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RUSVM Pharmacology > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

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1
Q

What are the non selective a-agonists?

A

Epinephrine

Norepinephrine

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2
Q

What are the selective a1 agonists?

A

Dopamine (high dose)

Phenylephrine

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3
Q

What are non-selective a antagonists?

A

Phenoxybenzamine

Phentolamine

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4
Q

What are selective a1-antagonists?

A

Prazosin

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5
Q

What are direct and indirect acting sympathomimetics?

A

Vasopressin
Ephedrine
Pseudoephedrine
Phenylpropanolamine (PPA)

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6
Q

What drugs are ACE inhibitors?

A

Enalapril

Benazepril

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7
Q

What is the MOA of enalapril and benazepril?

A

ACE inhibitors

Inhibit angiotensin II synthesis and aldosterone

Increase bradykinin (ACE usually inactivates)

  • vasodilator
  • stimulate PG
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8
Q

What is the osent on ACE inhibitors?

A

Usually slow with peak effects seen 1-2wks after starting treatment

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9
Q

Where are enalapril and benazepril metabolized and excreted

A

Both metabolized in the liver

Enalapril -renal clearance

Benazepril - hepatic > renal clearance

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10
Q

What are the indications for ACE inhibitors ?

A

Congestive heart failure
Hypertension
Protein losing renal disease -> reduce intraglomerular hypertension

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11
Q

What are the precautions to using ACE inhibitors ?

A

GI signs

Hypotension

Risk of worsening azotemia (high nitrogen) due to decrease GFR

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12
Q

What drug is a phosphdiesterase inhibitor?

A

Sildenafil

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13
Q

What is the MOA of sildenafil?

A

Phosphodiesterase V inhibitor -> increased cGMP -> nitric oxide (NO) mediated vasodilation

Smooth muscle of pulmonary vasculature

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14
Q

What are the therapeutic indications of sildenafil?

A

Treatment of pulmonary hypertension
Eisenmenger’s syndrome
Erectile dysfunction in humans

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15
Q

What are precautions to using sildenafil?

A

Systemic hypotension
Caution in hypovolemic patients, left ventricular outflow tract
GI signs

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16
Q

When is sildenafil contraindicated ??

A

Concurrent use with nitrates

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17
Q

What are the direct acting vasodilator?

A

Nitroprusside
Nitroglycerine
Hydralazine

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18
Q

What is the MOA of mictroprusside and nitroglycerine?

A

Increased formation of NO -> activate guanylyl cyclase -> increase cGMP -> stimulation of GMP-dependent protein kinase -> arteriolar and venous vasodilation

Relax vascular smooth muscle

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19
Q

What is the MOA of hydralazine?

A

Increase local PGI2 concentration -> alter cellular calcium metabolism in smooth muscle

  • interferes with calcium movements
  • prevent initiation and maintenance of contractile state
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20
Q

What are the indications to using hydralazine?

A 
Hypertensive crisis
Afterload reduction (severe CHF)
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21
Q

What are precautions to using hydralazine?

A

Hypotension -> may be severe
Syndrome
Weakness, lethargy

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22
Q

When is hydralazine contraindicated??

A

Renal disease
Reduce renal blood flow -> activate RAAS -> worsen renal injury

Pre-treat with ACE-I or spironolactone to reduce risk

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23
Q

What is the MOA of Amlodipine?

A

Calcium channel blocker

Inhibit the influx of extracellular calcium across myocardial and smooth muscle cell membranes

  • > decrease contractions
  • > dilation of the coronary and systemic arteries
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24
Q

What are the clinical effects of amlodipine?

A 
Neg inotropic effect
Neg chronotropic effect 
Increase oxygen delivery to myocardial tissue 
Decrease afterload 
Coronary vasodilation
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25
What effects does amlodipine have on the vasculature?
Decrease peripheral resistance | Decrease systemic BP
26
What is the drug of choice for first line treatment of hypertension in CATS :)
Amlodipine
27
What are precautions to using amlodipine?
``` Hypotension Bradycardia AV block GI signs Elevated liver enzymes ```
28
What drug is an angiotensin II antagonist?
Losartan
29
What is the MOA of losartan? What is its indication?
Angiotensin II receptor competitive antagonist Antihypertensive (adjunct therapy)
30
What is the mechanism of action of sildenafil?
PDE V inhibitor
31
What is the main indication of sildenafil?
Treat pulmonary hypertension
32
What drugs are used to treat pulmonary hypertension?
Sildenafil (drug of choice) Pimobendan (can delay the onset, but not the treatment of choice)
33
What is the main clinical indication of amlodipine?
Treats systemic hypertension
34
What is a more balanced venodilator, hydralazine or nitroprusside??
Nitroprusside
35
What is a hemostatic agent?
Helps support blood clotting
36
What is an anticoagulant?
Inhibit coagulation factors
37
What is an antithrobotic?
Inhibits platelets
38
What is a thrombolytic?
Break down an existing clot
39
What is the MOA of phytonadione
Vitamin K1 Necessary for the synthesis of coagulation factors II, VII, IX, X
40
What are the vitamin K-dependent coagulation factors??
II, VII, IX, X
41
What is the drug of choice for treatment of bleeding disorders associated with vitamin K1 deficiency
Phytonadione
42
What is the antidote for anticoagulant rodenticide toxicity or hemorrhage associated with warfarin ?
Phytonadione
43
How do you administer phytonadione?
ONLY give SQ -> risk of anaphylaxis if given IV
44
What are the hemostatic agents ?
Phytonadione - vit K1 Protamine sulfate Aminocaproic acid (antifibrinolytic) Desmopressin acetate (hormonal agent)
45
What is the MOA of protamine sulfate?
Complexes with heparin to form and inactive stable salt
46
What is the drug of choice for treatment of hemorrhage secondary to heparin over dosage?
Protamine sulfate
47
What are precautions to using protamine sulfate ?
Rapid IV injection ``` Hypotension Bradycardia Pulmonary hypertension Dyspnea Possible hypersensitivity reaction ```
48
What is the MOA of aminocaproic acid?
Inhibits fibrinolysis via inhibitory effects on plasminogen activation substances and some antiplasmin action (Inhibit clot breakdown)
49
What is used to treat conditions associated with increased bleeding due to hyperfibrinolysis?
Aminocaproic acid (antifibrinolytic)
50
Aminocaproic acid has been used prophylactiaclly to prevent post-op bleeding in _____________
Greyhounds
51
What is the MOA of desmopressin acetate?
Causes dose-dependent in plasma factor VIII and plasminogen factor Support primary hemostatis -> platelet function
52
What is the drug of choice for treatment of bleeding due to vonWillebrand's disease
Desmopressin Also for central Diabetes insipidus
53
What drug has been used to treat blooding due to aspirin toxicity in dogs
Desmopressin
54
What is a precaution to desmopressin use?
Fluid and sodium retention with overdose
55
What are the anticoagulants ?
Unfractionated heparin Low molecular weight heparin (dalteparin and enoxaparin) Warfarin sodium f
56
What is the MOA of unfractionated heparin?
Binds to antithrombin III to inactivate coagulation factor Xa and prevents the conversion of prothrombin to thrombin
57
What are the indications to use unfractionated heparin?
Heparinized saline flush Treat certain thromboembolic disease Prophylactic treatment in patients at risk of developing thromboembolic disease DIC (controversial)
58
What are precautions to using unfractionated heparin ?
Risk of bleeding Heparin-induced thrombocytopenia MONITORING -> coagulation time Administered IV or SQ
59
What are the low molecular weigh heparin ?
Dalteparin | Enoxaparin
60
What is the MOA of low molecular weight heparin?
Bind antithrombin III to inactivate coagulation factor Xa Preferentially inhibit factor Xa and have minimal impact on thrombin and clotting time
61
What are the therapeutic indications to low molecular weight heparin?
Prophylactic to treatment of pulmonary embolism or thromboembolic disease Deep vein thrombosis
62
What are precautions of low molecular weight heparin
Hemorrhage unlikely, but possible Must be given SQ Frequent dosing Expensive
63
What is the MOA of warfarin sodium?
Inhibit vitamin K epoxied reductase -> interfere with synthesis of coagulation factors II, VII, IX, and X
64
What are the therapeutic indications of warfarin
Primarily used in dogs for the oral, long-term treatment of thromboembolic disease
65
What are the precautions of warfarin?
Life threatening hemorrhage possible -> dose related CAREFUL monitoring of clotting times Highly protein bound -> drug drug interactions significant
66
What are the antithrombotics?
Aspirin (NSAID) Clopidogrel bisulfate (platelet aggregation inhibitor)
67
What is the MOA of Asprin
Reduce platelet aggregation through inhibiting synthesis of thromboxane A2 Selective COX1 inhibition. -> anti-inflammatory
68
What is the therapeutic indication of asprin ?
Prophylaxis or treatment of thrombotic disease - feline aortic thromboembolism - immune mediated hemolytic anemia
69
Asprin is contraindicated in what cases
GI ulceration and active GI bleeding
70
What are precautions of asprin use?
VERY long half life in cat -> EOD dose (72hrs) High dose can cause increased platelet aggregation
71
Clopidogrel bisulfate MOA?
Reduce platelet aggregation through selectively inhibiting the ADP receptor on the platelet surface
72
What is the therapeutic indications of clopidogrel bisulfate
Prophylaxis or treatment of thrombotic disease
73
When is clopidogrel bilsulfate used contraindicated?
GI ulceration and active GI bleeding
74
What is a precaution to using patent aggregation inhibitor ?
AKA clopidogrel Low risk of clinically significant bleeding when used alone
75
What are the thrombolytic drugs?
Streptokinase Urokinase Tissue plasminogen activator (t-PA)
76
What thrombolytic drug is fibrin clot specific?
Tissue plasminogen activator
77
What is the MOA of thrombolytic?
Activate plasminogen to breakdown existing clots-> thrombolysis
78
What is the therapeutic indication to using thrombolytic?
Treatment of existing thrombus or thromboembolism
79
What are precautions to thrombolytic use?
Life threatening hemorrhage possible Must be given IV
80
``` Which of the following dugs acts by inhibiting fibrinolysis ? Vitamin K1 Protamine sulfate Aminocaproic acid Clopidogrel ```
Aminocaproic acid
81
What is the specific antidote for anticoagulate rodenticide toxicity?
Vitamin K1 | AKA phytonadione
82
What is the MOA of clopidogrel?
Anti-platelet aggregation through ADP inhibition
83
What is a fibrin clot specific thrombolytic?
Tissue plasminogen activator

RUSVM Pharmacology (18 decks)

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