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Types of Drugs: Class: Anticholenergics “parasympatholytics” Type: Mode of action: Drug Names: (2) Uses: Cautions: (2) Type: Premedication Mode of Action: -Blocks receptor for acetylcholine in the automatic nervous system. - Blocks at muscarinic receptors (heart, GI, bronchi, salivary glands, iris) -Inhibits parasympathetic effects. Drug Names: Atropine, Glycopyrolate Uses: Increase heart rate, decrease salivation Cautions: Not for use in Tachycardia or GI obstruction/constipation. Atropine Class: Mode of Action: Common Name: Routes of Injection: Class: Anticholenergic Mode of Action: Blocks receptors for acetylcholine at muscarinic receptors. Acts in parasympathetic component of ANS. Common Name: NONE Routes of Injection: SQ, IM, IV (note: 15minutes for IM, Within 1 minute for IV) *Lasts 60-90 minutes* Therefore not practical if dog is sitting waiting for surgery but has pre-meds administered. Atropine Why used: -Good aspects(1) -Bad aspects (2) Effects: (7) When not to use: Reversal: Why used: -Increase heartrate -Decrease salivation -Good aspects: Treats bradycardia -Bad aspects: Short acting, atropine toxicity Effects: (7) blocks stimulation of the vagal nerve(increases HR), reduces production of saliva, reduces GI activity, causes dilation of pupils, reduces tear production, promotes bronchodilation, may produce thick mucus within the airways. When not to use: Tachycardia patients, GI obstruction/constipation Reversal: Physostigmine Atropine Notes from class: Name signs of Atropine Toxicity: What is the controversy over using atropine: When is atropine not practical: Toxicity: Signs are dilated pupils, tremors, ataxia can be treated with physostigmine Controversy: Is atropine needed with newer drugs? Some newer drugs don’t depress HR enough Practical: Atropine only lasts 60-90 minutes therefore if dog is sitting waiting for surgery to begin the atropine may wear off before surgery starts Glycopyrolate Class: Mode of Action: Common Name: Routes of Injection: Class: Anticholenergic Mode of Action: Blocks receptors for acetylcholine at muscarinic receptors. Acts in parasympathetic component of ANS. Common Name: None Routes of Injection: SQ, IM, IV (lasts 2-3 times longer than atropine) Why used: -Good aspects(4) -Bad aspects (1) Effects: (7) When not to use: Reversal: Why used: Used to increase heart rate, suppress salivation. -Good aspects: Lasts 2-3 times longer than atropine, less tachycardia, more effective at suppressing salivation, doesn’t cross placental barrier -Bad aspects: Does not treat bradycardia Effects: blocks stimulation of the vagal nerve(increases HR), reduces production of saliva, reduces GI activity, causes dilation of pupils, reduces tear production, promotes bronchodilation, may produce thick mucus within the airways. When not to use: Tachycardia patients, GI obstruction/constipation Reversal: Physostigmine Glycopyrolate Notes from Class: In case of bradycardia should you use Atropine or Glycopyrolate? Atropine should be used in cases of bradycardia Class: Phenothiazines Type: Mode of action: Drug Names: (1) Uses: (3) Type: Tranquilizer / Sedative Mode of action: CNS Depression Drug Names: Acepromazine Uses: Calm animal for easier handling and induction, need less anesthetic to induce induction, easier recovery for animals so they come out of anesthesia slowly and carefully. Acepromazine Class: Mode of Action: Common Name: Routes of Injection: Class: Phenothiazine Mode of Action: CNS Depression Common Name: None Routes of Injection: SQ, IM, IV Acepromazine Why used: -Good aspects (5) -Bad aspects (6) Effects: (6) When not to use: Reversal: -Good aspects(6) Sedation (up to 24 hours), anti-emetic (decreases nausea), anti-arrhythmic (helpful in cases of some anestheitics like halothane), anti-histamine, peripheral vasodilatation, -Bad aspects (6) No analgesia, decreases seizure threshold, no reversal, can cause low blood pressure, can change personality ie. Cause excitement, manufacture dose is to high. Effects: (6) Sedation, anti-emetic, anti-arrhythmic, anti-histamine, peripheral vasodaliation, effects on personality When not to use: Allergy testing, patients with low blood pressure, patients who previously had change in personality, patients with seizure history Reversal: NONE Acepromazine Class Notes: If you have more than __ in your syringe you should… What type of testing’s should you not use for? What patients should this not be used for? If you have more than .2 cc in your syringe you should question yourself. Don’t use in allergy testing Don’t use ace for patients with low blood pressure or those in shock Class: Benzodiazepines Type: Mode of action: Drug Names: (2) Uses: (5) Cautions: (2) Type: Tranquilizer / Sedative Mode of action: Causes release of inhibitory CNS neurotransmitter GABA in brain Drug Names: (2) Diazepam (Valium), Midazolam (Versed) Uses: Treats seizures, decreases anxiety, muscle relaxant, appetite stimulant, modify behavior (inappropriate urination) Cautions: (1) Is a controlled drug, can be addictive, no pain control Diazepam Class: Mode of Action: Common Name: Routes of Injection: Class: Benzodiazepine Mode of Action: Causes release of inhibitory CNS neurotransmitter GABA Common Name: Valium Routes of Injection: IM, IV Diazepam Why used: -Good aspects (2) -Bad aspects (3) Effects: (5) When not to use: (N/A) Reversal: Why used: -Good aspects Doesn’t sting in vein, very safe -Bad aspects Controlled drug, controlled substance, no analgesia Effects: (5) Treats seizures, decreases anxiety, muscle relaxant, appetite stimulant, modify behavior (inappropriate urination) When not to use: (N/A) Reversal: None Diazepam Class Notes: Whar about solubility/sensitivity of drug? When making ketamine valium which do you pull up first? When administering IV what method do you use? What is this sometimes a substitute for? - Diazepam is not water soluble therefore will precipitate with other drugs, also is is soluble in plastics therefore must not be in a plastic bottle. - Pull up the diazepam first then the ketamine - When administering IV administer slowly, or use IM - Sometimes a substitute for Acepromazine Midazolam Class: Mode of Action: Common Name: Routes of Injection: Class: Benzodiazepine Mode of Action: Causes release of inhibitory CNS neurotransmitter GABA Common Name: Versed Routes of Injection: IM/IV Midazolam Why used: -Good aspects (3) -Bad aspects (3) Effects: (5) When not to use: (N/A) Reversal: Why used: -Good aspects very safe, mixes better with other drugs, less irratating -Bad aspects Controlled drug, controlled substance, no analgesia Effects: (5) Treats seizures, decreases anxiety, muscle relaxant, appetite stimulant, modify behavior (inappropriate urination) When not to use: (N/A) Reversal: None Midazolam Class notes: What are the advantages to using midazolam vs. diazepam Water Soluble (mixes with other drugs) and doesn’t irate as much Class: Alpha 2 Agonists Type: Mode of action: Drug Names: (2) Uses: Cautions: (4) Type: Tranquilizer / Sedative Mode of action: Binds to receptors on sympathetic nerves in brain and spinal cord(results in the decrease of norepinephrine) Drug Names: (2) Xylazine, Metetomidine (Dormitor) Uses: muscle relaxation, sedation, analgesia (short) Cautions: (2) Severe bradycardia, Respiratory effects, vomiting, depressing GI activity. Xylazine Class: Mode of Action: Common Name: Routes of Injection: Class: Tranquilizer/Sedative Mode of Action: binds to receptors on sympathetic nerves in brain and spinal cord. Common Name: NONE Routes of Injection: IM or IV Xylazine Why used: -Good aspects (4) -Bad aspects (4) Effects: (7) When not to use: (N/A) Reversal: Xylazine Why used: Sedative/Pain Control -Good aspects (4) Analgesia, muscle relaxation, sedation, reversable -Bad aspects (4) Bradycardia, Respiratory effects, vomiting, Depress GI activity. Effects: (5) Analgesia, muscle relaxation, sedation, Bradycardia, Respiratory effects, vomiting, Depress GI activity. When not to use: (N/A) Reversal: Yohimbine (IV) Xylazine Class Notes: What is the number one side effect? Other than for sedation what can xylazine be used for? At what dosage is the reversal to be given? What is a prevention for bradycardia due to xylazine? Where is this metabolized? How long does analgesia last? Bradycardia is the number one side effect Xylazine can be used to induce vomiting Give at (5x) the dose An anticholenergic can be used to prevent bradycardia i.e. atropine glycopyrolate Is metabolized in the liver, metabolites are excreted in the urine Only about twenty minutes. Alternate pain control required Metetomidine Class: Mode of Action: Common Name: Routes of Injection: Class: Alpha 2 Agonists Mode of Action: binds to receptors on sympathetic nerves in brain and spinal cord. Common Name: Dormitor Routes of Injection: IM, IV Metetomidine Why used: -Good aspects (4) -Bad aspects (4) Effects: (7) When not to use: (N/A) Reversal: Why used: Sedative/Pain Control -Good aspects (4) Analgesia, muscle relaxation, sedation, reversable -Bad aspects (4) Bradycardia, Respiratory effects, vomiting, Depress GI activity. Effects: (5) Analgesia, muscle relaxation, sedation, Bradycardia, Respiratory effects, vomiting, Depress GI activity. When not to use: (N/A) Reversal: Atipamezole (antisedan) (IV) Metetomidine Class Notes: What is the number one side effect? At what dosage is the reversal to be given? What is a prevention for bradycardia due to metetomidine? Where is this metabolized? What is analgesia like timewise? Bradycardia is the number one side effect Give at (5x) the dose An anticholenergic can be used to prevent bradycardia i.e. atropine glycopyrolate Is metabolized in the liver, metabolites are excreted in the urine Short only 20 minutes Class: Opoids Type: Mode of action: Drug Names: (5) Uses: (3) Cautions: (2) Type: Traquilizers/Sedatives Mode of action: Pure agonist, mixed agonist, pure agonist blocks specific receptors Drug Names: Morphine(agonist), Fentanyl (agonist), oxymorphone(agonist), Naloxone (antagonist), Butorphanol (mixed) Uses: Preanesthesia, induction, analgesic (most effective) Cautions: (2) may cause CNS depression or excitement in dog, cats exhibit bizarre behavior. Class: Opoids Methods of Use: - Common components of …. Used to…. “Neuroleptanalgesia” what is it and how can it be produced - Common components of preanesthetic protocols, mixed with a tranqulizer or an anticholingeric Used to treat and prevent post-op pain Neuroleptanalgesa is profound sedation and analgesis which can allow one to perform minor surgery (usually does not work on healthy animals) can be produced by doeses of opioid at a high dose plus a tranquilizer. Class: Opoids Adverse Effects: (4) Reversibility: Can be reversed by… __ is preffered reversal agent Disadvantage: Adverse Effects: Decreases respiratory rate and tidal volume, GI function: initially, increased then, GI stasis = constipation, Addiction physical dependence (controlled drugs =PAPERWORK), Drug interactions ie. in patients on selegiline = FATAL Reversibility: can reverse the effects, esp. of pure agonists w/ “antagonists” Naloxone is preferred reversal agent, causes least respiratory depression, reversal of analgesia also occurs. Disadvantage: Costly, and requires a lot of paperwork. Morphine, fentanyl, oxymorphone Class: Mode of Action: n/a Common Name: n/a Routes of Injection: Uses Good: (3) Bad: (3) Class: Opoid, Purpe Agonist Mode of Action: Common Name: Routes of Injection: SQ,IM,IV Uses: Pain Control, Sedation Good: Excellent analgesia, safe , reversable Bad: Respiratory depression, GI Constipation, addictive/controlled substance = a lot of paperwork Butorphanol Class: Mode of Action: n/a Common Name: n/a Routes of Injection: Uses Good: (1) Bad: (4) Class: Opoids (Mixed Agonist /Antagonist) Mode of Action: n/a Common Name: n/a Routes of Injection: SQ, IN, UV Uses: Pain Control, Sedation Good: Moderate Pain Control Bad: Respiratory depression, GI constipation, Addiction /Controlled substance also partially reverses pain control of agonist Naloxone Class: Mode of Action: n/a Common Name: n/a Routes of Injection: Uses Good: (1) Bad: none Class: Opoid antagonist Mode of Action: n/a Common Name: n/a Routes of Injection: IV Uses: Reversal of agonist Good: Reverses opioid Bad: None