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50 Cards in this Set

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List some ways that animals exhibit pain
-whine/whimper
-aggressive
-growl
-guarding
-biting
-lick, chew, paw at site
What is preemptive analgesia?
Giving analgesics before patient is exposed to pain.
Why should preemptive analgesia be used?
Decreases the intensity and duration of post-procedure pain and minimizes chronic pain being established.
Pain Recognition (stage 1 of 4)
Transduction (1st order neuron): taking what happened and converting it into an electrical impulse.
Pain Recognition (stage 2 of 4)
Transmission (1st order neuron): transmission of nerve impules through peripheral nervous system. (carrying it toward CNS brain and spinal cord)
-Myelinated A-Delta Fibers:Faster
-Non-Myelinated C Fibers: Slower
Pain Recognition (stage 3 of 4)
Modulation (2nd order neuron): controls pain that goes to the brain and shuts it down (pass-out) Uses the bodys natural pain relievers (opiods, serotonergic, noradrenergic)
Pain Recognition (stage 4 of 4)
Perception of Pain (3rd order neroun): this is what you feel of the pain (sucess of the first three)
1st Order Neuron
(Transduction & Transmission)
Where it happens, picks it up and projects it to the spinal cord.
2nd Order Neuron
(Modulation)
Ascends the spinal cord toward the brain.
3rd Order Neuron
(Perception of Pain)
Projects to the brain.
Opioids (Narcotics)
Name the 6 in the notes:
OPIOIDS (NARCOTICS)
-Butorphanol ("Torb")
-Oxymorphone/Hydromorphone
-Fentanyl Patches
-Codeine
-Buprenorphine
Butorphanol ("Torb")
-injectable or oral
-mild pain relief
-45 min analgesic, 2 hr sedation
Oxymorphone/Hydromorphone
-stronger narcotic
-highly addictive
-injectable only
-4 to 6 hr duration or less
Fentanyl Patches
-take 12 hr to take effect
-3 day duration
-constant pain relief
-safety hazard (young children and fatal if eaten by animal!)
Codeine
-low strength
-unable to get alone, must mix w/ other drugs
Buprenorphine
-Cats: oral mucosa 100% availablity
Define Anti-Inflammatory Drugs
Reduce pain/tissue damage by blocking/reducing the inflammatory process.
How does Arachidonic Acid form?
(the inflammatory pathway) Damage of tissues causes phospholipase to break down phospholipids in the cell membrane which causes the release of Arachidonic Acid.
What does Cycloxygenase do?
When NSAIDS block their activity, it decreases the production of prostaglandins
What does Lipoxygenase do?
When NSAIDS block their activity, it decreases leukotriene production.
What does PgE and PgI2 do to the body?
-decreases volume, acidity, pepsin concentration of gastric secretions
-increases sodium secretions, neutralizing acid
-increases perfusion of gastric mucosa
-stimiulates gastric and enteric mucous production
-stimulates repair of GI epithelial cells
What does PgE2 do to the body?
-released in kidney in response to low blood perfusion, like shock, dehydration, or blood loss.
-dilates renal blood vessels
-NSAIDS prevent this compensation leading to death of kidney tissue
What is Phenylbutazone ("Bute") used for?
Commonly used in Equine medicine
-COX-1 & COX-2 inhibitor
-Highly protein bound
-Induce microsomal enzymes
What are the common side effects of Phenylbutazone ("Bute")?
-Retention of water
-Bone marrow suppression
-*Tissue necrosis if given SQ, IM (90% is given orally)
**NOT safe in CATS
Why should Aspirin be used cautiously in cats?
Because their liver does not metabolize aspirin well and can become easily intoxicated.
Dosing:
DOGS: BID
CATS: QOD
What are the common side effects of Aspirin?
-Gastrointestinal upset
-Nausea
-Gastric ulcers
-Kidney failure if excessive
-Inhibits platelets ability to clot
What do Ketofen (Ketoprofen), Ibuprofen, and Naproxen inhibit?
COX-1 and COX-2 inhibitor pathways,
Leukotriene inhibitor
Also Thromboxane inhibitor
Do Rimadyl and Etogesic cause bleeding problems?
Does NOT usually cause bleeding problems, so good choice for pre and post-surgical pain relief.
What animals should not be put on Rimadyl?
With history of Liver or Kidney disease
What is the most common side effect of Etogesic?
Hemmorhagic Diarrhea
What is the most common side effect of Deracoxib (Deramaxx)?
Vomiting
What is unique about Metacam (Meloxicam)?
COX-2 inhibitor, HIGHLY SELECTIVE COX-2 inhibition
How does Acetaminophen differ from NSAIDS?
No Anti-Prostaglandin effects of NSAIDS
Why is Acetaminophen toxic to cats?
Increased in cats due to LACK of GLUCURONIC ACID
(single dose of 50-60 mg/kg sufficient to kill)
How do you treat Acetaminophen Toxicity?
Mucomyst (acetylcysteine)
SUMMARY OF NSAIDS
-Excellent anti-inflammatory
-Must be cautious w/ surgery (except w/ Etogesic, Rimadyl, Metacam, & Deramaxx)
-Increase bleeding
-Ketoprofen, Aspirin:cause bleeding problems; CANNOT be used pre-op
-Rimadyl & Metacam has been used in Cats pre-op but is off label & one time dose.
Define Local Anesthetics
Anesthesia limited to a local area. (use of chemical agent to temperarily cause analgesia and loss of movement)
3 Advantages of Local Anesthetics
1. Low risk of toxicity
2. Low cost
3. Minimum patient recovery time
Disadvantages of Local Anesthetics
-risk of toxicity in small patient
-doesn't provide enough restraint used alone
-technically demanding
-ineffective in areas of fat, bone, cartilage, fascia, tendon, connective tissues
How does Local differ from General Anesthetics?
Locals:
-only effect local neurons (brain, spinal cord)
-no sedative effect
-few effects on cardio system
-good choice for very high risk patients since does not have systemic effects or cross placenta.
How do Local Anesthetics agents produce their effect in the body?
Local anesthetics are membrane stabalizing agents.
They occupy the sodium channels, preventing deionization and hence transmission of the impulse
In what conditions are local agents usually well absorbed?
Well Absorbed from:
-injured skin
-MM's
-respiratory epithelium
-IM, SQ
-IV
What are the side effects from Locals?
-tissue irritation
-paresthesia (tingling, pain, irritation during recovery)
-
What are 2 causes of toxicity from Locals?
What are the signs of toxicity from Locals?
HOW?
1.Excessive rapid absorption
2.Inadvertent IV injection
SIGNS:
-muscle twitching
-sedation
-hyperexcitability
-convulsions
-respiratory depression
-cardiac suppression
***If injected into Spinal Cord, Respiratory Paralysis
How do you prevent toxicity?
General Considerations:
-use sterile solutions/injection equip.
-do not inject inflamed areas
-use undamaged needles
-smallest gauge possible
-aspirate before injecting
-smallest possible concentr.of local
-smallest possible amount of anesthetic
**Lidocaine not more than 10 mg/kg SQ
Common Anesthetics Used
-Lidocaine: Shorter duration
-Bupivicaine: Longer duration
**Multiple local anesthetic blocks can be used
What would an Ideal Analgesic Plan include?
1. Preemptive analgesia:butorphanol or oxymorphone, Fentanyl night before (provide as much pain relief prior to procedure as possible)
-Etogesic, Metacam, Deramaxx, Rimadyl prior to procedure
-**NO Aspirin/Ketoprofen for 7 days!
2. General Anesthesia (supplemented with local anesthetics during procedure)
3. Use good pain relief after procedure (oral narcotic, Fentanyl patch, NSAID) attacking as many routes as possible
Complete Analgesic Plan If:
1. Preanesthetic
-narcotic
-NSAID
2. Intra-Operative
-general
-Local if possible
3. Post-Operative
-Narcotic
-NSAID
What is Wind-UP?
the process by which neurons start to "fire" with the pain process.
-Inhibited w/ ketamine CRI or amantadine
What meds can provide constant post-op pain relief?
Name 4 that are in the notes:
-medetomidine CRI
-Lidocaine CRI
-Fentanyl or morphine CRI
-Tramadol **Mu receptor partial agonist(only use if not using patch)