Page 366 - Cote clinical veterinary advisor dogs and cats 4th

154 Cheyletiellosis

omega-3 fatty acids control hypertension (p. weight, and diagnostics before prescribing/ kg q 24h SQ × 3-5 days starting 24 hours
501) • Test breeds at risk for MDR1/ABCB1-Δ after treatment. Monitor CBCs daily; start
administering chemotherapy.
VetBooks.ir • Muscle pain: treatment break, nonsteroidal Prevention Cardiotoxicosis (doxorubicin):
• Hepatotoxicosis: discontinue drug; treat acute
antibiotic prophylaxis when neutrophils
liver injury (p. 442)
< 1000/mcL.
mutation.
antiinflammatory, +/− gabapentin 10 mg/
risk for DCM and dogs with heart murmurs,
kg q 8-12h or opioid Allergic reactions: • Pretreatment cardiac evaluation for breeds at
• Dermatologic toxicity: treatment break, • L-Asparaginase: if received L-asparaginase pre- arrhythmias, or cardiomegaly
2
symptomatic treatment, pain medications, viously, premedicate with diphenhydramine • Limit cumulative dose to < 180-240 mg/m ;
prednisone (if antiinflammatory needed), 2 mg/kg IM 20 minutes before administra- substitute noncardiotoxic agent after 150 mg/
2
antibiotics (if needed for secondary infection) tion. Monitor patient 30-60 minutes after m (most commonly, mitoxantrone) (pp. 607
• Pulmonary fibrosis: supportive care, poor treatment. If allergic reaction, patient should and 609).
prognosis not receive L-asparaginase again. Hemorrhagic cystitis (cyclophosphamide):
• For toceranib AEs, treatment can usually be • Doxorubicin: administer slowly (10-20 • Concurrent furosemide 2 mg/kg, same route
resumed with dose reduction. minutes). If reaction, premedicate with as cyclophosphamide, ad lib water, frequent
diphenhydramine (as above) ± dexamethasone opportunities to urinate
Chronic Treatment SP 0.5 mg/kg SQ, and administer slower. Nephrotoxicosis/hepatotoxicosis:
Cardiotoxicosis, chronic bone marrow injury, Extravasation injury: • Serum biochemistry profiles and urinalyses
nephrotoxicosis, and hepatotoxicosis may • Administer chemotherapy only through an as in monitoring section; urine protein/
require ongoing therapy. IV catheter placed perfectly on first attempt creatinine ratio if proteinuria with recep-
in a vein not punctured within 24 hours. tor tyrosine kinase (RTK) inhibitors.
Drug Interactions Sedate patient if needed. S-adenosylmethionine (SAMe) to prevent
Veterinarians administering chemotherapy • Flush catheter with 3-5 mL of 0.9% NaCl lomustine hepatotoxicity
should know possible interactions with other before and after administration. Monitor
drugs. site for swelling during treatment. Do not Technician Tips
administer with a pump. • Technicians administering chemotherapy
Recommended Monitoring Acute vomiting: must be familiar with AEs that can occur
• CBC at expected neutrophil nadir with first • Administer chemotherapy slowly; pretreat during administration and how to prevent,
administration of a drug (typically 7 days with maropitant 1 mg/kg SQ 1 hour before recognize, and manage them.
after treatment, weekly for carboplatin and treatment. • It is important to quickly report extravasation
lomustine [in cats]). CBC before administra- GI toxicosis: of drug and any AEs observed.
tion of myelosuppressive drugs, monthly for • If patient hospitalized with GI toxicosis, • For each treatment, record the date, drug,
toceranib, q 2 months for chronic drugs reduce next dose by 10%-20%. dose, and site of administration.
(chlorambucil, melphalan) • History of GI toxicosis: prophylactic • Signs of serious AEs may be subtle (e.g.,
• Serum biochemistry profile and urinalysis q maropitant 2 mg/kg PO (dog) or 1 mg/kg lethargy, inappetence). It is important to
6 months, initially q 4 weeks for toceranib PO (cat) q 24h with that drug educate clients to communicate with the
(renal/urinary parameters). Liver enzymes • Avoid nonsteroidal antiinflammatory drugs veterinary team if AEs are suspected.
every other dose for lomustine. Creatinine (NSAIDs) or prednisone on same day as
every dose of cisplatin. toceranib. Client Education
Myelosuppression/febrile neutropenia: Clients should be provided with information
PROGNOSIS & OUTCOME • CBC before myelosuppressive chemotherapy. that allows them to recognize AEs of each
Do not treat if < 1500 neutrophils/mcL or drug and instructs them to seek veterinary
Most patients recover. Cardiotoxicosis, chronic < 100,000 platelets/mcL. Consider cause of care promptly.
bone marrow injury, nephrotoxicosis, and low platelet count. If suspect chronic bone
hepatotoxicosis generally do not resolve but marrow injury or patient receiving lomustine, SUGGESTED READING
may improve or stabilize. recommend consultation with oncologist. Gustafson DL, et al: Cancer chemotherapy. In
• CBC at neutrophil nadir after first dose of Withrow SJ, et al, editors: Small animal clinical
PEARLS & CONSIDERATIONS each myelosuppressive drug; if neutrophil oncology, ed 5, St. Louis, 2013, Saunders, pp
count < 1000 cells/mcL, reduce next dose 157-179.
Comments of that drug by 10%-20%. AUTHOR: Nicole C. Northrup, DVM, DACVIM
• Double-check dosage calculations, route • If overdose, recombinant human granulocyte EDITOR: Kenneth M. Rassnick, DVM, DACVIM
of administration, and patient’s history, colony-stimulating factor (rhG-CSF) 5 mcg/

Cheyletiellosis

BASIC INFORMATION Synonym GENETICS, BREED PREDISPOSITION
Walking dandruff Long-haired cats appear to be more commonly
Definition affected.
A highly contagious, zoonotic skin disease of Epidemiology
dogs, cats, and rabbits caused by the surface- SPECIES, AGE, SEX RISK FACTORS
living mite, Cheyletiella spp Young animals are more frequently affected. Animal shelters, breeding establishments, and
boarding/grooming facilities: increased risk

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