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Injectable Anesthetics Part II SGU SVM Pharmacology I Flashcards | StudBud
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Injectable Anesthetics Part II SGU SVM Pharmacology I
Injectable Anesthetics Part II SGU SVM Pharmacology I
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1
Ketamine: Facts
Given IV
Highly lipid soluble-well absorbed IM
Given IM
Controlled substance (schedule III)
2
Alfaxalone: Facts
Highly lipophilic
Synthetic neurosteroid anesthetic agent
Form: cyclodextrin, Alfaxalone molecule is inserted w/in cyclodextrin
Mechanism of action: enhance GABA effects
3
Adverse Effects of Ketamine: Miscellaneous
High abuse potential (DEA schedule III)
Don't use for animals w/ elevated intraocular pressure
Pain on IM injection (low pH)
Not to be used in animals w/ intracranial pressure
4
Alfaxolone: Respiratory & muscle relaxation effects
Cesarean section: good puppy viability
Dose-dependent respiratory depression – progress to apnea
Good; smooth induction and recover
Causes muscle loss
5
Alfaxolone: Facts
Dogs –alternative to propofol in Greyhound dogs
Very short shelf life; Large therapeutic index
Sheep: good recovery, no apnea; ↓ CVS effects
Induction in horses
6
Alfaxolone: CVS effects
↓ myocardial contractility
↓ arterial blood pressure
↑ HR
Effects similar to propofol–mild
7
Etomidate: CNS & CVS effects
Most used induction agent in dogs w/ pacemaker implantation
Minimal respiratory effects
↓ intracranial presure, cerebral blood flow, cerebral metabolic rate for O2
Unique - minimal to no CV effects
8
Tiletamine: Facts
Favorite drug for domeseticated owls
Lethal renal tubular necrosis in New Zealand white rabbit
Tigers: great controversy over the use of Telazol® in large cats and tigers
Pigs –preferred to use telazol+ ketamine+ xylazine
9
Ketamine effects: CNS
Emergence delirium --> reduced by tranqs and seds
Amnesia, no reactive to reflex central adrenergic stim → ↑ sympathetic tone
Direct myocardial depression
Altered consciousness/catalepsy
10
Etomidate: Respiratory effects
Possible ↑ respiratory depression risk when combo w/ drugs affecting CNS
No significant muscle relaxation
Minimal respiratory effects
Induction doses can result in brief periods of apnea
11
Etomidate: Muscular effects -- Doesnt provide significant muscle relaxation- muscle rigidity & myoclonus
True
False
12
Adverse Effects of Ketamine: CVS -- used cautiously with patients with CVS disease
True
False
13
Ketamine: S(+) ketamine isomer is more potent –more analgesia, less emergence delirium than R(-) isomer
False
True
14
Etomidate - Side Effects
Effect lasts for ~6 hours after injection (not for maintenance anesthesia)
RBC hemolysis (propylene glycol vehicle)
Adrenal function suppression (No long use or Iatrogenic Addison’s disease)
Myoclonus (attenuate w/ benzodiazepine or opioid)
15
Tiletamine: Facts
Dogs and horses: effects of tiletamine> zolazepam
Cats and pigs: effects of zolazepam > tiletamine
Horses –never use tiletamine as sole agent
Used for induction and maintenance of anesthesia in many veterinary species
16
Etomidate: Facts
Propylene glycol vehicle V use only
Not controlled, has wide safety margin
GABAA agonist → hypnosis & CNS depression
Clinical use: Induction of anesthesia in animals with CVS disease
17
Indications of Ketamine: Route of Administration
Oral
IV
IP
IM
18
Alfaxolone: Neurosteroid; no anesthesia
True
False
19
Alfaxolone: CNS effects
↓ intracranial pressure
↓ cerebral metabolic demands
↓ cerebral blood flow
Unconsciousness and anesthesia
20
Ketamine effects: Respiration
Bronchodilation: good choice for asthmatic/COPD condition
Apneustic pattern in horse
Mild effect on minute ventilation
Endotracheal intubation & anticholinergic drug is req,
21
Indications of Ketamine: Points to remember
Anaesthetized w/ DA – patients dont close eyes, don't look asleep
Horses – agitated recovery . Requires co-admin w/ seds/tranqs
Emergence delirium with small animals
Adequate lube for cornea
22
Alfaxolone: Route of Administration
IM
IV
Oral
SC
23
Adverse Effects of Ketamine: Cough and laryngospasm
Not a smooth recovery
Skeletal muscle rigidity
Use with benzodiazepines
common at induction
24
Alfaxolone: Poor induction and recovery quality if used as sole agent; always combine with other sedative drugs
True
False
25
Etomidate does not cause analgesia
True
False
26
Alfaxolone: Facts
DEA schedule IV; hepatic metabolism
FDA approved drug for GA in dogs and cats (also in exotics)
Cause CVS and respiratory depression
Half life -34 min (dogs); 43 min (cats)
27
Indications of Ketamine
Chemical Restraint
Analgesia
Rapid induction of general anesthesia
Physical restraint
28
Etomidate: Endocrine effects
Careful use w/ pre-existing adrenal-cortical diseases;not long use
Reversible inhibition of 11- beta-hydroxylase
↑ morbidity & mortality in sedated long-term due to ↓ cortisolproduction
No significant muscle relaxation
29
Ketamine: Mechanism of Action
Weak effects at μ
Highly lipid-soluble -large VD
Non-competitive NMDA antagonist
Monoaminergic, Muscarinic & sigma 1 receptors
30
Ketamine effects: CVS
↑ sympathetic activity → ↑ cardiac output & venous pressure, ↑ heart rate
Avoid in cats with hypertrophic cardiomyopathy
↑ O2 demand in myocardial cells → used with caution in cardiac patient
Direct myocardial depression
31
Adverse Effects of Ketamine: Emergence delirium
Not a smooth recovery
Recommend combining with sedative/tranquilizer
Skeletal muscle rigidity
common at induction
32
Alfaxolone: Indications
Induction of analgesia
Maintenance of anesthesia (CRI)
Maintenance of analgesia
Induction of anesthesia
33
Alfaxolone: Miscellaneous effects
No evidence of clinical interference w/ mineralo/glucocorticoids production
Intranasal route sloughs mucosa
Causes hemorrhages
Perivascular administration doesnt cause tissue damage/painful
