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Anesthetic agents 2

QuestionAnswer
Are opioids controlled substances? Yes
Do opioids produce sedation? Yes
Do opioids produce analgesia? Yes
7 Mu opioid receptor agonists ranked in order of potency compared to morphine Meperidine (1/8), MORPHINE, Hydromorphone (5x), Oxymorphone (10x), Fentanyl (100x), Etorphine (1000x), Carfentanil (10000x)
5 opioids that antagonize the Mu opioid receptor Naloxone, Butorphanol, Nalorphine, Diprenorphine, Nalbuphine
What is the opioid agonist-antagonist that we have been using as part of our premeds for out feline surgeries? Butorphanol
What is the opioid partial mu agonist that we have been using as part of our premeds for canine surgeries and for pain management in some of our feline patients? Buprenorphine
Reversal agent for Morphine Sulfate Naloxone
Reversal agent for Meperidine Naloxone
Reversal agent for Oxymorphone Naloxone
Reversal agent for Etorphine Diprenorphine
Reversal agent for Carfentanil Diprenorphine
What are the endogenous opioid peptides that opioids mimic? Beta-endorphins, dynorphins, enkephalins
What effects are produced by stimulating the Mu opioid receptors? analgesia, euphoria, respiratory depression, physical dependence, hypothermic actions
What effects are produced by stimulating the Kappa opioid receptors? analgesia, sedation, miosis
What effects are produced by stimulating the Sigma opioid receptors? struggling, whining, hallucinations, mydriasis
Give 6 clinical uses of opioid agonists analgesia, sedation, restraint, anesthesia, antitussives, antidiarrheals
What is neuroleptanalgesia? opioid + trangquilizer; profound state of sedation and analgesia induced by simultaneous admin of opioid and tranq
Which opioid receptors is butorphanol an agonist at? Kappa and sigma
Which opioid receptors is butorphanol an antagonist at? Mu
Which opioids have antitussive effects? Butorphanol, Torbutrol, Codeine
What are the adverse side effects of opioids? CNS- anxiety, disorientation, excitement, dysphoria; bradycardia, decreased resp and tidal volume, decreased PaO2 and PaCO2
What effects do opioids have on the GI system? salivation and vomit; initial diarrhea, vomit, flatulence; GI stasis
List some conditions in which you should avoid using opioids GI obstruction, head trauma, increased intraocular/intracranial pressure. glaucoma
Why do we avoid using IV opioids in cats? cause excitement
What are the indications for using opioid antagonists? Reverse undesirable effects- emergencies/overdose; wake up patient following sedation; reverse neuroleptanalgeisa; reviving neonates delivered by Csection
In general, why are injectable anesthetics such as barbiturates, propofol, and etomidate used with other agents? doesn't provide analgesia or muscle relax
What does "titration" mean? "to effect"- little % at time to effect
Are barbiturates controlled substance? yes
What are the clinical uses of barbiturates? rapid anestheic induction; allow intubation; sustain with inhalant or repeated doses/continuous infusion; use alone for short procedures
What is the reversal agent for barbiturates? none
Thiobarbiturates are highly soluble in which substance? fat
Oxy or thio? Phenobarbital oxybarbiturates
Oxy or thio? Pentobarbital Oxybarbiturates
Oxy or thio? Thiopental Thiobarbiturates
Long, short, or ultra short acting? Phenobarbital? long
Long, short, or ultra short acting? Pentobarbital short
Long, short, or ultra short acting? Thiopental ultrashort
lipid solubility? Phenobarbital low LS
Lipid solubility? Pentobarbital moderately LS
Lipid solubility? Thiopental high LS
Which form of barbiturates, ionized or nonpolar, passes through the cell membrane? Nonpolor (nonionized)
Why do you need to decrease the does of barbiturates in an acidotic patient? increased nonpolarization, increased drug amounts to brain, exaggerated patient response, lower does to anesthetize
which form of barbiturates, protein bound or free, enters the brain? Free, unbound
Why do you need to decreased the does of barbiturates in a patient with hypoproteinemia? results in more free (unbound) drugs = prolonged unconscious or death
Why should thiopental not be given to sighthounds or very thing animals? exaggerated potency because no fat to break it down
What may happen if thiobarbiturates are admin rapidly IV? apnea
What may happen if barbiturates are admin too slowly iv? CNS excitement
What adverse side effects are associated with the use of barbiturates? heart arryth with VPCs; resp- initial apnea, neonate depression; exaggerated potency in sighthounds, critically ill, hypoproteinemic, or acidotic; intraarterial injection- vasocontriction, pain, tissue necrosis
How can you minimize the adverse cardiovascular system side effects associated with barbiturates? slow admin, dilute concentration, preoxygenation, bag 2 to 3 times after intubation
Under what conditions do barbiturates have an exaggerated potency such that they would be contraindicated for used in these patients? sighthounds, critically ill, hypoproteinemic, acidotic
What can you expect during the recovery phase in dogs that have been given pentobarbital? paddling limb movement, prolonged, vocalization
Why should methohexital not be used animals with epilepsy or a history of seizure? excitement/serizures during induction and/or recovery
What is the primary indication for phenobarbital? anticonvulsant- epileptic seizures
How is phenobarbital admin? orally
What are the indications for pentobarbital? 1-2 hr general anesthesia, controls seizures in progress, euthanesia agent
How is pentobarbital admin? IV or IP
Why do you have to make sure thiopental is admin IV? avoid necrosis and tissue sloughing
Created by: Hillj2010