Download Pharmacotherapy in Reptiles

Pharmacotherapy in reptiles
univ. prof. Zdenek Knotek, DVM, PhD
University of Veterinary and Pharmaceutical Sciences Brno
Czech Republic
Pharmacokinetism - temperature
Reptiles are ectotherm vertebrates.
Their metabolism is dependent (influenced
with) on external temperature.
In nature – reptiles try to keep the body in
preferred body temperature (PBT) optimal
condition for metabolic pathways.
Patients keep their PBT - spending maximum
time in special part of the terraria - behavioral
thermoregulation.
Pharmacokinetism - temperature
Reptiles are ectotherm vertebrates.
Preferred optimum temperature zone (POTZ) is
condition for PBT.
• Keep your patients in POTZ – during
treatment, anaesthesia, surgery, recovery
period.
• Lower (suboptimal) temperatures – prolong
the recovery time.
• Lower (suboptimal) temperatures – increase
the risk of overdose drugs (aminoglycosides).
Special anatomy/physiology of reptiles
Quadriped reptiles - renal portal system.
Presence/absence – urinary bladder – ventral
extension of urodeum.
Central organ for final urine production.
Special anatomy/physiology of reptiles
• The most of snake species have only the right
lung.
Do not insert the endotracheal tube into left
lung rudiment.
• Reptiles have very low respiratory frequence.
It is lowest within anaesthesia.
• Reptiles can tolerate very low oxygen
concentration in peripheral blood (organs,
tissues).
• Semia-quatic/aquatic reptiles – shunt of blood
circulation within the period of submergence.
Special anatomy/physiology of reptiles
GIT – in carnivorous reptiles (crocodiles,
aquatic terapins,
snakes and some lizards) short distance.
Transit time for contrast fluids (X-ray), food,
drug metabolites is short (days).
GIT – in herbivorous reptiles (land tortoises,
lizards) long.
Transit time for contrast fluids (X-ray), food,
drug metabolites is long, very slow passage
(weeks).
DIAGNOSIS and TREATMENT
§1
Think before treat !
§2
Disease is complex !
§3
Concurrent diseases !
§4
Patient is complex !
§5
Topical and/or systemic treatment !
§6
Follow the recommendations !
§7
Reptiles- crocodiles, chelonians, snakes,
lizards
DIAGNOSIS and TREATMENT
EMERGENCY ?
Reptiles are generally presented injured or ill.
Good history - valuable lead to the problem.
In many cases - only an illusion.
Prepare your own questionare protocol
origin of the reptile
housing system
feeding regimen
temperature, air humidity, water, substrate,
UVB any previous treatment?
previous reproductive activity?
The success of treating a critical patient
relies very heavily on the environment in
which the animal must recover.
When possible make visually-separated
housing for each of the reptile patients.
They may experience unnecessary extra
stress in a living with visual contact with
other reptiles (predators).
Basic equipment to practice with reptiles
a gram scale
a lightweight plastic transport containers
endoscope (2.7 mm or less)
X–ray
microscope with oil immersion capability
quick-staining kit for smears and cytology,
centrifuge, haemocytometer
biochemistry testing system.
Side effects
Aminoglycosides
amikacin, gentamycin, kanamycin, netilmycin,
tobramycin
+ G- bacterial infections
glomerular filtration
-
nephrotoxic (neurotoxic, ototoxic, cardiotox) efects
Side effects
Tetracyclin ATBs
doxycyclin, chlortetracyclin, oxytetracyclin, tetracyclin
+ G+ i G- infections,
low nephrotoxic
-
teratogenic (pregnanc), nauzea, vomitus,
hepatotoxicefekt (liver steatosis),
bacteriostatic
Side effects
Quinolon
enrofloxacin, ciprofloxacin
+ G+ a G- infekcí,
suspect teratogenic (pregnancy),
negative influence on bones (growth, joints)
Metronidazole
+ (Clostridia, Entamoeba, Hexamita)
- neurotoxic efect
of reccommended doses
(heavy reptiles)
Ivermectin
+ (endoparasites, ectoparasites)
- toxic for tortoises, turtles
Administartion
Per os + GIT
Per cloacam
Parenteral
SC, IM, IPP, IV, IO
Metabolic (Allometric) scalling
BMR (kcal) = K.H0.75
• birds - passerine birds
• birds - non-passerine birds
• mammals
• reptiles
(K = 129)
(K = 78)
(K = 70)
(K = 10)
Antimicrobial
Agent
Acyclovir
Dosage
80 mg/kg PO q24h x10
agents ATB
Comments
Tortoises (herpes)
Topical (5% ointment) q12h Tortoises (herpes)
Ampicilin
Amikacin
20 mg/kg IM q24h x 7
Tortoises
2.5 mg/kg IM, SC q72h x 7
Nephrotoxic agent
Gentamycin 1.75 - 2.5 mg/kg IM q72 h x7
Nephrotoxic agent
Kanamycin
5 - 15 mg/kg q24 - 48 x 5 - 7 Nephrotoxic agent
Antimicrobial agents ATB
Agent
Dosage
Comments
Chloramphenicol
20 - 50 mg/kg PO
q24h x 7
Streptomycin
6 - 10 mg/kg IM
q24h x 5 - 7
Tetracycline
Tylosine
Cindamycin
Doxycycline
25 - 50 mg/kg IM, PO
q24h x 6
5 - 10 mg/kg IM
q24h x10 crocodiles
2.5 - 5 mg/kg PO
q12-24h x 7
50(1)+25(3 - 6)mg/kg IM q48 - 72h x 6
Antimicrobial agents ATB
Agent
Cefotaxime
Ceftazidime
Dosage
Comments
20 - 40 mg/kg IM
q24h x 7 - 14
20 mg/kg IM
q72h x 14 - 21
Cephalexin
20 - 40 mg/kg IM
q12h x 7
Cephalothin
20 - 40 mg/kg IM
q48h x 7 chelonians
Cephazolin
20 - 40 mg/kg IM
q24h x 7 - 14
Cephoperazone
125 mg/kg IM
q24h x 7 lizards
Antimicrobial agents ATB
Agent
Enrofloxacin
Ciprofloxacin
Dosage
10(15) mg/kg SC, PO
Comments
q24h x 7 - 21
10 mg/kg PO
q48h x 3 - 5
20 - 50 mg/kg PO
q24h x 3 - 5
Trimethoprim /
sulfamethoxazole
30(1)+15 mg/kg
q24h x 10 - 14
Sulphadimidine
50 mg/kg PO
q24h x 10
Sulphamerazine
25 mg/kg PO
q24h x 7
Metronidazole
Antifungal agents
Agent
Dosage
antimycotics
Comments
Amphotericin B
0.5 - 1 mg/kg PO, IPP q24 - 48h x 28
Griseofulvin
20 - 40 mg/kg PO
q72h x 5
topical
ointment
Clotrimazole
Fluconazole
Itraconazole
Ketoconazole
5 mg/kg PO
q24h x 28
24 mg/kg PO
q24h x 28
15 - 30 mg/kg PO
q24h x 28
Antifungal agents
Agent
antimycotics
Dosage
Comments
Chlorhexidine
20 ml/gal water bath
Lizards - dermatoph.
Malachite green
0.15 mg/l water x 1 hr
q24h x 14
Miconazole
Nystatin
Tolnaftate 1%
cream
topical
100 000 i.u./kg PO
topical
ointment
q24h x 10
q12h
Antiparasitic agents
Parasites
Amoeba
Flagellata
Agent
Dosage
Metronidazole
20 – 40 (100) mg/kg 3x
Dimetridazole
40 mg/kg q24h x 4
Paromomycin
35 – 60 mg/kg after week
Metronidazole
20 – 40 (100) mg/kg 3x
Dimetridazole
40 mg/kg q24h x 4
Ronidazole
10 mg/kg q24h x 10
Antiparasitic
Parasites
Coccidia
Agent
agents
Dosage
Toltrazuril
10 mg/kg q72h x 5
Sulfadimethoxine
Sulfamethoxydiazine
75 – 90 mg/kg I.day
40 – 45 mg/kg II. – IV.
40 – 60 mg/kg q24h x 4
Sulfadiazine
20 – 50 mg/kg q24h x 3
Cryptosporidium Trimethoprim /
sulfa
Spiramycin
30 – 60 mg/kg q24h x 7
160 mg/kg q24h x 10
Antiparasitic agents
Parasites
Agent
Ivermectin
Trematoda Praziquantel
Ivermectin
Cestoda
Dosage
0.2 mg/kg SC
 Chelonians
10 – 30 mg/kg q14 days
Praziquantel
0.2 mg/kg SC
 Chelonians
10 – 30 mg/kg q14 days
Niclosamid
150 mg/kg q14 days
Antiparasitic agents
Parasites
Agent
Dosage
Fenbendazole
10 – 30 mg/kg q 14 days
Pyrantel pamoate
5 mg/kg q 14 days
Nematoda Ivermectin
Piperazine
0.2 mg/kg SC
 Chelonians
40 – 60 mg/kg q 14 days
Albendazole
50 mg/kg q 14 days
Mebendazole
20 – 100 mg/kg q 14 days
Hormones + steroids
Agent
Dosage
Arginine vasotocin
0.5 - 1.0 μg/kg IV,IPP
Oxytocin
1 - 10 i.u./kg IM
Calcitonin
1.5 i.u./kg SC
Dexamethasone
2 - 4 mg/kg IM
q24h x 3
Prednisolone
2 - 5 mg/kg IM, PO
chronic pain
Nandrolone
1 mg/kg IM
Comments
q12 - 24h
after 2x calcium inj.
q8h x 2 - 3
anabolic, PHA
Nutritional
Agent
Ca - gluconate borogluconate
Ca - gluconate
Iodine
Iron dextran
Lactated Ringer
´s solution
/ mineral / fluid support
Dosage
10 - 50mg/kg IM
100mg/kg IPP, SC
2 - 4 mg/kg PO
12 mg/kg IM
10 - 25 ml/kg SC, IPP
Comments
hypocalcemia
q8h MBD, seizures
q24h x 2 - 3w
1 - 2 x w, crocodiles
q24h
Nutritional
Agent
Vitamin A
Vitamin B
complex
/ mineral / fluid support
Dosage
Comments
1000 - 5000 i.u./kg IM
q7-14d x 4
25 mg thiamine/kg PO
q24h x 3-7 days
Vitamin C
10 - 20 mg/kg SC, IM
q24h
Vitamin D3
200 i.u./kg IM, PO
q7days
Vitamin E
Vitamin K1
1 i.u./kg IM
25 mg/kg IM
1000 - 5000 i.u./kg IM
hypovitaminosis
coagulopaties
Miscellaneous
Agent
Dosage
agents
Comments
Allopurinol
10 - 20 mg/kg PO
q24h
Sucralfate
500 - 1000 mg/kg PO
q6 - 8h
Cimetidine
4 mg/kg PO, IM
q8 - 12h
Cisapride
0.5 - 2.0 mg/kg PO
Furosemide
5 mg/kg PO, IM
Metoclopramide
0.06 - 5 mg/kg PO
q24h
q12 - 24h
q24h x 7
Miscellaneous
Agent
Lactulose
Liquid paraffin
Dioctyl Na
sulfosuccinate
Barium sulfate
Dosage
0.5 ml/kg PO
25 (1:1 electr)/kg PO
agents
Comments
q24h
q24h, constipation
1 - 5 mg/kg PO
constipation
5 - 20 ml/kg PO
GIT contrast