Companion Animal Advanced Clinical Management WEEK 2
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The efficacy of some chemotherapy drugs depends on whether the target cells are in a sensitive phase of the cell cycle. This can almost always be predicted by their mechanism of action/cellular target molecule. Which of the following drugs is cell cycle phase-dependent?

  • Mechlorethamine, an alkylating agent
  • Carboplatin, a platinum analog
  • Cytosine arabinoside, a nucleotide analog (antimetabolite agent) (correct)
  • Toceranib (Palladia), a small molecule inhibitor

    • The dose of chemotherapy a clinician may select relies on several pharmacokinetic and pharmacodynamic considerations. Which of the following regarding chemotherapy dose considerations is TRUE?

  • The liver is a major detoxification organ, and frequently plays a role in chemotherapy metabolism. When liver dysfunction is present, the chemotherapy dose is frequently increased.
  • Treatment interval in both single and multiagent protocols is determined by the body’s tolerance. When determining treatment intervals in a standardized protocol (not patient specific), timing of neutropenia nadirs is the largest determining factor. (correct)
  • The chemotherapy dose for small dogs is sometimes calculated on a mg/kg basis rather than mg/m2 as the former is a better reflection of their reduced metabolic rate.
  • The MDR protein is a drug efflux protein, meaning it pumps drugs out of cells. Mutation leads to reduced expression of the MDR protein, leading to reduced uptake by cancer cells. Thus, the chemotherapy dose is frequently increased in MDR mutant patients.

    • Which of the following pairing of drug, species and side effect is INCORRECT?

  • Cisplatin, cats, fatal pulmonary edema
  • CCNU/lomustine, dogs, hepatotoxicity
  • Doxorubicin, cats, cardiotoxicity (correct)
  • Toceranib/Palladia, dogs, hypertension

    • A 7-year-old MN Labrador Retriever presents to your clinic 7 days after his first doxorubicin chemotherapy. He was feeling well yesterday, but this morning did not want to eat his breakfast and seems to be feeling worse since then. What is your top differential?

    <p>Neutropenia secondary to myelosuppression</p> Signup and view all the answers

    There are some forms of lymphoid cancer (such as chronic lymphocytic leukemia, or T-zone lymphoma) that act in a more indolent fashion. They are thus characterized by slower progression of the disease, and slower cell turnover/proliferation than seen in the more clinically aggressive forms of lymphoid cancers. Which of the following would be the MOST appropriate treatment option for a cancer that has a lower rate of proliferation?

    <p>Daily treatment with a low-dose alkylating agent</p> Signup and view all the answers

    What are the 3 most common general adverse effects associated with chemotherapy?

    <p>Bone marrow suppression, alopecia, gastrointestinal upset</p> Signup and view all the answers

    Which of the following chemotherapies crosses the blood-brain barrier and causes hepatotoxicity?

    <p>CCNU</p> Signup and view all the answers

    Doxorubicin can cause __________ in cats.

    <p>nephrotoxicity</p> Signup and view all the answers

    Which of the following drugs is an opioid that is commonly used as an antitussive in dogs with chronic bronchitis?

    <p>theophylline</p> Signup and view all the answers

    Which of the following chemotherapy drugs is a microtubule inhibitor, causes a peripheral neuropathy due to inhibition of microtubules that promote normal signaling along the axon, and can also cause a thrombocytosis due to alterations in microtubule management of megakaryocytes?

    <p>vincristine</p> Signup and view all the answers

    A 7-year-old castrated male domestic medium haired cat is presented in respiratory distress. Which of the following would be the best clinical finding to differentiate cardiac from non-cardiac causes of respiratory distress in this cat?

    <p>Strong abnormal/positive finding on a snap NT-ProBNP test</p> Signup and view all the answers

    In patients with pulmonary edema secondary to left-sided congestive heart failure, what therapeutic intervention will help improve blood oxygen levels the most rapidly?

    <p>flow by oxygen</p> Signup and view all the answers

    A 12-year-old DSH cat with a previous diagnosis of hypertrophic cardiomyopathy is presented in respiratory distress – pale mucous membranes, open-mouth breathing, eyes bulging. A brief point-of-care ultrasound identifies a large amount of pleural effusion, concerning for CHF. Sedation with butorphanol and a ½ dose of dexmedetomidine is given IM, an IV catheter is placed, and propofol is given to perform thoracocentesis. During the procedure, the patient goes into cardiopulmonary arrest. What would you have done differently for this patient?

    <p>Administer butorphanol and place in oxygen cage, wait 5-10 minutes then administer flow-by oxygen and perform thoracocentesis.</p> Signup and view all the answers

    A 13-year-old poodle mix is presented to you for a recheck exam and prescription refill of furosemide (your colleague at the practice has recently retired). You are reviewing the record and note the dog has had a grade III/VI left apical murmur first noted when he was 10 years old. He was brought in for a dry, honking cough when he was 11 years old, and a furosemide trial was prescribed (2 mg/kg twice daily (standard starting dose for CHF)). In the record it is noted that the cough mildly improved so the furosemide was continued. Radiographs have not been performed since he was 10 years old, and no abnormalities were noted at that time. Since the last visit, the owner says the cough is “about the same as it’s always been,” and the dog is otherwise doing fine. What is the problem with the current furosemide treatment plan?

    <p>The furosemide is likely causing induction of the RAAS system.</p> Signup and view all the answers

    Referring to the poodle mix in the previous question:

    A 13-year-old poodle mix is presented to you for a recheck exam and prescription refill of furosemide (your colleague at the practice has recently retired). You are reviewing the record and note the dog has had a grade III/VI left apical murmur first noted when he was 10 years old. He was brought in for a dry, honking cough when he was 11 years old, and a furosemide trial was prescribed (2 mg/kg twice daily – standard starting dose for CHF). In the record it is noted that the cough mildly improved so the furosemide was continued. Radiographs have not been performed since he was 10 years old, and no abnormalities were noted at that time. Since the last visit, the owner has decreased the dose to once daily and says the cough is “about the same as it’s always been.” And he is otherwise doing fine.

    Of the following choices, what would be your single best recommendation for this patient today?

    <p>Perform thoracic radiographs to assess the heart and pulmonary vessel size, and the lungs for pulmonary edema or other causes of cough.</p> Signup and view all the answers

    A 9-year-old Maine Coon cat is hospitalized for treatment of acute left-sided congestive heart failure secondary to hypertrophic cardiomyopathy characterized by respiratory distress and severe hypoxemia. He has been receiving supplemental oxygen and 4 mg/kg of furosemide every 6 hours for the last 24 hrs.

    His respiratory rate, heart rate, and mentation have greatly improved in the last 8 hours, but your astute technicians alert you that he has lost 5% of his body weight since admission and his urine production has decreased. You are concerned that he has mild but clinically obvious dehydration (likely 5% dehydrated (delayed skin tent, dry mucous membranes)) on exam. What would be your best recommendation for this patient?

    <p>Reduce the furosemide frequency to q 12 hours and offer free choice water and canned cat food.</p> Signup and view all the answers

    Why has spironolactone been added to the recommended initial therapy for dogs in congestive heart failure?

    <p>To address aldosterone effects that escape inhibition despite ACE inhibitors and ARBs (angiotensin receptor blockers).</p> Signup and view all the answers

    What is the most important nutritional treatment goal for all patients in Stage B2 thru Stage D heart disease?

    <p>Diet should be high in omega 3 FA and eaten consistently to maintain an ideal body weight.</p> Signup and view all the answers

    Why is moderate salt restriction recommended in patients (who are eating well!) in Stage C and Stage D heart disease?

    <p>High sodium intake can cause diuretic resistance and contribute to body water retention.</p> Signup and view all the answers

    Sassy is a 10-year-old female Schnauzer mix who is presented for increased thirst and urination, polyphagia, and a pot-bellied appearance. She has a historical diagnosis of MMVD and had an episode of congestive heart failure six months ago. She has been doing well on the medications (furosemide, enalapril, pimobendan, spironolactone) so far. An arterial blood pressure (Doppler method, average reading) is measured and is 200 mmHg. Initial lab work findings are highly suggestive of Cushing’s disease. Testing for Cushing’s disease is pending, and the veterinarian elects to start amlodipine in the meantime. Why is starting amlodipine a good treatment decision for this patient?

    <p>Hypertension will increase afterload and significantly affect workload on the left heart</p> Signup and view all the answers

    Where should the needle be placed when performing a thoracocentesis?

    <p>In the caudal aspect of the intercostal space.</p> Signup and view all the answers

    Which of the following is the MOST appropriate therapy for a patient with a hemothorax due to a coagulopathy from rodenticide ingestion?

    <p>Perform thoracocentesis if respiratory compromise is severe</p> Signup and view all the answers

    Which of the following can be safely used and is most effective to induce emesis in a cat?

    <p>xylazine</p> Signup and view all the answers

    Why is ingestion of raw bread dough potentially toxic to dogs? SELECT ALL THAT APPLY. a. dyspnea b. ethanol toxicosis c. gastric distension d. pancreatitis

    <p>It can lead to dyspnea, ethanol toxicosis, gastric distention</p> Signup and view all the answers

    Why is placement of a urinary catheter or frequent walks important in patients with chocolate toxicosis?

    <p>Methylxanthines can be absorbed through the urinary bladder wall.</p> Signup and view all the answers

    In dogs, xylitol toxicosis can lead to which of the following? SELECT ALL THAT APPLY. a. hepatic necrosis b. hypoglycemia c. renal failure d. seizure activity

    <p>Hepatic necrosis, Hypoglycemia, Seizure activity</p> Signup and view all the answers

    Which of the following is the preferred antidote for ethylene glycol toxicity?

    <p>fomepizole</p> Signup and view all the answers

    Paintball ingestion can lead to which of the following?

    <p>hypernatremia</p> Signup and view all the answers

    A dog that has been playing with a Bufo toad and is now hypersalivating and has brick red mucous membranes. Which of the following is the most important thing to do first?

    <p>oral lavage</p> Signup and view all the answers

    Match the toxin with the appropriate antidote therapy.

    1. Amphetamine A. pamidronate

    2. Selective serotonin reuptake inhibitor B. cyproheptadine

    3. Cholecalciferol C. vitamin K1

    4. Warfarin D. acepromazine

    <p>1-D, 2-B. 3-A, 4-C</p> Signup and view all the answers

    A ferret presents to your clinic with pyrexia, anorexia, and a mucopurulent nasal discharge. On examination you find a papular dermatitis on the chin and hyperkeratosis of the foot pads. Which of the following is the most accurate regarding treatment of this disease in ferrets?

    <p>There is no specific treatment, mortality may reach 100%</p> Signup and view all the answers

    What are the two most common causes of feline upper respiratory infections?

    <p>Feline herpes virus and feline calicivirus</p> Signup and view all the answers

    True or false: Most upper respiratory infections in cats are self-limiting and do not require treatment beyond supportive care.

    <p>True</p> Signup and view all the answers

    In addition to lethargy, anorexia, or fever, what clinical sign is an indication that antibiotic therapy may be required for a cat with an acute upper respiratory tract infection?

    <p>Mucopurulent nasal discharge</p> Signup and view all the answers

    Why is placement of a urinary catheter or frequent walks important in patients with chocolate toxicosis?

    <p>doxycycline</p> Signup and view all the answers

    A 2-year-old Miniature Lop rabbit presents with mucopurulent nasal discharge, discolored forelimbs and a history of sneezing. You suspect the rabbit has ‘snuffles’, also known as pasteurellosis. Which of the following is true about this condition?

    <p>Enrofloxacin is commonly used to treat this disease</p> Signup and view all the answers

    What type of drugs are terbutaline and albuterol?

    <p>bronchodilators</p> Signup and view all the answers

    Which of the following is an inhaled glucocorticoid that is used in the long-term management of feline asthma?

    <p>fluticasone</p> Signup and view all the answers

    Which of the following drugs is an opioid that is commonly used as an antitussive in dogs with chronic bronchitis?

    <p>hydrocodone</p> Signup and view all the answers

    All of the following may be indicated in the treatment of bacterial pneumonia EXCEPT which of the following?

    <p>cough suppressants</p> Signup and view all the answers

    Study Notes

    Chemotherapy and Cancer Treatment

    • The efficacy of some chemotherapy drugs depends on the cell cycle phase of target cells.
    • The mechanism of action or cellular target molecule can predict the cell cycle phase dependence of a chemotherapy drug.

    Pharmacokinetics and Pharmacodynamics

    • The dose of chemotherapy selected by a clinician relies on pharmacokinetic and pharmacodynamic considerations.

    Lymphoid Cancer

    • Some forms of lymphoid cancer, like chronic lymphocytic leukemia or T-zone lymphoma, are characterized by slower progression and cell turnover.
    • Treatment options for cancer with lower proliferation rates may differ from those with higher proliferation rates.

    Adverse Effects of Chemotherapy

    • The three most common general adverse effects associated with chemotherapy are:
      • Nausea and vomiting
      • Alopecia
      • Myelosuppression
    • Doxorubicin can cause cardiomyopathy in cats.
    • Vinblastine, a microtubule inhibitor, can cause peripheral neuropathy and thrombocytosis.

    Respiratory Distress and Heart Failure

    • In patients with pulmonary edema secondary to left-sided congestive heart failure, therapeutic interventions to improve blood oxygen levels rapidly include:
      • Oxygen supplementation
      • Furosemide administration
      • Thoracocentesis
    • Sedation and anesthesia in patients with heart failure require careful consideration to avoid cardiopulmonary arrest.

    Furosemide Treatment

    • The problem with the current furosemide treatment plan is the lack of radiographs to assess the patient's condition since the initial diagnosis.
    • The dose of furosemide may need to be adjusted, and the patient's condition should be reassessed regularly.

    Congestive Heart Failure

    • Spironolactone has been added to the recommended initial therapy for dogs with congestive heart failure to reduce morbidity and mortality.
    • Moderate salt restriction is recommended in patients with Stage C and Stage D heart disease to reduce fluid retention and improve cardiovascular health.

    Cushing's Disease

    • Initial lab work findings suggestive of Cushing's disease may lead to starting amlodipine to control hypertension.

    Thoracocentesis

    • The needle should be placed in the 7th or 8th intercostal space, just above the rib, to avoid lung puncture during thoracocentesis.

    Toxicology

    • In patients with hemothorax due to rodenticide ingestion, the most appropriate therapy is vitamin K1 administration.
    • Ingestion of raw bread dough can cause ethanol toxicosis in dogs due to yeast fermentation.
    • Xylitol toxicosis in dogs can lead to hepatic necrosis, hypoglycemia, renal failure, and seizure activity.
    • The preferred antidote for ethylene glycol toxicity is fomepizole.
    • Paintball ingestion can cause gastrointestinal signs and pancreatitis.
    • Placement of a urinary catheter or frequent walks are important in patients with chocolate toxicosis to prevent reabsorption of toxins.

    Upper Respiratory Infections

    • The two most common causes of feline upper respiratory infections are feline herpesvirus and calicivirus.
    • Most upper respiratory infections in cats are self-limiting and do not require treatment beyond supportive care.
    • Clinical signs indicating the need for antibiotic therapy in cats with acute upper respiratory tract infections include:
      • Purulent discharge
      • Ulcerative lesions
      • Systemic signs (fever, lethargy, anorexia)

    Ferrets and Rabbits

    • Ferrets with pyrexia, anorexia, and mucopurulent nasal discharge may have adrenal disease or insulinoma.
    • In ferrets, papular dermatitis on the chin and hyperkeratosis of the foot pads are indicative of adrenal disease.
    • Rabbits with mucopurulent nasal discharge, discolored forelimbs, and sneezing may have pasteurellosis or 'snuffles'.

    Asthma and Bronchitis

    • Terbutaline and albuterol are beta2-agonists used in the treatment of feline asthma.
    • Fluticasone is an inhaled glucocorticoid used in the long-term management of feline asthma.
    • Butorphanol is an opioid antitussive commonly used in dogs with chronic bronchitis.

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