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Anesthesia > Premedication > Flashcards

Premedication Flashcards

1
Q

why use premedication?

A
  • humane-minimizes stress
  • may decrease requirement
    • injectables
    • inhalants
  • synergism
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2
Q

neuroleptic

A

major sedatives

(early described antipsychotics)

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3
Q

analgesics

A

opioids

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4
Q

neuroleptoanalgesia

A

sedative + opioids

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5
Q

drug selection based on

A
  • species
  • age
  • physcial status (ASA)
  • animal behavior and attitude
  • procedure
  • duration of procedure
  • experience with drugs used!!!
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6
Q

anticholinergics

A
  • desired effect: anti-muscarinic effect at the post synaptic receptors
    • increase HR, treat bradycardia
  • undesired effect: anti-muscarinic effect at the presynaptic feedback receptor
    • worsening of bradycardia initially
  • atropine sulfate
  • glycopyrrolate
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7
Q

effects of anticholinergics

A
  • decrease vagal influence in HR
  • decrease secretions
  • bronchial dilation
  • increase anatomical and physiologic dead space
  • decrease GI motor and secretory activity
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8
Q

atropine sulfate

A
  • anticholinergic
  • tertiary amine molecule
  • high lipid solubility
    • easily crosses BBB and placental barrier
  • fast acting
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9
Q

glycopyrrolate

A
  • anticholinergic
  • synthetic quaternary ammonium molecule
  • low lipid solubility
    • doesn’t cross BBB and placenta
  • no effects on CNS
  • same peripheral effects of atropine
  • lasts longer than atropine (1.5-2 hours)
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10
Q

tranquilizers

A
  • major tranquilizers
    • phenothiazines
      • acepromazine
    • buyrophenones
      • Droperidol
      • Azaperone
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11
Q

acepromazine maleate

A
  • potent sedative and anxiolytic
  • anti-emetic
  • anti-arrhythmic properties
  • decreased dose requirement of other drugs
  • enhances analgesia of opioids
  • Boxer (very sensitive)
  • not reversible!
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12
Q

side effects of Ace

A
  • decreased BP and vasomotor reflex (alpha antagonist)
  • cardiac depression
  • peripheral alpha2-adrenergic blockade
  • relaxation of vascular smooth muscle
  • persistent or permanent penile paralysis (horses)
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13
Q

opioids

A
  • mu-agonists
    • morphine
    • fentanyl
  • partial agonists
    • buprenorphine
    • buprenorphine SR
  • k-agonist/mu-antagonists
    • butorphanol
  • antagonists
    • naloxone
    • naltrexone
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14
Q

mu-agonists

A
  • greater analgesic potential
  • duration and side effects used to decide which drug to use
    • respiratory depression
    • vomiting
    • bradycardia
    • decrease GI motility
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15
Q

morphine

A
  • mu agonist
  • prototype
  • potency = 1
  • long duration (4-6 hours)
  • histamine release
    • IV-administer carefully
    • hypotension
    • urticaria
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16
Q

hydromorphone

A
  • mu agonist
  • potency = 10
  • long duration (4-6 hours)
  • feline hyperthermia?
17
Q

methadone

A
  • mu agonist
  • potency = 1.5
  • long duration (4-6 hours)
  • NMDA- antagonist
18
Q

fentanyl

A
  • mu agonist
  • potency = 100
  • short duration (20-30 min)
    • most used as CRI
19
Q

buprenorphine

A
  • partial mu-agnoist
  • long onset of action
    • 30 min IV, 45-1 hr IM
  • long duration (6-12 hours)
  • bind strongly to receptor
    • reversible but takes more naloxone
  • cats: good oral bioavailability, over 85%
  • dogs: poor oral bioavailability, 39%
20
Q

butorphanol

A
  • k agonist/mu antagonist
  • good sedative
  • mild to moderate analgesia
  • can be used to reverse side effects of mu-agonists
  • very short acting
    • good for minor procedures
21
Q

nalbuphine

A
  • k agonist/mu antagonists
  • very similar to butorphanol
  • not controlled
  • comes in ampules
  • not used commonly
22
Q

benzodiazepines

A
  • diazepam
  • midazolam
    • anterograde amnesia
    • GABA
23
Q

diazepam

A
  • benzodiazepine
  • anxiolytic
  • muscle relaxant
  • anticonvulsant effect
  • rapidly crosses BBB and placental barrier
  • minimal CV effects (decrease BP and CO)
  • propylene glycol (high lipid solubility)-IV
  • inhibit inhibitory neurons before excitatory-spaz out = bolus!
24
Q

midazolam

A
  • water soluble (become lipid soluble pH > 4)
    • closing of imidazole ring
  • can be given IM
  • more potent but shorter acting than diazepam
  • similar effects to those of diazepam
  • crosses BBB and placental barrier
25
Q

zolazepam

A
  • most potent benzo used in vetmed
  • available only in telazol
    • 1:1 ratio
  • anticonvulsant and muscle relaxant
  • the least apt to cause CNS depression
26
Q

flumazenil

A
  • competitive antagonist of benzodiazepine receptor = reversal agent
  • very weak agonist effect (no anxiety with reversal)
27
Q

alpha2-adrenergic agonists

A
  • anxiolytic, sedative and muscle relaxant
  • analgesia
  • decrease ADH release
  • decrease insulin release (hyperglycemic)
  • hypertension follow by hypotension
  • reflex bradycardia
28
Q

CV effects of alpha2-agonists

A
  • decrease HR
    • hypertension
    • decrease sympathetic tone
  • decrease CO
    • decrease myocardial contractility
    • decrease HR
  • increase then decrease BP
29
Q

xylazine

A
  • alpha 2-agonists
  • less selective to alpha 2
  • more ataxia
  • shorter duration
30
Q

detomidine

A
  • alpha 2-agonist (LA)
  • still not very selective
  • profound sedation
  • ataxia
31
Q

romifidine

A
  • alpha 2 agonist (LA)
  • still not very selective
  • good sedation
  • less ataxia
32
Q

dexmedetomidine

A
  • alpha 2 agonist (SA)
  • most selective
  • profound sedation
  • may intubate some dogs
  • vasoconstriction
  • fast IM
33
Q

reversals

A
  • non-selective
    • tolazoline
    • yohimbine
    • only SC or IM
  • alpha 2 selective
    • atipamizole (dexmedetomidine)
    • only SC or IM
34
Q

guaifenesin

A
  • central muscle relaxant (different from NMB!)
  • used as adjuvant in large animal induction
  • it smoothes induction and decreases injectable dose
  • it disrupts transmission at spinal cord and brain stem
  • increase RR and decrease tidal volume (min vent unchanged)
35
Q

ketamine + alfaxalone =

A

premed to cause chemical restraint

higher doses than IV

used in difficult patients

Anesthesia (14 decks)

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