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Pharmacology > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

What are some common presenting complaints when a patient presents with GI upset?

A
  • Regurgitation
  • Vomiting
  • Diarrhea
  • Flatulence
  • Bloated
  • Constipation
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2
Q

What systems regulate the GI tract?

A
  • Autonomic nervous system, endocrine system and other biologic mediators
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3
Q

What does the parasympathetic portion of the GI do?

A

It increases intestinal motility and digestive secretions

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4
Q

What are the GI hormones are part of the endocrine system?

A

Gastrin, secret, cholecystokinin; functions include gastric acid secretion and gall bladder emptying

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5
Q

What other biologic mediators are included in the GI tract?

A

Histamine, serotonin and prostaglandin which line the stomach

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6
Q

What is involved in vomiting?

A

Numerous neurotransmitters are involved:

  • Histamine (H2)
  • Dopaminergic (D2)
  • Serotonergic (5-HT3)
  • Neurokinin (NK)
  • Acetylcholine (muscarinic M1)
  • Substance P
  • Others
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7
Q

What is vomiting?

A

Forecful ejection, from the mouth, of contents of stomach and sometimes proximal small intestine

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8
Q

What species can not vomit and why?

A

Horse, rabbit, and rodent and because they have a strong lower esophageal spinchter

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9
Q

Where is the central stimulation of vomiting and what does it do?

A

Medulla and it has direct stimulation in the emetic center, it provides stimulation of chemoreceptor trigger zone (CRTZ)

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10
Q

What peripheral stimulation of the GI tract?

A

GIT irritation, stimulation inner ear nerves (balance, motion sickness), stimulation forebrain (head, emotional trauma)

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11
Q

What are emetics used for?

A

Purposefully removing harmful gastric contents from toxin ingestion or foreign body ingestion

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12
Q

What are 2 centrally acting emetics?

A
  • Apomorphine - an opioid, it stimulates dopamine receptor in CRTZ
  • Xylazine - an a2 agonist, it stimulates CRTZ and emetic center in CATS
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13
Q

What are 2 locally acting emetics?

A
  • Hydrogen peroxide (careful in cats!)

- Syrup of ipecac

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14
Q

What are some phenothiazine derivative anti-emetics? What are they good for?

A
  • Acepromazine, chlopromazine, prochlorperazine

- They are useful for motion sickness, not good for irritants

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15
Q

What are some common side-effects of phenothiazine derivative anti-emetics?

A

Hypotension and sedation

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16
Q

What are some antihistamine derivative anti-emetics? What are they good for?

A
  • Diphenhydramine (Benadryl), dimenhydrinate (Dramamine)

- Motion sickness

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17
Q

What are some serotonin receptor antagonist antiemetics? What are they good for?

A
  • Ondansetron (Zofran), Dolasetron (Anzemet)

- Good for chemotherapy induced vomiting

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18
Q

What is an example of an NK1 receptor antagonist antiemetic? How does it work?

A
  • maropitant citrate (Cerenia)

- It blocks substance P binding to NK1 receptors in CRTZ

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19
Q

What is an example of a procainamide derivative antiemetic? What is it good for?

A
  • metoclopramide (Reglan)

- Helps poor GIT motility disorders, uremic vomiting, chemotherapy induced vomiting

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20
Q

What are some side effects of a procainamide derivative antiemetic? What is a contraindication of using one?

A
  • Behavioral, mild sedation, frenzied cats

- Contraindication - GIT obstruction

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21
Q

How does a systemic antacid/antiulcer work?

A

Increased pH by blocking acid production - decrease stomach lining irritation and hyperacidity

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22
Q

What is an example of a proton pump inhibitor antacid? What does it do? What is it good for?

A
  • omeprazole (Prilosec)
  • Decrease HCl production
  • Good for most conditions, especially gastrinomas, mastocytosis
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23
Q

What are some H2 receptor antagonist antacids/antiulcers? What do they do?

A
  • ranitidine, cimetidine, famotidine (Pepsid AC)

- Decrease HCl production

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24
Q

What makes up non-systemic antacid/antiulcers? What are some examples? What are they good for?

A
  • calcium (Tums, Rolaids)
  • magnesium (Mylanta)
  • Aluminum/magnesium combo (Maolox)
  • good for temporary relief
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25
What are some side effects of non-systemic antacid/antiulcers?
Rebound hyperacidity, constipation, diarrhea, may interfere with absorption of other drugs
26
Example of a gastromucosal protectant? How does it work?
- sucralfate (Carafate) | - It binds to surface of gastric ulcers
27
Example of a prostaglandin E1 analogue? What is it? What is it good for? SE?
- misoprostol - Gastric protective lining ingredient - It treats NSAID side effects or overdose
28
What are the side effects of prostaglandin E1 analogue?
Diarrhea, flatulence, abdominal pain
29
Define diarrhea. What are some causes?
- Loose to liquid stool - Hypersecretion - Osmotic overload (fiber) - Altered intestinal motility - Malabsorption/maldigestion - Local disease
30
What are some antidiarrheal medications that decrease peristalsis and increase segmental contractions?
- Anticholinergics such as Atropine, aminopentamide (Centrine) - Narcotics/opioids such as Diphenoxylate (Lomotil), loperamide (Immodium)
31
What are some antidiarrheal medications that block hypersecretions?
- Narcotics | - Antiinflammatory drugs such as Sulfasalazine, salicylates (Pepto-Bismol, Kaopectate)
32
What do protectant/adsorbent antidiarrheal medications do? What is an example?
- Coat lining (kaolin, pectin) and bind bacterial toxins | - Activated charcoal
33
What are some antibiotics used as antidiarrheal drugs?
- Metronidazole (Flagyl) - against anaerobic bacteria in colon, and giardia - Azulfidine - mostly antiinflammatory - Tylosin - macrolide antibiotic, often last used, DO NOT USE IN HORSES
34
What do laxatives/cathartics/purgatives do? What are they used to treat?
- Increase fluid content of feces | - Treats constipation, ease passage of hairballs, empty colon for x-rays, post-perineal/pelvic surgery
35
How do bulk laxatives work?
Pull water into bowel via osmosis
36
What do surfactants/stool softeners do?
Reduce surface tension to allow water to enter fecal matter
37
What are osmotic cathartics? What are some contraindications for using them?
- They act like bulk laxatives, but they're more aggressive (draw water into fecal matter through osmosis) - Sucralose (Toxiban)
38
What are pancreatic enzyme supplements used to treat?
Exocrine pancreatic insufficiency (EPI)
39
What are corticosteroids used to treat in the GI system? What are some side effects?
- Primary inflammatory GI conditions | - Increased acid secretion, immunosuppression, suppression of normal lining health
40
What are some examples of appetite stimulants?
Cyproheptadine, mirtazapine, diazepam
41
What are the basic objectives of cardiac drugs?
Control rate/arrhythmias, maintain cardiac output, increase oxygenation of blood, and ancillary treatment
42
What do Class IA antiarrhythmics do? What are they used to treat? Examples?
- Depress myocardial excitability (prolong refractory period), decrease automaticity (increase conduction times) - Treat atrial and ventricular tachyarrhythmias
43
What are some examples and side effects of Class IA antiarrhythmics? What are some examples?
- Quinidine (PO), procainamide (PO, IV) | - (rare): anorexia, vomiting, diarrhea, hypotension
44
What do Class IB antiarrhythmics do? What are they used to treat?
- Inhibit sodium influx by preventing depolarization (decrease cell automaticity))
45
What are some examples and side effects of Class IB antiarrhythmics? What are some examples?
- Lidocaine *WITHOUT epi* (IV) - treats VPS, v-tach - Tocainide and mexiletine (PO) - ataxia, vomiting, sedation, CATS - CNS very sensitive
46
What class of antiarrhythmics are rarely used in veterinary medicine?
Class IC, Class III
47
What are Class II antiarrhythmics? What do they do? | What are they used to treat?
- Beta-adrenergic blockers (B1, B2, or both) - They decrease cardiac conduction, reduce CO, decrease BP - Also treat atrial and ventricular tachyarrhythmias
48
What are some examples and side effects of Class II antiarrhythmics?
- Propanolol (IV or PO) - non-selective - Side effects include bradycardia, hypotension, worsening heart failure, bronchospasm, depression - Atenolol (PO) - selective B1 blocker - Side effects include all of propanolol, without bronchospasm
49
What are Class III antiarrhythmics?
- Bretylium and amiodarone | - Not typically used in veterinary medicine
50
What are Class IV antiarrhythmics and what do they do?
- Calcium channel blockers | - Depress contractile mechanism, automaticity
51
What are some examples of Class IV antiarrhythmics?
- Dilitazem (PO) - supraventricular tachyarrhythmias, common for HCM in cats - Amlodipine (PO) - hypertension
52
What is a positive inotrope and how do they work?
- Improve strength of contraction by increasing levels of calcium available in cardiac muscle - They can increase cardiac oxygen demand.
53
What is Digoxin? What does it do? What is it used for? SE?
- Positive inotrope - It improves cardiac contractions (increase calcium) - Decreases HR (increase parasympathetic stimulation, slow AV conduction) - Antiarrhythmic, helps dyspnea - Used in CHF secondary to valvular disease or cardiomyopathy, AF, SVT
54
What are some side effects of Digoxin?
Small therapeutic index - anorexia, vomiting, diarrhea, arrhythmias (heart block)
55
What is Pimobendan and what does it do?
- Positive inotrope - Calcium sensitizer, inhibits phosphodiesterase - Treats CVD, DCM
56
What are some side effects of Pimobendan?
Anorexia, lethargy, diarrhea
57
What is the basic flow of the renin-angiotensin-aldosterone system?
Renin release > angiotensinogen > angiotensin I > angiotensin II (via ACE) > vasoconstriction
58
Example of a venodilator? What is it used for? SE? Cautions for using?
- Decrease preload, ER management of pulmonary edema - Equine - leg to reduce swelling, treat laminitis SE: hypotension, rash Caution: must wear gloves when applying
59
What is an example of a venodilator? What are some side effects?
- Nitroglycerine (topical ointment) - Hypotension, rash - Caution: must wear gloves when applying
60
What is Prazosin? What does it do? What does it not cause?
- Combined vasodilator - Reduces BP and peripheral vasoconstriction by blocking a1-adrenergic receptor - Doesn't cause reflex tachycardia
61
What are ACE inhibitors and what are they used for?
- Combined vasodilators - They prevent angiotensin I > angiotensin II - treat CHF, hypertension associated with CRD or HCM
62
What are some examples of ACE inhibitors and what are some side effects?
- Enalapril and benazepril | - Hypotension, azotemia, vomiting, diarrhea, hyperkalemia
63
What are diuretics and what are they used for?
- most effective for edema, rapid onset - adjunctive w/ furosemide - antagonist of aldosterone - combined with loop or thiazide
64
What are some examples of diuretics and the side effects?
- Furosemide (loop diuretic) - Thiazides (PO - chlorothiazide, loop diuretic) - Spironolactone (PO - potassium-sparing) - May cause hypokalemia, dehydration, hyponatremia, ototoxicity (cats), weakness, shock
65
What are some ancillary drugs and treatments for heart failure?
Bronchodilators, oxygen therapy, sedation, aspirin, thoracocentesis, and abdominocentesis
66
What are the 3 mechanisms of bronchoconstriction?
1. Parasympathetic stimulation (acetylcholine) 2. Histamine receptors stimulation 3. Blockage of B-adrenergic receptor
67
What are the respiratory therapeutic principles?
Control secretions, control reflexes, and maintain good airflow
68
What is an example of a mucolytic? How does it work?
- Acetylcysteine (nebulization) | - It break down mucous, decrease viscosity of secretions
69
What is an example of an expectorant? How does it work?
- Guaifenesin (PO) - liquefy and dilute secretions - may result in mild drowsiness
70
What kinds of antitussives are rarely used in veterinary medicine, and why?
Peripheral acting, because they come in the form of cough drops and lozenges
71
What are some opiate central acting antitussives? What are they used for? SE?
- Butorphanol (IV, IM, SC, PO) - synthetic opiate - Hydrocodone (PO) - opiate - Codeine (PO) - opiate - chronic nonproductive cough or chronic harsh nonproductive coughs
72
What are some side effects of opiate central acting antitussives?
Sedation, ataxia, constipation, or GI upset
73
What are some non-opiate central acting antitussive?
- Dextromethorphan - Temaril-P - For non productive coughs
74
What are some side effects of non-opiate central acting antitussive?
- Drowsniness, GI upset, sedation, depression, hypotension, or minor CNS signs
75
How do bronchodilators work?
- Block PNS stimulation (acetylcholine) and histamine receptor stimulation - Stimulate or unblock B-adrenergic receptors
76
What are some examples of B2 adrenergic agonist bronchodilators?
- Epinephrine - life threatening ONLY - Pseudoephedrine - horses not being used for food - Albuterol - inhaler - Clenbuterol - horses - Terbutaline - cats during asthma attacks
77
What are some side effects of B2 adrenergic agonist bronchodilators?
Tachycardia and hypertension
78
What are some examples of cholinergic blocker bronchodilators?
- Minimally used for respiratory system - Atropine, aminopentamide (Centrine), glycopyrrolate - Ipratropium bromide - equine COPD
79
What are some examples of methylxanthine bronchodilators and their side effects?
- Aminophylline, theophylline | - Mild cardiac stimulation, minor diuresis, GIT upset, CNS stimulation, tachycardia, arrhythmia
80
What 2 examples of methylxanthine bronchodilators, but are toxic?
Caffeine and theobromine (found in chocolate)
81
What are some examples of antihistamine bronchodilators?
- Diphenhydramine (Benadryl) - Hydroxyzine (Atarax) - Clemastine (Tavist) - Cetirizine (Xertec) - Loratadine (Claritin) - Side effects include sedation, occasional GIT upset
82
What are corticosteroids used for in respiratory therapy?
- Treat allergic respiratory conditions (equine COPD, feline asthma, allergic airway disease) - Prednisone, prednisolone, dexamethasone, fluticasone (Flovent), triamcinolone (Vetalog)
83
What are goals of therapy for the endocrine system?
1. Correct deficiency or overabundance | 2. Manage desired effects
84
What is T4 needed for in the body?
- Maintain metabolic rate - Growth and development - Body temperature - HR
85
What does the body require to make T4?
Iodine
86
What drug is used to treat hypothyroidism?
Levothyroxine
87
What treatments are used for hyperthyroidism?
1. Methimazole - interferes with incorporation of iodine into T4 precursor SE: vomiting, anorexia, skin eruption 2. Radioactive Iodide (I-131) - permanently destroys part of thyroid gland SE: hypothyroidism if too much gland is destroyed
88
What are some causes of Cushings?
- Adrenal tumor - Pituitary dependent hyperadrenocorticism (pituitary adenoma secreting too much ACTH) - iatrogenic (administration of steroids)
89
What are some drugs used to treat Cushings?
- Mitotane - Treats PDH, permanently destroys adrenal cortex - Trilostane - Competitive inhibitor of receptor for cortisol secretion - Ketoconazole - Antifungal, used when mitotane not effective
90
What are some side effects to the drugs that treat Cushings?
Vomiting, diarrhea, ataxia, weakness, iatrogenic Addison's, lethargy, inappetance, anorexia
91
What are some drugs used to treat Addison's?
- Prednisone - Desoxycorticosterone Pivalate - Fludrocortisone Acetate

Pharmacology (4 decks)

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