concern with opioids?

A

respiratory suppression

251
Q

t/f - intraocular and intracranial pressure are increased under opioids

A

true

252
Q

define neuroleptanalgesia

A

use of a sedative and an opioid

253
Q

what 2 uses do opioids have in surgical procedures?

A
  1. preanesthetic meds

2. analgesia

254
Q

why is it important to know the half life of a drug you are reversing with naloxone hydrochloride?

A

if the half life of the drug you reversed is longer than the duration of action, you may see patient go down again depending on how much drug has been metabolized in their system

255
Q

how long is the duration of action for naloxone?

A

30-60 minutes

256
Q

what are some indicatiosn for use of trazodone?

A
  1. anxiety patients
  2. pre-op to reduce stress
  3. post-op to allow better recovery
257
Q

what is the mode of action for trazadone?

A

serotonin antagonist; blocks serotonin reuptake at presynaptic neuorn

258
Q

what unique situation may cause us to see aggression in patients once they are put on this medication?

A

if aggression has been suppressed due to fear - now the animal is at ease and the aggression can come out

259
Q

why would trazodone be used with other behaviour meds?

A

it has a faster onset of action while waiting for other medications to start working (4-6 weeks)

260
Q

what are the indications for use of gabapentin?

A

used for its analgesic and anxiolytic qualities

261
Q

what is unique about gabapentin as an analgesic?

A

it works at the nerve level to relieve neurogenic pain

262
Q

what can gabapentin be combined with to control patient pain?

A

gabapentin and an NSAID

263
Q

what is the generic name for Cerenia?

A

maropitant

264
Q

what are the indications for use of cerenia?

A

anti-emetic; prevents vomiting from premedication, helps patients eat faster post-op

265
Q

t/f - cerenia has some effect on visceral pain

A

true

266
Q

what does the acronym PISS stand for ?

A

pin index safety system

267
Q

what does the acronym DISS stand for?

A

diameter index safety system

268
Q

t/f - when giving injectable anesthetics we give the full dose in the syringe

A

false - iv anesthetics are administered “to effect”

269
Q

t/f - injectable anesthetics can be used on their own to produce general anesthesia

A

false - must be used with other agents to produce complete effects of GA

270
Q

what is propofol?

A

ultra short acting, non-barbituate anesthetic

271
Q

what is propofol used for?

A
  1. induction

2. short term maintenance

272
Q

what special exception is made for propofol IV ?

A

the solution is milky but it is okay to administer (it is fat soluble)

273
Q

how long is the onset of action for propofol?

A

30-60 seconds

274
Q

how long is the duration of action of propofol?

A

5-10 minutes

275
Q

how does a patient’s plasma protein level effect administration of propofol? why?

A

propofol binds to protein so if plasma protein is low there will be more drug free-flowing and potency will be higher

276
Q

t/f - propofol is rapidly removed from the brain by tissue redistribution

A

true

277
Q

how does bloodflow affect the action of propofol on the body?

A

after iv administration the highest areas of blood flow will receive the most drug; this happens through tissue redistribution

278
Q

how does propofol effect the CNS ?

A
  1. dose-dependent depression (sedation-GA)
  2. transient excitement/muscle tremors
  3. seizure-like signs
279
Q

how does propofol effect the cardiovascular system?

A
  1. depressant

2. transient hypotension

280
Q

how does propofol effect the respiratory system?

A
  1. possible apnea (post induction)
281
Q

why do you need to ensure the patient is breathing in gas post-induction? (propofol)

A

if they are not breathing in gas, they can wake up within 5 minutes

282
Q

what may happen if propofol is administered too slowly?

A

may cause excitement in the patient

283
Q

how can you reduce the risk of apnea when using propofol?

A

use with another pre-medication (lower dose)

284
Q

how long does it take for dogs and cats to fully recover from the effects of propofol?

A

dogs - 20 minutes

cats - 30 minutes

285
Q

what are some general characteristics of alfaxalone?

A
  1. short duration of action
  2. wide margin of safety
  3. use IV for induction and maintenance
  4. use IM in cats for deep sedation/light anesthesia
286
Q

what are some effects of alfaxalone?

A
  1. dose-dependent CNS depression
  2. can cause apnea
  3. hypotension
287
Q

what are some risks associated with alfaxalone?

A
  1. patient can easily wake up

2. can cause hypoxia

288
Q

t/f - alfaxalone does not require intubation

A

false - intubation is necesary

289
Q

how long does alfaxalone last in dogs and cats?

A

dogs - 10-15 minutes

cats - 15-20 minutes

290
Q

is it safe to combine alfaxalone with other injectable anesthetics?

A

no

291
Q

what is the most commonly used barbituate?

A

thiopental (pentothal)

292
Q

what are the characteristics of thiopental?

A
  1. high lipid solubility

2. rapid anesthetic effect, rapid recovery

293
Q

how are the effects of thiopental terminated?

A

through redistribution of drug into body fat

294
Q

what are some risks associated with thiopental?

A
  1. splenic enlargement
  2. avoided in sighthounds
  3. very rarely used
295
Q

what are 2 examples of dissociative anesthetics?

A
  1. ketamine

2. tiletamine

296
Q

t/f - dissociative anesthetics are used with other drugs to induce general anesthesia

A

true

297
Q

are dissociatives controlled?

A

yes

298
Q

t/f - dissociatives have no pain control

A

false - have good pain control at low doses

299
Q

what does an animal look like when under dissociative anesthesia?

A

trancelike state; animal appears awake but is immobile and unaware of surroundings

300
Q

t/f - dissociative anesthetics decrease windup through NMDA inhibition

A

true

301
Q

are the patient’s reflexes intact when under dissociative anesthesia?

A

yes

302
Q

how do dissociatives effect the cardiovascular system?

A

increased heart rate, cardiac output, and blood pressure

303
Q

what is apneustic respiration? when might we see it?

A

animal inhales, looks like they hold their breath and then they exhale ; might see at higher doses of dissociatives

304
Q

adverse effects of dissociatives?

A

increased intracranial and intraocular pressure

305
Q

t/f - there is one effective reversal agent for dissociative drugs

A

false - there is no effective reversal agent

306
Q

when does IV ketamine reach it’s peak action?

A

1-2 minutes after injection

307
Q

when does IM ketamine reach it’s peak action?

A

10 minutes after injection

308
Q

what is ketamine’s duration of effect?

A

20-30 minutes; increasing the dose will prolong duration but will not increase the anesthetic effect

309
Q

KetVal is the trade name for what drug combination?

A

ketamine and valium (diazepam)

310
Q

what is KetVal used for?

A

IV induction

311
Q

t/f - KetVal has a rapid onset of action

A

true - 30-90 seconds

312
Q

how long is the duration of action of ketval?

A

5-10minutes

313
Q

how long does it take for patients to recovery after being under ketval?

A

30-60 seconds

314
Q

what are some advantages to the ketamine diazepam combination?

A
  1. minimal cardiac depression
  2. good muscle relaxation
  3. superior recovery
  4. some analgesia
315
Q

what are some disadvantages to ketamine/diazepam combination?

A
  1. possibility of respiratory depression is greater in combination
  2. cannot use IM (midazolam can be used in place)
316
Q

what three drugs compose “kitty magic” ?

A
  1. dexdomitor
  2. ketamine
  3. opioid
317
Q

how can you easily reverse the effects of dexdomitor?

A

administer a half of dose of antisedan

318
Q

what is guaifenesin?

A

a non-controlled muscle relaxant

319
Q

t/f - guaifenesin is an anesthetic drug

A

false - it is neither anesthetic or analgesic

320
Q

at what point of the anesthetic procedure is guaifenesin used? what other drug is it combined with?

A

used with ketamine during induction protocol

321
Q

t/f - guaifenesin is administered with a slow IV drip

A

false - administered rapidly IV until animal is ataxic

322
Q

what species do we use guaifenesin for?

A

horses

323
Q

what risks are involved if guaifenesin is used without premedication?

A
  1. may cause excitement

2. increased risk of side effects

324
Q

can guaifenesin be used as a sole agent?

A

no; the sedation/analgesia are inadequate for surgery

325
Q

what are the adverse effects of propofol? how can you prevent it?

A
  1. apnea
  2. bradycardia
  3. hypovolemia
    minimize risk by titrating to effect
326
Q

how many ET tubes should you set out to prepare for intubation? how do you pick?

A

3 tubes; one based on weight, one a half size smaller, one a half size larger

327
Q

what position must your patient always be in for intubation?

A

sternal recumbency

328
Q

t/f - it is best practice to preoxygenate for 3 minutes prior to intubation

A

true - especially for brachycephalic breeds

329
Q

what should you always assess before intubating your patient?

A

depth of anesthesia

330
Q

what do you need to be cautious of when intubating a cat?

A

largynospasm - can be avoided by using a local anesthetic

331
Q

what is the opening called where you insert the endotracheal tube?

A

glottal opening

332
Q

t/f - the endotracheal tube should be advanced on expiration

A

false - should be advanced on inspiration

333
Q

how should you react to a patient coughing or resisting on intubation?

A

stop immediately and administer more induction agent

334
Q

how can you confirm the placement of the ET tube?

A
  1. look for condensation in the tube
  2. watch reservoir bag for movement
  3. palpation of neck
335
Q

how do you inflate the cuff?

A

use a syringe with 0.5ml increments until no leak is heard when reservoir bag is squeezed and pressure in the breathing circuit is 15cm H2O

SGT (5 decks)

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