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GIT Drugs Flashcards

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1
Q

What should antiemetic therapy only be considered as?

A

Symptomatic therapy

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2
Q

With vomiting what should be done while providing antiemetic therapy?

A

Determine and resolve underlying disease process

Antiemetic therapy only managing clinical signs

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3
Q

In what three things are antiemetic therapies inappropriate to use?

A

GI infections

  • May prolong infection

GI obstruction

  • Could increase motility resulting in perforation

GI toxicity

  • May prevent patient from eliminating toxin
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4
Q

When would antiemetics be considered with GI toxicity?

A

If animal has eliminated toxin already and vomiting is a secondary response

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5
Q

Where is vomiting coordinated?

A

Vomiting centre in medulla

Various nuclei

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6
Q

What areas feed back to the vomiting centre?

A

Chemoreceptor trigger zone

  • No blood-brain barrier

Peripheral receptors

  • Highest in duodenum but go down to large intestine

Toxins

Vestibular

  • Motion
  • Inner ear infection

Higher CNS

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7
Q

What differs between the different systems that feedback to the vomiting centre?

A

Neurotransmitter - need to know for different antiemetics

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8
Q

On what does the most common antiemetic in small animals act?

A

Nucleus tractus solitarius

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9
Q

What are the more important neurotransmitters in dogs?

A

D2 receptors in chemoreceptor trigger zone

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10
Q

What is apomorphine a more potent emetic agent in and on what does it act?

A

More potent in dogs

Doesn’t work in cats

D2-dopamine receptor agonist

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11
Q

Which neurotransmitters are more important in the cat and what are two drugs that are potent?

A

Alpha2-adrenergic receptors in CRTZ

Xylazine and prochlorperazine

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12
Q

Is histamine a more potent emetic in the dog or cat?

A

Dog

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13
Q

What are the 6 classes of antiemetic drugs?

A

NK1 antagonists

Metoclopramide

Phenothiazines

Antihistamines

5HT3 antagonists

Anticholinergics

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14
Q

What does Maropitant work on?

A

Nucleus tractus solitarius

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15
Q

What is Maropitant an effective antiemetic for in dogs?

A

Acute gastroenteritis

Cytotoxic-induced vomiting

Motion sickness - needs higher dose

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16
Q

Describe how Maropitant acts

A

Selective antagonist of Substance P at the NK1 receptor

Inhibits final common pathway involved in activating the vomiting reflex in CNS

Doesn’t matter about the source of vomiting stimulus

Effective against both peripheral and central stimuli

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17
Q

If vomiting persists with Maropitant use what needs to be determined?

A

The cause of vomiting

Drug only treating symptom not cause

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18
Q

What are the three places Metoclopramide acts?

A

D2 dopaminergic receptors

5HT3-serotonergic receptors

Peripheral pro-cholinergic effect

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19
Q

What is Metoclopramide indicated for?

A

Various emesis-inducing disorders involving central or peripheral activation of vomiting

Cancer chemotherapy

Gastroesophageal reflux

Decreased gastric emptying

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20
Q

How does metoclopramide prevent gastroesophageal reflux?

A

Flushing system empties stomach

Gastroesophageal reflux just doesn’t occur

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21
Q

What is decreased gastric emptying associated with?

A

Inflammatory gastrointestinal disorders

Gastric ulcers

Gastric neoplasia

Autonomic neuropathy (diabetes mellitus)

Pyloric stenosis

Postoperative gastric volvulus patient

Hypokalaemia

Abnormal gastric motility

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22
Q

Which drugs are not registered for animal use in the UK?

A

Phenothiazines

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23
Q

Which receptors do phenothiazines antagonise?

A

Alpha 1 and 2 adrenergic receptors4

D2 dopaminergic receptors

H1 and 2 histaminergic receptors

Muscarinic cholinergic receptors

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24
Q

What are the indications for phenothiazines?

A

Any central or peripheral cause of vomiting

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25
What do antihistamines act upon and what would they be used for?
H1 and H2 receptors in the chemoreceptor trigger zone Used for motion sickness in the dog not the cat
26
What are 5HT3 antagonists used to control?
Cytotoxic drug induced emesis
27
What are some examples of 5HT3 antagonists?
Dolasetron (Anzemet) Ondansatron (Zofran)
28
What are anticholinergics effective for?
Motion sickness Antagonism of M1 receptors in vestibular apparatus
29
What is the major problem associated with anticholinergics?
Effect on M2 receptors Result in potential for delayed gastric emptying and ileus (disruption of normal emptying)
30
What are 5 anti-ulcer drugs?
Nonsystemic antacids H2 receptor antagonists Sucralfate Misoprostol Omeprazole
31
Describe non-systemic antacid use
Inexpensive drugs Frequent oral administration - every 4 hours Treats but doesn't prevent
32
What are the three H2 receptor antagonists?
Cimetidine Ranitidine Famotidine
33
What are H2-receptor antagonists effective in treating?
Gastric ulceration caused by a variety of disorders * NSAIDs * Uraemia
34
What should we base our choice of H2 receptor antagonists on?
Cost Client convenience Concurrent drug therapy
35
What is sulcralfate indicated for?
Symptomatic treatment of gastric ulceration
36
What is Misoprostol?
Synthetic PGE1
37
What is the main indication for Misoprostol?
Management or prevention of NSAID toxicity
38
What does Misoprostol cause and why is it a safety issue?
Causes abortion Issue in relation to who should handle the drug
39
What is Omeprazole?
Proton pump inhibitor
40
Describe the use of Omeprazole in small animal veterinary medicine
Use is increasingly common but off label Ulcers or oesophagitis refractory to ther anti-ulcers Ulcers associated with gastrinomas or mast cell tumours
41
What is Gastroguard (omeprazole) used for?
Equine medicine for treatment and prevention of gastric ulcers
42
What do electrolyte solutions enhance?
Fluid absorption from the gut
43
What do electrolyte solutions depend on and are linked to?
Depend on active absorption of glucose and aminoacetic acid in small intestine Directly linked with water and sodium movement
44
What are the two types of motility modifying drugs?
Opioids Anticholinergics
45
What do opioids do?
Increase segmental contractions in gut (random/multi-directional) Prolong intestinal transit time Theoretically allow greater time for fluid to be absorbed
46
What do anticholinergics do within the gut?
Decrease peristalsis
47
What can opioids be effective for?
Symptomatic treatment * Relieve abdominal pain and tenesmus * Reduce defecation frequency
48
What are anticholinergics used little in?
Management of diarrhoea in dogs and cats
49
What are anticholinergics used in?
Management of spasmodic colic in horses
50
Which GIT drugs need to be avoided in cats?
Adsorbents Protectants
51
What are the dose rates of maropitant in dogs for prevention/treatment of emesis due to central/peripheral stimuli?
2mg/kg PO daily for up to 5 days 1mg/kg SC daily for up to 5 days
52
What is the dose rate for maropitant in the prevention of motion sickness?
8mg/kg PO daily for maximum of two days
53
How does metoclopramide cause increased gastric emptying?
Promotes release and increased sensitivity to acetylcholine in smooth muscle Results in: * Increased tone of lower oesophageal sphincter * Increased strength of oesophageal contractions * Increased gastric antral contractions * Relaxation of pylorus * Increased smooth muscle contraction in duodenum
54
What are the side effects of metoclopramide?
Infrequently cause mental changes * Hyperactivity * Aggression * Depression May cause gastric spasm and enhance vomiting
55
What are the side effects associated with antihistamines?
Drowsiness Xerostomia (dry mouth)
56
What are the side effects of phenothiazines?
Hypotension due to alpha-adrenergic receptor blocking action
57
What shouldn't anticholinergic drugs be used in?
Dogs with parvovirus
58
What could long term use of H2 antagonists cause?
Hypoacidity and bacterial overgrowth in the stomach Not a clinical concern
59
What should be done with H2 antagonists in patients with impaired renal function?
Dose should be reduced by 50%
60
What do calcium, magnesium and aluminium containing antacids tend to promote?
**Calcium** * Constipation **Magnesium** * Looser faeces **Aluminium** * Reduced gastric motility * Delay of gastric emtpying
61
What may administration of excessive calcium-containing antacids predispose the patient to?
Renal caliculi
62
What are the treatments for vomiting in both chronic and acute cases?
Chronic * Find underlying causes Acute * Fasting * Symptomatic treatment
63
What are the three things that drugs used to treat vomiting tend to affect?
Proton-pump inhibitors Anti-histamines Anti-cholinergics
64
Describe Sucralfate and what it is used in the treatment of
Aluminium hydroxide and sucrose octasulfate Dissociates in acid Causes binding to exudate at ulcer sites Forms a protective barrier and stimulates HCO3, mucus and prostaglandin secretion Used in treatment of oesophageal and gastric ulceration
65
What are the dose rates of Sucralfate in dogs?
\<20kg: 0.5mg/dog \>20kg: 1mg/dog
66
What are three HA receptor antagonists used to treat vomiting?
Cimetidine Ranitidine Famotidine
67
Describe the actions of cimetidine/ranitidine/famotidine
Inhibits gastric acid Some gastric prokinetic activity Used frequently to treat any sort of regurgitation/vomiting
68
What is a proton pump inhibitor used for treatment of vomiting?
Omeprazole
69
Describe the action and use of omeprazole
Proton pump inhibitor Binds parietal cells blocking H+/K+ Inhibits transport of H+ into the stomach Used for: * Gastric hyperacidity * GI ulcers * Erosions * Gastrinomas
70
What is another name for a gastrinoma?
Zollinger-Ellison syndrome
71
When should anti-emetic therapy be used?
Debilitating vomiting Animal in pain Marked fluid/electrolyte loss
72
What is the most appropriate anti-emetic treatment?
Management of the underlying disease Though the cause cannot always be determined in all patients
73
Why might anti-emetic therapy not always be desirable?
Vomiting can be protective so may not want to get rid of it
74
Describe the action and use of metoclopramide
Para-aminobenzoic acid derivative Central and GI effect Antagonises D2-dopaminergic & 5-HT3 receptors Upper GI prokinetic agent Can come in tablets, suspension or injection
75
What is a 5-HT3-serotonergic antagonist used for treating vomiting?
Ondansetron
76
What is the best anti-emetic for chemotherapy induced nausea and vomiting?
Ondansetron
77
What is Ondansetron good for?
Chemotherapy-induced nausea and vomiting Pancreatitis
78
What is a neurokinin-1 receptor antagonist?
Maropitant
79
Describe the action and use of Maropitant
Neurokinin-1 receptor antagonist Central and peripheral effects Stops substance P binding Very potent! Useful in any kind of vomiting
80
What is Maropitant licensed for use in and what are the dose rates?
Licensed in dogs - soon in cats Dose is 1mg/kg sub-cutaneous every 24hrs 2mg/kg orally every 24 hours
81
What are some surgical emergencies with small animal abdominal pains?
Septic peritonitis Risk of septic peritonitis Gastric dilatation and volvulus Metabolic emergency Vascular emergency Pyometra Dystocia
82
What are the pros and cons of pure opioids ans analgesia?
**Pros:** * Very good * Reversible * Sedation * Constant rate infusion **Cons:** * Sedation * Decrease GIT motility * Nausea * Injectable
83
What are the pros and cons of using partial agonist opioids for analgesia in small animals?
**Pro:** * Good analgesia * Minimal sedation * Less effect on GIT motility * Good transmucosal absorption in cats **Cons:** * Some sedation * Can decrease GIT motility
84
What are the pros and cons of using NSAIDs for analgesia in small animals?
**Pros:** * Anti-inflammatory * No sedation **Cons:** * Renal toxicity * GIT toxicity

Pharmacology (3 decks)

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