Respiratory therapeutics Flashcards
Symptomatic treatment of influenza
Rest
Decrease stress
Ensure adequate hydration
NSAIDs +/- paracetamol
When should antimicrobials be considered for equine influenza?
If a horse shows signs of respiratory disease > 10 days (high risk of escondary bacterial infection)
When are antiviral treatments used for equine influenza?
For very large outbreaks with severe morbidity
(drugs are limited and very expensive)
EHV-1,-4 treatment
Symptomatic treatment
Antiviral drugs occasionally used if neurological disease (valacyclovir)
Biosecurity is critical
Guttural pouch mycosis location
commonly located on the caudo-dorsal aspect of the medial compartment, over the internal carotid artery
Most common causative agent of guttural pouch mycosis
Aspegillus spp.
Most common clinical signs of guttural pouch mycosis
Due to cranial nerve and arterial damage within mucosal lining
Epistaxis (arterial wall erosion) - can lead to fatal haemorrhagic event
Dysphagia
Diangosis of guttural pouch mycosis
Endoscopic examination
Care not to dislodge any plaques that may lead to haemorrhage
Most common medical therapy for guttural pouch mycosis
Azoles
- inhibit fungal mediated synthesis of ergosterol via inhibition of cytochrome P-450 enzyme
Enilconazole
Administered via the biopsy channel of an endoscope
Antimicrobials for Strepequi var, equi (strangles)
Immunity impeded by antimicrobials so not for every case
Useful for
- acutely affected animals
- severe lymphadenopathy causing resp distress
- metastatic abscessation
- purpura haemorrhagica
Never use prophylactically
Penicillin is drug of choice
Treatment of metastatic abscessatio of strangles
may require long term (<6mo in some cases) antimicrobial therapy
Base treatment duration on re-examination and serial assessments of acute phase protein concentrations
Therapy of carrier status strangles
Chondroids need endoscopic or surgical removal
Gelatin/penicillin formulations to topically treat
Systemic antimicrobial therapy for bacterial pneumonia
Transtracheal or triple lumen catheter tracheal aspirate samples should be submitted for bacteriology
Initiate antimicrobial treatment whilst waiting
Penicillin/gentamycin/metronidazole are first line treatments
Usually require parenteral antibiotics for 4-10 days then oral can be used
Total duration of antibiotic administration is often 4-6 weeks
Inhaled therapies for bacterial pneumonia
Nebulised saline
Some antibiotics can be nebulised (gentamycin/cefquinome)
Unlikely in case of animals with significant lung pathology
Bronchodilators may be beneficial in some cases but not commonly used
Pleural effusion management
May need chest drains
Fibrinous adhesions could be problematic - inhibit effective drug penetration, and precede abscess formation
Recombinant tissue plasminogen activator (rTPA) can be used to break down fibrin
NSAIDs may be needed to minimise inflammation, control fever, and provide analgesia
Adequate hydration
Laminitis prophylaxis
Treatment of fungal pneumonia
Azoles
- itraconazole
- fluconazole
- vericonizole
Amphotericin B
- irritant, may cause phlebitis
Medical treatment of equine asthma
Corticosteroids reduce pulmonary inflammation
- fewer side effects if inhaled
Inhaled beta-2 agonists act on airway relief of airway obstruction
Oral and IV clenbutarol (ventipulmin)
Anticholinergics
Buscopan
Methylxanthines
Rescue therapy for respiratory distress at rest due to equine asthma
IV atropine/buscopan
IV dexamethasone
Maintenance therapy for equine asthma
Oral prednisolone +/- oral clenbutarol, until stable
Inhaled corticosteroid +/- inhaled bronchodilator for medium term maintenance and during times of challenge
Fix environmental triggers
Corticosteroid options for equine asthma
Tapering course of oral prednisolone
IV dexamethasone for acute distress
MDI: inhaled ciclesonide (licensed) fluticasone or beclomethasone (cascade)
Nebuliser: dexamethasone
Inhaled beta-2 agonists for equine asthma
Salmeterol: effective up to 12h
Salbuterol/albuterol: effective up to 1-2h
Adverse effects include sweating, tachycardia, muscle temors
Anticholinergics for equine asthma
E.g. glycopyrollate, ipratopium, atropine
Adverse effects include reduced GI tract motility/colic
Buscopan for equine asthma
Muscarinic recepto agonist
Shown to be an effective bronchodilator
Causes transient tachycardia but very minimal side effects and very safe/readily available
