Today's Veterinary Practice

SEP-OCT 2015

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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September/October 2015 | tvpjournal.com FRACTURE MANAGEMENT Peer Reviewed 30 IN SUMMARY The last article in this series, available in an upcoming issue of Today's Veterinary Practice, will discuss the various types of internal fxation methods for fracture management. ESF = external skeletal fxator; ILN = interlocking nail ; IM = intramedullary References 1. Meeson RL, Davidson C, Arthurs GI. Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. Vet Comp Orthop Traumatol 2011; 24:126-131. 2. Welch JA, Boudrieau RJ, DeJardin LM, Spodnick GJ. The intraosseous blood supply of the canine radius: Implications for healing of distal fractures in small dogs. Vet Surg 1997; 26(1):57-61. 3. Lappin MR, Aron DN, Herron HL, et al. Fractures of the radius and ulna in the dog. JAAHA 1983; 19:643. 4. Waters DJ, Breur GJ, Toombs JP. Treatment of common forelimb fractures in miniature and toy breed dogs. JAAHA 1993; 29:442. 5. Griffon DJ. Fracture healing. In Johnson AL, Houlton JE, Vannini R (eds): AO Principles of Fracture Management in the Dog and Cat. New York: Thieme Medical Publishers, 2005. 6. Budsberg SC. Osteomyelitis. In Tobias KM, Johnston SA (eds): Veterinary Surgery, Small Animal, 1st ed. Philadelphia: Elsevier, 2012. 7. Kraus KH, Bayer BJ. Delayed union, nonunions, and malunions. In Tobias KM, Johnston SA (eds): Veterinary Surgery, Small Animal, 1st ed. Philadelphia: Elsevier, 2012. MEREdITh KAPLER Meredith Kapler, DVM, is a small animal surgical resident at North Carolina State University. She has presented at the Veterinary Orthopedic Society Conference, instructs veterinary students, and contributed to research articles and a book chapter. She received her DVM from Uni - versity of Tennessee, completed a small animal intern- ship at Virginia–Maryland Regional College of Veterinary Medicine, and completed an orthopedic research fel - lowship at University of Tennessee. Upon completing her residency, she will work as a staff surgeon at Veterinary Specialty Hospital of the Carolinas. dAVI d dYCUS David Dycus, DVM, MS, Diplomate ACVS (Small Animal), is a staff orthopedic surgeon at the Veterinary Orthope - dic & Sports Medicine Group (VOSM) just outside Wash- ington, D.C. He has presented at national meetings and has lectured second- through fourth-year veterinary stu - dents. He has published an array of research articles and a book chapter. Dr. Dycus received his DVM from Mis - sissippi State University, completed a rotating internship at Auburn University, and completed an MS and small animal surgical residency at Mississippi State University. CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Description: NexGard ® (afoxolaner) is available in four sizes of beef-favored, soft chewables for oral administration to dogs and puppies according to their weight. Each chewable is formulated to provide a minimum afoxolaner dosage of 1.14 mg/lb (2.5 mg/ kg). Afoxolaner has the chemical composition 1-Naphthalenecarboxamide, 4-[5- [3-chloro-5-(trifuoromethyl)-phenyl]-4, 5-dihydro-5-(trifuoromethyl)-3-isoxazolyl]-N-[2-oxo-2-[(2,2,2-trifuoroethyl)amino]ethyl. Indications: NexGard kills adult feas and is indicated for the treatment and prevention of fea infestations (Ctenocephalides felis), and the treatment and control of Black-legged tick (Ixodes scapularis), American Dog tick (Dermacentor variabilis), Lone Star tick (Amblyomma americanum), and Brown dog tick (Rhipicephalus sanguineus) infestations in dogs and puppies 8 weeks of age and older, weighing 4 pounds of body weight or greater, for one month. Dosage and Administration: NexGard is given orally once a month, at the minimum dosage of 1.14 mg/lb (2.5 mg/kg). Dosing Schedule: NexGard can be administered with or without food. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes to ensure that part of the dose is not lost or refused. If it is suspected that any of the dose has been lost or if vomiting occurs within two hours of administration, redose with another full dose. If a dose is missed, administer NexGard and resume a monthly dosing schedule. Flea Treatment and Prevention: Treatment with NexGard may begin at any time of the year. In areas where feas are common year-round, monthly treatment with NexGard should continue the entire year without interruption. To minimize the likelihood of fea reinfestation, it is important to treat all animals within a household with an approved fea control product. Tick Treatment and Control: Treatment with NexGard may begin at any time of the year (see Effectiveness). Contraindications: There are no known contraindications for the use of NexGard. Warnings: Not for use in humans. Keep this and all drugs out of the reach of children. In case of accidental ingestion, contact a physician immediately. Precautions: The safe use of NexGard in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures (see Adverse Reactions). Adverse Reactions: In a well-controlled US feld study, which included a total of 333 households and 615 treated dogs (415 administered afoxolaner; 200 administered active control), no serious adverse reactions were observed with NexGard. Over the 90-day study period, all observations of potential adverse reactions were recorded. The most frequent reactions reported at an incidence of > 1% within any of the three months of observations are presented in the following table. The most frequently reported adverse reaction was vomiting. The occurrence of vomiting was generally self-limiting and of short duration and tended to decrease with subsequent doses in both groups. Five treated dogs experienced anorexia during the study, and two of those dogs experienced anorexia with the frst dose but not subsequent doses. Table 1: Dogs With Adverse Reactions. 1 Number of dogs in the afoxolaner treatment group with the identifed abnormality. 2 Number of dogs in the control group with the identifed abnormality. In the US feld study, one dog with a history of seizures experienced a seizure on the same day after receiving the frst dose and on the same day after receiving the second dose of NexGard. This dog experienced a third seizure one week after receiving the third dose. The dog remained enrolled and completed the study. Another dog with a history of seizures had a seizure 19 days after the third dose of NexGard. The dog remained enrolled and completed the study. A third dog with a history of seizures received NexGard and experienced no seizures throughout the study. To report suspected adverse events, for technical assistance or to obtain a copy of the MSDS, contact Merial at 1-888-637- 4251 or www.merial.com/NexGard. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/AnimalVeterinary/SafetyHealth. Mode of Action: Afoxolaner is a member of the isoxazoline family, shown to bind at a binding site to inhibit insect and acarine ligand-gated chloride channels, in particular those gated by the neurotransmitter gamma-aminobutyric acid (GABA), thereby blocking pre- and post-synaptic transfer of chloride ions across cell membranes. Prolonged afoxolaner-induced hyperexcitation results in uncontrolled activity of the central nervous system and death of insects and acarines. The selective toxicity of afoxolaner between insects and acarines and mammals may be inferred by the differential sensitivity of the insects and acarines' GABA receptors versus mammalian GABA receptors. Effectiveness: In a well-controlled laboratory study, NexGard began to kill feas four hours after initial administration and demonstrated >99% effectiveness at eight hours. In a separate well-controlled laboratory study, NexGard demonstrated 100% effectiveness against adult feas 24 hours post-infestation for 35 days, and was ≥ 93% effective at 12 hours post-infestation through Day 21, and on Day 35. On Day 28, NexGard was 81.1% effective 12 hours post-infestation. Dogs in both the treated and control groups that were infested with feas on Day -1 generated fea eggs at 12- and 24-hours post-treatment (0-11 eggs and 1-17 eggs in the NexGard treated dogs, and 4-90 eggs and 0-118 eggs in the control dogs, at 12- and 24-hours, respectively). At subsequent evaluations post-infestation, feas from dogs in the treated group were essentially unable to produce any eggs (0-1 eggs) while feas from dogs in the control group continued to produce eggs (1-141 eggs). In a 90-day US feld study conducted in households with existing fea infestations of varying severity, the effectiveness of NexGard against feas on the Day 30, 60 and 90 visits compared with baseline was 98.0%, 99.7%, and 99.9%, respectively. Collectively, the data from the three studies (two laboratory and one feld) demonstrate that NexGard kills feas before they can lay eggs, thus preventing subsequent fea infestations after the start of treatment of existing fea infestations. In well-controlled laboratory studies, NexGard demonstrated >97% effectiveness against Dermacentor variabilis, >94% effectiveness against Ixodes scapularis, and >93% effectiveness against Rhipicephalus sanguineus, 48 hours post-infestation for 30 days. At 72 hours post-infestation, NexGard demonstrated >97% effectiveness against Amblyomma americanum for 30 days. Animal Safety: In a margin of safety study, NexGard was administered orally to 8 to 9-week-old Beagle puppies at 1, 3, and 5 times the maximum exposure dose (6.3 mg/kg) for three treatments every 28 days, followed by three treatments every 14 days, for a total of six treatments. Dogs in the control group were sham-dosed. There were no clinically-relevant effects related to treatment on physical examination, body weight, food consumption, clinical pathology (hematology, clinical chemistries, or coagulation tests), gross pathology, histopathology or organ weights. Vomiting occurred throughout the study, with a similar incidence in the treated and control groups, including one dog in the 5x group that vomited four hours after treatment. In a well-controlled feld study, NexGard was used concomitantly with other medications, such as vaccines, anthelmintics, antibiotics (including topicals), steroids, NSAIDS, anesthetics, and antihistamines. No adverse reactions were observed from the concomitant use of NexGard with other medications. Storage Information: Store at or below 30°C (86°F) with excursions permitted up to 40°C (104°F). How Supplied: NexGard is available in four sizes of beef-favored soft chewables: 11.3, 28.3, 68 or 136 mg afoxolaner. Each chewable size is available in color-coded packages of 1, 3 or 6 beef-favored chewables. NADA 141-406, Approved by FDA Marketed by: Frontline Vet Labs™, a Division of Merial, Inc. Duluth, GA 30096-4640 USA Made in Brazil. ®NexGard is a registered trademark, and TM FRONTLINE VET LABS is a trademark, of Merial. ©2015 Merial. All rights reserved. 1050-4493-03 Rev. 1/2015 Body Afoxolaner Per Chewables Weight Chewable (mg) Administered 4.0 to 10.0 lbs. 11.3 One 10.1 to 24.0 lbs. 28.3 One 24.1 to 60.0 lbs. 68 One 60.1 to 121.0 lbs. 136 One Over 121.0 lbs. Administer the appropriate combination of chewables N 1 % (n=415) N 2 % (n=200) Vomiting (with and without blood) 17 4.1 25 12.5 Dry/Flaky Skin 13 3.1 2 1.0 Diarrhea (with and without blood) 13 3.1 7 3.5 Lethargy 7 1.7 4 2.0 Anorexia 5 1.2 9 4.5 Treatment Group Afoxolaner Oral active control

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