scott@vtx-cpd.com
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Replying to konstantinos C. 11/03/2022 - 18:09
Konstantinos,
I hope you are well. Thank you for your great question. Overall, it is probably not helpful to give omeprazole/gastroprotectants before giving NSAIDS. There was actually a recent study looking at this in patients with neoplasia:
https://pubmed.ncbi.nlm.nih.gov/34337965/
Bacterial overgrowth can have deleterious consequences when PPIs are administered with other drugs that can injure the small intestinal (SI) mucosa. It is common to prescribe PPIs in patients at risk for upper GI injury from nonsteroidal anti-inflammatory drugs (NSAIDs), but PPIs can alter the SI microbiome, increasing the risk of injury to the intestinal epithelium caused by NSAIDs. This effect is acid-independent and unrelated to gastric mucosa injury caused by NSAIDs. Inhibition of intestinal cyclooxygenase 1 and 2 (COX-1, COX-2) enzymes injures the SI mucosa. Enterohepatic recycling of NSAIDs likely plays a role whereby high concentrations of NSAIDs in bile are secreted into the duodenum in close proximity to the major duodenal papilla. Some of the most serious intestinal lesions in dogs caused by NSAIDs occur in this region. Small intestinal injury may be caused by increased numbers of gram-negative facultative anaerobic bacteria that flourish in the SI of patients treated with PPIs. Lesions are characterized by loss of villi, erosions, and multifocal ulcers distributed throughout the small bowel. Anaemia also may occur. Whereas some bacteria play a protective role against intestinal mucosal injury by NSAIDs, the intestinal dysbiosis arising from PPI administration increases the risk of NSAID-induced intestinal injury.
I hope that helps!
Scott 🙂
Replying to Raquel M. 24/03/2022 - 12:15
Hello Raquel!
Hope you are safe and well. Did the NSAIDs get discontinued just because of the grass eating? Has the dog had any GI signs. Any change in appetite?
Scott 🙂
Hello again!
I replied to this one on the other thread. Let me know if you can’s see it.
Thanks again.
Scott 🙂
This is so interesting Neus!
Would you mind if I shared this on our members forum?
Scott 🙂
Replying to Julie S. 21/03/2022 - 13:53
Hello Julie.
I hope you are well. Interesting question. Do you mean as an alternative to the PPI?
Scott 🙂
Replying to Rachel F. 21/03/2022 - 15:14
No problem.
Let me know how you get on with the Entyce. It really is a great drug!
I hope you are having a lovely week.
Scott 🙂
Hello Rachel.
I hope you are safe and well. This is a brilliant question regarding sucralfate. Coadministration of the following drugs with sucralfate results in a substantially decreased bioavailability of single doses of the drug: ciprofloxacin, theophylline, tetracycline, doxycycline, minocycline, phenytoin, and digoxin. The bioavailability of digoxin, tetracycline, doxycycline, and phenytoin was not decreased when they were given 2 hours before sucralfate. Sucralfate impairs absorption of ciprofloxacin in humans and dogs when administered concurrently, but the bioavailability of ciprofloxacin is markedly increased when administration of sucralfate is delayed by 2 hours. Interestingly, no significant difference in bioavailability was documented for enrofloxacin coadministered with sucralfate in dogs.
So, I know it is a massive pain, but it really should be 2 hours!
The silver lining is that there is a relatively narrow spectrum of use of sucralfate, so I would be asking myself whether it is really necessary before prescribing!
Regarding the Entyce, as far as I am aware, this is the only way of getting it in UK:
I will ask around and see if I can find an alternative. I really hope you are enjoying the course!
Scott 🙂
Replying to Kaloyan K. 16/03/2022 - 14:22
Kaloyan!
What a brilliant question! I am not able to find anything in dogs but this paper in the human literature:
https://pubmed.ncbi.nlm.nih.gov/30956473/
Seems that it was used in this study topically in the abdomen. I am not sure how extensively this is practiced. In Greyhounds that are bleeding I would probably still use IV in most cases.
I will ask some colleagues and see if they have ever used it topically in this way!
Replying to Ursula Lanigan 06/03/2022 - 22:54
Hello.
I think in any cases like this where there is heavy bleeding from the abdomen, there may indeed be an indication for TXA. The only possible contraindication would possibly be bleeding that was coming directly from a kidney (e.g. idiopathic renal haematuria). The issue here might be that if there is bleeding directly from the kidneys and we encourage clot formation with TXA, blot clots could get stuck in the ureters and cause a ureteric obstruction.
Hope that helps.
Scott 🙂
Replying to Laura B. 17/03/2022 - 12:35
Hey Laura.
I think this would be a perfect way of using it topically, especially in such tricky cases!
Scott 🙂
Replying to Raquel M. 17/03/2022 - 12:39
Hello Raquel.
I hope you are safe and well. Thank you so much for your question. I have popped your question below so I did not miss anything!
”Just curious as to when in the diagnostic process, would you recommend this? Is it after ruling out surgical disease? Is it when the vomiting is recurrent or chronic? Is it when there’s relapse of clinical signs of vomiting whilst on a treatment plan that worked before. Or relapse of clinical signs as soon as treatment ends?
And what criteria do you use to define when a case moves from an acute onset vomiting to chronic?”Folate and cobalamin is probably not that helpful in cases of acute vomiting and diarrhoea. Even in cases where you have ruled our surgical disease, if the symptoms are still quite acute ( a few days) then I would not consider folate and cobalamin. Cobalamin may be of use in cases of relapsing or recurrent signs as some patients with GI disease will not respond so well to treatment when folate is low. Cases of vomiting and diarrhoea become truly chronic after about 2-3 weeks and all chronic cases would benefit from folate and cobalamin.
Hope that helps.
Scott 🙂
Replying to Hannah B. 15/03/2022 - 16:20
Hello again Hannah!
Really interesting comments regarding the omeprazole. Hopefully we unlock this even more in lesson three. It really is one of my favourite topics. I think the first thing would be to consider whether the patient needs the omeprazole dispensed in oral form. If there is evidence of melena/haematemesis/confirmed ulcer then I would, but otherwise I would not. Your comments regarding tablet size for omeprazole are brilliant. I would really try not to go higher with the dose as I think we can see side effects with omeprazole, not to mention the dysbiosis! I love BOVA for this reason. I have popped the product list here… lots of lovely tablet sizes and formulations:
https://drive.google.com/file/d/1bL4sa0V_ApBT7UpQBtZorV4ZCyxL5w5d/view?usp=sharing
Hope that helps.
Scott 🙂
Replying to Hannah B. 15/03/2022 - 16:20
Hello Hannah.
I hope you are safe and well and enjoying the course. Regarding the maropitant; I am really happy using this longer-term if necessary. In the majority of cases the need for antiemetic therapy is less when the underlying problem is sorted out. If I am sending patients home with oral maropitant, it is normally not for more than 7 days. I must admit I often do 4 days as that suits the box sizes. The box size definitely does not indicate maximum length of dosing. Below is some data from Zoetis. I have the feeling this is unpublished data, but I have contacted a pal at Zoetis to see if I can get more information:
https://www.zoetisus.com/products/pages/cerenia/extended-therapy.aspx
I am really happy using oral maropitant longer term in cases that need it. I think the best example of this is chronic renal disease patients. Sometimes I will do every other day dosing, but if they need it, they need it!
Hope that helps!
Scott 🙂
Replying to Emma Holt 14/03/2022 - 10:59
Hello Emma.
Hope you are well.
I will pop all of the diet literature in the next couple of sessions (diarrhoea), including a good review I recently came across. I can feel your anticipation from here! 🙂
Metoclopramide is a interesting one. I have heard people talk about not wanting to use it because of fear that it might increase the chance of intestinal dehiscence. I must admit that post operative ileus is a much bigger issue. I think we are significantly over estimating the power of metoclopramide… I would be surprised if it broke down a wound! All we are really trying to do is promote movement it guts that are not moving very much, so I feel very comfortable using it. Normal gut movements should be tolerated.
Hope that helps.
Scott 🙂
Replying to Raquel M. 17/03/2022 - 14:50
No problem!
I am just so happy you find it useful. I love it when we have lots of good discussion!
Scott 🙂
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