GIPharm

Question 1

what controls the urge for food seeking, hunger/appetite, and satiety center

Answer 1

Hypothalamus

Question 2

when is it appropriate to use appetite stimulants?

Answer 2

• when a feeding tube cannot be places

- when underlying cause of anorexia or hyporexia has been removed but patient is still not eating.

Question 3

what is the MOA of cyproheptadine, and what is it used for?

Answer 3

Cyproheptadine is an apetite stimulant, and is a 5-HT (serotonin) antiagonist that inhibits the satiety center.

Question 4

what are some adverse affects of giving cyproheptadine, an appetitie stimulant?

Answer 4

• sedation

- anticholenergic effects (dry mucous membranes)

Question 5

when would you use mirtazapine?

Answer 5

it is used as an appetite stimulants

Question 6

what is the MOA of mirtazapine

Answer 6

• 5HT (serotonin) antagonist (antinausea effect, increased appetite)
• alpha adrenergic receptor antagonist (increased norepinephrine leading to increased appetite)
• H1 receptors (sedation)

Question 7

what is the most effective drug we have for appetite stimulant?

Answer 7

mirtazapine

Question 8

how often is mirtazapine dosed?

Answer 8

dosed every 3 days to reduce the risk of side effects

Question 9

what is capromorelin used for and what is it’s MOA

Answer 9

it is an appetite stimulant, and is a ghrelin receptor agonist

• only for used in dogs

Question 10

what is the most effective appetite stimulant for cats?

Answer 10

diazepam

Question 11

what receptors are found in the CRTZ

Answer 11

▪ Neurokinergic (NK1) 
▪ Serotonergic (5HT3) 
▪ Adrenergic (a2) 
▪ Dopaminergic (D2)
▪ Cholinergic (M1)
▪ Histaminergic (H1)

Question 12

what receptors are found in the emetic/vomiting center?

Answer 12

▪ Neurokinergic (NK1)
▪ Serotonergic (5HT3)
▪ Adrenergic (a2)

Question 13

what is apomorphine used for, and how does it work?

Answer 13

it is used as an emetic that stimulates the dopamine (D2) receptors in the CRTZ

Question 14

what is the drug of choice to cause emesis in cats and it’s MOA

Answer 14

• xylazine

- it is an alpha 2 agonist

Question 15

T or F
All emetics carry a risk of aspiration pneumonia especially in recumbent, sedated,
or very ill patients

Answer 15

True

Question 16

what is Metoclopramide used for? and what is it’s MOA

Answer 16

• it is an antiemetic
• serotonin antagonist (works better in dogs than cats)
  
  • promotility agent

Question 17

I am a NK1 receptor antagonist that inhibits substance P and works directly at the emetic center, and is generally used to treat motion sickness, chemotherapy induced nausea, and other causes neausea.

Answer 17

Maropitant (cerenia)

Question 18

what is ondansetron used for and what is it’s MOA

Answer 18

it is an antiemetics, that is a serotonin antagonists (much better than metoclopramide)

has to be dosed to 4x’s daily

Question 19

what are your options for antacids? and what is their MOA

Answer 19

• Aluminum hydroxide (Mylanta)
• Magnesium hydroxide (Milk of Magnesia)
• Calcium Carbonate (Tums)

these do not decrease the acid production, only neutralize it. Tums is the best/safest option.

Question 20

T or F

the disadvantage of using calcium carbonate is that it can be absorbed systemically and can cause alkalosis

Answer 20

True

Question 21

what drug options do you have if you need to prescribe a H2 antagonists

Answer 21

• famotidine
• ranitidine
• cimetidine
• nizatidine

Question 22

what are some advantages and disadvantages of using aluminum hydroxide

Answer 22

advantages is that it is not systemically absorbed, but it will cause drug interactions

Question 23

what are some advantages and disadvantages of using magnesium hydroxide?

Answer 23

it is more effective than Al hydroxide but can cause diarrhea, drug interactions, and is systemically absorbed

Question 24

what is cimetidine used for and what is it’s MOA

Answer 24

• it is an H2 antagonist that is the least potent, and shortest acting.
• it inhibits CYP 450 and can affect hepatic blood flow

Question 25

what is ranitidine used for and what is it's MOA

Answer 25

- it is an H2 antagonist blocker with intermediate potency - drug interactions are less likely than with cimetidine - has prokinetic effects (due to inhibition of AChE

Question 26

what are the two most potent H2 antagonists?

Answer 26

- famotidine | - nizatidine

Question 27

what are some side effects of famotidine

Answer 27

- bradycardia - can cause hemolysis in cats but does not inhibit CYP 450

Question 28

what are the H2 antagonists classically used for?

Answer 28

- uremic patients - mast cell tumors (histamine) - gastroesophageal reflux

Question 29

T or F | Famotidine should only be used for a couple days

Answer 29

True Famotidine only effective at increasing gastric pH for 2 days at high doses ▪Proton pump inhibitors are preferred

Question 30

if you had to prescribe a proton pump inhibitor what drug options should you choose from? which is considered the most effective?

Answer 30

- omeprazole (prilosec) given PO - pantoprazole (protonix) given IV Should give Omeprazole

Question 31

what are some drug interactions for Omeprazole

Answer 31

- inhibits CYP 450 and is the oral drug of choice for treating ulcers and esophagitis

Question 32

what is the IV drug of choice for treating ulcers and esophagitis?

Answer 32

Pantoprazole - it also has no reported inhibited CYP 450 effects

Question 33

what is misoprostal used for, and what effects does it have?

Answer 33

it is a mucosal protectant - inhibits gastric acid secretions - increases bicarb secreation - increases mucus secretion - increases gastric blood flow

Question 34

what would be a clinical indication for the use of misoprostal

Answer 34

- treatment and prevention of NSAID induced ulcers

Question 35

what are some adverse effects of using Misoprostal

Answer 35

- GI distress (abdimonal pain, diarrhea, nausea) - uterine contractions, vaginal bleeding, induction of parturition - can have a risk to women

Question 36

what is sucralfate used for and how does it work

Answer 36

mucosal protectant that binds to epithelial cell membranes and protects against HCl, bile and pepsin

Question 37

what is the net effect of adrenergic receptors

Answer 37

these are sympathetic tone receptors which inhibit motility

Question 38

what is the net effect of cholinergic receptors

Answer 38

these are parasympathetic receptors which will enhance motility

Question 39

what is the MOA of metoclopramide

Answer 39

it is a serotonin antagonist that sensitizes the GI smooth muscle to the effects of acetylcholine

Question 40

what are some clinical uses for metoclopramide

Answer 40

- ileus - GDV - delayed gastric emptying - gastroesophageal reflux

Question 41

what are some clinical uses for cisapride

Answer 41

cisapride enhances ACh release from intrinsic cholinergic neurons and is used for - megaesophagus in cats - gastroesophageal reflux - delayed gastric emptying - ileus - megacolon in cats

Question 42

why might you not use cisapride for the treatment of megaesophagus in dogs?

Answer 42

the dog esophagus is primarily made of skeletal muscle, which is in contrast to cats. Cisapride has action on smooth muscle and therefore would not have an effect in dogs.

Question 43

what condition would your prescribe ranitidine

Answer 43

- ileus - gastroesophageal reflux this drug primarily effects the Stomach, but has overall GI effects

Question 44

what is the MOA of Ranitidine

Answer 44

inhibition of acecholinesterase activity. | Also H2 receptor antagonist.

Question 45

what is the MOA of Nizatidine

Answer 45

H2 receptor blocker that inhibits acetylcholinesterase activity

Question 46

what clinical reasons would you use nizatidine

Answer 46

- delayed gastric emptying - constipation - pseudo-obstruction of the intestines - gastroesophageal reflux

Question 47

T or F Erythromycin can be used for prokinetic proposes in the distal GI track.

Answer 47

FALSE Whilt is it true that erythromycin does have prokinetic effects, it is less effective in the distal GI tract due to the lack of motilin receptors

Question 48

what are some clinical uses for Erythromycin

Answer 48

- delayed gastric emptying - gastroesophageal reflux - decreased colonic motility (dogs only) it is not commonly used in small animals

Question 49

Although Bethanechol is not typically used for GI motility, what can we use it for?

Answer 49

- used to improve bladder contractility | - potential used in megaesophagus

Question 50

what are the adverse effects of bethanechol

Answer 50

- bradycardia - increased gastric acid secretion - increased pancreatic secretions - SLUD

Question 51

what 2 opoids can you for their antidiarrheal effects

Answer 51

- diphenoxylate | - loperamide

Question 52

what are some adverse reactions for loperamide

Answer 52

it is an opoid what caus- es decreased GI motility - reactions in dogs with MDR1 mutation - Dogs - constipation, bload, sedation - cats - not recommended due to excitation behavior

Question 53

what is the MOA of laxatives

Answer 53

- they increase hydration of fecal mass | - Lubricate

Question 54

What type of enema should never be used in cats

Answer 54

Phosphate enemas

Question 55

under what cercumstances would you prescribe ursodeoxycholic acid

Answer 55

ursodeoxycholic acid or ursodiol is a water soluble bile acid used in - cholestasis gallbladder sludge mucoceles

Question 56

what is the MOA of ursodiol

Answer 56

- decreases hepatic synthesis and secretion of cholesterol - increases bile flow reduces hepatotoxic effects of bile salts

Question 57

what two drugs can you give to help protect the liver

Answer 57

- S-adenosyle methionine (SAMe) | - Silymarin (milk thistle)