231129 Juhl-McCrady Drugs in Veterinary Medicine.pdf

Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 Y R A N I R E T E V N I S DRUG MEDICINE UNIVERSITY OF ARIZON A COLLEGE OF PHARMACY 3 November 29/Dec 1, 202 DR. LINDSAY JUHL MISTRY INE WITH A MINOR IN CHE BS IN VETERINARY MEDIC ner) and Emergency Center (Ow Civano Animal Hospital...

Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 Y R A N I R E T E V N I S DRUG MEDICINE UNIVERSITY OF ARIZON A COLLEGE OF PHARMACY 3 November 29/Dec 1, 202 DR. LINDSAY JUHL MISTRY INE WITH A MINOR IN CHE BS IN VETERINARY MEDIC ner) and Emergency Center (Ow Civano Animal Hospital 520-600-7100 1 1 WHAT WE PLAN TO COVER • OVER THE COUNTER MEDICATIONS • USES • CONTRAINDICATIONS • SIDE EFFECTS • SPECIES DIFFERENCES • CLASSES OF MEDICATIONS COMMONLY USED • DIFFERENCES IN HUMANS VS ANIMALS • SIDE EFFECTS • COMMON TOXICITIES • ANTIDOTES 2 2 Civano Animal Hospital and Emergency Center/Tucson, Arizona 1 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 OTC MEDICATIONS 1) ANTIHISTAMINES-HISTAMINE BLOCKERS (H1, H2, H3, H4) • • • •USES • • • DIPHENHYDRAMINE HCL (BENADRYL) COMMON DOSAGE 1MG/LB LORATADINE (CLARITIN) 5-10MG PO Q24H CETIRIZINE (ZYRTEC) 5-10MG PO Q24H ALLERGIC REACTION MOST COMMON SEDATION FOR TRAVEL AND PREVENTION OF MOTION SICKNESS ADJUNCTIVE TREATMENT TO CONTROL TREMORS ASSOCIATED WITH ORGANOPHOSPHATE OR CARBAMATE TOXICITY •SIDE EFFECTS • SEDATION AND DROWSINESS MOST COMMON • DRY MOUTH, MYDRIASIS, BLURRED VISION, TACHYCARDIA, URINARY RETENTION, INTESTINAL ATONY • AGITATION, IRRITABILITY, CONVULSIONS, HYPERTHERMIA, AND DEATH ESP CATS • TASTES TERRIBLE, CATS WILL FOAM AT THE MOUTH • DO NOT GIVE IV! 3 3 OTC MEDICATIONS 2) ASPIRIN • DO NOT ADVISE IT PERIOD!! • HIGH RISK OF GI ULCERATION, EVEN AT “SAFE” LABEL DOSES • DOGGY ASPIRIN MARKETED, STILL UNSAFE • ONLY INDICATION FOR USE IN ANIMALS • PREVENT PTE/THROMBOEMBOLIC DISEASE ASSOCIATED WITH ITP, IMHA, CARDIAC DISEASE 4 4 Civano Animal Hospital and Emergency Center/Tucson, Arizona 2 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 OTC MEDICATIONS 3) NSAIDS • ACETAMINOPHEN (TYLENOL) • • CATS: NEVER OK: CAUSES METHEMOGLOBINEMIA, HEINZ BODY ANEMIA AND DEATH DOGS: OK AT LOW LEVELS 10-15MG/KG TID, SHORT DURATION ONLY IE 5-7 DAYS • IBUPROFEN (MOTRIN/ADVIL) • • • NEVER OK IN EITHER SPECIES GI ULCERS, RENAL FAILURE AND DEATH VARIOUS DEGREES OF TOXICITY 5 5 OTC MEDICATIONS 4) GI DRUGS • • • • MIRALAX: COMMONLY USED FOR PATIENTS WITH CHRONIC CONSTIPATION (RENAL DISEASE, MEGACOLON, MOTILITY DISORDERS) CANNED PUMPKIN HAS SIMILAR AFFECTS TO MIRALAX, BUT NOT AS RELIABLE LOPERAMIDE (IMMODIUM AD): DO NOT USE IF INFECTIOUS DIARRHEA IS SUSPECTED DIPHENOXYLATE HYDROCHLORIDE IN COMBINATION WITH 0.025 MG ATROPINE SULFATE (LOMOTIL): MOST COMMONLY USED AS AN ANTI-TUSSIVE IN DOGS WITH • COLLAPSING TRACHEA BISMUTH SUBSALICYLATE(PEPTO BISMOL): WILL CAUSE STOOLS TO BE BLACK LIKE TAR! • SIMETHICONE (GAS-X): COMMONLY USED IN SMALL MAMMALS/EXOTICS FOR GI STASIS -RELATED TO ASPIRIN, TOXICITY INCLUDES ANEMIA, LIVER DAMAGE ESPECIALLY CATS 6 6 Civano Animal Hospital and Emergency Center/Tucson, Arizona 3 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 OTC MEDICATIONS 5) TOPICALS • NEOSPORIN: NOT ADVISED, CAN CAUSE RENAL TOXICITY • • CATS CAN HAVE FATAL ANAPHYLACTIC REACTIONS WITH OPHTHALMIC PRODUCTS CAN BE FATAL TO EXOTIC SPECIES IF INGESTED • HYDROCORTISONE: COMMONLY USED FOR ALLERGIES • SILVER SULFADIAZENE CREAM: COMMONLY USED FOR BURNS/WOUNDS 7 7 OTC MEDICATIONS 6) GLUCOSAMINE/CHONDROITIN; NOT FDA REGULATED • COMMONLY USED FOR OA AND MANY JOINT DISEASES • CAN CAUSE GI SIDE EFFECTS IE FLATULENCE, LOOSE STOOL 7) FISH OILS; NOT FDA REGULATED • USED FOR MANY CONDITIONS SIMILAR TO PEOPLE, MOST COMMON IS ALLERGIC SKIN DISEASE • USE CAUTION IN PATIENTS WITH COAGULOPATHIES • CAN CAUSE GI SIDE EFFECTS, LOOSE STOOL, NAUSEA, ANOREXIA 8 8 Civano Animal Hospital and Emergency Center/Tucson, Arizona 4 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 MOST COMMONLY USED CLASSES OF MEDICATIONS ANTIBIOTICS OCULAR CARDIAC IMMUNOSUPPRESSIVE RESPIRATORY APPETITE STIMULANTS ENDOCRINE ANTI-FUNGALS ANTI-CONVULSANTS URINARY PAIN CONTROL ANTI-NAUSEA BEHAVIORAL MODIFICATION 9 9 ANTIBIOTICS • AUGMENTIN (CLAVAMOX) • AMOXICILLIN • CLINDAMYCIN • AZITHROMYCIN • CEPHALEXIN • NITROFURANTOIN • METRONIDAZOLE • PENICILLIN • DOXYCYCLINE • FLUOROQUINOLONES/ENROFLOXACIN • TYLOSIN 10 10 Civano Animal Hospital and Emergency Center/Tucson, Arizona 5 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 SIDE EFFECTS OF ANTIBIOTICS • GASTROINTESTINAL MOST COMMON FOR ALL ANTIBIOTICS • DRUG SPECIFIC • DOXYCYCLINE: • ESOPHAGEAL STRICTURE VERY COMMON IN CATS • ENAMEL HYPOPLASIA WHEN USED IN YOUNG ANIMALS • CAN RETARD FETAL SKELETAL DEVELOPMENT • PENICILLINS: • NEVER USE ORAL PRODUCTS IN EXOTICS = DEATH!! • FLUORQUINOLONES: • BLINDNESS IN CATS • DISRUPTS CARTILAGE DEVELOPMENT IN YOUNG ANIMALS 11 11 CARDIOVASCULAR DRUGS IN ANIMALS • AMLODIPINE: FIRST CHOICE FOR HYPERTENSION 0.2MG/KG PO Q24 • ACE INHIBITORS: ENALAPRIL OR BENAZPRIL 0.25-0.5MG/KG PO Q24-BID • MOST COMMONLY USED FOR EARLY RENAL DISEASE/PROTEINURIA • USED FOR VERY MILD HYPERTENSION • MUCH LESS POTENT/EFFECTIVE IN ANIMALS THAN HUMANS • CLOPIDOGREL (PLAVIX): COMMONLY USED TO PREVENT PTE WITH IMHA, ITP • DIGOXIN: USED FOR SVT’S; NARROW MARGIN OF SAFETY, MONITORING LEVELS IS KEY • DILTIAZEM (DILACOR): SVT’S, PULMONARY HYPERTENSION, SYSTEMIC HYPERTENSION, OR HYPERTROPHIC CARDIOMYOPATHY • WE WILL ASK CLIENT TO OPEN THE CAPSULE AND INDIVUALLY DOSE THE SPHERULES 12 12 Civano Animal Hospital and Emergency Center/Tucson, Arizona 6 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 CARDIOVASCULAR DRUGS IN ANIMALS • PIMOBENDAN (VETMEDIN): PDE-3 INHIBITOR, INCREASING INTRACELLULAR CA SENSITIVITY • INODILATOR (POSITIVE INOTROPIC AND VASODILATOR EFFECTS). • MOST COMMONLY USED FOR DILATED CARDIOMYOPATHY AND VALVULAR INSUFFICIENCY • EPIC TRIAL (STAGE B2, CARDIOMEGALY BUT NOT CHF) SHOWED THAT PIMOBENDANE DELAYED THE ONSET OF CHF OR CARDIAC DEATH COMPARED TO PLACEBO BY AN AVERAGE OF 462DAYS • DOSING 0.25MG/KG PO BID, GIVE ON EMPTY STOMACH • OK FOR CATS AND DOGS • THIS DRUG IS USUALLY COMPOUNDED DUE TO LIMITED AVAILABILITY 13 13 CARDIOVASCULAR DUGS IN ANIMALS • LIDOCAINE: • COMMONLY USED AS A CONTINUOUS RATE INFUSION (CRI) FOR VPCS’S, ABDOMINAL DISEASE/PAIN CONTROL AND FREE RADICAL SCAVENGER • TRANSITION TO MEXILLITINE PO • CAN BE VERY TOXIC IN CATS • NEUROTOXICITY SEEN AT HIGHER DOSES • DOPAMINE AND NOREPINEPHRINE • USED AS A CRI FOR HYPOTENSION VERY COMMONLY IN ER SETTING 14 14 Civano Animal Hospital and Emergency Center/Tucson, Arizona 7 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 15 15 CARDIOVASCULAR DRUGS IN ANIMALS • VIAGRA!!! (SILDENAFIL) • FIRST LINE DEFENSE FOR PULMONARY HYPERTENSION • PDE5 INHIBITOR • VERY EFFECTIVE, BUT EMBARRASSING FOR THE CLIENT • DIRUETICS • LASIX, SPIRONOLACTONE 16 16 Civano Animal Hospital and Emergency Center/Tucson, Arizona 8 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 17 17 18 18 Civano Animal Hospital and Emergency Center/Tucson, Arizona 9 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 RESPIRATORY • ALBUTEROL AND FLUTICASONE INHALERS: FIRST LINE DRUG AGAINST FELINE ASTHMA • WE HAVE AEROKAT SPACERS FOR ANIMALS, SODA BOTTLES WORK WELL • THEOPHYLLINE AND AMINOPHYLLINE: BRONCHITIS AND SPASMS • MUCH WIDER MARGIN OF SAFETY THAN HUMANS • HYDROCODONE (HYCODAN): VERY COMMONLY USED FOR COLLAPSING TRACHEA, CHRONIC BRONCHITIS, UPPER RESPIRATORY TRACT DISEASE ETC. • DO NOT USE ACETAMINOPHEN COMBO PRODUCTS IN CATS • BUTORPHANOL • PREFERRED DRUG FOR ANTITUSSIVE THERAPY 19 19 20 20 Civano Animal Hospital and Emergency Center/Tucson, Arizona 10 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 ENDOCRINE • THYROID SUPPLEMENTATION • 0.02MG/KG, DOSE MUCH HIGHER IN DOGS THAN HUMANS • DOGS GET HYPOTHYROIDISM AND CATS GET HYPERTHYROIDISM • MITOTANE (LYSODREN): COMMONLY USED TO TREAT HYPERADRENOCORTICISM WHICH IS EXTREMELY COMMON IN DOGS • VERY TOXIC AND POTENTIALLY LETHAL IN HUMANS • STEROIDS • PREDNISONE AND DEXAMETHASONE COMMONLY USED • CATS MUST HAVE PREDNISOLONE BECAUSE THEIR LIVER CANNOT CONVERT PRED TO PREDNISOLONE • SE: PU/PD, INCREASED APPETITE, AGGRESSION, ALOPECIA, DIABETES, HEART FAILURE, PANTING, TORN LIGAMENTS 21 21 ANTICONVULSANTS • PHENOBARBITAL • 2.2MG/KG BID (UP TO 5MG/KG), MUST HAVE BLOOD MONITORING • SE: HEPATIC INSUFFICIENCY, PU/PD, ANOREXIA, GI, ATAXIA, STUPOR • LEVETIRACETAM (KEPPRA) • 30MG/KG BID TO TID; XR IS PREFERRED • NO BLOOD MONITORING REQUIRED • ZONISAMIDE, POTASSIUM BROMIDE, PREGABALIN • DIAZEPAM/MIDAZOLAM INJECTABLE ONLY • CAUSES: EPILEPSY, BRAIN TUMOR, METABOLIC, TOXIN, VALLEY FEVER, CANCER, INFECTIOUS 22 22 Civano Animal Hospital and Emergency Center/Tucson, Arizona 11 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 PAIN CONTROL • ORAL • TRAMADOL: 3-10MG/KG PO TID: IE 50LB DOG 200-250MG SAFE DOSE!!! • RECENT LITERATURE: MUCH LESS EFFECTIVE AS DOGS PRODUCE LOW AND INCONSISTENT CONCENTRATIONS OF THE METABOLITE (M1) WHICH IS THE METABOLITE THAT CONTRIBUTES TO ANALGESIC EFFECTS IN PEOPLE. CLEARANCE IS ALSO MUCH HIGHER IN ANIMALS RESULTING IN A MUCH HIGHER REQUIRED DOSE • NOW TYPICALLY ONLY USED ON CONJUNCTION WITH AN NSAID • GABAPENTIN: 3-10MG/KG PO TID, UP TO 100MG PER CAT SAFE • USED FOR SEDATION ESP IN CATS AND CHRONIC NEUROPATHIC PAIN • AMANTADINE: 3-5MG/KG PO BID • CHRONIC OA • TYELONOL #3 (ACETAMINOPHEN + CODEINE): ONLY IN DOGS, <10 DAYS DURATION 23 23 PAIN CONTROL • • • FENTANYL, FULL MU AGONIST, CII HYDROMORPHONE, FULL MU AGONIST, CII METHADONE: FULL MU AGONIST, CII. • • • MORPHINE, FULL MU AGONIST, SOME DELTA ACTIVITY, CII • • • • WILL CAUSE VOMITING ALMOST 100% OF THE TIME CONTRAINDICATED IN PTS WITH MAST CELL TUMORS, HISTAMINE RELEASE MALIGNANT HYPERTHERMIA BUTORPHANOL, PARTIAL AGONIST/ANTAGONIST AT MU, AGONIST AT K, CIII • • • • EXCELLENT ALTERNATIVE TO PAIN CONTROL SINCE FENTANYL AND HYDRO HAVE BEEN ON BACK ORDER, BUT HIGH ADDICTION RATE USED ORALLY AS ANTITUSSIVE, MUCH LESS EFFECTIVE FOR PAIN CONTROL BUPRENORPHINE, PARTIAL MU AGONIST, 30X MORE POTENT THAT MORPHINE, CIII AMITRIPTYLINE: NEUROPATHIC PAIN IN CATS AND DOGS KETAMINE: NMDA BLOCKER DEXMEDETOMIDINE/MEDETOMIDINE: ALPHA 2 AGONIST 24 24 Civano Animal Hospital and Emergency Center/Tucson, Arizona 12 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 NSAID • GRAPIPRANT (GALLIPRANT): PROSTAGLANDIN E2 EP4-RECEPTOR ANTAGONIST • NEW CLASS OF NSAID FOR TREATING OSTEOARTHRITIS PAIN IN DOGS ONLY • IT DOES NOT INHIBIT CYCLOOXYGENASE, SO NOT A TYPICAL NSAID • THOUGHT TO PRODUCE LESS ACID IN THE STOMACH AND LARGE INTESTINE • RECOMMENDED FOR THOSE PATIENTS WITH UNDERLYING RENAL, HEPATIC OR GI DISEASE THAT NEED SOME FOR OF ANTI-INFLAMMATORY MEDICATION • 2MG/KG PO Q24 25 25 26 26 Civano Animal Hospital and Emergency Center/Tucson, Arizona 13 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 ANTI-NAUSEA MEDICATION • ZOFRAN (ONDANSETRON) • METOCLOPRAMIDE • MECLIZINE (OTC) 27 27 BEHAVIORAL MODIFICATION • FLUOXETINE (PROZAC): 1-2MG/KG PO Q24H • DO NOT USE WITH SSRI • SE: CONSTIPATION, URINE RETENTION AND SEIZURES REPORTED • ALPRAZOLAM: CAN CAUSE PARADOXICAL EFFECT • AMITRIPTYLINE: MORE COMMONLY USED IN CATS ESP FOR FLUTD 28 28 Civano Animal Hospital and Emergency Center/Tucson, Arizona 14 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 OCULAR MEDICATIONS • TOBRAMYCIN, GENTAMICIN, NEOMYCIN • DORZOLAMIDE (TRUSOPT) • TIMOLOL AND OTHER BETA BLOCKERS: USE EXTREME CAUTION IN PTS WITH AIRWAY DISEASE • LATANOPROST (XALATAN) AND TRAVOPROST (TRAVATAN) • ATROPINE DROPS: USED TO TREAT OCULAR PAIN AND PREVENT SYNECHIA • PREDNISOLONE ACETATE FOR UVEITIS • CYCLOSPORINE FOR DRY EYE 29 29 IMMUNOSUPPRESSIVES • STEROIDS • PREDNISONE MOST COMMONLY USED. ULCEROGENIC • AZATHIOPRINE • DO NOT USE IN CATS, SEVERE BONE MARROW SUPPRESSION • SE: HEPATOTOXICITY, PANCREATITIS AND GI ARE VERY COMMON • CYCLOSPORINE • IF USING HUMAN-LABELED PRODUCTS, DON’T CONFUSE SANDIMMUNE® WITH ATOPICA®/NEORAL®/GENGRAF® DOSAGES; THEY ARE NOT BIOEQUIVALENT • SE: GI MOST COMMON. CAN PUT IN FREEZER TO HELP REDUCE THESE SE • ALSO GIVEN WITH KETOCONAZOLE TO EFFECTIVELY LOWER REQUIRED DOSE • USES: ITP, IMHA, LUPUS, SEVERE ATOPIC DERMATITIS, STOMATITIS, HEPATITIS 30 30 Civano Animal Hospital and Emergency Center/Tucson, Arizona 15 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 APPETITE STIMULANTS • CAPROMORELIN • GHRELIN MIMETIC THAT STIMULATES APPETITE • USED IN DOGS (ENTYCE®) AND CATS (ELURA ®) • SMALL MOLECULE GIVEN ORALLY • MIRTAZIPINE • CYPROHEPTADINE • ALSO USED TO TREAT SE OF SSRI OVERDOSE/TOXICITY 31 31 ANTIFUNGALS • FLUCONAZOLE: 5-10MG/KG PO BID • SE: HEPATOTOXICITY, URINARY INCONTINENCE, GI • USED IN ALL SPECIES EXCEPT BIRDS, CAN KILL THEM • PREFERRED FOR COCCIDIOMYCOSIS • ITRACONAZOLE • PREFERRED FOR BLASTOMYCOSIS AND HISTOMYCOSIS • TYPICALLY LESS SE • CAN COMBINE WITH LUFENURON TO HELP INCREASE EFFICACY (CHITIN INHIBITOR) 32 32 Civano Animal Hospital and Emergency Center/Tucson, Arizona 16 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 33 33 URINARY • PRAZOSIN: 1MG PO BID • RELAXES URETHRAL SPHINCTER, USED VERY COMMONLY IN BLOCKED CATS • BETHANACOL: HELPS WITH BLADDER ATONY ASSOCIATED WITH PROLONGED URETHRAL OBSTRUCTION 34 34 Civano Animal Hospital and Emergency Center/Tucson, Arizona 17 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 TOXICITIES OF COMMON HUMAN MEDICATIONS 35 35 SSRI/BEHAVIORAL DRUGS • SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) ALL DIFFER STRUCTURALLY, BUT HAVE THE SAME ABILITY TO INHIBIT PRESYNAPTIC NEURONAL REUPTAKE OF SEROTONIN. • FLUOXETINE(PROZAC®), PAROXETINE (PAXIL®), SERTRALINE (ZOLOFT®), FLUXOVAMINE (LUVOX®), CITALOPRAM (CELEXA®), AND ESCITALOPRAM (LEXAPRO®). • SIGNS/SYMPTOMS: DEPRESSION, VOMITING, ANOREXIA, ATAXIA, MUSCLE TREMORS, ARRHYTHMIA (TACHYCARDIA AND BRADYCARDIA ARE POSSIBLE), HYPERTENSION, AGITATION, TREMORS, TACHYCARDIA, HYPERTHERMIA, DIARRHEA, SALIVATION, MYDRIASIS, SEIZURES, NYSTAGMUS, AND COMA • TREATMENT: IVF DO NOT HELP INCREASE EXCRETION. ACEPROMAZINE, CHLORPROMAZINE AND CYPROHEPTADINE AS WELL AS BP SUPPORT ARE KEY 36 36 Civano Animal Hospital and Emergency Center/Tucson, Arizona 18 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 AMPHETAMINES • AMPHETAMINES CAN BE FOUND IN BOTH PRESCRIPTION ADHD AND WEIGHT LOSS MEDICATIONS (RITALIN®, ADDERALL®, VYVANSE®, CONCERTA®), AS WELL AS ILLICIT SUBSTANCES (METHAMPHETAMINE, CRACK). PSEUDOEPHEDRINE IS FOUND IN COLD AND ALLERGY MEDICATIONS. • SIGNS/SYMPTOMS: PERIPHERAL VASOCONSTRICTION AND CARDIAC STIMULATION RESULTING IN HYPERTENSION, TACHYCARDIA, ATAXIA, AGITATION, TREMORS, AND SEIZURES. • TREATMENT: IVF, ACTIVATED CHARCOAL, PHENOTHIAZINES, CYPROHEPTADINE, DO NOT USE DIAZEPAM/MIDAZOLAM 37 37 THC AND MARIJUANA • OWNERS RELUCTANT TO REPORT • SIGNS/SYMPTOMS: LETHARGY, HYPERESTHESIA, MYDRIASIS, DROOLING, URINARY INCONTINENCE, STUPOR, COMA • TREATMENT: IVF, ACTIVATED CHARCOAL, DO NOT INDUCE EMESIS, TIME 38 38 Civano Animal Hospital and Emergency Center/Tucson, Arizona 19 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 BACLOFEN • BACLOFEN IS A CENTRALLY ACTING SKELETAL MUSCLE RELAXANT THAT MIMICS Γ- AMINOBUTYRIC ACID (GABA) WITHIN THE SPINAL CORD AND CAUSES A FLACCID PARALYSIS OF SKELETAL MUSCLES • SIGNS/SYMPTOMS: VOMITING, ATAXIA, AND VOCALIZATION/DISORIENTATION; BUT THE MOST LIFE-THREATENING SIGNS ARE DYSPNEA, RESPIRATORY ARREST, AND SEIZURES. DYSPNEA AND RESPIRATORY ARREST ARE SECONDARY TO PARALYSIS OF THE DIAPHRAGM AND INTERCOSTAL MUSCLES. • **CAN LAST UP TO 7 DAYS POST EXPOSURE • TREATMENT: IVF, INTRALIPID, ACTIVATED CHARCOAL, VENTILATORY SUPPORT 39 39 INTRALIPID THERAPY • CAN BE USEFUL IN OVERDOSES OR POISONINGS TO REDUCE FREE-DRUG BLOOD LEVELS OF FATSOLUBLE DRUGS OR TOXINS. • COMMON INDICATIONS: BUPIVACAINE, MEPIVACAINE, ROPIVACAINE, LIDOCAINE, MACROCYCLIC LACTONES (E.G., IVERMECTIN, MOXIDECTIN), CALCIUM CHANNEL BLOCKERS (E.G., DILTIAZEM, VERAPAMIL, AMLODIPINE) BETA-BLOCKERS (E.G., PROPRANOLOL, CARVEDILOL), ANTIDEPRESSANTS (E.G., BUPROPION, DOXEPIN, SERTRALINE, CLOMIPRAMINE), ANTIPSYCHOTICS (E.G., CHLORPROMAZINE, QUETIAPINE), ANTIEPILEPTICS (E.G., CARBAMAZEPINE, LAMOTRIGINE), AND MUSCLE RELAXANTS (E.G., BACLOFEN, CYCLOBENZAPRINE) • SE: PANCREATITIS • BUT VERY EFFECTIVE!!! 40 40 Civano Animal Hospital and Emergency Center/Tucson, Arizona 20 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 XYLITOL • CHEWING GUM, ADDITIVE TO MANY HUMAN MEDICATION SUSPENSIONS IE GABAPENTIN! • DOGS ONLY, NOT CATS • CAUSES LIVER FAILURE, HYPOGLYCEMIA • TYPICALLY REQUIRES HOSPITALIZATION WITH DEXTROSE SUPPLEMENTATION AND LIVER SUPPORT FOR SEVERAL DAYS 41 41 EXOTICS • FERRETS, RABBITS, RATS, BIRDS, TURTLES/TORTOISES, HEDGE HOGS, SNAKES, IGUANAS, WATER DRAGONS, BEARDED DRAGONS, GUINEA PIGS, CHINCHILLAS, SPIDERS, FISH, ETC • EVERYTHING IS OFF LABEL AND DOSES ARE EXTRAPOLATED. • MUST INFORM CLIENTS OF THIS PRIOR TO USING ANY DRUG • MUCH HIGHER METABOLISM SO DOSES ARE MUCH HIGHER 42 42 Civano Animal Hospital and Emergency Center/Tucson, Arizona 21 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 43 43 LARGE ANIMALS AND FARM ANIMALS • WITH DRAWAL TIMES: time required before an animal product can be prepared for sale or use following the last administration of a particular drug • WWW.VIN.COM HAS A DRUG LIBRARY WITH DRUG WITH DRAWL TIMES • THIS IS REQUIRED TO BE WRITTEN ON PRESCRIPTIONS INTENDED FOR USE IN FOOD ANIMALS WHICH INCLUDES CHICKENS (EGGS) • FOOD ANIMAL RESIDUE AVOIDANCE DATABANK • • WWW.FARAD.ORG LIST OF WITHDRAWAL TIMES AS WELL AS PROHIBITED DRUGS 44 44 Civano Animal Hospital and Emergency Center/Tucson, Arizona 22 Lindsay Juhl DMV/Drugs in Veterinary Medicine PCOL825A/Fall 2023 DRUGS WITH NO ALLOWABLE EXTRA-LABEL USES IN ANY FOODPRODUCING ANIMAL SPECIES • CHLORAMPHENICOL • CLENBUTEROL • DIETHYLSTILBESTEROL (DES) • FLUOROQUINOLONE–CLASS ANTIBIOTICS • GLYCOPEPTIDES – ALL AGENTS, INCLUDING VANCOMYCIN • MEDICATED FEEDS • NITROIMIDAZOLES – ALL AGENTS, INCLUDING DIMETRIDAZOLE, IPRONIDAZOLE, METRONIDAZOLE AND OTHERS • NITROFURANS – ALL AGENTS, INCLUDING FURAZOLIDINE, NITROFURAZONE AND OTHERS 45 45 QUESTIONS 46 [email protected] 46 Civano Animal Hospital and Emergency Center/Tucson, Arizona 23