Exam 1 Flashcards
A normal heart rate for a cat under anesthesia is?
100-200 bpm
A normal heart rate for a cow under anesthesia is?
48-90 bpm
A normal heart rate for a dog under anesthesia is?
50-160 bpm
A normal heart rate for a horse under anesthesia is?
How about for a foal?
Horse= 28-50 bpm
Foal= 28-80 bpm
A normal heart rate for sheep or goats under anesthesia is?
60-150 bpm
A normal resp rate for a dog, cat, horse or ruminant under anesthesia is?
10-20 RR
A normal temperature for a dog, cat, horse or ruminant under anesthesia is?
98-102.5 F
Boxers are prone to this cardiac abnormality:
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) aka Boxer Cardiomyopathy. The disease is where you have progressive replacement of myocardium, particuarly the right ventricular myocardium with fibro-fatty tissue. These dogs can develop ventricular tachyarrhythmias including v-tach and v-fib.
Cats and dogs having surgery should have water witheld this long prior to the procedure:
Water can be given up until the pre-meds are given.
Cats and dogs should have food witheld prior to surgery for this many hours:
6-12 hours
Cattle should have food witheld for this many hours prior to surgery:
18-24 hours
Cattle should have water witheld this long prior to surgery:
12-18 hours
CVP stands for ______ _____ ______ and measures what? What are normal values?
Central Venous Pressure and measures the hydrostatic pressure within the intrathoracic vena cava= right atrial pressure to check for adequacy of venous return.
Normal values 0-10 mm Hg (if low may need fluids, if high should stop fluids.)
Doberman pinschers commonly get this blood abnormality:
von Willebrand’s disease
During Stage III, Plane II of anesthesia, you will have sugglish palpebral reflexes and your corneal reflex will be:
Strong
During Stage IV of anesthesia the pupils will appear:
Central, widely dilated
Equine should have water witheld for this long prior to surgery:
Water may be given up until when the pre-med is given.
Equines should have food witheld for this many hours prior to surgery:
4-12 hours
Herding breeds of dogs are commonly associated with:
MDR1 gene mutation
Horses will _________ in light planes of anesthesia.
Lacrimate
How do anticholinergics work?
Competitively binds to muscarinic receptor at the post-synaptic cleft to prevent binding of Ach.
How is oscillometric BP obtained?
Blood flow through the arteries causes vibrations in arterial wall is translated to air in the BP cuff which is then detected and transduced into electrical signals to produce a reading.
Hypotension in the equine is defined as having the MAP < ______ .
MAP < 70
Hypotension in the small animal (dog or cat) is defined as having a MAP <______ or a SAP < _____.
MAP < 60
SAP <80
If a herding breed dog like a collie is positive for the MDR1 mutation, what does this mean?
Serious adverse drug reactions to antiparasitics like Ivermectin or Milbemycin, also to antidiarrheal agents like Loperamide and several anticancer drugs like Vincristine and Doxorubicin.
If you were monitoring a patient under anesthesia and noticed this occuring, what would you think is causing this?
Hypoventilation (due to a gradual increase in the ETCO2~less CO2 is being exhaled off.)
If you were monitoring a pet under anesthesia and you saw this wave form for it’s capnograph, what would you think?
Hyperventilation (due to a gradual decrease in ETCO2~more CO2 being exhaled off.)
In horses, the eyes will stay _______ as opposed to ventral medially rolling and you get nystagmus in Stage II.
Central
In the horse, this reflex persists even into deeper planes of anesthesia:
Corneal reflex
Increased lactate levels over 5 mmol/L indicate severe ______.
Hypoperfusion
Is it neccessary to fast a rabbit, rodent, small bird or neonate prior to surgery?
No, due to the fact they could develop hypoglycemia within a few hours of being fasted and they have an increased metabolic rate.
MAP stands for _______ _______ ______
and MAP = _____ x _____ or
MAP = (1/3[___-____])+_____
Mean Arterial Pressure
MAP= CO x SV or
MAP= (1/3[SAP-DAP])+DAP
Mini Schnauzers are sensitive little creatures and are susceptible to many things, but when it comes to EKGs they are prone to this abnormality:
Sick Sinus Syndrome
Peripheral nerve stimulators are used when?
If a neuromuscular blocker like Atricurium was used to determine the level of blockade and recovery from that blockage post-op.
Phenothiazines are _______ (____ & ____) receptor antagonists in the CNS.
Dopamine (D1 & D2) receptor antagonists in the CNS.
Phenothiazines work by blocking _____ receptors.
Alpha 1
Pigs are commonly associated with this condition:
Malignant hyperthermia
Pugs are an example of this type of dog:
Brachycephalic breeds
Quarter horses are commonly associated with this condition:
Hyperkalemic Periodic Paralysis (HYPP)
Rabbits have ________ _______ which is why giving atropine to a rabbit for bradycardia would be ineffective.
Atropine esterase
Small ruminants, calves and camelids should be fasted prior to surgery for this many hours:
12-18 hours
Small ruminants, calves and camelids should have water witheld for this many hours prior to surgery:
8-12 hours
T/F: Acepromazine can be easily reveresed.
False, it is long lasting (4-8 hours) and cannot be reversed.
T/F: Acepromazine can cause vomiting as a side effect.
False, Acepromazine actually has antiemetic properties (the exact opposite).
T/F: Atropine should not be used in patients with myasthenia gravis, ileus, GI obstruction, tachycardia due to thyrotoxicosis, or cardiac insufficiency, or myocardial ischemia.
True
T/F: It is ok to use Atropine and Dexmedetomidine together.
False!!! Can cause cardiac arrhythmias.
T/F: It is ok to use Atropine in a patient with narrow angle glaucoma.
False
T/F: The CO2 lines for the capnograph used in anesthesia lab were a “mainstream”.
False, They were a sidestream (and suck up around 150 mL/min to measure CO2.)
T/F: With Doppler you can determine the MAP (Mean Arterial Pressure).
False, you can only determine the SAP (systolic arterial pressure). You need to use oscillometric to obtain HR, SAP, MAP and DAP.
The wave forms associated with reading the SPO2 is called what?
Plethysmograph
This is the gold standard for assessing oxygenation (PaO2) and ventilation (PaCO2) status in a patient.
Arterial blood gas
This is the ideal stage and plane of anesthesia we want to be at and the one that most surgical procedures are performed at:
Stage III Plane II
This is the “light” surgical plane of anesthesia used commonly for minimally invasive procedures like a biopsy:
Stage III Plane I
This is the stage of anesthesia you don’t want to be at and where you have extreme CNS depression from anesthetic overdose.
Stage IV
This is the stage and plane of anesthesia where your patient may be “too deep” and the heart rate has slowed, there is no palpebral or corneal reflex and the pupils are progressively dilated and becoming more central.
Stage III Plane III
This is the stage and plane of anesthesia before anesthetic overdose where your patient is progressing to shock:
Stage III, Plane IV
This is the stage of anesthesia of voluntary movement (the patient is still able to lift and turn head without support.)
Stage I
This is the stage of kitties supermaning of the table, jk….it is the stage of delirium and involuntary movment:
Stage II
This is the stage of surgical anesthesia:
Stage III
This kitty has…..
“Ace eye”
What are 2 examples of anticholinergics?
Atropine and Glycopyrrolate
What are the 2 major types of SPO2 probes?
Transmission and Reflectance
What does “D” correspond with on this capnograph reading?
End-Tidal Concentration
What is an example of a Phenothiazine?
Acepromazine
What is PEA?
Pulseless Electrical Activity: can get electrical activity that doesn’t equal mechanical activity of the heart. (ie: if a pet has been euthanized, that animal still may have PEA).
What is the preferred anticholinergic in rabbits?
Glycopyrrolate since 1/3 to 1/2 of all rabbits have atropinase enzyme where they break down atropine quickly.
What is the problem with giving Epinephrine to a patient who has been given Acepromazine that may have gone into cardiac arrest?
Since Alpha 1 receptors are already being blocked by Ace, Epinephrine cannot bind and so it is left to bind with Beta 2 which can make the situation worse.
What is this?
Sphygmomanometer
What is von Willebrand’s disease?
Deficiency in or impairment of a protein called von Willebrand factor, an important component in the blood clotting process; lack of this means that platelets cannot bind. It subsequently takes longer for these dogs to form a clot.
What signs of anesthetic depth can you use to determine adequate surgical anesthesia plane (for a snake)?
Heart rate (an elevated heart rate may indicate too light of a plane of anesthesia, or a slowed heart rate may indicate too deep a plane of anesthesia.)
Also can use the tail reflex.
Which induction agents are known to cause a delayed recover in greyhounds and should be avoided?
Thiopental (barbituates)
and Propofol
With CO (carbon monoxide) poisoning or cyanide poisoning, this will influence the SPO2 how?
Will give a falsely high reading.
With methemoglobinemia you will get readings in the ______ for SPO2.
80%’s
Which 5 situations are reasons you should avoid the use of Acepromazine?
- Boxers
- Liver disease or portocaval shunts
- Breeding stallions due to increased liklihood of paraphimosis.
- von Willebrand’s disease or other clotting disorders.
- Shock or cardiovascular disease
Xylazine, Detomidine, Romifidine, Medetomidine and Dexmedetomidine all fall into the class of drugs called:
Alpha 2 Adrenoreceptor Agonists
The overall effect of Alpha 2 agonists are:
Sedation, muscle relaxation, and analgesia.
Alpha 2 agonists cause initial ________ and a ______ in arterial blood pressure followed by reflex ________.
Initial vasoconstriction and rise in artieral blood pressure followed by reflex bradycardia.
______ is an alpha 2 agonist that is used in equines for dentals and other standing procedure commonly.
Romifidine (lasts 45-90 minutes).
Tolazoline is a _______ agent for alpha 2 agonist drugs and should be avoided in ______.
Reversal agent, avoid in camelids.
Diazepam and Midazolam are examples of:
Benzodiazepines
T/F: Benzodiazepines provide excellent analgesia.
False, they provide NO analgesia.
Benzodiazepines are centrally acting _______ ______.
Muscle relaxants (by enhancing the activity of GABA by binding to a specific site on the GABAa receptor.
Diazepam must be formulated in ________ _________ to make the drug soluble. The problem with this is what?
Propylene glycol~ the problem is that rapid IV administration can cause bradycardia, hypotension or apnea.
T/F: Diazepam is water insoluble so it should be avoided IM because of poor absorption and because it is painful.
True
Midazolam is the better choice drug in what type of patient?
The sick, debilitated or older patients.
What is the reversal agent for Benzodiazepines?
Flumazenil
Morphine has a high affinity for _____ receptors but some affinity for ______ and _____.
High affinity for mu receptors and some affinity for delta and kappa receptors.
T/F: Morphine is hydrophobic compared to other opioids so it has a shorter duration of action.
False, Morphine is hydrophilic and has a longer duration of action compared with lipophilic drugs.
Hydromorphone is a ____-______ ______ _____ agonist.
Semi-synthetic pure mu agonist
T/F: Hydromorphone is 5-10x more potent then morphine.
True
Oxymorphone works best in ______ and _______ dogs.
Cats and small dogs
Fentanyl is a _______ ______ ______ agonist that is ______x more potent then Morphine.
Synthetic pure mu agonist, 100 x
T/F: It is ok to use transdermal Fentanyl (Recuvyra) in cats.
False, never use them in cats.
Remifentanil is unique because it metabolized by what?
Non-specific esterases that occur in the body (mainly skeletal muscle). This is advantageous because it leads to rapid clearance from the body because it does not depend on the liver or kidney.
T/F: Remifentanil is half as potent as Fentanyl.
Methadone is a ________ ______ _______ agonist with similar potency to morphine but causing less sedation and more dysphoria.
Synthetic pure mu agonist
Methadone is the least likely mu agonist to cause what?
Vomiting
Butorphanol is a mixed opioid ______-_______ and is an agonist at __________ receptors and partial _____ receptor agonist/_______.
Butorphanol is a mixed opioid agonist/antagonist and is an agonist at kappa receptors and partial mu receptor agonist/antagonist.
Butorphanol is used for mild to moderate ________ pain but is not effective for severe or _______ pain.
Used for mild to moderate visceral pain but is not used for severe or orthopedic pain.
Butorphanol can be used to reverse what?
Sedative or respiratory effects of a pure mu agonist.
Buprenorphine is a ______ _____ agonist and an antagonist at ________ receptors.
Partial mu agonist and an antagonist at kappa receptors.
Simbadol is….
SQ (subcutaneous) injectable Buprenorphine for cats for 24 hour surgical pain control.
Morphine, Hydromorphone, Oxymorphone, Fentanyl, Remifentanil, Methadone, Butorphanol, and Buprenorphine are all examples of:
Opioids
_______ is a opioid antagonist and is used to reverse pure mu and mixed agonist/antagonists because it has a high affinity for mu and kappa receptors but no intrisinc activity.
Naloxone
What are 2 antiemetics that can be given pre-operativley to limit vomiting or nausea commonly associated with opioids?
Maropitant (Cerenia)
or Metoclopramide
T/F: Maropitant is a neurokinin 1 receptor antagonist used for motion sickness commonly.
True
T/F: Metoclopramide blocks D2 receptors in the chemoreceptor trigger zone and also blocks serotonin receptors to contribute to antiemetic effects.
True
Metoclopramide has __________ effects which is why it is contraindicated in suspect or known GI obstructions.
Prokinetic
This hormone can be given to patients with von Willebrand’s disease prior to surgery.
Desmopressin, as it helps to increase von Willebrand’s factor.
This drug can be given to greyhounds to decrease post-operative bleeding by increasing clot strength.
Aminocaproic acid (anti-fibrinolytic agent).
Neuroleptanalgesia is a state of CNS depression and analgesia produced by the combination of a ________ or ________ and _______ drug.
Combo of tranquilizer or sedative and analgesic drug.
What are 3 big examples of neuroleptanalgesia?
Acepromazine (tranquilizer) + Opioid (analgesia)
Benzodiazepine (sedative) + Opioid (analgesia)
Alpha 2 agonist (sedative) + Opioid (analagesia)
Kitty magic contains…..
Dexmedetomidine (Alpha 2 agonist)~Sedative
Butorphanol (Opioid)~Analgesia
Ketamine
(Altogether produces heavy sedation and anesthesia)
** Lights out ;) **
Between Diazepam and Midazolam, which is the more expensive drug?
Diazepam at $3/mL vs Midazolam which is $1/mL
T/F: Acepromazine is a cheap and easy to come by drug.
True, which is why so many vets elect to use it as a sedative! (only $0.50/mL)
You want to choose an opioid for your canine patient but you currently work at a low cost clinic and want to keep your clients costs to a minimum, which would be the better choice: Butorphanol, Morphine or Fentanyl (if you only had these 3 on hand).
**Morphine because it is the cheapest, and lasts the longest.**
Fentanyl is cheap but it’s duration of action is short and frequently is given as a CRI.
Butorphanol is good for mild-mod visceral pain but is more expensive.
You have a collie that comes into your clinic for an elective procedure: would using Acepromazine, Morphine or Butorphanol be a good choice for this patient?
No, because of the potential for MDR1 gene mutation coding for a protein (P-glycoprotein) that drastically affects absorption, distribution, metabolism and excretion of drugs.
T/F: Pharmacokinetics is what the drug does to the body.
False, it’s what the body does to the drug.
Phenobarbital, Pentobarbital and Thiopental are examples of:
Barbituates
Which barbituate would make the best induction agent?
Thiopental because it is ultra-short acting (5-15 minutes).
Barbituates act by…..
Decreasing GABA (the main inhibitory neurotransmitter) dissociation from GABAa receptors.
Which breed of dog is more sensitive to barbituates?
Greyhounds
T/F: Barbituates depress the CNS, cause marked apnea (decreased responses to increasing CO2 levels), decreased CO, hypotension, possibly cardiac arrhythmias, decreased GI motility, contraindicated in pregnancy, and is very alkaline so can cause tissue necrosis and thrombophlebitis.
True
Barbituates undergo _______ metabolism so caution should be used in patients with significant _______ disease, hypothermia or depressed CV function.
Hepatic metabolism, so should be avoided in patients with hepatic disease.
The more _______ the barbituate is, the better.
Dilute (<5% in small animals and <10% in large animals).
T/F: Thiopental should be given slowly to a horse because of it’s adverse side effects.
False, push it…push it real good….and fast while you’re at it….or suffer.
This induction agent is classified as a neurosteroid.
Alphaxalone
T/F: Alphaxalone has a wide safety margin/high therapeutic index.
True
The main mechanism of Alphaxalone is….
That it enhances GABA dissociation from GABAa receptor +/- activation of central glycine receptors (inhibitory).
Thiopental was very alkaline, Alphaxalone is very_______.
Neutral (does not cause pain or sloughing.)
The vehicle of Etomidate is _______ _______.
Propylene glycol
Propylene glycol is seen in _________ and _________ and can cause ________ ________.
Diazepam and Etomidate and can cause acute hemolysis (so you’d never want to give a prolonged infusion of either).
The mechanism of action of Etomidate is….
Enhances the inhibitory action of GABA and binds GABAa receptors.
Although Etomidate is one of the more expensive induction agents, what would be the perk of picking this over another drug?
If you have a cardiovascular compromised patient this is your induction agent of choice because it has litle changes on HR, ABP and CO.
T/F: Etomidate is safe to use for a c-section.
True
T/F: Etomidate is safe to use in Addisonian patients.
False, it suppresses adrenocortical function so could put them into an Addisonian crisis.
One negative side effect of Etomidate is that it causes:
Nausea, vomiting and retching.
Etomidate undergoes ________ metabolism.
Hepatic
Propofol needs to be discarded within _____ hours of opening bcause there is no preservatives in it.
6
T/F: Ketamine is a lovely drug to give to a pet with glaucoma.
False, unless you want to work up an ophtho case with a super painful eye….yeah no.
Ketamine may raise IOP so stay away….
This is an example of…..
A multiple dosing regimen (the plus is that you get to ss (steady state) faster but the downside is you get unpredictable doses within a therapeutic window.)
This is an example of…..
IV Infusion aka CRI (takes longer to reach steady state but once we do, it’s smooth sailing within the therapeutic window).
Which of these drugs A or B has a slower clearance rate?
Drug A because it has a larger AUC (area under the curve). Drug B on the other hand has a smaller AUC and so it has a quicker clearance rate.
**Think smaller and quicker.**
Out of these 6 drugs, which would be best given as a CRI (can name more than one).
**Midazolam, Ketamine, Propofol**
Diazepam and Thiopental would be TERRIBLE as a CRI, not to mention Diazepam contains Propylene glycol which should never be given as a CRI.
Etomidate is also terrible for CRI’s b/c it too contains Propylene glycol.
At what point on this chart would we anticipate Fentanyl causing a prolonged recovery from infusion?
The 3 hour mark. [All other drugs on this chart are *ideal*]
What are the components of a “Triple Drip”? What species do we see this most frequently used in?
Triple Drip:
Xylazine (Alpha 2 agonist)~good sedation and muscle relaxation
Ketamine~ chemical restraint and dissociative anesthesia
GG (Guaifenesin)~additional central muscle relaxation
**We see this frequently used in equines.**
Which part of this standard vaporizer would contain pure 100% O2?
The inflow and the bypass (the bypass is the arm where pure O2 flows through w/o picking up any anesthetic gas~unless the vaporizer were tipped over of course.)
Which part of the standard vaporizer would contain O2 that is picking up anesthetic gas?
Vaporizing chamber
Which of these inhalants would be 2nd to most soluble?
Isoflurane because it takes longer to reach Fa (Alveolar concentration) from the amount inspired Fi.
_______ can cause malignant hyperthermia in which species? It is especially dangerous to this breed that is already predisposed to maliganant hyperthermia?
Halothane can cause malignant hyperthermia in pigs, dogs, cats, horses and people.
In vet med we are especially worried about the piggies.
Which types of animals are more prone to hyperthermia?
Opioid treated cats and obese furry dogs.
This class of drug is the mainstain for equine pain relief.
NSAIDs, they have a long duration and have the option for PO administration.
Where are some good sites to collect samples for blood gas analysis from on a small animal?
Dorsal pedal artery
Auricular artery
Femoral artery
Caudal artery
Ligual artery or vein
What are some good sites to collect a sample for blood gas analysis on a large animal?
Facial artery
Transverse Facial artery
Lateral dorsal metatarsal artery
Auricular artery
Lingual artery
Femoral artery
Median artery
Curtis the sheep is 3 y/o and being castrated by a 7th semester student here at Ross University. This is the first blood gas sample obtained under anesthesia of Curtis.
Firstly, is this animal acidemic or alkalotic?
What is the primary issue?
Is there any compensatory mechanisms occurring?
Is the lactate levels normal?
Is this an arterial or venous sample?
Acidemia
Respiratory acidosis is the primary issue (due to elevated CO2 levels).
Compensatory metabolic alkalosis.
Lactate levels are normal.
Arterial sample because SaO2 is 100% (>88%) and PaO2 is 400 mm Hg (~500 mm Hg).
*Know this*
What is this?
PEEP (Positive end-expiratory pressure): the airway pressure at the end of expiration is maintained above ambient pressure. PEEP is applied when positive pressure is maintained between inspirations that are delivered by a ventilator.
What does CPAP stand for?
Continuous Positive Airway Pressure- spontaneous breathing with positive pressure during both inspiratory and expiratory cycles.
**Little side note: CPAP are the sleep machines for people with sleep apnea**
What is this called?
The demand valve: inserted on the proximal end of the endotracheal tube and delivers IPPV (O2 only).
______ can be given for analgesia in ruminants and may cause excitement or vocalization.
Opioids (Hydromorphone or Butorphanol)
If the equine has made no attempt to rise in 1 hour post-operatively it should be encouraged to do what?
Sit in sternal recumbency.
