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TOday'S VeTerinary PracTice | September/October 2015 | tvpjournal.com cOnSider ThiS caSe Peer reviewed 44 median survival time of 115 days (range, 13–1526 days). 7 Median survival times were 698 days for cats with moderately differentiated tumors, and 75 days for cats with poorly differentiated tumors. however, the survival times did not take into account the presence or absence of metastatic disease at time of surgery. in a more recent study, signs, such as dyspnea and pleural effusion, as well as evidence of metastasis, were shown to be associated with signifcantly lower survival times. 2 Chemotherapy Limited studies have evaluated the use of chemotherapy in cats with evidence of primary pulmonary neoplasia and metastatic disease. One case report documents management of a single cat that had a well differentiated pulmonary carcinoma and no evidence of metastatic lesions, using lobe resection and adjuvant therapy with mitoxantrone. 8 IN SUMMARY • Primary metastatic bronchial carcinomas can be difficult to diagnose and may present with lameness as a primary complaint, as opposed to respiratory signs. • consider lung-digit syndrome as a possible differential diagnosis for an older cat presenting for progressive single or multiple limb pododermatitis and lameness. • difficulties of treatment and prognosis should be considered during management. • The majority of cats diagnosed with metastatic primary pulmonary adenocarcinoma are euthanized due to continued lameness or nonspecific signs of disease, including anorexia, depression, and lethargy. cBc = complete blood count; Fna = fne needle aspiration References 1. Goldfnch dn, argyle dJ. Feline lung-digit syndrome: Unusual metastatic patterns of primary lung tumours in cats. J Feline Med Surg 2012; 14(3):202-208. 2. Maritato Kc, Schertel er, Kennedy Sc, et al. Outcome and prognostic indicators in 20 cats with surgically treated primary lung tumors. J Feline Med Surg 2014; 16(12):979-984 [epub ahead of print]. Table 3: Number of Cats* with Adverse Reactions Reported During the Field Study with CONVENIA. Active Adverse Reaction CONVENIA Control (n=157) (n=163) Vomiting 10 14 Diarrhea 7 26 Anorexia/Decreased Appetite 6 6 Lethargy 6 6 Hyper/Acting Strange 1 1 Inappropriate Urination 1 0 *Some cats may have experienced more than one adverse reaction or more than one occurrence of the same adverse reaction during the study. Four CONVENIA cases had mildly elevated post-study ALT (1 case was elevated pre-study). No clinical abnormalities were noted with these findings. Twenty-four CONVENIA cases had normal pre-study BUN values and elevated post-study BUN values (37–39 mg/dL post-study). There were 6 CONVENIA cases with normal pre- and mildly to moderately elevated post-study creatinine values. Two of these cases also had an elevated post-study BUN. No clinical abnormalities were noted with these findings. One CONVENIA-treated cat in a separate field study experienced diarrhea post-treatment lasting 42 days. The diarrhea resolved. FOREI GN MARKET EXPERIENCE : The following adverse events were reported voluntarily during post-approval use of the product in dogs and cats in foreign markets: death, tremors/ataxia, seizures, anaphylaxis, acute pulmonary edema, facial edema, injection site reactions (alopecia, scabs, necrosis, and erythema), hemolytic anemia, salivation, pruritus, lethargy, vomiting, diarrhea, and inappetance. For a copy of the Material Safety Data Sheet, (MSDS) or to report a suspected adverse reaction call Zoetis Inc. at 1-888-963-8471. STORAGE INFORMATION: Store the powder and the reconstituted product in the original carton, refrigerated at 2° to 8° C (36° to 46° F). Use the entire contents of the vial within 56 days of reconstitution. PROTECT FROM LIGHT. After each use it is important to return the unused portion back to the refrigerato r in the original carton. As with other cephalosporins, the color of the solution may vary from clear to amber at reconstitution and may darken over time. If stored as recommended, solution color does not adversely affect potency. HOW SUPPLIED: CONVENIA is available as a 10 mL multi-use vial containing 800 milligrams of cefovecin as a lyophilized cake. NADA# 141-285, Approved by FDA Distributed by Zoetis Inc. Kalamazoo, MI 49007 Antimicrobial for Subcutaneous Injection in Dogs and Cats Only CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: Dogs CONVENIA is indicated for the treatment of skin infections (secondary superficial pyoderma, abscesses, and wounds) in dogs caused by susceptible strains of Staphylococcus intermedius and Streptococcus c anis (Group G). Cats CONVENIA is indicated for the treatment of skin infections (wounds and abscesses) in cats caused by susceptible strains of Pasteurella multocida. CONTRAINDICATIONS: CONVENIA is contraindicated in dogs and cats with known allergy to cefovecin or to b-lactam (penicillins and cephalosporins) group antimicrobials. Anaphylaxis has been reported with the use of this product in foreign market experience. If an allergic reaction or anaphylaxis occurs, CONVENIA should not be administered again and appropriate therapy should be instituted. Anaphylaxis may require treatment with epinephrine and other emergency measures, including oxygen, intravenous fluids, intravenous antihistamine, corticosteroids, and airway management, as clinically indicated. Adverse reactions may require prolonged treatment due to the prolonged systemic drug clearance (65 days). WARNINGS: Not for use in humans. Keep this and all drugs out of reach of children. Consult a physician in case of accidental human exposure. For subcutaneous use in dogs and cats only. Antimicrobial drugs, including penicillins and cephalosporins, can cause allergic reactions in sensitized individuals. To minimize the possibility of allergic reac tions, those handling such antimicrobials, including cefovecin, are advised to avoid direct contact of the product with the skin and mucous membranes. PRECAUTIONS: Prescribing antibacterial drugs in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to treated animals and may increase the risk of the development of drug- resistant animal pathogens. The safe u se of CONVENIA in dogs or cats less than 4 months of age and in breeding or lactating animals has not been determined. Safety has not been established for IM or IV administration. The long-term effects on injection sites have not been determined. CONVENIA is slowly eliminated from the body, approximately 65 days is needed to eliminate 97% of the administered dose from the body. Animals experiencing an adverse reaction may need to be monitored for this duration. CONVENIA has been shown in an experimental in vitro system to result in an increase in free concentrations of carprofen, furosemide, doxycycline, and ketoconazole. Concurrent use of these or other drugs that have a high degree of protein-binding (e.g. NSAIDs, propofol, cardiac, anticonvulsant, and behavioral medications) may compete with cefovec in-binding and cause adverse reactions. Positive direct Coombs' test results and false positive reactions for glucose in the urine have been reported during treatment with some cephalosporin antimicrobials. Cephalosporin antimicrobials may also cause falsely elevated urine protein determinations. Some antimicrobials, including cephalosporins, can cause lowered albumin values due to interference with certa in testing methods. Occasionally, cephalosporins and NSAIDs have been associated with myelotoxicity, thereby creating a toxic neutropenia 4 . Other hematological reactions seen with cephalosporins include neutropenia, anemia, hypoprothrombinemia, thrombocytopenia, prolonged prothrombin time (PT) and partial thromboplastin time (PTT), platelet dysfunction and transient increases in serum aminotransferases . ADVERSE REACTIONS: Dogs A total of 320 dogs, ranging in age from 8 weeks to 19 years, were included in a field study safety analysis. Adverse reactions reported in dogs treated with CONVENIA and the active control are summarized in Table 2. Table 2: Number of Dogs* with Adverse Reactions Reported During the Field Study with CONVENIA. Active Adverse Reaction CONVENIA Control (n=157) (n=163) Lethargy 2 7 Anorexia/Decreased Appetite 5 8 Vomiting 6 12 Diarrhea 6 7 Blood in Feces 1 2 Dehydration 0 1 Flatulence 1 0 Increased Borborygmi 1 0 *Some dogs may have experienced more than one adverse reaction or more than one occurrence of the same adverse reaction during the study. Mild to moderate elevations in serum g-glutamyl trans-ferase or serum alanine aminotransferase were noted post-treatment in several of the CONVENIA-treated dogs. No clinical abnormalities were noted with these findings. One CONVE NIA-treated dog in a separate field study experienced diarrhea post-treatment lasting 4 weeks. The diarrhea resolved. Cats A total of 291 cats, ranging in age from 2.4 months (1 cat) to 21 years, were included in the field study safety analysis. Adverse reactions reported in cats treated with CONVENIA and the active control are summarized in Table 3. January 2013 PAA035845A&P; (cefovecin sodium) Brief Summary of Prescribing Information Consider This Case continued on page 56