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SA Problems - DRUGS
SA Problems - DRUGS
33
Veterinary Medicine
Graduate
04/12/2013
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Term
Dexamethasone
 Definition
• Indications
o POTENT & long-acting AIF
o Immunosuppression
o Hypoadrenocorticism
o Pituitary-adrenal axis testing (i.e. LDDT & HDDT tests)
o Shock
o Ophthalmic conditions
• Side Effects
o PU/PD
o Polyphagia
o Dull dry hair coat
o Weight gain
o Panting
o Vomiting/diarrhea
o Elevated liver enzymes
o Pancreatitis
o GI ulcers
o Lipidemia
Term
Prednisone
 Definition
• Indications
o Hypoadrenocorticism
o AIF/Antipruritic
o Immune suppression
o Chemotherapy
• Side Effects:
o PU/PD
o Polyphagia
o Suppression of HPA axis
o Cushing’s syndrome
o Hepatopathy
o Opportunistic infections
o Muscle wasting
o Connective tissue & skin fragility
Term
Prednisolone
 Definition
• Indications
o Hypoadrenocorticism
o AIF/Antipruritic
o Immune suppression
o Chemotherapy
o Ophthalmic (inflammation of eyelids, conjunctiva, sclera, cornea & anterior segment of eye)
• Side Effects
o PU/PD
o Polyphagia
o Suppression of HPA axis
o Cushing’s syndrome
o Opportunistic infections
o Muscle wasting
o Connective tissue & skin fragility
• Note: Prednisone is converted to active prednisolone in the liver!!!!
Term
Clavamox
 Definition
• Indications
o Skin & soft tissue infections
o UTI
o Canine periodontal disease
• Side Effects
o Allergic reactions
Term
Famotidine
 Definition
• Indications
o Gastric, abomasal & duodenal ulcers
o Uremic gastritis
o Stress-related or drug induced erosive gastritis
o Esophagitis
o Duodenal & esophageal reflux
• Side Effects
o Acute oral overdoses  v/d, anorexia, dry mouth
o Rapid infusion  bradycardia, IVH in cats (when given IV)
Term
Metronidazole
 Definition
• Indications
o Giardia in dogs & cats
o Anaeroic & enteric infections
o Other parasites (Balantidium coli, trichomonas)
o GI disorders – immnomodulary effect?
• Side-Effects
o Dogs
 Dose-related neurologic disorders
 Lethargy, weakness
 Neutropenia
 Hepatotoxicity
 Hematuria
 Anorexia, nausea, vomiting, diarrhea
 Teratogenic
o Cats
 Vomiting
 Inappetance
 Hepatotoxicity
 CNS toxicity
 Teratogenic
 Overdose  anorexia, vomiting, depression, mydriasis, nystagumus, ataxia, head-tilt, deficit of proprioception, joint knuckling, disorientation, tremors, seizure, bradycardia, rigidity & stiffness
• Alternate Drugs
o Tylosin
o Oxytetracycline
o Fenbendazole
Term
Doxycycline
 Definition
• Indications
o Borellia burgdorferi
o Leptospirosis
o Ricketssia
o Chlamydia
o Mycoplasma
o Bartonella
o Bordatella
• Side Effects
o Vomiting/diarrhea, anorexia
o Contraindicated in pregnant or nursing animals
o Staining of teeth
o Esophageal strictures
• Alternative Drugs
o None
Term
Phenobarbitol
 Definition
• Indications
o Epilepsy
o Seizures
o Status epilepticus
• Side Effects
o Dogs
 Lethargy, depression, sedation
 Ataxia
 PU/PD
 Polyphagia
 Hepatotoxicity
 Elevated liver enzymes
o Cats
 Ataxia, lethargy
 Polyphagia
 PU/PD
• Alternative Drugs
o Potassium Bromide
o Diazepam
o For status epilepticus  diazepam
o Zonisamide
o Levetiracetam
o Gabapentin
o Clorazepate
o Felbamate
o Pregabalin
Term
Azathioprine
 Definition
• Indications
o Dogs: Immunosuppressive (IMHA, immune-mediated glomerulopathy, myasthenia gravis, chronic atrophic gastritis chronic active hepatitis, ITP, autoimmune skin diseases, SLE, IBD, rheumatoid arthritis, ocular fibrous histiocytomas, to prevent rejection of MHC-matched renal allografts in dogs)
o Cats: not generally recommended because of potential bone marrow suppression; immune mediated dermatologic disease, severe/refractory IBD
• Side Effects
o BONE MARROW SUPPRESSION IN CATS
o GI upset
o Poor hair growth
o Acute pancreatitis
o Hepatototoxicity
o Susceptible to infections or neoplastic illnesses with long term use
o Rapid withdrawal can lead to a rebound hyperimmune response in dogs recovering from IMHA
Term
Cyclosporine
 Definition
• Indications
o Ophthalmology: ocular inflammation, KCS
o Dermatology & Immune-mediate disorders: atopic dermatitis, anal furniculosis, SLE, ITP, IMHA, pemphigus, rheumatoid arthritis
o Reduce rejection of allografts in dogs & cats
• Side Effects
o GI: v/d, anorexia
o Nephrotoxicity
o Hepatotoxicity
o Long term use may predispose to bacterial or fungal infections
o Long term use with steroids may predispose patient to develop neoplastic diseases
o Increased hair growth in cats
o Several drug interactions
Term
Maropitant
 Definition
• Indications
o Acute vomiting
o Prevention of vomiting due to motion sickness
o IS NOT labeled for nausea!
• Side Effects
o Excessive droolinglethargic
o Vomiting not due to motion sickness
o Caution in dogs with hepatic dysfunction
Term
Mirtazapine
 Definition
• Indications
o Antiemetic
o Appetite stimulant
• Side Effects
o Sedation
o Vocalization
o Increased affection in cats
o Hypotension
o tachycardia
Term
Florinef
 Definition
• Indications
o Hypoadrenocorticism – has both corticosteroid (action relatively weak) and mineralocorticoid properties)
o Adjunctive therapy for hyperkalemia
• Side Effects
o Hypertension
o Edema
o Hypokalemia
o Side effects common to other glucocorticoids: PU/PD, polyphagia, panting, weight gain, etc
Term
DOCP- Desoxycorticosterone Pivalate (Percortan V)
 Definition
• Long acting mineralocorticoid (dosing interval may be as high as 30 days)
• Indications
o Hypoadrenocorticism
o Adjunctive therapy for hyperkalemia
• Side Effects
o PU/PD, hypernatremia, hypertension, edema, hypokalemia
o Prolonged overdoses may case cardiac enlargement
o Occasionally, irritation at injection site
Term
Trilostane (Vetoryl)
 Definition
• Indications
o Reduces synthesis of cortisol, aldosteroine and adrenal androgens
o Pituitary or adrenal dependent hyperadrenocorticism
o Alopecia X & adult malamutes with adult-onset alopecia
• Side Effects
o Lethargy
o Hyponatremia, hyperkalemia
o Vomiting/diarrhea, anorexia common during first couple of days due to steroid withdrawal
o Rare: adrenal necrosis and death
Term
Enrofloxacin (Baytril)
 Definition
• Indications
o Bactericidal fluoroquinolone
 Gram positive & gram negative bacilli and cocci including Staphylococcus, mycoplasma, mycobacteria, pseudomonas aeruginosa, klebsiella, E. coli, enterobacter, campylobacter, shigella, salmonella, haemophilus
 NOT effective against: anaerobes and not recommended for streptococci
 Although approved for gram + infections, don’t use if know it’s a gram + infection – reserve for more resistant infections, especially gram negative
 Dogs
• Susceptible infections
• Sepsis
• Skin, UTI
• Deep pyodermas
• Pseudomonas infections in soft tissue
• Lower respiratory tract infections
• Prostate infections
• Histiocytic ulcerative colitis
 Cats
• Susceptible infections of UT, skin & soft tissue
• Hemoplasmosis
o Side Effects
 Cartilage abnormalities in young animals
 GI upset
 Rare: elevated liver enzymes, ataxia, seizures, sdepression, letarthy and nervousness
 Hypersensitivity reactions or crystalluria are possible
 Ocular toxicity at high doses and aggression in cats
Term
Marbofloxacin (Zenequin)
 Definition
• Indications
o Dogs: susceptible infections of UT, skin, soft tissue, susceptible seudomonas otitis
o Cats: susceptible infections of UT, skin, soft tissue, hemoplasmosis
• Side Effects
o Same as for Enrofloxacin
Term
Metoclopramide (Reglan)
 Definition
• Indications
o Prokinetic (dogs & cats)
o Antiemetic (in dogs)
o Uncommon uses: induce milk let down for secondary agalactia; increase bladder contractility (dogs & cats)
• Side Effects
o Dogs:
 Changes in mentation & behavior (restlessness, involuntary spasms, aggression, and hyperactivity OR drowsiness, depression, constipation)
o Cats:
 Frenzied behavior, disorientation, constipation
o Overdose: sedation, ataxia, agitation, nausea, vomiting
Term
Omeprazole
 Definition
• Indications
o Proton pump inhibitor
o Prevent & treat gastroduodenal ulcers & erosions
• Side Effects
o GI upset
o UTI’s
o Proteinuria
o CNS disturbances
Term
Pantoprazole
 Definition
• Indications
o PP inhibitor similar to omeprazole
o Treatment or prevention of gastric-acid related pathologies
o Treatment of H. pylori
• Side Effects
o Vomiting/diarrhea
o Injection site reaction if given IV
Term
Cisapride
 Definition
• Indications
o Promotility agent
 Esophageal reflux, esophagitis, gastric stasis
 Constipation & megacolon in cats
o Urine retention disorders (enhances detrusor muscle contraction)
• Side Effects
o Vomiting/diarrhea, abdominal discomfort
o Rarely, prolonged QT intervals or other cardiac arrhythmias
o Overdose: diarrhea, lethargy, ataxia, hyperthermia, hypersalivation, muscle fasiculations, agitation, abnormal behavior, possible seizures (dogs)
Term
Sulfamethoxazole/Trimethoprim (SMZ/TMP)
 Definition
• Indications
o Susceptible UTI, pyoderma, soft tissue infections
 Gram +, Gram – (no Pseudomonas aeuriginosa)
 Some protozoa: pneumocystis carinii, coccidia and toxoplasma, hepatozoon canis/americanum

• Side-Effects
o Dogs:
 KCS
 Type 1 or 3 hypersensitivity reactions (urticaria, facial swelling)
 Acute neutrophilic hepatitis with icterus
 GI-anorexia, v/d
 Polyarthritis (esp. black/tan dogs)
 PU/PD, crystalluria
 Cholestasis
 Hypothyroidism
 Anemias
 Agranulocytosis
o Cats
 Anorexia
 Crystalluria
 Hematuria
 Leukopenias & anemias
Term
Cefazolin
 Definition
• Indications
o Gram + (excellent), gram negative (variable to poor)
o Sepsis
o Surgical prophylaxis
o Systemic infections
o Orthopedic infections
o Good against: beta-hemolytic strep, pasturella multocida, klebsiella pneumonia, obligate anaerobes, E. coli, Proteus, Staph pseudointermedius and schleiferi
o Resistant against: Bordatella bronchiseptica, Enterobacter, Enterococcus and Pseudomonas aeuroginosa
• Side Effects
o v/d
o hypersensitivity reactions (rash, urticarial, angioedema, fever)
o pain on IM injection (give IV over 3-5 min)
o renal damage (esp. if combined with gentamycin)
o neurotoxicity
o neutropenia
o agranulocytosis
o thrombocytopenia
o hepatitis
o positive coomb’s test
o interstitial nephritis and tubular necrosis
o trigger for IMHA
Term
Methimazole
 Definition
• Indications
o Hypothyroidism
o Prophylactic prevention of Cisplatin induced nephrotoxicity in dog
• Side Effects
o Vomiting, anorexia, depression (bitter taste & symptoms usually transient)
o Eosinophilia, leukopenia and lymphocytosis within first 8 weeks of treatment (usually transient)
o Facial pruritus in cats!
o Bleeding
o Hepatopathy
o Thrombocytopenia
o Agranulocytosis
o Positive diret antiglobulin test
o Acquired myasthenia gravis
o High levels in pregnant queens crosses the placenta and may induce hypothyroidism in kittens
Term
Furosemide
 Definition
• Indictions
o Loop II diurectic
o Congestive cardiomyopathy
o Pulmonary edema
o ascites
o Hypercalcuric nephrpathy
o Uremia
o Adjunctive therapy in hyperkalemia
o Antihypertensive agent
• Side Effects
o hyponatremia
o ototoxicity
o weakness & restlessness
o prerenal azotemia if dehydration occurs
o GI disturbances
o Anemia
o Leukopenia
Term
Levothyroxine
 Definition
• Indications
o Hypothyroidism in all species
• Side Effects
o Tachycardia
o PU/PD, polyphagia, panting
o Excitability & nervousness
o Some cats may appear apathetic
Term
Phenylpropanolamine (PPA)
 Definition
• Indications
o Uretheral sphincter hypotonus and resulting incontinence in dogs & cats
o Other pharmacologic effects:
 Increased vasoconstriction
 Increased HR
 Increased coronary blood flow
 Increased blood pressure
 Mild CNS stimulation
 Decreased nasal congestion & appetite
• Side Effects
o Restlessness
o Irritability
o Hypertension
o Anorexia
• Contraindications/Precautions
o Glaucoma
o Prostatic hypertrophy
o Hyperthyroidism
o DM
o Cardiovascular disorders
o Hypertension
Term
Ursodeoxycholic Acid
 Definition
• Indications
o Suppresses hepatic synthesis & secretion of cholesterol
o Reduces intestinal absorption of cholesterol
o Reduces cholesterol saturation in the bile
o Adjunctive therapy for cholesterol containing gall stones and patients with chronic liver disease, particularly with cholestasis
o Slows progression of inflammatory hepatic disorders (autoimmune hepatitis and acute hepatotoxicity)
• Side Effects
o none
Term
Amlodipine
 Definition
• Indications
o Inhibits calcium influx across cell membranes in both cardiac & vascular smooth muscle
o Hypertension in cats (DRUG OF CHOICE)
• Side Effects
o Cats
 Azotemia
 Lethargy
 Hypokalemia
 Reflex tachycardia
 Weight loss
o Dogs
 Gingival hyperplasia with long-term use
Term
SAMe
 Definition
• Indications
o Adjunctive treatment for:
 Liver disease,Osteoarthritis,Acetaminophen toxicity
• Side Effects: vomiting, anorexia, anxiety
Term
Enalapril
 Definition
• Indications
o ACE inhibitor
o Prevents formation of angiotensin II by competing with angiotensin  reduces aldosterone secretion and thus plasma renin activity is increased
o Vasodilator for use in heart failure or hypertension
o Adjunctive treatment for chronic renal failure or protein losing nephropathies
o Decreases afterload more than preload
• Side Effects
o GI : v/d, anorexia
o Hypotension
o Renal dysfunction
o Hyperkalemia
o Exercise intolerance
o Letheragy and inappetance in cats
Term
Benazepril
 Definition
• Indications
o ACE inhibitor
o vasodilator
o Heart failure (DCM, mitral valve disease, HCM)
o Hypertension
o Chronic renal failure
o PLN
o Proteinuria
• Side Effects
o GI: v/d, anorexia
o Hypotension
o Renal dysfunction
o hyperkalemia
Term
Itraconazole
 Definition
• Indications
o Systemic mycoses (aspergillosis, crytococcal meningitis, blastomycosis, histoplasmosis)
o Superficial candidiasis
o Dermatophytosis
• Side Effects
o Dogs
 Anorexia
 Hepatic toxicity
 Ulcerative skin lesions
 Vasculitis
 Limb edema
o Cats
 GI: v/d, anorexia
 Hepatotoxicity
 depression
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