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68 Cards in this Set
- Front
- Back
gastric ulcers often develop during ________ as a co-morbidity
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hospitalization
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the stomach produces ____ and ___ which are potentially damaging to the gastric mucosa
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acid and proteolytic enzymes
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the three main modes of mucosal protection include:
1. 2. 3. |
1. gastric acid neutralization
2. mucosal protectants 3. inhibition of gastric acid secretion |
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Misoprostol is a ________ and the MOA of Misoprostol is:
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A synthetic prostaglandin E1 analog.
To decrease parietal cell acid secretion |
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NSAIDs interfere with ______ synthesis which results in _______, ________ and _______.
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prostaglandin synthesis, mucus secretion, blood flow and bicarbonate production
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T of F The better an NSAID is at blocking nociceptors the more severe the effect is on the gastric mucosa.
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T
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What are the indications for misoprostol administration? (2)
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NSAID induced gastric ulceration (overdoses/accidental consumption) or as preemptive with high doses of glucocorticoids
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Typically you would like to take a patient off NSAIDs for at least __ weeks before starting them on steroids
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2
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What are the adverse effects associated with misoprostol? What animals should you avoid them in?
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diarrhea, gastric upset
Pregnant animals- causes smooth muscle contraction |
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Sucralfate reacts with gastric to form a ____ which then _____to the exposed submucosa.
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gel, adheres
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Sucralfate acts as a mucosal protectant by forming a direct ______ _______.
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physical barrier
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Sucralfate also has some minor _____ properties and there is some evidence for stimulation of ______ (which would increase mucus production and bicarbonate secretion)
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antacid, PGE2 and PGI2
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When is use of sucralfate indicated?
and if a lesion is in this section of the GIT ________ this drug would no longer be beneficial to the patient. |
esophageal, gastric or duodenal ulceration (gastric reflux, severe gastritis) or iatrogenic mucosal bleeding (NSAID gastritis, steroid induced lesions, surgical complications)
not indicated if the lesion is past the duodenum because it gets broken down |
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you should administer sucralfate at least ___ min before antacids.
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30
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what is the easiest and cheapest way to administer sucralfate
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you make crush and suspend the sucralfate in tap water or feed them the tablet if they will eat a horse pill
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what important medications will sucralfate inhibit the absorption of?
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flurorquinolones, digoxin (and cimetidine but its not really considered an impt one)
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it is ______ expensive and is used for ____term treatment in patients
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moderately (25 cents per tablet), short
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Gastric acid is produced by the ____ cells in the stomach and the pH can reach as low as _____ in a carnivore stomach
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parietal, 1
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blocking of the histamine receptors is a type of ______ antagonism and hence relies on the relative __________ of histamine and antagonist
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competitive, concentrations
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proton pump blockers bind ______ and hence are considered ______ blockers of gastric acid secretion
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covalently, absolute
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T or F
H2 receptor blockers can completely abolish gastric acid production and can lower pH to below 5 |
F that would be the PPIs
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which are more expensive proton pump inhibitors or H2 receptor blockers?
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proton pump inhibitors
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what protective mechanisms does the esophageal mucosa employ?
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not many! it will not heal easily in adverse conditions
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If you only have a gastric disease which antacid might you select?
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H2 receptor blockers
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if you have concurrent gastric and esophageal disease which type of antacid might you select
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a proton pump inhibitor
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list the three commonly used H2 blockers
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cimetiine, ranitidine, famotidine
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what is one of the major adverse effects of cimiedtidine? what is the outcome of this adverse effect?
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significant inhibitor of cytochrome P450. it interferes with drug metabolism
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how often must cimetidine be dosed?
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every 6-8 hours
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Ranitidine is known as _____ over the counter and has to be dosed _______.
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zantac, 2 x daily
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Famotidine has the least effect on this enzyme ______ but is the most ________
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cytochrome p450, expensive
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what is the MOA of omeprazole and what is its adverse effects
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MOA- irreversible inhibitor of parietal cell proton pumps. it mildly inhibits cytochrome p450.
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vomition is a ______ process and is controlled centrally by the _____ and ______.
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complex, chemoreceptor trigger zone, vomition center
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Maropitant is a ______ receptor antagonist which blocks the action of _____ in a common pathway to the vomition center
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NK1, substance P
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Maripotant needs to be dosed ___ x daily by _____ or per os.
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1, subcutaneous
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Maripotent is dispensed by the manufacturer in packages of 4 tablets because ____________.
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if the animal is still vomiting after this time it requires further work up
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The anitemetic effect of metoclopramide is predominantly _______. This is achieved by increasing ____ tone, decreasing ____ tone, increasing ________ and _______ motility.
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peripheral,
increasing LES tone decreasing pyloric tone increasing gastric and duodenal/jejunal motility |
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Metoclopramide also has some ____ activity which can lead to ____ side effects. it is a _____ antagonist
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central, neurological, dopamine
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Metoclopramide has a prokinetic effect but is not particularly good at preventing ____.
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nausea
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Metoclopramide can be given as a _____ (dose form) and is not cost prohbitive.
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CRI
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how common are side effects of metoclopramide and what are they?
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uncommon!
restless, circling, whining, disorientation, seizures and frenzied behaviour |
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Ondansetron/Dolasetron are available in ___ and ___ forms for about ___ dollars a dose. they should be adminstered ___ x daily
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IV and tablets
10 dollars 1-2 |
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ondansetron and dolasetron are ______ acting and are _____ receptor antagonists.
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centrally, serotonin/5HT3
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What is your first line choice when selecting an anti-emetic?
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maropitant
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many hospitalized patients are given _____ and _____ as single daily injections which is easy to maintain
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maropitant and 5HT3 antagonist
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What are some examples where it would be indicated to combine 3 antemetics?
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severe acute pancreatitis, gastric carcinoma, severe uremic gastropathy, chemotherapy related nausea and vomiting
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chronic GI enteroptathies include:
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chronic small intestinal diarrhea, weight loss, failure to thrive, vitamin malabsorption, steathorrea
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chronic enteropathies are most common in which if the companion animal species and in particular which breed
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large breed dogs, the german shepard
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which antibiotic has a good track record for the treatment of chronic enteropathies?
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tylosin
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What type of antibiotic is tylosin and what is its MOA
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macrolide, it inhibits protein synthesis
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Would tylosin be considered bactericidal or bacteriostatic? Which species is it marketed and labeled for use in?
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bacteriostatic
cattle, swine, poultry |
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the beneficial effect of tylosin is through the promotion of which microbe in the GIT
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lactobacillus
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the optimum dose of tylosin is not clear but recently they have been recommending ___ mg/kg ___ x daily. patients need at least how many weeks therapy
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25, 2
6 |
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which drug is known as the great white hope of chronic GI disease?
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metronidazole
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patients on metronidazole often see a clinical response but with rapid _______
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recrudescence
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metronidazole is effective against _________ and ______ and in particular for diarrhea related to this parasite_______
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bacteria, protozoa
giardia |
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You can see clinical benefits at a dose of ___mg/kg of metronidazole but to clear an infection of giardia completely you need to prescribe a dose of _____mg/kg BID for _____days
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10mg/kg
25 mg/kg 10 days |
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Protozoal infections are better treated with _______ because of lower likelihood of toxicity and increased efficacy.
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fenbendazole
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Sulfasalazine is effective at treating conditions in this region of the GIT
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the colon
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In the colon, _______ is cleaved by the bacteria into sulfapyridine and 5-aminosalycylic acid.
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sulfasalazine
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What are the 3 general mechanisms behind diarrhea
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1.secretory
2.osmotic 3.motility |
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secretory type diarrhea is often associated with _____ and _____
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bacterial toxins, some viruses
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osmotic type diarrhea is often associated with ________
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fat and carbohydrates not being absorbed
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motility type diarrhea is associated with ____, _____ and _______
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inflammation, drugs, some toxins
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The MOA of Loperamide is:
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motility modifier
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Opiate anitdiarrheals work by;
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1. reducing longitudinal colonic motility and increasing circumferential contractions
thereby increasing the duration of passage of ingesta |
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When are opiate antidiarrheals contraindicated? (3)
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1.when the patient has bacterial infections or has consumed any other toxins
2. in cats 3. collie breeds |
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Bismuth subsalicylate exerts its effects by being ______ protective
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directly
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salicyclate is an _________ so take care when dosing
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NSAID (aspirin)
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