#butorphanol

[zeromorph]

so at one point during my internship last summer, we had a bird who wasn't eating because of a beak injury, and one of the measures they took for her was placing a butorphanol pump to give her continuous pain relief with minimal handling for a while. then a couple months later in class we learned that butorphanol is considered somewhat middling as an analgesic compared to other opioids, so I asked my professor if she had any insight as to why the hospital might have chosen it for that procedure, but she didn't know.

by complete happenstance, I learned today that birds have more kappa receptors and fewer mu receptors than mammals, so butorphanol (kappa agonist, mu antagonist) is more effective for them than for us. voila! this is a mystery that has mattered to no one else in my vicinity but has haunted me for months and I wasn’t even looking for the answer just now. I am delighted.

[schlauemaus]

Pankreatitis (Hd)

= Entzündung des Pankreas

akut (meist schwerer Verlauf): kann wieder ausheilen chronisch (meist milderer Verlauf): irreversible morphologische Schäden (Fibrose/ Atrophie d. Parenchyms)

Ursachen

meist idiopathisch

fettreiche Mahlzeiten

Trauma

lokale Durchblutungsstörungen (OP, Schock)

Hyperkalzämie

Medikamente (Kaliumbromid, Phenobarbital, L-Asparaginase, Azathioprin, Kalzium)

selten: Babesien, Leishmanien

Selbstverdauung (bei schweren Verläufen) 1. vorzeitige Trypsinogenaktivierung -> Aktivierung anderer Verdauungsenzyme -> Ödematisierung, Blutungen, Nekrose v. Drüsenendzellen u. parapankreatischem Fettgewebe 2. Entzündung mit Entzündungszellen u. Zytokinen

Symptome

sehr variabel: subklinisch bis multiples Organversagen

schwerer Verlauf:

Erbrechen

Schwäche

Abdominalschmerz

Dehydratation

Durchfall

Fieber

chronisch: chron. Erbrechen, Abdominalschmerz, systemische Komplikationen

milder Verlauf:

Anorexie, Lethargie -> sehr unspezifisch

Systemische Komplikationen:

Dehydratation

Säure-Basen- & Elektrolytverschiebungen

DIC

akutes Nierenversagen

Myokarditis

posthepatischer Ikterus (wg. Schwellung v. Papilla duodeni major)

SIRS mit Multiorganversagen

Lokale Komplikationen:

Pankreasnekrosen

lokale Flüssigkeitsansmmlungen - akute nekrotische Flüssigkeitsansammlungen - Pseudozysten (Ansammlung v. sterilem Pankreassekret) - abgekapselte Pankreasnekrosen (Eiter meist steril)

Laboruntersuchungen

Blutuntersuchung:

je nach systemischen Komplikationen !Serumlipase und Amylase NICHT pankreasspezifisch! ggr. Thrombozytopenie Neutrophilie mit Linksverschiebung selten: Anämie Hypochlorämie, -phosphatämie erhöhte ALP und ALT Azotämie Hyperbilirubinämie, -cholesterinämie -> Befunde NICHT spezifisch f. Pankreatitis

Feinnadelaspiration (auch v. Flüssigkeitsansammlungen)

Zyto auf Entzündungszeichen checken Flüssigkeit meist Exsudat mit hoher Proteinkonzentration & Entzündungszellen

Röntgen

Durchführung um andere Differentialdiagnosen auszuschließen

Ultraschall

vergrößert Flüssigkeitsansammlungen Verminderte Echogenität -> Pankreasnekrose Erhöhte Echogenität -> Fettgewebsnekrosen

Diagnose

Messung d. pankreatischen Lipase (=canine pankreatische Lipase-Immunreaktivität, c-PLI)

hochspezifisch & sensitiv

Histologie einer Biopsie

einzige Möglichkeit f. definitive Diagnose sollte wegen hohem Narkoserisiko vermieden werden

Therapie

schwerer Verlauf:

Infusion

unter dauerhafter Kontrolle d. Serumelektrolytwerte

metabolische Unterstützung

Antiemese

Analgesie

Meperidin, Butorphanol, Morphin, Buprenorphin, Fentanyl

wenn Appetit: Füttern

kleine Portionen mehrmals täglich: kohlenhydratreich, fett- u. proteinarm alternative Ernährungsmethoden wenn nicht frisst (Ö-Sonde,...) !Auf keinen Fall Futterkarenz! Pankreatitis extrem katabolisch!

milder Verlauf:

Diät mit niedrigem Fettgehalt -> keine Besserung -> Immunsuppressiva

Prognose

mit systemischen Komplikationen: kann tödlich enden

milder Verlauf: günstig

[tranquilsanatorium]

source

Ringer's lactate with potassium chloride and butorphanol for veterinary use

[riyasworkplaceexperience]

Week 9 at The Clinic

This week was very different from other weeks. This week there was no power for most of the day. This meant that we were very limited in what we could do. For the firs half of the day half of the clinic had power and so we worked with the little power that we did have. After a few hours power shut off in the entire clinic. We had to stop appointments for about 2 hours. After the power came back on the servers to the hospital software was not working so we had to work without patient records for a while. We conducted appointments by writing notes on hand and we relied on what the client knew about their patient. Some patients had to reschedule for vaccines and a few were able to get vaccines.

Despite our lack of power, we still saw a few interesting patients and sadly we did have a euthanasia. The euthanasia was done on a black domestic short-hair who was around 15 years old. The owners had the cat for 11 years. The cat had a large cancerous tumor on its right hind limb. It seemed to be in a lot of pain and since the cat was so feral it many treatment options were not viable. This euthanasia was different than the first one I experienced because I was actually able to see the family interact with the patient before the procedure and I really saw how some of the techniques that were talked about in Veterinary Management were used.

When speaking to the clients we had to approach the topic very carefully. The team made sure to handle the clients with empathy and did things like made sure they were in a private and comfortable space they made sure to empathize with the clients and speak in a calming voice and offered comfort where it was appropriate. These are some of the things that I learned about in Veterinary Management and it was very eye opening to see how it was applied in real life.

To euthanize the patient, we used a solution called Euthasol. Euthasol is a commercial solution for euthanasia and it consists of a barbiturate known as pentobarbital. Pentobarbital is a fast-acting barbiturate. It achieves euthanasia because barbiturates can achieve all forms of CNS depression rapidly. This allows the patient to have a quick and peaceful passing. Before euthanizing this patient, we sedated the patient using something called “Kitty Magic” This is a combination of drugs that uses Ketamine, Dexmedetomidine and Butorphanol. These are sedative-hypnotic agents that allow the patient to be unconscious, relaxed and alleviates some of the pain the patient may be experiencing.

[thevettechstudent]

WEEK 6:

A 16-year-old M chihuahua came in with a honking cough that had been going on for 3 months.

He had a history of coughing for the past few years and was given hydrocodone tablets (an opioid that can be used to treat pain and coughing) in the past to help treat the coughing.

Collapsing trachea can be breed-dependent and is common in small dogs. It requires surgical repair with a stent placement. The cough can be symptomatically treated with hydrocodone or other cough suppressants.

Immediately we suspected collapsing trachea due to his honking cough, which is the most common sign of collapsing trachea.

He was put in the system to have radiographs taken.

He was given Cerenia (an anti-emetic) prior and was put in the cage for about 30 mins.

His cough seemed to subside after giving the Cerenia.

Butorphanol was given for sedation and radiographs were taken.

Butorphanol is an analgesic and sedative that is also an antitussive.

After the veterinarian checked the radiographs, we asked the owner to come back for repeat radiographs with the dog fasted. On the radiographs, it was hard to see anything due to the stomach being full.

While recovering in the cage, his coughing still subsided. I assumed it was due to being given Butorphanol since it is an antitussive.

He wasn't sent home with anything and will come back for repeat radiographs soon.

[banyan-sebring]

Butorphanol Addiction Treatment: Understanding The Side Effects

Butorphanol is a synthetic narcotic pain reliever used to help manage moderate to severe pain. It has many side effects, such as dizziness, nausea, drowsiness, and decreased respiration. Butorphanol can also interact with other medications and can be especially dangerous for those who drink alcohol; it can cause dangerous breathing problems and even death. Some mental health risks from using butorphanol include hallucinations, confusion, and altered mental states. Butorphanol abuse can become an addiction, especially if a person has existing mental health issues. Addiction to this drug can be dangerous and even fatal without proper medical care. Withdrawal symptoms can range from mild to severe, and seeking help from a treatment center is recommended for anyone suffering from this addiction. Here are a few bullet points to consider about butorphanol side effects and addiction: - Using butorphanol can cause severe physical and mental side effects - Abusing this drug may lead to addiction, which can be dangerous and even fatal - Professional help from addiction treatment centers should be sought if dealing with an addiction to butorphanol Butorphanol is not something to be taken lightly. Due to its serious side effects and risks of addiction, anyone taking this drug should be aware of the potential danger and follow their doctor’s instructions carefully. If addiction has already taken place, seeking professional help from an experienced drug rehabilitation center is the best course of action.

[obscure225]

Butorphanol nasal spray

[allthingsvetmed]

WEEK TEN

This week, we are discussing pharmacology. A few days ago we sedated an 8yr MN Large Breed dog for a small mass removal on his hind leg. We placed an 18G 1.5” IVC in his left cephalic vein, then  he was premedicated with Maropitant 1mg/kg IV and sedated with Dexmedetomidine 5mcg/kg and Butorphanol 0.2mg/kg IV. I had propofol drawn up to his 4mg/kg dose, just in case the two pre-medications were not enough. Thankfully, this brought him to an adequate plane of sedation. The mass was blocked with local Lidocaine and removed via scalpel blade excision. After the mass removal was finished, I reversed his Dexmedetomidine with Atipamezole 100mcg/kg IM into his right epaxial muscle. He took a little bit to wake up and required some continuous stimuli, but overall did very well. 

Let’s go over the drugs we used for this procedure. 

What is Maropitant?

Maropitant citrate, other wise known as cerenia is an anti-emetic agent that is very commonly used in veterinary medicine. Its method of action is to antagonize neurokinin-1 receptors which blocks substance P from binding. This occurs in the chemoreceptor trigger zone within the central nervous system. The dose for maropitant is usually 1mg/kg IV or SQ but can go up to 2mg/kg for enteral route. When giving an injection of cerenia, it is important to know that it can sting, no matter what route you give it. To reduce the level of sting, it is recommended to refrigerate the vial instead of keeping it at room temperature. It is unknown as to why it causes a stinging sensation. 

What is Dexmedetomidine? 

Dexmedetomidine, also known as Dexdomitor, is an alpha 2 agonist that is known for it’s potent sedative effects. It does have some analgesic effects as well, but not very strong. The dose is measured in micrograms and it can be given IV or IM. It has a biphasic effect on the cardiovascular system. In phase 1, you can see vasoconstriction which will result in pale pink mucous membranes. This increase in blood pressure will cause the baroreceptor reflex to kick in and will cause the heart rate to decrease as a reflex bradycardia. This leads into phase 2, where you can see vasodilation and a persistent bradycardia. 

What is Butorphanol?

Butorphanol is a partial mu opioid receptor agonist and a full kappa opioid agonist. It is used as a mild analgesic with very weak sedative effects. It is also called Torbugesic. It is also used as an antitussive agent. Butorphanol is commonly used in combinations with other drugs for pre-medications. 

What is Atipamezole? 

Atipamezole, also known as Antisedan, is a competitive alpha 2 antagonist that is used to reverse the effects of dexmedetomidine or medetomidine. By blocking the alpha 2 receptor channels, it prevents the agonist from binding, therefore ceasing the effects of the alpha 2 agonists. Atipamezole is only recommended to be given IM. If it were to be given IV it could cause rapid vascular relaxation and in combination with the bradycardia from the dexmedetomidine, can cause cardiac arrest. 

[schlauemaus]

Analgetika

Opioide

Antagonist: Naloxon (= reiner Antagonist -> blockiert auch körpereigene Opioide!)

Analgesie

Sedation

antitussiv (=Hustenhemmung)

Nebenwirkungen:

atemdepressiv

vagusstimulierend: periphere Vasodilatation u. Bradykardie (gelten bei vorsichtiger Dosierung aber als sicher; Absichern durch gemeinsame Gabe mit Parasympatholytikum/ Vagolytikum)

wird über Leber verstoffwechselt -> vor Gabe Leber checken

am wenigsten ausgeprägte (Neben)Wirkung haben partielle und Agonist-Antagonisten -> wenn starke Analgesie notwendig -> Gabe reiner Agonisten

Reine μ-Rezeptor Agonisten

= aktiviert alle Opioid-Rezeptoren

Fentanyl: stärkste sedative u. analgetische Wirkung; starke Bradykardie; kurze Wirkdauer (20min) -> meist Gabe als Dauertropf intraOP Pethidin: starke Histaminausschüttung bei i.v.-Gabe -> IMMER i.m. zB f. postOP Kältezittern; weniger Bradykardie/ Atemdepression; spasmolytisch -> gut für gastrointestinale Probleme Morphin: NICHT für Tiere zugelassen; gilt als Goldstandard; Histaminausschüttung bei i.v.-Gabe; emetisch & übelkeitserregend; Hyperthermie (außer Hd); Wirkungseintritt nach 2min, Wirkdauer 2-4 h je nach Dosierung Methadon: Bradykardie/ Atemdepression nur in hohen Dosierungen; es kann zu Erbrechen kommen; Wirkungseintritt i.v. nach 2min, Wirkdauer 2-4 h je nach Dosierung

Partielle μ-Rezeptor Agonisten

= aktiviert μ nicht komplett -> Wirkung geringer

fast nicht antagonisierbar, wegen hoher Rezeptorbindungsaffinität

Buprenorphin: weniger sedierend, gut analgetisch; längere Wirkdauer (4-8h) -> gut f. postOP-Phase; Ceiling-Effekt! (Schwellenwert aber sehr hoch); Ktz: kann zu Hyperthermie kommen, Applikation sehr gut über Maulschleimhaut möglich

κ-Rezeptor Agonisten & μ- Rezeptor Antagonist

= Aktivierung κ, Blockierung μ

Butorphanol: gut sedierend, schwach analgetisch; kein Suchtgift!; Ceiling-Effekt!; antiemetisch; kurze Wirkdauer: Hd (1-2h), Ktz (45min)

NSAIDs (= nicht-steroidale Antiphlogistika)

entzündungshemmend

analgetisch

antipyretisch

Nebenwirkungen

gastrointestinale Schädigung der Schleimhaut (zB Ulcera)

Schädigung der Niere (beeinträchtigt Autoregulation) -> Akutes Problem bei Hypotension

Blutungsneigung (wg. Hemmung d. Thrombozytenaggregation)

Verstärkung der Nebenwirkungen bei gemeinsamer Gabe mit Steroiden!

COX1 & COX 2- Hemmer

= haben grundsätzlich die meisten/ schwersten Nebenwirkungen resultierend durch die COX1-Hemmung (= nur COX2-Hemmung = weniger Nebenwirkungen)

Aspirin: Verwendung nur mehr als Blutverdünner Flunixin: sehr stark analgetisch; Gabe bei KolikPfd wenn Ursache bekannt, (Wirkungsdauer 8-12h); NIE präOP beim Kleintier -> verursacht postOP Niereninsuffizienz Ketoprofen: nicht beim Kleintier -> akutes Nierenversagen Phenylbutazon: NICHT bei Ktz wg. geringer therapeutischer Breite; gut antiinflammatorisch, Anreicherung in Entzündungsexsudat, lange Wirkung (12-24h)

Tolfenaminsäure

COX2-Hemmer

Carprofen Meloxicam: geeignet für Langzeitbehandlung (einziges f. Ktz! ABER: entweder orale Gabe ODER einmalige parenterale Injektion -> plötzliche Todesfälle durch Mischung beider Anwendungsformen) Vedaprofen

Coxibe (=selektive COX2-Hemmer)

Cimicoxib: Hd: auch bei Niereninsuffizienz u. f. Langzeittherapie zugelassen Mavacoxib: zugelassen nur f. Hd.: für Langzeittherapie (max. 6,5 Mo.) Wirkungsdauer: 1 Monat Robenacoxib: Gabe nur sinnvoll wenn Entzündung bereits vorhanden (Halbwertzeit kurz, sammelt sich aber im Entzündungsbereich an und hält lokal den Wirkungsspiegel); zugelassen beim Hd. f. Langzeittherapie

Andere Analgetika

Metamizol: stark analgetisch, antipyretisch und spasmolytisch; zugelassen für einmalige Verwendung; maskiert Schmerzen nicht -> gut für Initialbehandlung v. KolikPfd/ Schlundverstopfung und f. Kleintier bei viszeralem Schmerz; Nebenwirkung bei mehrmaliger Gabe großer Dosen: knochenmarksdepression Paracetamol: NICHT bei Ktz -> einmalige Gabe tödlich!; NUR für Hd.; kann gemeinsam mit Steroiden gegeben werden Gabapentin: für Tiere nicht zugelassen; Gabe bei chronischen/ neuropathischen Schmerzen Amantadin: für Tiere nicht zugelassen; Gabe bei chronischen/ neuropathischen Schmerzen Tramadol

[er-cryptid]

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[thevettechstudent]

WEEK 2:

A 9-year-old MN beagle mix came in for his senior wellness sedated radiographs (includes abdomen, thorax and VD shots), which is a routine that the clinic does for senior dogs to see if there are any abnormalities.

A blood draw was done for a CBC and CHEM profile. All results were normal except for the liver enzymes being elevated.

For radiographs, patient was pre-medicated with:

Butorphanol: a short acting anti-nociceptive, good for sedation

Midazolam: a sedative, anxiolytic and anxiolytic medication

Cerenia (maropitant): about an hour prior to avoid any vomiting due to the other pre-medications.

The shot shown here is a VD shot.

Upon radiographs we noticed that the heart was enlarged. The spleen and liver also showed to be slightly enlarged.

I am thinking that the dog could have congestive heart failure due to age. Since the liver enzymes are elevated and the liver is slightly enlarged the dog could be experiencing liver disease, like hepatitis (inflammation of the liver) or liver failure as well.

A full radiology report will be out next week - I will have an update.

For now, we recommended to the owner for a follow up ultrasound to further look into the heart to see if this patient will need any cardiac medication while also looking at the liver (since the liver enzymes were high.)

[bacsixanhvnhn-blog]

Thuốc Butorphanol bản chất là một loại thuốc giảm đau có chất gây nghiện tương tự như morphine. Thuốc có tác động lên vùng não để giúp bạn giảm đau. Thuốc cũng có tác dụng ngăn chặn tác dụng của thuốc giảm đau gây nghiên có thể gây ra các triệu chưngs ngừng thuốc ở người nghiện.

[mbimphblog]

A COMPARISON OF EPIDURAL BUTORPHANOL AND FENTANYL FOR POSTOPERATIVE ANALGESIA USING COMBINED SPINAL EPIDURAL ANAESTHESIA TECHNIQUE | UTTAR PRADESH JOURNAL OF ZOOLOGY

At the Krishna Institute of Medical Sciences Hospital, a prospective randomised controlled clinical comparative study titled "A Comparison of epidural Butorphanol 2 mg and Fentanyl 75 mcg for Postoperative analgesia using Combined Spinal Epidural Anaesthesia technique: A randomised double blind clinical study" was conducted in 40 patients aged 18 to 60 for elective physical conditions. All of the cases were presented. Combined spinal epidural anaesthesia with 4 mL 0.5 percent bupivacaine in the spinal canal and epidural butorphanol 2 mg (group B) or fentanyl 75 mcg (group F) diluted to 10 mL with normal saline immediately after surgery. Please see the link :- https://mbimph.com/index.php/UPJOZ/article/view/1837

[siglerprescriptiondrugcards]

Butorphanol Tartrate

This medication is a Schedule III drug.

Common Brand Names: Stadol

Therapeutic Class: A synthetic agonist-antagonist opiate analgesic.

Common Injectable Dosage Forms:

Injection: 1 mg/mL and 2 mg/mL in vials

Dosage Ranges:

The usual adult dose is 2 mg IM or 1 mg IV, which may be repeated every 3-4 hours as necessary. The usual effective range is 1-4 mg IM or 0.5-2 mg IV, repeated every 3-4 hours, depending on the severity of pain.

Administration and Stability: The drug may be given by IM injection or direct IV injection, undiluted. pH 3.5-5

Pharmacology/Pharmacokinetics: Butorphanol has both opiate analgesic and antagonist effects, resulting from its interaction with an opiate receptor in the CNS. The antagonistic effect probably results from competitive inhibition at this opiate receptor. After IV administration, onset of analgesia is in 1-minute, peak effects occur in 4-5 minutes, and the duration of effect is 2-4 hours. With IM use, onset is 10-30 minutes, peak effects occur in 30-60 minutes, and the duration of action is 3-4 hours. The drug is extensively metabolized in the liver to inactive metabolites, with elimination via the urine, bile, and feces. The elimination half-life is 2.5-4 hours.

Drug and Lab Interactions: Concomitant administration with pancuronium may cause an increase in conjunctival changes. Like opiate agonists, the CNS effects of butorphanol are additive with those of other CNS depressants such as anesthetics, sedatives, tranquilizers, and alcohol.

Contraindications/Precautions: Caution should be used when administering to patients with known hypersensitivity to other opiate agonists. Butorphanol should also be used with caution in patients with hepatic or renal dysfunction, and in patients with chronic respiratory problems. Individuals who preform hazardous tasks requiring mental alertness and/or physical coordination should be warned about adverse CNS effects of opiate agonists. In patients who have recently received substantial amounts of opiate agonists, caution should be exercised in the use of butorphanol as it could precipitate withdrawal. Pregnancy Category C/D.

Monitoring Parameters: Pain relief, respiratory and mental status, and blood pressure

Adverse Effects: Respiratory and/or circulatory depression are the chief hazards to opiate agonist therapy as respiratory arrest, shock, and cardiac arrest have occurred. Other CNS adverse effects include dizziness, sedation, coma, and dysphoria. Other side effects reported include nausea, vomiting, constipation, changes in biliary tract pressure, and urinary retention.

Common Clinical Applications: Effective in the management of moderate-to-severe pain associated with such conditions as cancer, neuropathies, burns, and surgery. Also used as an adjunct in anesthesia and during labor.

[gorillaz-girl]

“Hit twice on the head when young, 2D is a sweetheart with a blank sheet of paper where a brain should be. He has really good hair. People think he’s cool and enigmatic, but he’s just got a migraine. 2D idolises Murdoc, who, he feels, saved his life. Keyboard wizard, melodica maniac, graffiti compulsive and the perfect pin-up product. Voice like an angel. Arse like a satsuma. Mind full of zombies and painkillers. Says nothing controversial. Says nothing much at all. Loved by everyone (except the green-eyed Murdoc), 2D has legions of lady followers and would make a lovely boyfriend if only he’d wake up. Born: Crawley. Age: 23. Influences: Butorphanol Tartrate, Phil Oakey, Lucio Fulci.”