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Anesthesia Exam 3 > Management of Pain in Animals > Flashcards

Management of Pain in Animals Flashcards

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1
Q

what is the definition of pain?

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

the pain response involves 2 components. what are these?

A
  1. sensory component: nociception
  2. affective component: pain perception
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3
Q

what is the sensory component of pain?

A

nociception

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4
Q

what factors are reported to worsen pain conditions?

A

anxiety, stress, depression, anger, fatigue

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5
Q

what is the pain emotional aspect hypothesis?

A

a decrease in endogenous production of natural analgesics (ex descending inhibition)

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6
Q

what are your goals with general anestehsia?

A

unconsciousness
immobilization
relaxation
safety (patient and personnel)
analgesia

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7
Q

what is the first thing you want to investigate when managing a patient who is in pain?

A

determine the patient pain status and its potential etiology during PE (4th vital sign)- ie is it stress, anxiety, etc

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8
Q

how do you score pain in a patient?

A

pain score system

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9
Q

what is pre-emptive analgesi

A

analgesia provided BEFORE the painful stimulus occurs. it has the potential to be more effective than a similar analgesia treatment aftery surgery

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10
Q

what premedication-sedation drugs are commonly used with pre-emptive analgesia?

A

1.alpha 2 agonists
2. acepromazine (not an analgesic- but ace helps to decrease emotional component: anxiety, stress, etc which decreases pain severity)
3. opioids
4. benzodiazepines (not an analgesic)
5. NSAIDs

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11
Q

what meds commonly used with pre-emptive analgesia are NOT analgesics?

A

acepromazine + benzodiazepines

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12
Q

T/F: benzodiazepines have a decent spectrum of analgesia

A

false- benzos do not have analgesic properties

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13
Q

do anticholinergics increase or decrease HR?

A

increase HR

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14
Q

do anticholinergics dilate or constrict the airways?

A

dilate

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15
Q

a rodeo bull comes in for a hairline fracture treatment. what do you give for pre-medication and analgesia?

A

alpha 2 agonist: xylazine

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16
Q

what alpha 2 agonists are commonly used in LA?

A
  • dexmedetomidine
  • medetomidine
  • detomidine
  • romifidine
  • xylazin
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17
Q

what alpha 2 agonists are commonly used in SA?

A
  • dexmedetomidine
  • medetomdine
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18
Q

alpha 2 agonists in equine med

A

BEST FRIEND OF DRUGS! used alllll the time. essentail for equine sedation and analgesia

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19
Q

what are oral-transmucosal dexmed alpha 2 agonists?

A

sileo + OTM-DM

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20
Q

characteristics of alpha 2 agonists

A
  • potent sedative, anxiolytic and analgesic group of drugs
  • most common sedative-analgesic drugs used in emerg procedures in both SA and LA
  • essential for equine!!
  • alpha 2 agonists are short acting (20-60mins)
  • CAUSES SIGNIFICANT CV DEPRESSION!! BE CAREFUL!!
  • can be used basically any route
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21
Q

what is the downside with alpha 2 agonists?

A

they cause SIGNIFICANT CV depression
also are short acting (20-60 min)

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22
Q

common opioids

Study These Flashcards
A

morphine
hydromorphone
oxymorphone
methadone
fentanyl
buprenorphine
butorphanol
nalbuphine

23
Q

opioids characteristics

Study These Flashcards
A
  • potent analgesics, some can induce sedation
  • can cause nausea, dysphoria, delirium, GIT stasis: careful in LA!!
  • any route depending on drug properties
  • analgesic is variable in vet pts depending on species and indv response
24
Q

what side effects are seen with opioids?

Study These Flashcards
A

can cause nausea, dysphoria, delirium, GIT stasis: careful in LA!!

25
NSAIDS characteritics
- anti inflammatories and analgesics for both SA and LA - most common analgesics used in vet med - can predispose to renal dz, GIT ulcerations, liver dz - cats: meloxicam and robenacoxib - COX enzyme specificall
26
what are the most common analgesics used in vetmed?
NSAIDSw
27
what NSAIDS are approved in cats?
meloxicam and robenacoxib
28
how do NSAIDS work?
COX enzyme specifically tissue injury --> phospholipids --> arachidonic acid --> COX 1 or COX 2
29
COX 2 NSAIDS
- inflammatory prostaglandins: recruit inflamm cells, sensitize skin pain receptors, regulate hypothalamic temp control
30
COX 1
- cytoprotective prostaglandins - protect gastric mucosa - aid platelet aggregation
31
grapiprant
galliprant
32
galliprant (grapiprant)
- NSAID variation with different mechanism of action - blocks prostaglandin EP4 receptor, NOT COX enzymes - only approved for adult dogs weight more than 9 lbs with osteoarthritis - similar effect and complications to NSADSi but need more info
33
how does galliprant work?
blocks prostaglandin EP4 receptor, NOT COX enzymes
34
what animals is galliprant used in?
only approved for adult dogs weight more than 9 lbs with osteoarthritis
35
what is balanced anesthesia?
technique based on concept that administration of mixture of small amounts of several neuronal depressants summates the ADVANTAGES but not the disadvantages of individual drugs
36
what are advantages of balanced anesthesia?
- reduce amt of resp and CV depression drugs - prevent hypotension - prevent poor tissue perfusion and low DO2 - prevent hypoventilation - improved analgesia - considers pre-emptive analgesia
37
what drugs should you include with your GA protocol?
systemic analgesic drugs
38
what are examples of systemic analgesic drugs?
- opioids (hydro or methadone ex) - fentanyl CRI - ketamine CRI - lidocaine CRI - dexmed CRI using CRI to maintain adequate plasma concentration of the drug since some of them are short acting
39
T/F: with regional analgesia included with a GA protocol, you will have rare CV and resp depression
true
40
a dog presents with severe fractures of the radius and ulna. the dog is very painful and you want to make sure you give the best analgesia and anesthesia. what might you do to ensure this happens?
block the brachial plexus! regional analgesia
41
what is a Bier block?
- regional intravenous analgesia (lidocaine) - distal extremity limb and digital lesions/procedures - preferred for toe amputations: no bleeding, which makes surgery faster and cleaner - common procedure for hand surgery in humans
42
when is a Bier block indicated?
- distal extremity limb and digital lesions/procedures - preferred for toe amputations: no bleeding, which makes surgery faster and cleaner - common procedure for hand surgery in humans
43
what are non-pharmacological help methods for balanced analgesia?
- distraction - cutaneous stimulation - cold applications (numb nerve endings, but very superficial. a lot of pts don't like this tho) - splint and dressings: to immobilize an area that is in pain - minimize tissue trauma - cat burrito - ear twitch (horses and cats) - nose twitch (horses) - food (distraction for swine and cattle)
44
what is a good distraction for doing a painful procedure in swine and cattle?
food! ex a cow c section given alfalfa will be pretty happy
45
what drugs are commonly used to manage acute pain?
- opioids - alpha 2 agonists - ketamine - lidocaine - NSAIDS - gabapentin (oral) - tramadol (oral) - maropitant: treats nausea
46
why would you give lidocaine IV for acute pain?
it gives weak systemic analgesia and decreases MAC
47
allodynia
stimulation that was not painful is now painful. ex: sunburn now painful
48
for inflamm process, what drugs will you choose
antiinflammatory: NSAIDS, steroids etc
49
for neuropathic pain, what drugs will you choose?
gabapentin, amantadine
50
visceral pain: what drugs might you choose?
antiemetics and anti nausea drugs like maropitant
51
what other pharmocologic factors can help improve chronic pain?
exercise and emotional support: massages, walks, etc. improves blood flow and lymphatic flow to help reduce inflammation
52
what are alternative treatment options for pain management?
- physiotherapy - massage - acupuncture - homeopathy - nutraceuticals - general health: physical and mental - need adequate sleep!!
53
anxiolytic drugs
trazodone, alprazolam, acepromazine
54
anti-depressants
amitriptyline, fluoxetine

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