Flashcards in Treatments Deck (42):
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?
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?
- hepatopathy with abonormal dynamic cortisol
What haematological / biochemical abnormalities will you see in addisons?
Pre renal azotaemia
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
Tall spikey T waves
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
- Dextrose saline and Insulin IV
- Calcium gluconate
- monitor glucose and K+
- Dexamethasone IV q 24h
- oral prednisolone
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?
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?
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
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?
How can you measure the duration of insulin on a glucose curve?
Time from injection, past nadir, back to 14mM
At what dose of insulin should you start suspecting insulin resistance?
What should you maintain the nadir at using insulin?
How can you tell if the duration of insulin is too short?
Nadir sufficient but not for long enough
When treating diabetic ketoacidosis what glucose level should you aim for?
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
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
How can you treat hypothyroidism in dogs?
Monitor T4 8 hours post pill
Metabolic signs resolve in first few weeks, dermatological signs take months
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
What side effects can occur with anti-thyroid drugs?
Anorexia and vomiting
Pruritus and excoriation
Acquired myasthenia gravis
What must you monitor alongside thyroid levels in hyperthyroidism?
Creatinine and urea - mask unmasks renal disease
Heart - HCM common with hyperthyroidism
How can you control HCM in cats with hyperthyroidism?
Atenolol and Propanolol - to reduce the HR
What other treatment options are available for hyperthyroidism?
Surgical removal of the thyroid gland - risk of iatrogenic hypoparathyroidism
Radio iodine therapy
How should, you treat central diabetes insipidus?
How can you treat acromegaly in the bitch?
How can you treat acromegaly in the cat?
Control diabetes mellitus
Radiation of pituitary mass
How can you treat hypercalcaemia?
0.9% NaCl - 3-4x maintenance
What tumours cause hypercalcaemia of malignancy?
Anal sac adenocarcinoma
Myeloproliferative diseases - multiple myeloma
Bone lysis - osteosarcoma, SCC