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Veterinary Anesthesia & Analgesia Support Group |
| Practical Information for the Compassionate Veterinary Practitioner |
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| Alphabetical Drug Summaries | ||
| Dr. Bob Stein | ||
1) DERACOXIB
a) Classification
i) A coxib class COX2 selective NSAID b) General Information
i) Effective anti-inflammatory/analgesic generally free of significant GI side effects c) Advantages/Recommended use
i) Short term use for acute pain ii) Long term use in chronic pain for tolerant patients d) Cautionary Information
i) As with any NSAID, GI side-effects can be substantial (1) Discontinue use if GI signs develop ii) Avoid use in: (1) Combination with corticosteroids (a) Potentially increased ulcerogenic effect (2) Renal compromised patients, dehydrated or hypotensive patients, patients with hepatic disease, pregnancy, patients with pre-existing GI disease, coagulopathies iii) Monitor liver enzymes of canine patients on chronic therapy e) Dosage Information
i) Dogs – 1 to 2 mg/kg PO SID for general pain management (1) 3 to 4 mg/kg PO SID for up to 7 days for acute surgical pain ii) Cats – use of deracoxib is not recommended at this time f) Cost
i) Moderately high
2) DEXDOMITOR
a) Pfizer’s brand name for dexmedetomidine i) See dexmedetomidine
a) Classification
i) Alpha-2 agonist (1) The more potent dextro enantiomer of the racemic medetomidine b) General Information
i) Potent sedative/analgesic ii) Moderately short duration of effect (1 - 2 hours) c) Advantages/Recommended use
i) Best reserved for healthy patients needing a reversible agent ii) Significant reduction in induction agent and lower MAC of inhalants iii) 10 times more selective for alpha-2 vs. alpha-1 than xylazine iv) Can be used with ketamine and an opioid as an IM anesthetic protocol for short procedures d) Cautionary Information
i) DO NOT USE AS SOLE AGENT AT BOX LABEL DOSES (1) Label doses are as high as 0.040 mg/kg at smaller patient size ii) Do not use in debilitated or cardiovascularly unstable patients iii) Extremely stressed patients may not respond as well (1) Isolate in quiet, darkened room if possible to facilitate effect iv) May cause dramatic bradycardia (1) This can rarely be a an unresponsive, fatal bradycardia (2) Anticholinergic use is a debatable issue (the author does not routinely an antocholinergic when using alpha-2 agonists) (a) If anticholinergics are used with an alpha-2 agonist they should be given with or prior to the alpha-2 agent (b) Anticholinergics may be used after an alpha-2 agonist IF at least one hour has transpired since alpha-2 agonist administration v) Alpha-2 agonists depress insulin production (1) Use with caution or avoid in non-insulin dependent diabetics e) Dosage Information
i) Dog & Cats - general preanesthetic use (1) 0.0005 to 0.015 mg/kg (0.00025 to 0.0075 mg/lb) IV, IM, SC (2) 0.001 to 0.010 mg/kg (0.0005 to 0.005 mg/lb) is usually very adequate for dogs and cats when combined with an opioid ii) IM protocol (Anesthetic and cardiopulmonary effects of intramuscular morphine, medetomidine, ketamine injection in dogs. Ueyama Y, Waselau AC, Wiese AJ, Muir WW. Vet Anaesth Analg. 2008 Nov;35(6):480-7. Epub 2008 Aug 15.) (Anaesthetic and cardiopulmonary effects of intramuscular morphine, medetomidine and ketamine administered to telemetered cats. Wiese AJ, Muir WW. J Feline Med Surg. 2007 Apr;9(2):150-6. Epub 2007 Jan 2.) (1) 20 to 60 ug/kg DexMedetomidine, 5 mg/kg Ketamine, 0.2 mg/kg Morphine - combined and given IM (a) Use lower doses for dogs, higher doses for cat (b) Consider insulin syringes especially for smaller cats (c) Always use lean body weight when dosing (2) An IV catheter is highly recommended if not required (3) Intubation and Oxygen support is highly recommended if not required (a) Allows the easy addition of inhalant anesthetic agent should the patient be inadequately anesthetized for longer procedures f) Cost
i) High (especially if atipamazole is used)
4) DEXTROMETHORPHAN
a) Classification
i) An antitussive drug and an NMDA antagonist
b) General Information
i) Developed initially as a human cough suppressant ii) An oral prescription medication capable of NMDA antagonism useful in managing the central sensitization component of chronic pain management c) Advantages/Recommended use
i) Chronic pain management d) Cautionary Information
i) Reduce dose or discontinue in patients with hepatic dysfunction e) Dosage Information
i) Dogs & Cats (1) 0.5 to 2.0 mg/kg (0.25 to 1.0 mg/lb) TID to QID PO ii) Robitussin CoughGelsÒ are an OTC gelcap that contains 15 mg dextromethorphan per capsule and no other drugs. Vicks Formula 44 Cough ReliefÒ is a dextromethorphan only liquid OTC product that contains 2 mg/ml and comes in 118 ml bottles. f) Cost
i) Moderate
5) DIAZEPAM
a) Classification
i) A benzodiazepine hypnotic sedative agent b) General Information
i) Usually combined with ketamine or an opioid c) Advantages/Recommended use
i) Combined with ketamine for: (1) Older patients (2) Some cardiac patients ii) Combined with oxymorphone for: (1) Debilitated patients (2) Geriatric patients iii) Cats (1) Several hour duration makes it suitable for short term sedation in the cat iv) Spinal surgery cases (1) Give at extubation for muscle relaxation (decreases pain) v) Diazepam is reversible using flumazenil d) Cautionary Information
i) Propylene glycol base makes diazepam somewhat painful and less predictably absorbed than midazolam when given IM (1) Propylene glycol has potential to cause hemolysis and vasodilation if given in sufficient quantity ii) Rapid IV administration may lead to short term arrhythmia iii) Dogs (1) Extremely short duration makes it unsuitable for sedation as sole agent in the dog e) Dosage Information
i) Dogs & Cats
(1) Generally dose – 0.2 mg/kg to 0.4 mg/kg (0.1 to 0.2 mg/lb) IV, IM (2) IV induction #1 - combined with equal volume of Ketamine (a) Draw up 1cc of total mixture per 10 kg (20lb) (i) Give ½ initially, then to effect (ii) Reduce dose by 30% - 50% if depressed or heavily sedated by pre-meds (3) IV induction #2 - combined with fentanyl, hydromorphone, or oxymorphone – most useful for dogs (i) See Diazepam & an Opioid section under Induction Protocols for details (ii) Cats would need low dose Ketamine (1 to 5 mg/lb) or Propofol (0.5 to 2 mg/lb) to facilitate intubation (4) IV maintenance – most useful for dogs (a) See Diazepam & an Opioid section under Maintenance Protocols for details (i) Main indication would be canine patient with difficult to manage hypotension while on inhalant agent f) Cost
i) Low
6) DOBUTAMINE
a) Classification
i) Positive inotropic agent related to dopamine ii) Primarily a direct beta1-adrenergic agonist with mild beta2- and alpha1-adrenergic effects b) General Information
i) Used to help increase blood pressure in hypotensive patients ii) Compatible with most of the commonly used IV fluids including D5W, saline, and LRS (1) The initial vial and the diluted drug is stable for 24 hours c) Advantages/Recommended use
i) Used to increase blood pressure when an anesthetic reduction, IV fluids, and colloids are inadequate d) Cautionary Information
i) This drug must be diluted before administration (1) Final drug concentration must be no greater than 5.0 mg/ml ii) Use open vial and diluted drug for no longer than 24 hours iii) Use caution when mixing with other drugs (1) Confirm compatibility before doing so iv) Discontinue if significant increase in heart rate or if any arrhythmia develops (1) Arrhythmias are much less likely at dose rates below 0.008 mg/kg/min (0.004 mg/lb/min) e) Dosage Information
i) Dog – 0.001 to 0.010 mg/kg/min (0.0005 to 0.005 mg/lb/min) ii) Cats - use low end of dog dose range iii) Recipe for 0.002 mg/kg/min (0.001 mg/lb/min) dose (1) 4.8 ml @ 12.5 mg/ml = 60 mg (2) Add to 250 ml 0.9% saline for 0.24 mg/ml (3) Give 0.5 ml/kg/hour f) Cost
i) Low
7) DOMITOR
a) Pfizer’s brand name for medetomidine i) See medetomidine
8) DOPAMINE
a) Classification
i) Positive inotropic agent ii) Precursor to norepinephrine and epinephrine iii) Primarily beta1-adrenergic effects at therapeutic doses with alpha1-adrenergic effect at higher dose rates b) General Information
i) Used to help increase blood pressure in hypotensive patients ii) Compatible with many of the commonly used IV fluids including D5W, saline, and LRS (1) Diluted drug is stable for 24 hours c) Advantages/Recommended use
i) Used to increase blood pressure when an anesthetic reduction, IV fluids, and colloids are inadequate d) Cautionary Information
i) This drug should be diluted before administration ii) This drug is available in many different strengths – adjust recipes accordingly iii) Use open vial and diluted drug for no longer than 24 hours iv) Protect from light v) Use caution when mixing with other drugs (1) Confirm compatibility before doing so vi) Discontinue if significant increase in heart rate or if any arrhythmia develops (1) Arrhythmias are much less likely at dose rates below 0.020 mg/kg/min (0.010 mg/lb/min) e) Dosage Information
i) Dog – 0.002 to 0.010 mg/kg/min (0.001 to 0.005 mg/lb/min) ii) Cats - use low end of dog dose range iii) Recipe for 0.002 mg/kg/min (0.001 mg/lb/min) dose (1) 1.5 ml @ 40 mg/ml = 60 mg (2) Add to 250 ml 0.9% saline for 0.24 mg/ml (3) Give 0.5 ml/kg/hour f) Cost
i) Low
9) DURAMORPH
a) Classification
i) Preservative free morphine ii) Pure mu opioid agonist b) General Information
i) A specific preparation for epidural use c) Advantages/Recommended use
i) Epidural analgesia d) Cautionary Information
i) Single use 10 mg (10 ml) vials and 2 mg (2ml) vials - do not save residual meds e) Dosage Information
i) Epidural use (1) Dog & Cat - 0.1 mg/kg (0.045 mg/lb.) (a) 1 cc per 10 kg f) Cost
i) Moderately high – significant wastage |
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