Pain management

physiologic pathways for pain is very ___ between animals and humans, but it may be different

similar

Pain management should be baased on ___

evidence

Preemptive analgesia occurs before ___ ___

noxious stimulus

Preempitve analgesia prevents ___, makes it easier to ___, and less ___ are required

pain, control, drugs

Preemptive analgesia prevents pain so ___ and ___-___ doesn’t occur

sensitization, wind-up

preemtive analgesia decreases ___ and ___. Also decreases the possibility of ___ pain

intensity, duration, chronic

Multimodal analgesia inhibits ___, at ___ levels

nociception, different

Multimodal analgesia is balanced with at least ___ or more drugs, that have ___ classes that are ___ with each other

2, different, synergistic

Techniques that can be used with multimodal analgesia:

Acupuncture, massage, TENS, ESWT, Thermal therapy, laser, nursing

Advantages of multimodal analgesia: more ___, and fewer ___ effects

options, adverse

multimodal analgesia allows for fewer adverse effects in particular drugs like ___

opiods

Correlate therapy anticipates pain level and administer appropriate ___, and is related to ___

analgesics, preemption

To maintain the plane of pain management, it is better to stay ___ of pain, rather than catch-up. Also apply ___ ___ at appropriate intervals

ahead, regimented therapy

The proper duration of pain management is hard to estimate as we don’t ___ what animals do. Which is why some use a ___ ___

feel, protocol therapy

Opioids inhibits ___, ___, and ___

transduction, modulation, perception

NSAIDs inhibit ___ and ___

Transduction, modulation

Local anesthetics inhibits ___, ___, and ___

transduction, modulation, and transmission

a₂ Adrenergic agonists inhibits ___, ___, and ___

transmission, modulation, perception

NMDA receptor antagonists inhibits ___

modulation

adjuvant agensts include ___, ___ or ___, and ___

anticonvulsants, tranquilizers, sedatives, steroids

Pharmacokinetics is the determination of ___ ___ in the body, the drug ___, and ___ relationship, ___ , and ___ of administation

drug disposition, concentration, calculations, route

When determining the drug disposition in pharmocokinetics it takes into consideration: drug ___, metabolism into ___, ___ and ___

absorption, metabolites, distribution, elimination

Calculation for pharmocokinetics takes into consideration ___ and ___ ___

doses, dosage intervals

The route of administation of pharmacokinetics considers ___ of the drug, and ___ ___

concentration, clinical effects

pharmacodynamics is the ___ ___ and drug effect relationship

plasma concentration

Different types of drugs that effect the receptors: ___, and ___

agonists, antagonists

Characteristics of agonists: drug that ___, ___ and has a ___ ___

binds, activates, biologic effects

Types of agonists: ___ and ___

full, partial

Antagonists characteristics drug that ___, and has no ___

binds, effects

Types of antagonist drugs: ___, ___, and ___ ___

blockers, inhibitors, reversal agents

Opioids are highly ___, have a ___ ___, and are ___

efficacious, rapid onset, safe

Receptors: ___(μ), ___(κ), ___(δ), and ___(σ)

Mu, Kappa, Delta, Sigma

Mu receptors are ___ ___

primary, analgesic

Kappa receptors are ___ ___

primary sedation

Delta receptors are ___ ___

spinal analgesia

Sigma receptors can have adverse effects: ___, ___, ___ and ___

dysphoria, excitement, anxiety, restlessness

Opioids can be used throughout the ___, and have many ___ of administration

body, routes

Opioids used for severe pain: ___, ___, ___ ___, and ___

morphine, hydromorphone, fentanyl citrate, methadone

Morphine is seen as the “___ ___”, used with caution in ___, and has ___ effect, can cause ___, and theoretically can be used ___

gold standard, cats, paradoxic, vomitting, IV

Hydromorphone is ___-___ more effective than morphine, and has fewer ___ ___

5-7x, side effects

Fentanyl citrate is very ___, ___, lasts a ___ duration, can be used as ___, or ___

potent, synthetic, short duration, patches, CRI

Methadone is ___-___ effective than morphine, and can be used ___

1-1.5x, IV

Opiods used for moderate pain ___, and partially ___

buprenophine, butorphanol

Buprenophine has a high ___, ___ duration, can be used ___ in cats, but it does have a ___ effect for pain

affinity, longer, mucosal, ceiling

Opiods used for mild to moderate pain: ___

butorphanol

butorphanol is a ___, ___, and reverse ___ adverse effects, and has ___ duration pain relief

sedative, antitussive, mu, short

Synthetic opioid like used for moderate pain: ___

tramadol

Tramadol binds to ___ receptors, synergistics with ___, and ___ pain

mu, NSAIDS, allodynia

Opioid reversal agents: ___, ___, and ___

naloxone, nalmefene, naltrexone

Naloxone blocks all ___, and reverses ___, caution should be taken with ___ patients

receptors, analgesia, painful

Nalmefene is ___ effective that naloxone, and lasts ___

4x, longer

Naltrexone is similar to ___

nalmefene

NSAID mechanisms: ___, and ___-___

antipyretic, anti-inflammatory

NSAIDs are commonly used with ___ pain like arthritis, ___ pain like perioperative, and is ___ with other

chronic, acute, synergistic

NSAID cautions with ___ specifically with ___ and ___, ___, and drug ___ with other NSAIDS or ___, and impacts ___ ___

GI, intestinal, hepatic, renal, interactions, corticosteroids, primary hemostasis

Types of NSAIDS: 

Carprofen, deracoxib, firocoxib, etodolac, ketoprofen, meloxicam, tepoxalin, aspirin, piroxicam

Local anesthetics disrupt ___ ___, at any site, and blocks ___ ___ altering depolarization

neural thransmission, Na channels

Common local anesthetics: ___, and ___

lidocaine, bupivicaine

Lidocaine has a ___ onset, and has a ___ duration lasting ___-___

rapid, short, 1-1.5 hrs

Bupivicaine has ___ onset, but ___ duration

slower, longer

Methods of andimistering local anesthetics: ___, ___, ___, ___-___, ___

topical, infiltration, regional, intra-articular, systemic

Topical local anesthetics can be used on ___ ___, and ___ ___

mucous membranes, pleural tissues

Infiltration local anesthetic includes ___ or ___ block

nerve, line

Regional local anesthetics inlcudes: ___ ___, ___, ___ in the subarachnoid, ___

nerve plexus, epidural, spinal, IV

Local anesthetic can be directly injected into __-__

intra-articular

Local anesthetic can be used ___ like with a drip set

systemic

complications of local anesthetics

• Loss of nerve activity, depending on the location, can be motor or autonomic

• Nerve injection leads to loss of function can be temporary or permanent

• tissue irritation

• paresthesia, which can cause self-trauma

• allergy

• toxicity

a₂ agonists can be a ___, ___, and can be ___ with other drugs, and they can be ___

sedatives, analgesic, synergestics, reversed

Routes for a₂ agonists ___, ___ or ___

IM, IV, epidural

a₂ agonists function as an analgesic for a ___duration, and activate ___ and ___ receptors

short, central, peripheral

a₂ agonists are synergistics with ___

opioids

common a₂ agonists: ___, ___, ___

xylazine, medetomidine, dexmedatomidine

Cautions when using a₂ agonists: ___ could cause bradycardia, or heart blocks, ___ causing emesis in cats

cardiovascular, GI

CV issues caused in a₂ agonists: ___ and ___ ___

bradycardia, heart block

a₂ agonists can cause GI issue of ___ in ___

emesis, cats

Ketamine is a ___ ___ and requires a lower ___, which is why ___ is often used with ketamine

dissociative anesthetic, dose, CRI

Ketamine blocks ___ receptors, and prevents ___-___, and is ___ with other drugs

NMDA, windup, synergistic

Caution with ketalmine as it can cause ___, or ___ disease

cardiac, renal

Gabapentin is an ___ which prevent ___ ___, decreases ___ pain

anticonvulsant, Ca2+ influx, neuropathic

Caution with human gabapentin liquid as it may contain ___

xylitol

Multi-modal treatment options:

• thermotherapy

• massages

• therapeutic exercise

• hydrotherapy

• electrical stimulation

• acupuncture

• cold laser

Nursing care to manage pain includes maintaining ___, and ___ ___

environment, gentle handling

Maintain an environment by keeping the ___ clean and dry, give ___ oppurtunities, ___, and eliminate distracting ___

kennel, elimination, bedding, noises