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Intro to Pharmacology > Gastrointestinal Drugs > Flashcards

Gastrointestinal Drugs Flashcards

1
Q
A
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2
Q

The enteric nervous system is an extensive network of interconnected ____ and ____
interneurons within the gastrointestinal ___ that can control gut function _______ of the CNS

A

sensory, motor, wall, independently

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3
Q

The enteric nervous system is characterized by the presence of a complex intrinsic neural network that includes the _____
plexus and the ______ plexus

A

myenteric, submucosal

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4
Q

The submucosal plexus is located under the ______ layer of the gut. The myenteric plexus
resides between the ______ ____ muscle layer and the ____ _______ muscle layer

A

submucosal, inner circular, outer longitudinal

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5
Q

The ENS is extensively innervated by ________ _______ nerve fibers.Its sensory and motor interneurons can also be influenced by the CNS through input from _____ and ______ subdivisions

A

nonadrenergic-noncholinergic (NANC), sympathetic, parasympathetic

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6
Q
A

Myenteric plexus
Yellow represents nerve endings
Plexus submucosas

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7
Q

Emesis is a complex reflex activity (______ reflex) and its coordination is centered in the _______. Although several afferent pathways may be responsible for initiating emesis, all signals are
coordinated by the ____ center (______ center) located in the ____ _______. An important structure outside the GI-tract that supplies afferent input is the ________ ________ _____. This is sensitive to the presence of ____ and _____ in the blood

A

protective, brainstem, emetic, vomiting, mid brainstem, chemoreceptor
trigger zone (CTZ or CRTZ), drugs, toxins

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8
Q

Emesis is _________ induced to empty the ____ portion of the digest tract. List the examples in which emesis is induced:

A number of substances induce emesis by:
* Distending the ______, ______, _____, or _______ ( _______ organs)
* ________ the epithelium of the GI-tract (gastric _____ or _____)

A

pharmacologically, anterior

→ Preparation for induction of general anesthesia (food in the stomach)
→ Treatment of ingested, noncorrosive poisons

pharynx, esophagus, stomach, duodenum, hollow, Irritating, mucosa, pharynx

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9
Q

Peripherally acting (reflex) emetics
* Distention with ____ water or ____ can induce the emetic response
* In case of toxin ingestion, administration of ____ water by _____ tube may help ____ poisons
* Emesis can be induced in dogs by oral administration of a solution of: (1) Pharyngeal placement of a small amount of plain ____ _____ or neutral ____ _____, such as sodium carbonate OR (2) Orally administered _______ ______ (__%) often induces emesis rapidly in cats and dogs → fatal ______ of hydrogen peroxide foam is possible!
Copper sulfate (1%), zinc sulfate (1%)

A

warm, saline, warm, stomach, dilute

warm saturated (strong) sodium chloride

table salt, salt crystals, hydrogen peroxide, 3, aspiration

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10
Q

Prokinetic drugs increase GI ______, enhance the transit of ______ contents, and are used in ___ and ____ animals → occasionally in ruminants to stimulate gastric _______, ____ or _____ motility
* Intestinal motility is ↓ after intestinal disease, surgery → can lead to ____

A

motility, intraluminal, small, large, emptying, rumen, intestinal, ileus

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11
Q

Metoclopramide is a ____-soluble derivate of ____-________ __. It has a central (_________) and peripheral (________ and stimulator of ______
receptors) effects.

A

lipid, para-aminobenzoic acid, antidopaminergic, antidopaminergic, cholinergic

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12
Q

Metoclopramide has multiple actions:
→ D2 ______
→ Serotonin (5-HT3) _______
→ Serotonin (5-HT4) ______
→ Increase in the release of ____ in the ____-tract
→ Increase gastric _____
→ Increase ____ of the esophageal sphincter
→ Stimulates motility of the _______ (less effect on ____ segments)
→ Endocrine effects: transient increase in ______ and ______.

A

antagonist, antagonist, agonist, Ach, GI, emptying, tone, duodenum, distal, prolactin, aldosterone

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13
Q

Prokinetic drugs increase ?

A

GI motility

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14
Q

Metoclopramide is used in small animals to:
1. Stimulate ____ upper motility following _______ surgery (for gastric _____)
2. _______
3. Postoperative ____
4. Gastric _______
5. Idiopathic _____

–> Contraindicated in GI ______ or ______.

A

normal, corrective, dilation, Volvulus, ileus, ulceration, gastroparesis, obstruction, perforation

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15
Q

Metoclopramide: use in horses
* Some equine surgeons used infusion of metoclopramide to reduce __________ ____
* It may stimulate _____ ______ but not large bowel
* Undesirable side effects are common → ________ changes and ______
pain

A

postoperative ileus, small intestine, behavioral, abdominal

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16
Q

Metoclopramide: use in ruminants
* The clinical use of metoclopramide in large animals is ____ common
* It has a little usefulness in ____. It may ↑ the motility of the _____ in cattle and in sheep
* Metoclopramide is used successfully in cattle with functional ______ ______
* At doses higher than 0.1 mg/Kg in calves cause ?

A

less, cattle, rumen, pyloric stenosis
severe neurological side effects

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17
Q

Cisapride
* Cisapride was removed from the market → serious _______ and _____ in people. These
reactions have not been reported in _____
* It is still available via ______ pharmacists
* Cisapride has a great ______ effect. Agonist for the __-___ receptor on myenteric neurons and
antagonist for __-____ receptor → It may enhance release of ___ at the myenteric plexus
* It causes dose-dependent increased activity at ___ ____ sites: (?)

A

arrhythmias, deaths, animals, compounding, prokinetic, 5-HT4, 5-HT3, ACh, all GI

Esophagus, stomach, jejunum, ileum, small intestine, and colon

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18
Q

Cisapride

Clinical use in small animals
➢ treatment for ________ reflux, _____
gastric emptying, and _____ bowel motility
disorders
➢ Compared to ________, cisapride is
more effective for increasing ____ esophageal
sphincter ____ in dogs
➢ Cisapride has been used for treating chronic _______ in cats (effect on colonic _____ muscle)

A

gastroesophageal, delayed, small, metoclopramide, lower, tone, constipation, smooth

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19
Q
A
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20
Q

Domperidone is a dopamine (D2) _______. It may also have α1-receptor _____ and serotonin (5-HT2) _______ effects
* Its mechanism of action and prokinetic effects are similar to _____
* Domperidone does not cross the ____
* Its peripheral effects accelerate _____ intestinal transit. ______ activity is unaffected
_______ drugs increase GI motility

A

antagonist, antagonist, antagonist, metclopramide, BBB, small, Colonic, Prokinetic

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21
Q

Domperidone
* Domperidone has been investigated for use in horses to treat _____ toxicity and _____
* The oral absorption in horses is only __- ____%. ____ administration of ____ mg/Kg (the approved dose) had no effect on GI function but at __ mg/Kg ↑ stomach emptying
* ↑ digital laminal microvascular blood flow (horses) → ___________ ____ receptors.

Treatment of laminitis?
Fescue grass toxicosis: forage related disease involving the endocrine disruptive effect of ______ _____ (produce by fungus Neotyphodium coenophialum) on prolactin secretion

A

fescue, agalactia, 1, 1.5, PO, 1.1, 5, antagonist α2, ergot alkaloids

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22
Q

Erythromycin → a ________ antibiotic used to treat ______ infections
* Erythromycin stimulates GI motility at ____ doses → much lower than the antibacterial dose
* It stimulates GI motility via: activation of _____ receptors, release of endogenous ______ or _____ mechanisms in the upper GI tract
* Motilin is a _______ released from endocrine cells of the ________ mucosa. It ____ the motor contraction
* Most of the motilin receptors are on the ______ and _____ intestine
* Erythromycin is used clinically to increase gastric ______ and for the therapy of ______
esophagitis
* Concerns: may cause _______ (effect on the normal bacteria flora of the _______) and its routine use may promote antibacterial _______.

A

macrolide, bacterial, low, motilitin, motilitin, cholinergic, peptide, duodenal, ↑, stomach, proximal, emptying, reflux, diarrhea, intestine, resistance

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23
Q

Lidocaine
* It is a well-known ____ anesthetic. Lidocaine is used for ____
infiltration for ____ surgical procedures and to treat cardiac ______
* IV infusions of lidocaine improve intestinal _____ in ____
→ It reduces?

A

local, local, minor, arrhythmias, motility, horses, postoperative ileus

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24
Q

Postoperative ileus (widespread clinical problem) may be caused by?

A
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25
Q

How does lidocaine restore motility?

A
  • How lidocaine restores motility is not understood. It is said lidocaine does not have a direct prokinetic effect
  • It may act by inhibiting intestinal inflammation and reperfusion injury or via
    suppression of painful stimuli
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26
Q

What are the adverse effects of lidocaine?

A

Adverse effects
* Muscle fasciculation
* Ataxia and seizures ↓ rate of infusion

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27
Q

Name the Peripheral opiate antagonists:

A

alvimopan, methylnaltrexone, and naloxegol

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28
Q
  • Activation of opiate μ receptors in the intestinal smooth muscle ____ propulsive motility
  • μ-opiate receptors have been found in the _________ plexus, _______ plexus, and __________ muscle of ____
  • Activating these receptors has been used to treat some forms of _____ (e.g., _______)
  • Selective peripheral opiate antagonists act as peripheral opioid antagonists → they are unable to cross the ____ (______ polarity)
  • Alvimopan > methylnaltrexone → ______ and _____ of activity
  • Alvimopan is administered ____ → ___ bioavailability (6%) and produces a ____ effect on the intestine to promote ______.
  • Naloxegol is used for ____ treatment of ____-induced constipation
A

↓ , submucosal, myenteric, longitudinal, ileum, diarrhea, loperamide, BBB, high, potency, duration, orally, low, local, motility, oral, opioid

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29
Q

List the principal drugs used to manage GI ulceration in small and large animals.

A

Histamine (H2) receptors antagonists
sucralfate
proton pump inhibitors (omeprazole)
antacids

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30
Q

List the other clinical uses of the drugs typically used to treat GI ulcers in small and large animals.

Clinical uses
* ________
* _______ ulcers
* ____________ ulcers
* _________________ ulcer ________
* ______________
* ________ cells tumor
* _______________ syndromes
* Prevention and treatment of _____-induced ulcers
Gastric HCL secretion is _________ in carnivores rather than __________ as in humans

A

Clinical uses
* Gastritis
* Gastritis ulcers
* Duodenal ulcers
* Gastrointestinal ulcer prevention
* Esophagitis
* Mast cells tumor
* Hypergastrinemic syndromes
* Prevention and treatment of NSAID-induced ulcers
Gastric HCL secretion is intermittent in carnivores rather than continuous as in humans

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31
Q

Gastrointestinal ulceration
Gastrointestinal ulceration is an important medical problem in ____.
* Prevalance in animals involved in showing and racing → ___-___%
Contributing factors:
* ____ confinement
* Intense _____
* Diet (↑ ___ concentrated in diet)
* Racing ___
* _______ feeding schedule
* ↑ stomach ____
* Use of ____

A

horses, 81-93, Stall, exercise, energy, stress, Intermitent, acidity, NSAIDs

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32
Q

Drugs for Treatment of Gastrointestinal Ulcers in Animals
Antacids
* These drugs _______ stomach acid through a simple reaction to form ____ and
neutral ___
* Antacids are bases of either ?

Adverse effects
* _____ → they are seldom administered _____-term. They are not _______
* In animals with kidney disease, ________ accumulation may be a problem
* They interfere with the _____ absorption of other drugs → chelate with ___________ or ____________. Administer the AB __ h prior to the administration of the antacid drug

A

neutralize, water, salt, aluminium, magnesium, or calcium, Rare, long, absorbed, magnesium, oral, fluoroquinolones, tetracyclines, 2

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33
Q

List the effects of the following

A
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34
Q

The Histamine (H2) receptor antagonists are?

A

cimetidine, ranitidine, famotidine, and nizatidine

Christine Ran For Nuj

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35
Q
  • H2-receptor antagonists are _______, ______ inhibitors that reduce both the _______ and the ______ ion content of gastric secretion and the amount of pepsin
  • These drugs became popular after their release in the 1980s. Their use has declined → more _____ and _____-acting proton pump inhibitors
  • Blockade of histamine H2 receptors on gastric parietal cells inhibits gastric ____
  • In studies that have measured stomach acidity, or compared results with proton pump inhibitors ___-________ _______ were less effective
A

reversible, competitive, amount, hydrogen, potent, longer, acidity, H2-receptors antagonist

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36
Q

Acid secretion is stimulated by three receptors:

A
  1. Gastrin receptors: endocrine gastrin→ CCK
  2. Histamine type-2 (H2): paracrine
  3. Muscarinic receptor type-3 (M3): neuronal ACh
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37
Q
A

Inhibitors bind to proton pump and stop release of hydrogen.

38
Q

Use in small and large animals
* Cimetidine, the ____ drug in this group, has been administered to dogs at 10 mg/kg (IV, IM, or orally) every 6 to 8 h
* Among the H2-receptor antagonists, _____ and _____ inhibit anticolinesterase (AChE) activity and thus are _____ at antisecretory doses
* Clinical signs of ulceration may resolve within a few _____, but complete healing of the ulcers usually takes ___ to ___ days

A

oldest, ranitidine, nizatidine, prokinetic, days, 10, 14

39
Q

These drugs are not absorbed orally in ______ as well as in _____.

Ranitidine has been used in horses at a dose of 2.2 - 6.6 mg/Kg every 6 to 8 h

Cimetidine and ranitidine have been used in calves to maintain the ___ of the abomasum > 3.5.

Cimetidine 100 mg/Kg q 8 h, or ranitidine 50 mg/Kg q 8 h

A

horses, dogs, pH

40
Q

Adverse effects of Histamine (H2) receptor antagonists
* Side effects are ____ at usual dosages (even at relatively ___ doses)
* Anecdotal reports → ______ injection (IV) produced hemolytic anemia in ___, but when administered ___ over 5 minutes, there was no risk
* Drug interactions are possible → cimetidine _____ the clearance of other drugs
* Drug interactions → impair the ____ absorption of some drugs that require _____ (through the alteration of GI ___) → drug _______

A

minor, high, famotidine, cats, IV, inhibits, oral, acidity, pH, dissolution

STOPPED HERE TODAY ON 11/7

41
Q

Sucralfate
* Sucralfate dissociates in the acid milieu of the _____ to sucrose _____ and ____ hydroxide
* sucrose octasulfate polimerizes to a _____, ______ substance that binds to the ______ mucosa
* Sucralfate ↑ the mucosal synthesis of ________ → cytoprotective role
* It inactivates _____ and _______ bile acid
* Drug interaction: aluminum will chelate ____________ and ___________ → If they are needed, administer them first (30-2h prior to sucralfate)`

A

stomach, octasulfate, aluminium, viscous, sticky, ulcerated, prostaglandins, pepsin, adsorbs, fluoroquinolone, tetracycline

42
Q

Proton pump inhibitors (PPIs): Substituted benzimidazole
* The PPIs are the most _____ antisecretory drugs. ↓ _____ acid secretion by ___% to ___%
* They are potent and _______ antagonist of the ___,___,___ pump
* The PPIs are weak ____ and _______ and act as prodrugs in the physiological __ of the blood
* After systemic absorption, PPIs become trapped in the acidic _____ cells of the stomach.

A

potent, gastric, 80, 95, irreversible, H+-K+-ATPase, bases, unprotonated, pH, parietal

43
Q
A

PPIs that can be used. Only speaking about Omeprazole because functions of others are similar.

44
Q

Proton pump inhibitors (PPIs): Substituted benzimidazole
The inhibition of acid secretion is approx. ____% on day 1 of PPI administration
* Maximal inhibitory effect is thought to be achieved within approx. __-__ days

A

30, 2-4

45
Q

The effect of PPIs is ________ because acid secretion resumes only after ____ proton
pumps are synthesized in the ______ cells, which generally requires ___ to ___ hours,.

A

prolonged, new, parietal, 24, 48

46
Q

PPI: substituted benzimidazole
Clinical use
* PPIs are indicated to support ________ healing, prevention or treatment of ____________ reflux, treatment of _________ conditions
* Acid secretion is activated by ingestion of a ____ → administer PPIs __ min to __ h _____ to a meal to ensure maximal absorption
* If administered once daily, ______ administration is recommended because the prolonged fast results in _____ numbers of the ____, ____, ______ enzymes available to the secretory cannaliculi.
* There have been no benefits demonstrated for the co-administration of histamine H2 _______ and PPIs in animals
* All PPIs appear to inhibit a variety of _____ → caution when combining PPIs with other drugs metabolized by the _____.

A

gastroduodenal, gastroesophageal, hypersecretory, meal, 30, 1, prior, morning, higher, H+-K+-ATPase, antagonist, CYP enzymes, liver

47
Q

Adverse effects: as a result of chronic administration of PPI
* Because of loss of negative feedback mechanisms, gastrin levels are ______ (hypergastrinemia) → exert a _____ effect on the gastric mucosa
* Small intestinal bacterial overgrowth (SIBO). PPIs ___ population of bacteria by increasing the stomach pH → ______ syndromes and impaired vitamin ____ absorption
* At a dose of 1.1 mg/kg twice daily for 15 days ___ total bacteria in the duodenum (_________) and a ___ in stomach Helicobacter spp.
* Diarrhea is the most common adverse effect reported in ____ (but not in ____) and transient fluctuations in the ____ enzymes.

A

elevated, trophic, ↑ , malabsorption, B12, ↑, Lactobacillus, ↓, dogs, cats, liver

48
Q

Synthetic prostaglandins (PGE1): Misoprostol
* Prostaglandins of the E series inhibit gastric acid secretion by blocking ____ production through ____ receptors on _____ cells. Sucralfate can also stimulate production of this prostaglandin.
* It has been used in people to diminish the risk of ____ associated with NSAID therapy. Once ulcer is present, not as effective.
* In dogs, it prevents ______ hemorrhage and _____ associated with aspirin therapy, but has not been tested with other NSAIDs in small animals.

A

cAMP, EP3, parietal, ulcers, duodenal, ulceration

49
Q

Misoprostol stimulates mucous and ?

A
50
Q

Synthetic prostaglandins (PGE1): Misoprostol
* Misoprostol is helpful for preventing GI _____, but is ___ beneficial for treating ulcers once they occur
* ____, _____ and ____-induced gastric acid secretion is inhibit by misoprostol →___% to ___% of basal acid secretion may be inhibited (cytoprotective effect)
* Misoprostol can induce ______ contractions and is contraindicated in _______.

A

ulcers, less, Basal, nocturnal, food, 75, 85, uterine, pregnancy

51
Q

Drugs used to treat Helicobacter gastritis:
–> Treatment of gastritis and ulcers caused by the bacteria _________ _____ and ___________-like organisms has been used in animals that have not responded to other treatments. The role in disease in animals is not well documented.
* These organisms have been identified in biopsy specimens from dogs and cats
* In humans, Helicobacter spp. have the ability to decrease __-cells (D cells produce ________ which can inhibit production of gastric acids).
* Combination of metronidazole and/or clarothromycin, plus amoxicillin, and a PPI, or H2-receptor antagonist

A

Helicobacter pylori, Helicobacter, D, somatostatin

52
Q
A

3 important receptors involved in production of gastric acids: CCK, M3, Histamine 2 receptors.
Cimetidie can block this receptors
Omep can blockenzymes responsibel fro H secretion
Prostacclin stimulate production of Mucuous secretion but inhibit the production of ?

53
Q

Diarrhea is defined as an ________ in fecal water content resulting in increased _______, ______, or _____ of feces

A

increase, frequency, volume, fluidity

54
Q

Acute Diarrhea
______ onset in a previously ________ animal
* Lasts from __ days to __ weeks
* Self-limiting
* Resolves without _______

A

Sudden, healthy, 3, 2, consequences

55
Q

Chronic Diarrhea
* Lasts for over __ to __ weeks
* Associated with _______ passage of diarrheal stools
* Clinical signs:
* Eventually leads to weight ____ and chronic ______

A

3, 4, recurring, Fever, loss of appetite, nausea, and vomiting, loss, weakness

56
Q

The most important treatment for diarrhea should include:
* _____ therapy
* ______ replenishment
* Maintaining ___/___ balance
* Control of _______
Treatment may be needed to _______ relieve clinical signs
Many of the causes of diarrhea do ___ require drug therapy and the
disease is self-_____.

A

Fluid, Electrolyte, acid/base, discomfort, temporarily, not, limiting

57
Q

Mucosal protectants and adsorbents: ?

Protectants produce a coating of the GI epithelium that prevents _____ or ____ by potentially harmful substances.
________ bind chemical compounds → prevent the ______. They are eliminated in the feces

Kaolin-pectin formulation
* The action of kaolin-pectin is believed to be related to binding of bacterial _____ in the GI tract
* This product may change the _______ of stools, but it will not decrease ____ or _______
loss nor will it shorten the _______ of illness.
* Kao-Pectate formulations contain ______ as one of the active ingredients → some animals may be _______ to this.
* _______ may absorb or bind other drugs that are administered orally.

A

kaolin-pectin, bismuth subsalicylate

irritation, erosion, Adsorbents, absorption

toxins, consistency, fluid, electrolyte, duration, salicytate, sensitive, Pectin

58
Q

Bismuth subsalicylate: PeptoBismol
* It is considered to be a useful ________ treatment for _____ diarrhea
* It may have some ability to adsorb bacterial _______ and produce some gastric or intestinal _______ effect
* All of the salicylate from PeptoBismol is absorbed systemically when used in ____ and ____ → amount is unlikely to produce ________ ______ (overdoses)
* Bismuth also has an ___-_______ effect in the stomach
* Some animals may not like the _____
* PeptoBismol may turn the stools ___
* PeptoBismol has been administered for the treatment of acute diarrhea in large animals→ ____ and _____

A

symptomatic, acute, enterotoxins, protective, dogs, cats, salicylate, toxicity, anti- Helicobacter, taste, black, foals, calves

59
Q

Motility modifiers for treatment of diarrhea: anticholinergic drugs (antimuscarinic drugs)
These drugs _____ muscarinic action → antagonism of ___ and ____

  • ↓ Intestinal _____ and _____
  • ↓ Fluid secreted into the ______
  • ↓ abdominal ______
A

inhibit, M1, M3, motility, secretions, bowel, discomfort

60
Q

Stovepipe effect
With some forms of diarrhea these drugs may _______ the condition
The use of these drugs should be avoided if diarrhea is ________ (e.g., _________)

A

worsen, infectious, Salmonella

61
Q

List the anticholinergic drugs used to treat diarrhea. Name which are tertiary amines and quaternary amines.

A
62
Q

Motility modifiers for treatment of diarrhea: anticholinergic drugs (antimuscarinic drugs)
Adverse effects?
To avoid CNS effects → administer ______ amines
↓ _______ and they do not cross _____.

A
  • Systemic pharmacological effects
  • Ileus
  • Xerostomia
  • Urine retention
  • Cycloplegia
  • Tachycardia
  • CNS excitement

quaternary, lipophilicity, BBB

63
Q

Chronic administration of anticholinergic drugs (antimuscarinic drugs) can lead to stomach _______ and _______. Contraindicated in patients with _______ and _______

A

distention, discomfort, gastritis, vomiting

64
Q

Motility modifiers for treatment of diarrhea: _________ drugs (_________ drugs)
N-Butylscopolammonium bromide (Buscopan)
* It is an ___________ drug used for treatment of _____ (spasm of intestine) in horses
* It is also used to relax the _____ bowel → facilitate ______ examination and _________
* Within __-___ minutes of IV injection: ↓ intestinal ______ muscle contraction. Duration is _____ (___minutes)

Adverse effects
* ↑ in ____ rate (lasting for approx. __ min)
* It should not be used in horses with ______ or with ___

A

anticholinergic, antimuscarinic, antispasmodic, colic, large, rectal, colonoscopy, 5-10, smooth, short, 20, heart, 30, impaction, ileus

65
Q

Opioids
Endogenous _____ are also present in the intestinal wall → ?.
In cats enkephalin has been detected in both _____ and ____ plexuses.
In dogs the predominant location of enkephalin neurons is the ______ plexus
It is important to use opioids that produce ____ systemic effects

A

opioids, enkephalins, β-endorphin, and dynorphin, myenteric, submucosal, submucosal, little

66
Q

Opioids
* Opiotes act on the ___-type (____) and __-type (___) opiate receptors of the GI tract .
* They have both __________ and __________ actions
* ______-affinity, ________ binding of opioid receptors has been identified in longitudinal and circular smooth muscles and the myenteric and submucosal plexuses
* They __ propulsive intestinal contractions
* They __ the tone of GI sphincters
* Opiates have an ________ effect and stimulate absorption of ___, ______, and ____
* The effects on secretory diarrhea are caused by inhibition of ____ influx and ↓ ________ activity

A

μ, OP3, δ, OP1, antisecretory, antimotility, High, reversible, ↓, ↑, antisecretory, fluid, electrolytes, glucose, calcium, calmodulin

67
Q

The opioids ____________ ____________ and _____________ _____________ are used to treat diarrhea.

A

diphenoxylate hydrochloride, loperamide hydrochloride

68
Q
  • Diphenoxylate hydrochloride is a __________ derivate. It often administered in combination with ________ → _______ taste, ______ effect on salivary secretions → to discourage ______ by people
  • Diphenoxylate hydrochloride can penetrate the _______ → _______ opiate effects may occur
A

meperidine, atropine, bitter, drying, abuse, BBB, systemic

69
Q

Loperamide hydrochloride is a ________ derivate. It is the most often used (_____)
* Loperamide does not cause _______ nervous system opiated-related effects → __-___
* Intestinal _____ time and intestinal ______ capacity ↑ after treatment

A

butyramide, OTC, central, P-gp (also known as MDR1).

transit, luminal

70
Q

Diphenoxylate and loperamide hydrochloride are contraindicated in infectious _______ because opiates may significantly _____ the GI tract and increase the ______ of bacterial toxins.

A

diarrhea, slow, absorption

71
Q

Antimicrobial therapy for treatment of diarrhea
* The routine use of antimicrobial to treat diarrhea is _________ → a bacterial etiology cannot be identified
* Bacterial infection is not a major cause of ________ in small animals. In large animals diarrhea is often caused by bacteria ___._____
* Antimicrobials may _______ diarrhea → suppression of ______ microflora
* The used of antimicrobials should be based on a diagnosis of _____→ fecal gram staining
* Sufficiently severe ______ damage → bacterial translocation

IBI = Intestinal bacterial infection

A

questioned, diarrhea, E. Coli, worsen, normal, IBI, mucosal

72
Q

Enterotoxins are known to stimulate _______ secretions → production of ______

A

intestinal, cAMP

73
Q

Clinical signs of mucosal damage:

A
74
Q
A
75
Q

Antimicrobial therapy for treatment of diarrhea
Tylosin-responsive diarrhea
* Used to treat ____ diarrhea in dogs
* It affects both _____ and ______ bowel
* The specific _____ has not been identified
* __________ _____ and __________ _____ have been isolated

A

Chronic, large, small, etiology, Campylobacter jejuni and Clostridium perfringens

76
Q

The intestinal inflammatory diseases cover a wide range of etiologies grouped together.
Diseases can be caused by:

A
77
Q

IBD is characterized by infiltration of _______ cells in the ___ or ______ mucosa (____ or _____ intestine) –> Lymphocytic, plasmacytic, eosinophilic, neutrophilic

A

inflammatory, gastric, intestinal, small, large

78
Q

Drugs for Treatment of Inflammatory Intestinal Diseases
First steps:
→ ___________ therapy
→ _______ therapy (elimination of an _______ diet)
→ _______

When the first treatments have _____ or a specific etiology has not been identified, use:
→ __________ drugs
Initial medical management may vary with the severity and length of disease

A

Antiparasitic, Dietary, irritating, Probiotics, failed, Antiinflammatory

79
Q

Sulfasalazine is a combination of _______ and ___________ acid (mesalamine)

A

sulfapyridine, 5-aminosalicylic

80
Q

Sulfasalazine is used for the treatment of _____ → not as effective in _____ intestine
* The sulfonamide component is absorbed into the circulation and the salicylic acid remains active in the GI tract
* The intestinal anti-inflammatory effects → _______ inhibition (antilipooxygenase activity).
___ intestinal oxygen free radicals
* This drug cannot be used in patients that have allergic reactions to _________. In some dogs sulfonamide can produce ?

A

colitis, small, prostaglandin, ↓ , sulfonamides, keratoconjunctivitis sicca

81
Q

➢ Diagnosing colitis is based on _____ → to identify the predominant _______ cell
➢ Colitis is not usually associated with _______
Glucocorticoids: prednisolone
* It is believed that colitis is the result of _______ and ___-lymphocytes directed against the colonic _______ cells
* Corticosteroids suppress _____ synthesis, ______ migration, and _________ activation
* Budesonide is a ____ acting corticoisteroid used in people. The experience in dogs and cats has been ______, but there is some evidence of a ________ effect

A

biopsy, inflammatory, hypermotility, autoantibodies, T, epithelial, cytokine, leukocyte, lymphocyte, local, limited, beneficial

82
Q

___________ drugs: azathioprine

  • Azathioprine is metabolized to active metabolites → inhibit ________ lymphocytes suppressing ________ response
  • It has been used in dogs with __________ _____________ ______ disease
A

Immunosuppressive, activated, lymphocyte, severe inflammatory bowel

83
Q

__-__ ____ acid for colitis: eicosapentanoic acid
* The use of eicosapentanoic acid is beneficial (in people) for the treatment of _____
* Supplementation for ___ months reduced ________ levels in the colon. Clinical efficacy in ____ animals has not been reported.

A

N-3 fatty, colitis, 4, leukotriene, small

84
Q

___________ and ______ are drugs that increase the motility of bowel and change the character of the stool.

A

Laxatives, cathartics

85
Q

Laxatives and cathartics can be divided into:
* Bulk-________ laxatives
* Stool ______
* ________
* Saline _________ agents
* _________
These drugs promote the elimination of ____-form stool or increase ___
content of stool

A

forming, softener, Lubricants, hyperosmotic, Stimulants, soft, fluid

86
Q

Stimulant (irritant) laxatives: __________
* They cause __________ loss by inhibiting ___/___/_____ in the intestine
* They are ______ acting drugs
* Adverse effects can result from damage to ________ (____ use)

A

anthraquinone, electrolyte, Na+/K+-ATPase, rapid, enterocytes, chronic

87
Q

Hyperosmotic cathartics (saline cathartics)
* They are _______ electrolytes that draw fluid into the bowel via _______
* Onset of action __-___ h
* They cause intestinal ______. ↑ normal ______
* These drugs have been used to prepare animals for an ______ procedure or for treatment of _________

A

nonabsorbed, osmosis, 1- 3, distention, peristalsis, endoscopic, poisoning

88
Q

Bulk-forming laxatives: dietary plant fibers → _______

  • These agents are composed of _______ synthetic or natural _______ and ______ derivatives
  • They are resistant to ______ and attract ____ into the _____
  • These agents are more _____ acting (___ hr or ____)
A

carboxymethylcellulose, nonabsorbed, polysaccharide, cellulose, digestion, water, intestine, slow, 24, longer

89
Q

Lubricants: mineral ___ and liquid _____ (white petrolatum = _____)
* These agents act by coating the _____ of the stool with a water- _________ film
* They ↑ the ____ content of the stool
* The lubricant laxatives are ______ safe. Absorption from ___ tract in a small extent
* ______ ___ are popular for nonspecific GI problems in horses and cattle
* They are used for increasing the passage of _______ (___ balls) in cats

A

oil, petrolatum, vaseline, surface, immiscible, water, relatively, GI, Mineral oils, trichobezoars, hair

90
Q

Stool softeners (surfactants)
* These drugs act to _______ surface tension and allow more ____ to accumulate in the stool
* ______ _____ and _________ ______ are used to soften the stool
* Bile acids (__________ acid and __________ acid) produce both a choleretic (↑ ____ flow) and laxative effect
* _________ acid has an important effect in improving liver disease
* Castor oil is _______ in the bowel → release ______ acid causing an increased secretion of water in the small intestine

A

decreased, water, Docusate sodium, docusate calcium, dehydrocholic, ursodeoxycholic, bile, ursodeoxycholic, hydrolyzed, ricinoleic

91
Q

True or False
Regarding the proton pump inhibitors, the binding to the carrier is irreversible and restoration of acid secretion requires the novo synthesis of ATPase by the parietal cells.

A

True

92
Q

True or False
The SIBO effect may be a result of PPI administration.

A

True

Intro to Pharmacology (31 decks)

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