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Veterinary Clinical Pharmacology > GIPharm > Flashcards

GIPharm Flashcards

1
Q

what controls the urge for food seeking, hunger/appetite, and satiety center

A

Hypothalamus

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2
Q

when is it appropriate to use appetite stimulants?

A
  • when a feeding tube cannot be places

- when underlying cause of anorexia or hyporexia has been removed but patient is still not eating.

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3
Q

what is the MOA of cyproheptadine, and what is it used for?

A

Cyproheptadine is an apetite stimulant, and is a 5-HT (serotonin) antiagonist that inhibits the satiety center.

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4
Q

what are some adverse affects of giving cyproheptadine, an appetitie stimulant?

A
  • sedation

- anticholenergic effects (dry mucous membranes)

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5
Q

when would you use mirtazapine?

A

it is used as an appetite stimulants

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6
Q

what is the MOA of mirtazapine

A
  • 5HT (serotonin) antagonist (antinausea effect, increased appetite)
  • alpha adrenergic receptor antagonist (increased norepinephrine leading to increased appetite)
  • H1 receptors (sedation)
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7
Q

what is the most effective drug we have for appetite stimulant?

A

mirtazapine

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8
Q

how often is mirtazapine dosed?

A

dosed every 3 days to reduce the risk of side effects

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9
Q

what is capromorelin used for and what is it’s MOA

A

it is an appetite stimulant, and is a ghrelin receptor agonist

  • only for used in dogs
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10
Q

what is the most effective appetite stimulant for cats?

A

diazepam

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11
Q

what receptors are found in the CRTZ

A 
▪ Neurokinergic (NK1) 
▪ Serotonergic (5HT3) 
▪ Adrenergic (a2) 
▪ Dopaminergic (D2)
▪ Cholinergic (M1)
▪ Histaminergic (H1)
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12
Q

what receptors are found in the emetic/vomiting center?

A

▪ Neurokinergic (NK1)
▪ Serotonergic (5HT3)
▪ Adrenergic (a2)

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13
Q

what is apomorphine used for, and how does it work?

A

it is used as an emetic that stimulates the dopamine (D2) receptors in the CRTZ

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14
Q

what is the drug of choice to cause emesis in cats and it’s MOA

A
  • xylazine

- it is an alpha 2 agonist

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15
Q

T or F
All emetics carry a risk of aspiration pneumonia especially in recumbent, sedated,
or very ill patients

A

True

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16
Q

what is Metoclopramide used for? and what is it’s MOA

A
  • it is an antiemetic
  • serotonin antagonist (works better in dogs than cats)
    • promotility agent
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17
Q

I am a NK1 receptor antagonist that inhibits substance P and works directly at the emetic center, and is generally used to treat motion sickness, chemotherapy induced nausea, and other causes neausea.

A

Maropitant (cerenia)

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18
Q

what is ondansetron used for and what is it’s MOA

A

it is an antiemetics, that is a serotonin antagonists (much better than metoclopramide)

has to be dosed to 4x’s daily

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19
Q

what are your options for antacids? and what is their MOA

A
  • Aluminum hydroxide (Mylanta)
  • Magnesium hydroxide (Milk of Magnesia)
  • Calcium Carbonate (Tums)

these do not decrease the acid production, only neutralize it. Tums is the best/safest option.

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20
Q

T or F

the disadvantage of using calcium carbonate is that it can be absorbed systemically and can cause alkalosis

A

True

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21
Q

what drug options do you have if you need to prescribe a H2 antagonists

A
  • famotidine
  • ranitidine
  • cimetidine
  • nizatidine
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22
Q

what are some advantages and disadvantages of using aluminum hydroxide

A

advantages is that it is not systemically absorbed, but it will cause drug interactions

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23
Q

what are some advantages and disadvantages of using magnesium hydroxide?

A

it is more effective than Al hydroxide but can cause diarrhea, drug interactions, and is systemically absorbed

24
Q

what is cimetidine used for and what is it’s MOA

A
  • it is an H2 antagonist that is the least potent, and shortest acting.
  • it inhibits CYP 450 and can affect hepatic blood flow
25
Q

what is ranitidine used for and what is it’s MOA

A
  • it is an H2 antagonist blocker with intermediate potency
  • drug interactions are less likely than with cimetidine
  • has prokinetic effects (due to inhibition of AChE
26
Q

what are the two most potent H2 antagonists?

A
  • famotidine

- nizatidine

27
Q

what are some side effects of famotidine

A
  • bradycardia
  • can cause hemolysis in cats

but does not inhibit CYP 450

28
Q

what are the H2 antagonists classically used for?

A
  • uremic patients
  • mast cell tumors (histamine)
  • gastroesophageal reflux
29
Q

T or F

Famotidine should only be used for a couple days

A

True
Famotidine only effective at increasing gastric pH for 2 days at high doses
▪Proton pump inhibitors are preferred

30
Q

if you had to prescribe a proton pump inhibitor what drug options should you choose from?
which is considered the most effective?

A
  • omeprazole (prilosec) given PO
  • pantoprazole (protonix) given IV

Should give Omeprazole

31
Q

what are some drug interactions for Omeprazole

A
  • inhibits CYP 450

and is the oral drug of choice for treating ulcers and esophagitis

32
Q

what is the IV drug of choice for treating ulcers and esophagitis?

A

Pantoprazole

  • it also has no reported inhibited CYP 450 effects
33
Q

what is misoprostal used for, and what effects does it have?

A

it is a mucosal protectant

  • inhibits gastric acid secretions
  • increases bicarb secreation
  • increases mucus secretion
  • increases gastric blood flow
34
Q

what would be a clinical indication for the use of misoprostal

A
  • treatment and prevention of NSAID induced ulcers
35
Q

what are some adverse effects of using Misoprostal

A
  • GI distress (abdimonal pain, diarrhea, nausea)
  • uterine contractions, vaginal bleeding, induction of parturition
  • can have a risk to women
36
Q

what is sucralfate used for and how does it work

A

mucosal protectant that binds to epithelial cell membranes and protects against HCl, bile and pepsin

37
Q

what is the net effect of adrenergic receptors

A

these are sympathetic tone receptors which inhibit motility

38
Q

what is the net effect of cholinergic receptors

A

these are parasympathetic receptors which will enhance motility

39
Q

what is the MOA of metoclopramide

A

it is a serotonin antagonist that sensitizes the GI smooth muscle to the effects of acetylcholine

40
Q

what are some clinical uses for metoclopramide

A
  • ileus
  • GDV
  • delayed gastric emptying
  • gastroesophageal reflux
41
Q

what are some clinical uses for cisapride

A

cisapride enhances ACh release from intrinsic cholinergic neurons and is used for

  • megaesophagus in cats
  • gastroesophageal reflux
  • delayed gastric emptying
  • ileus
  • megacolon in cats
42
Q

why might you not use cisapride for the treatment of megaesophagus in dogs?

A

the dog esophagus is primarily made of skeletal muscle, which is in contrast to cats.
Cisapride has action on smooth muscle and therefore would not have an effect in dogs.

43
Q

what condition would your prescribe ranitidine

A
  • ileus
  • gastroesophageal reflux

this drug primarily effects the Stomach, but has overall GI effects

44
Q

what is the MOA of Ranitidine

A

inhibition of acecholinesterase activity.

Also H2 receptor antagonist.

45
Q

what is the MOA of Nizatidine

A

H2 receptor blocker that inhibits acetylcholinesterase activity

46
Q

what clinical reasons would you use nizatidine

A
  • delayed gastric emptying
  • constipation
  • pseudo-obstruction of the intestines
  • gastroesophageal reflux
47
Q

T or F

Erythromycin can be used for prokinetic proposes in the distal GI track.

A

FALSE

Whilt is it true that erythromycin does have prokinetic effects, it is less effective in the distal GI tract due to the lack of motilin receptors

48
Q

what are some clinical uses for Erythromycin

A
  • delayed gastric emptying
  • gastroesophageal reflux
  • decreased colonic motility (dogs only)

it is not commonly used in small animals

49
Q

Although Bethanechol is not typically used for GI motility, what can we use it for?

A
  • used to improve bladder contractility

- potential used in megaesophagus

50
Q

what are the adverse effects of bethanechol

A
  • bradycardia
  • increased gastric acid secretion
  • increased pancreatic secretions
  • SLUD
51
Q

what 2 opoids can you for their antidiarrheal effects

A
  • diphenoxylate

- loperamide

52
Q

what are some adverse reactions for loperamide

A

it is an opoid what caus- es decreased GI motility

  • reactions in dogs with MDR1 mutation
  • Dogs - constipation, bload, sedation
  • cats - not recommended due to excitation behavior
53
Q

what is the MOA of laxatives

A
  • they increase hydration of fecal mass

- Lubricate

54
Q

What type of enema should never be used in cats

A

Phosphate enemas

55
Q

under what cercumstances would you prescribe ursodeoxycholic acid

A

ursodeoxycholic acid or ursodiol is a water soluble bile acid used in
- cholestasis
gallbladder sludge
mucoceles

56
Q

what is the MOA of ursodiol

A
  • decreases hepatic synthesis and secretion of cholesterol
  • increases bile flow
    reduces hepatotoxic effects of bile salts
57
Q

what two drugs can you give to help protect the liver

A
  • S-adenosyle methionine (SAMe)

- Silymarin (milk thistle)

Veterinary Clinical Pharmacology (6 decks)

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