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Pharm 2 - GI 3

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isabellepjk's version from 2017-11-08 15:51

Laxatives and cathartics + misc

Question Answer
explain laxative vs catharticslaxative (aperients) facilitate excretion of soft formed stool. Cathartics (purgatives) produces a more fluid evacuation (and dec transit time)
what are the diff kinds of laxatives and cathartics?Emollient laxatives, Bulk-forming laxatives, Saline (osmotic) purgatives, Irritant cathartics, Neuromuscular purgatives
what are the emollient laxatives?mineral oil and Docusate sodium (dioctylsodium sulfosuccinate) (oil do'scus stick)
what should you know about mineral oil?very safe. Dont admin with docusate sodium. IF CHRONIC USE, might lead to development of granulomatous lesions in intestinal wall and liver. ALSO chronic use may impair absorption of fat soluble vitamins (A, D, E and K), other nutrients and co-administered drugs
what should you know about docusate sodium?emolent laxative. an anionic surface active agent. dont use with mineral oil.
precautions about emollient laxatives?NEVER USE MINERAL OIL AND DOCUSATE SODIUM TOGETHER. emulsification of the oil → absorption of oil
what are the bulk forming laxatives?Methylcellulose, carboxymethylcellulose sodium, bran (wheat fibre), Psyllium granules
how do bulk laxatives work?stay in intestine, absorb water, distend intestinal lumen--> stim myenteric plexus--> inc mvt
what should you know about Psyllium granules?use in small animals, ALSO used for the treatment of impactions caused by ingestion of sand
Saline (osmotic) purgatives MOA?salt pulls more water into intestine via osmosis. inc luminal size.
what are the saline(osmotic) purgatives?Magnesium sulphate(Epsom salt), Sodium sulphate(Glauber’s salt), Milk of magnesia, Hypertonic solutions(manitol, sorbitol), Lactulose
what should you know about lactulose?synthetic disaccharide which liberates acid salts, which dec intestinal pH (more acidic), which exerts osmotic effects. ALSO USE FOR HEPATIC ENCEPHALOPATHY (that milky sugar really sours up the intestines...but at least it protects the liver)
what are the Irritant (stimulant) cathartics?castor oil and anthraquinones (casting anthrax on your intestines would be irritating indeed)
what should you know about castor oil? (how does it work)acted upon by by pancreatic lipases → forms glycerol & ricinoleic acid which is an irritatant cathartic (RIC CAST the irritating bowel at my pancrease)
how do anthraquinones work?inactive glycosides undergo hydrolysis by bacterial enzymes in the large intestine to release the active aglycones (emodins)--> emodins act on myenteric plexus--> poop (only an EMO would think about anthrax)
what are the Neuromuscular purgatives? how do they work?Cholinergic agents (inc GIT motility) (ex:Neostigmine, physostigmine, bethanechol, carbachol). ALSO Vasopressin, oxytocin, PGF 2αand PG analogs (stimulate the visceral smooth muscle contraction)
Cholagogues vs Choleretics?Cholagogues cause contraction of the gall bladder. Choleretics increase secretion of bile by the hepatocytes.
what are some cholagogues?dietary fat, concentrated magnesium sulfate (a fatty magnum makes my galbladder squeeze out sulfur with excitement)
what are some Choleretics? what is the purpose of them?Glycocholate and taurocholate salts (they are salts!) and Ursodeoxycholic acid (secondary bile acid). used to help dissolve gall stones (just like what would usually be made in the liver to go to the gall bladder)
what are some enema solutions?soap water, isotonic/hypertonic sodium chloride solution, sorbitol, glycerol, sodium laurylsulfoacetate, mineral oil , sodium biphosphate
whats the purpose of a Retention enema? whats in it?enema is kept in longer, used to treat REFRACTORY impactions. made with 4% acetylcysteine
what are the 3 drugs used for treating frothy bloat? how do they work?Dimethicone, Poloxalene, Docusate sodium(also an emollent laxative). MOA= destroy surface tension of bubbles allowing them to burst (Can also use veggie oil but NEVER FISH OIL!!!!) (polo on cows leaves me frothing with anger, DOCUment it with this CONE on your head so no one recognizes how bloated you are)
which frothy bloat treatment can also be used prophylactically?Poloxalene (polo on a cow leaves me frothy with anger, to the point where i treat the anger prophylactically)
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Question Answer
diazepam is a what for what? for who?benzodiazepine used for appetite stimulation (orexigenic agent). CATS.
cyproheptadine is a what for what? for who?serotonin antagonist used for appetite stimulation (orecigenic agent). CATS. (serotonin suppresses appetite, so inhibit to inc appetite)
glucocorticoids can be used for what? for who?appetite stimulant in both dogs and cats
B-vitamins can be used for what? for who?appetite stimulant for both dogs and cats
anabolic steroids can be used for what? for who?appetite stimulant for both dogs and cats
dirlotapide is used for what, in who?appetite SUPPRESSENT in DOGS
antihistamines are used for what?to treat emesis (anti-emetic) DUE TO VESTIBULAR SYSTEM DISTURBANCES (aka motion sickness)
what is saline solution used for?PERIPHERALLY acting emetic
what is 3% hydrogen peroxide used for?PERIPHERALLY acting emetic
what is syrup if ipecac used for?PERIPHERALLY acting emetic
what is emetine?an active irritant alkaloid, active ingredient in ipecac syrup
what is Apomorphine hydrochloride? WHO is it used in?CENTRALLY acting emetic(technically is an opioid too), DOGS (NOTE: conunctival admin, contraindicated in centrally depressed dogs)
what is xylazine? WHO is it used in?CENTRALLY acting EMETIC(technically an alpha-2agonist too), CATS
cyclizine hydrochloride is a what?CENTRALLY acting ANTI-emetic
dimenhydrinate is a what?CENTRALLY acting ANTI-emetic
diphenhydramine hydrochloride is a what?CENTRALLY acting ANTI-emetic
Scopolamine is a what used for what?CENTRALLY acting ANTI-emetic for treating motion sickness (anti M1)
chlorpromazine is a what used for what?Phenothiazine derivative used as a CENTRALLY acting ANTI-emetic
triflupromazine is a what used for what?Phenothiazine derivative used as a CENTRALLY acting ANTI-emetic
prochlorperazine is a what used for what?Phenothiazine derivative used as a CENTRALLY acting ANTI-emetic
promethazine is a what used for what? Phenothiazine derivative used as a CENTRALLY acting ANTI-emetic
Haloperidol is a what used for what?(Butyrophenones)Centrally acting anti-emetics, antagonizes dopamine receptors
droperidol is a what used for what?(Butyrophenones)Centrally acting anti-emetics, antagonizes dopamine receptors
Granisetron is a what used for what?Peripheral 5-HT3 serotonin antagonists, used for controling emesis induced by chemotherapeutic agents/radiation therapy in small animals
Ondansetron is a what used for what?Peripheral 5-HT3 serotonin antagonists, used for controling emesis induced by chemotherapeutic agents/radiation therapy in small animals
Maropitant citrate is a what used for what?NK-1 receptor blocker, centrally acting anti-emetic (FDA approved)
Glycopyrrolate is a what used for what?(modulator of gastric motility) Anticholinergics/antimuscarinics acting peripherally as anti-emetics
propantheline is a what used for what?(modulator of gastric motility) Anticholinergics/antimuscarinics acting peripherally as anti-emetics
methscopolamine is a what used for what?(modulator of gastric motility) Anticholinergics/antimuscarinics acting peripherally as anti-emetics
metoclopramide is a what for what?a prokinetic agent(favor rapid gastric emptying) used as a peripherally acting anti-emetic
domperidone is a what for what?a prokinetic agent(favor rapid gastric emptying) used as a peripherally acting anti-emetic
kaolin is a what for what?cytoprotective agent which can act as a peripherally-acting anti-emetic
pectin is a what for what?cytoprotective agent which can act as a peripherally-acting anti-emetic
bismuth salts is a what for what?cytoprotective agent which can act as a peripherally-acting anti-emetic
Pirenzepine is a what used for what?selective antimuscarinic agent (anti-M1) which is used to reduce gastric acid secretion (eat pi, say M, and it soaks up the acid)
Cimetidine is a what used for what?H2 antagonist to dec gastric acid secretions. WEAKEST. (inhibit CYP450--> can use in acetminophen tox)
Ranitidine is a what used for what?H2 antagonist to dec gastric acid secretions.
Famotidine is a what used for what?H2 antagonist to dec gastric acid secretions. STRONGEST
Nizatidine is a what used for what?H2 antagonist to dec gastric acid secretions. PREFERRED FOR PT WITH LIVER DZ
Omeprazole is a what?Proton pump inhibitor (irreversible and most potent inhibitor of gastric acid secretion. Also choice to be combined with abx for helicobacter pylori infxn)
Misoprostol is a what? for what?Prostaglandin E1 analogue. Use for (1) Dec secretion of acid DOESNT ALTER HORMONE GASTRIN LEVELS-->DOES NOT CAUSE REBOUND ACID HYPERSECRETION! (2) cytoprotective
magnesium hydroxide is a what?NON-systemic antacid (cytoprotective agent). laxative in nature
aluminium hydroxide is a what?NON-systemic antacid (cytoprotective agent). causes constipation!
calcium carbonate is a what?NON-systemic antacid (cytoprotective agent)
sodium bicarbonate is a what?SYSTEMIC antacid (cytoprotective agent). might cause metabolic alkalosis, or liberation of CO2 from GI--> bleching or ruminal bloat
Sucralfate is a what?cytoprotective agent which binds to ulcerated areas to form a protective layer. NEEDS ACIDIC pH TO WORK
Bismuth subsalicylate is a what that does what?cytoprotective agent. cleaves and the bismuth ADsorbs the E coli toxins. CAUTION IN CATS BC NEED GLUCORONIDATION
Bethanechol is a what that does what?cholinergic agonist which stims GI motility
carbachol is a what that does what?cholinergic agonist which stims GI motility
Metoclopramide is a what that does what?central dopamine antagonist (works as an antiemetic AND as a prokinetic agent--> inc ACH release from cholinergic neurons--> stim muscarinic receptors of GIT--> prokinetic action)
Cisapride is a what that does what?a prokinetic with BROAD spectrum of activity, is also able to treat megacolon in cats
Domperidone is a what that does what?a prokinetic when action peripherally (is a dopamine antagonist)
morphine is a what that does what?opioid which decreases GI motility and gastric acid secretions
fentanyl is a what that does what?opioid which decreases GI motility and gastric acid secretions
meperidine is a what that does what?opioid which decreases GI motility and gastric acid secretions
diphenoxylate is a what that does what?opioid which decreases GI motility and gastric acid secretions
loperamide is a what that does what?opioid which decreases GI motility and gastric acid secretions
Difenoxin is a what that does what?active metabolite of diphenoxylate (which is a Meperidine congener, and meperidine is an opioid). used for decreasing GI motility and gastric acid secretions
Loperamide is a what that does what?Meperidine congener (meperidine is an opioid) used to dec GI motility. SAFE FOR CATS!
Paregoric is a what that does what?opioid which is used to dec GI motility--> preferred anti-diarrheal preparation in foals
Activated charcoal is a what that does what?adsorbent which is used in emergency treatment of poisoning
Cholestyramine is a what that does what? basic anion–exchange resin which is an adsorbent used to bind up bile salts
mineral oil is a what that does what?emollient laxatives. very safe. IF CHRONIC USE, might lead to development of granulomatous lesions in intestinal wall and liver. ALSO chronic use may impair absorption of fat soluble vitamins (A, D, E and K), other nutrients and co-administered drugs
Docusate sodium (dioctylsodium sulfosuccinate) is a what that does what?emollient laxatives. is an anionic surface active agent. dont use with mineral oil (will cause oil to be absorbed) also treats frothy bloat
Methylcellulose is a what?bulk forming laxative
carboxymethylcellulose sodium is a what?bulk forming laxative
bran (wheat fibre) is a what?bulk forming laxative
Psyllium granules is a what?bulk forming laxative
Magnesium sulphate(Epsom salt) is a what?saline(osmotic) purgative
Sodium sulphate(Glauber’s salt) is a what?saline(osmotic) purgative
Milk of magnesia is a what?saline(osmotic) purgative
mannitol is a what?saline(osmotic) purgative
sorbitol is a what?saline(osmotic) purgative
lactulose is a what?saline(osmotic) purgative. synthetic disaccharide which liberates acid salts, which dec intestinal pH (more acidic), which exerts osmotic effects. ALSO USE FOR HEPATIC ENCEPHALOPATHY (acidic pH alters ammonium so it wont be absorbed by systemic circulation)
tx hepatic encephalopathylactulose (dec intestinal pH, prevenets ammonium from being absorbed)
castor oil is a what? Irritant (stimulant) cathartics
anthraquinones is a what? Irritant (stimulant) cathartics
ricinoleic acid is a what?irritant cathartic which comes from cator oil which is acted upon by pancreatic lipases
emodins is what?anthraquinoes are acted upon by the enzymes in the large intestine to produce this, which acts as a irritant cathartic
Glycocholate and taurocholate saltsCholeretic used to dissolve gall stones
Ursodeoxycholic acidCholeretic used to dissolve gall stones
DimethiconeUsed to tx frothy bloat.
PoloxaleneUsed to tx frothy bloat.
Docusate sodiumalso an emollent laxative. Used to tx frothy bloat.
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