Diverse species

VSCI200 NSF
Exotics pharmacology 2

Rosie MacDiarmid
Learning Objectives
Lecture 1
 Administration
 Describe the different routes of
drug administration in exotic
species
 Explain the practicality of enteral
and parenteral administration in
exotic species
 Antibiotics
 Explain the practicality of
antibiotic use in exotic species
 Describe the different broad
categories of antibiotics and which
can be used in the exotic species
Lecture 2
 Analgesics
 Explain the practicality of pain
assessment in exotics
 Describe the different broad
categories of analgesic used in
exotics
 General Anaesthetics
 Explain the practicality of
induction / maintenance of
general anaesthesia in exotics
 Descibe the different general
anaesthetic agents used in exotics
Analgesia
Introduction
Analgesia in exotics is challenging due to:
Limited data on pharmacology in these species
High (small mammals & birds) or low metabolic rates
Difficulty in recognising pain
Studies have shown that pain perception in vertebrates is
analagous i.e. they DO feel pain
Rules to apply when determining whether to use analgesics
1. Would this lesion or procedure be painful to any species?
2. Is this lesion or procedure damaging to tissues in any
species?
3. Is the animal displaying abnormal behavioural responses?
Recognising Pain
If we can’t easily recognise when an exotic species is in
pain, how do we determine if analgesia is effective?
Gradually data is increasing in rats, rabbits, birds,
reptiles, amphibia and fish
BUT just because we know how a rat responds to pain,
that does not necessarily directly translate across to a
mouse or gerbil
AND even within an order/family there are differences
(e.g. buprenorphine efficacy in African greys is different
to amazons)
Exothermic Issues
Pharmacodynamics / pharmacokinetics will be
affected by body temperature
Body temperature of exothermic species (reptiles,
amphibia, fish) will vary, and therefore affect the
efficacy of a drug
As a rule efficacy of analgesia should be determined at
that patient’s optimal temperature zone
Analgesics
Categories of analgesics
Local anaesthetics
Opioids
Non-steroidal anti-inflammatories (NSAIDs)
Steroid anti-inflammatories
Pre-emptive analgesia
Analgesia is far more effective in domestic mammals if
given BEFORE pain occurs
This should therefore apply to exotic species too
Local anaesthetics
Block ion channels to prevent generation and
conduction of pain impulses
Can be toxic if rate of absorption exceeds rate of
elimination
Lidocaine
Effective in birds, reptiles, rabbits & rodents
Bupivicaine
Longer acting but rate of absorption exceeds elimination
in birds
Opioids
Block pain centrally by binding to μ-, κ- or δ-opioid
receptors (agonists)
Have a gas-anaesthesia-sparing effect
Adverse effects of respiratory & cardiac depression
Some can be reversed with antagonists
Small mammals similar to dogs/cats therefore μ-
agonists should be effective
In birds κ-receptors predominate therefore μ-agonists
might not be as effective
No data in reptiles
Opioids
Morphine
μ-agonist so likely effective in small mammals but unlikely in birds (no data in
reptiles)
Care with use in hindgut rabbits due to adverse GI effects
Butorphanol
Weak μ-agonist / strong κ-agonist
Gaseous anaesthetic-sparing effect in parrots
Buprenorphine
Partial μ-agonist / κ-?agonist ?antagonist
Ceiling effect after which no further analgesia occurs but side-effects increase
Adverse GI effects
May be effective in some birds but not African Greys
Limited (if any) effect in reptiles
Effective in small mammals
NSAIDs
Inhibition of cyclooxygenase (COX) in arachidonic
pathway
Arachidonic acid is precursor to prostaglandins (GI
protective)
Preferable to block COX-2 (inflammatory) rather than
COX-1 (GI protection / nephrotoxicity)
Can be effective in small mammals, birds & reptiles
Ketoprofen – potent COX-1 inhibitor
Carprofen – weak inhibitor / wide safety margin
Meloxicam – COX-2 inhibitor
Cortico-steroids (Glucocorticoids)
Potent anti-inflammatories
Prednisoloine, methylprednisolone, betamethasone,
dexamethasone
Pronlonged use has severe adverse side effects
Metabolic effects
Fluid retention
Adrenal suppression
Immune suppression
Not recommended for use in birds / reptiles as
immunosuppressive effects predispose to mycotic
infections
General Anaesthetics
Introduction
Anaesthesia = without sensation
Loss of consciousness
Analgesia
Muscle relaxation
Different agents achieve the above to differing degrees
Usually need to use a combination of drugs for effective general
anaesthesia
Induction – various routes of administration (inhalational, iv, im)
Maintenance – administered via respiratory system
Face mask
Endo-tracheal tube
Fasting prior to GA not usually recommended
ET Intubation
Preferable to use UNCUFFED ET tube compared to face mask as it ensure a
patent airway
Not practical in very small patients
Birds
Relatively easy to perform
Trachea narrows distally so tube of appropriate length required
Can intubate air sacs e.g. if tracheal obstruction
Small mammals
Strongly recommended in rabbits due to anatomy of mouth
Prone to laryngeal spasm therefore local anaesthetic spray required
Impractical in very small small mammals
Reptiles
Difficult but achievable in lizards / chelonians
Easy in snakes
ET intubation in rabbits
Induction Agents
Often use gaseous induction with 4-5% isofluorane via
mask
Rabbits breath-hold (can become hypoxic) if mask induction
so pre-med required or induce with injectable agent
Once anaesthetised ET intubate if possible
Can also use injectable agents
Propofol
Ketamine combinations
Alfaxalone
Fentanyl/fluanisone
Injectable Induction Agents
Small Mammals
Ketamine combinations, Fentanyl/fluanisone OK
Birds
Propofol metabolised in most birds too quickly to be
useful. If used need IPPV as respiratory depressant
Alfaxalone ineffective
Ketamine combinations good
 + benzodiazepines / α2-adrenergic agonists
Reptiles
Propofol, alfaxalone, ketamine combinations all OK
Maintenance Agents
Due to small size recommended breathing circuits
include Mapleson E / F & Bain
Halothane
No longer recommended as much safer agents
Can induce cardiac arrest
Isofluorane (2-3%)
Safe for all exotics
Sevofluorane
Less of a respiratory irritant cf isofluorane
Arguably safer than isofluorane
Breathing under GA
Small mammals
Spontaneous breathing occurs
Birds
Depends on recumbency
If in dorsal recumbency need IPPV due to weight of
pectorals / abdominal contents
Safest in lateral recumbency
Reptiles
Spontaneous breathing ceases under GA therefore all
reptiles need IPPV
Excellent resources for
exotics
http://www.lafebervet.com
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http://avianmedicine.net
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