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Small Animal Endocrinology > Treatments > Flashcards

Treatments Flashcards

1
Q

How should you treat Hyperadrenocorticism?

A

Trilostane - mainstay of treatment
- switches off the enzyme that converts cholesterol to cortisol

Mitotane - kills off adrenal cells
Lignan phytoestrogens and melatonin - normal cortisol but abnormal androgens

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2
Q

How frequently should you monitor response to hyperadrenocorticism therapy?

A

After the first two weeks
3 monthly for the first year
6 monthly from then on

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3
Q

What drug should you use to treat hypertension due to hyperadrenocorticism first line?

A

Benazepril - ACE inhibitor

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4
Q

What drug should you use to treat hypertension in hyperadrenocorticism if the patient has become refractory?

A

Amlodipine

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5
Q

When can you surgically remove an adrenal tumour?

A

If it is not invading the caudal vena cava

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6
Q

When is a hypophysectomy indicated in pituitary dependent hyperadrenocorticism?

A

When the patient goes duller following treatment

Space occupying lesion

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7
Q

What should you do in a Scottish terrier before diagnosing Cushings?

A

Liver biopsy

- hepatopathy with abonormal dynamic cortisol

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8
Q

What haematological / biochemical abnormalities will you see in addisons?

A 
Pre renal azotaemia
Hyponatraemia
Hyperkalaemia 
Acidosis
Mild non-regenerative anaemia
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9
Q

What is atypical addisons?

A

Cortisol deficiency with normal mineralocorticoids

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10
Q

What ECG abnormalities might you see with Hyperkalaemia?

A

Atrial standstill / reduced P wave amplitude
Prolonged QRS
Tall spikey T waves
Bradycardia

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11
Q

When should you be concerned about Hyperkalaemia causing ECG abnormalities?

A

Over 7 mol/L

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12
Q

How can you treat and addisonian crisis?

A

0.9% NaCl - 80 ml/kg/h
Change to lactated ringers after 1 hour

Monitor CRT, BP, lactate and urine output

Treat Hyperkalaemia

  • Dextrose saline and Insulin IV
  • Calcium gluconate
  • monitor glucose and K+

Supplement steroids
- Dexamethasone IV q 24h

Once eating

  • oral prednisolone
  • fludrocortisone
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13
Q

What maintenance therapy can you put a patient with addisons on?

A

Oral prednisolone - when stressed

DOCP - maintenance therapy

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14
Q

How often should you monitor a patient with addisons?

A

Monitor electrolytes at 2, 3 and 4 weeks

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15
Q

How should diabetes mellitus be managed?

A

Insulin injections
Diet changes
Set routine to ensure blood glucose is well controlled

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16
Q

What preparations of insulin are available?

A

Short acting insulin - regular crystalline insulin - for CRI
Intermediate acting insulin - caninsulin - licensed in dogs
Long acting - prozinc - licensed in cats

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17
Q

How should you manage diabetes in a dog?

A

Twice daily insulin injections, regularly spaced apart with food

(Usually controlled at about 0.8iu)h

High fibre, complex carbohydrate diet

18
Q

How should you manage diabetes mellitus in cats?

A

Prozinc - long acting injections twice daily
Many cats will go into remission or be maintained on very low doses

Low carbohydrates, high protein

19
Q

What is an oral hypoglycaemic drug?

A

Gilpizide - sulfonylureas

20
Q

How can you monitor diabetic patients?

A

Thirst
Appetite
Weight gain

Urine glucose - afternoon sample
Blood glucose after 1 week of insulin
Fructosamine after 2 weeks

21
Q

What should should you tell the client to watch out for and how can they treat hypoglycaemia?

A

Ataxia, collapse, seizure

Don’t give insulin dose
Feed ASAP

22
Q

What should the owner do if the animal is not eating?

A

Reduce dose by 50%

23
Q

Where should the nadir be on a blood glucose curve?

A

4.5-9mM

24
Q

How can you measure the duration of insulin on a glucose curve?

A

Time from injection, past nadir, back to 14mM

25
Q

At what dose of insulin should you start suspecting insulin resistance?

A

Over 2iu/kg

26
Q

What should you maintain the nadir at using insulin?

A

4-8mM

27
Q

How can you tell if the duration of insulin is too short?

A

Nadir sufficient but not for long enough

28
Q

When treating diabetic ketoacidosis what glucose level should you aim for?

A

8.4-16mmol/L

29
Q

How can you manage diabetic ketoacidosis?

A

Crystalline insulin CRI 0.1iu/kg/h
Monitor blood glucose hourly
Once concentration is under 14mmol/L start IM q 4-6 h
Once blood glucose is less than 16mmol/L start 5% dextrose
Monitor K+ and PO4 throughout

30
Q

What two fluid therapies should you give simultaneously in diabetic ketoacidosis?

A

Isotonic crystalloid + 20mM K+
- once blood glucose 10-15 add glucose

Crystalloid + 50iu/L soluable insulin

Monitor K+, glucose and acid base balance

Once ketones are gone and the dogs is eating swap on IM insulin

31
Q

How can you treat hypothyroidism in dogs?

A

Levothyroxine (leventa)
Monitor T4 8 hours post pill

Metabolic signs resolve in first few weeks, dermatological signs take months

32
Q

What medical management can you use for feline hyperthyroidism?

A

Thiamazole - inhibits the synthesis of thyroid hormone
- check total T4 after 2 weeks and then every 3 months

Carbimazole

33
Q

What side effects can occur with anti-thyroid drugs?

A 
Anorexia and vomiting
Pruritus and excoriation 
Blood dyscrasias
Hepatopathy
Acquired myasthenia gravis
34
Q

What must you monitor alongside thyroid levels in hyperthyroidism?

A

Creatinine and urea - mask unmasks renal disease

Heart - HCM common with hyperthyroidism

35
Q

How can you control HCM in cats with hyperthyroidism?

A

Atenolol and Propanolol - to reduce the HR

36
Q

What other treatment options are available for hyperthyroidism?

A

Surgical removal of the thyroid gland - risk of iatrogenic hypoparathyroidism

Radio iodine therapy

37
Q

How should, you treat central diabetes insipidus?

A

Desmopressin

38
Q

How can you treat acromegaly in the bitch?

A

Spay

39
Q

How can you treat acromegaly in the cat?

A

Control diabetes mellitus
Hypophysectomy
Radiation of pituitary mass

40
Q

How can you treat hypercalcaemia?

A 
0.9% NaCl - 3-4x maintenance 
Furosemide
Prednisolone 
Calcitonin
Biphosphonates
41
Q

What tumours cause hypercalcaemia of malignancy?

A 
Anal sac adenocarcinoma 
Lymphoma
Myeloproliferative diseases - multiple myeloma 
Thymoma 
Bone lysis - osteosarcoma, SCC
42
Q

How can you treat hypocalcaemia?

A

IV fluids
SC calcium gluconate

Ongoing oral calcium or oral vitamin D

Small Animal Endocrinology (2 decks)

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