Final Exam Flashcards
(251 cards)
1
Q
The first-line for general immunosuppression is typically
A
High dose glucocorticoids
2
Q
This drug is ~7-8x more potent than Prednisone
A
Dexamethasone
3
Q
Side effects from steroids
A
PU, PD, and panting
4
Q
May be used as adjunctive therapy (to reduce amount of glucocorticoid needed) or as solitary therapy for certain diseases.
A
Other immunosuppressive drugs
5
Q
Targets for immunosuppressive drug action
A
Antimetabolites and T-cell inhibitors
6
Q
Impair nucleic acid synthesis (DNA) particularly in rapidly dividing
immune cells, and can block signaling on T-cells
A
Antimetabolites
7
Q
This antimetabolite is given orally and should not be used in cats due to toxicity in the liver and bone marrow
A
Azathioprine
8
Q
This antimetabolite is less commonly used, given orally, and often reserved for immune disease unresponsiveness to other therapies
A
Mycophenolate mofetil
9
Q
This antimetabolite is often started with prednisone for difficult immune diseases
A
Azathioprine
10
Q
This antimetabolite is administered orally and has relatively few side effects
A
Leflunomide
11
Q
T-cell inhibitors
A
Cyclosporine and Tacrolimus topical
12
Q
Atopica, Neoral, and Sandimmune are all bioequivalent
A
FALSE, Sandimmune isn’t bioequivalent to the other two
13
Q
Topical used in management of dermatologic dz and
perianal fistulas.
A
Tacrolimus topical
14
Q
A polypeptide that blocks cyclophilin/calcineurin which reduces T-cell activation & response, inhibits production of various cytokines to alter function of other WBCs.
A
Cyclosporine
15
Q
Used topically on eye to treat keratoconjunctivitis sicca (KCS), used systemically to treat perianal fistules, or as an adjunct with glucocorticoids for other immune diseases
A
Cyclosporine
16
Q
Tacrolimus topical has a slightly different target than Cyclosporine but essentially the same mechanism of action
A
TRUE
17
Q
Have a relatively more narrow therapeutic index than other drugs and may require special handling
A
Cancer chemotherapy drugs
18
Q
When handling chemo should you wear protective equipment?
A
Yes. Gloves, mask, gown
19
Q
Where the cancer started
A
Primary cancer
20
Q
Foci of cancerous cells distant from the original neoplasm
A
Metastases or “mets”
21
Q
Is it possible to find mets without knowing where the primary cancer is?
A
Yep
22
Q
Complete eradication of the cancer
A
Cure
- Although this is sometimes possible, it is rarely the goal of therapy in veterinary oncology.
- Cures often involve extremely aggressive treatment protocols
23
Q
Decrease in or disappearance of signs and symptoms of cancer
A
Remission
- Can be partial or complete
- May be undetectable by available tests but it is not gone completely
24
Q
Treatment aimed at preserving the quality of life of the patient without specific focus on prolongation of life
A
Palliative care
25
Palliative care when the decision has been made to cease life- extending treatment and the patient’s further life expectancy is short
Hospice care
26
Drug that is capable of causing tissue necrosis when extravasated
Vesicant
27
Administration of the drug outside of the blood vessel
Extravasation
28
What does BAG stand for and which do we not worry about as much in veterinary medicine?
Bone marrow, Alopecia, GI
We don't really worry about alopecia
29
Most common of the adverse effects of chemo dugs
Gastrointestinal signs
30
Are antiemetics used before or during treatment when nausea is expected?
Yes
31
Lowest neutrophil count
Nadir
32
If neutropenia is severe what do you do?
Prophylactic antibiotics may be started
33
What kinds of dogs show more hair loss?
Dogs with continuously growing coats (poodles, terriers, Old English sheepdogs)
34
How do cats demonstrate alopecia?
Whiskers may fall out
35
Systemic adverse event that can be life-threatening and occurs
when there is a high tumor burden and treatment causes massive cell death and release of intracellular substances from the dying cancer cells
Acute tumor lysis syndrome
36
To reduce resistance developing in the cancer cell population and minimize toxicity to the patient
Multi-drug chemotherapy protocol
37
Differs from traditional protocols in that lower doses of drugs are given over longer periods of time
Metronomic chemotherapy
38
Dilation of the pupil
Mydriasis
39
Constriction of the pupil
Miosis
40
Most common reasons for using ophthalmic drugs
```
Dilation/constriction of the pupil
Decrease aqueous fluid production or IOP
Increase tear production
Decrease inflammation
Treat infection
Analgesia
```
41
What route of administration would you use to reach the anterior portion of the eye?
Topical
42
What route of administration would you use to reach the posterior portion of the eye?
Systemic
43
Give one drop at a time and then wait ____ and then give the next drop
5 minutes
44
Pupil dilation and constriction are controlled by the actions of
The PSNS and SNS
45
Direct acting parasympathomimetic, causes miosis that lasts about 2-6 hours, commonly used to localize parasympathetic lesions to the iris sphincter.
Pilocarpine
46
Pilocarpine is used to treat glaucoma and dry eye that is due to neurogenic causes.
FALSE. Uncommonly used to treat either
47
Indirect acting parasympathomimetics that increase uveoscleral drainage for up to 48 hours
Demecarium and Physostigmine
48
Indirect acting parasympathomimetic uncommonly used as a glaucoma preventative
Demecarium
49
Indirect acting parasympathomimetic that readily crosses the BBB
Physostigmine
-Not commonly used systemically, be cautious of the amount of systemic absorption in small patients
50
Indirect acting parasympathomimetic that causes miosis that lasts for a long time (>12 hours)
Echothiophate
51
Will cause paralysis of the iris sphincter muscle and ciliary body -- leading to potent mydriasis
Blocking the PSNS
52
Direct acting parasympatholytic that causes mydriasis and cycloplegia. Onset of ~1hr which can last 120+ hours
Atropine
53
Direct acting parasympatholytic that basically acts the SAME way as Atropine but has a faster onset (~15-30 mins) and shorter duration (~3-12 hours)
Tropicamide
54
Used as a mydriatic/cycloplegic to reduce pain associated with uveitis and may be used to break up/prevent synechiae when there is inflammation of the eye
Atropine
55
Cycloplegia is a major issue in what species?
Horses
56
What can be the issue with giving atropine to cats?
Bitter taste
57
Tropicamide is less bitter than atropine but still may cause hypersalivation in cats
TRUE
58
Atropine and Tropicamide should be used in primary glaucoma
Figgity figgity FALSE
59
These drugs also cause decreased production of aqueous humor (by reducing cAMP levels) and are sometimes used for that purpose as adjunct therapy in the management of glaucoma
Adrenergic agents
60
Direct acting a1 agonist that will cause mydriasis in the dog but can take some time to do so and is not very effective for pupil dilation in cats, horses, or cattle. It is used perioperatively for some surgeries to reduce local bleeding (vasoconstriction) and used sometimes in the diagnosis and localization of sympathetic lesions.
Phenylephrine
61
Nonselective beta-adrenergic antagonist thought to inhibit cAMP production leading to decreased aqueous humor formation, though there may also be some effect on Na/K/ATPase which also
reduces aqueous production. Often used in the chronic management of glaucoma. May cause miosis but not potent. Bradycardia could be seen if there is sufficient systemic absorption
Timolol
62
These block the carbonic anhydrase enzyme which results in decreased formatin of bicarbonate in the non-pigmented ciliary epithelium
Carbonic anhydrase inhibitors
63
Can be used topically or systemically in the management of glaucoma, however topical usage will reduce the potential for systemic adverse effects.
Carbonic anhydrase inhibitors
64
This CAI is effective in dogs and cats (less so in horses). It may cause more stinging than brinzolamide
Dorzolamide
65
This CAI is not effective in cats
Brinzolamide
66
These agents are analogs of Prostaglandin F which very selectively stimulate Prostaglandin F receptors in the eye to increase uveoscleral outflow of aqueous which reduces IOP. Very potent in reducing IOP in dogs but have questionable efficacy in cats and horses. Qork rapidly (within 30-120 minutes) and are synergistic with other anti-glaucoma medications. Adverse effects include miosis, so they should not be used in anterior lens luxation. Prostaglandins may exacerbate ocular inflammation.
Prostaglandin analogs
67
The most commonly used prostaglandin analog
Latanoprost
68
Most commonly needed to treat KCS and some immune-mediated corneal diseases
Immunosuppression of the eye
69
Typically the ‘first line’ for treatment of chronic immune-mediated ophthalmic diseases. Act by inhibiting T-lymphocytes. Longterm (or lifelong) therapy may be necessary. Accumulate in the corneal stroma and also penetrate the conjunctiva to be taken up into the lacrimal gland. Cause local immunosuppression so are contraindicated in the face of active infection. Avoid repeated contact with skin (of the person administrating the drug).
Cyclosporine
70
Has the same mechanism but possibly different receptor sites than Cyclosporine and sometimes works from some patients non-responsive to Cyclosporine therapy. Generally reserved as a second-line of therapy.
Tacrolimus
71
Inflammation in the anterior portion of the eye can be reduced with the use of
Glucocorticoids or NSAIDs
72
Provide more potent anti-
inflammatory effects than NSAIDs, however they also are more likely to impair healing and immune response to infection. Should NOT be used in the face of active infection or corneal ulcers. Use with caution in cats who may have chronic herpesvirus infx
Glucocorticoids
-commonly used agents: prednisolone acetate, dexamethasone sodium phosphate and hydrocortisone
73
Penetrates into the anterior chamber and so is better for treating anterior uveitis
Prednisolone acetate
74
Does not penetrate as well and so may be better for treating corneal inflammation
Dexamethasone sodium phosphate
75
Commonly combined in ‘triple antibiotic’ mixtures
Hydrocortisone
76
These drugs work through inhibition of COX-2 but may have some anti-COX-1 activity as wel. Used to treat ocular inflammation, particularly in situations where glucocorticoids are contraindicated.
NSAIDs
77
Two commonly used topical ophthalmic NSAIDs
Flurbiprofen and Diclofenac
78
Rare anaphylactic reaction in some cats to
Polymyxin B or Bacitracin
79
Topical ophthalmic antiviral agent
Gancyclovir
80
Systemic ophthalmic antiviral agent
Famcyclovir
81
Ophthalmic antifungal agent
Natamycin
82
Ophthalmic topical anesthetic, typically used to decrease corneal sensation to allow diagnostic evaluation.
Proparacaine
83
Inhibitor of appetite
Serotonin (5-HT1)
84
Stimulants of appetite
Norepinephrine (alpha-2)
Dopamine (D1 receptors)
GABA (by inhibiting the satiety center)
85
These drugs work by stimulating GABA which inhibits the satiety center to increase appetite, more effective in cats than dogs, generally useful for short term only, and most common side effect is sedation
Benzodiazepines (Diazepam, Midazolam)
86
Diazepam is typically given IV and Midazolam is given IM
TRUE
87
Oral use of this drug can cause idiosyncratic hepatotoxicity in cats
Diazepam
88
Appetite stimulation is observed at sub-hypnotic doses though the mechanism is not well understood but may involved stimulation of GABA and inhibition of 5-HT1. Given IV, provides a very short term increase in appetite.
Propofol
89
Repeated doses of this drug in cats can cause oxidative RBC injury and Heinz body anemia has been observed when it is used daily for >5 days
Propofol
90
Inhibit the satiety center by blocking 5-HT1 receptors
Serotonin antagonists
91
This appetite stimulant is effective in cats, not so much in dogs. Used orally, well absorbed, generally takes 2-3 days to see a response. Most common side effect is sedation.
Cyproheptadine
92
This appetite stimulant is a tricyclic antidepressant that blocks both 5-HT1 and 5-HT2 receptors and also increases NE
centrally. Used in dogs more than cats.
Mirtazapine
93
Drugs that induce emesis
Emetics
94
Drugs that suppress emesis
Antiemetics
95
Dogs have fewer Dopamine and Histamine receptors in the CRTZ, but more alpha-2 and serotonin receptors.
FALSE, cats
96
Receptors in the CRTZ that can stimulate vomiting
Serotonin (5-HT3)
Adrenergic (alpha-2)
Dopamine (D2)
Metabolic (toxins)
97
Most common peripherally acting emetic
Hydrogen peroxide 3%
98
Should you use Hydrogen Peroxide in cats?
Hell nah, higher risk of mucosal damage
99
Cause direct irritation to the oropharynx and gastric lining leading to stimulation of the emetic center and vomiting.
Peripherally acting emetics
100
Stimulate the vomiting center and tend to be more effective than peripheral emetics. Ideally used with toxin ingestion and vomiting needs to occur several times.
Centrally acting emetics
101
Stimulates dopamine receptors in the CRTZ, can be used by all routes (including conjunctival sac), more effective in dogs (efficacy ~10% in cats), overdose can cause respiratory depression but can be reversed by Naloxone
Apomorphine
102
Alpha-2 agonists, more effective emetics in cats because they have fewer dopamine receptors but more alpha-2 receptors than dogs.
Xylazine or Dexmedetomidine
103
Labeled for prevention of motion sickness in dogs (oral) and treatment of acute vomiting in dogs (oral or SC) and cats (SC). The injection stings, can be reduced by refrigeration.
Maropitant citrate
104
Dopamine antagonist that also blocks 5-HT3 receptors (at higher doses) and is also a prokinetic. Generally more potent than other dopamine antagonists like the Phenothizines and is used more commonly. Antagonizes apomorphine induced emesis.
Metoclopramide
105
Act on serotonin receptors centrally and peripherally, initially used for chemotherapy related nausea, more potent than Metoclopramide, most commonly given as an injectable but oral formulations are available.
Ondansetron
106
The original H2 blocker, has a lower potency than others in this group (H2 blockers) and duration of action may be less. Does not have an effect on GI motility. Also, it inhibits hepatic microsomal enzymes therefore a significant number of drug-drug interactions.
Cimetidine
107
This H2 blocker is more potent than Cimetidine and in canines it acts as a mild prokinetic. Microsomal enzyme inhibition is far less than with Cimetidine so fewer clinically relevant interactions.
Ranitidine
108
This H2 blocker has a similar potency and possibly slightly longer duration than Ranitidine. Does not have any effect on GI motility. Very few drug-drug interactions.
Famotidine
109
More potent than H2 blocker class, raise gastric pH by irreversibly inhibiting the H+/K+/ATPase proton pump which results in decreased hydrochloric acid production
Proton Pump Inhibitors
110
PPI used orally. Prilosec (human formulation) and Gastrogard (equine formulation)
Omeprazole
111
A prostaglandin analog. Increases mucus and sodium bicarbonate secretion, stimulates epithelialization of the mucosa and mucosal blood flow resulting in ulcer healing (COX-1). Used orally to treat NSAID induced gastric ulcers.
Misoprostol
112
A sucrose-aluminum compound, given orally. Binds to the ulcer site and protects it against acid, pepsin and bile. Requires and acidic environment to bind to mucosa. May also stimulate protective prostaglandins and antioxidants and increase mucosal blood flow. Poorly absorbed, acts locally, and has few side effects.
Sucralfate
113
Timing of dosing is important with this drug. It can impair the absorption of other drugs so it's recommended to wait 2 hours after administration before giving other oral medications.
Sucralfate
114
Oral antacids
Aluminum, Magnesium and Calcium salts
115
Inactivates pepsin and binds to bile salts, may stimulate prostaglandins
Aluminum hydroxide
116
All levels of the GIT are muscular and move
True
117
Movement of the gut wall
Motility
118
Time it takes for material to get from point A to point B within the GIT
Transit time
119
Increased GI motility
Acetylcholine (parasympathetic)
Serotonin (5-HT3)
Peptides (motilin)
120
Decreased GI motility
Norepinephrine (sympathetic)
Dopamine (suppresses Ach)
Endorphins (opioids)
121
It stimulates gastric motility and relaxes the pyloric sphincter (improved gastric emptying), peristalsis in the duodenum and jejunum (improved intestinal transit time) as well as increasing LES pressure. It has minimal effect on colonic motility. Commonly used in small animals. Relatively short duration of action
Metoclopramide
122
5-HT4 receptor agonist in enteric neurons to indirectly increase parasympathetic input. Also block dopamine, but to a lesser extent than metoclopramide does. Available by compounding and has a prokinetic effect on all parts of the GI tract, including the colon in equines. It is often used to treat megacolon in cats. Does not stimulate GI secretions.
Cisapide
123
H2 receptor antagonist and also has some cholinergic activity – most clinically apparent in the canine. Stimulate GI motility, increase LES tone and gastric emptying, and increase intestinal and colonic motility.
Ranitidine
124
Used in humans and has been investigated in equines for reducing postoperative ileus.
Lidocaine
125
Diarrhea is associated with hypomotility
False, hypermotility
126
These opioid drugs work on central and peripheral opioid receptors to inhibit propulsive motility, increase segmental motility, decrease intestinal secretion and inhibit the defecation reflex. Used in acute and sometimes chronic, nonspecific diarrhea. Should NOT be used in diarrhea due to bacterial causes.
Diphenoxylate and Loperamide
127
This anti-diarrheal opioid has a faster onset, longer duration of action and greater efficacy
Loperamide
128
This anti-diarrheal opioid crosses the BBB and thus has more side effects
Diphenoxylate
129
These compounds are not absorbed systemically, they coat and protect the GI mucosa or physically bind with toxic compounds locally in the gut lumen.
GI protectants and adsorbents
130
Commonly used nonspecific GI protectants/coating agents
Magnesium trisilicate and hydrated aluminum silicate
131
A special adsorbent use frequently in toxicosis. Comes with or without sorbitol
Activated charcoal
132
Possesses antimicrobial, anti-secretory and anti-inflammatory processes. Can cause toxicity in cats. Use of this drug will turn the patient's stool very dark.
Bismuth subsalicylate
133
These drugs promote defecation by increasing the frequency of defecation or the fecal volume, or by changing the consistency.
Laxative and cathartic drugs
134
Acts as mechanical or lubricant laxatives, or fecal softeners. Mineral oil and Laxatone are examples
Emollient laxatives
135
These absorb water and swell, stimulating reflexive peristaltic movement in the GIT. Psyllium and prunes are examples
Simple bulk laxatives
136
These are nonabsorbed or poorly absorbed compounds that attract water into the intestinal lumen by osmotic pressure and reflexively stimulate peristaltic activity. Sugar alcoholas (sorbitol) and polyethylene glycols (GoLYTELY) are examples
Osmotic cathartics
137
These irritate the GI mucosa an stimulate peristaltic activity and increased secretions. Bisacodyl is an example
Irritant cathartic
138
This extends the colon and can initiate the defecation reflex, it also introduces fluids to mix with the stool present in the colon. Plain warm water is an example
Enemas
139
This type of enema should NOT be used in cats
Phosphate-containing enema
risk of toxicity
140
Four steps of the nociception (pain) pathway
Transduction (peripheral tissue)
Transmission (via peripheral nerves)
Modulation (in the spinal cord)
Perception (in the brain)
141
Cause reversible blockade of transmission in peripheral nerves or spinal cord, usually to stop pain signals
Local anesthetics
142
Most commonly used local anesthetic in veterinary medicine. Used as a LA and also systemically. Banned in Europe for food producing animals. Rapid onset (~5 min) and medium duration (~40-60 min) (longer duration if given with epinephrine). Cats are more sensitive than dogs, sheep may be more sensitive than other livestock.
Lidocaine
143
Systemically used as a Class 1B antiarrhythmic, a CRI as an adjunctive analgesic, and as a CRI for GI prokinetic/anti-inflammatory (to treat/prevent post-op ileus in horses)
Lidocaine
144
Frequently used LA for local infiltration, nerve blocks, and epidurals. Potent with a slow onset (~20 min), duration up to 8 hours. Most cardiotoxic of the LAs
Bupivacaine
145
Used for diagnostic nerve blocks in horses. Similar to lidocaine but less irritating.
Mepivacaine
146
Won't be used as a LA but it is in some Penicillin G preparations. Toxic, can cause CNS stimulation -- excitement, seizures. Don't give IV.
Procaine
147
Used topically (ophthalmic formulation), allows for corneal & conjunctival manipulation. Rapid onset (~30s) and short duration (~10-20 min)
Proparacaine
148
These prevent inflammation by inhibiting cyclooxygenase (COX) enzymes (and are not steroids)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
149
NSAIDs are weak bases
N to the O!
They are weak acids
150
Constitutive, physiologic production of prostaglandins that play an important role in normal homeostasis.
COX-1
151
Inducible, prostaglandins produced during inflammation.
COX-2
152
Involved with GI mucosal maintenance & vasodilation in kidney in response to decreased blood flow.
PGE 1
153
For routine analgesia/anti-inflammatory uses which COX is generally preferable?
COX-2 selectivity
154
Should you use NSAIDs and steroids together?
No! Don't be stupid, make good choices.
155
Generally good absorption PO or IM. Highly protein bound (95-99%). Provide analgesia whether inflammation present or not.
NSAIDs
156
Large animal NSAID. Given PO, IV, IM (?). Labeled only for IV use in cattle, IM in swine. Muscle necrosis has been reported with IM administration, do NOT use IM in equines. Don't use in small animals. Used more so for visceral pain.
Flunixin Meglumine
157
Used commonly in horses, banned in dairy cattle. Tends to be used for musculoskeletal pain. Give PO or IV but do NOT give IM/SC (very irritating, sloughing/necrosis can be seen). Can mask lameness - withdrawal time may be required for racing animals.
Phenylbutazone ("Bute")
158
Preferential COX-2 NSAIDs
Carprofen
Meloxicam
Deracoxib
159
Commonly used in small animal medicine as analgesics and anti-inflammatory agents. Available in a variety of oral options and injectable.
Deracoxib
160
Approved for SINGLE injection use in cats
Meloxicam
161
Selective COX-2 NSAIDs
Firocoxib and Robenacoxib
162
Oral paste for horses, chewable tablets for dogs
Firocoxib
163
The first NSAID approved for multiple doses in cats
Robenacoxib
164
Generally greater COX-2 selectivity will have fewer adverse effects
True dat
165
If changing from NSAID to steroid
Sufficient washout period (typically 1-2 weeks)
166
If changing from steroid to NSAID
Will need to wean the steroid, then have minimum 1 week washout period
167
If changing between two different NSAIDs
Should still have washout – based on half-life or use a conservative default of 1 week.
168
Weak μ agonist (opioid) but also serotonin and NE reuptake inhibitor, M1 antagonist . Generally used as an oral analgesic. May lower seizure threshold, avoid in epileptic patients.
Tramadol
169
NMDA antagonist sometimes used as an adjunctive analgesic in small animals. Also an oral drug.
Amantadine
170
Sometimes used for control on neuropathic pain. MoA involves altering calcium influx in neuronal cells. May cause sedation/ataxia, frequent dosing required. Do not use human oral liquid in dogs (contains Xylitol)
Gabapentin
171
Anti-inflammatory & chondroprotective agents. Generally low toxicity, efficacy not always proven.
Glucosamine chondroitin
Polysulfated glycosaminoglycans (PSGAGs)
Pentosan polysulfate
Omega-3 fatty acids
172
Induces a state of behavioral change wherein anxiety is relieved and the patient is relaxed although aware of their surroundings.
Tranquilizer
173
Induces a state characterized by CNS depression and
| drowsiness, decreased awareness of surroundings.
Sedative
174
Induces sleep
Hypnotic
175
Induces stupor bordering on general anesthesia
Narcotic
176
Loss of sensation in a circumscribed body area.
Local/Regional anesthesia
177
Drug-induced unconsciousness characterized by controlled, reversible depression of the CNS with analgesia. The patient cannot be aroused. Sensory, motor and autonomic reflexes are reduced.
General anesthesia
178
Drugs that dissociate the thalamocortic and limbic systems resulting in a catatonic state where the eyes remain open and swallowing reflexes remain functional. Skeletal muscles maintain tone.
Dissociative anesthesia
179
Main inhibitory neurotransmitter
GABA
180
Ryanodine receptor antagonist, inhibits calcium release from the SER to cause muscle relaxation - does not generally affect respiratory muscles. Used for treatment of malignant hyperthermia primarily. Injectable is not compatible with saline of D5W.
Dantrolene
181
Centrally acting muscle relaxant (on the spinal cord) labeled for use in equines, used off-label in cattle. Used as an injectable, typically as a 5% solution for IV infusion. Onset of action is ~2 min and duration of action is 10-20 min. Depresses nerve impulses in the spinal cord, brainstem, and subcortical areas of the brain to cause centrally mediated generalized muscle relaxation, sedation +/- analgesia.
Guaifenesin (GG/GGE)
182
If >10% solution is used thrombophlebitis and/or hemolysis can be seen.
Guaifenesin (GG/GGE)
cattle are more sensitive to hemolysis than horses
183
Centrally acting muscle relaxant, chemically similar to Guaifenesin - works on the spinal cord. Approved for dogs, cats and horses. Generally not used with anesthesia, typically used to reduce muscle spasms. Adjunct therapy for medical management of IVDD and supportive therapy for tremorgenic toxicoses.
Methocarbamol
184
Used primarily in veterinary medicine for sedation but a few drugs in the class are more suitable for other indications. Drugs in this class work primarily as dopamine receptor antagonists.
Phenothiazines
185
Good sedation, moderate muscle relaxation, NO analgesia, and hypotension is a potential effect.
Phenothiazines
186
Epinephrine stimulates α1, α2, β1 and β2 so if α1 is blocked then β2 mediated vasodilation is unopposed leading to hypotension. What is this called?
Epinephrine reversal
187
Dogs with ABCB1 gene mutation may have a decreased response and shorter duration of effect with phenothiazines.
False. They have a pronounced response with a longer duration of effect.
188
Phenothiazines have a low oral availability in dogs (~20%)
True
189
The most important phenothiazine for the purposes of sedation. Frequently used along with opioids for restraint or anesthetic premedication. Hypotension is the predominant adverse effect, boxers are particularly sensitive to the CV effects and is not approved for use in food animals.
Acepromazine
190
Acepromazine provides analgesia
False - provides NONE
191
Potentiate GABA receptors. Bind to and activate benzodiazepine binding site on GABAa receptors to cause hyperpolarization of neurons.
Benzodiazepines
192
Mild sedation (can potentiate other drugs), good muscle relaxation, NO analgesia, minimal cardiorespiratory effects at normal doses. Used as an anxiolytic, an anticonvulsant, and an appetite stimulant.
Benzodiazepines
193
Prototypical benzodiazepine. High amount of propylene glycol so it should not be given IM (causes pain). Commonly used in anesthetic premedication or induction, also used for control of seizures (not chronic management). Avoid oral use in cats.
Diazepam
194
IM version of diazepam
Midazolam
195
Human approved benzodiazepine. Has a longer duration of action and hasn't been associated with hepatic necrosis when given orally to cats.
Alprazolam
196
Zolazepam
Benzodiazepine
197
Reversal agent for benzodiazepines as a class.
Flumazenil
Not common that we need to reverse these drugs
198
Commonly used in both large and small animal veterinary medicine. Act by agonizing a2 adrenergic and nonadregenergic receptors.
Alpha-2 agonists
199
Very good sedation, good muscle relaxation, MILD analgesia, biphasic CV effects, mild respiratory depression (more issues in sheep) and can be used as an emetic in cats.
Alpha-2 agonists
200
Humans can experience profound hypotension if inadvertently exposed to veterinary alpha-2 agonist drugs
True
201
Ruminants are more sensitive than small animals, equines and swine are the least sensitive.
Xylazine
202
Most commonly used alpha-2 agonist for small animals.
Dexmedetomidine
203
Used in equines and cattle. Available as a sublingual gel for horses. May produce less profound sedation and be more suitable for standing procedures in large animals.
Detomidine and Romifidine
204
Used to reverse the effects of alpha-2 agonists. Reversal with reverse ALL of the effects, including analgesia.
Alpha-2 antagonist
205
The antagonist should be roughly matched to the agonist used.
True
206
Less selective for a2:a1 and used when needed for reversal of xylazine
Yohimbine
207
Highly selective for a2:a1 and is used to reverse dexmedetomidine
Atipamezole
208
Agonists at opioid receptors (anything that can be displaced by naloxone)
Opioid
209
Naturally occurring drugs (alkaloids) extracted from opium
Opiates
210
Stupor bordering on general anesthesia
Narcosis
211
Combination of a sedative with an analgesic (opioid) which results in synergistic effects
Neuroleptanalgesia
212
Activate μ-opioid receptors completely
Full μ agonists
213
Activate some opioid receptors, but not completely
Partial agonists
214
Activate some opioid receptors and block others
Mixed agonist-antagonists
215
Block all opioid receptors
Full antagonists
216
Not a lot of sedation by themselves, not a lot of muscle relaxation, GREAT analgesia, respiratory depression effect.
Opioid agonists
217
Excitation, sweating, rigidity, coma, and seizures
Serotonin syndrome
218
Prototypical analgesic, onset 5-15 mins and last several hours, used in epidurals. Risk of histamine release, especially in dogs with IV use.
Morphine - full μ agonist
219
Less histamine release, used IV in place of morphine, similar onset and duration as morphine
Hydromorphone - full μ agonist
220
Potent, onset ~ 1 min and lasts ~30mins so suitable for CRI administration, available as a transdermal
Fentanyl - full μ agonist
221
Very potent (4000-10,000x morphine). Used in wildlife, specialized training required and must have antagonists on-hand
Carfentanil/Etorphine - full μ agonist
222
Semisynthetic partial μ agonist, will not see as much analgesia as a full μ agonist. Less apparent negative effects. Slower onset (~45 mins) and longer duration (up to 8 hours in cats) than morphine. More useful than other opioids for at-home analgesia, especially in cats where other options are limited.
Buprenorphine
223
Synthetic κ agonist and μ antagonist. Approved as analgesic in cats, dogs, and horses and as antitussive in dogs. One of the more commonly used opioids in equine, used in SA to ‘partially’ reverse a full mu agonist.
Butorphanol
224
Used to reverse the effects of opioids
Pure antagonists
225
Competitive receptor antagonist used for reversal of opioid-
induced adverse effects. Rapid onset (minutes) and short duration (1-2h) - repeated doses may be needed until the opioid is gone. Will reverse the analgesic effects as well!
Naloxone
226
Semisynthetic opioid, used orally as an antitussive. Human formulations may contain other drugs.
Hydrocodone
227
Pros of injectable anesthetics
Rapid onset of anesthesia
Rapid control of the airway
IM injection may be possible Minimal equipment
228
Cons of injectable anesthetics
Minimal control over waking Controlled substances
229
What kind of a state do dissociative anesthetics produce?
Catatonic
230
A barbiturate that is an IV anesthetic induction agent but not in North America because of ethical issues
Thipoental
231
IV or oral barbiturate used to control refractory seizures or in seizure management. Sometimes used as a mild sedative.
Phenobarbital
232
Barbiturate used primarily for euthanasia. Can be used to manage refractory seizures
Pentobarbital
233
These potentiate GAGA, creating a dose-dependent CNS depression, and offer full anesthesia, moderate muscle relaxation, NO analgesia. Side effects can be apnea, hypotension and arrhythmias.
Barbiturates
234
Full anesthesia, good muscle relaxation, NO analgesia. Side effects: respiratory depression, hypotension, and apnea on induction. Also used as an anticonvulsant. Will cause myotonia on induction.
Propofol
235
Emulsion containing egg lecithin and soybean oil. One of the few white liquids than can go IV. Once opened must be discarded within 24h.
Propoflo
236
Benzyl alcohol preservative. Once opened stable at room temp for 28 days. Not labeled for cats.
Propoflo 28
237
Given IV only. Metabolism is rapid, allowing for repeated dosing/CRI. Widely distributed to all tissues (lipid soluble drug).
Propofol
238
Neurosteroid which is an analog of progesterone. Does NOT bind to usual steroid receptors. Has similar pharmacokinetics to Propofol.
Alfaxalone
239
It exists. It's great for cardiac patients - for less stable cardiac patients because it has minimal CV or resp suppressant effects.. Can't be used as a CRI because it causes adrenal suppression and contains a lot of propylene glycol.
Etomidate
240
NMDA receptor channel blocker, inhibits activation by glutamate.
Dissociative anesthetics
241
Major dissociative anesthetic
Ketamine
242
Clinical manifestation of abnormal electrical activity in the brain
Seizure
243
Seizures that occur intermittently over months to years
Epilepsy
244
Seizures lasting 5min or longer, 2 or more discrete seizures without full recovery of consciousness in between.
Status epilepticus
245
2 or more seizures over minutes to hours with full recovery in between
Cluster seizures
246
First line for stopping a seizure because of high lipophilicty and rapid brain penetration. The most commonly used drug in this class to do so?
Benzodiazepines -- Diazepam
247
Potentiates GABA receptors. Long-acting barbiturate; controlled drug. Cytochrome p450 induction. Best choice drug for dogs and cat.
Phenobarbital
248
A salt/chemical available as a powder with an unknown MOA but raises seizure threshold by competing with Cl- transport. Must use loading dose or it will take 8-9 weeks to reach effective levels. Avoid in cats (asthma) and not metabolized by liver – good for patients with hepatopathies.
Bromide
249
Pyrrolidine derivative with an unknown MOA. Can be used as primary AED or add-on. Very safe with few side effects but expensive.
Levetiracetam
250
Sulfonamide-base, dogs on enzyme inducers require 2x dosage, rapid CNS penetration, tolerance may develop.
Zonisamide
251
Sympathetic GABA analog. Potentiates GABA; blocks Na channels. Usually used as an add-on, frequent dosing, oral solution contains xylitol (toxic in dogs) and sedation/ataxia with high doses.
Gabapentin
