118211
Description
Flashcards by Shrea Patel, updated more than 1 year ago
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Created by Shrea Patel
over 12 years ago
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| Question | Answer |
| Anti-ulcer drugs | H2 receptor antagonists Proton- pump inhibitors PG analogues Neutralising agents |
| Emetics | Xylazine Apomorphine (Ipecacuanha) |
| Xylazine | Especially cats I/M route best lower dose reduces sedation effect (last thing want if unwanted ingestion) |
| H2 receptors antagonists Cimetidine< Ranitidine< Famotidine All act on only 1 receptor. | Antihistamines only target H1. Decrease gastric acid and pepsin prod. Cimetidine: Oral bioavailability 70% decreased by food. Hepatic metabolism and renal elimination conjugated and active. Short t1/2 = 1hr, ideally 3x/day. Inhibits microsomal enzymes and reduces hepatic blood flow (care: lidocaine and propanolol) Can get rebound hypersecretion. Famotidine: Doesn't inhibit liver enzymes, can give IV but mix with saline for over 5 mins, dose reduction in renal failure. Ranitidine: No liver enzyme inhibition, can be IV, Prokinetic activity, dose reduction renal fail. |
| Apomorphine | Can give any route (IV, IM, SC, PO). Emetic properties predominate over opiate effects. Efficacy reduces with usage (if doesn't work well first time don't use again). Overdose= respiratory depression. Higher dose = opioid effects. Not suitable in cats. |
| PG analogues Omeprazole, Misoprostol | Omeprazole: More potent than H2 but longer to take effect (lag). Bind and irreversibly inhibits K ATPase on luminal cell aspect. Basic drug (enteric coating for absorption)but in stomach pH 5.1 favours unionised state for greater absorption. |
| Anti-emetics | Centrally acting (affect neural pathway): Maropitant Metacloprimide Antihistamines Phenothiazines Butyrophenone derivativees Serotonin antagonists Peripheral (Affect gut and indirect to decrease likelihood): Protectants Anticholinergics Prokinetics |
| Maropitant Cerenia | Antagonist of Substance P at Neurokinin - 1 receptor. Final common pathway in emetic centre = broad spectrum. Oral bioavailability - low due to high rate of first pass hepatic metabolism Non-linear kinetics 2 hepatic isoenzymes: 1 preferential route easily saturated but 2nd less specific but higher capacity. Hepatic clearance too. High Vd despite high plasma protein binding. Oral or SC dosing Dose range high - cause and route dependent |
| Metoclopramide Emeprid | Peripheral (Blocks D2receptors and causes local ACh release) and central (CRTZ: serotonin and D2 receptors) Effects: Increase oesophageal sphincter tone, decrease pyloric, increase gastric contractions and peristalsis of upper intestine. Short t1/2 = multiple dosing. Oral and parenteral admin. First pass metabolism significant. Renal and hepatic elimination Good Vd(inherent requirement for AE). Side effects: Behavioural changes, NOT in obstructions, constipation in long term use, NOT in epileptics (lowers threshold) Antagonists: Atropine and opioids. |
| Antihistamines Cyclizine, meclizine, diphenhydramine HCL. | For motion sickness (vestibular apparatus). Block H1 receptors. Side effects: Drowsiness (not newer generation but indicates poorer CNS access = poorer antiemetic) and dry mouth. Hepatic metabolism. Renal elimination. Good oral bioavailability. |
| Phenothiazines: ACP, Chlorpromazine, prochlorperazine | CRTZ: Dopamine and histamine receptor blockade. Broad spectrum. Hypotension can be sig. CARE: old/sick. Higher doses: Antimuscarinic effect. |
| Butyrophenone derivatives Haloperidol | Anti-dopaminergic. Potent tranquilisers/ sedatives |
| Serotonin antagonists Cyproheptadine, ondansetron | Originally used a lot in chemotherapy palliation (ondansetron). Short t1/2. Hepatic metabolism. Oral or parenteral administration. Less favourable because of maropitant (fewer doses/day). |
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