Ch. 30 - Pain Management

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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


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