Animal Disease States

Transcription

1 Animal Disease States Keri Chandley, CPhT, MBA

2 Behavioral Problems Often human psychotropic drugs Require modification Opportunity for compounding Improved compliance Dose modification Types of behavior problems Anxiety Aggression Fear Obsessive-Compulsive Treatment Approach Eliminate medical or nutritional causes Improve environment through positive behavior Add medication

3 Behavioral Problems Medication Benzodiazepines Azaperones SSRIs Tricyclic Antidepressants MAOIs Phenothiazines Dosage Forms Capsules, Transdermal Gels Suspensions, Treats

4 Behavioral Problems Goal of therapy is not to eliminate the problem but rather to reduce the objectionable behavior to a level that is acceptable to the owner. Dr. Barbara S. Simpson, CVM, Certified Applied Animal Behaviorist

5 Behavioral Problems Dr Simpson s Treatment Plan Lowest and most effective dosing Look for improvements within 1 month Modify dose based on owner s observation Watch for adverse effects Administer therapeutically effective dose for 2 months after the owner is satisfied with the outcome May take several months to achieve Gradually wean pet off

6 Behavioral Problems Bird Feather Plucking Common problem Dietary, infection, allergy, environmental, or emotional Emotional: amitriptyline, hydroxyzine, haloperidol, clomipramine, and buspirone Fruity flavors Small volume

7 Canine and Feline Thyroid Disease Common endocrine disorder Hypothyroidism more common in dogs Hyperthyroidism more common in cats Treatment Often human drugs modified by compounding

8 Hyperthyroidism in Cats Often benign enlargement of thyroid gland No breed or sex preference Middle-age to older cats Symptoms Weight loss, polyphagia, vomiting, polydipsia, polyuria, hyperactivity Diagnoses High serum Total T 4 High serum Free T 4 High serum Total T 3 Treatment Thyroidectomy Radioablation with I-131 Medication

9 Hyperthyroidism in Cats Methimazole Blocks thyroid hormone synthesis, impedes use of iodine Standard Dose 5-15mg orally, divided doses daily for 2-3 weeks* Increase in 2.5-5mg increments Use lowest possible dose Adverse effects Vomiting, anorexia, lethargy, thrombocytopenia, hemolytic anemia, agranulocytosis *Dosing guide for demonstration purposes only. Please refer to your veterinary medicine resource and/or veterinarian for appropriate dosing. This reference may not be used as sole resource for treatment.

10 Hyperthyroidism in Cats Compounding opportunities Transdermal gels Watch absorption Delayed first two weeks (compared to oral) but no statistical difference in levels at 4 weeks Lower GI side effects Better compliance Easier administration Treats Suspensions

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12 Hyperadrenocorticism in Dogs Cushing s Disease Chronic overproduction of glucocorticoid from adrenal glands Symptoms Hair loss, thin or damaged skin, increased appetite, altered fat metabolism, potbellied appearance, water and electrolyte imbalance, excessive drinking and urination Rare in cats Common endocrine disorder in male and female dogs, some breeds increased risk Usually occurs in older dogs (greater than 8 years) Pituitary tumors cause pituitary-dependent hyperadrenocorticism (PDH) in 80% of canine Cushing s disease 20% of canine cases caused by adrenal gland tumors that over-secrete cortisol Testing ACTH Stimulation Test Low-Dose and High-Dose Dexamethasone Suppression Tests

13 Hyperadrenocorticism in Dogs Drug Treatment Trilostane (Vetoryl ) Most common Potential carcinogen FDA Handling Source Mitotane (Lysodren ) Cytotoxic Handling Ketoconazole L-deprenyl (selegiline, Anipryl )

14 Hyperadrenocorticism in Dogs Compounding Opportunity Human drugs may be used Watch Vetoryl - Only if dose or strength is not appropriate Improved palatability, flavoring Improved compliance Capsules, Suspensions, Treats

15 Epilepsy Effects 0.5%-2.3% of dogs Rare in cats Some breeds more affected More prevalent in males Types Primary Generalized Epilepsy: genetic origin likely, generalized seizures Idiopathic epilepsy: genetic origin possible, partial seizures at onset of disease followed by secondary generalized seizures

16 Epilepsy Anticonvulsant treatment Potassium Bromide (KBr) Often primary treatment in seizure disorders Very long half-life Loading dose necessary to see steady-state therapeutic levels within one month (generally load over 5 days) Weight-based dosing Get new weight with new dosing! Therapeutic levels 1-2mg/ml* Adverse reactions: Sedation, toxicity Caution with CNS sedating drugs AND diuretics If using sodium bromide, dosing adjustments necessary Solutions may be kept for up to ONE YEAR in clear or amber glass or plastic at room temperature. Plumb s* Caution Excess OR Low Sodium Diets *Dosing guide for demonstration purposes only. Please refer to your veterinary medicine resource and/or veterinarian for appropriate dosing. This reference may not be used as sole resource for treatment.

17 Epilepsy Anticonvulsant treatment Phenobarbital Initiate phenobarbital (PB) (2mg/kg PO Q12H)* If seizures continue, double the dose Measure trough serum concentration (pre-dose) after 10 days If <20ug/ml increase dose by 25%, repeat trough level in 2 weeks* Repeat until trough between 20 to 30 ug/ml* If seizure controlled Maintain dose PB levels every 6 months Liver enzymes/function every year *Dosing guide for demonstration purposes only. Please refer to your veterinary medicine resource and/or veterinarian for appropriate dosing. This reference may not be used as sole resource for treatment.

18 Epilepsy Other Anticonvulsant treatment Levetiracetam (Keppra ) Zonisamide (Zonegran ) *Dosing guide for demonstration purposes only. Please refer to your veterinary medicine resource and/or veterinarian for appropriate dosing. This reference may not be used as sole resource for treatment.

19 Giardiasis Enteric infection of dogs with the protozoan parasite Giardia canis by water-borne transmission of cysts Occasionally effects cats Symptoms include soft, frothy diarrhea with rancid odor Diagnostic test Fecal smear

20 Giardiasis Treatment (extra-label use) Albendazole (Albenza ) 25mg/kg PO Q12H for 2 days, possible second 5 day course* Can cause myelosuppression Fenbendazole (Panacur ) 50mg/kg PO Q24H for 3 days, possible second 5 day course* Metronidazole (Flagyl ) 25mg/kg PO Q12H for 5 days in dogs* 12 to 25mg/kg PO for 5 days in cats* 67% effective in dogs *Dosing guide for demonstration purposes only. Please refer to your veterinary medicine resource and/or veterinarian for appropriate dosing. This reference may not be used as sole resource for treatment.

21 Metronidazole Dose on Metronidazole BASE Available as HCl or Benzoate HCl has bitter, metallic taste Benzoate more palatable (still bitter, but better) Conversion to benzoate Multiply dose by 1.6 to get equivalent Benzoate dose HCl salt excreted 50% unchanged, benzoate must be conjugated with glucronide for elimination Cats are deficient Drug accumulation and toxic effects Ataxia, fasciculation, blindness, aggression, coma, respiratory distress, and death Extrapolation of study data suggest 500mg/kg/day of benzoate would be toxic to cats with normal hepatic and renal function* Standard dose of benzoate is 19 to 40 mg/kg Q12-24H* Short term therapy reasonable Caution with drugs with phenolic benzene ring structure (benzyl alcohol or benzocaine) No documented evidence of toxicity in cats from parabenzoic acid preserved diluents *Dosing guide for demonstration purposes only. Please refer to your veterinary medicine resource and/or veterinarian for appropriate dosing. This reference may not be used as sole resource for treatment.