Ch. 30 - Pain Management
T or F: Because it can cause heart toxicity, lidocaine is not recommended for use in cats.
T
T or F: Diazepam does not provide pain relief.
T
T or F: Even though multiple analgesics are often given concurrently, it is recommended that no more than one NSAID be given to a patient at a time.
T
T or F: GI ulceration is the primary side effect of NSAIDs in large animals.
T
T or F: Lidocaine, bupivacaine, or tetracaine can be used topically to reduce pain associated with minor procedures such as urethral catheterization.
T
T or F: Lower doses of individual analgesics can be used when an analgesic protocol includes agents from multiple classes that attack more than one phase of the pain pathway.
T
T or F: Nociceptors are specialized nerve fibers that carry pain information, but not pleasant or neutral sensations.
T
T or F: Pain tolerance varies widely between species and individuals within a species.
T
mild to moderate pain
What type of pain would you expect from a laparotomy?
mild to moderate pain
What type of pain would you expect from a mass removal?
mild to moderate pain
What type of pain would you expect from castration?
severe pain
What type of pain would you expect from declawing?
mild to moderate pain
What type of pain would you expect from dental procedures?
severe pain
What type of pain would you expect from ear canal ablation?
severe pain
What type of pain would you expect from fracture repair?
severe pain
What type of pain would you expect from intervertebral disk herniation?
severe pain
What type of pain would you expect from limb amputation?
transmission
movement of a nerve impulse along peripheral nerves to the spinal cord
Pain is now considered by some to be the fifth vital sign. The other four are _____________, ____________, ____________, and _____________________.
temperature, pulse, respiration, and blood pressure
allodynia
transmission of pain impulses by fibers that normally carry pleasant or neutral impulses
local anesthetic
What drug class does mepivacaine belong to?
pure opioid agonist
What drug class does morphine belong to?
opioid antagonist
What drug class does naloxone hydrochloride belong to?
NSAID
What drug class does phenylbutazone belong to?
joint supplement & chondorprotective agent
What drug class does polysulfated GAGs belong to?
alpha-2 antagonist
What drug class does romifidine belong to?
joint supplement & chondroprotective agent
What drug class does sodium hyaluronate belong to?
synthetic opioid
What drug class does tramadol belong to?
alpha-2 agonist
What drug class does xylazine belong to?
T or F: Administering analgesics after pain occurs is often just as effective as giving them before it occurs.
F: Administering, whenever possible, analgesics before pain occurs appears to be more effective than using the same agent to treat pain once it occurs.
T or F: Large animals do not experience pain in the same way as small domestic animals and people.
F: All mammals, including large animals, have the same pain pathway and do experience pain, although they may not show signs of pain
T or F: Although pain has many negative physiologic effects, these effects are confined to the nervous system.
F: Although the nervous system is the main target of pain transmission, the body's response to pain signals is not limited to the nervous system.
T or F: Analgesics are generally used more often in large animals than in small animals.
F: Analgesics are generally used less often in large animals than in small animals
T or F: Even though pain has many damaging consequences, it can also be beneficial by limiting activity.
F: Dispelling the myth that pain is beneficial in limiting a recovering animal's activity is critical to quality patient care.
T or F: Allodynia is the phase of wind-up in which less and less stimulation is required to initiate pain.
F: Hyperalgesia is the phase of wind-up in which less and less stimulation is required to initiate pain. Allodynia is a phenomenon in which nerve fibers that normally carry pleasant or neutral information transmit pain sensations.
T or F: In animals, pain is usually easy to differentiate from normal postoperative behaviors.
F: It is often difficult for even the most experienced technician to distinguish between pain and other stress, such as the aberrant behavior that may occur postoperatively.
T or F: Opioids classified as partial agonists have a decreased effect but very similar side effects to pure agonists.
F: Opioids classified as partial agonists do have a decreased effect, but without many of the deleterious side effects of pure agonists.
T or F: Lidocaine with epinephrine is helpful for feline declaw blocks because it reduces bleeding.
F: The use of lidocaine with epinephrine for circumferential limb blocks such as the declaw block can cause loss of adequate blood flow because of constriction of arterioles.
T or F: A bilateral infraorbital dental block is a technique that can be used to provide analgesia for dental extractions of the upper and lower dental arcades.
F: This block is effective for dental extractions from the upper arcade, but a mandibular foramen block is required for dental extractions from the lower dental arcade.
T or F: Like people, domestic animals tend to readily show that they are in pain.
F: Unlike people, domestic animals tend to instinctively hide pain as they would in the wild so they do not appear weak when compared with the rest of the group and become prey
T or F: Giving butorphanol with a fentanyl patch will maximize the analgesic effects of the patch.
F: Use of mixed agonist-antagonist opioids such as butorphanol will reverse the effects of the fentanyl patch and should be avoided
preemptive analgesia
Pain management administered before any trauma occurs to prevent expected pain
wind-up phenomenon
The combination of allodynia and hyperalgesia
multimodal analgesia
The use of two or more analgesic drugs to alter more than one phase of the pain pathway
local anesthetic
What drug class does lidocaine belong to?
NSAID
What drug class does meloxicam belong to?
alpha-2 antagonist
What drug class does atipamezole belong to?
local anesthetic
What drug class does bupivacaine belong to?
partial opioid agonist
What drug class does buprenorphine belong to?
opioid agonist-antagonist
What drug class does butorphanol belong to?
NSAID
What drug class does carprofen belong to?
alpha-2 agonist
What drug class does detomidine belong to?
alpha-2 agonist
What drug class does dexmedetomidine belong to?
pure opioid agonist
What drug class does fentanyl belong to?
NSAID
What drug class does firocoxib belong to?
NSAID
What drug class does flunixin meglumine belong to?
pure opioid agonist
What drug class does hydromorphone belong to?
NMDA-receptor antagonist
What drug class does ketamine belong to?
NSAID
What drug class does ketoprofen belong to?
antagonist
a drug that blocks receptors
agonist
a drug that stimulates receptors
agonist-antagonist
a drug that stimulates some receptors and blocks others
hyperalgesia
a situation in which less and less stimulation is required to initiate pain
A circumferential ring block for declawing requires an SQ injections of 0.5% bupivacaine at a dose of a. 1.0 mL/10 lb body weight b. 1.0 mL/10 kg body weight c. 1.0 mL per cat d. 0.1 mL/10 lb body weight
a. 1.0 mL/ 10 lb body weight
The drug gabapentin has particular efficacy for a. acute pain b. deep pain c. neuropathic pain d. abdominal pain
c. neuropathic pain
The analgesics of choice for treatment of osteoarthritis are the a. NSAIDs b. opioids c. local anesthetics d. alpha-2 agonists
a. NSAIDs
The class of opioids with the most severe side effects are the a. pure agonists b. partial agonists c. mixed agonist-antagonists d. antagonists
a. pure agonists
In view of the efficacy gabapentin has in treating neuropathic pain, which of the following conditions would it be used to treat? a. resistance to being touched at a location with no tissue damage b. pain secondary to a severe infection c. postsurgical incisional pain d. limb pain resulting from trauma
a. resistance to being touched at a location with no tissue damage
As compared with morphine, the main advantages of fentanyl are a. shorter half life and faster onset of action b. faster onset of action and longer half life c. longer half life and slower onset of action d. slower onset of action and shorter half life
a. shorter half life and faster onset of action
During which phase of nociception does the mechanical, chemical or thermal energy that causes tissue damage get turned into electrical impulses by the nerve endings? a. transduction b. transmission c. modulation d. perception
a. transduction
modulation
amplifying or dampening of a nerve impulse in the CNS
dysphoria
an emotional state characterized by anxiety, depression, or unease
This class of analgesics works by inhibiting release of the neurotransmitter norepinephrine. a. NMDA inhibitors b. alpha-2 agonists c. NSAIDs d. anticonvulsants
b. alpha-2 agonists
The opioid most commonly used in large animals is a. morphine b. butorphanol c. fentanyl d. buprenorphine
b. butorphanol
One of the following species is more sensitive to morphine and therefore requires lower doses of this pure agonist. Which one is it? a. dog b. cat c. cow d. horse
b. cat
NMDA-receptor antagonists such as ketamine have a particular place in preventing and treating a. chronic pain b. wind-up pain c. neuropathic pain d. preexisting pain
b. wind-up pain
Drugs that provide analgesia by modifying inflammation are the a. opioids b. alpha-2 agonists c. NSAIDs d. local anesthetics
c. NSAIDs
The analgesic class most commonly used in horses is a. opioids b. alpha-2 agonists c. NSAIDs d. local anesthetics
c. NSAIDs
Cats can be given NSAIDs when indicated, but should never be given a. meloxicam b. carprofen c. acetaminophen d. aspirin
c. acetaminophen
Which of the following analgesic adjuncts is a nutraceutical and consequently is not regulated by the FDA? a. gabapentin b. tramadol c. chondroitin sulfate d. buprenorphine
c. chondroitin sulfate
The drug romifidine is an alpha-2 agonist analgesic. Which of the drugs listed below is also in this class? a. ketamine b. acepromazine c. dexmedetomidine d. morphine
c. dexmedetomidine
Dogs receiving NSAIDs are particularly prone to adverse effects relating to the GI system, whereas cats are particularly prone to adverse effects relating to the a. liver b. CNS c. kidneys d. blood
c. kidneys
Which of the following drugs is safe for use in patients with GI disturbances and thus is a good choice for dogs with gastric dilation volvulus (GDV), unlike many analgesics. a. carprofen b. hydromorphone c. lidocaine d. dexmedetomidine
c. lidocaine
The stinging sensation caused by injection of local anesthetics can be reduced b adding 0.1 mL of ______________ to 10 mL of the local agent. a. bupivacaine b. epinephrine c. sodium bicarbonate d. saline
c. sodium bicarbonate
This synthetic drug is available in oral form and produces opioid-like stimulation of the mu receptor, but with fewer side effects. a. fentanyl b. dexmedetomidine c. tramadol d. hydromorphone
c. tramadol
Neurotransmitters
chemicals that transmit nerve impulses between nerve cells
transduction
conversion of mechanical, chemical, and thermal energy into electrical impulses
Because of potential side effects of NSAIDs, patients should not receive them if they have a. bleeding abnormalities b. hypotension c. stomach ulcers d. any of the above
d. any of the above
An opioid that has a significantly longer duration of action than most is a. morphine b. hydromorphone c. butorphanol d. buprenorphine
d. buprenorphine
Which of the following drug combinations is representative of the anesthetic protocol known as "kitty magic"? a. morphine, acepromazine, and ketamine b. fentanyl, ketoprofen, and ketamine c. buprenorphine, meloxicam, and dexmedetomidine d. buprenorphine, dexmedetomidine, and ketamine
d. buprenorphine, dexmedetomidine, and ketmine
An epidural injection of lidocaine or morphine will provide analgesia to the a. pelvis only b. caudal abdomen only c. tail only d. caudal half of the body
d. caudal half of the body
Local anesthetics work by a. decreasing inflammation b. blocking mu receptors c. inhibiting norepinephrine release d. disrupting neural transmission
d. disrupting neural transmission
An NMDA receptor antagonist used to prevent wind-up phenomena is a. gabapentin b. xylazine c. acepromazine d. ketamine
d. ketamine
The analgesic class most commonly used in ruminants is a. opioids b. alpha-2 agonists c. NSAIDs d. local anesthetics
d. local anesthetics
The most commonly used NSAIDs in large animals are a. flunixin meglumine and carprofen b. carprofen and ketoprofen c. ketoprofen and phenylbutazone d. phenylbutazone and flunixin meglumine
d. phenylbutazone and flunixin meglumine
Signs of pain can be classified as physiologic or behavioral. Examples of behavioral signs of pain are a. tachycardia, dilated pupils, and howling b. biting, hiding, and hypertension c. tachypnea, reluctancy to move, and failure to groom d. screaming, escaping, and tucking the abdomen
d. screaming, escaping and tucking the abdomen
breakthrough pain
pain that occurs despite the use of a usual protocol
Signs of pain in animals can be categorized according to whether they are ______________ (ex. tachycardia or hypertension) or ________________ (ex. biting or guarding an incision).
physiologic, behavioral
Tissue damage results in inflammation. The classic signs of inflammation are localized __________________, ___________________, and __________________.
redness, heat, swelling
nociception
the process by which pain is detected by the nervous system