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VM 580 - Vet Surgery & Anesthesia > Mod 1 - Anesthesia Premed 8/16 > Flashcards

Mod 1 - Anesthesia Premed 8/16 Flashcards

Quiz 2

1
Q

what is tranquilization?

A

behavioral change - relaxed patient but still aware of surroundings

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2
Q

what is sedation?

A

centrally depressed and drowsy patient that is unaware of surroundings

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3
Q

T/F - if a patient is really wound up, it can override the CNS so that sedation drugs won’t be effective.

A

True

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4
Q

what is the only phenothiazine drug we use?

A

acepromazine

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5
Q

what is acepromazine’s MOA and what does this cause? (2)

A
  1. blocks dopamine receptors
    - antiemetic effect
    - loss of thermoregulatory control
  2. blocks alpha-1 receptors
    - hypotension
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6
Q

what are some important properties of acepromazine? (6)

A
  1. antiemetic
  2. antihistamine
  3. antiarrhythmic
  4. tranquilization
  5. inc. analgesic efficacy
  6. dec. MAC
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7
Q

what does MAC stand for?

A

minimal alveolar concentration

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8
Q

what are 3 side effects of acepromazine?

A
  1. platelet aggregation dysfunction (clotting factors affected)
  2. hypothermia
  3. hypotension
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9
Q

what are 3 facts of acepromazine’s pharmacokinetics?

A
  1. slow onset of action
  2. long duration of action
  3. NOT REVERSIBLE
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10
Q

what are 2 other effects you need to keep in mind when using acepromazine?

A
  1. dec. Hct by 20-30% (splenic relaxation)
  2. priapism in horses (prolonged erection w/o stimulation)
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11
Q

T/F - if a patient negatively reacts to acepromazine, you can use a reversal.

A

False - time and supportive care

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12
Q

T/F - benzodiazepines are reliable sedatives.

A

False - unreliable!

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13
Q

what are 3 types of benzodiazepines we commonly use?

A
  1. diazepam (valium)
  2. midazolam (versed)
  3. zolazepam
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14
Q

T/F - there is not a reversal for benzodiazepines.

A

False - there is one = flumazenil

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15
Q

what are benzodiazepines MOA and what does this cause?

A

binds to GABA receptors in CNS

  1. potentiate effects of GABA at receptors - hyperpolarization of neuronal membranes = depression of limbic system, thalamus, hypothalamus
  2. dec. polysynaptic activity - muscle relaxation
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16
Q

what are 3 properties of benzodiazepines?

A
  1. anticonvulsants
  2. muscle relaxants
  3. minimum cardiovascular & respiratory depression
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17
Q

T/F - benzodiazepines are a controlled substance.

A

True

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18
Q

T/F - benzodiazepines work best only in neonates.

A

False - neonates, geriatric patients, sick patients

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19
Q

T/F - diazepam is NOT water soluble and can ONLY be mixed with ketamine.

A

True

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20
Q

T/F - midazolam is NOT water soluble and can ONLY be mixed with ketamine.

A

False - water soluble, multiple administration routes

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21
Q

Diazepam is painful if given 1 and uptake is unpredictable. Diazepam also binds to 2.

A
  1. IM
  2. plastic
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22
Q

what is a side effect of benzodiazepines if given to healthy animals and if it’s the only sedative given in dogs, cats, and horses?

A

excitation

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23
Q

what is the MOA of alpha-2 adrenergic agonists and what does it cause? (3)

A
  1. stimulation of alpha-2 receptors both centrally & peripherally - sedation, analgesia, muscle relaxation
  2. binds to post-synaptic alpha-2s on sympathetically innervated arterial vessels - vasoconstriction&raquo_space; hypertension
  3. dec. NE released
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24
Q

what are 5 alpha-2 adrenergic agonists you may see? what patients are they each used in?

A
  1. xylazine (SA, LA)
  2. detomidine (equine, bovine)
  3. romifidine (equine only)
  4. medetomidine (mainly zoos/exotics)
  5. dexmedetomidine (mainly dogs & cats, some horses, zoo/exotics)
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25
Q

what are 3 alpha-2 adrenergic agonist reversals (antagonists)?

A
  1. atipamezole
  2. yohimbine
  3. tolazoline
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26
Q

alpha-2 adrenergic agonist can cause complex effects on the cardiovascular system. Name 4.

A
  1. bradycardia with possible AV block that can cause…
    …2. decreased CO
  2. peripheral vasoconstriction that can cause…
    …4. hypertension, which turns into hypotension in 45-60min
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27
Q

T/F - we should ALWAYS treat alpha-2 agonist-induced cardiovascular effects with an anticholinergic.

A

False - bradycardia is VERY patient-specific; what is normal for this patient and this breed?

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28
Q

what are the 3 general properties of alpha-2 agonists?

A
  1. great sedation
  2. good analgesia
  3. muscle relaxation
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29
Q

T/F - xylazine is the least potent of the 5 alpha-2 agonists, while medetomidine and dexmedetomidine are the most potent (meaning you can use less med/dexmed compared to xylazine).

A

True

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30
Q

what are 5 side effects that may occur when using alpha-2 agonists?

A
  1. emesis (cats)
  2. dec. GI motility & emptying
  3. loss of thermoregulation
  4. hyperglycemia
  5. diuresis
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31
Q

what is xylazine classified as?

what may occur in sheep with use of xylazine?

A

alpha-2 agonist

pulmonary edema

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32
Q

what are alpha-2 agonist clinical uses? (3)

A
  1. sedation
  2. diagnostic imaging
  3. short, minimally invasive procedures
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33
Q

regarding safety, what should you be aware of that may happen when using alpha-2 agonists?

A

aggression is possible
- dogs bite
- horses bite & kick

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34
Q

what is detomidine?

what species is detomidine used in?

how is it given?

A

alpha-2 agonist

horses

boluses or CRIs

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35
Q

what is dexmedetomidine?

what species is it used in?

how is it given?

A

alpha-2 agonist

small animals - mainly for diagnostic imaging

horses - CRI

36
Q

T/F - we can trust the dosing of dexmedetomidine on Plumbs for small animals.

A

False - labeled dose is HIGHER than what we clinically use!

37
Q

what are anticholinergic drugs? (2)

A
  1. parasympatholytic
  2. antimuscarinic
38
Q

what are the names of 3 parasympatholytic anticholinergic drugs?

A
  1. atropine
  2. glycopyrrolate
  3. scopolamine
39
Q

what is the MOA of anticholinergic drugs?

A

block muscarinic receptors at post-synaptic sites to inc. chronotropy (rate of heart conduction) = inc. HR
- (SA & AV nodes & atrial myocardium get vagal PS input)
- (muscarinic receptors found pre- & post-synaptically at SA & AV nodes)

40
Q

what occurs to the heart at low doses of anticholinergic drugs?

A

paradoxical inc. in vagal tone = dec. HR
- once post-synaptic muscarinic blockade occurs, inc. vagal tone resolves & HR inc.

41
Q

when are anticholinergic drugs indicated? (2)

A
  1. +/- bradycardia (it depends)
  2. hypotension
42
Q

what are 3 complications that may occur when using anticholinergic drugs?

A
  1. inc. O2 consumption
  2. dec. functional reserve
  3. other body system side effects
42
Q

Atropine
- drug type?
- (slow/fast) onset of action
- (short/long) duration of action
- dramatic (dec./inc.) in HR
- (centrally/peripherally) acting

A

anticholinergic
fast
short
inc.
centrally

43
Q

glycopyrrolate
- drug type?
- onset of action (slower/faster) than atropine
- (shorter/longer) duration of action than atropine
- not as drastic (dec./inc.) in HR
- (does/does not) cross BBB

A

anticholinergic
slower
longer
inc.
does not

44
Q

T/F - anticholinergic drugs are indicated in those patients with glaucoma or those with problems with aqueous humor drainage.

A

False - CONTRAindicated

45
Q

when is it indicated to use anticholinergic drugs? (2)

A
  1. prevent &/or treat bradycardia & AV blocks
  2. control muscarinic side effects
46
Q

T/F - opioid receptors are found throughout the body.

A

True

47
Q

what are the 3 types of opioid receptors?

what are properties of each?

A
  1. mu - most effective analgesics
  2. kappa - some analgesia (species dependent), sedation
  3. delta - some analgesia
48
Q

Opioids are (hydrophilic/lipophilic). They have extensive metabolism in mammalian species. They are eliminated in 1 & 2.

A

lipophilic
1. urine
2. feces

49
Q

When giving opioids, there are fewer side effects seen when given to (healthy/painful) patients due to ?.

A

painful
upregulation of receptors

50
Q

what do opioids do?

A

dec. release of excitatory NTM & hypopolarize nociceptors = dec. transmission within spinal cord

51
Q

what supraspinal effects do opioids have? (4)

A
  1. analgesia
  2. sedation
  3. altered thermoregulation
  4. significant respiratory depression
52
Q

what can happen if opioids are administered in high doses or via rapid IV infusion?

A

excitation

53
Q

Opioids, when combined with other drugs during anesthesia, can cause profound 1 that is characterized by inc. 2.

A
  1. respiratory depression
  2. PaCO2
54
Q

antitussive effects are produced when opioids bind to 1 & 2 receptors at the cough center in the medulla 3.

A
  1. mu
  2. kappa
  3. oblongata
55
Q

when discussing the heart, (bradycardia/tachycardia) commonly occurs with opioid use. This can be reversed via antimuscarinics, such as 1 or 2.

A

bradycardia
1. atropine
2. glycopyrrolate

56
Q

opioids can impair coordination of GI 1 and should be used cautiously in 2.

A
  1. motility
  2. horses
57
Q

which 3 species may develop hypothermia with opioid use?

A
  1. dogs
  2. rabbits
  3. birds
58
Q

which 4 species may develop hyperthermia with opioid use?

A
  1. cats
  2. pigs
  3. goats
  4. cattle
59
Q

T/F - schedule 1 drugs have a high potential for abuse with no currently accepted medical use.

A

True

60
Q

T/F - schedule 5 drugs have a high potential for abuse with no currently accepted medical use.

A

False - low abuse potential

61
Q

maropitant (cerenia) is a very potent 1 and will prevent it by 95%. It is a 2 receptor (ant/agonist) with minimal analgesic properties.

A
  1. antiemetic
  2. NK-1
    antagonist
62
Q

name 4 pure opioid agonists.

A
  1. morphine
  2. methadone
  3. fentanyl
  4. hydromorphone
63
Q

what is an opioid agonist-antagonist?

A

butorphanol

64
Q

what is an opioid partial agonist?

A

buprenorphine

65
Q

what are 2 opioid antagonists?

which opioid agonist is also considered an antagonist?

A
  1. naloxone
  2. naltrexone

butorphanol

66
Q

what are 6 side effects of opioids?

A
  1. bradycardia
  2. respiratory depression
  3. euphoria, dysphoria
  4. hypothermia
  5. hyperthermia in cats (w/hydromorphone)
  6. miosis ()-() (dogs) & mydriasis (0)-(0) (cats)
67
Q

T/F - fentanyl is 100x more potent than morphine.

A

True

68
Q

morphine is an inexpensive pure 1 opioid with an onset of action of 2 and a duration of action of 3.

A
  1. mu
  2. 20-30min
  3. 2-4hr
69
Q

T/F - you can use morphine in patients that are going to be skin tested.

A

False - morphine causes inc. histamine release

70
Q

T/F - morphine can be used in patients with head trauma, brain tumors, or patients undergoing ophthalmological procedures.

A

False - causes inc. IOP and may cause vomiting, which will inc. ICP & IOP

71
Q

hydromorphone has a (shorter/longer) duration of action compared to morphine and is (less/more) expensive.

A

shorter
more

72
Q

T/F - hydromorphone is a semisynthetic opioid.

A

True

73
Q

T/F - methadone, a synthetic opioid, is the most expensive of the opioids.

A

True

74
Q

morphine vs. hydromorphone vs. methadone

  1. which is the least likely to cause vomiting or histamine release?
  2. which has mild-moderate NMDA receptor antagonist activity, which is good for chronic or refractory pain?
A

1 & 2. methadone

75
Q

hydrocodone is a pure 1 agonist with (poor/excellent) bioavailability in dogs.

what is it used for?

A
  1. mu
    poor

antitussive

76
Q

fentanyl is a (short/fast) acting synthetic 1 with _2_x potency compared to morphine. it allows for MAC sparing up to 3%. it lasts 4 after a single IV injection, so it is usually given 5.

A
  1. opioid
  2. 80-100x
  3. 63%
  4. 15-30min
  5. CRI
77
Q

T/F - buprenorphine has a ceiling effect with variable analgesia.

A

True

78
Q

T/F - butorphanol is a great analgesic.

A

FALSE - great sedative & antitussive, but does NOTHING for pain!

79
Q

What are 3 common NSAIDs used at MSU that are COX-2 selective (COX-1 sparing)?

A
  1. carprofen
  2. meloxicam
  3. robenacoxib (onsior)
80
Q

the duration of action of robenacoxib (onsior) is 1. The label dose for cats is 2.

A
  1. 24hrs
  2. 3d
81
Q

which is NOT a desired effect of acepromazine?

A. antiemetic
B. MAC reduction
C. priapism
D. anxiolysis

A

C

82
Q

T/F - benzodiazepines are reliable sedatives in most small animal patients.

A

FALSE

83
Q

which is most likely a side effect shortly after an injection of dexmedatomidine?

A. excitement
B. vomiting
C. tachycardia
D. bradycardia

A

D.
- profound peripheral vasoconstriction inc. MAP = dec. HR

84
Q

which scenario is NOT the correct usage of an anticholinergic in most situations?

A. being administered before reversal of paralytic drugs
B. as part of a premed for a healthy & normal patient
C. treating bradycardia & hypotensive patient in surgery
D. preventing bradycardia in a procedure where vagus nerve may be manipulated

A

B.

VM 580 - Vet Surgery & Anesthesia (11 decks)

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