Geriatric Pet Health Issues & Medications, Part 1

As pets age they are more susceptible to certain conditions that can decrease longevity and diminish the quality of life.  Careful owner observation and regular office exams are important to catch many of these conditions early. Proper nutrition and pharmaceutical intervention can significantly decrease the morbidity associated with certain diseases and conditions of aging in the canine and feline.

 

Trigger: Monument Pharmacy CEO Rob Frisbie's dearly departed dog

 

 

There is no hard and fast rule for declaring when a pet is considered “senior,” but according to the AAHA Senior Care Guidelines, a pet is considered “senior” when it is within the last 25% of its life expectancy.1 The tables below from AVMA are helpful in determining an individual pet’s age in “human years.”2

 

Cat ‘s age

Equivalent in human years

7

45

10

58

15

75

20

98

 

Dog’s age

Equivalent in human years (*dog size lbs)

7

Small  (0-20 lbs); Medium (21-50 lbs): 44-47
Large(51-90 lbs);  Very large (>90 lbs): 50-56

10

Small – Medium: 56-60
Large – Very large: 66-78

15

Small – Medium: 76-83
Large – Very large: 93-115

20

Small – Medium: 96-105
Large: 120
The oldest recorded age of a cat is 34 years. The oldest recorded age of a dog is 29 years.

 

“While age itself is not a disease, the aging process induces complex and interrelated metabolic changes that complicate health care.”  Management decisions should not be based solely on the age of the patient, as many conditions that affect older pets can be controlled or cured.6  Senior pets are at increased risk for arthritis, renal and urinary tract issues, cardiovascular complications, ophthalmic conditions, endocrine disorders, and cancer. 3 Early detection and treatment of these conditions can help extend the longevity and quality of life for many companion animals.

 

Musculoskeletal System

Just like humans, pets are at increased risk of osteoarthritis as they age. 2 Oftentimes a very active pet presents to the clinic with lameness, limping, or significant decrease in activity. A thorough orthopedic exam may be indicated as hip dysplasia and knee ligament injuries are also more common in elderly pets.  Arthritis is caused by constant wear and tear on joints, and some breeds are more prone than others.  There are many treatments for pets suffering from arthritis pain ranging from special diets, supplements, prescription medications, and surgery. Owners must use great care in choosing supplements as many designed for humans are not appropriate for use in cats and dogs due to inappropriate strength, excipients, or even dosage form.  Prescription pain medications4 and supplements available for compounding by Monument Pharmacy include:

 

  • Amantadine- suspension, capsule
  • Buprenorphine*- suspension, transdermal gel
  • Butorphanol*- suspension, commercial tablet
  • Carprofen (Rimadyl®)- suspension, capsule, commercial tablet
  • Gabapentin- suspension, capsule
  • Methocarbamol- suspension, capsule
  • Tramadol*- suspension, capsule, transdermal gel, commercial tablet
    (Due to tramadol’s extremely bitter taste, transdermal gel is the preferred route of administration.)

*Prescriptions for Controlled substances require additional patient-specific information which varies by state. Please consult with a pharmacist for details.

NOTE: When used for analgesia, current research suggests that amantadine and gabapentin are adjunctive agents and not intended for use in monotherapy.

 

Cardiovascular Disease
Cardiovascular disease (including heart failure and hypertension) can be idiopathic or may occur secondarily to a comorbid condition — or even be caused by medication in the aging pet.  Cats especially are prone to anxiety-induced hypertension when at the clinic (similar to “white coat syndrome” in humans). Conditions that can cause hypertension include renal disease, hyperthyroidism, hyperaldosteronism, and phaeocromocytoma. Even certain medications can induce hypertension including steroids, sodium chloride, and NSAIDs.  Hypertension rarely has any symptoms and is usually discovered upon exam.  When treating hypertension, there are some species differences5 to note.  For example, calcium-channel blockers (amlodipine) are usually dosed once daily in dogs and cats.  However, angiotension-converting enzyme (ACE) inhibitors (benazepril, enalapril), and angiotension-receptor blocker (ARB) (telmisartan) are dosed once daily in cats but twice daily in canines.  Similarly, while ACE inhibitors (or ARBs) and calcium-channel blockers may be administered together, a calcium-channel blocker is usually recommended as initial therapy in cats and an ACE inhibitor (or ARB) in dogs.

 

Prescription medications available for compounding by Monument Pharmacy include:

 

  • Amlodipine- suspension, capsule, transdermal gel
  • Atenolol- suspension, capsule, transdermal gel
  • Benazepril- suspension, capsule, transdermal gel
  • Clopidogrel- suspension, capsule
  • Diltiazem- suspension, capsule, transdermal gel
  • Enalapril- suspension, capsule, transdermal gel
  • Furosemide- suspension, capsule, transdermal gel
  • Pimobendan- suspension, capsule
  • Sildenafil- suspension, capsule

 

Renal and Urinary Tract

Senior dogs and cats are at increased risk of renal disease and/or failure, urinary tract infection, and urinary incontinence.3 Common symptoms of chronic kidney (CKD) disease in the older pet may include anorexia, polydipsia, polyuria and/or oliguria, and emesis.  The progressive nature of renal disease produces a vicious cycle of progressive renal destruction; it is vital to manage associated issues to slow progression.  Secondary hypertension (see CARDIOVASCULAR section for available treatments), proteinuria, electrolyte abnormalities, and bacterial urinary tract infections are also likely develop as renal disease progresses. Prescription “renal” diets or supplements can significantly improve proteinuria.  With appropriate therapy, animals can survive for long periods with only a small fraction of functional renal tissue, perhaps 5%–8%.5

Compounded medications from a reputable veterinary compounding pharmacy will most likely be required due to dosage modification for pets with reduced renal function. The following medications are available in patient-specific compounded formulas to assist in your treatments:

 

  • Aluminum hydroxide- suspension, capsule, or powder
  • Amoxicillin- suspension (14-day expiration ONLY), capsule
  • Calcium acetate- suspension, capsule
  • Clindamycin- suspension, capsule
  • Enrofloxacin- suspension, capsule, transdermal gel
  • Nitrofurantoin- suspension, capsule
  • Omeprazole- capsule
  • Potassium citrate- suspension, capsule
  • Potassium gluconate- suspension (14-day expiration ONLY), capsule, powder
  • Sodium bicarbonate- capsule
  • Diethylstilbestrol (DES)- capsule, tablet, suspension
  • Phenylpropanolamine- suspension, capsule, commercial chewable tablet

 

Geriatrics is a very complex topic. Please see part 2 of this blog post for further reading on conditions affecting senior canine and felines including ophthalmic issues, endocrine disorders, and cancer.

 

For prescribers and their patients, quality means accuracy, consistency, professionalism and service.  At Monument Pharmacy, our licensed pharmacists and certified technicians prepare all of our compounded products with the utmost attention to detail regarding purity, potency, and consistency.  All ingredients are sourced from FDA-licensed suppliers, and compounded prescriptions are prepared according to exacting federal and Colorado state standards.

 

Most Rx orders for compounded medications received prior to 3pm Mountain can be shipped out the same business day. When you call, you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado.  We will beat others’ compound prices by 10%. Just let us know what you’re quoted or paying elsewhere. As an added value, we are able to ship many prescriptions via USPS first-class mail at no charge!  Our goal is for your service to be second to none.  Feel free to contact us for details at 1-800-595-7565.

 

References

  1. Goldston, Richart T, Hoskins, Johnny. Geriatrics & Gerontology of the Dog and Cat. Philadelphia: W.B. Saunders Co, 1995
  2. Senior Pet Care. AVMA. February 2009. Accessed July 2015.
    https://www.avma.org/public/PetCare/Pages/Caring-for-an-Older-Pet-FAQs.aspx
  3. AAHA Senior Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2005;41:81-91.
  4. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008
  5. Kahn, Cynthia, et al.  The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ:  Merck & Co, Inc. 2010
  6. Senior Care Guidelines (American Academy of Feline Practitioners). Journal of Feline Medicine and Surgery 2009;11:763-778 (accessed at http://jfm.sagepub.com/content/11/9/763.full.pdf)

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