lecture 12 inflammation and immune system

What initiates the healing process?

response to inflammation by tissues

What are the vascular changes of inflammation?

vasodilation and increased vessel permeability

How long does early/vascular phase of inflammation last?

up to a week

How long does delayed/Cellular Phase-last after an injury?

hours to days

What occurs due to tissue swelling pressure, Prostaglandin E2 sensory nerve receptors?

Pain

What occurs due to vasodilation, Pyrogens (fever producing substances) that affect temperature regulation?

Heat

What occurs early in inflammation due to vasodilation and Increased permeability → Blood accumulation?

Redness

What occurs in the delayed phase of inflammation due to increased plasma at the site secondary to arteriole dilation and increased capillary permeability?

Swelling

What occurs due to the accumulation of fluid, cells, and

cellular debris at the injury site. Pain also decreases mobility?

Decreased function

What des Cyclooxygenase metabolize AA to?

inflammation chemicals

What are two examples of inflammation chemicals?

Prostaglandins, Thromboxanes (Platelets)

What are anti-inflammatory drugs?

Drugs that reduce inflammation

What do NSAIDS block?

the action of cyclooxygenas

What do steroidal anti-inflammatory drugs block?

the action of phospholipase

What do many prostaglandins promote?

inflammation

Are some prostaglandins good? What is a side effect when inhibited?

yes, NSAID

What are COX-1?

Protective/good/“housekeeping” PGs

What are COX-2?

Inflammatory PGs

Inhibit COX-2 more/less than COX-1

They have a higher/lower safety margin

more, higher

________ reduce inflammation and provide analgesia. They are not considered immunosuppressive.

NSAIDs

NSAID class that is fever reducing

Antipyretic

Two adverse effects of NSAIDS

GI signs (vomiting, diarrhea, gastric ulceration, bleeding), Nephrotoxicity

Drug example of Salicylates

Aspirin (Acetylsalicylic acid)

Which species has a notable deficiency/lower level of glucuronyl transferase enzymes, requiring lower doses of drugs metabolized by this pathway?

cats

Phenylbutazone ("Bute")

-Species, use, and contraindication

equine, pain relief with musculoskeletal injuries, Banned in dairy cattle

Which three common veterinary NSAIDs are often used?

Carprofen, Ketoprofen (Ketofen), Naproxen (Equiproxen)

What everyday human NSAID must be strictly avoided in dogs and cats?

Ibuprofen

What are two equine Propionic Acid Derivatives?

Ketoprofen and Naproxen

Which Coxib drug class has Anti-cancer effects- Transitional Cell Carcinoma?

Deracoxib- Deramaxx

Which Coxib drug class

Which Coxib drug class has anti-cancer effects- TCC?

Firocoxib- Previcox, Equioxx

Which Coxib drug class is approved for use in cats?

Rebenacoxib- Onsior

Which Oxicam Group is approved for dogs and cats, and has a black box warning-“Repeated use in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats.?

Meloxicam

Which Oxicam Group is not considered as safe for routine use and used for bladder transitional cell carcinoma and other cancers?

Piroxicam

Flunixin meglumine: What are the common brand names and FDA-approved species?

-Banamine, Flunixamine

-horses, swine, cattle

Which NSAID is nonspecific COX inhibitor, possible lipoxygenase inhibition and topical ophthalmic inflammation?

Diclofenac sodium

Which NSAID is a dog and cat NSAID approved in Canada/Europe and used for pain/inflammation?

Tolfenamic acid

Which NSAID is not a COX inhibitor, PGE2 receptor antagonist at EP4 receptors, and not approved for use in cats?

Grapiprant (Galliprant)

Which NSAID Blocks PG synthesis and traps free radical hydroxide and approved use is topical for swelling?

Dimethyl Sulfoxide- DMSO

What are some NSAID Clinical Tips?

-Avoid use with GI, renal, or hepatic disease

-Stop using if GI or any other symptoms occur

-Bloodwork at the beginning of use and Q6-12 months

-Do not give other NSAIDs (including OTCs)

-Do not give steroids, wash-out period

Which drug inhibits Leukocyte Function Antigen-1 on inflammatory cells, is approved only for canine pancreatitis, and you should avoid handling if pregnant?

Fuzapladib (Panoquell-CA1)

Which drug has anti-inflammatory and cell membrane stabilization via phospholipase inhibition and is more widespread anti-inflammatory effect than NSAIDs?

Glucocorticoids- Cortisol

Which disease shows PU/PD/PP, Skin infections, Hair loss, Pendulous abdomen, has lowest effective dose, and is dogs>Cats?

Iatrogenic Cushing’s disease

Which disease:

-Adrenal cortex atrophy and not fully functional while on steroids

-Higher risk with prolonged use, long-acting, higher dose

-Life-threatening

-Weakness, Lethargy, Vomiting, Diarrhea

-Taper dose to allow function to return

-EOD dosing with long-term use

Iatrogenic Addison’s disease

What form(s) does Prednisone come in?

tablets

What form(s) does Prednisolone come in?

tablets and liquid

What form(s) does Dexamethasone come in?

tablets, injection

What does Temaril-P include?

Prednisolone with trimeprazine

What form(s) does Hydrocortisone come in?

tablet, topical

What form(s) does Methylprednisolone sodium succinate come in?

SOLU-Medrol injection

What form(s) does Methylprednisolone acetate come in?

Depo-Medrol injection

What form(s) does Betamethasone come in?

topical

What form(s) does Triamcinolone come in?

Tablet, Injection, Topical

What form(s) does Fluticasone come in?

inhaled

What form(s) does Budesonide come in?

oral (limited absorption- GI disease)

Which drugs are Histamine receptor antagonists that cause constriction of extravascular smooth muscle and stimulate allergy response?

Chlorpheniramine, Diphenhydramine (Benadryl), Trimeprazine (Temaril-P), Loratadine (Claritin), Cetirizine (Zyrtec)

Which drugs are Histamine receptor antagonists that increase gastric acid secretion?

Famotidine (Pepcid), Ranitidine, Cimetidine

What is Immunomodulation?

the adjustment of the immune response to a desired level

What do Immunomodulators do?

Activate or suppress the immune system

Which drug is an immunomodulator that suppresses T lymphocyte activity, blocks calcenurin and inhibits cytokine production and release?

Cyclosporine

Which are these brand names of Atopica, Neoral, Gengraf, Optimmune, Sandimmune?

Cyclosporine

Which drug is an immunomodulator that inhibits T Cell activation?

Tacrolimus

Which drug is an immunomodulator that is JAK1 and IL-31 receptors on sensory nerves trigger pruritus sensation and only approved in dogs 12 months or older?

Oclacitinib (Apoquel)

Which drug is an immunomodulator, Monoclonal Antibody, blocks IL-31 binding and has a 4-8 week duration?

Lokivetmab (Cytopoint)

Which drug is an immunomodulator and Targets nerve growth factor (NGF)?

Bedinvetmab (Librela)-Canine

What type of drug is Frunevetmab (Solensia)-Feline?

immunomodulator

Which drug is an immunomodulator that is approved for canine pyoderma and equine respiratory disease complex?

Propionibacterium acnes Injection

Which drug is an immunomodulator that is for Canine recurrent Staphylococcal pyoderma?

Staphylococcus aureus phage lysate (SPL)

Which drug is an immunomodulator and Low dosing & twice weekly initially with gradual increasing amount and concentration?

Allergen Specific Immunotherapy (ASIT)

What is the First USDA conditionally approved, monoclonal antibody treatment for Canine Parvovirus and is best to administer EARLY, as soon as patient diagnosed?

Canine Parvovirus Monoclonal Antibody (CPMA)

Which drug has a promising supportive adjunct rather than a guaranteed standalone cure?

Filgrastim

What are the four branches of Traditional Chinese Veterinary Medicine (TCVM)?

Acupuncture, Herbal Medicine, Food Therapy, Tui-Na (Manual therapy)