Small Animal Clinical Pharmacology & Therapeutics, 2nd edition.

The second edition of “Small Animal Clinical Pharmacology & Therapeutics,” is a multi-author soft-cover tome. It is an intimidating but inexpensive reference book detailing the pharmacology of drugs used in dogs and cats. It does not deal with pocket, avian, or exotic small animals, despite its title. The authors have emphasized evidence-based use of drugs, and all the chapters are extensively referenced. This encyclopedic book should be useful when one is looking for a medication solution to a patient’s problem. But the phrase: “too much information” comes to mind even though key points are highlighted. The first section deals with the principles of drug use. It is very theoretical with the most useful chapter discussing the emerging field of pharmacogenetics. I found the chapter on Therapeutic Drug Monitoring unclear as to the importance of monitoring some drugs, such as levetiracetam (very safe with minimal side-effects), and to the timing, such as thyroxine. The second section details drugs targeting infections or infestations. The principles of antimicrobial therapy are discussed in detail as are the specific drugs. Infections in various organs are likewise analyzed: at length. For example, otitis externa is dealt with over 8 pages. There are various flowcharts, which must have been more fun to design than they are useful; the ones on pyoderma and urinary tract infections being particularly confounding. To my surprise, Giardia was dismissed in 2 pages with nary a comment about cleaning up the environment, bathing the pet, adding fiber to the diet to improve the rate of success, or correcting other predisposing intestinal problems. This section does not advise the practitioner on which drug to reach for first to treat an infection, nor does it deal with the relative costs of medication. The third section takes a body systems approach to therapeutics but remains in the world of theory and detail. For example, diuretics are only passingly mentioned in the treatment of congestive heart disease, being discussed in detail under Drugs Affecting Urine Production. And again, there is little indication as to which diuretic to reach for. Some of the useful human medications that we regularly use are omitted. For example, in Chronic Renal Failure there is no mention of sevelamer for phosphate binding or clonazepam, mirtazapine, or cyproheptadine for appetite stimulation. The latter two are briefly included in the chapter on Gastrointestinal Pharmacology. The long-acting insulin, detemir, that is proving so useful in both diabetic dogs and cats is not mentioned. Glargine is discussed. Confusingly, managing diabetic dogs and cats are considered together. The fourth section deals with neuro-active drugs including those used for behavioral problems, seizures, pain, and inflammation. Again, there is a huge amount of detail but little in the way of recommendations for the selection of the initial medication, or the drug with the least side-effects and greatest safety, or any consideration of cost-benefit. The fifth section discusses inflammation and its management. The significant differences in bioavailability (mainly absorption) between prednisone and prednisolone are documented in the text but they are treated as equivalent in the dose table. Omitted are discussions about natural products (except glucosamines), the role of diet in managing many diseases, and concepts of low dose, short courses, decreasing doses, and/or intermittent doses. Emphasis is placed on therapeutic blood levels rather than clinical efficacy. This reference book is extensively indexed: 43 pages in very small print. Each chapter has an outline but the headings do not include page numbers which would be useful given that some chapters are 80 to 100 pages long. The emphasis of the authors is pharmacological rather than therapeutic; academic rather than practical. And did I mention that everything is described and discussed in detail. This extensive textbook may appeal to pharmacology professors and PhD students, but, in my opinion, it has limited use for veterinary practitioners even at its modest price.