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Clinical Pharmacology > Equine Resp Pharmacology > Flashcards

Equine Resp Pharmacology Flashcards

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1
Q

non infectious cough– TTW or BAL

A

BAL- cells in lower airways
(TTW- more diffuse, infectious)
case example- saw neutrophils and Curshman’s Spirals

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2
Q

RAO vs IAD

A

RAO over 25% neutrophils

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3
Q

Cough reflex- anatomy

A

Involuntary reflex

Sensory receptors in airway epithelia –> larynx to resp bronchioles.

Nerve fibers conduct afferent impulses within vagal, glossopharyngeal, trigeminal, phrenic nerves

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4
Q

do horses have more receptors in upper or lower airways

A

upper airways

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5
Q

Horses are ____ sensitive to upper airway cough receptors than other species

A

Less

Ex. pass stomach tube…into trachea-..more or may not cough

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6
Q

Anti-tussives in horses- indicated when

A

Persistent coughing, fatiguing, non productive cough

Not used often in horse

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7
Q

which anti-tussives are used infrequently in horses

A

Opiate agonists: Hydrocodone, Butorphanol

Non opioids: dextromethorphan

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8
Q

Anti tussives MOA

A

Direct suppression of cough center

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9
Q

Bronchodilators: methylxanthines (theophylline) MOA

A

Competitive non selective phosphodiesterase inhibitor (increases cAMP, protein kinase A, inhibits TNF-alpha and leukotriene synthesis)

Non selective adenosine receptor antagonist: Antagonization of A1, A2, A3 receptors + cardiac effects

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10
Q

Methylxantines- side effects

A

CNS excitation
arrhythmias
narrow safety margin

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11
Q

theophylline- effects on dexamethasone

A

Theophylline didn’t potentiate the effects of low dose Dexamethasone in horses with RAO

Didn’t improve lung fxn

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12
Q

MOA of Beta 2 adrenergic agonists (see map)

A

Bronchodilation, Decreased: plasma exudation, cholinergic neurotransmission, Bacterial adherence (good), Neutrophil fxn (not so good)
Increases: MC clearance

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13
Q

What are some selective Beta 2 agonists

A

Albuterol
Clenbuterol
Salmeterol

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14
Q

What are some non selective Beta 2 agonists

A

Very short acting (emergencies!)
Epinephrine
Isoproteranol

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15
Q

Can you use albuterol as a rescue drug

A

No– you get TOLERANCE (down regulation) and Tachypylaxis possibly

Uncoupling of adenylate cyclase

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16
Q

Toxicity/side effects of Beta 2 agonists: non selective Rescue drugs

A

Epi –> tachycardia, muscle fasiculations, sweating, hypertension
Isoproteranol –> tachycardia

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17
Q

Toxicity/side effects: Selective drugs (which ones are shorter/longer acting)

A

Albuterol- shorter acting
clenbuterol- longer acting
salmeterol- longer acting

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18
Q

Toxicity/side effects: Selective drugs

A

All have tachycardia, sweating, muscle fasiculations, excitation

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19
Q

3 indications for beta-2 agonist use

A

1) emergency therapy in horses w/marked airway obstruction or anaphylaxis (duration under 1 hr)
e. g. Epi and Iso

2) before exercise- relieves mild to moderate airway obstruction
3) before administration of aerosol corticosteroid preparations

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20
Q

why give beta 2 agonist before aerosol corticosteroid preparations

A

To improve pulmonary distribution of these surface active agents

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21
Q

Most common beta 2 agonist used in the horse

A

Clenbuterol- oral

Partial beta 2 agonist approved for use in horses

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22
Q

Clenbuterol tolerance? bioavailability? fat? inflammation?

A

tolerance can develop! start at low dose

excellent F of 87%
anti inflammatory properties

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23
Q

Tocolytic effect of clenbuterol

A

Slows progress of labor in dystocias

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24
Q

Inhaled drugs vs systemic drugs

A

Particles >10 micrometer– won’t go far

10 to 6 –> into cardiac inlet

5 to 1 –> into lungs

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25
Particles as large as ____ suspended in gas and administered as aerosol but only SMALL particles reach distal airways effectively
50 micrometers
26
Particle size of ___ are thetherapueitc aerosol that are maximally deposited in ___ airways
1-5 micrometers | lower airways
27
When does maximal deposition of inhaled drug occurs
when patients take slow, deep breaths with large tidal volumes but difficult to control breathing patterns of aimals
28
Albuterol- bioavailability in horses
Poor F in horses, give with devices such as Aerohippus or Nebulization instead
29
Albuterol- how long does it take to work
5 min
30
Salmeterol- how long does it last?
8-12 hours in severe asthma horses (long acting)
31
salmeterol- anti inflammatory properties
``` inhibits leukotriene and histamamine release from mast cells reduces eosinohils (esp with RAO) ```
32
when is salmeterol recommended
maintenance in therapy and pre-exercise administration mild to mod airway obstruction
33
Anti cholinergics- MOA
Parasymp system= dominant in the pulmonary ANS in mammals PS innervation throughout tracheobronchial tree of horse Use Muscarinic antagonist to block M3 receptor --> blocks PS
34
where is the greatest effect of anti cholinergics
Large central airways
35
where are muscarinic receptors
abundant in airway smooth muscle --> smooth muscle contraction and bronchoconstriction
36
M3 receptors is ___ mediated
vagally mediated, cholinergic stimulation
37
What is the primary mechanism of bronchospasm in severe equine asthma?
vagally mediated cholinergic stimulation of M3 receptors
38
Atropine
Non selective M1M2M3 antagonist
39
What does atropine decrease
release of intracellular Ca2+ from SR --> smooth muscle relaxation Rapid bronchodilation in horses
40
Atropine duration
short (.5 to 2 hours)
41
Atropine use in horses
limited- except as rescue
42
Atropine side effects!!
Ileus Impaired MC clearance Increased mucus viscosity CNS toxicity Tachycardia
43
Ipatromium bromide
Synthetic anticholinergic compound | Non selective muscarinic antagonist
44
Ipatromium bromide usage
Leads to bronchodilation, inhibits cough Nebulized or inhaler
45
Ipatromium bromide effect and lasts how long
usually in 15-30 min | Lasts 4-6 hours
46
N butylscopalammonium bromide AKA buscopan
Anticholinergic Quatenary ammonium compound used for gas/spasmodic colic in horses Potent bronchodilator
47
Buscopan adverse effects
minimal-- | TRANSIENT tachycardia, decreased borborygmi, pupillary dilation
48
Buscopan maximum effect
10 min after IV | usually effect within a few min! good response
49
Buscopan dissipation
1 hour after admin
50
Buscopan as a rescue drug?
Excellent rescue drug! AND excellent for determining if bronchostriction is involved!!!
51
Cromolyn Sodium Intal uses
Nebulized or used with inhaler
52
Cromolyn MOA
Inhibits mast cell degranulation | Interferes with Ca tarnsport across cell membrane
53
Cromolyn -- bronchodilation?
NO BRONCHODILATORY EFFECTS (must combine with another drug)
54
Cromolyn uses
limited uses, except in horse with known "triggers"
55
Cromolyn administration
Given prior to allergen exposure
56
Bronchconstriction is a PORTION of the problem, while ____ is a huge component
INFLAMATION
57
Glucocorticoids for anti inflammation, what is MOA
Increases beta 2 adrenergic mediated bronchial smooth muscle May prevent down regulation of beta receptors DECREASES inflammatory mediators
58
Corticosteroids indications
severe asthma and some cases of IAD or mild/mod asthma horses with severe diffuse airway dz need SYSTEMIC CS
59
Corticosteroids pros
improves pulmonary fxn, reduces inflammation
60
systemic vs inhaled CS
Inhaled-- won't get distributed when severely affected horse (need systemic CS)
61
CS onset and dosing
within hours increasing dose does NOT help in human or equine med
62
conservative dosing -- why is it recommended with CS
increasing dose doesnt help | NOT DOSE DEPENDENT
63
CS: systemic | Dexamethasone -- watch out for what
LAMINITIS | athough never proven, always worry about CS use and laminitis
64
CS: prednisolone vs prednisone
Prenisolone- doesn't decrease airway inflammation obstruction, as well as Dexamethasone does Predinisone- DOES NOT WORK!
65
why doesnt prednisone work
poor absorption rapid excretion hepatic failure of converting it to Prednisolone
66
CS: inhaled | effective when
horses with mild to moderate airway obstruction
67
CS: pros of aerosolized drug
reduces total therapeutic dose allows direct delivery to lower resp tract
68
CS: 3 formulas
Fluticasone Beclomethasone Flunisolide
69
Which of the 3 inhaled CS is most potent?
Fluticasone
70
Fluticasone vs beclomethasone vs Flunisolide in terms of potency and $
FBF Fluticasone = most potent and $$ Beclomethasone= moderate, similar $ Flunisolide= less potent but less $
71
corticosteroids and HPA
inhaled steroids can suppress HPA | up to 65% with fluticasone
72
CS and HPA-- effects gone within ___ days
1-2 days
73
Immunomodulatory drug
IFN alpha
74
IFN alpha
endogenous immunostimulant Antiviral Immunomodulatory Anti proliferative activity
75
IFN alpha ADMINISTRATION
ORAL!! for horses with mild asthma/IAD this activates natural defense system in oropharynx associated with lymphoid tissue
76
Mucolytics uses (human med vs equine)
human med (COPD and cystic fibrosis)N typically we don;t use with equine asthma! use more with broncho or pleural pneumonia cases
77
Mucolytic benefits
decreases viscosity, enhances clearance of bronchial exudates, productive cough
78
N acetylcysteine- mucomyst MOA
breaks disulfide bonds --> lowers viscosity
79
mucomyst uses
nebulizer, 20-50 mL of 10% solution q6
80
respiratory stimulants: Doxapram | Uses
stimulates resp center in emergency situations | neonates , anesthetic emergencies, overdose of benzodiazepines, opiates
81
Doxapram MOA
General CNS stimulant | Stimulates carotid and aortic chemoreceptors
82
Doxapram contraindications
Cerebral hemorrhage | Increased cerebral pressure
83
Resp stimulant: Caffeine | MOA
enhances ventilatory response (adenosine receptor A1 A2 antagonist) Increases respiratory drive

Clinical Pharmacology (7 decks)

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