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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
What are precautions to using maropitant
Injection stings Bone marrow suppression with high doses in young dogs
26
What is the MOA of metoclopramide?
Dopamine antagonist (also 5-HT) -> inhibit vomiting at CRTZ Higher doses prokinetic
27
What is the MOA of ondasetron ?
Serotonin (5-HT) antagonist centrally and peripherally -> inhibit vomiting at CRTZ and in GI tract
28
What two anti-emetics have activity both centrally and peripherally
Maropitant | Ondasetron
29
How is ondasetron usually administer?
injection There is an oral formulation available
30
What drug is labeled for motion sickness in dogs, and acute treatment of vomiting in dogs and cats?
Maropitant
31
Antihistamines "H2" blockers are used to treat what?
Gastric ulcer
32
What are the Antihistamine "H2" blockers?
Cimetidine Famotidine Ranitidine
33
What is the MOA of cimetidine, famodtinide, and ranitidine?
Competitively inhibit H2 in the stomach -> gastric acid and pepsin secretion inhibited
34
What is the most potent and longest acting H2 blocker?
Famodtidine
35
What H2 blocker may have prokinetic effects?
Ranitidine
36
What H2 blocker inhibits P450 enzymes?
Cimetidine
37
Where are the H2 blockers metabolized
Cimetidine and Ranitidine - liver | Famotidine -unchanged excreted in urine
38
What is the MOA of proton pump inhibitors and what drug is commonly used?
Irreversibly inhibit H/K/ATPase proton pump resulting in decreased HCl production Omeprazole
39
How is omeprazole administered?
Oral ONLY
40
What drug has the greatest effect on increasing grastic pH?
Omeprazole (proton pump inhibitor) More potent than H2 blockers
41
What is a precaution of omeprazole?
Can inhibit p450 enzyme
42
What is mioprostol? What are its main actions?
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
What is a precaution to misoprostol?
Can stimulate uterine contractions (abortion) | Diarrhea
44
What drug is most appropriate to react NSAID- induced gastric ulcers?
Misoprostol
45
What is the MOA of sucralfate?
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
How is sucralfate administered ?
Orally- local action only
47
Should you administer concurrent oral therapies before or after sucralfate
Before | Can bind/inhibit absorption of other drugs
48
What are the oral antacids and how do they reduce ulcers?
Aluminum, magnesium, and calcium salts Chemically neutralize HCl
49
What will bind phosphorus in the gut and may reduce absorption of other drugs
Oral antacids
50
For the GI tract, if the motility is decreased, the transit time will be ____________
Increased
51
What endogenous molecules will cause an increased GI motility
ACh (PSNS) Serotonin Peptides
52
What endogenous molecules will cause decreased GI motility?
Norepi Dopamine Endorphins (opioid)
53
What drugs INCREASE GI motility?
Serotonin agonist - cisapride - mosapride Dopamine antagonist - metoclopramide - domperidone
54
What is the MOA of cisapride ?
Serotonin agonsit -> prokinetic
55
What do I use to treat megacolon and constipation in cats?
Cisapride
56
What drugs DECREASE GI motility?
Anticholinergics - aminopentamide - atropine/gycopyrrolate Opioid -loperamide and diphenoxylate
57
What are GI protectants/absorbents?
Magnesium/aluminum products Bismuth subsalicylate Activated charcoal
58
What do you call mechanical lubricants line mineral oil or laxatone?
Emollient laxatives
59
What kind of drug stimulates movement by building up pressure in the intestine by absorbing water from the lumen?
Simple bulk laxatives
60
What drug will osmotically draw fluid into the GI lumen to improve motility
Osmotic cathartic
61
What irritates the GI mucosa to stimulate motility and secretions
Irritant Catharine
62
Who do you not give a phosphate enema to ?
Cats -> toxic
63
What drug to you used to manage hepatic encephalopathy?
Lactulose
64
How is lactulose administered?
Orally | Acute situation -> enema
65
What is the MOA of lactulose?
Ion trap ammonia in the colonic lumen to enhance removal from the body
66
What drug do I chose for chronic inflammatory over disease in small animals ?
Ursodiol
67
What is the MOA of ursodiol?
Bile salt-> choleretic (increase bile flow)
68
When is ursodiol contraindicated
Biliary obstruction
69
What do I use to treat exocrine pancreatic insufficiency (EPI)?
Pancrelipase (enzyme replacement therapy)
70
What are the products that can be used to treat exocrine pancreatic insufficiency
Viokase, Pancrezyme, raw pancreas Viokase has more enzyme and better efficacy than pancrezyme Raw pancreas is cheap but inconsistent
71
How is pancreatic enzyme replacement therapy administered?
Orally with meal
72
What can you give patients concurrently to improve efficacy of pancreatic enzyme replacement therapies ?
Famotidine | -> H2 blocker -> decreased acidity and pepsin in stomach -> less breakdown of the therapy

RUSVM Pharmacology (18 decks)

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