scott@vtx-cpd.com

Replying to Alice L 05/12/2021 - 20:49

Hey Alice.

Brilliant question! I will add it to the list.

Hopefully see you Thursday!

Scott 🙂

Replying to Madeleine Smith 01/12/2021 - 12:14

Never too late.

You have access to the lessons and discussion forum for 6 months… keep asking questions!

This is a really brilliant question. honestly, there is not any evidence to promote one 2nd line immunosuppression over another. You colleagues are right, there are some studies that show a varying time of effect with azathioprine, two weeks or more in some in vitro studies. I would go with any of the following:

Azathioprine: 2 mg/kg or 50 mg/m2 PO q24h. After 2-3 weeks, the dosing interval may be increased to every other day until treatment is discontinued.

Cyclosporine: 5 mg/kg PO q12h. Adjustment of this dosage may be guided by therapeutic drug monitoring (TDM) (see recommendation #28).

Mycophenolate mofetil: 8-12 mg/kg PO q12h.

The only other reason mycophenolate might be a good option is that there is an injectable form.

In short, any of the above will be fine!

Scott 🙂

Replying to Jeanette Tungesvik 26/11/2021 - 16:37

Hello.

Really interesting question and really challenging cases. I am glad the cat is doing well. Is this the only medication the cat is currently on? Is the cat urinating normally?

There are various different drug combinations that can be used, including diazepam, prazosin, bethanechol, a combination of diazepam and prazosin, or a combination of diazepam, prazosin and bethanechol.

I generally find diazepam is not necessary. I tend to use a combination of bethanechol and prazosin. Regarding the phenoxybenzamine; I would probably reduce this gradually. Reducing to once daily for a week and then every other day. I think it is worth weaning but impossible to know if this might be needed long term without trying.

Hope that helps.

Scott 🙂

Replying to Louise Groot 29/11/2021 - 15:11

This is a really great question Louise.

I am afraid there is not a straightforward answer! In veterinary medicine, colloids are indicated primarily for bolus intravascular volume support. Much of the decision making will be based on the individual case and what is available:

1. In hypovolaemic cases I would typically use a combination of isotonic crystalloids, hypertonic saline and blood products (if appropriate).

2. In cases where hypotension is the biggest issue I would use isotonic crystalloids, hypertonic saline and blood products when appropriate and consider vasopressors if this was not effective.

3. Cases where colloid support can be most tricky is cases with severe hypoalbuminaemia. Right now due to concerns about cost, safety, and availability of albumin products, synthetic colloids (HES) are used extensively for resuscitation and improvement of colloid oncotic pressure (COP) in veterinary medicine. Colloid CRIs have been used historically for improvement of COP, but the possible risk of increased side effects with cumulative doses and lack of improvement in outcome data from human studies indicate this practice should be further examined. Also, no large-scale human study has found a significant outcome advantage in patients given any colloid (natural or synthetic) over balanced isotonic crystalloids alone. As with any drug, the risks versus benefits of colloids should be carefully considered and their use titrated as needed for each individual patient. The lowest possible dose of HES should be used for the shortest period of time to minimize potentially underrecognized adverse effects in our veterinary patients. Further studies are needed to see if the use of natural albumin products such as canine serum albumin is superior to crystalloids alone in improving outcomes in veterinary patients.

Ultimately, I would be using them in cases where other options had been exhausted as far as supporting blood pressure and COP.

Hope that helps. Happy to chat through this more at Q&A too.

Scott 🙂

Replying to elaine elder 29/11/2021 - 19:38

Hey Elaine.

It is a really good question! We also used to use Oxyglobin during my residency. It went off the market and has not made any attempt to come back, so this is really not an option now.

Xenotransfusion is definitely a great option in the true emergency while you sort out getting actual cat blood by whatever means!

Scott 🙂

Replying to Zoe McGarry 19/11/2021 - 12:05

Hey Zoe.

Hope you are well.

I have started a whole new thread regarding the feline blood bank.

Would love to hear your thoughts.

Scott 🙂