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Moving Exam 2 > Steoid/nonsteroidal Pharm > Flashcards

Steoid/nonsteroidal Pharm Flashcards

(60 cards)

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1
Q

Anti-inflammatory effects glucocorticoids

A

Limits visible & microscopic signs of inflammation
Radiant, physical, chemical, infectious, hypersensitivity, immunmedited

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2
Q

What type of inflammation do NSAIDS not work against?

A

Hypersensitivity and immune mediated inflammation

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3
Q

GC mechanism of action

A

Transactivation of anti genes
- activate gene at locus by presence of particular gene at another locus
Transrepression of pro inflame genes
- one protein represses that activity of second protein

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4
Q

Action & effects of GC

A

Anti-inflammation
Immunosuppression
Adverse
Dose dependent effects

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5
Q

Physiologic doses - GC

A

Use low dose
- form of replacement therapy (dog w hypoadrenocorticism)
Prednisone & prednisolone (mineralocorticoid) + DOCP (desoxycorticosterone pivalate)
Fludrocortisone acetate

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6
Q

Dosing GC - anti inflame dose

A

Inhibit phospholipase A2
Decrease movement of WBC into inflamed tissue
Inhibit release of inflame mediators /enzymes
Stabilization of micro vascular integrity

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7
Q

Inhibit phospholipase A2

A
  • proximal mediator of arachidonic acid cascade
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8
Q

Decrease movement of WBC into inflamed tissue

A
  • reduce release of cytokines
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9
Q

Inhibit release of inflame mediators /enzymes

A
  • histamine, bradykinin
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10
Q

Stabilization of micro vascular integrity

A
  • for shock or CNS inflame
  • penetrate BBB (NSAIDS dont)
  • reduce edema
  • reduce cellular extravasation
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11
Q

Immunosuppressive doses of GC

A

Decrease macrophage function
Decrease lymphocyte function
T cell&raquo_space;> B cell

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12
Q

Chronic/cumulative dosing

A

Anti inflame or immunosuppressed dose
Chronic use can result in inhibition of Bcell antibody production

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13
Q

Dermatology & soft tissue effects

A
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14
Q

GIT adverse effects

A
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15
Q

Neuropsychiatric adverse effects

A
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16
Q

Eye adverse effects

A
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17
Q

Renal adverse effects

A
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18
Q

Bone adverse effects

A
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19
Q

Cardio adverse effects

A
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20
Q

Muscle adverse effects

A
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21
Q

Endocrine adverse effects

A
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22
Q

Minimizing adverse effects

A

Alternate date therapy
Taper dosing
Alternative routes of admin
Alternative therapeutic options
(Minimize not prevent)

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23
Q

Average blood work on GC - CBC

A

Neutrophilia
Lymphopenia
(Eosinopenia)
(Monocytosis)
(Basopenia)
“Stress leukogram”

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24
Q

Average chemistry work on GC

A

Hyperglycemia - glucosuria
Increased ALP/ALT - dogs esp
Hyperalbuminemia - cats esp
Dyslipidemias - cholesterol

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25
Dosing for dogs - prednisolone
Prenisolone Physiologic replacement - 0.2-0.3 mg/kg Anti inflame - 0.55-1.1 mg/kg Immunosuppressive - 2.2-4.4mg/kg
26
Dosing for cats - prednisolone
2.2-8.8mg/kg Fewer # of GC receptors Lower affinity of GC receptors
27
Action of prednisone
Intermediate action (12-36hr) 3.5x more potent than endogenous cortisol Mineralocorticoid action (less than endo) Oral in dogs - cheap Cats & horses - low bioavailability
28
Action of prednisolone
Intermediate action (12-36 hr) 4x more potent than endogenous cortisol Mineralocorticoid activity (< endo) Active metabolism of prednisone Oral in cats, dogs, horses & non rum species IV use - prednisolone sodium succinate - ER drugs, wide species spectrum
29
Action of dexamethasone
Long action >48 hr 30x more potent than endo No mineral activity
30
Dexamethasone injection
2mg/mL Polyethylene glycol base - caution repeated use in cats
31
Dexamethasone sodium phosphate
4mg/mL Equivalent to 3mg/mL dex - adjust dose
32
Dexamethasone PO tablet & powder
Fine just adjust dose
33
Triamcinolone base
Intermediate action 24-48 hrs 5x more potent No mineral activity Oral
34
Triamcinolone ester
Long action (weeks) 8x more potent No mineral activity IM/SC, intra-articular, intralesional
35
Methylprednisolone Na suc
Intermediate acting (12-36hr) 5x more potent No mineral activity IV/IM
36
Methylprednisolone acetate
Long acting (days to weeks) 2x more potent than prednisolone No mineral activity IM/SC, Intra articular intralesional
37
When to use GC
Immune mediated diseases Hypersensitivity Neurological disease / TBI (crosses BBB) Shock
38
When to use NSAIDS
Musculoskeletal disease (DJD) Infections Fever Peri-operative Wounds
39
Atypical NSAIDS
Acetaminophen (therapeutic not toxin) Dipyrone Grapirant
40
Acetaminophen - similarities to other NSAIDS
Anti-inflame properties - pain, fever, loss of function, fever, redness Same clinical indications as COX-2 inhibitors
41
Acetaminophen- differences from other NSAIDS
Minimal effects on COXI/COX2 in peripheral inflame Toxicity profile is different - liver, blood, not GI or kidney
42
Paracetamol
Same thing as acetaminophen
43
Mechanism of action for acetaminophen
Analgesics effects are centrally mediated (CNS) Reaches high concentrations in CNS Interacts w opioid receptors Increases serotonin in brain Inhibits substance P Inhibit COX 3 ? (Found in CNS of some species including dog)
44
clinical use for acetaminophen in horses
Pain/lameness - alone or combined w NSAIDS Fever
45
Clinical use for acetaminophen in dogs
Combined w codeine Tablet strength 300/60 Dose 10-15 mg/kg & 1-2 mg/kg
46
What species should you not use acetaminophen in ?
Cats - absolutely not They lack the liver enzyme to break down for proper function - hepatotoxic
47
Dipyrone
“Metamizole” IV use in horses Fever, PO ? Prohibited in food animals
48
Why is Dipyrone banned in food animals?
- causes blood of dyscrasias in humans Pulled from human market
49
Action of Dipyrone
Spasmolytic - inhibits release of intracell Ca - blocks muscle contraction (GIT) Rapidly metabolized - multiple active metabolites (4-MMA) - prodrug
50
Clinical uses for Dipyrone
Fever Colic (+butylscopolamine), anticholinergic/spasmolytic Analgesics & anti-pyretic in dogs Analgesics & anti inflame in cats
51
Grapiprant
First in class piprant Non-cox inhibiting prostaglandin receptor antagonist Specifically blocks EP4 receptor
52
Labeled use of grapiprant
Control of pain /inflammation associated w OA in dogs Safe up to 15x label dose for up to 9 months - dose dependent decreases in albumin Effective when compared to placebo
53
Adverse effects of grapiprant
Diarrhea, hemorrhagic MDR1 mutant
54
Grapiprant in cats
Orally absorbed - levels similar to therapeutic concentrations in dogs Safe after 28 days of admin
55
grapiprant in horses/alpacas
Not absorbed well - horses 30mg/kg = $6400/week Baby goats is fine
56
Efficacy of grapiprant
Some analgesics in dog spays Not as good as carprofen Minimal analgesics in cat spays
57
PSGAGs
Adequan - canine & equine Disease modifying osteoarthritis drug - IM 2x /week for 4 weeks Heparin analog
58
Cautions with PSGAGs
- avoid use in animals w bleeding disorders - avoid concurrent use w COX1 or non selective NSAIDS
59
DMSO
Free radical scavenging properties Used in horses to treat Endo tox, GIT, neurological disease, laminitis, rhabdomyolysis, HIE
60
Admin of DMSO
IV of 5-10% DMSO Lack efficacy data Cannot use in dairy operations

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