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Questions and Answers
What was one of the primary uses of intravenous lipid emulsion (ILE) before 2003?
Which of the following toxicants has been treated with ILE since its successful application in bupivacaine poisoning?
Which factor contributes to the effectiveness of ILE in treating intoxications?
What does a high volume of distribution (Vd) indicate about a drug's behavior in the body?
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Which of the following statements is true regarding baclofen and its response to ILE?
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What is the primary finding regarding serum toxicant concentrations after ILE administration in dogs?
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Which of the following is NOT a reason for inconsistencies in the study of ILE's clinical efficacy?
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What is the current recommendation of Poison Control Centers regarding ILE for most NSAID intoxications?
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What does the data suggest about the lipid sink theory in relation to ILE?
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Which NSAID is explicitly mentioned as being studied alongside ILE in the provided content?
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What is the gastric content recovery percentage with emesis performed within 30 minutes after ingestion?
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Which of the following is NOT a contraindication to emesis?
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What should be monitored when assessing exposure to metaldehyde in horses?
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How much metaldehyde is estimated to be in 1.13 kg of bait with 2.75% concentration?
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When emesis is ineffective or contraindicated, what alternative treatment is mentioned?
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What is the estimated oral LD50 of metaldehyde for horses?
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Which substance has the highest risk of aspiration when emesis is performed?
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What would be suspected if the exposure is right at the LD50 level?
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What is the primary reverse agent for hydromorphone?
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Which alpha-2 agonist was associated with the highest rate of emesis in the studies mentioned?
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What was a common severe side effect associated with the use of alpha-2 agonists?
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Why is hydrogen peroxide considered ineffective for inducing emesis in cats?
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What does the use of apomorphine to induce emesis target in the brain?
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Which of the following is NOT an effective method for inducing emesis in any species?
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Based on the studies, which drug induced emesis with a lower sedation score compared to dexmedetomidine?
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When giving dexmedetomidine, what is the typical intravenous median dose for inducing emesis in cats?
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What is the primary purpose of using cathartics in managing toxicant ingestion?
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Which of the following is a saline cathartic commonly used?
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Under what condition should cathartics not be administered?
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What is the contraindication for administering mineral oil in poisoning cases?
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What is the recommended dosage of sorbitol when administered?
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Why should mineral oil not be given with activated charcoal?
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What is the role of osmotic cathartics in treating poisonings?
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In what scenario is activated charcoal typically administered?
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Study Notes
Alpha-2 Agonists
- Dexmedetomidine and xylazine are alpha-2 agonists
- Serious effects include excessive sedation and cardiovascular collapse
- Antipamezole or yohimbine can be used to reverse the effects
Hydromorphone
- Hydromorphone is a mu-opioid receptor agonist
- Naloxone can be used to reverse the effects
Emesis in Cats
- Research shows that hydrogen peroxide is not effective in inducing emesis in cats
- Xylazine and dexmedetomidine induce emesis in cats
- Dexmedetomidine is more effective at inducing emesis in cats than xylazine
- Dexmedetomidine and xylazine are associated with sedation as a side effect
Hydromorphone and Dexmedetomidine in Cats
- A study published in 2019 found hydromorphone to be at least as effective as dexmedetomidine in inducing emesis in cats
- Hydromorphone was associated with a lower sedation score and less decrease in heart rate compared to dexmedetomidine
Ineffective Emetics in Cats
- Hydrogen peroxide is not very effective and can cause hemorrhagic gastritis
- Apomorphine is not effective in cats due to lower dopamine2 receptors in the CRTZ
- Apomorphine also causes CNS stimulation
Ineffective Emetics in All Species
- Salt can cause hypernatremia
- Syrup of ipecac can cause cardiac effects and prolonged vomiting
- Digital stimulation can cause physical injury
- Liquid dish soap is ineffective and can cause aspiration risk
- Forcing water can cause aspiration
- Raw eggs, Tabasco, and mustard are ineffective
Emetics: Timing and Usefulness
- Emesis is advised within 30 minutes after ingestion
- Gastric content recovery is higher when emesis occurs within 30 minutes of ingestion
- Emetics may be useful up to 6 hours after ingestion for grapes, raisins, chocolate, xylitol gum, bezoars, massive ingestions, and drugs that decrease gastric emptying
- Drugs that decrease gastric emptying include opioids, salicylates, anticholinergics, and tricyclic antidepressants
Contraindications for Emesis
- High risk of aspiration
- Already vomited
- History of seizures
- Corrosive agents (pH 11)
- Hydrocarbons (oil, gasoline, kerosene)
- Sharp/dangerous objects
- Non-toxic ingestion
Metaldehyde Exposure Assessment
- LD50 of metaldehyde in horses is 60 mg/kg
- If a horse ingested all 2.5 pounds of metaldehyde bait (containing 2.75% metaldehyde), the exposure would be 60 mg/kg, which is potentially lethal
Gastric Lavage
- Gastric lavage is often ineffective or even harmful
- It may be beneficial for cases of cryptosporidiosis in calves
Cathartics
- Cathartics speed the transit time of toxicants through the GI tract
- They decrease the time for toxicant absorption and decrease the time for desorption of the toxicant from activated charcoal
- Common cathartics include saline cathartics (sodium sulfate, magnesium sulfate) and saccharide cathartics (sorbitol)
- They work by increasing fluid volume within the GI tract, which stimulates motility and speeds expulsion of contents
- They are most useful for eliminating ingested solid toxicants and time-release or enteric-coated compounds
Sorbitol
- Sorbitol is administered as a 70% solution
- Dose is 1 - 2 ml/kg
- It is typically given with activated charcoal in a slurry solution
- It should be given only once
- Contraindications: lack of bowel sounds, intestinal obstruction or perforation, presence of diarrhea, hypotension, and electrolyte abnormalities
Mineral Oil
- Mineral oil is a laxative for horses and cattle
- It has a higher risk of aspiration than other cathartics
- It is no longer recommended for use in exposures to lipophilic compounds
- Do not give with activated charcoal
Decontamination Approach for Toxicosis in Heifers
- Based on the information provided, the heifers likely ingested a toxic plant from the hay
- Clinical signs of lethargy and diarrhea are consistent with plant poisoning
- Further investigation into the plant species is warranted
- Activated charcoal would be a reasonable decontamination approach
Intravenous Lipid Emulsion (ILE)
- ILE is a fat emulsion used to treat intoxications with fat-soluble compounds
- Historically it was used as a component for nutritional therapy, a vehicle for drug delivery, and to treat systemic intoxication from local anesthetics
- Since 2006, it has been used for other lipophilic drug and toxicant intoxications, including beta-blockers, calcium-channel blockers, parasiticides, herbicides, and psychotropic agents
ILE: Historical Experimental Data and Mechanism
- Research with bupivacaine-induced cardiotoxicity in dogs suggests that some animals respond to ILE therapy
- ILE may be beneficial for drugs with high volumes of distribution as these drugs distribute into fat and muscle, away from the serum
- While some poorly lipophilic drugs have shown positive response to ILE, other physiochemical factors may influence the response
- Examples of lipophilic drugs with varying volumes of distribution: verapamil (LogP = 3.8, Vd = 4.5), bupivacaine (LogP = 3.4, Vd = 0.7), and ethanol (LogP = -0.1, Vd = 0.5)
ILE Studies With NSAID Toxicoses in Dogs
- Studies with ibuprofen, naproxen, and carprofen in dogs showed that serum toxicant concentrations decreased after ILE administration
- However, these studies did not support the lipid sink theory
- Poison Control Centers currently do not recommend ILE for most NSAID intoxications
Inconsistencies in ILE Studies
- Inconsistencies in clinical efficacy studies may be due to:
- Patients receiving other treatments
- Differences in ILE dosing regimen
- Differences in ILE compounds
- Differences in exposure to toxicants/drugs
- Lack of measurement of serum concentrations of toxicants following ILE
Review and Self-Check
- Decontamination strategies can alter ADME processes
- Activated charcoal is not recommended for certain toxicants, including corrosive agents, hydrocarbons, and certain metals
- Giving activated charcoal in combination with sorbitol may reduce the effectiveness of the charcoal
- Emetics for different species have varied effectiveness and considerations
- ILE is a therapy based on a lipid sink theory, where fat is administered intravenously to sequester fat-soluble toxicants
- Exposure assessment is crucial for determining potential toxicity and guiding treatment
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Description
This quiz covers the pharmacology of alpha-2 agonists and mu-opioid receptor agonists, focusing on their effects and uses in feline medicine. It includes information on sedation, emesis induction, and comparisons of effectiveness between various agents. Test your knowledge on the best practices and recent research findings related to these veterinary drugs.
