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L16 (part 2): Analgesia Drugs and use
NSAIDS only
12
Veterinary Medicine
Undergraduate 3
06/01/2012

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Cards

Term
Use of NSAIDs
Definition
-important component of poly-modal therapies aimed at peri-op analgesia in D+C and mgmt of chronic pain, esp osteoarthritis
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Term
Factors when choosing NSAIDS
Definition
-analgesic efficacy of most vet. NSAIDs is similar -most important factor is safety -difference in side effects of diff. NSADs are apparent, esp. when used peri-op
Term
NSAIDS mech. of action
Definition
-antiinflam, antipyretic, antihyperalgesic, antiendotoxaemic, analgesic
-inhibit COX enzymes - decr. production of PGs, prostacyclins, TXA2
-PGs important in inflam pain in periphery, in production of primary hyperalgesia and in the transmission of noxious stimuli in the SC and higher centres
Term
NSAIDs side effects
Definition
related to PG production inhibition:
-impairment of renal function
-GI irritation and ulceration
-antithrombotic effects due to TXA2 inhibition (most NSAIDs do not do this at therapeutic levels - aspirin is exception)
-dec. liver function (related to long term use in indiv. animals - low reported incidence)
Term
Renal affects of NSAIDs
Definition
-in kidney, locally produced PGs are continually active in maintaining afferent arteriolar dilation - esp. important in periods of hypotension in maintaining normal kidney haemodynamics
-NSAIDs inhbit these PGs and so hypoperfusion of kidney can result w. degree of renal failure
Term
GI affects of NSAIDs
Definition
-GI ulceration most common and important side effect
-PGs normally promote mucus secretion, maintain mucosal BF, and help in modulation of gastric acid secretion - NSAIDs inhibit this
Term
Risk factors for GI ulceration
Definition
-history of GI ulceration
-geriatric and so dec. capacity for drug clearance
-biochem evidence of liver dysfunction
Term
clinical significance of COX selectivity
Definition
-GI side effects less common w. NSAIDs that selectively inhibit COX2
-potent COX1 inhibitors are highly ulcerogenic
-COX2 selectivity may be a useful predictor or GI safety but can not be used to predict general safety
-COX2 selectivity has little relevance in renal toxicity
-liver toxicity is rare and does not correlate w. COX selectivity
-COX selectivity does not effect efficacy
Term
Peri-op use of NSAIDs
Definition
-can provide effective analgesia in orthopaedic and soft tissue procedures in D+C -Meloxicam, Carprofen, Robenacoxib licensed in D+C for peri-op admin -all COX2 preferential w. minimal effects on renal VF in normal animals -admin of all other NSAIDs should be delayed until the animal has fully recovered from anaes. and is normotensive -strongly advised to avoid peri-op NSAIDs in animals w. impaired renal function
Term
NSAIDs post-op use
Definition
-ensure animal is fully recovered from anaes. and normotensive
Term
NSAIDs use in cats
Definition
-appear to be more at risk of side effects
-may relate to metabolic pathway / dec. metabolism or relative ease of OD
Term
Clinical recommendations fo peri-op admin of NSAIDs
Definition
-only admin NSAIDs licensed for pre-op admin in the peri-op period
-only admin NSAIDs pre-op to healthy animals undergoing routine procedures, in which hypotension is not anticipated
-do not give to trauma or shocked patients or until they are normotensive and CV stable
-do not give to animals w. pre-existing renal dz. or w. disorders of haemostasis
-use carefully in animals w. pre-existing liver dysfunction - may lead to incr. in half life and so inadvertent OD
-do not combine different NSAIDs or give NSAIDs and corticosteriods together
-min. wash-out period of 5-7 days is recommended when switching between NSAIDs or between NSAID and corticosteroid to avoid inadvertent drug interactions
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