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Cox1&2

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Mandar Kamble
Mandar Kamble
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Pain Management
Why Treat Pain? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MYTHS “ Anesthetics mask symptoms” “ Patient will harm itself if there’s no pain” “ Pain is difficult to assess”
The Truth! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Use of Analgesics in Practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pain Perception ,[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Degree and Type of Pain Depend On ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Preemptive Analgesia ,[object Object],[object Object]
Preemptive Analgesia Results In ,[object Object],[object Object]
Balanced Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Monitoring Signs of Pain Facial Expression Vocalization Body Posture Abnormal Gait Decreased Activity Level Attitude Appetite Grooming Urination/Defecation Habits
Methods of Pain Control ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Non-pharmacological Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids
Opiate Receptors MOA? 4 types of receptors: mu kappa sigma delta Should we be wondering why fraternities/sororities name themselves after receptors of pain??
Opioids: Backbone of Analgesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioid Administration ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opioid Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids (other effects) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fentanyl Patch ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fentanyl Patch ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioid Partial Agonists ,[object Object],[object Object],[object Object]
Opioid Mixed Agonist-Antagonist ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opioid Antagonists ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alpha-2 Agonists “thiazines”
Alpha-2 Agonists ,[object Object],[object Object],[object Object],[object Object],Engages receptors in CNS >> decrease norepinephrine
Xylazine: Good Things ,[object Object],[object Object],[object Object]
Xylazine: Bad Things ,[object Object],[object Object],[object Object],[object Object],[object Object],#1 ?
Xylazine: More Bad Things ,[object Object]
Xylazine: Reversal? ,[object Object],[object Object],[object Object]
Medetomidine ,[object Object],[object Object],[object Object],[object Object],Common name? Name?
Steroids = corticosteroids,glucocoticoids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Steroids: MOA inhibit phospholipase A2>>> inhibits prostoglandin/leukotrienes COX-2 COX-1 Phospholipase A2 Steroids inhibit here NSAIDS inhibit here Membrane Phospholipid Arachidonic Acid “ Bad” Prostaglandins Pain/Inflammation “ Good” Prostaglandins GI Protection Renal Blood Flow Thromboxane “ Platelets”
Side Effects and Toxicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More ! ,[object Object],[object Object],[object Object],[object Object]
Non-Steroidal Anti-inflammatory Drugs ( NSAIDS ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NSAIDS ,[object Object],[object Object],[object Object],[object Object],[object Object]
NSAIDS ,[object Object],[object Object],[object Object],[object Object],[object Object]
NSAIDS: MOA inhibit cyclooxygenase>>> inhibits prostoglandin/thromboxane COX-2 COX-1 Phospholipase A2 Steroids inhibit here NSAIDS inhibit here Membrane Phospholipid Arachidonic Acid “ Bad” Prostaglandins Pain/Inflammation “ Good” Prostaglandins GI Protection Renal Blood Flow Thromboxane “ Platelets” Fever
NSAIDS - Metabolism ,[object Object],[object Object],[object Object],[object Object],[object Object]
NSAIDS Inhibit Production of Protective GI Prostaglandins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prostaglandins in the Kidneys ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NSAIDS ,[object Object]
TYPES of NSAIDs
Phenylbutazone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Aspirin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neither Ibuprofen Nor Naproxen Is Recommended for Use in Cats Ibuprofen = “Advil” COX1 + COX2 Inhibitors Officially not recommended in dogs. most do OK if used like aspirin
Ketoprofen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Flunixin meglumine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Carprofen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etodolac ,[object Object],[object Object],[object Object],[object Object]
Derramax ,[object Object],[object Object],[object Object],[object Object]
“ Metacam” =Meloxicam ,[object Object],[object Object],[object Object],[object Object],[object Object]
NSAID Precautions ,[object Object],[object Object],[object Object],[object Object],[object Object]
NSAID Contraindications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Local Anesthetics
Local Anesthetics ,[object Object],[object Object]
Local Anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Commonly Used With Neuroleptanalgesic
Capsaicin ,[object Object],[object Object],[object Object]
St. Johnswort ,[object Object],[object Object],[object Object]
Chondroprotective Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],Examples: (oral) Synovi, Glycoflex (injectable) Adequan Can be mixed with many other ingredients (MSM, Creatine) to enhance effects.
Antibiotic Analogy to understand pain control ,[object Object],[object Object],[object Object],[object Object],[object Object]
Questions ??

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Cox1&2

  • 2.
  • 3. MYTHS “ Anesthetics mask symptoms” “ Patient will harm itself if there’s no pain” “ Pain is difficult to assess”
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Monitoring Signs of Pain Facial Expression Vocalization Body Posture Abnormal Gait Decreased Activity Level Attitude Appetite Grooming Urination/Defecation Habits
  • 13.
  • 14.
  • 15.
  • 17. Opiate Receptors MOA? 4 types of receptors: mu kappa sigma delta Should we be wondering why fraternities/sororities name themselves after receptors of pain??
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35. Steroids: MOA inhibit phospholipase A2>>> inhibits prostoglandin/leukotrienes COX-2 COX-1 Phospholipase A2 Steroids inhibit here NSAIDS inhibit here Membrane Phospholipid Arachidonic Acid “ Bad” Prostaglandins Pain/Inflammation “ Good” Prostaglandins GI Protection Renal Blood Flow Thromboxane “ Platelets”
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41. NSAIDS: MOA inhibit cyclooxygenase>>> inhibits prostoglandin/thromboxane COX-2 COX-1 Phospholipase A2 Steroids inhibit here NSAIDS inhibit here Membrane Phospholipid Arachidonic Acid “ Bad” Prostaglandins Pain/Inflammation “ Good” Prostaglandins GI Protection Renal Blood Flow Thromboxane “ Platelets” Fever
  • 42.
  • 43.
  • 44.
  • 45.
  • 47.
  • 48.
  • 49. Neither Ibuprofen Nor Naproxen Is Recommended for Use in Cats Ibuprofen = “Advil” COX1 + COX2 Inhibitors Officially not recommended in dogs. most do OK if used like aspirin
  • 50.
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56.
  • 57.
  • 59.
  • 60.
  • 61. Commonly Used With Neuroleptanalgesic
  • 62.
  • 63.
  • 64.
  • 65.