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Flashcards in Test 2 Deck (112):
1

What effects do opioids have on gastrointestinal activity?

Initial increase (diarrhea, vomiting) and then slowing (colic, constipation)

2

Why must morphine be given IV slowly?

To prevent release of histamine that can result in a fall in BP, flushing and pruritis

3

What is the name of the synthetic opioid that is similar to oxymorphone and hydromorphone?

Methadone

4

Which opioid can be used to reverse sedation and respiratory depression of pure agonists while maintaining analgesia?

Butorphanol

5

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

6

Morphine can be administered with _____ and ketamine to control severe pain

lidocaine

7

When is intraarticular injection of opioids indicated?

After elbow or stifle surgery

8

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

9

What is the most common used drug for epidural?

Morphine

10

When should an epidural be given in the surgical process?

After induction but before surgery begins

11

Which opioid is used as a transdermal patch?

Fentanyl

12

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

13

What are 3 situations in which you would choose Fentanyl?

Trauma, burns, cancer

14

What are 2 signs of Fentanyl overdose in dogs? Cats?

Dogs - ataxia and sedation
Cats - dysphoria and disorientation

15

Why should we avoid the use of fentanyl patches in animals that have fevers?

Heat may increase the amount of fentanyl absorbed

16

Give 3 examples of NSAIDs

Acetaminophen, Meloxicam, Carprofen, Acetylsalicyclic acid

17

What is the major gastrointestinal concern associated with NSAIDs?

Gastrointestinal ulcers

18

NSAIDs can have adverse reaction on platelets. How?

Impaired platelet aggregation leading to prolonged bleeding time

19

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

20

What is MLK? (3 drugs used for intraoperative analgesia)

Morphine, lidocaine, ketamine

21

What is the name of an anticonvulsant that can be used in patients with chronic pain that is unresponsive to NSAIDs?

Gabapentin

22

Give 3 examples of Multimodal Therapy

1. Acetaminophen and Codeine
2. Fentanyl and Meloxicam
3. Morphine and Meloxicam

23

What are 3 examples of Non-pharmacologic therapies for pain? (There is 7)

- Acupuncture
- Transcutaneous nerve stimulation
- Massage therapy
- Temperature therapy
- Physiotherapy
- Laser therapy
- Herbal remedies

24

Give an example of an elicit motor action triggered by pain

A dog biting upon a painful injection

25

What is nociception?

Network of events and responses that leads to the perception of pain. Defense mechanism to painful stimuli

26

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

27

What are the 4 steps of nociception

1. Transduction
2. Transmission
3. Modulation
4. Perception

28

______ therapy targets 2 or more of the pain receptors using more than 1 analgesic drug

Multimodal

29

What happens during Transduction

conversion of stimulis to impulse by peripheral nociceptor

30

What happens during Transmission

Transports nerve impulse to the spinal cord via first order neurons

31

What 3 nerve fibers are involved in the Transmission process?

A-Delta, C, A-Beta

32

What happens during Modulation

Amplification or dampening of pain signals at the synapses of the first order neurons of spinal cord

33

What happens during the Perception stage?

Cerebral cortical response to projected pain by third order neurons in the brain

34

What is primary hyperalgesia? How does it occur?

Peripheral hypersensitivity to pain, results from tissue damage and constant nerve stimulation

35

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

36

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

37

True or false: Pain can cause a decrease in insulin and an increase in epinephrine

True

38

How can pain cause cardiac arrhythmias?

Pain increases myocardial work and oxygen consumption due to vasoconstriction

39

Behavioural signs of pain include ______ in cats and ______ in dogs

Cats - hiding
Dogs - seeking owner comfort

40

What is one sign of pain specific to thoracic/abdominal pain?

Restlessness or unable to lie down

41

How do we assess pain level?

Various types of descriptive scales based on clinical signs and behaviour

42

Maximum dose of Lidocaine and Bupivicaine in small animals is ______mg/kg

0.4

43

What is the most common sedative used for ruminants? why?

Xylazine - deep sedation and easily reversed

44

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

45

True or false: Ruminants are sensitive to Xylazine and could potentially become recumbent

True

46

What is meant by a Double Drip?

Guaifenesin and Ketamine mixture for sedation in ruminants

47

What is meant by a Triple Drip?

Guaifenesin, Xylazine and Ketamine mixture for sedation in ruminants

48

How is Xylazine given for induction of adult cattle, sheep and goats?

Half dose IV and the other half IM

49

Why is Thiopental not suitable for CRI maintenance?

It cumulates within the body

50

What induction agent is appropriate for CRI maintenance in small ruminants?

Propofol

51

How do you intubate a small ruminant?

The exact same as a small animal

52

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

53

What size range of ET tubes are used for ruminants?

22-30 mm

54

For IV maintenance in adult cattle, Double Drip is infused at a rate of:

2-2.5 ml/kg/hour

55

Less than _____ bpm is considered bradycardia in ruminants

55

56

A blood pressure of ______ mmHg or more in a ruminant is considered hypertensive

200

57

True or false: Centrally fixed eye position is normal in ruminant anesthesia

False. Ventro-medial position is normal

58

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

59

What are 3 reasons we may tranquilize or sedate a horse?

Transport, imagine, dentistry, scoping, examination

60

True or false: Anesthesia is riskier in small animals than it is in horses

False - much riskier in horses.

61

Why do horses often have difficult inductions and recoveries?

Their natural temperament is prone to panic

62

What is the fasting protocol in equine patients?

0-12 hours without hay and up to 24 hours without grain. Do not withhold water

63

Foals can nurse for up to _____ hour(s) before induction to surgery

1

64

Why must we rinse the mouth of horses before intubation?

To remove any food particles that could be pushed into the trachea upon intubation

65

What is applied above the vein before placing a jugular catheter in a horse?

Lidocaine

66

A jugular catheter in a horse is held in place in one of 2 ways:

1. sutured to skin
2. vetbond glued to skin

67

Why isnt Diazepam used alone as a pre-med in horses?

Causes excitement - add Ketamine

68

What is the most frequently used sedation agent in horses?

Xylazine

69

Which pre-med drug has the longest duration for horses?

Romifidine

70

Name 2 Alpha-2 + Opioid sedative combinations used for large animals

Xylazine + Butorphanol, Detomidine + Butorphanol, or Romidifine + Butorphanol

71

True or false: Propofol induction can only be used on adult horses

False. Foals only

72

Allow the pre-med to work for MINIMUM ____ minutes before induction

5

73

What is the mix to make triple drip?

Guaifenesin - 1 L
1000 mg Ketamine
500 mg Xylazine

74

When inflating an ET tube in a horse, never surpass ______ml or the cuff can collapse

50

75

What is a "field drop"?

Recumbent anesthesia in the field. 10-15 minutes of anesthesia via either Xylazine IV or Ketamine and Diazepam

76

Horns grow from growth cells over the _____ area of the bovine head

Poll

77

What are 2 reasons why we dehorn calves?

1. Prevent injury to others
2. Reduce aggression

78

What is meant by the term Polled Cattle?

Genetically prevented from growing horns

79

What is the age range within which calves can be safest dehorned?

1 day to 2 months old

80

For the Cornual Nerve block, what is the best restraint for older calves?

Head gate

81

For dehorning calves, sedate with _____ and administer ______ for analgesia

Xylazine, NSAID

82

Where is the cornual nerve?

Between lateral canthus of eye and horn under the boney ledge

83

When do you know if the cornual nerve is frozen enough to dehorn the calf?

Upper eyelid drooping means it is frozen

84

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

85

Give 2 examples of elective orthopedic surgery

Hip dysplasia, cranial cruciate ligament injury

86

Give 2 examples of non-elective orthopedic surgery

Bone fracture, joint luxation, open fractures

87

If severe trauma, contamination or multiple bone fractures, ______ should be given prophylactically

antibiotics

88

The most common non-elective orthopedic surgery is:

Bone fracture

89

What is a Celiotomy?

Incision into the abdominal cavity (AKA laparotomy)

90

What 2 diagnostic steps must be taken before exploratory surgery is considered?

Radiographs and ultrasound

91

What should you have ready before abdominal surgery just incase there is peritonitis present?

Warm saline

92

What are 3 indications for Gastrotomy?

Foreign body, hairball, string gut, neoplasia

93

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

94

Most patients experiencing dystocia have underlying ______ which needs to be corrected

dehydration

95

What fluid rate should be given to emergency c-section patients?

Up to 1/3 shock rate of Isotonic Crystalloids, 30 ml/kg/hour

96

______ is a drug that helps stimulate breathing in neonates

Doxapram

97

What are the 4 emergency drugs used for C-sections?

Naloxone, Doxapram, Epinephrine, Atropine

98

Why avoid Acepromazine during c-section?

Causes fetal depression and hypotension and is not reversible

99

What 2 drugs are best for IV induction for planned c-sections?

Propofol or Alfaxalone

100

What pre-med drugs are best for emergency c-sections?

Hydromorphone and IM Atropine (half dose) -- plus or minus Midazolam

101

What induction drugs are best for emergency c-sections?

Propofol to effect or Morphine/Lidocaine epidural

102

What 2 things should be administered to the mom once the fetuses have passed?

Additional anesthesia and analgesia

103

During c-section, once the fetuses are out _____ can be applied to the uterus to speed up involution

Oxytocin

104

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
5. Fearful/stressed
6. Eating from a raised bowl
7. Rotating susceptible patient dorsally

105

What are 3 clinical signs of GDV? (There are 7)

1. Anxiety
2. Abdominal pain
3. Excessive salivation
4. Retching, no vomit
5. Mucus membranes pale
6. DIstention of abdomen behind ribs
7. Respiratory distress

106

GDV requires a fluid rate equivalent to:

Shock rates

107

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

108

What is a Gastropexy?

Permanent fixture of stomach to abdominal wall to prevent future GDV

109

The best pre-med for GDV patients that are not dyspneic is:

1. Hydro + Diazepam
2. Fentanyl + Midazolam

110

The best induction drug for GDV patients is:

1. Ketamine + Diazepam
2. Fentanyl + Diazepam
3. Hydromorphone + Diazepam

111

Why should Propofol be avoided in GDV dogs?

Causes splenic enlargement

112

After GDV surgery, no food for ______ hours

24