Lesson 100: drugs of the liver and pancreas

What is a listed mechanism of liver injury?

Oxidative injury.

Name another mechanism of liver injury.

Cholestatic liver disease.

Name a third mechanism of liver injury.

Metal accumulation.

What type of therapy are SAMe and Silymarin examples of?

Hepato-protective & Antioxidant therapy.

What type of therapy includes UDCA?

Choleretics and Cholagogues.

What drug is listed under Antifibrotic and Anti-inflammatory agents, besides Corticosteroids?

Colchicine.

What does SAMe stand for?

S-adenosylmethionine.

What key role does SAMe play in methylation support?

Donates CH₃ groups for phosphatidylcholine synthesis.

What is the benefit of phosphatidylcholine synthesis promoted by SAMe?

Stabilizes hepatocyte membranes and promotes bile flow.

SAMe increases the intracellular concentration of what major antioxidant?

Glutathione (GSH).

How does SAMe protect mitochondria?

Maintains membrane potential and reduces apoptosis in hepatocytes.

How does SAMe enhance detoxification?

Enhances conjugation reactions and reduces oxidative and drug-induced injury.

Name a therapeutic use for SAMe.

Chronic liver disease.

What severe condition is listed as a contraindication for SAMe?

Severe hepatic encephalopathy.

SAMe is often combined with Silymarin or what other drug for synergistic effect?

Ursodeoxycholic acid (UDCA).

What does UDCA stand for?

Ursodeoxycholic Acid.

What category of drugs includes UDCA?

Hepatoprotective Agents/choleretics.

Name a therapeutic use for UDCA related to bile flow.

Cholestatic Liver Diseases.

Name a therapeutic use for UDCA related to inflammation.

Immune-Mediated and Inflammatory Hepatopathies.

What condition is a contraindication for UDCA use?

Complete extrahepatic bile duct obstruction.

Why is complete extrahepatic bile duct obstruction a contraindication for UDCA?

Risk of bile retention and hepatocellular injury.

What is Silymarin commonly known as?

Milk thistle.

What is the action of Silymarin on the hepatocyte membrane?

Membrane stabilization (prevents entry of toxins like amanitin).

How does Silymarin function as an antioxidant?

Scavenges free radicals (ROS) and increases intracellular glutathione.

What effect does Silymarin have on ribosomal RNA formation?

Protein synthesis stimulation, promoting hepatocyte regeneration.

Silymarin inhibits what specific molecule related to inflammation?

Cytokines such as TNF-α.

What common toxicity is N-Acetylcystein indicated for?

Acetaminophen (paracetamol) toxicity.

Name a listed toxicity, besides Acetaminophen, for which N-Acetylcystein is indicated.

Aflatoxicosis.

Name a listed NSAID toxicity N-Acetylcystein might treat.

NSAIDs.

What drug is listed as both a choleretic and a hepatoprotective?

SAMe.

What type of agent is Cholecystokinin (CCK) classified as?

Cholagogues.

What condition must be ruled out before administering choleretics/cholagogues?

Extrahepatic biliary obstruction.

Name a vitamin listed under Antioxidants & Supportives.

Vitamin E.

Name a second vitamin listed under Antioxidants & Supportives.

Vitamin K1.

Name a mineral used in copper hepatopathy.

Zinc.

What drugs are used to treat Copper Storage Disease by chelation?

D-Penicillamine or Trientine.

What is the chelator used for Iron Storage Disease?

Deferoxamine (Desferal).

What is the most likely diagnosis for a Labrador retriever with rhodanine-positive granules in hepatocytes?

Copper toxicosis.

What is the primary target of SAMe?

Hepatocyte mitochondria, glutathione pathway.

What is the resulting outcome/effect of SAMe action?

Hepatoprotective, antioxidant.

How does Silymarin protect hepatocytes?

Scavenges ROS, stabilizes cell membrane.

What is the mechanism of action of UDCA related to bile flow?

Replaces toxic bile acids, increases bile flow.

What is the effect of N-Acetylcystein?

Hepatoprotective, antioxidant

How do Penicillamine and Trientine remove copper ions?

Chelation leading to urinary excretion.

How does Zinc decrease copper absorption?

By stimulating metallothionein synthesis in enterocytes.

In the plant toxicosis case, what clinical sign related to GI bleeding was presented?

Melena.

In the plant toxicosis case, how high were the reported ALT levels?

Elevated ALT (>2,000 U/L).

What measure can be taken to interrupt enterohepatic recirculation of toxins?

Activated charcoal or Cholestyramine.

What class of drugs includes N-acetylcysteine, SAMe, and Silymarin in an acute toxicosis approach?

Hepatoprotective therapy.

Name a GI protectant used in the supportive care approach.

Omeprazole, Sucralfate, or Pantoprazole.

What type of drugs are Maropitant and Ondansetron?

Antiemetics.

What is the purpose of Enzyme Replacement Therapy (ERT)?

Replaces missing digestive enzymes (lipase, amylase, protease) in animals with exocrine pancreatic insufficiency (EPI).

What is the main substance used in ERT for EPI?

Pancrelipase (from porcine pancreas).

How should Pancrelipase be administered?

Powder mixed with food.

What is an adverse effect of Pancrelipase if not mixed with food?

Oral irritation.

What is the primary therapeutic goal in Acute Pancreatitis?

Stabilize patient, control inflammation, prevent systemic complications.

What type of pain medication is recommended in acute pancreatitis?

Strong opioids (e.g., Methadone, Fentanyl, Hydromorphone).

What class of drugs should generally be avoided for analgesia in acute pancreatitis?

NSAIDs.

What appetite stimulant can be used in dogs with pancreatitis?

Capromorelin.

What appetite stimulant can be used in cats with pancreatitis?

Mirtazapine.

What is the duration of treatment for Acute Pancreatitis?

Short-term (days–weeks).

What is the nature of management for Chronic Pancreatitis?

Long-term or lifelong management.

What medication might be indicated in cats with triaditis to manage inflammation?

Prednisolone or budesonide.

What drug replaces or supplements endogenous insulin?

Insulin preparations (Caninsulin, Glargine, Detemir, etc.).

What type of agent is Glipizide?

Oral hypoglycemics.

How does Glipizide work?

Stimulates insulin release from pancreatic β-cells.

What is Glipizide primarily used for?

Mild Diabetes Mellitus (DM) in cats.

What are the digestive enzymes replaced by supplements in EPI?

Lipase, amylase, protease.

What is the mechanism of action of Maropitant?

NK1 antagonist.

What is the mechanism of action of Ondansetron?

5-HT3 antagonist.

What is the mechanism of action of Metoclopramide?

D2 antagonist.

What receptors do opioids like buprenorphine target for analgesia?

μ-opioid receptors.

In chronic immune-mediated pancreatitis, especially in cats, what anti-inflammatory drugs are used?

Corticosteroids.

What are the three components involved in Feline Triaditis?

Pancreatitis, inflammatory bowel disease (IBD), and cholangitis.

What supplement is often included in the treatment for Feline Triaditis?

Vitamin B12 (Cobalamin).

What medication controls vomiting by acting on the CTZ and vagal afferents?

Maropitant, Ondansetron, or Metoclopramide.

What supportive therapy involves IV crystalloids and monitoring glucose and electrolytes in cases of acute injury?

Fluid therapy.

Which hepatoprotective agents are often combined for synergistic effect?

SAMe and Silymarin or UDCA.

What substance listed under Antioxidants & Supportives is specifically needed in cats?

Taurin.

Name a Choleretic drug that is a Herbal extract.

Silymarin.

What is the main function of Corticosteroids in chronic immune-mediated pancreatitis?

Anti-inflammatory.

What is the purpose of Dietary management in Endocrine Pancreas therapy?

Glycemic control (decreasing postprandial glucose load).

Name a chelator listed under Drugs Acting on Liver.

D-Penicillamine.

What class of drugs includes UDCA, Choline, and Methionine?

Choleretics and Cholagogues.

What drugs are used to provide neuropathic pain control?

Gabapentin, amantadine, buprenorphine.

What is a dietary helper used in dogs for nutrition?

Capromorelin.

What is a concern with long-term use of PPIs in chronic pancreatitis management?

Minimize long-term PPI use.

What type of therapy is used in the treatment of chronic autoimmune pancreatitis?

Immunosuppressive therapy.

What drug replenishes glutathione and improves detoxification?

N-Acetylcystein.