Quiz 1 Flashcards by Ilicia Martin

Describe schedule one drugs and list some examples

No currently accepted medical use and a high potential for abuse
Heroin, LSD, Marijuana, ecstasy, peyote

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Describe Schedule II drugs and give some examples

High potential for abuse
Pure mu agonists- morphine, hydromorphine, oxymorphone, methadone, fentanyl, meperidine,

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Describe schedule III drugs and give some examples

Moderate to low potential for dependence/ abuse
Ketamine and buprenorphine

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Describe schedule IV drugs and give some examples

Low potential for abuse
Tramadol, benzodiazepines, butorphanol, alfaxalone

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Describe schedule V drugs
Give an example

Very low potential for abuse
Cough medicine with less than 200mg of codine

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Which drug is a phenothiazine and what is the mechanism of action

Acepromazine and sedative effect via antagonism of dopamine receptors

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Does acepromazine provide analgesia

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Can you reverse acepromazine

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What are the cardiovascular effects of acepromazine

Vasodilation, hypotension, anti-arrhythmic

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What GI use can acepromazine have

Anti-emetic

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What are the four examples of alpha-2 agonists

Dexmedetomidine, romifidine, detomidine, xylazine

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What is the mechanism of action of alpha-2 agonists

Produce sedation and hypnosis by activating the alpha-2 receptors in the locus ceruleus.
ALso decreases norepinephrine centrally and peripherally causing sedation and analgesia

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Are alpha-2 agonists scheduled by the DEA

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What are the cardiovascular effects of Alpha-2 agonists

Phase 1- vasoconstriction—> increase BP—> reflex bradycardia and decreases cardiac output
Phase 2- resolution of vasoconstriction and persistent low HR—> decreases blood pressure and cardiac output
significant decrease in cardiac output
Arrhythmias

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What does alpha-2 agonists do to the GI and urogenital tract

Decreased motility and causes patient to urinate

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Which alpha-2 agonist causes the largest increase in blood glucose

Xylazine

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You have a horse and a cow, who will get the larger dose of xylazine most likely

The horse, ruminants are very sensitive and get 1/10 the dose that horses get

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Which alpha-2 agonist would be good to give to a horse that will be trailered home soon after the procedure (you want to have less ataxia

Romifidine

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Which alpha-2 agonist is also available in a gel and is used to treat thunderstorm anxiety in small animals

Dexmedetomidine (Sileo)

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What reverses dexmedetomidine

Atipamizole

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What reverses xylazine, romifidine, and detomidine

Yohimbine

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Which alpha-2 agonist has a fast onset, short duration, and is safer and minimizes peripheral adverse effects while maintaining central ones

Zenalpha (medetomidine + vatinozan)

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Compare the effects of Pure mu, partial mu, and mixed agonist/antagonist opioids

Pure mu have profound analgesia with moderate sedation, partial mu have moderate analgesia with mild/no sedation, and mixed have mild analgesia (species dependent) and moderate sedation

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What schedules are the drugs that are pure mu, partial mu, and mixed agonists/antagonists

Pure Mu- schedule II
Partial Mu- Schedule III
Mixed- schedule IV

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How do opioids effect the cardiovascular, respiratory, and GI systems

They depress them/ slow them and can cause nausea and vomiting

What sedatives cause histamine release so you may see hives, hypotension, hyperthermia, and tachycardia in some patients

Opioids

Which opioid is the only one that may cause an increase in heart rate (not a histamine release reaction)

Meperidine

Which opioid can cause tremendous bradycardia

Methadone

Which opioid is typically given as a CRI because its duration of action is only 30 minutes

Fentanyl

Which opioid has the longest duration of action

Bupernorphine at 6-8 hours

Which opioid can actually be used to reverse pure Mu drugs and causes more sedation because it agonizes kappa receptors

Butorphanol

You are concerned a patient will have a histamine reaction to morphine if you give the drug IV. You elect to give it IM but what should you also give your patient

An anti-emetic because giving morphine not IV can cause vomiting (but IV causes more histamine release)

What is meant by the phrase “neuroleptic analgesia” and what is the benefit

Giving an opioid and a major sedative that work synergistically to provide more effective sedation and more profound analgesia You can use a lower dose of each drug too

What do we typically give to reverse an opioid

Naloxone

What is the mechanism of action of benzodiazepines

Causes sedation and anxiolytics by acting at GABA receptors

What is an important fact about how diazepam can not be given

It is not water soluble so it can’t be mixed with other drugs (unlike midazolam) with the exception of ketamine. Should also only be given IV

Do benzodiazepines provide analgesia

What are the CNS, Cardiovascular, and respiratory effects of benzodiazepines

CNS- depress limbic system, thalamus, and hypothalamus- calming effect, anticonvulsant, mild sedation (not super effective in healthy adults), causes muscle relaxation Minimal respiratory and cardiovascular effects

Which pre-med is a good choice for neonates, geriatric, and debilitated patients

Benzodiazepines

Benzodiazepines are commonly given with what as a co-induction agent

NMDA antagonists (ex. Ketamine and Valium

Which induction agents augment the GABA receptors (inhibitory pathway)

Propofol, alfaxalone, etomidate, barbiturates

Which induction agents suppress NMDA (excitatory pathway)

Ketamine and tiletamine

Which induction drug is metabolized at both hepatic and extrahepatic sites so it is good to use in patients that may have liver problems

Propofol

Which induction agent is good to use in patients with elevated intracranial pressure and why

Propofol because it decreases cerebral oxygen flow, blood flow and intracranial pressure Also alfaxalone but maybe not because it produces myoclonus

What should you always have when inducing with Propofol and why

Always should be able to intubate and ventilate a patient, give the dose slowly and titration to effect because it can cause significant respiratory depression

What might you do to a patient before giving Propofol

Preoxygenate

Is Propofol analgesic

Why is Propofol not the best choice to use in a cat that is needing to be anesthetized many times for wet to dry bandage changes on a severe wound, what would be a better choice for an induction agent

Propofol can cause oxidative injury and Heinz body anemia in cats if repeated doses are given in a short time frame. Alfaxalone is a better choice

What is a good induction agent to use when preforming a c-section and why

Propofol because it is rapidly metabolized by the fetus

You survived vet school and you finally got a job! One of your associates comes to you, knowing you just graduated from UGA, and says “Hurry! I was about to do a mass removal on this cat and I induced with alfaxalone and now it is having a seizure! You need to call the anesthesia department at UGA and ask them what the heck is going wrong!!” You remember your anesthesia teacher telling you something about this… What can you confidently tell your associate?

There is no need to call. Myoclonus (muscle tremors) is a normal reaction for alfaxalone and while it can look like a seizure it isn’t. The animal is fine.

What is a major perk of alfaxalone as a premed (hint it has to do with administration)

You can give it IM!

How does the different administrations of alfaxalone effect how it acts in an animal

When given IM it is better as a premed but given IV it acts like Propofol to induce a patient

What is a concern unique to using etomidate as an induction agent and knowing this what patients should you definitely not give it to

It can inhibit the enzyme which converts cholesterol to cortisol so it can depress the cortisol stress response, don’t give to patients that may have Addison’s because it may push them into an Addisonian crisis

What should you use etomidate with if using it as an induction agent

A benzodiazepine because it provides poor muscle relaxation

What is the induction agent of choice for patients in heart failure and why

Etomidate because it has minimal to no change in heart rate, BP, stroke volume, and cardiac output

How can the PCP derivatives (ketamine, telazol) be given

IV or IM

What are the CNS effects of PCP derivatives

When given alone without a premed- increased cerebral metabolic requirement for oxygen, increased cerebral blood flow, and increased intracranial pressure Less effect if patient already under anesthesia or heavily premeditated

What is the cardiovascular effect of PCP derivatives (ketamine, telazol)

Increased heart rate, blood pressure, and cardiac output and may cause tachycardia and arrhythmias due to sympathetic nervous system stimulation

What is a benefit of using PCP derivatives like ketamine for induction in a patient that you may need to remove an oral mass from?

Laryngeal function is maintained so the patient could protect their own airway

While ketamine by itself doesn’t cause significant respiratory depression, what can it do

Exacerbate the respiratory depressant effects of other drugs

Why are PCP derivatives (ketamine, telazol) good induction agents for patients with a traumatic injuries or needing painful orthopedic surgery, but what is a draw back so what are they often given with

They have a profound analgesia effect by antagonism of the NMDA receptors and work at opioid receptors However they provide poor muscle relaxation so they are often given with a benzodiazepine

What induction agent should you NOT use if you are doing a c-section

PCP derivatives (Ketamine, telazol) because they can cross the placental barrier and causes severe fetal depression