VET November 2023 The Monthly Magazine of the SOUTH AFRICAN VETERINARY ASSOCIATION Die Maandblad van die SUID-AFRIKAANSE VETERINÊRE VERENIGING A Basic Introduction to Backyard Poultry Medicine – Part 1 of 3 CPD THEME Small animal practice: Essential drugs list nuus•news www.wvac2024.com
Dagboek • Diary www.wvac2024.com Ongoing / Online 2023 November 2023 SAVETCON: Webinars. Info: Corné Engelbrecht, SAVETCON, 071 587 2950, corne@savetcon.co.za / https://app.livestorm.co/svtsos Valley Farm Animal Hospital: CPD Evenings Ongoing. Monthly lectures, various speakers on a variety of topics – free of charge Venue: Valley Farm Animal Hospital, 829 Old Farm Road, Faerie Glen, Pretoria. Info: admin@valleyfarmvet.co.za Acupuncture – Certified Mixed Species Course Info: Chi University: https://chiu.edu/courses/cva#aboutsouthafrica@tcvm.com Certification in Clinical Integrative Canine Rehabilitation (Through College of Integrative Veterinary Therapies) Info: https://civtedu.org/courses International Veterinary Immunology Symposium 17-22 November Venue: Skukuza, Kruger National Park Info: www.ivis2023.org August 2024 SAVA Oranje Vaal Branch Mini Congress 09-11 August Venue: Parys – venue to be confirmed. Info: conference@savetcon.co.za
November 2023 1 Contents I Inhoud President: Dr Paul van der Merwe president@sava.co.za Managing Director: Mr Gert Steyn md@sava.co.za/ +27 (0)12 346 1150 Editor VetNews: Ms Andriette van der Merwe vetnews@sava.co.za Bookkeeper: Ms Susan Heine accounts@sava.co.za/+27 (0)12 346 1150 Bookkeeper's Assistant: Ms Sonja Ludik bookkeeper@sava.co.za/+27 (0)12 346 1150 Secretary: Ms Elize Nicholas elize@sava.co.za/ +27 (0)12 346 1150 Reception: Ms Hanlie Swart reception@sava.co.za/ +27 (0)12 346 1150 Marketing & Communications: Ms Sonja van Rooyen marketing@sava.co.za/ +27 (0)12 346 1150 Membership Enquiries: Ms Debbie Breeze debbie@sava.co.za/ +27 (0)12 346 1150 Vaccination booklets: Ms Debbie Breeze debbie@sava.co.za/ +27 (0)12 346 1150 South African Veterinary Foundation: Ms Debbie Breeze savf@sava.co.za/ +27 (0)12 346 1150 Community Veterinary Clinics: Ms Claudia Cloete cvcmanager@sava.co.za/ +27 (0)63 110 7559 SAVETCON: Ms Corné Engelbrecht corne@savetcon.co.za/ +27 (0)71 587 2950 VetNuus is ‘n vertroulike publikasie van die SAVV en mag nie sonder spesifieke geskrewe toestemming vooraf in die openbaar aangehaal word nie. Die tydskrif word aan lede verskaf met die verstandhouding dat nóg die redaksie, nóg die SAVV of sy ampsdraers enige regsaanspreeklikheid aanvaar ten opsigte van enige stelling, feit, advertensie of aanbeveling in hierdie tydskrif vervat. VetNews is a confidential publication for the members of the SAVA and may not be quoted in public or otherwise without prior specific written permission to do so. This magazine is sent to members with the understanding that neither the editorial board nor the SAVA or its office bearers accept any liability whatsoever with regard to any statement, fact, advertisement or recommendation made in this magazine. VetNews is published by the South African Veterinary Association STREET ADDRESS 47 Gemsbok Avenue, Monument Park, Pretoria, 0181, South Africa POSTAL ADDRESS P O Box 25033, Monument Park Pretoria, 0105, South Africa TELEPHONE +27 (0)12 346-1150 FAX General: +27 (0) 86 683 1839 Accounts: +27 (0) 86 509 2015 WEB www.sava.co.za CHANGE OF ADDRESS Please notify the SAVA by email: debbie@sava.co.za or letter: SAVA, P O Box 25033, Monument Park, Pretoria, 0105, South Africa CLASSIFIED ADVERTISEMENTS (Text to a maximum of 80 words) Sonja van Rooyen assistant@sava.co.za +27 (0)12 346 1150 DISPLAY ADVERTISEMENTS Sonja van Rooyen assistant@sava.co.za +27 (0)12 346 1150 DESIGN AND LAYOUT Sonja van Rooyen PRINTED BY UVO: +27 (0)12 423 9460 VET nuus•news Diary / Dagboek II Dagboek • Diary Regulars / Gereeld 2 From the President 4 Editor’s notes / Redakteurs notas Articles / Artikels 8 List of essential medicines for cats and dogs 20 Sunny South Africa to The Grey UK Association / Vereniging 24 CVC News 26 Support for SAVA Community Veterinary Clinics (SAVA-CVC) 27 SAVA News 28 In Memoriam 30 Legal Mews Events / Gebeure 6 World Veterinary Association Congress 2024 29 Reunion: OP Class of 1968 Vet's Health / Gesondheid 32 Life Coaching Technical / Tegnies 33 Anaesthesia 38 Ophthalmology Column Relax / Ontspan 48 Life Plus 24 Marketplace / Markplein 42 Marketplace Jobs / Poste 43 Marketplace/Jobs / Poste 47 Classifieds / Snuffeladvertensies 20 38 29 www.wvac2024.com
Vetnuus | November 2023 2 « BACK TO CONTENTS We often hear paraphrases of belonging to an association such as “it pays to be associated”, but is there any worth or benefits of belonging to a professional association? An association is defined as a group of persons who share common interests or a common purpose and who are organized with varying degrees of formality. The history of the South African Veterinary Association (SAVA) had a useful prelude and a very eventful course. The first step towards the establishment of a locally organised veterinary profession dates from the inauguration of the Transvaal Veterinary Medical Association (TVMA) on 16 February 1903. The Cape of Good Hope followed with the Cape of Good Hope Veterinary Medical Society on 1 November and the inaugural meeting of the Natal Veterinary Medical Association (NVMA) took place in Pietermaritzburg on 19 November 1909. At a TVMA meeting on 23 June 1910, there was general agreement that a South African Veterinary Medical Association should be formed out of the TVMA, CVMS and NVMA. The TVMA took the initiative and the South African Veterinary Association (SAVA) was inaugurated on 1 April 1920, a professional association whose aim is to serve its members and to further the status and image of the veterinarian. The history of the SAVA has, however, never been static. New objectives are continually being identified by the current policymaking body, the Federal Council. Implementation of future decisions will continue to shape the history of this erudite and dynamic association. Have you ever wondered what is it about people who are members of an association that makes them soar above colleagues? Professional associations give their members the power to make real changes in their line of work. If your goal is to further your career and make meaningful connections, then you should join a professional association. Professional associations are like a home away from home. They give you a sense of security and belonging in your career. Joining a professional association comes with incredible benefits. Furthermore, it makes your professional life that much easier and smooth sailing. You will get help as a member through networking and research. You’ll also get exclusive access to several resources, and most importantly, you will learn not by reading alone, but by interacting with smarter people. Some benefits that you will reap are: • Access to information and resources regarding all aspects of your profession. • An opportunity to network with like-minded, and often highly qualified individuals. It is often said that a real doctor treats more than one species. That is so true and the daunting diversity of the veterinary professions can only be managed by associating with the “smarter people” in your field of interest. • The most important thing about joining these associations is the relationships you build. • Professional and personal development. An association is an organisation for members by members. It is not a company that provides all sorts of services against payment. It is members who uphold and serve to enhance the careers of their peers. I want to thank every member that is willing to serve in SAVA. Your contributions are often overlooked. What is concerning though, is that many branches and groups are struggling not only to survive but to get members willing to serve on their management structures. We must stop asking what SAVA is doing for us. We must ask what we can do, not for SAVA, but for the development of fellow colleagues. In the words of Edward Everett Hale: “Coming together is a beginning; keeping together is progress; working together is success”. Let us be proud of our professional association developing our colleagues for over 100 years. Let all of us be willing to serve thereby learning and developing ourselves in the process, to make SAVA the success as envisaged by those greats before us. v Kind regards, Paul van der Merwe From the President Dear members, “A man only learns in two ways, one by reading, and the other by association with smarter people” – Will Rogers 24-Hour, Toll-Free Helpline: 0800 21 21 21
November 2023 3 Hi, I’m Dr Roger and I’m the owner of Redgum Vet & Pet Boarding, and we do things differently. I love what I do; I love my team; I love where I live. And I’m looking for a third Vet to join us. If you love the idea of…. • Living and working in a rural community located amongst the ancient and remarkable Flinders Ranges • Variety in your cases • A modern practice with all the bells and whistles • The opportunity to learn, grow and pursue your professional interests….with mentoring from two very experienced Vets Then this is for you! Here’s the footprint…. • We happily pay very well (we want all our team well rewarded for the value they bring) • Small Animals only? ….. no problems! • Relocation contribution; • Wages reviewed and adjusted every three months; KPI based. • One week paid study leave; Registration and Radiation Licence fees paid We make your life easier by…. Having nurses ride shot gun with you so you can focus solely on doing Vet stuff! Experienced Vets - have the opportunity to specialise in your areas of choice. So, if you are ready to progress your career and have some adventure at the same time, we would love to hear from you! Maybe you’re thinking of more? Interested in being more than an employee? Want to secure your future in a proactive, busy, profitable business? Let’s make a time to chat! Email me at Louise@redgumvet.com.au Full-time position Do you love the great outdoors? Find solace and peace in nature? I can answer any questions you might have and you can get a feel for whether this is an adventure you want to be part of!
Vetnuus | November 2023 4 « BACK TO CONTENTS REMEMBER THAT BEING GRATEFUL IS ABOUT APPRECIATING WHAT ONE HAS, AS OPPOSED TO WHAT ONE WANTS. BEING THANKFUL OR THANKING SOMEONE OFTEN IMPLIES YOU ARE ACKNOWLEDGING YOUR THANKS FOR SOMETHING THAT SOMEONE HAS GIVEN YOU. Still suffering a little ‘adrenaline’ hangover, like I am sure many, many South Africans do, after the Springboks’ World Cup Victory I have a great thankfulness in my heart. That is whatever was left of my heart after the second one point victory in a row by the Boks. As a nation of many colours, we needed a little something to spark unity again. So many things (and unfortunately people) try to pull the people of this country apart. "Sport has the power to change the world." Nelson Mandela was not wrong when he coined that phrase! He continued: “Sport has the power to inspire. It has the power to unite people in a way that little else does. It speaks to youth in a language they understand.” Today I am part of that youth. Even in my little town, the colour green pulled strangers into conversations. The excitement was tangible. The victory is much more than the 2023 South Africa engraved on the Web Ellis Cup. These men are the heroes of the day. I am thankful that we won I am grateful for what it did for South Africa “Thanksgiving Day, annual national holiday in November in the United States and Canada celebrating the harvest and other blessings of the past year. Americans generally believe that their Thanksgiving is modeled on a 1621 harvest feast shared by the English colonists (Pilgrims) of Plymouth and the Wampanoag people” www.britannica.com Being on the other side of the world, the harvest season in South Africa is more likely to be in April and June and therefore the celebrations never really caught on. That is no reason why we cannot use November as a time to look back on the year and reflect on the things we can be thankful and grateful for. Finding things to be thankful for is quite easy as per the above definition it is an acknowledgement after you receive something. Some stuff you receive short term like a salary or an increase. But some things you receive but do not know the full effect thereof. One such thing is your upbringing. Only after you leave your growing-up home do you realise what it entails to manage a household. That should bring into the heart a thankfulness to the people who cared for you when you were growing up. I can be a very positive person and don’t find it difficult to identify things to be grateful for. Maybe I am spoiled by living in the bush has an effect but I wake up with a deep awareness of how blessed I am. I try and find things that I cannot live without. The basic things and I am grateful for them. Yesterday I was grateful that we had a pool and at 35 degrees I could jump in and cool down. Today I am grateful that it is not 35 degrees any more (Even though I know more heat will come) Take some time in November to reflect on what you have learned this year, and be grateful for the lessons that changed your personal or professional life. Take time to reflect on what you have achieved, it may be small like a new technique you mastered or maybe you did an Ironman. Take time to reflect on the people around you and how they shape your life. Have a great, thankful, grateful and happy November. Andriette v From the Editor Editor’s notes / Redakteurs notas Andriette van der Merwe Take time and love yourself, you are the only YOU. You are worthy, capable, strong, enough, intelligent, gifted
November 2023 5 Helicopter/Mobility/V360 DID THAT. SCIENCE 1. 21 days in dogs and 28 days in cats. Hill’s data on file. * Prescription Diet j/d is also available for cats. help pets run, walk and jump more easily in as little as 21 days1 *
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Vetnuus | November 2023 8 « BACK TO CONTENTS BACKGROUND The second version of the list of essential medicines is presented by members of the WSAVA Therapeutic Guidelines Group (TGG) following extensive internal and external peer-review. Internal peerreview was provided by TGG members in 2023, whereas external peer-review was performed by board-certified individuals and other WSAVA working groups. Additionally, there was a 3-month audit (January to March 2023) allowing any individual including WSAVA member affiliates to provide comments, suggestions and overall feedback. Any comment received was carefully considered by the TGG taking into consideration the definitions of core and complementary medicine. The updated (version 2) list is a product of several rounds of revision and based on expert consensus. This list of essential medicines should allow veterinarians to provide proper preventive care and treatment of the most frequent and important diseases in dogs and cats while maintaining appropriate animal welfare standards. The purpose of the list is to improve and facilitate regulatory oversight for ensuring appropriate medicines availability, drug quality, use and pharmacovigilance, while mitigating the growing black/counterfeit market of pharmaceutical products. The list of essential medicines is not intended to define what medicines should be always available within the clinic/hospital nor a drug compendium; rather that veterinarians should have ready access to these (medicines) if required for the prevention and treatment of specific diseases and conditions. Additionally, the committee understands that there is no “one-size fits all” and that there may be specific medicines used for endemic/epidemic diseases in some countries that the list does not cover. For example, the essential antimicrobials were defined as those medicines that are recommended as first line agents for treatment of at least one common disease condition but also taking into consideration the issue of antimicrobial resistance. DEFINITION Essential medicines are those that satisfy the primary health care and welfare needs of cats and dogs. USING THE LIST OF ESSENTIAL MEDICINES The definitions of essential medicines are based on a similar list of essential medicines in human medicine by the World Health Organization: https://www.who.int/medicines/publications/essentialmedicines/en/ However, our current approach does not involve, e.g. extensive systematic reviews and meta-analysis to demonstrate evidencebased information for each medicine as this may not be always achievable in veterinary medicine. Medicines presented in the list may or may not be approved and/or licensed for use in veterinary medicine, which may vary from country to country. From a regulatory standpoint, the list should be adapted in accordance with specific regional or national needs and conditions. The presence of a medicine in the essential medicines list carries no assurance as to the pharmaceutical quality of products containing that medicine. It is the responsibility of the relevant national or regional drug regulatory authority to ensure that each product is of appropriate pharmaceutical quality (including List of essential medicines for cats and dogs AUTHORS: P. V. Steagall *†,1, L. Pelligand ‡, S. Page§¶, J. L. Granick‖, F. Allerton**, P. M. Bęczkowski††, J. S. Weese ‡‡, A. K. Hrček§§, F. Queiroga¶¶‖‖*** and L. Guardabassi††† *Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada †Department of Veterinary Clinical Sciences, Centre for Animal Health and Welfare, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, SAR, China ‡The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, AL9 7TA, UK §Advanced Veterinary Therapeutics, Newtown, NSW, Australia ¶Honorary Associate, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW, Australia ‖Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA **Willows Veterinary Centre & Referral Service, Highlands Road Shirley, Solihull, West Midlands B90 4NH, UK ††Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, SAR, China ‡‡Department of Pathobiology and Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada §§Freelancer, Ljubljana, Slovenia ¶¶Animal and Veterinary Research Centre (CECAV), University of Trás-os- Montes and Alto Douro, Vila Real, Portugal ‖‖Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os- Montes and Alto Douro, Vila Real, Portugal ***Center for the Study of Animal Sciences, CECA-ICETA, University of Porto, Porto, Portugal †††Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark 1Corresponding author email: paulo.steagall@umontreal.ca An extract from an article made available by the World Small Animal Veterinary Association as published in September 2023
November 2023 9 stability) and that, when relevant, bioequivalent products can be interchangeable. Individuals should be also aware of potential different concentrations and formulations of each compound/ medicine, and possible drug combinations present in a commercial product. Additionally, this list is not meant to be used as a reference for dosage regimens, drug interactions, indications or contraindications, adverse effects or description of pharmacologic effects. It does not describe what medicines require monitoring, specific means of disposal/elimination/record keeping or follow-up consultations as the list should not be used as guidance for therapy. Essential medicines are presented in alphabetical order and divided by either drug category (anaesthetic, analgesics, immunomodulators, oncology drugs, sedatives, vaccines, antiparasitics and antimicrobials, including antibacterial, antifungal, antiprotozoal and antiviral drugs) or organ system/specialty (cardiorespiratory and renal, endocrinology, gastrointestinal, neurology, ophthalmology or reproduction). The essential list of medicines for dermatology is presented in other sections of the document (e.g. immunomodulators, antimicrobials, antiparasitics, etc.). Cross-reference between a drug category and an organ system is acknowledged where appropriate. Some veterinary specialties may not be listed as their lists of essential medicines have been merged into another drug category or organ system. CRITERIA FOR SELECTION OF ESSENTIAL MEDICINES Essential medicines are selected with due regard to disease prevalence and public/animal health relevance, evidence of clinical efficacy and safety, and comparative costs and cost-effectiveness. These medicines can be rarely replaced by other medicines and their absence could compromise public/animal health and welfare. The core list presents a list of minimum medicine needs for a basic health care system, listing the most efficacious, safe and costeffective medicines for priority conditions. Priority conditions are selected based on current and estimated future public/ animal health relevance, and potential for safe and cost-effective treatment. The complementary list presents essential medicines for priority diseases, for which advanced diagnostic or monitoring facilities, and/or advanced medical care, and/or advanced training are needed. In case of doubt, medicines may also be listed as complementary based on consistently higher cost or less attractive cost-effectiveness in a variety of settings and wide availability in the profession. ANAESTHETIC, ANALGESIC, SEDATIVE AND EMERGENCY DRUGS (The WSAVA Global Pain Council has published the 2022 WSAVA guidelines for appropriate recognition, assessment and treatment of pain including protocols with different drug availability: https://onlinelibrary.wiley.com/doi/10.1111/jsap.13566 The WSAVA Global Pain Council has published information on the minimum analgesic availability: https://www.wsava.org/WSAVA/ media/Documents/Committee%20 Resources/WSAVA-GPC-Position-minimum-analgesic-availability.pdf Core list 1) α2-Adrenoceptor agonists (xylazine, medetomidine or dexmedetomidine) Sedatives, muscle relaxants and analgesics that are used for premedication and chemical restraint with the benefit of reversibility (if an antagonist such as yohimbine, tolazoline or atipamezole is available). They are used as part of injectable protocols for spay-neuter programmes and may counteract the muscle rigidity produced by ketamine. 2) Adrenaline (epinephrine) Inotrope and vasoactive drug used in the emergency setting during cardiac arrest and/or the management of severe systemic anaphylaxis. 3) Antagonists of α2-adrenoceptors (yohimbine, tolazoline or atipamezole) Reversal of the effects produced by α2-adrenoceptor agonists. Reversal is often required to quicken anaesthetic recovery and manage adverse effects. 4) Anticholinergics (atropine or glycopyrrolate) Anticholinergic drug used for the prevention or treatment of bradycardia in the perioperative period and in the emergency setting during cardiac resuscitation. Topical atropine is used in the treatment of uveitis (see ophthalmology). 5) Benzodiazepines (midazolam or diazepam) Depressants of the central nervous system used for muscle relaxation and anti-seizure therapy. Often administered in combination with ketamine for anaesthetic induction. Midazolam can be administered intramuscularly (IM) as part of spay-neuter anaesthetic protocols. 6) Calcium gluconate or chloride This is used for the intravenous (iv) treatment of hypocalcaemia in dogs and cats, including periparturient hypocalcaemia or as part of treatment of hyperkalaemia. Cardiovascular parameters should be monitored during administration to prevent toxicity. Calcium gluconate is preferred over calcium chloride to avoid irritation associated with perivascular administration. 7) Corticosteroids These drugs are used for hypoadrenocorticism, inflammatory, immune-mediated and neoplastic conditions. 8) Crystalloid solutions These are a mixture of water and electrolytes and may be hypo-, iso-or hypertonic. Isotonic fluids are commonly used to replace metabolic, procedural and ongoing losses (i.e. prevention and treatment of dehydration and hypovolaemia) and to provide maintenance fluid requirements and a source of electrolytes (e.g. dextrose 5%, sodium chloride 0.9%, balanced electrolyte solutions such as lactated Ringer’s or Hartmann’s solution). Hypertonic solutions (e.g. hypertonic saline 7.5%) can be used for the treatment of increased intracranial pressure and in cases of severe hypotension. 9) Dextrose For emergency treatment of hypoglycaemia and fluid supplementation. 10) Dissociative anaesthetics (ketamine or tiletamine-zolazepam) Dissociative anaesthetic with anti-hyperalgesic (i.e. analgesic) properties administered for induction of anaesthesia, chemical restraint and often as part of injectable protocols for spayneuter programmes or disaster medicine. Ketamine must not be Leading Article
Vetnuus | November 2023 10 « BACK TO CONTENTS administered alone as an anaesthetic (see benzodiazepines) because it causes hypertonia and cataleptic effects (The WSAVA Global Pain Council has published information on the minimum analgesic availability: https://www.wsava.org/WSAVA/ media/ Documents/Committee%20 Resource s/WSAVA-GPC-Position-minimum-analgesic-availabili ty.pdf 11) Inhalant anaesthetics (isoflurane, sevoflurane) Inhalant anaesthetics have favourable pharmacokinetic profiles in terms of drug metabolism and elimination and should be preferred for long-term procedures where drug accumulation with injectable anaesthetic can compromise safety and animal welfare, or when injectable anaesthetics are not available. 12) Lidocaine Local anaesthetic drug with antiarrhythmic (i.e. treatment of ventricular arrhythmias), prokinetic and analgesic properties. Widely used in several local-regional anaesthetic techniques as the first line of analgesia in acute pain management. Other local anaesthetics may be used topically (see ophthalmology). 13) Non-dissociative anaesthetic agents (propofol or alfaxalone) General anaesthetics for iv administration. They can be used for procedural sedation, anaesthetic induction and maintenance, especially if ketamine is not available. 14) Non-steroidal anti-inflammatory drugs (NSAID) These drugs produce anti-inflammatory, antipyretic and analgesic effects that can be administered for the treatment of fever, acute and chronic pain. If one drug is to be chosen, preference should be given to a NSAID with a good safety profile that can be administered by enteral and parenteral routes of administration to both dogs and cats for short or long term. Topical NSAIDs can be used in specific conditions (see ophthalmology). 15) Opioids First line analgesics for the treatment of acute pain in the perioperative period. These drugs are required in cases of moderate to severe pain, especially if other analgesics are contra-indicated. Otherwise, pain management is suboptimal. If one drug is to be chosen, preference should be given to opioids with good efficacy and safety profile that can be administered to both dogs and cats. Some of these drugs have regulatory approval in various national veterinary markets (e.g. methadone or buprenorphine). 16) Osmotic diuretic (mannitol) Mannitol is indicated to reduce brain oedema and intracranial pressure. It is preferred to hypertonic saline because it does not require monitoring of electrolyte levels. It is also used in ophthalmology to decrease intraocular pressure associated with glaucoma. 17) Oxygen This is used for supplemental oxygenation to prevent or treat hypoxemia and in patients with respiratory distress. It is also used as a carrier gas in volatile anaesthesia. Oxygen can be administered via “flow-by”, facemasks, oxygen hoods or cages, nasal cannula or endotracheal intubation. 18) Potassium chloride This is used to prevent or treat hypokalaemia. It is also used for humane euthanasia once the animal is unconscious (e.g. during general anaesthesia). 19) Vitamin K1 Oral (PO) and injectable formulations are used in the treatment of rodenticide (e.g. warfarin, pindone, bromadiolone, etc.) toxicosis, and severe liver disease or biliary obstruction (parenteral formulation). Complementary list 1) Anti-thrombotic agents (clopidogrel, aspirin) These medicines are used for management of diseases associated with hypercoagulability. Conditions commonly associated with a hypercoagulable state include immune-mediated haemolytic anaemia, protein losing nephropathies and enteropathies, dirofilariasis, and cardiac disease. 2) Antihistamines (hydroxyzine, chlorphenamine or diphenhydramine) These are antagonists of histamine H1 receptors. They can be used in histamine-mediated allergic pruritus including urticaria, angioedema and hypersensitivity reactions including systemic anaphylaxis. Different formulations are available depending on the antihistamine drug. For example, diphenhydramine can be administered orally and iv. The final consensus for this group of medicines is that there is minimal evidence for the use of antihistamines; however, they have been reported to be used in clinical practice with few adverse effects. Leading Article Dear SAVA member Please note that Vethouse will close on Thursday, 21 December 2023 at 12:00 and resume business on 03 January 2024. SAVA wishes all its members and their families a joyous festive season and everything of the best for the year ahead. Kind regards Gert Steyn: Managing Director Geagte SAVV lid Neem asseblief kennis dat Vethuis sal sluit op Donderdag, 21 Desember 2023 om 12:00 en sal heropen op 03 Januarie 2024. Die SAVV wens alle lede en hul families ‘n wonderlike feestyd en alles van die beste vir die jaar wat voorlê. Vriendelike groete Gert Steyn: Besturende Direkteur
November 2023 11 3) Colloid solutions These solutions can be used in selected patients to increase oncotic pressure and expand circulating plasma volume. The type of colloid, volumes and speed of administration and risk of adverse effects vary among colloid solutions. The efficacy and safety profiles should be carefully considered before administration. 4) Fresh blood Giving the complexities of component processing and storage of blood products, veterinarians should be able to perform at least fresh whole blood transfusion for the treatment of severe hypovolaemia, anaemia and/or thrombocytopenia and factor replacement in coagulopathies within 4 to 6 hours of blood collection in dogs and cats. In some countries, veterinary blood banks are available. Quality control and transfusion practices of fresh blood should be optimal. 5) Lipid emulsions Fat emulsion solutions are used as a source of calories and essential fatty acids in parenteral nutrition. They are also used for the treatment of poisoning by fat soluble compounds including local anaesthetic and ivermectin toxicity. 6) Monoclonal antibodies anti-nerve growth factor These medicines are used for the treatment of osteoarthritis in dogs (bedinvetmab) and cats (frunevetmab). They may be beneficial when NSAIDs are contra-indicated or if pain is refractory to the administration of NSAIDs. ANTIMICROBIAL DRUGS Antibacterial and antiprotozoal drugs Systemic administration Core List 1) Amoxicillin This aminopenicillin is recommended as the first choice for treatment of bacterial cystitis and a variety of infections, including those caused by anaerobic bacteria. 2) Amoxicillin/clavulanic acid or a first-generation cephalosporin (cephalexin or cefadroxil) These β-lactams are widely used for management of superficial or deep pyoderma and other common skin and soft tissue infections associated with Staphylococci and other Gram-positive bacteria. 3) Ampicillin or benzylpenicillin Injectable preparations of these penicillins are recommended for treatment of life-threatening infections such as sepsis and acute pneumonia in combination with fluoroquinolones as well as acute treatment for the zoonotic infection, leptospirosis. 4) Cefazolin This injectable first-generation cephalosporin is recommended as the first choice when surgical prophylaxis is indicated. 5) Clindamycin This lincosamide is recommended in some countries as the first choice for management of canine superficial or deep pyoderma and elsewhere is considered an important alternative to amoxicillin/clavulanic acid and first generation cephalosporins for these indications. It is also recommended for treatment of infections involving anaerobic bacteria. Injectable preparations are important for combination therapy of life-threatening infections such as sepsis and acute pneumonia in association with fluoroquinolones or other antimicrobials providing Gram-negative coverage. Clindamycin has been shown to reach therapeutic levels in the central nervous system and it is also used for the treatment of infections with Mycoplasma, Neospora and Toxoplasma. 6) Doxycycline or minocycline This tetracycline is an essential antimicrobial for treatment of upper and lower respiratory tract infections, Lyme borreliosis and a variety of infections caused by obligate intracellular bacteria (Ehrlichia canis, Rickettsia rickettsii, Mycoplasma and Anaplasma spp.). 7) Enrofloxacin, marbofloxacin, orbifloxacin or pradofloxacin [The “OIE List of Antimicrobial Agents of Veterinary Importance” state that Fluoroquinolones (together with third and fourth generation cephalosporins and colistin) should: (1) not be used as preventive treatment, (2) not to be used as a first-line treatment unless justified, when used as a second-line treatment,it should ideally be based on the results of bacteriological tests and (3) extra-label/off label use should be limited and reserved for instances where no alternatives are available. Such use should be in agreement with the national legislation in force. https://www.oie.int/fileadmin/Home/eng/Our_scientific_expertise/ docs/pdf/AMR/A_OIE_List_antimicrobials_July2 019.pdf These fluoroquinolones are the first choices for treatment of prostatitis and meningitis due to their ability to penetrate the blood/prostate and blood/brain barriers, respectively. Injectable preparations are needed for treatment of lifethreatening infections such as pyelonephritis, or sepsis and acute pneumonia when used in combination with clindamycin or a penicillin. They are also useful for treatment of infections caused by bacteria that are resistant to first line agents. 8) Metronidazole This nitroimidazole is recommended for management of selected bacterial and protozoal enteric infections. 9) A sulfonamide potentiated with a dihydrofolate reductase inhibitor (e.g. sulfadiazine/trimethoprim) Potentiated sulfonamides are recommended as a first line agent for treatment of bacterial cystitis and are useful antimicrobials for treating skin and other infections, including central nervous system infections caused by susceptible bacteria and protozoa. Leading Article
Vetnuus | November 2023 12 « BACK TO CONTENTS Complementary List 1) Chloramphenicol This bacteriostatic antimicrobial has a broad-spectrum activity against Gram-positive, Gram-negative and obligate anaerobic bacteria. It is suitable for treatment of intraocular and CNS infections. Due to concerns of resistance development, its use should be restricted to animals with infections resistant to other antimicrobials [available in injectable, oral and topical (ophthalmic) formulations]. Topical administration Core List 1) Chlorhexidine gluconate This biguanide antiseptic is available in different forms (e.g. shampoos, sprays and ointments) for a variety of indications, including but not limited to otitis externa, gingivitis, periodontal disease, superficial skin infections, topical disinfection of wounds and perioperative skin antisepsis. 2) Enrofloxacin or marbofloxacin These fluoroquinolones are the first choices for treatment of otitis media and a valid alternative to aminoglycosides for management of otitis externa caused by Gram-negative bacteria. 3) Fusidic acid This fusidane is the first choice for management of otitis, eye and localised skin and wound infections associated with Staphylococci. 4) Florfenicol An increasingly used antibacterial agent for the management of staphylococcal otitis, usually as part of a combination product that includes antifungal and corticosteroid drugs. 5) Gentamicin or neomycin These aminoglycosides are the first choices for management of otitis externa caused by Pseudomonas aeruginosa and other Gram-negative bacteria. 6) Polymyxin B This polypeptide is a useful alternative to aminoglycosides and fluoroquinolones for management of otitis externa caused by Gram-negative bacteria. It is often used in combination with miconazole, an antifungal agent with antibacterial activity. 7) Povidone-iodine This iodophor antiseptic is widely used as an alternative of chlorhexidine gluconate for perioperative skin antisepsis, postoperative application to surgical incisions and emergency antisepsis in patients with minor lacerations, abrasions and burns. Antifungal drugs Core list 1) Agents for the treatment of dermatophyte infections. Azole antifungal drugs lead to depletion of lanosterol, the primary sterol of the fungal cell wall, by inhibiting cytochrome P450-dependent lanosterol C14-demethylase. Drugs include miconazole, fluconazole, econazole, itraconazole, clotrimazole and enilconazole. 2) Terbinafine An allylamine fungicidal agent that inhibits fungal squalene epoxidase to interrupt synthesis of ergosterol. Complementary list 1) Amphotericin B This drug binds to fungal cell membrane ergosterol leading to increased permeability and intracellular cation loss. Amphotericin B has poor oral availability and is administered iv. Antifungal activity is highly dependent on the formulation administered. Antiparasitic drugs Core list (It is acknowledged that the spectrum of these medicines may overlap and not every medicine might be available for the treatment of ecto and endoparasites.) VACCINATION BOOKS The LAST ORDERS for 2023 for vaccination books will be 30 November. No orders will be accepted after this – this is to ensure that stock will be dispatched by 15 December 2023. Orders for 2024 will resume on 16 January. To order/for more information contact Debbie Breeze on 012 346 1150 or debbie@sava.co.za Leading Article
November 2023 13 1) Amitraz Amitraz belongs to the formamidine class and acts as a monoamine oxidase inhibitor and octopamine agonist. It has activity as an acaricide and insect repellent, with major use in the treatment of demodicosis and myiases (Flystrike). 2) Arsenicals (melarsomine) The trivalent arsenical melarsomine is a Dirofilaria immitis adulticide. 3) Benzimidazoles and probenzimidazoles (febantel, fenbendazole, flubendazole, mebendazole and oxibendazole) These drugs bind to β-tubulin and prevent the formation of microtubules. They are particularly effective against nematodes, but selected agents can be used to treat other helminth and protozoal diseases. 4) Isoquinoline (praziquantel, epsiprantel) This class of drug causes severe contraction/muscle spasm and paralysis of sensitive parasites, resulting in death. These drugs are effective against cestodes (tapeworms) and many trematode species. 5) Isoxazolines (alfoxolaner, fluralaner, lotilaner and sarolaner) These drugs inhibit GABA (gamma-aminobutyric acid)-gated and glutamate-gated chloride channels. Depending on the formulation, they are effective against fleas, ticks and mites. Monthly and long-acting treatment formulations are available. 6) Macrocyclic lactones (avermectins: ivermectin, selamectin; milbemycins: milbemycin oxime, moxidectin) These drugs interact with and activate invertebrate glutamategated chloride channels conveying antinematodal activity and, for some agents, ectoparasite control with activity against fleas, mites and certain tick species (e.g. selamectin against fleas and mites). 7) Neonicotinoids (imidacloprid, nitenpyram, dinotefuran) These drugs inhibit insect post-synaptic nicotinic acetylcholine receptors, thus having selective activity against ectoparasites. 8) Phenylpyrazole (fipronil, pyripole) Fipronil and pyripole inhibit arthropod GABA-gated and glutamate-gated chloride channels and are active against fleas and ticks. 9) Pyrethrins and synthetic pyrethroids (pyrethrins, permethrin, deltamethrin, flumethrin) These drugs disrupt sodium channels affecting cell polarisation. They are effective against fleas and ticks depending on the drug and formulation. They may also have insect repellent properties and in some cases prevent the transmission of vector-borne pathogens. 10) Tetrahydropyrimidines (oxantel, pyrantel) These drugs are agonists of nematode acetylcholine nicotinic receptors with drug specific spectrum of activity against gastrointestinal nematodes. Complementary list 1) Emodepside A cyclo-octadepsipeptide acting as an agonist of latrophilin receptors providing a novel mechanism of nematocidal activity. 2) Insect development inhibitors or insect growth regulators (S-methoprene, pyriproxyfen) These drugs interfere with normal moulting and the development of arthropods. 3) Miltefosine or meglumine antimoniate The oral formulation of these drugs is commonly used in combination with allopurinol for the treatment of canine and feline leishmaniosis. 4) Oxadiazine (indoxacarb) This class of drugs is bioactivated by insect esterases and amidases and acts by blocking sodium channel receptors. It is effective against fleas. 5) Spinosyns (spinosad) These drugs bind to nicotinic acetylcholine receptors in the insect’s nervous system leading to disruption of acetylcholine transmission. They are effective against fleas. 6) Xanthine oxidase inhibitors (allopurinol) The oral formulation is used for the treatment of canine and feline leishmaniosis as the disease is allowed to be treated in many countries of the world. Antiviral drugs Core list 1) Nucleoside analogues Idoxuridine and trifluridine are used for the treatment of viral infections affecting the ocular surface. Remdesivir and/or GS441524 are used for the treatment of feline infectious peritonitis. Complementary list 1) Famciclovir This can be used systemically for treatment of acute ocular disease caused by feline herpesvirus type 1. BEHAVIOUR MODIFYING THERAPIES Core List 1) Clomipramine Used for the treatment of behavioural disorders including, but not limited to, separation anxiety, obsessive-compulsive changes and noise phobia. 2) Fluoxetine Used for the treatment of behavioural disorders including, but not limited to, separation anxiety, obsessive-compulsive changes, fear-based aggression and noise phobia. >>> 14 Leading Article
Vetnuus | November 2023 14 « BACK TO CONTENTS List of essential medicines for cats and dogs <<< 13 3) Trazodone Used for the treatment of behavioural disorders related to anxiety and/or phobia. CARDIORESPIRATORY AND RENAL SYSTEMS Core List 1) Aldosterone antagonist (spironolactone) Spironolactone alleviates cardiac remodelling in chronic cardiac disease and can be combined with antihypertensive drugs for treatment of refractory systemic hypertension. It can be used judiciously alongside loop diuretics for its anti-aldosterone effect and potassium-sparing activity. 2) Angiotensin converting enzyme (ACE) inhibitors (enalapril, benazepril, captopril, lisinopril and ramipril) or angiotensin receptorblockers (ARB) (telmisartan) ACE inhibitors and ARBs are mild vasodilators and reduce systemic vascular resistance, hypertrophy and aldosterone release, especially in the treatment of dogs with dilated cardiomyopathy or myxomatous mitral valve degeneration, and as second line for the management of systemic hypertension. These drugs are also utilised for the treatment of proteinuric kidney disease. 3) Inodilator (pimobendan) It combines the effect of a vasodilator and an inotrope in dogs with heart failure. It improves long-term outcomes in preclinical stages of dilated cardiomyopathy and mitral valve disease as well as during cardiac failure. 4) Loop diuretics (furosemide or torsemide) These agents block the reabsorption of sodium (and water) in the ascending loop of Henle. They are available for iv or oral administration and are indicated for the management of acute pulmonary oedema and heart failure. They may induce electrolyte imbalances and their effect is limited by the activation of the renin-angiotensin system. 5) Vessel selective calcium channel blocker (amlodipine) Amlodipine is used for feline and canine hypertension and is titrated orally to effect. Complementary List 1) Antagonists of β-adrenergic receptors (propranolol, atenolol or esmolol) These are negative inotropes and chronotropic drugs. They can be used for treatment of tachyarrhythmias or conditions with left and right ventricular outflow obstruction. 2) Cardiac glycosides (digoxin) This drug inhibits the sodium-potassium pump and facilitates increased concentrations of calcium influx. It produces weak positive inotropism while reducing sympathetic input and improving renal blood flow. Digoxin blocks the atrioventricular node and can be used in the treatment of atrial fibrillation. The drug is used in combination with other therapies in the treatment of heart failure in some specific cases. The drug can be administered orally or iv. 3) Cardiac-selective calcium channel blockers (verapamil or diltiazem) These are used in the management of supraventricular arrhythmias (oral and injectable forms). 4) Fluticasone This is an inhaled synthetic corticosteroid with profound antiinflammatory effects that is used in several upper respiratory tract and pulmonary disorders in dogs and cats including rhinitis, bronchitis, asthma and eosinophilic pneumonia. Metered dose inhalers combined with a spacer and appropriate mask should be used for administration. 5) Salbutamol This is a selective agonist of β2-receptors that may produce bronchodilation after aerosol or oral administration with the assumption that bronchoconstriction exists, particularly in cats. 6) Sodium channel blockers (lidocaine or procainamide) They are indicated for the management of significant ventricular arrhythmias that are associated with important haemodynamic changes. ENDOCRINOLOGY Core List 1) Antithyroid agent (methimazole/thiamazole) Thyroid hormone synthesis inhibitors act by interfering with the incorporation of iodine into the tyrosyl moiety of thyroglobulin. These agents are important in the treatment of feline hyperthyroidism. These medications are for oral administration but can be compounded as transdermal preparations. 2) Glucocorticoids A class of corticosteroids that bind to the glucocorticoid receptor. Can be used for the diagnosis of hyperadrenocorticism, including the differentiation of pituitary and adrenal dependent hyperadrenocorticism. Necessary for the treatment of 24-Hour Toll-Free Helpline: 0800 21 21 21
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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