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Flashcards in Treatments Deck (42):
1

How should you treat Hyperadrenocorticism?

Trilostane - mainstay of treatment
- switches off the enzyme that converts cholesterol to cortisol

Mitotane - kills off adrenal cells
Lignan phytoestrogens and melatonin - normal cortisol but abnormal androgens

2

How frequently should you monitor response to hyperadrenocorticism therapy?

After the first two weeks
3 monthly for the first year
6 monthly from then on

3

What drug should you use to treat hypertension due to hyperadrenocorticism first line?

Benazepril - ACE inhibitor

4

What drug should you use to treat hypertension in hyperadrenocorticism if the patient has become refractory?

Amlodipine

5

When can you surgically remove an adrenal tumour?

If it is not invading the caudal vena cava

6

When is a hypophysectomy indicated in pituitary dependent hyperadrenocorticism?

When the patient goes duller following treatment
Space occupying lesion

7

What should you do in a Scottish terrier before diagnosing Cushings?

Liver biopsy
- hepatopathy with abonormal dynamic cortisol

8

What haematological / biochemical abnormalities will you see in addisons?

Pre renal azotaemia
Hyponatraemia
Hyperkalaemia
Acidosis
Mild non-regenerative anaemia

9

What is atypical addisons?

Cortisol deficiency with normal mineralocorticoids

10

What ECG abnormalities might you see with Hyperkalaemia?

Atrial standstill / reduced P wave amplitude
Prolonged QRS
Tall spikey T waves
Bradycardia

11

When should you be concerned about Hyperkalaemia causing ECG abnormalities?

Over 7 mol/L

12

How can you treat and addisonian crisis?

0.9% NaCl - 80 ml/kg/h
Change to lactated ringers after 1 hour

Monitor CRT, BP, lactate and urine output

Treat Hyperkalaemia
- Dextrose saline and Insulin IV
- Calcium gluconate
- monitor glucose and K+

Supplement steroids
- Dexamethasone IV q 24h

Once eating
- oral prednisolone
- fludrocortisone

13

What maintenance therapy can you put a patient with addisons on?

Oral prednisolone - when stressed
DOCP - maintenance therapy

14

How often should you monitor a patient with addisons?

Monitor electrolytes at 2, 3 and 4 weeks

15

How should diabetes mellitus be managed?

Insulin injections
Diet changes
Set routine to ensure blood glucose is well controlled

16

What preparations of insulin are available?

Short acting insulin - regular crystalline insulin - for CRI
Intermediate acting insulin - caninsulin - licensed in dogs
Long acting - prozinc - licensed in cats

17

How should you manage diabetes in a dog?

Twice daily insulin injections, regularly spaced apart with food

(Usually controlled at about 0.8iu)h

High fibre, complex carbohydrate diet

18

How should you manage diabetes mellitus in cats?

Prozinc - long acting injections twice daily
Many cats will go into remission or be maintained on very low doses

Low carbohydrates, high protein

19

What is an oral hypoglycaemic drug?

Gilpizide - sulfonylureas

20

How can you monitor diabetic patients?

Thirst
Appetite
Weight gain

Urine glucose - afternoon sample
Blood glucose after 1 week of insulin
Fructosamine after 2 weeks

21

What should should you tell the client to watch out for and how can they treat hypoglycaemia?

Ataxia, collapse, seizure

Don't give insulin dose
Feed ASAP

22

What should the owner do if the animal is not eating?

Reduce dose by 50%

23

Where should the nadir be on a blood glucose curve?

4.5-9mM

24

How can you measure the duration of insulin on a glucose curve?

Time from injection, past nadir, back to 14mM

25

At what dose of insulin should you start suspecting insulin resistance?

Over 2iu/kg

26

What should you maintain the nadir at using insulin?

4-8mM

27

How can you tell if the duration of insulin is too short?

Nadir sufficient but not for long enough

28

When treating diabetic ketoacidosis what glucose level should you aim for?

8.4-16mmol/L

29

How can you manage diabetic ketoacidosis?

Crystalline insulin CRI 0.1iu/kg/h
Monitor blood glucose hourly
Once concentration is under 14mmol/L start IM q 4-6 h
Once blood glucose is less than 16mmol/L start 5% dextrose
Monitor K+ and PO4 throughout

30

What two fluid therapies should you give simultaneously in diabetic ketoacidosis?

Isotonic crystalloid + 20mM K+
- once blood glucose 10-15 add glucose

Crystalloid + 50iu/L soluable insulin

Monitor K+, glucose and acid base balance

Once ketones are gone and the dogs is eating swap on IM insulin

31

How can you treat hypothyroidism in dogs?

Levothyroxine (leventa)
Monitor T4 8 hours post pill

Metabolic signs resolve in first few weeks, dermatological signs take months

32

What medical management can you use for feline hyperthyroidism?

Thiamazole - inhibits the synthesis of thyroid hormone
- check total T4 after 2 weeks and then every 3 months

Carbimazole

33

What side effects can occur with anti-thyroid drugs?

Anorexia and vomiting
Pruritus and excoriation
Blood dyscrasias
Hepatopathy
Acquired myasthenia gravis

34

What must you monitor alongside thyroid levels in hyperthyroidism?

Creatinine and urea - mask unmasks renal disease
Heart - HCM common with hyperthyroidism

35

How can you control HCM in cats with hyperthyroidism?

Atenolol and Propanolol - to reduce the HR

36

What other treatment options are available for hyperthyroidism?

Surgical removal of the thyroid gland - risk of iatrogenic hypoparathyroidism

Radio iodine therapy

37

How should, you treat central diabetes insipidus?

Desmopressin

38

How can you treat acromegaly in the bitch?

Spay

39

How can you treat acromegaly in the cat?

Control diabetes mellitus
Hypophysectomy
Radiation of pituitary mass

40

How can you treat hypercalcaemia?

0.9% NaCl - 3-4x maintenance
Furosemide
Prednisolone
Calcitonin
Biphosphonates

41

What tumours cause hypercalcaemia of malignancy?

Anal sac adenocarcinoma
Lymphoma
Myeloproliferative diseases - multiple myeloma
Thymoma
Bone lysis - osteosarcoma, SCC

42

How can you treat hypocalcaemia?

IV fluids
SC calcium gluconate

Ongoing oral calcium or oral vitamin D