Wk 4 Flashcards
arachidonic acid cascade
Chemicals are released during cell damage; prostaglandins, leukotrienes, histamine, cytokines, etc
Proud flesh
Occurs in horses
An over production of granulation tissue- secondary healing can’t occur
Cyclooxygenase
an enzyme in the inflammatory cascade
makes prostaglandins
COX-1
maintains physiologic functions like renal blood flow, normal platelet aggregation, and the synthesis of the gastric mucosa (“good” prostaglandins)
COX-2
stimulates formation of prostaglandins which mediate inflammation (“bad” prostaglandins)
*can also play a role in ulcer healing and maintenance of renal blood flow during stress
Fever
an increase in the body temperature above normal
Destruction of invading viruses or bacteria by heat inactivation; or by
Facilitating biochemical reactions in the body
Pyrogen
Something that induces a fever
Exogenous
pyrogens come from outside the body, such as viruses and bacteria
Endogenous
pyrogens come from inside the body and are usually chemical mediators such as prostaglandins
NSAID
Non-steroidal Anti-inflammatory Drugs
inhibiting cyclooxygenase at the cellular level.
Adverse Effects of NSAIDs
GI ulceration and bleeding They interfere with the normal mucus coating of the stomach Nephrotoxicity Bone marrow suppression Bleeding tendencies Hepatotoxicity
Contraindications/Precautions of NSAIDS
DO NOT use concurrently with steroids or other non-steroidals
Increased chance of GI ulcers
Use with caution in animals with hypoproteinemia
Once to twice yearly blood panels are recommended to monitor liver & kidney functions when giving long-term
What bleeding disorder should not receive NSAID?
von Willebrand’s disease
Aspirin
Acetylsalicylic Acid
Used for analgesic, anti-inflammatory, anti-pyrexia, and anti-platelet effects
Decreased platelet aggregation (blood thinner)
What is Asprin used for in animals?
Mild to moderate pain associated with osteoarthritis
Pulmonary artery disease secondary to heartworm infestation
Anti-platelet effects help less thrombi form)
Cardiomyopathy in cats
Is Asprin safe for cats?
No, only used when absolutely necessary
Cats do not metabolize aspirin very well or very quickly & toxicity is very possible
5mg PO per cat every 3 days
Phenylbutazone
Bute, Butazolidin®
horses but is also approved for dogs
analgesic, anti-pyretic, and anti-inflammatory properties
Is Phenylbutazone safe for cattle?
No, only used when absolutely necessary
cattle, one dose requires a 30 day withdrawal time
Flunixin Meglumine
Banamine
horses but is approved for use in cattle and has been used off-label in dogs for parvovirus
Analgesic: pain from musculoskeletal disorders and very good analgesic for visceral pain (colic)
Anti-inflammatory: in endotoxemia and musculoskeletal issues
Anti-pyrexia: in endotoxemia and bovine respiratory disease, calf diarrheas
Can Banamine be used in febrile dogs?
Extreme care must be taken if used in febrile dogs; Banamine is very potent and takes the temperature down rapidly –sometimes too rapidly- which can be life threatening
Melena
Bloody poop
Carprofen
Rimadyl®
anti-inflammatory and analgesic but it does exhibit some effects on fever
In the US, approved for use only in dogs
Safer on the GI system than aspirin but GI signs may still occur; animal must be monitored for vomiting, diarrhea, melena
Etodolac
Etogesic®
more selective for inhibition of Cox-2 than Cox-1
used for the pain and inflammation associated with osteoarthritis in dogs
not safe in dogs under 12 months of age
cause irreversible KCS in some dogs
KCS
Dry eye
Meloxicam
Metacam®
Cox-2 preferential NSAID
Fewer side effects than other NSAIDs
GI effects are still possible but only occur occasionally and are usually transient
Renal toxicity is low
Unknown if Meloxicam causes hepatotoxicity like the other NSAIDs
Used for analgesia and inflammation associated with osteoarthritis as well as for post-op pain
In cats and small dogs, to prevent overdosing the Meloxicam should be placed on the food rather than directly into the mouth (dosing is by the drop)
Is Meloxicam safe for cats?
Has become common to use off-label in cats, too, but with CAUTION!
More susceptible to renal effects
Deracoxib
Deramaxx®
Predominantly inhibits Cox-2 and spares Cox-1 For the treatment of post-op pain
For the pain and inflammation associated with osteoarthritis in dogs
Tepoxalin
Zubrin®
A dual inhibitor of both cyclooxygenase and lipooxygenase so it blocks both arms of the arachidonic acid cascade.
Blocking LOX means a reduction in leukotrienes which contribute to inflammatory responses in joints and the GI tract
incoordination, incontinence, polyphagia, flatulence, hair loss, & trembling
Firocoxib
Previcox®
Inhibits COX-2 while sparing COX-1
Used to treat the pain and inflammation associated with canine osteoarthritis
Robenacoxib
Onsior
COX-2 selective NSAID for CATS
Alleviate post-op pain
weighing at least 5.5# and at least 6 mos of age for up to a max of 3 days
Grapiprant
Galliprant®
Prostaglandin E2 (PGE2) EP4 receptor antagonist
Non cyclooxygenase inhibiting NSAID
pain and inflammation associated with osteoarthritis in dogs
vomiting, diarrhea, decreased appetite, decreasing albumin and total protein
Is Ibuprofen safe for dogs and cats?
NO NO NO
Is Acetaminophen safe in cats?
NEVER, NEVER, NEVER in cats
Is Acetaminophen safe in dogs?
At very low dose, yes.
Can cause Methemoglobinemia
DMSO
dimethyl sulfoxide
free-radical scavenger (antioxidant) that has anti-inflammatory & analgesic effects
penetrates the skin; it serves as a carrier agent in promoting skin absorption of drugs and toxins; drugs which would not normally be absorbed topically will be if added to DMSO
used in head trauma & edema, post GI surgery, ischemic conditions
Adequan
PSGAG = polysulfated glycosaminoglycan
PSGAG reduces inflammation by reducing prostaglandins released in joint injury
Increases hyaluronate in the joint thereby increasing synovial fluid viscosity
Glucocorticoids
Corticosteroids
Adrenal insufficiency (Addison’s Disease)
Allergies
Asthma
Autoimmune disorders (thrombocytopenia, AIHA)
Neoplasia
Increased CSF pressure
Shock/toxemia
Steroid use is rarely a cure but a treatment for the symptoms of a disease
Contraindications/Precautions
Glucocorticoids
systemic fungal, viral & bacterial infections
Systemic steroids need to be tapered-off slowly. Stopping the systemic steroids suddenly may cause the animal to crash into an Addisonian crisis, a potentially life-threatening situation
Adverse Effects/Warnings
Glucocorticoids
PU/PD, polyphagia, panting, weight gain, dull haircoat, elevated liver enzymes, GI ulcers, DM, behavioral changes (depression/lethargy or aggression), redistribution of body fat
Glucocorticoids Dose
Depends on their use
anti-inflammatory vs. immunosuppressive
disease being treated
Prednisone/Prednisolone
Prednisone is a prodrug
Prednisone is biotransformed by liver enzymes into it’s active metabolite drug form, prednisolone.
cats are not efficient at the conversion and do better on prednisolone.
Local Anesthetics are used
Topically: skin eye
Infiltration; SQ IM, line block
IV: The Bier Block of the distal extremity
Regional: Epidurals nerve blocks
The calculated dose is for the entire animal
What is sometimes used to cause vasoconstriction?
epinephrine
Why would you want vasoconstriction when using local anesthetics.
Less perfusion less absorption of the local agent prolonged effect of the agent in the area
Less bleeding
used for ophthalmic procedures
Proparacaine
Proparacaine Properties
Primarily anesthetizes the cornea
Anesthesia is short, 5-10 minutes
Refrigerate
Protect from light
Lidocaine Properties
Immediate onset of action and short duration of effect (60-120 minutes)
78% of the administered dose reaches the general circulation
Lidocaine BURNS when first injected d/t low pH
Can mix 1:10 w/ sodium bicarbonate to neutralize it
Supplied: 1%, 2%**
Typical dose is 1-2 mg/kg of 2% lidocaine for local anesthesia
Bupivacaine Properties
Marcaine
A long-acting agent that is about 4 times more potent than lidocaine
The onset of action is 20 minutes and the duration of action is 4-6 hours
Most commonly used for regional and epidural nerve blocks
CNS and cardiac toxicity result from lower doses and blood levels than those reported for lidocaine
Therefore, ASPIRATE!
Not used in Bier blocks!
Tramadol
Schedule IV controlled drug
Dual action: Mu agonist (though not an opioid) & monoamine reuptake inhibitor (serotonin & norepi)
Can be used w/ NSAIDs or mu agonists (multimodal)
Side effects (rare): GI upset, sedation; tastes bad (bitter)
More recent studies suggest that it has no effect on osteoarthritis in dogs
Neurontin
Gabapentin
Anticonvulsant medication with purported adjunctive analgesic action
MOA is unclear
Used for many forms of chronic pain, though its best application may be for neuropathic pain**
Side effects: sedation, wt gain
Expensive
Multi-Modal Pain Management
The use of multiple pharmacological agents simultaneously for pain management.
Why use Multi-Modal Pain Management
Can reduce the amount of medications necessary to relieve pain.
Can minimize side-effects.
Using pre-surgical, surgical, and post-surgical techniques allows for better control of pain.
4 clinical signs of inflamation
Redness Heat Swelling Pain Loss of function
Amitriptyline
Tricyclic antidepressant (TCA)
Used in humans and animals as adjuncts to other analgesics (especially opioids) for chronic pain
Inhibit serotonin & norepinephrine reuptake, though they may have other analgesic effects
Actions at opioid receptors & on nerve transmission?
Side effects: sedation, anticholinergic effects
Amantidine
Oral NMDA receptor antagonist (caps or liquid)
Used to Tx Parkinson’s in humans
