management of anorexia Flashcards
Why do cats have high protein needs?
they are unable to down-regulate the nitrogen (protein) metabolising enzymes
Dependent on protein for gluconeogenesis
What does the loss of lean body mass lead to ?
impaired wound healing, poor immune function and reduced muscle strength.
What is the use of mirtazapine?
appetite stimulant and anti-emetic properties via multiple (ie, histaminergic, adrenergic, serotoninergic) pathways. This agent has been shown to stimulate the appetite of cats (at a dose of 3.75 mg every three days) in various disease processes and importantly the consumption of food was reported to be maintained for several days
What are the s/e/ contraindications of mirtazapine?
tachycardia, hyperactivity, vocalisation
Give a smaller dose less frequently in renal cases as it accumulates in renal failure
What are the main subgroups of complications from parenteral feeding?
metabolic complications (eg, hyperglycaemia, electrolyte imbalances), mechanical complications (eg, thrombophlebitis) and septic complications (eg, catheter infection or septicaemia)
When should the use of appetite stimulants be considered?
During the diagnostic phase
When environmental factors of inappetance are considered the cause
in chronically ill cats - e.g. ckd
when trying to ovecome food aversions when the initial condition has been resolved
Why consider the use of B vitamins in inappetant cats?
Cats have a higher requirement for some B vitamins when compared with dogs.
Experimental depletion of B vitamins results in anorexia in other species.
Supplementation with B vitamins may prevent this occurring, although no evidence exists to confirm this
Outline the use of cyproheptadine as an appetite stimulant
Serotonin antagonist, antihitamine
Not to be used in hepatic lipidosis
Can cause agitation and haemolysis
Do not use with mirtazapine
Often used long term, but effects can reduce over time
May take a few days to reach effective levels
Outline the use of benzodiazapines as an appetite stimulant
Thought to act centrally to increase eating
Cons - ataxia, sedation and unpredictable response to standard doses. Normally short lived
Diazepam can cause fatal hepatic necrosis orally
Superseeded by other drugs
What is serotonin syndrome?
three types of neuro-excitatory symptoms including:
a) neuromuscular hyperactivity (tremor, clonus, hyperreflexia, pyramidal rigidity);
b) autonomic hyperactivity (pyrexia, tachycardia, tachypnoea); and
c) altered mental status (agitation, excitement)
What should mirtazapine not be given with?
Tramadol, some other drugs
Due to increased risk of serotonin syndrome
Cyproheptadine is throught to be an antidote to this
