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Oral Tumors, Benign 711

Etiology and Pathophysiology in house with point-of-care kit (not validated Possible Complications
• Opioids have various uses in veterinary in pets). • Constipation due to decreased peristalsis
VetBooks.ir • Opioids are classified as agonist, agonist/ TREATMENT Recommended Monitoring Diseases and Disorders
• Aspiration pneumonia
medicine, including analgesia, emetic, antidi-
arrheal, cough suppression, and sedation.
antagonist, partial agonist, or antagonist.
They target specific opioid receptors, which Treatment Overview Heart rate, blood pressure, respiratory rate and
With known very recent ingestion and no clini-
effort, body temperature, oxygen saturation,
include mu, kappa, and delta that are found cal signs, decontamination can be attempted CNS depression
in various organs throughout the body. by inducing emesis (monitor respiratory status
The receptor targeted by the specific drug closely if using apomorphine). If symptoms are PROGNOSIS & OUTCOME
determines the clinical response. present, stabilize respiration, and use naloxone
• Mu receptors are responsible for analgesic (specific agonist for opioids). • Prognosis is generally good when naloxone
effects as well as for respiratory depression. has been used to reverse opioid effects and
• Kappa receptors are potently analgesic but are Acute General Treatment respiratory and cardiovascular status is
also responsible for dysphoria, dissociation, • Decontamination is rarely performed due properly maintained.
and sedation. to quick time frame of clinical signs and • Prognosis is guarded when seizures occur or
• Delta receptors are involved in spinal existence of reversal agent (p. 1087). if prompt veterinary care (and antidote) is
analgesia but also have antidepressant and • Provide ventilatory support, including not available.
neuroprotective effects. intubation and positive-pressure ventilation
in severe cases (p. 1185). PEARLS & CONSIDERATIONS
DIAGNOSIS • Naloxone 0.02-0.04 mg/kg IV, IM, or SQ for
dogs and cats. Doses up to 0.1 mg/kg may be Comments
Diagnostic Overview required to reverse buprenorphine, fentanyl, • Used fentanyl patches or the sticks from the
Diagnosis is based on the presenting clinical and tramadol; may need to repeat dosing fentanyl lollipops still contain enough drug
signs and history of ingestion. Due to the illicit • IV fluids for cardiovascular support; avoid to cause toxicosis.
nature of some opioids, many owners are not overhydration and monitor for noncardio- • Naloxone may be administered intranasally
forthcoming with complete or accurate histories. genic pulmonary edema if IV access is not available.
Over-the-counter illicit drug test kits can be • Diazepam 0.25-1.0 mg/kg slow IV for
used to confirm suspicion of exposure, but they seizures and dysphoric reactions. Monitor Prevention
have not been validated in animals. respiratory rate and effort closely (respiratory • Keep all medications out of reach of pets.
depression). • Handlers of narcotics detection dogs should
Differential Diagnosis • Cyproheptadine 1.1 mg/kg PO or per rectum carry naloxone at all times.
• Other drugs causing central nervous system for serotonin syndrome–like effects
(CNS) depression, including barbiturates, Technician Tips
benzodiazepines, phenothiazines, ivermectin, Drug Interactions • Confirm with the owner that the
marijuana, ethylene glycol, and alcohol • CNS depressants (e.g., barbiturates, pheno- opioid ingested is not combined with
• In the absence of known drug exposure, it is thiazines, centrally acting muscle relaxants, acetaminophen.
important to rule out nontoxic causes of signs tranquilizers, alcohol) increase respiratory • Make all efforts to obtain an accurate, honest
(e.g., hypoglycemia, meningoencephalitis, and CNS depression. history, especially when exposure to illicit
neoplasia, hepatic encephalopathy). • Diuretics may have decreased efficacy in some drugs is suspected.
congestive heart failure patients.
Initial Database • Monoamine oxidase (MAO) inhibitors Client Education
• Blood pressure: decreased or sometimes (amitraz, selegiline) may have additive effects Keep all medications away from pets.
increased or increase CNS depression.
• Blood gas: may see respiratory acidosis • S-adenosylmethionine (SAMe) may increase SUGGESTED READING
• O 2 saturation: may be low. serotonergic effects. Bischoff K: Toxicity of drugs of abuse. In Gupta RC,
• CBC, chemistry, and urinanalysis are • Erythromycin, itraconazole, fluconazole, editor: Veterinary toxicology, ed 2, Waltham, MA,
expected to be normal. cimetidine, rifampin, and digoxin decrease 2012, Elsevier, pp 475-477.
clearance and increase toxicity due to pro-
Advanced or Confirmatory Testing longed half-life and decreased metabolism. AUTHOR: Jodi Carlson, VMD, MS
Urine or blood can be sent to a veterinary • Some opioids may potentiate anticoagulant EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
diagnostic lab for an illicit drug screen or tested activity of warfarin.

Oral Tumors, Benign Client Education
Sheet

BASIC INFORMATION sites, some (e.g., acanthomatous ameloblastoma) local exophytic growth on the gingiva
may be locally invasive. (e.g., focal fibrous hyperplasia, peripheral
Definition odontogenic fibroma [fibromatous epulis
Benign and malignant masses are common in Synonyms and ossifying epulis], acanthomatous
the mouths of dogs. In cats, oral masses tend to • Benign oral neoplasia ameloblastoma [acanthomatous epulis])
be malignant more often than benign. Although • Epulis (plural, epulides) is a nonspecific (p. 306).
benign tumors do not metastasize to distant clinical descriptive term referring to a

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