30 Questions
In a reckless move, a client administered a dose of an over-the-counter (human) pediatric cold medication to his 5- YO MC DSH cat "...because he was sneezing a lot." Physical exam revealed gum pallor and a muddy gum color, and a blood film revealed extensive Heinz body inclusions on erythrocytes, along with eccentrocytes and ghost cells. What cold remedy ingredient is most likely causing this?
acetaminophen
NSAIDs are highly effective drugs in pain management because they directly target prostaglandin-mediated amplification of pain signaling at multiple points in the ‘pain pathway’. Which component of the pain pathway do they have the least direct impact on?
transmission
Which NSAID is FDA-approved for multiple doses in cats?
robenacoxib
True or false: Substantial increases in ALT and bile acids in serum biochemistry testing are expected during phenobarbital therapy, and usually resolve without changing the therapeutic plan.
False
Zonisamide can be used as an add-on drug to phenobarbital in seizure management. This can create a classic drug-drug interaction in which the dose of zonisamide needs to be _____.
increased
Which drug is NOT used to treat status epilepticus?
potassium bromide
Which of the following AEDs is contraindicated in cats?
potassium bromide
True or false: Drugs in the TCA class commonly exhibit anticholinergic adverse effects. This ‘adverse effect’ can provide benefits in dogs with separation anxiety.
True
Which drug is NOT an alpha-2 adrenergic agonist?
amitriptyline
Benzodiazepines are effectively used to treat some behavioral disorders. In cats, which benzodiazepine has been demonstrated to produce potentially fatal hepatotoxicity when orally administered for multiple days?
diazepam
True or false: Dogs with IVDD that are treated with glucocorticoids typically have a better outcome and long-term prognosis than dogs that are treated with nonsteroidal anti-inflammatory drugs (NSAIDs).
False
What is the most important prognostic factor to consider when making treatment decisions for a paralyzed patient with acute spinal trauma?
The presence of deep pain.
In which of the following dogs with intervertebral disk disease (IVDD) in the thoracolumbar region is surgery the best treatment recommendation?
A 6 YO MN Dachshund that is ambulatory with intractable pain.
In which patient with diskospondylitis would it be acceptable to start oral antibiotics?
A patient with slowly progressive disease.
You are treating a patient for diskospondylitis and are unable to find the causative organism. Which of the following antibiotics is recommended?
cefazolin
For patients with IVDD that do not need surgery, how long is it recommended to give NSAIDs?
7days
What needs to happen before antibiotics should be discontinued when treating a patient for diskospondylitis?
There is no radiographically visible lysis.
Conservative management of intervertebral disk disease (IVDD) consists of medication and strict cage rest. How long is strict cage rest recommended?
4wk
What is the only proven effective treatment for degenerative myelopathy?
there is no proven effective treatment
Which statement is true in relation to the treatment of metabolic bone disease in reptiles?
Salmon calcitonin (SCT) can induce life threatening hypocalcemia tetany if blood calcium levels are not appropriate.
Which therapeutic method is absolutely CONTRAINDICATED when cooling a hyperthermic patient?
Immersion in ice baths or cold water.
Which therapeutic method is recommended when managing a patient with hyperthermia and heat-induced illness?
Administering broad-spectrum antibiotics.
In which of the following patients would you recommend starting an antiepileptic drug?
A 6 YO FS Chihuahua mix that presented after having a grand mal seizure, lasting about a minute. She also had a seizure 3-to 4-weeks ago.
Which antiepileptic drug (AED) is recommended to be used as a second line AED with little evidence supporting its use as a monotherapy AED?
levetiracetam
Why is oxygen therapy important in a patient with status epilepticus or cluster seizures?
The brain has a high basal metabolic rate and is intolerant of deficits in oxygen and nutrient delivery, making oxygen support essential.
In dogs and cats, what is the most effective antiepileptic drug?
phenobarbital
What is the goal of emergent anticonvulsant therapy?
To stop all seizure activity immediately and to prevent all additional seizures for a 24-hour period.
In a hyperthermic patient, when should cooling attempts be discontinued?
When the body temperature decreases to 103 degrees Fahrenheit.
Which AED is recommended as a first line therapy to stop seizure activity in a patient with status epilepticus?
midazolam
Which drug can cause acute fatal hepatic necrosis when administered orally in cats?
diazepam
Study Notes
Feline Toxicity
- A 5-year-old male cat was administered a human pediatric cold medication, resulting in gum pallor, muddy gum color, Heinz body inclusions on erythrocytes, eccentrocytes, and ghost cells.
NSAIDs
- NSAIDs target prostaglandin-mediated amplification of pain signaling at multiple points in the pain pathway, with the least direct impact on the dorsal horn.
Feline-Specific NSAID
- Only one NSAID is FDA-approved for multiple doses in cats.
Phenobarbital and Zonisamide
- Phenobarbital therapy may cause substantial increases in ALT and bile acids in serum biochemistry testing, which usually resolve without changing the therapeutic plan.
- Zonisamide can be used as an add-on drug to phenobarbital in seizure management, requiring the dose of zonisamide to be increased.
Status Epilepticus Management
- One drug is not used to treat status epilepticus.
- One AED is contraindicated in cats.
Tricyclic Antidepressants (TCA)
- TCAs commonly exhibit anticholinergic adverse effects, which can provide benefits in dogs with separation anxiety.
Benzodiazepines
- One benzodiazepine has been demonstrated to produce potentially fatal hepatotoxicity when orally administered for multiple days in cats.
IVDD Treatment
- Dogs with IVDD treated with glucocorticoids typically have a better outcome and long-term prognosis than dogs treated with NSAIDs.
- The most important prognostic factor in making treatment decisions for a paralyzed patient with acute spinal trauma is the severity of the spinal cord injury.
- Surgery is recommended for dogs with IVDD in the thoracolumbar region with evidence of progressive neurologic deterioration.
- Oral antibiotics can be started in patients with diskospondylitis when the causative organism is unknown; cefazolin is recommended.
- NSAIDs should be given for 7-10 days in patients with IVDD that do not need surgery.
- Antibiotics should be discontinued when treating a patient for diskospondylitis when the patient remains asymptomatic for 2-3 weeks.
- Conservative management of IVDD consists of medication and strict cage rest for 4-6 weeks.
Degenerative Myelopathy
- There is only one proven effective treatment for degenerative myelopathy.
Reptile Medicine
- One statement is true in relation to the treatment of metabolic bone disease in reptiles.
Hyperthermia Management
- One therapeutic method is absolutely contraindicated when cooling a hyperthermic patient.
- Cooling methods should be discontinued when the patient's temperature reaches 103°F (39.4°C).
- One AED is recommended as a first-line therapy to stop seizure activity in a patient with status epilepticus.
- The goal of emergent anticonvulsant therapy is to stop seizure activity and prevent recurrence.
- In dogs and cats, one AED is the most effective antiepileptic drug.
- Oxygen therapy is important in a patient with status epilepticus or cluster seizures to prevent hypoxia.
Week 6 iRATs
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