Gastrointestinal Drugs Flashcards
The enteric nervous system is an extensive network of interconnected ____ and ____
interneurons within the gastrointestinal ___ that can control gut function _______ of the CNS
sensory, motor, wall, independently
The enteric nervous system is characterized by the presence of a complex intrinsic neural network that includes the _____
plexus and the ______ plexus
myenteric, submucosal
The submucosal plexus is located under the ______ layer of the gut. The myenteric plexus
resides between the ______ ____ muscle layer and the ____ _______ muscle layer
submucosal, inner circular, outer longitudinal
The ENS is extensively innervated by ________ _______ nerve fibers.Its sensory and motor interneurons can also be influenced by the CNS through input from _____ and ______ subdivisions
nonadrenergic-noncholinergic (NANC), sympathetic, parasympathetic
Myenteric plexus
Yellow represents nerve endings
Plexus submucosas
Emesis is a complex reflex activity (______ reflex) and its coordination is centered in the _______. Although several afferent pathways may be responsible for initiating emesis, all signals are
coordinated by the ____ center (______ center) located in the ____ _______. An important structure outside the GI-tract that supplies afferent input is the ________ ________ _____. This is sensitive to the presence of ____ and _____ in the blood
protective, brainstem, emetic, vomiting, mid brainstem, chemoreceptor
trigger zone (CTZ or CRTZ), drugs, toxins
Emesis is _________ induced to empty the ____ portion of the digest tract. List the examples in which emesis is induced:
A number of substances induce emesis by:
* Distending the ______, ______, _____, or _______ ( _______ organs)
* ________ the epithelium of the GI-tract (gastric _____ or _____)
pharmacologically, anterior
→ Preparation for induction of general anesthesia (food in the stomach)
→ Treatment of ingested, noncorrosive poisons
pharynx, esophagus, stomach, duodenum, hollow, Irritating, mucosa, pharynx
Peripherally acting (reflex) emetics
* Distention with ____ water or ____ can induce the emetic response
* In case of toxin ingestion, administration of ____ water by _____ tube may help ____ poisons
* Emesis can be induced in dogs by oral administration of a solution of: (1) Pharyngeal placement of a small amount of plain ____ _____ or neutral ____ _____, such as sodium carbonate OR (2) Orally administered _______ ______ (__%) often induces emesis rapidly in cats and dogs → fatal ______ of hydrogen peroxide foam is possible!
Copper sulfate (1%), zinc sulfate (1%)
warm, saline, warm, stomach, dilute
warm saturated (strong) sodium chloride
table salt, salt crystals, hydrogen peroxide, 3, aspiration
Prokinetic drugs increase GI ______, enhance the transit of ______ contents, and are used in ___ and ____ animals → occasionally in ruminants to stimulate gastric _______, ____ or _____ motility
* Intestinal motility is ↓ after intestinal disease, surgery → can lead to ____
motility, intraluminal, small, large, emptying, rumen, intestinal, ileus
Metoclopramide is a ____-soluble derivate of ____-________ __. It has a central (_________) and peripheral (________ and stimulator of ______
receptors) effects.
lipid, para-aminobenzoic acid, antidopaminergic, antidopaminergic, cholinergic
Metoclopramide has multiple actions:
→ D2 ______
→ Serotonin (5-HT3) _______
→ Serotonin (5-HT4) ______
→ Increase in the release of ____ in the ____-tract
→ Increase gastric _____
→ Increase ____ of the esophageal sphincter
→ Stimulates motility of the _______ (less effect on ____ segments)
→ Endocrine effects: transient increase in ______ and ______.
antagonist, antagonist, agonist, Ach, GI, emptying, tone, duodenum, distal, prolactin, aldosterone
Prokinetic drugs increase ?
GI motility
Metoclopramide is used in small animals to:
1. Stimulate ____ upper motility following _______ surgery (for gastric _____)
2. _______
3. Postoperative ____
4. Gastric _______
5. Idiopathic _____
–> Contraindicated in GI ______ or ______.
normal, corrective, dilation, Volvulus, ileus, ulceration, gastroparesis, obstruction, perforation
Metoclopramide: use in horses
* Some equine surgeons used infusion of metoclopramide to reduce __________ ____
* It may stimulate _____ ______ but not large bowel
* Undesirable side effects are common → ________ changes and ______
pain
postoperative ileus, small intestine, behavioral, abdominal
Metoclopramide: use in ruminants
* The clinical use of metoclopramide in large animals is ____ common
* It has a little usefulness in ____. It may ↑ the motility of the _____ in cattle and in sheep
* Metoclopramide is used successfully in cattle with functional ______ ______
* At doses higher than 0.1 mg/Kg in calves cause ?
less, cattle, rumen, pyloric stenosis
severe neurological side effects
Cisapride
* Cisapride was removed from the market → serious _______ and _____ in people. These
reactions have not been reported in _____
* It is still available via ______ pharmacists
* Cisapride has a great ______ effect. Agonist for the __-___ receptor on myenteric neurons and
antagonist for __-____ receptor → It may enhance release of ___ at the myenteric plexus
* It causes dose-dependent increased activity at ___ ____ sites: (?)
arrhythmias, deaths, animals, compounding, prokinetic, 5-HT4, 5-HT3, ACh, all GI
Esophagus, stomach, jejunum, ileum, small intestine, and colon
Cisapride
Clinical use in small animals
➢ treatment for ________ reflux, _____
gastric emptying, and _____ bowel motility
disorders
➢ Compared to ________, cisapride is
more effective for increasing ____ esophageal
sphincter ____ in dogs
➢ Cisapride has been used for treating chronic _______ in cats (effect on colonic _____ muscle)
gastroesophageal, delayed, small, metoclopramide, lower, tone, constipation, smooth
Domperidone is a dopamine (D2) _______. It may also have α1-receptor _____ and serotonin (5-HT2) _______ effects
* Its mechanism of action and prokinetic effects are similar to _____
* Domperidone does not cross the ____
* Its peripheral effects accelerate _____ intestinal transit. ______ activity is unaffected
_______ drugs increase GI motility
antagonist, antagonist, antagonist, metclopramide, BBB, small, Colonic, Prokinetic
Domperidone
* Domperidone has been investigated for use in horses to treat _____ toxicity and _____
* The oral absorption in horses is only __- ____%. ____ administration of ____ mg/Kg (the approved dose) had no effect on GI function but at __ mg/Kg ↑ stomach emptying
* ↑ digital laminal microvascular blood flow (horses) → ___________ ____ receptors.
Treatment of laminitis?
Fescue grass toxicosis: forage related disease involving the endocrine disruptive effect of ______ _____ (produce by fungus Neotyphodium coenophialum) on prolactin secretion
fescue, agalactia, 1, 1.5, PO, 1.1, 5, antagonist α2, ergot alkaloids
Erythromycin → a ________ antibiotic used to treat ______ infections
* Erythromycin stimulates GI motility at ____ doses → much lower than the antibacterial dose
* It stimulates GI motility via: activation of _____ receptors, release of endogenous ______ or _____ mechanisms in the upper GI tract
* Motilin is a _______ released from endocrine cells of the ________ mucosa. It ____ the motor contraction
* Most of the motilin receptors are on the ______ and _____ intestine
* Erythromycin is used clinically to increase gastric ______ and for the therapy of ______
esophagitis
* Concerns: may cause _______ (effect on the normal bacteria flora of the _______) and its routine use may promote antibacterial _______.
macrolide, bacterial, low, motilitin, motilitin, cholinergic, peptide, duodenal, ↑, stomach, proximal, emptying, reflux, diarrhea, intestine, resistance
Lidocaine
* It is a well-known ____ anesthetic. Lidocaine is used for ____
infiltration for ____ surgical procedures and to treat cardiac ______
* IV infusions of lidocaine improve intestinal _____ in ____
→ It reduces?
local, local, minor, arrhythmias, motility, horses, postoperative ileus
Postoperative ileus (widespread clinical problem) may be caused by?
How does lidocaine restore motility?
- How lidocaine restores motility is not understood. It is said lidocaine does not have a direct prokinetic effect
- It may act by inhibiting intestinal inflammation and reperfusion injury or via
suppression of painful stimuli
What are the adverse effects of lidocaine?
Adverse effects
* Muscle fasciculation
* Ataxia and seizures ↓ rate of infusion
Name the Peripheral opiate antagonists:
alvimopan, methylnaltrexone, and naloxegol
- Activation of opiate μ receptors in the intestinal smooth muscle ____ propulsive motility
- μ-opiate receptors have been found in the _________ plexus, _______ plexus, and __________ muscle of ____
- Activating these receptors has been used to treat some forms of _____ (e.g., _______)
- Selective peripheral opiate antagonists act as peripheral opioid antagonists → they are unable to cross the ____ (______ polarity)
- Alvimopan > methylnaltrexone → ______ and _____ of activity
- Alvimopan is administered ____ → ___ bioavailability (6%) and produces a ____ effect on the intestine to promote ______.
- Naloxegol is used for ____ treatment of ____-induced constipation
↓ , submucosal, myenteric, longitudinal, ileum, diarrhea, loperamide, BBB, high, potency, duration, orally, low, local, motility, oral, opioid
List the principal drugs used to manage GI ulceration in small and large animals.
Histamine (H2) receptors antagonists
sucralfate
proton pump inhibitors (omeprazole)
antacids
List the other clinical uses of the drugs typically used to treat GI ulcers in small and large animals.
Clinical uses
* ________
* _______ ulcers
* ____________ ulcers
* _________________ ulcer ________
* ______________
* ________ cells tumor
* _______________ syndromes
* Prevention and treatment of _____-induced ulcers
Gastric HCL secretion is _________ in carnivores rather than __________ as in humans
Clinical uses
* Gastritis
* Gastritis ulcers
* Duodenal ulcers
* Gastrointestinal ulcer prevention
* Esophagitis
* Mast cells tumor
* Hypergastrinemic syndromes
* Prevention and treatment of NSAID-induced ulcers
Gastric HCL secretion is intermittent in carnivores rather than continuous as in humans
Gastrointestinal ulceration
Gastrointestinal ulceration is an important medical problem in ____.
* Prevalance in animals involved in showing and racing → ___-___%
Contributing factors:
* ____ confinement
* Intense _____
* Diet (↑ ___ concentrated in diet)
* Racing ___
* _______ feeding schedule
* ↑ stomach ____
* Use of ____
horses, 81-93, Stall, exercise, energy, stress, Intermitent, acidity, NSAIDs
Drugs for Treatment of Gastrointestinal Ulcers in Animals
Antacids
* These drugs _______ stomach acid through a simple reaction to form ____ and
neutral ___
* Antacids are bases of either ?
Adverse effects
* _____ → they are seldom administered _____-term. They are not _______
* In animals with kidney disease, ________ accumulation may be a problem
* They interfere with the _____ absorption of other drugs → chelate with ___________ or ____________. Administer the AB __ h prior to the administration of the antacid drug
neutralize, water, salt, aluminium, magnesium, or calcium, Rare, long, absorbed, magnesium, oral, fluoroquinolones, tetracyclines, 2
List the effects of the following
The Histamine (H2) receptor antagonists are?
cimetidine, ranitidine, famotidine, and nizatidine
Christine Ran For Nuj
- H2-receptor antagonists are _______, ______ inhibitors that reduce both the _______ and the ______ ion content of gastric secretion and the amount of pepsin
- These drugs became popular after their release in the 1980s. Their use has declined → more _____ and _____-acting proton pump inhibitors
- Blockade of histamine H2 receptors on gastric parietal cells inhibits gastric ____
- In studies that have measured stomach acidity, or compared results with proton pump inhibitors ___-________ _______ were less effective
reversible, competitive, amount, hydrogen, potent, longer, acidity, H2-receptors antagonist
Acid secretion is stimulated by three receptors:
- Gastrin receptors: endocrine gastrin→ CCK
- Histamine type-2 (H2): paracrine
- Muscarinic receptor type-3 (M3): neuronal ACh
Inhibitors bind to proton pump and stop release of hydrogen.
Use in small and large animals
* Cimetidine, the ____ drug in this group, has been administered to dogs at 10 mg/kg (IV, IM, or orally) every 6 to 8 h
* Among the H2-receptor antagonists, _____ and _____ inhibit anticolinesterase (AChE) activity and thus are _____ at antisecretory doses
* Clinical signs of ulceration may resolve within a few _____, but complete healing of the ulcers usually takes ___ to ___ days
oldest, ranitidine, nizatidine, prokinetic, days, 10, 14
These drugs are not absorbed orally in ______ as well as in _____.
Ranitidine has been used in horses at a dose of 2.2 - 6.6 mg/Kg every 6 to 8 h
Cimetidine and ranitidine have been used in calves to maintain the ___ of the abomasum > 3.5.
Cimetidine 100 mg/Kg q 8 h, or ranitidine 50 mg/Kg q 8 h
horses, dogs, pH
Adverse effects of Histamine (H2) receptor antagonists
* Side effects are ____ at usual dosages (even at relatively ___ doses)
* Anecdotal reports → ______ injection (IV) produced hemolytic anemia in ___, but when administered ___ over 5 minutes, there was no risk
* Drug interactions are possible → cimetidine _____ the clearance of other drugs
* Drug interactions → impair the ____ absorption of some drugs that require _____ (through the alteration of GI ___) → drug _______
minor, high, famotidine, cats, IV, inhibits, oral, acidity, pH, dissolution
STOPPED HERE TODAY ON 11/7
Sucralfate
* Sucralfate dissociates in the acid milieu of the _____ to sucrose _____ and ____ hydroxide
* sucrose octasulfate polimerizes to a _____, ______ substance that binds to the ______ mucosa
* Sucralfate ↑ the mucosal synthesis of ________ → cytoprotective role
* It inactivates _____ and _______ bile acid
* Drug interaction: aluminum will chelate ____________ and ___________ → If they are needed, administer them first (30-2h prior to sucralfate)`
stomach, octasulfate, aluminium, viscous, sticky, ulcerated, prostaglandins, pepsin, adsorbs, fluoroquinolone, tetracycline
Proton pump inhibitors (PPIs): Substituted benzimidazole
* The PPIs are the most _____ antisecretory drugs. ↓ _____ acid secretion by ___% to ___%
* They are potent and _______ antagonist of the ___,___,___ pump
* The PPIs are weak ____ and _______ and act as prodrugs in the physiological __ of the blood
* After systemic absorption, PPIs become trapped in the acidic _____ cells of the stomach.
potent, gastric, 80, 95, irreversible, H+-K+-ATPase, bases, unprotonated, pH, parietal
PPIs that can be used. Only speaking about Omeprazole because functions of others are similar.
Proton pump inhibitors (PPIs): Substituted benzimidazole
The inhibition of acid secretion is approx. ____% on day 1 of PPI administration
* Maximal inhibitory effect is thought to be achieved within approx. __-__ days
30, 2-4
The effect of PPIs is ________ because acid secretion resumes only after ____ proton
pumps are synthesized in the ______ cells, which generally requires ___ to ___ hours,.
prolonged, new, parietal, 24, 48
PPI: substituted benzimidazole
Clinical use
* PPIs are indicated to support ________ healing, prevention or treatment of ____________ reflux, treatment of _________ conditions
* Acid secretion is activated by ingestion of a ____ → administer PPIs __ min to __ h _____ to a meal to ensure maximal absorption
* If administered once daily, ______ administration is recommended because the prolonged fast results in _____ numbers of the ____, ____, ______ enzymes available to the secretory cannaliculi.
* There have been no benefits demonstrated for the co-administration of histamine H2 _______ and PPIs in animals
* All PPIs appear to inhibit a variety of _____ → caution when combining PPIs with other drugs metabolized by the _____.
gastroduodenal, gastroesophageal, hypersecretory, meal, 30, 1, prior, morning, higher, H+-K+-ATPase, antagonist, CYP enzymes, liver
Adverse effects: as a result of chronic administration of PPI
* Because of loss of negative feedback mechanisms, gastrin levels are ______ (hypergastrinemia) → exert a _____ effect on the gastric mucosa
* Small intestinal bacterial overgrowth (SIBO). PPIs ___ population of bacteria by increasing the stomach pH → ______ syndromes and impaired vitamin ____ absorption
* At a dose of 1.1 mg/kg twice daily for 15 days ___ total bacteria in the duodenum (_________) and a ___ in stomach Helicobacter spp.
* Diarrhea is the most common adverse effect reported in ____ (but not in ____) and transient fluctuations in the ____ enzymes.
elevated, trophic, ↑ , malabsorption, B12, ↑, Lactobacillus, ↓, dogs, cats, liver
Synthetic prostaglandins (PGE1): Misoprostol
* Prostaglandins of the E series inhibit gastric acid secretion by blocking ____ production through ____ receptors on _____ cells. Sucralfate can also stimulate production of this prostaglandin.
* It has been used in people to diminish the risk of ____ associated with NSAID therapy. Once ulcer is present, not as effective.
* In dogs, it prevents ______ hemorrhage and _____ associated with aspirin therapy, but has not been tested with other NSAIDs in small animals.
cAMP, EP3, parietal, ulcers, duodenal, ulceration
Misoprostol stimulates mucous and ?
Synthetic prostaglandins (PGE1): Misoprostol
* Misoprostol is helpful for preventing GI _____, but is ___ beneficial for treating ulcers once they occur
* ____, _____ and ____-induced gastric acid secretion is inhibit by misoprostol →___% to ___% of basal acid secretion may be inhibited (cytoprotective effect)
* Misoprostol can induce ______ contractions and is contraindicated in _______.
ulcers, less, Basal, nocturnal, food, 75, 85, uterine, pregnancy
Drugs used to treat Helicobacter gastritis:
–> Treatment of gastritis and ulcers caused by the bacteria _________ _____ and ___________-like organisms has been used in animals that have not responded to other treatments. The role in disease in animals is not well documented.
* These organisms have been identified in biopsy specimens from dogs and cats
* In humans, Helicobacter spp. have the ability to decrease __-cells (D cells produce ________ which can inhibit production of gastric acids).
* Combination of metronidazole and/or clarothromycin, plus amoxicillin, and a PPI, or H2-receptor antagonist
Helicobacter pylori, Helicobacter, D, somatostatin
3 important receptors involved in production of gastric acids: CCK, M3, Histamine 2 receptors.
Cimetidie can block this receptors
Omep can blockenzymes responsibel fro H secretion
Prostacclin stimulate production of Mucuous secretion but inhibit the production of ?
Diarrhea is defined as an ________ in fecal water content resulting in increased _______, ______, or _____ of feces
increase, frequency, volume, fluidity
Acute Diarrhea
______ onset in a previously ________ animal
* Lasts from __ days to __ weeks
* Self-limiting
* Resolves without _______
Sudden, healthy, 3, 2, consequences
Chronic Diarrhea
* Lasts for over __ to __ weeks
* Associated with _______ passage of diarrheal stools
* Clinical signs:
* Eventually leads to weight ____ and chronic ______
3, 4, recurring, Fever, loss of appetite, nausea, and vomiting, loss, weakness
The most important treatment for diarrhea should include:
* _____ therapy
* ______ replenishment
* Maintaining ___/___ balance
* Control of _______
Treatment may be needed to _______ relieve clinical signs
Many of the causes of diarrhea do ___ require drug therapy and the
disease is self-_____.
Fluid, Electrolyte, acid/base, discomfort, temporarily, not, limiting
Mucosal protectants and adsorbents: ?
Protectants produce a coating of the GI epithelium that prevents _____ or ____ by potentially harmful substances.
________ bind chemical compounds → prevent the ______. They are eliminated in the feces
Kaolin-pectin formulation
* The action of kaolin-pectin is believed to be related to binding of bacterial _____ in the GI tract
* This product may change the _______ of stools, but it will not decrease ____ or _______
loss nor will it shorten the _______ of illness.
* Kao-Pectate formulations contain ______ as one of the active ingredients → some animals may be _______ to this.
* _______ may absorb or bind other drugs that are administered orally.
kaolin-pectin, bismuth subsalicylate
irritation, erosion, Adsorbents, absorption
toxins, consistency, fluid, electrolyte, duration, salicytate, sensitive, Pectin
Bismuth subsalicylate: PeptoBismol
* It is considered to be a useful ________ treatment for _____ diarrhea
* It may have some ability to adsorb bacterial _______ and produce some gastric or intestinal _______ effect
* All of the salicylate from PeptoBismol is absorbed systemically when used in ____ and ____ → amount is unlikely to produce ________ ______ (overdoses)
* Bismuth also has an ___-_______ effect in the stomach
* Some animals may not like the _____
* PeptoBismol may turn the stools ___
* PeptoBismol has been administered for the treatment of acute diarrhea in large animals→ ____ and _____
symptomatic, acute, enterotoxins, protective, dogs, cats, salicylate, toxicity, anti- Helicobacter, taste, black, foals, calves
Motility modifiers for treatment of diarrhea: anticholinergic drugs (antimuscarinic drugs)
These drugs _____ muscarinic action → antagonism of ___ and ____
- ↓ Intestinal _____ and _____
- ↓ Fluid secreted into the ______
- ↓ abdominal ______
inhibit, M1, M3, motility, secretions, bowel, discomfort
Stovepipe effect
With some forms of diarrhea these drugs may _______ the condition
The use of these drugs should be avoided if diarrhea is ________ (e.g., _________)
worsen, infectious, Salmonella
List the anticholinergic drugs used to treat diarrhea. Name which are tertiary amines and quaternary amines.
Motility modifiers for treatment of diarrhea: anticholinergic drugs (antimuscarinic drugs)
Adverse effects?
To avoid CNS effects → administer ______ amines
↓ _______ and they do not cross _____.
- Systemic pharmacological effects
- Ileus
- Xerostomia
- Urine retention
- Cycloplegia
- Tachycardia
- CNS excitement
quaternary, lipophilicity, BBB
Chronic administration of anticholinergic drugs (antimuscarinic drugs) can lead to stomach _______ and _______. Contraindicated in patients with _______ and _______
distention, discomfort, gastritis, vomiting
Motility modifiers for treatment of diarrhea: _________ drugs (_________ drugs)
N-Butylscopolammonium bromide (Buscopan)
* It is an ___________ drug used for treatment of _____ (spasm of intestine) in horses
* It is also used to relax the _____ bowel → facilitate ______ examination and _________
* Within __-___ minutes of IV injection: ↓ intestinal ______ muscle contraction. Duration is _____ (___minutes)
Adverse effects
* ↑ in ____ rate (lasting for approx. __ min)
* It should not be used in horses with ______ or with ___
anticholinergic, antimuscarinic, antispasmodic, colic, large, rectal, colonoscopy, 5-10, smooth, short, 20, heart, 30, impaction, ileus
Opioids
Endogenous _____ are also present in the intestinal wall → ?.
In cats enkephalin has been detected in both _____ and ____ plexuses.
In dogs the predominant location of enkephalin neurons is the ______ plexus
It is important to use opioids that produce ____ systemic effects
opioids, enkephalins, β-endorphin, and dynorphin, myenteric, submucosal, submucosal, little
Opioids
* Opiotes act on the ___-type (____) and __-type (___) opiate receptors of the GI tract .
* They have both __________ and __________ actions
* ______-affinity, ________ binding of opioid receptors has been identified in longitudinal and circular smooth muscles and the myenteric and submucosal plexuses
* They __ propulsive intestinal contractions
* They __ the tone of GI sphincters
* Opiates have an ________ effect and stimulate absorption of ___, ______, and ____
* The effects on secretory diarrhea are caused by inhibition of ____ influx and ↓ ________ activity
μ, OP3, δ, OP1, antisecretory, antimotility, High, reversible, ↓, ↑, antisecretory, fluid, electrolytes, glucose, calcium, calmodulin
The opioids ____________ ____________ and _____________ _____________ are used to treat diarrhea.
diphenoxylate hydrochloride, loperamide hydrochloride
- Diphenoxylate hydrochloride is a __________ derivate. It often administered in combination with ________ → _______ taste, ______ effect on salivary secretions → to discourage ______ by people
- Diphenoxylate hydrochloride can penetrate the _______ → _______ opiate effects may occur
meperidine, atropine, bitter, drying, abuse, BBB, systemic
Loperamide hydrochloride is a ________ derivate. It is the most often used (_____)
* Loperamide does not cause _______ nervous system opiated-related effects → __-___
* Intestinal _____ time and intestinal ______ capacity ↑ after treatment
butyramide, OTC, central, P-gp (also known as MDR1).
transit, luminal
Diphenoxylate and loperamide hydrochloride are contraindicated in infectious _______ because opiates may significantly _____ the GI tract and increase the ______ of bacterial toxins.
diarrhea, slow, absorption
Antimicrobial therapy for treatment of diarrhea
* The routine use of antimicrobial to treat diarrhea is _________ → a bacterial etiology cannot be identified
* Bacterial infection is not a major cause of ________ in small animals. In large animals diarrhea is often caused by bacteria ___._____
* Antimicrobials may _______ diarrhea → suppression of ______ microflora
* The used of antimicrobials should be based on a diagnosis of _____→ fecal gram staining
* Sufficiently severe ______ damage → bacterial translocation
IBI = Intestinal bacterial infection
questioned, diarrhea, E. Coli, worsen, normal, IBI, mucosal
Enterotoxins are known to stimulate _______ secretions → production of ______
intestinal, cAMP
Clinical signs of mucosal damage:
Antimicrobial therapy for treatment of diarrhea
Tylosin-responsive diarrhea
* Used to treat ____ diarrhea in dogs
* It affects both _____ and ______ bowel
* The specific _____ has not been identified
* __________ _____ and __________ _____ have been isolated
Chronic, large, small, etiology, Campylobacter jejuni and Clostridium perfringens
The intestinal inflammatory diseases cover a wide range of etiologies grouped together.
Diseases can be caused by:
IBD is characterized by infiltration of _______ cells in the ___ or ______ mucosa (____ or _____ intestine) –> Lymphocytic, plasmacytic, eosinophilic, neutrophilic
inflammatory, gastric, intestinal, small, large
Drugs for Treatment of Inflammatory Intestinal Diseases
First steps:
→ ___________ therapy
→ _______ therapy (elimination of an _______ diet)
→ _______
When the first treatments have _____ or a specific etiology has not been identified, use:
→ __________ drugs
Initial medical management may vary with the severity and length of disease
Antiparasitic, Dietary, irritating, Probiotics, failed, Antiinflammatory
Sulfasalazine is a combination of _______ and ___________ acid (mesalamine)
sulfapyridine, 5-aminosalicylic
Sulfasalazine is used for the treatment of _____ → not as effective in _____ intestine
* The sulfonamide component is absorbed into the circulation and the salicylic acid remains active in the GI tract
* The intestinal anti-inflammatory effects → _______ inhibition (antilipooxygenase activity).
___ intestinal oxygen free radicals
* This drug cannot be used in patients that have allergic reactions to _________. In some dogs sulfonamide can produce ?
colitis, small, prostaglandin, ↓ , sulfonamides, keratoconjunctivitis sicca
➢ Diagnosing colitis is based on _____ → to identify the predominant _______ cell
➢ Colitis is not usually associated with _______
Glucocorticoids: prednisolone
* It is believed that colitis is the result of _______ and ___-lymphocytes directed against the colonic _______ cells
* Corticosteroids suppress _____ synthesis, ______ migration, and _________ activation
* Budesonide is a ____ acting corticoisteroid used in people. The experience in dogs and cats has been ______, but there is some evidence of a ________ effect
biopsy, inflammatory, hypermotility, autoantibodies, T, epithelial, cytokine, leukocyte, lymphocyte, local, limited, beneficial
___________ drugs: azathioprine
- Azathioprine is metabolized to active metabolites → inhibit ________ lymphocytes suppressing ________ response
- It has been used in dogs with __________ _____________ ______ disease
Immunosuppressive, activated, lymphocyte, severe inflammatory bowel
__-__ ____ acid for colitis: eicosapentanoic acid
* The use of eicosapentanoic acid is beneficial (in people) for the treatment of _____
* Supplementation for ___ months reduced ________ levels in the colon. Clinical efficacy in ____ animals has not been reported.
N-3 fatty, colitis, 4, leukotriene, small
___________ and ______ are drugs that increase the motility of bowel and change the character of the stool.
Laxatives, cathartics
Laxatives and cathartics can be divided into:
* Bulk-________ laxatives
* Stool ______
* ________
* Saline _________ agents
* _________
These drugs promote the elimination of ____-form stool or increase ___
content of stool
forming, softener, Lubricants, hyperosmotic, Stimulants, soft, fluid
Stimulant (irritant) laxatives: __________
* They cause __________ loss by inhibiting ___/___/_____ in the intestine
* They are ______ acting drugs
* Adverse effects can result from damage to ________ (____ use)
anthraquinone, electrolyte, Na+/K+-ATPase, rapid, enterocytes, chronic
Hyperosmotic cathartics (saline cathartics)
* They are _______ electrolytes that draw fluid into the bowel via _______
* Onset of action __-___ h
* They cause intestinal ______. ↑ normal ______
* These drugs have been used to prepare animals for an ______ procedure or for treatment of _________
nonabsorbed, osmosis, 1- 3, distention, peristalsis, endoscopic, poisoning
Bulk-forming laxatives: dietary plant fibers → _______
- These agents are composed of _______ synthetic or natural _______ and ______ derivatives
- They are resistant to ______ and attract ____ into the _____
- These agents are more _____ acting (___ hr or ____)
carboxymethylcellulose, nonabsorbed, polysaccharide, cellulose, digestion, water, intestine, slow, 24, longer
Lubricants: mineral ___ and liquid _____ (white petrolatum = _____)
* These agents act by coating the _____ of the stool with a water- _________ film
* They ↑ the ____ content of the stool
* The lubricant laxatives are ______ safe. Absorption from ___ tract in a small extent
* ______ ___ are popular for nonspecific GI problems in horses and cattle
* They are used for increasing the passage of _______ (___ balls) in cats
oil, petrolatum, vaseline, surface, immiscible, water, relatively, GI, Mineral oils, trichobezoars, hair
Stool softeners (surfactants)
* These drugs act to _______ surface tension and allow more ____ to accumulate in the stool
* ______ _____ and _________ ______ are used to soften the stool
* Bile acids (__________ acid and __________ acid) produce both a choleretic (↑ ____ flow) and laxative effect
* _________ acid has an important effect in improving liver disease
* Castor oil is _______ in the bowel → release ______ acid causing an increased secretion of water in the small intestine
decreased, water, Docusate sodium, docusate calcium, dehydrocholic, ursodeoxycholic, bile, ursodeoxycholic, hydrolyzed, ricinoleic
True or False
Regarding the proton pump inhibitors, the binding to the carrier is irreversible and restoration of acid secretion requires the novo synthesis of ATPase by the parietal cells.
True
True or False
The SIBO effect may be a result of PPI administration.
True
