Toxins-1 meds and pesticides (Lanaux) Flashcards
1
Q
Objectives
A
- name common medications with toxic potential in small animals
- recognize toxic effects of pesticides in small animals
- manage symptomatic and asymptomatic patient affected by toxins
2
Q
NSAIDS
A
- COX enzyme inhibitors
- Cox selectivity may influene risk
- cox 1 const: homeostasis
- cox 2 const: inducible, inflammation
3
Q
NSAID COX selectivity
A
- Older NSAIDS non-selective
- eg: aspirin
- Newer NSAIDS may be cox-2 selective
- eg: carprofen
- serious effects possible with any NSAID
- dose is imp
- hypovolemia inc risk
4
Q
NSAIDS:
organ systems affected
A
- GI
- Kidneys
- Coagulation (platelets)
- Liver
5
Q
Examples of NSAID products
A
- Rimadyl
- Previcox
- Bayer
- Metacam
- Aleve
6
Q
NSAIDS:
GI effects
A
- prostaglandins needed for gastric mucosal health
- mucus production
- normal perfusion
- inhibiting prostaglandins
- risks GI ulceration
- slows healing of ulcers from lack of perfusion
7
Q
NSAIDS
GI PE findings
A
- Inappetance
- vomiting
- diarrhea
- melena
- hematemesis (coffeeground poo)
- hypovolemia
8
Q
NSAIDS
GI lab findings
A
- anemia
- high BUN compared to creatinine
9
Q
NSAIDS:
management of GI signs
TQ
A
- H2 receptor antagonists
- famotidine
- pepsid
- Proton pump inhibitors
- omeprazole
- Synthetic prostaglandin analogs
- misoprostol
- can cause abortion
- handle with care
- client education
- can cause abortion
- misoprostol
- Physical barrier to acid injury
- sucralfate
10
Q
NSAIDS TX
Supportive care-TQ
SX
A
- Supportive care depends on case
- IV fluids if hypovolemic (TQ)
- red blood cell transfusion if anemic
- anti-emetics if nauseated
- Surgery
- if severe intractable GI bleeding
- removal of bleeding ulcer
11
Q
Big NSAID offender of bleeding
A
Naproxen/aleve
12
Q
NSAIDS
Other side effects
A
- Kidneys
- AKI possible
- Dialytic and non-dialytic options
- see AKI notes
- Platelet dysfunction
- Aspirin is irreversible inhibitor - 5 days to wear off
- other NSAIDS are reversible
- Liver dysfunction
- less common
- acute liver injury possible
13
Q
Management of asymptomatic patient
A
- GI decontamination
- induce vomiting
- multiple doses of activated charcoal - for interohepatic recirc
- IV fluid diuresis
- Aim for 3 half-lives of drug
- about 72 hours
- Aim for 3 half-lives of drug
- Charcoal hemoperfusion
- limited availability
- Suitable for larger patients
- > 25kg dog
- Provides large surface area to bind toxin
14
Q
Analgesics:
Acetaminophen
A
- very toxic to cats
- toxic to dogs at high doses
- at risk organs
- liver
- RBCs
15
Q
Acetaminophen
Normal liver metabolism
Cats
A
- Normal liver metabolism
- 90% metabolized to non-toxic compounds
- 5% excreted unchanged in urine
- 5% converted to toxic NAPQI via CP450
- Cats limited in glucuronidation
- limited
16
Q
Acetaminophen
NAPQI
Hematological effects
Liver effects
A
- NAPQI
- induces oxidative damage
- binds to -SH groups in RBC and liver
- Hematological effects
- methemoglobinemia - chocolate brown gums
- heinz body anemia
- hemolytic anemia
- Liver effects
- centrilobular necrosis
- hepatocellular enzymes increase