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ACVIM.Pharm > Treatment of Sepsis > Flashcards

Treatment of Sepsis Flashcards

1
Q

What are the mainstays of treatment of sepsis?

A
  1. early aggressive CV resuscitation– O2, fluids, pressors, ionotropes, packed RBCs
  2. laminitis prevention
  3. removal of the cause of sepsis
  4. Neutralization of circulating endotoxin & other pAMPs
  5. inhibition of PAMP induced inflammation
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2
Q

What is the dose of plasma administration for sepsis?

A

20-40 ml/kg

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3
Q

What is the goal of plasma administration in sepsis/endotoxemia?

A

replace extravasated colloid from vascular leak

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4
Q

What are the advantages of plasma administration for sepsis/endotoxemia?

A

immunoglobulin

acute phas proteins

anti-coagulants

antiendotoxin Ab

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5
Q

What is the fluid bolus rate? and how often repeated?

A

20 ml /kg, then continue at 10-20 ml/kg for a total of 60-80 ml/kg

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6
Q

If no improvement with intravenous fluid boluses, then what can be administered to improve cardiovascular function?

A

colloids

inotropes

vasopressors

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7
Q

When should bicarb be supplemented?

A

<16 mmol/L

**post fluid restoration

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8
Q

During acidemia correction, what electrolyte should you supplement for?

A

potassium (10-20 mmol/L) to prevent hypokalemia

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9
Q

What pathogenic mechanisms of sepsis/endotoxemia lead to the development of laminitis?

A
  • insulin resistance
  • hyperlgycemia
  • microvascular injury & thrombosis
  • protease activation
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10
Q

What are prophylactic treatments to administer prior to appreciating an increase in digital pulses associated endotoxemia/sepsis, for the prevention of laminitis?

A

prompt fluid resuscitation

NSAIDs (dec inflamm mediators)

digital cryotherapy

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11
Q

During an intestinal strangulation, with return of intesinal blood flow could worsen endotoxemia & sepsis because:

A
  • sequestered endotoxin flushed into circulation
  • ischemia/reperfusion injury
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12
Q

What can be administered intraop/prophylatically before undoing an intesinal strangulation?

A

NSAIDs

ROS scavengers

Polymixin B

hyperimmuen plasma/serum

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13
Q

What medications can be administered to neutralize circulating endotoxin?

A

hyperimmune plasma & serum

polymixin B

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14
Q

What is the dose of polymixin B?

A

1,000 to 6,000 U/kg q8h

**dilute in saline and give over 15 minutes

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15
Q

What NSAIDs can be given to inhibit endotoxin induced inflammation & related sequlae through COX inhibition?

A

flunixin meglumine, phenylbutazone

ketoprofen, carprofen

meloxicam, firocoxib

aspirin

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16
Q

What are negative side effects of COX-1 and COX-2 inhibition?

A

gastric ulceration

R dorsal colitis

renal papillary necrosis

DEC intestinal motility

17
Q

Methylxanthine derivatives inhibit endotoxin induced inflammation & related sequelae through what mechanism?

A

suppress macro cytokine production via

phosphodiesterase inhitino

**INC intracellular cyclic adnosine monophosphate**

18
Q

What is an example of a methylxanthine derivative?

A

Pentoxyfylline

19
Q

What are the mechanisms that Pentoxyfylline inhibits endotoxin induced inflammation & related sequelae?

A

inhibits TNF alpha production

INC secretion of prostacyclin

20
Q

Dose of Pentoxyfylline

A

10 mg/kg PO q12h

21
Q

Corticosteroids inhibit endotoxin induced inflammation through what mechanisms?

A

dec cytokine production

stabilize cell membranes prevent neutrophil activation

22
Q

What can corticosteroids induce laminitis in septic horses?

A
  • INC sensitivity of digital vessels to constrictive effects of catecholamines
  • Inducing insulin resistance & hyperglycemia
23
Q

What anticoagulant therapies may be indicated in tx of colitis/endotoxemia?

A
  • heparin
  • clopidigrel
  • aspirin
24
Q

By what mechanism does unfractioned heparin beneficial as an anticoagulant in tx of sepsis/endotoxemia?

A

prevents microvascular thrombosis via AT-III

**cannot reverse existing thrombosis

25
Q

What is the mechanism of low molecular weight heparin as an anti-coagulant for the treatment of sepsis/endotox?

A

nonagglutinating wtih anticaogulation activity

**inhibits factor Xa**

26
Q

What is the dose of clopidogrel?

A

4 mg/kgPO once then 2 mg/kg PO every

27
Q

What is the dose of aspirin?

A

5 to 10 mg/kg PO q24 to 48 hours

28
Q

Reactive oxygen species cause:

A

corrosive tissue damage

potentiate production of inflammatory cytokines through activation of NF-kappaB

29
Q

What are examples of free radical scavengers that can be used in the treatment of endotoxemia/sepsis?

A

allopurinal

DMSO

Eythl pyruvate

30
Q

MOA of Allopurinal

A

hydroxyl radical scavenger

inhibitor xanthine oxidase activity

31
Q

MOA of DMSO

A

potent scaenger hydroxyl radicals (rats; variable in equine)

32
Q
A

ACVIM.Pharm (4 decks)

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