Drugs for treating reproductive disease Flashcards
Prostaglandins have what physiological effects?
Stimulate cervical dilation, increase myometrial activity.
Lysis of corpora lutea - progesterone concentrations then of course decline.
Clinical indications for prostaglandin use: (2)
Use: pyometra, metritis (expulsion of uterine content)
Prostaglandin F2-alpha/its synthetic analog
cloprostenol given what route with what frequency?
SC q12-24h 3-5 days,
in dogs intra vaginal misoprostol (prostaglandin E)
Effects within 30 min and persist 20-30 min.
Synthetic product has fewer side effects but may be less effective.
Side effects of prostaglandins
are dose dependent, diminish with repetition: panting, nausea,
vomiting, diarrhea, salivation
Given before feeding to reduce
anorexia/nausea.
● Risk of uterine rupture (closed cervix
pyometra).
● Pyometra recurrence is common after
treatment.
What is aglepristone?
A progesterone receptor blocker, trade name Alizin.
Indiication for use of aglepristone (2)
Use: pyometra to open closed cervix, chemical abortion induction
(Success rate in dogs with pyometra 75%,
success has been reported in cats)
Side effects of aglepristone
less severe than with prostaglandins: restlessness, loss of appetite,
diarrhea, abdominal cramps
Pyometra can be treated pharmacologically with what combo?
Pyometra: prostaglandins + progesterone receptor blocker (aglepristone)
● Decreased side effects, improved results
● Prostaglandin is a more effective uterotonic agent.
Alternatively,
prostaglandins + dopamine agonist (cabergoline)
What is cabergoline?
Effects?
Indicationn for use?
A Dopamine agonist drug, trade name Finilac / Galastop.
Rapid luteolysis - reduces plasma progesterone concentrations quickly.
Use: pyometra
Dopamine agonists effect on lactation.
such as cabergoline (Galastop)
Reduces prolactin secretion and milk production (antiprolactin therapy).
Use: galactostasis and severe mastitis if weaning, pseudocyesis (pseudopregnancy)
Pyometra treatment may include antibiotics in some cases. Describe the ABs.
● E coli - amoxicillin, amox/clav, cephalosporins, potentiated sulphonamides - potentially a combination.
● Combination of antimicrobials in life-threatening peritonitis, severe sepsis, septic shock.
Metritis, mastitis may occur within a week or two of whelping.
Treatment? (2)
Cephalexin, amox/clav safe for neonates
What drug causes teeth discoloration in juvenile animals?
tetracyclines
What drug causes Impaired cartilage development in juvenile animals?
Fluoroquinolones
What drug causes Autoimmune disorders and bone marrow suppression
in juvenile animals?
Sulfas (ABs)
Chloramphenicol use in nursing bitches and/or neonates?
Safety to neonates has been questioned owing to its association with toxicity in human infants.
Safe Analgesia for nursing bitches. (3)
Opioids
● Perioperatively in lactating dams
● Short term use is safe
● Avoid nursing neonates during peak drug levels and time nursing before the next dose
Tramadol
● Opiate-like agonist
● Efficacy for pain control controversial
NSAIDs
● Galactostasis, mastitis
● Neonates’ exposure in milk is a concern
● Use cautiously and short term
Oxytocin physiological effect (3)
Increases strength and duration of uterine contractions.
Stimulates milk ejection (but not synthesis!).
Indications for clinical use of oxytocin: (1)
Use: uterine causes of dystocia, only used if there is no evidence of obstruction.
Oxytocin administration dose and frequency.
0.25-2 IU/dog IM/IV, dose may be repeated 2 or 3 times at 30 min intervals or after each successful birth
+/- 10% calcium gluconate slowly IV before/concurrent with any subsequent dose of oxytocin even if serum Ca is WRI
+ glucose if hypoglycemic
Medicine appropriate for aiding slow labor. (3)
Oxytocin 0.25-2 IU/dog IM/IV, dose may be repeated 2 or 3 times at 30 min intervals or after each successful birth
+/- 10% calcium gluconate slowly IV before/concurrent with any subsequent dose of oxytocin even if serum Ca is WRI
+ glucose if hypoglycemic
If no fetus is delivered after three doses of oxytocin (+/- calcium, glucose), cesarean section is recommended.
If labor begins and a fetus is delivered, wait 30-45 min to determine if another dose is needed. Note that, Each additional dose of oxytocin may elicit a weaker response.
Describe Oxytocin effect on milk ejection.
● Causes contractions in the myoepithelium surrounding alveolar ducts
● Lacks galactopoietic properties so it stimulates milk ejection but not synthesis.
Metoclopramide is an
(primperan)
Antiemetic dopamine antagonist that promotes an increase in prolactin and milk production in whelping dams.
Indication: e.g. Agalactia
Side effects: CNS side effects: restlessness, agitation, ataxia
What is Domperidone?
Domperidone Brand name: Motilium
Is a Peripheral dopamine receptor antagonist - increases prolactin and milk
production.
Indication: e.g. Agalactia
Side effect: diarrhea
Why might you favor domperidone instead of metoclopramide for agalactiae?
Less permeable to the blood–brain barrier than metoclopramide and CNS effects are unlikely.
Acepromazine is a
Phenothiazine agent that Blocks postsynaptic dopamine receptors in the central nervous system.
It decreases anxiety, increases prolactin release.
Repro. related indications: anxious dam with agalactia. Nervous dams.
If used with metoclopramide, it may increase its CNS effects, so don’t.
Eclampsia treated with
10% calcium gluconate slowly IV, then CRI/SC until PO is possible. Wean or handfeed the puppies for at least 24 hours if not longer.
Nursing discontinued if hypocalcemia recurs.
Risk of Bradycardia/arrhythmias - stop administration and start slower.
Monitor body temperature (tremors can cause hyperthermia)
Glucose measurement
Calcium carbonate PO during the remaining period of lactation.
Treatment?
IVFT stabilization,
opioids (e.g. methadone, fentanyl)
maropitant
ABs (amox+clav) if needed
optionally alizin/aglepristone
then surgery, OHE
Treatment?
if infection: ABs. Must be safe for neonates!
e.g. amox.+clav., ampicillin
Opioids if needed
NSAIDs (there are some risks with nursing neonates)
paracetamol?
maropitant for appetite stimulation
cabergoline/Galastop if puppies old enough and can be weaned, otherwise - no.
Treatment?
cabergoline/Galastop 5 mcg/kg PO q 24h for 5-7 days
