9.5.2: Why is this patient vomiting?

Question 1

Maropitant
Use, formulation, species, other notes

Answer 1

Maropitant (POM-V)
* Anti-emetic
* Injection, tablets
* Cats and dogs
* Can sting on injection

Question 2

Metoclopramide
Use, formulation, species, other notes

Answer 2

Metoclopramide (POM-V)
* Injection and oral solution
* Anti-emetic via central dopamine (D2) and at higher dose serotonin (5HT3) antagonism in the CRTZ - dogs and cats
* Also a prokinetic in rabbits
* Injection is light sensitive (need to obscure bag if CRI)
* Activity may be inhibited by narcotic analgesics

Question 3

Apomorphine
Uses, formulation, species, other notes

Answer 3

Apomorphine (POM-V)
* Injection; other forms off license
* Stimulates emesis through D2 receptors in CRTZ
* Used in dogs, not recommended in cats
* Possible adverse reaction = dose dependent hypertension
* Should be avoided in possibly ivermectin sensitive (MDR1) collies as they are more susceptible to its effects

Question 4

Xylazine
Uses, formulation, species, other notes

Answer 4

Xylazine (POM-V)
* Injection
* Sedation and premed; also has been used to induce self-limiting emesis in cats (rapid; within 10 mins)
* Used in cats and dogs
* Do not use in animals with systemic CV disease, or if geriatric, pregnant, or diabetic

Question 5

Lactulose
Uses, formulation, species, other notes

Answer 5

Lactulose (P)
* Oral
* Used to treat constipation, and to reduce blood ammonia levels in patients with hepatic encephalopathy
* Cats and dogs
* Reduce dose if diarrhoea develops. May alter insulin requirement in diabetic patients.

Question 6

Paraffin
Uses, formulation, species, other notes

Answer 6

Paraffin (P)
* Oral, topical forms
* Laxative used to manage constipation: softens stools by interfering with intestinal water resorption
* Used in cats and dogs
* Do not give orally to patients with reduced gag reflex; tasteless and may not initiate normal swallowing if syringe fed so take care to avoid inhalation

Question 7

Cimetidine
Uses, formulation, species, other notes

Answer 7

Cimetidine (POM and POM-V)
* Injection, oral forms
* Histamine (H2) receptor antagonist that reduce histamine-induced gastric acid secretion. Used in management of oesophagitis, gastritis, gastric and duodenal ulcers
* Used in cats and dogs
* Rebound gastric acid secretion may be seen so taper therapy

Question 8

Famotidine
Uses, formulation, species, other notes

Answer 8

Famotidine (POM)
* Oral form = tablets
* Histamine (H2) receptor antagonist that blocks histamine-induced gastric acid secretion
* Used in cats and dogs
* Many times more potent than cimetidine but has poor oral bioavailability

Question 9

Omeprazole
Uses, formulation, species, other notes

Answer 9

Omeprazole (POM, POM-V)
* Oral forms: capules, tablets; also injectable form
* Proton-pump inhibitor - used pre-op to reduce reflux under GA, and in management of gastric / duodenal ulcers, oesophagitis etc.
* Used in cats and dogs
* Possible adverse effects include nausea, diarrhoea, constipation, skin rashes, and tooth fractures

Question 10

Ranitidine
Uses, formulation, species, other notes

Answer 10

Ranitidine (POM)
* Injection and tablets
* Histamine (H2) receptor antagonist so blocks histamine-induced gastric acid secretion
* Used in cats and dogs. Not an effective acid suppressant in healthy cats
* Has some prokinetic effects so may have some benefit when gastric motility is impaired by gastritis or ulceration
* Cardiac arrhythmias and hypotension occur if given rapidly IV

Question 11

Sucralfate
Uses, formulation, species, other notes

Answer 11

Sucralfate (POM)
* Oral forms: tablet, suspension
* Stimulates of mucosal defences and repair mechanisms (bicarbonate and PGE production, and binding of epidermal growth factor) so useful in treatment of oesophageal, gastric and duodenal ulceration
* Used in cats and dogs
* May decrease bioavailability of other drugs such as H2 antagonists