Anaesthesia drugs Flashcards
(210 cards)
1
Q
List examples of opioids
A
Fentanyl Morphine Methadone Pethidine Buprenorphine Butorphanol
2
Q
List examples of NSAIDs
A
Meloxicam Carprofen Ketaprofen Robenacoxib Firocoxib Phenylbutazone Grapiprant Flunixin
3
Q
List examples of local anaesthetics
A
Procaine Lidocaine Bupivacaine Mepivacaine Ropivacaine EMLA/lidocaine and procaine Proparacaine and tetracaine
4
Q
List the drugs that are unlicensed for veterinary species pain management
A
Gabapentin
Pregabalin
Amatadine
Amitriptyline
5
Q
State premed protocol for dogs and cats ASA I and II
A
ACP + opioid
Alpha 2 agonist + opioid
6
Q
State premed protocol for dogs ASA III
A
ACP + opioid
7
Q
State premed protocol for cats, dogs and rabbits ASA IV, V
A
Benzodiazepine + opioid
Benzodiazepine + ketamine
Opioid
8
Q
State premed protocol for cats ASA III
A
Benzodiazepine (midazolam) + ketamine
9
Q
State premed protocol for rabbits ASA I, II
A
ACP + opioid
Alpha 2 agonist + opioid
Fluanisone +/- benzodiazepine
10
Q
State premed protocol for rabbits ASA III
A
Benzodiazepine + opioid
11
Q
State an example of phenothiazines
A
Acepromazine
12
Q
List examples of alpha 2 agonists
A
Dexmedetomidine
Medetomidine
Romifidine
Xylazine
13
Q
List examples of benzodiazepines
A
Diazepam
Midazolam
14
Q
State an example of butyrophenones
A
Fluanisone, in combination with fentanyl
15
Q
List the injectable anaesthetic agents
A
Propofol Ketamine Alfaxalone Tiletamine Zolazepam Thiopental
16
Q
State licenced inhalational anaesthetic agents
A
Isoflurane
Sevoflurane
Nitrous
17
Q
List unlicensed inhalational anaesthetic agents
A
Halothane
Desflurane
18
Q
What are the licenced drugs for equine sedation?
A
Acepromazine Butorphanol Buprenorphine Pethidine Romifidine Xylazine
19
Q
How do opioids provide analgesia?
A
Act at endogenous opioid receptors in CNS, mu most effective at providing analgesia
20
Q
Which opioids are full mu agonists?
A
Methadone
Fentanyl
Morphine
Pethidine
21
Q
Which opioids are partial agonists?
A
Buprenorphine
Butorphanol
22
Q
What is the antagonist for opioids?
A
Nalaxone
23
Q
What is the usual admin method of opioids except pethidine?
A
IV
24
Q
What are alternative methods of admin of opioids?
A
SC
IM
Oral- does have significant first pass metabolism
25
List side effects of opioids
```
Bradycardia
Respiratory depression- DD, more when anaesthetised
Sedation- DD, dogs
Excitement- high doses, premed
Nausea- premed
Urinary effects- epidural
Low GI motility- chronic use
```
26
What is fentanyl licenced and used for?
Cats and dogs
| Cats, dogs, rabbits, horses
27
When is fentanyl used?
Interoperative, short term infusion
28
How long does fentanyl last?
Minutes
29
What are all opioids other than fentanyl used for?
General acute pre-, peri- and post-op pain
30
What is the licencing and species used in for morphine?
No licencing
| Cats, dogs, horses
31
How long does morphine and methadone last?
2-4 hours
32
What is the licencing and use of methadone?
Cats and dogs
| Cats and dogs
33
What is pethidine licenced and used for?
Cats, dogs, horses
| Mainly horses
34
How long does pethidine last?
Minutes
35
What is the licencing for butorphanol and buprenorphine and what are they used for?
Cats, dogs, horses
| Cats, dogs, rabbits
36
How long does buprenorphine last?
6 hours
37
How long does butorphanol last?
2 hours
38
How do NSAIDs cause analgesia?
Inhibit prostaglandin production by inhibiting COX and LOX enzymes
39
Which NSAIDs are licenced for dogs by injection and oral?
Meloxicam
Carprofen
Ketaprofen
Robenacoxib
40
Which NSAIDs are licenced for dogs by oral?
Firocoxib
Phenylbutazone
Grapiprant
41
Which NSAIDs are licenced for cats by injection and oral?
Meloxicam
Ketaprofen
Robenacoxib
42
Which NSAIDs are licenced for cats by injection?
Carprofen
43
Which NSAIDs are licenced for rabbits and which are used?
None licenced
Meloxicam
Sometimes carprofen
44
Which NSAIDs are licenced for horses by injection and oral?
Meloxicam
Firocoxib
Flunixin
Phenylbutazone
45
Which NSAIDs are licenced for horses by injection?
Ketaprofen
46
When do you need to be cautious when using NSAIDs?
Hepatic compromise- liver metabolism
Hypotensive
Dehydrated
Only one in multimodal analgesia
47
What are side effects to NSAIDs?
GI ulceration
Renal ischemia
Liver disease- dogs, idiosyncratic
Dullness and lethargy- cats
48
What are signs dogs or cats need medical attention when taking NSAIDs?
General illness
Vomiting
Diarrhoea
49
What are signs rabbits need medical attention when taking NSAIDs?
Anorexia
Bruxism
Depression
Vomiting
50
What are signs horses need medical attention when taking NSAIDs?
```
General illness
Colic
Dehydration
Diarrhoea
Weight loss
```
51
How do local anaesthetics work within the body?
Enter nerve fibres and block voltage gated Na+ channels stabilising the membrane whihc blocks nerve conduction
52
What is the effect of local anaesthetics on the body?
Blocks nociception then proprioception and mechanoreception
53
What is the rough pH of LAs?
Weak base
54
When do LAs become more ionised?
Higher pKa
| Lower pH
55
What is the effect of LAs becoming ionised?
Can't cross lipid membranes
| Slower action and less drug effect
56
What is the effect of LAs becoming more bound?
Longer duration of action
Lower toxicity
Less active
57
What effects the length of action of LAs?
Lipid solubility
Strength of binding to channel
Speed of metabolism
58
Which type of LAs is more stable and has longer half life?
Amides
59
What breaks down amide LAs?
Cytochrome P450 liver enzyme
60
What breaks down ester LAs?
Cholinesterase
| Forms PABA, can be allergen
61
What are LAs used for?
Balanced anaesthesia
Desensitisation
Post op pain relief
Lameness investigations
62
How does toxicity of LAs increase?
With potency and dose
63
How can risk of LA toxicity be reduces?
Dont exceed max dose
For large volumes dilute
Aspirate before admin
64
Describe the formulation of LAs
Salt solution to make water soluble
Low pH so stings on injection
Added vasoconstrictors to reduce speed of systemic absorption, prolong action, reduce bleeding, reduce toxicity
65
What are side effects of LAs?
```
Behavioural changes
Muscle twitching
CNS depression
Death
Hypotension
Dysrhythmias
```
66
How do you treat side effects of LAs?
Symptomatically as no reversal
67
What is the licencing and use of procaine and lidocaine?
Dogs, cats, horses
| Dogs, cats, rabbits, horses
68
How long does procaine last?
50 minutes
69
Why do licenced versions of procaine have adrenaline added?
Vasoconstriction
70
List LAs from least to most potent
Procaine
Lidocaine
Mepivacaine
Bupivacaine
71
How long does lidocaine last?
20-40 minutes
72
What is the speed of onset of lidocaine?
2-5 minutes
73
Which LAs have lower CVS and CNS toxicity than bupovacaine?
Lidocaine
| Ropivacaine
74
What is licencing and use of bupivacaine?
No licencing
| Cats, dogs, rabbits
75
How long does bupivacaine and ropivacaine last?
6 hours
76
Which LA does bupivacaine have a slower onset than?
Lidocaine
77
What is licencing and use of mepivacaine?
Horses
| Horses
78
How long does mepivacaine last?
2 hours
79
What is the main use of mepivacaine?
Digit nerve blocks
80
What is mepivacaine more potent and toxic than?
Lidocaine
81
What is licencing and use of ropivacaine?
No licencing
| Small animals
82
What is licencing and use of EMLA/lidocaine and procaine?
No licencing
| Rabbits
83
How long does EMLA last?
30-45 minutes
84
What is EMLA mainly used for?
Topical for IV placement
85
What is licencing and use for proparacaine an tertracaine?
No licencing
| Cats and dogs
86
How long does proparacaine and tetracaine last in cats and dogs?
Cats- 15 minutes
| Dogs- 45 minutes
87
What is the main use of proparacaine and tetracaine?
Desensitise cornea in ophthalmic preparations
88
What is paracetamol licenced for?
Dogs oral
89
Why can't cats use paracetamol?
Toxic
90
When is paracetamol given to horses
Added to analgesia in extreme pain
91
Why is paracetamol used?
When NSAIDs are contraindicated
92
What is licencing and use of tramadol?
Dogs- oral and injection
| Dogs, cats, rabbits
93
When is tramadol used?
Opioid alternative for at home
| Second analgesia in chronic pain
94
What can be side effects of tramadol to horses?
Reduced GI motility
95
How does tramadol provide analgesia?
Acts on mu opioid, noradrenergic and serotonergic systems
96
Why may tramadol not be preferred to be used?
Questions about efficacy
97
Why are the unlicensed analgesics used?
Second line analgesic in chronic pain
98
How does gabapentin act in the body?
Binds voltage gated calcium channels
99
What are the effects produced by gabapentin?
Sedation- more when combined with tramadol
100
When is gabapentin toxic?
In solution with xylitol
101
What makes pregabalin different to gabapentin?
Better oral bioavailability and half life
102
How does amantadine act in the body?
NMDA receptor agonist
103
What effect does amantadine have on the body?
Antihyperalgesic
104
When is amantadine used?
With other analgesics
105
How is amantadine excreted?
Renal
106
How do phenothiazines act in the body?
Dopamine receptor agonist, CNS
107
What is the effect of phenothiazines?
Sedation
108
What is ACP used for?
Cats and dogs premed or sedation
109
What are the methods of ACP admin?
SC
IM
IV
110
How does time to peak effect of ACP change if IM or IV admin?
IM- 30-40 minutes
| IV- 10-15 minutes
111
Why cant ACP be given orally?
Poor bioavailability
112
How long does ACP last?
4-6 hours
113
How is ACP, benzodiazepines, opioids and alpha 2 agonists metabolised?
Liver
114
What are side effects of ACP?
Peripheral vasodilation which lowers body temperature and BP
115
How do alpha 2 agonists act in the body?
Alpha 2 adrenergic receptor in CNS
116
What effects do alpha 2 agonists have on the body?
Sedation
Analgesia
Muscle relaxation
117
How is dose of alpha 2 agonists calculated due to its high potency?
Body surface area
118
How does speed of effect of alpha 2 agonists differ with IM or IV admin?
IM- 15 minutes
| IV- 5 minutes
119
What is atipamezole a reversal for?
Alpha 2 agonists
120
How long does alpha 2 agonists last when not reversed?
2-3 hours
121
What are side effects of alpha 2 agonists?
```
Bradycardia
Reduced CO
Hypertension then hypotension
2nd degree AV block
Respiratory depression
GI stasis
Hyperglycaemia
Increased urine production
Uterine contractions
```
122
How do benzodiazepines cause effect in the body?
Enhance GABA at GABA receptor
123
What is the effect on the body for benzodiazepines?
Sedation
Muscle relaxation
Minor tranquiliser
Anticonvulsant
124
How can sedation from benzodiazepines be improves?
Combine with opioid, ketamine, alpha 2 agonist
125
Describe how to administer benzodiazepines
Slow IV infusion as rapidly crosses BBB
126
Why does diazepam have longer action than midazolam?
Shorter half life but metabolites are active
127
What is the reversal for benzodiazepines and why is it rarely used?
Flumazenil
| Expensive
128
What are side effects for benzodiazepines?
Mild respiratory depression- DD
| Minimal CVS effects
129
What is diazepam licenced for?
Cats and dogs
130
What is midazolam licenced for?
Horses
131
How do butyrophenones act in the body?
Dopamine receptor agonist, CNS
| Interfere with GABA, norepinephrine, serotonin mediated activity
132
What effects does butyrophenones have on the body?
Sedation
133
What is fluanisone licenced for?
Small furries
134
How long does fluanisone last?`
30-60 minutes
135
What is the effect of combining fluanisone and benzodiazepines?
20-40 minutes muscle relaxation
136
What is a side effect of fluanisone?
Respiratory depression
137
What effects do opioids have on the body?
Sedation
| Analgesia
138
What are injectable anaesthetics used for?
```
Induction
Maintenance
TIVA
Triple- short term anaesthesia, alpha 2 agonist, ketamine, opioid IM
Euthanasia
```
139
What is propofol, tiletamine and zolazepam licenced for?
Cats and dogs
140
Why does propofol need to be administered IV?
Irritant otherrwise
141
What is propofols drug class?
Substituted phenol
142
How does propofol, alfaxalone and zolazepam act in the body?
GABA agonist
143
How fast is onset and duration of action of propofol?
Rapid
| 5-10 minutes
144
What effects does propofol havevfrom the anaesthetic triad?
Muscle relaxation and narcosis
| No analgesia
145
What is propofols binding and solubility like?
Highly bound
| Lipid soluble
146
How is propofol and alfaxalone metabolised and eliminated?
Rapid by liver
147
Why is propofol cumulative in cats and not dogs?
Cats lack glucorinidation pathway
148
What are side effects of propofol?
Post induction apnoea
| Hypotension from myocardial depression and peripheral vasodilation
149
What are preservative and non-preservative propofol used for?
Non-preservative- TIVA
| Preservative- open for 28 days
150
What is alfaxalone licenced for?
Cats, dogs, rabbits
151
Why is alfaxalone administered IV?
Irritant IM
152
What drug class is alfaxalone?
Neuroactive steroid
153
Describe the formulation of alfaxalone?
Clear solution containing cyclodextrin ring to make water solubule
154
What is binding for alfaxaolne?
20-50%
155
How fast is onset and duration of action of alfaxalone?
Rapid
| 15-30 minutes
156
Is alfaxalone cumulative?
No
157
What are side effects of alfaxaolne?
Respiratory depression
Post induction apnoea
Hypotension causing tachycardia
158
What is ketamine licenced for?
Cats, dogs, horses
159
How is ketamine administered?
IV and IM
160
What drug class is ketamine?
Phencyclidine derivative
161
How does ketamine and tiletamine act in the body?
NMDA antagonist
162
What effects does ketamine have on the body?
Analgesia and antihyperalgesia
163
Why is ketamine used in combination?
Poor muscle relaxation and reflexes are maintained
164
Why do you need a calm environment when using ketamine?
Slow onset
165
What makes ketamine non-cumulative?
Active metabolite nor-ketamine by the liver
166
How is ketamine excreted?
Renal
167
What is ketamine protein binding?
50%
168
What are side effects of ketamine?
Increased IOP and ICP
169
What is ketamine commonly used for?
Horses maintainance/TIVA
| Cats sedative IM or induction IV
170
How is tiletamine administered?
IM or IV
171
How does thiopental act in the body?
Barbiturate at GABA receptor
172
How is thiopental formulated?
2.5 or 5% powder in solution
173
What is the rough pH of thiopental?
Alkaline
174
How fast is onset of thiopental?
Rapid
175
What is the binding like for thiopental?
High
176
How is thiopental metabilised?
After distribution
177
Is thiopental cumulative?
Yes
178
What are side effects of thiopental?
Perivascular tissue necrosis
Cardiorespiratory depression
Short term ventricular bigeminy
179
What are inhalational anaesthetics used for?
Induction
| Maintainance
180
What are isoflurane and sevoflurane licenced for?
Cats and dogs
181
Is isoflurane irritant?
Yes to MM and airways
182
Is isoflurane and sevoflurane toxic?
Yes
183
Is isoflurane stable?
Yes and non-flammable
184
Is it easy to vaporise isoflurane and sevoflurane?
yes
185
Describe stability and flammability of sevoflurane
Stable in sodalime
| Flammable in oxygen or nitrous
186
State isoflurane MAC
1.4-1.6
187
What effects does isoflurane have from anaesthetic triad?
Narcosis
| Muscle relaxation
188
What are side effects of isoflurane and sevoflurane?
```
Hypotension
Bronchodilation
Reduced renal and hepatic perfusion
Vasodilation
Respiratory depression
Hypoventilation
Hypercapnia
```
189
How does uptake and elimination differ with isoflurane and sevoflurane?
Iso- slower, 1% metabolic elimination
| Sevo- faster, 3% metabolic elimination
190
What is isoflurane and sevoflurane blood gas solubility?
Iso- 1.4
| Sevo- 0.69
191
State sevoflurane MAC
2.1-2.6
192
What components of the anaesthetic triad does sevoflurane provide?
Narcosis
193
What effect does nitrous have on the body?
Analgesic
194
Why does nitrous have rapid uptake and elimination?
Insoluble
195
What is nitrous MAC?
Over 100%
196
What ratio with oxygen should nitrous be in rebreathing and non-rebreathing systems?
1: 2- non-rebreathing
1: 1- rebreathing
197
How is equine sedation delivered?
IV jugular or IM
198
What sedatives are licenced for horses?
```
Acepromazine
Xylazine
Romifidine
Butorphanol
Buprenorphine
Pethidine
```
199
What is a common combination for equine sedation?
Alpha 2 agonist + opioid
200
What effect does acepromazine have on horses?
Mild sedation
201
How long is onset of acepromazine in horses?
30 minutes
202
How long does ACP last in horses?
4-6 hours
203
How is ACP metabolised in horses?
Liver
204
Is ACP vasodilatory in horses?
Yes
205
What effects do alpha 2 agonists have on the body in horses?
Sedation
Analgesia
Muscle relaxation
206
What are side effects of alpha 2 agonists in horses?
```
Bradycardia
2nd degree AV block
Hypertension and vasoconstriction then hypotension
Hypoinsulinaemia
Decreased GI motility
```
207
What effect do opioids have on the body in horses?
Synergistic effect on analgesia
| Increased sedation and ataxia
208
What drugs are used in equine induction?
ACP 30 minutes before
Alpha 2 agonist in induction area
Thiopental and ketamine/diazepam in IV bolus
209
What effect does GGE/guaiphenesin have when given to horses in induction?
Muscle relaxant, no analgesia
210
What analgesia is used in horses?
```
NSAIDs
Opioids
Alpha 2 agonists
Ketamine
Local anaesthetics
```
