Drugs for treating reproductive disease

Question 1

Prostaglandins have what physiological effects?

Answer 1

Stimulate cervical dilation, increase myometrial activity.

Lysis of corpora lutea - progesterone concentrations then of course decline.

Question 2

Clinical indications for prostaglandin use: (2)

Answer 2

Use: pyometra, metritis (expulsion of uterine content)

Question 3

Prostaglandin F2-alpha/its synthetic analog
cloprostenol given what route with what frequency?

Answer 3

SC q12-24h 3-5 days,
in dogs intra vaginal misoprostol (prostaglandin E)

Effects within 30 min and persist 20-30 min.

Synthetic product has fewer side effects but may be less effective.

Question 4

Side effects of prostaglandins

Answer 4

are dose dependent, diminish with repetition: panting, nausea,
vomiting, diarrhea, salivation

Given before feeding to reduce
anorexia/nausea.

● Risk of uterine rupture (closed cervix
pyometra).
● Pyometra recurrence is common after
treatment.

Question 5

What is aglepristone?

Answer 5

A progesterone receptor blocker, trade name Alizin.

Question 6

Indiication for use of aglepristone (2)

Answer 6

Use: pyometra to open closed cervix, chemical abortion induction

(Success rate in dogs with pyometra 75%,
success has been reported in cats)

Question 7

Side effects of aglepristone

Answer 7

less severe than with prostaglandins: restlessness, loss of appetite,
diarrhea, abdominal cramps

Question 8

Pyometra can be treated pharmacologically with what combo?

Answer 8

Pyometra: prostaglandins + progesterone receptor blocker (aglepristone)

● Decreased side effects, improved results
● Prostaglandin is a more effective uterotonic agent.

Alternatively,
prostaglandins + dopamine agonist (cabergoline)

Question 9

What is cabergoline?

Effects?

Indicationn for use?

Answer 9

A Dopamine agonist drug, trade name Finilac / Galastop.

Rapid luteolysis - reduces plasma progesterone concentrations quickly.

Use: pyometra

Question 10

Dopamine agonists effect on lactation.

Answer 10

such as cabergoline (Galastop)

Reduces prolactin secretion and milk production (antiprolactin therapy).

Use: galactostasis and severe mastitis if weaning, pseudocyesis (pseudopregnancy)

Question 11

Pyometra treatment may include antibiotics in some cases. Describe the ABs.

Answer 11

● E coli - amoxicillin, amox/clav, cephalosporins, potentiated sulphonamides - potentially a combination.

● Combination of antimicrobials in life-threatening peritonitis, severe sepsis, septic shock.

Question 12

Metritis, mastitis may occur within a week or two of whelping.
Treatment? (2)

Answer 12

Cephalexin, amox/clav safe for neonates

Question 13

What drug causes teeth discoloration in juvenile animals?

Answer 13

tetracyclines

Question 14

What drug causes Impaired cartilage development in juvenile animals?

Answer 14

Fluoroquinolones

Question 15

What drug causes Autoimmune disorders and bone marrow suppression
in juvenile animals?

Answer 15

Sulfas (ABs)

Question 16

Chloramphenicol use in nursing bitches and/or neonates?

Answer 16

Safety to neonates has been questioned owing to its association with toxicity in human infants.

Question 17

Safe Analgesia for nursing bitches. (3)

Answer 17

Opioids
● Perioperatively in lactating dams
● Short term use is safe
● Avoid nursing neonates during peak drug levels and time nursing before the next dose

Tramadol
● Opiate-like agonist
● Efficacy for pain control controversial

NSAIDs
● Galactostasis, mastitis
● Neonates’ exposure in milk is a concern
● Use cautiously and short term

Question 18

Oxytocin physiological effect (3)

Answer 18

Increases strength and duration of uterine contractions.

Stimulates milk ejection (but not synthesis!).

Question 19

Indications for clinical use of oxytocin: (1)

Answer 19

Use: uterine causes of dystocia, only used if there is no evidence of obstruction.

Question 20

Oxytocin administration dose and frequency.

Answer 20

0.25-2 IU/dog IM/IV, dose may be repeated 2 or 3 times at 30 min intervals or after each successful birth

+/- 10% calcium gluconate slowly IV before/concurrent with any subsequent dose of oxytocin even if serum Ca is WRI

+ glucose if hypoglycemic

Question 21

Medicine appropriate for aiding slow labor. (3)

Answer 21

Oxytocin 0.25-2 IU/dog IM/IV, dose may be repeated 2 or 3 times at 30 min intervals or after each successful birth

+/- 10% calcium gluconate slowly IV before/concurrent with any subsequent dose of oxytocin even if serum Ca is WRI

+ glucose if hypoglycemic

If no fetus is delivered after three doses of oxytocin (+/- calcium, glucose), cesarean section is recommended.

If labor begins and a fetus is delivered, wait 30-45 min to determine if another dose is needed. Note that, Each additional dose of oxytocin may elicit a weaker response.

Question 22

Describe Oxytocin effect on milk ejection.

Answer 22

● Causes contractions in the myoepithelium surrounding alveolar ducts

● Lacks galactopoietic properties so it stimulates milk ejection but not synthesis.

Question 23

Metoclopramide is an

Answer 23

(primperan)

Antiemetic dopamine antagonist that promotes an increase in prolactin and milk production in whelping dams.

Indication: e.g. Agalactia
Side effects: CNS side effects: restlessness, agitation, ataxia

Question 24

What is Domperidone?

Answer 24

Domperidone Brand name: Motilium

Is a Peripheral dopamine receptor antagonist - increases prolactin and milk
production.

Indication: e.g. Agalactia

Side effect: diarrhea

Question 25

Why might you favor domperidone instead of metoclopramide for agalactiae?

Answer 25

Less permeable to the blood–brain barrier than metoclopramide and CNS effects are unlikely.

Question 26

Acepromazine is a

Answer 26

Phenothiazine agent that Blocks postsynaptic dopamine receptors in the central nervous system.

It decreases anxiety, increases prolactin release.

Repro. related indications: anxious dam with agalactia. Nervous dams.

If used with metoclopramide, it may increase its CNS effects, so don’t.

Question 27

Eclampsia treated with

Answer 27

10% calcium gluconate slowly IV, then CRI/SC until PO is possible. Wean or handfeed the puppies for at least 24 hours if not longer.
Nursing discontinued if hypocalcemia recurs.

Risk of Bradycardia/arrhythmias - stop administration and start slower.

Monitor body temperature (tremors can cause hyperthermia)
Glucose measurement

Calcium carbonate PO during the remaining period of lactation.

Question 28

Treatment?

Answer 28

IVFT stabilization,
opioids (e.g. methadone, fentanyl)
maropitant
ABs (amox+clav) if needed

optionally alizin/aglepristone

then surgery, OHE

Question 29

Treatment?

Answer 29

if infection: ABs. Must be safe for neonates!
e.g. amox.+clav., ampicillin

Opioids if needed
NSAIDs (there are some risks with nursing neonates)
paracetamol?
maropitant for appetite stimulation

cabergoline/Galastop if puppies old enough and can be weaned, otherwise - no.

Question 30

Treatment?

Answer 30

cabergoline/Galastop 5 mcg/kg PO q 24h for 5-7 days