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VTT Pharmacology 5
NSAIDS & Corticosteriods
| Question | Answer |
|---|---|
| What is the point of inflammation? | to counteract the injury walling off or removing the cause of the injury and to repair/replace damaged tissue |
| What are the disadvantages of inflammation? | If allowed to continue inflammation can cause further injury and tissue damage, allergy, shock. "Proud Flesh" |
| What is proud flesh? | exuberant granulation tissue |
| What is a pyrogen? | A substance that induces a fever |
| What is a fever? | Increase in body temperature above normal |
| What is the purpose of a fever? | Destruction of invading bacteria and viruses by way of deactivation by heat OR by facilitating biochemical reactions in the body (many of which increase with heat) |
| Exogenous pyrogens | Pyrogens that come from outside the body |
| Endogenous pyrogens | Pyrogens that come from within the body usually chemical mediators (ex. prostaglandins) These can be induced by something outside the body or can be released by damaged cells |
| What are the clinical signs of inflammation? | heat, swelling, inflammation and pain |
| Arachidonic acid cascade | |
| Cox-1 | maintains physiologic functions such as renal blood flow, Normal platelet aggregation, & synthesis of gastric mucosa release "good prostaglandins" |
| Cox-2 | Stimulates formation of prostaglandins which mediate inflammation |
| What is cyclooxegenase | One of the enzymes in the inflammatory cascade responsible for making prostaglandins |
| How do NSAIDS work? | by inhibiting cyclooxygenase at the cellular level |
| What are the indications for NSAID use? | Analgesia, anit-inflammatory, Anti-pyrexia, anti-platelet |
| Adverse effects of NSAIDS? | GI ulceration & bleeding, nephrotoxicity & hepatotoxicity , bleeding tendencies, bone marrow suppression |
| Contraindications/Precautions of NSAIDS? | Do not use concurrently with steroids or other NSAIDS, Use in caution with liver and renal insufficiencies contraindicated in animals with bleeding disorders (Von Willebrands) use caution with hypoprotenemic animals (highly protein bound) |
| When prescribing NSAIDS long term how often should blood panels be done and why?? | 1-2 times a year to monitor liver and renal function |
| What is the generic name for aspirin? | Acetylsalicylic acid |
| What is Aspirin used for?? | analgesic, anti-inflammatory, anti-pyrexic, anti-platelet effects |
| What is a common name for phenybutazone? | Butte |
| What are the common veterinary uses of aspirin? | mild to moderate pain and inflammation related to osteoarthritis, pulmonary artery disease secondary to heartworm infection, cardiomyopathy in cats |
| What is buffered aspirin? | aspirin combined with an antacid |
| What is the aspirin dosage for dogs? | 10-25mg/kg PO q8-12hrs with food (for analgesia) |
| What is the aspirin dosage for cats? Why? | 5mg/cat every 3 days ( cats do not metabolize well, therefore there is a very real danger of toxicity if not given properly) |
| What route of administration does phenylbutazone come in? | injectable, tablets, paste syringes |
| How can parenteral phenylbutazone given? | IV ONLY |
| What can long term use for phenylbutazone cause? | ulceration of the dorsal colon, renal failure |
| What is the withdrawl time for phenylbutazone in cattle? | 30days/ 1 dose (more for additional doses) |
| What is the generic name for Banamine? | Flunixin Megulmine |
| What animals is Flunixin megulumine approved for? | horses and cattle |
| What is the most common off label use of banamine? | dogs with parvovirus |
| leukopenic | too few white blood cells |
| septicemic | bacteria blood condition |
| endotoxemic | endotoxins in the blood |
| Why must extreme care be taken when giving banamine (flunixin meglumine) to febrile dogs? | It is so potent that it decreases the fever very rapidly, a rapid decrease in body temperature can be life threatening |
| Why is banamine injectable usually given IV? | IM can be irritating/painful |
| What other forms does banamine come in? | PO paste and granules |
| What are common veterinary uses for banamine? | Analgesic: musculoskeletal disorders (very good for visceral pain ex.colic) Anti-Inflammatory: in endotoxemia and musculoskeletal issues. Anti-pyrexia; endotoxemia, &bovine respiratory disease and calf diarrhea |
| What is the trade name for carprofen? | Rimadyl |
| What are the general uses for Rimadyl (carprofen)? | anti-inflammatory, and analgesic? |
| is carprofen an anti-pyrexic? | it does exhibit some effects on fever |
| idiosyncratic | not predictable |
| Iatrogenic | caused by "us" health care professionals |
| What species in carprofen approved for in the US? | dogs |
| what forms does carprofen come in? | injectable, tablets, chewables |
| What is the trade name for ketoprofen? | Ketofen (vet) Orudis (human) |
| Common uses for ketoprofen include | anti-inflammatory, analgesia, anti-pyretic |
| What species is ketoprofen approved for in the US? | Horses |
| What species is ketoprofen used for off label in the us (is approved for in Europe and Canada) | cats and dogs |
| What are the common uses in veterinary medicine? | Musculoskeletal pain and inflammation in horses, post-operative pain in cats and dogs |
| Whaen using ketoprofen what should patients be monitored for? | vomiting, anorexia, melena |
| What is the trade name for etodolac? | Etogesic |
| etodolac appears to be more selective for inhibition of _____ rather than_____ | cox-2, cox-1 |
| What is etodolac commonly used for? | pain and inflammation associated with osteoarthritis in dogs |
| Etodolac has not been proven safe in dogs ___________________ | 12months of age or younger |
| in addition to the "typical" adverse effects of NSAIDS what else does etodolac appear to cause in some dogs? | irreversible KCS |
| What is KCS? | Keratoconjuntivitis sicca or "Dry Eye" |
| How often is etodolac given? | ONCE daily |
| How often is ketoprofen given? | once daily IM for 3 days in cats and dogs and once daily IV for up to 5 days in horses |
| What is the trade name for Meloxicam? | Metacam (vet) Mobic (human) |
| What type of NSAID is Meloxicam? | Cox-2 preferential |
| Though meloxicam has few adverse effects than other NSAIDS what can still occur? | GI effects &renal toxicity are rare and it is unclear whether or not meloxicam causes hepatotoxicity |
| What is meloxicam commonly used for? | pain and inflammation associated with osteoarthritis, post op pain |
| How is meloxicam given to prevent overdose in cats and small dogs? | The meloxicam is places on the food, NOT in the mouth (dosing is in drops) |
| meloxicam has become common to use off label in what species (with caution) | cats (more susceptible to renal toxicity) |
| What did the FDA black box warning of meloxicam in 2010 state? | repeated dosing using the oral suspension in cats has caused deaths and renal failure in some cats in the US |
| After the black box warning how was meloxicam approved for use in cats? | injectable 5mg/mg as a single injection |
| How often is meloxicam given to dogs? | once daily in food |
| What is the trade name for deracoxib? | Deramaxx |
| What type of NSAID is deracoxib (Deramaxx)? | Cox-2 selective (predominantly inhibits cot-2 while sparing cox-1 at therapeutic doses |
| Deracoxib (Deramaxx) is indicated for what in dogs? | treatment of post op pain, pain and inflammation associated with osteoarthritis |
| How old must dogs be before meloxicam can be given? | 6 months |
| What forms does deracoxib (Deramaxx) come in? | Chewable tablets |
| What is important to communicate to the owner about chewable tablet medication? | This medications must be kept up high ( out of reach of dog) and preferably in a cupboard (still up high) because most dogs enjoy the taste and can/ will chew through the bottle devouring an entire bottle of medication causing toxicity |
| Isostinuria | The kidneys are no longer actively concentrating or diluting urine |
| What is the trade name for tepoxalin? | Zubrin |
| What type of NSAID is tepoxalin (Zubrin) | Dual inhibitor |
| What does a dual inhibitor do? | Dual inhibitors block both cyclooxygenase and lipoxygenase THEREFORE it blocks both arms of the arachidonic acid cascade |
| What does blocking LOX (lipoxygenase) mean? | reduction in leukotrienes which contribute to inflammatory responses in joints and the GI tract |
| In addition to the typical adverse effects you can expect to see with NSAIDS, what additional adverse effects can tepoxalin (Zubrin) cause? | incoordination, incontinence, polyphagia, flatulence, hair loss and trembling |
| What form is tepoxalin supplied in? | rapidly disintegrating tablet |
| What is the trade name for firocoxib? | Previcox |
| What type of NSAID is firocoxib (Previcox)? | cox-2 preferential, inhibits cox-2 while sparing cox-1 |
| What is firocoxib (Previcox) commonly used for? | the pain and inflammation associated with canine osteoarthritis |
| What form does firocoxib (Previcox) come in? | Chewable tablets |
| How often is firocoxib (Previcox? given? | once daily |
| What is the trade name for robenacoxib? | Onsior |
| What type of NSAID is robenacoxib (Onsior)? | cox 2 preferential |
| What species is robenacoxib (Onsior) approved for in the US?? | cats |
| indications for use of robenacoxib (Onsior) | To alleviate post-op pain following orthopedic Sx, spay, neuter in cats weighing at least 5.5# and at least 6months of age for a max of 3 days |
| What is a potential adverse effect of robenacoxib (Onsior) | renal failure |
| Can ibuprofen be given to cats and dogs? | NO, NEVER!! |
| Why do we not give ibuprofen to cats or dogs? | causes MAJOR TOXICITY including acute renal failure |
| Can Acetominaphen be given to cats and dogs? | Dogs only (in proper doses) NEVER CATS |
| What is Tylenol used for? | analgesia, anti-pyrexia |
| Is Tylenol a good anti-inflammatory? | NO |
| What does Tylenol cause in cats? | Methemoglobinemia, Tylenol causes normal hemoglobin to turn into methemoglobin which cannot carry oxygen, turns the blood brown, mm turn brown |
| What does DMSO stand for? | Dimethyl Sulfoxide |
| What is DMSO? | Free radical scavenger (antioxidant) that has analgesic and anti-inflammatory properties |
| Why can DMSO be used as a carrier agent | it easily penetrates the skin promoting skin absorption of drugs (and toxins) that would not normally be absorbed topically |
| What is a free radical scavenger? | an unstable molecule that causes oxidative damage by stealing electron from surrounding molecules thereby disrupting activity in the body's cells |
| What is the only FDA approved use of DMSO? | Topical application to reduce acute swelling due to trauma however it is used in many other ways including? head trauma & edema, post GI surgery and ischemic conditions |
| Should you wear gloves when handling DMSO? Why? | yes, it will penetrate your skin, you will get the effects of it, including penetration of any toxins on your skin |
| How should you prep the patient before administering DMSO? | The area the medication will be applied should be cleaned and dried to prevent any unwanted toxins etc.. to penetrate the skin with the DMSO |
| After DMSO application the animal will start smacking their lips snd swallowing, Why? | because they can taste it. The taste has been compared to garlic |
| What kind of drug is Adequan? | PSGAG |
| What does PSGAG stand for? | polysulfated glycosaminaglycan |
| How does a PSGAG reduce inflammation?? | by reducing prostaglandins released in joint injury, reduces hyaluronate in the joint thereby increasing synovial fluid viscosity |
| What species is Adequan approved for use in? | dogs, horses |
| route of administration of Adequan | IM or IA INTRA ARTICULAR |
| Where to glucocorticoids have effects? | every cell type and body system |
| uses for glucocorticoids | adrenal insufficiencies (addisons), allergies, asthma, autoimmune disorders, neoplasia, increased CSF pressure, shock/toxemeia |
| Is steroid ever a cure for an ailment? | no |
| How are anti-inflammatory effects mediated by glucocorticoids? | inhibition of the arachidonic acid cascade- acting on phospholipase |
| Steroids used in practives are what? | synthetic analogs of the naturally occurring glucocorticoids in the body |
| Why must systemic steroids be tapered off?? | because the body cannot tell the difference between the synthetic steroid and the natural one, there is a lag time when the medication is stopped before the adrenal cortex begins to signal the production of natural ones |
| When are glucocorticoids contraindicated? | in systemic, fungal, bacterial or viral infections, |
| What can happen if an animal is suddenly taken off steroids? | Addisonian crisis |
| adverse effects of glucocorticoids are usually associated with what? | long term therapy especially at higher doses |
| What are the most common signs of adverse effect | PU.PD, polyphagia, weight gain, dull hair coat, elevated liver enzymes, GI ulcers, DM, behavioral change (depression/lethargy OR aggression)redistribution of body fat |
| cats require_____ does but tend to have ______ sider effects | higher, fewer |
| What have steroids been found to cause in horses?? | laminitis |
| What forms are glucocorticoids available in? | all |
| steroid doses depend on their use, what use would use the lowest dose? | anti-inflammatory |
| steroid doses depend on their use, what use would use a moderate dose? | immunosuppressive |
| steroid doses depend on their use, what use would use a higher dose? | anti-neoplastic |
| What type of drug is prednisone? | prodrug |
| What is a prodrug? | a drug that is bio transformed into its active metabolite drugform |
| How is predisone biotransformed? | by the liver |
| What is prednisones active metabolite drug form? | prednisolone |
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Adeprey4311
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