Category Archives: Medications

Ear Meds- How To

How to Administer Ear Medication
By Dr. Karen Burgess

ears

404 Not Found

404 Not Found


nginx/1.12.2
Understanding the Ear

  • Always remember that the ear is a delicate structure. When inflamed or infected it may be very painful.ear pinna
  • The ear is really just a canal or tube lined by skin. If a pet has underlying skin disease it is common to also have ear issues and it is fairly uncommon for a pet to just “get an ear infection”. Instead it is often a sign of underlying skin disease or systemic allergies.
  • The anatomy of some breeds can affect the ear’s ability to stay healthy. Whether it is a too narrow passage or an ear with excessive secretions these are typically lifelong issues.
  • The ear canal is L-shaped with a vertical and horizontal portion. The vertical portion is visible to the naked eye, the horizontal portion is visible only via a veterinarian’s otoscope. The tympanic membrane (TM) lies at the end of the horizontal canal.  Often a pet owner may see a normal appearing vertical canal while the otoscope may reveal a completely occluded horizontal canal.  To address ear disease both the vertical and horizontal portion of the ear must be treated while protecting the TM.  The TM or eardrum can be damaged by disease, medications, or objects placed into the ear (i.e. Qtips).  While the eardrum can heal, damage can also potentially affect hearing longterm.

Medicating 101

  • If you feel you are not able to safely treat your pet’s ears, do not proceed. Ear cleaning can be scary and painful which could potentially make a normally docile animal become aggressive.
  • Before starting, gather supplies: ear medication, towels, treats, old clothing.
  • Location, location, location-find an area where your pet can be confined. An elevated surface or corner of a room often works well. Having an extra pair of hands is often helpful.  For smaller animals a towel can be used to “burrito” wrap and better control the process.

Process

  • Find an appropriate area to work in. Flooring with good grip or the ability to have your pet sit with their bottom against a corner or wall may be helpful.
  • Hold the ear flap up vertically with your non-dominant had allowing visualization of the ear canal.

ear 1

  • Holding medication in dominant hand, place the opening of the ear medication (often a spigot or long slender dropper) over the opening into the ear canal and gently squeeze instilling ointment or liquid into canal.

ear 2

  • Hold the ear flap (also called the pinna) closed like a resealable bag. Massage the base of the ear briefly as long as not too uncomfortable for pet.
  • Allow pet to shake head, medication may come out but some will stay in. Wipe inner ear flap if necessary to clean off any residual debris.
  • Give treats and verbal praise throughout process.

 

 

 

 

Photo Credit: <a href=”https://www.flickr.com/photos/41394394@N02/5909425915/”>gomagoti</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-sa/2.0/”>cc</a>

Photo Credit: <a href=”https://www.flickr.com/photos/12771303@N00/6057980/”>Daveybot</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by/2.0/”>cc</a>

Acepromazine (Promace).

Acepromazine
Promace
(Tranquilizer)
By Dr. Karen Burgess

ace, acepromazine, doggie downers, tranquilizer

 

Brand name and formulations

  • Promace and generic
  • Tablets, Injectable

What is acepromazine used for?
Acepromazine is used as a tranquilizer for dogs and cats.  The effects can be variable causing excessive sedation in some and no sedation in others. Another concern is that acepromazine has minimal effect on anxiety.  This would be similar to being afraid of snakes and then being put in a room with snakes just sleepy.  Acepromazine can also assist with motion sickness by decreasing nausea.

How is acepromazine given and what if a dose is missed?
Acepromazine is typically prescribed to be used as needed.  The effects of acepromazine can last anywhere from six to twelve hours.  A very conservative initial dose is typically prescribed with instructions to repeat dosing.

What side effects are associated with acepromazine?
Acepromazine may cause excessive sedation, abnormal gait (walking as if drunk, unstable on feet), and decreased blood pressure.  Elevation of the third eyelid is a common and normal occurrence with the use of acepromazine.

What patients should not take acepromazine?
Pets with liver disease, geriatric patients, and debilitated animals should use acepromazine cautiously.  Pets with MDR1 mutations (more common in herding breeds) may have prolonged effect from acepromazine.  Giant breeds, greyhounds, sight hounds, and Boxers also may be more sensitive.  Aggressive patients may become uninhibited while taking acepromazine leading to spontaneous aggression despite the appearance of being sedate.  Pets with a history of seizures should not use acepromazine.

What drugs should not be given with acepromazine?
Care should be taken when using acepromazine with other anesthetics, sedatives, or potentially depressing agents.  Antacids may affect absorption of acepromazine.  Do not use acepromazine with organophosphate insecticides.

 

Photo Credit: <a href=”https://www.flickr.com/photos/9352211@N06/3167933308/”>mastahanky</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>cc</a>

 

Alprazolam (Xanax).

Alprazolam
Xanax
(Anti-Anxiety, Tranquilizer)
By Dr. Karen Burgess

alprazolam, thunderstorm anxiety, firework anxiety, vet

Brand name and formulations

  • Xanax and generic
  • Tablets, Oral solution

What is alprazolam used for?
Alprazolam is used for the treatment of anxiety disorders.  It can also be used to assist with sedation, as a muscle relaxant, and as a tranquilizer.  Alprazolam is often used in treating panic disorders in pets.

What is alprazolam?
Alprazolam is a benzodiazepine similar to diazepam (valium) that acts in the brain to cause relaxation, anti-anxiety, and at times sedating effects.  Dependency is not considered a major concern in pets with the use of alprazolam.  Care should be taken in storing alprazolam as there is human abuse potential.

How is alprazolam given and what if a dose is missed?
Alprazolam is typically prescribed to be used on an as needed basis and is known for its ability to deal with immediate situations of anxiety (ex. Fourth of July, thunderstorms).  The maximum benefit from alprazolam is seen one to two hours after administration and the effects are short lived (four hours).

What side effects are associated with alprazolam?
Alprazolam may cause excessive sedation, abnormal gait (walking as if drunk, unstable on feet), and increased appetite.  Cats may become more irritable with the use of alprazolam.  Care should be taken using alprazolam in cats with liver value elevations.  Pets should be monitored initially as disinhibition may occur (alprazolam may allow for previously unseen aggression to demonstrate itself).

What drugs should not be given with alprazolam?
Do not give antacids within two hours of using alprazolam as absorption can be affected.  Use with caution in conjunction with other medications that cause central nervous system depression.  Drugs that are metabolized by the liver may delay alprazolam’s breakdown and lead to increased sedation.  Digoxin dosing may require adjustment while using alprazolam.

What follow up is necessary with alprazolam use?
Dosing may need to be adjusted based on results.

 

Photo Credit: <a href=”https://www.flickr.com/photos/49977253@N02/15467456315/”>peaceful-jp-scenery</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc-nd/2.0/”>cc</a>

Gabapentin (Neurotin).

Gabapentin
Neurotin
(Pain medication)
By Dr. Karen Burgess

gabapentin, pain management, arthritis 

Brand name and formulations

  • Neurontin and generic
  • Tablets, Capsules
  • DO NOT use human oral solution in pets as it contains xylitol (toxic in dogs)

What is gabapentin used for?
Gabapentin is used for the treatment of pain in dogs and cats.  While not good for sudden or acute pain, gabapentin is often prescribed to preempt pain or to treat general signs of chronic pain such as arthritis.  Gabapentin can also be used in the treatment of refractory seizures.

What is gabapentin?
Gabapentin’s method of action is not truly understood but it is believed to be related to blockage of pain directly at the nerve cell.

How is gabapentin given and what if a dose is missed?
Gabapentin is prescribed to be used typically every twelve hours but as often as every six hours.  Tolerance may develop over time necessitating dose increases.  The safe dose range is quite wide and therefore the latitude in dosing interval is wide.  If a dose is missed, go ahead and give the missed dose.  Use should not be abruptly stopped if gabapentin has been used for a long period.

What side effects are associated with gabapentin?
The most common side effect of gabapentin is drowsiness.  Some may notice ataxia similar to what is seen in inebriated individuals.  Often these signs will improve over time.  Urine testing for protein may be affected by gabapentin use.

What drugs should not be given with gabapentin?
Caution should be used when using gabapentin in conjunction morphine or hydrocodone.  Antacids may affect the absorption of gabapentin, allow two hours between use of these drugs simultaneously.

What pets should not take gabapentin?
Caution should be taken in using gabapentin in patients with kidney disease.

What follow up is necessary with gabapentin use?
Dosing is variable for gabapentin, if benefits are not observed at a particular dose, consult with Dr. Burgess for further recommendations.

 

Photo Credit: <a href=”https://www.flickr.com/photos/78019868@N05/7453308988/”>Public Places</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by/2.0/”>cc</a>

Tramadol (Ultram)

Tramadol
Ultram
(Pain medication)
By Dr. Karen Burgess

tramadol, pain management, arthritis 

Brand name and formulations

  • Ultram and generic
  • Tablets

What is tramadol used for?
Tramadol is used for the treatment of pain in dogs and cats.  It is also commonly prescribed after surgery and to treat general signs of arthritis.  Tramadol may also assist in cough management.

What is tramadol?
Tramadol is an opiate that blocks the sensation of pain centrally, or in the brain. Opiates are known for providing pain relief and euphoria but on the negative side, they can also lead to dependency, depression of the respiratory system and hallucinations.  Tramadol is more selective for receptors that tend to minimize these negative effects while still providing pain relief.  Similar to its close relative morphine, tramadol is a controlled substance and can have addictive tendencies in people.  This dependency issue is not considered a major issue in pets.  If children are in the household or any one with known addiction issues, extra care in the storing of tramadol location may be necessary (ex. locked safe).

How is tramadol given and what if a dose is missed?
Tramadol is prescribed to be used up to every six hours.  The safe dose range is quite wide and therefore the latitude in dosing interval.  If a dose is missed, go ahead and give the missed dose.  Use should not be abruptly stopped if tramadol has been used for a long period.

What side effects are associated with tramadol?
The most common side effect of tramadol is lethargy or depression.  Gastrointestinal side effects including vomiting, diarrhea, constipation, and loss of appetite may also occur.  Dilated pupils may also be noted.  Often these signs will improve over time.

What drugs should not be given with tramadol?
Caution should be used when using tramadol in conjunction with other medications that may cause depression such as antidepressants.  L-Deprenyl, SAMe, and amitraz should not be used along with tramadol.

What pets should not take tramadol?
Dogs with a history of seizures should be cautious in their use of tramadol.  Pets with liver or kidney disease may require lower doses.

What follow up is necessary with tramadol use?
Dosing is variable for tramadol, if benefits are not observed at a particular dose, consult with Dr. Burgess for further recommendations.

 

 

Photo Credit: <a href=”https://www.flickr.com/photos/11971338@N02/4323829269/”>josefnovak33</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>cc</a>

Mirtazapine (Remeron)

Mirtazapine
Remeron
(Appetite stimulant, anti-emetic)
By Dr. Karen Burgess

remeron, mirtazapine, appetite stimulant

 Brand name and formulations

  • Remeron
  • Tablet, dissolvable tablet

What is Mirtazapine used for?
Mirtazapine is used to stimulate the appetite and prevent vomiting.

What is Mirtazapine?
Mirtazapine is a human antidepressant that works in the brain to increase norepinephrine and serotonin activity stimulating appetite centers in the brain as a side effect.

How is Mirtazapine given and what if a dose is missed?
Mirtazapine is typically prescribed for once daily dosing in dogs and a twice weekly dosing in cats.  If a dose is missed and it is less than 12 hours late, go ahead and give missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose.  If using dissolvable tablet formulation, place it under the tongue and hold mouth shut for several seconds.  Follow with a swallow of water.

Are there any common adverse effects with the use of Mirtazapine?
Reported side effects include increased vocalization and affection in cats, drowsiness, and elevated heart rate.

Who should not take Mirtazapine?
Use with caution in patients that have heart disease.  Patients with liver or kidney disease may require a lower dose.

What drugs should not be given with Mirtazapine?
Mirtazapine should not be used in pets that have taken selegiline or amitraz in the last fourteen days.  Use with care in patients taking tramadol or fluoxetine.

What follow up is necessary with Mirtazapine use?
Withdrawal signs with discontinuation of mirtazapine can occur in humans after longterm use

 

Photo Credit: <a href=”https://www.flickr.com/photos/49468253@N07/5489476583/”>Portik Lorant</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>cc</a>

Probiotics (Proviable)

Probiotics
(Proviable, FortiFlora)
By Dr. Karen Burgess

probiotics, diarrhea, vomiting, sick

Brand name and formulations

  • Proviable-DC, FortiFlora
  • Capsule, paste, powder

What are probiotics used for?
Probiotics are used in the treatment of acute diarrhea associated with stress, change in diet, travel, and antibiotic usage.   There have been promising results seen also with the use of probiotics in the treatment of conditions causing chronic diarrhea.

What are probiotics?
Probiotics are good live bacteria or microorganisms that provide a health benefit to an animal.  They are considered live bacteria similar to those found naturally in the intestinal tract.  In cases of diarrhea, imbalance in the intestine occur often causing bad bacteria to outnumber good bacteria.  When given orally to pets, probiotics can help restore intestinal and overall health.  Prebiotics are also included in products such as Proviable and serve as food for the probiotics.

What is the difference between a product like Proviable and yogurt?
The bacteria found in yogurt is often not life or in the numbers necessary to help with diarrhea.

Is there a difference between probiotic products?
Yes.  Because probiotics are a nuetraceutical and not a drug therefore they are not regulated by anyone including the FDA.  This means that manufacturers can sell an inferior product with little to no live bacteria or benefit to a patient.  Proviable and FortiFlora are both produced by reliable companies and contain appropriate strains and numbers of bacteria.

How are probiotics given and what if a dose is missed?
Probiotics are typically prescribed for once daily dosing.  If a dose is missed and it is less than 12 hours late, go ahead and give missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose.  Use is typically continued for several days beyond resolution of symptoms at a minimum.  Probiotics are often nice for owners to have on hand to administer at the first sign of diarrhea or prior to a known stressful situation in hopes of prevention.

Are there any common adverse effects with the use of Probiotics?
No.

Who should not take probiotics?
Avoid use of probiotics in patients that are vomiting, severely dehydrated, or immunocompromised.

What drugs should not be given with probiotics?
Antibiotic efficacy can be affected by probiotics; separate administration times by two hours to avoid this as a concern.

 

 

Photo Credit: <a href=”https://www.flickr.com/photos/35359094@N08/5651836092/”>WilliamMarlow</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc/2.0/”>cc</a>

Maropitant (Cerenia)

Maropitant
Cerenia
(Anti-nausea, motion sickness, anti-inflammatory)
By Dr. Karen Burgess 

cerenia, nausea, vomiting, grass eating

Brand name and formulations

  • Cerenia
  • Tablets and Injectable

What is Cerenia used for?
Cerenia is labeled for the treatment and prevention of vomiting and motion sickness.  Recently Cerenia has also been found to be effective in treating a variety of inflammatory diseases and in the management of pain.

What is Cerenia?
Cerenia works in the brain by blocking Substance P, a neurotransmitter involved in vomiting.  It also has some effect on small intestine contractions and inflammation peripherally.

How is Cerenia given and what if a dose is missed?
Cerenia is typically prescribed for once daily dosing.  If a dose is missed and it is less than 12 hours late, go ahead and give missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose.  After use for five days a two day rest period is required before redosing Cerenia.  While giving with a small amount of food is recommended, avoid giving with treats that are fatty as this may affect efficacy.  Cerenia works on average within one hour of administration.

Are there any common adverse effects with the use of Cerenia?
Drooling, loss of appetite, diarrhea, and sedation may be seen at higher doses.   Pain at site of injection is seen in some patients.

Who should not take Cerenia?
Caution should be used in patients with liver disease or puppies younger than 11 weeks of age.

What drugs should not be given with Cerenia?
Side effects may be more common when used in conjunction with phenobarbital, thyroid hormone, and non-steroidal anti-inflammatories.

What follow up is necessary with Cerenia use?
No specific follow up is necessary with the use of Cerenia.

Photo Credit: <a href=”https://www.flickr.com/photos/35237093637@N01/32815499/”>emdot</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by/2.0/”>cc</a>

Prednisone

Prednisone, Prednisolone
Steroid
By Dr. Karen Burgess

prednisone, prednisolone, steroid, itchy

Formulations

  • Generic, human medication
  • Tablets

What is prednisone used for?
Prednisone decreases inflammation and at high doses acts as an immunosuppressive drug.  Allergic and autoimmune diseases, swelling in the nervous system, shock and cancer therapies all commonly utilize prednisone in their treatment.

What is prednisone?
Prednisone is a classified as a glucocorticoid hormone or steroid and is known for its broad anti-inflammatory effects.  Steroid hormone is naturally produced in the body by the adrenal gland and is necessary in very small quantities for survival.  Anabolic steroids, commonly referenced in sports, are used to build up tissue (muscle) while catabolic steroids such as prednisone break down stored resources to create energy.  Prednisone is changed into prednisolone in the liver making the two drugs interchangeable.

How is prednisone given and what if a dose is missed?
Prednisone is typically given in a tapering dose schedule to prevent potentially life threatening side effects.  When a pet is given prednisone as a medication it suppresses the adrenal gland’s natural production.  For this reason it can be very dangerous to suddenly stop prednisone treatment without giving the body ample time to restart its own steroid production.  If a dose is missed and it is less than 12 hours late, go ahead and give missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose.  Give prednisone with food to help prevent stomach upset.

What side effects can be expected and what pets should not receive prednisone therapy?
Steroids as a class stimulate the desire to drink and production of urine.  It is not uncommon for pets on prednisone to have urinary accidents in particular at the beginning of therapy and plans should be made for extra trips to the bathroom or cleaning of the litterbox.  Increase in appetite, panting, and behavior changes (including aggression) are also common side effects.  Suppression of the immune system by steroids can put a pet at increased risk for infection.  With long term prednisone therapy changes in skin, haircoat, and body musculature (potbellied appearance) are often noted.  Pets with heart disease may get worse on steroids.  Diabetes may develop with steroid treatment and diabetic pets in general should not receive steroids.  Pregnant pets should not take steroids.

What drugs should not be given with prednisone?
NSAIDs as a class should never be given at the same time as steroids.  This can be life threatening.  There should be a “washout” period when changing from an NSAID to a steroid.  Discuss how long to wait between NSAID and steroid use with your veterinarian.

Are there any other concerns with prednisone?
Steroids can alter several commonly run blood laboratory tests.  Make sure your veterinarian is aware of steroid therapy when interpreting labwork.

 

 

 

 

Photo Credit: <a href=”https://www.flickr.com/photos/38112256@N00/1778953537/”>Destinys Agent</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc/2.0/”>c

Praziquantel (Drontal Plus)

Praziquantel
Antiparasitic
(Droncit, Drontal Plus, Sentinel Spectrum)
By Dr. Karen Burgess

puppy, drontal, dewormer

Brand name and formulations

  • Praziquantel (generic formula)
  • Droncit, Drontal Plus, Sentinel Spectrum (brand name animal formula)
  • Tablet, Flavor Tablet, Injectable

What is praziquantel?
Praziquantel is an antiparasitic known for its efficacy against the tapeworm class of parasites.  The drug damages the parasites skin leading to disintegration.  Worms are not commonly seen in the feces in response to treatment.

How is praziquantel given and what if a dose is missed?
Praziquantel is typically prescribed as a single dose medication.

How should praziquantel be stored?
Store at room temperature and protected from light.

What side effects are associated with praziquantel?
Gastrointestinal signs including appetite loss, vomiting, and diarrhea occur in approximately 5% of patients taking praziquantel.  The oral formulation may taste bitter to pets.

What drugs should not be given with praziquantel?
There are no specific drug interactions of major concern.

What follow up is necessary with praziquantel use?
Prevention of future re-exposure is recommended via flea and rodent control.  Follow up fecal examination is recommended a week after treatment is completed.

 

 

Photo Credit: <a href=”https://www.flickr.com/photos/70757073@N00/135964682/”>Difusa</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc-nd/2.0/”>cc</a>Photo Credit: <a href=”https://www.flickr.com/photos/7997148@N05/5709207000/”>Khánh Hmoong</a> via <a href=”http://compfight.com”>Compfight</a> <a href=”https://creativecommons.org/licenses/by-nc/2.0/”>cc</a>