Signs of ulcers anorexia hematemesis pain melena NOTE

• Signs of ulcers: anorexia, hematemesis, pain, melena • NOTE: Many of these products effect the p. H of the stomach. Be sure to read the package insert as they will instruct not to give other oral meds for 2 hours after administration. Omeprazole, Lansoprazole Misoprostol TUMS, Rolaids, Maalox, Mylanta, Amphojel • Causes of ulcers: gastric hyperacidity, bile reflux from duodenum to stomach, accumulation of toxins in the blood (renal failure), stress, inhibition of Prostaglandin Type E, drugs (steroids, NSAIDS) Cimetidine , Ranitidine, Famotidine, Sucralfate ANTIULCER MEDICATIONS

H 2 Receptor Antagonists • H 2 receptors are one of three types of receptors on parietal cells. When receptor is stimulated by histamine, more hydrochloric acid is released from parietal cells. • H 2 receptor antagonists block the receptors and reduce the production of HCl.

Cimetidine *Tagamet, Ranitidine *Zantac, and Famotidine *Pepcid • Cimetidine is the least potent- must be given up to 4 times a day to see results. Ranitidine is given less frequently- twice daily. Famotidine is only given once daily. • Cimetidine inhibits some of the liver enzymes needed to metabolize other drugs. If given with other meds (especially cardiac drugs), cimetidine may cause their concentrations in the blood to rise to toxic levels. • All come in oral and injectable forms

Gastromucosal protectant. Sucralfate *Carafate • Disaccharide that forms a paste in the stomach and binds to the surface of ulcers to promote healing (gastric Band-aid) • Avoid giving with drugs that alkalinize the stomach because it works better in the normal p. H of the stomach (2 -3) – Nonabsorbable – Only side effect is constipation

Proton Pump Inhibitors. Omeprazole *Gastrogard, Lansoprazole *Prevacid • Bind to the luminal surface of parietal cells and inhibits the pump that moves hydrogen ions out of the cell. • end in the suffix –zole • Omeprazole (Gastrogard) – used in horses older than 4 weeks. Primarily for ulcers due to too little hay intake, reoccuring ulcers, or a sensitive growing GI tract • Lansoprazole (Prevacid) – treats reflux and blocks gastric acid production.

Prostaglandin Analogue- Misoprostol *Cytotec • Increases mucus production, decreases acid production. • Used to treat ulcers due to large doses of NSAIDS. • $$$ • Pregnant women should not handle; may cause abortion

Antacids- *TUMS, *Rolaids, *Maalox, *Mylanta, *Amphojel • Fast-acting, relatively nonabsorbable salts of aluminum, calcium, or magnesium that are used to neutralize acid molecules by converting HCl to weaker acids. • Frequent or large doses can cause electrolyte abnormalities. • Can affect other drugs by adsorbing to them, increasing stomach p. H, and increasing urinary p. H • Calcium and aluminum products can cause constipation, magnesium products can cause diarrhea. Many products contain both to counteract these effects.

LAXATIVES AND CATHARTICS Lactulose, Milk of Magnesia Metamucil, Bran, Docusate sodium Mineral oil, Petrolatum • Increase fluid content of feces, making them softer and easier to pass. • -Used for constipation, trichobezoars, colon evacuation, and surgeries of the rear-end • -Laxatives are used when the goal is to soften the stool, Cathartics are used when evacuation of the bowel is the goal.

Saline/Hyperosmotic Agents*Lactulose, *Milk of Magnesia • Contain magnesium or phosphate ions that are poorly absorbed. They pull water into the bowel lumen via osmosis. • Can cause electrolyte imbalances if treatment is prolonged or large doses are given.

Bulking agents- *Metamucil, Bran • Psyllium preparations that are indigestible that swell with water to increase the size of intestinal contents and stimulate peristalsis.

Lubricants- Mineral oil, Petrolatum *Laxatone • Oils that soften the fecal mass, making it easier to move through the body. • Mineral oil is often used in horses with impaction and/or colic, Petrolatum is often used in cats with hairballs.

Surfactants- Docusate sodium *Colace • Often in enema form. Reduce surface tension and allow water to penetrate stool. • Used to treat hard, dry feces in small animals, impaction in horses, digestive upset in cattle.

MISCELLANEOUS GI DRUGS

PROBIOTICS • Repopulate the GI tract with beneficial bacteria (Lactobacillus, Enterococcus), as diarrhea can cause a disruption of the normal intestinal flora • *Forti-Flora, *Fastrack gel, *Probiocin

ANTIBIOTIC • Metronidazole *Flagyl • Diarrhea can cause disruption of the normal flora and cause an overgrowth of anaerobic bacteria. Flagyl is effective against anaerobic bacteria & Giardia and returns stool to its normal consistency. • Neurological signs may be seen with moderate to high doses

BLOAT PREVENTION • Reduce or prevent foam formation in ruminants • Rumen is at risk for frothy bloat – Gas distention in rumen from grazing certain plants (legumes usually) that mixes with fluid to cause a froth – This froth can kill them by blocking the ability to burp • These agents break up the foam – *Therabloat, *Bloat Guard, *Bloat-Pac

ENZYMATIC SUPPLEMENTATION • Treatment for Pancreatic Enzyme Insufficiency • Pancreas is not making its digestive enzymes – Amylase, lipase, protease (enzymes used to digest fat, starch, and protein) • The enzymes can be provided to the patient in the diet – *Viokase, *Pancrezyme