Cardiovascular Drugs Flashcards by danielle youngman

What are cardiac stimulants used to treat?

Cardiogenic shock

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Beta 1 agonists are cardiac stimulants - list them in order of most potent to least.

Isoproterenol
Epinephrine
NE
Dopamine - safest

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What is an example of a phosphodiesterase inhibitor that is a cardiac stimulant?

Aminophylline

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T/F. Cardiac stimulants are positive chronotropes and positive inotropes.

True

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What are the 4 big effects of CHF?

1) increased SNS (catecholamine release stimulated, increased heart rate, arrhythmias, vasoconstriction)
2) increase RAAS (angiotensin II - retain sodium and water - edema.)
3) increase ADH (more edema)
4) myocardial hypertrophy (heart is working really hard to pump blood)

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T/F. In CHF, there is too much blood in the body.

False. The volume is adequate but it is not being distributed properly.

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What are some ways to treat CHF without drugs?

decrease sodium intake

- decrease exercise

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What is an example of a positive inotrope used to treat CHF? Route of administration?

Digitalis/Digoxin

per os, IV

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How does Digitalis work?

increases calcium concentration in the myocardiocytes by inhibiting NaK ATPase and increasing sodium to exchange for Ca –> this gives heart more energy to contract

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What is Digitalis used to treat? Why isn’t it used much anymore?

CHF and atrial arrhythmias in dogs

- narrow safety margin

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What would you use in a case of Digoxin toxicity?

Digibind

fluorescent AB that binds to Digoxin in the blood so that it cannot be absorbed

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As positive inotropes, when are Dopamine and Dobutamine used?

in emergencies –> 1 dose!

injection

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What are 2 examples of injectable inodilators?

Inamrinone

Milrinone

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Which is the most commonly used inodilator? Route of administration?

Pimobendan

oral

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What is Pimobendan used for?

Treat CHF in DOGS (due to dilated cardiomyopathy of chronic degenerative valvular disease)

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How does Pimobendan work?

sensitizes the heart to Ca by enhancing the interaction between Ca and troponin C

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When should you NOT use Pimobendan?

if you can’t increase the CO (i.e., d/t physical abnormalities)
hypertrophic cardiomyopathy

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T/F. ACE inhibitors are vasodilators.

True!

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When would you use an ACE inhibitor?

-treat CHF in dogs

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What are some examples of ACE inhibitors? Which is used in the US?

Enalapril, Benazapril, Captopril

US: Enalapril

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Which diuretics are best to use to treat CHF? Why?

Potassium sparing diuretics
because you don’t want to add a K imbalance (like with loops and thiazides) since the heart is already having problems
also these drugs antagonize Aldosterone and stop the potential issue with RAAS d/t CHF

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Which diuretics should you NOT use with CHF?

osmotics (used for LOCALIZED edema)

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Which beta blocker is best to use for CHF?

Carvedilol (nonselective Beta and alpha 1 blocker) - inhibits renin in RAAS

prolongs lifespan of heart failure patients
used in early CHF to block harmful SNS effects on heart

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T/F. Oxygen and nebulizer can be considered drug treatments for CHF.

True

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What is an arrhythmia?

An abnormality in the heart rate and rhythm

What are some causes of arrhythmia?

- innervation imbalance (psns vs sns) - electrolyte imbalance (K, Ca, Mg) - hypoxemia

Sodium channel blockers are class ___ antitachyarrhythmics.

What do antitachyarrhythmic class IA do and which drugs does the class include? IB? IC?

IA - prolongs AP - Quinidine IB - shortens AP - Lidocaine IC - not important

T/F. Class I antitachyarrhythmics can affect both atria and ventricles, but MOSTLY does atria.

FALSE. Mostly does ventricle

What is Quinidine used to treat? What antitachyarrhythmic drug class does it belong to?

-ventricular arrhythmias *ATRIAL FIBRILLATION IN HORSES* Class IA

What is Lidocaine used for? What antitachyarrhythmic drug class does it belong to?

- drug of choice for ventricular arrhythmias d/t anesthesia/surgery - Class IB

What is Phenytoin used for? What antitachyarrhythmic drug class does it belong to?

- treat digitalis-induced arrhythmias in dogs | - Class IB

Which Class II antitachyarrthmic drug is used to treat sudden onset supra ventricular tachycardia?

Propanolol

Which type of tachyarrhythmias do Beta Blockers treat?

supra ventricular and ventricular

What is Bretylium used for? What antitachyarrhythmic drug class does it belong to?

- treat recurrent tachyarrhythmias that do not respond to other drugs --> usually used just by cardiologists - Class III

What are Verapamil and Diltiazem used for? What antitachyarrhythmic drug class does it belong to?

- treat supra ventricular tachyarrhythmias, myocardial hypertrophy in cats - Class IV

Which Antitachyarrhythmic drugs only treat atrial arrhythmias?

Class IV

What are the MOA of the 4 classes of antitachyarrhythmic drugs? An examlple of each? What type of arrhythmias they are used for?

Class I: Na channel blockers (IA: prolong AP, Quinidine, supra ventricular and ventricular; IB: shortens AP, Lidocaine/Phenytoin, ventricular) Class II: Beta blockers, Propanolol, supraventricular and ventricular Class III: K-channel blockers, Bretylium, ventricular (mainly) Class IV: Ca-channel blockers, Verapamil/Diltiazem, supraventricular

What are the main drugs you would use to treat atrial tachyarrhythmias?

Digoxin, Ca-channel blockers

What is the main drug you would use to treat ventricular tachyarrhythmia?

Lidocaine

What is the drug of choice to treat supra ventricular and ventricular tachyarrhythmias in CATS?

beta blockers

Which drugs are used to treat bradyarrhythmias? Which degrees of bradyarrhythmia?

1) Incomplete AV block: Atropine or Isoproterenol 2) Sinus bradycardia: Atropine or Isoproterenol 3) Complete AV block: epinephrine

Your patient has an incomplete AV block causing bradyarrhythmia and also has low blood pressure, which drug should you treat them with?

Atropine NOT Isoproterenol because of the low BP (has strong B2 effects)

What are the #1, #2, and #3 vasoconstrictors?

1- phenylephrine (selective alpha 1 agonist) 2 - NE (nonselective alpha agonist) 3 - Epinephrine (nonselective alpha agonist)

What direct and indirect sympathomimetics are vasoconstrictors?

ephedrine pseudoephedrine phenylpropanolamine (PPA)

When should you use nonselective alpha blockers as vasodilators?

emergency hypertension - 1 dose | penotalmine, phenoxybenzamine

Selective alpha blocker: ________ | Vasodilator or Vasoconstrictor?

Prazosin | vasodilator

Presynaptic alpha 2 agonist: ______________ | does it increase or decrease BP?

Clonidine | decreases BP

Nonselective Beta locker used as a vasodilator

Propanolol

A beta and alpha 1 blocker that is used as a vasodilator

Carvedilol

A selective beta1 blocker used as a vasodilator

Atenolol

Which ACE inhibitor is available in the USA? | Is it long or short acting?

Enalapril | short acting

What is the route of administration for ACE inhibitors?

oral or injectable

What are ACE inhibitors used to treat?

CHF long term hypertension chronic renal insufficiency

What are some adverse effects of ACE inhibitors?

hypotension decreased GFR Captopril may cause idiosyncratic glomerular disease in some dogs

What is Losartan?

an angiotensin II antagonist

T/F. Hydrazine only dilates arteries.

True

What are 2 direct acting vasodilators?

Hydralazine | Nitrates (make NO)

Verapamil, Diltiazem, Amlodipine, Nifedipine are...

Calcium channel blockers

How do calcium channel blockers act on blood vessels?

direct vasodilators by inhibiting myocardial contraction

Verapamil is a (+/-) chronotrope and a (+/-) inotrope.

negative chronotrope | negative inotrope

What are calcium channel blockers used to treat?

tachyarrhythmia hypertension myocardial hypertrophy (Ditiazem) antianginal

Which drugs are best to use for treating hypertension in cats that do NOT have hyperthyroidism?

Calcium channel blockers (verapamil, diltiazem, amlodipine, nifedipine)

Which drugs should you use to treat a hypertensive cat with hyperthyroidism?

Beta blockers

Which calcium channel blocker is the best to treat myocardial hypertrophy?

Dilitiazem

``` Systolic and Diastolic Which do... Beta blockers treat? Calcium channel blockers treat? ACE inhibitors treat? ```

B-blockers: systolic and diastolic Ca channel blockers: systolic and diastolic ACE inhibitors: diastolic ONLY

Cardiovascular Drugs Flashcards

(66 cards)