Therapeutic Medications and Illicit Medications and Supplements

This article provides information on the toxicity of some therapeutic drugs, illicit drugs, and supplements. Medications in the therapeutic section are grouped into antibiotics, antipsychotic agents, bronchodilators, nonsteroidal anti-inflammatory drugs, opioids, and sedatives/tranquilizers. The section on illicit drugs and supplements provides information on more specific medications including commonly used or abused human medications and a few that are available only from Internet compounding pharmacies. Many drugs and supplements can be either therapeutic or illicit depending on the dosage and ultimate use of the horse. Some medications, however, are illicit no matter when and how they are administered.

Right dorsal colitis in horses: A multicenter retrospective study of 35 cases

BACKGROUND

Right dorsal colitis (RDC) is a nonsteroidal anti-inflammatory drug (NSAID) induced, protein losing enteropathy in horses associated with a high case fatality rate.

OBJECTIVES

To describe signalment, NSAID usage, clinical presentations, clinical pathology, ultrasonographic findings, treatments, outcomes, and factors associated with survival in horses diagnosed with RDC.

ANIMALS

Thirty-five horses from 7 Australian equine hospitals diagnosed with RDC.

METHODS

Retrospective case series. Clinical records of cases were accepted if definitively or presumptively diagnosed by an internist with RDC and had ≥3 of: hypoproteinemia or hypoalbuminemia; diarrhea with negative test results for infectious diseases; colic for which other diseases were excluded or right dorsal colon thickening on ultrasound. Descriptive data analysis was performed for categorical and continuous variables. Univariate binominal logistic regressions were used to assess factors associated with survival.

RESULTS

An overdose of NSAIDs occurred in 84% (21/25) cases where dose was known. Common clinical presentations included diarrhea (69%; 22/32), colic (61%; 20/33), and tachycardia (53%, 17/32). Common clinicopathological findings included hypoalbuminemia (83%; 26/31), hypocalcaemia (79%, 23/29), and hyperlactatemia (77%, 14/18). The right dorsal colon wall appeared subjectively thickened in 77% (24/31) cases using ultrasonography. Case fatality rate was 43% (15/35). Odds of survival significantly decreased with increasing heart rate (odds 0.84, 95% CI = 0.71-0.92, P = .01), packed cell volume (odds 0.91, 95% CI 0.82-0.98, P = .05) and abnormal appearance of mucous membranes (odds 0.05, 95% CI 0.005-0.28, P = .001) on hospital presentation.

CONCLUSIONS AND CLINICAL IMPORTANCE

An overdose of NSAIDs is common in horses diagnosed with RDC. Serum albumin concentrations should be monitored in horses receiving a prolonged course of NSAIDs. Overall prognosis for RDC remains fair.

Non-Steroidal Anti-Inflammatory Drugs and Associated Toxicities in Horses

Effective pain management in horses can be a challenge despite the understanding that appropriate analgesia improves animal welfare and increases treatment success. The administration of NSAID drugs, particularly phenylbutazone and flunixin, are common practice in equine veterinary patients. Known for their analgesic and anti-inflammatory properties, NSAIDs are used for the treatment of a variety of conditions in horses, from gastrointestinal to orthopedic pain. Despite extensive usage, NSAIDs have a narrow margin of safety and the body of literature documenting the efficacy and side effects of different NSAIDs is broad. The three main side effects associated with excessive or prolonged NSAID usage in horses include gastroduodenal ulceration, right dorsal colitis (RDC) and renal papillary necrosis. The use of cyclooxygenase-2 selective NSAIDS, such as firocoxib, are theoretically safer. The aim of this paper is to review the current literature on the use and efficacy of different NSAIDs, summarise the associated side effects of NSAID usage and evaluate the current state of knowledge for the diagnosis and treatment of such toxicities.

Estimation of Nitrite-Nitric Oxide Derivative-In Horses with Intestinal Colic by ESR Spectroscopy

Diseases of the gastrointestinal tract of horses are caused by many factors and have a complex pathogenesis. Developing effective methods of differential diagnostics is of high fundamental and applied importance. The pathogenesis of diseases of the digestive tract of horses accompanied by the development of inflammation and oxidative stress, can be associated with a lack of the nitrogen monoxide which controls many signaling pathways in the body. The level of the nitric oxide (NO) is involved in the regulation of the immune and nervous systems, the tone of all the blood vessels, and the courses of many pathological processes. The nitric oxide activates guanylate cyclase (sGC) and leads to vascular relaxation. The aim of this investigation was to study the metabolites of nitric oxide in horses suffered from intestinal diseases. The levels of nitric oxide in the blood serum of horses depending on their age and health state was studied. The concentration of nitrites in the blood serum of horses aged 6–25 years was 3.4 ± 4.2 μM, and in the young horses (1–5 years) the level of this indicator was 8.2 ± 5.4 μM. A sharp decrease in nitrite was observed in all the horses with intestinal diseases of 2 ± 0.9 μM, especially with tympanitic caecun of 0.6 ± 0.4 μM and with spasmodic colic of 1.8 ± 0.5 μM. The level of nitrosylhemoglobin HbNO in the blood of the diseased animals was higher than that in clinically healthy horses, regardless of age.

Ultrasound of the equine acute abdomen

Abdominal ultrasound is an invaluable aid in the evaluation of the colic patient but can be heavily influenced by patient preparation, individual horse-to-horse variation, availability of ultrasound transducers, technique, experience level of the examiner, and complexity of the abdominal disorder. This article describes ultrasonographic anatomy of the normal equine abdomen and technique for examination of the equine colic patient. Common abnormalities of the stomach, small intestine, large intestine, and peritoneal cavity are described along with other abnormalities that may be discovered with abdominal ultrasonography of the colic patient, such as masses, urolithiasis, cholelithiasis, and thoracic or cardiac lesions.

Contemporary use of acepromazine in the anaesthetic management of male horses and ponies: a retrospective study and opinion poll

REASON FOR PERFORMING STUDY

Current use of acepromazine in the anaesthetic management of male horses and ponies and associated risks are largely unknown.

OBJECTIVES

To explore anaesthetic acepromazine use and related adverse effects in the male horse.

METHODS

Of 8533 anaesthetised horses and ponies medical records of male animals treated perianaesthetically with acepromazine were reviewed. Demographic data, time and dose of acepromazine administration, co-administered drugs, quality of induction and recovery from anaesthesia, arterial blood pressures, and occurrence of penile dysfunction were recorded. Practising ACVA and ECVAA diplomates were polled on the use of acepromazine and its effects on blood pressure and penile dysfunction in the equine.

RESULTS

Of all animals, 12% females and 11% males (n=575 including 42% stallions) received perianaesthetic acepromazine, predominantly for premedication. Anaesthetic induction was smooth in 566 animals. Lowest mean arterial pressures averaged 65±9 mmHg. Recovery was good or very good in 70% of all animals and 74% stood after 1-2 attempts. In 14 horses (2.4%; 7 stallions, 7 geldings), penile prolapse occurred for 0.5-4 h and in one stallion (0.2%) for >12 but <18 h post recovery. Most surveyed anaesthesiologists use acepromazine in stallions (occasionally 63%; frequently 17%) but more frequently in geldings (occasionally 34%; frequently 59%) and mares (occasionally 38%; frequently 59%), primarily for premedication with other sedatives and analgesics. Persistent intraoperative hypotension was not frequently reported. Only 5% of surveyed anaesthesiologists recall penile prolapse post acepromazine administration lasting for >12 h and only one recalls 3 cases of irreversible penile prolapse in 20 years of anaesthesia practice.

CONCLUSIONS AND POTENTIAL RELEVANCE

The extremely low risk of permanent penile dysfunction (≤1 in 10,000 cases) does not justify more restricted use of acepromazine in the intact male vs. geldings and mares.

Acute diarrhea in hospitalized horses

The development of diarrhea among hospitalized horses is a major concern for equine veterinary hospitals and referral centers. It is a potential complication of hospitalization for surgical or medical procedures and can contribute to the morbidity and mortality of horses with gastrointestinal and non-gastrointestinal diseases. Unfortunately, it can be difficult to pinpoint the exact cause of acute diarrhea or colitis, and in most cases, the specific etiologic agent is presumptive or undetermined. This article discusses the major etiologic agents of diarrhea in hospitalized horses, considers factors that place hospitalized horses at special risk for diarrhea, and examines several infectious colitis outbreaks that have occurred at veterinary referral centers.

Right dorsal colitis in the horse: minireview and reports on three cases in Ireland

Right dorsal colitis (RDC) is an ulcerative inflammatory bowel disorder of the horse that has been associated with the administration of non-steroidal anti-inflammatory drugs (NSAIDs), particularly in horses treated when dehydrated or toxaemic. The acute form of RDC may result in profuse diarrhoea, severe colic, dehydration, endotoxic shock and even death; the chronic form may be manifest by mild to moderate intermittent colic, ventral oedema and weight loss with or without diarrhoea. The most consistent laboratory findings are anaemia, hypoproteinaemia, hypoalbuminaemia and hypocalcaemia. Medical management of RDC requires avoidance of NSAIDs, of stressful experiences and of large-volume diets. Specific medications such as sucralfate and metronidazole have been used to treat RDC in the horse. The use of dietary additions such as psyllium and corn oil has been mentioned in the literature.

RDC has not been reported previously in Ireland or Britain; here we report that the condition was diagnosed in three horses in Ireland on the bases of a history of phenylbutazone therapy, clinical signs, clinical pathology and ultrasonography. In two of the three horses the diagnosis was confirmed by direct inspection of the affected colon at celiotomy.