Preanesthetic 5

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Preanesthetic 5
2012-01-24 23:28:52
Clinical Practice

Clinical Practice
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  1. What are opioid drugs?
    drugs derived from opium, including synthetic
  2. What kind of plant are opioids originally derived from?
    poppy - opium poppy
  3. What is opium?
    juice from unripened poppy pods
  4. What are opioid drugs used for?
    preanesthetics, induction agents, and analgesics
  5. Name the original drug isolated from opium.
  6. What are "narcotics"?
    opioid drugs that induce addiction and are involved in criminal activity.
  7. How do opioids work? (what is their mode of action?)
    opioid drugs stimulate natural opioid receptors present in our bodies
  8. What is the name of the natural opioids produced by our bodies?
  9. Name the 3 opioid receptors present in our bodies.
    mu, kappa, delta
  10. What are these 3 opioid receptors located?
    on neurons, in the brain
  11. List the main effects produced in the patient when mu receptors are stimulated.
    mu - respiratory depression, euphoria, adidtion, profound analgesia, sedation
  12. List the main effects produced in the patient when kappa receptors are stimulated
    kappa - respiratory depression, analgesia, sedation
  13. Stimulation of which receptors produces the most profound analgesia - mu or kappa?
  14. Are sigma receptors considered to be pure opioid receptors?
  15. Do some opioids stimulate sigma receptors?
  16. Name 1 non-opioid drug that stimulates sigma rececptors.
  17. List the main effects produced in the patient when sigma receptors are stimulated.
    hallucinations, euphoria, dysphoria
  18. Why is there so much variation in the effects of different opoiod drugs?
    because different opioids can stimulate or block a different combination of opioid receptors.
  19. What is an agonist?
    a drug that stimulates (has an effect, has intrinsic activity) a receptor.
  20. Give 1 example of an opioid drug that is an antagonist for all 3 opioid receptors.
    naloxone - Narcan
  21. What is a mixed agonist/antagonist? (Specifically in reference to opioid drugs, for our purposes)
    an opioid drug that stimulates one or two opioid receptors, and blocks the other opioid receptors
  22. Give 1 example of an opioid drug that is a mixed agonist/antagonist.
    butorphanol - stimulates kappa, blocks mu
  23. What is the use of an agaonist drug?
    to have an effect - we give drugs to have an effect on the patient, to help the patient.
  24. What is the use of an antagoinst drug?
    we can use antagonists to block, or reverse, the effects of agonist drugs
  25. Why would we want to block the effect of an agonist drug?
    the patient may be affected more by the agonist drug than is safe, or be overdosed, or may simply not need the agonist drug effect any more.
  26. What is the use of a mixed agonist/antagonist drug?
    can be used to partially reverse the effects of an agonist drug. for example, morphine may cause too much respiratory depression, but we do not want to fully reverse it because we want the patient to have the analgesia. butorphanol can be given to partially reverse it
  27. What are the beneficial effects of opioids?
    analgesia. some depression - sedation. coough suppression - may be beneficial or not, depending on circumstances
  28. What is drug "potency"?
    how much of a drug it takes to produce the desired effect. it takes a larger amount of a less potent drug to have the same effect as a smaller amount of a more potent drug
  29. Briefly list the adverse effects of opioids
    may cause CNS depression or excitation; respiratory depression, panting; GI effects such as vomiting, diarrhea, flatulence, constipation, excess salivation; cardiovascular depression - bradycardia, hypotension; miosis in dogs, mydriasis in cats; addition in people.
  30. What do we call the bizarre behavior in cats caused by opioid overdose?
    "morphine mania"
  31. What is "PaO2"?
    P - partial pressure - the concentration of gas dissolved in a liquid. for our purposes, means "concentration". a = arterial. PaO2 is the concentration of oxygen in arterial blood
  32. What is PaCO2"?
    the concentration of carbon dioxide in arterial blood
  33. Does respiratory depression cause increased or decreased PaO2?
    decreased PaO2
  34. Does respiratory depression cause increase or decrease PaCO2?
    increased PaCO2
  35. Is increased PaCO2 associated with respiratory acidosis or alkalosis?
    respiratory acidosis
  36. What drug can we give to a patient to reduce opioid side effects such as vomiting, diarrhea, excessive salivation, and bradycardia?
  37. Briefly list the clinical signs of opioid overdosage
    excessive salivation, anxiety, pinpoint pupils, excitement, slow respiration, cyanosis, bradycardia, hypotension, tonic convulsions
  38. Are most opioids controlled or scheduled drugs?
  39. Can opioids be reversed (are opioids antagonist available)?
  40. List 4 opioid antagonists
    • naloxone - Narcan
    • levallorphan - Lorfan
    • nalorphine - Nalline
    • butorphanol - Torbutrol
  41. Which 1 of the four opioid antagonists is a pure antagoinst?
    • naloxone - Narcan is the pure antagoinst
    • the rest of them are mixed agonists/antagonists
  42. Do opioid antagonists reverse acepromazine, xylazine, or ketamine?
  43. For safe use of opioids, what 2 other types of drugs should be kept on hand?
    atropine, opioid reversers
  44. List 3 methods of use of opioids
    • preanesthetics
    • neuroleptanalgesia
    • analgesia
  45. What is neuroleptanalgesia?
    a specific drug combination - opioid + tranquilizer
  46. What is the advantage of the neuroleptanalgesia combination of drugs?
    synergistic effect - the drugs have a greater effect combined than either used alone
  47. How is neuroleptanalgesia used?
    • preanesthetic mixtures such as BAA (butorphanol - ace - atropine)
    • procedures requiring significant CNS depression
  48. What class of drugs is most effect for analgesia?
  49. Name 2 other classes of drugs that are analgesic
    • corticosteroids
    • NSAIDs (non-steroidal anti-inflammatory drugs)
  50. When should analgesic drugs be given - before pain occurs (before surgery) or after pain occurs (during or after surgery)?
    before pain occurs
  51. List 7 commonly used opioid drugs
    • morphine
    • meperidine - Demerol
    • oxymorphone - Numorphan
    • butorphanol
    • buprenorphine
    • apomorphine
    • fentanyl
  52. List the 3 trade names of butorphanol
    • Torbutrol
    • Torbugesic
    • Stadol (human product)
  53. What is Torbutrol approved for? Is it ever used off label?
    • cough suppression in dogs
    • yes - used for analgesia, preanesthetic
  54. What is another use for butorphanol, besides cough suppression, analgesia, and as a preanesthetic?
    mixed agonist antagonist - can be used to partially reverse morphine, meperidine, and oxymorphine
  55. Explain why butorphanol is a partial antagoinst to morphine.
    butorphanol stimulate kappa receptors and blocks mu receptors. morphine stimulates mu, kappa, delta. when used as a reverser to morphine, butorphanol reverses mu stimulation but keeps kappa stimulation in place
  56. Is butorphanol addictive?
    no - no mu stimulation
  57. In reference to butorphanol, what is the "ceiling effect"?
    increasing the dose of butorphanol causes increased respiratory depression up to a point, then the respiratory depression does not get any worse as the dose of butorphanol is increased even more
  58. Does buprenorphine - Buprenex provide more profound analgesia that butorphanol? Why?
    yes - because it is a mu agonist, and butorphanol is not
  59. What drug is the most effective emetic drug for dogs?
  60. What strange way can apomorphine be administered to a dog to cause vomiting?
    place pill in conjunctival sac, flush the eye when the dog starts to gag
  61. What is the most common indication for use of apomorphine?
    empty the stomach when a dog has ingested a poison
  62. What is the most effect emetic drug in the cat?
    xylazine - Rompun (given by injection)
  63. What classification is atipamezole - Antisedan
    alpha - 2 antagonist
  64. What classification is yohimbine - Yobine?
    alpha - 2 antagonist
  65. What classification is levallorphan - Lorfan?
    opioid antagonist
  66. What classification is nalorphine - Nalline?
    opioid antagonist
  67. What classification is acepromazine?
    phenathiazine tranquilizer
  68. What classification is detomidine - Dormosedan?
    alpha - 2 agonist sedative
  69. What classification is fentanyl - Duragesic?
  70. What classification is zolazepam?
    benzodiazepine tranquilizer
  71. What classification is apomorphine?
  72. What classification is atropine?
  73. What classification is naloxone - Narcan?
    opioid antagonist
  74. What classification is morphine?
  75. What classification is meperidine - Demerol?
  76. What classification is midazolam?
    benzodiazepine tranquilizer
  77. What classification is glycopyrrolate?
  78. What classification is butorphanol - Torbugesic?
  79. What classification is diazepam - Valium?
    benzodiazepine tranquilizer
  80. What classification is xylazine - Rompun?
    alpha - 2 agonist sedative
  81. What classification is medetomidine - Domitor?
    alpha - 2 agonist sedative
  82. What classification is buprenorphine - Buprenex?
  83. What classification is oxymorphine - Numorphan?