November 2023 15 hypoadrenocorticism. Prednisolone is also beneficial in the medical management of insulinoma. See gastrointestinal drugs and neurology for cross-reference. 3) Insulin (short, intermediate and long acting) Insulin is required for emergency treatment of diabetic ketoacidosis (short acting insulin), resulting from poorly controlled or undiagnosed diabetes mellitus. Porcine zinc insulins or human recombinant insulins (intermediate acting) are required for the long-term stabilisation and control of diabetes mellitus. Long acting insulin might be required when intermediate formulations fail to regulate. 4) Mineralocorticoid/Corticosteroid with mineralocorticoid effect (deoxycorticosterone pivalate, fludrocortisone) Mineralocorticoids or corticosteroids that act as mineralocorticoids that influence salt and water balance are needed in the long-term treatment of hypoadrenocorticism. Deoxycorticosterone pivalate is in injectable and fludrocortisone in (oral) form. 5) Steroid hormone synthesis inhibitor (trilostane, mitotane) These medications inhibit the production of pregnenolone from cholesterol and reduce the synthesis of steroid hormones. These medications can be used for treatment of hyperadrenocorticism and are for oral administration. 6) Synthetic thyroxine (levothyroxine) This medication is used to treat thyroid hormone deficiency in canine hypothyroidism. Complementary List 1) Hydroxylated metabolite of oestradiol, oestrone or similar class Functions as an agonist of oestrogen receptors to increase urethral sphincter tone in medical management of urethral sphincter mechanism incompetence. 2) Sympathomimetic agent (phenylpropanolamine) Functions as an agonist of α-and β-adrenergic receptors and stimulates the release of noradrenaline (norepinephrine). Phenylpropanolamine is used in cases of urinary incontinence. 3) Vasopressin analogue (desmopressin acetate; DDAVP) It is available for oral or conjunctival administration and is used in the treatment of central diabetes insipidus in dogs and cats. This can also be administered iv or subcutaneously to dogs with von Willebrand’s disease. EUTHANASIA DRUGS Core List 1) Barbiturates Barbiturates (thiopental or pentobarbital) may not be essential as anaesthetics, but they are crucial euthanasia agents especially in the absence of other anaesthetics (ketamine, propofol and alfaxalone) to induce unconsciousness before humane euthanasia. These drugs are often combined with other medicines as part of euthanasia solutions. 2) Potassium chloride This is also used for humane euthanasia once the animal is under general anaesthesia. See also anaesthetic, analgesic, sedative and emergency drugs. GASTROINTESTINAL SYSTEM Core List 1) Activated charcoal For the treatment of gastrointestinal toxicosis, since this is not absorbed from the gastrointestinal tract. 2) Antiemetic drugs: antagonists of D2-dopaminergic receptor and antagonists of 5-HT3 serotoninergic receptors (metoclopramide and ondansetron) or antagonists of neurokinin-1 receptor (maropitant) Indicated for the control of vomiting associated with drug administration or disease, and the prevention of motion sickness (i.e. maropitant only). These drugs are used for symptomatic therapy and do not treat the underlying disease. Metoclopramide lowers the risk of gastroesophageal reflux but does not prevent it. 3) Antiulcer drugs: antagonists of histamine-receptor (ranitidine or famotidine), sucralfate or proton pump inhibitors (omeprazole) Histamine-receptor antagonists decrease proton secretion and decrease gastric acid secretion that is stimulated by histaminergic pathways. Sucralfate adheres to ulcerated tissues creating a physical barrier and protecting against hydrogen ions, pepsin and bile, promoting ulcer healing. Proton pump inhibitors bind and irreversibly block H+/K+ATPase, blocking gastric secretion stimulated by all pathways. These agents are indicated for gastroduodenal ulceration, oesophagitis and gastritis. 4) Emetic agent (apomorphine or xylazine) Apomorphine stimulates dopamine receptors in the chemoreceptor trigger zone, inducing emesis after oral or parenteral administration. The drug is used in cases of inadvertent/accidental toxin/ drug ingestion if given promptly. Xylazine is an agonist of α2adrenergic receptors (see anaesthesia). It can be used in cats as an emetic agent; however, it may cause sedation. 5) Immunomodulatory therapy with glucocorticoids (prednisolone) This is used as an immunosuppressant agent for the treatment of different immune-mediated diseases. 6) Lactulose Lactulose acidifies the colonic contents. Ammonia is then trapped as ammonium and, in this form, the intestinal wall cannot absorb it. Lactulose is used to reduce ammonia concentrations in the treatment of hepatic encephalopathy, but also as an osmotic laxative in constipation. See neurology. Complementary List 1) Mirtazapine Tricyclic antidepressant used as an appetite stimulant mostly in cats. Leading Article
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