Pain Management *final (Packet 1)

Front 1

List some ways that animals exhibit pain

Back 1

-whine/whimper
-aggressive
-growl
-guarding
-biting
-lick, chew, paw at site

Front 2

What is preemptive analgesia?

Back 2

Giving analgesics before patient is exposed to pain.

Front 3

Why should preemptive analgesia be used?

Back 3

Decreases the intensity and duration of post-procedure pain and minimizes chronic pain being established.

Front 4

Pain Recognition (stage 1 of 4)

Back 4

Transduction (1st order neuron): taking what happened and converting it into an electrical impulse.

Front 5

Pain Recognition (stage 2 of 4)

Back 5

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

Front 6

Pain Recognition (stage 3 of 4)

Back 6

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)

Front 7

Pain Recognition (stage 4 of 4)

Back 7

Perception of Pain (3rd order neroun): this is what you feel of the pain (sucess of the first three)

Front 8

1st Order Neuron

Back 8

(Transduction & Transmission)
Where it happens, picks it up and projects it to the spinal cord.

Front 9

2nd Order Neuron

Back 9

(Modulation)
Ascends the spinal cord toward the brain.

Front 10

3rd Order Neuron

Back 10

(Perception of Pain)
Projects to the brain.

Front 11

Opioids (Narcotics)
Name the 6 in the notes:

Back 11

OPIOIDS (NARCOTICS)
-Butorphanol ("Torb")
-Oxymorphone/Hydromorphone
-Fentanyl Patches
-Codeine
-Buprenorphine

Front 12

Butorphanol ("Torb")

Back 12

-injectable or oral
-mild pain relief
-45 min analgesic, 2 hr sedation

Front 13

Oxymorphone/Hydromorphone

Back 13

-stronger narcotic
-highly addictive
-injectable only
-4 to 6 hr duration or less

Front 14

Fentanyl Patches

Back 14

-take 12 hr to take effect
-3 day duration
-constant pain relief
-safety hazard (young children and fatal if eaten by animal!)

Front 15

Codeine

Back 15

-low strength
-unable to get alone, must mix w/ other drugs

Front 16

Buprenorphine

Back 16

-Cats: oral mucosa 100% availablity

Front 17

Define Anti-Inflammatory Drugs

Back 17

Reduce pain/tissue damage by blocking/reducing the inflammatory process.

Front 18

How does Arachidonic Acid form?

Back 18

(the inflammatory pathway) Damage of tissues causes phospholipase to break down phospholipids in the cell membrane which causes the release of Arachidonic Acid.

Front 19

What does Cycloxygenase do?

Back 19

When NSAIDS block their activity, it decreases the production of prostaglandins

Front 20

What does Lipoxygenase do?

Back 20

When NSAIDS block their activity, it decreases leukotriene production.

Front 21

What does PgE and PgI2 do to the body?

Back 21

-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

Front 22

What does PgE2 do to the body?

Back 22

-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

Front 23

What is Phenylbutazone ("Bute") used for?

Back 23

Commonly used in Equine medicine
-COX-1 & COX-2 inhibitor
-Highly protein bound
-Induce microsomal enzymes

Front 24

What are the common side effects of Phenylbutazone ("Bute")?

Back 24

-Retention of water
-Bone marrow suppression
-*Tissue necrosis if given SQ, IM (90% is given orally)
**NOT safe in CATS

Front 25

Why should Aspirin be used cautiously in cats?

Back 25

Because their liver does not metabolize aspirin well and can become easily intoxicated.
Dosing:
DOGS: BID
CATS: QOD

Front 26

What are the common side effects of Aspirin?

Back 26

-Gastrointestinal upset
-Nausea
-Gastric ulcers
-Kidney failure if excessive
-Inhibits platelets ability to clot

Front 27

What do Ketofen (Ketoprofen), Ibuprofen, and Naproxen inhibit?

Back 27

COX-1 and COX-2 inhibitor pathways,
Leukotriene inhibitor
Also Thromboxane inhibitor

Front 28

Do Rimadyl and Etogesic cause bleeding problems?

Back 28

Does NOT usually cause bleeding problems, so good choice for pre and post-surgical pain relief.

Front 29

What animals should not be put on Rimadyl?

Back 29

With history of Liver or Kidney disease

Front 30

What is the most common side effect of Etogesic?

Back 30

Hemmorhagic Diarrhea

Front 31

What is the most common side effect of Deracoxib (Deramaxx)?

Back 31

Vomiting

Front 32

What is unique about Metacam (Meloxicam)?

Back 32

COX-2 inhibitor, HIGHLY SELECTIVE COX-2 inhibition

Front 33

How does Acetaminophen differ from NSAIDS?

Back 33

No Anti-Prostaglandin effects of NSAIDS

Front 34

Why is Acetaminophen toxic to cats?

Back 34

Increased in cats due to LACK of GLUCURONIC ACID
(single dose of 50-60 mg/kg sufficient to kill)

Front 35

How do you treat Acetaminophen Toxicity?

Back 35

Mucomyst (acetylcysteine)

Front 36

SUMMARY OF NSAIDS

Back 36

-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.

Front 37

Define Local Anesthetics

Back 37

Anesthesia limited to a local area. (use of chemical agent to temperarily cause analgesia and loss of movement)

Front 38

3 Advantages of Local Anesthetics

Back 38

1. Low risk of toxicity
2. Low cost
3. Minimum patient recovery time

Front 39

Disadvantages of Local Anesthetics

Back 39

-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

Front 40

How does Local differ from General Anesthetics?

Back 40

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.

Front 41

How do Local Anesthetics agents produce their effect in the body?

Back 41

Local anesthetics are membrane stabalizing agents.
They occupy the sodium channels, preventing deionization and hence transmission of the impulse

Front 42

In what conditions are local agents usually well absorbed?

Back 42

Well Absorbed from:
-injured skin
-MM's
-respiratory epithelium
-IM, SQ
-IV

Front 43

What are the side effects from Locals?

Back 43

-tissue irritation
-paresthesia (tingling, pain, irritation during recovery)
-

Front 44

What are 2 causes of toxicity from Locals?
What are the signs of toxicity from Locals?

Back 44

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

Front 45

How do you prevent toxicity?

Back 45

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

Front 46

Common Anesthetics Used

Back 46

-Lidocaine: Shorter duration
-Bupivicaine: Longer duration
**Multiple local anesthetic blocks can be used

Front 47

What would an Ideal Analgesic Plan include?

Back 47

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

Front 48

Complete Analgesic Plan If:

Back 48

1. Preanesthetic
-narcotic
-NSAID
2. Intra-Operative
-general
-Local if possible
3. Post-Operative
-Narcotic
-NSAID

Front 49

What is Wind-UP?

Back 49

the process by which neurons start to "fire" with the pain process.
-Inhibited w/ ketamine CRI or amantadine

Front 50

What meds can provide constant post-op pain relief?
Name 4 that are in the notes:

Back 50

-medetomidine CRI
-Lidocaine CRI
-Fentanyl or morphine CRI
-Tramadol **Mu receptor partial agonist(only use if not using patch)