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News from Aspen Meadow Veterinary Specialists
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happening at AMVS! Youmay notice in this andsubsequent issues, wehave changed format. AtAspen Meadow VeterinarySpecialists we have heardwhat you want, and want to give you the opportunity tocomment more! As you receive your Veterinary Voicethroughout the year, be sure to give us feedback so wecan publish future issues to meet your needs.
We have launched our monthly CE's for both Veterinariansand technicians. Our next CE is on March 12th. This CE isfor technicians and will be presented by AMVS HospitalDirector-Christine Kjeell on Basic EKG Interpretation. Setthe date in your calendars and call (303) 678-8844 toreserve your seat! AMVS is also pleased to announce the commencement ofmonthly Pet Loss Support Groups held at AMVS. Groupsare held on the 2nd Monday of each month at 6:30pm,and on the 4th Tuesday of each month, at 12:00pm(noon). These support groups are for both adults andchildren as they cope with grief associated with the loss ofa pet. Our licensed Marriage & Family Therapist, BarbWalker, is available for bereavement counseling and petloss support at your location and your convenience. Pleasecall us at (303) 678-8844 for more details.
News from Aspen Meadow Veterinary Specialists
We hope you enjoy the following article on NSAIDS.
Remember to use the Practice Points at the beginning ofthe article for your next case!As always, please contact us with any questions that youmay have, and enjoy Veterinary Voice! Please click the link below to FORWARD this email along toothers at your practice! Practice Points for YourNext Case-NSAIDS-Jason Cordeiro, DVM 1-Newer NSAIDS are no safer forkidneys than the older varieties.
2-Famotidine is the best choice for prevention of gastriculcers although Omeprazole, Sucralfate and Misoprostolare other options.
3-Tepoxalin (Zubrin) may be the safest NSAID regardingGI ulceration treatment 4-Meloxicam is the only NSAID approved for felines, therecommended dose is .1mg/kg SID for 3-5 days.
5-Washout periods are roughly 3-4 times the half-life.
27-45 hours for Carprofen, 36-48 hours for Aspirin. Whenin doubt, just wait longer! By now, we are familiar withthe ubiquitous COXoversimplification: COX 1 isconstitutive and good, COX 2 isinducible and bad. While COX 2is certainly the bad guy (accounting for, among otherthings, spinal-mediated hyperalgesia and even thelethargy and anorexia of chronic pain), COX 1 does have arole in inflammation as well.
In the kidneys, both COX 1 and COX 2 are constitutive.
COX 1 is important for the autoregulation of bloodflow News from Aspen Meadow Veterinary Specialists
from the renal cortex to the medulla. COX 2 plays animportant role in the control of urine flow. With respect tokidneys, NEWER DRUGS ARE NO SAFER THAN OLD ONES!Of course, never give NSAIDS with other nephroactivedrugs (ace inhibitors, Aminoglycosides, etc).
By the age of 3 months, puppy livers should be developedenough to handle NSAIDS. With respect to COX andhealing, once actual ulceration is present, COX 2 plays animportant role in ulcer repair and has also demonstratedto be important in healing of bony fractures as well as thehealing of superficial wounds by 2nd intention.
Delving into humans for a moment, we are finding out thatNSAIDs can decrease the risk of Alzheimer's (COX 2 isupregulated in central memory areas and involved inamyloid deposition) as well as cancer (COX 2 is involved inangiogenesis and resistance to apoptosis). Thus, takingyour baby aspirin once daily is not just for heart diseaseany more. However, keep in mind that every person whotakes an aspirin bleeds 5cc of blood! For the prevention of NSAID-associated GI ulceration, theantisecretory/H2 blocker famotidine is the best choice-it ismore potent and carries a smaller risk of drug interactionsthan ranitidine and cimetidine. With respect to treatingNSAID-dereived GI ulceration, a proton-pump inhibitorsuch as omeprazole in indicated, however, keep in mindthat thus drug is associated with broad inhibition of otherdrugs. Equally important is our old friend Sucralfate whichbinds to ulcers and stimulates local prostaglandinproduction. Lastly, exogenous prostaglandins likeMisoprostol are recommended but do stimulate moothmuscle and subsequently may be associated with transientdiarrhea.
Tepoxalin (Zubrin) is a dual inhibitor (COX & LIPOX) andmay be the safest NSAID available at present with respectto GI ulceration. A recent study (JAVMA 2006)demonstrated that no GI lesions (gross or microscopic)were present after 13 months at thirty times, and 24months at ten times maximum recommended dose. Thenext safest were carprofen (no lesions at six times thedose) and Meloxicam (microscopic lesions only at fivetimes the dose) versus markedly increased severity oflesions and associated deaths observed with Etodolac (atfive times the dose), Deracoxib (at three times the dosefor two weeks), and Firacoxib (at five times the dose forsix months). Firacoxib has a huge variability inbioavailability resulting in marked increase in risk fortoxicity.
Ketoprofen kills cats. Meloxicam is currently the onlyNSAID approved for feline use. Its is recommended that.1mg/mg dose SID is used from day one (no loading doseon first day). I know what you are thinking-you're thinking"Jason Cordeiro, what about washout times?" Well I amglad you asked! For any drug, the washout period isroughly 3-4 times the half life (the same period of time ittakes to reach a steady state). For Deracoxib, this equals News from Aspen Meadow Veterinary Specialists
three hours, for Carprofen 27-45 hours, for Meloxicam60-80 hours, for Aspirin 36-48 hours (but Aspirin doesirreversiblly inhibit platelet function therefore GI effectsshould be gone after 2 days (platelet interferance will takecloser to 2 weeks). It goes without saying that thesenumbers assume normal renal, hepatic and hemostaticfunction. The moral of the story; when in doubt, waitlonger to start a new NSAID!! Matt Rooney, DVM, MS, DACVSAspen Meadow Veterinary Specialists104 S. Main StreetLongmont, CO 80501303-678-8844 (p)303-678-8855 (f)[email protected] (e) This email was sent to [email protected] by [email protected].
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