Term
| Clinical Obj of Pain Mgmt |
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Definition
Minimize debilitating pathologic pain while maintaining the protective aspects associated with physiologic pain
-preemptive analgesia
-balanced analgesia
-dose to effect case by case |
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Term
| Importance of Pain Assessment |
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Definition
-Can be difficult to assess
-recognize behavior associated with pain
-chronic pain is more difficult to recognize
-anticipate levels of pain associated with surgical procedures, illness, or injuries
-physiologic parameters are NOT good indicators |
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Term
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Definition
-Vasodilation of local blood vessels
-Increased perm of capillaries
-granulocytes and monocyte migration
-swelling of the tissue
*Release of inflammatory mediators*
-activation of macrophages |
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Term
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Definition
-Not all Cox-2 is inducible
-Cox-1 derived PG's might mediate pain, inflammation and fever
-Cox-2 also involved in gene expression, neoplasia, bone modeling
-Some Cox-2 selective only effective at doses high enough to also inhibit Cox-1
-Cox-2 are generally safer in the GI tract |
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Term
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Definition
-well absorbed orally (some exceptions)
-lipophilic and low Vd
-Very high plasma protein binding
-mostly elim by liver
-extensive enterohepatic recycling in some cases |
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Term
| Drugs Interxns with NSAID's |
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Definition
-Furosemide (synergistic incerase of kidney tox)
-ACE inhibitors (suppress vasodilation effects, increased renal tox)
-Fluoroquinolones (may decrease seizure threshold)
-Aminoglycosides (NSAID's may increase their renal toxicity effects)
-Antacids (interfere with absorption) |
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Term
| Adverse effects of NSAID's |
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Definition
-mediated by inhibition of protective PG's
-Cats may be more sensitive to toxicity due to the lack of glucoronidation pathway
-enterohepatic circulation in dogs |
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Term
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Definition
-most common dose-limiting factor
-avoid concurrent use with glucocorticoids
-GI adaptation
-prevent toxicity when used long term by giving GI protectants (sucralfate) and synthetic PG's |
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Term
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Definition
-decrease renal blood flow
-decrease glomerular filtration
-major concern in:
-periop period
-hypotensive, hypovolemic situations
-CKD
-CHF |
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Term
| Hematological and Liver Tox |
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Definition
-NSAID's can cause idiosyncratic hepatotox in dogs (related to individual's sensitivity to drug)
-Avoid with bleeding disorders
-avoid during sx where hemorrhage may be a problem |
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Term
Question:
Which of the following is the most common concern with chronic NSAID use? |
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Definition
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Term
Question:
How can you best prevent the development of the occurrence of GI ulcers? |
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Definition
| Titrate dose to a minimum |
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Term
| General Principles of NSAID use |
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Definition
-Monitor: renal, liver, and coag status
-Cytoprotective measures
-Apply preemptively
-Avoid high doses |
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Term
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Definition
-Preferential COX-1 inhibitor
-oral only
-Metabolized by LIVER (accumulates in cats due to glucuronide conjugation)
-Metabolites excreted by kidneys (tubular absorption depends on pH) |
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Term
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Definition
-analgesic, anti-inflammatory, antiplatelet
-Antiplatelet effect good with HW and feline thromboembolism |
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Term
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Definition
-GI irritation
-Decrease clotting (stop 1 week prior to sx)
-Cartilage damage in arthritic dogs? |
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Term
Question:
Which of the following is true about aspirin? |
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Definition
| It can be used as a blood thinner |
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Term
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Definition
-IV and oral
-Cox-1 inhibitor
-good absorption and wide dist
-nonlinear PK (@ high doses or chronic use, the metabolism becomes saturated and the drug can accumulate)
-Therapeutic efficacy for 24 hrs |
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Term
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Definition
-Large and food animals
Cattle: prolonged 1/2 life; used for arthritis and mild laminitis; PROHIBITED IN DAIRY COWS
Horses:
-cheap and effective
-chronic therapy --> decrease dose and increase interval |
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Term
| Phenylbutazone Adverse Effects |
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Definition
-GI are most important in herbivore
-Renal (chronic use)
-blood dyscriasis in dogs |
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Term
Question:
Which of the following can be expected with long term use of Bute in horses? |
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Definition
| Drug elim decreases after awhile and dose needs to be decreased |
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Term
| Flunixin Meglumine (Banamine) |
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Definition
-very potent COX inhibitor (mostly COX-1)
-oral and injectable
-fast absorption with 80-90% bioavailability
-wide dist
- 1/2 life varies by species |
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Term
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Definition
Horses:
-colic, colitis, endotoxic shock, resp and ocular dz, laminitis
-low dose so as to not mask colic signs
Cattle:
-acute coliform mastitis with endotoxic shock, resp dz, septicemia, pain
Dogs:
-musculoskeletal disorders, endotoxic shock, sx
-tx beyond 3 days is toxic |
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Term
| Flunixin Meglumine Adverse Effects |
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Definition
-similiar to Bute (GI, renal, dyscriasis)
-IM injections are irritant (clostridial myositis in horses) |
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Term
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Definition
-Inhibits more COX-1 than COX-2
-used in dogs, cats, horses (post-op and chronic use--> not to be used pre-op due to bleeding)
-effects like 12-24 hrs
-one of the safest orally in SA (esp cats)
-less toxic than Banamine in horses
-Cattle: tx of E. coli endotoxic induced mastitis |
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Term
Question:
Which of the following NSAID's is more appropriate in the tx of acute mastitis in dairy cattle? |
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Definition
Flunixin and Ketoprofen
CANT USE BUTE- PROHIBITED |
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Term
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Definition
-Chronic and perioperative pain tx in dogs
-greater effect on COX-2
-safe in cats after single dosing
-Min antithromboxane activity
-Idiosyncratic liver tox in dogs is possible |
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Term
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Definition
-Cox-1 inhibition
-very long 1/2 life in dogs (40hrs)
-infreq dosing
-enterohepatic recycling |
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Term
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Definition
Dogs:
-tx of inflammation associated with TCC, cystitis, urethritis
-antitumor activity in TCC (acts as immunomodulator) |
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Term
| Piroxicam Adverse effects |
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Definition
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Term
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Definition
-COX-2 inhibition
-oral syrup and injectable form
-osteoarthritis, post-sx
-safer than piroxicam |
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Term
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Definition
-COX-2
-chronic arthritis in dogs
-well absorbed orally |
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Term
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Definition
-COX-2 inhibition
-chronic tx of pain and inflammation
-good oral absorption
-drugs excreted with bile and feces
-nonliner elimination
-safe |
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Term
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Definition
Cox-2 inhibition
-large volume of dist.
-chronic tx of pain and inflammation
-Drug excreted with bile and feces |
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Term
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Definition
Dogs:
-tx of pain and inflammation assoc with chronic osteoarthritis
-no time limit for tx
Cats:
-tx of acute pain and inflammation assoc with musculo-skeletal disorders
-tx up to 6 days |
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Term
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Definition
-COX/LOX
-osteoarthritis in dogs |
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Term
Naproxen (Aleve)
Ibuprofen (Advil) |
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Definition
-very potent OTC drugs
-COX-1
-considerable tox in dogs and cats
-enteroheptaic recycling |
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Term
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Definition
-acts only on centrally prod COX
-TOXIC IN CATS due to lack of glucoronidation enzymes
-safer in dogs |
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Term
Question:
Which of the following NSAID's is contraindicated in dogs? |
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Definition
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Term
Question:
Based only on its MOA, which of the following drugs is less likely to impact the GI with long-term usein dogs? |
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Definition
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Term
Question:
Which of the following NSAID's exhibits a low 24% plasma protein binding? |
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Definition
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Term
Question:
Which of the following is FDA approved for use in cats? |
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Definition
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Term
| Which of the following can be expected with long term use of acetaminophen in cats? |
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Definition
| The need to buy another cat (ha, he made a funny =p ) |
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