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Chapter 14 Drugs Used to Relieve Pain & Inflammation

Explain the anatomy & physiology associated with pain production & relief. Pain is an unpleasant sensory/emotional experience associated with tissue damage. Pain starts in the terminal ends of sensory nerve fibers called nociceptors. It is activated through chemical, mechanical or thermal stimulation.
List the four steps in the production of pain sensation. Transduction-nociceptors create impulses; transmission--impulses transmitted to CNS; modulation--suppression or amplification of impulses (sent to cerebral cortex); perception--impulses processed & recognition= pain perception.
What are the two types of fiber systems that transmit pain impulses? Type A delta fibers--sharp, localized pain; Type C unmyelinated fibers--dull, poorly localized pain (humans).
Discuss the difference between physiologic and pathologic pain. Physiologic--alerts the animal to potential danger & avoid further tissue damage. Pathologic--results from tissue/nerve damage; three classes: visceral-hollow abdominal organs; somatic-musculoskeletal system; neuropathic-injury of peripheral or CNS
Describe the concepts of preemptive & multimodal pain therapy. Preemptive--anticipate pain & provide medication to prevent it; multimodal--use of multiple products in coordination to provide most pain management possible w/ comfort of patient in mind.
List the physical signs associated with the expression of pain in animals. increased heart rate; increased respiratory rate; mydriasis; salivation; vocalization; changes in facial expression; aggression; guarding the site; restlessness; unresponsiveness; failure to groom; abnormal gait; abnormal stance.
Describe the mechanism of action of NSAIDs. Inhibit the enzyme cyclooxygenase (COX), of which there are two forms: COX 1 (constituted form)--modulates renal blood flow & synthesis of GI mucosa; COX 2 (induced form)--promotes formation of prostaglandin from arachidonic acid.
Which NSAIDs are thought to produce fewer GI side effects? those that inhibit COX-2.
List the different types of NSAIDs. salicylates; pyrazolone derivatives; flunixin meglumine; dimethyl sulfate (DMSO); buscopan compositum; acetaminophen; propionic acid derivatives.
Which NSAID has limited use in veterinary medicine & why? acetaminophen; it is discouraged due to the risk of potential toxicity.
Describe the uses for salicylates. mild to moderate pain (arthritis, hip displasia); post-adulticide treatment for heartworm disease; analgesia/anti-pyrexia; cats w/ cardiomyopathy; endotoxic shock.
Explain the uses of pyrazolone derivatives for pain management. Analgesia (mild to moderate pain); anti-inflammatory action; anti-pyrexia.
When is the use of flunixin meglumine appropriate for pain management? For use in horses/cattle for analgesia; anti-pyrexia; anti-inflammatory effects.
Describe the uses for dimethyl sulfate (DMSO). Topical for acute swelling in dogs & horses; IV adjunct to intestinal surgery; cerebral edema or spinal cord injury (IV); perivascular injection of chemotherapeutic agents (topical).
When is buscopan compositum used for pain? In horses, for abdominal pain associated w/ colic.
List some propionic acid derivatives and their uses. carprofen--degenerative joint disease; post-operative pain. naproxen--pain, inflammation, lameness (from myositis in horses); soft tissue diseases (horses). Etodolac & deracoxib--osteoarthritis in dogs. Firocoxib--osteoarthritis in dogs & horses
What are potential adverse side effects of NSAIDs? GI ulcers; GI bleeding; hepatotoxicity; nephrotoxicity; inhibition of cartilage metabolism; bone marrow suppression; bleeding tendencies from reduced platelet aggregation.
Describe how antihistamines work. They prevent histamine from combining with tissue receptors or by displacing histamine from receptor sites.
What is the difference between H1 histamine receptors and H2 histamine receptors? H1--affect progression of allergic response; may contribute to motions sickness & nausea. H2--cause increased flow of hydrochloric acid by GI mucosa; blockers reduce secretion and can be used to treat GI irritation/ulcers.
List the indications for muscle relaxants. Acute inflammatory & traumatic conditions of muscles and the spasms that may result.
Describe the two categories of corticosteroids & their effects. mineralcorticoids--regulate electrolyte & water balance in body; glucocorticoids--exert anti-inflammatory and immunosuppressive effects; influence metabolism of carbohydrate, fat & protein.
Describe the hypothalamic-pituitary-adrenal axis, which controls the release of corticosteroids in the body. Feedback mechanism related to cortisol level in blood. Hypothalamus sends CRF to anterior pituitary when level low; pituitary releases ACTH into blood, carried to adrenal cortex; adrenal gland releases cortisol. High level inhibits release of CRF.
List indications for the use of corticosteroids. allergic reactions/conditions; inflammatory conditions; shock/toxemia; laminitis; conjunctivitis/uveitis; Addison's disease; autoimmune disease; lymphocytic neoplasms.
Describe short- and long-term side effects of corticosteroid use. Short--polyuria, polydipsia, depressed healing, polyphagia & weight gain, hyperadrenocorticism, GI ulcers, abnormal behavior. Long--osteoporosis; hypoadrenocorticism; thinning of skin & muscle wasting.
What is the mechanism of action of local anesthetic agents? Prevent the generation and conduction of nerve impulses into peripheral nerves.
List indications for local anesthetic agents. General anesthesia not available or too dangerous; small laceration; diagnose lameness in horses; prevent straining during replacement of prolapsed uterus; place endotracheal tube in cats
Created by: kidtaxi9