Ch. 7 - Controlling Pain

Front 1

Physiologic pain has ______________ tissue injury.

Back 1

little or NO tissue injury

Front 2

Pathologic pain ____________ tissue injury

Back 2

follows

Front 3

Pathologic pain can be either ______ or _________.

Back 3

acute

chronic

Front 4

Example of chronic pathologic pain:

Back 4

arthritis

Front 5

Pathologic pain is classified base on these 3 things

Back 5

1. mechanism (ex. inflammatory, neuropathic)

2. origin (ex. visceral or somatic / superficial, deep)

3. severity of pain (mild, moderate, severe)

Front 6

Pain Modulation:

What vein is good to use for blood draws in dogs that seem especially sensitive to pain?

Back 6

saphenous

Front 7

What are the 4 steps of Nociception?

Back 7

1. transduction

2. transmission

3. modulation

4. perception

Front 8

What happens in transduction?

Back 8

stimuli are transformed into sensory electrical signals (action potentials))

Front 9

What happens in transmission?

Back 9

Sensory impulses are conducted to the spinal cord

Front 10

What happens in modulation?

Back 10

Impulses are either amplified or suppressed

Front 11

What happens in perception?

Back 11

Impulses are transmitted to brain where they are processed and recognized

Front 12

Each step of Nociception (the pain pathway) has different _______________.

Back 12

receptors

Front 13

Drugs target specific ____________ and block a specific _________.

Back 13

receptor

step

Front 14

Multimodal drug therapy:

Back 14

targeting two or more of the receptors

Front 15

Consequences of untreated pain (4)

Back 15

1. patient suffering

2. immune system suppression

3. inflammation and delayed wound healing

4. anesthetic risk & increased anesthetic doses

Front 16

Hyperalgesia = ___________________ and can lead to aggression in what species (due to being painful.)

Back 16

hypersensitivity to pain

cats

Front 17

Windup is a state of...?

Back 17

hyperexcitement due to pain

(spinal cord neurons are constantly stimulated)

Front 18

_____________ is released with pain and stress.

Back 18

ACTH

Front 19

Neuroendocrine changes can result in a ____________ state and ____________.

Back 19

catabolic

wasting

(ACTH release, elevated cortisol, epi, norepi, decreased insulin)

Front 20

Sympathetic stimulation can result in __________ ____________.

Back 20

cardiac arrhthmias

(due to increased myocardial work, vasoconstriction, and increased myocardial O2 consumption)

Front 21

Signs of pain:

Pain elicits a __________ response.

Back 21

stress

Front 22

Stress-related pain results in what type of physiological response?

Back 22

fight or flight

Front 23

When evaluating pain in an animal, be careful not to give in to our human tendency to ________________.

Back 23

anthropomorphize

Front 24

Preemptive Analgesia:

Back 24

the administration of pain meds BEFORE the pain occurs.

Front 25

Pr-anesthesia analgesia reduces what?

Prevents what?

Back 25

The overall requirement for anesthesia and duration of administration

windup

Front 26

Behavior responses to pain:

_____________ patient are less tolerant of pain

Back 26

young

Front 27

Behavior responses to pain:

_____________ are very stoic (what species)

Back 27

cattle

Front 28

Large breed dogs tend to be ___________ stoic than toy breeds.

Back 28

more

Front 29

Behavior response to pain depends on 4 other things:

Back 29

1. nature of pain

2. duration of pain

3. severity of pain

4. presence / absence of human

Front 30

Physical evidence of arthritic pain: (2)

Back 30

1. change in gait

2. change in level of activity

Front 31

Physical evidence of thoracic or abdominal pain: (2)

Back 31

1. reluctance to lie down

2. constantly shifting position

Front 32

What are other general physical evidences of pain? (4)

Back 32

1. vocalization

2. facial expression

3. change in appearance

4. change in attitude

Front 33

Pain assessment tools:

Use some sort of ___________ to rate pain and always be ______________.

Back 33

scale

consistent

Front 34

Assessing response to therapy:

Should see what?

Back 34

improvement in behavior / ability

Front 35

Examples of preemptive analgesia: (2)

Back 35

1. Fentanyl patch

2. NSAIDs

Front 36

Advantages of multimodal drug therapy: (3)

Back 36

1. covers multiple receptors and mechanisms of action

2. reduces dose of individual drugs

3. reduces dose of anesthetic agent

Front 37

Analgesia is needed at which stage of hospitalization and treatment?

Back 37

EVERY stage

1. pre-anesthesia

2. surgical period

3. immediately post-op

4. remainder of hospital stay

5. at home

Front 38

Choice of drug depends on these 4 things:

Back 38

1. type of pain

2. severity of pain

3. patient's general condition

4. route of delivery

Front 39

Opioids as analgesics:

Opioids vary in ___________, ________ and _____________ effects.

Back 39

potency

duration

adverse effects

Front 40

Opioids as analgesics:

Opioids are often combined with a ___________ to form a ___________________.

Back 40

tranquilizer

neuroleptanalgesic

Front 41

Name two tranquilizers

Back 41

acepromazine

dexmedetomidine (Dexdomitor)

Front 42

Opioids can help to diminish _______________.

Back 42

windup

Front 43

How long do opioids last?

Back 43

2 - 4 hours

Front 44

Are opioids a good choice for post-op pain?

Back 44

no

(effects will be wearing off by the time you get through induction, surgery, etc.)

Need to GIVE AGAIN

Front 45

Why are neuroleptanalgesics a better choice?

Back 45

they last longer post-operatively due to having a tranquilizer on board

Front 46

TRUE or FALSE:

Opioids can be used one or in combination with other drugs?

Back 46

TRUE

Front 47

As a sedative / anti-anxiety drug opioids may cause excitement in awake ____________ and _________.

Back 47

cats

horses

Front 48

What are the GI effects of opioids? (2 general)

Back 48

1. initial increase in GI activity

2. followed by slow-down in GI activity

Front 49

What are specific examples of the effects opioids have on the GI system?

Back 49

1. nasuea, vomiting, defecation

2. ileus, colic, constipation

Front 50

what is ileus?

Back 50

lack of gut activity

Front 51

Due to their GI effects, opioids are NOT a good choice for what species?

Back 51

horses

(also cows)

Front 52

Where are opioids metabolized?

Back 52

liver

Front 53

Morphine is a Schedule _______ drug

Back 53

II (two)

Front 54

Morphine is used for moderate to severe ___________ or ___________ pain

Back 54

visceral

somatic

Front 55

Somatic pain comes from the _______ and __________.

Visceral pain comes from the _________ __________.

Back 55

skin & deep tissues

internal organs

Front 56

TRUE or FALSE:

Morphine is PURE agonist:

Back 56

TRUE

Front 57

Morphine may cause ______________ or dysphoria in ___________ and ___________.

Back 57

excitement

cats, horses

Front 58

Morphine may cause ________ in dogs and horses.

Back 58

restlessness

Front 59

Morphine may be administered in any of the 6 following ways:

Back 59

1. IM

2. IV

3. SC

4. intra-articular

5. epidural

6. spinal injection

Front 60

Adverse side effects of morphine: (8)

Back 60

1. initial GI stimulation in dogs/cats

2. ileus and colic in horses

3. excitement and miosis in dogs

4. mydriasis in cats

5. hypothermia / hyperthermia in cats

6. bradycardia, panting

7. increased intraocular pressure

8. urinary retention

Front 61

Are opioids a good choice for head trauma / eye injury patients? Why or why not?

Back 61

NO - increased intraocular and intracranial pressure

Front 62

Oxymorphone: does it have more or less GI upset than morphine?

What schedule is it?

Back 62

LESS GI upset

II (two)

Front 63

Oxymorphone: is it more or less potent than morphine?

Back 63

MORE

Front 64

Oxymorphone has _______________ side effects and ___________ duration than morphine.

Back 64

fewer side effects

longer duration

Front 65

Disadvantage of oxymorphone?

Back 65

expensive

Front 66

Hydromorphone:

Can be used alone as a _________ or with a ___________.

Back 66

pre-med

tranquilizer

Front 67

Hydromorphone is ____________ potent than morphine and has ______________ side effects.

Back 67

less

fewer

Front 68

Fentanyl is one of the most __________ analgesics known.

Back 68

potent

Front 69

Fentanyl patch has a ___________ onset.

Back 69

rapid (2 minutes)

Front 70

Opioids are also _____________.

Back 70

narcotics

Front 71

Fentanyl has a short duration of effect (20-30 minutes) when administered how?

Back 71

IV

Front 72

Fentanyl can be administered in these 5 ways:

Back 72

1. continuous IV drip

2. transdermal patch

3. IM

4. SC

5. epidural injection

Front 73

Fentanyl can be used in combination with _____________ or ___________ drawn into _________ syringes.

Back 73

diazepam

midazolam

separate

Front 74

What should you always do when working with a Fentanyl patch?

Back 74

wear gloves

Front 75

Meperidine / Pethidine:

1. Used mostly as a _____________.

2. Route of administration:

3. Effective used with a _____________ in ____________. (species)

Back 75

1. pre-anesthetic med

2. SQ

3. tranquilizer, puppies

Front 76

What opioid is good to use with puppies (as a neuroleptanalgesic)?

Back 76

Meperidine (Pethidine)

Front 77

Butorphanol:

Best used in what species?

Back 77

horses

Front 78

Butorphanol is a Schedule ________ drug.

Back 78

IV (four)

Front 79

Buprenorphine:

1. Is a Schedule _______ drug.

2. Is used how in cats?

3. Route of administration?

4. commonly uses as a ________________.

Back 79

1. V (five)

2. on their gums

3. IM

4. pre-med

Front 80

TRUE or FALSE: Buprenorphine is a true agonist?

Back 80

FALSE - it's a partial (mu) agonist

Front 81

TRUE or FALSE:

Buprenorphine is used for moderate to severe pain.

Back 81

FALSE: used for mild to moderate pain

Front 82

Used with a sedative, Buprenorphine can prolong _______________ _________.

Back 82

sleep time

Front 83

Buprenorphine is often used to provide ___________________ analgesia to dogs and cats (what time?)

Back 83

post-op

Front 84

Nalbuphine is used as a ___________ _____________ for opioid agonists.

Back 84

reversal agent

Front 85

Is Nalbuphine a strong or a weak analgesic / sedative?

Back 85

weak

Front 86

Post-Op Opioids:

Disadvantages: 2

Back 86

1. short duration

2. adverse reactions

(resp. depression, bradycardia, excitement, apprehension, hyper salivation, mydriasis, excessive sedation, panting, increased sensitivity to sound, urinary retention, GI effects)

Front 87

Opioids - name 6

Back 87

1. morphine

2. oxymorphone

3. hydromorphone

4. Fentanyl

5. butorphanol

6. buprenorphine

Front 88

Can opioids be used in an IV infusion?

Back 88

YES

Front 89

Can opioids be used continuously?

Back 89

YES

Front 90

Opioids: IV infusion:

After an initial loading dose, opioids are given ___ ___________

Back 90

to effect

Front 91

Intra-articular injection blocks at what stage and is especially good after what procedures?

Back 91

Sensory (Transmission)

joint surgery

Front 92

What is the most common drug used in an epidural?

Why?

Back 92

morphine

long duration of action

Front 93

Epidural injection of morphine blocks what type of nerve transmission?

Back 93

sensory

(and sometimes motor)

Front 94

What is important to do when recovering an animal that's had a morphine epidural?

Back 94

reposition every 2 - 4 hours to prevent pulmonary atelectasis or prolonged pressure on superficial nerve

Front 95

NSAIDs: give 5 examples

Back 95

1. aspirin

2. acetaminophen

3. Meloxicam

4. Carprofen

5. Rimadyl

Front 96

NSAIDs are both _____________ and ______________.

Back 96

anti-inflammatory

non-steroidal

Front 97

Steroids can cause issues with the ___________ and the ______________.

Back 97

liver

kidneys

Front 98

steroids are eliminated by the ____________

Back 98

kidneys

Front 99

Adverse effets of NSAIDs:

Back 99

Prevent production of beneficial prostaglandins (because they block them ALL)

Front 100

When using NSAIDs, be careful of patients with _____________ disease.

Back 100

heart

Front 101

What type of drugs are the two most commonly used analgesics?

Back 101

opioids

NSAIDs

Front 102

Local anesthetics are used to treat or prevent _________________ pain.

Back 102

post-op

Front 103

Advantages of local anesthetics: (3)

Back 103

1. Complete anesthesia of affected area

2. low toxicity

3. rapid onset of action

Front 104

Disadvantages of local anesthetics: (2)

Back 104

1. short duration of action

2. CNS and cardiac toxicity with repeated use

Front 105

Alpha 2 Agonists (adrenoceptors) have limited use in ___________ animals.

Back 105

small

Front 106

Alpha 2 Agonists (adrenoceptors):

name 2:

Back 106

1. Xylazine

2. Dexdomitor

Front 107

Which A2Agonist is used in horses to provide sedation, muscle relaxation, and analgesia?

Back 107

Xylazine

Front 108

Ketamine blocks receptors at ________________________.

Back 108

the spinal cord

Front 109

Ketamine - does it produce analgesia?

Back 109

No, not by itself

Front 110

What can ketamine be combined with to provide intra-operative analgesia?

Back 110

morphine, lidocaine

Front 111

Adverse effects of Ketamine:

Back 111

1. tachycardia

2. hypertension

3. seizures

4. post-op delirium (the "crazies")

5. increased intraocular / intracranial pressure

6. salivation

Front 112

Corticosteroids as analgesics:

Have strong ______________________ properties.

Back 112

anti-inflammatory

Front 113

Corticosteroids as analgesics:

Decrease prostaglandin activity such as _______________.

Back 113

NSAIDs

Front 114

Corticosteroids as analgesics:

Do not use concurrently with _________.

Back 114

NSAIDs

Front 115

Corticosteroids as analgesics:

Adverse effects: (3)

Back 115

1. may cause ulcers

2. immunosuppression with long-term use

3. hyperadrenocorticism

Front 116

Hyperadrenocorticism is ________________ disease.

Back 116

Cushings

Front 117

Hypoadrenocorticism is __________________.

Back 117

Addison's

Front 118

What is crucial when stopping steroid use?

Back 118

diminished / tapered decrease

(need to teach adrenal gland to start producing on its own again)

Front 119

Tramadol as an analgesic:

Is Tramadol an opiate?

Back 119

NO

Front 120

How is Tramadol given?

When?

Back 120

orally

atfer patient has resumed eating

Front 121

Benefits of Tramadol? (2)

Back 121

1. can be given at home

2. alternative to using an opiate

Front 122

Do not use Tramadol concurrently with what other re-uptake inhibitors?

Back 122

norepineprhine or serotonin

Front 123

Tranquilizers: are they considered to be analgesics?

Back 123

NO

Front 124

Tranquilizers can be helpful in calming the excitement sometimes seen in ___________ and __________ after _______________ administration.

Back 124

cats

horses

opioid

Front 125

Tranquilizers may ___________ the effect of opioids in _______________ patients.

Back 125

increase

anxious

Front 126

Why is multimodal therapy useful?

Back 126

different drugs target different mechanisms along the pain pathway

Front 127

Examples of multimodal therapy:

(4 combos)

Back 127

1. Acetaminophen + codeine (dogs)

2. Fentanyl + Meloxicam

3. Morphine + injectable NSAID (meloxicam or carpfrofen)

4. MLK

Front 128

Home analgesia:

5 examples

Back 128

1. Fentanyl patch

2. Tramadol

3. NSAIDs

4. Oral morphine

5. Tylenol w/codein (dogs) + butorphanol

Front 129

Nursing Care: (7)

Back 129

1. clean, dry cage

2. quiet surroundings, comfortable bedding

3. opportunity to urinate / defecate

4. comfortable position / turning as needed

5. toys, blankets from home to reduce anxiety

6. eye ointment in unconscious patients to reduce corneal drying

7. touch, talking

Front 130

Non-pharmacologic therapies: (7)

Back 130

1. acupuncture

2. laser

3. transQ electric nerve stimulation

4. massage

5. physiotherapy

6. homeopathic / herbal

7. cold / heat therapy

Front 131

What is the reversal agent for most opioids?

Back 131

Naloxone