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174 Cards in this Set
- Front
- Back
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Two anticholinergic drugs
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Atropine
Glycopyrrolate |
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List three non-opioid tranquilizer classes.
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Phenothiazine
Benzodiazepines Alpha-2 agonists |
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3 uses of anticholinergic premeds.
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Prevent/treat bradycardia
Decrease respiratory secretions (thicken?) Decrease salivation |
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Effects of atropine on the cardiovascular system
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Increase HR
Secondary AV block at low doses |
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Effect of atropine on resipratory system
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Bronchodilation
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Which anticholinergic drug crosses the blood-brain barrier?
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Atropine
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Effect of atropine on the eye
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Pupil dilation (mydriasis)
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Effect of atropine on the GI tract
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Stasis
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Routes of atropine administration
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SQ, IM, IV
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Duration of atropine effect
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60-90 min
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How is atropine metabolized?
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Atropine esterases
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How does glycopyrrolate differ from atropine?
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Does not cross BBB or placenta
Longer onset and duration |
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3 contraindications for anticholinergic drug use.
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Tachycardia
Glaucoma Horses-- colic risk |
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4 uses for acepromazine
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Excellent sedative
Antiemetic Antiarrhythmic Antihistamine |
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How does acepromazine operate in the body?
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Blocks dopamine receptors
Blocks action of serotonin Blocks alpha-1 receptors |
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Cardiovascular effects of acepromazine
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Vasodilation and hypotension
Reflex tachycardia |
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Respiratory effects of acepromazine
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Minimal
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How does acepromazine interact with opioids?
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Synergistic effect
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True or false: Acepromazine provides no analgesia.
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True
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Describe the duration of acepromazine sedation.
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Long half life, long duration
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4 contraindications of acepromazine.
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Liver disease
Hypovolemia Anemia (decreases PCV) Shock |
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Advantages of acepromazine
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Good sedation
Decreases MAC Minimal respiratory effects Antiarrhythmic Inexpensive |
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Disadvantages of acepromazine
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Irreversible
Hypotension No analgesia Long lasting |
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Uses of benzodiazepines
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Mild sedation
Anxiolysis Anticonvulsant Muscle relaxation |
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How do benzodiazepines act on the body?
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Potentiate GABA
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Cardiovascular effects of benzodiazepines
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Minimal
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Respiratory effects of benzodiazepines
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Minimal
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This class of sedatives may cause paradoxical excitement in young animals.
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Benzodiazepines
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CNS effects of diazepam
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Calming
Anxiolysis Mild sedation Muscle relaxation |
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Routes of administration for diazepam
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IM, IV, PO
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How is diazepam metabolized and excreted?
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Liver--> urine and feces
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How does midazolam differ from diazepam?
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Not absorbed PO (water soluble at low pH)
Shorter duration |
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This benzodiazepine is only available with tiletamine as Telazol.
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Zolazepam
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Telazol is metabolized slower in which species: Canine or feline?
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Feline
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Benzodiazepine reversal agent
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Flumazenil
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Duration of action for flumazenil
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60 minutes
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How does flumazenil antagonize diazepam?
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Competitive antagonism
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When would flumazenil be indicated?
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Paradoxical excitement
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Which sedative has anticonvulsant properties: Acepromazine or diazepam?
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Diazepam
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Which sedative has antiemetic properties: Acepromazine or diazepam?
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Acepromazine
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Which sedative has antiarrhytmic properties: Acepromazine or diazepam?
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Acepromazine
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Used for alpha-2 agonists
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Sedation
Analgesia Muscle relaxation Anxyolisis |
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Cardiovascular effects of A2 agonists
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Bradycardia
AV blocks Hypertension followed by hypotension Decreased CO Pale mucous membranes |
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Respiratory effects of A2 agonists
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Decreased RR
Decreased tidal volume SIgnificant with other sedatives Peripheral venous desaturation |
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CNS effects of A2 agonists
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Dose dependent sedation
Anaglesia Muscle relaxation Personality changes |
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Do A2 agonists tend to cause hyperglycemia or hypoglycemia?
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Hyperglycemia
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How do A2 agonists affect the GI tract?
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Decrease GI motility
Emesis in cats |
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This class of sedatives causes an increase in urine production.
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A2 agonists
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This class of sedatives can cause facial edema in horses.
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A2 agonists
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Which class of sedatives can cause an increase in uterine tone and late-term avortion?
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A2 agonists
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Which has a higher A2 specificity: Medetomidine, romifidine, or xylazine?
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Medetomidine
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Duration of xylazine sedation and analgesia
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1 hour sedation
15-20 min analgesia |
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Which species is most sensitive to xylazine effects?
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Cattle
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These two sedatives can cause relaxation of the retractor penis muscle in horses.
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Acepromazine
Xylazine |
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Medetomidine is only labeled for use in which species?
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Dogs
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Why are there fewer side effects with medetomidine than with xylazine?
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Greater alpha-2 receptor specificity
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How does dexmedetomidine differ from medetomidine?
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Slightly higher A2 specificity (active enantiomer of medetomidine)
Labeled for both dogs and cats Similar sedation at 3/4 dose of medetomidine |
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Duration of dexmedetomidine sedation and analgesia
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1.5 hours sedation
45 min analgesia |
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Detomidine is approved for use in which species?
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Horses and cattle
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Does detomidine or xylazine have greater A2 specificity?
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Detomidine
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Onset time for detomidine
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2-5 min
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Duration of detomidine sedation.
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Up to 120 mins
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What is notable about romifidine among the A2 agonists?
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May produce less ataxia
Longer duration (60-180 mins) |
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Contraindications for using A2 agonists
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Cardiac disease/arrhythmia
Hypotension or shock Hepatic disease Renal insufficiency Urinary obstruction Seizure disorder Late pregnancy in cattle Diabetes |
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A2 antagonist packaged with medetomidine for reversal.
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Atipemazole
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How rapidy does atipemazole reverse A2 sedation
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5-10 minutes
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Which A2 antagonist is more selective for the receptor: Atipemazole or yohimbine?
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Atipemazole
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Concern when using yohimbine
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Excitation or anxiety possible
Less selective for A2 receptor |
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Which A2 antagonist is the least selective?
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Tolazoline
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A2 antagonists used in small ruminants
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Tolazoline
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Side effects of tolazoline include...
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GI bleeding
Abdominal pain Nausea |
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Advantages of A2 agonists
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Sedation
Analgesia Muscle relaxation Reversible |
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Disadvantages of A2 agonists
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Marked cardiovascular depression
Mild respiratory depression Emesis in cats Inconsistent in excited patients |
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Which drug class provides analgesia with sedation: Phenothiazines, benzodiazepines, or A2 agonists?
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A2 agonists
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How do opioids act on the body?
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Decrease neurotransmission and release of Ach, DA, NE, and Substance P
Activates opioid receptors |
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Uses of opioids include...
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Analgesia
(some sedation) Decrease anesthetic requirement |
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Cardiovascular effects of opioids
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Minimal!
Bradycardia possible |
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Respiratory effects of opioids
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Respiratory depression
Decrease RR Decrease Vt |
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Opioids have these effect on the CNS system.
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Analgesia
Sedation Excitation/dysphoria at high doses Nausea/Emesis Hypothermia Increase ICP |
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In which species do opioids cause miosis?
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Dogs, rats, rabbits
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In which species do opioids cause mydriasis?
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Cat, horse, sheep, monkey
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What effects do opioids have on the GI tract?
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Emptying, followed by stasis
Constipation Increased bilary pressure |
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List four full opioid agonists
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Morphine
Hydromorphone Oxymorphone Fentanyl |
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How long does morphine usually last?
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3-4 hours
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Advantage of using hydromorphone or oxmorphone over morphine.
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Less vomiting
No histamine release |
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This full opioid agonist has rapid onset, short duration, and excellent analgesic properties.
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Fentanyl
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Side effect of fentanyl
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Bradycardia
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List a partial opioid agonist.
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Buprenorphine
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This opioid has a higher affinity for the receptors than does morphine, in spite of being a partial agonist.
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Buprenorphine
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How long is the onset time for buprenorphine? What about the duration?
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Onset up to 45 mins
Duration 6-12 hours |
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Is buprenorphine a more effective sedative or analgesic?
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Analgesic
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How can buprenorphine be administered?
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IV, IM, SC, OTM
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List a mixed opioid agonist-antagonist.
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Butorphanol
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Is butorphanol a more effective sedative or analgesic?
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Sedative
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How long does butorphanol sedation last?
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1-1.5 hours
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In which species is butorphanol a popular choice for sedation?
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Horses
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Full opioid antagonist used to reverse opioid sedation.
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Naloxone
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How long do the effects of naloxone last?
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30 minutes (redosing needed)
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Why should naloxone be given SLOWLY if given IV?
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Avoid sudden reversal and return of pain
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How do barbiturates act in the body?
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GABA agonist
Glutamate antagonist |
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Which form of barbiturate is physiologically active: Ionized or Non-ionized?
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Non-ionized
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When barbiturated bind to albumin, are they made active or inactive?
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Inactive
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The four compatments to which barbiturates are distributed, in order:
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Plasma
Viscera Lean body mass Fat |
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Is thiopental an example of an ultra-short, short, or long-acting barbiturate?
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Ultra-short
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What determines the rate of awakening from thiopental induction?
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Redistribution in body compartments
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CNS effects of thiopental
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Dose dependent depression
Decreased CBF, CMR, ICP Depress thermoreg., vagus, respiratory, and vasomotor centers |
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True or false: Barbiturate anesthesia provides excellent sedation and analgesia.
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False. No analgesia.
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Cardiovascular effects of thiopental.
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Decrease CO, SV, contractility, BP, and peripheral vascular resistance
Increase HR transiently VPC's |
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Respiratory effects of thiopental
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Decreased RR
Decreased tidal volume Increase CO2 threshold Post-induction apnea |
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GI effects of thiopental
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Minimal
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Advantages of thiopental for induction
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CNS depression
Fast onset (30 sec) Ultra-short duration (5-10 min) Decrease ICP Long shelf life Inexpensive |
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Disadvantages of thiopental for induction
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CV depression
Respiratory depression Cumulative effects No analgesia Perivascular irritation Rough recovery if given alone |
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Mechanism of action for propofol.
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GABA agonist
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This induction agent is an ultra-short acting alkyphenol that is insoluble in water, stable at room temperature, and supports bacterial growth.
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Propofol
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CNS effects of propofol
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Rapid onset anesthesia
Rapid, reversible CNS depression Decreased CBF, ICP Anticonvulsant Isolated muscle twitching Decreased IOP |
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Cardiovascular effects of propofol
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Hypotension
Decreased vascular resistance HR same or increased Not arrhythmogenic |
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Respiratory effects of propofol
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Profound respiratory depression
Apnea (rate and dose dependant) Cyanosis Mild hypercapnea |
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Would propofol or thiopental be preferable if doing a Caesarean section? Why?
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Propofol, less neonatal depression
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Side effect of repeated propofol use in a cat
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Heinz body formation
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GI effects of propofol
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None
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Which induction agent can cause perivascular irritation: Thiopental or propofol?
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Thiopental
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How long does a single dose of propofol last?
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10 mins
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Where is propofol metabolized?
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Liver and lung
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How is propofol excreted?
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By the kidney as propofol glucuronide
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Advantages of propofol use for induction.
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Rapid onset
Short acting Non-cumulative No tissue irritation Decrease ICP, IOP Safe for C-section No hangover |
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Disadvantages of propofol use for induction
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Supports bacterial growth
SHort shelf life CV depressant Respiratory depressant No analgesia Myoclonus possible |
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How soon after opening should a 1:1 thiopental:propofol mixture be used?
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Within 24-48 hours
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Why use a 1:1 propofol:thiopental mixture?
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Improved stability/shelf life
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Why use a propofol:ketamine 1:1 mixture?
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Decrease side effects of each
(Opposing CV side effects) Lower dose of each drug |
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This induction agent may cause pain on injection and hemolysis, due to its mixture with propylene glycol.
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Etomidate
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CNS effects of etomidate
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Decrease CBF, ICP, and CMR
Maintains cerebral perfusion pressure Anticonvulsant Involuntary myoclonus |
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Cardiovascular effects of etomidate
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Minimal! Use for pts with CV disease or pts who are hemodynamically unstable
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Repiratory effects of etomidate
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Slight depression
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This induction agent may cause adrenal spuuression in dogs 3-4 hours after a single dose.
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Etomidate
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What adverse effects occur with etomidate at induction?
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Nausea, retching, or vomiting
Pain on injection |
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Hemodynamic effects of etomidate.
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Hemolysis and hematuria because of high osmolality
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Advantages of etomidate for induction.
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Fast onset
Ultra-short duration Minimal cadro and respiratory effects Decrease ICP, IOP Good choice for unstable C-section Wider TI |
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Disadvantages of etomidate for induction
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Adrenal suppression
No analgesia Retching, nausea, vomiting, myoclonus Hemolysis, pain on injection Expensive |
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List two dissociative anesthetics.
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Ketamine
Tiletamine |
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How does ketamine work on the body?
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Non-competitive antagonist at NMDA receptor
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Describe the neurologic state produced by ketamine.
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Trance-like
Immobility Waxy rigidity aka. cataleptic Also amnesic, unaware of environment Analgesia |
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What effect of ketamine is maintained at subclinical doses?
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Analgesia
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Is ketamine more effective at reducing somatic or visceral pain?
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Somatic pain
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CNS effects of ketamine
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Unconsciousness and analgesia
Epileptiform EEG activity Increased ICP, metabolic rate, CSF pressure Hallucinatory behavior |
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How does ketamine affect the cardiovascular system?
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Increases HR, CO, arterial BP
Negative ionotrope Increased myocardial O2 requirements Hypotension in critically ill patients |
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Respiratory effects of ketamine
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No significant depression
Decreased RR and tidal volume PaCO2 maintained Apneustic breath holding Intact laryngeal reflexes Increased secretions |
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With this induction agent, the muscles are rigid and eyes remain open. Corneal reflexes are intact.
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Ketamine
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Onset time of ketamine
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IV 30-90 sec
IM 3-5 min |
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Duration time of ketamine
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IV 3-10 min
IM 10-30 min |
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How is ketamine metabolized in the dog?
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Extensive hepatic metabolism
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How is ketamine metabolized in the cat?
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Excreted unchanged in the urine
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How is ketamine metabolized in the horse?
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60% metabolized in liver
40% unchanged in urine |
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This dissociative anesthetic is only available combined with zolazepam as Telazol.
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Tiletamine
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How does tiletamine compare to ketamine, with regards to its potency and effects?
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More potent
Similar effects |
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Which species experiences emergence delireum with Telazol, and why?
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Dog
Tiletamine effects last longer than zolazepam |
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Which species experiences prolonged recovery time with Telazol induction, and why?
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Cat
Zolazepam relaxation lasts longer than tiletamine effect. |
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Which induction agent has the fewest cardiorespiratory effects of those studied?
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Etomidate
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Which induction agents we've studied provide the smoothest induction on their own?
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Thiopental and propofol
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Which induction agent we've studied has the widest TI?
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Etomidate
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The quickest recovery time is seen with which induction agent out of those studied?
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Propofol
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The modern inhalants (sevo/iso/desflurane) have what effect on HR?
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Increase
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The modern inhalants (sevo/iso/desflurane) have what effect on CO?
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Decrease
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The modern inhalants (sevo/iso/desflurane) have what effect on stroke volume?
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Decrease
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The modern inhalants (sevo/iso/desflurane) have what effect on peripheral vascular resistance?
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Vast decrease
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The modern inhalants (sevo/iso/desflurane) have what effect on BP?
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Decrease
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The modern inhalants (sevo/iso/desflurane) have what effect on respiratory rate?
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Decrease
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Which of the modern inhalants has the lowest MAC (highest potency)?
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Isoflurane
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Which of the modern inhalants has the lowest solubility?
|
Desflurane (sevoflurane close behind)
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Which property is related to speed of inhalant anesthetic onset: solubility or MAC?
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Solubility
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When there is higher CO, will anesthetic onset be more rapid or slower?
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Slower
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Anesthetic onset will be quicker in debilitated animals because...
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Lower CO means proportionately more blood goes to brain
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What is MAC?
|
% concentration of inhalant anesthetic at which 50% of animals will not move in response to anesthetic stimulus.
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Will recovery time be faster with a more soluble anesthetic gas or a less soluble one?
|
Less soluble
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List some factors increasing MAC of inhalant anesthetics.
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Hyperthermia
Hyperthyroidism Hypernatremia CNS stimulant drugs |
