Test #2

Question 1

Atelectasis

Answer 1

May occur under anesthesia due to decreased tidal volume; lungs are not completely inflating.

Question 2

Line block

Answer 2

Continuous line of local anesthetic placed SQ proximal to target area

Question 3

Nociception

Answer 3

Detection of potential or actual tissue injury by the nervous system

Question 4

Pathologic pain

Answer 4

Pain felt after tissue injury

Question 5

Primary hyperalgesia

Answer 5

Hypersensitivity of an area close to site of injury due to presence of inflammation

Question 6

Respiratory minute volume

Answer 6

Amount of air moving in and out of lungs in 1 minute

Question 7

Sympathetic blockade

Answer 7

Can occur if local anesthetic is given too cranially; may result in bradycardia or hypotension

Question 8

Somatic pain

Answer 8

Pain originating from the musculoskeletal system

Question 9

Tidal volume

Answer 9

Amount of air moving in or out of the lungs in a single breath

Question 10

Windup

Answer 10

Central nervous system hypersensitivity; can be prevented by preemptive analgesia

Question 11

Bupivicaine

Answer 11

A0 local anesthetic that can be cardiotoxic if given IV.

Question 12

Buprenorphine

Answer 12

A partial opioid agonist that can be given by injection or transmucosally.

Question 13

Butorphanol

Answer 13

An opioid agonist-antagonist that can be used to partially reverse the effects of an opioid agonist while still providing analgesia.

Question 14

Fentanyl

Answer 14

A pure opioid agonist with very good potency but very short duration; often delivered via CRI or transdermal patch.

Question 14

Dexmedetomidine

Answer 14

An alpha-2 agonist used in small animals that provides sedation and analgesia, especially when combined with an opioid.

Question 15

Ketamine

Answer 15

A dissociative anesthetic that is effective at preventing windup because it blocks the NMDA receptor.

Question 15

Hydromorphone

Answer 15

A pure opioid agonist that is commonly used in small animals due to reasonable cost and duration of action (4-6 hours)

Question 16

Lidocaine

Answer 16

A local anesthetic with quick onset; often combined with epinephrine to prolong its effects.

Question 17

Meloxicam

Answer 17

A commonly used NSAID for dogs and cats, known as Metacam, available as injectable and oral forms.

Question 17

Morphine

Answer 17

The first opioid used in veterinary patients; now replaced by others that have fewer side effects but may be used for epidurals.

Question 18

Give me an example of an analgesic plan that targets 3 different pain receptors:

Answer 18

Common example is using an NSAID and opioids. MLK is a good example of this (morphine, lidocaine and ketamine)

Question 19

Common side effects of NSAIDS:

Answer 19

• Significant potential for toxicity
• Caution if dehydrated oy hypotensive
• GI ulceration (protective effect of prostaglandins)
• Liver disease (carprofen)
• Decreased platelet aggregation
• Renal toxicity
• Safe in young and middle-aged pets (normally hydration, kidneys and liver)
• Don’t give with glucocorticoids
• Don’t give to trauma patients until stable
• IV fluids and monitor blood pressure

Question 20

How do Nsaids work?

Answer 20

NSAIDS cause inhibition of prostaglandin synthesis (mediators of pain and inflammation). They inactivate cyclooxygenase (COX) (enzyme involved in production of prostaglandin). NSAIDS are metabolized by the liver and eliminated by the kidneys.

Question 21

Common side effects of Opiods:

Answer 21

• Excitement (high doses, usually in cats)
• Nausea
• Vomiting
• Defecation
• Horses may develop ileus and colic

Question 22

Describe preemptive analgesia:

Answer 22

Administering pain medication before the pain will happen to decrease requirement for analgesics. This helps prevent windup. This is part of the premedication prior to anesthesia.

Question 23

Give me an anesthetic plan that includes multimodal analgesic therapy:

Answer 23

Morphine, lidocaine and ketamine (MLK)

Question 25

Where does windup occur, when referring to the secondary sensitization:

Answer 25

Central nervous system hypersensitivity (WINDUP). NMDA receptors are activated during windup. Some drugs such as ketamine can block this receptor.

Question 26

perception

Answer 26

Perception – Impulses are transmitted to the brain, where they are processed and recognized.

Question 27

transmission

Answer 27

Transmission – Conduction of sensory impulses to spinal cord

Question 28

transduction

Answer 28

Transduction – transformation of noxious stimuli into action potentials by peripheral A-delta and C nerve fibers

Question 29

modulation

Answer 29

Modulation – Can either amplify or suppress impulses.

Question 30

List the advantages of multimodal analgesia:

Answer 30

- Use of several different drugs that target different receptors - Decreased amounts of each drug - Decreased amounts of anesthesia - Decreased risk of toxicity and side effects

Question 31

List the 4 components of the pain pathway in the correct order:

Answer 31

- Transduction - Transmission - Modulation - Perception

Question 32

Primary hyperalgesia is a response to:

Answer 32

Area close to site of tissue injury becomes painful to even normal stimulus.

Question 33

Describe physiologic pain:

Answer 33

Protective sensation of pain that occurs when there is a possibility of or actual tissue injury

Question 34

If an epidural anesthetic reaches the thoracic and cervical spinal cord, you may see:

Answer 34

Infiltration into cranial spinal cord can cause serious toxicity or even death.

Question 35

What do you need to remember when using neuromuscular blocking agents:

Answer 35

-NEVER given to a conscious animal. It is inhumane. - No tranquilizing, analgesic or anesthetic properties - Fully conscious and sensitive to pain, but cannot respond - Respiratory muscles paralyzed so cannot breathe on their own

Question 36

If a patient is connected to a ventilator while under anesthesia, you should:

Answer 36

Use higher levels of isoflurane, because the patient will be breathing more slowly.

Question 37

Most common acid base abnormality in an anesthetized patient is:

Answer 37

Metabolic Acidosis

Question 38

Which local anesthetic agent should be used when doing a Bier block:

Answer 38

Lidocaine

Question 39

When performing an epidural, it is important to be aware that the spinal cord in the cat may extend as far caudally as:

Answer 39

An epidural block should be done between L7 and sacrum. In cats, may extend to S1, so slight risk of entering subarachnoid space.

Question 40

Local anesthetic injected around a single major nerve is known as:

Answer 40

Regional anesthetic

Question 41

Local anesthetic block transmission of nerve impulses from WHAT neurons:

Answer 41

Local anesthetics target the neurons in the peripheral nervous system or spinal cord. They have no sedative effect

Question 41

Why are neuromuscular agents only given after patient is under general anesthetic?

Answer 41

Patient must be under anesthesia first, and respiration controlled. NEVER given to conscious animal – inhumane · No tranquilizing, analgesic or anesthetic properties · Fully conscious and sensitive to pain, but cannot respond · Respiratory muscles paralyzed so cannot breathe on their own

Question 42

Name 5 Physiologic and Behavioral signs that an animal is painful.

Answer 42

- Owner may see more at home - CVS – Hypertension, tachycardia and pale MM - Respiratory – tachypnea, shallow breathing, exaggerated abdominal breathing, panting and open mouth breathing - Opthalmic - mydriasis

Question 43

Compare and contrast opioids

Answer 43

Opioids: - Reverse with naloxone - Receptors in spinal cord and brain - Most last 2-4 hours - May cause excitement (especially in cats and horses) - Very large safety margin (can give to very sick animals) - Controlled drugs

Question 44

Compare and contrast NSAIDs

Answer 44

NSAIDS: - No reversal - Causes inhibition of prostaglandin synthesis (mediators of pain and inflammation) - Not controlled drugs - Only give to healthy animals (can cause issues with kidneys and liver) - Can cause GI ulcerations (give with food) - Don’t use with glucocorticoids

Question 45

Compare and contrast opioids and NSAIDs.

Answer 45

Both: - Both drugs treat pain - NSAIDS and Opioids are safe to combine with each other - Both metabolize in liver and excreted by kidneys - Both have oral and injectable forms