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CLIN PHARM > II - GI Small Animal > Flashcards

II - GI Small Animal Flashcards

1
Q

In what clinical situations would administering appetite stimulants be most effective?

A
  • feeding tube cannot be placed
  • underlying cause of anorexia/Hyporexia has been removed but patient is still not eating
  • short term during diagnostic phase
  • secondary to behavioral or environmental factors
  • overcome food aversion
  • chronically ill or palliative cases when a feeding tube cannot be placed
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2
Q

List five appetite stimulants.

A
  1. Cyproheptadine
  2. Mirtazapine
  3. Capromorelin (Entyce - dog, Elura - cat)
  4. Benzodiazepines: Diazepam
  5. Glucocorticoids
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3
Q

MOA: 5-HT3 (serotonin) antagonist

  • Hypothalamus secretes opiates which stimulate appetite, and serotonin inhibits opiate release
A

Cyproheptadine

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4
Q

This appetite stimulant shows some efficacy in cats as they are more sensitive to serotonin changes.

A

Cyproheptadine

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5
Q

Adverse effects of Cyproheptadine (4)

A

Sedation
Paradoxical CNS stimulation/aggression
Anticholinergic effects
Dry mucous membranes

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6
Q

MOA:
5HT3 (serotonin) antagonist - anti nausea, increased app.

Alpha adrenergic receptor antagonist - increased norepinephrine leads to increased app.

Histamine receptor antagonist - sedation

A

Mirtazapine

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7
Q

Adverse effects of Mirtazapine (5)

A

Sedation
Focalization
Behavior changes
GI upset
Irritation of pinna

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8
Q

Mirtazapine is an effective appetite stimulant for _______.

A

Dogs and cats

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9
Q

MOA: Ghrelin receptor agonist - directly signals hypothalamus and increases growth hormone excretion from the pituitary

A

Capromorelin - Entyce (dogs), Elura (cats)
Appetite stimulant

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10
Q

Adverse effects of this appetite stimulant identified so far are increased salivation after dosing and GI upset.

A

Capromorelin - Entyce (dogs), Elura (cats)

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11
Q

Capromorelin is FDA approved for which species?

A

Dogs (Entyce) and cats (Elura)

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12
Q

MOA: GABAminergic inhibition of satiety center

A

Benzodiazepines: Diazepam

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13
Q

As an appetite stimulant, diazepam is most effective in _______.

A

Cats

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14
Q

This appetite stimulant is administered IV and has a short half-life.

A

Diazepam

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15
Q

_________ cause polyphagia in dogs but are not recommended as an appetite stimulant due to side effects such as catabolic muscle loss.

A

Glucocorticoids

  • Also poor effects on appetite in cats
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16
Q

Name three receptors found in the Emetic/Vomiting Center

A

Neurokinergic - NK1
Serotonergic - 5HT3
Adrenergic - a2

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17
Q

Name six receptors found in the Chemoreceptor Trigger Zone (CRTZ)

A

Neurokinergic - NK1
Serotonergic - 5HT3
Adrenergic - a2
Dopaminergic - D2
Cholinergic - M1
Histaminergic - H1

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18
Q

CRTZ in cats:

Poorly developed ______ receptors.
Absence of ______ receptors.
Higher number of _______ receptors.

A

Dopaminergic - D2
Histaminergic - H1
Adrenergic - a2

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19
Q

CRTZ in dogs:

Well developed ________ and ________ receptors
Lower number of ________ receptors

A

Dopaminergic - D1 and Histaminergic - H1
Adrenergic - a2

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20
Q

Inducing emesis is most productive when performed within what time period?

A

Within 2-3 hours of ingestion

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21
Q

List five emetics used in small animal medicine.

A
  1. Apomorphine
  2. Ropinerole (Clevor)
  3. Xylazine
  4. Dexmedetomidine
  5. Hydrogen peroxide 3%
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22
Q

MOA: Stimulates dopamine D2 receptors in CRTZ to cause vomiting in dogs

Two drugs

A

Apomorphine
Ropinerole (Clevor)

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23
Q

Three adverse effects of apomorphine

A

Ocular irritation
Lethargy
Protracted nausea/vomiting

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24
Q

This drug is the emetic of choice in dogs.

A

Apomorphine

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25
Q

Apomorphine can be given ________.

A

IV (preferred) or conjunctival (tablet)

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26
Q

MOA: Alpha-2 agonist

Two drugs for inducing emesis.

A

Xylazine
Dexmedetomidine

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27
Q

In addition to ocular irritation and protracted vomiting, this drug inhibits prolactin and should not be used during pregnancy or lactation (staff should also be cautious when handling).

A

Ropinerole (Clevor)

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28
Q

How would you treat protracted nausea/vomiting brought about by Ropinerole and apomorphine?

A

Dopamine antagonists such as metoclopramide

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29
Q

Two drugs used to induce emesis in cats

A

Xylazine
Dexmedetomidine
IM or IV

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30
Q

How do you reverse Xylazine and Dexmedetomidine?

A

Xylazine - yohimbine

Dexmedetomidine - atipamezole

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31
Q

Depending on the dose used, sedation is a possible side effect for ______________ and _______________.

A

Xylazine and Dexmedetomidine

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32
Q

MOA: generates water and gas, foam expands the stomach, irritation stimulates GI nerve endings to induce emesis

A

Hydrogen peroxide

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33
Q

Why isn’t hydrogen peroxide recommended for inducing emesis in cats?

A

Low efficacy and increased risk of adverse effects

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34
Q

Adverse effects of hydrogen peroxide for inducing emesis

A

Gastritis
Esophagitis
GI ulceration
Air embolus

*particularly if overdosed or wrong concentration used

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35
Q

Name four antiemetics.

A
  1. Metoclopramide (Reglan)
  2. Maropitant (Cerenia)
  3. Ondansetron (Zofran)
  4. Dolasetron (Anzemet)
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36
Q

MOA: Serotonin antagonist and antidopaminergic; also a pro-motility agent

A

Metoclopramide (Reglan)

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37
Q

Which antiemetic works better in dogs than in cats?

A

Metoclopramide (Reglan)

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38
Q

Which antiemetic has a very short half-life and must be a CRI if given IV?

A

Metoclopramide (Reglan)

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39
Q

Adverse effects of metoclopramide (Reglan) - 3

A

Change in mentation/behavior
Disorientation
Constipation

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40
Q

MOA: Neurokinin-1 receptor antagonist; inhibits substance P - a key neurotransmitter involved in vomiting; works directly at the emetic center

A

Maropitant (Cerenia)

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41
Q

This antiemetic is used in dogs and cats

A

Maropitant (Cerenia)

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42
Q

Adverse effect of maropitant (Cerenia) - 1

A

Pain at site of injection (esp. SQ)

*refrigeration may reduce pain

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43
Q

MOA: serotonin antagonists

A

Ondansetron (Zofran)
Dolasetron (Anzemet)

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44
Q

Which antiemetics are often used for chemotherapy induced nausea?

A

Ondansetron (Zofran)
Dolasetron (Anzemet)
Maropitant (Cerenia)

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45
Q

Ondansetron can be given _______.

A

IV or PO

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46
Q

Dolasetron can be given ________.

A

PO, IV, SQ

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47
Q

Possible side effect for Ondansetron and Dolasetron - 1

A

P-glycoprotein substrates may cause neurological toxicity in herding breed dogs with the MDR1 mutation

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48
Q

Risk factors for GI ulceration

A
  • Drugs: NSAIDS, corticosteroids
  • Stress
  • Compromised mucosal blood supply: anesthesia, dehydration, hypoadrenocorticism
  • Inflammatory bowel disease
  • Gastronomy, adenocarcinoma
  • Helicobacter?
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49
Q

Risk factors for esophagitis and reflux

A

Gastroesophageal reflux
Esophageal dysmotility
Foreign body
Toxins
Caustic substances

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50
Q

Causes of gastroesophageal reflux

A

Primary idiopathic
Anesthesia associated
Secondary (inflammatory, neoplastic)
Hiatal hernia, brachycephalic syndrome
Many more

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51
Q

Causes of esophageal dysmotility

A

Megaesophagus
Myopathies/neuropathies
Neoplasia
Etc.

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52
Q

List three antacids found OTC and give their MOA.

A

Aluminum hydroxide (Mylanta)
Magnesium hydroxide (Milk of magnesia)
Calcium carbonate (Tums)

MOA: neutralize acid (don’t decrease production)

  • Insufficient evidence to recommend as treatment for ulceration or reflux in SA med; longer acting and more effective treatments are available
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53
Q

List four H2 antagonists used to reduce gastric secretions.

A

Famotidine (Pepcid)
Ranitidine
Cimetidine (Tagamet)
Nizatidine

54
Q

MOA: reversible, competitive antagonist at histamine H2 receptor in parietal cells; reduce gastric acid secretion; some have prokinetic effects

A

Histamine H2 Antagonists

  • Famotidine (Pepcid)
  • Ranitidine
  • Cimetidine (Tagamet)
  • Nizatidine
55
Q

H2 antagonists are classically used for:

A

Uremic patients and mast cell tumors

56
Q

Which H2 antagonist has the most drug interactions?

A

Cimetidine (Tagamet) - inhibits CYP 450

57
Q

Name the two proton pump inhibitors used in small animal medicine.

A

Omeprazole (Prilosec) - PO
Pantoprazole (Protonix) - IV

58
Q

MOA: inhibit the gastric hydrogen-potassium-ATpase proton pump; reduces gastric secretion

A

Omeprazole (Prilosec)
Pantoprazole (Protonix)

59
Q

How often should PPIs be given?

A

Twice daily

60
Q

What is considered to be the most effective treatment for increasing gastric pH and treatment of ulceration?

A

Proton pump inhibitors
- omprazole (Prilosec)
- Pantoprazole (Protonix)

61
Q

When should PPIs be tapered in dogs and cats?

A

After prolonged use > 3-4 weeks

62
Q

Which PPI inhibits CYP 450?

A

Omeprazole (Prilosec)

63
Q

Which PPI takes effect more rapidly?

A

Pantoprazole (Protonix)

64
Q

Name two mucosal protectants used in small animal medicine.

A

Misoprostal
Sucralfate

65
Q

MOA: Prostaglandin E1 analog; inhibits gastric acid secretion; increases bicarbonate secretion; increase mucus secretion; increase gastric blood flow

A

Mucosal protectant
- Misoprostal

66
Q

Clinical indications for misoprostal

A

Treatment and prevention of aspirin (and maybe other NSAID) induced ulcers

No indication of efficacy for treating glucocorticoid induced ulcers

67
Q

Adverse effects of misoprostal

A

GI distress

Uterine contractions, vaginal bleeding, induction of parturition - risk to women, handle with care

68
Q

MOA: When combined with acid forms sucrose octasulfate and aluminum hydroxide; binds to exposed epithelial cell membranes and not normal mucosa; protects mucosa against HCl, bile, pepsin; possibly stimulates local prostaglandin production

A

Sucralfate

69
Q

Drug interactions with Sucralfate

A

Affects oral absorption of drugs

70
Q

Is Sucralfate helpful in preventing/treating esophageal injury?

71
Q

Which drugs are superior for treatment of ulceration?

A

Proton Pump Inhibitors
- Omeprazole
- Pantoprazole

72
Q

A dog’s esophagus is essentially all ________.

A

Skeletal muscle

73
Q

The lower esophageal sphincter is made of ______.

A

Smooth muscle

74
Q

The cat’s esophagus is ________ the cranial 2/3 and ________ the distal 1/3.

A

Skeletal muscle
Smooth muscle

75
Q

Which receptors are sympathetic?

A

Adrenergic
- inhibit motility
- fight or flight

76
Q

Which receptors are parasympathetic?

A

Cholinergic
- enhance motility
- rest and digest

77
Q

List six prokinetic drugs used in small animal medicine.

A

Metoclopramide
Cisapride
Ranitidine (no longer on the market)
Nizatidine
Erythromycin
Bethanechol

78
Q

The clinical uses of this drug include ileus, GDV - post op, delayed gastric emptying, gastroesophageal reflux (increases LES tone).

A

Metoclopramide

79
Q

This drug’s site of action is mainly the proximal GI tract as the distal GI tract is less responsive.

A

Metoclopramide

80
Q

MOA: serotonin antagonist and antidopaminergic
Promotility MOA: sensitizes GI smooth muscle to effects of acetylcholine

A

Metoclopramide

81
Q

MOA: enhances acetylcholine from intrinsic cholinergic neurons; not antidopaminergic

82
Q

The site of action of this drug is smooth muscle from esophagus through to the colon.

83
Q

This prokinetic is metabolized by CYP 450, so it is affected by drugs that inhibit this enzyme.

84
Q

This prokinetic has minimal side effects that can include vomiting, diarrhea, and abdominal discomfort.

85
Q

Clinical uses for this drug include megaesophagus in cats, mega colon in cats, gastroesophageal reflux, delayed gastric emptying, and ileus.

A

Cisapride

*does not work in megaesophagus in dogs as their esophagus is all skeletal muscle

86
Q

Two prokinetics with MOA: H2 receptor blocker, inhibition of acetylcholinesterase activity

A

Ranitidine (no longer on the market)
Nizatidine

87
Q

Clinical uses for this drug include delayed gastric emptying, constipation, pseudo-obstruction of the intestines, and gastroesophageal reflux

A

Nizatidine

88
Q

What is the site of action of Nizatidine?

89
Q

What is the site of action of Ranitidine?

A

GI, especially stomach

90
Q

MOA: macrolide antibiotic with motilin-like activity

A

Erythromycin

91
Q

Why is ertythromycin less effective in the distal GI tract and diseased GI tract?

A

Lack of motilin receptors

92
Q

This drug is used for decreased colonic motility in dogs only.

A

Erythromycin

93
Q

This prokinetic inhibits CYP 450 (and interacts with Cisapride)

A

Erythromycin

94
Q

Possible adverse reaction of erythromycin.

A

Possible reactions with MDR1 mutations
Drug interaction - inhibition of CYP 450

95
Q

Cholinergic / prokinetic mainly used to improve bladder contractility but has potential use in megaesophagus

A

Bethanechol

96
Q

Adverse effects of this drug include SLUD, bradycardia, increased gastric acid secretion, and increased pancreatic secretions

A

Bethanechol

97
Q

What is the primary indication for drugs that suppress motility?

A

Diarrhea

*may be contraindicated for infectious causes of diarrhea

98
Q

List the motility modifiers / anti-diarrheals - 6

A

Diphenoxylate (Lomotil)
Loperamide (Imodium)
Kaolin/Pectin
Bismuth salts, charcoal
Metronidazole (Flagyl)
Tyrosine (Tylan)

99
Q

These two motility modifiers are not recommended for use in cats due to excitatory behavior.

A

Diphenoxylate and loperamide

100
Q

These motility modifiers cause constipation, bloat and sedation in dogs.

A

Diphenoxylate, loperamide

101
Q

Which motility modifers do not require a prescription?

A

Loperamide (Imodium)

  • Bismuth salts, charcoal (Pepto-Bismol) - efficacy unknown; can make stool black - don’t confuse with Melina; give with food due to GI upset
102
Q

Which motility modifier causes reactions in dogs with the MDR1 mutation?

A

Loperamide (Imodium)

103
Q

Motility modifier that binds enteric opioid receptors; direct inhibition of GI motility (2)

A

Diphenoxylate
Loperamide (Imodium)

104
Q

MOA: demulcent / protectant; relieves irritation by lining mucosal surface; absorbs some potential toxicants

A

Kaolin/Pectin

Efficacy as tx for diarrhea unknown
GI upset - give with food

105
Q

MOA: Synthetic nitroimidazole compound; disrupts bacterial DNA synthesis; effective against certain protozoal species and anaerobic bacteria

A

Metronidazole (Flagyl)

106
Q

This motility modifier has a wide range of doses, with increased risk of adverse effects at higher doses and extensive hepatic metabolism.

A

Metronidazole (Flagyl)

107
Q

Clinical uses for this drug include altering GI microbes, chronic enteropathy, EPI, and hepatic encephalopathy; Giardia, clostridium, anaerobic infections.

A

Metronidazole (Flagyl)

108
Q

Adverse effects of this drug include GI upset, hepatotoxicity, neurotoxicosis, and reduced olfactory function (hyposmia) in dogs.

A

Metronidazole (Flagyl)

109
Q

This drug does not improve outcome in dog with acute hemorrhagic diarrhea.

A

Metronidazole (Flagyl)

110
Q

MOA: Macrolide antibiotic; inhibits 50s subunit of bacterial ribosomes to inhibit protein synthesis, mainly bacteriostatic

A

Tylosin (Tylan)

111
Q

Adverse effects for this drug are considered minimal and uncommon but include potential hypersensitivity.

A

Tylosin (Tylan)

112
Q

Clinical uses for this drug include alteration of GI microbes, treatment of antibiotic responsive diarrhea or GI dysbiosis, chronic enteropathy, and EPI.

A

Tylosin (Tylan)

113
Q

This motility modifier can be given chronically but has a bitter taste so may need to be flavored or put in a capsule.

A

Tylosin (Tylan)

114
Q

Three treatments for constipation

A

Laxatives - Psyllium, wheat dextrin, pumpkin; preferred tx due to safety, tolerance, and efficacy

Osmotic - lactulose effective and commonly used

Lubricants - not generally advised due to risk of aspiration

115
Q

Megacolon is most commonly seen in _____.

116
Q

Treatment for megacolon includes diet modification, fiber, enemas, and surgery plus what two drugs?

A

Lactulose (laxative)
Cisapride

117
Q

Secondary esophagitis in megaesophagus is treated with ____ and ____.

A

Omeprazole
Sucralfate

118
Q

Are metoclopramide, Cisapride, and Bethanacol (promotility drugs) effective in treating megaesophagus in dogs?

A

No - dogs have no smooth muscle in the esophagus
These drugs only work on smooth muscle

119
Q

This drug is used in megaesophagus in dogs and cats as it is thought to allow for better esophageal clearance of ingest into the stomach, which can reduce regurgitation and improve weight gain.

A

Sildenafil (Viagra, Revatio)

120
Q

MOA: Phosphodiesterase-5 inhibitor that relaxes smooth muscle causing vasodilation; relaxes smooth muscle of lower esophageal sphincter for a short time

A

Sildenafil (Viagra, Revatio)

121
Q

This drug is effective in treating both dogs and cats with megaesophagus.

A

Sildenafil (Viagra, Revatio)

122
Q

Treatment options for EPI

A

Replacement pancreatic enzymes - viokase, pancreazyme
Dried extracts of bovine or porcine pancreas
Powdered form preferred

Cobalamin supplementation - vitamin B12

123
Q

EPI, chronic enteropathy, and pancreatitis (esp. cats) may need supplementation with ____.

A

Cobalamin - vitamin B12

124
Q

Chronic enteropathy is classified as responsive to these four things:

A

Diet
Fiber
Antibiotics - metronidazole or tylosin
Immunosuppressants
- steroids, cyclosporine, Mycophenolate, Chlorambucil, leflunomide, azathioprine (dogs only!)

125
Q

Denamarin, Denosyl, SAMe, and silymarin (milk thistle) are ______.

A

Hepatoprotectants

126
Q

MOA: decreases hepatic synthesis/secretion of cholesterol and intestinal absorption of cholesterol; allows solubilization of cholesterol-containing gallstones; increases bile flow; reduces hepatotoxic effects of bile salts; may reduce hepatocellular inflammatory changes and fibrosis

127
Q

Clinical uses for this drug include cholestasis, gallbladder sludge, and mucoceles.

A

Ursodiol
Ursodeoxycholic acid

128
Q

Two drugs used to treat hepatic encephalopathy

A

Lactulose
Neomycin (or amoxicillin, metronidazole)

129
Q

Hepatic encephalopathy is seen with severe liver failure (>70% loss) and _____.

A

Portosystemic shunts

130
Q

MOA: once reaching the colon, increases osmotic pressure drawing water into the bowel - laxative effect; metabolized by bacteria into acid metabolites; acidifies colonic contents; causes NH3 ammonia to migrate from blood into colon where it is trapped as NH4 ammonium and expelled with feces

A

Lactulose - nonabsorbable disaccharide

131
Q

MOA: given orally has minimal systemic absorption; local effects in the GI tract to reduce the number of ammonia producing bacteria

A

Aminoglycoside antibiotic
- Neomycin

CLIN PHARM (13 decks)

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