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Anesthesia > NSAIDs 1 > Flashcards

NSAIDs 1 Flashcards

1
Q

Carprofen (Rimadyl)

A

-oral chews and injectable)
-considered Cox-2 selective
>racemic mixture (S+R, S more selective for cox 2)
-used for osteoarthritis (chronic) and post-op pain

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2
Q

How do analgesic endpoints differ?

A

-various endpoints (behaviour? movement? cortisol? pressure?)
-differences in how procedure is performed
-drug administration affects dose, route, timing

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3
Q

Carprofen adverse effects

A

-low incidence of vomiting and diarrhea

-idiosyncratic (not dose dependent) hepatic toxicity in dogs
>occurs up to 1/2000 dogs
>occurs few days/weeks of therapy
>detected with pre-treatment blood sample

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4
Q

Meloxicam

A

-cox-2 preferential
-oral suspension (1.5mg/ml in dogs; 0.5 mg/ml in cats), tablets (1 or 2.5mg for dogs), injectable (0.5%; 5mg/ml for dogs and cats)

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5
Q

Why is meloxicam oral suspension useful?

A

Easier to individualize the dose
-can titrate down and use less but still get desired effect

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6
Q

Meloxicam indications

A

-acute and chronic musculoskeletal disorders in dogs
-acute musculoskeletal disorders in cats
-useful for post-op pain (orthopedic, soft tissue surgery)… better than butorphanol

**EBM study: arthritis high level of comfort

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7
Q

Adverse drug events from Meloxicam

A

Dogs: low incidence of vomiting and diarrhea

Cats: renal failure (often linked with dehydration)
USA: no musculoskeletal claim in cats (Black box warning- for long use)

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8
Q

Deracoxib (deramaxx)

A

-cox 2 selective
-chewable tablets
-use in dogs

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9
Q

Deracoxibb (deramaxx) indications

A

-chronic osteoarthritis in dogs
-orthopedic post-op pain in dogs

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10
Q

Deracoxib (deramaxx) adverse effects

A

-low incidence of vomiting and diarrhea
-renal tubular degeneration at high doses
-causes of GI tract perforation at high doses or with other NSAIDs/steroids

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11
Q

Firocoxid (previcox, prevequine)

A

-cox 2 selective
-chewable tablets for dogs and horses
-doses in dogs is 50x higher than horse. Means you are giving exact same amount for both species

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12
Q

Firocoxib (previcox, prevequine) indications

A

-osteoarthritis in dogs and horses
-post op pain in dogs

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13
Q

Firocoxib adverse events

A

-low incidence of vomiting and diarrhea (possibly lower than other NSAIDs)
-smaller therapeutic index in young dogs

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14
Q

Robenacoxib (onsior)

A

-cox 2 selective (very high in cats 502:1)
-oral tables and injectable solution

-a lot of evidence

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15
Q

Robenacoxib indications for cats

A
  1. Acute pain and inflammation (scratches/bites without abscesses and musculoskeletal injuries such as sprains and strains)
  2. Post op pain and inflammation
  3. Chronic musculoskeletal disorders
    **no other NSAIDs have chronic claim in cats (but likely meloxicam will work as well)
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16
Q

Robenacoxib indications for dogs

A
  1. Osteoarthritis in dogs
  2. Post op pain associated with soft tissue
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17
Q

Human NSAIDs in vet med?

A

Not approved
-Advil, tylenol (watch for methemoglobinemia), aspirin, aleve, voltaren

Toxicity! Mostly ibuprofen (Advil)

**Safety and efficacy is much lower than vet approved drugs. Often a small therapeutic window

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18
Q

Galliprant (grapiprant) mechanism

A

-PGE2 receptor antagonist (not a cox inhibitor)
>Blocks EP4 receptor by blocking PGE2 and mediating sensitization of sensory neurons

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19
Q

Galliprant use

A

-used for dogs with arthritis; no claims for use in post-op
-alternative to NSAIDs; can’t use them concurrently
-oral tablet (various sizes)

**Thought to be safer than NSAIDs, but efficacy might be lower.
>may want to use galliprant though in cases where dog may have GI ulcer history or liver/kidney diseases

20
Q

Galliprant possible adverse events

A

-vomiting
-diarrhea
-inappetence
-lethargy
-buccal ulcers
-immune mediated hemolytic anemia

21
Q

Solensia (frunevetmab) mechanism

A

-Not a drug; considered a biologic

-Monoclonal antibody specific for blocking feline nerve growth factor (NGF)
>NGF upregulated during chronic inflammatory conditions and are needed for pain response

22
Q

Solensia use

A

-Used in cats for arthritis

-Long-acting injection(half life=10-12 days, repeated monthly, need two injections to reach steady state)
>elimination=proteolysis

-Cmax= 3-7 days after dose
-minimal accumulation in plasma after 5 doses

23
Q

Solensia efficacy and safety

A

Efficacy: it works; but some individuals undergo placebo effect

Safety: high safety levels

24
Q

Librela (bedinvetmab)

A

Monoclonal antibody specific for canine nerve growth factor (NGF)
-similar to solensia
-repeated monthly
-Safety and efficacy high

25
Q

Can you combine NSAIDs with non-NSAIDs for osteoarthritis analgesia?

A

-Not great evidence. Benefits for multi-modal analgesia with other painful conditions
>synergism may not occur

26
Q

issues with determining NSAID safety

A
  1. cannot compare different products by adverse events because number of sales will affect it

2.Conditions of use vary between NSAIDs (one time vs long term)

  1. Voluntary reporting is skewed
  2. Amount of evidence
27
Q

What are you looking for in terms of safety in NSAIDS?

A

-vomiting and diarrhea are most common signs
-hepatic adverse effects; may lead to idiosyncratic rxn
-kidney injury and GI effects are dose dependent

28
Q

NSAID metabolism in cats

A

Cats are poor glucuronidators and hepatic clearance, therefore increased half life and then possibly increased toxicity risk

Approved products: meloxicam and robenacoxib

Other drugs, but not much data supporting their use: firocoxib
carprofen

29
Q

Using meloxicam in cats

A

-can be used in cats long term
>need to ensure they are hydrated

**safety: safely given to cats with renal failure (no decrease in lifespan) and may even slow renal disease in some cats suffering from both CKD and DJD

30
Q

KEYS to NSAID use in small animals

A

Effects: Gi lesions, GI signs, hepatic damage, renal damage

No newer NSADI is consistently more effective than others

Use lowest effective dose

31
Q

Phenylbutazone (Bute)

A

-NSAID
-oral and injectable products
-very old drug used for musculoskeletal inflammation (lameness) label indications

32
Q

Flunixin meglumine (Banamine)

A

-injectable solution (IV or IM)
-indicated for musculoskeletal disorders and visceral pain (ex.colic)

33
Q

Firocoxib (Prevequine)

A

-NSAID
-Used for osteroarthritis in horses
-generally safe
-oral tablet

34
Q

Meloxicam in horses?

A

-Extra label use in Canada but in UK, used for acute and chronic musculo-skeletal disorders, colic pain

35
Q

Pregnant mare NSAIDs?

A

No approved NSAIDs for pregnant mares

36
Q

Meloxicam injectable in food animals uses

A

Cattle: diarrhea, used for de-horning pain, mastitis, abdominal surgery
Sheep: pain and inflammation
Swine: non-infectious locomotor disorders to reduce lameness and inflammation

-not labelled for castration, BRD, anti-pyretic

**will have meat and milk withdrawal times

37
Q

Meloxicam oral suspension in food animals

A

-Only labelled for castration
*double the dose of injectable

-cheaper than injectable

38
Q

Flunixin (banamine)

A

-NSAID for food animals in toxic shock (endotoxemia) and pyrexia (fever); not analgesia
>believed to bind the endotoxin
-injectable

**has severe injection site rxns so can only be used IV

39
Q

Flunixin used transdermally

A

-Label use for pyrexia of BRD and mastitis, and analgesia for foot rot

40
Q

Ketoprofen (anafen)

A

-food animal NSAID (not other animals!!) for fever, pain, inflammation for a lot of disorders
-injectable
-cost is reasonable because able to earn it back from milking her

***no milk withdrawal period, short meat withdrawal time

41
Q

Aspirin

A

-not approved in USA, approved in Canada
-very poor bioavailability from the rumen

-cheap but get what you pay for

42
Q

Meloxicam use in sheep

A

-single dose lasts for days (14 days) to alleviated pain and inflammation

*no oral formulations approved for small ruminants; only approved in beef cattle
*Buccal meloxicam used in Australia

43
Q

NSAIDS used in pigs

A

-Ketoprofen (IM)- used for fever and inflammation due to respiratory disorders

Flunixin (IM)- pyrexia associated with SRD

Acetaminophen :pyrexia associated with SRD. Medicated water, 3 day WP

44
Q

Meloxicam for swine

A

-injectable (more dilute version for pigs)
-used for relief of post op pain associated with minor soft tissue surgery such as castrating and tail docking

45
Q

Resflor

A

Combination of flunixin and florfenicol
-used for BRD and fevers in cattle

46
Q

Zeleris

A

combination of Meloxicam and florfenicol

-used for BRD and fevers in cattle

47
Q

Draxxin KP

A

-combination of tulathromycin and ketoprofen
-used for BRD and fevers in cattle

*small dose volume

Anesthesia (24 decks)

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