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VMS3011 Veterinary Medicine 2 > Neuro Treatment > Flashcards

Neuro Treatment Flashcards

1
Q

Steroid responsive meningitis arteritis (companion animal)

A
  • Immunosuppression - corticosteroids (dexamethasone, prednisolone); mycophenolate, leflunomide
  • Monitor haematology + biochem monthly
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2
Q

Meningoencephalomyelitis unknown origin (MUO) (companion animal)

A
  • Immunosuppression - corticosteroids (dexamethasone, prednisolone); mycophenolate, leflunomide, cytosine arabinoside
  • Monitor haematology + biochem monthly
  • Life-long therapy - low dose
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3
Q

Feline infectious peritonitis (FIP) (cat)

A
  • Steroids
  • Interferon
  • Nucleoside analogues e.g. GS-5734 (remdesivir) (legal), incorporated into viral RNA, prevent replication of virus, antivirals
  • GS-441524 - tablet, convert to oral after 2w
  • 12w Tx, approx £8,000
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4
Q

Neuronal ceroid-lipofuscinoses (NCL)

A
  • Fatal
  • Seizure management
  • Minocycline - reduces neuro-inflam
  • Can try L-carnitine (for metabolic brain disease), non-specific for mitochondrial disease
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5
Q

Listeria meningoencephalitis (ruminants)

A
  • High dose procaine penicillin for at least 10d
  • TLC - food + water
  • Loss of saliva - dehydration, metabolic acidosis
  • Transfaunication - promote rumen func recovery
  • Corticosteroids (dexamethasone, cannot use in pregnant animals, risk of abortion) - cross BBB, prevent oedema + inflam
  • NSAIDs
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6
Q

Lead intoxication (ruminants)

A
  • Oral magnesium sulfate to precipitate lead in GIT
  • IV EDTA to bind to lead (when disease progressed)
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7
Q

Urea intoxication (ruminants)

A
  • Relieve bloat + give oral fluids w/ 6% vinegar
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8
Q

Sulfur intoxication (ruminants)

A
  • Thiamine/vitamin B1
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9
Q

Polioencephalomalacia/cerebrocortical necrosis (CCN)

A
  • Thiamine/vitamin B1 (high dose)
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10
Q

Streptococcal meningitis (pig)

A
  • Systemic AB - penicillin
  • NSAIDs/steroids
  • Rehydration
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11
Q

Brain abscess (production animal)

A
  • Systemic AB
  • NSAIDs
  • Euthanasia
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12
Q

Middle ear disease (calf)

A
  • Systemic AB against mycoplasma bovis -> macrolides
  • NSAIDs
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13
Q

Coenurosis / Gid (sheep)

A
  • Sx removal if cyst v close to brain’s surface
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14
Q

Coliform meningitis / septicaemia (ruminant neonate)

A
  • Systemic AB
  • IVFT
  • NSAIDs once urine output restored
  • Supportive therapy + nursing
  • IV glucose
  • Heat lamp
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15
Q

Hypoglycaemia (lamb)

A
  • IV/IP (intraperitoneal) glucose
  • Active warming
  • Oral milk for lambs
  • Address risk factors
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16
Q

Swayback (lamb)

A
  • Euthanasia
  • Prevention by appropriate + careful copper supplements
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17
Q

Hypoglycaemia (piglet)

A
  • Feed hourly
  • Give IP 15 mL 5% glucose, q4 - 6h + stomach tube
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18
Q

Bacterial meningitis (poultry)

A
  • Potentiated sulphonamide or Amoxycillin
19
Q

Avian encephalomyelitis (epidemic tremor)

A
  • Cull
  • Supportive (Vacc parents)
20
Q

Spinal osteomyelitis (poultry)

A
  • Potentiated sulphonamide or Amoxycillin
21
Q

Scoliosis (poultry)

A
  • No Tx
  • Review breeding
  • Check nutrition
22
Q

Discospondylitis (companion animal)

A
  • AB based on culture: 1st choice = cephalosporin (cephalexin) if negative culture/until results available (enrofloxacin, 2nd), continue for at least 2 m (some cases 12 m)
  • Disseminated fungal disease (aspergillus) - urine microscopy + mycological culture
  • Analgesia - NSAIDs (gabapentin, paracetamol, complementary acupuncture therapy)
23
Q

Mitochondrial myopathy (companion animal)

A
  • Nutritional modification
  • Cofactor Tx (shunt energy down NMDA Ca2+ pathway) - riboflavin, L-carnitine, thiamine, taurine
24
Q

Myasthenia gravis (fulminant/acute + severe onset) (companion animal)

A
  • Deal w/ aspiration pneumonia (due to megaoesophagus) - broad spectrum AB (IV cephalosporin) + metronidazole
  • Anticholinesterases - pyridostigmine bromide CRI, titrated slowly to effect or neostigmine SQ once (shorter-acting)
  • Immunosuppression (if pneumonia under control) - IV mycophenolate, dexamethasone
25
Q

Myasthenia gravis (maintenance) (companion animal)

A
  • Immunosuppression - prednisolone - avoid or low as possible (1mg/kg/day PO), PUPD inc aspiration pneumonia; mycophenolate 10mg/kg BID, Leflunomide 2-4mg/kg PO SD; azathioprine if mycophenolate / leflunomide not tolerated 1-2mg/kg q24-48h
  • Anticholinesterases - pyridostigmine bromide (Mestinon) 1-3 mg/kg PO BD/TD
26
Q

Polymyositis / Myasthenia gravis feeding (companion animal)

A
  • Small meals often (4 – 6 meals daily) - walnut sized balls; easy to prehend; high protein - high fat; anti-gulp bow
  • From height - raised/stairs /bailey chair
  • Coupage
  • Prokinetics - erythromycin (1–3 mg/kg BID); viagra?
27
Q

Neuroprotection - dietary manipulation (companion animal)

A
  • Antioxidant supplementation (protects against age-related neuronal impairments) - Vit E, C, carotenoids, flavonoids, selenium, L-carnitine, lipoic acid (not cats), essential fatty acids
  • Medium-chain triglycerides (MCTs) - metabolised to ketone bodies = alternative source of energy for neurones
28
Q

Cognitive decline (companion animal)

A
  • Altering neurotransmission - L-deprenyl (selegiline) -> inc noradrenalin + dopamine, neuro protective, improves memory + longevity, useful for anxiety/social withdraw, 4 w to see effects
  • Neuroprotection - propentofylline -> inc molecular signal adenosine, improves cerebral blood flow, glial cell modulator: stimulates astrocytes (protect nerve cells from inflam mediators, free radicals + glutamate), depresses microglial cells (inflam cells), not licensed in cats
29
Q

Sundown syndrome/sleep disorder (companion animal)

A
  • Melatonin
  • Alprazolam
  • Predictable routine
  • Daytime activity/interaction
  • Pheromone therapy
30
Q

Stupor/coma (unconsciousness) initial management (companion animal)

A
  • Raise head
  • Keep normal temperature
  • Maintain blood pressure
  • Maintain ventilation
  • Minimum data base - blood gas / electrolytes
31
Q

Hepatic encephalopathy (companion animal)

A
  • Mannitol
    – Vasogenic cerebral oedema
    – 0.25g/kg 15 - 20% solution over 30 - 60 mins
    – May be repeated 1-2 x after 4 - 8 hours if hydrated / electrolytes monitored / corrected
  • Lactulose (3.1 - 3.7 g/5ml)
    – Non-absorbable disaccharide
    – 3 parts lactulose 7 parts warm water retention enema
    – 18- 20ml/kg
    – Alters bacterial flora
    – Decreases bowel transit time
    – Decreases bowel pH
  • Antibiotics
    – Metronidazole 10mg/kg BID
    – Amoxicillin 10m/kg BID/TID
32
Q

Cerebral oedema (companion animal) / brain tumour

A
  • Hypertonic saline (7.5% - 3 - 5 mL/kg), wait 30 min, repeat boluses after checking acid.base electrolyte status (+ correction), +/- colloids, increases CO, dec intracranial pressure, but doesn’t restore cerebral blood flow
  • Mannitol (but repeated admin can result in hyperosmolar state + -> acute renal failure)
  • Corticosteroids - methylprednisolone, dexamethasone
33
Q

Stupor/coma (unconsciousness) management / cerebral oedema (companion animal)

A
  • Rehydrate (esp if using diuretics) - don’t over-hydrate -> inc cerebral oedema
  • Seizure control - diazepam, levetiracetam, phenobarbital, propofol infusion
  • Sedatives (reduce muscle spasm + brain metabolic requirements) - dexdomitor
  • Occipital craniectomy
34
Q

Neurogenic bladder management (companion animal)

A
  • Empty bladder: manually or indwelling catheter
  • Monitor UTI

Pharmacological aids:
- To relax urinary sphincter + express bladder 20 - 30 min after admin (UMN relaxation): prazosin, phenoxybenzamine (expensive); diazepam (caution in cats)
- To promote detrusor activity (only works if there is already some detrusor activity present): bethanechol, cholinergic agent, if urinary sphincter closed then will be painful

Sx:
- Sacral ventral root (motor) stimulation, placement of silicon-insulated platinum electrodes around both S2 nerve roots (open up spinal segments = laminectomy), attached subcutaneous receiver coil, activated transcutaneously -> urination on demand (can be painful)

35
Q

Sphincter mechanism incompetence

A
  • Phenylpropanolamine = sympathomimetic
  • If affected by lack of hormones - oestrogen/testosterone
36
Q

Epilepsy

A
  • Don’t delay Tx therapy - becomes more dangerous when inc seizures, will be become difficult to control epilepsy (inc freq)
  • 1y anti-epileptic drugs (dog): imepitoin (pexion); phenobarbital (+ diazepam); potassium bromide, to dec excitation of nerves (paroxysmal discharge = electrical activity associated w/ seizure)
  • Monitor: seizure dairy; serum conc for therapeutics; liver func; pancreas; haematology
  • If not controlled: switched to anticonvulsant e.g. pexion to phenobarbital; novel antiepileptic drugs (levetiracetam, zonisamide, topiramate (cats)); propentofylline; diet therapy
37
Q

Equine herpesvirus myeloencephalopathy (EHM)

A

Supportive care:
- Palatable feeds
- IVFT
- Nursing care

  • NSAIDs to reduce fever and inflammation
  • Heparin to prevent thrombus production
  • Valacyclovir to reduce viraemia
  • Biosecurity - isolation, prevent spread, limit horse to horse contact
38
Q

Viral encephalitis (equine herpesvirus myeloencephalopathy/west nile encephalopathy)

A

Mild cases:
- Tight monitoring and supportive care
- NSAIDs, fluids, etc.

Neurologic cases:
- Referral for ICU care and monitoring - IVFT
- NSAIDs
- Neuro-protective antioxidants - vit E
- Supportive + nursing care
- Recumbent horse care

  • Prevention - vaccination - esp. high-risk horses if travelling to endemic countries e.g. Italy, environmental control - mosquito control, monitor birds death + report to local authority
39
Q

Toxicoinfectious disease (clostridial neurotoxins) - tetanus (equine)

A
  • Vaccination (toxoid) - first vaccine at 6 mo of age, two vaccines 4 weeks apart, then booster q 2 years, pregnant mares: booster in the last trimester
  • Tetanus antitoxin - provides protection during risk period (lasts 3-4 weeks) (unvaccinated horses with wound/surgery) - combination of toxoid and antitoxin often used for at-risk case, routine administration in a neonate foal
  • AB: Penicillin or metronidazole
  • Debride and clean the wound
  • Sedatives & pain control: diazepam, butorphanol, etc.
  • Muscle relaxer: methocarbamol
  • Nursing care - keep the horse in a quite environment and minimise external stimuli, soft and palatable feeds, sling if recumbent
40
Q

Toxicoinfectious disease (clostridial neurotoxins/clostridium botulinum) - botulism (equine)

A
  • Hyperimmune plasma
  • Botulinum antitoxin: need to know right strain in the area
  • Supportive & nursing care: takes 7 – 10 days until new NMJ replaces toxin-bound tissues
  • Soft and palatable feeds, sling if needed, ventilator in young foals (50% fatal, esp if recumbent)
41
Q

Equine dysautonomia (equine grass sickness)

A
  • Nursing care
  • Supportive care
  • Prognosis is poor to grave
42
Q

Streptococcal suis meningitis (porcine)

A
  • Penicillin
  • Vacc sow + piglet
  • All-in-all-out / reduce batch mixing
  • Destock + disinfect (faeces + dust)
43
Q

Salt poisoning / water deprivation (porcine)

A
  • Nursing, spontaneous recovery
  • Betamethasone

VMS3011 Veterinary Medicine 2 (20 decks)

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