Companion Animal Therapeutics Flashcards
CaniLeish vacc (Virbac)
- Leishmaniasis (canine)
- Reduces risk of infection by promoting cell-mediated immunity
- Give to healthy seronegative dogs when at high risk
Eurican Herpes 205 (Boeringer)
- Canine herpes virus
- Pregnant bitches -> passive protection for puppies in first few days of life - Ab
- 1st = 7 - 10 d after mating date
- 2nd = 1 - 2 w before expected whelping
Milbemycin oxime, moxidectin, selamectin (Stronghold)
- Macrocyclic lactones (3-ML, clear)
- Endoparasites
- Ectoparasiticide
- Angiostrongylosis
Fenbendazole (Panacur), febantel
- Benzimidazoles
- Endoparasites - roundworms, e.g. angiostrongylus vasorum; protozoa - giardia
Praziquantel (Droncit/Drontal)
- Dipylidium tapeworm (endoparasite)
Phenypyrazole (fipronil)
- Ectoparasiticide
Imidaclopride / nitenpyram
- Ectoparasiticide
- Angiostrongylosis
Pyrethroids (nitenpyram)
- Ectoparasiticide
Amitraz
- Ectoparasiticide
- Demodex
Isoxazolines (Advocate, Advantage, Bravecto)
- Ectoparasiticide - treats most apart from tapeworms + ticks
Acaricide
- Mites + ticks
Insecticides
- Insects
Methoprene
- Juvenile hormone analogue, growth regulator
- Against ectoparasites
Lufenuron
- Insect development inhibitor, growth regulator
Delmadinone acetate (Tardak)
- Progestogen (synthetic analogue of P4)
- Temporary heat postponement
- Not licensed for use in females
- Male dogs - hypersexuality, prostatic hyperplasia (BPH)
Megestrol acetate (Ovarid)
- Progestogen (synthetic analogue of P4)
- Short-acting
- Temporary postponement of heat (start just before pro-oestrus)
- No longer licensed, may become again
- SE: steroid effect, good for Tx of pruritis, but if e.g. cat in dioestrus pot -> CEH pyo (P4 -> inc thickness of uterus, secretions, glandular secretions); P4 -> insulin resistance -> diabetes mellitus
Proligestone (Delvosteron)
- Cats, dogs, ferrets
- Progestogen (synthetic analogue of P4) - temporary heat postponement, only drug licensed
- Repeat injections in anoestrus/dioestrus
- Single injection in anoestrus/dioestrus
- Single injection at onset of pro-oestrus
- Not licensed in breeding male dog/cat
Milbolerone
- Synthetic androgen analogue (-ive feedback on HPG axis, tissues less responsive to E2)
- Prolonged oestrus postponement
- Unlicensed
Testosterone (Durateston)
- Androgen (-ive feedback on HPG axis, tissues less responsive to E2)
- Prolonged estrus postponement
- Not available in UK
- Dec spermatozoa + spermatozoal motility
- SE: prostatic hypertrophy; not licensed for use for control of breeding in males
Nandrolone
- Androgen (-ive feedback on HPG axis, tissues less responsive to E2)
- Prolonged oestrus postponement
- Licensed for CRF in cats
- SE: Masculising e.g. mounting behaviour, endometrial atrophy
Deslorelin (Suprelorin implant)
- GnRH agonist (desensitises GnRH receptors in anterior pit gland, dec LH + FSH production)
- Prolonged oestrus postponement / delayed onset of oestrus in bitches
- Licensed for use in prepubertal female dogs only (implant admin between 12 - 16 w/o), induced temporary infertility to delay first oestrus, initial dose causes surge of pit hormone release, may inc fertility until down-regulation occurs
- Benign prostatic hyperplasia (BPH) - dec FSH + LH -> dec testosterone -> smaller prostate
- Castration implant: slow release, long-acting implant; causes initial 14 d testosterone surge, then levels dec, infertility after 6 - 8 w implantation, lasts up to 6 - 12 m, longer in lighter dogs
- Induces infertility in male + female ferrets (only licensed in ferrets)
- Ovarian cysts - guinea pigs
- Oestrogen-induced mammary carcinomas - rats
- Egg-laying disorders (egg binding) - birds
- Ovarian agenesis Dx (absence of oestrus) - test E2 levels to see if inc if ovarian tissue present
- Induces oestrus; follicular cysts to induce ovulation
Aglepristone (Alizin)
- Dog, cat, rabbit
- Misalliance/preg termination
- Anti-progestogen (synthetic steroid), acts on uterus - main licensed drug
- Competes w/ P4 at receptor level, strong affinity for receptors in uterus, true competitor of any agonists
- Bitch: 2 doses 24 h apart from d 1 to d 45 after mating
- Queen: 2 doses 24 h apart early after mating give better results (off-license)
- Give in dioestrus - check vag cyto to make sure not too early
- Expensive
- Induction of parturition (un-licensed)
Oestadiol benzoate (Mesalin)
- Synthetic oestrogen - changes biochemical environment, affects transit time of zygote in ovduct, direct embryotoxic effects, early in preg (3 - 5 d post mating)
- Preg termination, no longer licensed
- SE: BM suppression, CEH, pyometra
- Cheaper
- Use Alizin
Prostaglandin (PGF2/PGF2a) (Dinoprost)
- Misalliance/preg termination (more common in mixed/FA)
- Lyse CL (but in dog, CL resistant to effects), cause uterine contractions (acts on ovaries)
- Serious SE if CVR disease present
- Not licensed for use in cats/dogs in UK
- PGF2-alpha may be used in for medical management of pyo
- Induction of parturition (un-licensed)
Cabergoline (Galastop)
- Misalliance/preg termination / abscence of oestrus, luteal ovarian cysts
- Inhibits prolactin production (prolactin maintains CL) -> luteolysis of CL at pit gland -> induces oestrus, bitch starts cycling again
- SE: transient hypotension
- Used in combo w/ PGF2a
- Pseudopregnancies - dopamine agonist - suppresses prolactin, when see more of clinical signs
Oxytocin
- Induction of parturition (un-licensed) (non-obstructive medical management) - rapid onset (minutes)
- Stimulation of uterine contraction to facilitate parturition in presence of fully dilated cervix
- Promote involution of post-parturient uterus + aid passage of retained placenta
- Aid control of post-partum haemorrhage
- Spastic, uncoordinated contractions of uterus if oxytocin admin rapid/high dose, delay parturition
- Control of post-partum haemorrhage
- Management of uterine prolapse (after replacement)
Nitroglycerine
- Induction of parturition (un-licensed)
- Softens cervix
Improvac
- GnRH agonist - suppresses FSH + LH (desensitises receptors to GnRH) preventing ovulation + sperm production
- Females only
- Hoofstock only
- Require course of primary vaccinations 4 - 6 w apart, then repeat injection every 4 m; considered effective 4 w after second primary injection
- [Pig castration - induces antibodies against GnRH to produce a temporary immunological suppression of testicular function, removes boar taint]
Permethrin
- Growth regulator, ectoparasiticide
Calcium gluconate
- Non-obstructive dystocia
- Induces uterine contractions
- Hypocalcaemia (peri-parturient disease) - eclampsia, puerperal tetany
Dextrose solution
- Non-obstructive dystocia, shortens parturition
- Hypoglycaemia (peri-parturient disease)
Doxapram
- NSAID
- Stimulation of respiration in neonates, dystocia
- Not used anymore
Amoxicillin
- Penicillin
- IV AB therapy for fading puppy/kitten syndrome
- (+ Calvulanic acid, beta-lactamase inhibitor)
- Acute disease/during leptopspiraemia (canine leptospirosis)
- Suspected parvovirus, if neutropoenic
- Acute D+ + systemic signs
- Mastitis
Cephalexin
- Cephalosporin - IV AB therapy for fading puppy/kitten syndrome
- Neonatal septicaemia
- Acute D+ w/ systemic signs indicating risk of bacteraemia/sepsis
Enrofloxacin (Baytril)
- AB (fluroquinolone)
- Neonatal septicaemia
L-tryptophan, L-theanine
- Nutraceutical - target affected neurotransmitters (serotonin, dopamine)
- Stress management
Fluoxetine, Alprazolam, Selegiline
- Stop nutraceuticals
- Target affected neurotransmitters (serotonin, dopamine, GABA)
- Stress management
Doxycycline
- Chronic renal carrier state of Canine Leptospirosis
Itraconazole
- Oral antifungal
- Aspergillosis
Clindamycin
- Toxoplasma gondii
Pimobendan
- Dilates blood vv -> strengthens heart’s ability to contract
- Congestive heart failure (dilated cardiomyopathy/valvular insufficiency)
- Inodilator - positive inotropic effect + vasodilatory action -> dec cardiac preload + afterload
- Phosphodiesterase (PDE) III inhibitor - can inc intracellular Ca^2+ + myocardial oxygenation
- Direct action on heart may be reduced in dogs w/ heart disease
- Vasodilation occurs by activity at periphery
- Mitral valve disease, pre-clinical DCM + CHF secondary to DCM
(Give w/ furosemide)
Furosemide
- Tx of fluid retention (oedema) + swelling due to CHF -> inc flow of urine in kidneys
- Loop diuretic, inhibits Na^+/K^+/Cl^- transporters
- Loss of Na^+/K^+/Cl^- + water in urine, excretion of Ca^2+/Mg^2+/H^+ increased
- Rapid onset effect (10 min after IV), short duration of action
- Renal failure
Famciclovir
- Antiviral prodrug
- V expensive
- FHV-1 keratitis; corneal sequestrum
- Expensive
- Cat flu (FHV - mainly, DNA virus)
Remdesivir and GS-441524
- Antiviral
- FIP
- Remdesivir = 10 mg/mL
- GS-441524 = 50 mg tablets - can be crushed + divided
Metronidazole
- AB
- Chronic D+/chronic enteropathy (IBD) (cats - not AB responsive)
- Clostridium perfringens (cat)
- Maybe giardia
- Category D AB - antibiotic responsive diarrhoea
- Bactericidal for Gram +ve / Gram –ve anaerobes
- Inhibits nucleic acid function by preventing DNA repair
- At high doses antiprotozoal – used for Giardia infection
- Appears to modulate the immune system – beneficial in ARD (IBD)
- (Doxycyclines + tetracyclines preferred)
Tylosin
- AB
- Chronic D+/chronic enteropathy (IBD) (cats - not AB responsive)
Oxytetracycline
- Chronic D+/chronic enteropathy (IBD) (cats - not AB responsive)
Rifampicin
- Macrolide AB
- Mycobacterial infection - Mycobacterium avium complex, leprosy
Clarithromycin
- Macrolide AB
- Mycobacterial infection
Ciprofloxacin
- Fluoroquinolone AB
- Mycobacterial infection
Ronidazole
- Anti-protozoal
- Tritrichomonas fetus (blagburni) protozoa (cat)
Maropitant
- Anti-emetic
- NK1 receptor antagonist
- 24 h action
Ondansetron
- Anti-emetic
- Anti-serotonergic (5-HT)
- Prescribing cascade (not licensed in animals, only humans), expensive, third line (when metoclopramide/maropitant not tolerated)
Metoclopromide
- Pro-kinetic + anti-emetic
- Dopamine D2 receptor antagonist at CRTZ
- Increases ACh release in upper GI tract
- Useful for preventing gastro-oesophageal reflux & promoting gastric emptying (acts on smooth muscles for contraction), not used for constipation (no effect on lower GIT)
Sucralfate
- Gastric protectant
- Mucosal-protectant
- Complex which reacts with stomach acid to form a paste, binds to proteins in ulcers forming protective barrier, stimulates PGE2 secretion
Omeprazole
- Gastric protectant
- Acid blocker, go-to drug - highly effective
- Suppresses stomach acid secretion
- Proton pump inhibitor
- GI signs in chronic renal failure
Ranitidine
- Gastric protectant
- General effect
- Rabbit - ileus
Famotidine
- Gastric protectant
- H2 blocker
- GI signs in chronic renal failure
Methadone
- Opioid
- μ Receptor agonist
- Dogs, cats
- 10 - 15 min IV, 20 - 30 min IM onset
- 4 hrs duration
- Strong analgesic
- NMDA antagonist
(Morphine has same effects)
Pethidine
- Opioid
- μ Receptor agonist
- Dogs, cats, horses
- <10 min IM onset
- 2 hrs duration
- Moderate analgesic
Fentanyl
- Opioid
- μ Agonist
- Dogs
- 1 - 2 min IV onset
- 20 min duration
- Very strong analgesic
Buprenorphine
- Opioid
- μ Partial agonist
- Dogs, cats, horses
- 45 - 60 min IM/IV onset
- q 6 - 8 hrs dogs + cats; 12 - - 24 hrs horse duration
- Moderate analgesia
- Can be give PO, e.g. during 1 w of ‘wash-out’ period of changing NSAIDs
- Breakthrough pain in chronic pain
Butorphanol
- Opioid
- μ Agonist / κ agonist
- Dogs, cats, horses
- 5 - 15 min IM/IV onset
- 0.5 - 6 hrs duration
- Mild analgesic - after procedure
- Use more for sedation, cannot top-up
Atipamezole
- Alpha-2 adrenoreceptor antagonist
- Licensed reversible of all effects for medetomidine/dexmedetomidine
Naloxone
- Opioid reversal
- Overdose
Adrenaline
- Stimulation of alpha-1 receptors in vascular smooth muscle -> vasoconstriction -> inc aortic diastolic pressure -> inc coronary perfusion pressure (CPP) + inc cerebral perfusion
- CPA - speeds up heart
- Low dose = 0.01 mg/kg
- High dose = 0.1 mg/kg
Atropine
- Inhibits muscarinic actions of Ach on structures innervated by postganglionic cholinergic nerves + smooth mm. -> inhibition of parasympathetic NS -> inc HR, bronchodilation, dec GI + resp secretions
- CPA - when inc vagal tone (dec HR, dec BP, hyperthermic) = ocular Sx, brachycephalics
- Max two doses in CPR
- Antidote for cholinesterase inhibitors - given to Tx symptoms in surgery, dries up salivation, reverse bronchoconstriction
- Also used for bradyarrhythmia
- Reverses excess vagal activity, Tx for bradyarrhythmia
- Peripheral + central antimuscarinic effects, depresses vagus -> inc HR
- If due to glycoside toxicity, withdraw/reduce dose
- Pacemaker implantation
Lidocaine
- Antidysrrhythmic class I
- Block Na^+ channels
- Rapid onset, IV bolus short duration (10-15 min), CRI
- Ventricular tachyarrhythmias dogs, cats, horses
- Cats more sensitive to neurotoxic effects
- Don’t use lidocaine + adrenaline solution in combo - counterproductive (adrenaline speeds up heart)
Apomorphine
- Emetic
- Dopamine (D2) agonist
- Stimulates CRTZ
- Dogs
- Dec absorption of toxins/GI decontamination
Ropinirole
- Emetic
- Drops into conjunctival sac then wash out eye when want to stop V+
- Dog
- Dec absorption of toxins/GI decontamination
Xylazine
- Alpha-2 agonist
- Sedative (high dose)
- Low dose = emetic, dec absorption of toxins/GI decontamination (cat)
Dexmedetomidine
- Alpha-2 agonist
- Sedative
- Dec absorption of toxins/GI decontamination (cat)
Hydrogen peroxide (H2O2)
- Dec absorption of toxins/GI decontamination
Activated charcoal
- Improves elimination/avoids reabsorption of toxins
- Powder better
- Makes faeces black
Lactulose, Sorbitol
- Laxative
- Improves elimination/avoids reabsorption of toxins
- Fermented in the large intestine to acetate and
lactate with consequent osmotic laxative effect. - Adjusted based on individual response
Antivenom
- Antidotes - snakes + spiders
Bisphosphonates
- Toxin antidote - VitD3/cholecalciferol
- Chelating agent for heavy metals
Fomepizole/ethanol
- Toxin antidote
- Ethylene glycol
Vit K1
- Toxin antidote
- Anticoagulant rodenticide
Acetylcysteine
- Toxin antidote
- Supports liver
- Paracetamol toxicity
Diazepam
- Muscle termor + seizure management
- Mycotoxicosis
Methocarbamol
- Muscle relaxant for muscle tremors
- Can be given rectally
- Organophosphate, carbamate, pyrethroid, metaldehyde toxicity
Intravenous lipid emulsions (ILE)
- Trap for lipophilic toxins -> dec free substance in circulation
- Organophosphates, carbamates, permethrin, macrolytic lactones - ivermectin, marijuana, lidocaine, NSAIDs, bromethalin, amphetamine, amlodipine, phenobarbital
- 1.5 mL/kg bolus followed by 0.25 to 0.5 mL/kg/minute constant-rate infusion
Mannitol
- Diuretic - inc blood flow to kidneys
- Acute renal failure
- Osmotic diuretic - hyperosmotic agent
- IV over 20 min
- Glaucoma
- (Reduced efficacy in uveitis due to breakdown of blood aq barrier)
Atenolol / metoprolol
- Antidysrhythmia class II
- Beta 1-adrenoceptor selective antagonists (beta-blockers)
- Competitive antagonists of noradrenaline + adrenaline, reduce O2 consumption, slow HR and improve filling
- Hypertrophic myopathy in cats
- Avoid in patients w/ CHF
- To dec high BP
Propranolol
- Antidysrhythmia class II
- Beta 1 and 2 (mixed) - adrenoceptor antagonist (beta-blockers)
- Competitive antagonists of noradrenaline + adrenaline, reduce O2 consumption, slow HR and improve filling
- Hypertrophic myopathy in cats
- Avoid in patients w/ CHF
- Not used anymore as beta-2 receptors in lungs + is non-selective
Sotalol
- Antidysrhythmia class III
- Prolong cardiac action potential through blockade of K^+ channels, inc refractory period in all cardiac tissues
- (+ Has non-selective class II actions)
- Chronic treatment of ventricular + supraventricular tachyarrhythmias
- Avoid in CHF (class II actions)
- Monitor plasma levels
Amiodarone
- Antidysrhythmia class III
- Prolong cardiac action potential through blockade of K^+ channels, inc refractory period in all cardiac tissues
- (+ class I, II, IV actions)
- Slow + variable GI absorption, slow onset action
- Variable efficacy, high freq of non-cardiac effects, only use when other agents ineffective
- Monitor plasma levels
Diltiazem
- Antidysrhythmia class IV
- Ca^2+ channel blocker - negative inotrope (dec myocardial contractibility), slows conduction in SA + AV nodes, vasodilation -> dec BP
- Supraventricular tachyarrhythmias, atrial tachycardia, flutter, hypertrophic cardiomyopathy (HCM) in cats
Verapamil
- Antidysrhythmia class IV
- Ca^2+ channel blocker - negative inotrope (dec myocardial contractibility), slows conduction in SA + AV nodes, vasodilation
- Second choice
Digoxin
- Antidysrhythmic agent
- Dec HR by reducing freq of SA node firing + inhibiting AV nodal conduction
- Treats atrial fibrillation
- Narrow therapeutic window, may cause excessively low HR
- Cats more sensitive to toxic effects than dogs
Pimobendan
- Inodilator - positive inotropic effect + vasodilatory action -> dec cardiac preload + afterload
- Phosphodiesterase (PDE) III inhibitor - can inc intracellular Ca^2+ + myocardial oxygenation
- Direct action on heart may be reduced in dogs w/ heart disease
- Vasodilation occurs by activity at periphery
- Mitral valve disease, preclinical DCM + CHF secondary to DCM
Dobutamine
- Inc myocardial contraction - direct acting synthetic catecholamine w/ direct beta-1 adrenergic agonist effects = positive inotropic
- Hypotension during anaesthesia - inc contractibility of heart w/o vasoconstriction, direct beta-1 adrenergic agonist = positive inotrope, increases BP
- Potent + short acting - CRI
- Produces less tachycardia compared to other beta-1 agonists
- Emergencies for acute HF
Benazepril / enalapril
- AKA Fortekor
- ACE inhibitors - vasodilation, reduce BP
- Dec proteinuria
- Manage hypertension, CHF, CKD
- Usually combined w/ other drugs
- Hypertensive retinopathy
Telmisartan
- Angiotensin II Receptor Blocker (ARBs) -> dec BP
- AKA Semintra (go-to)
- Angiotensin II receptor blocker (ARB)
- BID then SID
- Chronic renal failure - hypertension + proteinuria
- Cats
Furosemide
- Loop diuretic, inhibits Na^+/K^+/Cl^- transporters
- Loss of Na^+/K^+/Cl^- + water in urine, excretion of Ca^2+/Mg^2+/H^+ increased
- CHF
- Rapid onset effect (10 min after IV), short duration of action
- Diuretic (urinate out extra fluid), alleviates vol overload, IV/CRI
- Oliguric/anuric renal failure
- Acute kidney injury
Torasemide
- Loop diuretic, inhibits Na^+/K^+/Cl^- transporters
- Loss of Na^+/K^+/Cl^- + water in urine, excretion of Ca^2+/Mg^2+/H^+ increased
- Longer duration of action (once daily), angry cats
Spironolactone
- Diuretic, aldosterone receptor antagonist - binds competitively w/ mineral corticoid receptor in kidneys, heart + blood vv
- K^+ sparing diuretic - dec extracellular vol -> dec cardiac preload + left atrial pressure
- Inhibits aldosterone-mediated fibrosis + remodelling of myocardium + vasculature
- CHF (hypokalemia) + can be combined w/ other drugs
- Feline hyperaldosteronism (Conn syndrome)
Chlorothiazide / hydrochlorothiazide
- Thiazide diuretics - bind to Cl^- site of distal tubular Na^+/Cl^- co-transport system -> loss of Na^+ + Cl^- in urine
- 2nd/3rd line in end-stage HF (continued use -> disproportionate Cl^- loss -> acid-base disturbances + hypokalaemia
Amlodipine
- Calcium channel blockers - in vascular smooth muscle, class IV antidysrhythmic drug
- Anti-hypertensive in cats + dogs
- Gradual onset + slow waning effect, slow binding + dissociation from channel
- Little reflex tachycardia occurrence = safe drug long-term use in hypertension
- Once daily dosage
- One dose every 24 h, can double dose if no response
- Chronic renal failure - hypertension, causes peripheral vasodilation
- Hypertensive retinopathy
Butorphanol / codeine
- Antitussive - dec freq of coughing, painful non-productive/where coughing -> emphysema/inc intracranial pressure (dry cough)
- Suppress medullary cough centre
Bromhexine (dembrexine)
- Decongestant / mucolytic - inc secretion of fluid
Salbutamol / terbutaline
- Bronchodilator - beta-adrenoceptor agonist -> inc cyclic AMP -> relaxation of bronchial smooth muscles
- Tx of bronchospasm in inflammatory airway disease + irritation in cats + dogs
Theophylline
- Bronchodilator - methylxanthine, similar structure to caffeine + theobromine, relaxes smooth muscle + relieves bronchospasm, stimulant effect on respiration
- Dilates coronary aa. + inc strength of contraction of myocardium; acts on kidney to induce diuresis + potent stimulant of CNS
Prednisolone / dexamethasone
- Oral glucocorticoids - inhibit transcription of genes responsible for production of mediators convolved in airway inflammation (cytokines, chemokines, adhesion molecules)
- Manage exacerbations + establish control
Beclomethasone / fluticasone
- Inhaler glucocorticoid - inhibit transcription of genes responsible for production of mediators involved in airway inflammation (cytokines, chemokines, adhesion molecules)
- Maintain patients on inhaled
Methylprednisolone
- Prolonged release glucocorticoid steroid
- Useful for cats with asthma
Penicillins / cephalosporins
- E.g. Amoxicillin - broad-spectrum, systemic penicillin effective against Gram +ve and Gram -ve bacteria, inhibit bacterial cell wall synthesis
- Clavulanate potassium = irreversible inhibitor of bacterial β-lactamases and prevents hydrolysis of amoxicillin
- Streptococcal meningitis (S. suis I)
Oxytetracycline / doxycycline
- Tetracycline - inhibit protein synthesis in susceptible bacteria - bacteriostatic
- Broad spectrum activity - gram +ive + gram -ive bacteria - Pasteurella, Bordetella bronchiseptica, Staphylococcus aureus (+ other staph spp.) + streptococcus spp.
- Good lung penetration
Trimethoprim
- Folate antagonist – bacteriostatic
- Often combined with sulphonamides – ‘TMPS’ - bactericidal
- Combination has broad spectrum of activity, effective against Gram +ve and Gram -ve bacteria, including Streptococci, Staphylocci and Pneumococci spp)
Itraconazole (voriconazole / fluconazole)
- Antifungals - belong to azole class of antifungals
- Highly selective binding for fungal cytochrome P-450 isoenzymes, inhibit the synthesis of ergosterol (essential component of cell membranes for fungi
- Affect membrane-bound enzyme function
and membrane permeability, resulting in structural degeneration of the fungus
Diazepam, midazolam
- Benzodiazepines - pre-anaesthetic/sedation + anxiolytic + muscle relaxant
Atracurium, vercuronium
- Non-depolarising neuromuscular blocking agents (NMBAs)
- ACh antagonists, produce motor paralysis, muscles cannot contract
- Reversed using anticholinesterases e.g. neostigmine, pyridostigmine
Suxamethonium
- Neuromuscular blocking agents (NMBAs), depolarising agent
- ACh receptor agonist - not metabolised by acetylcholinesterase -> end plate cannot repolarise = irreversible
Glucosamine, chondroitin sulfate, antioxidants, EFAs
- Neutraceuticals, arthritis
- Component of cartilage, counter potentially damaging oxidants, weak anti-inflam properties
Polymixin B
- Binds to phospholipids in bacterial cytoplasmic mem + disrupts mem
- Bactericidal, G -ive bacteria
- Last resort category, B
Beclomethasone
- Anti-fungal
Grapiprant
- Non-steroidal, non-cyclooxygenase inhibiting anti-inflammatory drug
- Selective antagonist of the EP4 receptor - important in editing pain + inflammation
Pentosan polysulfate sodium (NaPPS)
- Semi-synthetic polymer with anti-inflammatory properties - lameness/DJD pain/OA in dogs
- Reduces metalloproteinases, preserving proteoglycan content and protecting cartilage matrix from degradation
- E.g. Cartrophen
- Duration of effect variable – max 3 courses of 4 injections in 12 months
- Concurrent use with steroids and NSAIDs contraindicated (risk of bleeding due to combined effects on platelet aggregation)
Bedinvetmab / frunevetmab
- Anti-NGF monoclonal antibody therapy
- Nerve growth factor (NGF) increases inflammatory mediators and stimulates nociceptors
- Bedinvetmab = a canine monoclonal antibody (mAb)
- Frunevetmab = a felinised mAb targeting NGF
- For long-term management of OA pain (not acute pain)
- Do not use in young animals (under 12 months) – critical role in development – or in pregnant or lactating animals (potentially teratogenic and foetotoxic)
Paracetamol
- NSAID with analgesic and antipyretic but weak anti-inflammatory (not long-term)
- MoA not clear - seems to have specific activity for the CNS COX enzyme, COX3 (few GI effects), may also reduce conduction in pain sensory neurones (action through TRPA1 ion channel)
- When NSAIDs cannot be used
- Careful with the dose in dogs – no veterinary product licensed, DO NOT USE IN CATS (do not have enzyme for metabolism)
- Oral w/ codeine
- Dog dose = 10 mg/kg PO (or IV) q 12 h
Tramadol
- Centrally acting analgesic with complex, weak opioid
- Mechanism of action involving opioid, norepinephrine, and serotonin receptors - reuptake inhibition
- Weak Mu opioid receptor agonist, synthetic analogue of codeine
- Oral - capsules/tablets
- Onset 1 - 4 h
- Management of mild to moderate acute pain + adjunctive analgesic in management of chronic arthritic pain
- Sedation at high doses, dysphoria more likely in cats
- Can be combined with other classes of analgesics - not as effective in dogs due to differences in metabolism - prefer Amantadine
Gabapentin / Pregabalin
- Analogue of the neurotransmitter GABA (GABA-A receptors control inhibitory of signalling), treatment of neuropathic pain
- Suppress glutamate + substance P release, interacts w/ neuronal Ca2+ channels, reduced depolarisation of mem of dorsal horn
- Cats - chronic pain
- Oral capsules
- Onset > 3 d
- MoA of its analgesic effect is unknown
- Start with a low dose and increase slowly
- May cause mild sedation and ataxia
Withdraw therapy slowly too (potential for rebound pain shown in humans) - E.g. Neurontin
L-deprenyl (Selegiline)
- Monoamine oxidase inhibitor, inc noradrenaline and dopamine, neuroprotective functions: improves memory & longevity; anxiety/social withdraw
- Dogs 0.5-1mg/kg PO SID;
- Cats 1mg/kg PO SID (not licensed)
- At least 4 weeks before positive effect may be seen (typically 8 weeks)
- Monoamine oxidase-increased cognitive function disorders
- For cognitive dysfunc
Amantadine
- Glutamate + NMDA receptor antagonist, not first-line
- For OA
- Oral - syrup or tablets
- Onset 4 - 6 w
- Excreted by kidneys
- Blocks excitatory signals in the CNS (mechanism similar to ketamine)
- Used in multimodal treatment for progressive moderate-severe OA pain and for pain relief in osteosarcoma - hyperalgesia (central sensitisation)
- Can increase risk of seizures when used in combination with tramadol
- Not first line - not licensed in vet species
Sodium levothyroxine - soloxine, thyrforon
- T4 supplement tablet
- Canine hypothyroidism (Addison’s), feline hypothyroidism