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CPD ARTICLE pump inhibitors on calcium metabolism and bone remodelling in dogs and cats suffering from chronic kidney disease may further increase the risk of osteoporosis and pathologic bone fractures in this population. Early studies in cats did not show overt changes in serum cobalamin levels but did raise concerns for changes in bone mineral density. For these reasons antacids should be used judiciously in dogs and cats, especially when suffering from renal disease, and its use should be limited to patients with clear risk factors or overt evidence of gastrointestinal ulceration or gastrointestinal haemorrhage. SUMMARY To summarise, our understanding of antiemetics and antacids have improved significantly over the last few years and is likely to continue to change and improve in the near future with new research. Maropitant has largely replaced many of the older antiemetics as an empirical choice and can often be used in combination with older antiemetics in refractory cases with even greater success. Proton pump inhibitors such as omeprazole and sucralfate form the cornerstones for the management of gastrointestinal ulcerations and there is little evidence for the use of older alternatives such as histamine receptor blockers. Omeprazole is the most readily available proton pump inhibitor to practice and has been shown to have a superior effect on gastric acid suppression when used twice daily instead of once daily as previously advised. Finally, these drugs are not without complications and side effects and should be used prudently. References: 1. Diemunsch P, Grélot L. Potential of substance P antagonists as antiemetics. Drugs 2000;60:533-546. 2. Ramsey D, Kincaid K, Watkins J, et al. Safety and efficacy of injectable and oral maropitant, a selective neurokinin1 receptor antagonist, in a randomized clinical trial for treatment of vomiting in dogs. Journal of veterinary pharmacology and therapeutics 2008;31:538-543. 3. la Puente‐Redondo D, Siedek E, Benchaoui H, et al. The anti‐ emetic efficacy of maropitant (Cerenia™) in the treatment of ongoing emesis caused by a wide range of underlying clinical aetiologies in canine patients in Europe. Journal of Small Ani- mal Practice 2007;48:93-98. 4. Sedlacek H, Ramsey D, Boucher J, et al. Comparative efficacy of maropitant and selected drugs in preven ting emesis induced by centrally or peripherally acting emetogens in dogs. Journal of veterinary pharmacology and therapeutics 2008;31:533- 537. 5. Lesman S, Boucher J, Grover G, et al. The pharmacokinetics of maropitant citrate dosed orally to dogs at 2 mg/kg and 8 mg/kg once daily for 14 days consecutive days. Journal of veterinary pharmacology and therapeutics 2013;36:462-470. 6. Narishetty ST, Galvan B, Coscarelli E, et al. Effect of refrigeration of the antiemetic Cerenia (maropitant) on pain on injection. Veterinary Therapeutics 2009;10:93. 7. Hor M, Chan S, Yow K, et al. Stability of admixtures of pethidine and metoclopramide in aqueous solution, 5% dextrose and 0· 9% sodium chloride. Journal of clinical pharmacy and thera- peutics 1997;22:339-345. 8. Parkinson S, Tolbert K, Messenger K, et al. Evaluation of the ef- fect of orally administered acid suppressants on intragastric pH in cats. Journal of veterinary internal medicine 2015;29:104- 112. 9. Bersenas AM, Mathews KA, Allen DG, et al. Effects of ranitidine, famotidine, pantoprazole, and omeprazole on intragastric pH in dogs. American journal of veterinary research 2005;66:425- 431. 10. Tolbert M, Graham A, Odunayo A, et al. Repeated famotidine administration results in a diminished effect on intragastric pH in dogs. Journal of veterinary internal medicine 2017;31:117- 123. 11. Tolbert MK, Odunayo A, Howell R, et al. Efficacy of intravenous administration of combined acid suppressants in healthy dogs. Journal of veterinary internal medicine 2015;29:556-560. 12. Johnston SA, Leib MS, Forrester SD, et al. The effect of misoprostol on aspirin‐induced gastroduodenal lesions in dogs. Journal of veterinary internal medicine 1995;9:32-38. 13. DW B, SG C. Burget DW, Chiverton SG, Hunt RH Is There an Optimal Degree of Acid Suppression for Healing of Duodenal Ulcers?//Gastroenterology. 1990; 99: 345-351. Gastroenterol- ogy 1990;99:345-351. 14. Yoo JH, Kwon C-I, Yoo K-H, et al. Effect of proton pump inhib- itor in patients with acute pancreatitis-pilot study. The Korean Journal of Gastroenterology 2012;60:362-367. 15. McLeland S, Lunn K, Duncan C, et al. Relationship among se- rum creatinine, serum gastrin, calcium‐phosphorus product, and uremic gastropathy in cats with chronic kidney disease. Journal of veterinary internal medicine 2014;28:827-837. 16. Quimby J, Lappin M. Evaluating sucralfate as a phosphate binder in normal cats and cats with chronic kidney dis- ease. Journal of the American Animal Hospital Association 2016;52:8-12. 17. Laine L, Nagar A. Long-term PPI use: balancing potential harms and documented benefits. The American journal of gastroenterology 2016;111:913. 18. Williamson K, Willard M, Payton M, et al. Efficacy of omepra- zole versus high‐dose famotidine for prevention of exer- cise‐induced gastritis in racing Alaskan sled dogs. Journal of veterinary internal medicine 2010;24:285-288. Dr. Wilco Botha, BSc BVSc (Hons) MMedVet (Med) Section of Small Animal Medicine, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria. 1st Annual Business Congress Skills training and updates on: Human Resources, FInancials & Marketing 11 - 12 October | Durban 25 - 26 October | Cape Town 29 - 30 October | Johannesburg Issue 03 | JULY 2018 | 33 For more information: www.ivpd.co.za