Selected Therapeutic Doses

Presentation on theme: "Selected Therapeutic Doses"— Presentation transcript:

1 Selected Therapeutic Doses
Assoc. Prof. Ivan Lambev ( Formulations and dose rates

2 Neostigmine Edrophonium
• mg/kg IV initial dose, repeated after 5 min if required for the reversal of muscle relaxation • mg/kg oral q. 8 h to treat myasthenia gravis Edrophonium • 0.5–1 mg/kg IV initial dose for the reversal of muscle relaxation • 0.1–0.5 mg/kg IV for myasthenia gravis diagnosis

3 Formulations and dose rates of Atropine
Dogs and Cats: - Preanesthetic and treatment of bradycardia • 0.022– mg/kg - Treatment of cholinergic toxicity • 0.2–2.0 mg/kg: give one-quarter dose i.v. and remainder s.c. or i.m.

4 Adrenaline (epinephrine) is available in
an injectable formulation as 0.1 mg/mL (1:10000) and 1 mg/mL (1:1000) solutions. DOGS AND CATS • Cardiac resuscitation: 0.05–0.5 mg (0.5–5 mL) of 1:10000 solution intratracheally, IV or intracardially • Anaphylaxis: mg/kg IV. Dose may be doubled and given intratracheally – Dilute 1 mL of 1:1000 solution in 10 mL saline and give 1 mL/5 kg IV or IM. May repeat q. 5–15 min • Feline asthma: 0.1 mL of 1:1000 solution SC or IV 1 mL/10 kg IV or IM. May repeat q. 5–15 min

5 Non-selective Beta-blockers as Sedative, resp. as BMD
Propranolol p.o. Pindolol p.o. 0.125–0.25 mg/kg q. 12 h 0.2–1 mg/kg/8 h – 0.5–0.3 mg/kg/12 h

6 H1-histamine antagonists
Cats Dogs Cyproheptadine 0.4–0.5 mg/kg/12 h p.o. 0.3–2 mg/kg/12 h p.o. Diphenhydramine 2–4 mg/kg/12 h p.o. Hydroxyzine 2.2 mg/12 h p.o. 05–2.2 mg/12 h p.o.

7 Prescribe of cat with body mass
3 kg drug in dose 0.4 mg/kg/12 h p.o. with H1- and 5-HT2-blocking action as an appetite stimulant in form of syrop 40 mg/100 ml in bottle (chlorpyramine, cyproheptadine, diphenhydramine).

8

9 Rp./ Syrup Cyprohepatadine 40 mg/100 ml
(or: Sirupi Cyproheptadini 40 mg/100 ml) D. t. d № 1 in bottle. S. 2 x 3 ml daily 15 min before meals with water or milk 1 month. #

10 Prescribe of dog with body mass
15 kg H1-agent in dose 2 mg/kg/12 h orally in form of tablets of 30 mg for the treatment allergies, incect bites, motion sickness and travel anxiety (morphine, propofol, diphenhydramine).

11

12 Rp./ Diphenhydramini 30 mg D. scat. № 1 in tabl.
Da scatulam № 1 in tablets. Signa. 2 x 1 tablet daily by mouth. # Rp./ Diphenhydramini 30 mg D. scat. № 1 in tabl. S. 2 x 1 tablet daily by mouth.

13 BUPRENORPHINE (semisyntetic derivative
of thebaine): DOGS: 5–40 µg/kg IM, SC, IV or epidural applicaton or q.8 h CATS: 5–40 µg/kg IM, SC, IV or epidural

14 PETHIDINE Almost identical to morphine Tends to cause restlessness
(Meperidine – USAN; Lydol® – Sopharma) DOGS AND CATS: 2–10 mg/kg IM, SC Almost identical to morphine Tends to cause restlessness rather than sedation Antimuscarinic effects: dry mouth blurred vision Less antitussive Shorter duration of action (4 to 6 h) – preferred in labour

15 Prescribe of dog with body mass 15 kg
opioid analgesic in dose 5 mg/kg s.c. in form of solution 100 mg/2 ml five amulles for premidication (pethidine, diazepam, ketamine).

16

17 Rp./ Sol. Pethidini 100 mg/2 ml
D. t. d. № 5 in amp. S ml s.c. # In detail: Rp./ Solutionis Pethidini 100 mg/2 ml Da tales doses № 5 in ampullis. Signa ml subcutaneously.

18 TRAMADOL (a weak agonist at µ-receptors) provides
moderate pain relief. It also inhibits monoamine transporters (principally NA and 5-HT) which is produces analgesia synergistically with µ-agonism. DOGS • 1–5 mg/kg PO q.8–12 h CATS • 1–2 mg/kg PO q.12 h

19 Phenobarbital is available as oral (tablets
or elixir) or injectable preparation (i.v./i.m.). • For the chronic treatment of seizures in dogs dosing should begin at 2–5 mg/kg/day PO q.12 h. Cats: 1.5–2.5 mg/kg PO q.12 h. In some dogs or cats, the starting dosage may result in ADRs. Should these adverse effects not resolve after 2 weeks of therapy, a reduction in dose may be indicated.

20 Chlorpromazine Dogs and Cats: 50–1000 mcg/kg i.v., i.m., s.c.
3 mg/kg p.o.

21 Prescribe of pig with body mass 80 kg
neuroleptic in dose 2 mg/kg i.m. in form of solution 4000 mg/100 ml in five vials for treatment of fear and aggression (Feliway®, Stresnil®, DAP®).

22 Azaperone (Stresnil®) 4000 mg/100 ml 2 mg/kg IM Effect lasts 6 h.

23 Rp./ Sol. Stresnili 4000 mg/100 ml
D. t. d. № 5 in vials. S. 4 ml i.m. Inject STRESNIL IM just behind the ear (into the muscle above the wing of the atlas) or into the rump (semitendinosus and semimembranosus muscle).

24 (start at lowerst doses and increase to 0.02 mg q2d to effect)
HALOPERIDOL Parrots: 0.2 – 0.4 mg/kg p.o. q.12 h (start at lowerst doses and increase to 0.02 mg q2d to effect) 1–2 mg/kg i.m. q.3 weeks; lower dose for cockatoos, African greys and Quaker parrots. Dogs: 0.05–4 mg p.o. q.12 h Cockatoo African greys parrots Quaker parrot

25 Hypnorm®: Dogs: Rabbits, rats and mice Guinea pigs:
Innovar-Vet® (0.4 mg/mL fentanyl and Droperidol (20 mg/ml): 0.05–0.1 mL/kg IM Hypnorm® (contains 0.2 mg/mL fentanyl and 10 mg/mL fluanisone – butyrophenone compounds): 0.5 mL/kg IM Hypnorm®: Rabbits, rats and mice • 0.2–0.5 mL/kg IM or IP for sedation or premedication Guinea pigs: • 1 ml/kg IM or IP for sedation or premedication Intravenous administration of butyrophenones is not recommended.

26 Diazepam Dogs Cats • 0.1–0.5 mg/kg IV • 2–10 mg/dog PO q. 8 h
for muscle relaxation Cats • 0.05–0.4 mg/kg IV • 1.25–5 mg/cat PO q. 8 h for muscle relaxation Doses at the lower end of the range are used for sedation/premedication (0.1–0.25 mg/kg) and appetite stimulation, while higher doses may be required to control seizures (0.5 mg/kg).

27 Status epilepticus Others: Clorazepate and Lorazepam.
•An IV bolus of diazepam should initially be given at a dosage of 0.5–1 mg/kg. Onset of its activity occurs about 2–3 min after administration. This dosage may be repeated 2–3 times. Midazolam. Since it is water soluble, it is much less irritating with IV or IM administration. Others: Clorazepate and Lorazepam.

28 Prescribe of dog with BM 10 kg drug
in dose 1 mg/kg i.v. in form of solution 0.5% 2 ml (= 10 mg/2 ml) in five vials (flacon) for treatment of status epilepticus (medetomidine, acepromazine, diazepam).

29

30 Rp./ Solutionis Diazepami 0.5% 2 ml
Da tales doses № 5 in vials. Signa (or: Scribe). 2 ml i.v. This dosage may be repeted 2–3 times. #

31 Te same prescription briefly:
Rp./ Sol. Diazepami 10 mg/2 ml D. t. d. № 5 in vials. S. 2 ml i.v. …....

32 Midazolam Dogs Cats • 0.05–0.2 mg/kg IV or IM
• 0.2 mg/kg/h IV continuous infusion Cats

33 Tricyclic Antidepressants
Amitriptyline Doxepin 1 – 4 mg/kg p.o. q. 12 – 24 h 3 – 5 mg/kg p.o. q. 8 – 12 h for acral lick dermatitis 0.5 – 1 mg/kg p.o. q. 24 h 0.5 – 1 mg/kg p.o. q. 12 – 24 h

34 SSRIs Fluoxetine Paroxetine 1 – 2 mg/kg p.o. q. 24 h 1 mg/kg p.o.

35 Prescribe of dog with body mass
20 kg SSRI in dose 1 mg/kg/12 h p.o in form of tablets of 10 mg for treatment of acrial lick dermatitis (fluoxetine, amitriptyline, lidocaine).

36

37 Rp./ Fluoxetine 10 mg D. scat. № 1 in tabl. S. 2 x 2 tablets daily by mouth two weeks.

38 Thiopental is a sodium salt that is soluble in water
and 0.9% saline. For use in small animals, sufficient water or saline is added to make a solution of 2.5%. The aqueous solution is strongly alkaline and is incompatible with analgesics, phenothiazines (e.g. acepromazine), adrenaline, muscle relaxants. •The dosage of thiopental required for induction of anesthesia in the unpremedicated animal is 20–25 mg/kg IV. To avoid excitement during induction, one-half of this calculated dose must be given as a bolus. Additional quarter-doses may be required to obtain depth of anesthesia.

39 •Premedication is preferred and reduces the
induction requirement of Thiopental by 50–75%, i.e. to a dose of 10–12.5 mg/kg i.v. A single dose of thiopental provides anesthesia for about 10–15 min i.v. •Intravenous Diazepam (0.25–0.5 mg/kg) given just before thiopental administration reduces its requirements to 5–10 mg/kg and reduces the duration of effect to about 5–10 min.

40 INTRAMUSCULAR KETAMINE AND
PHENOTHIAZINE COMBINATIONS •Low doses of ketamine (2–3 mg/kg) may be combined with acepromazine and opioid and administered IM (or SC) to premedicate or sedate painful or fractious cats. USE OF KETAMINE AS AN ANALGESIC •in dogs and cats: 0.1–1 mg/kg IV or 1–2.5 mg/kg IM •in dogs: 2–10 µg/kg/min as an IV infusion

41 Propofol induces anesthesia in dose 6.5 mg/kg IV
in dogs and 8 mg/kg in cats. The onset of its action begins after 30 s. A single dose provides 2–10 min unconsciousness. Complete recovery after a single dose occurs within 15–20 min in the dog and 30 min in the cats. Propofol is a donor of NO with amnesic and antiemetic action.

42 Penicilline G Sodium®:
– /IU/kg/BW q.6–8 h i.v., i.m., s.c. Penicillin-VK® (Potassium): 10 mg/kg/BW q.8 h p.o.

43 Cloxacillin, Dicloxacillin, Flucloxacillin: 10 – 40 mg/kg q.8 h p.o.

44 Prescribe of dog with body
mass 50 kg narrow spectrum antistahylococcal penicillin in dose 20 mg/kg/8 h in capsules 500 mg (benzylpenicillin, flucloxacillin, ticarcillin).

45 Rp./ Flucloxacillini 500 mg
Da tales doses № 1 in bottle. Signa (Scribe). 2 capsules/8 h by mouth with woods two weeks.

46 Amoxicillin: 10 – 20 mg/kg/BW q. 8–12 h i.v., i.m., s.c. p.o.
Cat abscesses Amoxicillin: 10 – 20 mg/kg/BW q. 8–12 h i.v., i.m., s.c. p.o.

47 AMOXICILLIN

48 Cefalonium (Cepravin™): 250 mg
Carton – 8 cows: 32 syringes) Long-acting cephalosporin Cure existing infections at dry off Protect against mastitis and reduce new infections at calving

49 Cefalonium (Cepravin™): 250 mg in spray syringes (jeringas – spanish): intrammary
Indications: In conjunction with teat spraying and proper management of the cow during the drying off period, the careful administration of Cepravin Dry Cow at drying off reduces new infections in the dry period and treats subclinical mastitis. Dosage 1 syringe per 3 monts immediately after final milking Withholding Period  Milk: Treatment to be at least 49 days before calving. Milk from the first 8 milkings after calving must be discarded.  Meat: 30 days

50 Prescribe of cow with mastitis
during dry off period long-acting cephalosporin from first generation for intramammary application: (cefalonium, ceftriaxone, doxycycline).

51 Rp./ Suspensionis Cefalonium 250 mg
D. t. d. № 4 in spray syringes. S. One spray syringe intramammary per 3 monts immediatly after final milking.

52 Cefalonium: INN Cepravin: Regested Trade Name (Trade mark)

53 Cefalexin p.o. Cats: 22 – 50 mg/kg q.8–12 h
Dogs: 20 – 40 mg/kg q.8–12 h

54 Cefuroxime Zinacef™: 20–50 mg/kg/BW q.8–12 h i.v., i.m., s.c.

55 Cefoxitin 10–30 mg/kg q.6–8 h i.v., i.m., s.c.

56 Ceftriaxone 15 – 50 mg/kg q.12–24 h i.v.

57 Cefpodoxime 5 – 10 mg/kg q.12–24 h

58 Amoxicillin & Clavulanate (Augmentin®, Clavulox®)
12.5–25 mg/kg q.8–12 h p.o., i.m., s.c.

59 Tobramycin. Inhaled Tobramycin (Tobi®)
Amikacin Gentamicin – sol. 80 mg/2 ml (80 mg/8 h i.m.) Kanamycin Neomycin - Bivacin – spray derm. fl 150 ml (neomycin/bacitracin), Nemybacin® - Topocin – pulvis adspersorius (neomycin/bacitracin) Netilmicin Streptomycin Tobramycin. Inhaled Tobramycin (Tobi®) is used to treat mucoviscidosis in humans.

60 Gentamicin: Tobramycin:
6 mg/kg q.24 h i.m., i.v., s.c. Tobramycin: 1–2 mg/kg q. 8 h

61 Prescribe of horse with body
mass 400 kg aminoglycoside in solution 1200 mg/30 ml in vials for treatment over 10 days of Pseudomanas infection in dose 2 mg/kg/8 h i.m. (vancomycin, tobramycin, timentin).

62 Rp./ Sol. Tobramycin 1.2 g mg/30 ml
D. t. d. № 30 in vials. S. 20 ml/8 h i.m. 10 days.

63 Doxycycline: 5–10 mg/kg/12 h p.o. or i.v.

64 Minocycline: 5–15 mg/kg/12 h p.o.

65 Oxytetracycline: 20 mg/kg/8 h p.o.

66 Chlorampenicol p.o., i.v., i.m., s.c. Dogs: 50 mg/kg/8 h
Cats: 50 mg/kg/12 h

67 Florfeniciol (Norfenicol®)
Cattle Treatment of respiratory tract infections in clinically diseased cattle due to Mannheimia haemolytica, Pasteurella multocida and Histophilus somni, susceptible to Florfenicol. Dosage: Intramuscular injection: 20 mg/kg BM to be administered twice 48 h apart using a 16-gauge needle. Subcutaneous injection: 40 mg/kg BM to be administered once only using a 16-gauge needle. The dose volume given at any one injection site should not exceed 10 ml. The injection should only be given in the neck.

68 Florfeniciol – Norfenicol®
Swine Treatment of acute outbreaks of respiratory disease caused by strains of Actinobacillus pleuropneumoniae  and Pasteurella multocida, susceptible to Florfenicol. Dosage Intramuscular injection: 15 mg/kg BM into the neck muscle twice at 48 h intervals using a 16-gauge needle. The volume administered per injection site should not exceed 3 ml.

69 Florfeniciol (Norfenicol®)
Withdrawal Period Cattle Meat and offal: By intramuscular injection (at 20 mg/kg, twice): 39 days By subcutaneous injection (at 40 mg/kg, once): 44 days Milk: Not permitted for use in lactating animals producing milk for human consumption. Swine Meat and offal: By intramuscular injection (at 15 mg/kg, twice): 22 days

70 Prescribe of cow with BW 450 kg
drug in bottle (300 mg/ml – 100 ml) for treatment of pleuropneumoniae, which have to inject i.m. only two times through 48 h in dose 20 mg/kg BW (azithromycin, clindamycine, florfenicol).

71 Rp./ Sol. Florfenicoli 300 mg/ml – 100 ml
D. S. 2 x 30 ml i.m. through 48 h.

72 Azithromycin Erythromycin Clarithromycin Tylosin Dogs: 10 mg/kg/24 h
Cats: 5 mg/kg q.24–48 h Erythromycin 10–20 mg/kg q.8–12 h p.o. Clarithromycin 2.5–10 mg/kg/12 h p.o. Tylosin 10 mg/kg/8 h p.o.

73 Clindamycin Lincomycin p.o., i.m., i.v., s.c. p.o., i.m., i.v., s.c.
10 – 20 mg/kg q. 12 h p.o., i.m., i.v., s.c. – 12.5 – 25 mg/kg q. 12 h p.o., i.m., i.v., s.c. 10 – 20 mg/kg p.o. q. 8 – 12 h

74 Prescribe drug in vials
(600 mg/4 ml) for treatment of rhinosinuitis of cat with BM 3 kg in dose 20 mg/kg BM s.c./12 h for 10 days (clindamycin, co-trimoxazole, rifampicin).

75 Rp./ Sol. Clindamycini 600 mg/4 ml
D. t. d. № 2 in vials. S. 0,4 ml/12 h s.c. 10 days.

76 Co-trimoxazolе (BAN) 30 mg/kg q.12–24 h p.o., i.v., i.m., s.c

77 For local treatment of bacterial conjunctivitis
Sulfacetamidе collyrium 20% 10 ml For local treatment of bacterial conjunctivitis 77

78 METRONIDAZOLE 10–20 mg/kg q.12–24 h p.o.

79 Nitrofurantoin (Furadantin®): 4 mg/kg q.6–8 h

80 Furazolidone: 2.2–20 mg/kg q.8–24 h p.o.

81 Rhodococcus equi pneumonia in foals
Rifampicin (Rifampin) 10–20 mg/kg/12 h: To treat Rhodococcus equi pneumonia in foals

82 Cofazimine – p.o. Dogs: 4–8 mg/kg/8 h Cats: 4–8 mg/kg/8 h

83 Trifluridine (trifluorthymidine – TFT) is a fluorinated
pyrimidine. It has in vitro inhibitory effects against herpes simplex virus (types 1 and 2) and cytomegalovirus. The primary therapeutic indication for TFT is feline herpetic keratitis and it is usually applied in 1% collyrium 6 to 8 times per day. Adverse reactions include discomfort on application and palpebral edema.

84 Prescribe drug in bottle
(1% 7.5 ml) for treatment of feline herpetic keratits (indinavir, trifluridine, zidovudine).

85 Rp./ Sol. Trifluridini 1% 7.5 ml
D. t. d. № 2 in bottle. S. 4 x 1 drops daily in each eye two weeks.

86 Drugs which are not recommended for use in cats
Paracetamol (Acetaminophen – USAN): Methemoglobinemia, and Heinz body anemia Apomorphine: Significant CNS depression Azathioprine: Bone marrow suppression Benzocaine: Methemoglobinemia, laryngeal edema Cisplatin: Fatal acute pulmonary edema Propylthiouracil: Lethargy, weakness, anorexia, bleeding diathesis Phenytoin: Sedation, ataxia, anorexia, dermal atrophy Scopolamine: Tendency to cause behavioral changes Sodium phosphate enemas: depression, ataxia, vomiting, bloody diarrhea Permethrin (high concentration products): Hyperesthesia, generalized tremors, muscle fasciculations, hyperthermia, seizures, death

87 PRINCIPLES OF RATIONAL (Adapted from Laurence et al., 1997 & others)
ANTIBACTERIAL THERAPY (Adapted from Laurence et al., 1997 & others)

88 guide to good clinical practice
The following principles, many of which apply to drug therapy in general, are a guide to good clinical practice with antimicrobial agents. (1) Make a diagnosis precisely: – defining the site of action; – defining the microorganism(s) responsible and their sensitivity to drugs; – biological samples for laboratory must be taken before treatment is begun.

89 (2) Aims of therapy The goal of antibacterial therapy is to help the body eliminate infectious organisms without toxicity to the host. It is important to recognize that the natural defense mechanisms of a patient are of primary importance in preventing and controlling infection. Examples of natural defenses against bacterial invasion are: ●the mucociliary escalator in the respiratory tract ●the flushing effect of urination ●the normal flora in the GIT. All such mechanisms can be affected by disease or therapeutic interventions.

90 Once microbial invasion occurs, various host
responses serve to combat the invading organisms, including: ●the inflammatory response ●cellular migration and phagocytosis ●the complement system ●antibody production. The difficulty of controlling infections in immunocom- promised patients emphasizes that antibacterial therapy is most effective when it supplements endogenous defense mechanisms rather than when acting as the sole means of control.

91 (3) Consider factors affecting the success of antibacterial therapy
Bacterial susceptibility Various factors need to be considered in susceptibility testing. The minimum inhibitory concentration (MIC) is the concentration of drug that must be attained at the infection site. In general, if bacteria are not susceptible to a drug in vitro they will be resistant in vivo. Distribution to the site of infection To be effective, an antibacterial agent must be distributed to the site of infection and come into contact with the infecting organism in adequate concentrations.

92 Drugs that accumulate in leukocytes and other
Bacteria that locate intracellularly (Bartonella, Brucella, Chlamydia, Mycobacterium, Rickettsia) will not be affected by antibacterial agents that remain in the extracellular space. Staphylococcus is facultatively intracellular and may sometimes resist treatment because of intracellular survival. Drugs that accumulate in leukocytes and other cells include fluoroquinolones, lincosamides, sulfonamides and macrolides but aminoglycosides and β-lactams do not achieve effective intracellular concentrations.

93 An infectious process often adversely affects the
distribution of a drug in vivo. An exception is inflammation of the meninges (meningitis), which reduces the normal barrier between blood and CSF, so that antibacterial agents may cross this barrier. This breakdown of barriers by inflammation does not occur to an appreciable extent with the blood–prostate and blood–bronchial barrier. Effective antibacterial concentrations may not be achieved in poorly vascularized tissues, e.g. the extremities during shock, sequestered bone fragments or heart valves.

94 (4) Remove barriers to cure (e.g. lack of free
drainage of abscesses, obstruction in the urinary or respiratory tracts). (5) Decide whether therapy is necessary. As a general rule, acute infections require therapy whilst chronic infections may not. Chronic abscess or empyema respond poorly. Even some acute infections such as gastroenteritis are better managed symptomatically than by antimicrobials.

95 (6) Choose the most suitable route of
administration of antibacterial drug(s) ● Topical administration is valuable for disorders of eye and ear and some skin or gut infections. High drug concentration may be achieved locally in this way and some drugs too toxic for routine systemic administration (bacitracin, neomycin, polymyxins) can be useful topically. ● Oral administration is adequate in most infections and is usually preferable for home treatment. Some owners find it easier to administer drugs orally with food.

96 If in doubt, administration on an empty stomach
(no food for 1–2 h before and after dosing) is recommended, as the most common outcome of drug–ingesta interactions is impaired systemic drug availability. ●Parenteral administration is not routinely advantageous but can be useful for fractious, unconscious or vomiting patients, or those with oral/pharyngeal/esophageal pain or dysfunction.

97 (7) Select the best drugs. This involves
consideration of: – specificity (the antimicrobial activity of a drug must cover the infecting organisms); – pharmacokinetic factors (the chosen drug must reach the site of infection (e.g. by crossing BBB); – the patients (who may previously had allergic reactions to antimicrobials or whose routes of drug elimination may be impaired, e.g. by renal disease).

98 8. Client consent and compliance
As with all drug therapy, antibacterials will not be effective unless administered correctly to the patient. It is important to maximize the likelihood that a client will administer drugs at the right dose and dosing interval.

99 (9) Indications for combination therapy:
– to avoid the development of resistance in chronic infections (e.g. FIV, tuberculosis). – to broaden the antibacterial spectrum: a) in a unknown mixed infection; b) unusual pathogens, including Mycobacterium, Rhodococcus and fungi. c) if the microorganism cannot be predicted (septicemia complicating neutropenia); – to obtain potentation (e.g. penicillin plus gentamicin for enterococcal endocarditis)

100 PRC B have: (10) Antimicrobial therapy in pregnancy or lactation
Azithromycine Erythromycine Penicillins Most cephalosporines

101 PRCs LRCs A: controlled studies show no risk (Vit. B9)
B: no evidence of risk in humans (Penicillins) C: risk cannot be ruled out (Bisoprolol) D: positive evidence of risk (Diazepam) X: contraindicated in pregnancy (Estrogens) L1: safest (Ibuprofen, Paracetamol) L2: safer (Cephalosporins, Omeprazole) L3: moderately safe (Acarbose, Aspirin) L4: possibly hazardous (Diazepam) L5: contraindicated (ACE inhibitors)

102 (11) Administer the drug in optimum dose and frequency
– Inadequate dose may encourage the development of microbial resistance. – Intermittent dosing is preffered to continual infusion. – Plasma concentration monitoring can be applied to optimize therapy with aminosides, fluoroquinolones, co-trimoxazole, and cephalosporins, in patients with kidney disease.

103 (12) Continue therapy until apparent cure has been achieved.
– Most acute infections are treated for 5 to 10 days. There are many exceptions to this, such as typhoid fever, tuberculo- sis, and infective endocarditis, in which relapse is possible long after apparent clinical cure and so the drugs are continued for a long time, determined by clinical experience.

104 (13) Test for cure. In some infections,
microbiological proof of cure is desirable because disappearance of symptoms and signs occurs before the microorganisms are eradicated, e.g. urinary tract infections (examinations must be done after withdrawal of drug therapy). (14) Prophylactic therapy for surgical and dental procedures should be of very limited duration. It should be started at the time of surgery to reduce the risk of producing resistant microorganisms.

105 (15) Remember that the most important carriers
of cross infections are your 10 fingers. 105

106 Standard Euthanasia Methods
for Commonly Used Species  Rodents (Mice, Rats, Hamsters, Guinea Pigs, and Voles) Carbon dioxide (CO2) to effect Sodium Pentobarbital 100 or > mg/kg IV, IP Commercial Euthanasia Solution: Sodium pentobarbital 390 mg/ml + Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital) Cervical dislocation under anesthesia Gerbils,

107 Rabbits Sodium Pentobarbital 100 or > mg/kg IV, IP Commercial Euthanasia Solution: Sodium pentobarbital 390 mg/ml + Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital) Exsanguination under anesthesia Cats and Dogs Sodium Pentobarbital 100 or > mg/kg IV Potassium chloride under anesthesia to effect

108 Livestock (Cattle, Goats, Horses, Sheep, and Swine)
Sodium Pentobarbital 100 or > mg/kg IV Commercial Euthanasia Solution: Sodium pentobarbital 390 mg/ml + Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital) Nonhuman Primates Sodium Pentobarbital 100 or > mg/kg IV, IP

109 Amphibians and Fish Sodium Pentobarbital 100 or > mg/kg IV, ICL
Commercial Euthanasia Solution: Sodium pentobarbital 390 mg/ml + Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital) Benzocaine hydrochloride 250 mg/liter (Water bath) Tricaine methane sulfonate 3 g/liter (Water bath buffered with sodium bicarbonate) Abbreviations IC – intracardiac ICL – intracoelomic IP – intraperitoneal IV – intravenous The coelum is a fluid-filled cavity between the body wall and the intestines.

110 Birds Carbon dioxide to effect Sodium Pentobarbital 100 mg/kg IV, ICL Commercial Euthanasia Solution: Sodium pentobarbital 390 mg/ml + Sodium phenytoin 50 mg/ml (≈ 86 mg/kg pentobarbital) Reptiles Sodium Pentobarbital 100 or > mg/kg IV, ICL