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Phenothiazines are considered a class of what?
Sedatives/tranquilizers
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What 2 drugs are classified as phenothiazines?
- Acepromazine (PromAce®)
- Chlorpromazine (Thorazine®)
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What is the MOA of phenothiazines? What are they categorized as?
- Block the post-synaptic dopamine receptors in the CNS
- Alpha-1 agonists
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What effects do phenothiazines have on the body?
- Sedation
- Anti-emetic
- Antihistamine
- Anti-arrythmic
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What are the uses of phenothiazines?
- Pre-anesthetic
- Itch relief
- Anti-emetic
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Do phenothiazines have analgesic effects?
No
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What are side effects involved in the use of phenothiazines?
- Penile prolapse
- Hypotension
- Decreased seizure threshold
- Paradoxical excitation/aggression
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What precautions/contraindications are associated w/ phenothiazines?
- Liver dysfunction
- Cardiac disease
- Geriatrics
- Giant breeds, boxers, greyhounds are more sensitive
- Cats and terriers more resistant
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Why should caution be taken when using phenothiazines in a patient with liver dysfunction?
Phenothiazines are metabolized by the liver
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What forms of administration are used for PromAce®?
SQ, IM, IV, Tabs
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Injectable routes for Acepromazine should not exceed this total amount.
3 mg
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What phenothiazine is used for it's anti-emetic effects?
Chlorpromazine (Thorazine®)
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What is the difference between a sedative and a tranquilizer?
A sedative reduces consciousness, while a tranquilizer reduces anxiety
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Is PromAce® a sedative or a tranquilizer?
Sedative
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Are phenothiazines controlled substances?
No
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Are benzondiazepines controlled substances?
No
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What is the mode of action of a benzodiazepine?
Depression of the limbic, thalamic and hypothalamic levels of CNS
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What effects fo benzodiazepines have on the body?
- Anti-anxiety/calming
- Skeletal muscle relaxation
- Anti-convulsant
- Few cardiovascular effects
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What do benzodiazepines not provide?
Analgesia
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What are some uses of benzodiazepines?
- Restraint/sedation
- Anti-anxiety
- Anti-convulsant
- Muscle relaxation
- Appetite stimulation (cats)
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When would benzodiazepines not be used due to contraindications?
- Pregnant animals due to cross placental ability
- Hepatic/renal disease
- Debilitated/geriatric patients
- Coma
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How should benzodiazepines be injected when administering IV? Why?
Slowly because they may cause pain and bradycardia/hypotension
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What is the reversal agent for benzodiazepines?
Flumazenil
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What are some side effects of benzodiazepine use?
- Muscle fasciculations, weakness and ataxia in horses @ doses for sedation
- Liver failure in cats receiving generic Diazepam® for several days
- Excitation of CNS in dogs when used alone
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What is the trade name for Valium?
Diazepam®
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What is Valium often used in combination with?
Ketamine
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Name a few characteristics about Diazepam®
- Absorbable in plastic
- Light sensitive
- Not water soluble
- Not compatible with most other agents
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What are the routes of admin. for Valium? What route is avoided due to poor absorption?
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What is the trade name for Midazolam?
Versed®
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Name 3 characteristics of Midazolam that are different than Diazepam®.
- IM absorbable
- Mixes with other agents
- Less tissue irritation
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What are the routes of admin. for Versed?
IV/IM
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Are Alpha-2 agonists controlled substances?
No
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What is the MOA for Alpha-2 agonists?
- Stimulation of the Alpha-2 receptors in CNS to decrease norepinephrine levels
- Decrease in heart & blood vessel activity
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Name effects of Alpha-2 agonists.
- Sedation
- Analgesia
- Muscle relaxation
- Emesis (cat)
- Thermoregulatory depression
- Bradycardia
- Vasoconstriction
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What are Alpha-2 agonist agents used for?
- Sedation
- PA
- Analgesia
- Emesis
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What age group are Alpha-2 agonists best used in?
Young, healthy patients
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When should extreme caution be taken when using an Alpha-2 agonist?
- Cardiac dz
- Hypotension/shock
- Liver/renal dz
- Seizure disorders
- Debilitated
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When is the use of Alpha-2 agonists contraindicated?
Animals receiving epinephrine or that have active heart arrhythmia
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Alpha-2 agonists can cause premature ________, and _____ _________ or ______ in cattle
Labor; rumen stasis; bloat
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The dose of Aplpha-2 agonists is reduced how much in cattle? Why?
10% because cattle are very sensitive to Alpha-2 agonists and they can cause rumen stasis and bloat
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What are the adverse effects of Alpha-2 agonists? (8)
- Muscle tremors
- Bradycardia
- Resp depression
- Mvmnt response to loud noise
- Polyuria (cat)
- Bloat (dogs)
- Sweating (horses)
- Hypotensive effects w/ other trainquilizers
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What are the 3 Alpha-2 agonists talked about in class? What are their trade names and reversals?
- Xylazine (Rompun®, AnaSed®, Gemini®): Yohimbine (Yobine®) for sm anml, Tolazoline (Tolazine®) for horses
- Dexmedetomidine (Dexdomitor®): Atipamezole (Antisedan®)
- Detomidine (Dormosedan®): Tolazine®, Antisedan®
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What units are Dexmedetomidine doses measured in?
BSA (mcg/m3)
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How can Dexdomitor® be adminstered?
IM/IV
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Dexmedetomidine is approved for use in dogs over ____ weeks of age and cats over _____ weeks of age.
16; 12
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What are effects of Dexmedetomidine?
- Bradycardia
- Decreased seizure threshold
- Hypertension
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What should Dexmedetomidine never be used with? Why?
Atropine because it causes severe arrhythmia's
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Why should Atipamezole not be given IV?
Vasoconstriction is reversed before bradycardia which can cause cardiovascular collapse
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What is Dormosedan® used for?
Sedation and analgesia in horses
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Barbiturates are controlled substances which are categorized into 4 classes based upon their action time. What are they?
- Long-acting (8-12 hrs)
- Intermediate-acting
- Short-acting (45 min - 2 hrs)
- Ultra-short acting (5 - 30 min)
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What is the mode of action of barbiturates?
Depression of the reticular activating system of the brain by inhibiting release of Ach & norepinephrine
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Barbiturates have a high lipid solubility. What are the steps of absorption associated with barbiturates?
- 1: goes to brain
- 2: slowly redistributed to muscle and adipose tissue
- 3: drug leaves brain
- 4: drug slowly released from muscle and adipose
- 5: metabolized in liver
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The _______ the lipid solubility of a barbiturate, the ________ tha amount redistributed to fat
Higher; higher
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What are the effects of barbiturates?
Cardiac, resp, and CNS depression
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When administered IV, barbiturates can commonly cause this.
Transient apnea
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What are the uses of barbiturates?
- Sedation
- Anti-convulsants
- Anesthetic induction
- Euthanasia
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List the contraindications and precautions associated with barbiturates.
- Resp depression pronounced in cats
- Decreased dosages with hypoproteinemia b/c they are protein bound
- Acidosis requires decreased doses b/c acidic pH has greater effects
- Perivascular necrosis it administered extravascular
- Caution w/ renal/hepatic compromise and hypotension
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What should barbiturates not be used in?
Sighthounds
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How are barbiturates dosed?
- To effect
- Dose calculated but only administered until effects are seen
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Do barbiturates have an excitement phase?
Yes
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What are adverse effects of barbiturates?
- Severe cariovascular, resp & CNS depression
- Paradoxical CNS excitement
- Death
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This drug is a DEA CIV, long-acting barbiturate.
Phenobarbital
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Phenobarbital is used for what?
Long term anticonvulsant therapy
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How long does it take Phenobarbital to reach therapeutic levels in the blood stream?
3 wks
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This barbiturate requires blood level monitoring due to its long term use due to the chance of liver enzyme elevation.
Phenobarbital
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What can be seen with Phenobarbital use?
PU/PD & polyphagia
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What are the admin routes for phenobarbital?
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Name the barbiturate that is an ultra-short acting DEA CIII drug.
Thiopental (Pentothal®)
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What is Pentothal® used for?
General anesthesia induction
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Should Pentothal® be used alone in horses? Why?
No b/c it causes excessive ataxia & excitement
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This drug is a DEA CII that is used to treat status epilepticus or for euthanasia.
Pentobarbital
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Name 4 euthanasia solutions.
- Fatal Plus
- Sleepaway
- FP-3
- Beuthanasia-D
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Pentobarbital is lowered to a CIII drug if one of these two drugs are added to it.
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Pentobarbital causes what w/ high doses?
Severe depression of the medullary, resp & vasomotor centers
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What is the dose of Pentobarbital? When can it be doubled?
- 1ml/10 lbs
- Known cardiac patients
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Pentobarbital solutions are typically viscous. What can be done to make administration easier?
- Lg gauge catheters
- Saline dilution
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How is Pentobarbital administered?
- IV
- IP - not ideal
- IC - pocket pets for euthanasia
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What are the uses of dissociatives?
- Anesthetic induction
- Restraint
- Anesthesia for short procedures
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What are the 2 dissociatives covered in class?
- Ketamine
- Tiletamine (Telazol®)
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What are the effects of dissociatives?
- Exaggerated reflex responses
- Marked light & sound sensitivity
- Increased muscle tone
- Fair M/S analgesia
- Poor visceral analgesia
- Tachycardia
- Vasoconstriction
- Apneustic resp
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What is the MOA for dissociatives?
- Overstimulation of the CNS causes analgesia & anesthesia
- Suppression of thalamic/cortical system
- Activation of limbic system (memory & emotion)
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Are dissociatives controlled sunstances?
Yes
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Are barbiturates reversible?
No
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What are contraindications/precautions associated with dissociatives?
- Rough recoveries
- No blinking therefore eye lubricant is important
- PLR cannot be monitored
- No use in animals for consumption
- Increase of IOP & intracranial pressure
- No use in renal & liver compromise, as well as hypertension & heart dz
- May induce seizures
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What are the adverse effects that may be seen with use of dissociatives?
- Pain w/ IM inj
- Increased salivation
- Resp depression
- Personality changes
- Emesis
- Vocalization
- Erratic/prolonged recovery
- Spastic, jerky movements
- Seizures, muscle tremors
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Ketamine is a C _ drug commonly used with what 4 drugs?
- III
- Diazepam®, Rompun®, PromAce®, and Guaifenesin
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The Ket/Xylazine combo has been known to cause what?
- Cardiac arrhythmias, pulmonary edema, resp depression in dogs
- Cardiovascular collapse post-op in cats
- Excellent analgesia, muscle relaxation and sedation in horses w/ min cardiovascular effects
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Ket/Val is mixed with ________ volumes in the same syringe and is administered _____ for anesthetic induction.
Equal; IV
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Ket/Ace combo is given __ and is commonly mixed with a full 10ml bottle of ______ and 1ml of _____, with a max. dose of __ no matter what the weight.
IM; Ketamine; Acepromazine; 1ml
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Telazol® is the trade name for what?
Tiletamine
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What class drug is Tiletamine?
CIII
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Before administration, Telazol® must be _________ and is well absorbed ___, but can also be used ___.
Reconstituted; IM; IV
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Tiletamine is used for _____________ and _____________
Anesthetic induction; short minor procedures
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Opiods are ________ that are naturally derived or synthetically produced from the ____________________. Thay are a DEA C_ drug.
Narcotics; opium poppy alkaloid; II
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What is the MOA of opiods?
Spinal cord and brain receptor reaction to opiods that are naturally stimulated by endorphins and enkephalins
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What are the 4 opiod receptors? What do they contribute to?
- Mu: analgesia, euphoria, physical dependence
- Kappa: vocalization, hallucinations
- Sigma: analgesia, sedation
- Delta: modify Mu
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What are the effects of opioids?
- Sedation (dog)
- Anxiety/excitement w/ IV admin (cat)
- Analgesia
- Marked resp depression
-
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What is the reversal agent for opioids?
Naloxone (Narcan®)
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Caution should be taken with opioids in animals with: (5)
- Hypothyroidism
- Renal dz
- Addison's dz (hypoadrenocorticism)
- Geriatrics/severely debilitated animals
- Resp distress
- Liver dz
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Opioids should not be used with the MOA inhibitors: (3)
- Monoamine oxidase: Anipryl
- Tricyclic antidepressants: Elavil (amitriptyline), Clomicalm (clomipramine)
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IV administration of opioids should be done __________ to prevent __________
Slowly; bronchoconstriction
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What are adverse effects seen with opioid use?
- Decreased resp & gastric motility
- Addiction/dependence/tolerance
- Facial swelling & hypotension (meperidine & morphine IV)
- Increased urinary sphincter tone w/ urine retention
- Excitation/mania w/ horse & cat
- Hyperthermia in cat/horse
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What receptor does Morphine react with?
Mu
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Is Morphine natural? What class drug is it?
Yes; CII
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How can morphine be admin.? How long does it stay active?
- SQ, IM, IV, Tabs, Rectally
- 2 - 4 hr duration
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What is the trade name for Oxymorphone?
Numorphan®
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Whay class drud is Numorphan®?
CII
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What opioid is 10x more potent than Morphine? 5x?
Numorphan®; Hydromorphone
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Is Oxymorphone synthetic or natural?
Synthetic
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What is Torbugesic® used for? What is it classified as?
Antitussive; opioid
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What are two other names for Torbutrol®?
Torbugesic®, Butorphanol
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Torbugesic come in an ____ form, while Torbutrol comes in a _____ form
Inj; Tab
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This opioid is delivered at a CRI when given IV.
Fentanyl
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What CIII opioid is 30x as potent as Morphine? What is its trade name? How is it given?
- Buprenorphine (Buprenex®)
- Buccal/sublingual
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When are neuroleptanalgesics used?
When significant CNS depression is needed but not anesthesia
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An ________ and _______ combined form a neuroleptanalgesic.
Opioid; tranquilizer
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Propofol is also known as _______ or ________.
Propoflo®; Rapinovet®
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A rapid, smooth anesthetic induction through slow IV administration is caused by?
Propoflo®
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Rapinovet® must be discarded after ___ hours due to it's short shelf life
6
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Propofol has no _______ effects and can cause significant ________ depression.
Analgesic; resp
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Propofol is an induction agent that is relatively safe to use with what condition?
Heart disease
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Why should Propofol be given w/ IV fluids?
To prevent hypotension
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This drug is useful in high risk patients due to it's minimal cardiovascular and pulmonary effects.
Etomidate
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What action does Etomidate have on the brain?
Maintains perfusion and decreases oxygen consumption
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Does Etomidate have a long onset of action?
No
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List adverse effects seen with Etomidate.
- Pain upon inj
- Vomiting
- Nausea
- Spontaneous muscle movements'RBC hemolysis w/ rapid induction
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This drug is a muscle relaxant often used in equine.
Guaifenesin
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What is Guaifenesin used for in small animals?
Antitussive
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What is the key ingredient in Guaifenesin?
Mucinex
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Dopram® stimulates the ________ of the brainstems to stimulate _______
Medulla; breathing
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What is Doxapram used for?
Increasing resp in animals with apnea or bradypnea
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What might Doxapram cause due to stimulation of the emotional and behavior centers of the brain?
- Aggression
- Muscle tremors
- Hallucinations
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How is Dopram® given to neonates?
Gtt under tongue
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