Lecture 21 Cardiovascular Toxicology-II Flashcards

1
Q
  1. What plant is pictured below?
  2. What does this plant do?
  3. Where can this be sourced from?
  4. Where is the toxin concentrated/located in the plant?
A
  1. Gossypol (Bi-naphthyl-aldehyde)
  2. Makes the cotton plant more insect-resistant
  3. cotton plants (Gossypium spp.); Cotton seed, cottonseed meal, cottonseed cake
  4. Toxin is concentrated in glands within the seeds
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2
Q

What plant is pictured below?

A

Gossypol (Bi-naphthyl-aldehyde)

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3
Q

Cottonseed is widely used in what industry?

A

Livestock Feed Industry

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4
Q

Cottonseed is high in what?
How much does it cost to use?
What is cottonseed deficient in?

A
  • High protein (26-40%)
  • High fiber (17-20%)
  • High fat (23%)
  • High energy content (91% total digestible
    nutrients [TDN])
  • Economical
  • BUT it is deficient in essential amino acids
    (lysine & tryptophan), vitamins (A & D)
    and minerals (calcium)
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5
Q

What species are susceptible to Gossypol (Bi-naphthyl-aldehyde)?

A
  • Monogastrics (but horses are relatively
    resistant)
  • Ruminants are resistant (young cattle are not)
    * Gossypol binds to soluble protein components in rumen liquor –> reduced toxicity
  • Sheep and poultry are of intermediate
    sensitivity
  • Maximum gossypol allowed in swine and
    poultry feed is 100 ppm –> Gossypol regulation in feed followed massive deaths of swine and poultry in 1900s
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6
Q

What is the ADME of Gossypol (Bi-naphthyl-aldehyde)?

◦ Gossypol occurs in _____ and _____ forms
◦ The _____ form is more bioavailable and toxic
◦ Exposure is always ____
◦ Gossypol accumulates in ? but not in ____

A

◦ Gossypol occurs in free and bound forms
◦ The free form is more bioavailable and toxic
◦ Exposure is always oral
◦ Gossypol accumulates in plasma, heart, liver,
muscle and testis but not in milk

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7
Q

What is the MOT of Gossypol (Bi-naphthyl-aldehyde)?

______ myocardial _______
- Destroys cardiac muscle and interferes with ________ by affecting ___ movement
 Has anti-________ effects in males (Damages ________ epith., decreased sperm _______) and females (Suppresses ______ and _________)
 Chelates _____ and causes lysis of RBCs –> ____
 Binds ______ _____ in GI tract making them
unavailable for absorption
 Inhibits ________ synthesis
 Induces nutritional deficiencies:?

A

Focal myocardial necrosis
- Destroys cardiac muscle and interferes with conduction by affecting K+ movement
 Has anti-fertility effects in males (Damages spermatogenic epith., sperm motility) and females (Suppresses estradiol and progesterone)
 Chelates iron and causes lysis of RBCs  anemia
 Binds amino acids in GI tract making them
unavailable for absorption
 Inhibits protein synthesis
 Induces nutritional deficiencies: vit. A & E, Ca, and amino acids

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8
Q

What are the clinical signs of Gossypol (Bi-naphthyl-aldehyde) toxicosis?

 May present as ________ death or ______ _______ breathing (‘_______’ in pig) unresponsive to _________ therapy
 Gradual heart ______ (edema, _____ vein
distension, congestion)
 Anorexia, weakness, rough hair-coat/poor-doer
and death
 Cattle may display decreased heat tolerance and hemoglobinuria
 Reproductive problems: decreased male & female fertility

A

 May present as sudden death or chronic labored breathing (‘thumping’ in pig) unresponsive to antibiotic therapy
 Gradual heart failure (edema, jugular vein
distension, congestion)
 Anorexia, weakness, rough hair-coat/poor-doer
and death
 Cattle may display decreased heat tolerance and hemoglobinuria
 Reproductive problems: decreased male & female fertility

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9
Q

Sudden death in Gossypol toxicosis is misdiagnosed in what species?

A

Mis-Dx in lambs: over-eating

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10
Q

Chronic labored breathing in Gossypol toxicosis is misdiagnosed as what?

A

Mis-Dx: pneumonia

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11
Q

How do you Dx Gossypol (Bi-naphthyl-aldehyde) toxicosis?

 History of extended feeding of _________ meal
or ___________ products
 Clinical signs, especially _____ death or chronic _____
 Lack of response to _________ therapy
 Postmortem lesions: signs of _________
are the most important
 Analytical detection of significant concentrations of ____ gossypol in feed
◦ Must be correlated with history, clinical signs, and PM findings

A

 History of extended feeding of cottonseed meal
or cottonseed products
 Clinical signs, especially sudden death or chronic
dyspnea
 Lack of response to antibiotic therapy
 Postmortem lesions: signs of cardiomyopathy
are the most important
 Analytical detection of significant
concentrations of free gossypol in feed
◦ Must be correlated with history, clinical signs, and PM findings

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12
Q

How do you Tx Gossypol (Bi-naphthyl-aldehyde) toxicosis?

A

 There is no effective Tx
 Remove source (withdraw cottonseed
products from diet)
 Activated charcoal and saline cathartics are
of little value
◦ Gossypol toxicosis entails chronic exposure and is cumulative in nature
 Treat heart failure and pulmonary edema
 Give nutritional supplements (vitamin A, Fe,
lysine and protein)

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13
Q

All toads produce _______, but venom potency
varies with ________ and __________ _________.

A

venom, species, geographic, locations

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14
Q

The most toxic toads in North America are?

A

◦ Rhinella marina formerly Bufo marinus (cane or
marine toad)
◦ Bufo alvarius (Colorado River toad)

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15
Q

Toxic toads are primarily found in ?

A

FL, TX, CO, AZ, HI

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16
Q

Which species are susceptible to toxic toads?

A

Dogs and sometimes cats and ferrets

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17
Q
A

Avoid “toad-licking” and “smoking toad”!
Sacrament for Church of the Toad of Light

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18
Q

What are the toxic principles of Toxic toad toxicosis?

A

Christine Sucks Balls In Bed

 Bufadienolides (bufagenins and bufotoxins)
◦ Structurally similar to cardiac glycosides
 Bufotenine
 Catecholamines (dopamine, epinephrine,
norepinephrine)
 Serotonin
 Indolealkylamines

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19
Q

Toxicity of toxic toads is variable, based on?

A

 Variable depending on size of toad and dog
◦ Severe toxicoses result when small dogs
encounter large toads (larger parotid glands
= more secretions = more toxins)
◦ 1mg secretion per kg bw results in clinical
signs of intoxication

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20
Q

Describe the ADME of toxic toad toxicosis.

A

 Exposure is usually in the summer and during
periods of high humidity
 Toxins are produced and stored in the parotid
glands which are along the neck and
parascapular region of the toad
 When mouthed/bitten by a dog/cat, toads
release toxins in a thick milky-white substance
via pores on the parotid glands
 The toxins are rapidly absorbed via the buccal
mucous membranes. They can be absorbed via
GI tract mucosa, broken skin and conjunctiva
 Elimination is via urine

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21
Q

What are the main exposure periods of toxic toads?

A

Main exposure periods
* Summer
* Late summer/fall
* Periods of high humidity

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22
Q

What is the MOT of toxic toad toxicosis?

 Bufadienolides are ________ ________-like
substances that inhibit ____/____/______
◦ Also affect voltage-gated ____, _____, and _____ channels → disruption of excitable cells
 Bufotoxins cause ___________
 Bufotenine has systemic ______ activity and
is a __________
 Indolealkylamines are ______________
 Catecholamines are ____________
 __________ and ___________ act
synergistically to produce greater cardio-
respiratory effects

A

 Bufadienolides are cardiac glycosides-like
substances that inhibit Na+,K+-ATPase
◦ Also affect voltage-gated Na+, K+, and Ca2+
channels → disruption of excitable cells
 Bufotoxins cause vasoconstriction
 Bufotenine has systemic pressor activity and
is a hallucinogen
 Indolealkylamines are hallucinogenic
 Catecholamines are arrhythmogenic
 Catecholamines and bufadienolides act
synergistically to produce greater cardio-
respiratory effects

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23
Q

What are the clinical signs of toxic toad toxicosis?

A

 Rapid onset, death can occur in 15 min
 Brick-red buccal cavity mucous membranes,
hypersalivation, vomiting, vocalization, pawing
at the mouth, and foaming at the mouth
 Anxiety, disorientation, ataxia, falling, blank
stare, mydriasis, nystagmus, hyperactivity,
hyperesthesia, opisthotonus, convulsions/
seizures, recumbency, coma
 Tachypnea, hyperthermia, acidosis (metabolic
and/or respiratory) and hyperkalemia
 Cardiac glycoside-like effects
◦ Arrhythmias (bradycardia, sinus tachycardia,
atrioventricular block, supraventricular and
ventricular tachycardia, ventricular fibrillation)
◦ Sudden death

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24
Q

How do you Dx toxic toad toxicosis?

A

History of witnessed exposure and clinical
signs

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25
Q

What is the DDx of toxic toad toxicosis?

A

 Toxicosis with acute onset of clinical signs
◦ Metaldehyde, methylxanthines, oleander,
foxglove, insoluble oxalate-containing plants,
pyrethrins/pyrethroids, anticholinesterase
insecticides
 Ingestion of acids and alkalis
 Heat stroke, trauma
 Antidepressants, sympathomimetics, -
blockers and -agonists

26
Q

How do you treat toxic toad toxicosis? - Decontamination

  1. _______ mouth with copious amounts of water
     Flush ________ to avoid ingestion of the water. Repeat 2-3 times, 5-10 min at a time
     Advise owners to perform this procedure at home _______ seeking veterinary care
     If severe signs are present, oral _____ is done by a veterinarian after ________, ______, and insertion of a ______ endotracheal tube
     ? are advised
A
  1. Flush mouth with copious amounts of water
     Flush rostrally to avoid ingestion of the water. Repeat 2-3 times, 5-10 min at a time
     Advise owners to perform this procedure at home
    before seeking veterinary care
     If severe signs are present, oral lavage is done by a veterinarian after stabilization, anesthesia, and insertion of a cuffed endotracheal tube
     Activated charcoal and a cathartic are advised
27
Q

How do you treat toxic toad toxicosis? - Symptomatic and supportive therapy

◦ Administer ___________ for tachycardia and
monitor ECG
◦ Use _______ doses for patients with pre-existing heart disease
◦ _________ may be used for unresponsive
tachyarrhythmia. ________ or _______ ________can also be used
◦ Give ________ only to patients with marked
bradycardia. _______ can be considered
◦ Atropine is contraindicated for ________: may worsen ________ & decrease _______ of toxins

A

◦ Administer propranolol for tachycardia and
monitor ECG
◦ Use lower doses for patients with pre-existing heart disease
◦ Lidocaine may be used for unresponsive
tachyarrhythmia. Phenytoin or procainamide
hydrochloride can also be used
◦ Give atropine only to patients with marked
bradycardia. Dopamine can be considered
◦ Atropine is contraindicated for hypersalivation: may worsen tachycardia & decrease dilution of toxins

28
Q

What drugs can be used to treat toxic toad toxicosis?
 Give __________ or a __________ for seizures, tremors and agitation
 Provide supplemental ________ for compromised respiration
 Treat hyperkalemia with ______, _______ and
_______ _________
 Correct metabolic acidosis with balanced
________ IV fluids or _______ ______ if blood pH <7.1
 Correct respiratory acidosis with _______ pressure ventilation
 Treat hyperthermia: IV fluids, tepid water
baths, alcohol placement on foot pads
 ________ (antidote) may be of value but has
not been clinically tested for toad toxicosis
 IV lipid emulsion may be beneficial in
reducing _______ of the more _______
constituents of the toad secretion, e.g., the
bufadienolides

A

What drugs can be used to treat toxic toad toxicosis?
 Give diazepam or a barbiturate for seizures,
tremors and agitation
 Provide supplemental oxygen for compromised
respiration
 Treat hyperkalemia with insulin, glucose and
sodium bicarbonate
 Correct metabolic acidosis with balanced
crystalloid IV fluids or sodium bicarbonate if
blood pH <7.1
 Correct respiratory acidosis with positive
pressure ventilation
 Treat hyperthermia: IV fluids, tepid water
baths, alcohol placement on foot pads
 Digibind (antidote) may be of value but has
not been clinically tested for toad toxicosis
 IV lipid emulsion maybe beneficial in
reducing toxicity of the more lipophilic
constituents of the toad secretion, e.g., the
bufadienolides

29
Q

List the sources of Ergot Alkaloids
(Ergot, ergotism, ergot poisoning)

A

 Sources: ergot alkaloids produced by the
fungus Claviceps purpurea that invades grasses (rye,
oats, barley, canary, brome, triticale, etc.). The
alkaloids include:
◦ Ergopeptine alkaloids, e.g., ergotamine,
ergovaline, ergosine, ergocristine, ergocornine
◦ Ergoline alkaloids, e.g., lysergic acid, ergonovine,
lysergol

30
Q

What species are susceptible to Ergot Alkaloids
(Ergot, ergotism, ergot poisoning)?

A

cattle, sheep, swine, horses

31
Q

List the Examples of Grasses Associated With Ergotism.

A
  1. Barley
  2. Rye
  3. Brome
  4. Triticale
32
Q

Identify the plants below.

A
33
Q

Toxins in Ergot Alkaloids are concentrated in what part of the plant?

A

Toxins are Contained in Sclerotia/Ergot Bodies

34
Q

Label the image below.

A
35
Q

What is the ADME of Ergot Alkaloid?

 _____ well-known
 Metabolism of ergot alkaloids is assumed to
take place in the ______
 Ergopeptine alkaloids are excreted via ____
and ergoline alkaloids via ____
 Residues have not been detected in _____ or
_____

A

 Not well-known
 Metabolism of ergot alkaloids is assumed to
take place in the liver
 Ergopeptine alkaloids are excreted via bile
and ergoline alkaloids via urine
 Residues have not been detected in meat or
milk

36
Q

What is the MOT of Ergot Alkalioid?

 Ergot alkaloids interact with biogenic amines
(3?):
◦ Inhibition of D1 dopamine vasodilatory receptors, agonism of ___-adrenergic and serotonin receptors: –> ________ –> ischemia and _______ formation
◦ Stimulation of D2 dopamine receptors in anterior pituitary –> decreased ________ secretion

A

 Ergot alkaloids interact with biogenic amines
(norepinephrine, serotonin and dopamine):
◦ Inhibition of D1 dopamine vasodilatory receptors, agonism of a1-adrenergic and serotonin receptors: –? vasoconstriction –> ischemia and gangrene formation
◦ Stimulation of D2 dopamine receptors in anterior pituitary –> decreased prolactin secretion

37
Q

What are the clinical signs of Ergot Alkaloid toxicosis?

Attributable to _________ and decreased _________
1. Gangrenous/cutaneous ergotism
◦ Lameness, swelling and sloughing of feet below the fetlocks. The ears and tail may also slough off
 Hyperthermia
2. Reproductive syndrome
◦ Agalactia, prolonged gestation, dystocia, abortions
3. Nervous syndrome (?): was thought to be more
common in carnivores, horses and sheep
◦ Possibly caused by tremorgenic mycotoxins

A

Attributable to vasoconstriction and decreased prolactin
 Gangrenous/cutaneous ergotism
◦ Lameness, swelling and sloughing of feet below the fetlocks. The ears and tail may also slough off
 Hyperthermia
 Reproductive syndrome
◦ Agalactia, prolonged gestation, dystocia, abortions
 Nervous syndrome (?): was thought to be more
common in carnivores, horses and sheep
◦ Possibly caused by tremorgenic mycotoxins

38
Q
A

Gangrenous ergotism

39
Q

How do you Dx Ergot Alkaloid toxicosis?

 Detection of ______ _______ _______ in plant tissues and feeds
 Determine ergot alkaloids concentrations in
____/____/________ feeds
 Analysis of animal ______ for ergot alkaloids
may be of value
 Clinical signs

A

 Detection of C. purpurea sclerotia in plant
tissues and feeds
 Determine ergot alkaloids concentrations in
forage/hay/processed feeds
 Analysis of animal tissues for ergot alkaloids
may be of value
 Clinical signs

40
Q

How do you treat Ergot Alkaloid toxicosis?

 ______ recognition is key to successful
treatment
 Remove animals from ______ of ergot
alkaloids
 Move animals to a ____, ______ environment
 Treat secondary _______ infections
 May institute treatment similar to that for
______ toxicosis (next) for severe poisoning

A

 Early recognition is key to successful
treatment
 Remove animals from sources of ergot
alkaloids
 Move animals to a dry, warm environment
 Treat 2o bacterial infections
 May institute treatment similar to that for
fescue toxicosis (next) for severe poisoning

41
Q

List the sources of Fescue.

A

Fescue Toxicosis
(Festuca arundinacea - Tall Fescue)
 Sources: Fescue, a major forage grass,
grown on ~35 million acres in the USA

42
Q
A

Tall fescue

43
Q
A

Fescue toxicosis
Fescue toxicosis costs US livestock industry $1 billion a year

44
Q

What are the toxic principles of Fescue toxicosis?

A

Toxic principles: ergot alkaloids
(Ergoline and ergopeptine) produced by the
endophytic fungus, Neotyphodium coenophialum

45
Q

_______ accounts for 90% of the alkaloid content

A

Ergovaline

46
Q
A

Fescue
Corkscrew growth pattern along cells

47
Q
A

Fescue
Neotyphodium coenophialum
Corkscrew growth pattern along cells

48
Q

Mutualism
Fungus generates toxins that make the fescue
resistant to drought, insects, nematodes, fungi
and herbivores; fescue provides comforting
internal environment and nutrients to fungus

A
49
Q

What is the MOT of Ergot Alkaloid toxicosis?
Interaction With Biogenic Amines

Interaction With Biogenic Amines
 D1 dopamine receptor ______ and ________ of alpha1-adrenergic and serotonergic receptors. Overall effects are:
1. ___________
 Impaired thermoregulation
 Impaired circulation to placenta, extremities,
and abdominal and pelvic fat
2. ________ contraction (a1-adrenergic effect)
3. _______ feed intake

A

 D1 dopamine receptor inhibition and
agonism of 1-adrenergic and serotonergic
receptors. Overall effects are:
◦ Vasoconstriction
 Impaired thermoregulation
 Impaired circulation to placenta, extremities,
and abdominal and pelvic fat
◦ Uterine contraction (1-adrenergic effect)
◦ Decreased feed intake

50
Q

What is the MOT of Ergot Alkaloid toxicosis?
Stimulation of D2-dopamine receptors

A

◦ Decreased prolactin secretion in pituitary –>
impaired lactogenesis –> agalactia
◦ Impaired steroidogenesis (low progesterone and
high estradiol) –> reproductive problems
◦ Decreased feed intake and inability to shed
winter hair coat
◦ Impaired metabolism of lipids and carbohydrates
◦ Dysregulation of thermoregulatory center –>
hypothermia or hyperthermia

51
Q

What are the clinical signs of Ergot Alkaloid toxicosis?

 3? are the most sensitive species (____>____>___)
 Four syndromes have been described: ?

A

 Horses, cattle and sheep are the most
sensitive species (horse>cattle>sheep)
 Four syndromes have been described:
◦ Fescue foot
◦ Summer slump
◦ Fat necrosis
◦ Reproductive and lactation problems

52
Q

What is fescue foot?

 Occurs in cattle in late ___ or ____ (_______ conditions)
 Characterized by progressive ________
 Initially: swelling and reddening of ______ _______, knuckling of pastern joints, arching of the
back and weight shifting among the limbs
 _______ necrosis above the hoof and in other
extremities (e.g., ears and tail)
 _____ limbs are more commonly affected

A

 Occurs in cattle in late fall or winter
(hypothermic conditions)
 Characterized by progressive lameness
 Initially: swelling and reddening of coronary
band, knuckling of pastern joints, arching of the
back and weight shifting among the limbs
 Ischemic necrosis above the hoof and in other
extremities (e.g., ears and tail)
 Hind limbs are more commonly affected

53
Q
A

Fescue foot, hoof loss

54
Q

What is summer slump?

 Typical complaint: Cattle ______
 Most _______ and _______ significant
syndrome in cattle & sheep characterized by:
◦ Reduced _____ intake, _____ and ____ production
◦ Reduced _________ and _______- rates
◦ Impaired __________ ability with heat
intolerance, hyperthermia and tachypnea
 Results in behavioral changes: cattle spend more time under _____ or at ______ holes/ponds
◦ ______ hair coat, lethargy, and diarrhea

A

 Typical complaint: Cattle “ain’t doing right”
(ADR)
 Most common and economically significant
syndrome in cattle & sheep characterized by:
◦ Reduced feed intake, growth and milk production
◦ Reduced conception and calving rates
◦ Impaired thermoregulatory ability with heat
intolerance, hyperthermia and tachypnea
 Results in behavioral changes: cattle spend more time
under shades or at watering holes/ponds
◦ Rough hair coat, lethargy, and diarrhea

55
Q
A
56
Q

What is fat necrosis (lipmatosis)?

 Observed in a variety of ruminants esp. ______ cattle following ______ exposure to the toxins
 Associated with the presence of ____ _____
fat in abdominal and pelvic cavities
◦ Fat masses are palpable trans-______ but are
normally seen at ________
 Result in _____ and _______ signs due to obstruction and/or constriction e.g.,
◦ Dystocia, bloat, nephrosis and uremia

A

 Observed in a variety of ruminants esp. mature
cattle following prolonged exposure to the
toxins
 Associated with the presence of hard necrotic
fat in abdominal and pelvic cavities
◦ Fat masses are palpable trans-rectally but are
normally seen at postmortem
 Result in digestive and genitourinary signs due to
obstruction and/or constriction e.g.,
◦ Dystocia, bloat, nephrosis and uremia

57
Q
A

Fat necrosis

58
Q

What is reproductive lactation syndrome?

 Occurs in ?
 The primary problems are ?
 Horses: ______ conception rate,
________ gestation with increased fetal ____, minimal signs of impeding ______, ___-bag presentation, dystocia, weak foals, edema of fetal membranes, and retained placenta

decreased Prolactin, decreased progesterone and decreased estradiol

minimal signs of impeding parturition: foal preceded by chorioallantois

red-bag presentation: foal preceded by chorioallantois

A

 Occurs in cattle, sheep and horses
 The primary problems are abortion,
stillbirth and agalactia
 Horses: decreased conception rate,
prolonged gestation with increased fetal
size, minimal signs of impeding parturition,
red-bag presentation, dystocia, weak foals,
edema of fetal membranes, and retained
placenta

decreased Prolactin, decreased progesterone and decreased estradiol

minimal signs of impeding parturition: foal preceded by chorioallantois

red-bag presentation: foal preceded by chorioallantois

59
Q
A
60
Q

How do you Dx reproductive lactation syndrome?

 Detection of ____ _________ in plant tissues
and seed
 Clinical signs
 Determine concentrations of _______ in
forage/hay
 Analysis of ergot alkaloids in animal _______

A

 Detection of N. coenophialum in plant tissues
and seed
 Clinical signs
 Determine concentrations of ergovaline in
forage/hay
 Analysis of ergot alkaloids in animal tissues

61
Q

How do you treat reproductive lactation syndrome?

 D___ receptor ______ (__________), a___-
adrenergic ________ (_______), and a__-_____ and ________ receptor blocker (______) have beneficial effects but:
◦ Not approved for food animals: side effects, drug residue concerns and require individual
administration

 For agalactia and prolonged gestation in mares:
________ (Equidone), ______, _____, ______ or ________ can be used
 These antagonize D2 receptor or deplete dopamine (reserpine)

A

 Early detection is key to successful Tx
◦ Rule out foot rot, frost bite and injuries
 Remove animals from infected fescue
◦ This may be impractical because of lack of
alternative forages and sources of hay
 D2 receptor antagonist (metoclopramide), 1-
adrenergic antagonist (prazosin), and 1-
adrenergic and serotonin receptor blocker
(phenoxybenzamine) have beneficial effects but:
◦ Not approved for food animals: side effects, drug residue concerns and require individual
administration
 For agalactia and prolonged gestation in mares:
domperidone (Equidone), perphenazine,
sulpiride, acepromazine or reserpine can be used
 These antagonize D2 receptor or deplete dopamine (reserpine)

62
Q

Ergotism vs. Fescue Toxicosis
 Different fungi
◦ C. purpurea vs. N. coenophialum
◦ Parasitism vs. mutualism
 Ergotism is most prevalent in late summer
when the seed heads of grasses mature
 Fescue toxicosis is most common in late fall
and winter

A