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43 Cards in this Set
- Front
- Back
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give 3 examples of pre-emptive analgesia
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used prior to tissue damage
opioid or alpha2 agonist transdermal Fentanyl patches |
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what is multimodal analgesia?
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simultaneous administration of a combination of analgesic agents with different modes of action and different side effects, which may act synergistically and achieve optimal analgesia with less risk of side effects than large doses of a single drug.
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name three families of endogenous opiods. Where are these peptides synthesized and stored?
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Met-enkephalin, Leu-enkephalin
Dynorphin B-endorphin |
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where is Met-enkephalin synthesized and stored?
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stored in many cells
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where is dynorphin synthesized and stored?
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in neurons, hypothalamus and myenteric plexus, co-stored w/ vasopressin in CNS
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where is B-endorphin synthesized and stored?
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stored in some neurons, endocrine cells, and anterior pituitary, co-stored with corticotrophi
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name three types of opoid receptors
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mu
delta k |
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what are the effects of the mu receptor?
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supraspinal analgesia, spinal analgesia, resp. depression, emesis, euphoria, addiction, modulation of rumination, enteric neurons, miosis, inhibition of ADH release
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what are the effects of the delta receptor?
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located in limbic system, control analgesia and modulation of mu receptors
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what are the effects of the K receptor?
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control spinal analgesia, sedation, vasopressin release, diuresis, and miosis.
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full agonist
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dose-dependent and can be enhanced by incremental dosing if analgesic administration has proved to be inadequate
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partial agonist
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incremental dosing can provide an inferior level of analgesia, associated with dysphoria buprenorphine and butorphanol
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what are the effects of opiod drugs on the CNS?
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analgesia and sedation
thermoregulation- reset hypothalamic thermo center miosis activate vomitting center depression of vasomotor, cough, and resp. center bradycardia and increased GIT motility |
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what are the effects of opiod drugs on respiration?
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resp. depressants
increased resp. rate brocho-constriction in dogs cough suppressant |
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what are the effects of opiods on the CVS?
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minimal effects on CVS
little or no change in BP and no effects on myocardial contractility inhibit sympathetic tone-bradycardia |
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what are the effects of opoids on the GI?
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vomitting (morphine)
depress propulsive movements of sm. intesting therefore intital defecation then constipation |
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what are the effects of opiods on the urinary system?
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significant urinary retention (increased ADH)
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what is tolerance to opiods?
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tolerance is the failure of a steady dose of the drug over time to sustain the desired pharmacological effect. tolerance of opiods generally occurs slowly in association with continuous dosing.
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list 5 advantages of opoids over other analgesic agents
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-profound drug and dose-dependent analgesia.
-benign cardio effects -anesthetic sparing effect -adverse effects can be antagonized -if ventilation is restricted by pain, then opiods will have positive ventilation effects |
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list 8 important side effects of opiods
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1. human abuse
2. respiratory depression 3. GI effects 4. Nausea/ vomitting 5. cardio effects 6. dyshoria, mania, behavioral effects 7. urinary retention 8. biliary statsis/ sphincter closure 9. tolerance |
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how does potency differ from efficacy?
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an opiod may have high potency (affinity for opiod receptors) but limited analgesic efficacy..NOT interchangeable concepts
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how do species differ in their response to opiods?
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humans, dogs, monkeys, rats, rabbits, birds- show depressive effects
dogs- may go through excitable phase, show miosis horses, pigs, cattle, sheep, and goats may show excitability at low doses; mydriasis |
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how do cats differ in their response to metabolism and morphine?
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cats develop mydriasis following opiods.
cats have deficiencies in glucuronidation and produce less morphine-6-glucuronide which contributes to the analgesic efficacy of morphine (so morphine in cats is not as good as in dogs) due to def. in glucuronidyl transferase enzyme system there is a considerably longer half life in the cat and dog. |
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why can we administer bupenorphine by syringe PO to cats?
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cats absorb buprenorphine very well across their oral mucous membranes (due to a more alkaline pH)
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what are the opiods of choice for management of severe pain?
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morphine, methadone, fentanyl are best for severe pain
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when should buprenorphine, meperidine (pethidine> and butorphanol be used?
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Buprenorphine and pethidine are useful in less painful procedures and less severe soft tissue injury
Butorphanol- good sedative and anti-tussive agent. |
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when should we avoid using morphine?
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do no use in patients where vomitting is contraindicated.
also be familar with the delay of onset |
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describe the properties and effects of naloxone
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opiod antagonist, main activity against m receptors
short half life short duration of effect, must often re-administer not a controlled drug does not cause CNS depression |
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how do fentanyl patches work? What is the delay of onset and duration of action of fentanyl patches in dogs and cats?
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diffuses through skin and is taken up by the cutaneous circulation effect w/i 12 hours in cats, 12-14 hrs. in dogs. Analgesia for 3 days, basal analgesia for up to 72 hours in dogs and cats.
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how should the skin be prepared for the application of fentaynl patch?
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shave area, no use of alcohol or soap. Need the lipids on the skin for diffusion.
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what is the analgesic mode of action of NSAIDs, and hwere are their principal sites of analgesic action ?
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inhibit synthesis of eicosaniods from arachidonic acid by blocking action of the cyclo-oxygenase enzymes. Have both central and peripheral actions.
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which NSAIDs are highly COX2 selective?
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with the exception of firecoxib (previcox) no other NSAID licensed for animal use is highly selective for COX 2
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what are the principle side effects of NSAIDs?
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GI ulceration
nephrotoxicity risk of renal decompensation decreased platelet aggregation plasma binding protein |
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list 5 key contraindications for NSAID administration
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-concurrent corticosteriod medicatoin
-hypotension or hypovolemia -gastric ulceration or vomitting -renal dysfunction -coagulopathy -renal dysfunction -pregnant/ lactating animals |
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how does metabolism of NSAIDs differ between cats and dogs?
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cats are deficient in glucuronidation enzymes, and have slow clearance and dose-dependent elimination of NSAIDs
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what is the analgesic mode of action of ketamine?
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antagonism of the N-methyl-D-aspartate (NMDA) glutamate receptor
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Ketamine is particularly indicated for pain management on certain conditions, list these conditions.
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for management of pain associated with burn wounds and phantom limb pain.
adjunctive analgesia in patients whose pain has not been controlled by standard analgesic of opioid/ NSAID |
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what is the principle analgesic mode of action of alpha 2 agonists?
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used as sedative agents.
effective analgesic dose is lower than the typically used for sedative purposes. |
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what is the mode of action of tramadol?
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produced analgesia through inhibition of seratonin and noradrenaline re-uptake and stimulation of seratonin release, mechanisms which facilitate descending spinal inhibitory pathways. hepatic metabolism
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what is the duration of time for tramadol?
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12 hours
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what are the indications of tramadol?
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useful in older dogs with chronic pain
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what is the mode of analgesic action and indication of Gabapentin?
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-anti-epileptic drug for treating partial seizures
-mode of analgesic action- calcium channels -used for neuropathic pain |
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what is the mode of action and indication of Amantidine?
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tx of drug-induced extrapyrimadial effects for parkinsons dz. Useful for neuropathic pain, allows lowering of opiod dose and helps improve opioid analgesia
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