Most, but not all of the medications that you will ever give your cat will be a veterinary preparation provided by your veterinarian, who maintains a pharmacy within his hospital. Sometimes you'll have to have a prescription filled at a drugstore, especially if your cat needs a drug that your veterinarian doesn't keep in stock. In this case, the prescription is handled just as if it were a prescription from your own physician.
Mail order catalogs, grocery, feed, pet supply stores, and home-veterinary care books also carry or describe a variety of over-the-counter (OTC), "natural" or "holistic" preparations. A STRONG WORD OF CAUTION: Never use these products without first consulting your veterinarian.
Following Directions
It is especially important not to use any drugs, whether they are veterinary or human preparations, in a manner inconsistent with the directions on the label unless your veterinarian tells you specifically to do so. Cats metabolize many drugs very slowly and can easily be overdosed if they are given too much of a drug or are given the drug too often. Aspirin is one good example. Even the common anti-diarrhea medication, Pepto-Bismol contains an aspirin-like ingredient. Both drugs can be used safely in cats, but only with careful dosing under the care of a veterinarian. There are many, many drugs with routine extra-label uses in veterinary medicine, but they should be closely supervised. Acetaminophen (Tylenol, etc.) and ibuprofen (Advil, Motrin, etc.) are
extremely toxic and should never be given to cats.
The amount of drug that your vet prescribes is based on your cat's weight, or for some medications, his body surface area. Your veterinarian also considers your cat's age or if a female cat is pregnant. Kittens do not handle drugs as well as adult cats do. Some drugs affect the developing skeleton, teeth, or nervous system. This could cause birth defects in the unborn fetus, or abnormal growth in young kittens. Your veterinarian will also consider any underlying diseases involving the kidney and liver, two organ systems important in metabolizing and eliminating drugs from the body. The goal is to achieve maximum benefit with minimal risk of toxicity.
It is very important that you follow the prescription directions and give your cat his medication on time and for the full duration of treatment. Be sure that you clearly understand the directions for use before you leave his office, including potential side effects, whether the medication needs to be refrigerated, and if it should be diluted, mixed, or shaken. Ask your veterinarian or his tech these questions, as most pharmacists are not familiar with the drugs used for animals. Use a calendar to help you keep track of when and for how long you give each medication. Keep a logbook or record of your cat's illnesses, writing down the name and dosage of drugs that are used to treat him, or peel off the label from the bottle or vial and stick it on the page. This is particularly helpful if you have several pets. Over the years, it becomes difficult to recall who had what problem, when, what drugs were used, and what dosages.
Failure to complete a course of treatment can result in a relapse or, in the case of antibiotics, in the growth of bacteria resistant to the drug. Complete your cat's prescription as directed - stopping treatment because he appeared to "be better" and saving the drugs "just in case he gets it again" doesn't do him any better now or later, for the prescriptions will have invariably expired and lost their potency.
Your veterinarian prescribes a course of therapy for your cat based on physical examination, appropriate laboratory tests, and experience. If your schedule limits your ability to give medications at certain times or if you find it easier to give your cat liquids versus pills, etc., let your vet know. He may be able to choose an equally effective preparation to accommodate your situation. Most treatments involve more than drugs; they involve rest, good nutrition, physical therapy and tender loving care.
How to Give Medications
Medicines in the form of pills, tablets, capsules, liquids, and pastes are given by mouth. Once inside the cat, they dissolve in the stomach or somewhere along the intestinal tract. Some of the drug is absorbed into the cat's circulatory system, which then delivers the drug into the body tissues. Some of the drug never gets absorbed at all, leaving the body with the feces. In fact, some tissues, such as the brain and the eye, have very effective barriers against chemicals. That's one reason why one antibiotic, for example, may be more useful than another, depending upon what tissue is infected.
It sounds complicated and it is. It's very important for you to know something of what happens to drugs once they are inside your cat. Then you will understand why it is so important to give your cat his medication on time and
finish the prescription. Have your veterinarian show you how to give medications and follow the instructions listed below for the various types of medications if you need additional help.
Pills, Tablets and Capsules
Work at a surface height about waist-high rather than bending or squatting over your cat on the floor. Some people will find it easier to sit cross-legged and tuck the cat in. Depending on the cat, this is how a lot of clothing become dustcloths if the cat decides to launch himself off your lap. Either way, position your cat with his back toward you, so that he can't back up. If you are right-handed, hold his head gently in your left hand, grasping just below the ears. With the pill, tablet or capsule in your right hand between your thumb and third finger, push his lower jaw down with your index finger and open his mouth. Place or drop the pill as far back on the tongue as you can. If you can give the pill a little nudge with your finger so that it goes over the base of the tongue, that will help to prevent him from working it forward and spitting it out. Quickly close his mouth and hold it shut. Gently stroke under the chin, speaking softly to him until he swallows the pill.
Cats can be very clever, holding pills in their mouth, only to spit them out when your back is turned. Butter, peanut butter, petrolatum, or hairball laxatives will help hold the pill to the roof of the mouth until your cat swallows it. If you are squeamish about sticking your fingers between your cat's teeth, there are wand type devices that hold the pill for you. Once inserted over the back of the tongue, push the plunger to release the pill.
Liquids and Pastes
Liquid medications come either in a
solution or
suspension form. Solutions are drugs dissolved in water and are usually clear. Suspensions are cloudy mixtures of a drug powder in water. The particles of powder tend to settle out as the bottle sits undisturbed. Most veterinary hospitals and pharmacies will add the appropriate amount of water to a bottle of powdered drug for you. If you are doing this yourself, be sure that you measure and add exactly the right amount of water. Too much or too little water will result in the wrong concentration of drug in the suspension. This means that your cat will be under- or overdosed with the drug when you administer it. Drug suspensions usually require refrigeration and shaking prior to use.
Drug pastes are not as common, but they are basically the same as drug suspensions except that the powder is mixed with a thick, inert substance. The powder doesn't settle out in the tube as it does in water, so it doesn't have to be shaken. In theory, pastes should be easier to give than liquids because they stick to the inside of the mouth until the cat swallows it.
Liquids and pastes are administered with an eye dropper or an extension called a
catheter tip on the tube. They have the advantage that you don't have to put your fingers into the cat's mouth. You also don't have to open his mouth as far, which is an important consideration for the less cooperative patients and for painful mouth conditions like severe
peridontal disease or jaw fractures. One disadvantage is that the medicines are not very palatable and unless you can squirt it way over the base of the tongue, your cat is going to get a not so pleasant tasting mouthful.
To give liquids or pastes, hold his head gently below the ears as you would for pills. Insert the tip of the dropper or catheter between the teeth on the upper and lower jaw on the side of the cat's mouth. Some cats are more accepting of the dropper or tip inserted from the front, between the incisors. Either approach will usually make cats open their mouth and make pushing motions with the tongue to get that thing out of there. Squirt the contents over the back of the tongue. It may take several squeezes of the bulb or plunger to do this thoroughly. Your cat might tolerate this better if you squirt small amounts into his mouth and allow him to swallow small portions of the dose at a time.
Until you get proficient at this, some of the medicine will be flung about if he shakes his head and tries to spit it out. If a large proportion of the dose is lost this way, your cat won't get enough of the medication to be effective. If the medication comes in more than one form, ask to be switched to one that affords you greater success.
Adding medicine to the food is generally not an acceptable method of medicating your cat. The off-odor and flavor can be enough to make him refuse the meal or, owing to the "snacking" nature of a cat's appetite, the dose will be inadequate. Occasionally you can use this technique successfully if you add small quantities of medicine (such as a crushed pill) to absolutely favorite foods. Try a tiny amount of unadulterated food the first time. If he eats it, mix the medication in the smallest amount he will eat at one time.
Eye Drops and Ointments
The eye is bathed in tears produced by glands located in the lids and in the tissues surrounding the eyeball itself. When an animal blinks, the eyelids sweep across the cornea like a squeegee. Tears collect and flow into a tiny opening located in the corner of the eye. From there, tears flow into ducts running through the nose and are swallowed. If the eyes are irritated by chemicals, dust, allergies, or infection, more tears are produced than can drain away and be swallowed. In that case, the eyes and nose become "runny."
Most domestic animals also have a third eyelid called a
nictitating membrane. If the eyes are irritated, this eyelid comes up and over the cornea more than usual. Sometimes this happens during general illness, unrelated to the eyes. Cats have some voluntary control over their third eyelid, meaning they can pull them up on their own.
This elaborate irrigation system explains why it is necessary to administer eye medication so frequently. The contact time for the medicine is actually very short, about 20 minutes, so the active ingredient must be absorbed into the eye tissues quickly. Many medications do not penetrate into the eye very effectively. For severe problems, veterinarians often use a combination of oral medication and topical ones. Because of the consequences of eye problems are so devastating, it is especially important to give these medications timely and properly. If you have trouble doing so, consider hospitalizing your cat for treatment.
To instill eye drops or ointments, restrain your cat as you would for any oral medication. If your cat is very sensitive to having his eyes manipulated, you may need to scruff him or wrap him in a towel. Holding his head in your hand and tipping his nose upward will cause him to open his eyes wide enough to drop in the medication. If not, gently part the lids with your thumb and forefinger. For eye ointments, roll down his lower lid and squirt a small strip of ointment in the pocket. Gently open and close the lids to distribute the medication over the eye itself. To prevent contamination with bacteria, don't touch the tip of the container to the tissues surrounding the eye.
The third eyelid is sometimes used as a natural bandage to cover the cornea in cases of deep ulceration or laceration. Your veterinarian will use this technique by placing one or two temporary sutures in the margin of the lid and pulling it up over the cornea. The sutures are tied over a button or piece of rubber tubing that prevents them from cutting into the upper eyelid. This doesn't sound very pleasant, but it is very effective in protecting the damaged cornea and seems to reduce pain. In these special cases, a small opening is left where the tip of an ointment tube can be inserted and medication instilled behind the closed lids.
Ear Drops and Ointments
The ear canals of domestic animals are shaped like the capital letter "L." There is a vertical portion that you can see, and a horizontal one that your veterinarian examines with an instrument called an
otoscope. The eardrum is at the base of the canal at the end of the L. Drainage and air circulation for the ear canal is quite poor because of this anatomy.
Ear infections tend to persist and recur. Medications must be dropped carefully into the opening, or a tube with a longer applicator tip must be used in order for the medicine to reach the horizontal portion of the canal.
To instill drops, grasp the ear flap gently with your thumb and forefinger. Find the opening among all the nooks and crannies. Hold the tip of the dropper close to the opening and squeeze out the desired number of drops. For ointments, insert the tip of the tube straight down into the opening of the vertical canal and give a squeeze. Without letting go of the ear flap, gently massage below the ear so the medication flows downward.
Once you've released the cat after applying either drops or ointments, he will shake his head and some of the medication will be flung back out. The goal is to get more in than is flung out.
Injections
The use of injectable medications is usually limited to the patients in the animal hospital. Proper dosing and administration of injections (shots), requires quite a bit of expertise and manual dexterity, along with a proficiency in animal handling. Injectable medications are used most often for animals who are very ill and require frequent assessment by the attending veterinarian. Many state laws, not to mention common sense, require strict methods for disposal of syringes and needles.
There are a few notable exceptions to the in-hospital-only rule for injectable medicines, such as the administration of insulin to a
diabetic cat. And some cats are simply impossible to handle to give oral medications. For routine
vaccinations, a veterinarian will determine if the local and state laws will permit an owner to give shots - for instance, in some locations of the United States, the
rabies vaccination is invalid unless administered by a licensed veterinarian.
Injectable medication is usually given in one of three ways:
subcutaneously (under the skin),
intramuscularly (in the muscle), and
intravenously (in a vein or in IV fluids).
Subcutaneous (subques) injections are the easiest and most frequently used. Properly done, they are nearly painless. Cats are endowed with a most advantageous physical trait, the loose skin over much of their bodies, especially between the shoulder blades. This is the location where most subcutaneous injections are given and where small pockets of fluids are often administered.
Syringes and needles come in a variety of sizes. Your veterinarian will provide you with the appropriate size for each. Do not use any other size syringe or needle than what he provides; this could result in a serious under- or overdose of medication.
To load a syringe with the proper dose, first break the seal by moving the plunger back and forth a few times. This will make it easier to draw up the dose. If the medication needs mixing, do this now.
If you are working with insulin, remember that this drug is very fragile. Mix insulin by gently rolling the bottle between your hands until it is uniformly in suspension.
Insert the needle straight into the rubber stopper on the bottle. Hold the bottle with the syringe upside down against the palm of your hand. Make sure that the needle is inside the liquid, not above it, or you will draw in only air. Pull back the plunger, drawing the drug into the syringe beyond the amount that you wish to give. Release the plunger and tap on the barrel of the syringe to cause any air bubble to rise and collect in a pocket just beneath the needle. Now push the plunger forward, pushing any air out through the needle, until the desired amount of the drug remains in the syringe. Remove the needle and replace the cap. Your veterinarian or his technician should go through this procedure with you until you are thoroughly familiar with each step.
As with any other medication, have your syringe ready and the dose drawn before you even approach your cat. You may place your cat on a suitable waist level surface as usual, or give the injection while the cat is distracted by a plate of food. Either way, grasp the loose skin between the shoulder blades with your thumb and middle finger. Gently pull it upward to create a tent. Feel for this with the forefinger of your other hand. Hold the syringe in your hand like a dart. Avoid the temptation to hold it with your thumb on the plunger. (This is a Hollywood creation - only doctors and nurses in movies and television hold a syringe like that.) Insert the needle into the tent. Pull back on the plunger and watch for a stream of blood to appear in the syringe. If there is, you have accidentally entered a blood vessel and should withdraw the needle immediately and try again. If no blood appears, push the plunger in all the way. Withdraw the needle.
If you are wondering about swabbing the area with alcohol, this is left up to you. This does very little to disinfect skin or fur, but wetting the skin or fur does help entry of the needle into the area you are trying to hit. Of course, you should not inject into an area that is obviously soiled.
Subcutaneous Fluids
"Fluids" (i.e., Ringers, lactated Ringers, dextrose, or sodium chloride solutions) are all clear, colorless liquids and contain a specific amount of salts and sugar that are balanced with the amount of the same substances in the blood. They are nonirritating to tissues and can be given subcutaneously or intravenously.
Subcutaneous administration can provide a cat with a reasonably large amount of fluid over a day's time. Your vet may prescribe periodic fluids for a very old cat with
kidney disease, who is drinking marginally enough water to meet his needs. Cats requiring long-term convalescent care for poisoning,
liver disease, or trauma may be given fluids as part of the overall therapy. There is a limit to the amount of fluid that a cat is capable of absorbing. The cat's need for fluid may exceed his capacity to absorb it from the subcutaneous tissues, and intravenous fluids will be necessary. Absorption will be influenced by your cat's body temperature.
Cats with a low body temperature cannot absorb subcutaneous fluids.
Intravenous administration is a much more controlled and effective method of giving fluids to animals who are dehydrated, need circulatory support or large volumes of fluid. Intravenous fluids require that a catheter be inserted into a vein. A number of veins are located close enough to the surface of the skin to be useful for this purpose: on the foreleg, on the inside of the thigh, on the outside of the ankle, and on the neck. These veins collapse easily when an animal shifts position or draws back a limb. Many vets use a pump to accurately control the rate of intravenous flow and prevent the patient from receiving too much or too little fluid. Your vet may do some very creative bandaging techniques to help keep the catheter in place. This is being explained, not because intravenous fluids are used very often in the home, but because you may see your cat trussed up in one of these devices at the hospital. This can be very upsetting if you don't understand why.
Fluids come in glass bottles or plastic bags and are usually dispensed in the one liter size, about a quart. The container is calibrated in 20-milliliter increments on the side. A milliliter is a metric unit of measure. There are about five milliliters in one teaspoon. The amount of fluid in the bottle or bag can be read when it is either right side up or hung upside down by its plastic handle. One end of an IV set has a drip chamber so you can see the fluid flow. This end plugs into a rubber or plastic stopper in the container. The other end is fitted with a needle.
Most IV set packages have illustrated instructions on the back showing how to assemble a fluid setup. Your vet will show you how to do it the first time, too. First unwrap the IV line. There will be a protective cap on the spiked end of the drip chamber. This apparatus is sterile, so don't remove the cap or touch it to any surface until you insert it into the bottle or bag. If using a bottle, peel off the metal tab and remove the metal cap over the end of the glass bottle to expose the sterile rubber stopper. Force the spike into the rubber stopper. If you are working with a plastic bag, peel off the plastic tab. Notice that there is a large hole, so don't turn the bag upside down until you have inserted the spiked end of the IV set.
Turn the bottle or bag upside down. Squeeze the drip chamber to create a slight vacuum, drawing fluid into the chamber up to the line. The apparatus can be suspended from a shower curtain or kitchen cabinet handle. Gravity causes the fluid to run through the line. Remove the protective cap from the end of the line and run out any air. Replace the cap with the appropriate size needle. There is a clamping device on the line to stop the flow. Air accidently injected subcutaneously is not harmful to your cat.
Place your cat on the work surface and lift the loose skin between his shoulder blades to form a tent, as you would to give any subcutaneous injection. Insert the needle into the center of the tent. You cat will feel very little discomfort. Roll open the clamp on the IV line and pinch it open if the plastic tube remains flattened. A steady stream of liquid should run into the drip chamber. If it flows too slowly, rotate the needle uder the skin until a steady stream forms.
Note the level of fluid at the start, and where the level should be when the proper dose has been given. There will probably be little need to restrain your cat other than to scratch his ears and chin. He may shift around a bit as the pocket of fluid forms. The stretching this causes may be slightly uncomfortable, in which you should create several small pockets rather than one large one. Pinch the skin where the needle exits as you withdraw the needle. A few drops of fluid might leak back out of the hole. Apply continued pressure for several seconds to keep the fluids from seeping out. Sometimes the seeping fluid may be slightly blood-tinged, but this is normal. Place the cap back on the needle. Dispose properly or, if your veterinarian has advised, return the used
capped needle to his hospital.
The fluid will be absorbed over several hours. Gravity will cause it to flow downward and your cat may develop very saggy elbows - this is normal, too. If any significant fluid remains at the time of the next dose, you should immediately contact your veterinarian. You cat may be unable to absorb the necessary dose and intravenous fluids may be required.
How-to Articles in This Series:
Article 1:
How to Choose a Vet
Article 2:
Hospital Admission of Your Cat
Article 3:
Preventive Care: Vaccinations, Serologic Testing, Spaying & Neutering
Article 4:
Preventative Care - Dental Care, Flea Control, and Grooming
Article 5:
Cooperation - Restraint Procedures and Trimming Claws
Article 6:
Keeping Records
Article 7:
Care in the Sick Room
Article 8:
Keeping Watch - Your Cat's Vital Signs
Article 9:
Nutrition for the Cat
Article 10:
Feeding the Cat - Including Newborn Kitten Feeding
Article 11: Medications and Prescriptions
Article 12:
Basic Nursing 101
Article 13:
Managing Bandages and Splints
Article 14:
Before and After Surgery and Dentistry
Article 15:
Pregnancy and Delivery
Article 16:
Euthanasia
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