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.pharmocology > Preanesthetic Agents > Flashcards

Preanesthetic Agents Flashcards

1
Q

Intramuscular

A

Stressed or excited patients
Allow 15-30 min for max effect
Muscle location important

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2
Q

Intravenous

A

Place IV catheter first
Allow 3-5 min max for effect

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3
Q

T/F: SQ not recommended for premedication

A

TRUE

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4
Q

Subcutaneous

A

Less vascular supply= slow rate of absorption
Uptake of drug is dependent on tissue perfusion
Lead to patchy absorption (drug dependent)

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5
Q

Most adverse drug effects are associated with _________

A

High drug doses

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6
Q

10 steps for anesthesia drug selection

A
  1. Antiemetic
  2. NSAID
  3. Opioid
  4. Sedative agent
  5. Is anticholinergic warranted
  6. Induction agent
  7. Maintenance agent
  8. Local/ regional blocks
  9. Intra- op nociceptive stimulation
  10. Post-op analgesic plan
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7
Q

Medication for pre-hospital sedation

A

Gabapentin and Pregabalin
Trazodone

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8
Q

Gabapentin & Pregabalin MOA

A

Binds to alpha 2 delta subunit or voltage dependent channel in CNS
↓ the release of glutamate , dopamine, NE, and serotonin

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9
Q

Gabapentin & Pregabalin uses

A

High doses= sedation
Adjunct analgesia or neuropathic pain

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10
Q

Trazodone MOA

A

Serotonin antagonist and reuptake inhibitor
Histamine antagonist and alpha-1 adrenergic antagonist

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11
Q

Trazodone uses

A

Sedation and anxiolysis within 1-2 hours

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12
Q

Caution of trazodone

A

Combining with SSRI, TCA, or MAOIs = serotonin syndrome

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13
Q

Chill protocol for pre-hospital sedation

A

Gabapentin night before visit
Gaba and melatonin 1-2 prior to appointment
Acepromazine admin 30 before appointment

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14
Q

Pre-anesthetic drug classes

A

Antiemetics
NSAIDs
Opioids
Phenothiazines
Benzodiazepines
Alpha-2 agonists
Anticholinergics

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15
Q

Antiemetic medications

A

Maropitant and Ondansetron

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16
Q

Maropitant (Cerenia)

A

Neurokinin (NK1) receptor antagonist
SQ or IV 45 min- 1 hr before premed
PO 2 hr before premed

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17
Q

Ondansetron (Zofran)

A

5-HT3 (serotonin type 3) receptor antagonist
IV, IM, SQ, PO
30 min before or with premeds

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18
Q

T/F: antiemetics will not decrease the incidence of gastroesophageal reflex (GER)

A

TRUE

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19
Q

What are NSAIDs used for?

A

Mild to moderate inflammatory pain
Onset time: 30-60 minutes

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20
Q

FDA approved NSAIDs in dogs

A

Carprofen, meloxicam and robenacoxib

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21
Q

FDA approved NSAIDs in cats

A

Meloxicam, robenacoxib

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22
Q

Precautions of NSAIDs

A

GI toxicity: excessively high dose, two NSAIDs @ the same time, conjunction with corticosteroids
Hypoalbuminemia
Metabolism in cats (deficiency glucoronyl transferase enzymes)

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23
Q

NSAID contraindications

A

Pre-existing hypotension, hypovolemia or renal dz
GI procedures

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24
Q

Opioids MOA

A

Bind to opioid receptors located @ presyn. and postsyn. sites in the CNS and peripheral tissues (mu, kappa, delta)

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25
Q

Pure agonist opioids

A

Morphine, hydromorphone
Class 2 controlled drugs

26
Q

Pure opioid uses

A

Prevention and tx of pain (visceral and somatic)
Sedation in pediatric, geriatric or debilitated patients

27
Q

Pure agonist opioid precautions

A

IV morphine or meperidine (histamine release)
Morphine less efficacious in cats
Dose dependent ↓ in RR, HR, and BP
Post-op hyperthermia in cats (hydro)
Vomiting

28
Q

Partial agonist opioids

A

Buprenorphine
Simbadol (more concentrated buprenophine)
Zorbium (transdermal buprenorphine)
class 3 drugs

29
Q

Buprenorphine

A

Less efficacious than the pure agonist opioids
For visceral and somatic pain

30
Q

Buprenorphine PK

A

Slow onset (30-45 min IM, 15-30 min IV)
High affinity for Mu receptors
Ceiling effects on resp. depression
30x more potent than morphine

31
Q

Zorbium use

A

Major orthopedic or neuro procedures
Dentals that require extensive extractions

32
Q

Zorbium PK

A

Onset time 1-2 hrs
Duration 4 days (96 hrs)
Must wear PPE or application

33
Q

T/F: Zorbium is for cats only

A

TRUE

34
Q

Agonist/ antagonist opioids

A

Butorphanol (class4 drug) and nalbuphine

35
Q

Agonist/ antagonist opioid uses

A

Treats mild visceral pain ONLY
Partial reversal agent for pure agonist

36
Q

Agonist/ antagonist opioid PK

A

Duration: 30 min- 1 hr
Ceiling effect on analgesia
4-7x as potent as morphine

37
Q

Buprenophine is 30x as potent as morphine and butorphanol is 4-7x. What does this information tell you?

A

It takes less of both drugs to achieve the desired effect

38
Q

Antagonist opioids

A

Naloxone and Nalmefene
Reversal agent for all opioid cases→ overdose and impending arrest

39
Q

Antagonist opioid precautions

A

Acute awareness of pain → sympathetic surge
Partial reversal difficult
Analgesia options limited after reversal

40
Q

Phenothazines (acepromazine) uses

A

Dopamine receptor antagonist → sedation
Major tranquilizer
Antiemetic, antihistamine and antiarrhythmic

41
Q

Acepromazine precautions

A

↓ PCV (sequestration of RBCs) → avoid in patients with anemia, blood loss and plate dysfunction
Patients with MDR1 mutation

42
Q

Benzodiapepines

A

Diazepam, midazolam

43
Q

Benzodiazepine uses

A

Anxiolytic
Enhance GABA and GABAa receptor
Mild sedation (minor tranq)→ young, old critically ill
Anticonvulsant
Skeletal m. relaxation

44
Q

Benzodiazepines are reversed with ___________

A

Flumazenil

45
Q

Benzodiazepine precautions

A

No analgesia
Not effective sedation in normal healthy patients
Caution with hypoproteinemic patients
Avoid patients with severe hepatic dz

46
Q

Alpha-2 agonists

A

Demedetomidine, medetomidine, xylazine, detomidine, romifidine

47
Q

Alpha-2 agonists uses

A

Profound sedation (major sedative)
Analgesia → short duration of action
M. relaxation

48
Q

Dexmedetomidine precautions

A

Cardiovascular effects- biphasic effect on BP and significant bradycardia
Inhibits ADH and insulin release
Appear unconscious but aren’t

49
Q

Alpha-2 agonists/ antagonists

A

Medetomidine, Vatinoxan hydrochlorides
IM injection
Onset- 5-15 min, duration 45 min

50
Q

Medetomidine

A

Central and peripheral effects
Provides sedation and analgesia

51
Q

Vatinoxan hydrochlorides

A

Alpha-2 antagonist (peripheral effect only)
Don’t cross BBB, affect sedation or analgesia

52
Q

Alpha-2 antagonists

A

Atipamezole
Yohimbine and tolazoline

53
Q

Atipamezole

A

Competitive reversal for dexmed and medtomidine
IM only
10x more concentrated than dexmed and 5x than metom

54
Q

When shouldn’t you use atipamezole?

A

Patient under general anesthesia→ hypotension and cardiovasc collapse
Post-op unless medical reason

55
Q

Yohimbine and tolazoline

A

Competitive reversal for xylazine
Administered slowly IV diluted with saline

56
Q

Anticholinergics

A

Atropine and glycopyrrolate

57
Q

Anticholinergic MOA

A

Block acetylcholine @ muscarinic receptors

58
Q

Anticholinergic uses

A

Tx sinus bradycardia or AV block
Tx ainoatrial arrest (atropine)

59
Q

Anticholinergic precautions

A

↓ salivation but ↑ viscosity
Arrhythmogenic

60
Q

T/F: routine use of anticholinergics is no longer recommended

A

TRUE
unless patients < 12 wks

.pharmocology (21 decks)

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