Pain Management Lecture Flashcards
(48 cards)
1
Q
Treatment for cat diagnosed with pancreatitis and Stage 1 CKD (lower creatinine, non-proteinuric, nonhypertensive) with low to moderate pain score
A
- Cerenia
- Gabapentin
2
Q
Conservation of pain pathway
A
- Physiology of sympathetic nerve stimulation and adrenocortical axis is largely the same for humans and animals
3
Q
Types of pain
A
- Somatic, visceral, neuropathic, emotional, acute, chronic
4
Q
Hormones involved in pain mediation
A
- Cortisol and epinephrine (from adrenal medulla)
5
Q
Cortisol and epinephrine for pain in physiologic doses and supra-physiologic and sustained levels
A
- great at physiologic doses (life-saving)
- Supra-physiologic and sustained may have confusing/detrimental effects
6
Q
Cortisol potency
A
- Very potent
7
Q
Cortisol release
A
- Release augmented by trauma, infection, heat/cold, surgery, disease, restraint, injection, epi/norepinephrine
8
Q
Cortisol effects
A
- anti-inflammatory effects
- Stimulates gluconeogenesis
- Decreases glucose utilization in the cell
- Promotes mobilization of FA from adipose tissue
- Promotes AA mobilization from muscle
9
Q
Epinephrine and cortisol
A
- Cortisol potentiates release of epinephrine
10
Q
Epinephrine side effects
A
- ileus (slowing down parasympathetic system)
- Decreased urine output
- Acts on Alpha and Beta adrenergic receptors (mydriasis, tachycardia, hypertension, tachypnea, hyper aware)
11
Q
Pain pathway parts
A
- Transduction
- Transmission
- Modulation
- Perception
12
Q
Traditional origin of pain
A
- Acute occurrences
- Trauma
- Injury
- Post surgical
13
Q
Medical pain
A
- Underestimated
- Chronic, insidious
- Progressive/regressive
- e.g. pancreatitis, gastroenteritis, hepatitis, cholangitis, arthritis, dermatitis, neoplastic
14
Q
Unintentional pain
A
- Brief, temporary
- Discomfort
- Day to day operation of a hospital
- Movement and techniques unrealized
- Sources of unintentional pain: palpation, restraint, catheter placement, injections, shaving/clipper sites, rectal exams, otic/ophthalmic exams, endsocopic evaluations
15
Q
Concurrent diseases to consider with pain dosing
A
- Arthritis, immune-mediated condition, GI disease, liver disease, kidney disease
- Dose reduction or escalation
16
Q
Concurrent medications to consider dose reduction
A
- Corticosteroids
- NSAIDs
- Alternative Immune suppressants
- Serotonin Re-uptake inhibitors
- Maybe if you have a hyperadrenocorticism dog with pain, don’t regulate it as well
17
Q
Acute or adaptive pain
A
- Nociceptive (high-threshold noxious stimuli, e.g. Tissue injury)
- INflammatory (tissue damage produces sensitivity of tissue associated with inflammatory response)
18
Q
Chronic or maladaptive pain
A
- Last 3-6 months in humans
- Central plasticity or central windup: lasts autonomously after stimulus has been discontinued or is sustained with low level nociceptor input from periphery
- NOT protective
- Pathologic pain driven by dysfunction or malfunction of the nociceptive system
- Neuropathic: damage to neural tissue
- Inflammatory
19
Q
Painful characteristics
A
- Diminished activity
- Changed interest in eating/drinking
- Difficulty standing, walking, or jumping
- Decreased grooming
- Changes in urination/defecation habits
20
Q
Pain assessment validated methods
A
- Glasgow Composite measure pain scale
- UNESP-BOTUCATU multi-dimensional composite pain scale
- ACUTE pain only
21
Q
Traditional analgesics
A
- Opioids
- NSAIDs
- Local anesthetics
- Dexmedetomidine
22
Q
Fentanyl MOA
A
- Mu agonist very potent
23
Q
Fentanyl routes
A
- CRI in hospital
- At home can be given as a patch
- The patch may be eaten which would be bad
24
Q
Simbadol overview
A
- FDA approved for buprenorphine
- Partial mu agonist
25
Duration of simbadol
- 24 hours
| - Some extended release formulations too
26
Administration of Simbadol
- SQ administration easier in some cats
27
Simbadol dose adjustments
- Don't be afraid
| - e.g. geriatric, sick patients; aggressive multimodal analgesia
28
Bad aspect of simbadol
- If you give too much, they will be like that for 24 hours
29
Tramadol in dogs bioavailability
- 65 +- 38%
| - Little to no production of active metabolite
30
Elimination of tramadol in dogs
- Rapid
31
Tramadol in dogs use
- Analgesia may be from SNRI rather than opioid pathway
- Use as part of MULTIMODAL analgesia
- Not appropriate to give as a monotherapy
32
Cat bioavailability of tramadol
- 93 +/- 7%
| - Produce an active metabolite
33
Use of tramadol in ats
- More likely to provide analgesia, but cats don't like the taste
- Can use for cats in feeding tube
34
Cyclo-oxygenase Inhibitors overview for pain
- Reduces production of prostaglandins (TXA2, PGI2, PGE1/PGE2)
- Not tissue specific
- COX-nonselective
- COX 2 inhibitor
35
Types of Nonsteroidal anti-inflammatory drugs
- *Carprofen, Deracoxib, Firoxicb, Robenacoxib, Meloxicam, Grapiprant
36
Adverse signs for NSAIDs
- Vomiting
- Diarrhea
- Melena
- Icterus
- Liver enzyme elevation
- Kidney injury
- She will not do in azotemic animals
37
Lidocaine
- As CRIs helps with pain
38
Lidocaine CRI indication
- Antiarrhythmic, analgesic, anti-hyperalgesic, anti-inflammatory, anti-endotoxic
- Promotes GI motility and return to normal bowel function
- Facilitates rehabilitation
- Protection against ischemia-reperfusion injury
39
Gabapentin
- Anti-epileptic
- $, easy to give, wide dosing range
- Elimination through kidney
40
Gabapentin MOA
- Inhibit L-type calcium channel to decrease release of neurotransmitters (GABA)
41
Elimination of Gabapentin
- Urine
| - Dose reduction in kidney disease?
42
Main adverse effect of Gabapentin
- Sedation
- Can enhance other drug-induced sedation
- Can use a 4x recommended dose before they get to the hospital
43
Ketamine infusions/amantadine MOA
- NMDA receptor antagonist
| - can use in combo with tramadol, gabapentin, NSAID
44
Maropitant
- Neurokinin-1 receptor antagonist
- Stops visceral bain and blocks the emetic center
- NK-1 receptor agonist = substance P
- No drug interactions reported
45
Amitriptyline
- Tricyclic antidepressant
- A lot of kitties that have issues with FIC or lower urinary tract disease may be given this to chill them out if they fail environmental modification
- Can be used for obstructed ureters
- Also a pain medication
46
Non-pharmacologic therapy
- Acupuncture, massage, laser, etc.
47
Treatment considerations for an inappetence and lethargic cat with history of cholangiohepatitis, pancreatitis, and hepatic lipidosis
- Cerenia x 2 weeks
- Simbadol in hospital
- Amantadine or Gabapentin
48
Boxer with acute suppurative necrotizing pancreatitis, suppurative hepatitis, and moderate eosinophilic enteritis pain treatment
- Icing
- Fentanyl
- Dexmedetomidine CRI
- Epidural
