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C & R II - wk1 > cardiovascular drugs > Flashcards

cardiovascular drugs Flashcards

1
Q

what are arteriodilators

A
  • work on systemic and pulmonary arterioles to decrease afterload
  • decreasing afterload in dogs with DCM and mitral regurgitation(MR) can help improve cardiac output
  • hydralazine, ca channel blockers, nitroprusside, ACEI
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2
Q

what is an example of a venous dilator

A

nitroglycerine

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3
Q

what are examples of balanced vasodilators

A
  • ACE inhibitors
  • nitrates (nitroprusside)
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4
Q

what are examples of arteriodilators

A
  • amlodipine
  • hydralazine
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5
Q

what is angiotensin II

A

important detrimental hormone in animals with heart dx

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6
Q

what does angiotensin II do

A
  • fluid and Na retention
  • vasoconstriction
  • increased thirst
  • vascular and myocardial fibrosis and pathologic tissue remodeling
  • increases aldosterone
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7
Q

what do ACEI do/are

A
  • balanced vasodilators
  • reduce aldosterone release, so reduced Na & H2O retention
  • prevent angiotensin II mediated myocardial fibrosis and remodeling
  • general anti-adrenergic effects
  • reduce vasopressin release (ADH)
  • reduce endothelin release
  • prevent glomerular capillary hypertension
  • reduce the metabolism of angiotensin 1-7 and bradykinin, both of which promote vasodilation and natriuresis
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8
Q

RAAS blockade

____ and ____ is recommended for dogs with CHF

A

ACEIs and spironolactone

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9
Q

concurrent administration of an ACEI and spironolactone helps prevent or manage:

A

hypokalemia in patients treated with loop diuretics

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10
Q

how are benazepril and enalapril excreted

A
  • benazepril: eliminated through hepatic and renal mechanisms
  • enalapril: renally eliminated
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11
Q

what is the most effect drug for inhibition of serum angiotensin-converting enzyme activity in horses

A

benazepril

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12
Q

what are the guidelines for monitoring ACEI

A
  • biochemical variables (1-2wks after initiation of therapy)
  • ACEIs can cause hyperkalemia (infrequently)
  • a small rise in serum creatinine is expected after ACEI initiation
  • blood pressure monitoring should ideally be performed at each recheck
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13
Q

what is semintra

A
  • management of feline hypertension
  • only FDA-approved tx for feline hypertension in an easy-to-give formula
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14
Q

what are the actions of nitrates

A
  • venous vasodilaton: increase venous capacitance (reduce preload)
  • arterial vasodilation (at high doses, reduce afterload)
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15
Q

what are the 3 major nitrates used

A
  • nitroglycerin
  • isosorbide (mono, di-) nitrate
  • nitroprusside
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16
Q

what is the mechanism of action of nitrates and tolerance

A
  • co-administration of n-acetylcystine which donates - SH
  • staggered therapy
  • several days of administration followed by several days off therapy
17
Q

how do arterioldilators work

A

reduce myocardial work-load

  • can reduce systemic blood pressure but not compromise organ perfusion
  • reduces afterlooad, and myocardial wall stress, so reduces myocardial oxygen consumption
  • unloads the failing heart
18
Q

what is IV nitroprusside

A
  • converted directly into NO w/o involvement of -SH groups & therefore tolerance does not develop
  • potent balanced vasodilation: both an arteriodilator as well as a venodilator
  • very short half-life and administered as CRI
  • toxicity high in dogs
19
Q

what are the indications to use IV nitroprusside

A

refractory CHF

20
Q

what are the adverse effects of using IV nitroprusside

A
  • hypotension
  • reflex tachycardia
21
Q

what are the two different classes of Ca channel blockers

A
  • dihydropyridines
  • non-dihyrdropyridines
22
Q

what are non-dihydropyridines

A

cardiac > vascular effects

verapamil and diltiazem

23
Q

what are the dihydropyridines

A

amlodipine and nicardipine

24
Q

what are the characteristics of DHP CCB

A
  • long duration of action
  • vascular&raquo_space; mycardial action
  • used to tx systemic hypertension
  • almost no effect on HR or inotropic state
25
Q

what is an ex of a phoshodiesterase inhibitor

A

pimobendan (balanced vasodilator)

26
Q

what is an example of a NaKATPase inhibitor

A

digoxin

27
Q

what are ex of sympathomimetics (beta receptor agonists)

A

dopamine, dobitamine

28
Q

how does pimobendan work

it is an inodilator

A
  • has both positive inotropic and vasodilatory effects
  • increased sensitization of the cardiomyocyte to Ca - leads to increased contractility (inotropy), and inhibition of phosphodiesterase 3 & 5 enyzmes
  • leads to smooth muscle relaxation
  • both increased contractility and afterload reduction, increases stroke volume and cardiac output
29
Q

what is the EPIC trial

A
  • pimobendan with dogs with CVD
  • delays the onset of CHF by approx. 15 moonths in dogs with preclinical DMVD compared to placebo
30
Q

what is digoxin

A
  • negative chronotrope
  • weak positive inotrope
  • favorable autonomic effects
  • normalizes baroreceptors
  • narrow therapeutic window and easy to cause toxicity
31
Q

what are the indications for digoxin

A

primarily rate control atrial fibrillation

32
Q

what are toxicity signs with digoxin

A
  • cardiac arrhythmias
  • GI
  • neurological
33
Q

what are sympathomimetics

A
  • mimic effect of native sympathetic transmitters (NE, E)
  • bind to cardiac beta-adrenergic receptors
  • activate cAMP -> protein phosphorylation -> increased Ca-actin/myocin binding
  • extensive first pass metabolism, short half lives (1-2 min)
  • given IV constant infusion
34
Q

what is dopamine

A

beta 1 and alpha 1 agonist

  • precursor of norepinephrine
  • binds to B-receptors (heart: increase heart rate and contractility)
  • binds to dopaminergic receptors (renal, mesenteric vessels, causing vasodilation)
  • dose dependent effects (high doses cause tachycardia and can also bind to a-adrenergic receptors causing vasoconstriction, excessive tachycardia)
35
Q

what is dobutamine

A

beta 1 agonist primarily

  • synthetic catecholamine
  • stimulates b1 receptors strongly, peripheral b2 and alpha 1 receptors weakly
  • used for acute phase support of low cardiac output and myocardial failure
36
Q

is dopamine a vasopressor

A

yes

37
Q

is dobutamine a vasopressor

A

no

C & R II - wk1 (13 decks)

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