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Anesthesia (SAB) > Lecture 12: Adjunct Drugs & Interactions (Exam 2) > Flashcards

Lecture 12: Adjunct Drugs & Interactions (Exam 2) Flashcards

1
Q

What are adjunct drugs to anesthesia & analgesia

A

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

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2
Q

Describe balanced anesthesia

A

Simultaneous use of multiple drugs & tech to produce anesthesia

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3
Q

Describe multimodal analgesia

A

Using 2 or more different drugs or techniques to manage pain

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4
Q

What can be given to limit nausea & vomiting? What can it lead to?

A
  • Antiemetics
  • May lead to aspiration pneumonia
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5
Q

Describe maropitant (cerenia)

A
  • Neurokinin-1 receptor antagonist
  • Often used for motion sickness
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6
Q

What are the perioperative period benefits of maropitant

A
  • Reduced incidence of vomiting from certain premed drugs
  • Improvement in recovery quality & a faster return to feeding
  • Potential MAC lower effects when admin as a CRI
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7
Q

What can happen if maropitant is given IV instead of SQ

A
  • Faster onset
  • Potential for hypotension
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8
Q

T/F: Maropitant prevents gastoesophageal reflux (GER)

A

False it does not

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9
Q

Who is generic & other formulation of maropitant FDA approved for

A

Use in dogs older than 4 M for motion sickness & acute vomiting

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10
Q

What is a common side effect of generic & other formulations of maropitant

A

Excessive drooling

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11
Q

Describe vomiting

A
  • Forceful ejection of stomach & upper intestinal contents
  • Can contain yellow bile or partially digested dog food
  • Usually smells sour & involves heaving
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12
Q

Describe regurgitation

A
  • Mild ejection of undigested food from the esophagus
  • Does not involve abdominal heaving
  • Tends to happen just after eating
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13
Q

Describe Ondansetron

A
  • 5HT3 receptor antagonist
  • Antiemetic that works @ the level of the vomiting center in the brain particularly useful for prevention of vomiting due to chemotherapy drugs or from anesthetic drugs that induce vomiting
  • Ava in tablet form, oral solution, & injectable solution
  • Less effective than maropitant in prevention of vomiting but oral admin can reduce incidence of nausea
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14
Q

Describe metoclopramide

A
  • Block dopamine D2 receptors in chemoreceptor trigger zone & also blocks serotonin receptors to contribute to antiemetic effects
  • Prokinetic effects reduce the amount of gastric fluid via increasing the rate of gastric emptying
  • Increase lower esophageal sphincter tone
  • May increase CNS depressant effects of anesthetic drugs
  • Do not give if there is a GI obstruction suspected, hx of seizure, or pheochromocytoma is present
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15
Q

Describe histamine receptor antagonists

A
  • Given to decrease acid production in the stomach
  • H2 antagonists such as famotidine or ranitidine
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16
Q

When is diphenhydramine commonly given

A

Prior to mast cell tumor removal to competitively counter the effects of histamine (H1 antagonist)

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17
Q

Describe proton pump inhibitors

A
  • Decrease gastric acid production by irreversibly blocking H+/K+ATPase
  • Omeprazole & pantoprazole are most commonly used
  • Long-acting drugs
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18
Q

What is the effect of NSAIDs on MAC

A

They have a sparing effect

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19
Q

When should NSAIDs be given

A

Give them postoperatively in case of hypovolemia or hypotension occurs during anesthetic period, leading to decreased renal blood flow

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20
Q

Describe glucocorticoids

A
  • Never give concurrently w/ NSAIDs
  • Used for anti-inflammatory, analgesic, immunosuppressive, & for physiologic support of Addisonian px
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21
Q

What antibiotics are used w/ anesthesia

A
  • Cefazolin
  • Unasyn (ampicillin/sulbactam)
  • Gentamicin
  • K-pen
  • PPG
  • Naxcel
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22
Q

How should cefazolin be given

A

In an IV slowly over 5 min

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23
Q

How should unasyn be given

A

IV slowly over 15 - 30 min

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24
Q

How should gentamicin be given

A

IV & administered slowly

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25
How should K-pen be given
IV slowly
26
How should PPG not be given
IV
27
What animals is Naxcel used on
Food animals
28
Describe aminocaproic acid
* Anti-fibrinolytic agent * Can be given to greyhounds to decrease postop bleeding by enhancing clot formation & increasing clot strength * Oral or injectable formulas * Give slowly IV after diluting in saline to prevent CV effects
29
What breed of dogs have a higher than norm rates of bleeding 24 - 48 H post op
Greyhounds
30
Describe Desmopressin
* Hormone given to temporarily increase von willebrand factor in dogs w/ a deficiency prior to surgery * Promotes vWf secretion from endothelium storage sites * Desmopressin is a synthetic replacement for vasopressin (a hormone that reduces urine production) * A nasal spray typically * Expensive
31
Describe Dantrolene
Peripherally acting muscle relaxant (works on skeletal muscle but can cause cardiac depression)
32
What is the MOA of Dantrolene
Ryanodine receptor antagonism -> reducing Ca2+ release from the SR into the cytoplasm
33
What is the indication of Dantrolene
For the tx & prevention of malignant hyperthemia & exertional rhabdomyolysis
34
Describe Doxapram
* CNS stimulant * Arousal from sedation/anesthesia (controversial), stimulation of respiration in neonates, & the assessment of laryngeal function (dogs & horses)
35
What is the MOA of Doxapram
Likely due to both central & peripheral effects -> increased activity of the respiratory nuclei of the medulla (significant increase in minute ventilation through an increase in RR & tidal vol)
36
What can an increased dosage of Doxapram lead to
Convulsions due to cortical stimulation
37
Describe Guaifenesin (aka GG)
* Central acting muscle relaxant w/ sedative properties * Likely works both in the brain & the spinal cord * Co-administered w/ IV anesthetics in horses & ruminants to induce & maintain anesthesia * No known analgesic properties * Wide therapeutic margin w/ mild cardiorespiratory effects
38
Define lidocaines
An amide local anesthetic drug used to provide locoregional analgesia & also used systemically to treat ventricular arrhythmias
39
What effects does lidocaine have
* MAC sparing * Anti-inflammatory * Analgesic * Prokinetic effects on the GI tract by stimulating intestinal motility
40
T/F: Lidocaine is not typically used in cats as a CRI due to potential toxicity
True
41
What does Lidocaine CRI treat in equine
* Ileus - stimulates intestinal muscle contraction (in vitro) + analgesia * Impactions * Duodenitis-jejunitis * Inflammation (preserves microvascular integrity, prevents neutrophil migration, & inhibits cytokine production)
42
How long is lidocaine CRI given
For 1 to 3 D
43
What are the signs of lidocaine toxicity
* Muscle fasicuulations * Weaknes * Recumbency When lidocaine is discontinued imm signs will quickly disappear
44
Describe a ketamine CRI
* NMDA receptor antagonist given as an intraoperative CRI binds @ the CNS receptors & prevents "wind up" * Best used to manage neuropathic types of pain (esp if the pain is chronic & the px has not responded well to other analgesic options) * Always combine w/ an opioid &/or lidocaine infusion
45
What opioids can be used for an opioid CRI
* Fentanyl * Remifentanil * Morphine * Hydromorphone * Butorphanol * Buprenorphine
46
How is an opioid CRI done
* Typically a loading dose is given first followed by the CRI * The drug is diluted in fluids & admin in a syringe pump or as part of the IVF given during during anesthesia (recommend an IV fluid pump over a free drip rate)
47
T/F: Morphine-lidocaine-ketamine (MLK) lowers the MAC of Isoflurane by at 48%
True
48
How is a MLK made
* In a 500ml bag of fluid @ 5ml/kg/hr add 24 mg of Morphine, 60 mg of ketamine (100mg/mL), & 300mg of Lidocaine (20mg/mL)
49
What will inhibit concious perception
* General anesthetics * Opioids * Alpha 2 agonist
50
What inhibits spinal cord sensitization
* Opioids * NSAIDs * NMDA antagonists * Alpha 2 agonists * Local anesthetics
51
What inhibits transmission along the peripheral nerves
*local anesthetics * Alpha 2 agonists
52
What inhibits nociceptor/painful stimulus?
* Local anesthetics * Opioids * NSAIDs
53
Calculate the following:
https://ivapm.org/professionals/cri-calculator/
54
What are some additional analgesic adjuncts
* Gabapentin * Pregabalin * Tramadol * Amantadine * Amitriptyline * Acetaminophen * Localregional anesthesia * Dexmedetomidine CRI
55
What pharmaceutical interactions can occur in vitro (syringe or vial)
* Drug precipitate * Toxic product * Inactivate one of the drugs * Acid-base interactions * Chemical incompatibilities
56
What PK & PD can be affected by in vivo drug interactions
* Absorption * ABCB 1 * Hepatic clearance * drug protein binding
57
What is the MDR1 gene mutation (ABCB1)
Some herding-breed dogs have a single mutation in a gene for a protein (p-glycoprotein) that drastically affects absorption, distribution, metabolism, & excretion of drugs
58
What is the P-glycoprotein
* An important part of the blood-brain barrier * Protects the body from toxic accumulations of substances
59
What drugs are affected by the MRD1 gene
* butorphanol * Acepromazine
60
Why does knowing if a dog has a MDR1 gene mutation matter
* Dog w/ this mutation may have more serious side effects such as CNS &/or respiratory depression from certain anesthetic drugs * Recovery may take longer & px may still appear sedated long after drugs should have norm worn off * Generally recommend reducing the norm dose by 25-50% in dogs that are homozygous for the mutation
61
What is incompatible w/ diazepam
* Precipitation will occur w/ aques solutions & significant absorption into soft plastic w/in 24 H * Heparin flush
62
What drugs are incompatible w/ alkaline solutions
* Epinephrine * Dobutamine * Dopamine
63
What is incompatible w/ phenylbutazone
Aqueous solutions
64
What should not be mixed w/ sodium bicarbonate
W/ solutions that contain calcium b/c precipitation may occur
65
Define addition
Simple additivity of fractional doses of two or more drugs
66
Define synergism
Response to fractional doses is greater than the response to the sum of the fractional doses
67
Define potentiation
Enhancement of action of one drug by a second drug that has no detectable action of its own
68
Define antagonism
Opposing action of one drug toward another
69
Define competitive antagonism
drugs that compete for the same receptor site
70
Define noncompetitive antagonism
Drugs act via different receptors

Anesthesia (SAB) (17 decks)

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