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104 Cards in this Set
- Front
- Back
What animal cannot vomit?
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Horses
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What are 3 things to consider with younger foals and ruminants?
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1) *Volume of distribution
2) Diet 3) Dosage interval varies |
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What are the 3 general indications of GI meds in large animals?
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1) Gastric ulcers
2) Postoperative ileus 3) Diarrhea |
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What does it mean if there are more drugs available for a condition?
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Drugs are probably less effective
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How are drugs often administered to animals with diarrhea?
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IV or intrarectal because with diarrhea have a dysfunctional GI and mucosa is altered
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What is a special consideration of ruminants with oral administration?
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What the first compartment of the rumen will do to the drug
-Same w/ camels who are pseudoruminants so have a 1st compartment similar to ruminants |
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When are antacids still used in ruminants?
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For rumen overload syndrome (grain overload, rumen acidosis, rumen impaction)
-Worry about pH of rumen bc of grain fermentation and release of lactic acids |
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What are 2 antacids used in ruminants for rumen overload syndrome?
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1) Magnalax
2) Rulax |
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What are 2 common "diseases" that H2 blockers are used for in large animal?
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1) Gastric ulcers
2) NSAID use |
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True or false. If you find a gastric ulcer in a horse you definitely need to treat it.
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False, gastric ulcers are present in almost every horse, have to ask yourself if it's clinically significant.
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What are the signs of gastric ulcers in foals? Adults?
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adults: Mild GI signs of pain- poor performance, change in behavior, weight loss, rough coat (Very non-specific)
Foals: much more profound signs of pain including rolling and laying on their back -*MAY SEE DIARRHEA IN FOAL BUT NOT IN ADULT |
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True or false. H2 blockers can be used for GI neoplasia such as melanomas to provide some relief.
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True, but just relieving, not treating.
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What are the 3 commonly used H2 blockers in large animal medicine?
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1) Famotidine (Pepcid)
-Common in small animal 2) Cimetidine (Tagamet) 3) Ranitidine (Zantac) |
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How often is famotidine administered in large animals?
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Every 24 hours
*Advantage *Disadvantage=expensive |
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What large animal(s) is famotidine usually used in?
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Foals
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Why is it bad to use a "polypharmacy" method to treating any disorder?
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Because anything over 3 drugs you can't predict the side effects of each drug and how they're all going to interact
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True or false. Not all drugs have side effects.
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False, ALL drugs have side effects, even oxygen has side effects
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What large animal(s) is Ranitidine usually used in?
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Foals, not as commonly used in adults bc of newer proton pump inhibitors, but is effect in adult horses
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How often is Ranitidine administered?
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Every 12-18 hours (can be up to 3X daily)
*More affordable than Famotidine |
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What is the biggest disadvantage of Cimetidine compared to Ranitidine and Famotidine?
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Has more potential for renal damage, especially in an animal with renal insufficiency
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Why shouldn't you combine Cimetidine with metaclopramide, sulfate or metronidazole?
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Because Cimetidine has strong inhibition of Cyt p450 so may inhibit drug removal
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What large animal(s) is Cimetidine used in?
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Foals
Adult horses |
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Why is Cimetidine not used very commonly in adult horses if the side effects aren't an issue?
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Have to give every 6-8 hours in adults
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True or false. There are antacids specifically designed for use in equids.
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False, there are no equine products so it is off-label usage
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What is the H2 blocker of choice in foals?
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Famotidine, more expensive but lowest frequency of administration which increases client compliance & more effective in foals
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What is the primary proton pump inhibitor used in large animals?
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Omeprazole (Gastrogard)
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True or false. Omeprazole is used off-label in adult horses.
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False, approved for use in adult horses, but not labeled for use in foals
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What is the primary therapeutic indication of Omeprazole?
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Used commonly in horses to treat and prevent gastric ulcers
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How often is Omeprazole administered?
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Effective and can be given once a day
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What is one downfall of Omeprazole compared to the H2 blockers?
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More expensive than H2 blockers
-Can be 50 dollars a day compared to 5 for Cimetidine |
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True or false. H2 blockers are used more commonly in foals than Omeprazole.
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True because Omeprazole comes as a single dose in a tube for a 500 kg horse, so easier to use H2 blockers
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What is a huge benefit of the effects of Omeprazole compared to antacids?
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Omeprazole can almost completely eliminate acid production and once a day
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What is a way to diagnose gastric ulcers since the signs are so vague?
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Gastroscopy
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What is the mechanism of action of Misoprostol?
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Prostaglandin E1 analog
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What is the primary therapeutic indication of Misoprostol in large animals?
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Prophylactic when using long term/high dose NSAID use
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Why isn't Misoprostol used very often in large animal medicine?
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Not very affordable in large animals, but is used in small animals
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What drug is considered an "antiulcer" drug in large animal medicine?
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Sucralfate
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What are 5 therapeutic uses of sucralfate in horses?
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1) Gastric ulcers
-Small & large animals 2) Treatment for right dorsal ulcerative colitis (RDUC) -Related to NSAID use 3) Treat esophagitis, gastritis, oral ulcers |
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In horses with right dorsal ulcerative colitis, PROFOUND _____ is a clinical sign.
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Hypoproteinemia, bc all the proteins leak out through the colon
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True or false. There's acid production in the colon.
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False! That's the stomach
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What part of the intestines are particularly affected in horses on NSAIDs?
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Right dorsal colon --> RDUC
Get ulcers developing there don't know why it's so sensitive |
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True or false. Sucralfate is also used in camelids.
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True
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How can you tell immediately if sucralfate is helping right dorsal ulcerative colitis?
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Proteins will increase rapidly after starting sucralfate treatment
-See it stabilize in about 72 hours |
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Sucralfate is used in conjunction with _______.
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H2 blockers
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What are the therapeutic indications of sucralfate in camelids?
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Third compartment ulcers and diarrhea
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Does Dr. Schlipf believe that you have to give Sucralfate a half an hour before H2 blockers or Omeprazole?
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No and it's a pain in the butt! It can be used topically and there's minimal evidence involved with that..
Dr. Rouleax-give separate Dr. Schlipf-give together |
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What is one side effect of sucralfate?
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May decrease absorption of some drugs
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What are 6 commonly used prokinetics?
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1) Erythromycin
2) Lidocaine 3) Metoclopramide 4) Domperidone 5) Yohimbine 6) Cisapride |
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Which drug is used as a prokinetic, but is not a true prokinetic?
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Lidocaine, but get indirect improvement in motility
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What are 2 therapeutic uses of prokinetics?
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1) Postoperative ileus (upper GI)
2) PRoximal jejunitis & duodenitis |
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What is the mechanism of action of erythromycin as a prokinetic?
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-Motilin receptor agonist on smooth muscle
-Release of Ach and motility in the enteric nervous system--> increases contractions |
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Where is the primary site of increased motility from erythromycin in small animals? Horses?
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-Small animals: stomach & proximal small intestine in most species
-Horses: Cecum and large intestine |
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True or false. Erythromycin enhances gastric emptying in normal horses.
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True
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How is erythromycin administered for use as a prokinetic?
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High doses so CRI or IV, but prolonged use or CRI induces receptor down regulation and inhibition of activity
-Erythromycin is not first choice for a prokinetic |
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How is lidocaine administered for use as a prokinetic?
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IV infusions (CRI)
Boluses are ineffective bc a very short half life |
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What is the mechanism of action of lidocaine?
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-Suppresses primary afferent neuron firing
-Anti-inflammatory properties -Direct stimulation of smooth muscle -Substance P? -Analgesic: think effects are more related to analgesic effects, pain decreases GI motility |
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What are the signs of lidocaine overdose?
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Excitement and weakness
-Large bolus too rapidly= excitement or more commonly weakness |
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What should you do if there's an obstruction of the IV line in a horse that's administering lidocaine and the horse gets a huge bolus and falls down in the corner?
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Shut off the drip and give the horse a few minutes and it will wear off bc of the short half life
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What is the mechanism of action of metoclopramide?
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-5HT-4 and 5HT-3 receptor agonist
-Antagonist at dopamine 1 & 2 receptors |
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What is associated with the extrapyramidal signs caused by metoclopramide?
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Dopamine 1 and 2 receptor antagonist
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True or false. Metoclopramide can be administered as an IV bolus dose to large animals.
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False, what causes side effects, give as CRI
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True or false. Metoclopramide can be administered orally to horses with post-operative ileus.
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False, they usually have reflux so there's not point
-Some use metoclopramide orally but he doesn't believe it works very well |
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True or false. Metoclopramide can be used for post-operative ileus.
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True, can be used but excitement is a big problem because of dopamine receptor antagonist
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What is the mechanism of action of domperidone?
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Antagonist at peripheral dopamine 2 receptors
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True or false. Domperidone is used for post-operative ileus.
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False, it's been shown to have a modest effect on experimental ileus, but not a lot of effect on promoting normal motility
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What is the mechanism of action of Yohimbine?
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Alpha-2 adrenoreceptor blocker
-Counteract sympathetic outflow in response to nociceptive stimulation and/or endotoxin |
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What are the therapeutic uses of yohimbine?
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Reversal agent for xylazine
-weak effect on cecal emptying -RARELY USED, but sometimes used in small ruminants |
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Why isn't Cisapride used in clinics?
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Not available, was taken off the market because caused death, but can get compounded..
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What is the mechanism of action of Cisapride?
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5HT-4 and 5HT-3 receptor agonist
-Enhanced acetylcholine release from myentic plexus |
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Cisapride is the same as _______, but without the antidopaminergic effects.
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Metoclopramide
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What parts of the GI tract is affected by Cisapride?
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Increased gastric, small intestinal and colonic activity
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What are the 3 therapeutic uses of Cisapride?
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1) Equine grass sickness
2) Large colon impactions 3) Precentative for post-operative ileus -Use in UK |
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True or false. Antiemetics aren't used in horses since they don't vomit.
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False, still use occasionally
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What 2 antiemetics are occasionally used in horses?
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1) Metaclopramide (upper GI prokinetic/gastric emptying)
2) Meclizine (Antivert) |
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What is the mechanism of action of Meclizine?
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Piperazine antihistamine
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What are 2 therapeutic uses of Meclizine other than an antiemetic?
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1) Vestibular disease secondary to Otitis media/interna
2) Geriatric vestibular disease |
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What is the mechanism of action of Buscopan?
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Anticholinergic effects via muscarinic receptors of smooth muscle cells
-Antispasmodic in horses: opposite of prokinetic, relaxes GI |
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What are 2 uses of Buscopan?
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1) Rectal palpation
-Antispasmodic in horses 2) Esophageal obstructions |
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What is the therapeutic use of charcoal?
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May decrease toxin absorption
-Used to decrease toxins, grain overload, overdose in humans |
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What are 2 therapeutic use of metronidazole in large animals?
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1) Clostridial diarrhea (enterocolitis)
2) Antiprotozoal and antibacterial (anaerobes) -Maybe anti-inflammatory effects... |
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What varies when using metronidazole for clostridial diarrhea compared to anaerobic GI infections?
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Used 4 times a day for anaerobic GI infections, but only twice a day for clostridial diarrhea
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What is the therapeutic use of Cyproheptadine?
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Appetite stimulant (cats it works well)
-*Used in horses w/o great success |
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What is the mechanism of action of cyproheptadine?
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Serotonin antagonist antihistamine
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What is a use of diazepam in camels and cats other than anti-anxiety?
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Appetite stimulant
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What drug is used for inflammatory bowel disease in small animals and horses?
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Corticosteroids
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What corticosteroid is most commonly used in large animals?
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Prednisolone
-Sometimes dexamethasone |
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True or false. DMSO IV is commonly used in clinics.
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False, at least not at our clinic, Dr. Schlipf hates DMSO! thinks its ineffective, potential side effect=carcinogen
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*What is always a possible risk of steroid use in horses?
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Laminitis
-Make sure to discuss risk with owners first! |
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What is acupuncture sometimes used for in large animals?
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Ileus and motility enhancement
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What is Saccharomyces boulardii used for in large animals?
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Beneficial effects in diarrhea demonstrated
-This is a probiotic |
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True or false. Pepto bismo is used in large animals.
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True, this is Bismuth subsalicylate, people love to poor it in but no evidence it does anything
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What is mineral oil used for in large animals?
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For grain overload in horses to absorb some toxins
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When can mineral oil be used to bind soluble toxins such as endotoxin?
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Within 24 h, if longer than that it won't help
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What drug is used for horses who have too much sand or soil in their GI?
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Psyllium mucilloid (metamucil)
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What is the therapeutic use of Bio-Sponge?
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To adsorb clostridial toxins
-Have to give frequently and in large doses to be effective |
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True or false. Motility altering drugs, such as Loperamide (Immodium), can be helpful in animals with diarrhea.
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False, avoid motility altering drugs in large animals w/ diarrhea
-Used in small animals |
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What is the therapeutic use of MgSO4?
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May be effective for colon impactions, pulls water into the colon -best softening agent is water
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Why is phenobarbital used in animals with liver disease? Why do we need to monitor animals on phenobarbital?
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-Use in foals with punicterus (bilirubin deposits in brain and brain damage) from hyperbilirubinemia
-Because has effects on the liver |
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What 3 bactericidal antibiotics are used in animals with a hepatopathy?
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1) TMS
2) Ceftiofur 3) Penicillin/Gentamicin -Depending on problem could be beneficial |
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What is the mechanism of action of flumazenil?
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Benzodiazepine receptor antagonist
-Use to reverse things like diazepam |
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What are 11 drugs (groups) used in animals with a hepatopathy ranging from hepatic encephalopathy and acute hepatitis to cholidocholithiasis?
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1) Bactericidal antibiotics
2) Flumazenil 3) Metronidazole 4) DMSO IV 5) Corticosteroids 6) Colchicine 7) Vitamin K1 8) Folic acid 9) Vitamin B1 10) Reduce blood ammonia- Neomycin, lactulose, acetic acid 11) Increased branched chain amino acids in diet |
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Why is metronidazole used in animals with a hepatopathy?
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Changes normal flora of GI
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What 3 drugs reduce blood ammonia?
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1) Neomycin: Changes GI flora
2) Lactulose: acidifies colon so decreases activity of microflora--> decreases ammonia production 3) Acetic acid: acidifies colon to reduce bacteria & ammonia |
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What is the mechanism of action of DMSO IV, pertaining to hepatopathies?
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Dissolve calcium bilirubinate stones/debris in bile ducts (possibly)
-May help dissolve stone accumulation in bile duct |