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16 Cards in this Set

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What are NSAIDs?
effective analgesics for the management of acute peri-operative pain and chronic pain

drugs are not controlled and mostly palatable with a long duration of action

can have many side effects

these meds can be given IV,SC and orally
What is the efficacy between NSAIDS?
studies comparing analgesic efficacy of different NSAIDs
fail to show a difference between drugs
Wat are the cox1:cox2 ration
depends on assay (cell, tissue type)
laboratory
species
in vitro VS in vivo
need PK/PD data in target species

COX2 selective, preferential
COX1 sparing

COX 2 selective drugs could "eliminate" gastric side effects but there is no relationship
What are the renal effects of NSAIDs?
prostaglandins regulate
-glomerular filtration rate
-renin release
-sodium excretion

-may impair GRF in patients with renal disease or hypotension
-may cause renal ischemia in patients with hypotension
What are renal concerns with NSAIDs?
hypotension
-renal perfusion is PG dependent

COX-2 is constitutive in the canine kidney
-renal blood flow, fluid balance
What is the relationship between hemostasis and NSAIDs?
COX 1 - causes platelet aggregation and vasoconstriction

COX 2 causes vasodilation and inhibits platelet aggregation

NSAIDS increase or decrease blood clotting depending on COX selectivity
What is COX - 2?
constitutive in kidney, GI mucosa, CNS, bone and cartilage
What are the GI effects of NSAIDs?
GI ulceration and bleeding
What are prostaglandins essental for?
-maintenance of mucosal blood flow
-bicarbonate and mucous secretion
-epithelialization
What are the benefits and costs of NSAIDs before surgery?
effective provision of analgesia

risk of GI bleeding and perforation
renal ischeima (peri-operative use)
hemorrhage more important during peri-operative use
What is pre-emptive analgesia?
antinociceptive treatment that prevents establishment of altered central processing of afferent input from injuries
When can NSAIDs be given?
before and after sedation
20 minutes after extubation
2,4,8 and 20 hours after surgery
What is the mechanism of action for NSAIDs?
NSAIDs are predominantly enzyme inhbitors

-true pre-emptive effect should be given 1-2 hours before start
Why do some dogs have trouble with NSAIDs?
- no work up brefore drugs are prescribed
-overdosed
-other medical problems
-other concurrent medication
How long should an animal be on NSAIDs?
there is no evidence based on recommendations

must provide alternative analgesic in the intervening period
What do you do if you don't give NSAIDS re operative what can you do?
-provide adequate analgesia using opioids
-use a combinations of systemic and local analgesia (local block/epidural)

-delayed NSAID administration until the animals is fully awake and normotensive after recovery from anesthesia