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ANESTHESIA > 14 – Small Animal NSAIDs > Flashcards

14 – Small Animal NSAIDs Flashcards

1
Q

Small animal NSAIDs examples

A
  • Carprofen (dogs)
  • Meloxicam (cats+dogs)
  • Coxibs
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2
Q

Carprofen

A
  • Considered ‘COX2 selective’
  • Racemic mixtures (S+R enantiomers)
    o S-enantiomer more potent
  • Oral chews and injectable
  • *only DOGS
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3
Q

Carprofen indications

A
  • Osteoarthritis (chronic)
    o *strong evidence
  • Post-op pain
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4
Q

Carprofen adverse events

A
  • Low, but variable incidence of vomiting and diarrhea
  • Idiosyncratic (NOT dose-dependent) hepatic toxicity in dogs!
    o Very rare (NOT HIGHER in LABS)
    o Within few days/weeks of therapy
    o Pre-treatment blood samples necessary to know (check liver enzymes)
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5
Q

Meloxicam

A
  • ‘COX-2 preferential’
  • Oral suspension, tablets, infectable
  • EBM analysis for arthritis=’high level of comfort’
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6
Q

Oral suspension of meloxicam: dog vs. cat doses

A
  • Dogs: 1.5mg/ml
  • Cats: 0.5mg/ml
  • *useful formulations=can come up with WHATEVER DOSE you want
  • **can use the LOWEST EFFECTIVE DOSE and TITRATE your way down
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7
Q

Meloxicam indications

A
  • Acute AND CHRONIC musculoskeletal disorders (dogs)
  • Acute musculoskeletal disorders (cats)
  • Post-op pain (orthopedic, soft tissue surgery)
    o Better than post-op butorphanol
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8
Q

Meloxicam adverse events

A
  • Dogs: typical
    o Low incidence of vomiting and diarrhea (similar to carprofen)
  • USA: NO musculoskeletal claim in cats (‘black box warning’)
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9
Q

Coxibs

A
  • COX-2 selective
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10
Q

Coxibs examples

A
  • Deracoxib (tablets, dogs)
  • Firocoxib (tablets, EQUINE as well)
  • Robenacoxib (oral+injectable, dogs and cats)
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11
Q

Coxibs indications

A
  • Chronic osteoarthritis
  • Orthopedic post-op pain (dogs)’
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12
Q

Coxibs adverse events

A
  • Low incidence of vomiting and diarrhea
  • Renal tubular degeneration at high doses
  • Cases of GI perforation at high doses
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13
Q

Firocoxib dose between dogs and horses

A
  • Dog dose is 50x more (5mg/kg dog vs. 0.1mg/kg horse)
    o Both get a 57mg tablet!
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14
Q

Robenacoxib (Onsior tablets) indications for cats

A
  • Relief of ACUTE pain and inflammation with cat bites and scratches
  • As an adjunctive medication in control of postoperative pain and inflammation
  • *Control of pain and inflammation with CHRONIC MUSCULOSKELETAL disorders (only one that has chronic)
  • *highly COX2 selective (maybe not great?)
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15
Q

Robenacoxib (Onsior tablets) indications for dogs

A
  • Control of pain and inflammation associated with OSTEOARTHRITIS
  • As an adjunctive medication in control of POSTOPERATIVE pain and inflammation with soft tissue surgery
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16
Q

‘old’ small animal NSAIDs

A
  • Ketoprofen (only large animal now)
  • Tolfenamic acid
  • Phenylbutazone
  • Dipyrone
  • Vedaprofen
17
Q

What about human NAIDS to use in vet med?

A
  • Not approved for vet med
  • *toxicity
    o Ibuprofen is a big one! (most cases do survive)
  • *’cheap alternative’ (NOT worth the RISK!)
18
Q

Safety and efficacy of human NSAIDs for small animals?

A
  • Not nearly as good as approved vet drugs
  • *smaller therapeutic window (increased effective dose and decreased toxic concentration)
19
Q

Small animal ‘not NSAIDs’ for osteoarthritis

A
  • Galliprant (dogs)
  • Solensia (cats)
  • Liberla (dogs)
20
Q

Galliprant

A
  • Recently approved for use in dogs with arthritis
  • Oral tablet
  • *PGE2 receptor antagonist (NOT a COX inhibitor)
    o Blocks EP4 receptor
21
Q

Galliprant blocks EP4 receptor

A
  • Involved in mediating pain and PGE2-elicted sensitization of sensory neurons
22
Q

Why use galliprant?

A
  • Theory might be safer than NSAIDs?
    o Since not blocking the production of PG, just the PG receptors
  • Data shows efficacy is likely worse!
  • Concurrent use with NSAIDs not recommended
    o Adverse events likely to occur
  • Ex. animal that already has GI problems or kidney issues
23
Q

Gallipratn adverse reactions

A
  • *relatively low incidence=safer than NSAIDs
  • Vomiting
  • Diarrhea
  • Anorexia
  • Lethargy
  • Buccal ulcer and IMHA (lower)
24
Q

Galliprant efficacy

A
  • Not fantastic treatment success
  • Slight difference between treatment and placebo
25
Q

Solensia

A
  • Recently approved to use in cats with arthritis
  • *monoclonal Ab specific for FELINE nerve growth factor (NGF)
  • Not really a drug, technically a ‘biologic’
  • Dose: 1-2mL/cat SC, repeated monthly
  • *doesn’t fix the osteoarthritis
26
Q

Nerve growth factor (NGF)

A
  • Upregulated during chronic inflammatory conditions (Ex. osteoarthritis)
  • Involved in pain response
27
Q

Solensia pharmacokinetic(PK) highlights

A
  • Long-acting injection
    o Half-life of 10-12 days
    o One injection per month
    o Two injections to reach steady state
  • **doesn’t get broken down quickly
    o Proteolysis (inactive peptides)
28
Q

o Proteolysis (inactive peptides)
Solensia efficacy and safety

A
  • It works and seems safe
  • Hard to do the studies in cats
  • Not necessarily better than NSAIDs
29
Q

Librela (bedinvetmab)

A
  • Approved for dogs with arthritis
    o Monoclonal antibody specific for canine NERVE GROWTH FACTOR (NGF)
  • Safe (only 1% do dogs developed anti-drug antibodies
30
Q

Is it good idea to combine NSAIDs with ‘not-NSAIDs’ for multi-modal osteoarthritis analgesia?

A
  • Don’t really know yet
  • *benefits of multimodal analgesia is well documented
  • BUT
    o Efficacy may not be synergistic for theses types
    o Choric use might be riskier than other analgesic regimes
  • ADVICE: be cautious, use LOWEST NSAID dose
31
Q

Pharmacovigilance (adverse event reporting): NSAID safety

A
  • Increased reported AE does NOT mean less safe (need a denominator)
  • Conditions of use vary between NSAIDs (one time vs. life-long)
  • Voluntary reporting can be skewed
  • Hard to find accurate data, objective comparisons are difficult
32
Q

Systematic review of NSAID safety in dogs

A
  • High evidence for carprofen, firocoxib and meloxicam
  • Less evidence for deracoxib, ketoprofen, robenacoxib (not necessarily less safe)
  • Vomiting and diarrhea most common clinical signs
  • Hepatic events more likely to be an idiosyncratic hepatoxicity (dose independent)
  • Kidney and GI can be DOSE-dependent
33
Q

NSAIDs in cats and safety

A
  • Decrease glucuronidation and hepatic clearance of NSAIDs=increase half-life
  • *approved products: meloxicam and robenacoxib
  • Firocoxib: minimal safety data
  • Carprofen: highly variable half-life between cats
34
Q

Meloxicam adverse drug events in cats

A
  • Renal failure caused by hypovolemia?
    o No change in GFR in euvolemic, healthy cats!
    o No change in GFR in euvolemic cats with azotemia
    o *dehydrated cats (and other animals)=more at risk of renal injury
  • Idiosyncratic or other mechanisms
  • Did NOT appear to reduce lifespan
  • Relatively now
35
Q

Is it okay to use Meloxicam in cats with chronic renal failure?

A
  • Make sure HYDRATED
  • Progression of renal failure is NO worse than a control group
  • Using a very small dose
  • Some evidence: may slow down progression of kidney disease?
36
Q

Long term NSAID use in cats summary

A
  • *can be done successfully
37
Q

What have we learned about NSAID use in small animals?

A

o GI lesions
o Other GI signs
o Hepatic and renal damage
- *no newer NSAIDs are consistently more effective than others
- *USE THE LOWEST EFFECTIVE DOSE!

ANESTHESIA (27 decks)

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