A new canine osteoarthritis medication, Librela (bedinvetmab), works on what part of the pain modulation pathway?
Correct Answer: B
Librela is a monthly injectable anti-nerve growth factor (NGF) monoclonal antibody (mAB) used in the treatment of osteoarthritis (OA) in dogs. It is similar to the Solensia drug that has been out a bit longer in the U.S. for cats. Benefits include only 1x monthly administration, rather than daily, and minimal to no effects on the liver/kidneys. NGF plays a key role in pain in animals with OA. This drug helps decrease NGF levels by binding to it, which reduces pain from OA, helps to limit further NGF release, and lessens the expression of pro-inflammatory mediators. This results in lowering the neurogenic inflammation component. COX1 and COX2 drugs are non-steroidal anti-inflammatory medications (NSAIDs), including carprofen, meloxicam, and deracoxib. They work on the inflammation portion of the pain pathway, but COX1 drugs are less selective and have more side effects than COX2 drugs. The NMDA (N-methyl-D-aspartate) receptors are part of the pain pathway, most notably understood in cases of central sensitization. Patients with chronic pain, over-activation of C-fibers, and continuous NMDA activation can lead to wind-up. Medications like amantadine (oral) or ketamine (injectable, in hospital) may help address wind-up concerns. However, this pathway isn't a commonly addressed path in the mainstay therapy of OA treatment in dogs. Mu receptors provide pain relief and are addressed by opioids, either as pure agonists (completely blocking the receptor), or as partial agonists +/- antagonists. This would include drugs like fentanyl and hydromorphone. However, while these drugs may be beneficial in acute pain conditions, they do not address inflammation, nor are they usually beneficial in the long-term management of OA. They may be used in the end stages of the disease as a part of multi-modal pain management. Still, due to the potential abuse on the human side, veterinarians tend not to prescribe this type of medication orally very often. It is most commonly used in the hospital.
Question 137
Stains are commonly used to evaluate various laboratory specimens. Proper storage is essential because many contain various dangerous components, including:
Correct Answer: B
There are numerous stains used in cytology, with multiple components. Some solutions are acidic, while others may be neutral or basic. Some contain aluminum cations, while others contain alcohol. The concern is alcohol, a highly flammable liquid, and other flammable liquids may also be present. Thus, proper storage in a flammable safe cabinet, with MSDS sheets for each stain type readily available in case of injury or exposure, is essential.
Question 138
Many general practitioners, not just oncologists, administer chemotherapeutic agents today. Care is needed when using these drugs, as many are possibly teratogenic, mutagenic, or carcinogenic. A chemo spill kit should be readily available for anyone using chemotherapy in their practice. All of the following should be provided in a chemotherapy spill kit except:
Correct Answer: D
Surgical gowns are insufficient for protection from chemotherapy agents, and a back-closing chemotherapy-resistant gown is necessary. Surgical gowns are not impervious and will not protect from spillage. Other components of a spill kit include: *Chemotherapy-specific gloves *Splash goggles *Face masks (ideally, respirators for many of the agents vs. simple surgical masks) *Disposable dustpan *Chemotherapy-specific sharps container *Chemotherapy spill sign *Hazardous waste labels *Absorbent, plastic-backed chemotherapy diapers *Chemotherapy non-spill, sealable, heavy-duty waste-disposal bags
Question 139
What is a common sign of impacted anal glands?
Correct Answer: D
Scooting or dragging the hind end is a common sign that the anal glands are either impacted or infected. Pets may scoot in an effort to empty the anal sacs or relieve the associated pruritus. Other signs of impacted anal glands include scratching, licking, and chewing the rear end. Pets may also scoot if they have irritation, parasites, or a perianal tumor. Diarrhea, vomiting, and increased gastrointestinal sounds are not normal signs associated with impacted anal glands. However, after an episode of diarrhea, it is not uncommon to see anal gland issues occur, since they are normally expressed with the expulsion of formed stool.
Question 140
Furosemide belongs to which class of drugs?
Correct Answer: B
Furosemide is a diuretic used to reduce fluid retention in patients with congestive heart failure. Other diuretics include spironolactone and hydrochlorothiazide. Beta-blockers slow conduction signals through the heart to slow heart rhythm. Drugs in this class include atenolol and propranolol. Calcium channel blockers also slow conduction signals through the heart to slow rhythm. Amlodipine and diltiazem are two examples of this class. ACE inhibitors modify RAAS (renin-angiotensin-aldosterone system) and produce vasodilation. They are commonly used to treat patients with congestive heart failure or high blood pressure (hypertension). Common examples include benazepril and enalapril.
