VPHM 142

1ST LAB EXAM

Main pain medications for Degenerative Joint Disease (DJD)/ Osteoarthritis (OA)

• NSAIDs

• GCCs

• Common drug of choice for Degenerative Joint Disease (DJD)

• COX-2 preferential NSAID

• Has analgesic, antipyretic, anti-inflammatory effect

Meloxicam

Prostanoids that Meloxcam inhibits

• Series-2 PGs

• TXAs (predominantly TXA2)

TRUE OR FALSE

Meloxicam is relatively highly bound to feline plasma proteins (97%) and volume of distribution is about 0.27 L/kg

TRUE

Common adverse effect of Meloxicam

• Gastrointestinal

• Renal

• Hematological

Give at least 2 non-surgery, non-drug treatment for DJD

• Weight management

• Diet modulation

  - Type, amount

• Exercise

• Physical rehabilitation and physical modalities

• Environmental modification

• Nutritional supplements

• Acupuncture

TRUE OR FALSE

GCCs has an analgesic effect like NSAIDs

FALSE

TRUE OR FALSE

Low-dose meloxicam in cats has an adverse effect in renal excretory function

FALSE

Effects of low-dose Meloxicam treatment in cats with Chronic Kidney Disease (CKD)

• Gastrointestinal

• Proteinuria

Surgery treatment for Degenerative Joint Disease (DJD)/ Osteoarthritis (OA)

• Joint replacement - Hip, elbow, knee

• Excision arthroplast - Removal of portion of a joint

• Arthrodesis - Fusing 2 bones together to create one big bone

• Joint dennervation

• Stem cell therapies

Give at least 1 base analgesics for Degenerative Joint Disease (DJD)/ Osteoarthritis (OA)

• NSAIDs - Paracetamol (acetaminophen; not in cats)

• Corticosteroids (for underlying immune-mediated diseasing resulting in polyarthritis)

• Adjunctive analgesics - Tramadol, amantadine, gabapentin, tricyclic antidepressants

• Postulated disease modifying drug - Polysulfated glycosaminoglycan

• Neuroablative procedures

TRUE OR FALSE

Degenerative Joint Disease (DJD)/Osteoarthritis (OA) or in case of cats (Feline arthritis) is most common in all ages of animals (young/senior animals)

FALSE

Most common in senior/elderly animals probably with other chronic conditions, complications, drug interactions

Main uses of GCCs

• Anti-inflammatory

• Immunosuppressive

• Replacement

Considerations before using GCC

• Benefits over risk

• Condition of the patient

• Predisposition to adverse effects

• Set starting dose, length of treatment, adjustments

• Choose preparation which would minimize adverse effects

• “Are there any other drugs to combine with it to minimize adverse effects?”

TRUE OR FALSE

One factor to consider during the use of GCC is by adjusting the dose according to the needs of individual patient

TRUE

• Choose appropriate starting dose

• Adjust dose according to needs of individual

  patient

Drugs used in the early 1900’s which were not totally efficient and they were mostly toxic to the animals.

Mineral, alkaloids

• Discovered in 1938

• Paved the way for the development of newer broad-spectrum drugs.

• Pioneer dewormer

Phenothiazine

Give at least 2 IDEAL drug properties

• Broad spectrum of activity

• Reach the proper site of the GI tract to come in contact with the specific worm

• Be effective in killing /removing the worm

• Wide safety margin (high selectivity)

• Easy to administer

• Minimal changes in animal routine (fasting, removal of water...)

• Minimal side-effects (diarrhea, loss of appetite...)

• Economical especially for the livestock producer

Common Roundworms, Hookworms, Whipworms, Pinworms

• Toxocara sp.

• Trichuris sp.

• Baylisascaris sp.

• Ascaris sp.

• Ancylostoma sp.

Common Flatworms (Tapeworms)

• Dipylidium sp.

• Taenia sp.

• Echinococcus sp.

• Systemically administered antiparasitic drug

• ivermectin, milbemycin; parenteral, topical w/systemic absorption

Endectocides

MOA of anthelmintic agents

• Starve worm

• Paralyze worm

Dosage form of anthelmintic agents

• Tablet

• Drench

• Paste

• Pour-on

• Spot-on

• Injectable

• In-feed

• Sustained-release boluses (continued - release, pulse-release)

USES of this anthelmintic drug

• Dogs and cats - for hookworms, roundworms

• Sheep and goats - for Strongyles

• Cattle - for Strongyles

• Horses - for Strongyles, pinworms and Ascarids

• Swine - for roundworms, strongyles

TETRAHYDROPYRIMIDINES

Parasite receptor of TETRAHYDROPYRIMIDINES

Nicotinic acetylcholine receptor

Sample drugs of TETRAHYDROPYRIMIDINES

• Pyrantel pamoate or tartrate

• N subtype: oxantel

• Morantel

This particular TETRAHYDROPYRIMIDINES is not effective against whipworms.

N subtype: oxantel

Mode of action of TETRAHYDROPYRIMIDINES

• Act as agonist

• Depolarization of parasite NM membrane leading to spastic paralysis

TRUE OR FALSE

Morantel, a TETRAHYDROPYRIMIDINES, has low systemic absorption therefore it is considered as poorly larvicidal.

TRUE

This anthelmintic has a side effect of salivation, and horses are more sensitive to toxic effects.

TETRAHYDROPYRIMIDINES

This anthelmintic:

• has no activity against cestodes and trematodes

• is for nematodes.

• affects ectoparasites if given parenterally

AVERMECTIN

Parasite receptor of AVERMECTIN

Glutamate-gated chloride channel

Sample drugs of AVERMECTIN

• Ivermectin

• Selamectin

• Moxidectin

• Milbemycin

Mode of action of AVERMECTIN

• Acts as an agonist

• Opens chloride channels leading to hyperpolarization and flaccid paralysis

Route of administration of Avermectin

Oral or parenteral (larvicidal if parenteral route)

TRUE OR FALSE

Glutamate-gated chloride channels (a receptor) is present in mammals

FALSE - it is not present in mammals

TRUE OR FALSE

Ivermectin toxicity is observed in Collie dogs, and Murray Grey Cattle breeds

TRUE

Parasite receptor for Praziquantel

Voltage-gated calcium channel

Drug of choice for Cestodes and Trematode

• Praziquantel

• Epsiprantel

This anthelmintic drug:

• Acts as an agonist

• Increases calcium influx resulting in rapid and

  sustained muscle contraction

Praziquantel

TRUE OR FALSE

Praziquantel has a high bioavailability.

TRUE

HOW DO YOU DEWORM A FISH?

Praziquantel powder

CAPC/CDC and AAHA/AVMA preventive healthcare guidelines

• Year-round control of intestinal parasites

• Perform routine fecal examination for intestinal parasites

• Year-round heartworm preventive

• Year-round flea and tick control

• Perform routine examination for fleas and ticks

Drugs for intestinal helminths of dogs

• Fenbendazole

• Milbemycin oxime

• Praziquantel + pyrantel pamoate + febantel

Dosage and route of administration of Fenbendazole

50 mg/kg for 3 days, PO

Dosage and route of administration of Milbemycin oxime

0.5 mg/kg, PO

Dosage and route of administration of Praziquantel + pyrantel pamoate + febantel

5mg/5mg/25mg/kg, PO

Helminths targeted by Fenbendazole

• Toxocara canis

• Toxocara leonina

• Ancylostoma caninum

• Uncinaria stenocephala

• Trichuris vulpis

• Trichuris pisiformis

Helminths targeted by Milbemycin oxime

• Toxocara canis

• Toxocara leonina

• Ancylostoma caninum

• Trichuris vulpis

Helminths targeted by Praziquantel + pyrantel pamoate + febantel

• Toxocara canis

• Toxocara leonina

• Ancylostoma caninum

• Uncinaria stenocephala

• Trichuris vulpis

• Trichuris pisiformis

• Echinococcus granulosus

• Echinococcus multilocularis

What family does Fenbendazole/Febantel belong to?

Benzimidazole

What family does Milbemycin oxime belong to?

Macrocyclic lactone-milbemycin group

This drug has an adverse effect of:

• Occasional vomiting

• Allergic reactions due to sudden death of worms

Fenbendazole/Febantel

This drug, at high doses, has an adverse effect of tremors, ataxia; may be safer in breeds with mdr1 mutation (AE occur at higher dose), complications may occur in microfilaria positive dogs

Milbemycin oxime

Below are the possible things that can happen after administration of anthelmintic drugs:

a. Vomiting or diarrhea due to death of worms in the gut; should be resolved within 24-48 hours

b. Adverse effects that depend upon the condition of the animal and the worm burden.

c. Animal must be monitored, and supportive treatment given as the need arises.

d. All of the above

d. All of the above

Only way of detecting anthelmintic drug resistance in vivo in dogs and cats

Fecal egg count reduction test

Things to consider to avoid drug resistance

• Avoid overuse

• Diagnose first before administration

Anthelmintic resistance in USA

• Dirofilaria immitis larvae

• Toxocara canis

• Dipylidium caninum

Other term for Feline Lower Airway Disease (FLAD)

Asthmatic bronchitis

Bronchial asthma

Allergic bronchitis

Factors leading to respiratory difficulty

• Hypersensitivity

• Inflammation + Bronchoconstriction

• Mucus production

• Cough/wheezing

Pathology of FLAD

• cells lining the lower respiratory tract

  (bronchioles) become sensitized to a particular

  inhaled allergen

• the allergen when inhaled, triggers an

  inflammatory response, causing constriction of

  the lower airways, recruitment of inflammatory

  cells to these airways, and mucus accumulation.

Management of FLAD

• Bronchodilation

• Reducing inflammation

• Restoring normal mucus clearance

Treatment of FLAD

Use of:

• Bronchodilator

• Anti-inflammatory agent

Treatment protocol for intermittent Acute Bronchial Asthma

Albuterol sulfate inhaler

Treatment protocol for mild to moderate Acute Bronchial Asthma

• Supplemental oxygen therapy

• Albuterol sulfate inhaler or terbutaline sulfate (0.325-0.625 mg total dose/cat, PO)

• Theophylline (25 mg/kg, PO in the evening) or Aminophylline (6.6 mg/kg, PO)

• Prednisolone

• Fluticasone propionate inhaler

Initial treatment for severe clinical signs of Acute Bronchial Asthma

• Supplemental oxygen therapy

• Albuterol sulfate inhaler or terbutaline sulfate

• Dexamethasone sodium phosphate (1 mg/kg IV or IM)

• Consider adjuvant magnesium administration

Treatment after stabilization of acute bronchial asthma

• Prednisolone

• Fluticasone propionate inhaler (wean to lowest possible dose)

• Albuterol sulfate inhaler

• Administered before inhaled GCC’s for maximum lung distribution of the steroid

• Rescue medication

Bronchodilators

TRUE OR FALSE

Bronchodilators are usually administered concurrently with inhaled GCCs for maximum lung distribution of the steroid

FALSE

Bronchodilators are administered before inhaled GCC

TRUE OR FALSE

Short acting like terbutaline, albuterol/salbutamol are preferred for acute attacks of bronchial asthma

TRUE

For acute attacks:

• short acting

• systemic preparation like injectable preparation (terbutaline)

Anti-inflammatory agent/drug for bronchial asthma

Glucocorticoid

This may cause insulin resistance, polyuria, cystitis, and inappropriate urination in cats.

Oral GCC

• Prednisone

• Prednisolone

• Dexamethasone

What is the most preferred GCC for treatment of FLAD?

Inhaled GCC

• Fluticasone

• Beclomethasone

• Budesonide

TRUE OR FALSE

GCC must be avoided in cats with concurrent diabetes mellitus, heart disease, or chronic FHV-1 infection

TRUE

GCC are classified as:

leukotriene receptor antagonists

These drugs are not suitable for acute episodes of bronchial asthma

• Zafirlukast

• Montelukast

Other medication/treatment for bronchial asthma

• Diet modification

• Environment medication

Ways in preventing feline asthma

• Avoid triggers

• Normalize health

• Pharmacological intervention

• Alternative medicine

  • Nutritional

  • Acupuncture

  • Immunotherapy

  • Stem cell therapy

Ways on monitoring feline asthma

• The client should report efficiency, inefficiency, or any changes in the cat.

• The schedule for monitoring will depend on the severity of the case

Signs of Urinary Tract Infection (UTI)

• Excessive water consumption (but there are some controversy about this)

• Urinating only small amounts at a time

• Urinating frequently and in multiple spots

• Inability to hold urine for the normal amount of time

• Bloody urine

Animals that have experienced three or more episodes of clinical cystitis within the preceding 12 months

Recurrent bacterial cystitis

Animals with bacteriuria in the absence of clinical signs

Subclinical Bacteriuria

A single recurrence of sporadic cystitis within the preceding 3 months can be classified as?

Recurrent bacterial cystitis

Drug recommendations for bacterial urinary tract infection

• Fluoroquinolones

  • Marbofloxacin

  • Orbifloxacin

  • Pradofloxain

TRUE OR FALSE

Treatment with analgesics alone (e.g. NSAIDs) could be considered while awaiting for urine culture results

TRUE

TRUE OR FALSE

If bacterial strains isolated are reported to be susceptible to the antimicrobial drug selected, no change in the treatment plan is required.

TRUE

TRUE OR FALSE

If empirical antimicrobials are initially prescribed, antimicrobial choice should be re-assessed when culture results are available.

TRUE

What bacteria is the most frequent isolated but has lower frequency of antimicrobial susceptibility compared to other bacterial species?

Escherichia coli

Good first-line option for sporadic bacterial cystitis but not recommended for pyelonephritis or prostatitis.

Amoxicillin (not drug of choice)

Reserved for infections caused by pathogens that are resistant to drugs that are actively excreted in urine in active form.

Doxycycline (not drug of choice)

• Reserve for documented resistant infections but good first line choice for pyelonephritis

• Considered first line of choice for infections that involve the prostate.

• Not recommended for Enterococcus sp.

Marbofloxacin 2.7-5.5 mg/kg PO every 24 hours

• Reserved for documented resistant infections but good first line choice for pyelonephritis.

• Considered first line of choice for infections that involve the prostate.

• Not recommended for Enterococcus sp.

Orbifloxacin

• Tablets: 2.5 - 7.5 mg/kg PO every 24 hours

• Suspension (cats): 7.5 mg/kg every 24 hours

• Evidence is published regarding efficacy for treating bacterial cystitis in dogs and cats.

• Greater activity against some bacteria than older fluoroquinolones (enterofloxacin, marbofloxacin, orbifloxacin)

• Theoretically a good first line choice for pyelonephritis, especially in CATS

• Not recommended for Enterococcus sp.

Pradoflixacin

• Dogs: 3-5 mg/kg PO every 24 h

• Cats: 3-5 mg/kg once daily (tablets) or 5-7.5 mg/kg every 24 h (suspension)

Comorbidities that should be considered in a dog or cat with bacterial cystitis

• Endocrinopathy

• Kidney disease

• Obesity

• Abnormal vulvar conformation

• Congenital abnormalities of the urogenital tract

• Prostatic disease

• Bladder tumor

• Polypoid cystitis

• Urolithiasis immunosuppressive therapy

• Rectal fistula

• Urinary incontinence/retention

Below are indications of what stage of kidney disease?

• Normal blood creatinine or normal or mild increase blood SDMA

• Other renal abnormality present

  • inadequate urinary concentrating ability

  • abnormal renal palpation or renal imaging findings

  • proteinuria

  • abnormal renal biopsy

Stage 1 Kidney Disease

• Dogs

  • Creatinine - < 1.4 mg/dl

  • SDMA - <18

• Cats

  • Creatinine - <1.6 mg/dl

  • SDMA - <18

Below are indications of what stage of kidney disease?

• Normal or mildly increased creatinine

• Mild renal azotemia

• Mildly increased SDMA

• Clinical signs usually mild or absent

Stage 2 Kidney Disease

• Dogs

  • Creatinine - 1.4 - 2.8 mg/dl

  • SDMA - 18-35

• Cats

  • Creatinine - 1.6 - 2.8 mg/dl

  • SDMA - 18-25

Below are indications of what stage of kidney disease?

• Moderate renal azotemia

• Extrarenal signs present

Stage 3 Kidney Disease

• Dogs

  • Creatinine - 2.9 - 5.0 mg/dl

  • SDMA - 36-54

• Cats

  • Creatinine - 2.9-5.0 mg/dl

  • SDMA - 26-38

Presence of many or marked systemic signs might justify classification as what specific stage of kidney disease?

Late Stage 3 Kidney Disease

Increasing risk of systemic clinical signs and uremic crises are signs of what stage of kidney disease?

Stage 4 Kidney Disease

• Dogs

  • Creatinine - > 5.0 mg/dl

  • SDMA - >54

• Cats

  • Creatinine - >5.0 mg/dl

  • SDMA - >38

Give at least 3 symptoms of Chronic Kidney Disease (CKD)

• Increased thirst and urination

• Weight loss

• Vomiting and diarrhea

• Weakness

• Poor coat appearance

• Seizures

• Constipation

• Blood in the urine

• Decreased appetite

• Bad breath

• Sore mouth or mouth ulcers

• Lack of energy and increased sleeping

• Depression

• Acute blindness

• Uncoordinated gait

• Swelling of bone structure