NSAIDS #2 Flashcards

1
Q

How are NSAIDs classified?

A
  1. Inhibitors of Prostanoids (PGs, TXA2)
  2. Miscellaneous Anti-Inflammatory Drugs
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2
Q

NSAIDs: Mechanisms of Action

A
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3
Q

NSAIDs: Adverse Effects

A

High doses
Long exposure
▪ Vomiting
▪ Diarrhea
**▪ GI ulceration, hemorrhage, and perforation
▪ Hepatotoxicity
▪ Renal toxicity
▪ Cardiovascular and blood toxicity
▪ CNS depression
▪ Circulatory disturbances
▪ Drug-drug interaction

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4
Q

NSAIDs that are used most commonly in humans can cause poisoning in small animals are?

A

Aspirin
Acetaminophen
Ibuprofen
Indomethacin
Naproxen

Pneumonic: IIAN

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5
Q
A
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6
Q

List the Desirable Features of NSAIDs
▪ Deactivate/desensitize _________ (_____)
▪ Attenuate ___________ response
▪ Synergistic with _______
▪ No ___________ or __________
▪ No ____________ depression
▪ Minimal ?
▪ ____ duration of action
▪ No ________ side effects

A

nociceptors, pain, inflammatory, opioids, addiction, dependence, respiratory, nausea/vomiting, Long, cognitive

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7
Q

COX-1 mediates ?

A

physiological responses (GI protection, platelet aggregation)

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8
Q

COX-2 is expressed by cells involved in ____________ (e.g.?) is responsible for
the synthesis of _____ and _____

A

inflammation, macrophages, monocytes, PGs, TXA2

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9
Q

Selective inhibition of COX-2 might have ?

A

better therapeutic responses

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10
Q

Selectivity of COX2 versus COX1 is often expressed as the?

A

COX1/COX2 inhibitory ratio

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11
Q

Write the inhibitory effect ratio.

If ratio is > _____, the drug is more specific for COX-2.

A

The inhibitory effect (IC50) = COX-1/COX-2;
COX-1/COX-2 >1, the drug is more specific for COX-2

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12
Q

COX-1 _______
COX-1 ______ ( _____ selective)
COX-2 _____
COX-2 _______
COX-2 ________ (______ selectivity)

A

selective, sparing, Non, specific, selective, preferential, limited

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13
Q

Potential benefits in inhibiting LOX pathway:

A

▪ Higher GI safety
▪ Greater analgesic efficacy

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14
Q

List the examples of Dual inhibitors:

A

Benoxaprofen
Ketoprofen
Licofelone
Corticosteroids (adverse effects)
Tepoxalin (Zubrin) is approved in Europe and USA
in animals (osteoarthritis in dogs)

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15
Q

List the NSAIDs that fall under the category of the following:

  1. Selective COX-1 inhibitor
  2. Non-selective COX inhibitors
  3. Selective COX-2 Inhibitors
  4. Dual Inhibitors - COX/LOX
A

See below

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16
Q

Selective COX-1 Inhibitors

A

Low-dose Aspirin

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17
Q

Non-selective COX Inhibitors

A

FAKIN

  • Naproxen (AleveR)
  • Ibuprofen (MotrinR, AdvilR)
  • Ketoprofen ((AnafenR)
  • Aspirin
  • Flunixin meglumine
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18
Q

Selective-COX-2 Inhibitors

A
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19
Q

Dual Inhibitors COX / LOX

A

Tepoxalin

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20
Q

Adverse effects of NSAIDs

A
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21
Q

NS –> Aspirin - Dogs

A

Aspirin is not USDA –registered for dogs, but some forms are marketed
for dogs as if there were FDA approval. There is an approved combination
with methylprednisolone (Cortaba tablets)

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22
Q

COX-2 Inh for dogs?

A

Pneumonic:

Christine Eats Many Penises

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23
Q

______________ is Registered for dogs but not actively marketed

A

Phenylbutazone

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24
Q

Carprofen (________) Available as an ____________ and ____ (COX-___ sparing in dogs)

A

Rimadyl, injectable, oral, 1

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25
Q

Meloxicam (_______) is Registered for cats also as a ___ dose, available as an _____ and __

A

Metacam, single, injectable, oral

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26
Q

The NS Ketoprofen (Anafen) is registered for ?

A

cats only

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27
Q

Deracoxib (_________) is (COX-__ ______, first veterinary drug in this group)

A

Deramaxx, 2, specific

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28
Q

_________ _______ (Arquel) is _______ but not marketed

A

Meclofenamic acid, registered

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29
Q

__________ ____ (Tolfedine) is registered in ______ only, available as an ______ and ___

A

Tolfenamic acid, Canada, injectable, oral

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30
Q

Aspirin is a NSAID used to reduce?

A

Pain
Fever
Inflammation
Platelet aggregation

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31
Q

Aspirin: (low doses) prevents?

A

heart attacks and strokes.

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32
Q

Salicylic acid from _____ ____ have been used for ____ relief since ancient times

A

willow, bark, pain

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33
Q

Modification of Salicylic acid to ______ ________ ______ (____) = Aspirin

A

Acetyl Salicylic Acid (ASA)

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34
Q

Use of aspirin for pain and prevention of myocardial infarction
▪ Understanding the molecular mechanism of aspirin

A
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35
Q

Aspirin MOA

A

Aspirin irreversible inhibits COX-1 resulting in
decreased PG synthesis
decrease TXA2 expression

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36
Q

Effects of Aspirin

A

Analgesic
Antipyretic
Anticoagulant: platelet aggregation reducer
Anti-inflammatory: PGs expression reducer

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37
Q

Asprin PK:
Absorption from the _____ and ___ intestine
Bound to _____ (70-90%)
_____ t1/2 in cats (~30 hrs); in dogs (~ 8 hrs); in horses (~ 5 hrs)
_____ are sensitive to aspirin toxicity _____ are sensitive to GI effects (bleeding)

A

stomach, upper, albumin, Long, Cats, Dogs

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38
Q

______ are sensitive to aspirin toxicity

A

Cats

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39
Q

_____ are sensitive to GI effects (bleeding)

A

Dogs

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40
Q

Adverse effects of Asprin:
▪ GI distress: ?
▪ Paradoxical-_______ (body T above ______ F (____ C)
▪ _____ventilation, respiratory _____ (_____ depression)
▪ Metabolic ______
▪ ___________
▪ Pulmonary ______ (______)
▪ If chronic use —– _________ during surgery
▪ In dogs with _____, long-term use may result in aggravation of joint disease
▪ Drug-drug interaction (_______)

A

vomiting, anorexia, GI ulceration, diarrhea
hyperpyrexia, 106.70, 41.50, Hyper, acidosis, CNS, acidosis, Dehydration, edema, sheep, bleeding, OA, Warfarin

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41
Q

Treatment of aspirin-toxicity:
▪ Induce ______ in the case of ____ toxicity
▪ Increase _____ of the drug: gastric lavage followed by administration of activated _____
▪ Increase _____ excretion of aspirin by administrating an ______ agent
▪ Initiate IV ___ therapy to address _____ and metabolic ______

A

emesis, acute, removal, charcoal, urinary, alkalinizing, fluid, dehydration, acidosis

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42
Q

Aspirin
Contraindications: Patients with _____ GI ______; _______ disorders, _____, or _____ insufficiency

A

active, bleeds, bleeding, asthma, renal

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43
Q

Flunixin meglumie AKA?

A

Banamine

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44
Q

Flunixin: A _____-_________ COX inhibitor with potent __________ and ______-___________ effects

A

non-selective, analgesic, anti-inflammatory

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45
Q

MOA of Flunixin meglumine
MOA: Shows greater COX-2 inhibitory effects than COX-1 in _________-.
In _________-, it appears to exhibit preferential COX-1 inhibitory effect

A

MOA: Shows greater COX-2 inhibitory effects than COX-1 in horses.
In dogs, it appears to exhibit preferential COX-1 inhibitory effect

46
Q

Uses of Flunixin meglumine
Uses:
▪ For the treatment of ____, ______, and _______ pain
▪ Exceptional property: it alleviates ________ pain related to colic
▪ In horses: effective in producing the _________ duration of ________ analgesia (~ ___ hrs)
▪ In cattle: for the control of _________ associated with respiratory disease, _________ and _______ (____ approved by FDA)

A

Uses:
▪ For the treatment of acute, visceral, and surgical pain
▪ Exceptional property: it alleviates visceral pain related to colic
▪ In horses: effective in producing the longest duration of postoperative analgesia (~ 13 hrs)
▪ In cattle: for the control of pyrexia associated with respiratory disease,
endotoxemia and mastitis (not approved by FDA)

47
Q

PK for Flunixin meglumine
PK:
▪ Administered via what routes:
▪ IV: a plasma t1/2 of 2-4 hrs (______); 3-6 hrs (____); 4hrs (____);1-1.5 hrs (____)
▪ IV: Duration of action is ___-____ hrs
▪ _____ excretion

A

IV, IM, horses, cattle, dogs, cats, 24-36, Renal

48
Q

Adverse Effects - Flunixin Meglumine
Adverse effects:
▪ _________ with IM administration
▪ Overdose in horses: ulcers on the ?, _____ depression, _______ (rare)
▪ In dogs: _____ failure and ___ damage

A

Adverse effects:
▪ Myonecrosis with IM
▪ Overdose in horses: ulcers on the tongue, gingiva, lips, and stomach
CNS depression, anorexia (rare)
▪ In dogs: renal failure and GI damage

49
Q

Ketoprofen: A ____-_______ COX inhibitor with ___-_________ and _______ effects

A

non-selective, anti-inflammatory, analgesic

50
Q

Ketoprofen MOA

A

MOA: Inhibition of COX-1 and COX-2 and LOX-pathway ( LTB4 synthesis)

51
Q

List the uses of Ketoprofen
Uses: In horses:
▪ Acute and chronic ___________ disorders

PK:
▪ Admin routes?
▪ Excellent bioavailability of ___-___%
▪ _____ elimination t1/2 of ~ 1 hr (horses); 1.5 hrs (dogs and cats)
▪ _____ excretion

A

Uses: In horses:
▪ Acute and chronic musculoskeletal disorders
PK:
▪ IV, IM, SC or PO
▪ Excellent bioavailability of 80-100%
▪ Short elimination t1/2 of ~ 1 hr (horses); 1.5 hrs (dogs and cats)
▪ Renal excretion

52
Q

Adverse effects of Ketoprofen?

Adverse effects:
▪ Safer profile compared to _____ or _________
▪ PO: GI injury including ______ and ______
▪ Caution in animals with ________ disorders (decreased platelet _______)
▪ Caution in animals with compromised _____ function

A

flunixin, phenylbutazone, ulceration, bleeding, hemostatic, aggregation, renal

53
Q

Phenylbutazone: The _____ and _____ profile in addition to its _____
makes it the most commonly used NSAID in the ____

A

safety, efficacy, affordability, horse

54
Q

Phenylbutazone MOA
Preferential COX-___ inhibitor in both ____ and ___

A

MOA: Preferential COX-2 inhibitor in both horses and dogs

55
Q

Phenylbutazone Uses

A

Uses:
▪ Osteoarthritis
▪ Various forms of lameness
▪ Rheumatism
▪ Other painful conditions of the limbs
▪ Nonspecific inflammation in other conditions

56
Q

Phenylbutazone PK
PK:
▪ After IV administration, t1/2 is ____-_____ hrs in the dog and horse
▪ Long duration of action (___-___ hrs)
▪ ______ metabolite (___________)
▪ High ______ binding
▪ Elimination via ____ excretion (25%)

A

PK:
▪ After IV administration, t1/2 is 2,5 – 6 hrs in the dog and horse
▪ Long duration of action (24 -72 hrs)
▪ Active metabolite (oxyphenylbutazone)
▪ High albumin binding
▪ Elimination via renal excretion (25%)

57
Q

Adverse effects of Phenylbutazone
▪ GI distress: ?
▪ Renal papillary _______
▪ ________ (hypovolemic shock, ulcer-mediated sepsis)

A

Adverse effects:
▪ GI distress: erosions, ulcers, anorexia, colic, diarrhea
▪ Renal papillary necrosis
▪ Death (hypovolemic shock, ulcer-mediated sepsis

58
Q

Contraindications of Phenylbutazone

A

Contraindications: Patients with serious cardiac, renal, hepatic injury, or hematologic disorder

59
Q

Carprofen: preferential COX-___ inhibitor with _____ and ____-_____ effects

A

2, analgesic, anti-inflammatory

60
Q

Carprofen MOA
Potency of carprofen for canine COX-___ is more than ______- fold greater relative to canine COX-___

A

MOA: Potency of carprofen for canine COX-2 is more than 100- fold greater relative to canine COX-1

61
Q

Carprofen Uses
1. _____-term and _____-term pain management
2. ______________ disorders

A

Uses: Short-term and long-term pain management
▪ Musculoskeletal disorders

62
Q

Carprofen PK
▪ Administrated via ?
▪ PO: the Tmax is short or long?
▪ Highly bound to _______ (99%)
▪ ______ metabolism
▪ Eliminated in the _____ and ______
▪ Elimination t1/2 in cats: ?
in dogs: ?

A

PK:
▪ PO, IV or SC
▪ PO: the Tmax is 1-3 hrs (dogs) SHORT
▪ Highly bound to albumin (99%)
▪ Liver metabolism
▪ Eliminated in the feces/urine
▪ Elimination t1/2 in cats: ~ 20 hrs LONG
in dogs: ~ 5-7 hrs MIDDLE GROUND?

63
Q

Carofen adverse effects
▪ Lower frequency of GI ______ and ______
▪ ___________, __________, __________
▪ Caution in patients with _____ or ____ dysfunction

A

Adverse effects:
▪ Lower frequency of GI ulceration and hemorrhage
▪ Diarrhea, anorexia, vomiting
▪ Caution in patients with hepatic or renal dysfunction

64
Q

Carprofen contraindications

A

Contraindications: Patients with hemostatic disorders; pregnant, lactating, or breeding bitches

65
Q

Meloxicam aka?

A

Metacam

66
Q

Meloxicam: A preferential COX-______ inhibitor with __________ and ____-________ effects

A

2, analgesic, anti-inflammatory

67
Q

Meloxicam MOA

A

MOA: COX2/COX1 selectivity ratio of ~ 10

68
Q

Meloxicam Uses
Uses: For treatment of chronic ____ and ________
▪ _______________
▪ ______-operative ______ pain

A

Uses: For treatment of chronic pain and inflammation
▪ Osteoarthritis
▪ Post-operative somatic pain

69
Q

Meloxicam PK
▪ PO: ______ absorption, Tmax ~ ___ hrs
▪ _______ bound to albumin (97%)
▪ The plasma t1/2 is ______-specific: 12-24 hrs (____); 15 hrs (____); 3 hr (_______)
▪ ______ metabolism
▪ Elimination in the ____

A

PK:
▪ PO: good absorption, Tmax ~ 8 hrs
▪ Highly bound tp labumin (97%)
▪ The plasma t1/2 is species-specific: 12-24 hrs (dogs); 15 hrs (cats); 3 hr (horses)
▪ Liver metabolism
▪ Elimination in the feces

70
Q

Meloxicam Adverse effects
___________ safe NSAID in dogs and cats
▪ ___ distress
▪ _________
▪ _______

^ all of the above are ____ and _____

A

Adverse effects:
Relatively safe NSAID in dogs and cats
▪ GI distress
▪ Anemia
▪ lethargy
Rare and transient

71
Q

Repeated use of Meloxicam in cats can evoke ______ ______ failure and _____

A

Caution: Repeated use in cats can evoke acute renal failure and death

72
Q

Meloxicam contraindications

A

Contraindications: Not recommended in pregnant, lactating or in young animals (< 4 months)

73
Q

Meloxicam is FDA-approved in ______.

A

cats

74
Q

Etodolac: A preferential COX-____ inhibitor with ______ and ____-________ effects

A

2, analgesic, anti-inflammatory

75
Q

Etodolac MOA

A

?

76
Q

Etodolac AKA

A

EtoGesic

77
Q

Etodolac Uses
▪ _____________ in dogs
▪ Other conditions

A

▪ Osteoarthritis in dogs
▪ Other conditions

78
Q

Etodolac PK
▪ PO: ______ absorption and a _____
onset of action (30-60 min)
▪ Is the half life long or short?
▪ ____ excretion

A

▪ PO: Rapid absorption and a rapid
onset of action (30-60 min)
▪ Long plasma t1/2 : 10-14 hrs
▪ Bile excretion

79
Q

Etodolac Adverse effects:
____ distress
______ depression
______totoxicity
_______toxicity
May induce ________________ _____ in dogs (monitor ____ production)

A

GI distress , CNS depression, hepatotoxicity, nephrotoxicity
May induce keratoconjunctivitis sicca in dogs (monitor tear production)

80
Q

Etodolac caution

A

Caution: In patients with hematological, renal, or hepatic impairment

81
Q

Tepoxalin: _____ inhibitor: _____-_______ COX inhibitor plus potent inhibitory effect on _____

A

Dual, non-selective, LOX

82
Q

Tepoxalin AKA

A

Zubrin

83
Q

Tepoxalin MOA
MOA: inhibition of COX-__, COX-___, and ___-LOX
reduction of the production of ____ mediators of pain, fever, and inflammation

A

MOA: inhibition of COX-1, COX-2, and 5-LOX
reduction of the production of PG mediators of pain, fever, and inflammatio

84
Q

Tepoxalin uses
▪ __________ in dogs
▪ _______ conditions in dogs
▪ ____- operative pain control

A

▪ Osteoarthritis in dogs
▪ Allergic conditions in dogs
▪ Postoperative pain control

85
Q

Tepoxalin PK
▪ Readily absorbed after _____
▪ _______ metabolized, one ____ metabolite, Both are highly bound to ______
▪ T1/2: __ hrs and __ hrs, respectively
▪ Elimination in the ______

A

▪ Readily absorbed after PO
▪ Rapidly metabolized, one active metabolite
▪ Both are highly bound to albumin
▪ T1/2: 2 hrs and 13 hrs, respectively
▪ Elimination in the feces

86
Q

Tepoxalin Adverse effects

A

▪ GI distress: vomiting, anorexia, diarrhea, ulceration
▪ CNS depression
▪ Hepatotoxicity
▪ Nephrotoxicity

87
Q

Deracoxib (DeramaxxR) Uses

A

▪ Osteoarthritis
▪ Post-operative pain and inflammation

88
Q

Deracoxib PK

▪ PO:
▪ _____ protein bound
▪ _____ excretion
▪ 20% may be excreted in the _____

A

▪ PO:
▪ Highly protein bound
▪ Bile excretion
▪ 20% may be excreted in the urine

89
Q

Deracoxib adverse effects

A

GI distress

90
Q

Firocoxib is also called ?

A

PrevicoxR, Equioxx

91
Q

Firocoxib uses?

A

Osteoarthritis

92
Q

Firocoxib PK
▪ The bioavailability: ~ 80% in _______
~ 40% in ___
▪ ______ protein bound
▪ _______ metabolism
▪ _____ excretion

A

▪ The bioavailability: ~ 80% in horses
~ 40% in dogs
▪ Highly protein bound
▪ Hepatic metabolism
▪ Fecal excretion

93
Q

Firocoxib adverse effects

A

▪ Diarrhea, mouth ulcers
▪ Excitation (rare)
^ horses

▪ Vacuolization in the brain
(high doses)
^ dogs

94
Q

Drugs that are rarely used in Veterinary Medicine

A

Non-selective COX Inhibitors:
Aspirin
Acetaminophen (TylenolR) ( particularly unsafe in cats)
(paracetamol)
Ibuprofen (Motrin, Advil)
Naproxen (Aleve) (used in horses to treat myositis, lameness)
Indomethacin

95
Q

Dimethyl sulfoxide (DMSO): a solvent for many _____, ____ and _____ compounds. It is clear, _____ to ____-yellow liquid, highly _______.

A

aromatic, organic, inorganic, colorless, straw, hygroscopic

96
Q

Dimethyl sulfoxide (DMSO) effects

A

▪ Anti-inflammatory: inhibits PG synthesis and traps free radicals
▪ Analgesic
▪ Skin penetrating
▪ Diuretic
▪ Anticholinesterase
▪ Weak antibacterial
▪ Weak antifungal

97
Q

Dimethyl sulfoxide (DMSO) PK
▪ Well absorbed after _______ application
▪ _________ & ______ distribution
▪ Primarily _____ excretion

A

▪ Well absorbed after topical application
▪ Extensive & rapid distribution
▪ Primarily renal excretion

98
Q

Dimethyl sulfoxide (DMSO) Uses
▪ _____ swelling (_________ trauma)
▪ Cerebral _____ & ______ (spinal cord trauma)
▪ _________ (urethral ________ in the cat)
▪ Superficial _____
▪ Skin _____
▪ Transient ______ conditions
▪ Edema of limbs resulting from _____
▪ _____ and _______ of mammary glands in the nursing bitch
▪ Severe __________ resulting from the extravascular injection of irritating drugs or lick granuloma

A

▪ Acute swelling (musculoskeletal trauma)
▪ Cerebral edema & paralysis (spinal cord trauma)
▪ Cystitis (urethral obstruction in the cat)
▪ Superficial burns
▪ Skin grafts
▪ Transient ischemic conditions
▪ Edema of limbs resulting from fractures
▪ Swelling and engorgement of mammary glands in the nursing bitch
▪ Severe inflammation resulting from the extravascular injection of irritating drugs or lick granuloma

99
Q

Dimethyl sulfoxide (DMSO) adverse effects
When used as labeled, it is _____
▪ Transient _____ effects
▪ High doses, long use —- ______
▪ IV: _______ and ________
▪ _____ and ____ damages, pulmonary ____
▪ CNS: _______, _________, ________

A

When used as labeled, it is safe
▪ Transient local effects
▪ High doses, long use —- myopia
▪ IV: hemolysis and hemoglobinuria
▪ Hepatic and renal damages, pulmonary edema
▪ CNS: sedation, coma, seizures

100
Q

OA is a degenerative joint disease that affects the dog’s spine and lower limbs leading
to stiffness and excruciating pain in the joint

A
101
Q

Synovial lining is a membrane surrounding each joint, SF
(synovial fluid) helps ensure smoot and easy body movement
Hyaluronic acid (HA) is a natural lubricant of the joints, part of
SF.

A
102
Q

Polysulfated glycosaminoglycan :

A

Disease-modifying osteoarthritis drugs (DMOADs)
(AdequanR) (PSGAG)

103
Q

PSGAG MOA
▪ PSGAG modulates clinical signs of ______ by indirectly promoting ______________ effect via different mechanism
▪ Improves joint articular function by having effects on _________ _____
▪ Anti-inflammatory: inhibition of _____ biosynthesis, ________ migration & ________ levels

A

▪ PSGAG modulates clinical signs of OA by indirectly promoting chondroprotective effect
via different mechanism
▪ Improves joint articular function by having effects on synovial fluid
▪ Anti-inflammatory: inhibition of PGE2 biosynthesis, leukocyte migration & interleukin levels

104
Q

PSGAG Uses

A

▪ To treat traumatic joint dysfunction (horses)
▪ To treat OA and prevent hip dysplasia (dogs)

105
Q

PSGAG PK

A

route: Intra-articularly (IA) or IM
▪ No information is available

106
Q

PSGAG Adverse Effects

A

When used as labeled, it is safe
Associated with drug administration, i.e. / septic arthritis
Polysulfated glycosaminoglycan (PSGAG)

107
Q

Hyaluronate sodium (HS)
MOA?

A cushioning effect: reducing cell ________
Lubricating effect on the _______ ___ tissue
A scavenging effect: removes ____-derived free radicals

A

A cushioning effect: reducing cell migration
Lubricating effect on the articular soft tissue
A scavenging effect: removes O2-derived free radicals

108
Q

Hyaluronate sodium Uses?
Uses: To treat _______ that is associated with OA in dogs and horses
PK: No information is available in _____
Adverse effects: Transient ____ effects: ?

A

Uses: To treat synovitis that is associated with OA in dogs and horses
PK: No information is available in animals
Adverse effects: Transient local effects: swelling, heat

109
Q

Hyaluronate sodium PK

A

PK: No information is available in animals

110
Q

Hyaluronate sodium Adverse effects

A

Adverse effects: Transient local effects: swelling, heat

111
Q

Guidelines for the safe use of NSAIDs
▪ Individualized dosage based on the drug’s ________, ____ of the animal, and _________ of action
▪ Screen patients for underlying ______ and _______ dysfunction by performing ________ diagnostic procedures
▪ Monitor the _________ status of patients. __________ animals should not be places on NSAIDs before the hydration status is improved
▪ An adequate ______ ______ period should be allowed prior administrating a new NSAID
▪ Administer the _______ possible effective dose for the ______ period to minimize risk of injury
▪ Concurrent use of __________ and _______ should be avoided due to increased risk of GI complications

A

Guidelines for the safe use of NSAIDs
▪ Individualized dosage based on the drug’s efficacy, age of the animal, and duration of action
▪ Screen patients for underlying renal and hepatic dysfunction by performing routine diagnostic
procedures
▪ Monitor the hydration status of patients. Hypovolemic animals should not be places on NSAIDs
before the hydration status is improved
▪ An adequate wash out period should be allowed prior administrating a new NSAID
▪ Administer the lowest possible effective dose for the shortest period to minimize risk of injury
▪ Concurrent use of glucocorticoids and NSAIDs should be avoided due to increased risk of
GI complications