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Atopic Dermatitis 91

○ Striated (skeletal) muscle relaxation • Bethanechol may enhance urethral sphincter Prevention
Diazepam: dogs: 2-10 mg/DOG PO q tone, and it is important to treat with alpha- • Successful management depends on identi-
■ 8h; cats: 2-5 mg/CAT PO q 8h (use antagonist (e.g., phenoxybenzamine, prazo- fication and treatment of underlying
VetBooks.ir with caution) or 0.2-0.5 mg/kg IV as Possible Complications • Monitoring voiding is important for postop- Diseases and Disorders
sin) before starting bethanechol.
disorder.
needed. Centrally acting muscle relax-
ant. Side effects: sedation, excitation,
idiosyncratic hepatic necrosis in cats. • Bladder wall fibrosis and permanent bladder erative neurosurgical and orthopedic patients.
Methocarbamol: dogs: 15-20 mg/kg hypotonia Technician Tips
■
PO q 8h; cats: initial dose 33 mg/kg • Recurrent UTI • To reduce risks for UTI, aseptic protocols
PO q 8h, then 20 mg/kg PO q 8h. (cleanse external catheter and genital areas;
Centrally acting muscle relaxant. Side Recommended Monitoring change collection bag) should be instituted
effects: weakness, sedation, lethargy, • Frequently monitor voiding activity (provide in patients requiring urinary catheterization.
vomiting. opportunity to urinate). • Secondary urine overflow increases risks for
• Detrusor muscle contraction • Monitor residual urine volume during urine scald and decubitus ulceration. The
○ Bethanechol (parasympathomimetic): catheterization procedures. If residual volume patient should be kept clean and dry on a
dogs: 5-25 mg/DOG PO q 8h; cats: normalizes, catheterization is no longer padded surface with frequent (q 4h) rotation
1.25-5 mg/CAT PO q 8h. Side effects: required. if recumbent.
ptyalism, vomiting, diarrhea, broncho- • Periodic urinalysis ± urine culture; initially
constriction. Contraindications: urethral every several weeks Client Education
or gastrointestinal obstruction. • If signs persist, the client will need instruc-
○ Cisapride (prokinetic; enhances acetylcho- PROGNOSIS & OUTCOME tions for intermittent bladder catheterization.
line release): dogs: 0.5 mg/kg PO q 8h; • The client should be educated to differentiate
cats: 1.25-5 mg/CAT PO q 8-12h. Side • Good if cause is non-neurogenic urine overflow from voluntary micturition.
effects: diarrhea, abdominal pain. • Guarded for sacral spinal cord lesions
• Poor for dysautonomia, nerve root avul- SUGGESTED READING
Chronic Treatment sion, nerve transection, or severe sacral Byron JK. Micturition disorders. Vet Clin Small Anim
• Resolution of underlying disorder spinal cord injury (especially with loss of 45:769-782, 2015.
• Long-term supportive drug therapy nociception)
• Maintain a small or empty bladder (intermit- AUTHOR: Joan R. Coates, DVM, MS, DACVIM
EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
tent catheterization may be required). PEARLS & CONSIDERATIONS
Drug Interactions Comments
• Bethanechol minimally effective if tight Expedient and early management of an over-
junctions completely disrupted or when distended bladder is crucial for resolution and
nerves have been avulsed or transected prevention of bladder wall fibrosis.

Atopic Dermatitis Client Education
Sheet

BASIC INFORMATION • Cats: no breed predispositions have been • Concurrent adverse cutaneous food reactions
demonstrated. (up to 25% in cats and 30% in dogs)
Definition • Secondary infections with bacteria and yeast
An inflammatory and pruritic cutaneous RISK FACTORS are common (especially dogs).
hypersensitivity disorder most commonly • Dogs: genotype influencing the skin barrier • Otitis externa (common in dogs, rare
associated with immunoglobulin E (IgE) function and immune response, certain in cats)
antibodies to environmental allergens with breeds are more at risk • Hyperhidrosis (sweating)
genetic predisposition • Environmental factors (e.g., regular bathing, • Conjunctivitis (20%-60% of dogs)
born during the pollen season) • Rhinitis (6.7% of dogs)
Epidemiology • Feline asthma (rare)
SPECIES, AGE, SEX GEOGRAPHY AND SEASONALITY
Dogs and cats: age of onset 4 months to • There is marked geographic variation in Clinical Presentation
7 years, typically between 6 months and specific allergen exposure.
3 years • Depending on exposure to sensitizing aller- HISTORY, CHIEF COMPLAINT
gens and the pruritic threshold, the clinical • Pruritus is the dominant chief complaint.
GENETICS, BREED PREDISPOSITION signs may be seasonal or nonseasonal. • May be presented for pruritic recurrent skin
• Breeds at risk may vary with geographic • Majority of patients with seasonal signs infection (without significant pruritus
region and breed popularity. exhibit perennial signs over a 1- to 4-year between episodes of skin infection).
• Dogs: Boston terrier, boxer, Chinese Shar-pei, period. • Other clinical signs may mimic any type of
Dalmatian, fox terrier, French and English pruritic dermatoses, particularly adverse
bulldogs, golden and Labrador retrievers, ASSOCIATED DISORDERS cutaneous food reactions (p. 345).
pug, shih tzu, West Highland white terrier, • Concurrent flea allergy dermatitis (more
Yorkshire terrier, and many others. prevalent in flea-endemic areas)

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