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Pharmacology > Chapter 4 - Gastrointestinal Tract > Flashcards

Chapter 4 - Gastrointestinal Tract Flashcards

1
Q

Monogastric

A

Single Stomach with 3 segments of the GI Tract

  • Stomach
  • Intestines
  • Cecum and Colon
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2
Q

Gastric

A

Related to the stomach

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3
Q

Enteric

A

Related to the duodenum, jejunum, or ileum

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4
Q

Colonic

A

Related to the large intestines or colon

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5
Q

Ruminant

A

A mammal with 4 chambered stomach

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6
Q

Forestomach of the ruminant consists of

A

Rumen, Reticulum, Omasum

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7
Q

“True Stomach” (Similar to the monogastric stomach)

A

Abomasum

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8
Q

Fermentative Digestion

A

Compartments of the ruminant stomach that physically break down and process the ruminant’s herbivorous (plant) diet

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9
Q

Rumination (“chewing cud”)

A

Reticulum and Rumen work together to receive and mix swallowed food, coarse materials are regurgitated from the rumen back into the mouth for further mastication before being swallowed again

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10
Q

Rumens primary function of digestion

A

Large fermentation vat containing microbes (bacteria and single-celled protozoa) that enzymatically break down foodstuff into smaller, absorbable components

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11
Q

Omasum and Abomasum primary function of digestion

A

Further mix ingesta (contents of the intestinal tract) perform some enzymatic digestion and begin the absorption of processed nutrients

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12
Q

Are horses classified as ruminants?

A

No –> nonruminant herbivores

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13
Q

Autonomic Nervous System (ANS)

A

Regulates bodily functions without involving conscious thought

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14
Q

Parasympathetic Nervous System (PSNS)

A

Slows heart rate, increases intestinal peristalsis and gland activity, and relaxes sphincters

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15
Q

Acetylcholine

A

Neurotransmitter associated with the PSNS that stimulates receptors in their target organs or tissues

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16
Q

Vagus Nerve

A

Cranial nerve X (10) - Carries parasympathetic nerve impulses to and from a wide variety of organs in the abdominal and thoracic cavities

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17
Q

PSNS is also known as …

A

The “Rest and Digest” System (because it increases digestive secretions, smooth muscle tone, and motility and improves blood flow to the GI tract)

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18
Q

Sympathetic Nervous System (SNS)

A

Balances or opposes the effects of the PSNS. (General inhibitory effect on the GI tract)

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19
Q

Ganglia

A

A cluster of neuron cell bodies

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20
Q

Norepinephrine

A

Neurotransmitter associated with the SNS

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21
Q

Organ that is part of the SNS, releases epinephrine into the blood when the medulla is stimulated by the sympathetic nerves

A

Adrenal gland (on top of the kidney)

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22
Q

SNS effects

A

Increases HR, BP, dilates pupils, opens respiratory airways, and redirects blood flow away from nonessential areas of the body to more essential organs and skeletal muscle needed for movement

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23
Q

SNS is also known as …

A

The ‘Fight or Flight” System (because the responses are part of the normal protective mechanism by which an animal can fight off prey or flee from a threatening situation)

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24
Q

Emesis (vomiting)

A

A normal, protective mechanism designed to remove poisonous or dangerous substances that have been ingested

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25
Q

Emetic drug

A

A dug that produces vomiting needed to remove a toxic substance before it can be absorbed into the body

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26
Q

Emetic center (vomiting center)

A

A group of special neurons located in the medullary structure of the brainstem that produces the physiologic actions associated with the period just before vomiting and during the actual act of vomiting itself

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27
Q

Nucleus Tractus Solitarius (NTS)

A

A set of neurons that has many receptors for drugs or compounds that can stimulate vomiting and thus can also be a site of action for drugs that suppress vomiting by blocking these receptors

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28
Q

Major receptors most commonly associated with emetic/antiemetic drugs

A
  • Serotonin receptors (5-HT receptors)
  • Acetylcholine receptors (Muscarinic cholinergic receptors/ M receptors)
  • Histamine receptors (H1 receptors)
  • Dopamine receptors (DA receptors)
  • Norepinephrine/epinephrine receptors (alpha-adrenergic receptors)
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29
Q

Chemoreceptor trigger zone (CRTZ)

A

A specialized cluster of nerves, adjacent to the emetic center, that constantly monitors the blood and the cerebrospinal fluid for chemicals that can stimulate the act of vomiting

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30
Q

Vestibular apparatus

A

Located in the inner ear, it is the organ responsible for balance (overstimulation causes vomiting associated with motion sickness and inner ear infections)

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31
Q

Maropitant

A

Cerenia - developed for controlling motion sickness in the dog and cat. The primary action is blocking the NK-1 receptors found in the main vomiting reflex pathway in the emetic center

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32
Q

Causes of vomiting elsewhere in the body

A
  • inflammation/overdistention of abdominal organs
  • inflammation of the peritoneum
  • stimulation of the pharynx
  • GI tract is irritated by a viral or bacterial infection
  • foreign body
  • overdistention of the lumen of the gut
  • ingestion of irritating chemicals
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33
Q

Animals incapable of vomiting

A

Horses, rabbits, rats, guinea pigs

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34
Q

Liquid toxins typically move beyond the stomach and into systemic circulation within how many hours?

A

2 hours

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35
Q

Solid poisons (rat bait blocks/pelleted rodenticide) may still be in the stomach for up to ____ hours after ingestion

A

4 hours

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36
Q

Centrally acting emetics

A

Acts by stimulating the emetic center or the CRTZ in the central nervous system

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37
Q

Locally acting emetics

A

Acts by directly stimulating the GI tract itself, which sends signals to the emetic center to produce vomiting

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38
Q

Apomorphine

A

Centrally acting emetic that is an opioid, chemically structured like dopamine so it relies on dopamine receptor stimulation in the CRTZ to produce emesis

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39
Q

List local acting emetics

A
  • 3% hydrogen peroxide
  • concentrated saltwater solution (not recommended)
  • syrup of ipecac (no longer produced)
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40
Q

Gastritis

A

Inflammation of the stomach

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41
Q

Hypernatremia

A

Increased sodium in the blood

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42
Q

Antiemetic drugs

A

Prevent or decrease vomiting by blocking receptors in the CRTZ, blocking receptors on the emetic center, and/or blocking peripheral receptors that could send signals to the brain to produce vomiting

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43
Q

Acute gastroenteritis

A

Inflammation of the stomach and intestines

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44
Q

Phenothiazine tranquilizers as antiemetics

A

Prevent or decrease vomiting by blocking receptors in the CRTZ, blocking receptors on the emetic center, and/or blocking peripheral receptors that could send signals to the brain to produce vomiting (acepromazine)

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45
Q

Antihistamine antiemetics

A

Work by blocking the H1 receptors on the CRTZ, which decreases the ability of the histamine-mediated signals sent from the inner ear vestibular apparatus to stimulate the CRTZ (diphenhydramine + dimenhydrinate)

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46
Q

Anticholinergic antiemetics

A

Block the effect of the acetylcholine neurotransmitter on acetylcholine receptors (specifically the Muscarinic cholinergic receptor (M1 cholinergic receptor)) (scopolamine)

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47
Q

Prokinetic drug

A

Stimulating movement or mobility, such as drugs that promote gastrointestinal motility

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48
Q

Metoclopramide

A

Acts both centrally and locally - Centrally it blocks dopamine receptors (and at higher doses Serotonin receptors on the CRTZ) More effective in dogs- DO NOT use in animals with seizures

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49
Q

Relatively contraindicated

A

Meaning don’t use the drug unless the medical condition justifies the risk

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50
Q

Absolutely contraindicated

A

Do not use the drug regardless of the medical condition

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51
Q

Antidiarrheals

A

Drugs that change intestinal motility or reduce the secretions that contribute to diarrhea

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52
Q

What are the 4 general forms diarrhea take?

A

1) Secretory
2) Exudative
3) Motility
4) Osmotic or Malabsorption

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53
Q

Enterotoxins

A

Toxins produced by intestinal bacteria

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54
Q

Secretory diarrhea

A

Often caused by bacterial toxins and intestinal inflammation. These can cause increased secretion of fluids into the intestinal lumen.

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55
Q

Exudative diarrhea

A

Caused by severe inflammation and intestinal damage, which leads to the loss of electrolytes, proteins, and blood into the intestinal lumen. This is often seen in cases of canine parvovirus infection.

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56
Q

Motility diarrhea

A

Characterized by a rapid movement of intestinal contents that prevents proper fluid absorption.

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57
Q

Osmotic/Malabsorption diarrhea

A

Occurs when water is held by osmotic particles in the intestinal contents (fiber, laxatives, undigested food).

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58
Q

Exocrine pancreatic insufficiency (EPI)

A

Pancreas is unable to produce normal amounts of digestive enzymes, resulting in food being poorly broken down

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59
Q

Segmental contractions

A

Circular contractions around a small segment of the intestine that mix the contents of the bowel

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60
Q

Peristaltic contractions

A

Move in waves to propel food along the GI tract

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61
Q

Hypermotility

A

Increased movement of bowel contents characterized by rapid peristalsis and audible gut sounds

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62
Q

Hypomotility

A

Decreased peristalsis

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63
Q

Atony

A

Few or no segmental contractions, few or no audible gut sounds

64
Q

Tenesmus

A

Straining, especially ineffectual and painful straining at stool or in urination

65
Q

Decreasing peristaltic movements

A

Decreased propulsion

66
Q

Increasing segmental contractions

A

Increasing resistance to flow of feces

67
Q

Name some of the breeds that have a genetic defect affecting the function of P-glycoprotein

A

Collies, shelties, Australian shepherds

68
Q

Ileus

A

A segment of the bowel fails to contract, resulting in a functionally ‘dead’ segment of the gut, producing colic

69
Q

Melena

A

Stools darkened by digested blood

70
Q

Adjunct drug

A

A drug used in addition to another drug

71
Q

Keratoconjunctivitis sicca

A

KCS/dry eye

72
Q

Adsorbents

A

Bind molecules to their outer surface decreasing availability of toxins for the intestinal absorption

73
Q

Protectants

A

Provide a coating or barrier that prevents absorption of toxins by the intestinal tract

74
Q

Liquid barium

A

Radiographic contrast for intestinal imaging - acts as a protectant and adsorbent

75
Q

Activated charcoal

A

Can adsorb enterotoxins and ingested toxins which prevents them from being absorbed into the body

76
Q

3 things activated charcoal (toxiban) does NOT adsorb

A
  • alcohol compounds (xylitol)
  • metals
  • petroleum products
77
Q

Laxatives

A

Used to increase the fluid content of the feces, making them softer and easing or promoting defecation - generally used when the goal is to soften the stool

78
Q

Cathartics and Purgatives

A

Used to increase the fluid content of the feces, making them softer and easing or promoting defecation - used when evacuation of the bowel is the goal

79
Q

Emollient laxatives

A

Lubricant oils and stool softeners (mineral oil, cod liver oil, glycerin)

80
Q

Bulk laxatives

A

Hydrophilic colloids - Indigestible plant fiber that osmotically pulls water into the bowel lumen or retains water in the feces, softening the stool (bran, psyllium, Metamucil)

81
Q

Osmotic Cathartics

A

Saline cathartics, more aggressive than osmotic bulk laxatives. Create an osmotic force that draws fluid into the intestinal lumen (Milk of magnesia/ Lactulose)

82
Q

Irritant Cathartics

A

Increase peristaltic movement via bowel irritation (castor oil/Dulcolax)

83
Q

Hepatic encephalopathy

A

Condition in which either a poorly functioning liver or the presence of vascular shunts that bypass the liver results in elevated ammonia concentrations in the blood, disrupting/depressing the normal function of the CNS leading to death

84
Q

Typical pH of the stomach

A

2-3

85
Q

Gastritis

A

Inflammation of the stomach/ stomach lining

86
Q

Parietal (oxyntic) cells

A

Produce hydrochloric acid (HCl)

87
Q

Chief cells

A

Produce pepsinogen (precursor t o pepsin)

88
Q

Mucous cells

A

Produce the mucous protective layer

89
Q

Gastric glands

A

Line the stomach and contain parietal, chief and mucous cells

90
Q

Control of the acid production via parietal cell stimulation from 3 receptors:

A

1) Histamine receptors
2) Acetylcholine receptors
3) Gastrin receptors

91
Q

Which receptor has the greatest effect on acid production?

A

Histamine (H2) receptor

92
Q

Enterochromaffin-like cells

A

Produce the histamine when stimulated by gastrin, which is produced by G cells located in the distal part of the stomach and proximal duodenum

93
Q

G cells

A

Release gastrin hormone in response to the presence of proteins in the stomach, the stretching of the stomach with food or liquid

94
Q

Gastrin hormone

A

Gastrins function is normally to signal a relaxation of the stomach wall (so more food can be stored) and to increase stomach acid production to begin the breakdown of food in the stomach

95
Q

What hormone do mast cell tumors release?

A

Histamine

96
Q

Mucus

A

Produced by the gastric glands, a complex of many substances that provides a gelatinous, protective coating for the stomach

97
Q

Mucins

A

Complex molecules produced by the mucus-producing cells in the gastric glands and are the main constituent of the mucous coating

98
Q

Bicarbonate Ions

A

Secreted and added to the mucous coat, making it more alkaline (neutralizes some of the HCl before it contacts the cells of the stomach wall)

99
Q

Pepsinogen

A

An enzyme precursor produced by chief cells in the stomach, when secreted into the acid environment, is activated to pepsin

100
Q

Pepsin

A

An enzyme capable of digesting protein

101
Q

Erosions/ Gastric Ulcers

A

Damage to the epithelial cells lining the stomach - shallow/superficial or severe enough to perforate completely through the stomach wall, allowing stomach contents to leak into the surrounding peritoneal cavity

102
Q

Antacids

A

Decrease stomach acidity by either chemically combining with the HCl to make a less acidic molecule OR by decreasing acid production

103
Q

Nonsystemic Antacids

A

Oral drug form NOT absorbed into the systemic circulation (neutralizes acid molecules in the stomach)
Typically made of Calcium, Magnesium or Aluminum

104
Q

Tums/Rolaids

A

Calcium carbonate/ Calcium carbonate + Magnesium hydroxide

105
Q

Mylanta/Maalox

A

Magnesium hydroxide + Aluminum hydroxide

Largest group of OTC nonsystemic antacids

106
Q

Milk of Magnesia

A

Pure magnesium hydroxide product

107
Q

Amphojel

A

Pure aluminum hydroxide product

108
Q

Calcium carbonate and aluminum hydroxide cannot be absorbed to any significant degree in the body.

Up to what percentage can Magnesium be absorbed by the body?

A

20%

109
Q

Patients with _______ disease/failure should not receive magnesium-based antacids

A

Renal

110
Q

Long-term use of calcium and aluminum antacids can cause what?

A

Constipation

111
Q

Long-term use of magnesium antacid products can cause what?

A

Diarrhea

112
Q

Gastric Acid Rebound Syndrome

A

Can be caused by calcium carbonate antacids and occurs because of these drugs’ ability to promote gastrin release, leading to more HCl production

113
Q

If a patient is receiving nonsystemic antacids along with other medications, what is the acceptable amount of time to give the antacid either before or after the other medications?

A

2 hours before or 3 hours after other medications have been administered

114
Q

Systemic Antacids

A

Absorbed by the body and interact with the stomach cells

115
Q

H2 Blockers

A

Block histamine receptors in the parietal cells, leading to reduction of acid production
“-tidine” suffix

116
Q

Proton (H+) Pump Inhibitors

A

Bind to the surface of parietal cells and inhibit the cells pumps that transport protons to the stomach lumen
“-azole” suffix

117
Q

Antiulcer

A

Adheres to ulcer lesions and promotes mucus production “Gastric band-aid”

118
Q

Can antacids and sucralfate be given together?

A

No, sucralfate requires an acidic environment to most effectively bind to the ulcer site

119
Q

Cimetidine, Zantac, Famotidine are examples of …

A

H2 Blocker antacids

120
Q

Gastrogard, Ulcergard, and Omeprazole are examples of …

A

Proton (H+) pump inhibitors

121
Q

Sucralfate/Carafate are examples of …

A

Antiulcer drug

122
Q

Synthetic Prostaglandin type drug (PgE)

A

Synthetic prostaglandin reduces acid production and increases mucus production and facilitates stomachs protective mechanisms for defense and healing

123
Q

Misoprostal is an example of …

A

Synthetic prostaglandin type drug

124
Q

Side effects of Misoprostol

A

Diarrhea, abdominal discomfort, cramping, colic, increased uterine contractions (premature birth or abortion)

125
Q

Rumen stasis

A

Condition in which the normal motility of the rumen is halted

126
Q

Ruminatorics

A

Prokinetic drugs that stimulate an atonic (no muscle tone) or flaccid rumen

127
Q

Neostigmine

A

Ruminatoric drug that works by preventing the breakdown of acetylcholine

128
Q

Miosis

A

Constricted pupils

129
Q

Ionophores

A

A group of antimicrobial drugs discovered in the 1950s that are capable of enhancing facilitated transport of ions across cell membranes (Na+, K+)

130
Q

The Ionophore drug Monensin (Rumensin) is commonly used to treat what?

A

Coddidiosis, a common protozoal disease in cattle and poultry

131
Q

Antibloat medications

A

Designed to reduce gas build-up or facilitate the removal of gas from the rumen

132
Q

Rumination

A

Partially digested plant food is regurgitated up the esophagus and into the mouth, where it is chewed and reswallowed

133
Q

Eructation

A

Expels built-up CO2 or methane gas from the rumen

134
Q

Bloat/ Ruminal tympany

A

Too much gas being trapped in the rumen

135
Q

Antibloat medications

A

Mineral oil, vegetable oil, poloxalene, dioctyl sodium succinate (DSS)

136
Q

How are anti-bloat medications administered?

A

Oral tube or direct ruminal injections through the flank with a large bore trochar needle

137
Q

Poloxalene

A

A synthetic compound that reduces the surface tension of rumen fluid and decreases froth formation (available in a liquid drench or as a ‘salt lick” block)

138
Q

Why do gastroenterologists not recommend the use of antimicrobials (antibiotics) to treat most cases of vomiting or diarrhea?

A

The most likely cause is VIRAL, not bacterial, so antimicrobials will be ineffective

139
Q

What are two major conditions antibiotics are recommended for?

A

Bacteremia or septicemia

140
Q

Tylosin (Tylan powder)

A

Macrolide antibiotic typically used in cattle and swine to treat GI and respiratory infections (gram negative and positive bacteria) also extra label in dogs + cats for chronic bacteria overgrowth

141
Q

Metronidazole (Flagyl)

A

Human drug, used to treat a diarrhea producing protozoa called Giardia (has both antibacterial and antiprotozoal properties)

142
Q

Metronidazole has significant side effects at high doses, or at normal doses with extensive use

A

CNS signs-> weakness, head tilt, seizures, staggering, disorientation, proprioceptive deficits

143
Q

Erythromycin

A

Macrolide antibiotic that can be classified as a pro-kinetic agent

144
Q

Sulfasalazine (Azulfidine)

A

(Antidiarrheal) Antibiotic that is broken down by colonic bacterial into sulfonamide sulfapyridine and the aspirin like prostaglandin blocking agent mesalamine (used for anti inflammatory process to treat colitis)

145
Q

Oral Electrolyte Replacements

A

Liquid or powder products containing essential electrolytes administered orally to help replace ions lost with diarrhea or vomiting

146
Q

What are the essential electrolytes?

A

Sodium, Potassium and Chloride

147
Q

Exocrine Pancreatic Insufficiency (EPI)

A

A condition in dogs and cats where the pancreas fails to produce sufficient amounts of digestive enzymes (Lipase, Amylase and various Proteinases)

148
Q

Lipase

A

Breaks down lipids

149
Q

Amylase

A

Breaks down starches

150
Q

Proteinases

A

Break down proteins

151
Q

Maldigestion

A

Inadequate digestion

152
Q

Malabsorption

A

Inadequate absorption of nutrients due to maldigestion

153
Q

Pancreatic enzyme supplements

A

Pancrezyme/Viokase

154
Q

How do pancreatic enzyme products work?

A

Mix powder into food 15-20 minutes before being offered to pet

155
Q

Corticosteroid use with GI disease

A

Controversial, beneficial antiinflamatory effect is offset by immunosuppression, increased gastric acid production, suppression of normal gastric protective and healing mechanisms, and increased risk of infection

156
Q

What GI condition may it be acceptable to consider corticosteroids as treatment?

A

Eosinophilic gastroenteritis - Lowest effective dose to control clinical signs, monitor for signs of gastric problems, dose should be decreased as soon as possible to minimize side effects

157
Q

Substance P

A

A neurotransmitter that stimulates vasodilation and contraction of intestinal and other smooth muscles.

Pharmacology (13 decks)

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