Lesson 72 part 1: General concepts of treatments of gastric ulcers

What is the therapeutic goal in treating gastroduodenal ulcers?

Restore normal physiology and heal the ulcer.

What is the first therapeutic target listed for treating gastric ulcers?

H2 receptor antagonists.

What is the second therapeutic target listed for treating gastric ulcers?

Proton Pump Inhibitors (PPI).

What is the third therapeutic target listed for treating gastric ulcers?

Prostaglandin analogs.

What is the first learning outcome regarding drugs with an effect on the stomach?

Identify the drug targets and mechanisms of action for drugs with an effect on the stomach.

What is the second learning outcome regarding drugs with an effect on the stomach?

Compare and contrast the effects of drugs with an effect on the stomach.

What is the third learning outcome regarding drugs with an effect on the stomach?

Evaluate the adverse effects and contraindications of drugs with an effect on the stomach.

What is the final learning outcome listed for the lesson?

Create a treatment protocol for gastric ulcerations in different animal species.

What are the three main categories of anti-ulcer drugs listed in the source?

Histamine-2 (H2) receptor antagonists, Proton-pump inhibitors, and Antacids.

What are two other categories of anti-ulcer drugs listed?

Sucralfate and Prostaglandin analogs.

What is the name of the horse presented in the clinical example?

Apollo.

What is Apollo's breed and use?

A Dutch Warmblood gelding used in show jumping.

How long was the history of Apollo's progressive behavioral and physical changes?

6 weeks.

What initial physical change did Apollo's owner note?

Reduced appetite (became a "picky eater").

What specific symptom was noted regarding Apollo's grain consumption?

Leaving portions of his grain uneaten.

What specific symptom was noted regarding Apollo's hay consumption?

Showing less interest in hay.

What physical symptom developed over time despite maintained feed quality?

Weight loss.

What was Apollo's body condition score (BCS) listed as?

4/9.

What marked sensitivity did Apollo exhibit?

Sensitivity to girthing.

What new-onset behavioral change was noted at feeding time?

Aggression (biting stall walls).

What behavior was noted when Apollo was approached with tack?

Nervousness.

How many episodes of mild colic did the owner report in the past month?

Three episodes.

How quickly did the reported colic episodes resolve?

Within 2 hours without veterinary intervention.

What behavior did stable staff observe between colic episodes?

Frequently stretching into a urination posture without producing urine.

What behavior did stable staff observe during grooming sessions?

Intermittent teeth grinding.

What are the three specific types of gastric/duodenal ulceration listed?

Equine squamous gastric disease (ESGD), Equine glandular gastric disease (EGGD), and Gastroduodenal ulcer disease (GDUD).

Name three Histamine-2 (H2) receptor antagonist drugs.

Cimetidine, ranitidine, and famotidine.

Which H2-receptor antagonists are recommended for dogs?

Ranitidine and famotidine.

Which H2-receptor antagonists are recommended for horses?

Cimetidine and ranitidine.

Which H2-receptor antagonists are recommended for calves?

Cimetidine and ranitidine.

What is noted about the general safety record of H2-receptor antagonists?

They have a good safety record.

What specific drug inhibits the clearance of other drugs via its action as a CYP450 inhibitor?

Cimetidine.

How can increased gastric pH affect the oral absorption of certain drugs?

It can affect the oral absorption of those drugs that require an acid pH for drug dissolution.

Besides acid reduction, what additional effect does Cimetidine have on the stomach?

Strengthens the gastric mucosal defenses and enhances cytoprotection.

What additional effect does Ranitidine have on motility?

Stimulates motility and increases gastric emptying and colonic motility.

How does Ranitidine achieve its effect on motility?

Via an anti-cholinesterase action.

Name three Proton-pump inhibitors (PPIs) listed.

Omeprazole, Pantoprazole, and Esomeprazole.

What is a key characteristic of PPIs regarding their action?

Irreversible.

Which PPIs are indicated for dogs and cats?

Omeprazole, Esomeprazole, and others.

For what types of ulcers are PPIs used in dogs and cats?

Treatment of cancer or NSAID-induced ulcers.

Which PPI is indicated for horses?

Omeprazole.

For what types of ulcers are PPIs used in horses?

Treatment of stress or NSAID-induced ulcerations.

What adverse effect of PPIs leads to a trophic effect on the gastric mucosa?

Elevated gastrin concentrations.

What adverse effect is seen in cats after chronic administration of PPIs?

Rebound hypersecretion of acid.

What common secondary adverse effect is associated with chronic PPI administration?

Small intestinal bacterial overgrowth (SIBO).

What is the general indication for Sucralfate in animals regarding ulcers?

Beneficial for the treatment of gastric ulcers in animals.

Is Sucralfate effective for the prevention of gastritis or gastric ulcers?

No, there is no evidence that it is effective for prevention.

What specific use is listed for Sucralfate in cats?

Useful in the prevention of oesophagitis in cats.

What adverse effect does Sucralfate have regarding the absorption of other drugs?

Reduction of the absorption of other drugs (e.g., tetracyclines).

What common gastrointestinal adverse effect is associated with Sucralfate?

Constipation.

What drug is a Prostaglandin analog listed?

Misoprostol.

What type of analogue is Misoprostol?

PGE analogue.

For what purpose is Misoprostol helpful regarding GI ulcers?

Helps to prevent GI ulcers.

Is Misoprostol generally beneficial for treating ulcers once they occur?

No, it is less beneficial for treating ulcers once they occur.

Misoprostol's use appears to be limited to what type of concurrent therapy?

NSAID therapy.

Name one adverse effect associated with Misoprostol?

Abdominal discomfort, cramping, or diarrhoea.

What serious reproductive adverse effect is caused by Misoprostol?

Abortion.

What precaution is recommended when handling Misoprostol?

Not recommended in pregnant animals (due to increasing uterine contractions and possible expulsion of uterine contents).

Misoprostol has anecdotal benefits for treating or preventing what condition in horses associated with phenylbutazone treatment?

Right dorsal colitis.

Name three types of Antacids listed.

Bismuth subsalicylate, aluminium hydroxide, and magnesium hydroxide.

What specific antacid is indicated for the treatment of gastric ulceration, oesophagitis, or gastritis?

Aluminium hydroxide.

What are the three properties of Bismuth (as an anti-ulcer drug)?

Cytoprotective, anti-endotoxic, and weak antibacterial properties.

Are adverse effects of Antacids/Bismuth common?

Adverse effects are rare.

What substance in antacids causes rare adverse effects related to drug absorption due to chelating effects?

Magnesium.

Antacids interfere with drug absorption due to the reduction of what?

Stomach acid.

Which drug, besides being an H2-receptor antagonist, also strengthens gastric mucosal defenses?

Cimetidine.

Which PPIs are used for the treatment of NSAID-induced ulcerations in horses?

Omeprazole.

The reduction of the absorption of other drugs is an adverse effect of which gastric protectant?

Sucralfate.

What is the major adverse effect limiting the use of Misoprostol in pregnant animals?

Abortion (increasing uterine contractions).