Anesthesiology Quiz 1 Part 5

kelseyfmeyer's version from 2015-09-08 16:58

Injectables: Tiletamine+zolazapam, TIVA

Question Answer
does ketamine or tiletamine have a longer duration of action?tiletamine
what is tiletamine always combined with? what is this combination commercially called? what is the ratio?zolazapam, called "telazol" (zoletil in europe), and is in a 1:1 ratio (usually 250mg each). Reconstitute by adding 5mL saline to powder
what is the pH of telazol?2-3.5
Tiletamine + zolazepam is similar to ketamine + ____, but the difference is...similar to ketamine+benzodiazepine, but the telazol is LONGER ACTING
what is recovery like from tiletamine+zolazapam? sp differences?recovery can be can be a rough recovery esp. in dogs!
which effects wear off first- tiletamine or zolazapams?zolazepam wears off first, which means recovery might end up with mm rigidity, excitations, and seizures
what are the clinical uses for tiletamine+zolazapam?induction agent for many species, and can be the sole anesthetic for short diagnostic and surgical procedures.
how can you administer tiletamine+zolazapam? notes about this? what should you know about dosing?IV, IM administration. However, IM can be painful (very low pH). Know that you CANNOT REDOSE.
how long is a solution of tiletamine+zolazapam good for once reconstituted?7 days if kept at under 5*C
what are the contraindications of tiletamine+zolazapam?SAME AS KETAMINE... (1) pts with CV disease (inc CV activity) (2) pts with hepatic insufficienty (metabolized by liver into active metabolites) (3) pts with renal insufficiency (Excreted via kidney) (4) Hyperthyerosis(hyperthyroid) pts, or OTHER dzs with high blood pressure. (5) PTS WITH HEAD TRAUMA/BRAIN TUMOR/EPILEPSY/MYELOGRAM (dye in CSF) (6) pts with inc intraocular pressure (7) c-section
explain TIVAtotal IV administration. it is the induction and maintainance of anesthesia by IV drugs only, and is usually a combination of an anaesthetic and an analgesic.
what are the two options for maintaining TIVA?intermittant bolus or CRI
what is TCI?target-controlled infusion
what GI-related side effect might you see with telazol?hypersalivation
what are the pros of TIVA?less anaesthetic equipment is needed, you can endoscopy airways, and there is less air pollution from gas anesthetics
what are the three drugs youd wanna use for TIVA when you want: HYPNOSISpropofol, alfaxolone, ketamine
what are the three drugs youd wanna use for TIVA when you want: ANALGESIAopioids(fentanyl), alpha-2 agonists, ketamine
what are the two drugs youd wanna use for TIVA when you want: MM RELAXATIONbenzodiazepines, guaifenesin


Question Answer
priapism in horsesace
bad for boxersace
Poikilothermia (temp disregulation)ace
SEQUESTERS RBCs to spleen (not splenic relaxation, that's the barbiturates)ace (peggy has a selfish spleen)
kickass pig sedativeazaperone
abortion in 3rd trimester of cows (category of drugs)a2 agonists (AA MY BABY, AA I WAS STARTLED! AA I HAVE TO PEE)
inhibits platelet aggregationace
hypoxemia/pulmonary edema in sheepa2 agonists
rumis 10xs more sensitive to this drug than other animalsxylazine
romifidine is what kinda drug?a2 agonist
inhibit insulin release--> hyperglycemia are what drugs?a2 agonists (AA sugar! I wanna eat once my visceral pain is gone)
premeds where the biggest prob is the CV effects (bradycardia and bradyarrythmias)ALPHA 2 AGONISTS (just think about how Two will easily drop your beating heart) (AA!! MY HEART!!)
which sedative/premed is awesome for transporting horses with due to minimal ataxia?romifidine
AV blocks is a side effectthis is the bradyarrythmias seen from a2 agonists (AAV is one too many As so the heart got blcoked...this is apparnetly happening when going from vasoconstriction to vasodilation)
startle response caused by...a2 agonists (AA! sorry i was startled)
what speed do you give atipamizole at, and why? (note: what does this drug do again?)SLOW because it is a a2-agonist ANTAGONIST but a2agonist cause analgesia, so you'll reverse the analgesia titrate slowly enough to bring them back but keep some analgesia (A(2) is the TIP of the ABC iceburg)
which drugs have it so sedation lasts longer than the analgesia, so you need to be aware of this?a2 agonists (my 2 choice is sedation longer than analgesia..not my number one) (it HAS analgesia, so this narrows it down)
what is tolazoline?reversal of xylazine (yohimbine also does this)
what is yohimbine?reversal of xylazine
what is atipamazolereversal for medetomidine/dexmedetomidine (can do other a2s but off label) (DEX TIPPED ME off)
potent visceral analgesia?a2agonists (AA, no organ pain feels great)
which drug reacts with potentiated sulfonamides in horses?detomidine (deto-AA! sorry saw sulfur hurting you)
inhibit ADH, leading to diuresisa2 agonists (AA I GOTTA PEE! AA MY HEART!!)
what is flumazenil?benzo (competitive) antagonist (ben wanted to reverse his flu)
these drugs don't provide good sedation in healthy adults, only the very young/old/sickbenzos (ben is such a hearty adult that the drugs dont make him sleepy!)
hemolysis and thrombophlebitis as side effectsguaifenesin
mild sedation in dogs, but excitement/inc locomotor activity in cats and horsesopiates
hyperthermia in cats and horses, hypothermia in dogsopiates
in dogs, large theraputic window. In cats and horses, small theraputic windowopiates
only opiate not metabolized by the liverremifentanyl
shortest acting opiate? longest?shortest=remifentanyl. Longest=buprenorphine
opiate with added NMDA antagonismmethadone (meth heads are crazy...yep.)
anticholinergic of choice for rabbitsglycopyrrolate
how to treat opioid induced bradycardia?anticholinergics (ONLY DO IF THEIR BP IS LOW TOO, WHICH MAY NOT BE THE CASE IN A2 AGONISTS)
cause pupil dilation what makes horses and cats freak outanticholinergics (basically atropine)
which causes too much salivation? which causes too little?too much= ketamine(dissaociatives). too little=atropine(anticholinergics)
ventricular bigeminythiopental
which category matters a lot if the animal is thin or fat?barbiturates (barb cares about being skinnny)
drug precipitates out of LRSthiopental (theo is lactate-intolerant)
repeated injections will lead to zero order kinetics (prolonged recovery)thiopental (theo has zero potential for for repeated insult)
bad for greyhoundsthiopental (thio would pull on my greyhounds ears)
regular or repeated use of this drug will cause a heinz body anemia in a catpropofol (michael jackson loves to kill cats by ruining their blood)
dont use in hyperlipidemia/pancreatitis ptspropofol
inhibits adrenocortical functionetomidate (ET loves your heart...but wants to punch you right in the adrenal glands)
drugs with lipid emulsionpropofol, etomidate (ET and michael jacks got fat)
hemolysisguaifenisen, etomidate, (in cats, propofol causes oxidative damage which i assume can lead to hemolysis) (remember that guai only will relax your mm at the cost of your blood, and ET will destroy your blood and adrenals)
good for high-risk cardiac patients/critical patientsEtomidate
drug that loves to accumulateTHIOOOOOOPENTAL! (theo hangs around even when he's unwanted)
prolonged recoveries in catsmorphine and propofol
NOT hepatic metabolismremifentanyl
extravascular tissue necrosis/tissue irritantguaifenisen, (DIAZEPAM is irritating to the vessels when IV admin, and that's the only admin allowed), thiopental, classical preparation of etomidate (etomidate and diazepam both has propylene glycol which is a big irritant, thiopental is SUPER alkaline) Ketamine/telazol causes pain on injection (pH low)
can cause anaphylaxismorphine/meperidine IV
mm relaxalfaxalone, guaifenesin, benzos (al and ben eating guai fruit)
drug not affected by plasma protein levelsAlfaxalone (Al doen't need no steak!)
excreted via bilealfaxalone (al has bile stones)
myoclonus and opisthotonus (severe state of hyperextension) in CATSalfaxalone (al stretched the cat over his knee into extension, and it was twitching)
CV stimulation effects overpower the myocardial depression effectsketamine
maintained reflexesketamine (dissacioatives)
inc ocular pressureketamine
analgesiasa2 agonists, opioids, dissacioatives
IM injectablesketamine/telazol, alfaxalone (Im' watching AL abuse KETAMINE)
mortality in fetus...reduced vigor in fetusmortality is barb. reduction in vigor is ketamine (barb gets abortions because she wants to stay thin)
shouldnt use in hyperthyroid ptsketamine (it'll wind them up more)
inc intrcranial pressureketamine
rough recovery in dogstelazol
rough induction phase in horsespropofol (prop up horses or else)
what dec anesthetic risk in horses?premed with ace and TIVA