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Heartworm Infection in a Dog

Ellen Yacobi

16 April 2017

Pharmacology and Pharmacy


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Black and Tan shepherd mix is approximately 2 years old. The patient has been coughing

for about two weeks since arriving at the animal shelter. On exam, the patients vital signs are as

followed:

Weight: 87.0 lbs

BCS: 2.5/5

Temp: 101.2F

Heartrate: 110 bpm

Respiratory Rate: 34 bpm

MM: pale pink

CRT: 2 seconds

Thoracic auscultation: WNL

Abdominal palpation: WNL

Skin/Coat: dry, rough, flea dirt at base of tail

Follow a heartworm and fecal test, the patient is diagnosed with Heartworm disease,

Toxocara canis, fleas, and malnutrition.

The recommended treatment by the veterinarian is two injections of melarsomine at 2.5

mg/kg IM and given 24 hours apart. The injections are given in the epaxial muscles on either

side of the vertebral column in between the L3 and L5 vertebrae. The medication is injected deep

into the muscle with a small gauge needle to prevent any leakage (Romich, 2010). Following the

treatment, the patient will receive a microfilaricide drug to kill any microfilaria that appear in

circulation. Since melarsomine is an adulticide, this medication is use to kill the adult

heartworms that live in the heart and the microfilaricide will kill the baby heartworms before

become adults (Romich, 2010).


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To make up melarsomine, it must be reconstituted with 2 ml of sterile water. Meaning,

the melarsomine is in a powder form that must be activated and prepared for injection. Once in

liquid form, the concentration is 25 mg/ml. The dosage for melarsomine is 2.5 mg/kg. The

patient will receive 3.95 ml per injection requiring at least 2 vitals per injection (total of 4 vials).

Along with the injections, the patient will be on prednisone 20 mg receiving 2 tablets every 24

hours for 3 days. The patient will be put on the steroid to help prevent any emboli, suppress the

immune system, and assist with any inflammation brought on by the injections and heartworms

dying.

Prior to undergo any heartworm treatment, the patient will receive an injection of

diphenhydramine. This is given preemptively to prevent any reactions from occurring during

treatment before they have an opportunity to start. Diphenhydramine is an antihistamine that

combats allergic reactions. Heartworms can cause allergic reactions and increase eosinophils in

the blood. The diphenhydramine will help reduce the histamines and inflammation.

After the heartworm treatment is completed, the veterinarian recommended that the

patient be on restrict confinement and aspirin to help reduce the potential for any emboli. The

patient will receive the 81 mg tablets at tablet by mouth twice daily (1/2 tablet per day) for 6

to 8 weeks. The patient also received selamectin or Revolution topical following the completion

of the adulticide treatment. The selamectin will help with destroying any microfilaria and the

treatment of fleas (Romich. 2010). The owner should also consider putting all the dogs in her

kennel on a flea preventative as fleas are contagious and will multiple quickly. After discussing

flea treatment options with Mrs. Hansen, she asks what flea dirt is and how the dogs get it. Flea

dirt is actually flea feces and the dogs get it from the fleas living on the dogs. When you wet the

flea dirt it will actually turn red like the color of blood since that is what fleas eat. Mrs. Hanson
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expressed concern about ticks and what she should do about them. If Mrs. Hanson is seeing ticks

on her dogs, it is recommended that she use a flea and tick product to kill both parasites. There

are some topical products that can get ticks but with advances it is recommended to use an oral

medication such as Bravecto or Nexguard. When treating the environment for fleas, the owner

can treat for ticks as well. But unfortunately, ticks are found in high areas and fall down to the

host upon the detection of CO2.

After explaining to Mrs. Hanson that her other dogs need to be on heartworm

preventative medications but we cannot prescribe medication without performing a heartworm

test. But it will be explained to the owner that by law we cannot prescribe a medication without

forming a patient/client/veterinarian relationship. I would possibly recommend to Mrs. Hanson

that she reach out to her local shelter that she is rescuing these dogs from and ask them about

preventative medicine and medications. Local shelters should be able to help her.

Several days later, Mrs. Hanson brings in a new patient that potentially ingested

chlorpyrifos. Chlorpyrifos is the active ingredient in a flea dip she recently used on the patient.

The main ingredient is an organophosphate that inhibits essential enzymes in the body. It affects

the neurotransmitters and keeps them attached to the receptors. This leads to seizures, trimmers,

and shaking. Chlorpyrifos also causes salivation, lacrimation, urination, defecation, dyspnea, and

emesis which a common acronym associated with the class of the drug(The Free Dictionary,

2017).
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Romich, J.A. (2010). Fundamentals of Pharmacology for Veterinary Technicians. Clifton Park,

NY:Delmar.

The Free Dictionary (2017). SLUDDE. Retrieved from

http://acronyms.thefreedictionary.com/SLUDDE

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