Premedication Flashcards
(69 cards)
1
Q
Aims of premedication (6)
A
• Relieve anxiety,/,fear, • Facilitate,handling, • Counteract side effects of anesthetic agents, – Nausea/Vomiting/Salivation, – Excessive mm tone – Bradycardia • Reduce the dose of anesthetics • Contribute to perioperative analgesia • Contribute to smooth recovery
2
Q
5 types of PMs
A
- sedatives and tranquilizers
- analgesics
- anticholinergics
- anti-emetics and GI protectants
- hypnotics
3
Q
3 sedative/tranquilizer examples
A
- phenothiazines
- benzodiazepines
- alpha 2 adrenergic agonists
4
Q
2 analgesic categories
A
- opiods
- NSAIDs
5
Q
Anti-emetics and GI protectants (6)
A
- NK-1 antagonists
- D2 antagonists
- 5-HT antagonists
- PPIs
- Anti-H2
- buffers
6
Q
3 hypnotic examples
A
- alfaxalone
- ketamine
- tiletamine
7
Q
Anticholinergic MOA
A
competative antagonist M AchR
8
Q
2 anticholinergics
A
- atropine
- glycopyrrolate
9
Q
anticholinergic side effects
A
- paradoxical bradycardia
- ↑ HR
- bronchodilation
- ↓ secretions (increased viscosity)
- Mydriasis
- ileus
- antisialogue
- sedation/hallucinations
10
Q
Which anticholinergic does NOT cross the BBB and placenta
A
Glycopyrrolate
11
Q
atropine metabolism
A
- Dog and human = hydrolysis + excreted unchanged
- Cat + small ruminants = hepatic and renal esterases
- Atropinase: 30% of rabbits
12
Q
glycopyrrolate metabolism
A
excreted unchanged in urine
13
Q
Why use anticholinergics as PM (3)
A
- prevent bradycardia
- reduce salivation
- reduce bronchial secretions
14
Q
Why not use anticholinergics as PM?
A
- Thickening, of, saliva, and, bronchial secretions,
- Decreased ,GI motility,
- Increased, myocardial, oxygen consumption /arrhythmias
- No study to prove benefit
15
Q
Effects of Phenothiazines
A
- tranquilization
- ↓ MAC
- vasodilation
- hypothermia
- antiemetic
- relax LES
- ↓ HCT and PLT aggregation
- antihistaminic
16
Q
Phenothiazine MOA
A
D2, alpha 1, H1, and M Ach R antagonists
17
Q
Acepromazine should be avoided in what patients?
A
- pediatric
- geriatric
- debilitated
- hepatic dysfunction
18
Q
Can ace be antagonized?
A
no
19
Q
________ can cause priaprism in breeding stallions and bulls
A
acepromazine
20
Q
benzodiazepine MOA
A
allosteric modulator of GABA a receptors
21
Q
effects of benzodiazepines (4)
A
- sedation
- anxiolysis
- anticonvulsant
- mm relaxants
22
Q
benzodiazepines are reliable sedatives in what patients?
A
- very young
- very old
- very sick
- small ruminants
- pigs
23
Q
benzos need to be associated with _________ or ________ for reliable sedative effect
A
- opioids
- hypnotics
24
Q
side effects of propylene glycol (found in Diazepam)
A
- hemolysis
- pain
- thrombophlebitis
- erratic IM/SQ absorption
- hepatic failure w/ chronic PO use
25
Benzodiazepines
- Diazepam
- Midazolam
- Zolazepam
- Flumazenil
26
_______ and ______ experience a smooth recovery with Telazol (Zolazepam) but _____ and ______ have a rough recovery
- cats and pigs
| - dogs and horses
27
_______________: competative antagonist of benzodiazepines
Flumazenil
28
What is the drawback of Flumazenil?
Can cause seizures
29
Effects of alpha-2 adrenergic agonists
- sedation
- MAC reduction
- emesis
- ileus
- CO reduction
- decreased ability to thermoregulate
- biphasic CV effects
- mild respiratory depressant
- cyanosis
- uterine ecbolic effect
- ↑ urine production
- suppression of stress response
- insulin suppresion (hyperglycemia and hyperkalemia in large felids?)
30
advantages of alpha-2 agonists
- reliable sedatives
- can be reversed
- analgesics
- not controlled
- variety of administration routes
31
do NOT give alpha 2 agonists to ______ or _______
- neonatal patients (rely on HR for CO maintenance)
| - sheep/goats (fulminant pulmonary edema)
32
_______ is used as a pro-emetic in cats
xylazine
33
__________ causes fulminant pulmonary edema in sheep/goats (mediated by macrophages)
alpha-2 agonists
34
_________ is an alpha 2 agonist avaliable as an oral gel
Detomidine
35
alpha-2 agonist which may be used as a CRI
Dexmedetomidine
36
3 uses of alpha 2 antagonists
- to terminate sedation
- to treat overdose
- after capture of wild animals
37
Considerations before using alpha-2 antagonists
- analgesia will be reversed too
- ketamine convulsive action may be revealed
- CV side effects
38
3 alpha-2 antagonists
- Tolazoline
- Yohimbine
- atipamezole
39
_________ alpha-2 antagonists is licensed IM only
Atipamezole
40
Tolazoline side effects
- fasciculations
- hypotension
- ventricular arrhythmias
- death
41
3 antiemetics
- Maropitant
- Metoclopramide
- Ondansetron
42
3 antiacids
- Famotidine
- Omeprazole
- Na citrate
43
_________ antacid must be given orally
Na citrate
44
Need to be careful with Na citrate as an antiacid in patients with __________ or __________
- CKD (metabolic alkalosis)
| - cardiac disease (risk of CHF due to Na overload)
45
Opioids undergo hepatic metabolism, with the exception of _________
Remifentanil
46
3 places opioids act on
- dorsal horn
- supra-spinal
- peripheral nerves
47
Sedation effects of opioids
- may cause dysphoria (horses) or euphoria (cats)
| - MAC sparing
48
effects of opioids
- mild respiratory depression
- anti-tussive
- bradycardia/AV blocks
- miosis (mydriasis in cats)
- both anti-emetics and pro-emetics
- ileus
- urinary retention
- immune suppression
- histamine release
- hypothermia in dogs
- hyperthermia in cats, ferrets, swine, and horses
49
the more_______ an opioid is , the faster they reach the emetic center and the less likely they are to cause vomiting
lipophilic
50
____________ is an opioid antagonist
Methylnaltrexone
51
9 common side effects of opiods
- dysphoria
- respiratory depression
- bradycardia
- N/v
- aspiration pneumonia
- ileus
- urinary retention
- hyper/hypothermia
- can induce hyperalgesia
52
4 reasons to use opioids as PM
- sedatives
- contribute to intra-operative analgesia
- MAC sparing effects
- minimal CV effects
- can contribute to a smooth, pain-free recovery
53
full mu agonist opiods
- morphine
- hydromorphone
- oxymorphone
- methadone
- fentanyl
- remifentanil
- tramadol
- Etorphine
- Carfentanil
54
________is an opioid that also acts as an NMDA antagonist
Methadone
55
__________ is an IV only opiod used in patients with severe liver disease
Remifentanil
56
Does Tramadol work better in cats or dogs?
dogs
57
________ is 4,000 times more potent than morphine and is antagonized with Diprenorphine
Etorphine
58
________ is 10,000 times more potent than morphine and is antagonized with Naltrexone
Carfentanil
59
_________ is a partial mu agonist
Buprenorphine
60
_________ is an opioid agonist-antagonist
Butorphanol
61
benefits of Butorphenol
- good sedative
- good anti-tussive
- does not cause emesis
62
3 opioid antagonists
- Naloxone
- Naltrexone
- Diprenorphine
63
________ and ___________ can be used to reverse the side effects of full mu agonists while retaining analgesia
- Butorphanol
| - Buprenorphine
64
NSAIDs inhibit _______ production by inhibiting COX
- eicosanoids
65
Side effects of NSAIDs
- GI injury (gastritis, enteritis, ulceration, perforation)
- kidney injury
- hepatotoxicity
- coagulation
66
Contraindications for NSAID therapy
- pre-existing GI disease
- pre-esisting kidney disease
- hepatic insufficiency, increased LEs?
- ↓ effective circulating volume
- concurrent or recent corticosteroid administration
- concurrent or recent administration of a different NSAID
- concurrent use of other potentially nephrotoxic drugs
- MCT
- coagulopathies
- pediatric patients
67
NSAIDs
- carprofen
- meloxicam
- Robenacoxib
- Firocoxib
- Deracoxib
- Flunixin meglumine
- Phenylbutazone
68
Signs of adequate sedation in horses
- head is lowered, below the shoulder (5 legged stance)
- not interested in their surroundings
- ptosis
- glazed eyes
- don't protest if you stick your fingers into their mouth
- don't attempt to withdraw their tongue if you pull it out
69
what will happen to cows once you give them xylazine (unlike horses)
they are likely to go down
