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Pharmaceutical Care of Select Avians & Exotics: Student Summary

  • Very few FDA-approved products
  • Less PK/PD data
  • Cost can be a concern / consideration
  • Can be both companions and food animals (e.g. pet chickens but produce eggs)
  • Wide diversity in physiology and behavior
  • Mostly prey species so they normally hide their symptoms. This means they often present very sick.
  • Trend toward low body weight patients
  • Husbandry can be challenging
  • Long life spans: may encounter diseases of older age that aren’t seen in other species
  • Caution: zoonotic transmission potential due to close owner contact

  • General Characteristics
    • Size – highly variable
    • Closer to reptiles than mammals
    • Crop – can be drug administration barrier
    • Renal-portal system – similar to reptiles; renally processed before entering systemic circulation
    • Dosing form selection considerations – no teeth, strong beaks, claws
    • Body temp 103-105 F
    • Internal genitalia – may be difficult to determine gender
    • Commonly present as emergency cases
      • May be emaciated and/or experiencing severe respiratory compromise
      • Patient should be stabilized first upon presentation to clinic. Explicit conditions may not represent the severity of illness.
  • Drug Administration – Think clinically!
    • Enrichment “toys” and foods can be used as drug delivery tools
    • Many drug formulations need to be liquids
    • Renally toxic drugs should be used carefully (renal-portal system)
    • The number of times per day a bird has to be handled can increase stress levels.
    • Restrain technique with towel (claws, beaks)
    • Crop tubes may be utilized
    • Intraosseous Injection
      • Good way to get drugs into systemic circulation (vs. IV, SQ, PO)
      • Bones are highly vascularized
      • 50% goes into circulations within 30 sec
      • Target locations: distal/proximal ulna, proximal tibiotarsal, lateral femur
      • Hypertonic or strongly alkaline drugs should be diluted
      • Volume limitations (1-2mL small birds; 8-25mL large birds)
    • Nebuilization
      • Can be utilized to treat respiratory tract or skin infections
      • Enclosed chamber needed to administer
  • Health is highly dependent on nutrition, husbandry, and enrichment
    • Hypovitaminosis A
      • Cause: all-seed diets are deficient in vitamin A
      • Prevention, supportive care, supplementation
    • Egg binding or chronic egg laying
      • Behavioral issues – obesity or sedentary
      • Cause: deficiencies of calcium, vitamin E, selenium, age of patient
    • Feather plucking
      • Cause: Lack of enrichment, socialization
      • Treatment options: fluoxetine, amitriptyline, clomipramine, haloperidol
  • Compounding Pearls
    • Caution with oral suspensions in oil, risk of aspiration
    • Injections with preservatives or vehicles that may have renal toxicity should be avoided (unless plan to dose caudally is in place)
    • Itraconazole formulations compounded from bulk chemical can be unstable and have reduced bioavailability
    • Medications for food or water may not be consumed at a regular rate when patient is ill
    • Seed or grain eating birds may have diets high in calcium that can interact with the oral bioavailability of tetracyclines
    • Be careful when using drug – coated feed or feed pellets, some birds remove the outer shell before consuming

  • General characteristics
    • Tremendous variation in temperature, diet, nutritional and physiologic requirements
    • Ectothermic ≠ cold-blooded
    • Ambient temperature (husbandry) alters pharmacokinetic of drugs
  • Drug administration
    • Topical – typically ineffective due to keratinized skin
    • Oral – highly variable GI transit times
    • SubQ/IV – difficult, limited access, vein collapse, renal-portal system
    • Intramuscular (IM)
      • Most common
      • Snakes: epixal muscles along spine (cranial third)
      • Lizards: triceps brachii in front legs
    • Alternative routes – intracardiac, intraosseous, intracelomic (thoracic)

  • General Characteristics
    • Monogastric, herbivores, or omnivores
    • Continually growing teeth
    • Coprophagic – consume their own feces
      • Coprophagia can increase oral drug transit time
    • Variable life span: 2-20 years
  • All Rodents
    • Antibiotic-induced enterocolitis
      • Destruction of gram-positive flora leading to proliferation of gram-negative organisms
      • Can be lethal
      • Acceptable antibiotics: chloramphenicol, metronidazole, tetracyclines, trimethoprim-sulfamethoxazole, fluoroquinolones, aminoglycosides
      • Contraindicated: penicillin, cephalosporins, vancomycin, erythromycin, clindamycin
  • Hamsters and Guinea Pigs
    • Avoid drugs that cause enterotoxemia: beta-lactams, clindamycin, erythromycin, tetracycline, bacitracin, vancomycin, and lincomycin
  • Other Pharmacology Considerations
    • Most readily accept sweet flavor
    • Coprophagia may change drug and formulation selection
    • Cheek pouches, where food is sometimes held, may also become a storage location for drugs

  • General Characteristics
    • Herbivores
    • GI flora primarily gram-positive bacteria and anaerobic organisms
      • Very susceptible to dysbiosis due to antimicrobial exposure; caution with drug selection
    • Coprophagic – consume their own feces
    • Unable to vomit
    • Consuming sweets can cause dangerous build up of gas in GI tract
      • Caution! No gas products should be orally administered
    • Very susceptible to stress
    • Continuously growing (elodont) teeth
      • Dental disease may occur; presents as anorexia, dropping food, weight loss
      • Abscess concerns
      • Regular dental maintenance important to prevent overgrowth
  • Other Pharmacology Considerations
    • Corticosteroids contraindicated due to immunosuppression and liver toxicity
    • Fipronil (active ingredient in some topical flea and tick products) should never be used on rabbits
    • Possible to incorporate drug delivery into their diets (high in forage and frequent eaters throughout the day)

  • General Characteristics
    • Obligate carnivores – low metabolic capacity for converting many xenobiotics found in plants (similar to felines)
    • Slow glucuronide metabolism of acetaminophen
    • Short digestive tract – oral drug transit time is short relative to other species; may impact rate and extent of oral drug absorption
    • Nimble bodies, curious nature
    • Affinity for rubbery textures; caution with some medication dispensing devices (rubber syringe stoppers); prone to gastrointestinal obstruction
  • Other Pharmacology Considerations
    • Gently restrain when administering medications; scruffing may provide effective restraint
    • Insulinoma risks – avoid high carbohydrate (formulations containing sugar)