Term
| What are some predisposing factors of NSAID toxicosis? |
|
Definition
-hydration status
-hypovolemia
-endotoxemia/sepsis
-other meds: NSAID combinations, aminoglycosides
-pre-existing kidney or liver dz
-BW
-idiosyncratic sensitivity: toxicosis at normal doses
-inadvertant overdose |
|
|
Term
| Rank the NSAIDs by toxicity. |
|
Definition
| -Phenylbutazone > Flunixin meglumine > Ketoprofen > Firocoxib |
|
|
Term
| What is our concern w/ giving NSAIDs to pregnant mares? |
|
Definition
-they cross the placenta
-foals are very sensitive to toxicity |
|
|
Term
| What are the CS of NSAID toxicity? |
|
Definition
-oral ulceration
-gastric ulceration: grain
-colonic ulceration: anorexia, colic, diarrhea, endotoxemia, wt loss, ventral edema |
|
|
Term
| What happens to foals w/ NSAID toxicity? |
|
Definition
-ptyalism
-bruxism
-gastric/gastroduodenal ulceration
-renal toxicity |
|
|
Term
| Which foals are at inc risk for gastroduodenal ulceration? |
|
Definition
|
|
Term
| Foals receiving NSAIDs may benefit from concurrent administration of which drugs? |
|
Definition
-omeprazole
-ranitidine
-sucralfate |
|
|
Term
| What happens to ponies with NSAID toxicity? |
|
Definition
| -develop oral & gastric ulceration, right dorsal colitis, renal crest necrosis easily |
|
|
Term
| What is the most common manifestations of NSAID toxicity in adults? |
|
Definition
|
|
Term
| What are the CS of right dorsal colitis due to NSAID toxicity? |
|
Definition
-anorexia
-colic
-diarrhea
-wt loss
-dependent edema
-endotoxemia/shock
-oral ulceration may be an early sign |
|
|
Term
| What are some differentials for right dorsal colitis due to NSAID toxicity? |
|
Definition
-sand enteropathy
-cyathostomiasis
-lawsonia enteritis
-colitis
-other causes of chronic colic, wt loss, hypoproteinemia |
|
|
Term
| How do we diagnose right dorsal colitis? |
|
Definition
-abdominal U/S on right 11-15th ICS
-thickening of wall variable (>3mm)
-gastroscopy: ulceration
-hypoproteinemia: hyperfibrinogenemia
-can be difficult to diagnose
-refractory to treatment |
|
|
Term
| How do we treat right dorsal colitis? |
|
Definition
-stop NSAIDs
-dietary management: pelleted feed |
|
|
Term
| How do we treat right dorsal colitis in acute phase? |
|
Definition
-Psyllium mucilloid
-Safflower or corn oil
-Sucralfate |
|
|
Term
| What kind of drug is Misoprostol? AE? |
|
Definition
-synthetic PGE1
-AE: cause colic, diarrhea |
|
|
Term
| What are some additional tx for right dorsal colitis? |
|
Definition
-metronidazole: anti-inflammatory
-endotoxic shock: crystalloids, polymyxin B
-hypoalbuminemic: plasma |
|
|
Term
| What are the complications of right dorsal colitis? |
|
Definition
-non-responsive to tx
-hypoproteinemia +/- anemia
-laminitis
-endotoxemia/shock
-stricture of right dorsal colon or surgery |
|
|
Term
| What drugs do we use to tx laminitis? |
|
Definition
-analgesia: no NSAIDs, use Butorphanol, Lidocaine, ice
-Acepromazine: blood flow
-nitroglycerine
-heparin
-pentoxifylline: anti-inflamm PO
-DMSO: free radical scavenger |
|
|
Term
| How do we mechanically treat laminitis? |
|
Definition
-sand: makes them put toe down & elevate heels
-styrofoam pads
-shoeing: heel elevation, sole support, move breakover point caudally |
|
|
Term
| How do we wind down treatment of right dorsal colitis? |
|
Definition
-maintain dietary modifications for 3-6m
-gradually re-introduce hay and grain after CS & hypoproteinemia resolve
-if unresponsive to tx, sx resection of the right dorsal colon can be attempted |
|
|
Term
| What can we see w/ renal papillary necrosis due to NSAID toxicity? |
|
Definition
-low USG
-urine sediment acute: WBC's, RBC's
-azotemia |
|
|
Term
| How do we treat renal papillary necrosis due to NSAIDs? |
|
Definition
-fluid & electrolyte therapy
-discontinue NSAIDs |
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