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Anesthesia > Premedication > Flashcards

Premedication Flashcards

(107 cards)

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1
Q

What is dissociative anesthesia

A

Form of general anesthesia characterized by catatonic state

Ketamine – information is processed w/o proper coordination in space/time

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2
Q

What is neuroleptanalgesia

A

State similar to general anesthesia produced by a sedative and an analgesic

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3
Q

What to Anticholinergics do

A

Inhibit parasympathetic nervous system

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4
Q

Anticholinergics are antagonists on which receptors and what are two drug examples

A

Antagonists on muscarinic acetylcholine receptors

Atropine and Glycopyrrolate

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5
Q

How is atropine given, does it cross BBB or placenta

A

IM, SC, PO - absorbs quickly

Crosses both

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6
Q

How does Glycopyrrolate differ from Atropine

A

Absorbs/onset slower
Doesn’t cross BBB/placenta
Dose is half
Water soluble not lipid

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7
Q

What are atropine and Glycopyrrolate used for

A

Increasing heart rate

Decreasing salivation/bronchial secretion

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8
Q

What are the contraindications of atropine and glycopyrrolate

A

Tachycardia, hyperthyroid, heart disease, narrow angle glaucoma

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9
Q

What are the cardiovascular side effects of anticholingergics

A

2nd AV block, bradycardia, cardiac arrest

Tachycardia, hypertension

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10
Q

Anticholinergics easily affect the _____, causing lot’s of ____ waves

A

SA node, lots of P waves

**atrial depolarization

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11
Q

Anticholinergics effect on ____ is weaker and comes later causing ____

A

AV node, AV blocks, bradycardia

**When AV node finally conducts there is excessive tachycardia

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12
Q

What happens when you combine Medetomidine and atropine

A

Vasoconstriction, tachycardia, hypertension

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13
Q

Routine co-administration of anticholinergic with _____ is contraindicted

A

Alpha 2 agonists and anticholinergics combined are contraindicted

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14
Q

What are some other effects of anticholinergics

A 
Relaxes lower esophagus (regurg)
Mydriasis (glaucoma)
Bronchodilation
Dries airway secretions
Intestinal paralysis
CNS toxicity
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15
Q

What group are the strongest sedatives

A

Alpha 2 agonists

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16
Q

Alpha 2 receptors on the presynaptic membrane

A

Suppression of NE release by negative feedback

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17
Q

Effects of alpha 2 on presynaptic

A

Sedation, Analgesia, reduction of sympathetic outflow from brain, reduction of stress response

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18
Q

Alpha 2 receptors on postsynaptic – location

A

In the wall of arteries and veins

** Alpha 1 receptors here also

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19
Q

Alpha 1 and 2 mediate ____

A

vasoconstriction

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20
Q

Alpha 2 receptor extra synaptic sites

A

Pancreas B Cells – Hyperglycemia

Adipocytes

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21
Q

Alpha 2 agonists CNS effects

A

Sedative
Some analgesia
Muscle relaxation

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22
Q

Alpha 2 agonists cause strong ____ leading to high ______

A

Strong vasoconstriction leading to high SVR and BP

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23
Q

Alpha 2 agonists can develop a reflex ____ resulting in ______

A

Reflex bradycardia resulting in low CO and tissue perfusion

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24
Q

Alpha 2 agonists respiratory effects

A

Bronchoconstriction, V/Q mismatch, lung edema and hypoxemia in ruminants

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25
Which alpha 2 agonists are containdicated in sheep
Xylazine
26
Which alpha 2 agonist most commonly causes vomiting in cats
Xylazine
27
Which drug may cause uterine contractions and abortion in cattle
Xylazine
28
Which Alpha 2 antagonist should always be used
Atipamezole
29
Medetomidine is a 50:50 _____
Racemic mixture
30
_______ is the active optical isomer
Dexmedetomidine
31
_______ is the inactive isomer
Levomedetomidine
32
_______ is twice as potent as medetomidine
dexmedetomidine
33
Phenothiazines act as antagonists on which receptors
Dopamine Serotonin Alpha 1 Histamine
34
What is a common long acting phenothiazine
Acepromazine
35
CNS effects of phenothiazine
Weaker sedative than alpha 2 NO ANALGESIC Antimetic effect Mild resp depression
36
phenothiazine is an antagonist on _____ receptors causing ____ and ____
Alpha 1 receptors causing vasodilation and hypotension ***May cause death in hypovolemic patients
37
phenothiazine can cause _____ in horses
penile prolapse
38
phenothiazine is used for _____ for premedication or post OP
Mild sedation for premedication or post OP
39
phenothiazine can be used for prevention/treatment of _____
Opioid dysphoria
40
What can be used for prevention of emesis caused by morphine
phenothiazines
41
phenothiazine can be used for sedation of dogs with _____
laryngeal paralysis
42
phenothiazines are contraindicatd with
``` *Hypovolemia, hemodynamic instability Very young/old Von-Willebrand dz *Boxers Breeding stallions ```
43
Two Butyrophenones
Droperidol and Azaperone
44
How do butyrophenones differ from acepromazine
More likely to cause behavioral side effects | Less hypotensive, stronger antiemetic
45
Benzodiazepines work on what type of receptor
GABA receptor agonists
46
Benzodiazepines have what type of effects
Sedative, anticonvulsant, muscle relaxant Minimal CV and resp effects No analgesia
47
GABA is the main ______ in the CNS
Inhibitory neurotransmitter in the CNS
48
GABA receptors are allosterically activated by
Benzodiazepines
49
This is the site of most anesthetics
GABA receptors ** Ketamine is an exception
50
Benzodiazepine agonists
Diazepam | Midazolam
51
Benzodiazepine antagonists
Flumazenil
52
Benzodiazepine sedation has a _______ effect
species specific effect
53
Benzodiazepines have a better sedative effects in
Ruminants, camelids, pigs, birds and ferrets
54
Benzodiazepines sedation causes disorientation in
Dogs, cats, horses
55
Benzodiazepines can be used as a premedication when combined with
Opioids, alpha 2 agonists or both
56
Benzodiazepines can be used for induction when combined with
``` Dissociative anesthetics (ketamine) Barbituates or propofol ```
57
Benzodiazepines can be used as a treatment for
Seizures (Status epilepticus)
58
Diazepam can be formulated in
Propylene glycol or lipid emulsion
59
Diazepams chemical compatibility is ____
limited
60
Diazepam has poor absorption and is ____ on IM injection
Painful
61
Midazolams chemical compatibility is ____, it is ___ potent than diazepam and is ____ acting
Chemical compatibility is good, it is more potent than diazepam and is shorter acting
62
Diazepam and Midazolam are both metabolized in the liver but which one has inactive metabolites
Midazolam has inactive metabolites
63
Midazolam can be given
IM or IV
64
What are opioids
exogenous substances that bind to opioid receptors and activate them
65
Opioids are the strongest available _______
systemic analgesics
66
Opioids are the best choice of treatment for
acute pain such as surgery
67
Opioids decrease the doses of ____
Anesthetics
68
Opioids have minimal ____ side effects
Minimal CV side effects
69
What are the three Opioid receptors and what they do
U - strong analgesia, resp depression K - weaker analgesia g - weaker analgesia (human)
70
Where are the locations of Opioid receptors
Brain, spinal cord (dorsal horn), peripheral nerves, inflamed organs (arthritis)
71
Four classifications of Opioids
Full agonist - full tissue response Partial agonists - partial response Antagonists - bind receptors but don't activate them Mixed agonist/antagonist - activate one receptor and inhibit another
72
What type of Opioid is butorphanol
Antagonist on Mu and agonist on kappa
73
Four drug schedules and an example of each
1 - heroin 2 - morphine (mu agonists) 3 - buprenorphine 4 - butorphanol, tramadol
74
Potency tells you the
Dose
75
Efficacy tells you the
Strength
76
Pharmacokinetics
Onset, duration of effect, administration strategy
77
CNS effects of Opioids
Analgesia Decreases MAC of inhalants (Primates > Dogs > Cats > Pigs > Horses)
78
Opioids sedation depends on
``` Species (primates and dogs are better) Pain level (stronger if there was pain) ```
79
Opioids can cause
Excitation (cats), dysphoria, tolerance, dependence
80
Opioids may trigger or inhibit
Vomiting -- stimulate chemoreceptor trigger zone outside of BBB, after entering brain they inhibit vomit center
81
____ soluble opioids (morphine) enter the brain slowly causing _____
Water soluble opioids enter more slowly causing more vomiting ** Fentanyl does the opposite
82
Opioids have minimal ____ effects
Cardiovascular effects
83
Opioids have no direct negative ____ or _____
No direct negative inotropy or vasodilation **May indirectly cause reduction in BP/bradycardia
84
Opioids are suitable for most _______
Risk patients
85
Opioids can be used for
Premedication, perioperative analgesia, treatment of acute and chronic pain
86
As a premedication opioids can be used alone or in combination with
Benzodiazpines, ketamine, acepromazine, Alpha 2 agonists
87
Fentanyl is a strong ____ as a _____ agonist
Fentanyl is a strong analgesic and is a full Mu agonist
88
Fentanyl has a ___ onset and ____ duration
Fast onset and short duration (15-20 min)
89
Remifentanil is similar to fentanyl but is ______ acting
Very short acting (5 min)
90
Butorphanol is works on what receptors
Antagonist on Mu and agonist on Kappa
91
Butorphanol is ____ and ____ acting analgesic
Weak and short acting analgesic
92
Buprenorphine is a ______ agonist
Partial Mu agonist
93
Buprenorphine is a ____ analgesic than butorphanol but weaker than _______ agonists
Stronger analgesic than butorphanol but weaker than full Mu agonists
94
Tramadol is a ___ analgesic
Weak analgesic
95
Tramadol metabolizes in the liver and its metabolite is a ________
Mu opioid agonist
96
Tramadol can be given ____ and it inhibits ____ and ____ reuptake
Can be given PO, inhibits NE and serotonin reuptake
97
What are two opioid antagonists and what is their duration
Naloxone - 30 min | Naltrexone - 10 hours
98
What are two muscle relaxants, are they central or peripheral
Guaifenesin - central | Dantrolene - Peripheral
99
Guaifenesin is commonly used in
Large animal anesthesia
100
Guaifenesin shouldn't be used alone because
Doesn't provide any analgesia or unconsciousness
101
Most commonly used concentration of Guaifenesin
5% in dextrose
102
> 10% concentration of Guaifenesin can cause
Thrombophlebitis
103
What is guaifenesin used for
Premed - improve muscle relaxation | Part of TIVA - Triple drip (GG + A2 + ketamine)
104
Dantrolenes site of action
muscle cells
105
Dantrolene is used for treatment of
Malignant hyperthermia
106
H1 antagonist
Diphenhydramine - anaphylactic reaction
107
H2 antagonist
Ranitidine, famotidine, cimetidine - increase stomach pH

Anesthesia (7 decks)

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