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GIT pharms Flashcards

1
Q

Appetite stimulants

A
  • Used mostly in anorectic cats
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2
Q

Cyproheptadine

A
  • Antihistamine (H1 blocker) with anti-serotonin (serotonin antagonist) properties
  • Not used for antihistamine effects!
  • Given 12hr IV or per os
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3
Q

Mirtazapine

A
  • Tricyclic antidepressant with α2 and serotonin antagonist properties
  • Good in cats
  • SE: sedation
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4
Q

Diazepam/midazolam

A
  • Stimulates GABA release
  • OID as need, avoid frequent use
  • SE: sedation, slows down gastric emptying, hepatotoxicity
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5
Q

Drugs to dry up salivary secretion

A
  • Most commonly used are the anti-muscarinic drugs, used for pre-medication purposes
    • E.g., atropine, glycopyrrolate and scopolamine
    • Less effective in ruminants than monogastrics
  • Side effects
  • Tachycardia
  • Dry mouth (xerostoma)
  • Constipation
  • Pupillary dilation (mydriasis)
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6
Q

Buccopharyngeal Washes/Antiseptics

A
  • Used after tartar removal; stomatitis or gingivitis
  • Should be non-irritant, non-toxic
  • Various commercial solutions for veterinary use on the market
-	Active compounds include:
•	5% NaHCO3
•	Hexetidine
•	Povidone iodine solution (Betadine)
•	Cetylpyridinium (Cepacol, C.E.T)
•	Chlorhexidine (Petdent)
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7
Q

Parasympathomimetics to relax the oesophagus

A
  • Neostigmine
  • Muscarinic action; increases availability of Ach at the neuromuscular junction therefore increases peristalsis and salivation
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8
Q

Anti-spasmodics to relax the oesophagus

A

• Proquamezine fumarate (Myspamol®); not commonly used

  • Hyoscine butylbromide (Buscopan®)
  • Doses available for extra-label use in most species
  • Good for choke in horses
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9
Q

Anti-ulcer drugs (H2 antagonists)

A
  • Cimetidine
  • Ramotidine
  • Famotidine: proven efficacy in the dog
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10
Q
  • Omeprazole
A
  • Non-competitive antagonist which binds irreversibly to H+K+ATPase pumps
  • Takes 3 – 4 days to have an effect (especially orally)
  • Given oid, but can be used bid
  • Expensive
  • Side effects; maldigestion
  • Used in horses, dogs, cheetahs
  • A proton-pump inhibitor
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11
Q

Sucralfate

A

o A coating or binding agent
o Adheres to erosions/ulcers and binds bile-salts and pepsin
o Appears to increase mucosal blood supply
o Usually used in conjunction with H2-antagonists or for a few days with omeprazole
o Also a very good for prophylactic in dogs and can be beneficial for gastritis cases

o Side effects

  • Can bind other drugs; administer 1 – 2 hrs prior to other drugs in multidrug therapeutic regimes
  • Monitor for constipation
  • Taste is a limiting factor
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12
Q

Misoprostol (PGE analogue)

A 
o A synthetic hormone
o Decreases acid formation
- Increase mucosal blood flow
- Stimulates the gastric mucosa
- Enhance mucosal defense mechanisms
o Might be superior for NSAID-related prophylaxis therapy 
o SE: Abdominal discomfort, Abortions
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13
Q

Apomorphine

A
  • Can give any route; usually in the conjunctival sac
  • Should vomit within 3 min
  • Remove with saline after vomiting
  • Repeated doses not very effective and suppresses CNS and VC
  • DOC in dogs
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14
Q

Xylazine

A
  • Given IM
  • DOC in cats
  • Other drugs have emesis as a side-effect (alpha-2 agonists, opioids, methylxanthines)
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15
Q

Maropitant citrate

A
  • MOA: Directly inhibits vomiting by blocking substance P binding at the NK1 receptors in the emetic centre
  • The only registered anti-emetic for dogs (injectable and tablets), in cats only injectable registered
  • Safe and effective
  • OID dosing; long receptor binding
  • Treats vomiting from multiple causes
  • Prevents vomiting due to motion sickness
  • Also provides some visceral analgesia
  • No adjustment needed in dogs with renal failure
  • Side effects (rare): bone marrow suppression in puppies, pain on injection
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16
Q
  • Metoclopramide
A
  • An anti-dopaminergics
  • Commonly used (oral tablets and syrup, injectable)
  • Can cause excitement in small dogs and cats
  • Crosses BBB and can give extrapyramidal effects
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17
Q
  • Domperidone
A
  • An anti-dopaminergic
  • Cannot cross BBB to cause CNS and extrapyramidal effects
  • Do not use when suspecting an obstruction
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18
Q

Phenothiazines

A
  • Multi-receptor antagonists: dopamine antagonists at lower doses (CTZ) and muscarine antagonists at higher doses (VC)
  • Prochlorperazine (Stemetil)

ACP:
• Often used as a premed with morphine in dogs
• Causes hypotension –avoid/hydrate prior to use in shock/ dehydrated animals

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19
Q

Anti-histamines as anti-emetics

A
  • Antagonists at the H1 receptors in the vestibular apparatus and CTZ
  • Cyclizine - good for motion sickness
  • Diphenhydramine hydrochloride
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20
Q

Anti-cholinergics

A
  • Ideal for motion sickness

* Scopolamine/hyoscine butylbromide (Buscopan)

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21
Q

Serotonin (type 3) antagonists

A

Antagonists at the CTZ, vomiting centre and in the GIT

Ondansetron (Zofran):
• Appears to be well tolerated by dogs
• Good for ICU cases not responding to metoclopramide

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22
Q

Osmotic laxatives and saline salts

A
  • Not absorbed therefore pull water into the GIT
  • Lactulose is a safe, first choice for mild constipation**
  • Can also use mannitol, glycerine or sorbitol
  • Access to water is a must
  • Magnesium sulphate (Epsom salt), Na2SO4 (Glauber’s salts, preferred in horses)
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23
Q

Bulk forming laxatives

A
  • Psyllium and sterculia, wheat bran, agar, carboxy methylcellulose
  • Increases fecal bulk, stool softer
  • Absorb water into the intestine, stimulate peristalsis
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24
Q

Mechanical lubricants and emollients

A
  • Petroleum products, some plant oils, liquid paraffin and surfactants such as dioctyl sodium succinate (Laxapet, Docusol)
  • Mechanical lubricants and stool softeners
  • Reduces surface tension and water reabsorption
  • Also used for impaction colic in horse
25
Q

Enemas

A
  • Fluid or suppositories administered per rectum to break up faecal impaction
Substances used:
•	Warm soapy water
•	Oily substances like glycerol and liquid paraffin
•	Surfactants 
•	(Docusol and other commercial brands)
26
Q

Enzymes for Exocrine Pancreatic Insufficiency (EPI) (Pet-Assist, DigestEaze)

A
  • Pancrealipase OR raw porcine pancreatic tissue
  • Not to be heated
  • Usually life-long treatment
27
Q

Probiotics (Protexin and many formulations!)

A

• Useful for restoring GIT microflora after antibiotics

28
Q

Antibiotics (acting local to GIT)

A
  • Metronidazole

* Effective against anaerobic bacteria and Giardia spp in large bowel diarrhoea

29
Q

Buscopan

A
  • Buscopan is the trade name
  • Contains hyoscine butylbromide (also called scopolamine butylbromide)
  • These alkaloids are anti-muscarinic and therefore causes GIT smooth muscle relaxation
  • Pure scopolamine is found in the Solanaceae family of plants (Night shade)
  • Datura spp
  • Brugmansia spp (Angel’s trumpets)
30
Q

Bio-Sponge for horses (Ditrioctahedral smectite)

A
  • PO for intestinal support in diarrhoea cases
  • Proven effect against Clostridium spp toxins
  • Can combine with metronidazole
31
Q

Metoclopramide

A
  • Post operative ileus in rabbits

* Upper GIT prokinetic

32
Q

Cisapride (compounded)

A
  • Effective in dogs and cats for gastro-oesophageal reflux

* Feline megacolon; also has motility enhancement in the colon

33
Q

Lignocaine

A
  • Used in horses
  • Indirect effect; prevents inhibitory effect on GIT motility
  • Analgesic/ anti-inflammatory effect on the GIT
34
Q

Amoxycillin and ampicillin (aminopenicillins)

A
  • Prime candidates for disturbing normal GIT flora
  • Suitable in treating cases of bacterial overgrowth due to anaerobic bacteria.
  • If culture and sensitivity not available for animal in a critical condition due to sepsis can consider combination of parenteral penicillins plus an aminoglycoside (amikacin or gentamicin)
  • Ensure that the patient is hydrated prior to using aminoglycosides
35
Q

Potentiated sulphonamides

A
  • Broad spectrum activity against invading aerobic and anaerobic bacteria
  • Minimally disrupt intestinal flora
36
Q

Sulphasalazine (sulpha-analogue)

A
  • Bacteria in the colon split into sulfapyridine and mesalazine
  • Sulfapyridine = sulphonamide antibiotic
  • Mesalazine (5-aminosalicylic acid) = anti-inflammatory in the colon
  • Used for treating colitis in dogs
  • Need to use for at least six weeks
  • Monitor for KCS
37
Q

Metronidazole (nitroimidazoles)

A
  • Broad spectrum of activity against anaerobic bacteria
  • Anti-protozoal properties
  • Seems to have immunomodulating properties in animals suffering from IBD
38
Q

Tetracyclines

A
  • Can be used for treatment of SIBO

* Doxycycline excreted directly through the mucosa of the digestive tract

39
Q

Lincomycin (lincosamides) and erythromycin (macrolides)

A
  • Limited value in the treatment of diarrhea; disruptive effects on microflora and needless expense
  • Erythromycin has a high incidence of drug induced vomiting
40
Q

Fluoroquinolones

A
  • Very effective at reducing the aerobic bacterial flora of faeces, generally without affecting the anaerobic flora
  • Potent gram-negative activity with a lower but often therapeutically useful activity against gram-positive aerobes
41
Q

Antacids; rumen acidosis

A

• DOC is MgO (Kyrogest)
- Not absorbed (non-systemic)
- Less CO2 produced than with alternative salts
• Note that proper dietary management and transition is important in preventing and managing rumen acidosis
• Ionophores can be used to modulate rumen microbial function
• Inhibit ruminal lactate producers

42
Q

OTC products for bloat

A
  • Poloxalene (Bloatguard)

* Dioctyl sodium sulphosuccinate (Docusol): Also used to loosen earwax and as enema

43
Q

On farm remedies for bloat

A
  • Cooking oil (up to 2 cups per bovine)
  • Liquid paraffin in milk (up to 60 ml per bovine)
  • Non-foaming detergents (automatic washing machines)
44
Q

Ruminotorics

A
  • Establish a suitable rumen environment (Rumix)
  • Multiple commercial mixes available
  • Can also use molasses, glycerol, propylene glycol, brewer’s yeast, good quality hay, fresh ruminal contents (transfaunation)
  • Always dose with large amounts of warm water and massage
45
Q

Anti-zymotics

A
  • suppress microflora and depresses rumen fermentation
  • Not commonly used, but can work if animal has overeaten
  • Antibiotics or protozoacides dosed orally, formalin, turpentine etc.
46
Q

Zinc acetate or gluconate

A

• For patients with chronic hepatic disease or fibrosis
o Chronic liver disease tends to result in a zinc deficiency which may impair immunoregulatory functions and favour collagen deposition leading to hepatic fibrosis
• Reduces absorption of copper, so useful for Cu storage disease
• Assists with detoxification of ammonium

47
Q

Ursodeoxycholicacid /ursodiol (Ursotan)

A
  • Thought to modify the cytotoxicity of the bile acids thus decreasing hepatocyte death, inflammation and fibrosis
  • Also thought to be directly cytoprotective to hepatocytes
  • Expensive
48
Q

Colchicine

A
  • An antimitotic agent that inhibits synthesis of collagen, thus can be antifibrotic
  • Questionable efficacy, and can have significant side effects (bone marrow suppression, haemorrhagic gastroenteritis or HGE)
49
Q

Anti-oxidants

A
  • S-Adenosyl-L-methionine (SAMe), allopurinol, desferroxamine
  • The administration of S-adenosyl-L-methionine provides the substrate required for the continued formation of glutathione, a primary defense antioxidant in the liver and RBCs
50
Q

Cholagogues

A
  • A compound that stimulates gall bladder contraction and bile acid release
  • May aid in fat digestion or for minor bile duct blockage?
  • Dietary fats
51
Q

Ceruletide

A
  • A decapeptide similar to gastrin
  • Acts at the CCK receptors to contract the gallbladder and relax the sphincter of Oddi
  • Parasympathomimetics e.g. pilocarpine can also be used to promote contraction of the gallbladder
52
Q

Choleretics

A
  • Increases bile production by the hepatocytes

* Ox bile extract, dehydrocholic acid, clanbutin, methoxynapthalene

53
Q

Neomycin

A
  • Reduces bacterial load

* Reduces the intestinal production of ammonia from glutamine metabolism

54
Q

Lactulose, used synergistically with neomycin

A

• Per os or as an enema in emergency
• Metabolised by gut microbes to low molecular weight organic acids
o Lactic acid, acetic acid, which acidify gut and trap ammonium ions (become ionized)
• Encourages bacterial nitrogen fixation
• Dose adjusted based on stool consistency and frequency

55
Q

Essential phospholipids

A

• Assist with fat oxidation, anti-inflammatory, membrane protective, antifibrotic

56
Q

Choline

A
  • Precursor is SAMe

* Assist with fat oxidation, DNA methylation, modulation of gene expression

57
Q

Methionine

A
  • Part of SAMe and precursor to choline

* Antioxidant

58
Q

Azathioprine

A

• Usually together with corticosteroids to lower dose if side effects develop

59
Q

Metronidazole

A

• Inhibits purine synthesis; suppresses cell mediated immunity and changes antibody production

pharms (5 decks)

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