NSAIDs

Question 1

What can be used to block histamine from binding to the H1 receptor?

Answer 1

Antihistamines

Question 2

What is used after the cell membrane is injured to keep from entering the arachidonic acid cascade?

Answer 2

Omega 3 FA

Question 3

What inhibits phospholipase?

Answer 3

Steroids

Question 4

What effects COX2 gene expression?

Answer 4

Steroids

Question 5

What can prevent cyclooxygenase from tuning arachidonic acid into prostaglandins, prostacyclin, and thromboxane?

Answer 5

NSAIDs

Question 6

What blocks the EP4 receptor?

Answer 6

Grapiprant

Question 7

What blocks interleukins?

Answer 7

CADI

Question 8

What blocks Janus kinase from casuing inflammation

Answer 8

Oclaitinib

Question 9

What blocks free radical release from cause inflammation?

Answer 9

DMSO

Question 10

What helps prevent proteases from causing inflammation?

Answer 10

GAGs

Question 11

Antihistamines are primarily used in what disease situations in dogs?

Answer 11

Only effective in managing allergies

Treatment or prevention of vaccine reactions

Question 12

Why should antihistamines be given cautiously, if at all, by the intravenous route?

Answer 12

IV administration can have an effect on the brain. A sudden bolus will cause a stimulatory effect and they get agitated and seizures have been reported
It can cause an excitatory reaction

Question 13

Offer a proposed mechanism of how omega3 fatty acids supplements decrease inflammation.

Answer 13

It is thought to alter the cell membrane phospholipid concentration leading to less arachidonic acid as a substrate for inflammation and/or production of anti-inflammatory cytokines

Question 14

Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, what is their proposed mechanism of action?

Answer 14

Supplies the building blocks for cartilage and inhibits proteases

Question 15

Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, how does the onset differ from more traditional treatments such as NSAIDs?

Answer 15

It has a very slow onset. It can take several weeks for it to show effect

Question 16

Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, what is their relative therapeutic index?

Answer 16

It is very safe

Question 17

Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, how much evidence supports the benefit or oral nutraceutical GAGS versus prescription injectable GAGs?

Answer 17

Adequan (injectable) has a better response rate than the nutraceutical/oral GAG

Question 18

Regarding glycosaminoglycans (GAGs) and their benefit in osteoarthritis, most oral GAGs include at least glucosamine and chondroitin sulfate. Which is likely the more effective?

Answer 18

Chondroitin sulfate

Question 19

What is the proposed mechanism of action of DMSO?

Answer 19

Rapidly penetrate the intact skin

Anti-inflammatory action due to ability to scavenge free radicals

Question 20

What are the most common conditions for approved topical use and extra‐label intravenous use of DMSO?

Answer 20

Approved as 90% gel and liquid for topical use in dogs and horses

• –Label indication is to reduce acute swelling due to trauma
• –Often used in managing accidental extravasation of cytotoxic IV drugs
• –Mild inhibition of platelets
• –Can carry small molecules transdermally

AMDUCA allows only for extra-label use of the approved veterinary product
—Used in a variety of conditions, but mainly CNS disease

Question 21

What is its relative therapeutic index of DMSO?

Answer 21

Has a really high therapeutic index

Question 22

What side‐effects can be seen with intravenous DMSO and what actions are taken to minimize the risk of these side‐effects?

Answer 22

Hemolysis and histamine release

DMSO is diluted to = 20% and given slowly to minimize

Question 23

What AMDUCA restrictions apply to the use of DMSO relative to allowable products for extra-label use?

Answer 23

AMDUCA allows only for extra-label use of the approved veterinary product, not chemical grade DMSO

Question 24

What nonsteroid‐responsive pruritic conditions often respond to oclacitinib? What warnings or contraindications does it have?

Answer 24

Food allergies and Sarcoptes
GI side effects occur only in 2.3% according to one study
Because oclacitinib is an immunomodulating drug, patients may be more susceptible ton infection, demodicosis, and neoplasia

Question 25

Contrast the mechanism of action of oclacitinib versus CADI.

Answer 25

Oclacitinib is a selective Janus kinase (JAK)-1 and JAK-3 inhibitor CADI is a canine monoclonal antibody against IL-31 which in turn decreases JAK-mediated itch

Question 26

Why may grapiprant have a larger therapeutic index than traditional NSAIDs?

Answer 26

It is working further down the arachidonic acid cascade and does not affect as much as NSAIDs It is only better than a NSAID in the side effect profile

Question 27

How can NSAID use adversely affect heart failure or hypertension and its treatment?

Answer 27

NSAIDs worsen congestive heart failure by increasing salt and water retention They blunt the anti-hypertensive effects of ACE inhibitors ad beta blockers due to the loss of vasodilatory prostaglandins

Question 28

Which NSAID commonly given as repeated doses in cats actually carries a label warning against this practice?

Answer 28

Meloxicam

Question 29

Which NSAIDs are approved in cats? | Which NSAIDs can be used chronically in cats?

Answer 29

Robenacoxid (for 3 days) Meloxicam injection Aspirin, piroxicam, robenacoxib, and meloxicam are all extra-label No NSAIDs are approved for chronic use. Though, oral meloxicam is used chronically against the label. Aspirin and Piroxicam can be used chronically

Question 30

Which NSAID is approved as a transmucosal oral spray?

Answer 30

Meloxicam

Question 31

Name a topical NSAID approved in horses

Answer 31

Surpass: 1% diclofenac sodium

Question 32

Which NSAIDs have shown activity in management of TCCs?

Answer 32

Piroxicam

Question 33

What role do endogenous prostaglandins play in maintaining renal blood flow as part of normal homeostasis versus when GFR decreases? Explain why this difference is important relative to NSAID use.

Answer 33

Normally vasodilatory prostaglandins in the kidney enhance GFR and inhibit chloride and sodium reabsorption that promote water loss NSAIDs can: ---Worsen congestive heart failure by increasing salt and water retention ---Blunt the anti-hypertensive effects of ACE inhibitors and beta blockers due to the loss of vasodilatory prostaglandins

Question 34

In most species aspirin is useful as an antipyretic, analgesic, and anticoagulant. How does the horse differ in the utility of aspirin and why? How does the cow differ?

Answer 34

Aspirin is not used as an anticoagulant in cows, though it is antipyretic and analgesic. Something else drive platelet function other than thromboxane Aspirin is only an anticoagulant in horses

Question 35

Under what conditions would acetaminophen be a good choice in a dog?

Answer 35

It is an effective antipyretic and analgesic for mild somatic pain It has little anti-inflammatory activity

Question 36

Which of the adverse reactions seen with NSAIDs are type B reactions?

Answer 36

Bone marrow suppression | Hepatotoxicity

Question 37

Why has phenylbutazone been banned by the FDA from use in adult dairy cattle?

Answer 37

Farmers were giving it for control of the lameness in cattle, but they weren’t following the withdrawal periods

Question 38

Which form of aspirin should not be used in the dog and why?

Answer 38

Don’t use enteric coated aspirin (Ecotrin) | Ecotrin sticks to the mucosa and erratically breaks off and goes through

Question 39

Name the five adverse events associated with use of NSAIDs. Indicate which two are type B adverse reactions.

Answer 39

GI ulceration Renal papillary necrosis Altered platelet function (except in cattle) Bone marrow suppression (type B adverse reaction) Hepatotoxicity (type B adverse reaction)

Question 40

When switching between NSAIDs what is a “washout” and why is it recommended? Which NSAID(s) would a washout be most warranted for?

Answer 40

In general, a day wash-out between NSAIDs is recommended and 10 days specifically for aspirin and adverse effects. The potential for adverse use, regular metabolic moniotoring, and regular metabolic monitoring should be performed

Question 41

What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of tetracyclines?

Answer 41

Inhibits collagenase and protein kinase C, inhibits granuloma formation Used in vet dentistry and ophthalmology

Question 42

What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of enrofloxacin?

Answer 42

Responsive histiocytic ulcerative colitis | Eradication of invasive intramucosal E. coli

Question 43

What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of macrolides?

Answer 43

Inhibits NF-κB activation in T cells, monocytes/macrophages Tylosin for refractory large bowel diarrhea Azithromycin for oral papillomatosis

Question 44

What is the non‐antibiotic benefit believed due to an ability to modulating inflammatory or immune responses of metronidazole?

Answer 44

Used for IBD 2 hypotheses for mechanism: ---Changing the intestinal microbiota prevents colonization by pathogenic bacteria ---Suppression of the microbiota might lead to down-regulation of aberrant host responses directed against microbial antigens that trigger and perpetuate chronic mucosal injury

Question 45

Which NSAID is approved as a transdermal formulation in cattle?

Answer 45

Flunixin (Finadyne Transdermal and Banamine Transdermal) | Approved as an antipyretic, not an analgesic