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Pharmacology II > Autonomic and Cardiac Review > Flashcards

Autonomic and Cardiac Review Flashcards

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1
Q

what is the main neurotransmitter of cholinergic NS

A

acetylcholine

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2
Q

what is the main neurotransmitters of the adrenergic NS

A

epinephrine, NE, DA

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3
Q

what is the main result of an alpha1 receptor agonist

A

vasoconstriction, increase BP

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4
Q

what is the main result of a beta1 receptor agonist

A

increase HR and contractility

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5
Q

what is the main result of a beta2 receptor agonist

A

dilation, bronchodilation

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6
Q

Does an M receptor agonist increase activity in PNS or SNS

A

PNS

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7
Q

what receptor does bethanecol target and agonist or antagonist

A

M receptor agonist

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8
Q

what is bethanecol indicated for

A

decreased bladder contractility, equine gastric ulcer syndrome (increase activity of PNS)

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9
Q

when are some examples of when bethanecol would be contraindicated

A

obstruction, gastric ulcers in small animals, hyperthyroidism (cause a-fib), hypotension, bradycardia, vagal nerve dysfunction, asthma (bronchoconstriction), hx recent GI sx

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10
Q

In myasthenia gravis, what does the drug want to inhibit

A

cholinesterase

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11
Q

what is the diagnostic drug of choice for myasthenia gravis

A

neostigmine

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12
Q

what is a potential adverse effect of neostigmine

A

cholinergic overdose-hypotensive, bradycardic, bronchoconstriction

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13
Q

what is the drug of choice in treating myasthenia gravis

A

pyridostigmine bromide

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14
Q

what are some adverse effects of pyridostigmine bromide

A

downregulate Mn receptors so constantly need to increase dose, can lead to intussception

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15
Q

is atracurium a cholinergic or adrenergic agonist or antagonist

A

cholinergic antagonist (decrease PNS activity)

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16
Q

what are the indications for atracurium

A

unblocking male cats and to paralyze animals

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17
Q

T or F: animals who received atracurium receive both an analgesic and pain relief effect

A

false! it just paralyzes them but they can feel everything

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18
Q

what is the order of muscles that become paralyzed with atracurium

A
  1. first small muscles become weak, flaccid, paralyzed
  2. small muscles
  3. large muscles
  4. abdominal and laryngeal muscles
  5. respiratory muscles
    **recover in reverse order
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19
Q

what drug is used to reverse the effects of atracurium

A

acetylcholinesterase inhibitors like neostigmine

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20
Q

is atropine sulfate a cholinergic or adrenergic agonist or antagonist

A

cholinergic antagonist

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21
Q

what receptor does atropine sulfate act on

A

M receptor competitive antagonist

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22
Q

what are the labeled used of atropine sulfate

A
  1. decrease secretions pre-anesthesia
  2. bradycardia, sinoatrial arrest, incomplete AV blocks
  3. vagally mediated or primary bradycardia
  4. tx cholinergic toxicities
  5. pain secondary to uveal or corneal dz
  6. dilation
  7. synechia breakdown
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23
Q

what effect does atropine sulfate have on the eyes

A

dilation, blocks accommodation, dry eyes, and increase IOP

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24
Q

what is an adverse effect of atropine sulfate in horses

A

colic (decreasing PNS activity)

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25
is glycopyrolate a cholinergic or adrenergic agonist or antagonist
cholinergic antagonist
26
what are some indications of glycopyrolate
1. pre-med for dogs and cats (labeled) 2. bradycardia (ELDU) 3. counteract imidiocarb in horses (ELDU)
27
you are trying to choose between using glycopyrolate or atropine sulfate in pregnant dog who is bradycardia under anesthesia, which is better
glycopyrolate- quaternary amine so has a lower distribution so won't cross placenta, milk or CNS like atropine sulfate will
28
is oxybutinin chloride a cholinergic or adrenergic agonist or antagonist
cholinergic antagonist
29
what is oxybutinin chloride indicated for
detrusor hyperreflexia in dogs
30
what are some potential side effects of oxybutinin chloride
tachycardia, bronchodilation, increase IOP (decrease PNS/increase SNS)
31
what are some contraindications for oxybutinin chloride
blocked patients, tachycardia, glaucoma
32
is isoproterenol a cholinergic or adrenergic agonist or antagonist
adrenergic agonist
33
what receptors does isoproterenol act on
direct acting B1 (increase HR and contractility) and B2 (bronchodilation) agonist
34
what are some indications for isoproterenol
1. bradycardic-B1 receptor 2. acute bronchoconstriction-B2 receptor
35
what are some adverse effects of isoproternol
hypotension, tachycardia
36
is epinephrine a cholinergic or adrenergic agonist or antagonist
agonist
37
what receptors does epinephrine act on
alpha1 (high dose), B1 (low dose)
38
what are some indications for epinephrine
1. cardiac arrest, bradycardia (B1-low dose) 2. anaphylaxis (alpha1-vasoconstriction)
39
is NE a cholinergic or adrenergic agonist or antagonist
adrenergic agonist
40
What are the indications of NE
Hypotension in dogs, cats and foals
41
What are some adverse effects of NE
Hypertension, arrhythmias, seizures
42
Is dopamine HCl a cholinergic or adrenergic agonist or antagonist
Adrenergic agonist
43
What are some indications for dopamine HCl
Hypotension in dogs and cats
44
What does low dose dopamine target/cause
DA receptors in renal and mesenteric vasculature causing dilation
45
What does high dose dopamine target/cause
Target alpha1 receptors resulting in vasoconstriction
46
Is phenylephrine a cholinergic or adrenergic agonist or antagonist
Adrenergic agonist
47
What receptor does phenylephrine HCl act on
Direct acting alpha1 agonist
48
What are some indications for phenylephrine HCl
1. Hypotension in cats and dogs 2. Ascending colon displacement in horses 3. Ophthalmic solution- induce myriadsis without loss of accommodation
49
When can phenylephrine be used in emergency situations
To increase BP if fluid blouses and atropine already on board or to increase CO without contractility or HR
50
What are some adverse affects of phenylephrine
Reflex bradycardia, hypertension, colic, hemorrhage, necrosis
51
What are some contraindications with phenylephrine
Arrhythmia or bradycardia, hypertension, renal or hepatic insufficiency, elderly, hyperthyroidism
52
Is dobutamine a cholinergic or adrenergic agonist or antagonist
Adrenergic agonist
53
What receptor does dobutamine act on
Direct acting B1 agonist
54
What are some indications for dobutamine HCl
Tx acute heart failure
55
What are some adverse affects of dobutamine
Tachycardia, arrhythmias, seizures
56
What are some contraindications for dobutamine
Subaortic stenosis, hypovolemia, myocardial infarction, arrhythmias, hypersensitivity
57
Which receptors does albuterol, clenbuterol, and terbutaline act on and what are they indicated for
Direct acting b2 agonists- indicated for bronchoconstriction
58
Is phenylpropanolamine a cholinergic or adrenergic agonist or antagonist
Adrenergic agonist
59
What are some indications for phenylpropanolamine
Urinary incontinence
59
What receptor does phenylpropanolamine act on
Mixed acting adrenergic agonist
60
What are some adverse effects of phenylpropanolamine
Urine retention, tachycardia, hypertension
61
What are some contraindications for phenylpropanolamine
Glaucoma, prostatic hypertrophy, hyperthyroidism, DM, CVD, kidney insufficiency, hypertension
62
Is ephedrine sulfate a cholinergic or adrenergic agonist or antagonist
Adrenergic agonist
63
What are some indications for ephedrine sulfate
1. Hypotension associated with anesthesia in dogs, cats and horses 2. Urinary incontinence but rarely used
64
What receptor does ephedrine sulfate act on
Mixed acting adrenergic agonist
65
Is prazosin a cholinergic or adrenergic agonist or antagonist
Adrenergic antagonist
66
What receptor does prazosin act on
Competitive Alpha1 antagonist
67
What are some indications for prazosin
1. Functional urethrospasm in dogs 2. Hypertension in dogs and cats 3. Adjunctive in CHF management with digoxin
68
Is phenoxybenzamine HCl a cholinergic or adrenergic agonist or antagonist
Adrenergic antagonist
69
What receptor does phenoxybenzamine HCl act on
Non competitive alpha1 antagonist
70
What are some indications for phenoxybenzamine
1. Functional urethrospasm in dogs, cats and horses 2. Pheochromocytoma
71
How does phenoxybenzamine treat a pheocrhomocytoma
Tumor releases NE and Epi cause severe hypertension, tachycardia, and arrhythmia. Phenoxybenzamine is a non-competitive alpha1 antagonist so will block alpha1 therefore avoiding vasoconstriction
72
What are some adverse effects of alpha1 antagonists
Hypotension, reflex tachycardia, nasal congestion, lethargy, GI effects, miosis, increased IOP, inhibit ejaculation
73
What are some contraindications for alpha1 antagonists
CHF, hypotensive, renal failure, colic, glaucoma
74
Are the following B1 or B1/2 antagonists: atenolol, esmolol, metoprolol. And what is their function
B1 antagonists- decreased HR and contractility
75
Are the following B1 or B1/2 antagonists: propranolol, sotalol, timolol. And what is their function
B1/2 antagonist: decrease HR and contractility (B1) and vasodilation (B2)
76
When are B-antagonists used
Tachycardic, hypertension
77
Which B-antagonists have a mild local anesthetic activity and what is mechanism
Propranolol and metoprolol via Na+ blockade
78
Which B-antagonists caused a marked decrease in HR in healthy cats and is contraindicated in cats with cardiac disease
Timolol
79
Which B antagonist is fast acting with short duration and usually used as diagnostic tool
Esmolol
80
Which B-antagonist can treat thyrotoxicosis
Propranolol
81
What are some adverse effects of B-antagonists
Bradycardia, bronchoconstriction, hypotension
82
What are some contraindications of B-antagonists
CVD, asthma/RAO, renal or hepatic insufficiency, DM
83
What class of drugs are furosemide, spironolactone, and hydrochlorothiazide
Diuretics
84
What class of drug are enalapril, benazepril, lisinopril, rampipril
ACE inhibitors
85
What class of drug is pimobendan
Calcium sensitizer
86
What class of drug is digoxin
Digitalis
87
What class of drug is dobutamine and dopamine
Sympathomimetics
88
What class of drug is carvedilol
Alpha and beta blocker
89
What class of drug is diltiazem
Calcium channel blockers
90
What is the result of hypertrophic cardiomyopathy
Impaired ventricular filling
91
What drugs are most effective in treating HCM
ACE inhibitors and furosemide
92
Where does furosemide act in tubular system
Loop diuretic
93
What diuretic is used for acute heart failure
Furosemide
94
T or F: furosemide should be used as a monotherapy in tx of chronic HF
False
95
What are some adverse effects of furosemide
Excessive fluid and or electrolyte losses
96
Which diuretic is primarily used to reduce exercise induced pulmonary hemorrhage in race horses
Furosemide
97
Which diuretic is also known as the k-sparing diuretic
Spironolactone
98
Which diuretic needs to be used cautiously in patients receiving ACEI or K supplement and why?
Spironolactone because can cause hyperkalemia
99
What diuretic is contraindicated in hyperkalemic patients
Spironolactone
100
Which diuretic can be used in adjunctive tx for hyperkalemic periodic paralysis in horses
Thiazide diuretics
101
How do ACE inhibitors work
Block conversion of angiotensin I to active angiotensin II- effects RAAS system
102
Angiotensin decreases the secretion of ___hormone which therefore decreases Na+ retention
Aldosterone
103
What are some indications for ACE inhibitors
Chronic HF, DCM, chronic valvular insufficiency, HCM
104
What is the drug of choice for systemic arterial hypertension in dogs
ACE inhibitors
105
What are some adverse effects of ACE inhibitors
Renal function deterioration, hypotension, GI upset, hyperkalemia
106
What are some common ACE inhibitors for HF
Enalapril, benazepril, ramipril, lisinopril
107
Which ACE inhibitor is labeled for dogs
Enalapril
108
What is the mechanism of action of pimobendan
Increases contractility by increasing myofilament sensitivity to Ca2+ Inhibits phosphodiesterase III which breaks down cAMP—> increase cAMP—> increase PKA—>activate L-type calcium channels—> increase myocardial contractions
109
What are some indications for pimobendan
HF from DCM or chronic mitral valve disease
110
What is the mechanism of action of digoxin
Binds and inhibits Na/K+ ATPase, decreases Na+/Ca2+ exchange therefore increase intracellular Ca2+—> increase contractility
111
What anti arrhythmic effects does digoxin have
Against supraventricular tachycardia humans
112
What is the max dose for digoxin
0.25mg/dog
113
What interactions can cause increased digitalis toxicity
Hypokalemia, B-antagonists, calcium channel blockers, antibiotics
114
How does potassium affect digitalis toxicity
Reduce toxicity
115
How does calcium affect digitalis toxicity
Enhances toxicity
116
What is the standard drug therapy for heart failure
1. Diuretics (furosemide) 2. ACE inhibitors 3. Pimobendan
117
Do drugs that act through nitric oxide dilate veins or arteries
Preferentially dilate veins but can dilate arteries
118
How does hydrazoline affect arteries and veins
Dilates arterioles not veins
119
What is hydrazine most effective in treating
CHF secondary to mitral valve insufficiency
120
what is the purpose of calcium channel antaognists
Decrease cardiac contractility, reduced impulse generation in SA node and slowed AV conduction
121
What is the mechanism of action of amlodipine besylate
Ca2+ channel blocker that causes vasodilation
122
What is the drug of choice in hypertensive cats
Amlodipine besylate
123
What is the mechanism of action of diltiazem
Depresses SA and at node
124
When is diltiazem used
HCM in cats and supraventicular tachycardia in dogs
125
Amlodipine or diltiazem: causes greater depression of SA and AV node and negative ionotropic
Diltiazem
126
Amlodipine or diltiazem: causes greater vasodilation and reflex tachycardia
Amlodipine
127
What is the mechanism of action of sildenafil
Selective inhibitor of cGMP and PDE5-producing vasodilation
128
When is sidenafil used
Pulmonary hypertension in dogs
129
What are the 2 aims of therapy of arrhythmias
1. Reduce ectopic pacemaker activity 2. Modify conduction or refractories to disable re-entry
130
What do Class I anti-arrhythmics block
All block sodium channels
131
What are the Class I A drugs
Quinidine and procainamide
132
What do class I A drugs block
Preferential block open or activated sodium channels- lengthen the duration of action potential (increase ERP)
133
What are the class I B drugs
Lidocaine
134
What do class I B drugs do
Preferentially block inactivated sodium channels, shorten action potential and ERP
135
What is the function of class II antiarrthymics
Reduce adrenergic activity
136
What anti-arrhythmic class are beta blockers
Class II
137
What is the function of class III anti-arrhythmics
K+ channel blockers and extend ERP
138
What are the class III anti-arrhythmic drugs
Sotalol, amiodarone
139
What is the function of class IV anti-arrhythmic drugs
Calcium channel blockers, decrease HR and contractility
140
What class of anti-arrhythmics is diltiazem
Class IV
141
What is the mechanism of action of quinidine
Binds to open and activated sodium channels- prolonging depolarization, AP and ERP
142
Quindine can block muscarinic receptors which results in___
Increase HR and AV conduction
143
What is the result of quinidine blocking alpha receptors
Hypotension, reflex tachycardia
144
What arrhythmias does quinidine tx
Supraventricular, ventricular arrhythmias, and re-entrant arrhythmias
145
When is quinidine contraindicated
Patients with MG, AV block, digitalis toxicity
146
What are some adverse effects of quinidine
Hypotension, widened QRS, prolonged QT, AV block, ventricular tachycardia
147
Which is more effective at treating ventricular arrhythmias: quinidine or procainamide
Quinidine
148
What arrythmias does lidocaine tx
Ventricular origin
149
T or F: lidocaine can be used orally
False, due to first pass effect
150
What class II drug is used to reduce supraventricular tachycardia, a-fib or atrial flutter
Propranolol
151
What class II drug is effective in treating supraventricular tachyarrythmias, systemic hypertension, and HCM
Atenolol
152
What class II drug tx acute supraventicular tachycardia
Esmolol
153
What drug is used to tx arrythmogenic cardiomyopathy in boxers
Sotalol
154
When is diltiazem used
A-fib, supraventicular tachycardia, HCM
155
What transporter does furosemide inhibit and what is the result
NKCC2, reduces Na+ absorption
156
How do loop diuretics cause hypokalemia and alkalosis
Increase excretion of Mg2+ and Ca2+
157
How do loop diuretics relieve pulmonary congestion
Increase PG synthesis and result in vasodilation
158
What are some uses for furosemide
1. Removal of edema fluid in HF 2. Tx hypercalcemia by increasing Ca2+ excretion 3. Prevents exercise induced pulmonary hemmorrhage and epitaxis in horses (likely due to Pg synthesis and dilation)
159
What are some adverse effects of furosemide
Hypokalemia (increase digitalis toxicity), hypocalcemia, hypomagnesemia, hyponatremia, hypovolemia
160
What receptor do thiazide diuretics act on
NCC in DCT, inhibit Na+ reabsorption
161
What are some adverse effects of thiazide diuretics
Hypokalemia, hypercalemia
162
When are thiazide diuretics used
Hyperkalemic periodic paralysis, long term HF, prevent calcium oxalate urotliths
163
What is chlorothiazide used for
Dairy cattle to tx post -Sarum udder edema
164
Where do potassium sparing diuretics/spironolactone act
ENAC, competitive inhibitor of aldosterone
165
When is spironolactone used
CHF (unresponsive to furosemide), hepatic cirrhosis, nephrotic syndrome, and severe ascites
166
When using spirnolactone what other heart drugs do you need to be cautious when using
ACE inhibitors and ARBS due to hyperkalemia
167
When is mannitol used
1. Acute renal failure 2. Decrease IOP 3. Decrease ICP 4. Protect kidney against nephrotoxic substances
168
What are some adverse effects of mannitol
Pulmonary edema in HF
169
What type of inhibitor is acetazolamide
Carbonic anhydrase inhibitor
170
What is the mechanism of action of acetazolamide
Inhibit CA enzyme, block HCO3- reabsorption, reduce Na+ reabsorption, increase Na/K+ exchange
171
What is acetazolamide used for
Reduce aqueous humor production in glaucoma patients, conjunctive tx in HYPP
172
What is the intrinsic coagulation pathway
Factor XII—> Factor XI—> Factor IX—> Factor VIII—> Factor X—< Factor V—< Factor II (thrombin)—> Factor I (fibrinogen)—> clot
173
What is the extrinsic coagulation pathway
Tissue factor—> factor VII—> factor X—> factor V—> Factor II (thrombin)—> Factor I (fibrinogen)—> clot
174
What are the vitamin K dependent coagulation
Factor II, Factor VII, Factor IX, Factor X
175
What are some examples of hypercoaguable/ thromboembolic states
1. Cats with HCM 2. Dogs with IMHA 3. Cushing dz 4. Animals with acute phase inflammation 5. Protein losing nephropathy
176
What are some examples of hypoocoaguable states
1. Post sx trauma intoxication 2. Genetic bleeding diathesis 3. Liver intoxication 4. Liver failure
177
What is warfarin sodium indicated for
Prophylactic treatment of thrombotic conditions
178
What is the mechanism of action of warfarin sodium
Blocks vitamin K epoxide reductase—> decrease clotting factors
179
What are some adverse effects of warfarin
Fatal hemorrhage associated with anemia, hematomas in any system
180
What are the indications for vitamin K
1. Rodenticide toxicity and moldy sweet clover 2. Prolonged sulfonamide treatment of birds for coccidosis 3. Congenital vitamin K dependent coagulopathy 4. Porcine hemorrhagic syndrome
181
What is the mechanism of action of vitamin K
Conjugates with y-glutamyl carboxylase and makes new y-glutamyl carboxylase (important to make clotting factors)
182
IM and deep SC administration of heparin can cause ___
Hematomas
183
Heparin requires the presence of what to work
Anti-thrombin III
184
What are some adverse effects of heparin
Bleeding risk in dogs with IMHA, can cause IMTP and platelet activation
185
What does rivaroxaban inhibit
Competitive inhibitor of Factor Xa
186
Does rivaroxaban require anti-thrombin III to work
No
187
What is mechanism of action of rivaroxaban
Blocks Factor Xa—> reduce clotting
188
What is the mechanism of action of acetylsalicyclic acid
Irreversible inhibitor of COX-1 preventing thromboxane production (blocking platelet aggregation)
189
What are some adverse effects of acetylsalicyclic acid
Life threatening metabolic acidosis, GI ulceration, nephrotoxicity
190
What is the mechanism of action of clopidogrel bisulfate
Irreversible inhibition of platelet ADP receptor
190
What are some contraindications of acetylsalicyclic acid
1. Being a cat 2. Hemorrhagic disorders
191
What is the mechanism of collasate
Activates platelets by binding collagen receptors
192
What are the indications for tissue plasminogen activator
Pulmonary thromboembolism, arterial thromboembolism
193
What is the mechanism of action of tissue plasminogen activator
Activates plasminogen and promotes Fibrinolysis
194
What are some indications for aminocaproic acid
1. Post sx- bleeding 2. Guttural pouch bleeding in horses
195
What are the indications for tranexamic acid
1. Post sx bleeding in dogs and cats
196
What are some adverse effects of tranexamic acid
Consistently induces vomiting in dogs

Pharmacology II (36 decks)

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