Treatments Flashcards
(42 cards)
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
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
What drug should you use to treat hypertension due to hyperadrenocorticism first line?
Benazepril - ACE inhibitor
What drug should you use to treat hypertension in hyperadrenocorticism if the patient has become refractory?
Amlodipine
When can you surgically remove an adrenal tumour?
If it is not invading the caudal vena cava
When is a hypophysectomy indicated in pituitary dependent hyperadrenocorticism?
When the patient goes duller following treatment
Space occupying lesion
What should you do in a Scottish terrier before diagnosing Cushings?
Liver biopsy
- hepatopathy with abonormal dynamic cortisol
What haematological / biochemical abnormalities will you see in addisons?
Pre renal azotaemia Hyponatraemia Hyperkalaemia Acidosis Mild non-regenerative anaemia
What is atypical addisons?
Cortisol deficiency with normal mineralocorticoids
What ECG abnormalities might you see with Hyperkalaemia?
Atrial standstill / reduced P wave amplitude
Prolonged QRS
Tall spikey T waves
Bradycardia
When should you be concerned about Hyperkalaemia causing ECG abnormalities?
Over 7 mol/L
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
What maintenance therapy can you put a patient with addisons on?
Oral prednisolone - when stressed
DOCP - maintenance therapy
How often should you monitor a patient with addisons?
Monitor electrolytes at 2, 3 and 4 weeks
How should diabetes mellitus be managed?
Insulin injections
Diet changes
Set routine to ensure blood glucose is well controlled
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
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
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
What is an oral hypoglycaemic drug?
Gilpizide - sulfonylureas
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
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
What should the owner do if the animal is not eating?
Reduce dose by 50%
Where should the nadir be on a blood glucose curve?
4.5-9mM
How can you measure the duration of insulin on a glucose curve?
Time from injection, past nadir, back to 14mM
