Hi everyone, and welcome to the Rumorcam CPD series. We're gonna be going through this CPD today, which will take approximately 30 minutes, and there will be a chance to ask questions at the end or email me with any questions that you might have at the very end. So what we're gonna go through today is the mechanisms of pain and then NSAIDs and how NSAIDs work.

We're then gonna have an introduction to the room ca range and then dosing and practical application and then we're gonna move on to FAQs at the end and just from some questions that we've had asked quite a lot, so there's a little list at the end for those questions that are recurring. So just a little bit about myself. My name is Kelsey Allison.

I'm a registered veterinary nurse. I graduated Harper Adams University in 2015 with a Bachelor of Science in veterinary nursing and practise management, and I am the Northern Territory manager for the UK and the product support executive. So let's start off with how pain works and the mechanism of pain.

So let's make a scenario, let's say that you injure your hand and let's say you touch something hot. What will happen is your immune cells are activated, such as your neutrophils, your macrophages, and your mast cells, and these will rush into the area to stop any bleeding, if there is any, or prevent any pathogens from entering the body. So as you can see from this diagram, we have got a few things going on.

If you have a break in the barrier of your skin, The immune cells will rush into that area to 1, prevent any bleeding, and 2, prevent anything from getting into that cut, because that is a break in your natural barrier. And also, as you can see, there is a splinter in there, again, that's gonna bring harmful things with it, harmful pathogens potentially. And this is again a breaking barrier of the skin.

So these immune cells need to come into that area. And these immune cells will recruit more and more and mount a full inflammatory response. So from there, they will release inflammatory mediators.

Now there's a few different types of inflammatory mediators, but the ones we're gonna concentrate on today and the most common ones are prostaglandins. Now we're gonna take you back to GCSE biology here. So these prostaglandins cause a depolarization of your nerve cell, F2, but the others on a sensory neuron.

So from this diagram, you've got your skin cell with your receptors in the skin. The, the pain will travel all the way along your sensory neuron, past your cell body and to your synaptic endings and then pass on to the next nerve cell and the next all the way up to your brain. So these nerve cells will feed a message to your spinal cord.

And again, we're going all the way back to biology here. This sends a message to the thalamus in your brain, and that is the relay station of your brain. So if we're going to follow this diagram, we've got your sensory neuron in your skin.

The response will travel all the way along your somatosensory pathway through your nerve cells, across your spinal cord, up your central nervous system pathway into your medulla oblongata and then into your sensory cortex. So this message is sent to the somatocentri cortex, and this is the part of the brain where your sensation is perceived. So this will tell the brain the origin of the pain.

And the reaction is obviously to pull your hand away from whatever it is that's burning you, whatever it is that hurts. So what's interesting about this and fascinating is that it happens within a split second. You don't have to think about your pulling your hand away.

You don't have to think about telling your motor neurons to pull your arm away. Your brain has already done it before you've thought about it. And it's also important to remember that anything that happens on the left hand side of your body happens on the right is perceive to the right hand side of your brain and vice versa.

So as you can see from the diagram, we have got a crossing over of the spinal cord segment there. So it's just important to remember that the left hand side pain is perceived on the right hand side of your brain. So these prostaglandins, these inflammatory mediators that we've already talked about have a lot of different functions, but when it comes to pain and inflammation, it can be a bit of a vicious cycle.

So when these inflammatory medias depolarized that nerve cell, so alert in the brain, this pain. That nerve cell will release more chemicals, which amplifies the inflammatory response. So the following nerve cell will be depolarized in the following, which then release more chemicals, which then amplifies the inflammatory response and by and so on and so forth.

So therefore, this creates more pain and more inflammation. So what are the culprits? These are the post glands, these are the inflammatory mediators, and they have a few different functions and some of which we've already talked about.

So we've talked about them sensitising the nerves to pain and we've talked about them stimulating the immune cells to cause an inflammation. They also initiate blood clotting, so again, if you've got a cut in the barrier of your skin, they will rush into the area to hopefully stop you from losing your lifeblood. They will also constrict or dilate blood vessels, and this is to do with again either stopping the blood flow to the area by constricting them or dilating them in order to flush out any pathogens that might potentially be in that area.

They also stimulate your hypothalamus to increase your body temperature, and this is to do again with any pathogens that might be in your system through the cut in the barrier of the skin. To stop anything from getting any further than it should. So these will hopefully kill off the pathogens that are already in your bloodstream.

And lastly but not least, they produced protective mucus in your stomach. Now this doesn't seem like a very helpful thing to do, and but it is quite important one and we can come back to a little bit later on. So we're gonna go through the mechanism of how these prostaglandins are produced.

Now I know this is a really wordy slide, so there is a diagram on the next one, so just bear with me. So we're gonna talk through it together. The immune cells convert the cell membrane, their phospholipid bilayer into a radonic acid.

This is then helped by an enzyme called cyclooxygenase, often abbreviated to COX. And this is a really important one, you're gonna need to remember that. And they produce prostaglandin H2 and from then prostaglandin E2 and prostaglandin F2.

Now this is the diagram that I was talking about earlier, so it is a little bit small I do apologise for that. So at the top there you put your phospholipid bilayer, obviously bio meaning two layers of phospholipids. They then convert into a radonic acid.

Helped by cyclooxygenase to make prostaglandin G2, prostaglandin H2, and then the bottom there, prostaglandin E2 and F2. Now as I said that the kids do and how anti-inflammatory mediators, it's not just about prostaglandin E2 and prostaglandin F2, but the others aren't as important as what we're gonna talk about today, but they do play a role. So it is important to, if you are interested to read around those.

So the enzyme responsible for making these prostaglandins, which we've talked about already is cyclooxygenase. Now, this is what's most important when we're talking about NSAIDs, when we talk about non-steroidal drugs and such as Ricca. So there's two different types of cyclooxygenase COX 1 and COX2.

Now they are named the same thing, but they do very different things in the body. So COX one maintains homeostasis. Now again, we're going back to GCSE biology here.

Homeostasis is the housekeeping of the body. It keeps your blood pressure where it should be. It keeps your body temper where it should be, everything ticking over exactly the way it should be for you to live your normal life.

So COX one derived prostaglandins, they promote a few different things. Most top of the list is secretion of protective gastric mucus, regulation of gastric acid. Promotion of platelet aggregation and maintenance of renal blood flow.

Now they sound like all different systems and they are but when we come back to what NSAIDs do and how NSAIDs are used, then they are important when it comes down to coxswa. Cox too do very prostaglandins are actually only do very different things in the body or trauma. So CO2 dry prolandins cause pain, inflammation and fever.

Now that sounds like it wouldn't be very helpful at all. But if we have an injury, we need the pain, the inflammation, the fever to start the healing process and also stop us from doing any further damage, so it is very useful. COX 1 is active at all times in your body, whereas COX 2 is only active when there's injury or trauma.

So why am I telling you all this? Well, so when we're talking about NSAIDs and what they do, they can be quite a few side effects from NSAID. We don't like to call them side effects, more adverse effects from NSAIDs, and that is often to do with the gastrointestinal system and also our kidneys.

So, Just popping back to when we were talking about the functions of prostaglandins here, we did talk about them producing protective mucus in the stomach. That is one of the main functions of prostaglandins. So, Quite a lot of our NSAIDs are what we refer to as CO2 selective, which is unfortunate because there's not many COX2 specific NSAIDs, so they will attempt to only stop COX 2 enzymes.

However, they will sometimes get COX 1 because they find it hard to distinguish between the two. So they are selective. They will select COX 2 enzymes, but not necessarily specific to getting just those.

So what happens is when we give an NSAID, so if in a human case something like ibuprofen in animal case something like meloxicam, we are potentially stopping those COX one prostaglandins from happening. And the problem here is, is that we can get these adverse effects. So if we are stopping COX one pros glandins, they can stop the secretion of protective gastric mucus.

And also, It deregulate or make irregulation of gastric acid. Now what happens here is, is that you've got less protective gastric mucus and potentially more gastric acid. That's gonna give you potential gastritis or stomach ache at the very least, and you'll know yourselves if you do take an ibuprofen on an empty stomach, it, it does give you a bit of stomach ache because you've got less attractive mucus and more gastric acid.

What happens is that COx one prostaglandins will promote platelet aggregation, so they will promote blood clotting. This isn't really too much of a problem we need to think about when it comes down to giving NAIDs to to animals or humans, but it is important to remember that if you have got an animal that already has a clotting issue, giving them an NSAID might exacerbate that. And also maintenance of renal blood flow.

So that's really important. If you think about your kidneys and how much blood and at high pressure is going through them kidneys at any one time, we want to keep that really well maintained. We want to keep that the same level all the time, otherwise we're gonna cause kidney injury.

If we're stopping these COX one prostaglandins from maintaining that renal blood flow, then we can cause nephritis or acute kidney injury or later down the line potentially kidney failure if we're doing it concurrently, if we've got a really long term use of it. And this is the reason why we do check the animals that have been a long term meloxicam for kidney values. We take blood tests, and we make sure that they are, they're doing OK on it, and if they start to deteriorate, potentially bring them off it.

And it's the same for you if you had adverse effects if we have an animal that comes in with vomiting or diarrhoea or gastric bleeding or potential gastritis, stomach ulcers, this can all be related to meloxicam as well so. NSAIDs as well. So that is quite often why we will say me as a nurse would say if you get an owner ringing up saying we've got an animal with vomiting and diarrhoea and they are on something like meloxicam will say stop the meloxicam because that's gonna exacerbate the issue.

So why am I giving you all this information? So those final products, the prostaglandin F2 and E2 are causing the fever, pain and inflammation. And what we want to be doing is inhibiting these with an effective pain relief medication.

So that leads me really nicely on to what is an NSAID. So NSAID stands for nonsteroidal anti-inflammatory drug, and it's any drug with the anti-inflammatory properties that is not a steroid, hence the name nonsteroidal. So these represent the most extensively used drugs of all time.

So in humans it is estimated over a million aspirins are taken every hour globally. I know that's across the world but still quite a lot of aspirins being taken, and they are really effective, they do the job and that's why we use them so much. So it's really extensively used in humans, really extensively used in veterinary.

Three main functions with an NSAID, analgesia, so preventing pain. Anti-inflammatory, reducing inflammation and antipyretic, so reducing that fever. And this is all to do with stopping those prostaglandins from doing their job.

So as I said before, there are a lot more inflammatory mediators that I haven't talked about in this presentation and because they're not directly related to NSAIDs, but they are worth knowing about. So there is a really informative video on YouTube called Pharmacology nonsteroidal anti-inflammatory drugs. The the guy that taught us this is absolutely brilliant.

He writes it all down, he talks you through it and it's very informative, and he is based on a human, but the the skills can be extrapolated. So it's really easy to follow if you want more information, then please do look that up. It's really interesting.

So that brings me on to the introduction to the room can range, and which we're gonna talk about obviously we have a whole range for small and we have got some large animal products as well. So it is worth knowing that we, you know, we can cater for large and small animals with this range. So introduction to the room camera we've got a brief overview here of of what we do cover.

So as you can see we've got available for dogs in the liquid oral in 4 different sizes, 2 sizes for the dog chewable, and then we have a small animal injection as well. New in and the newest product to join this range is the cats so we have the small animal injection and we also now have two sizes in the cats oral for our feline friends. We also have cattle and pigs who have a large animal injectable for those.

And then lastly we have an equine range too so we have our large animal injectable for equine range and then we also have 3 sizes of our equine oral. So again, active ingredient is meloxicam. We have it in a lot of different formulations and the presentation is a pale yellow liquid for the oral and the injectable and a pale yellow single scored chew tablet for the dogs, which can be split if you needed to because it is single scored.

So talking about the dog oral and again we've got it in 4 different sizes 15 mL, 42 mL, 100 mL, and 200 mL, and we have the 1 milligramme and 2.5 milligramme chewable tablets in packs of 100 and like I said, these are single scored, they can be split down if need be. So the strength of this is not 1.5 me per mL.

And this would be an initial dose of 0.2 meg per kg and then a maintenance dose of 0.1 meg per cake and this initial dose can be given either by oral which in case you give a double dose or you can give an injection and then carry on with the oral 24 hours later and I think this is the general consensus that if you had, an animal came in, for example, for lameness, and it was something like a soft tissue injury, then potentially we can give them an injection and then 24 hours later the owner can carry on with the oral room can dose.

I think that's generally the way that a lot of veterinarians do it, but there is a choice there if you wanted to give the double dose of the oral to start with, you can do. So what we have created is how long my bottle of Ruca oral dog will last and we have this for dogs and cats. This is just a little bit of a cheat sheet so that if owners come in and say, well, how long will this bottle last me you can tell them quick look how long a bottle lasts you.

So if you had a 25 kg dog and you gave them a 100 mL bottle, it would last them approximately 9 weeks. So there are some asterisks here. The first asterisk would be that this is all a maintenance dose, so we're not taking into account that double dose.

If you are giving one it is all based on a maintenance dose. And there is the double asterisk as well, just to say that this length of treatment with that size bottle will surpass the shelf life for this product once the immediate packaging has been opened. So for example, and it would be quite rare that you did this, if you were to give a 5 kg dog a 100 mL bottle, it would last them 43 weeks, and that is a very long time that is over the time allocated to that shelf life that product and once it's been opened and also it's just a little bit of an extra tool in your tool kit.

So that you can see the animal back again as we said before, we want to be checking their kidneys and we want to be seeing this animal to see firstly, have we got any adverse effects, and secondly, is the product working? Are they getting better? Is there something else underlying that we're missing here because the last thing we want to be doing is sending a 5 kg dog away for 43 weeks and the product not make the animal any better at all.

So it is worth just keeping an eye on that, especially for those bigger dogs that were potentially gonna have to see a bit more often as well. So again, 15 kg if you gave them 200 mL bottle 28 weeks, so they just passed the time, we ideally want to be seeing them again before the 28 week point definitely. And I said this is available in dog and cat, so we've got these cheat sheets available for you.

So like I said earlier, this is our newest addition to the range which is our cats oral. It's available in 55 mL and 15 mL and the strength is 0.5 mg per mL.

So the dose rate would be postoperatively 0.05 meg per cake, which is a 1.1 mL per kilogramme.

And if you have an acute or chronic musculoskeletal disorder, you can again double it well on this will be a quadruple dose on the first day, so 0.2 mg per cake on that first day and then drop down to a maintenance dose of 0.05 mg per kg, as long as that acute pain and inflammation persists.

Again, for chronic pain, we want to be reassessing at regular intervals, especially with our cats because the the kidneys are something that, our cats do struggle with. And if it is a cute again, we want to be checking it's working. So, like I said, we can do this both ways round if you wanted to give a quadruple dose of the oral on the first day, you can, but it's probably easier to give a dose of the small animal injectable and then move on to the oral maintenance dose.

It just makes it a bit easier for the owner and for the vets and the last thing we want to be doing is telling the owner to give a quadruple dose and then then give it. For the foreseeable and rather than dropping down to a maintenance because they didn't quite understand how it works. So again we've got the injectable as well for our small animals and this is available in bottles and this is a dose rate of 0.2 meg per cake for dogs and 0.3 me per cake for cats.

And the strength of this is 5 meg per mL. So for equine is available in the oral solution of a 100 mL and 250 mL and the strength here is 150 mg per mL. And the dose rate would be 0.6 me per cakes that works out 1 mL per 25 kg.

This has got a withdrawal for those occasions where we we are potentially send the animal slaughter and that is 3 days. And like I said, we have got the large animal injectable as well and these are available in 100 mL and 250 mL and there are a few different routes of administration here so for horses it is IV cattle IV or subcutaneous and for pigs it would be IM. The dose rates again are slightly different, but they're all on here, so 0.6 meg per cake for horses, 0.5 meg per cake for cattle, and 0.4 me per cake for pigs.

And then the withdrawal period for cattle meets 15 days, milk 5 days, pigs meet 5 days, horses meet 5 days on the injectable. So that leads me on to the frequently asked questions and these are just some ones that we have answered a lot and it's definitely worth popping into our presentation just because it is something that crops up quite often. So the first one does roomca differ clinically from any other meloxicam formulation?

No, it's the same. The active ingredient is meloxicam, and the strength of each product is equivalent to that of the brand leader. So it's exactly the same as all the meloxicams that you have been using.

Is there any supporting material for the room range? Oh my God, there's loads of supporting material. So there is a cheat sheet detailing how long a bottle of Rumica dog and cat oral solution will last at different doses that I've already talked about with you that is based on all the different bottle sizes and a few different weights for the animals.

I think it goes up to 50 kg, but it is I'm able to work out from there. We have a full set of data sheets in PDF formats. We also have a rumour camera vet brochure, which is our newest addition as well to this range we've got the entire vet brochure there.

We've got a full range of pack shots and product image what is an NZ. So have product information leaflets in PDF format for the chewable tablets and this is for your dispensing and it's quite possible that for the chewable ones they come in packs of 100, it's quite possible you'll be breaking them down into smaller packs and you can get the product information leaflet to pop into your new box to send away with your owner. We also have a live CPD or pre-recorded video as you're listening to now.

And probably the most important supporting material is our territory managers and we have a wide range of territory managers for your area and you'll be able to get in touch with them. They have a very wide skill sets and they will be able to help you out as much as they can. Can rumour cam be used in rabbits and guinea pigs?

So the roomca small animal range is licenced for cats and dogs only. However, the strength of the dog oral solution, the cat's oral solution, and the Romaca small animal injection are equivalent to that of the brand lead in meloxicam. Therefore, whatever current practise protocol you have in place at the moment may be continued using the Rumica range.

So this one is for the eagle eyed vet nurses that have been contacting me about this one. So with regards to treatment of cats, the rumorca injectable SPC, so the data sheet doesn't mention follow up treatment with roomca or solution. This, however, is stated dogs and why is this?

So on our SPC it says that you can follow up the treatment of oral solution for dogs with the follow up the treatment of the injectable with the oral solution for dogs. However, when it gets the cat part, it doesn't say anything. It doesn't contraindicate it, it just doesn't say anything at all.

And this is because the roomca cat or solution is a brand new product, and therefore the roomca injectable SPC has not yet been updated following the launch of the new cat brand. So despite this, you absolutely can prescribe Lumica cat oral solution following administration of roomam injectable. It would just start 24 hours later, exactly the same as how you would do it with a normal brand leading and meloxicam.

Is the cat swinge in mil rather than kilo? Yes, it is in line with the SPC. The cat syringe is laid out in units per mL.

So the dosage for this is very simple to relate to cat pet owners and the dose rate is 0.1 mL per kilogramme. So for example, if you had a 3.5 kg cats, they would require 0.35 mL of room.

We have currently got a string variation in progress and we do listen to feedback and we do absolutely understand that it can be a bit confusing change between brands and if the syringes laid out slightly differently. So we are in the process of making the syringes into kilos rather than meals. It will be the same dose rates so it won't be too difficult to explain, but it just makes it a little bit easier for pet owners.

Will there be a cat or small mammal injection in development, so there are no plans to develop a sole cat injectable or a small mammal licenced injectable. However, you can, Use the 5 mg per mL injection is licenced for both dogs and cats and you can get the 2 mg per mL injectable from other suppliers but we, we currently don't have anything licenced for small animals. Small mammals, sorry.

And we've also asked the two dog syringes are different and how do we use them? So yes, they are different and for the largest syringe, the dose is red on the clear ringe barrel like a normal syringe and and for the smallest syringe it's red on the plunger. So, what I often used as a nurse is that if you had owners that were struggling with this or they were struggling to tell where they needed to draw the ring up, you can get a marker or a sharpie and and you can mark these for the customers so you can be marking on the on the outside.

OK, you need to give 8 8 kg on here and just mark it on the 8 where they need to draw up to, especially if you've got those owners that are maybe a bit elderly or short sighted. And the same on the smallest range. What I would also potentially do, just as an extra tip or trick from a vet nurse, if you are giving these bottles out to a smaller dog and they were not gonna need the big syringe, take the bigger syringe out of the box.

One, it makes it a bit easier for owners to to understand what's going on. And they will obviously only use the smallest range, it just saves a little bit chance of overdosing. And you can also create yourself a little stash of big and small syringes in that way.

Again, if you have a 40 kg dog and that you give it to take the little syringe out because they're not gonna need it. And create yourself a little stash, create yourself a little drawerful, and then when it only comes to you and say they've lost their syringe, dogs eating it, they've chucked it in the bin, you can give them one of the syringes out of your little stash. So it's just a little bit helpful to create your first little stash of those.

And lastly for product support and technical queries, who do I speak to? So you can reach out to the territory managers on your area. So we have a set of 5 territory managers for the UK.

And we are all very happy to speak to you and you can see briefly from this map who is your territory manager. If you don't know who it is, then please do contact Chanel and we can tell you who it is alternatively, if you have any technical queries, you can always talk to me directly my email and my mobile are on here for you and for you to give me a ring if you need to. So that brings me to the end of our roomca CPD and I hope you've enjoyed it and I hope that it's been a bit informative for you.

So if you have any queries or have any questions, you can definitely reach out to the territory manager or you can reach out to me and we'll do our best to help. Thank you ever so much for listening and have a great day.