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60 Cards in this Set

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What are 5 reasons we use pain management in vet med?
Procedures are perceived to be painful in animals, owners concerns, new gen anesthetics are much better, decreased movement due to pain no longer seen as protective, survival rate & recovery time improve w/ pain management.
What the goal of pain management?
Allow patient to move, eat & sleep w/out undue discomfort; focused on first 12-24 hrs after routine surgery; longer if sever traums occured or espcially painful surgery.
What are nociceptors?
Sensory nerve cells in skin or deep tissue that can detect a noxious stimulus & convert it to nerve impulses.
How are impulses transmitted by neurons?
It's a chain of at least 3 neurons. Sensory neuron in tissue-spinal cord neuron-brain neuron (where pain in perceived).
What are 2 types of sensory neurons?
A delta fibers & C fibers.
What are A delta fibers?
Sensory neurons; myelinated nerve axons.
What are C fibers?
Sensory neurons; nonmyelinated nerve axons.
Characteristics of A delta fibers?
Sharp, discret pain; fast transmission; patient can localize the site easily.
Characteristics of C fibers.
Dull, aching or throbbing pain; slow transmission; patient cannot easily pinpoint the source.
What are the 2 types of pain?
Somatic & visceral.
What is somatic pain?
Pain in the skin, SC, muscle, bone & joints. Both A delta and C fibers are involved.
What is visceral pain?
Pain in the internal organs. Primarily C fibers only.
How do you classify intensity of pain?
Mild, moderate & severe.
How do you classify the duration of pain?
Acute or chronic.
Which is more response the analgesics: acute or chronic?
What is referred pain?
It's felt in a body part other than the cause.
What is hyperesthesia?
An increased sensitivity to stimulus.
What is neuropathic pain?
It's due direct damage to peripheral nerves or spinal cord; often poorly responsive to analgesics.
What are two factors which will affect the type of pain produced?
The type of tissue and the amount of damage to the tissue.
How does the type of tissue affect the pain produced?
Tissue with large numbers of nerve ending or nerve themselves have more pain.
What types of tissues will have more pain?
Ears, eyes, bones, joints, nerves, cervical discs; thoracic surgery is more painful than abdominal.
How does the amount of damage to the tissues affect the type of pain produced?
Large amounts of tissue damaged or removed will be more painful.
Which types of tissue damage will have more pain?
Mastectomy, enucleation, burns, hip replacement.
What are some signs of pain?
Decreased activity; restlessness; limping; increased HR, RR; abnormal body posture, dilation of pupils, depression, inappetance, vocalization, trembling/shaking, inability to sleep, licking or chewing.
How do you anticipate the amount of pain an animal is in so you can treat it?
The more signs, the more pain they're in. Treat to the expected level of pain for a their particular procedure or trauma.
What is preemptive use?
Administering drugs before or during surgery.
What are 3 ways to use drugs preemptively?
Analgesics used as preanesthetics, epidurals & local or regional nerve blocks
What is windup?
A buildup of chemical mediators in spinal cord that intensify the perception of pain.
What helps to prevent windup?
Preemptive drugs.
How do preemptive drugs prevent windup?
Surgical manipulation leads to mediators being released & remain in spinal cord leads to intensifying pain perception upon recovery.
What's a benefit for using a preemptive drug?
You don't need as much general anesthetic. You can use an analgesic drug during surgery rather than increasing anesthetic depth if patient shows signs of pain.
What are 4 types of drugs used for preemptive use?
NSAIDS, local anesthetics, opioids & balanced or multimodal analgesia.
How do NSAIDs work as a preemptive drug?
They work at tissue level. Prevent prostaglandin production by inativating enzymes involved.
Do NSAIDs have a direct affect on the brain?
Some of them do.
How do local anesthetics work as a preemtive drug?
They block transmission of pain impulses in sensory nerves.
How do opioids work as a preemptive drug?
They affect sites in brain & spinal cord to decrease perception of pain.
What is balanced or multimodal analgesia?
Using drugs from more than one class of analgesic.
Builup of chemical mediators in spinal cord that intensify the perception of pain is what?
How do balanced or multimodal analgesic drugs work as a preemptive drug?
The can decrease the amount of each drug - decreases side effect. It's a more effective pain relief.
What 3 things are opioids used for?
Preanesthetics, neuroleptanalgesia & post operative pain control.
How do opioids work as a preanesthetic?
They have a short duration (2-4 hrs). They are not as affective as local anesthetics to prevent windup.
When you use a pure agonist opioid for moderate to severe pain what are the affects?
Significant sedation, excellent analgesia; significant respiratory & cardiovascular side effects.
What are some pure agonist opioid used for moderate to severe pain?
Morphine, hydromorphone, oxymorphone, fentanyl.
What agonists would you use for mild to moderate pain?
Weak agonists - meperidine, buprenorphine, nalbuphine.
Which opioid is both an agonist and antagonist?
Are NSAIDs an effective analgesic for somatic or visceral pain?
Somatic (skin/muscle).
How long does it take for NSAIDs to take effect?
30-60 mns.
When are NSAIDs most often used? Preanesthetic, maintenance, induction, postoperative?
What are 3 significant side effects of NSAIDs that may increase a patients surgical risk?
Decreased platelet aggregation & renal blood flow. It's metabolized by the liver & excreted by kidney or bile.
What are some precautions to take when using NSAIDs?
Try not to use preemptively - if needed give IV fluids; use only in young to middle-aged healthy dogs; use carprofen; screen presurgically for kidney & liver function.
Which NSAIDs can you use to reduce the ulcerogenicity effects?
Carprofen, etodolac & meloxicam.
What else can you do to reduce the ulcerogenicity of NSAIDs besides using carprofen, etodolac or meloxicam?
Give with a meal & use GI protectants (sucralfate).
What are 4 advantages of NSAIDs over opioids?
Can be given oral; not controlled; little effect on respiratory or cardiovascular function; no sedative effect (for postop use).
What are some contraindications for using NSAIDs?
Tylenol toxic to cats; dehydrated or hypotensive patients; liver or kidney dysfunction; corticosteroids; GI disorders; low blood pressure; congestive heart failure; clotting disorders.
General characteristics of local anesthetics.
Preemptive use only; short duration; potential for toxicity.
General characteristics of alpha2 agonists.
Short duration; profound sedative effect; serious side effects; use only in young to middle-aged healthy animals; epidural, alone or with opiois is an option.
What are some serious side effects of alpha2 agonists?
Respiratory depression, vomiting, bradycardia, heart block, hypotension.
General characteristics of ketamine.
Preanesthetic in cats (IM,SC); IV, IM or PO for pain if other drugs not available - useful in trauma at low dose - little resp/cardiovascular effect.
When is ketamine contraindicated?
Cardiac or renal disease.
General characteristics of tranquilizers.
No direct analagesic effect; calm patients, allow opioids to work; use for opioid-induced excitement.