Lesson 69 pt 2: General Concepts of treatment of gastric ulcers

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

6 weeks.

What initial physical change did Apollo's owner note?

Reduced appetite or becoming a "picky eater."

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

Leaving portions of his grain uneaten.

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

Showing less interest in hay.

What 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 is one specific type of gastric disease listed for horses?

Equine squamous gastric disease (ESGD).

What is a second specific type of gastric disease listed for horses?

Equine glandular gastric disease (EGGD).

What is the third specific ulcer disease listed?

Gastroduodenal ulcer disease (GDUD).

What are three general categories of anti-ulcer drugs listed?

Histamine-2 receptor antagonists, Sucralfate, and Proton-pump inhibitors.

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

Prostaglandine analogues and Antacids.

What class of anti-ulcer drugs includes Cimetidine, Ranitidine, and Famotidine?

Histamine-2 receptor antagonists.

Which H2-receptor antagonists are indicated for dogs?

Ranitidine and Famotidine.

Which H2-receptor antagonists are indicated for horses?

Cimetidine and Ranitidine.

Which H2-receptor antagonists are indicated for calves?

Cimetidine and Ranitidine.

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

They have a good safety record.

What specific drug inhibits the clearance of other drugs by acting as a CYP450 inhibitor?

Cimetidine.

How can increased gastric pH affect the 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 defences and enhances cytoprotection.

What additional effect does Ranitidine have on motility?

Stimulates motility, increases gastric emptying, and increases colonic motility.

How does Ranitidine achieve its effect on motility?

Via an anti-cholinesterase (AchE) action.

What class of anti-ulcer drugs includes Omeprazole and Pantoprazole?

Proton-pump inhibitors (PPIs).

What is a key characteristic of PPIs regarding their action?

Irreversible.

Which PPIs are indicated for dogs and cats?

Omeprazole, Esomeprazol 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 hyper-secretion of acid.

What common secondary adverse effect is associated with PPI administration?

Small intestinal bacterial overgrowth (SIBO).

What enzyme system do PPIs inhibit?

CYP450 enzymes.

What is noted about the effectiveness of Sucralfate for treating gastric ulcers in animals?

It is beneficial for treatment.

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.

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 Prostaglandine analogue?

Misoprostol.

For what purpose is Misoprostol helpful regarding GI ulcers?

Preventing 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.

What type of analogue is Misoprostol?

PGE analogue.

Name one adverse effect associated with Misoprostol?

Abdominal discomfort, cramping, or diarrhoea.

What serious reproductive adverse effect is caused by Misoprostol?

Abortion (increasing uterine contractions and expulsion of uterine contents).

What precaution is recommended when handling Misoprostol?

Handling by pregnant personnel is not recommended.

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

Right dorsal colitis.

What is Aluminium hydroxide indicated for?

Treatment of gastric ulceration, oesophagitis or gastritis.

What drug possesses cytoprotective, anti-endotoxic, and weak antibacterial properties?

Bismuth.

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.

What is the overall therapeutic goal for gastric ulcers?

Restore normal physiology and heal ulcer.

What are the three primary therapeutic targets listed for gastric ulcers?

H2 receptor antagonists, Proton Pump Inhibitors (PPI), and Prostaglandine analogues.

What is one of the antibacterial properties of Bismuth?

Weak antibacterial properties.

What specific antibiotic's absorption is reduced by Sucralfate?

Tetracyclines.

What specific drug inhibits the CYP450 enzyme system, affecting drug clearance?

Cimetidine.

What drug is cytoprotective, anti-endotoxic, and weakly antibacterial?

Bismuth.

What drug class is associated with rebound hyper-secretion of acid in cats?

Proton-pump inhibitors (PPIs).

What drug is often used for treating gastric ulcers in animals but is not effective for prevention?

Sucralfate.

What class of drugs is represented by Omeprazole?

Proton-pump inhibitor.

What specific PPI is indicated for horses for stress or NSAID induced ulcerations?

Omeprazole.