Today's Veterinary Practice

NOV-DEC 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 34 NOVEMBER/DECEMBER 2018 todaysveterinarypractice.com 6. In which of these patients would you have the client increase the dose of gabapentin right now? a. Experiencing mild sedation at the current dose. b. Renal disease patient still showing some signs of pain despite a dose increase in the past 24 hours. c. Experiencing no sedation and still exhibiting pain despite a dose increase 3 days previously. d. Exhibiting no signs of pain despite being on a low dose of gabapentin administered q12h. 7. What role does amantadine play in pain relief? a. Antihyperalgesia b. Anti-inflammation c. Calcium channel blockade d. NMDA-receptor agonist 8. Current pharmacokinetic data for gabapentin and amantadine support a dosing interval of: a. At least q8h for gabapentin and q12h for amantadine b. Q12h for gabapentin and q24h for amantadine c. Q24h for gabapentin and q12h for amantadine d. At least q8h for gabapentin and once every 21 days for amantadine 9. Amantadine and gabapentin can be administered concurrently. a. True b. False 10. Which patient would be least likely to benefit from gabapentin or amantadine? A patient: a. With chronic untreated otitis that snaps if touched, even gently. b. With worsened elbow arthritis despite no evidence of worsening. c. Hit by a car and in extreme pain. d. After a forelimb amputation secondary to a painful nonunion of a radius–ulna fracture. Gabapentin and Amantadine for Chronic Pain: Is Your Dose Right? 1. What is another name for acute pain in healing tissue? a. Maladaptive b. Neuropathic c. Protective d. Osteoarthritic 2. Define maladaptive pain. a. Pain lasting more than 30 days b. Pain without biological value (not protective) c. Joint pain that develops from mild osteoarthritis d. Pain that prevents further damage to injured tissue 3. How does chronic pain with no physical neurologic damage become neuropathic pain? a. Damage occurred at some point in the pain syndrome, which led to neuropathic pain. b. Sensory pathway changes in response to chronic moderate/severe stimulus are essentially pathology of the nervous system. c. Neuropathic and chronic pain are equal. d. Cancer pain can become neuropathic if the tumor impinges on nerves. 4. Why is it important to adequately treat pain? a. Pain causes adverse effects that can negatively affect the patient's overall health. b. Untreated pain can get worse as changes occur in the pain pathway. c. Pain can decrease the patient's quality of life. d. All of the above. 5. Assuming no contraindication, which one should generally be the first choice in treatment and why? a. Gabapentin; chronic pain is always neuropathic pain, even if it is only mild. b. Amantadine; the NMDA receptors are always activated in chronic pain, making chronic pain very difficult to control. c. Opioids; only opioids control excruciating pain. d. Anti-inflammatory drugs; inflammation pain is a common source of chronic pain. LEARNING OBJECTIVES Readers will be able to compare protective pain and maladaptive pain, discuss the reasons that chronic pain can be difficult to treat and the need for multimodal analgesia, describe the role of gabapentin and amantadine in the treatment of chronic pain, and prepare treatment protocols. TOPIC OVERVIEW This article describes the complexity of chronic pain, the need for multimodal therapy, and the use gabapentin and amantadine at correct dosages and administration frequencies in treatment protocols. The article you have read has been submitted for RACE approval for 1 hour of continuing education credit and will be opened for enrollment when approval has been received. To receive credit, take the approved test online for free at vetfolio.com/ journal-ce . Free registration on VetFolio.com is required. Questions and answers online may differ from those below. Tests are valid for 2 years from the date of approval. CONTINUING EDUCATION

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