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Anaesthesia & Analgesia > Analgesia > Flashcards

Analgesia Flashcards

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1
Q

What is Analgesia?

A
  1. Loss of sensitivity to pain
    Or
  2. Absence of pain
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2
Q

What are Hypoalgesics?

A
  1. A more accurate term for drugs that reduce pain
  2. As total analgesia can only be obtained by using Local Anaesthetics (LAs)
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3
Q

What is Pre-emptive analgesia?

A
  1. The administration of analgesics prior to an anticipated painful stimulus or tissue trauma
  2. To prevent Neuron Sensitisation
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4
Q

What are the 2 reasons that you should admin pre-emptive analgesia to patients?

A
  1. Prevent pain pathway sensitisation
  2. Easier to manage pain post-operatively
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5
Q

List the 6 Analgesic drug groups!

A
  1. Opioids
  2. NSAIDs
  3. Alpha-2-Adrenoreceptor Agonists
  4. Local Anaesethetics
  5. Dissociative anaesthetics
  6. Anti-convulsants
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6
Q

What are the 2 types of Opioid

A
  1. Partial agonists
  2. Full agonists
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7
Q

True or False.

Opioids act centrally but not peripherally.

A

False.

Opioids act both centrally + peripherally.

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8
Q

Name the 4 Full agonist Opioids

A
  1. Morphine
  2. Fentanyl
  3. Pethidine
  4. Methadone
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9
Q

Name the 2 Partial agonist Opioids

A
  1. Butorphanol
  2. Buprenorphine
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10
Q

Are Full agonist Opioids used for:

A) Mild > Moderate pain
B) Moderate > Severe pain
C) Minimal > Mild pain

A

B) Moderate > Severe pain

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11
Q

Are Partial agonist Opioids used for:

A) Mild > Moderate pain
B) Moderate > Severe pain
C) Minimal > Mild pain

A

A) Mild > Moderate pain

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12
Q

What type of pain are Full agonist Opioids used for?

A
  • Moderate > Severe
  • As they bind fully
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13
Q

What type of pain are Partial agonist Opioids used for?

A
  • Mild > Moderate
  • As they bind partially
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14
Q

True or False.

Full agonist Opioids can be topped up, to increase the dose of analgesia to the patient.

A

True

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15
Q

What class of drug is this?

A
  1. Analgesic
  2. Full agonist Opioid
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16
Q

Give the 2 common drug names given to Methadone

A
  1. Comfortan
  2. Synthadon
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17
Q

True or False.

Methadone is not licensed for use in Cats but is in Dogs.

A

False.

It is licensed for use in both Dogs + Cats.

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18
Q

Can Methadone be administered IM?

A

Yes

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19
Q

List the 3 routes that Methadone can be administered to a patient

A
  1. IV
  2. SC
  3. IM
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20
Q

True or False.

Methadone provides sedation but no analgesia.

A

False.

Methadone provides analgesia but little sedation.

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21
Q

Think of moderate > severe pain examples..

Give 2 examples of when Methadone is commonly used in the VP

A
  1. Bitch spay
  2. Fracture repair
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22
Q

Give the 2 drug names commonly used for the partial Opioid agonist, Buprenorphine

A
  1. Vetergesic
  2. Buprecare
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23
Q

List 3 routes of admin for Buprenorphine

A
  1. IV
  2. IM
  3. OTM (Oral Trans-Mucosal)
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24
Q

What partial Opioid agonist can be given OTM in Cats?

A

Buprenorphine

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25
Why is **Buprenorphine** given **OTM** in **Cats**?
It is an **'*easier*' method** of providing **comparable levels of sedation**, as **IM** would
26
Give 2 example **procedures** to when **Buprenorphine** would be used?
1. **Superficical surgery** 2. Stitch-ups
27
What is **Fentadon**?
A **licensed** **injectable** form of **Fentanyl**
28
# CRI = Constant Rate Infusion What common **potent Full **agonist Opioid can be given by **CRI**?
Fentanyl
29
True or False. Fentanyl is a very potent Full agonist Opioid.
True
30
What **Opioid** is particulary **indicated** for pain that is associated with ***Major* Orthopeadic or Soft-tissue sx**?
1. Fentanyl 1. Due to it's **potent**, **full-binding** effects
31
True or False. Fentanyl patches can be used off-licence for outpatients.
True. But **extreme caution** is warned and rarely used.
32
What Opioid am I? 1. I come in an licensed injectable form. 2. I am very potent. 3. I can be given by CRI. 4. I am also indicated for major orthopaedic + soft tissue surgeries.
Fentanyl!
33
List 3 **adverse GI effects** caused by **Fentanyl**
1. **Intestinal spasms** *(affecting ENS + CNS)* 2. **Constipation** (Prolonged use) 3. **Contraction** of the **bile duct** *(cause blockage in SI)* ## Footnote ENS = Enteric NS
34
Why is it bad that **Fentanyl** causes the adverse effect of **contraction of the bile duct**?
1. Because contraction of the bile duct 2. **Disrupts** the **normal flow of bile + pancreatic secretions** in the **SI** 1. Leading to a **blockage** 2. Blockage can lead to *liver damage* or *bile peritonitis*
35
How does **Fentanyl** cause **Intestinal spasms** in patients?
1. It affects the **Enteric nervous system** + CNS 1. It binds to the Mu-Opioid receptor in these systems 2. Leading to **reduced gut motility**, **decreased secretions** + **increased muscle tone** in the **intestines** 3. Resulting in **decreased peristalsis** + ***spasm-like-contractions*** ## Footnote You can then work out how constipation can occur!
36
Name for **4 side effects** of **Fentanyl**
1. ***Excitement where no pain exists*** 2. ***Hyper excitement*** + ***seizures*** in **Cats** 3. Respiratory depression 4. **Supressed** **cough-reflex**
37
What drug causes **Hyper excitement + seizures** in **Cats**?
Fentanyl
38
List **3 contraindications** for using Fentanyl
1. ***Advanced*** **Respiratory dysfunction** 2. Severe **Liver failure** 3. Severe **Kidney** failure
39
How do **NSAIDs** work?
1. They **inhibit** the **production** of the inflammatory mediators, known as **Prostaglandins** 1. **Via** the **inhibition** of the **COX 1 + 2 enzymes**
40
True or False. Some drugs are **COX 2** selective, as COX **1** has a protective effect on the GI lining + Kidneys.
True!
41
At what **point** in the pain pathway do **NSAIDs** work?
The **Transduction** stage
42
What is this a demonstration of?
How **NSAIDs** disrupt the pain pathway
43
Do NSAIDs provide analgesia?
Yes
44
Why is it important to select the most appropriate **NSAID** for each individual patient?
1. Because despite all NSAIDs having similar qualities of analgesia 1. They **vary in safey profiles** + **different types** of **pain** ## Footnote Like peri-operative v chronic pain (osteoarthritis)
45
Name the 7 NSAIDs
1. Meloxicam 2. Carprofen 3. **Robenacoxib** 4. Aspirin 5. **Phenybutazone** 6. **Ketoprofen** 7. Paracetamol (Dogs only)
46
List the 3 most common used NSAIDs
1. Meloxicam 2. Carprofen 3. **Robenacoxib**
47
Name the 2 drugs names for **Meloxicam**
1. Metacam 2. **Meloxidyl**
48
Name the **3 species** that **Meloxicam** is currently **licensed** in
1. Dogs 2. Cats 3. **Guinea Pigs**
49
Name 2 other common drug names given to **Carprofen**
1. Rimadyl 2. **Carprovet**
50
What **2 species** is **Carprofen licensed** in?
1. Dogs 2. Cats
51
Provide the **2** other common names given to the NSAID, **Robenacoxib**
1. Previcox 2. **Onsior**
52
Name the **2 species** that **Robenacoxib** is **licensed** in
1. Dogs 2. Cats
53
What **NSAID** is considered **toxic** to **Cats**? & **Why**?
1. **Paracetamol**! 2. Because they **do not have the enzyme** to **break down** Paracetamol safely 3. Leading to an accumilation in the body, eventually **altering their RBCs**, making them **unable to carry haemaoglobin** 4. Leading to **multiple organ** dysfunction > **failure**
54
List **4 adverse effects** of **NSAIDs**
1. **GI irritation + ulceration** 2. Renal failure 3. **Blood imbalances** 4. Liver toxicity
55
List the **10** potential **contraindications** of using **NSAIDs**
1. **Hypotension** 2. Renal failure 3. **Dehydration** 4. GI bleeding 5. **Clotting disorders** (i.e.; VWD) 6. Use of other Nephrotoxic drugs 7. **Use of other Steriod drugs** 8. Animals **under 6 weeks** 9. **Pregnant** or **lactating** patients 10. Large doses in Cats
56
Why can't **NSAIDs** be used in **Hypotensive** patients?
1. Because **worsen kidney function** 1. By **prohibiting Prostaglandins** 1. Which **play** the **crucial role** in **maintaining Renal blood flow** 1. Leading to Acute Kidney Failure (**AKF**)
57
Why can't **NSAIDs** be used in **dehydrated** patients?
1. Because it can cause **fluid retention** 2. Making dehydration **worse** + causing **further strain on the Kidneys** 3. Lead to **AKF** ## Footnote AKF = Acute Kidney Failure
58
Why can't **NSAIDs** be used in patients with **Clotting disorders**?
1. Because **NSAIDs inhibit** the **production** of **Thromboxane A2** 2. This **promotes platelet aggregation + clot formation** 3. Leading to **prolonged bleeding + clotting times**
59
Why can't **NSAIDs** be used in patients who is recieving **Steroids**?
1. Because this **combo increases** **GI effects** (**Ulcers** + **bleeding**) 2. As **NSAIDs** **reduce Prostaglandins**, which **protect** the **stomach lining** 3. **Steriods** **weaken** the protective stomach **lining** **barrier** 2. As they **both** greatly impact the GI tract, **incr**easing the risk of **erosion + damage**
60
Why can't **NSAIDs** be used in patients **under** the age of **6 weeks**?
1. Due to their **immature Renal + Hepatic functions** 1. Leading to increased risk of toxicity + damage
61
Why can't **NSAIDs** be used in **pregnant** and **lactating** patients?
1. Pregnant + Lactating animals can **pass** **NSAIDs** through the **transplacental barrier** 2. It increases the risk of: * Birth defects * ***Patent Ductus Arteriosus*** * GI complications to mother
62
True or False. NSAIDs can be given with other NSAIDs, just not with Steriods.
False. Although it is **true** that NSAIDs **cannot be given with Steriods**, they should **not** be **used with other NSAIDs**.
63
Why should you **take care** with **NSAID dosage + intervals**, with **Cats**?
Because they have an **increased susceptibility** to **some** NSAIDs
64
Name **6 potential situations** when you should **avoid or take extreme care**, with administering **NSAIDs**?
1. Dehydration 2. **Hypotension** 3. **Shock** 4. Pre-existing Renal disease 5. Liver disease *(Overdose risk)* 6. **Current or previous use of Corticosteroids** or other NSAIDs
65

Anaesthesia & Analgesia (30 decks)

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