Flashcards in Test 2 Deck (112):
What effects do opioids have on gastrointestinal activity?
Initial increase (diarrhea, vomiting) and then slowing (colic, constipation)
Why must morphine be given IV slowly?
To prevent release of histamine that can result in a fall in BP, flushing and pruritis
What is the name of the synthetic opioid that is similar to oxymorphone and hydromorphone?
Which opioid can be used to reverse sedation and respiratory depression of pure agonists while maintaining analgesia?
True or false: Buprenorphine can be used to control moderate to severe pain
False. Buprenorphine is a partial mu agonist that produces some analgesia for mild to moderate pain
Morphine can be administered with _____ and ketamine to control severe pain
When is intraarticular injection of opioids indicated?
After elbow or stifle surgery
Where would you inject an opioid to provide analgesia to hind limbs, abdomen, caudal thorax, pelvis and tail all at once?
Epidural injection at the lumbosacral junction
What is the most common used drug for epidural?
When should an epidural be given in the surgical process?
After induction but before surgery begins
Which opioid is used as a transdermal patch?
True or false: A fentanyl patch is not adequate on its own and Butorphanol must be given beforehand to help
False. Butorphanol should not be given in combination with a fentanyl patch because Butorphanol can partially block opioid receptors
What are 3 situations in which you would choose Fentanyl?
Trauma, burns, cancer
What are 2 signs of Fentanyl overdose in dogs? Cats?
Dogs - ataxia and sedation
Cats - dysphoria and disorientation
Why should we avoid the use of fentanyl patches in animals that have fevers?
Heat may increase the amount of fentanyl absorbed
Give 3 examples of NSAIDs
Acetaminophen, Meloxicam, Carprofen, Acetylsalicyclic acid
What is the major gastrointestinal concern associated with NSAIDs?
NSAIDs can have adverse reaction on platelets. How?
Impaired platelet aggregation leading to prolonged bleeding time
Name 2 advantages and 2 disadvantages of using local anesthetics as analgesics
Advantages - low toxic dose, rapid onset of action
Disadvantage - short duration of action, cardiac toxic with repeated use
What is MLK? (3 drugs used for intraoperative analgesia)
Morphine, lidocaine, ketamine
What is the name of an anticonvulsant that can be used in patients with chronic pain that is unresponsive to NSAIDs?
Give 3 examples of Multimodal Therapy
1. Acetaminophen and Codeine
2. Fentanyl and Meloxicam
3. Morphine and Meloxicam
What are 3 examples of Non-pharmacologic therapies for pain? (There is 7)
- Transcutaneous nerve stimulation
- Massage therapy
- Temperature therapy
- Laser therapy
- Herbal remedies
Give an example of an elicit motor action triggered by pain
A dog biting upon a painful injection
What is nociception?
Network of events and responses that leads to the perception of pain. Defense mechanism to painful stimuli
What is the difference between Physiologic and Pathologic pain?
Physiologic pain is dependent on something (painful stimuli) activating peripheral pain receptors, it is a protective response.
Pathologic pain results from tissue injury or damage to nerves in which a pain reaction occurs to a non-painful stimuli
What are the 4 steps of nociception
______ therapy targets 2 or more of the pain receptors using more than 1 analgesic drug
What happens during Transduction
conversion of stimulis to impulse by peripheral nociceptor
What happens during Transmission
Transports nerve impulse to the spinal cord via first order neurons
What 3 nerve fibers are involved in the Transmission process?
A-Delta, C, A-Beta
What happens during Modulation
Amplification or dampening of pain signals at the synapses of the first order neurons of spinal cord
What happens during the Perception stage?
Cerebral cortical response to projected pain by third order neurons in the brain
What is primary hyperalgesia? How does it occur?
Peripheral hypersensitivity to pain, results from tissue damage and constant nerve stimulation
What is secondary hyperalgesia? How does it occur?
Central nervous system hypersensitivity or "wind-up" as a result of constant stimulation of spinal cord neurons
Name 5 consequences of untreated pain
1. catabolism (muscle breakdown)
2. Immune system suppression
3. Inflammation and delayed wound healing
4. Anesthetic risk
5. Patient suffering
True or false: Pain can cause a decrease in insulin and an increase in epinephrine
How can pain cause cardiac arrhythmias?
Pain increases myocardial work and oxygen consumption due to vasoconstriction
Behavioural signs of pain include ______ in cats and ______ in dogs
Cats - hiding
Dogs - seeking owner comfort
What is one sign of pain specific to thoracic/abdominal pain?
Restlessness or unable to lie down
How do we assess pain level?
Various types of descriptive scales based on clinical signs and behaviour
Maximum dose of Lidocaine and Bupivicaine in small animals is ______mg/kg
What is the most common sedative used for ruminants? why?
Xylazine - deep sedation and easily reversed
True or false: Butorphanol can be used alone for sedation in healthy adult ruminants
False - Butorphanol does not produce sedation in healthy adult ruminants. Combine with Xylazine or DIazepam
True or false: Ruminants are sensitive to Xylazine and could potentially become recumbent
What is meant by a Double Drip?
Guaifenesin and Ketamine mixture for sedation in ruminants
What is meant by a Triple Drip?
Guaifenesin, Xylazine and Ketamine mixture for sedation in ruminants
How is Xylazine given for induction of adult cattle, sheep and goats?
Half dose IV and the other half IM
Why is Thiopental not suitable for CRI maintenance?
It cumulates within the body
What induction agent is appropriate for CRI maintenance in small ruminants?
How do you intubate a small ruminant?
The exact same as a small animal
How do you intubate adult cattle?
- Use a mouth gag to prop the mouth open
- Hand over ET tube cuff
- Pass hand and tube toward glottis and digitally lower the epiglottis
- Blindly insert tube
What size range of ET tubes are used for ruminants?
For IV maintenance in adult cattle, Double Drip is infused at a rate of:
Less than _____ bpm is considered bradycardia in ruminants
A blood pressure of ______ mmHg or more in a ruminant is considered hypertensive
True or false: Centrally fixed eye position is normal in ruminant anesthesia
False. Ventro-medial position is normal
Why is it important for anesthetized ruminants to be positioned with the mouth lower than the pharynx?
To allow drainage of saliva and any regurgitated material from the mouth, preventing buildup in the pharynx, which could lead to aspiration
What are 3 reasons we may tranquilize or sedate a horse?
Transport, imagine, dentistry, scoping, examination
True or false: Anesthesia is riskier in small animals than it is in horses
False - much riskier in horses.
Why do horses often have difficult inductions and recoveries?
Their natural temperament is prone to panic
What is the fasting protocol in equine patients?
0-12 hours without hay and up to 24 hours without grain. Do not withhold water
Foals can nurse for up to _____ hour(s) before induction to surgery
Why must we rinse the mouth of horses before intubation?
To remove any food particles that could be pushed into the trachea upon intubation
What is applied above the vein before placing a jugular catheter in a horse?
A jugular catheter in a horse is held in place in one of 2 ways:
1. sutured to skin
2. vetbond glued to skin
Why isnt Diazepam used alone as a pre-med in horses?
Causes excitement - add Ketamine
What is the most frequently used sedation agent in horses?
Which pre-med drug has the longest duration for horses?
Name 2 Alpha-2 + Opioid sedative combinations used for large animals
Xylazine + Butorphanol, Detomidine + Butorphanol, or Romidifine + Butorphanol
True or false: Propofol induction can only be used on adult horses
False. Foals only
Allow the pre-med to work for MINIMUM ____ minutes before induction
What is the mix to make triple drip?
Guaifenesin - 1 L
1000 mg Ketamine
500 mg Xylazine
When inflating an ET tube in a horse, never surpass ______ml or the cuff can collapse
What is a "field drop"?
Recumbent anesthesia in the field. 10-15 minutes of anesthesia via either Xylazine IV or Ketamine and Diazepam
Horns grow from growth cells over the _____ area of the bovine head
What are 2 reasons why we dehorn calves?
1. Prevent injury to others
2. Reduce aggression
What is meant by the term Polled Cattle?
Genetically prevented from growing horns
What is the age range within which calves can be safest dehorned?
1 day to 2 months old
For the Cornual Nerve block, what is the best restraint for older calves?
For dehorning calves, sedate with _____ and administer ______ for analgesia
Where is the cornual nerve?
Between lateral canthus of eye and horn under the boney ledge
When do you know if the cornual nerve is frozen enough to dehorn the calf?
Upper eyelid drooping means it is frozen
What are the 2 types of bovine castration? Describe each
1. Elastrator/Bloodless - scrotal skin is not cut but the spermatic cords are externally crushed using a Burdizzo
2. Surgical - Scrotum is excised exposing spermatic cord to be cut using a Scalpel or Newberry knife
Give 2 examples of elective orthopedic surgery
Hip dysplasia, cranial cruciate ligament injury
Give 2 examples of non-elective orthopedic surgery
Bone fracture, joint luxation, open fractures
If severe trauma, contamination or multiple bone fractures, ______ should be given prophylactically
The most common non-elective orthopedic surgery is:
What is a Celiotomy?
Incision into the abdominal cavity (AKA laparotomy)
What 2 diagnostic steps must be taken before exploratory surgery is considered?
Radiographs and ultrasound
What should you have ready before abdominal surgery just incase there is peritonitis present?
What are 3 indications for Gastrotomy?
Foreign body, hairball, string gut, neoplasia
What are 3 reasons why an animal may need an emergency c-section?
1. failure of cervix to dilate
2. Malpositioned/large fetus
3. Small birth canal
Most patients experiencing dystocia have underlying ______ which needs to be corrected
What fluid rate should be given to emergency c-section patients?
Up to 1/3 shock rate of Isotonic Crystalloids, 30 ml/kg/hour
______ is a drug that helps stimulate breathing in neonates
What are the 4 emergency drugs used for C-sections?
Naloxone, Doxapram, Epinephrine, Atropine
Why avoid Acepromazine during c-section?
Causes fetal depression and hypotension and is not reversible
What 2 drugs are best for IV induction for planned c-sections?
Propofol or Alfaxalone
What pre-med drugs are best for emergency c-sections?
Hydromorphone and IM Atropine (half dose) -- plus or minus Midazolam
What induction drugs are best for emergency c-sections?
Propofol to effect or Morphine/Lidocaine epidural
What 2 things should be administered to the mom once the fetuses have passed?
Additional anesthesia and analgesia
During c-section, once the fetuses are out _____ can be applied to the uterus to speed up involution
What are 3 risk factors that make a dog more prone to GDV? (There are 7)
1. Deep chest/narrow thorax
2. Eats once a day
3. Exercise after eating
4. Consumption of large amounts of food or water
6. Eating from a raised bowl
7. Rotating susceptible patient dorsally
What are 3 clinical signs of GDV? (There are 7)
2. Abdominal pain
3. Excessive salivation
4. Retching, no vomit
5. Mucus membranes pale
6. DIstention of abdomen behind ribs
7. Respiratory distress
GDV requires a fluid rate equivalent to:
If a stomach tube cannot be placed to decompress the GDV, what can be used?
A trocar can be used in the left lateral abdomen
What is a Gastropexy?
Permanent fixture of stomach to abdominal wall to prevent future GDV
The best pre-med for GDV patients that are not dyspneic is:
1. Hydro + Diazepam
2. Fentanyl + Midazolam
The best induction drug for GDV patients is:
1. Ketamine + Diazepam
2. Fentanyl + Diazepam
3. Hydromorphone + Diazepam
Why should Propofol be avoided in GDV dogs?
Causes splenic enlargement