Anti inflammatory drugs Non steroidal anti inflammatory drugs steroids mechanism of action of anti inflammatory drugs adverse effects of drugs contraindications of anti inflammatory agents uses of anti inflammatory drugs dose rates of anti inflammatory agents list of anti inflammatory drugs

1. ANTI INFLAMMATORY DRUGS
Submitted to: Dr Hafiz Manzoor
Submitted by: M. Mutahir
2017-DVMN-029

2. References
Theresa Welch Fossum ( 151-152)
Complications in small animal surgery ( 92 , 97-105)
Merck veterinary manual (2707-2721)
Clinical vet guide ( 1-8)
Plumb’s veterinary drug handbook

3. Inflammation
•Inflammation is the complex pathophysiological response of
vascularized tissue to injury
•The injury may result from various stimuli, including thermal,
chemical, or physical damage; ischemia; infectious agents and
antigen-antibody interactions

7. NSAIDS
•NSAIDs have the potential to relieve pain and inflammation
without the potential metabolic, hemodynamic, and
immunosuppressive adverse effects associated with corticosteroids
•However, all NSAIDs have the potential for other adverse effects
that should be considered

8. Mode of action
•NSAIDs act primarily to reduce the biosynthesis of prostaglandins
by inhibiting Cyclooxygenase (COX)
•ln general, NSAIDs do not inhibit the formation of 5-lipoxygenase
(5-LOX) and hence leukotriene, or the formation of other
inflammatory mediators
•The novel NSAID tepoxalin is an exception in that it inhibits both
COX and 5-LOX

9. Pharmacologic effects
•All NSAlDs, except for acetaminophen ( also named paracetamol),
are antipyretic, analgesic, and anti-inflammatory
•They are routinely used for the relief of pain and inflammation
associated with osteoarthritis in dogs and horses and for colic,
navicular disease, and laminitis in horses
•As analgesics, they are generally less effective than opioids

10. Common NSAIDS
Flunixin
Ketoprofen
Naproxen
Meloxicam
Piroxicam
Phenylbutazone
Aspirin
Ketorolac
Acetaminophen

11. Flunixin
Uses/Indications:
Alleviation of inflammation and pain associated with
musculoskeletal disorders and alleviation of visceral pain
associated with colic
In cattle for the control of pyrexia associated with BRD and
endotoxemia, and control of inflammation in endotoxemia
In ruminants, flunixin is a better analgesic for visceral pain rather
than musculoskeletal pain
May improve hemodynamics in animals with septic shock

12. Contraindications
•Flunixin should be used cautiously in animals with renal, hepatic,
or hematologic diseases
•When using to treat colic, flunixin may mask the behavioral and
cardiopulmonary signs associated with endotoxemia or intestinal
devitalization
•In horses with known or suspected EGUS, use should be
avoided; repeated doses can exacerbate gastric ulcers
•Flunixin is usually considered contraindicated in cats

13. Adverse effects
•In horses following IM injection, reports of localized swelling,
induration, stiffness, and sweating have been reported
•Do not inject intra-arterially as it may cause CNS stimulation
(hysteria), ataxia, hyperventilation, and muscle weakness
•Flunixin appears to be a relatively safe agent for use in the horse, but
the potential exists for GI intolerance, hypoproteinemia, and
hematologic abnormalities to occur

14. •IM injections may rarely be associated with clostridial myonecrosis
•Hematochezia and hematuria have been reported in cattle treated
for longer than the 3-day recommendation.
•In dogs, GI distress is the most likely adverse reaction
•Clinical signs may include, vomiting, diarrhea, and ulceration
•In birds, flunixin has been shown to cause significant renal ischemia
and nephrotoxicity

15. Brand names

17. Ketoprofen
Uses/Indications:
•Ketoprofen is used in horses for the alleviation of inflammation and
pain associated with musculoskeletal disorders
NSAID of choice for short-term analgesia in cats
•Indicated for use in dogs and cats for the alleviation of inflammation,
lameness and pain due to osteoarthritis, hip dysplasia, disc disease,
spondylosis, panosteitis
•For the management of post-surgical pain

18. Contraindications/Precautions
•Patients with significant renal or hepatic impairment
•ketoprofen is highly protein bounded

19. Adverse Effects
•Ketoprofen appears to have low toxicity in horses
•Potentially, gastric mucosal damage and GI ulceration, renal crest
necrosis, and mild hepatitis may occur
•Do not administer intra-arterially and avoid SC injections
•In dogs or cats, ketoprofen may cause vomiting, anorexia, and GI
ulcers

24. Meloxicam
Uses/Indications:
•Meloxicam is principally used for the symptomatic treatment of
osteoarthritis in dogs
•In for cats for the control of postoperative pain and inflammation
associated with orthopedic surgery, ovariohysterectomy and
castration pre-operatively
•In calves to treat painful procedures such as castration or
dehorning

25. Contraindications/Precautions
•It should be used with caution in patients with impaired hepatic,
cardiac or renal function and hemorrhagic disorders
•Due to its long half-life in dogs, a 5–7 day washout period after
stopping meloxicam has been recommended before starting a new
NSAID
•Use extreme caution in dehydrated, hypovolemic, or hypotensive
animals as there is a potential increased risk of renal toxicity

26. Adverse Effects
•GI distress is the most commonly reported adverse effect
•Elevation of liver enzymes, pruritis, elevated creatinine, and renal
failure
•Repeated use of meloxicam in cats is associated with renal failure and
death

32. Piroxicam
Uses/Indications:
•In dogs, piroxicam may be beneficial in reducing the pain and
inflammation associated with degenerative joint disease
•Its primary use is in dogs as adjunctive treatment of bladder
transitional cell carcinoma
•It may also be of benefit in squamous cell carcinomas, mammary
adenocarcinoma, and transmissible venereal tumor (TVT)

33. Contraindications/Precautions
• Because peripheral edema has been noted in some human
patients, it should be used with caution in patients with severely
compromised cardiac function
•Piroxicam has not been evaluated for use in cats

34. Adverse Effects
•Doses as low as 1 mg/kg given daily have caused significant GI
ulceration, renal papillary necrosis, and peritonitis
• In dogs include: CNS effects (headache, dizziness), otic effects
(tinnitus), pruritis and rash, and peripheral edema
•In cats, GI effects (vomiting, anorexia, diarrhea) may be seen
•There are reports of piroxicam decreasing hematocrits in cats
when dosed daily for 7- 14 days

37. Phenylbutazone
Uses/Indications:
•“For the relief of inflammatory conditions associated with the
musculoskeletal system in dogs and horses”
• It has been used primarily for the treatment of lameness in
horses

38. Contraindications/Precautions
•Cautious use is recommended because of increased incidences of
hypoproteinemia and GI ulceration
•Phenylbutazone may cause decreased renal blood flow and sodium
and water retention, and should be used cautiously in animals with
preexisting renal disease or CHF
•Do not administer injectable preparation IM or SC as it is very irritating
(swelling, to necrosis and sloughing)

39. Adverse Effects
•Toxic effects in horses include oral and GI erosions and ulcers,
hypoalbuminemia, diarrhea, anorexia, and renal effects
•Phenylbutazone-induced blood dyscrasias and hepatotoxicity have
also been reported in dogs
•Bone marrow effects (aplastic anemia), renal and cardiovascular effects
(fluid retention to acute renal failure), and GI effects (dyspepsia to
perforated ulcers)
•The use of H2 blockers (cimetidine, ranitidine) have been suggested
for use in treating the GI effects

40. Brand names
1. Fenylbutazone: 200mg/ml : Orient traders
2. Pain go : 200mg/ml : Leads Pharma
3. Butadin :200mg/ml : Star Labs

41. Acetaminophen
Uses/Indications:
•Acetaminophen is occasionally used as an oral analgesic in dogs
•It may be particularly beneficial in dogs with renal dysfunction for
the treatment of chronic pain conditions
•In situations where moderate pain occurs, it may be used in
combination with tramadol

42. Contraindications/Precautions
•Acetaminophen is contraindicated in cats at any dosage
•Severe methemoglobinemia, hematuria, and icterus can be seen
•While dogs are not as sensitive to acetaminophen as cats, they may
also be susceptible to methemoglobinemia when given high dosages
•In dogs, it is generally not recommended during the immediate post-
operative phase due to an increased risk of hepatotoxicity

43. Brand names

44. Ketorolac
Uses/Indications:
•Ketorolac is used primarily for its analgesic effects for short-
term treatment of mild to moderate pain in dogs and rodents
•The duration of analgesic effect in dogs is about 8–12 hours

45. Contraindications/Precautions
•Ketorolac is relatively contraindicated in patients with a history of,
or preexisting, hematologic, renal or hepatic disease
•It should be used cautiously in patients with a history of GI ulcers,
or heart failure (may cause fluid retention), and in geriatric patients
•Because Ketorolac has a tendency to cause gastric erosion and
ulcers in dogs, long-term use (>3 days) is not recommended

46. Adverse Effects
•The primary issue in dogs is its GI toxicity
•GI ulceration can be common if the drug is used chronically
•Like other NSAIDS, platelet inhibition, renal, and hepatic
toxicity are also possible with this drug

49. Aspirin
Uses/Indications:
•Aspirin is used in all species for its analgesic and antipyretic effects
•Aspirin is used therapeutically for its effects on platelet aggregation in
the treatment of DIC and pulmonary artery disease secondary to
heartworm infestation in dogs
•It is also used in cats with cardiomyopathy
•Aspirin (at low doses) may be of benefit in the adjunctive treatment of
glomerular disease

50. Contraindications/Precautions
• It is relatively contraindicated in patients with hemorrhagic
disorders, asthma, or renal insufficiency
•Because aspirin is highly protein bound to plasma albumin, patients
with hypoalbuminemia may require lower dosages to prevent clinical
signs of toxicity
•Because of its effects on platelets, aspirin therapy should be halted,
if possible, one week prior to surgical procedures

51. Adverse Effects
•The most common adverse effect at therapeutic doses is gastric
(nausea, anorexia, vomiting) or intestinal irritation with varying
degrees of occult GI blood loss occurring
•The resultant irritation may result in vomiting and/or anorexia
•Severe blood loss may result in a secondary anemia or
hypoproteinemia
•Cats may develop acidosis from aspirin therapy

55. CORTICOSTEROIDS
Two classes of steroid hormones, mineralocorticoids and glucocorticoids,
are naturally synthesized in the adrenal cortex from cholesterol
Mineralocorticoids ( aldosterone) are so named because they are important
in maintaining electrolyte homeostasis
Glucocorticoids suppress virtually every component of the inflammatory
process; they inhibit PLA2, decrease synthesis of interleukins and
numerous other inflammatory cytokines, suppress cell-mediated immunity
and decrease production and activity of leukocytes

57. Dexamethasone
Uses/Indications:
Glucocorticoids have been used in an attempt to treat practically every
malady that afflicts animal, but there are three broad uses:
1) Replacement of glucocorticoid activity in patients with adrenal
insufficiency
2) As an antiinflammatory agent
3) As an immunosuppressive

58. Contraindications/Precautions
•Because dexamethasone has negligible mineralocorticoid effect, it
should generally not be used alone in the treatment of adrenal
insufficiency
•Do not administer the injectable rapidly intravenously ;
hypotension, collapse, and hemolytic anemia can occur
•There is a high incidence of gastrointestinal bleeding and colonic
perforation in canine neurosurgical patients treated with
dexamethasone

59. •Systemic use of Glucocorticoids is generally considered
contraindicated in systemic fungal infections
•Animals that have received glucocorticoids systemically should be
tapered off the drugs
•Animals, particularly cats, at risk for diabetes mellitus or with
concurrent cardiovascular disease should receive glucocorticoids
with caution due to these agents’ potent hyperglycemic effect

60. Adverse Effects
•Glucocorticoids can retard growth in young animals
•In dogs, polydipsia , polyphagia and polyuria , may all be seen
•Very high doses in dogs with spinal cord injuries have caused fatal
colon perforations
•Adverse effects associated with immunosuppressive doses are more
common
•Administration of dexamethasone may play a role in the development
of
laminitis in horses

63. Prednislone
Uses/Indications:
•There are there are four primary uses and dose ranges:
1) replacement or supplementation
2) as an antiinflammatory
3) as an immunosuppressive
4) as an antineoplastic agent