Treatments of Lameness Flashcards
What do NSAIDs do?
Inhibit the cyclooxygenase (COX) pathway and the production of prostaglandins
Which NSAIDs block both COX pathways?
Bute
Banamine
Aspirin
Naproxen
Which NSAIDs only block COX-2 pathways?
Firocoxib (Equioxx and Previcox)
Bute
Phenylbutazone
What are some concerns with the use of bute?
renal toxicity
gastric ulcers
Perivascular necrosis with IV
What are some concerns with Firocoxib?
Expense
Loading period
Off-label use
Potency
Blocks some good prostaglandins?
Why do you have to be careful with the use of corticosteroids?
It is hard to stop the use
Can speed up cartilage damage
Do not use if an infection is suspected
What are the benefits of corticosteroids?
Pain relief
Decreased production of MMPs which degrade the matrix
Decreased interleukin-1 (IL) and tumor necrosis factor (TNF-alpha) which decreases the synthesis of matrix molecules and induces the production of MMPs
MMP
Matrix metalloproteinases
Disadvantages of corticosteroids (Name three)?
Induces severe and irreversible chondrocyte necrosis
Decreases matrix production for 3-4 months
Affects other joints
Steroid-induced laminitis
Steroid arthropathy (accelerated joint destruction)
Provide pain relief which increases joint use and damage
Types of Steroids
Methylprednisolone (Depo-medrol, Predef)
Triamcinolone (Vetalog)
Betamethasone (Celestone)
In what joints should Methylprednisolone be used in?
Low-motion joints
In what joints should Triamcinolone be used in?
High-motion joints
What should be added with corticosteroids for intraarticular use?
HA and/or antibiotics (amikacin)
What is Hyaluronan (HA)?
a type of glycosaminoglycan (long unbranched polysaccharides)
Where is HA normally found?
Articular cartilage and synovial fluid
What are the uses of HA?
Injection of HA for horses with OA
Treats synovitis (slows progression of OA)
Lubricates the joint capsule
Local anti-inflammatory and analgesic
PSGAGs
Polysulfated Glycosaminoglycans
What is the brand name for PSGAGs?
Adequan
What do PSGAGs do?
stimulates chondrocyte metabolic activity
Inhibits the effects of enzymes involved in cartilage breakdown
Stimulates HA synthesis by the synovial membrane
Anti-inflammatory and analgesic
PPS
Pentosan Polysulfate
What does PPS come from?
Xylan, beechwood trees
What is the mechanism of action in PPS?
Stimulates the synthesis of proteoglycans and increases their inclusion in the extracellular matrix of cartilage
Stimulates synoviocytes to produce more HA
Inhibits inflammatory mediators
Increases blood flow by preventing clogged vessels
PAAG
Polyacrylamide Hydrogel
What are PAAGs used for?
Viscoelastic supplement with IA use for OA
Decreases joint capsule stiffness
Creates lubrication in the joint
Topical anti-inflammatories
1% diclofenac (Surpass, Voltaren)
DMSO (dimethyl sulfoxide)
Muscle relaxer
Methocarbamol (Robaxin)
Vasodilators
Isoxsuprine
Acepromazine
Anti-endotoxin
Banamine
Plasma
Polymixin-B
Pentoxifylline
Bisphosphonates
Tildren (Tiludronate disodium)
OSPHOS (Clodronate disodium)
What are biphosphonates used for?
Navicular
Bone spavin (OA)
Kissing Spine
What is the mechanism of action of bisphophonates?
biphosphonates encourage osteoclasts to undergo cell death which causes decreases in bone breakdown/resorption
What are some concerns with bisphophonates?
Colic (shortly after administration)
Renal Toxicity (with NSAIDs)
Not tested in growing or pregnant/lactating horses
Increased bone fragility over time
What are the additional mechanisms of action in Tildren?
Increases bone density short term
Inhibits the secretion of enzymes that degrade articular cartilage
What is a concern with OSPHOS?
off label use in race horses
When is cold therapy effective?
During the acute phase (first 24-48 hours)
When is hot therapy effective?
During the chronic phase (after 48 hours)
IRAP
Interleukin-1 Receptor Antagonist Protein
What is IL-1?
a major inflammatory mediator that causes inflammation, cartilage breakdown, and bone resorption
What does IRAP do?
IRAP competes with IL-1 for space on the receptor which blocks the inflammatory effects of IL-1
How is IRAP made?
Draw blood from horse
Incubate for 24 hours in a syringe with chromium coated beads, then centrifuge and inject into joint
What are the benefits of adult mesenchymal stem cells?
There is no risk of tissue rejection
Fibronectin
Aids in cell migration through the area of injection
What are the advantages of adipose stem cells
minimally invasive
more concentrated cells
a more diverse population of cells
1-day turn-around
PRP
Platelet Rich Plasma
How does PRP work?
Platelets clot and activate which release granules that form the fibrin matrix –> the fibrin matrix traps more platelets and provides the framework for fibroblast migration and adhesive glycoprotein
HBOT
Hyperbaric Oxygen Therapy
What does HBOT do?
Dramatically increases the amount of dissolved oxygen in plasma
Increases O2 concentration in all tissues
Stimulates angiogenesis
increases natural antioxidants and free radical scavengers
Enhances WBC action and potentiates antibiotics
What are the uses of HBOT?
Acute trauma
Laminitis
Surgical incisions
Chronic non-healing wounds
Bone infections
Ligament and Tendon Injuries
Pro-Stride
PRP and IRAP
