VETN 127B- Nursing Dogs and Cats II & III

Prescribing medications

only dvm initiated. us nurses cannot.

Diagnosis

logic based, disorder known.

Empirical medication

experienced based , means you know the medication will work.

Symptomatic medication

relieve clinical signs.  still might not have a diagnosis but can relieve any clinical signs.

Diagnostics medication

can confirm the diagnosis. Has a diagnostic method in mind. Is almost positive a certain medication will work so they give it to confirm the diagnosis.

Technicians jobs for medications

Verify orders with dvm. fill prescriptions (correct labeling). Correct administration. Observing patients response , keeping it in the medical records and being able to educate the owners on medication.

Administration “6 Rights”

Right Patient , Right Drug (check 3x) Right Dose (calculate 2x) , Right Route, Right Time, Right Documentation(sign)

Routes of administration

Enteral : oral, tubes. Inhalation: gas, vaporized , nebulize. Topical: dermal (skin), mucous membranes (in the eyes, in the mouth, inside rectum) , Transdermal: through the skin 

Parenteral Routes of administration

Intradermal (ID), Subcutaneous (SQ), Intravenous (IV), Intramuscular (IM) Intramuscular (IM) Intraperitoneal , Intraosseous (IO) , Intra-articular, intracardiac, spinal canal

Enteral drug forms

tablets, capsules, Liquids

liquid forms

solutions: mixed usually with alcohol or aqueous. Suspensions: floating , always shake well. Syrups: usually sugar. caution with Xylitol(sugar substitute) -very toxic to dogs.

Inhalant drug forms

gas , nebulized , mists

Topical drug forms

Emulsions: 2 liquids combined together that gently agitate to equally disperse. Ointments(oil based) , creams (water based), lotions .

Parenteral drug forms

solutions (IV,IM,SubQ) Suspensions (IM,SubQ, never IM), Oil-based ( IM) implants under tissues that slowly breaks down.

Enteral administration

absorption occurs in GI mucosa then gets into the circularity system. into the portal circulation straight to the liver. Then is systemic (goes through the rest of the body). Action: slower onset but lasts for a longer period of time.

Problems/reasons not to give for enteral administration

Emesis (vomiting) , slow onset (what if they need it fast), Gastric acid destroying medication, Rapid metabolism, Absorption +/- food.

Oral administration conveniences/contraindications

convenience: rapid, easy to teach clients with proper training. Contraindications: emesis, mouth/head trauma, inability to swallow or disease/surgeries that cause these issues.

Liquid administration 

taste-usually dogs and ferrets love. cats hate it

Tablets/capsules administration

dividing- be careful if its coating it can not be divided. if its scored it can be cut! Capsules: have the gelatin inside.

Pilling Methods

Pilling devices, but caution to not cause any trauma. Indications: if they are fractious or difficult. You can use your hand if they are cooperative but caution because your hand will be in there mouth.

Canine tips for pill popping

nose slightly elevated, touch roof of mouth distal to canine. hold mouth behind k9 teeth. make sure to put pill over the base of the tongue. to induce swallowing, rub throat, touch nose, or blow on nose. 

feline tips for pill popping

almost same has dogs just mouth is smaller. do it very fast. put pill on base of back of the tongue. prevent them from tasting it. induce swallowing like touching nose and blowing on it. 

tips for Liquid administration

dogs- tilt head up and put in between check and teeth and they will swallow it.

Enteral tubes , orogastric

medications: activated charcoal, gastric lavage( wash inside of stomach) , Decompression (stomach filled with gas), Feeding (for newborns when they aren’t nursing) .  Deliver Slowly, always!

enteral tubes restraint

dogs- most will let you do, moderate physical restraint. Cats must be sedated.

Complications of enteral tubes

aspiration (coming up into the lungs)- cause of improper placement. Regurgitation (swallow reflex)-never put a tube down a patient that doesn’t have the swallow reflex.

Equipment -orogastric tube

Tube -size dependent of animal and the purpose of it. Use speculum to prevent biting (use 2inch tape). Lubrication-water soluble. Syringes, +/-adapters to tube ‘christmas tree’

orogastric tube placement

measure to tip of the nose to the last rib and mark that distance. If it doesn’t proceed, take out and try again. Make sure to use enough lube so it slides down easier. Speculum- 2inch tape roll, someone hold muzzle and place tape in between mouth. plastic/wood-very cautious -could break jaw.

Orogastric insertion

once you insert into speculum to the phayngx(swallow reflex) then continue sliding down until you get to your mark. Then verify its correct. Palpate neck - esophagus on the left side so should feel two tubes not just trachea. Also could sniff the tube or listen for gas coming out. Coughing-could be in the lungs. imaging-taking radiograph to see your tube. 

Nasogastric/nasoesphageal

can feed. can give medications. placement-similar to OG. stomach-13th rib, esophagus-8th rib. Goes through the ventral meatus. can use a topical anesthesia- to help them with not sneezing. 

Nasogastric/nasoesphageal complications

if not place properly can go into the lungs and aspirate. Can dislodge it by them sneezing or pawing/rubbing it out, coughing. Epistaxis- bloody nose

Other  tubes

esophagostomy , gastrotomy( left side striaght in tummy), enterostomy(into intestine, bypass stomach) , pharyngostomy(gag) not reccomened

Inhalation Medications

Vaporize(liquid to gas), Nebulize(can do antibiotics and respiratory drugs) , Mists (inhalers)

Topical drug locations

skin, mucus membranes, ocular, oral, rectal, nasal, tracheal, mammary glands(in cows)

Local topicals (put on outside)

dips, shampoos, ointments, creams, powders.

Systemic topical (all over body)

absorbed across the mucus membrane. Transdermal, solutions, vaccines(bordetella)

Absorption across skin is ? skin vs. mucous membrane

Is very slow! skin is supposed to keep things out. If we want something to cross the skin is has to have special additives like DMSO with drug.  Mucous membranes are rapid absorption, isn’t mean’t to keep things out. 

General principles of topical medication

always use gloves cause it could affect us too getting onto our skin. Clean sites! might be +/- clipping hair. avoid contact with it. and prevent animals from licking. 

Tympanic membrane -cleaning

must make sure it’s intact! before using certain cleanings. only clean out what you can see.

topical eye formulations

ointments (oil based) or solutions ( water)

can treat what kind of eye diases

Intra and Extra. inside and outside of the eyeball.

Principles of eye medications

must have restraint. never let the containers contaminate the eye. can damage the eye.  never share eye medications. Intervals between eye drugs - 3-5minutes. 

Intranasal - can give?

vaccines, certain drugs, local anesthetics, decongestants( shrinks blood vessels then tissues shrink) , Or systemic drugs - antiseisure drugs - valium will absorb faster then rectally.

problems of intranasal

will cause sneezing, can cause infections. 

Technique for intranasal

tilt head slowly and carefully. instill medication slowly in each. Do nasal planum area-side of the nostril and let it drip in there. 

Intratracheal purposes

usually for emergency’s, rapid absorption. emergency drugs like atropine, lidocaine, and epinephrine.

Delivery of drugs intratracheally.

if they have tube already, shove drug down tube. or can take another long thinner tube put it down the first tube and put the drug in there. can do a catheter directly into trachea. or can do percutaneous(through skin) stick need through skin until into trachea and give drug

Cautions of intratracheal drug dilivery

caution, if not done right will creat trachea and nerve damage.

technique for intratracheal tube

have really good restraint, be under anesthesia! Visualize the larynx. Open between arytenoids. Watch tube go between two cartilage. once it’s in then can instill the drug and can use air or saline to make sure it goes all the way down to the trachea. 

catheter into trachea

same technique. no tube needed

Volumes for intratracheal dugs given

2x the IV dose. 

Rectal medications 

enemias, never use phosphate solutions! regularwater/soapy water.

Systemic rectal medications

antiemetics , if vomiting and can’t get drug into, antizeiure - better if no fecal materials for absorption so its rapid through mucosa.

rectal medication forms

tablets/suppositories - about 5cm deep. Liquids-through a tube-8-10 french tube warm water flush.

mammary topical method -speciesspecfic

typically Bovine, occasionally ovine(sheep) and caprine(goat)

Indications for topical mammary

Mastitis- inflammation of the mammary gland. 

technique

empty udder(get milk out) , clean the teat and then put some type of catheter in teat and inject meds, then close off so medication sits in there.

Transdermal patches for?

hormonal therapy, analgesics- fentanyl (controlled drug)

technique for transdermal patch

contact with skin! clip hair, gonna wear gloves so it doesn’t get in contact with us, make sure it’s dry, put it on and hold it for 1 minute, can even put staples to hold in contact

transdermal patch cautions

don’t touch the gel! don’t use heat pads in the area can change absorption levels and make it too quick. Prevent the animal from removing it, if it’s coming off must replace it with a whole new patch, no replacing. Make sure it’s labeled! with strength placement date and when to remove.

Intradermal for ?

allergy tests and TB test.

intradermal technique-allergy test

avoid hard scrub with aniseptic, small needle! bevel up. in the dermis, will still be able to see the needle. give injection and monitor reaction.

Subcutaneous- advantages

simple and usually well tolerated by animals, easy to teach owners, can give large volumes , meat producing animals can get it, no damage.

subcutaneous disadvantages

slower absorption, if dehydrated, in shock, won’t absorb fast enough. or obese will absorb very slowly. Or if it has irritating solutions like dextrose or glucose in it. -causing injection bateria.

Subcutaneous - medication administration

Vaccines- feline not interscapular - vaccine ociaiated sarcome, tumor-will be able to aputate leg. Fluids and drugs.

subcutaneous equipment

syringe, needles +/- extension , butterfly , drip set.

Subcutaneous technique

tent skin (no lesions), swab with alcohol, insert needle parallel to tent , aspirate (+blood, reposition) , inject slowly and should have minimal to no resistance.

Intramuscular injection Locations

Lumbar epaxial(muscles next to spine) caudally, Hamstring (semimembranosis,semitendinosis), Quadriceps (front of thigh), and Triceps (back of upper arm). Cervical (horses,cattle,pigs) -caudal to ear.

intramuscular- advantages

vascularity-going to absorb quickly. even poor solubility, like oily substances will absorb(slowly).

intrmuscular- disadvantages

can only give small volumes, vital structures-like sciatic nerve.  It is painful. Can cause muscle damage-never use in food producing animals. 

intramuscular technique- lumbar expaxial

have proper restraint. have all equipment. identify using landmarks- the wing of the ileum and the dorsal spinous process of the vertebrae. swab area first. insert needle straight, aspirate (+blood=reposition) , inject slowing, can massage area after.

intramuscular technique- hamstring

restraint.  palpate muscle, swab, insert needle in caudal medial direction (avoiding sciatic nerve), aspirate(+blood=reposition) , inject slowly , can massage after.

intramuscular technique. - Quadriceps

restraint. palpate muscle. swab , needle direction perpendicular, aspirate (+blood=reposition), inject slow, can massage after.

intramuscular technique- triceps

restraint. palpate muscle. swab area, insert needle at a perpendicular angle, aspirate (+blood=reposition), inject slowly, can massage after.

intravenous - locations

cephalic, saphenous, and jug vein. and others with access. 

intravenous- advantages

rapid onset, can give large volumes, can give irritating substances slowly. 

intravenous- disadvantages

short duration, laceration potential(damage vein and medication goes under skin), access problems. 

Rule of thumb for IV injections

Don’t give opaque medications- can’t see through the drug. There is an exception for TPN(total parental nutrition) and propofol.

Intravenous technique

same with blood drawls. same blood draw equipment. Restraint. start distal, occlude vein, expel any air bubbles, swab with alcohol, insert needle( verify placement) then once there stop occlusion and inject slowly. Make sure you aren’t seeing any swelling. 

Intraosseous (through bone) Locations

crest of ilium(very thin), trochanteric fossa(of femur), proximal humerus(on lateral aspect), proximal tibia(on medial aspect).

intraosseous equipment

intraosseous cannula with stylet in the middle. or specialized equipment like BIG (bone injection gun), Osteoport (screw in bone with hole in it to give meds in hole) , power drivers (drills in)

intraosseous - advantages

give large volumes very fast, give it in very small animals(size of mouse), exotic, failure of IV , give even irritating solutions.

intraosseous- disadvantages

painful insertion, +/- infection in bone. 

Intraosseous technique

always surgical prep. +/- anesthesia(depend on if using gun or not) , only one attempt( fail=different bone), stab incision through skin, bore motion(twisting and pushing forearm at same time), wrap once in middle and give fluids.

Contraindications

Sepsis or fractured bone.

Intraperitoneal (into peritoneal) indications

difficult access to iv, iq like very small animals, rapid absorptions

complications of intraperitoneal

organ puncture(like in kidney or liver), peritonitis(peritoneal inflammation) , irritant vs. septic.