Pain Management/Analgesia Pocket Prep Review

You are interested in specialization as a technician. While your doctors seem to be aware of pain management and various multi-modal protocols, there is still room for improvement, and you want to better yourself. You decide to become a Certified Veterinary Pain Practitioner (CVPP). This will permit you to specialize. The certification will help you utilize analgesics and other modalities to control pain and assist you and your veterinarians in developing pain management strategies and protocols for acute and chronic pain conditions. It may also help your current place of business expand its services and income. Through what organization can you receive this certification? A) IVAPM (International Veterinary Academy of Pain Management) B) AVMA (American Veterinary Medical Association) C) NAVTA (National Association of Veterinary Technicians in America) D) AAVSB (American Association of Veterinary State Boards)

A

You are performing anesthesia for the veterinarian, performing a spay and gastropexy (prophylactically) on an 18-month-old female Great Dane. She was premedicated about 3.5 hours ago, but an emergency came in, so surgery time was delayed. She was premedicated with methadone, dexmedetomidine, and induced with propofol. She is being maintained on oxygen and isoflurane. The patient remained stable and at an appropriate plane of anesthesia during the ovariohysterectomy. However, the veterinarian is starting to perform the gastropexy. As she begins to tack the stomach to the body wall, you notice that the patient's heart rate is increasing, her blood pressure is increasing, and her breathing has become more shallow. You are concerned that she is light and reacting to painful stimuli. You think that you saw the foot twitch a bit as well. You inform your doctor and suggest that the patient needs additional pain management.

A

You are visiting a farm with multiple cattle for routine preventative care. You notice that one of the cows not being evaluated today has a slight lameness. You ask the client if they would like the cow evaluated, and they say no. You ask why, in an attempt to educate the client about signs of pain in cows. The client may give all of the following reasons not to have the cow evaluated. Which excuse is false? A) The cow is eating normally and not losing weight, so she is not painful B) He doesn't have the funds right now to have her looked at. It would be cheaper to send the cow to slaughter. C) Pain medication cannot be used in dairy cattle D) Since the cow is still producing milk well, she isn't painful

C

You assist in developing a pain management protocol for a group of small ruminants. In discussing an upcoming farm visit with the veterinarian, you discuss pain management options. You discuss the most commonly used form of analgesics in ruminants. Which of the following is most widely used? A) Alpha 2-agonists B) Butorphanol C) Local analgesics D) NSAIDs

C

You bring your cat in to see the veterinarian because Fiesty, a 6-year-old MN DMH, hesitates to jump on the counters and even the bed. He still eats and drinks normally but seems to be playing a bit less with his toys. Radiographs are performed, and hip arthritis is evident on radiographs. You want to start pain management, but have tried everything from pilling Fiesty to using Churu™ to grinding meds up in food and flavoring them. He absolutely will not take oral medications. You request an injectable option. Your cat weighs 6.5 kg. Your veterinarian discusses Solensia™ with you, and you feel it will be worthwhile. Which of the following is false about frunevetmab? A) The labeled FDA dose for a cat weighing 6.5 kg is one vial (7 mg) SC, once monthly B) The target dose range is 1-2.8 mg/kg C) Do not administer concurrently with a vaccination on the same day D) The drug must be protected from light and refrigerated

C

You have a five-year-old FS Dachsund presenting with proprioceptive deficits. When talking with the owner, you discuss signs of these deficits and how to interpret if the pet is in pain. What statement would be correct for you to inform your client? A) Even if the dog has lameness in addition to the walking or standing changes, she is not likely in pain B) Dragging a limb, wobbliness, or crossing a limb over another while standing, doesn't mean your dog is in pain C) Even though your dog cannot move the back leg, she is likely in pain D) Even though your dog cannot use the back leg properly, she is not likely in pain

C

You are caring for a 6-year-old MN DSH post-op foreign body and intestinal biopsy patient. He had been doing well and was receiving doses of buprenorphine every eight hours. However, he is now 36 hours post-op and still isn't eating. The vet is talking with the owner about a feeding tube. Still, you wonder if it is just because the buprenorphine isn't sufficient for pain management and discuss with the vet possibly adding or changing the pain management protocol. All of the following may be appropriate, except: A) Intermittent methadone IV injections B) Zorbium and oral gabapentin C) Fentanyl CRI D) Lidocaine CRI

D

You have a patient coming to you because you carry bisphosphonates in your practice. The client wants to know how the drug works and why it may benefit the pet. You explain to the client that this type of drug may be used to treat pain in pets with which of the following conditions? A) Transitional cell carcinoma B) Squamous cell carcinoma C) Severe arthritis D) Bone cancer

D

You have a stable post-operative patient. He had a cranial cruciate and meniscal tear surgery. He had not been on appropriate pain management before surgery at home and was very painful prior to surgery. The surgeon is concerned and wants to make sure he isn't painful after surgery. How often should you assess this patient post-operatively for pain? A) Every 8 hours B) When the patient is vocalizing, not eating, or when out for a walk C) Every 1 to 2 hours D) Every 4 to 6 hours

D

During which phase of nociception does the brain interact with the nerves to modulate or alter the pain experience? A) Transduction B) Perception C) Transmission D) Modulation

D

Which of the following adjunctive therapies would not provide additional analgesia for a Dachshund with thoracolumbar IVDD, who is a paraplegic currently receiving opioids and anti-inflammatory medications? A) Muscle relaxer B) Sedative C) Anticonvulsant D) Antihistamine

D

Which of the following does not occur secondary to pain? A) Ileus B) Hypertension C) Arrhythmia D) Seizures

D

Which of the following medications would not be beneficial in treating a post-operative patient with signs of either dysphoria or emergence delirium? A) Midazolam B) Naloxone C) Butorphanol D) Hydromorphone

D

The owner of a cat with a saddle thrombus had no cost concerns and hospitalized the patient until the patient was stable, pain-free, received an echocardiogram, and was ready to go home. However, the patient didn't fully regain mobility in either hind leg. You are discharging the patient and discussing signs of pain to monitor moving forward. You also discuss the use of passive range of motion (PROM) to help the patient hopefully regain some range of motion in the affected limbs. Which of the following would be inappropriate when performing PROM? A) Hold the ankle joint flexed for 1-2 minutes, then in extension and repeat 3-10 times B) Massage the muscles being stretched C) For patients in lateral recumbency, the limbs should be parallel to the ground while working with them D) Never hyperextend joints

A

What type of opioid receptors are common in birds, and what pain medication would provide analgesia in this species? A) Kappa-receptors; butorphanol B) Mu-receptors; butorphanol C) Kappa-receptors; hydromorphone D) Mu-receptors; hydromorphone

A

You are asked to assist in managing a 6-YO MN Doberman. He presented as a GDV and had surgery 24 hours prior. He is not yet eating and, despite a Nocita® incisional block, remains painful on abdominal palpation. You alert the overnight emergency doctor. He has orders for hydromorphone as needed, but you feel this wouldn't be a good idea for all of the following reasons, except: A) It speeds up the GI tract and may lead to diarrhea B) It can cause GI upset, and the patient is already not eating C) It lasts six hours or less D) It can cause vomiting

A

You are asked to calculate drug dosages for an MLK CRI for a post-op hit-by-car patient with multiple fracture repairs. The patient is stable coming out of surgery, but you want to ensure the pet remains both stable and pain-free. All of the following explain why CRIs may be beneficial to patients, except: A) A higher dose of analgesia is achieved over a shorter period B) A lower dosage is delivered at any given time, resulting in fewer dose-related side effects C) They prevent peaks and valleys seen with the administration of some medications, such as opioids D) The use of two or more drugs from different drug classes provides additive or synergistic benefits

A

A five-year-old FS mixed-breed 20-kg dog, Akira, presents after being attacked on a walk by a German Shepherd and its housemate, a Schippere. The other dogs were up to date on rabies, and on presentation, Akira is bright, alert, and responsive. You see the following puncture wounds all over the dog. Until the wounds can be addressed and while waiting for bloodwork results and starting fluid resuscitation, which of the following is an appropriate pain medication to give the patient upon presentation to the hospital? A) Methadone 0.25 mg/kg IV B) Carprofen 2.2 mg/kg SQ C) Dexmedetomidine 375 mcg/m2 D) Butorphanol 0.2 mg/kg IV

A

A four-year-old Boer goat presents to the practice for dehorning. In anticipation of your veterinarian's need, you develop a preemptive plan for multimodal analgesia and sedation. Which of the following would not be sufficient pain management and sedation for this animal and this procedure? A) Butorphanol and a bupivacaine nerve block B) An alpha2-agonist, butorphanol, a local nerve block C) An alpha2-agonist and butorphanol D) Butorphanol, an IV anti-inflammatory pain medication and local anesthetic block

A

All of the following pain scales have been validated for use in small animals. All are approved for use by the American Animal Hospital Association (AAHA's 2022 Pain Management Guidelines for Dogs and Cats), except: A) Colorado Feline Acute Pain Scale B) Feline Musculoskeletal Pain Index (FMPI) C) UNESP-Botucatu Multidimensional Composite Pain Scale D) Feline Grimace Scale

A

Before using steroids for chronic disease, you need to provide your client with appropriate client education as to the possible long-term side effects. A dog with intervertebral disc disease (IVDD) has neurologic deficits that warrant surgery. However, the owner declines surgery due to financial concerns. The pet receives prednisone, gabapentin, and amantadine daily for pain management among non-medical modalities to support him. Which of the following would not occur with long-term steroid use in a dog with intervertebral disc disease? A) Hypoadrenocorticism B) Delayed wound healing C) Thin skin and hair loss D) Immunosuppresion

A

Opioids are commonly used for analgesia in veterinary medicine, more commonly in the hospital setting than at home. This is partly due to the risk of abuse by the pet parent or family, as well as restrictions with prescribing and side effects in our patients. Opioids can make patient pain assessment more difficult when used for pain management in post-op patients. This can commonly occur for all of the following reasons except? A) Hyperactivity B) Constipation C) Respiratory depression D) Excess sedation

A

In the nonpharmacologic management of pain, which choice is not a benefit of electrical stimulation devices such as TENS and NMES? A) Improved wound healing B) Enhanced lymphatic flow C) Reduced edema D) Provides pain control

B

Of commonly-used analgesics in veterinary medicine, all the following drugs exert their activity in the nociceptive pathway during transduction, except: A) Fentanyl B) Ketamine C) Carprofen D) Medetomidine

B

Pain is now recognized as the fourth vital sign by the AAHA and AAFP guidelines for dogs and cats. It is also well recognized in humans. All of the following components are said to encompass pain, except: A) Sensory component B) Verbal component C) Cognitive component D) Emotional component

B

Which medication is effective in the management of moderate levels of pain? A) Meloxicam B) Buprenorphine C) Ketamine D) Butorphanol

B

Which medication is typically used for chronic pain control in llamas? A) Butorphanol B) Meloxicam C) Fentanyl patches D) Xylazine

B

Which of the following describes adaptive pain? A) Pain above and beyond the protective response levels B) Normal physiological response to tissue damage or inflammation C) Pain that functions as a protective mechanism D) Pain secondary to a stimulus not normally painful

B

You are reviewing with the client the veterinarian's recommendations for a patient for hydrotherapy after an injury to the forelimbs, specifically swimming vs. underwater treadmill, though you suggest both are viable options. Your client asks why this wasn't recommended in the past when her dog injured her hind leg. What would be an appropriate response? A) Dogs swim with greater pelvic limb muscle movement than thoracic limb movement B) Dogs swim with greater thoracic limb muscle movement than pelvic limb movement C) Deeper water, as we would use with swimming, causes decreased buoyancy and would require too much hindlimb effort D) Swimming is more ideal for acute injury, while an underwater treadmill is better aimed at osteoarthritis management

B

Which of the following describes allodynia? A) Decreased sensitivity to painful stimuli B) Increased sensitivity to painful stimuli C) A pain response to a stimulus that is not usually painful D) Complete loss of sensation

C

You are training a new technician today and going over the possible pain management options for an older sheep coming in for castration. You note which of the following should be cautiously used because ruminants can easily overdose with this drug class? A) NSAIDS B) Alpha 2-agonists C) Local anesthetics D) Opioids

C

An alpaca presents to the hospital for a tibia-fibula fracture repair. You have evaluated this animal before and know that she is a bit flighty and a bit of a wimp when it comes to pain. You want to ensure that she has appropriate pain management once her epidural block wears off. Which of the following would be your first choice for post-op pain management? A) Use a CRI of lidocaine-ketamine B) Place an epidural catheter for morphine administration q 12 hours for 2-3 days C) Oral NSAID pain medication D) Place a fentanyl patch for up to 72 hours

B

During which phase of nociception does the "pain message" move to the cerebral cortex, which registers the exact location of the pain? A) Perception B) Transmission C) Modulation D) Transduction

B

Hydromorphone is an opioid analgesic which is widely used in the veterinary industry for the management of pain. This medication is said to have a high potential for abuse. It also has an accepted medical purpose with severe restrictions. Hydromorphone falls into what schedule of controlled drugs? A) Schedule V B) Schedule II C) Schedule I D) Schedule III

B

A horse presents with signs consistent with colic. The veterinarian on call has not yet reached the office. You do a cursory assessment of the patient and note that the patient is painful. The horse just started showing restlessness and pawing at the ground and isn't interested in food. He is also standing at the back of his stall. This started about an hour ago. The ride to the hospital was 30 minutes. Upon arrival, the owner expressed cost concerns and stated that he was only looking for non-surgical therapy options, regardless of the diagnosis. All of the following could be used to manage pain associated with colic, except: A) An alpha-2 agonist, e.g., detomidine or xylazine B) Flunixin meglumine (Banamine) C) Acetaminophen D) Butorphanol or other opioid

C

In many areas of the world, onychectomy is either illegal or being re-evaluated to determine the utility of the procedure and whether it should be performed. In most of the US, it is still legal. You may have to assist in this procedure. You want to ensure your veterinarian is providing sufficient pain management both before and after surgery and when the patient goes home. Which of the following would you be sure to include in this patient's take-home pain management plan? A) Fentanyl patch B) Anti-inflammatory pain medication C) 1-2 weeks of gabapentin D) E-collar

C

Pain causes adverse effects to various parts of the body secondary to increased cortisol levels and delayed healing. Which of the following negative effects would not be seen secondary to the presence of pain? A) Renal hypertension B) GI signs such as vomiting, nausea C) Decreased oxygen demand D) Cardiac arrhythmias

C

Veterinary nurses/technicians play vital roles in veterinary pain management. All of the following discuss key responsibilities that help develop and administer a pain management plan except: A) Log controlled drugs properly B) Routinely assess post-op patients for pain C) Allow the veterinarian to determine the appropriate pain management protocol D) Inform clinicians of patient pain scores and inappropriate pain management

C

What phase of nociception triggers the release of chemicals that excite the nociceptive nerve fibers? A) Transmission B) Modulation C) Transduction D) Perception

C

Which of the following best describes the term noxious? A) A drug-induced sleep B) Loss of sensation or feeling C) Something physically harmful or painful D) A sleep-like state

C

A client calls asking if we think her pet should be evaluated. The 10-year-old FS indoor-outdoor long-haired DSH was outside last night but came in before the owner went to bed. The cat usually has a great appetite, but today had to be coaxed off her bed for breakfast and only nibbled a small amount of wet food. The owner watched the cat throughout the day, noting that she was reluctant to move and inactive. You discuss with the owner other signs of pain. The owner relays that the cat demonstrated all of the following consistent with pain, except: A) Decreased or lack of grooming B) Hiding C) Purring D) Constricted pupils

D

Dehorning goats causes moderate to severe pain. Which of the following pain management techniques would not be applicable for this procedure? A) Local anesthesia B) Alpha-2 agonist C) Non-steroidal anti-inflammatory drug D) Epidural anesthesia

D