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Vet Hospital II Lecture Test #1
Crowder College Vet Hospital II Lecture Test #1-Anti-inflammatory drugs
101
Veterinary Medicine
Undergraduate 2
09/29/2011

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Term
Define pain.
Definition
An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Term
The body produces what two opiate-like substances that have an analgesic effect.
Definition
Endorphins and enkephalins.
Term
Pain receptors are called?
Definition
Nociceptors
Term
List and describe two types of fiber systems that carry impulses to the spinal cord.
Definition

1) Type A delta fibers-sharp, localized pain; myelinated

2) Type C-dull, localized pain; unmyelinated

Term
Info from the spinal cord travels through the ____ to the _____ for interpretation.
Definition
thalamus; cerebral cortex
Term
Why can't you depend on withdrawal alone from deep pain to diagnose spinal injuries?
Definition
Reflex arc may be intact.
Term
Cox is short for?
Definition
Cyclooxygenase
Term
What does Cox-1 do?
Definition
Maintains physiologic functions like renal blood flow and synthesis of gastric mucosa.
Term
What does cox-2 do?
Definition
promotes the formation of prostaglandin from cell membrane archidonic acid
Term
Prostaglandin is a chemical mediator responsible for what four things?
Definition

1) pain

2) fever

3) inflammation

4) platelet aggregation

Term
Glucocorticoids affect _____, an enzyme that is neccessary for the production of both _____ and _____.
Definition

Phospholipase

Leukotrienes 

Prostaglandins

Term
What two things do NSAIDS do that glucocorticoids do not?
Definition

1) produce analgesia

2) reduce fever

Term
List 4 adverse effects of NSAIDS?
Definition

1) GI ulceration and bleeding

2) Nephrotoxicity

3) Hepatotoxicity

4) Bone marrow suppression

5) inhibition of cartilage metabolism

6) bleeding from platelet inhibition

Term

Name two common salicylates.

Active ingredient?

Definition

Aspirin and Pepto-Bismol

acetlysalicylic acid

Term
Name four actions of salicylates.
Definition

1) antipyretic

2) analgesic

3) antiinflammatory

4) reduction of platelet aggregation

Term
List five clinical uses of salicylates.
Definition

1) relief of mild pain from musculoskeletal conditions

2) post-adulticide treatment for heartworm disease

3) antipyretic

4) treatment of cardiomyopathy in cats

5) treatment of endotoxic shock

Term
List two adverse effects of salicylates.
Definition

1) GI irritation leading to ulceration and bleeding

2) inability of cats to metabolize the drug rapidly

Term
Phenylbutazone is a _____ derivative.
Definition
Pyrazolone
Term
List four uses of phenylbutazone.
Definition

1) analgesia for mild-moderate pain

2) anti-inflamatory

3) antipyrexia

Term
List four clinical uses of Phenylbutazone.
Definition

1) treatment of lameness in horses

2) treatment of colic in horses

3) anti-inflammatory, antipyrexia, analgesic in dogs and cattle

Term
List four dosage forms of Phenylbutazone.
Definition

1) Butazolidin

2) Phenylzone

3) Equipalazone

4) Pro-bute

Term
List two adverse effects of Phenylbutazone and tell why it must be giving IV.
Definition

1) GI bleeding

2) bone marrow suppression

Give IV to avoid tissue sloughing.

Term
Flunixin Meglumine is labeled for what two species?
Definition

horses and cattle

used off-label for dogs and other species

Term
List five clinical uses of flunixin meglumine.
Definition

1) colic pain

2) musculoskeletal problems in horses

3) disk disease

4) endotoxic shock

5) parvo in dogs

Term
Trade name for flunixin meglumine?
Definition
Banamine
Term

Adverse effects of flunixin meglumine in horses?

In dogs?

Definition

Horses-swelling at injection site; sweating

Dogs-vomiting; diarrhea; gastric ulceration; nephrotoxitiy; melena

Term
What does DMSO stand for?
Definition
Dimethyl Sulfoxide
Term
What was Dimethyl sulfoxide originally developed as?
Definition
commercial solvent
Term
DMSO has what three effects?
Definition

1) anti-inflammatory

2) acts as a carrier to take other substances through the skin

3) vasodilation

Term
List five clinical uses of DMSO.
Definition

1) topical anti-inflammatory for acute swelling in dogs and horses

2) also given IV as adjunct to intestinal surgery

3) treats cerebral edema or spinal cord inflammation

4) treats for perivascular caparsolate administration

5) carries drugs across skin barrier

Term
List five adverse effects of DMSO.
Definition

1) garlic taste

2) skin irritation and burning

3) teratogenic

4) can carry undesirable substances across the skin

5) may interact with cholinesterase inhibitors such as organophophates.

Term
Acetaminophen is most commonly known as ____ and has what effect?
Definition

Tylenol

analgesic with limited anti-inflammatory and antipyretic effect

Term
What is the most common sign of acetaminophen toxicity?
Definition

Methemoglobinemia-denatures hemoglobin making it unable to carry oxygen.

Turns patient blue (cyanotic).

Term
What is the antidote for acetominophen toxicity?
Definition
Acetylcystine
Term
Trade name of carprofen.
Definition
Rimadyl-first selective cox-2 inhibitor in veterinary medicine
Term
Why is carprofen not approved for use in cats in the U.S.?
Definition
Too much variability in duration of action-injection can relieve pain for between 9-40 hours in cats.
Term
Clinical uses of carprofen.
Definition

Pain associated with DJD

Post-surgical pain

Term
List three adverse effects of carprofen.
Definition

1) GI ulceration/bleeding

2) heptotoxicity

3) nephrotoxicity

Term
Etodolac is also known as?
Definition
Etogesic-selective cox-2 inhibitor
Term
List the clinical uses of Etodolac.
Definition
1) manage pain and inflammation associated with osteoarthritis
Term
List four adverse effects of Etodolac.
Definition
Vomiting, diarrhea, lethargy, anorexia
Term
Deracoxib is commonly known as?
Definition
Deramaxx-coxib class; selective Cox-2 inhibitor
Term
What are two clinical uses of Deracoxib?
Definition

1) Reduce pain and inflammation associated with orthopedic surgery in dogs over 4 lbs.

2) Treat osteoarthritis in dogs greater than 14 lbs.

Term
Firocoxib is commonly known as?
Definition
Previcox-coxib class; selective Cox-2 inhibitor
Term
List three adverse effects of firocoxib.
Definition

1) GI issues

2) renal issues

3) hepatic issues

Term
Trade name of meloxicam?
Definition
Metacam-selective Cox-2 inhibitor
Term

Meloxicam is the only NSAID approved for what?

Why?

Definition

Single, one-time SQ injection in cats

It is metabolized by oxidation rather than having to be conjugated with glucuronic acid.

Term
List three organs adversely affected by meloxicam.
Definition

1) GI

2) Liver

3) Kidneys

Term
Tepoxalin is also known as?
Definition
Zubrin-rapidly disintegrating tablet that dogs can't spit out.
Term
Tepoxalin inhibits Cox-1 or Cox-2?
Definition
Both, but Cox-1 more than Cox-2 but company says that inhibition of lipoxygenase reduces damage to gastric mucosa.
Term
Trade name of Robenacoxib.
Definition

Onsior-newly approved by FDA; NSAID with multiple dosing capability in cats

January 2012

Term
Ketoprofen is a _____ _____ derivative.
Definition
Propionic acid
Term
List three desirable effects of Ketoprofen (Ketofen).
Definition

1) antipyretic

2) analgesic

3) anti-inflammatory

Term
Ketoprofen is labeled for what species in the U.S.?
Definition
Horses, but is widely used in dogs and cats in Europe
Term
List three adverse effects of Ketoprofen.
Definition

1) GI ulceration

2) renal dysfunction

3) generalized bleeding

Term
Naproxen is a ____ ____ derivative and is commonly known as?
Definition

Propionic Acid 

Equiprozen-horses

Naprosyn and Aleve-humans

Term
Naproxen is labeled for what species?
Definition
Horses, but is also used in dogs.
Term
List two clinical uses of naproxen.
Definition

1) Relief of pain/inflammation

2) lameness associated with myositis and other soft-tissue diseases

Term
Adverse effects of naproxen?
Definition

Horses-few

Dogs-GI ulceration/bleeding

Term
Ibuprofen is a ____ ____ derivative.
Definition
Propionic acid-DO NOT USE IN DOGS OR CATS!
Term
Adequan is the trade name for what drug?
Definition
Polysufated glycosaminoglycans
Term
How does Adequan work?
Definition
Reduces degenerative changes by increasing synovial fluid production.
Term
How do opioid agonists work and what do they do?
Definition
Bind with all opioid receptor sites to relieve moderate to severe pain.
Term
What class are all opioid agonists?
Definition
CII
Term

What is the main side effect of opioid agonists?

List three other side effects.

Definition

Respiratory depression

1) sedation

2) excitement (esp. cats)

3) addiction

Term
Name four common forms of opioid agonists.
Definition

1) Morphine sulfate

2) Oxymorphone (Numorphan)

3) Meperidine (Demerol)

4) Codeine

5) Fentanyl transdermal patch (Duragesic)

Term
Partial opioid agonists work how?
Definition

Some by binding with kappa receptors (analgesia,sedation, miosis) while antagonizing mu receptors (respiratory depression, analgesia, hypothermia, euphoria, addiction).

Others are partial mu agonists.

Term
List three side effects of partial opioid agonists?
Definition

1) sedation

2) ataxia

3) salivation

Term
Give two examples of partial opioid agonists and their schedule.
Definition

Butorphanol (Torbugesic)-CV

Buprenorphine (Buprenex)-CIII

Term
Tramadol is what kind of opioid and how does it work?
Definition

Synthetic opioid

Possesses weak agonist actions at the mu receptors, releases serotonin, and inhibits the reuptake of norepinephrine

Term
List three uses of Tramadol and tell why it is not a good choice for cats.
Definition

1) Control pain with surgery

2) Control pain with DJD

3) Relieve anxiety in dogs

Cats have to be dosed up to six times per day and Tramadol is not palatable.

Term
How do antihistamines work to prevent inflammation?
Definition
Prevent binding of histamine with receptors or displaces histamine
Term
What stimulates the release of histamine?
Definition
IgE antibodies to allergens
Term
H1 receptors are responsible for what two things?
Definition

1) Allergic response

2) Nausea from motion sickness

Term
H2 receptors are responsible for?
Definition
Increasing the flow of HCL in the stomach
Term
List five clinical uses of antihistamines.
Definition

Used to treat:

1) pruritis

2) urticaria 

3) angioedema

4) laminitis in horses and cows

5) downer cow syndrome

6) motion sickness

7) anaphylactic shock

8) upper respiratory tract conditions

Term
List some common H1 blockers.
Definition

Diphenhydramine (Benedryl)-antipruritic

Hydroxyzine HCL (Atarax)-antipruritic

Dimenhydrinate (Dramamine)-motion sickness

Promethazine (Phenergan)-antiemetic

Chlorpheniramine maleate (Chlor-Trimeton)-cats with respiratory congestion 

Term
List two H2 blockers and what they are used to treat.
Definition

Cimetadine (Tagamet)

Ranitidine (Zantac)

Prevent or treat gastric ulceration; antacids

Term
List five side effects of antihistamines.
Definition

1) drowsiness

2) weakness

3) dry mucous membranes

4) urinary retention

5) CNS stimulation with overdose

Term
How do muscle relaxants work?
Definition

Decrease muscle hyperactivity without decreasing muscle tone.

Selective action on spinal neurons

Term
What is the veterinary muscle relaxant called and list three side effects.
Definition

Robaxin (methocarbamol)

1) excessive salivation

2) emesis

3) muscle weakness

4) ataxia

Term
List five clinical uses of muscle relaxants.
Definition

1) IVD

2) sprains and strains

3) myositis, bursitis

4) muscle spasms

5) tying up in horses

Term
List three actions of corticosteroids.
Definition

1) antipruritic

2) anti-inflammatory

3) suppresses the immune system which can be used to treat immune-mediated diseases

Term
Where are corticosteroids naturally produced in the body?
Definition
Adrenal cortex
Term
How are corticosteroids classified?
Definition
Duration of action
Term
What are the two types of corticosteroids?
Definition

Mineralocorticoids (aldosterone)-regulte water and electrolyte balance

Glucocorticoids (cortisone)-anti-inflammatory; immunosuppressive; affects metabolism of fat, CHO, and protein

Term
How are cortisol levels in the body controlled?
Definition
Cortisol levels lower in the bloodstream so causing the hypothalamus to send corticotropin releasing factor to pituitary where ACTH is released causing the adrenal cortex to release cortisol (negative feedback system)
Term
How do corticosteroids produce an anti-inflammatory effect?
Definition
Block the enzyme phopholipase which is involved in the reaction which produces prostaglandin
Term
What changes in a CBC do you see with corticosteroids?
Definition

eosinopenia, lymphopenia, monocytopenia

neutrophilia

Term
What are the layers of the adrenal cortex?
Definition

Zona glomerulosa-mineralocorticoids

Zona fasciculata-glucocorticoids

Zona reticularis-sex hormones

Term
Corticosteroids are used to treat?
Definition
allergic reactions, musculoskeletal inflammation, shock/toxemia, laminitis, inflammatory conditions, Addison's disease, autoimmune disease, lymphocytic neoplasms
Term
T/F Corticosteroids have fewer side effects than NSAIDS.
Definition
False
Term

List two short-acting steroids.

<12 hours

Definition

Hydrocortisone

Cortisone

Term

List four intermediate acting steroids.

12-36 hours

Definition

Prednisone

Prednisolone

Methylpredisolone

Triamcinolone

Term

List four long acting steroids.

>48 hours

Definition

Betamethasone

Dexamethasone

Flumethasone

Paramethasone

Term
What is the most commonly administered form of corticosteroids?
Definition
Prednisone
Term
List some common adverse effects of corticosteroids.
Definition
PU/PD, thinning of skin and muscle wasting, depressed healing, polyphagia and weight gain, iatrogenic Cushing's disease, Addison's disease from sudden cessation, gastic ulcers, osteoporosis, abnormal behavior, can induce premature parturition and abortion
Term
How can side-effects of corticosteroids by minimized?
Definition

Oral alternate day dosing (am for dogs, pm for cats)

wean off

use aseptic techniques when injecting joints

don't use on corneal ulcers

Term
Action of lidocaine and bupivacaine.
Definition

Lidocaine-works in 5-10 minutes and lasts for 1-2 hours

Bupivacaine-works in 20 minutes and lasts for 4-6 hours

Use of ethyl alcohol prolongs effect-months?

Term
How can local anesthesias be administered?
Definition
Topically, injection to anesthetize nerve endings, injection into joint spaces, IV regional blocks, around nerve bodies (epidural, nerve block, paravertebral)
Term
List four adverse effects of local anethetics.
Definition

1) restlessness

2) excitement

3) hypotension

4) seizures

5) drowsiness

see problems if more than the total maximum dose is given

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