Day 2 - 1. Peroral, subcutaneous, intramuscular and intravenous drug application; microchip implantation.

Question 1

Application route of choice depends on:

Answer 1

– drug formulation
– product labelling
– required onset of action
– (place of action) 
– routes available

Question 2

Peroral medication - Indications

Answer 2

– Usually for long-term medications (owner)
– Drug effect on the GI tract (probiotics, activated charcoal)
– Drugs with systemic effect

Question 3

Forms of Peroral medications:

Answer 3

– peroral formulated drugs (pills, liquids)
– radiography contrast -gastrointestinal tract studies
– forced feeding

Question 4

Peroral application - Contraindications

Answer 4

1. Head and neck trauma
2. Decreased mental state
3. Recent surgery
4. Known/suspected injury of GI tract
5. Vomiting /regurgitation, dysphagia
6. Non-cooperative patient (risk of injury)

Question 5

1.Head and neck trauma

Answer 5

• tissue or bone injury
• damaged innervation
• decreased mental state

Question 6

2.Decreased mental state, definition:

Answer 6

• shock
• stupor
• coma
• seizure
• inability to swallow (properly)

Question 7

3.Recent surgery , what are the time limits?

Answer 7

stomach/bowel: <12-24h;

eosophagus: longer

Question 8

4.Known/suspected injury of GI tract, what kind of injury?

Answer 8

Perforation,

Foreign body/ileus

Question 9

5. Vomiting /regurgitation, dysphagia, what can help?

Answer 9

antiemetics, feeding position

Question 10

Peroral application - technique, Pilling:

Answer 10

– palatable / hidden in food or pill pockets
– Forced pilling: placement on base of tongue: mouth opening + close right after pill is placed
– induce swallowing (if necessary) flush with some water

Question 11

Peroral application - technique, liquids

Answer 11

– palatable (((mixed with food??)))
– mouth/muzzle kept rather closed during liquid administration with patient’s nose pointing horizontal or a bit upwards
– use lateral cheek pouch or diastema behind canine teeth to administer
– let the patient swallow during administration!

Cats: very small oral cavity volume! (0.5 ml!)
Agressive dogs: possible with tied muzzle

Question 12

Peroral application - complications

Answer 12

• Aspiration!
• Injury of patient
• if necrosis (e.g. foreign body ileus) or perforation was present; recent surgery
• Injury of the person treating the patient
• altered mental state of patient; agression; pain
• Inappropriate dosage – vomiting, regurgitation, spitting out the drug

Question 13

What does the needle size depend on?

Answer 13

(dogs, cats: 18-25 G)

• Patient size
• Admin route
• Injection thickness
• Injection volume

Question 14

:)

Answer 14

Keep up the good work!!

Question 15

Subcutaneous application - Indications

Answer 15

– injectable drugs labelled for sc. use 
– fluids (isotonic crystalloid infusions) 
– microchip
– hormone implants
– slower onset of action

Question 16

Subcutaneous application - Contraindications

Answer 16

• Drugs NOT labelled for sc. use
• oily injections, tissue irritative injections
• Poor s.c. adsorption (enrofloxacin, buprenorphin)
• If faster onset of action required and other admin. route available. (relative CI: bleeding diathesis, dermatitis)

Question 17

Subcutaneous infusion, general facts:

Answer 17

-Treat mild dehydration
-ONLY isotonic crystalloids!
-NOT: hypertonic, G containing, mannitol, colloids, blood products, lipid or amino acid infusion (tissue necrosis!!!)
-Amount: max. 10(-20) ml/kg per spot
– large dogs: max. 200 ml per spot
-warmed fluids
-Use large bore needle, often directly from infusion bag

Question 18

Subcutaneous injection - Complications, local:

Answer 18

• Hemorrhage/hematoma
• Granuloma (vaccines)
• Abscess (sterile/non-sterile)
• Tissue irritation, necrosis
• injection site sarcoma (even years later!)

Question 19

Subcutaneous injection - Complications, systemic reactions:

Answer 19

Allergy - hypersensitivity reactions, urticaria, angioedema, anaphylaxis!
- i.v. application by mistake

Question 20

Intramuscular drug application, indications

Answer 20

• Labelled for i.m. use
• Oily injections: always i.m.
• Tissue irritative drugs: often labelled to (deep) i.m. use

Question 21

Intramuscular drug application, contraindications:

Answer 21

– hemorrhagic diathesis

– myositis

Question 22

Intramuscular injection

• Localisation:

Answer 22

m. supra-, infraspinatus
m. triceps brachii
m. quadriceps femoris
m. semitendinosus/semimembranosus dorsal lumbar epaxial muscles
• drug volume: max. 2-5 ml per patient per muscle! (dep.on weight)

Question 23

Intramuscular injection - technique

Answer 23

Disinfection!
• Stick perpendicular
• Aspirate
• Slow injection

Question 24

Intramuscular injection - complications, local reactions

Answer 24

– Hemorrhage/hematoma
– Abscess (sterile / non-sterile)
– Tissue irritation, necrosis
– Peripheral nerve injury!

Question 25

Intramuscular injection - complications, systemic reactions

Answer 25

– Allergy, hypersensitivity reactions - anaphylaxis!

– i.v. application by mistake • e.g. oil embolism

Question 26

What do we use for the Intravenous drug application?

Answer 26

i.v. catheters / butterfy needle

Question 27

Intravenous drug application, appropriate veins:

Answer 27

• v. cephalica antebrachii
• v. saphena lateralis (dog)
• v. femoralis
• V. jugularis
• V. dorsalis pedis

Question 28

Intravenous injection

• Indications

Answer 28

– injections labelled for i.v. use
– fast onset of action required & i.v. route available
– (tissue irritative drugs: often i.v.)

Question 29

Intravenous injection, contraindications

Answer 29

oily injections or suspensions NEVER i.v.!!!!!

– (known/suspected hypersensitivity reaction to the drug or product!)

Question 30

I.v. injection - technique

Answer 30

• Aseptic technique
• Clipping the hair
• Disinfection of the skin
• Vein punction in 15-30- angle
• Aspirate blood prior injection
• Release vein compression
• Inject slowly

Question 31

Intravenous injection - complications, local reactions

Answer 31

– hemorrhage, hematoma
– phlebitis, thrombophlebitis, thrombosis
– Paravenous injection and necrosis

Question 32

Intravenous injection - complications, systemic

Answer 32

Systemic reactions
– hypersensitivity reactions 􏰀 anaphylaxis!!!
– septicaemia
– air embolism
– drug side effects are more likely if given too rapidly (e.g. apnea 􏰀 propofol, barbiturates; bradycardia, cardiac arrest 􏰀 potassium, calcium etc.)

Question 33

Microchipping in hungary:

Answer 33

Dogs: obligatory
Cats: mandatory

Dogs: country database; owner/keeper data, Rabies vaccination data and special remarks available for veterinarians if microchip number is known.

– Rabies vaccination, vaccination book No., pet passport issued: obligatory registration by veterinarian
– microchip insertion process strictly regulated

Question 34

Process of microchipping

Answer 34

– read patient before the insertion
– read microchip before insertion (and match with badge number)

– prepare site = left side of neck
– insert microchip
– read microchip
– registration:
• web database
• vaccination book, pet passport, pedigree paper etc. 
• veterinary facility database
• checking microchip before intervention