NSAIDS and Cannabis Flashcards
response of vascularized tissues to infections and damaged tissues that brings cells and molecules of host defense from the circulation to the sites where they are needed, in order to eliminate the offending agent = what
inflammation
the inflammatory mediators prostaglandins and leukotrienes are metabolites of what
arachidonic acid
NSAID drugs act on ____ enzymes
cyclooxyrgenase enzymes COX1 and COX2
what are constitutive vs inducible CLOX
constitutive = expressed at relatively constant level sin most tissues
inducible = induced by inflammatory stimuli
of COX1 and COX2, which is constitutive and has homeostatic functions, important in gastric mucosa, kidney, platelets, vascular endothelium? which is primarily induced by inflammatory cytokines and is produces prostanoids associated with inflammation, fever, and pain?
COX1 (constitutive), COX2 (inducible)
a non-selective COX inhibitor will inhibit ___, while a selective COX inhibitor to target pain, fever, inflammation would inhibit ____
both COX1 and COX2; COX2 (and a little bit of COX-1 effects also, not perfect)
give 6 clinical uses of NSAIDs
anti-inflammatory, analgesic, antipyretic, treatment septic shock, antithrombotic, anti-cancer in certain cases
COX inhibition reduces the ____ and _____ effects of prostaglandins
central and peripheral
Chronic nociceptor stimulation (as occurs with inflammation) results in changes at the level of the synapse within the spinal cord. Upregulation of ________ and __________ leads to sensitization of post-synaptic neurons = increased perception of pain
post-synaptic receptors and spinal cord COX-2 lead
septic shock occurs when
bacterial products, which can be LPS endotoxin or others, enter systemic circulation
septic shock leukocyte, complement, and endothelial cell activation lead to what 4 effects? what overall effect
immunosuppression; vasodilation (increased vascular permeability and decreased perfusion); systemic effects of fever, decreased ionotropy and metabolic abnormality; and microvascular thrombosis. multi-organ failure!
what should you consider about giving patients with poor perfusion (eg. in septic shock) NSAIDs.
benefits may not outweigh the risk
is a horse that is hemorrhaging a good candidate for NSAIDs? why?
no! both non-selective and selective COX-2 NSAIDs have some COX-1 inhibition. COX-1 is involved in platelet activation and aggregation, so going to increase bleeding.thin the blood
COX-2 is ________ in some tumours, therefore NSAIDs will have what effect in certain tumors
upregulated; suppress certain tumors
PK of NSAIDs: how is it bound? absorbed? metabolized? half-life?
highly protein bound, well-absorbed orally, metabolized liver, half-lief varies dramatically between species
give at least 5 adverse effects of NSAIDs
GI irritation (COV-1 has gastroprotective effects)and ulceration, renotoxicity if dehydrated/hypovolemic (renal papillary necrosis), hepatotoxicity, hemorrhage (inhibition of COX1 clotting), blood dyscrasia, delayed parturition, delayed tissue healing, delayed fracture healing (think, COX is involved in soft tissue and bones)
give 5 NSAIDs used in dogs
dogs only: carprofen CAR, deracoxib DER
dogs and cats: robenacoxib ROB
dogs and horses: firocoxib FIR
all species: meloxicam MXM
give 2 NSAIDs used in cats
meloxicam (used in all species) and robenacoxib (also used in dogs)
4 NSAIDs used in cattle
meloxicam MXM (used in all species)
aspirin, flunixin FLU, ketoprofen KET (also in horses)
give 7 horse NSAIDs
meloxicam MXM (used in all species)
aspirin, flunixin FLU, ketoprofen KET (also in cattle)
firocoxib FIR (also in dogs)
dipyrone, phenylbutazone PBZ (horse only)
in compromised patients, must balance ____ and ___ of using NSAIDs
risks and benefits.
should you give NSAIDs after GI surgery in small animals? why or why not
no! delay tissue healing, so increases risk of dehiscence
should you give NSAIDs for soft tissue surgery in small animals?
yes, after weighing risks and benefits.
what are the 2 best NSAID choices for dog soft tissue surgery
carprofen and meloxicam
what is the best evidence NSAID for cat soft tissue surgery
robenacoxib (also labelled for dogs, but not as much evidence as there is for meloxicam and carprofen). meloxicam is also possible for kitties but not as much evidence
what NSAID to give for doggie ortho sx
carprofen is best evidence
what NSAID to give for kittiecat ortho sx
robenacoxib (also what you give for soft tissue sx)
what to give for OA or MSK pain in dogs? 3 choices
meloxicam, firocoxib, carprofen. and be sure to titrate to lowest dose and lowest frequency of dose
what to give for OA or MSK pain in kitty cats?
meloxicam
what NSAID can you give to horses PO in Canada
firocoxib (also meloxicam and aspirin but not approved)
what 3 drugs can you give to horses for MSK pain? which is best for chronic
phenylbutazone and flunixin, firocoxib for chornic
what NSAID can you give to horses for GI pain/sx
flunixin
what NSAIDs should you not give in cattle? 5
phenylbutazone (never in production animals), carprofen, dipyrone, firocoxib, ibuprofen
grapriprant is labelled for what, in what species
dog OA pain (if not responding well to meloxicam, carprofen, or firocoxib)
what drugs should you not give simultaneously with NSAIDs? 2 categories
other NSAIDs (highly protein bound may displace causing too much drug in blood) and steroids (act at different points in arachidonic acid pathways, so increases adverse effects)
what are the unapproved NSAIDs to know about?
aspirin (ASA), ibuprofen, and acetaminophen )not technically an NSAID). also naproxen and piroxicam
aspirin can help with OA in dogs but not labelled
ibuprofen do not give–toxicity
acetaminophen (toxic to cats0
gabapentin is not an NSAID, but often used as a non-NSAID analgesic option. is there evidence of its efficacy as an analgesic in vet med
no
main psychotropic compound in cannabis
THC tetrahydrocannabinol
- Major non‐psychotropic component of Cannabis
- Has been suggested to be anxiolytic, antidepressant, antipsychotic, anticonvulsant, antinausea, antioxidant, anti‐ inflammatory, anti‐arthritic, antineoplastic
- In CNS is protective in animal models of epilepsy, anxiety, psychosis, Parkinson’s and Huntington’s disease
CBD cannabidiol
