respiratory pharm

Question 1

FDA-approved opioid anti-tussive

Answer 1

Butorphanol in dogs

lasts 4-10hrs, potent PO dose

Question 2

Most commonly used/effective opioid anti-tussive

Answer 2

Hydrocodone. Active metabolite = hydromorphone

Question 3

What do some hydrocodone formulations contain that make it a strict prohibit of use in cats?

Answer 3

Acetaminophen

Question 4

Non-opioid anti-tussive that is found OTC but not used in veterinary patients

Answer 4

Dextromethorphan:

Question 5

Where are beta-2 receptors located and what happens when stimulated?

Answer 5

in the airways -> when stimulated, get agonist effect = brochodilation

Question 6

3 most commonly used beta-2 agonists

Answer 6

Terbutaline, Albuterol, Clenbuterol

Question 7

What drugs would you use in ER situations where pt can’t breathe and is hypotensive?

Answer 7

non-specific beta-2 agonist like epinephrine

Question 8

Which beta-2 agonist is prohibited for use in food animals?

Answer 8

Clenbuterol b/c it can linger in tissues for long time -> may affect people who consume the meat

Question 9

Livestock: Adverse effect of beta-adrenergic agonists on repro system, and their use in tocolysis

Answer 9

Clenbuterol, Terbutaline, Albuterol:

Reproductive:
1. inhibits uterine motility
2. Tocolysis: obstretrical procedure where medicine is used delay labor presentation of pre-term contractions. Can also help with manipulations of a fetus in dystocia.

Question 10

Methylxanthines MoA

Answer 10

bronchodilation

Question 11

What two methylxanthines are often used in dogs, cats and rarely horses?

Answer 11

Theophylline and Aminophyilline

Question 12

What is the main adverse effect in HORSES of theophylline?

Answer 12

CNS stimulation

Question 13

Why is there an overdose/toxicity concern with methylxanthines like theophylline?

Answer 13

Theophylline gets metabolized into theobromine (just like chocolate), which undergoes extensive enterohepatic recirculation

Question 14

Advantages of inhalant drugs for respiratory disease

Answer 14

• high drug concentrations directly at disease site
• minimal systemic effects/toxicity
• therapeutic effect at fraction of systemic dose

Question 15

Disadvantages of inhalation therapy for respiratory disease

Answer 15

• Respiratory defenses prevent particulates reaching the lower airways
• need adapter (animals won’t breath-hold to allow for distribution)
• drug delivery depends on Vt, RR
• not all drugs suitable for aerosol delivery (airway irritants from preservatives in drug formulation)

Question 16

Describe importance of particle size of inhalant drug

Answer 16

small enough to get to bottom of lung, but big enough to stay there

Question 17

MDIs

Answer 17

Metered Dose Inhalers = pressurized cartridge dispenser that delivers a set amount of drug per “puff (actuation)”

Question 18

Identify / purpose

Answer 18

Spacers: keeps drug in chamber- allows for animal to get all of drug with multiple breaths

Question 19

Nebulizers MoA

Answer 19

deliver drug as vaporized steam, spray or mist

Question 20

What are the mainstay of treatment for inflammation in the airway, which is mediated by leukotrienes?

airway inflammation -> bronchoconstriction

Answer 20

Inhalant glucocorticoids
- fluticasone, beclomethasone, ciclesonide

Systemic dexamethasone and predniso[lo]ne are very effective as well, but they have a much greater risk of causing systemic adverse effects versus inhalant glucocorticoids

Question 21

Fluticasone vs Beclomethasone

Answer 21

Question 22

Ciclesonide

Aservo, Equihaler

Answer 22

FDA-approved glucocorticoid prodrug inhalant for horses, metabolized by lungs into active metabolite

Question 23

Mast Cell Stabilizers

Answer 23

Chloride-channel blockers that modulate mast cell-mediator (histamine) release

Mast cell stabilizers inhibit histamine release from mast cells and reduce airway hyper-responsiveness. They are given by inhalation prophylactically to patients with exercise-induced or allergen-induced asthma.

Question 24

Why are beta-2 adrenergic agonists often paired with a glucocortioid?

Answer 24

B/c beta-2 agonists have no anti-inflammatory properties, which is very important for controlling these inflamamtory upper airway diseases

e.g., albuterol

Question 25

Ipratropium bromide

Answer 25

Anti-cholinergic, atropine-derivative bronchodilator.

Question 26

Rule of thumb for URT

Answer 26

If still e/d/u/def but have URT signs (wheezing, conjunctivitis, etc.), wait 10 days

Question 27

most cases of bronchopneumonia are located in the ___

Answer 27

Interstitial Fluid - most abx get here w/out issue

Question 28

What abx will be used to treat LRT in horses?

Answer 28

macrolide +/- rifampin