Neurologic Drugs
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| Two types of drugs in the ANS | sympathetic (adrenergic) & Parasympathetic (Cholinergic)
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| What does Sympathetic nervous system do | "fight or flight"- increases HR, RR, & blood flow to muscles, decreases GI function, causes pupillary dilation
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| What does parasympathetic N.S. do | "homeostatic"- brings HR, RR, and blood flow to muscles back to normal levels; returns GI function to normal; constricts pupils to normal size
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| ANS drugs work by: | 1. acting like neurotransmitters
2. interfering with neurotransmitter release
.blocking attachment of neurotransmitters to receptors
4. interfering with the breakdown/re-uptake of neurotransmitters at the synapse
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| Cholinergic agents clinical uses: | 1. decrease IOP of glaucoma
2. help control vomiting
3. stimulate GI motility
4, treat urinary retention
5. act as antidote for neuromuscular blockers
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| Pilocarpine | (direct-parasympathomimetic)- decrease glaucoma associated IOP, treats neurogenic keratoconjunctivitis sicca (dry eyes)
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| metoclopramide (Reglan) | (direct-parasympathomimetic)- antiemetic; promotes gastric emptying
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| bethanechol | (direct-parasympathomimetic)- treat GI and urinary atony (muscle weakness)
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| organophosphate compounds | (indirect-parasympathomimetic) commonly used as insecticide dips; may result in toxicity if used inappropriately; clinical signs= SLUDD
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| what is SLUDD | salivation, Lacrimation, Urination, Digestion, Defecation
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| What are the adverse side effects of Cholinergic agents? | bradycardia, hypotension, heart block, lacrimation, V/D, increased intestinal activity, increased bronchial secretions
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| What are the clinical uses for anticholinergic drugs? | pre-anesthetic, treatment of V/D via a decrease in GI motility, dilation of pupils of examination, treatment of sinus bradycardia
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| what is a pre-anesthetic? | drying of secretions and prevention of bradycardia before anesthesia
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| atropine | preanesthetic to dry respiratory secretions and prevent bradycardia, dilate pupils for examination, emergency drug (fastest onset, less duration than glycopyrrolate),
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| glycopyrrolate | preanesthetic to dry respiratory secretions and prevent bradycardia, emergency drug (slower onset and longer duration of action than atropine)
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| pralidoxime | treat OP intoxication
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| What are the side effects of anticholinergic agents? | (dose related) drowsiness, disorientation, tachycardia, photophobia, constipation, anxiety, burning at injection site
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| what do adrenergic drugs do? | simulate the action of sympathetic N.S; bring about action at receptors mediated by epi & norepi; classified according to specific receptor types activated (alpha and beta)
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| What are the clinical uses of adrenergic drugs? | stimulate the heart to beat during cardiac arrest, reverse hypotension and bronchoconstriction of anaphylactic shock, strengthen the heart during CHF, correct hypotension through vasoconstriction, treat urinary incontinence, treat glaucoma
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| how do adrenergic drugs treat glaucoma? | increase outflow of and decrease production of aqueous humor
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| epinephrine | (sympathomimetic)- stimulates all receptors to cause increase in HR and CO; dilation of blood vessels in muscle; dilation of bronchioles; increase metabolic rate
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| norepinephrine | (sympathomimetic)- increase blood pressure
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| dopamine | (sympathomimetic)- precursor of epi and norepi; treat shock and CHF; increases renal perfusion
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| phenylpropanolamine | (sympathomimetic)- treat urinary incontinence in DOGS
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| dobutamine | (sympathomimetic)- short term treatment of heart failure
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| What are the adverse side effects of adrenergic drugs? | tachycardia, hypertension, nervousness, arrhythmias
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| What do adrenergic blocking agents (antiadrenergics/sympatholytics) do? | block the efforts of the adrenergic neurotransmitters (disrupt the activity of SNS); classified according to the site of their action (alpha/beta blockers)
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| acepromazine | (alpha blocker)-tranquillizer; causes vasodilation
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| yohimbine | (alpha blocker)- antidote for xylazine (tranquilizer) toxicity
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| atipamezole (Antisedan) | reversal agent for dexmedetomidine (Dexdomitor)
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| Side effects of alpha blockers | hypotension, tachycardia, muscle tremors
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| propranolol | beta blocker; used to treat cardiac arrhythmias an hypertrophic cardiomyopathy
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| atenolol | beta blocker; similar to propranolol
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| timolol | beta blocker; ophthalmic preparation used to treat glaucoma
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| adverse side effects of beta blockers | bradycardia, hypotension, worsening heart failure, bronchoconstriction, heart block, syncope
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| CNS drugs do: | alter nerve impulses to tranquilize or sedate animals, control pain, induce anesthesia, prevent/control seizures, antagonize/reverse effects of some depressant drugs, stimulate the CNS to treat cardiac/ respiratory depression/arrest, perform euthanasia
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| anesthesia | means without sensation
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| general anesthetics | affect the CNS, produce loss of sensation with partial or complete loss of consciousness
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| local anesthetics | block nerve transmission in the area of application with no loss of consciousness; uses: nerve blocks, aid in endotracheal tube placement, ease skin irritation
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| inhalant anesthetics | used to produce general anesthesia, liquid agents are vaporized in oxygen; distributed via concentration gradient in blood stream, vaporizer specific to anesthetic agent
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| effects of inhalant anesthetics | reversible depression of the CNS, muscle relaxation, slight analgesia, respiratory depression, slight cardiac depression, decreased blood pressure, potentiate cardiac arrhythmias
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| adverse affects of inhalant anesthetics | dose-related hypotension can cause decrease in renal perfusion; GI effects including nausea, vomiting, ileus
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| vapor pressure | measurement of the tendency of a liquid to evaporate
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| blood-gas solubility coefficient | measurement of the tendency of an agent to dissolve in blood; associated with the speed of induction, recovery, and change in anesthetic depth; lower coefficient= faster action
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| minimum alveolar concentration | measurement of the potency of an agent; how much agent is needed to attain surgical anesthesia; high MAC=less potent
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| Administration of local anesthetics | topically to mucous membranes and the cornea, infiltration of a wound or joint, IV with continuous drip, injection around nervous tissue
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| tranquilizers | calming agent used to calm animals; reduce anxiety and aggression
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| sedatives | calming agents used to quiet excited animals; decrease irritability and excitement
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| anti anxiety drugs | calming agent to lessen anxiousness, but do not make animals drowsy
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| Purpose of phenothiazine tranquilizers | dopamine blockers(alpha-adrenergic blockers)- actions: sedation, allay fear and anxiety, antiemetic- depress chemoreceptor trigger zone in brain, no analgesia
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| what is a precursor of epinephrine and norepinephrine | dopamine
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| phenothiazine tranquilizers | acepromazine, chlorpromazine, prochlorperazine
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| side effects of phenothiazine tranquilizers | profound hypotension (vasodilation), possible hypothermia, lower seizure threshold, protrusion of nictitating membrane, paraphimosis (horses only), bradycardia
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| What do benzodiazepine derivatives do | depress thalamic and hypothalamic regions of brain; limbic system; actions= sedation, muscle relaxation, anticonvulsant activity, reduction of anxiety, appetite stimulant, no analgesia
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| benzodiazepine derivatives | diazepam (Valium), midazolam (Versed), alprazolam (Xanax); Schedule IV controlled drugs
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| diazepam (Valium) | often used with ketamine for anesthesia, used for treatment of in process seizures
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| side effects of benzodiazepine derivatives | CNS excitement in dogs; overdose may cause excessive CNS depression
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| purpose of Alpha-2 agonists | bind to alpha-2 receptors on neurons, reduces production of norepinephrine, absence of norepinephrine causes sedation; used of sedation, preanesthetic, analgesia, emetic in cats
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| side effects of alpha-2 agonists | analgesia, muscle relaxation, decreased response to stimuli
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| dexmedetomidine (Dexdomitor) | alpha-2 agonists; sedative and analgesic; can be combined with other drugs to produce surgical anesthetic levels; side effects: bradycardia/heart block, biphasic BP response, decreased RR, vomiting; reversal agent= atipamezole (antisedan)
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| biphasic BP response | short period of hypertension followed by hypotension
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| poor peripheral perfusion | poor mm color and unreliable peripheral BP measurements
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| xylazine (Rompun, AnaSed) | alpha-2 agonist; sedation, some analgesia, muscle relaxant, emesis (cats); side effects= profound bradycardia, hypotension, hypoventilation, cardiac arrhythmias, increase sensitivity to epinephrine; ruminants are more sensitive; reversal agent= yohimbine
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| detomidine | alpha-2 agonist; used as sedative in horses, produces better analgesia than xylazine
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| romifidine | alpha-2 agonist; used as a sedative and preanesthetic in horses, facilitates handling.
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| barbituates | one of the oldest categories of CNS depressants, sedatives, anticonvulsants, general anesthetics, euthanasia agents, non-reversible, must be metabolized by liver prior to elimination, must be administered via IV due to tissue sloughing
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| pentobarbital | barbituate; short acting 1-2 hours; given IV or IP; uses: anticonvulsant and euthanasia; schedule II controlled drug
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| phenobarbital | barbituate; long acting 8-12 hours; primary use= anticonvulsant; oral and injectable, plasma drug levels must be monitored frequently; schedule IV controlled drug
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| thiopental | barbituate; ultra short acting 5-30 mins anesthetic induction agent; not currently in USA; IV only, causes tissue necrosis & tissue sloughing if perivascular injection, rapidly redistributed to fat; can cause apnea or CNS excitment; class III drug
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| Euthanasia solutions | barbituates; used to humanely end an animals life, should produce rapid unconsciousness followed by cessation of respiratory and cardiac functions, minimal struggling, vocalizations, or excessive voluntary movements, usually pentobarbital
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| Purpose of Dissociative agents | alter neurotrans activity causing depression of thalamus & cerebral cortex; sedation, restraint, analgesia, anesthesia; produce muscle rigidity, respiratory depression, minor cardiac stimulation; ataxic & hyper responsive anesthesia induction & recovery
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| ketamine (Ketaset) | dissociative; immobilizes patient but mild analgesic effect; primary sedative used in nonhuman primates; side effects: increased salivation, eyes remain open (need ocular lubricant), may cause burning sensation at injection site; schedule III drug
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| tiletamine (Telazol= tiletamine with zolazepam) | dissociative; provides better analgesia than ketamine; addition of zolazepam eliminates need for combination with other agents for muscle relaxation; schedule III drug
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| purpose of opiods | produce analgesia, sedation, and relieve anxiety, does not produce anesthesia; side effects= respiratory depression, excitement if given too rapidly; low doses= antitussive properties; produce effects by action on opiod receptors
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| opiods: Mu | found in pain regulating brain areas
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| opiods: Kappa/Delta | found in the cerebral cortex and spinal cord; areas associated with pain modulation
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| Opiods: Sigma | found in the brain
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| Full Opiod agonists | morphine, oxymorphone, fentanyl
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| partial opiod agonists | buprenorphine (Buprenex), butorphanol (Torbugesic), tramadol
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| buprenorphine (Buprenex) | Mu- partial agonist, Kappa- antagonist; Delta- antagonist (weak)
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| butorphanol (Torbugesic) | Mu- antagonist; Kappa- partial agonist
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| tramadol | Mu-agonist, serotonin-norepinephrine reuptake inhibitor
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| opiod antagonists | block the binding of opiods to their receptors, used to treat respiratory and CNS depression of opiod use, naloxone (Narcan)
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| neuroleptanalgesia | opiod + tranquilizer or sedative
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| neuroleptanalgesics | can cause a state of CNS depression and analgesia and may/may not produce unconsciousness, combination products may be prepared by vet; ex: acepromazine + morphine, xylazine + butorphanol
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