CCAT Pain Management and Pharmacology 5 — Questions and Answers
Question 1: When combining gabapentin and opioids for a rehabilitation patient, the primary clinical concern is:
- Hepatotoxicity from combined metabolism
- Additive CNS and respiratory depression (Correct answer)
- Antagonism reducing opioid efficacy
- Increased risk of GI ulceration
Correct answer: Additive CNS and respiratory depression
Both gabapentin and opioids cause CNS depression, and their combination can produce additive sedation and respiratory depression requiring dose adjustment.
Question 2: A feline patient is receiving robenacoxib for post-surgical pain. Compared to meloxicam, robenacoxib is characterized by its:
- Higher COX-1 selectivity and longer half-life
- Preferential tissue distribution and shorter plasma half-life (Correct answer)
- Renal excretion requiring dose reduction in all cats
- Equivalent COX-2 selectivity but superior GI safety
Correct answer: Preferential tissue distribution and shorter plasma half-life
Robenacoxib has a short plasma half-life but concentrates in inflamed tissues, providing prolonged local effect while reducing systemic exposure.
Question 3: The Feline Grimace Scale assesses pain by evaluating action units including:
- Ear position, eye opening, muzzle tension, whisker position, head position (Correct answer)
- Tail position, vocalization, appetite, grooming, and gait
- Heart rate, respiratory rate, cortisol, pupil size, and temperature
- Posture, muscle tone, response to palpation, and lameness grade
Correct answer: Ear position, eye opening, muzzle tension, whisker position, head position
The Feline Grimace Scale evaluates five facial action units: ear position, orbital tightening, muzzle tension, whisker position, and head position.
Question 4: Local anesthetic toxicity from accidental intravascular injection of bupivacaine in a small dog primarily manifests as:
- Acute hepatic failure within 24 hours
- Cardiovascular collapse due to cardiac sodium channel blockade (Correct answer)
- Anaphylactic shock from immune-mediated reaction
- Acute renal tubular necrosis
Correct answer: Cardiovascular collapse due to cardiac sodium channel blockade
Bupivacaine has high cardiac toxicity when given intravascularly, causing sodium channel blockade that leads to fatal ventricular arrhythmias and cardiac arrest.
Question 5: In a rehabilitation setting, which factor most strongly predicts the transition from acute to chronic pain in post-operative patients?
- Breed and body weight of the patient
- Inadequate perioperative pain control leading to sensitization (Correct answer)
- Owner compliance with home exercise programs
- The surgeon's technique and operative time
Correct answer: Inadequate perioperative pain control leading to sensitization
Inadequate acute pain management allows central sensitization to become established, dramatically increasing the likelihood of developing chronic pain states.
Question 6: Which pharmacological agent is classified as a 'piprant' and represents a novel NSAID mechanism for canine osteoarthritis pain?
- Carprofen
- Grapiprant (Correct answer)
- Meloxicam
- Deracoxib
Correct answer: Grapiprant
Grapiprant is a piprant that blocks the EP4 prostaglandin receptor directly rather than inhibiting COX enzymes, potentially offering a better GI and renal safety profile.
Question 7: A rehabilitation therapist assesses a patient and suspects opioid-induced hyperalgesia (OIH). OIH is characterized by:
- Decreased analgesic requirements over time
- Paradoxical increased pain sensitivity with opioid use (Correct answer)
- Tolerance developing to all opioid side effects simultaneously
- Pain limited to the original injury site only
Correct answer: Paradoxical increased pain sensitivity with opioid use
OIH is a paradoxical state where prolonged opioid exposure sensitizes nociceptive pathways, causing increased rather than decreased pain sensitivity.
CCAT Pain Management and Pharmacology 5
When combining gabapentin and opioids for a rehabilitation patient, the primary clinical concern is: