6 GI Drugs

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Questions and Answers

In managing gastrointestinal (GI) patients, which therapeutic intervention is often considered the MOST crucial?

  • Providing nutritional support
  • Fluid therapy (correct)
  • Administering anti-emetics
  • Administering antibiotics

What is the primary difference between replacement fluids and maintenance fluids in treating GI patients?

  • Maintenance fluids are designed to correct dehydration and electrolyte imbalances, while replacement fluids are for ongoing daily needs.
  • Replacement fluids contain a lower concentration of electrolytes than maintenance fluids.
  • Replacement fluids are typically administered intravenously, while maintenance fluids are given subcutaneously.
  • Maintenance fluids are designed for ongoing daily needs, while replacement fluids correct dehydration and electrolyte imbalances. (correct)

When administering intravenous potassium to a patient with hypokalemia, what is the MOST critical precaution to take?

  • Monitor the patient's heart rate for signs of bradycardia, which indicates potassium is infusing too quickly.
  • Administer potassium as a rapid bolus to quickly correct the deficiency.
  • Ensure the fluid bag is thoroughly mixed to avoid concentrated delivery of potassium. (correct)
  • Use a high concentration of potassium in the IV fluid to achieve a faster correction.

Which clinical finding would indicate that a patient is approximately 6-7% dehydrated?

<p>Delay in skin tent; dry mucous membranes; slight prolongation of capillary refill time (D)</p> Signup and view all the answers

A 7-week-old puppy is vomiting due to parvovirus. Considering the patient's age, which anti-emetic should be avoided?

<p>Maropitant (D)</p> Signup and view all the answers

A dog with a history of ingesting foreign objects presents with vomiting. Radiographs do not reveal an obstruction. Which anti-emetic would be LEAST appropriate?

<p>Metoclopramide (C)</p> Signup and view all the answers

What is the MOST important consideration when prescribing anti-emetics, especially in cases where the underlying cause of vomiting is not immediately clear?

<p>The use of anti-emetics can mask the signs of a more serious underlying condition. (A)</p> Signup and view all the answers

Why is famotidine considered more potent than cimetidine as an H2 blocker?

<p>Famotidine has a longer duration of action and higher potency at histamine receptors. (C)</p> Signup and view all the answers

What is the MOST significant consideration when administering H2 blockers like famotidine or cimetidine to patients with GI issues?

<p>Studies suggest that H2 blockers are inferior to proton pump inhibitors for managing GI conditions. (B)</p> Signup and view all the answers

In what scenario is misoprostol primarily indicated as a gastroprotectant?

<p>Preventing GI ulceration secondary to NSAID administration. (D)</p> Signup and view all the answers

What class of medication does Chlorpromazine belong to and what receptors does it antagonize to prevent vomiting?

<p>Phenothiazine; dopamine and histamine receptors (B)</p> Signup and view all the answers

Why are Tetracyclines and Fluoroquinolones like Doxycycline and Ciprofloxacin, administered with caution with Sucralfate?

<p>Sucralfate can decrease the absorption of these medications, reducing their effectiveness. (D)</p> Signup and view all the answers

In the context of acute hemorrhagic diarrhea syndrome (AHDS), what is the MOST critical consideration when deciding whether to use antibiotics?

<p>Antibiotics may be considered only if signs of sepsis are present to stop bacterial translocation. (C)</p> Signup and view all the answers

What potential effect does misoprostol have that warrants caution in women who are handling the medication?

<p>It can induce labor or abortion. (A)</p> Signup and view all the answers

Which of the following appetite stimulants is safe to use in cats with chronic kidney disease?

<p>Capromorelin (C)</p> Signup and view all the answers

What distinguishes capromorelin from mirtazapine in terms of their mechanisms as appetite stimulants?

<p>Capromorelin is a ghrelin-agonist, causing a hunger sensation, while mirtazapine antagonizes 5HTsc and H1 receptors. (A)</p> Signup and view all the answers

When should you use caution with compounded products?

<p>Appetite stimulants (A)</p> Signup and view all the answers

What would MOST warrant the use of intravenous fluids?

<p>Rehydration (D)</p> Signup and view all the answers

What do high levels of potassium potentially indicate?

<p>Use fluid without any (0.9% NaCl) (C)</p> Signup and view all the answers

What amount should insensible (feces, respiratory) losses be accounted for when calculating the amount of fluids that should be given to a patient?

<p>Maintenance 20ml/kg/day (C)</p> Signup and view all the answers

Why is Ondansetron a consideration as an anti-emetic?

<p>Blocks serotonin at vagal terminals in the GI tract (A)</p> Signup and view all the answers

What property of Metoclopramide warrants caution in pancreatitis patients?

<p>Pancreatic blood flow is regulated by dopaminergic receptors (C)</p> Signup and view all the answers

When should you avoid using Maropitant?

<p>As motion sickness in cats (C)</p> Signup and view all the answers

Which antiemetic requires the administration to be intravenous slowly?

<p>Ondansetron (C)</p> Signup and view all the answers

Why is it important to use caution when administering Omeprazole?

<p>It may cause diarrhea (B)</p> Signup and view all the answers

What are some adverse effects of Mirtazapine?

<p>Vocalizing, agitation and vomiting (B)</p> Signup and view all the answers

What effects warrant use for Sucralfate for healing GI tract?

<p>dissociates in an acidic environment (stomach) to sucrose sulfate and aluminum hydroxide (A)</p> Signup and view all the answers

What does Mirtazapine do to help stimulate appetite?

<p>Antagonism of 5HTsc and H1 receptors (B)</p> Signup and view all the answers

What is NOT a sign or symptom of dehydration?

<p>Urinary frequency (B)</p> Signup and view all the answers

What is a major contraindication for Metoclopramide?

<p>GI Obstruction (B)</p> Signup and view all the answers

What does the fluid replacement formula Body weight (kgs) x percent dehydrated/100 tell you?

<p>The Liters you need to rehydrate (C)</p> Signup and view all the answers

Why should you monitor a patients body weight during fluid monitoring?

<p>Remember 1L fluids = 1kg, he should gain 0.7kg just from rehydration alone (B)</p> Signup and view all the answers

In dogs, what is the oral dosage for Maropitant PO daily for motion sickness?

<p>8mg/kg (C)</p> Signup and view all the answers

What medication should be given with Piroxicam?

<p>Misoprostol (D)</p> Signup and view all the answers

What does fluid bolus refer to?

<p>Administering a large volume of fluid in a short time period (A)</p> Signup and view all the answers

Which of the following can happen if you mix Ondansetron with metoclopramide?

<p>May precipitate (C)</p> Signup and view all the answers

A patient presents with signs of hypovolemic shock and requires immediate fluid resuscitation. Considering the principles of fluid therapy in gastrointestinal patients, which of the following crystalloid fluid types would be the MOST appropriate initial choice for a rapid bolus?

<p>Lactated Ringer's Solution (LRS) (A)</p> Signup and view all the answers

A 9-year-old cat with chronic kidney disease and concurrent gastritis is prescribed famotidine. Which of the following adjustments to the standard famotidine administration should be considered in this patient?

<p>Decrease the frequency of administration due to potential for prolonged drug half-life. (D)</p> Signup and view all the answers

In a canine patient diagnosed with acute pancreatitis and persistent vomiting, metoclopramide is being considered as an anti-emetic. What is the PRIMARY pharmacological concern regarding the use of metoclopramide in this specific clinical scenario?

<p>The prokinetic effects of metoclopramide could potentially increase pancreatic enzyme release. (C)</p> Signup and view all the answers

A client is prescribed misoprostol for their dog receiving long-term piroxicam therapy. Which of the following instructions is MOST critical to convey to the client regarding the safe handling and administration of misoprostol?

<p>Women who are or may become pregnant should avoid direct contact with misoprostol. (A)</p> Signup and view all the answers

A 14-year-old cat with a history of chronic kidney disease and inappetence is being considered for appetite stimulant therapy. Considering the patient's comorbidities, which of the following appetite stimulants would be the SAFEST initial choice?

<p>Capromorelin oral solution (A)</p> Signup and view all the answers

A dog is diagnosed with parvoviral enteritis and is experiencing severe, intractable vomiting. While maropitant and ondansetron are both effective anti-emetics, what is a potential ADVANTAGE of choosing maropitant over ondansetron in this specific case?

<p>Maropitant has a broader spectrum of anti-emetic action, targeting both central and peripheral pathways. (A)</p> Signup and view all the answers

A veterinarian is formulating a fluid therapy plan for a dehydrated dog. They have calculated the replacement fluid volume and the maintenance fluid rate. To ensure accurate fluid administration and monitoring, what is the MOST critical next step in refining this fluid plan?

<p>Account for ongoing losses (vomiting, diarrhea) in the fluid rate. (B)</p> Signup and view all the answers

When considering the use of sucralfate in a patient receiving oral doxycycline for a concurrent condition, what is the PRIMARY rationale for staggering the administration of these two medications?

<p>To avoid sucralfate from binding to doxycycline in the gastrointestinal tract, reducing doxycycline absorption. (D)</p> Signup and view all the answers

In the context of acute hemorrhagic diarrhea syndrome (AHDS) in dogs, a study demonstrated 'no significant difference between treatment groups concerning mortality rate, dropout rate, duration of hospitalization, or severity of clinical signs' when comparing antibiotics to placebo. Based on this evidence, what is the MOST appropriate clinical implication for antibiotic use in typical AHDS cases?

<p>Antibiotics are indicated only in severe AHDS cases exhibiting signs of sepsis or bacterial translocation. (A)</p> Signup and view all the answers

A dog presents with motion sickness, and maropitant is chosen for oral administration. To optimize the efficacy of maropitant for motion sickness prevention, what is the MOST important instruction to provide to the owner regarding administration timing?

<p>Administer maropitant 2 hours prior to travel, ideally on an empty stomach or with a small amount of food. (B)</p> Signup and view all the answers

When comparing omeprazole and famotidine for the treatment of gastric ulceration, which statement accurately reflects a key pharmacological difference that influences clinical decision-making?

<p>Omeprazole, a proton pump inhibitor, directly inhibits the H+/K+ ATPase pump, resulting in more profound acid suppression than famotidine, an H2 blocker. (C)</p> Signup and view all the answers

A patient receiving pantoprazole intravenously for severe gastritis develops diarrhea. What is the MOST likely mechanism by which pantoprazole could contribute to this adverse effect?

<p>Alteration of the intestinal microbiome due to reduced gastric acidity. (C)</p> Signup and view all the answers

In a dog with suspected gastrointestinal obstruction, radiographs are inconclusive, and further diagnostics are pending. Considering anti-emetic therapy, which of the following anti-emetics would be LEAST appropriate to administer at this stage?

<p>Metoclopramide (D)</p> Signup and view all the answers

When calculating fluid replacement for a 10 kg dog estimated to be 7% dehydrated using the formula 'Body weight (kgs) x percent dehydration / 100', the result is 0.7. What is the CLINICAL INTERPRETATION of this value in the context of fluid therapy?

<p>The patient requires 0.7 liters of replacement fluids. (D)</p> Signup and view all the answers

A veterinary nurse is administering intravenous potassium chloride (KCl) supplementation to a hypokalemic patient. Which of the following administration techniques is MOST critical to prevent potential life-threatening complications?

<p>Ensure KCl is diluted appropriately in intravenous fluids and administered slowly over several hours. (B)</p> Signup and view all the answers

A dog receiving piroxicam for transitional cell carcinoma is prescribed misoprostol as a gastroprotectant. What is the PRIMARY mechanism by which misoprostol provides gastroprotection in this scenario?

<p>Enhancing mucosal blood flow and bicarbonate secretion. (A)</p> Signup and view all the answers

When considering the use of compounded medications in veterinary practice, especially for gastrointestinal drugs, what is the MOST significant concern regarding their use compared to commercially available, FDA-approved products?

<p>The efficacy and safety of compounded medications are not rigorously evaluated or guaranteed. (C)</p> Signup and view all the answers

In a patient exhibiting clinical signs consistent with 6-7% dehydration, which combination of physical examination findings would be MOST indicative of this dehydration level?

<p>Dry mucous membranes and delayed skin tent. (B)</p> Signup and view all the answers

A client reports that their cat, recently started on mirtazapine transdermal ointment for appetite stimulation, is exhibiting increased vocalization and agitation. What is the MOST appropriate initial recommendation to manage these adverse effects?

<p>Reduce the frequency of mirtazapine application to every 48-72 hours. (D)</p> Signup and view all the answers

Flashcards

Why fluids are crucial for GI patients?

Fluids are often the most important therapy for GI patients, providing rehydration, electrolyte balance, and maintenance.

Common replacement fluids

LRS, 0.9% NaCl and Normosol-R are replacement fluids. 0.45% NaCl and Normosol-M are maintenance fluids.

How to calculate replacement fluids?

Estimate dehydration (5-10%), multiply body weight (kgs) by the % dehydrated/100 to find liters needed for rehydration

Signs of dehydration in animals

Signs include: subtle loss of skin elasticity, delay in skin tent, dry mucous membranes, sunken eyes and signs of shock.

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Potassium fluid supplementation

If K is high, use fluid without any (0.9% NaCl.) If K is low, add up to 0.5mEq/kg/hour.

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How to monitor fluid therapy?

Fluids can be monitored by monitoring body weight and watching for ongoing losses.

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What triggers the vomiting reflex?

Stimulation of afferent nerves in the stomach and intestines, direct stimulation of glossopharyngeal nerve, trauma, motion sickness, blood-borne toxins.

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Maropitant's mechanism of action

Maropitant is a NK-1 antagonist that prevents Substance P from causing vomiting. It is great for broad spectrum anti-emesis.

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Doses for Maropitant (Cerenia)

Acute V with 1mg/kg daily SQ for dogs >2 mos and cats >4 mos old. IV 1mg/kg for dogs and cats >4 mos old and 2mg/kg PO for dogs > 2 months old only (not cats).

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How does Metoclopramide prevent vomiting?

Metoclopramide blocks dopamine and serotonin, and has prokinetic action, but avoid in GI obstruction.

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Metoclopramide safety and dosing

1-2mg/kg/day as a CRI or 0.3mg/kg SC or PO every 8 hours. May cause changed mentation or seizures.

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How Zofran works in humans

Ondansetron is a serotonin antagonist that can treat gastroenteritis and parvovirus. Used for pregnancy and chemotherapy-related vomiting in people

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H2 Blockers

H2 blockers are gastroprotectants that include Famotidine, Ranitidine & Cimetidine.

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H2 Blocker, Famotidine

Most potent, long duration H2 blocker 0.5mg/kg IV or PO q 12 hours. Side effects: Eliminated by liver and kidney. Can be used in dogs/cats with Gl ulceration or esophageal reflux.

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Cimetidine

Cimetidine is least powerful and CYP inhibitor, so drug interactions are possible; should be reviewed if ever use this drug.

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Omeprazole, a PPI

Gastroprotectant: Omeprazole. 1mg/kg PO q 12-24 hrs. May cause diarrhea. Use caution with drug interactions. CYP inhibitor

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Sucralfate

Breaks down in GI: Sucrose sulfate forms a viscous polymer to act as “band-aid binding to ulcerated Gl mucosa. Dose: Large dogs get 1gram PO q 8 hours

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Sucralfate indications

Increases prostaglandin (PGE) synthesis, ↓ pepsin, bile acids, ↑ epithelial growth factor. Use for trauma and chemical damage.

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How does Misoprostol work?

Prostaglandin (PGE) analogue. ↑ mucosal blood flow, ↑ mucus and bicarbonate secretion,↓ acidity

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Misoprostol indications and safety

Used to prevent: piroxicam to reduce chance of GI ulceration during treatment for transitional cell carcinoma. All women should either avoid handling or wear gloves!

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Mirtazapine

Drug ending ini -zepine: antagonists of 5HTsc and H1. oral vocalizing, agitation, vomiting, ataxia, dogs get 0.6mg/kg PO q 12.

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Capromorelin

Stimulates hunger by ghrelin-agonist. The approved label: Safe for cats with CKD at Cats: 2mg/kg PO q24.

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AHDS: acute hemoragic diarrhea syndrome:

Raspberry jam diarrhea, +/- vomiting

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Antibiotics (Metronidazole, Unasyn, Clavamox)

Drugs: Metronidazole, Unasyn, Clavamox. Pros:May help prevent bacterial translocation in severe AHDS cases. Cons:can make current signs worse.

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Study Notes

  • Fluids are often the most important therapy GI patients require.

Indications for Fluid Therapy

  • Rehydration
  • Replacing ongoing losses
  • Maintenance

Routes of Administration

  • Intravenous
  • Subcutaneous
  • Oral

Types of Fluids

  • Crystalloid therapy is a common fluid type.
  • Replacement fluids include LRS, 0.9% NaCl, and Normosol-R; balanced fluids are typically used.
  • Maintenance fluids include 0.45% NaCl and Normosol-M.
  • Electrolyte information (mEq) is available on fluid bags.
  • In practice, only a couple of fluid types are usually needed.

Fluid Dosage

  • Maintenance fluid dosage is 60ml/kg/day.
  • Sensible losses (urine) account for 40ml/kg/day of maintenance fluid needs.
  • Insensible losses (feces, respiratory) account for 20ml/kg/day of maintenance fluid needs.

Replace Dehydration

  • Estimate dehydration percentage from 5-10%.
  • The Liters of fluid needed to rehydrate equals body weight (kgs) x percent dehydrated/100.
  • Rehydration is typically done over 12 hours.
  • Some patients require a bolus or faster rehydration, while others need slower rehydration.

Potassium Considerations

  • If potassium is high, use fluid without any (0.9% NaCl).
  • If potassium is low, add up to 0.5mEq/kg/hour, intravenously.
  • Intravenous potassium can be fatal if given as a bolus; always mix well.
  • Follow the target mEq KCl per Liter fluids, which are based on serum potassium levels.
  • Target is 20 mEq KCl per Liter of fluid for 3.5-4.0 serum potassium levels.
  • Target is 30 mEq KCl per Liter of fluid for 3.0-3.5 serum potassium levels.
  • Target is 40 mEq KCl per Liter of fluid for 2.5-3.0 serum potassium levels.
  • Target is 60 mEq KCl per Liter of fluid for 2.0-2.5 serum potassium levels.
  • Target is 80 mEq KCl per Liter of fluid for less than 2.0 serum potassium levels.

Anti-Emetics

  • Maropitant (Cerenia), metoclopramide, and ondansetron are examples of commonly used medications.

Maropitant (Cerenia)

  • Neurokinin-1 (NK-1) antagonist is used to prevent vomiting at the vomiting center.
  • Broad-spectrum anti-emetic
  • It Is very effective
  • For acute vomiting:
  • Administer subcutaneously at 1mg/kg daily for dogs >2 months and cats >4 months old.
  • Administer intravenously at 1mg/kg daily slowly for dogs and cats >4 months old.
  • Administer orally at 2mg/kg PO daily; this is labeled for dogs >2 months old (not cats).

Maropitant for Motion Sickness

  • Administer 8mg/kg PO once daily for up to 2 days for dogs.
  • Administer 2 hours prior to the trip on an empty stomach.
  • It Is only labeled for dogs >4 months old.
  • It Is not labeled for cats.

Maropitant Safety Precautions

  • Metabolized by the liver, so exercise caution in patients with liver dysfunction.
  • Rarely reported adverse effects include pain on injection, lethargy, diarrhea, and bone marrow suppression in puppies less than 11 weeks.

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