SUMMARY

Anticholinergics: atropine & glycopyrrolate, scopolamine

MOA: parasympatholytic: blocks effects of PNS via muscarinic receptors (anti-muscarinic); doesn’t act on nicotinic. M1,3, 5 → Stimulatory. M2, 4 → Inhibitory
M1 – autonomic ganglia, salivary, and stomach gland
M2 – sinoatrial (SA) and AV nodes in the atrial myocardium (this is the one we usually look for b/c of heart)
M3 – smooth muscle contraction and eye accommodation
Muscarinic stimulation can cause SLUDD: Salivation, Lacrimation, Urination, Digestion, Defecation
Phenothiazines: acepromazine
MOA: D1, D2, α1 blocker
D2 – sedation, anti-emetic properties
α1 (on blood vessels) – vasodilation 🡪 hypotension (not used in high doses to prevent excess vasodilation) + antiarrythmic
D1 – not usually affected, except high doses, mediate coronary vasodilation, splanchnic and renal circulations
Long duration of action: 3-6 hours - keep in mind length of procedure bc there is no reversal. Takes 30 min to kick in - add that onto your prep time

Butyrophenones: droperidol, azaperone

Similar phram properties as phenothiazines but more potent, have a greater incidence of unexpected effects – paradoxical effects; less sedation and more autonomic effects
Neuroleptic sedative mediated via dopaminergic (D2) antagonism
Antagonistic activity on α1, histaminic, and cholinergic receptors
Benzodiazepines: midazolam, diazepam, zolazepam, flumazenil
MOA: enhance affinity of GABA at GABAA receptor; GABA is the primary inhibitory neurotransmitter in CNS.
GABA → Inhibitory neurotransmitter in the brain; Glutamate → Excitatory neurotransmitter in the brain
Opioids: Potent analgesia and other CNS effects (sedation, euphoria, dysphoria, excitement)
MOA: Opioid receptors (G-protein coupled receptor) Agonist:
μ-agonists: morphine, meperidine, fentanyl, hydromorphone, oxymorphone, methadone, tramadol
Partial μ-agonists: buprenorphine
Mixed κ-agonist - μ-antagonsits: butorphanol

*All listed dosages are for dogs unless otherwise specified

SEDATIVES AND ANESTHETICS

BENZODIAZEPINES
MOA: GABAa Receptor Agonist
General effects: Anti-anxiety & muscle relaxation d/t increased glycine activity. Promote anterograde amnesia and reduce anesthetic requirement. Produces skeletal muscle relaxation. Drug of choice for status
epilepticus/cluster seizures in dogs.
Clinical Use: Used to produce neuroleptanalgesia (very anxious & painful/and/or part of induction), urinary blockage (causes urethral muscles relaxation/pain management from spasms, helps urinary catheter
placement), anticonvulsant. Unpredictable as a solo sedative for healthy patients (cats= ↑ excitement w/ ↑ dose, horse=muscle relax, ataxia, non-existent sedation, pigs & ruminants = excellent). Not
recommended for tx of organophosphate, amphetamine, or human sleep-aid toxicity (may potentiate; use phenothiazines instead). Very good for use in cardiovascularly compromised and neonate patients.
Do not use Benzos in neurologically compromised patients (may lead to coma)
Drug Mechanism Effects General/Clinical Use Metabolism Contraindications/Adverse
- 3x more potent than - No pain during injection - Can be mixed with other drugs (5 Liver - Sensitive to light (photodegradation)
Midazolam diazepam, but shorter - Sedative, anxiolytic, anticonvulsant, and muscle ketamine: 1 midazolam) as premedication metabolized - More likely to cause excitement in cats
acting (30 - 40 min) relaxant effects - Can also be combined with - Preferred to Diazepam for liver dz
Dogs/cats: 0.1 - 0.3 - Highly water soluble, - Sedation unreliable when used alone (combine acepromazine, opioids, a2 Kidney patients
mg/kg SC, IV, IM
highly protein bound with other drugs when used to sedate dogs/cats agonists excreted
(intranasal/per
rectum for status - Rapid onset after injection [Ketamine most common]) - Can be given IM, SQ, IV, intranasal, per
epilepticus) - Blood gas values minimally changed rectum (unlike Diazepam) due to water
- Minimal effects on CV system solubility
Diazepam - Highly lipid soluble (oil - Anxiolytic, muscle relaxant, hypnotic, appetite - Do not administer if precipitate forms
 based)
- Longer acting than
Midazolam (60+ min.)
- Readily crosses BBB
Seizures: 0.5 - 1
- Highly protein-bound
mg/kg IV
- Contains propylene-glycol
stimulant, anticonvulsant effects
- Mixes poorly with other drugs (except
ketamine); creates cloudy appearance
- Pain on injection (d/t 40% propylene glycol);
recommend bv IV only: espec in small vessels,
erratic unpredictable absorption IM or SQ
- Minimal effects on CV or respiratory system
- Clinical dose vary according to desired
effect: anticonvulsant/sedative/co-
induction
- Preferred for seizure tx vs Midazolam due
to longer duration of action
- Hepatotoxicity in cats when given orally
- Do not use if liver dz (active metabolites)
- Significant absorption into plastic tubing
of syringe (don’t pull up ahead of time)
- Rapid IV in small animals can cause
hypotension/ cardiotoxicity (push slowly)
- Expensive! $$$

Manufactured in combo with tiletamine = Telazol Last longer than tiletamine in horses, pigs, and dogs (smooth recovery)
- 1mL: 50mg tiletamine + 50mg
Zolazepam zolazepam Last shorter than tiletamine in cats (poor reco very when given IM)
Only benzo licensed for vet use
Made into powder, must reconstitute
Benzodiazepine reversal
Flumazenil Only benzodiazepine antagonist available!
Specific & exclusive benzo competitive antagonist at GABA receptors: very high affinity (aka only works on the benzo site of the GABA receptor)

α2 ADRENERGIC AGONISTS
Potency: Dexmedetomidine > Medetomidine > Detomidine >> Romifidine > Xylazine
Summary: potent sedation, muscle relaxation, and analgesia; analgesia shorter than sedation; sig reduction in co-sedative dose; mild resp depression; hyperglycemia & diuresis; reversible!
o Initial vasoconstriction 🡪 reflex bradycardia 🡪 central mediated vasodilation 🡪 decreased CO 🡪 hypotension
Indications: happy/healthy, anxious/aggressive, CNS pathology, hypertrophic cardiomyopathy, heavy reliable sedation, excruciating pain
Contraindications: cardiac disease (CHF, dilative/obstructive pathologies), hypovolemic shock, diabetes, pregnancy (cattle/horse), newborns, urinary obstruction. Arrythmogenic.
Mech: Inhibits release of Norepinephrine __
Mechanism Uses/Indications Duration Metabolism Contraindications/Adverse
Neuroleptanalgesia: combined w/ opioid *cheapest!* On: 15min Cardio: severe
Given w/ ketamine= offset muscle rigidity in Neuroleptanalgesia: combined w/ opioid (IM) bradycardia + AV block
short procedures Given w/ ketamine= offset muscle rigidity in short procedures T½: common
cattle/dog: ↓ CO 50% in dog/horse
Food animal: Currently not approvedin US (off-label) 30min ↓ BP 20-30%
Sensitivity: bovine(brahman) > small rum. > SA Horse: most common premed for induction; standing sedation; horse: 50- SV stay same d/t
camelids > dog/cat > equine > swine (very 60min bradycardia
Xylazine resistant); bovine have most α2 receptors in Triple drip (guaifenesin + ket + xylazine) Resp:
brain IV = fast ↓ RR, ↑TV
onset Blood gas = unchanged
SQ = poor High
Decreases nerve conduction velocity in sedation dose(>1mg/kg/hr)=↓ vol
periphery min,↑ physio dead space,
↓O2 to tissues

Dexmed- Depression of CNS, GI and endocrine functions Premedication, sedation, analgesia in dogs and cats (too Peak Metab: Liver (caution if Endocrine depression effects can
etomidine Muscle relaxation expensive for large animal) analgesia: hepatic dz) inhibit insulin release
Reduces inhalant MAC 18-88% (dose-dep) Some emetic effects in cats (hydromorphone preferred) ~30min Excrete: Urine, some (=hyperglycemia)
Oromucosal More specific than xylazine for α2 (vs α1) dog/cat feces
gel (Sileo) Loses α2 selectivity as dose ↑ on IV or rapid Cardio: myocardial contractility not sig. affected (least effect) D: 60min May cause vomiting (give
infusion (can bind to α1 and have paradox affects) Preserves BF to vital organs (brain, kidney, heart, liver) cerenia!)
Take extreme care using in volume High dose: same as xylazine
depleted/hypertensive patients Low dose: less bradycardia, fewer AV blocks, less Pronounced CV effects. May
*Favorable for infusions d/t context-sensitive hyper/hypotension cause transient hypertension
half-life Dose lower than 1mcg/kg/hr: lack cardio effect while still due to vasoconstriction + reflex
 providing analgesia & some degree of sedation bradycardia - do not use in CV
compromised patients

Respiratory depression
Primarily horses; more potent & expensive D: 60min High potential for AV block +
than xylazine (longer bradycardia
Potent GI analgesia in horse = sev hours, may than xyl)
Detomidine
neg impact GI BF
Better for standing sedation when more time
is needed than xyl
Primarily horse; off label in dog/cat Peak:
Less ataxia than xyl & detomidine = great for 15min
dental procedures horse
Romifidine
D: 2hrs
(standing
sedation)
α2 ANTAGONIST: used to “arouse” patient or in emergency situation; REVERSAL for sedation/analgesia; does NOT reverse reflex bradycardia (will have to tx bradycardia after the reversal)
Specificity for α2 : Atipamazole > Yohimbine > Tolazoline
Yohimbine Horses & dogs; IV, IM, SQ
Tolazoline FDA for horse only but works well in rum & SA camelids; given ½ IV + ½ IM
Atipamazol FDA for dog only IM; IV for emergency only = may cause severe hypertension with CNS arousal followed by dysphoria/conclusions
e

Injectable Anesthetics
An
Ana Mm
Excret est
Drug Mechanism of Action Effects Uses/Indications Metabolism lges Rel Contraindications
ion hes
ia ax
ia
Barbituates
- Peripheral vasodilation - Prolonged recovery in
(↓BP, CO) sighthounds (Greyhound, irish
- Ultra-short duration (20 min) - Causes VPCs/VBCs Liver wolfhound, etc.)
- Decreases ICP + IOP
Thiopental - Muscle/fat redistribution - Potent respiratory (Cytochrom - Avoid if liver or kidney
- Anticonvulsant
- GABAA depression (apnea) e P-450) dysfunction
- Initial ↑HR - Avoid in extremely thin pts or
if low protein
- Ranges from conscious Urine
- Depresses synaptic - Preanesthetic (sedation)
sedation, (Glucu-
transmission in CNS - Rapid induction of general Long-acting (phenobarb)
unconsciousness ronides
- Depresses O2 utilization anesthesia induces hepatic enzymes to
Phenobarbital - ↓BP with reflex Liver, brain & ✔ No
- Activates GABA receptors - Anticonvulsant (phenobarbital) increase metabolism of other
Pentobarbital tachycardia sulfate
- Blocks glutamate binding at - Euthanasia (Beuthanasia) drugs
- Dose-dependant resp conjuga
AMPA receptors - Often given with Fentanyl
depression tes)
Non-Barbiturates
- Rapid onset, Short-acting - Decreases ICP (safe for - Anticonvulsant Primarily Urine ✔ No ✔ - Accumulates in cats (not
phenol (5- 10 min) TBI) - Short or long-term sedation with liver dogs) from long term use
Propofol - GABAA receptor agonist with - Potent respiratory and smooth recovery (cytochrom - Heinz body anemia in cats if
2 - 4 mg/kg IV NMDA receptor inhibition myocardial depressant - Induction (bolus)/maint of e p450) + given repeatedly
 - Brief apnea after
induction (pre- - Do not give Prop-28 as CRI
oxygenate, give slowly at (preservative)
- Decreases dissociation of
lowest possible dose) - Cardiac/respiratory
GABA from receptor anesthesia (CRI)
- Peripheral vasodilator, depressant; care in
CRI: 50 - 400 - Lipophilic - Clearance unaffected by
↓BP (15 - 40%) hypovolemic pt
mcg/kg/min IV - Crosses BBB hepatic/renal dysfunction Lungs
SLOWLY IV, to effect - Minimal effect on HR (no - Prolonged recovery in
- Minimal effect if extravasated - Minimal fetal depression when
reflex tachycardia) sighthounds (greyhounds,
used for C-section
- Appetite stimulation etc)
- Minimal analgesia (use - Enhances arrhythmogenic
opioid/a2/ace effects of epinephrine
concurrently)
- Can cause post-induction
apnea IV (potent resp.
depressor)
Alfaxalone
- Minimal effects on CO or
Sedation: 1 - 3
mg/kg IM - Short-acting neuroactive BP
- Caution if liver dysfunction
Induction: 1 - 2 steroid - Can cause psychomotor - Sedation, induction
Liver - Do not use IM by itself (rough
mg/kg IV - No pain on injection excitement on recovery - Combo with midazolam and Feces,
(Cytochrom ✔ No ✔ recovery) - follow with
SLOWLY IV to - No analgesia (esp. if premedding with butorphanol for minimal cardiac urine
effect
e P450) inhalant anesthetics
- GABA agonist (similar to a benzo) effects
- Severe CV depression if given
barbiturates) - ↑IOP
too fast IV!
- IM: Dose-depen. neuro
[10 mg/mL]
and respiratory
depression, tremors,
ataxia
Dissociatives
- Use with caution in
CV:
cardiovascular patients
Ketamine - Noncompetitive antagonists at - ↑ CO, mean aortic - Sedative
0.2 mg/kg IV - Wide margin of safety
NMDA receptors pressure, pulmonary - Anesthesia
Diaz/ Midazolam ✔ - Do no use with liver disease
- Prevent the binding of arterial pressure, ventral - Useful in combination with other
[5 mg/mL] Liver, rapid Urine ✔ Inte No - Protect Eyes
glutamate (excitatory) venous pressure, & HR agents in cats to reduce anxiety
+ nse - Do not use alone – muscle
5 - 7 mg/kg IV
- Some effect at opioid Respiratory: prior to procedure
rigidity and tremors
Ketamine receptors - Stimulates reflexes - Intense analgesia
(Combine with
[100mg/mL] - ↑ Muscle tone
Midazolam/Diazepam)
- Similar to Ketamine MOA
- Available only in conjunction with
- Longer duration (30 - 40 min) No
Tiletamine Zolazapam (Telazol)

Other Non-barbiturates
- Rapid induction
- Imidazoles - Potent hypnotic - Used in clinically affected CV - Cannot use as CRI (contains
- Suppresses adrenal-cortical - CNS depression patients (dogs): pacemakers, propylene glycol)
axis - Minimal effects on CVS PDA surgery, etc. Liver, rapid Urine No - Do not use if Addison’s
Etomidate - Agonist at GABA receptor (no hypotension) - Rapid recovery (causes adrenal suppression)
(Amidate) - Short duration (5 min) - Minimal effects on - Decreases ICP + IOP
respiration (no apnea)
 - Expectortant (helps
coughing by ↓ viscosity)
- Blocks reflexes
- Commonly used in horses and
- Lowers BP, but quickly Sed
- Short duration of action ruminants as adjunct anesthetic ✔
returns to normal ate
Guaifenesin for smoother induction
- HR and CO stay same
- Does not paralyze resp
muscles
Telazol =
Tiletamine + - Combo of dissociative and - Darting
Zolazepam benzodiazepine derivative

INHALANTS
MAC Metabolism Skeletal Mm Lungs Heart Liver & Kidney Other
- Mostly exhaled intact - Slight ↑HR
Dog: 1.4%
Isoflurane <0.2% Good relaxation - Bronchodilation - Maintain CO - Relatively wide margin of safety
Cat: 1.6% - Minimal Liver/Kidney
beneficial side effect - Can see ↓arterial BP
metabolism
- Good liver patients with liver
Desflurane <1%
dysfunction
- Least preferable for
liver/renal patients due - Unstable when exposed to soda
Dog: 2.4% to slightly higher % of lime
Sevoflurane 3% Small effect, like Iso Small effect, like Iso
Cat: 2.6% metabolism (use Iso or - More expensive than Isoflurane,
Des) and less potent

- Minimal effect
- Least respiratory effect, - Minimum in liver, not
Not good - Can induce myocardial - Requires pre-anesthetic
Nitrous Oxide MAC 188 exhaled intact metabolized
relaxant depression, but balanced - Used as adjunct
- Cough reflex remains - No effect on kidney
by indirect stimulation

OPIOIDS
Care with combining opioids with b will compete for mu receptors.
Full mu provides the best decrease in inhalant MAC, but adverse effects (CNS/resp depression, ataxia, vomiting, etc.) are less severe with partial agonists.
Opioids are generally contraindicated/used with caution in liver disease, hypothyroidism, renal insufficiency, Addison’s, head trauma, ↑ IOP. Reduce opioid dosages in dogs with MDRI-1 mutation by ~25%
(“white feet” breeds - Aussies, Collies, Shelties, etc.). Opioids are Schedule IV controlled substances. Provides the most effective analgesia for systemic treatment of acute pain.
Mechanism Effects Indications Duration Metabolism Contraindication/Adverse
Full μ- Metabolites: Moderate to severe pain On: slow: Poorly lipid Impaired metabolism in patients with
agonist Morphine-3-glucuronide inactive 15-30min soluble compromised liver and renal function
Morphine-6-glucuronide active Peak: 45-
Morphine Crosses BBB 90min
(slow) and D: longer:
placental 4-6hrs
barrier
Fentanyl Full μ- 100x as potent as morphine Moderate to severe pain D: 30min Metab: liver Short-acting + takes 30 minutes to take
IV or trans- agonist ↓HR Peak: Excrete: kidney effect
dermal/mucosal
patch
Meperidine analogue *clinically most common used 5min
 No histamine release in cat/dog Highly lipid
Dog: 5 ug - 10 ug soluble + Rapid
Cat: 2.5ug - 5ug redistribution to
inactive tissue
Hydro- μ-agonists 4-5x as potent as morphine BUT: Moderate to severe pain D: 4hrs Metab: liver
morphone Less sedation & euphoria than morphine
Dog: 0.05 - 0.2 No histamine release Highly water
Cat: 0.025 - 0.2 soluble
μ-agonists 10x morphine Moderate to severe pain Highly lipid
Oxymorphone soluble
Dog: 0.05 - 0.2 mg/kg
No opioid
Cat: 0.025 - 0.1
mg/kg hypothermia in
cats(?)
μ-agonists Synthetic: mixture of: R-methadone + S-methadone Moderate to severe pain - D: 4hr Metab: liver + Least amount of nausea/vomiting out
R: more potent + 10 fold infinity for opiod receptors μ and δ longer lasting (analgesia intestine of all the full-Mu opioids
S: NMDA receptor antagonist (chronic & neuropathic pain), ) Excrete: feces!
Methadone inhibits re-uptake of serotonin + norepi T½: 15hrs *good for renal
Dog: 0.1 - 1 mg/kg
Cat: 0.1 - 0.5 mg/kg
dysfxn

Highly lipid
soluble
Synthetic 0.1x potency of morphine More useful for analgesia in Causes sedation, but generally well-
opioid-like Inhibits serotonin and norepi re-uptake cats (controversial in dogs) tolerated. Unpleasant taste.
Tramadol full Stimulate presynaptic serotonin release
Dogs: 4 - 10 mg/kg μ-agonist Limited analgesic use in dogs as Do not combine with SSRIs or MAOIs
PO q8hr
Cats: 1 - 2 mg/kg PO
(mod. a sole agent - Most useful (risk of serotonin syndrome)
q12-24hr affinity) when combined with NSAIDs
or other analgesics Tramadol + Acetaminophen (Ultracet)
(gabapentin, a-2, etc.). contraindicated in cats
Full μ- 1/10th morphine Mild - Mod pain relief D: short: Metab: Risk of Serotonin syndrome - DON’T
agonist Anti-shivering effect 2-4hrs Extensive use in combo with:
Histamine release = strictly IM! hepatic (90%) MAO inhibitors (selegiline)
Anticholinergic + local anesthetic properties SSRI (prozac)
Meperidine Inhibits serotonin re-uptake (tx for serotonin syndrome:
Muoral, IM, IV, IA,
epi & transdermal
Cyproheptadine)

Contraindicated in renal insuff.

(Neurotoxic metabolite normeperidine
accumulates rapidly)
partial μ- “Simbadol”: sustained release bup Mild-mod pain On: 45min Has a ceiling effect; after a certain
agonists D: 6-8hrs dose, there is no increase in
Buprenorphine
high affinity (long d/t respiratory depression (valuable)
IV, IM, SQ, SL
slow
disassoc.)
Butorphanol κ-agonist Mild analgesia Anesthetic premedication/mild D: 60- Metab: Liver Do not use if excessive LRT mucous
(Torb) μ-antagonist Good sedative effects w/ ↓ dysphoria analgesic. Provides the least 120min Excrete: Urine production due to antitussive effects
(Partial No histamine release amount of analgesia of the for
Analgesic: 0.1 - 0.5 agonist) Antitussive opiods (not for use in cases of sedation, Not effective in reptiles, resp
mg/kg IM, IV, SC
Some antiemetic effects (not in cats) severe pain) <1 hr for depression in turtles/torts
CRI: 0.2 mg/kg IV analgesia
(LD) + 0.1 - 0.4
 Can reverse CNS/resp. depression of μ-opioids without Relief of chronic non- Only provides MILD analgesia!
reversing analgesia productive cough
(tracheobronchitis, laryngitis,
etc)
mg/kg/hr IV
Commonly used in colics
horses (combine with a2
agonist) due to minimal GI
effects
opioid Reverse: opioid-induced depression of ventilation + analgesia D: short: Can cause
antagonist Treatment of opioid overdose 30-45min nausea/vom
Naloxone
(non- ↑ sympathetic
selective) activity = pain?

INTRA-OPERATIVE MEDICATIONS
ANTIARRHYTHMICS
Administratio
Mechanism of Action Drug Indication Side Effects Other Information
n route
Class 1: Depress phase 0 of AP
- CV: tachycardia, hypotension,
Na+ - Slow propagation of the impulse
depressed contractility
blocker - Decrease spontaneous depolarization of IV available
o risk of VT
diseased atrial & ventricular myocytes Tx of afib in horses (& usually NG tube
o sudden death
Prolong AP duration 🡪 prolong refractory Quinidine cows) 🡪 converts back to Every 2-6h
Group 1A: - Colic, diarrhea
period of the myocytes sinus rhythm under close CV
intermediate - Nasal mucosal edema
PS: may increase HR and # of impulses monitoring
onset & - Depression, ataxia, seizure
+ traveling through the AV node α-adrenergic
offset of Na - Urticaria, laminitis
blockade
blockade;
+ Depress phase 0 of AP IV as a slow
block K
- Slow propagation of the impulse bolus (repeated Hypotension w/ rapid bolus
- Decrease spontaneous depolarization of Acute tx of VT in dogs or CRI) Tablets for oral admin available
Procainamide
diseased atrial & ventricular myocytes (2nd choice after lidocaine) IM but not used for dogs (GI side
Prolong AP duration 🡪 prolong refractory Oral effects)
period of the myocytes
Group 1B: Mildly depresses phase 0 of AP Lidocaine First choice for acute tx of VT IV bolus Nervousness, seizures (Tx w/ - Works better when HR is
Rapid onset - Slow propagation of the impulse in dogs (repeated or Valium) faster (use dependence)
& offset of - Decrease automaticity of diseased atrial & Can be used in cats & horses CRI) - Decreased efficacy if
Na+ blockade ventricular myocytes Dose in dogs hypokalemia
(local Increases post-repolarization refractoriness 2mg/kg
anesthetic) Increase refractory period by binding to the Divide dose by
Na+ channels, but does not prolong AP 50% in cats and
horses (more
sensitive)
IM
 Often combined to a β-
Oral (capsules) GI side effects (inappetence & blocker for better results
Mexiletine Long term tx of VT in dogs
3x a day vomiting) (adrenergic tone is a
trigger for arrhythmia)
- Situation of increased level of
catecholamine
(arrhythmias of
Blocks effect of NE on cells 🡪 blocks Ca+ pheochromocytoma,
entering cells anxiety, & post-op states)
β1 or increased cardiac - Bradycardia (tx w/ atropine) - Elimination via the liver
- slow rate of sinus node depolarization sensitivity to - Myocardial depression (tx w/ - Hyperthyroid cats are very
Non-
- slow AV node conduction catecholamines Oral every 8h dobutamine) sensitive to stress and
selective (β1, Propranolol
- inhibits pacemaker activity of Purkinje fibers (thyrotoxicosis) IV (bolus or CRI) - Bronchoconstriction- can develop very rapid
β2)
- decreases cardiac contractility - In combo with other contraindicated in cats w/ sinus tachycardia with
β2 antiarrhythmics for VTs as asthma & dogs w/ bronchitis IV propranolol
- smooth muscle contraction high adrenergic tone
Class 2:
- promotes bronchoconstriction promotes arrhythmias
β-
- To slow rate of SVT by
blocker
slowing conduction
s
through the AV node
- In combination with other
- Elimination by the kidneys
antiarrhythmics for VTs, as
- Selectivity is always higher
high adrenergic tone
Oral every 12h at a lower dose
promotes arrhythmias
Atenolol or 24h - Combo with Mexiletine is a
β1 (dogs and cats)
IV (bolus or CRI) very effective tx for VT,
- Slow rate of sinus node depolarization - To slow rate of SVT by
esp. Boxers w/
- Slow AV node conduction slowing conduction
Selective β- cardiomyopathy
- Inhibits aberrant pacemaker activity through AV node
Blocker (β1)
- Decreases cardiac contractility (negative - Very short acting- HL is 9
inotrope) min; effect dissipates in
20-30 min.
Esmolol Emergency tx of SVT & VT IV (bolus or CRI) - Effects dissipate rapidly
with side effects in
unstable animals
- Elim. by RBC esterase
- Prolongation of AP 🡪 prolongation of
refractory period - Lethargy, hypotension
Oral only every β-blocker as well
- Effect is more pronounced when the heart Sotalol Chronic tx of VT in dogs - Ventricular arrhythmias=
12h
rate is slower (reverse use-dependent proarrhythmia
effect)
- Prolongation of AP 🡪 prolongation of
Class 3: - Numerous and severe
refractory period IV
K+ blockers - Hepatic toxicity
- Effect is more pronounced w/ slower HR Oral- needs a Has antiarrhythmic
- Pulmonary fibrosis, ocular
(reverse use-dependent effect) Acute & chronic tx of SVT & loading period properties of all 4 classes,
Amiodarone abnormalities, thyroid
- Na channel blockade in ventricles (slows VT in dogs (7d) to reach but has too many side
dysfunction, GI upset
ventricular conduction) therapeutic effects 🡪 avoid using
- Hypersensitivity w/ IV
- β-adrenergic/ Ca+ channel blockade (slows AV blood levels
administration
node conduction)
Class 4: - Decrease depolarization rate in sinus and AV Diltiazem Treatment of SVT in dogs (& Oral Bradycardia - Targets myocytes
Ca+ channel blockers node cats) IV (bolus or CRI) Hypotension from decreased preferentially & a
 limited effect on the
o Slows HR (- chronotrope)
vessels
o Slows AV conduction
contractility & systemic - Amlodipine works
- Decrease Ca+ entry into AV & ventricular
vasodilation exclusively on the
myocyte (- inotrope) and into smooth
vessels 🡪 best tx for
vessel walls (vasodilation)
hypertension in cats
Oral only in
- Toxicity is difficult to
- Blocks Na+/K+ ATPasw pump resulting in dogs (0.005
predict 🡪 monitor
↑intracellular [Ca+] (weak + inotrope) mg/kg) every GI
Other Classification Digoxin Treatment of SVT in dogs serum levels
- Increases vagal tone (slow HR & AV node 12h Ventricular arrhythmias
- Toxicity worsened if
conduction) Rarely used IV
hypokalemic
in horses

ANTICHOLINERGICS
General Effects: Parasympatholytic effects (inhibit PSNS) via competitive inhibition of ACh at post-ganglionic parasympathetic muscarinic (not nicotinic) neuroeffector sites.
↓ vagal tone, bronchodilate, ↑ HR, ↑ contractility & CO
Clinical Use: included as pre-medication to prevent most bradycardia, maintain HR & CO, offset vagal reflexes, ↓ GI motility & respiratory secretions
Tx: sinus bradycardia, sinus arrest, sinus block, and 1o, 2o and 3o AV blocks
Procedures: myelogram, ophthalmology, tracheal procedures, neonates/old patients, brachiocephalic breeds (because of vagal tone reduction)
Contraindications: pre-existing tachycardia, ↓ GI motility (horses, ruminants, rabbits), avoid in GI infections (reduced toxin clearance). Not for tx of bradycardia caused by dexmedetomidine (use atipamezole)
Drug Mechanism Effects General / Clinical Use Metabolism Contraindications/Adverse
- Parasympatholytic: ↓ GI/resp secretions and motility - Cardiopulmonary resuscitation - Caution in ruminants; thick
Blocks muscarinic (M1, ↑ HR for the first 30 min - Severe/sudden bradycardia secretions = airway obstruction
M2) receptors of ACh ↑ contractility & CO - Cardiac arrest
Atropine (not nicotinic) - Excellent in brachycephalic breeds - Caution in narrow-angle
Bradycardia: 0.02 - Eye: mydriasis, cycloplegia = ↓ lacrimal secretions = - Some antiemetic use glaucoma (↑ IOP = blindness)
0.04 mg/kg IV - Onset 1 min (IV) and corneal drying, always use eye lube.
Cardiac arrest: 0.05 5 min (IM) - Caution in neurologic patients
mg/kg IV GI: ↓ motility: caution in horse/rabbits, ↑ esophageal (↑ICP)
Duration: 40 minutes sphincter tone
- Caution in horse/rabbits (↓ GI
motility)
Synthetic Low dose: Used to treat sinus bradycardia during If ER → atropine for faster
antimuscarinic agent ↓ salivation, bronchial secretions, sweating (except horses) anesthesia that is not emergency (d/t slow effect
similar to atropine onset)
Glycopyrrolate Mod dose: Decreases GI motility (but less
SA: 0.005 - 0.01 Does NOT cross ↑ HR Safer choice for tx of bradycardia in neurologic so than atropine)
mg/kg BBB/Blood-placental ↑ contractility & CO patients
barrier
Eq: 0.002- 0.005 High dose:
mg/kg Onset can take ~5 min ↓ GI/urinary tract motility
Duration: 60 minutes ↓ gastric acid secretion (very high doses)

CNS/Eye: NO effect on IOP/pupil diameter or ICP

Adrenergic Agents
Dose-dependent action on the SNS. Commonly used to manage CV function.

α1(most common): Smooth muscle → smooth muscle contraction, vasoconstriction (↑intracell [Ca2+]), ↑MAP, sphincter contraction, mydriasis, glycogenolysis
α2: CNS, platelets → sedation, analgesia, platelet aggregation, ↓ sympathetic response
 β1: Myocardium → positive inotropic and chronotropic
β2: Smooth muscle, Coronary vasculature → vasodilation
D1: CNS, vascular smooth muscle, kidney, SNS → vasodilation
D2: ↓ pituitary hormones and noadrenaline
Drug Mechanism of Action Effects Indication Side Effects/contraindications
- Increases MAC
- Non-selective agonist at
Epinephrine - Increase blood glucose
all adrenergic receptors
0.01 mg/kg IV, - Tachycardia likely
(a1, a2, b1, b2) Increase
Intratracheal - Catecholamine-induced arrhythmia: Pro-arrythmogenic (V. fib, VPC)
- Light sensitive CO
- Low dose: B1/B2 effects (↑CO, vasodilation, ↓PVR,
ER only - Rapid metabolism (short
↓BP), ↑Body temp
duration)
- High dose: a1 effects (↑SVR)
Hypotensio
- Low dose: B1 effects ( ↑HR, CO)
n
Norepinephrine - a1, a2 agonist - High dose (>0.5 ug/kg/min): ↑BP, ↑CO, ↑Vascular
(counteract - Extravasation will cause tissue necrosis
- B1 at very low doses resist
0.1 - 1 mcg/kg/min s - Catecholamine-induced arrhythmia: Pro-arrythmogenic (V. fib, VPC)
(↑HR/CO, ↓SVR)
vasodilatio
- Tachycardia less likely than with epinephrine
n)
Dopamine - Releases endogenous - Low dose (1-2 ug/kg/min): D1/D2
- Taper off CRI (will cause reduction in MAP/CO for ~30 min)
norepinepherine - High dose: B1/B2 (↑Contractility, ↑HR, ↑CO,
Dobutamine

Fluids:
● Maintenance:
○ Generally 5 ml/kg/hr for the standard euhydrated anesthesia patient
○ Cat Formula = 60 x body weight (kg)^0.75 per 24 hr (Rule of thumb 2–3 mL/kg/hr)
○ Dog Formula = 70 x body weight (kg)^0.75 per 24 hr (Rule of thumb 2–6 mL/kg/hr)