NSAIDS Flashcards
- Antihistamines are primarily used in what disease situations in dogs?
- Allergies Acute Type I Hypersensitivities (especially vaccine reactions)
- Atopy (allergic skin disease, often not monotherapy)
- Why should antihistamines be given cautiously, if at all, by the intravenous route?
• IV administration can cause an excitatory reaction (effects on brain, sudden bolus hitting the brain) (NEVER give IV)
o Agitated and cause seizures
o Best given IM
- Offer a proposed mechanism of how omega3 fatty acids supplements decrease inflammation.
• Alter cell membrane phospholipid composition leading to less arachidonic acid as substrate for inflammation and/or production of anti-inflammatory cytokines
• Change ratio of omega 6 to omega 3
o Omega 6 enters arachidonic acid cascade and may cause inflammation
o Omega 3 does NOT enter arachidonic acid cascade and may actually inhibit inflammation
- Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis:
• What is their proposed mechanism of action?
• How does the onset differ from more traditional treatments such as NSAIDs?
• What is their relative therapeutic index?
• How much evidence supports the benefit or oral nutraceutical GAGS versus prescription injectable GAGs?
• Most oral GAGs include at least glucosamine and chondroitin sulfate. Which is likely the more effective?
• What is their proposed mechanism of action?
o Supplies building blocks for cartilage
o Inhibits proteases
• How does the onset differ from more traditional treatments such as NSAIDs?
o Slow onset – slow acting disease modifier, takes weeks
• What is their relative therapeutic index?
o Very safe – HIGH therapeutic index
• How much evidence supports the benefit or oral nutraceutical GAGS versus prescription injectable GAGs?
o Oral nutraceuticals and injectable FDA approved GAGS DO NOT have strong evidence to benefit osteoarthritis
o Adequan (inj) has better response rate than oral supplements literature not as convincing as you would think
o Oral – have many other components (avocado extract, etc)
• Most oral GAGs include at least glucosamine and chondroitin sulfate. Which is likely the more effective?
o Chondroitin sulfate, because it is a KEY COMPONENT IN CARTILAGE
- Regarding DMSO
• What is the proposed mechanism of action?
• What are the most common conditions for approved topical use and extra‐label intravenous use?
• What is its relative therapeutic index?
• What side‐effects can be seen with intravenous DMSO and what actions are taken to minimize the risk of these side‐effects?
• What AMDUCA restrictions apply to the use of DMSO relative to allowable products for extra‐ label use?
- Regarding DMSO
• What is the proposed mechanism of action?
o Scavenges free radicals, combatting inflammation
• What are the most common conditions for approved topical use and extra‐label intravenous use?
o Topical
Managing accidental extravasion of cytotoic Iv drugs
Acute trauma (reduce swelling)
Mild inhibition of platelets
Can carry small molecules transdermally
o Extra-label IV use
CNS disease in horses
• What is its relative therapeutic index?
o Remarkably NONTOXIC (eliminated by lungs) Changes in lens occurred in studies with EXTREMELY large doses for 9 weeks
• What side‐effects can be seen with intravenous DMSO and what actions are taken to minimize the risk of these side‐effects?
o Must be diluted to ≤20% and given slowly to minimize hemolysis and histamine release
• What AMDUCA restrictions apply to the use of DMSO relative to allowable products for extra‐ label use?
o Allows 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
- “Because oclacitinib is an immunomodulating drug, patients may be more susceptible to infection, demodicosis, and neoplasia”
- Contrast the mechanism of action of oclacitinib versus CADI.
- CADI is a Canine Atopic Dermatitis Immunotherapeutic (canine monoclonal antibody) that targets IL-31, which decreases JAK kinase-mediated itch. NO immunosuppression.
- Oclacitinib (Apoquel) is a selective Janus kinase (JAK) – 1 and JAK-3 inhibitor used in order to decrease pruritis. Immunosuppression can occur.
- Why may grapiprant have a larger therapeutic index than traditional NSAIDs?
- Blocks prostaglandin 4 receptor (EP4)
- Grapiprant has a larger therapeutic index because they inhibit the EP4 receptor, but NOT everything that the NSAIDs inhibit (PGEs, thromboxane, etc).
- How can NSAID use adversely affect heart failure or hypertension and its treatment?
- Worsen congestive heart failure by increasing salt and water retention
- Block the anti-hypertensive effects of ACE inhibitors and beta blockers due to loss of vasodilatory prostaglandins
- Which NSAID commonly given as repeated doses in cats actually carries a label warning against this practice?
• Meloxicam, even though appropriate dosing can work
- Which NSAIDs are approved in cats?
• Aspirin • Piroxicam • Meloxicam = single injection Carprofen = singe dose • Robenacoxib
- 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 transitional cell carcinomas?
- Firocoxib- TCCs in dogs
* Piroxicam- concentrates in the urine and can slow progression of TCCs
- 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 kidney enhance GFR and inhibit chloride and sodium reabsorption that promote water loss
- Normally, when GFR decreases, COX2 dependent PG is released to vasodilate renal artery to increase renal blood flow.
- NSAIDS are COX2 inhibitors and therefore block PGs-leading to reductions in renal blood flow and can potentially cause acute renal failure
