1. HORSES Flashcards
DRUGS
most commonly used drug classes
-sedation
-analgesia
-antibacterial drugs
-some others
SID
1x day, Q 24h
BID
2x day, Q 12h
TID
3x day, Q 18h
QID
4x day, Q 6h
sedation: PHENODIAZINE
acepromazine
ACEPROMAZINE: mode of action
antagonizing dopamine
ACEPROMAZINE: sedation
-transportation, hoof trimming/shoeing, clipping
-nervous mare in clinic with foal
-laminitis
sedation: ACEPROMAZINE: anesthesia premedication
-less arrhythmias
-better recovery
ACEPROMAZINE routes
po, im, iv
ACEPROMAZINE: side effects
SYSTEMIC HYPOTENSION:
- can outlast sedation
- contraindicated in dehydrated, anemic and in shock horses
-contraindicated: foals, old horses
-contraindicated: stallions
ACEPROMAZINE: side effects > prescription drug
SHOULD NOT BE SOLD TO OWNERS FOR USE IN HOME
-misuse and overdosing
-increasing dose do not increase effect but side-effects
sedation and analgesia: A2-AGONIST> sedation ?
-dose-dependt
-low head-carriage
-decr. locomotor activity
-decr. response to stimulation
sedation and analgesia: A2-AGONIST> analgesia
-comparable to NSAIDS, OPIOIDS
sedation and analgesia: A2-AGONIST> also used as
premedication for general anesthesia (GA)
A2-AGONIST effect shows
-few min
-after IV administration
A2-AGONIST can be combined with
-opioids
-phenothiazine
A2-AGONIST: side-effects
-ataxia
-bradycardia and transient hypertension followed by hypotension
-decr.GI motility and decr. intestinal blood flow
-slow down esophageal motility: do not allow eating 2hours after sedation > risk of esophageal obstruction
-smooth muscle relaxation in upper airways
-hyåerglycemia, mydriasis, decr. HCT, sweating
sedation: A2-AGONIST : drugs
-xylazine: better analgesia in colic than opioids or flunixin
-detomidine: do not give 20 min before or after IV TMPS, sublingually onset of action 45min
-romifidine: produces less ataxia. less analgesia than xylazine or detomidine, analgesia lasts 1-3h
sedation and analgesia: OPIOIDS- mono therapy?
NOT as monotherapy in horses > always require alpha2-agonist or acepromazine
sedation and analgesia: OPIOIDS- BUTORPHANOL: 1.mechanism of action 2. description 3. side-effects
1.mechanism of action: partial myy-opioid receptor agonist, partial antagonist
- description: most used in horses: best pain relief amongst opioids, least side-effects, effect 30-90min
- side-effects: high doses can cause excitement, reduced GI motility, sudden head movements, ataxia
sedation and analgesia: OPIOIDS- MORPHINE: 1.mechanism of action 2. description 3. side-effects
- myy-opioid receptor agonist
- potentiates sedative and analgesic effect of other drugs
- anxiety (particularly in absence of strong pain), ileus , ataxia
opioids to use with?
ALWAYS use with alfa2-agonist > opioids CNS excitement otherwise!
analgesia: NSAID-how often used?
most common used drug class in horses
NSAID: main control?
control of pain (esp. inflammatory) and inflammation
-soft tissue
-musculosceletal
-colic pain
NSAIDS: used
-pain management
-fever
NSAIDS: mode of action
decreases eicosanoids in inflammatory lesions over inhibition of cyclooxygenases (COX)
NSAIDS: side effects > mostly mediated by?
> mostly mediated by? >INHIBiTION OF COX-1
-inhibition of intestinal motility, inc. colonic motility
-gastric and intestinal (right dorsal colon) ulceration> ponies more sensitive > more risk in hypovolemic horses or with prolonged treatment
-renal damage > geriatric, hypovolemic, hypotensive horses or horses with renal, cardiac or liver damage > renal papillary necrosis and Aki (Acute Kidney Injury)
-PLATELET DYSFUNCTION
NSAIDS: can combine with ?
-opioids
NSAIDS: FLUNIXIN MEGLUMIN
-most effective NSAID for visceral pain > caution when using
-anti-endotoxic in lower dosages > prevents some hemodynamic effects of endotoxemia
NEVER IM!!!! CLOSTRIDIAL MYOSITIS!!!
NSAIDS: PHENYLBUTAZONE
-mostly used orthopedic pain
-relatively narrow therapeutic index
-should be used with other drugs that bind to plasma proteins >gentamicin, sulfonamides
-hay delays oral absorption
NSAIDS: MELOXICAM
-More COX-2 selective than COX-1
-not as effective as flunixin in colic patients
-do not use in donkeys useless)
NSAIDS: KETOPROFEN
-very effective analgesic and anti-inflammatory agent
-not as effective as PBZ (PhenylButaZone) but less than melox
NSAIDS: CARPROFEN
-effective analgesic but weak anti-inflammatory agent
-more cox-2 selective than flunixin or PBZ but less than melox
-not investigated for colic pain
-better analgesic when pain is inflammatory in origin
NSAIDS: COXIBS > FIROCOXIB
-very strongly COX-2 selective
-FIROCOXIB
-if IV-solutions available > similar analgesia to flunixin in acute colic > can not be given/flushed with saline (precipitates)> flush with blood
SPASMOLYTICS: BUTYLSCOPOLAMINE
-spasmolytic used in colic
-sometimes combined with dipyrone
-analgesia lasts app.20min
-concurrent ttachycardia
-often used before rectal examination
ANALGESIA: LIDOCAINE-usage
-colic: pain management and treatment of ileus, anti-inflammatory
-decreases repercussion injury
local anesthetics: ways of insertion (1-4)
- subcutaneously > perineurial, around wound(infiltration)
- intraarticularly
- epidural anesthesia
- volume depends on area
local anesthetics: LIDOCAINE 2%
-rapid onset (4min), shortest duration (less 1,5h)
-causes most swelling and local irritation > unreliable in lameness examinations
-max. dose 250ml to 500kg > can be used as topical anesthetic
local anesthetics: BUPIVACAINE 2%
-slow onset, prolonged duration more than 3h
-toxic to chondrocytes = rustosolut!! (more than lidocaine)
-more potent than lidocaine and mepivacaine
local anesthetics: MEPIVACAINE 2%
-rapid onset (similar to lidocaine)
-least irritation to tissues, least toxic to chondrocytes
-less vasodilation compared to lidocaine, less effective as topical anesthetic than lidocaine
ANTIBIOTICS
USE WITH CARE
-not to use reserved ABs
protect me- BEVA- protects ABs in future of equine health
ANTIBIOTICS: WHICH AB TO CHOOSE?
-empirical
-bacterial culture > culture and sensitivity whenever possible
-reserve group AB
-route of administration
-price
-availability
-side - effects
-reactions with other drugs
AB: PENICILLINS (2)
- PROCAINE BENZYLPENICILLIN - NOT IV
- Na-BENZYLPENICILLIN - IV SLOWLY
side effects: soft feces, head shaking, salivation, mild colics
AB: AMINOGLYCOSIDES (2)
- GENTAMICIN - Irritate muscle, clostridial myositis -often as local ad.
- AMIKACIN
=concentration dependent
AB: AMINOGLYCOSIDES, side-effects
-nephrotoxicity : check creatinine before adm. > not dehydrated animals
-ototoxicity
-rarely as monotherapy
POTENTIATED SULFONAMIDES-added with?
-enhance effect of ABs
POTENTIATED SULFONAMIDES
-TRIMETOPRIM+SULFAMERAZINE
-TRIMETOPRIM+SULFADIAZINE
=NEVER IN SEDATED HORSES - sudden drop in BP, arrhythmia and death possible if combined with use of A2-AGONIST
TETRACYCLINES
-broad spectrum
-DOXYCYCLINE
-OXYTETRACYCLINE-nephrotoxic > very high doses treat contractures in foals 1x use (lihakset jänteet tai nivelsiteet jatkuvasti jännityksessä)
CEFALOSPORINES - generations (not often used in horses) (4)
- generation: CEFALEXIN, CEFAZOLIN, CEFADROXIL
2.generation: RESERVED AB!!!!!!! - generation: CEFTIOFUR, CEFOTAXIM
4.generation: CEFQUINOME
FLUOROQUINOLONES - broad spectrum, reserved AB (2)
very good for gram-
- ENROFLOXACIN: very good tissue penetration, not for young or growing horses (risk arhropathies)
- MARBOFLOXACIN: considered to cause less arthropaties than 1
NITROIMIDAZOLES
-METRONIDAZOLE : anaerobes, protozoa
side - effectL: inappetence, diarrhea
-prohibited animals for slaughter > note to passport
GLUCOCORTICOSTEROIDS - systemic (2)
- DEXAMETHASONE
- PREDNISOLONE
-laminitis risk! mostly in horses with EMS or PPID
-CORTISOL suppression
GLUCOCORTICOSTEROIDS: inhaled - alternative for respiratory disease (2)
- FLUTICASONE
- CICLESONIDE
-improve lung function
-safer regarding side-effects than systemic
-no cortisol suppression
drugs used in gastric ulcer treatment (5)
- OMEPRAZOLE: suppress gastric acid production (proton pump inhibitor)-more effective in empty stomach. for treatment of glandular and non-glandular ulcers
- ESOMEPRAZOLE: suppress gastric acid production (proton pump inhibitor)-cumulative effect from 5th day
- SUCRALFATE: binds to ulcerated mucosa, stimulated mucous secretion, PGE synthesis, enhances blood flow-add every glandular ulcer treatment protocol
- MISOPROSTOL: suppress gastric acid production: also anti-inflammatory effect > may cause abdominal pain- ONLY GLANDULAR ULCERS
- RANITIDINE: suppress gastric acid production (H2-receptor antagonist) > less effective: sometimes to ‘‘tail up’’ omeprazole
using medication in foals
-foals are not small adult horses!!
-always more cautions in foals reg. side-effects
-OFTEN DIFFERENT DOSAGES AND DOSING INTERVALS
routes of administration: systemic administration
-oral PO
-intramuscular IM
-intravenous IV
-per rectum PR
-subcutaneus SC
routes of administration: local administration
-intra-articular IA
-intravenous regional limb perfusion IVRLP
-local anesthesia
-into eye CORNEAL SURFACE
-inhalation
-nebulisation
-epidural anesthesia
administering drugs PO
-flush syringe 50-100 ml
-insert syringe from corner of mouth
-rise head up
-let horse swallow
-feed in stomach changes absorption of many drugs
administering drugs IM part 1
-choose right place
-insert whole needle im
-aspirate
-hold needle from hub and inject
administering drugs IM part 2
-absorption varies in different sites injection sites : neck>pectorals>gluteals>semimembranosus
-possible reactions at inj.sites: accesses, cellulitis, muscle swelling, pain
-not enough muscle mass Is limiting
-some drugs too irritating, painful
administering drugs IV
-needle
-single use IV catheter
-IV catether > sterilely
administering drugs IV part 2
-use upper 3rd of neck
-stasis
-insert needle into vein
-aspirate before and after administration
-take off stasis
-remove needle
administering drugs SC
-few systemic drugs
-local anesthesia
-nerve blocks
-lift up skin > easier to insert needle
administering drugs into eye
-ointment > medial canthus > 3rd eyelid
-break needle until hub
-open eyelids (no pressure on eyeball)
-spray from distance
-eye lavage system if many drugs, long-term treatment or horse does not allow to medicate
administering drugs into eye
-5min between diff. drugs
-when using drops only, serum is always last
-ointments always last
drug inhalation
-equihaler or babyhaler
-chake vial, insert drug into chamber>can be done away from horse
-put inhaler on 1 nostril
-let horse inhale 1-2min
NEBULIZATION
-nebulization: converts liquid to aerosol, inhalation, NaCl, gentamicin, dexamethasone and other hormones
IV regional limb perfusion
mostly aminoglycosides are used
-torniquet, nose twitch,, sedation if needed
