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RUSVM Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

What are the catecholamine B1- agonists?

A 
Epinephrine 
Norepinephrine 
Dopamine 
Dobutamine 
Isoproterenol
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2
Q

What two drugs are methylxanthines?

A

Aminophylline

Theophylline

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3
Q

What is the MOA of aminophylline ?

A

Phosphodiesterase (PDE) inhibition -> increase the amount of cAMP-> increase release of endogenous epinephrine

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4
Q

What is the main effect of aminophylline and theophylline?

A

Bronchodilation

  • direct relaxation of smooth muscle in bronchi and pulmonary vasculature
  • some centrally mediated respiratory stimulation

Weak chronotrope and inotrope
(Usually considered a side effect)

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5
Q

What are precautions to treating with aminophylline/theophylline?

A

Patient with cardiac disease or hypertension
->tachycardia

Seizure disorder 
Gastric ulcer 
Hyperthyroidism 
Severe hypoxia 
Renal or hepatic dysfunction
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6
Q

What are used in the treatment of congestive heart failure ?

A 
Positive inotrope 
Vasodilator 
Inodilator (both positive inoptropic  and vasodilator effects) 
Diuretics 
Beta blockers
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7
Q

What is the body’s normal compensatory mechanisms for congestive heart failure?

A

In response to decreased blood pressure:

  • Increase sympathetic tone
  • ADH secretion
  • RAAS activation

Myocardial remodeling

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8
Q

What to drugs are positive inotropes?

A

Digoxin

B-1agonsit (eg Dobutamine)

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9
Q

What is the MOA of digoxin?

A

Inhibit Na/K/ATPase in the myocardial cell membrane to increase sodium available for exchange for calcium

-> increase intracellular calcium -> positive inotropic effect

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10
Q

Digoxin is administered ________ most commonly, but is also available in _________

A

Orally; IV formulation

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11
Q

How is digoxin metabolized and excreted?

A

Small amount in liver
Enterohepatic recirculation

Dog and horse - renal excretion

Cat- renal and hepatic excretion

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12
Q

What drug has positive inoptropic effects but will reduce sinus rate/nodal conduction?

A

Digoxin

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13
Q

What should you see on a ECG of a patient on digoxin ???

A

Prolonged PR interval

-negative chronotropic/dromotropic effects

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14
Q

What are secondary effects/precautions of digoxin?

A

Renal- diuretic effect due to increase CO (cardiac diuretic)

GI irritation
Vomiting, nausea, anorexia
Diarrhea

Alter serum potassium
Acute-> hyperkalemia
Chronic-> hypokalemia

Tachycardia

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15
Q

What is the number one adverse effect of digoxin???

A

GI signs

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16
Q

What are factors that predispose a patient to digoxin-induced tachyarrhythmias?

A

HYPO kalemia / magnnesemia

HYPER calcemia / natremia

HYPER or HYPO thyroidism

Hypoxemia

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17
Q

How do you treat Digoxin toxicity???

A

Potassium supplementation

Anti-arrhythmic drugs as indicated

Cholestyramine -> decrease enterophepatic recirculation

Digibind -> specific antidote of a digoxin immune Fab

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18
Q

What are the clinical uses of digoxin?

A

Atrial fibrillation/flutter

Congestive heart failure -> not first line anymore

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19
Q

Pimobendan in a ________ type of drug

A

Inodilator

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20
Q

What is the MOA of primobendan?

A

Sensitize myocardial contractile apparatus to calcium-> result in positive inotropic effect

-Enhance interaction between calcium and troponin complex

Phosphodiesterase (PDE)III inhibitor -> result in vasodilator effect

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21
Q

How is pimobendan administered?

A

Oral absorption is rapid with 60% oral bioavailability

NO IV formulation

Dosed BID or TID

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22
Q

How is pimobendan excreted?

A

Feces

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23
Q

What is the most common side effect of pimobendan?

A

GI signs

-vomiting, inappetence, diarrhea

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24
Q

What are side effects associated with pimobendan??

A

GI signs
Seizure
PU/PD/
Arrhythmia (but less than digoxin)

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25
When is use of pimobendan contraindicated?
Aortic stenosis or any condition where augmentation of cardiac output is inappropriate for function or anatomic reasons
26
What is considered the drug of choice for treatment of congestive heart failure?
Pimobendan
27
T/F: pimobendan is an inodolator by increasing intracellular calcium available for exchange with sodium
F Inodilator through myocardial sensitization to calcium and PDE III inhibitor
28
Digoxin should not be used concurrently with ___________
Furosemide
29
_____________ is an abnormality in heart rate and rhythm
Arrhythmia Anything that is not a normal sinus rhythm
30
What is a normal sinus rhythm?
Normal physiological pattern of SA node to AV node You see a Pwave followed by QRS complex and Twave at regular intervals and rate
31
What are the three mechanisms of arrhythmia ?
Abnormal automaticity Abnormal conduction Disturbance in both automaticity and impulse conduction
32
What is the MOA of class I antiarrhythmic drugs
Sodium channel blockage | Membrane stabilization -> slowed conduction, decreased excitability and automaticity
33
What is the MOA of class II antiarrythmic drugs?
B adrenergic blockage (B blockers) | Reduces effect of sympathetic stimulation
34
What is the MOA of class III antiarrhythmic drugs?
Potassium channel blockade -> prolong AP duration and refractory period Anti-adrengergic effects Prolonged Q-t interval
35
What is the MOA of class IV antiarrythmic drugs?
Calcium channel blockage Greatest effects on SA and AV node
36
What drugs is a Class IA antiarrythmic ?
Quinidine Procainamide
37
What is a Class IB antiarrythmic ?
Lidocaine Mexilitine (oral formulation)
38
What is the drug of choice for treatment of atrial fibrillation in horses?
Quinidine
39
What are the uses of procainamide
Heart - second line antiarrhythmic, more effective for ventricular arrhythmias than atrial arrhythmias
40
What is the drug of choice for treatment of ventricular tachycardia in dogs?
Lidocaine
41
What are the Class II beta-blockers?
``` Propranolol Esmolol Atenolol Metoprolol Carvediol ```
42
What is a Non-selective B blocker?
Propranolol
43
What are the selective B blockers?
Esmolol Atenolol Metoprolol
44
What drugs is most indicated in a cat that has hypertrophic cardiomyopathy (HCM) secondary to hyperthyroidism?
Propranolol Preferred over selective B blockers because of its ability to inhibit T4 to T3 conversation
45
What drug would be used for short term treatment of SVT to determine if a beta blocker is effective at controlling the arrhythmia?
Esmolol (ultra short acting) CRI
46
What is the best treatment option for treatment of SVT in patients with bronhcoconstrictive disease?
Selective B1 antagonism Atenolol (most selective for B1)
47
What is the main clinical use of metoprolol?
Systemic hypertension Can be used for SVT or VPC (less common)
48
What drug has antiarrythmic properties but also reduces afterload through alpha 1 adrenergic receptor antagonism
Carvediol Useful in some cases of dilated cardiomyopathy in dogs
49
When is B blocker used contraindicated ?
Unstable or overt heart failure is present
50
What are adverse effects of B blockers ?
Most common in geriatric or unstable patients Hypotension Lethargy and depression Syncope Worsening CHF
51
When taking a patient off of B blockers, you should... ?
Wean of drug gradually B receptors are upregulated, if you remove B blocker completely you risk sympathetic storm
52
What are the Class III potassium channel blockers? What is the main effect of these drugs?
Sotalol (also non selective B blocker) Amiodarone Prolong the effective refractory period of cardiac action potential without decreasing conduction velocity (slow HR, covert back to normal sinus rhythm)
53
What is the main sed of sotalol?
Oral formulation useful for ongoing management of ventricular tachyarrythmia
54
Sotalol use is contraindicated with ?
Overt or low output CHF
55
____________ is often a 2nd or 3rd line treatment for antiarrythmia
Amiodarone
56
What are adverse effects of amiodarone ?
GI (most common) Bone marrow suppression and hepatotoxicity (to be most concerned about) Type I hypersensitivity
57
What are the Class IV calcium channel blockers? What is the main action of these drugs
Diltiazem Calcium entry blockade
58
What is the drug of choice for treatment of supraventricular tachycardia (SVT)
Diltiazam
59
What is the drug of choice to decrease ventricular response rate in treatment of atrial fibrillation?
Diltiazem
60
What are precautions to using diltiazem?
Pulmonary edema IV- Give VERY slowly Oral extended release capsules- must open capsule and give a single tablet (associated with overdose/lethal toxicity)
61
What two drugs are used in combination to treat atrial fibrillation in horses ?
Quinidine and diltiazem
62
____________ is a cofactors in variety of enzyme systems and may be used in treatment of refractory ventricular arrhythmias
Magnesium sulfate IV
63
What are vagal maneuvers ? What do they treat?
Treat SVT Increase pressure by carotid sinus massage and ocular pressure --> simulation to decrease HR
64
What is a fluid-responsive tachycardia?
Tachycardia due to severe dehydration -> hypovolemia
65
Analgesic-responsive tachycardia is usually due to ??
Painful condition - trauma - acute abdominal signs - post op
66
How can sinus bradycardia be treated?
Do nothing Atropine Glycopyrrolate Reversal agent (if indicated)
67
An absence of a p-wave is called ___________
Atrial standstill
68
What is atrial standstill most commonly caused by?
Severe hyperkalemia
69
What is emergency treatment of atrial standstill caused by severe hyperkalemia?
IV calcium gluconate Maybe : IV sodium bicarbonate Dextrose Insulin with dextrose
70
What are negative effects of chronic nervous system activation?
``` Tachycardia Tachyarrythmia Activate RAAS Down regulate B blockers Induce myocyte necrosis Altered myocyte energy substrate and calcium ion handling ```
71
What is the drug of choice for treatment of ventricular tachycardia?
Lidocaine
72
What is the drug of choice for treatment of atrial fibrillation with a high ventricular response rate?
Diltiazem
73
Mexilitine, sotalol, and amiodarone can all be used for ???
Treatment of ventricular arrhythmia

RUSVM Pharmacology (18 decks)

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