Pharmacology 3
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- What are corticosteroids used to tx? (5)
-
1. inflammatory dzs
2. pruritic dzs
3. Immune-mediated dzs
4. Shock
5. Many others - Natural corticosteroids are produced by the_________
- adrenal cortex
- The release of corticosteroids is controlled by the what?
- hypothalmic-pituitary-adrenal axis
- Corticosteroids used clinically are __________ produced
- synthetically
- Classification of corticosteroids is based on what?
- Predominant activity
- Two groups of corticosteroids
- mineralcorticoids, glucocorticoids
- What do mineralcorticoids do?
- Regulate electrolyte and water balance in the body.
- Group of drugs that inhibit the actions of histamines
- antihistimines
- Two major uses of antihistimines
- dermatology and allergies
- How is histimine released?
- It is released from mast cells in the skin due to cell destruction (bee stings, colds, injury) or through certain histimine liberators (drugs such as morphine, x-ray contract media).
- What can result from histimine release?
- pruritis, hypotension, and contstriction of bronchioles
- Tha major use of antihistimines is for what?
- Canine atophy (allergies)
- Approximately what percentage of allergies respond to a regimen of antihistimines?
- 30%
- What drug is the drug of choice for allergies? What else might be used?
- Antihistimines are drug of choice, but other tx such as glucocorticoids may be used. Antihistimines are safer though, and thus the first choice.
- Clinical uses of antihistimines (8)
- pruritis, urticaria, laminitis, motion sickness, anaphylactic shock, reverse sneeze syndrome, heaves in horses, and upper respiratory tract infections
- Side effects of antihistimines (5)
- sedation/lethargy, CNS excitation, teratogenicity (birth defects), anti-cholinergic action (decrease in secretions), rare agranulocytosis
- What is the most common side effect of antihistimines? When does it usually subside?
- Sedation or lethargy, subsides after 2-4 weeks
- What is a contraindication for antihistimines?
- Anticonvulsant drugs - both are CNS depressants
- Antihistimines are more effective when used preventively - why?
- Because they do not displace histimine when it is already combined with receptors.
- diphenhydramine trade name?
- Benadryl (R)
- Benadryl (R) generic name?
- diphenhydramine
- What are two of the most commonly used antihistimines?
- diphenhydramine/Benadryl (R) and chlorpheniramine/Chlor-trimetron (R)
- Which is not as effective for skin problems? diphenhydramine or chlorpheniramine?
- chlorpheniramine/Chlor-trimetron (R)
- What med is somewhat effective against heaves in horses?
- chlorpheniramine/Chlor-trimetron (R)
- Trade name for hydroxyzine HCL?
- Ataratx (R)
- What is the generic name for Atarax(R)?
- hydroxyzine HCL
- What antihistimine causes relaxation of skeletal muscles, has some analgesic effect, and fewer side effects than classic antihistimines?
- hydroxyzine HCL
- Trade name for terfenadine?
- Seldane(R)
- Generic name for Seldane(R)?
- terfenadine
- Trade name for dimenhydrinate?
- Dramamine(R)
- Generic name for Dramamine(R)?
- dimenhydrinate
- What antihistimine also has an antiemetic effect?
- dimenhydrinate/Dramamine(R)
- Trade name for pyrilamine maleate?
- Histavet(R)
- Generic name for Histavet(R)?
- pyrilamine maleate
- What are the two types of mineralocorticoids?
- aldosterone and fludrocortisone acetate/Florinef(R)
- What mineralcorticoid is natural?
- aldosterone
- What mineralocorticoid is synthetic?
- fludrocortisone acetate/Florinef(R)
- What is fludrocortisone acetate/Florinef(R) used for?
- used as replacement therapy for aldosterone
- What do glucocorticoids do?
- Have anti-inflammatory, immunosuppressant action, and also influence carbohydrate, fat, and protein metabolism. They keep the body from doing bad things to itself at the site of injury.
- Specific things that glucocorticoids do
- reduce capillary wall permeability, stabilize cells/lysosome membranes, inhibit phagocyte chemotaxis, reduce cell response to histimine, and maintain micro-circultaion at an injury site
- Two natural glucocorticoids
- cortisol and corticosterone
- Examples of synthetic glucocorticoids
- prednisone, prednisolone, betamethasone/Betason(R), dexamethasone/Azium(R), methyprednisolone/Depro-medrol(R), prednisolone sodium succinate/Solu-Delta-Cortef(R)
- Trade name for betamethasone
- Betason(R)
- Generic name for Betason(R)
- betamethasone
- Trade name for dexamethasone
- Azium(R)
- Generic name for Azium(R)
- dexamethasone
- Trade name for methyprednisolone
- Depro-medrol(R)
- Generic name for Depro-medrol(R)
- methyprednisolone
- Trade name for prednisolone sodium succinate
- Solu-Delta-Cortef(R)
- Generic name for Solu-Delta-Cortef(R)
- prednisolone sodium succinate
- What two synthetic glucocorticoids are often used interchangeably?
- prednisone and prednisolone
- What does the word "depo" mean?
- long-acting
- What synthetic glucocorticoid is **very** fast acting and is often used for shock?
- prednisolone sodium succinate/ Solu/Delta/Cortef(R)
- What is the most common use of a corticosteroid?
- allergic reactions
- what are some clinical uses of corticosteroids?
- allergic reactions, inflammatory conditions (reduces scar formation), shock, toxemia, lameness, Addison's, autoimmune dzs, inflammatory ocular dzs, lymphocytic neoplasias
- Side effects of short term uses of corticosteroids
- PU/PD/PP, wt gain due to PP and water retention, reduction in immune response, more susceptible to infections, inhibits the healing response, in high doses - gastric ulcers
- Side effects of long-term corticosteroid use
- Iatrogenic Cuchings dz, iatrogenic Addison's dz, decreased muscle mass, brittle bones
- Contraindications of corticosteroids
- pregnancy (may induce labor), diabetes, vaccinations, immature animals (slows growth and bone calcification), dehydrated animals, animals w/ actively healing wounds (slows healing), animals w/ severe infections, corneals ulcers - can cause cornea to rupture!
- NSAID stands for?
- Non-steroidal anti-inflammatories
- What does analgesic mean?
- anti-pain
- What does anti-pyretic mean?
- anti-fever
- Why are NSAIDs preferred over steroids?
- Analgesic and anti-pyretic effects and fewer side effects
- NSAIDs should be used with caution in _________ patients
- geriatric
- Combining NSAIDs w/__________ should be avoided
- corticosteroids
- OTC products should be checked carefully for any presence of _________
- acetominophen
- What is the "Triple A" effect of NSAIDs?
- Anti-inflammatory, anti-pyretic, analgesic
- NSAIDs are used as an analesic primarily for what type of problem?
- musculoskeltal - arthritis and hip dysplasia
- Advantages of NSAIDs over corticosteroids?
- no steroidal side effects such as PU/PD/PP, no CNS suppression in order to provide analgesia, fewer serious side effects than those associated w/ steroids
- Possible side effects of NSAIDS?
- GI bleeding and ulceration (most common), blood abnormalities, clotting problems, decreased renal blood perfusion, possible hepatotoxicity
- Contraindications of NSAIDs
- kidney or liver dz, hypotension, dehydration, thrombocytopenia or clotting dzs, GI ulcerative dzs, corticosteroid use
- flunixin meglumine
- Banamine (R)
- Banamine (R)
- flunixin meglumine
- phenylbutazone
- Butazolidin (R)
- Butazolidin (R)
- phenylbutazone
- acetylsalicylic acid
- asprin/ Ecotrin(R) - coated
- asprin
- acetylsalicyclic acid/ Ecotrin
- dimethyl sulfoxide
- DMSO (R)
- DMSO(R)
- dimethyl sulfoxide
- carprofen
- Rimadyl (R)
- Rimadyl(R)
- carprofen
- naproxen
- Naprosyn(R), Equiproxen(R)
- Naprosyn(R), Equiproxen(R)
- naproxen
- etodolac
- EtoGesic(R)
- EtoGesic
- etodolac
- examples of some meds used to manage pain for osteoarthritis in dogs but are neither steroids or NSAIDs
- Cosequin(R), PetFlex(R), Adequan(R), Arquel(R, Hyalovet(R), Seletoc(R)
- Example of a muscle relaxant?
- methocarbamol/Robaxin-V(R)
- What is methocarbamol/Robaxin-V(R)
- muscle relaxant
- What NSAID is used for acute pain management (post operative soft tissue)?
- flunixin meglumine/Banamine(R)
- For what med is one-time dosing recommended due to the potential for gastric ulcers and nephro toxicity?
- flunixin meglumine/ Banamine(R)
- What is also known as "bute"?
- phenaylbutazone/Butazolidin(R)
- What is used mostly as an anti-inflam in large animals - not recommended for small animals
- phenylbutazone/Butazolidin(R) - bute
- To what NSAID are cats **very** sensitive, should only be used by Rx from DVM, and if used, is used in VERY low doses for an extended period of time?
- acetylsalicyclic acid/asprin/Ecotrin(R)
- What med has many brand names, should be used in a buffered form, and provides cheap and effective tx of pain and inflammation?
- acetylsalicyclic acid/asprin/Ecotrin(R)
- What med will penetrate intact skin?
- dimethyl sulfoxide/DMSO(R)
- What med has a triple A effect but is used primarily as a universal solvent/carrier for other meds?
- dimethyl sulfoxide/DMSO(R)
- What med is only labeled for topical use?
- dimethyl sulfoxide/DMSO(R)
- What med will cause a garlic taste if touched?
- dimethyl sulfoxide/DMSO(R)
- What med is used for pain associated with degenerative joint dz or postoperative pain resulting from soft tissue or orthopedic pain?
- carprofen/Rimadyl(R)
- What med is approved for oral use in dogs only in the US but is used in dogs and cats in Europe?
- carprofen/Rimadyl
- What med has an adverse effect rate of less than 1%, but if toxic effects occur in both liver and kidneys, the results could be fatal?
- carprofen/Rimadyl(R)
- What med stays in dog plasma 5x as long as in humans, thus accurate dosing is difficult and it is not recommended for use in dogs?
- naproxen/Naprosyn(R)/Equiproxsen(R)
- What med is labeled for use in horses and humans?
- naproxen/Naprosyn(R), Equiproxen(R)
- Besides carprofen/Rimadyl(R), what other med is labeled for use in dogs for osteoarthritis?
- etodolac/EtoGesic(R)
- What meds are given IM or inter-articular, labeled for horses and dogs, reduces degenerative changes induced by non-infectious or traumatic joint dzs and promotes activity of the synovial membrane?
- Adequan(R) or Hyalovet(R)
- What med is approved for dogs, cats, and horses is used primarily to tx back problems but also used to tx disk problems, sprains, muscle spasms, etc? What kind of med is it?
- methocarbamol/Robaxin-V(R), it is a muscle relaxant
- What two NSAIDs have the potential for serious side effects and are not used in vet med?
- acetominophen and ibuprofen
- One _______ could be fatal to a cat
- Tylenol/acetominophen
- Symptoms of Tylenol/acetominphen poisoning
- facial edema, cyanosis, depression, anorexia
- Fever is a change in body temp from ________ causes, v. hypothermia which is from _________ causes
- fever-internal, hypothermia - external
- What are pyrogens? Examples?
- Chemical agents that cause fever - bacteria, viruses, drugs, fungi, immune complexes, leukocyte proteins, and damaged tissue
- What might happen if fever becomes excessive (over 107)?
- damge to liver, kidneys or CNS, cardiovascular collapse and shock
- 3 anti-pyretic drugs?
- buffered asprin/acetylcyclic acid, phenylbutazone/Butazolidin(R), flunixin meglumine/Banamine(R)
- 2 supplemental tx of fever?
- fluids, steroids (severe cases)
- With use of what med should you keep small animals well hydrated?
- flunixin meglumine/Banamine(R)