Clinical pharmacology of the gastrointestinal tract

Efeitos do PEG 3350 e de uma solução enteral, associados ou não ao Ringer lactato, e do NaCl 0,9% sobre a glicose, o lactato, o cortisol e a insulina de equinos hígidos

Este estudo objetivou avaliar e comparar a glicose e o lactato plasmáticos, bem como a insulina e o cortisol séricos, em éguas hígidas, não gestantes, tratadas com: polietilenoglicol 3350 (PEG); ou polietilenoglicol 3350 associado ao Ringer lactato (PEG+RL); ou solução isotônica poliônica enteral (SIPE); ou solução isotônica poliônica enteral associada ao Ringer lactato (SIPE+RL); ou solução de cloreto de sódio a 0,9% (NaCl). A avaliação laboratorial foi realizada nos tempos: imediatamente antes do início dos tratamentos (T0h); com seis horas (T6h) e ao final dos tratamentos (T12h); com 24 (T24h) e 48 horas (T48h) após T0h. Não ocorreu alteração significativa no lactato plasmático. Ocorreu apenas um discreto aumento nos valores da glicose e da insulina no tratamento SIPE, ocasionado pela presença de maltodextrina. O cortisol aumentou nos animais de todos os tratamentos, porém menor nos animais do SIPE. Conclui-se que os tratamentos não alteraram os valores da glicose, do lactato e da insulina em éguas hígidas e que a hidratação enteral em fluxo contínuo realizada no tratamento SIPE ocasionou menos estresse nos animais.

Efeitos laxativos do polietilenoglicol 3350 e de soluções eletrolíticas em equinos

Compararam-se a motilidade intestinal, a frequência de defecação, a umidade e o aspecto das fezes, o tempo médio de retenção (TMR) e a taxa de passagem (TxP) da ingesta no intestino grosso (ig), em cinco éguas hígidas tratadas com: polietilenoglicol 3350, na dose única de 1,5g kg-1, em bolus, por via enteral (PEG); ou por polietilenoglicol 3350, na dose única de 1,5g kg-1, em bolus, por via enteral, associado ao Ringer lactato, 15mL kg-1 h-1 por fluxo contínuo de 12h, via intravenosa (PEG+RL); ou por solução isotônica poliônica enteral, 15mL kg-1 h-1 em fluxo contínuo de 12h (SIPE); ou por solução isotônica poliônica enteral, 7,5mL kg-1 h-1 por fluxo contínuo de 12h, via enteral, associada ao Ringer lactato, 7,5mL kg-1 h-1 por fluxo contínuo de 12h, via intravenosa (SIPE+RL); ou por cloreto de sódio 0,9%, 15mL kg-1 h-1 por fluxo contínuo de 12h, via intravenosa (NaCl 0,9%). O PEG apenas amoleceu discretamente as fezes. O PEG+RL, o SIPE+RL e o NaCl 0,9% foram mais eficazes em amolecer as fezes e aumentar a frequência de defecação do que o PEG. O SIPE foi o único tratamento que aumentou a motilidade intestinal, e foi o melhor em aumentar a frequência de defecações, amolecer as fezes e diminuir o TMRig, aumentando a TxPig. Conclui-se que os cinco tratamentos demonstraram efeito laxativo, sendo o SIPE o mais eficaz.

Abdominal radiography in monitoring the resolution of sand accumulations from the large colon of horses treated medically

This retrospective study consisted of 14 horses (age 6 weeks-12 years) with radiographically evident sand accumulations cranioventrally in the abdomen and clinical signs suggestive of sand enteropathy. The horses were treated medically and resolution of sand was monitored radiographically. Routine treatment consisted of psyllium mucilloid, combined with magnesium sulphate and/or mineral oilif needed. Initially, the number, size and shape of the sand accumulations showed large variation and the response to therapy was not predictable based on the initial appearance of the accumulation. In 2 foals, some of the sand was passed and the rest was mixed with other intestinal contents within 2-4 days. Even large accumulations disappeared in 2-4 days with psyllium alone or combined with mineral oil in 4 horses. In another 4 horses, the size of the accumulations decreased but varying amounts remained approximately at the same site, despite treatment for 1-4 weeks, and all these horses also had either gastric or large colon impaction. Three horses had a limited response to psyllium treatment, but the accumulation resolved with repeated doses of magnesium sulphate, with or without mineral oil. One horse did not respond to prolonged laxative treatment but the accumulation resolved on pasture. Clinical improvement was not necessarily related to the resolution of sand. Radiography of the cranioventral abdomen was found to be a useful means for monitoring the resolution of sand and confirming the effect of medical treatment in removing sand from the large colon in the horse.

Gastrointestinal pharmacology

Diseases of the gastrointestinal tract that require pharmacologic management, usually in combination with other treatments, are gastric ulcers (omeprazole and others), colic (laxatives, analgesics), diarrhea (antibiotics, protectants and absorbents, glucocorticoids, motility inhibitors), reperfusion injury, postoperative ileus (prokinetic drugs), and adhesions. There is growing evidence that nonsteroidal anti-inflammatory drugs can alter important physiologic properties of the intestine; however, these drugs are valuable analgesics for horses and their use should be tempered with an awareness of their harmful effects. The role of antibiotics in treating gastrointestinal disease is controversial, but their ability to induce life-threatening diarrhea is well known and invites caution and defensible use of these drugs in horses.

Chemical restraint and analgesia in the horse

Chemical restraint in the standing horse is used for a variety of procedures in veterinary medicine. The choice of agent depends on the physical status, temperament, and size of the patient; the procedure to be performed; and safety for the patient, veterinarian, and owner. The combination of certain agents may provide more desirable restraint and analgesia than does the use of individual agents. The use of analgesics in the horse is not without side effects, some of which may be detrimental to the patient's condition. Analgesics should be chosen with these untoward effects in mind. Draft breeds possess differences that may provide a challenge to the practitioner. One such difference is their clinically apparent increased sensitivity to tranquilizers and sedative-hypnotics; consequently, reduced dose regimens for chemical restraint should be employed initially.

Pharmacokinetic studies of cimetidine hydrochloride in adult horses

Histamine type II (H2) antagonists inhibit gastric acid secretion and are useful in treating gastric and duodenal ulcer disease. To provide some information on the pharmacokinetics of the H2 antagonist cimetidine, adult horses were given 3.3 mg/kg cimetidine intravenously (iv) or 3.3 and 10 mg/kg orally. Plasma cimetidine concentrations after 3.3 mg/kg orally were too low to measure. Following 3.3 mg/kg iv, cimetidine displayed two-compartment characteristics with a t1/2 of 0.083 +/- 0.039 h and t1/2 of 2.23 +/- 0.64 h. The total body clearance was 0.443 +/- 0.160 litre/h/kg and the mean residence time was 2.74 +/- 1.11 h. This clearance and t1/2 are similar to that in man. The volume of distribution (Vss) and volume of the central compartment (Vc) were 1.138 +/- 0.230 and 0.276 +/- 0.102 litre/kg, respectively. After a single oral dose of 10 mg/kg as crushed tablets, peak plasma concentration of 1.81 +/- 0.82 micrograms/ml occurred at approximately 1.4 h. Oral absorption of cimetidine appeared variable and slow with an extent of absorption of 0.296 +/- 0.183 and a mean residence time for absorption of 1.99 +/- 0.79 h. This was less than in man. Based on a desired average steady state plasma concentration of 1.0 microgram/ml, 11.0 mg/kg/day iv and 48 mg/kg/day orally can be recommended in adult horses.

Prokinetic effects of cisapride, naloxone and parasympathetic stimulation at the equine ileo-caeco-colonic junction

The electromyogram of the terminal ileum, the caecum and the proximal right ventral colon was recorded in fasted conscious ponies receiving intravenously equiactive doses of pilocarpine (0.05 mg/kg) and carbachol (0.01 mg/kg) as acetylcholine analogues; cisapride (0.1 mg/kg) and metoclopramide (2 mg/kg) facilitating acetylcholine release from myenteric neurones and naloxone (0.05 mg/kg) as an antagonist of the endogenous inhibitory opioid system. Both cisapride and naloxone induced typical migrating spike bursts in the colon associated with contractions of caecal body and caecal base. Both pilocarpine and carbachol stimulated the terminal ileum but had opposite effects on the activity of the caeco-colonic segment which was decreased by pilocarpine and increased by carbachol. High doses of metoclopramide had weak and unspecific stimulatory motor effects. It is concluded that a true prokinetic effect at the equine ileo-caeco-colonic junction requires a motor profile which includes coordination between contractions sequentially involving the body and the base of the caecum and migrating spike bursts on the proximal colon. Such changes in the motor profile were produced by cisapride and naloxone and to a lesser extent by carbachol.

Initial treatment of colic

This article discusses some of the rationales for the medical management of colic during the initial treatment period. The issue of colic pain control and the masking of clinical signs that may indicate severe gastrointestinal disease is addressed. Therapeutic considerations related to dehydration, metabolic imbalances, hemostatic disorders, antimicrobial therapy, fecal consistency, gastrointestinal decompression, and regulation of intestinal motility are reviewed.