Pain Management/Analgesia practice questions

Answer: C) Vomiting, black or bloody stool and a decreased appetite

Owners of dogs on NSAIDs should report vomiting, diarrhoea, loss of appetite, black or bloody stool, decreased activity or yellowing of the gums or eyes. These can mean GI, liver or kidney problems, even in previously healthy dogs.

• AIncorrect. Increased appetite and weight gain are more typical of glucocorticoids. They are not the warning signs owners are told to watch for with NSAIDs.
• BIncorrect. Better mobility is the expected benefit of treatment, not an adverse reaction.
• CCorrect. The FDA lists vomiting, loss of appetite and bloody or black stool among NSAID side effects. They may signal GI ulceration or bleeding. Owners should also report diarrhoea, decreased activity and yellowing of the gums or eyes.
• DIncorrect. Sedation with constricted pupils fits an opioid effect. It is not a typical NSAID adverse reaction.

Answer: C) Opioid dysphoria

• AIncorrect. It may need attention.
• BIncorrect. Check for dysphoria too.
• CCorrect. The vet may adjust the drug.
• DIncorrect. Dysphoria is likely.

Answer: A) Weight reduction, controlled low-impact exercise, and an NSAID or anti-NGF monoclonal antibody

Chronic canine OA is managed in several ways at once: weight control, controlled low-impact exercise, and pain medication such as NSAIDs or the anti-NGF monoclonal antibody bedinvetmab.

• ACorrect. Weight control reduces joint loading and inflammation. Even modest weight loss can reduce lameness. Controlled low-impact exercise such as leash walks and swimming keeps mobility and muscle mass. NSAIDs and anti-NGF antibodies such as bedinvetmab (Librela) are first-line drugs for OA pain.
• BIncorrect. Long-term strict rest leads to muscle loss and joint stiffness. Controlled, regular low-impact exercise is recommended instead. Chronic OA pain usually needs ongoing pain control, not just treatment during flare-ups.
• CIncorrect. Giving corticosteroids together with NSAIDs greatly raises the risk of GI ulcers and is avoided. Long-term systemic steroids are not first-line OA treatment.
• DIncorrect. Extra calories cause weight gain, which increases joint load and inflammation. Supplements can be an add-on, but they do not replace effective pain medication.

Answer: B) GI ulceration

• AIncorrect. GI ulcers are the concern.
• BCorrect. Both can damage the GI lining.
• CIncorrect. GI ulcers are the concern.
• DIncorrect. The risk is GI ulcers.

Answer: A) The dog is likely in pain; score it with a pain scale and notify the veterinarian

Guarding the abdomen, an abnormal posture, and reluctance to move are classic signs of pain in dogs. After surgery, these signs call for a structured pain assessment and a prompt report to the veterinarian.

• ACorrect. Abdominal guarding, an abnormal hunched posture, and reluctance to move are recognized signs of pain in dogs. The technician should do a structured pain assessment and report it so analgesia can be adjusted.
• BIncorrect. Dogs in severe pain may lie still to limit discomfort. Stillness combined with guarding and an abnormal posture suggests pain, not comfort.
• CIncorrect. Leftover sedation doesn't explain guarding when the abdomen is touched or a hunched posture. Assuming these are drug effects risks leaving pain untreated.
• DIncorrect. Bladder comfort is worth checking, but guarding and reluctance to move after abdominal surgery point to pain first. Making the dog walk before assessing pain could make it worse.

Answer: A) It causes local vasoconstriction, which limits edema and reduces pain

In the acute phase after injury or surgery, cold therapy causes vasoconstriction that limits swelling and edema and adds some analgesia. Vasodilation and better tissue extensibility are effects of heat.

• ACorrect. Cold narrows local blood vessels and slows tissue metabolism and nerve conduction. This limits swelling and edema and gives some analgesia in the acute inflammatory phase.
• BIncorrect. Vasodilation and increased blood flow are effects of heat therapy. Heat is generally avoided in the acute phase because it can worsen swelling.
• CIncorrect. Making tissue more extensible before range-of-motion work is a goal of heat therapy, usually in later or chronic stages.
• DIncorrect. Cold slows nerve conduction only briefly. It is an add-on to multimodal analgesia, not a replacement for systemic analgesics.

Answer: D) For chronic muscle stiffness, after the acute phase

• AIncorrect. That risks burns.
• BIncorrect. Cold is used early.
• CIncorrect. Heat isn't used there.
• DCorrect. It increases blood flow.

Answer: C) A washout period

• AIncorrect. That's dangerous.
• BIncorrect. That's dangerous.
• CCorrect. Often several days.
• DIncorrect. That's dangerous.

Answer: A) A noninvasive adjunct to help relieve pain, reduce inflammation and support tissue healing

Therapeutic laser (photobiomodulation) is an adjunctive, noninvasive modality used mainly to reduce pain and inflammation and support healing within a multimodal plan. The supporting evidence is still mixed.

• ACorrect. Photobiomodulation uses red and near-infrared light to modulate cellular processes. It is used as an add-on modality for pain, inflammation and wound or musculoskeletal healing, although study results are mixed.
• BIncorrect. This describes high-power surgical lasers (e.g., CO2 lasers), not low-power therapeutic lasers used in rehabilitation.
• CIncorrect. Therapeutic laser does not sterilize wounds. Wound cleaning, debridement and appropriate antimicrobial management are still needed.
• DIncorrect. Photobiomodulation is an adjunct within a multimodal plan. It does not replace systemic analgesics for significant acute postoperative pain.

Answer: A) Cats have limited glucuronidation capacity, so some NSAIDs are cleared slowly and can accumulate

Cats have limited glucuronidation, so they clear some NSAIDs slowly, and the drugs can accumulate and cause kidney or GI toxicity. Use only feline-approved NSAIDs at labeled doses and durations.

• ACorrect. Cats break down some drugs poorly because glucuronide conjugation is limited, so NSAIDs can build up. This is why repeated meloxicam doses in cats are linked to kidney failure and death. Use only labeled feline products and doses.
• BIncorrect. It works the other way. Cats break down NSAIDs less efficiently, so higher or more frequent dosing raises the risk of toxicity.
• CIncorrect. Meloxicam (one injection before surgery) and robenacoxib (up to three daily doses) are FDA-approved for cats. No NSAID is approved for long-term use in cats.
• DIncorrect. NSAIDs relieve pain in cats by inhibiting cyclooxygenase, and approved feline NSAIDs control pain and inflammation after surgery. The concern is slow clearance, not lack of effect.