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PHARMACOLOGY - 2 > 20 – Vomiting and Diarrhea > Flashcards

20 – Vomiting and Diarrhea Flashcards

1
Q

Why is vomiting a good thing (what causes you to vomit)?

A
  • Removal of toxic/irritant material
  • Prevention of gastric rupture with ‘obstruction’
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2
Q

Where is the emetic center located?

A
  • In the medulla
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3
Q

What are some things that cause you to vomit?

A
  • Info from pharynx, viscera, cerebral cortex
  • *important to know what is causing it to know how to TREAT it
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4
Q

When are emetics commonly used?

A
  • After toxin ingestion
    o More rational to use right after toxin ingestion
  • Little evidence to demonstrate efficacy
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5
Q

What are some examples of emetics?

A
  • *Apomorphine
  • Alpha-2 agonists (emetic for cats via IM injection): CRTZ
    o Xylazine and Dexmedetomidine (50% in cats)
  • For people to try at home
    o Hydrogen peroxide (dogs)
    o Saturated salt solution (dogs)
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6
Q

What is Syrup of Ipecac

A
  • Causes GI irritation leading to vomiting
  • NOT really used in vet med
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7
Q

Apomorphine

A
  • Dopamine agonist in CRTZ (chemoreceptor trigger zone)
  • 90% effective in dogs
    o Less effective in cats
  • Administered in IV (or conjunctiva=no one does it)
  • *no analgesia (not a controlled drug)
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8
Q

What are opioids that may be used to induce vomiting?

A
  • Morphine
  • Hydromorphone (anesthesia pre-med)
  • *why fast before surgery
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9
Q

What are some reasons animals get sick (and vomit)?

A
  • Motion sickness
  • Parvo virus
  • Gastroenteritis
  • Chemotherapy
  • Uremia: cats with renal failure
  • Hair balls
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10
Q

What are the phenothiazine drugs (sedatives) that can STOP vomiting?

A
  • Acepromazine: injectable and powder only
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11
Q

What does acepromazine do?

A
  • Antagonizes dopamine
    o Inhibits the CTZ
  • Can DECREASE vomiting from OTHER CAUSES (ex. motion sickness)
    o When sleeping=don’t get motion sick
  • Anti-histamine: dogs
  • Weak anticholinergic: cats
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12
Q

What are the adverse drug events with Acepromazine?

A
  • Hypotension due to alpha-adrenergic blocks
  • Excessive sedation
  • Extrapyramidal signs (aggression)
  • Lowers seizure threshold in epileptics
  • Prolapsed 3rd eyelid, CYP-mediated drug interactions
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13
Q

Anticholinergic drugs

A
  • Block cholinergic afferent pathways from GI tract and vestibular system to emetic center
  • *humans NOT animals
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14
Q

Antihistamines (H1 blockers)

A
  • Block nerve transimission responsible fro transmission of VESTIBULAR STIMULI to the emtic center
  • Mild sedation
    o Ex. Benedryl, Gravol
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15
Q

Metoclopramide (injectable solution)

A
  • Low doses: inhibits DOPAMINE in CNS
  • Peripheral prokinetic effect: increases gastric acid and upper duodenal emptying
  • High doses: inhibits serotonin receptors in CRTZ
  • *was popular in small animals, but highly VARIABLE PK
  • Extrapyramidal effects
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16
Q

Ondansetron

A
  • Very potent anti-emetic
  • Very expensive! ($200/vial (one dose))
  • *inhibits 5-HT1 (serotonin) receptors on vagal nerve and CRTZ
  • *very good for chemotherapy, NOT motion sickness induced vomitting
17
Q

Why is Ondansetron useful as an anti-emetic during chemotherapy?

A
  • Cytotoxic drugs and radiation releases serotonin from enterochromaffin cells in small intestine
18
Q

Maropitant (Cerenia)

A
  • Neurokinin (NK1) receptor ANTAGONIST
    o Blocks binding of substance P (tachykinin) at emetic center
  • *works with various causes of emesis: stops everything causing vomiting
  • *acute vomiting (2mg/kg): dogs and cats
  • *motion sickness (8mg/kg=higher dose): dogs ONLY
    o Still probably going to use acepromazine
19
Q

Other uses of Maropitant?

A
  • May have analgesic and anti-inflammatory effects
    o Blocks substance P
  • May reduce inhalation anesthesia (MAC)
  • *NOT CONSISTENT
20
Q

What are the 3 parts of diarrhea treatment?

A
  1. Fluid therapy
  2. Electrolytes
  3. Acid/base treat
21
Q

Fluid therapy to treat diarrhea

A
  • *MOST IMPORTANT
  • Diarhea does NOT kill animal, dehydration and acidosis does!
  • Oral, IV, subcutaneous, etc.
22
Q

What must an oral rehydration therapy contain?

A
  • Water
  • Na
  • Cotransporter
  • *no matter how damage the mucosa is=the rehydration will go through
23
Q

How does Na enter the mucosa cell (4 ways)?

A
  • Na channel
  • Na-glucose co-transport (SGLT1)
  • Na-amino acid co-transport
  • Na-H+ exchanger (NHE3)
  • *use COTRANSPORT to maximize Na absorption!
24
Q

Electrolytes to treat diarrhea

A
  • Replace Na, Cl and probably K
25
Q

Acid/base balance treatment for diarrhea

A
  • Bicarbonate to treat ACIDOSIS
    o Can’t just give it orally
  • Metabolizable substrates that provide bicarb
    o Ex. citrate, propionate, acetate
    *usually more in calves
26
Q

Calf-lyte for calves contains

A
  • Lots of dextrose
  • NaCl
  • Glycine (AA)
  • Some K
  • Sodium acetate: bicarb donor
27
Q

What do people use to treat diarrhea?

A
  • Kaolin-Pectin: ‘chalk solution’
    o ‘sooth gut’
    o Used to mix morphine in it
  • Activated charcoal
  • Bismuth subsalicylate (Pepto-bismol): ‘travellers diarrhea’
    o Bismuth: coating (turn feces black)
    o Aspirin: anti-PGE
    o NO EVIDENCE
28
Q

Anticholinergic drugs to help with diarrhea?

A
  • Decrease intestinal motility and secretions
  • BUT: there are very few cases of diarrhea that are hypermotile
    o May actually worsen it be creating a ‘stove pipe’ effect
  • Systemic side effects (ex. tachycardia)
29
Q

Hyoscine butylbromide (Buscopan)

A
  • Antispasmodic and anticholinergic for horses
  • Colic to supress spasms
  • NO EVIDENCE as an anti-diarrheal
  • Can cause tachycardia and decrease gut sounds
30
Q

Opioids

A
  • Anti-secretoy and anit-motility effects by action on mu-receptors in GIT
  • Decrease intestinal contractions and increase segmentation=overall constipating effects
  • Increase tone of GI sphincters
  • Stimulate absorption of fluid and electrolytes
31
Q

What is an example of an opioid that may ‘treat’ diarrhea?

A
  • Loperamide (Imodium)
  • (Diphenoxylate)
  • (Paregoric)
32
Q

Loperamide (Imodium)

A
  • Maybe works? But normally your diarrhea will go away in a day or two
  • *don’t use with infectious diarrhea or dogs with ABC-B1 deletion
33
Q

Antimicrobial therapy for diarrhea

A
  • Only use those for KNOWN BACTEIAL CAUSES
  • But they can often CAUSE DIARRHEA
    o Bacterial flora is screwed up already and you’ll impact that more (ex. Nuflor, Baytril)
  • *may result in ‘carrier’ animals (ex. Salmonella, Campylobacter)
34
Q

What can happen in animals who are profoundly diarrheic?

A
  • breakdown in barrier and may be able to translocated into the blood=secondary septicemia
  • *use antibiotics to treat the secondary septicemia and NOT for the diarrhea
  • Ex. neonatal calf with not enough colostrum
  • Ex. parvo puppies
35
Q

Beware of OTC calf scour boluses!

A
  • Don’t bother
  • *not providing them with any fluids
  • May likely be a viral infection and wont work anyways
  • MOST will get better on their own without treatment
36
Q

NSAIDs for diarrhea

A
  • Meloxicam label claim for calf diarrhea (w/oral fluid therapy )
  • Ketoprofen
  • Flunixin: only when blood present in feces
  • *risk of renal adverse events=will reduce renal blood flow even more!
    o Do NOT be dehydrated and take NSAIDs
  • *may help if there is inflammation in the gut, but often that is not the case
37
Q

Meloxicam for dairy calves with naturally-occurring diarrhea?

A
  • Increased appetite
  • Faster rate of grain
  • No change in weaning weight
  • *maybe just makes you fell slightly better
38
Q

Crofelemer (Canalevia-CA1) in USA

A
  • Conditionally approved for chemotherapy-induced diarrhea in dogs
  • Botanical mixture in a delayed-release oral tablet
  • Inhibits channels to reduce ion flux=reduced osmotic gradient in lumen=decrease fluid efflux
39
Q

NOTHING REALLY WORKS TO TREAT DIARRHEA, GIVE THEM FLUIDS!

A
  • Still give food orally=can help the gut lining heal faster
  • *small amounts of highly digestible food (ex. chicken and rice)

PHARMACOLOGY - 2 (16 decks)

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