Pharm Test 2

anticonvulsants

anticonvulsants

help prevent seizures by suppressing the spread of abnormal electric impulses from the seizure focus to other areas of the cerebral cortex

Antipsychotics

major tranquilizer

they produce beneficial effects at the cost of calming all behaviors including those behaviors that you do not wish to be be decreased

antidepressant

a mood elevating drug

anxiolytics

drugs that lyse anxiety or decrease fear response

what is the drug of choice for long-term seizure control

phenobarbitol

how is phenobarbital measured in

grains

1 gran ~ 60 mg

what is the drug of choice for emergency seizure control

diazepam

a bendodiazepine tranquilizer

how does diazepam controls seizures

rapidly penetrated the blood brain barrier and enhances the inhibitory effects of GABA

what does GABA do

gamma aminobutyric acid

counters the effects of stimulatory neurotransmitters in the brain like acetylcholine and norepinephrine

diazepam is very effective when given

IV

why do we have to be careful when giving diazepam to cats

fatal idiosyncratic drug induced hepatopathy is seen in cats that have long term administration of diazepam

phenobarbital has a long or short half life

long, only needed once or twice per day

what is potassium bromide used for

a common adjunct therapy for animals whose seizures are not solely controlled by phenobarbital alone

what takes 3-5 months to reach steady-state concntration in the dog

potassium bromide

large loading doses are sometimes used to help with this but it narrows the therapeutic index

do we raise or lower the dose of phenobarbital when mixed with potassium bromide

lower

Primidone is an anticonvulsant that’s efficacy is dependent on what

the metabolism of primidone to phenobarbital

bc of this most doctors just give phenobarbital

what is the disadvantage with phenytoin (dilantin) as an anticonvulsant

maint. therapeutic concentration

has to be given 3 times per day

poor absorption, short half-life, and risk of liver damage

what is the disadvantage to clonazepam (klonopin) or lorazepam

most animals develop a significant tolerance so it would be too many pills to justify this medication for long term

Levetiracetam (Keppra) is an anticonvulsant that has positives and negatives. list them

good: doesn’t harm the lever like phenobarbital

bad: - has to be given up to 3 times per day

• it is expensive. cost $75 for 25 kg dog low end dose range

phenothiazine tranquilizers like acepromazine or haloperidol do what

antipsychotic

decreases inappropriate behavioral responses to stimuli

used to control learned fear responses like thunder and fireworks

what is a disadvantage to phenothiazine tranquilizers like acepromazine

reduces response to both normal and abnormal stimuli in their environment

Trazadone is a good drug for what

SARI serotonin antagonist reuptake inhibitor

• induces sedation and anxiolysis

• separation, noise phobia, vet visits, hospitalization

what are the three classes of antidepressants

tricyclic antidepressants

selective serotonin reuptake inhibitors

monoamine oxidase inhibitors

what are our tricyclic antidepressants

amitriptyline and clomipramine (Clomicalm)

what do tricyclic antidepressants like amitriptyline and clomipramine

decrease the reuptake of serotonin which allows the neurotransmitter to accumulate and prolongs the activity

amitriptyline also blocks the reuptake of norepinephrine

treat anxiety in dogs

Clomicalm (clomipramine) is used for what

OCD in dogs, also for separation anxiety and aggressive behaviors

what are the SSRIs selective serotonin reuptake inhibitors

fluoxetine, Fluvoxamine, paroxetine, sertraline

what do SSRIs do

enhance the effect of serotonin neurotransmitter by blocking the removal of the synaptic cleft

allows the serotonin to remain for a longer period of time to extend the effect

good for OCD, anxiety and agression

what are the monoamine oxidase inhibitors

selegilene (deprenyl or Anipryl)

most commonly used MAOI in vet med

what are monoamine oxidase inhibitors used for (anipryl)

treatment of cognitive dysfunction (old god senility)

increase the amount of dopamine found in cells of the CNS and enhance the effect

what are the anxiolytic drugs

tranquilizers that belong to the benzodiazepine group

diazepam, clonazepam

not frequently used for behavior modification

what is induction therapy

phase of chemo that is more intense therapy than maintenance

goal is to reduce the # of cancer cells, and ideally induce remission

what is maintenance therapy

a continuation of chemo that maintains remission and prevents relapse

what is rescue (salvage) therapy

re-induction chemo for patients who fail one standard protocol

what are the general side effects for chemo

inappetence, nausea, vomiting, diarrhea, dehydration, myelosuppression, alopecia

how can chemo drugs be absorbed to us

through the skin

inhalation

ingestion of food contaminated by aerosolization or direct contact

absorption or inhalation during opening of glass ampules

what are some things to remember for handling chemo drugs

prepare meds in vent hood in a low traffic area

wear proper PPE

use syringes and IV lines with screw-on attachments to prevent spillage

recheck the calculated dose

check that catheter is in vein and patent

discard syringes and needles in sealed bag immediately

storage of chemo drugs

• always wear gloves

• read storage requirements on container

  • store hazardous drugs separately from other drugs in a zip-lock

what should we do if a chemo drug is excreted in the urine or feces

encourage the px to urinate on soil where it will drain quickly

do not let the urine touch you

discard soiled bedding

contaminated surfaces washed gently

should pregnant women handle anything to do with chemotherapy

no

what are the most commonly used chemo drugs

• carboplatin

• chlorambucil

• cisplatin

• doxorubicin

• lomustine

• mitoxantrone

• vinca alkaloids

what is carboplatin used for

trade name: paraplatin

to treat osteosarcoma, melanoma, and a variety or carcinomas and sarcomas in dogs and cats

carboplatin and cisplatin comparison

carboplatin has less renal toxicity than cisplatin

carboplastin has greater myelosuppression than cisplatin

carboplatin will not cause vomting

what is a major drug reaction with carboplatin

aminoglycosides can increase risk of nephrotoxicity and vaccines may not be as effective

what patients do we not use carboplatin in

severe bone marrow suppression pxs

hypersensitivity to carboplatin

what is chlorambucil used for

trade name: Leukeran

immunosuppressant and antineoplastic

used in place of cyclophosphamide when patients are intolerant

adverse effects of chlorambucil

myelosuppression and GI toxicity

bone marrow suppression usually seen 1 month after treatment but can be treated if caught early

what is important to know about Chlorambucil

should not be given with food!

tablets must be stored in the refrigerator!

what is Cisplatin used for

trade name: Platinol-AQ

variety of carcinomas and sarcomas, intracavity lesions of equine sarcoids, and cutaneous neoplasias

what is the main adverse effect of cisplatin

nephrotoxicity

also myelosuppression

drug interactions with Cisplatin

aminoglycosides and amphotericin B can increase risk of nephrotoxicity

Furosemide increases risk of ototoxicity

what are contraindications of Cisplatin

cannot be used in cats!!!!!

causes fatal pulmonary edema and pleural effusion if administered systemically

also contraindicated in patients with renal impairment or myelosuppression

what is doxorubicin used for

trade name: Adriamycin or Doxil

lymphoma, leukemias, certain sarcomas and carcinomas in the dog

broadest spectrum antineoplastic drug in vet med

what are adverse effects of Doxorubicin

cardiac toxicity!!

bone marrow suppression, nephrotoxity, alopecia, gastroenteritis, stomatitis, extravastion leading to local phlebitis and pain (usually results in tissue necrosis)

what are some drug interactions with Doxorubicin

calcium channel blockers may increase risk for cardiotoxicity

phenobarbital may increase elimination

what are contraindications for Doxorubicin

myelosuppression patients

impaired cardiac function

patients who have reached total cumulative dose of doxorubicin

what is Lomustine used for

trade name: CeeNu

CNS neoplasma, lymphomas, mast cell tumors, and rescue agent for lymphosarcoma

what is the main adverse effect of Lomustine

hepatic toxicity in dogs

can also cause major bone marrow suppression, neutropenia

what are some drug interactions with Lomustine

immunosuppressive drugs may increase risk of infection

myelosuppressive drugs may cause additive bone marrow suppression

what is Mitoxantrone used for

trade name: Novantrone

lymphomas resistant to other drugs

25% higher response rate than Doxorubicin but does not cause mast cell degranulation

adverse effects of Mitoxantrone

mild to moderate GI toxicity

severe colitis, bone marrow suppression, lethargy, extravasation, turns the sclera of the eye and urine a blue-green color after therapy

what drug interactions should be considered with Mitoxantrone

vaccines should be used with caution during therapy

what is Vinblastine Sulfate used for

trade name: Velban

primarily for mast cell tumors in dogs and cats and rescue therapy in lymphosarcoma

adverse effects in Vinblastine Sulfate

severe consequences of extravasation resulting in phlebitis and pain

highly myelosuppresive, nausea, vomiting

what contraindications do we keep in mind with Vinblastine Sulfate

pre-existing leukopenia,

if neutrophil count is less than 5,000

if patient is suffering from severe bacterial infection

what do we use Vincristine Sulfate for

trade name: Oncovin

adjunct drug to treat lymphoma, leukemia, mast cell tumors, or soft tissue sarcomas

successful single agent for treatment of transmissible venereal tumors

over 90% cure rate

immune-mediated thrombocytopenia

adverse effects of Vincristine Sulfate

may cause more peripheral neurotoxic effects

severe consequences if extravasation occurs

anorexia or nausea

what is hypothyroidism

not enough thyroid hormone produced

what patients is hypothyroidism more commonly seen in

dogs

what drug is used for hypothyroidism

Levothyroxine (T4) supplement

adjust dose using TDM → therapeutic drug monitoring

what is TDM

therapeutic drug monitoring

POST PILL TESTING 4-6 hours after medication

blood sample at trough is most useful

what tubes do we not use in TDM samples

serum separator tubes

drug can diffuse into the gel and reduce the measured drug level

what is hyperthyroidism

when the thyroid gland produces too much thyroid hormone

CS: wt loss, PU/PD, increased activity, panting, unkempt hair coat, GI upset

hyperthyroidism is primarily a disease of

cats

what is the preferred treatment for hyperthyroidism in cats

Radioactive iodine (I-131)

should be quarantined until radioactivity is minimal

if we perform a surgical removal of the thyroid what do we have to do

make sure not to remove the parathyroid glands because it will induce life threatening hypocalcemia

what are other treatments of hyperthyroidism

Methimazole (Tapazole): maintenance therapy or prior to surgery or radioactive iodine therapy

orally or transdermally

adjust to lowest amount that controls symptoms and normal T4 concentrations

prone to bone marrow suppression, anorexia, vomiting, self mutilating of the face

Beta Blocker: Atenolol, a beta-1 selective antagonist

what is Diabetes mellitus

decreased production of insulin or decreased function of insulin

what oral tablet is used to treat Diabetes Mellitus

Glipizide

increases insulin secretion in type II diabetes

• only used in cats (25% of cats have type II)

causes GI, liver damage

insulin is nearly always a better choice

what is the best treatment for Diabetes mellitus

Insulin

necessary in dogs and preferred in cats

insulin is categorized based on

bovine: antigenically similar to cats

porcine: antigenically similar to dogs

human recombinant

short acting insulin is also referred to as

regular = crystalline insulin

(1-4 hrs)

given SC or CRI IV

emergency

intermediate insulin is

Lente (Vetsulin)

6-20 hr

SC

long acting insulin

PZI (protamine zinc insulin)

8-24 hrs

Galrgine

SC

what are the concentrations of insuin

40, 100, and 500 units/ml

if using insulin with a 40 U/ml concentration you must use what syring

U-40 syringe

same for other insulin concentrations

how do we reconstitute insulin

roll it not shake, it will create air bubbles if we shake it

complications with administration of insulin

patient does not eat

insulin shock= hypoglycemia

• due to overdose, decreased food intake, increased exercise

how to we treat hypoglycemia

50% dextrose IV approx 1cc/10 lbs dilute to 10-20 if using peripheral vein

clients can use karo syrup honey on gums

• only monosaccharides cross the gums

  • table sugar is a disaccharide that has to be digested before absorption occurs

what is an insulinoma

insulin-secreting tumor that causes hypoglycemia

give IV dextrose if animal presents for seizures

what is hyperadrenocorticism

Cushing’s disease

mainly a disease of dogs that is the production of extra cortisol

what are the two main drugs that are used for hyperadrenocorticism

Mitotane and Trilostane

what does Mitotane do

selectively destroys the adrenal cortex, works for both adrenal and pituitary dependent cushings

major toxicity is iatrogenic addison’s disease

monitor appetite closely during induction dosing and perform ACTH stim at first sign of decreased appetite

what does Trilostane do

inhibits enzyme necessary for cortisol production

approved in dogs

can cause iatrogenic addison’s disease

does not destroy tissue, more reversible in mitotane-induced addisons

what is hypoadrenocorticism

Addison’s disease

caused by a lack of glucocorticoids and mineralocorticoids

what is important to know about doing an ACTH stim test to diagnose hypoadrenocorticism

do not use prednisolone or prednisone until after ACTH stim test because it cross-reacts with cortisol on assay

what is the maintenance of hypoadrenocorticism

low dose prednisolone

PU/PD= dose too high

anorexia/vomiting = dose too low

meds used for addison’s disease

Fludrocortisone (Flurinef): has both glucocorticoid and mineralocorticoids activity

DOCP (Percortin): pure mineralocorticoid, given IM every 21-30 days

guide to maintenance therapy

PU/PD:

• decrease prednisone then decrease DOCP dose

• do not decrease DOCP interval

Depression, lethargy, vomiting, diarrhea

• increase prednisone dose

Hyperkalemia, Hyponatremia

• decrease DOCP interval 2-3 days

what is hyperparathyroidism

excess secretion of parathyroid hormone leading to high blood calcium

surgically treated disease to remove the parathyroid tumor

prior to surgery hyperkalemia must be managed

post-op hypokalemia must be managed