SAMPLER

Blackwell’s Five-Minute Veterinary Consult

About the Series Client Handout Table of Contents* Chapter 1* Appendix* Index*

*Excerpted from full text About the Series

• Subject experts cover all important • Customizable client handouts available diseases and conditions in a given for quick download on companion species website (select titles)

• Each topic covers subject basics, • Authoritative coverage of: diagnosis, treatment, medications, o Cats and dogs and follow-up care o Small mammals o Birds • Fast referencing with consistent, o Horses alphabetical format from book to book o Cattle, sheep, and goats (ruminant) o Lab tests and diagnostic • Alphabetical and subject-specific table procedures (cats and dogs) of contents for quick search o Veterinary practice management (clinical and textbook)

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Lymphoma—Cats Basics OVERVIEW • Lymphocytes are a type of white blood cell that are formed in lymphatic tissues throughout the body; lymphocytes normally are involved in the immune process • Lymphoma is cancer (malignancy) of lymphocytes that usually involves lymph nodes or other lymphatic tissue of the body, but may involve other organs of the body (such as the liver or kidneys) • Lymphoma in cats is found in various anatomic locations in the body, including the mediastinum (known as the “mediastinal form of lymphoma”)—the mediastinum is the center portion of the chest that contains the heart and other organs (except for the lungs); the gastrointestinal tract (known as the “alimentary form of lymphoma”); the kidneys (known as the “kidney or renal form of lymphoma”); multiple organs/tissues throughout the body (known as the “multi-centric form of lymphoma”); and the spinal cord (known as the “spinal form of lymphoma”) SIGNALMENT/DESCRIPTION OF PET Species • Cats Breed Predilections • Siamese and other Oriental breeds may be more likely to have lymphoma than other cat breeds Mean Age and Range • Mean age of feline leukemia virus (FeLV)-positive cats with lymphoma—3 years • Mean age of FeLV-negative cats with lymphoma—7 years • Median age of cats with localized lymphoma, outside of the lymph nodes—13 years • Most cats with Hodgkin's-like lymphoma are older than 6 years of age SIGNS/OBSERVED CHANGES IN THE PET • Depend on anatomic form • Mediastinal form (located in the center of the chest)—open-mouthed breathing; coughing; regurgitation; lack of appetite (known as “anorexia”); weight loss; the front part of the chest is very firm and resistant to gentle compression during physical examination; fast breathing rate (known as “tachypnea”) • Alimentary form (located in the gastrointestinal tract)—lack of appetite (anorexia); weight loss; sluggishness (lethargy); vomiting; constipation; diarrhea; black, tarry stools, due to the presence of digested blood (known as “melena”); frank blood in the stool; thickened intestines or abdominal masses • Kidney or renal form—consistent with kidney failure (such as vomiting; lack of appetite [anorexia]; increased thirst [known as “polydipsia”]; increased urination [known as “polyuria”]; and sluggishness [lethargy]); large, irregular kidneys • Nasal form (located in the nose or nasal passages)—discharge from the nose (known as “nasal discharge”) or bleeding in the nose and nasal passages (known as “epistaxis” or a “nosebleed”); facial deformity; abnormalities of the eyes; excessive tearing (known as “epiphora”); abnormal breathing sounds; sneezing; lack of appetite (anorexia) • Multi-centric form (located in multiple organs/tissues throughout the body)—possibly none in early stages; lack of appetite (anorexia), weight loss, and depression with progression of disease; enlargement of lymph nodes throughout the body; possible spleen and liver enlargement • Spinal form—quickly progressing weakness to partial paralysis in rear legs (known as “posterior paresis”) • Cutaneous (skin) lymphoma—itchiness (known as “pruritus); bleeding (hemorrhage); or masses on the skin accompanied by hair loss (hair loss known as “alopecia”) • All forms—fever; dehydration; depression; extreme weight loss with muscle wasting (known as “cachexia”) in some pets CAUSES • Feline leukemia virus infection—pets inconsistently test positive during illness (for example, 85% are positive with the mediastinal form, 45% with the kidney form, 20% with the multi-centric form, and 15% with the alimentary (intestinal) forms of lymphoma test positive on FeLV test); older cats with lymphoma are usually FeLV negative, while younger cats are usually FeLV positive RISK FACTORS • Feline leukemia virus exposure • Exposure to environmental tobacco smoke • Feline immunodeficiency virus infection Treatment HEALTH CARE • Outpatient, whenever possible • Supportive medical care, if needed depending on clinical signs • Fluid therapy, appetite stimulants, and other treatments based on clinical signs • Radiation therapy—may be used for localized lymphoma such as in the nose; relapses outside the radiation field are not uncommon • Consult a veterinary oncologist for chemotherapy doses, schedules, and to help assess best option(s) for treatment ACTIVITY • Normal DIET • No change in most cases; may require dietary change if cat has kidney failure • Can add omega-3 (n-3) fatty acids (fish oil origin) to the diet SURGERY • To relieve intestinal blockages or obstructions, repair “holes” in the intestinal tract (known as “perforations”) that develop secondarily to the presence of the tumor and to surgically remove individual tumors • To obtain biopsy specimens for microscopic examination Medications Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive • Chemotherapy—used in a combination or sequential protocol; some protocols have induction and maintenance periods • Many variations of similar combination chemotherapy exist; they all have similar effectiveness • Low-grade intestinal lymphoma can respond to oral chlorambucil and prednisolone Follow-Up Care PATIENT MONITORING • Physical examination, complete blood count (CBC), and platelet count—before each weekly chemotherapy treatment and one week after each time a new drug is administered, or if concerned about low blood cell counts • X-rays (radiographs) or advanced imaging—as necessary, depending on location of primary tumor PREVENTIONS AND AVOIDANCE • Avoid exposure to or breeding feline leukemia virus–positive cats POSSIBLE COMPLICATIONS • Low white blood cell counts (known as “leukopenia”) • Generalized bacterial infection (sepsis) • Lack of appetite (anorexia), vomiting, weight loss from side effects of chemotherapy or advancing lymphoma EXPECTED COURSE AND PROGNOSIS • Depends on initial response to chemotherapy, anatomic type, feline leukemia virus status, and tumor burden; overall response rate is 50–70% to treatment • Median survival with prednisone/prednisolone alone—1.5–2 months • Median survival with combination chemotherapy (COP or CHOP)—6–9 months • Mediastinal form (located in the center of the chest)—about 10% of affected pets with live more than 2 years • Median survival with alimentary form (located in the gastrointestinal tract)—8 months • Median survival with peripheral multi-centric form (located in multiple organs/tissues: “peripheral” refers to tissues away from the center of the body)—23.5 months • Median survival with kidney form—if FeLV-negative, 11.5 months; if FeLV-positive, 6.5 months • Median survival with nasal form—1.5–2.5 years with radiation and chemotherapy; chemotherapy may not improve survival over radiation alone • Cats with Hodgkin's-like lymphoma can do well for extended periods of time (months to years), even without treatment Key Points • A treatment protocol should be established that fits the pet and the owner's lifestyle • Side effects of chemotherapy are treatable and should be addressed promptly • Goal is to induce remission and achieve a good quality of life for pets for as long as possible • More than 80% of pet owners are pleased with their cat's quality of life during chemotherapy • Young cats with lymphoma are generally FeLV positive; overall survival for positive cats is 3.5-4 months, for negative cats 7-17.5 months Add patient-specific information or instructions to any client handout.

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Blackwell's Five-Minute Veterinary Consult: Canine and Feline, Sixth Edition, Larry P. Tilley and Francis W.K. Smith, Jr. © 2015 John Wiley & Sons, Inc.

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Contents

Topic Abortion, Spontaneous (Early Pregnancy Loss)—Cats 2 Abortion, Spontaneous (Early Pregnancy Loss)—Dogs 4 Abortion, Termination of Pregnancy 6 Abscessation 8 Acetaminophen (APAP) Toxicosis 10 Acidosis, Metabolic (Traditional Approach) 12 Acne—Cats 14 Acne—Dogs 15 Acral Lick Dermatitis 16 Acromegaly—Cats 17 Actinomycosis 19 Acute Abdomen 20 Acute Respiratory Distress Syndrome 23 Adenocarcinoma, Anal Sac 25 Adenocarcinoma, Lung 26 Adenocarcinoma, Nasal 27 Adenocarcinoma, Pancreas 29 Adenocarcinoma, Prostate 30 Adenocarcinoma, Renal 31 Adenocarcinoma, Salivary Gland 32 Adenocarcinoma, Skin (Sweat Gland, Sebaceous) 33 Adenocarcinoma, Stomach, Small and Large Intestine, Rectal 34 Adenocarcinoma, Thyroid—Dogs 35 Aggression to Unfamiliar People and Unfamiliar Dogs 37 Aggression Toward Children—Dogs 39 Aggression Toward Familiar People—Dogs 40 Aggression Toward Humans—Cats 42 Aggression, Food and Resource Guarding—Dogs 44 Aggression, Intercat Aggression 46 Aggression, Overview—Cats 49 Aggression, Overview—Dogs 51 Aggression—Between Dogs in the Household 55 Alkalosis, Metabolic (Traditional Approach) 57 Alopecia—Cats 59 Alopecia—Dogs 61 Alopecia, Non-Inflammatory—Dogs 63 Amebiasis 65

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Ameloblastoma 66 Amitraz Toxicosis 67 Amphetamines and ADD/ADHD Medication Toxicosis 69 Amyloidosis 71 Anaerobic Infections 73 Anal Sac Disorders 74 Anaphylaxis 75 Anemia of Chronic Kidney Disease 77 Anemia, Aplastic 79 Anemia, Heinz Body 80 Anemia, Immune-Mediated 81 Anemia, Iron-Deficiency 83 Anemia, Metabolic (Anemias with Spiculated Red Cells) 84 Anemia, Nonregenerative 85 Anemia, Nuclear Maturation Defects (Anemia, Megaloblastic) 87 Anemia, Regenerative 88 Anisocoria 90 Anorexia 92 Antebrachial Growth Deformities 94 Anterior Uveitis—Cats 96 Anterior Uveitis—Dogs 98 Antidepressant Toxicosis—SSRIs and SNRIs 100 Antidepressant Toxicosis—Tricyclic 102 Aortic Stenosis 104 Aortic Thromboembolism 106 Apudoma 109 Arteriovenous Fistula and Arteriovenous Malformation 110 Arteriovenous Malformation of the Liver 111 Arthritis (Osteoarthritis) 113 Arthritis, Septic 115 Ascites 117 Aspergillosis, Nasal 119 Aspergillosis, Systemic 121 Aspirin Toxicosis 123 Asthma, Bronchitis—Cats 124 Astrocytoma 126 Astrovirus Infection 127 Ataxia 128 Atherosclerosis 130 Atlantoaxial Instability 131 Atopic Dermatitis 133 Atrial Fibrillation and Atrial Flutter 135 Atrial Premature Complexes 138 Atrial Septal Defect 140 Atrial Standstill 141 Atrial Wall Tear 143 Atrioventricular Block, Complete (Third Degree) 145

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Atrioventricular Block, First Degree 147 Atrioventricular Block, Second Degree—Mobitz I 149 Atrioventricular Block, Second Degree—Mobitz II 151 Atrioventricular Valve Dysplasia 153 Atrioventricular Valve (Myxomatous) Disease 155 Atrioventricular Valvular Stenosis 158 Azotemia and Uremia 161 Babesiosis 164 Baclofen Toxicosis 166 Bartonellosis 167 Basal Cell Tumor 168 Battery Toxicosis 169 Baylisascariasis 170 Benign Prostatic Hyperplasia (BPH) 171 Benzodiazepine and Other Sleep Aids Toxicosis 172 Beta Blocker Toxicosis 174 Beta-2 Agonist Inhaler Toxicosis 175 Bile Duct Carcinoma 176 Bile Duct Obstruction (Extrahepatic) 177 Bile Peritonitis 180 Bilious Vomiting Syndrome 182 Blastomycosis 183 Blepharitis 185 Blind Quiet Eye 187 Blood Transfusion Reactions 189 Blue-Green Algae Toxicosis 190 Botulism 191 Brachial Plexus Avulsion 192 Brachycephalic Airway Syndrome 193 Brain Injury 195 Brain Tumors 197 Breeding, Timing 199 Bronchiectasis 201 Bronchitis, Chronic 202 Brucellosis 204 Calcium Channel Blocker Toxicosis 206 Campylobacteriosis 207 Candidiasis 208 Canine Coronavirus Infections 209 Canine Distemper 210 Canine Infectious Respiratory Disease 212 Canine Influenza 214 Canine Parvovirus Infection 216 Canine Schistosomiasis (Heterobilharziasis) 218 Capillariasis (Pearsonema) 219 Car Ride Anxiety—Dogs and Cats 220 Carbon Monoxide Toxicosis 223

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Carcinoid and Carcinoid Syndrome 224 Cardiac Glycoside Plant Toxicosis 225 Cardiomyopathy—Boxer (Arrhythmogenic Right Ventricular) 226 Cardiomyopathy, Dilated—Cats 227 Cardiomyopathy, Dilated—Dogs 230 Cardiomyopathy, Hypertrophic—Cats 233 Cardiomyopathy, Hypertrophic—Dogs 235 Cardiomyopathy, Restrictive—Cats 236 Cardiopulmonary Arrest 238 Carnitine Deficiency 240 Cataracts 241 Cerebellar Degeneration 243 Cerebellar Hypoplasia 244 Cerebrovascular Accidents 245 Ceruminous Gland Adenocarcinoma, Ear 247 Cervical Spondylomyelopathy (Wobbler Syndrome) 248 Chagas Disease (American Trypanosomiasis) 250 Chediak-Higashi Syndrome 251 Chemodectoma 252 Cheyletiellosis 253 Chlamydiosis—Cats 254 Chocolate (Methylxanthine) Toxicosis 256 Cholangitis/Cholangiohepatitis Syndrome 259 Cholecystitis and Choledochitis 262 Cholelithiasis 264 Chondrosarcoma, Bone 266 Chondrosarcoma, Larynx and Trachea 267 Chondrosarcoma, Nasal and Paranasal Sinus 268 Chondrosarcoma, Oral 269 Chorioretinitis 270 Chylothorax 272 Cirrhosis and Fibrosis of the Liver 274 Clostridial Enterotoxicosis 277 Coagulation Factor Deficiency 279 Coagulopathy of Liver Disease 281 Cobalamin Deficiency 283 Coccidioidomycosis 285 Coccidiosis 287 Cognitive Dysfunction Syndrome 288 Cold Agglutinin Disease 290 Colibacillosis 291 Colitis and Proctitis 293 Colitis, Histiocytic Ulcerative 296 Compulsive Disorders—Cats 297 Compulsive Disorders—Dogs 299 Congenital and Developmental Renal Diseases 301 Congenital Ocular Anomalies 303

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Congenital Spinal and Vertebral Malformations 305 Congestive Heart Failure, Left-Sided 307 Congestive Heart Failure, Right-Sided 309 Conjunctivitis—Cats 311 Conjunctivitis—Dogs 313 Constipation and Obstipation 315 Contact Dermatitis 317 Coonhound Paralysis (Acute Polyradiculoneuritis) 318 Copper Associated Hepatopathy 320 Coprophagia and Pica 324 Corneal and Scleral Lacerations 326 Corneal Opacities—Degenerations and Infiltrates 328 Corneal Opacities—Dystrophies 329 Corneal Sequestrum—Cats 330 Cough 331 Craniomandibular Osteopathy 333 Cruciate Ligament Disease, Cranial 334 Cryptococcosis 336 Cryptorchidism 338 Cryptosporidiosis 339 Crystalluria 340 Cutaneous Drug Eruptions 342 Cuterebriasis 343 Cyanosis 344 Cyclic Hematopoiesis 346 Cylindruria 347 Cysticercosis 348 Cytauxzoonosis 349 Deafness 350 Deciduous Teeth, Persistent 352 Degenerative Myelopathy 353 Demodicosis 355 Dental Caries 357 Dentigerous Cyst 359 Dermatomyositis 360 Dermatophilosis 362 Dermatophytosis 363 Dermatoses, Depigmenting Disorders 365 Dermatoses, Erosive or Ulcerative 367 Dermatoses, Exfoliative 369 Dermatoses, Neoplastic 371 Dermatoses, Papulonodular 373 Dermatoses, Sterile Nodular/Granulomatous 375 Dermatoses, Sun-Induced 377 Dermatoses, Vesiculopustular 378 Dermatoses, Viral (Non-Papillomatosis) 380 Destructive and Scratching Behavior—Cats 381

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Contents by Subject

Topic

Appendices

Appendix I Normal Reference Ranges for Laboratory Tests 1416 Table I-A Normal hematologic values 1416 Table I-B Normal biochemical values 1416 Table I-C Conversion table for hematologic units 1417 Table I-D Conversion table for clinical biochemical units 1418 Appendix II Endocrine Testing 1419 Table II-A Endocrine function testing protocols 1419 Table II-B Tests of the endocrine system 1420 Table II-C Conversion table for hormone assay units 1421 Appendix III Approximate Normal Ranges for Common Measurements in Dogs and Cats 1422 Appendix IV Normal Values for the Canine and Feline Electrocardiogram 1423 Appendix V Antidotes and Useful Drugs: Method of Treatment 1424 Appendix VI Toxic Home and Garden Hazards for Pets 1427 Table VI-A Toxic plants and their clinical signs—antidotes and treatment 1427 Table VI-B Herbal toxicities 1433 Table VI-C Household cleaners, disinfectants and solvents – products, clinical signs and treatment 1435 Appendix VII Pain Management 1440 Table VII-A Recommended parenteral opioid dosages and indications 1440 Table VII-B Recommended dispensable opioid dosages and indications 1440 Table VII-C Recommended parenteral NSAID dosage and indications 1441 Table VII-D Recommended dispensable NSAID dosage and indications 1441 Table VII-E Dosages and indications for selected drugs used to treat neuropathic pain 1442 Appendix VIII Glossary of Terminology for Seizures and Epileptic Disorders 1443 Appendix IX—Blackwell’s Five-Minute Consult Drug Formulary 1445 Appendix X—Conversion Tables 1549 Table X-A Conversion table of weight to body surface area (in square meters) for dogs 1549 Table X-B Approximate equivalents for degrees, Farenheit and Celsius 1549 Table X-C Weight-unit conversion factors 1550 Appendix XI Important Resources for Veterinarians 1551

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Behavior

Aggression to Unfamiliar People and Unfamiliar Dogs 37 Aggression Toward Children—Dogs 39 Aggression Toward Familiar People—Dogs 40 Aggression Toward Humans—Cats 42 Aggression, Food and Resource Guarding—Dogs 44 Aggression, Intercat Aggression 46 Aggression, Overview—Cats 49 Aggression, Overview—Dogs 51 Aggression—Between Dogs in the Household 55 Car Ride Anxiety—Dogs and Cats 220 Cognitive Dysfunction Syndrome 288 Compulsive Disorders—Cats 297 Compulsive Disorders—Dogs 299 Coprophagia and Pica 324 Destructive and Scratching Behavior—Cats 381 Destructive Behavior—Dogs 382 Excessive Vocalization and Waking at Nights 470 Fear and Aggression in Veterinary Visits 484 Fears, Phobias, and Anxieties—Cats 488 Fears, Phobias, and Anxieties—Dogs 490 Housesoiling—Cats 639 Housesoiling—Dogs 643 Marking, Roaming, and Mounting Behavior—Cats 845 Marking, Roaming, and Mounting Behavior—Dogs 847 Maternal Behavior Problems 852 Pediatric Behavior Problems and Training—Dogs 1025 Pediatric Behavior Problems—Cats 1027 Polyphagia 1090 Separation Distress Syndrome 1208 Submissive and Excitement Urination—Dogs 1282 Thunderstorm and Noise Phobias 1306 Unruly Behaviors: Jumping, Pulling, Chasing, Stealing—Dogs 1339

Cardiology

Aortic Stenosis 104 Aortic Thromboembolism 106 Arteriovenous Fistula and Arteriovenous Malformation 110 Ascites 117 Atherosclerosis 130 Atrial Fibrillation and Atrial Flutter 135 Atrial Premature Complexes 138 Atrial Septal Defect 140 Atrial Standstill 141

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Atrial Wall Tear 143 Atrioventricular Block Complete (Third Degree) 145 Atrioventricular Block, First Degree 147 Atrioventricular Block, Second Degree—Mobitz I 149 Atrioventricular Block, Second Degree—Mobitz II 151 Atrioventricular Valve Dysplasia 153 Atrioventricular Valve (Myxomatous) Disease 155 Atrioventricular Valvular Stenosis 158 Cardiomyopathy—Boxer (Arrhythmogenic Right Ventricular) 226 Cardiomyopathy, Dilated—Cats 227 Cardiomyopathy, Dilated—Dogs 230 Cardiomyopathy, Hypertrophic—Cats 233 Cardiomyopathy, Hypertrophic—Dogs 235 Cardiomyopathy, Restrictive—Cats 236 Cardiopulmonary Arrest 238 Carnitine Deficiency 240 Congestive Heart Failure, Left-Sided 307 Congestive Heart Failure, Right-Sided 309 Digoxin Toxicity 402 Ebstein’s Anomaly 429 Electric Cord Injury 437 Endocarditis, Infective 442 Endomyocardial Diseases—Cats 444 Fever 512 Heartworm Disease—Cats 573 Heartworm Disease—Dogs 574 Heat Stroke and Hyperthermia 576 Hypertension, Pulmonary 687 Hypertension, Systemic 689 Hypothermia 727 Idioventricular Rhythm 737 Left Anterior Fascicular Block 788 Left Bundle Branch Block 790 Lymphedema 827 Murmurs, Heart 887 Myocardial Infarction 909 Myocarditis 911 Patent Ductus Arteriosus 1021 Pericardial Effusion 1035 Pericarditis 1038 Peripheral Edema 1044 Peritoneopericardial Diaphragmatic Hernia 1047 Phlebitis 1057 Pleural Effusion 1063 Pulmonary Thromboembolism 1129 Pulmonic Stenosis 1131 Right Bundle Branch Block 1183

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Shock, Cardiogenic 1217 Shock, Hypovolemic 1219 Shock, Septic 1221 Sick Sinus Syndrome 1225 Sinus Arrest and Sinoatrial Block 1227 Sinus Arrhythmia 1229 Sinus Bradycardia 1231 Sinus Tachycardia 1233 Supraventricular Tachycardia 1284 Syncope 1286 Taurine Deficiency 1292 Tetralogy of Fallot 1297 Traumatic Myocarditis 1330 Vascular Ring Anomalies 1375 Vasculitis, Systemic 1377 Ventricular Arrhythmias/Sudden Death in German Shepherds 1378 Ventricular Fibrillation 1379 Ventricular Premature Complexes 1381 Ventricular Septal Defect 1383 Ventricular Standstill (Asystole) 1385 Ventricular Tachycardia 1387 Wolff-Parkinson-White Syndrome 1411

Dentistry

Deciduous Teeth, Persistent 352 Dental Caries 357 Dentigerous Cyst 359 Discolored Tooth/Teeth 406 Enamel Hypoplasia/Hypocalcification 438 Epulis 457 Gingival Hyperplasia/Enlargement 550 Halitosis 566 Malocclusions—Skeletal and Dental 837 Maxillary and Mandibular Fractures 854 Odontoma 961 Oral Masses 969 Oral Ulceration 973 Oronasal Fistula 979 Periodontal Diseases 1042 Stomatitis 1272 Stomatitis, Caudal—Cats 1274 Temporomandibular Joint Disorders 1293 Tooth Formation/Structure, Abnormal 1314 Tooth Fracture 1315 Tooth Luxation or Avulsion 1317

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Tooth–Missing 1318 Tooth Resorption—Cat 1319 Tooth Root Abscess (Apical Abscess) 1320

Dermatology

Acne—Cats 14 Acne—Dogs 15 Acral Lick Dermatitis 16 Alopecia—Cats 59 Alopecia—Dogs 61 Alopecia, Non-Inflammatory—Dogs 63 Anal Sac Disorders 74 Atopic Dermatitis 133 Cheyletiellosis 253 Contact Dermatitis 317 Cutaneous Drug Eruptions 342 Demodicosis 355 Dermatomyositis 360 Dermatophilosis 362 Dermatophytosis 363 Dermatoses, Depigmenting Disorders 365 Dermatoses, Erosive or Ulcerative 367 Dermatoses, Exfoliative 369 Dermatoses, Neoplastic 371 Dermatoses, Papulonodular 373 Dermatoses, Sterile Nodular/Granulomatous 375 Dermatoses, Sun Induced 377 Dermatoses, Vesiculopustular 378 Dermatoses, Viral (Non-Papillomatosis) 380 Ear Mites 428 Eosinophilic Granuloma Complex 447 Feline Paraneoplastic Alopecia 510 Feline Symmetrical Alopecia 511 Flea Bite Hypersensitivity and Flea Control 523 Food Reactions, Dermatologic 525 Lupus Erythematosus, Cutaneous (Discoid) 816 Lymphoma, Cutaneous Epitheliotropic 832 Malassezia Dermatitis 835 Mycobacterial Infections 897 Nail (Claw) and Nailbed (Clawfold) Disorders 927 Nasal Dermatoses—Canine 930 Notoedric Mange 956 Otitis Externa and Media 987 Panniculitis/Steatitis 1006 Papillomatosis 1011 Pemphigus 1032

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2 Blackwell’s Five-Minute Veterinary Consult A Abortion, Spontaneous (Early Pregnancy Loss)—Cats

Physical Examination Findings peritonitis; trauma; impending parturition or Purulent, mucoid, watery, or sanguineous dystocia vaginal discharge; dehydration, fever, CBC/BIOCHEMISTRY/URINALYSIS BASICS r r abdominal straining, abdominal discomfort. May be normal. Inflammatory leukogram DEFINITION CAUSES or stress leukogram depending on systemic r r Spontaneous abortion—natural expulsion Infectious disease response. Hemoconcentration and of fetus(es) prior to the point at which they r r Bacterial—organisms implicated in causing azotemia with dehydration. can sustain life outside the uterus. Early abortion via ascending infection include OTHER LABORATORY TESTS pregnancy loss—generalized term for any loss Escherichia coli, Staphylococcus spp., Infectious Causes of conceptus including early embryonic death Streptococcus spp., Chlamydia spp., Pasteurella r and resorption. Cytology and bacterial culture of vaginal spp., Klebsiella spp., Pseudomonas spp., discharge, fetus, fetal membranes, or uterine PATHOPHYSIOLOGY Salmonella spp., Mycoplasma spp., and r r contents (aerobic, anaerobic, and myco- r Infectious causes result in pregnancy loss Ureaplasma spp. Protozoal—Toxoplasma plasma). FeLV—test for antigens in queens r r directly by affecting the embryo, fetus, or fetal gondii Viral—FHV-1, FIV, FIP,FeLV, FPLV. using ELISA or IFA. FHV-1—IFA or PCR membranes, or indirectly by creating Non-infectious from corneal or conjunctival swabs, viral debilitating systemic disease in the queen. r r Uterine—cystic endometrial hyperplasia, isolation from conjunctival, nasal, or pharyn- r Non-infectious causes of pregnancy loss pyometra, chronic endometritis, anatomical geal swabs. FIP—submit fetal tissue for result from any factor other than infection abnormalities of the uterus, mechanical histopathology and immunohistochemistry. r r that leads to the death or premature expulsion trauma to uterus or fetus. Ovarian—early FIV—ELISA: confirm positive results with r of the conceptus (e.g., uterine disease, termination of corpora lutea function causes a Western blot. FPLV—viral isolation from inadequate maternal nutrition, endocrine decline in serum progesterone concentrations fetuses submitted for necropsy; document dysfunction, toxicity, genetic defects). resulting in early parturition/abortion. seroconversion in the queen. SYSTEMS AFFECTED Primary hypoluteoidism is rare but secondary Non-infectious Causes r r r r Endocrine Reproductive Other hypoluteoidism may result from certain drugs, To rule out anovulatory cycle, confirm prolonged stress and uterine inflammation. systems—any debilitating illness can result in r progesterone rise > 1.5 ng/mL one week r pregnancy loss. Fetal—chromosomal abnormalities following mating. Hypoluteoidism—serum resulting in abnormal or arrested development GENETICS r progesterone level < 1.0 ng/mL prior to and embryonic or fetal death. Systemic— Genetic defects are more prevalent in highly abortion indicates luteal failure but does not malnutrition or nutritional disorders such as inbred individuals; heritability of suscep- determine whether the luteal failure was taurine deficiency; vitamin A deficiency or r tibility to FIPV thought to be very high. primary or secondary Disorder of sexual toxicity; severe non-reproductive illness; INCIDENCE/PREVALENCE development can be evaluated with exogenous drug administration: estrogens, description of external genitalia, karyotype, Unknown—pregnancy frequently not glucocorticoids, PGF2𝛼, and dopamine and histopathology of reproductive tract. confirmed, owners may not recognize late agonists (cabergoline, bromocriptine) will IMAGING pregnancy loss if the queen is fastidious; early disrupt normal corpora lutea function; r embryonic death is difficult to document. fetotoxic or teratogenic drugs: Abdominal ultrasound in early gestation SIGNALMENT chemotherapeutic agents, antifungal agents, (21–25 days post-breeding) to confirm pregnancy and screen for evidence of Species some antibiotics (trimethoprim-sulfonamides, tetracyclines, gentamicin); modified live resorption. Later pregnancy, evaluate health Cat vaccines. and viability of fetus(es) and associated fluid Breed Predilections RISK FACTORS and membranes; abnormal uterine fluid Purebred cats—higher incidence of r accumulation and non-reproductive disease. Previous history of pregnancy loss r non-infectious abortion; inbreeding increases r r Radiograph— evaluates relative size, Concurrent systemic disease Recent risk of genetic disease. Predisposition to r number, and position of fetal skeletons; can trauma Purebred cat with high degree of developing FIP increased in some breeds r also be used to screen for fetal monsters, fetal inbreeding Very young or old queen including Bengal, Birman, and Himalayan. r malpresentation, and non-reproductive Previous use of progestins to suppress estrus r r disease. Mean Age and Range Malnourishment Homemade and raw Infectious abortion seen in all ages; r DIAGNOSTIC PROCEDURES diets Overcrowded or unsanitary r non-infectious abortion seen more commonly environment Genetic defects—necropsy aborted in young and aged queens. fetus(es); submit samples from aborted and r SIGNS stillborn fetus for karyotyping. Nutrition— General Comments submit sample of diet for nutritional analysis: of particular importance when queen is fed a Early embryonic death and resorption DIAGNOSIS r homemade and/or raw diet. Pedigree frequently have no clinical symptoms; any DIFFERENTIAL DIAGNOSIS analysis to evaluate inbreeding coefficient combination of historical and physical r r Evaluate cattery for vaccination protocols, examination findings may occur, with some Early pregnancy loss—failure to conceive, feeding regime, general sanitation procedures, queens displaying no symptoms. disorder of sexual development, anovulatory r and quarantine procedures for pregnant cycle Vulvar discharge—pyometra, r Historical Findings mucometra, uterine stump pyometra; queens and new arrivals. Submit Failure to deliver litter at expected time, vaginitis, metritis, cystitis; impending reproductive tract (uterus, ovaries, uterine return to estrus sooner than expected, parturition or dystocia; neoplasia or trauma of tubes) and aborted, stillborn, mummified decrease in abdominal diameter and weight urinary bladder, urethra, vagina, or uterus; fetus(es) and fetal membranes (fresh, loss, discovery of fetal material, behavior estrus—very little discharge typically seen refrigerated, on wet ice) for evaluation of r change, anorexia, vomiting, diarrhea. Abdominal straining or discomfort: urethral anatomic and pathologic changes, gross obstruction; intestinal foreign body; JWST589-A12-01 JWST589-Tilley Printer: Yet to Come August 1, 2015 10:10 279mm×216mm

Canine and Feline, Sixth Edition 3

(Continued) Abortion, Spontaneous (Early Pregnancy Loss)—Cats A

necropsy, histopathology, cultures, and viral serum progesterone concentration and isolation. tocodynamometry. CONTRAINDICATIONS r MISCELLANEOUS Terbutaline—cardiac or respiratory disease, AGE-RELATED FACTORS pyometra, infectious disease, hypertension. r r Queens > 6 years old have higher incidence TREATMENT Progesterone in oil—diabetes, pyometra, r infectious disease, CEH. of infertility. Pregnancy loss seen most APPROPRIATE HEALTH CARE frequently in very young and old queens. r PRECAUTIONS Outpatient management: typically no r ZOONOTIC POTENTIAL medical management required for Use of tocolytics to maintain pregnancy non-infectious stable queens; primary requires accurate documentation of breeding Toxoplasma gondii hypoluteoidism—can be managed on an dates to know when treatment should be SEE ALSO r r outpatient basis with tocolytic drugs in discontinued; tocolytics used most Breeding, Timing Sexual Development combination with tocodynamometry. successfully in combination with Disorders r Surgical management: OHE for queens tocodynamometry to establish desired dosing ABBREVIATIONS interval based on increasing preterm uterine r with severe illness due to pyometra or metritis. r CEH = cystic endometrial hyperplasia activity. Terbutaline can cause hypertension r ACTIVITY ELISA = enzyme-linked immunosorbent r leading to increased hemorrhage from the r r Isolation for queens with infectious disease. assay FeLV = feline leukemia virus FHV-1 r placental sites during parturition or at the r No activity restrictions for most non- = feline herpesvirus 1 FIPV = feline r time of c-section. r infectious pregnancy losses. Restrict activity infectious peritonitis virus FIV = feline r as indicated for pregnancy loss due to trauma. POSSIBLE INTERACTIONS immunodeficiency virus FPLV = feline r r Progesterone administration during panleukopenia virus IFA = indirect DIET r pregnancy is associated with masculinization fluorescent antibody OHE = ovario- Feed commercially available diet labeled for r of female fetuses; do not administer in the = use in pregnancy. Correct diets with hysterectomy PGF2𝛼 prostaglandin F2𝛼 first half of pregnancy and use with informed inappropriate taurine or vitamin A r INTERNET RESOURCES consent thereafter. Use of tocolytics to r concentrations. Avoid feeding raw meats or www.theriojournal.com maintain pregnancy is associated with r allowing queens to hunt during pregnancy to www.whelpwise.com increased risk of dystocia, failure of normal reduce risk for ingestion of pathogenic placental separation at parturition, lack of Suggested Reading bacteria and T. gondii. mammary gland development and milk Lamm CG. Clinical approach to abortion, CLIENT EDUCATION r production, and poor maternal behavior for stillbirth, and neonatal death in dogs and Infectious diseases—verify client is follow- the first few days postpartum. cats.VetClinNorthAm:SmallAnimPract ing good vaccination protocols and disease 2012, (42)3:501–513. surveillance measures and is utilizing Pretzer SD. Bacterial and protozoal causes of quarantine facilities for pregnant queens and r pregnancy loss in the bitch and queen. new arrivals. Breeding management— FOLLOW-UP Theriogenology 2008, 70(3):320–326. discuss normal reproductive behavior and Verstegen J, Dhaliwal G, Verstegen-Onclin K. good breeding management; advise clients to PATIENT MONITORING r Canine and feline pregnancy loss due to keep detailed records related to reproductive Serial ultrasound evaluation q 5–7 days to viral and non-infectious causes: a review. performance, pedigree analysis, and social evaluate fetal viability for queens receiving Theriogenology 2008, 70(3):304–319. behavior of queens within the cattery. tocolytics. r Author Milan Hess Nutrition—discuss routine diet PREVENTION/AVOIDANCE Consulting Editor Sara K. Lyle r recommendations for breeding queens; advise Institute infectious disease prevention, r homemade diets undergo nutritional analysis. control, and surveillance plan. Replace r Client Education Handout Genetic disease—increase in inbred infertile queens with more reproductively fit individuals; many reproductive traits are r available online r individuals. Avoid exposure to abortifacient, heritable. Discuss risk of zoonotic disease teratogenic, or fetotoxic drugs. from Toxoplasma gondii. POSSIBLE COMPLICATIONS r r Depends on etiology. Metritis, endometritis, uterine rupture, sepsis, shock. r MEDICATIONS Diabetes, CEH, masculinization of female fetuses with progesterone treatment. DRUG(S) OF CHOICE EXPECTED COURSE AND PROGNOSIS r Will depend on etiology. r r Infectious disease—normal pregnancy, Amoxicillin-clavulanic acid 13.75 mg/kg repeated abortion, or infertility possible with r PO q12h or enrofloxacin 5 mg/kg/day PO viral disease. Poor prognosis for normal based on bacterial culture results. r r pregnancy in queens with severe CEH. Fair Tocolytic therapy to prevent uterine prognosis for successful pregnancy with contractions and help maintain pregnancy: treatment for primary hypoluteoidism; Terbutaline 0.03–1.0 mg PO as needed based significant monitoring required for good r on tocodynamometry; 0.03 mg/kg PO q8h if outcome. Pregnancy loss due to genetic tocodynometry not available. r abnormalities likely to recur if queen is bred Hypoluteoidism: progesterone in to tom with similar pedigree. oil—2.0–3.0 mg/kg IM as needed based on JWST589-A13-02 JWST589-Tilley Printer: Yet to Come August 1, 2015 10:16 279mm×216mm

4 Blackwell’s Five-Minute Veterinary Consult A Abortion, Spontaneous (Early Pregnancy Loss)—Dogs

r Mycoplasma and Ureaplasma. OTHER LABORATORY TESTS r r Miscellaneous bacteria—E. coli, Serologic testing—B. canis, canine Streptococcus, Campylobacter, Salmonella. herpesvirus, and Toxoplasma, Neospora; collect BASICS r Miscellaneous viruses—distemper virus, serum as soon as possible after abortion; DEFINITION parvovirus, adenovirus. repeat testing for raising titers for canine r Loss of a fetus because of resorption in early Uterine herpesvirus, Toxoplasma, Neospora. Slide test r stages or expulsion in later stages of pregnancy. Cystic endometrial hyperplasia and for B. canis—very sensitive; negative results r PATHOPHYSIOLOGY pyometra. Trauma—acute and chronic. reliable; prevalence of false positives as high as r r r 60% (D-Tec CB®, Synbiotics Corp., Direct causes—congenital abnormality, Neoplasia. Embryotoxic drugs. r r r r (800)733-5500); PCR for B. canis now Chemotherapeutic agents. Estrogens. r infectious disease, trauma. Indirect r available; Definitive diagnosis made via Glucocorticoids—high dosages. r causes—infectious placentitis, abnormal culture. Tube agglutination test for ovarian function, abnormal uterine Ovarian r B. canis—gives titers; titers > 1:200 environment. Prostaglandins—lysis of corpora lutea. considered positive; titers from 1:50–1:200 r r SYSTEMS AFFECTED Dopamine agonists—lysis of corpora lutea considered suspicious. Agar gel r r via suppression of prolactin; bromocryptine, Reproductive. Any dysfunction of a major r immunodiffusion test for B. canis—effectively body system can adversely affect pregnancy. cabergoline. Hypoluteoidism—abnormal differentiates between false positives and true luteal function in the absence of fetal, uterine, GENETICS positives in agglutination tests; detects r or placental disease: progesterone No genetic basis for most causes of abortion. < cytoplasmic and cell surface antigens (Cornell r concentrations 1–2 ng/mL, most often seen University Animal Health Diagnostic Lymphocytic hypothyroidism—single-gene at 40–45 days gestation. r recessive trait in borzois. Laboratory, (607)253-3900). Baseline T4 Hormonal Dysfunction serum concentration (when no infectious INCIDENCE/PREVALENCE r r r Hypothyroidism; new data shows this is less agents are identified)—hypothyroidism is a True incidence unknown. Resorption common than previously thought. r r common endocrine disease and has been estimated between 11–13%, some estimates Hyperadrenocorticism. Environmental suggested as a cause for fetal wastage; role in up to 30% of at least one resorption. r factors—endocrine disrupting contaminants pregnancy loss unclear; subnormal T4 Incidence of stillbirth reported as 2.2–4.4%; have been documented in human and wildlife concentrations indicate need for further r increases with dystocia up to 22.3%. instances of fetal loss. testing (see Hypothyroidism). Serum SIGNALMENT Fetal Defects progesterone concentration (when no r r Species Lethal chromosomal abnormality. Lethal infectious agents are identified)— Dog organ defects. hypoluteoidism may cause fetal wastage; dogs depend on ovarian progesterone production Breed Predilections RISK FACTORS r throughout gestation (minimum of 2 ng/mL r Exposure of the brood bitch to carrier Familial lymphocytic hypothyroidism r r required to maintain pregnancy); collect reported in borzoi—prolonged interestrus animals Old age Hereditary factors sample and determine as soon as possible after interval, poor conception rates, abortion r abortion; in subsequent pregnancies, start midgestation, stillbirths. Many breeds weekly monitoring at week 3, which may be considered at risk for familial hypothyroidism before pregnancy can be documented with (see Hypothyroidism). DIAGNOSIS ultrasound; start biweekly sampling around Mean Age and Range the gestational age of previous loss. Pregnancy r DIFFERENTIAL DIAGNOSIS Infectious causes, pharmacologic agents r loss typically occurs during the seventh week Differentiate infectious from non-infectious r causing abortion, fetal defects—seen in all of gestation (see Premature Labor). Vaginal r causes—B. canis of immediate and zoonotic ages. Cystic endometrial hyperplasia— r culture—B. canis with positive serologic test; concern. Differentiate resorption from usually > 6 years old. Mycoplasma, Ureaplasma, other bacterial infertility—helped by early diagnosis of r agents; all except B. canis can be normal flora, Predominant Sex pregnancy. Historyofdruguseduring therefore diagnosis difficult from vaginal Intact bitches pregnancy—particularly during the first cultures alone; Salmonella associated with SIGNS trimester, or use of drugs (e.g., systemic illness in the bitch. Historical Findings dexamethasone, prostaglandins, ketoconazole, r r IMAGING Failure to whelp on time. Expulsion of griseofulvin, doxycycline, tetracycline, r Radiography—identifies fetal structures recognizable fetuses or placental tissues. dantrolene, among others) known to cause r r after 45 days of gestation; earlier, can Decrease in abdominal size; weight loss. fetal death. Vulvar discharges during r r determine uterine enlargement but cannot Anorexia. Vomiting, diarrhea. diestrus—may mimic abortion; evaluate r assess uterine contents. Behavioral changes. discharge and origin to differentiate uterine r from distal reproductive tract disease. Ultrasonography—identifies uterine size Physical Examination Findings r r Necropsy of aborted fetus, stillborn and contents; assesses fluid and its Sanguineous or purulent vulvar discharge. r puppies, and placenta(s)—enhances chances consistency; assesses fetal remains or fetal Disappearance of vesicles or fetuses of a definitive diagnosis, refrigerate but do not viability by noting heartbeats (normal, r previously documented by palpation, freeze prior to submission. History of > 200 bpm; stress, < 150 or > 280 bpm). ultrasonography, or radiography. r systemic or endocrine disease—may indicate DIAGNOSTIC PROCEDURES Abdominal straining, discomfort. r r r problems with the maternal environment. r Depression. Dehydration. Fever in Vaginoscopy—identify source of vulvar CBC/BIOCHEMISTRY/URINALYSIS some patients. discharges and vaginal lesions; use a scope of r r sufficient length (16–20 cm) to examine the CAUSES Usually normal. Systemic disease, uterine r infection, viral infection, or endocrine entire length of the vagina. Cytologic Infectious examination and bacterial culture—vagina r r abnormalities—may produce changes in Brucella canis. Canine herpesvirus. may reveal an inflammatory process (e.g., r CBC, biochemistries, or urinalysis. Toxoplasma gondii, Neospora caninum. uterine infection); technique for culture: use a JWST589-A13-02 JWST589-Tilley Printer: Yet to Come August 1, 2015 10:16 279mm×216mm

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(Continued)Abortion, Spontaneous (Early Pregnancy Loss)—Dogs A

guarded swab culture instrument to ensure an PREVENTION/AVOIDANCE r anterior sample (distal reproductive tract is Brucellosis and other infectious agents— normally heavily contaminated with bacteria), surveillance programs to prevent introduction MEDICATIONS r or collection of secretions via transcervical to kennel. OHE—for bitches with no r catheterization. DRUG(S) OF CHOICE breeding value. Use of modified-live r vaccines (e.g., some distemper, parvovirus, PATHOLOGIC FINDINGS PGF2𝛼 (Lutalyse, dinoprost Histopathologic examination and culture of tromethamine)—uterine evacuation after etc., vaccines). fetal and placental tissue—may reveal abortion; 0.05–0.1 mg/kg SC q8–24h; POSSIBLE COMPLICATIONS r infectious organisms; tissue culture, cloporostenol (Estrumate, cloprostenol)— Untreated pyometra—septicemia, toxemia, 𝜇 r particularly of stomach contents, to identify 1–5 g/kg SC q24h; not approved for use in death. Brucellosis—discospondylitis, infectious bacterial organisms. dogs, but adequate documentation legitimizes endophthalmitis, recurrent uveitis. its use; use only if all living fetuses have been EXPECTED COURSE AND PROGNOSIS expelled. r r Antibiotics—for bacterial disease; initially Pyometra—recurrence rate during subsequent cycle is high (up to 70%) unless TREATMENT institute broad-spectrum agent; specific agent r depends on culture and sensitivity testing of pregnancy is established. CEH—recovery of fertility unlikely; pyometra common APPROPRIATE HEALTH CARE vaginal tissue or necropsy of fetus. r r r complication. Hormonal dysfunction— Most bitches should be confined and Progesterone (Regu-Mate) at 0.088 mg/kg r often manageable; familial aspects should be isolated pending diagnosis. Hospitalization (1 mL/25 kg PO q24h); progesterone in oil at r r considered. Brucellosis—guarded; of infectious patients preferred. B. canis— 2 mg/kg IM q48–72h; progesterone ® extremely difficult to successfully eliminate highly infective to dogs; shed in high numbers (Prometrium ; 10 mg/kg PO q24h, adjust infection even if combined with neutering. during abortion; suspected cases should be daily dosage based on serum progesterone)— r isolated. Outpatient medical for documented hypoluteodism only to management—medically stable patients with maintain pregnancy, must have accurate due non-infectious causes of pregnancy loss, date to know when to discontinue therapy— endocrinopathies, or endometrial disease. inadvertently prolonging gestation will result MISCELLANEOUS r Partial abortion—may attempt to salvage in fetal death. AGE-RELATED FACTORS the live fetuses; administer antibiotics if a CONTRAINDICATIONS Older bitches more likely to have CEH bacterial component is identified. Progestogen supplementation— ZOONOTIC POTENTIAL NURSING CARE contraindicated in dogs with endometrial or B. canis—can be transmitted to humans, mammary gland disease. Dehydration—use replacement fluids, especially when handling the aborting bitch supplemented with electrolytes if imbalances PRECAUTIONS and expelled tissues; massive numbers of are identified by serum biochemistries. PGF2𝛼—metabolized in the lung; side effects organisms expelled during abortion. ACTIVITY are related to smooth muscle contraction, are Pathologists should be warned when B. canis Partial abortion—cage rest generally dose-related, and diminish with each is suspected. People that are recommended, although the positive effect on injection; panting, salivation, vomiting, and immunocompromised are at greatest risk for reducing further abortion is unknown. defecation common; dosing critical (LD50 for infection. DIET dinoprost—5 mg/kg). SEE ALSO r r r No special dietary considerations for ALTERNATIVE DRUG(S) Brucellosis Hypothyroidism Infertility, r uncomplicated cases Oxytocin—1 U/5 kg SC q6–24h for uterine Female—Dogs Premature Labor r CLIENT EDUCATION evacuation; should only be considered in cases Pyometra r where uterine evacuation is desired solely Critical for B. canis—if confirmed, ABBREVIATIONS through uterine contraction. r euthanasia recommended due to lack of CEH = cystic endometrial hyperplasia r r successful treatment and to prevent spread of OHE = ovariohysterectomy PGF2𝛼 = infection; may try OHE and long-term prostaglandin F2𝛼 antibiotics; discuss surveillance program for Suggested Reading kennel situations: monthly serology for all FOLLOW-UP Givens MD, Marley MSD. Infectious causes individuals, culling any positive animals, until PATIENT MONITORING of embryonic and fetal mortality. three consecutive negative tests are obtained; r r Partial abortion—monitor viability of Theriogenology 2008, 70(3):270–285. discuss zoonotic potential. Primary uterine remaining fetuses with ultrasonography; Verstegen J, Dhaliwal G, Verstegen-Onclin K. disease—OHE is indicated in patients with monitor systemic health of the dam for Canine and feline pregnancy loss due to no breeding value; cystic endometrial r remainder of pregnancy. Vulvar viral and non-infectious causes: A review. hyperplasia is an irreversible change. r discharges—daily; for decreasing amount, Theriogenology 2008, 70(3):304–319. Infertility or pregnancy loss—may recur in odor, and inflammatory component; for Author Julie T. Cecere subsequent estrous cycles despite successful r consistency (increasing mucoid content is Consulting Editor Sara K. Lyle immediate treatment. Prostaglandin r prognostically good). PGF 𝛼—continued Acknowledgment The author and editors treatment—discuss side effects (see Abortion, 2 r for 5 days or until most of the discharge ceases acknowledge the prior contribution of Beverly Termination of Pregnancy). Infectious r (range 3–15 days). B. canis—monitor after J. Purswell. diseases—establish surveillance and control neutering and antibiotic therapy; yearly measures. serologic testing to identify recrudescence. r SURGICAL CONSIDERATIONS Hypothyroidism—treat appropriately; Client Education Handout OHE—preferred for stable patients with no neutering recommended (hereditary nature); available online breeding value. see Hypothyroidism. JWST589-A14-03 JWST589-Tilley Printer: Yet to Come August 26, 2015 10:36 279mm×216mm

6 Blackwell’s Five-Minute Veterinary Consult A Abortion, Termination of Pregnancy

efficacy compared to midgestation but canbe less distasteful to client (less discharge and r BASICS DIAGNOSIS recognizable fetuses are not passed). PGF2𝛼 r and bromocriptine given in combination— DEFINITION Confirm pregnancy first, less than 40% of improves efficacy of either drug given alone. Termination of an unwanted pregnancy. May mismated bitches become pregnant: NURSING CARE ◦ Abdominal palpation (bitch: 31–33 days be accomplished by drugs that alter embryo N/A transport in the oviduct impeding after LH surge; queen: 21–25 days after ◦ ACTIVITY establishment of a pregnancy, and/or cause breeding). Transabdominal ultrasound > luteal regression, terminating an established (bitch: 25 days after LH surge; queen: Normal > ◦ pregnancy. Due to their possible side effects 16 days after breeding). Abdominal DIET > (CEH, aplastic anemia and bone marrow radiographs (bitch: 45 days after LH surge; Avoid feeding prior to each treatment and for > ◦ suppression), drugs that impair embryonic queen: 38 days after breeding). Serum 1–2 hours after treatments (reduces nausea > transit through the oviduct (estrogens) are not relaxin concentration in the bitch ( 28 days and vomiting). ® commonly used or recommended. after LH surge) (Witness Relaxin, Synbiotics/ CLIENT EDUCATION Zoetis Corp., http://synbiotics.com/index.html; PATHOPHYSIOLOGY r r (800)733-5500). Ascertain that a breeding Discuss patient’s reproductive future with After fertilization the embryo travels the owner. If no litters are desired, then OHE is took place; a tie in the bitch and coital r oviduct in a timely manner before entering “after-reaction” in the queen. the best option. Discuss with the client the the uterus. Impaired embryo transport potential side effects of the treatment options; DIFFERENTIAL DIAGNOSIS through the oviduct leads to embryonic r r r reach a mutual agreement on the treatment Hydrometra Mucometra Hematometra degeneration and implantation abnormalities. r r plan. In the dog and cat, pregnancy maintenance is Pyometra Pseudopregnancy SURGICAL CONSIDERATIONS dependent on progesterone production from CBC/BIOCHEMISTRY/URINALYSIS r OHE is recommended for patients with no the corpora lutea. In dogs and cats, Within normal limits during first half of r reproductive value or when owners do not maintenance of the corpora lutea during the pregnancy in healthy patients. Decrease in desire future litters. second half of gestation is also supported by PCV during second half of pregnancy in prolactin. Drugs that cause luteal regression, bitches and queens is normal. r antagonize PRL, and/or compete with Recommended as screening test prior to progesterone receptors will terminate treatment in patients with suspected MEDICATIONS pregnancy. underlying disease. SYSTEMS AFFECTED OTHER LABORATORY TESTS DRUG(S) OF CHOICE r r r r r Cardiovascular Digestive Neurologic Vaginal cytology—determines stage of Confirmation of pregnancy before initiating (caused by drugs used for treatment) any of the treatment protocols suggested r r estrous cycle and presence of sperm (absence Reproductive Respiratory does not rule out a previous breeding). below is recommended. Lengths of treatment GENETICS Methods to increase detection of sperm: suggested may vary; treatments should be continued until abortion is complete. N/A infuse and recover 5–10 mL of saline from ◦ PGF 𝛼: causes luteal regression with INCIDENCE/PREVALENCE anterior vagina using standard AI pipette, 2 centrifuge, examine pellet; collect routine subsequent decline in progesterone N/A cytology and allow swab to sit in 1–2 mL of concentration, cervical relaxation, and GEOGRAPHIC DISTRIBUTION saline, express fluid, centrifuge, examine uterine contractions; bitches and cats low r 𝜇 N/A pellet. Serum progesterone concentration dose protocol: 10 g/kg SC q6h for determines if the female is in diestrus and 7–10 days or until pregnancy terminated SIGNALMENT 𝜇 monitors luteal regression during treatment. (in the bitch), then 25 g/kg q6h for Species 𝜇 IMAGING 1–2 days; then 50 g/kg q6h for 3–4 days Dog and cat r (the queen is more resistant to the luteolytic Transabdominal ultrasound (method of Breed Predilections effects of PGF2𝛼 than bitches—often higher choice): diagnose pregnancy and monitor N/A doses for longer periods are required); bitch uterine evacuation during treatment. standard dose protocol: 100 𝜇g/kg SC q8h Mean Age and Range r Abdominal radiographs. for 2 days, then 200 𝜇g/kg SC q8h until Postpubertal bitch and queen PATHOLOGIC FINDINGS pregnancy termination; queens: Predominant Sex N/A 0.5–1 mg/kg SC q12h every other day > Pregnant bitch or queen day 40, or 2 mg/cat IM q24h for 5 days > SIGNS day 33. r ◦ Depends on stage of gestation: ◦ None Cloprostenol (prostaglandin analogue): 𝜇 ◦ Vaginal discharge ◦ Fetal expulsion TREATMENT bitches: 2.5 g/kg SC q8 or q12h every CAUSES 48 hours until pregnancy termination APPROPRIATE HEALTH CARE (∼6 days after start of treatment). r r r Impaired oviductal transport Luteal Physical examination before initiation of ◦ Dexamethasone: mode of action is r r regression Progesterone receptor antagonism treatment. Monitor 30–60 minutes after unknown; bitches: 0.2 mg/kg PO q8–12h RISK FACTORS treatment for side effects (vomiting, for 5 days, then decreasing from 0.16 to N/A defecation, hypersalivation, hyperpnea, 0.02 mg/kg over the last five days; r micturition, tachycardia). Pregnancy status treatment failures not uncommon. in early diestrus is unknown; ultrasound ◦ Cabergoline (PRL antagonist): causes confirmation of pregnancy is not possible luteal regression; bitches: 1.65 𝜇g/kg SC r until ∼4 weeks after breeding. Treatment on q24h for 5 days or 5 𝜇g/kg PO q24h for day 6–10 of diestrus—may have reduced 5days> day 40; queens: 1.65 𝜇g/kg SC for JWST589-A14-03 JWST589-Tilley Printer: Yet to Come August 26, 2015 10:36 279mm×216mm

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(Continued) Abortion, Termination of Pregnancy A

5days> day 30 or 5 𝜇g/kg PO q24h for ALTERNATIVE DRUG(S) EXPECTED COURSE AND PROGNOSIS r r 5days> day 35. The following drugs are recommended for The interestrous interval in bitches treated ◦ Bromocriptine (PRL antagonist): causes use in bitches but not available in the United with prostaglandins and PRL inhibitors may luteal regression; bitches: 50–100 𝜇g/kg States: ◦ Mifepristone (RU486; progestin and be shortened (∼1 month). Queens may q12h IM or PO for 4–7 days > day 35 glucocorticoid receptor antagonist): resume estrous behavior 7–10 days after r (50% effective); vomiting common side 2.5 mg/kg PO q12h for 4–5 days > day 32 of pregnancy termination. Subsequent estrus effect, reduce dose and give with meal. pregnancy (dog); no side effects have been fertility is not affected. ◦ Cloprostenol and cabergoline reported. ◦ Aglepristone (progestin and combination: bitches: cabergoline 5 𝜇g/kg glucocorticoid receptors antagonists): PO q24h for 10 days plus cloprostenol 10 mg/kg SC q24h for 2 days > 32 days 2.5 𝜇g/kg SC at start of treatment or post-LH surge (dog); pregnancy is terminated MISCELLANEOUS 1 𝜇g/kg SC at start of treatment and at day in 4–7 days; mild reaction at injection site 5 of treatment; treatment should be have been reported; mild vaginal discharge ASSOCIATED CONDITIONS initiated > 28 days post-LH surge; queen: may be observed. ◦ Aglepristone and N/A cabergoline 5 𝜇g/kg PO q24h plus cloprostenol combination: aglepristone AGE-RELATED FACTORS 𝜇 > cloprostenol 5 g/kg SC q48h ( 30 days (10 mg/kg SC) combined with cloprostenol N/A after breeding) until abortion is complete (1 𝜇g/kg SC) q24h for 2 days > 25 days ZOONOTIC POTENTIAL (∼ 9 days). pregnancy; pregnancy is terminated within ◦ Cloprostenol and bromocriptine 6 days. Side effects after treatment include N/A combination: bitches; bromocriptine vomiting and diarrhea. Vaginal discharge may PREGNANCY/FERTILITY/BREEDING 30 𝜇g/kg q8h PO for 10 days plus be observed. ◦ Aglepristone (10 mg/kg SC, N/A 𝜇 𝜇 cloprostenol 2.5 g/kg SC or 1 g/kg SC at q24h for 2 days) with intravaginal misoprostol SYNONYMS start of treatment and at day 5 of treatment; (200–400 𝜇g, depending on body size) daily Induced abortion treatment should be initiated > 28 days until abortion complete; abortion complete post-LH surge. within 7 days. Vomiting, diarrhea, polydipsia, SEE ALSO CONTRAINDICATIONS anorexia not observed with this regimen Breeding, Timing r ◦ GnRH antagonists (Acyline; blocks GnRH ABBREVIATIONS PGF2𝛼 and analogues: animals with r receptors at the pituitary gland, causing a CEH = cystic endometrial hyperplasia respiratory disease (bronchoconstriction); do r r decline in gonadotropins concentration): a GnRH = gonadotropin-releasing hormone not administer intravenously. Cabergoline 𝜇 r r single treatment with 110–330 g/kg SC is LH = luteinizing hormone OHE = and bromocriptine: avoid administration in r animals hypersensitive to ergot alkaloids; use recommended (dog); pregnancy is terminated ovariohysterectomy PCV = packed cell within 6–10 days after treatment; r with caution in patients with significantly volume PGF 𝛼 = prostaglandin F 𝛼 r r 2 2 impaired liver function. Estrogens may prepartum-like behavior has been observed; PRL = prolactin cause cystic endometrial hyperplasia, abortion may be followed by serosanguineous vaginal discharge for 2–3 days; not yet Suggested Reading pyometra, and bone marrow suppression Gobello C, Castex G, Corrada Y, Klima L, leading to pancytopenia. available in the US (currently in Phase I clinical trials for prostate cancer in men). De la Sota RL, Rodriquez R. Use of PRECAUTIONS prostaglandins and bromocriptine mesylate r PGF2𝛼 and analogues: side effects are for pregnancy termination in bitches. J Am dose-dependent and include vomiting, Vet Med Assoc 2002, 220(7):1017–1019. defecation, dyspnea, tachycardia, salivation, FOLLOW-UP Eilts BE. Pregnancy termination in the bitch restlessness, and anxiety; side effects subside and queen. Clin Tech Small Anim Pract within 60 minutes; the severity of effects can PATIENT MONITORING 2002, 17:116–123. be attenuated with premedication (> 15 In animals treated with luteolytic drugs FieniF,DumonC,TainturierD,BruyasJF. minutes) with a combination of atropine (prostaglandins and PRL antagonists), Clinical protocol for pregnancy termination (0.025 mg/kg); use extreme caution in dogs progesterone assays and transabdominal in bitches using prostaglandin F2𝛼.JReprod and cats with preexisting cardiopulmonary, Fertil Suppl 1997, 51:245–250. r ultrasound examinations should be performed liver, and renal diseases. Dexamethasone: to monitor decrease of serum progesterone Johnston SD, Root Kustritz MV, Olson PNS. polydipsia, polyuria, and polyphagia are concentration and complete evacuation of Prevention and termination of canine reported side effects. Long- term uterine contents. In patients treated with pregnancy. In: Canine and Feline administration has been associated with Theriogenology. Philadelphia: Saunders, r progesterone receptor antagonist drugs, hyperadrenocorticism. Cabergoline and transabdominal ultrasound examinations are 2001, pp. 168–192. bromocriptine: should be administered with recommended to monitor complete Johnston SD, Root Kustritz MV, Olson PNS. caution in patients with impaired liver evacuation of the uterus. Prevention and termination of feline function. Side effects may include vomiting PREVENTION/AVOIDANCE pregnancy. In: Canine and Feline and anorexia; prolonged use (> 2 weeks) may r Theriogenology. Philadelphia: Saunders, OHE for bitches and queens not intended cause coat color changes. r 2001, pp. 447–452. for breeding. Estrus suppression or Author Jose A. Len POSSIBLE INTERACTIONS confinement of bitches and queens intended r Consulting Editor Sara K. Lyle PGF2𝛼 and analogues: effect may be for breeding during a later cycle to avoid reduced by concomitant administration of mismating. progestins; use may enhance effects of r POSSIBLE COMPLICATIONS Client Education Handout oxytocin. Cabergoline and bromocriptine: Pregnancy termination may not be achieved available online cabergoline effects may be reduced with after one treatment protocol and continuation concomitant treatment with dopamine (D ) 2 or change in treatment protocol may be antagonists; avoid concomitant treatment necessary. with hypotensive drugs. JWST589-A15-04 JWST589-Tilley Printer: Yet to Come August 1, 2015 10:24 279mm×216mm

8 Blackwell’s Five-Minute Veterinary Consult A Abscessation

r r History of traumatic insult or previous Neoplasia—variable growth; consistent; infection. painful. r A rapidly appearing painful swelling with or Draining Tracts BASICS r without discharge, if affected area is visible. Mycobacterial disease r DEFINITION Physical Examination Findings Mycetoma—botryomycosis, actinomycotic r An abscess is a localized collection of purulent Determined by the organ system or tissue mycetoma, eumycotic mycetoma r exudate contained within a cavity. affected. Neoplasia r r PATHOPHYSIOLOGY Classic signs of inflammation (heat, pain, Phaeohyphomycosis r r swelling, and loss of function) are associated Sporotrichosis Bacteria are often inoculated under the skin r with specific anatomic location of the abscess. Systemic fungal infection—blastomycosis, via a puncture wound; the wound surface r then seals. Inflammation and discharge from a fistulous coccidioidomycosis, cryptococcosis, r When bacteria and/or foreign objects persist tract may be visible if the abscess is superficial histoplasmosis, trichosporosis and has ruptured to an external surface. in the tissue, purulent exudate forms and r CBC/BIOCHEMISTRY/URINALYSIS collects. A variably sized, painful mass of fluctuant to r r CBC—normal or neutrophilia with or Accumulation of purulent exudates—if not firm consistency attached to surrounding without regenerative left shift. Neutropenia tissues may be palpable. quickly resorbed or discharged to an external r and degenerative left shift if sepsis present. Fever if abscess is not ruptured and draining. r surface, stimulates formation of a fibrous r Urinalysis and serum chemistry capsule; may eventually lead to abscess Sepsis occasionally, especially if abscess profile—depends on system affected. r rupture. ruptures internally. Prostatic—pyuria. r r Prolonged delay of evacuation—formation CAUSES Liver and/or pancreatic—high liver enzymes r of a fibrous abscess wall; to heal, the cavity Foreign objects. and/or total bilirubin. r r must be filled with granulation tissue from Pyogenic bacteria—Staphylococcus spp.; Pancreatic (dogs)—high amylase/lipase. r which the causative agent may not be totally Escherichia coli; 𝛽-hemolytic Streptococcus Diabetes mellitus—persistent eliminated; may lead to chronic or spp.; Pseudomonas; Mycoplasma and hyperglycemia and glucosuria. intermittent discharge of exudate from a Mycoplasma-like organisms (l-forms); OTHER LABORATORY TESTS draining sinus tract. r Pasteurella multocida; Corynebacterium; FeLV and FIV—for cats with recurrent or SYSTEMS AFFECTED Actinomyces spp.; Nocardia; Bartonella. r slow-healing abscesses. r r Skin/Exocrine—percutaneous (cats > dogs); Obligate anaerobes—Bacteroides spp.; CSF evaluation—increase in cellularity and anal sac (dogs > cats) Clostridium spp.; Peptostreptococcus; protein expected with brain abscess. r r Reproductive—prostate gland (dogs > cats); Fusobacterium. Adrenal function— evaluate for mammary gland RISK FACTORS hyperadrenocorticism. r r Ophthalmic—periorbital tissues Anal sac—impaction; anal sacculitis. r r IMAGING Hepatobiliary—liver parenchyma Brain—otitis interna sinusitis oral infection. r r r Radiography—soft-tissue density mass in Gastrointestinal—pancreas (dogs > cats) Liver—omphalophlebitis sepsis. r affected area; may reveal foreign body. r GENETICS Lung—foreign object aspiration bacterial Ultrasonography—determine if mass is pneumonia. N/A r fluid filled or solid; determine organ system Mammary gland—mastitis. INCIDENCE/PREVALENCE r affected; reveal flocculent-appearing fluid Periorbital—dental disease; chewing of characteristic of pus; may reveal foreign N/A wood or other plant material. r object. GEOGRAPHIC DISTRIBUTION Percutaneous—fighting, trauma, or surgery. r r Echocardiography—helpful for diagnosis of Prostate gland—bacterial prostatitis. N/A r pericardial abscess. r SIGNALMENT Immunosuppression—FeLV/FIV infection, CT or MRI—helpful for diagnosis of brain immunosuppressive chemotherapy, acquired abscess. Species or inherited immune system dysfunctions, Cat and dog underlying predisposing disease (e.g., diabetes DIAGNOSTIC PROCEDURES Breed Predilections mellitus, chronic renal failure, Aspiration r N/A hyperadrenocorticism). Reveals a red, white, yellow, or green liquid. r Protein content > 2.5–3.0 g/dL. Mean Age and Range r N/A Nucleated cell count—3,000–100,000 (or more) cells/𝜇L; primarily degenerative Predominant Sex DIAGNOSIS neutrophils with lesser numbers of Mammary glands (female); prostate gland macrophages and lymphocytes. r (male) DIFFERENTIAL DIAGNOSIS Pyogenic bacteria—may be seen in cells and SIGNS Mass Lesions free within the fluid. r r General Comments Cyst—less or only transiently painful; If the causative agent is not readily r slower growing. identified with a Romanowsky-type stain, Determined by organ system and/or tissue r affected. Fibrous scar tissue—firm; non-painful. specimens should be stained with an acid-fast r r Associated with a combination of Granuloma—less painful; slower growing; stain to detect mycobacteria or Nocardia and generally firmer without fluctuant center. PAS stain to detect fungus. inflammation (pain, swelling, redness, heat, r and loss of function), tissue destruction, Hematoma/seroma—variable pain (depends Biopsy r and/or organ system dysfunction caused by on cause); non-encapsulated; rapid initial Sample should contain both normal and accumulation of exudates. growth but slow increase once full size is abnormal tissue in the same specimen. r Historical Findings attained; unattached to surrounding tissues; Impression smears—stained and examined. r r Often presented for nonspecific signs such fluctuant and fluid filled initially but more Tissue—submit for histopathologic as lethargy and anorexia. firm with organization. examination and culture. JWST589-A15-04 JWST589-Tilley Printer: Yet to Come August 1, 2015 10:24 279mm×216mm

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(Continued) Abscessation A

r Contact the diagnostic laboratory for SURGICAL CONSIDERATIONS EXPECTED COURSE AND PROGNOSIS r specific instructions. Appropriate debridement and drainage— Depends on organ system involved and Culture may need to leave the wound open to an amount of tissue destruction. r Affected tissue and/or exudate—aerobic and external surface; may need to place surgical anaerobic bacteria and fungus. drains. r r Blood and/or urine—isolate bacterium Early drainage—to prevent further tissue responsible for possible sepsis. damage and formation of abscess wall. MISCELLANEOUS r r Bacterial sensitivity. Remove any foreign objects(s), necrotic tissue, or nidus of infection. ASSOCIATED CONDITIONS PATHOLOGIC FINDINGS r FeLV or FIV infection r r Pus-containing mass lesion accompanied by Immunosuppression inflammation. r AGE-RELATED FACTORS Palpable—variably firm or fluctuant mass. r Ruptured—may see pus draining directly MEDICATIONS N/A from the mass or an adjoining tract. DRUG(S) OF CHOICE ZOONOTIC POTENTIAL r r Exudate—large numbers of neutrophils in r Minimal for pyogenic bacteria. Antimicrobial drugs—effective against the r various stages of degeneration; other infectious agent; gain access to site of Mycobacteria and systemic fungal infections inflammatory cells; necrotic tissue. infection. carry some potential. r r Surrounding tissue—congested; fibrin; large Broad-spectrum agent—bactericidal and PREGNANCY/FERTILITY/BREEDING number of neutrophils; variable number of with both aerobic and anaerobic activity; until Teratogenic agents—avoid use in pregnant lymphocytes; plasma cells; macrophages. r results of culture and sensitivity are known. animals. Causative agent variably detectable. Dogs and cats: amoxicillin (11–22 mg/kg PO SEE ALSO q8–12h); amoxicillin/clavulanic acid r Actinomycosis (12.5–25 mg/kg PO q12h); clindamycin r Anaerobic Infections (5 mg/kg PO q12h); and trimethoprim/ r Colibacillosis TREATMENT sulfadiazine (15 mg/kg PO IM q12h). Cats r Mycoplasmosis with Mycoplasma and l-forms: doxycycline r APPROPRIATE HEALTH CARE Nocardiosis (5 mg/kg PO q12h). r r r Depends on location of abscess and Aggressive antimicrobial therapy—sepsis or Sepsis and Bacteremia treatment required. peritonitis. ABBREVIATIONS r r Outpatient—bite-induced abscesses. CSF = cerebrospinal fluid r CONTRAINDICATIONS r Inpatient—sepsis; extensive surgical CT = computed tomography N/A r procedures; treatment requiring extended FeLV = feline leukemia virus r hospitalization. PRECAUTIONS FIV = feline immunodeficiency virus r r Establish and maintain adequate drainage. N/A MRI = magnetic resonance imaging r r Surgical removal of nidus of infection or POSSIBLE INTERACTIONS PAS = periodic acid-Schiff foreign object(s) if necessary. r N/A Institution of appropriate antimicrobial Suggested Reading therapy. ALTERNATIVE DRUG(S) Birchard SJ, Sherding RG, eds., Saunders NURSING CARE N/A Manual of Small Animal Practice. r Philadelphia: Saunders, 1994. Depends on location of abscess. r DeBoer DJ. Nonhealing cutaneous wounds. Apply hot packs to inflamed area as needed. r In: August JR, ed., Consultations in Feline Use protective bandaging and/or Internal Medicine. Philadelphia: Saunders, Elizabethan collars as needed. FOLLOW-UP r 1991, pp. 101–106. Accumulated exudate—drain abscess; PATIENT MONITORING McCaw D. Lumps, bumps, masses, and maintain drainage by medical and/or surgical Monitor for progressive decrease in drainage, lymphadenopathy. In: Ettinger SJ, Feldman means. r resolution of inflammation, and improvement EC, eds., Textbook of Veterinary Internal Sepsis or peritonitis—aggressive fluid of clinical signs. Medicine, 4th ed. Philadelphia: Saunders, therapy and support. PREVENTION/AVOIDANCE 1995, pp. 219–222. ACTIVITY r Percutaneous abscesses—prevent fighting. Author Adam J. Birkenheuer r Restrict until the abscess has resolved and Anal sac abscesses—prevent impaction; Consulting Editor StephenC.Barr adequate healing of tissues has taken place. consider anal saculectomy for recurrent cases. Acknowledgment The author and editors r DIET Prostatic abscesses—castration possibly acknowledge the prior contributions of r Sufficient nutritional intake to promote a helpful. Johnny D. Hoskins. r positive nitrogen balance. Mastitis—prevent lactation (spaying). r r Depends on location of abscess and Periorbital abscesses—do not allow chewing Client Education Handout treatment required. on foreign object(s). available online CLIENT EDUCATION POSSIBLE COMPLICATIONS r r Discuss need to correct or prevent risk Sepsis. r factors. Peritonitis/pleuritis if intra-abdominal or r Discuss need for adequate drainage and intrathoracic abscess ruptures. r continuation of antimicrobial therapy for an Compromise of organ function. r adequate period of time. Delayed evacuation may lead to chronically draining fistulous tracts. JWST589-A16-05 JWST589-Tilley Printer: Yet to Come August 1, 2015 10:44 279mm×216mm

10 Blackwell’s FiveMinute Veterinary Consult A Acetaminophen (apap) Toxicosis

INCIDENCE/PREVALENCE Other causes of methemoglobinemia r Common drug toxicity in cats; less frequent Onions/garlic r in dogs. Naphthalene BASICS r Chlorates GEOGRAPHIC DISTRIBUTION r DEFINITION Nitrites N/A r Sulfites Results from accidental animal ingestion or r SIGNALMENT Phenol owner administration of over-the-counter r Species Benzocaine acetaminophen-containing analgesic and r antipyretic medications. Cats more often than dogs Propylene glycol (cats) PATHOPHYSIOLOGY SIGNS CBC/BIOCHEMISTRY/URINALYSIS r When the normal biotransformation General Comments Methemoglobinemia and progressively mechanisms for detoxification Relatively common—owing to widespread rising serum concentrations of liver enzymes (ALT, AST)—characteristic. (glucuronidation and sulfation) are saturated, human use. r As hepatic function becomes impaired— cytochrome P450-mediated oxidation Historical Findings r decreased BUN, cholesterol, and albumin, produces a toxic metabolite (N-acetyl-p- Depression r and increased serum bilirubin. benzoquinone imine) that is electrophilic, Hyperventilation r r Heinz bodies (cats)—prominent in RBCs conjugates with glutathione, and binds to Darkened mucous membranes r within 72 hours. sulfhydryl groups leading to hepatic necrosis. Signs may develop 1–4 hours after dosing r Anemia, hemoglobinemia, and Dogs Physical Examination Findings r r hemoglobinuria or hematuria. Liver is most susceptible to toxicity. Progressive depression r r OTHER LABORATORY TESTS Signs commonly observed at exposures Salivation > r 100 mg/kg. Vomiting Acetaminophen plasma, serum, or urine r r Methemoglobinemia may develop at doses Abdominal pain concentrations > r 200 mg/kg. Tachypnea and cyanosis or muddy mucous IMAGING Cats membranes—reflect methemoglobinemia N/A r r Cannot effectively glucuronidate; more Edema—face, paws, and possibly forelimbs; DIAGNOSTIC PROCEDURES limited capacity for acetaminophen after several hours r N/A elimination than dogs. Chocolate-colored urine—hematuria and r Saturate glucuronidation and sulfation methemoglobinuria; especially in cats PATHOLOGIC FINDINGS r r biotransformation routes. Icterus Methemoglobinemia. r r r RBCs are most susceptible to oxidative Hypothermia Pulmonary edema. r r injury following glutathione depletion. Shock Centrilobular necrosis and congestion of the r r liver. Develop toxic cytochrome P450 metabolite Death r at much lower doses than dogs. CAUSES Renal tubular edema and degeneration with r proteinaceous tubular casts. Poisoned by as little as 50–60 mg/kg (often Acetaminophen toxicosis as little as one-half tablet); deacetylation of RISK FACTORS acetaminophen to p-aminophenol (PAP) r causes oxidative damage to RBCs, rapidly Nutritional deficiencies of glucose and/or sulfate producing methemoglobinemia by binding to r TREATMENT sulfhydryl groups on hemoglobin. Simultaneous administration of other r APPROPRIATE HEALTH CARE Slower-developing hepatotoxicosis may not glutathione-depressing drugs r be fully expressed before development of fatal With methemoglobinemia—must evaluate promptly. methemoglobinemia. r SYSTEMS AFFECTED With dark or bloody colored urine or r icterus—inpatient. Hemic/Lymph/Immune—RBCs are DIAGNOSIS NURSING CARE damaged by glutathione depletion, allowing DIFFERENTIAL DIAGNOSIS r oxidation of hemoglobin to methemoglobin. Gentle handling—imperative for clinically r Other causes of liver injury Hepatobiliary—liver necrosis (more r affected patients. Hepatotoxic mushrooms r commonindogs). r Induced emesis and gastric lavage—useful r Blue-green algae Cardiovascular (primarily cats)—edema of r within 4–6 hours of ingestion. Aflatoxins r the face, paws, and (to a lesser degree) r Anemia, hematuria, or hemoglobinuria— Iron, copper, zinc forelimbs through an undefined mechanism. r may require whole blood transfusion. Xylitol r GENETICS r Fluid therapy—maintain hydration and Cycad palms electrolyte balance. r r Cats—genetic deficiency in the glucuronide NSAIDs Oxygen therapy may be needed. r conjugation pathway makes them vulnerable. Drinking water—available at all times. r Food—offered 24 hours after initiation of treatment. JWST589-A16-05 JWST589-Tilley Printer: Yet to Come August 1, 2015 10:44 279mm×216mm

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(Continued) Acetaminophen (apap) Toxicosis A

ACTIVITY PREVENTION/AVOIDANCE SYNONYMS r r Restricted Never give acetaminophen to cats. Paracetamol r r DIET Give careful attention to the acetaminophen Tylenol N/A dose in dogs. SEE ALSO CLIENT EDUCATION POSSIBLE COMPLICATIONS Poisoning (Intoxication) Therapy r Warn client that treatment in clinically Liver necrosis and resulting fibrosis—may ABBREVIATIONS r affected patients may be prolonged and compromise long-term liver function in PAP = p-aminophenol r expensive. recovered patients. ALT = alanine aminotransferase r r Inform client that patients with liver injury EXPECTED COURSE AND PROGNOSIS AST = aspartate transaminase r r may require prolonged and costly Rapidly progressive methemoglobinemia— RBC = red blood cell r management. serious sign. D5W = 5% dextrose injection r SURGICAL CONSIDERATIONS Methemoglobin concentrations ≥ 50%— INTERNET RESOURCES grave prognosis. N/A r http://www.aspca.org/pet-care/poison- Progressively rising serum liver enzymes control/ 12–24 hours after ingestion—serious concern. r Expect clinical signs to persist 12–48 hours; Suggested Reading death owing to methemoglobinemia possible Plumb DC. Acetaminophen. In: Plumb DC, MEDICATIONS at any time. ed., Plumb’s Veterinary Drug Handbook, r DRUG(S) OF CHOICE Dogs and cats receiving prompt treatment 7th ed. Ames, IA: Wiley-Blackwell, 2011, r Activated charcoal 2 g/kg PO; immediately that reverses methemoglobinemia and pp. 6–8. after completion of emesis or gastric lavage. prevents excessive liver necrosis—may recover Plumlee KH. Hematic system. In: Plumlee r fully. KH, ed., Clinical Veterinary Toxicology. N-acetylcysteine (Mucomyst) 140 mg/kg r diluted in D5W as loading dose PO, IV; then Dogs—death as a result of liver necrosis St. Louis, MO: Mosby, 2004, p. 59. may occur within 72 hours. Schell MM, Gwaltney-Brant S. OTC drugs. 70 mg/kg diluted in D5W PO, IV, q6h for r 5–7 additional treatments. Cats—death as a result of methemo- In: Poppenga RH, Gwaltney-Brant SM, r S-adenosylmethionine (SAMe) as a globinemia occurs 18–36 hours after eds., Small Animal Toxicology Essentials. glutathione donor; 40 mg/kg PO × 1dose, ingestion. Chichester, UK: Wiley-Blackwell, 2011, then 20 mg/kg q24h PO × 7days. pp. 231–233. r Added benefit of using methylene blue, Sellon RK. Acetaminophen. In: Peterson ME, cimetidine, and/or ascorbic acid is Talcott PA, eds. Small Animal Toxicology, controversial. MISCELLANEOUS 3rd ed. St. Louis, MO: Elsevier, 2013, pp. 423–429. CONTRAINDICATIONS ASSOCIATED CONDITIONS Stockham SL, Scott MA. Fundamentals of Drugs that contribute to methemoglobinemia Keratoconjunctivitis sicca (KCS) may develop Veterinary Clinical Pathology, 2nd ed. or hepatotoxicity. in small-breed dogs as a sequela. Oxford: Blackwell, 2008, p. 186. PRECAUTIONS AGE-RELATED FACTORS Author Lisa A. Murphy Drugs requiring extensive liver metabolism or Young and small dogs and cats—greater risk Consulting Editor Lynn R. Hovda biotransformation—use with caution; expect from owner-given single-dose acetaminophen their half-lives to be extended. medications. Client Education Handout POSSIBLE INTERACTIONS ZOONOTIC POTENTIAL available online Drugs requiring activation or metabolism by None the liver have reduced effectiveness. PREGNANCY/FERTILITY/BREEDING Imposes additional stress and higher risk on exposed animals. FOLLOW-UP PATIENT MONITORING r Continual clinical monitoring of methemoglobinemia—vital for effective management; laboratory determination of methemoglobin percentage every 2–3 hours. r Serum liver enzyme activities (ALT, ALP) every 12 hours; monitor liver damage. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

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Appendix IX Mark G. Papich

Blackwell’s Five-Minute Consult Drug Formulary

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Acepromazine Phenothiazine Phenothiazines can Usually used as 5, 10, 25 mg tablet and Dog: Sedation (PromAce and many tranquilizer. Inhibits cause sedation as a preanesthetic in 10 mg/mL injection 0.5–2.2 mg/kg PO generic brands) action of dopamine as common side effect. combination with other q6–8h, or neurotransmitter. Used May cause drugs. When used as 0.02–0.1 mg/kg IV, IM, for sedation and 𝛼-adrenergic blockade. preanesthetic, dose SC in a single dose. Do preanesthetic Produces is ordinarily not exceed 3 mg total purposes. extrapyramidal side 0.02–0.2 mg/kg IM, dose in dogs effects in some SC, IV. Cat: Sedation individuals. 1.13–2.25 mg/kg PO q6–8h, or 0.02–0.1 mg/kg IM, SC, IV in a single dose Acetaminophen Analgesic agent. Exact Well tolerated in dogs Many OTC 120, 160, 325, 500 mg Dog: 15 mg/kg PO q8h (Tylenol and many mechanism of action is at doses listed. High formulations available. tablets Cat: not recommended generic brands) not known. Not a doses have caused liver Acetaminophen with prostaglandin toxicity. Do not codeine may have synthesis inhibitor. administer to cats. synergistic analgesic efficacy in some animals. Acetaminophen with Same as above, except See Codeine and See Codeine and Oral solution and Dog: Follow dosing codeine (Tylenol with the opiate codeine is Acetaminophen. Acetaminophen. tablets. Many forms, recommendations for codeine and many added to enhance for example: 300 mg codeine generic brands) analgesia acetaminophen plus Cat: Contraindicated either 15, 30, or 60 mg codeine Acetazolamide Glaucoma, Ca inhibitor Can potentially In combination with 125, 250 mg tablets 5–10 mg/kg PO (Diamox) produce hypokalemia other agents, is usually q8–12h (glaucoma); in some patients. used to decrease 4–8 mg/kg PO q8–12h Significant bicarbonate intraocular pressure in (other diuretic uses) loss can occur with treatment of glaucoma. repeated Hasbeenusedto administration. In dogs, produce alkaline urine possible respiratory to prevent formation of acidosis. some urinary calculi. Acetylcysteine Decreases viscosity of May cause Available as agent for 20% solution Antidote: 140 mg/kg (Mucomyst) secretions. Used as sensitization with decreasing viscosity of (loading dose), then mucolytic agent in eyes prolonged topical respiratory secretions, 70 mg/kg q4h IV or PO and in bronchial administration. May but most common use for 5 doses nebulizing solutions. react with certain is as a treatment for Eye: 2% solution However, as a donator materials in nebulizing intoxications topically q2h of sulfhydral group, equipment. used as antidote for intoxications (e.g., acetaminophen toxicosis in cats). Acetylsalicylic acid See Aspirin. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

1446 Blackwell’s Five-Minute Veterinary Consult

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) ACTH See Corticotropin. Activated charcoal See Charcoal, activated. Adequan See Polysulfated glycosaminoglycan (PSGAG). Albendazole Benzimidazole At approved doses, Used primarily as 113.6 mg/mL 25–50 mg/kg q12h (Valbazen) antiparasitic drug. there is a wide margin antihelmintic, but also suspension and PO × 3days Inhibits glucose uptake of safety. Adverse has demonstrated 300 mg/mL paste For Giardia,use in parasites. effects can include efficacy for giardiasis 25 mg/kg q12h × anorexia, lethargy, and 2days bone marrow toxicity. For respiratory At high doses, has parasites, use 50 mg/kg been associated with q24h PO × 10–14 days bone marrow toxicity. Adverse effects are possible when administered for longer than 5 days. 𝛽 𝜇 Albuterol (Proventil, 2-adrenergic agonist. Causes excessive Doses are primarily 2, 4, 5 mg tablets; 20–50 g/kg q6–8h; or Ventolin) Bronchodilator. 𝛽-adrenergic derived from 2mg/5mLsyrup up maximum of 𝛽 𝜇 Stimulates 2 receptors stimulation at high extrapolation of human 100 g/kg q6h to relax bronchial doses (tachycardia, dose. Well-controlled smooth muscle. May tremors). Arrhythmias efficacy studies in also inhibit release of occur at toxic doses. veterinary medicine are inflammatory Avoid use in pregnant not available. Onset of mediators, especially animals. action is 15–30 min; from mast cells. duration of action may be as long as 8 h. Allopurinol (Lopurin, Decreases production May cause skin Used in people 100, 300 mg tablets For urate urolith, Zyloprim) of uric acid by reactions primarily for treating 10 mg/kg q8h, then inhibiting enzymes (hypersensitivity) gout. In animals, used reduce to 10 mg/kg responsible for uric to decrease formation q24h, PO acid synthesis. Also of uric acid uroliths. For leishmaniasis, use used for leishmaniasis 10 mg/kg q12h PO for at least 4 months Alprazolam (Xanax) Tranquilizer Excess sedation; Often combined with 0.25, 0.5, 1, and 2 mg Dog: 0.025–0.1 mg/kg Benzodiazepine paradoxical excitement other sedatives and tablets q8h, PO anesthetics Cat: 0.125 mg per cat, PO q8h Alumunium carbonate Antacid (neutralizes Generally safe. May Antacid doses are Capsules (equivalent to 10–30 mg/kg PO q8h gel (Basaljel) stomach acid), and interact with other designed to neutralize 500 mg aluminum (with meals) phosphate binder in drugs administered stomach acid, but hydroxide) intestine orally. duration of acid suppression is short. Aluminium hydroxide Antacid (neutralizes Generally safe. May Antacid doses are 64 mg/mL oral 10–30 mg/kg PO q8h gel (Amphojel) stomach acid), and interact with other designed to neutralize suspension; 600 mg (with meals) phosphate binder in drugs administered stomach acid, but tablet intestine orally. duration of acid suppression is short. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

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Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Amikacin Aminoglycoside May cause Once-daily doses are 50, 250 mg/mL Dog: 15–30 mg/kg q24h IV, (Amiglyde-V antibacterial drug nephrotoxicosis with designed to maximize injection IM, SC [veterinary] and (inhibits protein high doses or peak minimum Cat: 10–14 mg/kg q24h IV, Amikin [human]) synthesis). Mechanism prolonged therapy. inhibitory IM, SC is similar to other May also cause concentration (MIC) aminoglycosides (see ototoxicity and ratio. Gentamicin sulfate), vestibulotoxicity. but may be more active than gentamicin. Aminopentamide Antidiarrheal drug. Use cautiously in Dosing guidelines 0.2 mg tablets; Dog: 0.01–0.03 mg/kg (Centrine) Anticholinergic (blocks animals with Gl stasis based on 0.5 mg/mL q8–12h IM, SC, PO acetylcholine at or when manufacturer’s injection Cat: 0.1 mg/cat q8–12h IM, parasympathetic anticholinergic drugs recommendation SC, PO synapse). are contraindicated (e.g., glaucoma). 6-Aminosalicylic acid See Mesalamine, Olsalazine. Amiodarone Class III antiarrhythmic Most common effect in Use for recurrent 100, 200, 300, Dog: start with 10–15 mg/kg (Cordarone) agent with dogs is decreased hemodynamically 400 mg tablets; q12h PO for 1 week, then potassium-channel appetite. Prolonged QT unstable ventricular 50 mg/mL 5–7 mg/kg q12h for 2 weeks blocking properties; interval is a concern. tachycardia; takes injection Maintenance doses are indicated for severe Other adverse effects weeks to achieve 7.5 mg/kg q24h, PO refractory atrial and include: bradycardia, therapeutic levels. Cat: no safe dose established ventricular arrhythmias chronic heart failure Typically, loading doses (CHF), hypotension, are administered, atrioventricular (AV) followed by block, thyroid maintenance dose. dysfunction, pulmonary Safe doses for injection fibrosis, and have not been hepatotoxicity. Acute established. cardiac toxicity has been observed in dogs. Amitraz (Mitaban) Antiparasitic drug for Causes sedation in Manufacturer’s dose 10.6 mL 10.6 mL per 7.5 L water ectoparasites. Used for dogs (𝛼2-agonist), should be used initially. concentrated dip (0.025% solution). Apply 3–6 treatment of mites, which may be reversed But, for refractory (19.9%) topical treatments q14d. For including Demodex. by yohimbine or cases, this dose has refractory cases, this dose Inhibits monoamine atipamezole. When been exceeded to has been exceeded to oxidase in mites. high doses are used, produce increased produce increased efficacy. other side effects efficacy. Doses that have been used reported include include: 0.025, 0.05, and pruritus, polyuria and 0.1% concentration applied polydipsia (PU/PD), 1–2× per week bradycardia, Iin extreme cases 0.125% hypothermia, solution applied to one-half hyperglycemia, and of the body alternating side (rarely) seizures. the next day, every day for 4 weeks to 5 months JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

1448 Blackwell’s Five-Minute Veterinary Consult

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Amitriptyline Tricyclic antidepressant Multiple side effects Doses are primarily 10, 25, 50, 75, 100, Dog: 1–2 mg/kg PO hydrochloride (Elavil) drug. Action is via are associated with based on empiricism. 150 mg tablets q12–24h inhibition of uptake of tricyclic There are no controlled Cat: 2–4 mg per serotonin and other antidepressants, such efficacy trials available cat/day PO transmitters at as antimuscarinic for animals. There is (0.5–1.0 mg/kg PO/day. presynaptic nerve effects (dry mouth, evidence for success May be divided into terminals. Used in rapid heart rate) and treating idiopathic 12h intervals.); cystitis: animals to treat variety antihistamine effects cystitis in cats. 2 mg/kg/day PO of behavioral disorders, (sedation). High doses Clomipramine is (2.5–7.5 mg/cat/day) such as anxiety. Used can produce preferred for behavior in cats for chronic life-threatening problems. idiopathic cystitis. cardiotoxicity. In cats, reduced grooming, weight gain, and sedation are possible. Amlodipine besylate Calcium Can cause hypotension In cats, efficacy has 2.5, 5, and 10 mg Dog: 2.5 mg/dog, or (Norvasc) channel-blocking drug and bradycardia. Use been established at tablets 0.1 mg/kg once of the dihydropyridine cautiously with other 0.625 mg/cat once daily PO class. Decreases vasodilators. daily. If cats are large Cat: 0.625 mg/cat calcium influx in size (> 4.5 kg) or initially, PO once daily, cardiac and vascular refractory, increase to and increase if needed smooth muscle. Its higher dose (J Vet Int to 1.25 mg/cat greatest effect is as a Med 12:157–162, (average is 0.18 mg/kg, vasodilator. In cats and 1998). once daily for dogs, it is used to treat hypertension) hypertension. Ammonium chloride Urine acidifier Do not use in patients Doses are designed to Available as crystals Dog: 100 mg/kg (generic) with systemic maximize urine q12h PO acidemia. May be acidifying effect. Cat: 800 mg/cat unpalatable when (approximately 1/3 to added to some 1/4 tsp) mixed with animals’ food. food daily Amoxicillin 𝛽-lactam antibiotic. Usually well tolerated. Dose recommendations 50, 100, 150, 200, 6.6–20 mg/kg (Amoxi-Tabs, Biomox, Inhibits bacterial: cell Allergic reactions are vary depending on the 400 mg tablets; 250 q8–12h PO and other brands. wall synthesis. possible. Diarrhea is susceptibility of and 500 mg capsules; [Omnipen, Principen, Generally possible with oral bacteria and location 50 mg/mL oral Totacillin are human broad-spectrum doses. of infection. suspension (human forms]) activity. Used for a forms) variety of infections in all species. Amoxicillin + 𝛽-lactam antibiotic + Same as for amoxicillin Same as for amoxicillin 62.5, 125, 250, 375 mg Dog: 12.5–25 mg/kg clavulanate potassium 𝛽-lactamase inhibitor tablets and q12h PO (Clavamox) (clavulanate/clavulanic 62.5 mg/mL suspension Cat: 62.5 mg/cat q12h acid) PO. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

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Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Amphotericin B Antifungal drug. Produces a Administer IV via slow 50 mg injectable vial Dog: 0.5 mg/kg IV (Fungizone) Fungicidal for systemic dose-related infusion diluted in (slow infusion) q48h to fungi, by damaging nephrotoxicosis. Also fluids, and monitor a cumulative dose of fungal membranes. produces fever, renal function closely. 4–8 mg/kg phlebitis, and tremors. When preparing IV Cat: 0.25 mg/kg IV solution, do not mix (slow infusion) q48h with electrolyte solutions (use D-5-W, for example); administer NaCI fluid loading before therapy. Amphotericin B, Same indications as for Renal toxicity is the Higher doses can be 100 mg/20 mL in lipid Dog: 2–3 mg/kg IV liposomal formulation conventional most dose-limiting used compared to formulation 3 times/week for 9–12 (ABLC, Abelcet) amphotericin B. effect. conventional treatments to a Liposomal formulations formulation of cumulative dose of may be used at higher amphotericin B. Dilute 24–27 mg/kg doses, and safety in 5% dextrose in Cat: 1 mg/kg IV margin is increased. water to 1 mg/mL, and 3 times/week for up to Expense is much higher administer IV over 12 treatments than for conventional 1–2 hours. formulations. Ampicillin (Omnipen, 𝛽-lactam antibiotic. Use cautiously in Dose requirements vary 250, 500 mg capsules; Ampicillin sodium: Principen, others Inhibits bacterial cell animals allergic to depending on 125, 250, 500 mg vials 10–20 mg/kg q6–8h IV, [human forms]) wall synthesis. penicillin-like drugs. susceptibility of of ampicillin sodium. IM, SC or 20–40 mg/kg bacteria. Absorbed Ampicillin trihydrate: q8h PO approximately 50% 10 and 25 g vials for Ampicillin trihydrate: less, compared with injection Dog: 10–50 mg/kg amoxicillin, when q12–24h IM, SC administered orally. Cat: 10–20 mg/kg q12–24h IM, SC Ampicillin + sulbactam Ampicillin plus a Same as for ampicillin Same as for amoxicillin 2:1 combination for 10–20 mg/kg IV, (Unasyn) 𝛽-lactamase inhibitor + clavulanate. injection. 1.5 and 3 g IM q8h (sulbactam). Sulbactam vials has similar activity as clavulanate. Ampicillin trihydrate 𝛽-lactam antibiotic. Use cautiously in Absorption is slow and 10, 25 mg vials for Dog: 10–50 mg/kg (Polyflex) Inhibits bacterial cell animals allergic to may not be sufficient injection q12–24h IM, SC wall synthesis. penicillin-like drugs. for acute serious Cat: 10–20 mg/kg infection. q12–24h IM, SC Amprolium (Corid) Enteric coccidiostat Toxicity observed only Used to control and 9.6% (9.6 g/dL) oral 1.25 g of 20% at high doses. CNS treat coccidiosis in solution; soluble amprolium powder to signs are caused by puppies. It is powder daily feed, or 30 mL of thiamin deficiency, administered orally, 9.6% amprolium which may be reversed often mixed with food. solution to 3.8 L of by adding thiamin to drinking water for the diet. 7days JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

1450 Blackwell’s Five-Minute Veterinary Consult

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Antacid drugs See Aluminum hydroxide, Magnesium hydroxide, Calcium carbonate. Apomorphine Emetic drug. Causes Produces emesis before Consult local poison 6 mg tablets 0.03–0.05 mg/kg IV hydrochloride (generic) emesis via dopamine serious adverse effects center or pharmacist 10 mg/mL ampule or IM, 0.1 mg/kg SC, or release or direct effects occur. Use cautiously in for availability. Not as 3 mL preloaded instill 0.25 mg in on chemoreceptor cats that may be effective in cats as syringes conjunctiva of eye trigger zone sensitive to opiates. dogs. (dissolve 6 mg tablet in 1–2 mL of saline) Ascorbic acid Vitamin. Used as Toxicity only at very Primarily used as Various forms, 100–500 mg/ (Vitamin C) acidifier. high doses nutritional supplement, including 250 mg/ml animal/day (diet but high doses have sodium ascorbate supplement), or been used for 100 mg/animal q8h treatment of certain (urine acidification) diseases. L-Asparaginase (Elspar) Anticancer agent. Hypersensitivity, Usually used in 10,000 U per vial for Dog: 400 U/kg IM Purified enzyme from allergic reactions combination with other injection weekly or 10,000 U/m2 E. coli. Used in drugs in cancer weekly × 3 weeks lymphoma protocols. chemotherapy Cat: 400 U/kg SC Depletes cancer cells of protocols weekly asparagine and interferes with protein synthesis. Aspirin (many generic Nonsteroidal Narrow therapeutic Analgesic and 81, 325 mg tablets Mild analgesia: (dog) and brand names anti-inflammatory drug index. High doses anti-inflammatory 10 mg/kg q12h PO [Bufferin, Ascriptin]) (NSAID). frequently cause doses have primarily Anti-inflammatory: Anti-inflammatory vomiting. Other Gl been derived from Dog: 20–25 mg/kg action is generally effects can include empiricism. q12h PO considered to be ulceration and Antiplatelet doses are Cat: 10–20 mg/kg caused by inhibition of bleeding. Cats lower because of q48h PO prostaglandins. Used susceptible to prolonged effect of Antiplatelet: as analgesic, salicylate intoxication aspirin on platelets. Dog: 5–10 mg/kg anti-inflammatory, and because of slow q24–48h PO antiplatelet drug. clearance. Use Cat: 81 mg/cat cautiously in patients q48–72h PO with coagulopathies because of platelet inhibition. Atenolol (Tenormin) 𝛽-adrenergic blocker. Bradycardia and heart Dosing precautions are 25, 50, 100 mg tablets Dog: Relatively selective for block are possible. May similar to other 6.25–12.5 mg/dog 𝛽 𝛽 1-receptor. Used produce bronchospasm -blocking drugs. q12–24h (or primarily as an in sensitive patients. Atenolol is reported to 0.25–1.0 mg/kg antiarrhythmic or for be less affected by q12–24h), PO other cardiovascular changes in hepatic Cat: 6.25–12.5 mg per conditions to slow metabolism than other cat q12h PO sinus rate. 𝛽-blockers. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

Canine and Feline, Sixth Edition 1451

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) 𝛼 Atipamezole 2-antagonist. Used to Can cause some initial When used to reverse 5 mg/mL injection Inject same volume as 𝛼 (Antisedan) reverse 2-agonists, excitement in some dexmedetomidine, used for such as animals shortly after inject same volume as dexmedetomidine. dexmedetomidine and reversal. used for Range of doses = xylazine. dexmedetomidine. 0.32 mg/kg for small animals to 0.14 mg/kg for large dogs Atovaquone (Mepron) In animals, it has been Adverse effects have There has been only 750 mg/5 mL liquid Dog: 13.3 mg/kg q8h, used, often in not been reported in limited experience for oral suspension PO for 10 days, usually combination with animals. In people, treatment of infections (150 mg/mL) in combination with azithromycin, to treat adverse reactions in animals. A few azithromycin (10 mg/kg refractory protozoan consist of skin rash, clinical trials have q24h, PO) diseases and cough, and diarrhea. shown efficacy when Cat: 15 mg/kg q8h, PO, bloodborne pathogens. combined with in combination with In dogs, it has been azithromycin for azithromycin (10 mg/kg used to treat Babesia treatment of protozoa q24h) gibsoni. infections. Atracurium (Tracrium) Neuromuscular Produces respiratory Administer only in 10 mg/mL injection 0.2 mg/kg IV initially, blocking agent depression and situations in which then 0.15 mg/kg every (nondepolarizing). paralysis. careful control of 30 min (or IV infusion Competes with Neuromuscular respiration is possible. at 4–9 𝜇g/kg/min) acetylcholine at blocking drugs have no Doses may need to be neuromuscular end effect on analgesia. individualized for plate. Used primarily optimum effect. Do not during anesthesia or mix with alkalinizing other conditions in solutions or lactated which it is necessary to Ringer’s solution. inhibit muscle contractions. Atropine (many generic Anticholinergic agent Potent anticholinergic Used ordinarily as 400, 500, 540 𝜇g/mL 0.02–0.04 mg/kg brands) (blocks acetylcholine agent. Do not use in adjunct with injection; 15 mg/mL q6–8h IV, IM, SC; effect at muscarinic patients with anesthesia or other injection 0.2–0.5 mg/kg IV, IM receptor), glaucoma, intestinal procedures. Do not mix (as needed) for parasympatholytic. ileus, gastroparesis, or with alkaline solutions. organophosphate and Used primarily as tachycardia. Side carbamate toxicosis adjunct to anesthesia effects of therapy or other procedures to include xerostomia, increase heart rate and ileus, constipation, decrease respiratory tachycardia, urine and gastrointestinal retention. secretion. Also used as antidote for organophosphate intoxication. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

1452 Blackwell’s Five-Minute Veterinary Consult

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Azathioprine (Imuran) Thiopurine Bone marrow Usually used in 25, 50, 75, and 100 mg Dog: 2 mg/kg q24h PO immunosuppressive suppression is most combination with other tablets; 10 mg/mL for initially then drug. Acts to inhibit T serious concern. Cats immunosuppressive injection 0.5–1 mg/kg q48h cell lymphocyte particularly are drugs (such as Cat (use cautiously): function. This drug is susceptible. There has corticosteroids) to treat 0.3 mg/kg q24h PO metabolized to been some association immune-mediated initially, then q48h, 6-mercaptopurine, with development of disease. Doses of with careful monitoring which may account for pancreatitis when 2.2 mg/kg in cats have (will require immunosuppressive administered with produced toxicity. compounding) effects. Used to treat corticosteroids. various immune-mediated disease. Azithromycin Azalide antibiotic. Vomiting is likely with Azithromycin may be 250 mg capsules, 250 Dog: 5–10 mg/kg PO (Zithromax) Similar mechanism of high doses. Diarrhea better tolerated than and 600 mg tablets, once daily for 5–7 days action as macrolides may occur in some erythromycin. Primary 100 or 200 mg/5 ml then tapering to q48h (erythromycin), which patients. difference from other oral suspension, and Cat: 5–10 mg/kg PO is to inhibit bacteria antibiotics is the high 500 mg vials for once daily for 7 days, protein synthesis via intracellular injection then tapering to q48h; inhibition of ribosome. concentrations upper respiratory Spectrum is primarily achieved. infection: 15 mg/kg gram-positive. q72h PO AZT (Azidothymidine) See Zidovudine. BAL (British See Dimercaprol. antilewisite) Benazepril (Lotensin) Angiotensin-converting Similar to those for Dose is based on 5, 10, 20, 40 mg tablets Dog: 0.25–0.5 mg/kg enzyme (ACE) inhibitor. captopril and enalapril approved use in dogs q24h PO, may be Used for hypertension in Europe and Canada. increased to 1 mg/kg in and heart failure. Monitor renal function dogs that are not Action is similar to and electrolytes responsive. enalapril and captopril 3–7 days after Cat (systemic initiating therapy and hypertension and renal periodically thereafter. disease): 0.5–1 mg/kg q24h PO, or 2.5 mg/cat per day up to maximum of 5 mg/cat per day PO Bethanechol chloride Muscarinic, cholinergic High doses of Administer injection SC No longer Dog: 5–15 mg/dog (Urecholine) agonist. cholinergic agonists only, not IV. Doses are commercially available. q8h PO Parasympathomimetic. will increase motility of derived from However, available Cat: 1.25–5 mg/cat Stimulates gastric and Gl tract and cause extrapolation of through compounding q8h PO intestinal motility, but abdominal discomfort human doses or via pharmacies primarily used to and diarrhea. Can empiricism. There are increase contraction of cause circulatory no well-controlled urinary bladder. depression in sensitive efficacy studies animals. available for veterinary species. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

Canine and Feline, Sixth Edition 1453

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Bisacodyl (Dulcolax) Laxative/cathartic. Acts Avoid use in patients Available as OTC 5 mg tablets Dog: 5 mg/animal via local stimulation of with renal disease. tablet. Doses are q8–24h PO Gl motility, most likely Avoid overuse. derived from Cat: 5 mg/cat q24h PO by irritation of bowel. extrapolation of Used primarily as human doses or via laxative or for empiricism. There are procedures in which no well-controlled bowel evacuation is efficacy studies necessary. available for veterinary species. Onset of action is approx. 1 h. Bismuth subsalicylate Antidiarrhea agent and Adverse effects are Available as OTC Oral suspension: 1–3 mL/kg/day (in (Pepto-Bismol) GI protectant. uncommon; however, product. Doses are 262 mg/15 mL, or divided doses) PO Anti-prostaglandin salicylate component is derived from 525 mg/mL in extra action of salicylate absorbed systemically, extrapolation of strength formulation; component may be and overuse should be human doses or via 262 mg tablets beneficial for enteritis. avoided in animals that empiricism. There are Bismuth component is cannot tolerate no well-controlled efficacious or treating salicylates (such as efficacy studies infections caused by cats and animals available for veterinary spirochete bacteria allergic to aspirin). species. (Helicobacter gastritis). Owners should be warned that bismuth will discolor stools. Bleomycin (Blenoxane) Anticancer, antibiotic Causes local reaction Injectable solution 15 U vials for injection Dog: 10 U/m2 IV or SC agent. Used for at site of injection. usually used in q24h for 3 days, then treatment of various Causes pulmonary combination with other 10 U/m2 weekly sarcomas and toxicity in people as anticancer agents. (maximum cumulative carcinomas. Exact well as fever and chills, Consult anticancer dose 200 U/m2) mechanism of action is but side effects are not protocols for details unknown, but may bind well documented in regarding use. to DNA and prevent veterinary species. synthesis. Budesonide (Entocort) Corticosteroid. No serious adverse The capsules are 1, 3 mg capsule 0.125 mg/kg q6–8h, Budesonide is a effects are reported. designed for human PO. Dose interval may locally-acting However, some use. When be increased to every corticosteroid. It is systemic absorption administering to 12 hours when designed to release may cause animals, do not disrupt condition improves locally – in the glucocorticoid effects the coating on the drug intestine – after oral in animals (such as or the intestinal release administration. Only a adrenal suppression). may be compromised. small fraction is absorbed systemically. Budesonide is used to treat inflammatory bowel disease. JWST589-bapp09 JWST589-Tilley Printer: Yet to Come September 9, 2015 11:15 279mm×216mm

1454 Blackwell’s Five-Minute Veterinary Consult

Dosage (Unless Otherwise Indicated, Drug Name (Trade or Pharmacology and Adverse Effects and Dosing Information Dose is the Same for Other Names) Indications Precautions and Comments Formulations Dogs and Cats) Bunamidine Used as anticestodal Vomiting and diarrhea Do not break tablets. 100, 200, 400 mg 20–50 mg/kg once PO hydrochloride agent. Primarily to treat have occurred after Administer tablets on tablets (Scolaban) tapeworm infections in use. Avoid use in young empty stomach. Do not dogs and cats. animals. feed for 3 h after Mechanism of action is administration. to damage integrity of protective integument on parasite. Bupivacaine Local anesthetic. Adverse effects rare Used for local 2.5 and 5 mg/mL 1 mL of 0.5% solution hydrochloride Inhibits nerve with local infiltration. infiltration or infusion solution injection per 10 cm for an (Marcaine, and conduction via sodium High doses absorbed into epidural space. epidural generics) channel blockade. systemically can cause One may admix Longer-acting and more nervous system signs 0.1 mEq sodium potent than lidocaine or (tremors and bicarbonate per 10 mL other local anesthetics. convulsions). After solution to increase pH, epidural decrease pain from administration, injection, and increase respiratory paralysis is onset. Use immediately possible with high after mixing with doses. bicarbonate. Buprenorphine Opioid analgesic. Partial Adverse effects are Used for analgesia, 0.324 mg/mL solution, Dog: 0.02 mg/kg IV, IM, hydrochloride 𝜇-receptor agonist, similar to other opiate often in combination 1.8 mg/mL solution for SC q4–8h (Buprenex [Vetergesic 𝜅-receptor antagonist. agonists, except there with other analgesics SC administration in Cat: 0.01–0.02 mg/kg in the UK]) Simbadol 25–50× more potent may be less respiratory or in conjunction with cats. For people, IV, IM, q4–8h than morphine. depression. general anesthesia. transdermal patches Buccal administration Buprenorphine may Dependency from Longer acting than and buccal tablets also in cat: 0.02–0.04 mg/kg cause less respiratory chronic use may be less morphine. Only are available. q8h, SC administration depression than other than with pure partially reversed by to cats using Symbadol opiates. agonists. naloxone 1.8 mg/mL solution: 0.24 mg/kg q24h, SC. Buspirone (BuSpar) Antianxiety agent. Acts Some cats show Some efficacy trials 5, 10, 15, and 30 mg Dog: 2.5–10 mg/dog by binding to serotonin increased aggression; suggest effectiveness tablets q12–24h PO or 1 mg/kg receptors. In veterinary some cats show for treating urine q12h PO medicine, has been increased affection to spraying in cats. There Cat: 2.5–5 mg/cat primarily used for owners. may be a lower relapse q12-24h PO (may be treatment of urine rate compared to other increased to 5–7.5 mg spraying in cats. drugs. per cat twice daily for some cats) Busulfan (Myleran) Anticancer agent. Leukopenia is most Usually used in 2 mg tablets 3–4 mg/m2 q24h PO Bifunctional alkylating severe side effect. combination with other agent and acts to anticancer agents. disrupt DNA of tumor Consult specific cells. Used primarily for protocol for details. lymphoreticular neoplasia. JWST589-IND JWST589-Tilley Printer: Yet to Come September 8, 2015 12:1 279mm×216mm

Index

Text in boldface denotes chapter discussions. Prefixes are normally ignored in the alphabetical sequence; thus S-adenosylmethionine is listed after adenosine. A Accutane. See Isotretinoin Acetylcysteine (N-acetylcysteine; NAC), ACE inhibitors. See Angiotensin- 1425 ABCB1 gene deletion, 225, 771 converting enzyme inhibitors for acetaminophen toxicosis, 11, 80, Abdomen, acute, 20–22 Acemannan, 501, 507 879 Abdominocentesis (paracentesis) Acepromazine, 1424 for acute hepatic failure, 601 for acute abdomen, 21 for amphetamine toxicosis, 70 for blue-green algae toxicosis, 190 for ascites, 118, 276, 609, 611, 686 for antidepressant toxicosis, 100, 103 formulary information, 1445 for bile peritonitis, 180 for aortic thromboembolism, 107 for hepatic encephalopathy, 598–599 for nephrotic syndrome, 946 for asthma and bronchitis in cats, 125 for hepatic lipidosis, 604 for peritonitis, 1048–1049 for baclofen toxicosis, 166 for hepatotoxicity, 627 Aberdeen terrier, dystocia, 424 for benzodiazepine/sleep aid toxicosis, for infectious canine hepatitis, 614 Abortion, 2–7 173 for keratoconjunctivitis sicca, 779 partial, in dogs, 5 for car ride anxiety, 221 for methemoglobinemia, 345, 879 spontaneous for epistaxis, 456 for mycotoxicosis, 901 in cats, 2–3 for excessive vocalization, 471 for sago palm toxicosis, 1193 in dogs, 4–5 formulary information, 1445 for ulcerative keratitis, 778 termination of pregnancy, 6–7 for hereditary Scotty cramp, 923 Acetylsalicylic acid. See Aspirin Abrus precatorius, 1431 for illicit/club drug toxicosis, 741 Achilles mechanism injuries, 889, 890 Abscessation, 8–9 for maternal behavior problems, 853 Achondroplasia, 980 anal sac, 9, 74 for pseudoephedrine/phenylephrine Aciclovir, for feline herpesvirus infection, hepatic, 616–617 toxicosis, 1122 496 orbital, 975–976 for thrombocytopenia, 1303 Acid burns, 1436 prostatic, 1110–1111 for thunderstorm and noise phobias, Acidosis, metabolic, 12–13 tooth root, 1320–1321 1306 Acitretin, for precancerous squamous Abyssinian cat for tracheal and airway collapse, 1325 lesions, 1258, 1262 aggression, 49 for urinary retention, 1346 Acne, 14–15 amyloidosis, 71, 72, 595 for ventricular arrhythmias, 1381, in cats, 14 anemia, 81, 88 1388 in dogs, 15 aortic thromboembolism, 106 for vestibular disease, 1393, 1395 papules and/or nodules, 373–374 chronic renal failure, 1164 for veterinary visits, 486, 487 Aconitum spp., 1430 hyperesthesia syndrome, 497 Acetaminophen Acquired portosystemic shunting. See hypothyroidism, 729 formulary information, 1445 Portosystemic shunting, myasthenia gravis, 895 for osteosarcoma, 986 acquired neonatal isoerythrolysis, 590 for pain management, 1442 Acral lick dermatitis, 16 paresis/paralysis, 906 for spondylosis deformans, 1255 Acromegaly, 17–18 pyruvate kinase deficiency, 1145 Acetaminophen-codeine, 1445 Actea spp., 1427 renal amyloidosis, 72, 301 Acetaminophen toxicosis, 10–11, 80 ACTH (corticotropin) retinal dysplasia, 303, 1174 Acetazolamide ectopic secretion, 650 stomatitis, 973, 1274 for caudal occipital malformation formulary information, 1465–1466 tooth resorption, 1319 syndrome, 1251 plasma reference ranges, 1420 Acanthamoeba infections, 65 formulary information, 1445 stimulation test, 1419 Acanthocytic anemia, 84 for hydrocephalus, 646 Actigall. See Ursodeoxycholic acid Acanthomatous ameloblastoma, canine for quadrigeminal cyst, 1151 Actinic keratosis, 377 (CAA), 457, 458, 969, 970 for syringomyelia and Chiari-like Actinomycosis, 19 Acanthomatous epulis (AE), 457, 458, malformation, 1290 Activated charcoal. See Charcoal, 969 Acetohydroxamic acid (AHA), 1358 activated Acarbose, 389, 665 Acetone toxicosis, 1439 Acupuncture, for spondylosis deformans, Acaricides, for tick control, 1311 Acetretin, for sun-induced dermatoses, 1255 Accreditation, 1553 377 Acute abdomen, 20–22

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1554 Index

Acute kidney injury (AKI), 1161–1163 for hepatotoxicity, 627 human-directed drugs inducing, 947, 948 for infectious canine hepatitis, 614 in cats, 42–43, 49 in ethylene glycol toxicosis, 469 for liver fluke infestations, 808 in dogs, 37–41, 51 in grape, raisin and currant toxicosis, for mycotoxicosis, 901 impulse control, in cats, 49 564 for phosphide rodenticide toxicosis, intercat, 46–48, 49 in heat stroke/hyperthermia, 577 1190 intermale, in cats, 46 Acute lymphoblastic leukemia, 800 for sago palm toxicosis, 1193 maternal, 852, 853 Acute pain, 996–999 Adequan. See Polysulfated in cats, 42, 46, 49 Acute polyradiculoneuritis glycosaminoglycans pain-related, in cats, 42, 49 (coonhound paralysis), Adonis spp., 1428 play-related 318–319 Adrenal insufficiency. See in cats, 42, 46, 49 Acute respiratory distress syndrome Hypoadrenocorticism in dogs, 51 (ARDS), 23–24 Adrenal tumors, hyperadrenocorticism, in kittens, 1027, 1028 ADAMTS17 gene, 797 649, 650, 651, 652, 653 predatory Adaptil, 485, 1209 Adrenalin. See Epinephrine in cats, 46, 49 Addisonian crisis, acute, 702, 703 𝛼-Adrenergic agonists, for urinary in dogs, 51 Addison’s disease. See incontinence, 748, 1030 recognition failure-related, in cats, 46 𝛼 Hypoadrenocorticism 2-Adrenergic agonists. See Alpha-2 redirected, in cats, 42, 46, 49 Adenocarcinoma, 24–36 agonists sexual, in cats, 46 𝛽 anal sac, 25 2-Adrenergic agonists. See Beta-2 status-related, in cats, 46 ceruminous gland, ear, 247 agonists territorial large intestine, 34 𝛼-Adrenergic antagonists. See in cats, 46, 49 lung, 26 Alpha-receptor antagonists in dogs, 37, 51 nasal, 27–28 𝛽-Adrenergic antagonists. See Beta to unfamiliar people/dogs (in dogs), pancreas, 29 blockers 37–38 prostate, 30 Adrenocorticotropic hormone. See in veterinary visits, 484–487 rectal, 34 ACTH Agkistrodon spp. envenomation, renal, 31 Adriamycin. See Doxorubicin 1241–1242 salivary gland, 32 Adverse event reporting, 1553 Aglepristone skin (sweat gland, sebaceous), 33 Aelurostrongylus abstrusus, 1073, 1074, for mammary gland hyperplasia, 839 small intestine, 34 1171, 1172 for pyometra, 1140, 1368 stomach, 34 Aerophagia, 521 for termination of pregnancy, 7 thyroid, 35–36 Aesculus spp., 1429 Air plant, 1427 Adenomyosis, epididymal, 1247 Affenpinscher, syringomyelia and Airedale terrier Adenosine, for supraventricular Chiari-like malformation, 1289 atrioventricular block, 151 tachycardia, 1285 Afghan hound cerebellar hypoplasia, 128, 244, 672 S-Adenosylmethionine (SAMe) chylothorax, 272 corneal dystrophy, 329 for acetaminophen toxicosis, 11 corneal dystrophy, 329 flank alopecia, 61, 63 for acute hepatic failure, 601 dilated cardiomyopathy, 230 lymphoma, 830 for aggression in cats, 50 lung lobe torsion, 815 melanocytic tumors, 863 for bile duct obstruction, 178 myocardial tumors, 910 pancreatic carcinoma, 29, 1401 for bile peritonitis, 181 sexual development disorders, 1214 plasmacytoma, 1062 for blue-green algae toxicosis, 190 testicular tumors, 758, 1207, 1213 spondylosis deformans, 1255 for cholangitis/cholangiohepatitis Aflatoxin toxicosis, 901 vaginal hyperplasia and prolapse, syndrome, 261 Afoxolaner, for flea control, 524 1369, 1370 for cholecystitis and choledochitis, Aggression, 37–56 von Willebrand disease, 455, 1404 263 affective (emotional), in dogs, 51 Airway collapse, 1324–1325 for cholelithiasis, 264 in cats, overview, 49–50 Airway obstruction. See also for chronic hepatitis, 610 to children, in dogs, 39 Brachycephalic airway for cirrhosis and fibrosis of liver, contact/petting-related, in cats, 42, 49 syndrome 276 defensive, in cats, 49 cardiopulmonary arrest, 238 for cognitive dysfunction syndrome, in dogs, overview, 51–54 dyspnea and respiratory distress, 422 289 between dogs in household, 55–56 hypercapnia, 656 for copper-associated hepatopathy, dominance (conflict), in dogs, 40–41, pulmonary edema, 1127, 1128 322 51 stertor and stridor, 1270–1271 for diabetic hepatopathy, 392–393 to familiar people, in dogs, 40–41, 51 Akita for fears, phobias and anxieties, 491 fear-related, in cats, 42, 46, 49 acral lick dermatitis, 16 for gallbladder mucocele, 530 food and resource guarding, in dogs, alopecia, 61, 63 for hepatic encephalopathy, 598 44–45 epulis, 457 for hepatic lipidosis, 604 frustration-related, in cats, 49 glaucoma, 551 JWST589-IND JWST589-Tilley Printer: Yet to Come September 8, 2015 12:1 279mm×216mm

Index 1555

hepatic amyloid, 595, 596 Allopurinol Amblyomma maculatum, 628, 1308, metabolic myopathy, 924 formulary information, 1446 1310 myasthenia gravis, 895 induced xanthinuria, 942, 1361 Amebiasis, 65 pemphigus foliaceus, 365, 378, 1032 for leishmaniasis, 796 Amebic meningoencephalitis, polyarthritis, 1082 for urate urolithiasis, 943, 1359 granulomatous, 65 pseudohyperkalemia, 666 Aloe, 1427 Ameloblastic fibro-odontoma (AFO), retinal disease, 1174, 1176 Alopecia, 59–64 961 sebaceous adenitis, 369, 1202 canine flank, 61, 63 Ameloblastoma, 66 uveodermatologic syndrome, 98, 270, in cats, 59–60 canine acanthomatous (CAA), 457, 365, 930, 1366 color mutant/dilution, 61 458, 969, 970 ventricular septal defect, 1383 in dogs, 61–64 Amelogenesis imperfecta, 406, 407, 1314 von Willebrand disease, 1404 endocrine, 59, 62 American bulldog Alaskan malamute feline paraneoplastic, 59, 510, 1015 lysosomal storage disease, 834 alopecia X, 61, 63 feline symmetrical, 511 retinal degeneration, 1174 corneal dystrophy, 329 non-inflammatory, in dogs, 61, 63–64 American cocker spaniel. See also Cocker glaucoma, 551 paraneoplastic, 1015 spaniel interstitial pneumonia, 1073 pinnal, 60, 61 aggression toward children, 39 lupus erythematosus, 816 post-clipping, 61, 63 anal sac disorders, 74 muscular dystrophy, 921 psychogenic, 59, 60, 297–298 anemia, 88 osteochondrodysplasia, 980 sex hormone, 59 atrioventricular block, 147, 151 ovulatory failure, 995 traction, 61 corneal dystrophy, 329 polyneuropathies, 1088 Alopecia areata, 59, 60, 61 cryptococcosis, 336 renal dysplasia, 301, 1164 Alopecia universalis, 59 dilated cardiomyopathy, 231, 240, retinal degeneration, 303, 1174 Alopecia X, 61, 63–64 1292 seasonal nasal hypopigmentation, 365 Alpha-2 agonists. See also Clonidine eyelash disorders, 476 skin tumors, 371 for aggression in dogs, 38, 56 glaucoma, 551 uveodermatologic syndrome, 1366 Alpha-receptor antagonists hemoglobinuria and myoglobinuria, zinc-responsive dermatosis, 185, 369, for hypertension, 690 590 930 for vertebral column trauma, 1391 phosphofructokinase deficiency, 88, Albendazole Alprazolam 560, 924, 1059 for baylisascariasis, 170 for aggression, 43 retinal degeneration, 1174 for capillariasis, 219 for car ride anxiety, 221 sexual development disorders, 1214 for cysticercosis, 348 for destructive behavior, 382 thrombocytopathy, 1051, 1300 formulary information, 1446 for excessive vocalization, 471 American Eskimo for giardiasis, 549 for fears, phobias and anxieties, 489, pyruvate kinase deficiency, 88, 1145 for microsporidiosis, 881 491 transitional cell carcinoma, 1327 for respiratory parasites, 1172 formulary information, 1446 American hairless terrier, 61 for trichinosis, 1333 for marking, roaming and mounting American pit bull terrier. See also Pit bull Albinism, 365 behavior, 848 terrier Albuterol (salbutamol) for separation distress syndrome, atopic dermatitis, 133 for asthma and bronchitis, 125, 203 1209 babesiosis, 164 formulary information, 1446 for thunderstorm and noise phobias, parvovirus enteritis, 216 toxicosis, 175 1306 sexual development disorders, 1214 Alcohol toxicosis, 467, 1439 Altrenogest, for premature labor, 1103 vaginal hyperplasia and prolapse, Aldactone. See Spironolactone Aluminum carbonate 1369, 1370 Aldosterone, plasma, 1420 formulary information, 1446 American shorthair cat Alkalosis, metabolic, 57–58 for hyperphosphatemia, 682 hypertrophic cardiomyopathy, 233 Alkeran. See Melphalan for renal failure, 1165 nephrolithiasis, 942 Allergic blepharitis, 185, 186 Aluminum hydroxide American Staffordshire terrier. See also Allergic conjunctivitis, 313, 314 formulary information, 1446 Staffordshire bull terrier Allergic contact dermatitis, 317 for hyperphosphatemia, 682 aortic stenosis, 104 Allergic dermatitis for iron toxicosis, 769 cerebellar degeneration, 243 alopecia, 59, 60 for renal secondary demodicosis, 355 feet, 1077 hyperparathyroidism, 680 dysmetria, 672 food reactions, 525, 527 Alveolar mucositis, 973, 1274 retinal degeneration, 1174 Allergic miliary dermatitis, feline, Amanita mushroom poisoning, 891 skin tumors, 371, 633 447–448 Amantadine, for neuropathic pain, 1442 sun-induced dermatosis, 377 Allergy testing, 133–134, 1120 Amaryllis spp., 1427 American trypanosomiasis, 250 Allomarking, artificial, for intercat Amblyomma americanum, 349, 1308, American water spaniel, alopecia, 61 aggression, 47 1310, 1311 Amiglyde-V. See Amikacin JWST589-IND JWST589-Tilley Printer: Yet to Come September 8, 2015 12:1 279mm×216mm

1556 Index

Amikacin Ammonium chloride for coccidioidomycosis, 286 for canine infectious respiratory formulary information, 1448 for cryptococcosis, 337 disease, 213 tolerance test, 1167 formulary information, 1449 for colibacillosis, 292 for urinary acidification, 1080 for fungal pneumonia, 1072 formulary information, 1447 Ammonium urate crystalluria, 340, 341 for histoplasmosis, 294, 636 for gastrointestinal obstruction, 548 Amorphous urate crystalluria, 340, 341 for leishmaniasis, 796 for nocardiosis, 953 Amoxicillin for protothecosis, 1119 for otitis externa and media, 988 for abscessation, 9 toxicity, 184 for peritonitis, 1049 for actinomycosis, 19 for urinary tract infections, 812 for urinary tract infections, 811 for aspiration pneumonia, 1375 Ampicillin Amino acid supplements, 392, 556, for clostridial enterotoxicosis, 278, for bronchiectasis, 201 1283 294 for canine infectious respiratory Aminoglycosides. See also specific agents for dermatophilosis, 362 disease, 213 for canine infectious respiratory for feline calicivirus infection, 492 for central nervous system infections, disease, 213 for feline herpesvirus infection, 496 871 for corneal and scleral lacerations, 327 formulary information, 1448 for clostridial enterotoxicosis, 278, for endocarditis, 443 for Helicobacter eradication, 535, 537, 294 nephrotoxicity, 947, 948 579, 1402 for dermatophilosis, 362 for nocardiosis, 953 for hepatic encephalopathy, 414, 598 for feline herpesvirus infection, 496 for sepsis and bacteremia, 1212 for leptospirosis, 799 formulary information, 1449 Aminopentamide, 770, 1447 for Lyme borreliosis, 820 for gastrointestinal obstruction, 548 Aminophylline, 76, 203 for mastitis, 851 for leptospirosis, 799 Amiodarone for tularemia, 1336 for near drowning, 412 for dilated cardiomyopathy, 232 for urinary tract infections, 811 for neutropenia, 952 formulary information, 1447 Amoxicillin-clavulanic acid for nocardiosis, 953 for ventricular arrhythmias, 1380, for abscessation, 9 for orbital abscess/cellulitis, 976 1382, 1388 for anaerobic infections, 73 for pancreatitis, 1003 Amitraz for anal sac disorders, 74 for peritonitis, 1049 for cheyletiellosis, 253 for bacterial folliculitis, 379 for pneumonia, 1068 for demodicosis, 355–356 for blepharitis, 186 for pyometra, 1140 formulary information, 1447 for bronchiectasis, 201 for streptococcal infections, 1275 for notoedric mange, 956 for canine infectious respiratory Ampicillin-clavulanate, for for sarcoptic mange, 1199 disease, 213 gastrointestinal obstruction, Amitraz toxicosis, 67–68 for dyschezia and hematochezia, 417 548 Amitriptyline for encephalitis, 440 Ampicillin-sulbactam for acral lick dermatitis, 16 for eosinophilic granuloma complex, for aspiration pneumonia, 1066 for aggression, 43, 48, 50 448 formulary information, 1449 for alopecia, 60, 511 formulary information, 1448 for pyothorax, 1143 for atopic dermatitis, 134 for mastitis, 851 Amprolium, 287, 1449 for compulsive disorders, 298, 300 for metritis, 880 Amyloid producing odontogenic tumor for fears, phobias and anxieties, 489 for oral ulceration, 974 (APOT), 961 for feline idiopathic lower urinary for otitis, 571, 988, 990 Amyloidosis, 71–72 tract disease, 499 for pneumonia, 1068 cutaneous, 375, 376 formulary information, 1448 for prostatitis/prostatic abscess, 1111 familial shar-pei fever, 481–482 for marking, roaming and mounting for pyoderma, 1137 hepatic, 595–596 behavior, 848 for pyometra, 1140 renal, 301 for neuropathic pain, 1442 for pyothorax, 1143 Anabolic agents, for weight loss and for polyphagia, 1091 for spontaneous abortion, 3 cachexia, 1407 for pruritus, 1121 for staphylococcal infections, 1267 Anaerobic infections, 73 for separation distress syndrome, 1210 for stomatitis, 1272 Anagen defluxion, 60, 61 for syringomyelia and Chiari-like for suppurative hepatitis/hepatic Anal prolapse, 1154 malformation, 1290 abscess, 617 Anal sac abscessation, 9, 74 for urine marking in cats, 641 for urinary tract infections, 811 Anal sac adenocarcinoma, 25 Amlodipine for vestibular disease, 1394, 1395 Anal sac disorders, 74 for atrial wall tear, 144 Amoxicillin-sulbactam, for hemorrhagic Analgesics, 997–998 for cerebrovascular accident, 246 gastroenteritis, 543 for acute abdomen, 21 for chronic kidney disease, 1165 Amphetamine toxicosis, 69–70 adjunctive, 998 for congestive heart failure, 308 Amphotericin B for anorexia, 93 formulary information, 1448 for aspergillosis, 122 for battery toxicosis, 169 for hypertension, 456, 690, 1177 for blastomycosis, 184 for chondrosarcoma, 266 JWST589-IND JWST589-Tilley Printer: Yet to Come September 8, 2015 12:1 279mm×216mm

Index 1557

for corneal and scleral lacerations, for nephrotic syndrome, 946 for acral lick dermatitis, 16 327 nephrotoxicity, 947 for actinomycosis, 19 for discospondylitis, 409 Angiotensin receptor blockers (ARBs) for acute abdomen, 22 for esophageal pain, 465 for ascites, 685–686 for anaerobic infections, 73 for hip dysplasia, 632 for cirrhosis and fibrosis of liver, for anal sac disorders, 74 for hypertrophic osteodystrophy, 695 275–276 for aspiration pneumonia, 1066, 1375 for lameness, 783 for hypertension, 690 for asthma and bronchitis in cats, 125 for pancreatitis, 1001, 1003 for hypoalbuminemia, 706 for bartonellosis, 167 for shoulder problems, 1224 for proteinuria, 1117 for battery toxicosis, 169 for spondylosis deformans, 1255 Animal drugs, 1553 for bile duct obstruction, 178 for syringomyelia and Chiari-like Anion gap, high, 12–13 for bile peritonitis, 180 malformation, 1290 Anionic detergents, 1435 for blepharitis, 186 Anaphylaxis, 75–76 Anipryl. See Selegiline for bronchiectasis, 201 blood transfusion reactions, 189 Anisocoria, 90–91 for brucellosis, 205 peripheral edema, 1045 Anodontia, total and partial, 1318 for campylobacteriosis, 207 Anaplasma, 433–434 Anophthalmos, 303 for canine distemper, 211 Anaplasma phagocytophilum, 433, 1310, Anorexia, 92–93 for canine infectious respiratory 1311 Antebrachial growth deformities, disease, 213 Anaplasma platys, 433, 1310, 1311 94–95 for canine influenza, 214 Anatoxins, 190 Anterior uveitis, 96–99 for catheter-related infections, 1058 Ancef. See Cefazolin anisocoria, 90 for central nervous system infections, Ancylostomiasis, 637 cataracts, 241 871 Andersonstrongylus milksi, 1171, 1172 in cats, 96–97 for cholangitis/cholangiohepatitis Androgen excess. See Hyperandrogenism in dogs, 98–99 syndrome, 260 Androgen insensitivity, complete and reflex, 777 for cholecystitis and choledochitis, partial, 1214 Anthelminthics 262–263 Androgenic steroids, for ehrlichiosis, 434 for bronchitis in cats, 125 for cholelithiasis, 264 Android. See Methyltestosterone for capillariasis, 219 for chronic bronchitis, 203 Anemia, 77–89 for colitis and proctitis, 294 for clostridial enterotoxicosis, 278 acanthocytic, 84 for diarrhea, 396 for coccidiosis, 287 aplastic, 79 for hookworms, 637 for colibacillosis, 292 in babesiosis, 164 for physalopterosis, 1060 for colitis and proctitis, 294, 296 in bile duct obstruction, 177 for respiratory parasites, 1172 for conjunctivitis, 312, 314 blood loss, 88, 89 for roundworms, 1192 for corneal and scleral lacerations, 327 of chronic kidney disease, 77–78, 85 for strongyloidiasis, 1276 for corneal opacities, 328 Heinz body, 80 for tapeworms, 1291 for cough, 332 immune-mediated, 81–82 Anti-inflammatory drugs. See also for diarrhea, 396, 397 of inflammatory disease, 85 Corticosteroids; Nonsteroidal for discospondylitis, 409 iron-deficiency, 83, 85 anti-inflammatory drugs for dyschezia and hematochezia, 417 metabolic (with spiculated red cells), for corneal and scleral lacerations, 327 for encephalitis, 440 84 for cough, 332 for eosinophilic granuloma complex, nonregenerative, 85–86 for dyschezia and hematochezia, 417 448 nuclear maturation defects for fecal incontinence, 746 for epididymitis and orchitis, 449 (megaloblastic), 87 for histiocytic ulcerative colitis, 296 for epiphora, 453 regenerative, 88–89 for hypertrophic osteodystrophy, 695 for esophageal disorders, 465 Angioedema, 342 for inflammatory/immune colitis, 294 for exocrine pancreatic insufficiency, Angiostrongylus cantonensis, 441 for rhinitis and sinusitis, 1181 475 Angiostrongylus vasorum, 246, 1073, Antiarrhythmic drugs for feline calicivirus infection, 492 1074, 1171, 1172 for cardiomyopathy, 226, 228, for feline herpesvirus infection, 496 Angiotensin-converting enzyme (ACE) 231–232 for fever, 513 inhibitors for myocarditis, 912 for gallbladder mucocele, 530 for atrial wall tear, 144 for traumatic myocarditis, 1330 for gastric dilation and volvulus for atrioventricular valve disease, 154, for ventricular arrhythmias, 1378, syndrome, 532 156, 159 1381, 1388 for gastrointestinal obstruction, 548 for cardiomyopathy, 231, 234, 237 Antibiotic-responsive diarrhea (ARD), for heat stroke/hyperthermia, 577 for cerebrovascular accident, 246 397. See also Small intestinal for Helicobacter eradication, 579 for congestive heart failure, 308, 310 dysbiosis for hemorrhagic gastroenteritis, 543 for familial shar-pei fever, 482 Antibiotics for hepatic encephalopathy, 414, 598 for hypertension, 456, 690 for abscessation, 9 for immunoproliferative enteropathy for kidney disease, 554, 1117, 1165 for acne, 14, 15 of Basenjis, 744