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wk 3 anesthesia
pain pathway and analgesia/ pre meds
| Question | Answer |
|---|---|
| transduction | Noxious stimulus (mechanical, chemical or thermal) is converted into electrical energy at the peripheral nociceptor Physical stimulus translated to electrical signal (depolarization) Can be blocked by local anesthetic drugs Prevent depolarization |
| transmission | Pain impulse transmitted via depolarization from the nociceptor Sensory nerve Spinal cord Brain |
| modulation | Pain signal can be modified spinal cord or brain by neurotransmitters Ascending Modulation – Descending Modulation – Dampens pain signal Naturally occurring “pain-killer” compounds Reason pain sensation differs at time of injury and hours later |
| perception | Recognition/interpretation of pain impulse at conscious level, non physiologic factors Emotions, mood, fear, etc. previous experiences, genetics Anesthesia prevents the conscious perception of pain, if not blocked pain preceived |
| what drugs work on Transduction | Local anesthetics Opioids Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) Corticosteroids |
| What drugs work on transmission | Local anesthetics a-2 agonists |
| what drugs work on modulation | Local anesthetics a-2 agonists Opioids NSAID’s Tricyclic Antidepressants (TCA’s) NMDA receptor antagonists |
| what drugs work on perception | Inhalant anesthetics Opioids A-2 agonists Benzodiazepines & Phenothiazines* *When used in combination w/ opioids or other analgesics |
| what is the goal of transduction | Inhibit peripheral sensitization |
| what is goal of transmission | Inhibit impulse conduction |
| what is goal of modulation | Inhibit central sensitization |
| what is goal of perception | Inhibit cerebral recognition of pain |
| physical signs of pain | Agitation/vocalization, quiet depressed inactive, difficult sleep Frowning, squinting, ears back, fail to groom, appear distant Aggressive or resist handling, stare into space, anorexia Seek comfort from owner or other animal silent and hunching |
| physiologic response to pain | Peripheral vasoconstriction Increased blood pressure (BP) Increased heart rate (HR) Blanched/pale mucous membranes (MM) Increased respiratory rate (RR) Increased white blood cell count Stress Leukogram |
| These physiological pain responses are caused by the SNS | Decreased tidal Volume Salivation Mydriasis |
| components of a stress leukogram | Lymphopenia Eosinopenia Monocytosis Neutrophilia |
| phases of anesthetic procedure | Premedication Induction Maintenance Recovery |
| Premedication | address pain, calm patient, prevent side effects smooth transition between planes muscle relaxation |
| induction | loss of consciousness |
| maintenance | maintain desired anesthetic plane using inhalent or injectable drugs |
| Rcovery | regain consciousness safely, drugs are redistributed/metabolized/eliminated |
| agonist | binds to and stimulates receptors |
| antagonist | binds to but does not stimulate receptors, also called reveral agents |
| partial agonist | binds to and partially stimulates receptors |
| agonist/antagonist | binds to more than 1 receptor type simultaneously stimulates one and blocks another |
| anticholinergics | atropine and glycopyrolate |
| phenothiozine tranquiizers | acepromazine compazine |
| opiods | morophine, butorphanol, buprenorphine, hydromorphone, fentanyl, meperdine, oxymorphone, tramadol |
| benzodiazepines | diazepam, midazolam, lorazapam |
| alpha 2 Agonists | xylazine, dexmedatomadine, medetomidins |
| Nsaids | meloxicam, deracoxib, carprofen, firocoxib, flunixin meglumine, robenacoxib, ketaprofen |
| anticholinergics block what | Achetocholine, prevent nerve transmission |
| atropine | anticholinergic, faster onset shorter duration of action used for bradycardia and drying up secertions |
| glycopyrrolate | anticholinergic, slower onset, longer duration of action |
| do phenothiazine tranquilizers offer analgesia | no |
| neuroleptanalgesia | Tranquilizer and a opiod |
| what does a neurolepanalgesic cause | sedation, altered awareness and analgesia |
| adveres effects of phenothiazine tranquilizer | hypothermia, hypotension and is contraindicated in shock sick or debilitated, and neonates and geriatrics, use in patients with seizures, arrhythmis effects, or decreased PCV, antiemitic properties and antihistamine effects |
| avoid this drug group in stallions due to possible persistent penile prolapse | Phenothiazine tranquilizers |
| this group of drugs causes profound bradycardia in boxers | phenothiazine tranquilizers |
| this group of drugs can be used in the pre, intra and post operative phases | opiods |
| antagonist for opiods | Naloxone ( narcan) |
| main clinical uses of opiods | Potent analgesics Decrease anxiety Sedation/chemical restraint Decrease doses of other agents (balanced multimodal/synergism) Other variable effects Species, agent & dose-related |
| opiods can be classified according to what receptors | Agonist Partial Agonist Antagonist Agonist-antagonist |
| what are the 4 opiod receptors | (1) Mu (m) (2)Kappa (k) (3) Delta (d) (4) Sigma (s) |
| opioid agonist work on what receptors | 1-3 |
| what are the opioid agonists | hydromorphone, fentanyl, oxymorphone, meperidine |
| pure agonists work on what receptors | all 4 |
| what opioid is a pure agonist | morophine |
| what opioids are partial agonists | Buprenorphine, Tramadol |
| what opioid is a agonist - antagonist | Butorphanol |
| what are the effects Mu receptors | Analgesia Sedation Euphoria Miosis Respiratory depression Addiction |
| what are the effects of the Kappa receptors | Analgesia < Mu Sedation Miosis Respiratory depression |
| what are the effects of the delta receptors | Analgesia (SC admin.) Motor dysfunction Cardiac stimulation Dysphoria |
| what are the effects of the Sigma receptors | Euphoria/dysphoria Hallucinations |
| respiratory effects of opiods | Resp depression- dose dependant, Salivation, Nausea and vomiting, panting, |
| Cardiovascular effects of opioids | bradycardia, decreased Co |
| what is special consideration for Morophine or Meperidine | Can cause Histamine release urine retention, IOP and addiction |
| what is the only opioid that can not be reversed | Buprenorphine |
| morphine | C II, Prototypical opioid Potency of other opioids compared to morphine 1o Mu activity; Some Kappa activity Effective for visceral & somatic pain Significant respiratory depression Mydriasis - Cat/horse Miosis – Dog |
| Hydromorphone | C II Strong Mu agonist Moderate to severe pain 4x more potent than Morphine, respiratory depression Greater analgesic effect than morphine Less histamine release, hyperthermia Less likely to cause hypotension, bradycardia |
| Fentanyl | C II Excellent for severe pain 100-250x more potent than morphine Short duration of action, bradycardia, respiratory depressant Most useful as CRI, transdermal patches available Lowers thermoregulatory set point |
| butorphanol | C IV Synthetic opioid Mixed agonist-antagonist Partial kappa agonist Partial mu agonist & antagonist Poor analgesic Analgesia only lasts ~45 minutes More effective for visceral than somatic pain MUCH better sedative |
| Buprenorphine | C III Good for moderate pain Mixed agonist-antagonist Partial Mu agonist Kappa antagonist Strong affinity for Mu receptors Long duration of action (8-12 hrs) Great post-op/post-trauma drug CANNOT be antagonized by naloxone |
| Tramadol | C IV Synthetic opioid Mu receptor-like activity Post-surgical or chronic pain Good choice if NSAID’s contraindicated Renal disease, long-term steroids, etc. Adjunct/multimodal analgesia Osteoarthritis (OA) pain Chronic pain, cancer pain, etc |
| uses of benzodiaepines | anticonvulsant activity |
| all are controlled substances, many are light sensitive, can be used in combination for premeds and induction, High margin of safety, skeletal muscle relaxation, cross placental border | benzodiazepines |
| what are the names of the benzodiazepines | Midazolam diazepam and Lorazepam Zolazepam ( one of two drugs that make up telazol |
| Flumazenil | antagonist for Benzodiazepines |
| C IV Drug of choice for Epileptics, NOT water soluble, IV administration only PO and rectal dosing available , Binds to plastic | Diazepam |
| C IV, Water Soluble, Does NOT bind to plastic | Midazolam |
| Can be administered IN for treatment of Status Epilecticus | Lorazepam |
| Xylazine and Dexmedatomadine | Alpha 2 agonist |
| Antagonist for Xylazine | Yohimbibe |
| Antagonist for Dex-d | Atipamazole |
| Moderate to heavy sedation Muscle relaxation Analgesia Used to relieve GIT/ visceral pain Less effect on somatic pain NOT controlled substances Fast onset Reversible Hepatic metabolism, Renal excretion | Alpha 2 agonist |
| Sympatholytic, Prevent NE release so causes sedation, muscle relaxation, and analgesia | alpha 2 mechanism of action |
| Emetic of choice in cats | Xylazine |
| Effects on CV System – Most profound Significant CV & myocardial depression Arrhythmogenic effect outlasts sedation 2nd degree AV Block Profound bradycardia Increased risk of arrhythmias when given to excited animals NE, EPI | Adverse effects of Alpha 2 |
| do not use in animals less than 12 weeks old, Debilitated, Geriatric and those with cardio vascular disease | Alpha 2 |
| Suppresses the release of insulin | Al[pha 2 |
| how is antisedan given | IM ONLY |
| how is Yohimbine given? | IV |
| true / false Alpha 2 can be absorbed across intact skin? | True |
| Ketoprofen, Acetylsalicylic acid ( asprin), Phenylbutazone, Banamine | Cox 1 |
| Carprofen , Meloxicam, Robenacoxib, Firocoxib | Cox 2 |
| this group of NSAIDS is preferred for managing pain and inflammation | Cox 2 |
| This Cox 1 is only labeled for horses in the US | Ketoprofen |
| This drug has a black box warning for cats | Meloxicam |
| This Cox 2 is labeled for dogs only | Deracoxib |
| labeled for horses and dogs | Firocoxib ( previcox) |
| This Cox 1 is banned in cattle | Bute |
| Approved for use in both horses and cattle | Flunixin Meglumine ( banamine) |
| tthis group of drugs can decrease stress response to surgery, reduce Iv and inhalant anesthetic requirements and reduce analgesia requirements | Local anesthetic agents |
| this group has the following disadvantages: Self mutilation, they can sting or burn, can show toxic signs | local anesthetic agents |
| This drug can not be administered IV in cats as it causes cardiovascular depression | Lidocaine |
| There should be always negative aspiration of blood before injection Lack of resistance on injection ALWAYS calculate maximum dose BEFORE drawing up drugs | 3 rules for nerve blocks |
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Corgimom
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