Analgesia

Question 1

Consequences of untreated pain (5)

Answer 1

Increased release of cortisol:
Increased risk of infection
Increased catabolism –> weight loss

Increased dose of anesthetic rx needed to maintain sx anesthesia –> increased anesthetic risk

Pain, self trauma, increased inflammation –> delayed wound healing

Primary and secondary hyperalgesia

Question 2

Primary hyperalgesia

Answer 2

Nociceptors at injury site become more sensitive –> increased peripheral pain sensitivity

Question 3

Secondary hyperalgesia “wind up pain”

Answer 3

Spinal receptors become more sensitive

NMDA receptors become activated

–> increased central pain sensitivity and perception

Question 4

Prayer position

Answer 4

Indicated acute abdominal pain in dogs

Pt requires immediate examination

Question 5

Ketamine: effect, dosing, administration

Answer 5

Blocks NMDA receptors –> prevent and treat wind up pain

Analgesic dose is much lower then anesthetic dose

IV (for analgesic use)

Question 6

Tramadol: effects (3), species, adverse effects (2)

Answer 6

Non-opioid mu receptor

Some NMDA receptor antagonism

Inhibits norepinephrine and serotonin uptake

Dogs - effectiveness is controversial

Sedation, occasional agitation

Question 7

Gabapentin: effects (2), adverse effect, caution, controlled?

Answer 7

Adjunct anticonvulsant

Analgesia –> neuropathic pain and hyperalgesia

Sedation - feature and a bug

Human liquid formulation contains xylitol

Not federally controlled, depends on the state

Question 8

Acetaminophen: effects (2), use

Answer 8

Analgesic

Antipyretic

Mostly short-term palliative therapy for moderate to severe pain

Often combined with an opioid

Question 9

Acetaminophen: caution (cats and ferrets)

Answer 9

Toxic at any dose!

Causes hepatotoxicity and methemoglobinemia

Question 10

Acetaminophen: cautions (dogs - 4)

Answer 10

Must be closely monitored for:
Hepatotoxicity

Nephrotoxicity

GI ulceration

Methemoglobinemia

Question 11

Monoclonal Antibodies: brand names (2), effect, use, administration, caution

Answer 11

Frunevetmab (Solensia) - cats
Bedinvetmab (Librela) - dogs

Binds to nerve growth factor, prevents it from binding to nociceptors –> reduces pain signaling to CNS

Control pain associated with osteoarthritis

SQ - monthly

Avoid accidental self injection!

Question 12

Multimodal analgesia

Answer 12

Using multiple analgesic agents that target different receptors in the nociception pathway