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Anesthetic agents 2
| Question | Answer |
|---|---|
| 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
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