Small Animal Clinical Pharmacology - CYF MEDICAL DISTRIBUTION

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MOTILITY-MODIFYING DRUGS DOGS •
CHAPTER 19 GASTROINTESTINAL DRUGS Formulations and dose rates Sulfasalazine is available as tablets or liquid. Various dosage regimens have been successfully used. DOGS • Some clinicians recommend a dose of 10–15 mg/kg PO q.8– 12 h for 2 weeks, then tapered to the lowest effective dose • Other reports suggest that higher doses are required, e.g. 20– 50 mg/kg (up to a maximum of 1 g) PO q.8 h; from 2–4 weeks, attempts can be made to taper the dose gradually (e.g. by reducing 25–50% of the dose every 2–4 weeks) to the lowest effective dose • Therefore, it is usually recommended to start at a low dose (e.g. 12.5 mg/kg PO q.8 h) and increase this after 4 weeks if it has been ineffective • Olsalazine is used in dogs that cannot tolerate sulfasalazine. The recommended dose is 10–20 mg/kg PO q.8 h CATS • 10–20 mg/kg PO q.24 h. The reduced dosing interval is used in light of increased sensitivity to salicylates in this species Pharmacokinetics After oral administration approximately 20–30% of the drug is absorbed in the small intestine. Some of this absorbed drug is believed to be excreted unchanged into the bile. Unabsorbed and biliary excreted drug is cleaved in the colon by bacterial flora. Because the colonic microflora is required to cleave the drug, sulfasalazine is not effective against small bowel inflammation. The sulfapyridine component is rapidly absorbed but only a small percentage of the 5-ASA is absorbed; both are metabolized in the liver and excreted in the urine. Olsalazine is poorly absorbed and that which is absorbed is rapidly eliminated. Approximately 98% of an oral dose is thought to reach the colon. Adverse effects ● The major adverse effect, although uncommon, is keratoconjunctivitis sicca. Should decreased tear production be recorded, this can be resolved by reducing the dose or discontinuing the drug altogether. ● Other occasional adverse effects include vomiting, allergic dermatitis, cholestatic jaundice, hemolytic anemia and leukopenia. ● Drug hypersensitivity manifested as lethargy, pyrexia, arthralgia and cutaneous drug eruption can occur with sulfonamide drugs and has been reported with the use of sulfasalazine. Known drug interactions ● Sulfasalazine may displace other highly proteinbound drugs such as methotrexate, warfarin, phenylbutazone, thiazide diuretics, salicylates and phenytoin. The clinical significance of these interactions has not been established. ● Sulfasalazine may decrease the bioavailability of folic acid or digoxin. Antacids may decrease the oral bioavailability of sulfasalzine if administered concurrently. ● Antacids may decrease the oral bioavailability of sulfasalazine if administered concurrently. ● As with other sulfonamides, sulfasalazine may affect blood thyroid concentrations, e.g. decreased total and free T4, increased cTSH. ● Olsalazine may causes increases in plasma concentrations of ALT and AST. APPETITE STIMULANTS The main appetite stimulants used in companion animals are the H 1 -receptor antagonists cyproheptadine and diazepam. In both drugs, the appetite stimulation is effectively a ‘side effect’ of the indication for which they were predominantly designed. Cyproheptadine also has serotonin antagonist and calcium channel-blocking properties. It is indicated for short-term use as an appetite stimulant in cats; profound anorexia or chronic nutritional disorders are better managed with more intensive nutritional support, i.e. tube feeding. The drug is well absorbed, almost completely metabolized in the liver and metabolites are excreted in the urine. The main side effects are sedation and anticholinergic effects (dry mucous membranes, mydriasis); occasional reports of hemolytic anemia have been described. Diazepam is used mainly for its anticonvulsant, anxiolytic and skeletal muscle relaxant properties. However, when used IV, it can be an effective appetite stimulant in cats. Again, only short-term (and preferably single) use is recommended. The IV preparation should be injected slowly, since rapid administration may cause marked excitation. Thrombophlebitis has also been reported. The drug should be used with caution in patients with pre-existing or suspected renal or hepatic insufficiency. The main side effects include muscle fasciculations, weakness, ataxia, behavior changes and excessive sedation. Fulminant hepatic necrosis has also been described in cats after oral administration (usually for >5 d). Given that the IV preparation is used for appetite stimulation, the significance of this finding is unclear. Nevertheless, cautious use is recommended. CATS Cyproheptadine • 1–4 mg per cat PO q.12–24 h 490
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An imprint of Elsevier Limited © E
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CONTRIBUTORS Matthias J Kleinz Depa
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Dedication To Tom, Rosalind and Jim
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CHAPTER 1 PRINCIPLES OF CLINICAL PH
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CHAPTER 2 CLINICAL PHARMACOKINETICS
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CHAPTER 3 ADVERSE DRUG REACTIONS Un
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CHAPTER 3 ADVERSE DRUG REACTIONS
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CHAPTER 4 THE PHARMACOLOGY OF THE A
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CHAPTER 5 ANESTHETIC AGENTS However
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CHAPTER 5 ANESTHETIC AGENTS The gre
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CHAPTER 5 ANESTHETIC AGENTS Table 5
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CHAPTER 5 ANESTHETIC AGENTS doses.
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CHAPTER 5 ANESTHETIC AGENTS concent
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CHAPTER 5 ANESTHETIC AGENTS X R 3 C
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CHAPTER 5 ANESTHETIC AGENTS Emergen
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CHAPTER 5 ANESTHETIC AGENTS inhalat
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CHAPTER 5 ANESTHETIC AGENTS and enh
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CHAPTER 5 ANESTHETIC AGENTS ● Exc
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CHAPTER 5 ANESTHETIC AGENTS Pharmac
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CHAPTER 5 ANESTHETIC AGENTS Central
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CHAPTER 5 ANESTHETIC AGENTS Table 5
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CHAPTER 5 ANESTHETIC AGENTS FURTHER
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CHAPTER 6 SEDATIVES ● noradrenali
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CHAPTER 6 SEDATIVES treatment, with
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CHAPTER 6 SEDATIVES Benzodiazepines
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CHAPTER 6 SEDATIVES It is not misci
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CHAPTER 6 SEDATIVES respectively. H
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CHAPTER 6 SEDATIVES Table 6.1 Sugge
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7 Behavior-modifying drugs Kersti S
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CHAPTER 7 BEHAVIOR-MODIFYING DRUGS
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8 Antibacterial drugs Jill E Maddis
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CHAPTER 8 ANTIBACTERIAL DRUGS phary
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CHAPTER 8 ANTIBACTERIAL DRUGS dose
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CHAPTER 8 ANTIBACTERIAL DRUGS Table
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CHAPTER 8 ANTIBACTERIAL DRUGS Bacte
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CHAPTER 8 ANTIBACTERIAL DRUGS lacta
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CHAPTER 8 ANTIBACTERIAL DRUGS Antis
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CHAPTER 8 ANTIBACTERIAL DRUGS inter
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CHAPTER 8 ANTIBACTERIAL DRUGS Teico
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CHAPTER 8 ANTIBACTERIAL DRUGS Diffe
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CHAPTER 8 ANTIBACTERIAL DRUGS forms
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CHAPTER 8 ANTIBACTERIAL DRUGS ● I
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CHAPTER 8 ANTIBACTERIAL DRUGS ● R
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CHAPTER 8 ANTIBACTERIAL DRUGS RIFAM
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9 Systemic antifungal therapy Josep
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CHAPTER 9 SYSTEMIC ANTIFUNGAL THERA
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10 Antiparasitic drugs Stephen W Pa
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CHAPTER 10 ANTIPARASITIC DRUGS ●
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CHAPTER 10 ANTIPARASITIC DRUGS Tabl
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CHAPTER 10 ANTIPARASITIC DRUGS leva
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CHAPTER 10 ANTIPARASITIC DRUGS ●
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CHAPTER 10 ANTIPARASITIC DRUGS Adve
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CHAPTER 10 ANTIPARASITIC DRUGS Mech
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CHAPTER 10 ANTIPARASITIC DRUGS Form
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CHAPTER 10 ANTIPARASITIC DRUGS prod
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CHAPTER 10 ANTIPARASITIC DRUGS Adve
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CHAPTER 10 ANTIPARASITIC DRUGS 62.5
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CHAPTER 10 ANTIPARASITIC DRUGS The
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CHAPTER 10 ANTIPARASITIC DRUGS In a
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CHAPTER 10 ANTIPARASITIC DRUGS func
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CHAPTER 10 ANTIPARASITIC DRUGS Para
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CHAPTER 11 GLUCOCORTICOSTEROIDS AND
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12 Immunomodulatory therapy Michael
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CHAPTER 12 IMMUNOMODULATORY THERAPY
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CHAPTER 13 NONSTEROIDAL ANTI-INFLAM
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CHAPTER 14 OPIOID ANALGESICS inflam
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A Agonist opioid (morphine) B Parti
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CHAPTER 14 OPIOID ANALGESICS Small
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CHAPTER 14 OPIOID ANALGESICS Clinic
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CHAPTER 14 OPIOID ANALGESICS Contra
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CHAPTER 14 OPIOID ANALGESICS Advers
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CHAPTER 14 OPIOID ANALGESICS Advers
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15 Cancer chemotherapy Jane M Dobso
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CHAPTER 15 CANCER CHEMOTHERAPY to m
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CHAPTER 15 CANCER CHEMOTHERAPY curr
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CHAPTER 15 CANCER CHEMOTHERAPY Tabl
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CHAPTER 15 CANCER CHEMOTHERAPY Clin
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CHAPTER 15 CANCER CHEMOTHERAPY ●
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CHAPTER 15 CANCER CHEMOTHERAPY best
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CHAPTER 15 CANCER CHEMOTHERAPY Form
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CHAPTER 15 CANCER CHEMOTHERAPY D-MA
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CHAPTER 16 ANTICONVULSANT DRUGS sei
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CHAPTER 16 ANTICONVULSANT DRUGS bit
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CHAPTER 16 ANTICONVULSANT DRUGS Kno
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17 Drugs used in the management of
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CHAPTER 17 DRUGS USED IN THE MANAGE
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CHAPTER 23 DRUGS AND REPRODUCTION n
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CHAPTER 23 DRUGS AND REPRODUCTION E
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CHAPTER 23 DRUGS AND REPRODUCTION F
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24 Topical dermatological therapy R
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CHAPTER 24 TOPICAL DERMATOLOGICAL T
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CHAPTER 25 OCULAR CLINICAL PHARMACO
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Index A α-adrenergic receptors 70,
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INDEX Antiplatelet drugs 456-457 pi
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INDEX Ceftazidime 168 Ceftiofur 166
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INDEX Drug receptors 4-8 Drug-drug
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INDEX Hepatic excretion 33 Hepatic
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INDEX Metabolism dogs vs cats 47 an
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INDEX Pentazocine 319, 327 Pentobar
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INDEX Semicarbazone 230 Septic arth
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