TECH120 Domain 90 Pain Management and Analgesia

37 cards | Total Attempts: 247 | Created by VINmedia | Last updated: Aug 21, 2017 | Total Attempts: 247

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Use Of Local And Regional Anesthesia Techniques Are Advantageous Both To The Patient And Practice For All Of The Following Reasons Except They (A) Decrease The MAC Of Inhalants Used.(B) Are A Generator Of Income For The Practice.(C) Lower The Post-operative Analgesic Dosages Of Several Medications.(D) Increase The Patient Recovery Time.

Cards In This Set

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Use of local and regional anesthesia techniques are advantageous both to the patient and practice for all of the following reasons except they (A) decrease the MAC of inhalants used. (B) are a generator of income for the practice. (C) lower the post-operative analgesic dosages of several medications. (D) increase the patient recovery time.	Correct Response: D Explanation: When local or regional blocks are performed they will help decrease recovery time. The patient will recover more quickly from general anesthesia because local/regional blocks help decrease MAC which allows a lower inhalant concentration to be used during the procedure.
A 5 yr old MC Labrador Retriever has presented with severe abdominal discomfort weakness lethargy and a fever of 103 degrees Fahrenheit. The dog had gotten into the trash 3 days ago and consumed many pieces of fatty steak. Based on blood work and abdominal ultrasound pancreatitis is highly suspected. The type of pain this patient is showing is best defined as (A) mild chronic somatic pain. (B) severe chronic visceral pain. (C) severe acute visceral pain. (D) mild acute somatic pain.	Correct Response: C Explanation: Judging pain intensity can be very subjective in veterinary medicine. Duration of pain: Acute pain occurs after tissue injury and has a short well characterized duration lasting from a few minutes to a few days; generally associated with surgical procedures or medical conditions causing inflammation. Chronic pain persists beyond the expected healing time and lasting up to weeks or months depending on the underlying cause; commonly associated with inflammation of joints urinary tract ears skin and neoplasia; affecting the animal’s quality of life and normal homeostasis. Tissue Pain: Somatic pain originates from damage to bones joints muscle or skin; generally well localized. Visceral pain arises from stretching distention or inflammation of hollow organs (intestinal tract) vital organs smooth muscle or peritoneal cavity.
A patient in pain may experience (A) an increased cardiac workload. (B) hypoxia. (C) decreased appetite. (D) urinary retention. (E) two or more of the above answer selections.	Correct Response: E Explanation: In addition to the above consequences the patient may also experience hypercapnia decreased pulmonary function ileus increased cortisol and catecholamine production (stress response) leading to hyperglycemia tissue catabolism immunosuppression fear and anxiety; Alpha 2 agonists would not be a good option to use alone in the treatment of moderate to severe pain. Midazolam does not provide any analgesia.
A patient will be going to surgery for surgical repair of a radius/ulna fracture. The most appropriate local/regional block for this case would be a(an) (A) epidural. (B) brachial plexus block. (C) radial/ulna/median block. (D) mental block.	Correct Response: B Explanation: A brachial plexus block is indicated for procedures on the front limbs distal to the elbow. An epidural is best suited for procedures that are caudal to the abdomen. They are most beneficial for procedures of the pelvis tail pelvic limbs and perineum but they can also be used for laparotomies and thoracotomies. The Radial/Ulna/Median block is also called the ring block. It is indicated for procedures of the foot such as declaw and tendonectomy. A mental block is a dental block performed to desensitize the lower lip.
After examining the mouth of a 12 year old feline you have anesthetized for a dental the veterinarian decides that the left lower canine and one premolar on the left lower side will need to be extracted. The dental block that should be used for this procedure is the left sided (A) infraorbital. (B) maxillary. (C) mental. (D) mandibular.	Correct Response: D Explanation: The extractions will be taking place on the mandible (lower jaw) so the only appropriate responses would be the mental or mandibular block. In this case the mandibular block would be the most beneficial since a canine tooth and a premolar will be extracted.
An aggressive Rottweiler presents with a fractured humerus. You have been asked by the veterinarian to formulate an anesthesia protocol. In order to provide analgesia during the procedure you determine the most appropriate premedication for the patient is (A) hydromorphone. (B) butorphanol. (C) medetomidine. (D) midazolam.	Correct Response: A Explanation: Hydromorphone is a pure mu agonist opioid with a duration of action of around 3-4 hours. Pure mu agonist opioid drugs are the most versatile opioid drug class. They are effective at treating both visceral and somatic pain and the effects are cumulative meaning that increasing the dosage or frequency of administration will provide increased analgesia. Butorphanol has a short duration of action (30min-1 hour) and should only be used on cases with MILD pain. Dexmedetomidine is classified as an alpha-2 agonist. This class provides some analgesia but the effects are short lived (30-45min). Alpha 2 agonists would not be a good option to use alone in the treatment of moderate to severe pain. Midazolam does not provide any analgesia.
An epidural would NOT be beneficial when performing (A) a forelimb amputation. (B) a C-section. (C) an exploratory laparotomy. (D) a femur fracture repair.	Correct Response: A Explanation: An epidural is best suited for procedures that are caudal to the abdomen. They are most beneficial for procedures of the pelvis tail pelvic limbs and perineum but they can also be used for laparotomies.
An example of multimodal analgesia is (A) placing a fentanyl patch 1 hour prior to surgery. (B) performing an epidural. (C) administering naloxone during recovery. (D) administering a morphine lidocaine ketamine (MLK) CRI intra-op.	Correct Response: D Explanation: Drug classes that can be used for multimodal analgesia include opioids alpha-2 agonists local anesthetics NSAIDs NMDA antagonists and miscellaneous drugs such as gabapentin amantadine and tramadol. The miscellaneous drugs are all administered orally and are generally sent home with the owner if continued pain management is necessary.
An example of sequential analgesia is the use of (A) naloxone to reverse buprenorphine. (B) yohimbine to reverse dexmedetomidine. (C) butorphanol to reverse hydromorphone. (D) naloxone to reverse morphine.	Correct Response: C Explanation: Sequential analgesia is a term used when an agonist/antagonist drug such as butorphanol or nalbuphine is used to partially reverse the pure mu agonist drugs. Accidental administration of extremely high dosages of the pure mu agonist drugs can result in respiratory depression and significant sedation. If a painful procedure is being performed sequential analgesia would be a better option to consider rather than full reversal with naloxone. Butorphanol and nalbuphine will block the effects of the mu receptor and therefore reverse the effects of the pure mu agonist drugs. However butorphanol and nalbuphine will stimulate the kappa receptor so some analgesia will be maintained.
Analgesic drugs should only be administered in recovery if the patient is showing signs of pain. (A) True (B) False	Correct Response: B Explanation: Patients that are recovering from a surgical procedure should be assessed for pain as soon as they are conscious. The anesthesia record should be evaluated to determine the time that analgesic drugs were given during premedication and if/when additional doses were administered during the procedure. Additional analgesia should be administered post-operatively if the duration of action of the analgesic drug has lapsed or if the patient shows signs of pain on recovery. Animals should be evaluated for pain every hour for the first few hours during surgical recovery. Observation should continue on a regular basis until the patient is discharged from the hospital.
Buprenorphine is 30 times as potent as morphine and butorphanol is 4-7 times. What does this information tell you? (A) Both drugs will provide better analgesia compared to morphine. (B) Both drugs will bind more tightly to the opioid receptors. (C) Both drugs require a smaller volume to achieve the desired effect. (D) Both drugs will antagonize morphine.	Correct Response: C Explanation: This is a very common misconception seen with opioid drugs. Potency is a measure of how much drug is required in order to achieve the desired effect. A highly potent drug will initiate a response even at low concentrations. The volume required to produce a response is smaller for buprenorphine and butorphanol compared to morphine. Potency does NOT tell you anything about the analgesic effectiveness. Efficacy is the term used to describe the maximum effect that can be achieved from a drug. A drug can have high potency but poor efficacy meaning a response is seen at very low doses but the response remains small even at high doses. The pure agonist opioid drugs have a greater efficacy compared to the partial mu agonist and agonist/antagonist opioid drugs.
Depending on the dosage and location of administration local anesthetics are capable of blocking (A) sensory neurons only. (B) motor neurons only. (C) sensory and motor neurons. (D) sensory motor and autonomic neurons.	Correct Response: D Explanation: Local anesthetics primarily target sensory neurons found in the peripheral tissues and effectively block the transmission of sensations such as pain heat cold and pressure from the skin muscles and other peripheral tissues to the brain. Motor neurons (voluntary movement) can also be affected when regional blocks such as epidurals are performed; blockades may cause paresis (weakness) or paralysis (loss of voluntary movement) of the affected area. The potential for the drugs to travel too far cranial and affect the autonomic nervous system exists if an excessive volume of local anesthetics are administered when performing an epidural. A sympathetic blockade may occur if local anesthetics travel cranial to the 11th thoracic vertebrae and can result in hypotension bradycardia and impaired ventricular contractions.
If acute pain has not been effectively managed it can lead to (A) chronic pain. (B) maladaptive pain. (C) peripheral sensitization. (D) central sensitization. (E) All of the above	Correct Response: E Explanation: Untreated acute pain and chronic pain both cause physical changes to occur in the brain and spinal cord (neuroplasticity) that reset how the nervous system responds to a painful stimulus. This is sometimes referred to as maladaptive pain. Maladaptive pain is usually persistent or recurrent and gives rise to peripheral and central sensitization. If acute pain is not managed in a quick and effective manner it can lead to chronic pain that is significantly more difficult to control.
In a conscious patient an inconclusive clinical sign of pain would be (A) an elevated heart rate. (B) vocalization. (C) nervousness. (D) a reluctance to move.	Correct Response: A Explanation: When a patient is under general anesthesia the vital signs (HR BP RR) are reliable indictors of pain. A sudden increase in these parameters without change in anesthetic depth usually indicates a painful response to surgical stimulation. However once a patient is conscious these parameters become unreliable as specific pain indicators.
In the USA the NSAIDs approved for use in the cat are (A) carprofen and meloxicam. (B) robenacoxib and meloxicam. (C) meloxicam and etodolac. (D) etodolac and carprofen.	Correct Response: B Explanation: In the USA meloxicam is approved for use in cats as a single one time dose for any given period of time. In March 2011 the FDA approved robenacoxib for use in cats. In some countries a single injection of carprofen is approved for cats. In Europe and Canada ketoprofen is approved for use in cats.