Veterinary Veterinary PharmacologyPharmacology

GITGITDr. Jahangir KaboutariDr. Jahangir KaboutariAssistant Professor of Assistant Professor of Pharmacology Faulty of Pharmacology Faulty of

Veterinary Medicine, Veterinary Medicine, University of University of Shahrekord. Shahrekord.

Shahrekord. Iran Shahrekord. Iran

Importance and function of the GITImportance and function of the GIT

Physiology of the GITPhysiology of the GIT

Pathology of the GIT, primary and secondary Pathology of the GIT, primary and secondary diseasedisease

Correct DX and specific and non specific Correct DX and specific and non specific treatmentstreatments

Nonspecific treatment regimensNonspecific treatment regimens

Correction of water and electrolyte imbalanceCorrection of water and electrolyte imbalance

GIT restGIT rest

Modulation of food regimen and nutrition supplyModulation of food regimen and nutrition supply

Amelioration of visceral painsAmelioration of visceral pains

Appetizer agentsAppetizer agents

Appetite center : Appetite center : ventrolat nuclei of the ventrolat nuclei of the hypothalamushypothalamus

Regulators :Regulators :Neurotransmitters and neuropeptidesNeurotransmitters and neuropeptides

Stimulatory NTs: Stimulatory NTs: Nep(Nep(αα2.R), Dopamine(D1.R),GABA2.R), Dopamine(D1.R),GABA

Inhibitory NTs:Inhibitory NTs: 5HT5HT

Stimulatory NPs:Stimulatory NPs: Opioids, Pancreatic polypeptidesOpioids, Pancreatic polypeptides

Inhibitory NPs: Inhibitory NPs: Calcitonin, Cholecystokinin , Corticotrpin Calcitonin, Cholecystokinin , Corticotrpin releasing factorreleasing factor

Appetizer agents : Appetizer agents : usually nonspecificusually nonspecific

Appetizer agentsAppetizer agents

11 - -Benzodiazepines: Benzodiazepines: Diazepam (Iv) & Oxazepam (Po)Diazepam (Iv) & Oxazepam (Po)::

GABA stimulation at appetite center , central inhibition of GABA stimulation at appetite center , central inhibition of satiety centersatiety center

Used in cats ,less effective in dogsUsed in cats ,less effective in dogs

22 - -Cyproheptadine:Cyproheptadine: 5HT &Histamine blocker ,used in 5HT &Histamine blocker ,used in geriatrics, adults and young people suffering form food geriatrics, adults and young people suffering form food eatingeating

Used in cats, may be not effective in dogsUsed in cats, may be not effective in dogs

Appetizer agentsAppetizer agents

33 - -Glucocorticoides & Vitamin B complexGlucocorticoides & Vitamin B complex

44 - -Gluconeogenesis inhibitors: Gluconeogenesis inhibitors: Hydrazine sulfateHydrazine sulfate

55 - -Gastric empting accelerators :Gastric empting accelerators :MetoclopramideMetoclopramide

66 - -Megetrol acetateMegetrol acetate

77 - -Anti chycotic ,antidepressant drugsAnti chycotic ,antidepressant drugs

88 - -BittersBitters

99 - -ZincZinc

Emetic & antiemetic agentsEmetic & antiemetic agents

ProtectiveProtective reflex mechanism , didn’t developed in reflex mechanism , didn’t developed in all spp: all spp: Carnivorous, primates, swine, reptiles , Carnivorous, primates, swine, reptiles , some birdssome birds:: capable of vomitingcapable of vomiting

Horse ,ruminants, rodents, guinea pig and rabbitHorse ,ruminants, rodents, guinea pig and rabbit : : incapable of vomitingincapable of vomitingMulticentral controlMulticentral control

Emetic centerEmetic center

Lat. reticular formation of the medulla, protected by Lat. reticular formation of the medulla, protected by BBBBBB

An integrating center for all emetic impulsesAn integrating center for all emetic impulses

Cerebral cortex: Cerebral cortex: pschycologic, visual& olfactory emesispschycologic, visual& olfactory emesis

Limbic system:Limbic system: emesis due to head injury & increase in emesis due to head injury & increase in ICPICP

Ach is the primary NT, Histamine via H1 is the Ach is the primary NT, Histamine via H1 is the secondary NTsecondary NT

Chemoreceptor trigger zone (CTZ)Chemoreceptor trigger zone (CTZ)Area postrema in the lat .wall of the 3Area postrema in the lat .wall of the 3rdrd ventricle ventricle

Incomplete BBB, nerve endings in direct contact with Incomplete BBB, nerve endings in direct contact with CSF, therefore more susceptible than emetic center CSF, therefore more susceptible than emetic center to the blood& CSF born agents , toxins and disease to the blood& CSF born agents , toxins and disease conditions : conditions : uremia , pyometra, liver disease, uremia , pyometra, liver disease, endotoxemia, radiation sickness disease, endotoxemia, radiation sickness disease, apomorphine, estrogens, digitalis, narcotic apomorphine, estrogens, digitalis, narcotic analgesicsanalgesicsDopamine is the main NT, while Dopamine is the main NT, while αα2.R in dog & 2.R in dog & cats,H1.R and 5HT.R may be involved as the cats,H1.R and 5HT.R may be involved as the secondary NTssecondary NTs

Vestibular apparatusVestibular apparatusImpulses originates form semicircular canal Impulses originates form semicircular canal vestibular nucleus via 8vestibular nucleus via 8 thth cervical nerves via cervical nerves via CTZ and cerebellum to emetic enterCTZ and cerebellum to emetic enter

Emesis due to motion sickness and labrynithitisEmesis due to motion sickness and labrynithitis

H1.R is the main NT, afferent emetic impulses H1.R is the main NT, afferent emetic impulses transmitted via Vague nervetransmitted via Vague nerve

Peripheral emetic impulses due to stimulation or Peripheral emetic impulses due to stimulation or distention of the visceral organs transmitted via 9distention of the visceral organs transmitted via 9 thth cervical nerve, Ach is the main NTcervical nerve, Ach is the main NT

The aim of induction of emesis is to emptying The aim of induction of emesis is to emptying the frontal portion of the GIT before the frontal portion of the GIT before

induction of anesthesia and in the case of induction of anesthesia and in the case of non corrosive, non irritant toxin ingestionnon corrosive, non irritant toxin ingestion

Emetic agents: Emetic agents: 1- centrally acting1- centrally acting

22 - -peripherally actingperipherally acting

Peripherally acting emetic agentsPeripherally acting emetic agentsDistention of the hallow organs by warm water & Distention of the hallow organs by warm water & hydrogen peroxidehydrogen peroxide

Oral administration of warm saturated salt Oral administration of warm saturated salt solution, placement a block of sodium carbonate solution, placement a block of sodium carbonate in the pharyngeal area of dogin the pharyngeal area of dog

Oral administration of 3% hydrogen peroxide Oral administration of 3% hydrogen peroxide solution to dog & catsolution to dog & cat

Oral administration of Ipecac syrupOral administration of Ipecac syrup

Ipecac syrupIpecac syrupOTC, contains Emetine alkaloid , used in pediatric OTC, contains Emetine alkaloid , used in pediatric medicinemedicinePeripheral action by gastric irritation, central action Peripheral action by gastric irritation, central action by CTZ stimulationby CTZ stimulationSide effects:Side effects: salivation ,lacrimation ,bronchial secretion salivation ,lacrimation ,bronchial secretion & diarrhea and lethargy in human& diarrhea and lethargy in humanOverdose :Overdose :potentially cardio toxic, potentially cardio toxic, hypotension ,arrhythmia and fatal myocarditishypotension ,arrhythmia and fatal myocarditisMax administration volume :Max administration volume :15 ml15 mlWhile repeated administration cause no emesis gastric While repeated administration cause no emesis gastric lavage should be donelavage should be doneDon’t use with activated charcoal due to reduced activityDon’t use with activated charcoal due to reduced activity

Centrally acting emetic agentsCentrally acting emetic agents ApomorphineApomorphine

synthetic morphine derivative with little sedative synthetic morphine derivative with little sedative effectseffects

Dopaminergic R stimulation in CTZDopaminergic R stimulation in CTZ

Fast acting:Fast acting:5-10 min after SC or conjunctival5-10 min after SC or conjunctival .adm.adm

CTZ stimulation while emetic center suppression: CTZ stimulation while emetic center suppression: lessless emetic effect in repeated administrationemetic effect in repeated administration

Emetic of choice in dog: Emetic of choice in dog: SC or intraconjuctivalSC or intraconjuctival

CNS stimulation> CNS depressionCNS stimulation> CNS depression

Contraindications:Contraindications:CNS or respiratory depression;CNS or respiratory depression; ingestion of strong acid, base & petroleum products; ingestion of strong acid, base & petroleum products; hypoxia and dyspenia ; shock; in the absence of hypoxia and dyspenia ; shock; in the absence of normal laryngeal reflexes; coma, seizure; severe normal laryngeal reflexes; coma, seizure; severe physical weakness; apomorphine sensitivity; CNS physical weakness; apomorphine sensitivity; CNS depressant toxicity and in unconscious patientsdepressant toxicity and in unconscious patients

Over dose symptoms: Over dose symptoms: CNS depression; restlessness;CNS depression; restlessness; respiratory depression; protracted emesis, in these respiratory depression; protracted emesis, in these cases administration of narcotic antagonist ( e.g. cases administration of narcotic antagonist ( e.g. Naloxone 0.04mg/kg ) is usefulNaloxone 0.04mg/kg ) is useful

Phenothiaze derivatives interact and negate Phenothiaze derivatives interact and negate emetic effect of apomorphineemetic effect of apomorphine

Centrally acting emetic agentsCentrally acting emetic agents xylazine (Rumpon)xylazine (Rumpon)

αα2 agonist: 2 agonist: fast acting; good to excellent sedation lasts fast acting; good to excellent sedation lasts up to 90-120 min; excellent analgesic activity lasts up to 90-120 min; excellent analgesic activity lasts 15-30 min15-30 min

αα2 stimulation in CTZ: 2 stimulation in CTZ: fast acting(1-5 min after IMfast acting(1-5 min after IM administration) emetic in catadministration) emetic in cat

0.05mg/kg:0.05mg/kg: emesis without sedation emesis without sedation

Contraindications:Contraindications: cardiac arrhythmia ; Epi cardiac arrhythmia ; Epi administration especially in the case of Halothane administration especially in the case of Halothane anesthesia , during 3anesthesia , during 3rdrd trimester of pregnancy trimester of pregnancy

Other CNS depressant agent exacerbate its Other CNS depressant agent exacerbate its sedationsedation

Antagonist :Antagonist :Yohimbine (cat:0.5mg/kg,Iv; dog: Yohimbine (cat:0.5mg/kg,Iv; dog: 0.1mg/kg ,Iv)0.1mg/kg ,Iv)

Used as a short acting analgesic agent in horse Used as a short acting analgesic agent in horse coliccolic

Ruminants are so sensitive to Xylazine sedation, Ruminants are so sensitive to Xylazine sedation, used cautiously especially in small ruminantsused cautiously especially in small ruminants..

sedation time lasts more in ruminant than in sedation time lasts more in ruminant than in horsehorse

Antiemetic agentsAntiemetic agents

Severe and prolong emesis leads to water and Severe and prolong emesis leads to water and electrolytes excretion; acid-base imbalance electrolytes excretion; acid-base imbalance and metabolic acidosisand metabolic acidosis

Antiemetic agents:Antiemetic agents: 1-centarlly acting1-centarlly acting

22 - -peripherally actingperipherally acting

Centrally acting antiemeticsCentrally acting antiemetics

Block the emetic impulses at higher cerebral Block the emetic impulses at higher cerebral centerscenters

11--muscarinic anticholinergics:muscarinic anticholinergics: in emetic center in emetic center

22 - -antidopaminregics: antidopaminregics: in CTZin CTZ

33 - -antihistaminergics: antihistaminergics: in vestibular apparatus and in vestibular apparatus and secondarily in CTZ& emetic centersecondarily in CTZ& emetic center

Centrally acting antiemetics Centrally acting antiemetics vestibular apparatusvestibular apparatus

Antihistamines: Antihistamines: CCyclizine. HCl ;Meclizine. HCl; yclizine. HCl ;Meclizine. HCl; Diphenhydramine. HClDiphenhydramine. HCl

Control motion sickness and emesis due to Control motion sickness and emesis due to labrynithitislabrynithitisNo effect on emesis form other originsNo effect on emesis form other originsSide effects: Side effects: Drowsiness & xerostomiaDrowsiness & xerostomia

Duration of action:Duration of action: 8-12 h 8-12 h

Centrally acting antiemeticsCentrally acting antiemeticsantimuscarinicsantimuscarinics

Belladonna alkaloids: Belladonna alkaloids: Hyoscine (scolpolmaine)Hyoscine (scolpolmaine)

synthetic agents :synthetic agents :Dicyclomine.HCl; Isopropamide Dicyclomine.HCl; Isopropamide iodideiodide

Control motion sickness in dogControl motion sickness in dogSide effects: Side effects: Drowsiness & xerostomiaDrowsiness & xerostomia

Duration of action:Duration of action: up to 6 h up to 6 h

Due to potential side effects contraindicated in Due to potential side effects contraindicated in catcat

Centrally acting antiemeticsCentrally acting antiemeticsCTZ acting agentsCTZ acting agents

11 - -Phenothizine derivativesPhenothizine derivatives

22 - -butyrophenone derivativesbutyrophenone derivatives

33 - -metoclopramidemetoclopramide

44 - -Trimethobenzamide.HClTrimethobenzamide.HCl

55 - -5HT antagonists5HT antagonists

CTZ acting agentsCTZ acting agentsPhenothiazine derivativesPhenothiazine derivatives

Chlorpromazine;Prochloperazine;Triflupromazine;Chlorpromazine;Prochloperazine;Triflupromazine;Perphenazine;Trifluoperazine,MeprazinePerphenazine;Trifluoperazine,Meprazine

Broad spectrum antiemetic in small animalsBroad spectrum antiemetic in small animals

Affect almost all centrally origin emesis except Affect almost all centrally origin emesis except those of those of labrynithitis ,at low doses via anti labrynithitis ,at low doses via anti dopaminergic and at higher doses by dopaminergic and at higher doses by antichilonergic mechanismsantichilonergic mechanisms..

Peripheral Peripheral αα blockade: blockade: sedation& hypotension and sedation& hypotension and may be need to fluid replacement therapymay be need to fluid replacement therapy..

CTZ acting agentsCTZ acting agentsButyrophenone derivativesButyrophenone derivatives

Haloperidol (Haldol); Droperidol(Inaspine)Haloperidol (Haldol); Droperidol(Inaspine)

Antidopaminergic; potent antiemetic& sedativeAntidopaminergic; potent antiemetic& sedative

Antipsychotic agents in humanAntipsychotic agents in human

Side effects like phenothiazinesSide effects like phenothiazines

CTZ acting agentsCTZ acting agentsMetoclopramnide (Reglan)Metoclopramnide (Reglan)

5HT antagonist &Antidopaminergic5HT antagonist &Antidopaminergic sensitivity of the upper GIT smooth muscle to Ach: sensitivity of the upper GIT smooth muscle to Ach:

stimulates upper GIT movement and accelerates stimulates upper GIT movement and accelerates gastric emptyinggastric emptyingNo effect on gastric, pancreatic& billiary secretionsNo effect on gastric, pancreatic& billiary secretionsBroad spectrum agent :Broad spectrum agent :control emesis due to blood born control emesis due to blood born agents and peripheral stimuliagents and peripheral stimuli

2020 times more potent than phenothiazines in times more potent than phenothiazines in control of apomorophine induced emesiscontrol of apomorophine induced emesis

Increases lower esophageal sphincter tone : Increases lower esophageal sphincter tone : uses uses in the treatment of esophageal reflux & gastric in the treatment of esophageal reflux & gastric motility disorders in human; abomasal impaction and motility disorders in human; abomasal impaction and emptying in sheep and cattle, intestinal ileus in horseemptying in sheep and cattle, intestinal ileus in horse

Good oral absorption; crosses placenta and Good oral absorption; crosses placenta and enters milk,T1/2=90 min in dogenters milk,T1/2=90 min in dog

Contra indications: Contra indications: GIT hemorrhage, obstruction and GIT hemorrhage, obstruction and perforation; seizureperforation; seizure

Side effectsSide effects

motion restlessness in dog; disorientation and motion restlessness in dog; disorientation and frenzy like behaviors in cat and constipationfrenzy like behaviors in cat and constipationIv injection in adult horse: Iv injection in adult horse: severe CNS effects; severe CNS effects; alternating periods of CNS stimulation alternating periods of CNS stimulation &depression,behavuoral changes , colic ( less &depression,behavuoral changes , colic ( less common in foals)common in foals)Extra pyramidal effects, temporary hypotension& Extra pyramidal effects, temporary hypotension& elevated prolactin level in human and may be in elevated prolactin level in human and may be in animalsanimalsmay affect Insulin dose and timingmay affect Insulin dose and timing

Drug interactionsDrug interactionsAtropine &narcotic analgesics negate GIT Atropine &narcotic analgesics negate GIT effectseffects

Absorption of drugs which mainly absorb in the Absorption of drugs which mainly absorb in the small intestine: small intestine: Cimetidine,Aspirin,Diazepam Cimetidine,Aspirin,Diazepam Tetracycline, AcetaminophenTetracycline, Acetaminophen

Absorption of drugs which mainly absorb in the Absorption of drugs which mainly absorb in the stomach: stomach: DigoxinDigoxin

Modification of dose or timing of Insulin injectionModification of dose or timing of Insulin injectionPhenothiazines;Butyrophenoines;sedative&narcotics: Phenothiazines;Butyrophenoines;sedative&narcotics: exacerbate extra pyramidal effectsexacerbate extra pyramidal effects

CTZ acting agentsCTZ acting agentsTrimethobenzamide.HClTrimethobenzamide.HCl(Tigan)(Tigan)

Potent antidopaminergic, weak antihistaminergicPotent antidopaminergic, weak antihistaminergic

Just suppresses CTZ ,no effect on emetic centerJust suppresses CTZ ,no effect on emetic center

Controls emesis due to: Controls emesis due to: radiation sickness disease, radiation sickness disease,

drugs, infections, anesthesia and uremiadrugs, infections, anesthesia and uremia

CTZ acting agentsCTZ acting agents5HT antagonists5HT antagonists

Ondansetron (Zofran): Ondansetron (Zofran): 5HT3.R blockader ;especially 5HT3.R blockader ;especially effective in cases of Cispaltin and other cancer effective in cases of Cispaltin and other cancer chemotherapeutics induced emesischemotherapeutics induced emesis

Cyproheptadine:Cyproheptadine: antiemetic in dog & cat antiemetic in dog & cat

To control Psychological –behavioral emesis:To control Psychological –behavioral emesis: sedatives such as barbiturates& diazepam can be sedatives such as barbiturates& diazepam can be usedused

Peripherally acting antiemeticsPeripherally acting antiemeticsUntiulcer drugs& those that prevent GIT epithelium Untiulcer drugs& those that prevent GIT epithelium form further irritationform further irritation

Anticholinegics &prokinetics which accelerate GIT Anticholinegics &prokinetics which accelerate GIT motilitymotility Glycopyrrolate,Propantheline,methoscopolamineGlycopyrrolate,Propantheline,methoscopolamine,Isoproopamide:,Isoproopamide: inhibition of afferent vagus nerve inhibition of afferent vagus nerve impulses , ameliorate spasm of the GIT smooth impulses , ameliorate spasm of the GIT smooth muscles, inhibition of entro-gastric secretions, don’t muscles, inhibition of entro-gastric secretions, don’t cross BBBcross BBB ,delays gastric emptying and should not be ,delays gastric emptying and should not be used more than 3 daysused more than 3 days

Methoscopolmine :Methoscopolmine :contraindicated in catcontraindicated in cat

Antiulcer drugsAntiulcer drugsAcid secretion : Acid secretion : gastric ,cephalic& intestinal phases food gastric ,cephalic& intestinal phases food induced acid secretion , basal phase spontaneous secretioninduced acid secretion , basal phase spontaneous secretion

HH++-K-K++ ATPase in parietal (oxyntic cells) ATPase in parietal (oxyntic cells)

Neurocrine pathway:Neurocrine pathway: Ach & muscarinic R, increase Ach & muscarinic R, increase cytosolic Cacytosolic Ca22++

Endocrine pathway:Endocrine pathway: Gastrin by increasing cytosolic Gastrin by increasing cytosolic CaCa22++

Paracrine pathway:Paracrine pathway: Autaciodes& Histamine H2R, Autaciodes& Histamine H2R, cAMP and cAMP dependent protein kinasecAMP and cAMP dependent protein kinase

Mocusal defense mechanismsMocusal defense mechanisms

Bicarbonate secretion into the GIT lumenBicarbonate secretion into the GIT lumenThick layer of alkaline mucusThick layer of alkaline mucusGastric epithelial barrierGastric epithelial barrierHigh mucosal blood flowHigh mucosal blood flowRapid reipthelializationRapid reipthelializationProduction of cytoprotective agentsProduction of cytoprotective agents

Gastric acid secretion is the prerequisite for Gastric acid secretion is the prerequisite for gastric ulcer formationgastric ulcer formation

Anti ulcer drugsAnti ulcer drugs11 - -Antisecretory agentsAntisecretory agents::

1-1anticholinergics1-1anticholinergics

1-21-2 H2 blockersH2 blockers

1-31-3 proton pump inhibitorsproton pump inhibitors

1-41-4 PGE1 analogsPGE1 analogs

22 - -Cytoprotective agentsCytoprotective agents 2-12-1 antacidsantacids

2-22-2 PGE1 analogsPGE1 analogs

2-32-3 sucralfatesucralfate

Antisecretory agents : Antisecretory agents : anticholinergicsanticholinergics

Hyoscine (scolpolamine) ,Dicyclomine.HCl; Hyoscine (scolpolamine) ,Dicyclomine.HCl; Isopropamide iodideIsopropamide iodide

Decrease food induced acid secretion up to30%Decrease food induced acid secretion up to30%Potentiate the effects of H2 blockersPotentiate the effects of H2 blockersPirenzepine and selective M1 subtype blockers Pirenzepine and selective M1 subtype blockers inhibit up to 60% of food induced acid secretion inhibit up to 60% of food induced acid secretion with fewer side effectswith fewer side effects

Antisecretory agents : Antisecretory agents : H2 blockersH2 blockers

Cimetidine (Tagamet), Cimetidine (Tagamet), Famotidine(Pepcid),Nizatidne(Axid), Famotidine(Pepcid),Nizatidne(Axid),

Ranitidine(Zantac)Ranitidine(Zantac)

Competitive and reversible H2 blockers which Competitive and reversible H2 blockers which decrease acid and pepsin secretiondecrease acid and pepsin secretion

Potency: Potency: Ranitidine 5-12>Cimetidine, Famotidine Ranitidine 5-12>Cimetidine, Famotidine 9>Ranitidine while 32> Cimetidine9>Ranitidine while 32> Cimetidine

Famotidine:Famotidine: longest duration of action longest duration of action

CimetidineCimetidine

Rapid oral absorption, food delays absorptionRapid oral absorption, food delays absorptionHepatic enzyme inhibitor, decreases HBF Hepatic enzyme inhibitor, decreases HBF therefore decreases metabolism of: therefore decreases metabolism of: Phenytoin,Theophyline,Digitoxin,Diazepam, Phenytoin,Theophyline,Digitoxin,Diazepam, Lidocaine,MorphineLidocaine,MorphineBy increasing gastric PH increases concentration By increasing gastric PH increases concentration of: of: Tetracycline,Erythromycin& Penicillin G ,while Tetracycline,Erythromycin& Penicillin G ,while decreases concentration of Ketoconazledecreases concentration of Ketoconazle

Antacids may delay its oral absorption therefore Antacids may delay its oral absorption therefore they should be administered at least 1hours they should be administered at least 1hours before or after Cimetidinebefore or after Cimetidine

IndicationsIndications:: Treatment or prevention of gastric, duodenal & Treatment or prevention of gastric, duodenal &

abomasal ulcers; uremia induced gastritis; abomasal ulcers; uremia induced gastritis; esophigitis; stress or drug induced erosive gastritis; esophigitis; stress or drug induced erosive gastritis; duodenal gastric refluxduodenal gastric reflux..Acid hyper secretion due to gastrinoma and systemic Acid hyper secretion due to gastrinoma and systemic mastocytosismastocytosis..Gastric bleeding of the upper portions of the GIT Gastric bleeding of the upper portions of the GIT which is not due to damage of large vesselswhich is not due to damage of large vessels..Exocrine pancreatic insufficiency: Exocrine pancreatic insufficiency: 30 minutes before 30 minutes before mealmeal..Prevention of GIT side effects of corticosteroidsPrevention of GIT side effects of corticosteroids..In uermic dogs decreases Parathyroid secretion, bone In uermic dogs decreases Parathyroid secretion, bone resoption ,phosphate serum levelresoption ,phosphate serum levelGastric ulcers in horseGastric ulcers in horse

Contraindications:Contraindications: sensitivity to drug, in pediatrics sensitivity to drug, in pediatrics and those patients with severe hepatic& renal and those patients with severe hepatic& renal insufficiencyinsufficiency..

Side effects:Side effects: dizziness, headache , antiandrogenic dizziness, headache , antiandrogenic effects which leads to gynecomastia , azospermia & effects which leads to gynecomastia , azospermia & decrease libido, skin rashes,, diarrhea and decrease libido, skin rashes,, diarrhea and constipation,constipation, agranulocytosis (rare in human), agranulocytosis (rare in human), transient cardiac arrhythmia and bradycardia (rapid Iv transient cardiac arrhythmia and bradycardia (rapid Iv injection)injection)..

Relapse of gasrtoduodenal ulcers, may be due to Relapse of gasrtoduodenal ulcers, may be due to rebound hyper secretionrebound hyper secretion

Famotidine& Nizatidine :Famotidine& Nizatidine :less likelihood of rebound less likelihood of rebound hyper secretion while Cimetidine has the most hyper secretion while Cimetidine has the most potential for rebound hyper secretionpotential for rebound hyper secretion

Ranitidine :Ranitidine :less bioavailability than Cimetidine, less bioavailability than Cimetidine, elimination T1/2=2/5 h , Oral absorption doesn't elimination T1/2=2/5 h , Oral absorption doesn't affected by the presence of foodaffected by the presence of food..

Famotidine:Famotidine: little oral absorption, unchanged urine little oral absorption, unchanged urine excretionexcretion..

Nizatidine:Nizatidine: rapid & complete oral rapid & complete oral absorption ,unchanged urine excretion, H2 blocker of absorption ,unchanged urine excretion, H2 blocker of choice in renal insuffiency caseschoice in renal insuffiency cases..

Antisecretory agents : Antisecretory agents : Proton pump Proton pump inhibitorsinhibitors

Omeprazole(Prilosec) ,Esmoprazole(Neium),LansoprazOmeprazole(Prilosec) ,Esmoprazole(Neium),Lansoprazole(Prevacid),Pantoprazole(Protonix),Rabeprazole(Aole(Prevacid),Pantoprazole(Protonix),Rabeprazole(A

ciphex)ciphex)

Potent HPotent H++-K-K++ATPase proton pump inhibitorsATPase proton pump inhibitors

Omprazole :30>antacid potency than CimetidineOmprazole :30>antacid potency than Cimetidine

Weak base, acid labile ,inactive entric coated capsule or Weak base, acid labile ,inactive entric coated capsule or slow release formulation, absorption takes place in slow release formulation, absorption takes place in intestineintestine

Selective protonation in parietal cells, concentrates up Selective protonation in parietal cells, concentrates up to 1000times and activates, irreversible proton pump to 1000times and activates, irreversible proton pump inhibitioninhibition..Lag time =3-5 daysLag time =3-5 daysInhibits basal and food induced acid secretion up to 90-Inhibits basal and food induced acid secretion up to 90-98%98% Food decreases bioavailability up to 50%,should be Food decreases bioavailability up to 50%,should be administered 1 hour before mealadministered 1 hour before meal

Inhibits cytochrome P.450 hepatic enzymesInhibits cytochrome P.450 hepatic enzymes : : decreases decreases metabolism of :Diazepam,Phenytoin,warfarinmetabolism of :Diazepam,Phenytoin,warfarin

Increases gastric PH and decreasesIncreases gastric PH and decreases absorption of drugs absorption of drugs that need low PH for absorption :that need low PH for absorption :Ketoconazole, ester and Ketoconazole, ester and metal salts of Ampicillinmetal salts of Ampicillin

IndicationsIndications::

Drug of choice :Drug of choice :Zollinger –Ellison syndromeZollinger –Ellison syndromeTreatment of gastro duodenal ulcersTreatment of gastro duodenal ulcersA paste form is available for treatment & preventions of A paste form is available for treatment & preventions of relapse of gastric ulcer in horserelapse of gastric ulcer in horsePain amelioration in gastric ulcersPain amelioration in gastric ulcersAcid secretion control in cases not responding to H2 Acid secretion control in cases not responding to H2 blockersblockersGastro esophageal Reflux Disease (GERD), Gastric Gastro esophageal Reflux Disease (GERD), Gastric ulcers related to NSAIDs& H. pylori, Prevention of ulcers related to NSAIDs& H. pylori, Prevention of stress related mucosal bleedingstress related mucosal bleedingGasrtinoma and other conditions leading to acid hyper Gasrtinoma and other conditions leading to acid hyper secretionsecretion

Side effectsSide effectsWell tolerated in human, dog and catWell tolerated in human, dog and cat

GIT disturbances: GIT disturbances: anorexia, colic, nausea& emesis, anorexia, colic, nausea& emesis, bloat, diarrheabloat, diarrhea

GIT infections, protenurea, CNS disturbancesGIT infections, protenurea, CNS disturbances

Hematological abnormalities( rare in human)Hematological abnormalities( rare in human)

Decrease in absorption and serum level of Vit.B12Decrease in absorption and serum level of Vit.B12

Duration of treatment: Duration of treatment: dog 4weeks,hore up to 90days,in dog 4weeks,hore up to 90days,in human more than 8 weeks is rarehuman more than 8 weeks is rare

PG E seriesPG E series

Misoprostol (cytotec)Misoprostol (cytotec)Interaction with basolat.mem receptors of parietal Interaction with basolat.mem receptors of parietal cells, decreases cAMP production and cAMP cells, decreases cAMP production and cAMP dependent protein kinase activitydependent protein kinase activity..

Orally active, local actionOrally active, local actionDecreases basal, nocturnal and food induced acid Decreases basal, nocturnal and food induced acid secretionsecretionNo rebound acid secretionNo rebound acid secretionLess effective than H2 blockers in decreasing Less effective than H2 blockers in decreasing luminal PH & pain relief duo to peptic ulcersluminal PH & pain relief duo to peptic ulcers

IndicationsIndicationsPrimary or adjunctive drug in treatment or Primary or adjunctive drug in treatment or prevention of case of peptic ulcers related to prevention of case of peptic ulcers related to NSAIDsNSAIDsRelief of symptoms of atonyRelief of symptoms of atonyDecrease or reversal of cyclosporine induced Decrease or reversal of cyclosporine induced nephrotoxicitynephrotoxicityDue to stimulation of amplitude& frequency of Due to stimulation of amplitude& frequency of uterine contractions, uterine bleeding,uterine uterine contractions, uterine bleeding,uterine content expulsion, softness& opening of cervix content expulsion, softness& opening of cervix can be used as a adjunctive drug in termination of can be used as a adjunctive drug in termination of pregnancypregnancy

88%88% of an oral dose absorbed rapidlyof an oral dose absorbed rapidlyFist pass effect ,hepatic metabolism with an Fist pass effect ,hepatic metabolism with an active metabolite, urine excretionactive metabolite, urine excretionFood &antacids delay drug absorption without Food &antacids delay drug absorption without effects on clinical efficacyeffects on clinical efficacy

Causations in use: Causations in use: sensitivity to PG or PG analogs, sensitivity to PG or PG analogs, coronary vessel diseases, cerebral diseasescoronary vessel diseases, cerebral diseases

Side effects: Side effects: transient GIT disturbances including transient GIT disturbances including diarrhea, abdominal pain, bloat emesis, uterine diarrhea, abdominal pain, bloat emesis, uterine bleeding and contraction in female dogsbleeding and contraction in female dogsMg containing antacids may exacerbate emesis related Mg containing antacids may exacerbate emesis related to Misoprostolto Misoprostol

Cytoprotective agents: AntacidsCytoprotective agents: Antacids

Alkalinizing agents which bind to and inactivate Alkalinizing agents which bind to and inactivate gastric acid& Pepsingastric acid& Pepsin

Bind to bile acids,stimulte mucosal protectants such Bind to bile acids,stimulte mucosal protectants such as PGE series & sulfhydrilsas PGE series & sulfhydrils

increasing gastric PH up to 3-4 without induction of increasing gastric PH up to 3-4 without induction of systemic alkalosissystemic alkalosis

Antacid capacity: water solubility, rate of reaction Antacid capacity: water solubility, rate of reaction with acid, rate of gastric emptying, rate of with acid, rate of gastric emptying, rate of dissolution of tables formsdissolution of tables forms

Antacid may interfere with oral absorption of: Antacid may interfere with oral absorption of: Oral iron preparations, Digoxin, Corticosteroids, Oral iron preparations, Digoxin, Corticosteroids, Captopril, Ketoconazole, Nitrofurantoin, Captopril, Ketoconazole, Nitrofurantoin, Penicillamine, Phenytoin, Ranitidine, Cimetidine, Penicillamine, Phenytoin, Ranitidine, Cimetidine, TetracyclineTetracycline

Concurrent administration may increase serum Concurrent administration may increase serum level of : level of : Aspirin, Quinidine, sympathomimetic Aspirin, Quinidine, sympathomimetic agentsagents

Indications :Indications :Gastric hyperacidity, peptic ulcers, Gastric hyperacidity, peptic ulcers, gastritis, reflux esophagitis, chronic renal failure, gastritis, reflux esophagitis, chronic renal failure, prevention of rumen acidosis related to grain prevention of rumen acidosis related to grain overloadoverload

Antacids: Sodium bicarbonateAntacids: Sodium bicarbonate

Systemic, rapid& short acting antacid, water Systemic, rapid& short acting antacid, water solublesoluble

1.5%1.5% solution is isotonicsolution is isotonic

May cause metabolic alkalosis especially when May cause metabolic alkalosis especially when used in high dose or in renal insufficiencyused in high dose or in renal insufficiency

Produced NaCl may causes water retention in Produced NaCl may causes water retention in cardiac &renal insufficiency, hypertension cardiac &renal insufficiency, hypertension casescases

IndicationsIndications::Treatment of metabolic acidosisTreatment of metabolic acidosisUrine alkalizationUrine alkalizationAdjunctive therapy : hypercalcemic,hyperkalemic Adjunctive therapy : hypercalcemic,hyperkalemic crisis'scrisis'sTreatment of metabolic acidosis related to neonatal Treatment of metabolic acidosis related to neonatal diarrhea& rumen lactic acidosisdiarrhea& rumen lactic acidosis

ContraindicationsContraindications::Metabolic or respiratory alkalosisMetabolic or respiratory alkalosisSever Chloride loss secondarily due to emesis or suction Sever Chloride loss secondarily due to emesis or suction of gastric content, risk of hypochloremic alkalosis of gastric content, risk of hypochloremic alkalosis related to diureticsrelated to diureticsHypocalcemia because of the risk of tetanyHypocalcemia because of the risk of tetany

Drug compatibilityDrug compatibility::

PH, cencentration,temperature& type of diluentPH, cencentration,temperature& type of diluent

Incompatible with: Incompatible with: 5%alcohol,5%dextrose,injectableVit C5%alcohol,5%dextrose,injectableVit C,,

Codeine, Epinephrine, Codeine, Epinephrine, Glycopyrrolate ,Hydromorphone ,regular Insulin , Glycopyrrolate ,Hydromorphone ,regular Insulin , Isoproterenol, Labetalol , Imipenem , Levorphanol , Mg. Isoproterenol, Labetalol , Imipenem , Levorphanol , Mg. sulfate , Meperidine ,Methadone , Oxytetracycline , sulfate , Meperidine ,Methadone , Oxytetracycline , Tetracycline , Procaine , Secobarbital , Tetracycline , Procaine , Secobarbital , Streptomycine ,Succinyl cholineStreptomycine ,Succinyl choline

Mix with CaMix with Ca2+2+ containing fluids: containing fluids: insoluble complexesinsoluble complexes

Oral drugs : Oral drugs : administer 2 hours before or after sodium administer 2 hours before or after sodium bicarbonatebicarbonate

Antacids:aluminium hydroxideAntacids:aluminium hydroxideAl.phosphate, Al. magnesium silicateAl.phosphate, Al. magnesium silicate

No systemic antacid, good absorbent&protectant by No systemic antacid, good absorbent&protectant by local stimulation of protective PGslocal stimulation of protective PGsIncrease gastric ph up to 4 ,rebound acid secretion Increase gastric ph up to 4 ,rebound acid secretion doesn't takes placedoesn't takes placeInsoluble Al.phosphate complex formation leads to Insoluble Al.phosphate complex formation leads to decrease phosphate absorption& control the serum decrease phosphate absorption& control the serum phosphate in renal diseasesphosphate in renal diseases..Constipative: Constipative: used with Mg salts to minimize used with Mg salts to minimize constipation & increases antacid capacityconstipation & increases antacid capacityMay be protective if administered with drugs such as May be protective if administered with drugs such as NSAIDs& Aminophylline which are not well NSAIDs& Aminophylline which are not well tolerated in patientstolerated in patients

Contraindicated in alkalosisContraindicated in alkalosis

Use with causation in gastric outlet obstruction Use with causation in gastric outlet obstruction due to delay in gastric emptyingdue to delay in gastric emptying

May deplete phosphate, causes muscular May deplete phosphate, causes muscular weakness, bone resoption and hypocalcaemiaweakness, bone resoption and hypocalcaemia

Rapid onset of action (less than 30 minutes)Rapid onset of action (less than 30 minutes),,

Due to short duration of action should be Due to short duration of action should be administered ever 3-4 hoursadministered ever 3-4 hours

Antacids: magnesium containing Antacids: magnesium containing productsproducts

Mg hydroxide ( milk of magnesia), Mg oxide, Mg hydroxide ( milk of magnesia), Mg oxide, Mg silicateMg silicate

Increase gastric PH up to 9 and induce rebound Increase gastric PH up to 9 and induce rebound acid secretionacid secretionLaxative natureLaxative natureRapid and long lasting antacid effectRapid and long lasting antacid effectNormally up to 20% of Mg can be absorbed Normally up to 20% of Mg can be absorbed systematically, which increase in renal failure systematically, which increase in renal failure and in repeated administration which may and in repeated administration which may leads to hyper magnesialeads to hyper magnesia

Antacids: Calcium carbonateAntacids: Calcium carbonate

Potent, rapid acting, long lasting antacidPotent, rapid acting, long lasting antacid

Side effects: Side effects: metabolic alkalosis, rebound hyper metabolic alkalosis, rebound hyper secretion ,hypercalcemia ,calciuria , metastatic secretion ,hypercalcemia ,calciuria , metastatic calcification , urolithiasis and constipation calcification , urolithiasis and constipation

may develop slowlymay develop slowly

Cytoproptectives:PGE1Cytoproptectives:PGE1

Misoprotol(Cytotec)Misoprotol(Cytotec)

Increases mucus ,bicarbonate secretion& mucosal Increases mucus ,bicarbonate secretion& mucosal blood flow ,enhances reeipthelializationblood flow ,enhances reeipthelialization

Stabilizes mast cell membrane damaged by Stabilizes mast cell membrane damaged by ulcerogenic agentsulcerogenic agents

Treatment & prevention of peptic ulcer related to Treatment & prevention of peptic ulcer related to NSAIDsNSAIDs

Not effective as H2blockers in the inhibition of Not effective as H2blockers in the inhibition of gastric acid secretion but is superior ingastric acid secretion but is superior in enhancing enhancing gastro duodenal healinggastro duodenal healing

Cytoprotectives: sucralfate Cytoprotectives: sucralfate (Carafate)(Carafate)

An alkalinizing Al.hydroxide complex with sucroseAn alkalinizing Al.hydroxide complex with sucrose . .

Local effects>systemic effectsLocal effects>systemic effects..

Reacts with gastric HCl, forms a insoluble pasty Reacts with gastric HCl, forms a insoluble pasty complex , bind to exudates protein of the complex , bind to exudates protein of the damaged tissue (anions of the GIT epithelium cell damaged tissue (anions of the GIT epithelium cell membrane)membrane) which forms a barrier in the which forms a barrier in the damaged area and protects the damaged tissue damaged area and protects the damaged tissue form more injuries by acid, bile and pepsinform more injuries by acid, bile and pepsin..

Bind with and inactivates bile acids & pepsinBind with and inactivates bile acids & pepsin . .

Binds with &accumulates epidermal growth factor in Binds with &accumulates epidermal growth factor in damaged areadamaged area..

Stimulates local production of PGI2,PGE2 & nitric Stimulates local production of PGI2,PGE2 & nitric oxide which leads to increase in mucosal blood flowoxide which leads to increase in mucosal blood flow..Directly stimulates mucosal angiogenesisDirectly stimulates mucosal angiogenesis..

Some antacid activity, may decrease gastric emptying Some antacid activity, may decrease gastric emptying raterateLeast systemic absorption after oral adm and least side Least systemic absorption after oral adm and least side

effectseffects. . Max protection depends on gastric acidity( PH<5) for Max protection depends on gastric acidity( PH<5) for activationactivation..The safest drug for treatment of gastro duodenal ulcerThe safest drug for treatment of gastro duodenal ulcer..

prokineticsprokinetics

Enhance transit of GIT content by inhibition of Enhance transit of GIT content by inhibition of inhibitory transmitters e.g. Dopamine or inhibitory transmitters e.g. Dopamine or promotion of excitatory transmitters e.g. Achpromotion of excitatory transmitters e.g. Ach

Species and organ specificitySpecies and organ specificity

11 - -cholinergic agentscholinergic agents

22 - -metoclopramidemetoclopramide

33 - -domperidonedomperidone

44 - -cisaparidecisaparide

Prokinetics: cholinergic agentsProkinetics: cholinergic agentsBethanecholBethanechol

Choline ester selectively binds M2 receptors Choline ester selectively binds M2 receptors with GIT and urinary activitywith GIT and urinary activity

Increases peristalsis and tone of lower Increases peristalsis and tone of lower esophageal sphincter, gastric and intestinal esophageal sphincter, gastric and intestinal peristaltic activity , gastric and pancreatic peristaltic activity , gastric and pancreatic

secretions, tone of detrusor musclesecretions, tone of detrusor muscle

Over dose : Over dose : increases bronchial contraction increases bronchial contraction &secretion,miosis,salivation and lacrimation&secretion,miosis,salivation and lacrimation

IndicationsIndications::

Large animals: stimulation of gastrointestinal activity, Large animals: stimulation of gastrointestinal activity, post operative gastrointestinal ileus, stimulation of post operative gastrointestinal ileus, stimulation of urination, enhancement of gastric emptying and urination, enhancement of gastric emptying and minimizing gasrtoesophageal reflux in foalsminimizing gasrtoesophageal reflux in foals

Feline dysautonomia for promotion of urinationFeline dysautonomia for promotion of urination

ContraindicationsContraindications::

Obstruction of urinary outlets, hyperthyroidism, peptic Obstruction of urinary outlets, hyperthyroidism, peptic ulcer or inflammatory condition of the GIT, recent ulcer or inflammatory condition of the GIT, recent surgery of the GIT with anatomists/resection, GIT surgery of the GIT with anatomists/resection, GIT obstruction, seizure, asthma, hypotension, sever obstruction, seizure, asthma, hypotension, sever bradycardia, co administration with other cholinergic bradycardia, co administration with other cholinergic

agentsagents

Drug interactionsDrug interactions : :

Procainamide, epinephrine, sympathomimetic Procainamide, epinephrine, sympathomimetic amines, atropine negate its effectsamines, atropine negate its effects

Ganglion blockers intensify GIT effects & Ganglion blockers intensify GIT effects & hypotensionhypotension

Side effectsSide effects

Mild in small animals: Mild in small animals: vomiting , diarrhea, salivation vomiting , diarrhea, salivation &anorexia&anorexia

Horse : Horse : salivation,lacrimation& colic( potentially)salivation,lacrimation& colic( potentially)

Overdose: Overdose: asthma, cardiac arrhythmia & hypotensionasthma, cardiac arrhythmia & hypotension

Antidote:Antidote: Atropine Atropine

Prokinetics: metoclopramideProkinetics: metoclopramide

Peripheral effects: Peripheral effects: increases Ach release from increases Ach release from intrinsic nerves, inhibition of D2 receptors which intrinsic nerves, inhibition of D2 receptors which leading to increases force and frequency of gastric leading to increases force and frequency of gastric contractions in antrum portion ,relaxation of pyloric contractions in antrum portion ,relaxation of pyloric sphincter , enhancement of peristaltic motility in the sphincter , enhancement of peristaltic motility in the duodenum& jejunum, promotes gastric emptyingduodenum& jejunum, promotes gastric emptying

Prokinetic indications:Prokinetic indications:treamnet of gastric motility treamnet of gastric motility disorders e.g. gastric distension, post operative disorders e.g. gastric distension, post operative paralysis, peptic ulcers, idiopathic gasrtoparesis, paralysis, peptic ulcers, idiopathic gasrtoparesis, gastric torsiongastric torsion

Prokinetics: DomperidoneProkinetics: DomperidoneD2 blocker, don’t cross BBB as readily as D2 blocker, don’t cross BBB as readily as metoclopramidemetoclopramidePeripherally coordinates antroduodenal contractions and Peripherally coordinates antroduodenal contractions and enhances transit time,no effect on colon motilityenhances transit time,no effect on colon motility Anti emetic & prokinetic agent in small animal: Anti emetic & prokinetic agent in small animal: more more effects on conditions due to delay in gastric emptying effects on conditions due to delay in gastric emptying than gastric hyper motilitythan gastric hyper motilityUses cautiously in Collie dogsUses cautiously in Collie dogsDon’t use with dopaminergic agentsDon’t use with dopaminergic agentsAntacids & H2 blockers decrease absorption of drugAntacids & H2 blockers decrease absorption of drug

Prokinetics: CisaprideProkinetics: Cisapride

Broadest spectrum oral prokinetic agentBroadest spectrum oral prokinetic agent

Dose dependentDose dependent

Indirectly increases Ach release form myenteric Indirectly increases Ach release form myenteric nerves, no interaction with dopamine nerves, no interaction with dopamine receptors and no extra pyramidal effectsreceptors and no extra pyramidal effects

Prokinetic effects: Prokinetic effects: esophagus, stomach, small esophagus, stomach, small

intestine& colonintestine& colon

Good oral absorption with first pass effectGood oral absorption with first pass effect

Indication in small animals: Indication in small animals: esophageal reflux, esophageal reflux, treatment of primary gastric stasis disorders, treatment of primary gastric stasis disorders, constipation& mega colonconstipation& mega colon

Contraindications :Contraindications :obstruction, perforation & obstruction, perforation & bleeding of the GITbleeding of the GIT

May have anticoagulant effectsMay have anticoagulant effectsIntensifies sedative effects of alcohol& Intensifies sedative effects of alcohol& benzodiazepinesbenzodiazepinesDon’t administer with :Don’t administer with :Ketoconazole, Ketoconazole, Itaconazole&Tetracycline due to risk of ventricular Itaconazole&Tetracycline due to risk of ventricular arrhythmiaarrhythmia

Protectant & AbsorbentsProtectant & AbsorbentsNo oral absorption, used commonly in anti No oral absorption, used commonly in anti diarrhea agentsdiarrhea agents

Protectants: Protectants: make a lining layer to protect GIT make a lining layer to protect GIT

epithelium form further irritation by noxious agentsepithelium form further irritation by noxious agents

Absorbents: Absorbents: bind physically with chemicals and bind physically with chemicals and

hinder their absorptionhinder their absorption

Mg. trisilicate, Kaolin, Pectin, bismuth salts , Mg. trisilicate, Kaolin, Pectin, bismuth salts , CaCa2+2+ carbonate, activated charcoal , Al. carbonate, activated charcoal , Al. trisilicate, Al.hydroxide, Al. phosphatetrisilicate, Al.hydroxide, Al. phosphate

Kaolin -PectinKaolin -Pectin

Absorbent& demulcent ,line the GIT epithelium, Absorbent& demulcent ,line the GIT epithelium, improve feces consistencyimprove feces consistency

Kaolin is a potent coagulant agent, can be useful Kaolin is a potent coagulant agent, can be useful in treatment of diarrhea related to mucosal in treatment of diarrhea related to mucosal erosion and bleedingerosion and bleeding

Can cause constipation especially in dehydrated Can cause constipation especially in dehydrated patientspatients

Bismuth saltsBismuth saltsBismuth sub salicylate, bismuth sub nitrate, bismuth Bismuth sub salicylate, bismuth sub nitrate, bismuth

sub carbonatesub carbonateBismuth sub salicylate: absorbent, anti Bismuth sub salicylate: absorbent, anti endotoxin,weak antibacterialendotoxin,weak antibacterialHydrolyzed to Bismuth carbonate& salicylate,while Hydrolyzed to Bismuth carbonate& salicylate,while most effect are related to bismuth, salicylate plays most effect are related to bismuth, salicylate plays role as anti PG to control secretory diarrhearole as anti PG to control secretory diarrhea Main indication :Main indication :control of diarrheacontrol of diarrhea

By making a protective lining layer & formation of By making a protective lining layer & formation of insoluble complexes with noxious agents can be insoluble complexes with noxious agents can be useful in improving mal indigestionuseful in improving mal indigestion

Useful in the treatment of flatulence and its bad smellUseful in the treatment of flatulence and its bad smell

Drug of choice in the treatment of acute diarrheaDrug of choice in the treatment of acute diarrhea

Contraindicated in salicylate hypersensitivityContraindicated in salicylate hypersensitivity

Fecal discolorationFecal discoloration

Radiopaque and may interferes with GIT radiographyRadiopaque and may interferes with GIT radiography

Interferes with oral absorption of other drugs e.g. Interferes with oral absorption of other drugs e.g. TetracyclineTetracycline

Chronic use: Chronic use: encephalopathy& osteodytrophyencephalopathy& osteodytrophy

Cats are so sensitive specially in conditions of intestinal Cats are so sensitive specially in conditions of intestinal inflammationinflammation

Activated charcoalActivated charcoalThe broadest spectrum ,rapid acting absorbentThe broadest spectrum ,rapid acting absorbent , ,

useful in the emergency treatment of intoxicationsuseful in the emergency treatment of intoxicationsForms stable complexes with noxious agents& enhances Forms stable complexes with noxious agents& enhances their excretiontheir excretion Administration every 6 h for 1-2 days increases Administration every 6 h for 1-2 days increases elimination of systemic absorbed toxinselimination of systemic absorbed toxinsUsually administer with a laxative or emetic agent with Usually administer with a laxative or emetic agent with gastric lavagegastric lavageOptimal ratio to toxin: Optimal ratio to toxin: 10 to 1used in 6 hours10 to 1used in 6 hoursFood decreases efficiencyFood decreases efficiency

Best results in toxicity with: Best results in toxicity with: Acetaminophen, Acetaminophen, Atropine, cardiac glycosides, phenytoin, strychnine, Atropine, cardiac glycosides, phenytoin, strychnine, morphine& ethylene glycolmorphine& ethylene glycol

Not effective in toxicity with: Not effective in toxicity with: cyanides, mineral cyanides, mineral acids, basic corrosive agents, organic solvents, acids, basic corrosive agents, organic solvents, ethanol, lead, iron & methanolethanol, lead, iron & methanol

Ipecac syrup negates absorbent effectIpecac syrup negates absorbent effect

Indication : Indication : absorption of intestinal gasses in bloat, absorption of intestinal gasses in bloat, gastric dilation ,indigestiongastric dilation ,indigestion

Cholestyramine resinCholestyramine resinBasic anion exchange resinBasic anion exchange resin

Non specific absorbent, decreases absorption of bile Non specific absorbent, decreases absorption of bile acids, lipoproteins, cholesterol& neutral acidsacids, lipoproteins, cholesterol& neutral acids

Indication: Indication: symptomatic treatment of diarrhea, specific symptomatic treatment of diarrhea, specific treatment of pruritus related to increase in bile acidstreatment of pruritus related to increase in bile acids

Side effects: Side effects: nausea , constipation, decrease in nausea , constipation, decrease in absorption of the fat soluble vitamins, steatorrheaabsorption of the fat soluble vitamins, steatorrhea

Should be administered with food or waterShould be administered with food or water

Laxatives &catharticsLaxatives &catharticsEnhance deification by increasing volume or Enhance deification by increasing volume or frequency of fecal massfrequency of fecal massLaxatives make soft feces, while cathartics make Laxatives make soft feces, while cathartics make watery feces and are more potent than laxativeswatery feces and are more potent than laxatives

11 - -Emollient laxativesEmollient laxatives22--Simple bulk laxativesSimple bulk laxatives

33--Irritant catharticsIrritant cathartics44 - -Osmotic catharticsOsmotic cathartics

55--Neuromuscular catharticsNeuromuscular cathartics

Emollient laxativesEmollient laxatives

Mechanical or lubricant laxativesMechanical or lubricant laxatives

No gastric absorption just soften and lubricate No gastric absorption just soften and lubricate fecal massfecal mass

Mineral oils e.g. liquid paraffin are mild & safeMineral oils e.g. liquid paraffin are mild & safe

Anionic surfactants e.g. dioctyl sodium Anionic surfactants e.g. dioctyl sodium sulfosuccinate or docusate. Nasulfosuccinate or docusate. Na++,, dioctyl dioctyl calcium sulfosuccinate :calcium sulfosuccinate :stool softenerstool softener

Liquid oils: liquid paraffinLiquid oils: liquid paraffin

Long term use: Long term use: interference with absorption of the fat interference with absorption of the fat soluble vitamins, nutrients and coadministered drugs, soluble vitamins, nutrients and coadministered drugs, decrease sensitivity &irritability of intestinal mucosa decrease sensitivity &irritability of intestinal mucosa which can leads to constipation, intestinal and which can leads to constipation, intestinal and lymphoid absorption which lead to granulomatous lymphoid absorption which lead to granulomatous injuriesinjuries

Mal administrationMal administration :lipid pneumonitis :lipid pneumonitis

Not suitable for diagnosis or treatment of GIT Not suitable for diagnosis or treatment of GIT obstructionobstruction

Simple bulk laxativesSimple bulk laxativesMethyl cellulose , carboxy methyl Methyl cellulose , carboxy methyl

cellulose ,Psyllium seeds ,wheat brancellulose ,Psyllium seeds ,wheat bran

Hygroscopic agents not absorbed in GIT , remain in Hygroscopic agents not absorbed in GIT , remain in GIT , absorb water and swell,producuing a bulky GIT , absorb water and swell,producuing a bulky emollient gel which distend GIT& increase emollient gel which distend GIT& increase peristaltic motility and lead to watery fecesperistaltic motility and lead to watery fecesCellulose & hemi cellulose undergo bacterial Cellulose & hemi cellulose undergo bacterial fermentation in large intestine, make volatile FA fermentation in large intestine, make volatile FA which precipitate laxative effect by osmotic which precipitate laxative effect by osmotic charactercharacterMetorism & excess watery feces may be resultMetorism & excess watery feces may be result

Osmotic catharticsOsmotic catharticsSalts which not absorbed from GIT, remain and absorb Salts which not absorbed from GIT, remain and absorb water by osmotic pressurewater by osmotic pressure

Onset of action:Onset of action:3-12 hours in simple3-12 hours in simple stomach,after18stomach,after18 hours in hours in ruminantsruminants

Water free access ,contraindicated in dehydrated Water free access ,contraindicated in dehydrated patientspatients

Mg salts e.g. Mg. sulfate; Mg .hydroxide (Epsom Mg salts e.g. Mg. sulfate; Mg .hydroxide (Epsom salt) ;Mg. oxide; Mg. citrate; Nasalt) ;Mg. oxide; Mg. citrate; Na++ .sulfate; Na .sulfate; Na++

phosphate; potassium sodium tartrate; sugar alcohols phosphate; potassium sodium tartrate; sugar alcohols e.g. manitol, sorbitol & disaccharide lactolosee.g. manitol, sorbitol & disaccharide lactolose

Mg salts: release CCKMg salts: release CCK

Mg. sulfate containing compounds often not use Mg. sulfate containing compounds often not use in horsesin horses

Sugar alcohols : Sugar alcohols : bacterial breakdown to produce bacterial breakdown to produce organic acids e.g. lactic acid which decrease colon organic acids e.g. lactic acid which decrease colon PH ,absorb water by osmotic effects& enhance colon PH ,absorb water by osmotic effects& enhance colon

motilitymotility

Lactolose: Lactolose: treatment of chronic constipation &hepatic treatment of chronic constipation &hepatic encephalopathyencephalopathy

Irritant catharticsIrritant cathartics

Stimulate lining mucosa of the GIT, initiate local Stimulate lining mucosa of the GIT, initiate local myneteric reflexes which leads to enhancement of myneteric reflexes which leads to enhancement of intestinal transitintestinal transit

Plat oils e.g. castor oil, olive oil, linseed oil; diphenyl Plat oils e.g. castor oil, olive oil, linseed oil; diphenyl methanes .e.g. Bisacodyl; Anthraquinones e.g. methanes .e.g. Bisacodyl; Anthraquinones e.g.

DanthroneDanthroneLipase hydrolysis in small intestine, release fatty acid , Lipase hydrolysis in small intestine, release fatty acid , form Na form Na ++ & K & K+ + salts ,produce irritant soapssalts ,produce irritant soaps Direct or indirect actingDirect or indirect acting

Contraindications :Contraindications : intestinal obstruction, non diagnosed intestinal obstruction, non diagnosed rectal hemorrhage, suspection to intestinal obstructionrectal hemorrhage, suspection to intestinal obstruction

Castor oilCastor oil

Rapid actingRapid acting

Should be followed by bulky, wet mealsShould be followed by bulky, wet meals

Use primarily in nonruminants ,often in cattle s& Use primarily in nonruminants ,often in cattle s& foalsfoals

Duration of action: 4-8 hours in small Duration of action: 4-8 hours in small animals,12-18 hours in large animalsanimals,12-18 hours in large animals

BisacodylBisacodyl Inhibits glucose absorption& NaInhibits glucose absorption& Na++-K-K++ATPase, direct ATPase, direct stimulation of sensory nerve ending in colon wall, stimulation of sensory nerve ending in colon wall, increases epithelial permeability & fluid content of increases epithelial permeability & fluid content of colon lumencolon lumen Oral or rectal cathartic in dog &catOral or rectal cathartic in dog &catOnset of action: Onset of action: 6-10 hours after oral administration ,15 6-10 hours after oral administration ,15 minutes after enemaminutes after enema

Indication: Indication: decease constipation and cleaning colon for decease constipation and cleaning colon for colonoscopy, after dehydration it is useful for colonoscopy, after dehydration it is useful for treatment of sever impaction of the GItreatment of sever impaction of the GISide effects: sometimes cramp & diarrheaSide effects: sometimes cramp & diarrhea

Anthraquinones: DanthroneAnthraquinones: Danthrone

Emodin cathartics, often with plant originEmodin cathartics, often with plant originIndirect acting in large intestineIndirect acting in large intestine: : bacterial bacterial hydrolysis , release active aglycans ( Emodin) which hydrolysis , release active aglycans ( Emodin) which stimulate myenteric plexus of the large intestinestimulate myenteric plexus of the large intestine

Avoid of repeated administration in large animal Avoid of repeated administration in large animal duo to slow onset of actionduo to slow onset of actionMay change the color of urineMay change the color of urineSenna& casgara sagrada:Senna& casgara sagrada: natural antraquinone natural antraquinone glycosidesglycosides

Neuromuscular purgativesNeuromuscular purgativesNeostigmine; Physostigmine; bethanechol;carbacholNeostigmine; Physostigmine; bethanechol;carbachol

Muscarinic cholinergic agents act at small intestine, fast Muscarinic cholinergic agents act at small intestine, fast acting: acting: 10-30 minutes after parentral administration,2-4 hours 10-30 minutes after parentral administration,2-4 hours after oral administrationafter oral administration

May exacerbate colic, use cautiously in physical May exacerbate colic, use cautiously in physical obstructionobstructionNeostigmineNeostigmine:: less side effects, used for the treatment of less side effects, used for the treatment of ruminal atony, enhance urination, stimulation of skeletal ruminal atony, enhance urination, stimulation of skeletal muscles contraction& peristaltic activity in cows, horses, muscles contraction& peristaltic activity in cows, horses, sheep's& swine's; treatment of curare like drug intoxication in sheep's& swine's; treatment of curare like drug intoxication in dogs, and invermectine intoxication in catsdogs, and invermectine intoxication in cats

Glucocorticoides decrease the efficacy of drugGlucocorticoides decrease the efficacy of drug

Generally laxative &cathartics are used for the Generally laxative &cathartics are used for the enhancement& precipitation of GIT enhancement& precipitation of GIT

motility ,emptying the GIT, treatment of motility ,emptying the GIT, treatment of constipation & GIT impactionconstipation & GIT impaction

Side effects: Side effects: severe and protracted diarrhea, severe and protracted diarrhea, abdominal colic which can leads to dehydration & abdominal colic which can leads to dehydration & even shock, decrease n the irritability of the intestinal even shock, decrease n the irritability of the intestinal mucosa , mega colon, bloat, loss of electrolytes, mucosa , mega colon, bloat, loss of electrolytes, secondary aldosteronism, steatorrhea, protein losing secondary aldosteronism, steatorrhea, protein losing gastroentropathy, severe calcium loss & gastroentropathy, severe calcium loss & osteomalsia& exacerbation of inflammatory intestinal osteomalsia& exacerbation of inflammatory intestinal diseasesdiseases

EnemaEnema

Placement of or administration of liquids or Placement of or administration of liquids or suppositories in the rectum to initiates defecation suppositories in the rectum to initiates defecation reflex, a simple way for treatment of constipationreflex, a simple way for treatment of constipation..

Enemas e.g. water soap, isotonic or hypertonic NaCl Enemas e.g. water soap, isotonic or hypertonic NaCl solution , sorbitol, glycerol, sodium lauryl solution , sorbitol, glycerol, sodium lauryl sulfoacetate, mineral oils, love oilsulfoacetate, mineral oils, love oil..

Phosphate containing agents should not be used in cats, Phosphate containing agents should not be used in cats, debilitated & weak animals because of the risk of debilitated & weak animals because of the risk of fetal hyper phospahtemia,hypocalcemia& fetal hyper phospahtemia,hypocalcemia& hypernatremia without correct diagnosishypernatremia without correct diagnosis

digestantsdigestants

Digestive agents used therapeutically for Digestive agents used therapeutically for enhancement of digestion to treat some enhancement of digestion to treat some diseases of the GIT and include natural diseases of the GIT and include natural digestive enzyme and or related compoundsdigestive enzyme and or related compounds

Pepsin plus HCl: Pepsin plus HCl: used inused in gastric achylia or absence gastric achylia or absence of HCl or digestive enzymes in gastric juiceof HCl or digestive enzymes in gastric juice

Diastases: Diastases: amylolytic enzymes used for as the amylolytic enzymes used for as the replacement therapy of pancreatic replacement therapy of pancreatic αα amylase and also amylase and also control of bloatcontrol of bloat

Pancreatic extracts: Pancreatic extracts: used as replacement therapy in used as replacement therapy in the cases of exocrine pancreatic insufficiency due to the cases of exocrine pancreatic insufficiency due to chronic pancreatitis,pancreatic hypoplasiachronic pancreatitis,pancreatic hypoplasia , ,

powder or non coated crushable tabletspowder or non coated crushable tablets

Bile acid& salts e.g. dehydrocholic acid; Bile acid& salts e.g. dehydrocholic acid; chenodeoxycholic acid enhance absorption of chenodeoxycholic acid enhance absorption of long chain fatty acids& fat soluble long chain fatty acids& fat soluble vitamins ,stimulates bile secretion form vitamins ,stimulates bile secretion form hapatocyteshapatocytes

Antidiarrhea agentsAntidiarrhea agents

Diarrhea usually accompanies with increase in Diarrhea usually accompanies with increase in digestive motility, decrease in transit time, digestive motility, decrease in transit time, increase in water and electrolyte excretion increase in water and electrolyte excretion (Na(Na++; Cl; Cl--; K; K++; H; H++) which can leads to metabolic ) which can leads to metabolic acidosisacidosis

Acute diarrheaAcute diarrhea may responds to symptomatic may responds to symptomatic therapy whit anti diarrhea agents, while therapy whit anti diarrhea agents, while chronic ones need to correct diagnosischronic ones need to correct diagnosis

Antidiarrhea agents:1. opiatesAntidiarrhea agents:1. opiates

Diphenoxylate; Lomotil ;Paregoric; Diphenoxylate; Lomotil ;Paregoric; LoperamideLoperamide

Inhibition of Ach release, decrease the Inhibition of Ach release, decrease the peristaltic motility and constriction of gastric peristaltic motility and constriction of gastric lumen, increase the tone of gastric lumen, increase the tone of gastric sphincters ,increase in transits time & sphincters ,increase in transits time & absorption of water and electrolytesabsorption of water and electrolytesOpiates are generally used for the symptomatic Opiates are generally used for the symptomatic

treatment of acute diarrheatreatment of acute diarrhea

DiphenoxylateDiphenoxylate Synthetic congener of MeperidineSynthetic congener of Meperidine

Decreases abdominal pain& colicDecreases abdominal pain& colic

Duration of treatment: Duration of treatment: 36-48 hours36-48 hours

Side effects: Side effects: constipation, bloat & sedationconstipation, bloat & sedation

May stimulate CNS in catsMay stimulate CNS in cats

Should not be used in the case of intestinal Should not be used in the case of intestinal inflammationsinflammations

Exacerbates the effects of : Exacerbates the effects of : barbiturates; phenothiazines; anti barbiturates; phenothiazines; anti histamines& anesthetic agentshistamines& anesthetic agents

Lomotil: diphenoxylate combined with atropineLomotil: diphenoxylate combined with atropine

Antidiarrhea agents: LoperamideAntidiarrhea agents: LoperamideUsed for treatment of diarrhea in dogs, acute colitis& Used for treatment of diarrhea in dogs, acute colitis& mal indigestion/mal absorptionmal indigestion/mal absorption

Side effects: Side effects: sedation, constipation& ileus, maysedation, constipation& ileus, may stimulates CNS in catsstimulates CNS in cats

Contraindications: Contraindications: severe bacterial enteritis, hepatic severe bacterial enteritis, hepatic diseases, obstruction of the GIT& urinary tract, diseases, obstruction of the GIT& urinary tract,

glaucomaglaucoma&&

Collie dogs are more sensitiveCollie dogs are more sensitive

If after 48 hours symptoms of diarrhea don’t If after 48 hours symptoms of diarrhea don’t improve ,drug administration should be discontinueimprove ,drug administration should be discontinue

Antidiarrhea agents: ParegoricAntidiarrhea agents: Paregoric

tincture of opiumtincture of opium

Used for the treatment of diarrhea in cats, horses Used for the treatment of diarrhea in cats, horses &cattle's once a day&cattle's once a day

Antidiarrhea agents:2. anticholinergicsAntidiarrhea agents:2. anticholinergics

Aminopentamide; propantheline; Isopropamide; Aminopentamide; propantheline; Isopropamide; methscopolaminemethscopolamine

Aminopentamide used for the treatment of acute Aminopentamide used for the treatment of acute abdominal spasm, tenesmus, pylorospams, abdominal spasm, tenesmus, pylorospams, hyperthropic gastritis and related emesis, emesis hyperthropic gastritis and related emesis, emesis & diarrhea in dogs and cats& diarrhea in dogs and cats

Contraindications: Contraindications: sensitivity to anticholinergic agents, sensitivity to anticholinergic agents, obstruction of the GIT, ulcerative colitis& bacterial obstruction of the GIT, ulcerative colitis& bacterial infectionsinfections

Antidiarrhea agents:3.protectants& Antidiarrhea agents:3.protectants& absorbentsabsorbents

Kaolin –pectin suspension; Kaolin –pectin suspensionKaolin –pectin suspension; Kaolin –pectin suspension

Absorb toxins and make protective layer which Absorb toxins and make protective layer which prevent gastric mucosa from further injuriesprevent gastric mucosa from further injuries

Used for the symptomatic treatments of acute Used for the symptomatic treatments of acute diarrheadiarrhea

Kaolin –pectin suspension used every 4-6 hours Kaolin –pectin suspension used every 4-6 hours orally in dog, cat, horse cattle& sheep; orally in dog, cat, horse cattle& sheep; bismuth sub salicylate used orally in horse and bismuth sub salicylate used orally in horse and cattle every 6-8 hourscattle every 6-8 hours

Drug used in intestinal inflammationDrug used in intestinal inflammationAminosalycilatesAminosalycilates

Drugs contain 5.amino salicylic acid (5ASA)Drugs contain 5.amino salicylic acid (5ASA)

Rapid absorption to the upper portions of the small Rapid absorption to the upper portions of the small intestine, often act locally at the inflamed intestine, often act locally at the inflamed intestinal mucosal areaintestinal mucosal area

Azo compounds& Mesalamine compounds: Azo compounds& Mesalamine compounds: formulation for releasing 5ASA to the different parts of formulation for releasing 5ASA to the different parts of small intestine or colonsmall intestine or colon

Modulate inflammatory mediators via cyclo-Modulate inflammatory mediators via cyclo-oxygenase &lipooxygenase pathways, oxygenase &lipooxygenase pathways, interfere with the synthesis of inflammatory interfere with the synthesis of inflammatory cytokines, inhibit NF.cytokines, inhibit NF.ΚΚB action, suppress the B action, suppress the activity of NKCs, mucosal lymphocytes activity of NKCs, mucosal lymphocytes &macrophages&macrophages

5ASA: 5ASA: 11stst line drug for the treatment of mild to line drug for the treatment of mild to moderate cases of ulcerative colitismoderate cases of ulcerative colitis

5ASA compounds: 5ASA compounds: useful for the treatment of mild to useful for the treatment of mild to moderate cases of crohnmoderate cases of crohn,,s disease that involved distal s disease that involved distal

ileum &colonileum &colon

Azo compounds of 5ASAAzo compounds of 5ASA

Sulfasalazine: Sulfasalazine: 5ASA plus s.pyridine5ASA plus s.pyridine

Balsalazide:Balsalazide:5ASA plus 4- amino benzoyl-5ASA plus 4- amino benzoyl-ββ- alanine- alanine

Osalazine: Osalazine: a combination ofa combination of 2 molecule of 5ASA2 molecule of 5ASA

Azo combination decreases the absorption of 5ASA Azo combination decreases the absorption of 5ASA form small intestine ,in the terminal portion of ileum form small intestine ,in the terminal portion of ileum & colon 5ASA detached and can reach to ileum & & colon 5ASA detached and can reach to ileum & coloncolon

S.salazine :S.salazine :many side effects due to the systemic many side effects due to the systemic absorption of s.pyridine especially in slow acetylatorsabsorption of s.pyridine especially in slow acetylators

Mesilamine compoundsMesilamine compounds

Pentasa:Pentasa: contain micro granules to releases contain micro granules to releases 5ASA throughout the small intestine5ASA throughout the small intestine

Asacol:Asacol: covered with PH sensitive resin, releases covered with PH sensitive resin, releases 5ASA in the distal ileum and frontal portion of 5ASA in the distal ileum and frontal portion of coloncolon

Rowasa & Canasa: Rowasa & Canasa: formulated to release 5ASA formulated to release 5ASA in the sigmoid colon& rectumin the sigmoid colon& rectum

GlucocorticoidsGlucocorticoids

Prednisolone; Prednisolone; prednisone;hydrocortisone;budenozoideprednisone;hydrocortisone;budenozoide

Generally used for the treatment of moderate to Generally used for the treatment of moderate to severe inflammatory intestinal diseasessevere inflammatory intestinal diseases

For the treatment of inflammatory conditions For the treatment of inflammatory conditions involve rectum or sigmoid colon rectal involve rectum or sigmoid colon rectal administration is the route of choiceadministration is the route of choice

TylosinTylosin

Macrolide antibiotic which binds to 30s Macrolide antibiotic which binds to 30s ribosome subunit, inhibits protein synthesis ribosome subunit, inhibits protein synthesis and thus it is bacteriostaticand thus it is bacteriostatic

Used orally for the treatment of chronic colitis in Used orally for the treatment of chronic colitis in small animals ,2-3 times per day with foodsmall animals ,2-3 times per day with food

MetronidazoleMetronidazole

A bactericidal antibiotic by disruption of DNAA bactericidal antibiotic by disruption of DNA

Affect almost obligatory anaerobic bacteria e.g. Affect almost obligatory anaerobic bacteria e.g. Clostridium. Spp; Fusobacterium; Peptococcus; Clostridium. Spp; Fusobacterium; Peptococcus;

PeptostreptococcusPeptostreptococcus

Affect protozoa's with Trichomonacidal& Affect protozoa's with Trichomonacidal& amoebocidal activity, also affect Balantidium amoebocidal activity, also affect Balantidium coli,Giardia& Entamoeba histolyticacoli,Giardia& Entamoeba histolytica

Inhibits cell mediated immune reactionsInhibits cell mediated immune reactions

Indications : Indications : treatment of giardiasis, trichimonasis, treatment of giardiasis, trichimonasis, balantidium coli, colic, systemic & digestive balantidium coli, colic, systemic & digestive infections related to susceptible anaerobic infections related to susceptible anaerobic

bacteria's( small animals);bacteria's( small animals); infection related to infection related to anaerobicanaerobic bacteria's (horses)bacteria's (horses)

Contra indications:Contra indications: sensitivity to nitroimidazole sensitivity to nitroimidazole derivatives, debilitated patients, pregnant derivatives, debilitated patients, pregnant animals ,milking mothers &human food producing animals ,milking mothers &human food producing animalsanimals

Caution :Caution : coadminstration with warfarin & other coadminstration with warfarin & other cumarin anticoagulants due to increase in cumarin anticoagulants due to increase in prothrobnim timeprothrobnim time

Ruminotoric agentsRuminotoric agents

Potentiate rumen contractionsPotentiate rumen contractions

Neostigmine &bethanechol :Neostigmine &bethanechol :increase the frequency increase the frequency of ruminal contraction transiently, used Sc in the of ruminal contraction transiently, used Sc in the cases of ruminal atonycases of ruminal atony

Opioid antagonists e.g. Naloxone:Opioid antagonists e.g. Naloxone: potentiate potentiate ruminal contractions, used for the treatment of ruminal contractions, used for the treatment of endotoxin related rumen stasisendotoxin related rumen stasis

Bitters e.g. red pepper, ginger& noxvomica:Bitters e.g. red pepper, ginger& noxvomica: stimulate rumen contractions by stimulation of stimulate rumen contractions by stimulation of salivationsalivation

Rumen anta acidsRumen anta acids

Mg.oxide; Mg.carbonate; Al.hydroxide; Mg.oxide; Mg.carbonate; Al.hydroxide; Al.carbonate; Ca .carbonateAl.carbonate; Ca .carbonate

Used for the treatment of rumen lactic acidosis Used for the treatment of rumen lactic acidosis related to grain overloadrelated to grain overload

Administration: Administration: orally every 8-12 hoursorally every 8-12 hours

Overdose especially Mg.oxide: Overdose especially Mg.oxide: risk of systemic risk of systemic alkalosisalkalosis

Rumen acidifiersRumen acidifiers

Vinegar& acid acetic 4-5%Vinegar& acid acetic 4-5%

Indication: Indication: simple indigestion, treatment of acute urea simple indigestion, treatment of acute urea toxicity by inhibition of urease enzyme and formation toxicity by inhibition of urease enzyme and formation of non absorbable ammonium ion which decrease of non absorbable ammonium ion which decrease ammonia absorptionammonia absorption

Mixed with cold water and administrated via Mixed with cold water and administrated via gastric tube every 6-8 hoursgastric tube every 6-8 hours

Anti bloat agentsAnti bloat agents

Bloat : Bloat : aggregation of gas in the GIT due to inability aggregation of gas in the GIT due to inability to expel of gasto expel of gas

Frothy bloat : increase in the surface tension of Frothy bloat : increase in the surface tension of rumen content and trapping of gas bubblesrumen content and trapping of gas bubbles

Anti bloat agents:Anti bloat agents: compounds which decrees surface compounds which decrees surface tension of rumen contents e.g. Poloxalene; paraffin ; tension of rumen contents e.g. Poloxalene; paraffin ; plans oil such as; soybean oil, sunflower oil, almond plans oil such as; soybean oil, sunflower oil, almond oiloil

Dioctyl sodium sulfosuccinate: Dioctyl sodium sulfosuccinate: used for the used for the treatment of frothy bloat in ruminants, abdominal treatment of frothy bloat in ruminants, abdominal impaction & mega colon in horse( max dose in impaction & mega colon in horse( max dose in hose:200mg/kg)hose:200mg/kg)

Poloxalene:Poloxalene: used for the prevention of bloat in used for the prevention of bloat in ruminantsruminants

Dimethicone:Dimethicone: decrease the surface tension and used decrease the surface tension and used for the treatment of bloat and other GIT disorders for the treatment of bloat and other GIT disorders with gass aggregationwith gass aggregation