7. GESTION DE LA REPUTACIÓN ONLINE
7.5. FIABILIDAD DE TRIPADVISOR
a) An alkaloid derived from morphine but is no longer classified as narcotic
b) A dopamine agonist
c) Reliable emetic for dogs: vomiting occurs occurs in 2-3 minutes after administration and may continue for 5-15 minutes
d) Causes CNS excitation in cats
e) Should not be used in advanced cases of toxicity because additional shock can kill the patient
f) Dose in dogs: 0.04 mg/kg IM of SC 3) IPECUC SYRUP
a) Has been used as emetic but the vomiting is not consistent b) They cause toxic effects and even death
c) An old drug but may still be apart of some drugs presently used 4) XYLAZINE
a) A sedative-analgesic
b) Do not use in shock animals where its sedative effect may aggravate condition
c) Dose: 0.05-1.0 mg/kg IM (emesis in cats, sometimes in dogs 1-3 mg/kg IM (dogs)
5) PROSTAGLANDIN F2
a.) Causes vomiting and defecation when given in high doses and may also cause bronchoconstriction
b) Usually used in reproductive disorder in the dog or in estrus synchronization in large animals.
a. LOCALLY ACTING EMETICS/IRRITANT EMETICS
These agents irritate the stomach - this will stimulate the vomiting center via the autonomic nervous system.
a. Hydrogen Peroxide (3%)
1) Induces vomiting within 5-10 mins.
2) Dose: 5 ml (1 tsp.) given orally b. Sodium Chloride
1) Used as solid and deposited at the back of the tongue or as a solution of 1-2 tsp.
in 1 cup water swallowed
2) Causes vomiting in about 15 mins.
c. Copper Sulfate, Zinc Sulfate, freshly ground mustard seed
4. Antiemetics
a. Agents that prevent or stop vomiting
b. The control of emesis is necessary because prolonged vomiting can cause exhaustion, dehydration, hypochloremia and metabolic alkalosis.
c. Indications
1) motion sickeness
2) vomiting associated with metabolic diseases
CENTRALLY-ACTING ANTIEMETICS
a. MOA: they raise the threshold of excitability of the CTZ or the vomiting center
I) Antihistamines
a) Dimenhydrinate (DramamineR)
- Dose: 8 mg/kg 0.8 hrs. PO (dog & cat) b) Diphenhydramine (BenadrylR)
- Dose: 2-4 mg/kg 0.8 hours PO (dog & cat) 1-2 mg/kg 0.8-12 hours IM
c) Cyclizine
- Dose: 25-100 mg daily in divided doses (dog & cat) d) Miclizine (BonamineR)
2) Tranquilizers
a) Chlorpromazine
- Dose: 0.5 mg/kg PO IM (dog & cat) b) Acepromazine
- Dose: 1 mg/kg (PO, IM (dog & cat) c) Promethazine
- Dose: 2 mg/kg an hour before travelliag (dog & cat)
3) Haloperidol
Dose: 0.02-0.1 mg/kg IM (dog)
LOCALLY-ACTING ANTIEMETICS
a) MOA: diminish irritating stimulant that begins in the stomach 1) Oral Antacids
(a) Indicated in dogs and cats to lessen gastric acidity on conditions like ulcer disease, acid hypersecretion due to renal failure, histamine release from mast cell tumors.
(b) Often incorrectly used as antiemetics because of their capability to reduce vomiting caused by gastric hyperacidity.
(c) They are not absorbed and therefore they do not cause systemic alkalosis.
(d) Excess may cause catharsis (increased peristalsis)
(e) Aluminum salts depletion of phosphates, which is characterised by weakness and demineralization
(f) May decrease asorption of other drugs from the stomach (eg.
tetracyclines)
(g) Decrease the secretion of pepsin so these should be given concurrently with inhibitors of gastric acid secretion
(h) Should be administered 0.4-6h to ensure control of gastric acidity
Example:
Magnesium Oxide Magnesium Hydroxide Magnesium Silicate Calcium Carbonate Calcium Hydroxide Almninum Hydroxide Ammonium Carbonate
- Dose: Magnesium hydroxide 5-10 ml PO 0.4-8 h Aluminum hydroxide 5-10 ml PO 0.4-8 h
2) Histamine-2 Antagonists/Inhibitors of Gastric Acid Secretion (a) These also referred to as ulcer- healing drugs
(b) They block H2 receptors found in the gastric mucosa which mediate acid secretion (c) Causes inhibition of cytochrome P-450 (cimetidine and ranitidine)
(d) Inhibit glucuronidation of acetaminophen (ranitidine)
(e) Inhibit renal clearance of basic drugs secreted by the renal tubules (f) Cimetidine has antiandrogen effects
- Doses:
CIMETIDINE 5-10 mg/kg BID-OID PO, IM, IV, 0.6-8 h (dogs & cats)
RANITIDINE 1-2 mg/kg BID PO, IM 0.12 h (dogs & cats) FAMOTIDINE* 0.5-1 mg/kg SID PO IV
NIZATIDINE* 5 mg/kg SID PO
*Doses currently used in dogs but not yet established.
OTHER ANTI-EMETICS
1) Metoclopramide
a. Has a dual mode of action
b. It possesses parasympathomimetic activity and promotes gastric emptying.
c. It is also a dopamine receptor antagonist with a direct depressant effect in the CTZ.
d. Has been used treating emesis such as those associated with cancer therapy, pasvovirus infection recovery from gastric dilatation, chronic gastritis, esophageal reflux
e. In dogs it is 35 x more potent than chlorpramazine - Dose:
Dog and Cat = 0.25-0.5 mg/kg PO SC, IM, IV 0.6-2 h or 1-2 mg/kg/day constant for infusion
2) Atropine
a. A cholinergic blocker
b. MOA: competes with acetylcholine for muscarinic receptor sites c. Decreases gut motility, tone, and secretory activity of gut
- Dose: 0.4 mg/kg SC, IM
5. Antidiarreal Drugs
a. Adsorbents
1) Absorb dissolved or suspended substances such as gases, toxins, and bacteria a) KAOLIN (Hydrated Aluminum Silicate)
(1) Usually in combination with pectin, a protectant
(2) Generally safe but gastric carcinoma may be produced with prolonged use
(3) Prevents absorption of certain drugs: tetracycline
(4) May not is able to absorb E. coli enterotoxin, its use in the treatment of neonatal diarrhea is not satisfactory
(5) Do not administer together with other drugs - Dose: horse/cow 50-200 g PO
Foal/Calf 15-60 g PO Dog up to 8 g PO 2) Activated Charcoal
a) Residue of destructive distillation of various organic materials and treated in such a way as to increase the surface area of the particles.
b) One of the components of the so-called "universal antidote", other components are magnesium oxide (antacid) and tannicacid (astringent)
3) Attapulgite
a) Absorb enterotoxines, especially in activated form b) Heating carries out activation
b. Protectants
1) Form a thin layer over skin or mucous membrane in order to prevent contact with possible irritants
a) PECTIN
(1) A purified carbohydrate from citrus or apple rinds b) BISMUTH SALTS (CARBONATE, SALICYLATE)
(1) Also antisecretory
(2) Use in the treatment of diarrhea (3) Carbonate has antacid effect
(4) Salicylate has local ant inflammatory effect (5) Can absorb E. coli enterotoxins
(6) Bismuth Subsalicylate 1-2 ml/kg q. 6-8 h for 1-2 days
c) SUCLRALFATE
(1) A nonabsorbable sulfate sucrose complex that protects denuded mucosa by adhering rightly to it.
(2) Indicated for gastroduodenal ulceration/erosion/ esophagitis, stress ulceration
(3) Other orally administered drugs should be used 1-2 h before after administration
(4) Side effect constipation
- Dose: 1/4-1 g PO TlD OID, depending on patient size d) MISOPROSTOL
(1) For treatment and prevention of gastroduodenal ulceration, particularly associated with NSAIDs
(2) A newer cytoprotective drug c. Motility Reducers/Inhibitors (Antispasmodics)
1) Drugs that prolongs transit time 2) Cholinergic Blockers:
a) Atropine
b) Methscopolamine
- Dose: 0,3-1.5 mg/kg 0.6-8 h for 1-2 days 3) Opiate Derivatives
a) MOA: Increase segmental motility and sphinchter muscle tone decrease peristalsis and movement of intestinal contents in the lumen b) Indicators: treatment of one specific acute and chronic diarrhea
c) May increase the risk for proliferation of pathogenic bacteria in the intestinal lumen
(1) DIPHENOXYLATE (+ atropine = lomotilR) (a) May be a sedative in dog
(b) Well absorbed in GIT and metabolized in liver - Dose: 0.5-0.1 mg/kg PO 0.6-8 h (dog)
(2) LOPERAMIDE HYDROCHLORIDE (Lormide®, Immodium®) - Dose: 0.8 mg/kg PO 0.8 h (dog)
(3) PAREGORIC
(a) Camphorated tincture of opium (b) Traditional remedy for diarrhea
6. Other Drugs acting on the GIT
a. Astringents
1) Produce protein-precipation acting limited to the surface of the cells (the permeability of the cells is reduced but the cells remain viable) Effects:
a) Protection of tissue form irritation substances b) Reduction of intestinal secretion
c) Reduction of absorption of toxic materials - Doses:
Tannic acid, Krameria, Gambir, Nutgal, Querium, Geranium
b. Carminatives
Effects: expulsion of gas and reduction of foam formation
Examples: Simethecon, Poloxalene, Turpentine, Camphor, Peppermint, Capsicum, and Ginger
7. Laxatives/Cathartics
a. Purgatives/cathartics/aperient: cause intensification of intestinal activity resulting in the expulsion of intestinal content from the colon and rectum b. Laxatives: cause similar action but the effect is milder
c. Both hasten the rate of passage of materials through the GIT and promote defecation
- indications: constipation
1) Removal of toxic materials from the GIT
2) Soften stool in cases when straining may be detrimental
eg.: rectal, vaginal/ or uterine prolapse) sometime to remove edema fluid)
a) STIMULANT LAXATIVES
1) Increase the propulsive motility of the bowel by a variety of mechanisms.
2) Contraindicated in the presence of obstructive lesions and not appropriate for long term use.
(A) Direct Irritant
(1) Phenopthalein
(a) Direct acting irritant cathartic
(b) Has prolonged action due to ricinoleic acid, which stimulate colonic motility and secretion
- Dose: pig's 1-2 g Dog 0.03-0.2 g
Cat 15-65 rog (2) Castor Oil
(a) Hydrolyzed in the intestine to ricinoleic acid which stimulates colonic motility and secretion
(3) Linseed Oil
(a) Metabolized to linoleic acid which has less irritant effect than ricinoleic acid
(B) Indirect Irritant - requires absorption and metabolism before they can exert their irritant action and stimulate intestinal movement
1) Danthron
a) An anthraquinone laxative b) A snythetic analogue of emodin
c) Slow-acting (effective within 6-14 h in dogs and cats, and within 12-36 hours in horses and cattle)
d) Prolonged use may lead to degeneration of the myenteric plexus leading to loss of intestinal motility e) Excreted into milk and may affect offspring
f) Commonly recommended for horse
- Dose: horse 15-40 g dog 300-400 mg cattle 20-45 g cat 100-250 mg 2) Bisacodyl
a) Stimulates colonic smooth muscle and myenteric plexus Dose: 5 mg/day (cats and small dogs)
10 mg/day (medium-sized dogs) 15-20 mg/day (large dogs)
3) Senna
4) Cascara Sargada
b) SIMPLE BULK FORMING LAXATIVES 1) Milder than that of stimulation laxative
2) Added to the food to promote soft feces and normal cooling motility for the prevention and control of constipation
3) Insoluble fiber laxatives derived from cereal grains and seed coats 4) MOA: absorb water, increase bulk of fecal content and soften fecal
consistency due to its hydrophilic properties --> bowel distention —
> increase pressure stimulus--> stimulates reflex contraction of intestinal musculature leading to increase in power and speed of peristalsis
Example: Methylcellulose PsyIlium compounds Bran
Agar
5) Mainly used small animals for their mild stimulant effects Indications:
Constipation - due to diets consisting of concentrated food with low fiber content
Diarrhea - gel laxatives trap large amounts of water so they are useful in the symptomatic treatment of diarrhea and under this condition they decrease the fecal fluid content --> decreased speed of intestinal transit
c) SALINE BULK FORMING/OSMOTIC LAXATIVES
1) Ionic compounds which are poorly absorbed from the GIT that retain and absorb water from the tissues into the intestinal lumen. The resulting bowel distention promotes peristalsis.
(a) Magnesium Sulfate (Epsom Salt)
Dose: as purgative as laxative
Cow 0.24-0.48 kg Horse 30-60 g Sheep 60-120 g Cow 60-120 g Sheep 7.7-15 g
Pig 15-30 g Dog 5-25 g Cat 2-5 g
Effect within 3-12- hours in simple stomached animals and after
Approximately 18 hours in ruminants
2) Contraindicated in dehydrated patients and those with renal disease 3) Fluid should be available throughout the treatment
4) Absorption of appreciate amount of Epsom's salt may cause CNS 5) Depression and neuromuscular blockade
6) In cases of poisoning with epsom’s salt, give patient activated charcoal and a stimulant cathartic (magnesium adsorbs to activated charcoal)
(b) Sodium Sulfate (Glauber's Salt) (c) Sodium Potassium Tartrate
d) LUBRICANT LAXATIVES
1) Lubricates intestinal mucosa and interferes with water absorption 2) These group have laxative rather than purgative action and their effect I
entirely mechanical.
3) Their oily and lubricant character enable them to coat the entire mucosa and intestinal contents thereby smoothens the passage of fecal material and reduce water absorption.
4) Prolonged use may interfere with absorption of nutrients.
(a) Mineral Oil
Dose: large animals 0.5 to 2.0 liters small animals 2.0 to 50 ml
(b) Liquid Paraffin
Dose: horses, cattle 0.5-2.0 liters
foals, calves 60-120 ml
Dogs 2-60 ml
Cats 2-10 ml
e.) EMOLLIENT LAXATIVES
1) These are surfactants, wetting agents or detergents
2) Reduce surface tension of intestinal contents by allowing fecal matter to be easily penetrated by water
3) Have slowly onest of action (1-2 days) 4) The induce hypovolemic shock in horses 5) May enhance toxicity of toxic drugs
6) Should not used with mineral oil because they can increase the undesirable absorption of mineral oil. The mineral oil reduces the emollient effect of the also docusate.
(a) Dioctyl Sodium Sulfosucciaate
(Docusate Sodium)
(b) Dioctyl calciuia (Docusate Calcium)
Dose: Cattle & Horse 5 – 10 g/animal Dogs 15 – 120 mg/animal Cats 5 – 30 mg/animal
8. Motility Modifiers/GIT Secretion Inhibitors a. Prokinetics (Cholinergics)
1) ARECOLINE - used as purgatives for the expulsion of taperworros NEOSTIGMINE, OHYSOSTIGMINE, CARBAMYLCHOLINE, BETHANNECHOL
METOCLOPRRAMIDE
2) MOTILITY REDUCERS/INHIBITORS - opiates and their derrivatives 9. Inhibitors of GIT Fluid Secretion
a. Anticholinergics
b. Phenothiazine tranquilizers
1) Mechanism may involve inhibition of calimodium, a calcium-binding protein required in intestinal ion and fluid secretion
c. Optiates
d. Prostaglandin inhibitors (NSAIDS) 10. Enemas
a. Refer to infusion of large volumes of warm fluid per return or warm, soapy water or glyceryl to soften fecal mass and float out impacted materials (eg.
undigested bone)
b. For removal impacted rectal and colonic contents in does or in the treatment of colic
11. Cholagogues
a. Drugs that stimulates bile flow b. Menbutone