Therapeutics and medication

image of Therapeutics and medication
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For ease of explanation in this chapter reptiles are divided into three groups: snakes, lizards and chelonians. The chapter adopts a practical approach to choosing the most appropriate method of drug administration for treating disease. An overview of fluid therapy, drug dose determination and dosage for selected pharmaceuticals is also provided.

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11.1 (a) The enclosure with clean paper substrate for a terrestrial reptile during the treatment period; (b) a cardboard box can serve as an appropriate form of shelter.
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11.2 Using an ophthalmic needle to flush the eye of a Greek tortoise. Flushing can be done using either saline or an antibiotic solution depending on the situation and which disease is being treated. Anaesthesia, even local, is not necessary for this procedure.
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11.3 The most effective method to make the chelonian nostrils patent before flushing is by gradually increasing the pressure exerted on the rostral part of the soft palate.
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11.4 Using sterile saline to rinse the nostrils of a red-eared terrapin.
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11.5 Topical administration of EMLA cream on the cloaca of a marginated tortoise.
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11.6 Iatrogenic kidney failure (gout, arrowed) in a veiled chameleon caused by administration of high doses of the nephrotoxic drug toltrazuril.
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11.7 Fluid therapy infusions consisting of sterile saline, Ringer’s solution or lactated Ringer’s solution being administered subcutaneously in (a) the pelvic limb in a chameleon and (b) the prefemoral fossa in a Greek tortoise.
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11.8 The end of a tube for insertion into the oral cavity and oesophagus is made blunt by (a) holding the tube briefly over a lighter flame. (b) After pressing the end of the tube gently between the fingers it becomes rounded and slightly wider.
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11.9 The mouth of an adult iguana can be opened by gently pulling the skin of the ventral dewlap at the same time as applying gentle pressure on both corners of the mouth.
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11.10 The force feeding of a male green iguana with a commercial herbivorous reptile diet.
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11.11 A technique for opening the mouth of chelonians. (a) A firm, flat plate is inserted between the margins of the upper and lower jaw. (b) The plate is slowly rotated until (c) the mouth is finally open.
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11.12 Using a gastric tube to force feed a Greek tortoise with a commercial herbivorous reptile diet.
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11.13 Using forceps as a mouth gag once the jaws of a snake have been opened.
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11.14 Insertion of an oesophagostomy tube for when repeated application of food or drugs via the digestive tract is required (see Chapter 13). (a) Kelly forceps are inserted through the mouth. (b) The skin and the oesophagus wall are incised. (c–d) The tips of the forceps are pushed through the oesophageal wall and the skin. (e) The catheter is pulled out from the oral cavity. (f) The end of the catheter is turned back and inserted (using the haemostat) into the caudal oesophagus. (g) Positioning of the tube is facilitated by the use of an endoscope.
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11.15 Adhesive tapes have been used to fix the external end of the oesophagostomy tube to the carapace of this Greek tortoise.
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11.16 The subcutaneous administration of drugs into the dorsal musculature in a snake.
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11.17 Most medications in chelonians can be administered into the areas of loose skin between the neck and thoracic limbs.
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11.18 The subcutaneous administration of drugs into the thoracic limb of a veiled chameleon.
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11.19 The intramuscular administration of drugs into the dorsal epaxial musculature in a four-lined snake.
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11.20 The intramuscular administration of drugs into the thoracic limb of a male green iguana.
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11.21 The intramuscular administration of a drug into the muscles of the thoracic limb in a Greek tortoise. (a) Always disinfect the skin with povidone iodine solution before (b) administering the drug.
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11.22 The intravenous route of administration into the subcarapacial (subveretebral) plexus in a Greek tortoise.
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11.23 The intravenous route of administration into the ventral tail vein in a veiled chameleon.
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11.24 The intravenous route of administration into the ventral tail vein in a king snake.
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11.25 Small amounts of medicinal solution may be slowly injected into the palatine veins () in a sedated or anaesthetized boid snake.
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11.26 (a–c) The intraosseous route of administration into the distal femur in a green iguana.
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11.27 The intraosseous route of administration in an adult chelonian. (a) After disinfecting the shell, a hole was drilled into the epiplastron. (b) Through this drill hole an intraosseous catheter can be inserted.
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11.28 The inserted needle in the tortoise in Figure 11.27 , is secured with tissue glue or cement.
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11.29 An intraosseous catheter (a) for fluid therapy in a tortoise. (b) Connected to a small infusion pump for continuous fluid therapy.
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11.30 The intracardial route of drug administration in a manually restrained ball python. The snake is placed on its back and the needle is inserted via the ventral approach.
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11.31 A fine sponge impregnated with gentamicin has been placed into the wound in a male green iguana.
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11.33 Implant administration: (a) electric transponder (microchip) used in the left-hand side of a female veiled chameleon; (b) GnRH implant administered in the right-hand side of a green iguana. A skin suture is not necessary as surgical glue can be used to close the small hole in the skin.
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11.34 Flushing the cloaca with saline in a Hermann’s tortoise.
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11.35 The gentle massage and subsequent opening of the cloaca in a female veiled chameleon using (a) a stainless steel probe, in order to (b) flush the cloaca with saline solution. This can be done either to relieve constipation or to rehydrate the patient.
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11.36 This small agamid lizard climbing a tree in Indonesia is seeking a suitable environment to maintain its preferred body temperature.
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11.37 A young emerald tree monitor in a quarantine terrarium.
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11.38 A red-eared terrapin kept on an electric heating pad during anaesthesia. Warm water heating pads can also be used.
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11.39 Loss of muscle tone in a boa constrictor after metronidazole intoxication.
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11.40 Iatrogenic hypervitaminosis A with hyperkeratosis, full skin-thickness sloughing and bleeding in a marginated tortoise.
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11.41 Cloacal prolapse in a Horsfield’s tortoise with hypocalcaemia.
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