Tranquilizers

1)    How does tranquilization differ from sedation?

-       Increasing doses of tranquilizers does not alter consciousness (and will increase side effects)

-       Increasing doses of sedatives will cause profound CNS depression

2)    What are the 3 classes of tranquilizers

-       Phenothiazine derivatives

-       Benzodiazepine derivatives

-       Alpha 2-agonists

3)    How do phenothiazine derivatives cause sedation?

-       Result of dopamine blockade

-       Inhibit postsynaptic central dopaminergic receptors (D2)

4)    How do phenothiazine derivatives exert their antiemetic effects?

-       D2 antagonism at the chemoreceptor trigger zone

5)    How do phenothiazine derivatives cause peripheral vasodilation?

-       Block the binding of norepinephrine at a-adrenergic receptors (a1 antagonism)

6)    List 3 specific examples of phenothiazine derivatives.

-       Acepromazine

-       Chlorpromazine

-       Promazine

7)    What are the general clinical uses of phenothiazine derivatives?

-       Sedation/ tranquilization

-       Reduce anxiety

-       Decrease vomiting

-       Reduce induction and maintenance drug

-       Improve the quality of induction and recovery

-       Commonly administered with opioids

8)    What is neuroleptanalgesia?

-       An opioid and a tranquilizer

9)    Are phenothiazine derivatives effective analgesics?

-       No analgesia

10) Which organ metabolizes most phenothiazines?

-       Liver

11) Which organ excretes most phenothiazines?

-       Kidneys

12) Is acepromazine a controlled drug?

-       NO

13) What general adverse side effects are associated with the use of acepromazine?

-       Hypotension through their vasodilator effects

-       Hypotherma through their vasodilator effects

-       Pain/ stinging on IM injection

-       Dose-related penile prolapse in male horses

14) What is the reversal agent for acepromazine?

-       No reversal agent

15) How would an overdose of adverse reaction associated with acepromazine be treated?

-       With supportive care (fluids, heat, support)

16) List the contraindications/precautions associated with the use of acepromazine?

-       Dehydration

-       Hypovolemia

-       CKD

-       Bleeding

-       Shock

-       Decreases HCT

-       Coagulopathy or thrombocytopenia

-       Glaucoma

-       Dogs with high vagal tone

-       Hepatic dysfunction

17) What is the consequence of inadvertent intracarotid injection of acepromazine in horses?

-       Convulsive seizures and death

18) What is the mechanism of action of benzodiazepine derivatives?

-       Primary inhibitor neurotransmitter in the CNS

19) List 6 benzodiazepine derivatives.

-       Diazepam (valium, diastat)

-       Midazolam (versed)

-       Alprazolam (Xanax)

-       Lorazepam (Ativan)

-       Zolazepam

-       Clonazepam (Klonipin)

20) What are the general clinical uses of benzodiazepine derivatives?

-       Anticonvulsants

-       Skeletal muscle relaxants

-       Anxiolysis

-       Sedation

21) Are benzodiazepines effective analgesics?

-       NO ANALGESIA

22) What general adverse side effects are associated with the use of benzodiazepines?

-       Limited when used as directed

-       Overdose= CNS depression

-       Paradoxical excitement, agitation, vocalization, and dysphoria

23) What is the DEA schedule for diazepam?

-       IV

24) What is the reversal agent for diazepam?

-       Flumazenil

25) Which organ metabolizes diazepam?

-       Liver

26) Which organ excretes diazepam?

-       Kidneys

27) List and describe the clinical uses of diazepam

-       Anesthetic induction

-       Anticonvulsant

-       Appetite stimulation in cats

-       Sedation

-       Skeletal muscle relaxant

28) List the adverse side effects associated with diazepam use.

-       Paradoxical stimulation in dogs, cats, horses

-       Agitation

-       Vocalization

-       Ataxia

29) Which animal species may exhibit paradoxical excitation following administration of diazepam?

-       Dogs

-       Cats

-       Horses

30) What clinical signs are associated with paradoxical stimulation following administration of diazepam?

-       Agitation

-       Vocalization

-       Ataxia

31) Which animal species may develop liver failure following repeated oral dosing of diazepam?

-       Cats= hepatic failure

32) List potential adverse side effects associated with use of diazepam in dogs.

-       Sedation

-       Ataxia

-       Increased activity

-       Increased appetite

-       Agitation

-       Diarrhea

-       Vomiting

-       Aggression

33) Describe the appropriate storage conditions for injectable diazepam.

-       Store at 15-30C

-       Protect from light

-       Do not give IM

-       Do not store in plastic syringes

34) Describe the appropriate storage conditions for diazepam tablets/capsules

-       Store in tight, light-resistant containers at 15-30C

35) What is the DEA schedule for midazolam?

-       IV

36) What is the reversal agent for midazolam?

-       Flumazenil

37) What are the general clinical uses of midazolam?

-       Anxiolytic sedative hypnotic

-       Minor tranquilizer

-       Anticonvulsant

38) Is midazolam an effective analgesic?

-       NO ANALGESIA

39) What are the indications for midazolam?

-       Anticonvulsant

-       Skeletal muscle relaxant

-       Sedation

40) What is the route of administration for midazolam if being used as an anticonvulsant?

-       IV or IN

41) Why can midazolam be given IM, while diazepam cannot?

-       More potent but shorter duration of action

42) Describe the potential adverse effects associated with midazolam use.

-       Prolonged recovery times in horses

-       Ataxia

-       Hyperphagia

-       Paradoxical stimulation

43) List contraindications for midazolam.

-       Portosystemic shunts

-       Hepatic dysfunction

-       Hepatic encephalopathy

-       Acute narrow-angle glaucoma

-       Renal disease

-       Hypoalbuminemia/ hypoproteinemia

-       Hypersensitivity

44) What is the DEA schedule for alprazolam?

-       IV

45) What is the reversal agent for alprazolam?

-       Flumazenil

46) What are the general clinical uses for alprazolam?

-       Anxiety disoarder

-       Urinary sphincter spasms

-       Seizures

47) List the indications for alprazolam.

-       Behavior indication

-       Prevention of anxiety during stressful or fear-producing events

-       Facilitation of urethral relaxation in patients with urine retention

48) What are the potential adverse effects or warnings associated with alprazolam use?

-       Sedation

-       Ataxia

-       Muscle relaxation

-       Hyperphagia

-       Enhance CNS depression

-       Disinhibtion in aggressive animals

49) Which animal species may exhibit paradoxical excitation with alprazolam use?

-       Dogs, cats, horses

50) List the contraindications for alprazolam use.

-       Same as midazolam

51) What are the general advantages associated with alpha-2-adrenergic receptor agonists?

-       Profound, reliable sedation

-       Analgesia

-       Act syngergistically with opioids

52) Are the alpha-2 agonists controlled drugs?

-       NO

53) List 5 examples of alpha-2-adrenergic receptor agonists.

-       Xylazine

-       Detomidine

-       Medetomindine

-       Dexmedetomidine

-       Romifidine

54) List the reversal agents for the alpha-2 agonists.

-       A-2 adrenergic antagonist drugs

55) What is the route of administration for the reversal agents for the alpha-2 agonists?

-       IV, IM, SQ

-       Transmucosal, transdermal

56) What are the indications for xylazine?

-       Analgesia

-       Sedation

-       Induction of emesis in cats

-       Preanesthetic

57) Describe the potential adverse effects of xylazine in dogs, cats, and horses.

-       Muscle tremors

-       Bradycardia

-       Paradoxical agitation

-       Hyperesthesia to auditory stimuli (horses may seem sedated but still kick)

-       Vomiting (cats)

58) Describe the potential adverse effects of xylazine in horses.

-       Hypertension

-       Hypotension

-       Bradycardia

-       Ataxia

-       Piloerection

-       Sweating

-       Splenomegaly

59) Describe the potential adverse effects of xylazine in ruminants.

-       Hypersalivation

-       Ruminal atony/bloat

-       Bradycardia

-       Ataxia

-       Hypothermia

60) What are the contraindications for xylazine?

-       Renal or hepatic impairment

-       Respiratory dysfunction

-       Cardiac abnormalities

-       Hypotension

-       Shock

-       Esophageal obstruction or gastric torsion

61) Describe precautions for using xylazine.

-       Dyspnea in brachycephalic dogs

-       Avoid Intracaroitd: causes violent seizures and collapse

62) What is the reversal agent for xylazine?

-       Tolazine

63) What are the indications for detomidine?

-       Analgesia

-       Sedation

-       Preanesthetic

-       Extra-label for anxiolysis

64) Describe general precautions with using detomidine.

-       Fatal cardiac arrhythmias

-       No breeding or pregnant animals

-       No food-producing animals

65) Why should detomidine not be given to pregnant animals?

-       Increases uterine contractions

66) What antibiotics should be avoided when using detomidine hydrochloride and why?

-       Potentiated sulfonamides

67) Describe the contraindications for using detomidine.

-       AV or SA block

-       Hypersensitvity to detomidine

-       Cardiovascular disease

-       Respiratory disease

-       Chronic renal failure

-       Shock

-       Stress due to extreme heat, cold, fatigue

68) Describe the potential adverse effects associated with detomidine use.

-       Hypertension

-       Hypotension

-       Bradycardia

-       Ataxia

-       Decreased intestinal motility leading to ileus

69) When should a reversal agent for detomidine be administered?

-       To reverse bradycardia and hypotension

70) What is the reversal agent for detomidine?

-       Yohimbine

-       Atipamezole

-       Naloxone

71) Why should you not use atropine to treat the bradycardia associated with alpha-2 agonists?

-       Can potentiate hypertension and ileus

72) How is dormosedan administered?

-       Sublingual use in horses only

73) What is the mechanism of action of the alpha-2 agonist medetomidine?

-       Inhibits adenyl cyclase, activiates G protein gated potassium channels, and alters voltage-gated calcium ion channels

74) What are the indications for medetomidine?

-       Analgesia

-       Sedation

-       Preanesthetic

75) Describe the potential adverse effects/warnings associated with medetomidine.

-       Hypertension

-       Bradycardia

-       Hypotension

-       Hypothermia

-       Hyperglycemia

-       Vomiting

-       Muscle tremors/twitching (dogs)

-       Hypoxemia (ruminants)

-       Pulmonary edema (sheep)

-       Edema of the head (horses)

76) Describe contraindications for medetomidine use.

-       Cardiac disease

-       Respiratory disorders

-       Liver or kidney disease

-       Shock

-       Debilitated dogs

-       Pregnant animals

77) What are the reversal agents for medetomidine, and what is the route of administration?

-       Atipamezole

-       Yohimbine

-       Nalonxone

-       IM

78) What are the indications for dexmedetomidine?

-       Analgesia

-       Sedation

-       Emetic

-       Preanesthetic

-       Noise aversion in dogs

79) Describe the potential adverse effects associated with dexmedetomidine.

-       Hyper/Hypotenison

-       Bradycardia

-       Ataxia

-       Hypothermia

-       Emesis

-       Salivation

-       Apnea

-       Piloerection

-       Sweating

-       Muscle tremors

80) List the contraindications/precautions for dexmedetomidine.

-       Same as medetomidine

-        

81) What are the reversal agents for dexmedetomidine, and what is their route of administration?

-       Same as medetomidine

82) Is dexmedetomidine more or less potent than medetomidine?

-       Dexmedetomidine

83) How does romifidine cause sedation?

-       YES, causes sedation

84) What animal species is romifidine approved for use in in the US?

-       Horses

85) What are the contraindications for romifidine?

-       Pregnant

-       Diabetes mellitus

-       Respiratory disease, hepatic or renal disease

-       Horses intended for human consumption

86) What are the indications for romifidine?

-       Analgesia

-       Sedation

-       Preanesthetic

87) What are the potential adverse effects/warnings associated with romifidine use in dogs and cats?

-       Bradycardia

-       AV block

-       Hypotension

-       Hypo/ hyperthermia

-       Vomiting

-       Irregular respiratory patterns

88) What are the potential adverse effects/warnings associated with romifidine use in horses?

-       Muscle tremors

-       Salivation

-       Penile relaxation

-       Urination

-       Lowering of head

-       Stridor

-       Decreased GI motility

89) What are the reversal agents for romifidine, and what is their route of administration?

-       Same as medetomidine