Exam 5 Flashcards
Hormone Drugs Lecture
Progesterones
- Function in reproduction
-Pro gestational
-Predominant hormone during diestrus
- Affects on the reproductive cycle
-Suppresses estrus behavior
-Female will not be receptive to natural mating
-Closes cervix
-Decreases myometrial contractions
-Lowers immune function locally within the uterus
-Prolonged use can contribute to pyometra
- Indications and modifications on the reproductive cycle
-Synchronization protocols (CIDR, melengestrol acetate)
-Maintenance of pregnancy: oral or injectable
-Estrus suppression
- Scenarios of positive/negative feedback loops
-Negative feedback on LH
- Generic and trade names for common drugs
Progesterone (P4): Altrenogest (Regumate, Altresyn, Matrix), MGA: melengestrol acetate (oral), Progesterone in oil (injectable), CIDR: controlled internal release drug (intravaginal)
Estrogens
- Function in reproduction
-Enhances estrus behavior
-Primes uterus for contractility
-Predominant in estrus
- Affects on the reproductive cycle
-Opens cervix
-Heightens immune function locally within uterus
- Indications and modifications on the reproductive cycle
-Synchronization protocols
-Enhances effects of being in estrus
-Thickens vaginal wall in bitches
-Induces behavior of estrus
-Interferes with unwanted breeding in dogs
-Treatment for urinary incontinence
-Can induce bone marrow suppression
- Scenarios of positive/negative feedback loops
-Negative feedback to FSH
- Generic and trade names for common drugs
-Estradiol 17B: naturally occurring, unconjugated.
-Estriol (Incurin): urinary incontinence in dogs
-Esterified estrogens (injectable): estradiol cypionate, estradiol benzonate.
-Estradiol valerate: longest acting
-Estrogen sulfate (Premarin): from fetus to placenta, good indicator of fetal vialibility
Testosterone
- Function in reproduction
-Muscle building
-Appetite stimulant
-Stops cyclicity
- Affects on the reproductive cycle
-Stops cyclicity
- Indications and modifications on the reproductive cycle
- Scenarios of positive/negative feedback loops
-Negative feedback on LH
-Stops cyclicity
- Generic and trade names for common drugs
-Mibolerone (Cheque Drops, Matenon)
-Stanozolol (Winstrol V)
Gonadotropins
- Function in reproduction
-Regulate FSH and LH release from the pituitary
-Secreted by hypothalamus
-Pulsative relase
- Affects on the reproductive cycle
-Initiate cyclicity
-Initiate ovulation
-Treat cystic ovarian syndrome
- Indications and modifications on the reproductive cycle
-Long term use can down regulate LH/FSH
- Scenarios of positive/negative feedback loops
-Causes release of LH
- Generic and trade names for common drugs
-Synthetic: Gonadorelin (Crystorelin, Factrel, Fetagyl)
Deslorelin equine (SucroMate, Ovuplant)
Bruserelin, xxxrelin (ferrets)
-Primarily causes release of LH
Prostaglandins
Side effects due to Arachidonic Acid Cascade
-Vomiting
-Sweating
-Colic
-Inappetence
- Function in reproduction
Prostaglandin F2-alpha
-Lyse luteal phase: short cycle the estrous cycle
-Stimulate uterine contractions: ecbolic
- Affects on the reproductive cycle
-Short cycle the estrous cycle (PGF2a)
-Smooth muscle relaxant (PGE1,2)
- Indications and modifications on the reproductive cycle
-Cervical relaxation
-Oviductal relaxation
- Scenarios of positive/negative feedback loops
- Generic and trade names for common drugs
Prostaglandin F2alpha
-Dinoprost tromethamine (Lutalyse)
-Cloprostenol sodium (Estrumate)
Prostaglandin E1, E2.
-Dinoprostone Gel (Primigyn or Prepidil) PGE2
-Misoprostol (Cytotec) PGE1
Dopamine antagonists
- Function in reproduction
-Stimulating lactogenesis
- Affects on the reproductive cycle
-Decreases dopamine
-Increases prolactin
- Indications and modifications on the reproductive cycle
-Stimulation of lactogenesis primarily fescue toxicosis
- Scenarios of positive/negative feedback loops
- Generic and trade names for common drugs
Equidone Gel trade name
Dopaminergic agents (Agonist)
- Function in reproduction
- Affects on the reproductive cycle
- Indications and modifications on the reproductive cycle
-May decrease milk production
-Induce abortion
-Treatment for Equine PPID
- Scenarios of positive/negative feedback loops
- Generic and trade names for common drugs
Pergolide (Prascend)
-Equine PPID treatment
Bromocryptine and Cabergoline (Dostinex)
-Induce abortion in dogs
Glucocorticoids
- Function in reproduction
- Affects on the reproductive cycle
- Indications and modifications on the reproductive cycle
- Scenarios of positive/negative feedback loops
- Generic and trade names for common drugs
Others
Follicle Stimulating Hormone
-Secreted by pituitary
-Target granulosa cells or sertoli cells
-Increase estrogen production
-Stimulated follicular growth
Used to superovulate
-Folltropin trade name
-reFSH: recombinant equine FSH (EquiPure)
Luteinizing Hormone
-Target the ceca cells or leydig cells
-Increase testosterone production
-Primarily used to stimulate ovulation
-reLH equine: Equine pure LH
Pg 600
-Combination of eCG and hCG
-Induces estrus in pigs
-induces superovulation in small ruminants
Human chorionic gonadotropin (hCG)
-LH-like activity
Equine chorionic gonadotropin (eCG)
-FSH and LH like
-Primarily FSH
Oxytocin
Ecbolic
-Initiates parturition
-Milk let down
-Uterine contraction
-Down regulates oxytocin receptors: used to prolong corpus luteum lifespan in horse
Tocolytics
Clenbuterol/Terbutaline
-Smooth muscle relaxation
-Bronchodilator
-Uterine relaxation
-Illegal in food producing animals
Buscopan
-N-butylscopolamonium bromide
-Indicated for control of abdominal pain (colic) associated with spasmodic colic, flatulent colic, and simple impactions in horses
-Antispasmodic and anticholinergic drug
-Suppresses spasms of the digestive system
-Decreases peristalsis for palpation per rectum
-May relax cervix with topical application
Reasons for manipulation of the reproductive tract
- Induce luteolysis
-PGF2A - Induce ovulation of a mature follicle
-LH - Suppress estrus
-Progesterone - Induce cyclicity in anestrus animals
-Gonadotropin release hormone
-FSH and LH release - Terminate pregnancy
-Estrogen
-Dopamine agonist: abortion - Manage dystocias
-Oxytocin - Treat uterine disease
-PGE1 - Increase milk production
-Oxytocin
-Domperidone: dopamine agonist
-Increases lactin (fescue toxicosis) - Super ovulate cyclic animals
-FSH - Growth promotant
-Estradiol
-Testosterone
-Progesterone
-Zeranol (Ralgio)
-MGA
-Stanozolol
-Boldenone undecyclenate
When to Use intrauterine treatment
-First time infections
-No history of chronic infetility
-Good biopsy score
-Antibiotic is not irritating to endometrium
-Do not require long term treatment
-Owner compliance, budget
Culture, cytology, history
Urinary pharmacology Lecture
Chronic kidney disease
- Diet
Phosphorous restriction
-Low Pi diet
Phosphorous binders
-Aluminum hydroxide
-Calcium carbonate
-Sevelamer
-Lanthanum
Goal: 4.5 mg/dl
- Hypertension
-RAAS inhibitors
-ACE inhibitors: Enalaprin, Benazepril. Decrease transglomerular pressure.
-ARB: Telmisartan, Losartan, Irbesartan
-Ca channel blockers: Amlodipine
- RAAS inhibition
-ACE Inhibitors
-ARB
-Spironolactone
- Proteinuria
-ACE-I & ARB
- Renal 2nd HPTH
-Decreased calcitriol = increase PTH release
-Calcitriol: PTH suppression. Anti-proliferative (anti-tumor), intestinal calcium and phosphorus absorption
-When phosphorus <6mg/dl, stop if >6mg/dl
- Anemia
-Epoetin
-Darbepoetin
Acute Kidney Injury
-Furosemide: thick ascending loop of Henle. Inhibits cotransport of Na along luminal surface
-Dopamine: increases RBF, GFR. Vasoconstriction, adrenergic receptors.
-Mannitol: Osmotic diuretic. Increases GFR and tubular flow. Free radical scavenger. Contraindicated in volume overload. Pulls intracellular fluid into intravascular space
-Diltiazem: reversal of renal vasoconstriction. Pre glomerular vasodilation, natriuresis independent of GFR. Prevents intracellular calcium accumulation
Urinary Stones
Urinary pathogens
-Amoxixillin
-TMS (pro prostate)
-Fluoroquinolones (pro prostate)
Stress induced urinary problems
-Acepromazine: inhibits dopaminergic (D2) receptors to cause sedation and tranquilization. Blocks norepinephrine at peripheral adrenergic receptors (Alpha adrenergic blocking/antagonist)
-Buprenorphine: partial mu receptor agonist
-MEMO!!
Urine obstruction/leakage
Sympathetic: storage phase
Parasympathetic: emptying phase
Cholinergic
B-adrenergic
Alpha adrenergic
-Phenylpropanolamine: stimulate urethral alpha receptors and cause norepinephrine release, increase urethral closure function. Hypertension side effect possible
PSMI Treatment
-PPA
-Estrogen: maintains urethral submucosal blood flow, maturation and periurethral Incurin (Estradiol) or Premarin collagen synthesis. Bone marrow suppression if overused. Combination with alpha-agonist synergistic
-Gonadotropin releasing hormone: effective as estrogen, Leuprolide acetate
-Testosterone: Methyltestorterone prostatic enlargement, should not be used with prostatic carcinoma.
Imipramine hydrochloride
-Both anticholinergic and beta agonist
-Encourages detrusor muscle relaxation and inhibiting detrusor contraction
Detrusor instability & Urge Incontinence
Treatment
-Anticholinergic medications
-Decrease detrusor contractions
Oxybutynin
-Direct muscarinic effects on bladder smooth muscle without affecting vasculature
-Antispasmodic and reduces maximum bladder pressures
-Side effects: diarrhea, constipation, hypersalivation.
Propantheline
-Direct antimuscarinic agent with effects on bladder smooth muscle
-Side effects: dry mouth, tachycardia, ielus, constipation
Detrusor-urethral dyssynergy
Alpha adrenergic blockage
-Phenoxybenzamine
-Prazosin: internal and external urethral sphincter
-Tamsulosin: internal urethral sphincter, q24 hrs
Striated muscle involvement
-Benzodiazepines: diazepam
-Acepromazine
-Methocarbamol
-Dantrolene and baclofen: potential side effects
Bladder or Detrusor Atony
-Bethanechol: parasympathomimetic
-Cisapride or Metoclopramide: dopaminergics
Urethrospasm - functional obstruction
-Alpha adrenergic blockage
-Skeletal muscle relaxation
Protein loss nephropathy
RAAS blockage
ACE-I
-Enalapril
-Benazapril
ARB
-Losartan
-Telmisartan
Calcium channel blocker
-Amlodipine
Anti-thrombotic treatment
-Aspirin
-Clopidogrel
Edema Control
-Furosemide
-Spironolactone
Integrative Medicine Lecture
Common terminology to describe health care options
Conventional Western Medicine
-Healing at the organ level
-Diagnosis
Integrative Health
-Conventional and complementary approaches
Complementary Health
-Non-mainstream
-Together
Alternative medicine
-In place of conventional
Functional medicine
-Personalized, integrative
-Prevention, management
-Root causes
-Naturopahty/naturopathic
The four bases or pillars of integrative medicine therapy
- Pharmaceuticals
-NSAIDs
-Gabapentin or pregabalin
-NMDA antagonists
-Monoclonal antibodies targeting NGF
-Tricyclic antidepressants
- Physical Medicine
-Acupuncture
-PEM
-Low level laser
-Massage
-Underwater treadmill
- Integrative nutrition/food therapy & supplements/nutraceuticals
-Omega 3 fatty acids
-Polysulfated glycoaminoglycans: injectable approved by FDA dogs and horses. Osteoarthritis. Adequan
-Yunnan Baiyao: stops bleeding.
-Curcuminoids
- Regenerative medicine
-Shock wave therapy: high energy wave sounds. OA, non-union fractures, wound healing. 1-3 treatments.
-PRF, PRFG and stem cell therapy
-Spryng veterinary medical device: Intra articular injection.
-Radio-isotope (tin-117n) therapy: Synovitis, OA.
MOA and clinical use of pharmaceuticals
NSAIDs
Gabapentin or pregabalin
-Gaba analog, bind to alpha2.. subunit of presympathetic voltage Calcium ion channels. Block release of excitatory neurotransmitters.
-Anxiolytic, anticonvulsant, neuropathic pain, MAC reduction. After OVH in cats
NMDA antagonists
Ketamine
-Prevent wind up
-Blockage of glutamate effects at the NMDA receptor
-Sub anesthetic dose in conjunction with analgesic
-Potentially lower dose of opioid
Amantadine
-Help allodynia and opioid tolerance in chronic pain cases
-NMDA antagonist
-Osteoarthritis, neuropathic pain
Monoclonal antibodies targeting NGF
-Bind to target molecules and blocks the activity of the target
-Nerve growth factor for OA
-Ex: Bedinvetmab, Frunevetmab
Tricyclic antidepressants
Amitriptyline
-Tricyclic antidepressant
-Blocks catecholamine uptake which enhances inhibitory systems
-Also has NMDA receptor antagonism activity
-Chronic pain with a neuropathic component
Tramadol
-Weakly binds to u opioid receptor
-Analgesic
-Chronic pain in cats
Good candidates for regenerative medicine options
Dorsi-flex Assist
-Sciatic nerve injury
-Tarsal hyperextension
-Wobblers, ataxia
Camelid Pharmacology Lecture
Be familiar with the drugs that are used more commonly
-No drugs are approved in US
-Extra label use necessary
Oral
-Dewormers
-Meloxicam
-Prednisone
SQ
-Lateral thoracic wall, behind the elbow
-Low in the neck cervical epaxial muscle
-Needle 20-18g x 1 inch, Crias 22g x 1 inch
IM
-Oxytocin
-Sedation
-Low in the neck, semimembranosus/semitendinosus
IV
-Flunixin
-Jugular vein
-Lateral saphenous
-Cephalic
Tissue damage
-Sodium iodide
-Phenylbutazone
Anesthesia - short term
-Xylazine (Yohimbine reversal)
-Butorphanol
-Ketamine
Induction
-Ketamine
-Diazepam
Caudal epidural
-Lidocaine: toxic dose 5mg/kg
Antimicrobials
-Ceftiofur
-Penicillin
-Aminoglycosides: Gentamicin, Amikacin
Endoparasite Tx
-Macrocyclin lactones
-Benzimidazoles
-Imidazothiazole
-Quinolone
Coccidia Tx
-Amprolium hydrochloride
-Sulfadimethoxine
-Ponazuril
Pain management
-Flunixin
-Meloxicam
-Phenylbutazone
-Ketoprofen
-Lidocaine
GI ulcer
-Omeprazole: oral not useful, need IV
-Pantoprazole
-Sucralfate: limited efficacy
Recognize drugs that should be used with caution or should not be used
Contraindicated
-Ionophores
-Tilmicosin
-Tolazoline
-Dinoprost
Tissue damage
-Sodium iodide
-Phenylbutazone
Adverse reactions and death
-Tolazoline
Florfenicol: avoid in crias
Oxytetracycline: avoid IM
Tulathromycin: save for aggressive infections, can cause acute death
Trimethoprim sulfamethoxazole: Not clinically effective oral
Understand limitations/risks when extrapolating from other species
Pain management
-Flunixin: transdermal not affective in camelids
-Meloxicam
-Phenylbutazone: longer 1/2 life
-Ketoprofen
-Lidocaine
Opioids
-Butorphanol
-Fentanyl: llamas 4 patches
-Morphine
-Lidocaine
Steroids
-Pregnancy loss in last trimester
-Anemia
-Hyperglycemia
Meningeal Worm Treatment
-Fenbendazole
-Moxidectin or ivermectin
-NSAIDs: flunixin meglumine, meloxicam
-Dexamethasone instead of NSAIDs
Other
Postpartum
-Oxytocin
-NSAID
-Antimicrobial
Agalactia
-Domperidone
Neonatal Sepsis
-Penicillin
-Ceftiofur
-Amikacin
-Gentamicin
-Flunixin
-Omeprazole
-Crystalloids, colloids
-Diazepam for seizures
Neonates
-Vitamin D
-Caffeine for dummy cria
-Enemas
-Selenium: Vit E
-Iron Dextran
-Vitamin B12
-Vitamin B complex
-Thiamine
-Capstar
-Propylene glycol
Endocrine - Hormone Pharmacology Lecture
Adrenals
- Hyperadrenocorticism
Trilostane
-MOA: competitive inhibition 3beta-hydroxysteroid dehydrogenase enzyme
-Blocks production of aldosterone and cortisol
Mitotane
-AKA o,p’DDD
-Potent adrenocorticolytic drug
Ketoconazole
-Reversibly inhibits adrenal steroid genesis with minimal effect on mineralocorticoids
L-Deprenyl
-Irreversible inhibitor of the enzyme monoamine oxidase type B
-Dopamine levels balanced
Others
-Melatonin
-HMR lignans
-SDG lignans
- Hyoadronocorticism
- Phenochromocytoma
-Tumor of chromaffin cells adrenal medulla
-Manage hypertension, arrhythmias before surgery
Alpha and beta blockage
- Hyperaldosteronism
Primary or idiopathic, AKA Addison’s disease
ACTH elevated
Mitotane or Trilostance induced
Tx
Acute
-Dexamethasone
-NaCl 0.9%
-Bicarbonate
-50% Dextrose
Maintenance
-Desoxycorticosterone pivalate DOCP: once per month injection
-Fludrocortisone acetate: daily oral
-Glucocorticoid: Prednisolone or Prednisone
Hyperaldosteronism
-K gluconate
-Spironolactone
-Amlodipine: hypertension tx
Thyroid
- Hyperthyroidism (cats)
-Diet
-Medication
-Surgery
-Radioactive iodine
Methimazole (Felimazole)
-Inhibits synthesis of thyroid hormone
-No anti tumor effect
Thiamazole
Carbimazole
- Hypothyroidism (dogs)
Levothyroxine
-T4 supplementation
Pancreas
Acromegaly = diabetes mellitus
-Somatostatin analogs
Diabetes Mellitus
Insulin
-Vetsulin: porcine lente
-ProZinc: human lente
-NPH: Human neural protamine hagedorn intermediate to Long 24 hrs DOGS
-Glargine: Human analog, Lantus 9-24 hrs CATS
-PZI-Vet: porcine, bovine 6-24hrs
-Determir: 12-24 hrs
-Lente: 24 hrs
Diet
Exercise
SGLT2 receptor inhibitors
-Bexacat
-Lowers blood sugar by increasing urine excretion of glucose
Hypothalamus/Petuitary gland
Diabetes insipidus - Central
ADH Vasopressin
-Oral or conjunctival
Nephrogenic
-Thiazide diuretics
-Low sodium
-No treatment
Parathyroid
- Hypoparathyroidism
-Slow IV calcium
-Vitamin D supplementation and oral calcium
- Hyperparathyroidism
Calcitriol
-Induces formation of its own receptor in parathyroid VDR
Calcium Carbonate
