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66 Cards in this Set
- Front
- Back
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All mu agonists provide moderate to marked _______ and profound __________.
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Marked sedation
Profound analgesia |
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True or false. The potency of mu agonists varies between drugs.
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True- adjust dose to achieve similar effects
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There is little difference in the efficacy of opioids, so you should choose the appropriate mu agonists to use based on what 3 things?
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1) Duration of action
2) Route of administration 3) Side effects |
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All mu agonists are schedule _______ narcotics.
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II
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What are the 8 mu agonist opioids?
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1) Morphine
2) Hydromorphone 3) Oxymorphone 4) Meperidine 5) Fentanyl 6) Alfentanil 7) Sufentanil 8) Remifentanil |
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What are the 5 short acting mu opioids?
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1) Fentanyl
2) Remifentanil 3) Sulfentanil 4) Alfentanil 5) Meperidine (Demerol) |
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How long do the effects of fentanyl last? How is it administered?
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-Very short duration ~ 15 minutes
-Often given CRI -Usually given IV, may be given IM but volume is relatively large -Can get sustained release patch |
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What are 2 common side effects of fentanyl?
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Bradycardia & bradyarrhythmia
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What is the duration of remifentanil? How is it administered
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EXTREMELY short duration (< 5 minutes)
-MUST be given CRI |
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Why is remifentanil pharmacokinetics unaffected by hepatic or renal dysfunction?
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Metabolized by non-specific plasma esterases
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Sufentanil and alfentanil are analogues of ________.
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Fentanyl
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Sufentanil and alfentanil have a shorter duration of action after ______.
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Prolonged infusion
-Seldomly used in vet med |
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What is the duration of Meperidine (Demerol)? How is it administered?
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Short duration ~45-60 minutes
Only give IM or orally -Significant histamine release |
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What is unique about Meperidine?
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Only opioid which tends to INCREASE heart rate
-Bradyarrhythmias are uncommon |
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Why is there limited usefulness of Meperidine (Demerol)?
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Short duration of effect
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What are the 3 longer acting mu agonists?
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1) Morphine
2) Hydromorphone 3) Oxymorphone |
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What is morphine used for?
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Good sedation, excellent analgesia
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Why do you have to use caution when administering morphine IV? What should you do?
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Associated with histamine release, so use caution and give very slowly
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Does morphine cause vomiting?
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Commonly seen within a few minutes of IM injection, but is an anti-emetic effect when full drug effect has occurred
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Which long acting mu agonist can given as an epidural?
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Morphine
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What is the main long acting mu agonist used at OSU?
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Hydromorphone
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What is hydromorphone used for?
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Good sedation, excellent analgesia
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How is hydromorphone administered?
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IV, but give slowly because may see excitement
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How does hydromorphone affect body temperature in cats?
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Causes hyperthermia in cats
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What are the side effects of hydromorphone?
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Vomiting, defecation
-panting, respiratory pattern changes common |
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Oxymorphone has essentially the same effect as _______.
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Hydromorphone
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Why is hydromorphone used over oxymorphone?
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Periods of unavailability led to a switch to hydromorphone
-Currently relatively expensive & inconvenient to use bc only available as 1 mL ampules |
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What are the 2 partial mu agonist opioids?
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1) Buprenorphine
2) Tramadol |
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What is the mechanism of action of buprenorphine? What activity does it have?
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Partial agonist at mu & NOP receptors
-Limited activity: mild sedation, mild to moderate analgesia |
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Why is buprenorphine relatively difficult to antagonize?
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Extremely high receptor affinity
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What is the onset and duration of buprenorphine?
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Relatively slow onset (30-60 m)
Long duration (6-12 h) |
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Buprenorpine is well absorbed via the _____ in cats.
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Oral mucosa
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How does tramadol cause an anti-anxiety effect?
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Inhibits norepinephrine & serotonin reuptake --> anti-anxiety effect
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How is tramadol administered?
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Only available in oral formulation in the US
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True or false. Tramadol can be used as a preanesthetic.
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False, not used as premed but often presented w/ dogs receiving tramadol
-Little apparent interaction w/ anesthesia protocols |
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What are 2 agonist-antagonist opioids?
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1) Butorphanol (Torbugesic)
2) Nalbuphine |
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What is the mechanism of action of butorphanol?
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Kappa agonist
Mu antagonist |
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What is butorphanol used for?
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Mild to moderate sedation and analgesia
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What is the duration and onset of butorphanol?
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Rapid onset, regardless of route
Relatively short duration (1-2 h)- dose dependent |
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What is the mechanism of action of nalbuphine?
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Kappa agonist
Mu antagonist |
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Nalbuphine is very similar to butorphanol, but how are they different?
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Nalbuphine isn't controlled and butorphanol is
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What is the chemical name of heroin?
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Diacetylmorphine
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What is percocet, percodan, locet and vicodan?
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Oxycodone or hydrocodone combined w/ aspirin or acetaminophen
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What are 2 very potent opioids?
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1) Etorphine (1000-30000 X potency of morphine)
2) Carfentanil (10000 x the potency of morphine) |
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What is a drug that can reverse all opioid agonist activity?
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Naloxone
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What is the administration of naloxone? Onset of naloxone? Duration of naloxone?
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IM, IV administration
Short duration of action 30-60 m Rapid onset |
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How do you accomplish partial reversal?
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Using naloxone to reverse an agonist- antagonist such as butorphanol or nalbuphine
- reverse mu mediated sedation, retain kappa mediated analgesia |
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Which opioids have maximum efficacy?
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Agonists:
1) Morphine 2) Hydromorphone 3) Oxymorphone 4) Fentanyl 5) Remifentanil 6) Meperidine (demerol) |
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What opioids have moderate efficacy?
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Agonists/ antagonists (butorphanol & nalbuphine)
Partial agonists (Buprenorphine, tramadol) |
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What are the 3 opioid agonists that have a short duration?
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Fentanyl
Remifentanil Meperidine |
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Do opioids cause analgesia? Do opioids decrease anxiety?
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Analgesia-yes
Decrease anxiety- yes, but usually need to mix w/ tranquilizer for good anxiety |
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Do opioids cause sedation/restraint?
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Yes
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Do opioids decrease anesthetic requirements?
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Definitely
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Do opioids decrease autonomic reflex activity?
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No
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Opioids have a similar effect to alpha2 agonists, so why are opioids used more commonly?
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Because opioids don't have a significant cardiovascular effect
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What is neuroleptanalgesia?
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Combination of neuroleptic agent and opioid analgesic
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What is the only neuroleptic agent in veterinary medicine?
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Acepromazine
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What is an example of a neuroleptanalgesic?
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Acepromazine + butorphanol
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What are the 3 clinical uses of neuroleptanalgesics?
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1) Sedation & analgesia for minor procedures (+/- local anesthetic)
2) Chemical restraint (premedication) 3) Anesthetic induction -Debilitated patients -Benzodiazepine + opioid e.g. diazepam + hydromorphone |
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What are 4 premedication considerations?
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1) Signalmen
-Species, breed, age 2) Patient temperament 3) Planned procedure -How painful? 4) Duration of effects -Outpatient VS inpatient procedures |
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What are 2 premedications that cause analgesia?
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Alpha 2 agonists
Opioids |
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Do opioids, alpha2 adrenergic agonists, benzodiazepines, phenothiazines or anticholinergics cause decreased anxiety?
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All but anticholinergics
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Do opioids, alpha2 adrenergic agonists, benzodiazepines, phenothiazines or anticholinergics cause sedation/restraint?
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All but anticholinergics
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Do opioids, alpha2 adrenergic agonists, benzodiazepines, phenothiazines or anticholinergics cause a decrease in anesthetic requirements?
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All but anticholinergics
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Do opioids, alpha2 adrenergic agonists, benzodiazepines, phenothiazines or anticholinergics cause a decrease in autonomic reflex activity?
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Only anticholinergics
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To accomplish balanced anesthesia is it better to use a single anesthetic or multiple drugs to achieve a safer & smoother process?
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Multiple drugs
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