Exam 2: Lecture 12: Adjunct drugs and reactions

Question 1

What are adjunct drugs to anesthesia and
analgesia?

Answer 1

Drugs that may or may not be common for clinical use, but
play a supportive role by the benefit that they provide the
patient

Question 2

Define Balanced anesthesia

Answer 2

simultaneous use of multiple drugs &
techniques to produce anesthesia

Question 3

Define Multimodal analgesia

Answer 3

using 2 or more different drugs
or techniques to manage pain

Question 4

Which drug is a neurokinin-1 receptor
antagonist, often used for motion sickness

Answer 4

Maropitant AKA Cerenia

Question 5

Maropitant (trade name: Cerenia) is a neurokinin-1 receptor
antagonist, often used for motion sickness. Benefits in perioperative
period include:

Answer 5

1. Reduced incidence of vomiting from certain premedication drugs
2. Improvement in recovery quality and a faster return to feeding
3. Potential MAC lowering effects (when administered as a CRI)

Question 6

What is an important clinical note for Maropitant

Answer 6

mportant clinical note – does not prevent gastroesophageal reflux (GER)

Question 7

Which drug is FDA approved for use in dogs for motion sickness and acute vomiting

• Common side effects of higher doses of _____ is excessive drooling

Answer 7

Maropitant AKA cerenia

Question 8

Is vomiting passive or active?

Answer 8

active

Question 9

Is regurgitation passive or active?

Answer 9

Passive

Question 10

Does the following describe Vomiting or regurgitation?

• Forceful ejection of stomach and upper intestinal contents
• Can contain yellow bile or partially digested dog food
• Usually smells sour and involves heaving

Answer 10

vomiting

Question 11

Does the following describe Vomiting or regurgitation?

• Mild ejection of undigested food from the esophagus
• Does not involve abdominal heaving
• Tends to happen just after eating

Answer 11

Regurgitation

Question 12

Which drug is a 5HT3 receptor antagonist?

Answer 12

Ondansetron

Question 13

Which drug is antimetric that works at the level of the vomiting center in the brain, particullary useful for prevention of vomiting due to chemotherapy drugs or from anesthetic drugs that induce vomiting

Answer 13

Ondansetron

• Less effective than maropitant in prevention of vomiting, but
  oral administration can reduce incidence of nausea.

Question 14

How is Ondansetron available?

Answer 14

Available in tablet form, oral solution and injectable solution

Question 15

Which drug Blocks dopamine D2 receptors in chemoreceptor trigger
zone and also blocks serotonin receptors to contribute to
antiemetic effects

Answer 15

Metoclopramide

Question 16

Which drug has prokinetic effects reduce amount of gastric fluid (via
increasing the rate of gastric emptying) and increase lower
esophageal sphincter tone

Answer 16

Metoclopramide

Question 17

What drug fits the following description:

❖May increase CNS depressant effects of anesthetic
drugs
❖Do NOT give if GI obstruction suspected, history of
seizures or pheochromocytoma is present

Answer 17

Metoclopramide

Question 18

Which drug class can be Given to decrease acid production in the stomach (H2 antagonists
such as famotidine or ranitidine)

Answer 18

Histamine receptor antagonists

Question 19

Which drug is commonly given prior to mast cell tumor removal
to competitively counter the effects of histamine (H1 antagonist)

Answer 19

Diphenhydramine

Question 20

An eight year olf female spayed boston terrier is presented with a solitary well circumscribed mass two cm in diameter on the left hip area. The owner reports that the mass occasionally appears inflamed and the dog has a history of allergies
- A fine need aspirate of the mass stained with Diff Quick is also shown
- What pre-operative treatment is indicated?

Answer 20

H1 histamine receptor antagonist - corticosteroids

Question 21

What drug Decreases gastric acid production by
irreversibly blocking H+/K+ ATPase

Answer 21

Proton pump inhibitor

Omeprazole and pantoprazole most
commonly used. Long-acting drugs

ACVIM consensus statement: judicious use of
acid suppressants warranted for long-term
administration. Routine use for treatment of
acute, nonerosive gastritis not
recommended.

Question 22

Prefer to give _______ postoperatively in case hypovolemia or
hypotension occurs during anesthetic period, leading to decreased
renal blood flow. But many practitioners give them before surgery.

Answer 22

NSAID’s

Question 23

What is the MAC spraing effect for Carprofen?

Answer 23

decreased MAC of Sevo to 2.10% in dogs

Question 24

What is the MAC sparing effect of meloxicam?

Answer 24

decreased MAC of Sevo to 2.06% in dogs

Question 25

NEVER give _______ concurrently with NSAIDs

Answer 25

Glucocorticoids

Question 26

_______ is Used for anti-inflammatory, analgesic, immunosuppressive, and for physiologic support of Addisonian patients

Answer 26

Glucocorticoids

Question 27

give Cefazolin _______ IV

Answer 27

Slowly - over 5 minutes

Question 28

give Unasyn (Ampicillin/Sulbactam) _______ IV

Answer 28

slowely - over 15-30 minutes

Question 29

You can give gentamicin if......

Answer 29

Given IV - administer slowely

Question 30

give K-pin ______

Answer 30

slowly through IV

Question 31

T/F: You can give PPG both IV and IM

Answer 31

FALSE!!!!! never give IV

Question 32

Which antibiotic is used in food animals - Genatmicin - K - pen - PPG - Naxcel

Answer 32

Naxcel

Question 33

How do you administer Aminocaproic acid?

Answer 33

Oral and injectable formulations available. Give slowly IV (over 30 minutes) after diluting in saline to prevent CV effects.

Question 34

Which drug is an Anti-fibrinolytic agent

Answer 34

Aminocaproic acid

Question 35

Define anti-fibrinolytic agent Aminocaproic acid

Answer 35

– Can be given to Greyhounds to decrease postoperative bleeding by enhancing clot formation and increasing clot strength (2012 studies by Marin et al) – Greyhounds typically have higher than normal rates of bleeding 24-48hrs post op → see bruising around surgical site

Question 36

Which Hormone given to temporarily increase von Willebrand factor in dogs with a deficiency prior to surgery. Promotes vWf secretion from endothelium storage sites.

Answer 36

Desmopressin

Question 37

_________ is a synthetic replacement for vasopressin → hormone that reduces urine production

Answer 37

Desmopressin

Question 38

How is desmopressin typically available?

Answer 38

Available as a nasal spray typically - Expensive! Usually have the owner purchase at human pharmacy.

Question 39

Which drug is a Peripherally acting muscle relaxant – Works on skeletal muscle, but cardiac depression reported at higher doses

Answer 39

Dantrolene

Question 40

MOA of Dantrolene

Answer 40

ryanodine receptor antagonism → reducing Ca2+ release from the SR into the cytoplasm

Question 41

Which drug is used for the treatment and prevention of malignant hyperthermia and exertional rhabdomyolysis

Answer 41

Dantrolene – Pigs, humans, dogs, horses – Injectable solution and oral capsules available – Dose is species dependent (dogs, cats, pigs: 1-3 mg/kg IV for treatment and 5 mg/kg PO once daily for prophylaxis)

Question 42

T/F: Doxapram is a CNS stimulant

Answer 42

true

Question 43

Which drug cases arousal from sedation/anesthesia (this use is controversial), stimulation of respiration in neonates, and assessment of laryngeal function (dogs & horses)

Answer 43

Doxapram

Question 44

What is the MOA for Doxapram

Answer 44

likely due to both central and peripheral effects → increased activity of the respiratory nuclei of the medulla. But full understanding of MOA is not clear. – Significant increase in minute ventilation through an increase in RR and tidal volume

Question 45

Which drug can cause Increased dosages can lead to convulsions due to cortical stimulation. Dosages cause differing effects among species. – Avoid in epileptic patients

Answer 45

Doxapram

Question 46

Which drug is Central acting muscle relaxant with sedative properties – Unknown MOA, but likely works both in the brain and spinal cord

Answer 46

Guaifenesin - GG

Question 47

Which drug can be Co-administered with IV anesthetics (e.g. ketamine) in horses and ruminants – To induce anesthesia – To maintain anesthesia

Answer 47

Guaifenesin - GG

Question 48

Which drug fits these characteristics › No known analgesic properties › Wide therapeutic margin, with mild cardiorespiratory effects when given at therapeutic doses › Commonly prepared in 5-15% solution with 0.9% saline or 5% dextrose solution. – Perivascular injection may cause necrosis

Answer 48

Guaifenesin - GG

Question 49

_______ is an amide local anesthetic drug used to provide locoregional analgesia and also used systemically to treat ventricular arrhythmias.

Answer 49

Lidocaine

Question 50

Which drug shows Body of evidence in many species (humans, dogs, horses) that shows MAC sparing, anti-inflammatory, and analgesic effects. Also has prokinetic effects on the GI tract by stimulating intestinal motility

Answer 50

Lidocaine

Question 51

T/F: Lidocaine is typically not used in cats

Answer 51

true!!! Not typically used in cats as a CRI due to potential for toxicity!

Question 52

Lidocaine us used in equine for the treatment of?

Answer 52

– Ileus → stimulates intestinal muscle contraction (in vitro) + analgesia – Impactions – Duodenitis-jejunitis – Inflammation → preserves microvascular integrity, prevents neutrophil migration, and inhibits cytokine production – Laminitis – Post-operative pain Often given for 1 to 3 days, but must be carefully monitored

Question 53

What are the signs of lidocaine toxicity?

Answer 53

– Muscle fasciculations, weakness, recumbency – Discontinue lidocaine immediately → signs should quickly disappear

Question 54

Which drug is a NMDA receptor antagonist given as an intraoperative CRI binds at the CNS receptors and prevents “wind up”

Answer 54

Ketamine

Question 55

Which drug is Best used to manage neuropathic types of pain → especially if the pain is chronic and the patient has not responded well to other analgesic options

Answer 55

Ketamine

Question 56

Always combine _______ with an opioid and/or lidocaine infusion

Answer 56

Ketamine

Question 57

Provide some examples of opioids that can be used as a CRI?

Answer 57

– Fentanyl – Remifentanil – Morphine – Hydromorphone – Butorphanol – Buprenorphine

Question 58

T/F: opioids are Typically a loading dose is given first, followed by CRI

Answer 58

True

Question 59

Why give a loading dose?

Answer 59

Get the drug into the theraputic windown and stay there rapidly - Best way to prevent pain

Question 60

What is a MLK CRI

Answer 60

Morphine - Lidocaine - Ketamine (MLK) CRI - found morphine, lidocaine, ketamine, and MLK significantly lowered isoflurane MAC by 48, 29, 25, and 45%, respectively. Not associated with adverse CV effects. - found infusion of dexmedetomidine, MLK, and DMLK decreased the MAC of isoflurane from baseline by 30%, 55%, and 90%, respectively.

Question 61

What should you add to an MLK bag after you add the drugs?

Answer 61

Label Date Initials

Question 62

Define Drug Interactions

Answer 62

› Some are harmful, some are beneficial › Can occur in vitro (in syringe or vial) vs. in vivo (in patient) › In vitro (pharmaceutical interactions) → drug precipitate, toxic product, or inactivate one of the drugs – Acid-base interactions – Chemical incompatibilities › In vivo → PK and PD can be affected – Absorption – ABCB1 – Hepatic clearance – Drug protein binding

Question 63

What is a MDR1 gene mutation (AKA ABCB 1 mutation)

Answer 63

Some herding-breed dogs have a single mutation in a gene coding for a protein (P-glycoprotein) that drastically affects absorption, distribution, metabolism and excretion of drugs

Question 64

____________ is an important part of the blood-brain barrier → protects body from toxic accumulations of substances

Answer 64

P-glycoprotein

Question 65

Anesthesia drugs affected by MDR1 gene mutations are?

Answer 65

- Butorphanol - acepromazine

Question 66

MDR1 gene mutation - why does this matter???

Answer 66

– Dog with this mutation may have more serious side effects, such as CNS and/or respiratory depression, from certain anesthetic drugs. – Recovery may take longer and patient may still appear sedate long after the drugs should have normally worn off. – Generally recommend reducing normal dose by 25-50% in dogs that are homozygous for the mutation.

Question 67

___________ – precipitation will occur with aqueous solutions and significant absorption into soft plastic (i.e. fluid bags or tubing) within 24 hours. Also incompatible with heparin flush

Answer 67

Diazepam

Question 68

Epinephrine, dobutamine, and dopamine are incompatible with _______ solutions

Answer 68

Alkaline

Question 69

Which drug precipitates with aqueous solutions

Answer 69

Phenylbutazone

Question 70

Which drugs do not mix with solutions that contain calcium (ex. LRS) because precipitation may occur

Answer 70

Sodium bicarbonate

Question 71

Define Addition

Answer 71

simple additivity of fractional doses of two or more drugs

Question 72

Define synergism

Answer 72

response to fractional doses is greater than the response to the sum of the fractional doses

Question 73

Define Potentiation

Answer 73

enhancement of action of one drug by a second drug that has no detectable action of its own

Question 74

Define Antagonism

Answer 74

opposing action of one drug toward another. Can be competitive (drugs compete for same receptor site) or noncompetitive ( drugs act via different receptors)

Question 75

What is defined as when you can give lower amount of each drug

Answer 75

Synergism

Question 76

What is defined as the higher amounts of each drug because they are antagonizing each other

Answer 76

Antagonism

Question 77

What is an Isobologram

Answer 77

Shows the connection when you give two drugs together and how they effect one another