Well, again, I'm Doctor Jim Carpenter, professor of zoological medicine at Kansas State University. So welcome to this column vet 2021 webinar. Exotic animal medicine, as you probably know, is one of the most rapidly growing fields in veterinary medicine and it's rapidly becoming an integral part of most companion practises.
So this presentation Today it's gonna focus on the pharmacotherapeutics and exotic small mammal. And but much of this will still apply to some of the principles in zoo and wildlife as well. Among the most popular of the of the exotic mammals are genios.
We have here. And guinea pigs and hamsters and gerbils and rats, and of course, two of the most popular ones are ferrets and rabbits, and there's others as well. First, I just want to briefly review the concept of evidence-based medicine, because this is really a a very important concept.
So what is it? Well, it is the reasonable use of best evidence in making decisions about the care of individual patients, and it also integrates the clinical experience and patient values with really more client values with the best available research information. So, if you look here, we have patient values, but we really say it's client values and preferences, what they want in this circle.
Over here is clinical expertise that we might have, and here is, you know, best evidence. So this emphasises the the use of evidence from well-designed, well conducted research, and not just the beliefs of clinicians. So what are the the steps involved?
Well, first, it formulates a clear clinical question from a patient's problem. Secondly, then we, you know, search literature for relevant clinical articles, critically appraises the evidence for its validity and usefulness. And then Implements useful findings in a in a clinical practise, and finally evaluates the efficacy of this application on a patient.
So following these steps, these 5 steps, it will improve the patient outcome and the the the client's satisfaction. For example, one of the strategies is to reduce inappropriate antimicrobial use of medicine, you know, is to apply pharmacokinetic, pharmacodynamic, principles to dosage regimens and how do we do that? Well, we do that through, research.
And that's one thing that we do, . Quite a lot, here at, at Kansas State University. So on what evidence are exotic animal formularies based, for example.
Well, in other words, what's the basis for selecting dosages? Well, formularies are one of the clinicians most useful tools. It's something I use all the time.
I imagine most of you do as well. But inappropriate dosages can result in ineffective or dangerous treatments. There was a review of two formularies not too long ago, which contained dosages for reptiles, for example, and only 38% were derived from primary research articles and 15% were derived from pharmacokinetic studies.
So, it means that the others were taken, you know, probably from the literature or personal experiences as well. The evidence behind exotic zoo animal therapeutics, therefore is, is currently limited. So, more, you know, PK studies are needed, but they are very expensive and they're very, you know, time consuming as well.
So pharmacokinetic studies in in small mammals are lacking, especially when you consider the number of drugs that are available and the number of species that we can potentially work with. Most of the dosages are based on, empirical data, observations, and experience. But, but because, you know, drug uptake depends on age, sex, physiology, diet, disease, etc.
It's important for us as veterinarians to know some of the, pharmaco biologic physiologic, and anatomical characteristics of these species, because we seldom have the opportunity or the financial resources actually to perform these studies. And what happens if you use inappropriate dosage as well? There's no telling what can happen, but, because for some reason inappropriate dosages may end up in very dramatic ways.
This is actually uherzilla, in Japan, but maybe that's fake news. I'm not sure. So it's important to note that most drugs used in small mammals are extra labelled.
For example, in the United States, very few are approved by the US Food and Drug Administration for use in these animals. Also, in, in the US we have a A relatively new law, I suppose, and Duca, and that permits us to Use drugs that are used on on other animals or those that are approved in other ways like humans, so we can do that. And the reason I mentioned that is because I imagine many of you in your countries have similar, you know, legal standards that you have to follow.
And you can do that if the reasoning is sound, but this act act also requires that the owner sign a consent form for extra label use of of the drug. And I, as I say in, in most of my lectures, and this is really important to talk about drug dosages, it's essential, that you obtain accurate body weight prior to administration of the drug. So we really recommend frequent weighing, routine weighing of animals as well, because sometimes we can also use this as a as a response to treatment.
So administering drugs to exotic small mammals often requires different skills and protocols, than those that are used for dogs and cats, for example, because of the unique anatomy, physiology, and small size of the patients that we work with. So this presentation is gonna review some information about compounding, and we'll discuss some of the issues involved in selecting an antibiotic, analgesic, you know, NSAID and other drugs such as nutraceuticals and the other one I'll talk about is is is gabapentin. So we'll start with, you know, compounding, and we do a lot of compounding at in Kansas state without exotic.
It's an awful lot. So exotic animal practitioners face, you know, daily challenges to meet the, pharmacoceutical needs of their small patients. But because there's very few drugs that are actually approved for use in these patients, you have to be some, find some challenging ways to meet those the drug needs.
So one is, extra label use products, secondly is using pharmaceutical products that are Perhaps made in other countries for, and then thirdly is compounding. So what is compounding? Compounding is the act of preparing, mixing, assembling, packaging.
And or labelling of a drug as a result of a practitioner, patient, pharmacist relationship. So compounding is very useful when you're trying to medicate orally, especially, but it can be challenging, because again, there's very few approved medications for tests. And it brings some legal and some ethical issues as well, that the practitioner just needs to address.
In the United States, and I'm sure other countries it must be in compliance with established laws. So here it must be done by or order of a licenced veterinarian within a valid veterinarian client patient relationship. So it means you have to have seen the animal and worked with it and the and the and the client.
And it has to be from an approved human or veterinary drug. And it is prescription. So compounding pharmacies permit access to medications that have become otherwise unavailable.
And secondly, it provides valuable alternative formulations for medications. This is something very important that we have to do in in practise. It also allows a wider range of treatment options.
For example, some people are having transdermal gels compounded. We at Kansas State, have a lot of flavoured suspensions made for our exotic pets so we can get it, so the clients can get it home. But they're also very tightly regulated, certainly in the United States and I assume in all the countries as well.
And why is that? Because there's been a number of incidences as, as you probably know, where a number of animals have died, including in the United States, a large number of horses, one time died because of the drug that they were administered was compounded inappropriately. Now this is a poorly labelled drug and this is one that a client brought us from from their animal, so they're referring to that, that's how they did it.
Again, it's gonna depend on the laws in your own country, but here we have to have proper label and this again is very improper. When I first started talking a little bit on compounding, I started to look at the literature, look at the references, look at the journals, and I was just kind of amazed, how much is really involved in compounding and how much you really have to know. There's Journals, there's various books.
And all the references, and they're really quite interesting actually it's not only are we talking about compounding, but also, you know, some interactions with all the drugs that you have to be aware. So when you're compounding, you have to be aware of potential incompatibilities between active and non-active ingredients, and this takes training. And so that's why it's it's it's used in consult with with a trained pharmacist, and a small mammals, most compounded drugs are used at PO.
And in cases where animals refuse to take medication because of the taste, compounding drugs use various flavour additives. So some of the preferred flavours for rabbits, for example, a carrot. Banana.
Vanilla butternut, lettuce, which I think is crazy, . Because I don't think lettuce has any flavour, but. Maybe a rabbit does.
Pineapple, strawberry, parsley, and celery. And I can say from our experience that, you know, rabbits and actually most of our exotics prefer two of these flavours, and that is banana or or strawberry. So this is how they compound drugs here from pills.
And it looks like something from the 1800s, you know, a mortar and a pestle. We also use two other products. One is called, I can see, or Sweet, which is a sugar-free vehicle, and oral suspending vehicle called A Plus, and in your country, you may have different names for the product.
But Based on that, that's how you can get a good product and then you can add your flavouring and this one company I think makes over 100 different flavours, so it's really crazy. So these are again available commercial. So as an example, a number of years ago I did a research study on marvel floescent in rabbits.
We wanted to study the, the chronicco kinetic centre determine the dosage that would be optimum, and so our pharmacist, the compounding pharmacist, Did all the calculations and you know, you got 25 milligramme marble tablets, you got appropriate number of them and a certain amount of sterile water, you can see strawberry flavour or plus or sweet, and again, or plus is kind of extender or plus or sweet is a non-sugar sweetener. Get a total volume and then she gives it to us and the dosage, the concentration is 10 milligrammes per amount and that's what we're gonna ask for. So we went from a pill.
He Marmo to a liquid that is, as you can see is properly labelled. They directions, how to take care of it, and the concentration. So, very well done.
But there are some compounding concerns that you should be aware of. For example, an associate of mine that I worked with here, did an evaluation in the compounding drugs, comparing that with the FDA approved formulations for doxycycline, and they did that for when they initially got it in 21 days after storage. So they determined that the the drug content of the compounded doxycycline formulations for veterinary use and of the US FDA approved doxycycline formulations on days one and 21 days of storage.
So what did they actually determine? Were there any differences between one that's commercially made and one that was compounded? Well, there was in this case.
The FDA, so that is the approved commercial ones that you would buy, had acceptable content in both days 1 and 21, but the compounded liquid formulations sent out to three different compounding laboratories. One had only 50% of the amount of oxy, one had 52% and one had 85%. So you have to be aware that there are some potential limitations, .
And compounding and not all compounding. Companies, agencies are are the same, are the same quality. Antibiotics are probably the most commonly used medications in small mammal medicine, as you know, and because there's a lack of pharmacokinetic studies in these species, dosages are often empirical.
So it's helpful to, therefore know that the basic pharmacological features and the side effects of the drugs being used for maximum safety and efficacy. So this is just an example. Antibiotics are, are commonly used in rabbit medicine, and rabbits, you have to know a little bit about, they're herbivorous, right?
They have gram-positive and anaerobic intestinal microflora. So the antibiotic choices are somewhat limited because many of the antibiotics used, could, or potentially used, could suppress, you know, healthy, normal flora. You can get dysbiosis or disruption of the normal.
You can also get enteritis, enterotoxemia as well. So these are some of the the antibiotics that we should generally avoid in rabbits. Amoxicillin, amoxicillin clabalin acid, which here is sold as lavamox ampicillin, cephalosporins, clindamycin, erythromycin, vancomycin, penicillin.
The acronym is is PAC, but there's also some reports of some other antibiotics listed here, that they've had issues with, but sometimes it may be. No sea or duration related. So therefore, you know, oral use of many antibiotics is contraindicated.
Any of these species. But something like, you know, penicillin. Penicillin is, is occasionally used parentally and rabbit so, and we use it, with some frequency here that's used in the treatment of treponema very successfully, and that is rabbit syphilis.
And we use it in in some cases of pastoralosis, but we use it on a limited basis, and we always make sure that the clients are monitoring the use and what do we mean by that? Well, you got to make sure that the rabbit is still doing well, it's eating OK, and is passing normal faeces. So when using the antibiotic, always look for the signs of dysbiosis, OK, and that decrease appetite, decrease faecal production or the size of the faeces in these animals.
Relatively safe antibiotics, this is important to know, and rabbits are the chloroquinolones. We'll talk about that a bit, the sulfas, chlorinacol and metronidazo. And there's some others as in pro as well it's it's it's it's quite good, but these are the ones that are really considered relatively safe again, you still have to monitor them.
But, you know, very few antibiotics have really been evaluated for their effectiveness. So again, we have to still rely somewhat on empirical data. Antibiotics that do not cause problems such as those that are listed under normal usage can still cause issues, maybe diarrhoea or something else, when they're given in, in either large doses or given for, you know, prolonged periods of time.
So again, you never use any drug, certainly an antibiotic in these animals. You always want to make sure the client is monitoring the health of that animal well. Again, a couple of the drugs that we commonly use are Arofloxacin.
We've had very good success with that. We probably use it or abuse it too much, I would say, and metronidazole also. So both of these are compounded for use in .
Small mammals. So what are some of the considerations in selecting appropriate antimicrobial agents for the small mamm? Well, first, the patient's clinical and pathological condition.
In other words, what is the specific pathogen that you're concerned about? Are there any concurrent diseases that you need to be aware of? Secondly, what's the organ system involve?
You know, is it the GI? Is it respiratory? Thirdly, is the patient's nutritional and hydration status.
That's important. And then which ant antimicrobial agent is most effective? Ideally it would be based on culture and sensitivity, but sometimes that cannot be done for various reasons.
And then you have a choice sometimes of bacterial static versus bacterial cycle. With the latter being preferred when the immune system is not capable of destroying the organism or in cases of sepsis. You also have to consider the dose and the rate of administration of the antimicrobial.
For example, if you have a drug that is required. Twice a day, or you have another drug that's required to be used 4 times a day. Everything else is equal, you would go to the twice a day because you'll have better compliance, less stress on the animal.
You also wanna consider the, the appropriate tissue concentration, the MICs, which means, you know, the mean inhibitory concentration, for the pathogen that should be obtained if possible. Potential adverse effects, you're aware of that so you can relay that on to the client and then owner compliance, you know, it's good to demonstrate how to get these drugs. For example, the rabbit, will in the street in front of the client, we'll wrap them in a towel in most cases, so they make them a a burrito with their head out, but after a while sometimes they get used to some of these flavoured drugs and you don't even have to restrain them and they take it willingly.
Some recommended dosages for rabbits are are listed here in the next slide and but again inro is certainly one of them, and PO route is preferred. sub-Q is also used, certainly maybe initially, but whenever you use NO, you really shouldn't give an IM because it is painful and it can cause tissue necrosis, and you can give it some cue, but if you do it, it has to be diluted. So maybe it's, you know, 4 to 1 or whatever you want, 10 to 1 if you're getting fluids anyway, it doesn't matter, but, you do want to avoid.
So the chloroquinolone, such as the Ero are the most commonly used antibiotics in human and veterinary medicine, and that they do include the Ero the Cipro, and the marble. They're bacterial cyto, versus both, you know, gramme positive and Gram-negative pathogens. And the, the adverse effects that you might see in other animals like, affecting immature cartilage is generally minimal exotic animals and I think it's only maybe a few references that I have seen pertaining to that.
These are just some of the other drug, drug dosages used in rabbits. Again, the formularies will have most of these dosages, but Marbo, Cipro, trime from sulfa is a very good drug to use. Here in this country, we made for children too, and so we can just use that.
It's already a liquid, it's flavoured and it's very inexpensive, so it is, it's something that we go through quite commonly, chlorin finacy. Also very good, but it does have some human health considerations as you know. Metronidazole, depending on the organism you're after and, and the zipro is also another good one and they depend on, on the, you know, disease or the, the issue you're trying to address.
So, you know, TMS is is so I try not to . This is a pill. We don't usually use pills and sounds.
They don't take them well, but there are liquid formulations as I just described. So TMS is a potentiated, it's bacterial cyto broad spectrum, low cost. And then, you know, chloro again I know human health concerns and more difficult to obtain in this country.
And then you know Cipro for example is also good. Now rabbits have a kind of a unique characteristic that they produce granulomatous abscesses, you know, caseus pus, which is impenetrable for most antibiotics. So in these cases where you have abscesses, it really requires excision and you know, antimicrobial therapy and maybe for for long periods of time.
1421 days, and maybe even longer. How about some of the antibiotics used in rodent medicine. It's inappropriate antibiotics, you know, raco the spectrum that these can result in you knowitis, antibiotic associated clostridial, you know, toxaemia.
Especially if they're administered poorly, and for example, chinchillas and guinea pigs, well, they are hindguts, hamsters, on the other hand, they, they have a distinct, for stomach with microorganisms. So you have to be aware of that. The antibiotic associated clostridial inotoxemia often occurs following the administration of these antibiotics, and these are pretty similar to those in rabbits, basically.
Also, in general, the antibiotics that you can that you can safely use in rabbits are generally safe for, for rodents, especially for the guinea pigs and chinchillas, which are the, you know, the, the hindgut from, you know, similar to, to a rabbit. So for dosages that you might want for other species like the ferret and the rodent, it just, you know, refer to an appropriate formula. So that's a little bit of a discussion we're gonna move down to analgesics.
This is also very important, and why is that? Because small mammals are increasingly considered to be part of the family unit rather than just a a possession. And more clients expect appropriate pain relief and they often requested actually, and veterinarians are more proactive in providing pain management and say that you know they were 20 or 30 years ago.
I remember when I went to Oklahoma State University we were working on a on an orthopaedic case and a dog and philosophy at least with this one was not to keep them on analgesics very long because they said, you know, having some pain is good so that way the animal would be moving less and it can feel more rapid. You know those philosophies have changed now. We do want we still want, don't want them to move a lot, but the ways of doing that are.
Discomfort or pain. So again, philosophies have changed. So the indications for analgesia.
Well, first, you know, post-surgical, post trauma, chronic pain. This is a good indication. Secondly, it reduces stress and stress-related disease like, you know, gastric ulcers, and promotes healing at a more rapid return to normal behaviour.
That can result in smoother recoveries. You know, following you, anaesthesia. And a preemptive analgesia may reduce need to for analgesics postoperatively.
So As you know, the administration now of analgesic drugs during, you know, pre-medication is now the standard in performing painful procedures. So assessing pain in small mammals is often difficult and requires knowledge of normal behaviour, which can be compared to their postoperative or post-trauma conditions. So it's always good to have some behavioural background in the species you're working with, and then you can get a better idea if they, you know, appear to be having pain.
Well, what are some of the signs of pain you might see? There may be subtle changes in activity level, and again, oftentimes this will be told to you by the client. Shifting of the body.
Position can indicate discomfort. Vocalisation may occur, roxy and hyper salivation, well, this is relatively common as well. Decreased appetite, and a lack of grooming may also be seen.
Now again, you often have to rely on, on the client's observation because they know the animal better than you are, and also sometimes in your presence, they may not be showing these signs as much as they would be at home. This identify this happens to be a beaver that we're working. Which is a rodent.
So, pain management in small mammals can be very challenging, and the point is that, well, as we said, there's a lack of approved products. Now you have a potential for some adverse drug reactions. Some difficulties in long-term drug administration.
And including compliance. And finally, you know, difficulty in in determining drug efficacy and stoic animals, sometimes it's hard to tell if you're getting much response if they may not be showing much, much pain initially, although you can imagine that they probably are in pain and discomfort. So rabbits and rodents ignore at the bottom of the food chain, and if these animals showed signs of disease or pain, they'd be more likely to be taken by a by a predator.
So therefore signs of pain may be subtle in some species. Pain management generally requires multimodal drug therapy, so that is using various drugs concurrently. So opioids and NSAIDs are two of the most commonly used drug classes.
And they can be used alone or they can be used in combination. And they can be also supplemented with neurceuticals and maybe some algebra analgesics. So the first one that we're gonna talk about is just opioids in general, the ones we most commonly use here.
And I, I assume probably I'm available in all of your countries as well, is a buprenorphine, borrenol, and tramadol. The pentadol is kind of a novel opioid drug, which is Potential. I've used it some.
I've done a research study on it as well. And also, hydromorphine and oxymorphine. Somebody's morphine in general as well.
For the NSAIDs, meloxicam is certainly the most popular, carprofen, ketorofen, fluixin occasionally, and then a potential one is mabioxin which we will. Talk about because it's only available in Europe at this point. So some some comments on the opioids.
They produce both central and peripheral alleviation of pain. They are some advantages. They're efficacious, they're safe, they're reversible, really very good.
And of the opioid receptors in small mammals, the new receptor is the most important in pain control. So although opioids provide the most effective analgesia for most types of pain, they can cause sedation. They can be difficult to prescribe for home use.
Potent e agoists such as morphine, hydromorphine, oxymorphine can cause a respiratory depression. So opioids, you know, they are, you know, they have effects on the cardiovascular system, and but they can be variable, and it depends on the species. For example, they can cause hypotension in ferrets and rats, but at the same level, they can cause hypertension in rabbits and mice, so they may be, you know, species that sort of.
You And they can also cause ileus in some species like the rabbit, but it would have to really be in most cases for prolonged use because short term use of opioids, most people think doesn't really have really any significant effect on GI. That's the reason we can't use it when we have GI stasis at least initially. Borphenol and and buprenorphine are used very commonly here, but they're synthetic opiate partial antagonists, they're also called mixed opioid agonist antagonists.
They're the most common opiates used in, in small mammals, and they have fewer side effects than other opioids, so that's that's positive. They have mini minimal respiratory effects and no significant central nervous system. Depression.
So this is broil, and bornil can come as pills and injectable. This is buprenorphine, and buprenorphine is is only injectable and it comes in a one use capsule and it's very expensive in contrast to the . But a buprenorphine in some species, they've had some luck just putting on the mucus membranes and having some absorption.
So that's another another way of of use. Bornol acts mostly at the kappa and the sigma opioid receptors. They're 4 to 7 times more potent and analgesic than than morphine, for example.
They have a faster onset though, and shorter duration than buprenorphine. So therefore, some veterinarians will give you a born a bornil first, and then later on followed by buprenorphine, you know, 2 to 3 hours later for longer duration. And that's important to know that you can produce profound sedation in ferrets with you.
So at whatever levels you're using in most of your small mammals, but it's fine, but you have to use a lower level ferrets. OK Individual variability, species variability. Buprenorphine acts primarily the new receptors.
It's a partial new agony, so relatively long duration and in, you know, in contrast to retor, and remember there are more new receptors in mammals, so that that's an advantage. You can But it does take longer to to to kick in. It's 30 times more potent than morphine, and it exhibits many of the same actions as the opiate agonist.
And it has very few adverse effects. They rarely respiratory depression. There's also one that is commercially made, in this country probably available anywhere and it's a sustained release, form of morphine made by wildlife pharmaceuticals.
So some people have had some, you know, success on that as well. So this is the buprenorphine and this container has 5 amphills and 1 millilitre each. So it's, it's a one use and it is relatively expensive compared to the.
But again, it is a longer duration and a little bit more allalgesic effect. So for example, the snow hairs here, they aren't feeling any pain. They just have a little, you know, they're doing high five after the injection of so that'll be fine.
Toberjezic, also comes in pills. And again, it's, it's very handy, easier to get and . It is good as its world.
And we have tramadol, and now tramadol is kind of an atypical opioid, it's a central acting analgesic. So it's all you think that is popular despite minimal evidence to its efficacy. Some vets don't find it clinically useful.
Others less so. Because there is a kind of a weaker affinity for, for, for the new receptors. We do use it, but it's difficult to evaluate its efficacy.
So it's a wide variation in response, even in the same species. It's used for treating, you know, mild to moderate pain, you know, neuralgia or post-op pain. It may be useful when you say, you know, can't be.
It's only comes in in oral form. And again, the dosage can vary with the species, and certainly more research is needed on its dosing, on its efficacy, and on its safety. So it's unfortunate that we can't be discussing this in person because I'd like to know what your your experience is again we have some veterarians that that talk very highly but others are not sure these certain species it's having much of effect.
Well, the petadol is kind of another novel atypical opioid. It's there's limited information about its analgesic dose, efficacy and safety. We did one study on it here.
And we really did not. Accurately determines its dose. But this is supposedly is good for moderate to severe pain.
There was one study on castration in rapids and it had excellent efficacy for reduction of surgical and post-surgical pain. So that is very, very encouraging. So that may be a, an up and comer, again, it'd be interesting to know what your experience is with this drug, or even if it's available in the country that you live in.
Insaids are increasingly being used in exotic small mammals, most commonly used analgesics and veterinary medicine. It provides analgesia for pain from inflammation, such as arthritis, mental disease, but it's not considered adequate for treating severely. There's little information on safety.
And on appropriate dosages in these animals. It's off label use, of course, and some other characteristics they may have is, you know, antiyretic. Actions that may have some long duration actions, certainly some species like 12 to 24 hours, which is quite good.
Insays can cause gastric ulceration in some species. Somehow you suspect it and I'm not quite sure how you would do that, but if you did, some people have used, soro thing or if people are using it long term they they use that to protect the gastric cells in vitro. The potential adverse effects of using insays in animals includes, you know, vomiting, anorexia, depression, and diarrhoea.
So these are 4 of the most commonly reported signs. Less commonly are GI ulceration, which I have not seen, but I'm sure it probably has occurred some don't know. Renal failure, hepatic failure, and death.
So they're all, you know, potential issues, especially for long term use for the animals not being monitored. The, the, the insides are . Contraindicated animals that are pregnant, have hepatic renal disease, have GI ulceration, or in shock and have, you know, poor perfusion, for example.
Some recommendations for reducing adverse side effects of NSAIDs and animals include first, the the need for a good history and physical examination of the animal. You want to monitor the serum biochemistries. Especially if it's prolonged use, avoid concurrent use of other NSAIDs or steroids, so they're counterindicated.
And you wanna ensure that the patient is hydrated during in safe there. So prior to and periodically during the administration of the NSAID, monitor for GI have had and renal toxicosis. We'll get some blood work.
So some of that commonly use NSAIDs and small mammals are meloxicam, which is the most popular carrofen, which, we have used some, more in the past than we are now. Ketorofen, flunixin, which I really haven't used in a number of years, but I'm sure it's fine, but most people think it shouldn't be used for more than 3 days. Maleoxin, which we'll talk about, and that's In Europe.
And again you can see appropriate formularies for for the dosages. Meloxicam I, Medicare. It's an NSAID is some antipyretic actions, selected for COX to alleviate pain and inflammation.
It's used for osteoarthritis and postoperative pain. Most commonly, the most commonly used in sate in exotic mammals, and it's available in both oral and injectable forms. So it's increasingly used because of its relative safety, it's ease of administration, and its apparent efficacy, and it's available in the palatable liquid solution that is readily accepted, accepted by our small exotic mammals.
I'm not gonna go through all this, but it's just very interesting. This is a study that we did here on meloxicam in rabbits, and I told you it can be expensive and time consuming. Well in this particular study, we want to know what the dosage was in rabbits.
So we did 3 studies over 5 years. First time we did it at 0.2 Migs per kBO daily days.
And we determined that the 0.2 was too low. Secondly, then we went up to what we thought it would be, which was one made for you, and that appeared to be accurate.
Based on what we know about other species, dogs and humans. And then a lot of people are asking me, well, can we use it longer term. So then we did a study.
One day perk and did it for almost a month, and during that time we monitored blood work we did everything else activity, food consumption and . And as it turned out, we didn't have any adverse signs in these 6 animals. It doesn't mean you won't, in some other animals, but everything including our pathology is all them were were sacrificed and evaluated, and there were no, no abnormality, no lesions.
That just gives you an idea about how expensive and time consuming some of these studies are. Carrofen, is the, you know, also selective cos to. Activity somewhat commonly used for analgesia and exotic mammals available in both injectable and PO forms, especially you know dogs that used with osteoarthritis and postoperative analgesia.
So probably should use it with some caution since our understanding of the drug in small mammals is somewhat limited, but again, it is used with some frequency. Maleoxid is relatively loose available in Europe, used to treat pain and inflammation in dogs with a degenerative disease, but it's long acting. It may lack, you know, act as long as, as, as, 3 weeks or longer than a dog.
So it does have potential. However, the downside is like in use in a rabbit, once it's in the rabbit, it's there for that period of time. We don't know how long it's gonna be.
2 weeks or 3 weeks, but if there are issues. Yeah, but If there are no issues, and it's a real chronic problem, it may be good for in terms of owner compliance. And then gabapentin so gabapentin is an, is an analgesic.
It can also use it also, multiple uses, including treating chronic pain, commonly used to treat neuropathic pain that does not respond to NSAIDs. It's often a part of a multi-modal approach or can be used with NSAIDs and opioids. The dose, you start with, you know, 5 to 10 days perk.
Twice a day or you can increase it as needed, but there are no controlled studies published to demonstrate efficacy. So, we just did a study actually on gabapentin and but we did it in flamingos, so, . Kind of an interesting drug.
Some people think it's really helpful and a few other people that I know that are experts pain are not sure it's as good as some people. So again, you know, they depend on the species or the dose and one's experience. Nutraceuticals, these products either treat an existing condition or optimise its overall health.
Some veterinarians are enthusiastic about their use and actually advocate their use. Whereas others are more sceptical. Probably true for most of the vets.
Some of the products are mainstream like omega 3 fish oils. That's good, you know, you can arthritis, glucosamide, people have mixed results and. I think it's very effective others considered a minimal value.
So the benefits and risks of most of the neutraceuticals out there are are there unknown, and they're not, they're not monitored. And they can be, they don't have to be approved. So very few have been been both proven safe and efficacious, and most are currently safe but with unknown, so some may just be like.
So for formularies, there are several out there. There's an exotic formulary is also a formulary. What we call the pink book Sparraitson Ros clinical medicine and surgery.
So, these formularies, you know, go through the antimicrobial, anti-fungal agents, anti-parasitic, chemical restraint, anaesthetic, analgesic agents, ophthalmic agents, etc. And other species. So this is just kind of a brief overview of the common uhronco therapy in small mammals.
I hope it answers some of your questions or maybe it was a review for some of you, I hope, but I do thank you for attending. Again, I'm sorry that we can't all be there in person to have more interactions, more discussions, but again, good luck with the rest of the conference. So thank you very much.