Anticoagulant Toxicity - Dog - VIN Flashcards

1
Q

These are derivatives of _______

A

Dicoumarol, a mycotoxin

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2
Q

AR inhibit which enzyme?

A

Vitamin K epoxide reductase

It stops recycling of vitamin K

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3
Q

How many generations ?

A

First and second

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4
Q

Which generation is more harmful and more common in toxicosis cases?

A

2 nd

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5
Q

Most common concentration is ?

A

0.0025 to 0.25 %

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6
Q

Name the vitamin k dependent factors

A

2,7,9,10

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7
Q

How long after infestion of toxic dose does coagulopathy develop?

A

3-7 days

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8
Q

Does PT become prolonged first or PTT

A

PT

Clinical hemorrhage not seen until both PT and PTT are SIGNIFICANTLY elevated

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9
Q

What dose merits veterinary management?

A

1st gen = >0.5 mg/kg

Others > 0.02 mg/kg

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10
Q

Can transdermal exposure cause coagulopathy?

A

No

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11
Q

Can ingestion of single poisoned rodent cause toxicosis?

A

UNLIKELY

possible if regular consumption ie barn cats

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12
Q

Whats limitation of measuring coagulation paramters?

A

Might not be accurate if pet has SEVERE liver disease

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13
Q

Does fdp increase in all cases?

A

50 percent only

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14
Q

Immediate rx?

A
  • stabilise life threatening signs first

- decontamination

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15
Q

Some info about stabilizing life threatening signs?

A
  • rx seizures if present
  • provide o2
  • provide blood replacement as needed(whole blood or FFP)
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16
Q

What does decontamination include?

A
  • emesis within 4-6 hrs

- activated charcoal after emesis

17
Q

Specific rx?

A

Vitamin K1

Oral route preferred
Other option is SQ

Can give injectable sol as oral in small patients

18
Q

Can we give vitamin k 3?

A

No

Only vitamin k1

19
Q

Dose of vitamin k1?

A

2.5-5 mg/kg PO/SQ SID or divided BID

  • don’t give IV → anaphylactic shock*
    Takes 6-12 hr for new clotting factors to form
    give with fatty meal
20
Q

Duration of initial rx with vit k1?

A

Warfarin 2 w
Bromadiolome 3 w
Others 1 m

Rx beyond this time frame might be needed if large dose infested.

21
Q

Supportive care?

A
  • avoid exercise for 1 week after therapy ended
  • avoid IM inj
  • avoid highly protein bound durgs such as nsaids
  • avoid other drugs such as metronidazole, neomycin, cimetidine, salicyclates
22
Q

When to recheck pt?

A

2-3 d post stopping k1

23
Q

What if pt still high on recheck?

A

R/o reexposure and continue it for 1-2 weeks more then again recheck 2-3 days post stopping

24
Q

Prognosis?

A

Good if prompt dx and rx

Otherwise it is second most common toxin causing death in comapnion animals

25
Differentials ?
``` Liver failure Other causes of vit k deficiency Dic Coagulation factor deficiency Thrombocytopathia Vw disease ```
26
Initial signs are vague; later on it depends on the location of bleeding T/F
T most common presentation is DYSPNEA -eg: brain → seizure - Bloody vomit and diarrhea are least common presentation
27
Most common presentation in ACR toxicity is ?
**DYSPNEA**
28
How long does if take for clotting factors to form after vitamin K1 ?
6-12 hr So if active bleeding then pet needs direct clotting factors i.e. whole blood,fresh plasma,FFP
29
What if pet ingested non toxic dose of ACR?
- close observation - check PT in 48 hrs - if PT normal → no Rx needed - if PT high → follow Rx protocol
30
5 most common symptoms in ACR toxicity?
• Lethargy • Anorexia • Increased RR/RE(**dyspnea**) • Hemoptysis • Lameness Initial signs are vague; later signs depend on location of bleeding; bloody vomit and diarrhea are least common symptoms Most common symptom is **DYSPNEA**
31
Dose of FFP and whole blood if needed in case of acute bleeding in ACR toxicity?
FFP = 10-20 ml/kg IV over 1-2 h WB = 20-40 ml/kg If anemia then (FFP + pRBC) or WB can be chosen If no anemia then FFP can be chosen