key: cord-0007488-v58gbqrw authors: Williams, Bruce H. title: Therapeutics in Ferrets date: 2017-04-26 journal: Vet Clin North Am Exot Anim Pract DOI: 10.1016/s1094-9194(17)30098-1 sha: ecb9b1faae7ada8b137bed6f4e4d1b3cd74152b5 doc_id: 7488 cord_uid: v58gbqrw The domestic ferret (Mustela putorius furo) continues to grow in popularity as a pet species in North America as well as many countries around the world. With this rapid growth comes an increased potential for small and exotic animal practitioners to expand their ferret clientele. This article reviews the commonly used therapeutics in ferrets, as well as the general principles and guidelines for their use. A ferret is not a cat, nor is it a dog. Ferrets are their own species, and many of their diseases are unique. One cannot extrapolate from one's knowledge of dog and cat diseases when treating ferrets, because even diseases that may be seen in all three species (e.g., insulinoma, adrenal neoplasia, mast cell tumors) have mark edly different courses and prognoses in ferrets than in dogs or cats. 2. Ferret owners are generally well informed about their pet's condition. More than any other pet owner, the ferret community is well connected, and many ferret owners routinely research the Internet or contact other ferret owners or veterinary consultants before or during the course of treatment. Be honest with your Subcutaneous injections such as vaccines or antibiotics are generally given to scruffed ferrets between the shoulder blades. Ferret skin is considerably tougher than dog or cat skin, and a new disposable needle (25-gauge) should always be used. Fluids can be administered subcuta neously along the ribs and on either side of the thoracic and cranio lumbar spine. Intramuscular injections are generally given into the quad riceps muscle (with care given to protect the sciatic nerve), and the lumbar musculature can be used as necessary. Even healthy ferrets generally do not possess a tremendous amount of muscle mass, and this diminishes in several disease conditions and old age. Although phlebotomy can occasionally be performed on unsedated ferrets distracted with Linatone or another coveted treat, intravenous injections are generally administered to anesthetized or sedated ferrets; this prevents extravasation of drugs in the event of movement. Injections or IV fluids can be administered to sedated ferrets in the cephalic or saphenous veins with 20-to 23-gauge butterfly catheter; indwelling catheters can be placed in either of these veins, as well as the jugular vein. Catheter placement (24- gauge over-the-needle) might require a modified cutdown technique, ranging from nicking the skin 'over the vein (with a sharp needle) to more invasive techniques in severely dehydrated animal. Intraosseous catheter placement can also be used in severely dehydrated patients for fluid administration; however, the use of other drugs is discouraged with intraosseous catheters to prevent bone marrow damage. Stomach tubes of a diameter of 5 mm or less can be used for administration of nutritional supplements or contrast media, but seda tion is often required. 11 Caution must be used in placement because ferrets may struggle and vomit. Because the ferret's cough reflex is poorly developed, intratracheal placement might go unnoticed by the practitioner, with devastating results. Antibiotics represent the largest class and most widely used of therapeutic agents used in ferrets. Ferrets are tolerant of a wide range of antibiotics; however, several general principles are important to re member when employing antibiotics in treating ferrets. ing. Ideally, antibiotics should be chosen as a result of diagnostic testing, rather than employed in an empiric fashion. In cases of suspected bacterial disease, broad-spectrum antibiotics such as amoxicillin (20 to can be administered immediately following diagnostic proce dures until definitive results are available. The use of antibiotics prior to culture and sensitivity of suspected viral lesions could skew results or totally negate efficacy. Additionally, premature use of antibiotics can reduce levels of bacteria below the thresh old needed for visualization of bacteria in cytology preparations or in tissue section. 2. Antibiotics can mask clinical signs. It is not uncommon that the use of antibiotics, even those not specifically warranted for a particular clinical disease, results in a decrease in the severity of clinical signs, yielding a false impression that an individual ani mal is responding appropriately to therapy. The typical clinical picture is that a sick animal is treated empirically with a broad spectrum antibiotic, resulting in an increase in appetite and activ ity and a return to normal body temperature. After several days, a recurrence in clinical signs is seen, and a different broad spectrum antibiotic is employed. In some cases, four and five antibiotics may be tried without success in the span of 2 to 3 weeks before any diagnostic procedures are attempted. 3. Antibiotics may result in clinical signs by themselves. Although broad-spectrum antibiotics are generally well tolerated by ferrets and do not result in life-threatening alterations of intestinal flora (as can be seen in rodents and rabbits), occasionally antibiotic usage can result in development of clinical signs. For example, approximately 5% to 10% of animals receiving amoxicillin at higher dosages (20 mg/ lb) become inappetent. In this case, reduc ing the dose of 20 mg/ kg or substituting enrofl oxacin at 10 mg/ kg can result in appetite recovery. Other antibiotics, such as metronidazole, can result in clinical signs ranging from inappet ance to nausea, ptyalism, or development of gastric ulcers owing to the stress of administration. The prudent practitioner ensures that antibiotics are warranted and specific for a disease or agent prior to their employment. 4. Be specific in the use of antibiotics. Over the years, the author has seen a number of antibiotics employed as broad-spectrum antibiotics, often as a result of impatience with clinical progress or a lack of proper diagnostic testing. One of the most commonly misused antibiotics is chloramphenicol, a drug that is efficacious in only one ferret disease, proliferative colitis (the result of Ileo bacter infection). A well-stocked pharmacy is no substitute for knowledge of ferret diseases or the judicious use of culture and sensitivity. A special note is warranted about the use of aminoglycosides in ferrets. Nephrotoxicity and ototoxicity of the aminoglycosides in domes tic animals has been well documented•; the same is true for the domestic ferret. Ferrets appear to be exquisitely sensitive to the nephrotoxic effects of gentamicin; the use of even published therapeutic dosages in this species can result in acute tubular necrosis and death. Some authors suggest that minimization of renal toxicity and neuromuscular blockade could be seen as a result of division of the total daily dose into three smaller doses given over 8 hours and dilution of the antibiotic with saline (4 mL/kg) and slow infusion over 20 minutes, followed by serial evaluation of blood urea nitrogen (BUN) and creatinine values. 22 The author recommends the use of this antibiotic only as a last resort follow ing positive identification of an organism that is sensitive to this antibi otic and no other. Amikacin appears to be a better choice for gram negative organisms that are sensitive to aminoglycosides. 3 Additionally, use of other aminoglycosides or cephalosporins in concert with amino glycoside antibiotics can potentiate the toxicity of this group of antibiot ics, and concurrent use with loop diuretics such as furosemide can potentiate ototoxicity (Table 1) . A wide array of anesthetics and analgesics are available for use in the ferret, with many having recently become available (Table 2) . Inhal ant anesthetics are the anesthetics of choice for ferrets, even those with chronic illness or critical injury. Owing to their small size, ferrets can be masked down easily; fractious patients can be placed in an induction cage. Inhalant anesthesia by mask is excellent for short procedures, including phlebotomy, and can be used even in some instances for somewhat longer procedures, such as castration or removal of skin tumors. Ferrets undergoing intra-abdominal surgery or extended or mul tiple surgical procedures should be intubated and maintained using a nomebreathing system. Intubation should be performed only on ferrets that have been masked down; this can be facilitated by local application of 0.05% lidocaine to the larynx with a cotton swab. Premedication is generally not necessary in the ferret when inhalant anesthetic is used. Of the inhalant anesthetics, isoflurane is by far the safest for use in the ferret, with side effects being uncommon. Reported side effects include dose-dependent cardiopulmonary depression in a small number of cases. 6 Halothane and methoxyfluorane can also be used in ferrets, but a higher rate of compound-specific side effects (hepatotoxicity and nephrotoxicity, respectively, and dose-dependent cardiopulmonary de pression with both) should be expected. Additionally, both isoflurane and halothane anesthesia result in a number of changes in the complete blood count in ferrets, decreasing hematocrit, hemoglobin concentration, red blood cell count, and plasma protein levels. 10 Traditionally, injectable anesthetics have been associated with sev eral problems in ferrets, such as prolonged induction and recovery, a need for premedications (e.g., atropine) and occasionally, unexpected death. Ketamine, often used in combination with other drugs, such as valium or acepromazine, to provide analgesia and muscle relaxation is probably the agent most commonly used but can result in prolonged recovery or seizure activity. Newer injectable anesthetics, such as meto midine (Dormitor, Pfizer Corp., New York, NY) and tiletamine / zola zepam (Telazol, Fort Dodge Animal Health, Fort Dodge, IA) are gaining It is hoped that the emergence of newer injectable anesthetics with a higher margin of safety will diminish the use of the older injectable anesthetics (e.g., xylazine and barbiturates) that characteristically pro duce dose-dependent effects such as prolonged recovery, cardiorespira tory depression, and marked difficulties in regulating the depth of anes thesia. When compared with newer injectables, xylazine, which in healthy patients can result in heart block, hypoxemia, and unexpected death, is a poor choice even when used with other anesthetics. Barbitu rates, which have long been used in ferrets in research settings, have a known history of drug interactions and prolonged recoveries, and also should probably be avoided in this species. A general note: Ferrets have a marked tendency to become hypo thermic during and immediately after anesthesia. The proper use of heat lamps, circulating water baths, and heated IV fluids markedly decreases the incidence of prolonged recovery and unexpected death in ferret surgical patients. The use of analgesia is becoming more commonplace in ferret sur gery. Analgesia results in a smoother recovery, a decrease in systemic stress and resultant stress-related diseases (e.g., gastric ulcers), and a more rapid return to normal behavior and function. Preemptive analge sia, or the administration of analgesic drugs during premedication, is an excellent option available for practitioners working with ferrets. Caution should be exercised, however, in employing analgesia in ferrets with injuries requiring prolonged cage rest past the immediate postoperative period. Buprenorphine, which has a prolonged period of action (up to 12 hours) and butorphanol are both well tolerated in ferrets (Table 3) . Premedications are rarely needed for routine ferret procedures in which inhalant anesthesia is used. Actually, in most instances, surgical recovery is smoother and more rapid if premedications are not used. A possible exception to this rule is the use of atropine when inhalation anesthesia is administered by facemask rather than by endotracheal tube. Premedications are commonly used with certain injectable anesthe tics, however. Atropine is used to counter the excessive salivation which can be seen with tiletamine/zolazepam or ketamine. Atropine also should be administered as a premedication whenever xylazine is used to counteract heart block. Acepromazine can be used to smooth recovery (Table 4) . One of the most important adjuncts to treating ill ferrets is providing for fluid and nutritional needs. Ill ferrets, like sick dogs and cats, rarely take in enough food and water to cover their needs. In the author's experience, dehydration is commonly underestimated in the ferret. The ferret's tough skin does not lend itself well to the skin turgor test; overall activity is a better clinical monitor for borderline dehydration. Empiric fluid therapy is often of benefit in ferrets with history of vague GI signs or a complaint of recent lethargy and can restore the ferret activity and attitude for a period. The normal daily intake of water for maintenance is approximately 75 to 100 mL/kg/ day for adult ferrets; ferrets pre senting in shock or those with profound losses from vomiting or diarrhea can require doses of up to 180 to 240 mL/kg over a 24-hour period. Noncritical ferrets do well with subcutaneous fluids; total intake should be divided and given every 8 to 12 hours. Most ferrets can readily absorb 30 to 60 mL subcutaneously, depending on size and body weight. Ferret owners can often perform this task at home, not only ensuring proper fluid therapy of the ferret at night and on weekends, but also assisting the veterinarian in the control of infectious diseases at the hospital. Lactated Ringer's solution is the backbone of fluid therapy in the ferret and has a wide application in this species. Dextrose in saline 2.5 or 5% is the solution of choice for hypoglycemic patients. 12 · 19 Another problem commonly facing practitioners is nutritional ther apy of the ill ferret. Many patients arrive at the hospital with a history of eating only treats (if anything) for several days prior to presentation. Ferrets, which generally eat every 4 to 6 hours, quickly mobilize fat stores to supply short-term energy needs. Over time, the flooding of the liver with fat results in elevations of alanine aminotransferase and serum alkaline phosphorus levels and a diffusely yellow gross appearance to the liver. Currently, nutritional supplements are extralabel uses of human foods or food supplements. The author's preference is Gerber Second Foods Chicken (Gerber, Inc., Fremont, MI)-a ferret-palatable supple ment that is highly digestible and can also be used as a treat or to mask unpalatable medications. An additional benefit to this product is that unlike many other nutritional supplements, it need not be administered by dosing syringe and can easily be fed by hand. Many veterinarians use Hills' a/ d (Hills Pet Products, Topeka, KS) for nutritional supple mentation with excellent results. In the ferret community, there is a vast array of recipes for nutritional supplements, known as "duck soup." The balance of these supplements is based on high-caloric human sup plements such as Ensure (Abbott Laboratories, Abbott Park, IL) or De liver 2.0 (Bristol-Myers Squibb, Princeton, NJ) combined with any num ber of additives. If giving nutritional supplements by syringe, administer at a rate of 2 ml to 5 ml every 2 to 3 hours. Ideally, ill ferrets can be trained to drink gruel from a saucer or bowl, at which time it can be fed ad libitum every 4 hours. In cases in which these products are used for over 30 days, it is wise to grind the ferret's normal ration and add it in powdered form to the mixture. This not only ensures that all trace mineral and vitamin requirements are met but also facilitates the animal's eventual return to normal rations. Ferrets on a high-quality feline or ferret mainte nance diet generally do not need additional mineral or vitamin supple mentation. Dosages for commonly administered vitamins and minerals are available here, however (Table 5) . A key to the proper fluid and nutritional support of the ferret patient is the delegation of this activity to the owner for the greatest extent possible. In the author's experience, ferret owners are generally capable of giving subcutaneous fluids and handfeeding ferrets on a round-the-dock basis, when such activity is required. Practitioners Heartworm disease is a commonly overlooked problem in ferrets. As ferrets are natural hosts for D. imnzitis, all ferrets living in heartworm endemic areas receive heartworm preventive medication. Although treatment for heartworms in the ferret is feasible, the overall survival rate of infected ferrets is significantly less than that of dogs, because of several reasons: (1) because ferrets do not produce circulating microfi laria, infections are less readily identified, (2) because of the small size of the ferret's heart, a smaller worm burden can result in heart failure and death, (3) increased incidence of aberrant migration of adults in the ferret as compared with the dog, and (4) difficulty in enforcing cage rest following treatment. Treatment for heartworm disease in ferrets is simi lar to that in dogs, with thiacetarsamide at 2.2 mg/ kg IV by cephalic catheter b.i.d. for 2 days. Immiticide (melarsomine dihydrochloride) can be used instead of thiacetarsemide but is associated with a lower sur vival rate. Additionally, antithrombotic therapy is recommended in all treated ferrets, starting with heparin at 100 U SC s.i.d. for 21 days, ,vhich is followed by 22 mg/ kg aspirin s.i.d. PO for 3 months. Oral prednisone given at 1 mg daily may also be of benefit. 8 Dermatophytosis occasionally is seen in ferrets housed outdoors or with other household pets who are infected. Infections are more severe in kits or ferrets who are immunosuppressed from concurrent disease. For infections that do not heal spontaneously, griseofulvin and topical keratolytic shampoos should effect a cure. Systemic fungal infections such as blastomycosis, coccidiomycosis, and histoplasmosis have been reported but fortunately are rare. Dosages for systemic antifungals are provided in Ta ble 6; however, a poor prog nosis should be offered to the owner before initiating any ty pe of therapy. The nephrotoxicity of amphotericin B is well known, and careful monitoring of BUN values and hydration status is warranted. Although ketoconazole is not as nephrotoxic, and the drug can be given orally rather than intravenously, results of therapy with this drug as the main stay of treatment have not been promising (Table 7) . Over the last few vears, there has been a tremendous amount of interest in finding medical options for the treatment of adrenal-associ-.... "" :,, The outcome of mitotane use in ferrets is at best unpredictable and ranges from no effect to widespread necrosis of the adrenal cortex with resultant adrenocortical insufficiency. Clinical results are generally palliative and tend to recur when the drug is discontinued. 21 Ketoconazole, which has been used in the dog to inhibit adrenocortical hormone production, appears to have no significant thera peutic effect in the ferret. Recently, new classes of drugs are being explored to treat adrenal disease in the ferret.* It should be noted, however, that these drugs affect only the debilitating clinical signs of the disease but not the growth of the adrenocortical lesion. Adrenocortical malignancies, although a minority of overall cases, continue to grow unchecked, resulting in life threatening complications. Leuprolide acetate (Lupron, TAP Pharmaceuticals, Deerfield, IL) is a gonadotropin-releasing hormone (GnRH) agonist, which through negative feedback inhibits the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland. In humans, *The following information was graciously provided by Dr. Charles A. Weiss, Potomac Animal Hospital, Potomac, Maryland, 1999. rats, and dogs it has been shown to significantly decrease serum levels of androgens and estrogens. 5 Bicalutamide (Casodex, Zeneca Pharmaceuticals, Wilmington, DE) is a nonsteroidal, androgen antagonist drug that blocks the androgen receptor at the level of the target organ and at the level of the hypothala mus. Biclutarnide is available in 50-mg tablets, which can be used at a dosage of 5 mg/kg once a day. 26 Results do not appear as encouraging as with leuprolide acetate, but it can be effective in certain individual animals. It works particularly well to alleviate the stranguria associated with an enlarged prostate. (Table 8 ). recommend ACTH stimulation test to evaluate corticolytic effects tion in the ferret, which is an induced ovulator. High levels of estrogens in jills that are not brought out of heat either by coitus or by use of therapeutic drugs can result in fatal bone marrow depression. In most cases, ovariohysterectomy is the logical and efficient method of bringing the jill out of heat, especially when prolonged estrus is the result of owner ignorance or neglect; however, ovulation can be induced in breeding jills or by animals that are not surgical candidates by injec tion of exogenous hormones. Human chorionic gonadotropin (Cystore lin, Merial Ltd., Athens, GA) can be used IM at a dose of 100 IU, or gonadotropin releasing hormone can be used at a dose of 20 µ.g either IM or subcutaneousl y. The dose can be repeated in 1 week if signs of estrus have not significantly regressed. Epoetin alfa (Epogen, Amgen, Inc., Thousand Oaks, CA), a recombi nant human erythropoietin, has been used in the ferret to stimulate the production of red blood cells in the bone marrow, but overall the results of this therapy are not encouraging. Diabetes mellitus occasionally is seen in the ferret. Although diabe tes is treatable in the ferret, blood glucose levels are notoriously difficult to regulate. Most animals are best regulated with NPH insulin, beginning at an empirical dosage of 0. 1 U insulin per ferret twice daily 19 Ultralente insulin, which may only require injection once daily, can be considered in ferrets when the blood glucose remains consistently lower than 200 mg/ dL (Table 9 ). 1 9 Cardiomyopathy is a common malady of American bloodlines of ferrets. A genetic problem of incomplete penetrance, all degrees of heart failure can be seen in ferrets of all ages. Older ferrets with less severe signs generally tend to respond to treatment more readily than do younger ferrets with more fulminant signs. It is prudent to caution the owner that cardiomyopathy is a progressive condition and that treatment only slows the progression of the disease, rather than effecting a cure or even stabilization. When using cardioactive drugs in the ferret, it is advisable to begin treatment at the lowest doses and frequency if possible and adjust upward as needed. Cardioactive drugs should not be administered in the absence of good follow-up and periodic evaluation. Electrocardiography, ultrasonography, radiography, and monitoring of blood levels of digi talis, as well as periodic evaluation of clinical chemistry values, helps to find and maintain the optimal levels and combinations of these drugs and adjunctive therapies. Although many cardioactive drugs have become popular in veteri nary medicine over the past 10 years, furosemide and digitalis are still the mainstays of therapy in this condition. In many cases, because the onset of clinical signs is slow, one or both of these drugs needs to be instituted at presentation. Because both hypertrophic and dilated cardiomyopathies are seen in the ferret (with dilated being the more common), practitioners should choose additional drugs with care and make sure that they are appro priate for the type of heart disease present. Angiotensin-converting enzyme (ACE) inhibitors (e.g., enalapril), which decrease vascular ten sion and thereby reduce edema can be used in cases of dilative cardio myopathy. Enalapril maleate is supplied in tablet form; if compounded into a solution, the solution is good for 24 hours only. Venodilators also can help in dilative cardiomyopathy by decreasing preload and can be applied directly to the skin. Hypotension can be seen when a combina tion of these drugs is used. A different armamentarium of adjunctive therapies is recommended for hypertrophic cardiomyopathy. Because the desired result is to in crease diastolic function and relax a thickened myocardium, calcium channel blockers and beta-adrenergic blockers are recommended. Owing to the predilection of these drugs to induce heart block, close clinical follow-up to include electrocardiography is recommended (Table 10) . Lymphosarcoma, or malignant lymphoma, is the commonest malig nancy in the ferret and the malignancy in which chemotherapy is most often attempted. Ferrets generally tolerate the use of common chemo therapeutic agents in lymphoma protocols well; however, only a small minority go into remission. Hence, it is best to give lymphoma patients a poor prognosis at the outset of chemotherapy, in hopes that one eventually will be proven wrong. Several protocols for lymphoma chemotherapy have been pub lished, 1• 7• 20 and the reader is directed to these articles and texts for a Table 11 ; however, these are only guideline values, and definitive dosages can be tailored to the size and weight of the patient, level of response to previous chemotherapy, and several other factors. Isotretinoin, a drug used in the prevention of skin cancer and cystic acne in humans, has been used as palliative therapy in ferrets with cutaneous lymphoma. 18 In addition, homeopathic, herbal, and vitamin treatments have been described for lymphoma in the ferret. 1 Owing to the many factors that must be considered when planning treatment for lymphoma patients, including the variant of lymphoma, tumor burden and distribution, age and general health, owner resources and desires, drug availability, and practitioner experience, there is probably no one "best" combination of drugs, radiation, and surgical intervention for ferrets with lymphoma. In geriatric patients, or in patients whose owners are unwilling With the exception of lymphoma, evaluation of antineoplastic agents in ferrets is sketchy at best and largely limited to case reports, often with questionable results. The use of chemotherapy in the treatment of other common neoplasms of the ferret, namely adrenocortical neoplasms and insulin-secreting tumors of the pancreas, are described in other sections and are considered to be inferior treatment modalities when compared with surgical removal. The author has also had the opportu nity of reviewing several cases in which streptozotocin was used in the treatment of insulinoma in the ferret without noticeable antineoplastic results. 26 Bleomycin was used in a ferret for metastatic squamous cell carcinoma, with initial decrease in the tumor size; however, remission was not seen. 9 Several generalizations and cautionary statements can be made in the use of chemotherapeutic agents in ferrets. 1. Great care should be exercised in the use of chemotherapeutic agents in ferrets. All intravenous chemotherapeutic agents should be given through an IV catheter to an anesthetized ferret, to minimize hazards to both veterinarian and patient. A subcutane ous vascular access port for administration of these drugs has been reported in the literature. 1 7 Great care should be exercised in handling many of these chemotherapeutic agents to minimize risks to veterinarians and technicians. 2. Consultation with a veterinary oncologist and referral should be considered in practices at which experience with the use of these agents is limited. 3. Careful and frequent monitoring of the clinical status, as well as blood parameters, to include weekly CBCs and platelet counts, should be part of every chemotherapy protocol. Several other drugs have wide application in ferret medicine. Al though this list should by no means be considered complete, it does include several commonly used therapeutics not previously covered. One of the most commonly used classes of therapeutic agents is that of gastrointestinal protectants and antacids. Protectants have wide use owing to the prevalence of gastrointestinal problems in the ferret. This, as well as their relatively high margin of safety, makes them a reasonable choice in many nonspecific gastrointestinal problems in the ferret. Bismuth subsalicylate (Pepto-Bismol, Procter and Gamble, Cincin nati, OH) is a commonly used compound in the treatment of Helicobacter muste/ae in the ferret. Although it is efficacious, the ferret's resistance to administration of this compound is the stuff of legend. Rather than the typical dosage of 1 mL/ kg every 8 hours, the author has found that 1 / 15 of a tablet ground up and added to a babyfood treat is generally much more palatable. Sucralfate (Carafate, Hoechst Marion Russel Phar maceuticals, Kansas City, MO) is an excellent treatment for ulcers in the ferret and should be instituted whenever ulcers of any cause are sus pected. Dosage is 75 mg/ kg 10 minutes before each meal, or four to six times dail y. This medication is well tolerated by ferrets. Kaolin-pectin solutions can be of some benefit in chronic diarrhea. Cimetidine (Tagamet, SmithKline Beecham, Philadelphia, PA) or famotidine (Pepcid, Merck, West Point, PA) can also be used in ferrets with stress ulcers but should be used with caution in ferrets with concurrent inflammatory bowel disease. Elevated gastric pH can worsen digestive function in ferrets with altered digestion from concomitant diseases (e.g., chronic atrophic gastritis or enteric coronavirus infection). Metoclopramide (Reglan, AH Robins, Richmond, VA) is effective in vomiting ferrets; however, practitioners should carefully examine vom iting ferrets for the presence of gastrointestinal foreign bodies or other types of blockage before considering its use. Anti-inflammatory medication is also widely used in the ferret. The ferret is considered to be a steroid-resistant species and tolerates the use of prednisone or other corticosteroid medications very well. Prednisone is most commonly used either as a palliative chemotherapy agent (see earlier discussion), as a glucogenic agent in the treatment of insulinoma, or as an anti-inflammatory agent in the treatment of chronic inflamma tory bowel disease. In the treatment of chronic inflammatory bowel disease, oral dosage of prednisone at 2.2 mg / kg is often enough to decrease the levels of inflammation in the gut to a level that facilitates normal regeneration; injectable prednisone yields less satisfactory results for this purpose. Dexamethasone is appropriate treatment in cases of shock or trauma for stabilization but generally has little effect against chronic inflammation in the ferret. In the author's experience, ferrets do not show significant clinical effects of steroid administration at levels of 2.2 mg/kg or less, such as elevations in the WBC counts, adrenocortical suppression, or peptic ulcers. Guidance would be to use corticosteroids in this species when indicated without reservation, but within reason. Insulin therapy, anti inflammatory Parturition induction (with oxytocin) Administer 10 min before feeding Bronchodilator, occasionally useful in asthma Sulfasalazine (Azulfidine, Pharmacia & Upjohn, Kalamazoo, MI) can h used in cases of chronic inflammatory bowel disease, but results ar usually disappointing. Flunixin meglumine (Banamine, Schering Plougl-Kenilworth, NJ) can be used preoperatively and postoperatively to de crease pain and inflammation associated with certain surgical proce