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Pharmacology I > Lecture 17/18 - GI medications > Flashcards

Lecture 17/18 - GI medications Flashcards

1
Q

What is responsible for protecting the stomach from acidic conditions?

A

Bicarbonate + Mucous

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2
Q

When do ulcers occur, most basic mechanism?

A

Acid > Protective layer

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3
Q

What can cause ulcers?

A 
Drugs = NSAIDs + Corticosteroids 
H.pylori 
Mast cell tumors 
GI diseases 
Long interavals of no food in horses
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4
Q

What is the most basic mechaism by which ulcers are healed?

A

decrease acid

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5
Q

What are common signs of ulcers in dogs?

A

Vomiting +/- blood
Weight loss + Anaemia
Black tarry stool

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6
Q

What are common signs of ulcers in cats?

A

Vomiting +/- blood
Anemia + Weight loss + loss of appetite
Abdominal pain
Tarry stool

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7
Q

What is EGUS?

A

Equine gastric ulcer syndrome

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8
Q

What type of horse is most prone to ulcerations?

A

Racing horses (~60%)

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9
Q

What is the most basic mechanism by which horses get ulcers?

A

Always producing acid, so must be able to eat at all times to prevent erosion of stomach lining

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10
Q

What are signs that a horse may have a stomach ulceration?

A

Poor appetite + Lethargy + Weight loss + Poor performance + Attitude

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11
Q

What are the two parts of a horses stomach?

A

Non-glandular + Glandular

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12
Q

What is ESGUS?

A

Non-glandular

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13
Q

What is EGGUS?

A

Glandular

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14
Q

What portion of the stomach is most prone to ulcerations?

A

Non-glandular

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15
Q

What is an important mechanism by which H+ is taken into the parietal cell?

A

Histamine from ECL cell stimulates H2

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16
Q

What is the important protective portion of the molecular cascade of parietal cells?

A

PGE2 + PGI2 –> stimulates EP3

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17
Q

What does EP3 do? (two different cells)

A

Superficial epi cell = mucous + bicarb

Parietal cell = prevents H+ secretion

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18
Q

What inhibits PG’s?

A

NSAIDs

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19
Q

What do antacids block?

A

H+ directly

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20
Q

What do proton pump inhibitors inhibit?

A

H/K ATPase

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21
Q

What is the pH at the mucous layer?

A

7

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22
Q

What is the pH in the gastric lumen?

A

2

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23
Q

What does Mg do in the stomach?

A

Binds H+
Not absorbed
Also acts as a laxative

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24
Q

What does Al do in the stomach?

A

Binds H+
Not absorbed
Causes constipation
Combine with Mg

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25
Q

What two transmitters increase acid production?

A 
M1/M3 = ACh 
H2 = Histamine
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26
Q

What are the three elements used in antacids?

A

Aluminum + Magnesium + Calcium

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27
Q

What is the product of antacids with H+?

A

Water + Neutral salt

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28
Q

When should antacids not be used? Why?

A

Renal failure

Mg will accumulate = CNS toxicity

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29
Q

What side effect do you see with Calcium as an antacid?

A

Creates CO2 = Burping

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30
Q

When should antacids be used, what types of Gi disorders?

A

Acidity in mild gastric disease

Don’t work with ulcerations

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31
Q

When is Mg used to cause diarrhea in cattle, goats, and sheep?

A

Grain overload

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32
Q

What type of receptor are H2’s linked with?

A

Gs = inc. cAMP

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33
Q

What are the four H2 antagonists?

A

Cimetidine
Ranitidine
Famotidine
Nizatidine

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34
Q

What is the result of H2 antagonists?

A

Reduction in Gastric acid + Pepsin secretion

35
Q

How should H2 antagonists be handled in renal patients?

A

50% the dose

36
Q

What should you watch out for with cimetidine?

A

Many drug interactions due to CYPs inhibition

37
Q

What can occur with ranitidine?

A

Increase motility through M stimulation + decrease in acid

38
Q

When is ranitidine recommended?

A

Feline megacolon

39
Q

When are H2 blockers benefical?

A

Gastric + Duodenal ulcerations
Gastric erosions
Esophageal reflux disease
Gastritis

40
Q

What H2 blocker is used in horses for ESGUS?

A

Ranitidine

41
Q

Why are H2 blockers used in severe allergic reactions?

A

Decrease vasodilation effect of histamine on BV

42
Q

How do proton pump inhibitors work?

A

Irreversible blockade of acid formation

43
Q

How long does it take proton pump inhibitors to work?

A

2 to 5 days

44
Q

Why do proton pump inhibitors have to be taken continuously?

A

Body will continue replacing H/K ATPase pumps

45
Q

How should proton pump inhibitors be given?

A

Empty stomach for best absorption

Eat 30 min later

46
Q

Where are proton pump inhibitors absorbed in the GI tract?

A

Intestine

47
Q

What are the three proton pump inhibitors?

A

Omeprazole
Esomeprazole
Pantoprazole

48
Q

When is a good time to use proton pump inhibitors in dogs?

A

Long-lasting acid suppression needed

Reduces risks of ulcers in dogs taking NSAIDs

49
Q

What can proton pump inhibitors treat in horses?

A

EGGUS + ESGUS

50
Q

What needs to be given with PPI in EGGUS?

A

Cytoprotectives

51
Q

What is important to tell the client when giving them PPI’s?

A

DO NOT CRUSH UP, need to be protected from stomach acid

52
Q

What are the most effective drugs in healing ulcers?

A

PPI’s

53
Q

What are possible adverse reactions to PPI’s?

A

Bacterial overgrowth
Aspiration pneumonia
Long-term increase in gastrin
Gastric cancer

54
Q

What does omeprazole inhibit? Do you need to worry about this?

A

P450’s. No, doesnt inhibit enough of it

55
Q

How do cytoprotective agents work?

A

Create physical barrier between gastric epi + gastric lumen

56
Q

How does bismuth work?

A

Bind to ulcer bed = protective coating

Increases PG’s = increased Bicard + decrease pepsin

57
Q

What is important to remember about bismuth?

A

Toxic to cats and probably dogs due to salicylate

58
Q

What are the side effects of sucralfate?

A

Constipation + Stomach upset

59
Q

Why does sucralfate cause constipation?

A

Aluminum

60
Q

When is sucralfate used in horses?

A

EGGUS

61
Q

What is used with sucralfate in EGGUS?

A

omeprazole

62
Q

What is misoprostol?

A

Synthetic PG’s E1 analogue

63
Q

When is misoprostol used?

A

NSAID use in older dogs

64
Q

What side effects can occur with misoprostol?

A

Diarrhea + Abdominal cramps

Increase nephrotoxicity of other drugs

65
Q

What does erythromycin stimulate?

A

Motilin

66
Q

What does cisapride stimulate?

A

Serotonin

67
Q

What are the two prokinetic D2 antagonists?

A

Metoclopramide + Doperiodone

68
Q

What do the prokinetic, D2 antagonists do?

A

Increase ACh release via D2 blockage

Reduce gastroesophageal reflux via increase sphincter tone

69
Q

What prokinetic drug is used in cats and dogs?

A

Metoclopramide

70
Q

What side effect can occur with metoclopramide? Why?

A

Can get into CNS
Excitement in horses + Anxiety + Involuntary movements
Increase potlactin

71
Q

When is metoclopramide used in dogs?

A

Vomiting disorders
Delayed gastric emptying (post-operative)
Decrease gastroesophageal reflux

72
Q

What is important to know about metoclopramide?

A

NOT APPROVED IN FOOD ANIMALS

73
Q

What is domperidone used for?

A

Increase prolactin secretion
Treat fescue toxicity + agalactia in mares
Vomiting + Reflux

74
Q

When is bethanechol used in dogs? Why?

A

Dogs have striated muscle in esophagus
Increases contraction
Treatment of megasesophagus
Cattle = cecal dilatation

75
Q

When is erythromycin used?

A

Diabetic gastroparesis in dogs

76
Q

What does Serotonin increase cause?

A

Increase ACh = increase motility SM

77
Q

When is ipecac used?

A

After ingestion of toxins or drug overdose

78
Q

How does apomorphine work?

A

Stimulates D2 in CTZ

79
Q

When should you NEVER induce vomiting?

A

If animal has swallowed strong acid or alkali compound

80
Q

What is really good at making cats vomit?

A

Xylazine

81
Q

What is a neurokinin antagonist in vet medicine?

A

Maropitant

82
Q

What does a neurokinin antagonist do?

A

Inhibit Substance P on NK1 receptor

83
Q

What are neurokinin antagonoist used for?

A

Acute vomiting
Motion sickneess
Chemotherapy

Pharmacology I (21 decks)

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