Podcast
Questions and Answers
Which physiological process is crucial for gastric acid production in the stomach?
Which physiological process is crucial for gastric acid production in the stomach?
Which statement accurately describes the incidence of Gastrointestinal Ulceration and Erosion (GUE) as presented in the text?
Which statement accurately describes the incidence of Gastrointestinal Ulceration and Erosion (GUE) as presented in the text?
Which of the following medications is NOT a GI protectant?
Which of the following medications is NOT a GI protectant?
What is a common indication for using GI protectants in dogs and cats?
What is a common indication for using GI protectants in dogs and cats?
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What is a potential complication that may require the use of GI protectants?
What is a potential complication that may require the use of GI protectants?
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Which of the following is a type of gastrointestinal disease that may require the use of GI protectants?
Which of the following is a type of gastrointestinal disease that may require the use of GI protectants?
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Which type of drug is considered superior to sucralfate for managing gastric ulcers and reflux esophagitis?
Which type of drug is considered superior to sucralfate for managing gastric ulcers and reflux esophagitis?
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What is the main mechanism of action of Proton Pump Inhibitors (PPIs) in reducing acid production?
What is the main mechanism of action of Proton Pump Inhibitors (PPIs) in reducing acid production?
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What happens when continuous administration of H2RA occurs?
What happens when continuous administration of H2RA occurs?
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Which Proton Pump Inhibitor uniquely accumulates in the acidic compartment of parietal cells?
Which Proton Pump Inhibitor uniquely accumulates in the acidic compartment of parietal cells?
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What is the common dosing frequency for 'Cimetidine' among the H2-Receptor Antagonists listed?
What is the common dosing frequency for 'Cimetidine' among the H2-Receptor Antagonists listed?
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Which of the following GI protectants has a mechanism of action that includes cytoprotective prostaglandin E1 analogue and ↑ bicarbonate secretion?
Which of the following GI protectants has a mechanism of action that includes cytoprotective prostaglandin E1 analogue and ↑ bicarbonate secretion?
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What is the mechanism of action for sucralfate to protect the gastric mucosa?
What is the mechanism of action for sucralfate to protect the gastric mucosa?
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Which GI protectant class is known for its cytoprotective properties and is effective in preventing GUE when used with high-dose aspirin?
Which GI protectant class is known for its cytoprotective properties and is effective in preventing GUE when used with high-dose aspirin?
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Which GI protectant class requires an acidic environment to be effective?
Which GI protectant class requires an acidic environment to be effective?
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Which GI protectant class is known for reducing GUE in glucocorticoid users?
Which GI protectant class is known for reducing GUE in glucocorticoid users?
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Which GI protectant exhibits antacid properties and interferes with the absorption of certain medications, such as ciprofloxacin and doxycycline?
Which GI protectant exhibits antacid properties and interferes with the absorption of certain medications, such as ciprofloxacin and doxycycline?
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Which PPI should be administered twice daily for treatment of GUE based on the information provided?
Which PPI should be administered twice daily for treatment of GUE based on the information provided?
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What should be done to minimize the risk of gastric acid hypersecretion when discontinuing long-term PPI use?
What should be done to minimize the risk of gastric acid hypersecretion when discontinuing long-term PPI use?
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Which antifungal has poor absorption when co-administered with PPIs?
Which antifungal has poor absorption when co-administered with PPIs?
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How does the use of PPIs impact the absorption of iron?
How does the use of PPIs impact the absorption of iron?
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Which prokinetic therapy option is not listed in the treatment plan for managing dysmotilities?
Which prokinetic therapy option is not listed in the treatment plan for managing dysmotilities?
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Study Notes
Gastrointestinal Pharmacology – Clinical Applications
- Top GI medications: Capromorelin/Mirtazapine, Cerenia, Cisapride, Metoclopramide, Ondansetron, Pantoprazole, Prednisone/Prednisolone, Probiotics (Visbiome/Proviable)
GI Protectants (GIPs)
- Antacids: oldest group of GIPs, not practical for most dog/cat patients
- Histamine type-2 receptor antagonists (H2RAs): inhibit HCl acid secretion
- Proton pump inhibitors (PPIs): inhibit HCl acid secretion, superior to other GIPs for treatment of GUE
- Misoprostol: cytoprotective, promotes repair of injured mucosal tissue
- Sucralfate: multiple mechanisms of action, adheres to ulcer site, protective not just a “Band-Aid”
Why Use GI Protectants?
- GI ulceration (GUE): high-dose corticosteroids, non-steroidal anti-inflammatory drugs, primary gastrointestinal tract disease, endoparasitism, esophagitis, gastroesophageal reflux (reflux esophagitis), bilious vomiting, unknown if CKD, hepatic disease, hypovolemic or hypotensive shock, hypoadrenocorticism, hit-by-car, sepsis
Medical Conditions Associated with Gastrointestinal Ulceration (GUE)
- True incidence of GUE is unknown, under-reported due to variability of clinical signs
- 88% of dogs had GUE in stomach, 6% had GUE of stomach and duodenum, 12% had GUE duodenum alone
- Disease odds ratio: NSAID admin 6.3, glucocorticoid admin 3.0, GI neoplasia 13.5, GI mechanical dz 4.8
Gastric Acid Production
- Parietal cell produces HCl, 3 receptors communicate with vasculature in submucosa: histamine 2, gastrin, and muscarinic
- H+/K+ Pump at lumen surface, ATP-dependent, exchange of H+ (out) for KCl (in)
Proton Pump Inhibitors (PPIs)
- Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole
- Administered twice daily, superior to other GIPs for treatment of GUE
- Clinical concerns: breaking or crushing an enteric-coated form may diminish protective effect, long-term use and increased risk for fractures, pneumonia, fecal dysbiosis
Clinical Concerns for PPIs
- Drug interactions: antifungals (poor absorption), iron (changes in gastric pH), mycophenolate (changes in gastric pH), clopidogrel (CYP), gradual tapering after administration of ≥ 4 weeks to avoid rebound gastric acid hypersecretion
Use of GIPs in Medical Conditions other than GUE
- Not limited to GUE, also used in other gastrointestinal conditions such as erosive gastritis, erosive esophagitis, gastroesophageal reflux
Prokinetic Therapy
- Manipulate gastric or gastrointestinal motility
- Primary dysmotilities create significant morbidity and can be frustrating to treat
- Secondary motility disorders also occur
H2-Receptor Antagonists (H2RAs)
- Cimetidine, Ranitidine, Famotidine
- All are equally effective in decreasing gastric acidity
- Continuous H2RA administration results in pharmacological tolerance
- Gastrin-induced up-regulation of enterochromaffin-like cell synthesis of histamine which competes with the antagonist at the parietal cell
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Description
Test your knowledge on gastrointestinal pharmacology, including clinical applications and top GI medications. Learn about GI protectants, antacids, H2-receptor antagonists, and proton pump inhibitors.
