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Clinical pharmacology > Drugs for treating GI disease in small animals > Flashcards

Drugs for treating GI disease in small animals Flashcards

1
Q

Antiemetics are for

A

control of nausea or prevention of vomiting

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2
Q

Neurokinin-1 (NK-1) receptor antagonists are…
give example

A

antiemetic drugs with unique anxiolytic, antidepressant, and antiemetic properties. The discovery of NK-1 receptor blockers was crucial in preventing emesis associated with cancer chemotherapy.

maropitant

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3
Q

What is a serotonin 5HT3 antagonist?
give examples

A

Selective serotonin receptor (5-HT3) antagonists block serotonin both peripherally on vagal nerve terminals in the gastrointestinal (GI) system and centrally in the chemoreceptor trigger zone in the area postrema of the fourth ventricle, resulting in powerful antiemetic effects.

(ondansetron, dolasetron, granisetron, and tropisetron)

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4
Q

what is D2 dopaminergic antagonist?
give example

A

Dopamine antagonists are medications that keep dopamine from activating certain types of cells in your brain and body.

A dopamine D2 receptor antagonist is used in the prevention and treatment of postoperative nausea and vomiting.

metoclopramide

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5
Q

alfa 2 adrenergic antagonist antiemetics?
give example

A

Alpha-2 adrenergic antagonists are a class of drugs that work by blocking the alpha-2 adrenergic receptors, thereby inhibiting the action of norepinephrine and other neurotransmitters.

While they are primarily used for conditions such as hypertension, anxiety, and some psychiatric disorders, they have also been investigated for their potential as antiemetics, drugs used to prevent or relieve nausea and vomiting.

such as yohimbine, mirtazipine

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6
Q

humoral pathway to vomiting

A

involves the stimulation of specific receptors in the gastrointestinal tract and other organs, which triggers a series of neural and hormonal responses ultimately leading to the sensation of nausea and the act of vomiting.

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7
Q

neural pathway to vomiting

A

The neural pathways involved in vomiting can be broadly categorized into central pathways originating in the brainstem and peripheral pathways arising from receptors in the gastrointestinal tract and other organs (humoral path).

The Chemoreceptor Trigger Zone or CTZ, located near the area postrema, is sensitive to various chemical stimuli such as toxins, drugs, and metabolic disturbances.

Activation of receptors in the CTZ can trigger the vomiting reflex directly or indirectly by stimulating the vomiting center.

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8
Q

most important mediators in vomiting (5)

A

dopamine-2 receptors (in the CTZ)
5-HT3 receptors (serotonin)
neurokinin 1 & substance P (P acts on the neurokinin1 receptors to induce nausea and vomiting)
H1 receptors (in the GI tract can stimulate vomiting)

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9
Q

maropitant is what type of drug

A

an NK1 neurokinin antagonist antiemetic

inhibits binding of substance P (key neurotransmitter in vomiting).

also acts as an antitussive and visceral analgesic.

contraindicated in toxicoses and GI obstructions.

tradenames: prevomax & cerenia

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10
Q

ondansetron is what type of drug

A

5HT3 serotonergic antagonist

both a central and peripheral antiemetic

used for nausea and vomiting but in combo with other antiemetics.

especially indicated for chemotherapy induced nausea.

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11
Q

metoclopramide is what type of drug

A

D2 dopaminergic antagonist, central antiemetic and prokinetic.

poor antiemetic in cats.

prokinetic in stomach and proximal GI tract so is okay for diarrhea cases (ie. parvo), will not worsen it.

maropitant and ondis are more effective and better tolerated though, but metoclopramide still has its place for use.

side effects: behavioral changes, vocalization etc.

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12
Q

indications for induction of emesis (2)

A

suspected or confirmed ingestion of a toxin
gastric foreign body

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13
Q

contraindications for induction of emesis (3)

A

symptomatic toxin/FB ingestion case

dangerous ingested object (corrosive, sharp etc.)

anesthetized animals

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14
Q

induction of emesis drug
in dogs
in cats

A

dogs: apomorphine
cats: dexmedetomidine

admin. antiemetic after vomiting complete. + atipamezole for the cats of course.

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15
Q

indications for gastroprotective therapy (5)

A

NSAID injury
other ulcers and gastritis (e.g. peptic ulcer disease)
stress-related mucosal damage
Chronic use of corticosteroids
Gastroesophageal reflux disease

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16
Q

what type of gastroprotectants are there (3)

A

proton pump inhibitors (acid suppressants)

antacids (neutralize)

mucosal protective agents (form a barrier over damaged mucosa)

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17
Q

antacids

A

such as aluminum hydroxide or magnesium hydroxide or calcium carbonate

less effective than acid suppressants

not monotherapy

neutralize gastric acid by directly reacting with it. They provide rapid but short-term relief from symptoms of heartburn and indigestion.

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18
Q

describe sucralfate

A

tradename antepsin

a gastric protectant, affinity for injured mucosa high

should be admin. in combo with acid suppressants but with 2 hours in between

particularly beneficial where there is pain

side effect: constipation

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19
Q

histamine type 2 antagonists are

A

acid suppressants such as, ranitidine and famotidine (Zantac, Pepcid)

should not be combined with proton pump inhibitors as there is no benefit.

ranitidine is more commonly used to promote GI motility because is weak acid suppressant.

indications: when weak acid suppressant activity is required. short term need such as anesthesia.

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20
Q

describe proton pump inhibitors

A

omeprazole, esomeprazole (nexium)

work by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (H+/K+ ATPase) in the gastric parietal cells. This inhibition significantly reduces gastric acid secretion, providing effective acid suppression.

more effective than H2-receptor antagonists.
esomeprazole is the drug of choice for for NSAID induced GI injury. not prophylactically though.

admin. on empty stomach, twice daily.

side effects: diarrhea, dysbiosis, rebound gastric acid secretion etc.

21
Q

prostaglandin analogs

A

such as misoprostol are not really used because we have PPIs.

side effect: abortion etc.

22
Q

indications for prokinetics
give drug examples (4)

A

gastric emptying and motility disorders

admin. only when GI obstruction ruled out.

e.g. metoclopramide, ranitidine, cisapride, eryhtromycin etc.

23
Q

metoclopramide

A

tradename primperan

both prokinetic and antiemetic

initial choice in animals with metabolic diseases with vomiting and/or delayed gastric emptying

24
Q

cisapride

A

no antiemetic effect, is prokinetic

more potent in gastric emptying of solids than metoclopramide is but also has more drug interactions

promotes esophageal motility in cats too (megaesophagus)

25
Q

ranitidine

A

zantac

acid suppressant and prokinetic

26
Q

erythromycin

A

prokinetic used in some countries

Erythromycin is a macrolide antibiotic that is well-known for its antibacterial properties. However, it also has an interesting side effect related to gastrointestinal motility.
Erythromycin has been found to stimulate gastrointestinal motility by mimicking the action of motilin, a gastrointestinal peptide hormone.

27
Q

types of laxatives: (5)

A

bulk forming
emollient
lubricant
hyperosmotic
stimulant

multiple can be used at the same time.

28
Q

bulk forming laxative

A

fiber

29
Q

emollient laxative

A

also known as stool softeners, are a type of laxative medication that works by softening the stool to make it easier to pass.

The main mechanism of action of emollient laxatives involves the incorporation of water and fat into the stool, which helps to lubricate and soften it.

docusate, potassium sulfosuccinate etc.

30
Q

lubricant laxatives

A

Lubricant laxatives are a type of laxative medication that works by coating the surface of the stool and the lining of the intestine with a slippery substance, making it easier for the stool to pass through the digestive tract.

mineral oil etc.

31
Q

hyperosmotic laxatives

A

Hyperosmotic laxatives are a type of laxative medication that works by drawing water into the bowel, softening the stool and increasing its volume, which stimulates bowel movements.

These laxatives contain substances that are not absorbed by the body and remain in the intestine, creating an osmotic gradient that pulls water into the colon.

lactulose (first choice), polyethylene glycol

32
Q

stimulant laxatives

A

Stimulant laxatives are a type of laxative medication that work by directly stimulating the nerves in the intestines, leading to increased motility and bowel movements.

bisacodyl does this

33
Q

simethicone is a

A

nonabsorbable antifoaming agent

indications: gaseous colic, flatulence

efficacy hasn’t actually been proven but is still used.

34
Q

mirtazepine

A

serotonin receptor antagonist/antidepressant for appetite stimulation

side effects include agitation, vomiting etc.

35
Q

appetite stimulants (5)

A

mirtazapine
benzodiazepines (dia + mida)
cyproheptadine (not available or used much anymore)
propofol (has been noted to improve appetite)
maropitant also seems to improve appetite whilst preventing nausea

36
Q

adsorbents/protectants for the GI tract (3)

A

activated charcoal (adsorbent)
kaolin/pectin (combo adsorb+protec.)
bismuth subsalicylate (protectant)

37
Q

synbiotics =

A

pre + probiotics

best to admin. 2h after antibiotic admin. because the AB will kill the probiotic.

38
Q

cobalamin,
indications

A

vit. B12

deficiency secondary to GI tract disease or EPI

39
Q

GI disease pain management (2)

A

favor maropitant and opioids

40
Q

immunosuppressive therapy indicated in GI cases when..?

A

when evidence of mucosal inflammation is present and no underlying cause is found

41
Q

examples of immunosuppressants (6)

A

prednisolone
azathioprine

chlorambucil
methotrexate

cyclosporine
mycophenolate

42
Q

sulfasalazine is an

A

anti-inflammatory

It belongs to a class of drugs called 5-aminosalicylates, which work by reducing inflammation in the gastrointestinal tract.

indicated for inflammatory large bowel disease

The exact mechanism of action of 5-ASA is not completely understood, but it is believed to work by inhibiting the production of inflammatory chemicals in the intestine and by scavenging free radicals, which can contribute to inflammation and tissue damage.

43
Q

young dog: frequent vomiting for few hours, slightly bloody. foreign body + obstruction ruled out. dog BAR and everything within normal limits.

choose treatment.

A

maropitant
esomeprazole
sucralfate/antepsin

44
Q

6m BAR puppy: diarrhea 2-3 days, 1x vomiting + giardiosis
treatment?

A

fenbendazole/pyrantel/praziquantel

1x maropitant
kaolin+pectin
probiotic

45
Q

adult cat: constipation, no dysuria. BAR otherwise.
treatment?

A

enema if severe enough but lactulose laxative initially.

once feces is softer we can switch to prevention so, sufficiently high fiber diet.

46
Q

3month old puppy: ADR, parvo confirmed.
treatment?

A

IVFT + added K+ and GLU

maropitant & ondansetron (synergistic)
esomeprazole

metoclopramide too for the prokinetic & antiemetic properties. in severe viral GI disease you may see gut stasis so you also need the prokinetic.

if secondary infection then AB.

buprenorfine
if pain worse, methadone/fentanyl (ket+lido CRI)
paracetamol for the fever

47
Q

adult dog: acute vomiting, hematochezia, ADR. dx acute hem. diarrhea syndrome
treatment?

A

IVFT

maropitant
(ondansetron if need)
esomeprazole if need

metoclopramide CRI

bupe/methadone/fentanyl

48
Q

adult female dog: acute vomiting, no diarrhea. dx pancreatitis.

A

IVFT + supplemental K+

maropitant
ondansetron if needed

methadone
iv parasetamol

ultra low fat diet

Clinical pharmacology (21 decks)

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