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Pharm Final > GI Drugs - Kumar TS > Flashcards

GI Drugs - Kumar TS Flashcards

0
Q

Which appetite stimulant is used in cats and acts through GABA?

A

diazepam (valium)

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1
Q

What neurotransmitter stimulates appetite? Which one inhibits appetite?

A

Stimulated by GABA

inhibited by serotonin

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2
Q

Which appetite stimulant for cats is an antihistaminic and antiserotonin agent?

A

cyproheptadine

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3
Q

What is the anti obesity drug used for dogs?

A

dirlotapide

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4
Q

What animals are NOT able to vomit effectively?

A

horses, ruminants, rodents

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5
Q

What are the the 4 afferent sources that can stimulate vomiting?

A

CTZ
vestibular
peripheral sensory receptors
higher CNS

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6
Q

What are the 5 neurotransmitters involved in vomiting?

A

dopamine, histamine, serotonin, Ach, substance P

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7
Q

What is the most important neurotransmitter for the CTZ to initiate vomiting?

A

dopamine

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8
Q

What is the neurotransmitters used to cause vomiting in the vestibular system?

A

Histamine and muscarinic

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9
Q

What is the primary neurotransmitter for peripheral sensory receptors?

A

acetylcholinne

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10
Q

What are the transmtters used for higher CNS centres for vomiting?

A

cholinergic and histamine

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11
Q

What pathway initiates emesis from increased intracranial pressure?

A

limbic pathway

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12
Q

What is the primary neurotransmitter used in psychogenic vomiting?

A

acetylcholine

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13
Q

Where are NK-1 receptors found?

A

emetic center and CTZ

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14
Q

Which peripheral acting emetic should not be dosed twice in cats?

A

ipecac

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15
Q

What are the 3 peripheral acting/reflex emetics?

A

salt water, hydrogen peroxide, ipecac

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16
Q

What are the 2 centrally acting emetics?

A

apomorphine

xylazine

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17
Q

Which centrally acting emetic is used in cats?

A

xylazine

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18
Q

What is the MOA for apomorphine?

A

opiod - dopaminergic receptors in CTZ`

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19
Q

How is apomorphine adminisstered?

A

subq or conjuctival

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20
Q

What is the contraindication of apomorphine?

A

animals with existing central depression because it depresses respiratory centers

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21
Q

What is the MOA of xylazine?

A

stimulates alpha 2 receptors in CTZ

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22
Q

What are the side effects of xylazine?

A

bradycardia

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23
Q

What can be used to prevent emesis at the vestibular apparatus?

A

anti histamines

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24
Q

What antimuscarinic can cross the BBB in dogs to prevent emesis?

A

scopolamine

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25
Q

What are the SE of antimuscarinics?

A

xerostomia, drowsiness, constipation, urine retention

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26
Q

What are the 5 anti emetic drugs acting on the CTZ?

A
  1. phenothiazines
  2. butyrophenone derivatives
  3. metoclopramide
  4. peripheral serotonin antagonists
  5. Nk1 receptor blockers - cerenia
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27
Q

What antiemetic drugs are “broad” spectrum?

A

phenothiazines

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28
Q

What should be done before giving animals phenothiazines (ace)?

A

fluid replacement

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29
Q

What are the contraindications of phenothiazines?

A

animals with seizures

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31
Q

What anti emetic effectively antagonizes apomorphine induced emesis?

A

metoclopramide

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32
Q

What is the MOA for metoclopramide?

A

dopamine antagonist, serotonin agonist and serotonin receptor antagoonist to CTZ

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33
Q

What CTZ anti emetic blocks transmission to CTZ an interferes with action of serotonin on peripheral receptors in GI tract?

A

peripheral serotonin antagonists (cyproheptadine)

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34
Q

What drug acts by blocking NK-1 receptor?

A

maropitant citrate (cerenia)

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35
Q

Why can’t cerenia be used in puppies less than 11 weeks of age?

A

can induce bone marrow hypocellularity

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36
Q

What are the 3 ways anticholinergic drugs exert its antiemetic activity?

A

inhibit vagus
relax GI smooth muscle
inhibit GI secretions

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37
Q

What receptors do butyrophenone derivatives act on?

A

antidopaminergic

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38
Q

What are the 2 SE of butyrophenone derivatives?

A

sedation and hypotension

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39
Q

What drug effectively antagonizes apomorphine induced emesis?

A

metoclopramide (reglan)

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40
Q

Why is the bioavailability of metclopramide only 50%?

A

extensive hepatic first pass metabolism

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41
Q

What are the SE of metclopramide in horses and cats?

A

hyperactivity, restlessness, tremors

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42
Q

What group of drugs are indicated for emesis induced by chemotherapeutic agents?

A

peripheral serotonin antagonists

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43
Q

What peripheral serotonin antagonist is used in small animals?

A

cyproheptadine (periactin)

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44
Q

What are some other examples of peripheral serotonin antagonists?

A

granisetron, palonosetron, ondansetron

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45
Q

What anti emetic is a NK-1 receptor blocker?

A

maropitant citrate (cerenia)

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46
Q

What is the contraindication of maropitant citrate (cerenia)?

A

puppies less than 11 weeks - bone marrow hypocellularity

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47
Q

What are the 3 ways anticholinergics exert antimetic activity?

A

inhibit vagus
relax GI spasm
inhibit GI secretions

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48
Q

What is the one drawback of anticholinergic drugs?

A

delays gastric emptying - dont use for more than 3 days

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49
Q

What are the 3 MOA for drugs to modulate gastric acid secretion?

A

block endogenous secretagogues
block proton pump
enhance cytoprotective effect

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50
Q

Which antisecretory drug is anticholinergic and selective for gastric M1 receptors?

A

pirenzepine

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51
Q

Which H2 receptor antagonist (of the antisecretory drugs) has the longest duration of action?

A

famotidine

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52
Q

What is the order of potency for H2 receptor antagonists of the antisecretory drugs?

A

famotidine>ranitidine>nizatidine>cimetidine

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53
Q

What drug is clinically useful in preventing acetaminophen toxicity in case of accidental overdose?

A

cimetidine

54
Q

What are the SE of H2 receptor antagonists?

A

thrombocytopenia, rebound acid hypersecretion, relapse ulcers, cutaneous drug eruption in cats

55
Q

What is the MOA of omeprazole (prilosec)?

A

inhibits proton pump

56
Q

What are the clinical indications of omeprazole (prilosec)?

A

short term treatment of gastric ulcers associated with gastrinomas

57
Q

What are the 4 adverse reactions to omeprazole (prilosec)?

A
  1. suppression of acid barrier - bacteria
  2. aspiration pneuomonia (megaesophagus)
  3. hypergastrinemia
  4. inhibits CYp450
58
Q

What drug does not alter serum gastrin levels, hence prevents rebound acid hypersecretion?

A

misoprostol (cytotec)

59
Q

What are the 3 non-systemic antacids?

A

salts of aluminum, magnesium, calcium

60
Q

What is the antacid of choice for mild ruminal acidosis?

A

aluminum hydroxide

61
Q

What drug is used as a systemic antacid?

A

sodium bicarbonate

62
Q

What are the 4 SE of antacids and which drug is most associated with each SE?

A

constipation - Al and Ca
Diarrhea - Mg
Hypercalcemia - Ca
hypophosphatemia - Al

63
Q

What drug is considered a potent agent in gastroduodenal ulcer healing caused by NSAIDs?

A

misoprostol

64
Q

What drug binds to the gastric ulcer, protects it, and promotes healing?

A

sucralfate

65
Q

What cytoprotective drug should be used cautiously in cats?

A

bismuth subsalicylate (glucoronidation)

66
Q

What is the MOA of bethanechol?

A

cholinergic agonist, enhances amplitude of GI contractions

67
Q

What are the indications of bethanechol?

A

postoperative ileus, urinary retention

68
Q

What are the SE of bethanechol?

A

obstruction, peritonitis, intestinal wall is compromised

69
Q

What is the MOA of metoclopramide?

A

enhances release of Ach in GI. peripherally antagonizes D2 receptors (blocks inhibitory)

70
Q

What are the 4 actions of metoclopramide?

A

increase tone of esophageal sphincter
increase GI contractions
relax pyloric sphicter, rapid emptying
penetrates BBB - antagonizes D receptors

71
Q

What are the 2 clinical indications of metoclopramide?

A

reflux esophagitis

gastric motility disorders

72
Q

What drug has the broadest spectrum of all the prokinetic agents?

73
Q

What are the indications for cisapride?

A

same as metoclopramide, constipation (mega colon in cats), and post operative ileus

74
Q

What is a prokinetic agent that peripherally antagonizes dopamine receptors only?

A

domperidone

75
Q

What are the main indications for using anticholinergic drugs for GI?

A

control diarrhea in calves and mild colin

76
Q

What is the net effect of using opiods on the GI?

A

decreased GI motility and secretions

increase tone of sphincters

77
Q

Opiods are superior to antimuscarinics in treating what?

A

non specific diarrhea

78
Q

What are the contraindications for using opiods during diarrhea?

A

when diarrhea is from invasive bacterial infection

79
Q

What is diphenoxylate used for clinically?

A

anti-diarrheal

80
Q

What is the active metabolite of diphenoxylate?

81
Q

What does loperamide do?

A

reduce excessive intestinal secretion, prolongs transit time

82
Q

What drug is a tincture of opium and used as an antidiarrheal in foals?

83
Q

What Gi protectant and adorbent should be used cautiously in cats?

A

bismuth subsalicylate

84
Q

What 2 drugs absorb E-coli enterotoxins?

A

Bismuth salts and activated charcoal

85
Q

What is the best choice for emergency treatment of poisoning?

A

activated charcoal

86
Q

What should be done after administering activated charcoal?

A

saline laxative 30-45 minutes afterwards

87
Q

What does cholestyramine bind to?

A

acidic side chains of bile acids

88
Q

What is the clinical indication for cholestyramine

A

pruritis associated with increased bile acids

89
Q

What are the adverse effects of cholestyramine?

A

nausea, constipation, steatorrhea, decreased B vitamins

90
Q

What kind of stool do cathartics/purgatives produce?

A

more fluid than laxatives

91
Q

What are the 3 emollient laxatives?

A

mineral oil, docusate sodium, paraffin

92
Q

What are aspects of emollient laxatives?

A

unchanged, not absorbed, soften and lubricate fecal mass

93
Q

What are aspects of bulk forming laxatives?

A

hydrophilic in nature, reflex peristaltic contractionn

94
Q

What are the 2 bulk forming laxatives?

A

bran, psyllium granules

95
Q

What is the most useful mild laxative for horses with sand colic?

A

psyllium granules

96
Q

What animals are saline/osmotic purgatives contraindicated in?

A

dehydrated animals

97
Q

Which osmotic purgative is fermented to organic acids and lowers the pH of colon contents?

98
Q

What can lactulose be used to treat?

A

dogs and cats - constipation, hepatic encephalopathy
horses - hepatic encephalopathy
can be admin by rectum

99
Q

What are examples of irritant/stimulant cathartics?

A

castor oil, ricinoleate, anthraquinones

100
Q

What is the MOA of irritant cathartics?

A

stimulate local myenteric reflexes, provoke fluid accumulation in intestinal lumen by active secretory mechanisms

101
Q

What irritant stimulant can cause superpurgation in horses when administered repeatedly?

A

anthraquinone

102
Q

What is the MOA of neuromusular purgatives?

A

muscarinic actions - increase motility

103
Q

What is the contraindication of neuromuscular purgatives?

A

mechanical obstruction of intestine

104
Q

What is the contraindication of ALL cathartics??

A

animal showing signs of abdominal pain

105
Q

what are the adverse effects of overdosing cathartics?

A

diarrhea, abdominal colic, dehydration, shock

106
Q

What type of enema preparations should not be used in cats?

A

ones that contain phosphate

107
Q

What can be given to foals to help pass the meconium?

A

docusate sodium

108
Q

What do cholagogues do?

A

contraction of gall bladder

109
Q

What do choleretics do?

A

increase secretion of bile

110
Q

What can be used to dissolve gallstones non surgicially?

A

Ursodeoxycholic acid (UDCA)

111
Q

What drug can reduce the surface tension of gas bubbles causing them to coalesce?

A

dimethicone

112
Q

What drug is used in the prevention and treatment of frothy bloat?

A

poloxalene

113
Q

What is contra indicated in ruminal bloat and stabalizes foam?

114
Q

What do phenothiazines NOT control for emesis?

A

labyrinthine stimulation (vestibular?)

115
Q

What are the 3 centrally acting emetics that are antidopaminergics?

A

phenothiazines
butyrophenones
metoclopramide

116
Q

What are examples of phenothiazine drugs?

A 
chlorpromazine
prochorperazine
triflupromazine
promethazine
trifluperazine
117
Q

What are examples of peripherally acting antiemetics?

A

demulscents, antacids, protectants such as kaolin, pectin

anticholinergic drugs, prokinetics

118
Q

What can chronic administration of antisecretory drugs to GI result in?

A

achlorhydria (malabsorption)

119
Q

What are the 2 SE associated with using misoprostol for decreasing gastric secretion?

A

diarrhea

increases uterine contraction (pregnancy contraindicated)

120
Q

How does omeprazole inhibit the proton pump?

A

goes to acidic environment of parietal cells, protonated and irreversibly binds pump

121
Q

What 2 non systemic antacids can be combine to balance bowel movements?

A

aluminum and magnesium

122
Q

What does sucralfate require in order to break up and bind to ulcers?

A

acidic environment

123
Q

What part of Bismuth subsaliicylate is absorbed?

A

salicylate

124
Q

What is postoperative illeus?

A

atony or paralysis of stomach or bowel

125
Q

What is the most potent and broad spectrum prokinetic agent?

126
Q

What prokinetic acts PERIPHERALLY as a dopamine antagonist?

A

domperidone

127
Q

Mineral oil should not be used with what because emulsification of the oil would facilitate its absorption?

A

docusate sodium

128
Q

What species should diphenoxylate be used cautiously because it causes excitabilty?

129
Q

What happens to castor oil after it is ingested?

A

hydrolyzed by pancreatic lipase into glycerol and ricinoleic acid

130
Q

What does ricinoleate do?

A

reduces absorption of fluid and stimulates peristalsis

131
Q

What are 2 substances that are cholagogues?

A

dietary fat and concentrated magnesium sulfate

132
Q

What can be administered for a retention enema thru a catheter?

A

acetylcysteine - breaks bonds

Pharm Final (11 decks)

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