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Quiz: Appropriate Gastroprotectant Use

Emily Nissa Gould, DVM, MS, DACVIM (SAIM), Texas A&M University

M. Katherine Tolbert, DVM, PhD, DACVIM (SAIM), Texas A&M University

Internal Medicine

|November 2019|Peer Reviewed|Web-Exclusive

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Gastroprotectants, which include antacids and acid suppressants, are one of the most widely used classes of medications in veterinary medicine. Acid suppressants such as H2-receptor antagonists (H2RAs; eg, famotidine, ranitidine) and proton pump inhibitors (PPIs; eg, omeprazole, pantoprazole, esomeprazole) decrease the amount of hydrochloric acid produced in the stomach by either blocking gastric acid stimulators (H2RAs) or inhibiting acid production directly at the gastric parietal cell interface (PPIs). In contrast, antacids neutralize the acid present in the stomach but do not stop future acid production. Because acid suppressants and antacids are inexpensive and readily available over-the-counter, inappropriate use of these drugs is of great concern. This quiz addresses common scenarios involving use of acid suppressants and antacids for the treatment of GI bleeding and injury in cats and dogs. 

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Quiz: Appropriate Gastroprotectant Use

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Sally, an ≈8-year-old spayed crossbreed dog, is presented for persistent upper GI bleeding characterized by marked melena, increased serum BUN:creatinine ratio, mild hypoalbuminemia, and moderate but strongly regenerative anemia. She has no history of recent NSAID or steroid therapy, and the remainder of her minimum database (eg, platelet count, urinalysis) is normal. Abdominal ultrasonography was supportive of focal gastric ulceration, but additional diagnostics, including abdominal CT to investigate a potential cause and upper GI endoscopy to visualize the source of bleeding, were declined due to financial constraints. Sally’s owner has been treating her with once-daily omeprazole therapy for the past 2 weeks. There is concern that the cause of Sally’s clinical signs may be a GI neoplasm (ie, gastrinoma).

What change should be made to Sally's treatment plan prior to measurement of serum gastrin concentrations?

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Quiz: Appropriate Gastroprotectant Use
2/8  Questions
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Sally, an ≈8-year-old spayed crossbreed dog, is presented for persistent upper GI bleeding characterized by marked melena, increased serum BUN:creatinine ratio, mild hypoalbuminemia, and moderate but strongly regenerative anemia. She has no history of recent NSAID or steroid therapy, and the remainder of her minimum database (eg, platelet count, urinalysis) is normal. Abdominal ultrasonography was supportive of focal gastric ulceration, but additional diagnostics, including abdominal CT to investigate a potential cause and upper GI endoscopy to visualize the source of bleeding, were declined due to financial constraints. Sally’s owner has been treating her with once-daily omeprazole therapy for the past 2 weeks. There is concern that the cause of Sally’s clinical signs may be a GI neoplasm (ie, gastrinoma).

When discussing drug administration instructions with Sally’s owners, what is particularly important to emphasize regarding administration of omeprazole tablets?

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Quiz: Appropriate Gastroprotectant Use
3/8  Questions
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Sally, an ≈8-year-old spayed crossbreed dog, is presented for persistent upper GI bleeding characterized by marked melena, increased serum BUN:creatinine ratio, mild hypoalbuminemia, and moderate but strongly regenerative anemia. She has no history of recent NSAID or steroid therapy, and the remainder of her minimum database (eg, platelet count, urinalysis) is normal. Abdominal ultrasonography was supportive of focal gastric ulceration, but additional diagnostics, including abdominal CT to investigate a potential cause and upper GI endoscopy to visualize the source of bleeding, were declined due to financial constraints. Sally’s owner has been treating her with once-daily omeprazole therapy for the past 2 weeks. There is concern that the cause of Sally’s clinical signs may be a GI neoplasm (ie, gastrinoma).

Which of the following are common adverse effects of chronic omeprazole administration in dogs or cats? (Select all that apply.)

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Quiz: Appropriate Gastroprotectant Use
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An ≈2-year-old neutered male golden retriever (Figure) is presented for fever, lethargy, purulent nasal discharge, lymphadenopathy, regurgitation, ptyalism, and dysphagia with apparent pain. The dog is diagnosed with blastomycosis and esophagitis, and treatment with a systemic antifungal is recommended.

What is the best treatment protocol for this dog’s esophagitis? (More than one answer might be correct.)

Clinician's Brief
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Quiz: Appropriate Gastroprotectant Use
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An ≈2-year-old neutered male golden retriever (Figure) is presented for fever, lethargy, purulent nasal discharge, lymphadenopathy, regurgitation, ptyalism, and dysphagia with apparent pain. The dog is diagnosed with blastomycosis and esophagitis, and treatment with a systemic antifungal is recommended.

Which of the following is true regarding concurrent antifungal therapy and omeprazole administration?

Clinician's Brief
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Quiz: Appropriate Gastroprotectant Use
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A colleague asks for a second opinion on the therapeutic management of Shadow (Figure), a 10-year-old spayed domestic shorthair cat with International Renal Interest Society stage III chronic kidney disease (CKD). Over time, Shadow has developed intermittent hyporexia and moderate anemia. There is concern that Shadow may have developed a gastric ulcer secondary to CKD-induced gastric hyperacidity.

Which statement is true regarding cats with CKD?

Clinician's Brief
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Quiz: Appropriate Gastroprotectant Use
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Waldo (Figure), a 4-year-old neutered male crossbreed dog, is presented for suspected upper GI ulceration secondary to concurrent NSAID and steroid administration. He has severe melena and delayed gastric emptying. His owner is financially limited and would like Waldo to be managed as an outpatient. Therapy with misoprostol and famotidine is initiated. 

Which of the following is true regarding oral famotidine administration?

Clinician's Brief
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Quiz: Appropriate Gastroprotectant Use
8/8  Questions
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Waldo (Figure), a 4-year-old neutered male crossbreed dog, is presented for suspected upper GI ulceration secondary to concurrent NSAID and steroid administration. He has severe melena and delayed gastric emptying. His owner is financially limited and would like Waldo to be managed as an outpatient. Therapy with misoprostol and famotidine is initiated.

Which of the following is true regarding misoprostol therapy for this patient?

Clinician's Brief
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Quiz: Appropriate Gastroprotectant Use
8/8  Questions
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Quiz: Appropriate Gastroprotectant Use

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References

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