Published on November 19, 2007
Issues In Veterinary Compounding: Issues In Veterinary Compounding Fadi Salem Chris Pantouris Matt Vo Joe Pizzuto Shyam Parikh Alex Torres Degenerative Myelopathy: Degenerative Myelopathy Based upon new pathophysiologic data DM can be described as MS in dogs. It occurs primarily in German Shepherd Dogs although a few other breeds can also be affected. The age of onset is 5-14 y. which corresponds to the 3rd-6th decades of human life. Pathophysiology: Pathophysiology Dx: Hx of progressive spinal ataxia & weakness that may be waxing and waning or progressive. Diffuse thoracolumbar spinal cord disfx. Elevated CSF protein in the lumbar cistern Electromyographic examination: No lower motor neuron disease. Disease localized to the white matter pathways of the spinal cord. Pathophysiology Cont…: Pathophysiology Cont… Some dogs exhibit antigen-binding cells specific to canine myelin basic protein. Immunoglobulins have been shown bound to the lesions within the spinal cord. These CSF proteins appear related to inflammation. Pathophysiology cont…: Pathophysiology cont… Immune-complexes lead to endothelial cell damage in the vessels of the CNS. fibrin is deposited in the perivascular spaces inflammatory cells stimulated to migrate into the lesions and release prostaglandins and cytokines leads to the activation of tissue enzymes and the formation of oxygen free-radicals which, in turn, leads to tissue damage and demyelination of the axons. In advanced cases there is a reduced number of axons, increased number of astroglial cells and increased density of vascular elements. Clinical Features: Clinical Features Loss of propioceptive function leading to posterior ataxia Initially characterized by knuckling of the toes, wearing of the nails and inner digits or the rear paws and stumbling Hyperactive tendon reflexes, crossed extensor reflexes and Babinski’s sign develop over time. Clinical Features: Clinical Features Pain sensation is largely spared. Dogs remain urinary and fecal continent until late in the disease. The course of disease is 6-12 months from onset of symptoms. Eventually, foreleg disfx will develop and finally the brain stem will succumb to demyelination. Treatment: Treatment Antiox-Q Mixture of vitamins recommended for dogs with DM 5 ml bid or 2.5 ml bid with or without food Shake well Do not refrigerate Treatment: Treatment Aminocaproic Acid MOA: inhibits fibrinolysis that is characteristic of disease Made as a 250 mg/ml solution (mix with chicken broth Oral solution given tid with or without food Treatment: Treatment N-Acetylcysteine (NAC) MOA: antioxidant with neuroprotective effects 75 mg/kg/day divided in 3 doses every day for two weeks, then every other day Refrigerate and keep lid tightly closed NAC Calculations: NAC Calculations 75mg/kg divided in 3 doses a day 40kg X 75mg = 3000mg = 30g 20g/100ml = 30g/150ml Inactive ingredients: edetate disodium, sodium hydroxide, and purified water. Compounding the NAC : Compounding the NAC Accurately weigh/measure all the ingredients. Using geometrical dilution take 150ml of 20% acetylcysteine and add it to 150ml of low sodium chicken broth. Then add this to 300ml of chicken broth. Stir well until there is a uniform mixture. Refrigerate product to preserve potency. Slide15: TOBI Conclusion: Conclusion Combination therapy of 2 medication along with dietary supplements and exercise are considered optimal therapy for DM. Treatment will only slow down the progression of the disease. The earlier the symptoms are recognized the more effective the therapy is likely to be. Slide17: (JOE didn’t make the height limit for the picture) Questions??: Questions??