Alternative Analgesics (Atypical NSAIDs And Opiods)

Question 1

Name some examples of atypical NSAIDs

Answer 1

Grapiprant, Acetaminophen, Dipyrone

Question 2

Why are these NSAIDs called “atypical”?

Answer 2

They have the same clinical effects of NSAIDs without affecting COX-1 or COX-2 or causing the same adverse effects

Question 3

What is the MOA of Grapiprant?

Answer 3

Non-COX-inhibiting prostaglandin receptor antagonist that specifically blocks the EP4 receptor

Question 4

Why is the EP4 receptor important?

Answer 4

It is important in mediating pain and inflammation (it is unregulated in chronic joint inflammation/OA in dogs)

Question 5

What is Grapiprant used for?

Answer 5

The control of pain and inflammation associated with OA in dogs

Question 6

In what two species is Grapiprant not well absorbed in?

Answer 6

Horses and Alpacas

Question 7

What is the MOA of acetaminophen?

Answer 7

(COX-3) Analegesic effects are largely centrally mediated

Question 8

Acetaminophen is largely used for pain/lameness and fever in what species?

Answer 8

Horses

Question 9

When prescribing acetaminophen to dogs, what is often combined with?

Answer 9

Codeine

Question 10

What is considered a toxic dose of acetaminophen in dogs?

Answer 10

100 mg/kg

Question 11

Acetaminophen is toxic to what species?

Answer 11

Cats because they make toxic metabolites

Question 12

What is another name for Dipyrone?

Answer 12

Metamizole

Question 13

In what group of animals can you not use Dipyrone in the US ?

Answer 13

Food animals

Question 14

What is Dipyrone used for in horses?

Answer 14

Fever and colic

Question 15

Dipyrone is AKA as a spasmolytic, what does this mean?

Answer 15

It blocks muscle contraction by inhibiting the release of intracellular Ca2+

Question 16

What are some uses for opioids?

Answer 16

Antitussive, analgesia, anti-diarrheal, +/- sedative, immobilization, induction of anesthesia, decrease MAC of inhalants

Question 17

For the Opioids that are agonist drugs, so higher doses result in increases in what?

Answer 17

Analgesia

Question 18

What are some opioid agonists?

Answer 18

Morphine, Fentanyl, and Hydroxymorphone

Question 19

What effect do partial Opioid agonists have?

Answer 19

A “ceiling” effect: higher doses do not result in increased analgesia or adverse effects

Question 20

What is a partial Opioid agonist?

Answer 20

Buprenorphine

Question 21

Name an Opioid antagonist

Answer 21

Naloxone

Question 22

Opioids have a large 1st pass ______ effect

Answer 22

Hepatic

Question 23

Opioids have a (large/small) volume of distribution

Answer 23

Large

Question 24

Where is the main site of action for Opioids?

Answer 24

CNS

Question 25

Where does metabolism and elimination of opioids take place?

Answer 25

Metabolism = hepatic
Elimination = renal

Question 26

Opioids are best for what kind of pain?

Answer 26

Severe, acute pain

Question 27

What is a major GI effect of Opioids in dogs?

Answer 27

Emesis

Question 28

Opioids causes mioisis in ______ and _______ in cats/horses

Answer 28

Dogs; mydriasis

Question 29

What is a big side effect of Opioids?

Answer 29

Cardiovascular depression

Question 30

When should you be most concerned when using Opioids?

Answer 30

Neonates, head trauma/CNS disease, respiratory disease

Question 31

What opioid is a preferred drug for epidural administration?

Answer 31

Morphine

Question 32

What drug is commonly used as a transdermal patch in vet med?

Answer 32

Fentanyl

Question 33

What pain level indicates injectable opioid use for acute and surgical pain?

Answer 33

Moderate to severe pain

Question 34

What is species is tramadol not considered an opioid?

Answer 34

Dogs and horses

Question 35

In what species IS tramadol considered an opioid?

Answer 35

Cats (and humans)

Question 36

Dogs and horses don’t achieve therapeutic concentrations of this metabolite unlike cats and human

Answer 36

M1