Exam 5: NSAID Toxicosis Flashcards
What is toxicology?
The study of adverse effects of chemical or physical agents on living organisms
What is a toxin?
Toxic substance produced by biological systems (plants, animals, fungi, bacteria)
What is a toxicant?
Toxic substance made by man
What is toxicity?
The degree to which a substance can damage an organism
What is toxicosis?
The disease state that results from exposure to a toxin or toxicant
What is toxicokinetics?
The rate a toxin or toxicant will enter the body and what happens to it when it is in the body
What is venom?
A toxin that is injected from a living organism into another
What does NSAID stand for?
Non-steroidal anti-inflammatory drug
Describe NSAIDs
Anti-inflammatory
Analgesic
Antipyretic
What are examples of NSAIDs?
Carprofen Meloxicam Deracoxib Firocoxib Robenacoxib Aspirin Ibuprofen Naproxen sodium
What would indicate that NSAIDs should be used?
Acute pain (surgery, injury)
Chronic pain (arthirits, neoplasia)
Inflammation
Fever
What can cause toxicosis in animals?
Human NSAIDs
Flavored medication
Accidental over dosage
Potentiating factors
What are potentiating factors that can cause toxicosis?
Concurrent corticosteroids (number 1 problem)
Multiple NSAIDs
Dehydration
Hypovolemia
Concurrent medications that may affect renal physiology
Pre-existing renal/GI disease
How do NSAIDs help with inflammation?
They inhibit prostaglandins via COX enzyme inhibition
What does COX1 do?
Renal perfusion
Gastric mucus secretion
Platelet function
What does COX2 do?
Mediation of pain, fever, and inflammation
Neoplasia
What are the highly selective drugs?
Firocoxib
Robenacoxib
Deracoxib
What are the moderately selective drugs?
Meloxicam
Carprofen
Etodolac
What are the drugs with little to no selectivity?
Aspirin
Piroxicam
Ketoprofen
Which drugs are more selective, newer or older drugs?
Newer
What can NSAID toxicosis cause?
Gastric ulceration (dose dpendent) Acute renal failure (dose dpendent) Neurotoxicosis (dose dpendent) Hepatic injury
What occurs with gastric ulceration?
Topical irritation
Disruption of gastric mucosa barrier
Delayed healing
Increased bleeding
What happens with acute renal faiulre?
NSAID induced decreased GFR
Prostaglandins cause dilation of renal afferent arteriole
How do you treat NSAID toxicosis that is acute?
Emesis
Activate charcoal
Supportive therapy to protect the kidneys, GI tract
Treat secondary problems
What is the supportive management used for GI?
Misoprostol
Sucralfate
H2 antagonists
Proton pump inhibitors
What is the supportive management used for renal?
Fluid diuresis with isotonic fluids at 1.5-2.5x maintenance
Monitor electrolytes, renal values, “in and outs”, and weight
Manage acid/base imbalances
Maintain fluid therapy until values decline
What is the long term management for NSAID toxicosis?
Dietary management (reduced protein and phosphorus)
SQ fluids
Famotidine/omeprazole, monitor bloodwork
