Anesthesia Test Section2

Front 1

What are the 4 phases of anesthesia?

Back 1

Pre-anesthesia

Induction--->unconsciousness

Maintenance & Monitoring

Recovery

Front 2

What anesthesia concerns are there with brachcephalic breeds?

Back 2

*airway obstruction concerns during RECOVERY
*tend to have stenotic nares
*Tracheal diameter tends to be smaller, so a smaller ET tube may be needed
*Increased Parasympathetic/Vagal tone may lead them to become bradiacardic during Sx
*Automatically a 2 on Physical Status/Risk scale due all the above.

Front 3

Sighthounds tend to have issues with what type of drugs due their low body fat?

Back 3

Barbituates

Front 4

When calculating anesthetic meds for an animal, if the animal is overweight, what weight should be used, actual or ideal weight?

Back 4

Ideal weight should be used

*Brain is same size no matter how fat the animal is**

Front 5

What is another concern we have with obese patients during anesthesia?

Back 5

*With have trouble ventilating themselves--Need more ventilatory support

*Are dyspnic, even at rest

Front 6

What are some concerns we have with emaciated/anorectic patients for anesthesia?

Back 6

*With these Pt's, we calculate drugs at ACTUAL weight rather than ideal.

*Hypothermia is an issue

*Hypoglycemia can be an issue ---add Dextrose to fluids

Front 7

What defines the geriatric life phase?

Back 7

Animal has lived 75-85% of expected lifespan

Front 8

What is one reason it is important to have fluids going during a Sx for a geriatric patient?

Back 8

MANY have early sub-clinical kidney failure and maintaining renal perfusion leads to less damage to already damaged kidneys.

Front 9

Anesthesia leads to a decreased blood pressure, therefore lowering renal perfusion, which kills off nephrons. How do we counteract the effects of lowered BP of anesthesia, thereby SAVING the nephrons?

Back 9

Give IV fluids to keep BP and therefore renal perfusion up.

Front 10

What are 2 concerns with geriatric patients and anesthesia?

Back 10

Hypothermia
Hypoglycemia

Front 11

What is the basic guideline for defining an animal as a neonate?

Back 11

Less than or equal to 8 WEEKS of age

*Study was done that came to the conclusion that physiologically neonates are the same as adults in regards to how they can process anesthesia. Have the same Kidney and liver function.

Front 12

What is a concern for neonates during anesthesia?

Back 12

Hypothermia and hypoglycemia

Front 13

What is one way to counteract the effects of hypoglycemia in patients where this is a concern during anesthesia?

Back 13

-With hold food for shorter amount of time
*add dextrose to IV fluids

Front 14

What are 2 basic rules of thumb for anesthesia with Geriatric and Neonates?

Back 14

*Use a shorter acting anesthesia since liver is not working as well

*Use a reversible drug that does not need to be metabolized.

Front 15

In regards to Sex-repro status, what are some items that need to be checked before anesthesia?

Back 15

*Cyptorchid is an increased surgical risk due to abdominal incision.
*Preg check-pregnant is increased risk
**ALWAYS have fluids going!!.
-If female is closer to term, when uterus and fetuses are being removed, BP will drop drastically, so consider increasing fluids or give a bolus.
*Estrus-increases blood flow to uterus, increase risk for hemorrhage during recovery.

Front 16

Why are animals with temperament issues a possible increased anesthetic risk?

Back 16

*Cannot do a P/E, pre-anes bloodwork, so animal is not fully pre-assessed
*Stress can predispose animal to cardiac arrythmias--->respiratory arrest

Front 17

Duration of problem affects anesthetic risk because_________________

Back 17

a longer existing problem will have more issues than one that recently started and was quickly caught, diagnosed and corrected.

Front 18

Concurrent disease should be _____________ prior to anesthesia/Sx.

Back 18

fixed if possible

Front 19

If an Pt has a history of seizures, what dugs should be avoided because of their tendency to lower seizure threshhold?

Back 19

Ketamine
Acepromazine
(Diazapam is a good alternative to Ace)

Front 20

What are some concerns if an animal has Addison's/Hypoadrenocorticism?

Back 20

-Will have low Na, High K

-These predispose an animal to bradycardia, arrythmia and cardiac arrest

_Should try to fix prior to anesthesia/Sx

Front 21

What are some concerns if an anima has DKA prior to Sx?

Back 21

Diabetic Ketoacidosis cause severe metabolic acidosis causing increase in blood ph

Front 22

Why is there a concern if an animal has liver or kidney disease?

Back 22

Interferes with drug metabolism

Front 23

WHat should be done if an animal has heart issues in regards to Sx?

Back 23

Avoid cardiovascular

Front 24

Why do we palpate for a pulse?

Back 24

To determine blood pressure and character of pulse (weak, bounding, thready)

Front 25

A weak or absent pulse may indicate?

Back 25

Hypotension due to pulses disappearing when systolic <60mmHg

Front 26

A bounding pulse indicates?

Back 26

hypertension

Front 27

A pulse deficit indicates?

Back 27

PVC's due to HR exceeding pulse

Front 28

Increased CRT and pale MM indicate?

Back 28

1. Peripheral Vasoconstriction due to cold, pain, alpha-2 agonists

2. Decreased tissue perfusion possibly due to:
Excessive anesthetic depth
Hypotension
Bradycardia
Blood loss, anemia
shock
Heart failure

Front 29

Cynosis is due to ?

Back 29

Hypoxia, increased amounts of reduced Hg

Front 30

Liver function is important in regards to anesthesia because?

Sx?

Back 30

Metabolism and elimination of anesthesia

Sx-produce clotting factors, albumin for maintaining oncotic pressure

Front 31

Why is renal function important in regards to anesthesia?

Back 31

-Anesthetic elimination, regulate distribution of H2O, electrolytes, blood pressure maintanence with Renin production

Front 32

What are some GI concerns in regards to anesthesia?

Back 32

Primarily V/D that will cause fluid and electrolyte imbalances, acid base imbalances
-Parasites can cause anemia, diarrhea
-GDV can impair ventilation and depress cardiac output

Front 33

What is the bare minimum Lab work that should be done prior to anesthesia?

Back 33

PCV/TP
-To diagnose anemia and evaluate O2 carrying capacity
--PCV less that 20-2% CAUSES HYPOXIA-->leads to poor tissue oxygenation

Front 34

What does TP eval tell us that we need to know prior to Sx?

Back 34

increased= dehydration
decreased=
over-hydration, liver disease, protein losing nephropathy, protein losing enteropathy (diarrhea), malnutrition/starvation

Front 35

What does the CBC tell us in regards to the RBC/Hct/Hgb?

Back 35

Oxygen carrying capacity

Front 36

What does the CBC tell us in regards to the WBC?

Back 36

Infection/inflammation
stress, fear
immunosuppression

Front 37

What does the CBC tell us when we see increased Eos?

Back 37

Parasite present
allergies

Front 38

What does the CBC tell us in regards to platelet evaluation?

Back 38

Ability to clot and coagulate

Front 39

What do blood chemistry/PA panels tell us in regards to Glucose?

Back 39

pancreatic function test

Front 40

What do blood chemistry/PA panels tell us in regards to BUN, Creatinine?

Back 40

Tells us about the GLomerular function of the kidney
-Will be increased (Azotemia) with impaired renal function
-Can be increased with dehydration, shock, hypotension
-BUN may decrease with liver disease

Front 41

What do blood chemistry/PA panels tell us in regards to ALT/ALK Phos?

Back 41

Tells us about liver function

ALT increase-hepatocyte damage or destruction

ALK Phos increase indicates HBO, Bone growth/injury

Front 42

What are the 6 tests the make up the PA panel?

Back 42

Glucose
BUN/ Creatinine
ALT/Alk Phos
TP

Front 43

What does a U/A tell us in regards to pre-anesthesia evaluation?

Back 43

-Renal tubules are functioning,
-Kidneys are functioning-->concentrating urine
-Hydration status
DIPSTICKS=ph, blood, bilirubin (liver), glucose/ketone , proteins
-SEDIMENTS-Crystals

Front 44

What is a concern in regards to hyperthermia and anesthesia?

Back 44

Increases metabolic rate and therefore O2 requirements

Front 45

What is the concern about hypothermia in regards to anesthesia?

Back 45

Decreases metabolism and INCREASES effects of anesthesia

Front 46

Prolonged CRT during anesthesia is often due to a common side effect anesthesia causes--peripherial vasoconstriction. What causes this?

Back 46

-Cold, hypothermia
-Pain response
-Alpha-2 agonists such as Xylazine

Front 47

Prolonged CRT during anesthesia is often due to a common side effect anesthesia causes--Decreased Tissue perfusion. This can be caused by:

Back 47

Decreased tissue perfusion
-Hypotension
-Bradycardia
-Blood loss/anemia
-Shock(don't write this on a test)
-Heart failure

Front 48

Early post-op hemorrhage will show what on the PCV and TP?

Back 48

PCV will look ok due to splenic contraction adding blood to circulation.
TP will decrease
---DO these if animal looks off to check for hemorrhage

Front 49

What can pre-surgical rads help with diagnosing?

Back 49

Fractures
-Thorax issues-pneumothorax, pulmonary contusions, diaphagmatic hernia, cancer=mets
-Abdominal issues such as ruptured bladder, GDV, urolithiasis

Front 50

What are 4 reasons a Pt should have an IVC if undergoing anesthesia/Sx?

Back 50

1. Easier to administer IV induction agents
2. Can use Constant Rate Infusion of anesthestics, analgesics
3. Easy administration of emergency drugs such as Epi, Atropine, Lidocaine
4. IV fluid administration-**maintain blood volume**support blood pressure**

Front 51

Fluids are recommended but not required for healthy animals during routine Sx such as spays and neuters. You definately want fluids during what kinds of Sx?

Back 51

-If Sx could result in significant blood loss such as spaying pregnant animal, amputation, splenectomy, big tumor removal
-If the Pt is debilitated, dehydrated, geriatric, has any electrolyte imbalances
-Long Sx
-Pt at risk of hypotension, shock

Front 52

What are some common Biologic/Physiologic responses to Pain?

Back 52

--Increased anxiety
-Increased HR, RR, BP
-Alters metabolism-catabolism
-May cause endocrine balance to be out of sync
-Decreases immune function
-Affects/decreases Cardio-pulmonary function
-Salivation
-Mydriasis
Pale MM, increased CRT

Front 53

What are some ways animals may show they are painful?

Back 53

-Vocalization-whining,groaning & moaning, crying
-FACIAL EXPRESSION-fixed stare-no eye contact, glazed/squinty eyes (esp. cats) and ears back
BODY POSTURE-hunched over, splinting of abdomen, abnormal posture, repeatedly changing positions
ACTIVITY-restless, reluctant to move
GUARDING of painful area
Licking and chewing of surgical area
ATTITUDE-depressed, unresponsive, aggressive
Appetite decreased

Front 54

The purpose of the Physical Status/Anesthetic scale is?

Back 54

Attempts to standardize the pre-operative evaluation of a patient's anesthetic risk and is based primarily on the presence and severity of systemic disease.

Front 55

Class I-EXCELLANT anesthetic risk is defined as:

Back 55

-Young, normal healthy patient with no discernable disease undergoing and elective procedure such as OHE, neuter, declaw
-Exam and blood work ALL normal

Front 56

Class II-GOOD anesthetic risk is defined as:

Back 56

-Pt with SLIGHT to MILD systemic disease w/no functional limitations
-Well-controlled disease of one body system
-Neonatal or geriatric
-Mild to moderate obesity
-Brachycephalics due to airway obstruction concerns in recovery
-Sighthounds when using barbituates
-For procedures such as:
simple Fx w/o shock
Cryptorchid
ACL repair in young healthy dog

Front 57

Class III-FAIR anesthetic risk is defined as:

Back 57

-Pt w/MODERATE systemic disease that limits activity but is not incapacitating
-Mild clinical signs
-CONTROLLED disease of 1 or more body systems
-Low to moderate fever
-Moderate dehydration
-hypovolemia
-anorexia/chachexia
-Anemia, Chronic heart, kidney disease
-For Procedures such as:
Complicated Fx repair
Mild to moderate CHEST trauma
ex-older dog with Pyo, 13 year old dog in for routine dental

Front 58

Class IV-POOR anesthetic risk is defined as:

Back 58

-Pt w/ SEVERE systemic disease that is a constant threat to life
-Has at least ONE severe disease that is poorly controlled
**SURGERY MUST be performed to save life
-Animal may have shock, Azotemia, Severe dehydration & hypovolemia, Morbid obesity, Severe anemia, emaciation, DKA, GDV, Uncompensated cardiac/renal/hepatic disease, severe respiratory disease
For procedures such as:
Severe chest trauma, diaphragmatic hernia, Equine colic

Front 59

Class V-GUARDED anesthetic risk is defined as:

Back 59

-Moribund--close to death
-Pt NOT expected to survive 24 hours with or without Sx.
-Sx performed in DESPERATION
-Advanced multi-system organ failure
-Severe shock
-Major trauma/severe head injury
-DIC/Sepsis
-Advanced GDV

Front 60

CLASS ___ + E anesthetic risk is defined as:

Back 60

a classification added to any of the other classifications to DENOTE EMERGENCY BASIS FOR ANESTHESIA. Always a poorer risk when operated on in an emergency situation versus another Pt in the same catagory.

Front 61

In regards to analgesia, the 4th vital sign is _______?

Back 61

Pain assessment

(TPR are the other 3)

Front 62

Multimodal approach to anesthesia is defined as and what is the advantage?

Back 62

-Different analgesia used in different ways to increase efficacy

-Advantage is better ability to control pain

Front 63

Define wind-up

Back 63

Hyperexcitability of central neurons due to constant bombardment of pain signals
-Animal is unconscious and this results in animal being increasingly sensitive to pain.
RESULTS in animal waking up with overwhelming pain sensation that is harder to control.

Front 64

Wind up leads to:

Back 64

ALLODYNIA-pain caused by stimulus that normally does not cause pain --such as petting

HYPERALGESIA-increased response to a painful stimulus

Front 65

What are 2 benefits of pre-emptive analgesia?

Back 65

-Decreases wind-up

-Decreases amount of GA, therefore making anesthesia safer

Front 66

What are the common analgesics?

Back 66

-Opioids
-NSAIDS
-Local analgesics
-Alpha-2 antagonists
-Low dose ketamine

Front 67

What are some basic facts about Opioids (narcotics)?

Back 67

1st choice-BEST Analgesic
-Act on pain receptors in brain and spinal cord
-May also produce some sedation
-Used for PA, neuroleptoanalgesia, intra and post op

Front 68

What are examples of opiods?

Back 68

-Morphine
-Hydromorphone
-Butorphanol
-Buprenorphine
-Remifentanil (very short duration)
-Tramadol-An OPIOID like drug that binds to opioid receptors but is not a narcotic or controlled drug.
------sent home for pain control

Front 69

What is a unique way that Buprenorphine can be administered?

Back 69

Cheek pouch in cats--oral trans-mucosal route

Front 70

What are some basic properties of NSAIDS?

Back 70

-Provides analgesia.
All are good for somatic pain, only some for visceral
-Carprofen and Rimadyl are good for BOTH somatic and visceral pain
-Are ANTI-INFLAMATORIES
-ARE ANTI-PYRETIC

Front 71

How do NSAIDS work?

Back 71

Cause inhibition of prostaglandins by inhibiting the specific enzymes-Cox-1 and Cox 2 which are important in the production of prostaglandins.

Front 72

What do prostaglandins do?

Back 72

Cause vasodilation, increased vascular permeability, sensitize peripheral pain receptors, granulation tissue.

Front 73

What are does the COX-1 enzyme do?

What are side effects we are concerned with for COX-1 inhibiting NSAIDS?

Back 73

-Enzyme is important for the production GOOD prostaglandins
-Maintain renal blood flow
-Involved in the production of gastric mucus.
Maintain platelet function

Therefore, COX-1 inhibiting NSAIDS may cause kidney failure and gastric ulcers (alter flow of blood to kidneys and decrease mucus production)

Front 74

Why are COX-2 NSAIDS a better choice?

Back 74

-COX-2 enzyme is important in production of prostaglandins that cause pain and inflammation.
-COX-2 enzymes have Less of a role in everyday basic body functions- so inhibiting them is more effective in stopping pain and less side effects such as renal failure and GI bleeding.

Front 75

What are some examples of COX-2 inhibiting NSAIDS?

Back 75

Carprofen
Meloxicam
Deracoxib
--with slight COX 1 qualities)

Front 76

What are some examples of NSAIDS?

Back 76

-Asprin
-Acetominophen
-Carprofen
-Meloxicam (kitties)
-etodolac
-ketoprofen
-piroxicam

Front 77

NSAIDS have a big variation between species. Asprin has a half life of 1 hr in a horse, 8 hours in a dog and how long in a cat?

Back 77

38 hours

Front 78

Injectable Carprofen provides analgesia for how long typically?

Back 78

24 hours

Front 79

Acetominophen is ok in dogs but should never be given to?

Back 79

Cats

Front 80

Ibuprofen should never be given to?

Back 80

Dogs AND cats

Front 81

What are some potential effects of NSAIDS?

Back 81

-Gastric Ulcers
-Renal toxicity
-Impaired platelet function
-Hepatic damage, esp in labs and retrievers

Front 82

What is the basic function of Local Anesthetics?

Back 82

To block sensory nerve impulses and transmission of pain impulses with a temporary loss of sensation.

Front 83

What are some of the benefits of Local anesthetics?

Back 83

-Few Cardiovascular side effects
-Low cost
-Good pain control
-Minimal patient recovery

Front 84

When are Local anesthetics used alone?

Back 84

-For small skin tumors

-In animals that cooperative so that a local is enough for their small procedure

Front 85

Locals are used in addition to GA for:

Back 85

Balanced anesthesia & Pain control during SX, leading to less ISO/SEVO being used.

Front 86

What routes are Local anesthetics given?

Back 86

-Topical
Ointments, Lidocaine for cat intubation, Splash block
-Infiltration into surgical area
Incisional block
Onchyectomy ring block
-Direct nerve block
Target specific nerves
-Intrarticular
-Epidural

Front 87

Drugs that are given as locals are sometimes given CRI. Lidocaine can be given as a CRI and it provides____________________ but should not be given to cats because ___________.

Back 87

a systemic analgesic effect

-Causes seizures and bradycardia

Front 88

What is MLK and how is it administered?

Back 88

Morphine-opioid
Lidocaine-local
Ketamine-dissociative

Given CRI

Front 89

What are the advantages of giving Lidocaine CRI or MLK CRI?

Back 89

-Provides analgesia
-Decreases vaporizer settings
-Increases GI motility ( a concern in horses)
-MLK decreases inhalant anesth. requirements by 25-30%

Front 90

Where is an Epidural given and with what meds?

Back 90

-Injected into epidural space in lumbrosacal space.
-This space contains fat and nothing should come back out of the Epi needle.
Can give a local med-loss of sensation and loss of motor function.
Can give an opioid for pain control post op.
-Can be combined

Front 91

What are some examples of local anesthetics?

Back 91

Lidocaine
-Bupivicaine
-Mepivicaine
-Tetracaine

Front 92

How long does Lidocaine last?

Back 92

1 hour
fastest onset, shortest duration

Front 93

How long does Bupivicaine last?

Back 93

4-6 hours
longer onset, longest duration

Front 94

How long does Mepivacaine last?

Back 94

2-3 hours

Front 95

Adding epinephrine to locals, especially to Lidocaine, has what effect?

Back 95

-In will increase duration of local anesthetic as much as 50% because it causes vasoconstriction .
-This slows uptake into the bloodstream, so stays put--stays local.
-Doubles the effect of Lidocaine from 1 to 2 hours
-Epi also helps control hemorrhage due to vasoconstrictive qualities

Front 96

What are some concerns about Lidocaine?

Back 96

Neurotoxicity leading to confusion, seizures

Front 97

What are some concerns about Bupivicaine?

Back 97

NEVER give IV -causes unresuscitatable cardiac arrest

Front 98

Alpha-2 agonists are sedatives that act on:

Back 98

-Pain receptors in the brain and spine to diminish pain perception
-Advantages is that the sedation lasts longer than analgesia
-have PROFOUND/DANGEROUS side effects. ONLY used on YOUNG and HEALTHY
-Bradycardia, hypotension, heart blocks, decreased CO are some of the concerns

Front 99

What are some examples of alpha-2 agonists?

Back 99

-Xylazine
-Dexmetatomidine
--Medetomidine-
Microdoses via IV/CRI as and adjunct with other analgesics to provide analgesia with fewer cardiovascular side effects, has been shown to decrease inhalant requirements by 20-30%

Front 100

Alpha-2 agonists are reversible with:

Back 100

Alpha-2 antagonists

Front 101

Ketamine is a cyclohexamine/dissociative anesthetic usually used for induction of anesthesia or as a GA for short procedures. It is also an NMDA receptor antagonist that does what?

Back 101

-NMDA receptors are pain receptors are pain receptors in the spinal cord and Microdoses of Ketamine block the pain receptor but limits the effect to stopping pain due to blocked pain receptor.

Front 102

Ketamine produces unconsciousness for PA or short procedures. Can be comnbined with Microdoses of what to enhance effects?

Back 102

MLK-
Morphine- analgesic
Lidocaine-Local anesthetic
Ketamine-NMDA receptor antagonist

Front 103

Balanced anesthesia is :

Back 103

The entire anesthetic period from beginning to end including the post-op pain control
-Pre-Anesthetic Drugs
-Induction drugs
-Maintenance drugs during Sx
-Post-op drugs

Front 104

Why do we use pre-anesthetic drugs?

Back 104

To sedate/tranqualize
Calm, decrease stress and anxiety
Muscle relaxation, decrease motor activity
-Aid in restraint for IVC...
-Pre-emptive analgesia
-Prevent bradycardia, dries secretions
-Decrease amount used of potentially more dangerous drugs
-Safer and smoother induction and recovery.
**Important part of SAFER anesthesia**

Front 105

PA Drug Regime

Back 105

-Given IM (Quicker effect) or SQ
-Given 15-30 minutes prior to induction
-IV route used sometimes in emergencies (atropine for bradycardia)

Front 106

What are the 5 routine pre-anesthetic drugs?

Back 106

-Anticholinergics
-Tranquilizers
-Alpha-2 agonists (sedatives)
-Opioids (narcotics)
-Neuroleptoanalgesia

Front 107

What are our 2 anticholinergic drugs?

Back 107

Atropine Sulfate/Atropine

Glycopyrrolate/Robinul-V

Front 108

What are the 2 branches of the Autonomic nervous system?

Back 108

-SYMPATHETIC-fight or flight
Also known as the Adrenergic
Stimulation results in release of Epinephrine
-PARASYMPATHETIC-rest & digest
Also known as the cholinergic
Stimulation results in release of acetylcholine

Front 109

What happens when the Sympathetic nervous system is stimulated?

Back 109

Release of Epinephrine results in:
-Increases HR, BP, RR
-Bronchial Dilation
-Decreases GI motility
-Decreases salivation
-Mydriasis
-Increases blood glucose

Front 110

What is the result of stimulation of the Parasympathetic/Cholinergic nervous system?

Back 110

--Release of Acetylcholine (neurotrans)
-Stimulates Vagus nerve that runs to lungs, heart, GI tract,eyes, pharynx which results in:
-Decreased HR, BP, RR
-Bronchial constriction
-Increases GI motility
-Miosis

Front 111

So, what are the results of ANTICHOLINERGIC drugs?

Back 111

-Act AGAINST the cholinergic/parasympathetic nervous system

-Block the function of acetylcholine and vagus nerve

Front 112

What is the acronym for the main effects of anticholinergics and what does it stand for?

Back 112

SLURED heart

-S-salivary-decreases salivary and respiratory secretions
Dry mouth-helps prevent airway obstruction(can result in thick mucous)
-L-lacrimal-decreases tear production
-U-urinary-contractions of bladder and ureters are reduced
-R-respiratory-causes brochodialation-which increases dead space-minimized with ET tube and ventilation
-Also decreases Respiratory secretions
-E-eyes-causes mydriasis, esp. cats. Decreases pupillary light reflex
D-Digestive, decreased GI motility
-H Heart-blocks stimulation of vagus nerve, preventing bradycardia, may increase HR

Front 113

When might Anticholinergics be used other than during anesthesia?

Back 113

Treat V/D

Front 114

What species are anticholinergics contraindicated and why?

Back 114

Horses

Because it decreases gut motility......possibly leading to colic

Front 115

What is the MAIN REASON for the use of anticholinergics in PA?

Back 115

To prevent BRADYCARDIA

*blocks acetocholines effect on the Vagus nerve

Front 116

What are anticholingergics an antidote for?

Back 116

Organophosphate (insecticide) poisoning

Front 117

Because of their effect on gut motility and possible ileus, anticholinergics are rarely used in horses. What are 2 possible conditions they may be used to treat?

Back 117

Bradycardia

2nd Degree heart block

Front 118

Atropine sulfate/Atropine has a fast onset of action but a short effect. How long does it typically last?

Back 118

60-90 minutes

Front 119

What are the effects of administering Atropine sulfate/Atropine?

Back 119

- Prevents bradycardia-->will increase HR
-Dries secretions
-Treat bradycardia, AV blocks
-Increase HR more than Glycopyrrolate/robinul-v
--Antidote for organophosphates
-Crosses BBB
-may be used for C-sections
-Treatment of choice during Sx

Front 120

Glycopyrrolate/Robinul-V is similar to Atropine but has a longer duration of effect of 4 hours. It does mean a longer onset of action and longer period of dry mouth but this one has a few advantages. What are they?

Back 120

-Prevents bradycardia W/O causing tachycardia

-Does NOT cross BBB or placenta

Front 121

What are the contraindications for giving Anticholinergics?

Back 121

-Pre-exisiting tachycardia
DON'T USE if HR:
>160bpm in small dog /cat
>140 bpm in medium dog
>120 bpm in large dog
-If gut stasis is a current issue
-Animal is hyperthyroid
-Animals with CHF
**watch for mucus plug in cats if used

Front 122

What are the 2 groups of tranquilizers?

Back 122

Phenothiazines
Benzodiazepines

Front 123

What are the basic properties of tranquilizers in relation to using them as a PA drug?

Back 123

-Relaxing and calming effect
-Decreases stress and anxiety
-Relaxes muscles, decreases motor activity
-Makes induction phase more quiet, so less induction drug is used
-**Be careful, animal may APPEAR sedated but can suddenly "wake up"
****NO ANALGESIA** but can improve the analgesic effects of other drugs

Front 124

What is the Phenothiazine we discussed in class?

Back 124

Acepromazine, Acetylpromazine/Promace

**cannot be reversed!!!**

Front 125

What are the 3 Benzodiazepines discussed in class?

Back 125

Diazepam/Valium

Midazolam/Versed

Zolezapam/(in Telazol)

Front 126

What are the basic properties of Phenothiazine Acepromazine/Promace?

Back 126

-Water soluble ( mixes easily with other water soluble drugs
-Yellow color
-Comes in 10 mg/ml concentration that is diluted down to 1mg/ml

Front 127

What routes can Acepromazine be given?

Back 127

PO
SQ
IM
IV-cautiously

Front 128

How long does Acepromazine, Acetylpromazine/Promace last?

Back 128

4-8 hours, sedation can last 24 hours

Can last 24-48 hours in geriatrics, neonates or animals with liver disease
---Due to prolonged recovery, dose is typically cut in half to reduce potency

Front 129

What are the basic effects of Phenothiazines- Acepromazine, Acetylpromazine/Promace?

Back 129

-Calming effect, decreases anxiety
-Decreased motor activity
-Muscle relaxation
-Above effects are less pronounced in cats than dogs

Front 130

What are some non-PA reasons for giving Ace?

Back 130

Anti-emetic
Calm animal prior to travel, thunderstorms etc

Front 131

What effect does Acepromazine, Acetylpromazine/Promace have on the heart?

Back 131

-Is an anti-arrhythmic drug
-Can prevent epinephrine induced arrhythmias and those caused by some anesthetics

Front 132

Why should ACE no be given to an animal undergoing allergy testing?

Back 132

It has some Antihistime effects

Front 133

What effects does Acepromazine, Acetylpromazine/Promace have on the circulatory & respiratory system?

Back 133

Causes SIGNIFICANT Vasodialation
---can result in profound hypotension
-Does NOT cause significant respiratory or cardiac depression but you may see these decrease as animal becomes calm.
-It does potentiate the ventilatory and cardiovascular depression effects of drugs used in anesthesia

Front 134

Is Ace a controlled substance?

Back 134

NO

Front 135

What breed of dog should Ace NOT be used in and why?

Back 135

Dobermans due to their predisposition to Von Willibrand's disease

Front 136

What are some anecdotal facts about Phenothiazine Acepromazine, Acetylpromazine/Promace?

Back 136

-Some believe that Boxers are abnormally sensitive to Ace, so it may hit them hard-start with half dose instead. Greyhounds and labs may be the same

Front 137

What is the max dose for ACE in ALL ANIMALS, NO MATTER WHAT THEIR SIZE?

Back 137

3mg (IM, SQ)

-Higher doses do NOT result in increased sedation and may induce SIGNIFICANT HYPOTENSION

****NOT REVERSIBLE***

Front 138

What is the reversal agent for the Benzodiazepine tranquilizer group?

Back 138

Flumazenil

**gives this group a wider safety margin

Front 139

Benzodiazepine Diazepam/Valium is not water soluble, so it does not mix well with most other drugs except which one? What routes is preferred?

Back 139

Ketamine

IV because absorption via IM or SQ route is unreliable

Front 140

Benzodiazepines Midolazam/Versed and Zolazepam in Telezol is Water soluble and can be given

Back 140

IM or SQ

Front 141

What is a common induction drug combo using Diazepam/Valium?

Back 141

Ket-Val

Ketamine-Valium

Front 142

AreBenzodiazepines Midolazam/Versed and Zolazepam in Telezol controlled substances?

Back 142

Yes, have great potential for human abuse

Front 143

What are the effects of Benzodiazepines?

Back 143

-Not as much CNS sedation as Ace
--Appear calm but not drowsy
*if used alone in young healthy animals, will not have much of an effect.
**If used as a sole agent, can cause excitement, making Pt more difficult to handle, esp if already painful.
-More effective in older or debilitated animals
-Benzo's work better when with other meds. ESP-OPIOIDS!-enhance sedation
-No analgesia
-Good skeletal muscle relaxation-counteract muscle rigidity
-Are anticonvulsants
-used in combo with drugs that have a potential to cause seizures

Front 144

What are Benzodiazepines commonly used for?

Back 144

PA-to calm and relax
-but not alone, in combo with other drugs, usually Opioids

-As an induction agent when mixed with other drugs such as Ketamine

Front 145

What are some other uses for Benzodiazepines?

Back 145

Tx for seizures
Appetite stimulant for cats
behavior modification
-marking in cats
-separation anxiety, excessive licking
-aggression

Front 146

Why do Benzodiazepines have a wide margin of safety?

Back 146

-Minimal effect on the CV and respiratory systems

-Flumazenil is its reversal agent for Benzo's

Front 147

What are some specifics about Benzodiazepine Diazepam/Valium?

Back 147

Given IV
Contains propylene glycol, so rapid IV administration can cause:
-Venous thrombosis and phlebitis
-Cardiopulmonary depression and cardiac arrhythmias
****so inject SLOWLY
-Not usually given as a sole agent-has minimal sedation and may cause excitement

Front 148

What are some specifics about Benzodiazepine Midazolam/Versed?

Back 148

Water soluble, so can mix with other PA drugs
-Can give IM or SQ
-Also has minimal sedation when given alone and may cause excitement
-Commonly combined with Fentanyl

Front 149

What are some specifics about Benzodiazepine Zolazepam found in Telezol?

Back 149

Is mixed with Tiletimine, a dissociative
-this combo aids in preventing catalepsy

-Can be used as an induction agent or sole anesthetic agent for short , minimally painful procedures

Front 150

Alpha-2 agonists are our sedatives and are also referred to as thaizine derivitives. What drugs are in this group?

Back 150

Xylazine/Rompun

Metomidine/Domitor

Dexmedetomidine/Dexdomitor

Detomidine/Dormoseden-Large animal use

Front 151

What drugs are reversal agents for the Alpha-2 agonist sedatives?

Back 151

Yohimbine/Yobine
Atipamezole/Antisedan
Tolazine/Priscoline

Front 152

What are some basic facts about Alpha-2 agonist sedatives?

Back 152

-NOT controlled substances
-Can be absorbed through skin and MM
----As little as 0.1 ml can cause Hypotension and sedation in people
-Xylazine has highest rate of anesthetic complications and death

Front 153

How do Alpha-2 agonist sedatives produce their effect?

Back 153

Bind to Alpha-2 adrenoreceptors on sympathetic nerves within brain and spinal cord and decrease norepinephrine

Front 154

What effects do Alpha-2 agonists have when they bind to the Alpha-2 adrenoreceptors in the brain and spinal cord?

Back 154

-Analgesia-short term
-Sedation-Potent sedative, sedation last longer than the analgesia
-Muscle relaxation

Front 155

What side effects do Alpha-2 agonist sedatives have?

Back 155

Affects receptors in heart and blood vessels, so has significant cardiovascular effects

-Is an EMETIC and causes vomiting in 50% of dogs and 90% of cats

Front 156

Alpha-2 agonist Sedatives are a potent sedative that induces a sleep like state comparable to phenothiazines--but more pronounced. Can be a sole agent for short minor procedures. How long does the sedation typically last?

Back 156

1-2 hours but can last as long as 6-10 hours in dogs and cats

**Animals are typically reversed right after the procedure

Front 157

What routes are safe for Alpha-2 agonist sedatives?

Back 157

IV, IM, SQ, epidural

-Highly agitated, nervous animals may react adversely and show excitement/aggression rather than sedation.**CALM animal before giving

**these are REVERSIBLE**

Front 158

What are some side effects of Alpha-2 agonist sedatives?

Back 158

-Bradycardia and arrythmias (1st and 2nd degree AV blocks)
-Decreased cardiac output
-Hypotension
-Respiratory depression
-hypothermia
-Peripherial vasoconstriction

Front 159

Why can CRT not be used as a reliable vital sign when using Alpha-2 agonist sedatives?--espcially Medetomidine..

Back 159

Peripherial vasoconstriction leads to poor tissue perfusion, so CRT is not reliable

Front 160

Why are Alpha-2 agonists not always a good idea in larger breed dogs?

Back 160

Can predispose them to GDV due to causing abdominal distention

Front 161

What side effect do Alpha-2 agonist sedatives have in horses?

Back 161

Sweating & Ataxia but good for treating GI pain associated with Colic

Front 162

What are some basic facts about Alpha-2 sedative Xylazine/Rompun?

Back 162

2% solution for small animals
10% solution for large animals

-Usually reversed with Yohimbine/Yobine
-Should only be used in young healthy animals
-Avoid use in debilitated animals and those with cardiovascular, respiratory, hepatic or renal dysfunction
**Remember pale MM due to vasoconstriction

Front 163

What are some basic facts about Alpha-2 agonist sedative Medetomidine/Domitor?

Back 163

Has a specific antagonist- Atipamezole/Antisedan

-Approved for use in dogs only but used in cats, horses and exotics

-UNIQUE dosing--mcg per square meter of body surface. A chart is used based on body weight
-Should only be used in young healthy animals
-Avoid use in debilitated animals and those with cardiovascular, respiratory, hepatic or renal dysfunction
**Remember pale MM due to vasoconstriction

Front 164

What are some potential side effects of Alpha-2 agonist sedative Medetomidine/Domitor?

Back 164

-Bradycardia is common
--May be prevented by giving Atropine at least 5 minutes PRIOR to Medetomidine. Will not be effective if given after and may actually CAUSE cardiac arrythmias and hypotension
**Reversible

Front 165

What are some basic facts about Alpha-2 agonist sedative Dexmedetomidine/Dexdomitor?

Back 165

-Newer drug
-Approved for use in dogs and cats
-Dosing in mcg per square meter surface area
-Can have adverse reactions in excited animals
-Should only be used in young healthy animals
-Avoid use in debilitated animals and those with cardiovascular, respiratory, hepatic or renal dysfunction
**Remember pale MM due to vasoconstriction

Front 166

In regards to Alpha-2 agonist sedative Dexmedetomidine/Dexdomitor, when should anticholinergics be given?

Back 166

BEFORE administration of Alpha-2 sedatives
Giving at the same time or after leads to adverse cardiovascular effects and cardiac arrhythmias.
**Reversible with Atipamezole/Antisedan

Front 167

In regards to Alpha-2 agonists, which reversal agents are used with which drug?

Back 167

Yohimbine for Xylazine

Antipamezole is specifically for Medetomidine and Dexmedetomidine

**reversal is recommended due to the adverse cardiovascular effects

Front 168

Opioids/Narcotics basic facts

Back 168

-used as PA, induction, analgesics, epidural, intraarticular
-MOST EFFECTIVE agent for pain control
Classified as opioid agonist, partial agonists, mixed agonist/antagonist and antagonists
-A CONTROLLED substance like the Benzos
-Produce sedation but sometimes excitement

Front 169

Opioids are reversible like Alpha-2 agonists and Benzo tranqs,and provide excellent analgesia from

Back 169

30 minutes to 12 hours, 24 for epidural

Front 170

What is one big advantage of opioids?

Back 170

Safe for healthy AND debilitated animals

Front 171

How do Opioids produce their effect?

Back 171

Act on receptors in the brain, specifically Mu, Kappa and Sigma.

Front 172

How are opioids classified?

Back 172

by how they affect receptors:

-Agonists stimulate all receptors
-Pure agonists are full Mu agonists
-Antagonists-block receptors
-Antagonist/Agonists-stimulate & block

Front 173

Which receptor is most important for blocking pain?

Back 173

Mu

Front 174

Which opioids are pure agonists?

Back 174

Morphine, hydromorphone, oxymorphone, methadone, fentanyl

Front 175

Which opioids is a Mixed agonist/antagonist?

Back 175

Butorphanol

Front 176

Which opioid is a partial agonist?

Back 176

Buprenorphine

Front 177

Which opioid is a pure antagonist and therefore a reversal agent?

Back 177

Naloxone

Front 178

What CNS effects do opioids have?

Back 178

-May cause CNS Depression(sedation) OR excitement (dysphoria) depending on Dose, drug and species
*cats do better if opioids are given SQ/IM and in lower dose/kg

Front 179

What are some specific effects opioids have on dogs?

Back 179

-Most will show sedation and analgesia
-High doses can cause hypnotic state called Narcosis-animal appears profoundly sedated but can be aroused with significant stimuli
-Endotracheal intubation is often possible with these alone, esp in sick patients
-Some may show dysphoria, esp in absence of pain-whining barking, anxiety, restlessness

Front 180

Oxymorphone mixes ok with what drug?

Back 180

valium

Front 181

Opioid-Benzo tranq. combo has what advantage over the Ket/Val combo?

Back 181

Safer due to both being reversible

Front 182

What are the analgesic effects of opioids?

Back 182

Most effective agents known for treatment of pain, Pure agonist such as morphine, fentanyl, hydromorphone being the best of this group.

-Excellent PA for animals undergoing painful Sx

Front 183

What respiratory effects do opioids have?

Back 183

**Respiratory depression is most common
-can be a serious side effect and is dose related and more likely to occur at higher doses or if given with another drug that is a respiratory depressant such as medetomidine.
-Causes panting due to have an effect on the thermoregulatory center of the brain

Front 184

What GI effects do opioids have?

Back 184

-Are an emetic
-increase GI motility--defecation, diarrhea and flatulance result

-Use of Atropine (anti-cholinergic) or acepromazine (anti-emetic) decrease these effects

Front 185

What are some miscellaneous effects of opioids?

Back 185

-Increased sensitivity to sound
-Increased salivation
-Bradycardia in higher doses
Sweating in horses (like Xylazine)

Front 186

Opioid Morphine basic facts are:

Back 186

Is a Pure agonist
-Duramorph is a preservative free form often used for epidurals
-Produces analgesia WITH sedation
-Inexpensive and effective pain control for moderate and severe pain for visceral AND somatic pain.
-Directly stimulates vomition center in the brain, so used with Acepromazine to decrease this effect

Front 187

How long does Morphine last?

Back 187

1-4 hours in dogs (injectable)
Can be given IM, SQ, IV in dogs only, epidural
-In DOGS, can be added to fluids and given CRI
Epidural can last 12024 hours
-Small IM or SQ doses in cats can last 4+ hours

Front 188

Morphine can cause excitement in some dogs, especially in absence of pain. In cats can cause

Back 188

excitement at higher doses. Given to cats IM or SQ but SQ has less side effects

**Best if given with a tranqualizer

Front 189

Opioid Hydromorphone/Dilauded is a pure agonist that is how much more potent than Morphine?

Back 189

5 times

Last 4 hours and can be given IV, SQ or IM in BOTH dogs and cats

Front 190

What are some effects of Opioid Hydromorphone/Dilauded?

Back 190

-Less likely to see vomiting
-less potential for causing excitement in cats
Similar side effects to other opioids:
respiratory depression
Dysphoria
Bradycardia
Panting

Front 191

What is the purpose of Opioids in PA?

Back 191

Pre-emptive analgesia

Front 192

Opioid Oxymorphone/Numorphan basic facts are:

Back 192

Pure Agonist-Full MU
-10 times more potent than Morphine
-More sedation than morphine
-less likely to cause vomiting than morphine
-Can be used in dogs and cats but may cause excitement in cats if given IV
-Many animals show increased sensitivity to sound and startle easily

Front 193

What are some basic facts about Opioid Fentanyl/Sublimaze?

Back 193

-Pure agonist
100-150 times more analgesic potency than morphine
-NOT RECOMMENDED for use in CATS. patch OK
-Lasts only 30 minutes, some commonly used as a CRI

Front 194

What are some facts about Fentanyl/Duragesic?

Back 194

-Is the patch form of Fentanyl
-Transdermal delivery of med
**takes 4-12 hours in cats and 12-24 hours in dogs to reach therapeutic levels in the blood
*Provides continuous, steady-state analgesia for 3-5 DAYS

Front 195

What are some basic facts about Butorphanol/Torbugesic, Torbutrol?

Back 195

-A MIXED agonist/antagonist
Kappa agonit/Mu antagonist
-Not as effective as the pure agonists in treating severe pain
-Safe and effective for mild to moderate visceral pain
-Less sedation unless used with a tranquilizer

Front 196

What can the opioid Butorphanol/Torbugesic, Torbutrol be used to reverse?

Back 196

Can partially reverse pure agonist
--can use to partially reverse respiratory depression and sedation of pure agonists as well as some analgesic effects

Front 197

How long do opioid Butorphanol/Torbugesic, Torbutrol last?

Back 197

1-4 hours
*1 hour in dogs--maybe...
up to 4 hours in cats
-Commonly used in horses and may last 3-4 hours
-Good antitussive

Front 198

What are some basic facts about opioid Buprenorphine/Buprenex?

Back 198

-Partial Mu agonist
-provides analgesia for mild to moderate pain but NOT effective for severe, ortho pain
-Has less sedation, better when used with a tranquilizer

Front 199

How does the opioid Buprenorphine/Buprenex come?

Back 199

in ampules that are often transferred to vials to use on multiple patients

Front 200

How long does the opioid Buprenorphine/Buprenex last?

Back 200

6 to 8 to 12 hours.

Average 6 to 8, sometime 12 in some patients.

LONGEST LASTING opioid

Front 201

What are are some advantages of the opioid Buprenorphine/Buprenex?

Back 201

Better analgesia in cats than dogs
-Can be given OTM

-More difficult to reverse than other opioids, Holds tight to the MU receptor.

Front 202

The one opioid antagonist is Naloxone hydrochloride/Narcan which makes it a

Back 202

REVERSAL AGENT (like Butorphanol, a mixed agonist/antagonist)

Front 203

How do Opioid antagonists work?

Back 203

As blocking agents that displace opioids from receptors, reversing ALL their effects.

Front 204

The one opioid antagonist is Naloxone hydrochloride/Narcan is a pure antagonist that blocks all 3 receptors and is the preferred reversal agent because it is most effective. What are some other important facts about this drug?

Back 204

-little clinical effect on its own
-Reversal of analgesia can be minimized by titrating to effect so that respiratory depression is partially reversed but affect on analgesia is minimized

Front 205

Final facts about The one opioid antagonist is Naloxone hydrochloride/Narcan..

Back 205

-Expensive
-Reversal is often unnecessary for routine anesthesia but helpful in anesthetic emergencies/OD.
-A drop placed under the tongue in neonates following C-section with opioids will help revive them.

Front 206

Acepromazine is often combined with what opioid for a good neuroleptic?

Back 206

butorphanol

Front 207

Diazepam is often combined with what opioid to produced a good neuroleptic?

Back 207

Hydromorphone