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Lameness in Horses in Exam 4 > Pharmacologic Management of Lameness > Flashcards

Pharmacologic Management of Lameness Flashcards

(65 cards)

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1
Q

What are the non-steroidal anti-inflammatory drugs (NSAIDs)

A

phenylbutazone (bute)

flunixin meglumine (Banamine)

firocoxib (Equioxx/Previcox)

aspirin

naproxen

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1
Q

What are the different kinds of medications?

A

NSAIDs

corticosteroids

hyaluronan

PSGAGs

pentosan

nutraceuticals

topical anti-inflammatories

muscle relaxers

laminitis medications

bisphosphonates

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2
Q

What is the mechanism of actions of NSAIDs?

A

Non-steroidal anti-inflammatory drugs

Inhibit cyclooxygenase (COX) pathway and production of prostaglandins (hormone-like effects)

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3
Q

What does the inhibition of COX-1 result in?

A

COX-1 results in goof (and bad) prostaglandins

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4
Q

What does the inhibition of COX-2 result in?

A

COX-2 results in bad (and good) prostaglandins

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5
Q

What NSAIDs block both COX-1 and COX-2 pathways?

A

Bute, Banamine, Aspirin, Naproxen

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6
Q

What are the COX-2 selective inhibitors?

A

Equioxx, Previcox

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7
Q

How is phenylbutazone used?

A

widely used in horses

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8
Q

What is the common dosage of phenylbutazone?

A

1 gram PO BID x 5 days

Then 1 gram PO SID x 5 days

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9
Q

What are the different formulations of bute?

A

Tablet powder, paste, injectable

Risk of perivascular necrosis with IV

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10
Q

What is the cost of bute?

A

$0.30 –> $18 per gram

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11
Q

What are the concerns of bute?

A

Renal toxicity, gastric ulcers

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12
Q

What is firocoxib?

A

COX-2 specific

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13
Q

What is the common dosage of firocoxib?

A

1 tube PO SID x 14 days

1 tablet PO SID x…

Needs loading period of 2-3 days

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14
Q

What are the different formulations of firocoxib?

A

Equioxx - paste, tablet, injectable

Previcox - tablet; off label

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15
Q

What are the different costs of firocoxib?

A

$11-14 per tube, $2-3 per tablet

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16
Q

What are the concerns of firocoxib?

A

loading periods, expense, off-label use, potency, blocks some good prostaglandins

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17
Q

What are corticosteroids?

A

Steroidal anti-inflammatories: Glucocorticoid

Different from mineralocorticoids and anabolic steroids

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18
Q

What are the issues with corticosteroids?

A

Mainstay of joint disease

Most potent and economical

Careful with use
- Once start, hard to stop
- Can speed up cartilage damage
- Do not use if suspect infection

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19
Q

What are the benefits of corticosteroids?

A

Pain relief

Decreased production of MMPs (matrix metalloproteinases), which degrade matrix

Decreased interleukin-1 (IL-1) and tumor necrosis factor (TNF-alpha), which decreases synthesis of matrix molecules and induce production of MMP

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20
Q

What are the disadvantages of corticosteroids?

A

Induce severe and irreversible chondrocyte necrosis

Decrease matrix production for 3-4 months

Affect other joints

Steroid-induced laminitis

Steroid arthropathy (accelerated joint destruction)

Provide pain relief –> increased joint use –> increased damage

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21
Q

What are the different types of corticosteroids and where are they best used?

A

Methylprednisolone (Depo-medrol, Predef)
- Low motion joints (distal hock, coffin, SI)
- Longest acting
- 20-400mg/joint, 120 mg total/horse

Triamcinolone (Vetalog)
- High motion joints (fetlock, carpus)
- Chondroprotective
- 5-10 mg/joint, 20mg total/horse

Betamethasone (Celestone)
- 20-40 mg/joint, 100 mg/horse

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22
Q

How should the intra articular use of corticosteriods be done?

A

Aseptic technique

Add HA and/or antibiotic
- Amikacin: Small volume, Cartilage friendly, Broad spectrum

Post-injection
- Bandage
- Rest with slow return to work: Time depends on joint

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23
Q

What is hyaluronan (HA)?

A

Type of glycosaminoglycan

Long unbranched polysaccharides

Others include chondroitin sulfate

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24
What are the different forms of hyaluronan?
Hyaluronic acid Sodium hyaluronate: Majority of products Hyaluronate
25
Where is hyaluronan present?
Present within articular cartilage - Synthesized by chondrocytes - Provides backbone for compressive stiffness Present within synovial fluid - Synthesized by synoviocytes (also in tendon sheaths and bursa) - Provides viscoelastic nature (viscous at low sheer rates, elastic at high sheer rates) - Boundary lubrication - lubricates synovial fluid/cartilage interface - Steric exclusion - physically excludes active inflammatory components and WBCs from joint cavity - Direct anti-inflammatory effects - prevents tendon adhesions
26
What are the uses of HA?
Documented decrease in concentration of HA w/ OA - Injected carries on role Treats synovitis - Slow progression of OA Aids in lubrication of joint capsule Local anti-inflammatory and analgesic
27
What is the important of HA safety?
Various products have excellent safety profiles 5% get joint flares - Also get with steroids - Difficult to distinguish from joint infections in 1st 24 hours - Mild swelling, lameness and elevated synovial WBCs - Self-limiting
28
What are the different routes of administration of HA?
Intra-articular - Single dose or every 6-8 weeks - Can be combined with corticosteroids - Unlike steroids, do not result in progressive cartilage and joint destruction - No rest required after administration Intravenous - Loading dose followed by monthly injections - Benefits all joints at lower potency
29
How do you choose HA for IA use?
Ability of HA to function dependent on molecular weight and concentration Price and molecular weight directly correlated Equine synovial fluid - Molecular weight of HA = 2-3 X 10^6 daltons - Concentration of HA = 0.33-1.5 mg/ml Can use lower MW HA for synovitis or mild OA Use higher MW HA for severe OA or to prevent adhesions
30
What are the different types of HA?
31
What is the brand name of polysulfated glycosaminoglycans (PSGAGs)
Adequan approved for IM and IA
32
What are PSGAGs?
chemically sulfated chondroitin sulfate
33
What do PSGAGs do?
stimulates chondrocyte metabolic activity inhibits effects of enzymes involved in cartilage breakdown stimulates HA synthesis by synovial membrane anti-inflammatory and analgesic
34
What is the history of PSGAGs?
Originally designed to be given IA Found that IA administration increased risk of joint infection and/or flare Went to IM injection, found therapeutic levels in multiple joints
35
What is the recommended dose for PSGAGs?
Recommend loading dose followed by monthly injections or 7 doses 4 days apart
36
What is the cost of PSGAGs?
Cost $55 per dose
37
What is pentosan polysulfate (PPS)?
Derived from xylan - Extracted from beechwood trees Popular in Australia and Europe - Now US too Used in humans - Prevent blood clots and fat build up in vessels Approved for treatment of OA in dogs
38
What is the mechanism of action of pentosan?
No analgesic or pain relieving effects Stimulates synthesis of proteoglycans and increases their inclusion in extracellular matrix of cartilage Stimulates synoviocytes to produce more HA Inhibits inflammatory mediators such as MMPs Increases blood flow to joint by preventing clogged vessels
39
What is the dose for pentosan?
6 mls (3mg/kg) IM or IV - Once a week for 4 weeks - Then once monthly Can also give 1 ml IA
40
What is polyacrylamide hydrogel (PAAG)?
Viscoelastic supplement - Non-degradable, synthetic - Used in human medicine IA use for osteoarthritis
41
What is the mechanism of action for polyacrylamide hydrogel (PAAG)?
Decrease joint capsule stiffness Viscosupplementation - Injecting lubricating fluid
42
What is the success rates of PAAG?
70% success rate return to soundness
43
What are nutraceuticals?
MANY different types on the market Not FDA approved, so no regulation "you get what you pay for"
44
What are the different types of nutraceuticals?
Cosequin ASU (Nutramax) - Does routine testing - Contains glucosamine, chondroitin sulfate, and MSM - Disadvantages - expensive EquiThrive (resveratrol)
45
What are the topical anti-inflammatories?
1% diclofenac (NSAID) DMSO (dimethyl sulfoxide)
46
What does 1% diclofenac (NSAID) do?
Joint pain and inflammation from arthritis Tendon or ligament injury 5 inch strip SID to BID for 10 days Can cause skin irritation Common brands - Surpass - Voltaren
47
What is DMSO used for?
Cellulitis, swelling, tendon or ligament injury, popped splint, septic arthritis or tenosynovitis Can also be given orally, IV or IA
48
What is the muscle relaxer and what is it used for?
Methocarbamol (Robaxin) - IV or oral - Back pain, muscle stiffness
49
What are the two laminitis medication vasodilators?
Isoxsuprine and acepromazine
50
What is isoxsuprine used for?
Oral Increases blood flow in most equine feet
51
What is acepromazine used for?
IV or IM Sedative Can cause paraphimosis
52
What are the anti-endotoxin laminitis medications?
Banamine - IV or oral Plasma - IV Polymyxin B - IV Pentoxifylline - Oral - Also RBC deformability
53
What are bisphosphonates used for?
Navicular syndrome Bone spavin (OA) Kissing spine
54
What is the mechanism of action for bisphosphonates?
Encourage osteoclasts to undergo cell death --> decrease in bone breakdown/resorption
55
What are the concerns of bisphosphonates?
Colic (shortly after administration) Renal toxicity (don't give with NSAIDs) Not tested in growing or pregnant/lactating horses Increased bone fragility over time
56
What is tildren also called?
Tiludronate disodium
57
What are the additional mechanisms of action of tildren?
Increases bone density in short term Inhibits secretion of enzymes that degrade articular cartilage
58
What is the technique of Tildren administration?
IV catheter - 45-90 minutes Complication - colic signs within 4 hours
59
What is the cost of Tildren treatments?
Cost $1200 per treatment Recommend 2 treatments
60
What is the real name of OSPHOS?
clodronate disodium
61
What is the technique of OSPHOS administration?
IM administration Spread 15 mls over 3 sites
62
What are the complications of OSPHOS?
Colic within 2 hours Sore injection sites for few days
63
What is the cost of OSPHOS treatments?
Cost $350 per treatment Repeat every 3 to 6 months
64
What is the concerns of OSPHOS usage?
Off-label use in racehorse

Lameness in Horses in Exam 4 (7 decks)

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