NSAIDs Flashcards
What can be used to block histamine from binding to the H1 receptor?
Antihistamines
What is used after the cell membrane is injured to keep from entering the arachidonic acid cascade?
Omega 3 FA
What inhibits phospholipase?
Steroids
What effects COX2 gene expression?
Steroids
What can prevent cyclooxygenase from tuning arachidonic acid into prostaglandins, prostacyclin, and thromboxane?
NSAIDs
What blocks the EP4 receptor?
Grapiprant
What blocks interleukins?
CADI
What blocks Janus kinase from casuing inflammation
Oclaitinib
What blocks free radical release from cause inflammation?
DMSO
What helps prevent proteases from causing inflammation?
GAGs
Antihistamines are primarily used in what disease situations in dogs?
Only effective in managing allergies
Treatment or prevention of vaccine reactions
Why should antihistamines be given cautiously, if at all, by the intravenous route?
IV administration can have an effect on the brain. A sudden bolus will cause a stimulatory effect and they get agitated and seizures have been reported
It can cause an excitatory reaction
Offer a proposed mechanism of how omega3 fatty acids supplements decrease inflammation.
It is thought to alter the cell membrane phospholipid concentration leading to less arachidonic acid as a substrate for inflammation and/or production of anti-inflammatory cytokines
Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, what is their proposed mechanism of action?
Supplies the building blocks for cartilage and inhibits proteases
Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, how does the onset differ from more traditional treatments such as NSAIDs?
It has a very slow onset. It can take several weeks for it to show effect
Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, what is their relative therapeutic index?
It is very safe
Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, how much evidence supports the benefit or oral nutraceutical GAGS versus prescription injectable GAGs?
Adequan (injectable) has a better response rate than the nutraceutical/oral GAG
Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, most oral GAGs include at least glucosamine and chondroitin sulfate. Which is likely the more effective?
Chondroitin sulfate
What is the proposed mechanism of action of DMSO?
Rapidly penetrate the intact skin
Anti-inflammatory action due to ability to scavenge free radicals
What are the most common conditions for approved topical use and extra‐label intravenous use of DMSO?
Approved as 90% gel and liquid for topical use in dogs and horses
- –Label indication is to reduce acute swelling due to trauma
- –Often used in managing accidental extravasation of cytotoxic IV drugs
- –Mild inhibition of platelets
- –Can carry small molecules transdermally
AMDUCA allows only for extra-label use of the approved veterinary product
—Used in a variety of conditions, but mainly CNS disease
What is its relative therapeutic index of DMSO?
Has a really high therapeutic index
What side‐effects can be seen with intravenous DMSO and what actions are taken to minimize the risk of these side‐effects?
Hemolysis and histamine release
DMSO is diluted to = 20% and given slowly to minimize
What AMDUCA restrictions apply to the use of DMSO relative to allowable products for extra-label use?
AMDUCA allows only for extra-label use of the approved veterinary product, not chemical grade DMSO
What nonsteroid‐responsive pruritic conditions often respond to oclacitinib? What warnings or contraindications does it have?
Food allergies and Sarcoptes
GI side effects occur only in 2.3% according to one study
Because oclacitinib is an immunomodulating drug, patients may be more susceptible ton infection, demodicosis, and neoplasia
Contrast the mechanism of action of oclacitinib versus CADI.
Oclacitinib is a selective Janus kinase (JAK)-1 and JAK-3 inhibitor
CADI is a canine monoclonal antibody against IL-31 which in turn decreases JAK-mediated itch
Why may grapiprant have a larger therapeutic index than traditional NSAIDs?
It is working further down the arachidonic acid cascade and does not affect as much as NSAIDs
It is only better than a NSAID in the side effect profile
How can NSAID use adversely affect heart failure or hypertension and its treatment?
NSAIDs worsen congestive heart failure by increasing salt and water retention
They blunt the anti-hypertensive effects of ACE inhibitors ad beta blockers due to the loss of vasodilatory prostaglandins
Which NSAID commonly given as repeated doses in cats actually carries a label warning against this practice?
Meloxicam
Which NSAIDs are approved in cats?
Which NSAIDs can be used chronically in cats?
Robenacoxid (for 3 days)
Meloxicam injection
Aspirin, piroxicam, robenacoxib, and meloxicam are all extra-label
No NSAIDs are approved for chronic use. Though, oral meloxicam is used chronically against the label. Aspirin and Piroxicam can be used chronically
Which NSAID is approved as a transmucosal oral spray?
Meloxicam
Name a topical NSAID approved in horses
Surpass: 1% diclofenac sodium
Which NSAIDs have shown activity in management of TCCs?
Piroxicam
What role do endogenous prostaglandins play in maintaining renal blood flow as part of normal homeostasis versus when GFR decreases? Explain why this difference is important relative to NSAID use.
Normally vasodilatory prostaglandins in the kidney enhance GFR and inhibit chloride and sodium reabsorption that promote water loss
NSAIDs can:
—Worsen congestive heart failure by increasing salt and water retention
—Blunt the anti-hypertensive effects of ACE inhibitors and beta blockers due to the loss of vasodilatory prostaglandins
In most species aspirin is useful as an antipyretic, analgesic, and anticoagulant. How does the horse differ in the utility of aspirin and why? How does the cow differ?
Aspirin is not used as an anticoagulant in cows, though it is antipyretic and analgesic. Something else drive platelet function other than thromboxane
Aspirin is only an anticoagulant in horses
Under what conditions would acetaminophen be a good choice in a dog?
It is an effective antipyretic and analgesic for mild somatic pain
It has little anti-inflammatory activity
Which of the adverse reactions seen with NSAIDs are type B reactions?
Bone marrow suppression
Hepatotoxicity
Why has phenylbutazone been banned by the FDA from use in adult dairy cattle?
Farmers were giving it for control of the lameness in cattle, but they weren’t following the withdrawal periods
Which form of aspirin should not be used in the dog and why?
Don’t use enteric coated aspirin (Ecotrin)
Ecotrin sticks to the mucosa and erratically breaks off and goes through
Name the five adverse events associated with use of NSAIDs. Indicate which two are type B adverse reactions.
GI ulceration
Renal papillary necrosis
Altered platelet function (except in cattle)
Bone marrow suppression (type B adverse reaction)
Hepatotoxicity (type B adverse reaction)
When switching between NSAIDs what is a “washout” and why is it recommended? Which NSAID(s) would a washout be most warranted for?
In general, a day wash-out between NSAIDs is recommended and 10 days specifically for aspirin and adverse effects.
The potential for adverse use, regular metabolic moniotoring, and regular metabolic monitoring should be performed
What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of tetracyclines?
Inhibits collagenase and protein kinase C, inhibits granuloma formation
Used in vet dentistry and ophthalmology
What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of enrofloxacin?
Responsive histiocytic ulcerative colitis
Eradication of invasive intramucosal E. coli
What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of macrolides?
Inhibits NF-κB activation in T cells, monocytes/macrophages
Tylosin for refractory large bowel diarrhea
Azithromycin for oral papillomatosis
What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of metronidazole?
Used for IBD
2 hypotheses for mechanism:
—Changing the intestinal microbiota prevents colonization by pathogenic bacteria
—Suppression of the microbiota might lead to down-regulation of aberrant host responses directed against microbial antigens that trigger and perpetuate chronic mucosal injury
Which NSAID is approved as a transdermal formulation in cattle?
Flunixin (Finadyne Transdermal and Banamine Transdermal)
Approved as an antipyretic, not an analgesic
