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Pharmacology 4


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GI pharmacology tx has been directed at _____ or ________ GI function
normalizing or improving
List some problems w/ the GI tract
regurgitation, vomiting, diarrhea, weightloss, colic, bloat, and abnormal bowel movements
autonomic nervous system
Stimulation of the____________portion of the ANS increases intestinal motility, increases secretions and stimulates relaxation of the sphincters.
Drugs that mimic the the stimulation of the parasympathetic portion of the ANS are called___________ drugs.
Drugs that inhibit the stimulation of the parasympathetic portion of the ANS are called __________ drugs.
__________ attaches to H2 receptors in the gastric parietal cells and causes the release of hydrochloric acid in the stomach.
What is the forced expulsion of stomach contents?
Vomiting is initiated by stimulation or activation of the ____________ center in the brain.
emectic (vomiting) center
The emectic center is located in the ________________.
Medulla oblongata
What is the CRTZ?
chemoreceptor trigger zone
Nine major categories of GI drugs
emetics, antiemetics, antidiarrheals, drugs to alter the pH, protectives, digestive enzymes, rumen function drugs, cathartics, and appetite stimulants
Stimulation of the _________ branch of the ANS will decrease intestinal motility, tone, and secretions and increase anal sphincter tone.
__________ such as gastrin, secretin, and cholecystokinin are released from intestinal cells and and control many functions such as gastric secretions, and gastric and gall bladder emptying.
Occasional vomiting in a dog or cat is considered _______.
Vomiting in horses, rabbits, rats is considered ____________.
abnormal and is often fatal
What is the normal process in ruminants in which semi-digested material from the rumen is "cast up" for chewing? Many birds do this as well.
What do emetics do?
They cause vomiting.
Emetics are used to remove approximately ____% of stomach contents
What are two uses of emetics?
To remove recently ingested poisons, and to empty stomach prior to anesthesia
Contraindications for emetics?
semi-conscious or seizing animals, animals that are shocky or having problems breathing, ingestions of caustic substances, animals that normally do not normally vomit.
What animals do not normally vomit?
horses, rabbits, and some rodents
Emetics are classified as to whether they act on the _____ or act _______
on the CRTZ (CNS) or act locally
Narcotic analgesics are what kind of emetic?
Centrally acting
What is the emetic of choice for dogs?
Apomorphine HCL (a narcotic analgesic)
What species are narcotic analgesics used in?
Dogs only
Two examples of narcotic analgesic emetics?
morphine, apomorphine HCL
What is the emetic of choice for cats?
How effective is xylazine/Rompun(R) as an emetic in cats? In dogs?
cats 90%, dogs 50%
Trade name for xylazine?
Generic name for Rompun(R)?
xylazine/Rompun(R) is not classified as an emetic, but the label indicates that it will produce vomiting. What is it actually?
morphine, apomorphine HCL, xylazine/Rompun(R), and to some extent, syrup of Ipecac, are all examples of what?
centrally acting emetics
What schedule is apomorphine HCL?
CII schedule
How is apomorphine HCL administered? Why?
It is not absorbed well orally thus is administered topically in the conjunctival sac or given parenterally.
What emetic is both centrally and locally acting?
syrup of Ipecac
What irritates the gastric/pharyngeal mucosa, thus causing reflex vomiting?
locally acting emetics
3 examples of locally acting emetics
hydrogen peroxide, warmed salt water, syrup of Ipecac
hydrogen peroxide, warmed salt water, and syrup of Ipecac are examples of what?
locally acting emetics
Side effect of syrup of Ipecac?
lacrimation, salivations, and cardiotoxicity in high doses. Should be used w/ caution in animals w/ heart problems
What do antiemetics do?
Prevent vomiting
4 uses of antiemetics?
1. To prevent motion sickness 2. prevent vomiting while under anesthesia 3. prevent post-op vomiting 4. to tx symptoms of persistent vomiting
If using an antiemtic to tx symptoms of persistent vomiting, how is is usually administered?
2 types of antiemetics
centrally acting and locally acting
phenothiazine derivatives, procainimide derivatives, and antihistimines are all types of what?
centrally acting antiemetics
phenothiazine derivatives are useful for what? Common side effect?
These centrally acting antiemetics are useful for motion sickness, common side effect is sedation
What is the brand name for the most common phenothiazine derivative centrally acting antiemetic? What kind of med is it?
Acepromazine(R), it is a tranquilizer
Trade name for chlorpromazine?
Generic name for Thorazine(R)?
Trade name for prochlorperazine?
Generic name for Darbazine(R)?
prochlorperazine/Darbazine(R), chlorpromazine/Thorazine(R), and Acepromazine(R), a tranquilizer, are all types of what?
phenothiazine derivatives - centrally acting antiemetics
What type of centrally acting antiemetic is useful for tx of parvo?
procainimide derivatives
What med is known as a "stomach dumper"?
Trade name for metoclopramide?
Generic name for Reglan(R)?
contraindication for metoclopramide/Reglan(R)?
GI obstruction
What med has a limited effect on GI secretions and effects that include increase GI contraction, emptying, and strengthens cardiac sphincter tone?
What is used as an antiemetic when vomiting is due to motion sickness or inner ear problems?
Two antihistimines also used as antiemetics?
Benadryl(R) and Dramamine(R)
Adverse side effect of antihistimines used as antiemetics?
What are locally acting antiemetics useful against?
vomiting caused by gastric irritation
How are locally acting antiemetics administered?
What might locally acting antiemetics contain?
local anesthetics, antacids, and protectants
Any protectants that contain _______ should not be given w/ other oral medications such as tetracycline, digoxin, corticosteroids & ketaconzole because they can interfere w/ or decrease absorption of these drugs.
Maalox(R), Mylanta(R), Milk of Magnesia(R), Pepto Bismol(R), and Kaopectate(R) are all examples of what?
locally acting antiemetics
What is the aim of tx w/ antidiarrheals?
to correct the underlying, primary cause
What can cause diarrhea?
parasites, viruses, bacteria, toxins, neoplasia
Describe acute onset of diarrhea
not watery, just soft
If animal is generally healthy, diarrhea onset is acute, and animal is up to date on vax, DVM may just run a couple of tests to rule out what?
When tx diarrhea, after R/O parasites, what kind of therapy may be initiated?
syptomatic therapy
Supportive tx of diarrhea may include what?
bland diet and fluid therapy
Three physiologic causes of diarrhea
hypersecretion of intestinal fluid/exudates and increased permeability, osmotic retention of water and overload, and intestinal hypomotility
describe this physiologic cause of diarrhea - hypersecretion of intestinal fluid/exudates and increased permeability
many microorganisms (E. coli& clostridium) release endotoxins that can increase intestinal secretions. Viruses and other organisms can damage the intestinal epithelium and result in the loss of fluid due to increased permeability
What causes this physiologic cause of diarrhea - osmotic retention of water and overload
poorly digested food, malabsorption, and maldigestion - rapid changes in diet can also cause digestion problems
Describe intestinal hypomotility
increase in the lumen diameter of the intestines and allows for faster passage of the contents - as a result the fluid content from the fecal matter is not well absorbed
Since hypomotility rather than hypermotility is now considered to be associated w/ diarrhea, what drugs should be used w/ caution?
anticholinergics and antispasmodics
What do most DVMs consider the drug of choice for the tx of diarrhea in dogs?
4 categories of antidiarrheal drugs
narcotic analgesics, anticholinergics/antispasmodics, antibiotics, and protectants
narcotic analgesics, anticholinergics/antispasmodics, antibiotics, and protectants are categories of what kind of drug?
What do narcotic analgesics do in the tx of diarrhea?
decrease intestinal secretions, increase motility, and increase intestinal absorption
Lotomil(R) and Immodium(R) are kinds of what?
narcotic analgesic antidiarrheals
The narcotic analgesic antidiarrheal Lotomil(R) is combined w/ atropine to discourage what?
What type of meds were widely used in the past when it was thought that hypermotility v. hypomotility was the cause of diarrhea?
Some commercial preparations of anticholinergics also contain a _________ and thus should be used w/ caution.
CNS supressant
What may be used for tx of bloody diarrhea or signs of sepsis along w/ diarrhea?
AB, aminoglycosides such as Neomycin(R) and Kanamycin(R)
What is not absorbed from the GI tract well and thus are effective in tx some cases of diarrhea due to bacterial infections but they also kill good bacteria in the gut
ABs, aminoglycosides and cephalosporins
What is a synthetic AB & antiprotozoal drug and its most common use is the tx of giardia and anaerobic infections in dogs and cats?
trade name for metronidazole
generic name for Flagyl(R)
What can cause anorexia, hepatotoxicity, neutropenia, and neurotoxicity?
What can upset the normal bacterial balance of the GI tract and as a result allow the overgrowth of harmful microorganisms such as salmonella, clostridium, and helicopacter?
antacids, acidifiers, and cimetidine/Tagamet(R) are used to what?
alter pH
What are antacids used for?
used to netutralize gastric HCl or increase the pH of the stomach
What are acidifiers used for?
used to decrease the the pH of gastric or rumen contents - most commonly used in large animal
What is vinegar used to tx?
urea and high protein toxicity in ruminants
What is cimetidine/Tagamet(R) used for?
It is a H2 blocker used to decrease acid production
Trade name for cimetidine?
Generic name for Tagamet(R)?
Demulcents and absorbents are two types of what?
How to demulcents work?
They form a protective layer over the GI mucosa and protect inflamed mucosa from further irritation.
How to absorbents work?
They absorb or bind up harmful toxins/chemicals and prevents absorbtion in the GI tract.
Trade name for bismuth subsalicylate?
Pepto Bismol(R)
Generic name for Pepto Bismol(R)?
bismuth salicylate
What demulcent protective is the only one shown to be effective due to its anti-inflammatory effect?
bismuth subsalicylate/Pepto-bismol(R)
Pepto-bismol(R) and Kaopectate(R) are examples of what?
demulcent protectives
What is Corrective Mixture (veterinary approved)?
Similar to Pepto-bismol(R), but veterinary approved
activated charcoal/SuperChar(R) is an example of what?
absorbent protective
trade name of activated charcoal?
generic name of SuperChar(R)?
activated charcoal
What are digestive enzymes?
Enzymes to aid digestion and absorption.
What would be a clinical use of digestive enzymes?
tx of pancreatic exocrine insufficiency
What should you do w/ digestive enzyme powder spilled on the skin?
remove immediately
What can inhaled digestive enzyme powder cause?
nasal irritation and possibility of an asthma attack
Viokase-V(R) and Pancreatin(R) are examples of what?
digestive enzyme pancreatic products
What are rumen function drugs used for?
tx rumen antony, restore normal rumen flora, and tx bloat
What does rumen function drug Neostigmine(R) do?
stimulates peristalsis
What are Viokase(R) and Pancreatin(R) examples of?
digestive enzyme pancreatic products
What is rumen function drug Probiocin(R) used for?
used in calves that are on AB tx to restore normal rumen flora
What is Therabloat(R) used for and how does it work?
used to tx frothy bloat - is an anti-foaming agent that acts as a surfactant and causes the bubbles to break down. The gas is then passed by eructation (belching) or the passing of a stomach tube
What are cathartics?
Indications for cathartics?
certain oral poisonings, empty the colon prior to x-ray or surgery, remove fecal impactions, certain cases of equine colic, used w/ certain anthelmintics
Three types of cathartics
bulk, lubricant, and stool softeners
How do bulk cathartics work?
They stimulate defecation by increasing the volume of the colon contents. They are often forms of ingestible plant material. They absorb water and swell the colon.
equine psyllium, Metamucil(R), and bran mash are all examples of what?
bulk cathartics
bran mash is a bulk cathartic often used in what species?
What are lubricant cathartics used for?
constipation and fecal impactions
How do lubricant cathartics work?
They are typically oil products that soften the fecal material and make it easier to to move through the GI tract
Laxatone(R), Kat-a-Lax(R), and Felaxin(R) are examples of what?
lubricant cathartics
Give some examples of lubricant cathartics
Laxatone(R), Kat-a-lax(R), and Felaxin(R)
What are stool softeners used for?
tx of hard, dry feces in small animals, impactions in horses, and digestive upset in cattle
How do stool softeners work?
surfactants, they enable water to penetrate the impacted stool
Colase(R) and Surfak(R) are examples of what?
stool softeners
Give two examples of stool softeners
Colase(R) and Surfak(R)
What type of med is considered obsolete - no evidence that they have any specific effect on appetite or food intake?
appetite stimulants
Anticonvulsants, steroids, some hormones, and tranquilizers such as Valium(R) can cause what undesired side effect?
diazepam/oxazepam/Valium(R), and B-vitamins are sometimes used as what?
appetite stimulants
Trade name for diazepam/oxazepam?
generic names for Valium(R)
omepreazole and lansoprazole are _______ that act as __________ ________ inhibitors. These agents bind to the secretory surface of the parietal cell to the enzyme Na-K ATPase. When this happens the enzyme is inactivated and the cell is unable to secrete
benzimidazoles, proton pump inhibitors
clinical uses of proton pump inhibitors
gastric/duodenal ulcers, esophagitis, and may be helpful in tx of hypersecretion associated w/ gastrinomas and mast cell tumors
_______ is the only gastromucosal potectant in common use in vet med
How do gastromucosal protectants work?
forms a pastelike substance in the stomach that binds to the surface of gastric ulcers thus protecting it from further damage and allowing healing to occur
How do saline/hyperosmotic laxatives work?
They are poorly absorbed from the GI tract thus hold water in the tract osmotically. The increased water in the tract then softens the stool and stimulates stretch receptors in the gut wall to enhance peristalsis
lactulose, (Cephulac,Constulose, Enulose), magnesium hydroxide (milk of magnesia are examples of what?
slaine/hyperosmotic laxatives

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