Test 2 Notes: Janet Flashcards Preview

Anesthesia -Scott Newman & Janet King > Test 2 Notes: Janet > Flashcards

Flashcards in Test 2 Notes: Janet Deck (205):
1

Why is species important when administering different medications & dosages?

Cats can be sensitive to medicines that are normally fine for dogs
Smaller animals need different dosages than larger animals

2

2 Breed complications during anesthesia

Brachycepahlics tend to get airway obstructions during recovery due to:
Small tracheas
Narrow nares
Parasympathetic tone

Sight hounds are sensitive to barbituates during recovery due to their lack of fat
(barbituates need fat to metabolize)

3

How should obese patients be dosed?

by their ideal weight -most drugs are dosed according to brain size, not weight

4

How should emaciated patients be dosed?

by their true weight -these patients are prone to hypothermia and hypoglycemia so a quick recovery is ideal, may need to add dextrose to fluids to prevent hypoglycemia

5

Geriatric patients are prone to ____

Early, sub-clinical renal failure & hypothermia
always use IV fluids!

6

Why is it important to have IV fluids running on a patient?

Functional nephrons need good renal perfusion (Blood pressure and volume)
IV fluids keep the nephrons functional and prevent renal failure in the long run

7

Both geriatric and young animals ideally need what kind of drugs during anesthesia?

Short acting
Reversible

8

If a female is in heat during a spay what could happen?

Hemorrhage risk is increased due to increased blood flow and bigger arteries around uterus

9

Why would pregnant spays be an increased risk?

The patient will be dehydrated due to the removal of the fetuses and all of the enzymes and fluids she was providing for them. Give bolus of fluids

10

Aggressive patients are at a higher risk due to ____

Lack of ability to get PA information
Increased stress

11

Why is knowing how long the surgery will be important?

So you know when to turn down the anesthetic %

12

Liver and Kidney problems could be and issue with anesthesia due to ____

Decreased metabolism- would have trouble excreting the drug

13

Vomiting/Diarrhea

loss of electrolytes
Dehydration
Acid/base imbalance

14

What type of drug do you avoid if you have a patient with a history of seizures? and why?

Epileptogenic Drugs
They have a lower seizure threshold

15

What two specific drugs should be avoided for epileptic dogs?

Ketamine & Acepromazine (Use Valium instead)

16

Hyperthyroidism in cats causes ____ during anesthesia

Increased heart rate

17

Why is it important to know if the patient is currently on any other drugs?

Not all drugs work well together and may produce adverse side effects

18

Anesthesia history would be beneficial to have because ____

You can see if the patient had any previous complications or allergies

19

How long should you withhold food & water before PA drugs are given?

8-12 hours for food, water is okay up until PA drugs are given

20

Why is food withheld before a anesthesia procedure?

Most anesthetic drugs will cause vomiting which could lead to aspiration

21

Normal patient temp.

101.5 +/- 1degreeF

22

Respiratory rate

15-30rpm in dogs
20-30rpm in cats

23

Fever may indicate ___ which may worsen following anesthesia due to ____

an infection
stress and immunosuppression

24

Hypothermia ____ the effects of anesthesia, so ___

Potentiates
Less drugs are needed

25

Hypothermia complications

Longer recovery
Delay in wound healing
Longer clotting times

26

Normal heart rate in dogs and cats and what spot is used to get this?

60-160 (up to 180 in toy breeds and 220 in puppies)

110-220 in cats

Femoral ARTERY

27

Cachexia means ____

emaciated

28

S&S or S&R stand for

Strong and Synchronous
Strong and Regular

29

What is evaluated when palpating a pulse?

rate and character

30

A weak or absent pulse may indicate ____

hypotension

31

A bounding pulse may indicate ____

Hypertension

32

What could auscultating the heart help you find?

The rate and rhythm
Could hear respiratory sinus arrhythmia (normal in dogs)
Cardiac murmurs (fast-slow-fast-slow: matches respirations)

33

2 Main reasons for increased CRT and pale MM color

Peripheral Vasoconstriction
Decreased Tissue Perfusion

34

Examples of Peripheral Vasoconstriction causes

Hypothermia
Pain
Alpha-2 agonists (sedatives)

35

Causes of Cyanosis and why this is a result

Hypoxia
Because there is an increase in the amount of unsaturated hemoglobin

36

Things to look at when evaluating the pulmonary system

Respiratory rate, depth and effort
MM color
Auscultation of breath sounds

37

What is important to know when evaluating neuro system?

History of seizures--avoid epileptogenic agents--use Valium= tranquilizer + anticonvulsant
Pupillary light reflex--both eyes should constrict

38

Hepatic function is important during anesthesia for ____

LIVER:
Metabolism and elimination of drugs
May effect other body systems

39

Renal function is important during anesthesia for ____

KIDNEYS:
Elimination
Water distribution
Electrolytes
Blood pressure
RBC production

40

Sign of abnormal renal function

PU/PD

41

Things to evaluate when checking GI system

Do they have any:
V/D-- dehydration & electrolyte imbalances
Parasites-- anemia, diarrhea
GDV-- impairs ventilation, decreased cardiac output, hypovolemic shock, ^^^RISK!
Ascites-- fluid in abdomen, could indicate liver dz. or heart failure

42

What are the bare minimum lab tests that should be run? What tube should be used?

PCV & TP
RTT

43

What does the PCV evaluate for?

Anemia
Oxygen carrying capacity
Hydration status

44

If your patient is dehydrated the PCV will have a ____ & if they are over-hydrated the PCV will have a

Relative increase

Relative decrease

45

TP evaluates for ____

Hydration status
Blood loss
Liver function

46

Increased TP would indicate

dehydration

47

Decreased TP could indicate ____

Over-hydration
Liver disease
Malnutrition

48

When there is blood loss and acute hemorrhage what will drop first?

TP, PCV will be normal ~12 hours post blood loss

49

CBC consists of what tests, and what will they evaluate?

RBC/Hct/Hgb= oxygen carrying capacity
WBC= leukocytosis (infection/stress) leukopenia (immunosuppression/viral infection)
Eos= parasites/allergies
Plt= coagulation

50

The PA panel usually includes what 4 things?

1. Glucose
2. BUN/Creat
3. ALT/alk phos
4. TP

51

Glucose

pancreatic function test (DM)
could be stress induced

52

How to differ between DM and stress induced glucose in urine

Urine test to check for ^ GLU

53

BUN/creatinine

Kidney function (glomerular filtration of kidney)

54

When will glomerular filtration of the kidney be increased?

(Azotemia)
When the animal is:
Dehydrated
In shock
Hypotension
or Impaired renal function

55

ALT/alk phos

Liver Function
ALT= hepatocyte damage or destruction
Alk phos= hepatobiliary obstruction or bone growth/injury

56

What is the liver specific enzyme in dogs and cats?

ALT

57

Normal electrolyte balance is important for _____

Normal physiologic function

58

Blood gas tests are more important in what species?

Equine anesthesia

59

Urinalysis consists of ____

USG-- renal tubular function
Dipsticks-- pH, blood, bilirubin, GLU
Sediment-- crystals (ethylene glycol/ammonium biurate)

60

What are 2 additional tests that may be run

ECG -- known heart dz.
Rads -- fractures, thorax, abdomen

61

4 reasons why placing a patient on a IVC is beneficial

1. easier to admin. IV induction agents (titrate)
2. can use CRI of anesthetics/analgesics
3. important if emergency drugs are needed
4. IV fluids

62

2 Reasons IV fluids are highly recommended

To maintain blood volume and support blood pressure

63

When would you DEFINITELY want IV fluids hooked up?

If the sx will result in significant blood loss
Patient is dehydrated
Long anesthesia
Animal is at risk for hypotension or shock

64

Class I anesthetic risk

Excellent anesthetic risk
Normal healthy patient getting a elective procedure only (OHE, Declaw, Neuter)

65

Class II anesthetic risk

Good anesthetic risk
Patient with slight to mild systemic disease
Well controlled disease of ONE body system
Neonatal or Geriatric
Mild to Mod obese
ACL repair
Brachycephalic
Sighthound
Well-regulated diabetic

66

Class III anesthetic risk

Fair anesthetic risk
Moderate systemic disease
Mild clinical signs
Controlled dz of 1 or more body systems
Low to moderate fever
Moderately dehydrated
Anorexia/Cachexia
Heart or renal disease
Complicated fracture

67

Class IV anesthetic risk

Poor anesthetic risk
Severe systemic disease that is a threat to life
At least 1 poorly controlled severe disease
High fever
Azotemia
Severe dehydration
Morbidly obese
Severe anemia
Emaciated
DKA, GDV
*Sx must be preformed to save life*

68

Class V anesthetic risk

Guarded anesthetic risk
Moribund (close to death)
Patient not expected to survive 24 hours with or without surgery
Sx preformed in desperation
Not expected to survive

69

What are some myths of pain in animals?

Animals don't perceive pain like people- they tolerate it better than humans
Owners won't pay for analgesics
Better to keep animals in pain so they won't ruin the sx. site

70

Biology/physiology of pain

Increased anxiety and stress
Alters metabolism
Affects endocrine system
Decreased immune function

71

Signs that animal is in pain

Vocalization
Facial expressions
Body posture- hunched over/abnormal
Activity- restless/not moving
Attitude- aggression/depressed
Guarding/Licking/Chewing
Decreased appetite
Not sleeping
Panting/Salivation

72

What are the first 4 vital signs?

1.Temp
2.Pulse
3.Resp.
4.Pain assessment

73

What is the wind-up effect?

Hyper-excitability of central neurons due to constant bombardment of pain signals -- will wake up with overwhelming pain sensation, harder to control.

74

Why should pre-emptive analgesics be used?

Decreases the wind-up effect
Decreases the amount of GA needed

75

What 2 things does the wind-up effect lead to?

Allodynia
Hyperalgesia

76

Allodynia

Pain caused by a stimulus that normally does not result in pain
ex: petting

77

Hyperalgesia

increased response to a painful stimulus
(Over-exaggerated)

78

Opioids

Agonists
Best choice

79

What do opioids act on?

receptors in the brain and spinal cord
may also provide some sedation

80

OTM

Oral trans-mucosal
Butorphanol- cheek pouch in cats

81

Routes of administration for Opioids

PO
IM & SQ
Transdermal (patch)
Intraarticular
Epidural

82

Epidural duration of action

Most commonly morphine
Provides 6-24 hours of analgesia to caudal thorax, abdomen, hind limbs, pelvis, and tail

83

3 Properties of NSAIDs

1. Analgesia
2. Anti-Inflammatory
3. Anti-Pyretic (decreases fever)

84

2 Types of NSAID analgesia

Somatic (bones/joints)
Visceral (soft tissues/organs)

85

NSAIDs cause inhibition of ____

Prostaglandins (inflammation)

86

What 2 enzymes are inhibited by NSAIDs?

COX1 & COX2 (important in production of prostaglandins)

87

COX1 produces ____ prostaglandins & maintain what 3 things?

GOOD
Renal blood flow
Production of gastric mucus
Platelet function

88

What can inhibition of the COX1 enzyme lead to?

Gastric ulcers
Kidney failure

89

COX2 enzymes produce prostaglandins that cause what 2 things?

Pain
Inflammation

90

What are some examples of NSAIDs?

Aspirin
Acetaminophen
Carprofen
Meloxicam
Deracoxib
Etodolac

91

What are some examples of Opioids?

Morphine
Hydromorphone
Fentanyl
Butorphanol

92

What is the shortest acting Opioid?

Remifentanil
8-10min.

93

What are 3 NSAIDs not typically used in animals due to toxicity?

Aspirin
Acetominophen
Ibuprofen

94

How long does injectable carprofen usually last?

24 hours of analgesia

95

What are 4 side effects of NSAIDs

Gastric ulcers
Renal toxicity
Impaired platelet function
Hepatic damage (from long term use)

96

If you are worried about an animal's liver before giving NSAIDs what test should you do?

Bile acids test to assess hepatic function
(fast animal, test, feed animal, and test again)

97

What do local anesthetics do?

Block sensory nerve impulses and transmission of pain impulses
Temporary loss of sensation

98

What are 4 benefits of local anesthetics?

Few cardiovascular side effects
Low cost
Good pain control
Minimal patient recovery

99

Why would local anesthetics be used with GA?

Not as much GA gasses are needed
Pain control during and after surgery

100

Topical local anesthetics normally come in an ____ and can be used to ____

Ointment
Decrease laryngospasms when intubating a cat
"Splash block" by applying directly on nerves during sx.

101

How are infiltration local anesthetics used?

By blocking the nerves on the incision site
Ring block for a Onychectomy

102

What does a direct nerve block do?

Targets specific nerves
Can be used for dental blocks,onychectomies, brachial plexus blocks, enucleation sx

103

MLK & benefit of this drug combo

Morphine Lidocaine Ketamine
IV Local anesthetic
Reduces inhalant anesth. requirements by 25-30%

104

FLK

Fentanyl Lidocaine Ketamine

105

Lidocaine patch

Produces analgesia, but no anesthetic effect
Apply at surgery site

106

Example of IV local anesthetics and benefits

CRI of Lidocaine
Analgesia
Decreased vaporizer settings
Increases GI motility (horses)

107

Where do you inject an epidural?

Into lumbosacral region

108

What does local epidural do?

Loss of sensation and motor function

109

What does a opioid epidural do?

Use for pain control post-op

110

4 examples of local anesthetics

Lidocaine
Bupivacaine
Mepivacaine
Tetracaine

111

What does adding epinephrine to local anesthetics do?

Causes vasoconstriction so local is not absorbed into the blood stream, and can increase the duration by 50%

112

What are some negative aspects of local anesthetics

Lidocaine toxicity- neurotoxicity
Lidocaine CRI in cats- can cause seizures and bradycardia
Bupivicaine- Never IV

113

Alpha 2 agonists are ____ & are _____ than analgesia

Sedatives
Longer lasting

114

What do Alpha-2 agonists act on?

Pain receptors in brain & spinal cord to diminish pain perception

115

Examples of Alpha-2 agonists

Xylazine
Medetomidine
Dexmedeomidine

116

How are Alpha-2 agonists reversed?

With Alpha-2 antagonists

117

Ketamine is a ____/____

Cyclohexamine/Dissociative

118

When is Ketamine commonly used?

For induction of anesthesia or as GA for short procedures (Does NOT create unconsciousness)

119

What are NMDA receptors?

Pain receptors in the spinal cord

120

Why would a NMDA antagonist be used?

To prevent a wind up effect

121

What are some non-pharmacologic methods of pain control?

Acupuncture
Massage
Chiropractic
Cold/Heat
Herbal
Nursing care

122

What 2 things can amplify pain and how is this prevented?

Anxiety & Fear
Sedatives and Tranquilizers can help calm the patient

123

What are 5 reasons why we use PA drugs?

1. Sedate/Tranquilize- calms, decreases stress, and muscle relaxation
2. Pre-emtive analgesia to prevent wind up
3. Prevent bradycardia, dry secretions
4. Decrease amount of GA needed
5. Safer and smoother induction & recovery

124

How are PA drugs given?

IM or SQ
IV for Diazepam or emergency drugs

125

What are 5 classifications of routine Pas?

Anticholinergics
Tranquilizers
Alpha-2 agonists (sedatives)
Opioids (narcotics)
Neuroleptanalgesia (Combo)

126

What are the 2 Anticholinergics?

Atropine sulfate (Atropine)
Glycopyrrolate (Robinul-V)

127

How do Anticholinergics work?

Against the cholinergic (parasympathetic) nervous system
Block function of acetylcholine and vagal nerve

128

What are the main effects of anticholinergics?

slured<3= Heart- prevents bradycardia or may increase rate

129

What is the MAIN reason for using an anticholinergic?

to prevent bradycardia

130

What is the duration of Atropine sulfate?

60-90 minutes

131

Which anticholinergic has a faster onset and increases the HR more?

Atropine

132

Which anticholinergic prevents bradycardia, without the risk of causing tachycardia?

Glycopyrrolate- milder on the heart than atropine

133

Which anticholinergic has a longer duration of action?

Glycopyrrolate

134

When would you NOT use an anticholinergic?

Tachycardic patient
Constipated
CHF or Hyperthyroidism

135

What are the 2 groups of Tranquilizers?

Benzodiazapines "P's"
Phenothiazines "Z's"

136

What is the 1 Phenothiazine Tranquilizer?

Acepromazine (Promace)

137

What are the 3 Benzodiazapine Tranquilizers?

Diazepam (Valium)
Midazolam (Versed)
Zolezapam (in Telazol)

138

What are some physical properties of Acepromazine?

Water soluble
Yellow
10mg/ml concentration (usually diluted to 1mg/ml)

139

How long do Phenothiazines last?

(Acepromazine)
4-8 hours, sedation can last 24 hours
24-48 hours in geriatric or neonates

140

What are 10 effects of Phenothiazines?

(Acepromazine)
Calming
Decreased anxiety
**Antiemetic (decreased V/D)
Antiarrhythmic
Antihistamine (dont use in animals getting allergy test)
**Vasodilation**- can cause profound hypotension and hypothermia
Prolapse of 3rd eyelid (Ace face)
Penile prolapse in horses
May lower seizure threshold
NO analgesia but can improve analgesic effects
Dysphoria in some cases

141

What is the maximum dose of Acepromazine?

3mg (IM,SQ)
NOT reversible!

142

What is the reversal agent for Benzodiazepines?

Flumazenil

143

What are some physical properties of Benzodiazepines?

Diazepam is NOT water soluble
(can only be mixed with Ketamine)
NO analgesic properties
Controlled -human abuse potential

144

What are some main effects of Benzodiazepines?

**Anti-anxiety and calming**
not as much CNS as Ace- appear calm, but still alert
NO Analgesia
Excitement instead of calming in some cases (works best when combined with other drugs)

145

What combination works best together to prevent excitement instead of calming?

Opioid & Benzodiazepines (tranquilizer)

146

Other effects of Benzodiazepines

Good skeletal muscle relaxation (counteracts muscle rigidity caused by Ketamine)
Anticonvulsant - good for PA patients with seizure disorders
Appetite stimulant
Behavior modification: (oral diazepam)- aggression, anxiety, marking, licking

147

Which group of tranquilizers has minimal adverse side effects?

Benzodiazepines

148

Diazepam

(Valium)
Benzodiazepine
Calming
Muscle relaxant
Anticonvulsant

149

How should Diazepam be given?

IV slowly
In combination with other drugs as PA
May cause excitement if given alone

150

Midazolam

(Versed)
Water soluble- can mix with other PA drugs
Given IM or SQ
Minimal sedation and possible excitement if used alone (use in combo)

151

Zolazepam

found in (Telazol)
Can be used as induction agent or sole anesthetic agent for short, minimally painful procedures

152

What 2 drugs are in Telazol?

Zolazepam & Tiletimine

153

What are the 3 Alpha-2 agonists?

(Sedatives)
Xylazine (Rumpun)
Medetomidine (Domitor)
Dexmedetomidine (Dexdomitor)

154

What is Xylazine reversed with?

Yohimbine alpha-2 antagonist (Yobine)

155

What are Dexmedetomidine and Medetomidine reversed with?

Atipamezole alpha-2 antagonist (Antisedan)

156

Properties of Alpha-2 agonists (sedatives)

NOT controlled
Reversible
Can be absorbed through skin & mm
Produce analgesia, sedation, muscle relaxation
Emetic- vomiting in 50% of dogs and 90% cats

157

How do Alpha-2 agonists (sedatives) work?

By binding to alpha-2 adrenoreceptors on sympathetic nerves within brain and spinal cord

158

Which group of drugs produces a potent, sleep-like state?

Alpha-2 agonists

159

Does sedation or analgesia last longer in alpha-2 agonists?

Sedation

160

How can alpha-2 agonists be given?

IV, IM, SQ, Epidural

161

Side effects of alpha-2 agonists

**Bradycardia and arrhythmias
Hypotension
Resp. depression
Hypothermia
Peripheral vasoconscriction

162

Xylazine

(Rompun)
Only used in young, healthy animals
Emetic

163

Medetomidine

(Domitor)
Only used in young, healthy, calm animals
Bradycardia is common

164

How is Medetomidine and Dexmedetomidine dosed?

By mcg per square meter of body surface (use chart for volume using body weight)

165

Dexmedetomidine

(Dexdomitor)
Newer version of Medetomidine (Domitor)
Adverse reaction in excited animals
Use only in young, healthy and calm patients

166

What should be given before administration of alpha-2 sedatives?

Anticholinergics to decrease adverse cardio effects

167

What group of drugs are the most effective for treatment of pain?

Opioids

168

How are Opioids used?

For PA- decrease GA and windup
Induction
Intra-articular

169

What are the 3 classifications of Opioids and which is the best?

Pure agonists
Partial agonists
Mixed agonist/antagonist

170

What are the 2 Opioid receptors in the brain?

Mu
Kappa
Sigma

171

What are the 5 Pure agonist Opioids?

Morphine
Hydromorphone
Oxymorphone
Methadone
Fentanyl

172

What is the 1 mixed agonist/antagonist opioid?

Butorphanl

173

What is the 1 partial agonist opioid?

Buprenorphine

174

What is the reversal of Pure Agonist Opioids?

Naloxone

175

What are some CNS effects of Opioids?

CNS depression or excitement (dysphoria)
Euphoria in some patients (Cats love buprenorphine)

176

What are some signs of dysphoria?

Whining, barking, anxiety, restlessness

177

Analgesic effects of Opioids?

Most effective as pure agonists
Excellent PA for animals having painful surgery

178

What is the most common side effect of Opioids?

Respiratory depression
can be serious
dose related- smaller doses are much safer

179

What are a few GI side effects of Opioids and what drug can be used to decrease these?

Emetic (Vomiting/Diarrhea)
Flatulence

Atropine or Acepromazine decreases these effects

180

Dogs get ___ and ___thermia with Opioids
Cats get ___ and ___thermia with Opioids

Miosis & Hypothermia
Mydriasis & Hyperthermia

181

Morphine

(Duramorph)
Pure agonist
Can cause dysphoria
Best when used with tranquilizer

182

What 2 things does Morphine produce?

(Duramorph)
Analgesia & Sedation

183

What are some benefits of Morphine?

(Duramorph)
Inexpensive and effective for severe pain
Can be added to fluids and given IV

184

Routes and duration of Morphine?

IM, SQ, IV (dogs only) Epidural
Epidural- 12-24 hours
IM or SQ- 4+ hours in cats (less chance of bad reaction SQ)

185

Hydromorphone

(Dilaudid)
Pure agonist
5X more potent than morphine
IV, SQ, or IM in both cats and dogs

186

Duration of Hydromorphone

Lasts 4 hours (IM,SQ)

187

Effects of Hydromorphone

Less likely to cause vomiting
Less potential to cause excitement in cats
-Resp. depression
-Dysphoria
-Bradycardia
-Panting

188

Oxymorphone

(Numorphan)
Pure agonist
10X more potent than morphine and more sedation

189

Duration and effects of Oxymorphone

(Numorphan)
3-4hours
Less likely to cause vomiting
More expensive than morphine and hydro
Increased sensitivity to sound

190

Fentanyl

(Sublimaze)
Pure agonist
100-150X more potent than morphine

191

Who is fentanyl not recommended in?

Cats

192

Duration of fentanyl

(Sublimaze)
Only 30min. so commonly used as CRI or Transdermal patch

193

Fentanyl patch brand name & facts

(Duragesic)
Transdermal delivery that provides continuous, steady-state analgesia for 3-5 days (Post op)

194

How long does it take the Fentanyl patch to reach therapeutic blood levels?

4-12 hours in cats
12-24 hours in dogs
Apply patch 12-24 hours prior to anesthesia

195

Butorphanol

(Torbugesic or Torbutrol)
Mixed agonist/antagonist
Not as effective as pure is at treatment of severe pain
Some sedation

196

What can Butorphanol reverse?

(Torbugesic or Torbutrol)
Partially reverses pure agonists- can use to somewhat reverse resp. depression, sedation, or dysphoria but also reverses some analgesic effects.

197

Duration of Butorphanol

(Torbugesic or Torbutrol)
1-4hours
1 hour in dogs
Up to 4 hours in Cats

198

Buprenorphine

(Buprenex)
Partial agonist
Expensive
Analgesia for mild to moderate pain
Some sedation
Has the longest duration

199

Duration of Buprenorphine

(Buprenex)
Lasts 6-8 hours and up to 12 in some patients

200

Which opioid has a better analgesia for cats that is administered OTM?

Buprenorphine (Buprenex)

201

What does OTM mean?

Oral Transmucosal
Cheek pouch administration in cats
(Buprenorphine/Buprenex)

202

What do Opioid antagonists do?

Displace opioids from receptors, causing a reversal of the agonist effect
Can reverse sedation, dysphoria, panting, resp. depression, hypotension, bradycardia...etc.

203

Naloxone blocks all ____ receptors

(Narcan)
Mu receptors
Can be titrated to minimize the reversal of analgesia

204

What is the elephant opioid?

Etorphine (M99)
3,000-8,000X more potent than morphine
Can immobilize elephants and other large mammals
Reversed with M5050

205

What are some common Neuroleptoanalgesics?

Acepromazine & Butorphanol
Diazepam & Hydromorphone
Versed & Fentanyl