Alternatives To NSAIDs And Opioids For Analgesia

Question 1

Name some alternatives to NSAIDs and Opioids for analgesia?

Answer 1

Anti-NGF mabs, Gabapentin, Amantadine, amitryptilline, alpha-2 agonists, bisphosphonates, CBD oil

Question 2

mAbs are first absorbed into the what?

Answer 2

Lymphatics

Question 3

mAbs are eliminated by what?

Answer 3

Metabolism

Question 4

What are some advantages of mAbs?

Answer 4

Large therapeutic index, highly specific therapy, long half-life (monthly dosing)

Question 5

What are some disadvantages of mAbs?

Answer 5

Cost, large size, parenteral administration, slow onset

Question 6

Name some mAbs that are anti-nerve growth factors in cats and dogs?

Answer 6

• Librela = ranevetmab/bedinvetmab (dogs)
• Solensia = frunevetmab (cats)

Question 7

Nerve growth factor is expressed at sites of _______ and _______ and is a major factor promoting pain and hyperalgesia

Answer 7

Injury and inflammation

Question 8

Nerve growth factor (NGF) binds to what receptor?

Answer 8

Tropomyosin receptor kinase A

Question 9

This is a calcium channel blocker with anticonvulsant activity; effective for neuropathic pain

Answer 9

Gabapentin

Question 10

What side effect is most common with Gabapentin?

Answer 10

Sedation/ataxia

Question 11

With gabapentin formulations, what should you avoid?

Answer 11

Formulations with xylitol

Question 12

Which drugs are NMDA antagonists that interrupt “wind up” or central sensitization?

Answer 12

Ketamine, Amantadine, Dextromethorphan

Question 13

What should be careful of when administering ketamine to horses?

Answer 13

Give low doses because they can fall over

Question 14

What drug is an oral NMDA-antagonist AND antiviral?

Answer 14

Amantadine

Question 15

What is the MOA of Tricyclic antidepressants?

Answer 15

Inhibit reuptake of monoamines (serotonin and norepinephrine)

Question 16

What drug in the tricyclic antidepressants class is the most studied as an analgesic?

Answer 16

Amitryptylline

Question 17

What drug in the local anesthetics class is used for infiltration during CCL surgeries and perineural blocks on cats?

Answer 17

Nocita (bupivacaine liposomal)

Question 18

How do you treat local anesthetic toxicity?

Answer 18

Lipid emulsion

Question 19

This is a NK1-receptor antagonist that prevents substance P binding

Answer 19

Maropitant (Cerenia)

Question 20

What is the MOA of bisphosphonates?

Answer 20

It is taken up by osteoclasts and decreases bone turnover/remodeling

Question 21

What to bisphosphonates bind to?

Answer 21

Calcium

Question 22

What are the two labeled bisphonphonates for horses and what are they used for?

Answer 22

Tildren (Tiludronate) and OsPho (clodronate)
- they are used to control signs associated with navicular syndrome in horses

Question 23

Clodronate (Osphos) is administered (IM/IV) and Tiludronate is administered (IM/IV)

Answer 23

IM;IV

Question 24

Name some alpha-2 agonists

Answer 24

Dexmedetomidine, Detomidine, Romifidine, Xylazine

Question 25

CB1 receptor agonists have ______ effects and CB2 receptor agonists have _____-________ ____

Answer 25

Psychotropic effects; anti-nociceptive effects

Question 26

This is a Cannabinoids that the FDA now defines as a drug

Answer 26

Epidolex (cannabidiol)

Question 27

This is a nondrug substance produced in a purified form intended to improve health and well-being

Answer 27

Nutraceuticals