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ACVIM SAIM Specialty 2023 > Pharm/Tox/Genetics > Flashcards

Pharm/Tox/Genetics Flashcards

1
Q

Immunosuppressive P-gp inhibitors?

A

Cyclosporine, tacrolimus (in humans or rodents)

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2
Q

Antibiotic/antifungal P-gp pump inhibitors?

A

Ketoconazole shown in dogs, erythromycin itraconazole in humans/rodents

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3
Q

Sedatives/opioids shown to be P-gp inhibitors in dogs?

A

Acepromazine (JVIM 2016), butorphanol, loperamide

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4
Q

Anti-parasitic P-gp pump inhibitors shown in dogs?

A

Ivermectin, milbemycin, selamectin, moxidectin

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5
Q

Should transdermal gabapentin be used in cats?

A

No - JVIM 2018

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6
Q

When is best to time gabapentin in cats?

A

1.5-2 hours (2 hours was what recommended in JFMS paper)

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7
Q

Changes to blood glucose, insulin, cortisol, and glucagon following dexmedetomidine injection in cats?

A

Increase in BG, decrease in glucagon; no change in insulin or cortisol (JFMS 2020)

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8
Q

How many cats vomited following administration of transmucosal detomidine?

A

7/7 within 2 minutes (JFMS 2020)

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9
Q

Which probably has the least sedation protocol if given IM in cats?
Butorphanol - Dexmedetomidine
Buprenorphine - Dexmedetomidine
Alfaxalone - Dexmedetomidine

A

Buprenorphine - dexmedetomidine (JFMS 2018) - this combo was also associated with higher incidence of vomiting compared to torb-dex

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10
Q

Dosages for posoconazole in cats?

A

30 mg/kg PO once and then 15 mg q48h or 15 mg/kg once and 7.5 mg q24h (JVIM 2016)

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11
Q

What was bioavailability of brandname itraconazole capsule compared to solution in healthy dogs?

A

85% of solution; however overall concentration were similar between formulations in contrast to other species (JVIM 2017)

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12
Q

Absorption of capsule to liquid brand-name itraconazole in cats?

A

Liquid absorption was 3x the capsule (also another reminder that compounded itraconazole should not be used) - JAVMA 2018

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13
Q

The MIC of a bacteria is 0.1 ug/mL. Can ciprofloxacin administered at 25 mg/kg SID for this bacteria in dogs?

A

No - If the MIC is less than or equal to the susceptibility breakpoint the bacteria is considered susceptible to the antibiotic and JVIM 2017 found that ciprofloxacin levels went up to 0.06 ug/mL in dogs (and lower in large dogs) on this dose

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14
Q

Which major antibiotics are exclusively (mostly) hepatic in their method of elimination?

A

Clindamycin, chloramphenicol, macrolides, rifampin (these all happen to be lipophilic drugs as well) - JVECC 2019 antibiotic review

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15
Q

PO administration of Clavamox (62.5 mg PO q12h) to healthy cats reached MICs of what value?

A

8 ug/ml. This is significant because current breakpoints are reported at 0.25 ug/ml which would report bacteria as a resistant when they actually may be susceptible if a UTI. JVIM 2021

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16
Q

Which was more frequently reported in azotemic cats than nonazotemic cats given Clavamox?
- Presence of side effects
- Vomiting
- More than 1 side effect

A

1+ side effect (JFMS 2020)

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17
Q

FDA doxycycline was better than compounded doxycycline at all time points (day 0 and day 21). Of compounded chews, liquids, and whole tablets, which were most likely to have acceptable contents by day 21?

A

Tablet. NO chew or liquid met standards by day 21. JAVMA 2017

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18
Q

What is recommended dose, frequency, and duration of guar-gum coated ronidazole that should address Tritrich in most cats?

A

30 mg/kg PO SID x14d (JFMS 2017) - guar gum so it can delay absorption and get to colon

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19
Q

Commercial gamciclovir ocular gel was well tolerated in cats when given q8h. T/F?

A

true - JFMS 2021 - had efficacy in vitro against FHV1 but they did not test this in vivo in this study

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20
Q

IV mycophenolate resulted in stable concentrations with little variability in cats. T/F?

A

False - lots of variability -JVIM 2017

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21
Q

What dose of mycophenolate was welltolerated in cats?

A

10 mg/kg q12h (for 7d) - JVIM 2019

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22
Q

Does IV or SQ administration of cytarabine result in higher concentrations?

A

IV - hence why some recommend doing IV rather than SQ for MUO JVIM 2020

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23
Q

What % of dogs on grapiprant (2 mg/kg/d) had occasional vomiting?

A

17% (so like 1 in 5) - compare to 6% in placebo (JVIM 2016)

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24
Q

Which occurred when cats with CKD were administered low dose meloxicam for 6 mo?
- Worsened Cr
- Worsened SDMA
- Urine clusterin
- Proteinuria

A

Proteinuria (JFMS 2021)

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25
Q

One should ideally wait how long after applying topical lidocaine before tracheal intubation in cats?

A

45 seconds (JFMS 2021)

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26
Q

Post-anesthesia hyperthermia was associated with which of the following agents?
- 0.24 mg/kg SQ buprenorphine
- 0.1 mg/kg SQ morphine

A

high dose bupre (JFMS 2021)

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27
Q

Is compounded solution from sublingual buprenorphine absorbed in cats?

A

Yes - but not to same extent (less extent) than commercial JFMS 2018

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28
Q

Is there MDR1 -like mutation in cats?

A

ya - ABCB1 1930_1931del TC ; these cats developed neuro signs after topical administration of macrocyclic lactone (JAVMA 2021)

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29
Q

Why are NSAID intoxications ideal for TPE?

A

They are highly protein bound and have low Vd (JVIM 2019)

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30
Q

Most common reported toxicosis reported to animal poison control for dogs vs cats

A

Chocolate and lilies (JAVMA 2020)

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31
Q

Common clinicopathologic signs consistent with amanita toxicity?

A

febrile, elevated ALT, hypoglycemia, coagulopathy (JAVMA 2021) - marked hypoglycemia and coagulopathic dogs may have poorer prognosis

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32
Q

Severe AKI and marked cerebellar signs can be consistent with what toxicity in dogs?

A

Grape or raisin toxicosis; Eleven dogs (73%) had marked forebrain, cerebellar, or vestibular signs - NOT associated with hypertension or severity of AKI (JVIM 2020)

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33
Q

Difference in presentation in dogs that ingested black walnut wood vs dogs that ingested black walnuts or hulls?

A

Wood - neurologic or musculoskeletal; walnuts/hulls - vomiting (JAVMA 2016)

34
Q

% of cats that vomited with xylazine vs dexmed?

A

43 vs 58% - not sig differently (so basically around 50%) - JAVMA 2016

35
Q

most common signs associated with diphenhydramine toxicosis in dogs?

A

nervous (lethargy, hyperactivity, agitation, hyperthermia, ataxia, tremors, and fasciculations) or cardiovascular (tachycardia) systems [clinical signs worsened with dose] - JAVMA 2016

36
Q

A dog that presents comatose, seizuring, with lactic acidosis can be consistent with what toxicity from a human pharmaceutical? What should be given to improve survival?

A

Isoniazid = antimycobacterial for tuberculosis; give pyridoxine IV (Vitamin B6)
Dogs that had clinical signs had seizures, CNS signs, GI, CV, urogenital, or resp signs. JAVMA 2017

37
Q

Signs with which two body systems are reported with lead toxicity in dogs?

A

GI and neuro (JAVMA 2017)

38
Q

What % of dogs exposed to duloxetine showed clinical signs? If signs were present, what were top 2 most common?

A

15%; top 2 signs were lethargy (40%) and mydriasis (33%) JAVMA 2019

39
Q

The frequency of mirtazapine may need to be increased or decreased in cats with liver disease?

A

Decreased (JVIM 2018)

40
Q

What was an unusual side effect noted with transdermal mirtazapine in cats?

A

Excessive meowing (JFMS 2020)

41
Q

How does mirtazapine work?

A

Antagonizes presynaptic alpha-2 receptors, serotonin receptors (5HT2c, 5H2A, 5-HT3) and histamine (H1) (JFMS)

42
Q

Which of the following changed following chronic omeprazole administration in cats?
Serum Ca
Cobalamin
Bone density
Magnesium
None of the above

A

None of the above -only gastrin increased JVIM 2016

43
Q

Like in people, repeated famotidine administration in dogs may result in increasingly diminished efficacy over time. T/F?

A

True - JVIM 2017

44
Q

Which protocol had a more diminished effect on gastric pH in cats over time? Famotidine twice daily every day or twice daily every second day?

A

Twice daily every day. However the twice daily every second day did not actually meet pH goals so is also not recommended JVIM 2019

45
Q

Esomeprazole at 1 mg/kg BID had better efficacy of controlling pH than 0.5 mg/kg BID in beagles. T/F?

A

False - no significant differences between the two JVIM 2019 [but small sample size -six Beagles)

46
Q

Which of the following was false regarding antiseizure in adult healthy cats?
- 500 mg single dose keppra XR maintains appropriate trough levels in all cats tested
- TID transdermal keppra maintains appropriate trough levels in all cats tested
- Transdermal phenobarbital had good correlation with serum phenobarbital

A

Transdermal phenobarbital had poor correlations with serum phenobarbital JVIM 2018 and 2019, JFMS 2019

47
Q

prevalence of phenobarbitone-associated adverse effects in cats?

A

47% (sedation and ataxia most common) - JFMS 2021

48
Q

Which of the following transdermal compounded medications may be efficacious?
- Transdermal furosemide
- Transdermal ondansetron
- Transdermal theophylline

A

Transdermal theophylline can acquire concentrations in individual cats but overall once a day STILL not recommended. in the other two negligible absorption (furosemide) or not clinically relevant drug levels (ondansetron) - JFMS 2017 (ondansetron), 2019, 2019

49
Q

Main difference between SQ and IV administration of apomorphone in dogs?

A

Time to emesis (15 min in SQ and 2 min in IV) - both caused similar freq of vomiting - JAVMA 2021

50
Q

What is prevalence of COMMD1 mutation in Bedlington Terriers in Korea? What % of these were alive at 4 years?

A

6%; 50% dead by 4 years (JVIM 2016)

51
Q

A 6-bp Deletion Variant in a Novel Canine Glutathione-S-Transferase Gene (GSTT5) was found to be common in what populations of dogs?

A

Research beagles and Pembroke Welsh Corgis (JVIM 2017)

52
Q

Treatment for acute methemoglobinemia is

A

NAC (for acetaminophen) or Methylene blue

53
Q

Cause for methemoglobinemia?

A

Toxicity (ibuprofen, acetaminophen) but also can be genetic from cytochrome b5 reductase deficiency (JVIM case reports)

54
Q

Inappetence and proteinuria in a young or middle aged Bracchi Italiano dog can be concerning for what disease?

A

Hereditary nephropathy (JAVMA 2021) (samples showed glomerular amyloidosis)

55
Q

Chloramphenicol can prolong elimination half-lives of which two more commonly used drugs (hint one is seizure med and one is induction agent)

A

Phenobarbital, propofol

56
Q

Cats lack what transporter that causes fluoroquinolones to become phototoxic?

A

ABCG2

57
Q

Canine leukocyte adhesion deficiency in Irish Setters is a result of an autosomal recessive mutation in which gene?
- Beta-2 integrin
- GSTT5
- KIRREL2
- PKD1

A

Beta2-integrin

58
Q

Mutations in which genes contribute to the protein losing nephropathy noted in Soft Coated Wheated Terrier?
- ABCB1 and ABCG2
- CHRNE1 and COLQ
- COMMD1 and ATP7B
- KIRREL2 and NPHS1

A

KIRREL2 and NPHS1

59
Q

Gingival hyperplasia is a side effect noted in which two more commonly used drugs?

A

Cyclosporine, amlodipine

60
Q

Which of the following does not require acidic pH to be absorbed?
- Mycophenolate
- Ketoconazole
- Voriconazole
- Fluconazole

A

Fluconazole (also itraconazole SOLUTION)

61
Q

MOA of Galliprant?

A

Blocks EP4 receptor (which is activated by PGE2)

62
Q

What are electrolyte concerns after administration of activated charcoal/sorbitol?

A

Hypernatremia

63
Q

What are concerns in regards to rodenticide zinc phosphide ingestion?

A

It is a corrosive and administration of food will cause further HCl secretion and cause further production of toxic fumes. Emesis needs to be done in well-ventilated area.

64
Q

General treatment recommendations for cholecalciferol ingestion?

A

Emesis/decontamination
Activated charcoal due to enterohepatic recirculation (do x6h up to 24h)
Promote calciuresis (furosemide +/- steroid, calciuresis)
If hypercalcemic > oral therapy indicated tgh
+/- phosphate binder
+/- pamidronate
Monitor Ca, P, renal values frequently (every 2-4d!) for next 2-4w

65
Q

Why is a giving a “one time shot” of VitK to nonclinical anticoag rodenticide ingestion dog not recommended?

A

not actually helpful unless PT is truly prolonged; Can falsely normalize PT in 1-2d but bleeding will occur afterwards (if toxic dose ingested)

66
Q

Toxic dose of xylitol?

A

0.1 g/kg

67
Q

Is activated charcoal indicated for xylitol?

A

No - does not bind well.

68
Q

Stages of ethylene glycol toxicosis?

A

Stage 1: This occurs within 30 minutes to 12 hours, and looks similar to alcohol poisoning. Ataxia, hypersalivating, vomiting, seizuring, and polyuria/polydipsia are seen.
Stage 2: This occurs within 12-24 hours post-exposure, and clinical signs seem to “resolve” to the pet owner; signs of dehydration, tachycardia, and tachypnea can be seen.
Stage 3: In cats, this stage occurs 12-24 hours after EG exposure. In dogs, this stage occurs 36-72 hours postingestion. During this stage, severe AKI occurs secondary to calcium oxalate crystalluria. Severe anorexia,
lethargy, hypersalivation, uremic halitosis, coma, depression, vomiting, and seizures can be seen.

69
Q

Clinicopathologic changes of EG toxicity?

A

AKI, metabolic acidosis, CaOx crystalluria, elevated anion gap

70
Q

What are signs to watch for with propylene glycol toxicity?

A

Clinical signs of PG toxicosis include CNS depression, narcosis, tachypnea (secondary to metabolic acidosis), muscle twitching (cats), hypotension (cats), cardiovascular
collapse, polyuria/polydipsia (secondary to an osmotic diuretic effect), and hematological changes (e.g., hemolytic anemia, Heinz body anemia)

71
Q

Treatments for amlodipine intoxication in dogs?

A

Address hypotension and effects (metabolic acidosis, hyperlactemia), address tachycardia or bradycardia, high dose insulin (basically to help heart and increase calcium influx and cause mild hypokalemia to enhance cardiac inotropy)

72
Q

General signs of PPA intoxication?

A

Neurological, GI (vomiting, hypersalivation), cardiac (hypertension, arrhythmias), AKI and myopathy (from hypertension), erythema of abdomen and ear pinnae > monitor ECG, kidney values, bloodwork, BP
Acepromazine first-line for sedation

73
Q

Clinicopathologic findings of lily ingestion in cats and treatment course?

A

Clinical pathology usually reveals moderate to marked azotemia, phosphorus, and potassium. Serum glucose may reflect a moderate to marked decrease, while liver enzymes may be normal to moderately elevated. Urinalysis generally reveals numerous casts, proteinuria, glucosuria, and isosthenuria. On occasion birefringent crystals, most likely attributable to decreased excretion of oxalates, will also be observed.
Early decontamination and diuresis. Delays of 18h-24h can result in grave prognosis.

74
Q

Main clinical manifestation (including bloodwork changes) after cycad ingestion?

A

Vomiting, less frequently CNS depression, diarrhea (± blood), anorexia, and neurological signs including weakness, ataxia, proprioceptive deficits, coma or seizures.
Clinicopathologic signs are basically varying degrees of ALI (including coag time prolongation), alterations of WBC and thrombcytopenia also common (>25%)

75
Q

Clinical signs of castor bean toxicosis?

A

Severe HGE with possible delayed effects on CNS, adrenals, kidney, liver.
Other signs -hyperthermia, colic, nausea, vomiting, dehydration, leukopenia, hemolysis, hemoglobinuria, kidney failure, progressing to terminal seizures and death
(Treatment is decontamination and support)

76
Q

Japanese breed dogs may be at increased risk of showing clinical signs due to what intoxication due to low-sodium and high-potassium phenotype due to an active Na-K pump found in the mature red blood cell
membrane?

A

Oxidant-induced hemolysis (onion, garlic)

77
Q

What is recommended to be administered with onion (and related plant) toxicosis?

A

Ascorbic acid (antioxidants not shown to be helpful)

78
Q

A hematologic sign that can occur with Brown recluse spider bite outside of the wound itself?

A

Coombs negative hemolytic anemia with hemoglobinuria developing within 24h of bite and persisting for up to 1 week (severity of systemic not correlated to local sign or vice versa)

79
Q

Due to the excretion of bromide, patients on KBr should avoid ingestion of what element?

A

Salt (Br undergoes tubular reabsorption in competition with Cl-, so more Cl- the more likely Br is to be washed out)

80
Q

How do cats differ from dogs in tolerating phenobarbital?

A

Less severe side effects, no auto-induction of P450, still 47% will show some side effect

ACVIM SAIM Specialty 2023 (12 decks)

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