Cardiac and Pulmonary

Question 1

cardiac glycosides

Answer 1

steroids that have a lactone group attached to the steroid nucleus

Question 2

Cardiac Glycoside Sources (4)

Answer 2

1. Cardiac medications (ex: digoxin)
2. Plants (Oleander, Foxglove, Lily-of-the-Valley, Milkweed),
3. Bufo Toads
4. Fireflies

Question 3

Cardiac Glycoside MOA

Answer 3

inhibits the sodium-potassium pump in cardiac muscle

Question 4

Cardiac Glycoside Clinical Signs

Answer 4

ARRYTHMIAS, GI upset (a lot of vomiting), hyperkalemia, lethargy, uneasiness, SUDDEN DEATH

Question 5

Cardiac Glycoside Antidote?

Answer 5

yes - Digibind

Question 6

Digibind

Answer 6

human antidote for digoxin, very expensive (but patient would go home quickly)

Question 7

Grayanotoxin MOA

Answer 7

binds to sodium channels in nerves, heart, and skeletal muscle, so cells are in prolonged depolarization

Question 7

Cardiac Glycoside Treatment

Answer 7

ACTIVATED CHARCOAL (decreases absorption by 96%), NO calcium-containing fluids, symptomatic tx (especially for arrythmias)

Question 8

Grayanotoxin Sources (4)

Answer 8

Rhododendron
Azalea
Laurel
Japanese pieris

Question 9

Grayanotoxin Clinical Signs

Answer 9

negative chronotropic action (sinus arrest)
also bloat/abdominal pain, vomiting, anorexia, teeth grinding, depression, ataxia, convulsions

Question 10

Do grayanotoxins have an antidote?

Answer 10

no

Question 11

Grayanotoxin Tx

Answer 11

decontaminate, monitor heart, symptomatic/supportive care

Question 12

What is the only part of the Yew plant that isn’t toxic?

Answer 12

the ripe fleshy fruit part

Question 13

Yew MOA

Answer 13

directly toxic to the cardiac myocyte ion channels

Question 14

Yew Clinical Signs

Answer 14

basically sudden death, can give AC but otherwise minimize stress and provide supportive care

Question 15

White Snakeroot Cardiovascular Signs

Answer 15

CHF and arrythmias; cause cardiac necrosis in horses and if recovered can have residual circulatory dysfunction

Question 16

Avocado Clinical Signs

Answer 16

cardiac arrythmias, myocardial necrosis, pulmonary congestion and edema

Question 17

Are all parts of an avocado toxic?

Answer 17

yes

Question 18

Toxin in Avocados?

Answer 18

persin

Question 19

Avocados can affect cardiac and _______ tissue

Answer 19

mammary

Question 20

Gossypol

Answer 20

from pigment gland in cottonseed and causes “thump” (pigs)

Question 21

Gossypol Clinical Signs

Answer 21

CHF, weakness, cyanosis, “thumping”

Question 22

What species is most susceptible to cardiac failure due to ionophores?

Answer 22

horses

Question 23

Albuterol TOXICOSIS MOA

Answer 23

beta-1 and 2 agonist (normally only 2)

Question 24

Albuterol Toxicosis Clinical Signs

Answer 24

tachycardia (200+ bpm and hypokalemia)

Question 25

Albuterol

Answer 25

commonly used to treat bronchospasm associated with asthma

Question 26

Albuterol Tx

Answer 26

propranolol (non-selective beta blocker for tachycardia)
decontaminate, symptomatic/supportive

Question 27

Phenylpropanolamine (PPA)

Answer 27

sympathomimetic agent withdrawn from human market but still used in vet med for controlling urinary incontinence in dogs (Proin)

Question 28

PPA Clinical Signs

Answer 28

tachycardia, agitated, and hypertension (very high), then later reflex bradycardia, depressed, and hypertensive

Question 29

PPA Tx

Answer 29

decontamination, heart/blood pressure drugs (ace or nitroprusside), fluids

Question 30

Why do you NOT give atropine to bradycardic PPA patients??

Answer 30

this will WORSEN the already awful hypertension - so make sure to take blood pressure before administering atropine

Question 31

Paraquat

Answer 31

bipyridylium herbicide for restricted use; used in malicious poisonings

Question 32

Paraquat MOA

Answer 32

forms a free radical and eventually lipid peroxides will stimulate a self-perpetuated damaging rxn; pulmonary specific toxin

Question 33

Paraquat Clinical Signs

Answer 33

oral and dermal burns, GI damage, renal failure and hepatocellular necrosis, but most importantly progressive pulmonary fibrosis

Question 34

Should you ever induce emesis with Paraquat?

Answer 34

YES even though it’s so corrosive, it is also incredibly deadly so this is where the risk needs to be taken

Question 35

pulmonary fibrosis

Answer 35

damage to lungs repaired by fibrosis but then the lung can’t expand so there’s no oxygen exchange and then your patient suffocates

Question 36

Should you give oxygen to Paraquat patients?

Answer 36

NO this increases free radicals therefore increasing pulmonary damage!

Question 37

Acute Bovine Pulmonary Emphysema and Edema (4 sources)

Answer 37

Question 38

Type 1 pneumocytes

Answer 38

main oxygen exchanger in lung that’s damaged when acute bovine pulmonary edema and emphysema occur

Question 39

Hydrogen Sulfide Signs

Answer 39

colorless gas (rotten eggs) that causes loss of smell, loss of consciousness, and death d/t direct paralysis of the respiratory center

Question 40

Hydrogen Sulfide Source?

Answer 40

pits! and apparently Yellowstone

Question 41

Fumonisin Pigs

Answer 41

heart failure is first but also causes pulmonary edema

Question 42

Teflon aka Polytetrafluoroethylene (PTFE)

Answer 42

nonstick cookware that release toxic particles upon heating that causes seizures and death in birds!

Question 43

Petroleum Distallates

Answer 43

remember these “defat” so if they’re aspirated they’ll do this to the lungs and you get chemical pneumonitis