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131 Cards in this Set
- Front
- Back
Physiologic pain has ______________ tissue injury. |
little or NO tissue injury |
|
Pathologic pain ____________ tissue injury |
follows |
|
Pathologic pain can be either ______ or _________. |
acute
chronic |
|
Example of chronic pathologic pain: |
arthritis |
|
Pathologic pain is classified base on these 3 things |
1. mechanism (ex. inflammatory, neuropathic)
2. origin (ex. visceral or somatic / superficial, deep)
3. severity of pain (mild, moderate, severe) |
|
Pain Modulation:
What vein is good to use for blood draws in dogs that seem especially sensitive to pain? |
saphenous |
|
What are the 4 steps of Nociception? |
1. transduction
2. transmission
3. modulation
4. perception |
|
What happens in transduction? |
stimuli are transformed into sensory electrical signals (action potentials)) |
|
What happens in transmission? |
Sensory impulses are conducted to the spinal cord |
|
What happens in modulation? |
Impulses are either amplified or suppressed |
|
What happens in perception? |
Impulses are transmitted to brain where they are processed and recognized |
|
Each step of Nociception (the pain pathway) has different _______________. |
receptors |
|
Drugs target specific ____________ and block a specific _________. |
receptor
step |
|
Multimodal drug therapy: |
targeting two or more of the receptors |
|
Consequences of untreated pain (4) |
1. patient suffering
2. immune system suppression
3. inflammation and delayed wound healing
4. anesthetic risk & increased anesthetic doses |
|
Hyperalgesia = ___________________ and can lead to aggression in what species (due to being painful.) |
hypersensitivity to pain
cats |
|
Windup is a state of...? |
hyperexcitement due to pain
(spinal cord neurons are constantly stimulated) |
|
_____________ is released with pain and stress. |
ACTH |
|
Neuroendocrine changes can result in a ____________ state and ____________. |
catabolic
wasting
(ACTH release, elevated cortisol, epi, norepi, decreased insulin) |
|
Sympathetic stimulation can result in __________ ____________. |
cardiac arrhthmias
(due to increased myocardial work, vasoconstriction, and increased myocardial O2 consumption) |
|
Signs of pain:
Pain elicits a __________ response. |
stress |
|
Stress-related pain results in what type of physiological response? |
fight or flight |
|
When evaluating pain in an animal, be careful not to give in to our human tendency to ________________. |
anthropomorphize |
|
Preemptive Analgesia:
|
the administration of pain meds BEFORE the pain occurs. |
|
Pr-anesthesia analgesia reduces what?
Prevents what? |
The overall requirement for anesthesia and duration of administration
windup |
|
Behavior responses to pain:
_____________ patient are less tolerant of pain |
young |
|
Behavior responses to pain:
_____________ are very stoic (what species) |
cattle |
|
Large breed dogs tend to be ___________ stoic than toy breeds. |
more |
|
Behavior response to pain depends on 4 other things: |
1. nature of pain
2. duration of pain
3. severity of pain
4. presence / absence of human |
|
Physical evidence of arthritic pain: (2)
|
1. change in gait
2. change in level of activity |
|
Physical evidence of thoracic or abdominal pain: (2) |
1. reluctance to lie down
2. constantly shifting position |
|
What are other general physical evidences of pain? (4) |
1. vocalization
2. facial expression
3. change in appearance
4. change in attitude |
|
Pain assessment tools:
Use some sort of ___________ to rate pain and always be ______________. |
scale
consistent |
|
Assessing response to therapy:
Should see what? |
improvement in behavior / ability |
|
Examples of preemptive analgesia: (2) |
1. Fentanyl patch
2. NSAIDs |
|
Advantages of multimodal drug therapy: (3) |
1. covers multiple receptors and mechanisms of action
2. reduces dose of individual drugs
3. reduces dose of anesthetic agent |
|
Analgesia is needed at which stage of hospitalization and treatment? |
EVERY stage
1. pre-anesthesia 2. surgical period 3. immediately post-op 4. remainder of hospital stay 5. at home |
|
Choice of drug depends on these 4 things: |
1. type of pain
2. severity of pain
3. patient's general condition
4. route of delivery |
|
Opioids as analgesics:
Opioids vary in ___________, ________ and _____________ effects. |
potency
duration
adverse effects |
|
Opioids as analgesics:
Opioids are often combined with a ___________ to form a ___________________. |
tranquilizer
neuroleptanalgesic |
|
Name two tranquilizers |
acepromazine
dexmedetomidine (Dexdomitor) |
|
Opioids can help to diminish _______________. |
windup |
|
How long do opioids last? |
2 - 4 hours |
|
Are opioids a good choice for post-op pain? |
no
(effects will be wearing off by the time you get through induction, surgery, etc.)
Need to GIVE AGAIN |
|
Why are neuroleptanalgesics a better choice? |
they last longer post-operatively due to having a tranquilizer on board |
|
TRUE or FALSE:
Opioids can be used one or in combination with other drugs? |
TRUE |
|
As a sedative / anti-anxiety drug opioids may cause excitement in awake ____________ and _________. |
cats
horses |
|
What are the GI effects of opioids? (2 general) |
1. initial increase in GI activity
2. followed by slow-down in GI activity |
|
What are specific examples of the effects opioids have on the GI system? |
1. nasuea, vomiting, defecation
2. ileus, colic, constipation |
|
what is ileus? |
lack of gut activity |
|
Due to their GI effects, opioids are NOT a good choice for what species? |
horses
(also cows) |
|
Where are opioids metabolized? |
liver |
|
Morphine is a Schedule _______ drug |
II (two) |
|
Morphine is used for moderate to severe ___________ or ___________ pain |
visceral
somatic |
|
Somatic pain comes from the _______ and __________.
Visceral pain comes from the _________ __________. |
skin & deep tissues
internal organs |
|
TRUE or FALSE:
Morphine is PURE agonist: |
TRUE |
|
Morphine may cause ______________ or dysphoria in ___________ and ___________. |
excitement
cats, horses |
|
Morphine may cause ________ in dogs and horses. |
restlessness |
|
Morphine may be administered in any of the 6 following ways: |
1. IM 2. IV 3. SC 4. intra-articular 5. epidural 6. spinal injection |
|
Adverse side effects of morphine: (8) |
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 |
|
Are opioids a good choice for head trauma / eye injury patients? Why or why not? |
NO - increased intraocular and intracranial pressure |
|
Oxymorphone: does it have more or less GI upset than morphine?
What schedule is it? |
LESS GI upset
II (two) |
|
Oxymorphone: is it more or less potent than morphine? |
MORE |
|
Oxymorphone has _______________ side effects and ___________ duration than morphine. |
fewer side effects
longer duration |
|
Disadvantage of oxymorphone? |
expensive |
|
Hydromorphone:
Can be used alone as a _________ or with a ___________. |
pre-med
tranquilizer |
|
Hydromorphone is ____________ potent than morphine and has ______________ side effects. |
less
fewer |
|
Fentanyl is one of the most __________ analgesics known. |
potent |
|
Fentanyl patch has a ___________ onset. |
rapid (2 minutes) |
|
Opioids are also _____________. |
narcotics |
|
Fentanyl has a short duration of effect (20-30 minutes) when administered how? |
IV |
|
Fentanyl can be administered in these 5 ways: |
1. continuous IV drip 2. transdermal patch 3. IM 4. SC 5. epidural injection |
|
Fentanyl can be used in combination with _____________ or ___________ drawn into _________ syringes. |
diazepam
midazolam
separate |
|
What should you always do when working with a Fentanyl patch? |
wear gloves |
|
Meperidine / Pethidine:
1. Used mostly as a _____________. 2. Route of administration: 3. Effective used with a _____________ in ____________. (species) |
1. pre-anesthetic med
2. SQ
3. tranquilizer, puppies |
|
What opioid is good to use with puppies (as a neuroleptanalgesic)? |
Meperidine (Pethidine) |
|
Butorphanol:
Best used in what species? |
horses |
|
Butorphanol is a Schedule ________ drug. |
IV (four) |
|
Buprenorphine:
1. Is a Schedule _______ drug. 2. Is used how in cats? 3. Route of administration? 4. commonly uses as a ________________. |
1. V (five)
2. on their gums
3. IM
4. pre-med |
|
TRUE or FALSE: Buprenorphine is a true agonist? |
FALSE - it's a partial (mu) agonist |
|
TRUE or FALSE:
Buprenorphine is used for moderate to severe pain. |
FALSE: used for mild to moderate pain |
|
Used with a sedative, Buprenorphine can prolong _______________ _________. |
sleep time |
|
Buprenorphine is often used to provide ___________________ analgesia to dogs and cats (what time?) |
post-op |
|
Nalbuphine is used as a ___________ _____________ for opioid agonists. |
reversal agent |
|
Is Nalbuphine a strong or a weak analgesic / sedative? |
weak |
|
Post-Op Opioids:
Disadvantages: 2 |
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) |
|
Opioids - name 6 |
1. morphine 2. oxymorphone 3. hydromorphone 4. Fentanyl 5. butorphanol 6. buprenorphine |
|
Can opioids be used in an IV infusion? |
YES |
|
Can opioids be used continuously? |
YES |
|
Opioids: IV infusion:
After an initial loading dose, opioids are given ___ ___________ |
to effect |
|
Intra-articular injection blocks at what stage and is especially good after what procedures? |
Sensory (Transmission)
joint surgery |
|
What is the most common drug used in an epidural?
Why? |
morphine
long duration of action |
|
Epidural injection of morphine blocks what type of nerve transmission? |
sensory
(and sometimes motor) |
|
What is important to do when recovering an animal that's had a morphine epidural? |
reposition every 2 - 4 hours to prevent pulmonary atelectasis or prolonged pressure on superficial nerve |
|
NSAIDs: give 5 examples |
1. aspirin 2. acetaminophen 3. Meloxicam 4. Carprofen 5. Rimadyl |
|
NSAIDs are both _____________ and ______________. |
anti-inflammatory
non-steroidal |
|
Steroids can cause issues with the ___________ and the ______________. |
liver
kidneys |
|
steroids are eliminated by the ____________ |
kidneys |
|
Adverse effets of NSAIDs: |
Prevent production of beneficial prostaglandins (because they block them ALL) |
|
When using NSAIDs, be careful of patients with _____________ disease. |
heart |
|
What type of drugs are the two most commonly used analgesics? |
opioids
NSAIDs |
|
Local anesthetics are used to treat or prevent _________________ pain. |
post-op |
|
Advantages of local anesthetics: (3) |
1. Complete anesthesia of affected area
2. low toxicity
3. rapid onset of action |
|
Disadvantages of local anesthetics: (2) |
1. short duration of action
2. CNS and cardiac toxicity with repeated use |
|
Alpha 2 Agonists (adrenoceptors) have limited use in ___________ animals. |
small |
|
Alpha 2 Agonists (adrenoceptors):
name 2: |
1. Xylazine
2. Dexdomitor |
|
Which A2Agonist is used in horses to provide sedation, muscle relaxation, and analgesia? |
Xylazine |
|
Ketamine blocks receptors at ________________________. |
the spinal cord |
|
Ketamine - does it produce analgesia? |
No, not by itself |
|
What can ketamine be combined with to provide intra-operative analgesia? |
morphine, lidocaine |
|
Adverse effects of Ketamine: |
1. tachycardia 2. hypertension 3. seizures 4. post-op delirium (the "crazies") 5. increased intraocular / intracranial pressure 6. salivation |
|
Corticosteroids as analgesics:
Have strong ______________________ properties. |
anti-inflammatory |
|
Corticosteroids as analgesics:
Decrease prostaglandin activity such as _______________. |
NSAIDs |
|
Corticosteroids as analgesics:
Do not use concurrently with _________. |
NSAIDs |
|
Corticosteroids as analgesics:
Adverse effects: (3) |
1. may cause ulcers
2. immunosuppression with long-term use
3. hyperadrenocorticism |
|
Hyperadrenocorticism is ________________ disease. |
Cushings |
|
Hypoadrenocorticism is __________________. |
Addison's |
|
What is crucial when stopping steroid use? |
diminished / tapered decrease
(need to teach adrenal gland to start producing on its own again) |
|
Tramadol as an analgesic:
Is Tramadol an opiate? |
NO |
|
How is Tramadol given?
When? |
orally
atfer patient has resumed eating |
|
Benefits of Tramadol? (2) |
1. can be given at home
2. alternative to using an opiate |
|
Do not use Tramadol concurrently with what other re-uptake inhibitors? |
norepineprhine or serotonin |
|
Tranquilizers: are they considered to be analgesics? |
NO |
|
Tranquilizers can be helpful in calming the excitement sometimes seen in ___________ and __________ after _______________ administration. |
cats
horses
opioid |
|
Tranquilizers may ___________ the effect of opioids in _______________ patients. |
increase
anxious |
|
Why is multimodal therapy useful? |
different drugs target different mechanisms along the pain pathway |
|
Examples of multimodal therapy:
(4 combos) |
1. Acetaminophen + codeine (dogs)
2. Fentanyl + Meloxicam
3. Morphine + injectable NSAID (meloxicam or carpfrofen)
4. MLK |
|
Home analgesia:
5 examples |
1. Fentanyl patch
2. Tramadol
3. NSAIDs
4. Oral morphine
5. Tylenol w/codein (dogs) + butorphanol |
|
Nursing Care: (7) |
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 |
|
Non-pharmacologic therapies: (7) |
1. acupuncture 2. laser 3. transQ electric nerve stimulation 4. massage 5. physiotherapy 6. homeopathic / herbal 7. cold / heat therapy |
|
What is the reversal agent for most opioids? |
Naloxone |