The slide is prepared specifically to let the aspirants be known about the instructions of common household drugs to your furry little friend. it holds the simple instructions and guidelines about toxicity of common drugs and must do measurements if ever happened or presented.

1. Drugs Contraindicated In
Cats
Nabeel ahmad
UNIVERSITY OF AGRICULTURE, FAISALABAD

2. The antidote to acetaminophen overdose is N-acetyl cysteine (140 mg/kg, per os). It is most effective when given within
eight hours of ingesting acetaminophen.
Administration of N-acetyl cysteine (NAC), a sulfur-containing amino acid, can reduce the extent of liver injury or
methemoglobinemia. NAC provides sulfhydryl groups, directly binds with acetaminophen metabolites to enhance their
elimination, and serves as a glutathione precursor. It is available as a 10% or 20% solution.
The loading dose is 140 mg/kg of a 5% solution IV or PO (diluted in 5% dextrose or sterile water), followed by 70 mg/kg,
PO, qid for generally seven or more treatments (some authors recommend up to 17 doses).
Vomiting can occur with oral NAC. NAC is not labeled for IV use; however, it can be administered as a slow IV (over 15–20
min) with a 0.2-micron bacteriostatic filter.
Activated charcoal and oral NAC should be administered 2 hr apart, because activated charcoal could adsorb NAC.
 Acetaminophen
Acetaminophen is contraindicated in cats at any dosage. Severe
methemoglobinemia, hematuria, and icterus can be seen. Cats are unable to
significantly glucuronidate acetaminophen due to relatively less amount of
Glucuronosyltransferase leading to toxic metabolites being formed and
resultant toxicity

3. Treatment (GI)
If the aspirin was recently ingested, then induce vomiting (Hydrogen peroxide (3%) applied to the back of the pharynx stimulates
vomiting via the ninth cranial nerve).
Gastric lavage and administration of activated charcoal
gastrointestinal protectants (e.g., sucralfate 250mg and misoprostol) will be used to help protect the gastrointestinal system.
Gastrointestinal protectants should be administered for a minimum of 1 to 2 weeks
Treatment (Renal)
IV FLUIDS (dextrose 5% in water along with sodium bicarbonate (3–5%) 2-5 mEq per kg of body weight, or 0.5-1.5 mL
per kg)
Diuresis may be enhanced by the administration of mannitol (1–2 grams/kg/hr).
Treatment of Nervous signs
Seizures may be controlled with IV diazepam (0.025 mg/kg)
 Aspirin
cats can’t break down the drug effectively. They take a long time to clear it
from their bodies. Liver breaks down aspirin using a protein called UGT1A6.
at version of this protein is barely producing in the liver. The cat genome has
a broken version of UGT1A6. The gene has been riddled with crippling
mutations that prevent it from producing a working protein

4. In cases presenting within 1 to 2 hours of ingestion, gastrointestinal decontamination may be
performed. This includes inducing vomiting and administering activated charcoal repeatedly.
Intravenous fluids will help with kidney function. Anti-vomiting medications along with gastrointestinal
protectants (e.g., sucralfate 250mg and misoprostol) will be used to help protect the gastrointestinal system.
Gastrointestinal protectants should be administered for a minimum of 1 to 2 weeks following ibuprofen poisoning
In patients that are anemic (have lost a lot of blood), blood transfusions may be required.
Typically 48 hours of intravenous fluids are needed to support the stomach and kidneys
 Ibuprofen
The toxic effect of ibuprofen depends on the dose, the number of doses ingested
and age of the cat. It is known that an acute ingestion of 50 mg/kg will produce a
toxic effect. The signs of ibuprofen toxicity in cats are vomiting, depression,
anorexia and diarrhea.
In cats, the drug is recycled over and over in the body via the liver instead of
being removed from the body. This recycling allows for repeated exposure and is
responsible for the poisoning effects.

5. Treatment (GI)
If the aspirin was recently ingested, then induce vomiting (Hydrogen peroxide (3%) applied to the back of the pharynx
stimulates vomiting via the ninth cranial nerve).
Gastric lavage and administration of activated charcoal
gastrointestinal protectants (e.g., sucralfate 250mg and misoprostol or omeprazole .5-1 mg/kg) will be used to help
protect the gastrointestinal system. Gastrointestinal protectants should be administered for a minimum of 1 to 2 weeks
Treatment (Renal)
IV FLUIDS (dextrose 5% in water) along with sodium bicarbonate (3–5%) 2-5 mEq per kg of body weight, or 0.5-1.5 mL
per kg)
Diuresis may be enhanced by the administration of mannitol (1–2 grams/kg/hr.).
Treatment of Nervous signs
Seizures may be controlled with IV diazepam (0.025 mg/kg)
 Naproxen
The most common cause of naproxen toxicity is a well-meaning owner who gives
the medication without knowing the toxic dose. The initial toxic effect is
bleeding stomach ulcers. In addition to ulcers, increasing doses of naproxen
eventually leads to kidney failure and, if left untreated, can be fatal.
findings in cats recorded in decreasing frequency included vomiting, lethargy,
and anorexia.
Cats are more sensitive to the kidney effects of naproxen. With massive overdose
or ingestion, severe kidney impairment can occur within 12 hours of ingestion but
may take up to five days. In severe cases, seizures may occur.
Naproxen can result in stomach ulcers at a dose of 2.5 mg per pound (6 mg/kg)
daily. Naproxen can result in kidney failure at a dose of 7 gm per pound (15
mg/kg).

6. Gastric lavage and activated charcoal. Intravenous fluids, anti-convulsants(diazepam 0.25-0.5mg/kg)- and anti-
histamines(Pheniramine maleate 2-4mg/kg) may be administered as required.
The recommended treatment for overdoses includes emesis only in cases of recent ingestion (<15 minutes). If clinical
signs are present, inducing vomiting is not recommended because of the increased risk of aspiration. In these cases,
activated charcoal with a cathartic should be given. Repeated doses may interrupt enterohepatic recirculation. Sodium
bicarbonate is needed if the patient is acidotic (blood pH: <7.4) or hypotensive or if cardiac arrhythmias are present.
Inducing alkalosis (blood pH: 7.45 to 7.55) with sodium bicarbonate prevented death after overdose in poisoned dogs
 Antidepressants
Accidental ingestion or administration of toxic dose of Anti-depressants such
benzodiazepines, tricyclic antidepressants (TCAs), antihistamines, azaparones,
selective serotonin re-uptake inhibitors (SSRIs), serotonin antagonist reuptake
inhibitors (SARIs) and beta-blockers may cause lethargy, vomiting, uncoordinated
gait, ataxia, tachycardia, mydriases, tremors, seizures, hyperthermia, and
diarrhea. The clinical signs may appear in 30 minutes after the ingestion.

7. induce vomiting (Hydrogen peroxide 3%) applied to the back of the pharynx stimulates vomiting via the ninth cranial
nerve).
Gastric lavage and administration of activated charcoal
Intravenous fluids (dextrose 5%), anti-convulsants (diazepam 0.25-0.5mg/kg)- and anti-histamines (Pheniramine
maleate 2-4mg/kg) may be administered as required
 Attention Deficient Hyperactivity Disorder (ADHD) medications.
Their ingestion is mostly accidental and even small doses of these drugs can
make your four-legged furry animal pay.
ADHD medications are stimulants, When cats ingest stimulant ADHD drugs, they
may also show an increase in activity, or they may sit unusually still and stare for
long periods of time. Internally, they will have an increase in heart rate, blood
pressure and body temperature, despite their lack of movement.
Possible symptoms of poisoning in cats include:
Restlessness, Panting, Hyperactivity, Sedation, Hyperthermia, Circling, Head
bobbing, Facial tics, Lip-smacking, Foot-paddling, sniffling,
Agitation/irritability/aggression, Muscle tremors, Seizures, tachycardia,
mydriases, Elevated blood pressure, Vomiting, Diarrhea, Drooling and Death

8. induce vomiting (Hydrogen peroxide (3%) applied to the back of the pharynx stimulates vomiting via the ninth cranial nerve).
Gastric lavage and administration of activated charcoal
intravenous fluids
Treat Bradycardia with repeated doses of atropine (0.2 – 0.5mg/kg)
Administration of insulin (4 IU/minute with glucose clamped), glucagon (50 micrograms/kg bolus, then 150
micrograms/kg/hour infusion), or epinephrine (1 microgram/kg/minute) affected animals have 100% survival rate
 Beta blocker
While beta-blockers are commonly used in cats and dogs, accidental overdose can result in
severe, life-threatening poisoning due to the drug’s narrow margin of safety. Overdose can result
in heart failure, a very slowed heart rate, severe hypo-tension (low blood pressure), and
secondary acute kidney failure.
Common signs to in beta blockers poisoning are:
 Nausea
 Vomiting
 Weakness
 Collapse
 Bradycardia
 Low blood pressure
 Lethargy

9. Administration of Radioactive iodine therapy
Removal of the thyroid glands, called surgical thyroidectomy, is a relatively straightforward surgical procedure
that has a good success rate.
Administration of Iodized salt in diet.
 Thyroid hormones
Also called thyrotoxicosis, hyperthyroidism is caused by an increase in production
of thyroid hormones (known as T3 and T4) from an enlarged thyroid gland.
Similar situations can also be seen from administration of such hormones he most
common clinical signs of hyperthyroidism are weight loss, increased appetite,
and increased thirst and urination. Hyperthyroidism may also cause vomiting,
diarrhea, and hyperactivity. It may cause heart diseases and high blood pressure.
The coat of affected cats may appear unkempt, matted, or greasy.

10.  Cholesterol medication (Lipitor)
Lipitor is often used to reduce cholesterol levels. Generally when pets get into
Lipitor, only mild side effects are seen, such as vomiting and diarrhea. Therefore,
Lipitor is not considered to have high toxicity levels for pets. Serious side effects
from these drugs come with long-term use, not one-time ingestions.

11. DRUG(S) OF CHOICE Acepromazine 0.025–0.05 mg/kg IV/IM as needed to control paradoxical reactions.
Cyproheptadine 2–4 mg/cat for control of paradoxical reactions. Flumazenil—a benzodiazepine reversal agent—0.01
mg/kg IV q1–2h as needed. ◦ It can be used to reverse both excessive sedation and paradoxical reaction. ◦ However,
flumazenil can cause seizures so its use is generally restricted to life-threatening situations.
Intravenous fluids.
 Sleep Aids (Benzodiazepines, Imidazopyridines, Paradoxical)
Benzodiazepines work by increasing the release of and/or facilitation of neurotransmitter gamma-
aminobutyric acid (GABA) activity, hey potentiate GABA’s effect, which increases the opening of the
chloride channel, leading to hyperpolarization of the nerve and decreased excitation. When dogs and
cats get into a toxic amount of benzodiazepines, clinical signs of severe sedation, in-coordination,
aggression, agitation, nausea, and vomiting may be seen. In severe cases, respiratory and
cardiovascular depression may be seen.
Imidazopyridines bind near the receptor subset that is responsible for sedation, while benzodiazepines bind to
all receptor subsets and so not only mediate sedation but are also anticonvulsant and anxiolytic.
Paradoxical reactions can occur and are typically described as excitement, irritability, and aberrant demeanor
in cats and excitement in dogs, when the expected effect is seizure control or sedation
Systems affected are
Gastrointestinal—vomiting, Hepatic—acute necrosis and failure in cats with diazepam and clonazepam ,
Nervous—CNS depression and/or paradoxical reactions, ataxia, coma, Respiratory—depression

12. Antibiotics
 Tetracyclines: these antibiotics can cause staining of the tooth enamel in young
animal and so are contraindicated in animals less than one month old.in cats, it
can cause fever. GI upset • Anorexia, abdominal pain, diarrhea, nausea and
vomiting (Doxycycline)
 Fluoroquinolones: these antibiotics can cause damage to the cartilage of growing
animals so are contraindicated in cats < 8 weeks and dogs < 18mths old.
 Cephalosporin in Cats – superinfection or anemia. Vomiting and diarrhea
 Neomycin>Kanamycin>amikacin –ototoxic • Cats more susceptible than dogs
 Chloramphenicol : In cats, dose-related blood dyscrasias is seen. They have longer
elimination half life in cats. Hypersensitivity reaction in cats –Aplastic anemia.
Reversible bone marrow depression. Kittens are deficient in microsomal enzymes
and there us inadequate drug metabolism which leads to bone marrow
suppression.

13.  Quinolones : Arthropathy due to use of Quinoles in kittens are common due
to chelation of Mg2+ in cartilage.
Enroflaxacin :5 to 25 mg/kg for 30 days pups and kittens - splitting of the
articular cartilage. Retinal degeneration; Acute blindness, mydriasis are seen due
to use of enroflaxacin - 20 mg/kg a day in cats.
Marbofloxacin and Orbifloxacin : large breeds of dogs- cats resistant to
Orbifloxacin effect
Difloxacin and orbifloxacin- Anorexia, decreased appetite, diarrhea, or vomiting
Enrofloxacin and orbifloxacin- ataxia, seizures
Orbifloxacin : hypersensitivity

14.  Lincosamide : Anorexia, diarrhea, vomiting ,Local irritation of abdominal
mucosa by oral dosing. Lip smacking and excess salivation in cats with
clindamycin
 Metronidazole : Neurological disturbances like ataxia, nystagmus, seizures,
tremors and weakness
Rifampin and nitro furans- cause the hemoglobinuria causing the red color
urine.
 Azathioprine/azithromycin: significant bone marrow toxicity
 Permethrin-containing flea products: Significant toxicity in cats

15. Anti-fungal Drugs
 Amphotericin: Is nephrotoxic. Causes renal vasoconstriction, binds to
membrane cholesterol in renal tubules. Cats more sensitive.
 Griseofulvin: Hepatotoxic, CNS disturbances and hemolytic alterations.
Kittens commonly affected due to inadequate glucuronyl conjugation.
Cats are terato and carcinogenic in high dose
 Ketoconazole: Hepatotoxic in cats. Decrease libido in males du to
suppression of testosterone

16. Antibiotics contraindicated in different
conditions
Beta lactams are safer compared to all other antibiotics in
most of the situations.