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RUSVM Pharmacology > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

Drugs acting on the GI system fall into what 5 categories?

A 
Appetite stimulant 
Inducer/suppressor of emesis 
Anti-ulcer
Increase/decrease GI motility 
Pancreas and liver
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2
Q

Where is the appetite and satiety center?

A

Hypothalamus

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3
Q

What are endogenous inhibitors of appetite?

A

Serotonin
Cholecystokinin
Glucagon-like peptide
Leptin

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4
Q

What are endogenous stimulants of appetite ?

A

GABA
Ghrelin
Dopamine
Norepinephrine

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5
Q

How does GABA stimulate appetite

A

By inhibiting the satiety center

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6
Q

What GABA agonists can be used to simulate appetite?

A

Benzodiazepine (Diazepam, midazolam)

Propofol

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7
Q

What species are benzodiazepines more useful for stimulating appetite?

A

Cats

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8
Q

What is the most common side effect of benzodiazepines as a appetite stimulant?

A

Sedation

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9
Q

How do I administer diazepam and midazolam ?

A

Diazepam -IV

Midazolam -IV or IM

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10
Q

What benzodiazepine can be given PO to cats?

A

Oxazepam

NOT diazepam-> hepatotoxicity

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11
Q

What drug is an agonist at the ghrelin receptor?

A

Capromorelin -> increases appetite

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12
Q

Capormorelin is labeled for _______

A

Dog

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13
Q

What is the MOA of cyproheptadine and mirtazapine?

A

Serotonin and histamine antagonist -> inhibit satiety center by blocking 5-HT receptor

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14
Q

What is the most common side effect of cyproheptadine?

A

Sedation

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15
Q

Cyproheptadine is more effective in __________ and mirtazapine is more effective in _________

A

Cat;dog

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16
Q

T/F: Cats have more A2 and 5-HT receptors than dogs, but have fewer D2 and H1

A

True

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17
Q

What peripheral emetic works by directly irritating the oropharynx/GI lining

A

Hydrogen peroxide 3%

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18
Q

Why can hydrogen peroxide not be used as an emetic in cats?

A

Hemorrhagic gastritis

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19
Q

What is the MOA of apomorphine ?

A

stimulates D2 receptors -> emesis

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20
Q

Oops.. i have accidentally overdosed a dog with apomorphine? What should i do?

A

Overdose can cause respiratory depression -> reverse with naloxone

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21
Q

What is my emetic of choice in the cats? What is the MOA?

A

Xylazine or Dexmedatomidine

A2-agonist (cats have more A2 receptors than dogs)

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22
Q

What are the 3 most common emetics?

A

Maroptiant
Metoclopramide
Ondasetron

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23
Q

What is the MOA of maropitant citrate?

A

NK1 receptor -> block substance P and reduces its contribution to vomiting (central at CRTZ and peripherally at GI tract)

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24
Q

What is the purpose of substance P

A

Integration of pain, stress, anxiety, and vomiting

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25
Q

What are precautions to using maropitant

A

Injection stings

Bone marrow suppression with high doses in young dogs

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26
Q

What is the MOA of metoclopramide?

A

Dopamine antagonist (also 5-HT) -> inhibit vomiting at CRTZ

Higher doses prokinetic

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27
Q

What is the MOA of ondasetron ?

A

Serotonin (5-HT) antagonist centrally and peripherally -> inhibit vomiting at CRTZ and in GI tract

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28
Q

What two anti-emetics have activity both centrally and peripherally

A

Maropitant

Ondasetron

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29
Q

How is ondasetron usually administer?

A

injection

There is an oral formulation available

30
Q

What drug is labeled for motion sickness in dogs, and acute treatment of vomiting in dogs and cats?

A

Maropitant

31
Q

Antihistamines “H2” blockers are used to treat what?

A

Gastric ulcer

32
Q

What are the Antihistamine “H2” blockers?

A

Cimetidine
Famotidine
Ranitidine

33
Q

What is the MOA of cimetidine, famodtinide, and ranitidine?

A

Competitively inhibit H2 in the stomach -> gastric acid and pepsin secretion inhibited

34
Q

What is the most potent and longest acting H2 blocker?

A

Famodtidine

35
Q

What H2 blocker may have prokinetic effects?

A

Ranitidine

36
Q

What H2 blocker inhibits P450 enzymes?

A

Cimetidine

37
Q

Where are the H2 blockers metabolized

A

Cimetidine and Ranitidine - liver

Famotidine -unchanged excreted in urine

38
Q

What is the MOA of proton pump inhibitors and what drug is commonly used?

A

Irreversibly inhibit H/K/ATPase proton pump resulting in decreased HCl production

Omeprazole

39
Q

How is omeprazole administered?

40
Q

What drug has the greatest effect on increasing grastic pH?

A

Omeprazole (proton pump inhibitor)

More potent than H2 blockers

41
Q

What is a precaution of omeprazole?

A

Can inhibit p450 enzyme

42
Q

What is mioprostol? What are its main actions?

A

Prostaglandin E analog

Direct decrease in acid production
Increase mucus and sodium bicarbonate secretion
Stimulate epithelializaiton of the mucosa
Stimulate mucosal blood flow

=> ulcer healing

43
Q

What is a precaution to misoprostol?

A

Can stimulate uterine contractions (abortion)

Diarrhea

44
Q

What drug is most appropriate to react NSAID- induced gastric ulcers?

A

Misoprostol

45
Q

What is the MOA of sucralfate?

A

Bind to ulcer site and protect against damage from acid, pepsin, and bile
->protective coating lasting up to 6 hrs

May also stimulate protective PGs and antioxidants and increase mucosal blood flow

46
Q

How is sucralfate administered ?

A

Orally- local action only

47
Q

Should you administer concurrent oral therapies before or after sucralfate

A

Before

Can bind/inhibit absorption of other drugs

48
Q

What are the oral antacids and how do they reduce ulcers?

A

Aluminum, magnesium, and calcium salts

Chemically neutralize HCl

49
Q

What will bind phosphorus in the gut and may reduce absorption of other drugs

A

Oral antacids

50
Q

For the GI tract, if the motility is decreased, the transit time will be ____________

51
Q

What endogenous molecules will cause an increased GI motility

A

ACh (PSNS)
Serotonin
Peptides

52
Q

What endogenous molecules will cause decreased GI motility?

A

Norepi
Dopamine
Endorphins (opioid)

53
Q

What drugs INCREASE GI motility?

A

Serotonin agonist

  • cisapride
  • mosapride

Dopamine antagonist

  • metoclopramide
  • domperidone
54
Q

What is the MOA of cisapride ?

A

Serotonin agonsit -> prokinetic

55
Q

What do I use to treat megacolon and constipation in cats?

56
Q

What drugs DECREASE GI motility?

A

Anticholinergics

  • aminopentamide
  • atropine/gycopyrrolate

Opioid
-loperamide and diphenoxylate

57
Q

What are GI protectants/absorbents?

A

Magnesium/aluminum products
Bismuth subsalicylate
Activated charcoal

58
Q

What do you call mechanical lubricants line mineral oil or laxatone?

A

Emollient laxatives

59
Q

What kind of drug stimulates movement by building up pressure in the intestine by absorbing water from the lumen?

A

Simple bulk laxatives

60
Q

What drug will osmotically draw fluid into the GI lumen to improve motility

A

Osmotic cathartic

61
Q

What irritates the GI mucosa to stimulate motility and secretions

A

Irritant Catharine

62
Q

Who do you not give a phosphate enema to ?

A

Cats -> toxic

63
Q

What drug to you used to manage hepatic encephalopathy?

64
Q

How is lactulose administered?

A

Orally

Acute situation -> enema

65
Q

What is the MOA of lactulose?

A

Ion trap ammonia in the colonic lumen to enhance removal from the body

66
Q

What drug do I chose for chronic inflammatory over disease in small animals ?

67
Q

What is the MOA of ursodiol?

A

Bile salt-> choleretic (increase bile flow)

68
Q

When is ursodiol contraindicated

A

Biliary obstruction

69
Q

What do I use to treat exocrine pancreatic insufficiency (EPI)?

A

Pancrelipase (enzyme replacement therapy)

70
Q

What are the products that can be used to treat exocrine pancreatic insufficiency

A

Viokase, Pancrezyme, raw pancreas

Viokase has more enzyme and better efficacy than pancrezyme

Raw pancreas is cheap but inconsistent

71
Q

How is pancreatic enzyme replacement therapy administered?

A

Orally with meal

72
Q

What can you give patients concurrently to improve efficacy of pancreatic enzyme replacement therapies ?

A

Famotidine

-> H2 blocker -> decreased acidity and pepsin in stomach -> less breakdown of the therapy

RUSVM Pharmacology (18 decks)

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