Once a diagnosis has been made and medical treatment is deemed necessary, safe and effective pharmacologic agents that exert the appropriate actions should be selected. A dosing regimen should be individualized for each patient. In addition to the route, which often is based on drug availability or convenience, a number of factors should be considered when designing a dosing regimen. These include host considerations that may alter the response to or disposition of the drugs. Adjustment in route, dose, or interval may be indicated based on host and drug factors. For antimicrobial drugs, microbial factors, including resistance, also should be considered. Finally, particularly for food animals, public health, environmental implications, and regulatory constraints must be considered.
Drugs that affect skeletal muscle function can be divided into several therapeutic categories. Some are used during surgical procedures to produce paralysis (neuromuscular blocking agents); others reduce spasticity (skeletal muscle relaxants) associated with various neurologic and musculoskeletal conditions. In addition, several therapeutic agents influence metabolic and other processes in skeletal muscle, including the nutrients required for normal muscle function used to prevent or mitigate degenerative muscular conditions (eg, selenium and vitamin E to prevent or treat muscular dystrophies such as nutritional myodegeneration ). Anabolic steroids, corticosteroids, NSAIDs, and various other anti-inflammatory agents (eg, dimethyl sulfoxide) are also used to treat acute and chronic conditions involving skeletal muscle.
Drugs used to modify or treat disorders of the nervous system fall into several categories: anticonvulsants or antiepileptic drugs (AEDs), tranquilizers, sedatives, analgesics, and psychotropic agents. Also All.see page Principles of Therapy of Neurologic Disease, All.chapter on page Analgesics Used in Animals, and All.page numonly Principles of Pharmacologic and Natural Treatment for Behavioral Problems.
Treatment with chemotherapeutic agents involves complex interrelationships among the host animal, infecting pathogen, and drug, the interactions of which comprise the chemotherapeutic triangle. Whenever a drug is used with the intent to kill the target, multiple factors affect therapeutic success. For instance, the target organism will implement mechanisms to avoid harm—most notably, resistance mechanisms. Microbes in particular are associated with numerous virulence factors and other mechanisms for self-protection, often also making the host sick at the same time. Likewise, host factors, which seemingly should help the host fend off infection, can become detrimental to successful treatment.
Many highly effective and selective anthelmintics are available, but such compounds must be used correctly, judiciously, and with consideration of the parasite/host interaction to obtain a favorable clinical response, accomplish good control, and minimize selection for anthelmintic resistance. Any decrease or increase of the recommended dose rate must always be discouraged. Underdosing is likely to result in lowered efficacy and possibly increased pressure for development of resistance. Overdosing may result in toxicity without necessarily increasing product efficacy.
Beta-lactam antimicrobials, named after the active chemical component of the drug (the 4-member beta-lactam ring), include the 6-membered ring-structured penicillins, monobactams, and carbapenems; and the 7-membered ring-structured cephalosporins and cephamycins. In addition to their chemical structure, the major difference between these two subclasses of beta-lactam antimicrobials is their susceptibility to beta-lactamase destruction, with the cephalosporins, in general, being more resistant.
Pathogenic fungi affecting animals are eukaryotes, generally existing as either filamentous molds (hyphal forms) or intracellular yeasts. In general, most primary fungal infections are caused by filamentous fungi, while most opportunistic fungal infections are due to yeasts; however, there is increasing recognition of opportunistic filamentous molds as well. Fungal organisms are characterized by low invasiveness and virulence. Factors that contribute to fungal infection include necrotic tissue, moist environment, and immunosuppression. Fungal infections can be primarily superficial and irritating (eg, dermatophytosis) or systemic and life-threatening (eg, blastomycosis, cryptococcosis, histoplasmosis, coccidioidomycosis). Clinically relevant dimorphic fungi grow as yeastlike forms in a host but as molds in vitro at room temperature; they include Candida spp, Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatum, Sporothrix schenckii, and Rhinosporidium.
Treatment for cancer is an important component of small animal practice and is used selectively in horses and cattle. Effective use of antineoplastic drugs depends on an understanding of basic principles of cancer biology, pharmacologic mechanisms of action, toxicities, and drug-handling safety.
Antiseptics and disinfectants are nonselective, anti-infective agents applied topically. Their activity ranges from simply reducing the number of microorganisms to an acceptable level of cleanliness (sanitization) to destroying all microorganisms (sterilization) on the treated surface. In general, antiseptics are applied on body tissues to suppress or prevent microbial infection, whereas disinfectants are germicidal compounds applied to facility surfaces. Both are generally applied after the surface has been cleaned, usually with soap.
The conventional approach to control viral diseases is to develop effective vaccines, but this is not always possible. The objective of antiviral therapy is to eradicate the virus, while minimally impacting the host, and to prevent further viral invasion. However, the method of replication of viruses makes them a greater challenge to treat than bacteria.
Arthropod parasites (ectoparasites) are major causes of livestock production losses throughout the world. In addition, many arthropod species can act as vectors of disease agents for both animals and people. Treatment with various parasiticides to reduce or eliminate ectoparasites is often required to maintain health and to prevent economic loss in food animals. Some ectoparasiticides were derived from pesticides used to protect crops. The choice and use of ectoparasiticides depend to a large extent on husbandry and management practices, as well as on the type of ectoparasite causing the infestation. Endectocides are capable of killing both internal and external parasites. Accurate identification of the parasite or correct diagnosis based on clinical signs is necessary for selection of the appropriate parasiticide. The selected agent can be administered or applied directly to the animal, or introduced into the environment to reduce the arthropod population to a level that is no longer of economic or health consequence.
A primary goal of animal producers worldwide is increased efficiency of conversion of feed into high-quality food products for humans, while minimizing risk to consumers. The physiologic mechanisms involved in converting feed into muscle, fat, and bone by animals are becoming more thoroughly understood. Consumer concerns about additives used for food production have focused on animal safety and well-being, organoleptic quality of the food, and potential health hazards to humans.
Inflammation is the complex pathophysiologic response of vascularized tissue to injury. The injury may result from various stimuli, including thermal, chemical, or physical damage; ischemia; infectious agents; antigen-antibody interactions; and other biologic processes. After tissue injury, the process of tissue healing includes three distinct phases: an inflammatory phase, a repair phase, and a remodeling phase. The desired outcome of the inflammatory response is isolation and elimination of the injurious agent to prepare for the repair of tissue damage at the site of injury and restoration of function. Finally, new tissue formed during the repair phase (eg, scar tissue) may be remodeled over several months.
Regenerative therapies including mesenchymal stem cells, platelet-rich plasma, and autologous serum products have become increasingly popular in veterinary medicine for treating horses and dogs. The primary goals of regenerative therapies are to modulate immune responses and prevent further tissue damage by the immune system, and to deliver trophic and growth factors to enhance endogenous tissue healing. Currently, no cell-based regenerative therapies have been approved by the FDA.
The adaptive immune system responds to microbial invasion by producing protective antibodies or cell-mediated immunity, or both. Appropriate administration of specific antigens, as in a vaccine, can result in effective, persistent immunity to infection. Microbial molecules also stimulate innate immune responses. These innate responses also promote adaptive immunity and can be used in the form of adjuvants to significantly increase responses to vaccines.