9. HORMONES Flashcards
SMALL ANIMALS
treatment of canine hypothyroidism
-LEVOTHYROXINE
synthetic form of thyroxine T4: life long T4 supplement
levothyroxine: goal
no clinical signs of disease
levothyroxine monitoring
clinical response + peak TT4 concentration
levothyroxine improvement
can take weeks to months
levothyroxine overdose
dogs are resistant to thyrotoxic effects of excessive T4 supplement
-up to 20x standard dosage
-clinical thyrotoxicosis over 90 nmol/l: panting, weight loss, hyperactivity, tachycardia, hyperthermia
>most signs resolve within few days of withdrawing therapy
levothyroxine gradual introduction
with concurrent illness : cardiac, hypoadrenocorticism, DM
>25-50% of starting dose
treatment of feline hyperthyroidism
anti-thyroid drugs: METHIMAZOLE
methimazole if too much
T4
methimazole anti-thyroid drug decrease production of
thyroid hormone, decrease circulating concentrations of thyroid hormone, reverse thyrotoxicosis
methimazole dose must be
titrated to individual needs
methimazole …. within 2-3 weeks
euthyroidism
methimazole doses adjusted to achieve
basal serumm tT4 concentration that is at or below middle of reference range for tT4
>trandermal
methimazole adverse effects within… and life threatining adverse effects
first 3 month
> life–threatining adverse effects: agranulocytosis, thrombocytopenia, severe hepatopathy
methimazole common and mild adverse effects
-GI signs: nausea, vomiting, lethargy, diarrhea
-leukopenia
-eosinophilia
-lymphocytosis>usually resolve despite continuing treatment
methimazole … therapy
life long
….tends to advance despite treatment with anti-thyroid drugs, thus commonly necessitates increases in drug dosage over time > in order to maintain euthyroidism
feline hyperthyroidism
…. regulates glucose metabolism
insulin
increases glucose uptake in peripheral tissues, increases glucose storage in liver, inhibits gluconeogenesis
insulin
insulin, treatment of
diabetes mellitus
insulin goal
control blood glucose below renal threshold as much of 24h period as possible > improve clinical signs > avoid clinically significant hypoglycemia
feline insulin
glargine insulin: long acting
canine insulin
porcine insulin zinc: intermediate acting
insulin dosage based on
patients estimated ideal body weight
insulin dosage should not be
increased more than q1-2w
insulin pharmacokinetics
vary depending on: insulin type, product formulation and individual patient’s response
insulin … window on each side of dosing interval
12 +/- 2h
…inactivated insulin
freezing/heating
insulin dosing
pens
treatment for canine pituitary dependent hyperadrenocorticism=CUSHING SYNDROME
trilostane
trilostane inhibit
synthesis of adrenocortical hormones cortisol and aldosterone
cushing syndrome, trilostane, goal
control of cortisol secretion
trilostane administer
with food q12h
trilostane monitoring
-frequent monitoring : clinical signs > ACTHST
trilostane adverse effects
-well tolerated
-lethargy
-mild electrolyte abnormalities
-GI signs: vomiting, diarrhea, inappetence
treatment of canine hypoadrenocorticism: ADDISON’S DISEASE
glucocorticoids
canine hypoadrenocorticism: ADDISON’S DISEASE has … deficiency
glucocorticoid (+mineralcorticoid)
chronic treatment of glucocorticoids
predisolone PO
-life-long supplementation
treatment of typical hypoadrenocorticism in addition to glucocorticoid
mineralcorticoids
:deoxycorticosterone pilavate (DOCP)/fludrocortisone
>electrolyte monitorin; Na ja K
fludrocortisone
mineralcorticoids
-dose adjusted by assessing serum Na and K conc > increase until Na:K is >28
